Experiences of tobacco cessation including a prescription approach among patients in Swedish primary health care with a focus on socioeconomically disadvantaged areas.

BACKGROUND: Tobacco Cessation on Prescription (TCP) is a new intervention that is being evaluated in socioeconomically disadvantaged areas in Swedish primary health care (PHC). Patients' perceptions of TCP are important to understand as this may have implications for the acceptability and adherence to treatment and explain cessation outcomes. Patients' general experiences of tobacco cessation are also important to explore to improve cessation support in this setting. AIM: To explore experiences of tobacco cessation and TCP among patients in Swedish PHC focusing on socioeconomically disadvantaged areas. METHODS: Inductive content analysis of transcripts from eight semi-structured interviews with patients recruited from the intervention group in a randomized controlled trial evaluating the effectiveness of TCP in socioeconomically disadvantaged areas in PHC in Stockholm. RESULTS: Two themes were identified: needing individualized support to quit, taking differences in patients' experiences of tobacco use and cessation into account, acknowledging individual factors such as impact of health and wellbeing on tobacco use and differing attitudes towards tobacco and cessation and needing a supportive environment to facilitate tobacco cessation, taking contextual factors like professional support from the health care system, the importance of the social environment and supportive societal structures into account. Regarding TCP, the prescription form was perceived as useful for providers but did not appear to have a direct impact on tobacco cessation from the informants' perspective. However, individualized counseling from a tobacco cessation specialist, an empathetic approach in the treatment and long-term follow-up was considered important. CONCLUSION: A holistic approach may be needed in cessation treatment, combined with interventions outside the health care system, to facilitate tobacco cessation among patients in socioeconomically disadvantaged areas in Swedish PHC. The TCP prescription form may be helpful for PHC providers but counseling and follow-up appear to be the most important components of TCP for patients in this setting.

Looming Vulnerability and Smoking Cessation Attempts.

INTRODUCTION: The looming vulnerability model holds that people become anxious when they perceive threats as growing larger and accelerating toward them in space and time. Preliminary research suggested that a guided imagery induction designed to activate a sense that health consequences of smoking are a looming threat led more smokers to attempt to quit. This study tested the effect on quit attempts in a larger sample and examined age, sex, and sensation seeking as moderators. AIMS AND METHODS: Adult smokers (≥10 cigarettes/day) screened for risk of anxiety or mood disorders (N = 278, 52% male; 77% African American) were randomly assigned to receive (1) looming vulnerability or (2) neutral guided imagery exercises. At a 4-week follow-up, they reported quit attempts, smoking rate, self-efficacy, outcome expectancies, and contemplation status. RESULTS: Those in the looming condition (17%) were no more likely than those in the control condition (20%) to make a quit attempt. There were no significant group differences in expectancies, contemplation, or follow-up smoking rate, and no significant moderators. CONCLUSIONS: The looming induction was the same one used in earlier work in which it had stronger effects. Those who respond to it with increased urgency about quitting smoking might be offset by others who are more reactant and deny the message. Inconsistencies across studies may reflect differences in inclusion criteria, such that the present sample was on average heavier smokers with longer smoking history and more severe nicotine dependence, yet higher self-efficacy. IMPLICATIONS: An induction designed to activate a sense that the health consequences of smoking constitute a looming vulnerability failed to increase quit attempts or reduce smoking rate among adult daily smokers. Inconsistencies across studies might reflect varying sample characteristics resulting from changes in screening criteria.

Tailoring a NICU-Based Tobacco Treatment Program for Mothers Who Are Dependent on Opioids.

OBJECTIVE: To collect formative information to design a tailored tobacco treatment intervention for women with newborns treated or evaluated for neonatal abstinence syndrome and to explore current tobacco use behaviors and facilitators and barriers to smoking cessation. DESIGN: Qualitative descriptive study. SETTING: An academic medical center in the southern United States. PARTICIPANTS: Mothers (N = 11) of newborns who were treated or evaluated for neonatal abstinence syndrome at birth within the preceding 3 months. Women recruited were older than 18 years and reported opioid dependence and smoking during pregnancy. METHODS: Participants took part in semistructured individual interviews that lasted approximately 1 hour. Interviews were professionally transcribed and analyzed in MAXQDA using content analysis. RESULTS: Five themes emerged from the data: Strategizing to Reduce Risk, Desire to Quit Smoking in the Future, Holding on to Smoking While Working Through Recovery, Feeling Judged by Nurses, and Feeling Supported and Empowered by Nurses. Participants reported that they to reduce risk to their newborns by avoiding second- and thirdhand smoke exposure. Participants wanted to stop smoking but reported many barriers, including multiple life stressors compounded by their newborns' extended stays in the hospital. However, most participants described overall positive experiences and the support of health care providers. CONCLUSION: Holistic tobacco treatment programs that incorporate stress relief and social support and are led by trusted health care providers have the potential to be effective to reduce smoking in new mothers with histories of opioid dependence disorders and smoking and whose newborns are in the NICU.

Implementation of tobacco cessation brief intervention in complementary and alternative medicine practice: qualitative evaluation.

BACKGROUND: This article presents findings from qualitative interviews conducted as part of a research study that trained Acupuncture, Massage, and Chiropractic practitioners' in Arizona, US, to implement evidence-based tobacco cessation brief interventions (BI) in their routine practice. The qualitative phase of the overall study aimed to assess: the impact of tailored training in evidence-based tobacco cessation BI on complementary and alternative medicine (CAM) practitioners' knowledge and willingness to implement BIs in their routine practice; and their patients' responses to cessation intervention in CAM context. METHODS: To evaluate the implementation of skills learned from a tailored training program, we conducted semi-structured qualitative interviews with 54 CAM practitioners in Southern Arizona and 38 of their patients. Interview questions focused on reactions to the implementation of tobacco cessation BIs in CAM practice. RESULTS: After participating in a tailored BI training, CAM practitioners reported increased confidence, knowledge, and motivation to address tobacco in their routine practice. Patients were open to being approached by CAM practitioners about tobacco use and viewed BIs as an expected part of wellness care. CONCLUSIONS: Tailored training motivated CAM practitioners in this study to implement evidence-based tobacco cessation BIs in their routine practice. Results suggest that CAM practitioners can be a valuable point of contact and should be included in tobacco cessation efforts.

¿Pueden el coaching, la inteligencia emocional y la programación neurolingüística (PNL) aportar herramientas útiles para potenciar la autoeficacia en la deshabituación del tabaquismo? La visión de los profesionales / ¿Can coaching, emotional intelligence and neurolingustic programming (NLP) provide useful tools to strengthen self-efficacy in smoking cessation? The view of the professionals

Se trata de un estudio que describe la utilidad que da un grupo de profesionales de medicina y enfermería a la formación en coaching, inteligencia emocional y PNL (programación neurolingüística) como herramientas para potenciar la autoeficacia de los pacientes sometidos a tratamiento para su tabaquismo. Objetivos. El objetivo principal de este trabajo es conocer el perfil y opinión de los profesionales que muestran interés hacia ese tipo de formación. Material y métodos. Se ha diseñado un curso de formación acreditado con 10 horas ofertado en dos ediciones. Se ha recogido una muestra de 55 alumnos que han completado de manera anónima un cuestionario específicamente diseñado a este efecto. Resultados. El 71% de los alumnos pertenecen al grupo profesional de enfermería, en el 80% son mujeres y el rango de edad más numeroso está entre 41-50 años. Los conocimientos adquiridos sobre el concepto de autoeficacia han sido muy altos ya que 34 de los 55 participantes respondió correctamente el 100% del cuestionario y ninguno falló más de 3 preguntas sobre 10. El 100% señaló su acuerdo con puntuación ≥ 8 puntos sobre 10 que 'En la deshabituación del tabaquismo es importante entrenar al paciente para que mejoren sus recursos relacionados con la autoeficacia' y el 94% señaló su acuerdo con ≥ 8 puntos sobre 10 que 'El coaching puede ser una buena herramienta para el incremento de la autoeficacia en nuestros pacientes'. Conclusiones. La formación en torno al concepto de autoeficacia resulta bien valorada por los profesionales y es rentable en términos de aprovechamiento. El coaching, la inteligencia emocional y la PNL (programación neurolingüística) pueden resultar buenas herramientas para ello (AU)

This is a study that describes the utility provided by training in coaching, emotional intelligence and NLP (neurolinguistic programming) to medical and nursing professionals as tools to strengthen self-efficacy of the patients subjected to smoking cessation treatment. Objectives. The primary objective of this work is to know the profile and opinion of the professionals who demonstrate interest in this type of training. Material and methods. A training course accredited with 10 hours offered in two editions has been designed. A sample of 55 students who have completed anonymously a questionnaire specifically designed to this effect was collected. Results. A total of 71% of the students belong to the professional group of nursing, 80% being women whose most numerous age range goes from 41-50 years. The knowledge acquired on the concept of self-efficacy was very high since 34 of the 55 participants correctly responded to 100% of the questionnaire and none incorrectly answered more than 3 questions out of 10. One hundred percent indicated their agreement with the score ≥ 8 points out of 10 that 'In smoking cessation, it is important to train the patient to improve their resources related with self-efficacy' and 94% indicted their agreement with ≥ 8 points out of 10 that 'Coaching can be a good tool to increase the self-efficacy in our patients.' Conclusions. Training regarding the concept of self-efficacy is well-evaluated by the professionals and is profitable in terms of utilization. Coaching, emotional intelligence and NLP (neurolinguistic programming) may be good tools for it (AU)

Tobacco cessation services in India: recent developments and the need for expansion.

Tobacco use is a major cause of preventable death and disease in India. Unfortunately, very few people in India quit tobacco use. Lack of awareness of harm, ingrained cultural attitudes, and lack of support for cessation maintains tobacco use in the community. The significant addictive property of nicotine makes quitting difficult and relapse common. Health professionals have received little training, and very few thus carry out proper assessments and interventions among tobacco users. Evidence from the developed countries suggests that brief interventions delivered by diverse health professionals are effective in tobacco cessation. Combining pharmacologic approaches with behavioral counseling produces better results than a single strategy. In India, early experiences with tobacco cessation occurred in the context of primary community education for cancer control. More recently, tobacco cessation clinics have been set up to develop models of intervention, and train health professionals in service delivery. These need to be expanded at the primary, secondary, and tertiary care levels, and cost-effective community tobacco cessation models need to be developed. Tobacco cessation forms one of the critical activities under the National Tobacco Control Program. Tobacco cessation needs to be urgently expanded by training health professionals in providing routine clinical interventions, increasing availability and subsidy on pharmacotherapy, developing wide-reaching strategies, such as quitlines and cost-effective strategies, such as group interventions.

Tobacco cessation via doctors of chiropractic: results of a feasibility study.

INTRODUCTION: There is a sizeable and growing body of empirical literature on the effects of physician advice to quit smoking. Because of the association between tobacco use and the health problems that may provoke referral to chiropractic care, doctors of chiropractic (DCs) may be able to give patients personalized proximal health feedback that may motivate them to quit. However, DCs have not been utilized in this role. The primary aim of this study was to design and refine a brief office-based tobacco intervention for use within chiropractic settings. METHODS: This study was conducted in 20 private chiropractic practices in 2 phases: (a) intervention development, in which we created and focus tested practitioner and patient materials, and (b) feasibility, in which we evaluated the impact of the intervention on 210 tobacco-using chiropractic patients. RESULTS: Analyses were conducted on 156 patients who exclusively smoked cigarettes. Using an intent-to-treat approach, assuming all nonresponders to be smokers, 13 (8.3%) reported 7-day abstinence at 6 weeks, 22 (14.1%) at the 6-month follow-up, and 35 (22.4%) at the 12-month assessment. Eleven participants (7.1%) reported prolonged abstinence at the 6-month follow-up, and 15 (9.6%) reported prolonged abstinence at 12 months. CONCLUSIONS: To our knowledge, this is the first study to refine a brief office-based treatment for tobacco dependence for use in chiropractic settings. The results of this study were promising and will lead to a randomized clinical trial. If found to be effective, this model could be disseminated to chiropractic practitioners throughout the United States.

Terapias psicológicas en la deshabituación tabáquica / Psychological therapies in tobacco addiction

La nicotina es la responsable del gran poder adictivo del tabaco como expresa el "Manual Diagnóstico y Estadístico de los Trastornos Mentales" (DSM-IV oe 1994) y la "Clasificación Internacional de enfermedades"(CI E-10).La dependencia que genera el tabaquismo no es sencilla, comprende múltiples factores, que provocan en el individuo una severa afectación que conlleva su perpetuación en el consumo. Así el tabaco provoca fundamentalmente dos tipos de dependencia: física o farmacológica y psicológica o psicocomportamental. No obstante, a las mismas se debe añadir el "hábito o automatismo", adquirido tras años de consumo diario de más de 20 cigarrillos de promedio. Por otro lado, el fumador inveterado asocia el consumo de tabaco con gran cantidad de estímulos, es el componente manual-oral del cigarrillo, al que además hay que sumar "la dependencia social" que genera el pitillo al constituir en muchas ocasiones el intermediario para comenzar una entrevista o mantener un conversación. Por todo ello, el tratamiento del tabaquismo es un tema complejo que requiere ser abordado de una forma multifactorial. Considerándolo no únicamente como una adicción física que requiere un tratamiento farmacológico, sino que además debe contemplar la realización de un tratamiento psicológico, ya sea individual o de grupo, que ayude al paciente a pasar de ser fumador a exfumador, aprendiendo a vivir sin tabaco. En este artículo hacemos una revisión de las distintas terapias psicológicas utilizadas en la deshabituación tabáquica (AU)

El empleo de las técnicas de sugestión como coadyuvantes de los programas multicomponentes en el tratamiento del tabaquismo: Estudio de caso único / The use of suggestion techniques as adjuntc to multimodal programme for smoking cessation. A case study

En este artículo se presenta en detalle un programa multicomponente para la reducción del tabaquismo. El programa incluye : reducción gradual de ingestión de nicotina y alquitrán, control de estímulos, reestructuración cognitiva, prevención de recaídas y el empleo de técnicas de sugestión para incrementar la eficacia del condicionamiento aversivo, estrategias de reducción de ansiedad y prevención de recaídas en situaciones difíciles. El programa consta de cinco sesiones de tratamiento y fue aplicado a una paciente fumadora durante un tiempo total de cinco semanas, con un período de seguimiento realizado en cuatro momentos diferentes: 1, 3, 6, y 12 meses. Los resultados señalan un progresivo descenso de la tasa de consumo desde la primera sesión de tratamiento, y al final del programa la paciente cesó por completo su consumo, manteniéndose abstinente durante un período de 12 meses (AU)

La hipnosis como adjunto en el tratamiento del hábito de fumar. Estudio de caso / Hypnosis as an adjunt to treatment for smoking cessation. A case Study

Se presenta el caso de una paciente de 33 años con dependencia a la nicotina que llevaba 9 años fumando una media de 35 cigarrillos diarios. Intentó dejarlo hace 3 años pero tuvo una recaída a los seis meses por problemas de ansiedad y continuó con su adicción. El tratamiento tuvo como objetivo que la paciente dejara de fumar evitando las posibles molestias del síndrome de abstinencia. Se aplicó un programa multicomponente de seis sesiones llevadas a cabo en un mes en el que se incluyeron: autoregistros, el método de auto-hipnosis rápida de Capafons y otras técnicas de auto-control; reestructuración cognitiva y prevención de recaídas. La paciente dejó de fumar en la fecha acordada, veintidós días después de comenzar el tratamiento, en la quinta sesión. El seguimiento a un año despu7és de haber finalizado el tratamiento ha dado como resultado la abstinencia, habiéndose minimizado los síntomas del síndrome de abstinencia y el aumento de peso (AU)

This paper deals with a case study of a 33-year-old patient whose diagnosis was nicotine dependence. She had smoked for nine years an average of 35 cigarettes per day. The patient tried to quit smoking three years ago but although she stopped smoking during a six-month period, she failed to keep her abstinence due to anxiety problems. The treatment goal was that the patient became abstinent with minimal withdrawal symptoms. A multimodal program of six sessions, which were carried out in a period of one month, was applied. This treatment included self-recording, Capafons’ rapid self-hypnosis method and other self-control techniques; cognitive restructuring, and relapse prevention. The patient quitted smoking at the date previously established, that is, twenty-two days after the beginning of the treatment, on the fifth session. The results were maintained throughout one year of the follow-up period and withdrawal symptoms and weight gain were minimized (AU)

Tobacco craving: intensity-related effects of imagery scripts in drug abusers.

Two experiments were conducted to determine whether active imagery would elicit tobacco craving in smokers with histories of drug abuse who were not interested in quitting smoking. In Experiment 1, the authors used scripts that contained positive, negative, or neutral affective content with and without descriptions of smoking urge. Scripts with urge content and negative affect scripts increased subjective reports of tobacco craving. An interaction between affective manipulation and urge content was observed on self-reported mood. In Experiment 2, positive affect scripts that varied in amount of urge content produced an orderly increase in tobacco craving as a function of urge intensity, suggesting that changes were specific to the imagery manipulation. In both experiments, increases in tobacco craving were positively correlated with craving for drug of choice, suggesting that stimuli that engender smoking urges may occasion craving for other drugs of abuse.

Effects of smokeless tobacco-related sensory and behavioral cues on urge, affect, and stress.

The hypothesis that smokeless tobacco-related sensory and behavioral cues can act as conditioned stimuli was tested in a counterbalanced double-blind experimental design. The nicotine content of snuff smokeless tobacco (ST) was manipulated for 24 male ST users by mixing ST with an ST substitute. Affect was manipulated through imagery scripts, stress was induced by a mental arithmetic task, and physiological measures and self-reported affect, stress, and urge for ST were collected. Urge for ST was consistently reduced regardless of the nicotine content in the ST conditions. Urge was increased by the stress manipulation and by negative affect when compared with positive affect. Urge for ST was positively correlated with stress and negative affect but was not correlated with positive affect. Physiological arousal was not related to urge. Results generally parallel studies of smoking and suggest that ST substitute products may aid ST cessation.