Cessação do tabagismo: uma análise retrospectiva em um município da região metropolitana do Rio Grande do Sul / Tobacco use cessation: a retrospective analysis in a municipality in the metropolitan region of Rio Grande do Sul

Introdução: o uso de produtos fumígenos derivados do tabaco é uma doença crônica não transmissível e uma das maiores mazelas mundiais em saúde pública. A atuação da Atenção Primária à Saúde na longitudinalidade do cuidado favorece o acolhimento dos tabagistas, sensibilização e aconselhamento para abandono deste hábito. Objetivos: analisar as taxas de abandono do hábito de fumar dentre os participantes do programa de combate ao tabagismo em um município da região metropolitana do Rio Grande do Sul. Métodos: trata-se de um corte transversal, retrospectivo, com análise dos registros de prontuários dos grupos no período de janeiro de 2018 a dezembro de 2021. Resultados: no total foram realizados 17 grupos de tratamento ao tabagismo no período, atendendo a 119 fumantes, em sua maioria mulheres e com média de 52,5±9,8 anos. Encontrou-se que 66,9% dos participantes deixaram de fumar até o quarto encontro. O uso de farmacoterapia (RC = 15,81; IC95%: 4,73 - 52,89), homens (RC = 1,62; IC95%: 0,68 - 3,90), estar presente em mais de quatro sessões (RC = 44,50; IC95%: 13,35 - 148,27) indivíduos com comorbidades do grupo cardiopatias (RC = 1,54; IC95%: 0,67 - 3,75) apresentaram maiores chances de abandono do tabagismo. Conclusões: A taxa de abandono do hábito de fumar foi superior nos participantes que comparecem a mais de quatro encontros, aqueles que tiveram moderado grau de dependência à nicotina, fumavam menos de um maço por dia, iniciaram a fumar jovens e apresentavam mais de 60 anos

Introduction: tobacco use is a major risk for noncommunicable diseases and one of the biggest illnesses in public health worldwide. The performance of Primary Health Care in the longitudinality of care favors the reception of smokers, awareness, and counseling for quitting this habit. Objectives: to analyze data about smoking cessation among integrants of the tobacco use cessation groups in Campo Bom/Rio Grande do Sul, Brazil. Methods: it's a crossectional observational study with a quantitative approach where we analyze secondary data from medical records of the group's cessation in the period from, January 2018 to December 2021. The present project was approved by the ethics research committee under the number: 5.583.858. Results: in total, 17 groups for tobacco use cessation were included during the period, serving 119 smokers, mostly women, and an average age of 52.5±9.8 years. It was found that 66.9% of the participants quit smoking until the fourth meeting. The pharmacotherapy use (OR = 15.81; IC95%: 4.73 ­ 52.89), male sex (OR = 1.62; IC95%: 0.68 ­ 3.90), being present on more than four sessions (OR = 44.50; IC95%: 13,35 - 148,27) and individuals of the cardiopathy group comorbidity (OR = 1.54; IC95%: 0.67 ­ 3.75) had higher chances on tobacco use cessation. Conclusions: The rate of tobacco use cessation was higher in those persons who participated in more than four meetings, had a moderate degree of nicotine dependence, smoked less than a pack by day, started smoking at a younger age, and were over 60 years old

The impact of smoking and smoking cessation interventions on outcomes following single-level anterior cervical discectomy and fusion procedures.

BACKGROUND: While several studies explore the impact of smoking tobacco on spinal fusion outcomes, there is a paucity of literature on the influence of modern smoking cessation therapies on such outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF). OBJECTIVE: Our study explores the outcomes of single-level ACDF surgery in nonsmokers, active smokers, and smokers undergoing cessation therapy. METHODS: MARINER30, an all-payer claims database, was utilized to identify patients undergoing single-level ACDF between 2010 and 2019. The primary outcomes were the rates of composite surgical complications, dysphagia, hematoma, symptomatic pseudarthrosis, instrumentation removal, need for revision surgery, and all-cause readmission rates within 30 and 90-days. RESULTS: The matched population consisted of 5769 patients undergoing single-level ACDF with 1923 (33.33%) in each of the following groups: (1) nonsmokers; (2) active smokers; and (3) patients undergoing smoking cessation therapy. Nonsmokers had significantly lower rates of composite surgical complications (3.74% vs 13.05% vs 15.08%), revision surgery (4.06% vs 20.07% vs 22.88%), instrumentation removal (0.83% vs. 2.08% vs. 2.76%), and dysphagia (0.36% vs 0.99% vs 0.62%) when compared to patients in the active smoking and smoking cessation groups, respectively. CONCLUSION: Patients using smoking cessation therapy were more likely to develop postoperative dysphagia and undergo revision surgery when compared to their actively smoking counterparts. While surgeons routinely recommend smoking cessation prior to surgery, the effects of smoking cessation therapies on surgical outcomes are not well characterized.

Characterizing Participant Perceptions about Smoking-Cessation Pharmacotherapy and E-Cigarettes from Facebook Smoking-Cessation Support Groups.

The prevalence of smoking among young adults aged 19-28 years old in the United States persists at rates of 14.3%. Young adults underutilize pharmacotherapy for smoking cessation, and the use of e-cigarettes has increased. We analyzed comments from online smoking-cessation support groups to understand young-adult smokers' views of pharmacotherapy and e-cigarettes, to provide a more in-depth insight into the underutilization of pharmacotherapy. A qualitative analysis was performed on comments about pharmacotherapy and e-cigarettes from participants enrolled in online smoking-cessation support groups in 2016-2020. A codebook was developed with a deductive approach to code the comments, followed by thematic analysis. Eighteen themes were identified, with four dominant themes: interest, benefit, knowledge, and flavor. Participants expressed less interest in both nicotine-replacement therapy and e-cigarettes; moreover, they expressed unfamiliarity with and misconceptions about pharmacotherapy, and recognized the enticing flavors of e-cigarettes. Participants often felt e-cigarettes were not useful for smoking cessation, but the flavors of e-cigarettes were appealing for use. Participants had mixed opinions about the use of e-cigarettes for smoking cessation, but predominantly felt e-cigarettes were not useful for smoking cessation. The use of social media may be an effective way to address misconceptions about pharmacotherapy for smoking cessation and increase willingness to accept assistance.

The Impact of Smoking Cessation Therapy on Lumbar Fusion Outcomes.

OBJECTIVE: While there are several reports on the impact of smoking tobacco on spinal fusion outcomes, there is minimal literature on the influence of modern smoking cessation therapies on such outcomes. Our study explores the outcomes of single-level lumbar fusion surgery in active smokers and in smokers undergoing recent cessation therapy. METHODS: MARINER30, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2019. The primary outcomes were the rates of any complication, symptomatic pseudarthrosis, need for revision surgery, and all-cause readmission within 30 and 90 days. RESULTS: The exact matched population analyzed in this study contained 31,935 patients undergoing single-level lumbar fusion with 10,645 (33%) in each of the following groups: (1) active smokers; (2) patients on smoking cessation therapy; and (3) those without any smoking history. Patients undergoing smoking cessation therapy have reduced odds of developing any complication following surgery (odds ratio 0.86, 95% confidence interval 0.80-0.93) when compared with actively smoking patients. Nonsmokers and patients on cessation therapy had a significantly lower rate of any complication compared with the smoking group (9.5% vs. 17% vs. 19%, respectively). CONCLUSIONS: When compared with active smoking, preoperative smoking cessation therapy within 90 days of surgery decreases the likelihood of all-cause postoperative complications. However, there were no between-group differences in the likelihood of pseudarthrosis, revision surgery, or readmission within 90 days.

Trends in the delivery of reimbursed nicotine replacement therapies between 2016 and 2019 in France.

OBJECTIVES: Describe the evolution of the expenses and the number of boxes of nicotine replacement therapy reimbursed by the French health insurance between 2016 (flat rate of €.150/year with advance payment) and 2019 (65% reimbursement without in advance payment and without a spending limit). SETTING AND PARTICIPANTS: Descriptive and analytical epidemiological study between January 1, 2016 and December 31, 2019 based on a retrospective collection of data from OpenMEDIC (the merged French health insurances drug claim database) on the number of reimbursed NRT boxes dispensed by community pharmacies and their annual cost. RESULTS: During 4 years, 7.4 million boxes of NRT were reimbursed (total cost of 148.4 million euros): approximately 300,000 in 2016, 650,000 in 2017, 1.9 million in 2018 and 4.6 million in 2019, namely a fifteen-fold increase between 2016 and 2019 (a geometric growth ratio of 2.5 each year). This increase was slightly more pronounced among men than among women, and concerned more NRT delivered from time to time (gums, tablets): transdermal devices proportion decreased from 79.7% of reimbursed NRT in 2016 to 52.9% in 2019, with an increase in gums (8% to 13.3%) and sublingual tablets (8.4% to 15.8%) over the same period. CONCLUSIONS: The evolution of NRT reimbursement comes with an increase in NRT deliveries. This suggests a real medical need rather than a short trend: therefore, this suggests a catch-up in the access to care.

An Evaluation of the Knowledge and Perceptions of Pharmacy Staff and Pre-Registration Students of E-Cigarettes Use: A Systematic Review.

INTRODUCTION: Pharmacy staff are a trusted source of advice on the safe and appropriate use of medicines and devices. Retail pharmacies deliver smoking cessation services and sell e-cigarettes in the UK. This review asks 'what knowledge, experience and ability do staff have to support e-cigarette users to quit smoking'. METHODS: A systematic literature search was undertaken drawn on predefined eligibility criteria and a comprehensive search strategy following the PRISMA guideline. Eligible papers reported survey-research published in English from 2015 to 2020. PubMed, Google Scholar, OVID, EMBASE and MEDLINE Databases were searched. No restrictions on study design or language were applied. Two reviewers independently screened for inclusion/exclusion and then extracted the relevant information from the articles for synthesis. RESULTS: Of 12 potentially eligible full-text studies, 1 was a duplicate, 7 were excluded as per eligibility criteria. Four papers were finally included in this literature review. Two studies indicated that pharmacy staff are less confident in giving advice on e-cigarette use. Knowledge on the adverse effects of e-cigarettes compared to traditional smoking cessation aids remain unclear. In one study, 42% of community pharmacists did not believe that e-cigarettes could be used for smoking cessation. Three studies identified need for specific regulations and professional support. The overall certainty of the evidence is 'low' or 'very low', with moderate levels of bias. CONCLUSION: Pharmacists may be well placed to implement e-cigarette smoking cessation interventions, but most practitioners lacked knowledge and ability to support these customers citing unclear risk of harm. Pharmacists felt secure in recommending traditional cessation tools. Further regulation, guidelines and training is needed. Findings may be less generalizable in countries where e-cigarettes are banned. Their extent of knowledge, experience and ability to support users of e-cigarettes within their community to quit smoking is lacking.

Nicotine Replacement Therapy during Pregnancy and Child Health Outcomes: A Systematic Review.

Tobacco smoking in pregnancy is a worldwide public health problem. A majority of pregnant smokers need assistance to stop smoking. Most scientific societies recommend nicotine replacement therapy (NRT) during pregnancy but this recommendation remains controversial because of the known fetal toxicity of nicotine. The objective of this systematic review was to provide an overview of human studies about child health outcomes associated with NRT use during pregnancy. The electronic databases MEDLINE, the Cochrane Database, Web of Science, and ClinicalTrials.gov were searched from the inception of each database until 26 December 2020. A total of 103 articles were identified through database searching using combination of keywords. Out of 75 screened articles and after removal of duplicates, ten full-text articles were assessed for eligibility and five were included in the qualitative synthesis. NRT prescription seems to be associated with higher risk of infantile colic at 6 months as in case of smoking during pregnancy, and with risk of attention-deficit/hyperactivity disorder. No association between NRT during pregnancy and other infant health disorders or major congenital anomalies has been reported. Well-designed controlled clinical trials with sufficient follows-up are needed to provide more information on the use of NRT or other pharmacotherapies for smoking cessation during pregnancy on post-natal child health outcomes.

Cigarro Eletrônico: Mocinho ou vilão? / Cigarrillo Electrónico: ¿Bueno o malo? / Electronic Cigarette: Good guy or bad guy?

RESUMEN Objetivo: Discutir los efectos sobre la salud causados por el uso de cigarrillos electrónicos. Material y métodos: Para ello, se realizó una búsqueda en la base de datos PubMed/Medline de artículos completos publicados en los últimos 10 años. Se utilizaron un total de 21 artículos, según los criterios de inclusión establecidos, con mayor prevalencia de estudios transversales. Resultados: Se encontró que los cigarrillos electrónicos pueden incluso ayudar en el cese del tabaquismo convencional, sin embargo, sus usuarios no están exentos de sufrir complicaciones de salud sistémicas. Estos contienen sustancias tóxicas y no deben considerarse completamente seguros e inofensivos. Conclusiones: se necesitan más estudios para determinar las implicaciones para la salud a largo plazo del uso de este deben considerarse completamente seguros e inofensivos.

SUMMARY Objective: to discuss the health effects caused by the use of electronic cigarettes. Material and Methods : A search was performed in the PubMed/Medline database of complete articles published in the last 10 years. A total of 21 articles were used, according to the established inclusion criteria, with a higher prevalence of cross-sectional studies. Results: It was verified that electronic cigarettes may even help in the cessation of conventional smoking, however, their users are not exempt from suffering systemic health complications. They present toxic substances and should not be considered totally safe and harmless. Conclusions : Further studies are still needed to determine the implications of the use of this electronic device on the health of its users in the long term.

Efficacy of Electronic Cigarettes for Smoking Cessation: A Systematic Review and Meta-Analysis.

OBJECTIVE: to synthesize evidence about the efficacy of electronic cigarettes versus Nicotine Replacement Therapy and placebo to quit smoking. DATA SOURCES: We searched for clinical trials with no publication date restriction until December 2019. The search included CENTRAL, MEDLINE, PsycINFO, Science Direct, Center for reviews and dissemination and HTA database and Trip database, clinical trials registries, gray literature and examined the references of relevant articles. INCLUSION AND EXCLUSION CRITERIA: Two review authors independently checked the titles and abstracts then the full text of initial hits. Main outcomes were sustained continuous abstinence rate, 7-day point prevalence abstinence rate, sustained reduction of 50% or greater in baseline cigarette consumption and adverse effects. DATA EXTRACTION AND SYNTHESIS: Two review authors independently extracted data and assessed risk of bias using the Cochrane RoB 2 tool. We conducted a random-effects model through the Mantel-Haenszel method. RESULTS: We retrieved 12 trials involving 9863 participants. CO- validated 1-month continuous abstinence rate improved by 33% in the e-cigarettes group (range 6-66%, moderate evidence). We are uncertain if e-cigarettess influence continuous abstinence rate at 3-, 6- and 12 months as well as sustained reduction of 50% or greater in baseline cigarette consumption at different follow-up periods. One study of 884 participants displayed improved 12-month 7-day point abstinence by 46% (range 17%-82%). E-cigarettes may increase or do not affect the proportion of serious adverse effect at 6 and 12 months follow up. CONCLUSION: Very low certainty evidence supported e-cigarettess to help quit smoking in the short term. There is not enough evidence to determine if e-cigarettess are a safe and efficacious means of smoking cessation in the long term (12+ months).

Critical steps in the path to using cessation pharmacotherapy following hospital-initiated tobacco treatment.

BACKGROUND: Hospital-initiated smoking cessation interventions utilizing pharmacotherapy increase post-discharge quit rates. Use of smoking cessation medications following discharge may further increase quit rates. This study aims to identify individual, smoking-related and hospitalization-related predictors of engagement in three different steps in the smoking cessation pharmacotherapy utilization process: 1) receiving medications as inpatient, 2) being discharged with a prescription and 3) using medications at 1-month post-hospitalization, while accounting for associations between these steps. METHODS: Study data come from a clinical trial (N = 1054) of hospitalized smokers interested in quitting who were randomized to recieve referral to a quitline via either warm handoff or fax. Variables were from the electronic health record, the state tobacco quitline, and participant self-report. Relationships among the predictors and the steps in cessation medication utilization were assessed using bivariate analyses and multivariable path analysis. RESULTS: Twenty-eight percent of patients reported using medication at 1-month post-discharge. Receipt of smoking cessation medications while hospitalized (OR = 2.09, 95%CI [1.39, 3.15], p < .001) and discharge with a script (OR = 4.88, 95%CI [3.34, 7.13], p < .001) were independently associated with medication use at 1-month post-hospitalization. The path analysis also revealed that the likelihood of being discharged with a script was strongly influenced by receipt of medication as an inpatient (OR = 6.61, 95%CI [4.66, 9.38], p < .001). A number of other treatment- and individual-level factors were associated with medication use in the hospital, receipt of a script, and use post-discharge. CONCLUSIONS: To encourage post-discharge smoking cessation medication use, concerted effort should be made to engage smokers in tobacco treatment while in hospital. The individual and hospital-level factors associated with each step in the medication utilization process provide good potential targets for future implementation research to optimize treatment delivery and outcomes. TRIAL REGISTRATION: Number: NCT01305928 . Date registered: February 24, 2011.