Michèle Tremblay

Behavioural interventions for smoking cessation : a meta-analysis of randomized controlled trials

AIMS Widely varying estimates of treatment effects have been reported in randomized controlled trials (RCTs) investigating the efficacy of behavioural interventions for smoking cessation. Previous meta-analyses investigating behavioural interventions have important limitations and do not include recently published RCTs. We undertook a meta-analysis of RCTs to synthesize the treatment effects of four behavioural interventions, including minimal clinical intervention (brief advice from a healthcare worker), and intensive interventions, including individual, group, and telephone counselling. METHODS AND RESULTS We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline, and PsycINFO databases. We included only RCTs that reported biochemically validated smoking cessation outcomes at 6 and/or 12 months after the target quit date. Outcomes were aggregated using hierarchical Bayesian random-effects models. We identified 50 RCTs, which randomized n = 26 927 patients (minimal clinical intervention: 9 RCTs, n = 6456; individual counselling: 23 RCTs, n = 8646; group counselling: 12 RCTs, n = 3600; telephone counselling: 10 RCTs, n = 8225). The estimated mean treatment effects were minimal clinical intervention [odds ratio (OR) 1.50, 95% credible interval (CrI) 0.84-2.78], individual counselling (OR 1.49, 95% CrI 1.08-2.07), group counselling (OR 1.76, 95% CrI 1.11-2.93), and telephone counselling (OR 1.58, 95% CrI 1.15-2.29). CONCLUSION Intensive behavioural interventions result in substantial increases in smoking abstinence compared with control. Although minimal clinical intervention may increase smoking abstinence, there is insufficient evidence to draw strong conclusions regarding its efficacy.

Water-pipe smoking among North American youths.

OBJECTIVES: The objectives of this analysis were to identify the sociodemographic characteristics of water-pipe users in a North American context and to describe concurrent psychoactive substance use. METHODS: Data on sociodemographic characteristics, water-pipe smoking, and use of other psychoactive substances were collected in 2007 through mailed self-report questionnaires completed by 871 young adults, 18 to 24 years of age, who were participating in the Nicotine Dependence in Teens Study, a longitudinal investigation of the natural history of nicotine dependence among adolescents in Montreal, Canada. Independent sociodemographic correlates of water-pipe use were identified in multivariate logistic regression analyses. RESULTS: Previous-year water-pipe use was reported by 23% of participants. Younger age, male gender, speaking English, not living with parents, and higher household income independently increased the odds of water-pipe use. Water-pipe use was markedly higher among participants who had smoked cigarettes, had used other tobacco products, had drunk alcohol, had engaged in binge drinking, had smoked marijuana, or had used other illicit drugs in the previous year. CONCLUSIONS: Water-pipe users may represent an advantaged group of young people with the leisure time, resources, and opportunity to use water-pipes. Evidence-based public health and policy interventions are required to equip the public to make informed decisions about water-pipe use.

A systematic review of the Diagnostic and Statistical Manual diagnostic criteria for nicotine dependence

The Diagnostic and Statistical Manual diagnostic criteria for nicotine dependence (DSM-ND) are based on the proposition that dependence is a syndrome that can be diagnosed only when a minimum of 3 of the 7 proscribed features are present. The DSM-ND criteria are an accepted research measure, but the validity of these criteria has not been subjected to a systematic evaluation. To systematically review evidence of validity and reliability for the DSM-ND criteria, a literature search was conducted of 16 national and international databases. Each article with original data was independently reviewed by two or more reviewers. In total, 380 potentially relevant articles were examined and 169 were reviewed in depth. The DSM-ND criteria have seen wide use in research settings, but sensitivity and specificity are well below the accepted standards for clinical applications. Predictive validity is generally poor. The 7 DSM-ND criteria are regarded as having face validity, but no data support a 3-symptom ND diagnostic threshold, or a 4-symptom withdrawal syndrome threshold. The DSM incorrectly states that daily smoking is a prerequisite for withdrawal symptoms. The DSM shows poor to modest concurrence with all other measures of nicotine dependence, smoking behaviors and biological measures of tobacco use. The data support the DSM-ND criteria as a valid measure of nicotine dependence severity for research applications. However, the data do not support the central premise of a 3-symptom diagnostic threshold, and no data establish that the DSM-ND criteria provide an accurate diagnosis of nicotine dependence.

Do the correlates of smoking cessation counseling differ across health professional groups

INTRODUCTION Smoking cessation counseling by health professionals is an effective approach to increase cessation rates among smokers. To guide the development of training and educational interventions, we surveyed six health professional groups including general practitioners (GPs), pharmacists, dentists, dental hygienists, nurses, and respiratory therapists, in order to describe current practices and identify the correlates of smoking cessation counseling. METHODS Self-administered questionnaires were mailed to 500 persons randomly selected from the membership lists of active licensed professionals in each health professional group in Québec. RESULTS Response proportions ranged from 52% (nurses) to 70% (dental hygienists). Compared with other groups, GPs and pharmacists undertook more counseling with patients ready to quit. GPs and respiratory therapists undertook more counseling with patients not ready to quit. Three factors emerged consistently across most groups as positively associated with counseling, including the belief that counseling is the role of health professionals, perceived self-efficacy to engage in effective counseling, and knowledge of community cessation resources. DISCUSSION The correlates of cessation counseling are similar across health professional groups. Interventions that address beliefs that cessation counseling is the role of health professionals, self-efficacy to provide effective counseling, and knowledge of community resources may result in improved cessation counseling practices among health professionals.

Cohort Profile: The Nicotine Dependence in Teens (NDIT) Study

The Nicotine Dependence in Teens (NDIT) study is a prospective cohort investigation of 1294 students recruited in 1999-2000 from all grade 7 classes in a convenience sample of 10 high schools in Montreal, Canada. Its primary objectives were to study the natural course and determinants of cigarette smoking and nicotine dependence in novice smokers. The main source of data was self-report questionnaires administered in class at school every 3 months from grade 7 to grade 11 (1999-2005), for a total of 20 survey cycles during high school education. Questionnaires were also completed after graduation from high school in 2007-08 and 2011-12 (survey cycles 21 and 22, respectively) when participants were aged 20 and 24 years on average, respectively. In addition to its primary objectives, NDIT has embedded studies on obesity, blood pressure, physical activity, team sports, sedentary behaviour, diet, genetics, alcohol use, use of illicit drugs, second-hand smoke, gambling, sleep and mental health. Results to date are described in 58 publications, 20 manuscripts in preparation, 13 MSc and PhD theses and 111 conference presentations. Access to NDIT data is open to university-appointed or affiliated investigators and to masters, doctoral and postdoctoral students, through their primary supervisor (www.nditstudy.ca).

Home smoking bans may increase the risk of smoking onset in children when both parents smoke.

INTRODUCTION Our objective was to determine if there is effect modification by home smoking bans in the association between parental smoking and cigarette smoking onset in children. METHODS Data on smoking onset, number of parents who smoke, and home smoking rules were collected from children who had never smoked in self-report questionnaires in grades 5, 7, 9, and 11. The association between number of parents who smoke and smoking onset in children was tested in pooled logistic regression in 2 groups defined by the presence or absence of a complete home smoking ban. RESULTS In homes without a complete ban and relative to participants with no parents who smoke, the odds ratio (95% confidence interval [OR (95% CI]) for smoking onset was 1.5 (1.1-1.9) when one parent smoked and 1.4 (1.0-2.1) when both parents smoked. In homes with a complete ban, the OR (95% CI) was 1.6 (1.1-2.3) if one parent smoked, but 4.9 (2.4-9.9) if both parents smoked. CONCLUSION The association between number of parents who smoke and smoking onset in children was modified by the presence of a complete home smoking ban. In homes with a complete smoking ban in which both parents smoke, it may be prudent those parents communicate clearly with their children about their reasons for implementing the ban as well as about their reasons for continuing to smoke.

Respiratory Therapists' Smoking Cessation Counseling Practices: A Comparison Between 2005 and 2010

OBJECTIVE: We assessed whether smoking cessation counseling practices and related psychosocial characteristics among respiratory therapists (RTs) improved between 2005 and 2010. METHODS: Data were collected in mailed self-report questionnaires in 2005 and in 2010, in random independent samples of active licensed RTs in Québec, Canada. RESULTS: The response proportion was 67.6% in 2005 and 59.9% in 2010. There were no substantial differences in mean cessation counseling scores according to year of survey. RTs who reported that they had received cessation counseling training during their studies or after their studies (when they were in practice) had statistically significantly better counseling practices for both patients ready and patients not ready to quit than untrained RTs. In addition, their self-efficacy to provide effective counseling was higher and they perceived fewer knowledge-related barriers to cessation. Further, RTs trained after their studies perceived fewer patient-related and time barriers to cessation counseling, and had better knowledge of community resources. CONCLUSIONS: Although the proportion of RTs trained in smoking cessation counseling during and after studies increased between 2005 and 2010 (from 3% to 14%, and from 17% to 29%, respectively), sustained efforts are needed to increase the number of trained RTs, so that this translates into positive observable changes in counseling practices.

Pharmacists’ Smoking Cessation Counseling Practices: A Comparison Between 2005 and 2010

INTRODUCTION To determine if smoking cessation counseling practices and related psychosocial characteristics improved among pharmacists between 2005 and 2010. METHODS Data were collected in 2005 and 2010 from randomly selected pharmacists in Québec, Canada. Participants completed mailed self-report questionnaires on cessation counseling practices and psychosocial characteristics (i.e., belief that counseling is the role of pharmacists, self-efficacy, barriers, and knowledge of community resources). The association between each of year and training (either during or after undergraduate studies) and each outcome was investigated in each sex separately with multiple linear regression models using pooled data across 2005 and 2010. RESULTS Among female pharmacists, cessation counseling for patients ready to quit improved over time. Training during and after undergraduate studies was significantly associated with higher self-efficacy, better knowledge of community resources, and improved counseling for patients ready and not ready to quit. Also, training after studies was significantly associated with more advantageous beliefs about counseling. Among male pharmacists, knowledge of community resources and perceived barriers to counseling improved over time, but there were no significant differences in cessation counseling. Training during and after undergraduate studies was significantly associated with higher self-efficacy. Training during undergraduate studies was also associated with higher counseling score in patients ready to quit, and training after studies was associated with better knowledge of community resources. CONCLUSION Smoking cessation counseling for patients ready to quit improved from 2005 to 2010 among female pharmacists but not among male pharmacists. Training is generally associated with improved counseling and improved cessation-related psychosocial characteristics.

Effect of anti-smoking legislation on school staff smoking may dissipate over time.

This study describes student perceptions of school staff smoking before and after implementation of legislation prohibiting smoking on school grounds. Students completed self-report questionnaires before (grade 6) and after (grade 7, 9 and 11) the law. The percentage of students reporting that school staff smoked in areas where smoking is forbidden was 19%, 32% and 33% in grade 7, 9 and 11, respectively. The mean(SD) score for the frequency with which students saw school staff smoking decreased after the ban but increased thereafter [2.5(1.1), 1.9(1.0), 2.4(1.1) and 2.3(1.1)] in grade 6, 7, 9 and 11, respectively [F(2.861,1662.229) = 45.350, P < 0.001]. These data suggest that the effect of the law dissipated over time.