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2.
Lancet Psychiatry ; 7(9): 762-774, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828166

RESUMO

BACKGROUND: People with schizophrenia have higher rates of smoking than the general population, and lower quit rates. Several randomised controlled trials have investigated the effectiveness of pharmacological interventions for smoking cessation over the past 20 years. We did a systematic review and pairwise and network meta-analysis of smoking abstinence to guide decision making in offering pharmacological interventions for smoking cessation for people with schizophrenia spectrum disorders. METHODS: We systematically reviewed PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, and China National Knowledge Infrastructure from inception to Sept 30, 2019, for randomised controlled trials of varenicline, bupropion, and nicotine replacement therapy for smoking cessation for people with schizophrenia spectrum disorders or psychotic disorders who were smokers at the time of study recruitment. Data were extracted from published studies on smoking abstinence outcomes and psychotic symptoms. We did pairwise and network meta-analyses for the primary outcome of smoking abstinence. Sensitivity analyses were done on study inclusion criteria, duration, quality, and location. This study is registered with the international prospective register of systematic reviews PROSPERO, CRD42018102343. FINDINGS: A total of 15 111 records were identified by the database searches, and 163 full-text articles were assessed for eligibility. 145 articles were then excluded for several reasons including insufficient data, or abstracts published in later studies, and 18 studies were included in the meta-analysis. In the pairwise meta-analyses, four studies with 394 participants assessed varenicline (RR 3·75, 95% CI 1·96-7·19, p<0·0001; I2=0%), four studies with bupropion and 292 participants (RR 3·40, 95% CI 1·58-7·34, p=0·0002; I2=0%), and three studies with 561 participants assessed nicotine replacement therapy (RR 4·27, 95% CI 1·71-10·65, p=0·0002; I2=0%). All three treatments were deemed superior to placebo. In the network meta-analysis, varenicline was superior to bupropion (RR 2·02, 95% CI 1·04-3·93; p=0·038) but no significant difference was found between varenicline and nicotine replacement therapy, or bupropion and nicotine replacement therapy. No agents were associated with changes in psychiatric symptoms, but varenicline was associated with higher rates of nausea than was placebo. INTERPRETATION: We found evidence to support use of pharmacological agents for smoking cessation for people with psychosis. Varenicline might be superior to bupropion; however, additional direct testing and combination trials of pharmacological agents for smoking cessation are required to inform clinical decision making for people with psychosis. FUNDING: None.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Bupropiona/uso terapêutico , Esquizofrenia , Abandono do Hábito de Fumar/métodos , Humanos , Metanálise em Rede , Nicotina/administração & dosagem , Agonistas Nicotínicos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Psicologia do Esquizofrênico , Vareniclina
3.
Health Psychol ; 39(9): 815-825, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32833483

RESUMO

Low income and low educational attainment are among the strongest predictors of both smoking prevalence and lapse (i.e., return) to smoking after cessation attempts. Treatment refinement is limited by inadequate knowledge of the specific lapse- or relapse-relevant vulnerabilities characteristic of populations that should be the target of treatment. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the role of 2 specific lapse-relevant targets relative to the higher stress characteristic of low-socioeconomic contexts: low distress tolerance and low working memory capacity. Furthermore, we use an innovative approach for understanding risk of smoking lapse in smokers undergoing a quit attempt to examine candidate mechanistic targets assessed not only during nicotine use, but also during the conditions smokers will face upon a cessation attempt-during stressful nicotine-deprivation windows. This study is designed to show the incremental value of assessments during deprivation windows, in part because of the way in which specific vulnerabilities are modified by, and interact with, the heightened stress and withdrawal symptoms inherent to nicotine-deprivation states. Specifically, the study is designed to evaluate whether a novel mindfulness intervention (mindfulness combined with interoceptive exposure) can improve upon existing mindfulness interventions and extend therapeutic gains to the modification of mechanistic targets assessed in high-stress or negative affectivity contexts. The overall goal is to validate mechanistic targets and associated interventions for the purpose of expanding treatment options for at-risk smokers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Memória de Curto Prazo/fisiologia , Abandono do Hábito de Fumar/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , Abandono do Hábito de Fumar/psicologia , Adulto Jovem
4.
Am J Physiol Lung Cell Mol Physiol ; 319(4): L585-L595, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32726146

RESUMO

In 2019, the United States experienced the emergence of the vaping-associated lung injury (VALI) epidemic. Vaping is now known to result in the development and progression of severe lung disease in the young and healthy. Lack of regulation on electronic cigarettes in the United States has resulted in over 2,000 patients and 68 deaths. We examine the clinical representation of VALI and the delve into the scientific evidence of how deadly exposure to electronic cigarettes can be. E-cigarette vapor is shown to affect numerous cellular processes, cellular metabolism, and cause DNA damage (which has implications for cancer). E-cigarette use is associated with a higher risk of developing crippling lung conditions such as chronic obstructive pulmonary disease (COPD), which would develop several years from now, increasing the already existent smoking-related burden. The role of vaping and virus susceptibility is yet to be determined; however, vaping can increase the virulence and inflammatory potential of several lung pathogens and is also linked to an increased risk of pneumonia. As it has emerged for cigarette smoking, great caution should also be given to vaping in relation to SARS-CoV-2 infection and the COVID-19 pandemic. Sadly, e-cigarettes are continually promoted and perceived as a safer alternative to cigarette smoking. E-cigarettes and their modifiable nature are harmful, as the lungs are not designed for the chronic inhalation of e-cigarette vapor. It is of interest that e-cigarettes have been shown to be of no help with smoking cessation. A true danger lies in vaping, which, if ignored, will lead to disastrous future costs.


Assuntos
Vapor do Cigarro Eletrônico/toxicidade , Doenças Pulmonares Intersticiais/epidemiologia , Lesão Pulmonar/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Vaping/efeitos adversos , Adolescente , Betacoronavirus , Infecções por Coronavirus/patologia , Suscetibilidade a Doenças/induzido quimicamente , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Feminino , Humanos , Doenças Pulmonares Intersticiais/induzido quimicamente , Lesão Pulmonar/induzido quimicamente , Lesão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/epidemiologia , Pneumonia Viral/patologia , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Doença Pulmonar Obstrutiva Crônica/mortalidade , Abandono do Hábito de Fumar/métodos , Estados Unidos/epidemiologia , Vaping/epidemiologia , Vaping/mortalidade
5.
PLoS One ; 15(6): e0233462, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502211

RESUMO

BACKGROUND: Behavioral intentions (motivational factors), attitudes, subjective norm (social pressures), and perceived behavioral control promote or discourage smoking behavior among adolescents. OBJECTIVE: To assess students' behavioral intentions, attitudes, subjective norms and perceived behavioral control on smoking using the Theory of Planned Behavior. The prevalence of smoking among the adolescents is also calculated. METHODS: In this cross-sectional study, structured self-administered questionnaires were used to collect data from adolescents in primary and secondary schools. Data on demographics, behavioral intentions, attitudes, subjective norms, and perceived behavioral control towards smoking were collected. Pearson product moment correlations and logistic regression models were used to determine factors associated with current smoking. RESULTS: A total sample of 2554 (mean age = 15; Range = 12-18 years) students participated in the study. Twenty-nine percent (n = 728) of the students had tried smoking at least once. Smoking was predicted by attitudes, subjective norms, perceived behavioral control and intention.There was a strong association between having a parent or guardian, caregiver or close friend who smoked (p < 0.001) and being a smoker. The majority of students (57%) conveyed that adults talked to them about the harmful effects of cigarette smoking and 50% had discussed smoking concerns with their friends. Students who had positive attitudes towards smoking like "smoking makes you confident" were more likely to be current smokers (OR: 1.63, 95% CI: 1.03-2.59). The feeling or conviction that they could refuse a cigarette if offered was an impediment from smoking (OR: 0.18, 95% CI: 0.13-0.26). CONCLUSIONS: Attitudes, subjective norms, and perceived behavioral control contributed significantly to the students' smoking. Right attitudes must be cultivated and behavioral control must be strengthened for early effective interventions to curtail smoking among adolescents.


Assuntos
Controle Comportamental/métodos , Abandono do Hábito de Fumar/métodos , Fumar/epidemiologia , Adolescente , Comportamento do Adolescente/psicologia , Atitude , Terapia Comportamental/métodos , Botsuana , Criança , Fumar Cigarros , Estudos Transversais , Feminino , Amigos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Intenção , Masculino , Instituições Acadêmicas , Abandono do Hábito de Fumar/psicologia , Estudantes , Inquéritos e Questionários , Fumar Tabaco
7.
N Z Med J ; 133(1517): 100-106, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32595224

RESUMO

The New Zealand government is aiming for Smokefree Aotorea, equivalent to a reduction in smoking prevalence to 5% or less by 2025. E-cigarettes may be one tool to meet this target, but how safe are they? Little is known about their long-term health implications in humans. In 2015, Public Health England commissioned a report summarising the available literature on e-cigarettes and coined the now well-known quantification that "e-cigarettes are 95% less harmful to your health than normal cigarettes". In this article, we argue that this is an unfounded quantification because the data required to make this quantification are not yet available. The value of '95% safer' was based on a study estimating the relative harms of nicotine-containing products that utilised scoring from a selected panel of experts. One of the key limitations of this quantification is that while the scores provided by the panellists were informed by knowledge, they are fundamentally value judgements and are not an exact science. E-cigarettes are probably safer than conventional cigarettes, however, there is mounting evidence that they are not without harm and the long-term health impacts are not yet known.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Governo , Saúde Pública , Abandono do Hábito de Fumar/métodos , Fumar/epidemiologia , Vaping/efeitos adversos , Redução do Dano , Humanos , Incidência , Nova Zelândia/epidemiologia , Fatores de Risco
9.
Medicine (Baltimore) ; 99(22): e20295, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481398

RESUMO

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.


Assuntos
Acupressão/métodos , Terapia por Acupuntura/métodos , Abandono do Hábito de Fumar/métodos , Teorema de Bayes , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
10.
Artigo em Inglês | MEDLINE | ID: mdl-32560517

RESUMO

Evidence and campaigns highlighting smoking and second-hand smoke risks have significantly reduced smoking prevalence and denormalised smoking in the home in Scotland. However, smoking prevalence remains disproportionally high in socioeconomically disadvantaged groups. Using stigma as a theoretical lens, this article presents a thematic analysis of parents' accounts of attempting to abstain from smoking at home, using nicotine replacement therapy (NRT), in disadvantaged areas of Edinburgh and the Lothians. Smoking stigma, particularly self-stigma, underpinned accounts, with two overarching themes: interplaying barriers and enablers for creation of a smoke-free home and reconceptualisation of the study as an opportunity to quit smoking. Personal motivation to abstain or stop smoking empowered participants to reduce or quit smoking to resist stigma. For those struggling to believe in their ability to stop smoking, stigma led to negative self-labelling. Previously hidden smoking in the home gradually emerged in accounts, suggesting that parents may fear disclosure of smoking in the home in societies where smoking stigma exists. This study suggests that stigma may act both as an enabler and barrier in this group. Reductions in smoking in the home were dependent on self-efficacy and motivations to abstain, and stigma was entwined in these beliefs.


Assuntos
Poder Familiar , Abandono do Hábito de Fumar/psicologia , Estigma Social , Poluição por Fumaça de Tabaco/prevenção & controle , Dispositivos para o Abandono do Uso de Tabaco , Populações Vulneráveis , Adolescente , Adulto , Criança , Pré-Escolar , Redução do Dano , Habitação , Humanos , Lactente , Masculino , Motivação , Poder Familiar/psicologia , Pais/psicologia , Escócia , Autoeficácia , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-32517176

RESUMO

Continued tobacco use after cancer diagnosis is detrimental to treatment and survivorship. The current reach of evidence-based tobacco treatments in cancer patients is low. As a part of the National Cancer Institute Cancer Center Cessation Initiative, the Mayo Clinic Cancer Center designed an electronic health record (EHR, Epic©)-based process to automatically refer ambulatory oncology patients to tobacco use treatment, regardless of intent to cease tobacco use("opt out"). The referral and patient scheduling, accomplished through a best practice advisory (BPA) directed to staff who room patients, does not require a co-signature from clinicians. This process was piloted for a six-week period starting in July of 2019 at the Division of Medical Oncology, Mayo Clinic, Rochester, MN. All oncology patients who were tobacco users were referred for tobacco treatment by the rooming staff (n = 210). Of these, 150 (71%) had a tobacco treatment appointment scheduled, and 25 (17%) completed their appointment. We conclude that an EHR-based "opt-out" approach to refer patients to tobacco dependence treatment that does not require active involvement by clinicians is feasible within the oncology clinical practice. Further work is needed to increase the proportion of scheduled patients who attend their appointments.


Assuntos
Registros Eletrônicos de Saúde , Neoplasias/complicações , Neoplasias/epidemiologia , Encaminhamento e Consulta , Abandono do Hábito de Fumar/métodos , Tabagismo/diagnóstico , Tabagismo/terapia , Humanos , Sistemas Computadorizados de Registros Médicos , Neoplasias/etiologia , Neoplasias/patologia , Uso de Tabaco , Interface Usuário-Computador
13.
Rev Assoc Med Bras (1992) ; 66(2): 146-152, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428148

RESUMO

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.


Assuntos
Agentes de Cessação do Hábito de Fumar/efeitos adversos , Abandono do Hábito de Fumar/métodos , Vareniclina/efeitos adversos , Adulto , Brasil , Feminino , Seguimentos , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Fatores Sexuais , Fatores Socioeconômicos , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
14.
BMC Psychol ; 8(1): 42, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357940

RESUMO

BACKGROUND: Despite the considerable success of comprehensive tobacco control efforts, tobacco use remains one of the greatest preventable causes of death and disease today. Over half of all smokers in the US make quit attempts every year, but over 90% relapse within 12 months, choosing the immediate reinforcement of smoking over the long-term benefits of quitting. Conceptual and empirical evidence supports continued investigation of high frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in reducing relapse and decreasing cigarette consumption. While this evidence is compelling, an optimal dosing strategy must be determined before a long-term efficacy trial can be conducted. The goal of this study is to determine a dosing strategy for 20 Hz rTMS that will produce the best long-term abstinence outcomes with the fewest undesirable effects. METHODS: This is a fully crossed, double-blinded, sham-controlled, 3x2x2 randomized factorial study. The three factors are duration (stimulation days: 8, 12, and 16); intensity (900 or 1800 pulses per day); and sham control. Participants (n = 258) will consist of adults (18-65) who are motivated to quit smoking cigarettes and who will be followed for 6 months post-quit. Outcomes include latency to relapse, point prevalence abstinence rates, delay discounting rates, cognitive-behavioral skills acquisition, and multiple measures of potential undesirable effects that impact participant compliance. DISCUSSION: This study integrates existing theoretical concepts and methodologies from neuropsychology, behavioral economics, brain stimulation, clinical psychology, and the evidence-based treatment of tobacco dependence in the development of a promising and innovative approach to treat tobacco dependence. This study will establish an optimal dosing regimen for efficacy testing. Findings are expected to have a significant influence on advancing this approach as well as informing future research on clinical approaches that combine rTMS with other evidence-based treatments for tobacco dependence and perhaps other addictions. TRIAL REGISTRATION: Clinical Trials NCT03865472 (retrospectively registered). The first participant was fully enrolled on November 26, 2018. Registration was posted on March 7, 2019.


Assuntos
Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Estimulação Magnética Transcraniana , Adulto , Idoso , Comportamento Aditivo , Protocolos Clínicos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal , Recidiva , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia
15.
Cochrane Database Syst Rev ; 5: CD013629, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32441810

RESUMO

BACKGROUND: Nicotine replacement therapy (NRT) delivers nicotine without the toxic chemicals present in tobacco smoke. It is an effective smoking cessation aid in non-pregnant smokers, but there is less evidence of effectiveness in pregnancy. Systematic review evidence suggests that pregnant women do not adhere to NRT as prescribed, which might undermine effectiveness. Electronic cigarettes (e-cigarettes) have grown in popularity, but effectiveness and safety in pregnancy are not yet established. The determinants of uptake and use of NRT and e-cigarettes in pregnancy are unknown. OBJECTIVES: To explore factors affecting uptake and use of NRT and e-cigarettes in pregnancy. SEARCH METHODS: We searched MEDLINE(R), CINAHL and PsycINFO on 1 February 2019. We manually searched OpenGrey database and screened references of included studies and relevant reviews. We also conducted forward citation searches of included studies. SELECTION CRITERIA: We selected studies that used qualitative methods of data collection and analysis, included women who had smoked in pregnancy, and elicited participants' views about using NRT/e-cigarettes for smoking cessation or harm reduction (i.e. to smoke fewer cigarettes) during pregnancy. DATA COLLECTION AND ANALYSIS: We identified determinants of uptake and use of NRT/e-cigarettes in pregnancy using a thematic synthesis approach. Two review authors assessed the quality of included studies with the Wallace tool. Two review authors used the CERQual approach to assess confidence in review findings. The contexts of studies from this review and the relevant Cochrane effectiveness review were not similar enough to fully integrate findings; however, we created a matrix to juxtapose findings from this review with the descriptions of behavioural support from trials in the effectiveness review. MAIN RESULTS: We included 21 studies: 15 focused on NRT, 3 on e-cigarettes, and 3 on both. Studies took place in five high-income countries. Most studies contributed few relevant data; substantially fewer data were available on determinants of e-cigarettes. Many studies focused predominantly on issues relating to smoking cessation, and determinants of NRT/e-cigarette use was often presented as one of the themes. We identified six descriptive themes and 18 findings within those themes; from these we developed three overarching analytical themes representing key determinants of uptake and adherence to NRT and/or e-cigarettes in pregnancy. The analytical themes show that women's desire to protect their unborn babies from harm is one of the main reasons they use these products. Furthermore, women consider advice from health professionals when deciding whether to use NRT or e-cigarettes; when health professionals tell women that NRT or e-cigarettes are safer than smoking and that it is okay for them to use these in pregnancy, women report feeling more confident about using them. Conversely, women who are told that NRT or e-cigarettes are as dangerous or more dangerous than smoking and that they should not use them during pregnancy feel less confident about using them. Women's past experiences with NRT can also affect their willingness to use NRT in pregnancy; women who feel that NRT had worked for them (or someone they know) in the past were more confident about using it again. However, women who had negative experiences were more reluctant to use NRT. No trials on e-cigarette use in pregnancy were included in the Cochrane effectiveness review, so we considered only NRT findings when integrating results from this review and the effectiveness review. No qualitative studies were conducted alongside trials, making full integration of the findings challenging. Women enrolled in trials would have agreed to being allocated to NRT or control group and would have received standardised information on NRT at the start of the trial. Overall, the findings of this synthesis are less relevant to women's decisions about starting NRT in trials and more likely to help explain trial participants' adherence to NRT after starting it. We considered most findings to be of moderate certainty; we assessed findings on NRT use as being of higher certainty than those on e-cigarette use. This was mainly due to the limited data from fewer studies (only in the UK and USA) that contributed to e-cigarette findings. Overall, we judged studies to be of acceptable quality with only minor methodological issues. AUTHORS' CONCLUSIONS: Consistent messages from health professionals, based on high-quality evidence and clearly explaining the safety of NRT and e-cigarettes compared to smoking in pregnancy, could help women use NRT and e-cigarettes more consistently/as recommended. This may improve their attitudes towards NRT or e-cigarettes, increase their willingness to use these in their attempt to quit, and subsequently encourage them to stay smoke-free.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Gestantes/psicologia , Pesquisa Qualitativa , Abandono do Hábito de Fumar/psicologia , Dispositivos para o Abandono do Uso de Tabaco , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Gravidez , Segurança , Fumar/psicologia , Abandono do Hábito de Fumar/métodos , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Adulto Jovem
17.
Monaldi Arch Chest Dis ; 90(1)2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32253889

RESUMO

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.


Assuntos
Terapia Comportamental/métodos , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Fumar/terapia , Tabagismo/terapia , Adolescente , Adulto , Idoso , Aconselhamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Estudos Prospectivos , Fumar/efeitos adversos , Fumar/psicologia , Inquéritos e Questionários , Tabagismo/complicações , Tabagismo/diagnóstico , Tabagismo/psicologia , Adulto Jovem
19.
JAMA ; 323(16): 1599-1608, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32343335

RESUMO

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.


Assuntos
Terapia Comportamental , Educação de Pacientes como Assunto , Atenção Primária à Saúde , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Uso de Tabaco/prevenção & controle , Adolescente , Adulto , Terapia Comportamental/métodos , Criança , Aconselhamento , Humanos , Guias de Prática Clínica como Assunto , Vaping/prevenção & controle , Adulto Jovem
20.
JAMA ; 323(16): 1590-1598, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32343336

RESUMO

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).


Assuntos
Terapia Comportamental/métodos , Aconselhamento , Educação de Pacientes como Assunto , Atenção Primária à Saúde , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Uso de Tabaco/prevenção & controle , Adolescente , Criança , Humanos , Vaping/prevenção & controle , Adulto Jovem
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