Antismoking centers in Milan's communal pharmacies: analysis of the 2010-2011 campaign.

Objectives: Recently, female smokers are increasing in Korea. This study aims to report the dependence of nicotine and the type of smoking as a factor influencing the success of smoking cessation among female smokers.Methods: Data were collected from the Comprehensive information system for smoking cessation service, and data from 862 women who used the smoking cessation service by Gyeongnam Tobacco Control Center between June 2015, and December, 2018, were used. After controlling demographic and smoking-related variables, a multiple logistic regression analysis was performed on the relationship between nicotine dependence, smoking type, smoking cessation related psychological factors and smoking cessation.Results: The smoking cessation rate of female smokers was 7.8%. Smoking type and nicotine dependence were low in stimulus-seeking type, and high in addiction, habit type, and complex type. After controlling demographic, health behavior and disease variables, the factors affecting female smokers’ smoking cessation were nicotine dependence (odds ratio, OR = 0.49, p= 0.020), preparation (OR = 7.14, p= 0.015), confidence (OR = 7.14, p= 0.015) of smoking cessation. In other words, smoking cessation among women who smoked was higher in the high group than in the group with low anti-smoking preparation and confidence and smoking cessation was higher in the low group than in the high group of nicotine dependence.Conclusions: The actual smoking cessation strategy for women considering related factors of smoking cessation is to reconsider the content of counseling interventions according to the type of smoking and to reduce the dependence of nicotine through a treatment approach for each type, resulting in a higher smoking cessation rate.

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Nurse-Conducted Smoking Cessation in Patients With COPD Using Nicotine Sublingual Tablets and Behavioral Support

Smoking cessation is a potentially appropriate role for community pharmacists because they are encouraged to advise on the correct use of nicotine replacement therapy (NRT) products and to provide behavioural support to aid smoking cessation. This review assessed the effectiveness of interventions by community pharmacy personnel to assist clients to stop smoking. A search was made of the Cochrane Tobacco Addiction Group database for smoking cessation studies conducted in the community pharmacy setting, using the search terms pharmacist* or pharmacy or pharmacies. Date of the most recent search: March 2003. Randomized trials which compared interventions by community pharmacy personnel to promote smoking cessation amongst their clients who were smokers compared to usual pharmacy support or any less intensive programme. The main outcome measure was smoking cessation rates at six months or more after the start of the intervention. Data were extracted by one author and checked by the second, noting: the country of the trial, details of participant community pharmacies, method of subject recruitment, smoking behaviour and characteristics of participants on recruitment, method of randomization, description of the intervention and of any pharmacy personnel training, and the outcome measures. Methodological quality was assessed according to the extent to which the allocation to intervention or control was concealed. Because of the potentially important cluster effects, we also rated trials according to whether they checked for or adjusted for these but, in the absence of consensus on how to pool cluster level data, we adopted a narrative approach to synthesizing the data, rather than a formal meta-analysis. We identified two trials which met our selection criteria. They included a total of 976 smokers. Both trials were set in the UK and involved a training intervention which included the Stages of Change Model; they then compared a support programme involving counselling and record keeping against a control receiving usual pharmacy support. In both studies a high proportion of intervention and control participants began using NRT. Both studies reported smoking cessation outcomes at three time points. However, the follow-up points were not identical (three, six and 12 months in one, and one, four and nine months in the other), and the trend in abstinence over time was not linear in either study, so the data could not be combined. One study showed a significant difference in self-reported cessation rates at 12 months: 14.3% versus 2.7% (p < 0.001); the other study showed a positive trend at each follow-up with 12.0% versus 7.4% (p = 0.09) at nine months. The limited number of studies to date suggests that trained community pharmacists, providing a counselling and record keeping support programme for their customers, may have a positive effect on smoking cessation rates. The strength of evidence is limited because only one of the trials showed a statistically significant effect.

Aim: Various methods are used in the treatment of cigarette addiction. The aim of the study is to compare the smoking cessation status of patients who applied for smoking cessation treatment and received varenicline treatment, nicotine replacement therapy (NRT), and acupuncture treatment. Methods: In the study, 402 individuals who received varenicline treatment, NRT, and acupuncture treatment for smoking cessation were included. The sociodemographic data of the individuals, the results of the Fagerström nicotine dependence test, and the data on smoking cessation obtained during the 6 months after the treatment were retrospectively scanned from the patient files. Results: Of the 402 individuals included in the study, 60.4% (n=243) were treated with varenicline, 28.1% (n=113) received NRT, and 11.4% (n=46) were treated with Acupuncture. 63.4% (n=255) of all the patients, 71.2% (n=173) of the patients treated with varenicline, 56.6% (n=64) of the patients who received NRT, and 39.1% (n=18) of the patients treated with Acupuncture quit smoking. It was found that the smoking cessation rate was higher in the patients treated with varenicline compared to other treatments (p&lt;0.001), and varenicline was more effective than other treatments in very high addiction (p&lt;0.001). Conclusion: Varenicline treatment, NRT, and acupuncture treatment are all effective methods for smoking cessation. Varenicline treatment is more effective in smoking cessation than other treatments, and this efficiency is higher than other treatments for very high addiction.

&lt;p&gt;目的：探討使用決策輔助工具(patient decision aids, PDA)選擇戒菸藥物，是否能提升戒菸成效。&lt;/p&gt; &lt;p&gt;方法：本研究是一篇歷史對照研究(historical control trial)，研發一份紙本決策輔助工具，輔助戒菸者在varenicline與合併尼古丁替代療法(combination nicotine replacement therapy)兩類藥物中做出選擇。2020年1月至2021年3月期間，於家庭醫學科戒菸門診進行收案，針對有意願接受藥物戒菸的民眾，由醫師擔任醫病共享決策的引導員(coach)，使用決策輔助工具協助其決定藥物的種類。對照組為2019年全年度在家庭醫學科戒菸門診接受藥物戒菸服務者，無使用決策輔助工具。以電話訪問調查第三個月以及第六個月的戒菸狀況，再以logistic regression等統計方法探討使用PDA是否影響戒菸成功率。&lt;/p&gt; &lt;p&gt;結果：排除療程中更換處方和失聯者，總共199人被納入研究（PDA組62人：男性佔80.6%，平均年齡為46.0歲；對照組137人，男性佔74.5%，平均年齡為49.4歲）。PDA組傾向選擇varenicline作為戒菸藥物(aOR=1.94, 95% CI 1.02-3.71)；兩組六個月點戒菸率無顯著差異(aOR=1.43, 95% CI 0.74-2.79)。&lt;/p&gt; &lt;p&gt;結論：以決策輔助工具選擇戒菸藥物，民眾偏好varenicline甚於合併尼古丁替代療法，但是並未對戒菸成功率造成顯著影響。醫病共享決策能否提升戒菸藥物的順從性，並增進戒菸治療的效益，需要進一步的研究。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Purpose: The study explored whether the use of patient decision aid (PDA) to select smoking cessation drugs can improve the effectiveness of smoking cessation.&lt;/p&gt; &lt;p&gt;Methods: This historical control trail developed a paper-based PDA to help smokers choose between varenicline and a combination of nicotine replacement therapy. From January 2020 to March 2021, people visiting the smoking cessation clinic of a family medicine department and willing to take drugs to quit smoking were enrolled into the PDA group of the study with doctors serving as coaches for shared decision-making and applying the PDA to help them decide on the types of drugs to use. Members in the control group were enrolled from people receiving the drug smoking cessation services in the same smoking cessation clinic in 2019 without using PDA. The smoking status after 3 and 6 months were collected by telephone interview. The effects of using PDA on smoking cessation were analyzed by logistic regression.&lt;/p&gt; &lt;p&gt;Results: A total of 199 people participating in the study, excluding those who changed prescriptions and lost contact during the course of treatment. Of the 62 participants in the PDA group, 80.6% were male, and the average age was 46.0. Of the 137 participants in the control group, 74.5% were male, and the average age was 49.4. The PDA group preferred varenicline as the smoking cessation drug (aOR=1.94, 95% CI 1.02-3.71). There was no significant difference in the smoking cessation rate between the two groups at six months (aOR=1.43, 95% CI 0.74-2.79).&lt;/p&gt; &lt;p&gt;Conclusion: When using PDA to select smoking cessation drugs, people appear to prefer varenicline over a combination of nicotine replacement therapy; however, this preference produces no significant influence on the success rate of smoking cessation. Whether shared decision-making help improve the compliance with the instructions of smoking cessation products and enhance the effectiveness of smoking cessation treatment requires further research.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Is nicotine replacement really ineffective? A reply to Stanley and Massey

Nicotine replacement therapies (NRTs) represent an effective means of promoting smoking cessation, but they remain underutilized. Negative attitudes and false beliefs about nicotine and nicotine replacement may cause NRT underutilization. In a randomized, controlled, single-blind study of nicotine gum, 97 smokers were assessed on their attitudes and knowledge about nicotine, nicotine replacement, and smoking cessation therapy. Information from these self-report measures was used in an intervention that provided tailored, brief feedback to promote positive attitudes and accurate knowledge about NRT. Considerable variability in pretreatment attitudes and knowledge was observed across individuals. Moreover, attitudes and knowledge showed a consistent pattern of intercorrelation and were systematically related to smoking characteristics (e.g., prior use of NRT, nicotine dependence, treatment completion). The brief feedback intervention led to a significant global elevation in attitudes about nicotine, NRT, and assisted cessation but not knowledge about nicotine. Changes in attitudes and knowledge were not significantly related to gum use or smoking cessation. Recommendations for the appropriate application of brief feedback are offered.

Background: Pharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic. Methods: This retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients’ smoking status at one year was assessed by telephone interview. Results: The patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients). The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p &lt; 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p &lt; 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse. Conclusion: Nicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

Cigarette smoking represents the most important source of preventable morbidity and premature mortality worldwide. Approximately 100 million deaths were caused by tobacco use in the 20th century. There are > 1 billion smokers worldwide, and globally the use of tobacco products is increasing, with the epidemic shifting to the developing world. Tobacco dependence is a chronic condition that often requires repeated intervention for success. Just informing a patient about health risks, although necessary, is usually not sufficient for a decision to change. Smokers should be provided with counseling when attempting to quit. Pharmacologic smoking cessation aids are recommended for all smokers who are trying to quit, unless contraindicated. Evidence-based guidelines recommend nicotine replacement therapy, bupropion SR, and varenicline as effective alternatives for smoking cessation therapy, especially when combined with behavioral interventions. Combination pharmacotherapy is indicated for highly nicotine-dependent smokers, patients who have failed with monotherapy, and patients with breakthrough cravings. An additional form of nicotine replacement therapy or an addition of a non-nicotine replacement therapy oral medication (bupropion or varenicline) may be helpful. The rate of successful smoking cessation at 1 year is 3% to 5% when the patient simply tries to stop, 7% to 16% if the smoker undergoes behavioral intervention, and up to 24% when receiving pharmacological treatment and behavioral support.

There is a high prevalence of smoking among people with severe mental ill health (SMI). Helping people with SMI to quit smoking could improve their health and longevity, and reduce health inequalities. However, those with SMI are less likely to access and engage with routine smoking cessation services than the general population. To compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation (BSC) intervention with usual stop smoking services for people with SMI. A pragmatic, two-arm, individually randomised controlled trial. Primary care and secondary care mental health services in England. Smokers aged ≥ 18 years with SMI who would like to cut down on or quit smoking. A BSC intervention delivered by mental health specialists trained to deliver evidence-supported smoking cessation interventions compared with usual care. The primary outcome was self-reported, CO-verified smoking cessation at 12 months. Smoking-related secondary outcomes were self-reported smoking cessation, the number of cigarettes smoked per day, the Fagerström Test for Nicotine Dependence and the Motivation to Quit questionnaire. Other secondary outcomes were Patient Health Questionnaire-9 items, Generalised Anxiety Disorder Assessment-7 items and 12-Item Short-Form Health Survey, to assess mental health and body mass index measured at 6 and 12 months post randomisation. The trial randomised 526 people (265 to the intervention group, 261 to the usual-care group) aged 19 to 72 years (mean 46 years). About 60% of participants were male. Participants smoked between 3 and 100 cigarettes per day (mean 25 cigarettes per day) at baseline. The intervention group had a higher rate of exhaled CO-verified smoking cessation at 6 and 12 months than the usual-care group [adjusted odds ratio (OR) 12 months: 1.6, 95% confidence interval (CI) 0.9 to 2.8; adjusted OR 6 months: 2.4, 95% CI 1.2 to 4.7]. This was not statistically significant at 12 months (p = 0.12) but was statistically significant at 6 months (p = 0.01). In total, 111 serious adverse events were reported (69 in the BSC group and 42 in the usual-care group); the majority were unplanned hospitalisations due to a deterioration in mental health (n = 98). The intervention is likely (57%) to be less costly but more effective than usual care; however, this result was not necessarily associated with participants' smoking status. Follow-up was not blind to treatment allocation. However, the primary outcome included a biochemically verified end point, less susceptible to observer biases. Some participants experienced difficulties in accessing nicotine replacement therapy because of changes in service provision. Efforts were made to help participants access nicotine replacement therapy, but this may have affected participants' quit attempt. People with SMI who received the intervention were more likely to have stopped smoking at 6 months. Although more people who received the intervention had stopped smoking at 12 months, this was not statistically significant. Further research is needed to establish how quitting can be sustained among people with SMI. Current Controlled Trials ISRCTN72955454. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 50. See the NIHR Journals Library website for further project information.

Smoking prevalence in Italy decreased by 37% from 1980 to now. This is due to changes in smoking initiation and cessation rates and is in part attributable to the development of tobacco control policies. This work aims to estimate the age- and sex-specific smoking initiation and cessation probabilities for different time periods and to predict the future smoking prevalence in Italy, assuming different scenarios. A dynamic model describing the evolution of current, former and never smokers was developed. Cessation and relapse rates were estimated by fitting the model with smoking prevalence in Italy, 1986-2009. The estimated parameters were used to predict prevalence, according to scenarios: (1) 2000-09 initiation/cessation; (2) half initiation; (3) double cessation; (4) Scenarios 2+3; (5) triple cessation; and (6) Scenarios 2+5. Maintaining the 2000-09 initiation/cessation, the 10% goal will not be achieved within next three decades: prevalence will stabilize at 12.1% for women and 20.3% for men. The goal could be rapidly achieved for women by halving initiation and tripling cessation (9.9%, 2016), or tripling cessation only (10.4%, 2017); for men halving initiation and tripling cessation (10.8%, 2024), or doubling cessation and halving initiation (10.5%, 2033), or tripling cessation only (10.8%, 2033). The 10% goal will be achieved within the next few decades, mainly by increasing smoking cessation. Policies to reach this goal would include increasing cigarette taxes, introducing total reimbursement of smoking cessation treatment, with a further development of quitlines and smoking cessation services. These measures are not yet fully implemented in Italy.

P1.10-09 Cessation Rates of an Expanded Pharmacy-Driven Smoking Cessation Program

Nicotine replacement therapy (NRT) is recommended as a smoking cessation aid for hospitalised smokers. We examined factors associated with NRT use during hospitalisation and after discharge, and NRT uptake when systematically offered free of cost. A nested analysis was conducted using data from a clinical trial that evaluated the effectiveness of a pharmacist-led smoking cessation intervention in 600 hospitalised smokers. NRT was used at least once by 285 (48%) participants during hospitalisation and by 287 (48%) participants during the 12 months post-discharge. Heavy smokers and those who expressed interest in using NRT for their next quit attempt at baseline interview were more likely to use NRT during hospitalisation [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.38, 2.74; OR 2.09, 95% CI 1.48, 2.95] and after discharge (OR 1.70, 95% CI 1.20, 2.41; OR 1.97, 95% CI 1.39, 2.79). Those using six or more medications were more likely to use NRT during hospitalisation (OR 1.65, 95% CI 1.05, 2.61). Post-discharge NRT users were more likely to have been initially admitted for a respiratory or cardiac problem (OR 1.51, 95% CI 1.05, 2.18). When NRT was offered free of cost to a subset of patients (n = 300), 157 (52%) used NRT during hospitalisation. Nicotine dependence and interest in using NRT predicted its use (OR 2.26, 95% CI 1.38, 3.70; OR 2.58, 95% CI 1.58, 4.20). Targeting heavy smokers, those with cardio-respiratory conditions and those interested in using NRT regardless of regimen complexity could improve NRT uptake.

Feasibility and Pilot Efficacy of a Brief Smoking Cessation Intervention Delivered by Vascular Surgeons: The Vascular Physician Offer and Report (VAPOR) Trial