A Multimedia Mobile Phone–Based Youth Smoking Cessation Intervention: Findings From Content Development and Piloting Studies

Background

While most young people who smoke want to quit, few access cessation support services. Mobile phone–based cessation programs are ideal for young people: mobile phones are the most common means of peer communication, and messages can be delivered in an anonymous manner, anywhere, anytime. Following the success of our text messaging smoking cessation program, we developed an innovative multimedia mobile phone smoking cessation intervention.

Objective

The aim of the study was to develop and pilot test a youth-oriented multimedia smoking cessation intervention delivered solely by mobile phone.

Methods

Development included creating content and building the technology platform. Content development was overseen by an expert group who advised on youth development principles, observational learning (from social cognitive theory), effective smoking cessation interventions, and social marketing. Young people participated in three content development phases (consultation via focus groups and an online survey, content pre-testing, and selection of role models). Video and text messages were then developed, incorporating the findings from this research. Information technology systems were established to support the delivery of the multimedia messages by mobile phone. A pilot study using an abbreviated 4-week program of video and text content tested the reliability of the systems and the acceptability of the intervention.

Results

Approximately 180 young people participated in the consultation phase. There was a high priority placed on music for relaxation (75%) and an interest in interacting with others in the program (40% would read messages, 36% would read a blog). Findings from the pre-testing phase (n = 41) included the importance of selecting “real” and “honest” role models with believable stories, and an interest in animations (37%). Of the 15 participants who took part in the pilot study, 13 (87%) were available for follow-up interviews at 4 weeks: 12 participants liked the program or liked it most of the time and found the role model to be believable; 7 liked the role model video messages (5 were unsure); 8 used the extra assistance for cravings; and 9 were happy with two messages per day. Nine participants (60%) stopped smoking during the program. Some technical challenges were encountered during the pilot study.

Conclusions

A multimedia mobile phone smoking cessation program is technically feasible, and the content developed is appropriate for this medium and is acceptable to our target population. These results have informed the design of a 6-month intervention currently being evaluated for its effectiveness in increasing smoking cessation rates in young people.     

The role of engagement in a tailored web-based smoking cessation program: randomized controlled trial

Background

Web-based programs for health promotion, disease prevention, and disease management often experience high rates of attrition. There are 3 questions which are particularly relevant to this issue. First, does engagement with program content predict long-term outcomes? Second, which users are most likely to drop out or disengage from the program? Third, do particular intervention strategies enhance engagement?

Objective

To determine: (1) whether engagement (defined by the number of Web sections opened) in a Web-based smoking cessation intervention predicts 6-month abstinence, (2) whether particular sociodemographic and psychographic groups are more likely to have lower engagement, and (3) whether particular components of a Web-based smoking cessation program influence engagement.

Methods

A randomized trial of 1866 smokers was used to examine the efficacy of 5 different treatment components of a Web-based smoking cessation intervention. The components were: high- versus low-personalized message source, high- versus low-tailored outcome expectation, efficacy expectation, and success story messages. Moreover, the timing of exposure to these sections was manipulated, with participants randomized to either a single unified Web program with all sections available at once, or sequential exposure to each section over a 5-week period of time. Participants from 2 large health plans enrolled to receive the online behavioral smoking cessation program and a free course of nicotine replacement therapy (patch). The program included: an introduction section, a section focusing on outcome expectations, 2 sections focusing on efficacy expectations, and a section with a narrative success story (5 sections altogether, each with multiple screens). Most of the analyses were conducted with a stratification of the 2 exposure types. Measures included: sociodemographic and psychosocial characteristics, Web sections opened, perceived message relevance, and smoking cessation 6-months following quit date.

Results

The total number of Web sections opened was related to subsequent smoking cessation. Participants who were younger, were male, or had less formal education were more likely to disengage from the Web-based cessation program, particularly when the program sections were delivered sequentially over time. More personalized source and high-depth tailored self-efficacy components were related to a greater number of Web sections opened. A path analysis model suggested that the impact of high-depth message tailoring on engagement in the sequentially delivered Web program was mediated by perceived message relevance.

Conclusions

Results of this study suggest that one of the mechanisms underlying the impact of Web-based smoking cessation interventions is engagement with the program. The source of the message, the degree of message tailoring, and the timing of exposure appear to influence Web-based program engagement.     

"I did it my way"--an explorative study of the smoking cessation process among Danish youth

Objective

To explore the smoking cessation process of adolescents and their attitudes and beliefs towards smoking cessation and cessation interventions.

Method

Focus group discussions and individual interviews during April–May 2004 with 26 persons aged 15–21 years who all initiated a quit attempt on 1 January 2004.

Results

The approach towards all stages of the youth smoking cessation process varied greatly among both successful and unsuccessful quitters. Apart from ‘commitment’ or the amount of energy put into a cessation attempt, there were no differences in the way successful and unsuccessful quitters approached the quit attempt. ‘Smoking friends’ and ‘social support’ were important for maintaining cessation. Further, participants had negative attitudes towards formalized smoking cessation interventions.

Conclusion

There are many approaches to the smoking cessation process. Whether an attempt is successful depends more on individual conditions and the amount of commitment invested in the attempt than on the specific cessation strategy used.

Practice Implications

Future adolescent smoking cessation interventions should be flexible regarding both structure and content and should focus on the individual learning process, rather than adhering to rigid cessation strategies.     

Tobacco smoke: Unraveling a controversial subject

Cigarettes are a modern and industrial form of tobacco use and obviously involve more than just tobacco. A multitude of physical processes and chemical reactions occur inside the burning zone of a cigarette. Cigarette smoke is an aerosol of liquid droplets (the particulate phase) suspended within a mixture of gases and semi-volatile compounds. Two kinds of smoke with different composition and properties are produced during smoking: mainstream smoke inhaled by the smoker and sidestream smoke, which is released into the environment between puffs from the lit end of the cigarette. Several techniques and modifications have altered the design of the cigarette during the last 50 years and changed smoke composition, with the effect of lower tar and nicotine smoke yields. An enormous amount of research has been done since the 1950s on smoke composition. With regard to the numerous toxic or carcinogenic constituents identified in tobacco smoke, there is a strong focus in the industry and with the authorities on the over 40 compounds, called "Hoffmann analytes". The yields of tar and nicotine in mainstream smoke of a cigarette brand as printed on the pack are measured with smoking machines under highly standardized conditions. Yields must comply with regulatory limits set in a number of countries. Smoking by machine is different from the smoking behavior of humans. There is a growing movement to develop more "realistic" methods to estimate smoke yields. But it is unclear whether alternative smoking regimens are more representative of human smoking behavior and provide better predictions of human exposure. Tobacco smoke has strong biological and toxicological effects in vitro and in vivo. There is an obvious need for developing a unified and validated testing approach particularly for the assessment of additives and the evaluation of new potentially reduced exposure products (PREPs). This paper gives a comprehensive overview of cigarette design, the composition and toxicity testing of smoke, and the way machines and people smoke - with links to the more detailed literature.     

戒烟对新诊断2型糖尿病合并下肢动脉疾病患者高敏C反应蛋白、纤维蛋白原及股动脉内膜中层厚度的影响

目的：了解戒烟后不同时期新诊断2型糖尿病合并下肢动脉硬化性疾病（LEAD）患者高敏CRP（hs—CRP）、纤维蛋白原及股动脉内膜中层厚度（IMT）的变化。方法：将120例初次明确诊断的2型糖尿病合并LEAD伴有吸烟史的男性患者分为吸烟组及戒烟组,每组60例。分别在戒烟前、3个月及1年后对hs-CRP、纤维蛋白原及股动脉IMT进行组间及组内自身对照比较。结果：戒烟3个月后hs-CRP、纤维蛋白原开始变化,1年后较戒烟前及吸烟组有明显改善（P均〈005）。戒烟3个月后戒烟组与吸烟组的股动脉IMT无明显差异（0．89±0．21对比0．91±0．16）,但12个月后戒烟组股动脉IMT与戒烟前及吸烟组比较差异具统计学意义（0．82±0．13对比0．89±0．17,P〈005）。结论：戒烟对新诊断2型糖尿病合并LEAD患者hs—CRP及血浆纤溶活性呈持续改善作用,较短时间戒烟不能改善股动脉IMT,但戒烟1年后股动脉IMT有逆转性改变。     

兰州理工大学新生吸烟认知情况调查分析

目的了解大学新生吸烟及其对吸烟的认识现状。为学校开展控烟健康教育工作提供依据。方法采用随机抽样的方法抽取兰州理工大学新生735名进行问卷调查,内容包括吸烟情况、吸烟认知和态度。结果尝试吸烟率男生为57.87%,女生为15.23%;现吸烟率男、女生分别为18.66%和2.65%。绝大多数学生95.64%知道吸烟有害健康,知道吸烟与肺癌、慢性支气管炎(分别占92.51%和93.87%)有关,但知道吸烟与消化性溃疡、膀胱癌疾病有关的比例较低,分别为32.38%和17.06%。结论大学新生吸烟率较高,少数新生对吸烟与健康关系的认知不足,态度消极。     

Does the effect go up in smoke? A randomized controlled trial of pictorial warnings on cigarette packaging

Objective

Placing a combination of a written warning and a graphic image on cigarette packaging (so called “pictorial warnings”) is one of the WHO Framework Convention on Tobacco Control's most controversial recommendations. Our randomized controlled trial investigated if pictorial warnings lead to significantly higher motivation to quit, as compared to written warnings alone.

Methods

Four pictorial warnings were selected from the EU Commission's official image catalogue. Study arm 1 (44 adult smokers) viewed only the written warnings while study arm 2 (44 adult smokers) viewed the corresponding pictorial warnings. Self-affirmation was a second randomly manipulated factor, and nicotine dependence a quasi-experimental third factor. The main outcome measured was the motivation to quit, with fear intensity as one of the secondary outcomes.

Results

Pictorial warnings were associated with a significantly higher motivation to quit. A pictorial warning was also associated with higher fear intensity. The effect of warnings appears to be independent of nicotine dependence and self-affirmation.

Conclusions

Nationwide implementation of pictorial warnings may be effective in increasing heavy smokers’ motivation to quit.

Practice implication

Due to the fact that perceived vulnerability, response and self-efficacy are not more strongly affected by pictorial warnings this effect may turn out to be short-term.     

吸烟对慢性阻塞性肺疾病患者血清及肺泡灌洗液中肿瘤坏死因子-α及干扰素-γ的影响

目的:评价吸烟对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者急性期、稳定期血清及肺泡灌洗液中肿瘤坏死因子-α(TNF-α)及干扰素-γ(IFN-γ)的影响.方法:分别测定正常对照组、非吸烟COPD组、持续吸烟COPD组及戒烟COPD组患者急性期、稳定期血清及肺泡灌洗液中TNF-α及IFN-γ的水平,并对各组血清及肺泡灌洗液中TNF-α及IFN-γ水平分别进行比较.结果:COPD患者无论在急性期还是稳定期,肺泡灌洗液中TNF-α水平较正常对照组高(P＜0.05).其中,持续吸烟的COPD患者肺泡灌洗液中TNF-α水平较非吸烟COPD组及戒烟COPD组高(P＜0.05).急性期及稳定期COPD患者血清中TNF-α水平较正常组高(P＜0.05).急性期及稳定期COPD患者血清及肺泡灌洗液中IFN-γ水平均较正常组高(P＜0.05).其中,持续吸烟的COPD患者肺泡灌洗液中IFN-γ水平较非吸烟COPD及戒烟COPD患者均高(P＜0.05).结论:COPD患者急性期及稳定期存在TNF-α及IFN-γ介导的全身及气道局部炎症反应增强.持续吸烟的COPD患者气道局部的炎症反应增强最显著,而戒烟的COPD患者较持续吸烟的COPD患者该炎症反应减弱.     

吸烟与中年人颈动脉粥样硬化的剂量-反应关系探讨

目的探讨中年人吸烟与颈动脉粥样硬化的关系。方法选择308例研究对象,进行问卷调查、实验室检查和颈动脉超声检查。结果吸烟组颈动脉斑块形成的人数明显高于不吸烟组,差异有高度统计学意义（P〈0．01）;吸烟者颈动脉斑块形成的例数随着吸烟指数的增加而增多,趋势性检验具有统计学意义（P〈0．01）。结论吸烟可增加中年人颈动脉粥样硬化的风险,且存在一定的剂量－反应关系。