The International Journal of Tuberculosis and Lung Disease the Official Journal of the International Union Against Tuberculosis and Lung Disease, 2010
Three district health boards (DHBs), organisations that govern public hospitals and services in A... more Three district health boards (DHBs), organisations that govern public hospitals and services in Auckland, New Zealand. To evaluate a commercial web-based smoking cessation programme (Smokestop). Smokestop was offered free of charge to 126 staff members of three Auckland DHBs who wanted to stop smoking. Following a 30 minute face-to-face enrolment meeting, participants were able to log on and use the programme. Nicotine replacement therapy (NRT) was available at no cost. All participants who used the programme at least once were followed up at 1, 3 and 6 months after first logging on for assessment of smoking status by self-report verified by carbon monoxide (CO) in expired breath. Of 104 participants who logged onto the programme, 12 (12%) achieved 6-month continuous CO-validated abstinence. Participant feedback was largely positive: 46% agreed that the programme had assisted them and 74% stated they would recommend it to other smokers. The concomitant use of NRT was seen as an important component. The results suggest that this internet-based smoking cessation programme is an acceptable method to deliver behavioural support to people who want help in stopping smoking, and that it shows promise as a smoking cessation intervention.
Studies that have examined gender differences in smoking cessation have produced mixed results. T... more Studies that have examined gender differences in smoking cessation have produced mixed results. The purpose of the study was to examine whether there are gender differences in long-term smoking abstinence rates in smokers treated with nicotine patches at a smoking cessation clinic in Taiwan, where 39% of men and 5% of women smoke. This study included 1,065 smokers, comprising of 940 men and 125 women. Smokers were invited to attend the clinic every 1-2 weeks for a maximum of eight visits over 90 days, where they received prescriptions for nicotine patches, counseling, and educational materials. Participants were contacted by telephone at 1 and 3 years after the first visit and were asked whether they had smoked at all over the past 7 days. The results showed that women were significantly less likely than men to be abstinent at 1 year (adjusted odds ratio [aOR] = 0.64; 95% CI [confidence interval] = [0.41, 0.99]; p = .044) and 3 years (aOR = 0.44; 95% CI = [0.27, 0.74]; p = .02). Mor...
Health technology assessment (Winchester, England), 2015
NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would... more NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. The setting for the study was SSSs in England. For the secondary analysis, routine data fro...
Cancer prevention research (Philadelphia, Pa.), 2015
Concern has been raised about the presence of toxicants in electronic cigarette (EC) aerosol, par... more Concern has been raised about the presence of toxicants in electronic cigarette (EC) aerosol, particularly carbonyl compounds (e.g., acrolein) that can be produced by heating glycerol and glycols used in e-liquids. We investigated exposure to carbon monoxide (CO), nicotine (by measuring cotinine in urine), and to acrolein (by measuring its primary metabolite, S-(3-hydroxypropyl)mercapturic acid (3-HPMA) in urine) before and after 4 weeks of EC (green smoke, a "cig-a-like" EC, labeled 2.4% nicotine by volume) use, in 40 smokers. Thirty-three participants were using EC at 4 weeks after quitting, 16 (48%) were abstinent (CO-validated) from smoking during the previous week (EC only users), and 17 (52%) were "dual users." A significant reduction in CO was observed in EC-only users [-12 ppm, 95% confidence interval (CI), -16 to -7, 80% decrease) and dual users (-12 ppm, 95%CI, -19 to -6, 52% decrease). Cotinine levels also declined, but to a lesser extent (EC-only user...
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 4, 2015
Standard treatments (STs) for smoking cessation typically combine pharmacotherapy and behavioral ... more Standard treatments (STs) for smoking cessation typically combine pharmacotherapy and behavioral support but do not address the sensory and behavioral aspects of smoking which may play a role in maintaining smoking behavior. Replacing such sensations temporarily after cessation may enhance treatment efficacy. We hypothesized that denicotinized cigarettes (DNCs), which have a very low nicotine content but provide these sensory and behavioral stimuli, could help alleviate urges to smoke and tobacco withdrawal symptoms and in turn enhance the efficacy of ST. Two hundred smokers seeking treatment received nine weekly behavioral support sessions and pharmacotherapy (100 used varenicline, 100 used nicotine replacement therapy). They were randomized on the target quit day to receive 280 DNCs (used ad libitum over 2 weeks in addition to ST) or ST alone. Urge-to-smoke frequency (2.61 vs. 2.96, P = .03) but not strength (2.85 vs. 3.10, P = .20) in the first week of abstinence was significantl...
This paper provides a concise review of the efficacy, effectiveness and affordability of healthca... more This paper provides a concise review of the efficacy, effectiveness and affordability of healthcare interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support. Cochrane reviews of randomised controlled trials (RCTs) of major healthcare tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6-12 month continuous abstinence rates. This was combined with analysis and evidence from 'real world' studies to form a judgement on the likely effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on WHO criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of savin...
We reviewed available research on the use, content and safety of electronic cigarettes (EC), and ... more We reviewed available research on the use, content and safety of electronic cigarettes (EC), and on their effects on users, to assess their potential for harm or benefit and to extract evidence that can guide future policy. Studies were identified by systematic database searches and screening references to February 2014. EC aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower. Long-term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders. EC are increasingly popular among smokers, but to date there is no evidence of regular use by never-smokers or by non-smoking children. EC enable some users to reduce or quit smoking. Allowing EC to compete with cigarettes in the market-place might decrease smoking-related morbidity and mortality. Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on curren...
To test whether a personalised letter from general practitioners advising their patients who are ... more To test whether a personalised letter from general practitioners advising their patients who are smokers to quit, together with an exchange card for one month of nicotine gum, prompts them to make quit attempts, is acceptable and feasible. Non-randomised before-after ecological study involving general practices in Auckland, New Zealand. Personalised letters with exchange cards for four weeks of nicotine gum were sent to 831 patients within a single Auckland health board area who were recorded as current smokers on their general practitioners files. The comparison group was the population in another Auckland health board area. We measured calls to Quitline and vouchers redeemed at pharmacies from both areas before and after the intervention. Follow-up surveys of recipients and general practitioners assessed acceptability. Quitline calls from baseline to the end of the intervention from the intervention district compared with a comparison district were not significantly higher (5%, 95...
To summarise the key recommendations made in the 2007 New Zealand Smoking Cessation Guidelines. A... more To summarise the key recommendations made in the 2007 New Zealand Smoking Cessation Guidelines. A comprehensive literature review of smoking cessation interventions was undertaken in November 2006. Recommendations were formulated from the findings of the literature review in line with the methods recommended by the New Zealand Guidelines Group. The Guidelines have been structured around a new memory aid (ABC) which incorporates and replaces the 5A's (ask, advise, assess, assist, arrange). ABC prompts healthcare professionals to ask about smoking status; give brief advice to stop smoking to all smokers; and provide evidence-based Cessation support for those who wish to stop smoking. Healthcare professionals should briefly advise all people who smoke to stop smoking, regardless of whether they say they are ready to stop smoking or not. They should then offer smoking cessation support which includes both behavioural (e.g. telephone and face-to-face support) and pharmacological (e.g...
To outline competencies to guide smoking cessation delivery by health workers in New Zealand. The... more To outline competencies to guide smoking cessation delivery by health workers in New Zealand. The cessation competencies were developed from a literature review of competencies measurable and relevant to New Zealand, the evidence for effectiveness of different interventions from the 2007 New Zealand Smoking Cessation Guidelines, and consultation with an expert group and smoking cessation providers throughout New Zealand. The literature review identified only a handful of relevant documents on smoking cessation workforce competencies. Thirty-nine skill and knowledge-based competencies, based on three standards from the 2007 New Zealand Smoking Cessation Guidelines were identified. Each competency has been assigned a level (core, generalist, and specialist) depending on the provider's role. The New Zealand smoking cessation competencies provide a basis for guiding expectations of the measurable knowledge and skills all workers providing smoking cessation should attain. Their utili...
The International Journal of Tuberculosis and Lung Disease the Official Journal of the International Union Against Tuberculosis and Lung Disease, 2010
Three district health boards (DHBs), organisations that govern public hospitals and services in A... more Three district health boards (DHBs), organisations that govern public hospitals and services in Auckland, New Zealand. To evaluate a commercial web-based smoking cessation programme (Smokestop). Smokestop was offered free of charge to 126 staff members of three Auckland DHBs who wanted to stop smoking. Following a 30 minute face-to-face enrolment meeting, participants were able to log on and use the programme. Nicotine replacement therapy (NRT) was available at no cost. All participants who used the programme at least once were followed up at 1, 3 and 6 months after first logging on for assessment of smoking status by self-report verified by carbon monoxide (CO) in expired breath. Of 104 participants who logged onto the programme, 12 (12%) achieved 6-month continuous CO-validated abstinence. Participant feedback was largely positive: 46% agreed that the programme had assisted them and 74% stated they would recommend it to other smokers. The concomitant use of NRT was seen as an important component. The results suggest that this internet-based smoking cessation programme is an acceptable method to deliver behavioural support to people who want help in stopping smoking, and that it shows promise as a smoking cessation intervention.
Studies that have examined gender differences in smoking cessation have produced mixed results. T... more Studies that have examined gender differences in smoking cessation have produced mixed results. The purpose of the study was to examine whether there are gender differences in long-term smoking abstinence rates in smokers treated with nicotine patches at a smoking cessation clinic in Taiwan, where 39% of men and 5% of women smoke. This study included 1,065 smokers, comprising of 940 men and 125 women. Smokers were invited to attend the clinic every 1-2 weeks for a maximum of eight visits over 90 days, where they received prescriptions for nicotine patches, counseling, and educational materials. Participants were contacted by telephone at 1 and 3 years after the first visit and were asked whether they had smoked at all over the past 7 days. The results showed that women were significantly less likely than men to be abstinent at 1 year (adjusted odds ratio [aOR] = 0.64; 95% CI [confidence interval] = [0.41, 0.99]; p = .044) and 3 years (aOR = 0.44; 95% CI = [0.27, 0.74]; p = .02). Mor...
Health technology assessment (Winchester, England), 2015
NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would... more NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. The setting for the study was SSSs in England. For the secondary analysis, routine data fro...
Cancer prevention research (Philadelphia, Pa.), 2015
Concern has been raised about the presence of toxicants in electronic cigarette (EC) aerosol, par... more Concern has been raised about the presence of toxicants in electronic cigarette (EC) aerosol, particularly carbonyl compounds (e.g., acrolein) that can be produced by heating glycerol and glycols used in e-liquids. We investigated exposure to carbon monoxide (CO), nicotine (by measuring cotinine in urine), and to acrolein (by measuring its primary metabolite, S-(3-hydroxypropyl)mercapturic acid (3-HPMA) in urine) before and after 4 weeks of EC (green smoke, a "cig-a-like" EC, labeled 2.4% nicotine by volume) use, in 40 smokers. Thirty-three participants were using EC at 4 weeks after quitting, 16 (48%) were abstinent (CO-validated) from smoking during the previous week (EC only users), and 17 (52%) were "dual users." A significant reduction in CO was observed in EC-only users [-12 ppm, 95% confidence interval (CI), -16 to -7, 80% decrease) and dual users (-12 ppm, 95%CI, -19 to -6, 52% decrease). Cotinine levels also declined, but to a lesser extent (EC-only user...
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 4, 2015
Standard treatments (STs) for smoking cessation typically combine pharmacotherapy and behavioral ... more Standard treatments (STs) for smoking cessation typically combine pharmacotherapy and behavioral support but do not address the sensory and behavioral aspects of smoking which may play a role in maintaining smoking behavior. Replacing such sensations temporarily after cessation may enhance treatment efficacy. We hypothesized that denicotinized cigarettes (DNCs), which have a very low nicotine content but provide these sensory and behavioral stimuli, could help alleviate urges to smoke and tobacco withdrawal symptoms and in turn enhance the efficacy of ST. Two hundred smokers seeking treatment received nine weekly behavioral support sessions and pharmacotherapy (100 used varenicline, 100 used nicotine replacement therapy). They were randomized on the target quit day to receive 280 DNCs (used ad libitum over 2 weeks in addition to ST) or ST alone. Urge-to-smoke frequency (2.61 vs. 2.96, P = .03) but not strength (2.85 vs. 3.10, P = .20) in the first week of abstinence was significantl...
This paper provides a concise review of the efficacy, effectiveness and affordability of healthca... more This paper provides a concise review of the efficacy, effectiveness and affordability of healthcare interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support. Cochrane reviews of randomised controlled trials (RCTs) of major healthcare tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6-12 month continuous abstinence rates. This was combined with analysis and evidence from 'real world' studies to form a judgement on the likely effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on WHO criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of savin...
We reviewed available research on the use, content and safety of electronic cigarettes (EC), and ... more We reviewed available research on the use, content and safety of electronic cigarettes (EC), and on their effects on users, to assess their potential for harm or benefit and to extract evidence that can guide future policy. Studies were identified by systematic database searches and screening references to February 2014. EC aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower. Long-term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders. EC are increasingly popular among smokers, but to date there is no evidence of regular use by never-smokers or by non-smoking children. EC enable some users to reduce or quit smoking. Allowing EC to compete with cigarettes in the market-place might decrease smoking-related morbidity and mortality. Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on curren...
To test whether a personalised letter from general practitioners advising their patients who are ... more To test whether a personalised letter from general practitioners advising their patients who are smokers to quit, together with an exchange card for one month of nicotine gum, prompts them to make quit attempts, is acceptable and feasible. Non-randomised before-after ecological study involving general practices in Auckland, New Zealand. Personalised letters with exchange cards for four weeks of nicotine gum were sent to 831 patients within a single Auckland health board area who were recorded as current smokers on their general practitioners files. The comparison group was the population in another Auckland health board area. We measured calls to Quitline and vouchers redeemed at pharmacies from both areas before and after the intervention. Follow-up surveys of recipients and general practitioners assessed acceptability. Quitline calls from baseline to the end of the intervention from the intervention district compared with a comparison district were not significantly higher (5%, 95...
To summarise the key recommendations made in the 2007 New Zealand Smoking Cessation Guidelines. A... more To summarise the key recommendations made in the 2007 New Zealand Smoking Cessation Guidelines. A comprehensive literature review of smoking cessation interventions was undertaken in November 2006. Recommendations were formulated from the findings of the literature review in line with the methods recommended by the New Zealand Guidelines Group. The Guidelines have been structured around a new memory aid (ABC) which incorporates and replaces the 5A's (ask, advise, assess, assist, arrange). ABC prompts healthcare professionals to ask about smoking status; give brief advice to stop smoking to all smokers; and provide evidence-based Cessation support for those who wish to stop smoking. Healthcare professionals should briefly advise all people who smoke to stop smoking, regardless of whether they say they are ready to stop smoking or not. They should then offer smoking cessation support which includes both behavioural (e.g. telephone and face-to-face support) and pharmacological (e.g...
To outline competencies to guide smoking cessation delivery by health workers in New Zealand. The... more To outline competencies to guide smoking cessation delivery by health workers in New Zealand. The cessation competencies were developed from a literature review of competencies measurable and relevant to New Zealand, the evidence for effectiveness of different interventions from the 2007 New Zealand Smoking Cessation Guidelines, and consultation with an expert group and smoking cessation providers throughout New Zealand. The literature review identified only a handful of relevant documents on smoking cessation workforce competencies. Thirty-nine skill and knowledge-based competencies, based on three standards from the 2007 New Zealand Smoking Cessation Guidelines were identified. Each competency has been assigned a level (core, generalist, and specialist) depending on the provider's role. The New Zealand smoking cessation competencies provide a basis for guiding expectations of the measurable knowledge and skills all workers providing smoking cessation should attain. Their utili...
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