Targeted Smoking Cessation Messages for Adolescents

Purpose

To develop and to conduct a preliminary evaluation of smoking cessation messages targeted for adolescents.

Method

We (a) conducted a formative evaluation to identify the optimal content and presentation approach for adolescent-targeted smoking cessation messages, (b) developed two smoking cessation videos catering to adolescent smokers' message preferences, and (c) copy tested the videos to determine the optimal message frame (gain vs. loss) using a quasi-experimental crossover design.

Results

In the formative evaluation, adolescent smokers preferred peer-delivered cessation messages that emphasized long-term health consequences and some social and short-term health consequences of smoking. The information from the formative evaluation was used to create a gain- (emphasized the benefits of quitting and joining a smoking cessation program) and a loss-framed video (emphasized the cost of continuing to smoke and consequences of failing to join a smoking cessation program). The copy test of the videos indicated that adolescents found the messages clear and appealing. The gain-framed message was considered more novel than the loss-framed message and was preferred by most participants. Nonetheless, the loss-framed version resulted in more positive attitudes toward quitting than the gain-framed version.

Conclusion

Little is known about how to construct effective smoking cessation messages tailored specifically for adolescent smokers. The study findings provide insight into adolescents' preferences for message content and presentation. Although considered less novel, providing loss-framed information may be most influential among adolescents. These findings have important implications for developing effective adolescent-targeted smoking cessation messages.     

The Effect of Cigarette Price Increases on Smoking Cessation in California

We investigated whether smoking cessation increased in California after a cigarette manufacturer’s retail price increase and an increase in the state cigarette excise tax. The sample for this study was drawn from the 1996 and 1999 California Tobacco Surveys. The rate of unsuccessful and successful quit attempts and the rate of abstinence were calculated for each month of the 14-month period preceding each survey administration. We combined the monthly rates for both surveys and used multiple regression modeling to test whether the proportion of smokers reporting a quit attempt and the proportion of smokers reporting abstinence increased during the period following the price increases. We included several covariates in our models to control for factors other than the price increases that could account for any increases observed in quit attempts and abstinence. Because smokers recall quits occurring closer to the date of the survey better than quits occurring further back in time, we included a term in the models representing the number of months elapsed between the survey administration and the reported quit. We also included terms in the models representing the months before and after the over-the-counter (OTC) availability of the nicotine patch and nicotine gum in 1996 to control for the increase in smoking cessation observed following the availability of OTC nicotine replacement therapy (NRT). Lastly, in order to control for increased quits made in January as a result of New Year’s resolutions, we included a term in our models for quit attempts and successful quits (abstinence) made during this month. Results of the regression analyses indicated a significantly greater proportion of smokers reported quit attempts (p < 0.05) in the months immediately following the cigarette price increases (after November 1998); however, a significant increase in abstinence was only observed from December 1998 through March 1999 (p < 0.05) relative to abstinence occurring before the price increases.     

Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration,Dual Use,and Relationship to Quit Attempts and Former Smoking

PurposeAs elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes.MethodsData from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13–18 years were analyzed with logistic regression.ResultsA total of 9.4% (8.0% ever–dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever–e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39–1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09–.12).ConclusionsSome Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.     

Prevalences of Stages of Change for Smoking Cessation in Adolescents and Associated Factors: Systematic Review and Meta-Analysis

Purpose

To synthesize evidence on the prevalences of stages of change (Transtheoretical Model) for smoking cessation in adolescents and associated factors.

戒烟药物研究进展

烟草危害人类健康,戒烟已经迫在眉睫。国际公认的戒烟药物有7种,包括5种尼古丁替代制剂、安非他酮缓释剂和伐尼克兰。尼古丁替代疗法是用纯净医用尼古丁代替烟雾中吸入的尼古丁;安非他酮缓释剂是种氨基酮类抗抑郁剂。通过增加中枢NE、5-HT及DA含量,两者都可减少戒断症状。伐尼克兰是种选择性烟碱受体部分激动剂,可竞争性的与α4β2尼古丁乙酰胆碱受体结合但部分激活受体,引起减半的受体应答效应,从而起到降低吸烟渴求和减少戒断症状的发生。对目前的戒烟药物现状作一综述。     

天津市居民吸烟及戒烟状况调查分析

目的：了解天津市居民吸烟状况、戒烟想法及戒烟方法的应用,为有针对性地在居民中开展健康教育活动提供依据,同时为制定相关控烟政策提供基础数据。方法使用 PPS 法(按规模大小成比例的概率抽样)在每个区抽取3个街道,共计16个区。使用 PPS 在每个街道抽取2个居委会抽样单位,采用随机抽样方法在每个居委会抽取70个家庭户,每个家庭户采用 KISH 表抽取1名调查对象,每个居委会完成50份调查问卷。结果男性现在吸烟率为42.35%,女性现在吸烟率为10.32%,男性吸烟率高于女性(χ2=760.956,P <0.05),不同文化程度居民吸烟率差异有统计学意义(χ2=95.605,P <0.05)。男性与女性现在吸烟者戒烟意愿差异无统计学意义(χ2=2.959,P >0.05),不同吸烟量的现在吸烟者戒烟意愿差异有统计学意义(χ2=30.434,P <0.05),随着吸烟者吸烟量的增大,想戒烟的比例也在逐渐降低。89.18%现在吸烟者选择靠自己毅力戒烟,7.06%选择拨打戒烟热线。在过去12个月,有42.25%医护人员建议吸烟者戒烟。非吸烟者对主动吸烟及吸入二手烟的危害知晓率高于吸烟者,有戒烟想法的人主动吸烟及吸入二手烟的危害知晓率高于吸烟者。结论应积极开展控烟工作,有针对性地对男性、女性吸烟者开展控烟干预工作,加大戒烟门诊、戒烟热线的宣传,提高医务人员的戒烟知识和戒烟技巧,广泛宣传主动吸烟与被动吸烟的危害,同时政府部门加强控烟法律执行力度,保证人民群众不受二手烟的危害。     

Participant- and Study-Related Characteristics Predicting Treatment Completion and Study Retention in an Adolescent Smoking Cessation Trial

Purpose

To determine which factors predict smoking cessation treatment completion and retention among adolescents.

Methods

In a multisite, randomized, controlled trial, the efficacy of motivational interviewing was compared with structured brief advice for smoking cessation and reduction in adolescents (n = 355) aged 14–18 years (55% female, 45% black, 12% Hispanic). Treatment spanned 12 weeks, with follow-up assessments at 24 weeks. Treatment completion was defined as completion of all five counseling sessions. Study retention was defined as completing the 24-week assessment. Participant and study variables served as predictors of treatment completion and retention.

Results

In all, 79% of participants completed all five counseling sessions and the same percent completed the 24-week assessment. Black race, precontemplation stage to cut back, and shorter length of time between the baseline assessment and the first counseling session were significantly associated with treatment completion. For every 7.5-day delay in starting treatment after the baseline visit, there was a 50% decrease in the odds of completing all five treatment sessions. Retention at 24 weeks was predicted by black race, younger age, greater maternal education, expectations of graduating college, and structured brief advice intervention.

Conclusions

High rates of treatment completion and study retention can be achieved in a multisession, behavioral intervention for adolescent smoking cessation. Findings suggest that treatment should begin soon after the intake session to maximize treatment completion. Enhanced efforts to retain older adolescents and youth with lower academic goals and lower family income will be important in future studies.     

Helping Smokers Quit: Understanding the Barriers to Utilization of Smoking Cessation Services

Context: Counseling smokers to quit smoking and providing them with pharmaceutical cessation aides are among the most beneficial and cost‐effective interventions that clinicians can offer patients. Yet assistance with quitting is not universally covered by health plans or offered by all clinicians. Analysis of stakeholders' perspectives and interests can identify the barriers to more widespread provision of cessation services and suggest strategies for the public policy agenda to advance smoking cessation. Methods: Review of literature and discussions with representatives of stakeholders. Findings: All stakeholders—health plans, employers, clinicians, smokers, and the government—face barriers to broader smoking cessation activities. These range from health plans' perceiving that covering counseling and pharmacotherapy will increase costs without producing commensurate health care savings, to clinicians' feeling unprepared and uncompensated for counseling. Like other preventive measures aimed at behavior, efforts directed at smoking cessation have marginal status among health care interventions. State governments can help correct this status by increasing Medicaid coverage of treatment and expanding coverage for state employees. The federal government can promote the adoption of six initiatives recommended by a government subcommittee on cessation: set up a national quit line, develop a media campaign to encourage cessation, include cessation benefits in all federally funded insurance plans, create a research infrastructure to improve cessation rates, develop a clinician training agenda, and create a fund to increase cessation activities through a new $2 per pack cigarette excise tax. Both the federal and state governments can increase cessation by adopting policies such as the higher cigarette tax and laws prohibiting smoking in workplaces and public places. Conclusions: Public policy efforts should assume greater social responsibility for smoking cessation, including more aggressive leadership at the state and federal levels, as well as through advocacy, public health, and clinician organizations.     

2015-2018年央补项目戒烟门诊患者首诊后1个月随访时戒烟率影响因素分析

目的 评估中央补助地方戒烟门诊项目实施效果,探索影响吸烟者戒烟成功的因素,以指导戒烟服务的提供和戒烟门诊工作的开展。方法 采用人群现场干预研究,由经过项目培训的医务人员,对吸烟者进行面对面访谈,完成调查问卷,并进行心理行为干预。已配备戒烟药物的医院,为患者开具相应药物。首诊1个月后开展随访干预,获得1个月随访7 d时点戒烟率。结果 1个月随访7 d时点戒烟率为34.1%。多元logistic回归结果显示, ≥60岁患病人群戒烟可能性最大;自身患病、首诊非每天吸烟、准备在30 d内戒烟、使用酒石酸伐尼克兰和盐酸安非他酮的患者,戒烟成功的可能性更大;未就业者相对于就业者更不利于戒烟;每日吸烟量越大、吸烟年限越长、晨起后第一支烟越急迫的患者,戒烟的可能性越小;是否有戒烟史对戒烟可能性没有影响。结论 从1个月随访时7 d时点戒烟率看,央补戒烟门诊项目戒烟干预有效。应加大对吸烟者的宣传,戒烟越早越有效。使用酒石酸伐尼克兰和盐酸安非他酮等药物能增加戒烟的可能性,应加强戒烟门诊有效药物的配备率。戒烟门诊医务人员帮助患者在戒烟过程中克服戒断症状很重要。     

The Chinese Community Smoking Cessation Project: A Community Sensitive Intervention Trial

This paper describes (1) the design, methods and baseline data of the first smoking cessation clinical trial for Chinese Americans with medical conditions - Chinese Community Smoking Cessation Project (CCSCP); (2) the collaborative process between researchers and the Chinese community; and (3) the barriers and facilitators of implementing the study. CCSCP was a culturally tailored, randomized, smoking cessation trial testing the efficacy of an intensive (physician advice, in-person counseling with nicotine replacement therapy, 5 telephone calls) compared to a minimal (physician advice and self-help manual) intervention. The study applied a community-sensitive research method involving community members in all phases of the research process in San Francisco Bay Area during 2001–2007. CCSCP recruited 464 smokers from health care facilities (79%) located in Chinese neighborhoods and through Chinese language media (21%). Baseline assessments and interventions were conducted in-person using translated and tested questionnaire and intervention materials. The majority of the participants were men (91%) with a mean age of 58.3 years, foreign born (98%), with less than high school education (58%), spoke no English (42%) and in non-skilled or semi-skilled occupations (60%) with <$20,000 household income (51%). Participants smoked regularly on an average 38.6 ± 17 years, smoked 9.1 ± 8 cigarettes per day and 85% smoked daily. Cultural tailoring of recruitment methods and intervention design led to successful enrollment and retention of participants, overcoming barriers faced by the participants. Community sensitive collaborative process facilitated implementation of study protocol in community health care settings.     

广州青少年吸烟现状研究

目的 了解广州城市青少年吸烟流行情况。方法 采用横断面随机抽样调查方法对广州城市12－18岁中学阶段的学生6名202名进行不记名问卷调查。结果 广州城市青少年的总吸烟率为25．31％（男性吸烟率为34．03％，女性吸烟率为16．28％），吸烟人群中，至少吸过一口烟占65．67％，现在吸烟占13．76％，曾经吸烟占20．57％，吸烟率与年龄，年级和学校类型相关，且存在统计学上意义（P＜0．0001），初一，二年级是青少年开始尝试吸烟的关键时期，。     

Predictors of smoking cessation during pregnancy among the women of Yamato and Ayase municipalities in Japan

Cigarette smoking during pregnancy affects the unborn fetus. This study aimed to investigate: (1) the smoking status of pregnant women before, during and after pregnancy in the Yamato and Ayase municipalities, Kanagawa, Japan; (2) the characteristics that differentiate successful spontaneous smoking quitters from continuous smokers during pregnancy; and (3) the awareness of risks of smoking that may influence smoking cessation during pregnancy. A community-based, cross-sectional survey of 420 postpartum women, who delivered their babies from July 2002 to October 2002, was performed. Out of 420 respondents, 275 (65.4%) did not smoke before and during pregnancy. Of the 145 women who smoked before pregnancy, 101 (69.3%) quit successfully while pregnant. Smoking prevalence during pregnancy was 10.4%. Out of 101 successful quitters during pregnancy, 22 (21.8%) women resumed smoking after childbirth. A multiple regression analysis showed that the independent predictors of smoking cessation during pregnancy were primiparous women and women living with non-smokers in the household. Although maternal age predicted smoking cessation in a simple regression analysis, this predictive value was lost in the multiple analysis. A simple analysis showed no significant association between the awareness of smoking risks and smoking cessation during pregnancy. It is suggested that Japanese smokers are more likely to quit while pregnant than women in other countries. In the future, smoking cessation programmes should be designed to help multiparous women and women living with smokers to give up smoking.     

武汉市青少年吸烟与体脂的关系研究

目的　探讨吸烟与体脂的关系。方法　 1 999年从武汉市 1 1个城区的初一年级的学生中运用分层整群抽样的方法抽出 2 0 0 4名学生 ,用美国生产的ELGII型测试仪对每个调查对象进行生物电阻抗 (BIA)的测量 ,再用BIO -Analogics软件将BIA转换成体脂百分比 ,作为测量体脂的指标。同时对他们进行吸烟行为调查 ,根据学生报告过去 30d的吸烟量作为吸烟的测量指标。采用单因素的t检验和多因素回归模型进行统计处理。结果　在男生中 ,吸烟天数与体脂百分比呈负相关 (P <0 .0 5) ,而女生吸烟天数与体脂百分比无统计学关联(P >0 .0 5) ;无论男生还是女生 ,吸烟量与体脂百分比未表现出明显的相关关系 (P >0 .0 5)。结论　吸烟对青少年体脂发育有一定的影响     

吸烟青少年心理应激及其心理健康水平的研究

较高的心理应激水平及不良心理卫生状况与成人吸烟相关联已见于报道，文中对这一关系在青少年吸烟者中是否存在作一探讨。作者选取经常吸烟的中专男生及非吸烟者各241人为研究对象，运用社会经历量表（SEC），症状自评量表（SCL－90）进行评定。结果表明，吸烟青少年消极社会经历评分高而积极社会经历评分低，吸烟者心理健康不良呈多方面，包括躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执等症状显著高于对照组。结果提示，吸烟青少年心理应激水平高、心理健康水平低，在劝阻青少年吸烟教育过程中要关注情感因素。     

戒烟对慢性阻塞性肺疾病患者肺功能和生活质量的影响

目的探讨戒烟对慢性阻塞性肺疾病(COPD)患者肺功能和生活质量的影响。方法对2008年12月-2009年12月在承德医学院附属医院呼吸科接受诊治的吸烟的COPD患者实施医生"劝导戒烟干预",干预时间为2个月。根据戒烟成功与否,将其分为戒烟组(36人)、吸烟组(28人),同期接受诊治的有吸烟史但已戒烟2年以上的COPD患者为曾吸烟组(26人),每隔3个月检测其第一秒呼气容积(FEV1)、用力肺活量(FVC)、呼气峰值流速(PEF),12个月后采用CAT评定量表对其生活质量进行测定。结果随访3个月后,戒烟组一氧化碳血红蛋白结合百分比(COHb%)较入组(0个月)时显著降低(P<0.05)。FEV1、FVC在各时间点戒烟组和吸烟组均高于曾吸烟组,差异有统计学意义(P<0.05)。随访12个月时,戒烟组FEV1、FVC均高于吸烟组,但差异无统计学意义;PEF较0个月时增高37ml,差异有统计学意义(P<0.05)。CAT显示,吸烟组痰量高于戒烟组和曾吸烟组(P<0.05)。结论戒烟可以提高COPD患者FEV1、FVC、PEF及其生活质量。     

Smoking Cessation Counseling Practices of Texas Pharmacists

A cross-sectional study was conducted to determine pharmacists’ awareness and education about smoking cessation and their communication with patients about smoking cessation. A survey was mailed to East Texas pharmacists practicing in the areas of hospital or clinical, retail or community, managed care, consultant, or academic pharmacy. Outcome measurements included: measures of the awareness of the 5 A’s and 5 R’s of smoking cessation, training received in smoking cessation, and communication practices regarding smoking cessation. There were 320 respondents. Approximately 10% of the respondents indicated they had received tobacco cessation counseling education during their formal educational training, 36% during continuing education programs, and 9% during both formal training and continuing education. About 44% reported they had received no tobacco cessation counseling training. Among pharmacists surveyed, 5% responded that they usually or always ask their patients if they smoke cigarettes, pipe, or cigars, 43% reported they sometimes or half of the time ask, and 45% said they never ask. There is a clear relationship between pharmacists awareness and education of smoking cessation techniques and their communication with patients about them. Pharmacy education leaders must continue their movement to include public health in the pharmacy curricula to produce pharmacists who are prepared to better serve the community. This project was funded by a grant from the Texas Department of State Health Services.     

Predictors of Smoking Cessation in Pregnancy and Maintenance Postpartum in Low-Income Women

Objective: To describe factors associated with smoking status of low-income women during pregnancy and postpartum. Methods: Data from a randomized clinical trial were used to conduct separate analyses on 327 women who smoked at baseline (time at enrollment) and for whom smoking status was available at delivery, and on 109 women who reported not smoking at delivery (quit spontaneously or after study enrollment) and for whom smoking status was available at 6-months postpartum. Salivary cotinine was used to assess the accuracy of self-reported smoking status for the sample as a whole. Data were collected between May 1997 and November 2000. Results: 18% of the 327 baseline smokers stopped smoking before delivery. Cessation was less likely in older women, those reporting Medicaid coverage (vs. commercial or no insurance), who were at a later week of pregnancy at baseline, were more addicted, had a husband/partner who smoked, and did not receive the study intervention. 37% of the 109 women who reported not smoking at delivery maintained abstinence at 6-months postpartum. Factors associated with abstinence were later week of pregnancy at baseline and quitting spontaneously with pregnancy, while women who lived with a smoker were less likely to report abstinence. Spontaneous quitters were less likely to relapse by 6 months postpartum than women who quit smoking later in pregnancy. Conclusions: Partner participation in smoking cessation programs for pregnant and postpartum women merits exploration. Lower relapse rates among spontaneous quitters indicate a need to foster an environment that encourages quitting at pregnancy.     

Incidence and Determinants of Cigarette Smoking Initiation in Young Adults

PurposeTo describe the incidence and identify predictors of smoking initiation in young adults.MethodsData were collected in self-report questionnaires in 22 cycles over 13 years in a prospective cohort investigation of 1,293 students recruited in 1999–2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Participants were 12.7 years of age on average at cohort inception and 24.0 years of age in cycle 22. Independent predictors of smoking initiation in young adulthood (post–high school) were identified in multivariable logistic regression analysis using generalized estimating equations.ResultsOf 1,293 participants, 75% initiated smoking by cycle 22. Of these, 44%, 43%, and 14% initiated before high school, during high school, and in the 6 years after high school, respectively. The incidence density rate of initiation was .33, .13, .14, .11, and .12 initiation events per person-year in grade 7, 8, 9, 10, and 11, respectively, and .05 post–high school. Independent predictors of smoking initiation in young adults included alcohol use, higher impulsivity, and poor academic performance.ConclusionsA total of 14% of smokers who initiated smoking before age 24 years did so after high school. The predictors of initiation in young adults may provide direction for relevant preventive interventions.     

基质金属蛋白酶-9及其组织抑制因子在戒烟大鼠肺组织中的表达

目的　研究基质金属蛋白酶 -9(MMP -9)及其组织抑制因子 -1(TIMP -1)在戒烟大鼠肺组织中的表达及可能作用机制。方法　建立吸烟肺气肿大鼠模型 ,5 0只雄性Wistar大鼠 ,随机分为 4月、6月对照组和吸烟 4月、6月组、戒烟组 (每组 10只 ) ,用原位杂交和免疫组化等方法观察肺组织基质金属蛋白酶 -9(MMP -9)、金属蛋白酶组织抑制因子 -1(TIMP -1)的mRNA及蛋白的表达 ,用免疫组化法观察IV型胶原在肺内的表达。结果　与相应的对照组相比 ,吸烟 4、6月组MMP -9、TIMP -1在肺组织表达均显著上升 ( P <0 0 1) ;与吸烟 4月组相比 ,戒烟组肺组织MMP -9mRNA及蛋白的表达均明显减少 ( P <0 0 5 ) ,而TIMP -1表达明显上升 (P <0 0 5 ) ,IV型胶原表达增加 (P <0 0 5 ) ;与吸烟 4月组相比 ,戒烟组血气分析改善。结论　戒烟能阻止阻塞性肺气肿进一步发展 ,可能通过抑制MMP -9和增强TIMP -1表达发挥作用