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Richard Holland - One of the best experts on this subject based on the ideXlab platform.
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Relapse to Smoking and health related quality of life secondary analysis of data from a study of Smoking Relapse prevention
PLOS ONE, 2018Co-Authors: Fujian Song, Caitlin Notley, Richard Holland, Annie Blyth, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen SuttonAbstract:Background: Previous studies have shown that Smoking and Smoking cessation may be associated with health-related quality of life (HRQoL). In this study, we compared changes in HRQoL in people who maintained abstinence with people who had Relapsed to Smoking. Methods: This was a secondary analysis of data from a trial of a Relapse prevention intervention in 1,407 short-term quitters. The European Quality of Life -5 Dimensions (EQ-5D) measured HRQoL at baseline, 3 and 12 months. Smoking outcome was continuous abstinence from 2 to 12 months, and 7-day Smoking at 3 and 12 months. We used nonparametric test for differences in EQ-5D utility scores, and chi-square test for dichotomised response to each of the five EQ-5D dimensions. Multivariable regression analyses were conducted to evaluate associations between Smoking Relapse and HRQoL or anxiety/depression problems. Results: The mean EQ-5D tariff score was 0.8252 at baseline. People who maintained abstinence experienced a statistically non-significant increase in the EQ-5D score (mean change 0.0015, P=0.88), while returning to Smoking was associated with a statistically significant decrease in the EQ-5D score (mean change -0.0270, P=0.004). After adjusting for multiple baseline characteristics, the utility change during baseline and 12 months was statistically significantly associated with continuous abstinence, with a difference of 0.0288 (95% CI: 0.0006 to 0.0571, P=0.045) between Relapsers and continuous quitters. The only difference in quality of life dimensions between those who Relapsed and those who maintained abstinence was in the proportion of participants with anxiety/depression problems at 12 months (30% vs. 22%, P=0.001). Smoking Relapse was associated with a simultaneous increase in anxiety/depression problems. Conclusions: People who achieve short-term Smoking abstinence but subsequently Relapse to Smoking have a reduced quality of life, which appears mostly due to worsening of symptoms of anxiety and depression. Further research is required to more fully understand the relationship between Smoking and health-related quality of life, and to develop cessation interventions by taking into account the impact of anxiety or depression on Smoking.
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The unique contribution of e-cigarettes for tobacco harm reduction in supporting Smoking Relapse prevention
Harm Reduction Journal, 2018Co-Authors: Caitlin Notley, Lynne Dawkins, Emma Ward, Richard HollandAbstract:We have little understanding of how vapers use e-cigarettes beyond cessation. E-cigarettes may have a role to play in reducing the health-related harms of tobacco Smoking, through not only assisting Smoking cessation attempts but also supporting long-term abstinence from Smoking. However, there are fears that vaping may lead to the ‘renormalisation’ of Smoking type behaviours. This study aimed to explore patterns of use and reported experiences of vapers quitting Smoking using an e-cigarette in relation to long-term Smoking status (abstinence or Relapse). A purposive sample of 40 UK vapers was matched to a sampling frame of demographic characteristics from a representative sample of UK quitters. Following full informed consent, semi-structured qualitative interviews were conducted. Data were thematically analysed by two members of the research team. Final thematic analysis was verified and agreed by consensus. The sample self-reported long histories of tobacco use and multiple previous quit attempts which had eventually resulted in Relapse back to Smoking, although a small but important group had never before attempted to quit. Initiating e-cigarette use was experienced as a revelation for some, who were quickly able to fully switch to using e-cigarettes as an alternative to tobacco Smoking. For others, periods of dual use or Smoking Relapse combined with attempts at vaping that were not initially satisfactory. Many of these chose a cheaper ‘cig-a-like’ device which they found to be inadequate. Experimentation with different devices and different setups, over time, resulted in some ‘sliding’ rather than switching to vaping. This involved periods of ‘dual use’. Some settled on patterns of vaping as a direct substitute of previous tobacco Smoking, whereas others reported ‘grazing’ patterns of vaping throughout the day that were perceived to support tobacco Smoking abstinence. Our data demonstrates that e-cigarettes may be a unique harm reduction innovation for Smoking Relapse prevention. E-cigarettes meet the needs of some ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction. Some vapers reported that they found vaping pleasurable and enjoyable—being more than a substitute but actually preferred, over time, to tobacco Smoking. This clearly suggests that vaping is a viable long-term substitute for Smoking, with substantial implications for tobacco harm reduction.
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differences in longer term Smoking abstinence after treatment by specialist or nonspecialist advisors secondary analysis of data from a Relapse prevention trial
Nicotine & Tobacco Research, 2016Co-Authors: Fujian Song, Caitlin Notley, Richard Holland, Annie Blyth, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen SuttonAbstract:Introduction: Smokers receiving support in specialist centers tend to have a higher short-term quit rate, compared with those receiving support in other settings from professionals for whom Smoking cessation is only a part of their work. We investigated the difference in longer-term abstinence after short-term Smoking cessation treatment from specialist and nonspecialist Smoking cessation services. Methods: We conducted a secondary analysis of data from a randomized controlled trial of selfhelp booklets for the prevention of Smoking Relapse. The trial included 1088 short-term quitters from specialist stop Smoking clinics and 316 from nonspecialist cessation services (such as general practice, pharmacies, and health trainer services). The difference in prolonged Smoking abstinence from months 4 to 12 between specialist and nonspecialist services was compared. Multivariable logistic regression analyses were conducted to investigate the association between continuous Smoking abstinence and the type of Smoking cessation services, adjusted for possible confounding factors (including demographic, socioeconomic, and Smoking history variables). Results: The proportion of continuous abstinence from 4 to 12 months was higher in short-term quitters from specialist services compared with those from nonspecialist services (39% vs. 32%; P = .023). After adjusting for a range of participant characteristics and Smoking variables, the specialist service was significantly associated with a higher rate of longer-term Smoking abstinence (odds ratio: 1.48, 95% CI = 1.09% to 2.00%; P = .011). Conclusions: People who receive support to stop Smoking from a specialist appear to be at lower risk of Relapse than those receiving support from a nonspecialist advisor.
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self help educational booklets for the prevention of Smoking Relapse following Smoking cessation treatment a randomized controlled trial
Addiction, 2015Co-Authors: Vivienne Maskrey, Caitlin Notley, Richard Holland, Annie Blyth, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen Sutton, Jo LeonardibeeAbstract:Aims: Most people who quit Smoking for a short term will return to Smoking again in 12 months. We tested whether self-help booklets can reduce Relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. Design: A parallel-arm, pragmatic individually randomized controlled trial. Setting: Smoking cessation clinics in England. Participants People who stopped Smoking for 4 weeks after receiving cessation treatment in stop Smoking clinics. Intervention: Participants in the experimental group (n = 703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n = 704) received a leaflet currently used in practice. Measurements: The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self#x02010;reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. Findings: There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75–1.16; P = 0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for Relapse and using strategies to handle urges to smoke were less likely to Relapse. Conclusions: In people who stop Smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to Smoking did not reduce Relapse.
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effectiveness and economic evaluation of self help educational materials for the prevention of Smoking Relapse randomised controlled trial
Health Technology Assessment, 2015Co-Authors: Annie Blyth, Caitlin Notley, Richard Holland, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen Sutton, Jo LeonardibeeAbstract:© Queen’s Printer and Controller of HMSO 2015. Background: Most people who quit Smoking successfully for a short period will return to Smoking again in 12 months. A previous exploratory meta-analysis indicated that self-help booklets may be effective for Smoking Relapse prevention in unaided quitters. Objectives: This study aimed to evaluate the effectiveness of a set of self-help educational booklets to prevent Smoking Relapse in people who had stopped Smoking with the aid of behavioural support. Design: This is an open, randomised controlled trial and qualitative process evaluation. Trial participants were randomly allocated to one of two groups, using a simple randomisation process without attempts to stratify by participant characteristics. The participant allocation was ‘concealed’ because the recruitment of quitters occurred before the random allocation. Setting: Short-term quitters were recruited from NHS Stop Smoking Clinics, and self-help educational materials were posted to study participants at home. Participants: A total of 1407 carbon monoxide (CO)-validated quitters at 4 weeks after quit date in NHS Stop Smoking Clinics. The trial excluded pregnant women and quitters who were not able to read the educational materials in English. Interventions: Participants in the experimental group (n = 703) received a set of eight revised Forever Free booklets, and participants in the control group (n = 704) received a single leaflet that is currently given to NHS patients. Main outcome measures: Follow-up telephone interviews were conducted 3 and 12 months after quit date. The primary outcome was prolonged, CO-verified abstinence from months 4 to 12 during which time no more than five cigarettes were smoked. The secondary outcomes included self-reported abstinence during the previous 7 days at 3 and 12 months, CO-verified abstinence at 12 months, costs (NHS and NHS and participant medication costs perspectives) and quality-adjusted life-years. Logistic regression analyses were conducted to investigate effect-modifying variables. A simultaneous qualitative process evaluation was conducted to help interpret the trial results. Results: Data from 1404 participants were used for the final analysis, after excluding three participants who died before the 12-month follow-up. The proportion with prolonged abstinence from months 4 to 12 after quit date was 36.9% in the intervention group and 38.6% in the control group. There was no statistically significant difference between the groups (odds ratio 0.93, 95% confidence interval 0.75 to 1.15; p = 0.509). There were no statistically significant differences between the groups in secondary Smoking outcomes. People who reported knowing risky situations for Relapse and using strategies to handle urges to smoke were less likely to Relapse. However, there were no differences between the groups in the proportion of participants who reported that they knew any more about coping skills, and no differences in reported use of strategies to cope with urges to smoke between the trial groups. The qualitative study found that some quitters considered self-help booklets unhelpful for Smoking Relapse prevention, although positive feedback by participants was common. Conclusions: Among quitters who had stopped Smoking with the aid of intensive behavioural support, there was no significant difference in the likelihood of Smoking Relapse between those who subsequently received a set of eight revised Forever Free booklets and those who received a single leaflet. Although many people had suboptimal strategies to prevent Relapse and most Relapsed, the Forever Free booklets proved an ineffective medium for teaching them the skills to prevent Relapse. Further research should focus on interventions that may increase the use of coping skills when required. Trial registration: Current Controlled Trials ISRCTN36980856. Funding: 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. 19, No. 59. See the NIHR Journals Library website for further project information.
Caitlin Notley - One of the best experts on this subject based on the ideXlab platform.
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Relapse to Smoking and health related quality of life secondary analysis of data from a study of Smoking Relapse prevention
PLOS ONE, 2018Co-Authors: Fujian Song, Caitlin Notley, Richard Holland, Annie Blyth, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen SuttonAbstract:Background: Previous studies have shown that Smoking and Smoking cessation may be associated with health-related quality of life (HRQoL). In this study, we compared changes in HRQoL in people who maintained abstinence with people who had Relapsed to Smoking. Methods: This was a secondary analysis of data from a trial of a Relapse prevention intervention in 1,407 short-term quitters. The European Quality of Life -5 Dimensions (EQ-5D) measured HRQoL at baseline, 3 and 12 months. Smoking outcome was continuous abstinence from 2 to 12 months, and 7-day Smoking at 3 and 12 months. We used nonparametric test for differences in EQ-5D utility scores, and chi-square test for dichotomised response to each of the five EQ-5D dimensions. Multivariable regression analyses were conducted to evaluate associations between Smoking Relapse and HRQoL or anxiety/depression problems. Results: The mean EQ-5D tariff score was 0.8252 at baseline. People who maintained abstinence experienced a statistically non-significant increase in the EQ-5D score (mean change 0.0015, P=0.88), while returning to Smoking was associated with a statistically significant decrease in the EQ-5D score (mean change -0.0270, P=0.004). After adjusting for multiple baseline characteristics, the utility change during baseline and 12 months was statistically significantly associated with continuous abstinence, with a difference of 0.0288 (95% CI: 0.0006 to 0.0571, P=0.045) between Relapsers and continuous quitters. The only difference in quality of life dimensions between those who Relapsed and those who maintained abstinence was in the proportion of participants with anxiety/depression problems at 12 months (30% vs. 22%, P=0.001). Smoking Relapse was associated with a simultaneous increase in anxiety/depression problems. Conclusions: People who achieve short-term Smoking abstinence but subsequently Relapse to Smoking have a reduced quality of life, which appears mostly due to worsening of symptoms of anxiety and depression. Further research is required to more fully understand the relationship between Smoking and health-related quality of life, and to develop cessation interventions by taking into account the impact of anxiety or depression on Smoking.
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The unique contribution of e-cigarettes for tobacco harm reduction in supporting Smoking Relapse prevention
Harm Reduction Journal, 2018Co-Authors: Caitlin Notley, Lynne Dawkins, Emma Ward, Richard HollandAbstract:We have little understanding of how vapers use e-cigarettes beyond cessation. E-cigarettes may have a role to play in reducing the health-related harms of tobacco Smoking, through not only assisting Smoking cessation attempts but also supporting long-term abstinence from Smoking. However, there are fears that vaping may lead to the ‘renormalisation’ of Smoking type behaviours. This study aimed to explore patterns of use and reported experiences of vapers quitting Smoking using an e-cigarette in relation to long-term Smoking status (abstinence or Relapse). A purposive sample of 40 UK vapers was matched to a sampling frame of demographic characteristics from a representative sample of UK quitters. Following full informed consent, semi-structured qualitative interviews were conducted. Data were thematically analysed by two members of the research team. Final thematic analysis was verified and agreed by consensus. The sample self-reported long histories of tobacco use and multiple previous quit attempts which had eventually resulted in Relapse back to Smoking, although a small but important group had never before attempted to quit. Initiating e-cigarette use was experienced as a revelation for some, who were quickly able to fully switch to using e-cigarettes as an alternative to tobacco Smoking. For others, periods of dual use or Smoking Relapse combined with attempts at vaping that were not initially satisfactory. Many of these chose a cheaper ‘cig-a-like’ device which they found to be inadequate. Experimentation with different devices and different setups, over time, resulted in some ‘sliding’ rather than switching to vaping. This involved periods of ‘dual use’. Some settled on patterns of vaping as a direct substitute of previous tobacco Smoking, whereas others reported ‘grazing’ patterns of vaping throughout the day that were perceived to support tobacco Smoking abstinence. Our data demonstrates that e-cigarettes may be a unique harm reduction innovation for Smoking Relapse prevention. E-cigarettes meet the needs of some ex-smokers by substituting physical, psychological, social, cultural and identity-related aspects of tobacco addiction. Some vapers reported that they found vaping pleasurable and enjoyable—being more than a substitute but actually preferred, over time, to tobacco Smoking. This clearly suggests that vaping is a viable long-term substitute for Smoking, with substantial implications for tobacco harm reduction.
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differences in longer term Smoking abstinence after treatment by specialist or nonspecialist advisors secondary analysis of data from a Relapse prevention trial
Nicotine & Tobacco Research, 2016Co-Authors: Fujian Song, Caitlin Notley, Richard Holland, Annie Blyth, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen SuttonAbstract:Introduction: Smokers receiving support in specialist centers tend to have a higher short-term quit rate, compared with those receiving support in other settings from professionals for whom Smoking cessation is only a part of their work. We investigated the difference in longer-term abstinence after short-term Smoking cessation treatment from specialist and nonspecialist Smoking cessation services. Methods: We conducted a secondary analysis of data from a randomized controlled trial of selfhelp booklets for the prevention of Smoking Relapse. The trial included 1088 short-term quitters from specialist stop Smoking clinics and 316 from nonspecialist cessation services (such as general practice, pharmacies, and health trainer services). The difference in prolonged Smoking abstinence from months 4 to 12 between specialist and nonspecialist services was compared. Multivariable logistic regression analyses were conducted to investigate the association between continuous Smoking abstinence and the type of Smoking cessation services, adjusted for possible confounding factors (including demographic, socioeconomic, and Smoking history variables). Results: The proportion of continuous abstinence from 4 to 12 months was higher in short-term quitters from specialist services compared with those from nonspecialist services (39% vs. 32%; P = .023). After adjusting for a range of participant characteristics and Smoking variables, the specialist service was significantly associated with a higher rate of longer-term Smoking abstinence (odds ratio: 1.48, 95% CI = 1.09% to 2.00%; P = .011). Conclusions: People who receive support to stop Smoking from a specialist appear to be at lower risk of Relapse than those receiving support from a nonspecialist advisor.
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self help educational booklets for the prevention of Smoking Relapse following Smoking cessation treatment a randomized controlled trial
Addiction, 2015Co-Authors: Vivienne Maskrey, Caitlin Notley, Richard Holland, Annie Blyth, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen Sutton, Jo LeonardibeeAbstract:Aims: Most people who quit Smoking for a short term will return to Smoking again in 12 months. We tested whether self-help booklets can reduce Relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. Design: A parallel-arm, pragmatic individually randomized controlled trial. Setting: Smoking cessation clinics in England. Participants People who stopped Smoking for 4 weeks after receiving cessation treatment in stop Smoking clinics. Intervention: Participants in the experimental group (n = 703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n = 704) received a leaflet currently used in practice. Measurements: The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self#x02010;reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. Findings: There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75–1.16; P = 0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for Relapse and using strategies to handle urges to smoke were less likely to Relapse. Conclusions: In people who stop Smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to Smoking did not reduce Relapse.
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effectiveness and economic evaluation of self help educational materials for the prevention of Smoking Relapse randomised controlled trial
Health Technology Assessment, 2015Co-Authors: Annie Blyth, Caitlin Notley, Richard Holland, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen Sutton, Jo LeonardibeeAbstract:© Queen’s Printer and Controller of HMSO 2015. Background: Most people who quit Smoking successfully for a short period will return to Smoking again in 12 months. A previous exploratory meta-analysis indicated that self-help booklets may be effective for Smoking Relapse prevention in unaided quitters. Objectives: This study aimed to evaluate the effectiveness of a set of self-help educational booklets to prevent Smoking Relapse in people who had stopped Smoking with the aid of behavioural support. Design: This is an open, randomised controlled trial and qualitative process evaluation. Trial participants were randomly allocated to one of two groups, using a simple randomisation process without attempts to stratify by participant characteristics. The participant allocation was ‘concealed’ because the recruitment of quitters occurred before the random allocation. Setting: Short-term quitters were recruited from NHS Stop Smoking Clinics, and self-help educational materials were posted to study participants at home. Participants: A total of 1407 carbon monoxide (CO)-validated quitters at 4 weeks after quit date in NHS Stop Smoking Clinics. The trial excluded pregnant women and quitters who were not able to read the educational materials in English. Interventions: Participants in the experimental group (n = 703) received a set of eight revised Forever Free booklets, and participants in the control group (n = 704) received a single leaflet that is currently given to NHS patients. Main outcome measures: Follow-up telephone interviews were conducted 3 and 12 months after quit date. The primary outcome was prolonged, CO-verified abstinence from months 4 to 12 during which time no more than five cigarettes were smoked. The secondary outcomes included self-reported abstinence during the previous 7 days at 3 and 12 months, CO-verified abstinence at 12 months, costs (NHS and NHS and participant medication costs perspectives) and quality-adjusted life-years. Logistic regression analyses were conducted to investigate effect-modifying variables. A simultaneous qualitative process evaluation was conducted to help interpret the trial results. Results: Data from 1404 participants were used for the final analysis, after excluding three participants who died before the 12-month follow-up. The proportion with prolonged abstinence from months 4 to 12 after quit date was 36.9% in the intervention group and 38.6% in the control group. There was no statistically significant difference between the groups (odds ratio 0.93, 95% confidence interval 0.75 to 1.15; p = 0.509). There were no statistically significant differences between the groups in secondary Smoking outcomes. People who reported knowing risky situations for Relapse and using strategies to handle urges to smoke were less likely to Relapse. However, there were no differences between the groups in the proportion of participants who reported that they knew any more about coping skills, and no differences in reported use of strategies to cope with urges to smoke between the trial groups. The qualitative study found that some quitters considered self-help booklets unhelpful for Smoking Relapse prevention, although positive feedback by participants was common. Conclusions: Among quitters who had stopped Smoking with the aid of intensive behavioural support, there was no significant difference in the likelihood of Smoking Relapse between those who subsequently received a set of eight revised Forever Free booklets and those who received a single leaflet. Although many people had suboptimal strategies to prevent Relapse and most Relapsed, the Forever Free booklets proved an ineffective medium for teaching them the skills to prevent Relapse. Further research should focus on interventions that may increase the use of coping skills when required. Trial registration: Current Controlled Trials ISRCTN36980856. Funding: 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. 19, No. 59. See the NIHR Journals Library website for further project information.
Raymond Niaura - One of the best experts on this subject based on the ideXlab platform.
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efficacy of acute administration of nicotine gum in relief of cue provoked cigarette craving
Psychopharmacology, 2003Co-Authors: Saul Shiffman, Raymond Niaura, William G Shadel, Moise Khayrallah, Douglas E Jorenby, Charles F Ryan, Clifford L FergusonAbstract:Rationale Acute cravings, often provoked by exposure to Smoking cues, appear to be important triggers for Smoking Relapse. Relief of acute craving may therefore be an important step in preventing Relapse.
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sustained release bupropion for pharmacologic Relapse prevention after Smoking cessation a randomized controlled trial
Annals of Internal Medicine, 2001Co-Authors: J T Hays, Nancy A. Rigotti, Richard D Hurt, Raymond Niaura, D Gonzales, M J Durcan, D P L Sachs, Troy D Wolter, A S Buist, J A JohnstonAbstract:Background Smoking Relapse is common after successful pharmacologic treatment for Smoking cessation. No previous studies have examined long-term drug therapy used expressly for prevention of Smoking Relapse. Objective To evaluate the efficacy of bupropion to prevent Smoking Relapse. Design Randomized, placebo-controlled trial. Participants 784 healthy community volunteers who were motivated to quit Smoking and who smoked at least 15 cigarettes per day. Intervention The participants received open-label, sustained-release bupropion, 300 mg/d, for 7 weeks. Participants who were abstinent throughout week 7 of open-label treatment were randomly assigned to receive bupropion, 300 mg/d, or placebo for 45 weeks and were subsequently followed for an additional year after the conclusion of the medication phase. Participants were briefly counseled at all follow-up visits. At the end of open-label bupropion treatment, 461 of 784 participants (58.8%) were abstinent from Smoking. Measurement Self-reported abstinence was confirmed by an expired air carbon monoxide concentration of 10 parts per million or less. Results The point prevalence of Smoking abstinence was significantly higher in the bupropion group than in the placebo group at the end (week 52) of drug therapy (55.1% vs. 42.3%, respectively; P = 0.008) and at week 78 (47.7% vs. 37.7%; P = 0.034) but did not differ at the final (week 104) follow-up visit (41.6% vs. 40.0%). The median time to Relapse was significantly greater for bupropion recipients than for placebo recipients (156 days vs. 65 days; P = 0.021). The continuous abstinence rate was higher in the bupropion group than in the placebo group at study week 24 (17 weeks after randomization) (52.3% vs. 42.3%; P = 0.037) but did not differ between groups after week 24. Weight gain was significantly less in the bupropion group than in the placebo group at study weeks 52 (3.8 kg vs. 5.6 kg; P = 0.002) and 104 (4.1 kg vs. 5.4 kg; P = 0.016). Conclusions In persons who stopped Smoking with 7 weeks of bupropion treatment, sustained-release bupropion for 12 months delayed Smoking Relapse and resulted in less weight gain.
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sustained release bupropion for pharmacologic Relapse prevention after Smoking cessation
Annals of Internal Medicine, 2001Co-Authors: Taylor J Hays, Nancy A. Rigotti, Richard D Hurt, Raymond Niaura, D Gonzales, M J Durcan, D P L Sachs, Troy D Wolter, Sonia A Buist, Andrew J JohnstonAbstract:In persons who had stopped Smoking during 7 weeks of bupropion treatment, sustained-release bupropion for 12 months delayed Smoking Relapse and resulted in less weight gain compared with patients w...
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cue exposure treatment for Smoking Relapse prevention a controlled clinical trial
Addiction, 1999Co-Authors: Raymond Niaura, David B Abrams, William G Shadel, Damaris J Rohsenow, Peter M Monti, Alan D SirotaAbstract:Aims. In an additive design, test the efficacy of cue exposure treatment for Smoking Relapse prevention as an adjunct to current standard cognitive behavioral and pharmacological treatments. Design. Randomized, controlled clinical trial. Setting. Outpatient behavioral medicine clinic. Participants. One hundred and twenty-nine cigarette smokers recruited through newspaper advertisements. Intervention. After receiving an initial counseling session for cessation and setting a quit day, 129 smokers were randomly assigned to one of four Relapse prevention treatment conditions: (1) brief cognitive behavioral; (2) cognitive behavioral and nicorette gum; (3) cognitive behavioral and cue exposure; and (4) cognitive behavioral and cue exposure with nicorette gum. All smokers met individually with their counselor for six RP sessions. Measures. Seven-day, point-prevalence abstinence rates (CO verified) taken at 1, 3, 6 and 12-months post-treatment and time to first slip. Findings. All manipulation checks and process measures suggested that the treatments were delivered as intended. There were no significant differences between conditions in point-prevalence abstinence rates or in time to first slip. Conclusions. These results call into question the utility of cue exposure treatment for Smoking Relapse prevention.
Stephen Sutton - One of the best experts on this subject based on the ideXlab platform.
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Relapse to Smoking and health related quality of life secondary analysis of data from a study of Smoking Relapse prevention
PLOS ONE, 2018Co-Authors: Fujian Song, Caitlin Notley, Richard Holland, Annie Blyth, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen SuttonAbstract:Background: Previous studies have shown that Smoking and Smoking cessation may be associated with health-related quality of life (HRQoL). In this study, we compared changes in HRQoL in people who maintained abstinence with people who had Relapsed to Smoking. Methods: This was a secondary analysis of data from a trial of a Relapse prevention intervention in 1,407 short-term quitters. The European Quality of Life -5 Dimensions (EQ-5D) measured HRQoL at baseline, 3 and 12 months. Smoking outcome was continuous abstinence from 2 to 12 months, and 7-day Smoking at 3 and 12 months. We used nonparametric test for differences in EQ-5D utility scores, and chi-square test for dichotomised response to each of the five EQ-5D dimensions. Multivariable regression analyses were conducted to evaluate associations between Smoking Relapse and HRQoL or anxiety/depression problems. Results: The mean EQ-5D tariff score was 0.8252 at baseline. People who maintained abstinence experienced a statistically non-significant increase in the EQ-5D score (mean change 0.0015, P=0.88), while returning to Smoking was associated with a statistically significant decrease in the EQ-5D score (mean change -0.0270, P=0.004). After adjusting for multiple baseline characteristics, the utility change during baseline and 12 months was statistically significantly associated with continuous abstinence, with a difference of 0.0288 (95% CI: 0.0006 to 0.0571, P=0.045) between Relapsers and continuous quitters. The only difference in quality of life dimensions between those who Relapsed and those who maintained abstinence was in the proportion of participants with anxiety/depression problems at 12 months (30% vs. 22%, P=0.001). Smoking Relapse was associated with a simultaneous increase in anxiety/depression problems. Conclusions: People who achieve short-term Smoking abstinence but subsequently Relapse to Smoking have a reduced quality of life, which appears mostly due to worsening of symptoms of anxiety and depression. Further research is required to more fully understand the relationship between Smoking and health-related quality of life, and to develop cessation interventions by taking into account the impact of anxiety or depression on Smoking.
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differences in longer term Smoking abstinence after treatment by specialist or nonspecialist advisors secondary analysis of data from a Relapse prevention trial
Nicotine & Tobacco Research, 2016Co-Authors: Fujian Song, Caitlin Notley, Richard Holland, Annie Blyth, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen SuttonAbstract:Introduction: Smokers receiving support in specialist centers tend to have a higher short-term quit rate, compared with those receiving support in other settings from professionals for whom Smoking cessation is only a part of their work. We investigated the difference in longer-term abstinence after short-term Smoking cessation treatment from specialist and nonspecialist Smoking cessation services. Methods: We conducted a secondary analysis of data from a randomized controlled trial of selfhelp booklets for the prevention of Smoking Relapse. The trial included 1088 short-term quitters from specialist stop Smoking clinics and 316 from nonspecialist cessation services (such as general practice, pharmacies, and health trainer services). The difference in prolonged Smoking abstinence from months 4 to 12 between specialist and nonspecialist services was compared. Multivariable logistic regression analyses were conducted to investigate the association between continuous Smoking abstinence and the type of Smoking cessation services, adjusted for possible confounding factors (including demographic, socioeconomic, and Smoking history variables). Results: The proportion of continuous abstinence from 4 to 12 months was higher in short-term quitters from specialist services compared with those from nonspecialist services (39% vs. 32%; P = .023). After adjusting for a range of participant characteristics and Smoking variables, the specialist service was significantly associated with a higher rate of longer-term Smoking abstinence (odds ratio: 1.48, 95% CI = 1.09% to 2.00%; P = .011). Conclusions: People who receive support to stop Smoking from a specialist appear to be at lower risk of Relapse than those receiving support from a nonspecialist advisor.
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self help educational booklets for the prevention of Smoking Relapse following Smoking cessation treatment a randomized controlled trial
Addiction, 2015Co-Authors: Vivienne Maskrey, Caitlin Notley, Richard Holland, Annie Blyth, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen Sutton, Jo LeonardibeeAbstract:Aims: Most people who quit Smoking for a short term will return to Smoking again in 12 months. We tested whether self-help booklets can reduce Relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. Design: A parallel-arm, pragmatic individually randomized controlled trial. Setting: Smoking cessation clinics in England. Participants People who stopped Smoking for 4 weeks after receiving cessation treatment in stop Smoking clinics. Intervention: Participants in the experimental group (n = 703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n = 704) received a leaflet currently used in practice. Measurements: The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self#x02010;reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. Findings: There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75–1.16; P = 0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for Relapse and using strategies to handle urges to smoke were less likely to Relapse. Conclusions: In people who stop Smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to Smoking did not reduce Relapse.
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effectiveness and economic evaluation of self help educational materials for the prevention of Smoking Relapse randomised controlled trial
Health Technology Assessment, 2015Co-Authors: Annie Blyth, Caitlin Notley, Richard Holland, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen Sutton, Jo LeonardibeeAbstract:© Queen’s Printer and Controller of HMSO 2015. Background: Most people who quit Smoking successfully for a short period will return to Smoking again in 12 months. A previous exploratory meta-analysis indicated that self-help booklets may be effective for Smoking Relapse prevention in unaided quitters. Objectives: This study aimed to evaluate the effectiveness of a set of self-help educational booklets to prevent Smoking Relapse in people who had stopped Smoking with the aid of behavioural support. Design: This is an open, randomised controlled trial and qualitative process evaluation. Trial participants were randomly allocated to one of two groups, using a simple randomisation process without attempts to stratify by participant characteristics. The participant allocation was ‘concealed’ because the recruitment of quitters occurred before the random allocation. Setting: Short-term quitters were recruited from NHS Stop Smoking Clinics, and self-help educational materials were posted to study participants at home. Participants: A total of 1407 carbon monoxide (CO)-validated quitters at 4 weeks after quit date in NHS Stop Smoking Clinics. The trial excluded pregnant women and quitters who were not able to read the educational materials in English. Interventions: Participants in the experimental group (n = 703) received a set of eight revised Forever Free booklets, and participants in the control group (n = 704) received a single leaflet that is currently given to NHS patients. Main outcome measures: Follow-up telephone interviews were conducted 3 and 12 months after quit date. The primary outcome was prolonged, CO-verified abstinence from months 4 to 12 during which time no more than five cigarettes were smoked. The secondary outcomes included self-reported abstinence during the previous 7 days at 3 and 12 months, CO-verified abstinence at 12 months, costs (NHS and NHS and participant medication costs perspectives) and quality-adjusted life-years. Logistic regression analyses were conducted to investigate effect-modifying variables. A simultaneous qualitative process evaluation was conducted to help interpret the trial results. Results: Data from 1404 participants were used for the final analysis, after excluding three participants who died before the 12-month follow-up. The proportion with prolonged abstinence from months 4 to 12 after quit date was 36.9% in the intervention group and 38.6% in the control group. There was no statistically significant difference between the groups (odds ratio 0.93, 95% confidence interval 0.75 to 1.15; p = 0.509). There were no statistically significant differences between the groups in secondary Smoking outcomes. People who reported knowing risky situations for Relapse and using strategies to handle urges to smoke were less likely to Relapse. However, there were no differences between the groups in the proportion of participants who reported that they knew any more about coping skills, and no differences in reported use of strategies to cope with urges to smoke between the trial groups. The qualitative study found that some quitters considered self-help booklets unhelpful for Smoking Relapse prevention, although positive feedback by participants was common. Conclusions: Among quitters who had stopped Smoking with the aid of intensive behavioural support, there was no significant difference in the likelihood of Smoking Relapse between those who subsequently received a set of eight revised Forever Free booklets and those who received a single leaflet. Although many people had suboptimal strategies to prevent Relapse and most Relapsed, the Forever Free booklets proved an ineffective medium for teaching them the skills to prevent Relapse. Further research should focus on interventions that may increase the use of coping skills when required. Trial registration: Current Controlled Trials ISRCTN36980856. Funding: 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. 19, No. 59. See the NIHR Journals Library website for further project information.
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Relapse to Smoking and health related quality of life secondary analysis of data from a study of Smoking Relapse prevention
PLOS ONE, 2018Co-Authors: Fujian Song, Caitlin Notley, Richard Holland, Annie Blyth, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen SuttonAbstract:Background: Previous studies have shown that Smoking and Smoking cessation may be associated with health-related quality of life (HRQoL). In this study, we compared changes in HRQoL in people who maintained abstinence with people who had Relapsed to Smoking. Methods: This was a secondary analysis of data from a trial of a Relapse prevention intervention in 1,407 short-term quitters. The European Quality of Life -5 Dimensions (EQ-5D) measured HRQoL at baseline, 3 and 12 months. Smoking outcome was continuous abstinence from 2 to 12 months, and 7-day Smoking at 3 and 12 months. We used nonparametric test for differences in EQ-5D utility scores, and chi-square test for dichotomised response to each of the five EQ-5D dimensions. Multivariable regression analyses were conducted to evaluate associations between Smoking Relapse and HRQoL or anxiety/depression problems. Results: The mean EQ-5D tariff score was 0.8252 at baseline. People who maintained abstinence experienced a statistically non-significant increase in the EQ-5D score (mean change 0.0015, P=0.88), while returning to Smoking was associated with a statistically significant decrease in the EQ-5D score (mean change -0.0270, P=0.004). After adjusting for multiple baseline characteristics, the utility change during baseline and 12 months was statistically significantly associated with continuous abstinence, with a difference of 0.0288 (95% CI: 0.0006 to 0.0571, P=0.045) between Relapsers and continuous quitters. The only difference in quality of life dimensions between those who Relapsed and those who maintained abstinence was in the proportion of participants with anxiety/depression problems at 12 months (30% vs. 22%, P=0.001). Smoking Relapse was associated with a simultaneous increase in anxiety/depression problems. Conclusions: People who achieve short-term Smoking abstinence but subsequently Relapse to Smoking have a reduced quality of life, which appears mostly due to worsening of symptoms of anxiety and depression. Further research is required to more fully understand the relationship between Smoking and health-related quality of life, and to develop cessation interventions by taking into account the impact of anxiety or depression on Smoking.
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differences in longer term Smoking abstinence after treatment by specialist or nonspecialist advisors secondary analysis of data from a Relapse prevention trial
Nicotine & Tobacco Research, 2016Co-Authors: Fujian Song, Caitlin Notley, Richard Holland, Annie Blyth, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen SuttonAbstract:Introduction: Smokers receiving support in specialist centers tend to have a higher short-term quit rate, compared with those receiving support in other settings from professionals for whom Smoking cessation is only a part of their work. We investigated the difference in longer-term abstinence after short-term Smoking cessation treatment from specialist and nonspecialist Smoking cessation services. Methods: We conducted a secondary analysis of data from a randomized controlled trial of selfhelp booklets for the prevention of Smoking Relapse. The trial included 1088 short-term quitters from specialist stop Smoking clinics and 316 from nonspecialist cessation services (such as general practice, pharmacies, and health trainer services). The difference in prolonged Smoking abstinence from months 4 to 12 between specialist and nonspecialist services was compared. Multivariable logistic regression analyses were conducted to investigate the association between continuous Smoking abstinence and the type of Smoking cessation services, adjusted for possible confounding factors (including demographic, socioeconomic, and Smoking history variables). Results: The proportion of continuous abstinence from 4 to 12 months was higher in short-term quitters from specialist services compared with those from nonspecialist services (39% vs. 32%; P = .023). After adjusting for a range of participant characteristics and Smoking variables, the specialist service was significantly associated with a higher rate of longer-term Smoking abstinence (odds ratio: 1.48, 95% CI = 1.09% to 2.00%; P = .011). Conclusions: People who receive support to stop Smoking from a specialist appear to be at lower risk of Relapse than those receiving support from a nonspecialist advisor.
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self help educational booklets for the prevention of Smoking Relapse following Smoking cessation treatment a randomized controlled trial
Addiction, 2015Co-Authors: Vivienne Maskrey, Caitlin Notley, Richard Holland, Annie Blyth, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen Sutton, Jo LeonardibeeAbstract:Aims: Most people who quit Smoking for a short term will return to Smoking again in 12 months. We tested whether self-help booklets can reduce Relapse in short-term quitters after receiving behavioural and pharmacological cessation treatment. Design: A parallel-arm, pragmatic individually randomized controlled trial. Setting: Smoking cessation clinics in England. Participants People who stopped Smoking for 4 weeks after receiving cessation treatment in stop Smoking clinics. Intervention: Participants in the experimental group (n = 703) were mailed eight booklets, each of which taught readers how to resist urges to smoke. Participants in the control group (n = 704) received a leaflet currently used in practice. Measurements: The primary outcome was prolonged, carbon monoxide-verified abstinence from months 4 to 12. The secondary outcomes included 7-day self#x02010;reported abstinence at 3 and 12 months. Mixed-effects logistic regression was used to estimate treatment effects and to investigate possible effect modifying variables. Findings: There were no statistically significant differences between the groups in prolonged abstinence from months 4 to 12 (36.9% versus 38.6%; odds ratio 0.93, 95% confidence interval 0.75–1.16; P = 0.524). In addition, there were no significant differences between the groups in any secondary outcomes. However, people who reported knowing risky situations for Relapse and using strategies to handle urges to smoke were less likely to Relapse. Conclusions: In people who stop Smoking successfully with behavioural support, a comprehensive self-help educational programme to teach people skills to identify and respond to high-risk situations for return to Smoking did not reduce Relapse.
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effectiveness and economic evaluation of self help educational materials for the prevention of Smoking Relapse randomised controlled trial
Health Technology Assessment, 2015Co-Authors: Annie Blyth, Caitlin Notley, Richard Holland, Vivienne Maskrey, Garry Barton, Tracey J Brown, Paul Aveyard, Max O Bachmann, Stephen Sutton, Jo LeonardibeeAbstract:© Queen’s Printer and Controller of HMSO 2015. Background: Most people who quit Smoking successfully for a short period will return to Smoking again in 12 months. A previous exploratory meta-analysis indicated that self-help booklets may be effective for Smoking Relapse prevention in unaided quitters. Objectives: This study aimed to evaluate the effectiveness of a set of self-help educational booklets to prevent Smoking Relapse in people who had stopped Smoking with the aid of behavioural support. Design: This is an open, randomised controlled trial and qualitative process evaluation. Trial participants were randomly allocated to one of two groups, using a simple randomisation process without attempts to stratify by participant characteristics. The participant allocation was ‘concealed’ because the recruitment of quitters occurred before the random allocation. Setting: Short-term quitters were recruited from NHS Stop Smoking Clinics, and self-help educational materials were posted to study participants at home. Participants: A total of 1407 carbon monoxide (CO)-validated quitters at 4 weeks after quit date in NHS Stop Smoking Clinics. The trial excluded pregnant women and quitters who were not able to read the educational materials in English. Interventions: Participants in the experimental group (n = 703) received a set of eight revised Forever Free booklets, and participants in the control group (n = 704) received a single leaflet that is currently given to NHS patients. Main outcome measures: Follow-up telephone interviews were conducted 3 and 12 months after quit date. The primary outcome was prolonged, CO-verified abstinence from months 4 to 12 during which time no more than five cigarettes were smoked. The secondary outcomes included self-reported abstinence during the previous 7 days at 3 and 12 months, CO-verified abstinence at 12 months, costs (NHS and NHS and participant medication costs perspectives) and quality-adjusted life-years. Logistic regression analyses were conducted to investigate effect-modifying variables. A simultaneous qualitative process evaluation was conducted to help interpret the trial results. Results: Data from 1404 participants were used for the final analysis, after excluding three participants who died before the 12-month follow-up. The proportion with prolonged abstinence from months 4 to 12 after quit date was 36.9% in the intervention group and 38.6% in the control group. There was no statistically significant difference between the groups (odds ratio 0.93, 95% confidence interval 0.75 to 1.15; p = 0.509). There were no statistically significant differences between the groups in secondary Smoking outcomes. People who reported knowing risky situations for Relapse and using strategies to handle urges to smoke were less likely to Relapse. However, there were no differences between the groups in the proportion of participants who reported that they knew any more about coping skills, and no differences in reported use of strategies to cope with urges to smoke between the trial groups. The qualitative study found that some quitters considered self-help booklets unhelpful for Smoking Relapse prevention, although positive feedback by participants was common. Conclusions: Among quitters who had stopped Smoking with the aid of intensive behavioural support, there was no significant difference in the likelihood of Smoking Relapse between those who subsequently received a set of eight revised Forever Free booklets and those who received a single leaflet. Although many people had suboptimal strategies to prevent Relapse and most Relapsed, the Forever Free booklets proved an ineffective medium for teaching them the skills to prevent Relapse. Further research should focus on interventions that may increase the use of coping skills when required. Trial registration: Current Controlled Trials ISRCTN36980856. Funding: 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. 19, No. 59. See the NIHR Journals Library website for further project information.
