1
|
El-Osta A, Hennessey C, Pilot C, Aumran Tahir M, Bagkeris E, Akram M, Alboksmaty A, Barbanti E, Bakhet M, Vos V, Banarsee R, Majeed A. A digital solution to streamline access to smoking cessation interventions in England; findings from a primary care pilot (STOPNOW study). PUBLIC HEALTH IN PRACTICE 2021; 2:100176. [PMID: 36101579 PMCID: PMC9461505 DOI: 10.1016/j.puhip.2021.100176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives Despite the proven efficacy of several smoking cessation medications that have been shown to improve long-term abstinence rates, approximately two-thirds of smokers report not having used medication in their most recent quit attempt. A main barrier could be delayed access to pharmacological interventions. This study investigated the utility of a primary care linked online portal to streamline timely access to pharmacological support to patients who want to quit smoking by making an asynchronous request for treatment to their general practitioner. Study design Prospective cohort study. Methods An online portal with added functionality was developed, which allowed patients with a unique link to make an asynchronous request for treatment. Two GP practices identified a total of 4337 eligible patients who received an SMS or email invite to engage with an online portal including an electronic survey to capture information about smoking behaviours and to request treatment. Portal informatics and patient level data were analysed to measure the efficacy of the online system in reducing the time between making a formal request to treatment and access to pharmacological support. The primary outcome measure was the time between making a formal request for treatment and access to pharmacological support from a designated community pharmacy. Results 323 patients (7.4%) initiated the survey, but only 56 patients completed the survey and made a formal request for treatment. 94% of participants did not return to use the portal to make a second or follow-up request for treatment. Only 3 participants completed the 12-week pathway. A total of 75 medication items were prescribed and collected by 56 patients. The time difference between the formal request to treatment and GP review ranged between 20 h and 1 week. The time difference between approval of prescription by the GP and access to medication was 5 days ± 2.1 days (range = 1.9–7.0 days). Conclusion The widespread adoption and diffusion of an IT enabled and asynchronous primary care led remote consultation pathway can streamline timely access to smoking cessation support without the need for the patient to see a GP or an independent prescriber in the first instance. Traditional face-to-face smoking cessation interventions may result in significant delays between the patient's decision to quit and access to effective pharmacological support or behavioural therapies. This was the first attempt in the UK where a GP-led online portal with added functionality was used to streamline timely access to pharmacotherapy for smoking cessation using an asynchronous formal request for treatment. We evaluated the findings of a primary care pilot from two general practices in West London where 4337 patients who are registered as smokers were contacted with unique link to access the portal. The pervasive use of a primary care-led online portal could enablie patients to make an asynchronous request for treatment without the need to visit the general practice.
Collapse
|
2
|
Carpenter MJ, Gray KM, Wahlquist AE, Cropsey K, Saladin ME, Froeliger B, Smith TT, Toll BA, Dahne J. A Pilot Randomized Clinical Trial of Remote Varenicline Sampling to Promote Treatment Engagement and Smoking Cessation. Nicotine Tob Res 2021; 23:983-991. [PMID: 33249458 PMCID: PMC8150130 DOI: 10.1093/ntr/ntaa241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/24/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Medication sampling is a clinically useful tool to engage smokers in the quitting process. Whether varenicline is suitable for sampling purposes is unclear. The purpose of this study was to examine the feasibility, uptake, and preliminary outcomes of varenicline sampling. METHODS Smokers (N = 99), both motivated to quit and not, were recruited and randomized to varenicline sampling versus not, with 12 week follow-up. The intervention consisted of mailing one-time samples of varenicline (lasting 2-4 wks), with minimally suggestive guidance on use. RESULTS Uptake of varenicline was strong, at 2 weeks (54% any use, 66% daily use) and 4 weeks (38%, 46%), with 58% of medication users seeking additional medication. Most users followed conventional titration patterns, self-titrating from 0.5 mg to 2 mg. Relative to control, varenicline sampling increased motivation (p = 0.006) and confidence to quit (p = 0.02), and decreased cigarette smoking (p = 0.02). Smokers receiving varenicline samples were significantly more likely to achieve 50% reduction in cigarettes per day (CPD), both immediately following the sampling exercise (Adjusted Odds Ratio [AOR] = 4.12; 95% CI: 1.39 to 12.17) and at final follow-up (AOR = 4.50; 95% CI: 1.56 to 13.01). Though cessation outcomes were not statistically significant, there was a 1.5 to 3-fold increase in quit attempts and abstinence from varenicline sampling throughout follow-up. These outcomes were comparable among smokers motivated to quit and not. CONCLUSIONS Unguided, user-driven sampling of varenicline sampling is a concrete behavioral exercise that is feasible to do and seems to suggest clinical utility. Sampling is a pragmatic clinical approach to engage more smokers in quitting. IMPLICATIONS Use of evidence-based pharmacotherapies for smoking cessation is low. Medication sampling is a pragmatic behavioral exercise that allows smokers to experience the benefits of using them, while promoting positive downstream effects towards quitting. While previous studies have shown that nicotine replacement therapy (NRT) sampling is viable and effective, whether this extends to varenicline is unclear. Results from this trial demonstrate that varenicline sampling is feasible, safe, and suggestive of clinically important steps toward quitting, deserving of a larger trial. CLINICAL TRIAL REGISTRATION NCT #03742154.
Collapse
Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Amy E Wahlquist
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama, Birmingham, UK
| | | | - Brett Froeliger
- Department of Psychiatry, University of Missouri, Columbia, MI
- Department of Psychological Sciences, University of Missouri, Columbia, MI
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Benjamin A Toll
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| |
Collapse
|
3
|
Carpenter MJ, Hughes JR. If at First You Don't Try …. Nicotine Tob Res 2020; 22:1431-1432. [PMID: 32266393 DOI: 10.1093/ntr/ntaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC.,Department of Public Health Sciences, MUSC, Charleston, SC.,Hollings Cancer Center, MUSC, Charleston, SC
| | - John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT
| |
Collapse
|
4
|
Minué-Lorenzo C, Olano-Espinosa E, Del Cura-González I, Vizcaíno-Sánchez JM, Camarelles-Guillem F, Granados-Garrido JA, Ruiz-Pacheco M, Gámez-Cabero MI, Martínez-Suberviola FJ, Serrano-Serrano E. Subsidized pharmacological treatment for smoking cessation by the Spanish public health system: A randomized, pragmatic, clinical trial by clusters. Tob Induc Dis 2019; 17:64. [PMID: 31582953 PMCID: PMC6770612 DOI: 10.18332/tid/111368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Research has shown that financing drug therapy increases smoking abstinence rates, although most of these studies have been carried out in the private healthcare setting. The aim of this work is to assess the effect of subsidized pharmacological treatment on smoking cessation rates by the Spanish public healthcare system. METHODS A pragmatic, randomized, clinical trial was performed by clusters. Randomization unit was the primary healthcare center and the analysis unit was the patient. Smokers consuming ≥10 cigarettes/day were randomly assigned to an intervention group that received financed pharmacological treatment or to a control group that followed usual care. The main outcome was self-reported or CO-confirmed continuous abstinence at 12 months. The main outcome, continuous abstinence rates (%), were compared between groups at 12 months post-intervention. A model was adjusted using mixed-effect logistic regression. RESULTS A total of 1154 patients were included from 23 healthcare centers. In the intention-to-treat analysis, self-reported abstinence after 12 months in the control and intervention groups, respectively, was 9.6% (37/387) and 15.4% (118/767) (gender-adjusted OR=1.75; 95% CI: 1.1–2.8); for CO-confirmed abstinence the corresponding values were 3.1% (12/387) and 6.4% (49/767) (gender-adjusted OR=1.72; 95% CI: 0.7–4.0). Pharmacological treatment use was 35.1% (136/387) in the control group, and 58.3% (447/767) in the intervention group (adjusted OR=4.25; 95% CI: 1.8–9.9) CONCLUSIONS Subsidizing pharmacological treatment for smoking cessation increases self-reported or CO-confirmed abstinence rates under realistic conditions in the primary care setting of the Spanish public health system.
Collapse
Affiliation(s)
- César Minué-Lorenzo
- Perales del Río Health Center, Dirección Asistencial Centro, Servicio Madrileño de Salud, Madrid, Spain
| | - Eduardo Olano-Espinosa
- Los Castillos Health Center, Dirección Asistencial Oeste, Servicio Madrileño de Salud, Madrid, Spain.,Area Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
| | - Isabel Del Cura-González
- Area Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain.,Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.,Red de Investigación Servicios de Salud en enfermedades crónicas, REDISSEC, Madrid, Spain
| | - Jose M Vizcaíno-Sánchez
- Fuentelarreina Health Center, Dirección Asistencial Norte, Servicio Madrileño de Salud, Madrid, Spain
| | | | - José A Granados-Garrido
- Guayaba Health Center, Dirección Asistencial Centro, Servicio Madrileño de Salud, Madrid, Spain
| | - Margarita Ruiz-Pacheco
- Doctor Castroviejo Health Center, Dirección Asistencial Norte, Servicio Madrileño de Salud, Madrid, Spain
| | - M Isabel Gámez-Cabero
- Majadahonda Valle de la Oliva Health Center, Dirección Asistencial Noroeste, Servicio Madrileño de Salud, Madrid, Spain
| | | | | |
Collapse
|
5
|
Cadham CJ, Jayasekera JC, Advani SM, Fallon SJ, Stephens JL, Braithwaite D, Jeon J, Cao P, Levy DT, Meza R, Taylor KL, Mandelblatt JS. Smoking cessation interventions for potential use in the lung cancer screening setting: A systematic review and meta-analysis. Lung Cancer 2019; 135:205-216. [PMID: 31446996 DOI: 10.1016/j.lungcan.2019.06.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Current guidelines recommend delivery of smoking cessation interventions with lung cancer screening (LCS). Unfortunately, there are limited data to guide clinicians and policy-makers in choosing cessation interventions in this setting. Several trials are underway to fill this evidence gap, but results are not expected for several years. METHODS AND MATERIALS We conducted a systematic review and meta-analysis of current literature on the efficacy of smoking cessation interventions among populations eligible for LCS. We searched PubMed, Medline, and PsycINFO for randomized controlled trials of smoking cessation interventions published from 2010-2017. Trials were eligible for inclusion if they sampled individuals likely to be eligible for LCS based on age and smoking history, had sample sizes >100, follow-up of 6- or 12-months, and were based in North America, Western Europe, Australia, or New Zealand. RESULTS Three investigators independently screened 3,813 abstracts and identified 332 for full-text review. Of these, 85 trials were included and grouped into categories based on the primary intervention: electronic/web-based, in-person counseling, pharmacotherapy, and telephone counseling. At 6-month follow-up, electronic/web-based (odds ratio [OR] 1.14, 95% CI 1.03-1.25), in-person counseling (OR 1.46, 95% CI 1.25-1.70), and pharmacotherapy (OR 1.53, 95% CI 1.33-1.77) interventions significantly increased the odds of abstinence. Telephone counseling increased the odds but did not reach statistical significance (OR 1.21, 95% CI 0.98-1.50). At 12-months, in-person counseling (OR 1.28 95% CI 1.10-1.50) and pharmacotherapy (OR 1.46, 95% CI 1.17-1.84) remained efficacious, although the decrement in efficacy was of similar magnitude across all intervention categories. CONCLUSIONS Several categories of cessation interventions are promising for implementation in the LCS setting.
Collapse
Affiliation(s)
- Christopher J Cadham
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Jinani C Jayasekera
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA.
| | - Shailesh M Advani
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA; The National Human Genome Research Institute, National Institutes of Health, 31 Center Drive, Bethesda, MD, USA
| | - Shelby J Fallon
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Jennifer L Stephens
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Dejana Braithwaite
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Jihyoun Jeon
- University of Michigan, School of Public Health, Ann Arbor, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Pianpian Cao
- University of Michigan, School of Public Health, Ann Arbor, 1415 Washington Heights, Ann Arbor, MI, USA
| | - David T Levy
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Rafael Meza
- University of Michigan, School of Public Health, Ann Arbor, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Kathryn L Taylor
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Georgetown University Medical Center-Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, 3300 Whitehaven St. NW, Washington, DC, USA
| | | |
Collapse
|
6
|
Giuliani ME, Liu G, Xu W, Dirlea M, Selby P, Papadakos J, Abdelmutti N, Yang D, Eng L, Goldstein DP, Jones JM. Implementation of a Novel Electronic Patient-Directed Smoking Cessation Platform for Cancer Patients: Interrupted Time Series Analysis. J Med Internet Res 2019; 21:e11735. [PMID: 30964445 PMCID: PMC6477574 DOI: 10.2196/11735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 01/16/2023] Open
Abstract
Background Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting. Objective The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. Methods A patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada’s largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts. Results A total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28% (2366/5343) using the paper-based approach to 65.72% (3538/5383) using CEASE (P<.01), and referrals offered to smokers who indicated interest in quitting increased from 18.6% (58/311) to 98.8% (421/426; P<.01). Accepted referrals decreased from 41% (24/58) to 20.4% (86/421), though the overall proportion of referrals generated from total current/recent tobacco users willing to quit increased from 5.8% (24/414) to 20.2% (86/426) due to the increase in referrals offered. At 1-month postscreening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in the past 4 weeks (pre: 28.9% [24/83] and post: 28.8% [83/288]). However, contact with the referral program increased from 0% to 78% in the postCEASE cohort (P<.001). Conclusions CEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services.
Collapse
Affiliation(s)
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Dongyang Yang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | |
Collapse
|
7
|
Selby P, Voci S, Zawertailo L, Baliunas D, Dragonetti R, Hussain S. Public health impact of a novel smoking cessation outreach program in Ontario, Canada. BMC Public Health 2018; 18:1117. [PMID: 30217187 PMCID: PMC6137944 DOI: 10.1186/s12889-018-6012-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Provision of evidence-based smoking cessation treatment may contribute to health disparities if barriers to treatment are greater for more disadvantaged groups. We describe and evaluate the public health impact of a novel outreach program to improve access to smoking cessation treatment in Ontario, Canada. Methods We partnered with Public Health Units (PHUs) located across the province to deliver single-session workshops providing standardized evidence-based content and 10 weeks (2007–2008) or 5 weeks (2008–2016) of nicotine replacement therapy (NRT). Participants completed a baseline assessment and were followed up by phone or e-mail at 6 months. We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate the public health impact of the program from 2007 to 2016. Given the iterative design and changes in implementation over time, data is presented annually or bi-annually. Results There were 26,122 enrollments from 2007 to 2016. Between 31 and 442 workshops were held annually. The annual reach was estimated to be 0.1–0.3% of eligible smokers in Ontario. Participants were older, smoked more heavily, had a lower household income, were more likely to be female and be diagnosed with a mood or anxiety disorder, and less likely to have a postsecondary degree compared to average Ontario smokers eligible for participation. The intervention was effective; at 6-month follow-up 22–33% of respondents reported abstinence from smoking. Adoption by PHUs was 81% by the second year of operation and remained high (72–97%) thereafter, with the exception of 2009–2010 (33–56%) when the program was temporarily unavailable to PHUs due to lack of funding. Implementation at the organizational level was not tracked; however, at the individual level, approximately half of participants used most or all of the NRT received. On average, maintenance of the program was high, with PHUs conducting workshops for 7 of the 10 years (2007–2016) and 4 of the 5 most recent years (2012–2016). Conclusions The smoking cessation program had a high rate of adoption and maintenance, reached smokers over a large geographic area, including individuals more likely to experience disparities, and helped them make successful quit attempts. This novel model can be adopted in other jurisdictions with limited resources.
Collapse
Affiliation(s)
- Peter Selby
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Sabrina Voci
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Dolly Baliunas
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Rosa Dragonetti
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada
| | - Sarwar Hussain
- Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T 1P7, Canada
| |
Collapse
|
8
|
Simon C, Bruneau L, Chirpaz E, Mété D. [Evaluation of the smoking cessation at the patients of Saint-Denis (Reunion island), over the year 2014]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:215-220. [PMID: 29459127 DOI: 10.1016/j.pneumo.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 01/07/2018] [Accepted: 01/12/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The fight against smoking is a major challenge for public health in Reunion Island. This French overseas department knows considerable social inequalities and so there is a possibility of free access to nicotine substitution among disadvantaged patients. The objective was to describe the social characteristics, the level of addiction to smoking and the actual level of smoking cessation at 18 months of tobacco-smoking patients from Reunion who consulted in 2014. METHODS It was an observational, retrospective, monocentric study carried out in the addictology service in the teaching hospital in Saint-Denis, Reunion Island. Inclusion of patients over the year 2014 who were mono-dependent on tobacco and who were consulting for the first time in order to give up smoking. RESULTS 122 patients were included, 51 % of women, of an average age of 47.5 years. The rate of smoking cessation at a year and a half was 23 %. There was no significant difference concerning smoking cessation according to the patient's level of addiction, the educational level, the profession or the level of confidence when stopping. DISCUSSION The proportion of patients who had given up at a year and a half in our study was comparable to the data found in international literature. The impact of free access to nicotine substitution on smoking cessation could not be estimated.
Collapse
Affiliation(s)
- C Simon
- Service des maladies respiratoires, CHU de Saint-Denis, Saint-Denis, Réunion.
| | - L Bruneau
- Unité de soutient méthodologique, CHU de Saint-Denis, Saint-Denis, Réunion.
| | - E Chirpaz
- Unité de soutient méthodologique, CHU de Saint-Denis, Saint-Denis, Réunion.
| | - D Mété
- Service d'addictologie, CHU de Saint-Denis, Saint-Denis, Réunion.
| |
Collapse
|
9
|
Ramsey T, Guo E, Svider PF, Lin H, Syeda S, Raza SN, Fribley AM. Laryngeal cancer: Global socioeconomic trends in disease burden and smoking habits. Laryngoscope 2018; 128:2039-2053. [PMID: 29508408 DOI: 10.1002/lary.27068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS To characterize health burden and determine the associated level of equality of laryngeal carcinoma (LC) burden at a global level. METHODS One hundred eighty-four countries were organized by socioeconomic status using Human Development Index (HDI) categorizations provided by the United Nations Development Program. Disability-adjusted life years (DALYs), obtained from The Global Health Data Exchange, were calculated and compared between each HDI category for the period from 1990 to 2015. Equality of LC burden was then evaluated with concentration indices. RESULTS Global LC burden, as measured by age-standardized DALYs, has improved significantly over the 25-year period studied. This burden has declined for very high, high, and medium HDI countries, whereas it has remained unchanged for low HDI countries. The majority of LC global burden was found in high socioeconomic countries before 2010 and has shifted toward low socioeconomic countries, as indicated by concentration indices. Over the last 25 years, Central and Eastern Europe continue to have the largest disease burden in the world. CONCLUSION This is the first analysis that we are aware of investigating health disparities of LC at a global level. The global burden of the disease has declined, which is a trend corresponding with significantly reduced smoking behaviors in developed countries. Although the global inequality gap decreased between 2010 and 2015, there remain reasons for concern. Smoking continues to trend upward in low socioeconomic countries, which could increase LC burden in low socioeconomic countries in the near future. A new global initiative directed toward low socioeconomic countries may yield dividends in preventing subsequent disparities in the LC burden. LEVEL OF EVIDENCE 4. Laryngoscope, 128:2039-2053, 2018.
Collapse
Affiliation(s)
- Tam Ramsey
- Department of Otolaryngology-Head and Neck Surgery, Detroit, Michigan, U.S.A
| | - Eric Guo
- Department of Otolaryngology-Head and Neck Surgery, Detroit, Michigan, U.S.A
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Detroit, Michigan, U.S.A
| | - Hosheng Lin
- Department of Otolaryngology-Head and Neck Surgery, Detroit, Michigan, U.S.A.,Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, U.S.A.,John Dingell VA Medical Center, Detroit, Michigan, U.S.A
| | - Sara Syeda
- Department of Economics, Wayne State University, Detroit, Michigan, U.S.A
| | - S Naweed Raza
- Department of Otolaryngology-Head and Neck Surgery, Detroit, Michigan, U.S.A.,Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, U.S.A
| | - Andrew M Fribley
- Department of Otolaryngology-Head and Neck Surgery, Detroit, Michigan, U.S.A.,Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, U.S.A.,Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, U.S.A
| |
Collapse
|
10
|
Phung A, Luo L, Breik N, Alessi-Severini S. Use of smoking cessation products: A survey of patients in community pharmacies. Can Pharm J (Ott) 2017; 150:326-333. [PMID: 28894502 DOI: 10.1177/1715163517723035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES At 17.3%, smoking rates in Manitoba continue to exceed the national average. In this province, a total health care spending of more than $200 million per year has been attributed to smoking. This study examined the use of smoking cessation agents, including nicotine replacement products and prescription medications, in a sample of smokers in the city of Winnipeg. METHODS A simple multiple-choice questionnaire was administered to willing individuals attending 2 community pharmacies in Winnipeg, Manitoba. Data on demographics, smoking habits, previous attempts of smoking cessation and previous and current use of over-the-counter and prescription smoking cessation products were collected anonymously. RESULTS Of the 2237 individuals who were approached, 586 were smokers (26.2%) and 180 responded to the survey (30.7%); 48.9% were female. A majority of smokers (32.8%) reported smoking 16 to 25 cigarettes per day. More than 90% had smoked for more than 5 years, 27.2% had more than 5 previous quit attempts and 82.1% used smoking cessation products with the intention to quit. Self-motivation (44.4%) and family/friend advice (28.3%) were major reasons for quitting. Impact of health care practitioners' advice was low (6.4%). More than 80% of respondents reported that they had no insurance coverage for their smoking cessation products. Despite having the highest rate of use, both nicotine gum (33.3%) and patches (24.4%) were reported to have lower rates of perceived efficacy. Electronic cigarette (97.9%) and varenicline (70.6%) had the highest rates of reported effectiveness. CONCLUSION Smokers wanting to quit undergo many attempts. Pharmacists should assume a key role in reaching out to smokers.
Collapse
Affiliation(s)
- Alan Phung
- College of Pharmacy (Phung, Luo, Breik, Alessi-Severini), University of Manitoba, Winnipeg, Manitoba
| | - Lauren Luo
- College of Pharmacy (Phung, Luo, Breik, Alessi-Severini), University of Manitoba, Winnipeg, Manitoba
| | - Noor Breik
- College of Pharmacy (Phung, Luo, Breik, Alessi-Severini), University of Manitoba, Winnipeg, Manitoba
| | - Silvia Alessi-Severini
- College of Pharmacy (Phung, Luo, Breik, Alessi-Severini), University of Manitoba, Winnipeg, Manitoba
| |
Collapse
|
11
|
van den Brand FA, Nagelhout GE, Reda AA, Winkens B, Evers SMAA, Kotz D, van Schayck OCP. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database Syst Rev 2017; 9:CD004305. [PMID: 28898403 PMCID: PMC6483741 DOI: 10.1002/14651858.cd004305.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tobacco smoking is the leading preventable cause of death worldwide, which makes it essential to stimulate smoking cessation. The financial cost of smoking cessation treatment can act as a barrier to those seeking support. We hypothesised that provision of financial assistance for people trying to quit smoking, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts. This is an update of the original 2005 review. OBJECTIVES The primary objective of this review was to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). We also assessed the cost effectiveness of different financial interventions, and analysed the costs per additional quitter, or per quality-adjusted life year (QALY) gained. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register in September 2016. SELECTION CRITERIA We considered randomised controlled trials (RCTs), controlled trials and interrupted time series studies involving financial benefit interventions to smokers or their healthcare providers, or both. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed the quality of the included studies. We calculated risk ratios (RR) for individual studies on an intention-to-treat basis and performed meta-analysis using a random-effects model. MAIN RESULTS In the current update, we have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both.Full financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from USD 97 to USD 7646 for the comparison of full coverage with partial or no coverage.There was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants).Full financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants).Full financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: nicotine replacement therapy (NRT): RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants.There was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants).We assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. We detected some imprecision but we judged this to be of minor consequence on the outcomes of this study. AUTHORS' CONCLUSIONS Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting. There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers. We are only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates.
Collapse
Affiliation(s)
- Floor A van den Brand
- Maastricht University (CAPHRI)Department of Family MedicineP.debyeplein 1MaastrichtZuid‐LimburgNetherlands6229 HA
| | - Gera E Nagelhout
- Maastricht University (CAPHRI)Department of Family MedicineP.debyeplein 1MaastrichtZuid‐LimburgNetherlands6229 HA
- IVO Addiction Research InstituteRotterdamNetherlands
- Maastricht University (CAPHRI)Department of Health PromotionMaastrichtNetherlands
| | - Ayalu A Reda
- Brown UniversityDepartment of Biostatistics, School of Public HealthProvidenceRIUSA
- Brown UniversityDepartment of SociologyProvidenceUSA
- Brown UniversityPopulation Studies and Training CentreProvidenceUSA
| | - Bjorn Winkens
- Maastricht UniversityDepartment of Methodology and Statistics, Faculty of Health Medicine and Life Sciences (FHML)Debyeplein 1MaastrichtNetherlands6200 MD
| | - Silvia M A A Evers
- Maastricht University (CAPHRI)Department of Health Services ResearchPO Box 6166200 MDMaastrichtNetherlands6229 ER
| | - Daniel Kotz
- Maastricht University (CAPHRI)Department of Family MedicineP.debyeplein 1MaastrichtZuid‐LimburgNetherlands6229 HA
- Heinrich‐Heine‐UniversityInstitute of General Practice, Addiction Research and Clinical Epidemiology, Medical FacultyDüsseldorfGermany
| | - Onno CP van Schayck
- Maastricht University (CAPHRI)Department of Family MedicineP.debyeplein 1MaastrichtZuid‐LimburgNetherlands6229 HA
| | | |
Collapse
|
12
|
Voci SC, Zawertailo LA, Hussain S, Selby PL. Association between adherence to free nicotine replacement therapy and successful quitting. Addict Behav 2016; 61:25-31. [PMID: 27235989 DOI: 10.1016/j.addbeh.2016.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/29/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Providing free nicotine replacement therapy (NRT) can be a cost-effective strategy for increasing quit attempts and cessation rates at a population level. However, the optimal amount of NRT to provide is unknown. Associations between duration of NRT use and abstinence may be overestimated as a result of reverse causality due to discontinuation following relapse. We examined the association between adherence to 10weeks of cost-free NRT and quit success at 6-month follow-up, after controlling for reverse causation by excluding participants who reported nonadherence due to relapse. METHODS Individuals 18years or older who smoked at least 10 cigarettes daily and intended to quit within 30days received 10weeks of NRT at a smoking cessation workshop. There were 3922 participants who attended one of 114 workshops in 70 different localities in Ontario, Canada from 2007 to 2008. RESULTS At end of treatment participants were asked whether they had used "all" of the NRT (20%), "most" of it (28%), "some" of it (47%), or whether they "did not use any" of it (5%). After controlling for reverse causation and adjusting for potential confounding variables, poorer quit success was reported by those who used either some (AOR=0.43, 95% CI=0.26-0.69, p=0.001) or none (AOR=0.30, 95% CI=0.09-0.95, p=0.041) of the NRT versus all 10weeks. Post-estimation contrasts revealed using some versus most of the NRT was also associated with poorer quit success (p=0.026). CONCLUSIONS After controlling for reverse causation, adherence to 10weeks of cost-free NRT was associated with successful abstinence at six months post-treatment.
Collapse
|
13
|
Dember LM, Archdeacon P, Krishnan M, Lacson E, Ling SM, Roy-Chaudhury P, Smith KA, Flessner MF. Pragmatic Trials in Maintenance Dialysis: Perspectives from the Kidney Health Initiative. J Am Soc Nephrol 2016; 27:2955-2963. [PMID: 27401689 PMCID: PMC5042681 DOI: 10.1681/asn.2016030340] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Pragmatic clinical trials are conducted under the real-world conditions of clinical care delivery. As a result, these trials yield findings that are highly generalizable to the nonresearch setting, identify interventions that are readily translatable into clinical practice, and cost less than trials that require extensive research infrastructures. Maintenance dialysis is a setting especially well suited for pragmatic trials because of inherently frequent and predictable patient encounters, highly granular and uniform data collection, use of electronic data systems, and delivery of care by a small number of provider organizations to approximately 90% of patients nationally. Recognizing the potential for pragmatic trials to generate much needed evidence to guide the care of patients receiving maintenance dialysis, the Kidney Health Initiative assembled a group of individuals with relevant expertise from academia, industry, and government to provide the nephrology community with information about the design and conduct of such trials, with a specific focus on the dialysis setting. Here, we review this information, and where applicable, use experience from the ongoing Time to Reduce Mortality in End Stage Renal Disease Trial, a large cluster-randomized, pragmatic trial evaluating hemodialysis session duration, to illustrate challenges and solutions to operational, ethical, and regulatory issues.
Collapse
Affiliation(s)
- Laura M Dember
- Renal, Electrolyte and Hypertension Division and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Patrick Archdeacon
- Office of Medical Policy and Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Eduardo Lacson
- Nephrology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Shari M Ling
- Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Prabir Roy-Chaudhury
- Division of Nephrology, The University of Arizona College of Medicine and Southern Arizona Veterans Administration Health Care System, Tucson, Arizona
| | - Kimberly A Smith
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Michael F Flessner
- Division of Kidney, Urology, and Hematology, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| |
Collapse
|
14
|
Selby P, Hussain S, Voci S, Zawertailo L. Empowering smokers with a web-assisted tobacco intervention to use prescription smoking cessation medications: a feasibility trial. Implement Sci 2015; 10:139. [PMID: 26429100 PMCID: PMC4590254 DOI: 10.1186/s13012-015-0329-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Varenicline and bupropion, efficacious smoking cessation medications, have had suboptimal impact due to barriers at the patient, practitioner and system level. This study explored the feasibility of a web-assisted tobacco intervention offering free prescription smoking cessation medication by mail if the smoker visited a physician for authorization. Methods Adult Ontarians, smoking at least 10 cigarettes daily, intending to quit within 30 days, with no contraindications to bupropion or varenicline were eligible. After an online assessment, eligible participants received an electronic personalized printable prescription form for a 12-week course of varenicline or bupropion to bring to a physician within 3 weeks for authorization, if appropriate. The physician’s office faxed prescriptions to an online pharmacy that couriered medication to the patient following medication counselling by telephone. Weekly motivational emails were sent during treatment. Participants were asked to complete follow-up questionnaires online at 7, 11, 15 and 41 weeks after enrollment. Results In total, 1214 individuals submitted an online assessment from April to September 2010 and 73.6 % (95 % confidence interval (CI) = 71.1–76.1 %; n = 893) were eligible. At least 65.8 % (95 % CI = 62.7–68.9 %; n = 588) of eligible participants subsequently visited a physician and 58.7 % (95 % CI = 55.5–61.9 %; n = 524) received medication (50.6 % varenicline [n = 265] and 49.4 % bupropion [n = 259]). Reasons for not filling a prescription were failure to visit a physician (80.1 %; 95 % CI = 73.8–86.5 %; n = 121), physician not prescribing the medication (15.9 %; 95 % CI = 10.1–21.7 %; n = 24) or other reasons (4.0 %; 95 % CI = 0.9–7.1 %; n = 6). Follow-up response rate was 66.7 % (95 % CI = 63.7–69.8 %; n = 596). Minimal issues were encountered with printing the prescription or medication delivery. Conclusions This study establishes the feasibility of using the Internet and free medication to enable smokers to engage physicians to treat this addiction. Implementation of this intervention can be scaled up by leveraging existing healthcare systems to treat smokers on a population level. Further evaluation in a randomized controlled trial is necessary. Trial registration ClinicalTrials.gov Identifier NCT01023659 Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0329-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Peter Selby
- Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, ON, M6J 1H4, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Ontario Tobacco Research Unit, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Sarwar Hussain
- Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, ON, M6J 1H4, Canada.
| | - Sabrina Voci
- Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, ON, M6J 1H4, Canada.
| | - Laurie Zawertailo
- Addictions Program, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, ON, M6J 1H4, Canada. .,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| |
Collapse
|
15
|
White CM, Rynard VL, Reid JL, Ahmed R, Burkhalter R, Hammond D. Stop-Smoking Medication Use, Subsidization Policies, and Cessation in Canada. Am J Prev Med 2015; 49:188-98. [PMID: 26033348 DOI: 10.1016/j.amepre.2015.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In 2000, Quebec began reimbursing stop-smoking medications (SSMs) through their provincial public drug insurance plan. Several other Canadian provinces have since begun offering SSM subsidies. Clinical trials indicate that SSMs can increase quit success; however, little evidence exists on patterns of use in "real-world" settings and impact on population quit rates. This study examines Canadian trends in SSM use and quit success over time, comparing provinces with differing subsidization policies. METHODS Secondary analyses were conducted in 2014 using nationally representative Canadian Tobacco Use Monitoring Survey data, 2004-2012, for current and former smokers who made a quit attempt in the past 2 years (N=26,094). Regression models tested for differences in SSM use and quit success in provinces with differing SSM coverage (i.e., none, partial, or comprehensive). RESULTS Smokers were more likely to use nicotine replacement therapy (NRT) in jurisdictions with comprehensive SSM coverage versus jurisdictions with partial (OR=1.39, 95% CI=1.22, 1.59) or no coverage (OR=1.43, 95% CI=1.21, 1.68). Prescription medication use was more likely in provinces with partial (versus no) coverage (OR=1.27, 95% CI=1.01, 1.59). Overall, smokers who attempted to quit were more likely to remain abstinent in jurisdictions with comprehensive versus partial (OR=1.20, 95% CI=1.12, 1.28) or no coverage (OR=1.23, 95% CI=1.00, 1.50). An interaction between coverage and cigarettes per day was observed, suggesting potentially greater impact of comprehensive coverage among heavier smokers. CONCLUSIONS Comprehensive subsidization policies are associated with modest increases in NRT use and quit success, but do not appear to impact prescription SSM use.
Collapse
Affiliation(s)
- Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Vicki L Rynard
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Robin Burkhalter
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
| |
Collapse
|