Journal of Smoking Cessation最新文献

Introduction: The emergence of electronic cigarettes (ECs) has become a growing phenomenon that has sharply split opinion among the public health community, physicians, and lawmakers.

Aims: We sought to determine chest physician perceptions regarding ECs.

Methods: We conducted a web-based survey of 18,000 American College of Chest Physician (CHEST) members to determine healthcare provider experiences with EC users and to characterize provider perceptions regarding ECs.

Results/findings: There were 994 respondents. 88% reported that patients had asked their opinion of ECs, and 31% reported EC use among at least 10% of their patients. More disagreed than agreed (41% vs. 21%) that patients could improve their health by switching from tobacco smoking to daily EC use. Respondents were split on whether ECs promote tobacco cessation (32% agree vs. 33% disagree).

Conclusions: Current perceptions of ECs are variable among providers. More than 1/3 of respondents felt that EC's could be used for smoking cessation for smokers who failed prior quit attempts with approved therapies. However, many respondents were not convinced that ECs will reduce harms from tobacco use. There is an urgent need to generate additional high quality scientific data regarding ECs to inform chest physicians, health professionals and the general public.

Introduction: This study evaluates the impact of baseline e-cigarette use on smoking cessation rates in a national sample of two-year college student smokers.

Methods: Participants were 1400 students from over 60 two-year colleges across 25 states who were current smokers enrolled in a web-assisted tobacco intervention (WATI) trial. Survey data were collected at baseline, 1-, 6-, and 12-months, with primary outcomes evaluated at 6-months.

Results: At 6-months, baseline e-cigarette users were more likely to report cessation of traditional cigarettes compared to non-users (OR 1.39, 95% CI 1.002-1.92). Cessation was also associated with higher baseline confidence in quitting and greater time to first cigarette in the morning. Baseline e-cigarette use was not found to be associated with self-reported cessation of all nicotine/tobacco products (OR 1.09, 95% CI 0.75-1.58) nor biochemically verified cessation of all nicotine/tobacco products (OR 0.83, 95% CI 0.47-1.47). Higher confidence was again associated with both self-reported and biochemically verified cessation of all nicotine/tobacco products. Female gender was associated only with biochemically verified cessation of all nicotine/tobacco products at 6-months.

Conclusions: Two-year college students represent a priority population for cessation interventions. The findings from this study highlight the complexities of evaluating the impact of e-cigarette use on cessation.

Introduction: We characterized tobacco use, cessation patterns, and patient satisfaction with a cessation support program at an NCI Designated Comprehensive Cancer Center following a mandatory tobacco assessment and automatic referral.

Methods: A 3-month follow-up survey (via web, paper, or telephone) was administered between March 2013 and November 2013 for all patients referred to and contacted by a cessation support service, and who consented to participation three months prior to administration. Patients were asked about their perceived importance and self-efficacy to quit smoking, quit attempts, and satisfaction with the cessation service.

Results: Fifty-two percent (257/499) of patients who participated in the cessation support service, and consented to be contacted again, completed a follow-up survey. Of those who participated, 9.7% were referred to the service as having recently quit tobacco (in the past 30 days) and 23.6% reported having quit at the time of first contact. At the 3-month follow-up, 48.1% reported being smoke-free for the previous seven days. When patients were asked about their experience with the cessation service, 86.4% reported being very or mostly satisfied with the service, and 64.3% reported that their experience with the service increased their satisfaction with the care received at the cancer centre.

Conclusions: Our findings suggest that recently diagnosed cancer patients are aware that quitting tobacco is important, are making attempts to quit, and are amenable to an opt-out automatic referral cessation support service as part of their cancer care.

Introduction: There is wide variation in the success rates of practitioners employed to help smokers to stop, even once a range of potential confounding factors has been taken into account. Aim: This paper examined whether personality characteristics of practitioners might play a role success rates. Methods: Data from 1,958 stop-smoking treatment episodes in two stop-smoking services (SSS) involving 19 stop-smoking practitioners were used in the analysis. The outcome measure was clients' biochemically verified quit status 4 weeks after the target quit date. The five dimensions of personality, as assessed by the Ten-Item Personality Inventory, were included as predictor variables: openness, conscientiousness, agreeableness, extraversion, and neuroticism. A range of client and other practitioner characteristics were used as covariates. A sensitivity analysis was conducted to determine if managers' ratings of practitioner personality were also associated with clients' quit status. Results: Multi-level random intercept models indicated that clients of practitioners with a higher extraversion score had greater odds of being abstinent at four weeks (self-assessed: OR = 1.10, 95% CI = 1.01-1.19; manager-assessed: OR = 1.32, 95% CI = 1.21-1.44). Conclusions: More extraverted stop smoking practitioners appear to have greater success in advising their clients to quit smoking. Findings need to be confirmed in larger practitioner populations, other SSS, and in different smoking cessation contexts. If confirmed, specific training may be needed to assist more introverted stop smoking practitioners.

Introduction: Text-message-based interventions hold great potential for intervention and are increasingly feasible, given advances in information technology.

Aims: This pilot randomized controlled trial (RCT) aims to compare the efficacy of self-versus expert-authored content delivered via text-messaging for smoking cessation.

Methods: Sixty-two participants aged 25-66 attended laboratory sessions pre- and post-30 days of text-messaging intervention. Participants were randomised to one of two experimental conditions - self-authorship (SA) only and SA with implementation intentions (SA+ii) - or active control. Participants composed 30-60 brief motivational cessation messages for use during their cessation attempt. SA+ii participants were further instructed to anticipate obstacles and form simple if-then plans to overcome them. Experimental groups received their self-authored texts during the intervention phase, whereas control participants received expert-authored messages.

Results: Overall, smoking decreased as measured by change in exhaled carbon monoxide (CO), F(1,59) = 4.43, p = 0.04. The SA+ii group showed slightly greater CO reduction (M = 3.63, SD = 5.39) than control (M = 0.03, SD = 5.80; t(40) = 2.08, p = 0.04). SA alone (M = 1.97, SD = 9.30) was not more effective than control.

Conclusions: SA does not appear to increase efficacy. However, this pilot supports prior research, indicating that text-based interventions can increase smoking cessation success and may decrease psychological symptoms of withdrawal. Much research is needed to identify ways to bolster intervention efficacy.

Background: Adherence to transdermal nicotine patches, one of the most popular and effective treatment for nicotine dependence, remains very low and is a strong predictor of cessation rates. This study examined individual factors related to adherence as well as differences over time between adherent (≥ 80% of daily patch use) and non-adherent participants (< 80% of daily patch use).

Methods: We analyzed data from 440 participants who received 8 weeks of 21mg transdermal nicotine and 4 behavioral counseling sessions within an effectiveness trial that examined the effects of long-term treatment. Multiple logistical regression assessed baseline variables associated with patch adherence and generalized estimating equations (GEE) were used to evaluate changes in craving and withdrawal, depressive and anxiety symptoms, substitute and complementary reinforcers, and side effects between participants who were or were not adherent.

Results: In a logistic regression model, being female, living with a child or children, and higher self-reported anxiety symptoms were predictive of lower patch adherence (p < .05). In the GEE analysis, adherence was significantly associated with: a greater reduction in craving, a greater engagement in substitute reinforcers, and a greater decrease in complementary reinforcers over time (p < .05).

Conclusions: Difficulties adhering to transdermal nicotine patches may be related to psychiatric comorbidity, difficulty managing nicotine craving, and challenges with engaging in substitute reinforcers and reducing exposure to complementary reinforcers. These constructs may serve as targets for interventions designed to increase treatment adherence.

Introduction: There are limited existing data describing the training methods used to educate tobacco cessation treatment providers around the world.

Aims: To measure the prevalence of tobacco cessation treatment content, skills training and teaching methods reported by tobacco treatment training programs across the world.

Methods: Web-based survey in May-September 2013 among tobacco cessation training experts across six geographic regions and four World Bank income levels. Response rate was 73% (84 of 115 countries contacted).

Results: Of 104 individual programs from 84 countries, most reported teaching brief advice (78%) and one-to-one counseling (74%); telephone counseling was uncommon (33%). Overall, teaching of knowledge topics was more commonly reported than skills training. Programs in lower income countries less often reported teaching about medications, behavioral treatments and biomarkers and less often reported skills-based training about interviewing clients, medication management, biomarker measurement, assessing client outcomes, and assisting clients with co-morbidities. Programs reported a median 15 hours of training. Face-to-face training was common (85%); online programs were rare (19%). Almost half (47%) included no learner assessment. Only 35% offered continuing education.

Conclusion: Nearly all programs reported teaching evidence-based treatment modalities in a face-to-face format. Few programs delivered training online or offered continuing education. Skills-based training was less common among low- and middle-income countries (LMICs). There is a large unmet need for tobacco treatment training protocols which emphasize practical skills, and which are more rapidly scalable than face-to-face training in LMICs.

Introduction: Despite the public health relevance of smoking in adolescents and emerging adults, this group remains understudied and underserved. High technology utilization among this group may be harnessed as a tool for better understanding of smoking, yet little is known regarding the acceptability of mobile health (mHealth) integration.

Methods: Participants (ages 14-21) enrolled in a smoking cessation clinical trial provided feedback on their technology utilization, perceptions, and attitudes; and interest in remote monitoring for smoking. Characteristics that predicted greater technology acceptability for smoking treatment were also explored.

Results: Participants (N=87) averaged 19 years old and were mostly male (67%). Technology utilization was high for smart phone ownership (93%), Internet use (98%), and social media use (94%). Despite this, only one-third of participants had ever searched the Internet for cessation tips or counseling (33%). Participants showed interest in mHealth-enabled treatment (48%) and felt that it could be somewhat helpful (83%). Heavier smokers had more favorable attitudes toward technology-based treatment, as did those with smartphones and unlimited data.

Conclusions: Our results demonstrate high technology utilization, favorable attitudes towards technology, and minimal concerns. Technology integration among this population should be pursued, though in a tailored fashion, to accomplish the goal of providing maximally effective, just-in-time interventions.

Introduction: The current study examined the level of agreement in expired-air carbon monoxide (CO) values, focusing especially on those confirming abstinence, between the two most commonly used CO monitors, the Vitalograph BreathCO and the Bedfont piCO+ Smokerlyzer.

Methods: Expired-air samples were collected via both monitors from adult dependent smokers (44 M, 34 F) participating in studies using CO values to confirm abstinence durations of: 24 hours, 12 hours, or no abstinence. All met DSM-IV nicotine dependence criteria and had a mean (SD) Fagerström Test of Cigarette Dependence score of 5.1 (1.8). Paired data collected across multiple visits were analyzed by regression-based Bland-Altman method of Limits of Agreement.

Findings: Analysis indicated a lack of agreement in CO measurement between monitors. Overall, the Bedfont monitor gave mean (±SEM) readings 3.83 (±.23) ppm higher than the Vitalograph monitor. Mean differences between monitors were larger for those ad lib smoking (5.65±.38 ppm) than those abstaining 12-24 hours (1.71±.13 ppm). Yet, there also was not consistent agreement in classification of 24 hour abstinence between monitors.

Conclusions: Systematic differences in CO readings demonstrate these two very common monitors may not result in interchangeable values, and reported outcomes in smoking research based on CO values may depend on the monitor used.