Classification of smoking cessation status with a backpropagation neural network

This study examined the ability of a backpropagation neural network (BPNN) classifier to distinguish between current and former smokers in the 2000 National Health Interview Survey (NHIS) sample adult file. The BPNN classifier performance exceeded that of random chance, with asymmetric 95% confidence intervals for A_z (area under receiver operating characteristic curve) = (0.7532, 0.7790). Separation of current and former smokers was imperfect, as illustrated by the receiver operating characteristic (ROC) curve. Additionally, performance did not exceed that of a comparison classifier created using logistic regression. Attribute subset selection identified three novel attributes related to smoking cessation status. This study establishes the ability of backpropagation neural networks to classify a complex health behavior, smoking cessation. It also illustrates the hypothesis-generating capacity of data mining methods when applied to large population-based health survey data. Ultimately, BPNN classifiers of smoking cessation status may be useful in decision support systems for smoking cessation interventions.     

The importance of practitioner smoking status: A survey of NHS Stop Smoking Service practitioners

Objective

To investigate the smoking status of stop smoking practitioners, the impact of this on their practice, and clients’ quit rates.

Methods

Smoking cessation practitioners in the UK NHS Stop Smoking Service were asked about their smoking status, client quit rates and practitioner–client interaction, using an online survey. Associations between responses were investigated using logistic regression.

Results

51% of the sample (N = 484) were ex-smokers. Most practitioners had been questioned about their smoking status by clients, with more never than ex-smokers claiming that this reduced their confidence when advising. Never smokers more frequently reported that clients questioned their ability as a practitioner, but no significant difference in quit rates was reported between never and ex-smokers.

Conclusion

Although evidence suggests smokers believe many practitioners are never smokers, this survey found that this is not true. Research investigating how many smokers might not be seeking support to quit because of this could be beneficial.

Practice implications

Raising awareness of the similarity of quit rates achieved by never and former smoker practitioners, and the experience practitioners draw upon when offering advice, might encourage greater use of the NHS SSS. It could also be beneficial to improve training in never smokers to address confidence issues.     

Effect of tailoring in an internet-based intervention for smoking cessation: randomized controlled trial

Background

Studies suggest that tailored materials are superior to nontailored materials in supporting health behavioral change. Several trials on tailored Internet-based interventions for smoking cessation have shown good effects. There have, however, been few attempts to isolate the effect of the tailoring component of an Internet-based intervention for smoking cessation and to compare it with the effectiveness of the other components.

Objective

The study aim was to isolate the effect of tailored emails in an Internet-based intervention for smoking cessation by comparing two versions of the intervention, with and without tailored content.

Methods

We conducted a two-arm, randomized controlled trial of the open and free Norwegian 12-month follow-up, fully automated Internet-based intervention for smoking cessation, slutta.no. We collected information online on demographics, smoking, self-efficacy, use of the website, and participant evaluation at enrollment and subsequently at 1, 3, and 12 months. Altogether, 2298 self-selected participants aged 16 years or older registered at the website between August 15, 2006 and December 7, 2007 and were randomly assigned to either a multicomponent, nontailored Internet-based intervention for smoking cessation (control) or a version of the same Internet-based intervention with tailored content delivered on the website and via email.

Results

Of the randomly assigned participants, 116 (of 419, response rate = 27.7%) in the intervention group and 128 (of 428, response rate = 29.9%) in the control group had participated over the 12 months and responded at the end of follow-up. The 7-day intention-to-treat abstinence rate at 1 month was 15.2% (149/982) among those receiving the tailored intervention, compared with 9.4% (94/999) among those who received the nontailored intervention (P < .001). The corresponding figures at 3 months were 13.5% (122/902) and 9.4% (84/896, P =.006) and at 12 months were 11.2% (47/419) and 11.7% (50/428, P = .91). Likewise, the intervention group had higher self-efficacy and perceived tailoring at 1 and 3 months. Self-efficacy was found to partially mediate the effect of the intervention.

Conclusion

Tailoring an Internet-based intervention for smoking cessation seems to increase the success rates in the short term, but not in the long term.     

Predictors of adolescent smoking cessation and smoking reduction

Objective

To investigate the processes of change, demographic, health- and smoking-related predictors of both smoking cessation and smoking reduction in adolescents.

Methods

Data were drawn from a sample of 755 adolescent smokers who participated in a study testing the efficacy of a text messaging-based intervention for smoking cessation. Demographic, health- and smoking-related variables were assessed at baseline. Five processes of smoking cessation, derived from the Transtheoretical Model and the Social Cognitive Theory, as well as outcome measures were assessed at 6-month follow up. Univariate and multivariate regression analyses were conducted to identify baseline and process variables to predict smoking abstinence and smoking reduction.

Results

Male gender (OR = 0.43, p < .01), lower alcohol consumption (OR = 0.90, p = .05) and a lower number of cigarettes smoked per day at baseline (OR = 0.87, p < .01) predicted smoking abstinence. Baseline physical activity predicted smoking reduction (OR = 1.04, p = .03). None of the examined process variables significantly predicted smoking abstinence. The process variable “counter-conditioning” predicted smoking reduction (OR = 1.46, p = .03).

Conclusions

Baseline predictors of smoking cessation differ from predictors of smoking reduction. Dynamic or modifiable variables play an important role in predicting adolescent smoking cessation.

Practice implications

Counter-conditioning might be an important element in adolescent smoking cessation interventions.     

Developing and maintaining patients’ trust during general practice consultations: The case of smoking cessation advice

Objective

The aim of this paper is to describe how the process of developing and maintaining trust is related to how and if smoking cessation advice is given in general practice consultations.

Methods

The study consisted of interviews with six Danish GPs and with 11 of their patients, on the basis of observations of their consultations.

Results

According to the findings of this study, both the GPs and the patients expected GPs to demonstrate in interaction with the patients their intent to evaluate and possibly resolve the patient's health problem. The GPs were also expected to show that they recognized the patient's health problem. Both GPs and patients felt that this would help to develop patients’ trust in their GPs. Smoking cessation advice during consultations could negate these demonstrations of GPs intents. Smoking cessation advice, however, could demonstrate interest and a desire to help and so develop trust.

Conclusion

Smoking cessation advice has the potential both to put trust under strain and to strengthen trust. The outcome depends on whether the advice conforms to what both patients and GPs expect from the interaction in general practice consultations.

Practice implications

To develop and maintain patients’ trust GPs should consider the specific expectations from the interaction with patients during consultations when giving smoking cessation advice.     

Interactive voice response telephony to promote smoking cessation in patients with heart disease: a pilot study

OBJECTIVE: A pilot study was conducted to determine the feasibility and potential efficacy of an interactive voice response (IVR) follow-up system for smokers recently hospitalized with coronary heart disease (CHD). METHODS: Ninety-nine smokers hospitalized with CHD completed a baseline questionnaire, were provided with bedside counseling, and offered nicotine replacement therapy. They were randomly assigned to a usual care (UC) or an IVR group. The IVR group received automated telephone follow-up calls 3, 14 and 30 days after discharge inquiring about their smoking status and confidence in remaining smoke-free. When deemed necessary, they were offered additional counseling. Smoking status was determined 52 weeks after hospital discharge. RESULTS: The 52-week point prevalence abstinence rate in the IVR group was 46.0% compared to 34.7% in the UC group (OR=1.60, 95% CI: 0.71-3.60; P=.25). After adjustment for education, age, reason for hospitalization, length of hospitalization, and quit attempts in the past year, the odds of quitting in the IVR group compared to the UC group were 2.34 (95% CI: 0.92-5.92; P=.07). CONCLUSIONS: IVR is a promising technology for following CHD patients attempting to quit smoking following discharge from hospital, however, a larger trial is required to confirm its efficacy. PRACTICE IMPLICATIONS: IVR may enhance the timely provision of follow-up counseling for smoking cessation in patients with CHD.     

Adenosine receptors in COPD and asymptomatic smokers: effects of smoking cessation

Our group has shown that 1-year smoking cessation persisted or increased airway inflammation in chronic obstructive pulmonary disease (COPD). We compared adenosine and adenosine receptor (AR) expression in COPD and asymptomatic smokers (AS) before and after 1-year smoking cessation. Sputum cytospins and bronchial biopsies of (ex)smoking COPD patients and AS were studied for A₁R, A_2AR, A_2BR, and A₃R expression. Adenosine and inflammatory mediators were measured in sputum supernatants. At baseline, COPD patients had lower levels of adenosine and higher levels of vascular endothelial growth factor in sputum than AS. Smoking cessation induced significantly different effects in COPD than in AS, i.e. an increase in percentages of A₃R expressing neutrophils and A₁R expressing macrophages in COPD as increase in adenosine and monocyte chemoattractant protein-1 levels in sputum. Adenosine-related effector mechanisms may contribute to the persistence and progression of airway inflammation in COPD following 1-year smoking cessation.     

Increased leptin and decreased ghrelin level after smoking cessation

Smoking cessation is associated with transient increases in body weight. Leptin and ghrelin are known to be major mediators of appetite, weight and the reward pathway. Therefore, this study assessed the changes in the plasma leptin and ghrelin level and their relationship with the body weight and appetite after smoking cessation in the Korean population. Eighteen subjects, who had stopped smoking for 2 months were enrolled in this study. The body mass index (BMI), body fat mass (BFM), waist-hip ratio (WHR), weight and appetite were measured before and after smoking cessation. In addition, the plasma leptin and ghrelin levels were measured. The BMI, BFM, WHR, weight and appetite were significantly higher than baseline in those who had gave up smoking for 2 months (p<0.05). The plasma leptin concentration increased and the plasma ghrelin level decreased after smoking cessation. The change in the leptin level was positively correlated with the change in the body mass index and body fat mass. These results do not support the direct mediation of the leptin-ghrelin-neuropeptide Y (NPY) system on weight gain after smoking cessation. It appears that weight and appetite is regulated by a more complicated mechanism after smoking cessation.     

Smoking intentions and mood preceding lapse after completion of treatment to aid smoking cessation

Objective

To examine the situation preceding “late” smoking relapse, particularly the availability of tobacco, mood and intentions at first lapse.

Methods

A questionnaire was sent to 1439 adults identified as abstinent after treatment with a National Health Service stop-smoking clinic over the previous 3 years. Relapsers were asked where they had obtained their first cigarette, their mood and intentions immediately before first lapse.

Results

40% (n = 556) responded, of whom 35.8% (n = 199) had relapsed. At the time of first lapse, only 27.1% had made a decision to return to smoking while 48.9% intended to smoke only one or two cigarettes before stopping again. In 45.7% of cases, respondents bought cigarettes to smoke again. Prior to lapse the majority (53.8%) reported “really needing a cigarette”. Similarly 53.8% reported being miserable at the time, while only 16% were happy.

Conclusion

The most common pattern of late lapse appears to be intending to suspend the quit attempt temporarily in circumstances of needing to smoke and of negative emotional state, and in many cases cigarettes are actually sought out.

Practice implications

Promoting strong ‘not a puff’ rules, a non-smoker identity and identifying negative mood as a potential vulnerability are important components of relapse prevention intervention.     

Implementation and effectiveness of a hospital smoking cessation service in Germany

Objective

Hospitalized smokers are often highly motivated to quit and receptive to assistance. There are few published accounts of hospital-based smoking cessation programmes implemented outside of a trial setting, particularly outside North America. We describe the implementation and effectiveness of a dedicated smoking cessation service in Freiburg, Germany.

Methods

Measures of implementation (e.g. number of patients referred and consenting to participate, receipt of post-discharge support) and effectiveness are presented.

Results

In the first 2 years of the service, 1432 patients were referred. Over half (55.3%) of counselled smokers agreed to participate. Sustained abstinence for 6 months was achieved by 28.0% (missing cases coded as smokers), whereas 7-day point prevalence rates were between 30 and 35% at 3, 6 and 12 months. Those who received 4+ post-discharge calls were more likely to achieve sustained abstinence, as were older smokers, those with higher self-efficacy, and cardiovascular patients.

Conclusion

Hospitalized patients in Germany are receptive to the offer of bedside counselling and to phone support post-discharge, and success rates are comparable to those achieved in other countries.

Practice implications

The findings argue strongly for the routine identification of smokers upon hospital admission, and the availability of cessation support both during hospitalization and following discharge.     

Keeping morality out and the GP in. Consultations in Danish general practice as a context for smoking cessation advice

OBJECTIVE: To describe consultations in Danish general practice as a context for a mass strategy of smoking cessation advice. METHODS: The focus of the study was on consultations for health problems that were not related to smoking. Interviews with eleven patients and their six GPs were grounded in observation of their own consultations. RESULTS: Patients and GPs agreed that the GP should adopt an attitude of moral acceptance towards patients. Ideals of moral acceptance of patients in general practice consultations were challenged by the prevailing negative moral values associated with smoking. A general aim of mutuality in the conversation in consultations could not always be achieved in smoking cessation advice. Achieving mutuality was especially a problem when smoking cessation advice was repeated at short intervals. CONCLUSION: Two elements of Danish general practice consultations were challenged by smoking cessation advice to patients without smoking-related illness: the ideal of moral acceptance of patients in general practice consultations held by GPs and patients and the wish for mutuality in the conversation during consultations. PRACTICE IMPLICATIONS: A conversation about smoking based on motivational interviewing would fit in the context of Danish general practice. Relieving the conversation of blocks due to moral implications, however, is still a challenge.     

Insular lesions and smoking cessation after first-ever ischemic stroke: A 3-month follow-up

Little is known about biological factors involved in post-stroke smoking cessation. A recent retrospective study has indicated a possible association between unilateral insular lesions of various origin and a rapid disruption of nicotine addiction. Given the above, the aim of the present prospective study was to assess a relationship between post-stroke smoking cessation and lesion localization. Eighty-seven patients with first-ever, unilateral, ischemic stroke who had been active smokers at stroke onset were examined during hospitalization and at 3-month follow-up. No association was found between any specific lesion localization (the insula, operculum, striatum, thalamus, internal capsule, brainstem) and smoking status at the 3-month follow-up visit. Patients with lacunar circulation strokes (LACS) were more likely to be non-smokers at the follow-up examination. No sudden disruption of nicotine addition was observed in patients with insular or other stroke locations. Concluding, post-stroke smoking cessation may not be associated with insular lesions.     

Online social networks and smoking cessation: a scientific research agenda

Background

Smoking remains one of the most pressing public health problems in the United States and internationally. The concurrent evolution of the Internet, social network science, and online communities offers a potential target for high-yield interventions capable of shifting population-level smoking rates and substantially improving public health.

Objective

Our objective was to convene leading practitioners in relevant disciplines to develop the core of a strategic research agenda on online social networks and their use for smoking cessation, with implications for other health behaviors.

Methods

We conducted a 100-person, 2-day, multidisciplinary workshop in Washington, DC, USA. Participants worked in small groups to formulate research questions that could move the field forward. Discussions and resulting questions were synthesized by the workshop planning committee.

Results

We considered 34 questions in four categories (advancing theory, understanding fundamental mechanisms, intervention approaches, and evaluation) to be the most pressing.

Conclusions

Online social networks might facilitate smoking cessation in several ways. Identifying new theories, translating these into functional interventions, and evaluating the results will require a concerted transdisciplinary effort. This report presents a series of research questions to assist researchers, developers, and funders in the process of efficiently moving this field forward.     

Application of a stage based motivational interviewing approach to adolescent smoking cessation: the Transtheoretical Model-based study

OBJECTIVE: To evaluate the results of stage-based motivational interviewing (MI) efforts to help adolescents quit smoking using the three constructs of Transtheoretical Models (TTM). The validity of Turkish translations of two key scales was also assessed. METHODS: A methodological and single group pre-post test study design was utilized. 275 adolescent smokers from one high school were recruited for validation of the scales and 60 of them participated in MI intervention. Change in smoking stage, interpretation of pros and cons of smoking, temptations, and smoking status were measured prior to the intervention, and follow-up was conducted at 3 and 6 months after intervention. RESULTS: The scales showed adequate reliability and validity for use in Turkish adolescent. Of the MI participants, 40% and 55% had made positive movements in stage at 3 and 6 months, respectively. The interpretations of the cons of smoking significantly increased and temptations dropped toward the action stage at 3 months, and pros of smoking and temptations decreased at 6 months consistently with TTM. The percentages of those who had quit smoking at 3 and 6 months were 18.3% and 33.3% respectively. CONCLUSION: A modest, short-term benefit of the intervention was provided to students towards stopping smoking and positive movement in stages was apparent. PRACTICAL IMPLICATIONS: Using the MI principles in specific stages based on TTM, health care providers can influence and empower adolescent smokers positively for quitting smoking.     

Implementing a hospital-based smoking cessation programme: evidence for a learning effect

OBJECTIVE: This study assessed a newly set-up, hospital-based smoking cessation clinic with regard to continuous abstinence rates and the effectiveness of concomittant nicotine replacement therapy. METHODS: Smoking status of 369 participants of this 8-week cognitive-behavioural smoking cessation group programme was obtained using exhaled carbon monoxide at the end of the course as well as self-report 6 months after the course. In addition to demographic data, FTND score, SDS score, and usage of nicotine replacement products were recorded. RESULTS: Overall, 29.8% of all participants reported to have been continuously abstinent for 6 months after the course. Success rates increased significantly during the first year after initiation of the programme (from 15 to 35%, p<0.001), indicating a learning process of the staff running the course. Nicotine replacement therapy was used by 51.3% of participants, but 58% of these discontinued its use within 5 weeks. Nicotine substitution for more than 5 weeks was associated with a 50% success rate after 6 months. CONCLUSIONS: Our data indicate a learning effect of smoking cessation course staff and a possible minimum duration required for nicotine replacement to be effective. PRACTICE IMPLICATIONS: The observed learning effect in smoking cessation programmes should be considered when evaluating newly established interventions of this kind. Patients tend to stop nicotine replacement therapy too early, thereby decreasing their chances of middle-term abstinence.     

Development of an interactive, Web-delivered system to increase provider-patient engagement in smoking cessation

Background

Patient self-management interventions for smoking cessation are effective but underused. Health care providers do not routinely refer smokers to these interventions.

Objective

The objective of our study was to uncover barriers and facilitators to the use of an e-referral system that will be evaluated in a community-based randomized trial. The e-referral system will allow providers to refer smokers to an online smoking intervention during routine clinical care.

Methods

We devised a four-step development and pilot testing process: (1) system conceptualization using Delphi to identify key functionalities that would overcome barriers in provider referrals for smoking cessation, (2) Web system programming using agile software development and best programming practices with usability refinement using think-aloud testing, (3) implementation planning using the nominal group technique for the effective integration of the system into the workflow of practices, and (4) pilot testing to identify practice recruitment and system-use barriers in real-world settings.

Results

Our Delphi process (step 1) conceptualized three key e-referral functions: (1) Refer Your Smokers, allowing providers to e-refer patients at the point of care by entering their emails directly into the system, (2) practice reports, providing feedback regarding referrals and impact of smoking-cessation counseling, and (3) secure messaging, facilitating provider–patient communication. Usability testing (step 2) suggested the system was easy to use, but implementation planning (step 3) suggested several important approaches to encourage use (eg, proactive email cues to encourage practices to participate). Pilot testing (step 4) in 5 practices had limited success, with only 2 patients referred; we uncovered important recruitment and system-use barriers (eg, lack of study champion, training, and motivation, registration difficulties, and forgetting to refer).

Conclusions

Implementing a system to be used in a clinical setting is complex, as several issues can affect system use. In our ongoing large randomized trial, preliminary analysis with the first 50 practices using the system for 3 months demonstrated that our rigorous preimplementation evaluation helped us successfully identify and overcome these barriers before the main trial.

Trial

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00797628","term_id":"NCT00797628"}}NCT00797628; http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00797628","term_id":"NCT00797628"}}NCT00797628 (Archived by WebCite at http://www.webcitation.org/61feCfjCy)     

Prospective determinants of smoking cessation in COPD patients within a high intensity or a brief counseling intervention

OBJECTIVES: The aims of this study were to identify prospective determinants of smoking cessation in COPD patients, and to assess whether prospective determinants vary between two different cessation interventions. METHODS: Two hundred and twenty-five moderate to severe COPD patients were randomly allocated to two smoking cessation interventions. One-year cotinine-validated continuous abstinence rates were 9% for the minimal intervention strategy for lung patients (LMIS) and 19% for the SmokeStopTherapy (SST). The baseline characteristics that showed a significant univariate relationship with 1-year continuous abstinence (p<.20) were included in the logistic regression model. This procedure was performed for each intervention separately. Variables that did not remain independent predictors were removed. RESULTS: For the SST separately, no independent significant predictor remained. For the LMIS, attitude towards smoking cessation (OR: 11.8; 95% CI: 1.7-81.5; p=.013) and cotinine level (OR: 2.1; 95% CI: 1.08-3.93; p=.028) remained significant predictors. Within the LMIS, 31% of the variance in continuous abstinence was explained by these variables (p=.003). CONCLUSION: This study suggests that a moderately intensive intervention (LMIS) is primarily suitable for COPD patients with a positive attitude regarding smoking cessation. The more intensive SST can be an alternative for patients without such baseline characteristic. PRACTICE IMPLICATIONS: This stepped-care approach in smoking cessation counseling may be useful in clinical practice and will enable health care providers to match interventions to individual needs and increase efficiency.     

Determinants of providing smoking cessation care in five groups of healthcare professionals: A cross-sectional comparison

Objective To investigate implementation of a tobacco dependence treatment guideline among five groups of healthcare professionals.Methods Data collected in The Netherlands (2016–2017) were compared among gynaecologists (N = 49), midwives (N = 68), respiratory nurses (N = 72), practice nurses (N = 84) and paediatricians (N = 38). Intentions to use the guideline, satisfaction with own implementation, and dosage delivered of quit-advice and assisting in quitting were predicted using linear regression analyses and regression tree analyses.Results Implementation of smoking cessation care (SCC) and barriers differed between the groups, with nurses reporting better implementation and fewer barriers. Main barriers were lacking training (gynecologists, pediatricians) and time (midwives). Regression tree analyses showed that self-efficacy and training interacted; participants with weaker self-efficacy provided more quit advice if they had participated in SCC training. Training was positively related to intentions to use the guideline, satisfaction, providing quit-advice, and assisting smokers in quitting.Conclusion Implementation of SCC is suboptimal, such that patients who smoke do not receive the highest quality of care. Profession and training in SCC are important determinants of implementation of SCC.Practice implications Efforts to improve implementation should be targeted at profession. Training is indicated, and may focus on skills for nurses, and knowledge for gynecologists, midwives and pediatricians.     

107例戒烟就诊者的疗效相关因素分析

对107例戒烟者资料的分析结果表明,与戒烟成功有关的因素包括:男性、戒前自我预测能戒掉、健康状况较差、良好的家庭支持监督系统、原戒烟时间较长、服用可乐宁药物;而戒断症状较严重,艾森克个性问卷 N 分较高者戒烟较困难。本文还对这些因素对结果的影响途径进行了简单的讨论。