Racial/Ethnic Disparities Impact the Real-World Effectiveness of a Multicomponent Maternal Smoking Cessation Program: Findings from the CTTP Cohort.

INTRODUCTION: Smoking during pregnancy adversely affects perinatal outcomes for both women and infants. We conducted a retrospective cohort study of the state-funded Comprehensive Tobacco Treatment Program (CTTP) - the largest maternal tobacco cessation program in San Bernardino County, California - to determine the real-world program effectiveness and to identify variables that can potentially improve effectiveness. METHODS: During 2012-2019, women who smoked during pregnancy were enrolled in CTTP's multicomponent behavioral smoking cessation program that implemented components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). RESULTS: We found that 40.1% achieved prolonged abstinence by achieving weekly, cotinine-verified, 7-day abstinence during 6 to 8 weeks of enrollment. Using intention-to-treat analyses, we computed that the self-reported point prevalence abstinence rate (PPA) at the six-month telephone follow-up was 36.7%. Cohort members achieving prolonged abstinence during the CTTP were five times more likely to achieve PPA six months after CTTP. Several non-Hispanic ethnicities (Black, Native American, White, or More than one ethnicity) in the cohort were two-fold less likely (relative to Hispanics) to achieve prolonged abstinence during CTTP or PPA at six months after CTTP. This disparity was further investigated in mediation analysis. Variables such as quitting during the first trimester and smoking fewer cigarettes at enrollment were also associated with achieving PPA at six months. DISCUSSION: Racial/ethnic health disparities that have long been linked to a higher rate of maternal smoking persist even when the pregnant smoker enrolls in a smoking cessation program.

Tobacco Quitline utilization compared with cigarette smoking prevalence in Virginia across rurality and Appalachian Status, 2011-2019.

Introduction: While cigarette smoking rates have declined, rural and Appalachian populations in the United States have not seen similar decreases. Quitline programs are promising strategies in reducing disparities in these areas, but research on their usage is limited. Methods: We employed Small Area Estimation on the Virginia Behavioral Risk Factor Surveillance System (2011-2019) to estimate county-level smoking prevalence and utilized The Quit Now Virginia Quitline data (2011-2019) to estimate Quitline users. We analyzed differences in Quitline utilization by rurality and Appalachian status using statistical t-tests. Stepwise regression assessed the absolute estimate of county features, including poverty rate, tobacco retailer density, physician availability, coal mining industry, and tobacco agriculture, on Quitline usage. Results: While the average smoking rate overall was 15.3 %, only 7.4 % of smokers accessed Quitline services from 2011 to 2019. Appalachian regions exhibited higher smoking rates (20.9 %) and lower quitline usage (4.8 %) compared to non-Appalachian areas (14 % smoking prevalence, 8 % quitline usage). Rural regions had higher smoking prevalence (19.0 %) than urban areas (12.9 %), but no significant difference in Quitline utilization (7.6 % vs. 7.2 %, p = 0.7). Stepwise regression revealed counties with more tobacco agriculture had 3.2 % (p = 0.04) lower Quitline utilization. Also, more physicians availability in the county was associated with 3.9 % higher Quitline usage (p = 0.03) and Appalachian counties exhibited a 3.6 % lower Quitline usage rate compared to non-Appalachian counties. Conclusion: A significant gap exists between cigarette smoking prevalence and Quitline utilization, particularly in underserved rural and Appalachian areas, despite no clear barriers to accessing this remote cessation resource. Implication: The study underscores persistent disparities in smoking rates, with rural and Appalachian regions in the United States facing higher smoking prevalence and limited utilization of Quitline services. Despite no clear barriers to access, the gap between smoking prevalence and Quitline usage remains significant, particularly in underserved areas. Tailoring interventions to address regional disparities and factors like tobacco agriculture and physician availability is essential to reduce smoking rates and improve Quitline utilization in these communities.

Embedding comprehensive smoking cessation programs into community clinics: study protocol for a cluster-randomized controlled trial.

BACKGROUND: Cigarette smoking among adults in the USA is a leading cause of preventable death worldwide, even though there has been a decline in prevalence since 2005. The addictive nature of nicotine is the chief reason smokers continue to use tobacco. Although the majority of smokers report a desire to quit smoking, a small minority who attempt to quit achieve long-term cessation. Combined, smoking cessation best practices include coordinated medication and behavioral treatments. However, these treatments are not currently adequately delivered to Medi-Cal beneficiaries in the publicly funded patient-centered medical homes (PCMHs) and community mental health clinics operated by Los Angeles County (LAC)-Department of Health Services (LACDHS) and LAC-Department of Mental Health (LACDMH). METHODS: This is a 5-year implementation, cluster-randomized comparative effectiveness trial that will support the implementation of smoking cessation services delivered in LAC-LACDHS-operated outpatient primary care clinics and in LAC-LACDMH-operated community mental health clinics. We will enroll 1000 participants from clinics that will offer smoking cessation services and 200 from clinics that will offer treatment as usual. Participants will be asked to complete assessments at baseline, 3 months, 6 months, and 12 months. The assessments will include self-reports on smoking history, anxiety, stress, quality of life, and participant satisfaction. Participants who are assigned to clinics that provide smoking cessation services will also be asked about the frequency of their participation in the smoking cessation services during the 12-month period. DISCUSSION: This study will evaluate the effectiveness and feasibility of implementing smoking cessation services in outpatient primary care and community mental health clinics. It will also determine if there will be higher rates of smoking cessation in the implementation sites as compared to the sites with treatment as usual. If the implementation proves to be effective, the plan is to sustain these services using a workflow we will develop in the LAC-operated sites. This would lead to ameliorating the significant smoking cessation treatment gaps among those served within the LAC Health Agency departments. TRIAL REGISTRATION: ClinicalTrials.gov NCT04717544 "Embedding comprehensive smoking cessation programs into community clinics." Registered on January 22, 2021.

Lessons from Cost-Effectiveness Analysis of Smoking Cessation Programs for Cancer Patients.

BACKGROUND: Smoking among patients diagnosed with cancer poses important health and financial challenges including reduced effectiveness of expensive cancer therapies. This study explores the value of smoking cessation programs (SCPs) for patients already diagnosed with cancer. It also identifies conditions under which SPCs may be wise investments. METHODS: Using a simplified decision analytic model combined with insights from a literature review, we explored the cost-effectiveness of SCPs. RESULTS: The findings provide insights about the potential impact of cessation probabilities among cancer patients in SCPs and the potential impact of SCPs on cancer patients' lives. CONCLUSION: The evidence suggests that there is good reason to believe that SCPs are an economically attractive way to improve outcomes for cancer patients when SCPs are offered in conjunction with standard cancer care.

[Assistance program in quitting tobacco use in Navarra. 25 years on stage]. / Programa de ayuda a dejar de fumar en Navarra. 25 años de andadura.

In Navarre, the Smoking Cessation Program (PAF) was launched in 1994, result of the collaboration between Public Health and Primary Care. In 2001 it was integrated into the Tobacco Regional Action Plan, together with the other two lines of action: prevention of smoking initiation and promotion of smoke-free spaces. PAF includes two levels of intervention, a basic and an intensive one, with programmed educational support, individual and group. Medications for smoking cessation have been intermittently subsidized by the Health Department of Navarre. In December 2017, funding of medications for smoking cessation was reintroduced, in the same conditions of any other medication. Treatments are limited to one per patient and year, always including educational support. In 2018, 6139 people benefited from this funding, 50% women and 60% with yearly income lower than 18000 euros. We carried out a preliminary evaluation through a telephone survey. Overall, 35% of participants reported to keep abstinent after one year, 40% among those who also received intensive educational support.

En Navarra el Programa de Ayuda a Dejar de Fumar (PAF) nace en 1994 fruto de la colaboración entre Salud Pública y Atención Primaria y desde 2001 se integra en el Plan Foral de Acción sobre el Tabaco, junto con otras dos líneas de actuación: prevención al inicio y espacios sin humo. El PAF incluye dos niveles de intervención, básico e intensivo, con apoyo educativo programado individual y grupal y periodos de financiación farmacológica. En diciembre de 2017 se reintrodujo la financiación de los fármacos para la deshabituación tabáquica en las mismas condiciones que el resto de medicamentos, limitada a un tratamiento por paciente y año, siempre en el contexto de un programa de apoyo educativo. En 2018 se beneficiaron de la financiación 6.139 personas, la mitad mujeres y 6 de cada 10 con rentas inferiores a 18.000 euros. Los resultados de la evaluación preliminar, realizada mediante encuesta telefónica, muestran una tasa declarada de abandono al año del 35%, que asciende al 40% si se recibe apoyo educativo.

How can we better help cancer patients quit smoking? The London Regional Cancer Program experience with smoking cessation.

Background: Because continued cigarette smoking after a cancer diagnosis is associated with detrimental outcomes, supporting cancer patients with smoking cessation is imperative. We evaluated the effect of the Smoking Cessation Program at the London Regional Cancer Program (lrcp) over a 2-year period. Methods: The Smoking Cessation Program at the lrcp began in March 2014. New patients are screened for tobacco use. Tobacco users are counselled about the benefits of cessation and are offered referral to the program. If a patient accepts, a smoking cessation champion offers additional counselling. Follow-up is provided by interactive voice response (ivr) telephone system. Accrual data were collected monthly from January 2015 to December 2016 and were evaluated. Results: During 2015-2016, 10,341 patients were screened for tobacco use, and 18% identified themselves as current or recent tobacco users. In 2015, 84% of tobacco users were offered referral, but only 13% accepted, and 3% enrolled in ivr follow-up. At the lrcp in 2016, 77% of tobacco users were offered referral to the program, but only 9% of smokers accepted, and only 2% enrolled in ivr follow-up. Conclusions: The Smoking Cessation Program at the lrcp has had modest success, because multiple factors influence a patient's success with cessation. Limitations of the program include challenges in referral and counselling, limited access to nicotine replacement therapy (nrt), and minimal follow-up. To mitigate some of those challenges, a pilot project was launched in January 2017 in which patients receive free nrt and referral to the local health unit.

Training for perioperative smoking cessation interventions: a national survey of anesthesiology program directors and residents.

STUDY OBJECTIVE: To ascertain current knowledge, attitudes, and practices of anesthesiology residents regarding tobacco control, and to determine the characteristics of current residency training offered in tobacco control. DESIGN: Electronically distributed survey instrument of anesthesiology residency program directors and residents. SETTING: University medical center. MEASUREMENTS AND MAIN RESULTS: The program director and resident response rates were 75/131 (57.3%) and 490/1182 (41.4%), respectively. Programs currently provide education regarding the perioperative consequences of smoking and, with the exception of the effect of smoking cessation shortly before surgery, resident knowledge reflected this curricular emphasis. However, the strong majority of programs did not offer education on how to ask about smoking status and advise cessation (79.5%) or help tobacco users quit before surgery (89.0%), though both program directors and residents felt these topics should be covered. A strong majority of residents (87.8%) felt the perioperative period was an effective time to assist in long-term smoking cessation, and desired education on tobacco control. Barriers to helping patients quit preoperatively included lack of time and low confidence in counseling abilities. CONCLUSIONS: A need exists for expanded formal education on perioperative tobacco cessation interventions for anesthesiology residents.