Factors associated with smoking cessation in exclusive smokers and dual users of e-cigarette and conventional cigarettes from CDTnet registry

Dual use of electronic cigarettes and conventional cigarettes may be a transitional state towards cigarette smoking cessation. However, maintaining dual use may increase tobacco-related consequences as smoking behavior persists. The aim of our study was to describe characteristics of dual users and explore factors associated with their one-month abstinence in comparison to exclusive smokers in French smoking cessation services (SCS). We retrospectively studied 5116 smokers registered in a national SCS registry between 2015 and 2018 and who attended at least two visits. We matched the retained exclusive smokers and dual users by age, sex, professional status and education level. We compared baseline information and validated smoking abstinence at one-month follow-up between the two groups. Predictors of abstinence were assessed using a multivariate model. Retained exclusive smokers and dual users had similar cessation rates (37%). Compared to exclusive smokers, dual users presented more comorbidities and a higher level of nicotine dependence. Factors positively associated with cessation in dual users were: being employed or retired, declaring three or more previous quit attempts, presenting with low nicotine dependence and high motivation to quit and benefiting from at least four follow-up consultations. Our results suggest that dual users seeking help to quit in SCS seem to benefit from support as much as exclusive smokers to reach abstinence, despite a higher level of nicotine dependence and comorbidities. Further research, especially qualitative, is needed on this specific group of smokers to provide tailored interventions to quit.

Sex-specific disparities in predictive factors of smoking cessation among smokers at high cardiovascular risk. Findings from a nationwide smoking cessation services cohort

Background

Tobacco use is a major risk factor for cardiovascular diseases (CVD), but smoking cessation (SC) reduces or even cancels the risk of CVD for both sex. Using data from the French national “Consultations de Dépendance Tabagique” (CDTnet) cohort, we aimed to determine the predictive factors of SC in men and women smokers at high cardiovascular (CV) risk (i.e. with a CV disease or risk factor).

Material and methods

Retrospective study from the French SC services CDT-net database. Inclusion criteria were age ≥18 years, and ≥1 CV risk factor (BMI ≥25 kg/m2, hypercholesterolemia, diabetes, arterial hypertension) or CVD (history of stroke, myocardial infarction or angina pectoris, peripheral arterial disease (PAD)). Smoking abstinence (≥28 consecutive days) was self-reported and confirmed by exhaled carbon monoxide <10 ppm. Logistic regression assessed the association between SC and sociodemographic factors, medical characteristics and patients' smoking profile.

Results

Among the 246,364 subjects in the database, 15% (36,864) fulfilled the inclusion criteria. One month-abstinence was lower in women (52.6% (n=8,102) vs 55% (n=11,848) in men, p<0.001). For both sex, smokers with the lowest abstinence rates were those with respiratory diseases (47% among women vs. 50% among men respectively), depression history (48% vs. 48%), anxiety or depression symptoms (49% vs 50%) use of anxiolytics/antidepressants, use of opioid substitution treatment, use of cannabis (42% vs 41%) and benefit less than 3 follow-up visits (36% vs 41%). Factors positively associated with SC in both sex were age >65 years, having a degree, being employed, coming by self-initiation or by one's relatives, being overweight, having previous quit attempts, presenting with low nicotine dependence and being confident in achieving abstinence. Factors negatively associated with abstinence only in women but not in men was alcohol disorder. Finally, factors negatively associated with abstinence only in men but not in women were PAD, and tobacco-related cancers.

Conclusion

Our results from a large nationwide database suggest the relevance of differentiated management according to sex in smokers at high CV risk, given the major sex-specific disparities in factors associated with abstinence rates.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): This work was supported by IReSP and INCa through a call for doctoral grants launched in 2019.

Identification of factors associated with smoking cessation in patients with coronary artery diseases. Findings from a large nationwide cohort of smoking cessation services

 

In patients with coronary artery diseases (CAD) (i.e. prior myocardial infarction (MI) or angina), smoking cessation (SC) is a major prevention goal. From a large French national database of SC services, we aimed to describe social, medical and smoking characteristics, as well as predictive factors of SC in men and women with CAD.

Methods

We conducted a retrospective study of smokers with CAD who visited a SC service and were included in the nationwide database of SC services (CDTnet). Endpoint was the abstinence rate, defined as SC maintained for at least 28 consecutive days, confirmed by an exhaled carbon monoxide <10 ppm.

Results

Among the 4,532 smokers with CAD (myocardial infarction and angina), 21% (948) were women. The mean age was 55 years in both sexes. Two-thirds had consulted after a hospital contact and nearly half (45%) smoked more than 20 cigarettes per day. Compared to men, women presented more often with anxio-depression symptoms (57% vs 41%) and respiratory diseases (38% vs 28%), were less educated (65% vs 73% had at least one degree), suffered less often from other cardiovascular diseases such as stroke or peripheral arterial disease (16% vs 21%) and much lower rate of alcohol misuse (9% vs 25%). Finally, 82% of smokers received Nicotine Replacement Therapy (NRT) at the first consultation. The abstinence rate achieved was similar in women and men (54%). Factors positively associated with SC in women were: having more than one previous quit attempt, having a level of education ≥ first secondary school diploma) (OR=1.42; CI95% [1.04–1.95]) and using an electronic cigarette at the first consultation (OR=2.74; CI95% [1.22–6.58]). In men, these factors were: being employed (OR=1.25; CI95% [1.08–1.45]), declaring high confidence in quitting (OR=1.24; CI95% [1.07–1.44]) and using NRT (OR=1.41; CI95% [1.13–1.74]). Psychiatric or respiratory diseases were negatively associated with SC in both men and women. In men, the factors negatively associated with SC were: smoking at home, having diabetes, using cannabis and presenting with high nicotine dependence. Among women, living with a smoker hampered SC.

Conclusion

Our findings on a large nationwide cohort from SC services showed that in smokers with prior MI or angina, it is important to take into account comorbidities, particularly psychiatric and respiratory disorders, in order to improve smoking cessation rates.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): This work was supported by IReSP and INCa through a call for doctoral grants launched in 2019

Specific risk factors profile and abstinence rate of female smokers at high cardiovascular risk from the nationwide smoking cessation services cohort CDT-net

Background

In women, smoking is particularly harmful to the cardiovascular (CV) system, and smoking cessation (SC) is a key issue for CV prevention.

Objectives

From a large nationwide database on subjects who visited SC services between 2001 and 2018, we aimed to describe the profile and abstinence rate among female smokers at high CV risk.

Methods

Observational study from the French CS services cohort CDT-net. Inclusion criteria were age ≥18 years, and ≥1 CV risk factor (i.e. body mass index ≥25 kg/m2, hypercholesterolemia, diabetes, hypertension, history of stroke, myocardial infarction or angina pectoris. Abstinence (≥28 consecutive days) was self-reported, and confirmed by measurement of exhaled carbon monoxide <10 ppm.

Results

Among 37,949 smokers, 16,492 (43.5%) were women. Compared to men, women were 3-y younger (48 vs 51 y, p<0.001) and more educated (≥ Bachelor degree: 55 vs 45%, p<0.001). The burden of CV risk factors was high in women and men: hypercholesterolemia (30% vs 33% p<0.001), hypertension (23% vs 26%, p<0.001) and diabetes (10 vs 13%, p<0.001). Compared to men, women suffered more often from obesity (27 vs 20%, p<0.001), respiratory diseases (COPD: 24% vs 21%, p<0.001; asthma: 16 vs 9%, p<0.001) and anxio-depressive symptoms (37.5 vs 26.5%, p<0.001). Although women were less nicotine dependent than men, their abstinence rate was lower (52 vs 55%, p<0.001).

Conclusion

Female smokers who visited SC services not only presented very high CV risk profile, but also elevated rates of lung diseases and anxio-depressive symptoms. Our findings highlight the need to strengthen CV prevention strategies, through comprehensive gender-tailored SC interventions.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): IReSP and INCa through a call for doctoral grants launched in 2019

Sociodemographic and Clinical Characteristics of Vapers Using E-Cigarettes Exclusively: The French Vapoquid Study

Electronic cigarettes are increasingly being used as smoking cessation aids. Most studies assess the dual use of e-cigarettes and traditional cigarettes, but there remains a paucity of literature concerning individuals who use e-cigarettes exclusively. Objective: The aim of this study is to examine the sociodemographic and clinical characteristics of exclusive e-cigarette users, and consider their willingness to quit e-cigarette use. Methods: A French online survey was conducted from March to December 2017. We assessed the following factors: sociodemographic factors; the clinical characteristics of e-cigarette use and its social acceptability; and the self-perceived effectiveness of nicotine replacement therapy (NRT). Associations between the listed factors and a willingness to quit e-cigarette use were examined. Results: A total of 386 exclusive e-cigarette users (70% men) participated in the study and were included in the analysis. Most respondents were not planning to quit e-cigarette use (75%). Compared to those who did not want to quit, a desire to quit was associated with using smoking cessation services (OR [95%CI]: 3.45 [1.82-6.56]), e-cigarette craving (OR [95%CI]: 2.63 [1.44-4.80]) and NRT past-use (1.78 [1.12-2.87]). Users who planned to quit expressed more concerns about smoking initiation among youths using e-cigarettes (OR [95%CI]: 3.62 [1.90-6.93]). In multivariate analysis, these associations remained significant for the use of smoking cessation services, e-cigarette cravings, and concerns about youth tobacco initiation. Conclusion: Most exclusive e-cigarette users were not likely to quit. Planned cessation was associated with using smoking cessation services, experiencing e-cigarette dependence symptoms, and being concerned about smoking initiation among teenager e-cigarette users.