Mobile Chat Messaging for Preventing Smoking Relapse Amid the COVID-19 Pandemic: A Pilot Randomized Controlled Trial.

INTRODUCTION: The ongoing COVID-19 pandemic had reduced access to traditional, in-person smoking cessation treatment. We examined the feasibility, acceptability, and potential effectiveness of mobile chat messaging in preventing smoking relapse in smokers who have recently quit smoking. METHODS: In this assessor-blinded, pilot randomized controlled trial in five cessation clinics, we recruited adult daily smokers who had been receiving cessation treatments and abstained for 3 to 30 days. The intervention group received real-time, personalized chat messaging on relapse prevention via WhatsApp for 3 months. The control group received generic text messaging on the harms of smoking and benefits of quitting for 3 months. The primary outcome was carbon monoxide-validated abstinence at 6 months post-treatment initiation. The trial was registered with ClinicalTrials.gov (NCT04409496). RESULTS: From June to July 2020, 108 of 130 (83%) eligible subjects were randomized to the intervention (N = 54) or control (N = 54) groups. The retention rate was 93% at 3 months (end of treatment) and 85% at 6 months. In the intervention group, 80% of participants responded to the chat messages at least once; 43% continuously engaged with the intervention over the 3-month intervention period. By intention-to-treat, validated abstinence at 6 months was higher in the intervention than control group (31% vs. 22%), with a relative risk of 1.72 (95% CI = 0.91% to 3.23%; p = .09) after adjusting for pre-quit nicotine dependence, duration of abstinence, and cessation treatment at baseline. CONCLUSIONS: This pilot trial showed the feasibility and acceptability of mobile chat messaging for relapse prevention with preliminary evidence on its effectiveness in increasing validated abstinence. IMPLICATIONS: Smoking relapse is the most likely outcome of smoking cessation attempts and an undertreated problem. This pilot trial showed the feasibility and acceptability of personalized chat messaging via WhatsApp for relapse prevention in recent abstainers amid the COVID-19 pandemic. The higher carbon monoxide-validated abstinence rate in participants who received chat messaging than controls showed preliminary evidence on the effectiveness of the intervention. Fully powered trials are warranted to test the intervention.

Effectiveness of WhatsApp online group discussion for smoking relapse prevention: protocol for a pragmatic randomized controlled trial.

BACKGROUND AND AIMS: Sustained psychosocial support via online social groups may help former tobacco users maintain abstinence. This study aims to examine the effectiveness of participating in a WhatsApp social group for long-term smoking cessation. DESIGN: Two-arm, open-labelled, pragmatic, individually randomized controlled trial. SETTING: All participants are service users of smoking cessation clinics, and all interventions are delivered via mobile phones. PARTICIPANTS: Participants included 1008 adult quitters who self-report no tobacco use in the past 3-30 days. INTERVENTIONS: The intervention group (n = 504) will join a WhatsApp social group to receive standardized and theory-based reminders of smoking relapse prevention and participate in discussion with other WhatsApp group members using their own mobile phones. All social groups will be led by counselors or specialist nurse practitioners. The control group (n = 504) will receive similar reminders via short messages to their own mobile phones but will not interact with other participants. The intervention duration for both groups is 8 weeks. Both groups will receive a booklet at baseline about how to prevent smoking relapse. MEASUREMENTS: The primary outcome is biochemically validated tobacco abstinence at 12 months after consent. COMMENTS: The findings will provide evidence concerning the utility of operating online social group discussion for prevention of smoking relapse and sustaining long-term abstinence.

Effectiveness of nicotine replacement therapy sample at outdoor smoking hotspots for initiating quit attempts and use of smoking cessation services: a protocol for a cluster randomised controlled trial.

INTRODUCTION: More than half of the smoking population in Hong Kong are unmotivated to quit. Only about 2% of tobacco users in the territory have ever used cessation aids such as nicotine replacement therapy (NRT). The present study aims to assess the effectiveness of delivering 1-week free NRT sample plus brief intervention to smokers at outdoor smoking hotspots on quit attempts and use of smoking cessation services. METHODS AND ANALYSIS: This is a two-arm, pragmatic, multisite, cluster randomised controlled trial (RCT) on the effectiveness of increasing quit attempts, use of cessation service and recruitment outcomes. Trained smoking cessation ambassadors will approach smokers at outdoor smoking hotspots, and deliver brief smoking cessation advice. Recruitment sessions are randomised to intervention or control group (allocation ratio 1:1). Participants in the intervention group (n=550) will receive 1-week free NRT sample (either patch or gum), brief medication advice from an onsite nurse and cessation service referral, whereas participants in control group (n=275) will only receive the brief advice and service referral. The primary outcomes are the proportion of participants who enrol in any cessation service in Hong Kong within 1 month of the recruitment, and the proportion of participants who report quit attempts at 1-month follow-up. Secondary outcomes include self-reported use of NRT, self-reported 7-day tobacco abstinence, 30-day abstinence at 3 months and 6 months, biochemically validated abstinence at 6 months, perceived importance, difficulty and confidence to quit (scale 0-10), and Incremental Behavior Change towards Smoking Cessation. Process outcomes include number of smokers who will be approached, will accept the brief smoking cessation advice or be recruited to participate in the RCT. ETHICS AND DISSEMINATION: The Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster approved the trial (UW 18-118). Findings will be disseminated through funding website, publication and conference presentations. TRIAL REGISTRATION NUMBER: NCT03717051.

Brief handgrip and isometric exercise intervention for smoking cessation: A pilot randomized trial.

INTRODUCTION: Isometric exercises reduce craving, negative affect, and withdrawal symptoms during smoking cessation. This randomized controlled trial (RCT) was the first to test if a brief intervention using a handgrip and isometric exercises including hand pushing/pulling was feasible and efficacious to increase tobacco abstinence at 6-month. METHODS: This was a single-blinded, 2-arm pilot RCT in 6 community-based smoking cessation clinics in Hong Kong. Smokers who consumed 10 or more cigarettes a day and were receiving cessation services were randomized to the exercise group (n = 108) who received a free handgrip and a leaflet about handgrip exercise, and watched a 5-minute video, or to the healthy-diet group (n = 100) who receive a similar dosage of intervention on healthy diet. The primary outcome was self-reported abstinence in the previous 4 weeks at 6-month follow-up. RESULTS: In the exercise group, about 36% reported doing the exercises when craving at 2-month follow-up. No significant difference in quit rate was found between groups (34% vs. 39%, OR = 0.80, P = .40). A posteriori analysis on the exercise group showed that self-reported exercises when craving (49% vs. 26%, OR = 2.69, 1.18-6.15, P = .02) and total adherence (including doing the exercises when craving, once a day, and/or for 2 weeks) (53% vs. 23%, OR = 3.70, 1.15-11.92, P = .03) were significantly associated with self-reported abstinence. CONCLUSIONS: The brief handgrip/isometric exercise intervention was feasible and achieved modest adherence without offering incentives or mandatory reminders. Preliminary evidence of benefits was observed in the intervention group if the exercises were done when craving. IMPLICATIONS: Our study indicates that a brief exercise intervention, including a free handgrip and educational video, was feasible for smokers receiving smoking cessation treatment. It was particularly efficacious in increasing tobacco abstinence when exercise adherence was high. TRIAL REGISTRATION: ClinicalTrial.gov (NCT02844296).

Smoking, quitting and mortality in an elderly cohort of 56,000 Hong Kong Chinese.

BACKGROUND: Although the harms of smoking are well established, it is unclear how they extend into old age in the Chinese. AIM: To examine the relationship of smoking with all-cause and major cause-specific mortality in elderly Chinese men and women, respectively, in Hong Kong. METHODS: Mortality by smoking status was examined in a prospective cohort study of 56,167 (18,749 men, 37,416 women) Chinese aged > or = 65 years enrolled from 1998 to 2000 at all the 18 elderly health centres of the Hong Kong Government Department of Health. RESULTS: After a mean follow-up of 4.1 years, 1848 male and 2035 female deaths occurred among 54,214 subjects (96.5% successful follow-up). At baseline, more men than women were current smokers (20.3% vs 4.0%) and former smokers (40.8% vs 7.9%). The adjusted RRs (95% CI) for all-cause mortality in former and current smokers, compared with never smokers, were 1.39 (1.23 to 1.56) and 1.75 (1.53 to 2.00) in men and 1.43 (1.25 to 1.64) and 1.38 (1.14 to 1.68) in women, respectively. For current smokers, the RRs (95% CI) for all-cause mortality were 1.59 (1.39 to 1.82), 1.72 (1.48 to 2.00) and 1.84 (1.43 to 2.35) for daily consumption of 1-9, 10-20 and > 21 cigarettes, respectively (p for trend <0.001). RRs (95% CI) were 1.49 (1.30 to 1.72) and 2.20 (1.88 to 2.57) in former and current smokers for all deaths from cancer, and 1.24 (1.04 to 1.47) and 1.57 (1.28 to 1.94) for all cardiovascular deaths, respectively. Quitters had significantly lower risks of death than current smokers from all causes, lung cancer, all cancers, stroke and all cardiovascular diseases. CONCLUSIONS: In old age, smoking continues to be a major cause of death, and quitting is beneficial. Smoking cessation is urgently needed in rapidly ageing populations in the East.

Obesity, physical activity, and mortality in a prospective chinese elderly cohort.

BACKGROUND: In older people, it is unclear whether obesity relates to mortality, which calls into question its etiologic role in disease and its public health relevance. This apparent lack of relationship in older people could be an artifactual result of their diverse health states. METHODS: We used Cox regression analysis to determine whether the effect of body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) or physical activity on mortality varied with health status in a prospective cohort study of Chinese people 65 years or older enrolled from 1998 to 2000 at all of the 18 Elderly Health Centers of the Hong Kong Government Department of Health. Health status was categorized into 5 morbidity groups using a 12-item index covering illnesses, medications, frailty, and smoking. RESULTS: After a mean follow-up of 4.1 years, there were 3819 deaths in 54 088 subjects (96.5% successful follow-up). The effect of BMI on mortality varied with baseline health status (P<.001). In the healthiest group, obese people (BMI >/=25) had higher mortality (adjusted hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.02-2.33), but in the unhealthiest group they had lower mortality (HR, 0.55; 95% CI, 0.49-0.63) compared with subjects of normal weight. Daily physical activity was associated with lower mortality compared with inactivity in the unhealthiest group (HR, 0.70; 95% CI, 0.61- 0.81) but not in the healthiest group. CONCLUSIONS: In the elderly, the relationship between obesity and mortality varies according to the underlying health status. In those with poor health status, obesity is associated with better outcome, whereas in those with initially good health status, obesity is associated with worse outcome.

Analysis of genome-wide association data highlights candidates for drug repositioning in psychiatry.

Knowledge of psychiatric disease genetics has advanced rapidly during the past decade with the advent of genome-wide association studies (GWAS). However, less progress has been made in harnessing these data to reveal new therapies. Here we propose a framework for drug repositioning by comparing transcriptomes imputed from GWAS data with drug-induced gene expression profiles from the Connectivity Map database and apply this approach to seven psychiatric disorders. We found a number of repositioning candidates, many supported by preclinical or clinical evidence. Repositioning candidates for a number of disorders were also significantly enriched for known psychiatric medications or therapies considered in clinical trials. For example, candidates for schizophrenia were enriched for antipsychotics, while those for bipolar disorder were enriched for both antipsychotics and antidepressants. These findings provide support for the usefulness of GWAS data in guiding drug discovery.

The association between depressive symptoms and mortality among Chinese elderly: a Hong Kong cohort study.

BACKGROUND: Increasingly, researchers have begun to explore the association between depression and mortality. The current study examined the association between depressive symptoms and all-cause and cause-specific mortality in Chinese older people. Further to examine whether any associations were similar by sex and health status. METHODS: We used the Chinese version of the 15-item Geriatric Depression Scale to measure depressive symptoms (Geriatric Depression Scale score ≥ 8) and Cox regression to examine the association with all-cause and cause-specific mortality in a population-based cohort study of all 56,088 enrollees, aged 65 years or older, from July 1998 to December 2000 at all 18 Elderly Health Centers of Department of Health of Hong Kong. The cohort was followed up for mortality till December 31, 2005. RESULTS: Depressive symptoms were associated with all-cause mortality (hazard ratio 1.21, 95% confidence interval: 1.08-1.37) in men only (p value for sex interaction <.05) and with suicide mortality in men (hazard ratio 2.81, 95% confidence interval: 1.13-7.01) and women (hazard ratio 2.40, 95% confidence interval: 1.18-4.82) but not with other major causes of death after adjusting for age, education, monthly expenditure, smoking, alcohol drinking, physical activity, body mass index, health status, and self-rated health. The associations did not vary with health status. CONCLUSIONS: Depressive symptoms were associated with all-cause mortality in men and with suicide in both sexes. Randomized controlled trials concerning the effects of treatment of depression on mortality are needed to clarify the causal pathways.

Moderate alcohol use, health status, and mortality in a prospective Chinese elderly cohort.

PURPOSE: A U-shaped relation between alcohol use and mortality may be due to biological hormesis, differential response (i.e., effect modification) by health status or changes in alcohol use with ill-health and aging (i.e., reverse causality).We examined whether alcohol had the same association with mortality in healthy and unhealthy older people. METHODS: We used Cox regression analysis to examine the association of alcohol with mortality by health status in a population-based cohort of 56,167 people (65+ years), enrolled during July 1998 to December 2000 in Hong Kong. RESULTS: After a mean follow-up of 4.1 years, there were 3,819 deaths in 54,087 subjects. Adjusted for age, socioeconomic position and lifestyle, both occasional and moderate types of alcohol use were associated with lower mortality compared to never-drinkers, relative risk (RR) 0.72 (95% confidence interval [CI] 0.63-0.83) and 0.73 (95% CI 0.59-0.90) in men and 0.77 (95% CI 0.64-0.94) and 0.54 (95% CI 0.29-1.01) in women. However, these associations were not maintained in those with good health status: RR 1.02 (95% CI 0.74-1.39) and 1.09 (95% CI 0.71-1.68) in men and 0.63 (95% CI 0.36-1.12) and 1.27 (95% CI 0.40-4.01) in women. CONCLUSIONS: Moderate alcohol use may only be beneficial for older adults in poor health.

Moderate alcohol use and mortality from ischaemic heart disease: a prospective study in older Chinese people.

BACKGROUND: Moderate alcohol use is generally associated with lower ischaemic heart disease (IHD) mortality but it is difficult to ascertain whether this is due to attributes of moderate alcohol users or the properties of alcohol itself. Evidence from populations with different patterns of alcohol use and IHD can provide crucial evidence. We assessed the association of moderate alcohol use with IHD mortality in older Chinese people from Hong Kong. METHODOLOGY: We used Cox regression to determine whether moderate alcohol use was associated with IHD mortality in a prospective, population-based cohort study of all 56,167 attendees, aged 65 years or over, from July 1998 to December 2000 at all 18 Elderly Health Centers operated by the Department of Health in Hong Kong. PRINCIPAL FINDINGS: After a median follow-up of 4.2 years, there were 406 (188 in men, 218 in women) deaths from IHD in 54,090 subjects (96.3% successful follow-up). Moderate alcohol use in men was not associated with IHD mortality adjusted only for age [Hazard Ratio, HR 1.01 (95% CI 0.55 to 1.84) compared with never drinkers] or additionally adjusted for socio-economic status and lifestyle. Almost all women were occasional drinkers and their current alcohol use was not significantly associated with IHD mortality [HR 0.88, (95% CI 0.51 to 1.53)]. CONCLUSIONS: Moderate alcohol use had no effect on IHD mortality in older Chinese men. Lack of replication of the usual protective effect of moderate alcohol use in a setting with a different pattern of alcohol use and IHD could be due to chance or could suggest that the protective effect of alcohol on IHD does not extend to all populations.

Age- versus time-comparative self-rated health in Hong Kong Chinese older adults.

OBJECTIVES: The main objectives were to examine the relation between age-comparative (self vs others of same age) self-rated health (SRH) and time-comparative (self this year vs last year) SRH, and to evaluate which was more strongly associated with specific physical health problems. METHODS: Cross-sectional data on two SRH measures and various physical health problems from 18749 male and 37413 female clients aged 65 or over from 18 Elderly Health Centres in Hong Kong were analysed using logistic regression with adjustment for potential confounders. RESULTS: Men were more likely to report 'better' and less likely to report 'worse' SRH than women. 'Normal' was the most common option but the proportions choosing this decreased with age on both SRH measures. There was a fairly weak but statistically significant correlation between these two measures, with Kappa coefficients of 0.125 and 0.167 for men and women, respectively. For both men and women, there were significantly positive linear trends between age-comparative SRH options from 'better' to 'worse' and physical health problems, such as respiratory diseases, musculoskeletal diseases, any active chronic diseases, functional disability, depressive symptoms, taking medication regularly, and admission to hospital last year. However, for time-comparative SRH, those who rated 'normal' had the smallest odds ratios in all of the physical health problems above than those who rated 'better' or 'worse'. CONCLUSIONS: The two SRH measures correlated with each other weakly but significantly. Age-comparative SRH was linearly, and time-comparative SRH was curvilinearly associated with physical health problems.

Obesity and depressive symptoms in Chinese elderly.

OBJECTIVES: The main objective was to examine the association between obesity and depressive symptoms among Chinese elderly in Hong Kong. METHODS: Cross-sectional data on depressive symptoms and body mass index from 56 167 clients aged 65 or over who enrolled as members of Elderly Health Centres from July 1998 to December 2000 were analysed using multiple logistic regression with adjustment of potential confounders. RESULTS: Among 18 750 men and 37 417 women, the prevalence [95% confidence interval (CI)] of depressive symptoms (based on the Geriatric Depression Scale) was 4.9% (4.6-5.2%) and 7.9% (7.6-8.1%) respectively (p < 0.001). The prevalence of obesity (by World Health Organisation Asian standard: body mass index > or =25.0) in women was significantly higher than that of men (42.1% (41.6-42.7%) vs 36.6% (35.9-37.3%), p < 0.001). Obese men and women were about 20% less likely to suffer from depressive symptoms compared with those with normal weight after adjustment for confounders, with odds ratios (95% CI) of 0.82 (0.69-0.97) and 0.78 (0.71-0.86) respectively. Negative linear trends were observed between depressive symptoms and BMI categories in both sexes, and women showed a greater slope and stronger statistical significance than men. CONCLUSIONS: Both obese elderly men and women in Hong Kong were less likely to suffer from depressive symptoms than those of normal weight. The results support the 'jolly fat' hypothesis previously restricted to men, and extend the hypothesis to female elderly. Chinese traditional culture and positive values towards obesity may be protective against depressive symptoms.