Vienna Lai

A block randomized controlled trial of a brief smoking cessation counselling and advice through short message service on participants who joined the Quit to Win Contest in Hong Kong

The present trial examined the effectiveness of brief interventions for smokers who joined the Hong Kong Quit to Win Contest to quit smoking. A block randomized controlled trial allocated 1003 adult daily smokers to three groups: (i) The TEL group (n = 338) received a 5-min nurse-led telephone counselling; (ii) The SMS group (n = 335) received eight text messages through mobile phone and (iii) The CONTROL group (n = 330) did not receive the above interventions. Participants with biochemically verified abstinence at 6-month follow-up could receive cash incentive. The primary outcome was the self-reported 7-day point prevalence (PP) of tobacco abstinence at 6-month follow-up. The abstinence rate in the TEL, SMS and CONTROL group was 22.2, 20.6 and 20.3%, respectively (P for TEL versus CONTROL = 0.32; P for SMS versus CONTROL = 0.40). When abstinence at 2-, 6- and 12-month follow-up was modelled simultaneously, the TEL group had a higher abstinence than the CONTROL group (Adjusted OR = 1.38, 95% CI = 1.01-1.88, P = 0 .04). In the Quit to Win Contest, the brief telephone counselling might have increased abstinence, but the text messages had no significant effect. Further studies on intensive intervention and interactive messaging services are warranted.

Electronic cigarette awareness and use among adults in Hong Kong.

INTRODUCTION Electronic cigarettes (e-cigarettes) have gained popularity rapidly in the Western world but data in the East are scarce. We examined the awareness and ever use of e-cigarettes, and reasons for e-cigarette use in a probability sample of adults in Hong Kong. METHODS Cross-sectional data were collected in 2014 from Chinese adults aged 15-65 in Hong Kong (819 never smokers, 800 former smokers, 800 current smokers) via computer-assisted telephone interviews (response rate: 73.8%). Analysis was limited to a subset of 809 respondents (i.e., 357 never smokers, 269 former smokers, 183 current smokers) who were randomly selected to answer questions on e-cigarettes. Chi-square analyses compared e-cigarette awareness and ever use by gender, age, education, and cigarette smoking status. Multivariable logistic regression examined if e-cigarette awareness was associated with demographic variables and cigarette smoking status. RESULTS 75.4% of adults had heard of e-cigarettes, and 2.3% reported having used e-cigarettes. Greater awareness was associated with male gender and higher education. Ever use of e-cigarettes was higher among males (3.6%, p=.03), younger adults (aged 15-29, 5.2%, p=.002), and current cigarette smokers (11.8%, p<.001). Common reasons for using e-cigarettes were curiosity (47.4%), the stylish product design (25.8%), and quitting smoking (13.6%). CONCLUSIONS Awareness of e-cigarettes was widespread in Hong Kong. Although the use of e-cigarettes was low, its relation with younger age and current smoking is of concern. Health surveillance of e-cigarette use is needed. Interventions should target young adults and cigarette smokers, and address the marketing messages, especially the effect of e-cigarettes on smoking cessation.

E-Cigarette Awareness, Perceptions and Use among Community-Recruited Smokers in Hong Kong

Background Electronic cigarettes (e-cigarettes) are being increasingly used. We examined the correlates associated with e-cigarette awareness, use and perceived effectiveness in smoking cessation among Chinese daily smokers in Hong Kong. Methods Daily smokers (N = 1,307) were recruited to a community-based randomised controlled trial (‘Quit to Win’) in 2014. Socio-demographic characteristics, conventional cigarette smoking status, nicotine addiction level, quit attempts, quit intention, e-cigarette awareness, use and perceived effectiveness on quitting were reported at baseline and 1-week follow-up. Multivariate logistic regression was used to identify factors associated with e-cigarette awareness, use and perceived effectiveness in quitting. Results Most smokers (82.6%, 95% CI 80.2%-84.9%) had heard about e-cigarettes, and 13.3% (11.3%-15.5%) ever used e-cigarettes. Most users (74.1%) and non-users (91.2%) did not perceive e-cigarettes as effective in quitting. Being younger and having a larger family income were associated with e-cigarette awareness. Being younger, a tertiary education and a stronger addiction to nicotine were associated with e-cigarette use, which was itself associated with lower levels of intention to quit and had no association with attempts to quit (P for trend 0.45). E-cigarette use, the last quit attempt being a month earlier, having made a quit attempt lasting 24 hours or longer and perceiving quitting as important were all associated with the perceived effectiveness of e-cigarettes in quitting (all P <0.05). Conclusions Among community-recruited smokers who intended to quit, awareness of e-cigarettes was high, but most did not perceive e-cigarettes as effective in quitting. Correlates concerning e-cigarette perceptions and use will help to inform prospective studies, public education and policy on controlling e-cigarettes.

Brief Advice on Smoking Reduction Versus Abrupt Quitting for Smoking Cessation in Chinese Smokers: A Cluster Randomized Controlled Trial

Aims To compare the efficacy of brief advice about cut-down-to-quit (CDTQ) with that of brief advice about quit immediately (QI), as delivered by trained volunteers, without the use of pharmacological therapy, to outreach-recruited Chinese smokers in Hong Kong who intend to quit smoking. Methods Smokers (N = 1077) who enrolled in the Quit and Win Contest 2014 and intended to quit or reduce smoking were randomized in participation sessions to CDTQ (n = 559) and QI (n = 518) groups. Subjects in the CDTQ group received brief advice and a card about smoking reduction. Subjects in the QI group received brief advice and a leaflet about quitting smoking. All received a smoking cessation booklet and corresponding CDTQ or QI brief telephone advice at intervals of 1 week, 1 month, or 2 months. The primary outcomes were self-reported 7-day point prevalence abstinence (PPA) at the 3-month and 6-month follow-ups. The secondary outcomes included abstinence rate as validated by biochemical tests, smoking reduction (≥50% reduction from baseline), and quit attempt (QA). The outcome assessors were blinded as to group assignment. Results By intention to treat, the QI and CDTQ groups showed similar results as regards (i) self-reported PPA (10.6% [95% CI 8.1%-13.6%] vs. 9.1% [95% CI 6.9%-11.8%]), (ii) validated abstinence rate (5.6% [3.8%-7.9%] vs. 5.4% [3.6%-7.6%]), and (iii) QA rate (59.2% [53.5%-64.8%] vs. 54.1% [48.7%-59.3%]) at 6-month. However, the CDTQ group showed a significantly higher reduction rate than the QI group (20.9% [CI 17.6%-24.5%] vs. 14.5% [11.6%-17.8%]). The overall intervention adherence was suboptimal (45.4%), particularly in the CDTQ group (42.3%). Self-efficacy as regards quitting of smoking was similar between the groups at 6 months. Conclusions Brief advice on CDTQ and QI had similar short-term PPAs. Longer-term follow-up is needed to understand the latent effect of smoking reduction on abstinence. Implications This is the first randomized controlled trial in ethnic Chinese smokers to evaluate the relative efficacy of brief advice on (a) CDTQ and (b) QI as regards quitting. The two interventions showed similar effects as regards PPA. The findings suggested that brief advice on CDTQ may be as effective as brief advice on QI in smokers recruited in community settings.

Intervention With Brief Cessation Advice Plus Active Referral for Proactively Recruited Community Smokers: A Pragmatic Cluster Randomized Clinical Trial

Importance Most smoking cessation (SC) clinics are costly, passive, and underused. Objective To compare the SC effect of a combined intervention involving brief, model-guided SC advice plus active referral to SC services (active referral group) with those of brief, model-guided SC advice only (brief advice group) and general SC advice only (control group). Design, Setting, and Participants A single-blind, 3-arm, pragmatic cluster randomized clinical trial was conducted including 1226 adult daily smokers in the general Hong Kong community proactively recruited to participate in the Quit-to-Win Contest held in 2015. The study was conducted from June 20 to September 24, 2015. Participants were randomly allocated to the active referral (n = 402), brief advice (n = 416), and control (n = 408) groups. Intention-to-treat analysis was used. Interventions Brief telephone counseling was offered to the active referral and brief advice groups at 1 and 2 months. Interventions were delivered by SC ambassadors who had undergone a short training period. Main Outcomes and Measures The primary outcome was the self-reported past 7-day point prevalence of abstinence (PPA) at 6 months. The secondary outcomes were carbon monoxide level–validated abstinence, smoking reduction, and SC service use. Results Participants included 991 (80.8%) men; mean (SD) age was 42.0 (14.8) years. The response rate was 68.2% at 3 and 72.3% at 6 months. The corresponding PPAs were 18.9% and 17.2% in the active referral group—higher than in the brief advice (8.9% and 9.4%; both P ⩽ .001) or control (14.0% and 11.5%; P = .03 at 6 months) groups. Compared with the other 2 groups, the active referral group had significantly higher validated abstinence rates (10.2% at 3 months and 9.0% at 6 months, all P < .05) with odds ratios of 2.84 (95% CI, 1.57-5.15) and 2.61 (95% CI, 1.46-4.68) at 3 months, and 1.85 (95% CI, 1.06-3.23) and 1.81 (95% CI, 1.04-3.16) at 6 months in the brief advice and control groups, respectively. The SC service use rate was significantly higher in the active referral group (25.1%) than in either brief advice (2.4%) or control (3.4%) groups at 6 months (P < .001). Conclusions and Relevance An intervention involving brief advice and active referral delivered to smokers in the community by volunteers can increase quitting in places where SC services are available but underused. Trial Registration clinicaltrials.gov Identifier: NCT02539875

Public Support for Electronic Cigarette Regulation in Hong Kong: A Population-Based Cross-Sectional Study

This study aimed to gauge the Hong Kong’s public support towards new e-cigarette regulation, and examine the associated factors of the support. We conducted a two-stage, randomized cross-sectional telephone-based survey to assess the public support towards the banning of e-cigarette promotion and advertisement, its use in smoke-free venues, the sale to people aged under 18, and regulating the sale of nicotine-free e-cigarettes. Adults (aged 15 years or above) who were never smoking (n = 1706), ex-smoking (n = 1712) or currently smoking (n = 1834) were included. Over half (57.8%) supported all the four regulations. Banning of e-cigarette promotion and advertisement (71.7%) received slightly less support than the other three regulations (banning of e-cigarette use in smoke-free venues (81.5%); banning of e-cigarette sale to minors (93.9%); sale restriction of nicotine-free e-cigarettes (80.9%)). Current smokers, and perceiving e-cigarettes as less harmful than traditional cigarettes or not knowing the harmfulness, were associated with a lower level of support. Our findings showed a strong public support for further regulation of e-cigarettes in Hong Kong. Current stringent measures on tobacco and e-cigarettes, and media reports on the harmfulness of e-cigarettes may underpin the strong support for the regulation.

Knowledge on harms of thirdhand smoking is associated with greater support on smokefree policies

3.2. Advances in protection from tobacco pollution, second- and third-hand smoke (PS-1001-3)

Does Electronic Cigarette Use Predict Abstinence from Conventional Cigarettes among Smokers in Hong Kong

Objectives: To investigate the effects of ever use of electronic cigarettes (ECs), many of which lack nicotine, on abstinence from convention cigarettes among Hong Kong adult smokers. Methods: We collected data from 956 daily smokers in 2014–2015 regarding ever EC use and smoking behaviors at baseline, any and past 30-day EC use at the 3-month follow-up. Outcomes measured at 6 months included past 7-day point prevalence abstinence (PPA), biochemically validated quitting, smoking reduction (≥50% from baseline) and cessation attempt. Logistic regression yielded adjusted odds ratios (AOR) for quitting in relation to EC use, adjusting for socio-demographic characteristics and smoking profile. Complete case, missing observation as smoking and propensity score analyses were conducted. Results: By complete case, ever EC use at baseline did not predict self-reported PPA (AOR 0.99, 95% CI 0.57–1.73), biochemically validated quitting (AOR 1.22, 95% CI 0.64–2.34), cessation attempt (AOR 0.74, 95% CI 0.48–1.14), or smoking reduction (AOR 0.89, 95% CI 0.54–1.47). EC use during the first 3 months did not predict quitting (AOR 1.02, 95% CI 0.22–4.71). Similar results were observed for missing observations as smoking and propensity score analyses. Conclusions: Any use of ECs, many of which lack nicotine, did not predict smoking abstinence among Hong Kong adult smokers.