Predictors of participation in a smoking cessation program among young adult smokers

Predictors of Patient Engagement in Telehealth-Delivered Tobacco Cessation Treatment during the COVID-19 Pandemic

Smoking causes one in three cancer deaths and may worsen COVID-19 outcomes. Telehealth tobacco cessation treatment is offered as a covered benefit for patients at the Stanford Cancer Center. We examined predictors of engagement during the COVID-19 pandemic. Data were abstracted from the Electronic Health Record between 3/17/20 (start of pandemic shelter-in-place) and 9/20/22, including patient tobacco use, demographics, and engagement in cessation treatment. Importance of quitting tobacco was obtained for a subset (53%). During the first 2.5 years of the pandemic, 2595 patients were identified as recently using tobacco, and 1571 patients were contacted (61%). Of the 1313 patients still using tobacco (40% women, mean age 59, 66% White, 13% Hispanic), 448 (34%) enrolled in treatment. Patient engagement was greater in pandemic year 1 (42%) than in year 2 (28%) and year 3 (19%). Women (41%) engaged more than men (30%). Patients aged 36-45 (39%), 46-55 (43%), 56-65 (37%), and 66-75 (33%) engaged more than patients aged 18-35 (18%) and >75 (21%). Hispanic/Latinx patients (42%) engaged more than non-Hispanic/Latinx patients (33%). Engagement was not statistically significantly related to patient race. Perceived importance of quitting tobacco was significantly lower in pandemic year 1 than year 2 or 3. Nearly one in three cancer patients engaged in telehealth cessation treatment during the COVID-19 pandemic. Engagement was greater earlier in the pandemic, among women, Hispanic/Latinx individuals, and patients aged 36 to 75. Sheltering-in-place, rather than greater perceived risk, may have facilitated patient engagement in tobacco cessation treatment.

Demographic and Clinical Predictors of Engaging in Tobacco Cessation Counseling at a Comprehensive Cancer Center

PURPOSE

To address challenges promoting tobacco cessation in oncology settings, it is important to understand characteristics associated with patient engagement in tobacco cessation treatment. This analysis examined predictors of participating in at least one tobacco cessation counseling session among patients referred to a comprehensive cancer center's Tobacco Intervention and Psychosocial Support (TIPS) service.

METHODS

Patients with cancer who reported current smoking or recently quitting and referred to TIPS between June 2017 and February 2020 were included in the analysis. Independent variables included sex, race and ethnicity, insurance type, cancer diagnosis (tobacco-related or not), age, nicotine dependence, and cigarettes smoked per day at baseline. The outcome variable was completion of at least one tobacco cessation counseling session among those assessed by the TIPS program. Unadjusted and adjusted analyses tested associations between the independent variables and tobacco cessation counseling engagement.

RESULTS

Of 360 oncology patients referred to the TIPS program, 224 (62.2%) were assessed and 120 (33%) engaged in at least one counseling session. After controlling for sociodemographics and tobacco use, the results demonstrated that patients diagnosed with tobacco-related cancers were 45.3% less likely to engage in the tobacco cessation program compared with those with non-tobacco-related cancers (P = .041).

CONCLUSION

Patients diagnosed with tobacco-related cancers were less likely to engage in TIPS. Additional therapeutic resources may be needed to engage these patients to address potential explanatory factors, such as stigma, guilt, and fatalism. More research is needed to explore the impact of a tobacco-related cancer diagnosis on treatment engagement.

A Web-Based Intervention to Increase Smokers' Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial

BACKGROUND

Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch.

OBJECTIVE

The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study.

METHODS

Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study.

RESULTS

A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Meanbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03).

CONCLUSIONS

This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.

Predictors of Enrollment of Older Smokers in Six Smoking Cessation Trials in the Lung Cancer Screening Setting: The Smoking Cessation at Lung Examination (SCALE) Collaboration

SIGNIFICANCE

Increased rates of smoking cessation will be essential to maximize the population benefit of low-dose CT screening for lung cancer. The NCI's Smoking Cessation at Lung Examination (SCALE) Collaboration includes eight randomized trials, each assessing evidence-based interventions among smokers undergoing lung cancer screening (LCS). We examined predictors of trial enrollment to improve future outreach efforts for cessation interventions offered to older smokers in this and other clinical settings.

METHODS

We included the six SCALE trials that randomized individual participants. We assessed demographics, intervention modalities, LCS site and trial administration characteristics, and reasons for declining.

RESULTS

Of 6,285 trial- and LCS-eligible individuals, 3,897 (62%) declined and 2,388 (38%) enrolled. In multivariable logistic regression analyses, Blacks had higher enrollment rates (OR 1.5, 95% CI 1.2,1.8) compared to Whites. Compared to 'NRT Only' trials, those approached for 'NRT+prescription medication' trials had higher odds of enrollment (OR 6.1, 95% CI 4.7,7.9). Regarding enrollment methods, trials using 'Phone+In Person' methods had higher odds of enrollment (OR 1.6, 95% CI 1.2,1.9) compared to trials using 'Phone Only' methods. Some of the reasons for declining enrollment included 'too busy' (36.6%), 'not ready to quit' (8.2%), 'not interested in research' (7.7%), and 'not interested in the intervention offered' (6.2%).

CONCLUSION

Enrolling smokers in cessation interventions in the LCS setting is a major priority that requires multiple enrollment and intervention modalities. Barriers to enrollment provide insights that can be addressed and applied to future cessation interventions to improve implementation in LCS and other clinical settings with older smokers.

IMPLICATIONS

We explored enrollment rates and reasons for declining across six smoking cessation trials in the lung cancer screening setting. Offering multiple accrual methods and pharmacotherapy options predicted increased enrollment across trials. Enrollment rates were also greater among Blacks compared to Whites. The findings offer practical information for the implementation of cessation trials and interventions in the lung cancer screening context and other clinical settings, regarding intervention modalities that may be most appealing to older, long-term smokers.

Age and pre quit-day attrition during smoking cessation treatment

The present study aimed to replicate the finding that younger age predicts higher pre quit-day attrition. Our second aim was to explain this relation by examining empirically and theoretically informed age-related risk factors for low smoking cessation treatment engagement. 136 participants (Mage = 44.2 years, SD = 11.3 years; age = 22-64 years) were randomized to 15-weeks of either 1) an exercise intervention (n = 72) or 2) a wellness education control condition (n = 64). First, a logistic regression analysis was employed to test whether younger adults were more likely than older adults to drop prior to quit date. Next, we assessed whether smoking related health concerns, social expectancies, and/or perceived severity of craving affected the strength of the relation between age and attrition, by adding these three variables to the logistic regression along with age. The logistic regression model indicated that younger age and treatment condition were significantly related to the odds of dropping from treatment prior to the scheduled quit date. Further, health concerns, social expectancies, and/or perceived severity of cravings did not account for the effect of age on pre quit-day attrition. These findings highlight the importance of identifying empirically and theoretically informed variables associated with the pre quit-day attrition problem of young smokers.

Predictors of participant ‘no-shows’ for intensive behavioral tobacco cessation treatment: recruitment, demographics, and distance

Introduction

Cognitive-behavioral therapy (CBT) for tobacco cessation is an evidence-based, yet underutilized intervention. More research is needed to understand why some treatment-seekers are ‘no-shows’ for the initial visit.

Aim

Examine factors associated with participant no-shows among smokers scheduled for group CBT.

Methods

Tobacco smokers (N = 115) were recruited from the community, screened, and if eligible, scheduled to begin group-based CBT plus nicotine replacement therapy. At the screening, participants reported their recruitment source, demographics, smoking history, and contact information. We computed the distance to the study site using the address provided. Regression analyses tested predictors of participant no-shows for the initial visit.

Results

Eligible participants were mostly recruited via flyers (56%), female (58%), African American (61%), middle-aged (Mage = 49 years), averaged 16 cigarettes per day, and resided 8 miles away from the study site. The overall initial visit no-show rate was 56%. Bivariate analyses indicated that respondents who were recruited online, younger, and lived further away from the site were more likely to be no-shows. Younger age significantly predicted failure to attend in the multivariable model.

Conclusions

Findings highlight potential barriers to participation in a group-based intervention, and have implications for pre-intervention engagement strategies and modifications that may increase reach and uptake.

What Factors Influence Non-Adherence to the Smoking Cessation Program?

OBJECTIVES

To improve our knowledge and understand how to deal with non-adherence to the support programs and to determine the rate and possible factors related to non-adherence in subjects who attended our smoking cessation clinic.

MATERIALS AND METHODS

This was a case-control study that included 550 subjects who applied to our smoking cessation clinic between June 1, 2011 and December 31, 2011. After a 1-year follow-up period, subjects were divided into two groups: adherent (controls) and non-adherent (cases). Sociodemographic and clinical parameters and smoking habits were evaluated. A p value <0.05 was considered significant.

RESULTS

Of the 550 subjects, the number of cases (non-adherent) was 135 (24.6%), and the number of controls (adherent) was 415 (75.4%). Age to begin smoking was significantly young in subjects with non-adherence to the program (p=0.026). The rate of receiving pharmacotherapy was significantly high in subjects with adherence (p<0.0001). No difference was found between the groups according to varenicline, bupropion, nicotine gum, or combined therapy use, whereas nicotine patch use alone significantly increased the rate of non-adherence (p=0.022). Multivariable logistic regression analysis showed that the age to begin smoking (p=0.045, odds ratio (OR): 1.05, 95% confidence interval (CI): 0.86-0.99) and pharmacotherapy (p<0.0001, OR: 5.00, 95% CI: 2.80-8.94) were independent variables that affected adherence to the program.

CONCLUSION

Care should be taken in the follow-up period when providing no pharmacotherapy and with subjects who started smoking at a young age.

School-level disadvantage and failed cessation treatment among adolescent smokers

INTRODUCTION

While understanding factors that lead to successful adolescent smoking cessation outcomes is necessary, it is also prudent to determine factors and conditions that contribute to failure to quit smoking. The present study posits that adolescents' proximal environments, such as schools, may influence cessation treatment outcomes.

METHODS

Using aggregated and geographically-referenced data from multi-year school-based cessation trials with 14-19 year olds seeking cessation in 5 States of the USA, the present study developed and applied a tobacco-specific socio-spatial model inclusive of Hierarchical Linear Modeling. Specifically, this novel approach spatially joined individual data files (n=8855) with measures of school (n=807) and county socio-economic factors. Once linked multi-level analyses explored the extent to which cessation treatment failure was explained by the interplay of individual, school and county-level factors. Treatment was deemed as failing to meet its primary goals if participants continued to smoke cigarettes, measured 3-months post baseline.

RESULTS

Ten per cent of the variation in cessation treatment failure was attributable to school-level variables. Adolescent smokers were more likely to experience failure to quit in: a) school districts with large percentages of the population having less than high-school education, and b) schools with a higher ratio of students to teachers. The strength of the relationship between cessation self-efficacy and treatment success was further weakened among adolescents attending schools with higher percentages of students eligible for free or reduced lunch programs.

CONCLUSIONS

Findings implicate school-level socio-economic disadvantage as a significant factor inhibiting cessation, regardless of adolescent self-efficacy to quit smoking. Understanding the interplay of proximal school environments and individual-level factors may provide insights to educators, policy makers and practitioners into the complexities that inhibit or strengthen an adolescent's smoking cessation treatment experience.

Associations between Culturally Relevant Recruitment Strategies and Participant Interest, Enrollment and Generalizability in a Weight-loss Intervention for African American Families

OBJECTIVE

Culturally relevant recruitment strategies may be an important approach for recruiting ethnic minorities for interventions. Previous research has examined associations between recruitment strategies and enrollment of African Americans (AA), but has not explored more deeply the role of incorporating sociocultural values into recruitment strategies. Our current study explores whether sociocultural recruitment mediums were associated with demographics, interest and enrollment in a weight-loss intervention.

METHOD

Sociocultural mediums included community partnerships, culturally relevant ads, sociocultural events, or word-of-mouth. Non-sociocultural mediums included community/school events that did not specifically target AAs. Analyses examined whether demographics of enrolled families differed by recruitment strategy and if recruitment strategy predicted scheduling a baseline visit, enrolling in a run-in phase, and enrolling in the intervention program.

RESULTS

Families recruited from culturally relevant ads, sociocultural events, or word-of-mouth were 1.96 times more likely to schedule a baseline visit (OR=1.96, 95% CI=1.05, 3.68) than families recruited from non-sociocultural mediums. No differences were found for sociocultural mediums on enrolling in the run-in phase or the intervention. However, among enrolled families, those recruited from sociocultural mediums were less likely to be employed (X(2) [1, N=142] =5.53, P<.05) and more likely to have lower income (X(2) [1, N=142] =13.57, P<.05).

CONCLUSION

Sociocultural mediums were associated with scheduling a baseline visit, but not enrollment. They were, however, effective in recruiting a more generalizable sample among enrolled participants based on demographic characteristics. Integrating sociocultural values into recruitment methods may be a valuable strategy for increasing interest in participation among underrepresented AA families.

Predictors of participation in a telephone-based Acceptance and Commitment Therapy for smoking cessation study

Background

Little is known about factors that influence participation in smoking cessation trials among Chinese populations. The aim of this study is to explore the characteristics of individuals who chose to participate and those who chose not to participate in a proactive telephone-based acceptance and commitment therapy program for smoking cessation within a Chinese sample, and to identify predictors of program participation. Understanding the factors that predict participation in smoking cessation trials may allow researchers and healthcare professionals to target their recruitment efforts to increase the enrollment of smokers in smoking cessation programs.

Methods

Participants were proactively recruited from six primary healthcare centers. Current cigarette smokers were screened for eligibility and then invited to complete a baseline questionnaire for the trial. The differences in characteristics between participants and non-participants as well as factors predictive of participation were analyzed using Chi-square tests and logistics regression.

Results

A total of 30,784 clinic attendees were approached. From these, 3,890 (12.6 %) smokers were screened and identified. Of the 3,890 smokers, 420 (10.8 %) were eligible to participate and completed the baseline questionnaires. The analysis showed that participants (n = 142) and non-participants (n = 278) differed significantly in terms of demographics, smoking-related, and psychological variables. The following characteristics were found to predict program participation: those with a relatively high level of dependence on nicotine (OR = 3.75; 95 % CI = 1.25–11.23), those in the contemplation (OR = 7.86; 95 % CI = 2.90–21.30) or preparation (OR = 24.81; 95 % CI = 8.93–68.96) stages of change, and those who had abstained for one month or less in a previous attempt at quitting (OR = 3.77; 95 % CI = 1.68–8.47).

Conclusions

The study shed light on the factors predictive of participation in a counseling-based smoking cessation program among a Chinese population. The results were encouraging, as most significant predictors (e.g., nicotine dependence, stage of change in smoking cessation) can be feasibly addressed or modified with interventions. No significant predictive relationships were found between psycho-social variables or socio-demographic variables and participation. Efforts should be made to increase the enrollment of smokers who are seemingly not yet ready to quit, and to tailor the program to fit the program’s participants.

Smoking cessation in homeless populations: who participates and who does not

INTRODUCTION

Although homeless individuals smoke at an alarmingly high rate, few smoking cessation clinical trials have focused on this vulnerable population. Little is known about recruitment efforts and suitable eligibility criteria for tobacco control research in homeless populations.

METHODS

The aim of this article is to describe the recruitment, eligibility, and enrollment of homeless smokers who participated in the Power to Quit smoking study, a randomized smoking cessation clinical trial funded by the National Institutes of Health. The study compared motivational interviewing and standard counseling while participants received an 8-week treatment of the nicotine patch.

RESULTS

Working with local emergency shelters, a total of 839 adult smokers were screened for study eligibility, 580 of whom (69.1%) met eligibility criteria. Of those eligible, 430 (74.1%) returned for randomization. Those who returned for randomization were older and more likely to have a phone number compared with eligible participants not enrolled. The most common reasons for exclusion included exhaled carbon monoxide levels less than or equal to 5 parts per million (indicating nonsmoking status), use of smoking cessation aid during the past 30 days, and not meeting the study definition of homelessness.

CONCLUSION

Knowledge of these factors may help researchers tailor criteria that accurately identify and include homeless smokers in future research.

Smoking re-initiation after cessation program: Comparison of associated factors between young and older adults

OBJECTIVE

To evaluate the associated factors in reinitiating the smoking habit among the participants of a smoking cessation program conducted in a tobacco cessation clinic of Manipal University, Manipal.

MATERIALS AND METHODS

This cross-sectional study was conducted among participants of a smoking cessation program who reinitiated smoking habit. A self-administered questionnaire was used that had information on demographic, habit history, knowledge on harmful effects of smoking behavior related to oral cavity and associated factors due to which individual was unable to quit the habit.

RESULTS

A total of 102 males (mean age = 39.91 ± 9.57) constituted the final sample. The results showed that habitual smokers were more likely to be ≥40 years and occasional smokers were all reported to be <93 years (P < 0.001). Cigarette smokers were more likely to be of younger age group while majority of the Beedi and cigarette + Beedi smokers were older adults (P < 0.001). The mean duration of the habit was significantly higher for older adults than young adults (P < 0.001). There was no significant difference in the number of packs between the age groups (P = 0.054). A significantly higher proportion of young adults than older adults were aware about oral cancer (P < 0.001). Significantly higher proportion of older adults than young adults tend to have a closest person to be a smoker (P = 0.05). A significant higher proportion of young adults reason their habit as for pleasure (84.6%) and relaxation (68.8%), while older adults reason it to be as tension (64.1%) or combined factors (70.6%). Peer pressure was almost same in both the age groups (P = 0.006). There were no significant differences in the withdrawal symptoms among young and older adults (P = 0.41).

CONCLUSION

Considerable differences were noticed between younger and older age groups in the factors which might play a role in re-intiating the smoking habit. A structured cessation program focused more on the above characteristics should be planned in public health programs based on the characteristics of the participants.

Characteristics of cigarette smokers who want to quit now versus quit later

This study evaluated factors associated with adult smokers' immediate readiness to quit. Eligible smokers were proactively recruited online and invited to participate in either a telephone-based study for those who intend to quit in the next 30days (Quit Now) or a telephone-based study for those who intend to quit, but not in the next month (Quit Later). Thirty-five percent of smokers declined participation altogether. Of those who remained, 25% chose Quit Now participation. Baseline data were collected via mail questionnaire and telephone interview. Quit Now and Quit Later participants (N=1132) differed on demographic, smoking history, and psychological variables. Independent predictors of Quit Now group membership included younger age, stronger intention to quit in the next six months, greater self-efficacy to cope with temptation to smoke, and more support from significant others related to quit attempts-much of which is modifiable. Understanding factors that predict smokers' immediate readiness to quit (measured here as Quit Now group membership) could contribute to the development of smoking cessation treatments tailored for smokers who are seemingly not yet ready to quit.

Predictors of smoking relapse in a cohort of adolescents and young adults in Monastir (Tunisia)

BACKGROUND

Smoking prevalence in adolescents and young adults is substantially elevated in Tunisia. Moreover, there is a lack of knowledge regarding the effectiveness and associated factors in smoking cessation interventions among adolescents and young adults. This study aims at identifying the major factors leading to smoking relapse among adolescents and young adults in the region of Monastir, Tunisia.

METHODS

We carried out a prospective cohort study at the smoking cessation center of the University hospital of Monastir, Tunisia. The population study consisted of all adolescents and young adults (15-30 years) consulted during a period of two years (2009 - 2010). A questionnaire was used to explore the patient's sociodemographic characteristics, smoking history, nicotine dependence (Fagerstrom test) and anxiety / depression (Hospital Anxiety and Depression Scale). A telephone survey was conducted in July 2011 to assess smoking cessation results. A multivariate Cox regression was used to identify predictors of smoking relapses.

RESULTS

A total of 221 adolescents and young adults were included in this study with a mean age of 25.5 ± 3.9 years. At follow up, 59 study participants (26.7%) were abstinent and the overall median abstinence was 2 months. In the multivariate analysis smoking relapse was associated with being an adolescent patient (HR 2.16; 95% CI: 1.54-3.05), medium or higher nicotine dependence at baseline (HR 2.66, 95% CI: 1.06-7.05 and HR 3.12, 95% CI: 1.20-8.12 respectively), not receiving treatment (HR 1.70, 95% CI: 1.25-2.33) and have friend who is a smoker (HR 1.63; 95% CI: 0.96-2.79).

CONCLUSION

The results of this study provide important information about beneficial effect of smoking cessation support for adolescent and young adults. More efforts must be deployed to deal with contributing factors to smoking relapse.

Racial differences in eligibility and enrollment in a smoking cessation clinical trial

OBJECTIVE

The purpose of this study was to compare the recruitment, eligibility screening, and enrollment of African American and White smokers into an intensive smoking cessation intervention trial [The Chicago STOP Smoking Trial (C-STOP)].

METHODS

We compared demographic, smoking, substance use, and medical/psychiatric screening data from the recruitment records of 1,189 non-Hispanic, African American and White smokers screened for eligibility in the last year of a randomized pharmacological and behavioral smoking cessation trial. The study took place at a large urban medical center and two satellite locations within the Chicago metropolitan area.

RESULTS

Interest levels in the study were high among African American smokers, with twice as many African Americans as Whites contacting study staff for information and an initial screening. However, African Americans were nearly three times as likely not to be enrolled in the trial as Whites, because of higher ineligibility rates, failure to attend a screening session, and lower participation rates even among those meeting eligibility requirements.

CONCLUSIONS

Racial differences were observed nearly at all levels of enrollment determination. These critical barriers to inclusion of African Americans in smoking cessation research limit our understanding of treatment efficacy and ultimately the ability to reduce the health disparities in tobacco-related disease experienced by African Americans.

Perceived difficulty quitting predicts enrollment in a smoking-cessation program for patients with head and neck cancer

PURPOSE/OBJECTIVES

To determine the predictors of participation in a smoking-cessation program among patients with head and neck cancer.

DESIGN

This cross-sectional study is a substudy of a larger, randomized trial of patients with head and neck cancer that determined the predictors of smokers' participation in a cessation intervention.

SETTING

Otolaryngology clinics at three Veterans Affairs medical centers (Ann Arbor, MI, Gainesville, FL, and Dallas, TX), and the University of Michigan Hospital in Ann Arbor.

SAMPLE

286 patients who had smoked within six months of the screening survey were eligible for a smoking-cessation intervention.

METHODS

Descriptive statistics and bivariate and multivariate logistic regression were used to determine the independent predictors of smokers' participation in an intervention study.

MAIN RESEARCH VARIABLES

Perceived difficulty quitting (as a construct of self-efficacy), health behaviors (i.e., smoking and problem drinking), clinical characteristics (i.e., depression and cancer site and stage), and demographic variables.

FINDINGS

Forty-eight percent of those eligible participated. High perceived difficulty quitting was the only statistically significant predictor of participation, whereas problem drinking, lower depressive symptoms, and laryngeal cancer site approached significance.

CONCLUSIONS

Special outreach may be needed to reach patients with head and neck cancer who are overly confident in quitting, problem drinkers, and patients with laryngeal cancer.

IMPLICATIONS FOR NURSING

Oncology nurses are in an opportune position to assess patients' perceived difficulty quitting smoking and motivate them to enroll in cessation programs, ultimately improving quality of life, reducing risk of recurrence, and increasing survival for this population.

Rates of enrollment in smoking cessation services following fax referrals from a children's hospital

OBJECTIVE

The aim of this study was to describe the rates of enrollment in tobacco dependence treatment among smoking adults who accepted a fax referral from health care providers at a children's hospital, and to examine smoker characteristics associated with enrollment.

METHODS

Secondary analysis of the state-sponsored fax referral and treatment program data on all referrals from Arkansas Children's Hospital in 2005 to 2007 was conducted. Enrollment was defined as attendance at 1 or more counseling sessions within 1 year of referral. Logistic regression analyses were used to identify demographic and tobacco-related characteristics associated with enrollment versus nonenrollment in a treatment program among those contacted by the program.

RESULTS

Of the 749 faxed referrals to the program, 157 (21.0%) enrolled in a treatment program and received 1 or more treatment sessions; 505 were contacted by the program, and of these, 147 (29%) enrolled. Women were more likely to enroll than men (odds ratio [OR] 1.81; 95% confidence interval [95% CI], 1.09-3.01). Whites were twice as likely to enroll than African Americans (OR 2.35; 95% CI, 1.28-4.33). Older age (OR 1.04; 95% CI, 1.01-1.06) and higher self-efficacy scores (OR 1.13; 95% CI, 1.02-1.26) increased the likelihood of enrollment.

CONCLUSIONS

Approximately 1 in 5 smokers who accepted a fax referral enrolled in and received intensive treatment services for tobacco dependence. Thus, innovative approaches are needed to increase enrollment among younger, African American, and male smokers.

Epidemiologic determinants affecting cigarette smoking cessation: a retrospective study in a National Health System (SSN) treatment service in Rome (Italy)

This retrospective study aims to evaluate epidemiologic characteristics of patients attending stop smoking courses, based on group therapy, testing their influence on smoking cessation in univariate and multivariate model. A total of 123 patients were included in this study. Mean age was 53 (±11). Sixty-seven percent were women. At the end of the courses 66% of patients stopped smoking, after 12 months only 39% remained abstinent. Patients younger than 50 years statistically tended to continue smoking 6 months (P = .02–R.R. = 1.49, C.I. 95%: 1.06–2.44) and 12 months (P = .03–R.R. = 1.37, C.I. 95%: 1.02–2.52) after the end of the courses. A low self-confidence in quitting smoking was significantly related to continuing tobacco consumption after 6 months (P = .016–R.R. = 1.84, C.I. 95%: 1.14–2.99). Low adherence to therapeutic program was statistically associated to maintenance of tobacco use at 6 months (P = .006–R.R. = 1.76, C.I. 95%: 1.32–2.35) and 12 months (P = .050–R.R. = 1.45, C.I. 95%: 1.11–1.88). This association was confirmed at 6 months in the analysis performed on logistic regression model (P = .013).

A profile of teen smokers who volunteered to participate in school-based smoking intervention

OBJECTIVES

Although a number of population-based studies have examined the characteristics of teens who attempt to quit smoking, few have identified the characteristics of youth who participate in structured cessation interventions, particularly those with demonstrated effectiveness. The purpose of the present study is to describe the sociodemographic and smoking-related characteristics of teen smokers who participated in the American Lung Association's Not On Tobacco (N-O-T) program, spanning eight years. N-O-T is the most widely used teen smoking cessation program in the nation.

METHODS

Drawn from multiple statewide N-O-T studies, this investigation examined data from 5,892 teen smokers ages 14-19 who enrolled in N-O-T between 1998-2006. We demonstrate similarities and differences between N-O-T findings and existing data from representative samples of US teen smokers where available and relevant.

RESULTS

N-O-T teens started smoking earlier, were more likely to be poly-tobacco users, were more dependent on nicotine, had made more previous attempts to quit, and were more deeply embedded in smoking contexts than comparative samples of teen smokers. Additionally, N-O-T teens were moderately ready to quit smoking, believed important people in their lives would support their quit efforts, yet had deficits in their confidence with quitting.

CONCLUSION

This profile of N-O-T teens can guide efforts for targeted recruitment strategies to enhance intervention reach for teen smoking cessation. Findings provide guidance for marketing and recruitment efforts of intensive, school-based cessation interventions among established teen smokers, particularly those who want to quit. Study results may shed light upon who is and is not enrolling in N-O-T.

Racial/Ethnic disparities in the use of nicotine replacement therapy and quit ratios in lifetime smokers ages 25 to 44 years

We examined racial/ethnic variations in the use of nicotine replacement therapy (NRT) and quit ratios among Caucasian, African American, Asian, and Latino lifetime smokers ages 25 to 44 years. We conducted cross-sectional analyses using data from individuals (n = 27,031) screened for enrollment in the Collaborative Study of the Genetics of Nicotine Dependence. Participants were randomly sampled from three Midwestern metropolitan areas using Health Maintenance Organization membership lists in Detroit, MI and Minneapolis, MN and a driver's license registry in St. Louis, MO from March 2003 to August 2005. A telephone survey collected information on smoking history, previous quit attempts, and sociodemographic characteristics. Among lifetime smokers (n = 9,216), univariate analysis indicated that African Americans (22%) and Latinos (22%) were significantly less likely to report having ever used NRT for smoking cessation than Caucasians (31%). Asians (22%) also reported lower rates of using NRT than Caucasians, but this difference was marginally significant (P = 0.06). These disparities persisted in multivariate analysis for African Americans [adjusted odds ratio (OR), 0.76; 95% confidence interval (95% CI), 0.63-0.91; P < 0.01] but not for Latinos (adjusted OR, 0.76; 95% CI, 0.54-1.06; P = 0.11) or Asians (adjusted OR, 0.98; 95% CI, 0.60-1.60; P = 0.95). As measured by the quit ratio, African Americans (35%) were less likely to have quit smoking than Caucasians (52%). This disparity persisted in multivariate logistic regression (adjusted OR, 0.66; 95% CI, 0.56-0.78; P < 0.001). Asian and Latino smokers were as likely as Caucasians to report smoking cessation. Future prospective studies are needed to assess whether lower utilization of cessation treatments such as NRT contribute to the observed disparity in quit ratios for African Americans.