Smoking rates and smoking cessation among individuals with multiple sclerosis

Purpose. Adults with physical disabilities tend to smoke at higher rates than smokers in the general population. No study to date, however, has assessed smoking prevalence and cessation among individuals with multiple sclerosis (MS). Such information is critically needed because smoking is more deleterious for individuals with MS than for smokers without MS and increases MS risk.

Method. Questionnaires were sent to 700 National Multiple Sclerosis Society Rhode Island Chapter members.

Results. Based on a 50% response rate, results demonstrated a 15.2% current smoker prevalence rate, which is lower than USA and Rhode Island general adult population averages. Individuals who smoked, however, tended to be heavy smokers, consuming 20 - 30 cigarettes daily, and had been smoking 10 years or longer. Smokers varied in their interest in quitting but seemed confident in their ability to do so. Respondents reported that it was difficult to quit because smoking was pleasurable; smoking was helpful in coping with boredom and with having MS; withdrawal symptoms were unpleasant; and treatment for tobacco dependence was expensive.

Conclusions. Efficacious smoking cessation interventions for smokers with MS should be developed to address a critical health need for a population of highly nicotine-dependent smokers who face numerous obstacles to quitting.     

Smoking rates and smoking cessation among individuals with multiple sclerosis

Purpose. Adults with physical disabilities tend to smoke at higher rates than smokers in the general population. No study to date, however, has assessed smoking prevalence and cessation among individuals with multiple sclerosis (MS). Such information is critically needed because smoking is more deleterious for individuals with MS than for smokers without MS and increases MS risk.

Method. Questionnaires were sent to 700 National Multiple Sclerosis Society Rhode Island Chapter members.

Results. Based on a 50% response rate, results demonstrated a 15.2% current smoker prevalence rate, which is lower than USA and Rhode Island general adult population averages. Individuals who smoked, however, tended to be heavy smokers, consuming 20 – 30 cigarettes daily, and had been smoking 10 years or longer. Smokers varied in their interest in quitting but seemed confident in their ability to do so. Respondents reported that it was difficult to quit because smoking was pleasurable; smoking was helpful in coping with boredom and with having MS; withdrawal symptoms were unpleasant; and treatment for tobacco dependence was expensive.

Conclusions. Efficacious smoking cessation interventions for smokers with MS should be developed to address a critical health need for a population of highly nicotine-dependent smokers who face numerous obstacles to quitting.     

Frequency of nurses’ smoking cessation interventions: report from a national survey

Aims and objectives. To describe the frequency of nurses’ delivery of tobacco cessation interventions (‘Five A’s’: Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses’ awareness of the Tobacco Free Nurses initiative. Background. Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web‐based resources about tobacco control. Design. Cross‐sectional survey of nurses (n = 3482) working in 35 Magnet‐designated hospitals in the USA (21% response rate). Method. A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse’s delivery of smoking cessation interventions (‘Five A’s’) was adapted for use on the web. Results. The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy. Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1·55, 95% CI 1·27, 1·90) and recommending medications (OR = 1·81, 95% CI 1·45, 2·24). Conclusions. Nurses’ delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions. Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence‐based interventions into clinical practice to help smokers quit. These findings support the value of Tobacco Free Nurses in providing nurses with information to support patients’ quit attempts.     

Smoking cessation and characteristics of success and failure among female high‐school smokers

Aim: The purpose of this study was to investigate the effects of a smoking cessation program on female high‐school students and to analyze the characteristics of students who quit smoking compared to those of students who failed to quit. Methods: This study used a mixed research design, including a pre‐ and post‐experimental design for measuring the effects of the smoking cessation intervention and a qualitative design using a focus group interview to analyze the characteristics of individuals who successfully quit in comparison to those who failed to stop smoking. Data were collected before and after the intervention through a self‐report questionnaire, a biochemical index, and a focus group interview. Results: After the intervention, positive changes in stage in the transtheoretical model for smoking‐cessation behavior increased significantly (P < 0.001), and the number of cigarettes smoked daily (P = 0.001), dependency on nicotine, expiratory CO levels, and positive frequency of urine nicotine levels decreased significantly (P < 0.001). Based on data from the focus group interview, students who stopped smoking showed different intrapersonal, interpersonal, and environmental characteristics compared to students who failed to stop smoking. Conclusion: The results suggest that the smoking‐cessation program could be more effective if it were to involve teachers and family members. In addition, a smoking‐prohibited community environment could assist in the control of adolescents' smoking behavior.     

Smoking cessation and serious mental illness: a service evaluation of a drop‐in stop smoking clinic on an acute in‐patient unit

Aims and objectives. To evaluate the effect of a stop smoking clinic on the quit rates of patients admitted to an acute in‐patient unit. Background. The relationship between poor physical health and severe mental illness is well established. High rates of smoking appear to play an important causal role in the excess morbidity and mortality in this population. Stop smoking interventions for the general population are clinically effective and cost‐effective. There is a small but promising evidence base for effective interventions to help people with a mental illness who wish to stop smoking but these have mostly been tested with community patients rather than acute in‐patients. Methods. A service evaluation of a drop‐in stop smoking clinic on an acute mental health in‐patient unit was conducted. Patients’ smoking status was measured at baseline and four weeks after their quit date using patient self‐report and an expired breath carbon monoxide reading. Results. Over a six‐month evaluation period, 46 patients set a quit date and 13 (28·3%) were abstinent at the four‐week follow‐up stage, verified by a carbon monoxide reading (χ² = 33, df = 1, sig p < 0·0001). Conclusions. This small‐scale evaluation has shown a drop‐in stop smoking intervention to be feasible, acceptable and associated with positive outcomes; further research with larger, more representative samples is required. Relevance to clinical practice. Enforcing smoke‐free legislation is a contentious issue on mental health in‐patient units, and there is a paucity of research to guide nursing practice in this area. An admission period in a smoke‐free environment provides a crucial opportunity to offer smoking cessation treatment. With appropriate resources, expertise and support, it appears possible to apply smoking cessation interventions that are successful within the general population to mental health patients during an acute admission.     

Who are the female smokers who seek treatment for smoking cessation: A Brazilian cohort study

Aim: To describe the sociodemographic, clinical, and behavioral characteristics of women who seek treatment for smoking cessation and to investigate the relationship between these characteristics and the nicotine dependence level and treatment duration. Methods: Data were collected using questionnaires that were administered to 655 women. Regression of generalized linear model and regression logistic ordinal were used to assess the correlation between the variables being studied. Findings: The average age of women in the study was 49 years. Among them were those who were employed (54.9%), who had high levels of nicotine dependence (78.5%), and whose primary reason for seeking treatment was related to health concerns (62%). The treatment duration was positively correlated with depression (p = 0.04), hypertension (p < 0.01), and with seeking treatment due to health concerns (p = 0.02). Conclusions: Our study indicates that adherence in women can be increased by providing treatment that is accessible to the lower class. It also indicates the need to reconceptualize the way therapeutic group sessions are conducted. We hypothesize that the reason for the high dropout rate after 6 months of treatment could be related to the way that group sessions operate.     

护理干预在早期慢性阻塞性肺疾病患者戒烟中的应用效果

目的探讨护理干预在早期慢性阻塞性肺疾病患者戒烟中的作用与效果。方法将早期慢性阻塞性肺疾病患者分为实验组102例和对照组110例。对照组给予常规健康教育,实验组给予多种形式的护理干预。比较两组患者的吸烟知识知晓率及吸烟行为。结果实验组患者吸烟知识知晓率高于对照组(P0.01),吸烟行为优于对照组(P0.01)。结论护理干预对提高早期慢性阻塞性肺疾病患者吸烟知识知晓率,降低吸烟率、戒烟后复吸率有重要作用。     

The effects of a smoking cessation programme on health‐promoting lifestyles and smoking cessation in smokers who had undergone percutaneous coronary intervention

Smoking is a major risk factor for not only the occurrence of myocardial ischaemia but also recurrences of vascular stenosis. This study aimed to evaluate health‐promoting lifestyles and abstinence rate after a smoking cessation programme. Sixty‐two smokers who had undergone percutaneous coronary intervention were randomly assigned to either the experimental or control group. The experimental group (n = 30) received 10 phone counselling sessions and 21 short message service messages for abstinence and coronary disease prevention, whereas the control group (n = 32) received only the standard education. After the intervention, 14 members of the experimental group had switched to a non‐smoking status, confirmed biochemically; moreover, their physical activity and stress management scores increased significantly. However, self‐efficacy of smoking cessation was not reflected in the cotinine levels. Thus, it is necessary not only to increase self‐efficacy but also to determine the factors that affect the success of smoking cessation so that they can be included in the intervention. Our results suggest that phone counselling and short message service messaging might be important tools for the realization of smoking cessation and lifestyle changes among patients who have undergone percutaneous coronary intervention.     

Effect of smoking cessation on markers of inflammation and endothelial cell activation among individuals with high risk for cardiovascular disease

Objective. To prospectively determine the effect of smoking cessation on markers of inflammation and endothelial cell activation. Material and methods: Thirty male and 22 female smokers of >7 cigarettes daily, aged 32–64 years with cardiovascular disease (CVD) or additional risk factors to smoking, participated in a program of smoking cessation with a follow‐up period of 1 year. Cessation was validated by carbon monoxide measurement in expired breath, and 41 of the patients completed the study (17 quitters and 24 non‐quitters). Plasma samples were drawn at baseline and after 1 year, and inflammatory markers were analyzed by enzyme immunoassays. Peripheral blood mononuclear cells (PBMCs) were isolated at baseline and 1 year in 6 quitters and 6 smokers and mRNA levels of interleukin‐8 (IL‐8), tumor necrosis factor α (TNFα) and intercellular adhesion molecule 1 (ICAM‐1) were analyzed by real‐time quantitative RT‐PCR. Results. Our main findings were: (i) While the concentration of soluble (s) ICAM‐1 decreased in quitters, it increased in smokers, with a significant difference in changes between the groups (p = 0.04). (ii) While there was only minor change in mRNA levels of IL‐8 in smokers, those who stopped smoking showed a decrease in the gene expression of IL‐8 (p<0.09; comparing difference in changes). (iii) Concentrations of the other measured parameters (E‐selectin, IL‐6, sCD40 ligand, TNFα, von Willebrand factor, and C‐reactive protein) were unchanged during follow‐up in both groups. Conclusion. Smoking cessation induced a reduction in ICAM‐1, suggesting a novel mechanism for the rapid reduction in the risk of CVD following smoking cessation.     

Reversal theory states and cigarette availability predict lapses during smoking cessation among adolescents

Although 67% of adolescent smokers say they want to quit, only 7% are able to do so. The purpose of this study was to use metamotivational states as described in reversal theory to predict whether adolescents who are trying to quit smoking will lapse (smoke a cigarette) or will resist smoking in highly tempting situations. Reversal theory holds that individuals switch between telic (serious-minded) and paratelic (playful) metamotivational states. Questionnaires and semistructured interviews were administered to 62 adolescents ages 14-19 who had participated in a smoking cessation program. Interviews were coded according to the Metamotivational State Interview and Coding Schedule, and the resulting data were analyzed using logistic regression analysis. Adolescents in the paratelic metamotivational state (OR = 15.34; 95% CI: 5.3, 43.6) or with cigarettes readily available (OR = 4.6; 95% CI: 1.6, 13.2) were more likely to lapse than were adolescents in the telic state or who required effort to obtain cigarettes. The variables telic/paratelic state and cigarette availability accurately predicted the outcome of highly tempting situations 80% of the time. Using reversal theory constructs to develop state-specific strategies shows promise as an additional tool for those in this age group coping with the temptation to smoke.     

Characteristics and smoking cessation outcomes of patients returning for repeat tobacco dependence treatment

Previous studies of tobacco dependence treatment have reported very low cessation rates among smokers who relapse and return to make a subsequent formal attempt to quit. This retrospective cohort study examined 1745 patients who attended a tobacco dependence clinic between 2001 and 2005, and the characteristics and outcomes of those who relapsed and returned for repeat treatment. Patients who returned for repeat treatment showed higher markers of nicotine dependence and were more likely to have a history of treatment for mental health problems than patients who attended the clinic for only one treatment episode. Among patients who relapsed and returned for repeat treatment, the 26-week abstinence rates were similar for each consecutive quit attempt (23%, 22% and 20%). Clinicians should encourage smokers who relapse after an initial treatment episode to return for treatment, and repeat treatment should focus on addressing high nicotine dependence and potentially co-occurring mental health problems in order to improve cessation outcomes.     

Guided Health Imagery for Smoking Cessation and Long-Term Abstinence

PURPOSE: To examine the effectiveness of guided imagery for immediate smoking cessation and long-term abstinence in adult smokers. DESIGN: A repeated measures design was used with 71 smokers recruited from a hospital outpatient clinic, 38 in the intervention group, and 33 in the control group. METHODS: Both study groups received educational and counseling sessions in their homes. The intervention group was provided with additional instruction in the use of guided imagery and was encouraged to practice this imagery at least once per day with a 20-minute audio-taped exercise for reinforcement. The repeated measures included smoking rates (cigarettes per day) that were measured and confirmed through corroborating friends and family. FINDINGS: At 24-months after the intervention, smoking abstinence rates were significantly higher for the guided health imagery intervention group (26% abstinence rate versus 12% abstinence rate for the placebo-control group). CONCLUSIONS: Guided imagery was an effective intervention for long-term smoking cessation and abstinence in adult smokers.