Predicting the life‐time benefit of school‐based smoking prevention programmes

Aim School‐based smoking prevention programmes may delay the age of smoking initiation, but do not appear to achieve lasting reductions in smoking prevalence beyond school‐leaving age. We explored whether delaying the age at which someone initiates smoking may have life‐time benefits by increasing the likelihood of quitting in later life. Design and setting Data from the General Household Survey of Great Britain were used in a logistic regression model to examine the association between age at which someone initiates regular smoking and the probability that the person will quit smoking later in life. The effect of confounding variables (sex, ethnicity, socio‐economic class, education and geographical location) was taken into account. The predicted relationship was used in a cohort model to estimate the life‐time reduction in smoking prevalence and all‐cause mortality of a school‐based smoking prevention programme. Results Age of regular smoking initiation was associated strongly with the probability of quitting later in life (coefficient ?0.103, P < 0.001). The strength of the association was slightly reduced but still significant when confounding variables were included (coefficient ?0.075, P < 0.001). An intervention that delays smoking initiation without decreasing smoking prevalence at age 18 may reduce adult smoking prevalence by 0.13–0.32% (depending on age) and all‐cause mortality by 0.09% over the life‐time of the sample. Conclusion School‐based smoking prevention programmes have potential for a beneficial effect over the life‐time of the participants even if they have no apparent effect at school‐leaving age.     

Cessation in the use of tobacco – pharmacologic and non‐pharmacologic routines in patients

Introduction: Approximately one‐third of the adult population in industrial countries and 70% in several Asian countries are daily smokers. Tobacco is now regarded as the world's leading cause of death. Approximately two‐thirds of lifelong smokers eventually die because of smoking. Smoking cessation is the most effective action to reduce mortality in patients with chronic obstructive pulmonary disease (COPD) and coronary heart disease. Objective: The aim of this study was to determine the effectiveness of smoking cessation programmes in patients with smoking‐related disorders. Methods: Medline was searched for studies of interventions for smoking cessation in patients. Results: In patients with cardiovascular diseases and COPD, smoking cessation programmes with behavioural support over several months significantly increase quit rates. The intensity of the programmes seems to be proportional to the effect. A long follow‐up period is probably the most important element in the programmes. Even the most intensive programmes are very cost‐effective in terms of cost per life‐year gained. Effective programmes can be delivered by personnel without special education in smoking cessation using simple intervention principles. Conclusions: In patients with smoking‐related disorders, smoking cessation interventions with several months of follow‐up are effective and easily applicable in clinical practice. Wider implementation of such programmes would be a cost‐effective way of saving lives. Please cite this paper as: Quist‐Paulsen P. Cessation in the use of tobacco – pharmacologic and non‐pharmacologic routines in patients. The Clinical Respiratory Journal 2008; 2: 4–10.     

Exploring perceptions of a rheumatoid arthritis‐specific smoking cessation programme

Aim

Smoking cessation is an important consideration in the management of rheumatoid arthritis (RA). The aim of the present study was to determine which aspects of a novel three‐month smoking cessation intervention were most useful for people with RA, and to identify areas for improvement.

Method

Thirty‐eight current smokers with RA (19 intervention and 19 control) enrolled in a previous randomized controlled trial (RCT) of smoking cessation and two arthritis educators who had provided the intervention were interviewed. The data were analysed thematically using a combination of deductive and inductive approaches to identify themes.

Results

Intervention participants and the educators identified individualized support and advice as the two most important components of the smoking cessation intervention. The generic smoking cessation components and education about the links between smoking and RA were also identified as important. Nicotine replacement therapy was provided to all participants and was the most commonly reported facilitator of smoking cessation. People with RA who reported being ready to quit smoking had more success at smoking cessation. The educators were positive about ongoing provision of the smoking cessation intervention.

Conclusion

The novel RA‐specific smoking cessation intervention that had formed the basis of the previous RCT provided useful and varied options to assist quitting smoking in RA. Successful quitters were ready and motivated to quit smoking regardless of their randomization status, with nicotine replacement therapy an effective aid to quitting. Support offered by the educators was critical in the participants' perspective.     

Assessment of factors associated with smoking cessation at diagnosis or during follow‐up of Crohn's disease

Background and Aim

Smoking cessation is known to improve the course of Crohn's disease (CD). However, the factors associated with smoking cessation after CD diagnosis have not been well established.

Methods

Clinical characteristics and change in smoking status were evaluated in 445 current smokers at the time of CD diagnosis. Patients were classified into three subgroups based on their final smoking status and time of smoking cessation: non‐quitters, quitters at diagnosis, and quitters during follow‐up.

Results

The overall smoking cessation rate was 55.7% (248 of 445 patients). The diagnosis of CD was the main reason for quitting (41.5%, 103 of 248 patients). Smoking cessation at the time of CD diagnosis was associated with intestinal resection within 3 months from CD diagnosis (odds ratio [OR] 2.355, 95% confidence interval [CI] 1.348–4.116, P = 0.003), light smoking (OR 2.041, 95% CI 1.157–3.602, P = 0.014), and initiation of smoking before 18 years of age (OR 0.570, 95% CI 0.327–0.994, P = 0.047). Light smoking (OR 1.762, 95% CI 1.019–3.144, P = 0.043) and initiation of smoking before 18 years (OR 0.588, 95% CI 0.381–0.908, P = 0.017) were also associated with overall smoking cessation.

Conclusion

Quitters after CD diagnosis, including quitters at diagnosis and quitters during follow‐up, had features distinct from those of non‐quitters. Given the motivation at CD diagnosis, a detailed history of smoking habits should be taken and all current smokers should be encouraged to quit smoking at the time of CD diagnosis.