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Borger T, Feather AR, Wakeman KE, Bowling W, Burris JL. Understanding cancer patients' desire to quit tobacco without assistance: A mixed-methods study. J Health Psychol 2024; 29:1074-1087. [PMID: 38282364 PMCID: PMC11283578 DOI: 10.1177/13591053231223345] [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: 01/30/2024] Open
Abstract
While many cancer patients who use tobacco try to quit post-diagnosis, some prefer to quit without using tobacco treatment, despite evidence against unassisted quit attempts. This study aimed to understand the rationale for some cancer patients' desire to quit tobacco without assistance. Thirty-five adult cancer patients who currently used tobacco and declined tobacco treatment because of the desire to quit unassisted provided data via a standardized questionnaire and a semi-structured interview. The sample was predominately White, non-Hispanic (85.71%) and female (68.57%). The most common cancer site was gynecological. Key themes that emerged from the interviews were: self-reliance, willpower, social norms, and negative attitudes toward tobacco treatment. The most frequently endorsed barrier to tobacco treatment was "I know others who have quit without tobacco treatment" (82.86%). This study with cancer patients identified affective, cognitive, and personality factors related to quitting unassisted, and social and systemic reasons to not use tobacco treatment.
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Affiliation(s)
- Tia Borger
- University of Kentucky, Lexington, KY, USA
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2
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Barnabe A, Gamache K, de Camargo JVP, Allen-Flanagan E, Rioux M, Pruessner J, Leyton M, Nader K. A novel stress-based intervention reduces cigarette use in non-treatment seeking smokers. Neuropsychopharmacology 2023; 48:308-316. [PMID: 36175551 PMCID: PMC9750979 DOI: 10.1038/s41386-022-01455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 12/26/2022]
Abstract
Tobacco use is the leading cause of preventable mortality worldwide. Since current smoking cessation aids show only modest efficacy, new interventions are needed. Given the evidence that stress is a potent trigger for smoking, the present randomized clinical trial tested whether stress could augment the effects of a memory updating (retrieval-extinction) intervention. Non-treatment seeking smokers (n = 76) were assigned to one of four conditions composed of either a stressful or non-stressful psychosocial challenge followed by either smoking or neutral cues. Ten minutes after this manipulation, all underwent a 60-minute extinction procedure during which they viewed smoking-related videos and images and manipulated smoking paraphernalia. Compared to participants who were not exposed to the laboratory stressor, the stressor-exposed groups exhibited greater psychophysiological responses during their intervention and greater decreases in cigarette use at two- and six-weeks follow-up independent of smoking cue exposure. Together, these findings suggest that the ability of stress to activate cigarette seeking processes can be exploited to decrease cigarette use. With replication, the stress-based intervention could become a novel strategy for decreasing cigarette use in non-treatment seeking smokers.Clinicaltrials.gov identifier: NCT04843969.
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Affiliation(s)
- Alexandra Barnabe
- grid.14709.3b0000 0004 1936 8649Department of Psychology, McGill University, Montreal, QC Canada
| | - Karine Gamache
- grid.14709.3b0000 0004 1936 8649Department of Psychology, McGill University, Montreal, QC Canada
| | | | - Erin Allen-Flanagan
- grid.14709.3b0000 0004 1936 8649Department of Psychology, McGill University, Montreal, QC Canada
| | - Mathilde Rioux
- grid.14709.3b0000 0004 1936 8649Department of Psychology, McGill University, Montreal, QC Canada
| | - Jens Pruessner
- grid.9811.10000 0001 0658 7699Department of Psychology, University of Konstanz, Baden-Württemberg, Germany ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, QC Canada
| | - Marco Leyton
- Department of Psychology, McGill University, Montreal, QC, Canada. .,Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada. .,Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada.
| | - Karim Nader
- grid.14709.3b0000 0004 1936 8649Department of Psychology, McGill University, Montreal, QC Canada
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3
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Gobarani RK, Weeks GR, Abramson MJ, Bonevski B, Paul E, Webb A, Kirsa S, Smith BJ, Thomas D, Perinpanathan S, Parkinson J, Meanger D, Coward L, Rofe O, Lee P, George J. Which smokers enrol in a hospital based smoking cessation trial? Survey of smoking related behaviours, quit attempts and motivation to quit. Health Promot J Austr 2022; 34:420-428. [PMID: 36065155 DOI: 10.1002/hpja.658] [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: 03/18/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Understanding smoking behaviours in hospital patients who smoke may improve inpatient cessation treatments. This study aimed to describe smoking-related behaviours, past-quit attempts, and self-reported difficulties experienced in quitting among those who enrolled in a smoking cessation trial of varenicline. METHODS Baseline data were obtained from adult hospitalised smokers (average ≥10 cigarettes/day in 4-weeks prior to hospitalisation) who enrolled in a randomised, placebo-controlled trial of varenicline ± nicotine lozenges at 5 Australian public hospitals. A logistic regression model tested the association between participant characteristics and quitting in the previous 12 months. RESULTS Participants' (n=320; 57% male, 52.5 ± 12.1 years old) motivation and confidence in quitting were high. A total of 120 participants (37.5%) had attempted quitting in the previous 12-months. Prior hospitalisation (P=0.008) and employment status (P=0.015) were significantly associated with past quit attempts. No statistically significant differences were noted in the reason for hospitalisation or the level of nicotine dependence between participants who attempted quitting in the previous 12 months and their counterparts. Smoking cessation pharmacotherapy was used by 55% of those attempting to quit; nicotine replacement therapy (65.2%) and varenicline (16.7%) most common. Stress or anxiety, urges to smoke and a lack of motivation were the difficulties experienced in past quit attempts. CONCLUSIONS Those who had a prior hospitalisation and were unemployed had significantly greater odds of reporting past quit attempts. Further research is needed to investigate the degree of adherence among inpatient smokers with the smoke-free hospital policies and the frequency of NRT provision and uptake on admission. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rukshar K Gobarani
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Gregory R Weeks
- Pharmacy Department, Barwon Health, Geelong, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Clinical Haematology Department, The Alfred, Melbourne, Victoria, Australia
| | - Ashley Webb
- Anaesthetist, Department of Anaesthesia and Pain Management, Peninsula Health, Frankston, Victoria, Australia
| | - Sue Kirsa
- Pharmacy Department, Monash Health, Clayton, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Brian J Smith
- General and Respiratory Medicine, Bendigo Hospital, Victoria, Australia
| | - Dennis Thomas
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia
| | | | | | - Darshana Meanger
- Pharmacy Department, Peninsula Health, Frankston, Victoria, Australia
| | - Lisa Coward
- Department of Anaesthesia and Pain Management, Peninsula Health, Frankston, Victoria, Australia
| | - Olivia Rofe
- Pharmacy Department, Eastern Health, Melbourne, Victoria, Australia
| | - Paula Lee
- Pharmacy Department, Eastern Health, Box Hill, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
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4
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van Westen-Lagerweij NA, Bommelé J, Willemsen MC, Croes EA. Mentioning smoking cessation assistance during healthcare consultations matters: findings from Dutch survey research. Eur J Public Health 2022; 32:747-752. [PMID: 36001051 PMCID: PMC9527971 DOI: 10.1093/eurpub/ckac106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Smoking cessation assistance (SCA) can help smokers to successfully quit smoking. It is unclear to what extent hearing about SCA from a healthcare professional is associated with using SCA during a quit attempt. Methods We used pooled survey data from the 2016, 2018 and 2020 ‘Module Substance Use’ survey in the Netherlands (N = 5928). Multivariate logistic regression analyses were used to determine the association between having heard about SCA from one or more healthcare professionals in the last year and the use of SCA during the most recent quit attempt in the last year. We used two models: model 1 included any type of assistance; model 2 included assistance typically recommended by treatment guidelines (i.e. counselling and pharmacotherapy). Results Hearing about any type of SCA from a healthcare professional in the last year was significantly associated with using any type of SCA during the most recent quit attempt [odds ratio (OR) = 2.96; 95% confidence interval (CI) 2.16–4.06; P < 0.001]. We found the strongest association between hearing about counselling and/or pharmacotherapy and using counselling and/or pharmacotherapy (OR = 5.40; 95% CI 4.11–11.60; P < 0.001). The odds of using SCA was not significantly higher for smokers who had heard about it from two or more healthcare professionals compared to one healthcare professional (OR = 1.38; 95% CI 0.79–2.42; P = 0.26). Conclusions Healthcare professionals can play a greater role in stimulating the use of SCA, especially counselling and pharmacotherapy, by mentioning it to smokers during consultations.
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Affiliation(s)
- Naomi A van Westen-Lagerweij
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands.,Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Jeroen Bommelé
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Marc C Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands.,Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Esther A Croes
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
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5
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Shevorykin A, Carl E, Mahoney MC, Hanlon CA, Liskiewicz A, Rivard C, Alberico R, Belal A, Bensch L, Vantucci D, Thorner H, Marion M, Bickel WK, Sheffer CE. Transcranial Magnetic Stimulation for Long-Term Smoking Cessation: Preliminary Examination of Delay Discounting as a Therapeutic Target and the Effects of Intensity and Duration. Front Hum Neurosci 2022; 16:920383. [PMID: 35874156 PMCID: PMC9300313 DOI: 10.3389/fnhum.2022.920383] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment for smoking cessation and delay discounting rate is novel therapeutic target. Research to determine optimal therapeutic targets and dosing parameters for long-term smoking cessation is needed. Due to potential biases and confounds introduced by the COVID-19 pandemic, we report preliminary results from an ongoing study among participants who reached study end prior to the pandemic. Methods In a 3 × 2 randomized factorial design, participants (n = 23) received 900 pulses of 20 Hz rTMS to the left dorsolateral prefrontal cortex (PFC) in one of three Durations (8, 12, or 16 days of stimulation) and two Intensities (1 or 2 sessions per day). We examined direction and magnitude of the effect sizes on latency to relapse, 6-month point-prevalence abstinence rates, research burden, and delay discounting rates. Results A large effect size was found for Duration and a medium for Intensity for latency to relapse. Increasing Duration increased the odds of abstinence 7–8-fold while increasing Intensity doubled the odds of abstinence. A large effect size was found for Duration, a small for Intensity for delay discounting rate. Increasing Duration and Intensity had a small effect on participant burden. Conclusion Findings provide preliminary support for delay discounting as a therapeutic target and for increasing Duration and Intensity to achieve larger effect sizes for long-term smoking cessation and will provide a pre-pandemic comparison for data collected during the pandemic. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT03865472].
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Affiliation(s)
- Alina Shevorykin
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Ellen Carl
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Martin C Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Colleen A Hanlon
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | - Cheryl Rivard
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Ronald Alberico
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Ahmed Belal
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Lindsey Bensch
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Darian Vantucci
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Hannah Thorner
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Matthew Marion
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
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6
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Yang T, Zhu Z, Barnett R, Zhang W, Jiang S. Tobacco Advertising, Anti-Tobacco Information Exposure, Environmental Smoking Restrictions, and Unassisted Smoking Cessation Among Chinese Male Smokers: A Population-Based Study. Am J Mens Health 2020; 13:1557988319856152. [PMID: 31185783 PMCID: PMC6563409 DOI: 10.1177/1557988319856152] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study examined the prevalence of unassisted smoking cessation among Chinese urban male smokers and factors important in the decision to quit. A cross-sectional survey employing multistage sampling involving 5,782 participants in six cities in China was conducted. Survey respondents reported their smoking cessation status and related individual and environmental variables. Among current smokers 1,112 or 35.0% (95% CI [31.0%, 40.8%]) had attempted to quit and of those who had made such an attempt 87.6% reported that they had done so without assistance. Of all former smokers (3,389), most (97.6%; 95% CI [96.7%, 98.5%]) quit without assistance. Logistic regression analysis showed those who engaged in physical exercise and who had more belief in their ability to quit were more than twice as likely to make a quit attempt and be successful than those in comparable reference groups. Exposure to tobacco advertising was negatively associated with both unassisted quit attempts and success. By contrast, exposure to anti-tobacco information was positively associated with unassisted quit attempts while household and workplace smoking restrictions were negatively associated with unassisted attempts to quit. Most attempts to quit smoking among Chinese males are unassisted. Unassisted attempts to quit smoking and success rates are highly influenced by the presence of environmental smoking restrictions, tobacco advertising, and exposure to anti-tobacco information. Smoking cessation programs and policies in China need to pay greater attention to the social and cultural norms, which perpetuate high levels of smoking.
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Affiliation(s)
- Tingzhong Yang
- 1 Children's Hospital/Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, China
| | - Zan Zhu
- 2 Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou, China
| | - Ross Barnett
- 3 Department of Geography, University of Canterbury, Christchurch, New Zealand
| | - Weifang Zhang
- 4 Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuhan Jiang
- 5 School of Humanities and Management, Zhejiang Chinese Medical University. Hangzhou, China
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7
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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: 7] [Impact Index Per Article: 1.4] [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.
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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
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8
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Using ‘Smart’ Technology to Aid in Cigarette Smoking Cessation: Examining an Innovative Way to Monitor and Improve Quit Attempt Outcomes. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AbstractIntroductionRecently, smartphone applications (apps) have been used as smoking cessation aids. Interactive apps appear to more effective than non-interactive apps. SmokeBeat, a smartphone app used in conjunction with a smartwatch, aims to detect smoking events, interact with the user as they occur and potentially stop smoking events before they occur in the future.AimsThe purpose of this feasibility study was to determine the sensitivity and specificity of SmokeBeat in detecting smoking events.MethodsThe feasibility of using the app as a smoking cessation aid was tested over a 2-week period by daily, dependent smokers. SmokeBeat's cigarette detection rate was measured in laboratory sessions both before and after the 2-week period. Fisher's exact test was used to compare detection rates from each session.Results/FindingsThe detection rate was 22.5% during session 1 and 41.7% during session 2. Once technological issues were controlled for (i.e., signal loss between smartphone and smartwatch), SmokeBeat's detection rate improved over the 2-week period, resulting in a 100% detection rate.ConclusionsApps which can detect smoking events in real time present an opportunity for a proactive and interactive smoking cessation aid – a potentially useful tool for individuals attempting to quit smoking.
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9
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Manis M, Tamm M, Stolz D. Unaided Smoking Cessation in Healthy Employees. Respiration 2017; 95:80-86. [PMID: 29131057 DOI: 10.1159/000481826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND According to guidelines, behavioral and pharmacological assistance should be offered to all smokers willing to quit. However, a large proportion of ex-cigarette smokers are self-quitters. OBJECTIVES To identify characteristics of long-term, unaided self-quitters, as compared to recurrent smokers among health care employees. METHODS University hospital employees (n = 5,218) were addressed through a 17-question questionnaire inquiring about past and current smoking behavior. Questions included daily cigarette consumption, pack-years, previous quit attempts, smoking-free period, and utilization of pharmacological therapies and counseling. RESULTS 2,574 (49.3%) questionnaires were returned. 791 subjects declared to have successfully quit smoking. A complete data set was available for 763 cases. Patients remained smoking free for a mean period of 11.8 ± 9.7 years. The most common smoking cessation method in these subjects was unaided (77.2%), followed by alternative approaches (15.4%), nicotine replacement therapy (4.5%), counseling (1.7%), and bupropion (1.2%). Smoking cessation was achieved with 1 attempt in 53% of the cases, 2 in 19%, 3 in 13%, and more than 3 attempts in 15%, respectively. On average, 2.4 ± 3.02 attempts led to successful smoking cessation. After 2 or more unsuccessful attempts, the odds ratio for a further unsuccessful smoking cessation was 2.58 (95% CI 1.94-3.45). CONCLUSION The majority of the ex-smokers quitted smoking without any behavioral or pharmacological support. The chance to successfully quit smoking without any help in a first or second attempt is considerably high. The risk for smoking recurrence after 2 ineffective quit attempts is markedly increased (OR 2.58).
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10
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McCarthy M, Siahpush M, Shaikh RA, Sikora Kessler A, Tibbits M. Social Disparities in Unaided Quit Attempts Among Daily Current and Former Smokers: Results From the 2010-2011 Tobacco Use Supplement to the Current Population Survey. Nicotine Tob Res 2016; 18:1705-10. [PMID: 26764257 DOI: 10.1093/ntr/ntw007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 01/05/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION There are well-documented inverse relationships between smoking and smoking cessation with measures of socioeconomic status. This study used nationally representative data to examine unaided quit attempts and their sociodemographic determinants among daily current and former smokers who made a quit attempt in the last 12 months. METHODS We used data from the 2010-2011 Tobacco Use Supplement to the Current Population Survey. We limited the analysis to current daily smokers who made a quit attempt in the past year and former smokers who were daily smokers 1 year prior to the survey (N = 8201). RESULTS Nearly 62% (n = 5078) of the sample made an unaided quit attempt. Adjusted results indicated unaided quit attempts were more likely among males compared to females (P < .001), younger age groups compared to older age groups (P < .001), non-Hispanic blacks compared to non-Hispanic whites (P < .001), among people with lower income compared to people with higher income (P < .001), and among people with lower nicotine dependence compared to those with higher nicotine dependence (P < .001). CONCLUSIONS Most quit attempts were unaided and there were significant sociodemographic disparities in unaided quit attempts. Considering that cessation aids enhance the likelihood of quitting, policies and programs should target populations which are more likely to attempt quitting without an aid and encourage them to use or provide subsidized cessation aids. Healthcare providers should advise their patients about approaches to quitting. IMPLICATIONS This study used the most recent nationally representative data for the United States to examine sociodemographic disparities in unaided quitting among current and former daily smokers who made a quit attempt in the last 12 months. Most quit attempts were unaided. People who were male, younger, non-Hispanic black, had lower nicotine dependence, and those who were low income were more likely to make an unaided quit attempt. These results could be used by policy makers and program planners to develop cessation interventions directed at specific populations to improve smoking cessation rates.
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Affiliation(s)
- Molly McCarthy
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Raees A Shaikh
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Asia Sikora Kessler
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Melissa Tibbits
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
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11
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Ryan MP, Hinojosa JJ. Conceptual obstacles to making use of four smoking-cessation strategies: What reasons do light smokers give for rejecting strategies? Health Psychol Open 2015; 2:2055102915624928. [PMID: 28070381 PMCID: PMC5193272 DOI: 10.1177/2055102915624928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Some smokers have safety and cost concerns about nicotine replacement therapy which discourage its use. We recruited 56 young adult light smokers to read detailed descriptions of a hybrid nicotine replacement therapy, a prescription drug treatment, scheduled reduced smoking, and a menu of self-help tactics. Participants listed five reasons smokers might reject each strategy. An emergent-category content analysis classified each response with a high degree of inter-rater reliability. Only one-third of 32 concerns were strategy-specific; the majority focused on the general difficulty of quitting. Most prevalent were “continued cravings,” “addiction too strong,” “takes too long,” and “won’t work.” These and other concerns reflect conceptual obstacles to be surmounted in smoking-cessation interventions.
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12
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Morphett K, Partridge B, Gartner C, Carter A, Hall W. Why Don't Smokers Want Help to Quit? A Qualitative Study of Smokers' Attitudes towards Assisted vs. Unassisted Quitting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6591-607. [PMID: 26068089 PMCID: PMC4483718 DOI: 10.3390/ijerph120606591] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/29/2015] [Accepted: 06/05/2015] [Indexed: 11/23/2022]
Abstract
The development of prescription medication for smoking cessation and the introduction of evidence-based guidelines for health professionals has increasingly medicalised smoking cessation. There are debates about whether medicalisation is a positive development, or whether it has devalued unassisted quitting. In this debate the views of smokers have been neglected. This study explored the attitudes of smokers towards a range of quitting methods, and their considerations when judging their value. We conducted semi-structured interviews with 29 smokers and analysed data using thematic analysis. The results show that the perceived nature of an individual smoker’s addiction was central to judgments about the value of pharmacological cessation aids, as was personal experience with a method, and how well it was judged to align with an individual’s situation and personality. Unassisted quitting was often described as the best method. Negative views of pharmacological cessation aids were frequently expressed, particularly concerns about side effects from prescription medications. Smokers’ views about the value of different methods were not independent: attitudes about cessation aids were shaped by positive attitudes towards unassisted quitting. Examining smokers’ attitudes towards either assisted or unassisted quitting in isolation provides incomplete information on quitting preferences.
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Affiliation(s)
- Kylie Morphett
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, 4029 Queensland, Australia.
- University of Queensland, School of Public Health, Corner of Wyndham Street and Herston Road, Herston, 4006 Queensland, Australia.
| | - Brad Partridge
- University of Queensland Centre for Youth Substance Abuse, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, 4029 Queensland, Australia.
| | - Coral Gartner
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, 4029 Queensland, Australia.
- University of Queensland, School of Public Health, Corner of Wyndham Street and Herston Road, Herston, 4006 Queensland, Australia.
| | - Adrian Carter
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, 4029 Queensland, Australia.
- School of Psychological Sciences, Monash University Clinical and Imaging Neuroscience, 770 Blackburn Road, Monash University, Clayton, 3800 Victoria, Australia.
| | - Wayne Hall
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, 4029 Queensland, Australia.
- University of Queensland Centre for Youth Substance Abuse, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, 4029 Queensland, Australia.
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Smith AL, Carter SM, Chapman S, Dunlop SM, Freeman B. Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers. BMJ Open 2015; 5:e007301. [PMID: 25933811 PMCID: PMC4420973 DOI: 10.1136/bmjopen-2014-007301] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE When tobacco smokers quit, between half and two-thirds quit unassisted: that is, they do not consult their general practitioner (GP), use pharmacotherapy (nicotine-replacement therapy, bupropion or varenicline), or phone a quitline. We sought to understand why smokers quit unassisted. DESIGN Qualitative grounded theory study (in-depth interviews, theoretical sampling, concurrent data collection and data analysis). PARTICIPANTS 21 Australian adult ex-smokers (aged 28-68 years; 9 males and 12 females) who quit unassisted within the past 6 months to 2 years. 12 participants had previous experience of using assistance to quit; 9 had never previously used assistance. SETTING Community, Australia. RESULTS Along with previously identified barriers to use of cessation assistance (cost, access, lack of awareness or knowledge of assistance, including misperceptions about effectiveness or safety), our study produced new explanations of why smokers quit unassisted: (1) they prioritise lay knowledge gained directly from personal experiences and indirectly from others over professional or theoretical knowledge; (2) their evaluation of the costs and benefits of quitting unassisted versus those of using assistance favours quitting unassisted; (3) they believe quitting is their personal responsibility; and (4) they perceive quitting unassisted to be the 'right' or 'better' choice in terms of how this relates to their own self-identity or self-image. Deep-rooted personal and societal values such as independence, strength, autonomy and self-control appear to be influencing smokers' beliefs and decisions about quitting. CONCLUSIONS The reasons for smokers' rejection of the conventional medical model for smoking cessation are complex and go beyond modifiable or correctable problems relating to misperceptions or treatment barriers. These findings suggest that GPs could recognise and respect smokers' reasons for rejecting assistance, validate and approve their choices, and modify brief interventions to support their preference for quitting unassisted, where preferred. Further research and translation may assist in developing such strategies for use in practice.
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Affiliation(s)
- Andrea L Smith
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Chapman
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sally M Dunlop
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Cancer Screening and Prevention, Cancer Institute NSW, Eveleigh, New South Wales, Australia
| | - Becky Freeman
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Cooperman NA, Richter KP, Bernstein SL, Steinberg ML, Williams JM. Determining Smoking Cessation Related Information, Motivation, and Behavioral Skills among Opiate Dependent Smokers in Methadone Treatment. Subst Use Misuse 2015; 50:566-81. [PMID: 25559697 PMCID: PMC4646090 DOI: 10.3109/10826084.2014.991405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Over 80% of people in methadone treatment smoke cigarettes, and existing smoking cessation interventions have been minimally effective. OBJECTIVE To develop an Information-Motivation-Behavioral Skills (IMB) Model of behavior change based smoking cessation intervention for methadone maintained smokers, we examined smoking cessation related IMB factors in this population. METHODS Current or former smokers in methadone treatment (n = 35) participated in focus groups. Ten methadone clinic counselors participated in an individual interview. A content analysis was conducted using deductive and inductive approaches. RESULTS Commonly known IMB factors related to smoking cessation were described. These factors included: the health effects of smoking and treatment options for quitting (information); pregnancy and cost of cigarettes (motivators); and coping with emotions, finding social support, and pharmacotherapy adherence (behavioral skills). IMB factors specific to methadone maintained smokers were also described. These factors included: the relationship between quitting smoking and drug relapse (information), the belief that smoking is the same as using drugs (motivator); and coping with methadone clinic culture and applying skills used to quit drugs to quitting smoking (behavioral skills). IMB strengths and deficits varied by individual. CONCLUSIONS Methadone maintained smokers could benefit from research on an IMB Model based smoking cessation intervention that is individualized, addresses IMB factors common among all smokers, and also addresses IMB factors unique to this population.
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Affiliation(s)
- Nina A Cooperman
- 1Rutgers Robert Wood Johnson Medical School, Division of Addiction Psychiatry , New Brunswick, New Jersey , United States
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van Rossem C, Spigt MG, Kleijsen JRC, Hendricx M, van Schayck CP, Kotz D. Smoking cessation in primary care: Exploration of barriers and solutions in current daily practice from the perspective of smokers and healthcare professionals. Eur J Gen Pract 2015; 21:111-7. [PMID: 25649048 DOI: 10.3109/13814788.2014.990881] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence based recommendations for smoking cessation are not followed in routine primary care. A better understanding is needed why smoking cessation treatment is still underutilized. OBJECTIVES To explore barriers and solutions of smoking cessation treatment, from the perspective of smokers and healthcare professionals in Dutch primary care. METHODS Focus groups were conducted with 14 smokers (smokers and ex-smokers) and semi-structured individual interviews with nine healthcare professionals (general practitioners and practice nurses). Data was analysed using the Constant Comparative Method. RESULTS Barriers that prevented successful smoking cessation treatment were the lack of awareness regarding the available smoking cessation treatments at the healthcare centre among smokers and the resistance against preventive tasks among healthcare professionals. Nonetheless, general practitioners (GPs) did not fear jeopardizing the doctor-patient relationship by discussing smoking. Quitting was regarded as the smokers' own responsibility and GPs felt that merely using medication was no guarantee for successful quitting. Even so, practice nurses and smokers preferred medication use. Proposed solutions were that GPs should advise smokers to quit, whereas someone else should deliver intensive behavioural support, preferably the practice nurse. CONCLUSION Smokers and healthcare professionals seem to wait for each other to start smoking cessation. GPs should know that they could discuss smoking cessation with every patient without jeopardizing the doctor-patient relationship, preferably followed by referral to a practice nurse for intensive behavioural support. Furthermore, more patients should know that they could receive pharmacological treatment as well as behavioural support for smoking cessation in their healthcare centre.
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Affiliation(s)
- Carolien van Rossem
- CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht , the Netherlands
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Kurko T, Linden K, Kolstela M, Pietilä K, Airaksinen M. Is nicotine replacement therapy overvalued in smoking cessation? Analysis of smokers' and quitters' communication in social media. Health Expect 2014; 18:2962-77. [PMID: 25292017 DOI: 10.1111/hex.12280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Internet discussion forums provide new, albeit less used data sources for exploring personal experiences of illness and treatment strategies. OBJECTIVE To gain an understanding of how discussion forum participants value nicotine replacement therapy (NRT) in smoking cessation (SC). SETTING Finnish national Internet-based discussion forum, STUMPPI, supporting SC and consisting of ten free discussion areas, each with a different focus. The analysis was based on STUMPPI forum participants' postings (n = 24 481) in five discussion areas during January 2007-January 2012. DESIGN Inductive content analysis of the postings concerning NRT use or comparing NRT to other SC methods. RESULTS Three major themes related to NRT in SC emerged from the discussions. These were as follows: (I) distrust and negative attitude towards NRT; (II) neutral acceptance of NRT as a useful SC method; and (III) trust on the crucial role of NRT and other SC medicines. The negative attitude was related to following perceptions: NRT use maintains tobacco dependence, fear of NRT dependence or experience of not gaining help from NRT use. NRT was perceived to be useful particularly in the initiation of SC attempts and in dealing with physiological dependence. The most highlighted factors of successful quitting were quitters' own psychological empowerment and peer support from the discussion community. CONCLUSIONS The majority of STUMPPI forum participants had low or balanced expectations towards the role of NRT in SC. More research from the smokers' and quitters' perspective is needed to assess the real value of NRT compared to other methods in SC.
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Affiliation(s)
- Terhi Kurko
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Kari Linden
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.,Global Innovative Pharma, Pfizer Oy, Helsinki, Finland
| | - Maija Kolstela
- Organisation for Respiratory Health in Finland, Helsinki, Finland
| | | | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Nagelhout GE, Hummel K, Willemsen MC, Siahpush M, Kunst AE, de Vries H, Fong GT, van den Putte B. Are there income differences in the impact of a national reimbursement policy for smoking cessation treatment and accompanying media attention? Findings from the International Tobacco Control (ITC) Netherlands Survey. Drug Alcohol Depend 2014; 140:183-90. [PMID: 24814565 PMCID: PMC4420147 DOI: 10.1016/j.drugalcdep.2014.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study examined possible income differences in the impact of a national reimbursement policy for smoking cessation treatment and accompanying media attention in the Netherlands in 2011. METHODS We used three waves of the International Tobacco Control (ITC) Netherlands Survey, a nationally representative longitudinal sample of smokers aged 15 years and older (n=1912). The main analyses tested trends and income differences in outcome measures (smokers' quit attempt rates, use of behavioral counseling, use of cessation medications, and quit success) and awareness variables (awareness of reimbursement possibilities, the media campaign, medications advertisements and other media attention) with generalized estimating equations analyses. RESULTS In the first half of 2011, there was a significant increase in quit attempts (odds ratio (OR)=2.02, p<0.001) and quit success (OR=1.47, p<0.001). Use of counseling and medications remained stable at 3% of all smokers in this period. Awareness of reimbursement possibilities increased from 11% to 42% (OR=6.38, p<0.001). Only awareness of the media campaign was associated with more quit attempts at the follow-up survey (OR=1.95, p<0.001). Results were not different according to smokers' income level. CONCLUSIONS The Dutch reimbursement policy with accompanying media attention was followed by an increase in quit attempts and quit success, but use of cessation treatment remained stable. The impact of the policy and media attention did not seem to have decreased or increased socioeconomic inequalities in quit attempts, use of cessation treatment, or quit success.
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Affiliation(s)
- Gera E. Nagelhout
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands,Alliance Smokefree Holland, The Hague, the Netherlands
| | - Karin Hummel
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands
| | - Marc C. Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands,Alliance Smokefree Holland, The Hague, the Netherlands
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Anton E. Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands
| | - Geoffrey T. Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Bas van den Putte
- Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands,Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, the Netherlands
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McQueen A, Shacham E, Sumner W, Overton ET. Beliefs, experience, and interest in pharmacotherapy among smokers with HIV. Am J Health Behav 2014; 38:284-96. [PMID: 24629557 DOI: 10.5993/ajhb.38.2.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To examine beliefs, prior use, and interest in using pharmacotherapy among people living with HIV/AIDS (PLWHA). METHODS Cross-sectional survey of smokers in a midwestern HIV clinic. RESULTS The sample (N = 146) included 69% men, 82% African Americans, 45% were in precontemplation for quitting, and 46% were interested in using pharmacotherapy. Primary reasons for non-use included cost and a belief that they would be able to quit on their own. Physician assistance was the strongest correlate of prior use. Perceived benefits and self-efficacy were the strongest correlates of willingness to use pharmacotherapy. CONCLUSIONS Future interventions should address misconceptions, perceived benefits, and self-efficacy for using cessation aids. Physicians should offer pharmacotherapy to all smokers.
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Affiliation(s)
- Amy McQueen
- Washington University School of Medicine, Department of Medicine, Division of Health Behavior Research, St. Louis MO, USA.
| | - Enbal Shacham
- Saint Louis University, College for Public Health and Social Justice, Department of Behavioral Sciences and Health Education, St. Louis MO, USA
| | - Walton Sumner
- Washington University School of Medicine, Department of Medicine, Division of General Medical Sciences, St. Louis MO, USA
| | - E Turner Overton
- University of Alabama at Birmingham, Department of Medicine, Division of Infectious Diseases, Birmingham AL, USA
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Cook-Shimanek M, Burns EK, Levinson AH. Medicinal nicotine nonuse: smokers' rationales for past behavior and intentions to try medicinal nicotine in a future quit attempt. Nicotine Tob Res 2013; 15:1926-33. [PMID: 23817584 DOI: 10.1093/ntr/ntt085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Nicotine replacement therapy (NRT) is a proven smoking cessation treatment. Previous research has reported low rates of NRT use among quit attempters. This study analyzed population-level nonuse rates and reasons for not using NRT. METHODS Data were from the 2008 adult Colorado Tobacco Attitudes and Behaviors Survey (TABS), a population-based, random-digit-dialed telephone survey (n = 14,156). Primary measures were past NRT nonuse and future intentions regarding NRT use among current smokers intending to quit. Multiple logistic regression was used to identify reasons for past NRT nonuse associated with intention to use NRT in the future, adjusted for factors known to influence NRT use. RESULTS Nearly, 80% of 1,095 current smokers who intended to quit had never used NRT. The most common reasons for nonuse were belief that "willpower" alone is sufficient for cessation (21.5%), perceived lack of NRT effectiveness (15.6%), and cost (14.3%). Willpower was more widely reported among Hispanics than Anglos (36.9% vs. 14.7%) and nondaily versus daily smokers (30.4% vs. 12.5%). Most previous NRT nonusers reported they would use cold turkey (65.2%) in their next quit attempt; NRT was the next most common choice (15.0%). In multivariate analysis, smokers identifying cost or willpower as a reason for previous nonuse had significantly lower odds of planning to use NRT in a future quit attempt. CONCLUSIONS The majority of smokers have never used NRT and do not plan to use it in the future. Cost and belief in willpower alone are significant barriers to using NRT in future smoking cessation attempt.
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Atkinson O, Coleman T, McNeill A, Lewis S, Jones LL. The role of nicotine replacement therapy for temporary abstinence in the home to protect children from environmental tobacco smoke exposure: a qualitative study with disadvantaged smokers. BMC Public Health 2013; 13:262. [PMID: 23521825 PMCID: PMC3620522 DOI: 10.1186/1471-2458-13-262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/08/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) has recently been licensed to help smokers to abstain from smoking for short time periods and recent studies have shown that 8-14% of smokers are regularly using NRT to cope when they cannot or are not allowed to smoke. These data suggest that, potentially, NRT for temporary abstinence might be an acceptable method to help smoking caregivers, who are not able to stop smoking completely, to avoid smoking whilst inside their home in order to protect their children from the harms of environmental tobacco smoke (ETS). The aim of this study was therefore to explore the concept of using NRT for temporary abstinence in the home, to protect children from exposure to ETS. METHODS Qualitative in-depth interviews were conducted with thirty six disadvantaged smoking parents who were currently, or had recently stopped smoking in the home with at least one child under the age of five. Parents were recruited from Children's Centres and Health Visitor Clinics in Nottingham, UK. Interviews were audio recorded and transcribed verbatim. Data were coded and analysed thematically to identify emergent main and subthemes. RESULTS Overall, participants responded negatively to the concept of attempting temporary abstinence in the home in general and more specifically to the use of NRT whilst at home to reduce children's exposure to ETS. Many parents would prefer to either attempt cutting down or quitting completely to make a substantial effort to change their smoking behaviour. There was limited interest in the use of NRT for temporary abstinence in the home as a first step to quitting, although some parents did express a willingness to use NRT to cut down as a first step to quitting. CONCLUSION Disadvantaged smoking parents were reluctant to initiate and maintain temporary abstinence with or without NRT as a way of making their homes smoke free to protect their children's health. More education about the specific risks of ETS to their children and the utility of NRT for use in the home might be needed to have a public health impact on children's health.
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Affiliation(s)
- Olesya Atkinson
- UKCTCS and Division of Primary Care, University of Nottingham, Nottingham, UK
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Bachmann M, Znoj H, Brodbeck J. Smoking behaviour, former quit attempts and intention to quit in urban adolescents and young adults: A five-year longitudinal study. Public Health 2012; 126:1044-50. [DOI: 10.1016/j.puhe.2012.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 06/22/2012] [Accepted: 08/08/2012] [Indexed: 11/17/2022]
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Willems RA, Willemsen MC, Nagelhout GE, de Vries H. Understanding smokers' motivations to use evidence-based smoking cessation aids. Nicotine Tob Res 2012; 15:167-76. [PMID: 22573725 DOI: 10.1093/ntr/nts104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Use of evidence-based smoking cessation aids (SCA) is an efficacious way to improve smoking cessation relapse rates. However, use of SCA in the Netherlands is particularly low. This study examined determinants of intention to use SCA in smokers willing to quit. METHODS The Dutch Continuous Survey of Smoking Habits, a cross-sectional population survey, was used. Respondents were smokers (n = 594) wanting to quit sometime in the future and who made at least one quit attempt in the past, categorized as past users of evidence-based SCA, past users of nonevidence-based SCA, and smokers who had never used SCA before (nonusers). Respondents were asked about past SCA use, motivational determinants regarding smoking cessation and SCA use, and intention to use SCA during a future quit attempt. RESULTS Older and more addicted smokers were more likely to have used evidence-based SCA. Evidence-based and nonevidence-based users reported stronger attitudes and perceived social norm as well as lower self-efficacy expectations regarding smoking cessation and SCA use than nonusers. Having positive outcome expectations and perceived social norm regarding SCA use were strong predictors of intention to use SCA. Self-efficacy regarding smoking cessation was negatively related with intention to use SCA. CONCLUSIONS Nonusers, nonevidence-based users, and evidence-based users have different motivations for using evidence-based SCA and should not be treated as a homogenous group in smoking cessation programs. Additionally, it is unclear whether nonusers should be encouraged to use SCA, given that this group is less addicted and more confident about quitting.
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Affiliation(s)
- Roy A Willems
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
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Brendryen H, Kraft P, Schaalma H. Looking Inside the Black Box: Using Intervention Mapping to Describe the Development of the Automated Smoking Cessation Intervention ‘Happy Ending’. J Smok Cessat 2012. [DOI: 10.1375/jsc.5.1.29] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractThe digital therapy intervention for smoking cessation, ‘Happy Ending’, has been shown to be efficacious in two previous randomised controlled trials. The aim of the current article is to disentangle the rationale of the intervention and describe its development. For this purpose, Intervention Mapping is used as a descriptive tool. The intervention is fully automated and delivered by means of the Internet and mobile phones. It is based on self-regulation theory, social cognitive theory, cognitive–behaviour therapy, motivational interviewing and relapse prevention. The ordering of the content is based on a reasoned chronology, modelled according to psychological processes that people experience at certain time points in a process of therapy-supported self-regulation. The design of the intervention is innovative in that it combines four media channels (SMS, IVR, e-mail, and web), and in the combination of just-in-time therapy and a tunnelling strategy based on the natural chronology of quitting. The two forms of just-in-time therapy are a craving helpline (mainly targeting negative affect), and the provision of relapse therapy based on a daily assessment of the target behaviour. The present article meets the recent calls for more thorough descriptions of interventions, and may inform systematic reviews and the development of interventions.
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Sheffer CE, Stitzer M, Landes R, Brackman SL, Munn T, Moore P. Socioeconomic disparities in community-based treatment of tobacco dependence. Am J Public Health 2012; 102:e8-16. [PMID: 22390525 DOI: 10.2105/ajph.2011.300519] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined socioeconomic disparities in a community-based tobacco dependence treatment program. METHODS We provided cognitive-behavioral treatment and nicotine patches to 2739 smokers. We examined treatment use, clinical and environmental, and treatment outcome differences by socioeconomic status (SES). We used logistic regressions to model end-of-treatment and 3- and 6-month treatment outcomes. RESULTS The probability of abstinence 3 months after treatment was 55% greater for the highest-SES than for the lowest-SES (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.03, 2.33) smokers and increased to 2.5 times greater for the highest-SES than for the lowest-SES smokers 6 months after treatment (AOR = 2.47; 95% CI = 1.62, 3.77). Lower-SES participants received less treatment content and had fewer resources and environmental supports to manage a greater number of clinical and environmental challenges to abstinence. CONCLUSIONS Targets for enhancing therapeutic approaches for lower socioeconomic groups should include efforts to ensure that lower-SES groups receive more treatment content, strategies to address specific clinical and environmental challenges associated with treatment outcomes for lower-SES smokers (i.e., higher dependence and stress levels and exposure to other smokers), and strategies to provide longer-term support.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Westmaas JL, Abroms L, Bontemps-Jones J, Bauer JE, Bade J. Using the internet to understand smokers' treatment preferences: informing strategies to increase demand. J Med Internet Res 2011; 13:e58. [PMID: 21873150 PMCID: PMC3222178 DOI: 10.2196/jmir.1666] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most smokers attempt to quit on their own even though cessation aids can substantially increase their chances of success. Millions of smokers seek cessation advice on the Internet, so using it to promote cessation products and services is one strategy for increasing demand for treatments. Little is known, however, about what cessation aids these smokers would find most appealing or what predicts their preferences (eg, age, level of dependence, or timing of quit date). OBJECTIVE The objective of our study was to gain insight into how Internet seekers of cessation information make judgments about their preferences for treatments, and to identify sociodemographic and other predictors of preferences. METHODS An online survey assessing interest in 9 evidence-based cessation products and services was voluntarily completed by 1196 smokers who visited the American Cancer Society's Great American Smokeout (GASO) webpage. Cluster analysis was conducted on ratings of interest. RESULTS In total, 48% (572/1196) of respondents were "quite a bit" or "very much" interested in nicotine replacement therapy (NRT), 45% (534/1196) in a website that provides customized quitting advice, and 37% (447/1196) in prescription medications. Only 11.5% (138/1196) indicated similar interest in quitlines, and 17% (208/1196) in receiving customized text messages. Hierarchical agglomerative cluster analysis revealed that interest in treatments formed 3 clusters: interpersonal-supportive methods (eg, telephone counseling, Web-based peer support, and in-person group programs), nonsocial-informational methods (eg, Internet programs, tailored emails, and informational booklets), and pharmacotherapy (NRT, bupropion, and varenicline). Only 5% (60/1196) of smokers were "quite a bit" or "very much" interested in interpersonal-supportive methods compared with 25% (298/1196) for nonsocial-informational methods and 33% (399/1196) for pharmacotherapy. Multivariate analyses and follow-up comparisons indicated that level of interest in pharmacotherapy ("quite a bit or "very much" vs. "not at all") varied as a function of education (n = 575, χ(2) (3) =16.6, P = .001), age (n = 528, χ(2) (3) = 8.2, P = .04), smoking level (n = 514, χ(2) (3) = 9.5, P = .02), and when smokers were planning to quit (n = 607, χ(2) (4) = 34.0, P < .001). Surprisingly, greater age was associated with stronger interest in nonsocial-informational methods (n = 367, χ(2) (3) = 10.8, P = .01). Interest in interpersonal-supportive methods was greater if smokers had used a quitline before (n = 259, χ(2) (1) = 18.3, P < .001), or were planning to quit earlier rather than later (n = 148, χ(2) (1) = 4.9, P = .03). CONCLUSIONS Smokers accessing the Internet for information on quitting appear to differentiate cessation treatments by how much interpersonal interaction or support the treatment entails. Quitting date, smoking level, and sociodemographic variables can identify smokers with varying levels of interest in the 3 classes of cessation methods identified. These results can potentially be used to more effectively target and increase demand for these treatments among smokers searching the Internet for cessation information.
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Affiliation(s)
- J Lee Westmaas
- Behavioral Research Center, American Cancer Society, Atlanta, GA, United States.
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Aubin HJ, Peiffer G, Stoebner-Delbarre A, Vicaut E, Jeanpetit Y, Solesse A, Bonnelye G, Thomas D. The French Observational Cohort of Usual Smokers (FOCUS) cohort: French smokers perceptions and attitudes towards smoking cessation. BMC Public Health 2010; 10:100. [PMID: 20184784 PMCID: PMC2841669 DOI: 10.1186/1471-2458-10-100] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 02/26/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite increasing governmental anti-smoking measures, smoking prevalence remains at a high level in France. METHODS The objectives of this panel study were (1) to estimate smoking prevalence in France, (2) to identify smokers' profiles according to their perceptions, attitudes and behaviour in relation to smoking cessation, (3) to determine predictive factors of quit attempts, and (4) to assess tobacco-related behaviours and their evolutions according to the changes in the smokers' environments. A representative sample of French population was defined using the quota method. The identified cohort of smokers was assessed, in terms of smoking behaviour, previous quit attempts, and intention to quit smoking. RESULTS A response rate of 66% for the screening enabled to identify a representative sample of the French population (N = 3 889) comprising 809 current smokers (21%). A majority of current smokers (63%) had made an attempt to quit smoking. Main reasons for having made the last attempt were cost (44%), social pressure (39%), wish to improve physical fitness (36%), fear of a future smoking-related disease (24%), and weariness of smoking (21%). Few attempts (16%) were encouraged by a physician. In those who used some kind of support (38%), NRT was the mostly used. Relapse was triggered by craving (45%), anxiety/stress (34%), a significant life event (21), weight gain (18%), and irritability (16%). Depression was rarely quoted (5%). Forty percent of smokers declared they intended to quit smoking permanently. Main reasons were cost (65%), physical fitness improvement (53%), fear of a future smoking-related disease (43%), weariness of tobacco (34%), and social pressure (30%). Using a smoking cessation treatment was considered by 43% of smokers that intended to quit. Barriers to smoking cessation were mainly fear of increased stress (62%), irritability (51%), and anxiety (42%), enjoying smoking (41%), and weight concerns (33%). CONCLUSION Smoking prevalence and smoking cessation attempts rate were lower in this survey than in previous reports. Cost and social pressure were the main reasons for quitting smoking, maybe an effect of dramatic tax increases and smoking ban.
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Affiliation(s)
- Henri-Jean Aubin
- Hôpital Paul Brousse (AP-HP), Villejuif, France, Hôpital Emile Roux(AP-HP), Limeil-Brévannes, INSEM U699, France.
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Zhu WH, Yang L, Jiang CQ, Deng LZ, Lam TH, Zhang JY, Chan SSC. Characteristics of smokers and predictors of quitting in a smoking cessation clinic in Guangzhou, China. J Public Health (Oxf) 2009; 32:267-76. [PMID: 19939788 DOI: 10.1093/pubmed/fdp107] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking cessation programs are well established in the West, but reports on smoking cessation clinics (SCCs) from China are lacking. On the basis of the Hong Kong experience and with strong support from Guangzhou Health Bureau, we established the first SCC in Guangzhou, China. The objective was to describe the characteristics of smokers, measure quit rates and examine predictors of successful quitting. METHODS During 2006-08, 220 smokers received individual counseling following the five A's and five R's. No medications were used. RESULTS At baseline, the mean (SD) age was 40 (14) years. Most (96%) were males, married (73%), currently employed (75%), college educated or above (54%); 77% had previous quitting attempts. By 14 May 2008, 195 reached the 6 months follow-up period. Of them, 79% (151/195) were successfully followed up, and 46 had quit. By intention to treat, the 6-month 7-day point prevalence quit rate was 24% [95% confidence interval (CI) 18-30%]. Smokers with more confidence in quitting or were at action stage were more successful in quitting with adjusted odds ratio of 2.39 (95% CI 1.01-5.30) and 5.50 (95% CI 1.08-28) respectively. CONCLUSIONS A pilot-model clinic free of charge and with systemic data collection, follow-up and evaluation should be a starting point for smoking cessation program in low-income countries.
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Solomon LJ, Hughes JR, Livingston A, Naud S, Callas PW, Peters EN, Kamon J, Etter JF. Cognitive barriers to calling a smoking quitline. Nicotine Tob Res 2009; 11:1339-46. [PMID: 19793785 DOI: 10.1093/ntr/ntp143] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study examined cognitive barriers that might prevent cigarette smokers who are interested in quitting from calling a smoking quitline. METHODS Using qualitative and quantitative methods, we developed a 53-item inventory of possible cognitive barriers to quitline access. A total of 641 daily smokers who reported high intentions to stop smoking in the next 30 days completed this inventory and were then prompted to call a toll-free smoking quitline (800-QUIT NOW) on 3 occasions. Two months later, they completed a follow-up phone interview to assess use of the quitline, quit attempts, and smoking status. RESULTS Exploratory and confirmatory factor analysis of the barrier items revealed a 5-factor solution: stigma, low appraisal of the service, no need for assistance, poor fit with the service, and privacy concerns. Endorsements of barrier factors were generally low. Although several barrier factor scores predicted concurrent intentions to call a quitline in the near future, none prospectively predicted calling the quitline by 2-month follow-up. DISCUSSION Cognitive barriers to use of quitlines remain elusive.
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Affiliation(s)
- Laura J Solomon
- Health Promotion Research, University of Vermont, 429 AR4, 1 South Prospect Street, Burlington, VT 05401-3444, USA.
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