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Bizier A, Jones A, Businelle M, Kezbers K, Hoeppner BB, Giordano TP, Thai JM, Charles J, Montgomery A, Gallagher MW, Cheney MK, Zvolensky M, Garey L. An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52090. [PMID: 38657227 PMCID: PMC11079772 DOI: 10.2196/52090] [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: 08/22/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. OBJECTIVE This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. METHODS This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute's QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). RESULTS Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. CONCLUSIONS The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52090.
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Affiliation(s)
- Andre Bizier
- University of Houston, Houston, TX, United States
| | | | - Michael Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Bettina B Hoeppner
- Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | | | | | - Audrey Montgomery
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Matthew W Gallagher
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, United States
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Michael Zvolensky
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lorra Garey
- University of Houston, Houston, TX, United States
- HEALTH Institute, Houston, TX, United States
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Endrighi R, Borrelli B. Pain-Related Smoking Expectancies and Smoking Behavior Among U.S. Adult Cigarette Smokers with Chronic Pain. Int J Behav Med 2023:10.1007/s12529-023-10239-1. [PMID: 37935908 DOI: 10.1007/s12529-023-10239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND This study investigated the factor structure of a measure of pain-smoking interrelations and expectancies (pain and smoking inventory (PSI)) and examined associations with risk factors for smoking maintenance among smokers with chronic pain (CP). METHOD Participants (n = 504; M age = 46 ± 13 years; 58% female) completed an online survey about health-related factors and smoking characteristics. Data were analyzed using Horn's parallel analysis (PA) and multiple linear regression. RESULTS PA indicated that a single-dimension structure was the best fit for the PSI. Our regression model accounted for 34% of the variance in PSI score. The PSI was associated with younger age, higher education, poorer physical functioning, greater pain severity and pain intensity, higher psychological distress, greater nicotine dependence, lower self-efficacy and greater perceived difficulty quitting, and lifetime use of behavioral treatment for quitting smoking. CONCLUSION This research is the first step in identifying potential targets for smoking cessation approaches tailored to smokers with CP.
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Affiliation(s)
- Romano Endrighi
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, 560 Harrison Ave, Boston, MA, 02118, USA.
| | - Belinda Borrelli
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, 560 Harrison Ave, Boston, MA, 02118, USA
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Dawson DB, Budhwani S, Breland JY, Kunik ME, Fletcher TL. The efficacy of tobacco cessation treatment for African American adults: a systematic review. Transl Behav Med 2023; 13:775-783. [PMID: 37279925 DOI: 10.1093/tbm/ibad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Despite proliferation of evidence-based tobacco cessation treatments, African American adults still suffer higher rates of tobacco-related diseases than White adults. Although tobacco cessation treatment is efficacious, there is a need to reassess the efficacy of tobacco cessation treatment for African American adults. Previous reviews of tobacco cessation treatment studies conducted through 2007 among African American adults highlight the limited research in this area and inconsistent findings on treatment characteristics impacting efficacy. This systematic review examined the efficacy of combined behavioral and pharmacological tobacco cessation treatment for African American adults. Database searches were used to identify studies examining tobacco cessation treatment for predominantly African American samples (>50%). Eligible studies were completed between 2007 and 2021 and (i) involved randomization comparing active combined treatment to a control comparison group and (ii) reported abstinence outcomes at 6 and/or 12 months. Ten studies met inclusion criteria. Active treatment groups typically consisted of a combination of nicotine replacement therapy and behavioral counseling. Abstinence rates for African American adults ranged from 10.0% to 34% in active treatment groups compared to 0.0%-40% in comparison control groups. Our results support the efficacy of combined treatment for tobacco cessation among African American adults. However, cessation rates for African American adults found in this review are lower than those in the general adult population (15%-88%). Additionally, our findings highlight the limited number of studies examining African American tobacco cessation rates and testing of tailored treatment for this population.
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Affiliation(s)
- Darius B Dawson
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Mark E Kunik
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Terri L Fletcher
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Hajizadeh A, Howes S, Theodoulou A, Klemperer E, Hartmann-Boyce J, Livingstone-Banks J, Lindson N. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2023; 5:CD000031. [PMID: 37230961 PMCID: PMC10207863 DOI: 10.1002/14651858.cd000031.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The pharmacological profiles and mechanisms of antidepressants are varied. However, there are common reasons why they might help people to stop smoking tobacco: nicotine withdrawal can produce short-term low mood that antidepressants may relieve; and some antidepressants may have a specific effect on neural pathways or receptors that underlie nicotine addiction. OBJECTIVES To assess the evidence for the efficacy, harms, and tolerability of medications with antidepressant properties in assisting long-term tobacco smoking cessation in people who smoke cigarettes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, most recently on 29 April 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in people who smoked, comparing antidepressant medications with placebo or no pharmacological treatment, an alternative pharmacotherapy, or the same medication used differently. We excluded trials with fewer than six months of follow-up from efficacy analyses. We included trials with any follow-up length for our analyses of harms. DATA COLLECTION AND ANALYSIS We extracted data and assessed risk of bias using standard Cochrane methods. Our primary outcome measure was smoking cessation after at least six months' follow-up. We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Our secondary outcomes were harms and tolerance outcomes, including adverse events (AEs), serious adverse events (SAEs), psychiatric AEs, seizures, overdoses, suicide attempts, death by suicide, all-cause mortality, and trial dropouts due to treatment. We carried out meta-analyses where appropriate. MAIN RESULTS We included a total of 124 studies (48,832 participants) in this review, with 10 new studies added to this update version. Most studies recruited adults from the community or from smoking cessation clinics; four studies focused on adolescents (with participants between 12 and 21 years old). We judged 34 studies to be at high risk of bias; however, restricting analyses only to studies at low or unclear risk of bias did not change clinical interpretation of the results. There was high-certainty evidence that bupropion increased smoking cessation rates when compared to placebo or no pharmacological treatment (RR 1.60, 95% CI 1.49 to 1.72; I2 = 16%; 50 studies, 18,577 participants). There was moderate-certainty evidence that a combination of bupropion and varenicline may have resulted in superior quit rates to varenicline alone (RR 1.21, 95% CI 0.95 to 1.55; I2 = 15%; 3 studies, 1057 participants). However, there was insufficient evidence to establish whether a combination of bupropion and nicotine replacement therapy (NRT) resulted in superior quit rates to NRT alone (RR 1.17, 95% CI 0.95 to 1.44; I2 = 43%; 15 studies, 4117 participants; low-certainty evidence). There was moderate-certainty evidence that participants taking bupropion were more likely to report SAEs than those taking placebo or no pharmacological treatment. However, results were imprecise and the CI also encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 23 studies, 10,958 participants). Results were also imprecise when comparing SAEs between people randomised to a combination of bupropion and NRT versus NRT alone (RR 1.52, 95% CI 0.26 to 8.89; I2 = 0%; 4 studies, 657 participants) and randomised to bupropion plus varenicline versus varenicline alone (RR 1.23, 95% CI 0.63 to 2.42; I2 = 0%; 5 studies, 1268 participants). In both cases, we judged evidence to be of low certainty. There was high-certainty evidence that bupropion resulted in more trial dropouts due to AEs than placebo or no pharmacological treatment (RR 1.44, 95% CI 1.27 to 1.65; I2 = 2%; 25 studies, 12,346 participants). However, there was insufficient evidence that bupropion combined with NRT versus NRT alone (RR 1.67, 95% CI 0.95 to 2.92; I2 = 0%; 3 studies, 737 participants) or bupropion combined with varenicline versus varenicline alone (RR 0.80, 95% CI 0.45 to 1.45; I2 = 0%; 4 studies, 1230 participants) had an impact on the number of dropouts due to treatment. In both cases, imprecision was substantial (we judged the evidence to be of low certainty for both comparisons). Bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.73, 95% CI 0.67 to 0.80; I2 = 0%; 9 studies, 7564 participants), and to combination NRT (RR 0.74, 95% CI 0.55 to 0.98; I2 = 0%; 2 studies; 720 participants). However, there was no clear evidence of a difference in efficacy between bupropion and single-form NRT (RR 1.03, 95% CI 0.93 to 1.13; I2 = 0%; 10 studies, 7613 participants). We also found evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), and some evidence that bupropion resulted in superior quit rates to nortriptyline (RR 1.30, 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants), although this result was subject to imprecision. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. AUTHORS' CONCLUSIONS There is high-certainty evidence that bupropion can aid long-term smoking cessation. However, bupropion may increase SAEs (moderate-certainty evidence when compared to placebo/no pharmacological treatment). There is high-certainty evidence that people taking bupropion are more likely to discontinue treatment compared with people receiving placebo or no pharmacological treatment. Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo, although bupropion may be more effective. Evidence also suggests that bupropion may be as successful as single-form NRT in helping people to quit smoking, but less effective than combination NRT and varenicline. In most cases, a paucity of data made it difficult to draw conclusions regarding harms and tolerability. Further studies investigating the efficacy of bupropion versus placebo are unlikely to change our interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over other licensed smoking cessation treatments; namely, NRT and varenicline. However, it is important that future studies of antidepressants for smoking cessation measure and report on harms and tolerability.
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Affiliation(s)
- Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seth Howes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elias Klemperer
- Departments of Psychological Sciences & Psychiatry, University of Vermont, Burlington, VT, USA
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Gender Differences Among Out-of-School Korean Adolescents in a Counselor-Visiting Smoking Cessation Program. J Addict Nurs 2023; 34:8-15. [PMID: 36857543 DOI: 10.1097/jan.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
ABSTRACT The purpose of this study was to explore the determinants of self-reported smoking cessation among out-of-school Korean adolescents who participated in a counselor-visiting smoking cessation program. This retrospective descriptive study analyzed data from the Korea Health Promotion Institute. Participants were enrolled between June 1, 2015, and December 31, 2017, at a regional smoking cessation center in a counselor-visiting smoking cessation program for out-of-school adolescents. Participants consisted of 807 adolescents (70.3% male) with a mean age of 16.9 ± 1.2 years. Multiple logistic regression analysis showed that female gender (OR = 1.54-1.92), cohort year 2016 (OR = 1.69-1.90), smoking more than half a pack a day (OR = 0.44-0.50), strong motivation to quit (OR = 1.44), and number of counseling in person (OR = 1.97-2.10) were statistically significant independent contributors to quitting, based on follow-up assessments at 4 weeks, 12 weeks, and 6 months. This study explored smoking cessation outcomes of a government-driven smoking cessation program that targeted out-of-school adolescents and identified several risk factors that affect a successful outcome. More research is necessary to evaluate the efficacy of such smoking cessation programs for marginalized or understudied populations.
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Gallus S, Cresci C, Rigamonti V, Lugo A, Bagnardi V, Fanucchi T, Cirone D, Ciaccheri A, Cardellicchio S. Self-efficacy in predicting smoking cessation: A prospective study in Italy. Tob Prev Cessat 2023; 9:15. [PMID: 37125003 PMCID: PMC10141785 DOI: 10.18332/tpc/162942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Predicting the success of smoking cessation might be crucial to guide towards the treatment of smoking dependence in a clinical setting. We analyzed the potential determinants of successful smoking cessation with a specific focus on self-efficacy in predicting quitting smoking. METHODS All consecutive smokers (n=478; 224 men and 254 women) attending the Careggi University Hospital Smoking Cessation Service in Florence (Italy) in 2018-2019 provided information on self-efficacy in predicting smoking cessation, using a 1-10 rating scale during their first visit. Patients were followed up for success in quitting smoking at 3, 6 and 12 months, validated through CO exhaled measurement. To evaluate the association between self-efficacy and the probability of success, we estimated multivariable relative risks (RRs) and corresponding 95% confidence intervals (CIs) through log-binomial models for longitudinal data. RESULTS Overall, 47.9% of smokers succeeded in their attempt to quit at 3 months, 40.2% at 6 months, and 33.9% at 12 months. Compared to low self-efficacy (rating scale 1-5), the RR of success in quitting smoking was 1.40 (95% CI: 1.06-1.85) for intermediate self-efficacy (scale 6-7) and 1.64 (95% CI: 1.28-2.12) for high self-efficacy (scale 8-10). CONCLUSIONS Self-efficacy is an independent determinant of smoking cessation. We recommend to systematically collect self-efficacy, together with other relevant variables, to predict successful smoking cessation. Moreover, strategies to develop and maintain high levels of self-efficacy are essential to increase quit success and improve treatment.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Cresci
- Anti-smoking center, Careggi University Hospital, Florence, Italy
- SOD of Alcohology, Careggi University Hospital, Florence, Italy
- Tuscan Regional Alcoholic Center, Careggi University Hospital, Florence, Italy
| | - Vera Rigamonti
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | | | - Donatello Cirone
- Tuscan Regional Alcoholic Center, Careggi University Hospital, Florence, Italy
| | - Angela Ciaccheri
- Anti-smoking center, Careggi University Hospital, Florence, Italy
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Lawrence TI. The Effects of Adverse Childhood Experiences (ACEs), Mental Illness, and Personality Differences on Attitudes Toward Self-Efficacy Among Females on Parole/Probation. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022:306624X221132232. [PMID: 36341488 DOI: 10.1177/0306624x221132232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Female offenders released from prison often face challenges within the community such as lack of employment, inconsistent attendance in substance use treatment, and complying with parole and probation conditions, which typically decreases their self-efficacy and motivation to refrain from reoffending. Despite this, much is still unknown of psychological factors that could impact female offenders' attitudes toward self-efficacy, such as mental illness symptoms, Adverse Childhood Experiences (ACEs), and personality differences. Thus, this cross-sectional study explored whether mental illness symptoms, ACEs, and personality differences were associated with attitudes toward self-efficacy (N = 398). Results suggest that mental illness symptoms, ACEs, and neuroticism negatively associated with attitudes toward self-efficacy in contrast to extraversion and conscientiousness. Parole/probation reentry and therapeutic implications are discussed.
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Jaspal R. Chemsex, Identity and Sexual Health among Gay and Bisexual Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12124. [PMID: 36231424 PMCID: PMC9564711 DOI: 10.3390/ijerph191912124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
This article focuses on some of the social, cultural and psychological aspects of drug use in sexualized settings in gay and bisexual men (referred to as "chemsex"). Using a narrative review approach, the article examines previous empirical research in this area and presents a novel theoretical approach for understanding and predicting chemsex behavior. Tenets of identity process theory from social psychology are drawn upon to offer an integrative theoretical framework within which the social, cultural and psychological underpinnings of chemsex can be collectively examined. Existing empirical research suggests that gay and bisexual men may experience sexuality-related stressors that can undermine feelings of self-esteem, self-efficacy, continuity and positive distinctiveness. Identity process theory examines how individuals react to threats to identity brought about by these stressors. In response to identity threat, gay and bisexual men may engage in chemsex as a coping response that encompasses and facilitates various, largely maladaptive, coping strategies and tactics. The more chemsex is perceived as enhancing identity processes and as averting identity threat, the more central it is likely to be to the identities of participants. The centrality of chemsex to one's identity may preclude self-withdrawal from the practice. Several directions for future research are presented based on existing work on chemsex viewed through the lens of identity process theory. These should form the basis of future empirical research in the sphere of sexual health among gay and bisexual men and the outcomes of this research should inform policy and practice in this area.
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Affiliation(s)
- Rusi Jaspal
- Vice-Chancellor's Office, University of Brighton, Brighton BN2 4GJ, UK
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Businelle MS, Garey L, Gallagher MW, Hébert ET, Vujanovic A, Alexander A, Kezbers K, Matoska C, Robison J, Montgomery A, Zvolensky MJ. An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38905. [PMID: 35635746 PMCID: PMC9153912 DOI: 10.2196/38905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. OBJECTIVE This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. METHODS In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. RESULTS This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. CONCLUSIONS If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38905.
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Affiliation(s)
- Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- HEALTH Institute, University of Houston, Houston, TX, United States
| | - Lorra Garey
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Matthew W Gallagher
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, United States
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin, TX, United States
| | - Anka Vujanovic
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Adam Alexander
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Cameron Matoska
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Jillian Robison
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Audrey Montgomery
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael J Zvolensky
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
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Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074034. [PMID: 35409717 PMCID: PMC8998497 DOI: 10.3390/ijerph19074034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/26/2022] [Indexed: 12/04/2022]
Abstract
Continued smoking after a cancer diagnosis is causally associated with increased risks of all-cause and cancer-specific mortality, and of smoking-related second primary cancers. Patient navigation provides individualized assistance to address barriers to smoking cessation treatment and represents a promising bridge to smoking cessation in persons with cancer who smoke cigarettes. We conducted a single-arm interventional cohort study of current smokers identified through prospective health record screening and recruited from Penn State Cancer Institute outpatient clinics. Consented participants received two telephone intervention sessions and gain-framed messaging-based smoking cessation educational materials designed for persons with cancer. The primary study outcome was the feasibility of the patient navigation-based intervention; the secondary outcome was the engagement in smoking cessation treatment at the two-month follow-up. Of 1168 unique screened Cancer Institute patients, 134 (11.5%) were identified as current cigarette smokers. Among 67 patients approached at outpatient clinics, 24 (35.8%) were interested in participating, 12 (17.9%) were enrolled, eight (11.9%) completed the intervention sessions and study assessments, and six engaged in smoking cessation treatment. The participants expressed satisfaction with the intervention sessions (median = 8.5, scale 0–10). The low recruitment rates preclude patient navigation as a feasible method for connecting cancer patients to smoking cessation treatment resources.
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Zhu N, Lin S, Dai L, Yu H, Xu N, Huang W, Yu X. Abrupt versus gradual smoking cessation with pre-cessation
varenicline therapy for Chinese treatment-seeking smokers:
A retrospective, observational, cohort study. Tob Induc Dis 2022; 20:29. [PMID: 35350549 PMCID: PMC8922294 DOI: 10.18332/tid/145993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study aimed to explore the efficacy of abrupt and gradual smoking cessation with pre-cessation varenicline therapy. METHODS A total of 278 smokers who experienced moderate-to-severe nicotine dependence and visited a Chinese smoking cessation outpatient clinic from March 2017 to February 2021 were enrolled. This was a retrospective, observational, cohort study. Participants were divided into two groups by the cessation strategy they received: the abrupt cessation group (n=139, tobacco was not controlled during the first 3 weeks before the target cessation date and smoking was entirely discontinued on the 22nd day) and the gradual cessation group (n=139, tobacco was gradually reduced in the first 3 weeks before the target cessation date and smoking was discontinued on the 22nd day). The abstinence rates were compared between groups (7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment; and 1-month and 3-month continuous abstinence rates of 6-month follow-up). Possible factors that influence efficacy, reasons for smoking cessation failure, and associated adverse events were also analyzed. RESULTS No significant difference in the 7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment was observed between the groups (p>0.05). The 1-month continuous abstinence rate of the gradual cessation group was higher than that of the abrupt cessation group (51.1% vs 31.7%; χ2=10.812, p=0.001). The 3-month continuous abstinence rate of the gradual cessation group was also higher than that of the abrupt cessation group (42.4% vs 27.3%; χ2=6.983, p=0.008). Abrupt cessation was a risk factor for successful smoking cessation than gradual cessation (AOR=2.39; 95% CI: 1.15–3.85, p=0.013),the motivation of ‘prevention and treatment of own diseases’ reduced the risk of incomplete abstinence (AOR=0.87; 95% CI: 0.38–0.99, p=0.049). The incidence of adverse events was higher in the abrupt cessation group than in the gradual cessation group. The incidence rates of nausea and insomnia were statistically significant differences. CONCLUSIONS Compared with abrupt cessation, gradual smoking cessation with pre-cessation varenicline therapy produced higher abstinence rates and relatively milder withdrawal symptoms.
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Affiliation(s)
- Ning Zhu
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Shanhong Lin
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Luyan Dai
- Department of Prevention and Health Care, Ningbo First Hospital, Ningbo, China
| | - Hang Yu
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Ning Xu
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Weina Huang
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, China
| | - Xiaopin Yu
- Department of Prevention and Health Care, Ningbo First Hospital, Ningbo, China
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Hartmann-Boyce J, Theodoulou A, Farley A, Hajek P, Lycett D, Jones LL, Kudlek L, Heath L, Hajizadeh A, Schenkels M, Aveyard P. Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev 2021; 10:CD006219. [PMID: 34611902 PMCID: PMC8493442 DOI: 10.1002/14651858.cd006219.pub4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most people who stop smoking gain weight. This can discourage some people from making a quit attempt and risks offsetting some, but not all, of the health advantages of quitting. Interventions to prevent weight gain could improve health outcomes, but there is a concern that they may undermine quitting. OBJECTIVES To systematically review the effects of: (1) interventions targeting post-cessation weight gain on weight change and smoking cessation (referred to as 'Part 1') and (2) interventions designed to aid smoking cessation that plausibly affect post-cessation weight gain (referred to as 'Part 2'). SEARCH METHODS Part 1 - We searched the Cochrane Tobacco Addiction Group's Specialized Register and CENTRAL; latest search 16 October 2020. Part 2 - We searched included studies in the following 'parent' Cochrane reviews: nicotine replacement therapy (NRT), antidepressants, nicotine receptor partial agonists, e-cigarettes, and exercise interventions for smoking cessation published in Issue 10, 2020 of the Cochrane Library. We updated register searches for the review of nicotine receptor partial agonists. SELECTION CRITERIA Part 1 - trials of interventions that targeted post-cessation weight gain and had measured weight at any follow-up point or smoking cessation, or both, six or more months after quit day. Part 2 - trials included in the selected parent Cochrane reviews reporting weight change at any time point. DATA COLLECTION AND ANALYSIS Screening and data extraction followed standard Cochrane methods. Change in weight was expressed as difference in weight change from baseline to follow-up between trial arms and was reported only in people abstinent from smoking. Abstinence from smoking was expressed as a risk ratio (RR). Where appropriate, we performed meta-analysis using the inverse variance method for weight, and Mantel-Haenszel method for smoking. MAIN RESULTS Part 1: We include 37 completed studies; 21 are new to this update. We judged five studies to be at low risk of bias, 17 to be at unclear risk and the remainder at high risk. An intermittent very low calorie diet (VLCD) comprising full meal replacement provided free of charge and accompanied by intensive dietitian support significantly reduced weight gain at end of treatment compared with education on how to avoid weight gain (mean difference (MD) -3.70 kg, 95% confidence interval (CI) -4.82 to -2.58; 1 study, 121 participants), but there was no evidence of benefit at 12 months (MD -1.30 kg, 95% CI -3.49 to 0.89; 1 study, 62 participants). The VLCD increased the chances of abstinence at 12 months (RR 1.73, 95% CI 1.10 to 2.73; 1 study, 287 participants). However, a second study found that no-one completed the VLCD intervention or achieved abstinence. Interventions aimed at increasing acceptance of weight gain reported mixed effects at end of treatment, 6 months and 12 months with confidence intervals including both increases and decreases in weight gain compared with no advice or health education. Due to high heterogeneity, we did not combine the data. These interventions increased quit rates at 6 months (RR 1.42, 95% CI 1.03 to 1.96; 4 studies, 619 participants; I2 = 21%), but there was no evidence at 12 months (RR 1.25, 95% CI 0.76 to 2.06; 2 studies, 496 participants; I2 = 26%). Some pharmacological interventions tested for limiting post-cessation weight gain (PCWG) reduced weight gain at the end of treatment (dexfenfluramine, phenylpropanolamine, naltrexone). The effects of ephedrine and caffeine combined, lorcaserin, and chromium were too imprecise to give useful estimates of treatment effects. There was very low-certainty evidence that personalized weight management support reduced weight gain at end of treatment (MD -1.11 kg, 95% CI -1.93 to -0.29; 3 studies, 121 participants; I2 = 0%), but no evidence in the longer-term 12 months (MD -0.44 kg, 95% CI -2.34 to 1.46; 4 studies, 530 participants; I2 = 41%). There was low to very low-certainty evidence that detailed weight management education without personalized assessment, planning and feedback did not reduce weight gain and may have reduced smoking cessation rates (12 months: MD -0.21 kg, 95% CI -2.28 to 1.86; 2 studies, 61 participants; I2 = 0%; RR for smoking cessation 0.66, 95% CI 0.48 to 0.90; 2 studies, 522 participants; I2 = 0%). Part 2: We include 83 completed studies, 27 of which are new to this update. There was low certainty that exercise interventions led to minimal or no weight reduction compared with standard care at end of treatment (MD -0.25 kg, 95% CI -0.78 to 0.29; 4 studies, 404 participants; I2 = 0%). However, weight was reduced at 12 months (MD -2.07 kg, 95% CI -3.78 to -0.36; 3 studies, 182 participants; I2 = 0%). Both bupropion and fluoxetine limited weight gain at end of treatment (bupropion MD -1.01 kg, 95% CI -1.35 to -0.67; 10 studies, 1098 participants; I2 = 3%); (fluoxetine MD -1.01 kg, 95% CI -1.49 to -0.53; 2 studies, 144 participants; I2 = 38%; low- and very low-certainty evidence, respectively). There was no evidence of benefit at 12 months for bupropion, but estimates were imprecise (bupropion MD -0.26 kg, 95% CI -1.31 to 0.78; 7 studies, 471 participants; I2 = 0%). No studies of fluoxetine provided data at 12 months. There was moderate-certainty that NRT reduced weight at end of treatment (MD -0.52 kg, 95% CI -0.99 to -0.05; 21 studies, 2784 participants; I2 = 81%) and moderate-certainty that the effect may be similar at 12 months (MD -0.37 kg, 95% CI -0.86 to 0.11; 17 studies, 1463 participants; I2 = 0%), although the estimates are too imprecise to assess long-term benefit. There was mixed evidence of the effect of varenicline on weight, with high-certainty evidence that weight change was very modestly lower at the end of treatment (MD -0.23 kg, 95% CI -0.53 to 0.06; 14 studies, 2566 participants; I2 = 32%); a low-certainty estimate gave an imprecise estimate of higher weight at 12 months (MD 1.05 kg, 95% CI -0.58 to 2.69; 3 studies, 237 participants; I2 = 0%). AUTHORS' CONCLUSIONS Overall, there is no intervention for which there is moderate certainty of a clinically useful effect on long-term weight gain. There is also no moderate- or high-certainty evidence that interventions designed to limit weight gain reduce the chances of people achieving abstinence from smoking.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amanda Farley
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Laura L Jones
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Laura Kudlek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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de Granda-Orive JI, Pascual-Lledó JF, Asensio-Sánchez S, Solano-Reina S, García-Rueda M, Martínez-Muñiz MÁ, Lázaro-Asegurado L, Buljubasich D, Luhning S, Pendino RL, Cienfuegos-Agustín I, Jiménez-Ruiz CA. Is the motivation to quit smoking a predictor of abstinence maintenance? Tob Prev Cessat 2021; 7:48. [PMID: 34239998 PMCID: PMC8240875 DOI: 10.18332/tpc/136506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to explore the utility of measuring motivation to quit smoking as a predictor of abstinence maintenance among smokers who wanted to quit and who were included in a multicenter study conducted in daily clinical practice. METHODS This observational, longitudinal (prospective cohort), multicenter study was conducted in smoking clinics in Spain and the Argentine Republic in daily clinical practice. Motivation was assessed using three quantitative motivation tests and a Visual Analogue Scale. Statistical analysis included descriptive, association measures and logistic regression models. RESULTS Of a total of 404 subjects, 273 were ultimately included for analysis (147 women; 53.8%), mean age 51±11 years). In one year, 53.5% (36.13% by intention to treat) of subjects (146) were successful in quitting smoking [men: 45.2% (66) and women: 54.8% (80)], with no differences between sexes. None of the scales utilized was associated, in an unquestionable or direct way, with long-term abstinence, although three of them, in a very complex model, with additional variables and added interactions, were associated with the ‘result’ variable, when other variables intervened in certain circumstances. CONCLUSIONS None of the analyzed motivational scales alone demonstrated an association with success or failure in quitting smoking; thus, their use in isolation is of no value. Some of the scales analyzed might be related to the maintenance of abstinence but in complex models where other variables intervene, which makes interpretation considerably difficult. Therefore, the predictive capacity of the tests analyzed, based on the models, was low.
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Affiliation(s)
| | | | | | | | | | | | | | - Daniel Buljubasich
- Respiratory Department, Sanatorio Nuestra Señora del Rosario, IPAM Medical Center, Rosario, Argentine Republic
| | - Susana Luhning
- Pneumonology Department, Humana Private Medical Institute, External Consultation Assistance Center, Córdoba, Argentine Republic
| | - Roge-Lio Pendino
- Respiratory Department, Sanatorio Nuestra Señora del Rosario, IPAM Medical Center, Rosario, Argentine Republic
| | | | - Carlos A Jiménez-Ruiz
- Madrid Community Specialized Smoking Unit, San Carlos Clinical Hospital, Madrid, Spain
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Rajani NB, Mastellos N, Filippidis FT. Self-Efficacy and Motivation to Quit of Smokers Seeking to Quit: Quantitative Assessment of Smoking Cessation Mobile Apps. JMIR Mhealth Uhealth 2021; 9:e25030. [PMID: 33929336 PMCID: PMC8122290 DOI: 10.2196/25030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/18/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023] Open
Abstract
Background Decreasing trends in the number of individuals accessing face-to-face support are leaving a significant gap in the treatment options for smokers seeking to quit. Face-to-face behavioral support and other interventions attempt to target psychological factors such as the self-efficacy and motivation to quit of smokers, as these factors are associated with an increased likelihood of making quit attempts and successfully quitting. Although digital interventions, such as smoking cessation mobile apps, could provide a promising avenue to bridge the growing treatment gap, little is known about their impact on psychological factors that are vital for smoking cessation. Objective This study aims to better understand the possible impact of smoking cessation mobile apps on important factors for successful cessation, such as self-efficacy and motivation to quit. Our aim is to assess the self-efficacy and motivation to quit levels of smokers before and after the use of smoking cessation mobile apps. Methods Smokers seeking to quit were recruited to participate in a 4-week app-based study. After screening, eligible participants were asked to use a mobile app (Kwit or Quit Genius). The smoking self-efficacy questionnaire and the motivation to stop smoking scale were used to measure the self-efficacy and motivation to quit, respectively. Both were assessed at baseline (before app use), midstudy (2 weeks after app use), and end-study (4 weeks after app use). Paired sample two-tailed t tests were used to investigate whether differences in self-efficacy and motivation between study time points were statistically significant. Linear regression models investigated associations between change in self-efficacy and change in motivation to quit before and after app use with age, gender, and nicotine dependence. Results A total of 116 participants completed the study, with the majority being male (71/116, 61.2%), employed (76/116, 65.6%), single (77/116, 66.4%), and highly educated (87/116, 75.0%). A large proportion of participants had a low to moderate dependence on nicotine (107/116, 92.2%). A statistically significant increase of 5.09 points (95% CI 1.83-8.34) from 37.38 points at baseline in self-efficacy was found at the end of the study. Statistically significant increases were also found for the subcomponents of self-efficacy (intrinsic and extrinsic self-efficacies). Similarly, a statistically significant increase of 0.38 points (95% CI 0.06-0.70) from 5.94 points at baseline in motivation to quit was found at the end of the study. Gender, age, and nicotine dependence were not statistically significantly associated with changes in self-efficacy and motivation to quit. Conclusions The assessed mobile apps positively impacted the self-efficacy and motivation to quit of smokers making quit attempts. This has important implications on the possible future use of digitalized interventions and how they could influence important psychological factors for quitting such as self-efficacy and motivation. However, further research is needed to assess whether digital interventions can supplement or replace traditional forms of therapy.
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Affiliation(s)
- Nikita B Rajani
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Nikolaos Mastellos
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Smoking Is Related to Reduced Motivation, But Not Global Cognition, in the First Two Years of Treatment for First Episode Psychosis. J Clin Med 2021; 10:jcm10081619. [PMID: 33920376 PMCID: PMC8069411 DOI: 10.3390/jcm10081619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Smoking is highly prevalent in people with psychotic disorders, even in the earliest phases of the illness. The neural mechanisms of nicotine dependence and psychosis overlap and may also be linked to deficits in neurocognition and motivation in psychosis. Both neurocognition and motivation are recognized as important clinical targets, though previous research examining the effects of smoking on these features has been inconsistent. Here, we examine the relationships between smoking status and neurocognition and motivation over the first two years of treatment for psychosis through a secondary analysis of the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) dataset. In a sample of 404 individuals with first-episode psychosis, we examined linear mixed-effects models with the group (smoker vs. non-smoker) by time (baseline, 12-month, 24-month) interaction as a predictor of global cognition and motivation. While all individuals showed enhanced global cognition and motivation over the 24-month course of treatment, non-smokers showed significantly greater gains in motivation. These changes in motivation also corresponded to improvements in functioning over the 24-month period. No significant effects of smoking were observed for global cognition. Our findings suggest that motivation and smoking cessation may be important early treatment targets for first-episode psychosis programs.
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Ma Z, Nan X, Iles IA, Butler J, Feldman R, Wang MQ. Effects of self-affirmation on responses toward graphic cigarette warning labels: testing the mediating role of perceived susceptibility and self-efficacy. HEALTH EDUCATION 2020. [DOI: 10.1108/he-06-2020-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study is to examine the effects of self-affirmation on African American smokers' intentions to quit smoking sooner and desire to stop smoking altogether in response to viewing graphic cigarette warning labels. It also tested the mediating role of perceived susceptibility and self-efficacy in explaining the impact of self-affirmation.Design/methodology/approachAfrican American smokers (N = 158) were recruited to participate in a controlled experiment. Participants first completed a short questionnaire about their demographic background and smoking-related attitudes and behavior. They were then randomly assigned to engage in either a self-affirmation task or a control task and viewed two graphic cigarette warning labels subsequently. Participants then responded to a questionnaire about their perceived susceptibility to smoking-related diseases, perceived self-efficacy to quit smoking, intentions to quit smoking and desire to stop smoking altogether.FindingsResults showed that engaging in self-affirmation prior to exposure to graphic cigarette warning labels increased African American smokers' perceived susceptibility to smoking-related diseases, but decreased their perceived self-efficacy to quit smoking. Furthermore, self-affirmation indirectly enhanced smokers' intentions to quit smoking sooner and desire to stop smoking altogether through increased perceived susceptibility. It also had an unexpected negative indirect effect on intentions to quit smoking sooner through decreased self-efficacy.Originality/valueThis study is one of the few studies that investigates the effect of self-affirmation on African American smokers' responses toward graphic cigarette warning labels.
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Caponnetto P, Polosa R, Robson D, Bauld L. Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders. Health Psychol Res 2020; 8:9042. [PMID: 32510003 PMCID: PMC7267811 DOI: 10.4081/hpr.2020.9042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
This narrative review focuses on the topic of tobacco smoking amongst people with schizophrenia spectrum disorders. We searched PubMed, PsycInfo and Scopus databases for schizophrenia spectrum disorders and smoking and included articles about the epidemiology of tobacco smoking in people with schizophrenia spectrum disorders, examining the relationship between smoking and mental health. This narrative review describes that a higher prevalence, frequency and impact of both high nicotine dependence and its harmful effects in patients with schizophrenia spectrum disorders compared with those in the general population. Despite several existent theories, the reasons for high smoking rates, the high dependence on nicotine and severity of nicotine withdrawal symptoms are not fully understood. The main aim of this paper is to inform mental health personnel and particularly clinical and health psychologists about the impact and role of tobacco smoking for smokers with schizophrenia spectrum disorders.
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Affiliation(s)
| | | | | | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco & Alcohol Studies, Nottingham, UK
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Abstract
BACKGROUND Whilst the pharmacological profiles and mechanisms of antidepressants are varied, there are common reasons why they might help people to stop smoking tobacco. Firstly, nicotine withdrawal may produce depressive symptoms and antidepressants may relieve these. Additionally, some antidepressants may have a specific effect on neural pathways or receptors that underlie nicotine addiction. OBJECTIVES To assess the evidence for the efficacy, safety and tolerability of medications with antidepressant properties in assisting long-term tobacco smoking cessation in people who smoke cigarettes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Specialized Register, which includes reports of trials indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO, clinicaltrials.gov, the ICTRP, and other reviews and meeting abstracts, in May 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) that recruited smokers, and compared antidepressant medications with placebo or no treatment, an alternative pharmacotherapy, or the same medication used in a different way. We excluded trials with less than six months follow-up from efficacy analyses. We included trials with any follow-up length in safety analyses. DATA COLLECTION AND ANALYSIS We extracted data and assessed risk of bias using standard Cochrane methods. We also used GRADE to assess the certainty of the evidence. The primary outcome measure was smoking cessation after at least six months follow-up, expressed as a risk ratio (RR) and 95% confidence intervals (CIs). We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed-effect model. Similarly, we presented incidence of safety and tolerance outcomes, including adverse events (AEs), serious adverse events (SAEs), psychiatric AEs, seizures, overdoses, suicide attempts, death by suicide, all-cause mortality, and trial dropout due to drug, as RRs (95% CIs). MAIN RESULTS We included 115 studies (33 new to this update) in this review; most recruited adult participants from the community or from smoking cessation clinics. We judged 28 of the studies to be at high risk of bias; however, restricting analyses only to studies at low or unclear risk did not change clinical interpretation of the results. There was high-certainty evidence that bupropion increased long-term smoking cessation rates (RR 1.64, 95% CI 1.52 to 1.77; I2 = 15%; 45 studies, 17,866 participants). There was insufficient evidence to establish whether participants taking bupropion were more likely to report SAEs compared to those taking placebo. Results were imprecise and CIs encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 21 studies, 10,625 participants; moderate-certainty evidence, downgraded one level due to imprecision). We found high-certainty evidence that use of bupropion resulted in more trial dropouts due to adverse events of the drug than placebo (RR 1.37, 95% CI 1.21 to 1.56; I2 = 19%; 25 studies, 12,340 participants). Participants randomized to bupropion were also more likely to report psychiatric AEs compared with those randomized to placebo (RR 1.25, 95% CI 1.15 to 1.37; I2 = 15%; 6 studies, 4439 participants). We also looked at the safety and efficacy of bupropion when combined with other non-antidepressant smoking cessation therapies. There was insufficient evidence to establish whether combination bupropion and nicotine replacement therapy (NRT) resulted in superior quit rates to NRT alone (RR 1.19, 95% CI 0.94 to 1.51; I2 = 52%; 12 studies, 3487 participants), or whether combination bupropion and varenicline resulted in superior quit rates to varenicline alone (RR 1.21, 95% CI 0.95 to 1.55; I2 = 15%; 3 studies, 1057 participants). We judged the certainty of evidence to be low and moderate, respectively; in both cases due to imprecision, and also due to inconsistency in the former. Safety data were sparse for these comparisons, making it difficult to draw clear conclusions. A meta-analysis of six studies provided evidence that bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.71, 95% CI 0.64 to 0.79; I2 = 0%; 6 studies, 6286 participants), whilst there was no evidence of a difference in efficacy between bupropion and NRT (RR 0.99, 95% CI 0.91 to 1.09; I2 = 18%; 10 studies, 8230 participants). We also found some evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), whilst there was insufficient evidence to determine whether bupropion or nortriptyline were more effective when compared with one another (RR 1.30 (favouring bupropion), 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants). There was no evidence that any of the other antidepressants tested (including St John's Wort, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs)) had a beneficial effect on smoking cessation. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. AUTHORS' CONCLUSIONS There is high-certainty evidence that bupropion can aid long-term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high-certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer SAEs than those taking placebo (moderate certainty). Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as NRT and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as SSRIs, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions. Due to the high-certainty evidence, further studies investigating the efficacy of bupropion versus placebo are unlikely to change our interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over front-line smoking cessation aids already available. However, it is important that where studies of antidepressants for smoking cessation are carried out they measure and report safety and tolerability clearly.
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Affiliation(s)
- Seth Howes
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Jamie Hartmann-Boyce
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | | | - Bosun Hong
- Birmingham Dental Hospital, Oral Surgery Department, 5 Mill Pool Way, Birmingham, UK, B5 7EG
| | - Nicola Lindson
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
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Kruse GR, Thawal V, Gupte HA, Chaudhuri L, Pradhan S, Howard S, Rigotti NA. Tobacco Use and Subsequent Cessation Among Hospitalized Patients in Mumbai, India: A Longitudinal Study. Nicotine Tob Res 2020; 22:363-370. [PMID: 30778542 DOI: 10.1093/ntr/ntz026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/14/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Hospitalization is an important setting to address tobacco use. Little is known about post-discharge cessation and treatment use in low- and middle-income countries. Our objective was to assess tobacco use after hospital discharge among patients in Mumbai, India. METHODS Longitudinal observational study of inpatients (≥15 years) admitted at one hospital from November 2015 to October 2016. Patients reporting current tobacco use were surveyed by telephone after discharge. RESULTS Of 2894 inpatients approached, 2776 participated and 15.7% (N = 437) reported current tobacco use, including 5.3% (N = 147) smokers, 9.1% (N = 252) smokeless tobacco (SLT) users, and 1.4% (N = 38) dual users. Excluding dual users, SLT users, compared to smokers, were less likely to report a plan to quit after discharge (42.6% vs. 54.2%, p = .04), a past-year quit attempt (38.1% vs. 52.7%, p = .004), to agree that tobacco has harmed them (57.9% vs. 70.3%, p = .02) or caused their hospitalization (43.4% vs. 61.4%, p < .001). After discharge, 77.6% of smokers and 78.6% of SLT users reported trying to quit (p = .81). Six-month continuous abstinence after discharge was reported by 27.2% of smokers and 24.6% of SLT users (p = .56). Nearly all relapses to tobacco use after discharge occurred within 30 days and did not differ by tobacco type (log-rank p = .08). Use of evidence-based cessation treatment was reported by 6.5% (N = 26). CONCLUSIONS Three-quarters of tobacco users in a Mumbai hospital attempted to quit after discharge. One-quarter reported continuous tobacco abstinence for 6 months despite little use of cessation treatment. Increasing post-discharge cessation support could further increase cessation rates and improve patient outcomes. IMPLICATIONS No prior study has measured the patterns of tobacco use and cessation among hospitalized tobacco users in India. Three-quarters of tobacco users admitted to a hospital in Mumbai attempted to quit after discharge, and one-quarter remained tobacco-free for 6 months, indicating that hospitalization may be an opportune time to offer a cessation intervention. Although smokers and SLT users differed in socioeconomic status, perceived risks and interest in quitting, they did not differ in their ability to stay abstinent after hospital discharge.
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Affiliation(s)
- Gina R Kruse
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | | | | | - Sydney Howard
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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20
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Clyde M, Pipe A, Reid R, Els C, Tulloch H. A bidirectional path analysis model of smoking cessation self-efficacy and concurrent smoking status: impact on abstinence outcomes. Addict Biol 2019; 24:1034-1043. [PMID: 30088695 DOI: 10.1111/adb.12647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/04/2018] [Accepted: 05/27/2018] [Indexed: 11/28/2022]
Abstract
Self-efficacy is routinely associated with abstinence in the addictions literature, and is a major component relapse-prevention models. The magnitude of this relationship has been brought into question following equivocal results in studies controlling for concurrent smoking status. The aim of our study was to clarify the relationship between cessation self-efficacy, smoking status, and cessation outcomes in a cohort of treatment-seeking smokers. Smokers participating in the FLEX trial, a randomized trial investigating the efficacy of three pharmacologic treatments for smoking cessation, completed questionnaires assessing cessation self-efficacy at baseline and at weeks 1, 3, 5 and 10 post-target quit date; smoking status was verified using expired carbon monoxide. Structural models were fit in order to ascertain the relationship between cessation self-efficacy and concurrent smoking at each time-point, and to assess the association between cessation self-efficacy, smoking and seven-day point prevalence smoking status at week 10. A total of 737 treatment-seeking smokers participated. In our path model, self-efficacy and smoking status at all time points were associated with week 10 abstinence (except week 3 self-efficacy), after controlling these values' previous time-points. All direct pathways between cessation self-efficacy and smoking were also significant, supporting a bidirectional relationship. Our results support a bidirectional and reciprocal relationship between cessation self-efficacy and concurrent smoking behavior; participants with higher confidence were more likely to be smoke-free, and concurrent smoking status predicted levels of confidence over the ensuing weeks. Both measures were associated with week 10 abstinence. Our results indicate that while correlated, both cessation self-efficacy and current smoking behavior during a cessation attempt are important independent markers of ultimate cessation success.
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Affiliation(s)
- Matthew Clyde
- Prevention and Rehabilitation Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
- Department of Psychology; University of Ottawa; Ottawa Ontario Canada
| | - Andrew Pipe
- Prevention and Rehabilitation Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Robert Reid
- Prevention and Rehabilitation Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Charl Els
- Department of Psychiatry; University of Alberta; Edmonton Alberta Canada
| | - Heather Tulloch
- Prevention and Rehabilitation Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
- Department of Psychology; University of Ottawa; Ottawa Ontario Canada
- Department of Medicine; University of Ottawa; Ottawa Ontario Canada
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21
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Zou G, Wei X, Deng S, Yin J, Ling L. Factors influencing the implementation of a pilot smoking cessation intervention among migrant workers in Chinese factories: a qualitative study. BMC Public Health 2019; 19:870. [PMID: 31269929 PMCID: PMC6609399 DOI: 10.1186/s12889-019-7223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/21/2019] [Indexed: 12/03/2022] Open
Abstract
Background Tobacco control intervention with Chinese internal migrants, especially those working in factories has rarely been investigated. This study aims to identify aids and barriers to implementing a comprehensive pilot intervention aimed at reducing smoking among migrant workers working in factories in China. Method Twenty in-depth interviews were conducted 3 months into the intervention, with managers, migrant workers and team leaders in two factories, where the pilot intervention was implemented, in Zhongshan city in Guangdong, a southern Chinese province. Data analysis was based on the thematic approach. Results This study identifies the societal, individual and programmatic factors that could influence the implementation of a pilot smoking cessation intervention among migrant workers in the two Chinese factories. At the societal level, social customs and relationships where smoking is seen as essential in social communications was the most important barrier to the implementation of smoking cessation intervention. At the individual level, migrant-related features such as low education, high mobility and poor integration with local residents, together with poor health beliefs and attitudes added to the challenges of implementing smoking cessation intervention. At the programmatic level, the role of small-team leaders was generally positive, although limited due to their busy work patterns and poor powers of enforcement. Conclusion Achieving successful smoking cessation intervention in factories could be challenging with many migrants, as multi-level factors including social context, intervention delivery, individual and migrants’ characteristics play an important role in shaping the implementation of the intervention. Our study suggests the importance of tailoring interventions for the migrant factory workers. Trial registration ChiCTR-OPC-17011637 at Chinese Clinical Trial Registry. Retrospectively registered on 12th June 2017.
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Affiliation(s)
- Guanyang Zou
- School of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, 510000, Guangdong, China.,Centre for Migrant Health Policy, Sun Yat-sen University, Guangzhou, 510000, Guangdong, China
| | - Xiaolin Wei
- Division of Clinical Epidemiology &Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M2J 4A6, Canada
| | - Simin Deng
- Kangning Hospital, Shenzhen, 518000, Guangdong, China
| | - Jia Yin
- School of Health Policy and Management, Shandong University, Jinan, 250000, Shandong, China
| | - Li Ling
- Centre for Migrant Health Policy, Sun Yat-sen University, Guangzhou, 510000, Guangdong, China. .,Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510000, Guangdong, China.
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22
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Poggiolini C. High self-efficacy regarding smoking cessation may weaken the intention to quit smoking. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1574096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Claudia Poggiolini
- IKMZ – Department of Communication and Media Research, University of Zurich, Andreasstrasse 15, Zürich 8050, Switzerland
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23
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Baskerville NB, Struik LL, Guindon GE, Norman CD, Whittaker R, Burns C, Hammond D, Dash D, Brown KS. Effect of a Mobile Phone Intervention on Quitting Smoking in a Young Adult Population of Smokers: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10893. [PMID: 30355563 PMCID: PMC6231795 DOI: 10.2196/10893] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/25/2018] [Accepted: 07/12/2018] [Indexed: 01/23/2023] Open
Abstract
Background Digital mobile technology presents a promising medium for reaching young adults with smoking cessation interventions because they are the heaviest users of this technology. Objective The aim of this study was to determine the efficacy of an evidence-informed smartphone app for smoking cessation, Crush the Crave (CTC), on reducing smoking prevalence among young adult smokers in comparison with an evidence-informed self-help guide, On the Road to Quitting (OnRQ). Methods A parallel, double-blind, randomized controlled trial with 2 arms was conducted in Canada to evaluate CTC. In total, 1599 young adult smokers (aged 19 to 29 years) intending to quit smoking in the next 30 days were recruited online and randomized to receive CTC or the control condition OnRQ for a period of 6 months. The primary outcome measure was self-reported continuous abstinence at the 6-month follow-up. Results Overall follow-up rates were 57.41% (918/1599) and 60.48% (967/1599) at 3 and 6 months, respectively. Moreover, 45.34% (725/1599) of participants completed baseline, 3-, and 6-month follow-up. Intention-to-treat analysis (last observation carried forward) showed that continuous abstinence (N=1599) at 6 months was not significantly different at 7.8% (64/820) for CTC versus 9.2% (72/779) for OnRQ (odds ratio; OR 0.83, 95% CI 0.59-1.18). Similarly, 30-day point prevalence abstinence at 6 months was not significantly different at 14.4% (118/820) and 16.9% (132/779) for CTC and OnRQ, respectively (OR 0.82, 95% CI 0.63-1.08). However, these rates of abstinence were favorable compared with unassisted 30-day quit rates of 11.5% among young adults. Secondary measures of quit attempts and the number of cigarettes smoked per day at 6-month follow-up did not reveal any significant differences between groups. For those who completed the 6-month follow-up, 85.1% (359/422) of young adult smokers downloaded CTC as compared with 81.8% (346/423) of OnRQ, χ21(N=845)=1.6, P=.23. Furthermore, OnRQ participants reported significantly higher levels of overall satisfaction (mean 3.3 [SD 1.1] vs mean 2.6 [SD 1.3]; t644=6.87, P<.001), perceived helpfulness (mean 5.8 [SD 2.4] vs mean 4.3 [SD 2.6], t657=8.0, P<.001), and frequency of use (mean 3.6 [SD 1.2] vs mean 3.2 [SD 1.1], t683=5.7, P<.001) compared with CTC participants. Conclusions CTC was feasible for delivering cessation support but was not superior to a self-help guide in helping motivated young adults to quit smoking. CTC will benefit from further formative research to address satisfaction and usage. As smartphone apps may not serve as useful alternatives to printed self-help guides, there is a need to conduct further research to understand how digital mobile technology smoking cessation interventions for smoking cessation can be improved. Trial Registration ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i)
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Affiliation(s)
- Neill Bruce Baskerville
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, ON, Canada
| | - Laura Louise Struik
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Godefroy Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Cameron D Norman
- Cense Ltd, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robyn Whittaker
- National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
| | - Catherine Burns
- Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - David Hammond
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Darly Dash
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - K Stephen Brown
- Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
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Tuovinen EL, Saarni SE, Kinnunen TH, Ollila H, Ruokolainen O, Patja K, Männistö S, Jousilahti P, Kaprio J, Korhonen T. Weight concerns as a predictor of smoking cessation according to nicotine dependence: A population-based study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2018; 35:344-356. [PMID: 32934537 PMCID: PMC7434149 DOI: 10.1177/1455072518800217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Nicotine-dependent smokers find it difficult to quit smoking. Additionally,
smoking-specific weight concerns may affect smoking cessation although the
evidence is controversial. We investigated whether smoking-specific weight
concerns predict the probability of cessation and, if so, whether the effect
varies according to the level of nicotine dependence. Methods: The study was conducted with a population-based sample of 355 adult daily
smokers who participated in the baseline examination in 2007 and in the 2014
follow-up. Baseline nicotine dependence was classified as low or high
(Fagerström Test for Nicotine Dependence; 0–3 vs. 4–10 points). Within these
groups, we examined whether baseline weight concerns predict smoking status
(daily, occasional, ex-smoker) at follow-up by using multinomial logistic
regression with adjustment for multiple covariates. Results: Among low-dependent participants at baseline, 28.5% had quit smoking, while
among highly dependent participants 26.1% had quit smoking. The interaction
between weight concerns and nicotine dependence on follow-up smoking status
was significant. Among participants with low nicotine dependence per the
fully adjusted model, greater weight concerns predicted a lower likelihood
of both smoking cessation (relative risk ratio 0.93 [95% CI 0.87–1.00]) and
smoking reduction to occasional occurrence (0.89 [95% CI 0.81–0.98]). Weight
concerns were not associated with follow-up smoking status among
participants with high nicotine dependence. Conclusions: Weight concerns are associated with a smaller likelihood of quitting among
smokers with low nicotine dependence. Weight concerns should be addressed in
smoking cessation interventions, especially with smokers who have low
nicotine dependence.
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Affiliation(s)
| | | | - Taru H Kinnunen
- University of Helsinki, Finland; and Behavioral Science Consulting, North Andover, MA, USA
| | - Hanna Ollila
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Satu Männistö
- National Institute for Health and Welfare, Helsinki, Finland
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25
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Worley MJ, Isgro M, Heffner JL, Lee SY, Daniel BE, Anthenelli RM. Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial. Addict Behav 2018; 84:263-270. [PMID: 29763835 DOI: 10.1016/j.addbeh.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation. METHODS The sample includes male, AD smokers (N = 129) with 1-32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up. RESULTS Overall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82-0.90), motivation to quit (IRRs = 0.65-0.85), and intrinsic reasons for quitting (IRRs = 0.96-0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05-1.07), impulsivity (IRRs = 1.01-1.03), weight-control expectancies (IRRs = 1.10-1.15), and childhood sexual abuse (IRRs = 1.03-1.07) predicted more cigarettes/day. CONCLUSIONS Smokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.
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Affiliation(s)
- Matthew J Worley
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States.
| | - Melodie Isgro
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., M3-B232, PO Box 19024, Seattle, WA 98109, United States
| | - Soo Yong Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
| | - Belinda E Daniel
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States
| | - Robert M Anthenelli
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
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26
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Girvalaki C, Papadakis S, Vardavas C, Pipe AL, Petridou E, Tsiligianni I, Lionis C. Training General Practitioners in Evidence-Based Tobacco Treatment: An Evaluation of the Tobacco Treatment Training Network in Crete (TiTAN-Crete) Intervention. HEALTH EDUCATION & BEHAVIOR 2018; 45:888-897. [PMID: 29862845 DOI: 10.1177/1090198118775481] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rates of tobacco treatment delivery in primary care are suboptimal. AIMS We report on the effectiveness of the TiTAN Crete intervention on rates of patient-reported 4As (ask, advise, assist, arrange) tobacco treatment and general practitioner's (GP) knowledge, attitudes, self-efficacy, and intentions. METHODS A quasi-experimental pilot study with pre-post evaluation was conducted in Crete, Greece (2015-2016). GPs ( n = 24) intervention and control group and a cross-sectional sample of their patients ( n = 841) were surveyed before the implementation of the intervention. GPs in the intervention group received training, practice, and patient tools to support the integration of the 4As treatment into clinical routines. Intervention group GPs ( n = 14) and a second cross-sectional sample of patients ( n = 460) were surveyed 4 months following the intervention to assess changes in outcomes of interest. Multilevel modeling was used to analyze data. RESULTS Among GPs exposed to the intervention, significant increases in knowledge, self-efficacy, and rates of 4As delivery were documented between the pre- and postassessment and compared with those of the control group. Specifically, the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for 4As delivery between the pre-and postassessment among GPs exposed to the TiTAN intervention were as follows: Ask AOR 3.66 (95% CI [2.61, 5.14]); Advise AOR 4.21 (95% CI [3.02, 5.87]); Assist AOR 13.10 (95% CI [8.83, 19.42]) and Arrange AOR 4.75 (95% CI [2.67, 8.45]). CONCLUSION We found significant increases in rates at which GPs delivered evidence-based tobacco treatment following exposure to the TiTAN intervention. Future research should examine methods for supporting broader dissemination of well-designed training interventions in general practice.
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Affiliation(s)
| | - Sophia Papadakis
- 1 University of Crete, Heraklion, Greece.,2 University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,3 University of Ottawa, Ottawa, Ontario, Canada
| | | | - Andrew L Pipe
- 2 University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,3 University of Ottawa, Ottawa, Ontario, Canada
| | - Eleni Petridou
- 4 National and Kapodistrian University of Athens, Athens, Greece
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Taniguchi C, Tanaka H, Saka H, Oze I, Tachibana K, Nozaki Y, Suzuki Y, Sakakibara H. Changes in self-efficacy associated with success in quitting smoking in participants in Japanese smoking cessation therapy. Int J Nurs Pract 2018; 24:e12647. [DOI: 10.1111/ijn.12647] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 01/22/2018] [Accepted: 02/16/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Chie Taniguchi
- Department of Nursing, Japan and Visiting Scholar, Nagoya Medical Center, Clinical Research Center; Sugiyama Jogakuen University; Nagoya Japan
| | - Hideo Tanaka
- Kishiwada Public Health Center of Osaka Prefecture, Japan and Visiting Scholar, Division of Epidemiology and Prevention; Aichi Cancer Center Research Institute; Nagoya Japan
| | - Hideo Saka
- Department of Respiratory Medicine and Medical Oncology; National Hospital Organization Nagoya Medical Center; Nagoya Japan
| | - Isao Oze
- Division of Molecular & Clinical Epidemiology; Aichi Cancer Center Research Institute; Nagoya Japan
| | - Kazunobu Tachibana
- Department of Education and Training, Department of Respiratory Medicine; National Hospital Organization Kinki-Chuo Chest Medical Center; Sakai Japan
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine; Japan Community Healthcare Organization Chukyo Hospital; Osaka Japan
| | - Yukio Suzuki
- Department of Respiratory Medicine; Kitasato University Kitasato Institute Hospital; Tokyo Japan
| | - Hisataka Sakakibara
- Department of Nursing; Nagoya University Graduate School of Medicine; Nagoya Japan
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28
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Pinsker EA, Hennrikus DJ, Erickson DJ, Call KT, Forster JL, Okuyemi KS. Trends in self-efficacy to quit and smoking urges among homeless smokers participating in a smoking cessation RCT. Addict Behav 2018; 78:43-50. [PMID: 29125976 DOI: 10.1016/j.addbeh.2017.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In the U.S., approximately 73% of homeless adults smoke cigarettes and they experience difficulty quitting. Homeless smokers report low self-efficacy to quit and that smoking urges are a barrier to quitting. Self-efficacy to quit and smoking urges are dynamic and change throughout smoking cessation treatment. This study examines changes in self-efficacy to quit and smoking urges throughout a smoking cessation intervention among the homeless and identifies predictors of change in these characteristics. METHODS Homeless smokers (n=430) participating in a smoking cessation randomized controlled trial in the U.S. completed surveys at baseline, and weeks 1, 2, 4, 6, 8, and 26 on demographic and smoking characteristics (i.e., confidence to quit, self-efficacy to refrain from smoking, and smoking urges). A growth curve analysis was conducted by modeling change in the smoking characteristics over time and examining the variability in the change in smoking characteristics by demographic characteristics and treatment group. RESULTS Among the full sample, self-efficacy to refrain from smoking increased linearly over time, confidence to quit increased until the midpoint of treatment but subsequently decreased, and smoking urges decreased until the midpoint of treatment but subsequently increased. There were race differences in these trajectories. Racial minorities experienced significantly greater increases in self-efficacy to refrain from smoking than Whites and Blacks had higher confidence to quit than Whites. CONCLUSIONS White participants experienced less increase in self-efficacy to refrain from smoking and lower confidence to quit and therefore may be a good target for efforts to increase self-efficacy to quit as part of homeless-targeted smoking cessation interventions. Sustaining high confidence to quit and low smoking urges throughout treatment could be key to promoting higher cessation rates among the homeless.
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29
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Green JP, Lynn SJ. A Multifaceted Hypnosis Smoking-Cessation Program: Enhancing Motivation and Goal Attainment. Int J Clin Exp Hypn 2017; 65:308-335. [PMID: 28506140 DOI: 10.1080/00207144.2017.1314740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Smoking cessation remains a major health priority. Despite public campaigns against smoking and widespread availability of smoking-cessation treatments, many people continue to smoke. The authors argue that the "problem of motivation," that is, suboptimal or fluctuating motivation to resist smoking urges and to comply with the demands of treatment, commonly undermines treatment seeking and adherence, appreciably reducing the success rates of smoking-cessation programs. The authors describe the history of the Winning Edge smoking-cessation program and discuss ways to enhance motivation before, during, and after formal treatment. They illustrate how hypnotic suggestions, administered in the context of their program, can promote cognitive, behavioral, and emotional commitment to treatment and enhance motivation to live a smoke-free life.
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30
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Fox AT, Martin LE, Bruce J, Moreno JL, Staggs VS, Lee HS, Goggin K, Harris KJ, Richter K, Patten C, Catley D. Executive function fails to predict smoking outcomes in a clinical trial to motivate smokers to quit. Drug Alcohol Depend 2017; 175:227-231. [PMID: 28458075 PMCID: PMC5425305 DOI: 10.1016/j.drugalcdep.2017.01.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/16/2016] [Accepted: 01/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Executive function (EF) is considered an important mediator of health outcomes. It is hypothesized that those with better EF are more likely to succeed in turning their intentions into actual health behaviors. Prior studies indicate EF is associated with smoking cessation. Experimental and longitudinal studies, however, have yielded mixed results. Few studies have examined whether EF predicts post-treatment smoking behavior. Fewer still have done so prospectively in a large trial. We sought to determine if EF predicts quit attempts and cessation among community smokers in a large randomized trial evaluating the efficacy of motivational interventions for encouraging cessation. METHODS Participants (N=255) completed a baseline assessment that included a cognitive battery to assess EF (Oral Trail Making Test B, Stroop, Controlled Oral Word Association Test). Participants were then randomized to 4 sessions of Motivational Interviewing or Health Education or one session of Brief Advice to quit. Quit attempts and cessation were assessed at weeks 12 and 26. RESULTS In regression analyses, none of the EF measures were statistically significant predictors of quit attempts or cessation (all ps>0.20). CONCLUSIONS Our data did not support models of health behavior that emphasize EF as a mediator of health outcomes. Methodological shortcomings weaken the existing support for an association between EF and smoking behavior. We suggest methodological improvements that could help move this potentially important area of research forward.
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Affiliation(s)
- Andrew T Fox
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Laura E Martin
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA; Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jared Bruce
- Department of Psychology, University of Missouri - Kansas City, 5030 Cherry Hall, Room 313, Kansas City, MO, 64110, USA
| | - Jose L Moreno
- Department of Psychiatry, University of Texas Health Science Center - San Antonio,7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Vincent S Staggs
- Health Services and Outcomes Research, Children's Mercy Kansas City,2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri - Kansas City,2411 Holmes Street Kansas City, MO 64108, USA
| | - Hyoung S Lee
- Interdisciplinary Arts and Sciences, University of Washington Tacoma, 1900 Commerce St, Tacoma, WA 98402-3100, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City,2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri - Kansas City,2411 Holmes Street Kansas City, MO 64108, USA
| | - Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana,Skaggs Building Room 352, Missoula, MT 59812, USA
| | - Kimber Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Christi Patten
- Department of Psychology and Psychiatry, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City,2401 Gillham Rd., Kansas City, MO 64108, USA
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Cropsey KL, Hendricks PS, Schiavon S, Sellers A, Froelich M, Shelton RC, Carpenter MJ. A pilot trial of In vivo NRT sampling to increase medication adherence in community corrections smokers. Addict Behav 2017; 67:92-99. [PMID: 28063325 DOI: 10.1016/j.addbeh.2016.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/13/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Individuals in the criminal justice system demonstrate high rates of cigarette use (70-80%) and low adherence to smoking cessation medication. Educational approaches have not been shown to promote adherence or cessation, though medication sampling has boosted both use and cessation. The objective of the present study was to determine whether In vivo nicotine replacement therapy (NRT) sampling approach increases NRT adherence among criminal justice smokers during a subsequent quit attempt. METHODS We conducted a pilot study with 43 community corrections smokers randomized to a 4-session (one 30-min session per week) precessation intervention of either In vivo NRT sampling (Session 1: patch; Session 2: gum; Session 3: combination NRT (cNRT); Session 4: review) vs. 4 time-matched sessions of standard smoking cessation with cNRT started after Session 1. Both groups received an additional 8weeks of cNRT following the four intervention sessions. RESULTS During the in vivo administration of NRT, total withdrawal and craving severity significantly decreased from pre- to post-session compared to Control participants. In vivo participants evinced greater patch use at Session 4 and greater gum use through Week 8 relative to Controls. DISCUSSION In vivo NRT sampling may increase NRT adherence relative to standard counseling sessions among criminal justice smokers. A larger trial of this novel intervention appears to be warranted.
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Uziel L, Baumeister RF. The Self-Control Irony: Desire for Self-Control Limits Exertion of Self-Control in Demanding Settings. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2017; 43:693-705. [PMID: 28903642 DOI: 10.1177/0146167217695555] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Self-control is a highly adaptive human capacity. Accordingly, development of self-control is widely encouraged. Whereas the benefits of having self-control are well documented, little is known about the impact of wanting self-control. The present investigation fills this void by exploring the effect of desire for self-control on the ability to exert self-control. It was expected that in the context of demanding self-control challenges, a desire for self-control will highlight a discrepancy between one's goals and perceived performance potential, leading to reduced efficacy beliefs and task disengagement. Four studies ( N = 635) supported the prediction. Study 1 showed that a strong desire impaired performance on a demanding task but not on a simple task. Study 2 conceptually replicated the decrement in performance and established causality by experimentally manipulating desire for self-control. Studies 3 and 4 showed that reduction in efficacy beliefs mediate the effect. Implications of the findings are discussed.
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Affiliation(s)
- Liad Uziel
- 1 Bar-Ilan University, Ramat-Gan, Israel
| | - Roy F Baumeister
- 2 Florida State University, Tallahassee, USA.,3 University of Queensland, Australia
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Cropsey KL, Clark CB, Stevens EN, Schiavon S, Lahti AC, Hendricks PS. Predictors of medication adherence and smoking cessation among smokers under community corrections supervision. Addict Behav 2017; 65:111-117. [PMID: 27816035 PMCID: PMC5907501 DOI: 10.1016/j.addbeh.2016.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/04/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. METHODS Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. RESULTS The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. CONCLUSIONS These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population.
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Affiliation(s)
- Karen L Cropsey
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Sparks Center 1016, 1720 2nd Ave. South, Birmingham, AL 35294, USA.
| | - C Brendan Clark
- Wichita State University, Department of Psychology, Box 34, Wichita, Kansas 67260-0034, USA.
| | - Erin N Stevens
- Auburn Psychology Group, LLC. 861-D North Dean Road, Auburn, AL 36830, USA.
| | - Samantha Schiavon
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Sparks Center 1016, 1720 2nd Ave. South, Birmingham, AL 35294, USA.
| | - Adrienne C Lahti
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Sparks Center 1016, 1720 2nd Ave. South, Birmingham, AL 35294, USA.
| | - Peter S Hendricks
- University of Alabama at Birmingham, School of Public Health, Department of Health Behavior, 227L Ryals Public Health Building, 1665 University Blvd., Birmingham, AL 35294, USA.
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Mindfulness treatment for substance misuse: A systematic review and meta-analysis. J Subst Abuse Treat 2017; 75:62-96. [PMID: 28153483 DOI: 10.1016/j.jsat.2017.01.008] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/09/2016] [Accepted: 01/18/2017] [Indexed: 01/19/2023]
Abstract
High rates of relapse following substance misuse treatment highlight an urgent need for effective therapies. Although the number of empirical studies investigating effects of mindfulness treatment for substance misuse has increased dramatically in recent years, few reviews have examined findings of mindfulness studies. Thus, this systematic review examined methodological characteristics and substantive findings of studies evaluating mindfulness treatments for substance misuse published by 2015. The review also includes the first meta-analysis of randomized controlled trials of mindfulness treatments for substance misuse. Comprehensive bibliographic searches in PubMed, PsycInfo, and Web of Science, identified 42 pertinent studies. Meta-analytic results revealed significant small-to-large effects of mindfulness treatments in reducing the frequency and severity of substance misuse, intensity of craving for psychoactive substances, and severity of stress. Mindfulness treatments were also effective in increasing rates of posttreatment abstinence from cigarette smoking compared to alternative treatments. Mindfulness treatment for substance misuse is a promising intervention for substance misuse, although more research is needed examining the mechanisms by which mindfulness interventions exert their effects and the effectiveness of mindfulness treatments in diverse treatment settings.
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Motivational interviewing and the decisional balance procedure for cessation induction in smokers not intending to quit. Addict Behav 2017; 64:171-178. [PMID: 27619008 DOI: 10.1016/j.addbeh.2016.08.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/11/2016] [Accepted: 08/30/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The decisional balance (DB) procedure examines the pros and cons of behavior change and was considered a component in early formulations of Motivational Interviewing (MI). However, there is controversy and conflicting findings regarding the use of a DB exercise within the treatment of addictions and a need to clarify the role of DB as a component of MI. METHODS College tobacco smokers (N=82) with no intentions on quitting were randomly assigned to receive a single counseling session of either Motivational Interviewing using only the decisional balance component (MIDB), or health education around smoking cessation (HE). Assessments were obtained at baseline, immediately post-treatment, 1week, and 4weeks. RESULTS Compared to HE, the MIDB sessions scored significantly higher on the Motivational Interviewing Treatment Integrity (MITI) scale (all standardized differences d>1, p<0.001). Unexpectedly, self-report Pros of smoking scores increased for MIDB but decreased for HE (MIDB vs HE standardized difference d=0.5; 95%CI 0.1 to 1.0, p=0.021). Both groups showed significant reductions in smoking rates and increases in motivation to quit, quit attempts, and self-reported abstinence, with no significant group differences. Changes in the Pros of smoking were correlated with MITI scores, but not with cessation outcomes. In contrast, increases in the Cons of smoking and therapeutic alliance were predictive of better cessation outcomes. CONCLUSIONS The decisional balance exercise as formulated by earlier versions of MI may be counter-productive and cautions around its use are warranted. Instead, improved cessation outcomes appear associated with increasing perceived benefits of quitting and positive therapeutic alliance.
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The challenge of reducing smoking in people with serious mental illness. THE LANCET RESPIRATORY MEDICINE 2016; 4:835-844. [DOI: 10.1016/s2213-2600(16)30228-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 12/28/2022]
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Park E, Choi SH, Duffy SA. The Effect of Re-randomization in a Smoking Cessation Trial. Am J Health Behav 2016; 40:667-74. [PMID: 27561870 DOI: 10.5993/ajhb.40.5.14] [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] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this sub-study was to determine whether operating engineers (heavy equipment operators) who failed to quit smoking in a randomized controlled trial would benefit from re-exposure to the interventions one year later. METHODS Operating Engineers attending workplace safety training groups during the winters of 2010 to 2012 were randomized by training group to either to the Tobacco Tactics Web-based intervention or the 1-800-QUIT-NOW telephone line. Of the 145 original participants, 41 reappeared in training groups one year later and were re-randomized with their group. Seven-day point prevalence quit rates at 30-days and 6-months post-intervention were analyzed using the chi-square test and Fisher's exact test. RESULTS At 30-day follow-up, an additional 9.8% (4/41) of repeaters had quit smoking. At 6-month follow-up, 12.2% (5/41) of repeaters had quit smoking. At 30-day follow-up, increased quitting was more common among those re-randomized to the intervention group than among those who received the control treatment, although this was not statistically significant and was no longer true at 6-month follow-up. CONCLUSIONS Because many smokers make multiple attempts to quit smoking, re-enrollment of participants in smoking cessation trials may produce additional quitters.
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Affiliation(s)
- Eunhee Park
- University at Buffalo, School of Nursing, Buffalo, NY, USA
| | - Seung Hee Choi
- Michigan State University, College of Nursing, East Lansing, MI, USA
| | - Sonia A Duffy
- Ohio State University, School of Nursing, Columbus, OH, USA.
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Harris KJ, Bradley-Ewing A, Goggin K, Richter KP, Patten C, Williams K, Lee HS, Staggs VS, Catley D. Recruiting unmotivated smokers into a smoking induction trial. HEALTH EDUCATION RESEARCH 2016; 31:363-374. [PMID: 27081187 PMCID: PMC4872594 DOI: 10.1093/her/cyw018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
Little is known about effective methods to recruit unmotivated smokers into cessation induction trials, the reasons unmotivated smokers agree to participate, and the impact of those reasons on study outcomes. A mixed-method approach was used to examine recruitment data from a randomized controlled cessation induction trial that enrolled 255 adult smokers with low motivation to quit. Over 15 months, 33% of smokers who inquired about the study were enrolled. Common recruitment methods included word-of-mouth, print advertisements and clinic referrals. Frequently mentioned reasons for participating included to: gain financial incentives (44.7%), learn about research or help others quit (43%), learn about smoking and risks (40%) and help with future quits (i.e. Quit Assistance, 23.9%). Separate regression models predicting study outcomes at 26 weeks indicated that smokers who said they participated for Quit Assistance reported higher motivation to quit (B 1.26) and were more likely to have made a quit attempt (OR 2.03) compared to those not mentioning this reason, when baseline characteristics were controlled. Understanding reasons for unmotivated smokers' interest in treatment can help practitioners and researchers design effective strategies to engage this population.
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Affiliation(s)
- Kari Jo Harris
- School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Skaggs Rm 352, Missoula, MT 59812
| | - Andrea Bradley-Ewing
- Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics; Schools of Medicine and Pharmacy, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics; Schools of Medicine and Pharmacy, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108
| | - Kimber P Richter
- Department of Preventive Medicine & Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, 4004 Robinson, Kansas City, KS 66160
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW Rochester, MN 55905
| | - Karen Williams
- Department of Biomedical and Health Informatics, University of Missouri-Kanas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108
| | - Hyoung S Lee
- Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, WA 98402
| | - Vincent S Staggs
- Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108 and
| | - Delwyn Catley
- Children's Mercy Hospitals and Clinics, Center for Children's Healthy Lifestyles & Nutrition, Department of Pediatrics, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
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Catley D, Goggin K, Harris KJ, Richter KP, Williams K, Patten C, Resnicow K, Ellerbeck EF, Bradley-Ewing A, Lee HS, Moreno JL, Grobe JE. A Randomized Trial of Motivational Interviewing: Cessation Induction Among Smokers With Low Desire to Quit. Am J Prev Med 2016; 50:573-583. [PMID: 26711164 PMCID: PMC4841713 DOI: 10.1016/j.amepre.2015.10.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Despite limitations in evidence, the current Clinical Practice Guideline advocates Motivational Interviewing for smokers not ready to quit. This study evaluated the efficacy of Motivational Interviewing for inducing cessation-related behaviors among smokers with low motivation to quit. DESIGN Randomized clinical trial. SETTING/PARTICIPANTS Two-hundred fifty-five daily smokers reporting low desire to quit smoking were recruited from an urban community during 2010-2011 and randomly assigned to Motivational Interviewing, health education, or brief advice using a 2:2:1 allocation. Data were analyzed from 2012 to 2014. INTERVENTION Four sessions of Motivational Interviewing utilized a patient-centered communication style that explored patients' own reasons for change. Four sessions of health education provided education related to smoking cessation while excluding elements characteristic of Motivational Interviewing. A single session of brief advice consisted of brief, personalized advice to quit. MAIN OUTCOMES MEASURES Self-reported quit attempts; smoking abstinence (biochemically verified); use of cessation pharmacotherapies; motivation; and confidence to quit were assessed at baseline and 3- and 6-month follow-ups. RESULTS Unexpectedly, no significant differences emerged between groups in the proportion who made a quit attempt by 6-month follow-up (Motivational Interviewing, 52.0%; health education, 60.8%; brief advice, 45.1%; p=0.157). Health education had significantly higher biochemically verified abstinence rates at 6 months (7.8%) than brief advice (0.0%) (8% risk difference, 95% CI=3%, 13%, p=0.003), with the Motivational Interviewing group falling in between (2.9% abstinent, 3% risk difference, 95% CI=0%, 6%, p=0.079). Both Motivational Interviewing and health education groups showed greater increases in cessation medication use, motivation, and confidence to quit relative to brief advice (all p<0.05), and health education showed greater increases in motivation relative to Motivational Interviewing (Cohen's d=0.36, 95% CI=0.12, 0.60). CONCLUSIONS Although Motivational Interviewing was generally more efficacious than brief advice in inducing cessation behaviors, health education appeared the most efficacious. These results highlight the need to identify the contexts in which Motivational Interviewing may be most efficacious and question recommendations to use Motivational Interviewing rather than other less complex cessation induction interventions. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01188018.
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Affiliation(s)
- Delwyn Catley
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri
| | - Kari Jo Harris
- School of Public and Community Health Sciences, The University of Montana, Missoula, Montana
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
| | - Karen Williams
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
| | - Andrea Bradley-Ewing
- Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Hyoung S Lee
- School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, Washington
| | - Jose L Moreno
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
| | - James E Grobe
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
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Ferron JC, Devitt T, McHugo GJ, A Jonikas J, Cook JA, Brunette MF. Abstinence and Use of Community-Based Cessation Treatment After a Motivational Intervention Among smokers with Severe Mental Illness. Community Ment Health J 2016; 52:446-56. [PMID: 26932324 DOI: 10.1007/s10597-016-9998-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
Motivational interventions help people with mental illness try to quit smoking, but few studies have evaluated factors associated with this groups' cessation with community treatment. We examined predictors of abstinence after a brief motivational intervention among smokers with severe mental illness. Education, stage of change post intervention, and use of cessation treatment predicted any 1-week period of self-reported abstinence over 6 months (29%). Cessation treatment mediated the relationship between stage of change and abstinence. Because treatment was the key modifiable predictor of abstinence, future research should establish strategies that improve motivation for, access to, and retention in cessation treatment. Clinical Trials Identifier NCT01412866.
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Affiliation(s)
- Joelle C Ferron
- Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA.
| | | | - Gregory J McHugo
- Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA
| | - Jessica A Jonikas
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Mary F Brunette
- Psychiatric Research Center, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA
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Piñeiro B, López-Durán A, del Río EF, Martínez Ú, Brandon TH, Becoña E. Motivation to quit as a predictor of smoking cessation and abstinence maintenance among treated Spanish smokers. Addict Behav 2016; 53:40-5. [PMID: 26441045 DOI: 10.1016/j.addbeh.2015.09.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/12/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although quitting motivation predicts smoking cessation, there have been inconsistent findings regarding motivation predicting long-term maintenance of abstinence. Moreover, most such research has been conducted in North America and the United Kingdom. The aim of this study was to examine motivation to quit as a predictor of smoking cessation and of abstinence maintenance in a Spanish sample. METHOD The sample comprised 286 Spanish smokers undergoing psychological treatment for smoking cessation. Motivation to quit was assessed pre-treatment and post-treatment with the Readiness to Quit Ladder. Abstinence post-treatment and at 6month follow-up was biochemically verified. RESULTS Participants with higher levels of pre-treatment and post-treatment motivation were more likely to be abstinent at the end of the treatment (OR=1.36) and at 6month follow-up (OR=4.88). Among abstainers at the end of the treatment (61.9%), higher levels of motivation to quit post-treatment predicted maintaining abstinence at 6months (OR=2.83). Furthermore, participants who failed to quit smoking reported higher levels of motivation to quit post-treatment than they had pretreatment (p<.001). CONCLUSIONS Motivation to quit smoking predicted short and long-term cessation, and also predicted long-term maintenance of abstinence. These results have implications for understanding motivational processes of smoking cessation in general, while extending research to Spanish smokers. They may also help in the design of cessation and relapse-prevention interventions. Specifically, the results suggest that motivational enhancement is important throughout the cessation and maintenance periods.
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Predictors for Smoking Cessation with Acupuncture in a Hong Kong Population. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:189694. [PMID: 26347786 PMCID: PMC4548099 DOI: 10.1155/2015/189694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/26/2015] [Indexed: 12/04/2022]
Abstract
Background. Observational studies of smoking cessation with acupuncture have been reported widely; however, few researchers have focused on its predictors. Objective. This paper attempts to explore the predictors for smoking cessation with acupuncture in a Hong Kong population, aiming to provide references for clinical treatment in the future. Methods. We performed a secondary analysis of data from our observational study “Acupuncture for Smoking Cessation (2011–2014)” in Hong Kong. A total of 23 indexes were selected as possible predictors, and study participants with complete information of 23 indexes were included. By taking 8-week and 52-week smoking cessation results as dependent variables, binary logistic regression method was used to identify the predictors. Additionally, based on an M5P decision-tree algorithm, an equation of “successful rate of smoking cessation with acupuncture” was calculated. Results. (1) 2,051 study participants were included in total. (2) According to the results of binary logistic regression, variables including treatment location, total number of acupuncture sessions received, and whether the study participants received at least 6 sessions of acupuncture were taken as the short-term predictors; gender, treatment location, Fagerstrom Test for Nicotine Dependence (FTND), and total number of acupuncture sessions received were taken as the long-term predictors. (3) According to study participants' FTND, treatment location, and number of cigarettes smoked/day, the equation of “successful rate of smoking cessation with acupuncture” was established. Conclusion. Receiving sufficient and qualified acupuncture is the leading factor for short-term smoking cessation with acupuncture, whereas individual factors and smoking background play a more important role in long-term smoking cessation with acupuncture.
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Richter KP, Shireman TI, Ellerbeck EF, Cupertino AP, Catley D, Cox LS, Preacher KJ, Spaulding R, Mussulman LM, Nazir N, Hunt JJ, Lambart L. Comparative and cost effectiveness of telemedicine versus telephone counseling for smoking cessation. J Med Internet Res 2015; 17:e113. [PMID: 25956257 PMCID: PMC4468596 DOI: 10.2196/jmir.3975] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 11/15/2022] Open
Abstract
Background In rural America, cigarette smoking is prevalent and health care providers lack the time and resources to help smokers quit. Telephone quitlines are important avenues for cessation services in rural areas, but they are poorly integrated with local health care resources. Objective The intent of the study was to assess the comparative effectiveness and cost effectiveness of two models for delivering expert tobacco treatment at a distance: telemedicine counseling that was integrated into smokers’ primary care clinics (Integrated Telemedicine—ITM) versus telephone counseling, similar to telephone quitline counseling, delivered to smokers in their homes (Phone). Methods Smokers (n=566) were recruited offline from 20 primary care and safety net clinics across Kansas. They were randomly assigned to receive 4 sessions of ITM or 4 sessions of Phone counseling. Patients in ITM received real-time video counseling, similar to Skype, delivered by computer/webcams in clinic exam rooms. Three full-time equivalent trained counselors delivered the counseling. The counseling duration and content was the same in both groups and was available in Spanish or English. Both groups also received identical materials and assistance in selecting and obtaining cessation medications. The primary outcome was verified 7-day point prevalence smoking abstinence at month 12, using an intent-to-treat analysis. Results There were no significant baseline differences between groups, and the trial achieved 88% follow-up at 12 months. Verified abstinence at 12 months did not significantly differ between ITM or Phone (9.8%, 27/280 vs 12%, 34/286; P=.406). Phone participants completed somewhat more counseling sessions than ITM (mean 2.6, SD 1.5 vs mean 2.4, SD 1.5; P=.0837); however, participants in ITM were significantly more likely to use cessation medications than participants in Phone (55.9%, 128/280 vs 46.1%, 107/286; P=.03). Compared to Phone participants, ITM participants were significantly more likely to recommend the program to a family member or friend (P=.0075). From the combined provider plus participant (societal) perspective, Phone was significantly less costly than ITM. Participants in ITM had to incur time and mileage costs to travel to clinics for ITM sessions. From the provider perspective, counseling costs were similar between ITM (US $45.46, SD 31.50) and Phone (US $49.58, SD 33.35); however, total provider costs varied widely depending on how the clinic space for delivering ITM was valued. Conclusions Findings did not support the superiority of ITM over telephone counseling for helping rural patients quit smoking. ITM increased utilization of cessation pharmacotherapy and produced higher participant satisfaction, but Phone counseling was significantly less expensive. Future interventions could combine elements of both approaches to optimize pharmacotherapy utilization, counseling adherence, and satisfaction. Such an approach could commence with a telemedicine-delivered clinic office visit for pharmacotherapy guidance, and continue with telephone or real-time video counseling delivered via mobile phones to flexibly deliver behavioral support to patients where they most need it—in their homes and communities. Trial Registration Clinicaltrials.gov NCT00843505; http://clinicaltrials.gov/ct2/show/NCT00843505 (Archived by WebCite at http://www.webcitation.org/6YKSinVZ9).
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Affiliation(s)
- Kimber P Richter
- University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS, United States.
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Abstract
Smoking is highly prevalent among HIV+ individuals and studies indicate that it may be associated with poor ART adherence, though the relationship is poorly understood. In addition little is known about interest in quitting among HIV+ smokers who are having adherence difficulties. We examined smoking and ART adherence among 203 HIV+ individuals enrolled in a randomized trial of interventions to increase ART adherence. Prior analyses indicated there were no overall treatment group effects. Smoking status and motivation to quit was assessed at baseline and ART adherence was assessed at week 12, 24, 36, and 48. Longitudinal generalized estimating equation analysis that controlled for treatment group revealed that smoking status was not significantly related to adherence over time. Motivation to quit was high with 58 % intending to quit in the next 6 months and 25 % intending to quit in the next 30 days. Findings suggest that smoking is not associated with adherence among those with adherence difficulties. However it does not diminish importance of addressing both behaviors especially given HIV+ smokers substantial interest in changing smoking behavior.
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Baskerville NB, Struik LL, Hammond D, Guindon GE, Norman CD, Whittaker R, Burns CM, Grindrod KA, Brown KS. Effect of a mobile phone intervention on quitting smoking in a young adult population of smokers: randomized controlled trial study protocol. JMIR Res Protoc 2015; 4:e10. [PMID: 25599695 PMCID: PMC4319093 DOI: 10.2196/resprot.3823] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/30/2014] [Accepted: 11/23/2014] [Indexed: 12/31/2022] Open
Abstract
Background Tobacco use remains the number one cause of preventable chronic disease and death in developed countries worldwide. In North America, smoking rates are highest among young adults. Despite that the majority of young adult smokers indicate wanting to quit, smoking rates among this age demographic have yet to decline. Helping young adults quit smoking continues to be a public health priority. Digital mobile technology presents a promising medium for reaching this population with smoking cessation interventions, especially because young adults are the heaviest users of this technology. Objective The primary aim of this trial is to determine the effectiveness of an evidence-informed mobile phone app for smoking cessation, Crush the Crave, on reducing smoking prevalence among young adult smokers. Methods A parallel randomized controlled trial (RCT) with two arms will be conducted in Canada to evaluate Crush the Crave. In total, 1354 young adult smokers (19 to 29 years old) will be randomized to receive the evidence-informed mobile phone app, Crush the Crave, or an evidence-based self-help guide known as “On the Road to Quitting” (control) for a period of 6 months. The primary outcome measure is a 30-day point prevalence of abstinence at the 6-month follow-up. Secondary outcomes include a 7-day point prevalence of abstinence, number of quit attempts, reduction in consumption of cigarettes, self-efficacy, satisfaction, app utilization metrics, and use of smoking cessation services. A cost-effectiveness analysis is included. Results This trial is currently open for recruitment. The anticipated completion date for the study is April 2016. Conclusions This randomized controlled trial will provide the evidence to move forward on decision making regarding the inclusion of technology-based mobile phone interventions as part of existing smoking cessation efforts made by health care providers. Evidence from the trial will also inform the development of future apps, provide a deeper understanding of the factors that drive change in smoking behavior using an app, and improve the design of cessation apps. This trial is among the first to assess the effect of a comprehensive and evidence-informed mHealth smoking cessation app on a large sample of young adult smokers. Strengths of the trial include the high-quality research design and in-depth assessment of the implementation of the intervention. If effective, the trial has the potential to demonstrate that including mHealth technology as a population-based intervention strategy can cost-effectively reach a greater proportion of the population and help young adult smokers to quit. Trial Registration ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i).
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Affiliation(s)
- Neill Bruce Baskerville
- Propel Centre for Population Health Impact, Lyle S. Hallman Institute, University of Waterloo, Waterloo, ON, Canada.
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Tuovinen EL, Saarni SE, Kinnunen TH, Haukkala A, Jousilahti P, Patja K, Kaprio J, Korhonen T. Associations of Weight Concerns With Self-Efficacy and Motivation to Quit Smoking: A Population-Based Study Among Finnish Daily Smokers. Nicotine Tob Res 2014; 17:1134-41. [PMID: 25542916 DOI: 10.1093/ntr/ntu277] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/11/2014] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Concerns about weight gain occurring after smoking cessation may affect motivation and self-efficacy towards quitting smoking. We examined associations of smoking-specific weight concerns with smoking cessation motivation and self-efficacy in a population-based cross-sectional sample of daily smokers. METHODS Six-hundred biochemically verified (blood cotinine) current daily smokers comprising 318 men and 282 women aged 25-74 years, were studied as part of the National FINRISK (Finnish Population Survey on Risk Factors on Chronic, Noncommunicable Diseases) study and its DIetary, Lifestyle and Genetic factors in the development of Obesity and Metabolic syndrome (DILGOM) sub-study that was conducted in Finland in 2007. Self-reported scales were used to assess weight concerns, motivation and self-efficacy regarding the cessation of smoking. Multiple regression analyses of concerns about weight in relation to motivation and self-efficacy were conducted with adjustments for sex, age (years), body mass index (BMI, [kg/m(2)]), physical activity (times per week), and further controlled for nicotine dependence (Fagerström Test for Nicotine Dependence). RESULTS Higher levels of weight concerns were associated with lower self-efficacy (β = -0.07, p < .001) after adjusting for sex and age. The association remained after additional adjustment for BMI and physical activity (β = -0.07, p < .001). After further controlling for nicotine dependence the association became weaker but remained significant (β = -0.04, p = .02). There were no statistically significant associations between concerns about weight and motivation for smoking cessation (β = 0.02, p = 0.16). CONCLUSIONS These cross-sectional population-based data do not support earlier findings that suggest that smokers with high levels of weight concerns are less motivated to quit smoking. Our data suggest that daily smokers who are highly concerned about weight may have lower self-efficacy for cessation of smoking.
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Affiliation(s)
| | - Suoma E Saarni
- Psychiatry Division, Turku University Central Hospital, Turku, Finland; Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland
| | - Taru H Kinnunen
- Department of Oral Health Policy and Epidemiology, Harvard Medical School, Boston, MA; Behavioral Science Consulting, Hopkinton, MA
| | - Ari Haukkala
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Kristiina Patja
- Independent Researcher, Association for Continuous Medical Education in Finland, Pro Medico, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland
| | - Tellervo Korhonen
- Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Mental Health and Substance Abuse Services, National Institute of Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Wen KY, Miller SM, Lazev A, Fang Z, Hernandez E. Predictors of smoking cessation counseling adherence in a socioeconomically disadvantaged sample of pregnant women. J Health Care Poor Underserved 2014; 23:1222-38. [PMID: 24212170 DOI: 10.1353/hpu.2012.0096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Implementing and evaluating smoking cessation interventions in underserved populations has been found difficult due to high rates of non-adherence to the prescribed protocol. To understand better the barriers to cessation participation, we studied low-income inner-city pregnant women who were enrolled in either a standard or highly intensive quit smoking counseling program. The results showed that 1) in the prenatal phase, non-attendance was predicted by a greater number of cigarettes smoked per day; 2) in the postpartum follow-up phase, non-attendance was predicted by lower educational level and higher self-efficacy for quitting smoking; and 3) participants with more children living at home were at increased risk of rescheduling the postpartum follow-up session. These findings suggest that innovative delivery strategies are needed more effectively to assess and address risk factors for non-adherence to smoking cessation trials among underserved minority pregnant/postpartum smokers.
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48
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Cropsey KL, Leventhal AM, Stevens EN, Trent LR, Clark CB, Lahti AC, Hendricks PS. Expectancies for the effectiveness of different tobacco interventions account for racial and gender differences in motivation to quit and abstinence self-efficacy. Nicotine Tob Res 2014; 16:1174-82. [PMID: 24719492 PMCID: PMC4184395 DOI: 10.1093/ntr/ntu048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/02/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Racial and gender disparities for smoking cessation might be accounted for by differences in expectancies for tobacco interventions, but few studies have investigated such differences or their relationships with motivation to quit and abstinence self-efficacy. METHODS In this cross-sectional study, 673 smokers (African American: n = 443, 65.8%; women: n = 222, 33.0%) under criminal justice supervision who enrolled in a clinical smoking cessation trial in which all received bupropion and half received counseling. All participants completed pretreatment measures of expectancies for different tobacco interventions, motivation to quit, and abstinence self-efficacy. The indirect effects of race and gender on motivation to quit and abstinence self-efficacy through expectancies for different tobacco interventions were evaluated. RESULTS African Americans' stronger expectancies that behavioral interventions would be effective accounted for their greater motivation to quit and abstinence self-efficacy. Women's stronger expectancies for the effectiveness of pharmacotherapy accounted for their greater motivation to quit, whereas their stronger expectancies for the effectiveness of behavioral treatments accounted for their greater abstinence self-efficacy. CONCLUSIONS Findings point to the mediating role of expectancies for treatment effectiveness and suggest the importance of exploring expectancies among African Americans and women as a way to augment motivation and self-efficacy.
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Affiliation(s)
- Karen L Cropsey
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL;
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Erin N Stevens
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL
| | - Lindsay R Trent
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL
| | - C Brendan Clark
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL
| | - Adrienne C Lahti
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL
| | - Peter S Hendricks
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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Jacobson JD, Catley D, Lee HS, Harrar SW, Harris KJ. Health risk perceptions predict smoking-related outcomes in Greek college students. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:743-51. [PMID: 25222173 PMCID: PMC4449614 DOI: 10.1037/a0037444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Health risk perception in smoking behavior was prospectively evaluated in a cluster-randomized trial for smoking cessation in Greek college students. Perceived Vulnerability (PV), Precaution Effectiveness, Optimistic Bias, and smoking behavior measures (quit attempts and cessation) were assessed in college-aged Greek student smokers at baseline, end of treatment (3 months), and follow-up (6 months). Using generalized estimating equations, baseline risk perception variables and change in risk perception variables between baseline and end of treatment were examined as predictors of the dichotomous smoking outcome variables. Results revealed that higher baseline PV [OR = 1.42 (1.21, 1.68)] predicted a greater likelihood of a quit attempt (n = 267). An increased likelihood of cessation [OR = 1.41 (1.15, 1.72)] was also predicted by an increase in PV from baseline to end of treatment (n = 243). Overall results suggested that PV was the strongest predictor of smoking behavior change, supporting further examination of health risk perceptions in promoting smoking cessation among Greek college smokers.
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Affiliation(s)
| | | | | | | | - Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana
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50
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Lee HS, Catley D, Harris KJ. Improving understanding of the quitting process: psychological predictors of quit attempts versus smoking cessation maintenance among college students. Subst Use Misuse 2014; 49:1332-9. [PMID: 24758706 PMCID: PMC4086835 DOI: 10.3109/10826084.2014.901386] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined motivation, positive and negative outcome expectations of quitting, and self-efficacy as predictors of quit attempts and cessation maintenance in a smoking cessation intervention for college students (N = 303). Psychological measures assessed at baseline were used to predict smoking behavior outcomes. Analysis of variance (ANOVA) and logistic regression analysis revealed that motivation and self-efficacy were strong, differential predictors of quit attempts and cessation maintenance, respectively. This study extends the previous findings regarding psychological predictors of quitting processes to college students, and suggests the need for interventions tailored according to phases of quitting processes.
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Affiliation(s)
- Hyoung S Lee
- 1Interdisciplinary Arts and Sciences, University of Washington Tacoma , Tacoma, Washington , USA
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