Alan C. Geller, Vaughan W. Rees, Daniel R. Brooks.
The Proposal for Smoke-Free Public Housing Benefits, Challenges, and Opportunities for 2 Million Residents.
JAMA. Published online February 15, 2016. doi:10.1001/jama.2016.1380
Implementation of a smoke-free policy presents both an unparalleled opportunity and a duty to help low-income smokers quit and so narrow the gap in smoking rates that contributes to the higher burden of poor health outcomes experienced by this population. As a matter of equity, resources must be made available to help smokers quit.
Shafer PR, Davis KC, Patel D, Rodes R, Beistle D.
Association Between Media Dose, Ad Tagging, and Changes in Web Traffic for a National Tobacco Education Campaign: A Market-Level Longitudinal Study.
J Med Internet Res. 2016 Feb 17;18(2):e39. doi: 10.2196/jmir.5343.
In 2012, the US Centers for Disease Control and Prevention (CDC) launched Tips From Former Smokers (Tips), the first federally funded national tobacco education campaign. In 2013, a follow-up Tips campaign aired on national cable television networks, radio, and other channels, with supporting digital advertising to drive traffic to the Tips campaign website. The objective of this study was to use geographic and temporal variability in 2013 Tips campaign television media doses and ad tagging to evaluate changes in traffic to the campaign website in response to specific doses of campaign media. Linear regression models were used to estimate the dose-response relationship between weekly market-level television gross rating points (GRPs) and weekly Web traffic to the Tips campaign website. This relationship was measured using unique visitors, total visits, and page views as outcomes. Ad GRP effects were estimated separately for ads tagged with the Tips campaign website URL and 1-800-QUIT-NOW.
In the average media market, an increase of 100 television GRPs per week for ads tagged with the Tips campaign website URL was associated with an increase of 650 unique visitors (P<.001), 769 total visits (P<.001), and 1255 total page views (P<.001) per week. The associations between GRPs for ads tagged with 1-800-QUIT-NOW and each Web traffic measure were also statistically significant (P<.001), but smaller in magnitude. Based on these findings, we estimate that the 16-week 2013 Tips television campaign generated approximately 660,000 unique visitors, 900,000 total visits, and 1,390,000 page views for the Tips campaign website. These findings can help campaign planners forecast the likely impact of targeted advertising efforts on consumers' use of campaign-specific websites.
Schauer GL, Malarcher A, Mann N, Fabrikant J, Zhang L, Babb S.
How Tobacco Quitline Callers in 38 US States Reported Hearing About Quitline Services, 2010-2013.
Prev Chronic Dis. 2016 Feb 4;13:E17. doi: 10.5888/pcd13.150325.
Telephone-based tobacco quitlines are an evidence-based intervention, but little is known about how callers hear about quitlines and whether variations exist by demographics or state. This study assessed trends in "how-heard-abouts" (HHAs) in 38 states. Data came from the Centers for Disease Control and Prevention's (CDC's) National Quitline Data Warehouse, which stores nonidentifiable data collected from individual callers at quitline registration and reported quarterly by states. Callers were asked how they heard about the quitline; responses were grouped into the following categories: media, health professional, family or friends, and "other." We examined trends from 2010 through 2013 (N = 1,564,437) using multivariable models that controlled for seasonality and the impact of CDC's national tobacco education campaign, Tips From Former Smokers (Tips). Using data from 2013 only, we assessed HHAs variation by demographics (sex, age, race/ethnicity, education) and state in a 38-state sample (n = 378,935 callers).
From 2010 through 2013, the proportion of HHAs through media increased; however, this increase was not significant when we controlled for calendar quarters in which Tips aired. The proportion of HHAs through health professionals increased, whereas those through family or friends decreased. In 2013, HHAs occurred as follows: media, 45.1%; health professionals, 27.5%, family or friends, 17.0%, and other, 10.4%. Media was the predominant HHA among quitline callers of all demographic groups, followed by health professionals (except among people aged 18-24 years). Large variations in source of HHAs were observed by state. Most quitline callers in the 38-state sample heard about quitlines through the media or health care professionals. Variations in source of HHAs exist across states; implementation of best-practice quitline promotional strategies is critical to maximize reach
Nohlert E, Öhrvik J, Helgason ÁR.
Non-responders in a Quitline Evaluation are More Likely to be Smokers - a Drop-out and Long-term Follow-up Study of the Swedish National Tobacco Quitline.
Tob Induc Dis. 2016 Feb 3;14:5. doi: 10.1186/s12971-016-0070-2. eCollection 2016.
A previous randomized controlled trial (RCT) of the Swedish National Tobacco Quitline detected no significant differences in smoking cessation outcomes between proactive and reactive services at 12-month follow-up. However, the response rate was only 59 % and non-responders were over-represented in the proactive service. We performed a drop-out analysis to assess the smoking status of initial responders and non-responders. At 29-48 months after the first call, a postal questionnaire with six questions was sent to 150 random clients from the RCT database, with equal numbers from the proactive and reactive services as well as responders and non-responders at 12-month follow-up. Clients who did not return the questionnaire were contacted by telephone. The outcome measures were point prevalence (PP) and 6-month continuous abstinence (CA), and their associations with response status at 12 months were assessed by logistic regression.
The response rate was 74 % (111/150). Abstinence was significantly higher among initial responders than non-responders (PP 54 % vs. 32 %, p = .023 and CA 49 % vs. 21 %, p = .003). The odds ratios for initial responders vs. initial non-responders were, for PP = 2.5 (95 % CI 1.1-5.6, p = .024), and for CA = 3.7 (95 % CI 1.5-8.9, p = .004), after adjusting for proactive/reactive service. Non-responders to a 12-month follow-up smoking cessation questionnaire in a quitline setting were more likely to be smokers 1.5-3 years later. We propose a conservative correction factor of 0.8 for self-reported abstinence in telephone-based cessation studies if the response rate is approximately 55-65 %.
Marina Unrod, Vani N. Simmons, Steven K. Sutton, K. Michael Cummings, Paula Celestino, Benjamin M. Craig, Ji-Hyun Lee, Lauren R. Meltzer, Thomas H. Brandon.
Relapse-Prevention Booklets as an Adjunct to a Tobacco Quitline: A Randomized Controlled Effectiveness Trial.
Nicotine Tob Res (2016) 18 (3):298-305.doi: 10.1093/ntr/ntv079
Relapse prevention (RP) remains a major challenge to smoking cessation. Previous research found that a set of self-help RP booklets significantly reduced smoking relapse. This study tested the effectiveness of RP booklets when added to the existing services of a telephone quitline. Quitline callers (N = 3458) were enrolled after their 2-week quitline follow-up call and randomized to one of three interventions: (1) Usual Care: standard intervention provided by the quitline, including brief counseling and nicotine replacement therapy; (2) Repeated Mailings (RM): eight Forever Free RP booklets sent to participants over 12 months; and (3) Massed Mailings: all eight Forever Free RP booklets sent upon enrollment. Follow-ups were conducted at 6-month intervals, through 24 months. The primary outcome measure was 7-day-point-prevalence-abstinence.
Overall abstinence rates were 61.0% at baseline, and 41.9%, 42.7%, 44.0%, and 45.9% at the 6-, 12-, 18- and 24-month follow-ups, respectively. Although RM produced higher abstinence rates, the differences did not reach significance for the full sample. Post-hoc analyses of at-risk subgroups revealed that among participants with high nicotine dependence (n = 1593), the addition of RM materials increased the abstinence rate at 12 months (42.2% vs. 35.2%; OR = 1.38; 95% CI = 1.03% to 1.85%; P = .031) and 24 months (45% vs. 38.8%; OR = 1.31; 95% CI = 1.01% to 1.73%; P = .046). Sending self-help RP materials to all quitline callers appears to provide little benefit to deterring relapse. However, selectively sending RP booklets to callers explicitly seeking assistance for RP and those identified as highly dependent on nicotine might still prove to be worthwhile.
Neri AJ, Momin BR, Thompson TD, Kahende J, Zhang L, Puckett MC, Stewart SL
Use and Effectiveness of Quitlines Versus Web-based Tobacco Cessation Interventions Among 4 State Tobacco Control Programs.
Cancer. 2016 Feb 8. doi: 10.1002/cncr.29739. [Epub ahead of print]
Comparative effectiveness studies of state tobacco quitlines and Web-based tobacco cessation interventions are limited. In 2009, the US Centers for Disease Control and Prevention undertook a study of the comparative effectiveness of state quitlines and Web-based tobacco cessation interventions. Standardized questionnaires were administered to smokers who enrolled exclusively in either quitlines or Web-based tobacco cessation services in 4 states in 2011-2012. The primary outcome was the 30-day point prevalence abstinence (PPA) rate at 7 months both between and within interventions.
A total of 4086 participants were included in the analysis. Quitline users were significantly older, more heterogeneous in terms of race and ethnicity, less educated, less likely to be employed, and more often single than Web-based users. The 7-month 30-day PPA rate was 32% for quitline users and 27% for Web-based users. Multivariate models comparing 30-day PPA rates between interventions indicated that significantly increased odds of quitting were associated with being partnered, not living with another smoker, low baseline cigarette use, and more interactions with the intervention. After adjustments for demographic and tobacco use characteristics, quitline users had 1.26 the odds of being abstinent in comparison with Web-based users (95% confidence interval, 1.00-1.58; P = .053). This is one of the largest comparative effectiveness studies of state tobacco cessation interventions to date. These findings will help public health agencies develop and tailor evidence-based tobacco cessation programs. Further research should focus on users of Web-based cessation interventions sponsored by state health departments and their cost-effectiveness. Cancer 2015. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
Fu SS, van Ryn M, Nelson D, Burgess DJ, Thomas JL, Saul J, Clothier B, Nyman JA, Hammett P, Joseph AM.
Proactive Tobacco Treatment Offering Free Nicotine Replacement Therapy and Telephone Counselling for Socioeconomically Disadvantaged Smokers: a Randomised Clinical Trial.
Thorax. 2016 Mar 1. pii: thoraxjnl-2015-207904. doi: 10.1136/thoraxjnl-2015-207904. [Epub ahead of print]
Evidenced-based tobacco cessation treatments are underused, especially by socioeconomically disadvantaged smokers. This contributes to widening socioeconomic disparities in tobacco-related morbidity and mortality. The Offering Proactive Treatment Intervention trial tested the effects of a proactive outreach tobacco treatment intervention on population-level smoking abstinence and tobacco treatment use among a population-based sample of socioeconomically disadvantaged smokers. Current smokers (n=2406), regardless of interest in quitting, who were enrolled in the Minnesota Health Care Programs, the state's publicly funded healthcare programmes for low-income populations, were randomly assigned to proactive outreach or usual care. The intervention comprised proactive outreach (tailored mailings and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive, telephone counselling). Usual care comprised access to a primary care physician, insurance coverage of Food and Drug Administration-approved smoking cessation medications, and the state's telephone quitline. The primary outcome was self-reported 6-month prolonged smoking abstinence at 1 year and was assessed by follow-up survey.
The proactive intervention group had a higher prolonged abstinence rate at 1 year than usual care (16.5% vs 12.1%, OR 1.47, 95% CI 1.12 to 1.93). The effect of the proactive intervention on prolonged abstinence persisted in selection models accounting for non-response. In analysis of secondary outcomes, use of evidence-based tobacco cessation treatments were significantly greater among proactive outreach participants compared with usual care, particularly combination counselling and medications (17.4% vs 3.6%, OR 5.69, 95% CI 3.85 to 8.40). Population-based proactive tobacco treatment increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers. Findings suggest that dissemination of population-based proactive treatment approaches is an effective strategy to reduce the prevalence of smoking and socioeconomic disparities in tobacco use.
Steven L. Bernstein, June-Marie Rosner, Benjamin Toll,
Cell Phone Ownership and Service Plans Among Low-Income Smokers: The Hidden Cost of Quitlines.
Nicotine Tob Res
(2016)doi: 10.1093/ntr/ntw042First published online: February 26, 2016
Quitlines (QLs) are free, effective sources of treatment for tobacco dependence. Although the QL number is toll-free, the use of cellphones as the sole source of telephony may impose an unintended cost, in terms of cell minutes. To quantify the use of cell-only telephony among self-pay or Medicaid smokers, assess their calling plans, and estimate the impact of a typical course of QL counseling. A survey of smokers age >= 18 years visiting an American urban emergency department from April-July, 2013.
773 smokers were surveyed, of whom 563 (72.8%) were low-income, defined as having Medicaid or no insurance. All low-income smokers had at least one phone: 48 (8.5%) reported land-lines only, 159 (28.2%) land-lines and cells, and 356 (63.2%) cells only. Of the cellphone owners, monthly calling plans provided unlimited minutes for 339/515 (65.8%), <250 minutes for 124 (24.1%), and >250 minutes for 52 (10.0%). Another recent trial found that QL users make a median of 1 call lasting 28 minutes, with the 75th and 90th percentiles of calls and minutes at 3 and 4 calls, and 48 and 73.6 minutes, respectively. Thus, robust use of QL services could consume 11-29% of a low-income smoker’s typical 250 monthly cell minutes. Among low-income smokers, cellphones are often the sole telephone. Robust use of the QL may impose a substantial burden on low-income smokers’ calling plans, and therefore deter use of the QL. Exempting calls to QLs from counting against smokers’ plans may help promote QL utilization.
Marc L. Steinberg, Jill M. Williams, Naomi F. Stahl, Patricia Dooley Budsock, Nina A. Cooperman
An Adaptation of Motivational Interviewing Increases Quit Attempts in Smokers With Serious Mental Illness.
Nicotine & Tobacco Research, 2016, 243–250. doi:10.1093/ntr/ntv043 Advance Access publication March 5, 2015
Smokers with serious mental illness (SMI) have a high smoking prevalence and a low quit rate. Motivational interviewing (MI) is an empirically supported approach for addressing substance use disorders and may motivate smokers with SMI to quit. We randomized smokers (N = 98) with SMI to receive a single 45-minute session of (1) MI with personalized feedback or (2) interactive education. We hypothesized that participants receiving the MI intervention would be more likely to follow-up on a referral for tobacco dependence treatment, to make a quit attempt, and to quit smoking than those receiving the interactive educational intervention.
Smokers receiving an MI intervention were significantly more likely to make a quit attempt by the 1-month follow-up (34.7% vs. 14.3%; OR = 4.39 [95% CI = 1.44 to 13.34], P = .009); however, these quit attempts did not translate into abstinence. In addition, 32.7% of those receiving MI followed-up on a referral for tobacco dependence treatment (vs. 20.4% receiving interactive education; OR = 2.02 [95% CI = 0.76 to 3.55], P = .157). MI Treatment Integrity Code ratings indicated that the interventions were easily distinguishable from each other and that MI was delivered with proficiency. Despite the intervention’s brevity, participants reported high levels of therapeutic alliance with their therapist. A brief adaptation of MI with personalized feedback appears to be a promising approach for increasing quit attempts in smokers with SMI, but future research is required to determine how to best help smokers with SMI to attain sustained abstinence.
Craig N. Sawchuk, Peter Roy-Byrne, Carolyn Noonan, Andy Bogart, Jack Goldberg, Spero M. Manson, Dedra Buchwald
The Association of Panic Disorder, Posttraumatic Stress Disorder, and Major Depression With Smoking in American Indians.
Nicotine Tob Res
(2016) 18 (3):259-266.doi: 10.1093/ntr/ntv071First published online: April 6, 2015
Rates of cigarette smoking are disproportionately high among American Indian populations, although regional differences exist in smoking prevalence. Previous research has noted that anxiety and depression are associated with higher rates of cigarette use. We asked whether lifetime panic disorder, posttraumatic stress disorder, and major depression were related to lifetime cigarette smoking in two geographically distinct American Indian tribes. Data were collected in 1997–1999 from 1506 Northern Plains and 1268 Southwest tribal members; data were analyzed in 2009. Regression analyses examined the association between lifetime anxiety and depressive disorders and odds of lifetime smoking status after controlling for sociodemographic variables and alcohol use disorders. Institutional and tribal approvals were obtained for all study procedures, and all participants provided informed consent.
Odds of smoking were two times higher in Southwest participants with panic disorder and major depression, and 1.7 times higher in those with posttraumatic stress disorder, after controlling for sociodemographic variables. After accounting for alcohol use disorders, only major depression remained significantly associated with smoking. In the Northern Plains, psychiatric disorders were not associated with smoking. Increasing psychiatric comorbidity was significantly linked to increased smoking odds in both tribes, especially in the Southwest. This study is the first to examine the association between psychiatric conditions and lifetime smoking in two large, geographically diverse community samples of American Indians. While the direction of the relationship between nicotine use and psychiatric disorders cannot be determined, understanding unique social, environmental, and cultural differences that contribute to the tobacco-psychiatric disorder relationship may help guide tribe-specific commercial tobacco control strategies.
David C. N. Wong, Sophia S. C. Chan, Tai-hing Lam
Depressive Symptoms Delayed Quit Attempts and Shortened Abstinence in Young Smokers of the Hong Kong Youth Quitline.
Nicotine Tob Res (2016) 18 (3):251-258.doi: 10.1093/ntr/ntv065
Young smokers often report depressive symptoms while receiving smoking cessation counseling. This study examines time patterns in the quitting process among young smokers with or without notable depressive symptoms. The quitting trajectories of young smokers aged 12 to 25 (n = 578) who called the Youth Quitline in Hong Kong between March 2006 and May 2011 were recorded and analyzed through multiple telephone sessions over periods of up to 6 months. The time patterns of young smokers who had or did not have notable depressive symptoms were compared using nonparametric Kaplan–Meier methods with log-rank tests.
Among young smokers with low levels of nicotine dependence, those who had notable depressive symptoms were less likely to initiate a quit attempt within 28 days after their baseline telephone intervention (probability = .38 vs. .60; P value = .04). Furthermore, young smokers who had notable depressive symptoms were less likely to remain abstinent from smoking for 2 days after starting a quit attempt (probability = .50 vs. .64; P value = .012). Young adults aged 18 or above were more likely to relapse into smoking (adjusted HR = 1.50, 95% CI = 1.01, 2.22). Depressive symptoms may delay young smokers from initiating quit attempts and shorten their abstinence. A baseline screening process is suggested for identifying youths with co-occurring depressive disorder and nicotine dependence. Further studies should examine a collaborative model of smoking cessation that involves both counselors and physicians in preventing young smokers from rapid relapses after they make quit attempts.
Cooper J, Borland R, Yong HH, Fotuhi O.
The Impact of Quitting Smoking on Depressive Symptoms: Findings From the International Tobacco Control Four-Country Survey.
Addiction. 2016 Feb 25. doi: 10.1111/add.13367. [Epub ahead of print]
To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Prospective cohort with approximately annual waves. Mixed effect logistic regressions tested whether Time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether Time 1 (T1) symptoms moderated this relationship. Waves 5 to 8 of the Four Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, USA, UK and Australia. 6978 smokers who participated in telephone surveys.
T1 and T2 depressive symptoms in the last 4 weeks assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: 1) No attempt since T1; 2) Attempted and relapsed; 3) Attempted and abstinent at T2. Compared with no attempt, relapse was associated with reporting T2 symptoms (OR = 1.46, 95% CI:1.33,1.59). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was positively associated with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI:1.45,2.03) and those with T1 symptoms (OR = 1.45, 95% CI:1.23,1.70). Abstinence was positively associated for those without T1 symptoms (OR = 1.37, 95% CI:1.10,1.71) and negatively associated for those with T1 symptoms (OR = 0.74, 95% CI:0.59,0.94). Age significantly moderated these associations. Relapse did not predict T2 symptoms for those aged 18 to 39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18 to 39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40 to 55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged over 55 (OR = 1.97, 95% CI = 1.35, 2.87). Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people over age 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking.
Cooper J, Borland R, McKee SA, Yong HH, Dugué PA.
Depression Motivates Quit Attempts But Predicts Relapse: Differential Findings for Gender From the International Tobacco Control Study.
Addiction. 2016 Feb 17. doi: 10.1111/add.13290. [Epub ahead of print]
To determine whether signs of current depression predict attempts to quit smoking, and short-term abstinence among those who try, and to test moderating effects of gender and cessation support (pharmacological and behavioural). Prospective cohort with approximately annual waves. Among smokers at one wave we assessed outcomes at the next wave using mixed-effects logistic regressions. Waves 5-8 of the Four Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, USA, UK and Australia. A total of 6811 tobacco smokers who participated in telephone surveys.
Three-level depression index: (1) neither low positive affect (LPA) nor negative affect (NA) in the last 4 weeks; (2) LPA and/or NA but not diagnosed with depression in the last 12 months; and (3) diagnosed with depression. Outcomes were quit attempts and 1-month abstinence among attempters. Depression positively predicted quit attempts, but not after controlling for quitting history and motivational variables. Controlling for all covariates, depression consistently negatively predicted abstinence. Cessation support did not moderate this effect. There was a significant interaction with gender for quit attempts (P = 0.018) and abstinence (P = 0.049) after controlling for demographics, but not after all covariates. Depression did not predict abstinence among men. Among women, depressive symptoms [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.49-0.81] and diagnosis (OR = 0.46, 95% CI = 0.34-0.63) negatively predicted abstinence. Smokers with depressive symptoms or diagnosis make more quit attempts than their non-depressed counterparts, which may be explained by higher motivation to quit, but they are also more likely to relapse in the first month. These findings are stronger in women than men.
Alana M. Rojewski, Stephen Baldassarri, Nina A. Cooperman, Ellen R. Gritz, Frank T. Leone, Megan E. Piper, Benjamin A. Toll, and Graham W. Warren.
Exploring Issues of Comorbid Conditions in People Who Smoke.
Nicotine Tob Res
(2016)doi: 10.1093/ntr/ntw016First published online: January 17, 2016
Smoking affects comorbid disease outcomes, and patients with comorbid conditions may have unique characteristics that are important to consider when treating tobacco use. However, addressing tobacco in patients being treated for comorbid conditions is not a consistent practice. Recognizing the need for a “call-to-action” to address tobacco use in people with comorbid conditions, the Tobacco Treatment Network within the Society for Research on Nicotine and Tobacco (SRNT) convened a Comorbidities Workgroup to explore the relationship between smoking and comorbid disease to identify common themes including: the harms associated with continued tobacco use, the frequency of comorbid disease and tobacco use, the potential effect of comorbid disease on the ability to quit tobacco use, the association between tobacco use and suboptimal disease-specific treatment response, and evidence regarding potential approaches to improve addressing tobacco use in patients with comorbid disease. Five candidate conditions (psychiatric, cancer, cardiovascular, pulmonary, and human immunodeficiency virus infected patients) were explored. Across comorbid conditions, smoking adversely affects treatment efficacy and promotes other adverse health conditions. People with comorbid conditions who smoke are motivated to quit and respond to evidence-based smoking cessation treatments. However, tobacco cessation is not regularly incorporated into the clinical care of many individuals with comorbidities. Optimal strategies for addressing tobacco use within each comorbid disease are also not well defined. Further work is needed to disseminate evidence-based care into clinical practice for smokers with comorbid disease and addiction research should consider comorbid conditions as an important construct to explore.
This article explores how physical and psychiatric conditions may interact in the treatment of tobacco dependence, and discusses the need for smoking cessation as a critical component of comorbid condition management. Five common comorbid domains—psychiatric, cancer, pulmonary, cardiovascular, and human immunodeficiency virus (HIV)—are highlighted to illustrate how these different conditions might interact with smoking with respect to prevalence and harm, motivation to quit, and cessation treatment utilization and success.
Annette R. Kaufman, Amber R. Koblitz, Alexander Persoskie, Rebecca A. Ferrer, William M. P. Klein, Laura A. Dwyer and Elyse R. Park.
Factor Structure and Stability of Smoking-Related Health Beliefs in the National Lung Screening Trial.
Nicotine Tob Res (2016) 18 (3):321-329.doi: 10.1093/ntr/ntv091
Absolute and comparative risk perceptions, worry, perceived severity, perceived benefits, and self-efficacy are important theoretical determinants of tobacco use, but no measures have been validated to ensure the discriminant validity as well as test-retest reliability of these measures in the tobacco context. The purpose of the current study is to examine the reliability and factor structure of a measure assessing smoking-related health cognitions and emotions in a national sample of current and former heavy smokers in the National Lung Screening Trial. A sub-study of the National Lung Screening Trial assessed current and former smokers’ (age 55–74; N = 4379) self-reported health cognitions and emotions at trial enrollment and at 12-month follow-up. Items were derived from the Health Belief Model and Self-Regulation Model.
An exploratory factor analysis of baseline responses revealed a five-factor structure for former smokers (risk perceptions, worry, perceived severity, perceived benefits, and self-efficacy) and a six-factor structure for current smokers, such that absolute risk and comparative risk perceptions emerged as separate factors. A confirmatory factor analysis of 12-month follow-up responses revealed a good fit for the five latent constructs for former smokers and six latent constructs for current smokers. Longitudinal stability of these constructs was also demonstrated. This is the first study to examine tobacco-related health cognition and emotional constructs over time in current and former heavy smokers undergoing lung screening. This study found that the theoretical constructs were stable across time and that the factor structure differed based on smoking status (current vs. former).
Fucito LM1,2,3, Czabafy S4, Hendricks PS5, Kotsen C6, Richardson D7, Toll BA1,8,9; Association for the Treatment of Tobacco Use and Dependence (ATTUD)/Society for Research on Nicotine and Tobacco (SRNT) Synergy Committee.
Pairing Smoking-cessation Services with Lung Cancer Screening: A Clinical Guideline From the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco.
Cancer. 2016 Feb 24. doi: 10.1002/cncr.29926. [Epub ahead of print]
Smoking cessation is crucial for reducing cancer risk and premature mortality. The US Preventive Services Task Force (USPSTF) has recommended annual lung cancer screening with low-dose computed tomography (LDCT), and the Center for Medicare and Medicaid Services recently approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history. The Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) developed the guideline described in this commentary based on an illustrative literature review to present the evidence for smoking-cessation health benefits in this high-risk group and to provide clinical recommendations for integrating evidence-based smoking-cessation treatment with lung cancer screening. Unfortunately, extant data on lung cancer screening participants were scarce at the time this guideline was written. However, in this review, the authors summarize the sufficient evidence on the benefits of smoking cessation and the efficacy of smoking-cessation interventions for smokers ages 55 to 77 years to provide smoking-cessation interventions for smokers who seek lung cancer screening. It is concluded that smokers who present for lung cancer screening should be encouraged to quit smoking at each visit. Access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results, and motivation to quit should not be a necessary precondition for treatment. Follow-up contacts to support smoking-cessation efforts should be arranged for smokers. Evidence-based behavioral strategies should be used at each visit to motivate smokers who are unwilling to try quitting/reducing smoking or to try evidence-based treatments that may lead to eventual cessation. Cancer 2016. © 2016 American Cancer Society.
Kruger J, O'Halloran A, Rosenthal AC, Babb SD, Fiore MC.
Receipt of Evidence-based Brief Cessation Interventions by Health Professionals and Use of Cessation Assisted Treatments Among Current Adult Cigarette-only Smokers: National Adult Tobacco Survey, 2009-2010.
BMC Public Health. 2016 Feb 11;16(1):141. doi: 10.1186/s12889-016-2798-2.
Helping tobacco smokers to quit during a medical visit is a clinical and public health priority. Research suggests that most health professionals engage their patients in at least some of the '5 A's' of the brief cessation intervention recommended in the U.S. Public Health Service Clinical Practice Guideline, but information on the extent to which patients act on this intervention is uncertain. We assessed current cigarette-only smokers' self-reported receipt of the 5 A's to determine the odds of using optimal cessation assisted treatments (a combination of counseling and medication). Data came from the 2009-2010 National Adult Tobacco Survey (NATS), a nationally representative landline and mobile phone survey of adults aged ≥18 years. Among current cigarette-only smokers who visited a health professional in the past 12 months, we assessed patients' self-reported receipt of the 5 A's, use of the combination of counseling and medication for smoking cessation, and use of other cessation treatments. We used logistic regression to examine whether receipt of the 5 A's during a recent clinic visit was associated with use of cessation treatments (counseling, medication, or a combination of counseling and medication) among current cigarette-only smokers.
In this large sample (N = 10,801) of current cigarette-only smokers who visited a health professional in the past 12 months, 6.3 % reported use of both counseling and medication for smoking cessation within the past year. Other assisted cessation treatments used to quit were: medication (19.6 %); class or program (3.8 %); one-on-one counseling (3.7 %); and telephone quitline (2.6 %). Current cigarette-only smokers who reported receiving all 5 A's during a recent clinic visit were more likely to use counseling (odds ratio [OR]: 11.2, 95 % confidence interval [CI]: 7.1-17.5), medication (OR: 6.2, 95 % CI: 4.3-9.0), or a combination of counseling and medication (OR: 14.6, 95 % CI: 9.3-23.0), compared to smokers who received one or none of the 5 A's components. Receipt of the '5 A's' intervention was associated with a significant increase in patients' use of recommended counseling and medication for cessation. It is important for health professionals to deliver all 5 A's when conducting brief cessation interventions with patients who smoke.
Jessica A. Kulak, Monica E. Cornelius, Geoffrey T. Fong, Gary A. Giovino.
Differences in Quit Attempts and Cigarette Smoking Abstinence Between Whites and African Americans in the United States: Literature Review and Results From the International Tobacco Control US Survey.
Nicotine Tob Res (2016) 18 (suppl 1): S79-S87. doi: 10.1093/ntr/ntv228
While cigarette smoking prevalence is declining among US adults, quit rates may differ between white and African American smokers. Here, we summarize the literature on smoking cessation behaviors in whites and African Americans across four study designs and report the findings of new analyses of International Tobacco Control (ITC) US Survey cohort data. We reviewed 32 publications containing 39 relevant analyses that compared quit attempts and abstinence between US whites and African Americans. Two additional longitudinal analyses were conducted on 821 white and 76 African American cigarette smokers from Waves 7 and 8 of the ITC US Survey (mean follow-up = 19 months).
Of 17 total analyses of quit attempts, nine (including the ITC US Survey) observed that African American smokers were more likely than whites to attempt to quit during a given year; seven found no differences. Whites were more likely than African Americans to be abstinent in five of six retrospective cohort analyses and in two of five considered community- and population-based cohort studies. Four of these 11 analyses, including one from the ITC US Survey, found no differences. Of 11 population- or community-based analyses, all seven that found significant differences indicated that whites were more likely to quit than African Americans. These findings, combined with the similar results from population-based birth cohort analyses, support the conclusion that white smokers are more likely to quit than African American smokers. Efforts to encourage and support quitting among all tobacco users remain a priority. This article provides a review of the literature on smoking cessation among African American and white smokers, and adds new analyses that compare quit attempts and abstinence between US African Americans and whites. Results demonstrate a clear distinction between the findings of cross-sectional and retrospective cohort studies with those of cohort studies. Reasons for these differences merit further study.
Sally C. Curtin, and T.J. Mathews.
Smoking Prevalence and Cessation Before and During Pregnancy: Data From the Birth Certificate, 2014.
National Vital Statistics Reports Volume 65, Number 1 February 10, 2016
This report presents findings for 2014 on maternal smoking prevalence and cessation before and during pregnancy as collected on the 2003 U.S. Standard Certificate of Live Birth, for a 46-state and District of Columbia reporting area, representing 95% of all births in the United States. Cigarette smoking and cessation rates 3 months before and during pregnancy are presented by maternal age; race and ethnicity; marital status; educational attainment; source of payment at delivery (private insurance, Medicaid, and self-pay); receipt of benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children; prenatal care initiation; and jurisdiction.
About 1 in 10 women who gave birth in 2014 smoked during the 3 months before pregnancy (10.9%), and about one-quarter of these women (24.2%) did not smoke during pregnancy (i.e., quit before pregnancy). The smoking rate at any time during pregnancy was 8.4%, with 20.6% of women who smoked in the first or second trimesters quitting by the third trimester. Smoking during pregnancy was more prevalent for women aged 20–24 (13.0%) than for other ages, and by race and Hispanic origin, the highest rate was for non- Hispanic American Indian or Alaska Native women (18.0%). Smoking during pregnancy ranged from 1.8% in California to 27.1% in West Virginia. The highest smoking cessation rates before and during pregnancy were for women with the highest educational attainment, private insurance, and non-Hispanic Asian and Hispanic race and ethnicity. On average, women who continued to smoke during pregnancy smoked fewer cigarettes as the pregnancy progressed, from 13 per day before pregnancy to 9 per day by the third trimester.
Chen JS, Nguyen AH, Malesker MA, Morrow LE.
High-Risk Smoking Behaviors and Barriers to Smoking Cessation Among Homeless Individuals.
Respir Care. 2016 Feb 9. pii: respcare.04439. [Epub ahead of print]
Although tobacco practices and the effects of tobacco use among the general American population are well described, minimal data exist regarding tobacco use and barriers to smoking cessation among homeless individuals. Anonymous, voluntary surveys based on a previously implemented instrument were completed by 100 smoking individuals residing at a homeless shelter. These surveys assessed high-risk smoking behaviors and respondents' perceived barriers to long-term smoking cessation.
Ninety percent of study participants reported engaging in at least one of the high-risk tobacco practices. Nicotine replacement therapy was perceived by respondents to be the most desired form of smoking cessation aid. Excessive stress with use of tobacco smoking to alleviate stress and anxiety was the most significant self-perceived barrier to smoking cessation. High-risk tobacco practices are remarkably common among smoking homeless individuals. Despite literature consistently showing that non-nicotine tobacco cessation pharmacotherapies (varenicline, buproprion) have higher smoking cessation rates, nicotine replacement monotherapy was perceived as more valuable by survey respondents. Although lack of financial resources was expected to be the biggest barrier to successful cessation, social stressors and the use of smoking to cope with homelessness were perceived as a greater obstacle in this cohort. Given the paucity of data on the long-term effects of the high-risk tobacco behaviors reported by these homeless smokers, this study highlights the need for further investigations regarding tobacco use and tobacco cessation in this vulnerable population.
Hile SJ, Feldman MB, Alexy ER, Irvine MK.
Recent Tobacco Smoking is Associated with Poor HIV Medical Outcomes Among HIV-Infected Individuals in New York.
AIDS Behav. 2016 Feb 2. [Epub ahead of print]
Tobacco smoking is associated with adverse health effects among people living with HIV (PLWH), including a higher risk of cancer and cardiovascular problems. Further, there is evidence that PLWH are two to three times more likely to smoke than the general population. The aim of this study was to examine the association between tobacco smoking and biomarkers of HIV disease progression, including unsuppressed viral load (viral load >200 copies/mL) and low CD4 cell count (<200 cells/mm3). Recent tobacco smoking was reported by 40 % (n = 5942) of 14,713 PLWH enrolled in Ryan White Part A programs in the New York City metropolitan area. In multivariate analyses controlling for sociodemographic and clinical characteristics, recent tobacco smoking was independently associated with unsuppressed viral load (AOR = 1.38, CI 1.26-1.50) and low CD4 cell count (AOR = 1.12, CI 1.01-1.24). Findings suggest the importance of routine assessments of tobacco use in clinical care settings for PLWH.
Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P
Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial.
Ann Intern Med. 2016 Mar 15. doi: 10.7326/M14-2805. [Epub ahead of print]
Most smoking cessation guidelines advise quitting abruptly. However, many quit attempts involve gradual cessation. If gradual cessation is as successful, smokers can be advised to quit either way. To examine the success of quitting smoking by gradual compared with abrupt quitting.Randomized, controlled noninferiority trial. (International Standardized Randomized Controlled Trial Number Register: ISRCTN22526020).Primary care clinics in England.697 adult smokers with tobacco addiction.Participants quit smoking abruptly or reduced smoking gradually by 75% in the 2 weeks before quitting. Both groups received behavioral support from nurses and used nicotine replacement before and after quit day.
The primary outcome measure was prolonged validated abstinence from smoking 4 weeks after quit day. The secondary outcome was prolonged, validated, 6-month abstinence. At 4 weeks, 39.2% (95% CI, 34.0% to 44.4%) of the participants in the gradual-cessation group were abstinent compared with 49.0% (CI, 43.8% to 54.2%) in the abrupt-cessation group (relative risk, 0.80 [CI, 0.66 to 0.93]). At 6 months, 15.5% (CI, 12.0% to 19.7%) of the participants in the gradual-cessation group were abstinent compared with 22.0% (CI, 18.0% to 26.6%) in the abrupt-cessation group (relative risk, 0.71 [CI, 0.46 to 0.91]). Participants who preferred gradual cessation were significantly less likely to be abstinent at 4 weeks than those who preferred abrupt cessation (38.3% vs 52.2%; P = 0.007).Blinding was impossible. Most participants were white.Quitting smoking abruptly is more likely to lead to lasting abstinence than cutting down first, even for smokers who initially prefer to quit by gradual reduction.
van der Tempel J, Noormohamed A, Schwartz R, Norman C, Malas M, Zawertailo L
Vape, Quit, Tweet? Electronic Cigarettes and Smoking Cessation on Twitter.
Int J Public Health. 2016 Feb 3. [Epub ahead of print]
Individuals seeking information about electronic cigarettes are increasingly turning to social media networks like Twitter. We surveyed dominant Twitter communications about e-cigarettes and smoking cessation, examining message sources, themes, and attitudes. Tweets from 2014 were searched for mentions of e-cigarettes and smoking cessation. A purposive sample was subjected to mixed-methods analysis. Twitter communication about e-cigarettes increased fivefold since 2012. In a sample of 300 tweets from high-authority users, attitudes about e-cigarettes as smoking cessation aids were favorable across user types (industry, press, public figures, fake accounts, and personal users), except for public health professionals, who lacked consensus and contributed negligibly to the conversation. The most prevalent message themes were marketing, news, and first-person experiences with e-cigarettes as smoking cessation aids. We identified several industry strategies to reach Twitter users. Our findings show that Twitter users are overwhelmingly exposed to messages that favor e-cigarettes as smoking cessation aids, even when disregarding commercial activity. This underlines the need for effective public health engagement with social media to provide reliable information about e-cigarettes and smoking cessation online.
John H. Hwang, Matthew Lyes, Katherine Sladewski, Shymaa Enany, Elisa McEachern, Denzil P. Mathew, Soumita Das, Alexander Moshensky, Sagar Bapat, et al.
Electronic Cigarette Inhalation Alters Innate Immunity and Airway Cytokines While Increasing the Virulence of Colonizing Bacteria.
Journal of Molecular Medicine.First online: 25 January 2016. doi:10.1007/s00109-016-1378-3
Electronic (e)-cigarette use is rapidly rising, with 20 % of Americans ages 25–44 now using these drug delivery devices. E-cigarette users expose their airways, cells of host defense, and colonizing bacteria to e-cigarette vapor (EV). Here, we report that exposure of human epithelial cells at the air–liquid interface to fresh EV (vaped from an e-cigarette device) resulted in dose-dependent cell death. After exposure to EV, cells of host defense—epithelial cells, alveolar macrophages, and neutrophils—had reduced antimicrobial activity against Staphylococcus aureus (SA). Mouse inhalation of EV for 1 h daily for 4 weeks led to alterations in inflammatory markers within the airways and elevation of an acute phase reactant in serum. Upon exposure to e-cigarette vapor extract (EVE), airway colonizer SA had increased biofilm formation, adherence and invasion of epithelial cells, resistance to human antimicrobial peptide LL-37, and up-regulation of virulence genes. EVE-exposed SA were more virulent in a mouse model of pneumonia. These data suggest that e-cigarettes may be toxic to airway cells, suppress host defenses, and promote inflammation over time, while also promoting virulence of colonizing bacteria
Neill Bruce Baskerville, Sunday Azagba, Cameron Norman, Kyle McKeown, and K. Stephen Brown.
Effect of a Digital Social Media Campaign on Young Adult Smoking Cessation.
Nicotine Tob Res (2016) 18 (3):351-360.doi: 10.1093/ntr/ntv119
Social media (SM) may extend the reach and impact for smoking cessation among young adult smokers. To-date, little research targeting young adults has been done on the use of SM to promote quitting smoking. We assessed the effect of an innovative multicomponent web-based and SM approach known as Break-it-Off (BIO) on young adult smoking cessation. The study employed a quasi-experimental design with baseline and 3-month follow-up data from 19 to 29-year old smokers exposed to BIO (n = 102 at follow-up) and a comparison group of Smokers’ Helpline (SHL) users (n = 136 at follow-up). Logistic regression analysis assessed differences between groups on self-reported 7-day and 30-day point prevalence cessation rates, adjusting for ethnicity, education level, and cigarette use (daily or occasional) at baseline.
The campaign reached 37 325 unique visitors with a total of 44 172 visits. BIO users had significantly higher 7-day and 30-day quit rates compared with users of SHL. At 3-month follow-up, BIO participants (32.4%) were more likely than SHL participants (14%) to have quit smoking for 30 days (odds ratio = 2.95, 95% CI = 1.56 to 5.57, P < .001) and BIO participants (91%) were more likely than SHL participants (79%) to have made a quit attempt (odds ratio = 2.69, 95% CI = 1.03 to 6.99, P = .04). The reach of the campaign and findings on quitting success indicate that a digital/SM platform can complement the traditional SHL cessation service for young adult smokers seeking help to quit.
Cornelia Pechmann, Kevin Delucchi, Cynthia M Lakon, Judith J Prochaska
Randomised Controlled Trial Evaluation of Tweet2Quit: a Social Network Quit-smoking Intervention.
We evaluated a novel Twitter-delivered intervention for smoking cessation, Tweet2Quit, which sends daily, automated communications to small, private, self-help groups to encourage high-quality, online, peer-to-peer discussions. A 2-group randomised controlled trial assessed the net benefit of adding a Tweet2Quit support group to a usual care control condition of nicotine patches and a cessation website. Participants were 160 smokers (4 cohorts of 40/cohort), aged 18–59 years, who intended to quit smoking, used Facebook daily, texted weekly, and had mobile phones with unlimited texting. All participants received 56 days of nicotine patches, emails with links to the smokefree.gov cessation website, and instructions to set a quit date within 7 days. Additionally, Tweet2Quit participants were enrolled in 20-person, 100-day Twitter groups, and received daily discussion topics via Twitter, and daily engagement feedback via text.
The primary outcome was sustained abstinence at 7, 30 and 60 days post-quit date. Participants (mean age 35.7 years, 26.3% male, 31.2% college degree, 88.7% Caucasian) averaged 18.0 (SD=8.2) cigarettes per day and 16.8 (SD=9.8) years of smoking. Participants randomised to Tweet2Quit averaged 58.8 tweets/participant and the average tweeting duration was 47.4 days/participant. Tweet2Quit doubled sustained abstinence out to 60 days follow-up (40.0%, 26/65) versus control (20.0%, 14/70), OR=2.67, CI 1.19 to 5.99, p=0.017. Tweeting via phone predicted tweet volume, and tweet volume predicted sustained abstinence (p<0.001). The daily autocommunications caused tweeting spikes accounting for 24.0% of tweets. Tweet2Quit was engaging and doubled sustained abstinence. Its low cost and scalability makes it viable as a global cessation treatment.
Siahpush M, Shaikh RA, Smith D, Hyland A, Cummings KM, Kessler AS, Dodd MD, Carlson L, Meza J, Wakefield M.
The Association of Exposure to Point-of-Sale Tobacco Marketing with Quit Attempt and Quit Success: Results from a Prospective Study of Smokers in the United States.
Int J Environ Res Public Health. 2016 Feb 6;13(2). pii: E203. doi: 10.3390/ijerph13020203.
The aim was to assess the association of exposure to point-of-sale (POS) tobacco marketing with quit attempt and quit success in a prospective study of smokers in the United States. Data were collected via telephone-interview on exposure to POS tobacco marketing, sociodemographic and smoking-related variables from 999 smokers in Omaha, Nebraska, in the United States. Exposure to POS tobacco marketing was measured by asking respondents three questions about noticing pack displays, advertisements, and promotions in their respective neighborhoods stores. These three variables were combined into a scale of exposure to POS tobacco marketing. About 68% of the respondents participated in a six-month follow-up phone interview and provided data on quit attempts and smoking cessation. At the six-month follow-up, 39.9% of respondents reported to have made a quit attempt, and 21.8% of those who made a quit attempt succeeded in quitting. Exposure to POS marketing at baseline was not associated with the probability of having made a quit attempt as reported at the six-month follow-up (p = 0.129). However, higher exposure to POS marketing was associated with a lower probability of quit success among smokers who reported to have attempted to quit smoking at six-month follow-up (p = 0.006). Exposure to POS tobacco marketing is associated with lower chances of successfully quitting smoking. Policies that reduce the amount of exposure to POS marketing might result in higher smoking cessation rates.
Centers for Disease Control and Prevention.
Promoting Quitting Among Adults and Young People: Outcome Indicators for Comprehensive Tobacco Control Programs—2015.
Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2015.
This update provides a revised logic model and 46 outcome indicators for Goal Area 3 of the National Tobacco Control Program, which addresses promoting quitting among adults and young people.