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Journal of Medical Internet Research Aug 2022There is little consensus regarding effective digital health interventions for diverse populations, which is due in part to the difficulty of quantifying the impact of... (Review)
Review
BACKGROUND
There is little consensus regarding effective digital health interventions for diverse populations, which is due in part to the difficulty of quantifying the impact of various media and content and the lack of consensus on evaluating dosage and outcomes. In particular, digital smoking behavior change intervention is an area where consistency of measurement has been a challenge because of emerging products and rapid policy changes. This study reviewed the contents and outcomes of digital smoking interventions and the consistency of reporting to inform future research.
OBJECTIVE
This study aims to systematically review digital smoking behavior change interventions and evaluate the consistency in measuring and reporting intervention contents, channels, and dose and response outcomes.
METHODS
PubMed, Embase, Scopus, PsycINFO, and PAIS databases were used to search the literature between January and May 2021. General and journal-based searches were combined. All records were imported into Covidence systematic review software (Veritas Health Innovation) and duplicates were removed. Titles and abstracts were screened by 4 trained reviewers to identify eligible full-text literature. The data synthesis scheme was designed based on the concept that exposure to digital interventions can be divided into intended doses that were planned by the intervention and enacted doses that were completed by participants. The intended dose comprised the frequency and length of the interventions, and the enacted dose was assessed as the engagement. Response measures were assessed for behaviors, intentions, and psychosocial outcomes. Measurements of the dose-response relationship were reviewed for all studies.
RESULTS
A total of 2916 articles were identified through a database search. Of these 2916 articles, the title and abstract review yielded 324 (11.11%) articles for possible eligibility, and 19 (0.65%) articles on digital smoking behavior change interventions were ultimately included for data extraction and synthesis. The analysis revealed a lack of prevention studies (0/19, 0%) and dose-response studies (3/19, 16%). Of the 19 studies, 6 (32%) reported multiple behavioral measures, and 5 (23%) reported multiple psychosocial measures as outcomes. For dosage measures, 37% (7/19) of studies used frequency of exposure, and 21% (4/19) of studies mentioned the length of exposure. The assessment of clarity of reporting revealed that the duration of intervention and data collection tended to be reported vaguely in the literature.
CONCLUSIONS
This review revealed a lack of studies assessing the effects of digital media interventions on smoking outcomes. Data synthesis showed that measurement and reporting were inconsistent across studies, illustrating current challenges in this field. Although most studies focused on reporting outcomes, the measurement of exposure, including intended and enacted doses, was unclear in a large proportion of studies. Clear and consistent reporting of both outcomes and exposures is needed to develop further evidence in intervention research on digital smoking behavior change.
Topics: Humans; Internet; Smoking; Text Messaging; Tobacco Smoking
PubMed: 36006682
DOI: 10.2196/38470 -
Journal of Preventive Medicine and... Mar 2021The aim of this study was to identify factors associated with quitting smoking in Indonesia.
OBJECTIVES
The aim of this study was to identify factors associated with quitting smoking in Indonesia.
METHODS
Data on 11 115 individuals from the fifth wave of the Indonesia Family Life Survey were analyzed. Quitting smoking was the main outcome, defined as smoking status based on the answer to the question "do you still habitually (smoke cigarettes/smoke a pipe/use chewing tobacco) or have you totally quit?" Logistic regression was performed to identify factors associated with successful attempts to quit smoking.
RESULTS
The prevalence of quitting smoking was 12.3%. The odds of successfully quitting smoking were higher among smokers who were female (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 2.08 to 3.33), were divorced (aOR, 2.45; 95% CI, 1.82 to 3.29), did not chew tobacco (aOR, 3.01; 95% CI, 1.79 to 5.08), found it difficult to sacrifice smoking at other times than in the morning (aOR, 1.29; 95% CI, 1.14 to 1.46), and not smoke when sick (aOR, 1.32; 95% CI, 1.14 to 1.54). About 59% of variance in successful attempts to quit smoking could be explained using a model consisting of those variables.
CONCLUSIONS
Female sex, being divorced, not chewing tobacco, and nicotine dependence increased the odds of quitting smoking and were associated with quitting smoking successfully. Regular and integrated attempts to quit smoking based on individuals' internal characteristics, tobacco use activity, and smoking behavior are needed to quit smoking.
Topics: Adolescent; Adult; Female; Humans; Indonesia; Male; Middle Aged; Prevalence; Smoking; Smoking Cessation
PubMed: 33845534
DOI: 10.3961/jpmph.20.293 -
Chest Jun 2023Hypomethylation of the aryl hydrocarbon receptor repressor (AHRR) gene indicates long-term smoking exposure and might therefore be a monitor for smoking-induced disease...
BACKGROUND
Hypomethylation of the aryl hydrocarbon receptor repressor (AHRR) gene indicates long-term smoking exposure and might therefore be a monitor for smoking-induced disease risk. However, studies of individual longitudinal changes in AHRR methylation are sparse.
RESEARCH QUESTION
How does the recovery of AHRR methylation depend on change in smoking behaviors and demographic variables?
STUDY DESIGN AND METHODS
This study included 4,432 individuals from the Copenhagen City Heart Study, with baseline and follow-up blood samples and smoking information collected approximately 10 years apart. AHRR methylation at the cg05575921 site was measured in bisulfite-treated leukocyte DNA. Four smoking groups were defined: participants who never smoked (Never-Never), participants who formerly smoked (Former-Former), participants who quit during the study period (Current-Former), and individuals who smoked at both baseline and follow-up (Current-Current). Methylation recovery was defined as the increase in AHRR methylation between baseline and follow-up examination.
RESULTS
Methylation recovery was highest among participants who quit, with a median methylation recovery of 5.58% (interquartile range, 1.79; 9.15) vs 1.64% (interquartile range, -1.88; 4.96) in the Current-Current group (P < .0001). In individuals who quit smoking, older age was associated with lower methylation recovery (P < .0001). In participants who quit aged > 65 years, methylation recovery was 5.9% at 5.6 years after quitting; methylation recovery was 8.5% after 2.8 years for participants who quit aged < 55 years.
INTERPRETATION
AHRR methylation recovered after individuals quit smoking, and recovery was more pronounced and occurred faster in younger compared with older interim quitters.
Topics: Humans; Longitudinal Studies; Basic Helix-Loop-Helix Transcription Factors; Repressor Proteins; Smoking; DNA Methylation; Transcription Factors
PubMed: 36621758
DOI: 10.1016/j.chest.2022.12.036 -
International Journal of Environmental... Aug 2021Tobacco taxation and price policies are considered the most effective for lowering demand for tobacco products. While this statement is based on research from numerous...
Tobacco taxation and price policies are considered the most effective for lowering demand for tobacco products. While this statement is based on research from numerous countries, scant evidence exists on this topic for Israel. Accordingly, we assessed the association between cigarette prices and smoking prevalence and intensity from a national sample of adults in Israel (2002-2017). Data on smoking behavior were derived from the Israeli Knowledge Attitudes and Practices (KAP) survey, a repeated cross-sectional survey. Price information is from the Economist Intelligence Unit (EIU) since it was not collected in the KAP survey. We used the price of a pack of 20 cigarettes for Marlboro and the local brand. These two price variables were the primary independent variables, and we adjusted for inflation. The dependent variables were current smoking (yes/no) and smoking intensity, defined as the number of cigarettes smoked per week. Multivariable analysis was employed using a two-part model while adjusting for covariates. The first step of the model utilized logistic regression with current smoking as the dependent variable. The second step examining smoking intensity as the dependent variable, used OLS regression. Price elasticity was estimated as well. Analysis revealed that a one-unit increase (Israeli currency) in the price of local brand of cigarettes was related to 2.0% (OR = 0.98; 95%CI 0.98, 0.99) lower odds of being a current smoker, adjusting for covariates including household income. Moreover, a one unit increase in the price of the local brand of cigarettes was related to consuming 1.49 (95% CI -1.97, -1.00) fewer weekly cigarettes, controlling for household income and covariates. Similar results were found with the Marlboro cigarette prices. The total price elasticity of cigarette demand, given by the sum of price elasticities of smoking prevalence and intensity, showed that a 10.0% increase in the price is associated with a 4.6-9.2% lower cigarette consumption among Israeli adults. Thus, increasing cigarette prices will likely lead to a reduction in cigarette smoking thereby improving public health in Israel.
Topics: Adult; Commerce; Cross-Sectional Studies; Humans; Israel; Smoking; Taxes; Tobacco Products
PubMed: 34444117
DOI: 10.3390/ijerph18168367 -
Public Health Nursing (Boston, Mass.) Nov 2020The recent COVID-19 pandemic may catalyze smoking behavior modification. The purpose of the study was to examine factors associated with reducing smoking exposure during...
OBJECTIVE
The recent COVID-19 pandemic may catalyze smoking behavior modification. The purpose of the study was to examine factors associated with reducing smoking exposure during the COVID-19 outbreak.
DESIGN
Cross-sectional design using the Health Belief Model to develop an online survey distributed throughout Ohio early during the outbreak.
SAMPLE
810 adults in Ohio (77.9% non-smokers, 22.1% current smokers).
MEASUREMENTS
Sociodemographic factors, smoking and behavior changes since the COVID-19 outbreak, and perceived risk of infection were collected. Logistic regression analyses were conducted to determine factors associated with indoor smoking bans and factors associated with desire to quit smoking since the outbreak.
RESULTS
For the overall sample, the odds of indoor smoking bans were significantly associated with never smoked, college education, single-family residence, not living with smokers, and perceived importance of avoiding public places. For smokers, the desire to quit smoking since the COVID-19 outbreak was associated with diabetes and perceived risk of severe infection.
CONCLUSIONS
Identified factors inform residential smoking exposure reduction through indoor smoking bans. Having an increased perceived risk of severe infection among smokers may motivate cessation. Public health nurses can provide accurate and accessible resources for smoking cessation during the COVID-19 pandemic to promote healthy lifestyle modification.
Topics: Adolescent; Adult; COVID-19; Cross-Sectional Studies; Female; Health Belief Model; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Ohio; Pandemics; Public Health Nursing; Risk Assessment; Smoking; Smoking Cessation; Surveys and Questionnaires; Young Adult
PubMed: 32981125
DOI: 10.1111/phn.12814 -
Nicotine & Tobacco Research : Official... Jan 2019Cue reactivity (CR) research has reliably demonstrated robust cue-induced responding among smokers exposed to common proximal smoking cues (eg, cigarettes, lighter)....
INTRODUCTION
Cue reactivity (CR) research has reliably demonstrated robust cue-induced responding among smokers exposed to common proximal smoking cues (eg, cigarettes, lighter). More recent work demonstrates that distal stimuli, most notably the actual environments in which smoking previously occurred, can also gain associative control over craving. In the real world, proximal cues always occur within an environment; thus, a more informative test of how cues affect smokers might be to present these two cue types simultaneously.
METHODS
Using a combined-cue counterbalanced CR paradigm, the present study tested the impact of proximal (smoking and neutral) + personal environment (smoking and nonsmoking places) pictorial cues, on smokers' subjective and behavioral CR; as well as the extent to which cue-induced craving predicts immediate subsequent smoking in a within-subjects design.
RESULTS
As anticipated, the dual smoking cue combination (ProxS + EnvS) led to the greatest cue-induced craving relative to the other three cue combinations (ProxS + EnvN, ProxN + EnvS, and ProxN ± EnvN), ps < .004. Dual smoking cues also led to significantly shorter post-trial latencies to smoke, ps < .01. Overall CR difference score (post-trial craving minus baseline craving) was predictive of subsequent immediate smoking indexed by: post-trial latency to smoke [B = -2.69, SE = 9.02; t(143) = -2.98, p = .003]; total puff volume [B = 2.99, SE = 1.13; t(143) = 2.65, p = .009]; and total number of puffs [B = .053, SE = .027; t(143) = 1.95, p = .05].
CONCLUSIONS
The implications of these findings for better understanding the impact of cues on smoking behavior and cessation are discussed.
IMPLICATIONS
This novel cue reactivity study examined smokers' reactivity to combined proximal and distal smoking cues. Exposure to a combination of two smoking cues (proximal and environment) led to the greatest increases in cue-induced craving and smoking behavior compared to all other cue combinations. Further, the overall magnitude of cue-induced craving was found to significantly predict immediate subsequent smoking. This work provides new insight on how exposure to various cues and cue combinations directly affect smokers' craving and actual smoking behavior, as well as the relationship between those two indices of reactivity.
Topics: Adult; Conditioning, Psychological; Cues; Female; Forecasting; Humans; Male; Middle Aged; Smokers; Smoking; Smoking Cessation; Tobacco Smoking; Young Adult
PubMed: 29370401
DOI: 10.1093/ntr/nty009 -
Genes Dec 2022There are several established predictors of smoking, but it is unknown if these predictors operate similarly for young and old smokers. We examined clinical data from...
There are several established predictors of smoking, but it is unknown if these predictors operate similarly for young and old smokers. We examined clinical data from the National Lung Screening Trial (NLST) to determine the predictive ability of gender, body mass index (BMI), marital status, and race on smoking behavior, with emphasis on gender interactions. In addition, we validated the self-report of smoking behaviors for a subgroup that had available epigenetic data in the form of cg05575921 methylation. Participants were N=9572 current or former smokers from the NLST biofluids database, age 55-74, minimum of 30 pack years, and mostly White. A subgroup of N=3084 who had DNA were used for the self-report validation analysis. The predictor analysis was based on the larger group and used penalized logistic regression to predict the self-report of being a former or current smoker at baseline. Cg05575921 methylation showed a moderate ability to discriminate among former and current smokers, AUC = 0.85 (95% confidence interval = [0.83, 0.86]). The final selected variables for the prediction model were BMI, gender, BMI by gender, age, divorced (vs. married), education, and race. The gender by BMI interaction was such that males had a higher probability of current smoking for lower BMI, but this switched to females having higher current smoking for overweight to obese. There is evidence that the self-reported smoking behavior in NLST is moderately accurate. The results of the primary analysis are consistent with the general smoking literature, and our results provide additional specificity regarding the gender by BMI interaction. Body weight issues might play a role in smoking cessation for older established smokers in a similar manner as younger smokers. It could be that women have less success with cessation when their BMI increases.
Topics: Male; Humans; Female; Aged; Middle Aged; Self Report; Smoking; Tobacco Smoking; Smoking Cessation; Epigenesis, Genetic
PubMed: 36672765
DOI: 10.3390/genes14010025 -
International Journal of Environmental... Apr 2022The male smoking rate in China declined moderately through the 1990s and early 2000s, but the decline has since stagnated. It is unclear why the decline stalled and...
INTRODUCTION
The male smoking rate in China declined moderately through the 1990s and early 2000s, but the decline has since stagnated. It is unclear why the decline stalled and whether it stalled uniformly across all social strata. Theories that view socioeconomic status as a fundamental cause of health predict that socioeconomic gaps in smoking may widen, but theories emphasizing the cultural context of health behavior cast doubt on the prediction. We investigated changes in the socioeconomic gaps in smoking during recent decades in China.
METHODS
We applied growth-curve models to examine inter- and intra-cohort changes in socioeconomic gaps in male smoking in China using data from a national longitudinal survey spanning 25 years.
RESULTS
We found diverging trends in smoking in men with different education levels among the post-1980 cohorts; for high-education men, smoking participation consistently declined, but for low-education men, the decline stopped and possibly reversed. The stagnation in the decline in overall smoking rate since 2010 was mostly due to the stalling of the decline of smoking among low-education men in the most recent cohorts. The diverging trends were a continuation of a general trend in expanding educational gaps in smoking that emerged in the cohorts born after 1960. Our analysis also identified widening educational gaps over age within each cohort.
CONCLUSION
We identified a long-term widening in educational gaps in smoking in China. An effective way to reduce smoking, social inequality in smoking and possibly health disparities in China is to target the smoking behavior of vulnerable groups.
Topics: China; Educational Status; Humans; Male; Smoking; Socioeconomic Factors; Tobacco Smoking
PubMed: 35457786
DOI: 10.3390/ijerph19084917 -
International Journal of Colorectal... May 2023Early-onset colorectal neoplasms (EoCRN) include both benign and malign colorectal tumors, which occur before the age of 50. The incidence of EoCRN is rising worldwide.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Early-onset colorectal neoplasms (EoCRN) include both benign and malign colorectal tumors, which occur before the age of 50. The incidence of EoCRN is rising worldwide. Tobacco smoking has previously been proven to be related to the development of various tumor types. However, its relationship with EoCRN is not clearly defined. Hence, we carried out a systematic review and a meta-analysis to evaluate the relationship between smoking status and the risk of EoCRN.
METHODS
A systematic search of PubMed, EMBASE, and Web of Science up to September 7, 2022, was performed for studies that evaluated the association of smoking status with EoCRN. The quality of the case-control study was evaluated with the Newcastle‒Ottawa Scale. The quality of the cross-sectional studies was evaluated with the American Health Care Research and Quality checklist. Fixed-effects models were used to pool odds ratios (ORs) to evaluate the relationship between the risk of developing EoCRN and smoking status. The meta-analyses were performed with Review Manager version 5.4, and funnel plots and publication bias tests were produced by STATA software.
RESULTS
A total of six studies were included in this meta-analysis. After pooling the results of these six studies, we found that current smokers carry a relatively high risk of developing EoCRN (OR, 1.33; 95% confidence interval [CI], 1.17-1.52) compared to never-smokers. Ex-smokers were not at a significantly increased risk for developing EoCRN (OR, 1.00; 95% CI, 0.86-1.18).
DISCUSSION
Smoking behavior is significantly associated with an increased risk for developing EoCRN and might be one of the reasons for the increasing incidence. Ex-smokers who quit are not at significant risk of developing EoCRN.
Topics: Humans; Case-Control Studies; Cross-Sectional Studies; Smoking; Risk Factors; Tobacco Smoking; Neoplasms
PubMed: 37147435
DOI: 10.1007/s00384-023-04405-w -
Nicotine & Tobacco Research : Official... Dec 2017Although studies have suggested that implicit attitudes may predict smoking-related decisions, evidence that changes in implicit attitudes toward smoking are related to...
INTRODUCTION
Although studies have suggested that implicit attitudes may predict smoking-related decisions, evidence that changes in implicit attitudes toward smoking are related to changes in smoking behavior is lacking. Using data from a trial comparing interventions to induce quit attempts among unmotivated smokers, this study examined whether changes in implicit attitudes were associated with quit attempts and cessation after controlling for explicit motivation.
METHODS
Daily smokers recruited from the community completed measures of implicit attitudes (Implicit Association Test) and explicit measure of motivation to smoke at baseline, mid-intervention (week 12 [W12]) and follow-up (week 26 [W26]). Quit attempts and cessation were assessed at follow-up, and cessation was biochemically verified.
RESULTS
As hypothesized, Implicit Association Test scores became more negative from baseline to W12, a change that was sustained at follow-up. Logistic regression analyses in which implicit attitudes were used to predict smoking outcomes revealed that negative changes in implicit attitudes from baseline to W12 and from baseline to W26 were significantly related to quit attempts (OR = 0.71, 95% CI [0.52, 0.97], p < .05 for both) independent of explicit motivation. Negative changes in implicit attitudes from baseline to W26 were significantly related to cessation (OR = 0.50, 95% CI [0.25, 1.00], p < .05).
CONCLUSIONS
Negative changes in implicit attitudes were associated with positive changes in smoking behavior independent of explicit motivation. This result indicates that smoking cessation interventions may be enhanced by incorporating strategies to change implicit attitudes, and that changes in implicit attitudes are also potentially important intervention outcomes.
IMPLICATIONS
Smoking cessation interventions may be improved by going beyond the current focus on explicit psychological constructs and targeting automatic cognitive processes such as implicit attitudes. The results are encouragement to examine how best to manipulate smokers' implicit attitudes as well as to determine the effect on their smoking behavior.
Topics: Attitude to Health; Female; Humans; Male; Middle Aged; Motivation; Smoking; Smoking Cessation
PubMed: 27679606
DOI: 10.1093/ntr/ntw259