A WeChat-based smoking cessation intervention for Chinese smokers: a feasibility study

WeChat is the largest social media platform in China, yet few WeChat-based smoking cessation interventions have been investigated to date. The objective of this study was to develop and test the feasibility of a WeChat-based smoking cessation intervention for smokers in China. Participants were recruited using WeChat and were then randomized into one of three groups: the Standard Group, the Enhanced Group, and the wait-list Control Group. Feasibility indicators including program reach, recruitment rate, recruitment efficiency, cost per person, attrition rate, intervention message exposure, group discussion utilization rate, intervention message engagement, satisfaction, and the likelihood of recommending to others were measured with assessed. Analyses included Chi-square and Fisher exact test, as well as analysis of variance test. A responsive participant is defined as a participant that responded to a certain assessment. A total of 1,132 individuals connected with ("friended") our project on WeChat between July 1 and August 5, 2019. Of these, 403 were eligible to participate, consented, and completed the baseline assessment. As a result, 136, 135, and 132 smokers were randomly assigned to the Standard Group, the Enhanced Group, and the Control Group, respectively. The total program recruitment rate was 35.6% and the attrition rate was 46.4%. The program cost was $0.85 per person. All responsive participants read at least one message during the intervention and engaged with intervention messages 56.8% of the time. Most responsive participants reported being very or somewhat satisfied, highly or somewhat engaged, and were willing to recommend our program to others. This study demonstrated the feasibility of a smoking cessation interventions using WeChat. The program could be expanded to deliver smoking cessation interventions to a large population of smokers.

A WeChat-based smoking cessation intervention for Chinese smokers: A pilot study

BACKGROUND

China is the largest tobacco producer and has the highest number of tobacco consumers in the world. Extensive research has demonstrated the utility of social media for smoking cessation. WeChat is the most commonly used social media platform in China, but has not yet been utilized for smoking cessation interventions. The objectives of this study are (1) to evaluate the efficacy of a WeChat-based smoking cessation intervention; and (2) to examine a possible additive effect of integrating oral health and smoking-related information into a tailored, Transtheoretical Model (TTM) guided smoking cessation intervention.

METHODS

Eligible adults were recruited through WeChat from July 1 to August 6, 2019, to participate in a 3-arm, single-blinded, randomized controlled trial. We enrolled and randomized 403 participants into three groups: the Standard Group, Enhanced Group, or a Waitlist-Control Group. Participants in the Standard Group received 20 smoking cessation-related messages for 2 weeks; participants in the Enhanced Group received this same protocol plus 6 oral health-related messages over an additional week. Participants in the Control Group received smoking cessation-related messages, after the post-intervention assessment. The primary outcome was TTM Stage of Change, and the secondary outcomes were 7-day Point Prevalence Abstinence (PPA), 24-h PPA, daily cigarette use, and nicotine dependence at 4 weeks follow-up post intervention, comparing intervention groups with the control group. The overall program attrition rate was 46%. Paired t-tests, McNemar tests, and linear and logistic regression were used to examine differences in smoking cessation outcomes within and between groups.

RESULTS

Participants in the Enhanced Group (β = -1.28, 95%CI: -2.13, -0.44) and the Standard Group (β = -1.13, 95%CI: -1.95, -0.30) reported larger changes in nicotine dependence scores, compared to participants in the Waitlist Group. No statistically significant differences were found between the Enhanced Group and the Standard Group.

DISCUSSION

This WeChat-based intervention was effective for smoking cessation overall. The addition of oral health information did not significantly improve the intervention.

Urban and Rural Disparities in a WeChat-Based Smoking Cessation Intervention among Chinese Smokers

INTRODUCTION

Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally. Moreover, health disparities regarding tobacco consumption and smoking cessation are growing between rural and urban populations worldwide. Social media interventions for tobacco cessation may effectively reach both groups. The objective of this study was to evaluate the efficacy of a WeChat-delivered smoking cessation intervention among rural and urban Chinese smokers, and to assess moderating variables that may contribute to differential intervention efficacy.

METHODS

WeChat was used to recruit smokers into this intervention study between 1 July and 5 August 2019. Participants were randomized to one of three intervention schedules: participants in the Standard Group and the Enhanced Group received 20 smoking-related messages over 2 weeks, whereas participants in the Enhanced Group received an extra 6 oral health-related messages for one week. Participants in the control group received 20 smoking-related messages after the post-intervention assessment. Participants completed questionnaires at baseline and at 4 weeks follow-up. Our primary outcome was smoking cessation stage of change and secondary outcome was 24-h point prevalence abstinence (PPA). Urban and rural areas were based on self-reported living areas. Chi-squared test, Fisher's exact test, ANOVA test, linear regression, and logistic regression were used for analysis.

RESULTS

Overall, 403 participants completed the intervention (233 rural, 107 suburban, 63 urban). Compared to urban participants, rural participants were more likely to have progressed to a later stage of change (β = 0.40, 95% CI: 0.13, 0.67) and to report higher 24-h PPA rates at follow-up (aOR = 3.23, 95% CI: 1.36, 7.68). After stratification by living area, the intervention effects in stage of change and 24-h PPA rate at follow-up were only found in the urban subgroup.

DISCUSSION

Smokers who lived in rural areas reported better smoking cessation outcomes compared with urban smokers; however, the efficacy of a WeChat-based smoking cessation intervention was only found for participants living in an urban area. WeChat based smoking cessation interventions should be used to promote smoking cessation in urban, suburban, and rural areas.

Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline

Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.

Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.

Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.

Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

Using social media for smoking cessation interventions: a systematic review

Background:

Previous studies have shown that smoking tobacco significantly increases both incidence and mortality rates for many diseases. Social media has become one of the most influential platforms for various smoking cessation interventions. However, results from smoking cessation interventions have differed from study to study. Limited studies have summarised cessation outcomes from social media–based interventions. Therefore, the objective of this review is to explore the effectiveness of using social media for smoking cessation.

Methods:

We searched PubMed, MEDLINE, PsycINFO, and CINAHL for articles between June 2008 and June 2018, and also assessed the references of selected articles. We included studies that used social media as intervention platforms, provided a baseline assessment before the intervention, and provided smoking cessation outcomes after the intervention.

Results:

We identified 13 original studies that enrolled between 16 and 1698 participants; 7-day Point Prevalence Abstinence (PPA) rate was the most frequently used measure of abstinence, with a range of 7%–75%, regardless of the measurement time, study design, and analysis methods. Social media–based smoking cessation interventions were effective, because (1) smokers reported higher 7-day PPA rates after intervention compared to baseline and (2) smokers reported higher 7-day PPA rates in intervention groups than in control groups. Moreover, at each time point, approximately half of all smokers in studies reporting abstinence were found to be biochemically abstinent. There were no significant differences in the effectiveness of smoking cessation outcomes between those that used existing popular social networking platforms (e.g. Pechmann et al’s studies) and those that used individually designed interactive platforms (e.g. MyLastDip, iQuit system, Quitxt system).

Conclusions:

This review highlights the effectiveness of social media–based smoking cessation intervention studies. Due to the widespread use of social media, as well as its low cost, we suggest embedding smoking cessation interventions within existing popular social media platforms.

Cellular and humoral autoreactivity in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a morbid, refractory lung disorder with an unknown pathogenesis. To investigate potential adaptive immune mechanisms in IPF, we compared phenotypes and effector functions of peripheral CD4 T cells, autoantibody production, and proliferative responses of pulmonary hilar lymph node CD4 T cells to autologous lung extracts from afflicted patients and normals. Our results show that greater proportions of peripheral CD4 T lymphocytes in IPF subjects expressed MHC class II and CD154 (CD40L), and they more frequently elaborated TGF-beta1, IL-10, and TNF-alpha. Abnormal CD4 T cell clonal expansions were found in all IPF patients, and 82% of these subjects also had IgG autoantibodies against cellular Ags. IPF lung extracts stimulated proliferations of autologous CD4 T cells, unlike preparations from normals or those with other lung diseases, and the IPF proliferative responses were enhanced by repeated cycles of stimulation. Thus, CD4 T cells from IPF patients have characteristics typical of cell-mediated pathologic responses, including augmented effector functions, provision of facultative help for autoantibody production, oligoclonal expansions, and proliferations driven by an Ag present in diseased tissues. Recognition that an autoreactive immune process is present in IPF can productively focus efforts toward identifying the responsible Ag, and implementing more effective therapies.

Fibronectin synthesis by aorta explants from rabbits fed high cholesterol diets

Fibronectin synthesis was studied in aorta explants in culture from rabbits fed a high fat-high cholesterol diet. [3H]Mannose and [14C]leucine were used to label oligosaccharide side chains and the protein core, respectively. The synthesis was followed by monitoring immunoprecipitable fibronectin from the culture medium using polyclonal goat anti-rabbit fibronectin antibody. Synthesis of fibronectin increased by [14C]leucine (81%) and [3H]mannose (29%) incorporation over controls. On gel filtration, fibronectin synthesized by controls and cholesterol-fed rabbit resolved into four fractions. Pulse-chase experiment with [3H]glucosamine or [3H]leucine showed that fibronectin secreted by the aorta explants from rabbits fed high fat-high cholesterol diets incorporated an increased amount of radioactivity. Pulsing with [3H]mannose showed decreased incorporation of the label. During the chase period, the rate of secretion of fibronectin into the media by the hypercholesterolemic rabbit aorta explants was increased. The fibronectin that bound to the gelatin or heparin columns from cholesterol-fed rabbit aorta media had lower levels of [3H]mannose incorporated into the glycoprotein than the control. These results indicate that there is an alteration in carbohydrate composition of the fibronectin synthesized by the aorta explants from rabbits fed a high cholesterol diet. High fat-cholesterol intake could play a causative role in matrix dysfunction during atherogenesis by altering glycoprotein synthesis.