1
|
Sumodhee D, Walsh H, Brose L, McNeill A, McEwen A, Duaso MJ. Support Provided by Stop-Smoking Practitioners to Co-users of Tobacco and Cannabis: A Qualitative Study. Nicotine Tob Res 2024; 26:23-30. [PMID: 37429576 PMCID: PMC10734383 DOI: 10.1093/ntr/ntad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/17/2023] [Accepted: 07/10/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Co-use of tobacco and cannabis is highly prevalent among cannabis users and is associated with poorer tobacco cessation outcomes. This study explored the barriers and enablers influencing stop-smoking practitioners' ability to provide optimal support to co-users. AIMS AND METHODS Online semi-structured interviews were audio recorded. Interviewees (n = 20) were UK-based certified stop-smoking practitioners. An interview schedule informed by the "capability", "opportunity", "motivation" (COM-B) model was designed to explore participants' perceived barriers and enablers in better supporting co-users to achieve abstinence of both substances or tobacco harm reduction. The transcripts were analyzed using framework analysis. RESULTS Capability: Practitioners' lack of knowledge and skills undermines their delivery of smoking cessation interventions to co-users. Interestingly, when cannabis is used for medicinal reasons, practitioners feel unable to provide adequate support. Opportunity: Service recording systems play an important role in screening for co-use and supporting co-users. When responding to clients' specific needs and practitioners' uncertainties, a positive therapeutic relationship and a support network of peers and other healthcare professionals are needed. Motivation: supporting co-users is generally perceived as part of practitioners' roles but there are concerns that co-users are less likely to successfully stop smoking. CONCLUSIONS Practitioners are willing to support co-users, but their lack of knowledge and access to an appropriate recording system are barriers to doing so. Having a supportive team and a positive therapeutic relationship is perceived as important. Identified barriers can be mostly addressed with further training to improve tobacco cessation outcomes for co-users.
Collapse
Affiliation(s)
- Dayyanah Sumodhee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (FNMPC), King’s College London, London, UK
| | - Hannah Walsh
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (FNMPC), King’s College London, London, UK
| | - Leonie Brose
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, Dorchester, UK
| | - Maria J Duaso
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care (FNMPC), King’s College London, London, UK
| |
Collapse
|
2
|
Kotti T, Katsampouris E, Ruparel M, McEwen A, Dickson JL, Duffy SW, Waller J, Janes SM, Quaife SL. A randomised controlled trial testing acceptance of practitioner-referral versus self-referral to stop smoking services within the Lung Screen Uptake Trial. Addiction 2023; 118:2007-2013. [PMID: 37331722 PMCID: PMC10952744 DOI: 10.1111/add.16269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 05/04/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND AND AIMS Optimising smoking cessation (SC) referral strategies within lung cancer screening (LCS) could significantly reduce lung cancer mortality. This study aimed to measure acceptance of referral to SC support by either practitioner-referral or self-referral among participants attending a hospital-based lung health check appointment for LCS as part of the Lung Screen Uptake Trial. DESIGN Single-blinded two-arm randomised controlled trial. SETTING England. PARTICIPANTS Six hundred forty-two individuals ages 60 to 75 years, who self-reported currently smoking or had a carbon monoxide reading over 10 ppm during the lung health check appointment. INTERVENTION AND COMPARATOR Participants were randomised (1:1) to receive either a contact information card for self-referral to a local stop smoking service (SSS) (self-referral, n = 360) or a SSS referral made on their behalf by the nurse or trial practitioner (practitioner-referral, n = 329). MEASUREMENTS The primary outcome was acceptance of the practitioner-referral (defined as participants giving permission for their details to be shared with the local SSS) compared with acceptance of the self-referral (defined as participants taking the physical SSS contact information card to refer themselves to the local SSS). FINDINGS Half (49.8%) accepted the practitioner-made referral to a local SSS, whereas most (88.5%) accepted the self-referral. The odds of accepting the practitioner-referral were statistically significantly lower (adjusted odds ratio = 0.10; 95% confidence interval = 0.06-0.17) than the self- referral. In analyses stratified by group, greater quit confidence, quit attempts and Black ethnicity were associated with increased acceptance within the practitioner-referral group. There were no statistically significant interactions between acceptance by referral group and any of the participants' demographic or smoking characteristics. CONCLUSIONS Among participants in hospital-based lung cancer screening in England who self-reported smoking or met a carbon monoxide cut-off, both practitioner-referral and self-referral smoking cessation strategies were highly accepted. Although self-referral was more frequently accepted, prior evidence suggests practitioner-referrals increase quit attempts, suggesting practitioner-referrals should be the first-line strategy within lung cancer screening, with self-referral offered as an alternative.
Collapse
Affiliation(s)
- Theodora Kotti
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUnited Kingdom
| | - Evangelos Katsampouris
- Wolfson Institute of Population Health, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUnited Kingdom
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of MedicineUniversity College LondonLondonUnited Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and TrainingDorchesterUnited Kingdom
| | - Jennifer L. Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of MedicineUniversity College LondonLondonUnited Kingdom
| | - Stephen W. Duffy
- Wolfson Institute of Population Health, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUnited Kingdom
| | - Jo Waller
- School of Cancer and Pharmaceutical SciencesKing’s College LondonLondonUnited Kingdom
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of MedicineUniversity College LondonLondonUnited Kingdom
| | - Samantha L. Quaife
- Wolfson Institute of Population Health, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUnited Kingdom
| |
Collapse
|
3
|
Anastasaki M, Papadakis S, Tsiligianni I, Anastasiou F, Pooler J, McEwen A, Lionis C. Training general practitioners in Greece in ‘Very Brief Advice’ on smoking: The FRESH AIR Project. Tob Prev Cessat 2022. [DOI: 10.18332/tpc/151002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
4
|
Katsampouris E, Kotti T, Ruparel M, McEwen A, Dickson J, Duffy S, Waller J, Janes S, Quaife S. Rates of acceptance between opt-out vs opt-in smoking cessation referral strategies among current smokers attending a lung health check offering lung cancer screening. Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
5
|
Yeates L, Gardner K, Do J, van den Heuvel L, Leslie F, Semsarian C, McEwen A, Adlard L, Ingles J. COPESCD — An Online Community Supporting Families After Sudden Cardiac Death in the Young: A Protocol for a Pilot Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
6
|
Quaife SL, Ruparel M, Dickson JL, Beeken RJ, McEwen A, Baldwin DR, Bhowmik A, Navani N, Sennett K, Duffy SW, Waller J, Janes SM. Reply to Wilson: Improving Lung Cancer Screening Uptake. Am J Respir Crit Care Med 2020; 202:1193-1194. [PMID: 32525401 PMCID: PMC7560797 DOI: 10.1164/rccm.202005-1699le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Samantha L. Quaife
- University College LondonLondon, United Kingdom
- Corresponding author (e-mail: )
| | | | | | - Rebecca J. Beeken
- University College LondonLondon, United Kingdom
- University of LeedsLeeds, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and TrainingDorchester, United Kingdom
| | | | | | - Neal Navani
- University College London HospitalLondon, United Kingdom
| | | | | | - Jo Waller
- University College LondonLondon, United Kingdom
- King’s College LondonLondon, United Kingdom
| | | |
Collapse
|
7
|
Golombek M, Williams N, Warner NH, Parker T, Williams MG, Daubar I, Calef F, Grant J, Bailey P, Abarca H, Deen R, Ruoff N, Maki J, McEwen A, Baugh N, Block K, Tamppari L, Call J, Ladewig J, Stoltz A, Weems WA, Mora‐Sotomayor L, Torres J, Johnson M, Kennedy T, Sklyanskiy E. Location and Setting of the Mars InSight Lander, Instruments, and Landing Site. Earth Space Sci 2020; 7:e2020EA001248. [PMID: 33134434 PMCID: PMC7583488 DOI: 10.1029/2020ea001248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/09/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
Knowing precisely where a spacecraft lands on Mars is important for understanding the regional and local context, setting, and the offset between the inertial and cartographic frames. For the InSight spacecraft, the payload of geophysical and environmental sensors also particularly benefits from knowing exactly where the instruments are located. A ~30 cm/pixel image acquired from orbit after landing clearly resolves the lander and the large circular solar panels. This image was carefully georeferenced to a hierarchically generated and coregistered set of decreasing resolution orthoimages and digital elevation models to the established positive east, planetocentric coordinate system. The lander is located at 4.502384°N, 135.623447°E at an elevation of -2,613.426 m with respect to the geoid in Elysium Planitia. Instrument locations (and the magnetometer orientation) are derived by transforming from Instrument Deployment Arm, spacecraft mechanical, and site frames into the cartographic frame. A viewshed created from 1.5 m above the lander and the high-resolution orbital digital elevation model shows the lander is on a shallow regional slope down to the east that reveals crater rims on the east horizon ~400 m and 2.4 km away. A slope up to the north limits the horizon to about 50 m away where three rocks and an eolian bedform are visible on the rim of a degraded crater rim. Azimuths to rocks and craters identified in both surface panoramas and high-resolution orbital images reveal that north in the site frame and the cartographic frame are the same (within 1°).
Collapse
Affiliation(s)
- M. Golombek
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - N. Williams
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - N. H. Warner
- Department of Geological SciencesSUNY GeneseoGeneseoNYUSA
| | - T. Parker
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - M. G. Williams
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - I. Daubar
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
- Department of Earth, Environmental, and Planetary SciencesBrown UniversityProvidenceRIUSA
| | - F. Calef
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - J. Grant
- Smithsonian Institution, National Air and Space MuseumWashingtonDCUSA
| | - P. Bailey
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - H. Abarca
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - R. Deen
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - N. Ruoff
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - J. Maki
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - A. McEwen
- Lunar and Planetary LaboratoryUniversity of ArizonaTucsonAZUSA
| | - N. Baugh
- Lunar and Planetary LaboratoryUniversity of ArizonaTucsonAZUSA
| | - K. Block
- Lunar and Planetary LaboratoryUniversity of ArizonaTucsonAZUSA
| | - L. Tamppari
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - J. Call
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | | | | | | | - L. Mora‐Sotomayor
- Centro de Astrobiología (CSIC/INTA)Instituto Nacional de Técnica AeroespacialMadridSpain
| | - J. Torres
- Centro de Astrobiología (CSIC/INTA)Instituto Nacional de Técnica AeroespacialMadridSpain
| | | | | | - E. Sklyanskiy
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| |
Collapse
|
8
|
Papadakis S, Anastasaki M, Papadakaki M, Antonopoulou Μ, Chliveros C, Daskalaki C, Varthalis D, Triantafyllou S, Vasilaki I, McEwen A, Lionis C. 'Very brief advice' (VBA) on smoking in family practice: a qualitative evaluation of the tobacco user's perspective. BMC Fam Pract 2020; 21:121. [PMID: 32580760 PMCID: PMC7315478 DOI: 10.1186/s12875-020-01195-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 06/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Very Brief Advice on smoking (VBA) is an evidence-based intervention designed to increase quit attempts among patients who smoke. VBA has been widely disseminated in general practice settings in the United Kingdom, however its transferability to Southern European settings is not well established. This study sought to document the perspectives of Greek general practice patients in terms of the acceptability and satisfaction with receiving VBA from their general practitioner (GP) and its influence on patients' motivation to make a quit attempt. We also examine patient identified barriers and facilitators to acting on VBA. METHODS Semi-structured interviews were conducted with 50 patients who reported current tobacco use recruited from five general practices in Crete, Greece. All patients received VBA from their GP and interviews were conducted immediately after the GP appointment. Thematic analysis was used to analyze data. RESULTS The majority of patients were satisfied with the VBA intervention. Approximately one quarter of patients reported they were motivated to make an attempt to quit smoking after receiving VBA from their GP. Patients identified a clear preference for VBA to be delivered in a supportive manner, which communicated genuine concern versus fear-based approaches. Patients with an existing smoking-related illness were more likely to report plans to act on their GP's VBA. Patients not ready to quit smoking indicated they would be likely to seek the support of their GP for future quit attempts as a result of VBA. Many patients reported low self-efficacy with quitting and apprehension about available quit smoking supports. CONCLUSIONS VBA was positively received by the majority of smokers interviewed. Participating patients confirmed the motivational role of advice when delivered in a supportive and caring manner. Personal health status, beliefs about quit smoking supports, and low self-efficacy appear to influence patient's motivation to make an aided quit attempt.
Collapse
Affiliation(s)
- Sophia Papadakis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box: 2208, 71003, Heraklion, Crete, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box: 2208, 71003, Heraklion, Crete, Greece
| | - Maria Papadakaki
- Department of Social Work, School of Health Sciences, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | | | | | | | | | | | - Irene Vasilaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box: 2208, 71003, Heraklion, Crete, Greece
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, Dorchester, UK
| | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box: 2208, 71003, Heraklion, Crete, Greece.
| |
Collapse
|
9
|
Quaife SL, Ruparel M, Dickson JL, Beeken RJ, McEwen A, Baldwin DR, Bhowmik A, Navani N, Sennett K, Duffy SW, Wardle J, Waller J, Janes SM. Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials. Am J Respir Crit Care Med 2020; 201:965-975. [PMID: 31825647 PMCID: PMC7159423 DOI: 10.1164/rccm.201905-0946oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
Rationale: Low uptake of low-dose computed tomography (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity.Objectives: To compare the effect of a targeted, low-burden, and stepped invitation strategy versus control on uptake of hospital-based Lung Health Check appointments offering LDCT screening.Methods: In a two-arm, blinded, between-subjects, randomized controlled trial, 2,012 participants were selected from 16 primary care practices using these criteria: 1) aged 60 to 75 years, 2) recorded as a current smoker within the last 7 years, and 3) no prespecified exclusion criteria contraindicating LDCT screening. Both groups received a stepped sequence of preinvitation, invitation, and reminder letters from their primary care practitioner offering prescheduled appointments. The key manipulation was the accompanying leaflet. The intervention group's leaflet targeted psychological barriers and provided low-burden information, mimicking the concept of the U.K. Ministry of Transport's annual vehicle test ("M.O.T. For Your Lungs").Measurements and Main Results: Uptake was 52.6%, with no difference between intervention (52.3%) and control (52.9%) groups in unadjusted (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.82-1.16) or adjusted (OR, 0.98; 95% CI, 0.82-1.17) analyses. Current smokers were less likely to attend (adjusted OR, 0.70; 95% CI, 0.56-0.86) than former smokers. Socioeconomic deprivation was significantly associated with lower uptake for the control group only (P < 0.01).Conclusions: The intervention did not improve uptake. Regardless of trial arm, uptake was considerably higher than previous clinical and real-world studies, particularly given that the samples were predominantly lower socioeconomic position smokers. Strategies common to both groups, including a Lung Health Check approach, could represent a minimum standard.Clinical trial registered with www.clinicaltrials.gov (NCT02558101) and registered prospectively with the International Standard Registered Clinical/Social Study (N21774741).
Collapse
Affiliation(s)
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Jennifer L. Dickson
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Rebecca J. Beeken
- Research Department of Behavioural Science and Health and
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, Dorchester, United Kingdom
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, United Kingdom
| | - Neal Navani
- Department of Thoracic Medicine, University College London Hospital, London, United Kingdom
| | - Karen Sennett
- Killick Street Health Centre, London, United Kingdom
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; and
| | - Jane Wardle
- Research Department of Behavioural Science and Health and
| | - Jo Waller
- Research Department of Behavioural Science and Health and
- School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| |
Collapse
|
10
|
Affiliation(s)
- N. Berry
- Department of Microbiology, Manchester Royal Infirmary, Oxford Road Manchester, M13 9WL, United Kingdom
| | - I. Hassan
- Department of Microbiology, Manchester Royal Infirmary, Oxford Road Manchester, M13 9WL, United Kingdom
| | - S. Majumdar
- Department of Microbiology, Manchester Royal Infirmary, Oxford Road Manchester, M13 9WL, United Kingdom
| | - A. Vardhan
- Manchester Institute of Nephrology & Transplantation Manchester Royal Infirmary, Oxford Road Manchester, M13 9WL, United Kingdom
| | - A. McEwen
- Department of Microbiology, Manchester Royal Infirmary, Oxford Road Manchester, M13 9WL, United Kingdom
| | - R. Gokal
- Manchester Institute of Nephrology & Transplantation Manchester Royal Infirmary, Oxford Road Manchester, M13 9WL, United Kingdom
| |
Collapse
|
11
|
Robinson J, McEwen A, Heah R, Papadakis S. A 'Cut-Down-To-Stop' intervention for smokers who find it hard to quit: a qualitative evaluation. BMC Public Health 2019; 19:403. [PMID: 30987623 PMCID: PMC6466646 DOI: 10.1186/s12889-019-6738-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background English Stop Smoking Services primarily deliver behavioural interventions to support abrupt quit attempts. Recent evidence suggests an alternative approach could be offered to clients involving a more gradual reduction of cigarettes smoked leading to complete abstinence, known as ‘Cut Down To Stop’ (CDTS). The purpose of this study was to explore the experiences of stop smoking practitioners and service users who participated in a pilot study of a CDTS service. Methods The CDTS intervention was pilot tested in a Stop Smoking Service in London, England. As part of the CDTS intervention clients who were still smoking 2 weeks after their quit date were offered tailored advice, medication and support to reduce their current smoking by half, with the aim to stop smoking altogether within a six-month period. A qualitative evaluation was conducted involving a focus group discussion with nine practitioners involved in the delivery of the CDTS intervention and telephone interviews with 18 CDTS service users. Thematic analysis was performed. Results Service users and practitioners were very positive about their experience with the CDTS intervention. The intervention was found to be an effective way of keeping clients engaged with the service and was felt to increase the likelihood they might quit and/or re-engage in service for future quit attempts. Elements that contributed to the attractiveness of the CDTS intervention included: 1) the trust and empathetic relationship developed between service users, practitioners and their referring primary care provider; 2) time and flexibility for service users to engage in the quitting process at their own pace; 3) setting progressive goals and building service user confidence; 4) the opportunity to experiment with quit smoking medications; and, 5) the on-going contact with the practitioner/service. Conclusions Service users who are not successful with quitting abruptly may benefit from a CDTS intervention. This study highlights the important role of ‘relationships’, time and ‘flexible’ service delivery models in engaging service users who are not initially successful with quitting. The findings of this study have the potential to inform decision-making regarding the value of the CDTS approach for the English Stop Smoking Service and cessation services worldwide.
Collapse
Affiliation(s)
- J Robinson
- School of Social and Political Sciences, University of Glasgow, Florentine House, 53, Hillhead St, G12 8QS, Glasgow, UK.
| | - A McEwen
- National Centre for Smoking Cessation and Training (NCSCT), 1 Great Western Industrial Centre, Dorchester, DT1 1RD, UK
| | - R Heah
- Department of Law, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, L69 7DT, Liverpool, UK
| | - S Papadakis
- Sophia Papadakis, Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y4W7, Canada
| |
Collapse
|
12
|
Aveyard P, Lindson N, Tearne S, Adams R, Ahmed K, Alekna R, Banting M, Healy M, Khan S, Rai G, Wood C, Anderson EC, Ataya-Williams A, Attwood A, Easey K, Fluharty M, Freuler T, Hurse M, Khouja J, Lacey L, Munafò M, Lycett D, McEwen A, Coleman T, Dickinson A, Lewis S, Orton S, Perdue J, Randall C, Anderson R, Bisal N, Hajek P, Homsey C, McRobbie HJ, Myers-Smith K, Phillips A, Przulj D, Li J, Coyle D, Coyle K, Pokhrel S. Nicotine preloading for smoking cessation: the Preloading RCT. Health Technol Assess 2019; 22:1-84. [PMID: 30079863 DOI: 10.3310/hta22410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data. OBJECTIVES To assess (1) the effectiveness, safety and tolerability of nicotine preloading in a routine NHS setting relative to usual care, (2) the mechanisms of the action of preloading and (3) the cost-effectiveness of preloading. DESIGN Open-label randomised controlled trial with examination of mediation and a cost-effectiveness analysis. SETTING NHS smoking cessation clinics. PARTICIPANTS People seeking help to stop smoking. INTERVENTIONS Nicotine preloading comprised wearing a 21 mg/24 hour nicotine patch for 4 weeks prior to quit date. In addition, minimal behavioural support was provided to explain the intervention rationale and to support adherence. In the comparator group, participants received equivalent behavioural support. Randomisation was stratified by centre and concealed from investigators. MAIN OUTCOME MEASURES The primary outcome was 6-month prolonged abstinence assessed using the Russell Standard. The secondary outcomes were 4-week and 12-month abstinence. Adverse events (AEs) were assessed from baseline to 1 week after quit day. In a planned analysis, we adjusted for the use of varenicline (Champix®; Pfizer Inc., New York, NY, USA) as post-cessation medication. Cost-effectiveness analysis took a health-service perspective. The within-trial analysis assessed health-service costs during the 13 months of trial enrolment relative to the previous 6 months comparing trial arms. The base case was based on multiple imputation for missing cost data. We modelled long-term health outcomes of smoking-related diseases using the European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) model. RESULTS In total, 1792 people were eligible and were enrolled in the study, with 893 randomised to the control group and 899 randomised to the intervention group. In the intervention group, 49 (5.5%) people discontinued preloading prematurely and most others used it daily. The primary outcome, biochemically validated 6-month abstinence, was achieved by 157 (17.5%) people in the intervention group and 129 (14.4%) people in the control group, a difference of 3.02 percentage points [95% confidence interval (CI) -0.37 to 6.41 percentage points; odds ratio (OR) 1.25, 95% CI 0.97 to 1.62; p = 0.081]. Adjusted for use of post-quit day varenicline, the OR was 1.34 (95% CI 1.03 to 1.73; p = 0.028). Secondary abstinence outcomes were similar. The OR for the occurrence of serious AEs was 1.12 (95% CI 0.42 to 3.03). Moderate-severity nausea occurred in an additional 4% of the preloading group compared with the control group. There was evidence that reduced urges to smoke and reduced smoke inhalation mediated the effect of preloading on abstinence. The incremental cost-effectiveness ratio at the 6-month follow-up for preloading relative to control was £710 (95% CI -£13,674 to £23,205), but preloading was dominant at 12 months and in the long term, with an 80% probability that it is cost saving. LIMITATIONS The open-label design could partially account for the mediation results. Outcome assessment could not be blinded but was biochemically verified. CONCLUSIONS Use of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication. TRIAL REGISTRATION Current Controlled Trials ISRCTN33031001. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 41. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tearne
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Adams
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Khaled Ahmed
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rhona Alekna
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Miriam Banting
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Mike Healy
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Shahnaz Khan
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Gurmail Rai
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Carmen Wood
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Emma C Anderson
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | | | - Angela Attwood
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Kayleigh Easey
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Megan Fluharty
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Therese Freuler
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Megan Hurse
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Jasmine Khouja
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Lindsey Lacey
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Marcus Munafò
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Andy McEwen
- National Centre for Smoking Cessation and Training (NCSCT), Dorchester, UK
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anne Dickinson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sophie Orton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Johanna Perdue
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Randall
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Rebecca Anderson
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Natalie Bisal
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Celine Homsey
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Hayden J McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Katherine Myers-Smith
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anna Phillips
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Dunja Przulj
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jinshuo Li
- Health Sciences, University of York, York, UK
| | - Doug Coyle
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
| | - Katherine Coyle
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
| | - Subhash Pokhrel
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
| |
Collapse
|
13
|
Hiscock R, Arnott D, Dockrell M, Ross L, McEwen A. Stop Smoking Practitioners' understanding of e-cigarettes' use and efficacy with particular reference to vapers' socioeconomic status. J Smok Cessat 2019; 14:21-31. [PMID: 30828391 PMCID: PMC6390726 DOI: 10.1017/jsc.2018.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: We have undertaken four online surveys of Stop Smoking Service (SSS) practitioners in England, between 2011 and 2016, in order to enhance our understanding of e-cigarettes: a fast moving new phenomenon. It is important to understand whether e-cigarettes can ameliorate or exacerbate health inequalities given that smoking is one of the most serious causes of excessive mortality and morbidity among disadvantaged groups globally. Aims: To update findings of previous surveys and examine socioeconomic status differences in e-cigarette use and efficacy. Methods: Analysis was undertaken of electronic surveys, particularly, the most recent 2016 survey (n = 514) and 2015/16 SSS client routine monitoring data. Results: SSS practitioners were becoming more positive about e-cigarettes: 42% agreed that e-cigarettes were a good thing compared with 15% in 2011. Reported use of e-cigarettes among SSS clients was low (about 3%) despite higher quit rates (63% of clients reported being quit at four week follow-up, compared with 51% overall). Where socioeconomic differences in e-cigarettes' efficacy for quitting were identified, affluent and working smokers were advantaged. Conclusions: Low use of e-cigarettes by clients and practitioner opinions suggest that further education of SSS staff is needed if they are to adopt the current service recommendations about e-cigarettes.
Collapse
Affiliation(s)
- Rosemary Hiscock
- Department for Health, University of Bath, Bath, UK
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
| | | | | | - Louise Ross
- Stop Smoking Service Leicester City Council, Leicester, UK
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
- National Centre for Smoking Cessation and Training (NCSCT), Dorchester, UK
| |
Collapse
|
14
|
Cooper S, Orton S, Campbell KA, Ussher M, Coleman-Haynes N, Whitemore R, Dickinson A, McEwen A, Lewis S, Naughton F, Bowker K, Sinclair L, Bauld L, Coleman T. Attitudes to E-Cigarettes and Cessation Support for Pregnant Women from English Stop Smoking Services: A Mixed Methods Study. Int J Environ Res Public Health 2019; 16:E110. [PMID: 30609823 PMCID: PMC6338976 DOI: 10.3390/ijerph16010110] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
Abstract
Smoking in pregnancy remains a public health problem. In the UK e-cigarettes are the most popular aid to quitting smoking outside of pregnancy, but we don't know the extent of e-cigarette use in pregnancy or how English Stop Smoking Services (SSS) respond to pregnant women who vape. In 2015 we surveyed SSS managers about cessation support for pregnant women and responses to clients who vaped. Subsequently we interviewed a sub-sample of managers to seek explanations for the SSS' position on e-cigarettes; interviews were thematically analysed. Survey response rate was 67.8% (72/106); overall managers reported 2.2% (range 1.4⁻4.3%) of pregnant clients were using e-cigarettes. Most SSS reported supporting pregnant women who already vaped, but would not recommend e-cigarette use; for women that were still smoking and not using e-cigarettes, 8.3% of SSS were likely/very likely to advise using e-cigarettes, with 56.9% of SSS unlikely/very unlikely to advise using them. Fifteen respondents were interviewed; interviewees were generally positive about the potential of e-cigarettes for cessation in pregnancy although concerns about perceived lack of evidence for safety were expressed and most wanted research on this. Clear guidance on e-cigarette use informed by pregnancy specific research will assist SSS to provide consistent evidence-based support.
Collapse
Affiliation(s)
- Sue Cooper
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Katarzyna A Campbell
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK.
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - Naomi Coleman-Haynes
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Rachel Whitemore
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Anne Dickinson
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Andy McEwen
- National Centre of Smoking Cessation and Training, Dorchester DT1 2DY, UK.
| | - Sarah Lewis
- Division of Epidemiology and Public health, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB, UK.
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK.
| | - Katharine Bowker
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Lesley Sinclair
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| |
Collapse
|
15
|
McEwen A. My family and other animals: comparative requirements for human and animal metabolism studies. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Quaife SL, Vrinten C, Ruparel M, Janes SM, Beeken RJ, Waller J, McEwen A. Smokers' interest in a lung cancer screening programme: a national survey in England. BMC Cancer 2018; 18:497. [PMID: 29716550 PMCID: PMC5930691 DOI: 10.1186/s12885-018-4430-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/24/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Following the recommendation of lung cancer screening in the US, screening committees in several European countries are reviewing the evidence for implementing national programmes. However, inadequate participation from high-risk groups poses a potential barrier to its effectiveness. The present study examined interest in a national lung cancer screening programme and modifiable attitudinal factors that may affect participation by smokers. METHODS A population-based survey of English adults (n = 1464; aged 50-70 years) investigated screening intentions in different invitation scenarios, beliefs about lung cancer, early detection and treatment, worry about lung cancer risk, and stigma. Data on smoking status and perceived chances of quitting were also collected, but eligibility for lung screening in the event of a national programme was unknown. RESULTS Intentions to be screened were high in all three invitation scenarios for both current (≥ 89%) and former (≥ 94%) smokers. However, smokers were less likely to agree that early-stage survival is good (43% vs. 53%; OR: 0.64, 0.46-0.88) or be willing to have surgery for an early stage, screen-detected cancer (84% vs. 94%; OR: 0.38, 0.21-0.68), compared with former smokers. Willingness to have surgery was positively associated with screening intentions; with absolute differences of 25% and 29%. Worry about lung cancer risk was also most common among smokers (48%), and one fifth of respondents thought screening smokers was a waste of NHS money. CONCLUSIONS A national lung cancer screening programme would be well-received in principle. To improve smokers' participation, care should be taken to communicate the survival benefits of early-stage diagnosis, address concerns about surgery, and minimise anxiety and stigma related to lung cancer risk.
Collapse
Affiliation(s)
- Samantha L. Quaife
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, Rayne Building, University College London, 5 University Street, London, WC1E 6JF UK
| | - Samuel M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, Rayne Building, University College London, 5 University Street, London, WC1E 6JF UK
| | - Rebecca J. Beeken
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Andy McEwen
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| |
Collapse
|
17
|
Simonavicius E, Robson D, McEwen A, Brose LS. Cessation support for smokers with mental health problems: a survey of resources and training needs. J Subst Abuse Treat 2017; 80:37-44. [PMID: 28755771 PMCID: PMC5555355 DOI: 10.1016/j.jsat.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 01/05/2023]
Abstract
AIMS Around thirty percent of smokers have a mental health problem. Smoking cessation has been associated with mental health benefits, but smoking prevalence remains high in populations with mental health problems. This study aimed to assess mental health related knowledge, practice, and training needs of practitioners supporting smoking cessation. METHODS UK stop smoking practitioners (n=717) recruited via a database of a national provider of smoking cessation training in June 2016 sufficiently completed an online survey about available resources, knowledge, confidence, and training needs related to smoking cessation and mental health. Responses were described and compared between practitioners with a mental health lead and those without such a lead in their service using chi-square statistics and t-tests. RESULTS A considerable proportion agreed (37%) or were undecided (28.9%) that smoking helped people with mental health problems feel better and agreed (17.2%) or were undecided (30.2%) that cessation would exacerbate mental health symptoms. Only 11.6% said their service had designated funding for smokers with mental health problems and 26.5% were or had a staff member who was a dedicated lead practitioner for mental health work. Practitioners from services that had a dedicated mental health lead were more confident in supporting smokers with different mental health problems and using different pharmacotherapies (all p<0.001) and were more likely to disagree that cessation was detrimental (p=0.001). A majority of practitioners were interested in training, particularly about smoking cessation effects on psychiatric medication (84.3% of n=632) and how to tailor stop smoking support to clients with mental health problems (82.4%). CONCLUSION Practitioners who support smoking cessation have limited knowledge about mental health and smoking but are willing to learn and improve. However, they are hindered by a lack of resources.
Collapse
Affiliation(s)
- Erikas Simonavicius
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Debbie Robson
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, 1 Great Western Industrial Centre, Dorchester, United Kingdom
| | - Leonie S Brose
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; UK Centre for Tobacco and Alcohol Studies, United Kingdom
| |
Collapse
|
18
|
Quaife SL, Marlow LAV, McEwen A, Janes SM, Wardle J. Attitudes towards lung cancer screening in socioeconomically deprived and heavy smoking communities: informing screening communication. Health Expect 2017; 20:563-573. [PMID: 27397651 PMCID: PMC5513004 DOI: 10.1111/hex.12481] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While discussion continues over the future implementation of lung cancer screening, low participation from higher risk groups could limit the effectiveness of any national screening programme. OBJECTIVES To compare smokers' beliefs about lung cancer screening with those of former and never smokers within a low socioeconomic status (SES) sample, to explore the views of lower SES smokers and ex-smokers in-depth, and to provide insights into effective engagement strategies. DESIGN, SETTING AND PARTICIPANTS Using proactive, community-based recruitment methods, we surveyed 175 individuals from socioeconomically deprived communities with high smoking prevalence and subsequently interviewed 21 smokers and ex-smokers. Participants were approached in community settings or responded to a mail-out from their housing association. RESULTS Interviewees were supportive of screening in principle, but many were doubtful about its ability to deliver long-term survival benefit for their generation of "heavy smokers." Lung cancer was perceived as an uncontrollable disease, and the survey data showed that fatalism, worry and perceived risk of lung cancer were particularly high among smokers compared with non-smokers. Perceived blame and stigma around lung cancer as a self-inflicted smokers' disease were implicated by interviewees as important social deterrents of screening participation. The belief that lungs are not a treatable organ appeared to be a common lay explanation for poor survival and undermined the potential value of screening. CONCLUSIONS Attitudes towards screening among this high-risk group are complex. Invitation strategies need to be carefully devised to achieve equitable participation in screening.
Collapse
Affiliation(s)
- Samantha L. Quaife
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Laura A. V. Marlow
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Andy McEwen
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| | - Samuel M. Janes
- Lungs for Living Research CentreUCL RespiratoryDivision of MedicineUniversity College LondonLondonUK
| | - Jane Wardle
- Health Behaviour Research CentreDepartment of Epidemiology and Public HealthUniversity College LondonLondonUK
| |
Collapse
|
19
|
Herbeć A, McEwen A, Zatoński W. Development and evaluation of STAR - an expert digital platform supporting training and delivery of cessation interventions by healthcare professionals. Tob Prev Cessat 2017. [DOI: 10.18332/tpc/71170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
20
|
Forman J, Harris JM, Lorencatto F, McEwen A, Duaso MJ. National Survey of Smoking and Smoking Cessation Education Within UK Midwifery School Curricula. Nicotine Tob Res 2017; 19:591-596. [DOI: 10.1093/ntr/ntw230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022]
|
21
|
Verbiest M, Brakema E, van der Kleij R, Sheals K, Allistone G, Williams S, McEwen A, Chavannes N. National guidelines for smoking cessation in primary care: a literature review and evidence analysis. NPJ Prim Care Respir Med 2017; 27:2. [PMID: 28108747 PMCID: PMC5434788 DOI: 10.1038/s41533-016-0004-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/30/2016] [Accepted: 11/25/2016] [Indexed: 11/08/2022] Open
Abstract
National guidelines for smoking cessation in primary care can be effective in improving clinical practice. This study assessed which parties are involved in the development of such guidelines worldwide, which national guidelines address primary care, what recommendations are made for primary care settings, and how these recommendations correlate with each other and with current evidence. We identified national guidelines using an online resource. Only the most recent version of a guideline was included. If an English version was not available, we requested a translation or summary of the recommendations from the authors. Two researchers independently extracted data on funding sources, development methodologies, involved parties, and recommendations made within the guidelines. These recommendations were categorised using the pile-sort method. Each recommendation was cross-checked with the latest evidence and was awarded an evidence-rating. We identified 43 guidelines from 39 countries and after exclusion, we analysed 26 guidelines (22 targeting general population, 4 targeted subpopulations). Twelve categories of recommendations for primary care were identified. There was almost universal agreement regarding the need to identify smokers, advice them to quit and offer behavioural and pharmacological quit smoking support. Discrepancies were greatest for specific recommendations regarding behavioural and pharmacological support, which are likely to be due to different interpretations of evidence and/or differences in contextual health environments. Based on these findings, we developed a universal checklist of guideline recommendations as a practice tool for primary care professionals and future guideline developers. SMOKING CESSATION SUPPORT IN PRIMARY CARE UNIVERSAL GUIDELINES SOUGHT: An international team call for a universal guideline for primary-care practitioners who help patients to stop smoking. Although many nations have such guidelines, no studies have examined whether these guidelines are consistent with the current evidence. Marjolein Verbiest at the National Institute for Health Innovation, The University of Auckland, New Zealand, and co-workers of the International Primary Care Respiratory Group and the National Centre for Smoking Cessation and Training reviewed, evaluated and compared 26 national guidelines. Almost all guidelines place importance on identifying smokers, advising them to quit and providing behavioural and medication-based support. However, there were discrepancies in the support offered, which could be due to different interpretations of evidence, costs of medication and cultural differences. The authors offer a checklist for primary care that can inform future universal guidelines suitable for primary care.
Collapse
Affiliation(s)
- Marjolein Verbiest
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand.
- Centre for Longitudinal Research - He Ara ki Mua, School of Population Health, The University of Auckland, Auckland, New Zealand.
| | - Evelyn Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kate Sheals
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Siân Williams
- International Primary Care Respiratory Group (IPCRG), Westhill, Scotland, UK
| | - Andy McEwen
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
22
|
Horst C, Ruparel M, Quaife S, Ahmed A, Taylor M, Bhowmik A, Burke S, Shaw P, McEwen A, Waller J, Baldwin DR, Navani N, Thakrar R, Janes SM. S130 The prevalence of undiagnosed copd on spirometry and emphysema on low-dose ct scans in a lung cancer screening demonstration pilot: a teachable moment? Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
23
|
Bauld L, Hiscock R, Dobbie F, Aveyard P, Coleman T, Leonardi-Bee J, McRobbie H, McEwen A. English Stop-Smoking Services: One-Year Outcomes. Int J Environ Res Public Health 2016; 13:E1175. [PMID: 27886140 PMCID: PMC5201316 DOI: 10.3390/ijerph13121175] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 12/02/2022]
Abstract
The UK is a global leader in stop-smoking support-providing free behavioral support and cessation medication via stop smoking services (SSS) without charge to smokers. This study aimed to explore the client and service characteristics associated with abstinence 52 weeks after quitting. A prospective cohort study of 3057 SSS clients in nine different areas of England who began their quit attempt between March 2012 and March 2013 was conducted. Important determinants of long-term quitting were assessed through quit rates and multivariable logistic regression. Our results showed that the overall weighted carbon monoxide validated quit rate for clients at 52 weeks was 7.7% (95% confidence interval (CI) 6.6-9.0). The clients of advisors, whose main role was providing stop-smoking support, were more likely to quit long-term than advisors who had a generalist role in pharmacies or general practices (odds ratio (OR) 2.3 (95% CI 1.2-4.6)). Clients were more likely to achieve abstinence through group support than one-to-one support (OR 3.4 (95% CI 1.7-6.7)). Overall, one in thirteen people who set a quit date with the National Health Service (NHS) Stop-Smoking Service maintain abstinence for a year. Improving abstinence is likely to require a greater emphasis on providing specialist smoking cessation support. Results from this study suggest that over 18,000 premature deaths were prevented through longer-term smoking cessation achieved by smokers who accessed SSS in England from March 2012 to April 2013, but outcomes varied by client characteristic and the type of support provided.
Collapse
Affiliation(s)
- Linda Bauld
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
- UK Centre for Tobacco and Alcohol Studies.
| | - Rosemary Hiscock
- UK Centre for Tobacco and Alcohol Studies.
- Department for Health, University of Bath, Bath BA2 7AY, UK.
| | - Fiona Dobbie
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
- UK Centre for Tobacco and Alcohol Studies.
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies.
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies.
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK.
| | - Hayden McRobbie
- UK Centre for Tobacco and Alcohol Studies.
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies.
- National Centre for Smoking Cessation and Training (NCSCT), 1 Great Western Industrial Centre, Dorchester DT1 1RD, UK.
| |
Collapse
|
24
|
Naughton F, Hopewell S, Lathia N, Schalbroeck R, Brown C, Mascolo C, McEwen A, Sutton S. A Context-Sensing Mobile Phone App (Q Sense) for Smoking Cessation: A Mixed-Methods Study. JMIR Mhealth Uhealth 2016; 4:e106. [PMID: 27637405 PMCID: PMC5045522 DOI: 10.2196/mhealth.5787] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/13/2016] [Accepted: 05/20/2016] [Indexed: 01/05/2023] Open
Abstract
Background A major cause of lapse and relapse to smoking during a quit attempt is craving triggered by cues from a smoker's immediate environment. To help smokers address these cue-induced cravings when attempting to quit, we have developed a context-aware smoking cessation app, Q Sense, which uses a smoking episode-reporting system combined with location sensing and geofencing to tailor support content and trigger support delivery in real time. Objective We sought to (1) assess smokers’ compliance with reporting their smoking in real time and identify reasons for noncompliance, (2) assess the app's accuracy in identifying user-specific high-risk locations for smoking, (3) explore the feasibility and user perspective of geofence-triggered support, and (4) identify any technological issues or privacy concerns. Methods An explanatory sequential mixed-methods design was used, where data collected by the app informed semistructured interviews. Participants were smokers who owned an Android mobile phone and were willing to set a quit date within one month (N=15). App data included smoking reports with context information and geolocation, end-of-day (EoD) surveys of smoking beliefs and behavior, support message ratings, and app interaction data. Interviews were undertaken and analyzed thematically (N=13). Quantitative and qualitative data were analyzed separately and findings presented sequentially. Results Out of 15 participants, 3 (20%) discontinued use of the app prematurely. Pre-quit date, the mean number of smoking reports received was 37.8 (SD 21.2) per participant, or 2.0 (SD 2.2) per day per participant. EoD surveys indicated that participants underreported smoking on at least 56.2% of days. Geolocation was collected in 97.0% of smoking reports with a mean accuracy of 31.6 (SD 16.8) meters. A total of 5 out of 9 (56%) eligible participants received geofence-triggered support. Interaction data indicated that 50.0% (137/274) of geofence-triggered message notifications were tapped within 30 minutes of being generated, resulting in delivery of a support message, and 78.2% (158/202) of delivered messages were rated by participants. Qualitative findings identified multiple reasons for noncompliance in reporting smoking, most notably due to environmental constraints and forgetting. Participants verified the app’s identification of their smoking locations, were largely positive about the value of geofence-triggered support, and had no privacy concerns about the data collected by the app. Conclusions User-initiated self-report is feasible for training a cessation app about an individual’s smoking behavior, although underreporting is likely. Geofencing was a reliable and accurate method of identifying smoking locations, and geofence-triggered support was regarded positively by participants.
Collapse
Affiliation(s)
- Felix Naughton
- Behavioural Science Group, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Herold R, Schiekirka S, Brown J, Bobak A, McEwen A, Raupach T. Structured Smoking Cessation Training for Medical Students: A Prospective Study. Nicotine Tob Res 2016; 18:2209-2215. [PMID: 27613926 PMCID: PMC5103940 DOI: 10.1093/ntr/ntw191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Physician adherence to guideline recommendations regarding the provision of counseling and support for smokers willing to quit is low. A lack of training during undergraduate medical education has been identified as a potential cause. This prospective intervention study evaluated a novel teaching module for medical students. METHODS As part of a 6-week cardiovascular course, 125 fourth-year undergraduate medical students received a multimodal and interactive teaching module on smoking cessation, including online learning material, lectures, seminars, and practical skills training. Short- and medium-term effects on knowledge, skills, attitudes, and self-reported practice were measured using written examinations and an objective structured clinical examination at the end of the module and 6 months later. Results were compared to data obtained from a historical control cohort (n = 70) unexposed to the intervention. RESULTS At the 6-month follow-up, scores in the knowledge test were significantly higher in the intervention than the control group (61.1% vs. 51.7%; p < .001). A similar pattern was observed in the objective structured clinical examination (71.5% vs. 60.5%; p < .001). More students in the intervention than control group agreed that smoking was a chronic disease (83.1% vs. 68.1%; p = .045). The control group was more likely to report recording smoking status (p = .018), but no group difference was detected regarding the report of advising to quit (p = .154). CONCLUSIONS A novel teaching module for undergraduate medical students produced a sustained learning outcome in terms of knowledge, skills, and attitudes but not self-reported practice. IMPLICATIONS Studies across the world have identified considerable knowledge gaps and deficits in practical training with regard to smoking cessation counseling in undergraduate medical students. This paper describes a teaching intervention informed by current recommendations for the design of educational activities aimed at enabling medical students to deliver adequate behavior change counseling. The teaching module was tailored to the needs of a specific healthcare system. Given its effectiveness as demonstrated in this prospective study, a rollout of this intervention in medical schools might have the potential to substantially improve medical students' knowledge, skills, and attitudes in relation to smoking cessation counseling.
Collapse
Affiliation(s)
- Ronja Herold
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah Schiekirka
- Division of Medical Education Research and Curriculum Development, University Medical Centre Göttingen, Göttingen, Germany
| | - Jamie Brown
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | | | - Andy McEwen
- National Centre for Smoking Cessation and Training, London, UK
| | | |
Collapse
|
26
|
Dobbie F, Hiscock R, Leonardi-Bee J, Murray S, Shahab L, Aveyard P, Coleman T, McEwen A, McRobbie H, Purves R, Bauld L. Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study. Health Technol Assess 2016; 19:1-156. [PMID: 26565129 DOI: 10.3310/hta19950] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. OBJECTIVES The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. DESIGN The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. SETTING The setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services. PARTICIPANTS There were 202,804 cases included in secondary analysis and 3075 in the prospective study. INTERVENTIONS A combination of behavioural support and stop smoking medication delivered by SSS practitioners. MAIN OUTCOME MEASURES Abstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test. RESULTS Just over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have remained abstinent than those who were seen by a general practitioner (GP) practice and pharmacy providers [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2 to 4.6]. Clients who received group behavioural support (either closed or rolling groups) were three times more likely to stop smoking than those who were seen by a GP practice or pharmacy providers (OR 3.4, 95% CI 1.7 to 6.7). Satisfaction with services was high and well-being at baseline was found to be a predictor of abstinence from smoking at longer-term follow-up. Continued use of NRT at 1 year was rare, but no evidence of harm from longer-term use was identified from the data collected. CONCLUSIONS Stop Smoking Services in England are effective in helping smokers to move away from tobacco use. Using the 52-week CO-validated quit rate of 8% found in this study, we estimate that in the year 2012-13 the services supported 36,249 clients to become non-smokers for the remainder of their lives. This is a substantial figure and provides one indicator of the ongoing value of the treatment that the services provide. The study raises a number of issues for future research including (1) examining the role of electronic cigarettes (e-cigarettes) in smoking cessation for service clients [this study did not look at e-cigarette use (except briefly in the longer-term NRT study) but this is a priority for future studies]; (2) more detailed comparisons of rolling groups with other forms of behavioural support; (3) further exploration of the role of practitioner knowledge, skills and use of effective behaviour change techniques in supporting service clients to stop smoking; (4) surveillance of the impact of structural and funding changes on the future development and sustainability of SSSs; and (5) more detailed analysis of well-being over time between those who successfully stop smoking and those who relapse. Further research on longer-term use of non-combustible nicotine products that measures a wider array of biomarkers of smoking-related harm such as lung function tests or carcinogen metabolites. FUNDING The National Institute for Health Research Health Technology Assessment programme. The UK Centre for Tobacco and Alcohol Studies provided funding for the longer-term NRT study.
Collapse
Affiliation(s)
- Fiona Dobbie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| | - Rosemary Hiscock
- UK Centre for Tobacco and Alcohol Studies, UK.,Department for Health, University of Bath, Bath, UK
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Susan Murray
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| | - Lion Shahab
- UK Centre for Tobacco and Alcohol Studies, UK.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies, UK.,Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies, UK.,National Centre for Smoking Cessation and Training, London, UK
| | - Hayden McRobbie
- UK Centre for Tobacco and Alcohol Studies, UK.,Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, UK
| | - Richard Purves
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,Department for Health, University of Bath, Bath, UK
| | - Linda Bauld
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| |
Collapse
|
27
|
Campbell KA, Cooper S, Fahy SJ, Bowker K, Leonardi-Bee J, McEwen A, Whitemore R, Coleman T. 'Opt-out' referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support. Tob Control 2016; 26:300-306. [PMID: 27225017 PMCID: PMC5520259 DOI: 10.1136/tobaccocontrol-2015-052662] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/20/2016] [Indexed: 11/22/2022]
Abstract
Background In the UK, free smoking cessation support is available to pregnant women; only a minority accesses this. ‘Opt-out’ referrals to stop smoking services (SSS) are recommended by UK guidelines. These involve identifying pregnant smokers using exhaled carbon monoxide (CO) and referring them for support unless they object. Methods To assess the impact of ‘opt-out’ referrals for pregnant smokers on SSS uptake and effectiveness, we conducted a ‘before–after’ service development evaluation. In the 6-month ‘before’ period, there was a routine ‘opt-in’ referral system for self-reported smokers at antenatal ‘booking’ appointments. In the 6-month ‘after’ period, additional ‘opt-out’ referrals were introduced at the 12-week ultrasound appointments; women with CO≥4 ppm were referred to, and outcome data were collected from, local SSS. Results Approximately 2300 women attended antenatal care in each period. Before the implementation, 536 (23.4%) women reported smoking at ‘booking’ and 290 (12.7%) were referred to SSS. After the implementation, 524 (22.9%) women reported smoking at ‘booking’, an additional 156 smokers (6.8%) were identified via the ‘opt-out’ referrals and, in total, 421 (18.4%) were referred to SSS. Over twice as many women set a quit date with the SSS after ‘opt-out’ referrals were implemented (121 (5.3%, 95% CI 4.4% to 6.3%) compared to 57 (2.5%, 95% CI 1.9% to 3.2%) before implementation) and reported being abstinent 4 weeks later (93 (4.1%, 95% CI 3.3% to 4.9%) compared to 46 (2.0%, 1.5% to 2.7%) before implementation). Conclusions In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation.
Collapse
Affiliation(s)
- Katarzyna A Campbell
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Samantha J Fahy
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Katharine Bowker
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Andy McEwen
- National Centre for Smoking Cessation and Training (NCSCT), London, UK
| | - Rachel Whitemore
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| |
Collapse
|
28
|
Quaife SL, Ruparel M, Beeken RJ, McEwen A, Isitt J, Nolan G, Sennett K, Baldwin DR, Duffy SW, Janes SM, Wardle J. The Lung Screen Uptake Trial (LSUT): protocol for a randomised controlled demonstration lung cancer screening pilot testing a targeted invitation strategy for high risk and 'hard-to-reach' patients. BMC Cancer 2016; 16:281. [PMID: 27098676 PMCID: PMC4839109 DOI: 10.1186/s12885-016-2316-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/14/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Participation in low-dose CT (LDCT) lung cancer screening offered in the trial context has been poor, especially among smokers from socioeconomically deprived backgrounds; a group for whom the risk-benefit ratio is improved due to their high risk of lung cancer. Attracting high risk participants is essential to the success and equity of any future screening programme. This study will investigate whether the observed low and biased uptake of screening can be improved using a targeted invitation strategy. METHODS/DESIGN A randomised controlled trial design will be used to test whether targeted invitation materials are effective at improving engagement with an offer of lung cancer screening for high risk candidates. Two thousand patients aged 60-75 and recorded as a smoker within the last five years by their GP, will be identified from primary care records and individually randomised to receive either intervention invitation materials (which take a targeted, stepped and low burden approach to information provision prior to the appointment) or control invitation materials. The primary outcome is uptake of a nurse-led 'lung health check' hospital appointment, during which patients will be offered a spirometry test, an exhaled carbon monoxide (CO) reading, and an LDCT if eligible. Initial data on demographics (i.e. age, sex, ethnicity, deprivation score) and smoking status will be collected in primary care and analysed to explore differences between attenders and non-attenders with respect to invitation group. Those who attend the lung health check will have further data on smoking collected during their appointment (including pack-year history, nicotine dependence and confidence to quit). Secondary outcomes will include willingness to be screened, uptake of LDCT and measures of informed decision-making to ensure the latter is not compromised by either invitation strategy. DISCUSSION If effective at improving informed uptake of screening and reducing bias in participation, this invitation strategy could be adopted by local screening pilots or a national programme. TRIAL REGISTRATION This study was registered with the ISRCTN (International Standard Registered Clinical/soCial sTudy Number: ISRCTN21774741) on the 23rd September 2015 and the NIH ClinicalTrials.gov database (NCT0255810) on the 22nd September 2015.
Collapse
Affiliation(s)
- Samantha L Quaife
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, Rayne Building, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Rebecca J Beeken
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andy McEwen
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - John Isitt
- Resonant Media, 55 Old Compton Street, London, W1D 6HW, UK
| | - Gary Nolan
- Resonant Media, 55 Old Compton Street, London, W1D 6HW, UK
| | - Karen Sennett
- Killick Street Health Centre, 75 Killick Street, London, N1 9RH, UK
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, City Campus, Nottingham, NG5 1 PB, UK
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, Rayne Building, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| |
Collapse
|
29
|
Abstract
Background Rates of smoking and smoking cessation vary with socio-economic status. The objectives were to assess the association between neighbourhood deprivation, completion of treatment to support quit attempts and success of quit attempts—while taking into account other predictors of outcome. Methods 555,744 quit attempts supported by English Stop Smoking Services in 2009–2012 were linked to the Index of Multiple Deprivation (IMD) 2010 ranks for the clients’ neighbourhood and split into deciles relative to the national IMD. Logistic regressions tested the association between neighbourhood deprivation and completion (4-week follow-up) of treatment and biochemically validated success (expired-air carbon monoxide <10ppm) while adjusting for demographics and intervention characteristics. Sensitivity analyses assessed subsamples: first supported attempts (n = 364,397), those with recorded cigarette dependence (n = 98,659) and completed treatment (n = 416,436). Results Higher neighbourhood deprivation was associated with reduced completion (ORadj = 0.949, 95% CI: 0.947 to 0.951) and success (ORadj = 0.957, 95% CI: 0.955 to 0.959). Results of sensitivity analyses were consistent with those of the main analysis. Conclusions Neighbourhood deprivation was associated with small but consistent reductions in completion and success of evidence-based interventions. These associations were not explained by intervention characteristics, demographics or dependence and reduced completion did not fully account for reduced success.
Collapse
Affiliation(s)
- Leonie S. Brose
- National Addiction Centre & UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Andy McEwen
- National Centre for Smoking Cessation and Training & Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom
| |
Collapse
|
30
|
Jawad M, Choaie E, Brose L, Dogar O, Grant A, Jenkinson E, McEwen A, Millett C, Shahab L. Waterpipe Tobacco Use in the United Kingdom: A Cross-Sectional Study among University Students and Stop Smoking Practitioners. PLoS One 2016; 11:e0146799. [PMID: 26745806 PMCID: PMC4706414 DOI: 10.1371/journal.pone.0146799] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Despite cigarette-like adverse health outcomes associated with waterpipe tobacco smoking and increase in its use among youth, it is a much underexplored research area. We aimed to measure the prevalence and patterns of waterpipe tobacco use and evaluate tobacco control policy with respect to waterpipe tobacco, in several universities across the UK. We also aimed to measure stop smoking practitioners' encounter of waterpipe tobacco smoking. METHODS We distributed an online survey to six UK universities, asking detailed questions on waterpipe tobacco. Multivariable logistic regression models, adjusted for age, gender, ethnicity, graduate status, university and socioeconomic status (SES) assessed associations between waterpipe tobacco smoking (single use and dual use with cigarettes) and sociodemographic variables. SES was ascertained by average weekly self-spend on non-essentials. We also descriptively analysed data from a 2012 survey of stop smoking practitioners to assess the proportion of clients that used waterpipe regularly. RESULTS f 2217 student responses, 66.0% (95% CI 63.9-68.0%) had tried waterpipe tobacco smoking; 14.3% (95% CI 12.8-15.8%) reported past-30 day use, and 8.7% (95% CI 7.6-9.9%) reported at least monthly users. Past-30 day waterpipe-only use was associated with being younger (AOR 0.95, 95% CI 0.91-0.99), male (AOR 1.44, 95% CI 1.08-1.94), higher SES (AOR 1.16, 95% CI 1.06-1.28) and belonging to non-white ethnicities (vs. white, AOR 2.24, 95% CI 1.66-3.04). Compared to less than monthly users, monthly users were significantly more likely to have urges to smoke waterpipe (28.1% vs. 3.1%, p<0.001) report difficulty in quitting (15.5% vs. 0.8%, p<0.001), report feeling guilty, and annoyed when criticised about waterpipe smoking (19.2% vs. 9.2%, p<0.001). Nearly a third (32.5%) of respondents who had tried waterpipe had violated the UK smokefree law and a quarter (24.5%) reporting seeing health warnings on waterpipe tobacco packaging or apparatuses. Of 1,282 smoking cessation practitioners, a quarter (23.4%, 95% CI 21.5-26.1%) reported having some clients who regularly use waterpipes, but 69.5% (95% CI 67.0-72.0%) never ask clients about waterpipe use. Three quarters (74.8%, 95% CI 72.4-77.1%) want more information about waterpipe tobacco smoking. CONCLUSIONS While two thirds of university students have ever tried waterpipe tobacco, at least monthly use is less common. Regular users display features of waterpipe tobacco dependence, and a substantial minority of SSS practitioners encounter clients who regularly use waterpipe. The lack of training on waterpipe for SSS practitioners and reported violations of smokefree laws for waterpipe highlight the need for regular surveillance of and a coordinated tobacco control strategy for waterpipe use.
Collapse
Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Hampshire, SO16 6YD, United Kingdom
- * E-mail:
| | - Elham Choaie
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Leonie Brose
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8BB, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom
| | - Aimee Grant
- Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, CF14 4YS, United Kingdom
| | - Elizabeth Jenkinson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom
| | - Andy McEwen
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom
| | - Lion Shahab
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| |
Collapse
|
31
|
Hiscock R, Bauld L, Arnott D, Dockrell M, Ross L, McEwen A. Views from the Coalface: What Do English Stop Smoking Service Personnel Think about E-Cigarettes? Int J Environ Res Public Health 2015; 12:16157-67. [PMID: 26703638 PMCID: PMC4690984 DOI: 10.3390/ijerph121215048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/25/2015] [Accepted: 12/11/2015] [Indexed: 12/02/2022]
Abstract
The UK Stop Smoking Services (SSS) are a source of information and advice on e-cigarettes for smokers and thus it is important to understand the knowledge of, and attitudes towards, e-cigarettes held by stop smoking practitioners. The datasets were English SSS quarterly monitoring returns (n = 207,883) and an online survey of English SSS practitioners, managers, and commissioners between 26th November and 15th December 2014 (n = 1801). SSS monitoring data suggested 2% of clients were using e-cigarettes to quit with SSS and that clients using e-cigarettes had similar quit rates to clients using Varenicline. Most SSS personnel are waiting for licenced e-cigarettes to become available before they will recommend them to clients. However, less than a quarter view e-cigarettes as "a good thing". Managers and commissioners were more positive than practitioners. SSS personnel working for the NHS (hospitals and GP surgeries) were less positive about e-cigarettes than those employed elsewhere. E-cigarettes were cited as the most important reason for the recent decline in service footfall. Thus dissemination of information about e-cigarettes needs to be examined and services should address their stance on e-cigarettes with some urgency.
Collapse
Affiliation(s)
- Rosemary Hiscock
- Department of Health, University of Bath, Bath BA2 7AY, UK.
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham NG5 1PB, UK.
| | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham NG5 1PB, UK.
- School of Health Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - Deborah Arnott
- Action on Smoking and Health (ASH), Suites 59-63, 6th Floor, New House, 67-68 Hatton Garden, London EC1N 8JY, UK.
| | - Martin Dockrell
- Public Health England, Skipton House, 80 London Road, London, SE1 6LH, UK.
| | - Louise Ross
- Stop Smoking Service Leicester City Council, Leicester LE1 6TH, UK.
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham NG5 1PB, UK.
- National Centre for Smoking Cessation and Training (NCSCT), 1-6 Yarmouth Place, LondonW1J 7BU, UK.
| |
Collapse
|
32
|
Jones LL, McEwen A. Evaluating an online training module on protecting children from secondhand smoke exposure: impact on knowledge, confidence and self-reported practice of health and social care professionals. BMC Public Health 2015; 15:1132. [PMID: 26573632 PMCID: PMC4647284 DOI: 10.1186/s12889-015-2488-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare professionals report that a lack of training is the primary barrier to raising the issue of secondhand smoke (SHS). An open access online training module was therefore developed for those working with smoking families to deliver effective very brief advice on SHS. The current study aimed to evaluate the following: (1) does knowledge increase as a result of participating in the online training module, and (2) does the module impact on participant confidence and self-reported practice relating to SHS. Methods Those accessing the module were invited to participate in an evaluation to assess participants’ knowledge about, and confidence in, delivering very brief advice on SHS. Change in knowledge was assessed via ten multiple choice questions and confidence was assessed by Likert scale responses to three statements. Data were collected across three time points: pre-training, post-training and after 3 months. Data were also collected at 3 months post module completion on self-reported changes in practice and key learning points. Results Data at all three time points were available for 178 participants (~1 % of those who visited the module homepage over a 2 year period). Knowledge and confidence to deliver effective very brief advice for SHS significantly increased between the pre- and post-training assessments and was maintained at 3 months. Eighty-four percent self-reported that they perceived taking part in the training had led to positive changes in their clinical practice. Conclusions There is potential for this module to be embedded within training programmes across health and social care professions, which may help to increase the knowledge and confidence of health and social care professionals to deliver very brief advice for SHS to smoking families. Future research needs to explore whether the smoking families who receive very brief advice for SHS are motivated to make changes to their home smoking behaviours and whether roll-out of this intervention would be cost-effective.
Collapse
Affiliation(s)
- Laura L Jones
- UK Centre for Tobacco and Alcohol Studies and Institute of Applied Health Research, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies and Cancer Research UK Health Behaviour Research Centre, Epidemiology and Public Health, University College London, London, UK. .,National Centre for Smoking Cessation and Training, London, UK.
| |
Collapse
|
33
|
Kruse GR, Rigotti NA, Raw M, McNeill A, Murray R, Piné-Abata H, Bitton A, McEwen A. Tobacco Dependence Treatment Training Programs: An International Survey. Nicotine Tob Res 2015; 18:1012-8. [PMID: 26117835 DOI: 10.1093/ntr/ntv142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/18/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In line with Article 14 guidelines for the WHO Framework Convention on Tobacco Control, we aimed to assess the progress in training individuals to deliver tobacco cessation treatment. METHODS Cross-sectional web-based survey in May-September 2013 among 122 experts in tobacco control and training from 84 countries (73% response rate among 115 countries surveyed). We measured training program prevalence, participants, and challenges faced. RESULTS Overall, 21% (n = 18/84) of countries, mostly low and middle-income countries (LMICs; P = .002), reported no training program. Among 66 countries reporting at least one training program, most (84%) trained healthcare professionals but 54% also trained other individuals including community health workers, teachers, and religious leaders. Most programs (54%) cited funding challenges, although stability of funding varied by income level. Government funding was more commonly reported in higher income countries (high 56%, upper middle 50%, lower middle 27%, low 25%; P = .03) while programs in LMICs relied more on nongovernmental organizations (high 11%, upper middle 37%, lower middle 27%, low 38%; P = .02). CONCLUSIONS One in five countries reported having no tobacco treatment training program representing little progress in terms of training individuals to deliver tobacco treatment in LMICs. Without more trained tobacco treatment providers, one of the tenets of Article 14 is not yet being met and health inequalities are likely to widen. More effort and resources are needed to ensure that healthcare worker educational programs include training to assess tobacco use and deliver brief advice and that training is available for individuals outside the healthcare system in areas with limited healthcare access.
Collapse
Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA;
| | - Nancy A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Martin Raw
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Ann McNeill
- Department of Addictions, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Rachael Murray
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Hembadoon Piné-Abata
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Asaf Bitton
- Department of Medicine, Harvard Medical School, Boston, MA; Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, London, United Kingdom; Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom
| |
Collapse
|
34
|
Brose LS, McEwen A, Michie S, West R, Chew XY, Lorencatto F. Treatment manuals, training and successful provision of stop smoking behavioural support. Behav Res Ther 2015; 71:34-9. [PMID: 26057438 DOI: 10.1016/j.brat.2015.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/15/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Translating evidence-based behaviour change interventions into practice is aided by use of treatment manuals specifying the recommended content and format of interventions, and evidence-based training. This study examined whether outcomes of stop smoking behavioural support differed with practitioner's use and evaluation of treatment manuals, or practitioner's training. METHODS English stop smoking practitioners were invited to complete an online survey including questions on: practitioners' training, availability, use and perceived utility of manuals, and annual biochemically-validated success rates of quit attempts supported (practitioner-reported). Mean success rates were compared between practitioners with/without access to manuals, those using/not using manuals, perceived utility ratings of manuals, and consecutive levels of training completed. RESULTS Success rates were higher if practitioners had a manual (Mean (SD) = 54.0 (24.0) versus 48.0 (25.3), t(838) = 2.48, p = 0.013; n = 840), used a manual (F(2,8237) = 4.78, p = 0.009, n = 840), perceived manuals as more useful (F(3,834) = 2.90, p = 0.034, n = 840), and had completed training (F(3,709) = 4.81, p = 0.002, n = 713). Differences were diminished when adjusting for professional and demographic characteristics and no longer reached statistical significance using a conventional alpha for perceived utility of manuals and training status (both p = 0.1). CONCLUSIONS Practitioners' performance in supporting smokers to quit varied with availability and use of treatment manuals. Evidence was weaker for perceived utility of manuals and practitioners' evidence-based training. Ensuring practitioners have access to treatment manuals within their service, promoting manual use, and training practitioners to competently apply manuals is likely to contribute to higher success rates in clinical practice.
Collapse
Affiliation(s)
- Leonie S Brose
- National Addictions Centre, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Xie Yin Chew
- Department of Psychology and Language Sciences, University College London, London, UK.
| | - Fabiana Lorencatto
- Health Services Research and Management, School of Health Sciences, City University London, London, UK.
| |
Collapse
|
35
|
Quaife SL, McEwen A, Janes SM, Wardle J. Smoking is associated with pessimistic and avoidant beliefs about cancer: results from the International Cancer Benchmarking Partnership. Br J Cancer 2015; 112:1799-804. [PMID: 25950385 PMCID: PMC4647255 DOI: 10.1038/bjc.2015.148] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/30/2015] [Accepted: 04/07/2015] [Indexed: 11/09/2022] Open
Abstract
Background: Smoking cessation is the key cancer prevention behaviour for smokers; nonetheless, smokers can
still benefit from earlier diagnosis of cancer. However, fewer smokers participate in screening
despite their increased risk, which may reflect different beliefs about cancer. Methods: A UK population-representative sample of ⩾50 year-olds (n=6965) was surveyed
using the Awareness and Beliefs about Cancer measure. These analyses examine six items on cancer
beliefs (e.g., ‘cancer can often be cured'), and four on help-seeking barriers (e.g.,
‘I would be too embarrassed'). Results: Smokers were more likely to hold pessimistic cancer beliefs than never-smokers or former-smokers
on four of six items. For example, 34% agreed ‘a cancer diagnosis is a death
sentence', compared with 24% of non/former-smokers (P<0.001). More
smokers (18%) than non/former-smokers (11%) would not want to know if they had
cancer (P<0.01). The only barrier to symptomatic help-seeking differing by smoking
status was ‘worry about what the doctor might find' (36% vs 28%,
P<0.01). Associations were independent of demographics, self-rated health and cancer
experience. Conclusions: Smokers held more pessimistic and avoidant beliefs about cancer, which could deter
early-detection behaviour. A better understanding of these beliefs is needed to increase engagement
in early diagnosis by this high-risk group.
Collapse
Affiliation(s)
- S L Quaife
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| | - A McEwen
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| | - S M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, Rayne Building, University College London, 5 University Street, London WC1E 6JF, UK
| | - J Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| |
Collapse
|
36
|
Taggar JS, Lewis S, Docherty G, Bauld L, McEwen A, Coleman T. Do cravings predict smoking cessation in smokers calling a national quit line: secondary analyses from a randomised trial for the utility of 'urges to smoke' measures. Subst Abuse Treat Prev Policy 2015; 10:15. [PMID: 25884378 PMCID: PMC4414292 DOI: 10.1186/s13011-015-0011-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/08/2015] [Indexed: 11/28/2022]
Abstract
Background Single-item urges to smoke measures have been contemplated as important measures of nicotine dependence This study aimed to prospectively determine the relationships between measures of craving to smoke and smoking cessation, and compare their ability to predict cessation with the Heaviness of Smoking Index, an established measure of nicotine dependence. Methods We conducted a secondary analysis of data from the randomised controlled PORTSSS trial. Measures of nicotine dependence, ascertained before making a quit attempt, were the HSI, frequency of urges to smoke (FUTS) and strength of urges to smoke (SUTS). Self-reported abstinence at six months after quitting was the primary outcome measure. Multivariate logistic regression and Receiver Operating Characteristic (ROC) analysis were used to assess associations and abilities of the nicotine dependence measures to predict smoking cessation. Results Of 2,535 participants, 53.5% were female; the median (Interquartile range) age was 38 (28–50) years. Both FUTS and HSI were inversely associated with abstinence six months after quitting; for each point increase in HSI score, participants were 16% less likely to have stopped smoking (OR 0.84, 95% C.I 0.78-0.89, p < 0.0001). Compared to participants with the lowest possible FUTS scores, those with greater scores had generally lower odds of cessation (p across frequency of urges categories=0.0026). SUTS was not associated with smoking cessation. ROC analysis suggested the HSI and FUTS had similar predictive validity for cessation. Conclusions Higher FUTS and HSI scores were inversely associated with successful smoking cessation six months after quit attempts began and both had similar validity for predicting cessation. Electronic supplementary material The online version of this article (doi:10.1186/s13011-015-0011-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jaspal S Taggar
- Division of Primary Care, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Sarah Lewis
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Graeme Docherty
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Linda Bauld
- Institute for Social Marketing, University of Stirling, Stirling, UK.
| | - Andy McEwen
- Cancer Research UK Health Behavioural Research Centre, University College London, London, UK.
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| |
Collapse
|
37
|
Anwar A, Archibald S, Audisio D, Badman G, Bergin J, Bew SP, Bloom J, Bushby N, Busigin A, Chan MYT, Davies J, Dilworth J, Dunscombe M, Elmore CS, Engstrom P, Fuchter MJ, Geach NJ, Georgin D, Griffiths A, Hansen P, Hardcastle G, Hiatt-Gipson GD, Hickey MJ, Kitson SL, Lashford A, Lenz E, Lewinton S, Lockley WJS, Loreau O, Maddocks S, Marlière P, McEwen A, Moody TS, Morgan P, Roe SJ, Schenk DJ, Speed DJ, Stockman RA, Sumal K, Taran F, Thurston S, Waring M, Watters WH. Abstracts of the 23rd International Isotope Society (UK group) Symposium: synthesis and applications of labelled compounds 2014. J Labelled Comp Radiopharm 2015. [DOI: 10.1002/jlcr.3276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
38
|
Gould GS, Watt K, McEwen A, Cadet-James Y, Clough AR. Predictors of intentions to quit smoking in Aboriginal tobacco smokers of reproductive age in regional New South Wales (NSW), Australia: quantitative and qualitative findings of a cross-sectional survey. BMJ Open 2015; 5:e007020. [PMID: 25770232 PMCID: PMC4360823 DOI: 10.1136/bmjopen-2014-007020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess the predictors of intentions to quit smoking in a community sample of Aboriginal smokers of reproductive age, in whom smoking prevalence is slow to decline. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey involved 121 Aboriginal smokers, aged 18-45 years from January to May 2014, interviewed at community events on the Mid-North Coast NSW. Qualitative and quantitative data were collected on smoking and quitting attitudes, behaviours and home smoking rules. Perceived efficacy for quitting, and perceived threat from smoking, were uniquely assessed with a validated Risk Behaviour Diagnosis (RBD) Scale. MAIN OUTCOME MEASURES Logistic regression explored the impact of perceived efficacy, perceived threat and consulting previously with a doctor or health professional (HP) on self-reported intentions to quit smoking, controlling for potential confounders, that is, protection responses and fear control responses, home smoking rules, gender and age. Participants' comments regarding smoking and quitting were investigated via inductive analysis, with the assistance of Aboriginal researchers. RESULTS Two-thirds of smokers intended to quit within 3 months. Perceived efficacy (OR=4.8; 95% CI 1.78 to 12.93) and consulting previously with a doctor/HP about quitting (OR=3.82; 95% CI 1.43 to 10.2) were significant predictors of intentions to quit. 'Smoking is not doing harm right now' was inversely associated with quit intentions (OR=0.25; 95% CI 0.08 to 0.8). Among those who reported making a quit attempt, after consulting with a doctor/HP, 40% (22/60) rated the professional support received as low (0-2/10). Qualitative themes were: the negatives of smoking (ie, disgust, regret, dependence and stigma), health effects and awareness, quitting, denial, 'smoking helps me cope' and social aspects of smoking. CONCLUSIONS Perceived efficacy and consulting with a doctor/HP about quitting may be important predictors of intentions to quit smoking in Aboriginal smokers of reproductive age. Professional support was generally perceived to be low; thus, it could be improved for these Aboriginal smokers. Aboriginal participants expressed strong sentiments about smoking and quitting.
Collapse
Affiliation(s)
- Gillian Sandra Gould
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Andy McEwen
- Health Behaviour Research Centre, Epidemiology and Public Health, University College London, London, UK
| | - Yvonne Cadet-James
- Indigenous Centre, James Cook University, Townsville, Queensland, Australia
| | - Alan R Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| |
Collapse
|
39
|
Brose LS, West R, Michie S, McEwen A. Changes in success rates of smoking cessation treatment associated with take up of a national evidencebased training programme. Prev Med 2014; 69:1-4. [PMID: 25152508 DOI: 10.1016/j.ypmed.2014.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/26/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The English 'stop smoking services' provide behavioural support to some 700,000 smokers annually. Success rates of the services varied considerably before 2010 and had been in slight decline so, to improve performance, a national programme of evidence-based practitioner training was developed to improve knowledge and skills-based competences. This study evaluated whether uptake of the training was associated with improvements in success rates of services. METHODS Mean 4-week biochemically verified abstinence rates were compared for 146 (of 151) stop smoking services between 2008-10 (before roll-out of training) and 2011-13 (after roll-out), and the change in success rates for each service was regressed on to the number of practitioners per service trained in a) knowledge (online) and b) skills (face-to-face). RESULTS Success rate across all services improved between the two periods (34.1% to 36.5%, p=0.01 1-tailed; 95% CI for difference 0.44-4.48). The magnitude of improvement for each service was associated with the number of practitioners who completed the knowledge and skills training (beta=0.22, p=0.005 1-tailed), and marginally with the number who completed the knowledge training (beta=0.14, p=0.047 1-tailed). CONCLUSION English stop smoking services that have greater uptake of a national evidence-based training programme showed greater improvements in success rates.
Collapse
Affiliation(s)
- Leonie S Brose
- UK Centre for Tobacco and Alcohol Studies, Addictions, Institute of Psychiatry, King's College London, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
| | - Susan Michie
- Clinical, Educational and Health Psychology, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
| | - Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training (NCSCT), UK
| |
Collapse
|
40
|
Docherty G, Lewis S, McEwen A, Bauld L, Coleman T. Does use of ‘non-trial’ cessation support help explain the lack of effect from offering NRT to quitline callers in a RCT?: Table 1. Tob Control 2014; 23:524-5. [PMID: 23880552 PMCID: PMC4215351 DOI: 10.1136/tobaccocontrol-2013-051107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Graeme Docherty
- Department of Epidemiology and Public Health, UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Department of Epidemiology and Public Health, UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham, UK
| | - Andy McEwen
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, UK Centre for Tobacco Control Studies, University College London, London, UK
| | - Linda Bauld
- UK Centre for Tobacco Control Studies, Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Tim Coleman
- Division of Primary Care, UK Centre for Tobacco Control Studies and NIHR School for Primary Care Research, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| |
Collapse
|
41
|
Raupach T, Al-Harbi G, McNeill A, Bobak A, McEwen A. Smoking cessation education and training in U.K. medical schools: a national survey. Nicotine Tob Res 2014; 17:372-5. [PMID: 25257981 DOI: 10.1093/ntr/ntu199] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking cessation is one of the most cost-effective of all health interventions. Physicians are in a strong position to encourage smokers to make a quit attempt and to help them achieve long-term abstinence. Formal teaching on tobacco-related disease, the evidence base of smoking cessation, and practical skills training regarding cessation advice and counseling are therefore important parts of undergraduate medical education. A survey of U.K. medical schools conducted 11 years ago revealed substantial deficits in the curricular coverage of these topics. This study aimed at establishing whether the situation has improved since then. METHODS In 2013, all U.K. medical schools were invited to participate in an online survey of their curricular coverage of tobacco addiction and smoking cessation. RESULTS Of the 33 medical schools, 22 (67%) schools responded. Health effects of smoking were addressed in more than 90% of curricula, and factual knowledge on nicotine addiction and withdrawal symptoms was covered in 50% of curricula. Only 1 in 3 medical schools offered practical skills training in artificial (i.e., role play) or clinical settings, and 50% of schools did not address smoking in summative assessments. CONCLUSIONS Practical skills training regarding cessation counseling is insufficient at most U.K. medical schools and may have become worse during the last 11 years. Increased curricular coverage-including summative assessments-of these topics would ensure that future physicians are adequately equipped to encourage and support effective evidence-based quit attempts in their patients.
Collapse
Affiliation(s)
- Tobias Raupach
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK; Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany;
| | - Ghada Al-Harbi
- Department of Service Development and Health Promotion, Primary Health Care Corporation, Doha, Qatar
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, King's College London, UK Centre for Tobacco and Alcohol Studies, London,UK
| | | | - Andy McEwen
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK; National Centre for Smoking Cessation and Training, London, UK
| |
Collapse
|
42
|
Hiscock R, Goniewicz ML, McEwen A, Murray S, Arnott D, Dockrell M, Bauld L. E-cigarettes: online survey of UK smoking cessation practitioners. Tob Induc Dis 2014; 12:13. [PMID: 25170337 PMCID: PMC4147097 DOI: 10.1186/1617-9625-12-13] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of e-cigarettes (inhalable vapour producing battery powered devices that aim to simulate tobacco cigarettes), is rising in a number of countries, but as yet none of these products are regulated as medicinal devices or available as smoking cessation treatments. Smokers seeking support from health professionals to stop smoking are interested in e-cigarettes and may be buying them to aid a quit attempt. Determining what smokers are asking, and what health professionals think about these products may have implications for smoking treatment services in a number of countries. METHODS Stop smoking service advisors, managers and commissioners in the United Kingdom were asked to take part in two surveys on e-cigarettes. Data was analysed from 587 practitioners who completed a survey in 2011 and 705 practitioners who completed a repeat survey in 2013. Responses to multiple choice questions and free text comments were analysed. RESULTS Responding practitioners reported that interest in, and use of, e-cigarettes is growing among adults seeking help to stop smoking in the UK. In 2013 91% of respondents reported that interest in e-cigarettes had grown in the past year and whilst in 2011, 2% of respondents reported a 'quarter to a half' of their clients saying that they were regularly using e-cigarettes, by 2013 this had increased to 23.5% (p < .001). Responding practitioners' views towards e-cigarettes became more positive between the first and second surveys (15% strongly agreed/agreed in 2011 that 'e-cigarettes are a good thing' rising to 26% in 2013). However, they continued to have concerns about the products. In particular, analysis of free text responses suggested practitioners were unsure about safety or efficacy for smoking cessation, and were worried that smokers may become dependent on the products. Practitioners were also aware of the potential of e-cigarettes to undermine smokers' willingness to use evidence-based methods to stop, and to challenge policies aiming to denormalise tobacco smoking. CONCLUSIONS Health professionals are asking for reliable and accurate information on e-cigarettes to convey to smokers who want to quit. Randomized controlled trials and ongoing surveillance of e-cigarette use and its consequences for smoking cessation rates and smoking treatment services are required.
Collapse
Affiliation(s)
- Rosemary Hiscock
- Department for Health, University of Bath, Bath, UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | | | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- National Centre for Smoking Cessation and Training (NCSCT), London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Susan Murray
- School of Applied Social Science, University of Stirling, Stirling, UK
| | | | | | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- Institute for Social Marketing, University of Stirling, Stirling, UK
| |
Collapse
|
43
|
Lindson-Hawley N, Coleman T, Docherty G, Hajek P, Lewis S, Lycett D, McEwen A, McRobbie H, Munafò MR, Parrott S, Aveyard P. Nicotine patch preloading for smoking cessation (the preloading trial): study protocol for a randomized controlled trial. Trials 2014; 15:296. [PMID: 25052334 PMCID: PMC4223826 DOI: 10.1186/1745-6215-15-296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 07/09/2014] [Indexed: 11/25/2022] Open
Abstract
Background The use of nicotine replacement therapy before quitting smoking is called nicotine preloading. Standard smoking cessation protocols suggest commencing nicotine replacement therapy only on the first day of quitting smoking (quit day) aiming to reduce withdrawal symptoms and craving. However, other, more successful smoking cessation pharmacotherapies are used prior to the quit day as well as after. Nicotine preloading could improve quit rates by reducing satisfaction from smoking prior to quitting and breaking the association between smoking and reward. A systematic literature review suggests that evidence for the effectiveness of preloading is inconclusive and further trials are needed. Methods/Design This is a study protocol for a multicenter, non-blinded, randomized controlled trial based in the United Kingdom, enrolling 1786 smokers who want to quit, funded by the National Institute for Health Research, Health Technology Assessment program, and sponsored by the University of Oxford. Participants will primarily be recruited through general practices and smoking cessation clinics, and randomized (1:1) either to use 21 mg nicotine patches, or not, for four weeks before quitting, whilst smoking as normal. All participants will be referred to receive standard smoking cessation service support. Follow-ups will take place at one week, four weeks, six months and 12 months after quit day. The primary outcome will be prolonged, biochemically verified six-month abstinence. Additional outcomes will include point prevalence abstinence and abstinence of four-week and 12-month duration, side effects, costs of treatment, and markers of potential mediators and moderators of the preloading effect. Discussion This large trial will add substantially to evidence on the effectiveness of nicotine preloading, but also on its cost effectiveness and potential mediators, which have not been investigated in detail previously. A range of recruitment strategies have been considered to try and compensate for any challenges encountered in recruiting the large sample, and the multicentre design means that knowledge can be shared between recruitment teams. The pragmatic study design means that results will give a realistic estimate of the success of the intervention if it were to be rolled out as part of standard smoking cessation service practice. Trial registration Current Controlled Trials ISRCTN33031001. Registered 27 April 2012.
Collapse
Affiliation(s)
- Nicola Lindson-Hawley
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, OX2 6GG Oxford, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Hsueh KC, Hsueh SC, Chou MY, Pan LF, Tu MS, McEwen A, West R. Varenicline versus transdermal nicotine patch: a 3-year follow-up in a smoking cessation clinic in Taiwan. Psychopharmacology (Berl) 2014; 231:2819-23. [PMID: 24522334 DOI: 10.1007/s00213-014-3482-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE A network meta-analysis of randomized trials and real-world comparative studies strongly suggest that varenicline is more effective in aiding smoking cessation than single form nicotine replacement therapy (NRT). Modeling the health benefits attributable to this difference relies on extrapolation to lifetime cessation, but to date, follow-up has only extended to 12 months. Longer term follow-up data are helpful in checking these assumptions. OBJECTIVES This study aimed to compare the sustained abstinence rates of smokers using varenicline versus nicotine patch in their quit attempt up to 36 months. METHOD Five hundred eighty-seven smokers were recruited at Kaohsiung Veteran General Hospital between Feb 2006 and Aug 2009. Participants received counseling from a physician and received either varenicline (N=296) or the nicotine patch (N=291) for smoking cessation. Both varenicline and nicotine patch users could receive their medications for a maximum of 8 weeks. Participants were followed up by telephone at 3, 6, 12, and 36 months from the first visit. The primary outcome measure was self-reported sustained abstinence up to 36 months. Measures were also taken of smoking characteristics, cigarette dependence, and sociodemographic characteristics. RESULTS Multiple logistic regression of 36-month sustained abstinence on to medication adjusting for other baseline variables showed a significant advantage for varenicline, OR=7.94 (95 % CI 1.87-33.74). CONCLUSION An 8-week course of varenicline appears to yield higher abstinence rate up to 3 years than a similar length course of nicotine transdermal patch in routine clinical practice where behavioral support is available.
Collapse
Affiliation(s)
- Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung, 813, Taiwan,
| | | | | | | | | | | | | |
Collapse
|
45
|
Richards B, McNeill A, Croghan E, Percival J, Ritchie D, McEwen A. Smoking cessation education and training in UK nursing schools: A national survey. ACTA ACUST UNITED AC 2014. [DOI: 10.5430/jnep.v4n8p188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
46
|
Gould GS, Watt K, McEwen A, Cadet-James Y, Clough AR. Validation of risk assessment scales and predictors of intentions to quit smoking in Australian Aboriginal and Torres Strait Islander peoples: a cross-sectional survey protocol. BMJ Open 2014; 4:e004887. [PMID: 24902729 PMCID: PMC4054635 DOI: 10.1136/bmjopen-2014-004887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Tobacco smoking is a very significant behavioural risk factor for the health of Australian Aboriginal and Torres Strait Islanders, and is embedded as a social norm. With a focus on women of childbearing age, and men of similar age, this project aims to determine how Aboriginal and Torres Strait Islander smokers assess smoking risks and how these assessments contribute to their intentions to quit. The findings from this pragmatic study should contribute to developing culturally targeted interventions. METHODS AND ANALYSIS A cross-sectional study using quantitative and qualitative data. A total of 120 Aboriginal and Torres Strait Islander community members aged 18-45 years will be recruited at community events and through an Aboriginal Community Controlled Health Service (ACCHS). Participants will be interviewed using a tablet computer or paper survey. The survey instrument uses modified risk behaviour scales, that is, the Risk Behaviour Diagnosis (RBD) scale and the Smoking Risk Assessment Target (SRAT) (adapted from the Risk Acceptance Ladder) to determine whether attitudes of Aboriginal and Torres Strait Islander smokers to health risk messages are predictors of intentions to quit smoking. The questionnaire will be assessed for face and content validity with a panel of Indigenous community members. The internal consistency of the RBD subscales and their patterns of correlation will be explored. Multivariate analyses will examine predictors of intentions to quit. This will include demographics such as age, gender, nicotine dependence, household smoking rules and perceived threat from smoking and efficacy for quitting. The two risk-assessment scales will be examined to see whether participant responses are correlated. ETHICS AND DISSEMINATION The Aboriginal Health & Medical Research Council Ethics Committee and university ethics committees approved the study. The results will be published in a peer-reviewed journal and a community report will be disseminated by the ACCHS, and at community forums. NOTE ABOUT TERMINOLOGY We use the term Aboriginal and Torres Strait Islander peoples, except where previous research has reported findings from only one group for example, Aboriginal people. Indigenous is used here to refer to Indigenous peoples in the international context, and issues, policies or systems, for example, Indigenous health, Indigenous tobacco control.
Collapse
Affiliation(s)
- Gillian Sandra Gould
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, Queensland, Australia
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Kerrianne Watt
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
| | - Andy McEwen
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Yvonne Cadet-James
- School of Indigenous Australian Studies, James Cook University, Townsville, Queensland, Australia
| | - Alan R Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| |
Collapse
|
47
|
Abstract
Stop smoking practitioners appear to differ in effectiveness, but the stability of their success rates over time is unknown. The purpose of this study was to assess the degree of stability of success rates of stop smoking practitioners over several years of practice. Using routinely collected practice data, the success rates of 197 practitioners active between April 2009 and April 2012 in the English stop smoking services were correlated across years before and after adjusting for client and intervention characteristics. Changes in client and intervention characteristics were assessed. Success rates for individual practitioners correlated highly in successive years (r = 0.64 to 0.68, p < 0.001, ICC = 0.56) and moderately over non-successive years (r = 0.39 to 0.51, p < 0.001). There was no evidence for increasing effectiveness over time. Practitioners' effectiveness is moderately stable over time. Research is needed to establish what characterises the practice of the more successful practitioners.
Collapse
Affiliation(s)
- Leonie S. Brose
- />UK Centre for Tobacco and Alcohol Studies, Addictions, Institute of Psychiatry, King’s College London, London, UK
| | - Robert West
- />Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Andy McEwen
- />Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- />National Centre for Smoking Cessation and Training (NCSCT), London, UK
| |
Collapse
|
48
|
Brose LS, Chong CB, Aspinall E, Michie S, McEwen A. Effects of standardised cigarette packaging on craving, motivation to stop and perceptions of cigarettes and packs. Psychol Health 2014; 29:849-60. [PMID: 24559249 DOI: 10.1080/08870446.2014.896915] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess whether standardised packs of the form introduced in Australia are associated with a reduction in acute craving and/or an increase in motivation to stop, and to replicate previous findings on perceptions of packaging, perceptions of smokers using it and perceived effects on behaviour. DESIGN Following abstinence of at least 12 h, 98 regular and occasional smokers were randomised to exposure to their own cigarette package, another branded package or a standardised package. MAIN OUTCOME MEASURES Craving (QSU-brief), motivation to stop, both at baseline and post-exposure. Ratings of 10 attributes concerning package design, perceived smoker characteristics and effects on behaviour, post-exposure only. RESULTS For craving, a mixed model ANCOVA showed a significant interaction of packaging and time of measurement (F(2,94) = 8.77, p < .001, partial η(2) = .16). There was no significant main effect or interaction for motivation to stop smoking (p = .9). The standardised pack was perceived to be significantly less appealing and less motivating to buy cigarettes, smokers using them were perceived as less popular and cigarettes from them expected to taste worse. CONCLUSION Standardised cigarette packaging may reduce acute (hedonic) craving and is associated with more negative perceptions than branded packaging with less prominent health warnings.
Collapse
Affiliation(s)
- Leonie S Brose
- a Clinical, Educational and Health Psychology , University College London (UCL) , London , UK
| | | | | | | | | |
Collapse
|
49
|
Gould GS, Watt K, Stevenson L, McEwen A, Cadet-James Y, Clough AR. Developing anti-tobacco messages for Australian Aboriginal and Torres Strait Islander peoples: evidence from a national cross-sectional survey. BMC Public Health 2014; 14:250. [PMID: 24625235 PMCID: PMC3995618 DOI: 10.1186/1471-2458-14-250] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/18/2014] [Indexed: 11/23/2022] Open
Abstract
Background Smoking rates in Australian Aboriginal and Torres Strait Islander peoples remain high, with limited impact of government measures for many subgroups. The aim of this cross-sectional study was to investigate differences in organisational practice for developing anti-tobacco messages for these target populations. Methods Telephone interviews were conducted with 47 organisation representatives using a structured questionnaire based on health communication and health promotion frameworks. Responses were coded into phases of message development, message types (educational, threat, positive or advocacy), target groups, message recommendations, and evaluations undertaken. Cultural sensitivity for message development was divided into surface structure (use of images, language, demographics) and deep structure (use of socio-cultural values). A categorical principal component analysis explored the key dimensions of the findings and their component relationships. Results Among organisations interviewed, a community-orientated, bottom-up approach for developing anti-tobacco messages was reported by 47% (n = 24); 55% based message development on a theoretical framework; 87% used a positive benefit appeal; 38% used threat messages. More Aboriginal Medical Services (AMSs) targeted youth (p < 0.005) and advised smokers to quit (p < 0.05) than other types of organisations. AMSs were significantly more likely to report using deep structure in tailoring messages compared with non-government (p < 0.05) and government organisations (p < 0.05). Organisations that were oriented to the general population were more likely to evaluate their programs (p < 0.05). A two-dimensional non-linear principal component analysis extracted components interpreted as “cultural understanding” (bottom-up, community-based approaches, deep structures) and “rigour” (theoretical frameworks, and planned/completed evaluations), and accounted for 53% of the variability in the data. Conclusion Message features, associated with successful campaigns in other populations, are starting to be used for Aboriginal and Torres Strait Islander peoples. A model is proposed to facilitate the development of targeted anti-tobacco messages for Aboriginal and Torres Strait Islander peoples. Organisations could consider incorporating both components of cultural understanding-rigour to enable the growth of evidence-based practice.
Collapse
Affiliation(s)
- Gillian S Gould
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, PO Box 6811, Cairns, Queensland 4870, Australia.
| | | | | | | | | | | |
Collapse
|
50
|
Beard E, Brose LS, Brown J, West R, McEwen A. How are the English Stop Smoking Services responding to growth in use of electronic cigarettes? Patient Educ Couns 2014; 94:276-281. [PMID: 24290243 DOI: 10.1016/j.pec.2013.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/03/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess extent of electronic cigarette use by smokers attending Stop Smoking Services, the advice given about electronic cigarettes and whether this usage is recorded. METHODS Fifty-eight managers and 1284 practitioners completed an online survey. Questions covered use of electronic cigarettes, the advice given and whether use was recorded in client databases. RESULTS Ninety per cent (n=1150) and 95% (n=1215) of practitioners respectively, reported that their clients were using electronic cigarettes and that they had been asked about them. Seventy-one per cent (n=41) of managers reported that they had a policy on the advice to be given; of whom 85% (n=35) said that practitioners should say that products were unlicensed. Fifty-five per cent (n=707) of practitioners reported giving such advice and 11% (n=138) said they warned smokers about their safety. Only 9% (n=119) reported that they recorded clients' use. CONCLUSION Although use of electronic cigarettes by smokers in Stop Smoking Services is common, few provisions are in place to record their use. Practitioners mostly advise that products are not licensed. PRACTICAL IMPLICATIONS There is a need to consider additional training for practitioners on use of e-cigarettes and harm reduction generally to ensure that advice is consistent and evidence-based.
Collapse
Affiliation(s)
- Emma Beard
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training, London, UK.
| | - Leonie S Brose
- National Centre for Smoking Cessation and Training, London, UK; UK Centre for Tobacco and Alcohol Studies (UKCTAS), Addictions, Institute of Psychiatry, King's College London, UK
| | - Jamie Brown
- Cancer Research UK Health Behaviour Research Centre, University College London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training, London, UK
| | - Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, UK; National Centre for Smoking Cessation and Training, London, UK
| |
Collapse
|