Changes in Cigarette Smoking and Vaping in Response to the COVID-19 Pandemic in the UK: Findings from Baseline and 12-Month Follow up of HEBECO Study

This study investigated UK adults’ changes in cigarette smoking and vaping during the COVID-19 pandemic and factors associated with any changes. Data were from an online longitudinal study. A self-selected sample (n = 332) of 228 smokers and 155 vapers (51 participants were both smokers and vapers) completed 5 surveys between April 2020 and June 2021. Participants self-reported data on sociodemographics, COVID-19-related, and smoking/vaping characteristics. During the 12 months of observations, among smokers, 45% self-reported a quit attempt (27.5% due to COVID-19-related reasons) since the onset of COVID-19 pandemic and the quit rate was 17.5%. At 12 months, 35.1% of continuing smokers (n = 174) reported smoking less and 37.9% the same, while 27.0% reported an increase in the number of cigarettes smoked/day. Among vapers, 25.0% self-reported a quit attempt (16.1% due to COVID-19-related reasons) and the quit rate was 18.1%. At 12 months, 47.7% of continuing vapers (n = 109) reported no change in the frequency of vaping/hour, while a similar proportion reported vaping less (27.5%) and more (24.8%). Motivation to quit smoking and being younger were associated with making a smoking quit attempt and smoking cessation. Being a cigarette smoker was associated with vaping cessation. Among a self-selected sample, COVID-19 stimulated more interest in reducing or quitting cigarette smoking than vaping.

Middle Managers, Personnel Turnover, and Performance: A Long‐Term Field Experiment in a Retail Chain

In a randomized controlled trial, a large retail chain’s Chief Executive Officer (CEO) sets new goals for the managers of the treated stores by asking them to “do what they can” to reduce the employee quit rate. The treatment decreases the quit rate by a fifth to a quarter, lasting nine months before petering out, but reappearing after a reminder. There is no treatment effect on sales. Further analysis reveals that treated store managers spend more time on human resources (HR) and less on customer service. Our findings show that middle managers are instrumental in reducing personnel turnover, but they face a trade-off between investing in different activities in a multitasking environment with limited resources. The treatment does produce efficiency gains. However, these occur only at the firm level. This paper was accepted by Joshua Gans, business strategy.

Effects of a Mobile App Called Quittr, Which Utilizes Premium Currency and Games Features, on Improving Engagement With Smoking Cessation Intervention: Pilot Randomized Controlled Trial

Background Numerous mobile health (mHealth) apps have been developed to support smokers attempting to quit smoking. Although these apps have been reported to be successful, only modest improvements in the quit rate have been measured. It has been proposed that efforts to improve user engagement and retention may improve the quit rate further. Owing to the high cost of smoking-related disease, it is considered worthwhile to pursue even small improvements. Objective The aim of this study was to test a novel smartphone app that leverages premium currency strategies developed by the mobile games industry in an attempt to improve engagement and retention with a smoking cessation intervention. Methods We designed and developed a smoking cessation app called “Quittr” in line with previously developed smoking cessation mHealth apps. In addition to this established framework, we added a stand-alone fully featured city-building clicker-style game called “Tappy Town,” and a premium virtual currency called “QuitCoins.” The user earns QuitCoins for using the app in a way that contributes positively toward their quit attempt, and they can redeem these coins in Tappy Town for bonuses. To establish whether these features improved engagement and retention, we ran a 5-month randomized controlled trial where the intervention group had the full app with the extra games features, while the control group had the standard app only. Recruitment was performed via web-based advertising. Participants (N=175) had no direct contact with the researchers or other support staff. Results No significant differences in terms of engagement, retention, or smoking outcomes were found between the control and intervention groups. However, survey data indicated that the majority of the participants valued Tappy Town (10/17, 59%) and the QuitCoins rewards system (13/17, 77%). Usage data also suggested that Tappy Town was widely played and was generally appealing to users (mean total time spent in app, control group: 797 seconds vs intervention group: 3502 seconds, P<.001). Analysis of the results suggests that users in the intervention group may have been negatively affected by the aspects of the chosen design, and some theories were explored to explain this unexpected outcome. Conclusions Although the novel features of the Quittr app failed to improve the key outcomes measured in this study, there were enough positive indications to warrant further exploration of the concept. Additional research will be required to identify and correct any design flaws that may have adversely affected our participants before a follow-up study can be completed. Trial Registration Australian and New Zealand Clinical Trials Register ACTRN12617000491369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372661&isReview=true

Abstract 13872: Cue Restricted Smoking Increases Quit Rates With Varenicline

Introduction: Varenicline effectively helps smokers quit by reducing withdrawal symptoms and blocking the reward of smoking. However, most quitters return to smoking within 1 year. “Cue-restricted smoking” is a behavioral technique designed to increase quit rates by asking smokers attempting to quit to restrict smoking to the standing position, while alone, in an isolated area facing a wall, with the cigarette as the only stimulus. Hypothesis: We compared the effectiveness of cue-restricted smoking cessation advice versus standard target quit date advice from day 8 of initiating varenicline in smokers making a quit attempt at the Smoking Cessation Service at the Prevention Department of the Heart Institute, Sao Paulo, Brazil. Methods: Using retrospective clinic records we compared quit rates in 281 smokers (50% males) instructed in the cue-restricted smoking cessation method during 2016-18 to quit rates in 324 smokers (46% males) advised to completely stop smoking on the target quit date which we previously used during 2011-14. All were prescribed varenicline for 12 weeks alone, with the addition of bupropion if needed after 4 weeks. Follow-up consisted of behavioral support at 4-6 visits during active drug treatment and telephone counselling at 24 and 52 weeks. The smoking cessation rate was confirmed with expired carbon monoxide at the 12-week clinic visit and only by telephone at 52 weeks. Results: The mean age of smokers was 49 ±12 years both groups and the number of cigarettes smoked daily was similar (18/day in the cue-restricted versus 19/day in the target quit day group). The smoking cessation rate at 12 weeks was 75% in the cue-restricted versus 45% in the target quit day group (relative risk 1.8; 95% confidence interval 1.4-2.2; p<0.001). At 52 weeks the quit rate was 65% vs 34% respectively (relative risk 1.9; 95% confidence interval 1.5-2.4; p<0.001). Conclusion: Cue restricted smoking substantially increased the chance of quitting compared with standard advice during treatment with varenicline . These results should be further studied in a randomized controlled trial.

Effectiveness of an individual acceptance and commitment therapy for smoking cessation, delivered face-to-face and by telephone to adults recruited in primary health care settings: a randomized controlled trial

Background The aim of this study was to examine the effectiveness of delivering an individual Acceptance and Commitment Therapy (ACT) for smoking cessation among a Chinese population. Methods Participants were recruited from six primary health care centers. A total of 144 were eligible to take part in the study and agreed to be randomized to the intervention (ACT) group (n = 70) and control group (n = 74), respectively. Both groups received self-help materials on smoking cessation. The ACT group also underwent an initial face-to-face session and two telephone ACT sessions at 1 week and 1 month following the first session. They were re-contacted through telephone follow-ups at 3, 6, and 12 months by research assistants. The primary outcome was self-reported 7-day point-prevalence abstinence at the 12-month follow-up session. Other outcomes included biochemically validated quitting, quitting attempts, the intention to quit, the self-perception of quitting, and psychological flexibility. Results There was no significant difference in the self-reported 7-day point prevalence quit rate at the 12-month follow-up between the intervention group (24.3%) and the control group (21.6%) (risk ratio = 1.12; 95%CI = (0.62, 2.05); p = 0.704). Greater improvements in secondary outcomes from baseline to the 12-month follow-up were observed in the ACT group than in the control group, including a forward progression in the participants’ readiness to quit smoking (p = 0.014) and increased psychological flexibility (p = 0.022). Conclusions This study is the first evidence of a randomized-controlled trial on the adoption of an individual ACT for smoking cessation, delivered initially in primary health care settings and subsequently by telephone within a Chinese population. The present study found that the brief ACT intervention could not produce a significant quit rate but was promising in terms of bringing about cognitive changes, including greater psychological flexibility, and more confidence about quitting, when compared to the use of self-help materials only among the general population. Trial registration This trial was registered prospectively with the U.S. National Library of Medicine: (NCT01652508) on 26th July 2012.

Impact of COVID-19 on the Hong Kong Youth Quitline Service and Quitting Behaviors of Its Users

Tobacco use is a possible risk factor for contracting and spreading COVID-19. We aimed to describe the impact of the COVID-19 pandemic on the Youth Quitline service and quitting behaviors of its users in Hong Kong. We conducted a telephone survey involving 201 participants of the Youth Quitline service, and retrospectively analyzed the operation and use of Quitline since the COVID-19 outbreak in Hong Kong. The number of incoming calls to the Youth Quitline and the participants′ quit rate has increased since the COVID-19 outbreak in Hong Kong. Many participants (68%) did not realize that tobacco use potentially increased their risk for developing and spreading COVID-19; however, 43% agreed that the pandemic motivated their intention to quit, and 83% changed their smoking habits during the pandemic. These changes were mainly due to wearing masks (30%), closure of bars/pubs (25%), suspension of classes (14%), and being unable to socialize with friends (24%). Overall, 58% reduced their tobacco use; of these participants, 66% reported a ≥50% reduction in daily cigarette consumption. The participants reduced their smoking during the COVID-19 pandemic despite lacking knowledge about the potentially increased risk for contracting COVID-19 from continued smoking. The pandemic could create new opportunities to motivate young smokers to quit smoking, especially those seeking support for smoking cessation, and may further contribute to reducing the risks posed by COVID-19.

Dental Students as Smoking Cessation Counsellors: Patients’ and Providers’ Perspective

Introduction: This study assesses dental students’ and patients’ perceptions on the role of dental students as smoking cessation counsellors as well as the patient’s quit rate at the University of XX. Materials and methods: Self-administered questionnaires were distributed to all senior dental students (n=154) in XX University and telephone call interviews were conducted on their patients (n=169) who received smoking cessation counselling from September 2010 to June 2013. Results: Response rates for dental students and patients were 68.2% and 67.3% respectively. Most of the dental students in this study were females (72.3%) whereas the majority of patients were males (97.6%). An average of six months follow up indicated that 22.5% of patients had quit smoking, 65.3% reduced the number of cigarettes smoked and 6.5% had relapsed. About a third of patients surveyed (33.1%) believed that smoking cessation counselling was extremely helpful compared to what students perceived (5.7%, p<0.01). A higher percentage of patients (89.9%) rated the smoking cessation counselling performance as “excellent”, as compared to students’ rating (58.1%, p<0.01). The majority of the dental students and patients agreed that students should enquire about patients tobacco usage, information regarding the effects of smoking on oral health should be transmitted to patients and that quit smoking assistance should be offered. Conclusion: Smoking cessation counselling conducted by dental students seemed to be effective in assisting patients to reduce the number of cigarettes smoked and in quitting smoking. To some extent, both patients and students had positive attitudes towards smoking cessation counselling.

Effect of Additional Motivational Interviewing on Smoking Abstinence for 1-Year among Korean Adolescents: Results from A Comparative Retrospective Study in Quitline

The aim of this study was to evaluate the effect of additional motivational enhancement through telephone-based counseling on short- and long-term smoking abstinence among Korean adolescents. Methods: A comparative retrospective study was conducted based on the longitudinal follow up in Quitline from 2010 to 2017. A total of 533 and 178 adolescent smokers voluntarily participated in the 1-year quitting counseling only (group A, who were ready to quit) and the additional 4-week motivational interviewing before 1-year quitting counseling (group B, who were ambivalent about quitting), respectively. The outcomes were self-reported continuous abstinence at 30-day, 6-month, and 1-year follow up. Logistic regression was applied to estimate the effect of potential factors, including motivational enhancement, on cessation outcome. Results: At baseline, adolescents in group B had a lower motivation to quit than those in group A (p < 0.001). The successful quit rates at 30-day, 6-month, and 1-year follow up were 37.2%, 12.8%, and 11.4% in group A and 33.7%, 15.2%, and 11.2% in group B, respectively. After adjusting factors as appropriate, successful quit rates in group B were not significantly different from the rates in group A. Higher self-efficacy increased the successful quit rate at 30-day, 6-month, and 1-year follow up, similar in subgroup analysis by gender. Never-drinking showed significant association with 30-day successful quit in the whole population and among boys. The lower number of smoking triggers was associated with an increased 30-day successful quit rate among boys only. Conclusions: Counseling for motivational enhancement could be a promising approach for better quitting outcomes. Improving self-efficacy and eliminating smoking triggers should be continuously strengthened during the quitting process.