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Dickreuter JL, Schmoor C, Jähne A, Bengel J, Pschichholz B, Lorz C, Schulz C, Vozelj J, Leifert JA. Effectiveness of residential versus outpatient therapy for smoking cessation: The START randomized clinical trial. Addiction 2024. [PMID: 38982899 DOI: 10.1111/add.16594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 05/22/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND AND AIMS Tobacco smoking represents a major cause for preventable death and morbidity. Results from non-randomized studies suggest that smoking cessation therapy in a residential setting might be a new viable way to facilitate smoking abstinence. We aimed to test the effects of residential multicomponent group therapy for smoking cessation compared with outpatient group therapy. DESIGN Prospective parallel-group open-label randomized superiority trial, with assessments at baseline, 6 and 12 months. SETTING Recruitment throughout Germany via media advertisements. PARTICIPANTS Adult smokers (≥10 cigarettes/day) randomly assigned to residential (n = 157) or outpatient (n = 158) therapy. 51.8% female; mean age 53.2 years; mean years of smoking 34.4. INTERVENTION AND COMPARATOR Residential 9-day smoking cessation group therapy comprising six daily therapy sessions and supportive interventions for cessation and daily structure embedded in the routines of a somatic rehabilitation center, compared with weekly outpatient smoking cessation group therapy (3-7 weeks) provided in routine care courses close to the participants' places of residence, both including at least 9 h of behavioral therapy. MEASUREMENTS Co-primary outcomes were self-reported continuous 6- and 12-month abstinence (hierarchically ordered). Primary analyses were conducted in the therapy-uptake population including participants who started therapy with sensitivity analyses in the intention-to-treat population of all randomized participants. FINDINGS Intervention uptake rates were 87.3% (n = 137) in the residential and 60.1% (n = 95) in the outpatient group. In the therapy-uptake population, abstinence rates were 46.7% in the residential versus 26.3% in the outpatient group at 6 months (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.39-4.33, P = 0.0019) and 39.4% versus 24.2% at 12 months (OR = 2.04, 95% CI = 1.14-3.64, P = 0.017). Biochemically validated abstinence rates at 12 months were 33.1% in the residential versus 17.4% in the outpatient group (OR = 2.35, 95% CI = 1.22-4.51, P = 0.011). In the intention-to-treat population, self-reported and biochemically validated abstinence rates at 12 months were 34.4% in the residential versus 14.6% in the outpatient group (OR = 3.08, 95% CI = 1.77-5.34, P < 0.0001) and 28.6% versus 10.3% (OR = 3.48, 95% CI = 1.85-6.52, P = 0.0001), respectively. CONCLUSIONS Residential therapy exclusively for smoking cessation is feasible and effective and could be a beneficial new treatment for smokers.
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Affiliation(s)
- Jonas Levin Dickreuter
- Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Barbara Pschichholz
- Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christina Lorz
- Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christina Schulz
- Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jana Vozelj
- Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jens Albert Leifert
- Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Breisgau-Klinik, Bad Krozingen, Germany
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Van den Brand FA, Martinelli T, de Haan-Bouma CI, Meerkerk GJ, Winkens B, Nagelhout GE. How a 5-Day Stay in the Tobacco-Free Environment of the Stoptober House Supports Individuals to Quit Smoking: A Mixed Methods Pilot Study. Eur Addict Res 2024; 30:103-113. [PMID: 38527439 DOI: 10.1159/000537929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION The Stoptober House is part of the annual national Stoptober smoking cessation campaign in the Netherlands. During the first week of October, 48 volunteers resided in the tobacco-free Stoptober House for 5 days and received smoking cessation counseling. This pilot study explored how the Stoptober House may have facilitated smoking cessation among participants. METHODS We included 48 individuals who were selected for the Stoptober House (intervention group) and 67 individuals who were not selected (control group). Surveys were conducted at baseline, immediately after 2 and 8 weeks of post-intervention. We compared self-reported abstinence, psychosocial mediators related to smoking cessation, and perceived active elements of the Stoptober House between the intervention and control groups using t/χ2 tests and linear mixed model (LMM) analysis. Sixteen semi-structured qualitative interviews were conducted to explore participants' perspectives on the elements contributing to their success in quitting smoking. RESULTS At 8 weeks of follow-up, a higher proportion of participants in the intervention group (24/48 [50%]) reported being abstinent compared to the control group (5/67 [7%]; p < 0.001). Among participants who reported making a quit attempt, 22/38 (57.9%) in the intervention group remained abstinent compared to 4/17 (23.5%) in the control group (p = 0.022). The intervention group also exhibited higher self-efficacy to quit smoking throughout the follow-up period and higher social support immediately after the Stoptober House. No significant differences were observed in other psychosocial factors. The interviews highlighted several perceived elements of the Stoptober House that contributed to smoking cessation success, including restricted smoking opportunities, access to smoking cessation counselors, and peer support. CONCLUSION This pilot study suggests that the Stoptober House provides support that can help people quit smoking. Further research is needed to confirm these findings and determine the cost-effectiveness of this intervention in promoting long-term abstinence among specific groups of smokers.
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Affiliation(s)
- Floor A Van den Brand
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Charlotte I de Haan-Bouma
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Gera E Nagelhout
- IVO Research Institute, The Hague, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Spoelstra SK, van de Graaf RC, Dijkstra A. Residential Treatment Exclusively for Tobacco Use Disorder: A Narrative Review. J Addict Med 2024; 18:33-41. [PMID: 37847568 DOI: 10.1097/adm.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Tobacco use disorder is a major public health issue, and novel smoking cessation approaches are urgently needed. Residential treatment programs have been suggested as a potentially effective treatment for tobacco use disorder. However, there is limited literature on residential treatment programs for patients who are exclusively dependent on nicotine. AIM The aim of this study is to review the literature on residential treatment programs for patients admitted exclusively for tobacco use disorder. METHODS A literature search was conducted in PubMed with the aim of identifying relevant articles on residential treatment exclusively for tobacco use disorder from inception until February 2023. References in retrieved articles were screened for additional relevant articles. RESULTS Fourteen studies on residential treatment programs for tobacco use disorder were identified. The duration of the residential cessation programs ranged from 3 days to 3 weeks. Individualized or group cognitive behavioral therapy and tailored pharmacotherapy were the key components of the programs. Eligibility criteria for the programs included moderate to severe tobacco use disorder as measured by Fagerström or Diagnostic and Statistical Manual of Mental Disorders (DSM), consistent relapses, smoking-related comorbidities (eg, cardiovascular or pulmonary diseases), and daily use of (smokeless) tobacco. The 6- and 12-month 7-day point prevalence rate ranged from 58% to 26%, whereas the 6- and 12-month continuous abstinence rate ranged from 52% to 29%. CONCLUSIONS Based on the literature we reviewed, residential smoking cessation programs targeted exclusively at individuals with tobacco use disorder have shown effectiveness, particularly for those who are highly dependent on tobacco and have a history of relapse. However, more research is needed to further explore the effectiveness of these programs and to determine the optimal program components and duration.
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Affiliation(s)
- Symen Kornelis Spoelstra
- From the Addiction Care Northern Netherlands, Groningen, the Netherlands; NHL Stenden University of Applied Science, Leeuwarden, the Netherlands (SKS); Occupational Health Service Medprevent, Lippenhuizen, The Netherlands (RCVDG); and Department of Psychology, University of Groningen, Groningen, the Netherlands (AD)
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Leifert JA, Schulz C, Engler U. Residential treatment exclusively for smoking cessation in
patients with Crohn’s disease: Results from a pilot study. Tob Induc Dis 2022; 20:60. [PMID: 35836910 PMCID: PMC9227602 DOI: 10.18332/tid/149481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cigarette smoking is a risk factor for the induction and severity of the course of Crohn’s disease (CD). Hospital admission may be required for treatment of the disease but is generally not available solely for smoking cessation. Outpatient group therapy is readily available, however long-term quit rates are limited. Residential treatment for smoking cessation may offer a more intense contact between patient and therapist, and may result in higher abstinence rates in a sensitive group of patients. The objective of this pilot study is to evaluate the feasibility of implementing a residential program with hospital admission, exclusively for smoking cessation for patients suffering from CD. METHODS Twelve eligible smokers suffering from CD were recruited for a 9-day inpatient smoking cessation treatment. Treatment consisted of single and group behavioral therapy together with supportive measures such as exercise therapy, relaxation techniques or nutritional counselling. Nicotine replacement therapy or prescription medication was offered according to the Fagerström test for nicotine dependence (FTND) score and treatment guidelines. Quit rates were assessed by CO-testing during hospital treatment and by follow-up calls 6 months after discharge. RESULTS All recruited participants arrived on time for treatment and collectively stopped smoking on the 2nd day after admission. All participants completed the therapy process without relapse and left the hospital smoke-free (100% quit rate on discharge, CO monitored). Self-reported abstinence rates after 6 months were 72.7% for continuous abstinence and 81.8% for 7-day point prevalence abstinence. CONCLUSIONS Residential treatment exclusively for smoking cessation is feasible and efficient and may be a valuable treatment option for patients suffering from CD.
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Affiliation(s)
- Jens A. Leifert
- Comprehensive Cancer Center Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
- Department of Oncology, Breisgau Klinik, Bad Kozingen, Germany
| | - Cornelia Schulz
- Comprehensive Cancer Center Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Uta Engler
- Comprehensive Cancer Center Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
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Dickreuter J, Jähne A, Leifert JA. Stationäre Behandlung exklusiv zur Raucherentwöhnung
– Konzept einer intensivierten verhaltenstherapeutischen
Gruppentherapie. SUCHTTHERAPIE 2022. [DOI: 10.1055/a-1731-6386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Zusammenfassung
Zielsetzung Angesichts hoher Morbidität und Mortalität
durch Tabakabhängigkeit besteht ein dringender Bedarf an effektiven
Angeboten zur Raucherentwöhnung. Die leitliniengemäß
durchgeführten ambulanten Therapien sind in ihrer langfristigen
Wirksamkeit jedoch limitiert. Im Folgenden wird ein erstmalig in Deutschland
entwickeltes wissenschaftliches stationäres Therapiekonzept
ausschließlich zur stationären Raucherentwöhnung
beschrieben und die Evidenz für die langfristige Effektivität
dieser intensivierten Therapieform zur Raucherentwöhnung diskutiert.
Methodik Es handelt es sich um ein multimodales neuntägiges
verhaltenstherapeutisches Therapiekonzept für den stationären
Einsatz. Die Entwöhnung wird als Gruppentherapie
leitliniengemäß von einem mobil einsetzbaren Team geschulter
Raucherentwöhner:innen durchgeführt, ergänzt durch
Angebote zur Förderung der Gruppenkohäsion, Tagesstrukturierung,
zum Bewegungstraining, Ernährungsmanagement, Ressourcenaufbau,
Expositionstraining rückfallkritischer Situationen und zur
achtsamkeitsbasierten Stressbewältigung.
Schlussfolgerungen Eine stationäre
Raucherentwöhnungstherapie ist als vielversprechende Ergänzung
bzw. Alternative zur ambulanten Entwöhnung umsetzbar. Die intrinsische
Abstinenzmotivation soll in einem geschützten Rahmen bei professioneller
Betreuung und Unterstützung in der Gruppe gestärkt werden mit
Fokus auf den Transfer der Kompetenzen in den Alltag. Erste Studienergebnisse
weisen auf eine hohe langfristige Entwöhnungsquote hin. Eine
wissenschaftliche Überprüfung der (Kosten-)Effektivität
anhand randomisiert-kontrollierter Studien steht noch aus.
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Affiliation(s)
| | | | - Jens A. Leifert
- Universitätsklinikum Freiburg, Tumorzentrum (CCCF),
Freiburg
- Breisgau-Klinik, Abteilung Innere Medizin – Onkologie, Bad
Krozingen
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Lee D, Lee KS, Lee A, Ahn H, Lee HK, Kim H, Lee J, Seo HG. Successful Smoking Cessation among Women Smokers Based on Utilizing National Smoking Cessation Service Type in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126578. [PMID: 34207330 PMCID: PMC8296442 DOI: 10.3390/ijerph18126578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Background: This study aimed to evaluate the successful smoking cessation across different national smoking cessation services. Methods: This study included data that had been previously entered into the integrated information system for smoking cessation services and comprised 144,688 participants after excluding missing data. These clinics provide face-to-face counseling, phone calls, text messages, and e-mail services for six months and nine sessions. Results: The women-only program had the lowest success rate (11.3%). Compared with the women-only program, the six-month success rate of smoking cessation clinic at public health centers (OR = 3.72, CI = [3.52, 3.92]), visiting-type smoking cessation clinics (OR = 2.97, CI = [2.79, 3.16]), the residential 4 -night 5-day program (OR = 7.79, CI = [6.49, 9.35]), and a program for inpatients (OR = 2.36, CI = [1.89, 2.94]) showed a significant increase. Conclusions: Emotional labor workers who participated in the women-only program had low smoking cessation success rates, while those who participated in the residential 4-night 5-day program had high success rates.
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Affiliation(s)
- Dahyeon Lee
- Department of Health Promotion, Graduate School of Public Health, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Kang-Sook Lee
- Department of Health Promotion, Graduate School of Public Health, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Public Health, Graduate School, The Catholic University of Korea, Seoul 06591, Korea
- Korean Association on Smoking or Health, Seoul 07238, Korea; (H.A.); (H.-K.L.); (H.K.); (J.L.)
- Correspondence: (K.-S.L.); (H.-G.S.); Tel.: +82-10-2289-1938 (K.-S.L.); +82-10-7101-0255 (H.-G.S.)
| | - Ahnna Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Public Health, Graduate School, The Catholic University of Korea, Seoul 06591, Korea
| | - Hyeju Ahn
- Korean Association on Smoking or Health, Seoul 07238, Korea; (H.A.); (H.-K.L.); (H.K.); (J.L.)
| | - Hyun-Kyung Lee
- Korean Association on Smoking or Health, Seoul 07238, Korea; (H.A.); (H.-K.L.); (H.K.); (J.L.)
| | - Hyekyeong Kim
- Korean Association on Smoking or Health, Seoul 07238, Korea; (H.A.); (H.-K.L.); (H.K.); (J.L.)
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea
| | - Jakyoung Lee
- Korean Association on Smoking or Health, Seoul 07238, Korea; (H.A.); (H.-K.L.); (H.K.); (J.L.)
- Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
| | - Hong-Gwan Seo
- Korean Association on Smoking or Health, Seoul 07238, Korea; (H.A.); (H.-K.L.); (H.K.); (J.L.)
- National Cancer Center, Goyang-si 10408, Korea
- Correspondence: (K.-S.L.); (H.-G.S.); Tel.: +82-10-2289-1938 (K.-S.L.); +82-10-7101-0255 (H.-G.S.)
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