Effect of Nicotine Replacement Therapy on Stress and Smoking Behavior in Surgical Patients

2005 ◽  
Vol 102 (6) ◽  
pp. 1138-1146 ◽  
Author(s):  
David O. Warner ◽  
Christi A. Patten ◽  
Steven C. Ames ◽  
Kenneth P. Offord ◽  
Darrell R. Schroeder
Keyword(s):  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Psychological Stress ◽  
Perceived Stress ◽  
Smoking Behavior ◽  
Perioperative Period ◽  
Nicotine Withdrawal ◽  
Surgical Patients ◽  
Nicotine Replacement ◽  
Stress Score

Background Many surgical patients are dependent on nicotine. Smoke-free policies in healthcare facilities mandate abstinence from smoking, which could contribute to psychological stress in the perioperative period. The authors tested the hypothesis that nicotine replacement therapy decreases psychological stress in cigarette smokers scheduled to undergo elective surgery and determined whether nicotine replacement therapy affects postoperative smoking behavior, even when not specifically prescribed to promote abstinence. Methods In this double-blind, placebo-controlled trial, 121 smokers, of whom 116 received a study intervention, were randomly assigned to receive either active (nicotine-containing) or placebo patches, beginning on the morning of surgery and continuing for up to 30 days after discharge from the hospital. Outcomes included the Perceived Stress Score, the Nicotine Withdrawal Score, and subject self-report of smoking behavior. Results The Perceived Stress Score and the Nicotine Withdrawal Score did not change significantly from baseline over the immediate perioperative period and did not differ between active or placebo patch groups (all P > 0.19). The percentage of placebo versus active patch subjects reporting 7-day abstinence at 30 days postoperatively (30% vs. 39%; P = 0.29) did not differ significantly between groups. At 30 days postoperatively, subjects in both groups significantly reduced their cigarettes smoked per day from baseline, but those receiving active patches reported a greater decrease (a mean decrease of 11 +/- 11 vs. 15 +/- 7 cigarettes/day in placebo and active groups; P = 0.045). Conclusion Routine nicotine replacement therapy is not indicated in smokers undergoing surgery for the purposes of managing nicotine withdrawal and stress but can modify some aspects of postoperative smoking behavior.

scholarly journals Development of a Mobile Health Intervention with Personal Experiments for Smokers Who Are Ambivalent About Quitting: Formative Design and Testing (Preprint)

2020 ◽  
Author(s):  
Jaimee L Heffner ◽  
Sheryl L Catz ◽  
Predrag Klasnja ◽  
Brooks Tiffany ◽  
Jennifer B McClure
Keyword(s):  
Pilot Study ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Mobile Health ◽  
Smoking Behavior ◽  
Nicotine Replacement ◽  
Counseling Intervention ◽  
The Core ◽  
Core Content ◽  
Quit Smoking

BACKGROUND The majority of cigarette smokers want to quit someday but are not ready to commit to long-term abstinence. However, available smoking cessation treatments are not well-suited to meet the needs of these ambivalent smokers. Low-cost, high-reach mobile health (mHealth) interventions may be a cost-efficient means of offering assistance to ambivalent smokers, yet there are currently no evidence-based options available for this group. OBJECTIVE The aim of this study was to develop and preliminarily evaluate the core content for an mHealth program targeting adult smokers who are ambivalent about quitting. The core content consisted of a series of “personal experiments” similar to those tested as part of a counseling intervention in prior work, including brief cognitive or behavioral tasks designed to boost readiness for changing smoking behavior. METHODS We conducted individual user interviews (N=3) to refine program content, and then conducted a one-arm pilot study (N=25) to assess user receptivity and the potential impact of the experiments on motivation and self-efficacy to quit or reduce smoking. RESULTS In user interviews, participants liked the concept of the personal experiments. Participants in the pilot study found a medium-fidelity prototype to be highly acceptable. After watching a brief orientation video that explained how the program works, most participants (80%, 20/25) indicated that it sounded interesting, primarily because it did not require any commitment to quit. All participants (100%, 25/25) completed all 7 experiments, including a 24-hour quit attempt, although not all were able to refrain from smoking for a full day based on qualitative feedback on the experiment. The mean rating of usefulness of the overall program was 4.12 (SD 1.09) out of 5, and the average rating of the difficulty of the experiments was 2.16 (SD 1.18) out of 5. At the last assessment point, 92% (23/25) of the participants indicated that they were more interested in either quitting or cutting back than when they began the program, and 72% (18/25) said that if the program had included a free trial of nicotine replacement therapy, they would have used it to try to quit smoking. CONCLUSIONS This formative work confirmed that ambivalent smokers are willing to use and will remain engaged with an mHealth intervention that employs the novel concept of personal experiments to enhance their motivation for and ability to quit smoking. The addition of action-oriented treatment (self-help and free nicotine replacement therapy, quitline referral) could further support users’ efforts to stop smoking and remain quit.

scholarly journals Case Report: Nicotine Replacement Therapy (NRT) in Hospitalized Surgical Patient

2015 ◽  
Vol 10 (1) ◽  
pp. 2-4 ◽  
Author(s):  
Laurel Sisler ◽  
Susan Trout ◽  
Carol Ripley-Moffitt ◽  
Adam O. Goldstein
Keyword(s):  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Motor Vehicle ◽  
Withdrawal Symptoms ◽  
Surgical Patients ◽  
Rehabilitation Service ◽  
Surgical Patient ◽  
Potential Health ◽  
Nicotine Replacement ◽  
Impaired Wound Healing

Hospital surgical services are often reluctant to offer nicotine replacement therapy (NRT) to inpatients due to concerns that nicotine leads to vasoconstriction and impaired wound healing. However, multiple potential health benefits result from offering NRT to hospitalized surgical patients who use tobacco products. A 28-year-old female patient, hospitalized following a motor vehicle accident, experienced severe nicotine withdrawal symptoms and a strong desire to smoke. After a Tobacco Treatment Specialist (TTS) consultation, the Physical Medical and Rehabilitation service at the hospital began her on NRT with positive outcomes. The patient experienced decreased cravings and withdrawal symptoms, as well as an increased desire to remain tobacco free after discharge. More surgical patients may have an increased commitment to remain tobacco free after discharge, if their withdrawal symptoms are treated during hospitalization using NRT.

Smoking Behavior and Perceived Stress in Cigarette Smokers Undergoing Elective Surgery

2004 ◽  
Vol 100 (5) ◽  
pp. 1125-1137 ◽  
Author(s):  
David O. Warner ◽  
Christi A. Patten ◽  
Steven C. Ames ◽  
Kenneth Offord ◽  
Darrell Schroeder
Keyword(s):  
Psychological Stress ◽  
Perceived Stress ◽  
Elective Surgery ◽  
Smoking Status ◽  
Perioperative Period ◽  
Nicotine Withdrawal ◽  
Withdrawal Symptoms ◽  
Perceived Stress Scale ◽  
Cigarette Smokers ◽  
Stress Scale

Background The forced abstinence from cigarettes accompanying surgery in smoke-free facilities may increase psychological stress by removing a coping mechanism and by nicotine withdrawal. The authors tested the hypothesis that abstinence from cigarette smoking contributes to psychological stress in the perioperative period. Methods The authors assessed measures of nicotine withdrawal (Hughes-Hatsukami nicotine withdrawal scale) and perceived stress (including the Perceived Stress Scale) in 141 cigarette smokers scheduled to undergo elective surgery. To separate the effects of stress arising from tobacco abstinence from the effects of other perioperative stressors, such as pain, these measures were also obtained in 150 surgical patients who did not use tobacco. Assessments were performed at intervals beginning at the time of preoperative medical evaluation and ending 30 days postoperatively. Results Perceived Stress Scale scores were significantly (P < 0.001) higher in smokers throughout the study period. There was little significant interaction between smoking status and time, indicating that changes in Perceived Stress Scale score during the perioperative period did not differ between smokers and nonsmokers. The same result was found if analysis was restricted to data collected before hospital discharge (and thus during assured abstinence). Similar results were found for the nicotine withdrawal scale, suggesting that smokers did not experience more withdrawal symptoms relative to nonsmokers. Conclusions Although smokers report increased baseline stress, smoking status does not affect changes in perceived stress over the perioperative period. Nicotine withdrawal symptoms do not seem to be a clinically significant problem in the perioperative period for most smokers.

Is Stress Management Training a Useful Addition to Physician Advice and Nicotine Replacement Therapy during Smoking Cessation in Women? Results of a Randomized Trial

2005 ◽  
Vol 20 (2) ◽  
pp. 127-134 ◽  
Author(s):  
Monika E. Slovinec D'Angelo ◽  
Robert D. Reid ◽  
Stephen Hotz ◽  
Jane Irvine ◽  
Roanne J. Segal ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Confidence Interval ◽  
Stress Management ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Perceived Stress ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Nicotine Replacement ◽  
Quit Smoking

Purpose. To determine whether a stress management (SM) program could improve cessation rates when added to usual care (UC) among women attempting to quit smoking. Design. Randomized controlled trial conducted during a 12-month period. Setting. Smoking cessation clinics located within two tertiary care centers in Ottawa, Ontario. Subjects. A total of 332 women smokers 19 years or older who smoked 10 or more cigarettes per day were recruited via advertisements. Intervention. Either UC (physician advice and nicotine replacement therapy) or UC plus an eight-session group SM training program (coping skills development relevant to smoking-specific and generic stressors). Measures. Point prevalence abstinence 2 and 12 months after study intake. A secondary outcome of interest was change in perceived stress during the intervention period. Results. On an intent-to-treat basis, the addition of SM to UC had no incremental effect on 2-or 12-month abstinence rates. Abstinence rates at 2 months were 26.2% vs. 31.7% in the UC and SM groups, respectively (p = .59). At 12 months, the rates were 18.5% vs. 20.7% (p = .86). When quit rates were compared including only participants who demonstrated adequate adherence to the intervention protocol, there was a significant difference between the UC and SM groups at 2 months (34.9% vs. 48.7%; adjusted odds ratio, 1.88; 95% confidence interval, 1.04–3.42; p = .04) but not at 12 months (23.0% vs. 28.2%; adjusted odds ratio, 1.24; 95% confidence interval, .64–2.41; p = .53). There was a significant reduction in perceived stress from preintervention to postintervention; however, this decrease was not moderated by group assignment. Conclusion. The addition of SM in our setting neither increased abstinence rates nor reduced perceived stress over and above UC in women motivated to quit smoking. Poor attendance at the SM intervention undermined its effectiveness.

scholarly journals Development of a Mobile Health Intervention with Personal Experiments for Smokers Who Are Ambivalent About Quitting: Formative Design and Testing

10.2196/21784 ◽  
2020 ◽  
Vol 4 (8) ◽  
pp. e21784
Author(s):  
Jaimee L Heffner ◽  
Sheryl L Catz ◽  
Predrag Klasnja ◽  
Brooks Tiffany ◽  
Jennifer B McClure
Keyword(s):  
Pilot Study ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Mobile Health ◽  
Smoking Behavior ◽  
Nicotine Replacement ◽  
Counseling Intervention ◽  
The Core ◽  
Core Content ◽  
Quit Smoking

Background The majority of cigarette smokers want to quit someday but are not ready to commit to long-term abstinence. However, available smoking cessation treatments are not well-suited to meet the needs of these ambivalent smokers. Low-cost, high-reach mobile health (mHealth) interventions may be a cost-efficient means of offering assistance to ambivalent smokers, yet there are currently no evidence-based options available for this group. Objective The aim of this study was to develop and preliminarily evaluate the core content for an mHealth program targeting adult smokers who are ambivalent about quitting. The core content consisted of a series of “personal experiments” similar to those tested as part of a counseling intervention in prior work, including brief cognitive or behavioral tasks designed to boost readiness for changing smoking behavior. Methods We conducted individual user interviews (N=3) to refine program content, and then conducted a one-arm pilot study (N=25) to assess user receptivity and the potential impact of the experiments on motivation and self-efficacy to quit or reduce smoking. Results In user interviews, participants liked the concept of the personal experiments. Participants in the pilot study found a medium-fidelity prototype to be highly acceptable. After watching a brief orientation video that explained how the program works, most participants (80%, 20/25) indicated that it sounded interesting, primarily because it did not require any commitment to quit. All participants (100%, 25/25) completed all 7 experiments, including a 24-hour quit attempt, although not all were able to refrain from smoking for a full day based on qualitative feedback on the experiment. The mean rating of usefulness of the overall program was 4.12 (SD 1.09) out of 5, and the average rating of the difficulty of the experiments was 2.16 (SD 1.18) out of 5. At the last assessment point, 92% (23/25) of the participants indicated that they were more interested in either quitting or cutting back than when they began the program, and 72% (18/25) said that if the program had included a free trial of nicotine replacement therapy, they would have used it to try to quit smoking. Conclusions This formative work confirmed that ambivalent smokers are willing to use and will remain engaged with an mHealth intervention that employs the novel concept of personal experiments to enhance their motivation for and ability to quit smoking. The addition of action-oriented treatment (self-help and free nicotine replacement therapy, quitline referral) could further support users’ efforts to stop smoking and remain quit.

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