Are health conditions and concerns about health effects of smoking predictive of quitting? Findings from the ITC 4CV Survey ( 2016-2018 )

Repeated participation in hospital smoking cessation services and its effectiveness in smoking cessation: a seven-year observational study in Taiwan

OBJECTIVE

The purpose of this study was to evaluate repeated participation in hospital smoking cessation services and its related factors and to explore the correlation between the frequency of participation and its effectiveness in smoking cessation. This study uniquely follows participants over a seven-year period after the removal of financial barriers, with a maximum charge of TWD 200 (USD 6.4) for cessation medications in Taiwan.

METHODS

A secondary analysis of data from a regional teaching hospital in Central Taiwan was conducted, utilizing the database of the Smoking Cessation Therapy Management Center of Health Promotion Administration and the hospital's documentation from 2013 to 2019. Successful smoking cessation was defined as a non-smoking status at the six-month follow-up stages. Repeat participation was identified through the hospital's smoking cessation logs. Logistic and Cox regression analyses were conducted to meet the study objectives, with all statistical procedures performed on SAS version 9.4.

RESULTS

In this study, 19.16% of the smoking cessation service users participated repeatedly over a period of seven years. After adjusting for the observation time, the Cox regression analysis showed that those who experienced the side effects of smoking cessation, long-term smokers, and those with a history of disease were more likely to participate again (HR:1.39;1.17;2.60). However, those who smoked heavily, drank alcohol, and failed to quit smoking after previous participation were significantly less likely to participate again (HR:0.59,0.55,0.70;0.89;0.66). Finally, this study found no significant correlation between the frequency of repeated participation and the effectiveness of the last smoking cessation service.

CONCLUSION

A certain proportion of smokers repeatedly participate in the same hospital's smoking cessation program, which does not diminish its effectiveness. It is implied that relaxing the limit on the quantity of smoking cessation services subsidies will contribute to overall tobacco harm control efforts.

Sex-specific predictive factors of smoking cessation in subjects at high cardiovascular risk

Smoking is a major risk factor for cardiovascular diseases (CVD), in particular in women, but smoking cessation (SC) reduces or even cancels the risk for both sexes. Using a nationwide SC services database, we aimed to determine the predictive factors of SC in men and women smokers with CV risk factors (CVRF) or CVD. A retrospective study from the French CDTnet database was conducted. Inclusion criteria were age ≥18years, and≥1 CVRF (Body Mass Index ≥25kg/m2, hypertension, diabetes, hypercholesterolemia) or CVD (myocardial infarction (MI) or angina pectoris, stroke, peripheral arterial disease [PAD]). Self-reported smoking abstinence (≥28 consecutive days) was confirmed by exhaled carbon monoxide<10ppm. Logistic regression analysis assessed the association between SC and sociodemographic, medical characteristics, and smoking profile. Among the 36,864 smokers at high CV risk, abstinence rate was slightly lower in women than in men, (52.6% [n=8,102] vs 55.0% [n=11,848], P<0.001). For both sexes, factors associated with the lowest abstinence rates were diabetes, respiratory and psychiatric diseases, anxiolytic/antidepressant use, and cannabis consumption. In women, the factors associated with smoking abstinence were suffering from MI or angina and taking contraceptive pill and the factors associated with persistent smoking were alcohol disorder and high cigarette consumption. In men, there was a positive relationship between overweight and abstinence while being dual users of cigarettes and electronic cigarettes at first visit, having tobacco-related diseases (cancer and PAD) and taking opioid substitution treatment were associated with persistent smoking. Finally, in both sexes, the factors associated with abstinence were: age≥65years, having a diploma, being employed, self-referred or encouraged by entourage, ≥1 previous quit attempt, ≤20 cigarettes per day consumption, benefiting from SC medication prescription and ≥4 follow-up visits. In conclusion, our results suggest the relevance of SC intensive management in smokers at high CV risk, based on sociodemographic, medical, and smoking behaviour characteristics, as well as a gender-specific SC approach.

Gender differences in cigarette smoking cessation attempts among adults who smoke and drink alcohol at high levels: Findings from the 2018-2020 International Tobacco Control Four Country Smoking and Vaping Surveys

BACKGROUND

This study examined the association between alcohol consumption and smoking cessation behaviour of adults who smoke in four countries.

METHODS

Data came from 4275 adults (≥18 years) who smoked tobacco ≥ monthly and participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Surveys (Australia: n = 720; Canada: n = 1250; US: n = 1011; England: n = 1294). The 2018 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) survey data coded into three levels ('never/low', 'moderate' or 'heavy' consumption) were analysed using multivariable logistic regression models to predict any smoking cessation attempts and successful cessation by 2020 survey, and whether this differed by gender and country.

RESULTS

Compared to never/low alcohol consumers, only those who drink heavily were less likely to have made a quit smoking attempt (40.4 % vs. 43.8 %; AOR = 0.69, 95 % CI = 0.57-0.83, p < .001). The association differed by gender and country (3-way interaction, p < .001), with females who drink heavily being less likely to attempt to quit smoking in England (AOR = 0.27, 95 % CI = 0.15-0.49, p < .001) and Australia (AOR = 0.38, 95 % CI = 0.19-0.77, p = .008), but for males, those who drink moderately (AOR = 2.18, 95 % CI = 1.17-4.06, p = .014) or heavily (AOR = 2.61, 95 % CI = 1.45-4.68, p = .001) were more likely to make a quit attempt in England only. Alcohol consumption did not predict quit success.

CONCLUSION

Heavy alcohol use among adults who smoke appears to only undermine the likelihood of trying to quit smoking with some variation by gender and country of residence, but not their chances of succeeding if they tried.

Comparison of attempts and plans to quit tobacco products among single, dual, and triple users

INTRODUCTION

Tobacco users are categorized as single, dual, and triple users based on the number of tobacco products (cigarettes, e-cigarettes, and heated tobacco products) used. This study addressed a literature gap by examining how adult Korean tobacco users' quit attempts/plans differed based on the user type, and the associated psychosocial and subjective health-related factors.

METHODS

We used a questionnaire to examine participants' self-reported health, stress, health concerns, health behavior, tobacco addiction, intentions/plans to quit, and demographic characteristics. Data were analyzed using chi-squared tests, one-way analysis of variance, and multiple linear regression.

RESULTS

Of the 1288 tobacco users, 55.4%, 28.3%, and 16.4% were single, dual, and triple users, respectively. Self-rated health and stress were lowest among single users and highest among triple users. Most user types had intentions/plans to quit, especially triple users. Quit attempts and plans increased with increasing health behaviors and time elapsed before first tobacco use in the morning, but decreased with higher stress and self-rated addiction.

CONCLUSIONS

Intentions/plans to quit tobacco use varied based on the type of tobacco user. Multiple users had higher self-rated health, plans to quit, and self-reported addiction; they considered themselves healthy or engaged in healthy behaviors to offset problems from tobacco use and used multiple tobacco products to quit smoking. Highly stressed users had fewer plans to quit and used tobacco for stress relief. Thus, the provision of accurate information about tobacco products and stress management is important to promote successful quitting.

Self-reported depression and anxiety and healthcare professional interactions regarding smoking cessation and nicotine vaping: Findings from 2018 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Survey

INTRODUCTION

People with mental health conditions are disproportionately affected by smoking-related diseases and death. The aim of this study was to assess whether health professional (HP) interactions regarding smoking cessation and nicotine vaping products (NVPs) differ by mental health condition.

METHODS

The cross-sectional 2018 International Tobacco Control Four Country (Australia, Canada, England, United States) Smoking and Vaping Survey data included 11040 adults currently smoking or recently quit. Adjusted weighted logistic regressions examined associations between mental health (self-reported current depression and/or anxiety) and visiting a HP in last 18 months; receiving advice to quit smoking; discussing NVPs with a HP; and receiving a recommendation to use NVPs.

RESULTS

Overall, 16.1% self-reported depression and anxiety, 7.6% depression only, and 6.6% anxiety only. Compared with respondents with no depression/anxiety, those with depression (84.7%, AOR=2.65; 95% CI: 2.17-3.27), anxiety (82.2%, AOR=2.08; 95% CI: 1.70-2.57), and depression and anxiety (87.6%, AOR=3.74; 95% CI: 3.19-4.40) were more likely to have visited a HP. Among those who had visited a HP, 47.9% received advice to quit smoking, which was more likely among respondents with depression (AOR=1.58; 95% CI: 1.34-1.86), and NVP discussions were more likely among those with depression and anxiety (AOR=1.63; 95% CI: 1.29-2.06). Of the 6.1% who discussed NVPs, 33.5% received a recommendation to use them, with no difference by mental health.

CONCLUSIONS

People with anxiety and/or depression who smoke were more likely to visit a HP than those without, but only those with depression were more likely to receive cessation advice, and only those with depression and anxiety were more likely to discuss NVPs. There are missed opportunities for HPs to deliver cessation advice. NVP discussions and receiving a positive recommendation to use them were rare overall.

Cigarette Smoking in Response to COVID-19: Examining Co-Morbid Medical Conditions and Risk Perceptions

During the initial wave of the Coronavirus Disease 2019 (COVID-19) pandemic in the U.S., information was mixed about the relative COVID-19 risks and potential benefits associated with cigarette smoking. Therefore, we sought to understand individual differences in the impact of COVID-19 on cigarette smoking in a sample of adults who reported recent use, with a particular focus on chronic medical conditions likely associated with increased COVID-19 risk. Participants completed an online survey of smoking behavior, demographic variables, medical history, and COVID-19 risk perceptions between July and August 2020 (N = 286). We examined whether medical conditions, COVID-19 risk perceptions and/or demographic characteristics were related to smoking changes in response to the pandemic (i.e., no change, decrease, increase) using multinomial logistical regression. Younger age, higher COVID-19 risk perceptions and Black versus White race were associated with greater odds of decreased smoking compared to no smoking change. Moreover, having at least one chronic medical condition was associated with greater odds of increased smoking relative to no change. The results have important implications for tobacco cessation treatment and preventive healthcare during the ongoing COVID-19 pandemic and other public health threats.

The Predictive Utility of Valuing the Future for Smoking Cessation: Findings from the ITC 4 Country Surveys

Background: Delay discounting (DD) and time perspective (TP) are conceptually related constructs that are theorized as important determinants of the pursuit of future outcomes over present inclinations. This study explores their predictive relationships for smoking cessation. Methods: 5006 daily smokers at a baseline wave provided 6710 paired observations of quitting activity between two waves. Data are from the International Tobacco Control (ITC) smoking and vaping surveys with samples from the USA, Canada, England, and Australia, across three waves conducted in 2016, 2018 and 2020. Smokers were assessed for TP and DD, plus smoking-specific predictors at one wave of cessation outcomes defined as either making a quit attempt and/or success among those who tried to quit which was ascertained at the subsequent survey wave. Results: TP and DD were essentially uncorrelated. TP predicted making quit attempts, both on its own and controlling for other potential predictors but was negatively associated with quit success. By contrast, DD was not related to making quit attempts, but high DD predicted relapse. The presence of financial stress at baseline resulted in some moderation of effects. Conclusions: Understanding the mechanisms of action of TP and DD can advance our understanding of, and ability to enhance, goal-directed behavioural change. TP appears to contribute to future intention formation, but not necessarily practical thought of how to achieve goals. DD is more likely an index of capacity to effectively generate competing future possibilities in response to immediate gratification.