Leonardi-Bee, Jo
Berlin, Ivan
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Background: Tobacco smoking is by far the most deadly and preventable lifestyle factor for public health, both globally and nationally. Nevertheless, it is estimated that worldwide, more than 1.1 billion adults are smokers. Today, 16% (0.8 million) of the adult population in Denmark are daily smokers, while 23% (1.1 million) consider themselves smokers, and one in four deaths are smoking related. The most effective method of reducing smoking prevalence is by employing a two-tier strategy to 1) prevent adolescents from initiating smoking and 2) offer effective help to smokers to quit.
The aim of this thesis was to evaluate the effect of intensive smoking cessation interventions (ISCI) on successful quitting through different study designs, synthesised from cohort studies and a review of randomised controlled trials. The aim was fulfilled through 4 scientific studies, each with their own objective.
Studies: A systematic review with meta-analysis (I) was set up to compare ISCI and shorter interventions in randomised controlled trials (RCT). Initially, 9,569 unique papers were identified, and, after screening for relevant studies, 18 RCTs were included, investigating a total of 10,131 smokers. The studies were primarily conducted in Western Europa and the USA. The body of evidence for three of four outcomes were graded moderate, and the last outcome was graded low. A random effect meta-analysis revealed that smokers randomised to ISCI were significantly more likely to be successful quitters compared to shorter interventions for all four outcomes. The primary outcome (continuous abstinence in the short and long term) increased the chance of success 3-fold.
A methodological study (II) of the Danish National Smoking Cessation Database (SCDB) was undertaken. The development of the SCDB and the most commonly registered smoking cessation interventions (SCI) were described, as were the data collection and validity.
Two cohort studies based on the data from the SCDB were conducted to evaluate the effectiveness of SCI in real life. One study investigated the effectiveness of five different SCIs (III) and found that the intensive Gold Standard Programme’ (GSP - Standard SCI in Denmark) was the only intervention that was effective for both men and women. The other cohort study was set up to investigate the effectiveness of the GSP in a vulnerable subgroup of smokers diagnosed with severe mental disorder (SMD) (IV). The study showed that smokers with SMD were significantly less likely to become successful quitters compared to smokers without mental disorders. However, one in every four smokers with SMD managed to stay continuously smoke-free for at least 6 months compared to one in three in the comparison group. The data were analysed using a mixed-effect logistic regression model. In both cohort studies, compliance was identified as the strongest predictor of a successful outcome.
Conclusion: This thesis adds to the evidence on intensive smoking cessation interventions (ISCI) through different study designs. The results from both study designs favoured ISCI, although the GSP was significantly less effective in smokers with SMD compared to smokers without mental illness. To develop effective SCI in the future, it is important to evaluate the effects in an RCT and to follow-up the post-implementation effects in real life (e.g., through a national SCDB).
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Title: | PERIOPERATIVE SMOKING CESSATION |
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Keywords: | Smoking cessation, Perioperative, Surgery |
Publication Date: | 2023 |
Abstract: | This thesis is concerned with the issue of smoking in the surgical population. Globally, over 300 million adults undergo surgery annually and around 60 million are smokers. The population impact of this is enormous. Moreover, smoking increases postoperative complications and is a leading cause of morbidity and mortality. Smoking rates are declining in the general population; but remains higher among surgical populations. Despite being an important modifiable risk factor, and the availability of treatments for smoking, many patients presenting for surgery still smoke and many resume smoking after surgery. Importantly, unfortunately in surgical settings, the implementation of evidence-based cessation interventions is still suboptimal. The time around surgery is a “teachable moment” and surgical guidelines recommend that all patients who smoke should be provided with evidence-based smoking cessation assistance. This thesis seeks to answers the following questions: What are the factors that determine abstinence from smoking after surgery? What is (are) the best smoking cessation intervention(s) in the surgical setting? What factors constitute barriers and facilitators to the implementation of effective smoking cessation interventions? Is cytisine effective for smoking cessation? Will the use of cytisine and behavioral counselling delivered via personalized video messaging increase abstinence from smoking at 6 months post-randomization among surgical patients? Using a variety of research methodologies, the data provided across the 5 papers in this thesis inform these knowledge gaps. Chapter 1 is an introduction providing the rationale for conducting each of the included studies. Chapter 2 is a secondary analysis from the Vascular events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study that evaluated the determinants of smoking abstinence in a representative sample of patients undergoing major non-cardiac surgery. Chapter 3 is a systematic review, pairwise meta-analysis, and network meta-analysis of randomized controlled trials evaluating preoperative smoking cessation interventions. Chapter 4 is a scoping review that explores the barriers and facilitators to smoking cessation in the surgical setting. Chapter 5 is a systematic review and meta-analysis of cytisine for smoking cessation Chapter 6 reports on the rationale and design of the PeRiopEratiVE smokiNg CessaTion (PREVENT) randomized controlled trial evaluating the efficacy and safety of cytisine versus placebo, and in a 2x2 factorial, personalized video messaging versus standard care for smoking cessation among adults undergoing surgery. Chapter 7 is the conclusion chapter wherein I discuss the key findings, limitations, and implications of the research presented in this PhD thesis. |
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In this section
Binnie, Vivian Isobel (2004) A randomised controlled trial of 'brief' smoking cessation advice and NRT, delivered by dental hygienists, to patients in a dental setting. PhD thesis, University of Glasgow.
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The role that dental team members can play in the smoking cessation field is largely unevaluated. The work of this PhD thesis encompasses two phases, the first was to develop a means of determining smoking status, using analysis of continine, a nicotine metabolite. The second phase looked at the efficacy of dental hygienist-delivered smoking cessation advice in a dental setting. The aim of the first study was to compare continue levels in different biological fluids collected from both smokers and non-smokers, and to relate the findings to self-reported smoking status. Patients recruited to the study were asked to provide samples of urine, blood and saliva (both stimulated and unstimulated). Data collected from patients by questionnaire included information on smoking behaviour, such as daily number of cigarettes smoked, and environmental exposure to smoke. Following sample collection, patients were asked to rate the acceptability of each sampling method. Samples were analysed using enzyme immunoassay (EIA) kits. In total, 80 patients participated, with 49 smokers and 31 non-smokers. There was clear differentiation between smokers and non-smokers (p<0.001) for all the different samples in terms of cotinine concentration. A significant relationship was seen between cotinine levels and daily number of cigarettes for both salivas and urine (all p < 0.001) but not for serum. Participants found serum and urine collection methodologies 'very acceptable' (67% and 66%, respectively) whereas 9% found collection of stimulated saliva 'not at all acceptable'. Thus, continine, as analysed by EIA kits, whatever the collection method, shows good differentiation between smokers and non-smokers. Salivary samples have the advantage of being non-invasive. However, collection methodology is important, as continine levels may vary.
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the general literature of smoking cessation, smoking cessation self-efficacy, or one's confidence in their ability to abstain from smoking, is a consistent predictor of positive abstinence outcomes. The overall purpose of this dissertation was to investigate smoking cessation self-efficacy as a
significance of a smoking cessation program in their journey to quitting. However, all. participants also reported other critical factors to successful cessation, including. willpower, commitment, the support of friends and family, and stress as a cause of. unsuccessful quit attempts.
relation to smoking cessation is needed. To this end, a social norm lens is applied to two types of smoking cessation strategies relevant to emerging adults: mass media campaigns and e-cigarettes. The chapter ends with a brief overview of the problem that the research addresses and concludes with the aims of the thesis. Tobacco: burden and ...
methods, as well as participant reactions to particular anti-smoking advertisements and quit support methods. Results: Almost all participants reported an interest in quitting smoking. Stress relief, boredom relief, relaxation, and oral satisfaction were the main benefits of smoking. Downsides to smoking included negative short-term health impacts,
markers of disadvantage compared to men. Disadvantage appeared to mediate smoking cessation outcomes in women by increasing nicotine addiction. Markers of nicotine dependence predicted smoking cessation outcomes in women. However, the qualitative investigation indicated that the emotional side of addiction also appeared to have an
This thesis aimed to contribute to the development of smoking cessation services in national, local and occupational settings, by evaluating the potential effects of smoking cessation policies and interventions at national and local levels, including occupational settings. We found evidence that smoking increases both the risk and number of ...
Introduction. Cigarette smoking harms almost every organ of the body resulting in premature death in half of all smokers, 1 and unfortunately there are over one billion smokers in the world. 2 The prevalence of ever having tried to quit smoking varies in different countries, for example, less than 20% of smokers in China and Malaysia reported recent attempts to quit. 3 Additionally, the ...
treatment (Week 4), abstinence rate at 6 months, and our smoking outcomes (e.g., craving, withdrawal) showed no significant differences between groups. No differences were found in adverse events reported between the groups. This study provides evidence of the potential benefit of having a combined treatment for smoking cessation. Project II
smoking cessation programs and provide a better understanding of the social meaning of smoking and its association with other health risks. Results show that the tweets and Twitter profiles can illustrate social inequalities between sample members and that the Filter has reached their target audience. The results further
has revealed that nurses do not consistently provide smoking cessation interventions for their patients who use tobacco. The results of some studies showed that only 35% of nurses offer smoking cessation interventions as part of their practice in primary care settings (Good, Frazier, Wetta-Hall, Ablah, and Molgaard, 2004).
The primary outcome was smoking cessation at the latest time point in pregnancy at which this was measured, and secondary outcomes were safety related. ... Claire, Ravinder (2021) Assessing the efficacy of Nicotine Replacement Therapy for smoking cessation during pregnancy. PhD thesis, University of Nottingham. Preview. PDF (Thesis corrections ...
The most effective method of reducing smoking prevalence is by employing a two-tier strategy to 1) prevent adolescents from initiating smoking and 2) offer effective help to smokers to quit. The aim of this thesis was to evaluate the effect of intensive smoking cessation interventions (ISCI) on successful quitting through different study ...
The barriers and facilitators to smoking cessation experienced by women's partners during pregnancy and the post-partum period: a systematic review of qualitative research ... scores ranged from 23-32 (Additional file 2). The thesis by Gage [16] was not quality appraised, as the checklist used was not designed for theses. The journal paper ...
disadvantaged SEP moderated effectiveness for smoking cessation compared with non-SEP-tailored approaches. SEP-tailored interventions were no more effective than non-SEP-tailored interventions for smoking cessation among disadvantaged smokers. Second, studies 2 and 3 modelled population-level trends in e-cigarette usage by SEP.
Maternal smoking in pregnancy is a leading cause of maternal and fetal morbidity and mortality. Smoking rates are declining in the western world; however, this decline is uneven, modulated by social class and deprivation. Despite being an important reversible risk factor, there is a lack of focus on smoking cessation within obstetrics. Our early work identified smokers as a group that engaged ...
Additionally, the current methods for smoking cessation are sub-optimally utilized in surgical settings. We need further research to evaluate new interventions, and ways of delivering smoking cessation care for smokers undergoing surgery. ... PhD Thesis on Perioperative Smoking Cessation: 6.81 MB: Adobe PDF: View/Open: Show full item record ...
for these smokers to quit smoking. Daily smokers also have lower self-efficacy towards quitting compared to nondaily smokers, which is predictive of future quitting behavior, intentions to quit, and quit attempts (Oksuz et al., 2007). Characteristics of Nondaily Smokers. Since research suggests that college smoking is an
This thesis analyses the relationship between education and smoking cessation. It focuses on the soft skills as an interpretation of the relationship. This thesis tests the theory that education leads to better skills, and those skills are being used for smoking cessation, which has been considered as one of the plausible explanations.
ease and the smoking prevalence will decrease.3. Methodology3.1 Study DesignThe objective of this thesis is to determine the influence of smoking cessation interventions on the intention to quit and sm. king prevalence for different sexes, age-categories and socio-economic status. This wi.
The role that dental team members can play in the smoking cessation field is largely unevaluated. The work of this PhD thesis encompasses two phases, the first was to develop a means of determining smoking status, using analysis of continine, a nicotine metabolite. The second phase looked at the efficacy of dental hygienist-delivered smoking cessation advice in a dental setting.
cessation methods, and belief in the importance of smoking cessation treatment in TB programs. Conclusion: Tobacco use is a common risk factor for TB disease in Pakistan. There is a high prevalence ... Jonathan Golub, PhD (Thesis Advisor) Gayane Yenokyan, PhD . iv THESIS READERS AND FINAL ORAL EXAMINATION COMMITTEE .
Additionally, although the PhD focuses on smoking cessation interventions, there is no known difference between smoking cessation and smokeless tobacco cessation techniques. Hence, the findings could be useful for some LMICs where the smoking during pregnancy rate alone is low, but tobacco use during pregnancy is high, e.g. Madagascar (12%).
The study found that addiction-related barriers include smoking history, craving a cigarette, smoking as part of a daily routine, and failed attempts to quit. Non-addiction-related barriers include a lack of knowledge of quitting strategies, psychosocial stress, lack of willpower and peer influence. Structural barriers include ineffective ...