Does non-smoker identity following quitting predict long-term abstinence? Evidence from a population survey in England

Aims: ‘Categorical self-labels’ (e.g. thinking of oneself as a smoker or non-smoker) are important aspects of identity that can have a fundamental influence on behaviour. To explore the role identity aspects relating to smoking can play in smoking cessation and relapse, this study assessed the prospective associations between taking on a non-smoker identity following quitting and long-term abstinence.  Methods: A representative sample of 574 ex-smokers in England who quit smoking in the past year was followed-up at three (N=179) and six months (N=163). Post-quit identity relating to smoking (‘I still think of myself as a smoker’ or ‘I think of myself as a nonsmoker’), and demographic and smoking-related characteristics were assessed at baseline. Self-reported smoking abstinence was assessed at follow-ups.  Results: Non-smoker identity was reported by 80.3% (95%CI 76.8-83.4) of recent exsmokers. Younger age (p=0.017) and longer abstinence (p<0.001) were independently associated with a post-quit non-smoker identity. After adjusting for covariates, non-smoker identity (p=0.032) and length of abstinence at baseline (p<0.001) were associated with continued abstinence at three months follow-up, and baseline length of abstinence (p=0.003) predicted continued abstinence at six months.  Conclusions: The majority of people who quit smoking recently consider themselves as nonsmokers. Younger people and those who have been abstinent for longer are more likely to take on a non-smoker identity. Ex-smokers who make this mental transition following a quit attempt appear more likely to remain abstinent in the medium term than those who still think of themselves as smokers

Associations between self-esteem and smoking and excessive alcohol consumption in the UK: a cross-sectional study using the BBC UK Lab database

Introduction There is mixed evidence regarding the associations between self-esteem and smoking and excessive alcohol consumption. This study aimed to investigate whether self-esteem is associated with smoking status and alcohol consumption in a large sample of adults in the United Kingdom after adjusting for age, sex, socio-economic status and depressed mood. Methods Design: Cross-sectional correlational study conducted under the aegis of the British Broadcasting Corporation (BBC) between 2009 and 2013. Participants: 187,398 respondents (67.9% female) with a mean age of 32.82 years (SD=12.41) providing complete data. Setting: UK. Measures Online self-report questionnaire. The outcomes were smoking status (current smoker, ever smoker) and alcohol consumption (current drinker, excessive drinker); the input variable was self-esteem measured using a Single Item Self-Esteem Scale; covariates were age, sex, SES, and depressed mood measured using a single item question. Results The odds of being an ever smoker and a current smoker were greater in people with lower self-esteem (AdjOR 0.97; 95% CI 0.95-0.99, Cohen’s d=-0.02; and AdjOR 0.96; 95% CI 0.94-0.99, Cohen’s d=-0.02 respectively). The odds of being a current drinker were lower in people with lower self-esteem (AdjOR 1.20, 95% CI 1.17-1.24, Cohen’s d=0.10) while being an excessive drinker was associated with lower self-esteem (β=-0.13, p<0.001, F(5,187392)=997.14, p<0.001, Cohen’s d=0.3). Conclusions Lower self-esteem appears to be positively associated with ever- and current smoking and excessive alcohol consumption and negatively associated with current alcohol consumption

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

AbstractBackgroundInternet-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.MethodsWe 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.ResultsParticipants 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 (21.3min vs. 1.0min, p<0.001).ConclusionsMumsQuit 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

Are digital interventions for smoking cessation in pregnancy effective?:A systematic review and meta-analysis

Smoking in pregnancy remains a global public health issue due to foetal health risks and potential maternal complications. The aims of this systematic review and meta-analysis were to explore: (1) whether digital interventions for pregnancy smoking cessation are effective, (2) the impact of intervention platform on smoking cessation, (3) the associations between specific Behaviour Change Techniques (BCTs) delivered within interventions and smoking cessation, and (4) the association between the total number of BCTs delivered and smoking cessation. Systematic searches of nine databases resulted in the inclusion of 12 published articles (n = 2970). The primary meta-analysis produced a sample-weighted odds ratio (OR) of 1.44 (95% CI 1.04–2.00, p=0.03) in favour of digital interventions compared with comparison groups. Computer-based (OR=3.06, 95% CI 1.28 – 7.33) and text-message interventions (OR=1.59, 95% CI 1.07 – 2.38) were the most effective digital platform. Moderator analyses revealed seven BCTs associated with smoking cessation: information about antecedents; action planning; problem solving; goal setting (behaviour); review behaviour goals; social support (unspecified); and pros and cons. A meta-regression suggested that interventions using larger numbers of BCTs produced the greatest effects. This paper highlights the potential for digital interventions to improve rates of smoking cessation in pregnancy

A mixed-method systematic review and meta-analysis of mental health professionals’ attitudes toward smoking and smoking cessation among people with mental illnesses

BACKGROUND AND AIMS: People with mental illnesses and substance abuse disorders are important targets for smoking cessation interventions. Mental health professionals (MHPs) are ideally placed to deliver interventions, but their attitudes may prevent this. This systematic review therefore aimed to identify and estimate quantitatively MHPs attitudes towards smoking and main barriers for providing smoking cessation support and to explore these attitudes in‐depth through qualitative synthesis. METHODS: The online databases AMED, EMBASE, Medline, PsychINFO, HMIC and CINAHL were searched in March 2015 using terms relating to three concepts: ‘attitudes’, ‘mental health professionals’ and ‘smoking cessation’. Quantitative or qualitative studies of any type were included. Proportions of MHPs' attitudes towards smoking and smoking cessation were pooled across studies using random effects meta‐analysis. Qualitative findings were evaluated using thematic synthesis. RESULTS: Thirty‐eight studies including 16 369 participants were eligible for inclusion. Pooled proportions revealed that 42.2% [95% confidence interval (CI) = 35.7–48.8] of MHPs reported perceived barriers to smoking cessation interventions, 40.5% (95% CI = 30.4–51.0) negative attitudes towards smoking cessation and 45.0% (95% CI = 31.9–58.4) permissive attitudes towards smoking. The most commonly held beliefs were that patients are not interested in quitting (51.4%, 95% CI = 33.4–69.2) and that quitting smoking is too much for patients to take on (38%, 95% CI = 16.4–62.6). Qualitative findings were consistent with quantitative results, revealing a culture of smoking as ‘the norm’ and a perception of cigarettes as a useful tool for patients and staff. CONCLUSIONS: A significant proportion of mental health professionals hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions; many report a lack of time, training and confidence as main barriers to addressing smoking in their patients

“If I had known…” – a theory-informed systematic analysis of missed opportunities in optimising use of nicotine replacement therapy and accessing relevant support: A qualitative study.

Introduction Nicotine replacement therapy (NRT) is often used sub-optimally in smoking cessation attempts, especially when purchased over-the-counter (OTC). Previous research has focused on cognitive and attitudinal factors as potential reasons for low adherence to NRT. This study drew on theoretical frameworks of behaviour to comprehensively explore smokers’ NRT use to identify new intervention targets and improve the support offered to NRT users. Methods Semi-structured face-to-face interviews were conducted with 16 adult UK-based smokers and recent ex-smokers who used NRT during quit attempts in past five years. The COM-B (Capability, Opportunity, Motivation, Behaviour) model and the Theoretical Domains Framework (TDF) informed the topic guide and analyses. Data were analysed using framework analysis in Nvivo 11. Results Two related behaviours were identified relevant to optimal NRT use: use of NRT per se (B1), and engaging with information and support with NRT use (B2). A meta-theme of ‘missed opportunity’ identified instances when smokers had a chance to use NRT or get access to support, but did not or could not engage in these behaviours. For B1 these included limited ability to use and apply NRT, low motivation to optimise use, and lack of role models. For B2 they included low awareness of optimal NRT use techniques, selective information-seeking, low expectations, limited exposure to guidelines, deficient advice from healthcare professionals, and suboptimal product display. Participants often mentioned their prior suboptimal experience negatively affecting subsequent use and views. Participants expressed a need for more accessible and comprehensive guidelines on NRT. Conclusions There appear to be important missed opportunities for optimal use of Nicotine Replacement Theory both in terms of use itself and access to and use of information on optimal use. These missed opportunities appear to arise from a range of capability, motivational and opportunity-related factors. Funding This work was supported by AH’s 4-year British Heat Foundation PhD Studentship at UCL (FS/13/59/30649). RW and IT salaries are funded by a programme grant from Cancer Research UK (CRUK; C1417/A22962). The funding bodies had no role in the study design, data analysis or preparation of the present manuscript

"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.

PURPOSE: Nicotine 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. METHODS: Semi-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. RESULTS: Two 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. CONCLUSIONS: There 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

Healthcare Providers’ Views on Digital Smoking Cessation Interventions for Pregnant Women

Introduction: Digital smoking cessation aids may benefit pregnant smokers who do not wish to receive face-to-face behavioural support. Healthcare providers (HCPs) who interact with pregnant smokers may have valuable insights into their development and use. Aims: To explore HCPs' views of using digital smoking cessation interventions with pregnant women in order to inform the design and delivery of digital smoking cessation interventions. Methods: Two structured focus groups were conducted with HCPs (n = 16) who provided smoking cessation support for pregnant women in England. Discussions covered participants' general views about digital smoking cessation interventions, the potential of such interventions for smoking cessation support for pregnant smokers, and recommendations for future intervention development. Transcripts were analysed thematically. Results: HCPs identified a variety of ways in which digital interventions could benefit pregnant smokers, such as by providing anonymity, offering consistent quality of advice, and being available on demand. The identified limitations of digital smoking cessation interventions included lack of access among those most economically disadvantaged, the need for high levels of self-motivation, and lack of human contact. Addressing pregnant smokers' negative perceptions of smoking cessation support, providing rewarding experiences, and tailoring the intervention to smokers' level of confidence were among HCPs' recommendations. Conclusions: HCPs indicated that digital interventions offer a range of potential benefits that could make them useful for pregnant smokers. Nonetheless, important limitations and recommendations regarding their design and delivery were identified and these need to be addressed in intervention development

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

Internet-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