Smoking Cessation Treatment for Parents Who Dual Use E-Cigarettes and Traditional Cigarettes

INTRODUCTION

An increasing number of parents use both e-cigarettes and cigarettes (dual users). Previous studies have shown that dual users may have higher rates of contemplating smoking cessation than parents who only smoke cigarettes. This study was aimed to assess the delivery of tobacco cessation treatment (prescription for nicotine replacement therapy and referral to the quitline) among parents who report being dual users vs. cigarette-only smokers.

METHODS

A secondary analysis of parent survey data collected between April and October 2017 at 10 pediatric primary care practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was conducted. Parents were considered to be dual users of cigarettes and e-cigarettes if they reported smoking a cigarette, even a puff, in the past seven days and using an e-cigarette within the past 30 days. Parents were asked if they received a prescription for nicotine replacement therapy and referral to the quitline to help them quit from their child's clinician. Multivariable logistic regression examined factors (dual use, insurance status, relationship to the child, race, and education status of the parent) associated with delivery of smoking cessation treatment (receiving prescriptions and/or enrollment in quitline) to smoking parents. Further, we compared the rates of tobacco cessation treatment delivery to dual users in the usual-care control practices vs. intervention practices.

RESULTS

Of 1007 smokers or recent quitters surveyed in the five intervention practices, 722 parents reported current use of cigarettes-only and 111 used e-cigarettes. Of these 111 parents, 82 (73.9%) reported smoking cigarettes. Parents were more likely to report receiving any treatment if they were dual users vs. cigarette-only smokers (OR 2.43, 95% CI 1.38, 4.29). Child's insurance status, parents' sex, education, and race were not associated with parental receipt of tobacco cessation treatment in the model. No dual users in the usual-care control practices reported receiving treatment. Discussion. Dual users who visited CEASE intervention practices were more likely to receive treatment than cigarette-only smokers when treatments were discussed. An increased uptake of tobacco cessation treatments among dual users reinforces the importance of discussing treatment options with this group, while also recognizing that cigarette-only smokers may require additional intervention to increase the acceptance rate of cessation assistance. This trial is registered with ClinicalTrials.gov, Identifier: NCT01882348.

A longitudinal study into the reciprocal effects of identities and smoking behaviour: Findings from the ITC Netherlands Survey

OBJECTIVE

Although it has been found that identity constructs related to smoking are associated with changes in smoking behaviour, the direction of causal associations is as yet unclear. This study aims to clarify the nature and direction of these associations.

METHODS

In this longitudinal study we examined the reciprocal relations between identity constructs (i.e., smoker self-identity, quitter self-identity and smoker group-identity), intention to quit and smoking and quitting behaviour among a sample of 1036 smokers and ex-smokers, using cross-lagged structural equation modelling. Moreover, we tested whether these relations differed by socio-economic status (SES).

RESULTS

Identity and smoking behaviour were reciprocally related in that in intention to quit and smoking behaviour consistently predicted identity change, and identity predicted (changes in) intentions to quit and smoking behaviour. Behaviour appears more important for identity change than identity for behaviour change. Furthermore, quitter self-identity appears more important than smoker self- and group-identity. Relationships did not differ significantly between SES-groups. The findings were replicated using a cross-validation sample.

CONCLUSION

Results imply that changing smoking behaviour may be a vehicle to change smoking-related identity. Moreover, strengthening identification with quitting is more crucial for quit success than decreasing smoker identities. The finding that behaviour may be more important for identity than vice versa, if replicated, may call for additions to identity theories.

[Dutch tobacco control policy: milestones in the past and a look into the future]

- As early as 1975, the Health Council of the Netherlands was aware of what an effective tobacco control policy should constitute.- Centre-right governments in the 1980's and 1990's impeded the implementation of such a policy. In 1988, the Tobacco Act was introduced, but this had no effect on smoking rates.- In 2002, the Tobacco Act was amended, introducing more far-reaching measures, which resulted in a reduction in the number of smokers.- To accelerate the downward trend in smoking rates, more investments need to be made in mass media campaigns, and tobacco tax rates will need to be increased each year.- One of the concrete measures recommended in 1975 by the Health Council of the Netherlands, which has still not materialised, is reducing the number of tobacco vendors. New regulations for this policy are expected to be developed in the coming years.

Educational differences in associations of noticing anti-tobacco information with smoking-related attitudes and quit intentions: findings from the International Tobacco Control Europe Surveys

This study examined educational differences in associations of noticing anti-tobacco information with smoking-related attitudes and quit intentions among adult smokers. Longitudinal data (N = 7571) from two waves of six countries of the International Tobacco Control (ITC) Europe Surveys were included. Generalized estimating equation analyses and multiple linear and logistic regression analyses were conducted. Higher educated smokers noticed anti-tobacco information slightly more often than lower educated smokers (F(2) = 25.78, P < 0.001). Noticing anti-tobacco information was associated with more negative smoking-related attitudes (β = 0.05, P < 0.001) and more quit intentions (OR = 1.08, P < 0.001). Among smokers without a quit intention at baseline, a positive association was found for noticing anti-tobacco information at baseline with follow-up quit intention (OR = 1.14, P = 0.003). No other longitudinal associations were found. No educational differences were found in the association of noticing anti-tobacco information with smoking-related attitudes but associations with quit intentions were found only among low (OR = 1.12, P = 0.001) and high educated respondents (OR = 1.11, P < 0.001) and not among moderate educated respondents (OR = 1.02, P = 0.43). Noticing anti-tobacco information may positively influence quit intentions and possibly smoking-related attitudes. Lower educated smokers were as likely to be influenced by anti-tobacco information as higher educated smokers but noticed anti-tobacco information less often; increasing reach of anti-tobacco information may increase impact in this group.

Does a smoking prevention program in elementary schools prepare children for secondary school?

INTRODUCTION

A smoking prevention program was developed to prepare children in elementary school for secondary school. This study assessed the effects on smoking in secondary school.

METHODS

In 2002, 121 schools in The Netherlands were randomly assigned to the intervention or control group. The intervention group received 3 lessons in 5th grade of elementary school and a second 3 lessons in 6th grade. The control group received "usual care". Students completed 5 questionnaires: before and after the lessons in 5th and 6th grade and in the first class of secondary school. At baseline, 3173 students completed the questionnaire; 57% completed all questionnaires.

RESULTS

The program had limited effect at the end of elementary school. One year later in secondary school significant effects on behavioral determinants and smoking were found. The intervention group had a higher intention not to smoke (β=0.13, 95% confidence interval=0.01-0.24) and started to smoke less often than the control group (odds ratio=0.59, 95% confidence interval=0.35-0.99): smoking increased from 2.5% to 3.6% in the intervention group and from 3.2% to 6.5% in the control group. Girls showed the largest differences in smoking between intervention and control condition.

CONCLUSIONS

A prevention program in elementary school seems to be effective in preventing smoking.

The impact of a lung cancer computed tomography screening result on smoking abstinence

Receiving a lung cancer computed tomography screening result might be a teachable moment for smoking cessation, but it might also unintentionally reassure smokers to continue smoking. The objective of the present study was to investigate whether test results were associated with smoking abstinence in the Dutch-Belgian Randomised Controlled Lung Cancer Screening Trial (NELSON trial). Two random samples of male smokers who had received either only negative test results (n=550) or one or more indeterminate test result (n=440) were sent a questionnaire 2 yrs after randomisation. Smokers with an indeterminate result reported more quit attempts (p=0.02), but the prolonged abstinence rate in smokers receiving a negative test (46 (8.9%) out of 519 subjects) was comparable with the abstinence rate in smokers with one or more indeterminate results (48 (11.5%) out of 419 subjects) (p=0.19). A statistically insignificant increase was found after one or more indeterminate test result (10.9 and 15.0%, respectively) compared with receiving only negative test results (8.9%) (p=0.26). In conclusion, the outcome of the screening test had no impact on future smoking abstinence in male smokers, although all results suggest more favourable implications after one or more follow-up recommendations. Screening test outcomes could be used as a teachable moment for smoking cessation.

Applying an Equity Lens to Tobacco-Control Policies and Their Uptake in Six Western-European Countries

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

Sustainability of the prevention of passive infant smoking within well-baby clinics

This study assessed the antecedents of continued use of an education program to prevent passive smoking in infants. It consists of a booklet for parents and a manual for health professionals describing a five-step procedure for discussing passive smoking. A questionnaire was sent to 67 managers, 670 nurses, and 335 physicians working in well-baby clinics (response rate: 70%, 53%, 47% respectively). Questions concerned the completeness of use, level of institutionalization, and characteristics of the organization, the user, and the dissemination strategy. Seventy-one percent of nurses and 42% of physicians worked with the program. They foremost provided the first three steps of the five-step procedure. Physicians' completeness of use was related to their perceived responsibility in providing this education, and nurses' use was related to their perceived self-efficacy, responsibility, training attendance, participation in the adoption decision, and level of institutionalization. Diffusion efforts should focus on improving the completeness of use and level of institutionalization.

A randomized controlled trial to assess the effects of reimbursing the costs of smoking cessation therapy on sustained abstinence

AIMS

We studied whether reimbursement for smoking cessation treatment (SCT) can increase prolonged abstinence from smoking up to 2 years. SETTING, PARTICIPANTS AND DESIGN: From the general population, we recruited smokers and assigned them randomly to a control group (n = 634) or an intervention group (n = 632). For 6 months, participants in the intervention group could apply for reimbursement and received information regarding the reimbursed SCT. Participants in the control group received no reimbursement or information.

MEASUREMENTS

In this follow-up study, prolonged abstinence from smoking was defined as reported being abstinent from at least 7 days before the end of reimbursement until the follow-up assessment 6 months or 2 years later.

FINDINGS

At 6 months after the end of reimbursement, 18 participants in the control group (2.8%) and 35 participants (5.5%) in the intervention group reported sustained abstinence for at least 6 months [odds ratio (OR) = 2.0, 95% confidence interval (CI) 1.1-3.6]. Two years after the reimbursement period, 10 participants in the control group (1.6%) and 27 participants in the intervention group (4.3%) still reported sustained abstinence (OR = 4.1, 95% CI 1.7-10.2). The overall effectiveness of SCT increased with reimbursement and was 22% in the intervention group and 8% in the control group after 2 years.

CONCLUSIONS

Reimbursement may be an effective strategy to increase the prolonged abstinence rate even after 2 years.

Reimbursement for smoking cessation treatment may double the abstinence rate: results of a randomized trial

AIMS

Few smokers who try to quit smoking use smoking cessation treatment (SCT), and cost could be one factor. To increase the number of successful quitters, we assessed whether financial reimbursement for SCT would encourage the use of SCT and would as a result increase the 6-month point abstinence rate.

SETTING AND PARTICIPANTS

We recruited smokers aged over 18 years from a random sample of Dutch inhabitants insured by one health insurance company. INTERVENTION AND DESIGN: The smokers were assigned randomly to the intervention group (n = 632) or control group (n = 634). Respondents in the intervention group received an offer of reimbursement for nicotine replacement therapy, bupropion and behavioural counselling. No reimbursement was offered to the control group. To preclude a change of behaviour due to disappointment in the control group, we used a randomized consent design.

FINDINGS

During the reimbursement period, 10.8% smokers in the intervention group reported having used SCT compared with 4.1% in the control group (OR = 2.9, 95% CI 1.8-4.7). In the intervention group, 23.4% smokers tried to stop compared with 20.8% in the control group (OR = 1.2, 95% CI 0.9-2.4). After 6 months, the biochemically validated 7-day point prevalence abstinence rate was 5.5% in the intervention group and 2.8% in the control group (OR = 2.3, 95% CI 1.2-4.1).

CONCLUSIONS

Reimbursement for SCT seems efficacious in increasing the use of SCT and may double the number of successful quitters.

Periconceptional smoking: an exploratory study of determinants of change in smoking behavior among women in the fertile age range

How can women who are not yet pregnant be motivated to stop smoking before they become pregnant? Epidemiological studies have suggested that periconceptional smoking and smoking during the first trimester of the pregnancy may lead to congenital abnormalities. To motivate women to stop smoking before pregnancy, more insight is needed into the differences between 'smoking' women who want to have children and those who do not. A sample of 931 women (65% response rate) aged 15-45 years returned a questionnaire with questions about their smoking behavior, wish to have children, risk perceptions, attitude to smoking, personal efficacy and stage of readiness to change. In spite of some positive outcomes (e.g. negative attitude to smoking, relatively high risk perceptions of the relationship between congenital anomalies and smoking), one cannot automatically assume that these women will stop smoking before they get pregnant. (1) Beliefs, attitude and readiness to change were not well integrated and grounded cognitively. (2) Women who smoked were pessimistic about their ability to quit. Future campaigns need to 'invite' women to associate and to integrate risk information about the relationship between smoking and congenital abnormalities with other cognitions (attitude, intention). It is also important to instruct women in how to stop smoking and to remain non-smokers.

Parental education on passive smoking in infancy does work

BACKGROUND

Passive smoking is harmful to young children. A protocol has been developed to allow health care workers to communicate with parents about preventing passive smoking. The main message was to refrain from smoking in the presence of the child. The aim of the study was to assess the effectiveness of this education programme.

METHOD

The prevalence of smoking in the presence of infants aged 0-10 months was compared before and after the implementation of the education programme. National samples of mothers completed questionnaires in 1996 (n = 1,129) and in 1999 (n = 2,534). Questions were asked about smoking in the living room in the presence of infants, and about parental smoking, and background characteristics.

RESULTS

The prevalence of passive infant smoking decreased from 41% to 18%. The adjusted odds ratio for passive infant smoking in 1999 compared to 1996 was 0.34 (0.26-0.44) when none of the parents smoked, 0.19 (0.14-0.27) when one of the parents smoked, and 0.30 (0.20-0.44) when both parents smoked.

CONCLUSION

The implementation of this health education programme seems to have been very successful in reducing passive smoking in children. Implementation of similar health education programmes in other countries is recommended.

Prevention of smoking in adolescents with lower education: a school based intervention study

OBJECTIVE

To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students.

DESIGN

Group randomised controlled trial.

SETTING

26 Dutch schools that provided junior secondary education.

SUBJECTS

1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years.

INTERVENTION

Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition.

MAIN OUTCOME MEASURES

Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis.

RESULTS

In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant.

CONCLUSIONS

In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.

[The efficacy of smoking cessation methods available in the Netherlands: a systematic review based on Cochrane data]

OBJECTIVE

To obtain an overview of data from the Cochrane Library on smoking-cessation methods and aids available in the Netherlands.

DESIGN

Systematic literature review.

METHOD

Common smoking-cessation methods in the Netherlands in 1999 and 2000 were selected from previous research. Data from relevant Cochrane reviews about these cessation methods were collected, after which the efficacy was calculated as a pooled odds ratio and the effectiveness as a percentage of 12 months' continuous abstinence.

RESULTS

The following methods were found to be more efficacious than placebo: tailored written advice, individual counselling, telephonic counselling, group courses, all forms of nicotine-replacement therapy, bupropion and nortriptyline. Acupuncture was not superior to placebo. It was not possible to draw any unequivocal conclusions about hypnotherapy. No randomised studies were found with respect to the 'Allen Carr method'. Rates of 12 months' continuous abstinence were as follows for those methods with proven efficacy: tailored advice: 7%, individual counselling: 16%, telephonic counselling: 7.5%, nicotine gum: 17%, nicotine patch: 13%, nicotine inhaler: 17%, nicotine tablets: 20%, bupropion: 17%, and nortriptyline: 24%. The success rates for nicotine tablets and nortriptyline were based on only 2 and 1 study respectively.

CONCLUSION

Several effective smoking-cessation methods are available in the Netherlands. In trials the long-term effectiveness of these methods was between 7-24%.

The effectiveness of policy and health education strategies for reducing adolescent smoking: a review of the evidence

This paper identifies the most effective measures to prevent smoking among adolescents. A review was made of the international literature concerning a ban on tobacco advertising, restrictions on sales to youth, product regulation, price increase of cigarettes and educational strategies. It is concluded that isolated measures produce little effect. Most effect may be expected from a combination of a complete ban on tobacco advertising, increasing prices, restricting tobacco product sales to tobacconists, mass media education aimed at youth and intensifying school education. A less effective measure is limiting the age at which adolescents are allowed to buy cigarettes.

Applying a contingency model of strategic decision making to the implementation of smoking bans: a case study

A model of strategic decision making was applied to study the implementation of worksite smoking policy. This model assumes there is no best way of implementing smoking policies, but that 'the best way' depends on how decision making fits specific content and context factors. A case study at Wehkamp, a mail-order company, is presented to illustrate the usefulness of this model to understand how organizations implement smoking policies. Interview data were collected from representatives of Wehkamp, and pre- and post-ban survey data were collected from employees. After having failed to solve the smoking problem in a more democratic way, Wehkamp's top management choose a highly confrontational and decentralized decision-making approach to implement a complete smoking ban. This resulted in an effective smoking ban, but was to some extent at the cost of employees' satisfaction with the policy and with how the policy was implemented. The choice of implementation approach was contingent upon specific content and context factors, such as managers' perception of the problem, leadership style and legislation. More case studies from different types of companies are needed to better understand how organizational factors affect decision making about smoking bans and other health promotion innovations.

Differential beliefs, perceived social influences, and self-efficacy expectations among smokers in various motivational phases

BACKGROUND

The ASE model, an integration of social psychological models, states that motivational phases and the transition from one phase to another can be predicted by behavioral determinants. The goal of the present study was to replicate the so-called O pattern that was found in earlier Dutch studies.

METHODS

In four cross-sectional studies (N = 918, N = 354, N = 225, N = 317), smokers filled in a questionnaire based on the ASE model, while the motivational phase question was based on the stage definitions from the Transtheoretical model.

RESULTS

Precontemplating smokers perceived fewer advantages of quitting than contemplators. Precontemplators encountered less support for quitting than contemplators. Contemplators reported lower self-efficacy expectations than those in preparation, while this group had lower self-efficacy expectations than respondents in action. Ex-smokers in maintenance reported fewer disadvantages of quitting than those in action.

CONCLUSIONS

Since changes in cognitive determinants are thought to mediate transitions in motivational phases, the results can be used to tailor health education messages to the needs of smokers in the various motivational phases. The results suggest that smokers in precontemplation would benefit most from information about the pros of quitting and from obtaining support for quitting. Smokers in contemplation and preparation may benefit most from self-efficacy-enhancing information.

Long-term effectiveness of two Dutch work site smoking cessation programs

This article reports on one of the few experimental studies in Europe to examine work site smoking cessation. The study examined whether a comprehensive intervention (self-help manuals, group courses, a mass media campaign, smoking policies, and a second-year program) is more effective than a minimal intervention (self-help manuals only). Eight work sites participated in the study. The effect of treatment on smoking cessation depended on nicotine dependency levels: Heavy smokers had more success with the comprehensive smoking cessation intervention than with the minimal intervention (with respect to both 14-month quit rate and 6-month prolonged abstinence). For heavy smokers, exposure to mass media exhibitions or to group courses had a beneficial effect on prolonged abstinence. Comprehensive programs may be most appropriate in Dutch work sites with large proportions of heavily addicted smokers.

Validity and reliability of self-reported exposure to environmental tobacco smoke in work offices

Environmental tobacco smoke (ETS) is an occupational carcinogen. Large companies often examine ETS exposure by employee surveys. However, reliable and valid self-report measures have been lacking. This study compared validity and reliability of various self-report measures. One hundred and seven nonsmokers from 11 Dutch worksites were interviewed. Three self-report measures were correlated with nicotine concentrations collected with area monitors in nonsmokers' offices. Nicotine concentrations averaged 12.7 micrograms/m. The item "How much tobacco smoke, on average, is there during a day in your work office?" correlated highest with nicotine concentrations (r = 0.65; P < 0.001) and produced the lowest standard error of measurement. It was concluded that this simple self-report item may be a valid measure to assess the reach and effectiveness of worksite smoking policies.

Saying "no" to environmental tobacco smoke: determinants of assertiveness among nonsmoking employees

BACKGROUND

Nonsmokers' assertiveness can help regulate smoking in worksites by enhancing the salience of nonsmoking social norms. This study examined determinants of employees' assertiveness toward smoking colleagues.

METHODS

Cross-sectional data were collected from 898 nonsmoking Dutch employees. Potential determinants were chosen using the attitude-social influence-efficacy model.

RESULTS

Fifty-one percent of nonsmoking employees asked co-workers not to smoke. Assertive respondents had colleagues who more often acted assertively toward smokers at work, had a more positive attitude to asking colleagues not to smoke, and had a higher perceived self-efficacy. Moreover, assertive employees more often perceived hindrance from environmental tobacco smoke (ETS) and had more negative beliefs about ETS at work.

CONCLUSIONS

What matters is whether ETS is perceived as bothersome and harmful. It is likely that both conditions must be met for nonsmokers to behave assertively. Worksite educational programs could focus more on increasing nonsmokers' awareness of the harmfulness of regular exposure to ETS at work to increase social pressure on employees who smoke in places that are shared by smokers and nonsmokers. However, the effectiveness of such strategies is yet unknown.

Annoyance from environmental tobacco smoke and support for no-smoking policies at eight large Dutch workplaces

OBJECTIVE

To collect descriptive data on annoyance from environmental tobacco smoke (ETS), attitudes toward smoking at the workplace, and support for a no-smoking policy.

DESIGN

Survey of eight large companies in four sectors of Dutch industry.

SUBJECTS

A representative sample of smoking and non-smoking employees (n = 1480).

RESULTS

Thirty-five per cent of non-smoking employees felt it was "annoying" to "very annoying" when their colleagues smoked during worktime, and 78% thought a smoky work environment was harmful to their health. About two-thirds of non-smokers "sometimes" to "often" experienced annoyance from ETS at their workplace. The individual solution approach (no explicit policy) is not only rejected by most nonsmokers but also by many smokers. In three sectors of industry, there was much support among employees for a smoking ban except for work areas designated for smoking.

CONCLUSIONS

These results could encourage more companies to implement smoking restrictions and they may be used as reference data by companies wanting to develop effective no-smoking policies.

Determinants of intention to quit smoking among Dutch employees: the influence of the social environment

BACKGROUND

This study examines the influence of the social environment in worksites on employees' intention to quit smoking by applying the attitude-social influence-efficacy model.

METHODS

Regression analyses were conducted with 509 smoking employees from eight Dutch worksites. Variables of interest were attitudes toward smoking, perceived social pressure to quit, perceived smoking behavior of others, self-efficacy, demographics, smoking history variables, company type, and smoking tolerance.

RESULTS

Attitude, social pressure from people out-side the worksetting (partner, children), and self-efficacy explained 23% of the variance for intention. Past behavior increased the adjusted R2 from 0.23 to 0.29. Social influences in the worksite were unrelated to employees' intention to quit smoking.

CONCLUSIONS

It was concluded that, in Dutch work-sites, social influences stemming from people at work have less influence on employees' intention to quit smoking than other important people outside the work situation. Implications for smoking control strategies in worksites are briefly discussed.