Factors associated with successful tobacco use cessation among teachers in Bihar state, India: a mixed-method study.

Although tobacco use is declining in several countries including India (dropping from 35% in 2009-10 to 29% 2016-17 among adults)-it still poses a huge burden on India, as the world's second largest consumer of tobacco products. In Bihar state, with a prevalence of 25%, the Bihar School Teachers Study (BSTS) successfully enlisted teachers as role models for encouraging quitting and changing social norms pertaining to tobacco. The study used a mixed-methods approach to identify factors associated with teachers' quitting. Qualitative data were collected through focus groups with teachers and school principals. Quantitative data were collected through a written survey administered to school personnel post-intervention. Key findings from focus groups were that teachers and principals quit using tobacco and promoted cessation because they wanted to model positive behaviors; specific information about tobacco's harms aided cessation; and the BSTS intervention facilitated a school environment that supported quitting. Survey results indicated teachers who reported knowing people who quit using tobacco in the prior year were far more likely to quit as were teachers who reported that their school's tobacco policy was completely enforced. The combination of qualitative and quantitative data yielded important insights with strong implications for future interventions.

A qualitative study on a 30-year trend of tobacco use and tobacco control programmes in Islamic Republic of Iran.

We conducted in-depth interviews with key tobacco control policy-makers to explore their views and opinions of trends in tobacco use and the effectiveness of tobacco control programmes over the past 3 decades. A qualitative interview study was conducted in 2014 using a grounded theory approach. In-depth interviews were conducted with 86 key tobacco control policy-makers and data collection was based on principles of saturation. The core code "tobacco consumption and its control programme" was extracted and its related themes were listed. After review and classification by an expert panel, 9 categorized codes emerged. The final 31 codes were ordered according to their conceptual differentiations. Overall, tobacco consumption was constant over the past 3 decades; however it was increasing in females and young people and decreasing in older people; hookah consumption was increasing. A positive outcome is that tobacco use is now viewed negatively in the Islamic Republic of Iran, largely due to tobacco control programmes but the current situation is still not ideal and a comprehensive tobacco control law is needed.

Tracking intervention delivery in the 'Tobacco-Free Teachers/Tobacco-Free Society' program, Bihar, India.

In health education and behavior change interventions, process tracking monitors the delivery of an intervention and its receipt to the intended audience. A randomized controlled trial in the state of Bihar, India was conducted to help school teachers become tobacco free through appropriately designed intervention program and delivery system. We describe the results from process tracking of this intervention delivery. The intervention program was centred on six topics delivered in each school through 12 sessions over 6 successive months. The program deliverers recorded the process measures as total number of sessions and program-components implemented (fidelity); time spent conducting sessions (dose) and proportion of teachers attending at least one session (reach). The outcome measures (teachers' exposure to intervention messages and tobacco policy adoption) were assessed post-intervention. All 12 sessions were delivered in 33 out of 36 schools. Thirty-one schools implemented all six program components. In 18 schools, ≥95% of the teachers participated in one or more sessions. Thirty-three schools received 12 or more hours of dose. In 29 schools, 100% teachers reported exposure to all program messages. Tobacco policy was adopted by all schools. Thus, the intervention was generally delivered as planned and it had a positive impact on teachers and schools.

Senior dental student's attitudes toward older adults and knowledge of geriatric dental care in the Islamic Republic of Iran.

Dental students should have knowledge of geriatric dental care and positive attitudes toward elderly patients. This study assessed senior dental students' knowledge of geriatric dental care and their attitude towards elderly patients. A descriptive cross-sectional questionnaire survey was conducted on volunteer senior students in all dental schools (n = 512) in the Islamic Republic of Iran. The completed questionnaires (n = 464) were analysed. The mean scores of respondents' knowledge and attitudes were 12.7 (SD 2.9) and 48 (SD 6.1) respectively. Female and male students' knowledge did not differ significantly but their attitudes score was different. The majority of dental students had low to moderate levels of knowledge of geriatric dental care and attitudes toward elderly people; therefore, an intervention programme is indicated. We conducted the study to use the findings to incorporate geriatric dental care programmes into dental school curricula in the Islamic Republic of Iran.

Utilization of a telephone interactive voice-response tobacco cessation support service in the Islamic Republic of Iran.

Telephone smoking cessation counselling is a very cost-effective means of reaching dependent smokers in a population. We investigated the frequency of contacts and the types of topics that people accessed after a national telephone helpline was set up in the Islamic Republic of Iran at the beginning of 2011. From a total of 23 979 calls received over a 24-month period, 26.5% of callers hung up without selecting any menus. The most frequently accessed menu was addresses of smoking cessation support services (23.9%), followed by methods of smoking cessation (14.0%), self-help materials for quitting smoking (11.8%) and nicotine dependence assessment (10.4%). The average number of contacts decreased dramatically after the first month of the service but there was a significant increase in the 2 months preceding the feast of Ramadan. Religious messages provide a good opportunity to engage individuals in smoking cessation and may be useful in the planning of media campaigns.

Patients' attitudes towards the role of dentists in tobacco cessation counselling after a brief and simple intervention.

Dental professionals are in a unique position to promote smoking cessation among their patients. We evaluated the effects of a brief counselling intervention by a dentist on patients' attitude towards the role of dentists in tobacco cessation programmes. In a semi-experimental study in Tehran, Islamic Republic of Iran, 70 eligible smokers were selected and randomly assigned to intervention and control groups. The initial attitudes of the patients regarding tobacco cessation counselling services provided by the dentist were determined using a validated questionnaire. The intervention group received a brief chair-side counselling by a dentist based on the 5 A's approach, while no intervention was provided for the control group. At 8-weeks follow-up, smokers receiving the intervention showed significantly more positive attitudes towards the role of the dentist in advising patients to quit smoking compared with those in the control group. More responsibility could be transferred to dentists for tobacco prevention.

WHO MPOWER tobacco control scores in the Eastern Mediterranean countries based on the 2011 report.

The aim of this cross-sectional study was to quantify the implementation of MPOWER tobacco control policies among Eastern Mediterranean Region countries. Information was obtained from the 2011 WHO MPOWER report. A checklist was designed and its scoring was agreed by Iranian and international tobacco control specialists. Seven questions were scored from 0-4 and 3 from 0-3. The 22 countries were ranked by their total score on a scale of 0 to 37. The highest scores were achieved by the Islamic Republic of Iran, Egypt and Jordan 29, 28 and 26 respectively. Twelve of the countries (55%) scored more than half of the possible score (19). The lowest and highest scores for all countries summed were on sections related to banning smoking in public places (18) and tobacco advertising bans (66) respectively. Compliance with smoke-free policies was especially low. MPOWER programmes are accepted in the Region but there is considerable room for improvement. Input from countries based on their successes and challenges is needed to strengthen the programmes.

Which form of nicotine replacement therapy is more effective for quitting smoking? A study in Tehran, Islamic Republic of Iran.

Nicotine replacement therapy can double the chance of success for smokers attempting to quit. This observational study aimed to compare quit rates of different formulations of nicotine replacement among clients referred to a smoking cessation clinic in Tehran, Islamic Republic of Iran. Clients entering the study (n = 308) participated in 4 sessions of behavioural therapy, chose a type of nicotine replacement to use (patches, chewing gum, tablets or both patches and gum) and were followed up for 12 months. After 4 weeks of quitting, 88.2% (246/279) reported abstaining from smoking. Self-reported maintenance rates for quitting were 54.9% after 6 months and 36.2% after 12 months follow-up. A significant correlation was found between type of nicotine replacement and quit rate. Use of nicotine patches and chewing gum together had the highest quit rate (95.2%) after 4 weeks and at 12 months follow-up (62.5%). Consuming 2 forms of nicotine replacement in therapy could result in enhanced rates of long-term quitting.

Status and costs of smoking cessation in countries of the Eastern Mediterranean Region.

The aim of this cross-sectional observational study was to address the health care situation in regard to smoking cessation efforts and expenditure, and to provide a basis for future studies and for implementing tobacco control programmes throughout the Eastern Mediterranean Region of the World Health Organization. Information collected included methods and cost of services for tobacco cessation from all 16 participating countries. In 10 countries, cessation programmes were directed by primary physicians. In 13 countries, nicotine gum and in 14 countries nicotine patches were accessible in pharmacies. Bupropion was available at pharmacies (with a written prescription) in 6 countries and varenicline in 7 countries. However, the mean cost of each service was significantly higher than the price of a pack of cigarettes. In countries with support services for tobacco cessation, directors need to provide care at the society level that is considerably less costly and widely accessible.

Effects of short-term use of nicotine gum in pregnant smokers.

OBJECTIVES: To compare blood concentrations of nicotine and cotinine and maternal and fetal hemodynamic effects resulting from use of nicotine gum versus cigarette smoking in pregnant smokers. METHODS: Pregnant women (24 to 36 weeks' gestation) who smoked chronically were randomly assigned with a 1:2 randomization scheme to either a group that smoked cigarettes (n = 10) or to a group that stopped smoking and chewed at least six pieces of nicotine gum (2 mg nicotine per piece) per day (n = 19). Blood nicotine and cotinine concentrations, maternal heart rate and blood pressure, uterine resistance index, and fetal heart rate and umbilical artery resistance index were obtained before and after one cigarette was smoked at baseline and after 5 continuous days of either chewing gum or smoking. RESULTS: A significant reduction from baseline in nicotine (p < 0.0001) and cotinine (p < 0.0025) concentrations was observed in those who chewed nicotine gum compared with those who smoked cigarettes. No significant differences in the changes in maternal or fetal hemodynamic parameters from baseline to estimated time of peak nicotine exposure were observed between those who smoked cigarettes and those who chewed nicotine gum. CONCLUSION: Short-term use of nicotine gum delivers less nicotine than usual cigarette smoking in pregnant women.

Tobacco, alcohol, and caffeine use and cessation in early pregnancy.

OBJECTIVES: Little is known about what happens when individuals attempt to make multiple behavior changes simultaneously. Pregnant women in particular are often in the position of needing to change several behaviors at once, including giving up more than one pleasurable substance. We investigated the success of pregnant women in spontaneously quitting tobacco, alcohol, or caffeine, alone or in combination. METHODS: Pregnant women (n = 7489) were identified in the practices of large health maintenance organizations in Seattle and Minneapolis and were interviewed by telephone. Analyses examined the patterns of using and quitting more than one substance, and the extent to which using more than one substance predicts ability to quit other substances. RESULTS: Use of the three substances tended to cluster within individuals. Users of multiple substances were less likely to quit each substance than users of single substances. However, in the subgroup of multiple substance users who had quit one substance, having quit a second substance was more, rather than less, common. In multivariate analyses predicting quitting, demographic variables, and not having been pregnant previously were significant predictors of quitting each substance; being a nonsmoker predicted quitting alcohol, and being a nonsmoker and nondrinker predicted quitting caffeine. CONCLUSIONS: The reasons for difficulty in quitting more than one substance are unknown but may include the difficulty of formulating appropriate behavioral strategies or less concern about healthy behavior in pregnancy. Many women in the study successfully quit using two substances, however, and counseling should focus on achieving that outcome.

Survey of smoking patterns, attitudes, and interest in quitting.

We conducted a survey of 875 smokers in a Minnesota Heart Health Program community who were nonparticipants in screening and intervention. We found particular levels of interest in quitting and in formal cessation topics and programs among these smokers. Also, we collected information on smoking history, social environment, and anticipated barriers to quitting. Most noteworthy was the finding that more than half of the respondents indicated a desire to be contacted by telephone to receive information on materials on, classes on and ways of quitting smoking. Topics of particular interest to smokers included physical addiction, stress reduction, and (for women) methods of avoiding weight gain after quitting. Only 7% of respondents reported that they definitely did not want to quit, and approximately one-third of those interested in quitting indicated that they would seek outside help in doing so. The findings support the viability of "reverse" helpline procedures in which smokers are contacted directly and offered assistance in quitting.

Readiness to quit as a predictor of smoking changes in the Minnesota Heart Health Program.

The relation between two indexes of readiness to quit smoking obtained at baseline and subsequent quitting 2-7 years later was examined. Baseline data from the Minnesota Heart Health Program were used to construct 3-item composites of interest in quitting (alpha = .76) and past quitting behavior (alpha = .64). With baseline smoking controlled, both measures predicted quitting at the 2- and 7-year follow-ups but not at 4 years. Only interest in quitting was significant at the 7-year follow-up when both indexes entered the model. Given the representative community sample and the long interval from baseline to the final assessment, the findings provide support for the readiness construct.

Relapse and risk perception among members of a smoking cessation clinic.

Assessed perceptions of the health risks associated with smoking in comparison with not smoking among members of smoking cessation clinics. We measured these perceptions at three different time periods during the clinic, and then again at a 6-month follow-up. Results indicated that members who were abstinent at the follow-up had lowered their perceptions of the likelihood of contracting smoking-related illnesses (e.g., emphysema) if they were not smoking. In contrast, those who had relapsed lowered their perceptions of the health risks associated with smoking, but not their perceptions of nonsmoking disease vulnerability. The implications of these changes in risk perception for therapy involvement are discussed.

Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation.

Correlates of concern about weight gain following smoking cessation and self-efficacy about controlling weight gain were examined in 940 men and 1,166 women who were surveyed on 2 occasions as part of a randomized trial of work-site interventions for smoking cessation. Weight concerns were positively associated with female sex, body weight, dieting for weight control, nicotine addiction, and social encouragement to quit. Bivariate analyses replicated prior findings that elevated weight concerns are associated with a reduced likelihood of quitting smoking, at least in women. Analyses controlling for demographics, nicotine dependence, and social factors replicated prior findings that weight concerns are not negatively related to smoking cessation and that some measures of concern are positively related to cessation. These analyses suggest that conflicting findings found in this literature are due primarily to how weight concerns are defined and whether covariates like nicotine addiction are used in data analyses.

Use of carbon monoxide breath validation in assessing exposure to cigarette smoke in a worksite population.

Assessed the usefulness of carbon monoxide (CO) breath validation of self-reported smoking status in a large worksite population (N = 4,647). CO assessment was performed as part of a baseline survey procedure. CO levels differed substantially in relation to self-reported smoking status and amount smoked. Correcting for ambient exposure (estimated by mean CO levels among never smokers) produced more satisfactory results than uncorrected CO levels. Striking company differences were observed in mean CO exposures among self-reported never smokers. An unexpected finding was that 17.1% of current smokers reported smoking less than daily. Although the CO measure was excellent in detecting moderate and heavy smokers, it was inadequate in detecting occasional and light smokers. If detection of occasional or lighter smoking is critical to the purposes of the study, the more expensive (but more accurate) cotinine measure is preferred.

Stress, depressive symptoms, and smoking cessation among pregnant women.

Perceived stress and depressive symptoms were examined as correlates and predictors of smoking cessation during pregnancy in a sample of 819 pregnant smokers (454 baseline smokers and 365 baseline quitters). Women who quit early in pregnancy had lower levels of stress and depressive symptoms than baseline smokers. Adjusting for level of addiction and other demographic factors related to stress and depressive symptoms eliminated the significant association between depressive symptoms and smoking cessation. Lower levels of stress and depressive symptoms were not predictive of cessation in later pregnancy. Prenatal healthcare providers should continue to assess level of addiction and provide targeted intensive cessation interventions. Interventions that reduce stress and depression may also be of benefit to women who are continuing smokers in early pregnancy.

Partner smoking status and pregnant smoker's perceptions of support for and likelihood of smoking cessation.

Perceptions of support for cessation of smoking during pregnancy, likelihood of quitting, and partner smoking status were explored in a sample of 688 pregnant smokers (372 baseline smokers and 316 baseline quitters). Women with nonsmoking partners were significantly more likely to be baseline quitters than women with partners who smoked. Baseline quitters reported significantly more positive support from their partners than did continuing smokers (p = .02). Neither partner smoking status nor partner support at baseline was associated with cessation or relapse later in pregnancy. Women reported greater support, both positive and negative, from nonsmoking partners than from partners who smoked (p = .001). Among partner smokers, those who were trying to quit were perceived to be particularly supportive. Cessation interventions for expectant fathers may increase pregnant women's success at quitting.

The relationship between smoking and body weight in a population of young military personnel.

Evidence indicates that middle-aged smokers weigh less than nonsmokers and that smoking cessation reliably produces weight gain, but recent studies have questioned the weight control "benefits" of smoking in younger populations (the time that people typically initiate smoking). The relationship between smoking and body weight was evaluated in all U.S. Air Force Basic Military Training recruits during a 1-year period (n = 32,144). Those who smoked prior to Basic Military Training (n = 10,440) were compared to never smokers or experimental smokers. Results indicated that regular-current smoking had no relationship to body weight in women (p > .05) and a very small effect in men (p < .05). Ethnicity, education, income, and duration and intensity of smoking did not affect the relationship between smoking and body weight. It was concluded that smoking has no effects on the body weights of young women and minimal effects in young men.

Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial.

AIMS: To assess the effects of a smoking cessation program for recovering alcoholics on use of alcohol, tobacco and illicit drugs after discharge from residential treatment. DESIGN AND SETTING: A randomized community intervention trial design was employed in which 12 residential drug treatment centers in Iowa, Kansas and Nebraska were matched and then randomly assigned to the intervention or control condition. PARTICIPANTS: Approximately 50 adult residents (inpatients) from each site were followed for 12 months after treatment discharge. INTERVENTION: Participating residents in the six intervention centers received a 4-part, individually tailored, smoking cessation program while those in the six control sites received usual care. FINDINGS: Both moderate and heavy drinking rates were reduced in the intervention group. Intervention site participants were significantly more likely than controls to report alcohol abstinence at both the 6-month (OR = 1.59, 95%CI: 1.09-2.35) and 12-month assessment (OR = 1.84, 95%CI: 1.28-2.92). Illicit drug use rates were comparable. Effect of the intervention on tobacco quit rates was not statistically significant. CONCLUSIONS: Counseling alcoholics in treatment to quit smoking does not jeopardize the alcohol recovery process. However, low-intensity tobacco interventions are unlikely to yield high tobacco quit rates.