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2.
Res Nurs Health ; 43(1): 40-47, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31788826

RESUMEN

As a part of Korea's smoking cessation policy, the price of tobacco was increased in January 2015. Initially, the smoking rate among adolescents began to decrease. The current data, however, show that the adolescent smoking rate is on the rise. Alongside price policies, there is a need to further understand additional preventive measures that promote successful smoking cessation by identifying the factors that influence maintenance of smoking cessation in adolescents. This study aimed to identify the factors that influence smoking cessation in adolescents after attempting smoking cessation after increase in tobacco price. The study used large-scale, nationwide, secondary data obtained from the Korean Youth Risk Behavior Web-Based Survey. The sample included a total of 627 subjects who reported an attempt to quit smoking after the tobacco price increased. Descriptive statistics, t test, the χ2 test, and multiple logistic regression were used. The results showed that household economic status, school type, suicidal ideation, experience of exposure to secondhand smoke at home, and experience of witnessing teaching staff smoking were significant factors related to maintenance of smoking cessation among adolescents. To increase the success rate of smoking cessation, future intervention programs should include school environment structure and address emotional and psychological issues such as suicide.


Asunto(s)
Conducta del Adolescente/psicología , Costos y Análisis de Costo/estadística & datos numéricos , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/psicología , Fumar/economía , Fumar/psicología , Productos de Tabaco/economía , Adolescente , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , República de Corea , Cese del Hábito de Fumar/métodos , Factores Socioeconómicos , Encuestas y Cuestionarios
4.
BMC Health Serv Res ; 19(1): 924, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791307

RESUMEN

BACKGROUND: The potential economic benefit in terms of reduced healthcare costs when patients quit smoking after hospital discharge has not been directly measured. The aim of this study was to compare the costs for hospital admission and six-month follow-up for a cohort of patients who self-reported abstinence from cigarettes at 6 months after hospital discharge and a matched group of patients who reported continued smoking. MATERIALS AND METHODS: This was a secondary analysis of a recent population-based clinical trial cohort (ClinicalTrials.gov ID: NCT01575145), with cohort membership determined by self-reported 7 day point prevalence abstinence at 6 months after the index hospital discharge. Participants were admitted to Mayo Clinic Hospital, Rochester, MN, between May 5, 2012 and August 10, 2014 for any indication and lived in the areas covered by postal codes included in Olmsted County, MN. Propensity score matching was used to control for differences between groups other than smoking status, and any residual imbalance was adjusted through generalized linear model with gamma distribution for cost and log-link transformation. RESULTS: Of 600 patients enrolled in the clinical trial, 144 could be contacted and self-reported 7 day point prevalence abstinence at 6 months after hospital discharge. Of these patients, 99 were successfully matched for this analysis. The cost for the index hospitalization was significantly greater in patients who abstained compared to those that did not abstain (mean difference of $3042, higher for abstainers, 95% CI $170 to $5913, P = 0.038). However, there was no difference between mean 6-month follow-up costs, number of inpatient hospitalizations, or number of emergency room visits for abstainers versus non-abstainers. CONCLUSION: There was no evidence to support the hypothesis that abstinence at 6 months after hospital discharge is associated with a decrease in health care costs or utilization over the first 6 months after hospital discharge.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Alta del Paciente , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/estadística & datos numéricos , Estudios de Cohortes , Femenino , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Minnesota , Proyectos de Investigación
5.
BMC Public Health ; 19(1): 1700, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31852536

RESUMEN

BACKGROUND: The rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness. METHODS/DESIGN: One hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life. DISCUSSION: This study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy. TRIAL REGISTRATION: Trial registration number: NCT04013724. Name of registry: ClinicalTrials.gov. URL of registry: https://register.clinicaltrials.gov Date of registration: 9 July 2019 (retrospectively registered). Date of enrolment of the first participant to the trial: 5th September 2017. Protocol version: 2.0.


Asunto(s)
Terapia Conductista/métodos , Análisis Costo-Beneficio/estadística & datos numéricos , Consejo/métodos , Calidad de Vida/psicología , Cese del Hábito de Fumar/métodos , Cese del Uso de Tabaco/psicología , Tabaquismo/terapia , Adulto , Anciano , Anciano de 80 o más Años , Terapia Conductista/economía , Consejo/economía , Femenino , Humanos , Kenia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cese del Hábito de Fumar/economía , Cese del Uso de Tabaco/estadística & datos numéricos
6.
Artículo en Inglés | MEDLINE | ID: mdl-31569603

RESUMEN

We used a two-part model for the estimation of the price elasticity of participation and consumption of cigarettes by the duration of the smoking habit and a continuous-time split-population model for the estimation of prevalence and duration of smoking onset and smoking addiction, allowing for covariates in the participation component of the model. Results: We computed the total price elasticity of consumption of cigarettes by quartiles of addiction and found that for the people located in the lowest quartile of addiction the total price elasticity is around -0.51; while for those located in the highest quartile of addiction this figure is only -0.19. Then, a 10% increase in cigarette prices, via taxes, reduces the consumption of those in the early stages of the addiction by 5% and for those with a longer history of addiction by only 1.9%. Estimating the continuous-time split-population model we found that, at the mean starting age of 15 years, an increase of 10% in real cigarette prices is expected to delay smoking onset by almost two and a half years. On the other hand, the same policy is less effective to reduce the duration of the habit because there is no meaningful relationship between the duration of the smoking habit and the real price of cigarettes.The policy of raising cigarette excise taxes, to increment prices, seems to be more effective to delay smoking onset. On the other hand, the same policy is less effective to reduce the duration of the habit. A policy recommendation that emerges from this evidence is that for people with a developed addiction a combination of increasing taxes and other public health policies, like cessation therapies, could prove more effective.


Asunto(s)
Comercio , Política de Salud/economía , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/psicología , Fumar/economía , Fumar/psicología , Productos de Tabaco/economía , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Modelos Económicos , Modelos Psicológicos , Prevalencia , Estudios Retrospectivos , Fumar/epidemiología , Cese del Hábito de Fumar/estadística & datos numéricos , Impuestos , Adulto Joven
8.
Rev Esp Salud Publica ; 932019 Jul 15.
Artículo en Español | MEDLINE | ID: mdl-31273187

RESUMEN

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.


Asunto(s)
Promoción de la Salud/métodos , Programas Nacionales de Salud , Atención Primaria de Salud/métodos , Cese del Hábito de Fumar/métodos , Adulto , Femenino , Encuestas de Atención de la Salud , Promoción de la Salud/economía , Promoción de la Salud/estadística & datos numéricos , Humanos , Renta , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Educación del Paciente como Asunto/economía , Educación del Paciente como Asunto/métodos , Pobreza , Atención Primaria de Salud/economía , Atención Primaria de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/estadística & datos numéricos , España
9.
Trials ; 20(1): 337, 2019 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-31182134

RESUMEN

BACKGROUND: NHS community pharmacies provide effective smoking cessation services; however, there is scope for increasing throughput and improving quit rates. This trial examines whether the Smoking Treatment Optimisation in Pharmacies (STOP) intervention can improve smoker engagement to increase service throughput, retention and quitting. METHODS: This study is a pragmatic, cluster randomised controlled trial in 60 pharmacies in England and Wales. All workers in intervention pharmacies are offered STOP training while control pharmacies provide usual care. The STOP intervention, based on behavioural and organisational theories, comprises educational sessions for staff and environmental prompts in the pharmacy. Intervention fidelity is assessed by actors visiting pharmacies posing as smokers. The primary outcome is throughput, defined as the number of smokers who join the programme, set a firm quit date and undergo at least one stop smoking treatment session, and is measured using routinely collected data. Secondary outcomes include retention and quit rates at 4 weeks and continuous abstinence at 6 months verified by salivary cotinine. Cost-effectiveness is estimated using quality-adjusted life years and the probability that the intervention is effective at different levels of willingness to pay is calculated. DISCUSSION: The trial will generate evidence to inform the public health smoking cessation strategy in England and Wales, and may help to shape service commissioning decisions. The STOP intervention model may help inform the undertaking of a range of health behaviour change tasks in community pharmacies. TRIAL REGISTRATION: ClinicalTrials.gov, ISRCTN16351033. Retrospectively registered on 21 March 2017.


Asunto(s)
Farmacias , Ensayos Clínicos Controlados Aleatorios como Asunto , Cese del Hábito de Fumar/métodos , Análisis por Conglomerados , Análisis Costo-Beneficio , Humanos , Evaluación de Resultado en la Atención de Salud , Cese del Hábito de Fumar/economía
10.
Am J Public Health ; 109(7): e1-e8, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31095414

RESUMEN

Background. Tobacco companies have actively promoted the substitution of cigarettes with purportedly safer tobacco products (e.g., smokeless tobacco, e-cigarettes) as tobacco harm reduction (THR). Given the tobacco, e-cigarette, and pharmaceutical industries' substantial financial interests, we quantified industry influence on support for THR. Objectives. To analyze a comprehensive set of articles published in peer-reviewed journals assessing funding sources and support for or opposition to substitution of tobacco or nicotine products as harm reduction. Search Methods. We searched PubMed, Embase, Web of Science, and PsycINFO with a comprehensive search string including all articles, comments, and editorials published between January 1, 1992, and July 26, 2016. Selection Criteria. We included English-language publications published in peer-reviewed journals addressing THR in humans and excluded studies on modified cigarettes, on South Asian smokeless tobacco variants, on pregnant women, on animals, not mentioning a tobacco or nicotine product, on US Food and Drug Administration-approved nicotine replacement therapies, and on nicotine vaccines. Data Collection and Analysis. We double-coded all articles for article type; primary product type (e.g., snus, e-cigarettes); themes for and against THR; stance on THR; THR concepts; funding or affiliation with tobacco, e-cigarette, pharmaceutical industry, or multiple industries; and each author's country. We fit exact logistic regression models with stance on THR as the outcome (pro- vs anti-THR) and source of funding or industry affiliation as the predictor taking into account sparse data. Additional models included article type as the outcome (nonempirical or empirical) and industry funding or affiliation as predictor, and stratified analyses for empirical and nonempirical studies with stance on THR as outcome and funding source as predictor. Main Results. Searches retrieved 826 articles, including nonempirical articles (21%), letters or commentaries (34%), editorials (5%), cross-sectional studies (15%), systematic reviews and meta-analyses (3%), and randomized controlled trials (2%). Overall, 23.9% disclosed support by industry; 49% of articles endorsed THR, 42% opposed it, and 9% took neutral or mixed positions. Support from the e-cigarette industry (odds ratio [OR] = 20.9; 95% confidence interval [CI] = 5.3, 180.7), tobacco industry (OR = 59.4; 95% CI = 10.1, +infinity), or pharmaceutical industry (OR = 2.18; 95% CI = 1.3, 3.7) was significantly associated with supportive stance on THR in analyses accounting for sparse data. Authors' Conclusions. Non-industry-funded articles were evenly divided in stance, while industry-funded articles favored THR. Because of their quantity, letters and comments may influence perceptions of THR when empirical studies lack consensus. Public Health Implications. Public health practitioners and researchers need to account for industry funding when interpreting the evidence in THR debates.


Asunto(s)
Conflicto de Intereses , Cese del Hábito de Fumar/economía , Prevención del Hábito de Fumar/economía , Dispositivos para Dejar de Fumar Tabaco/economía , Sistemas Electrónicos de Liberación de Nicotina/economía , Reducción del Daño , Humanos , Cese del Hábito de Fumar/métodos , Industria del Tabaco/economía , Productos de Tabaco/economía
11.
Int J Occup Med Environ Health ; 32(3): 363-377, 2019 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-31063158

RESUMEN

OBJECTIVES: This study aimed at assessment of the perceived barriers and motivators to smoking cessation among socially-disadvantaged populations in Poland. It is hypothesized that different factors can be considered depending on the level of smoking addiction. Therefore, a comparison between light and heavy smokers was performed. MATERIAL AND METHODS: Data collected during the second wave of a cross-sectional study carried out in the Piotrkowski District in October 2016 - February 2017 among 1668 socio-economically disadvantaged persons constituted the source of information for the present study. Barriers and motivators to smoking cessation among daily smokers were identified via face-to face interviews. RESULTS: About one-third of the studied population admitted to being current daily smokers, almost 75% of whom were heavy smokers. The most common barriers to quitting smoking were related to difficulties in quitting (62%), the lack of willingness to quit (56%), as well as addiction and withdrawal symptoms (craving cigarettes [65%], habit [56%], stress and mood swings [55%]). A significantly higher proportion of such barriers was noted among heavy smokers compared to light smokers (p < 0.05). The following motivations to quit were pointed out by the respondents: available pharmacotherapy (47%), access to a free-of-charge cessation clinic (40%), and encouragement and support provided by their doctor (30%), with no differences between various levels of smoking addiction (p > 0.05). CONCLUSIONS: Developing effective interventions targeted at unique deprived populations requires understanding the barriers and motivators to quitting smoking. Social support and financial issues, including free-of-charge pharmacotherapy and cessation clinics, as well as doctor's encouragement and support, are crucial for successful smoking cessation in this vulnerable population. Int J Occup Med Environ Health. 2019;32(3):363-77.


Asunto(s)
Motivación , Fumadores/psicología , Cese del Hábito de Fumar/psicología , Poblaciones Vulnerables/psicología , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polonia , Pobreza/psicología , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/métodos , Apoyo Social , Encuestas y Cuestionarios , Dispositivos para Dejar de Fumar Tabaco/economía
13.
J Altern Complement Med ; 25(5): 526-534, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31017453

RESUMEN

Background: Smoking is associated with many preventable diseases and deaths. Globally, more than 6 million deaths per year are related to smoking. This study aimed to evaluate the pragmatic effectiveness of traditional and complementary medicine (T&CM) interventions for the smoking cessation treatment and to calculate the incremental cost-effectiveness ratio (ICER) of these interventions. Methods: The study design was a pragmatic, open-label randomized trial. The hypothesis of this trial was that the smoking cessation success rate increases with the addition of T&CM methods. The intervention group was provided T&CM interventions in addition to nicotine replacement therapy (NRT) and counseling, whereas the control group was treated with only NRT and counseling. Individuals received treatment for 4 weeks, then follow-up care for 20 weeks. Results: Forty-one participants were enrolled and assigned to either an intervention group or a control group at a ratio of 1:1. The odds ratio values at 4 weeks were 1.96 (0.51-8.51) in intention-to-treat analysis and 3.27 (0.75-17.75) in per-protocol analysis. The amount of smoking (cigarettes) decreased in both groups: from 17.2 ± 10.31 (baseline) to 1.7 ± 3.02 (4 weeks) in the intervention group and from 12.9 ± 5.47 (baseline) to 3.3 ± 5.96 (4 weeks) in the control group. The total medical costs per patient were $212.20 USD in the intervention group and $170.80 in the control group. The adjusted ICER of T&CM interventions was $13,355. Conclusions: This pilot study evaluated the clinical feasibility of T&CM used in conjunction with NRT and counseling for the smoking cessation treatment. However, there was no statistically significant effectiveness of T&CM interventions to raise cessation success rate. This study demonstrates the necessity for further studies based on large-scale randomized controlled trials.


Asunto(s)
Terapia por Acupuntura , Aromaterapia , Cese del Hábito de Fumar , Dispositivos para Dejar de Fumar Tabaco , Terapia por Acupuntura/economía , Terapia por Acupuntura/estadística & datos numéricos , Adulto , Anciano , Aromaterapia/economía , Aromaterapia/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Síndrome de Abstinencia a Sustancias , Dispositivos para Dejar de Fumar Tabaco/economía , Dispositivos para Dejar de Fumar Tabaco/estadística & datos numéricos , Resultado del Tratamiento , Adulto Joven
15.
JAMA Netw Open ; 2(4): e192307, 2019 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-30977860

RESUMEN

Importance: Reducing smoking is associated with a reduction in health care costs, including in the short run. Medicaid recipients smoke at higher rates than the general population, which suggests that investments to reduce smoking in this population would reduce short-run Medicaid costs. Objective: To estimate the short-run (1-year) change in health care expenditure associated with a 1% decrease in absolute smoking prevalence in all US states. Design, Setting, and Participants: Economic evaluation based on state Medicaid expenditures and the elasticity between changes in smoking prevalence and health care costs. Data sources were the 2017 Behavioral Risk Factors Surveillance System, 2017 National Health Interview Survey, and Kaiser Family Foundation Total Medicaid Spending for fiscal year 2017. Analysis was conducted in 2018. Participants were all people receiving Medicaid in all US states and the District of Columbia. Exposures: Cigarette smoking. Main Outcomes and Measures: Short-run (1-year) change in health care costs. Results: Reducing absolute smoking prevalence by 1% in each state was associated with substantial Medicaid savings the following year, totaling $2.6 billion (in 2017 dollars). Each state saved a median (interquartile range) of $25 million ($8 million to $35 million). Conclusions and Relevance: Effective efforts to reducing smoking could be a cost-effective way to reduce Medicaid costs in the short run.


Asunto(s)
Fumar Cigarrillos/economía , Fumar Cigarrillos/epidemiología , Gastos en Salud/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Cese del Hábito de Fumar/economía , Adulto , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología
16.
Prev Med ; 123: 143-151, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30902700

RESUMEN

One explanation for the increasing smoking-related health inequalities is the limited access of lower socioeconomic status (SES) smokers to smoking cessation support. In order to understand this limited access - and to eventually improve accessibility - we provide a structured overview of the barriers that lower SES smokers face in the successive phases of access to cessation support. Our literature review included 43 papers on barriers of access to cessation support for lower SES smokers, published before June 2016. We used the access to health care framework to categorize the extracted barriers into (a) either the abilities of smokers or dimensions of cessation support and (b) one of the successive phases of access to support. We found that lower SES smokers encounter many barriers. They are present in all phases of access to cessation support, and different barriers may be important in each of these phases. We also found that each phase transition is hampered by barriers related to both the abilities of smokers and the dimensions of cessation support, and that these barriers tend to interact, both with each other and with the disadvantaged living conditions of lower SES smokers. In conclusion, reducing smoking-related health inequalities by improving lower SES smokers' access to smoking cessation support requires a comprehensive approach. Our structured overview of barriers may serve as a starting point for tailoring such an approach to the multitude of barriers that prevent lower SES smokers from accessing cessation support, while simultaneously taking into account their disadvantaged living conditions.


Asunto(s)
Disparidades en el Estado de Salud , Cese del Hábito de Fumar/métodos , Fumar/efectos adversos , Encuestas y Cuestionarios , Adulto , Comprensión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Pobreza , Medición de Riesgo , Fumar/economía , Cese del Hábito de Fumar/economía , Factores Socioeconómicos , Estados Unidos , Poblaciones Vulnerables/estadística & datos numéricos
17.
PLoS One ; 14(3): e0212838, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30822321

RESUMEN

There are more than one billion smokers globally according to the World Health Organization (WHO) report in 2017. Every year tobacco use causes nearly 6 million deaths worldwide. To deal with the smoking epidemic, society needs to invest resources efficiently. In this paper we introduce an optimal control model to determine the optimal mix of smoking initiation and cessation interventions to reduce smoking. We construct the model to reach a smoking prevalence target within a specific time horizon while minimizing cost. Our performance measure captures the cost of policy implementation over time, adjusting for inflation and social discounting. The analytical solutions to the model are presented in forms of ordinary differential equations (ODE). We then conduct several numerical simulations using data from the National Health Interview Survey (NHIS) and empirical studies. We first present analytical solutions for our model to solve for the optimal mix of smoking interventions. Then we simulate a public health policy to achieve 5% smoking prevalence in the US by 2030 using different combinations of real-life interventions. We examine the optimal trajectories, allocative efficiency and annual total cost of smoking cessation and initiation interventions. We find consistent results across all simulations. Our specific example reveals that the most efficient way to reach stated goal is by targeting cessation interventions first, and then gradually shifting resources to initiation interventions over time. While our numerical results are specific to the intervention we selected, our framework can be easily expanded to consider other potential interventions. We discuss the implications of our approach for the formulation of dynamic public health policies.


Asunto(s)
Política de Salud , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar/métodos , Fumar Tabaco/prevención & control , Adolescente , Adulto , Humanos , Modelos Económicos , Prevalencia , Cese del Hábito de Fumar/economía , Prevención del Hábito de Fumar/economía , Fumar Tabaco/efectos adversos , Fumar Tabaco/epidemiología , Estados Unidos , Adulto Joven
18.
Comput Math Methods Med ; 2019: 8189270, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30863458

RESUMEN

This paper aims at investigating how the media coverage and smoking cessation treatment should be implemented, for a certain period, to reduce the numbers of smokers and patients caused by smoking while minimizing the total cost. To this end, we first propose a new mathematical model without any control strategies to investigate the dynamic behaviors of smoking. Furthermore, we calculate the basic reproduction number ℛ 0 and discuss the global asymptotic stabilities of the equilibria. Then, from the estimated parameter values, we know that the basic reproduction number ℛ 0 is more than 1, which reveals that smoking is one of the enduring problems of the society. Hence, we introduce two control measures (media coverage and smoking cessation treatment) into the model. Finally, in order to investigate their effects in smoking control and provide an analytical method for the strategic decision-makers, we apply a concrete example to calculate the incremental cost-effectiveness ratios and analyze the cost-effectiveness of all possible combinations of the two control measures. The results indicate that the combination of media coverage and smoking cessation treatment is the most cost-effective strategy for tobacco control.


Asunto(s)
Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/métodos , Fumar/fisiopatología , Tabaquismo/economía , Tabaquismo/terapia , Algoritmos , Número Básico de Reproducción , China/epidemiología , Análisis Costo-Beneficio , Promoción de la Salud , Humanos , Medios de Comunicación de Masas , Modelos Teóricos , Tabaco , Tabaquismo/prevención & control
19.
Am J Prev Med ; 56(4): 548-562, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30772152

RESUMEN

INTRODUCTION: Workplace tobacco control interventions reduce smoking and secondhand smoke exposure among U.S. workers. Data on smoke-free workplace policy coverage and cessation programs by industry and occupation are limited. This study assessed smoke-free workplace policies and employer-offered cessation programs among U.S. workers, by industry and occupation. METHODS: Data from the 2014-2015 Tobacco Use Supplement to the Current Population Survey, a random sample of the civilian, non-institutionalized population, were analyzed in 2018. Self-reported smoke-free policy coverage and employer-offered cessation programs were assessed among working adults aged ≥18 years, overall and by occupation and industry. Respondents were considered to have a 100% smoke-free policy if they indicated smoking was not permitted in any indoor areas of their workplace, and to have a cessation program if their employer offered any stop-smoking program within the past year. RESULTS: Overall, 80.3% of indoor workers reported having smoke-free policies at their workplace and 27.2% had cessation programs. Smoke-free policy coverage was highest among workers in the education services (90.6%) industry and lowest among workers in agriculture, forestry, fishing, and hunting industry (64.1%). Employer-offered cessation programs were significantly higher among workers reporting 100% smoke-free workplace policies (30.9%) than those with partial/no policies (23.3%) and were significantly higher among indoor workers (29.2%) than outdoor workers (15.0%). CONCLUSIONS: Among U.S. workers, 100% smoke-free policy and cessation program coverage varies by industry and occupation. Lower smoke-free policy coverage and higher tobacco use in certain industry and occupation groups suggests opportunities for workplace tobacco control interventions to reduce tobacco use and secondhand smoke exposure.


Asunto(s)
Cobertura del Seguro/estadística & datos numéricos , Servicios de Salud del Trabajador/estadística & datos numéricos , Política para Fumadores/legislación & jurisprudencia , Cese del Hábito de Fumar/legislación & jurisprudencia , Lugar de Trabajo/legislación & jurisprudencia , Adolescente , Adulto , Anciano , Femenino , Humanos , Cobertura del Seguro/economía , Masculino , Persona de Mediana Edad , Servicios de Salud del Trabajador/economía , Prevalencia , Autoinforme/estadística & datos numéricos , Política para Fumadores/economía , Fumar/efectos adversos , Fumar/epidemiología , Fumar/terapia , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/estadística & datos numéricos , Contaminación por Humo de Tabaco/prevención & control , Estados Unidos/epidemiología , Lugar de Trabajo/economía , Lugar de Trabajo/estadística & datos numéricos , Adulto Joven
20.
Value Health ; 22(2): 177-184, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30711062

RESUMEN

OBJECTIVES: To determine the cost-effectiveness of an incentive-based stop-smoking intervention that paid Medicaid recipients who smoke to take calls from a tobacco quit line. METHODS: A cost-effectiveness analysis was conducted alongside a randomized controlled trial. The analysis was conducted from a health care systems perspective on the basis of costs and effectiveness over a 6-month follow-up. Participants (n = 1900) were recruited from May 2013 to June 2015 through quit line (n = 980), clinic-based (n = 444), or community-based (n = 476) referrals. Incentive group participants (n = 948) received $30 a call for taking up to five tobacco quit line calls and $40 for biochemically verified tobacco abstinence at 6 months. Control group participants (n = 952) did not receive financial incentives for taking quit line calls. Intervention resource costs included incentive payments to participants, counselor and administrative staff time, and smoking cessation medications. Smoking status at baseline and 6 months was determined for all study participants via carbon monoxide (CO) breath tests (abstinence: CO < 7 ppm). Cost-effectiveness analysis calculated the incremental cost-effectiveness ratio (ICER). RESULTS: Incentive treatment produced higher 6-month CO-confirmed 7-day point-prevalence abstinence than did the control treatment (21.6 vs. 13.8%; P < 0.001). The ICER of the financial incentives intervention was $2316 (95% confidence interval $1582-$4270) per additional person who quit. The study ICER compares favorably with other smoking treatments, such as varenicline combined with proactive telephone counseling, whose ICER has been estimated at $2600 per additional smoker who quits. CONCLUSIONS: Use of financial incentives to engage with tobacco quit line treatment is a cost-effective option to enhance smoking cessation rates for low-income smokers.


Asunto(s)
Análisis Costo-Beneficio/métodos , Medicaid/economía , Motivación , Pobreza/economía , Cese del Hábito de Fumar/economía , Fumar/economía , Adulto , Femenino , Estudios de Seguimiento , Promoción de la Salud/economía , Promoción de la Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , Fumadores , Fumar/terapia , Cese del Hábito de Fumar/métodos , Estados Unidos/epidemiología
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