Which Behavior Change Techniques May Help Waterpipe Smokers to Quit? An Expert Consensus Using a Modified Delphi Technique.

Introduction: Waterpipe smoking is addictive and harmful. The determinants of waterpipe smoking may differ from those of cigarette smoking; therefore, behavioral approaches to support quitting may also differ between these two tobacco products. While some evidence exists on effective behavioral change techniques (BCTs) to facilitate cigarette smoking cessation, there is little research on waterpipe smoking cessation. Methods: Twenty-four experts were selected from the author lists of peer-reviewed, randomized controlled trials on waterpipe smoking cessation. They were invited to two rounds of a consensus development exercise using modified Delphi technique. Experts ranked 55 BCTs categorized further into those that promote; "awareness of harms of waterpipe smoking and advantages of quitting" (14), "preparation and planning to quit" (29), and "relapse prevention and sustaining an ex-smoker identity" (12) on their potential effectiveness. Kendall's W statistics was used to assess agreement. Results: Fifteen experts responded in round 1 and 14 completed both rounds. A strong consensus was achieved for BCTs that help in "relapse prevention and sustaining ex-smoker identity" (w = 0.7; p < .001) and a moderate for those that promote "awareness of harms of waterpipe smoking and advantages of quitting" (w = 0.6; p < .001) and "preparation and planning to quit" (w = 0.6; p < .001). Providing information on the consequences of waterpipe smoking and its cessation, assessing readiness and ability to quit, and making people aware of the withdrawal symptoms, were the three highest-ranking BCTs. Conclusion: Based on expert consensus, an inventory of BCTs ordered for their potential effectiveness can be useful for health professionals offering cessation support to waterpipe smokers. Implications: Waterpipe smoking is addictive, harmful, and gaining global popularity, particularly among youth. An expert consensus on behavior change techniques, likely to be effective in supporting waterpipe smokers to quit, has practice and research implications. Smoking cessation advisors can use these techniques to counsel waterpipe smokers who wish to quit. Behavioral and public health scientists can also use these to develop and evaluate behavioral support interventions for this client group.

Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK.

BACKGROUND: People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK. METHODS: We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine. RESULTS: The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients' motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content - maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation. CONCLUSION: We developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial.

Identifying and understanding barriers to sexually transmissible infection testing among young people.

BACKGROUND: To counter the disproportionate impact of sexually transmissible infections (STIs) among young people and encourage higher levels of STI testing, it is necessary to identify the factors that influence STI testing. METHODS: A mixed-methods study incorporating a cross-sectional quantitative survey and qualitative analysis of individual interviews was conducted in England. Some 275 university students aged 17-25 years completed an online questionnaire. Interviews were conducted with a purposively selected sample of eight men and women. RESULTS: Multivariate analysis of quantitative data revealed that injunctive norms (i.e. a desire to comply with others' wishes for testing), descriptive norms (i.e. perceptions of others' behaviour) and shame related to STIs predicted past testing behaviour. Intention to undergo testing was predicted by greater perceived susceptibility, past testing, stronger injunctive norms and greater willingness to disclose sexual histories. Qualitative analysis of interview data confirmed the importance of perceived susceptibility, normative beliefs, stigma and shame, and perceived ease of testing. CONCLUSIONS: To increase STI testing among young people, there is a need to promote pro-testing norms, address low perceived susceptibility and make testing easier.

Evaluation of the impact of the S.T.A.B.L.E. Program on the pretransport care of the neonate.

PURPOSE: To determine whether the S.T.A.B.L.E. Program increases health care providers' confidence and clinical abilities in pretransport stabilization and to assess the care of transported neonates before and after S.T.A.B.L.E. Program education. DESIGN: A descriptive design was used to evaluate health care providers ' confidence about pretransport stabilization and to assess infant outcomes before and after S.T.A.B.L.E. education. SAMPLE: Sixty-four participants in the S.T.A.B.L.E. Program in Nova Scotia participated in this study over a 13-month period. Thestudy evaluated the charts of all neonates transported tothe IWK Health Centre over two one-year periods, before and after the S.T.A.B.L.E. Program. MAIN OUTCOME VARIABLE: Perceived confidence and incorporation of S.T.A.B.L.E. Program principles among regional health care provide:rs and neonatal stability at time of transfer were measured. RESULTS: Ninety-six percent of participants indicated that the course was relevant and useful. Ninety percent indicated that they felt more confident about their ability to provide neonatal pretransport stabilization, and 86.5 percent reported adoptionof the S.T.A.B.L.E. Program principles into their practice. There were no differences in infant outcomes between the pre- and post-S.T.A.B.L.E. time periods.