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Rábade-Castedo C, Zamarrón-Sanz C, Hermida-Ameijeiras Á, Abelleira-Paris R, Casal-Mouriño A, Ferreiro-Fernández L, Rodríguez-Núñez N, Ricoy-Gabaldón J, Toubes-Navarro ME, Álvarez-Dobaño JM, Valdés-Cuadrado L. Effect of an intensive tobacco cessation program on the smoker narrative: A content analysis and grounded theory. Tob Induc Dis 2024; 22:TID-22-40. [PMID: 38362270 PMCID: PMC10867740 DOI: 10.18332/tid/183607] [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: 08/06/2023] [Revised: 12/28/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The smoker's narrative during smoking quitting provides insight into aspects not fully explored in daily clinical practice. The aim of the study was to analyze the smoker narrative using two types of methodologies: content analysis and grounded theory, before and after smoking cessation intervention, provided to the smoker in a specialized Smoking Cessation Unit accredited by the Spanish Society of Pneumology and Thoracic Surgery. METHODS A prospective observational study of current smokers included in a tobacco cessation program between 2017 and 2020 was conducted at the Smoking Cessation Unit of Santiago de Compostela Health Area, Spain. Routine clinical variables and patient narrative data were collected. A descriptive analysis of the sample, the content of the textual corpus, and a grounded theory were performed in semi-structured interviews at baseline and at follow-up at 6 months. RESULTS A total of 116 patients were included (mean age 55.6 ± 10.6 years; 56.9% male; mean nicotine dependence score 5.7 ± 1.6). Quantitative analysis of the narrative shows that the most frequent phrases and words are associated with smoking, nicotine craving, and predisposition for smoking cessation. After the intervention, phrases related to the manifestation of abstinence, response to pharmacological treatment, and self-perception of smoking cessation were predominant. In the qualitative analysis, the most frequent categories in the smoker's textual corpus were dependence, motivation, and emotionality, which decreased after the intervention (11.4%, 21.4%, and 9.9%, respectively) accompanied by increased satisfaction (19.2%) and the manifestation of abstinence (21.5%). CONCLUSIONS Motivation, nicotine dependence, and sensitivity to emotions are all closely intertwined in the current smoker narrative and can be modified as a consequence of treatment.
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Affiliation(s)
- Carlos Rábade-Castedo
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, España
| | - Carlos Zamarrón-Sanz
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Álvaro Hermida-Ameijeiras
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, España
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Romina Abelleira-Paris
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Ana Casal-Mouriño
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Lucia Ferreiro-Fernández
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, España
| | - Nuria Rodríguez-Núñez
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Jorge Ricoy-Gabaldón
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - María Elena Toubes-Navarro
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - José Manuel Álvarez-Dobaño
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, España
| | - Luis Valdés-Cuadrado
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Universitario de Santiago de Compostela, Santiago de Compostela, España
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, España
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Hock ES, Franklin M, Baxter S, Clowes M, Chilcott J, Gillespie D. Covariates of success in quitting smoking: a systematic review of studies from 2008 to 2021 conducted to inform the statistical analyses of quitting outcomes of a hospital-based tobacco dependence treatment service in the United Kingdom. NIHR OPEN RESEARCH 2023; 3:28. [PMID: 37881466 PMCID: PMC10596416 DOI: 10.3310/nihropenres.13427.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
Background Smoking cessation interventions are being introduced into routine secondary care in the United Kingdom (UK), but there are person and setting-related factors that could moderate their success in quitting smoking. This review was conducted as part of an evaluation of the QUIT hospital-based tobacco dependence treatment service ( https://sybics-quit.co.uk). The aim of the review was to identify a comprehensive set of variables associated with quitting success among tobacco smokers contacting secondary healthcare services in the UK who are offered support to quit smoking and subsequently set a quit date. The results would then be used to inform the development of a statistical analysis plan to investigate quitting outcomes. Methods Systematic literature review of five electronic databases. Studies eligible for inclusion investigated quitting success in one of three contexts: (a) the general population in the UK; (b) people with a mental health condition; (c) quit attempts initiated within a secondary care setting. The outcome measures were parameters from statistical analysis showing the effects of covariates on quitting success with a statistically significant (i.e., p-value <0.05) association. Results The review identified 29 relevant studies and 14 covariates of quitting success, which we grouped into four categories: demographics (age; sex; ethnicity; socio-economic conditions; relationship status, cohabitation and social network), individual health status and healthcare setting (physical health, mental health), tobacco smoking variables (current tobacco consumption, smoking history, nicotine dependence; motivation to quit; quitting history), and intervention characteristics (reduction in amount smoked prior to quitting, the nature of behavioural support, tobacco dependence treatment duration, pharmacological aids). Conclusions In total, 14 data fields were identified that should be considered for inclusion in datasets and statistical analysis plans for evaluating the quitting outcomes of smoking cessation interventions initiated in secondary care contexts in the UK. PROSPERO registration CRD42021254551 (13/05/2021).
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Affiliation(s)
- Emma S. Hock
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Matthew Franklin
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Susan Baxter
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Mark Clowes
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - James Chilcott
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Duncan Gillespie
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
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Klonizakis M, Gumber A, McIntosh E, Brose LS. Medium- and longer-term cardiovascular effects of e-cigarettes in adults making a stop-smoking attempt: a randomized controlled trial. BMC Med 2022; 20:276. [PMID: 35971150 PMCID: PMC9380327 DOI: 10.1186/s12916-022-02451-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Smoking is a major risk factor for cardiovascular disease and smoking cessation reduces excess risk. E-cigarettes are popular for smoking cessation but there is little evidence on their cardiovascular health effect. Our objective was to compare the medium- and longer-term cardiovascular effects in smokers attempting to quit smoking using e-cigarettes with or without nicotine or prescription nicotine replacement therapy (NRT). METHODS This was a single-center, pragmatic three-arm randomized (1:1:1) controlled trial, which recruited adult smokers (≥ 10 cigarettes/day), who were willing to attempt to stop smoking with support (n = 248). Participants were randomized to receive behavioral support with either (a) e-cigarettes with 18 mg/ml nicotine, (b) e-cigarettes without nicotine, and (c) NRT. Flow-mediated dilation (%FMD) and peak cutaneous vascular conductance (CVCmax) responses to acetylcholine (ACh) and sodium nitroprusside (SNP), mean arterial pressure (MAP), and other outcomes were recorded at baseline, 3, and 6 months after stopping smoking. Data were analyzed using generalized estimating equations (GEE). RESULTS At 3- and 6-month follow-up, %FMD showed an improvement over baseline in all three groups (e.g., p < 0.0001 at 6 months). Similarly, ACh, SNP, and MAP improved significantly over baseline in all groups both at 3 and 6 months (e.g., ACh: p = 0.004, at 6 months). CONCLUSIONS Smokers attempting to quit experienced positive cardiovascular impact after both a 3- and 6-month period. None of the groups (i.e., nicotine-containing and nicotine-free e-cigarettes or NRT) offered superior cardiovascular benefits to the others. TRIAL REGISTRATION ClinicalTrials.gov NCT03061253 . Registered on 17 February 2017.
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Affiliation(s)
- Markos Klonizakis
- Lifestyle Exercise and Nutrition Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, S10 2BP, UK.
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, S10 2BP, UK.
| | - Anil Gumber
- Lifestyle Exercise and Nutrition Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, S10 2BP, UK
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Emma McIntosh
- Lifestyle Exercise and Nutrition Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, S10 2BP, UK
| | - Leonie S Brose
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
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Short-Term Cardiovascular Effects of E-Cigarettes in Adults Making a Stop-Smoking Attempt: A Randomized Controlled Trial. BIOLOGY 2021; 10:biology10111208. [PMID: 34827200 PMCID: PMC8614829 DOI: 10.3390/biology10111208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
Simple Summary E-cigarettes are popular for smoking cessation but knowledge of their effect on cardiovascular health is limited. We compared the short-term cardiovascular effects in 248 smokers who quit smoking using e-cigarettes with or without nicotine or prescription nicotine replacement therapy (NRT). All participants received behavioural support. We assessed the cardiovascular effects of these stop smoking methods 3 days following quit date. Our work suggests that e-cigarettes offer similar vascular health benefits to that of NRT. This happens at a very early stage in the stop smoking process (3 days). Abstract Smoking increases cardiovascular disease (CVD) risk by leading to endothelial injury. E-cigarettes remain a popular way to stop smoking. Evidence on their effect on cardiovascular health is growing but remains limited, particularly in the short-term. The main objective of this study was to compare short-term cardiovascular effects in smokers who quit smoking using e-cigarettes with or without nicotine or prescription nicotine replacement therapy (NRT). This was a single-centre (Sheffield, UK) pragmatic three-arm randomised controlled trial which recruited adult smokers (≥10 cigarettes per day), who were willing to attempt to stop smoking with support (n = 248). Participants were randomised to receive either: (a) behavioral support and e-cigarettes with 18 mg/mL nicotine (n = 84); (b) behavioral support and e-cigarettes without nicotine (n = 82); (c) behavioral support and NRT (n = 82). Flow Mediated Dilation (%FMD), peak cutaneous vascular conductance responses to acetylcholine (ACh) and sodium nitroprusside (SNP) and mean arterial pressure (MAP) were recorded at baseline and three days after stopping smoking. General Linear Models were used to compare changes between groups and changes from follow-up. Adjusting for baseline, at follow-up, all outcomes (for the 208 participants that completed the 3-day assessments) with the exception of SNP had improved significantly over baseline and there were no differences between groups (%FMD F = 1.03, p = 0.360, df = 2,207; ACh F = 0.172, p = 0.84, df = 2,207; SNP F = 0.382, p = 0.68, df = 2,207; MAP F = 0.176, p = 0.84, df = 2,207). For smokers ≥20 cigarettes per day, benefits were also pronounced. Smoking cessation showed positive cardiovascular impact even after a 3-day period and the effects did not differ between nicotine-containing e-cigarettes, nicotine-free e-cigarettes and NRT.
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Wee LH, West R, Tee GH, Yeap L, Chan CMH, Ho BK, Perialathan K, Nik Mohamed MH, Michie S, Jackson SE. Effectiveness of training stop-smoking advisers to deliver cessation support to the UK national proposed standard versus usual care in Malaysia: a two-arm cluster-randomized controlled trial. Addiction 2021; 116:2150-2161. [PMID: 33220115 PMCID: PMC8359305 DOI: 10.1111/add.15346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/29/2020] [Accepted: 11/17/2020] [Indexed: 01/29/2023]
Abstract
AIMS To assess the effectiveness of training stop smoking services providers in Malaysia to deliver support for smoking cessation based on the UK National Centre for Smoking Cessation and Training (NCSCT) standard treatment programme compared with usual care. DESIGN Two-arm cluster-randomized controlled effectiveness trial across 19 sites with follow-up at 4-week, 3-month, and 6-month. SETTING Stop smoking services operating in public hospitals in Malaysia. PARTICIPANTS Five hundred and two smokers [mean ± standard deviation (SD), age 45.6 (13.4) years; 97.4% male] attending stop smoking services in hospital settings in Malaysia: 330 in 10 hospitals in the intervention condition and 172 in nine hospitals in the control condition. INTERVENTION AND COMPARATOR The intervention consisted of training stop-smoking practitioners to deliver support and follow-up according to the NCSCT Standard Treatment Programme. The comparator was usual care (brief support and follow-up). MEASUREMENTS The primary outcome was continuous tobacco smoking abstinence up to 6 months in smokers who received smoking cessation treatment, verified by expired-air carbon monoxide (CO) concentration. Secondary outcomes were continuous CO-verified tobacco smoking abstinence up to 4 weeks and 3 months. RESULTS Follow-up rates at 4 weeks, 3 months and 6 months were 80.0, 70.6 and 53.3%, respectively, in the intervention group and 48.8, 30.8 and 23.3%, respectively, in the control group. At 6-month follow-up, 93 participants in the intervention group and 19 participants in the control group were abstinent from smoking, representing 28.2 versus 11.0% in an intention-to-treat (ITT) analysis assuming that participants with missing data had resumed smoking, and 52.8 versus 47.5% in a follow-up-only (FUO) analysis. Unadjusted odds ratios (accounting for clustering) were 5.04, (95% confidence interval (CI) = 1.22-20.77, P = 0.025) and 1.70, (95% CI = 0.25-11.53, P = 0.589) in the ITT and FUO analyses, respectively. Abstinence rates at 4 week and 3 month follow-ups were significantly higher in the intervention versus control group in the ITT but not the FUO analysis. CONCLUSIONS On an intention-to-treat analysis with missing-equals-smoking imputation, training Malaysian stop smoking service providers in the UK National Centre for Smoking Cessation and Training standard treatment programme appeared to increase 6 month continuous abstinence rates in smokers seeking help with stopping compared with usual care. However, the effect may have been due to increasing follow-up rates.
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Affiliation(s)
- Lei Hum Wee
- Universiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | | | | | - Bee Kiau Ho
- Ministry of HealthBandar Botanic Health CentreMalaysia
| | | | | | - Susan Michie
- Centre for Behaviour ChangeUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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Guillaumier A, Skelton E, Tzelepis F, D'Este C, Paul C, Walsberger S, Kelly PJ, Palazzi K, Bonevski B. Patterns and predictors of nicotine replacement therapy use among alcohol and other drug clients enrolled in a smoking cessation randomised controlled trial. Addict Behav 2021; 119:106935. [PMID: 33848758 DOI: 10.1016/j.addbeh.2021.106935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Nicotine replacement therapy (NRT) use to support client smoking quit attempts is low and inconsistent at alcohol and other drug (AOD) treatment services. This study examined predictors of any NRT use and combination NRT use among AOD clients who were smokers. METHODS The study was part of a cluster-RCT of an organisational change intervention to introduce smoking cessation support as part of routine treatment in 32 AOD services. The intervention provided AOD services with free NRT and training. Service clients completed baseline (n = 896), 8-week (n = 471) and 6.5-month (n = 427) follow-up surveys. Mixed-model logistic regression examined whether baseline socio-demographic and smoking variables were associated with single and combination NRT use. RESULTS At 8-weeks follow-up 57% (n = 269/471), and at 6.5-months 33% (n = 143/427) of participants reported using at least one form of NRT. Odds of NRT use at 8-weeks follow-up were greater among participants from treatment vs control group (OR = 3.69, 95%CI 1.8-7.4; p < 0.001), higher vs lower nicotine dependence (OR = 1.74 95%CI 1.1-2.8; p = 0.024), or those motivated to quit (OR = 1.18 95%CI 1.0-1.4; p = 0.017). At 6.5-months, only the treatment arm remained significant. Combination NRT use at the 8-week follow-up was higher among those in treatment vs control group (OR = 2.75 95%CI 1.4-5.6; p = 0.005), or with higher vs lower nicotine dependence (OR = 2.12 95%CI 1.2-3.8; p = 0.014). No factors were associated with combination NRT use at 6.5-months. CONCLUSIONS An organisational change intervention that supplied AOD services with NRT training and products to provide to clients during treatment significantly increases client single form and combination NRT use in the short term.
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Affiliation(s)
| | | | - Flora Tzelepis
- The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Hunter New England Population Health, Wallsend, Australia
| | - Catherine D'Este
- The University of Newcastle, Callaghan, Australia; Australian National University, Canberra, Australia
| | - Christine Paul
- The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | - Peter J Kelly
- The University of Wollongong, Illawarra Health and Medical Research Institute, School of Psychology, Northfields Avenue, Wollongong, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, Australia
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Latif A, Murray RL, Waters C, Leonardi-Bee J. Understanding willingness to access and experiences of NHS Stop Smoking Services: a qualitative systematic review with meta-aggregation synthesis. Public Health 2021; 194:216-222. [PMID: 33962099 DOI: 10.1016/j.puhe.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES NHS Stop Smoking Services (NHS-SSS) have been available in the United Kingdom (UK) since 2000. The service has proven to be effective, however uptake remains below aspirations. Understanding people's willingness and reasons for accessing and engaging with NHS-SSS is, therefore, important. The aim of this systematic review is to summarise the findings from qualitative research to understand people's views, perceptions and willingness to access NHS-SSS. STUDY DESIGN Qualitative systematic review with meta-aggregation synthesis. METHODS Four electronic databases were searched for published qualitative studies, from Jan 2000 to Jan 2020. Following the screening, data extraction and quality assessment, data synthesis was conducted using meta-aggregation based on a patient-centred theoretical framework. We explored five 'demand-side' dimensions of service accessibility: the ability to perceive, seek, reach, pay and engage. Confidence in the synthesised findings relating to dependability and credibility was established using CONQual. RESULTS Seventeen studies were included in the review. Twelve categories emerged, contributing to five synthesised statements, all with a CONQual rating of moderate confidence. Access and willingness to use NHS-SSS were found to be related to an individual's readiness to perceive that smoking is a problem for which a solution should be sought, their ability to seek a perceived effective treatment, to conveniently reach NHS-SSS, their perceptions around associated costs and tailoring care to improve engagement with individuals. CONCLUSIONS By using a theoretical framework incorporating healthcare access, this study provides policymakers valuable insights into people's willingness to access these services. Willingness to access NHS-SSS is multifaceted, nuanced and complex. Strategies to promote NHS-SSS uptake should include making services more attractive, relevant and responsive to individual perceptions around smoking and health. Given the higher prevalence of smoking in less affluent socioeconomic groups and in some ethnic minority groups, the importance of having a comprehensive and inclusive tobacco control policy, one that is linguistically and culturally sensitive, cannot be overstated.
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Affiliation(s)
- Asam Latif
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
| | - Rachel L Murray
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
| | - Claire Waters
- Public Health Wales, Health Improvement Division, Cardiff, Wales, UK.
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
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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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Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2021; 1:CD013229. [PMID: 33411338 DOI: 10.1002/14651858.cd013229.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Smoking is a leading cause of disease and death worldwide. In people who smoke, quitting smoking can reverse much of the damage. Many people use behavioural interventions to help them quit smoking; these interventions can vary substantially in their content and effectiveness. OBJECTIVES To summarise the evidence from Cochrane Reviews that assessed the effect of behavioural interventions designed to support smoking cessation attempts and to conduct a network meta-analysis to determine how modes of delivery; person delivering the intervention; and the nature, focus, and intensity of behavioural interventions for smoking cessation influence the likelihood of achieving abstinence six months after attempting to stop smoking; and whether the effects of behavioural interventions depend upon other characteristics, including population, setting, and the provision of pharmacotherapy. To summarise the availability and principal findings of economic evaluations of behavioural interventions for smoking cessation, in terms of comparative costs and cost-effectiveness, in the form of a brief economic commentary. METHODS This work comprises two main elements. 1. We conducted a Cochrane Overview of reviews following standard Cochrane methods. We identified Cochrane Reviews of behavioural interventions (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials) for smoking cessation by searching the Cochrane Library in July 2020. We evaluated the methodological quality of reviews using AMSTAR 2 and synthesised data from the reviews narratively. 2. We used the included reviews to identify randomised controlled trials of behavioural interventions for smoking cessation compared with other behavioural interventions or no intervention for smoking cessation. To be included, studies had to include adult smokers and measure smoking abstinence at six months or longer. Screening, data extraction, and risk of bias assessment followed standard Cochrane methods. We synthesised data using Bayesian component network meta-analysis (CNMA), examining the effects of 38 different components compared to minimal intervention. Components included behavioural and motivational elements, intervention providers, delivery modes, nature, focus, and intensity of the behavioural intervention. We used component network meta-regression (CNMR) to evaluate the influence of population characteristics, provision of pharmacotherapy, and intervention intensity on the component effects. We evaluated certainty of the evidence using GRADE domains. We assumed an additive effect for individual components. MAIN RESULTS We included 33 Cochrane Reviews, from which 312 randomised controlled trials, representing 250,563 participants and 845 distinct study arms, met the criteria for inclusion in our component network meta-analysis. This represented 437 different combinations of components. Of the 33 reviews, confidence in review findings was high in four reviews and moderate in nine reviews, as measured by the AMSTAR 2 critical appraisal tool. The remaining 20 reviews were low or critically low due to one or more critical weaknesses, most commonly inadequate investigation or discussion (or both) of the impact of publication bias. Of note, the critical weaknesses identified did not affect the searching, screening, or data extraction elements of the review process, which have direct bearing on our CNMA. Of the included studies, 125/312 were at low risk of bias overall, 50 were at high risk of bias, and the remainder were at unclear risk. Analyses from the contributing reviews and from our CNMA showed behavioural interventions for smoking cessation can increase quit rates, but effectiveness varies on characteristics of the support provided. There was high-certainty evidence of benefit for the provision of counselling (odds ratio (OR) 1.44, 95% credibility interval (CrI) 1.22 to 1.70, 194 studies, n = 72,273) and guaranteed financial incentives (OR 1.46, 95% CrI 1.15 to 1.85, 19 studies, n = 8877). Evidence of benefit remained when removing studies at high risk of bias. These findings were consistent with pair-wise meta-analyses from contributing reviews. There was moderate-certainty evidence of benefit for interventions delivered via text message (downgraded due to unexplained statistical heterogeneity in pair-wise comparison), and for the following components where point estimates suggested benefit but CrIs incorporated no clinically significant difference: individual tailoring; intervention content including motivational components; intervention content focused on how to quit. The remaining intervention components had low-to very low-certainty evidence, with the main issues being imprecision and risk of bias. There was no evidence to suggest an increase in harms in groups receiving behavioural support for smoking cessation. Intervention effects were not changed by adjusting for population characteristics, but data were limited. Increasing intensity of behavioural support, as measured through the number of contacts, duration of each contact, and programme length, had point estimates associated with modestly increased chances of quitting, but CrIs included no difference. The effect of behavioural support for smoking cessation appeared slightly less pronounced when people were already receiving smoking cessation pharmacotherapies. AUTHORS' CONCLUSIONS Behavioural support for smoking cessation can increase quit rates at six months or longer, with no evidence that support increases harms. This is the case whether or not smoking cessation pharmacotherapy is also provided, but the effect is slightly more pronounced in the absence of pharmacotherapy. Evidence of benefit is strongest for the provision of any form of counselling, and guaranteed financial incentives. Evidence suggested possible benefit but the need of further studies to evaluate: individual tailoring; delivery via text message, email, and audio recording; delivery by lay health advisor; and intervention content with motivational components and a focus on how to quit. We identified 23 economic evaluations; evidence did not consistently suggest one type of behavioural intervention for smoking cessation was more cost-effective than another. Future reviews should fully consider publication bias. Tools to investigate publication bias and to evaluate certainty in CNMA are needed.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Kuipers MAG, West R, Beard EV, Brown J. Impact of the "Stoptober" Smoking Cessation Campaign in England From 2012 to 2017: A Quasiexperimental Repeat Cross-Sectional Study. Nicotine Tob Res 2020; 22:1453-1459. [PMID: 31246257 PMCID: PMC7443602 DOI: 10.1093/ntr/ntz108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/26/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Since 2012, England has an annual "Stoptober" campaign for collective smoking cessation. Our aim was to assess (1) overall impact of the Stoptober campaign on quit attempts over its first 6 years, (2) consistency of impact over the campaign years, and (3) the role of the campaign budget. METHODS We used data of 51 399 adult smokers and ex-smokers in 132 repeat cross-sectional monthly surveys in England, 2007-2017. In a quasiexperimental design, adjusted logistic regression analyses compared past-month quit attempt rate between (1) October and other months in the year, between 2007-2011 and 2012-2017; (2) October and other months, across years 2012-2017; and (3) October and other months, between high-budget (2012-2015) and low-budget Stoptober campaigns (2016-2017). Bayes factors (BF) differentiated insensitive data and absence of an effect. RESULTS (1) In 2012-2017, quit attempts were more prevalent in October versus other months (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.00 to 1.53), whereas similar in 2007-2011 (OR: 0.95, 95% CI: 0.76 to 1.18; BF = 0.2); data were somewhat insensitive but supported this difference (OR: 1.30, 95% CI: 0.97 to 1.75; BF = 2.1). (2) In 2012-2017, quit attempt prevalence ranged from 3.1% to 8.5% in October and 5.0% to 7.3% in other months. The difference between October and other months was large in 2012 (absolute unadjusted difference of 3.3%; OR: 1.92, 95% CI: 1.23 to 2.98) and 2015 (3.1%; OR: 1.84, 95% CI: 1.14 to 2.95), but small in 2013-2014 and 2016-2017 (0.36 < BF < 1.02). (3) Data were somewhat insensitive but supported interaction with campaign budget (OR: 1.50, 95% CI: 0.92 to 2.44; BF = 2.2). DISCUSSION In 2012-2017, there appears to have been an increase in past-month quit attempts during October in England. The increase was inconsistent across Stoptober campaigns and appears to have been greater when the campaign budget was higher. IMPLICATIONS Over the first 6 years of Stoptober campaigns, there appears to have been an overall increase in past-month quit attempts during October in England, and the data imply that a sufficiently high budget contributes to greater impact of the Stoptober campaign. These findings encourage the further spread of the Stoptober campaign to other countries. Future research should clarify how increased quit attempts as a consequence of Stoptober translate into quit success and which of Stoptober's ingredients were most important in increasing quit attempts, especially among vulnerable groups.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Emma V Beard
- Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Kotsen C, Santorelli ML, Bloom EL, Goldstein AO, Ripley-Moffitt C, Steinberg MB, Burke MV, Foulds J. A Narrative Review of Intensive Group Tobacco Treatment: Clinical, Research, and US Policy Recommendations. Nicotine Tob Res 2020; 21:1580-1589. [PMID: 30124924 DOI: 10.1093/ntr/nty162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/14/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Clinical practice guidelines recommend comprehensive treatment for tobacco dependence including pharmacotherapies and behavioral interventions. Group counseling may deliver unique treatment aspects not available with other modalities. This manuscript provides a narrative review of group treatment outcomes from real-world practice settings and complements recent meta-analyses of randomized controlled trials (RCTs). Our primary goals were to determine whether group treatments delivered in these settings have yielded similar quit rates compared to individual treatment and to provide recommendations for best practices and policy. METHODS Group treatment was defined as occurring in a clinical or workplace setting (ie, not provided as part of a research study), led by a professionally trained clinician, and offered weekly over several weeks. English language PubMed articles from January 2000 to July 2017 were searched to identify studies that included outcomes from both group and individual treatment offered in real-world settings. Additional data sources meeting our criteria were also included. Reports not using pharmacotherapy and research studies (eg, RCTs) were excluded. The primary outcome was short-term, carbon monoxide (CO)-validated point prevalence abstinence (4-week postquit date). RESULTS The review included data from 11 observational studies. In all cases, group treatment(s) had higher 4-week CO-validated quit rates (range: 35.5%-67.3%) than individual treatment(s) (range: 18.6%-53.3%). CONCLUSIONS Best practice group treatments for tobacco dependence are generalizable from research to clinical settings and likely to be at least as effective as intensive individual treatment. The added advantages of efficiency and cost-effectiveness can be significant. Group treatment is feasible in various settings with good results. IMPLICATIONS A major barrier to achieving high rates of tobacco abstinence is under-utilization of evidence-based treatment interventions. This review demonstrates the effectiveness and utility of group treatment for tobacco dependence. Based on the available data described in this narrative review in conjunction with existing RCT data, group treatment for tobacco dependence should be established and available in all behavioral health and medical settings. Group tobacco treatment is now one of the mandated reimbursable tobacco treatment formats within the US health care system, creating enormous opportunities for widespread clinical reach. Finally, comprehensive worksite group programs can further extend impact.
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Affiliation(s)
- Chris Kotsen
- Tobacco Quitcenter, Lung Cancer Institute, Steeplechase Cancer Center, RWJ Barnabas Health, Robert Wood Johnson Barnabas Health University Hospital Somerset, Somerville, NJ
| | - Melissa L Santorelli
- Community Health and Wellness Unit, New Jersey Department of Health, State of New Jersey, Trenton, NJ
| | - Erika Litvin Bloom
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam O Goldstein
- Tobacco Intervention Programs, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Carol Ripley-Moffitt
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Michael B Steinberg
- Rutgers Tobacco Dependence Program, Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Jonathan Foulds
- Population Health and Cancer Control Program, Cancer Institute, College of Medicine, Penn State University, Hershey, PA
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Chander S, Santhakumar S, Solomon S. Study protocol to assess the effectiveness of pharmacistmanaged
stop-smoking services : A randomized
controlled trial. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/118243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Brose LS, Bowen J, McNeill A, Partos TR. Associations between vaping and relapse to smoking: preliminary findings from a longitudinal survey in the UK. Harm Reduct J 2019; 16:76. [PMID: 31888637 PMCID: PMC6938007 DOI: 10.1186/s12954-019-0344-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most smokers attempting to quit relapse. There is little evidence whether the use of e-cigarettes ('vaping') increases or decreases relapse. This study aimed to assess 1) whether vaping predicted relapse among ex-smokers, and 2) among ex-smokers who vaped, whether vaping characteristics predicted relapse. METHODS Longitudinal web-based survey of smokers, recent ex-smokers and vapers in the UK, baseline in May/June 2016 (n = 3334), follow-up in September 2017 (n = 1720). Those abstinent from smoking ≥ 2 months at baseline and followed up were included. Aim 1: Relapse during follow-up was regressed onto baseline vaping status, age, gender, income, nicotine replacement therapy use and time quit smoking (n = 374). Aim 2: Relapse was regressed onto baseline vaping frequency, device type, nicotine strength and time quit smoking (n = 159). RESULTS Overall, 39.6% relapsed. Compared with never use (35.9%), past/ever (45.9%; adjOR = 1.13; 95% CI, 0.61-2.07) and daily vaping (34.5%; adjOR = 0.61; 95% CI, 0.61-1.89) had similar odds of relapse, for non-daily vaping evidence of increased relapse was inconclusive (65.0%; adjOR = 2.45; 95% CI, 0.85-7.08). Among vapers, non-daily vaping was associated with higher relapse than daily vaping (adjOR = 3.88; 95% CI, 1.10-13.62). Compared with modular devices (18.9% relapse), tank models (45.6%; adjOR = 3.63; 95% CI, 1.33-9.95) were associated with increased relapse; evidence was unclear for disposable/cartridge refillable devices (41.9%; adjOR = 2.83; 95% CI, 0.90-8.95). Nicotine strength had no clear association with relapse. CONCLUSION Relapse to smoking is likely to be more common among ex-smokers vaping infrequently or using less advanced devices. Research into the effects of vaping on relapse needs to consider vaping characteristics.
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Affiliation(s)
- Leonie S Brose
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Julia Bowen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timea R Partos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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14
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Santos MDDV, Santos SV, Caccia-Bava MDCGG. [The prevalence of strategies for cessation of tobacco use in primary health care: an integrative review]. CIENCIA & SAUDE COLETIVA 2019; 24:563-572. [PMID: 30726388 DOI: 10.1590/1413-81232018242.27712016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/23/2017] [Indexed: 11/22/2022] Open
Abstract
The habit of tobacco use/smoking, which is a major concern of Primary Health Care (PHC), is a serious public health problem and the main avoidable cause of death in the world. The relevance of actions, whose focus is to facilitate the cessation of this habit, motivates the discussion of studies that have different approaches to tackle this issue by seeking to train PHC professionals accordingly. A search was conducted in the Lilacs, MEDLINE and Web of Science databases for recent scientific publications (2010-2015). The key words were combined with Boolean operators and, after analysis of the articles found, 75 are discussed in this article since they have strategies with a higher prevalence in PHC. The conclusion drawn is that the brief or intense individual approach using the 5A method (Transtheoretical Model) is the most widely adopted, as well as bupropion and nicotine replacement patches. The increasing use of hard technology requires new studies that examine their impact on the treatment of smokers. It was clearly revealed that there is a need for health professionals to be better prepared to address the issue with the users, in addition to a lack of stimulus and proper conditions to work in the PHC team directly reflecting scientific advances in clinical practice.
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Affiliation(s)
- Meire de Deus Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
| | - Stella Vieira Santos
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Monte Alegre. 14048-900 Ribeirão Preto SP Brasil.
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15
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Hartmann-Boyce J, Fanshawe TR, Lindson N, Livingstone-Banks J, Ordóñez-Mena JM, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd013229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jamie Hartmann-Boyce
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Thomas R Fanshawe
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Nicola Lindson
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Jonathan Livingstone-Banks
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - José M. Ordóñez-Mena
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Paul Aveyard
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
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16
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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 2018; 28:s119-s128. [PMID: 29880598 PMCID: PMC6589489 DOI: 10.1136/tobaccocontrol-2018-054389] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [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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17
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West R, Coyle K, Owen L, Coyle D, Pokhrel S. Estimates of effectiveness and reach for 'return on investment' modelling of smoking cessation interventions using data from England. Addiction 2018; 113 Suppl 1:19-31. [PMID: 28833834 PMCID: PMC6032933 DOI: 10.1111/add.14006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/10/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Estimating 'return on investment' (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool (http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. METHODS Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. FINDINGS Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single-form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster-acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face-to-face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self-help materials (1%). There was insufficient evidence to obtain reliable, country-specific estimates for interventions such as websites, smartphone applications and e-cigarettes. CONCLUSIONS Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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Affiliation(s)
- Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Kathryn Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
| | - Lesley Owen
- Centre for GuidelinesNational Institute for Health and Care ExcellenceLondonUK
| | - Doug Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
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Healey A, Roberts S, Sevdalis N, Goulding L, Wilson S, Shaw K, Jolley C, Robson D. A Cost-Effectiveness Analysis of Stop Smoking Interventions in Substance-Use Disorder Populations. Nicotine Tob Res 2018; 21:623-630. [DOI: 10.1093/ntr/nty087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/30/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Andrew Healey
- King’s Improvement Science, King’s College London, UK
| | - Sarah Roberts
- King’s Improvement Science, King’s College London, UK
| | - Nick Sevdalis
- King’s Improvement Science, King’s College London, UK
| | - Lucy Goulding
- King’s Improvement Science, King’s College London, UK
| | - Sophie Wilson
- King’s Improvement Science, King’s College London, UK
| | - Kate Shaw
- King’s Improvement Science, King’s College London, UK
| | - Caroline Jolley
- Centre of Human & Aerospace Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, UK
- Department of Respiratory Medicine, King’s College Hospital NHS Foundation Trust, UK
| | - Deborah Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK
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Sung B. Effects of Different Types of Smoking Cessation Treatments for South Korean Adult Smokers without an Intention to Quit. J Lifestyle Med 2018; 8:33-41. [PMID: 29581958 PMCID: PMC5846642 DOI: 10.15280/jlm.2018.8.1.33] [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: 10/22/2017] [Accepted: 11/30/2017] [Indexed: 11/27/2022] Open
Abstract
Background While there are many different ways to quit smoking, current methods are not equally successful. The objective of this study was to analyze the effects of different types of stop smoking treatment for South Korean adult smokers without an intention to quit. Methods This cross-sectional study used data of 14,174 adults (age 19 years and over) from the Korea national health and nutrition examination survey (2007–2012) who have experience of smoking. The data were analyzed using multiple logistic regression. Results According to multiple logistic regression analysis, the education and counseling plus prescription drug group (OR = 14.831, 95% CI = 1.256 to 175.136) and education and counseling plus NRT group (OR = 3.060, 95% CI = 1.971 to 4.748) were associated with increased odds of quitting success compared to the no intervention group. Second, the education and counseling group was associated with increased odds of quitting success compared to the no intervention group (OR = 4.944, 95% CI = 3.463 to 7.058). Third, education and counseling plus NRT (OR = 0.325, 95% CI = 0.161 to 0.657) and NRT alone (OR = 0.322, 95% CI = 0.175 to 0.593) were associated with decreased odds of quitting success compared to the group using prescription drug only. Conclusion These findings suggest that an approach utilizing education and counseling plus prescription drugs is the most successful type of stop smoking treatment for South Korean adult smokers without an intention to quit.
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Affiliation(s)
- Baksun Sung
- Research Committee, Korea Institute for Health and Welfare Policy, Seoul, Korea
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Gilbert H, Sutton S, Morris R, Petersen I, Wu Q, Parrott S, Galton S, Kale D, Magee MS, Gardner L, Nazareth I. Start2quit: a randomised clinical controlled trial to evaluate the effectiveness and cost-effectiveness of using personal tailored risk information and taster sessions to increase the uptake of the NHS Stop Smoking Services. Health Technol Assess 2018; 21:1-206. [PMID: 28121288 DOI: 10.3310/hta21030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The NHS Stop Smoking Services (SSSs) offer help to smokers who want to quit. However, the proportion of smokers attending the SSSs is low and current figures show a continuing downward trend. This research addressed the problem of how to motivate more smokers to accept help to quit. OBJECTIVES To assess the relative effectiveness, and cost-effectiveness, of an intervention consisting of proactive recruitment by a brief computer-tailored personal risk letter and an invitation to a 'Come and Try it' taster session to provide information about the SSSs, compared with a standard generic letter advertising the service, in terms of attendance at the SSSs of at least one session and validated 7-day point prevalent abstinence at the 6-month follow-up. DESIGN Randomised controlled trial of a complex intervention with follow-up 6 months after the date of randomisation. SETTING SSSs and general practices in England. PARTICIPANTS All smokers aged ≥ 16 years identified from medical records in participating practices who were motivated to quit and who had not attended the SSS in the previous 12 months. Participants were randomised in the ratio 3 : 2 (intervention to control) by a computer program. INTERVENTIONS Intervention - brief personalised and tailored letter sent from the general practitioner using information obtained from the screening questionnaire and from medical records, and an invitation to attend a taster session, run by the local SSS. Control - standard generic letter from the general practice advertising the local SSS and the therapies available, and asking the smoker to contact the service to make an appointment. MAIN OUTCOME MEASURES (1) Proportion of people attending the first session of a 6-week course over a period of 6 months from the receipt of the invitation letter, measured by records of attendance at the SSSs; (2) 7-day point prevalent abstinence at the 6-month follow-up, validated by salivary cotinine analysis; and (3) cost-effectiveness of the intervention. RESULTS Eighteen SSSs and 99 practices within the SSS areas participated; 4384 participants were randomised to the intervention (n = 2636) or control (n = 1748). One participant withdrew and 4383 were analysed. The proportion of people attending the first session of a SSS course was significantly higher in the intervention group than in the control group [17.4% vs. 9.0%; unadjusted odds ratio (OR) 2.12, 95% confidence interval (CI) 1.75 to 2.57; p < 0.001]. The validated 7-day point prevalent abstinence at the 6-month follow-up was significantly higher in the intervention group than in the control group (9.0% vs. 5.6%; unadjusted OR 1.68, 95% CI 1.32 to 2.15; p < 0.001), as was the validated 3-month prolonged abstinence and all other periods of abstinence measured by self-report. Using the National Institute for Health and Care Excellence decision-making threshold range of £20,000-30,000 per quality-adjusted life-year gained, the probability that the intervention was more cost-effective than the control was up to 27% at 6 months and > 86% over a lifetime horizon. LIMITATIONS Participating SSSs may not be representative of all SSSs in England. Recruitment was low, at 4%. CONCLUSIONS The Start2quit trial added to evidence that a proactive approach with an intensive intervention to deliver personalised risk information and offer a no-commitment introductory session can be successful in reaching more smokers and increasing the uptake of the SSS and quit rates. The intervention appears less likely to be cost-effective in the short term, but is highly likely to be cost-effective over a lifetime horizon. FUTURE WORK Further research could assess the separate effects of these components. TRIAL REGISTRATION Current Controlled Trials ISRCTN76561916. FUNDING DETAILS This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hazel Gilbert
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Richard Morris
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Simon Galton
- Smokefree Camden (Public Health), NHS Camden, London, UK
| | - Dimitra Kale
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Molly Sweeney Magee
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Leanne Gardner
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London, London, UK
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21
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McRobbie H, Hajek P, Peerbux S, Kahan BC, Eldridge S, Trépel D, Parrott S, Griffiths C, Snuggs S, Myers Smith K. Tackling obesity in areas of high social deprivation: clinical effectiveness and cost-effectiveness of a task-based weight management group programme - a randomised controlled trial and economic evaluation. Health Technol Assess 2018; 20:1-150. [PMID: 27802843 DOI: 10.3310/hta20790] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An increasing number of people require help to manage their weight. The NHS recommends weight loss advice by general practitioners and/or a referral to a practice nurse. Although this is helpful for some, more effective approaches that can be disseminated economically on a large scale are needed. OBJECTIVE To assess whether or not a task-based weight management programme [Weight Action Programme (WAP)] has better long-term effects than a 'best practice' intervention provided in primary care by practice nurses. DESIGN Randomised controlled trial with cost-effectiveness analysis. SETTING General practices in east London, UK. PARTICIPANTS Three hundred and thirty adults with a body mass index (BMI) of ≥ 30 kg/m2 or a BMI of ≥ 28 kg/m2 plus comorbidities were recruited from local general practices and via media publicity. Those who had a BMI of > 45 kg/m2, had lost > 5% of their body weight in the previous 6 months, were currently pregnant or taking psychiatric medications were excluded. Participants were randomised (2 : 1) to the WAP or nurse arms. INTERVENTIONS The WAP intervention was delivered in eight weekly group sessions that combined dietary and physical activity, advice and self-monitoring in a group-oriented intervention. The initial course was followed by 10 monthly group maintenance sessions open to all participants in this study arm. The practice nurse intervention (best usual care) consisted of four one-to-one sessions delivered over 8 weeks, and included standard advice on diet and physical activity based on NHS 'Change4Life' materials and motivational support. MAIN OUTCOME MEASURES The primary outcome measure was weight change at 12 months. Secondary outcome measures included change in BMI, waist circumference and blood pressure, and proportion of participants losing at least 5% and 10% of baseline body weight. Staff collecting measurements at the 6- and 12-month follow-ups were blinded to treatment allocation. The primary outcome measure was analysed according to the intention-to-treat principle, and included all participants with at least one recorded outcome at either 1, 2, 6 or 12 months. The analysis employed a mixed-effects linear regression model, adjusted for baseline weight, age, sex, ethnicity, smoking status and general practice. The European Quality of Life-5 Dimensions-5 Levels questionnaire was completed and used to estimate quality-adjusted life-years (QALYs) within the cost-effectiveness analysis. RESULTS There were 330 participants (WAP arm, n = 221; nurse arm, n = 109; 72% women). A total of 291 (88%) participants (WAP arm, n = 194; nurse arm, n = 97) were included in the main analysis for the primary outcome. Weight loss at 12 months was greater in the WAP arm than in the nurse intervention arm [-4.2 kg vs. -2.3 kg; difference -1.9 kg, 95% confidence interval (CI) -3.7 to -0.1 kg; p = 0.04]. Participants in the WAP arm were more likely than participants in the nurse arm to have lost at least 5% of their baseline body weight at 12 months (41% vs. 27%; odds ratio 14.61, 95% CI 2.32 to 91.96; p = 0.004). The incremental cost-effectiveness ratio for WAP over and above the nurse arm is £7742 per QALY. CONCLUSIONS A WAP delivered in general practice better promotes weight loss over 12 months than a best usual practice nurse-led weight loss programme. LIMITATIONS The trial recruited mostly women. Research is needed into factors that would make weight loss programmes more attractive to men. TRIAL REGISTRATION Current Controlled Trials ISRCTN45820471. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 79. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hayden McRobbie
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Hajek
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Sarrah Peerbux
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Sarah Snuggs
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Katie Myers Smith
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Walker N, Gainforth H, Kiparoglou V, Robinson H, van Woerden H, West R. Factors moderating the relative effectiveness of varenicline and nicotine replacement therapy in clients using smoking cessation services. Addiction 2018; 113:313-324. [PMID: 28804929 DOI: 10.1111/add.14004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/31/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Abstract
AIMS To assess how far the greater effectiveness of varenicline over nicotine replacement therapy (NRT) is moderated by characteristics of the smokers or setting in clinical practice. DESIGN We used observational data from 22 472 treatment episodes between 2013 and 2016 from smoking cessation services in England to assess whether differences between varenicline and NRT were moderated by a set of smoker and setting characteristics: these included level of social deprivation, age, gender, ethnic group, nicotine dependence and treatment context. From the above, 15 640 episodes were analysed in relation to 4-week quit and 14 273 episodes at 12 weeks. All two-way interactions involving pharmacotherapy were fitted in addition to the main effects and a parsimonious model identified using a backwards stepwise selection procedure. SETTING England PARTICIPANTS: Clients of smoking cessation service (number of individuals in 4-week quit analysis = 15 640). MEASUREMENTS Four-week carbon monoxide-validated (primary outcome) and 12-week self-reported (secondary outcome) quit success/failure. FINDINGS At both follow-up points, varenicline was associated with higher success rates overall [P < 0.001 at both 4 and 12 weeks; adjusted odds ratio (OR) varenicline versus NRT = 1.82 (95% confidence interval (CI) = 1.61, 2.06) and 2.58 (95% CI = 2.26, 2.94) at 4 and 12 weeks, respectively]. At 12 weeks, the relative benefits of varenicline were found to be influenced by the setting in which advice was provided [P < 0.001 for interaction pharmacotherapy × setting; adjusted odds ratio for varenicline × pharmacy setting = 0.53 (95% CI = 0.42, 0.69) and for varenicline × general practice (GP) setting = 0.79 (95% CI = 0.64, 0.98) against a baseline of 1 for varenicline × community setting]. The same trends were evident at 4 weeks, but this did not translate to statistical significance. There was inconclusive evidence for moderating effects of other variables. CONCLUSIONS Varenicline use was associated with higher smoking cessation rates than nicotine replacement therapy in routine clinical practice, irrespective of a wide range of smoker characteristics, but the difference was less in certain intervention settings, most notably pharmacy but also GP practice, compared with community setting.
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Affiliation(s)
- Neil Walker
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
- Gloucestershire Retinal Research Group, Cheltenham General Hospital, Cheltenham, UK
| | - Heather Gainforth
- School of Health and Exercise Sciences, University of British Columbia, BC, Canada
| | - Vasiliki Kiparoglou
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford, UK
| | | | - Hugo van Woerden
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
- Centre for Health Science, University of the Highlands and Islands, Inverness, UK
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Wehbe L, Ubhi HK, West R. Want, need and habit as drivers of smoking behaviour: A preliminary analysis. Addict Behav 2018; 76:135-138. [PMID: 28806637 DOI: 10.1016/j.addbeh.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/30/2017] [Accepted: 07/08/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Models of tobacco smoking behaviour propose that anticipated pleasure or satisfaction, the need to alleviate a nicotine-induced drive state and a stimulus-driven impulse potentially play an important role. This study aimed to provide a preliminary assessment of how far urges to smoke are reported by smokers and whether the strength of such urges prior to a quit attempt predicts short-term success at quitting. METHODS In a prospective study, 566 smokers attending a treatment programme to help smokers quit completed a written questionnaire covering frequency of different types of urge to smoke (automatic impulse - 'automatic urges', anticipated pleasure - 'pleasure urges', and fulfilling a need - 'need urges'). They were asked to rate this for whichever of these urges was dominant for them. The questionnaire also assessed daily cigarette consumption, time to first cigarette of the day, age and gender. Carbon monoxide verified smoking status was recorded at 1 and 4weeks after the target quit date. FINDINGS A total of 47.9% (271) of smokers reported that automatic urges were dominant, 21.7% (123) reported pleasure urges to be dominant, and 30.4% (172) reported need urges to be dominant. The strength of automatic urges predicted abstinence at both 1week (OR=0.74, p=0.005, 95%CI=0.60-0.92) and 4weeks (OR=0.73, p=0.008, 95%CI=0.59-0.92). Associations between other urge types and abstinence were not statistically significant. CONCLUSIONS A substantial proportion of smokers attending a clinic for help with quitting report that their dominant urges to smoke occur without any anticipation of pleasure or relief and the strength of the automatic urges predicts failure to sustain abstinence following a quit attempt.
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Affiliation(s)
- Luis Wehbe
- Instituto Ave Pulmo, Fundación Enfisema, Mar del Plata, Argentina
| | - Harveen Kaur Ubhi
- Cancer Research UK Health Behaviour Research Centre, University College London, London WC1E 6BT, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London WC1E 6BT, UK; National Health Service Centre for Smoking Cessation and Training, London, UK
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24
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Nichols JAA, Grob P, Kite W, Williams P, de Lusignan S. Using a genetic/clinical risk score to stop smoking (GeTSS): randomised controlled trial. BMC Res Notes 2017; 10:507. [PMID: 29061161 PMCID: PMC5653992 DOI: 10.1186/s13104-017-2831-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/13/2017] [Indexed: 12/12/2022] Open
Abstract
Background As genetic tests become cheaper, the possibility of their widespread availability must be considered. This study involves a risk score for lung cancer in smokers that is roughly 50% genetic (50% clinical criteria). The risk score has been shown to be effective as a smoking cessation motivator in hospital recruited subjects (not actively seeking cessation services). Methods This was an RCT set in a United Kingdom National Health Service (NHS) smoking cessation clinic. Smokers were identified from medical records. Subjects that wanted to participate were randomised to a test group that was administered a gene-based risk test and given a lung cancer risk score, or a control group where no risk score was performed. Each group had 8 weeks of weekly smoking cessation sessions involving group therapy and advice on smoking cessation pharmacotherapy and follow-up at 6 months. The primary endpoint was smoking cessation at 6 months. Secondary outcomes included ranking of the risk score and other motivators. Results 67 subjects attended the smoking cessation clinic. The 6 months quit rates were 29.4%, (10/34; 95% CI 14.1–44.7%) for the test group and 42.9% (12/28; 95% CI 24.6–61.2%) for the controls. The difference is not significant. However, the quit rate for test group subjects with a “very high” risk score was 89% (8/9; 95% CI 68.4–100%) which was significant when compared with the control group (p = 0.023) and test group subjects with moderate risk scores had a 9.5% quit rate (2/21; 95% CI 2.7–28.9%) which was significantly lower than for above moderate risk score 61.5% (8/13; 95% CI 35.5–82.3; p = 0.03). Conclusions Only the sub-group with the highest risk score showed an increased quit rate. Controls and test group subjects with a moderate risk score were relatively unlikely to have achieved and maintained non-smoker status at 6 months. ClinicalTrials.gov ID NCT01176383 (date of registration: 3 August 2010) Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2831-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John A A Nichols
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, GU2 7XH, UK. .,, 60 Manor Way, Onslow Village, Guildford, Surrey, GU2 7RR, UK.
| | - Paul Grob
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Wendy Kite
- , Jardim De Bensafrim, Lote 8, Bensafrim, 8600 069, Argave, Portugal
| | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, Surrey, GU27XH, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, GU2 7XH, UK
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Abstract
PURPOSE OF REVIEW Electronic cigarette (e-cigarette) use is rapidly increasing, with many users reporting trying e-cigarettes as a method to quit combustible cigarettes. This review highlights recently published studies assessing the use of e-cigarettes as a tool for cessation of combustible cigarettes. RECENT FINDINGS When evaluating data from four randomized controlled trials and multiple cohort studies, differential association between e-cigarette use and cessation rates was seen. Cessation rates are highest in UK cohort studies and in studies using a multifaceted approach, such as with the addition of varenicline. The largest evidence base is derived from observational cohort studies. Overall, the current evidence remains too small for conclusive results regarding efficacy of e-cigarettes for combustible cessation. There does appear to be a consistent reduction in daily combustible cigarette use in regular e-cigarette users. SUMMARY Currently, there are conflicting data which can be used to support or dismiss e-cigarettes as a tool for smoking cessation. As larger population-based studies become available, the potential harms and benefits of e-cigarettes will become clearer. In the short term, shared decision-making with combustible cigarette users will be imperative when considering e-cigarettes as a smoking cessation tool.
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Vaz LR, Coleman T, Fahy SJ, Cooper S, Bauld L, Szatkowski L, Leonardi-Bee J. Factors associated with the effectiveness and reach of NHS stop smoking services for pregnant women in England. BMC Health Serv Res 2017; 17:545. [PMID: 28789643 PMCID: PMC5549362 DOI: 10.1186/s12913-017-2502-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK National Health Service provides Stop Smoking Services for pregnant women (SSSP) but there is a lack of evidence concerning how these are best organised. This study investigates influences on services' effectiveness and also on their propensity to engage pregnant smokers with support in stopping smoking. METHODS Survey data collected from 121/141 (86%) of SSSP were augmented with data from Hospital Episode Statistics and the 2011 UK National Census. 'Reach' or propensity to engage smokers with support was defined as the percentage of pregnant smokers setting a quit date with SSSP support, and 'Effectiveness' as the percentage of women who set a quit date who also reported abstinence at four weeks later. A bivariate (i.e. two outcome variable) response Markov Chain Monte Carlo model was used to identify service-level factors associated with the Reach and Effectiveness of SSSP. RESULTS Beta coefficients represent a percentage change in Reach and Effectiveness by the covariate. Providing the majority of one-to-one contacts in a clinic rather than at home increased both Reach (%) (β: 6.97, 95% CI: 3.34, 10.60) and Effectiveness (%) (β: 7.37, 95% CI: 3.03, 11.70). Reach of SSSP was also increased when the population served was more deprived (β for increase in Reach with a one unit increase in IMD score: 0.55, 95% CI: 0.25, 0.85), had a lower proportion of people with dependent children (β: -2.52, 95% CI: -3.82, -1.22), and a lower proportion of people in managerial or professional occupations (β: -0.31, 95% CI: -0.59, -0.03). The Effectiveness of SSSP was decreased in those areas that had a greater percentage of people >16 years with no educational qualifications (β: -0.51, 95% CI: -0.95, -0.07). CONCLUSIONS To engage pregnant smokers and to encourage them to quit, it may be more efficient for SSSP support to be focussed around clinics, rather than women's homes. Reach of SSSP is inversely associated with disadvantage and efforts should be made to contact these women as they are less likely to achieve abstinence in the short and longer term.
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Affiliation(s)
- L R Vaz
- UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2RD, UK.
| | - T Coleman
- UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2RD, UK
| | - S J Fahy
- UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2RD, UK
| | - S Cooper
- UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2RD, UK
| | - L Bauld
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA, UK
| | - L Szatkowski
- UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2RD, UK.,UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building 2, Hucknall Road, Nottingham, NG5 1PB, UK
| | - J Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2RD, UK.,UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building 2, Hucknall Road, Nottingham, NG5 1PB, UK
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Semwal M, Taylor G, Car J. Personalised information for improving the uptake of smoking cessation programs. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:260. [PMID: 28706928 DOI: 10.21037/atm.2017.04.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Monika Semwal
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gemma Taylor
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Prestwich A, Moore S, Kotze A, Budworth L, Lawton R, Kellar I. How Can Smoking Cessation Be Induced Before Surgery? A Systematic Review and Meta-Analysis of Behavior Change Techniques and Other Intervention Characteristics. Front Psychol 2017. [PMID: 28638356 PMCID: PMC5461364 DOI: 10.3389/fpsyg.2017.00915] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Smokers who continue to smoke up to the point of surgery are at increased risk of a range of complications during and following surgery. Objective: To identify whether behavioral and/or pharmacological interventions increase the likelihood that smokers quit prior to elective surgery and which intervention components are associated with larger effects. Design: Systematic review with meta-analysis. Data sources: MEDLINE, Embase, and Embase Classic, CINAHL, CENTRAL. Study selection: Studies testing the effect of smoking reduction interventions delivered at least 24 h before elective surgery were included. Study appraisal and synthesis: Potential studies were independently screened by two people. Data relating to study characteristics and risk of bias were extracted. The effects of the interventions on pre-operative smoking abstinence were estimated using random effects meta-analyses. The association between specific intervention components (behavior change techniques; mode; duration; number of sessions; interventionist) and smoking cessation effect sizes were estimated using meta-regressions. Results: Twenty-two studies comprising 2,992 smokers were included and 19 studies were meta-analyzed. Interventions increased the proportion of smokers who were abstinent or reduced smoking by surgery relative to control: g = 0.56, 95% CI 0.32–0.80, with rates nearly double in the intervention (46.2%) relative to the control (24.5%). Interventions that comprised more sessions, delivered face-to-face and by nurses, as well as specific behavior change techniques (providing information on consequence of smoking/cessation; providing information on withdrawal symptoms; goal setting; review of goals; regular monitoring by others; and giving options for additional or later support) were associated with larger effects. Conclusion: Rates of smoking can be halved prior to surgery and a number of intervention characteristics can increase these effects. There was, however, some indication of publication bias meaning the benefits of such interventions may be smaller than estimated. Registration: Prospero 2015: CRD42015024733
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Affiliation(s)
| | - Sally Moore
- Bradford Institute for Health ResearchBradford, United Kingdom
| | - Alwyn Kotze
- Department of Anaesthesia, Leeds Teaching Hospitals NHS TrustLeeds, United Kingdom
| | - Luke Budworth
- School of Psychology, University of LeedsLeeds, United Kingdom
| | - Rebecca Lawton
- School of Psychology, University of LeedsLeeds, United Kingdom.,Bradford Institute for Health ResearchBradford, United Kingdom
| | - Ian Kellar
- School of Psychology, University of LeedsLeeds, United Kingdom
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Stepankova L, Kralikova E, Zvolska K, Pankova A, Ovesna P, Blaha M, Brose LS. Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up. Ann Behav Med 2017; 51:454-463. [PMID: 28035641 PMCID: PMC5440483 DOI: 10.1007/s12160-016-9869-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Smoking is more prevalent among people with depression. Depression may make cessation more difficult and cessation may affect depression symptoms. PURPOSE The aims of this study were to assess the associations between (1) baseline depression and 1-year smoking abstinence and (2) abstinence and change in depression. METHODS Observational study using data collected routinely in a smoking cessation clinic in the Czech Republic from 2008 to 2014. Aim 1: N = 3775 patients; 14.3% reported mild and 15.4% moderate/severe baseline depression levels measured using Beck's Depression Inventory (BDI-II). Logistic regressions assessed if depression level predicted 1-year biochemically verified abstinence while adjusting for patient and treatment characteristics. Aim 2: N = 835 patients abstinent at 1 year; change in depression was analysed using Chi-square statistics, t test and mixed method analyses of variance. RESULTS Rate of abstinence was lower for patients with mild (32.5%, OR = 0.68; 95% CI: 0.54 to 0.87, p = 0.002) and moderate/severe depression (25.8%; OR = 0.57, 95% CI: 0.45 to 0.74, p < 0.001) compared with patients without depression (40.5%). Across abstinent patients, the majority with baseline depression reported lower depression levels at follow-up. Overall mean (SD) BDI-II scores improved from 9.2 (8.6) to 5.3 (6.1); t(834) = 14.6, p < 0.001. There were significant main effects of time (F(1832) = 880.8, p < 0.001, partial η2 = 0.51) and baseline depression level (F(2832) = 666.4, p < 0.001, partial η2 = 0.62) on follow-up depression and a significant depression * time interaction (F(2832) = 296.5, p < 0.001, partial η2 = 0.42). CONCLUSIONS In this effective smoking cessation clinic, depression at the start of treatment predicted reduced smoking abstinence 1 year later. Patients abstinent from smoking experienced considerable improvement in depression.
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Affiliation(s)
- Lenka Stepankova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
| | - Eva Kralikova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Studničkova 7, 128 00 Praha 2, Czech Republic
| | - Kamila Zvolska
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
| | - Alexandra Pankova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Studničkova 7, 128 00 Praha 2, Czech Republic
| | - Petra Ovesna
- Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic
| | - Milan Blaha
- Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic
| | - Leonie S Brose
- Psychology and Neuroscience, King’s College London, UK and UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, SE5 8BB London, UK
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Beard E, Brown J, West R, Angus C, Kaner E, Michie S. Healthier central England or North-South divide? Analysis of national survey data on smoking and high-risk drinking. BMJ Open 2017; 7:e014210. [PMID: 28249851 PMCID: PMC5353327 DOI: 10.1136/bmjopen-2016-014210] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics. DESIGN Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies. MEASURES Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT. RESULTS In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p<0.001; RR 0.91, p<0.05), East of England (RR 0.86, p<0.001), South East (RR 0.92, p<0.05) and London (RR 0.85, p<0.001). High-risk drinking was more common in the North but was less common in the Midlands, London and East of England. Adjustment for sociodemographics had little effect. There was a higher prevalence in the North East (RR 1.67, p<0.001), North West (RR 1.42, p<0.001) and Yorkshire and the Humber (RR 1.35, p<0.001); lower prevalence in the East Midlands (RR 0.69, p<0.001), West Midlands (RR 0.77, p<0.001), East of England (RR 0.72, p<0.001) and London (RR 0.71, p<0.001); and a similar prevalence in the South East (RR 1.10, p>0.05) CONCLUSIONS: In adjusted analyses, smoking and high-risk drinking appear less common in 'central England' than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities.
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Affiliation(s)
- Emma Beard
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Robert West
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Colin Angus
- ScHARR, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Gilbert H, Sutton S, Morris R, Petersen I, Galton S, Wu Q, Parrott S, Nazareth I. Effectiveness of personalised risk information and taster sessions to increase the uptake of smoking cessation services (Start2quit): a randomised controlled trial. Lancet 2017; 389:823-833. [PMID: 28129989 PMCID: PMC5357975 DOI: 10.1016/s0140-6736(16)32379-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/18/2016] [Accepted: 10/25/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND National Health Service Stop Smoking Services (SSSs) offer help to smokers motivated to quit; however, attendance rates are low and recent figures show a downward trend. We aimed to assess the effectiveness of a two-component personalised intervention on attendance at SSSs. METHODS We did this randomised controlled trial in 18 SSSs in England. Current smokers (aged ≥16 years) were identified from medical records in 99 general practices and invited to participate by their general practitioner. Individuals who gave consent, were motivated to quit, and had not attended the SSS within the past 12 months, were randomly assigned (3:2), via computer-generated randomisation with permuted blocks (block size of five), to receive either an individually tailored risk letter and invitation to attend a no-commitment introductory session run by the local SSS (intervention group) or a standard generic letter advertising the local SSS (control group). Randomisation was stratified by sex. Masking of participants to receipt of a personal letter and invitation to a taster session was not possible. The personal letter was generated by a research assistant, but the remainder of the research team were masked to group allocation. General practitioners, practice staff, and SSS advisers were unaware of their patients' allocation. The primary outcome was attendance at the first session of an SSS course within 6 months from randomisation. We did analysis by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN 76561916. FINDINGS Recruitment, collection of baseline data, delivery of the intervention, and follow up of participants took place between Jan 31, 2011, and July 12, 2014. We randomly assigned 4384 smokers to the intervention group (n=2636) or the control group (n=1748); 4383 participants comprised the intention-to-treat population. Attendance at the first session of an SSS course was significantly higher in the intervention group than in the control group (458 [17·4%] vs 158 [9·0%] participants; unadjusted odds ratio 2·12 [95% CI 1·75-2·57]; p<0·0001). INTERPRETATION Delivery of personalised risk information alongside an invitation to an introductory session more than doubled the odds of attending the SSS compared with a standard generic invitation to contact the service. This result suggests that a more proactive approach, combined with an opportunity to experience local services, can reduce patient barriers to receiving treatment and has high potential to increase uptake. FUNDING National Institutes of Health Research Health Technology Assessment.
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Affiliation(s)
- Hazel Gilbert
- Research Department of Primary Care and Population Health, UCL, London, UK.
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Richard Morris
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Simon Galton
- Smokefree Camden (Public Health), NHS Camden, London, UK
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, UCL, London, UK
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Proportion of Time Spent Delivering Support Predicts Stop Smoking Advisor Quit Rate Independently of Training, Experience, and Education. J Smok Cessat 2017. [DOI: 10.1017/jsc.2016.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Despite a downwards trend in smoking prevalence, smoking remains the UK's biggest preventable cause of premature mortality. Specialist stop smoking support programmes provided by the NHS have helped to reduce smoking prevalence and whilst there has been a vast amount of research investigating the most effective behavioural and pharmacological support models, little is known about the impact of smoking cessation advisor's smoking status and clinical effectiveness on quit rates. This study aimed to identify factors that contribute to NHS stop smoking advisor performance using a quantitative cross-sectional design via an online survey that was completed by 159 participants in 24 London boroughs. Multiple regression analyses revealed that level of training, years practiced, level of advisor education, number of patients supported in a given year, and smoking status had no significant impact on NHS stop smoking advisor quit rate in this sample. However, the model revealed that proportion of time spent delivering smoking cessation support was significantly associated with quit rate. It is imperative that this finding is considered when recruiting, commissioning, and training new smoking cessation advisors or provider organisations.
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Wu J, Tombor I, Shahab L, West R. Usability testing of a smoking cessation smartphone application ('SmokeFree Baby'): A think-aloud study with pregnant smokers. Digit Health 2017; 3:2055207617704273. [PMID: 29942594 PMCID: PMC6001180 DOI: 10.1177/2055207617704273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/10/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Only a few digital interventions have been developed for pregnant smokers, and little is known about the acceptability and usability of smartphone apps to aid cessation in pregnancy. This study aimed to explore pregnant smokers' views on the design, content and usability of a pregnancy-specific smoking cessation app in order to inform intervention development and optimisation. METHODS Ten interviews were conducted and the 'think-aloud' protocol was used in order to explore participants' views about a smoking cessation smartphone app ('SmokeFree Baby'). The data were subsequently thematically analysed. Participants were 18 and over, pregnant, and daily or weekly cigarette smokers. RESULTS Three main themes were identified: views about the design elements, mode of delivery and content of the intervention. App design was considered as an important element that might influence potential users' engagement with the intervention. Participants felt that the intervention content was educational, motivational and non-judgemental. However, it was emphasised that the app should provide further options for personalisation and include more practical features. CONCLUSIONS Delivering smoking cessation support via a smartphone app can be feasible and acceptable for pregnant smokers. They appear to value content that is motivational, educational and personalised, and meeting these requirements may be important for user experience and promoting engagement with the intervention.
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Affiliation(s)
- Joyce Wu
- Department of Behavioural Science and Health,
University College London, UK
| | - Ildiko Tombor
- Department of Behavioural Science and Health,
University College London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health,
University College London, UK
| | - Robert West
- Department of Behavioural Science and Health,
University College London, UK
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Use of aids for smoking cessation and alcohol reduction: A population survey of adults in England. BMC Public Health 2016; 16:1237. [PMID: 27931202 PMCID: PMC5146832 DOI: 10.1186/s12889-016-3862-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/22/2016] [Indexed: 02/04/2023] Open
Abstract
Background It is important for policy planning to chart the methods smokers and high-risk drinkers use to help them change their behaviour. This study assessed prevalence of use, and characteristics of users, of support for smoking cessation and alcohol reduction in England. Methods Data were used from the Smoking and Alcohol Toolkit Studies, which involve monthly face-to-face computer-assisted interviews of adults aged 16+ in England. We included data collected between June 2014 and July 2015 on 1600 smokers who had made at least one quit attempt and 911 high-risk drinkers (defined as scores >8+ on the full AUDIT or 5+ on questions 1–3 of the AUDIT-C) who had made an attempt to cut down in the past 12 months. Participants provided information on their socio-demographic characteristics and use of aids during their most recent quit attempt including pharmacotherapy, face-to-face counselling, telephone support, self-help materials (digital and printed), and complementary medicine. Results A total of 60.3% of smokers used aids in the past year, compared with just 14.9% of high-risk drinkers. Use of pharmacotherapy was high among smokers and very low among drinkers (56.0%versus1.2%). Use of other aids was low for both behaviours: face-to-face counselling (2.6%versus4.8%), self-help materials (1.4%versus4.1%) and complementary medicine (1.0%versus0.5%). Use of aids was more common among smokers aged 25–54 compared with 16–24 year olds (25–34,ORadj1.49,p = 0.012; 35–44,ORadj1.93,p < 0.001; 35–44,ORadj1.93,p < 0.001; 45–54,ORadj1.66,p = 0.008), with cigarette consumption >10 relative to <1 (10–20,ORadj2.47,p = 0.011; >20,ORadj4.23,p = 0.001), and less common among ethnic minorities (ORadj0.69,p = 0.026). For alcohol reduction, use of aids was higher among ethnic minority groups (ORadj2.41;p = 0.015), and those of social-grade D/E relative to AB (ORadj2.29,p = 0.012&ORadj3.13,p < 0.001). Conclusion In England, the use of pharmacotherapy is prevalent for smoking cessation but not alcohol reduction. Other aids are used at a low rate, with face-to-face counselling being more common for alcohol reduction than smoking cessation. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3862-7) contains supplementary material, which is available to authorized users.
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Levene L, Baker R, Khunti K, Bankart M. Variations in coronary mortality rates between English primary care trusts: observational study 1993-2010. J Public Health (Oxf) 2016; 38:e455-e463. [PMID: 28158701 PMCID: PMC6092919 DOI: 10.1093/pubmed/fdv162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In England, coronary heart disease (CHD) mortality has declined, but variations remain. Methods This study aimed to describe under 75-year CHD mortality variations across geographically defined populations. Regression slopes for mortality data as a function of time were calculated for all 151 English primary care trusts (PCTs), giving the change in the expected age adjusted rate for each extra year. Results Between 1993 and 2010, the mean age-standardized CHD mortality rate decreased from 107.76 to 35.12 per 100 000, but the coefficient of variation increased from 0.21 to 0.27. The slope of decline was significantly less after 2004 (β −4.91 for 1993–2003, −3.04 for 2004–2010). The proportion of smokers decreased by 24.6%. The estimated proportion of the population with controlled hypertension increased by 74.4% (2003–2010), but diabetes increased by 138% (1994–2010) and the proportion of obese people increased by 74.3% (1993–2010). There was a greater decline in CHD mortality in PCTs with greater deprivation and smoking (2006–2010). Conclusions Since 2004, there has not been a relative reduction of variations in CHD mortality. Appropriate strategies to improve early detection and effective management of risk factors are needed to lower overall CHD mortality further and to reduce persistent variations across England.
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Affiliation(s)
- L.S. Levene
- Department of Health Sciences, University of Leicester, 22-28 Princess Road W, Leicester LE1 6TP, UK
| | - R. Baker
- Department of Health Sciences, University of Leicester, 22-28 Princess Road W, Leicester LE1 6TP, UK
| | - K. Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences & Psychology, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - M.J.G. Bankart
- Department of Health Sciences, University of Leicester, 22-28 Princess Road W, Leicester LE1 6TP, UK
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‘I Sat Filling in This Form While Smoking and It Was Divine’. An Analysis of Free-Text Comments from Smokers Who Report They Have No Intention of Quitting in the Next Six Months. J Smok Cessat 2016. [DOI: 10.1017/jsc.2014.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Smokers unmotivated to quit are neglected by smoking cessation research. Free-text comment analysis is a potentially useful way to gain insight into this group's beliefs.Aims: To analyse the free-text comments provided by smokers unmotivated to quit as part of a randomized controlled trial of computer-tailored feedback for smoking cessation.Method: A random sample of 58,660 smokers were sent a smoking behaviour questionnaire (SBQ). The responses and follow-up outcomes of those providing free-text comments were compared to those who did not to assess the representativeness of the former group of smokers. The comments of participants unmotivated to quit (631) were thematically analysed.Results: Those who provided a comment differed from those who did not on variables including education level and quit attempts at six-month follow-up. Emergent themes included; justification of smoking and restricting smoking instead of quitting.Conclusions: The findings illustrate the value of free-text comments in identifying issues important to respondents. The identified themes highlight areas for future research in smokers unmotivated to quit including cutting down as a path to quitting and explicit messages regarding the inability of positive health behaviours to balance out the negative impact of smoking on health.Trial registration: Current Controlled Trials ISRCTN05385712.
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Bauld L, Hiscock R, Dobbie F, Aveyard P, Coleman T, Leonardi-Bee J, McRobbie H, McEwen A. English Stop-Smoking Services: One-Year Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1175. [PMID: 27886140 PMCID: PMC5201316 DOI: 10.3390/ijerph13121175] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 12/02/2022]
Abstract
The UK is a global leader in stop-smoking support-providing free behavioral support and cessation medication via stop smoking services (SSS) without charge to smokers. This study aimed to explore the client and service characteristics associated with abstinence 52 weeks after quitting. A prospective cohort study of 3057 SSS clients in nine different areas of England who began their quit attempt between March 2012 and March 2013 was conducted. Important determinants of long-term quitting were assessed through quit rates and multivariable logistic regression. Our results showed that the overall weighted carbon monoxide validated quit rate for clients at 52 weeks was 7.7% (95% confidence interval (CI) 6.6-9.0). The clients of advisors, whose main role was providing stop-smoking support, were more likely to quit long-term than advisors who had a generalist role in pharmacies or general practices (odds ratio (OR) 2.3 (95% CI 1.2-4.6)). Clients were more likely to achieve abstinence through group support than one-to-one support (OR 3.4 (95% CI 1.7-6.7)). Overall, one in thirteen people who set a quit date with the National Health Service (NHS) Stop-Smoking Service maintain abstinence for a year. Improving abstinence is likely to require a greater emphasis on providing specialist smoking cessation support. Results from this study suggest that over 18,000 premature deaths were prevented through longer-term smoking cessation achieved by smokers who accessed SSS in England from March 2012 to April 2013, but outcomes varied by client characteristic and the type of support provided.
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Affiliation(s)
- Linda Bauld
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
- UK Centre for Tobacco and Alcohol Studies.
| | - Rosemary Hiscock
- UK Centre for Tobacco and Alcohol Studies.
- Department for Health, University of Bath, Bath BA2 7AY, UK.
| | - Fiona Dobbie
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
- UK Centre for Tobacco and Alcohol Studies.
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies.
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies.
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK.
| | - Hayden McRobbie
- UK Centre for Tobacco and Alcohol Studies.
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies.
- National Centre for Smoking Cessation and Training (NCSCT), 1 Great Western Industrial Centre, Dorchester DT1 1RD, UK.
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Beard E, Shahab L, Cummings DM, Michie S, West R. New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline? CNS Drugs 2016; 30:951-83. [PMID: 27421270 DOI: 10.1007/s40263-016-0362-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A wide range of support is available to help smokers to quit and to aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that the needs of tobacco users are met. This paper compares the first-line smoking cessation medications with (1) two variants of these existing products: new galenic formulations of varenicline and novel nicotine delivery devices; and (2) 24 alternative products: cytisine (novel outside Central and Eastern Europe), nortriptyline, other tricyclic antidepressants, electronic cigarettes, clonidine (an anxiolytic), other anxiolytics (e.g. buspirone), selective serotonin reuptake inhibitors, supplements (e.g. St John's wort), silver acetate, Nicobrevin, modafinil, venlafaxine, monoamine oxidase inhibitors (MAOIs), opioid antagonists, nicotinic acetylcholine receptor (nAChR) antagonists, glucose tablets, selective cannabinoid type 1 receptor antagonists, nicotine vaccines, drugs that affect gamma-aminobutyric acid (GABA) transmission, drugs that affect N-methyl-D-aspartate (NMDA) receptors, dopamine agonists (e.g. levodopa), pioglitazone (Actos; OMS405), noradrenaline reuptake inhibitors and the weight management drug lorcaserin. Six 'ESCUSE' criteria-relative efficacy, relative safety, relative cost, relative use (overall impact of effective medication use), relative scope (ability to serve new groups of patients) and relative ease of use-are used. Many of these products are in the early stages of clinical trials; however, cytisine looks most promising in having established efficacy and safety with low cost. Electronic cigarettes have become very popular, appear to be efficacious and are safer than smoking, but issues of continued dependence and possible harms need to be considered.
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Affiliation(s)
- Emma Beard
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK.
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK.
| | - Lion Shahab
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK
| | - Damian M Cummings
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK
| | - Robert West
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK
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Fai SC, Yen GK, Malik N. Quit rates at 6 months in a pharmacist-led smoking cessation service in Malaysia. Can Pharm J (Ott) 2016; 149:303-312. [PMID: 27708676 PMCID: PMC5032936 DOI: 10.1177/1715163516662894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Smoking cessation clinics have been established in Malaysia since 2004, but wide variations in success rates have been observed. This study aimed to evaluate the proposed pharmacist-led Integrated Quit Smoking Service (IQSS) in Sabah, Malaysia, and identify factors associated with successful smoking cessation. METHODS Data from 176 participants were collected from one of the quit-smoking centres in Sabah, Malaysia. Pharmacists, doctors and nurses were involved throughout the study. Any health care provider can refer patients for smoking cessation, and free pharmacotherapy and counselling was provided during the cessation period for up to 3 months. Information on demographic characteristics, smoking behaviours, follow-up and pharmacotherapy were collected. The main outcome measure was the abstinence from smoking, which was verified through carbon monoxide in expired air during the 6-month follow-up. RESULTS A 42.6% success rate was achieved in IQSS. Smoking behaviour such as lower cigarette intake and lower Fagerström score were identified as factors associated with success. On top of that, a longer duration of follow-up and more frequent visits were significantly associated with success in quitting smoking. CONCLUSION Collaboration among health care practitioners should be the main focus, and we need a combination of proven effective modalities in order to create an ideal smoking cessation module.
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Affiliation(s)
- Sui Chee Fai
- Luyang Health Clinics, Kota Kinabalu, Sabah, Malaysia
| | - Gan Kim Yen
- Luyang Health Clinics, Kota Kinabalu, Sabah, Malaysia
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Bartlett YK, Gartland N, Wearden A, Armitage CJ, Borrelli B. "It's my business, it's my body, it's my money": experiences of smokers who are not planning to quit in the next 30 days and their views about treatment options. BMC Public Health 2016; 15:716. [PMID: 27488047 PMCID: PMC4972968 DOI: 10.1186/s12889-016-3395-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Current evidence-based smoking cessation treatments in the UK are only offered to smokers ready to quit within 30 days. This study reports the experiences of smokers who are not ready to quit and explores the types of intervention approaches that might engage them. METHODS Five focus groups were conducted with smokers who had no plans to quit within 30 days (n = 32, 44 % female). Verbatim transcripts were analyzed thematically using Nvivo 10 software. RESULTS Participants were ambivalent towards their own smoking, but the majority indicated they would like to quit someday. Smoking was seen both to hinder and facilitate social interactions, depending on the social norms of the participant's social circle. Participants reported that, when they perceive pressure to quit smoking, they respond defensively; concurrently, existing approaches to encouraging smoking cessation were seen as unappealing. In contrast, the importance of intrinsic motivation to quit was emphasized, and interventions that were tailored, increased intrinsic motivation and kept the smoker engaged in activities incompatible with smoking were preferred. CONCLUSIONS Despite not planning to quit in the next 30 days, the majority of participants wanted to quit smoking at some point. Even if existing services were offered to smokers not planning to quit in the next 30 days, it is unlikely that these services would meet the needs of this population. Future research should explore novel approaches to appeal specifically to smokers not planning to quit in the next 30 days, such as encouraging engagement with activities incompatible with smoking and fostering non-smoking habits.
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Affiliation(s)
- YK Bartlett
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - N. Gartland
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - A. Wearden
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - CJ Armitage
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - B. Borrelli
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Henry M Goldman School of Dental Medicine, Boston University, Boston, MA USA
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Dobbie F, Hiscock R, Leonardi-Bee J, Murray S, Shahab L, Aveyard P, Coleman T, McEwen A, McRobbie H, Purves R, Bauld L. Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study. Health Technol Assess 2016; 19:1-156. [PMID: 26565129 DOI: 10.3310/hta19950] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. OBJECTIVES The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. DESIGN The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. SETTING The setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services. PARTICIPANTS There were 202,804 cases included in secondary analysis and 3075 in the prospective study. INTERVENTIONS A combination of behavioural support and stop smoking medication delivered by SSS practitioners. MAIN OUTCOME MEASURES Abstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test. RESULTS Just over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have remained abstinent than those who were seen by a general practitioner (GP) practice and pharmacy providers [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2 to 4.6]. Clients who received group behavioural support (either closed or rolling groups) were three times more likely to stop smoking than those who were seen by a GP practice or pharmacy providers (OR 3.4, 95% CI 1.7 to 6.7). Satisfaction with services was high and well-being at baseline was found to be a predictor of abstinence from smoking at longer-term follow-up. Continued use of NRT at 1 year was rare, but no evidence of harm from longer-term use was identified from the data collected. CONCLUSIONS Stop Smoking Services in England are effective in helping smokers to move away from tobacco use. Using the 52-week CO-validated quit rate of 8% found in this study, we estimate that in the year 2012-13 the services supported 36,249 clients to become non-smokers for the remainder of their lives. This is a substantial figure and provides one indicator of the ongoing value of the treatment that the services provide. The study raises a number of issues for future research including (1) examining the role of electronic cigarettes (e-cigarettes) in smoking cessation for service clients [this study did not look at e-cigarette use (except briefly in the longer-term NRT study) but this is a priority for future studies]; (2) more detailed comparisons of rolling groups with other forms of behavioural support; (3) further exploration of the role of practitioner knowledge, skills and use of effective behaviour change techniques in supporting service clients to stop smoking; (4) surveillance of the impact of structural and funding changes on the future development and sustainability of SSSs; and (5) more detailed analysis of well-being over time between those who successfully stop smoking and those who relapse. Further research on longer-term use of non-combustible nicotine products that measures a wider array of biomarkers of smoking-related harm such as lung function tests or carcinogen metabolites. FUNDING The National Institute for Health Research Health Technology Assessment programme. The UK Centre for Tobacco and Alcohol Studies provided funding for the longer-term NRT study.
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Affiliation(s)
- Fiona Dobbie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| | - Rosemary Hiscock
- UK Centre for Tobacco and Alcohol Studies, UK.,Department for Health, University of Bath, Bath, UK
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Susan Murray
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| | - Lion Shahab
- UK Centre for Tobacco and Alcohol Studies, UK.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies, UK.,Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies, UK.,National Centre for Smoking Cessation and Training, London, UK
| | - Hayden McRobbie
- UK Centre for Tobacco and Alcohol Studies, UK.,Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, UK
| | - Richard Purves
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,Department for Health, University of Bath, Bath, UK
| | - Linda Bauld
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
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42
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Braillon A, Bewley S. Choosing between financial incentives to patients or teaching practitioners basic pharmacology and motivational interviewing. Addiction 2016; 111:1114-5. [PMID: 27157908 DOI: 10.1111/add.13307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 01/16/2023]
Affiliation(s)
| | - Susan Bewley
- Women's Health Academic Centre, Kings College London, London, UK.
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43
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Faulkner K, Sutton S, Jamison J, Sloan M, Boase S, Naughton F. Are Nurses and Auxiliary Healthcare Workers Equally Effective in Delivering Smoking Cessation Support in Primary Care? Nicotine Tob Res 2015; 18:1054-60. [PMID: 26453668 PMCID: PMC4826488 DOI: 10.1093/ntr/ntv206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 08/29/2015] [Indexed: 11/23/2022]
Abstract
Introduction: Smoking cessation support is increasingly delivered in primary care by auxiliary healthcare workers in place of healthcare professionals. However, it is unknown whether this shift might affect the quality and impact of the support delivered. Methods: Data from the iQuit in Practice randomized control trial of cessation support in General Practice was used (N = 602). Analyses assessed whether cessation advisor type (nurse or healthcare assistant [HCA]) was associated with abstinence (primary outcome: self-reported 2-week point prevalence abstinence at 8 weeks follow-up), the advice delivered during the initial consultation, pharmacotherapies prescribed, patient satisfaction, initial consultation length, and the number and type of interim contacts. Results: There were no statistically significant differences in abstinence for support delivered by HCAs versus nurses at 8 weeks (HCAs 42.8%, nurses 42.6%; unadjusted odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.73 to 1.40), or at 4 weeks or 6 months follow-up. There were no statistically significant differences in advice delivered, the types of pharmacotherapies prescribed or patient satisfaction. Compared with nurses, HCA consultations were longer on average (HCAs 23.6 minutes, nurses 20.8 minutes; P = .002) and they undertook more interim contacts (HCAs median 2, nurses median 1; P < .001), with contact more likely to be face-to-face than phone call (HCAs 91.2%, nurses 70.9%; OR = 4.23, 95% CI = 2.86 to 6.26). Conclusions: HCAs appear equally effective as nurses in supporting smoking cessation, although they do this with greater patient contact. Using auxiliary practitioners to deliver cessation support could free up nurse time and reduce costs. Implications: This study found that primary care patients receiving smoking cessation support from auxiliary healthcare workers were just as likely to be abstinent up to 6 months later as those patients seen by nurses. While the auxiliary healthcare workers achieved this with slightly increased patient contact time, the advice delivered, pharmacotherapies provided and patient satisfaction were similar to that of nurses. Expanding the auxiliary healthcare worker role to include smoking cessation support could increase role satisfaction and reduce the costs of cessation support delivery in primary care.
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Affiliation(s)
- Kathryn Faulkner
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - James Jamison
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Melanie Sloan
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Sue Boase
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Felix Naughton
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
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44
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Saladin ME, McClure EA, Baker NL, Carpenter MJ, Ramakrishnan V, Hartwell KJ, Gray KM. Increasing progesterone levels are associated with smoking abstinence among free-cycling women smokers who receive brief pharmacotherapy. Nicotine Tob Res 2015; 17:398-406. [PMID: 25762749 DOI: 10.1093/ntr/ntu262] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Preclinical and human laboratory research suggests that (a) progesterone may decrease drug reward, craving, and smoking behavior, and (b) estradiol may enhance drug reward and smoking behavior. A modest majority of treatment research examining the relationship between menstrual cycle phase and outcomes suggests that the luteal menstrual phase, with its uniquely higher progesterone levels, is associated with better cessation outcomes. However, no studies to date have examined the effects of naturally occurring variation in progesterone and estradiol levels on medication-assisted smoking cessation. The present study sought to fill this notable gap in the treatment literature. METHODS Weekly plasma progesterone and estradiol levels were obtained from nicotine-dependent female smokers enrolled in a 4-week cessation trial. Participants (N = 108) were randomized to receive a 4-week course of either varenicline (VAR) tablets and placebo patches or placebo tablets and nicotine patches. Plasma samples were obtained 1 week before their cessation attempt and weekly during medication administration. Abstinence was assessed weekly. RESULTS Weekly hormone data replicated commonly observed menstrual cycle patterns of progesterone and estradiol levels. Importantly, increases in progesterone level were associated with a 23% increase in the odds for being abstinent within each week of treatment. This effect was driven primarily by nicotine patch-treated versus VAR-treated females. CONCLUSIONS This study was the first to identify an association between progesterone level (increasing) and abstinence outcomes in free-cycling women smokers who participated in a medication-based treatment. Furthermore, the potential benefits of progesterone may vary across different pharmacotherapies. Implications of these findings for smoking cessation intervention are discussed.
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Affiliation(s)
- Michael E Saladin
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC; Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC;
| | - Erin A McClure
- Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC
| | - Nathaniel L Baker
- Department Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Matthew J Carpenter
- Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | - Karen J Hartwell
- Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Substance Abuse Treatment Center, Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Kevin M Gray
- Clinical Neuroscience Division, Medical University of South Carolina, Charleston, SC; Youth Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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45
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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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46
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Grant A, Ashton K, Phillips R. Foucault, surveillance, and carbon monoxide testing within stop-smoking services. QUALITATIVE HEALTH RESEARCH 2015; 25:912-22. [PMID: 25294348 PMCID: PMC4452544 DOI: 10.1177/1049732314553992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Health professionals have adopted proactive testing for early evidence of disease. Researchers have identified that this leads to enumerated understandings and shapes behavior in productive ways. Smoking-cessation advisors regularly test clients for carbon monoxide (CO), but client views of this had not previously been explored. We interviewed 23 clients of a United Kingdom-based stop-smoking service regarding their experiences of CO testing. The majority of participants were successful quitters. We used ATLAS.ti 7 as a data-management tool during structured qualitative analysis. Our findings reveal that clients believed the results of their CO tests. Many became enumerated in their understanding, and thus placed themselves in a hierarchy with other members of their group. Almost all clients found that knowing their CO test score was motivating. We conclude that additional research is needed to understand the experiences of CO testing among clients who do not quit.
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Affiliation(s)
| | - Kathryn Ashton
- Public Health Wales National Health Service Trust, Cardiff, United Kingdom
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47
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Ussher M, Brown J, Rajamanoharan A, West R. How do prompts for attempts to quit smoking relate to method of quitting and quit success? Ann Behav Med 2015; 47:358-68. [PMID: 24046150 DOI: 10.1007/s12160-013-9545-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Understanding how prompts for quit attempts relate to quitting methods and success may improve smoking cessation interventions. PURPOSE This study aims to establish whether prompts for quitting are associated with quitting method and success. METHODS Using a cross-sectional design, 6,126 past-year smokers who had tried to quit in the last 12 months, were asked to identify prompts contributing to their most recent attempt. RESULTS Attempts prompted by health professional advice were significantly more likely to involve use of treatments and gradual rather than abrupt cessation (odds ratios (ORs; 95 % confidence interval (CIs)) = 3.64 (3.14-4.22), 0.68 (0.59-0.78); respectively) but were not more likely to succeed. Attempts prompted by concern about current or future health, or cost, were more likely to succeed (OR (95 % CIs) = 1.79 (1.38-2.32), 1.25 (1.01-1.54), and 1.41 (1.13-1.76)). CONCLUSIONS Quit attempts prompted by health professional advice appear to be more likely to involve gradual reduction and use of treatments. Those prompted by health concerns and cost appear more likely to succeed.
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Affiliation(s)
- Michael Ussher
- Division of Population Health Sciences and Education, St George's University of London, Cranmer Terrace, London, UK,
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48
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Ormston R, van der Pol M, Ludbrook A, McConville S, Amos A. quit4u: the effectiveness of combining behavioural support, pharmacotherapy and financial incentives to support smoking cessation. HEALTH EDUCATION RESEARCH 2015; 30:121-133. [PMID: 24848555 DOI: 10.1093/her/cyu024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The 'quit4u' stop smoking service (SSS) was developed by National Health Service (NHS) Tayside for smokers in deprived areas of Dundee (UK). quit4u combined behavioural support and pharmacotherapy with financial incentives for each week that participants remained quit. A quasi-experimental study was undertaken with smokers using quit4u between 2009 and 2011 compared with smokers using SSSs in the rest of Scotland. The outcome measures were: number of quit attempts; quit rates at 1, 3 and 12 months; cost-effectiveness. Mechanisms of change were explored through quantitative and qualitative research that explored the views and experiences of service users and professionals involved in quit4u. The number of quit attempts made using SSSs in deprived areas of NHS Tayside increased by 44% between 2007 and 2010. quit4u had significantly higher quit rates at 1 month (49.9% versus 33.7%), 3 months (30.7% versus 14.2%) and 12 months (9.3% versus 6.5%) compared with similar smokers using other SSSs. The incremental cost per quitter was £2296. A combination of elements kept clients engaged and supported quit attempts: carbon monoxide (CO) tests, financial incentives, high-quality pharmacy support, rolling groups and greater varenicline use. quit4u may provide an effective and cost-effective model for engaging and supporting smokers in deprived areas to quit.
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Affiliation(s)
- R Ormston
- ScotCen Social Research, Edinburgh, UK, Health Economics Research Unit, University of Aberdeen, Aberdeen, UK and UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - M van der Pol
- ScotCen Social Research, Edinburgh, UK, Health Economics Research Unit, University of Aberdeen, Aberdeen, UK and UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - A Ludbrook
- ScotCen Social Research, Edinburgh, UK, Health Economics Research Unit, University of Aberdeen, Aberdeen, UK and UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - S McConville
- ScotCen Social Research, Edinburgh, UK, Health Economics Research Unit, University of Aberdeen, Aberdeen, UK and UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - A Amos
- ScotCen Social Research, Edinburgh, UK, Health Economics Research Unit, University of Aberdeen, Aberdeen, UK and UK Centre for Tobacco and Alcohol Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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49
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Association of amount and duration of NRT use in smokers with cigarette consumption and motivation to stop smoking: a national survey of smokers in England. Addict Behav 2015; 40:33-8. [PMID: 25218069 DOI: 10.1016/j.addbeh.2014.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/03/2014] [Accepted: 08/22/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Clinical trials have found that the use of nicotine replacement therapy (NRT) to reduce cigarette consumption results in significant declines in cigarette consumption and increases smokers' propensity to quit. However, observational "real-world" studies have found much smaller effects. This may be because of low levels of NRT use. This study examined the association between amount and duration of NRT use amongst those attempting to reduce their cigarette consumption with motivation to quit and cigarette consumption. METHODS Data came from 2,158 smokers who took part in the Smoking Toolkit Study. A representative survey of smokers in England aged 16+. RESULTS Only 54.4% of patch users and 32.2% of non-transdermal NRT users reported using NRT with a frequency that would be expected to substantially influence cigarette consumption (4+ units per day for acute NRT forms and at least daily for transdermal patches). Those using the patch at or above this threshold smoked 1.3 cigarettes per day fewer than those using it below the threshold (p=0.059), whilst those using non-transdermal NRT at or above this threshold smoked 0.9 cigarettes less per day (p=0.022). In both cases, those using NRT more frequently had greater motivation to quit. Less than 1/5th of participants reported using a combination of NRT products. Use of NRT long-term was associated with lower motivation to quit and higher cigarette consumption. CONCLUSION Smokers attempting to reduce their cigarette intake are underusing NRT and this is associated with cigarette consumption and motivation to quit. These findings may explain why population-based studies have failed to report similar findings to clinical trials.
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50
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Brose LS, West R, Michie S, McEwen A. Changes in success rates of smoking cessation treatment associated with take up of a national evidencebased training programme. Prev Med 2014; 69:1-4. [PMID: 25152508 DOI: 10.1016/j.ypmed.2014.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/26/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The English 'stop smoking services' provide behavioural support to some 700,000 smokers annually. Success rates of the services varied considerably before 2010 and had been in slight decline so, to improve performance, a national programme of evidence-based practitioner training was developed to improve knowledge and skills-based competences. This study evaluated whether uptake of the training was associated with improvements in success rates of services. METHODS Mean 4-week biochemically verified abstinence rates were compared for 146 (of 151) stop smoking services between 2008-10 (before roll-out of training) and 2011-13 (after roll-out), and the change in success rates for each service was regressed on to the number of practitioners per service trained in a) knowledge (online) and b) skills (face-to-face). RESULTS Success rate across all services improved between the two periods (34.1% to 36.5%, p=0.01 1-tailed; 95% CI for difference 0.44-4.48). The magnitude of improvement for each service was associated with the number of practitioners who completed the knowledge and skills training (beta=0.22, p=0.005 1-tailed), and marginally with the number who completed the knowledge training (beta=0.14, p=0.047 1-tailed). CONCLUSION English stop smoking services that have greater uptake of a national evidence-based training programme showed greater improvements in success rates.
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Affiliation(s)
- Leonie S Brose
- UK Centre for Tobacco and Alcohol Studies, Addictions, Institute of Psychiatry, King's College London, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
| | - Susan Michie
- Clinical, Educational and Health Psychology, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
| | - Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
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