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Siddiqui F, Kanaan M, Croucher R, Bauld L, Fieroze F, Kumar P, Mazhar L, Pandey V, Jackson C, Huque R, Iqbal R, Siddiqi K. Behavioural support and nicotine replacement therapy for smokeless tobacco cessation in Bangladesh, India and Pakistan: A pilot randomized controlled trial. Addiction 2024; 119:1366-1377. [PMID: 38769627 DOI: 10.1111/add.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/07/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND AIMS Smokeless tobacco (ST) use in South Asia is high, yet interventions to support its cessation are lacking. We tested the feasibility of delivering interventions for ST cessation in South Asia. DESIGN We used a 2 × 2 factorial design, pilot randomized controlled trial with a duration of 26 weeks, including baseline and follow-up (6, 12 and 26 weeks) assessments. SETTING Two primary health-care facilities each in Dhaka (Bangladesh) and Karachi (Pakistan) and a walk-in cancer screening clinic in Noida (India) took part. PARTICIPANTS Adult daily ST users willing to make a quit attempt within 30 days. Of 392 screened, 264 participants [mean age: 35 years, standard deviation = 12.5, 140 (53%) male] were recruited between December 2020 and December 2021; 132 from Bangladesh, 44 from India and 88 from Pakistan. INTERVENTIONS Participants were randomized to one of three treatment options [8-week support through nicotine replacement therapy (NRT, n = 66), a behavioural intervention for smokeless tobacco cessation in adults (BISCA, n = 66) or their combination (n = 66)] or the control condition of very brief advice (VBA) to quit (n = 66). MEASUREMENTS Recruitment and retention, data completeness and feasibility of intervention delivery were evaluated. Biochemically verified abstinence from tobacco, using salivary cotinine, was measured at 26 weeks. FINDINGS Retention rates were 94.7% at 6 weeks, dropping to 89.4% at 26 weeks. Attendance in BISCA pre-quit (100%) and quit sessions (86.3%) was high, but lower in post-quit sessions (65.9%), with variability among countries. Adherence to NRT also varied (45.5% Bangladesh, 90% India). Data completion for key variables exceeded 93% among time-points, except at 26 weeks for questions on nicotine dependence (90%), urges (89%) and saliva samples (62.7%). Among follow-up time-points, self-reported abstinence was generally higher among participants receiving BISCA and/or NRT. At 26 weeks, biochemically verified abstinence was observed among 16 (12.1%) participants receiving BISCA and 13 (9.8%) participants receiving NRT. CONCLUSIONS This multi-country pilot randomized controlled trial of tobacco cessation among adult smokeless tobacco users in South Asia demonstrated the ability to recruit and retain participants and report abstinence, suggesting that a future definitive smokeless tobacco cessation trial is viable.
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Affiliation(s)
- Faraz Siddiqui
- Department of Health Sciences, University of York, York, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Ray Croucher
- Department of Health Sciences, University of York, York, UK
| | - Linda Bauld
- Usher Institute and Behavioural Research UK, University of Edinburgh, Edinburgh, UK
| | | | - Prashant Kumar
- National Institute of Cancer Prevention Research, Noida, India
| | | | - Varsha Pandey
- National Institute of Cancer Prevention Research, Noida, India
| | | | - Rumana Huque
- ARK Foundation, Dhaka, Bangladesh
- University of Dhaka, Dhaka, Bangladesh
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
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Pahwa V, Pimple SA, Bhattacharjee A, Kuberkar D, Mishra GA, Chaturvedi P. Behavioural interventions for tobacco cessation in India: A systematic review and meta-analysis. J Family Med Prim Care 2023; 12:2542-2551. [PMID: 38186806 PMCID: PMC10771179 DOI: 10.4103/jfmpc.jfmpc_1017_23] [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: 06/20/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 01/09/2024] Open
Abstract
Tobacco consumption is an area of public health concern in India. One of the unmet needs of many low-resource countries is to provide cost-effective tobacco cessation interventions for reducing tobacco-related mortality. This article reviews studies on non-pharmacological interventions for tobacco cessation in India. A systematic review by PICO (population, intervention, comparison, outcome) of behavioural intervention-based tobacco cessation studies that met the inclusion criteria, with a minimum 1-month follow-up, reporting outcomes in terms of frequencies or percentages published between 2010 and 2020 was performed. Following the review stages, 16 studies comprising 9,613 participants were included in the review. A pooled estimate was derived using both fixed-effects and random-effects models. The intervention showed good overall efficacy for any tobacco user (relative risk [RR] = 1.73 [95% confidence interval [CI]: 1.58-1.90) (fixed-effect model)] and (RR = 2.02 [95% CI: 1.64-2.48] [random-effects model]). Behavioural intervention studies targeted towards only smokers (RR of 1.81 [95% CI: 1.55-2.11] and 1.96 [95% CI: 1.52-2.53]) and combined smoking and smokeless tobacco users (RR of 1.69 [95% CI: 1.50-1.90] and 2.12 [95% CI: 1.49-3.01]) were equally efficacious. The review provides the effectiveness of behavioural interventions in quitting tobacco among users of both smoking and smokeless forms of tobacco. The review findings are of particular significance to inform health policy decisions on the integration of cost-effective brief behavioural intervention into existing health care services in resource-constrained countries.
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Affiliation(s)
- Vandita Pahwa
- Department of Preventive Oncology, Homi Bhabha Cancer Hospital and Research Center, New Chandigarh, Punjab, India
| | - Sharmila A. Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepali Kuberkar
- Department of Library Science, Digital Library, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gauravi A. Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head Neck Surgery, Deputy Director, Centre for Cancer Epidemiology (CCE), Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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Goel S, Anjali C, Kar SS, Joseph N, Kumar R, Medini SK, Das M. Comparative assessment of implementation of Cigarette and Other Tobacco Products Act in three States of India: A pre-post study. Indian J Med Res 2023; 158:455-465. [PMID: 38238021 PMCID: PMC10878487 DOI: 10.4103/ijmr.ijmr_2359_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND OBJECTIVES The Cigarette and Other Tobacco Products Act (COTPA) limits the sale of tobacco products, promotion and advertising and packaging of tobacco products in India. Periodic monitoring of the level of compliance with all sections of COTPA is obligatory to assess the effectiveness of the act. METHODS This pre-post study aimed to assess the change in the level of compliance with different sections of COTPA in selected States. A total of 3849 and 2176 samples were assessed during the study in November 2020 and October 2021, respectively; using the EpiData Software. RESULTS Average compliance with section 4 of COTPA was highest in Puducherry during baseline [51.88%, prevalence ratio (PR)=0.72, 95% confidence interval (CI): 0.51-1.02] and in Telangana during endline assessment (66.1%, PR=0.6, 95% CI: 0.48-0.74). A visible change with section 5 of COTPA was observed in Telangana (40.08 to 93.12%, PR=0.04, 95% CI: 0.02-0.07). Compliance with section 6a of COTPA decreased in Puducherry (81.34 to 71.83%, PR=1.84, 95% CI: 1.14-2.95) and increased for Meghalaya and Telangana. The average compliance with sections 7, 8 and 9 (for Puducherry 51.09 vs . 48.8%, Meghalaya 54.94 vs . 46.18% and Telangana 73 vs . 51.91%, respectively) decreased in all States. An increase in average compliance was observed with sections 4 and 5 ( P =0.19 and 0.11, respectively) and a decrease with sections 7, 8 and 9 ( P =0.02) of COTPA in all three States. For sections 6a ( P =0.06) and 6b ( P =0.01), a mixed response was noted. INTERPRETATION CONCLUSIONS The findings of this study suggest that the level of compliance with sections 4 and 5 of COTPA increased because they are strictly monitored compared to sections 7-9, which are less enforced by the States. There is a need to monitor sections 7-9 (pack warning) to fulfill the objectives related to the World Health Organization (WHO) Framework Convention on Tobacco Control.
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Affiliation(s)
- Sonu Goel
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - C Anjali
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sitanshu Sekhar Kar
- Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Neema Joseph
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajeev Kumar
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Shravan Kumar Medini
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Munmee Das
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Satish P, Khetan A, Shah D, Srinivasan S, Balakrishnan R, Padmanandan A, Hejjaji V, Hull L, Samuel R, Josephson R. Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial. J Gen Intern Med 2023; 38:3162-3170. [PMID: 37286774 PMCID: PMC10247264 DOI: 10.1007/s11606-023-08243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings. OBJECTIVE We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling. DESIGN Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India. PARTICIPANTS Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking. INTERVENTION A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge. MAIN MEASURES The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training. KEY RESULTS Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001). CONCLUSIONS Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates. TRIAL REGISTRATION URL: http://www. CLINICALTRIALS gov . Unique identifier: NCT03521466.
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Affiliation(s)
- Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Aditya Khetan
- Division of Cardiology, McMaster University, Hamilton, ON, Canada
| | | | - Shuba Srinivasan
- Department of General Medicine, SMSIMSR, Muddenahalli, Karnataka, India
| | | | - Arun Padmanandan
- Senior Zonal AEFI Consultant, Ministry of Health and Family Welfare, Govt of India, New Delhi, India
| | - Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Leland Hull
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Reema Samuel
- Department of Psychiatry, Christian Medical College, Vellore, India
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Krishnamoorthy Y, Elangovan V, Rajaa S. Non-pharmacological Interventions for Tobacco Cessation in India: A Systematic Review and Network Meta-analysis. Nicotine Tob Res 2023; 25:1701-1708. [PMID: 37195879 DOI: 10.1093/ntr/ntad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/17/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Non-pharmacological management of tobacco cessation has been reported to yield a high level of abstinence from tobacco usage. However, it is unclear which type of non-pharmacological intervention to be adopted in national tobacco control program. Hence, we undertook this review to identify the best non-pharmacological tobacco cessation therapies for tobacco cessation. AIMS AND METHODS Systematic literature search was performed in EMBASE, SCOPUS, PubMed Central, CENTRAL, MEDLINE, Google Scholar, ScienceDirect, and Clinicaltrials.gov from 1964 until September 2022. Randomized controlled trials assessing the effectiveness of non-pharmacological intervention for tobacco cessation in India were eligible for inclusion. Comparative intervention effect estimates obtained from network meta-analyses were represented as pooled odds ratio (OR) with 95% confidence interval (CI). RESULTS 21 studies were eligible for the analysis. More than half of the studies had high risk of bias. E-Health intervention had the highest OR (pooled OR = 9.90; 95% CI: 2.01 to 48.86) in terms of tobacco cessation rate followed by group counseling (pooled OR = 3.61; 95% CI: 1.48 to 8.78) and individual counseling (pooled OR = 3.43; 95% CI: 1.43 to 8.25). Brief advice or self-help intervention or comparison between each of these interventions against each other (both direct and indirect network) did not yield any significant results. CONCLUSIONS E-Health intervention was the best intervention followed by group intervention and individual face-to-face counseling intervention for tobacco cessation in India. Nonetheless, more high-quality large-scale RCTs either individual or by combining the e-Health, individual, or group counseling interventions are required to provide conclusive evidence and subsequent adoption into the national health programs in India. IMPLICATIONS This study would aid the policymakers, clinicians, and public health researchers in choosing the right tobacco cessation therapy to be offered across various levels of the healthcare delivery system, including major health facilities providing drug therapy (ie, concurrently with pharmacological treatment for tobacco cessation) in India. The study findings can be adopted by the national tobacco control program to decide the appropriate intervention package and identify the areas of focus to perform tobacco-related research in the country.
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Affiliation(s)
| | - Venmathi Elangovan
- Department of Community Medicine, ESIC Medical College and Hospital, Chennai, India
| | - Sathish Rajaa
- Department of Community Medicine, ESIC Medical College and Hospital, Chennai, India
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Mazumdar P, Zavala G, Aslam F, Muliyala KP, Chaturvedi SK, Kandasamy A, Nizami A, Ul Haq B, Kellar I, Jackson C, Thomson H, McDaid D, Siddiqi K, Hewitt C, Siddiqi N, Gilbody S, Murthy P, Dadirai Mdege N. IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S): A protocol for a randomised controlled feasibility trial of a combined behavioural and pharmacological support intervention. PLoS One 2023; 18:e0287185. [PMID: 37315070 DOI: 10.1371/journal.pone.0287185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION The prevalence of smoking is high among people living with severe mental illness (SMI). Evidence on feasibility, acceptability and effectiveness of smoking cessation interventions among smokers with SMI is lacking, particularly in low- and middle-income countries. We aim to test the feasibility and acceptability of delivering an evidence-based intervention,i.e., the IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S) intervention that is a combination of behavioural support and smoking cessation pharmacotherapies among adult smokers with SMI in India and Pakistan. We will also test the feasibility and acceptability of evaluating the intervention in a randomised controlled trial. METHODS We will conduct a parallel, open label, randomised controlled feasibility trial among 172 (86 in each country) adult smokers with SMI in India and Pakistan. Participants will be allocated 1:1 to either Brief Advice (BA) or the IMPACT 4S intervention. BA comprises a single five-minute BA session on stopping smoking. The IMPACT 4S intervention comprises behavioural support delivered in upto 15 one-to-one, face-to-face or audio/video, counselling sessions, with each session lasting between 15 and 40 minutes; nicotine gum and/or bupropion; and breath carbon monoxide monitoring and feedback. Outcomes are recruitment rates, reasons for ineligibility/non-participation/non-consent of participants, length of time required to achieve required sample size, retention in study and treatments, intervention fidelity during delivery, smoking cessation pharmacotherapy adherence and data completeness. We will also conduct a process evaluation. RESULTS Study will address- uncertainty about feasibility and acceptability of delivering smoking cessation interventions, and ability to conduct smoking cessation trials, among adult smokers with SMI in low- and middle-income countries. CONCLUSIONS This is to inform further intervention adaptation, and the design and conduct of future randomised controlled trials on this topic. Results will be disseminated through peer-review articles, presentations at national, international conferences and policy-engagement forums. TRIAL REGISTRATION ISRCTN34399445 (Updated 22/03/2021), ISRCTN Registry https://www.isrctn.com/.
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Affiliation(s)
- Papiya Mazumdar
- Department of Health Sciences, University of York, York, United Kingdom
- School of Politics and International Studies, University of Leeds, Leeds, United Kingdom
| | - Gerardo Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi, Pakistan
| | | | | | - Arun Kandasamy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Asad Nizami
- Institute of Psychiatry, Rawalpindi, Pakistan
| | - Baha Ul Haq
- Institute of Psychiatry, Rawalpindi, Pakistan
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Cath Jackson
- Department of Health Sciences, University of York, York, United Kingdom
- Valid Research Ltd, Wetherby, United Kingdom
| | | | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, United Kingdom
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Hull York Medical School, Heslington, United Kingdom
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Gakkhar A, Mehendale A, Mehendale S. Tobacco Cessation Intervention for Young People. Cureus 2022; 14:e30308. [PMID: 36407239 PMCID: PMC9659423 DOI: 10.7759/cureus.30308] [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: 09/10/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023] Open
Abstract
Most adolescent tobacco control programs focus on preventing consumption, but teen smoking persists. It is uncertain whether adult-specific therapies can assist adolescents in quitting smoking. The rising incidence of smoking in low and middle-socioeconomic countries and the challenges of conducting tobacco cessation programs in these settings (due to increasing population, poor lifestyle, lack of awareness and education, professional stress, and non-compliance) need an emphasis on the scope of trials to conduct tobacco cessation in these settings. In the 11th Five Year Plan, the Indian government introduced a new National Tobacco Control Program, which currently spans 108 districts in 31 states across the country. The objective is to review the randomized control trials of selected individuals held in India and assess and evaluate the effectiveness of the steps taken by the government to help people quit tobacco consumption. These programs are important because of the hazards and impact they have on the public health indices of the nation. The government has taken steps like prohibiting smoking in public areas and banning sources. Several programs, particularly those that employed group counselling, included a range of approaches that proved beneficial in helping young people quit smoking. The RCTs mentioned are psychosocially followed by behavioral and pharmacological therapies. The challenges faced are not having participatory health care, motivating tobacco users to quit even in the short-term, adequate coverage; barriers at a different level of implementation (at a regional, state, or national level); and interference by the tobacco industry should be eliminated. The currently functioning programs in India are the National Tobacco Control Program, the National and three Regional Quitlines and mCessation.
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Affiliation(s)
- Avni Gakkhar
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Ashok Mehendale
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shivansh Mehendale
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Insititute of Medical Sciences, Wardha, IND
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Morar T, Robertson L. Smoking cessation among people with mental illness: A South African perspective. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 36073100 PMCID: PMC9453116 DOI: 10.4102/safp.v64i1.5489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Tobacco use is recognised as a serious, worldwide public health concern. Smoking cessation is of great interest across a wide range of medical specialities, including family medicine. However, smoking cessation among people with mental illness (PWMI) has attracted scant attention in South African literature. This is despite PWMI suffering disproportionately from the damages of tobacco. The harms of smoking are not limited to physical health but extend to mental health. This article discusses the need for multifaceted smoking cessation treatments for PWMI in the public health sector, taking into consideration the prevalence and unique drivers of smoking in this population. A brief overview of patterns of tobacco use, associated harms and smoking cessation interventions in South Africa is given; all within the context of mental illness.
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Affiliation(s)
- Tejil Morar
- Department of Psychiatry, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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Siddiqui F, Bauld L, Croucher R, Jackson C, Kellar I, Kanaan M, Pokhrel S, Huque R, Iqbal R, Khan JA, Mehrotra R, Siddiqi K. Behavioural support and nicotine replacement therapy for smokeless tobacco cessation: protocol for a pilot randomised-controlled multi-country trial. Pilot Feasibility Stud 2022; 8:189. [PMID: 35996179 PMCID: PMC9396808 DOI: 10.1186/s40814-022-01146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Smokeless tobacco (ST) is consumed globally by more than 350 million people, with approximately 85% of all users based in South and Southeast Asia. In this region, ST products are cheap and easily accessible. Evidence-based interventions to people quit ST use are lacking. This study aims to test the feasibility of conducting a future definitive trial of ST cessation, using a culturally adapted behavioural intervention, and/or nicotine replacement therapy (NRT) in three South Asian countries. METHODS We will conduct a factorial design, randomised-controlled pilot trial in Bangladesh, India and Pakistan. Daily ST users will be recruited from primary health care settings in Dhaka, Noida and Karachi. Participants will be individually randomised to receive intervention A (4 or 6 mg NRT chewing gum for 8-weeks), intervention B (BISCA: face-to-face behavioural support for ST cessation), a combination of interventions A and B or usual care (Very Brief Advice - VBA). The participants will provide demographic and ST use related data at baseline, and at 6, 12 and 26 weeks of follow-up. Salivary cotinine samples will be collected at baseline and 26 weeks. The analyses will undertake an assessment of the feasibility of recruitment, randomisation, data collection and participant retention, as well as the feasibility of intervention delivery. We will also identify potential cessation outcomes to inform the main trial, understand the implementation, context and mechanisms of impact through a process evaluation and, thirdly, establish health resource use and impact on the quality of life through health economic data. DISCUSSION The widespread and continued use of ST products in South Asia is consistent with a high rate of associated diseases and negative impact on the quality of life. The identification of feasible, effective and cost-effective interventions for ST is necessary to inform national and regional efforts to reduce ST use at the population level. The findings of this pilot trial will inform the development of larger trials for ST cessation among South Asian users, with relevance to wider regions and populations having high rates of ST use. TRIAL REGISTRATION ISRCTN identifier 65109397.
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Affiliation(s)
- Faraz Siddiqui
- Department of Health Sciences, University of York, Heslington, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK.
| | - Ray Croucher
- Department of Health Sciences, University of York, Heslington, UK
| | - Cath Jackson
- Department of Health Sciences, University of York, Heslington, UK
- Valid Research Ltd., Wetherby, UK
| | - Ian Kellar
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, UK
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Department of Health Sciences, Brunel University London, Uxbridge, UK
| | | | - Romaina Iqbal
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ravi Mehrotra
- Department of Health Sciences, University of York, Heslington, UK
- ICMR - India Cancer Research Consortium, New Delhi, India
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, UK
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Fakir AMS, Bharati T. Healthy, nudged, and wise: Experimental evidence on the role of information salience in reducing tobacco intake. HEALTH ECONOMICS 2022; 31:1129-1166. [PMID: 35347817 PMCID: PMC9310572 DOI: 10.1002/hec.4509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
We evaluate the performance of two behavioral interventions aimed at reducing tobacco consumption in an ultra-poor rural region of Bangladesh, where conventional methods like taxes and warning labels are infeasible. The first intervention asked participants to daily log their tobacco consumption expenditure. The second intervention placed two graphic posters with warnings about the harmful effects of tobacco consumption on tobacco users and their children in the sleeping quarters of the participating households. While both interventions reduced household tobacco consumption expenditure, male participants who logged their expenditure substituted cigarettes with cheaper smokeless tobacco. The reduction in tobacco intake is larger among males with a non-tobacco consuming spouse. Exploratory analysis reveals that risk-averse males who spent relatively more on tobacco responded more to the logbook intervention. More educated, patient males with children below age five responded better to the poster intervention. The findings suggest that in countries with multi-tiered tobacco excise tax structures, which incentivize downward substitution, extending complementary demand-side policies that worked elsewhere to the rural poor might be unwise. Instead, policies may leverage something as universal as parental concern for their children's health to promote better health decision-making.
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Affiliation(s)
- Adnan M. S. Fakir
- Department of EconomicsUniversity of Sussex Business SchoolBrightonUK
| | - Tushar Bharati
- Department of EconomicsUniversity of Western Australia Business SchoolPerthWestern AustraliaAustralia
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Huynh N, Tariq S, Charron C, Hayes T, Bhanushali O, Kaur T, Jama S, Ambade P, Bignell T, Hegarty T, Shorr R, Pakhale S. Personalised multicomponent interventions for tobacco dependence management in low socioeconomic populations: a systematic review and meta-analysis. J Epidemiol Community Health 2022; 76:jech-2021-216783. [PMID: 35623792 PMCID: PMC9279829 DOI: 10.1136/jech-2021-216783] [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: 03/17/2021] [Accepted: 03/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND There remains a disproportionally high tobacco smoking rate in low-income populations. Multicomponent tobacco dependence interventions in theory are effective. However, which intervention components are necessary to include for low socioeconomic status (SES) populations is still unknown. OBJECTIVE To assess the effectiveness of multicomponent tobacco dependence interventions for low SES and create a checklist tool examining multicomponent interventions. METHODS EMBASE and MEDLINE databases were searched to identify randomised controlled trials (RCTs) published with the primary outcome of tobacco smoking cessation measured at 6 months or post intervention. RCTs that evaluated tobacco dependence management interventions (for reduction or cessation) in low SES (experience of housing insecurity, poverty, low income, unemployment, mental health challenges, illicit substance use and/or food insecurity) were included. Two authors independently abstracted data. Random effects meta-analysis and post hoc sensitivity analysis were performed. RESULTS Of the 33 included studies, the number of intervention components ranged from 1 to 6, with smoking quit rates varying between 1% and 36.6%. Meta-analysis revealed that both the 6-month and 12-month outcome timepoints, multicomponent interventions were successful in achieving higher smoking quit rates than the control (OR 1.64, 95% Cl 1.41 to 1.91; OR 1.74, 95% Cl 1.30 to 2.33). Evidence of low heterogeneity in the effect size was observed at 6-month (I2=26%) and moderate heterogeneity at 12-month (I2=56%) outcomes. CONCLUSION Multicomponent tobacco dependence interventions should focus on inclusion of social support, frequency and duration of components. Employing community-based participatory-action research approach is essential to addressing underlying psychosocioeconomic-structural factors, in addition to the proven combination pharmacotherapies. PROSPERO REGISTRATION NUMBER CRD42017076650.
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Affiliation(s)
- Nina Huynh
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Saania Tariq
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Tavis Hayes
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Onkar Bhanushali
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tina Kaur
- Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sadia Jama
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Preshit Ambade
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ted Bignell
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
| | - Terry Hegarty
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
| | - Risa Shorr
- Learning Services, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Smita Pakhale
- The Bridge Engagement Centre, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
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Abstract
BACKGROUND Mindfulness-based smoking cessation interventions may aid smoking cessation by teaching individuals to pay attention to, and work mindfully with, negative affective states, cravings, and other symptoms of nicotine withdrawal. Types of mindfulness-based interventions include mindfulness training, which involves training in meditation; acceptance and commitment therapy (ACT); distress tolerance training; and yoga. OBJECTIVES To assess the efficacy of mindfulness-based interventions for smoking cessation among people who smoke, and whether these interventions have an effect on mental health outcomes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, and trial registries to 15 April 2021. We also employed an automated search strategy, developed as part of the Human Behaviour Change Project, using Microsoft Academic. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs that compared a mindfulness-based intervention for smoking cessation with another smoking cessation programme or no treatment, and assessed smoking cessation at six months or longer. We excluded studies that solely recruited pregnant women. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. We measured smoking cessation at the longest time point, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of intervention and type of comparator. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We summarised mental health outcomes narratively. MAIN RESULTS We included 21 studies, with 8186 participants. Most recruited adults from the community, and the majority (15 studies) were conducted in the USA. We judged four of the studies to be at low risk of bias, nine at unclear risk, and eight at high risk. Mindfulness-based interventions varied considerably in design and content, as did comparators, therefore, we pooled small groups of relatively comparable studies. We did not detect a clear benefit or harm of mindfulness training interventions on quit rates compared with intensity-matched smoking cessation treatment (RR 0.99, 95% CI 0.67 to 1.46; I2 = 0%; 3 studies, 542 participants; low-certainty evidence), less intensive smoking cessation treatment (RR 1.19, 95% CI 0.65 to 2.19; I2 = 60%; 5 studies, 813 participants; very low-certainty evidence), or no treatment (RR 0.81, 95% CI 0.43 to 1.53; 1 study, 325 participants; low-certainty evidence). In each comparison, the 95% CI encompassed benefit (i.e. higher quit rates), harm (i.e. lower quit rates) and no difference. In one study of mindfulness-based relapse prevention, we did not detect a clear benefit or harm of the intervention over no treatment (RR 1.43, 95% CI 0.56 to 3.67; 86 participants; very low-certainty evidence). We did not detect a clear benefit or harm of ACT on quit rates compared with less intensive behavioural treatments, including nicotine replacement therapy alone (RR 1.27, 95% CI 0.53 to 3.02; 1 study, 102 participants; low-certainty evidence), brief advice (RR 1.27, 95% CI 0.59 to 2.75; 1 study, 144 participants; very low-certainty evidence), or less intensive ACT (RR 1.00, 95% CI 0.50 to 2.01; 1 study, 100 participants; low-certainty evidence). There was a high level of heterogeneity (I2 = 82%) across studies comparing ACT with intensity-matched smoking cessation treatments, meaning it was not appropriate to report a pooled result. We did not detect a clear benefit or harm of distress tolerance training on quit rates compared with intensity-matched smoking cessation treatment (RR 0.87, 95% CI 0.26 to 2.98; 1 study, 69 participants; low-certainty evidence) or less intensive smoking cessation treatment (RR 1.63, 95% CI 0.33 to 8.08; 1 study, 49 participants; low-certainty evidence). We did not detect a clear benefit or harm of yoga on quit rates compared with intensity-matched smoking cessation treatment (RR 1.44, 95% CI 0.40 to 5.16; 1 study, 55 participants; very low-certainty evidence). Excluding studies at high risk of bias did not substantially alter the results, nor did using complete case data as opposed to using data from all participants randomised. Nine studies reported on changes in mental health and well-being, including depression, anxiety, perceived stress, and negative and positive affect. Variation in measures and methodological differences between studies meant we could not meta-analyse these data. One study found a greater reduction in perceived stress in participants who received a face-to-face mindfulness training programme versus an intensity-matched programme. However, the remaining eight studies found no clinically meaningful differences in mental health and well-being between participants who received mindfulness-based treatments and participants who received another treatment or no treatment (very low-certainty evidence). AUTHORS' CONCLUSIONS We did not detect a clear benefit of mindfulness-based smoking cessation interventions for increasing smoking quit rates or changing mental health and well-being. This was the case when compared with intensity-matched smoking cessation treatment, less intensive smoking cessation treatment, or no treatment. However, the evidence was of low and very low certainty due to risk of bias, inconsistency, and imprecision, meaning future evidence may very likely change our interpretation of the results. Further RCTs of mindfulness-based interventions for smoking cessation compared with active comparators are needed. There is also a need for more consistent reporting of mental health and well-being outcomes in studies of mindfulness-based interventions for smoking cessation.
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Affiliation(s)
- Sarah Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
| | - Emma Norris
- Health Behaviour Change Research Group, Brunel University London, London, UK
| | | | - Emily Hayes
- Centre for Behaviour Change, University College London, London, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Siddharthan T, Pollard SL, Quaderi SA, Rykiel NA, Wosu AC, Alupo P, Barber JA, Cárdenas MK, Chandyo RK, Flores-Flores O, Kirenga B, Miranda JJ, Mohan S, Ricciardi F, Sharma AK, Das SK, Shrestha L, Soares MO, Checkley W, Hurst JR. Discriminative Accuracy of Chronic Obstructive Pulmonary Disease Screening Instruments in 3 Low- and Middle-Income Country Settings. JAMA 2022; 327:151-160. [PMID: 35015039 PMCID: PMC8753498 DOI: 10.1001/jama.2021.23065] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Most of the global morbidity and mortality in chronic obstructive pulmonary disease (COPD) occurs in low- and middle-income countries (LMICs), with significant economic effects. OBJECTIVE To assess the discriminative accuracy of 3 instruments using questionnaires and peak expiratory flow (PEF) to screen for COPD in 3 LMIC settings. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of discriminative accuracy, conducted between January 2018 and March 2020 in semiurban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda, using a random age- and sex-stratified sample of the population 40 years or older. EXPOSURES Three screening tools, the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE; range, 0-6; high risk indicated by a score of 5 or more or score 2-5 with low PEF [<250 L/min for females and <350 L/min for males]), the COPD in LMICs Assessment questionnaire (COLA-6; range, 0-5; high risk indicated by a score of 4 or more), and the Lung Function Questionnaire (LFQ; range, 0-25; high risk indicated by a score of 18 or less) were assessed against a reference standard diagnosis of COPD using quality-assured postbronchodilator spirometry. CAPTURE and COLA-6 include a measure of PEF. MAIN OUTCOMES AND MEASURES The primary outcome was discriminative accuracy of the tools in identifying COPD as measured by area under receiver operating characteristic curves (AUCs) with 95% CIs. Secondary outcomes included sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS Among 10 709 adults who consented to participate in the study (mean age, 56.3 years (SD, 11.7); 50% female), 35% had ever smoked, and 30% were currently exposed to biomass smoke. The unweighted prevalence of COPD at the 3 sites was 18.2% (642/3534 participants) in Nepal, 2.7% (97/3550) in Peru, and 7.4% (264/3580) in Uganda. Among 1000 COPD cases, 49.3% had clinically important disease (Global Initiative for Chronic Obstructive Lung Disease classification B-D), 16.4% had severe or very severe airflow obstruction (forced expiratory volume in 1 second <50% predicted), and 95.3% of cases were previously undiagnosed. The AUC for the screening instruments ranged from 0.717 (95% CI, 0.677-0.774) for LFQ in Peru to 0.791 (95% CI, 0.770-0.809) for COLA-6 in Nepal. The sensitivity ranged from 34.8% (95% CI, 25.3%-45.2%) for COLA-6 in Nepal to 64.2% (95% CI, 60.3%-67.9%) for CAPTURE in Nepal. The mean time to administer the instruments was 7.6 minutes (SD 1.11), and data completeness was 99.5%. CONCLUSIONS AND RELEVANCE This study demonstrated that screening instruments for COPD were feasible to administer in 3 low- and middle-income settings. Further research is needed to assess instrument performance in other low- and middle-income settings and to determine whether implementation is associated with improved clinical outcomes.
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Affiliation(s)
- Trishul Siddharthan
- Division of Pulmonary and Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Suzanne L. Pollard
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Now with the National Institutes of Health, Bethesda, Maryland
| | | | - Natalie A. Rykiel
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Adaeze C. Wosu
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Patricia Alupo
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Julie A. Barber
- Department of Statistical Science, University College London, London, United Kingdom
| | - Maria Kathia Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ram K. Chandyo
- Department of Community Medicine, Kathmandu Medical College, Nepal
| | - Oscar Flores-Flores
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Biomedical Research Unit, A.BPRISMA, Lima, Peru
- Centro de Investigación del Envejecimiento (CIEN), Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru
| | - Bruce Kirenga
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sakshi Mohan
- Centre for Health Economics, University of York, York, United Kingdom
| | - Federico Ricciardi
- Department of Statistical Science, University College London, London, United Kingdom
| | - Arun K. Sharma
- Child Health Research Project, Institute of Medicine Tribhuvan University, Kathmandu, Nepal
| | - Santa Kumar Das
- Child Health Research Project, Institute of Medicine Tribhuvan University, Kathmandu, Nepal
| | - Laxman Shrestha
- Child Health Research Project, Institute of Medicine Tribhuvan University, Kathmandu, Nepal
| | - Marta O. Soares
- Centre for Health Economics, University of York, York, United Kingdom
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John R. Hurst
- UCL Respiratory, University College London, London, United Kingdom
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Quynh Mai V, Van Minh H, Truong Nam N, Thao Anh H, Minh Van N, Thi Trang N, Shelley D. Cost Analysis of Community-Based Smoking Cessation Services in Vietnam: A Cluster-Randomized Trial. Health Serv Insights 2021; 14:11786329211030932. [PMID: 34393491 PMCID: PMC8358574 DOI: 10.1177/11786329211030932] [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: 12/28/2020] [Accepted: 06/17/2021] [Indexed: 11/15/2022] Open
Abstract
The study aimed to estimate the cost for developing and implementing 2 smoking cessation service delivery models that were evaluated in a 2-arm cluster randomized trial in Commune Health Centers (CHCs) in Vietnam. In the first model (4As) CHC providers were trained to ask about tobacco use, advise smokers to quit, assess readiness to quit, and assist with brief counseling. The second model included the 4As plus a referral to Village Health Workers (VHWs) who were trained to provide multisession home-based counseling (4As + R). An activity-based ingredients (ABC-I) costing approach with a healthcare provider perspective was applied to collect the costs for each intervention model. Opportunity costs were excluded. Costs during preparation and implementation phase were estimated. Sensitivity analysis of the cost per smoker with the included intervention' activities were conducted. The cost per facility-based counseling session ranged from USD 9 to USD 11. Cost per home-based counseling session at 4As + R model was USD 4. The non-delivery cost attributed to supportive activities (eg, Monitoring, Logistic, Research, General training) was USD 107 per counseling session. Cost per smoker ranged from USD 6 to USD 451. The study analyzed and compared cost of implementing and scaling community-based smoking cessation service models in Vietnam.
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Affiliation(s)
- Vu Quynh Mai
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Hoang Van Minh
- Hanoi University of Public Health, Hanoi, Vietnam.,National Institute of Health Sciences, Bach Mai Hospital (NIHS), Hanoi, Vietnam
| | | | | | | | | | - Donna Shelley
- New York University School of Global Public Health, New York, NY, USA
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Parthasarathi A, Shankar M, Madhivanan P, Lokesh KS, Undela K, Krishna MT, Mahesh PA. Determinants of Tobacco Use and Nicotine Dependence Among Healthcare
Students and Their Undergraduate Peers. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x17666210713163954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Global estimates suggest that tobacco will account for 8 million deaths
per year by 2030. The Global Adult Tobacco Survey (2016-17) reported that more than half of men
and one in ten women aged 15 years and above smoke in India.
Introduction:
Health science courses students (HCS), being the future of our health care system,
are expected to be more knowledgeable regarding the hazards of tobacco and are considered less
likely to use it compared to their peers (non-HCS) from other fields. The aim of the study is to determine
the prevalence and determinants of tobacco use and levels of nicotine dependence amongst
HCS and non-HCS students.
Methods:
Web-based survey (response rate of 72%) employing Global Youth Tobacco Survey
(GYTS) and Fagerström standardized questionnaires (n = 4770 [21.5 (SD: ± 1.61) years: 62%
male] was filled by HCS (43.5%) and non-HCS (56.3%) students from three universities. A descriptive,
comparative and multivariate analysis was performed.
Results:
Half of non-HCS and a third of HCS used tobacco, with a higher proportion of male users
in both groups. 70% of overall participants showed ‘low nicotine dependence’ with a higher proportion
of ‘high dependence’ within the non-HCS group (13.89% vs. 9.2%). There were crucial differences
in specific determinants and ages of initiation of tobacco use between the two groups.
Conclusion:
Tobacco use in HCS, apart from personal health risks, may potentially affect their future
commitment to support patients in tobacco cessation programs. There is a need for further research
into tobacco prevention and cessation programs tailored to the needs of student groups
based on the determinants affecting them.
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Affiliation(s)
| | - Malavika Shankar
- Subbaiah Institute of Medical Sciences, Shimoga, Karnataka, India
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, the
University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | | | - Krishna Undela
- Department of Pharmacy Practice National Institute
of Pharmaceutical Education and Research (NIPER) Guwahati, India
| | - Mamidipudi Thirumala Krishna
- University Hospitals Birmingham NHS Foundation
Trust, Institute of Immunology & Immunotherapy and Institute of Clinical Sciences, University of Birmingham,
Birmingham, UK
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Completeness of reporting and risks of overstating impact in cluster randomised trials: a systematic review. Lancet Glob Health 2021; 9:e1163-e1168. [PMID: 34297963 PMCID: PMC9994534 DOI: 10.1016/s2214-109x(21)00200-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
Overstating the impact of interventions through incomplete or inaccurate reporting can lead to inappropriate scale-up of interventions with low impact. Accurate reporting of the impact of interventions is of great importance in global health research to protect scarce resources. In global health, the cluster randomised trial design is commonly used to evaluate complex, multicomponent interventions, and outcomes are often binary. Complete reporting of impact for binary outcomes means reporting both relative and absolute measures. We did a systematic review to assess reporting practices and potential to overstate impact in contemporary cluster randomised trials with binary primary outcome. We included all reports registered in the Cochrane Central Register of Controlled Trials of two-arm parallel cluster randomised trials with at least one binary primary outcome that were published in 2017. Of 73 cluster randomised trials, most (60 [82%]) showed incomplete reporting. Of 64 cluster randomised trials for which it was possible to evaluate, most (40 [63%]) reported results in such a way that impact could be overstated. Care is needed to report complete evidence of impact for the many interventions evaluated using the cluster randomised trial design worldwide.
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Hejjaji V, Khetan A, Hughes JW, Gupta P, Jones PG, Ahmed A, Mohan SKM, Josephson RA. A combined community health worker and text messagingbased intervention for smoking cessation in India: Project MUKTI - A mixed methods study. Tob Prev Cessat 2021; 7:23. [PMID: 33791445 PMCID: PMC8005919 DOI: 10.18332/tpc/132469] [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: 11/30/2020] [Revised: 12/26/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We sought to evaluate the effectiveness of a community health worker (CHW) led smoking cessation intervention, supplemented by text messages, and tailored to an individual’s readiness to quit. METHODS We conducted a cluster randomized controlled trial (April 2018–August 2019) in adult smokers residing in a semi-urban region of India. Participants in the intervention arm received CHW-led home visits and had the option of choosing to receive regular text messages. The dose and content of CHW counseling and text messages were tailored to the participant’s readiness to quit. The control group received brief education only. Primary outcome was biochemically verified smoking cessation at the end of 12 months. Both intention-to-treat and as-treated analyses were performed. RESULTS A total of 238 (mean age 43±12.3 years, male 96.2%) participants were enrolled; 151 (64%) in the intervention arm and 83 (35.4%) in the control arm. At 12 months, 31 (20.5%) participants in the intervention arm and 9 (10.8%) in the control arm quit smoking (absolute risk difference=9.7%; RR=1.69; 95% CI: 0.04–71.33, p=0.74). In the as-treated analysis, 17 (36.9%) of the 46 participants who received optimal dose of the intervention quit smoking. CONCLUSIONS CHW-led home-based counseling, supplemented by regular text messages, led to an increase in quit rates for smoking, especially among those exposed to a higher dose of the intervention. However, the difference in cessation rates was not statistically significant. Future studies should consider testing mobile application-based multimedia messaging with larger populations, as a supplement to CHW-based counseling.
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Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas, United States
| | - Aditya Khetan
- Department of Cardiovascular Medicine, McMaster University Medical Center, Hamilton, Canada
| | - Joel W Hughes
- Department of Psychology, Kent State University, Kent, United States
| | - Prashant Gupta
- Department of Psychology, All India Institute of Medical Sciences, New Delhi, India
| | - Philip G Jones
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas, United States
| | - Asma Ahmed
- Department of Surgery, Ramaiah Medical College, Bangalore, India
| | - Sri Krishna Madan Mohan
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center - Case Western Reserve University, Cleveland, United States
| | - Richard A Josephson
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center - Case Western Reserve University, Cleveland, United States
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Hu Y, Xie J, Chang X, Chen J, Wang W, Zhang L, Zhong R, Chen O, Yu X, Zou Y. Characteristics and Predictors of Abstinence Among Smokers of a Smoking Cessation Clinic in Hunan China. Front Public Health 2021; 9:615817. [PMID: 33816416 PMCID: PMC8017299 DOI: 10.3389/fpubh.2021.615817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background: More than 300 million smokers make China the largest cigarette consumer globally, which is a huge economic burden. Smoking cessation (SC) clinics can offer counseling and follow-up services. The operational experience of SC clinics in China needs to be summarized and improved based on research evidence. Purpose: The objectives of this study were to describe quit rates among attendees of SC clinics in Hunan and assess predictors of successful SC. Methods: The participants in this study were smokers who visited the SC clinic of Hunan Cancer Hospital from February 1, 2015 to September 30, 2018. Individuals who received individual counseling and assessment from the SC clinic staff and were willing to quit smoking were eligible for inclusion. Those with critical illness or cancer were excluded. Application of smoking cessation clinic registration form (unified by Chinese Center for Disease Control and Prevention) was used to assess participants at the consultation. Follow-ups and counseling were performed over telephone at 1 week, 1 month, and 3 months after the initial cessation consultation or in times of need. Successful SC was checked for at 3 months after the start of SC. Results: A total of 328 smokers (mean age 45.67 ± 12.38 years) had participated. The abstinence rate at 3 months was 28.4%. Binary regression analysis revealed significant independent predictors to be the total numbers of SC follow up sessions, previous SC attempts, and participants' decision on when to quit smoking (The relative to quit immediately group, quit within 30 days, quit after 30 days, and undecided quit were less likely to succeed in quitting. while quit within seven days had no statistical significance. Conclusion: SC clinics can achieve a desirably high quit rate. Participant's previous attempts at quitting, three or more follow-ups, and the decision to quit immediately or within seven days were factors helpful in predicting the success of SC.
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Affiliation(s)
- Yina Hu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jianghua Xie
- Hunan University of Chinese Medicine, Changsha, China
| | - Xiaochang Chang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jianhua Chen
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wei Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Lemeng Zhang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Rui Zhong
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ouying Chen
- Hunan University of Chinese Medicine, Changsha, China
| | - Xinhua Yu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yanhui Zou
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Gupta S, Jhanjee S, Dhawan A. Effectiveness of Interventions Based on Yogic Breathing Practices (IB-YBP) on Substance Use Disorders-A Systematic Review of the Randomized Control Trials and Quasi-Experimental Trials. Subst Use Misuse 2021; 56:1624-1641. [PMID: 34286672 DOI: 10.1080/10826084.2021.1942056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interventions based on Yogic Breathing Practices (IB-YBP) have shown promising results for substance use disorders (SUD). Research in this area is methodologically heterogeneous and only a few, but restricted, systematic reviews are available. The current systematic review aims to assess the effectiveness of IB-YBP for SUD. Materials and Methods: PubMed, Cochrane's Library, EBSCO-Medline, and Google Scholar databases were searched for the randomized- (RCTs) and quasi-randomized trials. Research involving participants with SUD, of either gender or any age, assessing the effectiveness of the IB-YBP either as a standalone intervention or as an adjuvant to standard treatment versus standard pharmacological/non-pharmacological treatment or no-intervention control were included. Studies having participants with co-morbid psychiatric illness and interventions not having IB-YBP as the predominant component were excluded. Results: The initial literature search yielded 396 articles and upon screening, only 14 studies were found eligible for this review. Most studies have researched IB-YBP as an adjunct to the standard treatment for SUD. Evidence for the effectiveness of IB-YBP is mostly available for tobacco and opioid use disorders, though only for short-term outcomes; however, literature is scarce for alcohol- and cocaine-use disorders. This review documented the effectiveness of the IB-YBP for substance use-related outcome parameters such as abstinence, quality of life (QoL), mood, craving, and withdrawal symptoms. Conclusion: IB-YBP may be an effective adjuvant to standard treatment for various SUD. However, more research is required to compare its effectiveness with standard treatment, and assessing its long-term efficacy, for it to be strongly recommended as a treatment strategy.
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Affiliation(s)
- Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, India
| | - Sonali Jhanjee
- National Drug Dependence Treatment Centre (NDDTC) & Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Dhawan
- National Drug Dependence Treatment Centre (NDDTC) & Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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20
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Steinberg ML, Rosen RL, Versella MV, Borges A, Leyro TM. A Pilot Randomized Clinical Trial of Brief Interventions to Encourage Quit Attempts in Smokers From Socioeconomic Disadvantage. Nicotine Tob Res 2020; 22:1500-1508. [PMID: 32161942 DOI: 10.1093/ntr/ntaa047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/09/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cigarette smoking disproportionately affects communities of low socioeconomic status where greater smoking prevalence and poorer cessation rates have been observed. Utilizing brief evidence-based interventions to increase cessation attempts may be an effective and easily disseminable means by which to mitigate undue burden in this population. AIMS AND METHODS The current intervention randomized daily smokers (N = 57) recruited from a local community soup kitchen to receive either Brief (eg, 30 m) Motivational Interviewing, Nicotine Replacement Therapy (NRT) sampling, or a Referral-Only intervention. Approximately half of participants (50.9%) reported not completing high school and many reported either just (41.4%) or not (40.4%) meeting basic expenses. Follow-up was completed approximately 1-month postintervention. RESULTS Nonsignificant group differences indicated that participants randomized to the NRT sampling condition were more likely to make a quit attempt (moderate effect size). Approximately 40% of the sample reported making a serious quit attempt at follow-up. Significant differences in cigarettes per day at follow-up, controlling for baseline, were observed, with participants in the Motivational Interviewing condition, only, reporting significant reductions. Participants randomized to the NRT condition were significantly more likely to report using NRT patch and lozenge at follow-up (large effect). There were no differences between groups with respect to seeking behavioral support. Finally, we found that subjective financial strain moderated the effect of condition on change in cigarette consumption where NRT sampling was more effective for participants reporting less financial strain. CONCLUSIONS Findings provide initial evidence for personalizing brief interventions to promote quit attempts in low-income smokers. IMPLICATIONS While most clinical research on tobacco use and dependence focuses on successful sustained abstinence, the current study is novel because it examined three brief interventions designed to increase the number of quit attempts made by a nontreatment-seeking group suffering from health disparities (ie, smokers from socioeconomic disadvantage). These data suggest that nontreatment-seeking smokers from socioeconomic disadvantage can be influenced by Brief MIs and these interventions should be used to motivate smokers from socioeconomic disadvantage to make a quit attempt. Future studies should examine combined MIs including pharmacological and behavioral interventions.
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Affiliation(s)
- Marc L Steinberg
- Rutgers Robert Wood Johnson Medical School, Department of Psychiatry, New Brunswick, NJ
| | - Rachel L Rosen
- Rutgers University, Department of Psychology, Piscataway, NJ
| | - Mark V Versella
- Rutgers University, Department of Psychology, Piscataway, NJ
| | - Allison Borges
- Rutgers University, Department of Psychology, Piscataway, NJ
| | - Teresa M Leyro
- Rutgers University, Department of Psychology, Piscataway, NJ
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Hejjaji V, Khetan A. A Community-Based Intervention for Hypertension in Rural South Asia. N Engl J Med 2020; 382:e99. [PMID: 32558481 DOI: 10.1056/nejmc2006112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Vittal Hejjaji
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Aditya Khetan
- Population Health Research Institute, Hamilton, ON, Canada
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Shin HY, Kim KY, Kang P. Concept analysis of community health outreach. BMC Health Serv Res 2020; 20:417. [PMID: 32404160 PMCID: PMC7222455 DOI: 10.1186/s12913-020-05266-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/28/2020] [Indexed: 11/11/2022] Open
Abstract
Background The definition of community health outreach to promote the health of vulnerable populations depends heavily on the particulars of the given health project and community. There is no consistency in the definitions attached to the concept itself. Our study aimed to clarify the general definition of community health outreach to facilitate its understanding and use. Methods Walker and Avant’s (2010) method of concept analysis was used to understand community health outreach. A total of 45 articles were included in the analysis after having searched for text on database portals like PubMed, Scopus, CINAHL complete and EMBASE published between 2010 and 2018. Results The defining attributes of the concept of community health outreach were purposive, temporary, mobile and collaboration with community. The antecedents were population facing health risks and awareness of health risks. The consequences were increased accessibility and health promotion. Conclusion This study proposed the definition of community health outreach as a temporary, mobile project that involves the collaboration of a community to undertake its purposeful health intervention of reaching a population facing health risks. This definition provides a general understanding of the outreach undertaken by health workers and enables the strong connection between health professionals and community residents.
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Affiliation(s)
- Hye Young Shin
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 10408, Gyeonggi-do, Republic of Korea.,College of Nursing, Baekseok Culture University, 1 Baekseokdaehak-ro, Dongnam-gu, Cheonan-si, 31065, Chungcheongnam-do, Republic of Korea
| | - Ka Young Kim
- Department of Nursing, College of Nursing, Gachon University, 191 Hambakmoeiro, Yeonsu-gu, Incheon, 21936, Republic of Korea.
| | - Purum Kang
- College of Nursing, Woosuk University, 443 Samnye-ro, Samnye-eup, Wanju, Jeonbuk, 55338, Republic of Korea.
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Nethan ST, Sinha DN, Sharma S, Mehrotra R. Behavioral Interventions for Smokeless Tobacco Cessation. Nicotine Tob Res 2020; 22:588-593. [PMID: 31251347 DOI: 10.1093/ntr/ntz107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/27/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Consumption of smokeless tobacco (SLT) is on the rise (especially in the World Health Organization South-East Asian region) and has numerous repercussions over the consumer's health. This article reviews studies performed for SLT cessation using behavioral interventions, worldwide till 2017. METHODS A systematic review by PICO (Problem, intervention, comparison, outcome) of behavioral intervention-based SLT cessation studies with minimum 6 months' follow-up, reporting outcomes in terms of risk ratios (RRs) and 95% confidence interval (CI), published between 1992 and 2017 was performed. This was followed by a meta-analysis of the outcomes of these studies by deriving the pooled estimates by the random effects model, for those on adults and youth, categorized according to the type of country where the study was performed, that is, in terms of developed or developing. Publication bias among the included studies was assessed by the Begg's test. RESULTS Nineteen eligible studies comprising 24 498 participants, from all over the world were included. Behavioral interventions showed overall efficacy in SLT cessation in adults (RR = 1.63, 95% CI = 1.32 to 1.94) both in the developed (RR = 1.39, 95% CI = 1.16 to 1.63) and developing (RR = 2.79, 95% CI = 2.32 to 3.25) countries. However, these interventions did not prove effective for SLT cessation among youth overall (RR = 1.07, 95% CI = 0.73 to 1.41), either in the developed (RR = 1.39, 95% CI = 0.58 to 2.21) or in the developing (RR = 0.87, 95% CI = 0.68 to 1.07) countries. Publication bias was noted in all the studies among adults (p = .22) and youth (p = .05). CONCLUSION Behavioral interventions as a single modality are effective in SLT cessation, both in the developed and developing countries. Health care providers should be sensitized to provide the same. IMPLICATIONS A recent literature survey by Cochrane reviewed studies on interventions for SLT, including behavioral interventions, which included only those from the developed countries. The current analysis provides a broader, global update on the same by including studies performed both in the developed and developing countries (specifically the South-East Asian region-the high burden countries of SLT products).
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Affiliation(s)
- Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, Uttar Pradesh, India
| | | | - Shashi Sharma
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, Uttar Pradesh, India
| | - Ravi Mehrotra
- ICMR-National Institute of Cancer Prevention and Research (NICPR), Noida, Uttar Pradesh, India
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Kock L, Brown J, Hiscock R, Tattan-Birch H, Smith C, Shahab L. Individual-level behavioural smoking cessation interventions tailored for disadvantaged socioeconomic position: a systematic review and meta-regression. Lancet Public Health 2019; 4:e628-e644. [PMID: 31812239 PMCID: PMC7109520 DOI: 10.1016/s2468-2667(19)30220-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Socioeconomic inequalities in smoking cessation have led to development of interventions that are specifically tailored for smokers from disadvantaged groups. We aimed to assess whether the effectiveness of interventions for disadvantaged groups is moderated by tailoring for socioeconomic position. METHODS For this systematic review and meta-regression, we searched MEDLINE, PsycINFO, Embase, Cochrane Central Register, and Tobacco Addiction Register of Clinical Trials and the IC-SMOKE database from their inception until Aug 18, 2019, for randomised controlled trials of socioeconomic-position-tailored or non-socioeconomic-position-tailored individual-level behavioural interventions for smoking cessation at 6 months or longer of follow-up in disadvantaged groups. Studies measured socioeconomic position via income, eligibility for government financial assistance, occupation, and housing. Studies were excluded if they were delivered at the community or population level, did not report differential effects by socioeconomic position, did not report smoking cessation outcomes from 6 months or longer after the start of the intervention, were delivered at a group level, or provided pharmacotherapy with standard behavioural support compared with behavioural support alone. Individual patient-level data were extracted from published reports and from contacting study authors. Random-effects meta-analyses and mixed-effects meta-regression analyses were done to assess associations between tailoring of the intervention and effectiveness. Meta-analysis outcomes were summarised as risk ratios (RR). Certainty of evidence was assessed within each study using the Cochrane risk-of-bias tool version 2 and the grading of recommendations assessment, development, and evaluation approach. The study is registered with PROSPERO, CRD42018103008. FINDINGS Of 2376 studies identified by our literature search, 348 full-text articles were retrieved and screened for eligibility. Of these, 42 studies (26 168 participants) were included in the systematic review. 30 (71%) of 42 studies were done in the USA, three (7%) were done in the UK, two (5%) each in the Netherlands and Australia, and one (2%) each in Switzerland, Sweden, Turkey, India, and China. 26 (62%) of 42 studies were trials of socioeconomic-position-tailored interventions and 16 (38%) were non-socioeconomic-position-tailored interventions. 17 (65%) of 26 socioeconomic-position-tailored interventions were in-person or telephone-delivered behavioural interventions, four (15%) were digital interventions, three (12%) involved financial incentives, and two (8%) were brief interventions. Individuals who participated in an intervention, irrespective of tailoring, were significantly more likely to quit smoking than were control participants (RR 1·56, 95% CI 1·39-1·75; I2=54·5%). Socioeconomic-position-tailored interventions did not yield better outcomes compared with non-socioeconomic-position-tailored interventions for disadvantaged groups (adjusted RR 1·01, 95% CI 0·81-1·27; β=0·011, SE=0·11; p=0·93). We observed similar effect sizes in separate meta-analyses of non-socioeconomic-position-tailored interventions using trial data from participants with high socioeconomic position (RR 2·00, 95% CI 1·36-2·93; I2=82·7%) and participants with low socioeconomic position (1·94, 1·31-2·86; I2=76·6%), although certainty of evidence from these studies was graded as low. INTERPRETATION We found evidence that individual-level interventions can assist disadvantaged smokers with quitting, but there were no large moderating effects of tailoring for disadvantaged smokers. Improvements in tailored intervention development might be necessary to achieve equity-positive smoking cessation outcomes. FUNDING Cancer Research UK.
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Affiliation(s)
- Loren Kock
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.
| | - Jamie Brown
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | | | - Harry Tattan-Birch
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Charlie Smith
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
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Joseph LM, Lekha TR, Boban D, Jose P, Jeemon P. Perceived facilitators and barriers of enrolment, participation and adherence to a family based structured lifestyle modification interventions in Kerala, India: A qualitative study. Wellcome Open Res 2019; 4:131. [PMID: 31828226 PMCID: PMC6896244 DOI: 10.12688/wellcomeopenres.15415.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 02/03/2023] Open
Abstract
Background: The objective of the study was to describe participants’ and providers’ perspectives of barriers and facilitators of enrolment, participation and adherence to a structured lifestyle modification (SLM) interventions as part of the PROLIFIC trial in Kerala, India. Methods: Family members who had been enrolled for 12-months or more in a family-based cardiovascular risk reduction intervention study (PROLIFIC Trial) were purposively sampled and interviewed using a semi-structured guide. The non-physician health workers (NPHWs) delivering the intervention were also interviewed or included in focus groups (FGDs). Thematic analysis was used for data analysis. Results: In total, 56 in-depth interviews and three FGDs were conducted. The descriptive themes emerged were categorised as (a) motivation for enrolment and engagement in the SLM interventions, (b) facilitators of adherence, and (c) reasons for non-adherence. A prior knowledge of familial cardiovascular risk, preventive nature of the programme, and a reputed organisation conducting the intervention study were appealing to the participants. Simple suggestions of healthier alternatives based on existing dietary practices, involvement of the whole family, and the free annual blood tests amplified the adherence. Participants highlighted regular monitoring of risk factors and provision of home-based care by NPHWs as facilitators for adherence. Furthermore, external motivation by NPHWs in setting and tracking short terms goals were perceived as enablers of adherence. Nonetheless, home makers expressed difficulty in dealing with varied food choices of family members. Young adults in the programme noted that dietary changes were affected by eating out as they wanted to fit in with peers. Conclusions: The findings suggest that a family-based, trained healthcare worker led SLM interventions are desirable and feasible in Kerala. Increasing the number of visits by NPHWs, regular monitoring and tracking of lifestyle goals, and targeting young adults and children for dietary changes may further improve adherence to SLM interventions.
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Affiliation(s)
- Linju M Joseph
- Centre for Chronic Disease Control, New Delhi, New Delhi, 110016, India
| | - T R Lekha
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Dona Boban
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Prinu Jose
- Centre for Chronic Disease Control, New Delhi, New Delhi, 110016, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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26
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Khetan A, Zullo M, Rani A, Gupta R, Purushothaman R, Bajaj NS, Agarwal S, Madan Mohan SK, Josephson R. Effect of a Community Health Worker-Based Approach to Integrated Cardiovascular Risk Factor Control in India: A Cluster Randomized Controlled Trial. Glob Heart 2019; 14:355-365. [PMID: 31523014 DOI: 10.1016/j.gheart.2019.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Eighty percent of premature mortality from cardiovascular disease occurs in low- and middle-income countries. Hypertension, diabetes, and smoking are the top risk factors causing this disease burden. OBJECTIVES The study aimed to test the hypothesis that utilizing community health workers (CHWs) to manage hypertension, diabetes and smoking in an integrated manner would lead to improved control of these conditions. METHODS This was a 2-year cluster (n = 12) randomized controlled trial of 3,556 adults (35 to 70 years of age) in a single town in India, who were screened at home for hypertension, diabetes, and smoking. Of these adults, 1,242 (35%) had at least 1 risk factor (hypertension = 650, diabetes = 317, smoking = 500) and were enrolled in the study. The intervention group had behavioral change communication through regular home visits from community health workers. The control group received usual care in the community. The primary outcomes were changes in systolic blood pressure, fasting blood glucose, and average number of cigarettes/bidis smoked daily among individuals with respective risk factors. RESULTS The mean ± SD change in systolic blood pressure at 2 years was -12.2 ± 19.5 mm Hg in the intervention group as compared with -6.4 ± 26.1 mm Hg in the control group, resulting in an adjusted difference of -8.9 mm Hg (95% confidence interval [CI]: -3.5 to -14.4 mm Hg; p = 0.001). The change in fasting blood glucose was -43.0 ± 83.5 mg/dl in the intervention group and -16.3 ± 77.2 mg/dl in the control group, leading to an adjusted difference of -21.3 mg/dl (95% CI: 18.4 to -61 mg/dl; p = 0.29). The change in mean number of cigarettes/bidis smoked was nonsignificant at +0.2 cigarettes/bidis (95% CI: 5.6 to -5.2 cigarettes/bidis; p = 0.93). CONCLUSIONS A population-based strategy of integrated risk factor management through community health workers led to improved systolic blood pressure in hypertension, an inconclusive effect on fasting blood glucose in diabetes, and no demonstrable effect on smoking. (Study of a Community-Based Approach to Control Cardiovascular Risk Factors in India [SEHAT]; NCT02115711).
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Affiliation(s)
- Aditya Khetan
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA; SEHAT, Dalkhola, India.
| | - Melissa Zullo
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA; School of Public Health, Kent State University, Kent, OH, USA
| | - Anitha Rani
- Department of Community Medicine, Sri Ramachandra Medical College and Research Institute, Porur, India
| | | | | | - Navkaranbir S Bajaj
- Division of Cardiovascular Disease, Department of Internal Medicine and Radiology, University of Alabama, Birmingham, AL, USA
| | | | - Sri Krishna Madan Mohan
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Richard Josephson
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA; School of Public Health, Kent State University, Kent, OH, USA
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27
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Joseph LM, Lekha TR, Boban D, Jose P, Jeemon P. Perceived facilitators and barriers of enrolment, participation and adherence to a family based structured lifestyle modification interventions in Kerala, India: A qualitative study. Wellcome Open Res 2019; 4:131. [DOI: 10.12688/wellcomeopenres.15415.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The objective of the study was to describe participants’ and providers’ perspectives of barriers and facilitators of enrolment, participation and adherence to a structured lifestyle modification (SLM) interventions as part of the PROLIFIC trial in Kerala, India. Methods: Family members who had been enrolled for 12-months or more in a family-based cardiovascular risk reduction intervention study (PROLIFIC Trial) were purposively sampled and interviewed using a semi-structured guide. The non-physician health workers (NPHWs) delivering the intervention were also interviewed or included in focus groups (FGDs). Thematic analysis was used for data analysis. Results: In total, 56 in-depth interviews and three FGDs were conducted. The descriptive themes emerged were categorised as (a) motivation for enrolment and engagement in the SLM interventions, (b) facilitators of adherence, and (c) reasons for non-adherence. A prior knowledge of familial cardiovascular risk, preventive nature of the programme, and a reputed organisation conducting the intervention study were appealing to the participants. Simple suggestions of healthier alternatives based on existing dietary practices, involvement of the whole family, and the free annual blood tests amplified the adherence. Participants highlighted regular monitoring of risk factors and provision of home-based care by NPHWs as facilitators for adherence. Furthermore, external motivation by NPHWs in setting and tracking short-term health goals were perceived as enablers of adherence. Nonetheless, home makers expressed difficulty in dealing with varied food choices of family members. Young adults in the programme noted that dietary changes were affected by eating out as they wanted to fit in with peers. Conclusions: The findings suggest that a family-based, trained healthcare worker led SLM interventions are acceptable in Kerala. Increasing the number of visits by NPHWs, regular monitoring and tracking of lifestyle goals, and targeting young adults and children for dietary changes may further improve adherence to SLM interventions.
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28
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Khetan A, Hejjaji V, Hughes J, Gupta P, Barbhaya D, Madan Mohan SK, Josephson RA. Rationale and design of a study to test the effectiveness of a combined community health worker and text messaging-based intervention for smoking cessation in India (Project MUKTI). Mhealth 2019; 5:15. [PMID: 31380407 PMCID: PMC6624352 DOI: 10.21037/mhealth.2019.05.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/24/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Nearly 275 million individuals in India consume tobacco every day, with more than 1 million dying annually as a result. Few people in India have access to smoking cessation services, an essential component of combating tobacco use globally. We hypothesize that a strategy of systematic community health worker (CHW) based counseling that covers eligible people who smoke in a geographical area, combined with text messaging support, will result in improved quit rates. METHODS The study is a cluster randomized controlled trial that will be conducted at 2 sites in India. Sixteen clusters will be randomized into either an intervention or control arm. A total of 560 smokers between the age of 18 and 70 will be recruited from their home through CHWs. Smokers at all stages of change will be offered the intervention, which is based on the transtheoretical model of change. RESULTS Pre-contemplative participants will be offered health education and motivational interviewing through CHWs. They will also be offered a low frequency form of text messaging, focused on health education and the benefits of quitting. Participants who are actively contemplating quitting smoking will be offered a more intensive intervention, with more frequent visits by CHWs and more intensive text messaging support. Contemplative participants will be encouraged to set a quit date, and all participants will be assessed periodically for stage of change to provide the appropriate intervention. Participants who set a quit date will be encouraged to use NRT to help with quitting. Control group participants are provided with brief smoking cessation advice only, at the start of the trial. The primary outcome will be self-reported abstinence for the past 14 days, biochemically verified by exhaled CO levels (cut-off 10 ppm) assessed at the end of 1 year of the intervention. CONCLUSIONS We will test whether a CHW-based intervention that incorporates motivational interviewing, text messaging and supportive counseling can prove effective in systematically helping smokers quit.
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Affiliation(s)
- Aditya Khetan
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Vittal Hejjaji
- Saint Luke’s Mid America Heart Institute, University of Missouri Kansas City, MO, USA
| | - Joel Hughes
- Department of Psychology, Kent State University, Kent, OH, USA
| | - Prashant Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Dweep Barbhaya
- Seth G. S. Medical College and K. E. M. Hospital, Mumbai, India
| | - Sri Krishna Madan Mohan
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Richard A. Josephson
- Harrington Heart & Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
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Holliday R, Preshaw PM, Ryan V, Sniehotta FF, McDonald S, Bauld L, McColl E. A feasibility study with embedded pilot randomised controlled trial and process evaluation of electronic cigarettes for smoking cessation in patients with periodontitis. Pilot Feasibility Stud 2019; 5:74. [PMID: 31171977 PMCID: PMC6547559 DOI: 10.1186/s40814-019-0451-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/29/2019] [Indexed: 11/21/2022] Open
Abstract
Background Tobacco smoking is a major risk factor for several oral diseases, including periodontitis, and electronic cigarettes (e-cigarettes) are increasingly being used for smoking cessation. This study aimed to assess the viability of delivering and evaluating an e-cigarette intervention for smoking cessation within the dental setting, prior to a definitive study. Methods A feasibility study, comprising a pilot randomised controlled trial and qualitative process evaluation, was conducted over 22 months in the Newcastle upon Tyne Hospitals NHS Dental Clinical Research Facility, UK. The pilot trial comprised a two-armed, parallel group, individually randomised, controlled trial, with 1:1 allocation. Participant eligibility criteria included being a tobacco smoker, having periodontitis and not currently using an e-cigarette. All participants received standard non-surgical periodontal therapies and brief smoking cessation advice. The intervention group additionally received an e-cigarette starter kit with brief training. Proposed outcomes for a future definitive trial, in terms of smoking behaviour and periodontal/oral health, were collected over 6 months to assess data yield and quality and estimates of parameters. Analyses were descriptive, with 95% confidence intervals presented, where appropriate. Results Eighty participants were successfully recruited from a range of dental settings. Participant retention was 73% (n = 58; 95% CI 62–81%) at 6 months. The e-cigarette intervention was well received, with usage rates of 90% (n = 36; 95% CI 77–96%) at quit date. Twenty percent (n = 8; 95% CI 11–35%) of participants in the control group used an e-cigarette at some point during the study (against advice). The majority of the outcome measures were successfully collected, apart from a weekly smoking questionnaire (only 30% of participants achieved ≥ 80% completion). Reductions in expired air carbon monoxide over 6 months of 6 ppm (95% CI 1–10 ppm) and 12 ppm (95% CI 8–16 ppm) were observed in the control and intervention groups, respectively. Rates of abstinence (carbon monoxide-verified continuous abstinence for 6 months) for the two groups were 5% (n = 2; 95% CI 1–17%; control group) and 15% (n = 6; 95% CI 7–29%; intervention group). Conclusions Data suggest that a definitive trial is feasible and that the intervention may improve smoking quit rates. Insights were gained into how best to conduct the definitive trial and estimates of parameters to inform design were obtained. Trial registration ISRCTN, ISRCTN17731903; registered 19 September 2016 http://www.isrctn.com/ISRCTN17731903. Electronic supplementary material The online version of this article (10.1186/s40814-019-0451-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard Holliday
- 1Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW UK
| | - Philip M Preshaw
- 1Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW UK.,2National University Centre for Oral Health, National University of Singapore, Singapore, Singapore
| | - Vicky Ryan
- 3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Falko F Sniehotta
- 3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
| | - Suzanne McDonald
- 3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK.,4Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane and Women's Hospital Campus, Herston, Queensland 4029 Australia
| | - Linda Bauld
- 5Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Elaine McColl
- 3Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX UK
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Nethan ST, Sinha DN, Chandan K, Mehrotra R. Smokeless tobacco cessation interventions: A systematic review. Indian J Med Res 2019; 148:396-410. [PMID: 30666002 PMCID: PMC6362721 DOI: 10.4103/ijmr.ijmr_1983_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background & objectives: Smokeless tobacco (SLT) consumption is a global health issue with about 350 million users and numerous adverse health consequences like oral cancer and myocardial disorders. Hence, cessation of SLT use is as essential as smoking cessation. An update on the available literature on SLT cessation intervention studies is provided here. Methods: Through an extensive literature search on SLT cessation intervention studies, using keywords such as smokeless tobacco, cessation, interventions, quitlines, brief advice, nicotine replacement therapy, nicotine gum, nicotine lozenge, nicotine patch, bupropion, varenicline, mHealth, etc., 59 eligible studies were selected. Furthermore, efficacy of the interventions was assessed from the reported risk ratios (RRs) [confidence intervals (CIs)] and quit rates. Results: Studies were conducted in Scandinavia, India, United Kingdom, Pakistan and the United States of America, with variable follow up periods of one month to 10 years. Behavioural interventions alone showed high efficacy in SLT cessation; most studies were conducted among adults and showed positive effects, i.e. RR [CI] 0.87 [0.7, 1.09] to 3.84 [2.33, 6.33], quit rate between 9-51.5 per cent, at six months. Regular telephone support/quitlines also proved beneficial. Among pharmacological modalities, nicotine lozenges and varenicline proved efficacious in SLT cessation. Interpretation & conclusions: Globally, there is limited information available on SLT cessation intervention trials, research on which must be encouraged, especially in the low-resource, high SLT burden countries; behavioural interventions are most suitable for such settings. Appropriate training/sensitization of healthcare professionals, and school-based SLT use prevention and cessation programmes need to be encouraged.
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Affiliation(s)
- Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | | | - Kumar Chandan
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Ravi Mehrotra
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
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Luk TT, Li WHC, Cheung DYT, Wong SW, Kwong ACS, Lai VWY, Chan SSC, Lam TH, Wang MP. Chat-based instant messaging support combined with brief smoking cessation interventions for Chinese community smokers in Hong Kong: Rationale and study protocol for a pragmatic, cluster-randomized controlled trial. Contemp Clin Trials 2019; 77:70-75. [PMID: 30593882 DOI: 10.1016/j.cct.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/17/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Novel approaches to engage community smokers in smoking cessation are needed as smokers typically lack motivation to quit or use evidence-based tobacco dependence treatment. Mobile instant messaging apps (e.g., WhatsApp, Facebook Messenger) are widely used but under-studied as a mobile health modality for delivering smoking cessation support. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a chat-based intervention using mobile instant messaging combined with brief interventions for community smokers. METHODS This is a two-arm, parallel, accessor-blinded, pragmatic cluster-randomized controlled trial on an estimated 1172 daily cigarette smokers aged ≥18 years proactively recruited from 68 community sites (cluster) throughout Hong Kong. Subjects in intervention group received three months of chat-based, instant messaging support guided by acceptance and commitment therapy and other behavioural change techniques, integrated with brief advice and active referral to a smoking cessation service using the AWARD (Ask, Warn, Advise, Refer, Do-it-again) intervention model. Control group received brief advice to quit plus a self-help booklet at baseline. Outcomes were assessed at 1-, 2-, 3- and 6-month after baseline. The primary outcome is abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 6-month after baseline. Primary analyses will be based on intention-to-treat. COMMENTS This is the first trial examining the effectiveness of a chat-based cessation support programme combined with brief interventions in promoting abstinence. The intervention model can be adapted for other behavioural change treatments and more advanced digital smoking cessation intervention.
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Affiliation(s)
- Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | - Sze Wing Wong
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong.
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Mistry R, Jones AD, Pednekar MS, Dhumal G, Dasika A, Kulkarni U, Gomare M, Gupta PC. Antenatal tobacco use and iron deficiency anemia: integrating tobacco control into antenatal care in urban India. Reprod Health 2018; 15:72. [PMID: 29720206 PMCID: PMC5932801 DOI: 10.1186/s12978-018-0516-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/24/2018] [Indexed: 12/19/2022] Open
Abstract
Background In India, tobacco use during pregnancy is not routinely addressed during antenatal care. We measured the association between tobacco use and anemia in low-income pregnant women, and identified ways to integrate tobacco cessation into existing antenatal care at primary health centers. Methods We conducted an observational study using structured interviews with antenatal care clinic patients (n = 100) about tobacco use, anemia, and risk factors such as consumption of iron rich foods and food insecurity. We performed blood tests for serum cotinine, hemoglobin and ferritin. We conducted in-depth interviews with physicians (n = 5) and auxiliary nurse midwives (n = 5), and focus groups with community health workers (n = 65) to better understand tobacco and anemia control services offered during antenatal care. Results We found that 16% of patients used tobacco, 72% were anemic, 41% had iron deficiency anemia (IDA) and 29% were food insecure. Regression analysis showed that tobacco use (OR = 14.3; 95%CI = 2.6, 77.9) and consumption of green leafy vegetables (OR = 0.6; 95%CI = 0.4, 0.9) were independently associated with IDA, and tobacco use was not associated with consumption of iron-rich foods or household food insecurity. Clinics had a system for screening, treatment and follow-up care for anemic and iron-deficient antenatal patients, but not for tobacco use. Clinicians and community health workers were interested in integrating tobacco screening and cessation services with current maternal care services such as anemia control. Tobacco users wanted help to quit. Conclusion It would be worthwhile to assess the feasibility of integrating antenatal tobacco screening and cessation services with antenatal care services for anemia control, such as screening and guidance during clinic visits and cessation support during home visits.
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Affiliation(s)
- Ritesh Mistry
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I, Room 3806, Ann Arbor, MI, 48109-2029, USA.
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, USA
| | | | - Gauri Dhumal
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Anjuli Dasika
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I, Room 3806, Ann Arbor, MI, 48109-2029, USA
| | - Ujwala Kulkarni
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, USA
| | | | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
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Abstract
Background Globally, over 300 million people consume diverse smokeless tobacco (ST) products. They are addictive, cause cancer, increased cardiovascular mortality risks and poor pregnancy outcomes. Purpose of Review To identify gaps in implementing key ST demand-reduction measures, focused literature reviews were conducted and findings synthesized according to relevant WHO Framework Convention on Tobacco Control (FCTC) Articles. Recent Findings The literature supports implementation of ST demand-reduction measures. For taxation, labelling and packaging, most administrations have weaker policies for ST than cigarettes. Capacity to regulate ST contents and offer cessation support is lacking. There is poor compliance with bans on ST advertising, promotion and sponsorship. Summary The literature on implementation of WHO FCTC for ST is limited. Although strengths of ST demand-control activities are currently identifiable from available literature, full implementation of FCTC is lacking. A wider evidence-based response to WHO FCTC is proposed, particularly for countries facing the greatest disease burdens.
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Perceived stress and smoking across 41 countries: A global perspective across Europe, Africa, Asia and the Americas. Sci Rep 2017; 7:7597. [PMID: 28790418 PMCID: PMC5548752 DOI: 10.1038/s41598-017-07579-w] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022] Open
Abstract
Within recent years, there has been a seismic shift in smoking rates from high-income to low- and middle-income countries (LMICs). Evidence indicates that perceived stress may comprise a barrier for smoking cessation, but little is known about the association of perceived stress and smoking in LMICs. We conducted a cross-sectional, community-based study comprising 217,561 people [mean age 38.5 (SD = 16.1) years, 49.4% males]. A perceived stress score [range 2 (lowest-stress) 10 (highest-stress)] was computed from the Perceived Stress Scale. Multivariable logistic regression analyses were conducted. In the overall sample, a one-unit increase in perceived-stress resulted in a 5% increased odds of smoking (OR = 1.05; 95%CI = 1.03–1.06). Increased stress was associated with smoking in Africa (OR = 1.06; 95%CI = 1.04–1.09), Americas (OR = 1.03; 95%CI = 1.01–1.05), and Asia (OR = 1.06; 95%CI = 1.04–1.08), but not Europe (OR = 0.99; 95%CI = 0.95–1.02). Increasing levels of perceived stress were significantly associated with heavy smoking (≥30 cigarettes per day) among daily smokers (OR = 1.08; 95%CI = 1.02–1.15). A country-wide meta-analysis showed that perceived stress is associated with daily smoking in most countries. Prospective studies are warranted to confirm/refute this relationship, which may have meaningful public health implications.
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Siddiqi K, Elsey H. Supporting the urban poor to quit tobacco: adding years to lives. Thorax 2017; 72:105-106. [PMID: 27815521 DOI: 10.1136/thoraxjnl-2016-209435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Helen Elsey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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