Association between current cigarette prices and cessation behaviors among male adult smokers: findings from 2018 to 2020 ITC Vietnam surveys.

BACKGROUND: This study evaluated the impact of the tax increase in January 2019 on changes in intention to quit and the effect of cigarette prices on quit attempts and successful quitting among male cigarette smokers in Vietnam. METHODS: Data were derived from the ITC project in Vietnam, which included 1585 adult smokers at baseline (Wave 1, Aug-Oct 2018) followed up to waves 2 (Sep-Nov 2019) and 3 (Sep-Dec 2020). Generalized estimating equations regression was performed to estimate changes in the intention to quit. Multiple logistic regression analysis was used to evaluate the cigarette price of a cigarette pack in relation to quit attempts and successful quitting. RESULTS: The increase in cigarette tax in 2019 did not significantly increase the likelihood of the intention to quit. After the tax increase, 63.6% of participants who smoked made a quit attempt, and 27.6% successfully quit smoking in the follow-up waves. However, the price of a cigarette pack was not significantly associated with quit attempts and successful quitting. The study did not observe a significant impact of cigarette prices on quit attempts and successful quitting in all subgroups of household income. Factors associated with quit attempts included the number of cigarettes smoked and the intention to quit, while those associated with successful quitting included age, dual use of cigarettes and other tobacco products, and the intention to quit. CONCLUSION: Current cigarette prices were not associated with cessation behaviors even within the lowest household income group. Therefore, a sharp rise in cigarette tax is required to incentivize smokers to quit smoking.

Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: A Randomized Clinical Trial.

Importance: Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions. Objectives: To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES. Design, Setting, and Participants: This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024. Interventions: Participants were randomized to usual care (UC) for smoking cessation (counseling plus pharmacotherapy) or UC plus abstinence-contingent financial incentives (UC plus FI). Main Outcomes and Measures: The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (PPA) at 26 weeks after the quit date. Secondary outcomes included biochemically verified 7-day PPA at earlier follow-ups, 30-day PPA at 12 and 26 weeks, repeated 7-day PPA, and continuous abstinence. Multiple approaches were employed to handle missing outcomes at follow-up, including categorizing missing data as smoking (primary), complete case analysis, and multiple imputation. Results: The 320 participants had a mean (SD) age of 48.9 (11.6) and were predominantly female (202 [63.1%]); 82 (25.6%) were Black, 15 (4.7%) were Hispanic, and 200 (62.5%) were White; and 146 (45.6%) participated during the COVID-19 pandemic. Overall, 161 were randomized to UC and 159 were randomized to UC plus FI. After covariate adjustment with missing data treated as smoking, assignment to UC plus FI was associated with a greater likelihood of 7-day PPA at the 4-week (adjusted odds ratio [AOR], 3.11 [95% CI, 1.81-5.34]), 8-week (AOR, 2.93 [95% CI, 1.62-5.31]), and 12-week (AOR, 3.18 [95% CI, 1.70-5.95]) follow-ups, but not at the 26-week follow-up (22 [13.8%] vs 14 [8.7%] abstinent; AOR, 1.79 [95% CI, 0.85-3.80]). However, the association of group assignment with smoking cessation reached statistical significance at all follow-ups, including 26 weeks, with multiple imputation (37.37 [23.5%] in the UC plus FI group vs 19.48 [12.1%] in the UC group were abstinent; AOR, 2.29 [95% CI, 1.14-4.63]). Repeated-measures analyses indicated that participants in the UC plus FI group were significantly more likely to achieve PPA across assessments through 26 weeks with all missing data estimation methods. Other secondary cessation outcomes also showed comparable patterns across estimation methods. Participants earned a mean (SD) of $72 ($90) (of $250 possible) in abstinence-contingent incentives. Participation during the COVID-19 pandemic reduced the likelihood of cessation across assessments. Conclusions and Relevance: In this randomized clinical trial, incentivizing smoking cessation did not increase cessation at 26 weeks when missing data were treated as smoking; however, the UC plus FI group had greater odds of quitting at follow-ups through 12 weeks. Cessation rates were higher for the UC plus FI group at all follow-ups through 26 weeks when multiple imputation was used to estimate missing outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT02737566.

Tax increases as an incentive to quit smoking: is thinking about quitting due to a tobacco tax increase associated with post-tax increase smoking cessation?

BACKGROUND: The cost of tobacco is one of the most reported reasons to quit smoking. The Netherlands increased tobacco taxes twice in the span of nine months: a €1 increase per pack in April 2020, and a €0.12 increase per pack in January 2021. This study examines to what extent people report to think about quitting due to the upcoming tax increase(s), as well as how it relates to their age, income or educational level. Additionally, we examined whether thinking about quitting was associated with quit intention and quit behaviour, and whether these associations were different for the two tax increases. METHODS: Longitudinal data from the International Tobacco Control (ITC) Netherlands Surveys, Cohort 2 were used (N = 5919 observations; wave 1 (February - March 2020): n = 2051; wave 2 (September - November 2020): n = 1919; wave 3 (June - July 2021): n = 1949). Generalised Estimating Equation (GEE) regressions were fit to test the associations between thinking about quitting due to the tax increase and post-tax increases in quit intention, serious quit attempts, and quitting smoking (≤ 1 cigarette a month), as well as sociodemographic variables. RESULTS: Circa half of the people who smoke reported thinking about quitting smoking due to the upcoming tax increase (Wave 1 = 51.3% (n = 1052); Wave 2 = 47.3% (n = 849)). Individuals who reported thinking about quitting smoking due to upcoming tax increase(s) were more likely to have increased their quit intention (aOR: 2.00, p ≤ .001) or have carried out a serious quit attempt (aOR:1.48, p ≤ .001) post-tax increase. More people attempted to quit smoking between wave 2 and 3 (post 2021 increase) than between wave 1 and 2 (post 2020 increase). We did not find an interaction effect between wave and thinking about quitting for quit intention, quit attempts, and quitting smoking. CONCLUSIONS: Tax increases stimulate people to think about quitting. Thinking about quitting due to an upcoming tax increase was associated with more positive quit intention and serious quit attempts.

[Application of the cigarette purchase tasks in achieving China' s tobacco control goals].

OBJECTIVE: To assess cigarette demand among Chinese smokers through a cigarette purchase task (CPT) and to evaluate cigarette prices under different hypothetical scenarios in order to meet the goals of smoking prevalence reduction in China. METHODS: In the study, 447 participants completed a hypothetical CPT at baseline assessments of a trial, thus, cigarette demand curves were individually fitted for each participant using an exponentiated version of the exponential demand model. Typically, five demand indices were derived, intensity (consumption when free), breakpoint (first price at which consumption is suppressed to 0), maximum output (Omax), maximum price (Pmax, price at which Omax occurred), and elasticity (the ratio of the change in quantity demanded to the change in price). A one-way analysis of variance was used to explore the correlations between the cigarette purchase task indices and socio-demographic and smoking characteristics. The one-way decay model was employed to simulate the smoking cessation rates and determine optimal cigarette prices in a series of scenarios for achieving 20% smoking prevalence. RESULTS: The price elasticity drawn from CPT was 0.54, indicating that a 10% price increase could reduce smoking by 5.4% in the participated smokers. Smokers with higher income were less sensitive to cigarette prices (elasticity=-2.31, P=0.028). Cigarette purchase task indices varied significantly among the smokers with different prices of commonly used cigarettes, tobacco dependence, and smoking volume. The smokers who consumed cigarettes of higher prices reported higher breakpoint, Omax and Pmax, but lower intensity (P=0.001). The smokers who were moderately or highly nicotine dependent reported higher intensity, breakpoint, Omax and Pmax, and they had lower intensity (P=0.001). The smokers who had a higher volume of cigarettes reported higher intensity and Omax, and lower intensity (P < 0.001). To achieve the goal of reducing smoking prevalence to 20% in mainland China, we estimated the desired increase on smoking cessation rate and prices accordingly in a series of scenarios, considering the gender variance and reduced smoking initiation. In scenario (a), to achieve a smoking prevalence goal of 20%, it would be necessary for 24.81% of the current smokers to quit smoking when there were no new smokers. Our fitting model yielded a corresponding value of 59.64 yuan (95%CI 53.13-67.24). Given the assumption in scenario (b) that only males quitted smoking, the desired cessation rates would be 25.82%, with a higher corresponding price of 62.15 yuan (95%CI 55.40-70.06) to induce desired cessation rates. In the proposed scenario (c) where 40 percent of the reduction in smoking prevalence came from reduced smoking initiation, and females and males equally quitted smoking due to increased cigarette prices, the price of a pack of cigarettes would be at least 37.36 yuan (95%CI 32.32-42.69) (equals to $ 5.20) per pack to achieve the cessation rate of 14.89 percent. In scenario (d) where only males quitted smoking due to increased cigarette prices considering the reduced smoking initiation, the respective smoking cessation rates should be 15.49% with the desired prices of 38.60 yuan (95%CI 33.53-44.02). After adjusting for education levels and income levels in scenario (c), the price of cigarettes would be at least 37.37 yuan/pack (equals to $ 5.20) (95%CI 30.73-44.94) and 37.84 yuan/pack (equals to $ 5.26) (95%CI 31.94-44.53), respectively. CONCLUSION: Cigarette purchase task indices are significantly associated with income levels and prices of commonly used cigarettes, levels of tobacco dependence, and smoking volume, which is inspiring in studying price factors that influence smoking behavior. It is suggested that higher cigarette prices, surpassing the current actual market level, is imperative in mainland China. Stronger policy stra-tegies should be taken to increase tobacco taxes and retail cigarette prices to achieve the Healthy China 2030 goal of reducing smoking prevalence to 20%.

A systematic review of the modelling and economic evaluation studies assessing regulatory options for e-cigarette use.

BACKGROUND: Governments around the world are considering regulating access to nicotine e-cigarettes to prevent uptake among youth however people that smoke tobacco may use them to assist with smoking cessation. The health and cost implications of regulating e-cigarette use among populations are unknown but have been explored in modelling studies. We reviewed health economic evaluation and simulation modelling studies that assessed long-term consequences and interpret their potential usefulness for decision-makers. METHODS: A systematic review with a narrative synthesis was undertaken. Six databases were searched for modelling studies evaluating population-level e-cigarette control policies or interventions restricting e-cigarette use versus more liberalized use. Studies were required to report the outcomes of life years, quality-adjusted life years (QALYs) and/or healthcare costs. The quality of the studies was assessed using two quality assessment tools. RESULTS: In total, 15 studies were included with nine for the United States and one each for the United Kingdom, Italy, Australia, Singapore, Canada, and New Zealand. Three studies included cost-utility analyses. Most studies involved health state transition (or Markov) closed cohort models. Many studies had limitations with their model structures, data input quality and transparency, and insufficient analyses handling model uncertainty. Findings were mixed with 11 studies concluding that policies permitting e-cigarette use lead to net benefits and 4 studies concluding net losses in life-years or QALYs and/or healthcare costs.Five studies had industry conflicts of interest. CONCLUSIONS: While authors did conclude net benefit than net harm in more of the studies so far conducted, the significant limitations that we identified with many of the studies in this review, make it uncertain whether or not countries can expect net population harms or benefits of restrictive versus unrestrictive e-cigarette policies. The generalizability of the findings is limited for decision-makers. In light of the deep uncertainty around the health and economic outcomes of e-cigarettes, simulation modelling methods and uncertainty analyses should be strengthened.

Interpreting results, impacts and implications from WHO FCTC tobacco control investment cases in 21 low-income and middle-income countries.

BACKGROUND: Tobacco control investment cases analyse the health and socioeconomic costs of tobacco use and the benefits that can be achieved from implementing measures outlined in the WHO Framework Convention on Tobacco Control (WHO FCTC). They are intended to provide policy-makers and other stakeholders with country-level evidence that is relevant, useful and responsive to national priorities and policy context. METHODS: This paper synthesises findings from investment cases conducted in Armenia, Cabo Verde, Cambodia, Chad, Colombia, Costa Rica, El Salvador, Eswatini, Georgia, Ghana, Jordan, Laos, Madagascar, Myanmar, Nepal, Samoa, Sierra Leone, Sri Lanka, Suriname, Tunisia and Zambia. We examine annual socioeconomic costs associated with tobacco use, focusing on smoking-related healthcare expenditures, the value of lives lost due to tobacco-related mortality and workplace productivity losses due to smoking. We explore potential benefits associated with WHO FCTC tobacco demand-reduction measures. RESULTS: Tobacco use results in average annual socioeconomic losses of US$95 million, US$610 million and US$1.6 billion among the low-income (n=3), lower-middle-income (n=12) and upper-middle-income countries (n=6) included in this analysis, respectively. These losses are equal to 1.1%, 1.8% and 2.9% of average annual national gross domestic product, respectively. Implementation and enforcement of WHO FCTC tobacco demand-reduction measures would lead to reduced tobacco use, fewer tobacco-related deaths and reduced socioeconomic losses. CONCLUSIONS: WHO FCTC tobacco control measures would provide a positive return on investment in every country analysed.

Effect of 3 months and 12 months of financial incentives on 12-month postpartum smoking cessation maintenance: A randomized controlled trial.

BACKGROUND AND AIMS: Offering financial incentives is effective for smoking cessation during pregnancy. We tested the effectiveness of financial incentives for maintaining postpartum cessation, comparing 12-month and 3-month incentives with each other and with usual care (UC). DESIGN, SETTING AND PARTICIPANTS: This study was a pragmatic, multi-centre, three-arm randomized controlled trial involving four English, National Health Service, stop smoking services. A total of 462 postpartum women (aged ≥ 16 years) took part, who stopped smoking during pregnancy with financial incentives, validated as abstinent from smoking at end of pregnancy or early postpartum. INTERVENTIONS: Interventions comprised (i) UC; (ii) UC plus up to £60 of financial voucher incentives offered to participants and £60 offered to an optional significant-other supporter, over 3 months postpartum, contingent upon validated abstinence ('3-month incentives'); or (iii) UC plus '3-month incentives' plus £180 of vouchers offered to participants over 9 months postpartum, contingent upon abstinence ('12-month incentives'). MEASUREMENTS: Primary outcome: biochemically validated abstinence at 1 year postpartum. To adjust for testing all comparisons between groups with equal precision, P < 0.017 was necessary for significance. SECONDARY OUTCOMES: self-reported and validated abstinence at 3 months postpartum; self-reported abstinence at 1 year postpartum. FINDINGS: Primary outcome ascertainment: abstinence was 39.6% (63/159) 12 months incentives, 21.4% (33/154) 3 months incentives and 28.2% (42/149) UC. Adjusted odds ratios [95% confidence interval (CI)] = 12-month versus 3-month incentives OR = 2.41 (95% CI = 1.46-3.96), P = 0.001; 12 months versus UC 1.67 (1.04-2.70), P = 0.035; 3 months versus UC 0.69 (0.41-1.17), P = 0.174. Bayes factors indicated that for 12-month versus 3-month incentives and 12 months versus UC there was good evidence for the alternative hypothesis, and for 3 months versus UC there was good evidence for the null hypothesis. CONCLUSIONS: This randomized controlled trial provides weak evidence that up to £300 of voucher incentives over 12 months is effective for maintaining smoking abstinence postpartum compared with usual care. There was good evidence that 12-month incentives are superior to those over only 3 months, for which there was no evidence of effectiveness relative to usual care.

Economic Evaluation of Enhanced vs Standard Varenicline Treatment for Tobacco Cessation.

Importance: Smoking is the leading preventable cause of death and illness in the US. Identifying cost-effective smoking cessation treatment may increase the likelihood that health systems deliver such treatment to their patients who smoke. Objective: To evaluate the cost-effectiveness of standard vs enhanced varenicline use (extended varenicline treatment or varenicline in combination with nicotine replacement therapy) among individuals trying to quit smoking. Design, Setting, and Participants: This economic evaluation assesses the Quitting Using Intensive Treatments Study (QUITS), which randomized 1251 study participants who smoked into 4 conditions: (1) 12-week varenicline monotherapy (n = 315); (2) 24-week varenicline monotherapy (n = 311); (3) 12-week varenicline combination treatment with nicotine replacement therapy patch (n = 314); or (4) 24-week varenicline combination treatment with nicotine replacement therapy patch (n = 311). Study enrollment occurred in Madison and Milwaukee, Wisconsin, between November 11, 2017, and July 2, 2020. Statistical analysis took place from May to October 2023. Main Outcomes and Measures: The primary outcome was 7-day point prevalence abstinence (biochemically confirmed with exhaled carbon monoxide level ≤5 ppm) at 52 weeks. The incremental cost-effectiveness ratio (ICER), or cost per additional person who quit smoking, was calculated using decision tree analysis based on abstinence and cost for each arm of the trial. Results: Of the 1251 participants, mean (SD) age was 49.1 (11.9) years, 675 (54.0%) were women, and 881 (70.4%) completed the 52-week follow-up. Tobacco cessation at 52 weeks was 25.1% (79 of 315) for 12-week monotherapy, 24.4% (76 of 311) for 24-week monotherapy, 23.6% (74 of 314) for 12-week combination therapy, and 25.1% (78 of 311) for 24-week combination therapy, respectively. The total mean (SD) cost was $1175 ($365) for 12-week monotherapy, $1374 ($412) for 12-week combination therapy, $2022 ($813) for 24-week monotherapy, and $2118 ($1058) for 24-week combination therapy. The ICER for 12-week varenicline monotherapy was $4681 per individual who quit smoking and $4579 per quality-adjusted life-year (QALY) added. The ICER for 24-week varenicline combination therapy relative to 12-week monotherapy was $92 000 000 per additional individual who quit smoking and $90 000 000 (95% CI, $15 703 to dominated or more costly and less efficacious) per additional QALY. Conclusions and Relevance: This economic evaluation of standard vs enhanced varenicline treatment for smoking cessation suggests that 12-week varenicline monotherapy was the most cost-effective treatment option at the commonly cited threshold of $100 000/QALY. This study provides patients, health care professionals, and other stakeholders with increased understanding of the health and economic impact of more intensive varenicline treatment options.

Electronic Decision-Making Tool for Smoking Cessation (Pare de Fumar Conosco) Versus Standard of Care: A Cost-Effectiveness Analysis.

OBJECTIVES: The study aimed to evaluate the cost-effectiveness of the Pare de Fumar Conosco software compared with the standard of care adopted in Brazil for the treatment of smoking cessation. METHODS: In the cohort of smokers with multiple chronic conditions, we developed an decision tree model for the benefit measures of smoking cessation. We adopted the perspectives of the Brazilian Unified Health System and the service provider. Resources and costs were measured by primary and secondary sources and effectiveness by a randomized clinical trial. The incremental cost-effectiveness ratio (ICER) was calculated, followed by deterministic and probabilistic sensitivity analyses and deterministic and probabilistic sensitivity analyses. No willingness to pay threshold was adopted. RESULTS: The software had a lower cost and greater effectiveness than its comparator. The ICER was dominant in all of the benefits examined (-R$2 585 178.29 to -R$325 001.20). The cost of the standard of care followed by that of the electronic tool affected the ICER of the benefit measures. In all probabilistic analyses, the software was superior to the standard of care (53.6%-82.5%). CONCLUSION: The Pare de Fumar Conosco software is a technology that results in cost savings in treating smoking cessation.

Incremental net monetary benefit of using varenicline for smoking cessation: A systematic review and meta-analysis of economic evaluation studies.

AIMS: To conduct a systematic review and meta-analysis and pool the incremental net benefits (INBs) of varenicline compared with behaviour support with bupropion or nicotine replacement therapy (NRT), behaviour support alone and unaided cessation in adult smokers making a first-time attempt to quit. METHODS: A search for economic evaluation studies was conducted from inception to 30 September 2022, on PubMed, Embase, Cost-Effectiveness Analysis (CEA) Registry by Tufts Medical Centre, EconLit and the NHS Economic Evaluation Database (NHS EED). Eligible studies were included if they were (1) conducted among adults ages 18 years old and older who were smokers attempting to quit for the first time; (2) compared varenicline to behaviour support with bupropion or NRT, behaviour support alone and unaided cessation; and (3) performed a CEA or cost-utility analysis. The INBs were calculated and pooled across studies stratified by country income level and study perspective using the random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic and Cochrane Q statistic. RESULTS: Of the 1433 identified studies, 18 studies were included in our review. Our findings from healthcare system/payer perspective suggested that the use of varenicline is statistically significantly cost-effective compared with bupropion (pooled INB, $830.75 [95% confidence interval, $208.23, $1453.28]), NRTs ($636.16 [$192.48, $1079.84]) and unaided cessation ($4212.35 [$1755.79, $6668.92]) in high-income countries. Similarly, varenicline is also found to be cost-effective compared to bupropion ($2706.27 [$1284.44, $4128.11]), NRTs ($3310.01 [$1781.53, $4838.50]) and behavioural support alone ($5438.22 [$4105.99, $6770.46]) in low- and middle-income countries. CONCLUSION: Varenicline is cost-effective as a smoking cessation aid when compared with behavioural support with bupropion or nicotine replacement therapies and behavioural support alone in both high-income countries and low- and middle-income countries, from the healthcare system/payer perspective in adult smokers who attempt to quit for the first time.

Effects of an Increased Financial Incentive on Follow-up in an Online, Automated Smoking Cessation Trial: A randomized Controlled Study Within a Trial.

INTRODUCTION: Poor retention in clinical trials can impact on statistical power, reliability, validity, and generalizability of findings and is a particular challenge in smoking cessation studies. In online trials with automated follow-up mechanisms, poor response also increases the resource need for manual follow-up. This study compared two financial incentives on response rates at 6 months follow up, in an online, automated smoking cessation feasibility trial of a cessation smartphone app (Quit Sense). AIMS AND METHODS: A study within a trial (SWAT), embedded within a host randomized controlled trial. Host trial participants were randomized 1:1 to receive either a £10 or £20 voucher incentive, for completing the 6-month questionnaire. Stratification for randomization to the SWAT was by minimization to ensure an even split of host trial arm participants and by 6-week response rate. Outcome measures were: Questionnaire completion rate, time to completion, number of completers requiring manual follow-up, and completeness of responses. RESULTS: Two hundred and four participants were randomized to the SWAT. The £20 and £10 incentives did not differ in completion rate at 6 months (79% vs. 74%; p = .362) but did reduce the proportion of participants requiring manual follow-up (46% vs. 62%; p = .018) and the median completion time (7 days vs. 15 days; p = .008). Measure response completeness rates were higher among £20 incentive participants, though differences were small for the host trial's primary smoking outcome. CONCLUSIONS: Benefits to using relatively modest increases in incentive for online smoking cessation trials include more rapid completion of follow-up questionnaires and reduced manual follow-up. IMPLICATIONS: A modest increase in incentive (from £10 to £20) to promote the completion of follow-up questionnaires in online smoking cessation trials may not increase overall response rates but could lead to more rapid data collection, a reduced need for manual follow-up and reduced missing data among those who initiate completing a questionnaire. Such an improvement may help to reduce bias, increase validity and generalizability, and improve statistical power in smoking cessation trials. TRIAL REGISTRATION: Host trial ISRCTN12326962, SWAT repository store ID 164.

The association between excise taxes and smoking and vaping transitions-Findings from the 2016-2020 ITC United States surveys.

BACKGROUND: While a growing number of studies examined the effect of e-cigarette (EC) excise taxes on tobacco use behaviors using cross-sectional surveys or sales data, there are currently no studies that evaluate the impact of EC taxes on smoking and vaping transitions. METHODS: Using data from the US arm of the 2016-2020 International Tobacco Control Four Country Smoking and Vaping Survey (ITC 4CV), we employed a multinomial logit model with two-way fixed effects to simultaneously estimate the impacts of cigarette/EC taxes on the change in smoking and vaping frequencies. RESULTS: Our benchmark model suggests that a 10 % increase in cigarette taxes led to an 11 % reduction in smoking frequencies (p < 0.01), while EC taxes did not have a significant effect on smoking frequencies. CONCLUSION: Our findings suggest that increasing cigarette taxes may serve as an effective means of encouraging people who smoke to cut back on smoking or quit smoking. The impact of increasing EC taxes on smoking transitions is less certain at this time.

How and why do financial incentives contribute to helping people stop smoking? A realist review.

BACKGROUND: Tobacco smoking remains a key cause of preventable illness and death globally. In response, many countries provide extensive services to help people to stop smoking by offering a variety of effective behavioural and pharmacological therapies. However, many people who wish to stop smoking do not have access to or use stop smoking supports, and new modes of support, including the use of financial incentives, are needed to address this issue. A realist review of published international literature was undertaken to understand how, why, for whom, and in which circumstances financial incentives contribute to success in stopping smoking for general population groups and among pregnant women. METHODS: Systematic searches were undertaken from inception to February 2022 of five academic databases: MEDLINE (ovid), Embase.com, CIHAHL, Scopus and PsycINFO. Study selection was inclusive of all study designs. Twenty-two studies were included. Using Pawson and Tilley's iterative realist review approach, data collected were screened, selected, coded, analysed, and synthesised into a set of explanatory theoretical findings. RESULTS: Data were synthesised into six Context-Mechanism-Outcome Configurations and one overarching programme theory after iterative rounds of analysis, team discussion, and expert panel feedback. Our programme theory shows that financial incentives are particularly useful to help people stop smoking if they have a financial need, are pregnant or recently post-partum, have a high threshold for behaviour change, and/or respond well to external rewards. The incentives work through a number of mechanisms including the role their direct monetary value can play in a person's life and through a process of reinforcement where they can help build confidence and self-esteem. CONCLUSION: This is the first realist review to synthesise how, why, and for whom financial incentives work among those attempting to stop smoking, adding to the existing evidence demonstrating their efficacy. The findings will support the implementation of current knowledge into effective programmes which can enhance the impact of stop smoking care. PROSPERO REGISTRATION NUMBER: CRD42022298941.

Cigarette Prices and Disparities in Smoking Cessation in the United States.

INTRODUCTION: Achieving cessation in people with established smoking patterns remains a challenge. Increasing cigarette prices has been one of the most successful strategies for lowering smoking rates. The extent to which it has remained effective in encouraging cessation among adults in recent years and how the effectiveness has varied by sociodemographic characteristics is unclear. AIMS AND METHODS: Using repeated cross-sectional data collected by the Tobacco Use Supplement of the Current Population Survey, we investigate the relationship between cigarette prices and cessation from 2003 to 2019 in adults at least 25 years old. We examine the associations between price and cessation in the population overall and by sex, race and ethnicity, and socioeconomic status. RESULTS: We found mixed support for associations between greater local prices and cessation. Unadjusted models showed that greater local prices were associated with greater odds of cessation, but the associations did not persist after controlling for sociodemographic characteristics. The associations did not significantly differ by respondent characteristics. Sensitivity analysis using alternative specifications and retail state price as the main predictor showed similar results. Sensitivity analysis with controls for e-cigarette use in the 2014-2019 period showed that greater local price was associated with cessation among adults with less than a high school degree. When stratified by year of data collection, results show that greater local prices were associated with cessation after 2009. CONCLUSIONS: Overall, the study adds to the conflicting evidence on the effectiveness of increasing prices on smoking cessation among adults with established smoking patterns. IMPLICATIONS: Higher cigarette prices have been one of the most successful tools for lowering smoking prevalence. It remains unclear how effective they have been in recent years in encouraging adults with established smoking patterns to quit. The study's results show that greater local prices were associated with higher odds of cessation, but the association did not persist after sociodemographic adjustment. In a sensitivity analysis, greater local price was associated with cessation among people with less than a high school degree in models controlling for e-cigarette use. We also found evidence that greater local price was associated with cessation after 2009. More comprehensive smoke-free coverage was also associated with greater odds of cessation. The study's results highlight that encouraging cessation among adults with an established smoking pattern remains a challenging policy problem even when cigarette prices rise.

Financiación de los tratamientos para ayudar a dejar de fumar: ¿para cuándo? / Funding smoking cessation therapy: When can we expect it?

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Programa de ayuda a dejar de fumar en Navarra. 25 años de andadura / Assistance program in quitting tobacco use in Navarra. 25 years on stage

En Navarra el Programa de Ayuda a Dejar de Fumar (PAF) nace en1994 fruto de la colaboración entre Salud Pública y Atención Primaria y desde 2001 se integra en el Plan Foral de Acción sobre el Tabaco, junto con otras dos líneas de actuación: prevención al inicio y espacios sin humo. El PAF incluye dos niveles de intervención, básico e intensivo, con apoyo educativo programado individual y grupal y periodos de financiación farmacológica. En diciembre de 2017se reintrodujo la financiación de los fármacos para la deshabituación tabáquica en las mismas condiciones que el resto de medicamentos, limitada a un tratamiento por paciente y año, siempre en el contexto de un programa de apoyo educativo. En 2018 se beneficiaron de la financiación 6.139personas, la mitad mujeres y 6 de cada 10 con rentas inferiores a 18.000 euros. Los resultados de la evaluación preliminar, realizada mediante encuesta telefónica, muestran una tasa declarada de abandono al año del 35%, que asciende al 40% si se recibe apoyo educativo. CONCLUSIONES: El PAF en Navarra cuenta con un modelo de intervención una amplia experiencia en la colaboración entre Atención Primaria y Salud Pública, que es necesario mantener y reforzar. La financiación de los fármacos para ayudar a dejar de fumar en el PAF es efectiva. El éxito es mayor si la persona recibe apoyo educativo y contribuye a la equidad ya que favorece el acceso de personas con renta menor. Se vislumbran nuevos retos de futuro en las tres líneas de actuación del plan

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-freespaces. 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. CONCLUSIONS: PAF in Navarre is an intervention model based on a large experience of collaboration between Primary Care and Public Health, which is necessary to promote. Funding medications for smoking cessation have proved to be effective with in PAF program and it may contribute to equity as it facilitates the access to people with lower income. Success rates are greater receiving educational support. There are new challenges in the future related to all action lines of the Action Plan

Facebook recruitment of smokers: comparing gain- and loss-framed ads for the purposes of an Internet-based smoking cessation intervention / Recrutamento de fumantes através do Facebook: uma comparação de anúncios com informações positivas e negativas em uma intervenção online voltada para a cessação do tabagismo / Captación de fumadores a través de Facebook: comparación de anuncios resaltados sobre los beneficios de dejar de fumar y los perjuicios del tabaquismo para una campaña publicitaria realizada en Internet como intervención contra el tabaquismo

Abstract: Gain- and loss-framed messages about smoking behavior have commonly been used to promote cessation. However, there are still no clear conclusions as to what kind of message is more effective for motivating smokers to quit. This study compared the effectiveness of loss- and gain-framed messages in the online recruitment of smokers via Facebook Advertising. Loss- and gain-framed messages about smoking were created and released as Facebook ads. Users who clicked on the ads were automatically redirected to the "Live Without Tobacco" intervention (http://www.vivasemtabaco.com.br). The amount spent on the ads was BRL 647.64. Data were collected from the Facebook Ads platform and from a relational database. Analyses were performed on the 6,350 users who clicked on one of the ads and 1,731 who were successfully redirected to the intervention. Gain-framed ads reached 174,029 people and loss-framed ads reached 180,527. The former received 2,688 clicks, while the latter received 3,662. The cost of the click was BRL 0.12 per gain-framed ad and BRL 0.09 per loss-framed ad. Loss-framed ads reached more users, got more clicks (and website accesses), and led to more accounts and quit plans being created. Loss-framed messages about smoking appear to be more cost-effective for both initial recruitment and intervention engagement. Facebook has proven to be a good outreach and recruitment tool and can be a solution for the difficulty in reaching smokers for cessation interventions.

Resumo: A cessação do tabagismo tem sido promovida através de mensagens positivas, focadas em ganhos, e negativas, focadas em perdas. Entretanto, ainda não há conclusões claras sobre o tipo de medida mais eficaz na motivação dos fumantes para deixar de fumar. O estudo comparou a efetividade das mensagens negativas e positivas no recrutamento online de fumantes através de anúncios no Facebook. Mensagens negativas e positivas sobre o tabagismo foram criadas e divulgadas pelo Facebook Ads. Ao clicar nos anúncios, os usuários eram automaticamente direcionados para a intervenção "Viva Sem Tabaco" (http://www.vivasemtabaco.com.br). O valor gasto na divulgação foi de BRL 647,64. Os dados foram extraídos da plataforma de anúncios do Facebook e de uma base de dados relacionais. As análises foram realizadas para os 6.350 usuários que clicaram em um dos anúncios e para os 1.731 usuários que foram redirecionados para a intervenção. Os anúncios positivos atingiram 174.029 pessoas e os negativos 180.527, que foram convertidas em 2.688 e 3.662 cliques, respectivamente. O custo do clique foi de BRL 0,12 para os anúncios positivos e de BRL 0,09 para os negativos. Os anúncios negativos atingiram mais usuários, receberam mais cliques no site e tiveram maior conversão em número de contas e planos de cessação criados. As mensagens sobre as perdas associadas com o tabagismo parecem ser mais custo-eficazes, tanto no recrutamento quanto no engajamento dos fumantes na intervenção. O Facebook mostrou ser uma boa ferramenta de divulgação e recrutamento e pode ser uma solução para a dificuldade de alcançar fumantes para intervenções de cessação.

Resumen: Los anuncios resaltados sobre los efectos del tabaco se han utilizado para luchar contra el tabaquismo. No obstante, todavía no existen conclusiones claras sobre qué tipo de mensaje es el más efectivo para motivar a los fumadores a dejar este hábito. Este estudio comparó la efectividad de anuncios resaltados sobre los beneficios de dejar de fumar y otros sobre los perjuicios del tabaquismo para una campaña de captación de fumadores en línea a través de Facebook Advertising. Estos anuncios fueron creados y divulgados mediante Facebook Ads. Los usuarios que hicieron clic en los anuncios fueron automáticamente redirigidos a la intervención "Vive sin Tabaco" (http://www.vivasemtabaco.com.br). La cantidad invertida para su difusión fue BRL 647.64. Los datos se recogieron de la plataforma Facebook Ads y de una base de datos relacional. Los análisis se realizaron con 6.350 fumadores que hicieron clic en uno de los anuncios y con los 1.731 que fueron redirigidos a la intervención. Los anuncios sobre los beneficios de dejar de fumar llegaron a 174.029 personas y los relativos a los perjuicios a 180.527, que se convirtieron en 2.688 y 3.662 clics, respectivamente. El coste del clic fue BRL 0.12 para los anuncios sobre los beneficios de dejar de fumar y BRL 0.09 en el caso de los que subrayaban los perjuicios. Estos últimos alcanzaron a más usuarios, tuvieron más clics en la página web, y existió una conversión más grande entre el número de cuentas y planes creados para dejar de fumar. Asimismo, estos anuncios se muestran como más costo efectivos, tanto para la captación, como para la implicación de fumadores en esta intervención. Facebook ha demostrado ser una buena herramienta de alcance y captación y puede ser una solución para evitar la dificultad de llegar a fumadores en intervenciones de lucha contra el tabaquismo.

Propuesta de cesación del tabaco para la Atención Primaria de Salud (APS) en Chile, bajo un enfoque costo-beneficio / Smoking cessation proposal for Primary Health Care (PHC) in Chile, under a cost-benefit approach

Objetivo. El propósito de esta investigación fue realizar una evaluación económica costo-beneficio ex ante (evaluación previa) de un programa piloto integral de prevención y tratamiento de cesación tabáquica en los centros de salud familiar (CESFAM) de la Atención Primaria de Salud (APS) de la comuna de Peñalolén, ubicada en el área oriente de Santiago de Chile. Pacientes y método. El estudio corresponde a la evaluación económica del programa piloto integral de prevención y cesación tabáquica, considerando los costos y beneficios que generará el programa, contra la realidad actual de ausencia de programa de cesación tabáquica, incluyéndose a 100 adultos de ambos sexos de 25 a 65 años. Los cálculos se realizaron en un horizonte temporal de 33,77 años con una abstinencia esperada del 30%. Se consideró como costes el uso de espacios en los recintos de salud, gestión del programa, capacitación universal, selectiva e intensiva a los funcionarios de los centros de salud, así como, medicamentos y honorarios profesionales de médicos, psicólogos, kinesiólogos y nutricionistas más utilización de plataforma on-line y aplicaciones en móviles. Resultados. La evaluación social del Programa fue positiva, obteniendo un valor actual neto (VAN) social de 1.113.304 Euros. La sociedad se beneficia con un ahorro de 2.226.873 Euros, siendo el ahorro en gasto de tabaco para los abstinentes, el mayor componente 1.235.978 Euros. Este Programa tiene un beneficio-coste de 14,34, es decir, por cada 1 Euros invertido en el programa se ahorran 4,16 Euros en el sistema de salud y un ahorro personal de 7,96 Euros. Conclusiones. La evaluación económica costo-beneficio del 'Programa de Prevención y Tratamiento Integral de Tabaquismo RespiraLibre' demuestra que este logra liberar recursos en el sistema de salud, en la productividad de las empresas y produce un importante ahorro a quienes dejan de fumar. Sería una ganancia para la comunidad y la red asistencial, al optimizar su uso. Esta investigación aporta evidencia para la realización y posterior expansión de esta estrategia de cesación en la APS en Chile (AU)

Objective. The purpose of the research was to make an ex ante cost-benefit economic evaluation of a comprehensive pilot program of prevention and treatment of smoking cessation in the family health centers (CESFAM) of the Primary Health Care (PHC) of the Peñalolen district, located in the East area of Santiago de Chile. Patients and method. The study corresponds to the economic evaluation of the comprehensive pilot program of smoking prevention and cessation, considering the costs and benefits that the program will generate compared to the current reality of an absence of a smoking cessation program. It includes 100 adults of both genders, aged 25 to 65 years. The calculations were performed in a time frame of 33.77 years with expected abstinence of 30%. Costs were considered as the use of spaces in the health care premises, program management, universal, selective and intensive training of the public employees of the health care centers as well as medications and professional fees of the physicians, psychologists, kinesiologists, and nutritionists used most of the on-line platform and cell phone applications. Results. The social evaluation of the Program was positive, obtaining a social net present value (NPS) of 1,113,304 Euros. The society benefits with a savings of 2,226,873 Euros, the savings being in costs of tobacco for the abstinent, the largest component being 1,235,978 Euros. This program has a cost-benefit of 14.34, that is for every 1 Euros invested in the program, 4.16 Euros was saved in the health care system and a personal savings of 7,96 Euros. Conclusions. The cost-benefit economic evaluation of the 'Comprehensive smoking prevention and Treatment RespiraLibre Program' shows that this is successful in freeing resources in the health care system, in the productivity of companies and produces a significant savings for those who quit smoking. It would be a gain for the community and care network, by optimizing its use. This research provides evidence for the performance and subsequent expansion of this cessation strategy in the PHC in Chile (AU)

Evolución de la Unidad de Deshabituación Tabáquica del Centro de Salud de Maspalomas desde su acreditación en 2010 al 2016 / Evolution of the Smoking cessation unit (SCU) of the Health Care Site of Maspalomas since its accreditation in 2010 to 2016

Objetivo. Conocer los cambios producidos en la unidad, comparando los resultados actuales con los obtenidos en el año 2010. Método. Pacientes remitidos de noviembre del 2015 a junio de 2016: 102 pacientes. Se realiza abordaje individualizado con visitas protocolizadas con dos componentes principales: 1. Entrevista motivacional, y 2. Individualización del tratamiento farmacológico según dependencia, patología asociada y preferencias del paciente, entre otros. Análisis. Se realiza descripción global de muestra y resultados de la unidad y se comparan los resultados obtenidos en el 2010 con los obtenidos entre 2015 y 2016. Se busca asociación entre variables con el estado de fumador a los 6 meses. Resultados. Edad 49,6 (DE 10,4), 55,5% varones, 13,9% otra nacionalidad, 32,7% nivel socioeconómico bajo, 25% otros tóxicos, 14,9% EPOC, 12,9% asma, 9,9% patología psiquiátrica, 6,9% VIH. Edad inicio 16,9 (DE 3,25), test Fagerström con alta dependencia 67,8%, uso vareniclina 55,5%, terapia sustitutiva con nicotina 6,9%, bupropión 5,9% y solo motivacional 5%. Se asociaron con estado de fumador a los 6 meses el nivel socio económico bajo, consumir otros tóxicos, antecedentes familiares de patologías tabáquicas, antecedentes personales de cardiopatías, patología psiquiátrica, asma o EPOC (ODDS > 1) y el uso de vareniclina o acudir a más de 3 citas en la UDT (ODDS < 1). Conclusiones. Existen mejoras, tanto organizativas como en resultados de cesación. Esto no parece relacionado con cambios en el perfil de fumadores remitidos. Podrían deberse al mayor uso de fármacos con mayor evidencia científica, la financiación del 50% del tratamiento o la mayor adherencia terapéutica (AU)

Objective. To know the changes produced in the unit, comparing the current results with those obtained in the year 2010. Method. Patients referred from November 2015 to June 2016: 102 patients. An individualized approach was performed with protocolized visits with two main components: 1. Motivational interview, and 2. Individualization of the pharmacological treatment according to dependency, associated condition and preferences of the patient, among others. Analysis. A global description was performed of the sample and results of the unit and the results obtained in 2010 were compared with those obtained between 2015 and 2016. An association between variables with the status of the smoker at 6 months was investigated. Results. Age 49,6 (SD 10.4), 55.5% males, 13.9% another nationality, 32.7% low social-economic level, 25% other toxic agents, 14.9% COPD, 12.9% asthma, 9.9% psychiatric condition, 6.9% HIV. Onset age 16.9 (SD 3.25), Fagerström test with high dependency 67.8%, use of varenicline 55.5%, nicotine replacement therapy 6.9%, bupropion 5.9% and only motivational 5%. Low economical social level, consuming other toxic agents, family background of smoking conditions, personal background of heart diseases, psychiatric condition, asthma or COPD (ODDS >1) and use of varenicline or coming to more than 3 appointments in the SCU (ODDS <1) were associated with the status of the smoker at 6 months. Conclusions. There are improvements, both organizational as well in the results of smoking cessation. These do not seem to be related with changes in the profile of the smokers referred. They could be due to the better use of the drugs with better scientific evidence, financing of 50% of the treatment or better therapeutic adherence (AU)

Manutenção da abstinência do tabaco por ex-fumantes: estudo fenomenológico / Mantenimiento de la abstinencia del tabaco por los exfumadores: estudio fenomenológico / Maintenance of tobacco withdrawal by former smokers: a phenomenological study

Resumo OBJETIVO Compreender a vivência de ex-fumantes acerca da manutenção da abstinência do tabaco. MÉTODOS Pesquisa qualitativa que utilizou o referencial teórico-metodológico da Fenomenologia Social de Alfred Schütz. Realizou-se a entrevista fenomenológica em 2016 com 12 ex-fumantes de um município de Minas Gerais, Brasil. Os depoimentos foram organizados em categorias e discutidos com base na literatura. RESULTADOS A manutenção da abstinência do tabaco foi revelada nas categorias: "Ganhos na saúde, sociabilidade e finanças"; "Convívio com a vontade de fumar e com o aumento do peso corpóreo"; "Autodeterminação e utilização de estratégias substitutivas" e "Manter-se longe do cigarro". CONCLUSÕES Estes resultados alertam os profissionais de saúde para a necessidade de apoiar ex-fumantes a manter-se nesta condição. Isso implica considerar não só os efeitos negativos da abstinência tabágica, como também o contexto social em que o ex-fumante está inserido, que poderá influenciar na manutenção ou não da abstinência do cigarro.

Resumen OBJETIVOS Comprender la experiencia de ex-fumadores con respecto a mantener la abstinencia al tabaco. MÉTODOS Investigación cualitativa que utilizó la Fenomenología Social de Alfred Schütz. Se llevó a cabo la entrevista fenomenológica en 2016 con 12 ex-fumadores de una ciudad de Minas Gerais, Brasil. Los testimonios fueron organizados en categorías y discutidos con base en la literatura. RESULTADOS Se revelaron las categorías: "Las ganancias em la salud, la sociabilidad y la financiación"; "La convivencia com el deseo de fumar y aumento del peso corporal"; "La autodeterminación y el uso de estrategias sustitutivas" y "Para permanecer fuera de los cigarrillos". CONCLUSIONES Estos resultados llaman la atención de los profesionales de la salud hacia la necesidad de apoyar a los ex-fumadores parapermanecer libres de tabaco. Esto implica considerar no sólo los efectos negativos de la abstinencia de fumar sino el contexto social en el que se inserta el ex-fumador, el cualpuede influir en el mantenimiento o no de la abstinencia al cigarrillo.

Abstract OBJECTIVE To understand the experience of former smokers maintaining tobacco abstinence. METHODS Qualitative research using the theoretical-methodological reference of the Social Phenomenology, as defined by Alfred Schütz. The phenomenological interview was carried out in 2016 with 12 former smokers from a city in the state of Minas Gerais, Brazil. The statements were organized into categories and discussed based on the literature. RESULTS The maintenance of tobacco abstinence was revealed in the categories: "Health, sociability, and financial gains"; "Living with the urge to smoke and with the increase of body weight"; "Self-determination and use of replacement strategies"; and "Staying away from cigarettes." CONCLUSIONS These results alert health professionals to the need to provide support to former smokers so they can remain smoke-free. This implies considering not only the negative effects of the tobacco abstinence, but also the social context in which former smokers are inserted that might have an impact on the maintenance or not of the cigarette withdrawal.