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Han X, Xu Z, Ma D, Ling Z, Dong X, Yan X, Chen Y, Lu G, Yin X, Xu H. Effect of smoking cessation on the likelihood of pancreatitis and pancreatic cancer. Tob Induc Dis 2024; 22:TID-22-130. [PMID: 39006371 PMCID: PMC11241968 DOI: 10.18332/tid/190635] [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: 04/03/2024] [Revised: 06/21/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Tobacco smoking is a major risk factor for various diseases worldwide, including pancreatic exocrine diseases such as pancreatitis and pancreatic cancer (PC). Currently, few studies have examined the impact of smoking cessation on the likelihood of common pancreatic exocrine diseases. This study sought to determine whether smoking cessation would reduce pancreatitis and PC morbidity. METHODS This cohort study used data from the UK Biobank (UKB) to examine the association between smoking status and the likelihood of pancreatitis and PC among 492855 participants. The subjects were divided into never smokers, ex-smokers, and current smokers. Using a multivariate-adjusted binary logistic regression model, we analyzed the relationship between different smoking conditions and the likelihood of pancreatitis and PC. Further, we studied the impact of smoking cessation on pancreatitis and PC compared with current smoking. RESULTS After adjusting for potential confounders, current smokers had higher odds for acute pancreatitis (AP) (AOR=1.38; 95% CI: 1.18-1.61), chronic pancreatitis (CP) (AOR=3.29; 95% CI: 2.35-4.62) and PC (AOR=1.72; 95% CI: 1.42-2.09). People who quit smoking had comparable odds for the diseases as those who never smoked. Compared with current smokers, ex-smokers had reduced odds for AP (AOR=0.76; 95% CI: 0.64-0.89), CP (AOR=0.31; 95% CI: 0.21-0.46), and PC (AOR=0.62; 95% CI: 0.50-0.76). Subgroup analysis revealed reduced odds for these pancreatic diseases in males and females. CONCLUSIONS Smokers have an increased odds for pancreatitis and pancreatic cancer. Moreover, smoking cessation can significantly reduce the odds for acute pancreatitis, chronic pancreatitis and pancreatic cancer.
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Affiliation(s)
- Xiao Han
- Department of Oncology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zouhua Xu
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Yangzhou University, Yangzhou University, Kunshan, China
| | - Dongmei Ma
- Department of Oncology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhi Ling
- Department of Oncology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xiaowu Dong
- Yangzhou Key Laboratory of Pancreatic Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Pancreatic Center, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xuebing Yan
- Department of Oncology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yong Chen
- Department of Oncology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Guotao Lu
- Yangzhou Key Laboratory of Pancreatic Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Pancreatic Center, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xudong Yin
- Department of Oncology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Pancreatic Diseases, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Hongwei Xu
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Yangzhou University, Yangzhou University, Kunshan, China
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Nagarajan K, Kumarswamy K, Begum R, Panibatla V, Singarajipura A, Adepu R, Munjattu JF, Sellapan S, Arangba S, Goswami A, Swamickan R, Basha J, Dsouza PM, Muniyandi M. Self-driven solutions and resilience adapted by people with drug-resistant tuberculosis and their caregivers in Bengaluru and Hyderabad, India: a qualitative study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 22:100372. [PMID: 38420270 PMCID: PMC10900834 DOI: 10.1016/j.lansea.2024.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/08/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Background One-fifth of people with drug-resistance tuberculosis (DR-TB) who were initiated on newer shorter treatment regimen (with injection) had unfavourable treatment outcomes in India as on 2020. Evidence on self-driven solutions and resilience adapted by people with DR-TB (PwDR-TB) towards their multi-dimensional disease and treatment challenges are scarce globally, which we aimed to understand. Methods In this qualitative study using positive deviance framework, we conducted semi-structured in-depth interviews among consenting adult PwDR-TB (7 women, 13 men) who completed shorter treatment regimen (including injections) with maximum treatment adherence. The study was conducted in the southern districts of Bengaluru and Hyderabad, India between June 2020 and December 2022. Caregivers (14 women, 6 men) and health providers (8 men, 2 women) of PwDR-TB were also interviewed. Interviews were conducted in local language (Kannada, Tamil, Telugu, Urdu and Hindi) and inquired about practices, behaviours, experiences, perceptions and attributes which enabled maximum adherence and resilience of PwDR-TB. Interviews were audio recorded, transcribed, and translated to English and coded for thematic analysis using inductive approach. Findings Distinctive themes explanatory of the self-driven solutions and resilience exhibited by PwDR-TB and their caregivers were identified: (i) Self-adaptation towards the biological consequences of drugs, by personalised nutritional and adjuvant practices, which helped to improve drug ingestion and therapeutic effects. Also home remedies and self-plans for ameliorating injection pain. (ii) Perceptual adaptation towards drugs aversion and fatigue, by their mind diversion practices, routinisation and normalisation of drug intake process. and constant reinforcement and re-interpretation of bodily signs of disease recovery (iii) Family caregivers intense and participatory care for PwDR-TB, by aiding their essential life activities and ensuring survival, learning and fulfilling special nutritional needs and goal oriented actions to aid drug intake (iv) Health care providers care, marked by swift and timely risk mitigation of side-effects and crisis response (v) Acquired self-efficacy of PwDR-TB, by their decisive family concerns resulting in attitudinal change. Also being sensitised on the detrimental consequences of disease and being motivated through positive examples. Interpretation Synthesised findings on self-driven solutions and resilience towards the multi-dimensional DR-TB challenges provides opportunity for developing and testing new interventions for its effectiveness in DR-TB care settings globally. Designing and testing personalised cognitive interventions for PwDR-TB: to inculcate attitudinal change and self-efficacy towards medication, developing cognitive reinforcements to address the perception burden of treatment, skill building and mainstreaming the role of family caregivers as therapeutic partners of PwDR-TB, curating self-adaptive behaviours and practices of PwDR-TB to normalise their drug consumptions experiences could be the way forward in building resilience towards DR-TB. Funding United States Agency for International Development (USAID) through Karnataka Health Promotion Trust (KHPT), Bengaluru, India.
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Affiliation(s)
- Karikalan Nagarajan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Karthikeyan Kumarswamy
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Rehana Begum
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Vikas Panibatla
- TB Alert India, Hyderabad, West Marredpally, Secunderabad, Telangana, 500026, India
| | - Anil Singarajipura
- State TB Office, 2nd Floor, Arogya Soudha, Magadi Road, Bengaluru, Karnataka, 560023, India
| | - Rajesham Adepu
- State TB Office, Directorate of Medical & Health Services, Hyderabad, Telangana, 500095, India
| | - Joseph Francis Munjattu
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Senthil Sellapan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Stephen Arangba
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | | | | | - Javeed Basha
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Pearl Maria Dsouza
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Malaisamy Muniyandi
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
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Liu Y, Lu L, Yang H, Wu X, Luo X, Shen J, Xiao Z, Zhao Y, Du F, Chen Y, Deng S, Cho CH, Li Q, Li X, Li W, Wang F, Sun Y, Gu L, Chen M, Li M. Dysregulation of immunity by cigarette smoking promotes inflammation and cancer: A review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 339:122730. [PMID: 37838314 DOI: 10.1016/j.envpol.2023.122730] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/26/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023]
Abstract
Smoking is a serious global health issue. Cigarette smoking contains over 7000 different chemicals. The main harmful components include nicotine, acrolein, aromatic hydrocarbons and heavy metals, which play the key role for cigarette-induced inflammation and carcinogenesis. Growing evidences show that cigarette smoking and its components exert a remarkable impact on regulation of immunity and dysregulated immunity promotes inflammation and cancer. Therefore, this comprehensive and up-to-date review covers four interrelated topics, including cigarette smoking, inflammation, cancer and immune system. The known harmful chemicals from cigarette smoking were summarized. Importantly, we discussed in depth the impact of cigarette smoking on the formation of inflammatory or tumor microenvironment, primarily by affecting immune effector cells, such as macrophages, neutrophils, and T lymphocytes. Furthermore, the main molecular mechanisms by which cigarette smoking induces inflammation and cancer, including changes in epigenetics, DNA damage and others were further summarized. This article will contribute to a better understanding of the impact of cigarette smoking on inducing inflammation and cancer.
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Affiliation(s)
- Yubin Liu
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China
| | - Lan Lu
- Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Sichuan Industrial Institute of Antibiotics, School of Pharmacy, Chengdu University, Chengdu, Sichuan, China
| | - Huan Yang
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China
| | - Xu Wu
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China; South Sichuan Institute of Translational Medicine, Luzhou, Sichuan, China
| | - Xinyue Luo
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Jing Shen
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China; South Sichuan Institute of Translational Medicine, Luzhou, Sichuan, China
| | - Zhangang Xiao
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China; South Sichuan Institute of Translational Medicine, Luzhou, Sichuan, China
| | - Yueshui Zhao
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China; South Sichuan Institute of Translational Medicine, Luzhou, Sichuan, China
| | - Fukuan Du
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China; South Sichuan Institute of Translational Medicine, Luzhou, Sichuan, China
| | - Yu Chen
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China; South Sichuan Institute of Translational Medicine, Luzhou, Sichuan, China
| | - Shuai Deng
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China; South Sichuan Institute of Translational Medicine, Luzhou, Sichuan, China
| | - Chi Hin Cho
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China
| | - Qianxiu Li
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China
| | - Xiaobing Li
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Wanping Li
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Fang Wang
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Yuhong Sun
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Li Gu
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Meijuan Chen
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
| | - Mingxing Li
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China; Cell Therapy & Cell Drugs of Luzhou Key Laboratory, Luzhou, Sichuan, China; South Sichuan Institute of Translational Medicine, Luzhou, Sichuan, China.
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Lim L, Wang VX. Framing Slogans for Responsible Gambling Campaigns: A Tale of Two Models. Healthcare (Basel) 2023; 11:2754. [PMID: 37893828 PMCID: PMC10606591 DOI: 10.3390/healthcare11202754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
This study investigates the persuasive mechanism of slogans employed in responsible gambling campaigns. We analyse slogans from official posters in the U.S., Singapore, and Macau, focusing on two domains. First, the Theory of Planned Behaviour is applied to examine the intention to gamble expressed in the slogans to reveal how gambling is positioned in social contexts. Second, two framing devices-i.e., conceptual metaphors and the frame of gains/losses-are examined to understand how these framing devices reinforce the persuasive message while interacting with each other. Two models of persuasion emerge from our data-one encouraged 'grounded games' for enjoyment, while the other discouraged gambling due to its potentially 'harmful' consequences. We advocate for a gestalt view on the theoretical constructs that contribute to the overall effectiveness of persuasive messaging. These constructs should be integrated into an analytical framework, with particular attention given to the framing effect of conceptual metaphors and the gain/loss frame, and their interplay.
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Affiliation(s)
- Lily Lim
- MPU-Bell Centre of English, Macao Polytechnic University, Macau SAR, China
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Mangone L, Marinelli F, Bisceglia I, Zambelli A, Zanelli F, Pagano M, Alberti G, Morabito F, Pinto C. Changes in the Histology of Lung Cancer in Northern Italy: Impact on Incidence and Mortality. Cancers (Basel) 2023; 15:3187. [PMID: 37370797 DOI: 10.3390/cancers15123187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This study assessed the incidence, mortality, and survival of lung cancer subtypes of NSCSLC (non-small-cell lung cancer), SCLC (small-cell lung cancer), and other morphologies. It is an observational epidemiological study using 7197 cases from the Reggio Emilia Cancer Registry recorded between 2001 and 2020 in males and females. The incidence of NSCLC in 5104 males indicates a significant 3% annual increase until 2013 and then a decline of -3.2% that is not statistically significant; until 2014, mortality increased significantly (3.2%), but it then decreased non-significantly (-12.1%), especially squamous cell cancer. In 2093 females, the incidence and mortality trends continued to rise significantly through 2012, and then they began to slightly decline (not statistically significant). The two-year relative survival of NSCLC increased from 32% to 38% in males and from 42% to 56% in females. SCLC in males decreased significantly both in incidence and mortality, while in women, it showed a slight increase (significantly for incidence but not for mortality). This study is important because it analyzes the decrease in lung cancer in males and the increase in females in relation to the different histotypes. Our study's findings confirmed a decline in male incidence and death beginning in 2013. We were unable to determine if the drop in cigarette smoking and the introduction of new drugs such as EGFR in first-line therapy were responsible for the lower incidence.
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Affiliation(s)
- Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42122 Reggio Emilia, RE, Italy
| | - Francesco Marinelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42122 Reggio Emilia, RE, Italy
| | - Isabella Bisceglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42122 Reggio Emilia, RE, Italy
| | - Alessandro Zambelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42122 Reggio Emilia, RE, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42122 Reggio Emilia, RE, Italy
| | - Maria Pagano
- Medical Oncology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42122 Reggio Emilia, RE, Italy
| | - Giulia Alberti
- Medical Oncology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42122 Reggio Emilia, RE, Italy
| | - Fortunato Morabito
- Biotechnology Research Unit, Azienda Sanitaria Provinciale di Cosenza, 87051 Aprigliano, CS, Italy
| | - Carmine Pinto
- Medical Oncology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42122 Reggio Emilia, RE, Italy
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Djochie RDA, Anto BP, Opare-Addo MNA. Determinants of adverse reactions to first-line antitubercular medicines: a prospective cohort study. J Pharm Policy Pract 2023; 16:70. [PMID: 37291618 DOI: 10.1186/s40545-023-00577-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The success of tuberculosis treatment relies on patients adhering to their medication regimen consistently. However, adherence levels tend to decrease among patients who experience adverse drug reactions to antitubercular medications, leading to suboptimal treatment outcomes. Hence, this study aimed to examine the types, incidence rates, and severity of adverse reactions caused by first-line antitubercular drugs. Additionally, it aimed to identify factors associated with the development of these reactions. By doing so, the study aimed to facilitate the provision of personalized and effective treatment to patients, ultimately improving treatment outcomes. METHODS Newly diagnosed patients with active tuberculosis were monitored from the start of their treatment until the completion of therapy. Any adverse reactions to anti-TB drugs that they encountered were carefully recorded. The collected data were analyzed using appropriate statistical methods such as analysis of variance, Chi-squared test, Fisher's exact test, and independent t-tests. Logistic regression was employed to assess the association between adverse drug reactions and various socio-demographic and clinical factors of the patients, using odds ratios as a measure of association. RESULTS Among the 378 patients included in the study, 181 individuals (47.9%) reported experiencing at least one adverse drug reaction, with an incidence rate of 1.75 events per 100-person months. The majority of these reactions occurred during the intensive phase of treatment. The gastrointestinal tract was the most commonly affected system, followed by the nervous system and skin. Patients aged over 45 years (OR = 1.55, 95% CI 1.01-2.39, p = 0.046) and those with extrapulmonary tuberculosis (OR = 2.41, 95% CI 1.03-5.64) were more likely to develop gastrointestinal reactions. Female gender was a significant predictor of both skin (OR = 1.78, 95% CI 1.05-3.02, p = 0.032) and nervous system (OR = 1.65, 95% CI 1.07-2.55, p = 0.024) reactions. Additionally, alcohol use and HIV infection were identified as independent predictors of adverse drug reactions affecting all three systems. CONCLUSION Significant risk factors for developing antitubercular drug adverse reactions include alcohol consumption, cigarette smoking, being HIV positive, female gender and extrapulmonary tuberculosis.
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Affiliation(s)
- Richard Delali Agbeko Djochie
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences Kwame Nkrumah University of Science and Technology, Kumasi Private Mailbag, Kumasi, Ghana
| | - Berko Panyin Anto
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences Kwame Nkrumah University of Science and Technology, Kumasi Private Mailbag, Kumasi, Ghana.
| | - Mercy Naa Aduele Opare-Addo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences Kwame Nkrumah University of Science and Technology, Kumasi Private Mailbag, Kumasi, Ghana
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Panda R, Lahoti S, Mishra A, Prabhu RR, Das S, Satapathy DM, Nazareth I. Designing a mobile health smokeless tobacco cessation intervention in Odisha, India: User and provider perspectives. Digit Health 2023; 9:20552076221150581. [PMID: 36655182 PMCID: PMC9841872 DOI: 10.1177/20552076221150581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023] Open
Abstract
Objective There is limited evidence on the development of mobile health (mHealth) interventions for smokeless tobacco (SLT) cessation, despite its widespread use in South Asia. This formative qualitative study explored the perceptions of tobacco users and healthcare providers (HCPs) regarding developing a mHealth intervention for SLT cessation. Methods This was a qualitative study using in-depth interviews (IDIs) with tobacco users (n = 26) and primary care physicians (PCPs) (n = 5) and focus group discussions (FGDs) with counsellors (n = 2) in four urban primary health centres (UPHCs) in Berhampur, Odisha from February to March 2020. The data were coded and analysed by two researchers using a framework analysis method. The discussion guides and initial codes were developed based on the Transtheoretical Model (TTM) of behaviour change. Results The results were elaborated under four themes: (1) Current scenario of SLT use; (2) Barriers and facilitators for quitting SLT; (3) Barriers and facilitators for mHealth counselling; and (4) Design and delivery of the proposed intervention. SLT use was prevalent in the community regardless of sociodemographic factors. Peer factors accounted for both tobacco consumption as well as considering cessation. Participants considered mobile message counselling helpful and acceptable. Not having a mobile phone and illiteracy were identified as barriers while ease of access and rising popularity of social media applications were considered facilitators to the use of mHealth for quitting tobacco. Participants preferred messages that were pictorial, short and simple, in the local language, and tailored to individual's needs. Conclusions This is the first study that provides evidence within the Indian context that the text messaging platform may be used for delivering an SLT cessation intervention. The integration of a theoretical basis and research findings from target users can guide future intervention development.
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Affiliation(s)
- Rajmohan Panda
- Research Division, Public Health Foundation of India, New Delhi, India
| | - Supriya Lahoti
- Research Division, Public Health Foundation of India, New Delhi, India
| | - Arti Mishra
- Project ECHO (Extension for Community Healthcare Outcomes), New Delhi, India
| | - Rajath R Prabhu
- Research Division, Public Health Foundation of India, New Delhi, India
| | - Sangeeta Das
- Research Division, Public Health Foundation of India, India
| | | | - Irwin Nazareth
- Department of Primary Care and Population Sciences, University College London, London, UK
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Li J, Hui X, Fu J, Ahmed MM, Yao L, Yang K. Electronic cigarettes versus nicotine-replacement therapy for smoking cessation: A systematic review and meta-analysis of randomized controlled trials. Tob Induc Dis 2022; 20:90. [PMID: 36339933 PMCID: PMC9582581 DOI: 10.18332/tid/154075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/09/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Nicotine-replacement therapy (NRT) and electronic cigarettes (e-cigarettes) have been frequently used for smoking cessation. The aim of this review is to investigate the effectiveness and safety of e-cigarettes versus NRT for smoking cessation. METHODS We searched PubMed, EMBASE, the Cochrane Library from inception to 10 October 2021. We included randomized controlled trials (RCTs) comparing e-cigarettes versus NRT for smoking cessation. Two authors independently screened titles, abstracts and full texts for eligibility. Paired authors extracted data, assessed risk of bias, and used GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) to rate the certainty of evidence. RESULTS The study included five RCTs with 1748 participants. The meta-analysis suggested the e-cigarettes versus NRT increased the ≥6 months continuous abstinence rate (RR=1.67; 95% CI: 1.21-2.28; 55 more per 1000 participants, low certainty), and 7-day point abstinence rate at ≥6 months follow-up (RR=1.43; 95% CI: 1.19-1.72; 84 more per 1000, low certainty). However, we found no evidence that e-cigarettes versus NRT increased 3-6 months continuous abstinence rate (RR=1.07; 95% CI: 0.73-1.57; 10 more per 1000, very low certainty) and <3 months continuous abstinence rate (RR=1.20; 95% CI: 0.90-1.60; 54 more per 1000, low certainty); similar results were found at <3 months follow-up (RR=1.19; 95% CI: 0.92-1.54; 55 more per 1000, very low certainty) and 3-6 months follow-up in 7-day point abstinence rate (RR=1.01; 95% CI: 0.70-1.44; 2 more per 1000, very low certainty). The adverse events were not significant between e-cigarettes and NRT other than throat irritation (RR=1.27; 95% CI: 1.13-1.42; 118 more per 1000, low certainty). CONCLUSIONS E-cigarettes appeared to be superior to NRT in ≥6 months continuous abstinence rate and 7-day point abstinence rate. At short-term duration, we found no evidence that e-cigarettes compared to NRT increased the <6 months continuous abstinence rate and 7-day point abstinence rate.
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Affiliation(s)
- Jing Li
- Health Technology Assessment Centre, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People’s Republic of China
| | - Xu Hui
- Health Technology Assessment Centre, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People’s Republic of China
| | - Jiani Fu
- Second Clinical Medical College, Lanzhou University, Lanzhou, People’s Republic of China
| | | | - Liang Yao
- Department of Health Research Methodology, McMaster University, Hamilton, Canada
| | - Kehu Yang
- Health Technology Assessment Centre, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People’s Republic of China,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, People’s Republic of China
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Park ER, Skurla SE, Caballero GYJ, Friedman ER, Ponzani C, Wallace R, Malin J, Keating NL. Long-term follow-up of smokers following lung and colorectal cancer diagnosis. Support Care Cancer 2022; 30:7801-7809. [PMID: 35552828 DOI: 10.1007/s00520-022-07111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Continued smoking after a cancer diagnosis limits the effectiveness of treatment, increases the risk of cancer recurrence or secondary malignancies, and is associated with poorer quality of life and survival. A cancer diagnosis may provide a meaningful timepoint for quitting, but the prevalence and characteristics of continued smoking through survivorship are poorly understood. METHODS In the multi-regional Cancer Care Outcomes Research and Surveillance (CanCORS) cohort, we examined smoking rates and factors associated with continued smoking at long-term follow-up among lung and colorectal cancer patients. This paper builds upon previous CanCORS participant data addressing quit rates and associated characteristics at baseline and 5 months post-diagnosis. RESULTS At long-term follow-up (median 7.3 years post-diagnosis [IQR = 5.9-8.7]), 16.7% of lung cancer and 11.6% of colorectal cancer survivors continued to smoke combustible cigarettes. Factors independently associated with continued smoking at long-term follow-up included being male, younger, not married or partnered, having Medicare, Medicaid/other public or no insurance, more depression symptoms, smoking more cigarettes per day, and having a history of lung disease (p < .05). Continued smoking did not vary by lung vs. colorectal cancer diagnosis. CONCLUSION Of active smokers at the time of diagnosis, an important minority of lung and colorectal cancer survivors continued to smoke well into survivorship. Understanding characteristics associated with continued smoking after a cancer diagnosis may help inform the development of tobacco treatment programs for cancer patients and survivors. IMPLICATIONS FOR SURVIVORS While addressing smoking cessation at the time of diagnosis is critical to ensure better long-term treatment outcomes and quality of life, it is essential to continue smoking cessation discussions and efforts throughout care and survivorship.
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Affiliation(s)
- Elyse R Park
- Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA.
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MB, USA.
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Sarah E Skurla
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA
| | | | - Emily R Friedman
- Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Colin Ponzani
- Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Robert Wallace
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | | | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Medicine, Brigham and Women's Hospital, Boston, MA, USA
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10
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Ostroff JS, Shelley DR, Chichester LA, King JC, Li Y, Schofield E, Ciupek A, Criswell A, Acharya R, Banerjee SC, Elkin EB, Lynch K, Weiner BJ, Orlow I, Martin CM, Chan SV, Frederico V, Camille P, Holland S, Kenney J. Study protocol of a multiphase optimization strategy trial (MOST) for delivery of smoking cessation treatment in lung cancer screening settings. Trials 2022; 23:664. [PMID: 35978334 PMCID: PMC9383667 DOI: 10.1186/s13063-022-06568-3] [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: 04/01/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is widespread agreement that the integration of cessation services in lung cancer screening (LCS) is essential for achieving the full benefits of LCS with low-dose computed tomography (LDCT). There is a formidable knowledge gap about how to best design feasible, effective, and scalable cessation services in LCS facilities. A collective of NCI-funded clinical trials addressing this gap is the Smoking Cessation at Lung Examination (SCALE) Collaboration. METHODS The Cessation and Screening to Save Lives (CASTL) trial seeks to advance knowledge about the reach, effectiveness, and implementation of tobacco treatment in lung cancer screening. We describe the rationale, design, evaluation plan, and interventions tested in this multiphase optimization strategy trial (MOST). A total of 1152 screening-eligible current smokers are being recruited from 18 LCS sites (n = 64/site) in both academic and community settings across the USA. Participants receive enhanced standard care (cessation advice and referral to the national Quitline) and are randomized to receive additional tobacco treatment components (motivational counseling, nicotine replacement patches/lozenges, message framing). The primary outcome is biochemically validated, abstinence at 6 months follow-up. Secondary outcomes are self-reported smoking abstinence, quit attempts, and smoking reduction at 3 and 6 months. Guided by the Implementation Outcomes Framework (IOF), our evaluation includes measurement of implementation processes (reach, fidelity, acceptability, appropriateness, sustainability, and cost). CONCLUSION We will identify effective treatment components for delivery by LCS sites. The findings will guide the assembly of an optimized smoking cessation package that achieves superior cessation outcomes. Future trials can examine the strategies for wider implementation of tobacco treatment in LDCT-LCS sites. TRIAL REGISTRATION ClinicalTrials.gov NCT03315910.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Donna R Shelley
- School of Global Public Health, New York University, New York, USA
| | - Lou-Anne Chichester
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | | | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Andrew Ciupek
- GO2 Foundation for Lung Cancer, Washington, D.C., USA
| | | | | | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elena B Elkin
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, USA
| | - Irene Orlow
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Chloé M Martin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Sharon V Chan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Victoria Frederico
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Phillip Camille
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Susan Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Jessica Kenney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
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11
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The efficacy and safety of acupuncture and nicotine replacement therapy for smoking cessation: study protocol for a randomized controlled trial. Trials 2022; 23:465. [PMID: 35668503 PMCID: PMC9169389 DOI: 10.1186/s13063-022-06384-9] [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: 08/06/2021] [Accepted: 05/07/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Tobacco hazard is one of the most serious public health problems, accounting for up to 6 million deaths worldwide p.a. We aim to determine the efficacy and safety of acupuncture and/or nicotine replacement therapy on smoking cessation. METHODS We will recruit 96 participants who are willing to quit smoking by acupuncture and/or nicotine replacement therapy in Chengguan, Xigu and Heping Districts, Lanzhou city, for multicenter randomized, double-blind, double-dummy controlled clinical trial. Following obtained the informed consent forms, all eligible participants will be randomly divided into 4 groups: (1) acupuncture combined with nicotine patch, (2) acupuncture combined with sham nicotine patch, (3) sham acupuncture combined with nicotine patch, and (4) sham acupuncture combined with sham nicotine patch. These participants will be treated with different intervention modalities for 8 weeks and then will be followed-up for 8 weeks. The SPSS 26.0 software will be applied to analyze the clinical effects and adverse reactions of different intervention measures for smoking cessation. DISCUSSION This trial is a prospective, pragmatic, randomized, multicenter trial study protocol. The outcomes will illustrate the efficacy and safety of acupuncture and/or nicotine patches for smoking cessation. Provide smokers with a superior smoking cessation program. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100042912 . Registered on January 31, 2021.
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12
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Petrocchi S, Ongaro G, Calvello M, Feroce I, Bonanni B, Pravettoni G. A randomized controlled trial comparing self-referred message to family-referred message promoting men's adherence to evidence-based guidelines on BRCA1/2 germline genetic testing: A registered study protocol. PLoS One 2022; 17:e0266327. [PMID: 35395021 PMCID: PMC8992988 DOI: 10.1371/journal.pone.0266327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/16/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This is a registered study protocol on a randomized controlled trial (RCT) testing an intervention aimed to improve men's adherence to evidence-based guidelines on BRCA1/2 germline genetic testing. BRCA1- and BRCA2-associated Hereditary Breast and Ovarian Cancer Syndrome (HBOC) increases the relative and absolute risk of developing breast and ovarian cancer and, to a lesser extent, prostate and pancreatic cancer. Men face BRCA-related cancer risks as women do, although with a different magnitude, and they may also transmit the mutations to their children. Notwithstanding, men are under-tested compared to women and the communication is not tailored on their needs. The present RCT applies principles of the Health Action Process Approach (HAPA) in testing the psychological determinants of the men's adherence to evidence based guidelines on BRCA1/2 germline genetic and testing the efficacy of two messages. METHODS A total of 264 participants will be involved, among the men's relatives of women with verified germline mutations. The study entails a pre- post- evaluation with randomization of the participants in two conditions corresponding to the two messages. DISCUSSION The expected results provide answers related to the impact of action self-efficacy, outcome expectancy (personal or familiar), risk perception, health risk aversion, intolerance of uncertainty, perceived barriers, and coping self-efficacy on informed decision-making. Data gathered from this study may inform health care providers, policy makers, and public health managers about the communication strategy for men and about the psychological variables influencing decision-making. TRAIL REGISTRATION Name of the Registry: Clinical Trials. Trial registration number: NCT04683068. Date of registration: 16/12/2020. URL of trial registry record: https://www.clinicaltrials.gov/.
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Affiliation(s)
- Serena Petrocchi
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Ongaro
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mariarosaria Calvello
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Irene Feroce
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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13
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Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074034. [PMID: 35409717 PMCID: PMC8998497 DOI: 10.3390/ijerph19074034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/26/2022] [Indexed: 12/04/2022]
Abstract
Continued smoking after a cancer diagnosis is causally associated with increased risks of all-cause and cancer-specific mortality, and of smoking-related second primary cancers. Patient navigation provides individualized assistance to address barriers to smoking cessation treatment and represents a promising bridge to smoking cessation in persons with cancer who smoke cigarettes. We conducted a single-arm interventional cohort study of current smokers identified through prospective health record screening and recruited from Penn State Cancer Institute outpatient clinics. Consented participants received two telephone intervention sessions and gain-framed messaging-based smoking cessation educational materials designed for persons with cancer. The primary study outcome was the feasibility of the patient navigation-based intervention; the secondary outcome was the engagement in smoking cessation treatment at the two-month follow-up. Of 1168 unique screened Cancer Institute patients, 134 (11.5%) were identified as current cigarette smokers. Among 67 patients approached at outpatient clinics, 24 (35.8%) were interested in participating, 12 (17.9%) were enrolled, eight (11.9%) completed the intervention sessions and study assessments, and six engaged in smoking cessation treatment. The participants expressed satisfaction with the intervention sessions (median = 8.5, scale 0–10). The low recruitment rates preclude patient navigation as a feasible method for connecting cancer patients to smoking cessation treatment resources.
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Erdmann M, Edwards B, Adewumi MT. Effect of Electronic Portal Messaging With Embedded Asynchronous Care on Physician-Assisted Smoking Cessation Attempts: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220348. [PMID: 35226082 PMCID: PMC8886534 DOI: 10.1001/jamanetworkopen.2022.0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Despite the substantial health and financial burdens of smoking and the availability of effective, evidence-based interventions in primary care settings, few smokers and physicians use these strategies for smoking cessation. OBJECTIVE To evaluate whether electronic outreach to smokers with embedded asynchronous care increases the number of quit attempts and explore the roles of the message sender (ie, primary care physician [PCP] vs health care system) and patient-related characteristics. DESIGN, SETTING, AND PARTICIPANTS This quality improvement randomized clinical trial was designed to measure 2 factors: (1) electronic outreach messaging with and without a survey link to asynchronous care and (2) messaging by a personal PCP or health system. The study was conducted within the electronic health record and portal messaging platform of a large health system in the South Central US. Participants were adult patients 18 years or older who were designated as smokers in their electronic health records. Data were collected from January 13 to February 24, 2020, with participating PCPs surveyed in July 2020. INTERVENTIONS Portal messages encouraging a quit attempt and offering physician assistance were sent to smokers who were randomly selected and assigned to 1 of 4 conditions (message with or without embedded asynchronous care and PCP or system as sender). Half of the messages contained an invitation to come to clinics and the other half contained a link to access asynchronous care. MAIN OUTCOMES AND MEASURES The primary outcome was electronic health record-documented quit attempts (1 indicates quit attempt; 0, no quit attempt), which were tracked 30 days after the electronic outreach. Secondary outcomes included physician perceptions of the electronic outreach intervention, using a 5-point scale to assess perceptions of workload, comfort with providing medication from survey information, and further interest in the program 6 months after the intervention. RESULTS A total of 188 participants (99 women [52.4%] and 89 men [47.3%]) with mean (SD) age of 55.2 (13.9) years were randomized to 1 of 4 conditions. Group 1 (n = 46) received a message from the PCP without a link to the survey; group 2 (n = 48) received a message from the PCP with a link to asynchronous care in the form of the survey. Group 3 (n = 47) received a message from the health system without a link to the survey; group 4 (n = 47) received a message from the health system with a link to the survey. No statistically significant difference in documented quite attempts was found among the 4 study groups. There was also no statistically significant difference in quit attempts between the group that received the asynchronous care survey link and the group that did not (odds ratio, 2.50 [95% CI, 0.72-8.72]). However, the quit attempt rate for those with asynchronous care offered (9 of 95 [9.5%]) was more than double the quit attempt rate for those with in-person care offered (4 of 93 [4.3%]). CONCLUSIONS AND RELEVANCE This quality improvement randomized clinical trial did not find a statistically significant difference in physician-assisted quit attempts among patients who received electronic with asynchronous care vs those who received outreach alone, regardless of whether the message source was a PCP or a health system. However, the program engaged patients in difficult-to-reach rural areas as well as younger patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05172219.
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Affiliation(s)
- Marjorie Erdmann
- Center for Health Systems Innovation, Spears School of Business, Oklahoma State University, Tulsa
| | - Bryan Edwards
- Department of Management, Spears School of Business, Oklahoma State University, Tulsa
| | - Mopileola Tomi Adewumi
- College of Osteopathic Medicine, Center for Health Sciences, Oklahoma State University, Tulsa
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15
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Rash CJ, Alessi SM, Foster N, Tamborlane W, Van Name MA, Wagner JA. Tobacco use patterns and clinical outcomes in the T1D exchange. J Diabetes Complications 2022; 36:108128. [PMID: 35058139 PMCID: PMC8881793 DOI: 10.1016/j.jdiacomp.2022.108128] [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: 08/17/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 02/03/2023]
Abstract
AIMS This study examined associations between tobacco use and diabetes outcomes using the T1D Exchange Registry. METHODS Adult participants (N = 933) completed standardized questionnaires including self-reported outcomes: past year serious hypoglycemic and diabetic ketoacidosis episodes, diabetes self-care, diabetes distress, and self-monitoring of blood glucose. Chart-extracted outcomes included HbA1c, nephrology and neuropathy diagnoses, and BMI. We examined the relation of tobacco use status (never, former, current) and frequency of use (daily versus less than daily) to these outcomes. RESULTS The majority had never used tobacco (55%, n = 515); 27% (n = 252) were former users and 18% (n = 166) were current users (with 31% using daily). Tobacco status was associated with HbA1c, BMI, self-care, distress, and blood glucose monitoring frequency. Across most outcomes, current users evidenced worse values relative to never users, and former users were largely similar to never users. Daily use was associated with significantly worse outcomes on HbA1c, diabetes self-care, and distress scores relative to less than daily use. CONCLUSIONS These cross-sectional comparisons suggest that current tobacco use is associated with worse status on important clinical diabetes indicators. Former users did not evidence these deleterious associations. Findings point to potential diabetes-specific motivators that could inform tobacco cessation interventions.
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16
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Gupta S, Panchal P, Sadatsafavi M, Ghanouni P, Sin D, Pakhale S, To T, Zafari Z, Nimmon L. A personalized biomedical risk assessment infographic for people who smoke with COPD: a qualitative study. Addict Sci Clin Pract 2022; 17:1. [PMID: 34991699 PMCID: PMC8734321 DOI: 10.1186/s13722-021-00283-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/03/2021] [Indexed: 01/24/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Despite proof of effectiveness and universal guideline recommendations, smoking cessation interventions are underused in practice. We sought to develop an infographic featuring personalized biomedical risk assessment through future lung function decline prediction (with vs without ongoing smoking) to both prompt and enhance clinician delivery of smoking cessation advice and pharmacotherapy, and augment patient motivation to quit. Methods We recruited patients with COPD and pulmonologists from a quaternary care center in Toronto, Canada. Infographic prototype content and design was based on best evidence. After face validation, the prototype was optimized through rapid-cycle design. Each cycle consisted of: (1) infographic testing in a moderated focus group and a clinician interview (recorded/transcribed) (with questionnaire completion); (2) review of transcripts for emergent/critical findings; and (3) infographic modifications to address findings (until no new critical findings emerged). We performed iterative transcript analysis after each cycle and a summative qualitative transcript analysis with quantitative (descriptive) questionnaire analysis. Results Stopping criteria were met after 4 cycles, involving 20 patients (58% male) and 4 pulmonologists (50% male). The following qualitative themes emerged: Tool content (infographic content preferences); Tool Design (infographic design preferences); Advantages of Infographic Messaging (benefits of an infographic over other approaches); Impact of Tool on Determinants of Smoking Cessation Advice Delivery (impact on barriers and enablers to delivery of smoking cessation advice in practice); and Barriers and Enablers to Quitting (impact on barriers and enablers to quitting). Patient Likert scale ratings of infographic content and format/usability were highly positive, with improvements in scores for 20/21 questions through the design process. Providers scored the infographic at 77.8% (“superior”) on the Suitability Assessment of Materials questionnaire. Conclusions We developed a user preference-based personalized biomedical risk assessment infographic to drive smoking cessation in patients with COPD. Our findings suggest that this tool could impact behavioural determinants of provider smoking-cessation advice delivery, while increasing patient quit motivation. Impacts of the tool on provider care, patient motivation to quit, and smoking cessation success should now be evaluated in real-world settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00283-1.
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Affiliation(s)
- Samir Gupta
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Division of Respirology, Department of Medicine, St. Michael's Hospital, Suite 6044, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Puru Panchal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Parisa Ghanouni
- Faculty of Health, School of Occupational Therapy, Halifax, NS, Canada
| | - Don Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Smita Pakhale
- Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Teresa To
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
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17
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Edwards DJ. Ensuring Effective Public Health Communication: Insights and Modeling Efforts From Theories of Behavioral Economics, Heuristics, and Behavioral Analysis for Decision Making Under Risk. Front Psychol 2021; 12:715159. [PMID: 34721162 PMCID: PMC8548420 DOI: 10.3389/fpsyg.2021.715159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/21/2021] [Indexed: 01/08/2023] Open
Abstract
Public health (PH) messaging can have an enormous impact on shaping how individuals within society behave, and can ensure it is in a safe and responsible way, consistent with up-to-date evidence-based PH guidelines. If done effectively, messaging can save lives and improve the health of those within society. However, unfortunately, those within Government PH bodies typically have little training about how to effectively represent PH messages in a way that is consistent with psychological theories of cognitive bias, in order to avoid cognitively biasing the public through their messages. As a result of this, inadequate representation of PH messages can result, which can often lead to cognitive bias in those from the public who read or listen to the message information. This can lead to poor decision making of the pubic as a whole, which can then further lead to harm and even death of public members as a result of these poor decisions. One way to minimize the problem of bias in decision making is to explore psychology theories that model how bias can occur from PH messaging, and identify ways in which PH agencies can utilize such approaches to improve the effectiveness of their messages. Previous focus has been largely on behavioral economic theories, however, here, other accounts are offered in addition to these. These include theories of heuristics and theories from the behavior analysis domain, which may increase the predictive power of modeling bias, and have applications for how best to represent PH message information which minimize bias.
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Affiliation(s)
- Darren J. Edwards
- Department of Public Health, Policy, and Social Sciences, Swansea University, Swansea, United Kingdom
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Tailored Cigarette Warning Messages: How Individualized Loss Aversion and Delay Discounting Rates Can Influence Perceived Message Effectiveness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910492. [PMID: 34639792 PMCID: PMC8507605 DOI: 10.3390/ijerph181910492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/17/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022]
Abstract
Current text-only cigarette warning labels (long-term, loss-framed messages) may not motivate positive changes in smoking behavior. The current project was a cross-sectional study examining the effects of tailored cigarette warnings on perceived message effectiveness (PME) in adult smokers (n = 512) conducted using Amazon Mechanical Turk (M-Turk) in January–February 2020. Participants were an average age of 40.7 (SD = 11.6), with the majority of the sample being female (62.2%) and White (88.9%). Participants reported smoking an average of 14.6 cigarettes/day (SD = 9.2) with an average FTND score of 4.6 (SD = 2.2). Participants were asked to complete a tobacco use history questionnaire, and mixed gambles and delay discounting tasks before random assignment to one of five message groups. The groups were based on a 2 (gain versus loss framing) ×2 (short-term versus long-term framing) between-subject design; a fifth group served as the control group. All experimental messages reported higher PME scores than the control (p values < 0.001, Cohen’s d = 1.88–2.48). Participants with shallower delayed reward discounting and lower loss aversion rates reported higher total PME scores, p values < 0.05. Our findings also suggest that loss aversion rates vary widely among smokers and that individuals are more responsive to messages congruent with their behavioral economic profile. Specifically, smokers who viewed messages congruent with their loss aversion and delay discounting rates reported higher PME scores than those who viewed incongruent messages (p = 0.04, Cohen’s d = 0.24). These preliminary findings suggest that anti-smoking campaigns may best impact smokers by tailoring messages based on individual loss aversion and delay discounting rates versus a one-size-fits-all approach.
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19
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Tubman JG, Meca A, Schwartz SJ, Velazquez MR, Egbert AW, Soares MH, Regan T. Brief Underage Alcohol Use Screener Scores Predict Health Risk Behaviors. J Sch Nurs 2021; 37:323-332. [PMID: 31455127 PMCID: PMC7388151 DOI: 10.1177/1059840519871092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to determine if adolescents' scores on a 2-item underage alcohol use screener predict risky consequences of past-year alcohol use and other health risk behaviors in a nonclinical, school-based sample of adolescents. A predominantly minority sample of 756 middle and high school students completed in-school tablet-based surveys on past-year underage alcohol use and a range of health risk behaviors. Higher scores for self alcohol risk and peer alcohol risk were associated with higher risk of past-year riding with a drunk driver and past 90-day measures of cigarette use, marijuana use, unplanned sex, and unprotected intercourse. The National Institute of Alcohol Abuse and Alcoholism Brief Alcohol Screener is a useful tool for school-based service providers, including school nurses, to identify and address the needs of adolescents at high risk of the development of alcohol use disorders, as well as a range of preventable health risk behaviors.
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Affiliation(s)
| | - Alan Meca
- Old Dominion University, Norfolk, VA, USA
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20
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Al Zhranei RM, Ismail M, Allah M, Alzahrani M. The Impact of Verbal Encouragement and Repeating on the Measurement of Spirometry in Healthy Adult. Cureus 2021; 13:e18714. [PMID: 34790469 PMCID: PMC8583246 DOI: 10.7759/cureus.18714] [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] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Vital Capacity (VC) is measured by spirometry. VC can differ according to weight, age, gender, race and height of the investigated person. Repetition of the same tasks has been proven to enhance adults' performance. Encouraging on some tasks have shown to result in a significant difference. Aim This study aimed to examine if verbal encouragement and repetition of spirometry would make a difference in the results. Method This is a randomized clinical trial involving 136 healthy volunteers, randomly allocated to one of two groups: control and intervention groups. In both groups, VC was assessed as the baseline (VC1). VC was assessed again after ten days maximally (VC2). The third time of measuring VC was assessed again after ten days maximally (VC3). The verbal encouragement was provided only to the intervention group during iVC2 and iVC3, and only repeating was required from the control group in cVC2 and cVC3. Results and Conclusion There was no significant difference in VC after the third trial in the control group compared to the baseline measurement (p-value= 0.836). On the other hand, verbal encouragement in the third trial had a significant difference in VC compared to the baseline measurement (p-value= 0.000).
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Affiliation(s)
- Raid M Al Zhranei
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammad Ismail
- Respiratory Therapy Administration, King Abdullah Medical City, Makkah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed Allah
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mousa Alzahrani
- Respiratory Therapy Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
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21
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Vides-Porras A, Cáceres P, Company A, Guillen O, Arrien MA, Castellano Y, Margalef M, Yantuche W, Fernández E, Martínez C. Gaining insight into the implementation of an e-learning smoking cessation course in Latin American countries. Health Promot Int 2021; 36:349-362. [PMID: 32594125 DOI: 10.1093/heapro/daaa054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Continuous medical education focused on health problems emerging in low- and middle-income countries (LMICs) is scarce. Although tobacco consumption is increasing in LMICs, there is a lack of tobacco cessation training programs in these countries. To promote smoking cessation interventions in Bolivia, Guatemala and Paraguay, we adapted an e-learning program developed in Catalonia (Spain). This process evaluation study reports on reach, dose and satisfaction of participants with the course, as well as the contextual factors of its application. We conducted a multiple method evaluation, which included a survey and several focus groups, each one specific to the same type of healthcare professional (nurses, doctors, other professionals). Two hundred and ninety-two participants registered into the online course. The motivation for undertaking the course was different between doctors and nurses. The main sources of difficulty in enrolling and finishing the course were the technical problems experienced when accessing the platform, and lack of acquaintance with computers and the Internet in general. Our results show that implementing e-learning education in hospitals from LMICs is feasible, especially when there are similarities between participating countries and the country in which the original program was developed. However, several elements such as strong organizational commitment, technical support and resources and adequate communication channels should be provided to facilitate enrollment and training completion. Efforts to improve Internet access should be made to avoid jeopardizing students' motivation to enroll and complete online training.
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Affiliation(s)
- Ana Vides-Porras
- School of Social Sciences, Universidad del Valle de Guatemala, 18 Av. 11-95 zona 15 Vista Hermosa III, Guatemala 01015, Guatemala
| | - Paula Cáceres
- Radiation Oncology Department, Instituto de Cancerología y Hospital Dr. Bernardo del Valle S., 6 Av 6-58 Z-11, Guatemala
| | - Assumpta Company
- E-oncologia Unit, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Guillen
- E-oncologia Unit, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Martha Alicia Arrien
- Instituto Oncologico del Oriente Boliviano de Santa Cruz de la Sierra Av. Marcelo Terceros Bánzer, Santa Cruz de la Sierra, Bolivia
| | - Yolanda Castellano
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO 08907.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mercè Margalef
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO 08907.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Wendy Yantuche
- Oncologic Surgery, Instituto de Cancerología y Hospital Dr. Bernardo del Valle S, Guatemala
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO 08907.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907.,Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO 08907.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Department of Nursing: Public Health, Mental Health and Maternal and Child Health, Faculty of Medicine and Health Sciences, Universitat de Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
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22
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Gowarty MA, Longacre MR, Vilardaga R, Kung NJ, Gaughan-Maher AE, Brunette MF. Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study. JMIR Ment Health 2021; 8:e26873. [PMID: 34255699 PMCID: PMC8295834 DOI: 10.2196/26873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/29/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Young adults with serious mental illness (SMI) have higher smoking rates and lower cessation rates than young adults without SMI. Scalable interventions such as smartphone apps with evidence-based content (eg, the National Cancer Institute's [NCI's] QuitGuide and quitSTART) could increase access to potentially appealing and effective treatment for this group but have yet to be tested in this population. OBJECTIVE The goal of this user-centered design study is to determine the user experience (including usability and acceptability) of 2 widely available apps developed by the NCI-QuitGuide and quitSTART-among young adult tobacco users with SMI. METHODS We conducted usability and acceptability testing of QuitGuide and quitSTART among participants with SMI aged between 18 and 35 years who were stable in community mental health treatment between 2019 and 2020. Participants were randomly assigned to use QuitGuide or quitSTART on their smartphones. App usability was evaluated at baseline and following a 2-week field test of independent use via a video-recorded task completion protocol. Using a mixed method approach, we triangulated 4 data sources: nonparticipant observation, open-ended interviews, structured interviews (including the System Usability Scale [SUS]), and backend app use data obtained from the NCI. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis. RESULTS Participants were 17 smokers who were not interested in quitting, with a mean age of 29 (SD 4) years; 41% (n=7) presented with psychotic disorders. Participants smoked an average of 15 (SD 7) cigarettes per day. The mean SUS scores for QuitGuide were similar at visits one and two (mean 64, SD 18 and mean 66, SD 18, respectively). The mean SUS scores for quitSTART numerically increased from visit one (mean 55, SD 20) to visit two (mean 64, SD 16). Acceptability scores followed the same pattern. Observed task completion rates were at least 75% (7/9 for QuitGuide, 6/8 for quitSTART) for both apps at both visits for all but 2 tasks. During the 13-day trial period, QuitGuide and quitSTART users interacted with their assigned app on an average of 4.6 (SD 2.8) days versus 10.8 (SD 3.5) days, for a mean total of 5.6 (SD 3.8) interactions versus 41 (SD 26) interactions, and responded to a median of 1 notification (range 0-8) versus 18.5 notifications (range 0-37), respectively. Qualitative comments indicated moderate to high satisfaction overall but also included concerns about the accuracy of the apps' feedback. CONCLUSIONS Both QuitGuide and quitSTART had acceptable levels of usability and mixed levels of acceptability among young adults with SMI. The higher level of engagement with quitSTART suggests that quitSTART may be a favorable tool for young adult smokers with SMI. However, clinical support or coaching may be needed to overcome initial usability issues.
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Affiliation(s)
- Minda A Gowarty
- Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Meghan R Longacre
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Nathan J Kung
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Ashley E Gaughan-Maher
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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23
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Examining the role of healthcare access in racial/ethnic disparities in receipt of provider-patient discussions about smoking: A latent class analysis. Prev Med 2021; 148:106584. [PMID: 33930432 DOI: 10.1016/j.ypmed.2021.106584] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 12/28/2022]
Abstract
Using insurance as a single indicator of healthcare access in examining the association between race/ethnicity and healthcare encounter-based interventions for smoking may not be adequate. In this study, we assessed the role of healthcare access using multifactorial measures in accounting for racial/ethnic disparities in the receipt of provider-patient discussions, defined as either being asked about smoking or advised to quit smoking by providers. We identified adult current smokers from the 2015 National Health Interview Survey. We first conducted a latent class analysis (LCA) to identify the underlying patterns of healthcare access measured by 13 indicators of healthcare access and utilization. We then used a propensity score - based weighting approach to examine racial/ethnic disparities in receiving provider-patient discussions about smoking or quitting in stratified groups by the distinct healthcare access clusters. Out of the 4134 adult current smokers who visited a doctor or a healthcare provider during the past 12 months, 3265 (79.90%) participants were classified as having high healthcare access and 869 (20.10%) participants as having low healthcare access. Compared to non-Hispanic whites, Hispanics had significantly lower odds of being asked about smoking (OR 0.46, 95% CI (0.27-0.77)) and being advised to quit (OR 0.57, 95% CI (0.34-0.97)) in the low access group, but neither association was significant in the high access group. In addition to increasing health insurance coverage, reducing other healthcare access barriers for Hispanics will likely facilitate provider-patient discussion and promote tobacco cessation among Hispanic smokers.
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24
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Hoeppner BB, Hoeppner SS, Carlon HA, Abry A, Darville A, Rohsenow DJ. Preparing for the Quit Day: Comparing Beliefs of Nondaily Versus Daily Young Adult Smokers as They Prepare for a Quit Attempt. Nicotine Tob Res 2021; 23:1038-1046. [PMID: 32882037 DOI: 10.1093/ntr/ntaa166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 09/01/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Most smoking cessation approaches are modeled on heavy daily smoking. With increasing prevalence of nondaily smoking, it may be necessary to modify these approaches for nondaily smokers. AIMS To provide information about beliefs and attitudes relevant to smoking cessation for nondaily smokers. METHODS Secondary analysis of two prospective studies on young adult smokers (18-24 years of age) provided brief advice to quit smoking. Measures include baseline levels of constructs relevant to smoking cessation counseling and perceived benefits of and barriers to smoking cessation. RESULTS Participants (n = 40 nondaily, 122 daily smokers) were predominantly White (70% and 84%, respectively), gender-balanced (50% and 43% female), full-time college students (89% and 95%). At baseline, nondaily smokers reported lower levels of nicotine dependence (p < .001; nondaily: Fagerström Test for Nicotine Dependence (FTND) = 0.8 ± 1.5, daily: FTND = 3.1 ± 1.9), lower urge to smoke (p < .001), greater self-efficacy when facing external smoking stimuli (p = .03), expecting to experience fewer positive effects (reduced negative affect, p = <.001, stimulation, p = .02), and valuing the importance of smoking effects less (ps < .01) than daily smokers. During counseling, nondaily smokers generated both fewer benefits of cessation (Wald X2(df = 1) = 4.91, p = .027) and fewer barriers (Wald X2(df = 1) = 5.99, p =.014) than daily smokers. Withdrawal was not listed by nondaily smokers as a barrier (p < .01). CONCLUSIONS Constructs relevant to smoking cessation for daily smokers were less salient to young nondaily smokers, compared with moderately addicted young daily smokers, as indicated by responses to standardized scales and by the generation of fewer benefits and barriers in counseling. Interventions may need to find novel ways to engage nondaily smokers, particularly young adult, in smoking cessation efforts. IMPLICATIONS This study is unique in eliciting benefits and barriers from nondaily smokers as they are about to make a quit attempt. This is a critically important point in time, as this is the point in time in which an action plan is formed and can be informed and enhanced by smoking cessation support. Our study further allowed direct comparison to daily smokers undergoing the same procedures, which allowed the identification of unique factors that may impact nondaily smokers in their quit attempt, which may guide intervention efforts. Use of a mixed method design further strengthen the rigor of this study.
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Affiliation(s)
- Bettina B Hoeppner
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Susanne S Hoeppner
- Department of Psychiatry, Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA
| | - Hannah A Carlon
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alexandra Abry
- Department of Psychiatry, Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Damaris J Rohsenow
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
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25
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Abstract
The impact of tobacco smoking treatment is determined by its reach into the smoking population and the effectiveness of its interventions. This review evaluates the reach and effectiveness of pharmacotherapy and psychosocial interventions for smoking. Historically, the reach of smoking treatment has been low, and therefore its impact has been limited, but new reach strategies such as digital interventions and health care system changes offer great promise. Pharmacotherapy tends to be more effective than psychosocial intervention when used clinically, and newer pharmacotherapy strategies hold great promise of further enhancing effectiveness. However, new approaches are needed to advance psychosocial interventions; progress has stagnated because research and dissemination efforts have focused too narrowly on skill training despite evidence that its core content may be inconsequential and the fact that its mechanisms are either unknown or inconsistent with supporting theory. Identifying effective psychosocial content and its mechanisms of action could greatly enhance the effectiveness of counseling, digital, and web interventions.
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Affiliation(s)
- Timothy B Baker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
| | - Danielle E McCarthy
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
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26
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Liu B, Zhan S, Wilson KM, Mazumdar M, Li L. The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094593. [PMID: 33926078 PMCID: PMC8123707 DOI: 10.3390/ijerph18094593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
Objective: We aimed to examine the influence of increasing levels of discussion (both asked and advised, either asked or advised but not both, and neither asked nor advised) on quit behavior. Methods: We included 4133 adult current smokers from the 2015 National Health Interview Survey. The primary outcomes were quit intent and quit attempt, and the secondary outcomes were methods used for quitting. We used an instrumental variable analysis, as well as propensity score weighted and multivariable logistic regressions. Results: Compared to no discussion, having both or only one discussion, respectively, increased quit intent (OR = 1.65, 95% CI = 1.63–1.66 and OR = 1.02, 95% CI = 0.99–1.05), quit attempt (OR = 1.76, 95% CI = 1.75–1.77 and OR = 1.60, 95% CI = 1.57–1.63). Among those who attempted to quit (n = 1536), having both or only one discussion increased the use of pharmacologic (OR = 1.99, 95% CI = 1.97–2.02 and OR = 1.56, 95% CI = 1.49–1.63) or behavioral (OR = 2.01, 95% CI = 1.94–2.08 and OR = 2.91, 95% CI = 2.74–3.08) quit methods. Conclusions: Increasing levels of provider–patient discussion encourages quit behavior, and should be an integral part of reducing the health and economic burden of smoking. Strategies that promote the adherence and compliance of providers to communicate with patients may help increase the success of smoking cessation.
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Affiliation(s)
- Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Correspondence:
| | - Serena Zhan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Karen M. Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA;
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
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27
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Demiguel V, Blondel B, Bonnet C, Nguyen-Thanh V, Saurel-Cubizolles MJ, Regnault N. Trends in Tobacco Smoking in Pregnant Women: Data From French National Perinatal Surveys. Int J Public Health 2021; 66:602873. [PMID: 34744568 PMCID: PMC8565271 DOI: 10.3389/ijph.2021.602873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/11/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives: To describe maternal smoking trends in France between 1972 and 2016, and identify whether maternal characteristics associated with smoking in the 3rd trimester of pregnancy evolved between 2010 and 2016. Methods: Using French National Perinatal Surveys, we estimated proportions of smokers and the number of cigarettes smoked both just before pregnancy and during the 3rd trimester from 1972 to 2016. We used a Poisson model with robust variance to estimate prevalence ratios for smoking during pregnancy. Results: Proportions of mothers quitting smoking were relatively stable (46.0% in 1972 and 45.8% in 2016). The number of cigarettes smoked just before pregnancy and in the 3rd trimester decreased from 1995 onward. However, proportions of smokers remained high before (30.1%) and during the 3rd trimester in 2016 (16.2%). Smoking in the 3rd trimester was associated with a lower education level and lower income in both 2010 and 2016, whereas the association with age, country of birth and parity varied according to the survey year. Conclusion: Early targeted interventions are needed for smokers who plan to have a child and must take smokers' characteristics during pregnancy into account.
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Affiliation(s)
- Virginie Demiguel
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Béatrice Blondel
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Camille Bonnet
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Viêt Nguyen-Thanh
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
| | - Marie-Josèphe Saurel-Cubizolles
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), Paris, France
| | - Nolwenn Regnault
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France
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28
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Cunningham JA, Leatherdale ST, Chaiton M, Tyndale RF, Schell C, Godinho A. Offering nicotine patches to all households in a community with high smoking rates: Pilot test of a population-based approach to promote tobacco cessation. Int J Popul Data Sci 2021; 6:1400. [PMID: 34007899 PMCID: PMC8104059 DOI: 10.23889/ijpds.v6i1.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The objective of this project is to determine the effectiveness of targeting a community with a high smoking rate with the distribution of free-of-charge nicotine patches in order to promote tobacco cessation. Methods/Design One small community with an elevated smoking rate (compared to national and provincial averages) has been identified. All households in the community will be sent a letter offering one smoker (18 years or older; 10 or more cigarettes per day) in the household a free-of-charge mailed five-week supply of nicotine patches (up to a total of 800 five-week kits will be available for distribution). Participants receiving nicotine patches will be asked to complete a six-month follow-up survey assessing tobacco cessation defined as 30-day point prevalence abstinence. In addition, attempts will be made to employ ongoing national population surveys containing cigarette smoking variables to compare changes in smoking prevalence in the target community to other communities with similar characteristics. Discussion We will examine whether the concentrated distribution of mailed nicotine patches will result in a measurable reduction in smoking rates in the target community. If demonstrated, this would provide support for the targeted population-level distribution of an effective individual-level public health intervention. Clinical Trials registration NCT04534231
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Affiliation(s)
- John A Cunningham
- Centre for Addiction and Mental Health, Toronto, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, Toronto, M5T 1R8, Canada.,Research School of Population Health, the Australian National University, Canberra, 2601, Australia
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, N2L 3G1, Canada
| | - Michael Chaiton
- Centre for Addiction and Mental Health, Toronto, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, M5T 3M7, Canada
| | - Rachel F Tyndale
- Centre for Addiction and Mental Health, Toronto, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, Toronto, M5T 1R8, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Christina Schell
- Centre for Addiction and Mental Health, Toronto, M5S 2S1, Canada
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29
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Hu L, Li L, Ji J. Machine learning to identify and understand key factors for provider-patient discussions about smoking. Prev Med Rep 2020; 20:101238. [PMID: 33224719 PMCID: PMC7666379 DOI: 10.1016/j.pmedr.2020.101238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/07/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
We sought to identify key determinants of the likelihood of provider-patient discussions about smoking and to understand the effects of these determinants. We used data on 3666 self-reported current smokers who talked to a health professional within a year of the time the survey was conducted using the 2017 National Health Interview Survey. We included wide-ranging information on 43 potential covariates across four domains, demographic and socio-economic status, behavior, health status and healthcare utilization. We exploited a principled nonparametric permutation based approach using Bayesian machine learning to identify and rank important determinants of discussions about smoking between health providers and patients. In the order of importance, frequency of doctor office visits, intensity of cigarette use, length of smoking history, chronic obstructive pulmonary disease, emphysema, marital status were major determinants of disparities in provider-patient discussions about smoking. There was a distinct interaction between intensity of cigarette use and length of smoking history. Our analysis may provide some insights into strategies for promoting discussions on smoking and facilitating smoking cessation. Health care resource usage, smoking intensity and duration and smoking-related conditions were key drivers. The "usual suspects", age, gender, race and ethnicity were less important, and gender, in particular, had little effect.
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Affiliation(s)
- Liangyuan Hu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Healthcare Delivery, Mount Sinai Health System, New York, NY, USA
| | - Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Healthcare Delivery, Mount Sinai Health System, New York, NY, USA
| | - Jiayi Ji
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Healthcare Delivery, Mount Sinai Health System, New York, NY, USA
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Jenssen BP, Kelly MK, Faerber J, Hannan C, Asch DA, Shults J, Schnoll RA, Fiks AG. Parent Preferences for Pediatric Clinician Messaging to Promote Smoking Cessation Treatment. Pediatrics 2020; 146:peds.2019-3901. [PMID: 32571991 PMCID: PMC7329258 DOI: 10.1542/peds.2019-3901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Insights from behavioral economics suggests that the effectiveness of health messages depends on how a message is framed. Parent preferences for smoking cessation messaging has not been studied in pediatrics, warranting further exploration to maximize benefit. We sought to assess parents' perceptions regarding the relative importance of distinct message framings to promote their smoking cessation. METHODS We conducted a cross-sectional discrete choice experiment in which parent smokers rated the relative importance of 26 messages designed to encourage them to begin cessation treatment. Messages varied on who was featured (child, parent, or family), whether the message was gain or loss framed, and what outcome was included (general health, cancer, respiratory illnesses, child becoming a smoker, or financial impact). The participants were 180 parent smokers attending primary care visits with their children at 4 diverse pediatric sites. The main outcome was the importance of smoking cessation messages based on who was featured, gain or loss framing, and the outcome emphasized. RESULTS Parent smokers highly prioritized cessation messages emphasizing the impact of quitting smoking on their child versus parent or family. Messages focusing on respiratory illness, cancer, or general health outcomes consistently ranked highest, whereas messages focused on the financial benefits of quitting ranked lowest. Gain versus loss framing did not meaningfully influence rankings. CONCLUSIONS Parent smokers identified smoking cessation messages that emphasized the impact on their child, with outcomes focused on respiratory health, cancer, or general health, as most important. The clinical impact of these messages should be tested in future research.
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Affiliation(s)
- Brian P. Jenssen
- Departments of Pediatrics,,PolicyLab and the Center for Pediatric Clinical
Effectiveness, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Mary Kate Kelly
- PolicyLab and the Center for Pediatric Clinical
Effectiveness, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | - Chloe Hannan
- PolicyLab and the Center for Pediatric Clinical
Effectiveness, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | | | - Robert A. Schnoll
- Psychiatry, Perelman School of Medicine, University
of Pennsylvania, Philadelphia, Pennsylvania,Abramson Cancer Center, Penn Medicine, Philadelphia,
Pennsylvania
| | - Alexander G. Fiks
- Departments of Pediatrics,,PolicyLab and the Center for Pediatric Clinical
Effectiveness, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
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31
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Ali R, Zhang Z, Bux Soomro M, Gogan ICW, Soomro HR. Tobacco control via quick response code and mobile health technologies: Empirical-evidence of the health belief model theory. HUMAN SYSTEMS MANAGEMENT 2020. [DOI: 10.3233/hsm-190629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Rahib Ali
- School of Management Science and Economy, Harbin Institute of Technology, Heilongjiang, China
| | - Ziqiong Zhang
- School of Management Science and Economy, Harbin Institute of Technology, Heilongjiang, China
| | - Muhammad Bux Soomro
- Computer Science Department, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Larkana Campus, Pakistan
| | | | - Habib Rehman Soomro
- Management Sciences Department, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Larkana Campus, Pakistan
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Australian University Student Perceptions of Health Messages on Cigarette Sticks. HEALTH COMMUNICATION 2020; 35:456-464. [PMID: 30676104 DOI: 10.1080/10410236.2019.1567442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
University students are exposed to casual smoking, increasing their risk of developing nicotine addiction, which can extend into adulthood. A novel anti-tobacco intervention being investigated is the use of health warnings on individual cigarette sticks. We explored the perceptions of university students on the effectiveness of health warnings on cigarette packaging and individual cigarette sticks. An online survey was distributed to first-year university students enrolled at a regional university in North-Eastern Australia. Participants rated on 5-point Likert scales and commented using open-text comment boxes, the effectiveness of current cigarette packaging warnings, and 12 text warnings (divided into four themes; immediate and short-term consequences [ISC], long-term and mortality consequences [LMC], social and financial consequences [SFC], and supportive messages to quit [SMQ]) on individual cigarette sticks, in preventing non-smokers from smoking, and in encouraging current smokers to quit. Participants (n = 479; Mean age = 22 years) rated three themes (ISC, LMC, and SFC) as being overall more effective (all p < .001) than current packaging warnings (Odds Ratios = 5.93 [4.51-7.80], 3.60 [2.79-4.64], and 2.86 [2.21-3.69] respectively). Participants described a desensitisation to current packaging warnings, and the novel warnings displayed potentially overcoming this issue, with over 85% agreeing that individual cigarette sticks should include health warnings. Health warnings on cigarette sticks may serve as an effective means in reducing tobacco use, with the provision of this additional intervention for communicating the health and other negative consequences of smoking likely reinforcing the effects of current packaging warnings.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University
| | | | - Beverley Glass
- College of Medicine and Dentistry, James Cook University
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Jankowski M, Lawson JA, Shpakou A, Poznański M, Zielonka TM, Klimatckaia L, Loginovich Y, Rachel M, Gereová J, Minarowski Ł, Naumau I, Kornicki K, Pepłowska P, Kovalevskiy V, Raskiliene A, Bielewicz K, Krištúfková Z, Mróz R, Majek P, Skoczyński S, Zejda JE, Brożek GM. Smoking Cessation and Vaping Cessation Attempts among Cigarette Smokers and E-Cigarette Users in Central and Eastern Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E28. [PMID: 31861455 PMCID: PMC6981418 DOI: 10.3390/ijerph17010028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/24/2022]
Abstract
Our aim is to assess the smoking cessation and vaping cessation activity, including quit attempts and willingness to quit among university students in Central and Eastern Europe, as well as to investigate personal characteristics associated with smoking cessation and vaping cessation attempts. Data were collected by questionnaire which included 46 questions on cigarette and e-cigarette use. Questionnaires were obtained from 14,352 university students (aged 20.9 ± 2.4 years; cooperation rate of 72.2%). For the purposes of this analysis, only data from exclusive cigarette smokers (n = 1716), exclusive e-cigarette users (n = 129), and dual users (216) were included. Of all cigarette smokers, 51.6% had previously tried to quit smoking and 51.5% declared a willingness to quit cigarette smoking in the near future. Among all e-cigarette users only 13.9% had ever tried to quit using the e-cigarette and 25.2% declared a willingness to give up using e-cigarette in the near future. The majority of the group did not use pharmacotherapy to quit cigarette (87.5%) or e-cigarette (88.9%) use. Our results indicate that while most university students have some desire to quit conventional smoking, those who use e-cigarettes do not have the same desire.
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Affiliation(s)
- Mateusz Jankowski
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland
| | - Joshua Allan Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, P.O. Box 23, Saskatoon, SK S7N 2Z4, Canada
- Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada
| | - Andrei Shpakou
- Department of Sports Medicine and Rehabilitation, Yanka Kupala State University of Grodno, 22 Ozheshko Str, 230023 Grodno, Belarus
| | - Michał Poznański
- Department of General and Oncological Pulmonology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Kopcińskiego 22 Str, 90-153 Lodz, Poland
| | - Tadeusz Maria Zielonka
- Department of Family Medicine, Warsaw Medical University, Banacha Street 1a, 02-097 Warsaw, Poland
| | - Ludmila Klimatckaia
- Department of Social Pedagogy and Social Work, Krasnoyarsk State Pedagogical University named after V.P. Astafiev, A. Lebedeva 89 Str, 660017 Krasnoyarsk, Russia
| | - Yelena Loginovich
- Institute of Biology Systems and Genetic Research, Lithuanian University of Health Sciences, MLK, Eivenių 4 Str, LT-50103 Kaunas, Lithuania
| | - Marta Rachel
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, University of Rzeszów, Kopisto 2a Str, 35-359 Rzeszow, Poland
- Department of Allergology and Cystic Fibrosis, Clinical Provincial Hospital No. 2, Lwowska 60 Str, 35-301 Rzeszów, Poland
| | - Justína Gereová
- Department of Epidemiology, Faculty of Public Health, Slovak Medical University in Bratislava, Limbová 14 Str, 833 03 Bratislava, Slovak
| | - Łukasz Minarowski
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Żurawia 14 Str, 15-540 Bialystok, Poland
| | - Ihar Naumau
- Department of General Hygiene and Ecology, Grodno State Medical University, Gorkogo 80 Str, 230009 Grodno, Belarus
| | - Kamil Kornicki
- Department of General and Oncological Pulmonology, Norbert Barlicki Memorial Teaching Hospital No. 1, Medical University of Lodz, Kopcińskiego 22 Str, 90-153 Lodz, Poland
| | - Paulina Pepłowska
- Department of Family Medicine, Warsaw Medical University, Banacha Street 1a, 02-097 Warsaw, Poland
| | - Valeriy Kovalevskiy
- Department of Childhood Psychology, Krasnoyarsk State Pedagogical University named after V.P. Astafiev, Lebedeva 89 Str, 660017 Krasnoyarsk, Russia;
| | - Asta Raskiliene
- Institute of Biology Systems and Genetic Research, Lithuanian University of Health Sciences, MLK, Eivenių 4 Str, LT-50103 Kaunas, Lithuania
| | - Krzysztof Bielewicz
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, University of Rzeszów, Kopisto 2a Str, 35-359 Rzeszow, Poland
| | - Zuzana Krištúfková
- Department of Epidemiology, Faculty of Public Health, Slovak Medical University in Bratislava, Limbová 14 Str, 833 03 Bratislava, Slovak
| | - Robert Mróz
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Żurawia 14 Str, 15-540 Bialystok, Poland
| | - Paulina Majek
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland
| | - Szymon Skoczyński
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Ziolowa 45/47, 40-635 Katowice, Poland
| | - Jan Eugeniusz Zejda
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland
| | - Grzegorz Marek Brożek
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland
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Hussen MA, Etu ES. The state of smokeless tobacco cessation in a context lacking cessation services: Evidence from Ethiopia. Tob Induc Dis 2019; 17:74. [PMID: 31768166 PMCID: PMC6843185 DOI: 10.18332/tid/112668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/15/2019] [Accepted: 09/28/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cessation attempts for smokeless tobacco (SLT) have been studied in the countries that provide comprehensive cessation services, but there is no evidence about SLT cessation in Ethiopia, where there are no comprehensive tobacco cessation services. The objective of this study was to determine cessation attempts and related factors among daily SLT users. METHODS We analyzed the data obtained from a cross-sectional survey of SLT users in Borena zone, Ethiopia, focusing on a subset of 600 daily SLT users. Participants were adult SLT users aged ≥18 years. The dependent variable was SLT cessation attempt. Multivariable logistic regression was performed to identify association between cessation attempts and explanatory variables. Analyses were performed using SPSS version 20. RESULTS Overall, 18.5% reported having tried to quit SLT in the past 12 months. In multivariable analyses, SLT cessation attempts were significantly associated with being male (AOR=1.96, 95% CI: 1.13-3.40), current dual-product user (AOR=2.11, 95% CI: 1.31-3.38), being advised by α health professional (AOR=1.82, 95% CI: 1.13-2.92), current knowledge (AOR=1.20, 95% CI: 1.00-1.44), and risk perception (AOR=1.06, 95% CI: 1.02-1.10). CONCLUSIONS A low cessation attempt rate among daily SLT users calls for comprehensive cessation intervention. More attention to factors such as knowledge of the health consequences of SLT use, risk perception and health workers advice will be required to encourage cessation attempts.
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Affiliation(s)
- Mamusha A. Hussen
- Department of Health, Behaviour and Society, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Edao S. Etu
- Department of Public Health, School of Health Science, Goba Referral Hospital, Madda Walabu University, Goba, Ethiopia
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Stevens EM, Wetter DW, Vidrine DJ, Hoover DS, Frank-Pearce SG, Nguyen N, Li Y, Waters AJ, Meade CD, Wagener TL, Vidrine JI. Enhancing Smoking Risk Communications: The Influence of Need for Cognition. Am J Health Behav 2019; 43:950-962. [PMID: 31439101 PMCID: PMC7045173 DOI: 10.5993/ajhb.43.5.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: One way to enhance the impact of smoking health risk messages may be to tailor their content to individual difference factors such as need for cognition (NFC). In this study, we examined how NFC influenced responses to different smoking risk messages. Outcomes included knowledge, risk perceptions, and behavioral expectations related to quitting smoking. Methods: We randomized 402 participants to one of 4 different risk message sets that were manipulated in terms of emotionality and framing in a 2x2 design: (1) factual gain-framed, (2) factual loss-framed, (3) emotional gain-framed, and (4) emotional loss-framed. Results: Statistically significant main effects emerged for NFC and emotionality. For certain risk perceptions, those with lower NFC reported greater perceived risk in response to emotional messages and lower risk in response to factual messages; those with higher NFC showed an opposite pattern. Similarly, those with lower NFC reported greater risk in response to gain-framed messages and lower risk in response to loss-framed messages; the opposite pattern emerged for those lower in NFC. Conclusions: Findings highlight the importance of an individual difference variable in influencing the impact of different types of smoking risk messages.
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Affiliation(s)
- Elise M Stevens
- Postdoctoral Research Fellow, Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK; and ,
| | - David W Wetter
- Jon M. and Karen Huntsman Presidential Professor, and Director of the Center for Health Outcomes and Population Equity (HOPE), University of Utah and the Huntsman Cancer Institute, Salt Lake City, UT
| | - Damon J Vidrine
- Professor and Program Co-leader, Cancer Prevention and Control Program, Stephenson Cancer Center and the Director of Intervention Research for the Oklahoma Tobacco Research Center
| | - Diana Stewart Hoover
- Assistant Professor, Department of Health Disparities Research, MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Summer G Frank-Pearce
- Assistant Professor of Research in Biostatistics, Department of Biostatistics and Epidemiology, College of Public Health, Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Nga Nguyen
- Biostatistician, MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Yisheng Li
- Associate Professor, MD Anderson Cancer Center, The University of Texas, Houston, TX
| | - Andrew J Waters
- Professor, Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD
| | - Cathy D Meade
- Professor, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Theodore L Wagener
- Associate Professor and Director of Tobacco Regulatory Science Research, Oklahoma Tobacco Research Center at the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jennifer I Vidrine
- Professor and Associate Director for Cancer Prevention and Control and Director of the Oklahoma Tobacco Research Center, Stephenson Cancer Center, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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A Pilot Study of a Standardized Smoking Cessation Intervention for Patients with Vascular Disease. Ann Vasc Surg 2019; 61:91-99.e3. [PMID: 31449932 DOI: 10.1016/j.avsg.2019.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The goal of this study is to evaluate the efficacy of a smoking cessation intervention performed by a vascular surgery provider compared with current smoking cessation practices. METHODS Patients with peripheral arterial and aneurysmal disease who presented to the vascular surgery service at a tertiary care center over a 9-month period were randomized to either control or intervention group. Both control and intervention groups received 2 weeks of free nicotine patches and referral to an outpatient smoking-cessation program. The intervention group additionally received a brief presentation by a vascular surgeon regarding the benefits of smoking cessation, with a focus on vascular complications. At enrollment and at follow-up, patients underwent carbon monoxide breath testing and completed a survey. The primary outcome was smoking cessation or reduction among control and intervention groups in patients who underwent medical management, endovascular procedures, or open surgical procedures. Fisher's exact test was used to assess the primary outcome among groups. RESULTS Fifty-nine patients were enrolled in the trial initially, but 55 had 1-month follow-up (control n = 28, intervention n = 27) and 52 had long-term follow-up (control n = 28, intervention n = 24). By long-term follow-up, 40 patients (77%) had reduced smoking by at least 50% and 16 patients (31%) had quit completely. At long-term follow-up, 88% of patients in the intervention group and 68% of patients in the control group reduced smoking (P = 0.1). CONCLUSIONS A large proportion of vascular patients who received 2 weeks of nicotine replacement with or without the addition of brief smoking cessation counseling delivered by a vascular surgery provider were able to reduce smoking and maintain reduction after 6 months. Delivery of a brief standardized smoking cessation counseling session by a vascular surgery provider is safe and feasible. Additional randomized controlled trials with large enrollment periods and long follow-up are needed to determine the efficacy of this intervention in comparison to standard care.
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Pourtau L, Martin E, Menvielle G, El Khoury-Lesueur F, Melchior M. To smoke or not to smoke? A qualitative study among young adults. Prev Med Rep 2019; 15:100927. [PMID: 31321203 PMCID: PMC6612927 DOI: 10.1016/j.pmedr.2019.100927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/12/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Abstract
Smoking is the major preventable cause of disease and premature death in many countries, including France, where approximately 30% of adults are daily smokers. About 60% of them want to quit, however, long-term smoking cessation rates are low, particularly among individuals with low socio-economic position. The aim of this study is to examine whether motivations for smoking cessation among young adults differ across socio-economic groups. 3 focus groups of smokers and former smokers aged 22–40 years were constituted and conducted in November 2014 in Paris. Data from the focus groups were analyzed thematically and in a cross-cutting manner. Our study shows the existence of social “communities” of smokers, in occupational and festive contexts. In addition, new forms of resistance to public health messages are observed (“neutralization”), particularly among smokers with low socioeconomic position. Finally, stress is often cited as a source of unsuccessful smoking cessation or smoking relapse. Tobacco smoking is a social behavior and is associated with symbolic as well as relational benefits, particularly among smokers who have low socioeconomic position. To be effective, interventions aiming to decrease smoking levels in the population should aim to create group dynamics encouraging smokers to quit and address the physical as well as the psychological consequences of smoking withdrawal. Young adults who smoke congregate in social “communities”, at work or at parties. Persons with low socioeconomic status “neutralize” the risks related to smoking. Smoking is a social behavior, associated with symbolic and relational benefits.
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Affiliation(s)
- Lionel Pourtau
- Université Paris Sud/Paris Saclay, Laboratoire EA 1610, équipe ES3, Kremlin-Bicêtre, France
| | - Elise Martin
- Université Paris Sud/Paris Saclay, Laboratoire EA 1610, équipe ES3, Kremlin-Bicêtre, France
| | - Gwenn Menvielle
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012 Paris, France
| | - Fabienne El Khoury-Lesueur
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012 Paris, France
| | - Maria Melchior
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012 Paris, France
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Do Couple-Focused Cessation Messages Increase Motivation to Quit Among Dual-Smoker Couples? J Smok Cessat 2019; 14:95-103. [PMID: 31191733 DOI: 10.1017/jsc.2018.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Dual-smoker couples are a highly prevalent group who report low motivation to quit smoking. Aims This study tested the effect of a messaging intervention (couples- vs. individual-focused smoking outcomes) on motivation to quit among dual-smoker couples and examined the moderating effect of perceived support. Methods A total of 202 individuals in 101 dual-smoker couples were randomized by dyad using a 2 (frame: gain/loss) by 2 (outcome focus: individual/couple) factorial design. Participants reviewed scenarios of either positive or negative outcomes of quitting versus not quitting as they applied to either the individual or the couple. Participants then reported their own motivation to quit and motivation for their partner to quit. The main outcome was motivation to quit smoking. Results No main effects of framing or message focus emerged. Significant interactions between message focus and negative support predicted motivation for self and partner to quit. Individuals who reported lower negative support reported greater motivation for self to quit and less motivation for partner to quit after reviewing couple- (vs. individual-) focused messages. Conclusions Individuals in dual-smoker couples typically report low motivation to quit smoking. Couple-focused messages may increase motivation to quit among individuals who are not receiving negative support from their partners.
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Lee HY, Lee MH, Sharratt M, Lee S, Blaes A. Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach. JMIR Mhealth Uhealth 2019; 7:e13256. [PMID: 31199340 PMCID: PMC6592403 DOI: 10.2196/13256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 12/30/2022] Open
Abstract
Background Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke’s thematic analysis was used to identify core themes. Results Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population’s perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Mi Hwa Lee
- School of Social Work, College of Heath and Human Performance, East Carolina University, Greenville, NC, United States
| | - Monica Sharratt
- School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, MN, United States
| | - Sohye Lee
- Loewenberg College of Nursing, University of Memphis, Memphis, TN, United States
| | - Anne Blaes
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Twin Cities, MN, United States
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: A four-country study. Tob Induc Dis 2019; 17:23. [PMID: 31582934 PMCID: PMC6751965 DOI: 10.18332/tid/104753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Innovations in tobacco control interventions are required to ensure continued reductions in global tobacco use, and to minimise attributable morbidity and mortality. We therefore aimed to investigate the perceived effectiveness of current cigarette packaging warnings and the potential effectiveness of cigarette-stick warnings across four countries. METHODS An online survey was distributed to adult smokers in Australia, Canada, the United Kingdom, and the United States. Participants rated (using a 5-point Likert scale) and commented on the effectiveness of current cigarette packaging warnings and text warnings on eight cigarette sticks that prompted smokers to quit. Ratings were analysed using proportional odds logistic regression, and comments were analysed using content analysis. RESULTS Participants (N=678, mean age=44.3 years) from all four countries perceived cigarette packaging warnings as being minimally effective in prompting smokers to quit, citing desensitisation and irrelevance of the warnings, with US participants particularly critical of the text-only warnings. Compared to packaging warnings, the cigarette-stick warnings describing the financial costs of smoking and the effect of smoking on others, were the highest rated in all four countries (OR=3.42, 95% CI: 2.75–4.25, p<0.001 and OR=2.85, 95% CI: 2.29–3.55, p<0.001, respectively) and cited as strong messages to reduce smoking. Half of the participants either ‘agreed’ or ‘strongly agreed’ to the use of cigarette-stick warnings. CONCLUSIONS The findings of this study suggest that cigarette packaging warnings may experience a loss of effectiveness over time, eventually resulting in minimal impact on smoker behaviour. Health and non-health focused warnings and messages on individual cigarette sticks represent a novel and potentially effective method for reducing tobacco use. This would complement tobacco control interventions currently employed, resulting in public health benefits.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. A systematic review of the perceptions of adolescents on graphic health warnings and plain packaging of cigarettes. Syst Rev 2019; 8:25. [PMID: 30654833 PMCID: PMC6335796 DOI: 10.1186/s13643-018-0933-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Graphic health warnings on tobacco packaging and the plain packaging of tobacco products are key tobacco control interventions. This systematic review investigates the perceptions of adolescents towards these packaging interventions. METHODS Published, original-research, English-language articles from 1 January 2000 to 1 September 2017 were identified through a systematic literature search of the PubMed, CINAHL, PsycINFO, Web of Science, and Scopus databases. Articles describing investigations into the perceptions of adolescents aged 11 to 19 years towards graphic health warnings and/or plain-packaged cigarettes were included in this review. RESULTS Nineteen articles, involving 15,935 adolescent participants, of which 72.85% were non-smokers or ex-smokers and 27.15% occasional or daily smokers, met the eligibility criteria. Graphic health warnings were perceived as more effective than text-only warnings, with warnings depicting lung cancer, and oral diseases being perceived as particularly effective. Health warnings increased viewer fear, anxiety, shock, and guilt and were considered effective in preventing non-smokers from experimenting with tobacco and prompting current smokers to quit. Plain packaging reduced the attractiveness and other positive attributes of cigarette packaging, with darker colours found to be the most effective. When used in combination, plain packaging increased the visibility of graphic health warnings, with participants also perceiving them as having an increased tar content and having more serious health risks, and increased thoughts of quitting amongst smokers. CONCLUSIONS Graphic health warnings and plain packaging appear to increase adolescent awareness of the dangers of tobacco use. Further research into the most effective warnings to use in combination with plain packaging is needed to ensure the greatest reduction in tobacco use and prevent tobacco-attributable morbidity and mortality in this vulnerable population.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Building 047, Pharmacy, 1 James Cook Drive, Townsville, QLD 4810 Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Building 047, Pharmacy, 1 James Cook Drive, Townsville, QLD 4810 Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Building 047, Pharmacy, 1 James Cook Drive, Townsville, QLD 4810 Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Building 047, Pharmacy, 1 James Cook Drive, Townsville, QLD 4810 Australia
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Gu Q, Hu C, Chen N, Qu J. A comparison between lung carcinoma and a subcutaneous malignant tumor induced in rats by a 3,4-benzopyrene injection. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:3934-3942. [PMID: 31949781 PMCID: PMC6962791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/21/2018] [Indexed: 06/10/2023]
Abstract
Lung cancer is one of the most common carcinomas worldwide. It is of value to know whether lung is more vulnerable to carcinogens than other tissues. In this study we compared the carcinogenic potential of 3,4-benzopyrene administered by intrapulmonary injection or subcutaneous injection. Ninety rats were randomly divided into three groups (n=30/group). Rats under deep anesthesia were treated with 3,4-benzopyrene by intrapulmonary injection or scapular subcutaneous injection, or with the vehicle by subcutaneous injection. The Rats were sacrificed when they developed advanced somatic sarcomas or severe dyspnea and the rats without severe phenotypes were sacrificed after 1 year. The tumors were isolated and examined with H&E staining. The expression of Bcl-2, CYP1A1, and NF-κB mRNA and protein in somatic sarcoma and lung carcinoma tissues was examined by in situ hybridization, immunohistochemistry, and Western blot. No tumor development was observed in the control rats. Fifteen of the 30 rats receiving an intrapulmonary injection of 3,4-benzopyrene developed lung carcinomas, whereas all 30 rats treated with subcutaneous injection developed a malignant neoplasm under the skin. Positive Bcl-2, CYP1A1, and NF-κB protein staining was observed in lung carcinoma and subcutaneous malignant neoplasm but Bcl-2 protein expression was much stronger in subcutaneous malignant neoplasms than in lung carcinoma. The expression pattern of Bcl-2, CYP1A1, and NF-κB mRNA in lung carcinoma and subcutaneous malignant neoplasms was consistent with its protein expression. Our results indicated that the lung is not more vulnerable to carcinogens than other tissues. The lung may acquire a protective mechanism against lung carcinogenesis through regulation of Bcl-2 expression.
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Affiliation(s)
- Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South UniversityChangsha, Hunan Province, P. R. China
- Key Cite of National Clinical Research Center for Respiratory DiseaseChangsha, Hunan Province, P. R. China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South UniversityChangsha, Hunan Province, P. R. China
- Key Cite of National Clinical Research Center for Respiratory DiseaseChangsha, Hunan Province, P. R. China
| | - Ni Chen
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South UniversityChangsha, Hunan Province, P. R. China
- Key Cite of National Clinical Research Center for Respiratory DiseaseChangsha, Hunan Province, P. R. China
| | - Jingjing Qu
- Department of Respiratory Medicine, Xiangya Hospital Affiliated to Central South UniversityChangsha, Hunan Province, P. R. China
- Key Cite of National Clinical Research Center for Respiratory DiseaseChangsha, Hunan Province, P. R. China
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Bade BC, Hyer JM, Bevill BT, Pastis A, Rojewski AM, Toll BA, Silvestri GA. A Patient-Centered Activity Regimen Improves Participation in Physical Activity Interventions in Advanced-Stage Lung Cancer. Integr Cancer Ther 2018; 17:921-927. [PMID: 29900753 PMCID: PMC6142103 DOI: 10.1177/1534735418781739] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Physical activity (PA) is a potential therapy to improve quality of life in patients with advanced-stage lung cancer (LC), but no PA regimen has been shown to be beneficial, clinically practical, and sustainable. We sought to test the hypothesis that a patient-centered activity regimen (PCAR) will improve patient participation and PA more effectively than weekly phone calls. METHODS In patients with advanced-stage LC, we implemented a walking-based activity regimen and motivated patients via either weekly phone calls (n = 29; FitBit Zip accelerometer) or PCAR (n = 15; FitBit Flex, an educational session, and twice-daily gain-framed text messages). Data collection over a 4-week period was compared, and a repeated-measures, mixed-effects model for activity level was constructed. RESULTS Subjects receiving PCAR more frequently used the device (100% vs 79%) and less frequently had missing data (11% vs 38%). "More active" and "less active" groups were created based on mean step count in the first week. "Less active" patients in the PCAR group increased their PA level, whereas PA level fell in the "more active" group. Most subjects found PCAR helpful (92%) and would participate in another activity study (85%). DISCUSSION Compared with weekly phone calls, PCAR has higher patient participation, is more likely to improve PA in "less active" subjects, and has high patient satisfaction. A multifaceted PA regimen may be a more efficacious mechanism to study PA in advanced LC. PCAR should be used in a randomized controlled trial to evaluate for improvements in symptom burden, quality of life, and mood.
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Affiliation(s)
| | - J Madison Hyer
- 2 Medical University of South Carolina, Charleston, SC, USA
| | | | - Alex Pastis
- 3 Academic Magnet High School, North Charleston, SC, USA
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Lammers D, Zhang Z, Povieriena I, Pipe A. Students working against tobacco: A novel educational program to improve Canadian medical students' tobacco counselling skills. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e72-e78. [PMID: 30018686 PMCID: PMC6044310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Medical professionals should be appropriately trained in the field of smoking cessation counseling and be familiar with related tobacco-control issues. Sadly, Canadian medical students receive little education regarding smoking cessation. METHODS University of Ottawa medical students created Students Working Against Tobacco (SWAT), a program that provides its members with tobacco education and opportunities to discuss tobacco use, smoking prevention and cessation with elementary-school students. Surveys assessing student knowledge and confidence in addressing tobacco issues were administered to the participating students at the start of the program and following their delivery of a school presentation. RESULTS Students initially lacked knowledge, skills and experience in addressing tobacco issues and discussing smoking prevention and cessation counselling. Following their involvement in the SWAT program, students' smoking cessation counselling knowledge and skills improved, and they expressed confidence in becoming more engaged in this important preventive health issue. CONCLUSION Until smoking cessation is incorporated into undergraduate medical education programs, gaps will remain in the preparation of tomorrow's physicians regarding the provision of effective smoking cessation counselling and their broader understanding of this important health issue. Currently, there are constraints limiting the number of medical undergraduates that SWAT is able to involve and influence.
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Affiliation(s)
- Deanna Lammers
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Zach Zhang
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Iuliia Povieriena
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada
| | - Andrew Pipe
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada
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Lammers D, Zhang Z, Povieriena I, Pipe A. Students working against tobacco: A novel educational program to improve Canadian medical students' tobacco counselling skills. CANADIAN MEDICAL EDUCATION JOURNAL 2018; 9:e72-e78. [PMID: 30018686 DOI: 10.36834/cmej.36920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Medical professionals should be appropriately trained in the field of smoking cessation counseling and be familiar with related tobacco-control issues. Sadly, Canadian medical students receive little education regarding smoking cessation. METHODS University of Ottawa medical students created Students Working Against Tobacco (SWAT), a program that provides its members with tobacco education and opportunities to discuss tobacco use, smoking prevention and cessation with elementary-school students. Surveys assessing student knowledge and confidence in addressing tobacco issues were administered to the participating students at the start of the program and following their delivery of a school presentation. RESULTS Students initially lacked knowledge, skills and experience in addressing tobacco issues and discussing smoking prevention and cessation counselling. Following their involvement in the SWAT program, students' smoking cessation counselling knowledge and skills improved, and they expressed confidence in becoming more engaged in this important preventive health issue. CONCLUSION Until smoking cessation is incorporated into undergraduate medical education programs, gaps will remain in the preparation of tomorrow's physicians regarding the provision of effective smoking cessation counselling and their broader understanding of this important health issue. Currently, there are constraints limiting the number of medical undergraduates that SWAT is able to involve and influence.
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Affiliation(s)
- Deanna Lammers
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Zach Zhang
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Iuliia Povieriena
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada
| | - Andrew Pipe
- Faculty of Medicine, University of Ottawa, Ontario, Canada
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada
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Moodie C. Adult smokers' perceptions of cigarette pack inserts promoting cessation: a focus group study. Tob Control 2018; 27:72-77. [PMID: 28153959 DOI: 10.1136/tobaccocontrol-2016-053372] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Tobacco companies have a long tradition of including promotional material within cigarette packs, such as cigarette cards and coupons. Only in Canada are they required, by the government, to include educational material within cigarette packs, in the form of inserts highlighting the benefits of quitting or providing tips on how to do so. METHODS Twenty focus groups were conducted in Glasgow and Edinburgh in 2015, with smokers (n=120) segmented by age (16-17, 18-24, 25-35, 36-50, >50), gender and social grade, to explore perceptions of the inserts used in Canada. RESULTS The consensus was that these inserts would capture attention and be read due to their novelty and visibility before reaching the cigarettes, and as they can be removed from the pack. While they may be ignored or discarded, and rotation was considered necessary, they were generally thought to prolong the health message. The positive style of messaging was described as refreshing, educational, encouraging, reassuring and inspirational and thought to increase message engagement. It was regarded as more sympathetic than command-style messaging, offering smokers 'a bit of hope'. The inserts were often considered preferable to the on-pack warnings, although it was felt that both were needed. Some participants suggested that inserts could encourage them to stop smoking, and they were generally viewed as having the potential to alter the behaviour of others, particularly younger people, would-be smokers and those wanting to quit. CONCLUSIONS Inserts are an inexpensive means of communication and offer regulators a simple way of supplementing on-pack warnings.
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Affiliation(s)
- Crawford Moodie
- Department of Health Sciences and Sport, Institute for Social Marketing, University of Stirling, Stirling, UK
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Kim HK, Lee TK. Conditional Effects of Gain-Loss-Framed Narratives among Current Smokers at Different Stages of Change. JOURNAL OF HEALTH COMMUNICATION 2017; 22:990-998. [PMID: 29199898 DOI: 10.1080/10810730.2017.1396629] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examines how current smokers respond differently to gain-loss-framed antismoking narratives depending on their stages of change to quit smoking. An experiment (N = 461) was conducted with a 2 (narrative perspective: first person vs. third person) × 2 (framing: gain vs. loss) factorial design having smoker's stage of change (precontemplation vs. contemplation/preparation) as a moderator. We observed differential framing effects depending on smoker's current stages of change only when they were exposed to first-person narratives. For precontemplators, a loss-framed (vs. a gain-framed) first-person narrative induced greater quit intentions and stage progression. Conversely, among contemplators and preparers, a gain-framed (vs. a loss-framed) first-person narrative led to greater quit intentions and stage progression. These interactive patterns were partly mediated by self-referencing and perceived similarity. This study proposes an alternative mechanism to explain the conditional framing effect by stages of change and highlights the importance of tailoring messages to smoker's psychosocial characteristics and needs.
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Affiliation(s)
- Hye Kyung Kim
- a Wee Kim Wee School of Communication and Information , Nanyang Technological University , Singapore
| | - Tae Kyoung Lee
- b Department of Communication , University of Utah , Salt Lake City , UT , USA
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Martínez C, Company A, Guillen O, Margalef M, Arrien MA, Sánchez C, Cáceres de León P, Fernández E. Adaptation, Implementation Plan, and Evaluation of an Online Tobacco Cessation Training Program for Health Care Professionals in Three Spanish-Speaking Latin American Countries: Protocol of the Fruitful Study. JMIR Res Protoc 2017; 6:e7. [PMID: 28128731 PMCID: PMC5303198 DOI: 10.2196/resprot.6487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/21/2016] [Accepted: 11/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tobacco cessation training programs to treat tobacco dependence have measureable effects on patients' smoking. Tobacco consumption in low- and middle-income countries (LMICs) is high and slowly decreasing, but these countries usually lack measures to face the epidemic, including tobacco cessation training programs for health professionals and organizations. Based on a previous online smoking cessation training program for hospital workers in Spain, the Fruitful Study aims to increase smoking cessation knowledge, attitudes, self-confidence, and performance interventions among health care professionals of three Spanish-speaking low- and middle-income Latin American and Caribbean (LAC) countries. OBJECTIVE The purpose of this paper is to describe the methodology and evaluation strategy of the Fruitful Study intended to adapt, implement, and test the effectiveness of an online, evidence-based tobacco cessation training program addressed to health professionals from Bolivia, Guatemala, and Paraguay. METHODS This study will use a mixed-methods design with a pre-post evaluation (quantitative approach) and in-depth interviews and focus groups (qualitative approach). The main outcomes will be (1) participants' attitudes, knowledge, and behaviors before and after the training; and (2) the level of implementation of tobacco control policies within the hospitals before and after the training. RESULTS To date, adaptation of the materials, study enrollment, and training activities have been completed. During the adaptation, the main mismatches were language background and content adaptation. Several aids were developed to enable students' training enrollment, including access to computers, support from technicians, and reminders to correctly complete the course. Follow-up data collection is in progress. We have enrolled 281 hospital workers. Results are expected at the beginning of 2017 and will be reported in two follow-up papers: one about the formative evaluation and the other about the summative evaluation. CONCLUSIONS There is a need to learn more about the cultural and content elements that should be modified when an online tobacco cessation training program is adapted to new contexts. Special attention should be given to the personal and material resources that could make the implementation possible. Results from the Fruitful Study may offer a new approach to adapting programs to LMICs in order to offer education solutions with the use of emerging and growing communication technologies. CLINICALTRIAL Clinicaltrials.gov NCT02718872; https://clinicaltrials.gov/ct2/show/NCT02718872 (Archived by WebCite at http://www.webcitation.org/6mjihsgE2).
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Affiliation(s)
- Cristina Martínez
- Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet del Llobregat, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.,Universitat Internacional de Catalunya, Medicine and Health Sciences School, Sant Cugat del Vallés, Spain
| | - Assumpta Company
- Institut Català d'Oncologia-ICO, Training Unit, L'Hospitalet de Llobregat, Spain
| | - Olga Guillen
- Institut Català d'Oncologia-ICO, Training Unit, L'Hospitalet de Llobregat, Spain
| | - Mercè Margalef
- Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet de Llobregat, Spain
| | - Martha Alicia Arrien
- Management Department, Instituto Oncologico del Oriente Boliviano de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia
| | - Claudia Sánchez
- Public Health Department, Ministerio de Salud y Pública y Bienestar Social, Asuncion, Paraguay
| | - Paula Cáceres de León
- Radiation Oncology Department, Instituto de Cancerología y Hospital Dr. Bernardo, Guatemala, Guatemala
| | - Esteve Fernández
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain.,Institut Català d'Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, L'Hospitalet de Llobregat, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, L'Hospitalet del Llobregat, Spain
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- Management Department, Instituto Oncologico del Oriente Boliviano de Santa Cruz de la Sierra, Santa Cruz de la Sierra, Bolivia.,Public Health Department, Ministerio de Salud y Pública y Bienestar Social, Asuncion, Paraguay.,Radiation Oncology Department, Instituto de Cancerología y Hospital Dr. Bernardo, Guatemala, Guatemala
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Zhang B, Chaiton MO, Diemert LM, Bondy SJ, Brown KS, Ferrence R. Health professional advice, use of medications and smoking cessation: A population-based prospective cohort study. Prev Med 2016; 91:117-122. [PMID: 27496392 DOI: 10.1016/j.ypmed.2016.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The mediating role of cessation medications in the association between health professional advice and quitting behaviors is unclear. METHODS Data were from the Ontario Tobacco Survey longitudinal study, collected between July 2005 and June 2011 in Ontario, Canada. The analytic sample included 3437 baseline smokers who were seen by health professionals during follow-up. Logistic regression with generalized estimating equations and mediation analysis techniques were used to examine the impact of advice and medications on quitting outcomes (making a quit attempt, short-term quitting 1-6months and long-term quitting>6months). RESULTS Those who received advice to quit smoking were more likely to use cessation medications than those who did not receive advice (21% vs. 13%, P<0.001). Receiving advice was associated with making a quit attempt (adjusted odds ratio (OR) 1.25, 95% confidence interval (CI) 1.10-1.41) and long-term quitting (adjusted OR 1.49, 95% CI 1.10-2.02), but not with short-term quitting. Use of cessation medications was associated with making a quit attempt (adjusted OR 11.83, 95% CI 9.93-14.08), short-term quitting (adjusted OR 3.69, 95% CI 2.90-4.68), and long-term quitting (adjusted OR 2.73, 95% CI 1.95-3.82). Using prescription medications was associated with a higher likelihood of quitting short-term (adjusted OR 2.43, 95% CI 2.59-3.74) and long-term (adjusted OR 2.27, 95% CI 1.23-4.17) than using NRT. Use of cessation medications was a significant mediator in the pathway from receiving advice to quitting. CONCLUSION Health professionals should advise smokers to quit and encourage them to use cessation medications, especially prescription medications when trying to quit.
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Affiliation(s)
- Bo Zhang
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Michael O Chaiton
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Lori M Diemert
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Susan J Bondy
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - K Stephen Brown
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Statistics and Actuarial Science, University of Waterloo, Ontario, Canada
| | - Roberta Ferrence
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada. Prev Med 2016; 88:59-65. [PMID: 26970037 PMCID: PMC4902777 DOI: 10.1016/j.ypmed.2016.03.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/17/2016] [Accepted: 03/06/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND In June 2012, Canada implemented new pictorial warnings on cigarette packages, along with package inserts with messages to promote response efficacy (i.e., perceived quitting benefits) and self-efficacy (i.e., confidence to quit). This study assessed smokers' attention toward warnings and inserts and its relationship with efficacy beliefs, risk perceptions and cessation at follow-up. METHODS Data were analyzed in 2015 from a prospective online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014. Generalized Estimating Equation models were estimated to assess associations between reading inserts, reading warnings and efficacy beliefs (self-efficacy, response efficacy), risk perceptions, quit attempts of any length, and sustained quit attempts (i.e., 30days or more) at follow-up. Models adjusted for socio-demographics, smoking-related variables, and time-in-sample effects. RESULTS Over the study period, reading warnings significantly decreased (p<0.0001) while reading inserts increased (p=0.004). More frequent reading of warnings was associated independently with stronger response efficacy (Boften/very often vs never=0.28, 95% CI: 0.11-0.46) and risk perceptions at follow-up (Boften/very often vs never=0.31, 95% CI: 0.06-0.56). More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up (Btwice or more vs none=0.30, 95% CI: 0.14-0.47), quit attempts (ORtwice or more vs none=1.68, 95% CI: 1.28-2.19), and sustained quit attempts (ORtwice or more vs none=1.48, 95% CI: 1.01-2.17). CONCLUSIONS More frequent reading of inserts was associated with self-efficacy to quit, quit attempts, and sustained quitting at follow-up, suggesting that inserts complement pictorial HWLs.
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