Knowledge synthesis of smoking cessation among employed and unemployed young adults

An overview of systematic reviews on predictors of smoking cessation among young people

Understanding the factors that influence smoking cessation among young people is crucial for planning targeted cessation approaches. The objective of this review was to comprehensively summarize evidence for predictors of different smoking cessation related behaviors among young people from currently available systematic reviews. We searched six databases and reference lists of the included articles for studies published up to October 20, 2023. All systematic reviews summarizing predictors of intention to quit smoking, quit attempts, or smoking abstinence among people aged 10-35 years were included. We excluded reviews on effectiveness of smoking cessation intervention; smoking prevention and other smoking behaviors; cessation of other tobacco products use, dual use, and polysubstance use. We categorized the identified predictors into 5 different categories for 3 overlapping age groups. JBI critical appraisal tool and GRADE-CERqual approach were used for quality and certainty assessment respectively. A total of 11 systematic reviews were included in this study; all summarized predictors of smoking abstinence/quit attempts and two also identified predictors of intention to quit smoking. Seven reviews had satisfactory critical appraisal score and there was minimal overlapping between the reviews. We found 4 'possible' predictors of intention to quit smoking and 119 predictors of smoking abstinence/quit attempts. Most of these 119 predictors were applicable for ~10-29 years age group. We had moderate confidence on the 'probable', 'possible', 'insufficient evidence', and 'inconsistent direction' predictors and low confidence on the 'probably unrelated' factors. The 'probable' predictors include a wide variety of socio-demographic factors, nicotine dependence, mental health, attitudes, behavioral and psychological factors, peer and family related factors, and jurisdictional policies. These predictors can guide improvement of existing smoking cessation interventions or planning of new targeted intervention programs. Other predictors as well as predictors of intention to quit smoking need to be further investigated among adolescents and young adults separately.

Has the distribution of smoking across young adult transition milestones changed over the past 20 years? Evidence from the 1970 British Cohort Study (1996) and Next Steps (2015-16)

Introduction

Transitions into work and family life during young adulthood exacerbate differences in the progression of smoking over the life-course. Few have considered how changes in smoking and the transition to adulthood in the past two decades have influenced these relationships over time.

Methods

We compared the distribution of smoking at ages 25–26 across transition milestones among 3764 men and 4568 women in the 1970 British Cohort study (1996) and 3426 men and 4281 women in the Next Steps study (2015–16). We regressed occasional and daily smoking status on educational attainment, economic activity, living arrangements, relationship status, and parenthood, adjusting for family background, socio-demographics, and smoking history.

Results

There were few differences in associations between the 1996 and 2015-16 samples. Young men and women were less likely to smoke if they had higher education, were homeowners, and cohabited with a partner. Women were less likely to smoke occasionally if they were full-time students, and men were less likely to smoke daily if they were employed full-time and not living with children. However, comparing associations in 2015–16 to 1996: 1) in men, higher education had a weaker negative association and living with a partner had a stronger negative association with daily smoking; 2) in women, independently renting had a weaker positive association with daily smoking.

Conclusions

Despite considerable changes in smoking and the transition to adulthood over the past two decades, the distribution of smoking at ages 25–26 across transition milestones has been relatively stable during this time period in Great Britain.

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Smoking at ages 25–26 was associated with economic activity, living arrangements, relationship status, and parenthood in 1996 and 2015–16.

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Differences in smoking across transition milestones differed by gender.

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Differences in smoking did not substantially change between 1996 and 2015–16.

Patterns and prevalence of daily tobacco smoking in Australia by industry and occupation: 2007-2016

INTRODUCTION

Australian workers' daily tobacco smoking over time was examined by industry, and occupation, to identify factors associated with high/low prevalence.

METHODS

Secondary analyses of 2007, 2010, 2013 and 2016 National Drug Strategy Household Surveys were undertaken (pooled n=49,395). Frequency analyses informed subsequent modelling of select industries and occupations. Four logistic regression models estimated adjusted effects of demographics on daily smoking in industries with high (≥20%) and low (≤15%) daily smoking prevalence, and occupations with high (≥20%) and moderate/low (<20%) daily smoking prevalence.

RESULTS

The sample comprised: 55.7% men; 34.1% 25-39 year olds; 31.4% New South Wales residents; 70.1% metropolitan residents; 66.9% high SES workers; and 70.6% with low psychological distress. Daily smoking prevalence differed by industry and occupation in 2007, generally decreasing between 2007-2016. In high prevalence industries, daily smoking was associated with male gender and age (25-39 year olds); and in low prevalence industries with males and non-metropolitan workers. In high prevalence occupations, daily smoking was associated with males, female non-metropolitan workers, and age 25-39 years; and in moderate/low prevalence occupations with non-metropolitan workers, and negatively associated with females aged 14-24 years. In all models, increased odds of daily smoking were associated with low socio-economic status and very high psychological distress.

CONCLUSIONS

Low socio-economic status and very high psychological distress were risk factors for daily smoking regardless of industry, occupation, or high pre-existing smoking prevalence. Targeted, as well as universal, interventions are required for workplaces and workers with greatest smoking vulnerability and least smoking cessation progress.

IMPLICATIONS

Specific strategies are warranted for identified industries, occupations and subgroups with increased odds of daily tobacco smoking. Industries/occupations with moderate/low smoking prevalence may confer workers some protection but are not without risk; some subgroups in these settings (e.g., non-metropolitan areas), had elevated daily smoking risk. Hence, the following are supported: 1. Universal interventions directed at low socio-economic workers, and workers with very high psychological distress regardless of workplace; 2. Interventions targeted at high prevalence industries; 3. Cessation efforts targeted for young workers in high prevalence industries/occupations, and 4. Focussed interventions addressing specific needs of non-metropolitan at-risk workers in low prevalence industries.

A randomized controlled trial to test the effectiveness of a peer-based social mobile game intervention to reduce smoking in youth

Smoking is a major cause of worldwide morbidity and mortality. Almost no evidence-based intervention programs are available to help youth quit smoking. We argue that ineffective targeting of peer influence and engagement difficulties are significant barriers to successful youth smoking cessation. To address these barriers, we developed the mobile game intervention HitnRun. A two-armed randomized controlled trial (RCT; n = 144) was conducted and young smokers (Mage = 19.39; SDage = 2.52) were randomly assigned to either play HitnRun or read a psychoeducational brochure. Prior to, directly following the intervention period, and after three-month follow-up, weekly smoking behavior, abstinence rates, intervention dose, and peer- and engagement-related factors were assessed. Results indicated similar reductions in weekly smoking levels and similar abstinence rates for both groups. Yet, we found a dose effect with HitnRun only: The longer participants played HitnRun, the lower their weekly smoking levels were. In the brochure group, a higher dose was related to higher weekly smoking levels at all measurement moments. Exploratory analyses showed the most powerful effects of HitnRun for participants who connected with and were engaged by the intervention. Future work should build on the promising potential of HitnRun by increasing personalization efforts and strengthening peer influence components.

Comparison of Developers' and End-Users' Perspectives About Smoking Cessation Support Through the Crush the Crave App

Background

High smoking rates among end-users, combined with their high rates of app use, render this age group as a particularly captive audience for quit smoking apps. There is emerging evidence that apps are an effective way to support smoking cessation among end-users. How the expectations behind the design of apps align with the needs and preferences of end-users, and if this differs by gender, is poorly understood, limiting the ability to evaluate and scale these interventions.

Objective

The objective of this qualitative case study was to detail how the overall design approach of Crush the Crave (CTC), a quit smoking app that targets end-users, compares with young adult women’s and men’s perspectives and experiences, with consideration for the influence of gender.

Methods

Semistructured interviews were conducted with 15 developers involved in the development of CTC and 31 young adult CTC users. Data were analyzed inductively to derive thematic findings of the perceived pros and cons of CTC by both developers and end-users. Findings were grouped under 4 categories (1) technology and platforms utilized for the app, (2) foundation of app content, (3) underlying focus of the app, and (4) look, feel and functionality of the app.

Results

Under the category, technology and platforms utilized for the app, it was found that both developers and end-users agreed that apps aligned with the needs and preferences of young adult smokers. Major limitations with the technology identified by end-users were the frequent “glitches” and requirement for internet or data. For the category, foundation of app content,developers agreed that the strength of CTC was in its strong evidence-base. What mattered to end-users, however, was that the content was packaged positively, focusing on the benefits of quitting versus the consequences of smoking. It was found under the category, underlying focus of the app, that the individually-led focus of the app resonated with both developers and end-users, especially young men. Under the final category, look, feel and functionality of the app, it was found that developers were very positive about the app's aesthetics but end-users thought that the aesthetics incited a negative effect. Also, while end-users found it easy to use, they did not find the app intuitive. Finally, end-users thought that, because the app functions were largely based on a user’s quit date versus their ongoing efforts, this often lent to unmeaningful data.

Conclusions

The current study findings highlight the importance of understanding multiple perspectives of stakeholders involved in a mobile-based intervention. By gathering the viewpoints of developers and end-users, both problematic and effective approaches that underlie development goals were revealed as a means of informing the development, implementation, and evaluation of future electronic health (eHealth) interventions.

Tobacco cessation mobile app intervention (Just Kwit! study): protocol for a pilot randomized controlled pragmatic trial

BACKGROUND

Adolescence and young adulthood are critical times of initiation and progression to daily use of tobacco. However, it is difficult to recruit young adults to traditional smoking cessation and retention rates are typically low. Smartphone cessation applications (apps) can provide real-time responses to smoking urges and related cues, which are known to be important factors in lapse and relapse. Given the popularity of smartphones among young adults and the considerably higher download rates of commercially developed apps compared to research-based apps, there is a need to design pragmatic studies that evaluate commercial tobacco cessation apps. The aims of this pilot study are to assess the impact on tobacco cessation of using a smartphone app compared with usual care and to generate feasibility data to inform a future fully powered clinical trial.

METHODS

We will conduct an open randomized controlled trial with parallel groups. Participants will be selected from hospitalized patients and must be aged 18-30 years, interested in cessation, smoked > 5 cigarettes/day over the past 30 days, and own an Apple or Android smartphone. Participants who are eligible will be randomized to either a smartphone experimental group or patient-initiated follow up (usual care). As this study seeks to assess feasibility, the primary data will include (1) recruitment rates, (2) retention rates, and (3) adherence, measured through user engagement with the app.

DISCUSSION

This pilot trial will be the first to evaluate a commercially available smartphone app for tobacco cessation in a hospitalized setting. Data generated by this study can be used for larger fully powered trials such as comparative effectiveness studies against apps developed by academics or health scientists based on behavioral theories, or cost-effectiveness analyses of mobile interventions.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03538678 . Registered on 28 May 2018.

The Crush the Crave Quit Smoking App and Young Adult Smokers: Qualitative Case Study of Affordances

Background

Mobile phone apps have emerged as a promising way to reach young adult smokers, given their high mobile phone ownership rates and openness to receiving cessation support via digital technologies. Although emerging evidence indicates that quit smoking apps are an effective way to reduce smoking among young adults, lacking is formative evaluative research that captures the perspectives of end-users.

Objective

The objective of this study was to contribute insights toward understanding how young adults interact with the Crush the Crave (CTC) app, and how this interaction shapes young adults’ smoking cessation experiences and practices, with consideration of the influence of gender.

Methods

Semistructured interviews were conducted with 31 young adult CTC end-users. Guided by sociomateriality theory and an affordances approach, data were inductively analyzed to derive thematic findings in relation to the impacts of CTC on quit efforts, and to expose the underlying affordances (mechanisms) that lend to these outcomes. Findings were grouped according to the 4 design components of CTC: credibility, social support, task support, and dialogue support.

Results

The credibility component of CTC played an important role in harnessing the trust of young adults because it afforded them promise in relation to its potential effectiveness in assisting them with quitting smoking. The social support component lent to various end-user practices and experiences that rendered this aspect as the weakest component in supporting quit efforts. Although most functions situated in the task and dialogue support components were found to be helpful, there were a few affordances in CTC that resulted in negative experiences, notably weaning from smoking. Gender-related influences were also evident. For example, young men preferred to control and self-manage their quitting and, therefore, did not engage with functions that afforded journaling or reminding to stay on track. Women, in contrast, were more likely to benefit from these affordances.

Conclusions

An affordances approach is productive for gaining an in-depth understanding of how mobile apps interact with end-users to lend to particular outcomes. The study findings have implications for developing and improving apps for helping young adults quit smoking, as well as apps that target other health behaviors. Productive affordances may also serve as a framework for leveraging apps for smoking cessation.

Treatment barriers among younger and older socioeconomically disadvantaged smokers

OBJECTIVES

Underutilization of smoking cessation treatments contributes to high rates of smoking in socioeconomically disadvantaged populations. Guided by a conceptual framework, the present study explored how healthcare provider factors, social environment characteristics, and cessation beliefs influence treatment utilization among low-income smokers and whether these associations vary by age.

STUDY DESIGN

Analyses were conducted on baseline data from 2406 participants enrolled in a randomized controlled trial that evaluated the effectiveness of a proactive outreach cessation intervention among a sample of younger (18-34 years) and older (35-64 years) smokers enrolled in public healthcare assistance programs.

METHODS

Multivariable logistic regression models predicted past year cessation treatment utilization (CTU) among younger and older smokers. Independent variables included measures of healthcare provider barriers, social environment characteristics, and cessation beliefs.

RESULTS

Younger smokers were less likely to have CTU than older smokers (27.2% vs 36.2%; P <.001). In both groups, number of cigarettes per day, more problems accessing healthcare, receiving medication-related cessation advice, and readiness to quit were positively associated with CTU (P <.05). Among younger smokers, living with another smoker was associated with lower odds of CTU while receipt of cessation advice was associated (P = .033) with higher odds of CTU.

CONCLUSIONS

In this sample of low-income smokers, interest in quitting was high but treatment utilization was low. Increasing utilization of cessation treatments via interventions that target issues specific to low-income smokers, including healthcare provider access and advice, the home environment, and motivation to quit, is an important step toward reducing smoking rates in this population.

Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review

BACKGROUND

With an ageing population, there is an increasing societal impact of ill health in later life. People who adopt healthy behaviours are more likely to age successfully. To engage people in health promotion initiatives in mid-life, a good understanding is needed of why people do not undertake healthy behaviours or engage in unhealthy ones.

METHODS

Searches were conducted to identify systematic reviews and qualitative or longitudinal cohort studies that reported mid-life barriers and facilitators to healthy behaviours. Mid-life ranged from 40 to 64 years, but younger adults in disadvantaged or minority groups were also eligible to reflect potential earlier disease onset. Two reviewers independently conducted reference screening and study inclusion. Included studies were assessed for quality. Barriers and facilitators were identified and synthesised into broader themes to allow comparisons across behavioural risks.

FINDINGS

From 16,426 titles reviewed, 28 qualitative studies, 11 longitudinal cohort studies and 46 systematic reviews were included. Evidence was found relating to uptake and maintenance of physical activity, diet and eating behaviours, smoking, alcohol, eye care, and other health promoting behaviours and grouped into six themes: health and quality of life, sociocultural factors, the physical environment, access, psychological factors, evidence relating to health inequalities. Most of the available evidence was from developed countries. Barriers that recur across different health behaviours include lack of time (due to family, household and occupational responsibilities), access issues (to transport, facilities and resources), financial costs, entrenched attitudes and behaviours, restrictions in the physical environment, low socioeconomic status, lack of knowledge. Facilitators include a focus on enjoyment, health benefits including healthy ageing, social support, clear messages, and integration of behaviours into lifestyle. Specific issues relating to population and culture were identified relating to health inequalities.

CONCLUSIONS

The barriers and facilitators identified can inform the design of tailored interventions for people in mid-life.

Effect of a Digital Social Media Campaign on Young Adult Smoking Cessation

INTRODUCTION

Social media (SM) may extend the reach and impact for smoking cessation among young adult smokers. To-date, little research targeting young adults has been done on the use of SM to promote quitting smoking. We assessed the effect of an innovative multicomponent web-based and SM approach known as Break-it-Off (BIO) on young adult smoking cessation.

METHODS

The study employed a quasi-experimental design with baseline and 3-month follow-up data from 19 to 29-year old smokers exposed to BIO (n = 102 at follow-up) and a comparison group of Smokers' Helpline (SHL) users (n = 136 at follow-up). Logistic regression analysis assessed differences between groups on self-reported 7-day and 30-day point prevalence cessation rates, adjusting for ethnicity, education level, and cigarette use (daily or occasional) at baseline.

RESULTS

The campaign reached 37 325 unique visitors with a total of 44 172 visits. BIO users had significantly higher 7-day and 30-day quit rates compared with users of SHL. At 3-month follow-up, BIO participants (32.4%) were more likely than SHL participants (14%) to have quit smoking for 30 days (odds ratio = 2.95, 95% CI = 1.56 to 5.57, P < .001) and BIO participants (91%) were more likely than SHL participants (79%) to have made a quit attempt (odds ratio = 2.69, 95% CI = 1.03 to 6.99, P = .04).

CONCLUSION

The reach of the campaign and findings on quitting success indicate that a digital/SM platform can complement the traditional SHL cessation service for young adult smokers seeking help to quit.

Picture Me Smokefree: a qualitative study using social media and digital photography to engage young adults in tobacco reduction and cessation

Background

Young adults have high rates of tobacco use compared to other subpopulations, yet there are relatively few tobacco interventions specifically targeted to this group. Picture Me Smokefree is an online tobacco reduction and cessation intervention for young adults that uses digital photography and social networking.

Objective

The main goal of the project was to determine the feasibility of engaging young adults in participating in user-driven, online forums intended to provide peer support and motivate critical reflection about tobacco use and cessation among this high-use, hard-to-reach population. A related aim was to explore the influence of gender-related factors on participation, in order to determine the need for online interventions to be tailored to the specific gender preferences reflecting young men and women’s participation styles.

Methods

A total of 60 young adults ages 19-24 years who self-identified as current cigarette smokers or who had quit within the last year were recruited from across British Columbia, Canada, and participated in an online photo group on Facebook over a period of 12 consecutive weeks. A variety of data collection methods were used including tracking online activity, a brief online follow-up survey, and qualitative interviews with study participants. Data analysis involved descriptive statistics on recruitment, retention, and participation and qualitative (eg, narrative analysis, synthesis of feedback) feedback about participant engagement.

Results

Findings from this study suggest good potential for Facebook as an accessible, low-cost platform for engaging young adults to reflect on the reasons for their tobacco use, the benefits of quitting or reducing, and the best strategies for tobacco reduction. Young adults’ frequent use of mobile phones and other mobile devices to access social networking permitted ease of access and facilitated real-time peer-to-peer support across a diverse group of participants. However, our experience of conducting the study suggests that working with young tobacco users can be accompanied by considerable recruitment, participation, and retention challenges. Our findings also pointed to differences in how young women and men engaged the photo-group intervention that should be considered, bearing in mind that in follow-up interviews participants indicated their preference for a mixed gender and “gender neutral” group format.

Conclusions

Tobacco interventions for youth and young adults should be embedded within the existing social networking platforms they access most frequently, rather than designing a stand-alone online prevention or intervention resource. This subpopulation would likely benefit from tobacco reduction interventions that are gender-sensitive rather than gender-specific.

Effect of a mobile phone intervention on quitting smoking in a young adult population of smokers: randomized controlled trial study protocol

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).

Psychological, social and familial factors associated with tobacco cessation among young adults

BACKGROUND/AIMS

The younger individuals quit smoking, the greater the health benefits. We studied the role of adolescent and concurrent psychological, social and familial factors in successful tobacco cessation in a general population sample of French young adults.

METHODS

Our data came from participants of the TEMPO cohort study and their parents (members of the GAZEL cohort study) in France. Among regular smokers (n = 678), Cox proportional hazards models were used to estimate hazard ratios of self-reported tobacco cessation of at least 12 months in relation to individual and socioenvironmental variables.

RESULTS

On average, participants (mean: 28.9 years) smoked for 10.51 years (SD = 5.9); the majority had attempted to quit smoking at least once (59.5%). In multiple regression analyses, cannabis use in the preceding year and recent financial difficulties were both negatively associated with successful smoking cessation. Conversely, living with a partner and, for women only, recent pregnancy or childbirth were associated with an increased likelihood of tobacco cessation.

CONCLUSIONS

This study highlights the importance of young adults' cannabis use, family situation and socioeconomic context with regard to their smoking behavior. Physicians and public health decision makers aiming to decrease the burden of tobacco smoking should take into consideration these social and behavioral factors.

Steps in tailoring a text messaging-based smoking cessation program for young adults

Steps to develop or refine text messaging-based interventions are largely missing from the literature. Here, the authors describe steps in refining Stop My Smoking USA, a text messaging-based smoking cessation program for smokers 18-25 years old. Research activities included the following: needs assessment focus groups (n = 35); a content advisory team to affirm message acceptability (n = 10); and two beta tests to confirm technological feasibility (n = 12 and 28, respectively). Various recruitment strategies were tested to identify the optimal methods to reach young adult smokers ready to quit. Each stage of the refinement process yielded new insights, resulting in improved message content and tone, an effective recruitment strategy, and the identification and subsequent resolution of technology challenges. Findings suggest that young adults prefer messages that provide concrete behavioral strategies to overcome cravings, and which are positive in tone. Craigslist was the most efficient recruitment method and yielded a sample that was racially and economically diverse. Despite a successful beta test of initial technological feasibility, extensive problems were subsequently experienced in a beta test of the technological feasibility of the entire program. Iterative program refinement and adaptation on the basis of user input is necessary to ensure salience, while extensive field testing is required to ensure proper functioning of technology-based programs.

Correlates of cessation success among Romanian adults

BACKGROUND

Tobacco smoking and its consequences are a serious public health problem in Romania. Evidence-based data on factors associated with successful smoking cessation are crucial to optimize tobacco control. The aim of the study was to determine the sociodemographic and other factors associated with smoking cessation success among adults.

MATERIALS AND METHODS

Data was from a sample of 4,517 individuals derived from the Global Adult Tobacco Survey (GATS). GATS is a cross-sectional, nationally representative household survey implemented in Romania in 2011. Data was analyzed with logistic regression.

RESULTS

Among females, the quit rate was 26.3% compared with 33.1% in males (P < 0.02). We found disparities in cessation success among the analyzed groups of respondents. Being economically active, being aged 40 and above, and having an awareness of smoking health consequences were associated with long-term quitting smoking among men, while initiating smoking at a later age increased the odds of quitting smoking among women. However, cohabitation with nonsmokers was the strongest predictor of successful cessation among both genders.

CONCLUSION

Programs increasing quit rates and encourage cessation among groups less likely to quit, adopting voluntary smoke-free homes, and increasing the awareness of smoking and tobacco pollution risks are needed.

Cultural and social influences on adolescent smoking dissipate by emerging adulthood among Hispanics in Southern California

The aim of the present study was to identify risk factors for smoking among Hispanic adolescents and determine whether these factors continued to influence smoking into emerging adulthood. Data were drawn from 932 Hispanics in the greater Los Angeles area who were surveyed in high school in 2007 and then again in emerging adulthood from 2010 to 2012. Logistic regression assessed the associations between predictors in adolescence and smoking in adolescence while an order one transition logistic model assessed predictors in adolescence and smoking in emerging adulthood. Adult and sibling smoking status, perceptions of smoking, perceived discrimination, and fatalism all influenced smoking in adolescence but not in emerging adulthood. Once Hispanics reach emerging adulthood different tactics to reduce smoking will be needed and are where future research should be directed.

Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis

BACKGROUND

Governments can intervene to change health-related behaviours using various measures but are sensitive to public attitudes towards such interventions. This review describes public attitudes towards a range of policy interventions aimed at changing tobacco and alcohol use, diet, and physical activity, and the extent to which these attitudes vary with characteristics of (a) the targeted behaviour (b) the intervention and (c) the respondents.

METHODS

We searched electronic databases and conducted a narrative synthesis of empirical studies that reported public attitudes in Europe, North America, Australia and New Zealand towards interventions relating to tobacco, alcohol, diet and physical activity. Two hundred studies met the inclusion criteria.

RESULTS

Over half the studies (105/200, 53%) were conducted in North America, with the most common interventions relating to tobacco control (110/200, 55%), followed by alcohol (42/200, 21%), diet-related interventions (18/200, 9%), interventions targeting both diet and physical activity (18/200, 9%), and physical activity alone (3/200, 2%). Most studies used survey-based methods (160/200, 80%), and only ten used experimental designs. Acceptability varied as a function of: (a) the targeted behaviour, with more support observed for smoking-related interventions; (b) the type of intervention, with less intrusive interventions, those already implemented, and those targeting children and young people attracting most support; and (c) the characteristics of respondents, with support being highest in those not engaging in the targeted behaviour, and with women and older respondents being more likely to endorse more restrictive measures.

CONCLUSIONS

Public acceptability of government interventions to change behaviour is greatest for the least intrusive interventions, which are often the least effective, and for interventions targeting the behaviour of others, rather than the respondent him or herself. Experimental studies are needed to assess how the presentation of the problem and the benefits of intervention might increase acceptability for those interventions which are more effective but currently less acceptable.

Pilot RCT results of stop my smoking USA: a text messaging-based smoking cessation program for young adults

INTRODUCTION

To address the lack of smoking cessation programs available to young adults, Stop My Smoking (SMS) USA, a text messaging-based smoking cessation program, was developed and pilot tested.

METHODS

This was a two-arm randomized controlled trial with adaptive randomization (arms were balanced by sex and smoking level [heavy vs. light]), conducted nationally in the United States. One hundred sixty-four 18- to 25-year-old daily smokers who were seriously thinking about quitting in the next 30 days were randomized to either (a) the 6-week SMS USA intervention (n = 101) or (b) an attention-matched control group aimed at improving sleep and physical activity (n = 63). The main outcome measure was 3-month continuous abstinence, verified by a significant other. Participants but not researchers were blinded to study arm allocation.

RESULTS

Based upon intent-to-treat analyses, intervention participants (39%) were significantly more likely than control participants (21%) to have quit at 4 weeks postquit (adjusted odds ratio [aOR] = 3.33, 95% confidence interval [CI]: 1.48, 7.45). Findings were not sustained at 3 months postquit, although rates in the SMS USA group were favored (40% vs. 30%, respectively; aOR = 1.59, 95% CI: 0.78, 3.21). Subsequent analyses suggested that among intervention participants, SMS USA might be more influential for youth not currently enrolled in a higher education (p = .06).

CONCLUSIONS

Consistent with pilot studies, the sample was underpowered. Data suggest, however, that the SMS USA program affects smoking cessation rates at 4 weeks postquit. More research is needed before conclusions can be made about long-term impact. Identifying profiles of users for whom the program may be particularly beneficial also will be important.

Correlates of smoking among young adults: the role of lifestyle, attitudes/beliefs, demographics, and exposure to anti-tobacco media messaging

BACKGROUND

Young adults (18-24 years) have the highest smoking rate of any age group. Unlike youth/adult populations where there is one primary message targeting behavior, anti-tobacco campaigns targeting young adults should contain messages of prevention and cessation. The objective was to identify factors influencing young adult cigarette use, employing the Centers for Disease Control and Prevention logic model, with an emphasis on the role of lifestyle, tobacco use tolerance, and attitudes/beliefs.

METHODS

Cross-sectional data were collected from 4401 young adults using telephone interviews in 2010 as part of the evaluation for the Tobacco Free Florida Campaign. Multivariate logistic regression was used to examine the relationship between current smoking status and lifestyles, tolerance of tobacco use, and attitude/belief variables.

RESULTS

The young adult cigarette prevalence rate is 20.3%, with males more likely to be smokers (25.1%) than females (15.6%) and non-Hispanic Whites more likely to be smokers than other racial/ethnic groups (23.8%). Significant associations were found between lifestyle variables (frequent bar/club, drinks per month, and number of friends who smoke), tolerance of tobacco use (allow smoke in house/car and moderate tobacco use), and four attitude/belief indices and current smoking behavior.

CONCLUSIONS

Results suggest lifestyles and attitudes/beliefs should be key behavioral targets of prevention programs aimed at young adults. Data strongly suggest that as young adults reject negative labels attached to smokers, they are more likely to smoke. Prevention (and cessation) programs may need to reduce barriers that result in segregating nonsmokers/smokers so smokers can have an increased chance of adopting attitudes/beliefs of nonsmokers.

"It is just not part of the culture here": young adults' photo-narratives about smoking, quitting, and healthy lifestyles in Vancouver, Canada

In this article we consider young adults' photo-narratives about smoking and quitting and their linkages to themes of healthy lifestyles and the culture of place in Vancouver, Canada. Drawing from a pilot study using participant-driven photography with a group of twelve young women and men ages nineteen to twenty-six, participants' visual and narrative representations of being a smoker and the process of quitting smoking were analyzed. Findings suggest "healthy lifestyle" imperatives within the Vancouver context may be productive for facilitating cessation, but may also have exclusionary effects.

A review of the evidence on technology-based interventions for the treatment of tobacco dependence in college health

BACKGROUND

The college years are a critical time in the development of smoking behavior and tobacco use. Smoking is linked to 30% of cancer deaths, 80% of deaths from chronic obstructive pulmonary disease, and early cardiovascular disease and death. Effective cessation interventions at this time provide an opportunity to drastically reduce premature morbidity and mortality.

AIMS

To review available evidence on Internet interventions with young adults, including methodology, theoretical frameworks and outcome measures for tobacco treatment to guide the development of a program in college health.

METHODS

A comprehensive literature search for studies published from January 1999 to February 2011, in multiple databases was conducted, along with hand-searching of reference lists. Inclusion criteria were: participants aged 18-30 years, intervention involved the Internet through either Web sites or e-mail or texting, and outcome measurement of tobacco cessation/abstinence. Studies were evaluated utilizing a tool synthesized from guidelines presented by the Cochrane Collaboration.

FINDINGS

Eight studies met the inclusion criteria (four randomized controlled trials, four cohort studies). Theoretical frameworks utilized were the Transtheoretical Model of Change, Health Belief Model, Theory of Social Support, and social cognitive theory. Interventions varied and included computer-generated advice letters, Web-based cessation guides, computer-generated text messages, and peer e-mail support. With smoking abstinence as the primary outcome measure, there was a statistically significant improvement in quit rates. Because of the use of multiple components, differences in interventions and the number of contacts, it is not clear what types of computer-based applications are most effective. Small sample sizes, lack of control groups, and inconsistency in outcome measures limit the ability to provide conclusive evidence to support these interventions-but support the feasibility to use in the design of future programs.

CONCLUSIONS

Use of technology-based interventions, such as the Internet, may be an effective tool for tobacco treatment interventions, especially with college students. There is great potential to reach large numbers of students, many who may not identify themselves as smokers or seek traditional methods for treatment. Additional research is needed to determine which technology-based interventions are most effective and to provide more conclusive evidence.

Mood management intervention for college smokers with elevated depressive symptoms: a pilot study

OBJECTIVE

This pilot study examined smoking reduction and cessation among college smokers with elevated depressive symptomatology participating in a group-based behavioral counseling, mood management, and motivational enhancement combined intervention (CBT).

PARTICIPANTS AND METHODS

Fifty-eight smokers (smoked 6 days in the past 30) were randomized to 6 sessions of CBT (n = 29) or a nutrition-focused attention-matched control group (CG; n = 29).

RESULTS

Relative to CG participants, significantly more CBT participants reduced smoking intensity by 50% (χ(2)[1, N = 58] = 4.86, p = .028) at end of treatment. Although CBT participants maintained smoking reductions at 3- and 6-month follow-up, group differences were no longer significant. No group differences in cessation emerged. Finally, participants in both groups evidenced increased motivation to reduce smoking at end of treatment (F[1, 44] = 11.717, p = .001, η(p)(2) = .207).

CONCLUSIONS

Findings demonstrate the utility of this intervention for smoking reduction and maintenance of reductions over time among a population of college students with elevated depressive symptomatology.

Effects of tobacco taxation and pricing on smoking behavior in high risk populations: a knowledge synthesis

Tobacco taxation is an essential component of a comprehensive tobacco control strategy. However, to fully realize the benefits it is vital to understand the impact of increased taxes among high-risk subpopulations. Are they influenced to the same extent as the general population? Do they need additional measures to influence smoking behavior? The objectives of this study were to synthesize the evidence regarding differential effects of taxation and price on smoking in: youth, young adults, persons of low socio-economic status, with dual diagnoses, heavy/long-term smokers, and Aboriginal people. Using a better practices approach, a knowledge synthesis was conducted using a systematic review of the literature and an expert advisory panel. Experts were involved in developing the study plan, discussing findings, developing policy recommendations, and identifying priorities for future research. Most studies found that raising cigarette prices through increased taxes is a highly effective measure for reducing smoking among youth, young adults, and persons of low socioeconomic status. However, there is a striking lack of evidence about the impact of increasing cigarette prices on smoking behavior in heavy/long-term smokers, persons with a dual diagnosis and Aboriginals. Given their high prevalence of smoking, urgent attention is needed to develop effective policies for the six subpopulations reviewed. These findings will be of value to policy-makers and researchers in their efforts to improve the effectiveness of tobacco control measures, especially with subpopulations at most risk. Although specific studies are needed, tobacco taxation is a key policy measure for driving success.

Motivational interviewing for smoking cessation in college students: a group randomized controlled trial

OBJECTIVE

To examine the efficacy of four individually-delivered Motivational Interviewing counseling sessions for smoking cessation versus a matched intensity comparison condition.

METHOD

From 2006-2009, students attending college in the Midwest smoking at least 1 of 30 days were recruited regardless of their interest in quitting. 30 fraternities and sororities were randomized, resulting in 452 participants.

RESULTS

No significant differences were found for 30-day cessation between treatment and comparison at end of treatment (31.4% vs 28%, OR=1.20, 95% CI 0.72,1.99) or at follow-up (20.4% vs 24.6%, OR=0.78, 95% CI 0.50,1.22). Predictors of cessation at follow-up, regardless of condition, included more sessions attended (OR 1.2, 95% CI 1.1,1.8) and more cigarettes smoked in 30 days at baseline (OR 4.7, 95% CI 2.5,8.9). The odds of making at least one quit attempt were significantly greater for those in the smoking group at end of treatment (OR 1.75, 95% CI 1.11,2.74) and follow-up (OR 1.66, 95% CI 1.11,2.47). Modeling showed reduction in days smoked for both groups. At end of treatment, more frequent smokers in the treatment condition had greater reductions in days smoked.

CONCLUSION

Motivational Interviewing for smoking cessation is effective for increasing cessation attempts and reducing days smoked in the short run.

An algorithm for tailoring pharmacotherapy for smoking cessation: results from a Delphi panel of international experts

BACKGROUND

Evidence-based smoking cessation guidelines recommend nicotine replacement therapy (NRT), bupropion SR and varenicline as first-line therapy in combination with behavioural interventions. However, there are limited data to guide clinicians in recommending one form over another, using combinations, or matching individual smokers to particular forms.

OBJECTIVE

To develop decision rules for clinicians to guide differential prescribing practices and tailoring of pharmacotherapy for smoking cessation.

METHODS

A Delphi approach was used to build consensus among a panel of 37 international experts from various health disciplines. Through an iterative process, panellists responded to three rounds of questionnaires. Participants identified and ranked "best practices" used by them to tailor pharmacotherapy to aid smoking cessation. An independent panel of 10 experts provided cross-validation of findings.

RESULTS

There was a 100% response rate to all three rounds. A high level of consensus was achieved in determining the most important priorities: (1) factors to consider in prescribing pharmacotherapy: evidence, patient preference, patient experience; (2) combinations based on: failed attempt with monotherapy, patients with breakthrough cravings, level of tobacco dependence; (3) specific combinations, main categories: (a) two or more forms of NRT, (b) bupropion + form of NRT; (4) specific combinations, subcategories: (1a) patch + gum, (1b) patch + inhaler, (1c) patch + lozenge; (2a) bupropion + patch, (2b) bupropion + gum; (5) impact of comorbidities on selection of pharmacotherapy: contraindications, specific pharmacotherapy useful for certain comorbidities, dual purpose medications; (6) frequency of monitoring determined by patient needs and type of pharmacotherapy.

CONCLUSION

An algorithm and guide were developed to assist clinicians in prescribing pharmacotherapy for smoking cessation. There appears to be good justification for "off-label" use such as higher doses of NRT or combination therapy in certain circumstances. This practical tool reflects best evidence to date of experts in tobacco cessation.