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Matthews JA, Sallis HM, Dyer ML, McConville R, Isotalus H, Attwood AS. Associations Between Self-Reported Sleep Quality, Fatigue Severity, Factors Associated With Successful Cessation, and Cessation Beliefs Among Regular Smokers. Nicotine Tob Res 2024; 26:835-842. [PMID: 37996095 PMCID: PMC11190051 DOI: 10.1093/ntr/ntad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Smokers report poorer sleep than nonsmokers and sleep quality deteriorates further during cessation, increasing risk of smoking relapse. Better understanding of the relationship between sleep and relapse-related outcomes could inform novel approaches to smoking cessation support. The aim of this study was to investigate same-day associations of self-reported sleep quality and fatigue severity with factors associated with successful cessation and cessation beliefs, among regular smokers. METHODS This cross-sectional observational study (n = 412) collected self-reported sleep quality, fatigue severity, and factors associated with successful cessation and cessation beliefs among regular smokers via an online survey (60% male). RESULTS There was evidence of an association between sleep quality (SQ) and reduced 24-hour (β = -0.12, p = .05) and lifetime (β = -0.09, p = .04) abstinence self-efficacy. In addition, poorer SQ and higher fatigue severity (FS) were associated with increased smoking urges (SQ: β = 0.27, p < .001; FS: β = 0.32, p < .001), increased barriers to cessation (SQ: β = 0.19, p < .001; FS: β = 0.32, p < .001), and increased perceived risks to cessation (SQ: β = 0.18, p < .001; FS: β = 0.26, p < .001). Fatigue severity was weakly associated with increased perceived benefits to cessation (β = 0.12, p = .017). CONCLUSIONS Self-reported sleep quality and fatigue severity were associated with multiple factors associated with successful cessation and cessation beliefs. Further research is needed to extend these findings by using different methods to identify the temporal direction of associations and causality. IMPLICATIONS This study is the first to examine associations between sleep quality, fatigue severity, and factors associated with successful cessation and cessation beliefs. Findings show that both sleep quality and fatigue severity are associated with multiple factors associated with successful cessation and could be modifiable targets for future smoking cessation interventions. Furthermore, our data suggest that fatigue severity has an independent effect on multiple factors associated with successful cessation when accounting for sleep quality. This indicates that fatigue, independent of sleep quality, could be an important factor in a quit attempt.
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Affiliation(s)
- Joe A Matthews
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Electrical and Electronic Engineering, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Integrative Cancer Epidemiology Programme at the University of Bristol, Bristol, UK
| | - Hannah M Sallis
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- CAMH (Centre for Academic Mental Health), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maddy L Dyer
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Ryan McConville
- Department Engineering and Mathematics, Ada Lovelace Building, University of Bristol, University Walk, Bristol, UK
| | - Hanna Isotalus
- Department of Electrical and Electronic Engineering, University of Bristol, Bristol, UK
| | - Angela S Attwood
- School of Psychological Science, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Integrative Cancer Epidemiology Programme at the University of Bristol, Bristol, UK
- Bristol Biomedical Research Centre at the University of Bristol, Bristol, UK
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2
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Hock ES, Franklin M, Baxter S, Clowes M, Chilcott J, Gillespie D. Covariates of success in quitting smoking: a systematic review of studies from 2008 to 2021 conducted to inform the statistical analyses of quitting outcomes of a hospital-based tobacco dependence treatment service in the United Kingdom. NIHR OPEN RESEARCH 2023; 3:28. [PMID: 37881466 PMCID: PMC10596416 DOI: 10.3310/nihropenres.13427.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
Background Smoking cessation interventions are being introduced into routine secondary care in the United Kingdom (UK), but there are person and setting-related factors that could moderate their success in quitting smoking. This review was conducted as part of an evaluation of the QUIT hospital-based tobacco dependence treatment service ( https://sybics-quit.co.uk). The aim of the review was to identify a comprehensive set of variables associated with quitting success among tobacco smokers contacting secondary healthcare services in the UK who are offered support to quit smoking and subsequently set a quit date. The results would then be used to inform the development of a statistical analysis plan to investigate quitting outcomes. Methods Systematic literature review of five electronic databases. Studies eligible for inclusion investigated quitting success in one of three contexts: (a) the general population in the UK; (b) people with a mental health condition; (c) quit attempts initiated within a secondary care setting. The outcome measures were parameters from statistical analysis showing the effects of covariates on quitting success with a statistically significant (i.e., p-value <0.05) association. Results The review identified 29 relevant studies and 14 covariates of quitting success, which we grouped into four categories: demographics (age; sex; ethnicity; socio-economic conditions; relationship status, cohabitation and social network), individual health status and healthcare setting (physical health, mental health), tobacco smoking variables (current tobacco consumption, smoking history, nicotine dependence; motivation to quit; quitting history), and intervention characteristics (reduction in amount smoked prior to quitting, the nature of behavioural support, tobacco dependence treatment duration, pharmacological aids). Conclusions In total, 14 data fields were identified that should be considered for inclusion in datasets and statistical analysis plans for evaluating the quitting outcomes of smoking cessation interventions initiated in secondary care contexts in the UK. PROSPERO registration CRD42021254551 (13/05/2021).
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Affiliation(s)
- Emma S. Hock
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Matthew Franklin
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Susan Baxter
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Mark Clowes
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - James Chilcott
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Duncan Gillespie
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
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Taylor AH, Thompson TP, Streeter A, Chynoweth J, Snowsill T, Ingram W, Ussher M, Aveyard P, Murray RL, Harris T, Callaghan L, Green C, Greaves CJ, Price L, Creanor S. Effectiveness and cost-effectiveness of behavioural support for prolonged abstinence for smokers wishing to reduce but not quit: Randomised controlled trial of physical activity assisted reduction of smoking (TARS). Addiction 2023; 118:1140-1152. [PMID: 36871577 DOI: 10.1111/add.16129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/13/2022] [Indexed: 03/07/2023]
Abstract
AIMS For smokers unmotivated to quit, we assessed the effectiveness and cost-effectiveness of behavioural support to reduce smoking and increase physical activity on prolonged abstinence and related outcomes. DESIGN A multi-centred pragmatic two-arm parallel randomised controlled trial. SETTING Primary care and the community across four United Kingdom sites. PARTICIPANTS Nine hundred and fifteen adult smokers (55% female, 85% White), recruited via primary and secondary care and the community, who wished to reduce their smoking but not quit. INTERVENTIONS Participants were randomised to support as usual (SAU) (n = 458) versus multi-component community-based behavioural support (n = 457), involving up to eight weekly person-centred face-to-face or phone sessions with additional 6-week support for those wishing to quit. MEASUREMENTS Ideally, cessation follows smoking reduction so the primary pre-defined outcome was biochemically verified 6-month prolonged abstinence (from 3-9 months, with a secondary endpoint also considering abstinence between 9 and 15 months). Secondary outcomes included biochemically verified 12-month prolonged abstinence and point prevalent biochemically verified and self-reported abstinence, quit attempts, number of cigarettes smoked, pharmacological aids used, SF12, EQ-5D and moderate-to-vigorous physical activity (MVPA) at 3 and 9 months. Intervention costs were assessed for a cost-effectiveness analysis. FINDINGS Assuming missing data at follow-up implied continued smoking, nine (2.0%) intervention participants and four (0.9%) SAU participants achieved the primary outcome (adjusted odds ratio, 2.30; 95% confidence interval [CI] = 0.70-7.56, P = 0.169). At 3 and 9 months, the proportions self-reporting reducing cigarettes smoked from baseline by ≥50%, for intervention versus SAU, were 18.9% versus 10.5% (P = 0.009) and 14.4% versus 10% (P = 0.044), respectively. Mean difference in weekly MVPA at 3 months was 81.6 minutes in favour of the intervention group (95% CI = 28.75, 134.47: P = 0.003), but there was no significant difference at 9 months (23.70, 95% CI = -33.07, 80.47: P = 0.143). Changes in MVPA did not mediate changes in smoking outcomes. The intervention cost was £239.18 per person, with no evidence of cost-effectiveness. CONCLUSIONS For United Kingdom smokers wanting to reduce but not quit smoking, behavioural support to reduce smoking and increase physical activity improved some short-term smoking cessation and reduction outcomes and moderate-to-vigorous physical activity, but had no long-term effects on smoking cessation or physical activity.
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Affiliation(s)
| | | | - Adam Streeter
- Faculty of Health, University of Plymouth, Plymouth, UK.,Institut für Epidemiologie und Sozialmedizin, University of Münster, Munster, Germany
| | | | - Tristan Snowsill
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Wendy Ingram
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK.,Population Health Research Institute, St. George's University of London, London, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, UK
| | - Rachael L Murray
- Lifespan and Population Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tess Harris
- Population Health Research Institute, St. George's University of London, London, UK
| | | | - Colin Green
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Lisa Price
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Siobhan Creanor
- University of Exeter Medical School, University of Exeter, Exeter, UK
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4
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Kennedy M, Barrett E, Heris C, Mersha A, Chamberlain C, Hussein P, Longbottom H, Bacon S, Maddox R. Smoking and quitting characteristics of Aboriginal and Torres Strait Islander women of reproductive age: findings from the Which Way? study. Med J Aust 2022; 217 Suppl 2:S6-S18. [PMID: 35842912 PMCID: PMC9545217 DOI: 10.5694/mja2.51630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe smoking characteristics, quitting behaviour and other factors associated with longest quit attempt and the use of nicotine replacement therapy (NRT) and stop-smoking medication (SSM) in a population of Indigenous Australian women of reproductive age. DESIGN, SETTING AND PARTICIPANTS A national cross-sectional survey of Aboriginal and Torres Strait Islander women aged 16-49 years who were smokers or ex-smokers was conducted online during the period July to October 2020. MAIN OUTCOME MEASURES Quitting experience: attempt to cut down, time since last quit attempt, longest period without smoking, attempt to cut down during last quit attempt, any use of NRT and/or SSM. RESULTS Most of the 428 participating women (302 [70.6%]) reported using an Aboriginal health service. Younger women (16-20-year-olds) smoked fewer cigarettes daily (24/42 [57.1%], 0-5 cigarettes per day), waited longer to smoke after waking (20/42 [47.6%], > 60 minutes after waking), and were categorised as low smoking dependency compared with those aged 35 years and over. One-third of women (153 [35.7%]) had ever used NRT and/or SSM. A greater proportion of older women (35-49-year-olds) had sustained a quit attempt for years (62/149 [45.6%]) and reported trying NRT and/or SSM (78/149 [52.4%]) than women in younger age groups. Quitting suddenly rather than gradually was significantly associated with sustained abstinence (prevalence ratio, 1.27 [95% CI, 1.10-1.48]). Among women who had never used NRT or SSM, most (219/275 [79.6%]) reported reasons for this in the category of attitudes and beliefs. NRT and SSM use was also more likely among women who were confident talking to their doctor about quitting (odds ratio, 2.50 [95% CI, 1.23-5.10]) and those who received most of their information from a health professional (odds ratio, 1.71 [95% CI, 1.11-2.63]). CONCLUSION Aboriginal and Torres Strait Islander women want to quit smoking and are making attempts to quit. Quitting suddenly, rather than reducing cigarette consumption, is associated with increased sustained abstinence. Health providers can enable access and uptake of NRT and/or SSM and should recognise that NRT and/or SSM use may change over time. Consistent messaging, frequent offers of smoking cessation support, and access to a range of smoking cessation supports should be provided to Aboriginal and Torres Strait Islander women to enable them to be smoke-free.
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Affiliation(s)
| | - Eden Barrett
- National Centre for Epidemiology and Population Health, Australian National UniversityCanberraACT
| | - Christina Heris
- National Centre for Epidemiology and Population Health, Australian National UniversityCanberraACT
| | | | - Catherine Chamberlain
- University of MelbourneMelbourneVIC
- Judith Lumley Centre, La Trobe UniversityMelbourneVIC
| | - Paul Hussein
- Yerin Eleanor Duncan Aboriginal Health CentreWyongNSW
| | - Hayley Longbottom
- Waminda South Coast Women’s Health and Welfare Aboriginal CorporationNowraNSW
| | - Shanell Bacon
- Nunyara Aboriginal Health Clinics, Central Coast Local Health DistrictGosfordNSW
| | - Raglan Maddox
- National Centre for Epidemiology and Population Health, Australian National UniversityCanberraACT
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5
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Liu W, Andrade G, Schulze J, Doran N, Courtney KE. Using Virtual Reality to Induce and Assess Objective Correlates of Nicotine Craving: Paradigm Development Study. JMIR Serious Games 2022; 10:e32243. [PMID: 35166685 PMCID: PMC8889474 DOI: 10.2196/32243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 01/30/2023] Open
Abstract
Background Craving is a clinically important phenotype for the development and maintenance of nicotine addiction. Virtual reality (VR) paradigms are successful in eliciting cue-induced subjective craving and may even elicit stronger craving than traditional picture-cue methods. However, few studies have leveraged the advances of this technology to improve the assessment of craving. Objective This report details the development of a novel, translatable VR paradigm designed to both elicit nicotine craving and assess multiple eye-related characteristics as potential objective correlates of craving. Methods A VR paradigm was developed, which includes three Active scenes with nicotine and tobacco product (NTP) cues present, and three Neutral scenes devoid of NTP cues. A pilot sample (N=31) of NTP users underwent the paradigm and completed subjective measures of nicotine craving, sense of presence in the VR paradigm, and VR-related sickness. Eye-gaze fixation time (“attentional bias”) and pupil diameter toward Active versus Neutral cues, as well as spontaneous blink rate during the Active and Neutral scenes, were recorded. Results The NTP Cue VR paradigm was found to elicit a moderate sense of presence (mean Igroup Presence Questionnaire score 60.05, SD 9.66) and low VR-related sickness (mean Virtual Reality Sickness Questionnaire score 16.25, SD 13.94). Scene-specific effects on attentional bias and pupil diameter were observed, with two of the three Active scenes eliciting greater NTP versus control cue attentional bias and pupil diameter (Cohen d=0.30-0.92). The spontaneous blink rate metrics did not differ across Active and Neutral scenes. Conclusions This report outlines the development of the NTP Cue VR paradigm. Our results support the potential of this paradigm as an effective laboratory-based cue-exposure task and provide early evidence of the utility of attentional bias and pupillometry, as measured during VR, as useful markers for nicotine addiction.
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Affiliation(s)
- Weichen Liu
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Gianna Andrade
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Jurgen Schulze
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Neal Doran
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Veterans Affairs San Diego Healthcare System, La Jolla, CA, United States
| | - Kelly E Courtney
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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6
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Kunicki ZJ, Hallgren M, Uebelacker LA, Brown RA, Price LH, Abrantes AM. Examining the effect of exercise on the relationship between affect and cravings among smokers engaged in cessation treatment. Addict Behav 2022; 125:107156. [PMID: 34710842 PMCID: PMC8629942 DOI: 10.1016/j.addbeh.2021.107156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
Cigarette smoking is associated with multiple adverse health outcomes. When smokers attempt to quit smoking, one of the leading predictors of relapse are cravings. Recent research shows a relationship between positive and negative affect, exercise, and cravings, but the exact nature of this relationship has yet to be understood. This study explored the relationships between positive and negative affect and cravings in a sample of participants with elevated levels of depressive symptoms (N = 202; 68.8% female; mean age = 46.1 years) who were enrolled in a smoking cessation trial to test the efficacy of a 12-week exercise intervention relative to a health education control on smoking outcomes. Data on affect and craving were gathered before weekly study intervention sessions, and data on cravings were gathered again after each session. The results showed that negative affect had a significant and positive association with cravings before an exercise or health education session. After the session, positive and negative affect were not significant predictors of changes in cravings from pre-session. However, regardless of level of positive or negative affect participants in the exercise condition showed greater reductions in craving pre- to post-class than those in the control condition. These findings suggest that negative affect is associated with cravings, but cravings can be mitigated by exercise.
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Affiliation(s)
- Zachary J Kunicki
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States.
| | - Mats Hallgren
- Karolinska Institute, Department of Global Public Health, Sweden
| | - Lisa A Uebelacker
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States; Butler Hospital, Behavioral Medicine and Addictions Research, United States
| | - Richard A Brown
- The University of Texas at Austin, School of Nursing, United States
| | - Lawrence H Price
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States
| | - Ana M Abrantes
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States; Butler Hospital, Behavioral Medicine and Addictions Research, United States
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7
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Skelton E, Lum A, Cooper LE, Barnett E, Smith J, Everson A, Machart J, Baker AL, Halpin S, Nielssen O, Clapham M, Bonevski B. Addressing smoking in sheltered homelessness with intensive smoking treatment (ASSIST project): A pilot feasibility study of varenicline, combination nicotine replacement therapy and motivational interviewing. Addict Behav 2022; 124:107074. [PMID: 34509787 DOI: 10.1016/j.addbeh.2021.107074] [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: 11/24/2020] [Revised: 06/14/2021] [Accepted: 07/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND This pilot study aimed to test the feasibility of providing varenicline in combination with nicotine replacement therapy (NRT) and motivational interviewing (MI) to adult male smokers attending a clinic in a hostel for homeless people. METHODS A single group pre- and post-treatment (12 weeks following intervention commencement) design with embedded process evaluation (at weekly counselling and fortnightly safety check-ins). Participants were 20 male smokers attending a health clinic within a homelessness service in Sydney, Australia, between December 2019 and March 2020. Participants set a target quit date 7-days post intervention commencement. Adverse events, self-reported abstinence, cigarettes per day, treatment adherence and acceptability of the study interventions were assessed 12 weeks post intervention commencement. Abstinence was biochemically verified. Results are complete cases. RESULTS Retention was 65% at 12-weeks post-intervention commencement (n = 13). No related adverse events were reported. Three participants (15%) reported continuous abstinence. Two participants self-reported 30-day point prevalence abstinence (10%), confirmed by CO level. Participants who did not quit smoking (n = 10), reported a significant reduction in the number of cigarettes smoked per day (19.4 vs 4.7, p < .01). Cravings, withdrawal symptoms, and psychological distress significantly decreased from baseline to 12-week follow-up (all < 0.01). Adherence to the pharmacological interventions was good, most used combination NRT and varenicline. Adherence to the counselling sessions was low, attending three of 12 sessions. Both NRT and MI were rated as highly acceptable. Some participants expressed concerns about the safety of varenicline. CONCLUSIONS The intervention was feasible and acceptable and associated with short-term smoking cessation and significant reductions in the number of cigarettes smoked-per-day.
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8
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Bonevski B, Manning V, Wynne O, Gartner C, Borland R, Baker AL, Segan CJ, Skelton E, Moore L, Bathish R, Chiu S, Guillaumier A, Lubman DI. QuitNic: A Pilot Randomized Controlled Trial Comparing Nicotine Vaping Products With Nicotine Replacement Therapy for Smoking Cessation Following Residential Detoxification. Nicotine Tob Res 2021; 23:462-470. [PMID: 32770246 PMCID: PMC7885782 DOI: 10.1093/ntr/ntaa143] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/30/2020] [Indexed: 12/22/2022]
Abstract
Introduction The QuitNic pilot trial aimed to test the feasibility of providing a nicotine vaping product (NVP) compared with combination nicotine replacement therapy (NRT) to smokers upon discharge from a smoke-free residential substance use disorder (SUD) treatment service. Methods QuitNic was a pragmatic two-arm randomized controlled trial. At discharge from residential withdrawal, 100 clients received telephone Quitline behavioral support and either 12-week supply of NRT or an NVP. Treatment adherence and acceptability, self-reported abstinence, cigarettes smoked per day (CPD), frequency of cravings, and severity of withdrawal symptoms were assessed at 6 and 12 weeks. Results are reported for complete cases and for abstinence outcomes, penalized imputation results are reported where missing is assumed smoking. Results Retention on was 63% at 6 weeks and 50% at 12 weeks. At 12 weeks, 68% of the NRT group reported using combination NRT while 96% of the NVP group used the device. Acceptability ratings for the products were high in both groups. At 12 weeks, 14% of the NVP group and 18% of the NRT group reported not smoking at all in the last 7 days. Mean CPD among continued smokers decreased significantly between baseline to 12 weeks in both groups; from 19.91 to 4.72 for the NVP group (p < .001) and from 20.88 to 5.52 in the NRT group (p < .001). Cravings and withdrawal symptoms significantly decreased for both groups. Conclusions Clients completing residential withdrawal readily engaged with smoking cessation post-treatment when given the opportunity. Further research is required to identify the most effective treatments postwithdrawal for this population at elevated risk of tobacco-related harm. Trial registration number ACTRN12617000849392 Implications This pilot study showed that smoking cessation support involving options for nicotine replacement and Quitline-delivered cognitive behavioral counseling is attractive to people after they have been discharged from SUD treatment. Both nicotine vaping products and nicotine replacement therapies were highly acceptable and used by participants who reported reductions in cravings for cigarettes and perceptions of withdrawal symptoms and reductions in number of cigarettes smoked. Some participants self-reported abstinence from cigarettes—around one in five reported having quit smoking cigarettes at 12 weeks postdischarge. The results have significant public health implications for providing quit support following discharge from SUD treatment.
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Affiliation(s)
- Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Victoria Manning
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Coral Gartner
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia.,Faculty of Health and Behavioural Sciences, Queensland Alliance of Environmental Health Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Ron Borland
- The Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Catherine J Segan
- The Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eliza Skelton
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Lyndell Moore
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Ramez Bathish
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Simon Chiu
- Hunter Medical Research Institute (HMRI), Lambton, NSW, Australia
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Australia
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9
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Klemperer EM, Mermelstein R, Baker TB, Hughes JR, Fiore MC, Piper ME, Schlam TR, Jorenby DE, Collins LM, Cook JW. Predictors of Smoking Cessation Attempts and Success Following Motivation-Phase Interventions Among People Initially Unwilling to Quit Smoking. Nicotine Tob Res 2021; 22:1446-1452. [PMID: 32236417 DOI: 10.1093/ntr/ntaa051] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/18/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Most people who smoke cigarettes are not willing (ie, not ready) to make a quit attempt (QA) at any given time. Unfortunately, interventions intended to increase QAs and the success of QAs are only modestly effective. Identifying processes leading to QAs and quitting success could guide intervention development. AIMS AND METHODS This is a secondary analysis of a randomized factorial trial of 6 weeks of motivation-phase interventions among primary care patients (N = 517) who were initially unwilling to quit but were willing to reduce their smoking. Using logistic regression, we controlled for treatment condition and tested whether baseline or change in smoking-related constructs after 6 weeks of treatment predicted (1) making an at least 24 h QA between weeks 6 and 26 and (2) quitting success at week 26 (7-day point-prevalence abstinence among those who made a QA). Predictors included cigarettes/day, time to first cigarette, motivation to quit, quitting self-efficacy, anticipated urges to smoke if quit, positive affect, negative affect, and time spent around others who smoke. RESULTS In multivariable models that included all smoking-related constructs, changes in the following variables predicted initiating a QA above and beyond other variables: greater baseline time to first cigarette (odds ratio [OR] = 1.60), increases in time to first cigarette (OR = 1.27), and increases in quitting self-efficacy (OR = 1.14). Increased motivation to quit predicted conversion of a QA into quitting success at 26 weeks (OR = 1.36). CONCLUSION Predictors of making a QA differed from predictors of quitting success. Predictors of QAs and success could each serve as important treatment targets of motivation-phase interventions. IMPLICATIONS Motivation-phase interventions for people initially unwilling to quit smoking cigarettes may be improved by striving to increase their (1) time to first cigarette and quitting self-efficacy to promote QAs and (2) motivation to quit to promote quit success. Future experimental tests of such interventions are needed to identify causal determinants of QAs and quitting success.
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Affiliation(s)
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI
| | - John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI
| | - Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI
| | - Tanya R Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI
| | - Linda M Collins
- Department of Human Development and Family Studies and Statistics, Pennsylvania State University, University Park, PA
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI
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10
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Kittaneh AA, Sidhu NK, Tackett AP, Lechner WV. Effects of Negative Emotion on Abstinence Induced Change in Urge to Vape and Measures of Vaping Dependence. Subst Use Misuse 2021; 56:768-776. [PMID: 33706646 DOI: 10.1080/10826084.2021.1892143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Negative emotion and craving to smoke are established factors driving the maintenance of combustible cigarette use and dependence. The current study aimed to examine whether these findings extend to e-cigarette use. Toward that aim, change in vaping urge following abstinence was examined as a function of negative emotion. Additionally, a mediation model which previously demonstrated relationships between negative emotion, craving, and combustible cigarette dependence was tested in e-cigarette users. METHOD Daily e-cigarette users (N = 32, Mage = 21 years, SDage = 7 years; 78% white) completed a battery of psychological, behavioral, and smoking-related measures in a human laboratory setting. Using their personal devices, participants completed a 5-minute ad-libitum vaping session, a baseline measure of vaping urge, followed by a 2-hour observed abstinence period and a final assessment of vaping urge. RESULTS Multivariate regression and two mediation models were utilized to examine factors associated with vaping dependence. The results of these models indicated that negative affect predicted vaping urge following observed abstinence. The relationship between negative affect and measures of vaping dependence and habit, respectively, were significantly mediated by changes in urge during the abstinence period. CONCLUSIONS These preliminary results indicate that psychological constructs underlying vaping dependence are similar to those previously found to be associated with combustible cigarette dependence. Further research examining whether these constructs, namely negative affect and change in urge following abstinence, will be important variables to target for vaping cessation treatments is needed.
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Affiliation(s)
- Ahmad A Kittaneh
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Natasha K Sidhu
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Alayna P Tackett
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - William V Lechner
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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11
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Taylor A, Thompson TP, Ussher M, Aveyard P, Murray RL, Harris T, Creanor S, Green C, Streeter AJ, Chynoweth J, Ingram W, Greaves CJ, Hancocks H, Snowsill T, Callaghan L, Price L, Horrell J, King J, Gude A, George M, Wahlich C, Hamilton L, Cheema K, Campbell S, Preece D. Randomised controlled trial of tailored support to increase physical activity and reduce smoking in smokers not immediately ready to quit: protocol for the Trial of physical Activity-assisted Reduction of Smoking (TARS) Study. BMJ Open 2020; 10:e043331. [PMID: 33262194 PMCID: PMC7709511 DOI: 10.1136/bmjopen-2020-043331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Smoking reduction can lead to increased success in quitting. This study aims to determine if a client-focused motivational support package for smoking reduction (and quitting) and increasing (or otherwise using) physical activity (PA) can help smokers who do not wish to quit immediately to reduce the amount they smoke, and ultimately quit. This paper reports the study design and methods. METHODS AND ANALYSIS A pragmatic, multicentred, parallel, two group, randomised controlled superiority clinical trial, with embedded process evaluation and economics evaluation. Participants who wished to reduce smoking with no immediate plans to quit were randomised 1:1 to receive either (1) tailored individual health trainer face-to-face and/or telephone support to reduce smoking and increase PA as an aid to smoking reduction (intervention) or (2) brief written/electronic advice to reduce or quit smoking (control). Participants in both arms of the trial were also signposted to usual local support for smoking reduction and quitting. The primary outcome measure is 6-month carbon monoxide-confirmed floating prolonged abstinence following participant self-reported quitting on a mailed questionnaire at 3 and 9 months post-baseline. Participants confirmed as abstinent at 9 months will be followed up at 15 months. ETHICS AND DISSEMINATION Approved by SW Bristol National Health Service Research Committee (17/SW/0223). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals. Results will be disseminated to trial participants and healthcare providers. TRIAL REGISTRATION NUMBER ISRCTN47776579; Pre-results.
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Affiliation(s)
- Adrian Taylor
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Tom P Thompson
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Michael Ussher
- Division of Population Health Sciences and Education, University of London, St George's, London, UK
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Division of Public Health and Primary Health Care, Oxford, UK
| | | | - Tess Harris
- Division of Population Health Sciences and Education, University of London, St George's, London, UK
| | - Siobhan Creanor
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Colin Green
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Jade Chynoweth
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Wendy Ingram
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK
| | - Helen Hancocks
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Tristan Snowsill
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lynne Callaghan
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Lisa Price
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Jane Horrell
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jennie King
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alex Gude
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Mary George
- Division of Population Health Sciences and Education, University of London, St George's, London, UK
| | - Charlotte Wahlich
- Division of Population Health Sciences and Education, University of London, St George's, London, UK
| | - Louisa Hamilton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Division of Public Health and Primary Health Care, Oxford, UK
| | - Kelisha Cheema
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Campbell
- School of Medicine, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Dan Preece
- Public Health, Plymouth City Council, Windsor House, Plymouth, Devon, UK
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12
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Watson NL, Heffner JL, Mull KE, McClure JB, Bricker JB. Which Method of Assessing Depression and Anxiety Best Predicts Smoking Cessation: Screening Instruments or Self-Reported Conditions? Nicotine Tob Res 2020; 22:1860-1866. [PMID: 32484870 DOI: 10.1093/ntr/ntaa099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/26/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Affective disorders and symptoms (ADS) are predictive of lower odds of quitting smoking. However, it is unknown which approach to assessing ADS best predicts cessation. This study compared a battery of ADS screening instruments with a single, self-report question on predicting cessation. Among those who self-reported ADS, we also examined if an additional question regarding whether participants believed the condition(s) might interfere with their ability to quit added predictive utility to the single-item question. METHODS Participants (N = 2637) enrolled in a randomized controlled trial of web-based smoking treatments completed a battery of five ADS screening instruments and answered a single-item question about having ADS. Those with a positive self-report on the single-item question were also asked about their interference beliefs. The primary outcome was complete-case, self-reported 30-day point prevalence abstinence at 12 months. RESULTS Both assessment approaches significantly predicted cessation. Screening positive for ≥ one ADS in the battery was associated with 23% lower odds of quitting than not screening positive for any (p = .023); those with a positive self-report on the single-item had 39% lower odds of quitting than self-reporting no mental health conditions (p < .001). Area under the receiver operating characteristic curve values for the two assessment approaches were similar (p = .136). Adding the interference belief question to the single-item assessment significantly increased the area under the receiver operating characteristic curve value (p = .042). CONCLUSIONS The single-item question assessing ADS had as much predictive validity, and possibly more, than the battery of screening instruments for identifying participants at risk for failing to quit smoking. Adding a question about interference beliefs significantly increased the predictive utility of the single-item question. IMPLICATIONS This is the first study to demonstrate that a single-item question assessing ADS has at least as much predictive validity, and possibly more, than a battery of validated screening instruments for identifying smokers at highest risk for cessation failure. This study also demonstrates adding a question about interference beliefs significantly adds to the predictive utility of a single, self-report question about mental health conditions. Findings from this study can be used to inform decisions regarding how to assess ADS in the context of tobacco treatment settings.
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Affiliation(s)
- Noreen L Watson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kristin E Mull
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Psychology, University of Washington, Seattle, WA
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13
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Alzyoud S, Veeranki SP, Pbert L. Waterpipe tobacco smoking: nicotine dependence and smoking control strategies among youth. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1738572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sukaina Alzyoud
- Department of Community and Mental Health, Faculty of Nursing, Hashemite University, Zarqa, Jordan
- World Health Organization, Amman, Jordan
| | - Sreenivas P. Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
- Premier Applied Sciences, Premier Inc., Charlotte, North Carolina, USA
| | - Lori Pbert
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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14
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Nadaleti NP, Ribeiro JF, Ferreira PM, Santos SVMD, Terra FDS. Self-esteem and consumption of alcohol, tobacco, and other substances in outsourced workers. Rev Lat Am Enfermagem 2019; 27:e3199. [PMID: 31618392 PMCID: PMC6792343 DOI: 10.1590/1518-8345.3401.3199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/29/2019] [Indexed: 01/20/2023] Open
Abstract
Objective to evaluate self-esteem, the consumption of alcohol, tobacco and other
substances in outsourced workers of a public university. Method a descriptive-analytical, cross-sectional, quantitative study developed with
316 outsourced workers from a municipality in the Southeast of Brazil. Data
was collected through a characterization tool, the Rosenberg Self-Esteem
Scale and the Alcohol, Smoking and Substance Involvement Screening Test. For
data analysis, we used descriptive statistics, Pearson’s chi-square test,
Fisher’s exact test, odds ratio and logistic regression. Results the majority of workers had high self-esteem and some used alcohol, tobacco,
marijuana and inhalants. A significant association between gender, age group
and work shift with self-esteem; between the risk of developing problems
related to alcohol consumption with sex, age group, marital status,
religious belief and number of children; between the practice of physical
activity and the risk of developing problems related to the consumption of
tobacco products was found. Conclusion this study contributes to the increase of knowledge due to the small number
of researches involving this subject and to contribute to the nurses to have
subsidies to work with this population using strategies to combat the
triggers of psychic disorders.
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Affiliation(s)
- Nayara Pires Nadaleti
- Universidade Federal de Alfenas, Escola de Enfermagem, Alfenas, MG, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Jefferson Felipe Ribeiro
- Universidade Federal de Alfenas, Escola de Enfermagem, Alfenas, MG, Brasil.,Bolsista do MEC/SESu/PET, Brasil
| | - Poliana Martins Ferreira
- Universidade Federal de Alfenas, Escola de Enfermagem, Alfenas, MG, Brasil.,Bolsista do MEC/SESu/PET, Brasil
| | - Sérgio Valverde Marques Dos Santos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil.,Bolsista da Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brasil
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15
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Stennett A, Krebs NM, Liao J, Richie JP, Muscat JE. Ecological momentary assessment of smoking behaviors in native and converted intermittent smokers. Am J Addict 2019; 27:131-138. [PMID: 29489042 DOI: 10.1111/ajad.12690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES About 22% of adult smokers in the U.S. are intermittent cigarette smokers (ITS). ITS can be further classified as native ITS who never smoked daily and converted ITS who formerly smoked daily but reduced to intermittent smoking. Ecological momentary assessment (EMA) was conducted to determine the behaviors and experiences that are associated with the decision to smoke. METHODS The study included 24 native ITS and 36 converted ITS (N = 60) from the Pennsylvania Adult Smoking Study. A baseline questionnaire, daily log, and an EMA smoking log that assessed emotions, activities, and smoking urges was filled out with each cigarette for 1 week to capture 574 smoking sessions. RESULTS Both groups had very low levels of cigarette dependence. Both groups were more tempted to smoke in positive or negative situations than situations associated with habituation. EMA showed that the most common emotional state during smoking sessions was positive (47%), followed by negative (32%), neutral (16%), and mixed (5%) emotions. Smokers were more likely to smoke during activities of leisure (48%) than during performative duties (29%), social (16%) or interactive occasions (7%). Converted ITS were more likely to smoke alone compared to native ITS (p < .001). DISCUSSION AND CONCLUSIONS ITS report minimal levels of dependence when captured on traditional scales of nicotine dependence, yet experience loss of autonomy and difficulty quitting. The majority of the ITS reported positive emotions and leisure activities while smoking, and smoked during the evening. SCIENTIFIC SIGNIFICANCE The current paper identifies environmental and behavioral factors that are associated with smoking among ITS in real time. (Am J Addict 2018;27:131-138).
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Affiliation(s)
- Andrea Stennett
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jason Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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16
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2018. SELECTION CRITERIA Randomised or quasi-randomised controlled trials which offered proactive or reactive telephone counselling to smokers to assist smoking cessation. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We pooled studies using a random-effects model and assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I2 statistic. In trials including smokers who did not call a quitline, we used meta-regression to investigate moderation of the effect of telephone counselling by the planned number of calls in the intervention, trial selection of participants that were motivated to quit, and the baseline support provided together with telephone counselling (either self-help only, brief face-to-face intervention, pharmacotherapy, or financial incentives). MAIN RESULTS We identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long-term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms.Among trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self-help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate.In studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate. In subgroup analysis, we found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta-regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self-help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate-certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. There is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. Evidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention.
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Affiliation(s)
| | - José M. Ordóñez‐Mena
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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17
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Guillaumier A, Manning V, Wynne O, Gartner C, Borland R, Baker AL, Segan CJ, Skelton E, Moore L, Bathish R, Lubman DI, Bonevski B. Electronic nicotine devices to aid smoking cessation by alcohol- and drug-dependent clients: protocol for a pilot randomised controlled trial. Trials 2018; 19:415. [PMID: 30071863 PMCID: PMC6090830 DOI: 10.1186/s13063-018-2786-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Up to 95% of people entering treatment for use of alcohol or other drugs (AOD) smoke tobacco. Smokers receiving treatment for AOD use are interested in quitting and make quit attempts, but relapse is more common and rapid compared with the general population of smokers. New ways to address smoking in this population are needed. Electronic nicotine devices (ENDs) or electronic cigarettes hold significant potential as both cessation aids and harm reduction support. This study focuses on the potential of ENDs to facilitate smoking cessation and to sustain it in the medium term among people in treatment for AOD use. The aim of this trial is to explore the effectiveness, feasibility and acceptability of ENDs for smoking cessation compared with combination nicotine replacement therapy (NRT) for clients after discharge from a smoke-free AOD residential withdrawal service. Methods/design The study is a pragmatic randomised controlled trial. In total, 100 participants will be recruited following admission to a smoke-free residential withdrawal service in Melbourne, Australia. Participants will complete a baseline survey and be randomised to either the END group (n = 50) or the NRT group (n = 50) prior to discharge. Both groups will receive telephone counselling support from quitline. Follow-up measures will be assessed at 6 and 12 weeks following discharge. The primary outcome is continuous abstinence from smoking at 12 weeks post discharge. Secondary outcomes include: 7-day point prevalence from smoking, point prevalence abstinence from all nicotine (including NRT and ENDs), cravings and withdrawal, time to relapse, and treatment adherence (use of NRT, ENDs and quitline). Discussion This is the first randomised controlled trial to assess the effectiveness and acceptability of ENDs within a population dependent on AOD, a priority group with very high levels of smoking. The research will test a model of how to incorporate novel smoking cessation support into a period of high treatment receptiveness. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN12617000849392. Registered on 8 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2786-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashleigh Guillaumier
- School of Medicine & Public Health, University of Newcastle, Callaghan, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.,Turning Point, Eastern Health, Fitzroy, Australia
| | - Olivia Wynne
- School of Medicine & Public Health, University of Newcastle, Callaghan, Australia
| | - Coral Gartner
- Faculty of Medicine, School of Public Health, The University of Queensland, St Lucia, QLD, Australia
| | - Ron Borland
- The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Amanda L Baker
- School of Medicine & Public Health, University of Newcastle, Callaghan, Australia
| | - Catherine J Segan
- The Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eliza Skelton
- School of Medicine & Public Health, University of Newcastle, Callaghan, Australia
| | - Lyndell Moore
- School of Medicine & Public Health, University of Newcastle, Callaghan, Australia
| | - Ramez Bathish
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.,Turning Point, Eastern Health, Fitzroy, Australia
| | - Dan I Lubman
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.,Turning Point, Eastern Health, Fitzroy, Australia
| | - Billie Bonevski
- School of Medicine & Public Health, University of Newcastle, Callaghan, Australia.
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18
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Schensul JJ, Begum S, Nair S, Oncken C. Challenges in Indian Women’s Readiness to Quit Smokeless Tobacco Use. Asian Pac J Cancer Prev 2018; 19:1561-1569. [PMID: 29936780 PMCID: PMC6103596 DOI: 10.22034/apjcp.2018.19.6.1561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: In India, there are few cessation programs for women smokeless tobacco (SLT) users who want to quit.
This paper uses Fishbein’s IM model to identify women SLT users’ challenges to quitting and multilevel correlates of
“readiness to quit”. Methods: A survey of SLT use among women of reproductive age was conducted in 2010-13 in an
urban slum community of Mumbai with a representative sample of 409 married women aged 18 to 40 years using at least
one type of SLT daily. Data were analyzed using frequencies, bivariate statistics and logistic regression. Results: Social
influences to continue SLT use included husband’s use (71%), family influence and positive beliefs and norms about use.
Pressure to quit from significant others influenced past quit attempts but media had no effect on reported behavior. Four
groups represented different readiness to quit statues based on intention to quit and past quit/reduce attempts. Seventeen
percent had no intention of quitting or reducing; their husbands were more likely to be tobacco users. Half of (52%)
the sample had attempted to quit/reduce tobacco and intended to do so in the future. These women were depressed.
Fifteen percent had tried to quit but did not intend to again. Correlates were positive beliefs and norms about SLT and
withdrawal symptoms. Conclusions: Cessation programs should be made available to women, addressing correlates of
women’s readiness to quit statuses. Results suggest the need for more complex social/contextual approaches to sustained
cessation of SLT use including addressing depression and withdrawal, improved media messages and campaigns tailored
to women, and support from family members.
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Affiliation(s)
- Jean J Schensul
- Institute for Community Research, 2Hartford Square West, Ste 100, Hartford, USA.
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19
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Lechner WV, L Gunn R, Minto A, Philip NS, Brown RA, Uebelacker LA, Price LH, Abrantes AM. Effects of Negative Affect, Urge to Smoke, and Working Memory Performance (n-back) on Nicotine Dependence. Subst Use Misuse 2018; 53:1177-1183. [PMID: 29185837 PMCID: PMC7376498 DOI: 10.1080/10826084.2017.1400569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Three key domains including negative emotionality, incentive salience, and executive function form the core functional elements of addictive behaviors. Variables related to these broader domains have been studied extensively in relation to one another; however, no studies to date, have examined models including variables from all three domains, in relation to nicotine dependence. METHOD Smokers (N = 117), 65.8% female, 78% white, mean age of 44.4 (SD = 10.8), enrolled in a smoking cessation program completed measures of negative affect (a component of negative emotionality), urge to smoke (incentive salience), and working memory (WM; a core executive function), during a baseline assessment period prior to initiating treatment. RESULTS Negative affect was associated with greater urge to smoke, and this elevated urge to smoke was associated with higher levels of nicotine dependence. Further, a significant moderated mediation indicated that WM moderated the relationship between increased urge to smoke and nicotine dependence. For those with low to average WM, urge to smoke was significantly related to nicotine dependence; however, for those with higher WM (+1 SD), urge to smoke stemming from negative affect was not associated with nicotine dependence. CONCLUSIONS To our knowledge, this is the first reported relationship between negative affect, urge to smoke, WM, and nicotine dependence. Although preliminary, results indicate that WM may moderate the relationship between urge to smoke associated with negative affect and nicotine dependence. Treatments targeting WM may be particularly useful for individuals with average to low WM who experience urge to smoke related to negative affect.
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Affiliation(s)
- William V Lechner
- a Department of Psychological Sciences , Kent State University , Kent , Ohio , USA.,b Center for Alcohol and Addiction Studies , Brown University School of Public Health , Providence , Rhode Island , USA
| | - Rachel L Gunn
- b Center for Alcohol and Addiction Studies , Brown University School of Public Health , Providence , Rhode Island , USA
| | - Alexia Minto
- c Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , Rhode Island , USA
| | - Noah S Philip
- d Butler Hospital , Providence , Rhode Island , USA.,e Center for Neurorestoration and Neurotechnology , Providence VA Medical Center , Providence, Rhode Island , USA
| | | | - Lisa A Uebelacker
- c Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , Rhode Island , USA.,d Butler Hospital , Providence , Rhode Island , USA
| | - Lawrence H Price
- c Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , Rhode Island , USA.,d Butler Hospital , Providence , Rhode Island , USA
| | - Ana M Abrantes
- c Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University , Providence , Rhode Island , USA.,d Butler Hospital , Providence , Rhode Island , USA
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Johnson JM, Muilenburg JL, Rathbun SL, Yu X, Naeher LP, Wang JS. Elevated Nicotine Dependence Scores among Electronic Cigarette Users at an Electronic Cigarette Convention. J Community Health 2017; 43:164-174. [DOI: 10.1007/s10900-017-0399-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abdolahi A, Williams GC, Benesch CG, Wang HZ, Spitzer EM, Scott BE, Block RC, van Wijngaarden E. Immediate and Sustained Decrease in Smoking Urges After Acute Insular Cortex Damage. Nicotine Tob Res 2017; 19:756-762. [PMID: 28199722 PMCID: PMC5896541 DOI: 10.1093/ntr/ntx046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/07/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Smoking urges are fundamental aspects of nicotine dependence that contribute significantly to drug use and postquit relapse. Recent evidence has indicated that damage to the insular cortex disrupts smoking behaviors and claims to reduce urges associated with nicotine use, although tools that assess urge have yet to be used to validate these findings. We examined the effect of insular versus non-insular damage on urge using a well-accepted urge scale. METHODS This 3-month observational prospective cohort study consisted of 156 current smokers hospitalized for acute ischemic stroke (38 with insular infarctions, 118 with non-insular infarctions). During hospitalization, the Questionnaire of Smoking Urges (QSU)-brief was assessed retrospectively based on experiences before the stroke (baseline, T0), prospectively immediately following the stroke (T1) and once more via telephone at 3-month follow-up (T2), with higher scores indicating greater urge. Bivariate statistics and multivariable linear regression were used to evaluate differences in QSU-brief scores, relative to baseline, between exposure groups, controlling for age, baseline dependence, stroke severity, use of nicotine replacement, and damage to other mesocorticolimbic regions. RESULTS A greater reduction in QSU-brief score was seen in the insular group compared to the non-insular group from T0 to T1 (covariate-adjusted difference in means of -1.15, 95% CI: -1.85, -0.44) and similarly from T0 to T2 (covariate-adjusted difference in means of -0.93, 95% CI: -1.79, -0.07). CONCLUSIONS These findings confirm the potential role of the insula in regulating nicotine-induced urges and support the growing evidence of its novelty as a key target for smoking cessation interventions. IMPLICATIONS Human lesioning studies that evaluate the insula's involvement in maintaining nicotine addiction make inferences of the insula's role in decreasing urge, but do not use validated instruments that directly assess urges. This study corroborates prior findings using the continuous Questionnaire of Smoking Urges to quantify changes in urge from before lesion onset to immediate and 3-month follow-up time points.
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Affiliation(s)
- Amir Abdolahi
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
- Department of Acute Care Solutions, Philips Research North America, Cambridge, MA
| | - Geoffrey C Williams
- Departments of Medicine, Psychiatry, and Clinical and Social Sciences in Psychology, University of Rochester Medical Center, Rochester, NY
| | - Curtis G Benesch
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Eric M Spitzer
- Department of Radiology, Rochester General Health System, Rochester, NY
| | - Bryan E Scott
- Department of Radiology, Rochester General Health System, Rochester, NY
| | - Robert C Block
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
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Riaz M, Lewis S, Coleman T, Aveyard P, West R, Naughton F, Ussher M. Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial. Addiction 2016; 111:1656-65. [PMID: 26997495 PMCID: PMC5084769 DOI: 10.1111/add.13395] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/26/2015] [Accepted: 03/14/2016] [Indexed: 11/27/2022]
Abstract
AIMS To examine the ability of different common measures of cigarette dependence to predict smoking cessation during pregnancy. DESIGN Secondary analysis of data from a parallel-group randomized controlled trial of physical activity for smoking cessation. The outcomes were biochemically validated smoking abstinence at 4 weeks post-quit and end-of-pregnancy. SETTING Women identified as smokers in antenatal clinics in 13 hospital trusts predominantly in southern England, who were recruited to a smoking cessation trial. PARTICIPANTS Of 789 pregnant smokers recruited, 784 were included in the analysis. MEASUREMENTS Using random-effect logistic regression models, we analysed the effects of baseline measures of cigarette dependence, including numbers of cigarettes smoked daily, Fagerström Test of Cigarette Dependence (FTCD) score, the two FTCD subscales of Heaviness of Smoking Index (HSI) and non-Heaviness of Smoking Index (non-HSI), expired carbon monoxide (CO) level and urges to smoke (strength and frequency) on smoking cessation. Associations were adjusted for significant socio-demographic/health behaviour predictors and trial variables, and area under the receiver operating characteristic (ROC) curve was used to determine the predictive ability of the model for each measure of dependence. FINDINGS All the dependence variables predicted abstinence at 4 weeks and end-of-pregnancy. At 4 weeks, the adjusted odds ratio (OR) (95% confidence interval) for a unit standard deviation increase in FTCD was 0.59 (0.47-0.74), expired CO = 0.54 (0.41-0.71), number of cigarettes smoked per day 0.65 (0.51-0.84) and frequency of urges to smoke 0.79 (0.63-0.98); at end-of-pregnancy they were: 0.60 (0.45-0.81), 0.55 (0.37-0.80), 0.70 (0.49-0.98) and 0.69 (0.51-0.94), respectively. HSI and non-HSI exhibited similar results to the full FTCD. CONCLUSIONS Four common measures of dependence, including number of cigarettes smoked per day, scores for Fagerström Test of Cigarette Dependence and frequency of urges and level of expired CO, all predicted smoking abstinence in the short term during pregnancy and at end-of-pregnancy with very similar predictive validity.
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Affiliation(s)
- Muhammad Riaz
- Population Health Research Institute, St George's University of LondonLondonUK
| | - Sarah Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Tim Coleman
- Division of Primary Care and UK Centre for Tobacco and Alcohol StudiesUniversity of NottinghamNottinghamUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCLLondonUK
| | - Felix Naughton
- Behavioural Science Group, Institute of Public HealthUniversity of CambridgeCambridgeUK
| | - Michael Ussher
- Population Health Research Institute, St George's University of LondonLondonUK
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Impact and Duration of Brief Surgeon-Delivered Smoking Cessation Advice on Attitudes Regarding Nicotine Dependence and Tobacco Harms for Patients with Peripheral Arterial Disease. Ann Vasc Surg 2016; 38:113-121. [PMID: 27521828 DOI: 10.1016/j.avsg.2016.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite the recognized benefits of smoking cessation, many clinicians question if a brief smoking cessation intervention can help dedicated smokers with peripheral arterial disease understand nicotine dependence and harms related to smoking. We investigated the impact and durability of a multimodal smoking cessation intervention on patient attitudes regarding nicotine dependence and the health effects of smoking. METHODS We conducted a pilot cluster-randomized trial of a brief smoking cessation intervention at 8 vascular surgery practices between September 1, 2014 and August 31, 2015. Compared with control sites, patients at intervention sites received protocolized brief cessation counseling, medications, and referrals to a quitline. After their clinic visit and again at 3 months, participants completed a brief survey about patient attitudes regarding nicotine dependence and the health effects of smoking. Responses to questions were analyzed using chi-squared test and Student's t-test. RESULTS All trial participants (n = 156) complete the initial survey, and 75 (45%) participants completed the follow-up survey. Intervention and control patients both reported a greater than 30-pack-year history (80% vs. 90%, P = 0.07) and previous failed quit attempts (77% vs. 78%, P = 0.8). Compared with usual care, patients in the intervention group were more likely to describe hearing advice to quit from their surgeon (98% vs. 77%, P < 0.001), and expressed "a lot" or "some" interest in quitting (95.4% vs. 85.7%, P = 0.05). Patients in the intervention group were also more likely to acknowledge their addictive behaviors, consistently scoring higher on question bank items regarding nicotine addiction (52.9 vs. 48.0, P = 0.006) and the negative health effects of smoking (scaled score 56.6 vs. 50.6, P = 0.001). When resurveyed 3 months after intervention, patients in the intervention group had larger declines in nicotine dependence and health effect domains, suggesting durable impact of the intervention on patient attitudes regarding nicotine addiction and smoking harms. CONCLUSIONS Brief smoking cessation counseling by a vascular surgeon increases patient interest in smoking cessation and awareness of smoking harms, and this effect was durable 3 months after intervention. This evidence suggests that even brief counseling within a surgical clinic has the potential to impact patient desire to quit.
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