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Lee SS, Senft Everson N, Sanderson M, Selove R, Blot WJ, King S, Gilliam K, Kundu S, Steinwandel M, Sternlieb SJ, Cai Q, Warren Andersen S, Friedman DL, Connors Kelly E, Fadden MK, Freiberg MS, Wells QS, Canedo J, Tyndale RF, Young RP, Hopkins RJ, Tindle HA. Feasibility of precision smoking treatment in a low-income community setting: results of a pilot randomized controlled trial in The Southern Community Cohort Study. Addict Sci Clin Pract 2024; 19:16. [PMID: 38491559 PMCID: PMC10941447 DOI: 10.1186/s13722-024-00441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/29/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The feasibility of precision smoking treatment in socioeconomically disadvantaged communities has not been studied. METHODS Participants in the Southern Community Cohort Study who smoked daily were invited to join a pilot randomized controlled trial of three smoking cessation interventions: guideline-based care (GBC), GBC plus nicotine metabolism-informed care (MIC), and GBC plus counseling guided by a polygenic risk score (PRS) for lung cancer. Feasibility was assessed by rates of study enrollment, engagement, and retention, targeting > 70% for each. Using logistic regression, we also assessed whether feasibility varied by age, sex, race, income, education, and attitudes toward precision smoking treatment. RESULTS Of 92 eligible individuals (79.3% Black; 68.2% with household income < $15,000), 67 (72.8%; 95% CI 63.0-80.9%) enrolled and were randomized. Of these, 58 (86.6%; 95% CI 76.4-92.8%) engaged with the intervention, and of these engaged participants, 43 (74.1%; 95% CI 61.6-83.7%) were retained at 6-month follow-up. Conditional on enrollment, older age was associated with lower engagement (OR 0.83, 95% CI 0.73-0.95, p = 0.008). Conditional on engagement, retention was significantly lower in the PRS arm than in the GBC arm (OR 0.18, 95% CI 0.03-1.00, p = 0.050). No other selection effects were observed. CONCLUSIONS Genetically informed precision smoking cessation interventions are feasible in socioeconomically disadvantaged communities, exhibiting high enrollment, engagement, and retention irrespective of race, sex, income, education, or attitudes toward precision smoking treatment. Future smoking cessation interventions in this population should take steps to engage older people and to sustain participation in interventions that include genetic risk counseling. TRIAL REGISTRATION ClinicalTrials.gov No. NCT03521141, Registered 27 April 2018, https://www. CLINICALTRIALS gov/study/NCT03521141.
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Affiliation(s)
- Scott S Lee
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA.
| | - Nicole Senft Everson
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | | | - William J Blot
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Stephen King
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Karen Gilliam
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Suman Kundu
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Mark Steinwandel
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Sarah J Sternlieb
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Qiuyin Cai
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Shaneda Warren Andersen
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- University of Wisconsin-Madison, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Debra L Friedman
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | - Erin Connors Kelly
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | - Matthew S Freiberg
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Quinn S Wells
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
| | | | - Rachel F Tyndale
- Centre for Addiction and Mental Health, and Departments of Pharmacology & Toxicology, and Psychiatry, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Hilary A Tindle
- Vanderbilt University Medical Center, 2525 West End Ave. Suite 450, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
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Zhang D, Liu R, Li X, Yuan Y, Zhou G. How do self-exempt beliefs affect intentions to quit smoking? An exploration of the mediating role of threat appraisal and coping appraisal. Front Psychol 2023; 14:1260561. [PMID: 38098517 PMCID: PMC10720447 DOI: 10.3389/fpsyg.2023.1260561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Numerous smokers are cognizant of the detrimental effects associated with this habit yet exhibit a persistent reluctance to cease their tobacco consumption. Self-exempt beliefs serve as an obstacle to the cessation of this addictive behavior. This research explored the impact of self-exempt beliefs on the readiness to quit smoking based on the Protection Motivation Theory (PMT) model and the mediating roles of threat appraisal and coping appraisal. Methods Self-exempt beliefs, PMT constructs, and the intention to quit smoking constituted the theoretical model. The questionnaires were collected from 488 Chinese adult male smokers based on snowball sampling. Exploratory Factor Analysis (EFA) was used to examine the underlying factor structure of the pre-designed self-exempt beliefs scale. The reliability, validity, path coefficients, and explanatory power of the model were calculated using Partial Least Squares Structural Equation Modeling (PLS-SEM). Results and discussion The results showed that : (1) three common factors (skeptic beliefs, bulletproof beliefs, and "worth it" beliefs) with a total of 11 items were retained after EFA; (2) skeptic beliefs and "worth it" beliefs had a significantly negative effect on both threat appraisal and coping appraisal, while bulletproof beliefs did not; (3) bulletproof beliefs had a significantly positive direct impact on intention to quit, "worth it" beliefs had a significantly negative direct impact on intention, while skeptic beliefs had no significantly direct impact on intention; (4) threat appraisal and coping appraisal positively and significantly predicted cessation intention; and (5) threat appraisal and coping appraisal, as two main cognitive processes, acted as full mediations between skeptic beliefs and the intention to quit, as complementary partial mediations between "worth it" beliefs and the intention, and as non-mediation between bulletproof beliefs and the intention. Our findings suggest that efforts to undermine or "prevent" these self-exempt beliefs, particularly "worth it" and skeptic beliefs, may be an effective tactic for health communication interventions for quitting smoking.
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Affiliation(s)
- Dan Zhang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Institute of Health Development, Guizhou Medical University, Guiyang, China
| | - Runhua Liu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Institute of Health Development, Guizhou Medical University, Guiyang, China
| | - Xinchen Li
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Yuanyuan Yuan
- Department of Management Engineering, Guizhou Traffic Technician and Transportation College, Guiyang, China
| | - Geyao Zhou
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
- Guizhou Provincial Institute of Health Development, Guizhou Medical University, Guiyang, China
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Kasza KA, Hammond D, Gravely S, O'Connor RJ, Meng G, East K, Borland R, Cummings KM, Fong GT, Hyland A. Associations between nicotine vaping uptake and cigarette smoking cessation vary by smokers' plans to quit: longitudinal findings from the International Tobacco Control Four Country Smoking and Vaping Surveys. Addiction 2023; 118:340-352. [PMID: 36110040 PMCID: PMC9812858 DOI: 10.1111/add.16050] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Most population studies that evaluate the relationship between nicotine vaping and cigarette cessation focus on limited segments of the smoker population. We evaluated vaping uptake and smoking cessation considering differences in smokers' plans to quit. DESIGN Longitudinal International Tobacco Control (ITC) Four Country Smoking and Vaping Surveys were conducted in 2016, 2018 and 2020. SETTING This study was conducted in the United States, Canada, England and Australia. PARTICIPANTS Participants of this study were adult daily cigarette smokers who had not vaped in the past 6 months at baseline and had participated in two or more consecutive waves of the ITC Four Country Smoking and Vaping Surveys (n = 2815). MEASUREMENTS Plans to quit cigarette smoking was assessed at baseline (within 6 months, beyond 6 months, not planning to quit) and at follow-up (within 6 months vs not within 6 months), cigarette smoking cessation was assessed at follow-up (smoking less than monthly [including complete cessation] vs daily/weekly/monthly smoking) and inter-wave vaping uptake was assesed between baseline and follow-up (none, only non-daily vaping and any daily vaping). Generalized estimating equations were used to evaluate whether inter-wave vaping uptake was associated with smoking cessation at follow-up and with planning to quit at follow-up, each stratified by plans to quit smoking at baseline. FINDINGS Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR], 8.58; 95% CI, 5.06-14.54). Among smokers planning to quit, smoking cessation rates were similar between those who did and did not take up daily vaping (25.1% vs 16.8%; AOR, 1.91; 95% CI, 0.91-4.00), although we could not account for potential use of cessation aids. Daily vaping uptake was associated with planning to quit smoking at follow-up among those initially not planning to quit (AOR,6.32; 95% CI, 4.17-9.59). CONCLUSIONS Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers.
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Affiliation(s)
- Karin A Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Katherine East
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Geoffrey T Fong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Cobos-Campos R, Apiñaniz A, Sáez de Lafuente A, Parraza N. Development, validation and transfer to clinical practice of a mobile application for the treatment of smoking. Aten Primaria 2022; 54:102363. [PMID: 35636019 PMCID: PMC9142851 DOI: 10.1016/j.aprim.2022.102363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The main objective is to transfer to clinical practice a new smoking cessation application ("Vive sin Tabaco" a) in all health centers of the public Basque Health Service. DESIGN An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. SITE: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. INTERVENTION AND MAIN MEASUREMENT Development of "Vive sin Tabaco"; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected. RESULTS The percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. CONCLUSIONS The conception of "Vive sin tabaco" as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.
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Affiliation(s)
- Raquel Cobos-Campos
- Bioaraba Health Research Institute, Epidemiology and Public Health Group, Vitoria-Gasteiz, Spain.
| | - Antxon Apiñaniz
- Bioaraba Health Research Institute, Epidemiology and Public Health Group, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Aranbizkarra I Health Center, Vitoria-Gasteiz, Spain; Department of Preventive Medicine and Public Health, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Arantza Sáez de Lafuente
- Bioaraba Health Research Institute, Epidemiology and Public Health Group, Vitoria-Gasteiz, Spain
| | - Naiara Parraza
- Bioaraba Health Research Institute, Epidemiology and Public Health Group, Vitoria-Gasteiz, Spain
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Estimated Failure to Report Unsuccessful Quit Attempts by Type of Cessation Aid: A Population Survey of Smokers in England. J Smok Cessat 2022; 2022:5572480. [PMID: 36568905 PMCID: PMC9762728 DOI: 10.1155/2022/5572480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction It has been estimated that smokers tend to fail to report unsuccessful quit attempts that lasted a short time and occurred a longer time ago. However, it is unclear whether the failure to report unsuccessful quit attempts varies by the type of cessation aid used. Methods A total of 5,892 smokers aged 16+ years who had made 1+ quit attempts in the past year were surveyed between January 2014 and December 2020 as part of the Smoking Toolkit Study. Respondents indicated when their most recent quit attempt started, how long it lasted, and which cessation aid(s) were used (e.g., unaided, varenicline, and behavioural support). The percentage failure to report for each cessation aid and 95% bootstrap confidence intervals (CIs) were estimated with an established method. Test for equality of proportions was performed to examine whether quit attempts lasting between one day and one week and that started >6 months ago failed to be reported at a different rate depending on the cessation aid used. Results We estimated that after three months, 97% (95% CI = 96%-98%) of unaided quit attempts lasting less than one day, 80% (95% CI = 79%-81%) of those lasting between one day and one week, and 60% (95% CI = 59%-61%) of those lasting between one week and one month fail to be reported. Compared with unaided attempts, the estimated percentage failure to report quit attempts that lasted between one day and one week and that started >6 months ago was significantly lower for attempts involving behavioural support (92% of unaided attempts vs. 75% of attempts involving behavioural support, χ 2(1) = 9.29, p = 0.002). No other significant differences were detected. Conclusions Smokers in England appear to fail to report a substantial proportion of unsuccessful quit attempts. This failure appears particularly prominent for attempts that last a short time or occurred longer ago and appears lower for attempts involving behavioural support compared with unaided attempts.
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Yong HH, Gravely S, Borland R, Gartner C, Cummings KM, East K, Tagliaferri S, Elton-Marshall T, Hyland A, Bansal-Travers M, Fong GT. Do smokers' perceptions of the harmfulness of nicotine replacement therapy and nicotine vaping products as compared to cigarettes influence their use as an aid for smoking cessation? Findings from the ITC Four Country Smoking and Vaping Surveys. Nicotine Tob Res 2022; 24:1413-1421. [PMID: 35368082 PMCID: PMC9356684 DOI: 10.1093/ntr/ntac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
Introduction This study examined whether smokers’ harm perceptions of nicotine replacement therapy (NRT) and nicotine vaping products (NVPs) relative to cigarettes predicted their subsequent use as smoking cessation aids during their last quit attempt (LQA). Aims and Methods We analyzed data from 1,315 current daily smokers (10+ cigarettes per day) who were recruited at Wave 1 (2016), and who reported making a quit attempt by Wave 2 (2018) of the International Tobacco Control Four Country Smoking and Vaping Surveys in Australia, Canada, England, and the United States. We used multinomial logistic regression models to examine prospective associations between harm perceptions of (a) NRT and (b) NVPs and their use at LQA, controlling for socio-demographic and other potential confounders. Results Smokers who perceive that (a) NRT and (b) NVPs are much less harmful than cigarettes were more likely to subsequently use the respective product as an aid than using no aid or other aids during LQA (adjusted relative risk ratio [aRRR] = 3.79, 95%CI = 2.16–6.66; and aRRR = 2.11, 95%CI = 1.29–3.45, respectively) compared to smokers who perceive these products as equally or more harmful. Additionally, those who perceive NVPs as much less harmful than cigarettes were less likely to use NRT as a quit aid (aRRR = 0.34, 95%CI = 0.20–0.60). No country variations for these associations were found. Conclusions This study found that smokers’ perceptions of the harmfulness of (a) NRT and (b) NVPs relative to cigarettes predicted the respective product use when trying to quit smoking. Corrective education targeting misperceptions of nicotine products’ relative harmfulness may facilitate their use for smoking cessation. Implications Nicotine replacement therapy and nicotine vaping products are two commonly used smoking cessation aids. This study demonstrates that misperceptions of the harms of nicotine products relative to cigarettes influence their use for smoking cessation. Believing that nicotine vaping products are much less harmful than cigarette smoking may lead some smokers to prefer these products over nicotine replacement therapy to aid smoking cessation. Education targeting misperceptions of nicotine products’ harmfulness relative to cigarettes may enable smokers to make informed choices about which are appropriate to aid smoking cessation.
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Affiliation(s)
| | | | - Ron Borland
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Coral Gartner
- The University of Queensland, Brisbane, Queensland, Australia
| | | | - Katherine East
- University of Waterloo, Waterloo, Ontario, Canada.,King's College London, London, UK
| | | | | | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Geoffrey T Fong
- University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Gravely S, Cummings KM, Hammond D, Borland R, McNeill A, East KA, Loewen R, Martin N, Yong HH, Li L, Liber A, Levy DT, Quah ACK, Ouimet J, Hitchman SC, Thompson ME, Boudreau C, Fong GT. Self-Reported Quit Aids and Assistance Used By Smokers At Their Most Recent Quit Attempt: Findings from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey. Nicotine Tob Res 2021; 23:1699-1707. [PMID: 33837435 PMCID: PMC8403237 DOI: 10.1093/ntr/ntab068] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/06/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION This study retrospectively describes smoking cessation aids, cessation services, and other types of assistance used by current and ex-smokers at their last quit attempt in four high-income countries. AIMS AND METHODS Data are from the Wave 3 (2020) International Tobacco Control Four Country Smoking and Vaping Survey in Australia, Canada, England, and the United States (US). Eligible respondents were daily smokers or past-daily recent ex-smokers who made a quit attempt/quit smoking in the last 24-months, resulting in 3614 respondents. Self-reported quit aids/assistance included: nicotine vaping products (NVPs), nicotine replacement therapy (NRT), other pharmacological therapies (OPT: varenicline/bupropion/cytisine), tobacco (noncombustible: heated tobacco product/smokeless tobacco), cessation services (quitline/counseling/doctor), other cessation support (e.g., mobile apps/website/pamphlets, etc.), or no aid. RESULTS Among all respondents, at last quit attempt, 28.8% used NRT, 28.0% used an NVP, 12.0% used OPT, 7.8% used a cessation service, 1.7% used a tobacco product, 16.5% other cessation support, and 38.6% used no aid/assistance. Slightly more than half of all smokers and ex-smokers (57.2%) reported using any type of pharmacotherapy (NRT or OPT) and/or an NVP, half-used NRT and/or an NVP (49.9%), and 38.4% used any type of pharmacotherapy (NRT and/or OPT). A quarter of smokers/ex-smokers used a combination of aids. NVPs and NRT were the most prevalent types of cessation aids used in all four countries; however, NRT was more commonly used in Australia relative to NVPs, and in England, NVPs were more commonly used than NRT. The use of NVPs or NRT was more evenly distributed in Canada and the US. CONCLUSIONS It appears that many smokers are still trying to quit unassisted, rather than utilizing cessation aids or other forms of assistance. Of those who did use assistance, NRT and NVPs were the most common method, which appears to suggest that nicotine substitution is important for smokers when trying to quit smoking. IMPLICATIONS Clinical practice guidelines in a number of countries state that the most effective smoking cessation method is a combination of pharmacotherapy and face-to-face behavioral support by a health professional. Most quit attempts however are made unassisted, particularly without the use of government-approved cessation medications. This study found that about two in five daily smokers used approved cessation medications (nicotine replacement therapy (NRT) or other approved pharmacotherapies, such as varenicline). Notably, nicotine substitution in the form of either NRT and nicotine vaping products (NVPs) were the most common method of cessation assistance (used by one in two respondents), but the proportion using NRT and/or NVPs varied by country. Few smokers who attempted to quit utilized cessation services such as stop-smoking programs/counseling or quitlines, despite that these types of support are effective in helping smokers manage withdrawals and cravings. Primary healthcare professionals should ask their patients about smoking and offer them evidence-based treatment, as well as be prepared to provide smokers with a referral to trained cessation counselors, particularly when it comes to tailoring intensive treatment programs for regular daily smokers. Additionally, healthcare providers should be prepared to discuss the use of NVPs, particularly if smokers are seeking advice about NVPs, wanting to try/or already using an NVP to quit smoking, have failed repeatedly to quit with other cessation methods, and/or if they do not want to give up tobacco/nicotine use completely.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne VIC, Australia
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Shaping Public Health Policies to Reduce Inequalities & Harm (SPECTRUM), UK
| | - Katherine A East
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ruth Loewen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Lin Li
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne VIC, Australia
| | - Alex Liber
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, NW, Washington, DC, USA
| | - David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, NW, Washington, DC, USA
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Sara C Hitchman
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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Abstract
The impact of tobacco smoking treatment is determined by its reach into the smoking population and the effectiveness of its interventions. This review evaluates the reach and effectiveness of pharmacotherapy and psychosocial interventions for smoking. Historically, the reach of smoking treatment has been low, and therefore its impact has been limited, but new reach strategies such as digital interventions and health care system changes offer great promise. Pharmacotherapy tends to be more effective than psychosocial intervention when used clinically, and newer pharmacotherapy strategies hold great promise of further enhancing effectiveness. However, new approaches are needed to advance psychosocial interventions; progress has stagnated because research and dissemination efforts have focused too narrowly on skill training despite evidence that its core content may be inconsequential and the fact that its mechanisms are either unknown or inconsistent with supporting theory. Identifying effective psychosocial content and its mechanisms of action could greatly enhance the effectiveness of counseling, digital, and web interventions.
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Affiliation(s)
- Timothy B Baker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
| | - Danielle E McCarthy
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
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Sheffer CE, Al-Zalabani A, Aubrey A, Bader R, Beltrez C, Bennett S, Carl E, Cranos C, Darville A, Greyber J, Karam-Hage M, Hawari F, Hutcheson T, Hynes V, Kotsen C, Leone F, McConaha J, McCary H, Meade C, Messick C, Morgan SK, Morris CW, Payne T, Retzlaff J, Santis W, Short E, Shumaker T, Steinberg M, Wendling A. The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2416. [PMID: 33801227 PMCID: PMC7967787 DOI: 10.3390/ijerph18052416] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.
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Affiliation(s)
- Christine E. Sheffer
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abdulmohsen Al-Zalabani
- Tobacco Treatment Specialist Training and Certification Program at College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Andrée Aubrey
- Tobacco Treatment Specialist Course, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
| | - Rasha Bader
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Claribel Beltrez
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Susan Bennett
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Ellen Carl
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Caroline Cranos
- Tobacco Treatment Specialist Training Program, Center for Tobacco Treatment Research and Training, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Audrey Darville
- BREATHE Online Tobacco Treatment Specialist Training Program, College of Nursing, University of Kentucky, Lexington, KY 40504, USA;
| | - Jennifer Greyber
- Duke-UNC Tobacco Treatment Specialist Training Program, Duke Smoking Cessation Program, Duke Cancer Center, Durham, NC 27705, USA;
| | - Maher Karam-Hage
- Tobacco Treatment Training Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Feras Hawari
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Tresza Hutcheson
- Tobacco Treatment Specialist Training Program, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Victoria Hynes
- Tobacco Treatment Education & Training Program, MaineHealth Center for Tobacco Independence, Portland, ME 04101, USA;
| | - Chris Kotsen
- Tobacco Treatment Specialist Training Program, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA;
| | - Frank Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jamie McConaha
- Tobacco Treatment Specialist Training and Certificate Program, School of Pharmacy, Duquesne University, Pittsburg, PA 15282, USA;
| | - Heather McCary
- Tobacco Treatment Specialist Certification Program, The Breathing Association, Columbus, OH 43203, USA;
| | - Crystal Meade
- Tobacco Prevention and Control Program, Wellness and Prevention Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA;
| | | | - Susan K. Morgan
- Tobacco Treatment Training Program, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA;
| | - Cindy W. Morris
- Rocky Mountain Tobacco Treatment Specialist Training Program, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Thomas Payne
- ACT Center for Tobacco Treatment, Education and Research, University of Mississippi Medical Center Cancer Institute, Jackson, MS 39213, USA;
| | - Jessica Retzlaff
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Wendy Santis
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Etta Short
- Optum’s Quit for Life Program, Eden Prairie, MN 55344, USA;
| | - Therese Shumaker
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Michael Steinberg
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Ann Wendling
- Tobacco Cessation Program, Healthways, A Sharecare Company, Franklin, TN 37067, USA;
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Cobos-Campos R, Mar J, Apiñaniz A, de Lafuente AS, Parraza N, Aizpuru F, Orive G. Cost-effectiveness analysis of text messaging to support health advice for smoking cessation. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:9. [PMID: 33588885 PMCID: PMC7885425 DOI: 10.1186/s12962-021-00262-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. METHODS We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. RESULTS Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of €7.4 and €1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. CONCLUSIONS Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres.
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Affiliation(s)
- Raquel Cobos-Campos
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain.
| | - Javier Mar
- Osakidetza Basque Health Service, Primary Care Research Unit of Gipuzkoa, Alto Deba Hospital, Arrasate-Mondragón, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Biodonostia Health Research Institute, San Sebastián, Spain
| | - Antxon Apiñaniz
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Lakuabizkarra Health Centre, Vitoria-Gasteiz, Spain
- Preventive Medicine and Public Health Department, University of Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Arantza Sáez de Lafuente
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
| | - Naiara Parraza
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
| | - Felipe Aizpuru
- Preventive Medicine and Public Health Department, University of Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Subdirectorate of Health Care, Vitoria-Gasteiz, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Vitoria-Gasteiz, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.
- Bioaraba Health Research Institute, Nanobiocel Research group, Vitoria-Gasteiz, Spain.
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain.
- Singapore Eye Research Institute, Singapore, Singapore.
- CIBER Bioengineering, Biomaterials and Nanomedicine (CIBERBBN), Institute of Health Carlos III, Madrid, Spain.
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11
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Chaiton M, Diemert LM, Bondy SJ, Cohen JE, Fung MD, Zhang BR, Ferrence RG. Real-World Effectiveness of Pharmaceutical Smoking Cessation Aids: Time-Varying Effects. Nicotine Tob Res 2020; 22:506-511. [PMID: 30260455 DOI: 10.1093/ntr/nty194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/25/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND There are a limited number of studies that have examined the real-world effectiveness of smoking cessation aids and relapse longitudinally in population-representative samples. This study examines the association between use of nicotine gum, patch, bupropion, and varenicline and time to relapse as well as any changes in the association with increased length of abstinence. METHODS Data of 1821 current adult smokers (18+) making their first serious quit attempt were compiled from 4504 individuals enrolled in the Ontario Tobacco Survey, a representative telephone survey of Ontario adults, which followed smokers every 6 months for up to 3 years. Use of cessation aids at the time of initial report of a quit attempt was analyzed. A flexible parametric survival model was developed to model length of abstinence, controlling for potential confounders. RESULTS The best fit model found knots at 3, 13, 43, and 212 days abstinent, suggesting different rates of relapse in the periods marked by those days. Use of the patch and varenicline was associated with lower rates of relapse, but no positive effect was found for bupropion or nicotine gum. The effectiveness of the patch reversed in effect after the first month of abstinence. CONCLUSIONS This study is one of few reports of long-term quitting in a population-representative sample and demonstrates that the effectiveness of some pharmacological cessation aids (the patch and varenicline can be seen in a population sample). Previous failures in real-world studies of the effectiveness of smoking cessation aids may reflect differences in the products individuals use and differences in the timing of self-reported cessation. IMPLICATIONS While a large number of randomized controlled trials have shown the efficacy of many pharmaceutical smoking cessation aids, evidence of their effectiveness in observational studies in the real world is ambiguous. This study uses a longitudinal cohort of a representative sample of smokers to show that the effectiveness of pharmaceutical cessation aids can be demonstrated in real-world use situations, but effectiveness varies by product type and has time-varying effects.
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Affiliation(s)
- Michael Chaiton
- Ontario Tobacco Research Unit, University of Toronto, Toronto, ON.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Lori M Diemert
- Ontario Tobacco Research Unit, University of Toronto, Toronto, ON
| | - Susan J Bondy
- Ontario Tobacco Research Unit, University of Toronto, Toronto, ON.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Joanna E Cohen
- Ontario Tobacco Research Unit, University of Toronto, Toronto, ON.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON.,Health, Behavior and Society Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, ML
| | - Michael D Fung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Bo R Zhang
- Ontario Tobacco Research Unit, University of Toronto, Toronto, ON.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Roberta G Ferrence
- Ontario Tobacco Research Unit, University of Toronto, Toronto, ON.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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12
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Pierce JP, Benmarhnia T, Chen R, White M, Abrams DB, Ambrose BK, Blanco C, Borek N, Choi K, Coleman B, Compton WM, Cummings KM, Delnevo CD, Elton-Marshall T, Goniewicz ML, Gravely S, Fong GT, Hatsukami D, Henrie J, Kasza KA, Kealey S, Kimmel HL, Limpert J, Niaura RS, Ramôa C, Sharma E, Silveira ML, Stanton CA, Steinberg MB, Taylor E, Bansal-Travers M, Trinidad DR, Gardner LD, Hyland A, Soneji S, Messer K. Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16. PLoS One 2020; 15:e0237938. [PMID: 32877429 PMCID: PMC7467279 DOI: 10.1371/journal.pone.0237938] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy. OBJECTIVE To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use. DESIGN Cohort study of US sample, with annual follow-up. PARTICIPANTS US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013-14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443). EXPOSURES Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2. ANALYSIS Propensity score matching (PSM) of groups using different methods to quit. OUTCOME MEASURES 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome. RESULTS Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products. LIMITATIONS The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA. CONCLUSION Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.
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Affiliation(s)
- John P. Pierce
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Tarik Benmarhnia
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Ruifeng Chen
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Martha White
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
| | - David B. Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, New York, United States of America
| | - Bridget K. Ambrose
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Kelvin Choi
- National Institute for Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Blair Coleman
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey, United States of America
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
| | - Maciej L. Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T. Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, Ontario, Canada
| | - Dorothy Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - James Henrie
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Karin A. Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Sheila Kealey
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jean Limpert
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Raymond S. Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, New York, United States of America
| | - Carolina Ramôa
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Eva Sharma
- Westat, Rockville, Maryland, United States of America
| | - Marushka L. Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America
- Kelly Government Solutions, Rockville, Maryland, United States of America
| | | | - Michael B. Steinberg
- Rutgers Center for Tobacco Studies, New Brunswick, New Jersey, United States of America
| | - Ethel Taylor
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Dennis R. Trinidad
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
| | - Lisa D. Gardner
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
- Westat, Rockville, Maryland, United States of America
| | - Samir Soneji
- Department of Health Behavior, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Karen Messer
- Moores Cancer Center, University of California San Diego, San Diego, California, United States of America
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America
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13
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Carpenter MJ, Wahlquist AE, Dahne J, Gray KM, Garrett-Mayer E, Cummings KM, Davis R, Egan BM. Nicotine replacement therapy sampling for smoking cessation within primary care: results from a pragmatic cluster randomized clinical trial. Addiction 2020; 115:1358-1367. [PMID: 31916303 PMCID: PMC7292788 DOI: 10.1111/add.14953] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Within the context of busy clinical settings, health-care providers need practical, evidence-based options to engage smokers in quitting. Sampling of nicotine replacement therapy [i.e. provision of nicotine replacement therapy (NRT starter kits)] is a brief, pragmatic strategy to address this need. We aimed to compare the effects of NRT sampling plus standard care (SC), relative to SC alone, provided by primary care providers during routine clinic visits. DESIGN Cluster-randomized clinical trial. SETTING Twenty-two primary care clinics in South Carolina, USA. PARTICIPANTS Adult smokers [n = 1245; 61% female, mean age = 50.7, standard deviation (SD) = 13.5] both motivated and unmotivated to quit, seen during routine clinical visit. Interventions were provider-delivered SC (n = 652, 12 clinics) cessation advice or SC + a 2-week supply of both nicotine patch and lozenge, with minimal instructions on use (n = 593; 10 clinics). MEASUREMENTS The primary outcome was 7-day point prevalence smoking abstinence at 6-month follow-up, using intent-to-treat. Additional outcomes included NRT use and quit attempts, assessed at 1, 3 and 6 months following baseline. FINDINGS Seven-day point prevalence abstinence rates were significantly higher in the NRT sampling group throughout follow-up, including at 6 months [12 versus 8%, odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.0-2.4]. NRT sampling increased prevalence of any use of NRT (65 versus 25%, OR = 5.8, 95% CI = 4.3-7.7), with higher prevalence of use at 6 months (25 versus 14%, OR = 2.0, 95% CI = 1.5-2.7). NRT sampling increased the rate of quit attempts in the initial month (24 versus 18%, OR = 1.5, 95% CI = 1.0-2.3) but had no significant effect on overall rate of quit attempts (48 versus 45%, OR = 1.2, 95% CI = 0.8-1.7). CONCLUSION Providing smokers with a free 2-week starter kit of nicotine replacement therapy increased quit attempts, use of stop smoking medications and smoking abstinence compared with standard care in a primary care setting.
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Affiliation(s)
- Matthew J. Carpenter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC)
- Department of Public Health Sciences, MUSC
- Hollings Cancer Center, MUSC
| | - Amy E. Wahlquist
- Department of Public Health Sciences, MUSC
- Hollings Cancer Center, MUSC
| | - Jennifer Dahne
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC)
- Hollings Cancer Center, MUSC
| | - Kevin M. Gray
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC)
- Hollings Cancer Center, MUSC
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, MUSC
- Hollings Cancer Center, MUSC
- now with American Society of Clinical Oncology
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina (MUSC)
- Department of Public Health Sciences, MUSC
- Hollings Cancer Center, MUSC
| | - Robert Davis
- Greenville Health System and Care Coordination Institute
| | - Brent M. Egan
- Greenville Health System and Care Coordination Institute
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14
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Perski O, Herbeć A, Shahab L, Brown J. Influence of the SARS-CoV-2 Outbreak on the Uptake of a Popular Smoking Cessation App in UK Smokers: Interrupted Time Series Analysis. JMIR Mhealth Uhealth 2020; 8:e19494. [PMID: 32463375 PMCID: PMC7296974 DOI: 10.2196/19494] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out mobile health support, such as smartphone apps. OBJECTIVE We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. METHODS Data were from daily and nondaily adult smokers in the United Kingdom who had downloaded the Smoke Free app between January 1, 2020, and March 31, 2020 (primary analysis), and January 1, 2019, and March 31, 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalized as March 1, 2020 (primary analysis), and January 15, 2020 (secondary analysis). Generalized additive mixed models adjusted for relevant covariates were fitted. RESULTS Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. Calculation of Bayes factors (BFs) indicated that the data for the primary analysis favored the null hypothesis compared with large associations (for level, BF=0.25; for slope, BF=0.26) but were insensitive to the detection of small associations (for level, BF=0.78; for slope, BF=1.35). CONCLUSIONS In the United Kingdom, between January 1, 2020, and March 31, 2020, and between January 1, 2019, and March 31, 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a large step change or increasing trend in downloads of a popular smoking cessation app. Findings on the association of the SARS-CoV-2 outbreak with a small step change or increasing trend were inconclusive.
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Affiliation(s)
- Olga Perski
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Aleksandra Herbeć
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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15
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Cheung YTD, Chan CHH, Ho KS, Tang C, Lau CWH, Li WHC, Wang MP, Lam TH. Effectiveness of nicotine replacement therapy sample at outdoor smoking hotspots for initiating quit attempts and use of smoking cessation services: a protocol for a cluster randomised controlled trial. BMJ Open 2020; 10:e036339. [PMID: 32269028 PMCID: PMC7170641 DOI: 10.1136/bmjopen-2019-036339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION More than half of the smoking population in Hong Kong are unmotivated to quit. Only about 2% of tobacco users in the territory have ever used cessation aids such as nicotine replacement therapy (NRT). The present study aims to assess the effectiveness of delivering 1-week free NRT sample plus brief intervention to smokers at outdoor smoking hotspots on quit attempts and use of smoking cessation services. METHODS AND ANALYSIS This is a two-arm, pragmatic, multisite, cluster randomised controlled trial (RCT) on the effectiveness of increasing quit attempts, use of cessation service and recruitment outcomes. Trained smoking cessation ambassadors will approach smokers at outdoor smoking hotspots, and deliver brief smoking cessation advice. Recruitment sessions are randomised to intervention or control group (allocation ratio 1:1). Participants in the intervention group (n=550) will receive 1-week free NRT sample (either patch or gum), brief medication advice from an onsite nurse and cessation service referral, whereas participants in control group (n=275) will only receive the brief advice and service referral. The primary outcomes are the proportion of participants who enrol in any cessation service in Hong Kong within 1 month of the recruitment, and the proportion of participants who report quit attempts at 1-month follow-up. Secondary outcomes include self-reported use of NRT, self-reported 7-day tobacco abstinence, 30-day abstinence at 3 months and 6 months, biochemically validated abstinence at 6 months, perceived importance, difficulty and confidence to quit (scale 0-10), and Incremental Behavior Change towards Smoking Cessation. Process outcomes include number of smokers who will be approached, will accept the brief smoking cessation advice or be recruited to participate in the RCT. ETHICS AND DISSEMINATION The Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster approved the trial (UW 18-118). Findings will be disseminated through funding website, publication and conference presentations. TRIAL REGISTRATION NUMBER NCT03717051.
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Affiliation(s)
| | - Ching Han Helen Chan
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | - Kin Sang Ho
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | - Celeste Tang
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | | | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
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Herbec A, Brown J, Shahab L, West R, Raupach T. Pragmatic randomised trial of a smartphone app (NRT2Quit) to improve effectiveness of nicotine replacement therapy in a quit attempt by improving medication adherence: results of a prematurely terminated study. Trials 2019; 20:547. [PMID: 31477166 PMCID: PMC6720069 DOI: 10.1186/s13063-019-3645-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/09/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) bought over the counter (OTC) appears to be largely ineffective for smoking cessation, which may be partially explained by poor adherence. We developed and evaluated the NRT2Quit smartphone app (for iOS) designed to improve quit attempts with OTC NRT by improving adherence to the medications. METHODS This study was a pragmatic double-blind randomised controlled trial with remote recruitment through leaflets distributed to over 300 UK-based community pharmacies. The study recruited adult daily smokers (≥10 cigarettes per day) who bought NRT, wanted to quit smoking, downloaded NTR2Quit and completed the registration process within the app. Participants were automatically randomly assigned within the app to the intervention (full) version of NRT2Quit or to its control (minimal) versions. The primary outcome was biochemically verified 4-week abstinence assessed at 8-week follow-up using Russell Standard criteria and intention to treat. Bayes factors were calculated for the cessation outcome. Secondary outcomes were self-reported abstinence, NRT use, app use and satisfaction with the app. RESULTS The study under-recruited. Only 41 participants (3.5% of the target sample) were randomly assigned to NRT2Quit (n = 16) or the control (n = 25) app versions between March 2015 and September 2016. The follow-up rate was 51.2%. The intervention participants had numerically higher biochemically verified quit rates (25.0% versus 8.0%, P = 0.19, odds ratio = 3.83, 0.61-24.02). The calculated Bayes factor, 1.92, showed that the data were insensitive to test for the hypothesis that the intervention app version aided cessation. The intervention participants had higher median logins (2.5 versus 0, P = 0.01) and were more likely to use NRT at follow-up (100.0% versus 28.6%, P = 0.03) and recommend NRT2Quit to others (100.0% versus 28.6%, P = 0.01). CONCLUSIONS Despite very low recruitment, there was preliminary but inconclusive evidence that NRT2Quit may improve short-term abstinence and adherence among smokers using NRT. Well-powered studies on NRT2Quit are needed, but different recruitment methods will be required to engage smokers through community pharmacies or other channels. TRIAL REGISTRATION ISRCTN ISRCTN33423896 , prospectively registered on 22 March 2015.
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Affiliation(s)
- Aleksandra Herbec
- Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
- Centre for Behaviour Change, University College London, Room 353, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Jamie Brown
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Lion Shahab
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Robert West
- Behavioural Science and Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Tobias Raupach
- Centre for Behaviour Change, University College London, Room 353, 1-19 Torrington Place, London, WC1E 6BT UK
- National Centre for Smoking Cessation and Training, 1 Great Western Industrial Centre, Dorchester, DT1 1RD UK
- Clinic for Cardiology and Pneumology, University Medical Centre, Universitaetsmedizin Goettingen UBFT, Robert-Koch, Strasse 40, 37075 Goettingen, Germany
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Cheung YTD, Cheung Li WH, Wang MP, Lam TH. Delivery of a Nicotine Replacement Therapy Sample at Outdoor Smoking Hotspots for Promoting Quit Attempts: A Pilot Randomized Controlled Trial. Nicotine Tob Res 2019; 22:1468-1475. [DOI: 10.1093/ntr/ntz138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Outdoor smoking hotspots are convenient venues for promoting smoking cessation. This randomized controlled trial aimed to obtain proof-of-concept evidence of the feasibility and preliminary effectiveness on quit attempts of delivering a 1-week free nicotine replacement therapy sample (NRTS) to smokers.
Methods
This pilot parallel, single-blinded, two-group (1:1) randomized controlled trial proactively recruited adult smokers in outdoor smoking hotspots in Hong Kong. Smokers consuming at least 10 cigarettes per day and fit for NRT use were individually randomized to receive either a 1-week NRT gum/patch and brief advice lasting 10 minutes (NRTS, n = 50), or receive only brief advice (control, n = 50). The primary outcomes were any self-reported quit attempts (stop smoking for at least 24 hours) at 1- and 3-month telephone follow-up. Risk ratios from log-binomial regression models were used to assess the associations.
Results
The NRTS increased quit attempts at 1-month (14% vs. 10%; adjusted risk ratio = 1.25, 95% CI = 0.43 to 3.61) and 3-month follow-up (26% vs. 12%; adjusted risk ratio = 2.17, 95% CI = 0.89 to 5.27), but the differences were not significant. Trial participation rate was about 81.3%. Around 54% of the intervention group participants used the NRT sample by the first month. The NRT users reported generally positive feedback about the usefulness of NRT sample for smoking cessation. Major factors of not using NRT included bad gum taste and their perception that NRT was not useful.
Conclusions
Delivering NRTS to smokers in outdoor smoking hotspots was feasible and efficacious in increasing NRT use. Additional post-recruitment support to sustain the use of NRT and cessation services is needed.
Implications
Our study supported that smokers at outdoor smoking hotspots can be approached for a brief smoking cessation intervention including an onsite delivery of NRTS. Delivering NRTS and a brief advice on using NRT to these smokers was feasible and efficacious to increase NRT use. A larger trial on the benefits on quit attempts and long-term abstinence is warranted.
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Affiliation(s)
| | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
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Barnett PG, Ignacio RV, Kim HM, Geraci MC, Essenmacher CA, Hall SV, Sherman SE, Duffy SA. Cost-effectiveness of real-world administration of tobacco pharmacotherapy in the United States Veterans Health Administration. Addiction 2019; 114:1436-1445. [PMID: 30924195 DOI: 10.1111/add.14621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/09/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Cost-effectiveness studies in randomized clinical trials have shown that tobacco cessation pharmacotherapy is among the most cost-effective of health-care interventions. Clinical trial eligibility criteria and treatment protocols may not be followed in actual practice. This study aimed to determine whether tobacco cessation pharmacotherapy is cost-effective in real-world settings. DESIGN A retrospective analysis of costs and outcomes. SETTING Hospitals and clinics of the US Veterans Health Administration, USA. PARTICIPANTS A total of 589 862 US veterans who screened positive for tobacco use in 2011. INTERVENTION AND COMPARATOR Tobacco users who initiated smoking cessation pharmacotherapy in the 6 months after screening were compared with those who did not use pharmacotherapy in this period. Pharmacotherapy included nicotine replacement therapy, bupropion (if prescribed at 300 mg per day or specifically for tobacco cessation) or varenicline. MEASURES Effectiveness was determined from responses to a subsequent tobacco screening conducted between 7 and 18 months after the treatment observation period. Cost of medications and prescribing health-care encounters was determined for the period between initial and follow-up tobacco use screening. Multivariate fixed-effects regression was used to assess the effect of initial treatment status on cost and outcome while controlling for differences in case-mix with propensity weighting to adjust for confounding by indication. FINDINGS Thirteen per cent of participants received tobacco cessation pharmacotherapy within 6 months of initial screening. After an average of an additional 218.1 days' follow-up, those who initially received pharmacotherapy incurred $143.79 in additional treatment cost and had a 3.1% absolute increase in tobacco quit rates compared with those who were not initially treated. This represents an incremental cost-effectiveness ratio of $4705 per quit. The upper limit of the 99.9% confidence region was $5600 per quit. Without propensity adjustment, the cost-effectiveness ratio was $7144 per quit, with the upper limit of the 99.9% confidence region $9500/quit. CONCLUSIONS Tobacco cessation pharmacotherapy provided by the US Veterans Health Administration in 2011/12 was cost-effective in this real-world setting, with an incremental cost-effectiveness ratio of $4705 per quit.
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Affiliation(s)
- Paul G Barnett
- Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Rosalinda V Ignacio
- VA Center for Clinical Management and Research, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Hyungjin Myra Kim
- VA Center for Clinical Management and Research, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA.,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA
| | - Mark C Geraci
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, IL, USA
| | | | - Stephanie V Hall
- VA Center for Clinical Management and Research, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Scott E Sherman
- VA New York Harbor Healthcare System, New York, NY, USA.,Department of Population Health, NYU School of Medicine, New York University, New York, NY, USA
| | - Sonia A Duffy
- VA Center for Clinical Management and Research, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,College of Nursing, Ohio State University, Columbus, OH, USA
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Tindle HA, Greevy RA. Smoking Cessation Pharmacotherapy, Even Without Counseling, Remains a Cornerstone of Treatment. J Natl Cancer Inst 2019; 110:545-546. [PMID: 29281038 DOI: 10.1093/jnci/djx246] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/25/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Vanderbilt Center for Tobacco, Addiction, and Lifestyle (ViTAL), Nashville
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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Chung-Hall J, Craig L, Gravely S, Sansone N, Fong GT. Impact of the WHO FCTC over the first decade: a global evidence review prepared for the Impact Assessment Expert Group. Tob Control 2019; 28:s119-s128. [PMID: 29880598 PMCID: PMC6589489 DOI: 10.1136/tobaccocontrol-2018-054389] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present findings of a narrative review on the implementation and effectiveness of 17 Articles of the WHO Framework Convention on Tobacco Control (FCTC) during the Treaty's first decade. DATA SOURCES Published reports on global FCTC implementation; searches of four databases through June 2016; hand-search of publications/online resources; tobacco control experts. STUDY SELECTION WHO Convention Secretariat global progress reports (2010, 2012, 2014); 2015 WHO report on the global tobacco epidemic; studies of social, behavioural, health, economic and/or environmental impacts of FCTC policies. DATA EXTRACTION Progress in the implementation of 17 FCTC Articles was categorised (higher/intermediate/lower) by consensus. 128 studies were independently selected by multiple authors in consultation with experts. DATA SYNTHESIS Implementation was highest for smoke-free laws, health warnings and education campaigns, youth access laws, and reporting/information exchange, and lowest for measures to counter industry interference, regulate tobacco product contents, promote alternative livelihoods and protect health/environment. Price/tax increases, comprehensive smoking and marketing bans, health warnings, and cessation treatment are associated with decreased tobacco consumption/health risks and increased quitting. Mass media campaigns and youth access laws prevent smoking initiation, decrease prevalence and promote cessation. There were few studies on the effectiveness of policies in several domains, including measures to prevent industry interference and regulate tobacco product contents. CONCLUSIONS The FCTC has increased the implementation of measures across several policy domains, and these implementations have resulted in measurable impacts on tobacco consumption, prevalence and other outcomes. However, FCTC implementation must be accelerated, and Parties need to meet all their Treaty obligations and consider measures that exceed minimum requirements.
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Affiliation(s)
- Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Natalie Sansone
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Soulakova JN, Crockett LJ. Unassisted Quitting and Smoking Cessation Methods Used in the United States: Analyses of 2010-2011 Tobacco Use Supplement to the Current Population Survey Data. Nicotine Tob Res 2018; 20:30-39. [PMID: 27798084 DOI: 10.1093/ntr/ntw273] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/05/2016] [Indexed: 11/15/2022]
Abstract
Introduction The study estimated the prevalence of unassisted quitting (ie, quitting without pharmacological aids or other interventions) among former smokers and identified the most common smoking cessation methods used by U.S. adult smokers who quit smoking between 2007 and 2011. Among long-term quitters, smoking-related behaviors and factors associated with using pharmacological methods and quitting unassisted were examined. Methods The analytic sample consisted solely of former smokers, including 3,583 "long-term quitters" (those who quit 1 to 3 years prior to the survey) and 2,205 "recent quitters" (those who quit within a year prior to the survey), who responded to the 2010-2011 Tobacco Use Supplement to the Current Population Survey. Results About 72% of former smokers quit unassisted, 26% used at least one pharmacological method, and 7% used at least one nonpharmacological method. The most common pharmacological methods were the nicotine patch (12%), Chantix/Varenicline (11%), and a nicotine gum/lozenge (8%). For long-term quitters, cutting back on cigarettes gradually and relying on social support were more commonly associated with pharmacological methods. Among long-term quitters, younger adults (18 to 44 years old), Non-Hispanic Blacks, Hispanics, those who were less nicotine dependent prior to quitting and those who did not visit a doctor in the past 12 months before quitting had higher odds of reporting unassisted quitting than quitting with pharmacological methods. Conclusions Unassisted quitting remains the predominant means of recent and long-term smoking cessation in the United States. Attempters may try different ways of quitting during the same quit attempt. Implications Unassisted quitting remains a much more common method for recent and long-term smoking cessation than use of pharmacological or nonpharmacological methods. Smokers may try different ways of quitting during the same quit attempt. Thus, population-based studies that investigate the use of particular methods while ignoring other ways of quitting may overestimate the benefits of certain methods for smoking cessation.
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Affiliation(s)
- Julia N Soulakova
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL
| | - Lisa J Crockett
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE
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Leas EC, Pierce JP, Benmarhnia T, White MM, Noble ML, Trinidad DR, Strong DR. Effectiveness of Pharmaceutical Smoking Cessation Aids in a Nationally Representative Cohort of American Smokers. J Natl Cancer Inst 2018; 110:581-587. [PMID: 29281040 PMCID: PMC6005055 DOI: 10.1093/jnci/djx240] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/28/2017] [Accepted: 10/31/2017] [Indexed: 01/29/2023] Open
Abstract
Background Despite strong efficacy in randomized trials, the population effectiveness of pharmaceutical aids in long-term smoking cessation is lacking, possibly because of confounding (factors that are associated with both pharmaceutical aid use and difficulty quitting). Matching techniques in longitudinal studies can remove this confounding bias. Methods Using the nationally representative Tobacco Use Supplement to the Current Population Survey (TUS-CPS), we assessed the effectiveness of medications to aid quitting among baseline adult smokers who attempted to quit prior to one year of follow-up in two longitudinal studies: 2002-2003 and 2010-2011. Pharmaceutical aid users and nonusers with complete data (n = 2129) were matched using propensity score models with 12 potential confounders (age, sex, race-ethnicity, education, smoking intensity, nicotine dependence, previous quit history, self-efficacy to quit, smoke-free homes, survey year, and cessation aid use). Using matched data sets, logistic regression models were fit to assess whether use of any individual pharmaceutical aid increased the proportion of patients who were abstinent for 30 days or more at follow-up. Results Propensity score matching markedly improved balance on the potential confounders between the pharmaceutical aid use groups. Using matched samples to provide a balanced comparison, there was no evidence that use of varenicline (adjusted risk difference [aRD] = 0.01, 95% confidence interval [CI] = -0.07 to 0.11), bupropion (aRD = 0.02, 95% CI = -0.04 to 0.09), or nicotine replacement (aRD = 0.01, 95% CI = -0.03 to 0.06) increased the probability of 30 days or more smoking abstinence at one-year follow-up. Conclusions The lack of effectiveness of pharmaceutical aids in increasing long-term cessation in population samples is not an artifact caused by confounded analyses. A possible explanation is that counseling and support interventions provided in efficacy trials are rarely delivered in the general population.
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Affiliation(s)
- Eric C Leas
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Climate, Atmospheric Science and Physical Oceanography, Scripps Institution of Oceanography, La Jolla, CA
| | - Martha M White
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Madison L Noble
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
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Hartmann‐Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev 2018; 5:CD000146. [PMID: 29852054 PMCID: PMC6353172 DOI: 10.1002/14651858.cd000146.pub5] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) aims to temporarily replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. OBJECTIVES To determine the effectiveness and safety of nicotine replacement therapy (NRT), including gum, transdermal patch, intranasal spray and inhaled and oral preparations, for achieving long-term smoking cessation, compared to placebo or 'no NRT' interventions. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register for papers mentioning 'NRT' or any type of nicotine replacement therapy in the title, abstract or keywords. Date of most recent search is July 2017. SELECTION CRITERIA Randomized trials in people motivated to quit which compared NRT to placebo or to no treatment. We excluded trials that did not report cessation rates, and those with follow-up of less than six months, except for those in pregnancy (where less than six months, these were excluded from the main analysis). We recorded adverse events from included and excluded studies that compared NRT with placebo. Studies comparing different types, durations, and doses of NRT, and studies comparing NRT to other pharmacotherapies, are covered in separate reviews. DATA COLLECTION AND ANALYSIS Screening, data extraction and 'Risk of bias' assessment followed standard Cochrane methods. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS We identified 136 studies; 133 with 64,640 participants contributed to the primary comparison between any type of NRT and a placebo or non-NRT control group. The majority of studies were conducted in adults and had similar numbers of men and women. People enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. We judged the evidence to be of high quality; we judged most studies to be at high or unclear risk of bias but restricting the analysis to only those studies at low risk of bias did not significantly alter the result. The RR of abstinence for any form of NRT relative to control was 1.55 (95% confidence interval (CI) 1.49 to 1.61). The pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976 participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4 trials, 887 participants) for nicotine nasal spray. The effects were largely independent of the definition of abstinence, the intensity of additional support provided or the setting in which the NRT was offered. A subset of six trials conducted in pregnant women found a statistically significant benefit of NRT on abstinence close to the time of delivery (RR 1.32, 95% CI 1.04 to 1.69; 2129 participants); in the four trials that followed up participants post-partum the result was no longer statistically significant (RR 1.29, 95% CI 0.90 to 1.86; 1675 participants). Adverse events from using NRT were related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. Attempts to quantitatively synthesize the incidence of various adverse effects were hindered by extensive variation in reporting the nature, timing and duration of symptoms. The odds ratio (OR) of chest pains or palpitations for any form of NRT relative to control was 1.88 (95% CI 1.37 to 2.57, 15 included and excluded trials, 11,074 participants). However, chest pains and palpitations were rare in both groups and serious adverse events were extremely rare. AUTHORS' CONCLUSIONS There is high-quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect. The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT. NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non-ischaemic chest pain and palpitations.
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Affiliation(s)
- Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | | | - Weiyu Ye
- University of OxfordOxford University Clinical Academic Graduate SchoolOxfordUK
| | - Chris Bullen
- University of AucklandNational Institute for Health InnovationPrivate Bag 92019Auckland Mail CentreAucklandNew Zealand1142
| | - Tim Lancaster
- King’s College LondonGKT School of Medical EducationLondonUK
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Soulakova JN, Crockett LJ. Level of Cigarette Consumption and Duration of Smoking Abstinence During Failed Quit Attempts Among Long-Term Daily Smokers: the Role of Race/Ethnicity and Cessation Aids. J Racial Ethn Health Disparities 2018; 5:293-303. [PMID: 28444627 PMCID: PMC5656561 DOI: 10.1007/s40615-017-0370-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 11/25/2022]
Abstract
The goal of this study was to determine whether race/ethnicity and use of smoking cessation aids are associated with the duration of the last serious quit attempt and reductions in cigarette consumption among long-term daily smokers who tried, and failed, to quit smoking during the preceding year. Data came from the 2010-2011 Tobacco Use Supplement survey conducted in the USA, and analyses included 6672 reports of long-term daily smokers (i.e., smokers who smoked daily for 1 year or longer) who made at least one serious quit attempt in the past 12 months. About 39% of these smokers used at least one smoking cessation aid during their last quit attempt. Use of aids was significantly lower for non-Hispanic Black (NHB, 29%) and Hispanic (HISP, 29%) smokers than for non-Hispanic White (NHW, 42%) smokers, possibly due to differences in socioeconomic status and access to healthcare for smoking cessation. The effect of using any aids on mean cigarette reduction and duration of the last long quit attempt (i.e., one that lasted a day or more) was similar across race/ethnicity. Using any aids did not substantially influence mean cigarette reduction but was positively associated with duration of the quit attempt: the duration was 6 days longer (CI = 3:10), on average, when aids were used than when smokers attempted to quit unassisted. Race/ethnicity was significantly associated with mean cigarette reduction (p = 0.023); non-Hispanic American Indian and Alaska Native smokers had the highest mean reduction (of 3 cigarettes, CI = 1:5) among the racial/ethnic groups considered. Use of aids may help increase duration of quit attempts and thus, may increase likelihood of quitting successfully in the near future.
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Affiliation(s)
- Julia N Soulakova
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA.
| | - Lisa J Crockett
- Department of Psychology, University of Nebraska-Lincoln, 315 Burnett Hall, Lincoln, NE, 68588-0308, USA
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Hummel K, Nagelhout GE, Fong GT, Vardavas CI, Papadakis S, Herbeć A, Mons U, van den Putte B, Borland R, Fernández E, de Vries H, McNeill A, Gravely S, Przewoźniak K, Kovacs P, Trofor AC, Willemsen MC. Quitting activity and use of cessation assistance reported by smokers in eight European countries: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2018; 16:A6. [PMID: 31363422 PMCID: PMC6659556 DOI: 10.18332/tid/98912] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION There is clear evidence that the use of cessation aids significantly increases the likelihood of successful smoking cessation. The aim of this study was to examine quitting activity and use of cessation aids among smokers from various European countries. Subgroup differences were also examined for sex, income, education, and age in each country. METHODS Cross-sectional data were collected in 2016 from 10,683 smokers in eight European countries participating in the ITC Project: England (n=3,536), Germany (n=1,003), Greece (n=1,000), Hungary (n=1,000), the Netherlands (n=1,136), Poland (n=1,006), Romania (n=1,001), and Spain (n=1,001). We measured quitting activity, including quit attempts in the previous 12 months and intention to quit, use of cessation aids (i.e., medication, quitlines, internet, local services, and e-cigarettes), and whether respondents had received advice about quitting and e-cigarettes from health professionals. RESULTS Quit attempts were most common in England (46.3%) and least common in Hungary (10.4%). Quit intention was highest in England and lowest in Greece. Use of e-cigarettes to quit was highest in England (51.6%) and lowest in Spain (5.0%). Use of cessation aids was generally low across all countries; in particular this was true for quitlines, internet-based support, and local services. Receiving health professional advice to quit was highest in Romania (56.5%), and lowest in Poland (20.8%); few smokers received advice about e-cigarettes from health professionals. No clear differences were found for sex and income groups. Across countries, smokers with lower education reported less quitting activity. CONCLUSIONS Quitting activity and use of cessation methods were low in most countries. Greater quit attempts and use of cessation aids were found in England, where large investments in tobacco control and smoking cessation have been made. Health professionals are important for motivating smokers to quit and promoting the effectiveness of various methods, but overall, few smokers get advice to quit.
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Affiliation(s)
- Karin Hummel
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Gera E. Nagelhout
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
- IVO Research Institute, The Hague, the Netherlands
| | - Geoffrey T. Fong
- Department of Psychology & School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I. Vardavas
- University of Crete (UoC), Heraklion, Greece
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Sophia Papadakis
- University of Crete (UoC), Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Aleksandra Herbeć
- Health Promotion Foundation, Warsaw, Poland
- UK Centre for Tobacco and Alcohol Studies, London, United Kingdom
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Ute Mons
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bas van den Putte
- Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Australia
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), and Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Catalonia, Spain
- School of Medicine and Health Sciences, University of Barcelona, Catalonia, Spain
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, London, United Kingdom
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Shannon Gravely
- Department of Psychology & School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Piroska Kovacs
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Marc C. Willemsen
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands
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Smith PH, Weinberger AH, Zhang J, Emme E, Mazure CM, McKee SA. Sex Differences in Smoking Cessation Pharmacotherapy Comparative Efficacy: A Network Meta-analysis. Nicotine Tob Res 2017; 19:273-281. [PMID: 27613893 DOI: 10.1093/ntr/ntw144] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/04/2016] [Indexed: 01/08/2023]
Abstract
Introduction Converging clinical and biological evidence suggest sex is an important factor when selecting a pharmacological intervention for smoking cessation. The current investigation used network meta-analyses to estimate sex differences in the comparative efficacy of transdermal nicotine (TN), varenicline, and sustained release (SR) bupropion for smoking cessation. Methods Systematically searched previously published reviews and databases (Medline, PsycINFO, Embase) of randomized, double-blind, placebo-controlled trials of bupropion-SR, TN, and varenicline for cigarette smoking cessation in primary care/general community samples were included. Results Thirty-two studies met all criteria and 28 (88%) were included in the final analyses, representing 14 389 smokers (51% female). Results of the full sample (women and men combined) mirrored those from a Cochrane Tobacco Addiction Group network meta-analysis of smoking cessation pharmacotherapy, showing VAR>TN=BUP. All medications improved quit rates over placebo for both women and men. Relative to placebo, varenicline efficacy was similar for women and men. Significant sex differences were evident when comparing varenicline versus TN and varenicline versus bupropion. For women, varenicline was more efficacious than TN (RR = 1.41; 95% CI = 1.12,1.76) and bupropion (RR = 1.38; 95% CI = 1.08,1.77). For men, outcomes for those treated with TN and bupropion were similar to those treated with varenicline. There were no differences in efficacy when comparing bupropion versus TN. Conclusions The advantage of varenicline over bupropion SR and TN is greater for women than men. Clinicians should strongly consider varenicline as the first option treatment for women. Among men, the advantage of varenicline over TN or bupropion is less clear. Implications This study provides information for the sex-informed treatment of nicotine addiction among cigarette smokers. Relative to placebo, women and men achieved similar outcomes when treated with varenicline; however the advantages of varenicline over transdermal patch and bupropion were greater for women compared to men.
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Affiliation(s)
- Philip H Smith
- Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, New York, NY.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ju Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Erin Emme
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
| | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT
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Fix BV, O’Connor RJ, Benowitz N, Heckman BW, Cummings KM, Fong GT, Thrasher JF. Nicotine Metabolite Ratio (NMR) Prospectively Predicts Smoking Relapse: Longitudinal Findings From ITC Surveys in Five Countries. Nicotine Tob Res 2017; 19:1040-1047. [PMID: 28387850 PMCID: PMC5896535 DOI: 10.1093/ntr/ntx083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/05/2017] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The ratio of trans 3'-hydroxycotinine (3HC) to cotinine (nicotine metabolite ratio [NMR]) is a biomarker of the rate of nicotine metabolism, with higher NMR indicating faster metabolism. Higher NMR has been found to be associated with higher daily cigarette consumption and less success stopping smoking in cessation trials. This study examines differences in NMR among population-based samples of smokers in the five countries and explores the relationship between NMR and smoking abstinence. METHODS Participants (N = 874) provided saliva samples during International Tobacco Control (ITC) surveys in the United States, United Kingdom, Mauritius, Mexico, and Thailand conducted in 2010/2011 with follow-up surveys in 2012/2013. When all samples were received, they were sent to a common laboratory for analysis using liquid chromatography and tandem mass spectroscopy. RESULTS There was significant variation in NMR across countries (F = 15.49, p < .001). Those who reported smoking at follow-up had a mean NMR of 0.32, compared to a mean NMR of 0.42 in participants who reported that they had stopped (F = 8.93; p = .003). Higher mean NMR values were also associated with longer quit duration (p = .007). There was no substantial difference in NMR between current smokers who made a failed quit attempt and those who made no attempt-both had significantly lower NMR compared to those who quit and remained abstinent. Smokers with a higher NMR were more likely to report that they stopped smoking compared to those with a lower NMR (odds ratio = 2.67; 95% confidence interval: 1.25 to 5.68). CONCLUSIONS These results suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking. IMPLICATIONS Results of this study suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking.
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Affiliation(s)
- Brian V Fix
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC; Department of Tobacco Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Heckman BW, Cummings KM, Kasza KA, Borland R, Burris JL, Fong GT, McNeill A, Carpenter MJ. Effectiveness of Switching Smoking-Cessation Medications Following Relapse. Am J Prev Med 2017; 53:e63-e70. [PMID: 28336353 PMCID: PMC5522631 DOI: 10.1016/j.amepre.2017.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/16/2016] [Accepted: 01/23/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Nicotine dependence is a chronic disorder often characterized by multiple failed quit attempts (QAs). Yet, little is known about the sequence of methods used across multiple QAs or how this may impact future ability to abstain from smoking. This prospective cohort study examines the effectiveness of switching smoking-cessation medications (SCMs) across multiple QAs. METHODS Adult smokers (aged ≥18 years) participating in International Tobacco Control surveys in the United Kingdom, U.S., Canada, and Australia (N=795) who: (1) completed two consecutive surveys between 2006 and 2011; (2) initiated a QA at least 1 month before each survey; and (3) provided data for the primary predictor (SCM use during most recent QA), outcome (1-month point prevalence abstinence), and relevant covariates. Analyses were conducted in 2016. RESULTS Five SCM user classifications were identified: (1) non-users (43.5%); (2) early users (SCM used for initial, but not subsequent QA; 11.4%); (3) later users (SCM used for subsequent, but not initial QA; 18.4%); (4) repeaters (same SCM used for both QAs; 10.7%); and (5) switchers (different SCM used for each QA; 14.2%). Abstinence rates were lower for non-users (15.9%, OR=0.48, p=0.002), early users (16.6%, OR=0.27, p=0.03), and repeaters (12.4%, OR=0.36, p=0.004) relative to switchers (28.5%). CONCLUSIONS Findings suggest smokers will be more successful if they use a SCM in QAs and vary the SCM they use across time. That smokers can increase their odds of quitting by switching SCMs is an important message that could be communicated to smokers.
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Affiliation(s)
- Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - Ron Borland
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, Kentucky; Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, King's College London, Strand, London, United Kingdom
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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29
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Skinner A, Havard A, Tran DT, Jorm LR. Access to Subsidized Smoking Cessation Medications by Australian Smokers Aged 45 Years and Older: A Population-Based Cohort Study. Nicotine Tob Res 2017; 19:342-350. [PMID: 27613898 DOI: 10.1093/ntr/ntw202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/23/2016] [Indexed: 11/13/2022]
Abstract
Introduction The principal aim of this study was to assess the accessibility of subsidized cessation medications to socioeconomically disadvantaged smokers, including smokers living in regional and remote communities. Methods Analyses used baseline questionnaire and linked Pharmaceutical Benefits Scheme data for 18 686 regular smokers participating in the 45 and Up Study, a large-scale Australian cohort study of people aged 45 years and older. Participants who were dispensed nicotine replacement therapy, varenicline, or bupropion were identified from the Pharmaceutical Benefits Scheme data, which provide an essentially complete record of participants' access to subsidized pharmaceuticals. Associations between the supply of each pharmacotherapy and a range of sociodemographic and health-related variables were evaluated using multiple logistic regression. Results The odds that participants were supplied with a cessation medication declined markedly with increasing age for participants older than 60 years and were substantially higher for participants who smoked 20 or more cigarettes/day than for participants who smoked fewer than 10 cigarettes/day. Participants with no formal qualification and those residing in socioeconomically disadvantaged areas had higher odds of receiving nicotine replacement therapy or varenicline than university-educated participants and participants living in the least disadvantaged areas. There was no evidence that participants residing in regional and remote communities had lower odds of receiving a cessation medication than participants residing in major cities. Conclusions Older Australian smokers' access to cessation pharmacotherapies is determined predominantly by age and daily cigarette consumption and does not appear to be limited by educational achievement, socioeconomic disadvantage, or remoteness. Implications Promoting the use of cessation medications is a principal measure proposed to achieve Australia's National Tobacco Strategy 2012-2018 goal of reducing cigarette consumption among socioeconomically disadvantaged smokers. The results of this large-scale cohort study indicate that access to cessation pharmacotherapies is determined primarily by age and daily cigarette consumption, and is not limited by socioeconomic circumstances, providing some reassurance that existing government subsidies are sufficient to ensure that pharmaceutical aids are accessible to all Australian smokers.
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Affiliation(s)
- Adam Skinner
- Centre for Health Research, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia.,Centre for Epidemiology and Evidence, NSW Ministry of Health, North Sydney, New South Wales, Australia
| | - Alys Havard
- Centre for Health Research, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia.,Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Duong Thuy Tran
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Health Research, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia.,Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Matthews AK, Cesario J, Ruiz R, Ross N, King A. A Qualitative Study of the Barriers to and Facilitators of Smoking Cessation Among Lesbian, Gay, Bisexual, and Transgender Smokers Who Are Interested in Quitting. LGBT Health 2017; 4:24-33. [PMID: 28068208 DOI: 10.1089/lgbt.2016.0059] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) individuals are significantly more likely to smoke compared with their heterosexual and cisgender counterparts. The purpose of this study was to explore barriers to and facilitators of smoking cessation readiness among LGBT smokers. METHODS This descriptive study used a qualitative approach. Four 90-minute focus groups (eligibility criteria: age ≥21, self-identify as LGBT, current smoker, interest in quitting smoking) were conducted. Participants also completed a brief survey that measured additional demographic characteristics and smoking behaviors. Topics explored included quit experiences, attitudes and beliefs, barriers to and facilitators of cessation, and cultural factors related to smoking behaviors. Established qualitative methods were used to conduct the focus groups and data analysis. RESULTS The mean age of participants (N = 31) was 37.1 years with the majority identifying as male (58.1%). The sample group was racially diverse: 32% were African American, 39% were White, and 29% were more than one race. Interest in quitting was high (M = 9.0, range 0-10). Barriers to smoking cessation fell under the broad themes of individual-level factors, cultural factors, psychosocial factors, and access to treatment. Facilitators of smoking cessation included stage of readiness, health concerns, social stigma, a shift in social norms, financial costs, and improving dating prospects. CONCLUSIONS Interest in smoking cessation was high in this sample of LGBT smokers and influenced by a range of facilitators. Nevertheless, several general and culturally specific barriers to smoking cessation readiness were identified. The study results have implications for future research and the development of outreach, prevention, and treatment programs.
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Affiliation(s)
- Alicia K Matthews
- 1 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago , Chicago, Illinois
| | - John Cesario
- 2 Department of Oncology, University of Illinois Hospital and Health Systems Sciences , Chicago, Illinois
| | - Raymond Ruiz
- 1 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago , Chicago, Illinois
| | - Natalie Ross
- 3 Department of Research, Howard Brown Health Center , Chicago, Illinois
| | - Andrea King
- 4 Department of Psychiatry and Behavioral Neuroscience, University of Chicago , Chicago, Illinois
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Motschman CA, Gass JC, Wray JM, Germeroth LJ, Schlienz NJ, Munoz DA, Moore FE, Rhodes JD, Hawk LW, Tiffany ST. Selection criteria limit generalizability of smoking pharmacotherapy studies differentially across clinical trials and laboratory studies: A systematic review on varenicline. Drug Alcohol Depend 2016; 169:180-189. [PMID: 27863344 DOI: 10.1016/j.drugalcdep.2016.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The selection criteria used in clinical trials for smoking cessation and in laboratory studies that seek to understand mechanisms responsible for treatment outcomes may limit their generalizability to one another and to the general population. METHODS We reviewed studies on varenicline versus placebo and compared eligibility criteria and participant characteristics of clinical trials (N=23) and laboratory studies (N=22) across study type and to nationally representative survey data on adult, daily USA smokers (2014 National Health Interview Survey; 2014 National Survey on Drug Use and Health). RESULTS Relative to laboratory studies, clinical trials more commonly reported excluding smokers who were unmotivated to quit and for specific medical conditions (e.g., cardiovascular disease, COPD), although both study types frequently reported excluding for general medical or psychiatric reasons. Laboratory versus clinical samples smoked less, had lower nicotine dependence, were younger, and more homogeneous with respect to smoking level and nicotine dependence. Application of common eligibility criteria to national survey data resulted in considerable elimination of the daily-smoking population for both clinical trials (≥47%) and laboratory studies (≥39%). Relative to the target population, studies in this review recruited participants who smoked considerably more and had a later smoking onset age, and were under-representative of Caucasians. CONCLUSIONS Results suggest that selection criteria of varenicline studies limit generalizability in meaningful ways, and differences in criteria across study type may undermine efforts at translational research. Recommendations for improvements in participant selection and reporting standards are discussed.
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Affiliation(s)
- Courtney A Motschman
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Julie C Gass
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Jennifer M Wray
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA; VA Center for Integrated Healthcare, VA Western NY Medical Center, Buffalo, NY, 14215, USA
| | - Lisa J Germeroth
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Nicolas J Schlienz
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Diana A Munoz
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Faith E Moore
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA; Department of Psychology, University of Central Florida, Orlando, FL, 32816, USA
| | - Jessica D Rhodes
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, The State University of New York, Park Hall, Buffalo, NY, 14260, USA.
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Cheung YTD, Leung JPK, Cheung CKC, Li WHC, Wang MP, Lam TH. Motivating smokers at outdoor public smoking hotspots to have a quit attempt with a nicotine replacement therapy sample: study protocol for a randomized controlled trial. Trials 2016; 17:355. [PMID: 27456342 PMCID: PMC4960677 DOI: 10.1186/s13063-016-1485-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 06/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About half of the daily smokers in Hong Kong have never tried and have no intention to quit smoking. More than one-third (37.9 %) of daily smokers have attempted to quit but failed. Nicotine replacement therapy (NRT) is a safe and effective pharmacotherapy to increase abstinence by reducing withdrawal symptoms during the early stage of smoking abstinence. However, the prevalence of NRT use in Hong Kong is lower than in most developed countries. The proposed study aims to assess the effectiveness of providing free NRT samples to smokers on increasing quit attempts and the quit rate. METHODS Trained university undergraduate students as ambassadors will invite smokers at outdoor public smoking hotspots to participate in the randomized controlled trial, in which eligible smokers will be randomized to receive a 1-week free NRT sample and medication counselling (intervention) or advice to purchase NRT on their own (control). The primary outcome is self-reported quit attempts (no smoking for at least 24 hours) in the past 30 days at 1-month and 3-month telephone follow-up. DISCUSSION The findings will inform the effectiveness of delivering free NRT samples at outdoor public smoking hotspots to increase quit attempts and abstinence. The study will also provide information on smokers' adherence to the NRT sample, side effects and safety issues related to the usage. This will improve the design of a large trial to test the effect of the NRT sample. TRIAL REGISTRATION ClinicalTrials.gov NCT02491086 . Registered on 7 July 2015.
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Affiliation(s)
- Yee Tak Derek Cheung
- School of Public Health, The University of Hong Kong, Hong Kong, China. .,School of Nursing, The University of Hong Kong, Hong Kong, China.
| | | | | | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Rabin RA, Ashare RL, Schnoll RA, Cinciripini PM, Hawk LW, Lerman C, Tyndale RF, George TP. Does cannabis use moderate smoking cessation outcomes in treatment-seeking tobacco smokers? Analysis from a large multi-center trial. Am J Addict 2016; 25:291-6. [PMID: 27187893 DOI: 10.1111/ajad.12382] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/12/2016] [Accepted: 04/30/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Tobacco and cannabis are frequently used in combination and cannabis co-use may lead to poor tobacco cessation outcomes. Therefore, it is important to explore if cannabis co-use is associated with a reduced likelihood of achieving successful tobacco abstinence among treatment-seeking tobacco smokers. The present study examined whether current cannabis use moderated tobacco cessation outcomes after 12 weeks of pharmacological treatment (varenicline vs. nicotine patch vs. placebo) with adjunctive behavioral counseling. METHODS Treatment-seeking tobacco smokers (N = 1,246) were enrolled in an intent-to-treat study, of which 220 were current cannabis users. Individuals were randomly assigned to 12 weeks of placebo (placebo pill plus placebo patch), nicotine patch (active patch plus placebo pill), or varenicline (active pill plus placebo patch), plus behavioral counseling. The primary endpoint was biochemically verified 7-day point prevalence abstinence at the end of treatment. RESULTS Controlling for rate of nicotine metabolism, treatment arm, age, sex, alcohol, and level of nicotine dependence, cannabis users were as successful at achieving biochemically verified 7-day point prevalence abstinence compared to tobacco-only smokers. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Findings suggest that cannabis use does not hinder the ability to quit tobacco smoking. Future tobacco cessation studies should employ prospective, longitudinal designs investigating cannabis co-use over time and at different severity levels. (Am J Addict 2016;25:291-296).
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Affiliation(s)
- Rachel A Rabin
- The Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Division of Schizophrenia, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Schnoll
- Abramson Cancer Center and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, SUNY, Buffalo, New York
| | - Caryn Lerman
- Abramson Cancer Center and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tony P George
- The Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Division of Schizophrenia, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Di Ciano P, Guranda M, Lagzdins D, Tyndale RF, Gamaleddin I, Selby P, Boileau I, Le Foll B. Varenicline-Induced Elevation of Dopamine in Smokers: A Preliminary [(11)C]-(+)-PHNO PET Study. Neuropsychopharmacology 2016; 41:1513-20. [PMID: 26442600 PMCID: PMC4832011 DOI: 10.1038/npp.2015.305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/02/2015] [Accepted: 09/20/2015] [Indexed: 01/26/2023]
Abstract
Varenicline, a nicotinic partial agonist, is the most effective treatment for tobacco use disorder. However, its mechanism of action is still unclear and may involve stimulating dopaminergic transmission. Here we used PET imaging with [(11)C]-(+)-PHNO to explore for the first time the impact of varenicline on dopamine transmission in the D2-rich striatum and D3-rich extra-striatal regions and its relationship with craving, withdrawal and smoking. Eleven treatment-seeking smokers underwent two PET scans with [(11)C]-(+)-PHNO, each following 12-h overnight smoking abstinence both prior to receiving varenicline and following 10-11 days of varenicline treatment (ie, at steady-state drug levels). Subjective measures of craving and urges to smoke were also assessed on the days of the PET scans. Varenicline treatment significantly reduced [(11)C]-(+)-PHNO binding in the dorsal caudate (p=0.008) and reduced some craving measures. These findings provide the first evidence that varenicline is able to increase DA levels in the human brain, a factor that may contribute to its therapeutic efficacy.
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Affiliation(s)
- Patricia Di Ciano
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
| | - Mihail Guranda
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
| | - Dina Lagzdins
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
| | - Rachel F Tyndale
- Pharmacogenetics Laboratory, CAMH, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Islam Gamaleddin
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
- Institute of Environmental Studies and Research, Ain Shams University, Cairo, Egypt
| | - Peter Selby
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Ambulatory Care and Structured Treatment Program, CAMH, Toronto, ON, Canada
- Dalla Lana School of Public Health, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Isabelle Boileau
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Addiction Imaging Group, Research Imaging Centre, CAMH, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, CAMH, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
- Ambulatory Care and Structured Treatment Program, CAMH, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Igarashi A, Goto R, Suwa K, Yoshikawa R, Ward AJ, Moller J. Cost-Effectiveness Analysis of Smoking Cessation Interventions in Japan Using a Discrete-Event Simulation. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:77-87. [PMID: 26597111 PMCID: PMC4740570 DOI: 10.1007/s40258-015-0204-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Smoking cessation medications have been shown to yield higher success rates and sustained abstinence than unassisted quit attempts. In Japan, the treatments available include nicotine replacement therapy (NRT) and varenicline; however, unassisted attempts to quit smoking remain common. OBJECTIVE The objective of this study was to compare the health and economic consequences in Japan of using pharmacotherapy to support smoking cessation with unassisted attempts and the current mix of strategies used. METHODS A discrete-event simulation that models lifetime quitting behaviour and includes multiple quit attempts (MQAs) and relapses was adapted for these analyses. The risk of developing smoking-related diseases is estimated based on the duration of abstinence. Data collected from a survey conducted in Japan were used to determine the interventions selected by smokers initiating a quit attempt and the time between MQAs. Direct and indirect costs are assessed (expressed in 2014 Japanese Yen). RESULTS Using pharmacotherapy (NRT or varenicline) to support quit attempts proved to be dominant when compared with unassisted attempts or the current mix of strategies (most are unassisted). The results of stratified analyses by age imply that smoking cessation improves health outcomes across all generations. Indirect costs due to premature death leading to lost wages are an important component of the total costs, exceeding the direct medical cost estimates. CONCLUSIONS Increased utilisation of smoking cessation pharmacotherapy to support quit attempts is predicted to lead to an increase in the number of smokers achieving abstinence, and provide improvements in health outcomes over a lifetime with no additional costs.
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Affiliation(s)
- Ataru Igarashi
- Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo Bunkyo, Tokyo, 113-0033, Japan.
| | - Rei Goto
- Hakubi Center of Advanced Research, Kyoto University, Yoshida-ushinomiyacho, Sakyo, Kyoto, 6068501, Japan
- Graduate School of Economics, Kyoto University, Yoshida-honmachi, Sakyo, Kyoto, 6068501, Japan
| | - Kiyomi Suwa
- Pfizer Japan Inc., 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Reiko Yoshikawa
- Pfizer Japan Inc., 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Alexandra J Ward
- Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA
| | - Jörgen Moller
- Evidera, Metro Building, 6th Floor, 1 Butterwick, Hammersmith, London, W6 8DL, UK
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Pavey TG, Gartner CE, Coombes JS, Brown WJ. Assessing the effectiveness of High Intensity Interval Training (HIIT) for smoking cessation in women: HIIT to quit study protocol. BMC Public Health 2015; 15:1309. [PMID: 26714460 PMCID: PMC4696187 DOI: 10.1186/s12889-015-2631-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/16/2015] [Indexed: 02/04/2023] Open
Abstract
Background Smoking and physical inactivity are major risk factors for heart disease. Linking strategies that promote improvements in fitness and assist quitting smoking has potential to address both these risk factors simultaneously. The objective of this study is to compare the effects of two exercise interventions (high intensity interval training (HIIT) and lifestyle physical activity) on smoking cessation in female smokers. Method/design This study will use a randomised controlled trial design. Participants: Women aged 18–55 years who smoke ≥ 5 cigarettes/day, and want to quit smoking. Intervention: all participants will receive usual care for quitting smoking. Group 1 - will complete two gym-based supervised HIIT sessions/week and one home-based HIIT session/week. At each training session participants will be asked to complete four 4-min (4 × 4 min) intervals at approximately 90 % of maximum heart rate interspersed with 3- min recovery periods. Group 2 - participants will receive a resource pack and pedometer, and will be asked to use the 10,000 steps log book to record steps and other physical activities. The aim will be to increase daily steps to 10,000 steps/day. Analysis will be intention to treat and measures will include smoking cessation, withdrawal and cravings, fitness, physical activity, and well-being. Discussion The study builds on previous research suggesting that exercise intensity may influence the efficacy of exercise as a smoking cessation intervention. The hypothesis is that HIIT will improve fitness and assist women to quit smoking. Australian New Zealand Clinical Trials Registry ACTRN12614001255673 (Registration date 02/12/2014)
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Affiliation(s)
- Toby G Pavey
- Centre for Research on Exercise, Physical Activity and Health (CRExPAH), School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia Campus, Brisbane, QLD, 4072, Australia.
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston Campus, Brisbane, 4006, Australia.
| | - Jeff S Coombes
- Centre for Research on Exercise, Physical Activity and Health (CRExPAH), School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia Campus, Brisbane, QLD, 4072, Australia.
| | - Wendy J Brown
- Centre for Research on Exercise, Physical Activity and Health (CRExPAH), School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia Campus, Brisbane, QLD, 4072, Australia.
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Utilisation of Nicotine Replacement Therapy within a Hospital Pharmacist Initiated Smoking-Cessation Intervention – A Pragmatic Randomised Controlled Trial. J Smok Cessat 2015. [DOI: 10.1017/jsc.2015.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction:Hospital pharmacists currently play a limited role in the management of nicotine withdrawal and smoking-cessation. They have multiple tasks and limited time; a strong evidence base is required to determine importance of including smoking-cessation interventions into their routine practice.Aims:The aims of this study were to evaluate the effectiveness of a hospital pharmacist initiated smoking-cessation intervention (SCI) in increasing the utilisation of Nicotine Replacement Therapy (NRT) in hospitalised smokers, and in increasing quit rates post-discharge.Methods:This study was conducted in a tertiary referral hospital using a pragmatic randomised control design. After screening, 100 inpatient smokers were enrolled and randomised by the research pharmacist (RP) to either the intervention or usual care arm (n= 50 for both arms). Smoking-cessation advice was available to all smokers during their hospital stay under the smoking management policy, which represented usual care. However, this approach is often unstructured and provided on an ad-hoc basis. Those in the intervention arm received brief SCI from the RP, who also facilitated NRT prescribing if required. Prescribing rates of NRT in the hospital and on discharge in both the groups were compared. Participants were contacted by phone three-months after enrolment to assess their seven-day point prevalence of abstinence (PPA) from smoking and use of NRT post-discharge.Results:A significantly higher proportion of participants in the intervention arm used NRT in the hospital (82% vs. 24%,Χ2= 33.8,p< 0.001) and at discharge (68% vs. 12%,Χ2= 32.7,p< 0.0001) and significantly more participants who received SCI from the RP continued to use NRT after discharge (OR 3.1, CI 1.2 to 8.2). A similar number of participants in both the groups claimed seven-day PPA after three-months (18% usual-care vs. 15% intervention-arm, OR 0.8, CI 0.24 to 2.67).Conclusions:Hospital pharmacist led brief SCI can enhance the utilisation of NRT in hospital and after discharge; there was no clear effect on cessation rates at three months. There is a need to explore feasible options for a coordinated, multidisciplinary approach to smoking-cessation in hospital and across the continuum, which may have a greater impact on long term smoking-cessation rates.
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West R, Raw M, McNeill A, Stead L, Aveyard P, Bitton J, Stapleton J, McRobbie H, Pokhrel S, Lester‐George A, Borland R. Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction 2015; 110:1388-403. [PMID: 26031929 PMCID: PMC4737108 DOI: 10.1111/add.12998] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/10/2015] [Accepted: 05/22/2015] [Indexed: 12/11/2022]
Abstract
AIMS This paper provides a concise review of the efficacy, effectiveness and affordability of health-care interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support. METHODS Cochrane reviews of randomized controlled trials (RCTs) of major health-care tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6-12-month continuous abstinence rates. This was combined with analysis and evidence from 'real world' studies to form a judgement on the probable effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on World Health Organization (WHO) criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of saving a life-year was less than or equal to the per-capita gross domestic product for that category of country. RESULTS Brief advice from a health-care worker given opportunistically to smokers attending health-care services can promote smoking cessation, and is affordable for countries in all World Bank income categories (i.e. globally). Proactive telephone support, automated text messaging programmes and printed self-help materials can assist smokers wanting help with a quit attempt and are affordable globally. Multi-session, face-to-face behavioural support can increase quit success for cigarettes and smokeless tobacco and is affordable in middle- and high-income countries. Nicotine replacement therapy, bupropion, nortriptyline, varenicline and cytisine can all aid quitting smoking when given with at least some behavioural support; of these, cytisine and nortriptyline are affordable globally. CONCLUSIONS Brief advice from a health-care worker, telephone helplines, automated text messaging, printed self-help materials, cytisine and nortriptyline are globally affordable health-care interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face-to-face behavioural support and varenicline can promote cessation.
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Affiliation(s)
- Robert West
- Cancer Research UK Health Behaviour Research CentreUniversity College LondonLondonUK
| | - Martin Raw
- Special Lecturer, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Ann McNeill
- Professor of Tobacco Addiction, King's College London, UK Centre for Tobacco and Alcohol StudiesNational Addiction CentreLondonUK
| | - Lindsay Stead
- Cochrane Tobacco Addiction Group, Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Paul Aveyard
- Professor of Behavioural Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory QuarterUniversity of OxfordOxfordUK
| | - John Bitton
- Professor of Epidemiology, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - John Stapleton
- Reader in Addiction Statistical Analysis, Addictions Department, Institute of PsychiatryKings College LondonLondonUK
| | - Hayden McRobbie
- Reader in Public Health Interventions, Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | | | - Ron Borland
- Cancer Council Victoria, Melbourne, VictoriaAustralia
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Tomaz PRX, Santos JR, Issa JS, Abe TO, Gaya PV, Krieger JE, Pereira AC, Santos PCJL. CYP2B6 rs2279343 polymorphism is associated with smoking cessation success in bupropion therapy. Eur J Clin Pharmacol 2015; 71:1067-73. [PMID: 26153084 DOI: 10.1007/s00228-015-1896-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/26/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggested that polymorphisms in the CYP2B6 gene (which encodes an isoenzyme that metabolizes bupropion) and in the ANKK1 gene (which is located in the ANKK1/DRD2 gene cluster) might influence response to therapy. Thus, the aim of the present study was to evaluate whether the CYP2B6 and ANKK1 polymorphisms are associated with the response to smoking cessation therapies in patients from a smoking cessation assistance program. METHODS The cohort study enrolled 478 smokers who received behavioral counseling and drug therapy (bupropion, nicotine replacement therapy, and/or varenicline). Smoking cessation success was considered for patients who completed 6 months of continuous abstinence. Fagerström test for nicotine dependence (FTND) and Issa situational smoking scores were analyzed for nicotine dependence (ND). The ANKK1 rs1800497, CYP2B6*4 (rs2279343), CYP2B6*5 (rs3211371), and CYP2B6*9 (rs3745274) polymorphisms were genotyped by high resolution melting analysis or by restriction fragment length polymorphism. RESULTS Patients with CYP2B6 rs2279343 wild-type AA genotype had higher success rate (48.0 %) compared with patients carrying AG or GG genotypes (CYP2B6*4 variant) (35.5 %) on bupropion therapy. The AA genotype was associated with higher OR for success during bupropion therapy (OR = 1.92, 95 % CI = 1.08-3.42, p = 0.03) in a multivariate model. We did not observe significant differences in the FTND and Issa scores according to the studied polymorphisms. CONCLUSION We showed that patients with CYP2B6*4 (rs2279343) variant had lower success rate with bupropion. Likely, the CYP2B6*4 variant, which leads to a rapid predicted metabolic phenotype for the isoenzyme, influences the pharmacological activity of bupropion. Our finding suggests that CYP2B6*4 may be an important genetic marker for individualized bupropion pharmacotherapy.
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Affiliation(s)
- Paulo Roberto Xavier Tomaz
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Thomas DP, Briggs VL, Couzos S, Panaretto KS, Sterren AE, Stevens M, Borland R. Use of nicotine replacement therapy and stop‐smoking medicines in a national sample of Aboriginal and Torres Strait Islander smokers and ex‐smokers. Med J Aust 2015; 202:S78-84. [DOI: 10.5694/mja15.00205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/11/2015] [Indexed: 11/17/2022]
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Paynter J, Glover M, Bullen C, Sonia D. An intervention to reduce the number of convenience stores selling tobacco: feasibility study. Tob Control 2015; 25:319-24. [DOI: 10.1136/tobaccocontrol-2014-052045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 03/23/2015] [Indexed: 11/04/2022]
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Effect of nicotine replacement therapy on quitting by young adults in a trial comparing cessation services. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 20:E7-E15. [PMID: 24458316 DOI: 10.1097/phh.0b013e3182a0b8c7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Young adult smokers have the highest smoking prevalence among all US age groups but are least likely to use evidence-based cessation counseling or medication to quit. OBJECTIVE Use and effectiveness of nicotine patch were explored in a randomized trial evaluating smoking cessation interventions with this population. PARTICIPANTS Smokers aged 18 to 30 (n = 3094) were recruited through online and off-line methods and from telephone quit lines and analyzed. DESIGN Smokers were enrolled in a pretest-posttest trial, and randomized to 1 of 3 cessation services. SETTING Trial delivering counseling services by self-help booklet, telephone quit lines, or online expert system in the 48 continental United States. INTERVENTION Smokers could request a free 2-week course of nicotine replacement therapy (NRT) patches from the project. MAIN OUTCOME MEASURE Follow-up surveys at 12 and 26 weeks assessed smoking abstinence, use of NRT, counseling, and other cessation medications, and smoking-related variables. RESULTS Overall, 69.0% of smokers reported using NRT (M = 3.2 weeks) at 12 weeks and 74.8% (M = 3.3 weeks) at 26 weeks. More smokers who were sent the free nicotine patches (n = 1695; 54.8%) reported using NRT than those who did not receive them (12 weeks: 84.3% vs 41.9%, P < .001; 26 weeks: 87.6% vs 51.1%, P < .001). The use of NRT was associated with greater smoking abstinence at 12 weeks (P < .001) and 26 weeks (P < .05), especially if used for more than 2 weeks (P < .001). Smokers assigned to a self-help booklet or cessation Web site and heavier smokers were most likely to use NRT (P < .05), whereas those reporting marijuana use and binge drinking used NRT less (P < .05). CONCLUSIONS Many young adults were willing to try NRT, and it appeared to help them quit in the context of community-based cessation services. Strategies should be developed to make NRT available to this age group and support them in using it to prevent lifelong smoking.
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Zhang B, Cohen JE, Bondy SJ, Selby P. Duration of nicotine replacement therapy use and smoking cessation: a population-based longitudinal study. Am J Epidemiol 2015; 181:513-20. [PMID: 25740789 PMCID: PMC4371764 DOI: 10.1093/aje/kwu292] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the present study, we examined the association between duration of nicotine replacement therapy (NRT) use and smoking cessation using data from the Ontario Tobacco Survey longitudinal study (3 waves of data collected between July 2005 and December 2009). We used logistic regression with generalized estimating equations to examine the association between NRT use (any use and <4 weeks, 4.0–7.9 weeks, 8.0–11.9 weeks, and ≥12 weeks of use compared with nonuse) and quitting smoking (≥1 month). Using NRT was not associated with quitting when use duration was not taken into account (adjusted odds ratio (OR) = 1.08, 95% confidence interval (CI): 0.86, 1.35). Compared with abstaining from NRT when attempting to quit smoking, using NRT for less than 4 weeks was associated with a lower likelihood of quitting (adjusted OR = 0.51, 95% CI: 0.38, 0.67); however, using NRT for 4 weeks or longer was associated with a higher likelihood of cessation (for 4.0–7.9 weeks of NRT use, adjusted OR = 2.26, 95% CI: 1.58, 3.22; for 8.0–11.9 weeks of NRT use, adjusted OR = 3.84, 95% CI: 2.24, 6.58; and for ≥12 weeks of NRT use, adjusted OR = 2.80, 95% CI: 1.70, 4.61). Thus, use of NRT for less than 4 weeks was associated with reduced likelihood of cessation, whereas NRT use for longer periods of time was associated with a higher likelihood of cessation.
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Affiliation(s)
- Bo Zhang
- Correspondence to Dr. Bo Zhang, Room: T521, Ontario Tobacco Research Unit (OTRU), 33 Russell Street, Toronto, Ontario, Canada M5S 2S1 (e-mail: )
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Smith PH, Kasza KA, Hyland A, Fong GT, Borland R, Brady K, Carpenter MJ, Hartwell K, Cummings KM, McKee SA. Gender differences in medication use and cigarette smoking cessation: results from the International Tobacco Control Four Country Survey. Nicotine Tob Res 2015; 17:463-72. [PMID: 25762757 PMCID: PMC4402353 DOI: 10.1093/ntr/ntu212] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/26/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION There is conflicting evidence for gender differences in smoking cessation, and there has been little research on gender differences in smoking cessation medication (SCM) use and effectiveness. Using longitudinal data from the International Tobacco Control Four Country Surveys (ITC-4) conducted in the United Kingdom, the United States, Canada, and Australia, we examined gender differences in the incidence of quit attempts, reasons for quitting, use of SCMs, reasons for discontinuing use of SCMs, and rates of smoking cessation. METHODS Data were analyzed from adult smokers participating in the ITC-4, annual waves 2006-2011 (n = 7,825), as well as a subsample of smokers (n = 1,079) who made quit attempts within 2 months of survey. Adjusted modeling utilized generalized estimating equations. RESULTS There were no gender differences in the likelihood of desire to quit, plans to quit, or quit attempts between survey waves. Among quit attempters, women had 31% lower odds of successfully quitting (OR = 0.69; 95% CI = 0.51, 0.94). Stratified by medication use, quit success was lower among women who did not use any SCMs (OR = 0.59; 95% CI = 0.39, 0.90), and it was no different from men when medications were used (OR = 0.73; 95% CI = 0.46, 1.16). In particular, self-selected use of nicotine patch and varenicline contributed to successful quitting among women. CONCLUSIONS Women may have more difficulty quitting than men, and SCMs use may help attenuate this difference.
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Affiliation(s)
- Philip H Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Karin A Kasza
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ron Borland
- VicHealth Center for Tobacco Control, Cancer Council Victoria, Victoria, Australia
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC
| | - Karen Hartwell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC
| | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT;
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Schnoll RA, Goelz PM, Veluz-Wilkins A, Blazekovic S, Powers L, Leone FT, Gariti P, Wileyto EP, Hitsman B. Long-term nicotine replacement therapy: a randomized clinical trial. JAMA Intern Med 2015; 175:504-11. [PMID: 25705872 PMCID: PMC4410859 DOI: 10.1001/jamainternmed.2014.8313] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The US Food and Drug Administration adopted labeling for nicotine patches to allow use beyond the standard 8 weeks. This decision was based in part on data showing increased efficacy for 24 weeks of treatment. Few studies have examined whether the use of nicotine patches beyond 24 weeks provides additional therapeutic benefit. OBJECTIVE To compare 8 (standard), 24 (extended), and 52 (maintenance) weeks of nicotine patch treatment for promoting tobacco abstinence. DESIGN, SETTING, AND PARTICIPANTS We recruited 525 treatment-seeking smokers for a randomized clinical trial conducted from June 22, 2009, through April 15, 2014, through 2 universities. INTERVENTIONS Smokers received 12 smoking cessation behavioral counseling sessions and were randomized to 8, 24, or 52 weeks of nicotine patch treatment. MAIN OUTCOMES AND MEASURES The primary outcome was 7-day point prevalence abstinence, confirmed with breath levels of carbon monoxide at 6 and 12 months (intention to treat). RESULTS At 24 weeks, 21.7% of participants in the standard treatment arm were abstinent, compared with 27.2% of participants in the extended and maintenance treatment arms (χ(2)(1) = 1.98; P = .17). In a multivariate model controlled for covariates, participants in the extended and maintenance treatment arms reported significantly greater abstinence rates at 24 weeks compared with participants in the standard treatment arm (odds ratio [OR], 1.70 [95% CI, 1.03-2.81]; P = .04), had a longer duration of abstinence until relapse (β = 21.30 [95% CI, 10.30-32.25]; P < .001), reported smoking fewer cigarettes per day if not abstinent (mean [SD], 5.8 [5.3] vs 6.4 [5.1] cigarettes per day; β = 0.43 [95% CI, 0.06-0.82]; P = .02), and reported more abstinent days (mean [SD], 80.5 [38.1] vs 68.2 [43.7] days; OR, 1.55 [95% CI, 1.06-2.26]; P = .02). At 52 weeks, participants in the maintenance treatment arm did not report significantly greater abstinence rates compared with participants in the standard and extended treatment arms (20.3% vs 23.8%; OR, 1.17 [95% CI, 0.69-1.98]; P = .57). Similarly, we found no difference in week 52 abstinence rates between participants in the extended and standard treatment arms (26.0% vs 21.7%; OR, 1.33 [95% CI, 0.72-2.45]; P = .36). Treatment duration was not associated with any adverse effects or adherence to the counseling regimen, but participants in the maintenance treatment arm reported lower adherence to the nicotine patch regimen compared with those in the standard and extended treatment arms (mean [SD], 3.94 [2.5], 4.61 [2.0], and 4.7 [2.4] patches/wk, respectively; F2,522 = 6.03; P = .003). CONCLUSIONS AND RELEVANCE The findings support the safety of long-term use of nicotine patch treatment, although they do not support efficacy beyond 24 weeks of treatment in a broad group of smokers. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01047527.
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Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Patricia M Goelz
- National Comprehensive Cancer Network, Ft Washington, Pennsylvania
| | - Anna Veluz-Wilkins
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sonja Blazekovic
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Lindsay Powers
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia
| | - Peter Gariti
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - E Paul Wileyto
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Khanom A, Hill RA, Morgan K, Rapport FL, Lyons RA, Brophy S. Parental recommendations for population level interventions to support infant and family dietary choices: a qualitative study from the Growing Up in Wales, Environments for Healthy Living (EHL) study. BMC Public Health 2015; 15:234. [PMID: 25881187 PMCID: PMC4364488 DOI: 10.1186/s12889-015-1561-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/17/2015] [Indexed: 11/29/2022] Open
Abstract
Background Childhood obesity presents a challenge to public health. This qualitative study explored the main barriers to dietary choices faced by parents with infants, and the types of interventions and policy level recommendations they would like to see put in place, to promote a healthier food environment. Methods 61 semi-structured interviews with prospective parents and parents of infants (61 mothers and 35 fathers) were conducted. Families were selected according to community deprivation levels using the Townsend Deprivation Index to ensure a representative sample from deprived and affluent neighbourhoods. Inductive thematic analysis was used to analyse the data. Results Parents identified triggers which led to unhealthy dietary choices such as reliance on fast food outlets due to; shift work, lack of access to personal transport, inability to cook, their own childhood dietary experiences, peer pressure and familial relationships. Parents who made healthy dietary choices reported learning cooking skills while at university, attending community cooking classes, having access to quality food provided by church and community organisations or access to Healthy Start vouchers. They called for a reduction in supermarket promotion of unhealthy food and improved access to affordable and high-quality fresh produce in the local area and in supermarkets. There was a strong message to policy makers to work with commercial companies (food manufactures) as they have resources to lower costs and target messages at a diverse population. Provision of targeted advice to fathers, minority ethnic parents, and tailored and practical advice and information on how to purchase, prepare, store and cook food was requested, along with community cookery classes and improved school cookery lessons. Conclusions There is a need for parent directed community/population level interventions that aims to reduce socio-ecological barriers to making healthy dietary choices. Parents desired improvements in meals provided in workplaces, schools and hospitals, as well as increased access to healthy foods by increasing local healthy food outlets and reducing unhealthy, fast food outlets. Knowledge and skills could then be enhanced in line with these improvements, with confidence gained around cooking and storing food appropriately.
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Affiliation(s)
- Ashrafunnesa Khanom
- College of Medicine, Swansea University, Swansea, SA2 8PP, Wales, United Kingdom.
| | - Rebecca A Hill
- College of Medicine, Swansea University, Swansea, SA2 8PP, Wales, United Kingdom.
| | - Kelly Morgan
- College of Medicine, Swansea University, Swansea, SA2 8PP, Wales, United Kingdom.
| | - Frances L Rapport
- College of Medicine, Swansea University, Swansea, SA2 8PP, Wales, United Kingdom.
| | - Ronan A Lyons
- College of Medicine, Swansea University, Swansea, SA2 8PP, Wales, United Kingdom.
| | - Sinead Brophy
- College of Medicine, Swansea University, Swansea, SA2 8PP, Wales, United Kingdom.
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Kasza KA, Cummings KM, Carpenter MJ, Cornelius ME, Hyland AJ, Fong GT. Use of stop-smoking medications in the United States before and after the introduction of varenicline. Addiction 2015; 110:346-55. [PMID: 25331778 PMCID: PMC4469178 DOI: 10.1111/add.12778] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/18/2014] [Accepted: 10/14/2014] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate trends in use of stop-smoking medications (SSMs) before and after varenicline (Chantix™) was introduced to the market-place in the United States, and to determine whether varenicline reached segments of the population unlikely to use other SSMs. DESIGN Cohort survey. SETTING United States. PARTICIPANTS A nationally representative sample of adult smokers in the United States interviewed as part of the International Tobacco Control Four Country Survey between 2004 and 2011. Primary analyses used cross-sectional data from 1737 smokers who attempted to quit (∼450 per wave). MEASUREMENTS Reporting an attempt to quit smoking; use of each of the following types of SSMs for the purpose of quitting smoking: nicotine gum, nicotine patch, other nicotine replacement therapy, bupropion and varenicline. FINDINGS There was a significant increase in the rate of use of any SSM among quit attempters across the study period [odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.10-1.21 per year]. This increase was largest after varenicline was introduced (OR = 1.16, 95% CI = 1.07-1.26 per year); however, there was a decline in nicotine patch use during this time (OR = 0.87, 95% CI = 0.76-0.99 per year). Varenicline users were generally similar to users of other SSMs but differed from those who did not use any SSMs, in that they tended to be older (OR = 5.46, P = 0.024), to be white (OR = 2.33, P = 0.002), to have high incomes (OR = 1.85, P = 0.005), to have high nicotine dependence prior to quitting (OR = 2.40, P = 0.001) and to have used medication in the past (OR = 3.29, P < 0.001). CONCLUSIONS The introduction of varenicline in the United States coincided with a net increase in attempts to quit smoking and, among these, a net increase in use of stop-smoking medications. The demographic profile of varenicline users is similar to the profile of those who use other stop-smoking medications and different from the profile of those who attempt to quit without any medication.
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Affiliation(s)
- Karin A Kasza
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
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Poulsen PB, Spillemose H, Nielsen G, Hergel LL, Wedell-Wedellsborg D, Strand M, Ringbæk T. Real-life effectiveness of smoking-cessation treatments in general practice clinics in Denmark. The Escape Smoke project. Respir Med 2015; 109:218-27. [DOI: 10.1016/j.rmed.2014.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 11/26/2022]
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Siahpush M, Shaikh RA, McCarthy M, Sikora Kessler A, Tibbits M, Singh GK. Association between duration of use of pharmacotherapy and smoking cessation: findings from a national survey. BMJ Open 2015; 5:e006229. [PMID: 25586367 PMCID: PMC4298107 DOI: 10.1136/bmjopen-2014-006229] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the association of the duration of use of prescription medications and nicotine replacement therapy (NRT) with smoking cessation using a national sample of the general population in the USA, controlling for nicotine dependence and sociodemographic variables. SETTING USA PARTICIPANTS We used data from the 2010-2011 Tobacco Use Supplement to the US Current Population Survey. We limited the analysis to current daily smokers who made a quit attempt in the past year and former smokers who were a daily smoker 1 year prior to the survey (n=8263). Respondents were asked about duration of use of prescription medication (varenicline, bupropion, other) and NRT (nicotine patch, gum/lozenges, nasal spray and inhaler) for smoking cessation. PRIMARY OUTCOME MEASURE Successful smoking cessation. Individuals who reported to have smoked at least 100 cigarettes in their lifetime but were not smoking at all at the time of the interview and were a daily smoker 1 year prior to the interview were considered to have successfully quit smoking. RESULTS After adjusting for daily cigarette consumption and sociodemographic covariates, we found evidence for an association between duration of pharmacotherapy use and smoking cessation (p<0.001). Adjusted cessation rates for those who used prescription medication or NRT for 5+ weeks were 28.8% and 27.8%, respectively. Adjusted cessation rates for those who used prescription medication or NRT for less than 5 weeks varied from 6.2% to 14.5%. Adjusted cessation rates for those who used only behavioural counselling and those who attempted to quit smoking unassisted were 16.1% and 16.4%, respectively. CONCLUSIONS Use of pharmacotherapy for at least 5 weeks is associated with increased likelihood of successful smoking cessation. Results suggest that encouraging smokers who intend to quit to use pharmacotherapy and to adhere to treatment duration can help improve chances of successful cessation.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Raees A Shaikh
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Molly McCarthy
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Asia Sikora Kessler
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Tibbits
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gopal K Singh
- US Department of Health & Human Services, Rockville, Maryland, USA
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Increasing the Quality and Availability of Evidence-based Treatment for Tobacco Dependence through Unified Certification of Tobacco Treatment Specialists. J Smok Cessat 2014. [DOI: 10.1017/jsc.2014.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Each year, tobacco use causes over 6 million deaths and is responsible for hundreds of billions of dollars in health care and economic costs in the world (WHO, 2011). If current trends continue, tobacco is expected to kill over 1 billion people in the 21st century, making it one of the single greatest causes of preventable death and disease in history (WHO, 2011). Long-term abstinence from tobacco use dramatically improves individuals’ health, reduces the incidence of tobacco-related disease, and is clearly responsible for saving lives (Anthonisen et al., 2005). Most tobacco users express a desire to achieve long-term abstinence from tobacco use and make numerous unsuccessful quit attempts over the course of many years (Borland, Partos, Yong, Cummings, & Hyland, 2012; CDC, 2011). Evidence-based treatments for tobacco use and dependence greatly improve the chances that quit attempts result in long-term abstinence (Chambless & Hollon, 1998; Chambless et al., 1998; Compas, Haaga, Keefe, Leitenberg, & Williams, 1998; Fiore et al., 2008; Zwar et al., 2004). Increasing the availability of high-quality evidence-based treatment for tobacco use and dependence will make it more likely that tobacco users use evidence-based treatments and that quit attempts translate into long-term abstinence. The professionalisation of treatment for tobacco dependence by the development of a rigorous, unified Tobacco Treatment Specialist (TTS) certification process will increase the availability of high-quality evidence-based treatment for tobacco use and dependence for all tobacco users.
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