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1.
Rev. Bras. Med. Fam. Comunidade (Online) ; 19(46): e-3565, 20241804.
Artigo em Inglês, Português | LILACS | ID: biblio-1566116

RESUMO

Objetivo: O estudo teve por objetivo avaliar o Programa Nacional de Controle do Tabagismo (PNCT) em Mato Grosso do Sul, taxas de cobertura, abandono, cessação, uso de medicamentos, rede de serviços de saúde e as razões pelas quais algumas Equipes de Saúde da Família de Campo Grande ainda não aderiram ao programa. Métodos: Trata-se de uma pesquisa descritiva, com abordagem quantitativa, baseada em dados primários e secundários sobre o PNCT em Mato Grosso do Sul. Os dados primários foram obtidos por meio de questionário aplicado aos profissionais das Equipes de Saúde da Família (ESF) de Campo Grande, sem oferta do programa e avaliados quanto à frequência e presença de correlação entre as variáveis analisadas utilizando V de Cramer e teste de χ2. Os dados secundários foram obtidos do consolidado do Instituto Nacional de Câncer José Alencar Gomes da Silva com os registros produzidos pelos serviços. Resultados: As taxas de adesão, efetividade e apoio farmacológico na capital e interior foram: 66,80 e 59,79%; 20,58 e 34,91%; 32,14 e 99,86%, respectivamente. A oferta do programa ocorreu em 49,37% municípios e 43,85% das Unidades Básicas de Saúde (UBS) estimadas. Houve correlações entre ser capacitado e implantar o programa; treinamento de ingresso e oferta na UBS. As dificuldades relatadas pelos profissionais foram a pandemia de COVID-19, a sobrecarga e/ou equipe pequena e/ou falta de tempo e a ausência de capacitação/treinamento. Conclusões: O PNCT em Mato Grosso do Sul apresenta baixa cobertura e oferta restrita na rede de saúde, além do desempenho mediano de assistência aos tabagistas. Evidencia-se a necessidade de investimento em capacitação/treinamento, prioritariamente para as ESF de Campo Grande, dando-lhes condições de responder às necessidades de promoção da saúde, reconhecendo o programa como de maior custo-efetividade.


Objective: The objective of this study was to evaluate the National Tobacco Control Program (PNCT) in Mato Grosso do Sul, coverage rates, dropout, cessation, use of medication, the health services network and the reasons why Family Health Teams in Campo Grande have not yet joined the program. Methods: This was a descriptive study with a quantitative approach, based on primary and secondary data on the PNCT in Mato Grosso do Sul. The primary data were obtained by means of a questionnaire administered to Family Health Teams (ESF) in Campo Grande, which did not offer the program and evaluated the frequency and presence of correlation between the variables analyzed using Cramer's V test and the χ2 test. The secondary data were obtained from the consolidated records of the José Alencar Gomes da Silva National Cancer Institute with the records produced by the services. Results: The rates of adherence, effectiveness and pharmacological support in the capital and interior were: 66.80 and 59.79%; 20.58 and 34.91%; and 32.14 and 99.86%, respectively. The program was offered in 49.37% of the municipalities and 43.85% of the Basic Health Units (UBS) estimated. There were correlations between being trained and implementing the program and entry training and provision in the UBS. The difficulties reported by professionals were the COVID-19 pandemic, overload and/or a small team and/or lack of time and the absence of training. Conclusions: The PNCT in Mato Grosso do Sul has low coverage and restricted supply in the health network, in addition to average performance in assisting smokers. There is a clear need to invest in capacitation/training, primarily for the ESF in Campo Grande, enabling them to respond to the needs of health promotion, recognizing the program as more cost-effective.


Objetivo: El objetivo de este estudio fue evaluar el Programa Nacional de Control del Tabaco (PNCT) en Mato Grosso do Sul, las tasas de cobertura, el abandono, la cesación, el uso de medicamentos, la red de servicios de salud y las razones por las que los Equipos de Salud de la Familia en Campo Grande aún no se han unido al programa. Métodos: Se trata de un estudio descriptivo con abordaje cuantitativo, basado en datos primarios y secundarios sobre el PNCT en Mato Grosso do Sul. Los datos primarios se obtuvieron por medio de un cuestionario aplicado a los Equipos de Salud de la Familia (ESF) de Campo Grande, que no ofrecían el programa y evaluaron la frecuencia y la presencia de correlación entre las variables analizadas utilizando la V de Cramer y la prueba de la χ2. Los datos secundarios se obtuvieron de los registros consolidados del Instituto Nacional del Cáncer José Alencar Gomes da Silva con los registros producidos por los servicios. Resultados: Las tasas de adherencia, eficacia y apoyo farmacológico en la capital y en el interior fueron: 66,80 y 59,79%; 20,58 y 34,91%; 32,14 y 99,86%, respectivamente. El programa fue ofrecido en el 49,37% de los municipios y en el 43,85% de las Unidades Básicas de Salud (UBS) estimadas. Hubo correlación entre estar capacitado e implementar el programa; capacitación de entrada y oferta en las UBS. Las dificultades relatadas por los profesionales fueron la pandemia del COVID-19, la sobrecarga y/o un equipo pequeño y/o la falta de tiempo y la ausencia de capacitación. Conclusiones: El PNCT en Mato Grosso do Sul tiene baja cobertura y oferta restringida en la red de salud, además de un desempeño medio en la asistencia a los fumadores. Hay una clara necesidad de invertir en la creación de capacidad / formación, principalmente para la ESF en Campo Grande, lo que les permite responder a las necesidades de promoción de la salud, reconociendo el programa como más rentable.


Assuntos
Humanos , Atenção Primária à Saúde , Estratégias de Saúde Nacionais , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Controle do Tabagismo
2.
JMIR Res Protoc ; 13: e60325, 2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39230946

RESUMO

BACKGROUND: Electronic nicotine delivery systems (ENDS)-e-cigarettes or vapes-have been shown to substantially reduce or eliminate many toxins compared with cigarette smoke, but simultaneously ENDS use also produces their own unique toxins. Yet the patterns of use among people who use ENDS are not homogeneous. Some people who use ENDS also smoke cigarettes (dual use). Other people who formerly smoked cigarettes are completely substituting ENDS (exclusive use). A small number of people who have never smoked cigarettes are using ENDS (naïve use of nicotine). Each of these patterns of use results in different exposures to toxins. Unfortunately, epidemiological studies routinely group together any ENDS use regardless of other tobacco use. OBJECTIVE: This umbrella review primarily aims to present all the evidence available on the respiratory effects of ENDS use by adults based on their pattern of use: dual use, exclusive use, and naïve use. With each of these patterns of use, are there benefits, no changes, or harmful effects on respiratory functioning? Our objective is to provide clinicians with a detailed analysis of how different patterns of ENDS use impact respiratory functioning and to point to the best sources of evidence. METHODS: This umbrella review follows the Methods for Overviews of Reviews framework and the PRIOR (Preferred Reporting Items for Overviews of Reviews) statement. Systematic reviews published since 2019 will be searched across 4 databases and 3 gray literature sources. Additional searches will include citation chasing, references lists, and referrals from respiratory specialists. The quality of included reviews will be evaluated using the AMSTAR2 (A Measurement Tool to Assess Systematic Reviews) checklist. We will document biases in 3 areas: protocol deviations, biases from the Oxford Catalogue of Bias, and internal data discrepancies. Two reviewers will independently conduct the search and quality assessments. Our analysis will focus on reviews rated as moderate or high confidence by AMSTAR2. We will use the Vote Counting Direction of Effect method to manage expected data heterogeneity, assessing whether ENDS use is beneficial or detrimental, or has no effect on respiratory functions based on the pattern of use. RESULTS: The review is expected to be completed by December 2024. The database search was concluded in April 2024, and data extraction and bias assessment were completed in June 2024. The analysis phase is planned to be completed by October 2024. CONCLUSIONS: A thorough and comprehensive assessment of the evidence will better inform the contentious debate over the respiratory effects of ENDS providing much needed clarity by linking their effects to specific usage patterns. This analysis is particularly crucial in understanding the risks associated with continued cigarette smoking. TRIAL REGISTRATION: PROSPERO CRD42024540034; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=540034. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60325.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Humanos , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Vaping/efeitos adversos , Vaping/epidemiologia , Revisões Sistemáticas como Assunto
3.
Addiction ; 2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39231467

RESUMO

AIMS: To summarise systematic reviews on tobacco addiction published by the Cochrane Tobacco Addiction Group (CTAG) from 2021 to 2023. METHODS: We identified all new and updated Cochrane Reviews published by CTAG between 2021 and 2023. We present key results from these reviews and discuss promising avenues for future research. RESULTS: CTAG published five new reviews and one overview of reviews, and updated eight reviews. Review evidence showed that all main pharmacotherapies (varenicline, cytisine, bupropion and nicotine replacement therapy [NRT], especially when patches are combined with fast acting forms like gum) are effective for smoking cessation, as are nicotine e-cigarettes. Evidence suggested similar magnitude of effects of varenicline, cytisine, and nicotine e-cigarettes; these emerged as the most effective treatments. Evidence also supported behavioural counselling and financial incentives for smoking cessation. Secondary analyses of the Cochrane review of e-cigarettes for smoking cessation showed over half of participants assigned to e-cigarette conditions were still using them at six months or longer, that biomarkers of potential harm significantly reduced in people switching from smoking to vaping or to dual use, and that there was insufficient evidence to draw associations between e-liquid flavours and smoking cessation. Findings on mindfulness-based interventions, interventions delivered by dental and primary care professionals, interventions to prevent weight gain after smoking cessation, and interventions for waterpipe cessation were less certain. Reviews of observational evidence showed that smoking cessation reduced cardiovascular events and mortality in people living with cardiovascular disease, and improved mental health. CONCLUSIONS: Nicotine replacement therapy (especially patches combined with fast acting forms), varenicline, cytisine, bupropion, nicotine e-cigarettes, behavioural counselling, and financial incentives are all effective ways to help people quit smoking. Quitting smoking improves mental health and reduces cardiovascular events and mortality in people living with cardiovascular disease.

4.
Artigo em Inglês | MEDLINE | ID: mdl-39233773

RESUMO

INTRODUCTION: E-cigarettes have rapidly gained a market share in South Africa and globally. Concerns have been raised over the growing popularity of e-cigarettes among young people, who are frequently drawn to these novel products and are especially targeted by marketers. Using a qualitative method, this study aimed to gain insight into young adults' knowledge, experiences, and perceptions of e-cigarette use in Cape Town, South Africa. METHODS: We conducted five focus groups (FGs) among students of the University of Cape Town (n=48; 46% females; 54% males; aged 18-25 years). These FGs, which included both e-cigarette users and non-users, were audio-taped, transcribed verbatim, and analyzed thematically using Nvivo 12 software. RESULTS: Despite their lack of information about the chemical constituents of e-cigarettes and their harm, participants perceived them as healthier than combustible cigarettes. Participants equated the pleasant smell and environmental friendliness of e-cigarettes with safety. The absence of e-cigarette regulation was interpreted as evidence of their safety. Participants indicated that the lack of anti-e-cigarette indoor policies, the deceptive marketing regarding their safety, and their low price compared to combustible cigarettes, had key roles in increasing young people's use of e-cigarettes. CONCLUSIONS: Findings highlight factors at multiple levels contributing to e-cigarette use among young people in South Africa. Comprehensive strategies for e-cigarette regulation and prevention are needed. Potential strategies include increasing knowledge of e-cigarette harms through evidence-based communication campaigns and strengthening e-cigarette regulations by limiting e-cigarette advertisements, banning vaping in public places, and reducing the flavors used in e-cigarettes.

5.
J Cancer Educ ; 2024 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-39237801

RESUMO

Smoking by cancer patients impairs treatment outcomes and prognoses across cancer types. Previous research shows greater smoking cessation motivation and quit rates among patients with cancers strongly linked to smoking (i.e., thoracic, head and neck) compared to other cancer types (e.g., melanoma). Therefore, there is a need to increase cessation motivation among patients with malignancies less commonly associated with smoking. Yet, no targeted educational materials exist to meet this information gap. This manuscript describes the development of theory-based self-help educational materials, targeted by cancer type, to increase motivation to quit smoking among patients with cancers not widely perceived as smoking-related (i.e., breast, melanoma, bladder, colorectal, gynecological). Using a three-phase iterative process, we first conducted in-depth interviews with our intended audience (N = 18) to identify information needs and nuanced content. Themes included patients' low knowledge about the connection between smoking and cancer etiology and outcomes; negative affect, habit, dependence, and weight gain as quitting barriers; and a preference for positive and non-judgmental content. Second, content creation was based on interview findings, the scientific literature, and framed following the teachable moment model. Last, learner verification and revisions via interviews with 22 patients assessed suitability of draft materials, with generally favorable responses. Resulting edits included tailoring cost savings to the cancer context, explaining cessation medications, and increasing appeal by improving the diversity (e.g., race) of the individuals in the photographs. The final booklets are low cost, easy to disseminate, and-pending efficacy studies-may expand smoking cessation to a wider spectrum of cancer patients.

6.
Drug Alcohol Depend Rep ; 12: 100275, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39253369

RESUMO

Introduction: Patients with pulmonary nodules detected through lung cancer screening or as incidental findings are often followed in lung health and screening programs. The use of personalized pharmacotherapy for smoking cessation informed by the nicotine metabolite ratio (NMR), a measure of nicotine metabolism, has not yet been evaluated in this setting. This pilot randomized controlled trial (RCT) evaluated the feasibility of conducting a larger trial. Methods: Through a pragmatic RCT design, participants were recruited from a Mid-Atlantic lung health and screening program. Eligible participants smoked >5 cigarettes per day and completed a blood draw to determine NMR before being randomized to standard or NMR-guided care treatment arms. Standard care participants were offered nicotine replacement therapy (NRT) or varenicline and a referral to phone-based smoking cessation counseling. NMR-guided participants received standard care except they were provided a personalized medication recommendation based on their NMR. Study outcomes included measures of feasibility, medication uptake, and treatment matching (i.e., uptake of the optimal medication). Results: More than 80 % of 205 screened patients were eligible. However, only 37 (22 %) of these patients enrolled in the study, with a mean age of 65 years, 43 % female, and 25 % Black. Nearly all patients who declined cited a disinterest in smoking cessation. Participants in both treatment arms had high rates of medication uptake (68 %), with NMR-guided participants showing a trend towards greater treatment matching (55 % vs. 29 %). Conclusions: The results of this pilot study provide support for conducting a larger RCT of an NMR-guided smoking cessation intervention in a lung health and screening setting. Consideration should be given to augmenting the intervention to address barriers to study entry.

7.
Addiction ; 2024 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-39256314

RESUMO

AIMS: To evaluate the effectiveness of mobile smoking cessation (SC) treatment with 1-week nicotine replacement therapy (NRT) sampling on recruitment and quitting outcomes. DESIGN: Two-arm cluster RCT (1:1 ratio), single-blinded, at 244 recruitment sessions in Hong Kong outdoor smoking hotspots from October 2018-December 2019. SETTING: Participant were recruited by ambassadors and treated at the mobile SC truck. PARTICIPANTS: 834 adult (≥18 years, male 81.3%) daily smokers, Chinese-speaking, non-NRT users in the past month, consented after nurse-led intervention in mobile SC truck were randomized to the experimental (n = 482 male 79.5%) and the control group (n = 352, male 83.8%). INTERVENTION AND COMPARATOR: The experimental group received a 1-week free NRT sample, an NRT instruction card, and mobile SC treatment including onsite nurse-led brief medication advice (about 15 minutes) and referral to SC clinics. The control group received the same mobile SC treatment. MEASUREMENTS: Primary outcome was self-reported quit attempts at 1-month follow-up. Secondary outcomes included SC service use at 1 month, and biochemically validated abstinence (exhaled carbon monoxide < 4 ppm; or saliva cotinine < 10 ng/ml) at 6-month follow-up. Additionally, a post-hoc cost analysis was conducted. FINDINGS: By intention-to-treat, the two groups showed similar prevalence of quit attempts (44·4% versus 43·5%, risk ratio (RR) = 1·04, 95% confidence interval (CI) = 0·79-1·37, P = 0·79). Compared with the control group, the experimental group showed lower SC service use at clinics (32·4% versus 44·9%, RR = 0·72, 95%CI = 0·57-0·91, P = 0·006), but no significant difference in validated abstinence (4·6% versus 2·8%, RR = 1·64, 95%CI = 0·76-3·50, P = 0·21). The experimental recruitment sessions recruited more smokers for onsite medication advice than the control session (mean 6·7 vs 5·0, adjusted incident rate ratio = 1·30, 95%CI = 1·08-1·56, P = 0·005). CONCLUSIONS: Mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling did not increase quit attempts or abstinence outcomes among recruited daily smokers in Hong Kong. The intervention increased smokers' uptake of onsite medication advice but reduced subsequent smoking cessation service use at clinics.

8.
Nicotine Tob Res ; 2024 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-39243356

RESUMO

INTRODUCTION: Lung cancer screening (LCS) trials, targeting people with smoking history, have demonstrated reduced mortality. How to optimally embed evidence-based smoking cessation support in LCS, including in Australia, needs to be better understood. We sought experts' perspectives to identify potential barriers and effective implementation strategies. METHODS: Perceptions of providing smoking cessation support in LCS were elicited in 24 focus groups and three individual interviews with clinicians, cancer screening program managers/policymakers, and researchers during 2021. We conducted framework analysis and mapped key topics to the updated Consolidated Framework for Implementation Research. RESULTS: Experts (N=84 participants) strongly supported capitalising on an "opportune time" for smoking cessation and new LCS participant contact opportunities throughout the screening and assessment pathway. Many advocated for adapting existing cessation resources to the LCS setting and providing support without participant costs. Experts generally considered referral alone to established programs (e.g., telephone Quitline) as insufficient, but likely helpful in follow-up, and dedicated cessation specialist roles as essential. Broader cessation messaging (via mass media/community channels) was also suggested to reinforce individualised support. Experts described inherent alignment, and an ethical responsibility, to deliver smoking cessation as a core LCS component. It was suggested that LCS-eligible participants' varied experiences of stigma, health literacy, and motivation, be considered in cessation supports. Primary care support and individualised interventions were suggested to facilitate implementation. CONCLUSIONS: Experts considered smoking cessation support essential in LCS. The expert-identified and multi-level implementation strategies described here can directly inform smoking cessation-specific planning for Australia's forthcoming National LCS Program. IMPLICATIONS: The international literature includes few examples considering how best to provide smoking cessation support within a lung cancer screening (LCS) program in advance of program commencement. Our analysis, using the updated Consolidated Framework for Implementation Research, is one of the first to explore experts' perspectives within this context. Experts identified multiple implementation barriers to providing smoking cessation support within and outside of an Australian LCS program, including key work infrastructure barriers, and advocated for providing tailored interventions within this program. Our foundational work in a new targeted screening program's pre-implementation phase will allow international comparisons to be made.

9.
Midwifery ; 139: 104163, 2024 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-39243596

RESUMO

BACKGROUND: Providing smoking cessation care has not successfully prevented women who quit smoking during pregnancy from relapsing due to multi-level barriers. AIM: This paper explores systemic barriers to providing smoking cessation care, focusing on relapse prevention among pregnant and postpartum Aboriginal and Torres Strait Islander women (hereafter Aboriginal). METHODS: Twenty-six interviews were conducted between October 2020 and July 2021 with health professionals, health promotion workers and managers working in Aboriginal smoking cessation across six Australian states and territories. Data were thematically analysed. FINDINGS: Themes emerging from the data included: (a) limited time, competing priorities and shortage of health professionals; (b) a need for more knowledge and skills for health professionals; (c) influences of funding allocations and models of smoking cessation care; (d) lack of relevance of anti-tobacco messages to pregnancy and postpartum relapse; and (e) ways forward. Several barriers emerged from policies influencing access to resources and approaches to smoking cessation care for Aboriginal women. Individual-level maternal smoking cessation care provision was often under-resourced and time-constrained to adequately meet Aboriginal women's needs. Identified needs for health professionals included more time, knowledge and skills, better cultural awareness for non-Indigenous health professionals, and salient anti-tobacco messages for pregnant women related to long-term cessation. CONCLUSION: To drive smoking cessation in pregnant and postpartum Aboriginal women, we recommend adequately reimbursing midwives and Aboriginal Health Workers/Professionals to allow them to provide intensive support, build confidence in Quitline, continue health professionals' capacity-building and allocate consistent funding to initiatives that have been efficacious with Aboriginal women.

10.
Nicotine Tob Res ; 2024 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-39251402

RESUMO

INTRODUCTION: People with HIV (PWH) cite smoking within their social networks as a barrier to quitting. We examined the feasibility, acceptability, and preliminary efficacy of a tailored intervention, Peer Navigation Social Support for Smoking cessation (PNSS-S), designed specifically for PWH who smoke. METHODS: We randomized 64 PWH who smoked (mean age 54.5 years; 41% female) to PNSS-S or standard care (SC). After meeting with a clinic nurse to discuss quitting strategies and pharmacotherapy, the PNSS-S group received 12 weekly phone calls from a trained HIV peer navigator (PN), who provided smoking cessation counseling and social support for quitting. Outcomes were assessed at 12- and 24-weeks. RESULTS: Sixty-two percent of participants indicated interest in quitting at baseline. PN utilization was high with a mean number of weekly calls completed of 8.9 (SD 3.1), demonstrating excellent feasibility. Higher treatment satisfaction scores (29.1 [SD 3.0]) were reported in PNSS-S, compared to control (25.8 [SD 4.1], t = -3.39, d = 0.89, p = .001). Notably, positive social support for quitting increased significantly from baseline to week 12 in PNSS-S (17.4 [SD 11.4] to 25.1 [SD 12.2], p = .01), whereas SC showed no significant change (t = 1.11, df 29, p = .24). At week 24, 5 (16.6%) participants in PNSS-S and 3 (8.8%) in SC endorsed 7-day point prevalence smoking abstinence: OR=2.05 95% CI=[0.45-10.88]. CONCLUSIONS: Peer-based smoking cessation counseling increased the odds of abstinence and significantly increased social support for quitting. Further study is warranted. IMPLICATIONS: Cross training HIV peer navigators to address smoking cessation may be a cost-effective approach, as it utilizes existing HIV clinic-based resources. By strengthening social support and providing a peer-based approach, this intervention may help reduce the burden of tobacco-related health issues in this population, ultimately contributing to better overall health and longevity for PWH. Further research is needed to refine and expand upon these findings.

11.
BMC Public Health ; 24(1): 2443, 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39251941

RESUMO

INTRODUCTION: People living in coastal communities have some of the worst health outcomes in the UK, driven in part by high smoking rates. Deprived coastal communities include socially disadvantaged groups that struggle to access traditional stop smoking services. The study aimed to seek the views of people who smoke living in coastal communities, to assess the optimal smoking cessation intervention for this population. In addition, the Template for Intervention Description Replication (TIDieR) checklist was adapted as an analytical framework for qualitative data to inform intervention design. METHODS: Current or recent ex-smokers (n = 25) were recruited to participate in qualitative interviews from a range of community locations in a deprived English seaside town. A thematic analysis of the interview data was undertaken adapting the TIDieR framework. This analysis was triangulated with relevant literature and notes from stakeholder meetings and observations to map onto the TIDieR checklist to describe the optimal intervention. RESULTS: Barriers to quitting smoking in the target population included low motivation to quit, high anxiety/boredom, normalisation of smoking and widespread illicit tobacco use. There was broad support for combining behavioural support, e-cigarettes and financial incentives, with a strong preference for the intervention to be delivered opportunistically and locally within (non-healthcare) community settings, in a non-pressurising manner, ideally by a community worker specially trained to give stop smoking support. CONCLUSIONS: An intensive community-based smoking cessation intervention was acceptable to the target population. Adapting the TIDieR checklist as a deductive qualitative analytical framework offered a systematic approach to intervention development. Combined with other intervention development activities, this ensured that the intervention design process was transparent and the proposed intervention was well defined. It is recommended that prior to intervention development researchers speak to members of the target population who may give valuable insight into the optimal intervention.


Assuntos
Pesquisa Qualitativa , Abandono do Hábito de Fumar , Humanos , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/métodos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Lista de Checagem , Inglaterra , Idoso , Adulto Jovem , Entrevistas como Assunto
12.
Addiction ; 2024 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-39252616

RESUMO

BACKGROUND AND AIMS: Pathways of transitioning from tobacco smoking to vaping after receiving an e-cigarette-based smoking cessation intervention have been minimally explored. STUDY AIMS: 1) identify pathways between intervention delivery and final follow-up; 2) describe baseline and post-intervention statistical data in relation to smoking/vaping behaviour of the different pathway groups; 3) explore qualitative participant perspectives contextualising pathway groups. DESIGN: Embedded mixed-methods analysis of data collected for the Cessation of Smoking Trial in the Emergency Department (COSTED) randomised controlled trial. SETTING: Recruitment from 6 Emergency Departments (5 in England and 1 in Scotland) between January and August 2022. PARTICIPANTS: 366 adult smokers who were randomised to receive the COSTED intervention and provided data at 6-month follow-up. Qualitative subsample of 24 participants interviewed after follow-up. INTERVENTIONS: Brief smoking cessation advice, provision of an e-cigarette starter kit and referral to the local Stop Smoking Service. MEASUREMENTS: Descriptive statistical reporting of identified pathways and smoking/vaping behaviour at baseline and 6-month follow-up. Semi-structured phone/video interviews analysed thematically. FINDINGS: 13.4% (n = 49) of participants quit smoking within 1 month of receiving the intervention, 19.1% (n = 70) quit between 1 and 6 months, 24.9% (n = 91) reduced cigarettes per day (CPD) by at least 50%, and 42.6% did not experience a significant smoking reduction. Approximately a third of participants who quit reported not vaping at follow-up. Reporting dual use was associated with a reduction in CPD. Appoximately a third reported experimenting with a different device to the one provided as part of the intervention. Quitters reported themes of satisfaction with vaping, changes in environment facilitating quitting and motivation to quit. CONCLUSIONS: Dual use of cigarettes and e-cigarettes can result in a reduction of smoking and may preclude quitting smoking. Sustained e-cigarette use is not always necessary for quitting success. Success depends on personal context as well satisfaction with vaping.

13.
J Affect Disord ; 367: 67-74, 2024 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-39222855

RESUMO

BACKGROUND: Korea has one of the highest suicide rates in the world. Many factors associated with suicidal thoughts or behaviors are known. This study examines the association between 1) smoking status or intensity (pack-years) and 2) risk of suicide mortality in South Korea. METHODS: We analyzed data from 3,966,305 individuals aged ≥20 who underwent health examinations conducted by the South Korean National Health Insurance Service in 2009 and were followed until December 2021. Participants were categorized based on their baseline smoking status and intensity. We performed a Multivariate Cox proportional hazards regression analysis with subgroup analysis by age, sex, body mass index, alcohol consumption, regular exercise, and depression. RESULTS: During an 11.1-year follow-up period, 12,326 individuals died by suicide. Compared with never-smokers, increased hazard ratios of suicide mortality were observed in current smokers (1.64, 95 % CI = 1.56-1.72), but not in ex-smokers. The suicide mortality risk of current smokers increased for all types of smoking intensity without a dose-response relationship. The association between smoking and suicide mortality risk was stronger among women, non-drinkers, adults aged <40 years, non-obese patients, and individuals without depression. LIMITATION: Given that the study used retrospective data, the causal relationship remains unclear. CONCLUSION: Current smoking is associated with a significant increased risk of suicide mortality. Smoking cessation is crucial to prevent suicide, especially among young adults, non-obese individuals, non-drinkers, women, and those without depression. Government policies in South Korea should focus on raising awareness about smoking hazards and providing cessation education to reduce the suicide mortality.

14.
Intern Med ; 2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39231671

RESUMO

Adult multisystem Langerhans cell histiocytosis (MS-LCH) is rare and has a poor prognosis. A 67-year-old man with MS-LCH presented with a hepatic tumor rupture and multiple masses in the lungs, liver, and pancreas. Despite the initial aggressive disease course and involvement of organs at risk, the patient experienced spontaneous regression and lesion disappearance following smoking cessation without chemotherapy. A literature review revealed a distinct subset of MS-LCH that can be managed by smoking cessation and careful observation through follow-up imaging. This suggests that careful observation through follow-up imaging may be a reasonable alternative to chemotherapy in select adult cases of MS-LCH.

15.
Tob Induc Dis ; 222024.
Artigo em Inglês | MEDLINE | ID: mdl-39220716

RESUMO

INTRODUCTION: Muscle strength is known to play an important role in the health of older adults. The health burden of cigarette smoking among older adults remains significant. We investigated the association between smoking cessation and dynapenia among older lifetime smokers in Korea. METHODS: This study is a secondary dataset analysis of cross-sectional data from theKorea National Health and Nutrition Examination Survey (KNHANES) 2016- 2019. We included 1450 participants aged 65-79 years, excluding those who had never smoked. Dynapenia was defined as grip strength <28 kg for men and <18 kg for women based on the Asian Working Group for Sarcopenia 2019 criteria. Multivariable logistic regression analysis evaluated the association between smoking cessation and dynapenia. RESULTS: Compared with current smokers, the adjusted odds ratio (AOR) of dynapenia in former smokers was 0.66 (95% CI: 0.44-0.99). The AORs for smoking cessation periods of ≤10 years, 10-20 years, 20-30 years, and >30 years were 0.67 (95% CI: 0.39-1.16), 0.61 (95% CI: 0.36-1.03), 0.65 (95% CI: 0.37-1.14), and 0.52 (95% CI: 0.25-1.06), respectively. The AOR for dynapenia significantly decreased with the years since smoking cessation (p for trend=0.043). CONCLUSIONS: Our findings suggest that smoking cessation can reduce the likelihood of dynapenia among older lifetime smokers, with a decreasing likelihood trend associated with longer cessation periods.

16.
Artigo em Inglês | MEDLINE | ID: mdl-39223443

RESUMO

BACKGROUND: Pharmacist-led smoking cessation programs in pre-admission clinics (PAC) have shown to increase quit attempts and achieve abstinence by the day of surgery (DOS). AIMS: To evaluate the feasibility of Pharmacist E-script Transcription Service (PETS) initiated nicotine replacement therapy (NRT) in PAC, including smoking cessation on DOS. METHODS: A single centre, pre and post-intervention pilot study conducted at an Australian public hospital PAC. In a two-month intervention period, PAC nursing staff invited smokers (≥1 cigarette/day) to see a smoking cessation PET pharmacist. Pharmacist-initiated NRT and Quitline© referrals were offered. Cessation outcomes were compared with the preceding two-month control period. PRIMARY OUTCOME: feasibility of intervention. SECONDARY OUTCOMES: DOS smoking abstinence rates and three-months post-surgery. RESULTS: PAC nurses identified 112 smokers over 4 months; 53 during pre-intervention period, and 59 during intervention period. Twenty-two intervention patients (37%) accepted seeing the pharmacist, with 16 subsequent Quitline© referrals (73%) and 11 NRT prescriptions (50%) written. The median nursing smoking status documentation time increased in the intervention period (1 min vs. 4, p < .001). The intervention did not impact pharmacist's workload. Verified abstinence increased from 8.5% (4/47) pre-intervention to 9.4% (5/53) post-intervention, p =1.00. Relapse rates in the intervention period increased (20% vs. 50%) at three-months post-surgery. CONCLUSION: A PETS-initiated NRT program in PAC is feasible and increased preoperative use of NRT and Quitline© with minimal impact on smoking cessation. SO WHAT?: This study has highlighted the importance of implementing a multidisciplinary smoking cessation program in PAC however, larger studies are needed to determine the true impact of the program on smoking cessations.

17.
Artigo em Inglês | MEDLINE | ID: mdl-39218351

RESUMO

Smoking increases insulin resistance via multiple mechanisms but is a poorly understood risk factor for onset of type-2 diabetes. It is also associated with impaired beta-cell function in humans, but again the mechanisms are poorly understood. Mechanistic studies of the impact of smoking on carbohydrate metabolism mainly evaluated nicotine as the causal agent, and more rarely other tobacco constituents, making it impossible to conclude that the risk of diabetes is linked to the effects of nicotine alone. Active smoking also has negative impact on glycemic control in both type-1 and type-2 diabetic patients. It increases the risk of all-cause mortality and worsens the chronic complications of diabetes. Impact on microangiopathic complications in type-2 diabetic patients, however, is more controversial. Data on pharmacological and behavioral strategies for smoking cessation used in the general population are more sparse in diabetic patients, despite opportunities with recent therapeutic trials involving varenicline and GLP-1 analogues. It is essential for diabetic patients to stop smoking, and diabetologists must get involved in smoking cessation as they have done for many years in therapeutic education, which can easily include measures to help patients stop smoking.

18.
J Health Psychol ; : 13591053241274091, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39219274

RESUMO

Motivational interviewing (MI) is a common approach for smoking cessation counselling, yet little is known about the use of MI techniques in practice. This qualitative content analysis applied a published classification of content and relational MI techniques to a sample of 30 Quitline transcripts (January-March 2019) from Queensland, Australia. Overall, 36 MI techniques (94.7%) were identified at least once within the total sample. On average, 20 techniques (52.6%) were used in an individual conversation with a small difference observed between initial and follow-up calls. Techniques most frequently applied across conversations were largely relational, while techniques addressing client ambivalence/resistance were less frequently/never applied. Variability in techniques between individual initial and follow-up calls highlights the high degree of personalisation when applying MI to smoking cessation. Further investigations exploring associations of individual techniques and cessation outcomes are warranted. The classification may prove useful for assessments of fidelity for training and monitoring activities.

19.
JMIR Hum Factors ; 11: e56505, 2024 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-39159451

RESUMO

BACKGROUND: Our prototype smoking cessation chatbot, Quin, provides evidence-based, personalized support delivered via a smartphone app to help people quit smoking. We developed Quin using a multiphase program of co-design research, part of which included focus group evaluation of Quin among stakeholders prior to clinical testing. OBJECTIVE: This study aimed to gather and compare feedback on the user experience of the Quin prototype from end users and smoking cessation professionals (SCPs) via a beta testing process to inform ongoing chatbot iterations and refinements. METHODS: Following active and passive recruitment, we conducted web-based focus groups with SCPs and end users from Queensland, Australia. Participants tested the app for 1-2 weeks prior to focus group discussion and could also log conversation feedback within the app. Focus groups of SCPs were completed first to review the breadth and accuracy of information, and feedback was prioritized and implemented as major updates using Agile processes prior to end user focus groups. We categorized logged in-app feedback using content analysis and thematically analyzed focus group transcripts. RESULTS: In total, 6 focus groups were completed between August 2022 and June 2023; 3 for SCPs (n=9 participants) and 3 for end users (n=7 participants). Four SCPs had previously smoked, and most end users currently smoked cigarettes (n=5), and 2 had quit smoking. The mean duration of focus groups was 58 (SD 10.9; range 46-74) minutes. We identified four major themes from focus group feedback: (1) conversation design, (2) functionality, (3) relationality and anthropomorphism, and (4) role as a smoking cessation support tool. In response to SCPs' feedback, we made two major updates to Quin between cohorts: (1) improvements to conversation flow and (2) addition of the "Moments of Crisis" conversation tree. Participant feedback also informed 17 recommendations for future smoking cessation chatbot developments. CONCLUSIONS: Feedback from end users and SCPs highlighted the importance of chatbot functionality, as this underpinned Quin's conversation design and relationality. The ready accessibility of accurate cessation information and impartial support that Quin provided was recognized as a key benefit for end users, the latter of which contributed to a feeling of accountability to the chatbot. Findings will inform the ongoing development of a mature prototype for clinical testing.


Assuntos
Grupos Focais , Abandono do Hábito de Fumar , Humanos , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Queensland , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Aplicativos Móveis
20.
Arch Cardiovasc Dis ; 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39089897

RESUMO

Smoking is a major risk factor for cardiovascular diseases (CVD), in particular in women, but smoking cessation (SC) reduces or even cancels the risk for both sexes. Using a nationwide SC services database, we aimed to determine the predictive factors of SC in men and women smokers with CV risk factors (CVRF) or CVD. A retrospective study from the French CDTnet database was conducted. Inclusion criteria were age ≥18years, and≥1 CVRF (Body Mass Index ≥25kg/m2, hypertension, diabetes, hypercholesterolemia) or CVD (myocardial infarction (MI) or angina pectoris, stroke, peripheral arterial disease [PAD]). Self-reported smoking abstinence (≥28 consecutive days) was confirmed by exhaled carbon monoxide<10ppm. Logistic regression analysis assessed the association between SC and sociodemographic, medical characteristics, and smoking profile. Among the 36,864 smokers at high CV risk, abstinence rate was slightly lower in women than in men, (52.6% [n=8,102] vs 55.0% [n=11,848], P<0.001). For both sexes, factors associated with the lowest abstinence rates were diabetes, respiratory and psychiatric diseases, anxiolytic/antidepressant use, and cannabis consumption. In women, the factors associated with smoking abstinence were suffering from MI or angina and taking contraceptive pill and the factors associated with persistent smoking were alcohol disorder and high cigarette consumption. In men, there was a positive relationship between overweight and abstinence while being dual users of cigarettes and electronic cigarettes at first visit, having tobacco-related diseases (cancer and PAD) and taking opioid substitution treatment were associated with persistent smoking. Finally, in both sexes, the factors associated with abstinence were: age≥65years, having a diploma, being employed, self-referred or encouraged by entourage, ≥1 previous quit attempt, ≤20 cigarettes per day consumption, benefiting from SC medication prescription and ≥4 follow-up visits. In conclusion, our results suggest the relevance of SC intensive management in smokers at high CV risk, based on sociodemographic, medical, and smoking behaviour characteristics, as well as a gender-specific SC approach.

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