Predicting smoking cessation, reduction and relapse six months after using the Stop-Tabac app for smartphones: a machine learning analysis.

BACKGROUND: An analysis of predictors of smoking behaviour among users of smoking cessation apps can provide useful information beyond what is already known about predictors in other contexts. Therefore, the aim of the present study was to identify the best predictors of smoking cessation, smoking reduction and relapse six months after starting to use the smartphone app Stop-Tabac. METHOD: Secondary analysis of 5293 daily smokers from Switzerland and France who participated in a randomised trial testing the effectiveness of this app in 2020, with follow-up at one and six months. Machine learning algorithms were used to analyse the data. The analyses for smoking cessation included only the 1407 participants who responded after six months; the analysis for smoking reduction included only the 673 smokers at 6-month follow-up; and the analysis for relapse at 6 months included only the 502 individuals who had quit smoking after one month. RESULTS: Smoking cessation after 6 months was predicted by the following factors (in this order): tobacco dependence, motivation to quit smoking, frequency of app use and its perceived usefulness, and nicotine medication use. Among those who were still smoking at follow-up, reduction in cigarettes/day was predicted by tobacco dependence, nicotine medication use, frequency of app use and its perceived usefulness, and e-cigarette use. Among those who had quit smoking after one month, relapse after six months was predicted by intention to quit, frequency of app use, perceived usefulness of the app, level of dependence and nicotine medication use. CONCLUSION: Using machine learning algorithms, we identified independent predictors of smoking cessation, smoking reduction and relapse. Studies on the predictors of smoking behavior among users of smoking cessation apps may provide useful insights for the future development of these apps and future experimental studies. CLINICAL TRIAL REGISTRATION: ISRCTN Registry: ISRCTN11318024, 17 May 2018. http://www.isrctn.com/ISRCTN11318024 .

Predicting the Users' Level of Engagement with a Smartphone Application for Smoking Cessation: Randomized Trial and Machine Learning Analysis.

INTRODUCTION: Studies of the users' engagement with smoking cessation application (apps) can help understand how these apps are used by smokers, in order to improve their reach and efficacy. OBJECTIVE: The present study aimed at identifying the best predictors of the users' level of engagement with a smartphone app for smoking cessation and at examining the relationships between predictors and outcomes related to the users' level of engagement with the app. METHODS: A secondary analysis of data from a randomized trial testing the efficacy of the Stop-Tabac smartphone app was used. The experimental group used the "full" app and the control group used a "dressed down" app. The study included a baseline and 1-month and 6-month follow-up questionnaires. A total of 5,293 participants answered at least the baseline questionnaires; however, in the current study, only the 1,861 participants who answered at least the baseline and the 1-month follow-up questionnaire were included. Predictors were measured at baseline and after 1 month and outcomes after 6 months. Data were analyzed using machine learning algorithms. RESULTS: The best predictors of the outcomes were, in decreasing order of importance, intention to stop smoking, dependence level, perceived helpfulness of the app, having quit smoking after 1 month, self-reported usage of the app after 1 month, belonging to the experimental group (vs. control group), age, and years of smoking. Most of these predictors were also significantly associated with the participants' level of engagement with the app. CONCLUSIONS: This information can be used to further target the app to specific groups of users, to develop strategies to enroll more smokers, and to better adapt the app's content to the users' needs.

Withdrawal Symptoms From E-Cigarette Abstinence Among Adult Never-Smokers: A Pilot Experimental Study.

INTRODUCTION: Use of e-cigarettes among never-smokers has substantially increased; yet there are few descriptions of the consequences of such use. We assessed whether adult never-smokers can have withdrawal from cessation of e-cigarettes. METHODS: In an un-blinded pre-post clinical trial, 30 never-smoker daily e-cigarette users used their own nicotine-containing e-cigarette for 7 days followed by 6 days of biologically confirmed abstinence. Participants monitored symptoms of nicotine withdrawal nightly via an Interactive Voice Response system. They attended three lab visits/week to provide expired carbon monoxide and urine samples to determine compliance. FINDINGS: Abstinence increased all the DSM5 symptoms of tobacco withdrawal and this occurred in the majority of participants. The increase in severity of withdrawal was small and rarely impaired functioning. CONCLUSIONS: Our finding suggests that withdrawal symptoms can occur in never-smokers who stop e-cigarettes abruptly. However, the severity of withdrawal appears to be small and may not be of clinical or regulatory significance. Although our sample size was small and thus replication tests of our results are indicated, it may be prudent to warn never-smokers that withdrawal symptoms may occur. IMPLICATIONS: This study indicates that withdrawal symptoms can occur in never-smokers who are daily e-cigarette users. However, the severity of withdrawal from e-cigarette abstinence in never-smokers appears to be small and may not be of clinical or regulatory significance. Given our small sample size, replication of our results is warranted. Nevertheless, it might be prudent to warn never-smokers of addiction to e-cigarettes.Clinical Trial Registration = NCT02825459.

Withdrawal Symptoms From E-Cigarette Abstinence Among Former Smokers: A Pre-Post Clinical Trial.

INTRODUCTION: The major aim of this study was to test whether abstinence from e-cigarettes causes withdrawal symptoms in former smokers. METHODS: We conducted an unblinded, within-participants, pre-post clinical trial in which 109 former smokers who were current daily electronic cigarette (e-cigarette) users used their own e-cigarette for 7 days followed by 6 days of biologically confirmed abstinence engendered via an escalating contingency payment system. Participants monitored symptoms of nicotine withdrawal daily via an Interactive Voice Response system. They also attended three laboratory visits per week for carbon monoxide and cotinine testing to verify abstinence. RESULTS: Half of participants completely abstained for a week. All the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) tobacco withdrawal symptoms, craving for e-cigarettes, craving for tobacco cigarettes, and the four possible new withdrawal symptoms (anhedonia, impulsivity, mood swings, and positive affect) increased during abstinence. Weight increased and heart rate decreased with abstinence. Symptoms showed the prototypical inverted U time pattern of a withdrawal state. The magnitude of withdrawal appeared to be somewhat less than that in a prior study of abstinent daily tobacco cigarette smokers. More severe withdrawal on the first 2 days of abstinence did not predict abstinence on the last day of the study. CONCLUSIONS: Former smokers who are daily e-cigarette users transfer physical dependence on tobacco cigarettes to dependence on e-cigarettes. The severity of withdrawal from e-cigarettes appears to be only somewhat less than that from daily tobacco cigarette use. Replication tests that include placebo controls, testing for pharmacological specificity, and including never-smokers, non-daily e-cigarette users and dual users are indicated. IMPLICATIONS: Our results indicate e-cigarettes can maintain physical dependence. This adverse effect should be included in any risk vs. benefit calculation. Also, potential and current e-cigarette users should be informed that abrupt cessation of e-cigarettes can cause withdrawal symptoms. TRIAL REGISTRATION: NCT02825459.

An online survey of users of tobacco vaporizers, reasons and modes of utilization, perceived advantages and perceived risks.

BACKGROUND: Tobacco vaporizers heat tobacco without burning it, to produce an inhalable aerosol. Various models have recently appeared on the market, mostly manufactured by the tobacco industry, but few of the studies published on tobacco vaporizers are independent from the manufacturers. The goals of this study were to explore who uses tobacco vaporizers, how these products are used, reasons for utilization, perceived advantages and risks. METHODS: Online questionnaire collected from October 2016 to January 2018 in self-selected visitors aged > 18 to an anti-addiction website. RESULTS: We obtained 170 valid responses, of whom 104 were using tobacco vaporizers. For homogeneity, we included only the 102 users of the Brand 1 tobacco vaporizer in our analysis, as there were only two users of other vaporizers. Among these 102 vaporizer users, about half were current cigarette smokers (57%), the rest were former cigarette smokers. The median age was 41, and the median duration of utilization was 9 months. Most (88%) used the vaporizer daily, 8% were occasional users and 4% were past users. Among current smokers, 80% were currently trying to reduce their cigarette consumption and 29% were trying to quit. The vaporizer was used mainly to replace cigarettes (94%), because it was perceived to be less toxic than cigarettes (89%), to help stop smoking or to avoid starting smoking again (72%), or to reduce cigarette consumption (71%). Current smokers who were daily or occasional vaporizer users reported smoking a median of 8.0 cigarettes per day, compared with 20.0 per day before they started to use the vaporizer (p < .0001, Wilcoxon signed-rank test). CONCLUSIONS: In this online sample of early adopters, Brand 1 was by far the most frequently used tobacco vaporizer. It was used by current or former smokers only, mainly to replace cigarettes, and satisfaction ratings were good. Users considered the tobacco vaporizer to be less toxic than cigarette smoke and perceived it to be helpful for reducing or stopping smoking.

[Addictions]. / Addictions.

New drugs available in a click, plethora of games, new regulations on cannabis, addiction medicine has a lot to do ! In 2018, Switzerland recognized a training certificate in addiction medicine, pathological gambling entered into ICD-11 and vaping, first considered with suspicion, found a place in the pharmacopoeia of the fight against tobacco. That's not all, on the alcohol front, we realized that even a small glass can hurt and the medicine of addictions evolved towards models of recovery that aim to improve quality of life with chronic diseases. Finally, the American opioid prescription epidemic is worrying in Switzerland, even if the situation and the context are very different.

Nouvelles drogues disponibles en un clic, pléthore de l'offre de jeux, nouvelles réglementations sur le cannabis, la médecine de l'addiction a bien à faire ! En 2018, nous voyons apparaître en Suisse une reconnaissance de la formation en médecine de l'addiction, les jeux font leur entrée dans la CIM-11 et le vapotage d'abord considéré avec méfiance trouve une place dans la pharmacopée de la lutte contre le tabac. Mais ce n'est pas tout, sur le front de l'alcool on s'aperçoit que même un petit verre peut faire mal et la médecine des addictions évolue vers des modèles de soins qui visent à mieux vivre avec la maladie plutôt que de s'en défaire. Finalement, l'épidémie américaine de prescription détournée d'opioïdes inquiète en Suisse, même si la situation et le contexte sont très différents.

Electronic Cigarette: A Longitudinal Study of Regular Vapers.

Introduction: It is unclear how vaping behavior changes over time in regular vapers, and what occurs when vapers relapse to smoking or when they stop vaping. We assessed change in vaping and smoking behaviors over 12 months in regular vapers. Methods: A longitudinal study of 3868 regular vapers enrolled on the Internet in 2012-2015 ("baseline"), followed after one (n = 1631, 42%), three (n = 1337, 35%), six (n = 1148, 30%), and 12 months (n = 893, 23%). Results: Participants had been vaping for a median of five months at baseline. Most (77%) were former smokers, who had not smoked for a median of three months at baseline. Over 12 months, enjoyment gradually became the most frequently cited reason to vape (93%), and vaping to deal with craving for tobacco gradually decreased (from 87% to 56%). In exclusive vapers (ex-smokers), nicotine concentration in e-liquids decreased over time (from 12 to 9 mg/mL), but puffs/day remained stable (200 puffs/day). After 12 months, 9% of 687 former smokers relapsed to smoking and 28% of 64 daily smokers (dual users) stopped smoking. After 12 months, when participants stopped vaping, they tended to relapse to smoking (+18% daily smokers among those who stopped vaping versus -2% in permanent vapers, p < .001). When ex-smokers relapsed to smoking, they tended to stop vaping. Conclusions: After 12 months, enjoyment and relapse prevention were the most important reasons to vape. Rates of relapse to smoking were low in former smokers and quit rates were high in current smokers. Stopping vaping was associated with relapsing to smoking. Implications: Even in established vapers, vaping behavior and reasons to vape change over time. This should be taken into account by clinicians, manufacturers and regulators. Results from this non-representative sample can help generate hypotheses that can later be tested in representative samples of vapers.

Development of a Self-Report Measure of Reward Sensitivity:A Test in Current and Former Smokers.

INTRODUCTION: Tobacco use or abstinence may increase or decrease reward sensitivity. Most existing measures of reward sensitivity were developed decades ago, and few have undergone extensive psychometric testing. METHODS: We developed a 58-item survey of the anticipated enjoyment from, wanting for, and frequency of common rewards (the Rewarding Events Inventory-REI). The current analysis focuses on ratings of anticipated enjoyment. The first validation study recruited current and former smokers from Internet sites. The second study recruited smokers who wished to quit and monetarily reinforced them to stay abstinent in a laboratory study and a comparison group of former smokers. In both studies, participants completed the inventory on two occasions, 3-7 days apart. They also completed four anhedonia scales and a behavioral test of reduced reward sensitivity. RESULTS: Half of the enjoyment ratings loaded on four factors: socializing, active hobbies, passive hobbies, and sex/drug use. Cronbach's alpha coefficients were all ≥0.73 for overall mean and factor scores. Test-retest correlations were all ≥0.83. Correlations of the overall and factor scores with frequency of rewards and anhedonia scales were 0.19-0.53, except for the sex/drugs factor. The scores did not correlate with behavioral tests of reward and did not differ between current and former smokers. Lower overall mean enjoyment score predicted a shorter time to relapse. DISCUSSION: Internal reliability and test-retest reliability of the enjoyment outcomes of the REI are excellent, and construct and predictive validity are modest but promising. The REI is comprehensive and up-to-date, yet is short enough to use on repeated occasions. Replication tests, especially predictive validity tests, are needed. IMPLICATIONS: Both use of and abstinence from nicotine appear to increase or decrease how rewarding nondrug rewards are; however, self-report scales to test this have limitations. Our inventory of enjoyment from 58 rewards appears to be reliable and valid as well as comprehensive and up-to-date, yet is short enough to use on repeated occasions. Replication tests, especially of the predictive validity of our scale, are needed.

A mixed methods feasibility study of nicotine-assisted smoking reduction programmes delivered by community pharmacists - The RedPharm study.

BACKGROUND: Pivotal trials have established that, among people who have no immediate intention to quit smoking, nicotine replacement therapy (NRT) helps people reduce and eventually stop smoking. The prime aim of this trial was to investigate the feasibility of implementing such a programme in community pharmacies. In addition, we investigated the effectiveness of providing behavioural support compared with self-help methods and of shorter compared with standard length reduction programmes. METHODS: Pharmacists were trained to deliver a smoking reduction programme and opportunistically invite people to participate in the programme. In a 2 × 2 factorial design, eligible volunteers were randomised to either receive in-person behavioural support or a self-help booklet. In both cases, participants were supported to set targets to reduce their smoking and use behavioural techniques to assist reduction. In addition, participants were randomised to cut down and stop over 4 weeks or over 16 weeks, but in either case continue NRT for up to nine months. We assessed uptake and adherence to the programme and smoking cessation four weeks and six months after a quit day and reduction in the three months following programme end and incorporated a qualitative processes assessment. RESULTS: Only 68 of the planned 160 smokers could be recruited. Pharmacists were deterred by the bureaucracy of trial enrolment and that many smokers did not return for further support. Pharmacists sometimes subverted the randomisation or provided support to participants in the self-help arm. Smokers stayed in the programme for an average of 6 weeks rather than the 9 months envisaged. Rates of follow-up declined to around 20% of participants by 12 months. There was insufficient evidence to assess whether support or speed of reduction enhanced cessation or reduction but cessation and reduction were less common overall than in the pivotal trials for licensing NRT for this indication. CONCLUSIONS: This programme of smoking reduction and the trial design to assess its effectiveness proved unpopular to potential participants and pharmacists. As a result, the trial produced no evidence on the effectiveness of behavioural support or speed or smoking reduction. A trial of this programme in this context is unfeasible. TRIAL REGISTRATION: ISRCTN 54805841 . Registered 18 March 2010.

E-cigarettes: methodological and ideological issues and research priorities.

Cigarette combustion, rather than either tobacco or nicotine, is the cause of a public health disaster. Fortunately, several new technologies that vaporize nicotine or tobacco, and may make cigarettes obsolete, have recently appeared. Research priorities include the effects of vaporizers on smoking cessation and initiation, their safety and toxicity, use by non-smokers, dual use of vaporizers and cigarettes, passive vaping, renormalization of smoking, and the development of messages that effectively communicate the continuum of risk for tobacco and nicotine products. A major difficulty is that we are chasing a moving target. New products constantly appear, and research results are often obsolete by the time they are published. Vaporizers do not need to be safe, only safer than cigarettes. However, harm reduction principles are often misunderstood or rejected. In the context of a fierce ideological debate, and major investments by the tobacco industry, it is crucial that independent researchers provide regulators and the public with evidence-based guidance. The methodological and ideological hurdles on this path are discussed in this commentary.

Electronic cigarettes and cannabis: an exploratory study.

AIMS: To describe cannabis 'vaping' with electronic cigarettes (e-cigarettes) or electronic vaporizers (e-vaporizers). METHODS: Internet survey in 2013-2014. Participants were 11 people who 'vaped' cannabis with e-cigarettes and 44 people who vaped cannabis with e-vaporizers, enrolled online. RESULTS: Most participants were men (78%). They had used e-cigarettes for 6 days and e-vaporizers for 50 days on average to vape cannabis. Current users of e-cigarettes vaped cannabis on 2 days/week versus 6 days/week for users of e-vaporizers. In these devices, they mostly inserted cannabis buds and oil rather than hashish or wax/butane honey oil. Dual users, who both smoked and vaped cannabis, currently smoked 5 joints/week compared to 14 joints/week before they started to vape cannabis (p = 0.004). Half the participants (45%) reported that vaping cannabis helped them stop or reduce their total cannabis use, 37% that it had no impact on their cannabis use, and 6% that it increased it. Vaping cannabis was perceived as healthier and more discrete than smoking it (less odor). Disadvantages included dry mouth and fewer positive cannabis effects. CONCLUSIONS: Cannabis vaping via e-cigarettes or e-vaporizers is an infrequent behavior that was previously almost undocumented. E-cigarettes do not appear to be a very appealing way to use cannabis.

[New tobacco vaporizers: how to react?]. / Nouveaux vaporisateurs de tabac: comment réagir?

Cigarette combustion, rather than either tobacco or nicotine, is the cause of a public health disaster. Fortunately, several new technologies that vaporize nicotine or tobacco may make cigarettes obsolete. Some of these new technologies are developed and owned by the tobacco industry, which invests massively for the research and development of these products. Because of its past scientific misconduct, the tobacco industry is ostracized. In the context of a fierce ideological debate on these new products, it is crucial that regulators and the public are provided with evidence-based guidance. Should the scientific production in this field be done with or without the tobacco industry? This thorny issue is discussed in this comment.

An 8-year longitudinal study of long-term, continuous users of electronic cigarettes.

BACKGROUND AND AIMS: E-cigarettes have been available for over 15 years, but relatively little is known about long-term users. Our aim was to describe change over time in behaviours, attitudes and dependence in long-term users. DESIGN AND PARTICIPANTS: A longitudinal study of 375 e-cigarette users enrolled on the Internet in 2012-2016 and surveyed again in 2021 (8 years later on average), who continuously used e-cigarettes in the interval. FINDINGS: Fewer people in 2021 (11 %) than at baseline (33 %) had smoked tobacco in the past 31 days. Participants switched from second-generation models at baseline (e.g. Ego) to box mods in 2021 (e.g. iStick), they used larger refill bottles, they used home-made e-liquids twice as often, they used tobacco flavours less often and the nicotine concentration in e-liquids decreased from 12 to 6 mg/mL. There was no change over time in the time to the first e-cigarette puff of the day, but an e-cigarette dependence score of 0-100 decreased from 75 to 60, the frequency and strength of urges to vape decreased (from 31 % to 18 % of "strong" urges) and the proportion of people who said they would be likely to succeed if they tried to stop vaping increased. Compared to baseline, fewer people in 2021 reported vaping to cope with cravings or other smoking cessation symptoms, and fewer people reported vaping to quit smoking, to avoid relapse into smoking, or to reduce their tobacco consumption (p < 0.001 for all differences). CONCLUSIONS: In long-term, continuous users, over a period of 8 years, substantial changes were observed in the models of e-cigarettes used, in the flavours and strength of e-liquids, and in the reasons for vaping. Their level of nicotine dependence tended to decrease over time. These users were satisfied with e-cigarettes and vaped mostly because they felt that vaping was less dangerous than smoking, and for enjoyment.

An internet survey of use, opinions and preferences for smoking cessation medications: nicotine, varenicline, and bupropion.

INTRODUCTION: We assessed use, compliance and preferences among smoking cessation medications in a "real world" sample of current and former smokers. METHODS: Internet survey on a smoking cessation website (French/English, 2008-2010) to assess use of nicotine replacement therapies (NRT), varenicline, and bupropion. RESULTS: There were 885 participants (39% current smokers, 61% former smokers), the majority of the sample (70%) was female. The most frequently used medications were, in order: patches (40%), varenicline (23%), nicotine gum (16%), nicotine lozenge/tablet (10%), bupropion (8%), and inhaler (3%). Satisfaction, perceived relief of craving/withdrawal and effectiveness were best for varenicline and lowest for gum. In current users, duration of use was longest for gum (121 days), lozenge/tablet (152 days) and shortest for patch (25 days). Daily use was good for lozenge (9 pieces/day) but less than recommended for gum (6 pieces/day) and inhaler (2 plugs/day). People who tried more than 1 medication found varenicline more effective and satisfactory than NRT or bupropion; and users preferred patch to gum. By smoking status, former smokers had more education, reported greater use of medications (daily, over time) and reported more satisfaction with medications than current smokers. CONCLUSIONS: An Internet survey showed smoking cessation medications differed significantly in perceived effectiveness, satisfaction, and smoking status (former vs. current smoking). Except for lozenge/tablet, insufficient daily use remained a problem with acute NRTs. For all medications, improving outcome may require better instruction for proper use, approval of new indications (precessation) or development of new medications that bypass compliance issues that undermine success.

Effects of large financial incentives on motivation to quit smoking and on cigarette dependence.

BACKGROUND: Financial incentives enhance long-term smoking cessation rates, but their effects on motivation to quit in those who fail to quit are not well documented. AIM: To test the effects of large financial incentives on motivation to quit smoking and on cigarette dependence in smokers who failed to quit despite receiving incentives. PARTICIPANTS: Low-income smokers in the general population in Geneva, Switzerland, in 2011-2013. METHODS: A randomised controlled trial with follow-up after three, six and 18 months. Participants were assigned to receive either booklets plus access to a smoking cessation website (control group, n = 404), or the same intervention plus financial incentives (intervention group, n = 401). Incremental financial rewards, to a maximum of CHF 1500 (USD 1650, GBP 1000), were offered for biochemically verified smoking abstinence. No in-person counselling, telephone counselling, or medications were provided. MEASUREMENTS: Intrinsic and extrinsic motivation to quit, intention to quit, cigarette dependence. FINDINGS: In smokers at 6-month follow-up, intrinsic motivation decreased in the control group (-0.24 SD units, p < 0.001), extrinsic motivation increased in the intervention group (+0.35 SD units, p = 0.001), and twice as many participants in the intervention group (35 %) than in the control group (17 %, p < 0.001) said they intended to quit smoking in the next 30 days. Quit attempts were more frequent and their duration was longer in the intervention group than in the control group. The intervention had no impact on cigarette dependence scores. CONCLUSIONS: Large financial incentives increased motivation to quit smoking in smokers who failed to quit smoking despite receiving incentives.

Corrigendum: Comparing Tobacco and Alcohol Policies From a Health Systems Perspective: The Cases of the Philippines and Singapore.

[This corrects the article DOI: 10.3389/ijph.2022.1605050.].

A critique of the Australian National Health and Medical Research Council CEO statement on electronic cigarettes.

This paper critically analyses a statement by Australia's National Health and Medical Research Council (NHMRC) on e-cigarettes in May 2022 that will be used to guide national policy. We reviewed the evidence and the conclusions drawn in the NHMRC Statement. In our view, the Statement is not a balanced reflection of the benefits and risks of vaping because it exaggerates the risks of vaping and fails to compare them to the far greater risks of smoking; it uncritically accepts evidence of harms from e-cigarettes while adopting a highly sceptical attitude towards evidence of their benefits; it incorrectly claims that the association between adolescent vaping and subsequent smoking is causal; and it understates the evidence of the benefits of e-cigarettes in assisting smokers to quit. The Statement dismisses the evidence that vaping is probably already having a positive net public health effect and misapplies the precautionary principle. Several sources of evidence supporting our assessment were published after the NHMRC Statement's publication and are also referenced. The NHMRC Statement on e-cigarettes does not present a balanced assessment of the available scientific literature and fails to meet the standard expected of a leading national scientific body.

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya.

Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs' response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.

An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia.

Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services.

Implementation and impact of anti-smoking interventions in three prisons in the absence of appropriate legislation.

OBJECTIVE: To assess the acceptability and impact of anti-smoking policies in three prisons in Switzerland. METHODS: A before-after intervention study in A) an open prison for sentenced prisoners, B) a closed prison for sentenced prisoners, and C) a prison for pretrial detainees. Prisoners and staff were surveyed before (2009, n=417) and after (2010-2011, n=228) the interventions. Medical staff were trained to address tobacco dependence systematically in prisoners. In prison A, a partial smoking ban was extended. No additional protection against second-hand smoke was feasible in prisons B and C. RESULTS: In prison A, more prisoners reported receiving medical help to quit smoking in 2011 (20%) than in 2009 (4%, p=0.012). In prison A, prisoners and staff reported less exposure to second-hand smoke in 2011 than in 2009: 31% of prisoners were exposed to smoke at workplaces in 2009 vs 8% in 2011 (p=0.001); in common rooms: 43% vs 8%, (p<0.001). No changes were observed in prisons B and C. CONCLUSIONS: Reinforcement of non-smoking rules was possible in only one of the three prisons but had an impact on exposure to tobacco smoke and medical help to quit. Implementing anti-smoking policies in prisons is difficult in the absence of appropriate legislation.