Readiness to quit smoking in rural communities

The purpose of this study was to determine psychosocial and demographic factors associated with readiness to quit smoking among rural current and recent former smokers. This cross-sectional study of 333 rural adults was part of a larger quasi-experimental study testing the effect of a population-based Quit and Win Contest on quitting. Readiness to quit, partner support to quit smoking, stressful life events, depressive symptoms, and demographic characteristics were measured via a phone interview three months after the Contest. Participants with greater positive partner support to quit smoking were more ready to quit. Minority participants were more ready to quit, compared with Caucasian respondents.     

Smoking cessation: a consensus statement with special reference to primary care

Nicotine addiction is a serious medical condition that needs to be treated like any other chronic disease. Primary care must play a key role in smoking cessation and offering help should be a routine part of primary care practice. As the most frequent opportunity for intervention lies within primary care, GPs should ensure that they raise the issue of stopping smoking at least annually with their smoking patients. When the smoker is ready to stop, the initial personal involvement of the GP is likely to increase the chance of a successful quit attempt. Follow-up may be with another healthcare professional. The support of healthcare professionals for the smoker who is motivated to quit, combined with appropriate pharmacotherapy, can substantially increase the chances of a successful quit attempt. Secondary care staff should also make every effort to help people to stop smoking and should communicate effectively with primary care--opportunities during hospitalisation are frequently missed. Specialist smoking cessation clinics have an essential role in providing more intensive specialist treatment and the expertise to partner and support the primary care effort. Smoking cessation is one of the most cost-effective healthcare interventions that can be made.     

Partner influences on smoking cessation: A longitudinal study of couple relationships

Introduction: Despite declines in population tobacco use, smoking remains unacceptably high. Smoking cessation may be particularly difficult in couple relationships when partners continue to smoke, and when relationship satisfaction is low. This study examined the longitudinal influence of partner tobacco use and relationship satisfaction on the likelihood of smoking cessation. Methods: Data were obtained from 238 tobacco-using couples aged between 18 and 45 over three assessments from a nationally representative sample of Australian households. Results: There was high concordance between partner smoking six years after the initial assessment, with a little more than three-quarters (76.1%) of non-smokers residing with partners who had also ceased smoking. Step-wise logistic regression models indicated that females were more likely to cease smoking if their partners had previously quit. Males were more likely to quit smoking when they perceived their relationship as highly satisfying and their partner had stopped smoking. Female partners were also more likely to quit smoking when they were highly satisfied with their relationships. Conclusions: Both partner’s smoking status and relationship satisfaction are important considerations in smoking-related cessation. For entrenched smokers in couple relationships, involvement of partners in interventions may be useful.     

Do smoke-free laws in rural, distressed counties encourage cessation?

The authors examined the association between smoke-free laws and smoking/cessation behaviors and secondhand smoke exposure among current and former smokers in rural, distressed counties. A quasi-experimental, two-group design compared outcomes between participants from a county with a longstanding smoke-free law (n = 252) and those living in four demographically similar counties without smoke-free laws ( n = 250). Participants were recruited using random digit dialing. Controlling for demographic factors, those in the treatment group reported greater nicotine dependence, were more likely to have smoke-free workplaces, and less likely to have smoke-free homes. There were no differences in smoking status, past-year quit attempts, intent to quit in 5 years, cigarettes per day, or time since last cigarette. Smokers in the treatment group were just as likely to attempt to quit, despite greater nicotine dependence. Findings showed that making nonsmoking the social norm through policy change may be more difficult in rural, distressed areas.     

Smoking reduction treatment with 4-mg nicotine gum: a double-blind, randomized, placebo-controlled study

BACKGROUND: Smoking reduction may provide a harm-reduction alternative treatment for smokers who are not ready to quit smoking. This study evaluated the efficacy of nicotine gum in helping smokers reduce or quit smoking. METHODS: This randomized, double-blind, placebo-controlled trial involved 364 smokers who were not ready to quit but were willing to reduce their smoking intensity. Participants received either 4-mg nicotine gum (n = 184) or placebo gum (n = 180) as desired for up to 12 months. The primary outcome was sustained smoking reduction, which was defined as a decrease in daily cigarette consumption of at least 50% compared with baseline. Secondary measures included point-prevalence abstinence, intention to quit, and cardiovascular risk markers. RESULTS: At 4 months, the sustained smoking reduction rate in the nicotine gum group was twice that of the placebo group (15.8% versus 6.7%, P = .008). Point-prevalence abstinence was 6.6% for the nicotine gum group and 2.2% for the placebo group (P = .07). At 13 months, there was a significant difference in the smoking reduction rate for the nicotine (8.2%) and placebo (2.8%) groups (P = .036). At month 13, the abstinence rates were 12% and 4.5% for the nicotine and placebo groups, respectively (P = .012). Concomitant use of nicotine gum and cigarette smoking was well tolerated. Carbon monoxide levels decreased significantly (P = .01). CONCLUSION: Nicotine gum may be an efficacious harm-reduction alternative for smokers who are not ready to quit and may promote smoking cessation, the ultimate goal in the treatment of tobacco dependence.     

The ‘Take a Break’ game: Randomized trial protocol for a technology-assisted brief abstinence experience designed to engage lower-motivated smokers

BackgroundWhile smoking continues to be the most preventable cause of mortality in the United States, most current smokers remain not ready to quit at any given time. Engaging these ‘motivation phase’ smokers with brief experiences to build confidence and practice skills related to cessation could lead to sooner and more successful quit attempts. Increasingly available mobile technology and gamification can be used to provide smokers with accessible and engaging support.MethodsWe describe our protocol for conducting a randomized controlled trial evaluating Take a Break, an mHealth-based smoking pre-cessation challenge designed for smokers not ready to quit. Participants in the intervention receive 1) Motivational Messages, 2) text message Challenge Quizzes, 3) Goal-setting with tobacco treatment specialist, 4) Coping Mini-Games apps, and 5) Recognition and Rewards for participation during a 3-week challenge. Access to coping mini-games and motivational messaging continues for 6-months. Both intervention and comparison group participants receive brief Nicotine Replacement Therapy (NRT) sampling and daily smoking assessment text messages for three weeks. Primary outcomes include number of days abstinent during the challenge, change in patient-reported self-efficacy after the challenge, time to first quit attempt following the challenge, and 7-day point prevalent smoking cessation at six months.ConclusionTake a Break is an innovative approach to engage those not prepared for a quit attempt. Take a Break provides motivation phase smokers with tools and a brief experience to prepare them for a quit attempt, filling a gap in tobacco cessation support and current research.     

Introducing a new stop smoking service in an acute UK hospital: A qualitative study to evaluate service user experience

PurposeSmoking is a risk factor for numerous cancers yet many smokers do not become motivated to quit until they are admitted to hospital with a smoking-related illness.The provision of smoking cessation services in hospitals could therefore be helpful to these patients. This study aimed to explore the user experience of one such service in a UK hospital and identify whether the service assisted patients to quit smoking.MethodA qualitative approach was used which incorporated face-to-face structured interviews with 44 patients across 4 clinical specialties in an acute hospital in the UK. Data collection also involved follow-up telephone interviews with nineteen participants approximately 6 weeks later. Data were analysed using a thematic analysis.ResultsPatients with a variety of diagnoses, including cancer, participated in the study and all welcomed the opportunity to access the hospital service. Hospital was seen as an appropriate venue, where it was easier to make a quit attempt and there was ready access to nicotine replacement therapy (NRT) and a supportive environment. A number of ‘pushes’ towards, and ‘pulls’ away from quitting emerged from the data and were demonstrated outwardly by how ready the patient was to quit.ConclusionsThe hospital environment provided a prime opportunity to offer stop smoking advice, assessment and treatment to patients. The provision of this service outside of traditional locations broadened opportunities for access particularly when patients were ready to quit. This service therefore made a positive contribution to the stop smoking agenda.     

A couple-focused intervention to prevent postnatal smoking relapse: PRISM study design

BackgroundMaternal smoking is one of the most modifiable factors with clear adverse effects for the fetus and the entire family. Addressing the dearth of pregnancy smoking interventions with partner support, PRISM (Prevent Relapse In SMoking) is a partnership between a research institution and the two largest state-owned obstetrics and gynecology clinics in Cluj-Napoca, Romania. The study will assess the efficacy of a couple-focused telephone-counseling program to prevent smoking relapse among mothers who quit smoking closely before or during pregnancy.Methods/designThe intervention is a program for couples based on motivational interviewing delivered over the phone after birth. The study is an ongoing randomized controlled trial of 250 Romanian women recruited soon after childbirth, who quit smoking in the six months before pregnancy or no later than the end of the first pregnancy trimester and remained abstinent (which was biochemically verified) until delivery. Participants were randomized to: (1) a control arm (usual care); and (2) an intervention arm consisting of up to 4 postnatal counseling calls for mothers and their partners using motivational interviewing to encourage the woman to remain smoke-free and the partner to support her decision. The primary outcome is maternal smoking abstinence at 6 months postpartum (biochemically verified).DiscussionPRISM has the potential to identify strategies to reduce maternal postnatal relapse and increase partner quitting. If successful, the program may be an effective method to prevent and reduce smoking, which may lead to improved child, mother, and partner health both in the short and the long term.     

Secondhand tobacco smoke exposure, nicotine dependence, and smoking cessation

OBJECTIVE: To explore the association among the number of sources of secondhand tobacco smoke (SHS) exposure, nicotine dependence (ND), and smoking cessation. DESIGN: A secondary analysis of cross-sectional data. Responses for the main study were obtained in 2001 from a controlled trial of the Quit and Win Tobacco Free Contest in Kentucky. SAMPLE: 822 current smokers. MEASUREMENTS: Demographic variables (age, gender, educational status, income, and ethnicity) the number of sources of SHS exposure, smoking frequency, length of abstinence from smoking, age of smoking initiation, smoking cessation attempts, intentions to quit smoking, and ND. RESULTS: The number of sources of SHS exposure was associated with higher ND and smoking frequency, and related to low intentions and attempts to quit smoking. The number of sources of SHS exposure contributed to 11% of the variance in the final ND model, after accounting for control and potential mediating variables. CONCLUSIONS: The number of sources of SHS exposure may be an important factor influencing ND and intentions and attempts to quit smoking. Further studies are needed to explore the association between SHS exposure and ND among smokers to guide treatment and policy development.     

Smoking cessation intervention with pregnant women and new parents (part 2): A focus group study of health visitors and midwives working in the UK

A qualitative, focus group study was undertaken in the United Kingdom with NHS-employed health visitors and midwives to examine their attitudes towards smoking in pregnancy and their perception of their professional role in smoking cessation/relapse prevention work with women in their care. The health visitors and midwives felt there were several social and personal reasons why women smoke in pregnancy. Most felt a professional responsibility to intervene with smokers, even though they also felt their intervention was ineffective unless patients were ‘ready’ to quit and a multidisciplinary team was in place to support their patients according to their individual needs. Midwives and health visitors are willing to promote smoking cessation with their patients, but feel there are personal and organisational barriers to providing an effective service. Respondents held mixed views on the effectiveness of interventions for smoking cessation highlighting the need for evidence-based training.     

Social attitudes towards smoking in pregnancy in East Surrey: A qualitative study of smokers,former smokers and non-smokers

A qualitative study was undertaken to explore social attitudes towards smoking by pregnant women, mothers of preschool children and their partners based in Merstham and Horley, East Surrey. All respondents felt that smoking in pregnancy was associated with considerable social stigma and negative social attitudes. Non-smokers were particularly negative in their views on smoking in pregnancy feeling that it was socially unacceptable. Women who smoked during pregnancy reported various negative social experiences such as receiving criticism from health professionals and community associates. They reported feeling under pressure to quit to achieve social acceptability as much as for health improvements. Some pregnant smokers denied smoking to health professionals, partners and colleagues and used private smoking places out of public view to reduce the chances of detection. Women who smoked or had a partner who smoked were more accepting of smoking in pregnancy than non-smokers and former smokers. Moreover, residents from the more socio-economically deprived area of Merstham were more tolerant of smoking in pregnancy and parenthood, compared to Horley-based respondents, regardless of their personal smoking status. They gave examples of local women they knew who had smoked in pregnancy without apparent complication. While all respondents were aware of health risks associated with smoking, smokers did not feel the risks were personally relevant to them and were exaggerated in an anti-smoking society. Health professionals need to be aware that pregnant women may not disclose smoking activity due to perceived social stigma and may require more intensive smoking cessation support services in socio-economically deprived areas.     

The participation of health professionals in a smoking-cessation programme positively influences the smoking cessation advice given to patients

This study assessed the degree of smoking cessation advice given by health professionals, before and after their participation in a smoking cessation study using bupropion-sustained release (bupropion SR, Zyban). A total of 690 physicians and nurses who had smoked an average of 10 cigarettes/day over the previous year and were motivated to quit smoking, were randomised in a double-blind manner to receive bupropion SR (days 1-3, 150 mg/day; days 4-49, 150 mg twice daily) or placebo for 7 weeks, with follow-up to week 52. All subjects received regular follow-up and brief motivational support throughout the study. Questions regarding their smoking cessation advice formed part of the study, with the aim of determining whether study participants became more proactive with their smoking cessation advice. A positive shift from baseline to end of study was observed with respect to the advice and support they gave to their smoking patients. These changes were not related to study treatment or current smoking status. An increase in advising patients to quit smoking and in offering cessation counselling was observed. Participation in a smoking-cessation study by physicians and nurses who smoke has a positive effect, regardless of study medication, in smoking cessation advice and counselling given to their patients.     

Predictors of short-term smoking cessation among Korean American men

ABSTRACT Objectives: The purpose of this study was to examine which demographic, smoking behavior, and theoretical variables of theory of planned behavior would predict smoking cessation attempts among Korean American men. Design: This is a longitudinal study and data collection was conducted at baseline and 1‐month follow‐up. Sample: At baseline, 118 Korean adult male smokers were recruited into the study and of these, 93 participated at follow‐up. Measures: Study questionnaires consisted of demographic data, smoking behavior, and theoretical variables. Analysis: A multiple regression analysis was performed to identify correlates of behavioral intentions to quit smoking at baseline and binary logistic regression analysis for predictors of actual quitting behavior at follow‐up. Results: Among smoking behavior variables, past‐year quit attempts and average number of cigarettes smoked per day explained 15% of the variance in behavioral intentions to quit smoking ( p<.0001). Two theoretical variables attitudes and perceived family social norms increased the explanatory power by 22% ( p<.0001) with an overall of 37%. Religion and perceived family social norms had about 32% predictive power over actual quitting behavior ( p<.0001). Conclusions: Any smoking cessation programs planned for Korean American men consider encouraging family members to affirm antismoking messages to this ethnic subgroup.     

Demographic, psychosocial, and contextual correlates of tobacco use in sexual minority women

Demographic, psychosocial, and contextual correlates of tobacco use among sexual minority women (SMW) were assessed using data from a larger lesbian, gay, bisexual, and transgender (LGBT) study. Of the 171 participants, 42% (n = 71) were smokers. However, 61% of smokers reported a recent quit attempt, and 39% were taking action toward or planning to quit. In multivariable logistic regression, lack of insurance, frequent attendance at LGBT bars, greater awareness of anti‐smoking messages, and fewer perceived deterrents to smoking were associated with greater odds of smoking. Our findings provide additional support for elevated smoking rates among SMW and help to identify factors associated with smoking in this population. Awareness of prevention campaigns, recent quit attempts, and intention to quit were high, suggesting opportunities for smoking cessation. © 2011 Wiley Periodicals, Inc. Res Nurs Health     

Statewide demonstration of not on tobacco: a gender-sensitive teen smoking cessation program.

This study represented the largest statewide demonstration (n = 346) of the teen smoking cessation program Not On Tobacco (N-O-T) to date and one of the few systematically controlled teen smoking cessation trials reported in the literature. Results showed that N-O-T female teens were 4 times more likely to quit smoking almost 6 months after the program ended than female teens who received a brief intervention (BI). The quit rate for the N-O-T female groups was significantly higher than that for female brief intervention comparison groups. The study demonstrated that 2 times more N-O-T than BI teens quit smoking overall. Differences in the biochemically validated quit rate between the N-O-T groups and the brief intervention groups overall and for male participants were not statistically different, however. Furthermore, findings showed that N-O-T was more effective than the brief intervention in assisting youth with cigarette reduction. There was a significant difference in the reduction rate between the N-O-T and the BI groups on weekdays and weekends 6 months after the program ended. Overall, approximately 84% of N-O-T teens either quit or reduced smoking, compared with approximately 55% of BI teens. This study is 1 phase of an ongoing multiphase evaluation of N-O-T. This study resulted in several important findings that will help guide future teen cessation studies and tobacco cessation efforts of school health professionals.     

Smoking Habits of Emergency Department Patients: An Opportunity for Disease Prevention

Objective: To determine smoking habits, levels of addiction, readiness to quit, and access to primary care among ED patients.
Methods: A questionnaire was administered prospectively to all non-critical adult patients who presented to one university hospital ED during 23 randomly selected four-hour time blocks; 336 (89%) of 376 eligible patients responded. Self-reported smoking was validated by carbon monoxide breath testing in a pilot sample of 49 patients.
Results: The study patients were mostly young (mean age = 35 ± 15 years), female (59%), white (62%), and high school-educated (73%). Of the 336 ED patients, 41% were current smokers (95% CI = 0.36–0.46); 42% of these were "moderately" to "very highly" dependent on nicotine (Fagerstrom Test for Nicotine Dependence > 4). Of those who smoked, 68% stated they wanted to quit, and 49% wanted to quit within the month. Fifty-six percent of all those who smoked stated that they had never been told to quit smoking by any physician. Thirty-five percent of the ED sample (118 patients) relied upon EDs for most or all of their routine, primary health care; 55% (95% CI = 0.46–0.64) of these patients were current smokers.
Conclusions: The prevalence rates of smoking and nicotine addiction among ED patients are high. Almost half of ED smokers are ready to quit, but most state they have never been told by a physician to do so. Finally, a large proportion of ED smokers receive their primary care in EDs. Therefore, the ED may be an underused setting for smoking cessation intervention.