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Paul Aveyard - One of the best experts on this subject based on the ideXlab platform.
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Smoking Reduction interventions for Smoking cessation
The Cochrane database of systematic reviews, 2019Co-Authors: Nicola Lindson, Elias M. Klemperer, Bosun Hong, José M Ordóñez-mena, Paul AveyardAbstract:© 2019 The Cochrane Collaboration. Background The standard way most people are advised to stop Smoking is by quitting abruptly on a designated quit day. However, many people who smoke have tried to quit many times and may like to try an alternative method. Reducing Smoking behaviour before quitting could be an alternative approach to cessation. However, before this method can be recommended it is important to ensure that abrupt quitting is not more effective than reducing to quit, and to determine whether there are ways to optimise Reduction methods to increase the chances of cessation. Objectives To assess the effect of Reduction-to-quit interventions on long-term Smoking cessation. Search methods We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, Embase and PsycINFO for studies, using the terms: cold turkey, schedul*, cut* down, cut-down, gradual*, abrupt*, fading, reduc*, taper*, controlled Smoking and Smoking Reduction. We also searched trial registries to identify unpublished studies. Date of the most recent search: 29 October 2018. Selection criteria Randomised controlled trials in which people who smoked were advised to reduce their Smoking consumption before quitting Smoking altogether in at least one trial arm. This advice could be delivered using self-help materials or behavioural support, and provided alongside Smoking cessation pharmacotherapies or not. We excluded trials that did not assess cessation as an outcome, with follow-up of less than six months, where participants spontaneously reduced without being advised to do so, where the goal of Reduction was not to quit altogether, or where participants were advised to switch to cigarettes with lower nicotine levels without reducing the amount of cigarettes smoked or the length of time spent Smoking. We also excluded trials carried out in pregnant women. Data collection and analysis We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for Smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison (no Smoking cessation treatment, abrupt quitting interventions, and other Reduction-to-quit interventions) and carried out meta-analyses where appropriate, using a Mantel-Haenszel random-effects model. We also extracted data on quit attempts, pre-quit Smoking Reduction, adverse events (AEs), serious adverse events (SAEs) and nicotine withdrawal symptoms, and meta-analysed these where sufficient data were available. Main results We identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. We judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results. We identified very low-certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of Reduction-to-quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing Reduction-to-quit interventions with abrupt quitting (standard care) we found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). We judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that Reduction-to-quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a Reduction aid. Our analysis comparing Reduction using pharmacotherapy with Reduction alone found low-certainty evidence, limited by inconsistency and imprecision, that Reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast-acting NRT or varenicline are used (both moderate-certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low-or very low-quality evidence). More evidence is likely to change the interpretation of the latter effects. Although there was some evidence from within-study comparisons that behavioural support for Reduction to quit resulted in higher quit rates than self-help resources alone, the relative efficacy of various other characteristics of Reduction-to-quit interventions investigated through within-and between-study comparisons did not provide any evidence that they enhanced the success of Reduction-to-quit interventions. Pre-quit AEs, SAEs and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that AEs occurred more frequently in studies that compared Reduction using pharmacotherapy versus no pharmacotherapy; however, the AEs reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting SAEs, or changes in withdrawal symptoms, differed between trial arms. Authors' conclusions There is moderate-certainty evidence that neither Reduction-to-quit nor abrupt quitting interventions result in superior long-term quit rates when compared with one another. Evidence comparing the efficacy of Reduction-to-quit interventions with no treatment was inconclusive and of low certainty. There is also low-certainty evidence to suggest that Reduction-to-quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast-acting NRT or varenicline (moderate-certainty evidence). Evidence for any adverse effects of Reduction-to-quit interventions was sparse, but available data suggested no excess of pre-quit SAEs or withdrawal symptoms. We downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision. Future research should aim to match any additional components of multicomponent Reduction-to-quit interventions across study arms, so that the effect of Reduction can be isolated. In particular, well-conducted, adequately-powered studies should focus on investigating the most effective features of Reduction-to-quit interventions to maximise cessation rates.
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A mixed methods feasibility study of nicotine-assisted Smoking Reduction programmes delivered by community pharmacists - The RedPharm study
BMC public health, 2017Co-Authors: Amanda Farley, Jean-françois Etter, Sarah Tearne, Taina Taskila, Rachel H. Williams, Susan Macaskill, Paul AveyardAbstract:Pivotal trials have established that, among people who have no immediate intention to quit Smoking, nicotine replacement therapy (NRT) helps people reduce and eventually stop Smoking. The prime aim of this trial was to investigate the feasibility of implementing such a programme in community pharmacies. In addition, we investigated the effectiveness of providing behavioural support compared with self-help methods and of shorter compared with standard length Reduction programmes. Pharmacists were trained to deliver a Smoking Reduction programme and opportunistically invite people to participate in the programme. In a 2 × 2 factorial design, eligible volunteers were randomised to either receive in-person behavioural support or a self-help booklet. In both cases, participants were supported to set targets to reduce their Smoking and use behavioural techniques to assist Reduction. In addition, participants were randomised to cut down and stop over 4 weeks or over 16 weeks, but in either case continue NRT for up to nine months. We assessed uptake and adherence to the programme and Smoking cessation four weeks and six months after a quit day and Reduction in the three months following programme end and incorporated a qualitative processes assessment. Only 68 of the planned 160 smokers could be recruited. Pharmacists were deterred by the bureaucracy of trial enrolment and that many smokers did not return for further support. Pharmacists sometimes subverted the randomisation or provided support to participants in the self-help arm. Smokers stayed in the programme for an average of 6 weeks rather than the 9 months envisaged. Rates of follow-up declined to around 20% of participants by 12 months. There was insufficient evidence to assess whether support or speed of Reduction enhanced cessation or Reduction but cessation and Reduction were less common overall than in the pivotal trials for licensing NRT for this indication. This programme of Smoking Reduction and the trial design to assess its effectiveness proved unpopular to potential participants and pharmacists. As a result, the trial produced no evidence on the effectiveness of behavioural support or speed or Smoking Reduction. A trial of this programme in this context is unfeasible. ISRCTN 54805841 . Registered 18 March 2010.
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Does Smoking Reduction worsen mental health?: A comparison of two observational approaches
BMJ open, 2015Co-Authors: Gemma M J Taylor, Amy E Taylor, Marcus R. Munafò, Ann Mcneill, Paul AveyardAbstract:Objectives: The association between Smoking Reduction and mental health is of particular interest given that many smokers report that Smoking offers mental health benefits. We aimed to assess the association between Smoking Reduction and change in mental health using two different analytical approaches to determine if there was any evidence of an association. There were no prior hypotheses. Design: A secondary analysis of prospective individual level patient data from 5 merged placebo-controlled randomised trials of nicotine replacement therapy for Smoking Reduction. Participants: All participants were adult smokers, selected because they wanted to reduce but not stop Smoking, and had smoked for at least 3 years. Participants were excluded if they were pregnant, breastfeeding, under psychiatric care, deemed to be unfit by a general practitioner, or part of a cessation programme. 2066 participants were enrolled in the trials, 177 participants were biologically validated as prolonged reducers, and 509 as continuing smokers at both 6-week and 18-week follow-ups. Primary outcome: Change in mental health from baseline to an 18-week follow-up was measured using the emotional well-being subscale on the Short Form Health Survey-36. Results: After adjustment for confounding variables, the differences for reducers compared with continuing smokers were: regression modelling −0.6 (95% CI −4.4 to 3.2) and propensity score matching 1.1 (95% CI −2.0 to 4.1). Conclusions: Smoking Reduction, sustained for at least 12 weeks, was not associated with change in mental health, suggesting that reducing Smoking was no better or worse for mental health than continuing Smoking. Clinicians offering Smoking Reduction as a route to quit can be confident that, on average, Smoking Reduction is not associated with negative change in mental health.
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Assessing the association between the use of NRT for Smoking Reduction and attempts to quit Smoking using propensity score matching
Drug and alcohol dependence, 2012Co-Authors: Emma Beard, Paul Aveyard, Jamie Brown, Robert WestAbstract:Background: Smokers who use nicotine replacement therapy (NRT) to aid Smoking Reduction (SR) are more likely to quit Smoking than those who try to reduce without NRT. This could be because NRT enhances the likelihood of quitting or because those who are motivated to quit choose to use NRT (i.e., selection bias). Methods: 'Propensity score matching' was used to assess whether the increased likelihood of a quit attempt in those using NRT for SR would remain in a subsample of smokers paired on variables indicative of the likelihood of making a quit attempt and using NRT (i.e., when selection bias is reduced). Measures were obtained on a range of Smoking and socio-demographic variables at baseline, then after 3 and 6 months. Fifty-eight smokers who were attempting SR at 3 months were matched on baseline measures to 58 smokers not using NRT for SR. The odds of their going on to make a quit attempt in the following 3 months were then compared. Results: In smokers matched on motivational and other variables for their propensity to use NRT to aid Smoking Reduction, those using NRT for SR had three times greater odds of reporting a quit attempt than those not using NRT (OR 3.23; CI 1.49-7.01; p
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Promoting Smoking cessation through Smoking Reduction during Ramadan.
Addiction (Abingdon England), 2011Co-Authors: Paul Aveyard, Rachna Begh, Aziz Sheikh, Amanda AmosAbstract:Ramadan restricts Smoking and leads to Reduction. Recent research on Reduction has focused upon using nicotine replacement therapy (NRT) as a substitute for missed cigarettes and behavioural approaches have been neglected, despite evidence of efficacy. Ramadan reminds us of the need to harness these natural experiments to enhance Smoking Reduction and hence cessation.
Russell E. Glasgow - One of the best experts on this subject based on the ideXlab platform.
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Defining and understanding success at Smoking Reduction: A mixed-methods study
Addictive behaviors, 2010Co-Authors: Paul A. Estabrooks, Bridget Gaglio, Tammy L. Smith, Erica F Morse, Allison E Edwards, Russell E. GlasgowAbstract:Much is known about the outcomes of different Smoking Reduction and cessation programs. However there is a lack of information about the degree to which such programs can achieve successes after initial failures. This study evaluated the patterns of success and failure during a Smoking Reduction intervention with a sample of 164 adult smokers (mean age 62; mean baseline Smoking rate 21.2 cigarettes per day) who wanted to reduce their Smoking but were not ready to attempt cessation. Success was defined by both self-reported number of cigarettes smoked assessed during counseling calls and carbon monoxide levels at 3 and 12 month follow-ups. There was a strong relationship between initial success/failure and eventual outcome using both assessment methods, and a moderate relationship between success categorization using the different methods (r = .43). Qualitative contextual data identified that types of travel, work and family environmental barriers experienced differed across success categories. This research confirms the importance of initial success in changing addictive behaviors and suggests directions for future research; including ways to enhance initial success, and the suggestion that more study is needed regarding the generalizability of these findings across settings and behaviors.
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Long-term results of a Smoking Reduction program.
Medical care, 2009Co-Authors: Russell E. Glasgow, Bridget Gaglio, Paul A. Estabrooks, Alfred C. Marcus, Debra P. Ritzwoller, Tammy L. Smith, Arnold H. Levinson, Anna Sukhanova, Colin O'donnell, Erica F. FerroAbstract:Introduction There have been few comprehensive evaluations of Smoking Reduction, especially in health care delivery systems, and little is known about its cost, maintenance of reduced Smoking, or robustness across patient subgroups. Methods A generally representative sample of 320 adult smokers from an HMO scheduled for outpatient surgery or a diagnostic procedure was randomized to enhanced usual care or a theory-based Smoking Reduction intervention that combined telephone counseling and tailored newsletters. Outcomes included cigarettes smoked, carbon monoxide levels, and costs. Results Both intervention and control conditions continued to improve from 3- to 12-month assessments. Between-condition differences using intent-to-treat analyses on both self-report and carbon monoxide measures were nonsignificant by the 12-month follow-up (25% vs. 19% achieved 50% or greater Reductions in cigarettes smoked). The intervention was implemented consistently despite logistical constraints and was generally robust across patient characteristics (eg, education, ethnicity, health literacy, dependence). Conclusions In the absence of nicotine replacement therapy, the long-term effects of this Smoking Reduction intervention seem modest and nonsignificant. Future research is indicated to enhance intervention effects and conduct more comprehensive economic analyses of program variations.
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Using theory and technology to design a practical and generalizable Smoking Reduction intervention.
Health promotion practice, 2008Co-Authors: Bridget Gaglio, Paul A. Estabrooks, Debra P. Ritzwoller, Tammy L. Smith, Erica F. Ferro, Russell E. GlasgowAbstract:The aim of this article is to describe the process of using theory to form strategies for a generalizable Smoking Reduction intervention delivered through multiple intervention modalities. This report describes the process of integrating theory, data from diverse sources, staff from three different organizations, and different intervention modalities into an efficient, large-scale Smoking Reduction program featuring automated data from electronic medical records, computer-assisted telephone interviews, and tailored newsletters. The authors successfully developed a program that was consistently implemented as planned for 320 smokers in a managed care organization. The mapping of theory to intervention, data transfer and security procedures, and processes and strategies used to overcome challenges to intervention implementation should provide lessons learned for similar health promotion projects. Few intervention studies discuss details of how they translate theory into practice or how they integrate different modalities and collaborating institutions, but such integration is critical for project success.
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Evaluating initial reach and robustness of a practical randomized trial of Smoking Reduction.
Health psychology : official journal of the Division of Health Psychology American Psychological Association, 2008Co-Authors: Russell E. Glasgow, Bridget Gaglio, Paul A. Estabrooks, Alfred C. Marcus, Tammy L. Smith, Arnold H. Levinson, Suhong TongAbstract:Objective: This study evaluated the reach, initial effectiveness, and potential moderators and mediators of results of a Smoking Reduction program. Design: A generally representative sample of 320 adult smokers from an HMO, scheduled for outpatient surgery or a diagnostic procedure, were randomized to enhanced usual care or a theory-based Smoking Reduction intervention that combined telephone counseling and tailored newsletters. Main Outcome Measures: Self-reported number of cigarettes smoked and carbon monoxide levels. Results: The intervention enrolled 30% of known eligible smokers and produced Reductions of 3 cigarettes per day greater than enhanced usual care. Intervention participants were significantly more likely than control participants to achieve at least a 50% Reduction in self-reported number of cigarettes using complete cases, imputation analyses, and intent-to-treat procedures. Similar patterns were seen for carbon monoxide results but were significant only in complete case analyses. The intervention was generally robust across patient characteristics (e.g., education, ethnicity, health literacy, and dependence) and phone counselors. Conclusion: Initial results suggest that this program has potential to reach and assist smokers who may not participate in cessation programs. Additional research is indicated to enhance intervention effects, assess maintenance, and evaluate public health impact.
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Tailored behavioral support for Smoking Reduction: development and pilot results of an innovative intervention
Health education research, 2007Co-Authors: Arnold H. Levinson, Russell E. Glasgow, Bridget Gaglio, Tammy L. Smith, Jana Cahoon, Alfred C. MarcusAbstract:Reduction of Smoking may increase the likelihood of eventual Smoking cessation among those not ready to quit. We describe the development and acceptance of a Smoking-Reduction intervention that integrates telephone counseling sessions with newsletters. A computer-assisted telephone interviewing program generates real-time-tailored counseling delivered by lay interviewers. Pilot participants (n = 53) were adult smokers scheduled for outpatient procedures in a health maintenance organization, randomized to intervention or a control condition (quarterly mailings). Smoking levels were measured by self-report and biochemically. Among intervention participants continuing at 3 months, all but one rated their telephone support person positively on all dimensions. Counseling calls were 'about right' in number, and newsletters were perceived as quite personal. Intervention recipients reported Smoking significantly fewer mean cigarettes per day at 3 months than at baseline, and significantly fewer than control participants. Comparisons were non-significant under intent-to-treat analyses and on biochemical measures. The program was well received by outpatients who were not ready to quit Smoking, and was implemented successfully by telephone staff who had no previous Smoking cessation counseling experience. An ongoing trial is evaluating effectiveness, cost and relationship to eventual cessation.
Bridget Gaglio - One of the best experts on this subject based on the ideXlab platform.
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Defining and understanding success at Smoking Reduction: A mixed-methods study
Addictive behaviors, 2010Co-Authors: Paul A. Estabrooks, Bridget Gaglio, Tammy L. Smith, Erica F Morse, Allison E Edwards, Russell E. GlasgowAbstract:Much is known about the outcomes of different Smoking Reduction and cessation programs. However there is a lack of information about the degree to which such programs can achieve successes after initial failures. This study evaluated the patterns of success and failure during a Smoking Reduction intervention with a sample of 164 adult smokers (mean age 62; mean baseline Smoking rate 21.2 cigarettes per day) who wanted to reduce their Smoking but were not ready to attempt cessation. Success was defined by both self-reported number of cigarettes smoked assessed during counseling calls and carbon monoxide levels at 3 and 12 month follow-ups. There was a strong relationship between initial success/failure and eventual outcome using both assessment methods, and a moderate relationship between success categorization using the different methods (r = .43). Qualitative contextual data identified that types of travel, work and family environmental barriers experienced differed across success categories. This research confirms the importance of initial success in changing addictive behaviors and suggests directions for future research; including ways to enhance initial success, and the suggestion that more study is needed regarding the generalizability of these findings across settings and behaviors.
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Long-term results of a Smoking Reduction program.
Medical care, 2009Co-Authors: Russell E. Glasgow, Bridget Gaglio, Paul A. Estabrooks, Alfred C. Marcus, Debra P. Ritzwoller, Tammy L. Smith, Arnold H. Levinson, Anna Sukhanova, Colin O'donnell, Erica F. FerroAbstract:Introduction There have been few comprehensive evaluations of Smoking Reduction, especially in health care delivery systems, and little is known about its cost, maintenance of reduced Smoking, or robustness across patient subgroups. Methods A generally representative sample of 320 adult smokers from an HMO scheduled for outpatient surgery or a diagnostic procedure was randomized to enhanced usual care or a theory-based Smoking Reduction intervention that combined telephone counseling and tailored newsletters. Outcomes included cigarettes smoked, carbon monoxide levels, and costs. Results Both intervention and control conditions continued to improve from 3- to 12-month assessments. Between-condition differences using intent-to-treat analyses on both self-report and carbon monoxide measures were nonsignificant by the 12-month follow-up (25% vs. 19% achieved 50% or greater Reductions in cigarettes smoked). The intervention was implemented consistently despite logistical constraints and was generally robust across patient characteristics (eg, education, ethnicity, health literacy, dependence). Conclusions In the absence of nicotine replacement therapy, the long-term effects of this Smoking Reduction intervention seem modest and nonsignificant. Future research is indicated to enhance intervention effects and conduct more comprehensive economic analyses of program variations.
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Using theory and technology to design a practical and generalizable Smoking Reduction intervention.
Health promotion practice, 2008Co-Authors: Bridget Gaglio, Paul A. Estabrooks, Debra P. Ritzwoller, Tammy L. Smith, Erica F. Ferro, Russell E. GlasgowAbstract:The aim of this article is to describe the process of using theory to form strategies for a generalizable Smoking Reduction intervention delivered through multiple intervention modalities. This report describes the process of integrating theory, data from diverse sources, staff from three different organizations, and different intervention modalities into an efficient, large-scale Smoking Reduction program featuring automated data from electronic medical records, computer-assisted telephone interviews, and tailored newsletters. The authors successfully developed a program that was consistently implemented as planned for 320 smokers in a managed care organization. The mapping of theory to intervention, data transfer and security procedures, and processes and strategies used to overcome challenges to intervention implementation should provide lessons learned for similar health promotion projects. Few intervention studies discuss details of how they translate theory into practice or how they integrate different modalities and collaborating institutions, but such integration is critical for project success.
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Evaluating initial reach and robustness of a practical randomized trial of Smoking Reduction.
Health psychology : official journal of the Division of Health Psychology American Psychological Association, 2008Co-Authors: Russell E. Glasgow, Bridget Gaglio, Paul A. Estabrooks, Alfred C. Marcus, Tammy L. Smith, Arnold H. Levinson, Suhong TongAbstract:Objective: This study evaluated the reach, initial effectiveness, and potential moderators and mediators of results of a Smoking Reduction program. Design: A generally representative sample of 320 adult smokers from an HMO, scheduled for outpatient surgery or a diagnostic procedure, were randomized to enhanced usual care or a theory-based Smoking Reduction intervention that combined telephone counseling and tailored newsletters. Main Outcome Measures: Self-reported number of cigarettes smoked and carbon monoxide levels. Results: The intervention enrolled 30% of known eligible smokers and produced Reductions of 3 cigarettes per day greater than enhanced usual care. Intervention participants were significantly more likely than control participants to achieve at least a 50% Reduction in self-reported number of cigarettes using complete cases, imputation analyses, and intent-to-treat procedures. Similar patterns were seen for carbon monoxide results but were significant only in complete case analyses. The intervention was generally robust across patient characteristics (e.g., education, ethnicity, health literacy, and dependence) and phone counselors. Conclusion: Initial results suggest that this program has potential to reach and assist smokers who may not participate in cessation programs. Additional research is indicated to enhance intervention effects, assess maintenance, and evaluate public health impact.
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Tailored behavioral support for Smoking Reduction: development and pilot results of an innovative intervention
Health education research, 2007Co-Authors: Arnold H. Levinson, Russell E. Glasgow, Bridget Gaglio, Tammy L. Smith, Jana Cahoon, Alfred C. MarcusAbstract:Reduction of Smoking may increase the likelihood of eventual Smoking cessation among those not ready to quit. We describe the development and acceptance of a Smoking-Reduction intervention that integrates telephone counseling sessions with newsletters. A computer-assisted telephone interviewing program generates real-time-tailored counseling delivered by lay interviewers. Pilot participants (n = 53) were adult smokers scheduled for outpatient procedures in a health maintenance organization, randomized to intervention or a control condition (quarterly mailings). Smoking levels were measured by self-report and biochemically. Among intervention participants continuing at 3 months, all but one rated their telephone support person positively on all dimensions. Counseling calls were 'about right' in number, and newsletters were perceived as quite personal. Intervention recipients reported Smoking significantly fewer mean cigarettes per day at 3 months than at baseline, and significantly fewer than control participants. Comparisons were non-significant under intent-to-treat analyses and on biochemical measures. The program was well received by outpatients who were not ready to quit Smoking, and was implemented successfully by telephone staff who had no previous Smoking cessation counseling experience. An ongoing trial is evaluating effectiveness, cost and relationship to eventual cessation.
Robert West - One of the best experts on this subject based on the ideXlab platform.
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Does Smoking Reduction make smokers happier? Evidence from a cross-sectional survey
Journal of Smoking Cessation, 2013Co-Authors: Emma Beard, Jamie Brown, Robert WestAbstract:Objectives: Stopping Smoking leads to greater happiness and life satisfaction. This raises the question as to whether harm Reduction, i.e. Smoking Reduction (SR) and the use of Nicotine Replacement Therapy (NRT) for SR, might lead to a similar benefit. This is of importance, given that the National Institute of Clinical Excellence in the UK is due to release guidance on harm Reduction in 2013.Design: Data were collected from 1,532 smokers involved in the Smoking Toolkit Study.Method: Participants were asked if they were cutting down and if they were using Nicotine Replacement Therapy (NRT). Smokers also rated happiness and life satisfaction.Results: There was no evidence of an association between SR or use of NRT for SR and either reported ‘happiness’ or ‘life satisfaction’. Nor was there an association between measures of ‘happiness’ or ‘life satisfaction’ and cigarette consumption.Conclusion: It appears that SR is not associated with mental health benefits. This suggests that complete cessation may be necessary for benefits to be incurred. Prospective studies are necessary to confirm these findings.
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Does Smoking Reduction make smokers happier? Evidence from a cross-sectional survey
The Journal of Smoking Cessation, 2013Co-Authors: Emma Beard, Jamie Brown, Robert WestAbstract:Objectives: Stopping Smoking leads to greater happiness and life satisfaction. This raises the question as to whether harm Reduction, i.e. Smoking Reduction (SR) and the use of Nicotine Replacement Therapy (NRT) for SR, might lead to a similar benefit. This is of importance, given that the National Institute of Clinical Excellence in the UK is due to release guidance on harm Reduction in 2013. Design: Data were collected from 1,532 smokers involved in the Smoking Toolkit Study. Method: Participants were asked if they were cutting down and if they were using Nicotine Replacement Therapy (NRT). Smokers also rated happiness and life satisfaction. Results: There was no evidence of an association between SR or use of NRT for SR and either reported 'happiness' or 'life satisfaction'. Nor was there an association between measures of 'happiness' or 'life satisfaction' and cigarette consumption. Conclusion: It appears that SR is not associated with mental health benefits. This suggests that complete cessation may be necessary for benefits to be incurred. Prospective studies are necessary to confirm these findings. Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013.
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Was the Expansion of the Marketing License for Nicotine Replacement Therapy in the United Kingdom to Include Smoking Reduction Associated With Changes in Use and Incidence of Quit Attempts
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2013Co-Authors: Emma Beard, Ann Mcneill, Carla Bruguera, Jamie Brown, Robert WestAbstract:BACKGROUND In December 2009 and January 2010, the UK Medicines and Healthcare Products Regulatory Agency expanded the marketing license for a number of nicotine replacement therapies (NRTs) to include Smoking Reduction without an intention to stop completely. This study examined whether this was associated with a change in incidence of use of NRT for harm Reduction (i.e., Smoking Reduction and/or temporary abstinence) and in Smoking cessation activity. METHODS Data were taken from 10,497 smokers who took part in the Smoking Toolkit Study, which involves monthly representative household surveys of adults aged 16+ in England. Incidence of use of NRT for Smoking Reduction and/or temporary abstinence and attempts to stop Smoking in 2009 was compared with the 2 years following the expansion of the marketing license. RESULTS Expansion of the license was not associated with an increase in incidence of NRT use for harm Reduction, which was already substantial prior to the change. The odds of a quit attempt were lower in the second year following the license change relative to the year before, but there was no change in the success of quit attempts. CONCLUSIONS Expansion of the UK marketing license for NRT to include Smoking Reduction without the intention of quitting was not associated with an increase in use of NRT for this purpose. It was followed by a Reduction in the incidence of quit attempts (but not their success) although this may have been a continuation of a pre-existing decline.
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Assessing the association between the use of NRT for Smoking Reduction and attempts to quit Smoking using propensity score matching
Drug and alcohol dependence, 2012Co-Authors: Emma Beard, Paul Aveyard, Jamie Brown, Robert WestAbstract:Background: Smokers who use nicotine replacement therapy (NRT) to aid Smoking Reduction (SR) are more likely to quit Smoking than those who try to reduce without NRT. This could be because NRT enhances the likelihood of quitting or because those who are motivated to quit choose to use NRT (i.e., selection bias). Methods: 'Propensity score matching' was used to assess whether the increased likelihood of a quit attempt in those using NRT for SR would remain in a subsample of smokers paired on variables indicative of the likelihood of making a quit attempt and using NRT (i.e., when selection bias is reduced). Measures were obtained on a range of Smoking and socio-demographic variables at baseline, then after 3 and 6 months. Fifty-eight smokers who were attempting SR at 3 months were matched on baseline measures to 58 smokers not using NRT for SR. The odds of their going on to make a quit attempt in the following 3 months were then compared. Results: In smokers matched on motivational and other variables for their propensity to use NRT to aid Smoking Reduction, those using NRT for SR had three times greater odds of reporting a quit attempt than those not using NRT (OR 3.23; CI 1.49-7.01; p
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Use of nicotine replacement therapy for Smoking Reduction and during enforced temporary abstinence: a national survey of English smokers
Addiction (Abingdon England), 2010Co-Authors: Emma Beard, Ann Mcneill, Paul Aveyard, Jennifer A. Fidler, Susan Michie, Robert WestAbstract:Aims To assess the prevalence of nicotine replacement therapy (NRT) use for Smoking Reduction (SR) and temporary abstinence (TA), the association between the two and the strength of the association between NRT use for SR or TA and socio-demographic characteristics, cigarette consumption and past quit attempts.Design Cross-sectional monthly surveys.Setting England.Participants A total of 11414 smokers.Measurements Participants were asked (i) whether they were reducing the amount they smoked: if so, whether they used NRT; and (ii) whether they used NRT for TA. Demographic characteristics, daily cigarette consumption and whether a quit attempt had been made in the past 12 months were also assessed.Findings Of the participants, 56% were attempting SR, 14% were using NRT for SR and 14% were using NRT for TA. Use of NRT for SR and TA were highly correlated. The nicotine patch was the most commonly used form of NRT. The use of NRT for SR, compared with unassisted SR, was more common among older smokers, while the use of NRT for TA was more common among women. Cigarette consumption was higher in those using NRT for SR than those attempting SR without NRT. The use of NRT for SR and TA was associated positively with past quit attempts.Conclusions Nicotine replacement therapy use for Smoking Reduction and temporary abstinence is common in England. The use of NRT for SR and TA does not appear to be associated with lower cigarette consumption relative to SR or TA without NRT, but is associated with a higher rate of past quit attempts. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.
Jean-françois Etter - One of the best experts on this subject based on the ideXlab platform.
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A mixed methods feasibility study of nicotine-assisted Smoking Reduction programmes delivered by community pharmacists - The RedPharm study
BMC public health, 2017Co-Authors: Amanda Farley, Jean-françois Etter, Sarah Tearne, Taina Taskila, Rachel H. Williams, Susan Macaskill, Paul AveyardAbstract:Pivotal trials have established that, among people who have no immediate intention to quit Smoking, nicotine replacement therapy (NRT) helps people reduce and eventually stop Smoking. The prime aim of this trial was to investigate the feasibility of implementing such a programme in community pharmacies. In addition, we investigated the effectiveness of providing behavioural support compared with self-help methods and of shorter compared with standard length Reduction programmes. Pharmacists were trained to deliver a Smoking Reduction programme and opportunistically invite people to participate in the programme. In a 2 × 2 factorial design, eligible volunteers were randomised to either receive in-person behavioural support or a self-help booklet. In both cases, participants were supported to set targets to reduce their Smoking and use behavioural techniques to assist Reduction. In addition, participants were randomised to cut down and stop over 4 weeks or over 16 weeks, but in either case continue NRT for up to nine months. We assessed uptake and adherence to the programme and Smoking cessation four weeks and six months after a quit day and Reduction in the three months following programme end and incorporated a qualitative processes assessment. Only 68 of the planned 160 smokers could be recruited. Pharmacists were deterred by the bureaucracy of trial enrolment and that many smokers did not return for further support. Pharmacists sometimes subverted the randomisation or provided support to participants in the self-help arm. Smokers stayed in the programme for an average of 6 weeks rather than the 9 months envisaged. Rates of follow-up declined to around 20% of participants by 12 months. There was insufficient evidence to assess whether support or speed of Reduction enhanced cessation or Reduction but cessation and Reduction were less common overall than in the pivotal trials for licensing NRT for this indication. This programme of Smoking Reduction and the trial design to assess its effectiveness proved unpopular to potential participants and pharmacists. As a result, the trial produced no evidence on the effectiveness of behavioural support or speed or Smoking Reduction. A trial of this programme in this context is unfeasible. ISRCTN 54805841 . Registered 18 March 2010.
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Postintervention effect of nicotine replacement therapy for Smoking Reduction: a randomized trial with a 5-year follow-up.
Journal of clinical psychopharmacology, 2007Co-Authors: Jean-françois Etter, Evelyne LaszloAbstract:Abstract We tested whether a Reduction of cigarette consumption obtained after 6 months of nicotine replacement therapy was maintained 5 years after the end of this treatment. Heavy smokers (mean = 30 cigarettes per day) who had no intention of quitting Smoking were randomly assigned to a 6-month treatment of nicotine (15-mg patch, 4-mg gum, and/or 10-mg inhaler, n = 265), placebo (n = 269), or no intervention (n = 389). Products were sent by mail, and education was limited to a booklet. Of 923 participants, 879 (95%) were followed after 6 months and 671 (73%) after 5 years. After 6 months, Smoking Reduction was larger for nicotine (−10.9 cigarettes per day) than for placebo (−8.7) and no treatment (−4.9, all P ≤ 0.022). After 5 years, cigarette consumption (20 cigarettes per day, all P ≥ 0.2) and Smoking cessation rates (17% to 21%, all P > 0.2) were similar in all groups. In smokers, 5-year continuous abstinence was higher in those who had reduced their cigarette consumption by at least 50% between baseline and 6 months than in those who did not reduce (11.9% vs 5.6%; P = 0.011; odds ratio, 2.3; 95% confidence interval, 1.2-4.2). Thus, the initial effect of the treatment on Smoking Reduction was not maintained after 5 years. However, reducing cigarette consumption was associated with a higher chance of subsequently quitting Smoking. Nicotine replacement therapy in unmotivated smokers had no deleterious effect on dependence levels and Smoking behavior.
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Assigned Versus Perceived Placebo Effects in Nicotine Replacement Therapy for Smoking Reduction in Swiss Smokers
Journal of consulting and clinical psychology, 2005Co-Authors: Reuven Dar, Florencia Stronguin, Jean-françois EtterAbstract:In this report, the authors explore the relationships of perceived treatment to outcome in a large, placebo-controlled trial of nicotine replacement treatment for Smoking Reduction. In the original study (J. F. Etter, E. Laszlo, J. P. Zellweger, C. Perrot, & T. V. Perneger, 2002), which was conducted in French-speaking Switzerland, smokers were randomly assigned to receive nicotine, matching placebo products, or no intervention. At the end of the 6-month study, participants were asked to guess whether they had received nicotine or placebo. In the present analysis, the authors examined the difference in Smoking Reduction between those who believed they had received nicotine and those who believed they had received placebo. Regardless of actual treatment, smokers who believed they had received nicotine had significantly better outcome than those who believed they had received placebo.
