Aleksandra Herbec

Smoker Identity and Its Potential Role in Young Adults’ Smoking Behavior: A Meta-Ethnography

Objective: Identity is an important influence on behavior. To identify potential targets for smoking cessation interventions in young adults, we synthesized findings from qualitative studies on smoker identity and potential influences on smoking and smoking cessation. Methods: A systematic search of 4 electronic databases up to September 19, 2013, was conducted to identify qualitative studies on smoker identity in smokers and ex-smokers aged 16–34. Key concepts were extracted from individual studies and synthesized into higher-order interpretations by following the principles of meta-ethnography. Results: Seventeen relevant papers were identified. At the highest level of interpretation, we identified 4 types of findings: (a) contributory factors to identity, (b) identity in relation to smoking, (c) contextual and temporal patterning, and (d) behavior in relation to smoking. Contributory factors included the desire to establish aspirational individual and social identities, enact a smoker identity appropriate to the momentary social context, and alter personal nonsmoking rules when consuming alcohol. Smoker identity was multifaceted and incorporated individuals’ defensive rationalizations, and both positive and negative feelings attached to it. Smoker identities took time to develop, were subject to change, and were context dependent. Identity was found to play a role in quit attempts. Conclusions: Qualitative research into the identity of young adult smokers has established it as a multifaceted phenomenon serving important functions but also involving conflict and defensive rationalizations. It develops over time and contextual factors influence its expression. The nature of a smoker’s identity can play an important role in smoking cessation.

Pilot randomized controlled trial of an internet-based smoking cessation intervention for pregnant smokers ('MumsQuit')

Background Internet-based Smoking Cessation Interventions could help pregnant women quit smoking, especially those who do not wish to, or cannot, access face-to-face or telephone support. This study aimed to preliminarily evaluate the effectiveness and usage of a fully automated smoking cessation website targeted to pregnancy, ‘MumsQuit’, and obtain an initial effect-size estimate for a full scale trial. Methods We recruited 200 UK-based pregnant adult smokers online to a two-arm double-blind pilot RCT assessing the effectiveness of MumsQuit compared with an information-only website. MumsQuit was adapted from a generic internet smoking cessation intervention, ‘StopAdvisor’. The primary outcome was self-reported continuous 4-week abstinence assessed at 8 weeks post-baseline. Secondary outcomes were automatically collected data on intervention usage. Results Participants smoked 15 cigarettes per day on average, 73% were in the first trimester of their pregnancy, 48% were from lower socioeconomic backgrounds, and 43% had never used evidence-based cessation support. The point estimate of odds ratio for the primary outcome was 1.5 (95% CI = 0.8–2.9; 28% vs. 21%). Compared with control participants, those in the MumsQuit group logged in more often (3.5 vs. 1.3, p < 0.001), viewed more pages (67.4 vs. 5.7, p < 0.001) and spent more time browsing the website (21.3 min vs. 1.0 min, p < 0.001). Conclusions MumsQuit is an engaging and potentially helpful form of support for pregnant women who seek cessation support online, and merits further development and evaluation in a full-scale RCT.

Differences in fMRI intersubject correlation while viewing unedited and edited videos of dance performance

Intersubject correlation (ISC) analysis of functional magnetic resonance imaging (fMRI) data provides insight into how continuous streams of sensory stimulation are processed by groups of observers. Although edited movies are frequently used as stimuli in ISC studies, there has been little direct examination of the effect of edits on the resulting ISC maps. In this study we showed 16 observers two audiovisual movie versions of the same dance. In one experimental condition there was a continuous view from a single camera (Unedited condition) and in the other condition there were views from different cameras (Edited condition) that provided close up views of the feet or face and upper body. We computed ISC maps for each condition, as well as created a map that showed the difference between the conditions. The results from the Unedited and Edited maps largely overlapped in the occipital and temporal cortices, although more voxels were found for the Edited map. The difference map revealed greater ISC for the Edited condition in the Postcentral Gyrus, Lingual Gyrus, Precentral Gyrus and Medial Frontal Gyrus, while the Unedited condition showed greater ISC in only the Superior Temporal Gyrus. These findings suggest that the visual changes associated with editing provide a source of correlation in maps obtained from edited film, and highlight the utility of using maps to evaluate the difference in ISC between conditions.

The needs and preferences of pregnant smokers regarding tailored Internet-based smoking cessation interventions: a qualitative interview study

BackgroundInternet-based Smoking Cessation Interventions (ISCIs) may help pregnant smokers who are unable, or unwilling, to access face-to-face stop smoking support. Targeting ISCIs to specific groups of smokers could increase their uptake and effectiveness. The current study explored the needs and preferences of pregnant women seeking online stop smoking support with an aim to identify features and components of ISCIs that might be most attractive to this population.MethodsWe conducted qualitative interviews with thirteen pregnant women who completed the intervention arm of a pilot randomized controlled trial of a novel ISCI for pregnant smokers (‘MumsQuit’). The interviews explored women’s views towards MumsQuit and online support with quitting smoking in general, as well as their suggestions for how ISCIs could be best targeted to pregnancy. Interview transcripts were analyzed using Framework Analysis.ResultsParticipants expressed preferences for an accessible, highly engaging and targeted to pregnancy smoking cessation website, tailored to individuals’ circumstances as well as use of cessation medication, offering comprehensive and novel information on smoking and quitting smoking in pregnancy, ongoing support with cravings management, as well as additional support following relapse to smoking. Participants also viewed as important targeting of the feedback and progress reports to baby’s health and development, offering personal support from experts, and providing a discussion forum allowing for communication with other pregnant women wanting to quit .ConclusionsThe present study has identified a number of potential building blocks for ISCIs targeted to quitting smoking in pregnancy. Pregnant smokers willing to try using ISCI may particularly value an engaging intervention offering a high degree of targeting of comprehensive information to them as a group and tailoring support and advice to their individual needs, as well as one providing post-relapse support, peer-to-peer communication and personal support from experts.

Alcohol taxation and premature mortality in Europe

www.thelancet.com Vol 385 March 28, 2015 1181 5 Popova LA. The results of the modern demographic policy in Russia. Int J Reg Devel 2014; 1: 26–38. 6 Zaridze D, Lewington S, Boroda A, et al. Alcohol and mortality in Russia: prospective observational study of 151 000 adults. Lancet 2014; 383: 1465–73. slowed and Lithuania’s mortality in men worsened. In 2008, alcohol prices were increased again in Poland and the rate of decreasing premature mortality returned to the same levels before 2002 (unpublished). The Russian Government announced that it would reduce the price of vodka by 16% in February, 2015. Similar to Poland, this decision follows a period of rapid improvements to health. After 50 years of stagnation, the health indicators of the Russian population, especially of young and middle-aged men, have been improving since 2005. As with Lithuania, Poland, and Finland, the decision to lower alcohol prices will probably contribute to halting this health transformation in Russia, especially because vodka consumption continues to be a key contributor to its high rates of premature mortality. Lithuania, Poland, and Finland increased alcohol taxes a few years after reducing them. We fi nd it diffi cult to understand why Russia would be willing to repeat the same mistakes as its neighbouring countries rather than learning from them.

Smokers’ Views on Personal Carbon Monoxide Monitors, Associated Apps, and Their Use: An Interview and Think-Aloud Study

Smartphone-based personal carbon monoxide (CO) monitors and associated apps, or “CO Smartphone Systems” (CSSs) for short, could enable smokers to independently monitor their smoking and quitting. This study explored views and preferences regarding CSSs and their use among 16 adult, UK-based smokers. First, semi-structured interviews explored participants’ expectations of CSSs. Secondly, a think-aloud study identified participants’ reactions to a personal CO monitor and to existing or prototype apps. Framework Analysis identified five themes: (1) General views, needs, and motivation to use CSSs; (2) Views on the personal CO monitor; (3) Practicalities of CSS use; (4) Desired features in associated apps; and (5) Factors affecting preferences for CSSs and their use. Participants had high expectations of CSSs and their potential to increase motivation. Priority app features included: easy CO testing journeys, relevant and motivating feedback, and recording of contextual data. Appearance and usability of the personal CO monitor, and accuracy and relevance of CO testing were considered important for engagement. Participants differed in their motivation to use and preferences for CSSs features and use, which might have non-trivial impact on evaluation efforts. Personal CO monitors and associated apps may be attractive tools for smokers, but making CSSs easy to use and evaluating these among different groups of smokers may be challenging.

If I'd Known …-a Theory-Informed Systematic Analysis of Missed Opportunities in Optimising Use of Nicotine Replacement Therapy and Accessing Relevant Support: a Qualitative Study.

PurposeNicotine replacement therapy (NRT) is often used suboptimally by smokers. Previous research has focused on cognitions and attitudes as potential reasons. This study drew on theoretical frameworks of behaviour to comprehensively explore smokers’ NRT use to identify new intervention targets.MethodsSemi-structured face-to-face interviews were conducted with 16 adult UK-based smokers and ex-smokers who used NRT in recent quit attempts (mean (SD) age = 34.9(10.3); 82.3% women). The COM-B (capability, opportunity, motivation, behaviour) model and the theoretical domains framework informed the interviews and analyses. Data were analysed in NVivo 11.ResultsTwo related behaviours were identified relevant to NRT use: use of NRT per se and engaging with information and support with NRT use. A meta-theme of “missed opportunity” identified instances when smokers did not or could not engage in these behaviours. For use of NRT per se, these included limited knowledge, poor technique of use, low motivation to optimise use, and lack of role models. For engaging with information and support, they included low awareness of optimal use techniques, selective information-seeking, low expectations, limited exposure to guidelines, deficient advice from healthcare professionals, and suboptimal product display. Prior suboptimal experience tended to negatively affect subsequent use and views. Participants were interested in accessible and comprehensive guidelines on NRT and its use.ConclusionsThere appear to be important missed opportunities for optimal use of NRT both in terms of use itself and engagement with information on optimal use. These missed opportunities arise from a range of capability, motivational, and opportunity-related factors.

Lessons learned from unsuccessful use of using personal carbon monoxide monitors to remotely assess abstinence in a pragmatic trial of a smartphone stop smoking app – A secondary analysis

Introduction Verifying abstinence remotely in trials of digital cessation interventions remains a major challenge. This study reports on using personal carbon monoxide (CO) monitors to assess abstinence in a pragmatic trial of a standalone cessation app involving automated recruitment with no researcher contact. Methods The study involved secondary data analysis of remote CO testing in a randomized trial (ISRCTN10548241) comparing two versions of a cessation app (BupaQuit). Trial participants were adult UK-based smokers interested in quitting, who were recruited online (02/2015–03/2016). Participants were followed-up through the app, email or phone at 4 weeks. Fifty-nine participants reporting not smoking were posted a personal CO monitor with instructions, and emailed two reminders. The monitors required installing software on a Windows PC. Participants were not reimbursed but retained the device. We recorded the proportion of CO tests returned, test results, self-reported ease of use, correct use, acceptability, and reasons for missing results. Results Fifteen (25.4%) CO results were returned, of which 86.6% were <10 ppm and 53.3% were <5 ppm, indicating abstinence (corresponding to 20.9% and 12.9% of all trial participants self-reporting abstinence, respectively). These 15 participants found the test easy, acceptable and believed they conducted it correctly. Eight (18.2%) of the missing results were accounted for, including no access to a Windows PC, barriers to receiving packages, and unwillingness to share results. Conclusion Remote validation using personal CO monitors may not yet be feasible in pragmatic studies of cessation apps in which participants are recruited with no reimbursement or direct contact with researchers.

Treatment of tobacco dependence among HIV-infected patients: rationale and preliminary actions taken in Poland

Tobacco smoking and non-communicable diseases related to tobacco use are currently the most important health challenges in population of HIV positive patients, also in Poland. Treatment of tobacco dependence in HIV-infected individuals is now emerged as one of the most important areas for clinical care. One of the rationale for intensifying smoking cessation efforts in HIV population comes from epidemiological observations suggesting that tobacco smoking is responsible for 7 years of life lost in HIV-infected smokers. The Health Promotion Foundation in collaboration with the HIV specialised medical society in Poland has launched a multi-component programme aimed at reducing the prevalence of tobacco smoking in HIV population at least by half in the next years. The programme involves several activities: (1) research aimed at characterising the smoking epidemic among HIV positive patients in Poland; (2) assessment and capacity building in smoking cessation among healthcare professionals who treat HIV patients; as well as (3) formulation of recommendations for a comprehensive nationwide programme of tobacco dependence treatment in this group of patients in Poland.