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1.
Medicine (Baltimore) ; 99(22): e20295, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32481398

RESUMEN

BACKGROUND: Tobacco epidemic remains a major challenge to public health, with >7 million deaths attributable to tobacco smoking p.a. Quitting smoking is a proven way of reducing the harm of smoking. Nicotine replacement therapy (NRT), auricular acupressure and acupuncture are used for quit smoking, but it remains to be explored which is relatively more effective. Furthermore, a Bayesian network meta-analysis will be applied to determine the relative effects and/or safety of different smoking cessation treatments. METHODS/DESIGN: A literature search for randomized controlled trials (RCTs) will be performed in five electronic databases from inception to December 2019, including PubMed, the Cochrane library, EMBASE, Web of Science, and Chinese Biomedical Database (SinoMed). Cochrane Collaboration quality assessment tool will be used for the risk of bias assessment. A Bayesian network meta-analysis will be performed using WinBUGS 1.4.3, and Stata 14 will be applied to draw the network diagram, while RevMan 5.3.5 will be used to produce funnel plot for assessing the risk of publication bias. Recommended rating, development and grade methodology will also be utilized to assess the quality of evidence. RESULTS: We will evaluate the effect of different smoking cessation treatments (e.g., acupuncture, auricular acupressure, and NRT) by directly traditional meta-analysis and indirectly Bayesian network meta-analysis. CONCLUSION: Our study will provide smokers with the available evidence on the efficacy and safety of quitting regimens.


Asunto(s)
Acupresión/métodos , Terapia por Acupuntura/métodos , Cese del Hábito de Fumar/métodos , Teorema de Bayes , Humanos , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación
3.
Rev Assoc Med Bras (1992) ; 66(2): 146-152, 2020 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-32428148

RESUMEN

Varenicline is a useful pharmacological option for smoking cessation. Unfortunately, there is a lack of studies on its effectiveness, retention, and side effects in low- and middle-income countries. The present study aimed to investigate gender differences regarding these outcomes in a Brazilian clinical sample (n = 124). The 12-week treatment protocol included six consultations with a psychiatrist and six sessions of cognitive-behavioral therapy. All subjects received varenicline on the first evaluation, following the standard posology for 12 weeks and instructions to stop smoking after the second week of treatment. Both Mini-International Neuropsychiatric Interview (MINI) Plus and Fagerstrom Test for Nicotine Dependence were applied at baseline. The UKU-Side Effects Rating Scale was administered at weeks 3, 7, and 11, and the Questionnaire of Smoking Urges-Brief at weeks 1, 5, and 9 to ascertain the side effects of the medication and craving, respectively. At the end of the 12-week treatment, abstinence was biochemically assessed. At months 6 and 12 after the treatment, follow-up telephone interviews were conducted to access nicotine abstinence. Short- and long-term abstinence and retention rates did not differ between genders. However, women presented more side effects than men, especially in the second half of the treatment. Increased dream activity, reduced duration of sleep, constipation, and weight loss were the most notable side effects. Despite women reporting more side effects than men, this difference did not influence the treatment success rates.


Asunto(s)
Agentes para el Cese del Hábito de Fumar/efectos adversos , Cese del Hábito de Fumar/métodos , Vareniclina/efectos adversos , Adulto , Brasil , Femenino , Estudios de Seguimiento , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Factores Sexuales , Factores Socioeconómicos , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento
4.
PLoS One ; 15(4): e0231095, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32348306

RESUMEN

INTRODUCTION: Varenicline tartrate is superior for smoking cessation to other tobacco cessation therapies by 52 weeks, in the outpatient setting. We aimed to evaluate the long-term (104 week) efficacy following a standard course of inpatient-initiated varenicline tartrate plus Quitline-counselling compared to Quitline-counselling alone. METHODS: Adult patients (n = 392, 20-75 years) admitted with a smoking-related illnesses to one of three hospitals, were randomised to receive either 12-weeks of varenicline tartrate (titrated from 0.5mg daily to 1mg twice-daily) plus Quitline-counselling, (n = 196) or Quitline-counselling alone, (n = 196), with continuous abstinence from smoking assessed at 104 weeks. RESULTS: A total of 1959 potential participants were screened for eligibility between August 2008 and December 2011. The proportion of participants who remained continuously abstinent (intention-to-treat) at 104 weeks were significantly greater in the varenicline tartrate plus counselling arm (29.2% n = 56) compared to counselling alone (18.8% n = 36; p = 0.02; odds ratio 1.78; 95%CI 1.10 to 2.86, p = 0.02). Twenty-two deaths occurred during the 104 week study (n = 10 for varenicline tartrate plus counselling and n = 12 for Quitline-counselling alone). All of these participants had known or developed underlying co-morbidities. CONCLUSIONS: This is the first study to examine the efficacy and safety of varenicline tartrate over 104 weeks within any setting. Varenicline tartrate plus Quitline-counselling was found to be an effective opportunistic treatment when initiated for inpatient smokers who had been admitted with tobacco-related disease.


Asunto(s)
Cese del Hábito de Fumar/métodos , Fumar/tratamiento farmacológico , Fumar Tabaco/tratamiento farmacológico , Vareniclina/administración & dosificación , Adulto , Anciano , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Agonistas Nicotínicos/administración & dosificación , Pacientes Ambulatorios , Fumar/epidemiología , Fumar/psicología , Tabaco/efectos adversos , Fumar Tabaco/epidemiología , Fumar Tabaco/psicología , Resultado del Tratamiento
6.
Monaldi Arch Chest Dis ; 90(1)2020 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-32253889

RESUMEN

We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was <0.05. The point prevalence of abstinence rate (questionnaire validated) 1 month to 6 months was almost 4 times. Our intervention (RIBCS) succeeded in increasing the abstinence rates during the study period among smokers with a lower motivation to quit (pre-contemplators and contemplators) as well as those ready to quit (preparators). This is significant because of most existing smoking-cessation interventions target only motivated smokers, with few having a positive effect in smokers with a lower motivation to quit.


Asunto(s)
Terapia Conductista/métodos , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Fumar/terapia , Tabaquismo/terapia , Adolescente , Adulto , Anciano , Consejo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Estudios Prospectivos , Fumar/efectos adversos , Fumar/psicología , Encuestas y Cuestionarios , Tabaquismo/complicaciones , Tabaquismo/diagnóstico , Tabaquismo/psicología , Adulto Joven
8.
JAMA ; 323(16): 1599-1608, 2020 04 28.
Artículo en Inglés | MEDLINE | ID: mdl-32343335

RESUMEN

Importance: Interventions to discourage the use of tobacco products (including electronic nicotine delivery systems or e-cigarettes) among children and adolescents may help decrease tobacco-related illness and injury. Objective: To update the 2013 review on primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents to inform the US Preventive Services Task Force. Data Sources: The Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MEDLINE, PsyINFO, and EMBASE (September 1, 2012, to June 25, 2019), with surveillance through February 7, 2020. Study Selection: Primary care-relevant studies; randomized clinical trials and nonrandomized controlled intervention studies of children and adolescents up to age 18 years for cessation and age 25 years for prevention. Trials comparing behavioral or pharmacological interventions with no or a minimal tobacco use intervention control group (eg, usual care, attention control, wait list) were included. Data Extraction and Synthesis: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality. Studies were pooled using random-effects meta-analysis. Main Outcomes and Measures: Tobacco use initiation; tobacco use cessation; health outcomes; harms. Results: Twenty-four randomized clinical trials (N = 44 521) met inclusion criteria. Behavioral interventions were associated with decreased likelihood of cigarette smoking initiation compared with control interventions at 7 to 36 months' follow-up (13 trials, n = 21 700; 7.4% vs 9.2%; relative risk [RR], 0.82 [95% CI, 0.73-0.92]). There was no statistically significant difference between behavioral interventions and controls in smoking cessation when trials were restricted to smokers (9 trials, n = 2516; 80.7% vs 84.1% continued smoking; RR, 0.97 [95% CI, 0.93-1.01]). There were no significant benefits of medication on likelihood of smoking cessation in 2 trials of bupropion at 26 weeks (n = 523; 17% [300 mg] and 6% [150 mg] vs 10% [placebo]; 24% [150 mg] vs 28% [placebo]) and 1 trial of nicotine replacement therapy at 12 months (n = 257; 8.1% vs 8.2%). One trial each (n = 2586 and n = 1645) found no beneficial intervention effect on health outcomes or on adult smoking. No trials of prevention in young adults were identified. Few trials addressed prevention or cessation of tobacco products other than cigarettes; no trials evaluated effects of interventions on e-cigarette use. There were few trials of pharmacotherapy, and they had small sample sizes. Conclusions and Relevance: Behavioral interventions may reduce the likelihood of smoking initiation in nonsmoking children and adolescents. Research is needed to identify effective behavioral interventions for adolescents who smoke cigarettes or who use other tobacco products and to understand the effectiveness of pharmacotherapy.


Asunto(s)
Terapia Conductista , Educación del Paciente como Asunto , Atención Primaria de Salud , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar/métodos , Uso de Tabaco/prevención & control , Adolescente , Adulto , Terapia Conductista/métodos , Niño , Consejo , Humanos , Guías de Práctica Clínica como Asunto , Vapeo/prevención & control , Adulto Joven
9.
JAMA ; 323(16): 1590-1598, 2020 04 28.
Artículo en Inglés | MEDLINE | ID: mdl-32343336

RESUMEN

Importance: Tobacco use is the leading cause of preventable death in the US. An estimated annual 480 000 deaths are attributable to tobacco use in adults, including from secondhand smoke. It is estimated that every day about 1600 youth aged 12 to 17 years smoke their first cigarette and that about 5.6 million adolescents alive today will die prematurely from a smoking-related illness. Although conventional cigarette use has gradually declined among children in the US since the late 1990s, tobacco use via electronic cigarettes (e-cigarettes) is quickly rising and is now more common among youth than cigarette smoking. e-Cigarette products usually contain nicotine, which is addictive, raising concerns about e-cigarette use and nicotine addiction in children. Exposure to nicotine during adolescence can harm the developing brain, which may affect brain function and cognition, attention, and mood; thus, minimizing nicotine exposure from any tobacco product in youth is important. Objective: To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of primary care interventions for tobacco use prevention and cessation in children and adolescents. The current systematic review newly included e-cigarettes as a tobacco product. Population: This recommendation applies to school-aged children and adolescents younger than 18 years. Evidence Assessment: The USPSTF concludes with moderate certainty that primary care-feasible behavioral interventions, including education or brief counseling, to prevent tobacco use in school-aged children and adolescents have a moderate net benefit. The USPSTF concludes that there is insufficient evidence to determine the balance of benefits and harms of primary care interventions for tobacco cessation among school-aged children and adolescents who already smoke, because of a lack of adequately powered studies on behavioral counseling interventions and a lack of studies on medications. Recommendation: The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-feasible interventions for the cessation of tobacco use among school-aged children and adolescents. (I statement).


Asunto(s)
Terapia Conductista/métodos , Consejo , Educación del Paciente como Asunto , Atención Primaria de Salud , Cese del Hábito de Fumar/métodos , Prevención del Hábito de Fumar/métodos , Uso de Tabaco/prevención & control , Adolescente , Niño , Humanos , Vapeo/prevención & control , Adulto Joven
10.
PLoS One ; 15(3): e0229411, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32142514

RESUMEN

BACKGROUND: Smoking among adolescents remains a global public health issue as youth continue to maintain high prevalence rates. The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well established, yet there is still a need for studies targeting high school students. The aim of the study was to determine the effectiveness of a text-based smoking cessation intervention among high school students in Sweden. METHODS: The study was a two-arm randomized trial conducted from January 10 2018 to January 11 2019, data were analysed from April 12 2019 to May 21 2019. Inclusion criteria were high school students who were daily or weekly smokers willing to attempt to quit smoking and owned a mobile phone. The study invited all students at 630 high schools units throughout Sweden. The intervention group received text messages based on components of effective smoking cessation interventions for 12 weeks. The control group were offered treatment as usual. The primary outcomes were self-reported prolonged abstinence (not having smoked more than 5 cigarettes over the last 8 weeks) and 4-week point prevalence of smoking abstinence. FINDINGS: A total of 535 participants, with a median age of 17 (IQR 16-18), were randomized into the study; 276 (164 [59.4%] women) were allocated to the intervention and 259 (162 [62.5%] women) to the control group. The outcomes of the trial were analyzed on a total of 212 (76.8%) participants in the intervention group and 201 (77.6%) participants in the control group. Prolonged abstinence at the 3-month follow-up was reported by 49 (23.1%) individuals in the intervention group and 39 (19.4%) individuals in the control group (adjusted OR, 1.21; 95% CI, 0.73-2.01; P value, .46). Four-week point prevalence of complete smoking cessation was reported by 53 (25.0%) individuals in the intervention group and 31 (15.4%) individuals in the control group (adjusted OR, 1.87; 95% CI, 1.12-3.17; P value, .018). CONCLUSIONS: Estimates of 4-week point prevalence of complete cessation was 10 percentage points higher in the group that were given access to the intervention compared to the control. Findings provide confirmation that text messaging-based smoking cessation programs can affect quit rates among adolescents. TRIAL REGISTRATION: ISRCTN15396225; registration date October 13, 2017, https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3028-2.


Asunto(s)
Terapia Conductista , Teléfono Celular/estadística & datos numéricos , Conductas Relacionadas con la Salud , Cese del Hábito de Fumar/métodos , Fumar/epidemiología , Estudiantes/psicología , Telemedicina/métodos , Adolescente , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Autoinforme , Fumar/psicología , Prevención del Hábito de Fumar , Suecia/epidemiología , Envío de Mensajes de Texto/estadística & datos numéricos
11.
PLoS One ; 15(3): e0229637, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32134977

RESUMEN

INTRODUCTION: Despite tobacco being an important preventable factor with respect to ill health and death, it is a legal substance that harms and kills many of those who use it. Text messaging smoking cessation interventions have been evaluated in a variety of contexts, and are generally considered to have a positive effect on smoking cessation success. In order for text messaging interventions to continue to be useful as prevalence of smoking decreases, it may be necessary to tailor the interventions to specific individuals. However, little is known with regard to who benefits the most and least from existing interventions. METHODS: In order to identify heterogenous treatment effects, we analyzed data from a randomized controlled trial of a text messaging smoking cessation intervention targeting university students in Sweden. We used a Bayesian hierarchical model where the outcome was modelled using logistic regression, and so-called horseshoe priors were used for coefficients. Predictive performance of the model, and heterogeneous treatment effects, were calculated using cross-validation over the trial data. RESULTS: Findings from the study of heterogenous treatment effects identified less effect of the intervention among university students with stronger dependence of nicotine and students who smoke a greater quantity of cigarettes per week. No heterogeneity was found with respect to sex, number of years smoking, or the use of snuff. DISCUSSION: Results emphasize that individuals with a more developed dependence of nicotine may have a harder time quitting smoking even with support. This questions the dissemination and development of text messaging interventions to university students in the future, as they may not be the optimal choice of intervention for those with a more developed dependence. On the other hand, text messaging interventions may be useful to disseminate among university students that are at risk of developing a strong dependence. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 75766527; http://www.controlled-trials.com/ISRCTN75766527.


Asunto(s)
Cese del Hábito de Fumar/métodos , Fumar/terapia , Estudiantes/psicología , Fumar Tabaco/terapia , Adulto , Teorema de Bayes , Terapia Conductista/métodos , Femenino , Humanos , Masculino , Nicotina/administración & dosificación , Suecia , Envío de Mensajes de Texto , Tabaco sin Humo , Universidades , Adulto Joven
12.
PLoS One ; 15(3): e0230656, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32214373

RESUMEN

INTRODUCTION: Smoking is a strong risk factor for disease severity in Crohn's disease (CD) and cessation improves outcomes. The nicotine metabolite ratio (NMR) predicts cessation success with pharmacotherapy: varenicline doubles cessation over nicotine replacement therapy (NRT) for "normal", but not "slow" metabolizers. Varenicline side effects are heightened in slow metabolizers. Methods using NMR to optimize cessation pharmacotherapy have not been evaluated in CD. AIMS: We aim to determine the prevalence of smoking in a CD population and then assess these smokers' attitudes toward a personalized metabolism-informed care (MIC) approach to cessation. METHODS: In this observational study, we surveyed 1098 patients visiting an inflammatory bowel disease center about their smoking history. We then evaluated a subgroup of individuals with CD (n = 32) who participated in a randomized controlled trial of smoking cessation using MIC versus usual care. For MIC, medication selection was informed by the NMR (normal ≥0.31 vs. slow <0.31). The primary outcomes were intervention satisfaction and match rates between NMR and medication choice. RESULTS: The baseline prevalence of smoking in our CD population was 13%. Intervention participants reported high rates of satisfaction (85%) and chose a medication that matched their NMR result more often in the MIC group (100% vs. 64%, p = 0.01). Six of 16 (37.5%) patients prescribed varenicline discontinued due to side effects. CONCLUSION: MIC produced high rates of satisfaction and matching between NMR and medication in CD patients, supporting patient acceptance and feasibility of precision smoking cessation in this population. To reduce smoking in CD, therapies such as MIC are needed to maximize efficacy and minimize side effects.


Asunto(s)
Enfermedad de Crohn/patología , Nicotina/metabolismo , Cese del Hábito de Fumar/métodos , Adulto , Bupropión/efectos adversos , Bupropión/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Proyectos Piloto , Prevalencia , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Fumar/tratamiento farmacológico , Fumar/epidemiología , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Resultado del Tratamiento , Vareniclina/efectos adversos , Vareniclina/uso terapéutico
13.
Rev Infirm ; 69(257): 43-44, 2020 Jan.
Artículo en Francés | MEDLINE | ID: mdl-32146967

RESUMEN

In the field of addictology, care integrates activities that reactivate forgotten senses, emotions and postures. A "Photographs" workshop, led by a nurse in the addictology department, was modulated into a "Brief group photo-motivational intervention" to help people quit smoking. From this experience emerged an educational sequence of "Photo-Expression" integrated into the patient's therapeutic education programme "Help to stop smoking".


Asunto(s)
Cese del Hábito de Fumar/métodos , Humanos , Entrevista Motivacional , Educación del Paciente como Asunto , Fotograbar , Psicoterapia Breve , Psicoterapia de Grupo
14.
Aust N Z J Public Health ; 44(2): 116-120, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32050298

RESUMEN

OBJECTIVE: This study aimed to explore factors influencing community service organisation (CSO) staff members' willingness to provide tobacco cessation support to clients experiencing disadvantage. METHODS: Face-to-face semi-structured interviews were conducted with 29 staff members from seven services in the alcohol and other drugs, homelessness, and mental health sectors in Western Australia. RESULTS: The primary barriers to providing cessation support were believing that addressing smoking was not a priority relative to other issues, being a current smoker, and the lack of a formal tobacco cessation program within the organisation. Factors that appeared to be most influential in enabling the delivery of cessation support were organisational processes requiring staff to routinely ask clients about tobacco use, confidence to provide support, and being a past smoker. CONCLUSIONS: The introduction of organisational procedures that include routine cessation care should be of high priority in CSOs to help reduce smoking rates among clients. Staff may also benefit from receiving training in the provision of cessation support and education about the importance and feasibility of addressing smoking concurrently with other issues. Implications for public health: The results may inform future efforts to increase the delivery of cessation care to groups of people experiencing disadvantage and comorbidity.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/organización & administración , Organizaciones , Cese del Hábito de Fumar/métodos , Adolescente , Adulto , Anciano , Actitud Frente a la Salud , Australia , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Bienestar Social , Australia Occidental , Adulto Joven
15.
Dtsch Arztebl Int ; 117(1-2): 7-13, 2020 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-32008606

RESUMEN

BACKGROUND: Clinical guidelines on smoking cessation contain recommendations for various evidence-based methods. The goal of this study was to provide a represen- tative analysis for Germany of the percentage of smokers who try to quit smoking at least once per year, the use of evidence-based methods and other methods of smoking cessation, and potential associations of the use of such methods with the degree of tobacco dependence and with socioeconomic features. METHODS: Data from 19 waves of the German Smoking Behavior Questionnaire (Deutsche Befragung zum Rauchverhalten, DEBRA), from the time period June/July 2016 to June/July 2019, were analyzed. Current smokers and recent ex-smokers (<12 months without smoking) were asked about their smoking cessation attempts in the past year and the methods they used during the last attempt (naming more than one method was permitted). The degree of tobacco dependence in current smokers was assessed with the Heaviness of Smoking Index. RESULTS: Out of 11 109 current smokers and 407 recent ex-smokers, 19.9% (95% confidence interval: [19.1; 20.6]) had tried to quit smoking at least once in the preceding year. 13.0% of them [11.6; 14.5] had used at least one evidence-based method during their last attempt. The stronger the tobacco dependence, the more likely the use of an evidence-based method (odds ratio [OR] = 1.27 [1.16; 1.40]). Pharmacotherapy (nicotine replacement therapy, medication) was used more com- monly by persons with higher incomes (OR = 1.44 per 1000 euro/month [1.28; 1.62]). Electronic cigarettes were the most commonly used single type of smoking cessation support (10.2 % [9.0; 11.6]). CONCLUSION: In Germany, only one in five smokers tries to quit smoking at least once per year. Such attempts are only rarely supported by evidence-based methods and are thus likely to fail. The high cost of treatment must be borne by the individual and thus fall disproportionately on poorer smokers. It follows that there is an urgent need for vered by health insurance pro- viders, in order to give all smokers fair and equal access to the medical care they need.


Asunto(s)
Fumadores/psicología , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Práctica Clínica Basada en la Evidencia/estadística & datos numéricos , Alemania , Humanos , Fumadores/estadística & datos numéricos , Factores Socioeconómicos , Tabaquismo/psicología
16.
Expert Opin Pharmacother ; 21(5): 581-590, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32011186

RESUMEN

Introduction: Rates of tobacco smoking are high in people with schizophrenia with greater difficulty of quitting smoking compared to the general population, which also relate to the increased cardiovascular and cancer risks in this co-occurring disorder. Therefore, effective smoking cessation pharmacotherapies addressing tobacco co-morbidity are imperative.Areas covered: In this review, the authors performed an extensive systematic electronic literature review examining the efficacy and safety of first-line pharmacotherapies for smoking cessation, including varenicline, sustained-release bupropion, and nicotine replacement therapies (NRT) using continuous abstinence rates over 10-12-week periods in smokers with schizophrenia. Twelve trials reporting smoking cessation outcomes using interventions in schizophrenia were included and risk ratio (RR) was used.Expert opinion: Our findings support the efficacy and safety of first-line pharmacotherapies for the treatment of tobacco use disorder in smokers with schizophrenia. Further research on the long-term effectiveness and safety of these agents in community samples is warranted. Smoking cessation pharmacotherapies may warrant the consideration of the emerging use of electronic nicotine delivery systems while neuromodulation techniques also offer promise.


Asunto(s)
Esquizofrenia/tratamiento farmacológico , Cese del Hábito de Fumar/métodos , Fumar/tratamiento farmacológico , Benzazepinas/uso terapéutico , Bupropión/uso terapéutico , Humanos , Agonistas Nicotínicos/uso terapéutico , Quinoxalinas/uso terapéutico , Fumar/psicología , Dispositivos para Dejar de Fumar Tabaco , Vareniclina/uso terapéutico
17.
BMC Public Health ; 20(1): 7, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906908

RESUMEN

BACKGROUND: Reaching tobacco users is a persistent challenge for quitlines. In 2014, ClearWay MinnesotaSM changed its quitline services and media campaign, and observed substantial increases in reach and strong quit outcomes. Oklahoma and Florida implemented the same changes in 2015 and 2016. We examined whether the strategies used in Minnesota could be replicated with similar results. METHODS: We conducted a cross-sectional observational study of Minnesota's QUITPLAN® Services, the Oklahoma Tobacco Helpline, and Florida's Quit Your Way program. Each program offers free quitline services to their state's residents. For each state, data were compared for 1 year prior to service changes to 1 year after services changed and promotions began. Registration and program utilization data from 21,918 (Minnesota); 64,584 (Oklahoma); and 141,209 (Florida) program enrollees were analyzed. Additionally, outcome study data from 1542 (Minnesota); 3377 (Oklahoma); and 3444 (Florida) program enrollees were analyzed. We examined treatment reach, satisfaction, 24-h quit attempts, 30-day point prevalence abstinence rates, select demographic characteristics, registration mode (post period only), and estimated number of quitters. Data were analyzed using χ2 analyses and t-tests. RESULTS: Treatment reach rates increased by 50.62% in Oklahoma, 66.88% in Florida, and 480.56% in Minnesota. Significant increases in the estimated number of quitters were seen, ranging from + 42.75% to + 435.90%. Statistically significant changes in other variables (satisfaction, 24-h quit attempts, 30-day point prevalence abstinence rates, gender, and race) varied by state. During the post period, participants' method of registration differed. Online enrollment percentages ranged from 19.44% (Oklahoma), to 54.34% (Florida), to 70.80% (Minnesota). In Oklahoma, 71.63% of participants enrolled by phone, while 40.71% of Florida participants and 26.98% of Minnesota participants enrolled by phone. Fax or electronic referrals comprised 8.92% (Oklahoma), 4.95% (Florida), and 2.22% (Minnesota) of program enrollees, respectively. CONCLUSIONS: Changing quitline services and implementing a new media campaign increased treatment reach and the estimated number of participants who quit smoking in three states. Quitline funders and tobacco control program managers may wish to consider approaches such as these to increase quitline utilization and population health impact.


Asunto(s)
Difusión de Innovaciones , Líneas Directas/organización & administración , Cese del Hábito de Fumar/métodos , Adulto , Estudios Transversales , Femenino , Florida , Humanos , Masculino , Persona de Mediana Edad , Minnesota , Oklahoma , Evaluación de Programas y Proyectos de Salud , Cese del Hábito de Fumar/estadística & datos numéricos
18.
Ann Thorac Surg ; 109(2): e137-e139, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31586615

RESUMEN

The outcomes of an intensive, preoperative smoking cessation program in patients undergoing lung resection were evaluated. Of 340 patients undergoing resection, 82 were currently smoking. Sixty-one were involved in our smoking cessation program, and 45 patients (73.7%) in the program were able to quit by surgery. At the 6-month and 1-year follow-up, 29 (64.4%) and 22 patients (48.9%) abstained from smoking. An intensive smoking cessation program in the perioperative period demonstrated a high success rate, with good results up to 1 year postoperatively for those able to quit before surgery.


Asunto(s)
Neumonectomía , Cuidados Preoperatorios/métodos , Cese del Hábito de Fumar/métodos , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Tiempo
19.
Anaesthesia ; 75(2): 171-178, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31646623

RESUMEN

Free nicotine patches may promote pre-operative smoking cessation. Smokers (≥ 10 cigarettes.day-1 ) awaiting non-urgent surgery were randomly assigned (3:1) to an offer of free nicotine patches or a control group who were not offered free nicotine patches. The suggested regimen lasted 5 weeks, with patch strength decreasing incrementally after 3 and 4 weeks. The primary outcome was smoking abstinence for ≥ 4 weeks, as self-reported by participants on the day of surgery, including, where possible, corroboration using exhaled carbon monoxide testing. Out of 600 included smokers, 447 (74.5%) were randomly assigned to an offer of pre-operative nicotine patches, with 175 (39.1%) of these accepting the offer and 56 (12.5%) using patches for ≥ 3 weeks. Out of 396 participants offered nicotine patches who were included for analysis, 36 (9.1%) quit smoking for ≥ 4 weeks before surgery as compared with 8 (5.9%) controls, OR 1.5 [95%CI 0.7-3.2], p = 0.300. Sixty-three (15.9%) quit smoking for 24 h before surgery as compared with 15 (11.1%) controls, OR 1.4 [95%CI 0.8-2.4], p = 0.200. Participants offered nicotine patches were more likely to engage in a cessation attempt lasting more than 24 h, 46 (11.6%) vs. 5 (3.7%), OR 3.4 [95%CI 1.8-8.8], p = 0.010. Out of 78 participants who quit smoking by the day of surgery and were followed up at 6 months, 46 (59%) had relapsed. Offering free nicotine patches stimulated interest in quitting compared with controls, but our protocol had limited effectiveness.


Asunto(s)
Procedimientos Quirúrgicos Electivos , Cuidados Preoperatorios/métodos , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/terapia , Dispositivos para Dejar de Fumar Tabaco , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Resultado del Tratamiento
20.
J Oral Pathol Med ; 49(3): 181-189, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31642553

RESUMEN

BACKGROUND: Electronic cigarettes (e-cigarettes) and other electronic vaping devices are commonly used as a method to help tobacco smoking cessation. However, the data on their safety and efficacy are currently scarce. The aim of this review was to explore the role of e-cigarettes in tobacco cessation among tobacco users. TYPES OF STUDIES REVIEWED: PubMed, EMBASE, Scopus, Web of Science, and grey literature from January 1990 were searched up to and including September 2018. Two independent reviewers performed the study selection according to eligibility criteria. RESULTS: A total of 13 studies that met the eligibility criteria were included. The majority of studies were done in the USA, and all studies were longitudinal cohort studies. The odds of increased smoking cessation in association with e-cigarette use ranged from onefold to sixfolds. No significant increase in smoking cessation was found among e-cigarette users compared with non-e-cigarette users. Pattern of e-cigarette had positive influence on smoking cessation among users. CONCLUSIONS AND PRACTICAL IMPLICATIONS: E-cigarette use was not significantly associated with increased smoking cessation among cigarette smokers. We also found that pattern of e-cigarette may have significant effect on smoking cessation capability of e-cigarettes. Well-designed randomized controlled clinical trials are needed to assess the clinical efficacy of e-cigarettes in comparison with approved smoking cessation therapies.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar/métodos , Vapeo , Humanos , Estudios Longitudinales , Fumadores
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