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Abstract
BACKGROUND Mindfulness-based smoking cessation interventions may aid smoking cessation by teaching individuals to pay attention to, and work mindfully with, negative affective states, cravings, and other symptoms of nicotine withdrawal. Types of mindfulness-based interventions include mindfulness training, which involves training in meditation; acceptance and commitment therapy (ACT); distress tolerance training; and yoga. OBJECTIVES To assess the efficacy of mindfulness-based interventions for smoking cessation among people who smoke, and whether these interventions have an effect on mental health outcomes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, and trial registries to 15 April 2021. We also employed an automated search strategy, developed as part of the Human Behaviour Change Project, using Microsoft Academic. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs that compared a mindfulness-based intervention for smoking cessation with another smoking cessation programme or no treatment, and assessed smoking cessation at six months or longer. We excluded studies that solely recruited pregnant women. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. We measured smoking cessation at the longest time point, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of intervention and type of comparator. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We summarised mental health outcomes narratively. MAIN RESULTS We included 21 studies, with 8186 participants. Most recruited adults from the community, and the majority (15 studies) were conducted in the USA. We judged four of the studies to be at low risk of bias, nine at unclear risk, and eight at high risk. Mindfulness-based interventions varied considerably in design and content, as did comparators, therefore, we pooled small groups of relatively comparable studies. We did not detect a clear benefit or harm of mindfulness training interventions on quit rates compared with intensity-matched smoking cessation treatment (RR 0.99, 95% CI 0.67 to 1.46; I2 = 0%; 3 studies, 542 participants; low-certainty evidence), less intensive smoking cessation treatment (RR 1.19, 95% CI 0.65 to 2.19; I2 = 60%; 5 studies, 813 participants; very low-certainty evidence), or no treatment (RR 0.81, 95% CI 0.43 to 1.53; 1 study, 325 participants; low-certainty evidence). In each comparison, the 95% CI encompassed benefit (i.e. higher quit rates), harm (i.e. lower quit rates) and no difference. In one study of mindfulness-based relapse prevention, we did not detect a clear benefit or harm of the intervention over no treatment (RR 1.43, 95% CI 0.56 to 3.67; 86 participants; very low-certainty evidence). We did not detect a clear benefit or harm of ACT on quit rates compared with less intensive behavioural treatments, including nicotine replacement therapy alone (RR 1.27, 95% CI 0.53 to 3.02; 1 study, 102 participants; low-certainty evidence), brief advice (RR 1.27, 95% CI 0.59 to 2.75; 1 study, 144 participants; very low-certainty evidence), or less intensive ACT (RR 1.00, 95% CI 0.50 to 2.01; 1 study, 100 participants; low-certainty evidence). There was a high level of heterogeneity (I2 = 82%) across studies comparing ACT with intensity-matched smoking cessation treatments, meaning it was not appropriate to report a pooled result. We did not detect a clear benefit or harm of distress tolerance training on quit rates compared with intensity-matched smoking cessation treatment (RR 0.87, 95% CI 0.26 to 2.98; 1 study, 69 participants; low-certainty evidence) or less intensive smoking cessation treatment (RR 1.63, 95% CI 0.33 to 8.08; 1 study, 49 participants; low-certainty evidence). We did not detect a clear benefit or harm of yoga on quit rates compared with intensity-matched smoking cessation treatment (RR 1.44, 95% CI 0.40 to 5.16; 1 study, 55 participants; very low-certainty evidence). Excluding studies at high risk of bias did not substantially alter the results, nor did using complete case data as opposed to using data from all participants randomised. Nine studies reported on changes in mental health and well-being, including depression, anxiety, perceived stress, and negative and positive affect. Variation in measures and methodological differences between studies meant we could not meta-analyse these data. One study found a greater reduction in perceived stress in participants who received a face-to-face mindfulness training programme versus an intensity-matched programme. However, the remaining eight studies found no clinically meaningful differences in mental health and well-being between participants who received mindfulness-based treatments and participants who received another treatment or no treatment (very low-certainty evidence). AUTHORS' CONCLUSIONS We did not detect a clear benefit of mindfulness-based smoking cessation interventions for increasing smoking quit rates or changing mental health and well-being. This was the case when compared with intensity-matched smoking cessation treatment, less intensive smoking cessation treatment, or no treatment. However, the evidence was of low and very low certainty due to risk of bias, inconsistency, and imprecision, meaning future evidence may very likely change our interpretation of the results. Further RCTs of mindfulness-based interventions for smoking cessation compared with active comparators are needed. There is also a need for more consistent reporting of mental health and well-being outcomes in studies of mindfulness-based interventions for smoking cessation.
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Affiliation(s)
- Sarah Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
| | - Emma Norris
- Health Behaviour Change Research Group, Brunel University London, London, UK
| | | | - Emily Hayes
- Centre for Behaviour Change, University College London, London, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Ramos GG, Sussman S, Moerner L, Unger JB, Soto C. Project SUN: Pilot Study of a Culturally Adapted Smoking Cessation Curriculum for American Indian Youth. JOURNAL OF DRUG EDUCATION 2022; 51:10-31. [PMID: 35788160 DOI: 10.1177/00472379221111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
American Indian Alaska Native (AIAN) youth have disproportionately higher rates of commercial tobacco product use compared to other racial and ethnic groups in the U.S. These rates underscore a need for commercial tobacco product cessation interventions that are culturally informed. This project studied the development, implementation, and some impact data of an adapted version of Project EX, an evidence-based intervention for teen smoking cessation. Implementation challenges resulted in a change from a three-arm to a single-arm trial with 37 AIAN youth who participated in an eight-week curriculum. Intent-to-treat analysis with biochemical validation results indicated that 32% (N = 12/37) of youth quit smoking at the three-month follow-up. Participants reported being satisfied with the program overall and enjoying the culturally adapted activities. This study detailed the program's adaptation and lessons learned during implementation.
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Affiliation(s)
| | - Steve Sussman
- 5116University of Southern California, Los Angeles, CA, USA
| | - Lou Moerner
- 5116University of Southern California, Los Angeles, CA, USA
| | | | - Claradina Soto
- 5116University of Southern California, Los Angeles, CA, USA
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Merkin A, Nikolaev A, Nikoforov I, Komarov A, Glover M. Trends in tobacco smoking and smoking cessation in Russia with a focus on Indigenous populations: A narrative review. GLOBAL EPIDEMIOLOGY 2021; 3:100043. [PMID: 37635728 PMCID: PMC10446109 DOI: 10.1016/j.gloepi.2020.100043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Tobacco smoking is one of the main preventable causes of illness and premature death. Globally, more than 7 million people die annually from diseases associated with smoking, and this number is projected to increase to 8 million per year by 2030. Wide disparities in smoking prevalence exist by gender, age, socioeconomic status, rurality and ethnicity. In several countries, smoking is disproportionately high among the Indigenous populations. Objective This review assesses the prevalence and harm of smoking and current trends in smoking cessation among the diverse multi-ethnic populations of Russia, with a particular emphasis on Indigenous populations. Data sources We systematically searched health, nursing, social science and grey literature databases and bibliographies for relevant studies. Search strings combined keywords related to smoking prevalence and smoking cessation with keywords related to Russia and the Indigenous populations of Russia. Study selection Studies were included if they were published between 1 January 2005 and 14 October 2020, and if they reported prevalence of tobacco smoking and/or activities and outcomes of a smoking cessation programme or ban in the Russian Federation. Conclusions Tobacco smoking is significant in the entire Russian population, a higher prevalence of smoking in Indigenous populations compared to the dominant Russian (Slavic) ethnic group is common. Smoking prevalence data for most of the Indigenous ethnic groups of Russia remains unclear. Tobacco control interventions for Indigenous groups are underdeveloped even though they have the potential to deliver proportionately greater reduction in smoking harm.
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Affiliation(s)
| | | | | | - Alexander Komarov
- National Centre for Development of Social Support and Rehabilitation, Moscow, Russia
| | - Marewa Glover
- Centre of Research Excellence: Indigenous Sovereignty & Smoking, Auckland, New Zealand
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Three-month effects of Project EX: A smoking intervention pilot program with Korean adolescents. Addict Behav Rep 2018; 9:100152. [PMID: 31193802 PMCID: PMC6542411 DOI: 10.1016/j.abrep.2018.100152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 11/20/2022] Open
Abstract
Despite current prevention and cessation efforts, adolescent smoking remains a pressing issue worldwide, including in Korea. The current study evaluates Project EX-Korea, a teen tobacco use cessation program, three months after baseline. The quasi-experimental trial intervention involved 160 smokers in 10th to 12th grade, 85 from the program condition schools and 75 from the control. At three-month follow-up, the intent-to-treat (ITT) quit rate in the program group (30.2%) was 3.6 times that of the rate in the standard care control group (9.2%; p < 0.05). Among those who did not quit, those in the program group smoked less on average than those in the control group, but there was no difference in follow-up mFTQ scores between the two non-quitter groups. As teen tobacco use cessation programming is much needed in Korea, Project EX is a plausible program to implement among Korean adolescents. Teen tobacco use cessation programming is still much needed in Korea and worldwide. Project EX is a credible tobacco cessation program to help Korean adolescents quit. The program group's quit rate was 3.6 times that of the control group's quit rate. Non-quitters in the program group smoked less than those in the control group.
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Gonzálvez MT, Morales A, Orgilés M, Sussman S, Espada JP. Role of smoking intention in tobacco use reduction: A mediation analysis of an effective classroom-based prevention/cessation intervention for adolescents. Addict Behav 2018; 84:186-192. [PMID: 29723801 DOI: 10.1016/j.addbeh.2018.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although some school-based tobacco cessation and prevention programs have been proven to be effective, there remains a lack of understanding of how these programs succeed. METHODS This longitudinal study aimed to test smoking intention as a mediator of Project EX's intervention efficacy to reduce tobacco use. Using a computerized random number generator, six high schools located in the Mediterranean coast were randomly selected to participate in the program condition (Spanish version of Project EX) or the waiting-list control group with baseline, immediate-posttest, and 12-month follow-up assessments. At baseline, 685 adolescents aged 14-20 years (mean age: 14.87; SD = 0.92; 47.4% were females) were evaluated using self-administered tests of tobacco, and smoking intention. A biomarker of smoke inhalation, a measurement of exhaled carbon monoxide (ECM), was used. Mediation analyses were conducted using the PROCESS v2.12 macro for Windows. RESULTS Project EX had a significant effect on smoking intention. Indirect effects indicated that Project EX reduced the ECM level, and number of cigarettes used. CONCLUSIONS This is the first Spanish study that explored intention as a mediator of the long-term efficacy of Project EX to reduce tobacco use in adolescents. Results suggested that interventions that reduce consumption intention at short-term are more likely to be successful in decreasing tobacco use in the long-term.
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Affiliation(s)
- María T Gonzálvez
- Department of Health Psychology, Miguel Hernandez University, Avda. de la Universidad, s/n., 03202 Elche (Alicante), Spain.
| | - Alexandra Morales
- Department of Health Psychology, Miguel Hernandez University, Avda. de la Universidad, s/n., 03202 Elche (Alicante), Spain
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernandez University, Avda. de la Universidad, s/n., 03202 Elche (Alicante), Spain
| | - Steve Sussman
- Preventive Medicine/Psychology, University of Southern California, United States
| | - José P Espada
- Department of Health Psychology, Miguel Hernandez University, Avda. de la Universidad, s/n., 03202 Elche (Alicante), Spain
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Hartmann‐Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev 2018; 5:CD000146. [PMID: 29852054 PMCID: PMC6353172 DOI: 10.1002/14651858.cd000146.pub5] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) aims to temporarily replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. OBJECTIVES To determine the effectiveness and safety of nicotine replacement therapy (NRT), including gum, transdermal patch, intranasal spray and inhaled and oral preparations, for achieving long-term smoking cessation, compared to placebo or 'no NRT' interventions. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register for papers mentioning 'NRT' or any type of nicotine replacement therapy in the title, abstract or keywords. Date of most recent search is July 2017. SELECTION CRITERIA Randomized trials in people motivated to quit which compared NRT to placebo or to no treatment. We excluded trials that did not report cessation rates, and those with follow-up of less than six months, except for those in pregnancy (where less than six months, these were excluded from the main analysis). We recorded adverse events from included and excluded studies that compared NRT with placebo. Studies comparing different types, durations, and doses of NRT, and studies comparing NRT to other pharmacotherapies, are covered in separate reviews. DATA COLLECTION AND ANALYSIS Screening, data extraction and 'Risk of bias' assessment followed standard Cochrane methods. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS We identified 136 studies; 133 with 64,640 participants contributed to the primary comparison between any type of NRT and a placebo or non-NRT control group. The majority of studies were conducted in adults and had similar numbers of men and women. People enrolled in the studies typically smoked at least 15 cigarettes a day at the start of the studies. We judged the evidence to be of high quality; we judged most studies to be at high or unclear risk of bias but restricting the analysis to only those studies at low risk of bias did not significantly alter the result. The RR of abstinence for any form of NRT relative to control was 1.55 (95% confidence interval (CI) 1.49 to 1.61). The pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976 participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4 trials, 887 participants) for nicotine nasal spray. The effects were largely independent of the definition of abstinence, the intensity of additional support provided or the setting in which the NRT was offered. A subset of six trials conducted in pregnant women found a statistically significant benefit of NRT on abstinence close to the time of delivery (RR 1.32, 95% CI 1.04 to 1.69; 2129 participants); in the four trials that followed up participants post-partum the result was no longer statistically significant (RR 1.29, 95% CI 0.90 to 1.86; 1675 participants). Adverse events from using NRT were related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. Attempts to quantitatively synthesize the incidence of various adverse effects were hindered by extensive variation in reporting the nature, timing and duration of symptoms. The odds ratio (OR) of chest pains or palpitations for any form of NRT relative to control was 1.88 (95% CI 1.37 to 2.57, 15 included and excluded trials, 11,074 participants). However, chest pains and palpitations were rare in both groups and serious adverse events were extremely rare. AUTHORS' CONCLUSIONS There is high-quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect. The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT. NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non-ischaemic chest pain and palpitations.
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Affiliation(s)
- Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | | | - Weiyu Ye
- University of OxfordOxford University Clinical Academic Graduate SchoolOxfordUK
| | - Chris Bullen
- University of AucklandNational Institute for Health InnovationPrivate Bag 92019Auckland Mail CentreAucklandNew Zealand1142
| | - Tim Lancaster
- King’s College LondonGKT School of Medical EducationLondonUK
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Fanshawe TR, Halliwell W, Lindson N, Aveyard P, Livingstone‐Banks J, Hartmann‐Boyce J. Tobacco cessation interventions for young people. Cochrane Database Syst Rev 2017; 11:CD003289. [PMID: 29148565 PMCID: PMC6486118 DOI: 10.1002/14651858.cd003289.pub6] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006. OBJECTIVES To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO. SELECTION CRITERIA We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up. MAIN RESULTS Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias. AUTHORS' CONCLUSIONS There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.
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Affiliation(s)
- Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - William Halliwell
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - Paul Aveyard
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
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Prokhorov AV, Khalil GE, Foster DW, Marani SK, Guindani M, Espada JP, Gonzálvez MT, Idrisov B, Galimov A, Arora M, Tewari A, Isralowitz R, Lapvongwatana P, Chansatitporn N, Chen X, Zheng H, Sussman S. Testing the nicotine dependence measure mFTQ for adolescent smokers: A multinational investigation. Am J Addict 2017; 26:689-696. [PMID: 28708935 DOI: 10.1111/ajad.12583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As a measure of nicotine dependence among adolescent smokers, the modified Fagerström Tolerance Questionnaire (mFTQ; seven items), has been successfully used in the United States (USA). Nonetheless, the validity and reliability of mFTQ at the international level is still needed. The current study is the first to test the validity and reliability of mFTQ in four countries: Thailand, Spain, the USA, and Russia. METHODS In a cross-sectional survey, mFTQ, risk factors of nicotine dependence, and sociodemographic characteristics were assessed. Risk factors included age of first cigarette, frequency of alcohol use, frequency of marijuana use, and number of cigarettes smoked yesterday. Salivary cotinine was also obtained in Thailand and Spain. RESULTS For all four countries, mFTQ exhibited a single factor structure, as supported by previous work in the USA. For all studied countries except Thailand, mFTQ presented acceptable internal reliability. Overall, risk factors of nicotine dependence have predicted mFTQ scores across countries. Frequency of alcohol use in the USA and frequency of marijuana use in Thailand and Spain were not associated with mFTQ scores. DISCUSSION AND CONCLUSIONS mFTQ is a single-factor measure of nicotine dependence that shows acceptable internal consistency and validity across countries. Further work can advance the scale and tailor it to different cultures. SCIENTIFIC SIGNIFICANCE mFTQ can be a clinically practical international measure of nicotine dependence. This study provides initial support for the utility of the mFTQ among Thai, Spanish, American, and Russian adolescents. Further research is needed to test and advance mFTQ across cultures. (Am J Addict 2017;26:689-696).
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Georges E Khalil
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dawn W Foster
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Salma K Marani
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michele Guindani
- Department of Statistics, University of California Irvine, Irvine, California
| | | | | | - Bulat Idrisov
- Bashkir State Medical University, Ufa, Bashkortostan
| | - Artur Galimov
- Bashkir State Medical University, Ufa, Bashkortostan
| | - Monika Arora
- Health Promotion and Tobacco Control Public Health Foundation of India, New Delhi.,HRIDAY, Health Related Information Dissemination Among Youth, New Delhi
| | - Abha Tewari
- Health Promotion and Tobacco Control Public Health Foundation of India, New Delhi.,HRIDAY, Health Related Information Dissemination Among Youth, New Delhi
| | | | | | | | - Xinguang Chen
- University of Florida, Gainesville, Florida.,Wuhan Center for Disease Prevention and Control, Hubei Sheng, China
| | - Hong Zheng
- WestEd, San Francisco, San Francisco, California
| | - Steve Sussman
- University of Southern California, Los Angeles, California
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Gonzálvez MT, Espada JP, Orgilés M, Sussman S. Two-year Effects of a Classroom-based Smoking Prevention and Cessation Intervention Program. Eur Addict Res 2017; 23:122-128. [PMID: 28595196 PMCID: PMC5687913 DOI: 10.1159/000475985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Project EX is a classroom-based smoking prevention and cessation intervention program that has been well evaluated and designed for assessing the prevention and cessation effects among adolescents in Spain. However, its long-term efficacy is still unknown. This study deals with the outcomes of a 2-year follow-up evaluation of Project EX. METHODS The intervention was tested using a clustered randomized controlled trial involving 1,546 Spanish students from 3 program schools and 3 control schools. At the end of the 2-year follow-up period, 722 subjects had completed the questionnaires (266 in the control condition and 456 in the program condition) administered to them. RESULTS Compared to the control condition, the program condition revealed a greater reduction in nicotine dependence (p = 0.04), smoking intention (p = 0.02), and in the number of cigarettes smoked during the previous month (p = 0.03). The CO monitor repeated assessments revealed a significant decrease of ppm levels in the program group (p < 0.001). Intent-to-treat quit rates were 14.28 and 0%, respectively, for the program and control conditions. CONCLUSIONS This study provides evidence about the long-term effectiveness of the Project EX classroom-based program for smoking prevention and cessation among adolescents in Spain.
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Affiliation(s)
| | - José P. Espada
- Department of Health Psychology, Miguel Hernandez University
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernandez University
| | - Steve Sussman
- Preventive Medicine/Psychology, University of Southern California
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Three-month effects of Project EX: A smoking intervention pilot program with Thai adolescents. Addict Behav 2016; 61:20-4. [PMID: 27235988 DOI: 10.1016/j.addbeh.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/22/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022]
Abstract
Adolescent smoking is a major public health problem around the world, including Thailand. The current study provides a three-month follow-up evaluation of the Project EX tobacco use cessation program among Thai adolescents. The intervention was tested involving a quasi-experimental trial with 185 smokers, with two program and two control condition schools (within each condition, one school in Bangkok Province and one school in Nakhon Pathom Province). At 3-month follow-up, the intent-to-treat (ITT) quit rate was 23% in the program group and 11% in the standard care control group (p<0.02). The intervention also lowered the level of last 30-day smoking at follow-up among persons who did not quit in the program condition, while no change in level of smoking was reported in the control condition. These results are promising for teen tobacco use cessation programming in Thailand.
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Gonzálvez MT, Espada JP, Orgilés M, Morales A, Sussman S. Nicotine Dependence as a Mediator of Project EX's Effects to Reduce Tobacco Use in Scholars. Front Psychol 2016; 7:1207. [PMID: 27570514 PMCID: PMC4981589 DOI: 10.3389/fpsyg.2016.01207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/29/2016] [Indexed: 11/13/2022] Open
Abstract
In Spain, 44% of 14-18-year-olds have smoked, and 12.5% have smoked cigarettes in the last 30 days. Nicotine is one of the most addictive substances, and can lead to serious addiction in adulthood with adverse consequences to one's health. School plays a relevant role in health promotion and preventing risk behaviors such as tobacco consumption. Despite the fact that some school-based tobacco cessation and prevention interventions prove to be effective for their purposes, there is a lack of understanding as to why these programs succeed or fail. This longitudinal study aims to test the nicotine dependence (ND) as a mediator of Project EX's effect - a tobacco-use cessation program developed for high school youth to reduce tobacco consumption in scholars. Six high schools located in the Mediterranean coast were randomized for the participation of the program (Spanish version of Project EX) or a waiting-list group with baseline, immediate-posttest, and 12-month follow-up assessments. At baseline, 1,546 adolescents aged 14-21 years old (mean age: 15.28; SD = 1.20; 46% were women) were evaluated by self-administered tests on tobacco consumption and ND. A biomarker of smoke inhalation - a measurement of exhaled carbon monoxide (ECM) - was used. Participants who were smokers (N = 501; 32%) were selected for this study. Mediation analyses were conducted using the PROCESS v2.12 macro for Windows. The significant criterion was p ≤ 0.05, and 5,000 samples were used for bias-corrected bootstrap confidence intervals. Results indicated that Project EX indirectly decreased the number of cigarettes smoked in the last month, the number of cigarettes smoked within the last 7 days, the number of daily cigarettes, and ECM level at 12-month follow up through decreasing the level of ND in the short-term. This is the first Spanish study that explores ND as a mediator of the long-term efficacy of Project EX to reduce tobacco consumption in adolescents. Results suggest that interventions that reduce ND at short-term are more likely to be successful to decrease tobacco use at long-term.
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Affiliation(s)
- María T Gonzálvez
- Department of Health Psychology, Miguel Hernández University Elche, Spain
| | - José P Espada
- Department of Health Psychology, Miguel Hernández University Elche, Spain
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernández University Elche, Spain
| | - Alexandra Morales
- Department of Health Psychology, Miguel Hernández University Elche, Spain
| | - Steve Sussman
- Department of Preventive Medicine, University of Southern California, Los Angeles CA, USA
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Project EX-India: A classroom-based tobacco use prevention and cessation intervention program. Addict Behav 2016; 53:53-7. [PMID: 26454232 DOI: 10.1016/j.addbeh.2015.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 08/25/2015] [Accepted: 09/11/2015] [Indexed: 11/22/2022]
Abstract
Tobacco use experimentation is most frequent between the ages of 15–24 in India. Therefore, programming to counteract tobacco use among adolescents is needed. There is a lack of evidence-based teen tobacco use prevention and cessation programs. The current study provides an outcome evaluation of the Project EX tobacco use prevention and cessation program among Indian adolescents (16–18 years). An eight-session classroom-based curriculum was adapted to the Indian context and translated from English to Hindi (local language). Next, it was tested using a quasi-experimental design with 624 Indian students at baseline, involving two program and two control schools, with a three-month post-program follow-up. Project EX involves motivation enhancement (e.g., talk shows and games) and coping skills (e.g., complementary and alternative medicine) components. Program participants rated complementary and alternative medicine (CAM) activities like meditation, yoga and healthy breathing higher than talk shows and games. Compared to the standard care control condition, the program condition revealed a prevention effect, but not a cessation effect. Implications for prevention/cessation programming among Indian teens are discussed. This study was approved by the Independent Ethics Committee, Mumbai.
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Espada JP, Gonzálvez MT, Orgilés M, Sussman S. One-year effects of Project EX: A smoking intervention pilot program with Spanish adolescents. J Health Psychol 2016; 22:1067-1074. [PMID: 26826168 DOI: 10.1177/1359105315623628] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adolescent smoking is a major public health problem, which has led to the development of cessation programs such as Project EX. However, there is no evidence for the long-term efficacy of cessation among Spanish adolescents. This study provides a 1-year follow-up evaluation of the Project EX tobacco use cessation program among 211 smokers. The intent-to-treat 30-day smoking quit rate for the program group was 7.81 percent ( p = .04), whereas no smokers quit in the control group ( p = .02). The intervention had a significant influence on future smoking expectation, intention, motivation to quit, and overall level of 30-day smoking. Long-term outcomes of the Project EX clinic-based program are promising for adolescent smokers in Spain.
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Gonzálvez MT, Espada JP, Orgilés M, Soto D, Sussman S. One-Year Effects of Project EX in Spain: A Classroom-Based Smoking Prevention and Cessation Intervention Program. PLoS One 2015; 10:e0130595. [PMID: 26090821 PMCID: PMC4474549 DOI: 10.1371/journal.pone.0130595] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/21/2015] [Indexed: 11/29/2022] Open
Abstract
Background Tobacco use prevalence rates are high among Spanish adolescents. Programming to counteract tobacco use is needed. Methods and Findings The current study provides a one-year follow-up outcome evaluation of Project EX, an eight-session classroom-based curriculum. The intervention was tested using a randomized controlled trial with 1,546 Spanish students, involving three program and three control schools. Compared to the control condition, the program condition revealed a greater reduction in nicotine dependence (p < .05) and CO ppm levels (p < .001), and lower consumption of cigarettes at last month (p = .03). Conclusions Long-term outcomes of the Project EX classroom-based program are promising for adolescent prevention and possibly cessation in Spain.
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Affiliation(s)
- María T. Gonzálvez
- Department of Health Psychology, Miguel Hernandez University, Elche, Spain
- * E-mail:
| | - José P. Espada
- Department of Health Psychology, Miguel Hernandez University, Elche, Spain
| | - Mireia Orgilés
- Department of Health Psychology, Miguel Hernandez University, Elche, Spain
| | - Daniel Soto
- University of Southern California, Los Angeles, California, United States of America
| | - Steve Sussman
- University of Southern California, Los Angeles, California, United States of America
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Pilot clinic study of Project EX for smoking cessation with Spanish adolescents. Addict Behav 2015; 45:226-31. [PMID: 25725191 DOI: 10.1016/j.addbeh.2015.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite efforts to prevent smoking, the prevalence of smoking in Spanish adolescents remains high. So far, there are no evidence-based smoking cessation programs for adolescents in Spain. METHODS This study describes the evaluation of Project EX, an eight-session school-based clinic smoking cessation program, with Spanish cigarette smokers 13-19 years of age, from 9 schools (four program condition schools and five control condition schools). A group-randomized controlled trial was used. There were 211 smokers at baseline (112 program group, and 99 control group). Evaluation involved an immediate pretest and posttest survey (administered five-weeks later) and six-month follow-up (after the immediate posttest). RESULTS At immediate posttest, Project EX significantly reduced future nicotine dependence scores (mFTQ; p<.001), and increased intention to quit smoking (p<.001), and led to a higher previous day (prior to assessment) quit rate (p<.03). At the six-month follow-up, the percentage of quitters in the program group was 14.28%, whereas no smokers quit smoking in the control group (p<.04), and Project EX had a significant influence on future smoking expectation (p=.006) and overall level of 30-day smoking. CONCLUSIONS Results for the Project EX school-based clinic are promising for adolescent smokers in Spain, although difficulties in recruitment and high attrition are of concern. Findings and limitations are discussed and suggestions for future research are suggested.
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Simon P, Kong G, Cavallo DA, Krishnan-Sarin S. Update of Adolescent Smoking Cessation Interventions: 2009-2014. CURRENT ADDICTION REPORTS 2015; 2:15-23. [PMID: 26295017 PMCID: PMC4540362 DOI: 10.1007/s40429-015-0040-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The treatment of adolescent tobacco dependence is an imperative public health goal. Adolescent-focused smoking cessation interventions have shown modest results at most, indicating the need for the development of innovative and effective interventions for this vulnerable population. This review aims to provide an update of smoking cessation interventions for youth by reviewing the literature published between 2009 and November 2014 evaluating psychosocial and pharmacological interventions. Based on this examination, future directions for research in advancing the development of adolescent-focused tobacco treatments are provided.
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Espada JP, Gonzálvez MT, Guillén-Riquelme A, Sun P, Sussman S. Immediate Effects of Project EX in Spain: A Classroom-Based Smoking Prevention and Cessation Intervention Program. JOURNAL OF DRUG EDUCATION 2015; 44:3-18. [PMID: 25721322 DOI: 10.1177/0047237915573523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Tobacco use is of high prevalence among Spanish adolescents. Programming to counteract tobacco use has been needed. There is a lack of knowledge on the efficacy of teen tobacco use cessation programming. The current study provides an immediate outcome evaluation of the Project EX tobacco use prevention and cessation program among Spanish adolescents. An eight-session, classroom-based curriculum was translated from English to Spanish and adapted to the Spanish culture. Next, it was tested using a randomized controlled trial with 1,546 Spanish students, involving three program and three control high schools. Participants at the program group provided moderately favorable process ratings of the program. Compared to the standard care control condition, the program condition revealed a greater reduction in smoking intentions and CO ppm levels.
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Affiliation(s)
| | | | | | - Ping Sun
- University of Southern California, Los Angeles, USA
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Sussman S, Arriaza B, Grigsby TJ. Alcohol, tobacco, and other drug misuse prevention and cessation programming for alternative high school youth: a review. THE JOURNAL OF SCHOOL HEALTH 2014; 84:748-58. [PMID: 25274175 DOI: 10.1111/josh.12200] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 05/20/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Relative to youth in regular high schools, alternative high school (AHS) youth are at high risk for alcohol, tobacco, and other drug (ATOD) misuse. Prevention and cessation efforts are needed for this population. METHODS A systematic, exhaustive literature search was completed to identify ATOD misuse prevention and cessation research studies with AHS youth. RESULTS For the AHS population, 23 ATOD misuse prevention or cessation program evaluations were located. This review indicated that successful efforts have focused on instruction in motivation enhancement, life coping skills, and decision making. CONCLUSIONS Alcohol, tobacco, and other drug misuse prevention and cessation programming for AHSs is effective, delivered in the classroom or as a school-based clinic. There is little evidence, though, that this programming is effective when delivered through other modalities such as via computer or bridging beyond the school setting. More research and application of evidence-based programming are recommended for youth in AHS settings.
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Affiliation(s)
- Steve Sussman
- Preventive Medicine, Psychology, and Social Work, Institute for Health Promotion and Disease Prevention Research, University of Southern California Soto Street Building, 2001 North Soto Street, Room 302A, Los Angeles, CA 90032.
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Carim-Todd L, Mitchell SH, Oken BS. Mind-body practices: an alternative, drug-free treatment for smoking cessation? A systematic review of the literature. Drug Alcohol Depend 2013; 132:399-410. [PMID: 23664122 PMCID: PMC3770754 DOI: 10.1016/j.drugalcdep.2013.04.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The limited success of current smoking cessation therapies encourages research into new treatment strategies. Mind-body practices such as yoga and meditation have the potential to aid smoking cessation and become an alternative drug-free treatment option. The aim of this article is to assess the efficacy of yoga and other meditation-based interventions for smoking cessation, to identify the challenges of clinical trials applying mind-body treatments, and to outline directions for future research on these types of therapies to assist in smoking cessation. METHODS A systematic review of the scientific literature. RESULTS Fourteen clinical trials met the inclusion criteria defined for this review. Each article was reviewed thoroughly, and evaluated for quality, design, and methodology. Although primary outcomes differed between studies, the fourteen articles, most with limitations, reported promising effects supporting further investigation of the use of these practices to improve smoking cessation. CONCLUSIONS The literature supports yoga and meditation-based therapies as candidates to assist smoking cessation. However, the small number of studies available and associated methodological problems require more clinical trials with larger sample sizes and carefully monitored interventions to determine rigorously if yoga and meditation are effective treatments.
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Affiliation(s)
- Laura Carim-Todd
- Department of Neurology, Oregon Health & Science University (OHSU), Portland, OR, USA; Oregon Center for Complementary & Alternative Medicine in Neurological Disorders (ORCCAMIND), Oregon Health & Science University (OHSU), Portland, OR, USA.
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Abstract
BACKGROUND Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the second update of a Cochrane review first published in 2006. OBJECTIVES To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register in February 2013. This includes reports for trials identified in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsyclNFO. SELECTION CRITERIA We included randomized controlled trials, cluster-randomized controlled trials and other controlled trials recruiting young people, aged less than 20, who were regular tobacco smokers. We included any interventions; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months follow-up among those who smoked at baseline. DATA COLLECTION AND ANALYSIS Both authors independently assessed the eligibility of candidate trials and extracted data. Included studies were evaluated for risk of bias using standard Cochrane methodology. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at longest follow-up. MAIN RESULTS Twenty-eight trials involving approximately 6000 young people met our inclusion criteria (12 cluster-randomized controlled trials, 14 randomized controlled trials and 2 controlled trials). The majority of studies were judged to be at high or unclear risk of bias in at least one domain. Many studies combined components from various theoretical backgrounds to form complex interventions.The majority used some form of motivational enhancement combined with psychological support such as cognitive behavioural therapy (CBT) and some were tailored to stage of change using the transtheoretical model (TTM). Three trials based mainly on TTM interventions achieved moderate long-term success, with a pooled risk ratio (RR) of 1.56 at one year (95% confidence interval (CI) 1.21 to 2.01). The 12 trials that included some form of motivational enhancement gave an estimated RR of 1.60 (95% CI 1.28 to 2.01). None of the 13 individual trials of complex interventions that included cognitive behavioural therapy achieved statistically significant results, and results were not pooled due to clinical heterogeneity. There was a marginally significant effect of pooling six studies of the Not on Tobacco programme (RR of 1.31, 95% CI 1.01 to 1.71), although three of the trials used abstinence for as little as 24 hours at six months as the cessation outcome. A small trial testing nicotine replacement therapy did not detect a statistically significant effect. Two trials of bupropion, one testing two doses and one testing it as an adjunct to NRT, did not detect significant effects. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. AUTHORS' CONCLUSIONS Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence or continuous abstinence at six months), especially those incorporating elements sensitive to stage of change and using motivational enhancement and CBT. Given the episodic nature of adolescent smoking, more data is needed on sustained quitting. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. There is not yet sufficient evidence to recommend widespread implementation of any one model. There continues to be a need for well-designed adequately powered randomized controlled trials of interventions for this population of smokers.
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Affiliation(s)
- Alan Stanton
- Heart of England Foundation Trust, 3, The Green, Shirley, UK, B90 4LA
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Idrisov B, Sun P, Akhmadeeva L, Arpawong TE, Kukhareva P, Sussman S. Immediate and six-month effects of Project EX Russia: a smoking cessation intervention pilot program. Addict Behav 2013; 38:2402-8. [PMID: 23639851 PMCID: PMC3715312 DOI: 10.1016/j.addbeh.2013.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/24/2013] [Accepted: 03/25/2013] [Indexed: 10/27/2022]
Abstract
This study evaluates the performance of the Project EX tobacco use cessation program in Russian summer recreational camps. An eight-session clinic-based tobacco use cessation program for adolescents was tested during the summer of 2011 in an experimental pilot trial that involved different youth that rotated through camps. Conditions were nested within camps. Two rotations of unique subject groups of smokers (program and standard care control) through each of five camps provided the means of controlling for campsite by condition. Assignment of condition by rotation was random (by a flip of a coin), achieving reasonable baseline comparability (total n=164 smokers at baseline, 76 program group, 88 standard care control group). Evaluation involved an immediate pretest and posttest and a six-month telephone follow-up. At immediate posttest, Project EX was moderately well-received, significantly reduced future smoking expectation (46% reduction in EX program condition versus 8% in control, p<.0001), decreased intention to not quit smoking (-5.2% in EX versus +1.4% in control, p<.05), and increased motivation to quit smoking (0.72 versus -0.04, p<.0001). At the six-month follow-up, program subjects reported a higher intent-to-treat quit rate during the last 30days (7.5% versus 0.1%, p<.05). For the subjects who remained monthly smokers at the six-month follow-up, Project EX reduced subjects' level of nicotine dependence (-0.53 versus +0.15, p<.001). The results were quite promising for this program, which included motivation enhancement, coping skill, and alternative medicine material. However, further research on teen tobacco use cessation programming in Russia with larger sample sizes, involving other locations of the country, and with stronger research designs is needed.
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Affiliation(s)
- Bulat Idrisov
- Bashkortostan State Medical University, Pediatrics Department, 3 Lenina Street, Ufa, Russia, 450008;
| | - Ping Sun
- University of Southern California, Department of Preventive Medicine, 2001 N. Soto Street, SSB MC 9239, Los Angeles, CA 90032, USA;
| | - Leila Akhmadeeva
- Bashkortostan State Medical University, Department of Neurology, Neurosurgery and Medical Genetics, 3 Lenina Street, Ufa, Russia, 450008;
| | - Thalida Em Arpawong
- University of Southern California, Department of Preventive Medicine, 2001 N. Soto Street, SSB MC 9239, Los Angeles, CA 90032, USA;
| | - Polina Kukhareva
- University of North Carolina at Chapel Hill, Collaborative Studies Coordinating Center, 137 E. Franklin Street, Suite 203, Chapel Hill, NC 27514, USA;
| | - Steve Sussman
- University of Southern California, Departments of Preventive Medicine and Psychology, 2001 N. Soto Street, SSB Room 302A, Los Angeles, CA 90032, USA;
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Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012; 11:CD000146. [PMID: 23152200 DOI: 10.1002/14651858.cd000146.pub4] [Citation(s) in RCA: 441] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of nicotine replacement therapy (NRT) is to temporarily replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. OBJECTIVES The aims of this review were: To determine the effect of NRT compared to placebo in aiding smoking cessation, and to consider whether there is a difference in effect for the different forms of NRT (chewing gum, transdermal patches, oral and nasal sprays, inhalers and tablets/lozenges) in achieving abstinence from cigarettes. To determine whether the effect is influenced by the dosage, form and timing of use of NRT; the intensity of additional advice and support offered to the smoker; or the clinical setting in which the smoker is recruited and treated. To determine whether combinations of NRT are more likely to lead to successful quitting than one type alone. To determine whether NRT is more or less likely to lead to successful quitting compared to other pharmacotherapies. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register for papers mentioning 'NRT' or any type of nicotine replacement therapy in the title, abstract or keywords. Date of most recent search July 2012. SELECTION CRITERIA Randomized trials in which NRT was compared to placebo or to no treatment, or where different doses of NRT were compared. We excluded trials which did not report cessation rates, and those with follow-up of less than six months. DATA COLLECTION AND ANALYSIS We extracted data in duplicate on the type of participants, the dose, duration and form of nicotine therapy, the outcome measures, method of randomization, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS We identified 150 trials; 117 with over 50,000 participants contributed to the primary comparison between any type of NRT and a placebo or non-NRT control group. The risk ratio (RR) of abstinence for any form of NRT relative to control was 1.60 (95% confidence interval [CI] 1.53 to 1.68). The pooled RRs for each type were 1.49 (95% CI 1.40 to 1.60, 55 trials) for nicotine gum; 1.64 (95% CI 1.52 to 1.78, 43 trials) for nicotine patch; 1.95 (95% CI 1.61 to 2.36, 6 trials) for oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials) for nicotine inhaler; and 2.02 (95% CI 1.49 to 2.73, 4 trials) for nicotine nasal spray. One trial of oral spray had an RR of 2.48 (95% CI 1.24 to 4.94). The effects were largely independent of the duration of therapy, the intensity of additional support provided or the setting in which the NRT was offered. The effect was similar in a small group of studies that aimed to assess use of NRT obtained without a prescription. In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2 mg gum, but weaker evidence of a benefit from higher doses of patch. There was evidence that combining a nicotine patch with a rapid delivery form of NRT was more effective than a single type of NRT (RR 1.34, 95% CI 1.18 to 1.51, 9 trials). The RR for NRT used for a short period prior to the quit date was 1.18 (95% CI 0.98 to 1.40, 8 trials), just missing statistical significance, though the efficacy increased when we pooled only patch trials and when we removed one trial in which confounding was likely. Five studies directly compared NRT to a non-nicotine pharmacotherapy, bupropion; there was no evidence of a difference in efficacy (RR 1.01; 95% CI 0.87 to 1.18). A combination of NRT and bupropion was more effective than bupropion alone (RR 1.24; 95% CI 1.06 to 1.45, 4 trials). Adverse effects from using NRT are related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. There is no evidence that NRT increases the risk of heart attacks. AUTHORS' CONCLUSIONS All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50 to 70%, regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT.
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Affiliation(s)
- Lindsay F Stead
- Department of Primary Care Health Sciences, University of Oxford,Oxford,UK.
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Sussman S. International Translation of Project EX: A Teen Tobacco Use Cessation Program. SUCHT 2012; 58:317-325. [PMID: 23885135 PMCID: PMC3718560 DOI: 10.1024/0939-5911.a000205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS There are relatively few documented teen tobacco use cessation efforts outside the United States (U.S.). Project EX is an evidence-based program that consists of eight sessions, as a school-based clinic tobacco cessation-only version and a classroom-based prevention and cessation version. This paper provides a 'snapshot' of progress on international translation of ProjectEXpilot study work in eight countries that have been approached thus far. The program was implemented in Wuhan, China; Israel and partners; Bashkortostan, Russia; and Elche, Spain. Implementation is planned for Vienna, Austria; Mumbai, India; and Bangkok, Thailand. This work will lead eventually to a greater understanding regarding preference for type of programming (e.g., clinic versus classroom modality), challenges in recruitment and retention, program receptivity, and short-term (approximately 3-month post-program) quit rates. PROTOCOL AND INTERIM RESULTS OF INTERNATIONAL TRANSLATION OF PROJECT EX Convenience samples are being recruited based on previous contacts with each location. A protocol was sent to each location, proposing a controlled design, in which subjects enter cessation groups or become a wait-list control, with an immediate pretest, posttest, and 3-month follow-up. Language translation of program materials was completed in seven of the eight locations. Several variations in design and implementation were demanded though. For example, youth fear of reporting tobacco publicly mandated to researchers that the prevention/cessation classroom version be implemented in some locations (Israel and partners, and India). Program effects are suggested across countries. CONCLUSIONS Ongoing partnerships with parties actively involved in tobacco control facilitate pilot testing of teen tobacco use cessation programming. The Project EX curriculum appears quite translatable, though having flexibility in implementation modality eased being able to pilot test the program. Research on this cognitive-behavioral, motivation enhancement approach continues.
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Affiliation(s)
- Steve Sussman
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, California, USA
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Sussman S, Sun P. Youth tobacco use cessation: 2008 update. Tob Induc Dis 2009; 5:3. [PMID: 19183452 PMCID: PMC2644896 DOI: 10.1186/1617-9625-5-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 01/30/2009] [Indexed: 11/10/2022] Open
Abstract
In this paper, an empirical review of 64 teen tobacco use cessation studies is provided. Examined include program contents, delivery modalities, number of contacts, and expected quit rates. In addition, means of recruitment and retention of smokers in programming are discussed. Also, promising contemporary methods of teen smoking cessation are examined, including use of pharmacologic adjuncts, electronic technology, and cigarette price increases (and no smoking policy). Conclusions are made regarding implications for developing and implementing teen tobacco use cessation programs.
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Affiliation(s)
- Steve Sussman
- Department of Psychology, Institute for Health Promotion and Disease Prevention Research, University of Southern California, Alhambra, CA, USA.
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Sussman S, Miyano J, Rohrbach LA, Dent CW, Sun P. Six-month and one-year effects of project EX-4: a classroom-based smoking prevention and cessation intervention program. Addict Behav 2007; 32:3005-14. [PMID: 17628346 PMCID: PMC4076165 DOI: 10.1016/j.addbeh.2007.06.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 04/26/2007] [Accepted: 06/04/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study evaluated the efficacy of a version of Project EX that was adapted for implementation in the classroom context (Project EX-4). This paper reports the program outcomes based on pretest, six-month, and one-year follow-up surveys. METHODS An 8 session classroom-based curriculum was tested with a clustered randomized controlled trial that involved a total of 1097 students in 6 program and 6 control alternative high schools. Weekly and monthly smoking was assessed at the three time points. Outcome effects were analyzed with multi-level random coefficients models. RESULTS Students in the program condition experienced a greater reduction in weekly smoking and monthly smoking, at 6-and-12-month follow-ups. The net change varied between -5.1% and -7.6%, comparing the program condition to the control condition. CONCLUSIONS The implementation of Project EX in a classroom setting produced decreases in smoking among students in the program, relative to those in the standard care control condition. It is likely that a classroom-based smoking prevention/cessation program can lead to lower overall smoking prevalence than a cessation program that is implemented in a school-based smoking cessation clinic format.
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Affiliation(s)
- Steve Sussman
- Institute for Health Promotion and Disease Prevention Research and Departments of Preventive Medicine and Psychology, University of Southern California, USA.
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Sun P, Miyano J, Rohrbach LA, Dent CW, Sussman S. Short-term effects of Project EX-4: a classroom-based smoking prevention and cessation intervention program. Addict Behav 2007; 32:342-50. [PMID: 16820267 PMCID: PMC3134402 DOI: 10.1016/j.addbeh.2006.05.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 04/13/2006] [Accepted: 05/24/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Researchers continue to try to develop effective teen tobacco use prevention and cessation programs. Three previous school clinic-based studies established the efficacy of Project EX for teen smoking cessation. This fourth study adapts Project EX to the classroom context. This paper reports the findings based on pretest and posttest surveys conducted immediately prior and post-intervention. METHODS An eight-session classroom-based curriculum was developed and tested with a randomized controlled trial that involved a total of 1097 students in six program and six control continuation high schools. Program-specific knowledge and smoking measures were assessed at both the pretest and posttest surveys, and were used to evaluate the program's effect on the immediate outcomes. The immediate outcomes effects were analyzed with multi-level random coefficients models. RESULTS Program students provided favorable process ratings of the overall program and each session. Compared with the students in the control condition, students in the program condition showed a greater change in correct knowledge responses from pretest to posttest (beta=+5.5%, p=0.0003). Students in the program condition also experienced a greater reduction in weekly smoking (beta=-6.9%, p=0.038), and intention for smoking in the next 12 months (beta=-0.21 in 5-level scale, p=0.023). CONCLUSIONS EX-4 immediate outcome results revealed favorable student responses to the program, increases in knowledge, and decreases in smoking relative to a standard care control condition.
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Affiliation(s)
- Ping Sun
- Institute for Health Promotion and Disease Prevention Research and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1000 South Fremont Avenue, Box 8, Alhambra, CA 91803, USA.
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Abstract
BACKGROUND Teenage smoking prevalence is around 15% in developing countries (with wide variation from country to country), and around 26% in the UK and USA. Although most tobacco control programmes for adolescents are based around prevention of uptake, there are also a number of initiatives to help those who want to quit. Since those who do not smoke before the age of 20 are significantly less likely to start as adults, there is a strong case for programmes for young people that address both prevention and treatment. OBJECTIVES To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Tobacco Addiction Group's Specialized Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, and the bibliographies of identified trials. We also searched the 'grey' literature (unpublished materials), and contacted authors and experts in the field where necessary. SELECTION CRITERIA Types of studies: Randomized controlled trials, cluster-randomized controlled trials and controlled trials. TYPES OF PARTICIPANTS Young people, aged less than 20, who are regular tobacco smokers. Types of interventions: The interventions ranged from simple ones such as pharmacotherapy, targeting individual young people, through complex programmes targeting people or organizations associated with young people (for example, their families or schools), or the community in which young people live. We included cessation programmes but excluded programmes primarily aimed at prevention of uptake. Types of outcome measures: The primary outcome was smoking status at six months follow up, among those who smoked at baseline. We report the definition of cessation used in each trial (e.g seven- or thirty-day point prevalence abstinence, or sustained or prolonged abstinence), and we preferred biochemically verified cessation when that measure was available. DATA COLLECTION AND ANALYSIS Both authors independently assessed the eligibility of candidate trials identified by the searches, and extracted data from them. We categorized included trials as being at low, medium or high risk of bias, based on concealment of allocation, blinding (where applicable) and the handling of attrition and losses to follow up. We conducted limited meta-analyses of some of the trials, provided that it was appropriate to group them and provided that there was minimal heterogeneity between them. We estimated pooled odds ratios using the Mantel-Haenszel method, based on the quit rates at longest follow up for trials with at least six months follow up from the start of the intervention. MAIN RESULTS We found 15 trials, covering 3605 young people, which met our inclusion criteria (seven cluster-randomized controlled trials, six randomized controlled trials and two controlled trials). Three trials used or tested the transtheoretical model (stages of change) approach, two tested pharmacological aids to quitting (nicotine replacement and bupropion), and the remaining trials used various psycho-social interventions, such as motivational enhancement or behavioural management. The trials evaluating TTM interventions achieved moderate long-term success, with a pooled odds ratio (OR) at one year of 1.70 ( 95% confidence interval (CI) 1.25 to 2.33) persisting at two-year follow up with an OR of 1.38 (95% CI 0.99 to 1.92). Neither of the pharmacological intervention trials achieved statistically significant results (data not pooled), but both were small-scale, with low power to detect an effect. The three interventions (5 trials) which used cognitive behavioural therapy interventions did not individually achieve statistically significant results, although when the three Not on Tobacco trials were pooled the OR 1.87; (95% CI 1.00 to 3.50) suggested some measure of effectiveness. Although the three trials that incorporated motivational interviewing as a component of the intervention achieved a pooled OR of 2.05 (95% CI 1.10 to 3.80), the impossibility of isolating the effect of the motivational interviewing in these trials meant that we could not draw meaningful inferences from that analysis. AUTHORS' CONCLUSIONS Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence at six months), especially those incorporating elements sensitive to stage of change. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. Psycho-social interventions have not so far demonstrated effectiveness, although pooled results for the Not on Tobacco trials suggest that that this approach may yet prove to be effective; however, their definition of cessation (one or more smoke-free days) may not adequately account for the episodic nature of much adolescent smoking. There is a need for well-designed adequately powered randomized controlled trials for this population of smokers, with a minimum of six months follow up and rigorous definitions of cessation (sustained and biochemically verified). Attrition and losses to follow up are particularly problematic in trials for young smokers, and need to be kept to a minimum, so that management and interpretation of missing data need not compromise the findings.
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Affiliation(s)
- G M Grimshaw
- Warwick Medical School, Medical Teaching Centre, University of Warwick, Coventry, UK.
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