Nicotine replacement therapy to aid gradual cessation in smokers with no intention to quit: Association between reduction quantity and later abstinence.

OBJECTIVE: We examined how quantity and trajectory of smoking reduction influence later abstinence in smokers without intention to quit and being prescribed free nicotine replacement therapy (NRT). METHOD: We conducted an a posteriori analysis from a data archive of adult smokers in a randomized controlled trial of smoking reduction using counseling and free NRT (n = 928). Reduction was analyzed as the absolute and percentage decrease in self-reported daily cigarette consumption at three follow-ups (1 week, 1 and 3 months) compared with the baseline. Logistic regression model and multiple imputation were used to examine the association between early reduction and abstinence at 6 months. RESULTS: Reducing 10% of cigarette consumption at the three follow-ups was associated with 16% (95% CI 5-28%), 23% (95%CI 11-36%) and 27% (95% CI 13-42%) increase in abstinence, respectively. Greater reduction predicted abstinence when the percentage reduction was more than one-third (above 31.4%). Progressive increase in the percentage reduction predicted more abstinence (OR = 1.90, 95%CI 1.01-3.58). CONCLUSIONS: Greater percentage reduction by at least one-third and progressive reduction predicted abstinence in those who reduced smoking. Such new evidence can guide the improvement of clinical service for tobacco dependency treatment and support further studies on smoking reduction and cessation.

A randomized controlled trial of a smoking reduction plus nicotine replacement therapy intervention for smokers not willing to quit smoking.

AIMS: To examine the effectiveness of smoking reduction counselling plus free nicotine replacement therapy (NRT) for smokers not willing to quit. DESIGN, SETTING AND PARTICIPANTS: A total of 1154 Chinese adult smokers not willing to quit but who were interested in reducing smoking were allocated randomly to three arms. Intervention group A1 (n=479) received face-to-face counselling on smoking reduction and adherence to NRT at baseline, 1 week and 4 weeks with 4 weeks of free NRT. Group A2 (n=449) received the same intervention, but without the adherence intervention. Control group B (n=226) received simple cessation advice at baseline. MEASUREMENTS: Self-reported 7-day point prevalence of tobacco abstinence and reduction of cigarette consumption (≥50%) at 6 months and continuous use of NRT for 4 weeks at 3 months. FINDINGS: Using intention-to-treat analysis, compared to control group B, the intervention groups (A1+A2) had achieved higher 6-month tobacco abstinence (17.0% versus 10.2%, P=0.01) and reduction rates (50.9% versus 25.7%, P<0.001). There was no significant difference in the 4-week NRT adherence rate at 3 months, but group A1 achieved a higher abstinence rate than group A2 at 6 months (20.9% versus 12.9%; P=0.001). CONCLUSIONS: In smokers with no immediate plans to quit, smoking reduction programmes with behavioural support and nicotine replacement therapy are more effective than brief advice to quit. Current guidelines recommend advice to quit on medical grounds as the best clinical intervention in this group of smokers, but smoking reduction programmes offer an alternative and effective option.

Smoking-cessation and adherence intervention among Chinese patients with erectile dysfunction.

BACKGROUND: Whether the association between smoking and erectile dysfunction is causal is uncertain. No RCTs have been previously conducted on cessation counseling and additional nicotine replacement therapy (NRT) adherence counseling among smokers with erectile dysfunction. PURPOSE: The aim of the study was to determine if smoking-cessation counseling in conjunction with NRT increases quitting and NRT adherence compared to usual care, and if stopping smoking would improve erectile function among Chinese erectile dysfunction patients who smoke. DESIGN: An RCT was conducted. Data were collected in 2004-2007 and analyzed in 2008. SETTING/PARTICIPANTS: The sample included 719 Chinese adult erectile dysfunction patients who smoked at least 1 cigarette per day, intended to quit smoking within the next 7 days, and would use NRT. INTERVENTIONS: Group A1 received 15-minute smoking-cessation and 3-minute NRT adherence counseling at baseline, 1 week, and 4 weeks with free NRT for 2 weeks. Group A2 received the same treatment, except for the adherence counseling. Group B received 10 minutes of quitting advice. All subjects received a self-help quitting booklet at first contact. MAIN OUTCOME MEASURES: Self-reported 7-day tobacco abstinence at 6 months, 4-week NRT adherence at 1 month, and improvement in erectile dysfunction condition at 6 months. RESULTS: The intervention groups (A1+A2) achieved higher rates of abstinence, both self-reported (23% vs 12.8%, RR=1.79, 95% CI=1.22, 2.62) and biochemically validated (11.4% vs 5.5%, RR=2.07, 95% CI=1.13, 3.77), than the control group. The NRT adherence rate did not differ between Groups A1 and A2 (13.7% vs 12.7%, RR=1.08, 95% CI=0.69, 1.69). An improvement in erectile dysfunction status from baseline to 6 months was associated with self-reported quitting at 6 months but not with intervention status. CONCLUSIONS: Although quitting smoking was associated with improvement in erectile dysfunction, this study found significant outcome differences among the means used to achieve smoking cessation. TRIAL REGISTRATION: ISRCTN13070778.

Health promotion in older adults: evidence-based smoking cessation programs for use in primary care settings.

Tobacco dependency is a growing problem among older adults. Given the addictive nature of tobacco use, smokers need a multifactorial treatment program to help stop smoking. Health care professionals can play a pivotal role in the promotion of a smoking cessation treatment program to people of all ages, including the elderly. This paper presents important evidence that smoking cessation services for the elderly are effective, and describes how primary care physicians can support elderly people quit smoking.

Pattern of alternative medicine usage among the Chinese breast cancer patients: implication for service integration.

The study examined the pattern of and factors associated with use of alternative medicine (AM) among Chinese breast cancer patients. An analytical, cross-sectional survey of 352 breast cancer patients from two breast cancer centers was conducted in 1997. Amongst the respondents, the usage rate of alternative medicine was 27.8%. Factors forming the use of AM included being young to middle-aged, having higher education and a belief that AM would enhance orthodox treatment. A substantial proportion of Chinese breast cancer patients use AM besides conventional medicine. There is a need to integrate AM with conventional medicine to improve the service provision for cancer patients.

Lessons from the severe acute respiratory syndrome outbreak in Hong Kong.

Severe acute respiratory syndrome (SARS) is now a global public health threat with many medical, ethical, social, economic, political, and legal implications. The nonspecific signs and symptoms of this disease, coupled with a relatively long incubation period and the initial absence of a reliable diagnostic test, limited the understanding of the magnitude of the outbreak. This paper outlines our experience with public health issues that have arisen during this outbreak of SARS in Hong Kong. We confirmed that case detection, reporting, clear and timely dissemination of information, and strict infection control measures are essential in handling such an infectious disease outbreak. The need for an outbreak response unit is crucial to combat any future outbreak.

Risk factors for sexually transmitted diseases and casual sex among Chinese patients attending sexually transmitted disease clinics in Hong Kong.

BACKGROUND: The risk factors for sexually transmitted diseases (STDs) and having casual sex among the Chinese people are unknown. GOAL: The goal of the study was to estimate the prevalence of STDs and to develop a profile of risk behavior among patients attending STD clinics in Hong Kong. STUDY DESIGN: In a clinic-based, cross-sectional study, 448 patients attending two government STD clinics were randomly sampled and interviewed by means of a structured questionnaire. RESULTS: The prevalence of STDs was 51% (70% of men and 35% of women). Attendees who had STDs diagnosed were more likely to be male, never married, and smokers and alcohol users (ever) and to have had casual sex or sex during travel with someone not their usual partner. Those who did not always use condoms were more likely to be male and never married. Having had casual sex was reported by 63% of the respondents. Those who reported having had casual sexual encounters were more likely to have the following characteristics: male; never married; no religious belief; ever smoker and alcohol user; current STD; had sex during travel; history of STD; inconsistent condom user; and perception of being at low risk for STD. After adjustment, only male gender was associated with casual sexual encounters. CONCLUSION: The results of this study indicated several risk factors among Chinese patients for the acquisition of STDs, for not using condoms, and for having casual sex. This information is useful in strengthening and evaluating currently available STD prevention and control strategies for the Chinese population in Hong Kong and elsewhere.