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Ibrahim AK, Syed Sulaiman SA, Awaisu A, Shafie AA. Impact of brief smoking cessation intervention on quitting rate and glycemic control in patients with diabetes: a randomized controlled trial. J Int Med Res 2023; 51:3000605231208598. [PMID: 37890143 PMCID: PMC10612461 DOI: 10.1177/03000605231208598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the impact of a brief smoking cessation intervention among patients with diabetes. METHODS This randomized interventional clinical trial involved patients with diabetes who smoked tobacco and attended the outpatient diabetes clinic at Penang Hospital, Malaysia. Participants were randomized into a control group that usual care for patients with diabetes, or an intervention group that received a 5-minute physician-delivered brief counseling session on tobacco cessation using the 5A's strategy, in addition to usual care. Primary outcome measures were assessed over three visits (every 3-4 months) including mean glycated hemoglobin level, quitting rate, blood pressure, and mean number of cigarettes smoked per day. RESULTS In total, 126 participants were finally enrolled in the study, with 63 patients each in the intervention and control groups. There was no significant difference between the two groups with respect to glycemic control, blood pressure, and quitting rate. However, patients in both groups reduced their cigarette consumption. CONCLUSIONS The present brief smoking cessation intervention did not result in better glycemic control, blood pressure, or quitting rates among patients with diabetes. This patient group may require more intensive guidance for better outcomes.Trial registration: This study is registered in ClinicalTrials.gov (NCT04864327); https://clinicaltrials.gov/ct2/results?pg=1&load=cart&id=NCT04864327.
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Affiliation(s)
| | | | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Asrul Akmal Shafie
- School of Pharmaceutical Science, Universiti Sains Malaysia, Penang, Malaysia
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Lin H, Liu Y, Zhang H, Zhu Z, Zhang X, Chang C. Assessment of a Text Message-Based Smoking Cessation Intervention for Adult Smokers in China: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e230301. [PMID: 36857056 PMCID: PMC9978944 DOI: 10.1001/jamanetworkopen.2023.0301] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
IMPORTANCE Successful smoking cessation strategies are an important part of reducing tobacco use. However, providing universal smoking cessation support can be a challenge for most countries because it requires sufficient resources. One way to expand access is to use mobile technologies to provide cessation support. OBJECTIVE To assess the efficacy of a behavior change theory-based smoking cessation intervention using personalized text messages. DESIGN, SETTING, AND PARTICIPANTS This study was a 2-arm double-blind randomized clinical trial conducted in 5 cities in China. Daily or weekly smokers 18 years or older were eligible for inclusion if they owned a mobile phone and used the WeChat social media app. A total of 722 participants were randomized to the intervention or control group between April 1 and July 27, 2021. INTERVENTIONS Intervention group participants received a personalized text message-based smoking cessation intervention that was based on the transtheoretical model and protection motivation theory and developed by this study's investigators. Control group participants received a nonpersonalized text message-based smoking cessation intervention developed by the US National Cancer Institute. Both groups received 1 to 2 text messages per day for 3 months through the app. MAIN OUTCOMES AND MEASURES The primary outcome was the biochemically verified 6-month sustained abstinence rate, defined as the self-report of no smoking of any cigarettes after the designated quit date, which was validated biochemically by an expired air carbon monoxide level of less than 6 ppm at each follow-up point. RESULTS A total of 722 participants (mean [SD] age, 41.5 [12.7] years; 716 men [99.2%]; all of Chinese ethnicity) were randomly assigned to the intervention group (360 participants) or the control group (362 participants). Biochemically verified continuous abstinence at 6 months was 6.9% in the intervention group and 3.0% in the control group (odds ratio [OR], 2.66; 95% CI, 1.21-5.83). Among smokers with low nicotine dependence, the intervention group had significantly better abstinence rates for most of the indicators after adjusting for covariates (eg, biochemically verified 24-hour point prevalence of abstinence at 1 month: adjusted OR, 2.15; 95% CI, 1.05-4.38). Among smokers with moderate and high nicotine dependence, only the biochemically verified 24-hour point prevalence of abstinence at 6 months was statistically significant (adjusted OR, 4.17; 95% CI, 1.34-3.00). The pattern was similar for quitting intention, and the personalized text message-based intervention was more effective for smokers who had strong quitting intention than for those who had weak quitting intention. CONCLUSIONS AND RELEVANCE In this study, the behavior change theory-based smoking cessation intervention using personalized text messages was more effective than an intervention using nonpersonalized text messages. The intervention was most effective among smokers with low nicotine dependence and strong quitting intention. This study's findings also provide further evidence regarding the potential benefits of mobile health interventions for other behaviors. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR2100041942.
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Affiliation(s)
- Haoxiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yihua Liu
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengjie Zhu
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Xiaoyue Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
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Lin H, Wang Y, Xing Y, Han Y, Zhang C, Luo T, Chang C. Why was a personalized mobile cessation intervention more likely to promote smokers from the preparation stage to the action stage than a nonpersonalized intervention? A double-blind, randomized control trial (Preprint). J Med Internet Res 2022; 25:e41911. [PMID: 37099360 PMCID: PMC10173036 DOI: 10.2196/41911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Most mobile cessation studies have found that such interventions have a higher quitting rate than interventions providing minimal smoking cessation support. However, why such interventions are effective has been almost unstudied by researchers. OBJECTIVE This paper describes the principles of the personalized mobile cessation intervention-based WeChat app and used generalized estimated equations to assess why a personalized mobile cessation intervention was more likely to promote smokers from the preparation stage to the action stage than a nonpersonalized intervention. METHODS This is a 2-arm, double-blind, randomized controlled trial in five cities in China. The intervention group received a personalized mobile cessation intervention. The control group received a nonpersonalized SMS text message smoking cessation intervention. All information was sent by the WeChat app. The outcomes were the change in protection motivation theory construct scores and the change in transtheoretical model stages. RESULTS A total of 722 participants were randomly assigned to the intervention or control group. Compared with those who received the nonpersonalized SMS text message intervention, smokers who received the personalized intervention presented lower intrinsic rewards, extrinsic rewards, and response costs. Intrinsic rewards were determinants of stage change, thus explaining why the intervention group was more likely to promote smokers from the preparation stage to the action stage (odds ratio 2.65, 95% CI 1.41-4.98). CONCLUSIONS This study identified the psychological determinants at different stages to facilitate smokers moving forward to the next stage of quitting behavior and provides a framework to explore why a smoking cessation intervention is effective. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100041942; https://tinyurl.com/2hhx4m7f.
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Affiliation(s)
- Haoxiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Ying Wang
- Linzi Disease Control and Prevention Center, Zibo, China
| | - Yanling Xing
- Linzi Disease Control and Prevention Center, Zibo, China
| | - Yinglian Han
- Linzi Disease Control and Prevention Center, Zibo, China
| | | | - Ting Luo
- Linzi Disease Control and Prevention Center, Zibo, China
| | - Chun Chang
- School of Public Health, Peking University, Beijing, China
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Lin H, Chen M, Yun Q, Zhang L, Chang C. Protection motivation theory and smoking quitting intention: findings based on structural equation modelling and mediation analysis. BMC Public Health 2022; 22:838. [PMID: 35473619 PMCID: PMC9044871 DOI: 10.1186/s12889-022-13263-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Although many smoking cessation strategies have been implemented, only a few strategies at the population level are grounded in theory. Even in those interventions based on specific theories, most studies have focused only on the outcome. The main objective of this study was to demonstrate the utility of protection motivation theory (PMT) in explaining smoking quitting behaviour among adults, with the goal of providing valuable evidence for further intervention strategies. METHOD This was a cross-sectional study. Participants were randomly selected on the street from 26 provinces in mainland China. Data were collected via face-to-face interviews. Cronbach's alpha coefficient and the interclass correlation coefficient (ICC) were used to assess the reliability of the individual PMT constructs. We applied structural equation modelling (SEM) to test how well the PMT constructs predicted intention. A bootstrap test was performed to test the potential mediators. RESULTS The Cronbach's alpha coefficients of all the subscales ranged from 0.71 to 0.74. Greater intentions were significantly associated with higher threat appraisal (Coef. = 0.18, P < 0.01) and coping appraisal (Coef. = 0.24, P < 0.01). Threat appraisal was significantly associated with higher perceived severity and vulnerability but inversely associated with extrinsic rewards and intrinsic rewards. Coping appraisal was significantly associated with higher self-efficacy and response efficacy but inversely associated with response cost. The R2 of quitting intention was 0.12, which means that 12% of quitting intention was predicted by PMT constructs. For threat appraisal, approximately 19.8% of the effects on lower threat appraisal were mediated by higher extrinsic rewards. For coping appraisal, approximately 42.8% of the effects on higher coping appraisal were mediated by higher response efficacy. CONCLUSION This study finds that PMT is a sound theoretical framework for predicting smoking quitting intention among adults. Coping appraisal has a stronger effect than threat appraisal for predicting quitting intention. Mediation analyses confirmed that extrinsic rewards and response efficacy mediated the relationship between PMT constructs and quitting intention. Our findings are essential for understanding quitting behaviour among adults and support more effective smoking cessation activities.
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Affiliation(s)
- Haoxiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Meijun Chen
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Qingping Yun
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Lanchao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China.
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Hasan SI, Kaai SC, Amer Nordin AS, Mohd Hairi F, Danaee M, Yee A, Ahmad Tajuddin NA, Kamaludin IS, Grey M, Yan M, Driezen P, Thompson ME, Quah ACK, Fong GT. Who Are More Likely to Have Quit Intentions among Malaysian Adult Smokers? Findings from the 2020 ITC Malaysia Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3035. [PMID: 35270727 PMCID: PMC8910535 DOI: 10.3390/ijerph19053035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
Increasing quitting among smokers is essential to reduce the population burden of smoking-related diseases. Smokers' intentions to quit smoking are among the strongest predictors of future quit attempts. It is therefore important to understand factors associated with intentions to quit, and this is particularly important in low- and middle-income countries, where there have been few studies on quit intentions. The present study was conducted to identify factors associated with quit intentions among smokers in Malaysia. Data came from the 2020 International Tobacco Control (ITC) Malaysia Survey, a self-administered online survey of 1047 adult (18+) Malaysian smokers. Smokers who reported that they planned to quit smoking in the next month, within the next six months, or sometime beyond six months were classified as having intentions to quit smoking. Factors associated with quit intentions were examined by using multivariable logistic regression. Most smokers (85.2%) intended to quit smoking. Smokers were more likely to have quit intentions if they were of Malay ethnicity vs. other ethnicities (adjusted odds ratio (AOR) = 1.82, 95% confidence interval (CI) = 1.03-3.20), of moderate (AOR = 2.11, 95% CI = 1.12-3.99) or high level of education vs. low level of education (AOR = 1.97, 95% CI = 1.04-3.75), if they had ever tried to quit smoking vs. no quit attempt (AOR = 8.81, 95% CI = 5.09-15.27), if they received advice to quit from a healthcare provider vs. not receiving any quit advice (AOR = 3.78, 95% CI = 1.62-8.83), and if they reported worrying about future health because of smoking (AOR = 3.11, 95% CI = 1.35-7.15 (a little worried/moderately worried vs. not worried); AOR = 7.35, 95% CI = 2.47-21.83 (very worried vs. not worried)). The factors associated with intentions to quit smoking among Malaysian smokers were consistent with those identified in other countries. A better understanding of the factors influencing intentions to quit can strengthen existing cessation programs and guide the development of more effective smoking-cessation programs in Malaysia.
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Affiliation(s)
- Siti Idayu Hasan
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia; (S.I.H.); (F.M.H.); (M.D.); (A.Y.); (N.A.A.T.); (I.S.K.)
| | - Susan C. Kaai
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (S.C.K.); (M.G.); (M.Y.); (P.D.); (A.C.K.Q.); (G.T.F.)
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia; (S.I.H.); (F.M.H.); (M.D.); (A.Y.); (N.A.A.T.); (I.S.K.)
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Farizah Mohd Hairi
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia; (S.I.H.); (F.M.H.); (M.D.); (A.Y.); (N.A.A.T.); (I.S.K.)
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Mahmoud Danaee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia; (S.I.H.); (F.M.H.); (M.D.); (A.Y.); (N.A.A.T.); (I.S.K.)
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Anne Yee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia; (S.I.H.); (F.M.H.); (M.D.); (A.Y.); (N.A.A.T.); (I.S.K.)
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Nur Amani Ahmad Tajuddin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia; (S.I.H.); (F.M.H.); (M.D.); (A.Y.); (N.A.A.T.); (I.S.K.)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Ina Sharyn Kamaludin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia; (S.I.H.); (F.M.H.); (M.D.); (A.Y.); (N.A.A.T.); (I.S.K.)
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Matt Grey
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (S.C.K.); (M.G.); (M.Y.); (P.D.); (A.C.K.Q.); (G.T.F.)
| | - Mi Yan
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (S.C.K.); (M.G.); (M.Y.); (P.D.); (A.C.K.Q.); (G.T.F.)
| | - Pete Driezen
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (S.C.K.); (M.G.); (M.Y.); (P.D.); (A.C.K.Q.); (G.T.F.)
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada
| | - Mary E. Thompson
- Department of Statistics and Actuarial Sciences, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada;
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (S.C.K.); (M.G.); (M.Y.); (P.D.); (A.C.K.Q.); (G.T.F.)
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (S.C.K.); (M.G.); (M.Y.); (P.D.); (A.C.K.Q.); (G.T.F.)
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada
- Ontario Institute for Cancer Research, 661 University Ave., Suite 510, Toronto, ON M5G 0A3, Canada
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Lin HX, Zhang Y, Chen MJ, Zheng YT, Yun QP, Zhang LC, Zhang WT, Zhu BC, Liu Z. The characteristics and patterns of e-cigarette use and its
association with cigarette cessation intention in a Chinese
smoking population: A mediation analysis. Tob Induc Dis 2022; 20:16. [PMID: 35221859 PMCID: PMC8832540 DOI: 10.18332/tid/144251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The use of e-cigarettes has become more common in China, but the research on e-cigarettes in China, while growing, is still limited. This study examined the characteristics and patterns of e-cigarette use, and analyzed the possible mediators between cigarette cessation intention and e-cigarette use in a Chinese smoking population. METHODS This was a cross-sectional study conducted in mainland China. By convenience sampling method, the participants were recruited from 85 major commercial streets of several large cities in China. The study interviewers completed face-to-face interviews and uploaded the completed questionnaires into the online survey platform. The participants were contacted for clarification if any problems were detected. Logistic regression yielded adjusted odds ratios (ORs) for ever use of e-cigarettes. We further conducted a mediation analysis to estimate the effect of possible mediators. RESULTS From July to August 2020, a total of 738 smokers were invited to participate in this study; 613 smokers were identified as eligible and 609 smokers were included in this analysis. Of them, 24 (3.94%) participants were currently using e-cigarettes, and 165 (27.09%) participants have ever used e-cigarettes. The participants with younger age were more likely to have ever used e-cigarettes, ranging from 37.5% in the 18–29 years age group to 6.5% in the 60–69 years age group. After controlling for demographic characteristics and nicotine dependence, the ever use of e-cigarettes was significantly associated with younger age, higher education level, higher monthly income, previous smoking cessation attempts and quitting intention. With the mediation analysis, the education level is confirmed as a mediating factor, and approximately 42.86% of the effects were mediated through the channel of higher socioeconomic status. CONCLUSIONS This is the first study to examine the possible mediators between cigarette cessation intention and e-cigarette use in a Chinese smoking population. The findings revealed that high socioeconomic status, particularly higher education level, was a major mediating factor.
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Affiliation(s)
- Hao-Xiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yan Zhang
- China Journal of Traditional Chinese Medicine and Pharmacy, Beijing, China
| | - Mei-Jun Chen
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yun-Ting Zheng
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Qing-Ping Yun
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Lan-Chao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Wan-Tong Zhang
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Chen Zhu
- Department of Pharmacology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhao Liu
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China
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Lin H, Chen M, Zheng Y, Yun Q, Chang C. The association of workplace health education with smoking-related behaviour and unequal gains by job position in China: ABWMC programme findings. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:56. [PMID: 34193205 PMCID: PMC8247140 DOI: 10.1186/s13011-021-00392-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
Background Although the Chinese government has introduced a series of regulations to promote tobacco-related health education in workplaces, their implementation has been far from satisfactory. The aim of the present study was to explore the association of company-level tobacco-related health education and employee smoking behaviour. Methods Data from the 2018 Asia Best Workplace Mainland China programme were used to address these aims. This was a cross-sectional study that included 14,195 employees from 79 companies in mainland China. Spearman correlation tests were used to examine unadjusted correlations between the study variables, and binary logistic regression was used for multivariable analysis. The dependent variables included smoking-related variables or health information-seeking behaviour. The explanatory variable was the company-level tobacco-related health education. Results Tobacco-related health education was associated with better smoking harm awareness (OR = 2.23; 95% CI = 1.94–2.56), lower second-hand smoke exposure (OR = 0.73; 95% CI = 0.66–0.81), better perception of the workplace environment (OR = 2.04; 95% CI = 1.84–2.26) and positive health information-seeking behaviour (OR = 2.07; 95% CI = 1.86–2.30). Job position interacted with health education, suggesting that the positive association of health education was lower for general employees than employees who held an administrative position. Conclusions Tobacco-related health education is not only associated with lower SHS exposure but also related to more positive environmental perceptions and health attitudes, and these effects are significant for higher-ranking employees. Policy makers should recognize and reduce these potential health disparities.
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Affiliation(s)
- Haoxiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Meijun Chen
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Yunting Zheng
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Qingping Yun
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China.
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Abo-Tabik M, Benn Y, Costen N. Are Machine Learning Methods the Future for Smoking Cessation Apps? SENSORS 2021; 21:s21134254. [PMID: 34206167 PMCID: PMC8271573 DOI: 10.3390/s21134254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
Smoking cessation apps provide efficient, low-cost and accessible support to smokers who are trying to quit smoking. This article focuses on how up-to-date machine learning algorithms, combined with the improvement of mobile phone technology, can enhance our understanding of smoking behaviour and support the development of advanced smoking cessation apps. In particular, we focus on the pros and cons of existing approaches that have been used in the design of smoking cessation apps to date, highlighting the need to improve the performance of these apps by minimizing reliance on self-reporting of environmental conditions (e.g., location), craving status and/or smoking events as a method of data collection. Lastly, we propose that making use of more advanced machine learning methods while enabling the processing of information about the user’s circumstances in real time is likely to result in dramatic improvement in our understanding of smoking behaviour, while also increasing the effectiveness and ease-of-use of smoking cessation apps, by enabling the provision of timely, targeted and personalised intervention.
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Affiliation(s)
- Maryam Abo-Tabik
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester M1 5GD, UK;
| | - Yael Benn
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6GX, UK
- Correspondence: (Y.B.); (N.C.)
| | - Nicholas Costen
- Department of Computing and Mathematics, Manchester Metropolitan University, Manchester M1 5GD, UK;
- Correspondence: (Y.B.); (N.C.)
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Lin H, Lin Y, Xiao L, Chen Y, Zeng X, Chang C. How do smoking status and smoking cessation efforts affect TB recurrence after successful completion of anti-TB treatment? A multicentre, prospective cohort study with a 7-year follow-up in China. Nicotine Tob Res 2021; 23:1995-2002. [PMID: 34059890 DOI: 10.1093/ntr/ntab117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/27/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Many important risk factors are associated with tuberculosis (TB) recurrence; among them, smoking is the most common and modifiable behavioural factor. We aimed to assess the association of smoking status and cessation support during anti-TB treatment with subsequent TB recurrence. METHOD A 7-year prospective cohort study was performed on 634 TB patients in China. The participants were grouped by smoking status at baseline. Cox proportional hazards models were applied to analyse the association between baseline characteristics and TB recurrence. The cumulative incidence of TB recurrence was estimated by Kaplan-Meier curves. RESULTS Multivariable analysis showed that patients who continued smoking during anti-TB treatment were at higher risk for TB recurrence (HR= 3.45; 95% CI: 1.54-7.73) than nonsmokers. Moreover, this risk remained significant even in those who stopped smoking during anti-TB treatment (HR = 2.75; 95% CI: 1.47-5.14) than nonsmokers. The association between smoking and TB recurrence was stronger for smear-positive TB patients than for smear-negative TB patients. Among all the subgroups, patients who continued smoking had a higher TB recurrence rate over the 7-year follow-up than those who successfully quit during their anti-TB treatment (log-rank statistic, P< 0.01). With the increase in the number of cigarettes smoked daily, the TB recurrence risk also increased accordingly (log-rank statistic, P= 0.02). CONCLUSION Our findings highlight the importance of incorporating effective smoking cessation intervention measures into TB services and call for continuous monitoring of TB recurrence. Among patients who continue smoking or have a history of smoking, special attention should be given to smear-positive patients and heavy smokers when monitoring recurrence.
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Affiliation(s)
- Haoxiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Lixin Xiao
- Xingguo County Tuberculosis Dispensary, Xingguo, China
| | - Yongming Chen
- Xingguo County Tuberculosis Dispensary, Xingguo, China
| | - Xianglin Zeng
- Ningdu County Tuberculosis Dispensary, Ningdu, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Centre, Beijing, China
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10
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Factors associated with the quitting intention among Chinese adults: Application of protection motivation theory. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01500-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractThe main objective of this study was to examine the use of protection motivation theory (PMT) in explaining smokers’ quitting intentions among Chinese adults with the goal of providing valuable evidence to promote theory-guided and culturally appropriate cessation interventions. This cross-sectional study included 613 participants randomly selected from 26 provinces in Mainland China. Cronbach’s alpha and interclass correlation coefficients (ICC) were used to assess the reliability of individual PMT constructs. A multiple linear regression was used for the multivariable analysis. Cronbach’s alpha coefficient of the 23 items was 0.74. Cronbach’s alpha coefficient of all the subscales varied from 0.71 to 0.74. Stronger quitting intentions were significantly associated with higher perceived vulnerability (Coef. = 0.13, P < 0.01), self-efficacy (Coef. = 0.28, P < 0.01), and response efficacy (Coef. = 0.23, P < 0.01) but inversely associated with intrinsic rewards (Coef. = −0.15, P < 0.01). Greater quitting intentions were significantly associated with higher threat (Coef. = 0.19, P < 0.01) and coping appraisals (Coef. = 0.25, P < 0.01). Regarding behaviour, longer quitting attempts were significantly associated only with self-efficacy (Coef. = 0.13, P < 0.01) and response cost (Coef. = −0.18, P < 0.01) Our results confirmed the applicability of PMT for predicting the quitting intention in Chinese adults. Self-efficacy is the only factor that has a predictive effect on both the intention and behaviour. To improve the effectiveness of smoking-cessation interventions, specific attention should be directed during their design to the more influential PMT constructs.
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Lin HX, Liu Z, Chang C. The Effects of Smoke-Free Workplace Policies on Individual Smoking Behaviors in China. Nicotine Tob Res 2020; 22:2158-2163. [PMID: 32597480 DOI: 10.1093/ntr/ntaa112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Studies have shown that smoke-free (SF) workplace policies can create an SF environment, but most of them have focused only on reducing secondhand smoke (SHS) exposure or changing smoking behavior. Our study aims to explore the effects of SF workplace policies and the pathway between workplace SF policies and SHS exposure. METHOD 14 195 employees from 79 companies in China participated in this survey. Binary logistic regression is used to examine the direct effects of SF workplace policies. Structured Equation Modeling approach is used to test other indirect effects. The Sobel test is used to estimate the mediation effect. RESULTS Working in a company with SF policies was associated with lower SHS exposure (odds ratio = 0.56; 95% confidence interval = 0.51 to 0.60). Such policy were associated with lower smoking prevalence (Coef. = -0.05, p < .05) and positively associated with smoking harm awareness (Coef. = 0.07, p < .05) and SHS harm awareness (Coef. = 0.05, p < .05). Sobel test suggests that approximately 16.3% of the effects on SHS exposure reduction are mediated through the channel of lower smoking prevalence for males. For smokers, we did not identify a direct effect of such policies on quitting intentions, but a significant indirect effect via increased smoking harm awareness (Coef. = 0.07, p < .05) and lower smoking consumption (Coef. = -0.10, p < .05) were found. CONCLUSION This study finds that SF workplace policies are not only associated with lower SHS exposure but also related to some indirect effects. Further mediation analyses for males confirmed that the effect on SHS exposure reduction is mediated through the channel of lower smoking prevalence. IMPLICATIONS This study joins the debate in recent years on the effects of workplace SF policies and provides evidence with more comprehensive data from Asia Best Workplace Mainland China program. It shows that SF workplace policies not only can reduce SHS exposure but also are associated with lower smoking prevalence, fewer cigarettes smoked, and higher smoking harm-related awareness. These findings provide valuable evidence to promote such policies in all workplaces and underline the need for more stringent SF policies to be enacted in all countries.
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Affiliation(s)
- Hao-Xiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhao Liu
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
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12
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Lin H, Chang C, Liu Z, Tan H. The effect of the presence of children on adult smoking behaviour: empirical evidence based on China family panel studies. BMC Public Health 2020; 20:1448. [PMID: 32972391 PMCID: PMC7513303 DOI: 10.1186/s12889-020-09543-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a number of studies linking family and marriage factors with health behaviour, the effects of children on the health behaviour of parents are still understudied. This study explored the association between the presence of children and adults' smoking behaviours. METHODS This study used panel data from the China Family Panel Studies 2010 and 2012, and the data set included 23,157 households and 45,513 adults. Logistic regression was performed to analyse the association of the presence of children on adults' smoking behaviours. Subgroup regression was used to examine heterogeneous effects. RESULTS Full sample regressions showed that the number of children was significantly inversely associated with smoking behaviour (OR = 0.93; 95% 0.90-0.96). Further subsample regression finds that such effect is only significant among the high-education group (OR = 0.92; 95% 0.87-0.97), high-skill workers (OR = 0.89; 95% 0.80-0.99) and couples who had an age gap greater than 2 years (OR = 0.91; 95% 0.88-0.95). CONCLUSIONS Our findings confirm the existence of the upward intergenerational effect of the presence of children on adults' smoking behaviour in China. However, such effects are not equal across all demographic characteristics. Future research could explore other parts of the upward mechanism and possible pathways for a stronger effect. In resource-poor areas, targeting cessation activities at those who have children at an early age may be an effective strategy.
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Affiliation(s)
- Haoxiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38. Xueyuan Rd, Haidian District, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38. Xueyuan Rd, Haidian District, Beijing, China.
| | - Zhao Liu
- Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, No.2 Yinghuadongjie, Chaoyang District, Beijing, China.
| | - Huaqing Tan
- Guanghua School of Management, Peking University, Beijing, China
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