Tailored communications for smoking cessation: past successes and future directions

Tailored communications are one of the most promising approaches to smoking cessation interventions for entire populations. Assessments based on the Transtheoretical Model are processed by computer-based expert systems that generate feedback reports tailored to each individual to accelerate their progress through the stages of change for smoking cessation. Seven studies are reviewed that range from a more traditional clinical trial to trials on entire populations of smokers to population trials designed to change multiple behaviours, including smoking. A series of three tailored communications was found to produce long-term point prevalence abstinence rates within the narrow range of 22-26% abstinence. This same range of abstinence was found even when two or three other behaviours (e.g. diet and sun protection) were treated in the population. These results point to a future in which health behaviour risk interventions will be assessed not solely by their efficacy but by their population impact.     

The feasibility of providing community pharmacy‐based services for alcohol misuse: A literature review

Objectives Excessive consumption of alcohol is a major public health concern. The use of community pharmacies and pharmacists as sources of public health information and services is gaining greater recognition. The objective of this review was to provide an overview of the evidence on the feasibility, effectiveness and acceptability of providing community pharmacy‐based services to address the excessive consumption of alcohol. Methods Electronic databases were searched for the period 1996–2007 to identify relevant evidence. Searches were also conducted of relevant pharmacy and addiction journals. Information was sought from key contacts in pharmacy and alcohol research. Studies were included if they were conducted in a community pharmacy setting. Key findings The review comprised three feasibility studies which included 14 pharmacies and 500 customers. Non‐significant reductions in alcohol consumption were reported with two studies following brief interventions by pharmacists. Between 30% and 53% of pharmacy customers were identified as having hazardous or harmful drinking behaviour. Customer opinion of the pharmacy‐based alcohol services was not reported. Conclusions There has been little empirical evaluation of the effectiveness of community pharmacy‐based services for alcohol misuse. The evidence presented in this review suggests that community pharmacy‐based screening is feasible. Organisations and individuals involved with tackling excessive alcohol consumption should consider the inclusion of community pharmacies and pharmacists as part of their strategies to address this problem. Large‐scale studies are needed to evaluate the short‐ and long‐term effects and cost‐effectiveness of community pharmacy‐based interventions to reduce excessive alcohol consumption, as well as to explore the acceptability of the service to users.     

Encouraging smoking cessation among disadvantaged groups: a qualitative study of the financial aspects of cessation

Introduction and Aims. This study aimed to explore perceptions about financial aspects of smoking cessation among a group of disadvantaged welfare agency clients and their carers. Design and Methods. Qualitative focus groups and in‐depth interviews were supplemented with participant exit surveys about preferred smoking cessation strategies. Each discussion was audiotaped, transcribed and analysed using a thematic analysis. The setting was six non‐government community welfare service organisations operating in New South Wales, Australia. Eleven social services offered by these organisations participated. Thirty two clients participated in six client focus groups, 35 staff participated in six staff focus groups and eight manager telephone interviews were conducted. Results. Clients indicated that the cost of nicotine replacement therapy was a barrier to its use and that financial incentives were acceptable. Of the 16 possible strategies listed in the exit survey, the three selected as the most preferred by clients incorporated financial or non‐financial assistance. By contrast, staff and managers selected financial and non‐financial incentives as the least preferred and least feasible strategies. Discussion and Conclusions. The study found high acceptance of incentives as a smoking cessation strategy among a disadvantaged group of non‐government welfare service clients. The comparatively low level of desirability and feasibility from the perspective of service staff and managers suggests implementation of such an approach within the community service setting requires careful further testing.[Bonevski B, Bryant J, Paul C. Encouraging smoking cessation among disadvantaged groups: A qualitative study of the financial aspects of cessation. Drug Alcohol Rev 2011;30:411–418]     

Cardiovascular drug use prior to diagnosis of diabetes: A pilot study in community pharmacy

Objectives The literature indicates that cardiovascular drug use is higher during the years prior to diagnosis of type 2 diabetes mellitus. As there are pharmaco‐epidemiological and economic consequences of enhanced medication use prior to diagnosis of diabetes, there is a need for a comparative analysis of the drug‐use pattern by patients with a subsequent diagnosis of diabetes and control patients. This pilot study aimed to investigate cardiovascular drug use in patients with a subsequent diagnosis of diabetes using data extracted from 200 community pharmacies in the Belgian township of Hasselt. Methods Based on community pharmacy data, a retrospective case‐control study compared the drug use of patients with a subsequent diagnosis of type 2 diabetes (cases) with patients without a subsequent diagnosis (controls). Cases were identified if patients started taking metformin (and possibly other drugs used in diabetes) during the 2004–2006 study period. Drug use was expressed as a binary variable, reflecting whether or not a patient took drugs belonging to a specific cardiovascular subclass. Key findings Our dataset consisted of 158 cases with a subsequent diagnosis of type 2 diabetes and 632 control patients. Patients with a subsequent diagnosis of type 2 diabetes had a higher propensity to take cardiovascular drugs prior to diagnosis than control patients. This trend was observed across all cardiovascular drug classes, except for calcium‐channel blockers, and was statistically significant for β‐blocking agents and agents acting on the renin‐angiotensin system. Conclusions A positive association was observed between cardiovascular drug use and subsequent diagnosis of type 2 diabetes. This study emphasizes the potential role for community pharmacy in early identification of diabetes using more targeted screening based on cardiovascular drug use as derived from pharmacy databases.     

Language issues in the community pharmacy: A perspective from Wales

Objectives This study aimed to obtain the views of Welsh speakers to explore the role of the Welsh language in community pharmacies in bilingual communities in Wales. Methods Two communities with a high proportion of Welsh speakers were purposively identified for the research: one in North Wales and one in West Wales. Stage 1: semi‐structured interviews with a purposive sample of Welsh speakers to identify key themes. Data collection continued until no new themes emerged. Interviews were tape‐recorded, transcribed verbatim, coded manually and analysed thematically. Stage 2: self‐complete questionnaire developed based on the interview results. The anonymous, bilingual questionnaire and covering letter, with a postage‐paid envelope, were delivered to 500 homes (250 in each community) for completion by the person in the household who visited a pharmacy most often. There was no follow‐up mailing due to anonymity. Data were analysed using SPSS version 12. Key findings Results from both interviews (n = 36) and questionnaires (response rate was 52%, 82% of whom were Welsh speakers) found that the majority of Welsh speakers in the study were able to understand English but preferred to use Welsh in the pharmacy. They would find it easier to explain symptoms and would ask more about their medication if they could speak Welsh with the pharmacist. In addition, the study participants would generally feel more at ease with a Welsh‐speaking pharmacist and would feel they were getting a better service if they could use their first language. Conclusions This study of Welsh speakers indicates that language choice is important for bilingual people who may prefer to use their native, minority language for consultation with health professionals. Further, it is clear that a concordant partnership between patient and pharmacist is less likely where one party is using a language with which they are not confident or comfortable. Pharmacists need to be aware of the linguistic needs and preferences of bilingual clients.     

Smoking cessation in adults: A dual process perspective

This study applied Cognitive Experiential Self Theory to investigate the role of smoking expectancies and experiential associations with cigarette use in predicting smoking cessation in a sample of 155 Australian adults. Two discrete changes in the cessation process were investigated. The first involved a cognitive transition from not intending to quit smoking to intending to quit, and the second involved a behavioral transition from intending to quit to successful cessation. Multinomial logistic regression analyses suggested that experiential associations played no role in the transition from not intending to intending to quit, but moderated the effects of three types of smoking expectancies (negative consequences, positive reinforcement, and negative reinforcement) on the transition from intending to quit to successful cessation. The facilitative effects of smoking expectancies on cessation were substantially attenuated in participants who possessed more positive experiential associations with smoking.