A personalized biomedical risk assessment infographic for people who smoke with COPD: a qualitative study

Background Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Despite proof of effectiveness and universal guideline recommendations, smoking cessation interventions are underused in practice. We sought to develop an infographic featuring personalized biomedical risk assessment through future lung function decline prediction (with vs without ongoing smoking) to both prompt and enhance clinician delivery of smoking cessation advice and pharmacotherapy, and augment patient motivation to quit. Methods We recruited patients with COPD and pulmonologists from a quaternary care center in Toronto, Canada. Infographic prototype content and design was based on best evidence. After face validation, the prototype was optimized through rapid-cycle design. Each cycle consisted of: (1) infographic testing in a moderated focus group and a clinician interview (recorded/transcribed) (with questionnaire completion); (2) review of transcripts for emergent/critical findings; and (3) infographic modifications to address findings (until no new critical findings emerged). We performed iterative transcript analysis after each cycle and a summative qualitative transcript analysis with quantitative (descriptive) questionnaire analysis. Results Stopping criteria were met after 4 cycles, involving 20 patients (58% male) and 4 pulmonologists (50% male). The following qualitative themes emerged: Tool content (infographic content preferences); Tool Design (infographic design preferences); Advantages of Infographic Messaging (benefits of an infographic over other approaches); Impact of Tool on Determinants of Smoking Cessation Advice Delivery (impact on barriers and enablers to delivery of smoking cessation advice in practice); and Barriers and Enablers to Quitting (impact on barriers and enablers to quitting). Patient Likert scale ratings of infographic content and format/usability were highly positive, with improvements in scores for 20/21 questions through the design process. Providers scored the infographic at 77.8% (“superior”) on the Suitability Assessment of Materials questionnaire. Conclusions We developed a user preference-based personalized biomedical risk assessment infographic to drive smoking cessation in patients with COPD. Our findings suggest that this tool could impact behavioural determinants of provider smoking-cessation advice delivery, while increasing patient quit motivation. Impacts of the tool on provider care, patient motivation to quit, and smoking cessation success should now be evaluated in real-world settings.

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.

Development of a WeChat-based mobile messaging smoking cessation intervention for Chinese immigrant smokers: Qualitative interview Study (Preprint)

BACKGROUND Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to the low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers’ access to cessation programs. OBJECTIVE This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese globally. METHODS This study consisted of two phases. In phase 1, we developed a mobile message library based on Social Cognitive Theory (SCT). We culturally adapted messages from two SCT-based text messaging smoking cessation programs (i.e., SmokefreeTXT and Decídetexto). We also developed new messages tailored to Chinese immigrant smokers who are not ready to quit smoking and messages addressing their barriers to quitting and misconceptions (e.g., willpower, nicotine replacement therapy). In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (7 females) in New York City between July and August 2021. The interviews explored participants’ smoking and quitting experiences, followed by the assessment of messages. Participants reviewed 17 messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) on their phone via WeChat. They rated each message on a 0-10 visual analog scale to indicate to what extent the message enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. We assessed participants’ understanding of the messages, sought feedback on poorly rated messages, and explored their preferences for content, length, and format. Participants also provided feedback about their concerns with the WeChat cessation intervention and recommendations for frequency and timing of messages. RESULTS Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including the lack of skills to cope with stress and stay abstinent at work. Participants expressed strong interests in the WeChat mobile messaging cessation intervention and commented on the intervention’s potential to expand their access to smoking cessation treatment (e.g., take minimum time, access information at times of their convenience). CONCLUSIONS Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions on promoting abstinence among Chinese immigrant smokers. CLINICALTRIAL NA

Tobacco/Nicotine Use Among Individuals Using Cannabis for Therapeutic Purposes

OBJECTIVE: While the relationship between recreational cannabis and nicotine use is well established, little is known about nicotine use among users of cannabis for therapeutic purposes (CTP). METHOD: Patients attending a medical marijuana dispensary (N = 697; 75.3% White; 60.0% male) completed a survey examining nicotine use, routes of administration of nicotine and cannabis, and CTP qualifying conditions. RESULTS: More than one-third (39.3%) of participants reported current nicotine use. Compared to exclusive cigarette smokers, non-users of nicotine, and e-cigarette users were approximately four times more likely to vape, rather than to smoke, cannabis. Almost a third of those reporting e-cigarette use (30.6%) and more than half (56.7%) of those reporting smoking cigarettes reported stopping for one day or longer in the past year because they were trying to quit. Furthermore, 46.8% of cigarette smokers reported plans to quit smoking in the next six months (but not in the next month) and an additional 31.6% planned to quit in the next month. Having a psychiatric condition was associated with nicotine use and higher motivation to quit smoking. CONCLUSIONS: Users of CTP are more likely to use nicotine products than the general population. Importantly, the route of administration of nicotine products is related to the route of administration of CTP. If aerosolized (vaped) CTP is a less harmful route of administration than smoked CTP, dispensary staff should be aware of this relationship and take this into account when recommending a non-combustible route.

Effects of electronic cigarette e-liquid flavouring on cigarette craving

BackgroundE-liquid flavour restrictions may discourage electronic cigarette (e-cigarette) uptake among youth. However, possible unintended consequences may include reduced appeal and effectiveness of e-cigarettes for smoking cessation. Non-tobacco flavours appear to be important for smoking cessation, but how and why are currently unclear.MethodsWe conducted an experimental study in a UK sample of adult daily smokers using an independent groups design (N=84). Participants were randomised to use an e-cigarette with nicotine-containing fruit/sweet-flavoured e-liquid (blackcurrant, strawberry, vanilla, caramel) or unflavoured e-liquid for 1 week. The primary outcomes were average, peak and cue-elicited cigarette craving (the latter was assessed using a cue exposure task). The secondary outcomes were smoking lapse occurrence, enjoyment of the e-cigarette, ease of transitioning from smoking to using an e-cigarette, intentions to continue using an e-cigarette, intentions and motivation to quit smoking, return to smoking, and continuation of e-cigarette use.ResultsE-liquid flavouring did not appear to have an effect on average cigarette craving (b 0.18, 95% CI −0.44 to 0.79, p=0.57), peak cigarette craving (b −0.12, 95% CI −0.59 to 0.35, p=0.62) or cue-elicited cigarette craving (b −0.21, 95% CI −3.86 to 3.43, p=0.91). We did not find evidence of a difference in secondary outcomes.ConclusionsWe did not find evidence to suggest that nicotine-containing fruit/sweet-flavoured and unflavoured e-liquids have different effects on cigarette cravings after 1 week of use. Further research is needed to establish if differences emerge over longer periods of exposure and extend to smoking cessation outcomes.

PENGARUH INTERVENSI MEDIA SOSIAL (WHATSAPP) DENGAN FLYER TERHADAP PERUBAHAN PERILAKU MEROKOK REMAJA PADA MASA PANDEMI COVID-19 DI DESA TOMADO KECAMATAN LINDU

Adolescent smoking behavior is a behavior that endangers health, but there are still many teenagers who become smokers who started when they were teenagers or at the age of 11 years, especially teenage boys who often did this action. The use of appropriate media can affect the knowledge of respondents. In general, this study aims to determine the effect of social media intervention (whatsapp) with flyers on changes in adolescent smoking behavior during the COVID-19 pandemic in Tomado Village, Lindu District, Sigi Regency, Central Sulawesi. And specifically, the research objective was to determine the effect of social media intervention (whatsapp) with flyers on smoking knowledge, smoking frequency, changes in smoking attitudes, and adolescent motivation to quit smoking. This type of research is a quasi-experimental design with a pretest-posttest two group design. The research sample used purposive sampling method and obtained a sample of 40 people. The instrument of this research used questionnaires, observation sheets, pretest and posttest questionnaires, and media flyers. Analysis of research data using a comparative test, namely Paired sample t-test, and Independent t-test. The results showed that there was a significant difference in respondents' knowledge about the dangers of smoking in the intervention group, while in the control group it was found that there was no significant difference in respondents' knowledge; there was a significant difference in the frequency of adolescent smoking in the intervention group and the control group; there is a significant difference in adolescent smoking attitudes in the intervention group and the control group; there was a significant difference in motivation to quit smoking in the intervention group and the control group.

Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial

Objectives. To test a tailored mobile health (i.e., mHealth) intervention for waterpipe tobacco cessation in young adults. Methods. From 2018 to 2020 at 2 US sites, we conducted a randomized trial with 349 waterpipe tobacco smokers aged 18 to 30 years randomized to control (no intervention), untailored, or tailored intervention arms. Intervention arms received a 6-week mHealth intervention conveying risks of waterpipe tobacco through text and images and strategies to enhance motivation and support quitting. The tailored intervention was personalized to baseline measures and intervention text message responses. Risk appraisals, motivation to quit, waterpipe smoking frequency, and cessation were assessed at 6 weeks, 3 months, and 6 months. Results. At 6 months, cessation was higher in the tailored (49%) than the control arm (29%; odds ratio = 2.4; 95% confidence interval = 1.3, 4.2) and smoking frequency was lower in the tailored (mean = 3.5 days) than the control arm (mean = 4.3 days; P = .006). At interim follow-ups, significant differences in other outcomes favored the tailored intervention. Conclusions. Tailored mobile messaging can help young adult waterpipe tobacco smokers quit. This scalable intervention is poised for population implementation.