Outcome of a smoking cessation programme run in a routine hospital setting

Abstract
Background : Although tobacco smoking remains the largest preventable cause of mortality in Australia, resources to assist with cessation remain scarce. Research studies have demonstrated improved cessation rates with interventions such as counselling and pharmacotherapy, but there is little information on success in routine clinical practice.
Aims : To determine the outcome of a smoking cessation programme run in a routine hospital outpatient setting.
Methods : A prospective audit of patients referred to an outpatient smoking cessation programme by hospital specialists or general practitioners. The programme consisted of fortnightly counselling sessions, with nicotine replacement therapy when clinically indicated. Self-reported abstinence rates were determined by contacting patients by letter or telephone at 3 and 12 months. Abstinence was confirmed, whenever possible, by measuring the expired carbon monoxide (CO) concentration.
Results : Over 12 months, 226 new patients were seen through the programme. There was a correlation between the number of cigarettes smoked and the baseline Fagerstrom score ( r = 0.49, P < 0.001). Approximately 40% of subjects could not be contacted for follow up. At 3 months the self-reported abstinence rate was 31%, falling to 19% by 12 months. Measurement of expired CO concentrations proved that self-reported abstinence was reliable.
Conclusions : The abstinence rates achieved by our programme compared well with those previously reported in the literature, demonstrating the effectiveness of a smoking cessation programme run in routine clinical practice. There was an increasing relapse rate during the period of follow up. (Intern Med J 2002; 32: 24–28)     

The role of genes in tobacco smoking during adolescence and young adulthood: a multivariate behaviour genetic investigation

Aims To incorporate a psychosocial model of tobacco smoking into a behaviour genetic design to examine genetic and environmental influences on variation in smoking involvement. Design Longitudinal twin study. Setting and participants Twins initially aged between 13 and 18 years and registered with the Australian Twin Registry were surveyed three times between 1988 and 1996. A total of 414 pairs of identical and same‐sex fraternal twin pairs participated in all three surveys, aged between 20 and 25 at wave 3. Biometric modelling estimated the influence of genetic and environmental factors in determining variation in smoking at each wave, both before and after adjusting for perceived smoking behaviours of peers and parents. Measurements Twins answered a questionnaire on their own smoking status and reported on the use of tobacco by parents and friends as they perceived it, at each survey wave. Findings At all three surveys, current smokers were more likely to have parents who smoked and to have smokers among their peers. Genes and environmental factors, both common and unique, contributed to variation in smoking behaviours. However, after controlling for the smoking behaviours of peers and parents, the role of genes in determining variation in smoking involvement was reduced by 100% at wave 1 and by 30% at wave 2. Friends’ smoking reduced the magnitude of the common environment variance by 11%, 30% and 40% at waves 1, 2 and 3, respectively. Parents’ smoking behaviours explained part of the common environment. Biometric modelling of the covariation between smoking involvement and peer smoking suggested that genes might influence smoking involvement at wave 1 by influencing choice of peers. Conclusion Environmental factors play the greatest role in determining variation in tobacco smoking among adolescents and young adults. Among adolescents, genes may influence variation in smoking behaviours indirectly by influencing choice of peers. However, genes seem to have a direct influence on variations in the smoking behaviours of young adults.     

Persistent Impact of Cigarette Smoking on Asthma

Objective. In the present study we assessed the impact of former cigarette smoking on asthma control and treatment effectiveness. Methods. A total of 104 patients with uncontrolled asthma were included in the study. The group of former smokers consisted of 33 subjects, whereas the never smokers group consisted of 71 subjects of similar age and gender. Spirometry, classification of asthma severity, and control were assessed according to Global Initiative for Asthma (GINA) guidelines. Quality of life was measured with the use of the Saint George Hospital Respiratory Questionnaire (SGHRQ). Results. Asthma was more severe in the group of former smokers both before and after treatment; p < 0.001. Severe asthma (OR 7.8 CI 2.8-21.9) and cigarette smoking (OR 3.5 CI 1.3-9.2) were associated with difficulties in asthma control achievement. Total quality of life significantly improved in the group of non-smokers; p = 0.02, whereas in former smokers this effect was not significant; p > 0.05. Conclusion. Cigarette smoking has a persistent, dose-dependent, negative impact on the response to treatment in patients with uncontrolled asthma even after smoking cessation. Smoking cessation should remain the ultimate goal in treatment of asthmatic patients. More efforts should be undertaken to decrease smoking initiation, especially in teenagers.     

Very low rate and light smokers: smoking patterns and cessation-related behaviour in England, 2006-11

Aims There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate‐to‐heavy (10+ CPD) smokers in England. Design Cross‐sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants A total of 23 245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6‐month follow‐up. Measurements We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow‐up. Findings Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9–32.8%). Compared with moderate‐to‐heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio‐economic background. They were more motivated to quit and enjoyed smoking less. During the 6‐month follow‐up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate‐to‐heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate‐to‐heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over‐the‐counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree.     

Goals indicate motivation to quit smoking

AIMS: To test if goals indicate motivation to quit smoking and predict which smokers will make a quit attempt. DESIGN: A 28-day natural history feasibility study of smoking cessation and reduction. SETTING: The study was conducted via telephone calls and mailings. PARTICIPANTS: A total of 186 cigarette smokers. MEASUREMENTS: At baseline participants reported one of the following goals for the next 30 days: to quit abruptly, quit gradually, reduce but not quit, or not change their smoking. They also reported motivation to quit smoking on an Intention to Quit Ladder. Throughout the study they reported their cigarette consumption via daily telephone messages. FINDINGS: Self-reported motivation to quit differed among goals (F = 286.6, df = 3, P < 0.01). Goals significantly predicted the likelihood of making a quit attempt in the 28 days of the study. In comparison to smokers with the goal of not changing, smokers with a goal of quitting abruptly were more likely to make a quit attempt [relative risk (RR) = 9.6, P < 0.01], as were those with a goal of quitting gradually (RR = 4.5, P = 0.01). Those with a goal of reducing only appeared to be more likely to make a quit attempt than those with a goal of not changing, but the difference was not statistically significant (RR = 3.1, P = 0.15). Smokers with a goal of quitting abruptly were more likely to make a quit attempt than those with a goal of quitting gradually (RR = 2.1, P < 0.05). CONCLUSIONS: Goals indicate not only preferred method of change but also motivation. Differences in gradual versus abrupt cessation outcomes may be due to motivational rather than methodological differences. Those who plan to quit gradually or reduce only may need additional motivational interventions.     

Adolescent smoking and depression: evidence for self-medication and peer smoking mediation

Aims   The nature of the relationship between adolescent smoking and depression is unclear and the mechanisms that account for the comorbidity have received little investigation. The present study sought to clarify the temporal precedence for smoking and depression and to determine whether these variables are linked indirectly through peer smoking.
Participants   The sample was composed of 1093 adolescents participating in a longitudinal study of the behavioral predictors of smoking adoption.
Design and measurements   In this prospective cohort study, smoking, depression, peer smoking and other covariates were measured annually from mid-adolescence (9th grade; age 14) to late adolescence (12th grade, age 18).
Findings   Parallel processes latent growth curve models supported a bidirectional relationship between adolescent smoking and depression, where higher depression symptoms in mid-adolescence (age 14) predicted adolescent smoking progression from mid- to late adolescence (ages 14–18). A significant indirect effect indicated that higher depression symptoms across time predicted an increase in the number of smoking peers, which in turn predicted smoking progression from mid-adolescence to late adolescence. In addition, smoking progression predicted a deceleration of depression symptoms from mid- to late adolescence. A significant indirect effect indicated that greater smoking at baseline predicted a deceleration in the number of smoking peers across time, which predicted a deceleration in depression symptoms from mid-adolescence to late adolescence.
Conclusions   The current study provides the first evidence of bidirectional self-medication processes in the relationship between adolescent smoking and depression and highlights peer smoking as one explanation for the comorbidity.     

Short-term Changes in Self-rating Depression Scale Scores after Smoking Cessation in Neurotic Patients

Objective The psychological status is a key factor in smoking continuance. However, details on short-term changes in mild depressive states after smoking cessation (SC) are still unknown. The purpose of the present study was to investigate these short-term changes. Methods A total of 989 patients who visited our SC Clinic were assessed using the Zung Self-Rating-Depression-Scale (SDS), an official instrument to measure depressive tendencies. The participants were classified into normal and neurotic groups based on their SDS scores during their initial visit; they were assessed again 2, 4, 8, and 12 weeks thereafter. Results The majority of patients in the neurotic group were women. These patients were also younger, with a higher nicotine dependence, and presented with a lower successful SC rate than the patients in the normal group. A decrease in SDS scores after starting the SC treatment was observed only in the neurotic group, especially during the first two weeks. In patients who continued to smoke, no improvement in depressive tendencies was noted in this period. Conclusion Depressive tendencies of patients with neurosis improve in the initial stages of the SC treatment (i.e., within two weeks after starting the treatment). This finding fills the mentioned knowledge gap regarding the effects of SC on mild depressive states in the short term.     

Parental Smoking and Smoking Behavior in Asthmatic and Nonasthmatic Adolescents

Background. Smoking may have serious consequences for asthmatics. Nevertheless, studies have shown that smoking behavior among asthmatics is similar to or even higher than that of nonasthmatics. Since the relationship between parental smoking and child smoking is well established, this study examined whether the association between parental and child smoking behavior is similar for asthmatic and nonasthmatic adolescents. The impact of parental smoking history was also explored. Methodology. A cross-sectional sample of 10,087 Dutch adolescents was used to assess the prevalence of asthma and smoking behavior. Moreover, respondents had to report whether one of their parents currently smoked, had stopped, or had never smoked. In case a parent was a former smoker, the respondent had to report his or her own age at the moment that the parent stopped smoking. Results. Logistic regression analyses showed that, compared with nonasthmatic adolescents, asthmatic adolescents were more likely to have smoking parents. Furthermore, similar associations were found between parental smoking and adolescent smoking among asthmatic and nonasthmatic adolescents. The time at which maternal smoking ceased was associated with a decreased likelihood for ever smoking for both asthmatic and nonasthmatic adolescents. Conclusions. Asthmatic adolescents need to become more aware of the health risks of smoking. Therefore, tailor-made antismoking campaigns are needed at schools to reduce misconceptions among asthmatic adolescents about the risks of smoking. In addition, a personal intervention approach aimed particularly at smoking parents of an asthmatic child, may make them aware of the consequences for their offspring and help them to stop smoking.     

Prospective prediction of children's smoking transitions: role of parents' and older siblings' smoking

AIMS: To use a novel social epidemic probability model to investigate longitudinally the extent to which parents' and older siblings' smoking predict children's smoking transitions. DESIGN: Parents' and older siblings' smoking status was assessed when children were in 3rd grade (baseline). Three smoking transitions were assessed over the period of child/adolescent smoking acquisition (up to 12th grade): (1) transition from never smoking to trying smoking, (2) transition from trying to monthly smoking and (3) transition from monthly to daily smoking. SETTING: Forty Washington State school districts participating in the long term Hutchinson Smoking Prevention Project (HSPP). PARTICIPANTS AND MEASUREMENTS: Participants were the 5520 families for whom data on both parents' and older siblings' baseline smoking status, as well as on children's smoking transitions, were available. FINDINGS: The probability that a smoking parent influenced their child to make the first transition to trying smoking was 32% (95% CI: 27%, 36%); to make the second transition from trying to monthly smoking, 15% (95% CI: 10%, 19%); and to make the third transition from monthly to daily smoking, 28% (95% CI: 21%, 34%). The probability that an older sibling influenced a child to make the first transition to trying smoking was 29% (95% CI: 17%, 39%); to make the second transition from trying to monthly smoking, 0% (95% CI: 0%, 8%); and to make the third transition from monthly to daily smoking, 20% (95% CI: 4%, 33%). CONCLUSIONS: In contrast to previous research, the results provide new evidence suggesting that family smoking influences both initiation and escalation of children's smoking. Results also quantify, in terms of probabilities, the importance of parents' and older siblings' smoking on children's three major smoking transitions. Parents' smoking, as well as older siblings' smoking, are important behaviors to target in preventing adolescents from making smoking transitions.     

Parental Smoking and Smoking Behavior in Asthmatic and Nonasthmatic Adolescents

Background. Smoking may have serious consequences for asthmatics. Nevertheless, studies have shown that smoking behavior among asthmatics is similar to or even higher than that of nonasthmatics. Since the relationship between parental smoking and child smoking is well established, this study examined whether the association between parental and child smoking behavior is similar for asthmatic and nonasthmatic adolescents. The impact of parental smoking history was also explored. Methodology. A cross-sectional sample of 10,087 Dutch adolescents was used to assess the prevalence of asthma and smoking behavior. Moreover, respondents had to report whether one of their parents currently smoked, had stopped, or had never smoked. In case a parent was a former smoker, the respondent had to report his or her own age at the moment that the parent stopped smoking. Results. Logistic regression analyses showed that, compared with nonasthmatic adolescents, asthmatic adolescents were more likely to have smoking parents. Furthermore, similar associations were found between parental smoking and adolescent smoking among asthmatic and nonasthmatic adolescents. The time at which maternal smoking ceased was associated with a decreased likelihood for ever smoking for both asthmatic and nonasthmatic adolescents. Conclusions. Asthmatic adolescents need to become more aware of the health risks of smoking. Therefore, tailor-made antismoking campaigns are needed at schools to reduce misconceptions among asthmatic adolescents about the risks of smoking. In addition, a personal intervention approach aimed particularly at smoking parents of an asthmatic child, may make them aware of the consequences for their offspring and help them to stop smoking.     

An examination of early smoking experiences and smoking status in a national cross-sectional sample

AIMS: To extend previous work showing lightheadedness from and liking for smoking to be associated with continued smoking while controlling for demographics and social influences that can also contribute to progression to established smoking. DESIGN AND SETTING: Random digit dialing telephone survey conduced on 3383 never smokers, non-smokers, former smokers and current smokers in the continental United States. MEASUREMENTS: Demographic information (sex, race, age, education level), smoking history, reactions to early experiences with smoking (lightheadedness, liking), whether parents, siblings or friends smoked when respondent was a teenager. FINDINGS: Lightheadedness and liking interacted-those who liked smoking (regardless of lightheadedness) were very likely to progress to established smoking, while non-likers who experienced lightheadedness were more likely than non-likers who did not experience lightheadedness to progress. These results held even after adjusting for demographic (sex, age, race, education) and social influences (parents, siblings and friends smoking). CONCLUSIONS: Lightheadedness from early smoking appears to be associated with having smoked 100 cigarettes only among those who report not liking early smoking. Overall, this study supports the literature suggesting that early experiences, particularly liking smoking, are associated with becoming a regular smoker.     

Smoking and smoking cessation in Latin America: a review of the current situation and available treatments

Tobacco smoking is a growing problem throughout Latin American countries, especially in underdeveloped countries where poverty and lack of education about the dangers of smoking may make people more susceptible to becoming smokers. Moreover, the economies of many Latin American countries have become dependent on the production of tobacco. Furthermore, because of the associated promotion of tobacco, smoking has integrated into many Latin American cultures. Nevertheless, the harmful health effects of tobacco use are well documented, including greatly increased risks of developing chronic obstructive pulmonary disease, cardiovascular disease, and many forms of cancer. The medical costs associated with treating these diseases far outweigh the economic benefits of producing and selling this deadly crop. To control the tobacco pandemic in Latin American countries, nicotine addiction must be recognized and treated as a disease. Governments, both national and local, need to be more involved in enacting anti-smoking policies such as higher tobacco taxation, control of illegal tobacco smuggling, and reimbursement of medical smoking cessation interventions. The training of health professions in the area of nicotine addiction must also be improved, so that they may better assist smokers in their quit attempts and advise patients on, and prescribe, effective smoking cessation pharmacotherapies.