Journal of Smoking Cessation最新文献

Introduction: The National Comprehensive Cancer Control Program (NCCCP) and National Tobacco Control Program (NTCP) are both well-positioned to promote the use of population-based tobacco cessation interventions, such as state quitlines and Web-based interventions.

Aims: This paper outlines the methodology used to conduct a comparative effectiveness research study of traditional and Web-based tobacco cessation and quitline promotion approaches.

Methods: A mixed-methods study with three components was designed to address the effect of promotional activities on service usage and the comparative effectiveness of population-based smoking cessation activities across multiple states.

Results/findings: The cessation intervention component followed 7,902 smokers (4,307 quitline users and 3,595 Web intervention users) to ascertain prevalence of 30-day abstinence rates 7 months after registering for smoking cessation services. User characteristics and quit success was compared across the two modalities. In the promotions component, reach and use of traditional and innovative promotion strategies were assessed for 24 states, including online advertising, state Web sites, social media, mobile applications, and their effects on quitline call volume. The partnership intervention component studied the extent of collaboration among six selected NCCCPs and NTCPs.

Conclusions: This study will guide program staff and clinicians with evidence-based recommendations and best practices for implementation of tobacco cessation within their patient and community populations and establish an evidence base that can be used for decision making.

Introduction: Smoking cessation among adults is associated with increased happiness. This association has not been measured in parents, a subset of adults who face uniquely stressful and challenging circumstances that can affect happiness.

Aims: To determine if parental smoking cessation is associated with increased happiness and to identify characteristics of parental quitters who experience increased happiness.

Methods: 1355 parents completed a 12-month follow-up interview from a U.S. national trial, Clinical Effort Against Secondhand Smoke Exposure (CEASE). Multivariable logistic regression examined if level of happiness was independently associated with quitting smoking and identified characteristics associated with feeling happier after quitting smoking.

Results/findings: Parents' level of happiness was independently associated with quitting smoking (aOR=1.60, 95% CI=1.42-1.79). Factors associated with increased happiness among quitters include engaging in evidence-based cessation assistance (aOR=2.69, 95% CI=1.16-6.26), and adopting strictly enforced smoke-free home (aOR=2.55, 95% CI=1.19-5.48) and car (aOR=3.85, 95% CI=1.94-7.63) policies. Additionally, parents who believed that being a smoker got in the way of being a parent (aOR=5.37, 95% CI=2.61-11.07) and who believed that thirdhand smoke is harmful to children (aOR=3.28, 95% CI=1.16-9.28) were more likely to report feeling happier after quitting.

Conclusions: Parents who quit smoking reported being happier than parents who did not quit. Though prospective studies can clarify what factors cause an increase in happiness, letting pediatricians know that most parents who smoke report being happier when quitting may facilitate communication with parents around cessation.

Trial registration: ClinicalTrials.gov, Identifier: NCT00664261.

Background: Following cessation interventions, self-reported smoking abstinence with biochemical verification is the "gold standard" for defining outcomes. Because obtaining biochemical verification is challenging in community studies, we compared self-reported cessation among smokers completing treatment to the smoking status reported by each participant's spouse or proxy.

Method: Participants were smokers who had reported quitting 12 months after a cessation intervention. Participants had either attended a smoking cessation clinic or they were patients seen by physicians who had recently participated in a cessation-training program. Proxies living with these participants were interviewed by telephone to ask about their partner's smoking status. We compared the participants' responses to those from their spouses.

Results: At 12 months, 346 of 1423 baseline smokers had quit; 161/346 reported non-smokers were called and 140 proxies were interviewed. The participants averaged 51 years of age, 69% were women. At baseline, the mean number of cigarettes smoked per day was 20.1 (SD = 9.9) and the average number of quit attempts was 2.4 (SD = 1.2). Cessation methods used were medical advice (21%) and/or pharmacotherapy (79%). Of the 140 spouses interviewed, only 10 (7.1%) reported that their partners were currently smoking.

Conclusions: Proxy-reported data on smoking status could be used to validate self-report.

Introduction: Tobacco use and harm continue to increase in low- and middle income countries (LMICs) globally. Smoking cessation is the most effective means of reducing morbidity and mortality from tobacco use. Increasing the prevalence of ex-users is an indicator of population cessation.

Aims: This study provides the first examination of factors associated with ex-tobacco use status in the Dominican Republic (DR), a LMIC in the Latin America and Caribbean region.

Methods: Baseline surveillance was conducted for 1177 randomly selected households in 7 economically disadvantaged DR communities (total N=2680 adult household members).

Results: Ex-user prevalence was 10.6% (1.0%-18.5% across communities), 14.8% were current users (9.1-20.4), and quit ratios were 41.7% (9.7%-52.7%). Among ever-users, females (OR 2.02, 95% CI 1.41, 2.90), older adults (45-64: OR 1.75, 95% CI 1.12, 2.74; 65+: OR 2.09, 95% CI 1.29, 3.39), and those who could read/write (OR 1.64, 95% CI 1.08, 2.50), had health conditions (OR 1.63, 95% CI 1.11, 2.41), and lived with ex-users (OR 1.70, 95% CI 1.12, 2.58) were over 60% to two times as likely to be ex-users. Those from remote communities (OR 0.52, 95% CI 0.36, 0.74), using chewed tobacco (OR 0.14, 95% CI 0.04, 0.48) and living with tobacco users (OR 0.55, 95% CI 0.37, 0.81) were less likely to be ex-users.

Conclusions: Ex-user prevalence and quit ratios were lower than for high income countries. Implementing broad tobacco control measures, combined with clinically targeting vulnerable groups, may increase tobacco cessation to most effectively reduce this public health crisis.

Introduction: Spousal support predicts smoking cessation. China is the world's largest consumer of tobacco, with drastic differences in smoking prevalence among men and women. Thus, understanding marital interactions around husbands' smoking has implications for cultures with similarly large gender disparities in smoking.

Aims: We examined interactions among family members regarding husbands' smoking in homes with small children in Shanghai.

Methods: In Spring 2013, we conducted in-person semi-structured interviews among 13 male smokers and 17 female nonsmokers recruited from an urban and a suburban community in Shanghai.

Results/findings: To encourage husbands' cessation or reduction, some women reported intervening either directly or indirectly through their children, emphasizing the health consequences for the smoker and the family. Some women reported not conversing about cessation due to concern about conflict, tolerance, or resignation. Women reported that their husbands' responses to anti-smoking messages from family members included promises to quit in the future or noting the strength of the nicotine addiction and the disadvantages of quitting. Men reported the importance of smoking in work/culture and argued against the research about the harms of smoking.

Conclusions: Interventions targeting motivators for cessation among men and to support women in encouraging their husbands' cessation should be developed.

Introduction: Smokers' treatment expectancies may influence their choice of a particular medication as well as their medication experience.

Aims: This study examined the role of smokers' treatment expectancies to their smoking cessation outcomes in a completed, randomized, placebo-controlled trial of naltrexone for smoking cessation, controlling for perceptions of treatment assignment.

Methods: Treatment seeking cigarette smokers (N = 315) were randomized to receive either naltrexone (50 mg) or placebo in combination with nicotine patch and behavioral counseling. Expectancies for naltrexone as a smoking cessation aid were assessed at baseline and 4 weeks after the quit date.

Results: More positive baseline medication expectancies predicted higher quit rates at one month in the naltrexone (OR =1.45, p =.04) group but were associated with lower quit rates in the placebo group (OR =.66, p =.03). Maintaining and/or increasing positive medication expectancies in the first month of treatment was associated with better pill adherence during this interval in the naltrexone group (ps <.05). Positive baseline medication expectancies were also associated with the perception of having received naltrexone over placebo among all participants.

Conclusions: Positive medication expectancies in smokers may contribute to better treatment response. Assessing treatment expectancies and attempting to maintain or improve them may be important for the delivery, evaluation, and targeting of smoking cessation treatments.

Background: Physician-implemented interventions for smoking cessation are effective but infrequently used. We evaluated smoking cessation practices among physicians in Argentina.

Methods: A self-administered survey of physicians from six clinical systems asked about smoking cessation counselling practices, barriers to tobacco use counselling and perceived quality of training received in smoking cessation practices.

Results: Of 254 physicians, 52.3% were women, 11.8% were current smokers and 52% never smoked. Perceived quality of training in tobacco cessation counselling was rated as very good or good by 41.8% and as poor/very poor by 58.2%. Most physicians (90%) reported asking and recording smoking status, 89% advised patients to quit smoking but only 37% asked them to set a quit date and 44% prescribed medications. Multivariate analyses showed that Physicians' perceived quality of their training in smoking cessation methods was associated with greater use of evidence-based cessation interventions. (OR = 6.5; 95% CI = 2.2-19.1); motivating patients to quit (OR: 7.9 CI 3.44-18.5), assisting patients to quit (OR = 9.9; 95% CI = 4.0-24.2) prescribing medications (OR = 9.6; 95% CI = 3.5-26.7), and setting up follow-up (OR = 13.0; 95% CI = 4.4-38.5).

Conclusions: Perceived quality of training in smoking cessation was associated with using evidence-based interventions and among physicians from Argentina. Medical training programs should enhance the quality of this curriculum.

Malaysia introduced graphic health warning labels (GHWLs) on all tobacco packages in 2009. We aimed to examine if implementing GHWLs led to stronger warning reactions (e.g., thinking about the health risks of smoking) and an increase in subsequent quitting activities; and to examine how reactions changed over time since the implementation of the GHWLs in Malaysia and Thailand where GHWL size increased from 50-55% in 2010. Data came from six waves (2005-2014) of the International Tobacco Control Southeast Asia Survey. Between 3,706 and 4,422 smokers were interviewed across these two countries at each survey wave. Measures included salience of warnings, cognitive responses (i.e., thinking about the health risks and being more likely to quit smoking), forgoing cigarettes, and avoiding warnings. The main outcome was subsequent quit attempts. Following the implementation of GHWLs in Malaysia, reactions increased, in some cases to levels similar to the larger Thai warnings, but declined over time. In Thailand, reactions increased following implementation, with no decline for several years, and no clear effect of the small increase in warning size. Reactions, mainly cognitive responses, were consistently predictive of quit attempts in Thailand, but this was only consistently so in Malaysia after the change to GHWLs. In conclusion, GHWLs are responded to more frequently, and generate more quit attempts, but warning wear-out is not consistent in these two countries, perhaps due to differences in other tobacco control efforts.

The tobacco epidemic in Syria is characterized by high rates of cigarettes smoking in men and dramatic reemergence of waterpipe smoking, especially among youths and women. The Syrian Center for Tobacco Studies (SCTS), an NIH-funded pioneer research and capacity building institution, has developed a research infrastructure and conducted three randomized clinical trials to develop and rigorously test culturally-appropriate tobacco treatment programs integrated into primary healthcare (PHC) centers. This review aimed to discuss challenges and lessons learned from the Syrian experience. Addressing these challenges may inform future cessation research activities in Syria and other developing countries. To develop a research infrastructure, the SCTS has established Syria's first IRB and trained physicians/medical students in both tobacco treatment and research methods. Main challenges to conduct the cessation trials were difficulties of coordination between the local and international collaborators; high Smoking Rates among PHC providers; lack of pharmacological agents used in tobacco treatment; and difficulties of conducting research in a politically volatile region. Strategies to overcome these challenges were ensuring an active and regular involvement of all investigator; and advocating for a national smoking-cessation plan that involves training health care providers in smoking cessation treatment and make pharmacological agents used in smoking cessation available.

Engaging partners for tobacco control within low and middle income countries (LMICs) at early stages of tobacco control presents both challenges and opportunities in the global effort to avert the one billion premature tobacco caused deaths projected for this century. The Dominican Republic (DR) is one such early stage country. The current paper reports on lessons learned from 12 years of partnered United States (US)-DR tobacco cessation research conducted through two NIH trials (Proyecto Doble T, PDT1 and 2). The projects began with a grassroots approach of working with interested communities to develop and test interventions for cessation and secondhand smoke reduction that could benefit the communities, while concurrently building local capacity and providing resources, data, and models of implementation that could be used to ripple upward to expand partnerships and tobacco intervention efforts nationally. Lessons learned are discussed in four key areas: partnering for research, logistical issues in setting up the research project, disseminating and national networking, and mentoring. Effectively addressing the global tobacco epidemic will require sustained focus on supporting LMIC infrastructures for tobacco control, drawing on lessons learned across partnered trials such as those reported here, to provide feasible and innovative approaches for addressing this modifiable public health crisis.