Suicide Prevention Referrals in a Mobile Health Smoking Cessation Intervention

Automated mobile health (mHealth) programs deliver effective smoking cessation interventions through text message platforms. Smoking is an independent risk factor for suicide, so the Department of Veterans Affairs incorporated information about the Veterans Crisis Line into its SmokefreeVET smoking cessation text messaging program. Almost 7% of all SmokefreeVET enrollees have accessed this information. Because of the reach and automated nature of this and similar programs, we recommend including a referral to a suicide prevention hotline for all smoking cessation mHealth interventions.Mobile health (mHealth) interventions have altered the health care landscape with new opportunities available to both patients and health care providers. However, with the adoption of any technology, potential consequences also emerge. mHealth activities include a wide variety of health care tasks delivered via automated programs and live human interactions. We discuss a key clinical issue that is most relevant to automated interventions that are delivered without human involvement.Automated mHealth programs can enhance population-based approaches to health care through increased reach of interventions and patient engagement, with the added benefit of cost reduction. Examples of such programs include health promotion interventions delivered via mobile text messaging service and smartphone applications. Smoking and tobacco use cessation programs have been early adopters of mHealth, with established efficacy.1,2 Despite their considerable potential as platforms from which to deliver population-level health interventions, these interventions lack clearly defined guidelines and protocols with regard to patient safety.     

Prenatal Smoking Cessation Intervention and Gestational Weight Gain

BackgroundQuitting smoking is often associated with weight gain and prenatal cessation may lead to increased gestational weight gain (GWG). Although previous reports have suggested a link between prenatal smoking cessation and GWG, no studies have examined the relationship between cessation and guideline-recommended GWG, and there is little information about the relationship between the timing of prenatal cessation and GWG. Thus, we examine GWG among women in a community prenatal smoking cessation program and assess the relationship between the timing of prenatal cessation GWG.MethodsPregnant women from care clinics serving economically disadvantaged women who participated in a smoking cessation intervention offered free of charge, self-reported weight, and provided biochemical verification of smoking. Relationships between duration of cessation and GWG were evaluated in t-tests and regression models. GWG was calculated from self-reported weight before pregnancy and self-reported weight at the last visit before delivery.FindingsWomen who quit earlier during pregnancy had greater GWG (16.9 ± 7.5 kg) than did those who never quit (13.6 ± 8.9). After adjusting for timing of weight assessment and prepregnancy body mass index, however, GWG was not different between women who did and did not quit.ConclusionQuitting earlier in pregnancy is associated with greater GWG, but women who do and do not quit do not differ on total GWG. Despite increased GWG with early cessation, the maternal and fetal health benefits of prenatal smoking cessation outweigh risks of potential risks of excessive GWG.     

青少年戒烟信息通信技术干预实施方案可行性分析

目的设计整合个性化手机短信和网络互动交流通信技术的青少年个性化戒烟干预方案,论证其实施的可行性。方法在文献评阅、定性和定量研究的基础上,设计并制定基于信息通信技术的个性化戒烟干预实施方案,以自行阅读戒烟宣传手册为对照,在上海市6所中等职业技术学校募集176名吸烟学生,进行为期3个月的群干预对照试验,调查受试者对于该干预模式感兴趣程度、可接受性和自感有用性。结果 80%以上的干预对象对于本项目实施中的5个主要干预环节感到有兴趣,认为基于通信技术的戒烟干预方法的优点突出体现在方便实用(37.5%)、容易记住(33.3%)和内容更适合自己(26.7%)。与对照组采用的阅读戒烟文字材料比较,新型的干预方法在增强戒烟信心、掌握技巧、减少吸烟量和缓解压力方面尤显优势。结论基于信息通信技术的个性化、交互式戒烟干预模式在青少年吸烟人群中进行现场干预实施的可接受性和满意度较高,具有较强的可行性。     

Using an Intervention Mapping Approach to Develop a Program for Preventing High Blood Pressure in a Marginalized Afro-Colombian Population: A Community-Based Participatory Research

Journal of Prevention - The prevention of high blood pressure (HBP) is an important public health initiative worldwide, since HBP is the main risk factor for cardiovascular diseases and increases...     

The Impact of Quitting Smoking on Weight Among Women Prisoners Participating in a Smoking Cessation Intervention

Objectives. We examined the impact of smoking cessation on weight change in a population of women prisoners.Methods. Women prisoners (n = 360) enrolled in a smoking cessation intervention; 250 received a 10-week group intervention plus transdermal nicotine replacement.Results. Women who quit smoking had significant weight gain at 3- and 6-month follow-ups, with a net difference of 10 pounds between smokers and abstainers at 6 months. By the 12-month follow-up, weight gain decreased among abstainers.Conclusions. We are the first, to our knowledge, to demonstrate weight gain associated with smoking cessation among women prisoners. Smoking cessation interventions that address postcessation weight gain as a preventative measure may be beneficial in improving health and reducing the high prevalence of smoking in prisoner populations.Smoking and obesity are the 2 major causes of mortality and morbidity in the United States.^1,2 Although smoking is the leading preventable cause of death, resulting in approximately 440 000 deaths each year,³ obesity is a growing epidemic and is the second leading cause of preventable death, resulting in more than 300 000 deaths annually.^4,5 Whereas smoking rates have declined from their peak in the 1960s, obesity rates have been steadily climbing each year, and obesity is expected to soon eclipse smoking as the most preventable cause of mortality in the United States.¹The relationship between smoking and weight is complex, and the mechanisms by which smoking influences weight are not fully understood. Smoking affects weight by increasing metabolic rate and decreasing caloric absorption, which is thought to help suppress appetite.⁶ Sympathoadrenal activation by nicotine is thought to be primarily responsible for the metabolic effect of smoking.⁷ Smoking is also associated with increased energy expenditure.⁸ Smoking a single cigarette also decreases caloric consumption by 3% within 20 minutes.⁹Compared with light smokers and nonsmokers, heavy smokers tend to have greater body weight, which likely reflects a clustering of risk behaviors (i.e., little physical activity and poor diet) and increased insulin resistance and accumulation of abdominal fat.^6,10,11 Overall, smokers tend to be less physically active than nonsmokers, which may confound explanations of weight differences between smokers and nonsmokers.¹²Most studies on weight and smoking have reported postcessation weight gain. Smoking cessation has been associated with approximately 10 pounds of weight gain after 1 year of abstinence,¹³ suggesting that health benefits from smoking cessation may be mitigated to some degree by increased health risks associated with weight gain.¹⁴ To prevent or reduce weight gain, those administering cessation programs are recommended to integrate follow-up support for weight control, provide regular body weight measurement, provide recommendations for dietary change, and encourage increased physical activity.¹⁴ Despite concerns about weight, few studies have systematically investigated weight gain following smoking cessation, particularly with underserved populations such as prisoners.Correctional populations especially are vulnerable to the negative health consequences of smoking. Smoking rates are 3 to 4 times higher among correctional populations than among the general population, and smoking is normative within the correctional environment.^15–17 Smoking prevalence is 70% to 80% among male and female prisoners,^15–20 while almost half (46%) of adolescents in juvenile justice are daily smokers.²¹ This compared to about 21% of adults in the general population who are current smokers.²² However, in the research literature, the emphasis on smoking prevalence, prevention, cessation, and policies is much greater among other populations than it is among criminal justice populations—despite the human, health, and economic costs that occur in prison and in the community.^20,23In addition to the larger prevalence of smoking in prisons, there is less access to interventions for smoking cessation in correctional facilities. Lack of resources amplifies the negative health risks associated with smoking, such as heart, circulatory, and respiratory problems. Over the past 2 decades, correctional facilities in the United States have implemented tobacco-control policies ranging from restrictions on indoor smoking to complete tobacco bans.²⁴ Tobacco restrictions and bans have not succeeded in suppressing smoking, and reduced access to programs and materials that might increase long-term smoking cessation have paralleled them.^16,17,24,25We recently conducted a randomized controlled trial of smoking cessation with women prisoners and found 7-day point prevalence cessation rates comparable to those seen in community smoking cessation interventions.¹⁵ The intervention combined nicotine replacement with a 10-week group therapy intervention.²⁶ The community-tested intervention was modified for the prison environment and included a discussion of weight gain and weekly monitoring of weight during the intervention and follow-up assessments.¹⁵ Point prevalence quit rates for intervention participants were 18% at end of treatment, 17% at 3-month follow-up, 14% at 6-month follow-up, and 12% at 12-month follow-up, compared with less than 1% at these same time points for control participants.¹⁵ We examined differences in weight change over time for (1) women in the intervention condition compared with women in the control condition and (2) women in the intervention condition who quit smoking compared with those who continued to smoke. To our knowledge, ours is the first study to conduct such a trial among women prisoners.     

Development of a Culturally Targeted Smoking Cessation Intervention for African American Smokers

In this paper we describe the development a culturally targeted (CT) smoking cessation intervention for low-to-middle income African–American smokers. Based on theoretically based guidelines, modifications were made to a standard treatment manual for group-based smoking cessation counseling that incorporates cognitive-behavioral, motivational, and twelve step skills. Approximately 41% of the standard treatment materials were modified, and four new modules were developed. A pilot study was conducted to compare acceptability, feasibility and early outcome indicates in African American smokers randomized to the CT intervention compared with existing data from African American smokers treated using a non-targeted standard approach (ST). Outcomes from the CT pilot study were promising: results showed high levels of feasibility, acceptability and better adherence to nicotine replacement therapy, higher quit rates, and better retention and follow-up compared with the ST. Findings suggest that a culturally targeted and intensive group based smoking cessation treatment is plausibly effective in improving smoking cessation outcomes in African American smokers, warranting a larger randomized trial.     

Cost-Effectiveness Analysis of Smoking Cessation Interventions in Japan Using a Discrete-Event Simulation

Background

Smoking cessation medications have been shown to yield higher success rates and sustained abstinence than unassisted quit attempts. In Japan, the treatments available include nicotine replacement therapy (NRT) and varenicline; however, unassisted attempts to quit smoking remain common.

Objective

The objective of this study was to compare the health and economic consequences in Japan of using pharmacotherapy to support smoking cessation with unassisted attempts and the current mix of strategies used.

Methods

A discrete-event simulation that models lifetime quitting behaviour and includes multiple quit attempts (MQAs) and relapses was adapted for these analyses. The risk of developing smoking-related diseases is estimated based on the duration of abstinence. Data collected from a survey conducted in Japan were used to determine the interventions selected by smokers initiating a quit attempt and the time between MQAs. Direct and indirect costs are assessed (expressed in 2014 Japanese Yen).

Results

Using pharmacotherapy (NRT or varenicline) to support quit attempts proved to be dominant when compared with unassisted attempts or the current mix of strategies (most are unassisted). The results of stratified analyses by age imply that smoking cessation improves health outcomes across all generations. Indirect costs due to premature death leading to lost wages are an important component of the total costs, exceeding the direct medical cost estimates.

Conclusions

Increased utilisation of smoking cessation pharmacotherapy to support quit attempts is predicted to lead to an increase in the number of smokers achieving abstinence, and provide improvements in health outcomes over a lifetime with no additional costs.

     

Using Community-Based Participatory Research to Characterize Health and Lifestyle Behaviors of Montagnards,a Refugee-Origin Asian-American Subgroup

Montagnards, an indigenous multitribal refugee-origin population concentrated in North Carolina, remain an invisible, medically underserved, and socioeconomically underrepresented Asian American sub-group. Yet this group is resilient, with language diversity, rich cultural traditions and family caregiving in multigenerational households. Using community-based participatory research methods, we developed and administered a two-part survey to 144 Montagnard adults, documenting socioeconomic characteristics, health indicators and lifestyle behaviors. Forty-one percent of participants had no formal education, 76% had little/no English proficiency and 28% described having a very hard time paying their bills. Seventy-seven percent were overweight per BMI category, 79% had elevated blood pressure and 100% scored high for significant depressive symptoms. Participants reported high levels of physical inactivity and daily dietary intake of MSG. However, Montagnards reported limited tobacco and alcohol use, a diet of fresh vegetables and rice, and regular church attendance. These represent protective lifestyle behaviors and targets for culturally responsive health interventions.

     

Factors Affecting Korean Registered Nurses' Intention to Implement Smoking Cessation Intervention

Objectives

Nurses have been identified as an instrumental partner in tobacco reduction. This study aimed to examine factors affecting Korean nurses'' intention to implement smoking cessation intervention in Busan, Korea.

Methods

The participants were a total of 215 Korean registered nurses. A self-administered questionnaire evaluated predisposing factors, motivational factors (attitude, social influence, and self-efficacy) and intention to implement smoking cessation intervention. Data were analyzed by t tests, Pearson''s correlation, and hierarchical multiple regression.

Results

The mean age of the participants was 28.12 ± 5.72 years. The majority of the participants were staff nurses (85.6%), and 64.2% of the sample had < 5 years of work experience. Significant predictors of intention to implement smoking cessation intervention included perceived barrier of smoking cessation intervention (β = −0.128, p = 0.023), willingness to receive smoking cessation training (β = 0.123, p = 0.034), more positive attitude (β = 0.203, p = 0.002), higher social influence (β = 0.292, p < 0.001), and higher self-efficacy toward smoking cessation intervention (β = 0.151, p = 0.021), which explained 45% of the total variance of intention to implement smoking cessation intervention.

Conclusion

Attitude, social influence, and self-efficacy towards smoking cessation intervention had a significant positive influence in determining the intention to implement smoking cessation intervention. These findings can be used to develop evidence-based smoking cessation training programs for nurses in Korea. The programs should aim for positive attitude, higher social influence, and higher self-efficacy in hospital settings.     

The Effectiveness of a Directly Mailed Smoking Cessation Intervention to Australian Discharged Hospital Patients

Background. The objective was to assess the effectiveness of a directly mailed smoking cessation intervention to discharged hospital patients.Methods. A randomized controlled trial was used. In the 2 weeks after discharge, smokers in the intervention group were sent by mail a personally addressed letter from their medical consultant urging them to quit plus a self-help quitting manual, and smokers in the control group received usual care. Patients were surveyed about their smoking status at 6 and 12 months after discharge. A total of 1858 discharged patients responded to both questionnaires. The main outcome measures were self-reported smoking in past week at 6 and 12 months after discharge. Quitters at 12 months were biochemically tested for evidence of smoking.Results. The results failed to show that smoking cessation advice directly mailed to a broad cross-section of discharged hospital patients who smoke led to smoking cessation. However, the intervention increased cessation among smokers with medical conditions for which quitting is highly relevant. In general, patients who were more likely to quit were older, had entered the hospital as an emergency case, and had a medical diagnosis for which quitting is highly relevant.Conclusions. This study suggests that hospital patients who smoke and are also diagnosed with conditions which call for quitting are more likely to quit if they receive from their consultant a personalized letter advising them to quit and a self-help manual.     

Using Community-Based Participatory Mixed Methods Research to Understand Preconception Health in African American Communities of Arizona

The article discusses Arizona’s strategic implementation and evaluation of the first time motherhood initiative grant (FTMI) to understand preconception health among African American men and women in Arizona. Longitudinal focus groups assessed whether African American men and women in the targeted areas comprehended and recalled the messages related to preconception health. Matched pre and posttests assessed community members’ knowledge of preconception as well as physicians’ perceptions on preconception health and care. Focus-group data were transcribed and coded by independent coders to conduct content analyses. Inter-rater reliability and agreement among coders, bivariate and multivariate statistics were conducted for quantitative matched pre and posttests data using SAS v9.2 (SAS Institute, Cary, NC). The social marketing campaign had limited impact in recall and comprehension of the preconception health message among African American men and women. Data from focus groups revealed that African American men and women perceived preconception health to be vital. And results from the pretest and posttests of community-based presentations, further supported this finding. Evidence from Grand Round presentations indicated that practitioners and health care providers had diverging views on preconception health. Use of community-based participatory mixed methods research can facilitate better understanding of the efficacy of strategic interventions such as FTMI and can provide valuable information on preconception health. Cost limitations often prohibit extensive evaluation of social marketing campaigns, hence, evaluators and researchers should assess the feasibility of conducting an efficacy study versus an effectiveness study in evaluating social marketing campaigns.     

Development of Young Adults Eating and Active for Health (YEAH) Internet-Based Intervention via a Community-Based Participatory Research Model

ObjectiveTo develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model.DesignInvestigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19–24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery.ResultsQualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed.Conclusions and ImplicationsApplying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction.     

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.     

Gender Differences in Smoking Cessation

Men and women have traditionally consumed cigarettes very differently, demonstrating widely varying patterns of prevalence during the past eight decades. For example, though the prevalance of smoking among men increased dramatically soon after the turn of the century, an analogous though less dramatic increase among women was not observed for another 25-30 years. Similarly, when a dramatic decrease in smoking prevalence among men was observed following the 1964 Surgeon General's Report, a comparable decrease among women was not seen until 15 years later. Such differences in smoking patterns have led to the widespread belief that giving up smoking is more difficult for women than it is for men. This paper reviews various studies which address this issue and suggests areas in which further research is needed.     

Ancillary Care in Community-Based Public Health Intervention Research

Community-based public health intervention research in developing countries typically takes place not in clinics but in people''s homes and other living spaces. Research subjects and their communities may lack adequate nutrition, clean water, sanitation, and basic preventive and therapeutic services.Researchers often encounter unmet health needs in their interactions with individual subjects and need ethical guidelines to help them decide how to respond.To what extent do researchers have an ethical obligation to provide ancillary care—health care beyond what is necessary to ensure scientific validity and subjects'' safety? We discuss a case example from Nepal and propose a simple 2-step sequence of questions to aid decision making.PEOPLE LIVING IN LOW-REsource settings around the world suffer disproportionately from preventable or treatable conditions, including respiratory infections, diarrheal diseases, malnutrition, neonatal infections, and complications of pregnancy and childbirth. To alleviate the global burden of disease, it is crucial to develop and evaluate new approaches to the delivery of health interventions in low-resource settings. To this end, community-based public health intervention (CBPHI) research is designed to assess the effectiveness of health interventions delivered in the absence of advanced clinical facilities. For example, a group of simple preventive and curative newborn care interventions, delivered to women in their homes by community health workers, reduced neonatal mortality by 34%, as compared with services normally available in rural Bangladesh.¹In CBPHI research, by contrast with similar efforts based in facilities such as clinics, semiskilled local community health workers and data collectors typically carry out research activities in people''s homes and other functional living spaces. (CBPHI research may be, but is not necessarily, community-based participatory research, in which community members collaborate actively in all phases of research, from the choice of objectives to the communication of results.²) Host communities may lack adequate nutrition, clean water, sanitation, and basic preventive and therapeutic health services. CBPHI research workers therefore often encounter unmet health needs in their interactions with subjects. For instance, pregnant women invited to enroll in studies of interventions directed at neonatal health outcomes may lack access to basic antenatal care such as micronutrient supplementation.To what extent, and for what reasons, do CBPHI researchers have an ethical duty to respond to such unmet needs on the part of subjects in their studies?³ This is a question of obligations to provide ancillary care. Ancillary care is health care that research subjects need but that is not necessary to secure scientific validity in meeting research objectives or to prevent or redress research-related harms.^4,5 Ethical analysis of obligations to provide ancillary care has focused mainly on clinic-based trials.^4–8 Here we extend this ethical analysis to CBPHI research. After briefly reviewing key elements of the current ancillary care discussion, we outline 3 attributes that frequently occur together in CBPHI research and illustrate these attributes with a case example from Nepal. We propose a simple 2-step sequence of questions to aid decision making about the provision of ancillary care, and we illustrate the practical implementation of this sequence through analysis of the case example.     

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。