Effectiveness of tobacco cessation interventions for different groups of tobacco users in Sweden: a study protocol for a national prospective cohort study.

INTRODUCTION: Tobacco is still one of the single most important risk factors among the lifestyle habits that cause morbidity and mortality in humans. Furthermore, tobacco has a heavy social gradient, as the consequences are even worse among disadvantaged and vulnerable groups. To reduce tobacco-related inequity in health, those most in need should be offered the most effective tobacco cessation intervention. The aim of this study is to facilitate and improve the evaluation of already implemented national tobacco cessation efforts, focusing on 10 disadvantaged and vulnerable groups of tobacco users. METHODS AND ANALYSIS: This is a prospective cohort study. Data will be collected by established tobacco cessation counsellors in Sweden. The study includes adult tobacco or e-cigarette users, including disadvantaged and vulnerable patients, receiving in-person interventions for tobacco or e-cigarette cessation (smoking, snus and/or e-cigarettes). Patient inclusion was initiated in April 2020. For data analyses patients will be sorted into vulnerable groups based on risk factors and compared with tobacco users without the risk factor in question.The primary outcome is continuous successful quitting after 6 months, measured by self-reporting. Secondary outcomes include abstinence at the end of the treatment programme, which could be from minutes over days to weeks, 14-day point prevalence after 6 months, and patient satisfaction with the intervention. Effectiveness of successful quitting will be examined by comparing vulnerable with non-vulnerable patients using a mixed-effect logistic regression model adjusting for potential prognostic factors and known confounders. ETHICS AND DISSEMINATION: The project will follow the guidelines from the Swedish Data Protection Authority and have been approved by the Swedish Ethical Review Authority before patient inclusion (Dnr: 2019-02221). Only patients providing written informed consent will be included. Both positive and negative results will be published in scientific peer-reviewed journals and presented at national and international conferences. Information will be provided through media available to the public, politicians, healthcare providers and planners as these are all important stakeholders. TRIAL REGISTRATION NUMBER: NCT04819152.

Psychosocial determinants of attrition in a longitudinal study of tobacco use in youth.

To gain knowledge on psychosocial characteristics that predict the propensity of participation in longitudinal studies, attrition was analysed in a cohort of 3020 adolescents participating in the baseline survey of a longitudinal study with repeated followup focusing on adolescents' tobacco use. During the followup surveys, the proportion of responders was constantly at or above 90%. There were 941 adolescents (31.2%) who failed to participate in at least one of the six followup surveys. Boys had a fifty percent increased risk of nonparticipation compared with girls. Adolescents in families with experience of divorce, unemployment, and change of residence had a higher risk of nonparticipation. An increasing number of stressful life events during the previous year, uptake of tobacco use, number of friends, perceived performance at school, truancy, and alcohol use during the last term also independently associated with nonparticipation. Diverse psychosocial characteristics are independently associated with nonparticipation of youths in longitudinal studies.

Symptoms of nicotine dependence in a cohort of Swedish youths: a comparison between smokers, smokeless tobacco users and dual tobacco users.

AIMS: To determine whether symptoms of nicotine dependence, addiction and withdrawal symptoms differ between exclusive smokers, exclusive snus (moist snuff) users and dual users. DESIGN: A cross-sectional survey of a cohort subsample. Setting County of Stockholm, Sweden. PARTICIPANTS: Current exclusive smokers (n = 466), exclusive snus users (n = 209) and dual users (n = 144), mean age 17.6 years. MEASUREMENTS: Self-reported life-time experience of nicotine dependence and withdrawal symptoms in periods of discontinued tobacco use. Selected items from the modified Fagerstöm Tolerance Questionnaire (mFTQ), the Hooked on Nicotine Checklist (HONC) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). FINDINGS: The odds ratio of endorsing each of four mFTQ items as well as the HONC item investigating the risk of feeling addicted to tobacco was two to five-fold higher for exclusive snus users and for dual users compared to exclusive smokers. One DSM-IV item (difficult to refrain from use) was elevated among dual users compared to smokers. Dual users reported the highest prevalence of any withdrawal symptom in contrast to exclusive snus users, who reported a lower risk of withdrawal symptoms compared to exclusive smokers. CONCLUSIONS: Smokeless tobacco users show symptoms of nicotine dependence at least as frequently as cigarette smokers. Symptoms of nicotine dependence and of withdrawal during quit attempts are particularly frequent in the subgroup of users who combine smokeless tobacco with smoking.

Maternal smoking during pregnancy: a comparison between concurrent and retrospective self-reports.

Retrospective reports of smoking in pregnancy are of importance for clinical or scientific purposes. Careful analyses of stability and accuracy of recalled behaviour are, therefore, needed. In 1998, the mothers of 2369 pre-teens born in Sweden retrospectively reported their smoking behaviour during the first trimester of the index pregnancy. We matched these reports with those recorded by midwives at the beginning of the index pregnancy, using information from the Swedish Medical Birth Registry. Using this registry as gold standard, the sensitivity and specificity of the retrospective reports containing any smoking were 83.9% and 92.8% respectively, but the sensitivity was low for daily smoking, 56.0%. Of the 222 discordant reports, 19.0% were due to mothers recalling daily smoking which was not reported at the time of pregnancy, and 42% were due to failure to recall smoking reported at the time of pregnancy, while the remaining 39% retrospectively reported occasional smoking, whereas they were registered as non-daily smokers when pregnant. Retrospective recall of pregnancy smoking is fairly stable over time.

School and family participation in a longitudinal study of tobacco use: some methodological notes.

School-based recruitment of youth for a research purpose is problematic, as one has to deal with multiple ethical and practical constraints. This study reports on predictors of schools' and families' participation in a longitudinal study of tobacco use among 11-year-old children. School size, but not tobacco policy, was linked to participation. High parental education and average social status in the residence area were associated with parental consent. Given the social background, prevalence of parental tobacco use was close to the expected. Compliance of responsible adults in youth research cannot be predicted on the basis of simple behavioural models.