Original Articles
Characteristics of LGBT Quitline Callers Across 14 States
- Amy V. Lukowski, Chad Morris, Susan E. Young, David Tinkelman
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- Published online by Cambridge University Press:
- 09 August 2016, pp. 183-189
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The lesbian, gay, bisexual, and transgender (LGBT) communities in the United States are disproportionately impacted by smoking, including incidence rates and a lower rate of cessation success. Previous studies have shown that the emotional impact of social stigma and discrimination have contributed to this pronounced health disparity. Utilising data from three years of quitline callers receiving cessation treatment from National Jewish Health, we examine how LGBT callers differ from straight/heterosexual callers in terms of demographic characteristics, tobacco use history, and the prevalence and consequences of emotional or mental health problems. Findings suggest that the LGBT population begins using tobacco in pre-adolescence at a much higher rate than other quitline callers. The most striking finding is that the LGBT callers report higher rates of mental health issues than other callers. In addition, these individuals feel that their mental health issues negatively impact their ability to have a successful quit attempt. This study contributes to the broader understanding of factors associated with elevated rates of tobacco use in the LGBT community, which may inform potential specialised prevention and cessation efforts for this high-risk population.
Smoking Cessation Interventions Amongst New Zealand Dental Students: A Survey
- Deepa Mistry, Jonathan Broadbent, Colleen Murray
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- Published online by Cambridge University Press:
- 05 August 2016, pp. 190-198
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Introduction: The NZ Government has set the goal of a smoke-free country by 2025. Research has shown that NZ dentists engage little in promotion of smoking cessation amongst their patients. The knowledge of, and attitudes towards, smoking cessation interventions of NZ dental students has not previously been reported.
Aims: To investigate smoking cessation intervention practices of clinical dental students and explore perceived barriers to their delivery.
Methods: A survey was conducted of all students in the three clinical years of the 5-year New Zealand dental training programme.
Results: The response rate was 73.7%. At least half of the participants did not recall the inclusion of smoking cessation intervention information in the curriculum. The majority (70.9%) used a routine protocol to identify smokers. Almost two-thirds felt that smoking cessation interventions are important, whilst two-fifths felt it is their duty as a health professional. Lack of knowledge and time were the most common barriers.
Conclusions: Although most dental students identify patients who smoke, the majority provide no cessation intervention services. This appears to be due to a lack of knowledge about available organisations and referral procedures. As future health professionals, dental students need better education in this area.
Protocol
Who Opted Out of an Opt-Out Smoking-Cessation Programme for Hospitalised Patients?
- Georges J. Nahhas, K. Michael Cummings, Vince Talbot, Matthew J. Carpenter, Benjamin A. Toll, Graham W. Warren
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- Published online by Cambridge University Press:
- 31 August 2016, pp. 199-204
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Introduction: The Medical University of South Carolina (MUSC) hospital implemented an inpatient opt-out smoking-cessation service where smokers received a mandatory smoking-cessation consult and phone follow-up within 1-month post-discharge.
Aim: To examine predictors of patients who opted-out of bedside counselling or follow-up phone calls.
Methods: Eligible adult cigarette smokers admitted to the MUSC hospital were enrolled in the programme. Opting-out of bedside consult or follow-up calls were assessed separately using log-linear modelling where predictors included patient demographics, length of hospitalisation, insurance type, smoking history, and motivation/confidence to quit.
Results: Of the 38,758 admitted patients (February 2014–May 2015), 6,684 reported currently smoking and were automatically referred to bedside-consult. Approximately 26% of smokers made contact with the counselor, most of whom (83%) accepted the consult. Amongst patients eligible for post-discharge follow-up (n = 3485), 49% responded to the calls. Those who opted-out of the bedside-consult were mostly males (RR = 1.29). Those who did not respond to follow-up calls were younger age (RR = 1.33), with Medicaid/no insurance (RR = 1.17), and had not received a bedside consult (RR = 1.32).
Conclusions: An opt-out smoking-cessation programme was feasible and acceptable to most patients and was able to reach 65% of eligible smokers; 17% opted-out of bedside counselling; <1% asked to be removed from further phone calls.
Original Articles
Triggers of Smoking Lapses Over the Course of a Quit Attempt
- Stuart G. Ferguson, Saul Shiffman, Leigh Blizzard
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- Published online by Cambridge University Press:
- 31 August 2016, pp. 205-212
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Introduction: Both withdrawal severity and smoking cues can trigger lapses. However, the temporal relationship between these two sets of triggers is unknown.
Aims: To explore the time course of lapse triggers during a quit attempt.
Methods: Across two cessation studies, 186 lapsers monitored their smoking in real-time for up to 7 weeks over the course of a quit attempt. During lapses, participants were asked to report the primary trigger of the event; this, including the time of the event relative to quit day, was logged by an electronic diary. Log multinomial regression was used to estimate the probability that each lapse would be withdrawal-triggered or cue-triggered.
Results: Log multinomial regression showed that the probability of a first lapse being triggered by withdrawal rose in the initial days of a quit attempt before dropping as the quit attempt progressed (P < 0.01). The probability of a cue-triggered lapse rose over the course of a quit attempt (P < 0.05).
Conclusions: The results are consistent both with the time course of withdrawal symptoms and with theoretical predictions about the relationship between nicotine dependence and stimulus control. The results have implications for tailoring smoking-cessation treatments; in particular, for the stepwise provision of smoking-cessation assistance over the course of a quit attempt.
Content and Methods used to Train Tobacco Cessation Treatment Providers: An International Survey
- Gina R. Kruse, Nancy A. Rigotti, Martin Raw, Ann McNeill, Rachael Murray, Hembadoon Piné-Abata, Asaf Bitton, Andy McEwen
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- Published online by Cambridge University Press:
- 03 October 2016, pp. 213-220
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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 programmes around the world.
Methods: Web-based survey in May–September 2013 amongst tobacco cessation training experts across six geographic regions and four World Bank income levels. In total, 104 individual training programmes responded.
Results: Of 104 individual programmes, most reported teaching brief advice (78%) and one-to-one counselling (74%); telephone counselling was uncommon (33%). Overall, teaching of knowledge topics was more commonly reported than skills training. Programmes in lower income countries less often reported teaching about medications, behavioural 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. Programmes reported a median 15 hours of training. Face-to-face training was common (85%); online programmes were rare (19%). Almost half (47%) included no learner assessment. Most (65%) offered no continuing education.
Conclusions: Nearly all programmes reported teaching evidence-based treatment modalities in a face-to-face format. Few programmes delivered training online or offered continuing education. Skills-based training was less common amongst low- and middle-income countries (LMICs). There is an unmet need for tobacco treatment training protocols which emphasise practical skills and which are more rapidly scalable than face-to-face training in LMICs.
Smoking Cessation Care for People with a Mental Illness: Family Carer Expectations of Health and Community Services
- Jacqueline M. Bailey, Paula M. Wye, Emily A. Stockings, Kate M. Bartlem, Alexandra P. Metse, John H. Wiggers, Jennifer A. Bowman
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- Published online by Cambridge University Press:
- 22 November 2016, pp. 221-230
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Introduction: Smoking prevalence remains high among people with a mental illness, contributing to higher levels of morbidity and mortality. Health and community services are an opportune setting for the provision of smoking cessation care. Although family carers are acknowledged to play a critical role in supporting the care and assistance provided by such services to people with a mental illness, their expectations regarding the delivery of smoking cessation care have not been examined.
Aims: To explore family carer expectations of smoking cessation care provision by four types of health services, to clients with a mental illness, and factors associated with expectations.
Methods: A cross-sectional survey was conducted with carers of a person with a mental illness residing in New South Wales, Australia. Carers were surveyed regarding their expectations of smoking cessation care provision from four types of health services. Possible associations between carer expectation of smoking cessation care provision and socio-demographic and attitudinal variables were explored.
Results: Of 144 carers, the majority of carers considered that smoking cessation care should be provided by: mental health hospitals (71.4%), community mental health services (78.0%), general practice (82.7%), and non-government organisations (56.6%). The factor most consistently related to expectation of care was a belief that smoking cessation could positively impact mental health.
Conclusions: The majority of carers expected smoking cessation treatment to be provided by all services catering for people with a mental illness, reinforcing the appropriateness for such services to provide smoking cessation care for clients in an effective and systematic manner.
SmokefreeTXT Behaviour Change Technique Analysis
- Iva Stoyneva, Kisha Coa, Jillian Pugatch, Amy Sanders, Mary Schwarz, Heather Cole-Lewis
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- Published online by Cambridge University Press:
- 20 December 2016, pp. 231-243
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Mobile text-messaging smoking cessation interventions have demonstrated their efficacy in increasing cessation rates. These interventions tend to be multifaceted and there is a need to specify their building blocks. The purpose of this study was to use the Behavioural Change Techniques Taxonomy V1 (BCTTv1) to systematically analyse the behaviour change techniques present in the SmokefreeTXT (SFTXT) adult programme. The entire SFTXT library was coded using the BCTTv1. Frequencies were calculated to assess the presence of BCT groups and unique BCTs in the entire programme. The mix of BCTs was also examined by programme week and during periods of high user dropout. Of the 16 groups of behavioural techniques, 14 were present in SFTXT. Of the 93 distinct BCTs, 41 were present in the full SFTXT message library. The most prevalent BCT groups were Feedback and Monitoring, Natural Consequences, Social Support, and Shaping Knowledge. There were differences in the mix of BCTs across the duration of the intervention. The results will enable us to test how changes in the use of specific BCTs and their frequency of use over time, impact (1) engagement with the programme (particularly during the days with high dropout rates), and (2) smoking cessation outcomes over time.