Does Utilitarian Policy such as Smoking Cessation Lend Support to Wider Aspirin Use?

Tobacco control policy seems to be based on a utilitarian principle that public health is best served by a range of measures that will provide overall population benefit. Aspirin may have a potential wider role since meta-analysis of randomized controlled trials shows it reduces the risk of a first vascular event and also cancer. Are smoking cessation and the public health potential of aspirin different? The benefit versus risk balance of aspirin, an inexpensive and easily available medicine, deserves serious consideration as a public health measure in middle age. Smoking cessation and wider aspirin use are not seen as either competing or duplicating policy areas, but complementary. Their comparison has been purposefully selected because of common impacts, namely reduced vascular disease and cancer with increases in undesirable effects, notably gastrointestinal pathology. Part of the driver for this paper is to convey the message that public health policy has benefits and risks and the concept of a universally effective policy is unrealistic. Is it time for public health action to increase the use of aspirin?     

Steps in Tailoring a Text Messaging–Based Smoking Cessation Program for Young Adults

Steps to develop or refine text messaging–based interventions are largely missing from the literature. Here, the authors describe steps in refining Stop My Smoking USA, a text messaging–based smoking cessation program for smokers 18–25 years old. Research activities included the following: needs assessment focus groups (n = 35); a content advisory team to affirm message acceptability (n = 10); and two beta tests to confirm technological feasibility (n = 12 and 28, respectively). Various recruitment strategies were tested to identify the optimal methods to reach young adult smokers ready to quit. Each stage of the refinement process yielded new insights, resulting in improved message content and tone, an effective recruitment strategy, and the identification and subsequent resolution of technology challenges. Findings suggest that young adults prefer messages that provide concrete behavioral strategies to overcome cravings, and which are positive in tone. Craigslist was the most efficient recruitment method and yielded a sample that was racially and economically diverse. Despite a successful beta test of initial technological feasibility, extensive problems were subsequently experienced in a beta test of the technological feasibility of the entire program. Iterative program refinement and adaptation on the basis of user input is necessary to ensure salience, while extensive field testing is required to ensure proper functioning of technology-based programs.     

Can we help our patients to stop smoking?: the experience of the Smoking Cessation Program

Objetive: To describe the process and results of the Smoking Cessation Program in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking?Methods: Prospective series of cases that included all smokers (n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months.Results: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of 72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking (95% CI: 14.8-26.1).Conclusions: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads.     

Exploring Factors Influencing Smokers’ Information Seeking for Smoking Cessation

This study addressed the factors influencing smokers’ information seeking pertaining to the health risks of smoking. In particular, this study aimed to extend the risk information seeking and processing model by taking into account the role of autonomous motivations used to stimulate smokers’ information-seeking behavior. The results of a Web-based survey indicated that information insufficiency was positively associated with health information–seeking behavior and that negative affective responses were positively associated with information insufficiency and health information–seeking behavior. In addition, autonomous motivations were positively associated with information insufficiency and information-seeking behavior. The results indicated that risk perception was positively related to autonomous motivations and negative affective response. Finally, informational subjective norm was positively related to autonomous motivations and negative affective responses. The implications of this study for future research are discussed.     

Turning “Smoking Man” Images Around: Portrayals of Smoking in Men's Magazines as a Blueprint for Smoking Cessation Campaigns

Published scholarship documents the prevalence and health risks of smoking among men. There is also a rich tradition of studying the normative influences of the media in constructing and propagating images of healthy/unhealthy behaviors such as smoking. To understand the construction of these media-propagated smoking images toward male audiences, this article studies all advertising and editorial content of 3 major men's magazines for 2001 using rhetorical and content analyses. The emergent themes construct the smoking man as sensual, in another place, independent, and mysterious. The authors recommend turning around these themes of the masculine “smoking man” for the purpose of strategic media planning and developing message-targeting guidelines for smoking cessation and prevention messages directed at men.     

How Do Perceptions About Cessation Outcomes Moderate the Effectiveness of a Gain-Framed Smoking Cessation Telephone Counseling Intervention?

The distinction between prevention and detection behaviors provides a useful guideline for appropriately framing health messages in terms of gains or losses. However, this guideline assumes that everyone perceives the outcomes associated with a behavior in a consistent manner, as prevention or detection. Individuals' perceptions of a behavior vary, and so the effects of framed messages may be optimized by considering individuals' perceptions rather than the prevention or detection function of the behavior. The authors tested this message-framing paradigm in a secondary analysis of data from a trial evaluating gain-framed smoking cessation counseling delivered through a state quitline (Toll et al., 2010 Toll , B. A. , Martino , S. , Latimer , A. , Salovey , P. , O'Malley , S. , Carlin-Menter , S., … Cummings , K. M. ( 2010 ). Randomized trial: Quitline specialist training in gain-framed vs standard-care messages for smoking cessation . Journal of the National Cancer Institute , 102 , 96 – 106 .[Crossref], [Web of Science ®] , [Google Scholar]). Smokers (N = 2,032) who called a state quitline received either gain-framed or standard care messages. Smokers' beliefs about the positive consequences of stopping smoking (outcome expectancies) were evaluated at baseline. Smoking status and self-efficacy were assessed at 3 months. Outcome expectancies moderated the framing effects among men but not among women. Men in the gain-framed counseling condition who had positive outcome expectancies were more likely to quit and had more confidence in their ability to quit or to remain abstinent than men who were uncertain of the positive outcome of smoking cessation. Among men, self-efficacy mediated the moderated framing effects of the intervention on quit status. These findings suggest that it may be useful to consider sex and individual differences in outcome expectancies when delivering gain-framed smoking cessation messages in the context of a state quitline.     

Smoking Cessation during Pregnancy and Relapse after Childbirth: The Impact of the Grandmother’s Smoking Status

Objectives Smoking during pregnancy can result in negative effects in exposed children. It is well established that the smoking status of husbands is a major predictor of smoking among pregnant women. It was investigated whether the smoking status of the women's parents and parents-in-law has an impact on smoking cessation during pregnancy and relapse after birth above the smoking status of the husband. Method An initial sample of 458 women and their husbands was assessed prospectively during a 17-month period after birth regarding smoking habits. Five months after birth the women and their husbands reported the smoking status of their own parents. Results Smoking during pregnancy was related to the smoking status of the women's husband and mother. Women with a husband and mother who smoke were more likely to continue smoking. Relapse after smoking cessation during pregnancy was related to the smoking status of the husband and the mother-in-law. The smoking status of the women's father and father-in-law was not related to smoking cessation or relapse. Conclusion The smoking status of the pregnant women's mothers and mothers-in-law is related to fetal and newborn's nicotine exposure. The findings suggest benefits of taking the smoking status of pregnant women's mothers and mothers-in-law into account in smoking prevention programs for pregnant women and mothers with infants.     

Who Wants to Quit? Characteristics of American Indian Youth Who Seek Smoking Cessation Intervention

No group is more at-risk for tobacco-related health disparities than are American Indian youth. Little is known about their readiness to quit smoking and the extent to which cessation programs may require cultural tailoring related to recruitment, implementation, or content. This study identifies unique characteristics of American Indian teen smokers who enrolled in a school-based smoking cessation program, Not On Tobacco (called N-O-T). Using data from N-O-T intervention trials conducted in North Carolina between 2001 and 2004, the present study (a) describes the characteristics of American Indian participants (n = 91); (b) determines if basic demographics and smoking history affect intervention readiness; and (c) compares findings with non-Native participants (n = 138) enrolled in N-O-T within the same state. Upon enrollment, 80% of the sample reported that they planned to quit smoking in the next 1–6 months. We found significant differences between American Indian and non-Native youth on smoking history, with non-Natives smoking with greater intensity and frequency. Contrary to previous reports, American Indian youth in this study smoked with less intensity and were more ready to quit smoking than non-Native youth. Results reveal previously unreported characteristics of American Indian teen smokers. Study findings may advance the development of effective marketing, recruitment, and programming among American Indian teen smokers into cessation programs, particularly N-O-T, which is the only teen smoking cessation program which includes an adaptation specifically for American Indians.     

Smoking in Pregnancy in West Virginia: Does Cessation/Reduction Improve Perinatal Outcomes?

To determine if pregnant women decreasing/quitting tobacco use will have improved fetal outcomes. Retrospective analysis of pregnant smokers from 6/1/2006–12/31/2007 who received prenatal care and delivered at a tertiary medical care center in West Virginia. Variables analyzed included birth certificate data linked to intervention program survey data. Patients were divided into four study groups: <8 cigarettes/day–no reduction, <8 cigarettes/day–reduction, ≥8 cigarettes/day–no reduction, and ≥8 cigarettes/day–reduction. Analysis performed using ANOVA one-way test for continuous variables and Chi-square for categorical variables. Inclusion criteria met by 250 patients. Twelve women (4.8%) quit smoking; 150 (60%) reduced; 27 (10.8%) increased; and 61 (24.4%) had no change. Comparing the four study groups for pre-term births (<37 weeks), 25% percent occurred in ≥8 no reduction group while 10% occurred in ≥8 with reduction group (P = 0.026). The high rate of preterm birth (25%) in the non-reducing group depended on 2 factors: (1) ≥8 cigarettes/day at beginning and (2) no reduction by the end of prenatal care. Finally, there was a statistically significant difference in birth weights between the two groups: ≥8 cigarettes/day with no reduction (2,872.6 g) versus <8 cigarettes/day with reduction (3,212.4 g) (P = 0.028). Smoking reduction/cessation lowered risk of pre-term delivery (<37 weeks) twofold. Encouraging patients who smoke ≥8 cigarettes/day during pregnancy to decrease/quit prior to delivery provides significant clinical benefit by decreasing the likelihood of preterm birth. These findings support tobacco cessation efforts as a means to improve birth outcome.     

Smoking in apartment buildings – Spatiality,meanings and understandings

Increased higher density urban living may exacerbate exposure to environmental tobacco smoke.Using a social practices lens, this research explored the locations, experiences and governance of smoking in apartment buildings in Melbourne, Australia, through semi-structured interviews in high-rise buildings ranging from subsidised housing to luxury apartments. Tacit rules on acceptable locations, building rules and smoke alarms in public areas consigned smoking to balconies and building entrances. The perceived health threat from second hand smoke and mental stress due to invasion of olfactory and visual privacy undermined the full enjoyment of the home environment. Interventions may benefit from targeting the link between smoking and balconies.     

Maintenance of Smoking Cessation in the Postpartum Period: Which Interventions Work Best in the Long-Term?

Smoking during pregnancy has been linked to a variety of adverse outcomes for both maternal and child health. Decades of studies have sought to increase cessation antepartum and reduce relapse postpartum. A number of effective interventions exist to significantly reduce smoking rates during pregnancy; however, less is known about how to prevent relapse in the postpartum period. This review investigates interventions to prevent relapse in the long-term postpartum period. We focus specifically on nonspontaneous quitters (individuals who quit smoking as a result of an external intervention) to reveal differences in long-term response to interventions for this population compared to spontaneous quitters. A systematic literature search yielded 32 relevant studies of pharmacological, behavioral, and incentives-based interventions. Results were compiled, analyzed, and compared in order to evaluate success factors in maintaining cessation postpartum. Though intervention groups showed consistently higher quit rates during pregnancy than control groups, none of the intervention types were effective at preventing relapse in the longer-term postpartum period. One study maintained significantly higher abstinence in the longer-term period postpartum using a mix of behavioral and incentives strategies. Additional research in this area is needed to identify optimal intervention strategies to reduce long-term postpartum relapse, particularly for nonspontaneous quitters.     

Does Stigmatization Motivate People to Quit Smoking? Examining the Effect of Stigmatizing Anti-Smoking Campaigns on Cessation Intention

Stigmatization against smokers characterizes many of today’s anti-smoking campaigns in the United States. It is believed that stigmatization motivates people to quit smoking by arousing a state of emotional distress, such as shame, in viewers. However, stagnant cessation rates among socioeconomically disadvantaged smokers imply that stigmatizing campaigns might be ineffective in promoting cessation among those low in socioeconomic status. To understand the effectiveness of stigmatizing campaign messages, we proposed a moderated mediation model and experimentally tested it among current smokers (n = 136). Results show that exposure to a stigmatizing message significantly lowered smokers’ cessation intentions who have lower income and less self-efficacy. The conditional negative effect of the message was accounted for by shame experienced by smokers.     

The Economic Potential of Smoking Cessation Interventions at the Point of Diagnosis of Non–Small Cell Lung Cancer

ObjectivesStopping smoking has proven benefits in nearly all illnesses but the impact and health economic benefits of stopping smoking after a diagnosis of lung cancer are less well defined. We assessed the cost-effectiveness of smoking cessation (SC) services for patients with newly diagnosed lung cancer against current usual care, where patients are unlikely to receive SC service referral.MethodsA health economic model was constructed in Excel. The modelled population comprised of patients with a new diagnosis of non–small cell lung cancer (NSCLC). Data from the LungCast data set (Clinical Trials Identifier NCT01192256) were used to estimate model inputs. A structured search of published literature identified inputs not represented in LungCast, including healthcare resource use and costs. Costs were estimated from a 2020/2021 UK National Health Service and Personal Social Services perspective. The model estimated the incremental quality-adjusted life-year (QALY) gained in patients with newly diagnosed NSCLC receiving targeted SC intervention than those receiving no intervention. Extensive one-way sensitivity analyses explored input and data set uncertainty.ResultsIn the 5-year base case, the model estimated an incremental cost of £14 904 per QALY gained through SC intervention. Sensitivity analysis estimated an outcome range of between £9935 and £32 246 per QALY gained. The model was most sensitive to the estimates of relative quit rates and expected healthcare resource use.ConclusionThis exploratory analysis indicates that SC intervention for smokers with patients with newly diagnosed NSCLC should be a cost-effective use of UK National Health Service resources. Additional research with focused costing is needed to confirm this positioning.     

Does State Certification or Licensure Influence Outpatient Substance Abuse Treatment Program Practices?

In the United States, state governments legally authorize outpatient substance abuse treatment programs. In some states, programs are certified or accredited (ideal standards). Other states license programs (minimal standards). Additionally, some states authorize programs through “deemed status”, which is afforded to programs attaining accreditation from a national accrediting body. Primary legal research and the National Survey of Substance Abuse Treatment Services’ (N-SSATS) data were used to examine the relationships between state authorization type (certification/accreditation vs licensure with and without deemed status) and outpatient treatment program practices. Programs in certification/accreditation (vs licensure) states had significantly higher odds of offering wrap-around and continuing care/after care services associated with better long-term treatment outcome. Programs in states that allowed for certification/accreditation with deemed status had significantly lower odds of infectious disease testing, but higher odds of providing group and family counseling. Results suggest that state authorization type may impact services offered by outpatient treatment programs. This study was conducted at The MayaTech Corporation, 1100 Wayne Avenue, Suite 900, Silver Spring, MD, 20910, USA.     

Global alignment of immunization safety assessment in pregnancy – The GAIA project

Immunization in pregnancy provides a promising contribution to globally reducing neonatal and under-five childhood mortality and morbidity. Thorough assessment of benefits and risks for the primarily healthy pregnant women and their unborn babies is required. The GAIA project was formed in response to the call of the World Health Organization for a globally concerted approach to actively monitor the safety of vaccines and immunization in pregnancy programs. GAIA aims to improve the quality of outcome data from clinical vaccine trials in pregnant women with a specific focus on the needs and requirements for safety monitoring in LMIC.In the first year of the project, a large and functional network of experts was created. The first outputs include a guidance document for clinical trials of immunization in pregnancy, a basic data collection guide, ten case definitions of key obstetric and neonatal health outcomes, an ontology of key terms and a map of pertinent disease codes.The GAIA Network is designed as an open and growing forum for professionals sharing the GAIA vision and aim. Based on the initial achievements, tools and services are developed to support investigators and strengthen immunization in pregnancy programs with specific focus on LMIC.