Effectiveness of National Residential Smoking Cessation Program

We aimed to investigate the effectiveness of the Korean national five-day residential smoking cessation program and the factors affecting the long-term smoking cessation of participants. The residential smoking cessation program (2017–2018) recruited smokers with a smoking duration ≥ 20 years and who have attempted to quit smoking more than twice and/or smokers with chronic morbidities. Participants underwent an intensive intervention, including individual psychological therapy, group therapy, medical counseling, and pharmacotherapy. The 6-month continuous abstinence rate (CAR) was assessed via self-reports, the urine cotinine levels, and/or expired-air carbon monoxide levels. Logistic regression was used to analyze the adjusted odds ratio (aOR) to assess factors related to smoking cessation. Overall, 484 participants who completed the residential program and questionnaire were evaluated. The 3- and 6-month CAR were 81.82% and 63.22%, respectively. The aOR of 6-month continuous abstinence was lower among participants with severe nicotine dependence (aOR: 0.46, 95% confidence interval [CI]: 0.26–0.81) and higher among participants with combination therapy of varenicline with short-term nicotine replacement therapy (NRT) (aOR: 1.64, 95% CI: 1.07–2.51), with higher self-efficacy (aOR: 1.97, 95% CI: 1.15–3.37). The residential smoking cessation program was effective. High self-efficacy, combination therapy of varenicline with short-term NRT, and low nicotine dependence were associated with a high 6-month CAR.

Effects of morbidity on smoking cessation: a national smoking cessation program

Background In smokers with chronic diseases, we examined the abstinence rates over 6 months and its affecting factors in the context of the Korea National Health Insurance Service (NHIS) smoking cessation program. Methods To identify 6-month abstinence, we extracted a sample of 15,017 participants using the multi-stage stratified cluster sampling method from the 359,047 individuals enrolled in the 2016 NHIS smoking cessation program and 1500 smokers responded to the telephone survey. From this group, 1245 individuals (48.50 ± 12.55 years; men 89.8%) were enrolled, as they had no missing information for confounding variables. We compared chronic disease distribution between participants and current smokers in the 2016 Korea National Health and Nutrition Examination Survey. We evaluated the factors affecting continuous abstinence rate (CAR) across patients with different chronic diseases: hypertension, diabetes mellitus (DM), dyslipidemia (DL), chronic obstructive pulmonary disease, and major depressive disorder (MDD). Results While participation of DM patients was high, the participation of DL patients was relatively low. The CAR over 6 months was 44.74%. The adjusted odds ratio (OR) for continuous abstinence over 6 months was significantly lower in the MDD group than in the no-MDD group (OR 0.43, 95% confidence interval [CI] 0.21 to 0.85). The factors of program completion (complete versus incomplete: OR 3.11, 95% CI 2.43 to 3.98), region (non-metropolitan areas versus Seoul metropolitan area: OR 1.28, 95% CI 1.01 to 1.61), and nicotine dependence (severe versus light or moderate: OR 0.64, 95% CI 0.50 to 0.83) were significantly associated with CAR. Conclusions The smoking cessation program was not actively recruiting smokers with chronic diseases. The CARs in each disease group were not different from those in the non-disease groups, except that the MDD group had a lower CAR over 6 months than the no-MDD group. Recruiting smokers with chronic diseases and improving their CARs depends on the careful identification of their characteristics.

Psychiatric co-morbidity and multi-morbidity in the EAGLES trial: Descriptive correlates and associations with neuropsychiatric adverse events, treatment adherence, and smoking cessation

Introduction Psychiatric and substance use disorders represent barriers to smoking cessation. We sought to identify correlates of psychiatric co-morbidity (2 diagnoses) and multi-morbidity (3+ diagnoses) among smokers attempting to quit and to evaluate whether these conditions predicted neuropsychiatric adverse events (NPSAEs), treatment adherence, or cessation efficacy (CE). Method Data were collected from November 2011 to January 2015 across sixteen countries and reflect the psychiatric cohort of the EAGLES trial. Participants were randomly assigned to receive varenicline, bupropion, nicotine replacement therapy, or placebo for 12 weeks and were followed for an additional 12 weeks post-treatment. NPSAE outcomes reflected sixteen moderate-to-severe neuropsychiatric symptom categories, and CE outcomes included continuous abstinence at weeks 9-12 and weeks 9-24. Results Of the 4103 participants included, 36.2% were diagnosed with multiple psychiatric conditions (20.9% co-morbidity, 15.3% multi-morbidity). Psychiatric co- and multi-morbidity were associated with several baseline factors, including male gender, non-white race/ethnicity, more previous quit attempts, and more severe mental health symptoms. The incidence of moderate-to-severe NPSAEs was significantly higher (p<0.01) in participants with multi-morbidity (11.9%) than those with co-morbidity (5.1%) or primary diagnosis only (4.6%). There were no significant (ps>0.05) main effects or interactions with treatment condition for diagnostic grouping on treatment adherence or CE outcomes. Conclusions While having multiple psychiatric diagnoses increased risk of developing moderate-to-severe NPSAEs during a quit attempt, neither co- nor multi-morbidity were associated with treatment adherence or odds of quitting. These findings reassure providers to advise smokers with multiple stable psychiatric conditions to consider using FDA-approved medications when trying to quit.

Cessation rates from a national collective social network smoking cessation programme: results from the ‘I quit smoking with Facebook on March 21’ Swiss programme

Background Programmes for collective smoking cessation, based on the British model Stoptober, are proposed by public health units in many countries. There is a need for data estimating the rate at which participants in these programmes are successful in quitting smoking. We report a prospective study carried out as part of a large-scale collective cessation programme conducted in Switzerland in 2017.Methods 1112 participants among the 7008 smokers enrolled in the collective cessation programme were recruited before the start of the attempt. Continuous abstinence was measured 10 days, 3 months and 6 months after the start of the attempt. Participants who dropped out at follow-up were considered to have failed the attempt (worst-case scenario).Results The continuous abstinence rate was at least 37.9% at 10-day follow-up, 18.8% at 3-month follow-up and 13.1% at 6-month follow-up. Similar levels of continuous abstinence as the worst-case scenario were found in sensitivity analyses including those whose quit attempt started before the beginning of the programme and where multiple imputation was used to replace dropouts. Sensitivity analyses using complete cases or an indicator of abstinence which allows occasional lapses found around double the abstinence rates.Conclusions Our results support the potential usefulness of large-scale collective cessation campaigns and suggest that such programmes based on social networks are promising areas for future smoking cessation programme activity.

The Effectiveness Analysis of ‘Quit-Calendar’ Related to Current Smokers under ‘Quit-For-King’ Project (Phase II)

ackground: Quit-Calendar has been developed and initially tested in Phase I for the Quit-For-King project. The effectiveness and satisfaction of its properties were later investigated among village health volunteers. Objective: To investigate the Quit-Calendar effectiveness, factors related to quit success, and its satisfaction under the ‘Quit-For-King’ Project. Materials and Methods: One hundred eleven current smokers underwent the program. Each participant needed to go ‘cold turkey’ technique, which mean to stop smoking at once, then received 5A counseling and a Quit-Calendar. The measuring parameters included continuous abstinence rate (CAR) and point prevalence abstinence rate (PAR), investigated at 2-weeks, 1-, 3-, and 6- month periods via statistical analysis. Results: Most of the participants were males (96.4%), smoked 10 cigarettes per day (53%), heavy smokers. They were mostly in ‘preparation stage’ of change (49%). CAR was 26.11% and PAR values increased by the end of the 6-month. There were statistically significant differences between the numbers of quitters using Quit-Calendar (p<0.001). Only three factors, including numbers of cigarettes, minor illness, and levels of readiness to quit significantly affected quit success (p<0.001). The smokers stated that the Quit-Calendar could possibly help them to quit smoking. Nonetheless, some limitations need to be resolved. Conclusion: Quit-For-King project has been successful over a 3-year period. The Quit-Calendar is one of the cessation aids that promote quit success and help quitters to overcome nicotine withdrawal. Keywords: Quit-For-King, Quit-Calendar, Continuous abstinence rate (CAR), Point prevalence abstinence rate (PAR), Village health volunteers

Durability of Abstinence After Completing a Comprehensive Digital Smoking Cessation Program Incorporating a Mobile App, Breath Sensor, and Coaching: Cohort Study

Background Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements, including a personal portable breath carbon monoxide sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow up in this cohort. Objective The aim of this study was to assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence. Methods This prospective remote cohort study included US-based cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), self-reported quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence. Results A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow up, CPD were reduced by 52.6% (SE 2.1; P<.001) among all 319 participants, and most completers (152/288, 52.8%) reduced their CPD by at least 50%. Overall, most completers (232/288, 80.6%) made at least one quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow up compared with 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in about a quarter of those who onboarded (76/319, 23.8%) and in most who reported 30-day PPA at the end of Pivot (76/88, 86.4%), with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory regression analyses, lower baseline CPD, more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting), and higher education were associated with achieving abstinence. Conclusions This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence throughout follow up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results, and suggest that Pivot is an effective and durable solution for smoking cessation. Trial Registration ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643

Effectiveness of Aerobic Exercise on Smoking Cessation in Adults: A Systematic Review and Meta-Analysis

Background: The specific benefits of aerobic exercises in smoking cessation are unclear, as they have different characteristics, intensities, and durations. The purpose of this systematic review with meta-analysis was to evaluate the effects of aerobic exercise, with or without co-interventions, compared with a control group of cognitive behavior treatment on smoking cessation. Methods: This review was prospectively registered on PROSPERO, and the searches were performed from 2016 to 2018. Randomized controlled trials evaluating the effects of aerobic exercise, with or without nicotine therapy replacement, compared with usual care were included. The primary outcome was smoking cessation defined as the prevalence of those who quit or continuous abstinence. Meta-analysis was calculated using random effects model in the comprehensive meta-analysis software. Results: The authors identified 18 trials reporting data for a total of 2815 participants. There was moderate-quality evidence that aerobic exercise was better than usual care in promoting smoking cessation at short term (11 trials, risk ratio 0.79; 95% confidence interval, 0.66–0.94). However, there were no differences between aerobic exercises and usual care at medium- or long-term follow-ups. Conclusions: According to review, aerobic exercise may be effective in promoting smoking cessation at short-term, but not at medium- and long-term follow-ups.

Efficacy of Electronic Cigarettes for Smoking Cessation: A Systematic Review and Meta-Analysis

Background: Smoking is a major public health problem and widely recognized as one cause of premature morbidity and mortality. No updated evidence to conclude about the certainty of evidence for adopting E-Cigarettes as smoking cessation intervention despite enough debate. We aim to synthesize available evidence to assess the efficacy as well as safety of E-Cigarettes versus different forms of NRT and placebo to quit smoking. Methods: We comprehensively searched of clinical trials in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), PsycINFO, Science Direct, Center for reviews and dissemination and HTA database and Trip database. We also searched clinicalTrial.gov and WHO International Clinical Trials Registry Platform (ICTRP) portal. We searched grey literature including Dissertations (ProQuest Dissertations and Theses), Web of Science Thomson Reuters: Conference Proceedings Citation Index, and unpublished manuscripts, examined the references of relevant articles, hand searched topic-specific journals and contacted authors for incomplete data. After data extraction, we assessed the risk of bias using the Cochrane RoB 2 tool. We synthesized data by random-effects model through the Mantel-Haenszel method and R software. We conducted subgroup analysis by length of follow-up and sensitivity analysis by restricting to only studies with low risk of bias. We created a summary of findings table based on GRADE approach. Results: We retrieved 12 clinical trials involving 9863 participants. Four studies were judged as low risk of bias across five domains of RoB 2 tool and the rest were judged as unclear risk of bias. CO- validated one-month continuous abstinence rate was significantly higher in E-cigarettes group than control (5 studies, 32.6 vs 23.1%, N = 1970, RR 1.335, 95 % CI 1.068; 1.667, moderate evidence). However, Three-month and six- month abstinence rate didn’t differ significantly between E-cigarettes and control groups (3 Studies, 12.1 vs 12.8%, N=1099, RR 1.52, 95% CI 0.348; 6.701) and (7studies, N = 5435,10.2 vs 6.6%, RR 1.347, 95%CI 0.953; 1.903, very low evidence) respectively. There is very low certainty evidence of effect of E-cigarettes compared to control whether NRT or placebo on sustained reduction of 50% or greater in baseline cigarette consumption at different follow-up periods (1 month, 3 studies, 50.9 vs 33.2%, N = 955, RR 1.29, 95 % CI 0.59; 2.82), (3 Month , 3 studies, 43.2 vs 25.3%, N = 1067, RR 1.36, 95 % CI 0.66; 2.79), (6 month , 5 studies, 27.1 vs 13.4%, N = 1981, RR 1.38, 95 % CI 0.90; 2.11) and at 12 month (1 study, 14.5 vs 12%, N = 300, RR 1.21, 95 % CI 0.64; 2.27). Only one study of 884 participants displayed improved point abstinence by 46% (improvement range 17-82%) in E-cigarettes group relative to control at 12 months (1study, 32.7 vs 22.3%, N = 884, RR 1.46, 95 % CI 1.17; 1.82, moderate evidence). E-cigarettes may increase the proportion of serious adverse effect at 6 month-follow up (1 study, 9.3 vs 5.1%, N = 657, RR 1.81, 95 % CI 1.03; 3.19, low evidence) Conclusion: We are uncertain if E-cigarettes improve continuous abstinence rate at short term (1 month). There is very low certainty evidence of the effect of E-cigarettes compared to control whether NRT or placebo on the sustained reduction of 50% or greater in baseline cigarette consumption as well as 7-day point prevalence abstinence rate at 1-,3-, and 6-month follow-up periods. Long term efficacy of E-cigarettes is unknown, and E-cigarettes may increase or have no effects on the proportion of serious adverse effect at 6 months follow up. The information presented are indeed useful for policy makers , public health practitioners, and to encourage further research. Further clinical trials are needed to assess the long-term efficacy and safety of E-cigarettes and ongoing trials are urgently needed to help concluding about the efficacy of E-cigarettes for smoking cessation. Objective: to synthesize evidence about the efficacy of electronic cigarettes versus Nicotine Replacement Therapy and placebo to quit smoking. Data sources: We searched for clinical trials with no publication date restriction until December 2019. The search included CENTRAL, MEDLINE, PsycINFO, Science Direct, Center for reviews and dissemination and HTA database and Trip database, clinical trials registries, gray literature and examined the references of relevant articles. Inclusion and exclusion criteria: Two review authors independently checked the titles and abstracts then the full text of initial hits. Main outcomes were sustained continuous abstinence rate, 7-day point prevalence abstinence rate, sustained reduction of 50% or greater in baseline cigarette consumption and adverse effects. Data extraction and synthesis: Two review authors independently extracted data and assessed risk of bias using the Cochrane RoB 2 tool. We conducted a random-effects model through the Mantel-Haenszel method. Results: We retrieved 12 trials involving 9863 participants. CO- validated 1-month continuous abstinence rate improved by 33% in the e-cigarettes group (range 6-66%, moderate evidence). We are uncertain if e-cigarettess influence continuous abstinence rate at 3-, 6- and 12 months as well as sustained reduction of 50% or greater in baseline cigarette consumption at different follow-up periods. One study of 884 participants displayed improved 12-month 7-day point abstinence by 46% (range 17%-82%). E-cigarettes may increase or do not affect the proportion of serious adverse effect at 6 and 12 months follow up. Conclusion: Very low certainty evidence supported e-cigarettess to help quit smoking in the short term. There is not enough evidence to determine if e-cigarettess are a safe and efficacious means of smoking cessation in the long term (12+ months).

Durability of Abstinence After Completing a Comprehensive Digital Smoking Cessation Program Incorporating a Mobile App, Breath Sensor, and Coaching: Cohort Study (Preprint)

BACKGROUND Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements, including a personal portable breath carbon monoxide sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow up in this cohort. OBJECTIVE The aim of this study was to assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence. METHODS This prospective remote cohort study included US-based cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), self-reported quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence. RESULTS A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow up, CPD were reduced by 52.6% (SE 2.1; <i>P</i>&lt;.001) among all 319 participants, and most completers (152/288, 52.8%) reduced their CPD by at least 50%. Overall, most completers (232/288, 80.6%) made at least one quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow up compared with 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in about a quarter of those who onboarded (76/319, 23.8%) and in most who reported 30-day PPA at the end of Pivot (76/88, 86.4%), with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory regression analyses, lower baseline CPD, more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting), and higher education were associated with achieving abstinence. CONCLUSIONS This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence throughout follow up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results, and suggest that Pivot is an effective and durable solution for smoking cessation. CLINICALTRIAL ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643

Free, easy and effective: how young adults used 8 weeks of mailed nicotine patches and to what effect

IntroductionResearch shows the mass distribution of free nicotine replacement therapy (NRT) is a high-impact, population-level strategy for smoking cessation; but underrepresentation of younger, and/or lighter, smokers challenges generalisability of findings to young adult smokers.AimsThis naturalistic study examined how and with what effect young adult smokers used free nicotine patches provided through a mass mailout programme.MethodsIn total, 5,025 eligible 18–29 year-old smokers who accessed an online ordering platform received self-help materials and an 8-week course of patches matched to their consumption level (<10 cigarettes per day (cpd); ≥10 cpd). No other behavioural support occurred. Whether participants used patches correctly and achieved 30-day continuous abstinence at 6-month follow-up were assessed.ResultsAmong 694 participants with complete data: 89% used some patches; 8% used the patches correctly for 8 weeks; 31.0% (95% confidence interval (CI) = 27.6, 34.7) achieved abstinence. Adjusted logistic regression analysis showed the highest odds of abstinence was associated with the correct use of patches (odds ratio = 2.8, 95% CI = 1.5, 5.1).ConclusionsMass distribution of free patches may be an effective public health measure for supporting younger, lighter smokers to attempt cessation, reduce consumption, or achieve abstinence. Emphasising why and how to use NRT for the entire treatment course may enhance outcomes.