An Evaluation of the Impact of a Multicomponent Stop Smoking Intervention in an Irish Prison

The disproportionately high prevalence of tobacco use among prisoners remains an important public health issue. While Ireland has well-established legislative bans on smoking in public places, these do not apply in prisons. This study evaluates a multi-component tobacco control intervention in a medium security prison for adult males in Ireland. A stop-smoking intervention, targeting staff and prisoners, was designed, implemented, and evaluated with a before-and-after study. Analysis was conducted using McNemar’s test for paired binary data, Wilcoxon signed rank test for ordinal data, and paired T-tests for continuous normal data. Pre-intervention, 44.3% (n = 58) of the study population were current smokers, consisting of 60.7% of prisoners (n = 51) and 15.9% of staff (n = 7). Post-intervention, 45.1% of prisoners (n = 23/51) and 100% of staff (n = 7/7) who identified as current smokers pre-intervention reported abstinence from smoking. Among non-smokers, the proportion reporting being exposed to someone else’s cigarette smoke while being a resident or working in the unit decreased from 69.4% (n = 50/72) pre-intervention to 27.8% (n = 20/72) post-intervention (p < 0.001). This multicomponent intervention resulted in high abstinence rates, had high acceptability among both staff and prisoners, and was associated with wider health benefits across the prison setting.

A Pilot Study on Approach Bias Modification in Smoking Cessation: Activating Personalized Alternative Activities for Smoking in the Context of Increased Craving

Background The act of smoking has been associated with the automatic activation of approach biases towards smoking-related stimuli. However, previous research has produced mixed findings when smokers are trained to avoid such smoking-related stimuli through the application of Approach Bias Modification (ApBM). As such, this study aimed to test an improved ApBM (ApBM +), where smokers were trained to approach personalized alternative activities for smoking in the context of increased craving, in addition to training smoking-avoidance responses. Methods Sixty-seven daily smokers motivated to quit (M age = 29.27, 58.2% female) were randomly assigned to seven sessions of either ApBM + (n = 26), standard-ApBM (n = 19), or sham-ApBM (n = 22), after a brief motivational smoking intervention. Primary outcomes of approach biases for smoking and for alternative activities and secondary outcomes of smoking-related behaviors were assessed at pre-test, post-test, and 1-month follow-up. Results Overall, no group differences by condition were demonstrated in changing approach biases or smoking-related behaviors at post-test and 1-month follow-up. A trend level indication for differences in changes of smoking-approach biases between sham-ApBM and ApBM + for relatively heavy smokers was found at post-test. This was primarily driven by a significant increase in smoking-approach biases within the sham-ApBM condition and a trend decrease in smoking-approach biases within the ApBM + condition. Conclusions Our findings did not provide support for the current ApBM + concerning improved effects across the whole sample. Diverging training effects on approach biases for smoking in relatively heavy smokers warrants further research, for which we provide some suggestions.

PREVALENCE OF ADDICTION IN MALE PATIENTS POSTED FOR ORTHOPAEDIC OPERATIONS AND ITS SURGICAL OUTCOME

Introduction: Addiction of tobacco and other substances is a signicant surgical risk factor for peri-operative surgical events. Orthopedic perioperative complications of smoking include impaired wound healing, augmented infection, delayed and/or impaired fracture union and arthrodesis and worst total knee and hip arthroplasty results. This study is designed to analyse such routinely recorded data and observe prevalence addiction in male patients posted for orthopaedic operation. Material and methods: This Observational Retrospective study was conducted in MRD, ESI-PGIMSR & MC. All elective post-surgical patients who underwent surgery in between the period of January 2017 to December 2017. Total 120 patients were present in this study. Result: The most signicant effects of intervention were seen for wound-related complications (5% vs 31%, p=0·001), cardiovascular complications (0% vs 10%, p=0·08), and secondary surgery (4% vs 15%, p=0·07). The median length of stay was 11 days (range 7–55) in the smoker and 13 days (8–65) in the nonsmoker. Conclusion: Smoking is a risk factor for wound infection and cardiopulmonary complications in almost any type of surgery; smokers make up a considerable proportion of the total number of postoperative complications. An effective smoking intervention programme applied 6–8 weeks before surgery more than halved the frequency of postoperative complications, with the greatest effect on wound-related and cardiovascular complications.

Smoking intervention programme for male secondary-school students in south-western Saudi Arabia

A one-day antismoking programme was conducted for 289 students in a male secondary school in Abha, Saudi Arabia. The one-group pretest/post-test design to evaluate the programme was based on an Arabic version of the WHO standard questionnaire for young people. The results showed that the prevalence rate of regular smoking was 14.5%. The students showed marked variability in correct responses to various factual items. The programme had a significant impact on nonsmokers [P < 0.01] and prespecialty students [P < 0.01]. With the exception of smokers, the students showed an overall positive attitude towards public action, but the impact of the one-day programme was less than satisfactory

Barriers to Building More Effective Treatments: Negative Interactions Among Smoking-Intervention Components

Meaningfully improved mental and behavioral health treatment is an unrealized dream. Across three factorial experiments, inferential tests in prior studies showed a pattern of negative interactions, suggesting that better clinical outcomes may be obtained when participants receive fewer rather than more intervention components. Furthermore, relatively few significant main effects were found in these experiments. Modeling suggested that negative interactions among components may account for these patterns. In this article, we evaluate factors that may contribute to such declining benefit: increased attentional or effort burden; components that produce their effects via the same capacity-limited mechanisms, making their effects subadditive; and a tipping-point phenomenon in which people near a hypothesized tipping point for change will benefit markedly from weak intervention and people far from the tipping point will benefit little from even strong intervention. New research should explore factors that cause negative interactions among components and constrain the development of more effective treatments.

Socio-economic differences in smoking among adolescents in a school-based smoking intervention: The X:IT II study

Aims: Socio-economic inequalities in health behaviour may be influenced by health interventions. We examined whether the X:IT II intervention, aiming at preventing smoking in adolescence, was equally effective among students from different occupational social classes (OSC). Methods: We used data from the multi-component school-based smoking preventive intervention X:IT II, targeting 13- to 15-year-olds in Denmark. The intervention was tested in 46 schools with 2307 eligible students at baseline (response rate=86.6%) and had three main intervention components: smoke-free school time, smoke-free curriculum and parental involvement. We used a difference-in-difference design and estimated the change in current smoking after the first year of implementation in high versus low OSC. Analyses were based on available cases ( N=1190) and imputation of missing data at follow-up ( N=1967). Results: We found that 1% of the students from high OSC and 4.9% from low OSC were smokers at baseline (imputed data), and 8.2% of the students from high OSC and 12.2% from low OSC were smokers at follow-up. Difference-in-difference estimates were close to zero, indicating no differential trajectory. Conclusions: As intended, the X:IT II intervention, designed to apply equally to students from all socio-economic groups, did not seem to create different trajectories in current smoking among adolescents in high and low socio-economic groups. To diminish social inequality in health, future studies should carefully consider the ability to affect all socio-economic groups equally, or even to appeal mainly to participants from lower socio-economic groups, as they are often the ones most in need of intervention.