Original Articles
Household Smoking Restrictions Relate to Time to First Cigarette Smoked in the Morning
- Marc L. Steinberg, Naomi F. Stahl, Jill M. Williams
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- Published online by Cambridge University Press:
- 24 February 2015, pp. 1-5
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Introduction: The time a smoker waits until the first cigarette of the morning is often used as a measure of dependence with the rationale that more dependent smokers will smoke sooner upon waking than will less dependent smokers after going several hours without a cigarette overnight.
Aims: We sought to examine the relationship between time-to-first-cigarette (TTFC) and household smoking restrictions in two independent samples.
Methods: Two samples of smokers, one treatment-seeking community sample (N = 433) and one non-treatment seeking sample of smokers with serious mental illness (i.e., Schizophrenia, Schizoaffective Disorder, or Bipolar I Disorder) (N = 94), provided information on cigarette dependence with the Fagerström Test for Nicotine Dependence (FTND) and on household smoking restrictions.
Results: Half (50%) of smokers with serious mental illness and 36.7% of smokers from the general population reported that there were no limitations to smoking in their home. Household smoking restrictions were significantly and positively related to TTFC in both samples.
Conclusions: These data indicate that greater attention to TTFC may be warranted. The TTFC item is intended to measure dependence based on the premise that greater dependence should be associated with shorter TTFC. If TTFC is related to a household smoking ban, however, this item may not be assessing dependence as intended in some cases.
A Cross-Sectional Study of Happiness and Smoking Cessation Among Parents
- Jeremy E. Drehmer, Bethany Hipple, Deborah J. Ossip, Emara Nabi-Burza, Jonathan P. Winickoff
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- 24 March 2015, pp. 6-14
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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: The aim of this study was to determine if parental smoking cessation is associated with increased happiness and to identify characteristics of parental quitters who experience increased happiness.
Methods: A total of 1,355 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 paediatricians know that most parents who smoke report being happier when quitting may facilitate communication with parents around cessation.
Mixed-Methods for Comparing Tobacco Cessation Interventions
- Behnoosh Momin, Antonio Neri, Lei Zhang, Jennifer Kahende, Jennifer Duke, Sonya Goode Green, Ann Malarcher, Sherri L. Stewart
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- Published online by Cambridge University Press:
- 05 May 2015, pp. 15-21
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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 (CER) 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 seven 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.
Review Article
Descriptive Evaluation of a Smoking Cessation Support Service for Chronic Disease Clients Within a Hospital Admissions Risk Program
- Pam Shields, Robyn Bradley, Marnie Graco, A. Hutchinson
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- 15 June 2015, pp. 22-31
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Introduction: The Northern Alliance HARP smoking cessation program provides support to chronic disease participants who desired to quit smoking. This is an individualised program with pharmacotherapy and behavioural support, delivered by specialist clinicians.
Aims: The aims of this descriptive evaluation were to explore factors that affect abstinence rates, record those rates, and describe the impact of anxiety, depression, self-efficacy, quality of life and motivation on quit rates at three months.
Methods: Data was collected prospectively from clients enrolled in the service. Participants were assessed for abstinence at three months, six months and one year by carbon monoxide (CO) monitoring and self-reporting. Factors predictive of quitting were analysed using logistic regression; factors with a p value < 0.05 and 95% CI not containing one were considered statistically significant.
Results: 103 clients were assessed and 86 were enrolled in the program. The odds of successful quitting at three months CO verified was higher amongst completers of the program compared to non-completers (OR = 6.6, 95% CI = 2.03–21.57, p = 0.002). The probability of sustained quitting at one year was over 18 times higher in the group who completed the program (n = 16/21 completers and n = 1/4 non-completers) (OR 18.5, 95% CI, 2.32–147.34, p = 0.006). No other factors predicted quitting.
The rate of quitting was 28.7% at three months, 19.5% at six months and 10.3% at one year, CO verified. Measures of anxiety and depression, self-efficacy, quality of life and motivation did not influence either the quit rate or the likelihood of completing the course of treatment at three months.
Original Articles
Motivations for Smoking Cessation and the Impact of Regulatory Tax Increases Amongst Fathers within the Pacific Islands Families Study
- El-Shadan Tautolo, Leon Iusitini, Steve Taylor, Janis Paterson
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- Published online by Cambridge University Press:
- 17 June 2015, pp. 32-37
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Aims: To examine the prevalence of smoking, motivations for cessation, and impact of tobacco excise tax increases amongst a cohort of Pacific fathers at 11 years after the birth of their child.
Methods: Within the context of broader interviews, 723 Pacific fathers participating in the Pacific Islands Families (PIF) Study were surveyed about their smoking at the 11-year measurement point. Prevalence of smoking was calculated, alongside motivations to quit, and the impact of increases to the excise tax on tobacco.
Results: Smoking prevalence amongst Pacific fathers remains high (38%) at 11 years postpartum, although 81% of smokers disclosed interest in quitting smoking. The strongest motivation to quit smoking was their ‘own health’ (n = 185, 82%), followed by ‘the cost’ (n = 148, 66%), and the impact on ‘their child's health’ (n = 113, 50%). Among smokers, 12% (n = 31) had never attempted to quit, whereas 63% (n = 159) had made multiple attempts. Approximately 70% (n = 191) of smokers indicated the New Zealand Government-initiated tobacco excise tax increases caused them to reduce their tobacco consumption.
Conclusions: High smoking prevalence amongst this cohort raises serious concerns about the risks Pacific families and communities face from smoking. Maintaining a sustained series of tobacco excise tax increases, alongside the utilisation of information on key motivators for Pacific fathers to quit smoking, may prove more effective in supporting Pacific communities to achieve the New Zealand Government's Smokefree 2025 goal.
Validation of Non-Smoking Status by Spouse Following a Cessation Intervention
- Raul M. Mejia, Sandra Braun, Lorena Peña, Steven E. Gregorich, Eliseo J. Pérez-Stable
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- Published online by Cambridge University Press:
- 15 June 2015, pp. 38-42
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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.
Letter
Vaping Shadows Tobacco Control: Imperatives for Malaysia
- Keivan Ahmadi, Ireneous N. Soyiri
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- Published online by Cambridge University Press:
- 17 June 2015, pp. 43-44
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Electronic cigarettes (e-cigarettes) have been the subject of numerous debates in the literature. (Bullen et al., 2013; Cressey, 2014; The Lancet, 2013) So much discussion has been on it this year alone to the extent that the word vape, which means ‘to inhale and exhale the vapour produced by an e-cigarette or similar device’, has become the Oxford Dictionaries Word of the year. E-cigarettes have gained popularity amongst the youth who are smokers and want to quit as well as among children and adult non-smokers who fancy it. (Centers for Disease Control and Prevention, 2013; Dawkins, Turner, Roberts & Soar, 2013; Emery, Vera, Huang & Szczypka, 2014; News & Angeles, n.d.; Serrie, 2014; US Drug and Food Administration, 2014) Even in rural communities in middle- and low-income countries, their availability in shopping centres and through multilevel marketing schemes is common (I.N.S., unpublished observation/data).
Original Articles
Utilisation of Nicotine Replacement Therapy within a Hospital Pharmacist Initiated Smoking-Cessation Intervention – A Pragmatic Randomised Controlled Trial
- D. Gupta, K. Winckel, J. Burrows, J. Ross, J. W. Upham
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- Published online by Cambridge University Press:
- 02 October 2015, pp. 45-54
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Introduction: Hospital pharmacists currently play a limited role in the management of nicotine withdrawal and smoking-cessation. They have multiple tasks and limited time; a strong evidence base is required to determine importance of including smoking-cessation interventions into their routine practice.
Aims: The aims of this study were to evaluate the effectiveness of a hospital pharmacist initiated smoking-cessation intervention (SCI) in increasing the utilisation of Nicotine Replacement Therapy (NRT) in hospitalised smokers, and in increasing quit rates post-discharge.
Methods: This study was conducted in a tertiary referral hospital using a pragmatic randomised control design. After screening, 100 inpatient smokers were enrolled and randomised by the research pharmacist (RP) to either the intervention or usual care arm (n = 50 for both arms). Smoking-cessation advice was available to all smokers during their hospital stay under the smoking management policy, which represented usual care. However, this approach is often unstructured and provided on an ad-hoc basis. Those in the intervention arm received brief SCI from the RP, who also facilitated NRT prescribing if required. Prescribing rates of NRT in the hospital and on discharge in both the groups were compared. Participants were contacted by phone three-months after enrolment to assess their seven-day point prevalence of abstinence (PPA) from smoking and use of NRT post-discharge.
Results: A significantly higher proportion of participants in the intervention arm used NRT in the hospital (82% vs. 24%, Χ2 = 33.8, p < 0.001) and at discharge (68% vs. 12%, Χ2 = 32.7, p < 0.0001) and significantly more participants who received SCI from the RP continued to use NRT after discharge (OR 3.1, CI 1.2 to 8.2). A similar number of participants in both the groups claimed seven-day PPA after three-months (18% usual-care vs. 15% intervention-arm, OR 0.8, CI 0.24 to 2.67).
Conclusions: Hospital pharmacist led brief SCI can enhance the utilisation of NRT in hospital and after discharge; there was no clear effect on cessation rates at three months. There is a need to explore feasible options for a coordinated, multidisciplinary approach to smoking-cessation in hospital and across the continuum, which may have a greater impact on long term smoking-cessation rates.
Factors Associated with the Adoption of Tobacco Cessation Programmes in Schools
- Melissa A. Little, Pallav Pokhrel, Steve Sussman, Karen J. Derefinko, Zoran Bursac, Louise Ann Rohrbach
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- Published online by Cambridge University Press:
- 02 February 2016, pp. 55-62
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Background: Although there are now a number of evidence-based tobacco use cessation programs available for dissemination, almost all adolescent tobacco cessation research comprises efficacy and effectiveness studies. As a result, there is a need for more research to guide the scaling up of these programs.
Methods: The current study utilized data from a cross-sectional sample of 205 administrators and tobacco prevention program coordinators in school districts and county offices of education throughout California, to explore factors that affect the adoption of tobacco cessation programs in schools.
Results: We found that several characteristics of the community, organization and individual respondent were associated with the adoption of evidence-based tobacco cessation programs in schools, including identifying tobacco use prevention as a community priority, having school-level SUP coordinators, greater coordinator effort devoted to tobacco use prevention, having a program champion, and currently receiving TUPE funds (all ps < .05).
Conclusions: Although the availability of dedicated tobacco education funds is an important factor in schools adopting tobacco cessation programs with proven effectiveness, our results suggest that strengthening education agencies' capacity to implement prevention programming, through dedicated resources and personnel, has the potential to lead to increased adoption of tobacco cessation programs.