Original Articles
An Exercise Programme for Smoking Cessation: Perceptions of the Fit2quit Trial Intervention
- Vaughan Roberts, Leila Pfaeffli Dale, Enid Dorey, Christopher Bullen, Ralph Maddison
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- Published online by Cambridge University Press:
- 04 August 2014, pp. 135-142
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Introduction: Few trials of exercise interventions for smoking cessation have included a qualitative evaluation of the intervention from the participants' perspective.
Aims: To determine the perceptions of participants who received a 6-month telephone counselling exercise intervention to aid smoking cessation.
Methods: Participants in the Fit2Quit study intervention group were asked to take part in a semi-structured phone interview. All interviews were digitally recorded and transcribed verbatim, and a general inductive approach to data analysis was followed.
Results/Findings: Twenty participants from the intervention group completed an interview. The following themes emerged from the analyses: (1) The support people were genuinely interested in what I was achieving, (2) new awareness, new attitude, new lifestyle: I could see the benefits, (3) lack of time, willpower and money stopped me from changing and (4) I would have preferred a “more hands on” approach: Recommendations for future programmes.
Conclusions: A telephone counselling intervention to enhance exercise for smoking cessation was well received. Aspects of the intervention, particularly the provision of support and encouragement from the participant support person, were beneficial. Suggested improvements were greater tailoring of the call schedule, greater face-to-face contact and provision of a buddy system or support group. Such improvements may increase adherence and, therefore, effectiveness of exercise interventions for smoking cessation.
Smokers’ Treatment Expectancies Predict Smoking Cessation Success
- Lisa M. Fucito, Benjamin A. Toll, Corey R. Roos, Andrea C. King
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- Published online by Cambridge University Press:
- 27 August 2014, pp. 143-149
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Introduction: Smokers’ treatment expectancies may influence their choice of a particular medication as well as their medication experience.
Aims: This study examined the role of smokers’ treatment expectancies to their smoking cessation outcomes in a completed, randomized, placebo-controlled trial of naltrexone for smoking cessation, controlling for perceptions of treatment assignment.
Methods: Treatment-seeking cigarette smokers (N = 315) were randomized to receive either naltrexone (50 mg) or placebo in combination with nicotine patch and behavioural counselling. Expectancies for naltrexone as a smoking cessation aid were assessed at baseline and four weeks after the quit date.
Results: More positive baseline medication expectancies predicted higher quit rates at one month in the naltrexone group (OR = 1.45, p = 0.04) but were associated with lower quit rates in the placebo group (OR = 0.66, p = 0.03). Maintaining and/or increasing positive medication expectancies in the first month of treatment was associated with better pill adherence during this interval in the naltrexone group (ps < 0.05). Positive baseline medication expectancies were also associated with the perception of having received naltrexone over placebo among all participants.
Conclusions: Positive medication expectancies in smokers may contribute to better treatment response. Assessing treatment expectancies and attempting to maintain or improve them may be important for the delivery, evaluation, and targeting of smoking cessation treatments.
Smoking Cessation after Myocardial Revascularization Procedures
- Thiago Gonçalves Schroder e Souza, Jonathan Batista Souza, Evandro Bertanha Nunes, Roberto Mário Arruda Verzola, Cláudia Vanessa Barrionuevo, Leandro Menezes Alves da Costa, Márcio Gonçalves de Sousa
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- Published online by Cambridge University Press:
- 13 August 2014, pp. 150-153
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Introduction: Smoking is associated with the development of coronary artery disease and influences negatively the prognosis of patients undergoing myocardial revascularization procedures. However, the rate of smoking cessation after these procedures is not well established in the literature. We aimed to evaluate the rate of smoking cessation in patients undergoing revascularization procedures, immediately and after 12 months of follow-up.
Methods: We examined smoking patients from a unique cardiology center who underwent myocardial revascularization procedures between January 2010 and December 2011. These patients were allocated to two groups according to the revascularization procedure performed: Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Interventions (PCI). Data related to cessation or maintenance of smoking were obtained at subsequent clinical appointments or telephone calls.
Results: Among 173 patients selected, 118 (68.2%) underwent PCI and 55 (31.8%) underwent CABG. After revascularization procedures, the total rate of smoking cessation was 79.3%. Furthermore, there was no significant difference between the two groups (83.6% – CI 95%: 71.2–92.2% for CABG, and 79.3% – CI 95%: 70.8–86.3% for PCI). The maintenance of smoking cessation after one year was 53.2%, similar between groups (52.7% for CABG and 53.4% for PCI). Nevertheless, the average time of smoking cessation was significantly higher in the CABG group (6.9 months versus 4.5 months for PCI).
Conclusions: Coronary interventions add important value to smoking cessation, and the smoking cessation rates were similar, independent of the procedure executed.
Prospective Evaluation of Factors Predicting Nicotine Withdrawal Symptoms Among Korean Americans
- Sun S Kim, Hua Fang, Sherry A. McKee, Douglas Ziedonis
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- Published online by Cambridge University Press:
- 04 September 2014, pp. 154-162
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Introduction: This study examined factors predicting nicotine withdrawal symptoms following quitting among Korean American smokers who were receiving counseling and nicotine replacement therapy.
Methods: The sample comprised 90 Korean American smokers selected from a two-arm randomised controlled trial of a smoking cessation intervention (culturally adapted versus treatment as usual). Nicotine withdrawal symptoms were assessed weekly for the first four weeks from the target quit day, using the Minnesota Nicotine Withdrawal Scale (MNWS). Only those who participated in two or more weekly assessments of the symptoms were included.
Results: Among the nine withdrawal symptoms listed in the MNWS, craving and disturbed sleep decreased over time whereas the remaining symptoms had no significant effect of time. Women or individuals who perceived greater risks of quitting smoking reported more withdrawal symptoms after controlling for abstinence status. Although withdrawal symptoms did not change, on average, with time, the rates of change varied randomly across individuals. Women reported more withdrawal symptoms in the first week after quitting and showed a higher rate of decline of the symptoms over time than men.
Conclusions: Korean American smokers who are women or who perceive greater risks of quitting smoking may require more intensive treatment to effectively deal with post-quit withdrawal symptoms.
Design and Feasibility of a Hatha Yoga Intervention for Smoking Cessation
- Tammy L. Burns, Amy E. Mayer, Shavonne M. Washington-Krauth, Ryan W. Walters, Amy J. Arouni
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- Published online by Cambridge University Press:
- 12 September 2014, pp. 163-172
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Introduction: Effective interventions for smoking cessation are critically needed. Yoga has only begun to be evaluated for smoking cessation.
Aims: The primary aim was to assess participant satisfaction and perceived benefit of Hatha yoga. Secondary aims were to test evaluation tools, recruitment and retention techniques, and to generate preliminary effect size for a randomized trial.
Methods: This was a non-randomized, single-group, pilot study. Thirty-one participants entered the study and received group behavioural therapy followed by 30 minutes of Hatha yoga instruction. Participant satisfaction was assessed at the conclusion of eight sessions. Point prevalence smoking abstinence was assessed at the end of the intervention period.
Results: Participants were 36% male with an average age of 47 years (range 22–72) and a mean of 12.7 ± 5.6 cigarettes per day. Mean duration of smoking was 26.1 ± 15 years. Participant satisfaction was very high (88% very satisfied). Smoking abstinence at the end of the intervention was 29%.
Conclusions: Hatha yoga is acceptable and feasible to aid in smoking cessation. A regimen that includes breathing, postures, and meditation has been developed for testing in a randomized trial.
Effectiveness of Coping Strategies at Alleviating Cue-Induced Craving: a Pilot Study
- Michelle Dicker, Mai Frandsen, Matthew A. Palmer, Stuart G. Ferguson
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- Published online by Cambridge University Press:
- 15 September 2014, pp. 173-178
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Introduction: Results from observational studies suggest that smoking-related cues play a role in triggering relapse. Coping strategies are among the most commonly used cessation strategies, but little is known about how they aid quitting.
Aims: The aim of this pilot study was to evaluate the effect of a suite of selected coping techniques on alleviating cue-induced cravings.
Methods: Thirty-seven daily smokers (Intervention: 20; Control: 17) participated in two laboratory cue-reactivity sessions, separated by approximately one week, during which craving was assessed before and after exposure to smoking-related cues. Following the first session, participants in the Intervention Group were taught a suite of coping strategies. During the second session, participants in the Intervention Group were encouraged to use these strategies.
Results: Participants in the Intervention Group reported a slight decrease in craving following the acute exposure manipulation at the second session, compared to an increase in craving among participants in the Control Group. Intervention Group participants also reported a decrease in craving following prolonged exposure to the smoking cues (compared to an increase in craving among Control Group participants). In both cases, the difference between groups was more pronounced among smokers who responded to the cue-reactivity manipulation. The observed differences were not significant.
Conclusions: The results of this pilot study suggest that coping techniques may be beneficial in alleviating both the initial spike in craving observed following acute cue exposure, and aid recovery during prolonged exposure. These findings need to be replicated in a larger study.
Enrolling Smokers from Health Systems into Quitline Services: ‘Results of two enrollment strategies’
- Barrett Sewali, Janet L. Thomas, Hongfei Guo, Kevin Peterson, Jasjit S. Ahluwalia, Matthew J. Carpenter, Christi Patten, Edward F. Ellerbeck, Kolawole S. Okuyemi
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- Published online by Cambridge University Press:
- 11 November 2014, pp. 179-187
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Objective: To determine the effects of motivational interviewing (MI) counselling versus a minimal intervention control on the enrollment of smokers in the Minnesota QUITPLAN Helpline.
Study design: Two-group randomized controlled trial of 235 community-dwelling adult smokers. Participants were randomly assigned to receive either a three-session phone based motivational interviewing intervention (n = 118) or the control (n = 117) consisting of mailed printed materials about the Minnesota QUITPLAN helpline services.
Data collection: Participants completed demographic and smoking-related survey questionnaire at baseline (by mail) and at weeks 4 and 26 (by phone) follow-up. Quitline enrollment status data was provided by the Minnesota QUITPLAN Helpline.
Principal findings: At week 4 follow-up, a higher proportion of participants in the MI group (22.3%) had enroled in the Minnesota QUITPLAN Helpline compared to those in the control arm (13.6%; p = 0.098). At week 26 follow-up, enrollment rates were similar for MI (28.0%) and control (26.5%) arms. Of those who enroled in the Helpline, participants in the MI group reported completing more Helpline sessions than those in control group (4.9 vs. 3.2; p = 0.087).
There was no significant interaction between readiness to quit and intervention for the outcome of enrollment in the Helpline.
Conclusions: A minimal intensity control such as mailing printed materials resulted in quitline enrollment rates similar to a more resource intensive intervention like motivational interviewing and several folds higher than the current state or national averages. We recommend that health plans should consider mailing smoking cessation promotional messages to encourage smokers to enrol in quitlines.
Use of Smoking Cessation Interventions by Physicians in Argentina
- Veronica Schoj, Raul Mejia, Mariela Alderete, Celia P. Kaplan, Lorena Peña, Steven E. Gregorich, Ethel Alderete, Eliseo J. Pérez-Stable
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- Published online by Cambridge University Press:
- 21 November 2014, pp. 188-197
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Background: Physician-implemented interventions for smoking cessation are effective but infrequently used. We evaluated smoking cessation practices among physicians in Argentina.
Methods: A self-administered survey of physicians from six clinical systems asked about smoking cessation counselling practices, barriers to tobacco use counselling and perceived quality of training received in smoking cessation practices.
Results: Of 254 physicians, 52.3% were women, 11.8% were current smokers and 52% never smoked. Perceived quality of training in tobacco cessation counselling was rated as very good or good by 41.8% and as poor/very poor by 58.2%. Most physicians (90%) reported asking and recording smoking status, 89% advised patients to quit smoking but only 37% asked them to set a quit date and 44% prescribed medications. Multivariate analyses showed that Physicians' perceived quality of their training in smoking cessation methods was associated with greater use of evidence-based cessation interventions. (OR = 6.5; 95% CI = 2.2–19.1); motivating patients to quit (OR: 7.9 CI 3.44–18.5), assisting patients to quit (OR = 9.9; 95% CI = 4.0–24.2) prescribing medications (OR = 9.6; 95% CI = 3.5–26.7), and setting up follow-up (OR = 13.0; 95% CI = 4.4–38.5).
Conclusions: Perceived quality of training in smoking cessation was associated with using evidence-based interventions and among physicians from Argentina. Medical training programs should enhance the quality of this curriculum.