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1 – 10 of 709Sudhanshu Patwardhan and Jed E. Rose
The purpose of this paper is to review the barriers in the dissemination of effective smoking cessation treatments and services globally. Offering tobacco users help to stop using…
Abstract
Purpose
The purpose of this paper is to review the barriers in the dissemination of effective smoking cessation treatments and services globally. Offering tobacco users help to stop using tobacco is a key demand reduction measure outlined under Article 14 of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). Implementing Article 14 can reap great dividends for the billion plus tobacco users around the world and their families, friends and societies.
Design/methodology/approach
A review of the status of the global implementation of Article 14 using available literature on smoking cessation products, services and national guidelines. Discussing innovative approaches being currently explored in South Asia that can lead to faster adoption and implementation of Article 14 globally.
Findings
Major gaps remain in cessation products’ availability and resource allocation for cessation services globally. Current licensed products are falling short on delivering and sustaining smoking cessation. Innovation in cessation products and services needs to build on learnings in nicotine pharmacokinetics, behavioural insights from consumer research and tap into 21st century tools such as mobile based apps. National implementation of FCTC’s Article 14 needs to follow guidelines that encourage integration into existing health programmes and health-care practitioners’ (HCPs) upskilling.
Originality/value
Smoking cessation is a desirable health outcome and nicotine replacement products are a means of achieving cessation through tobacco harm reduction. E-cigarettes are sophisticated nicotine replacement products. Innovation is urgently needed to fill the gaps in smoking cessation products and services, and for converting global policy into local practice. In low- and middle-income countries (LMICs), HCPs’ knowledge, attitudes and practice regarding tobacco use and cessation may hold the key to rapidly scaling up cessation support and delivery to achieve FCTC objectives sooner. Additionally, HCPs can play an important role in offering smoking cessation support in existing national health programmes for TB, cancer screening and maternal and child health. Also, widely prevalent smartphone devices may deliver smoking cessation through telemedicine in LMICs sooner, leapfrogging the hurdles of the existing health-care infrastructure.
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Pamela Kaduri, Jessie Mbwambo, Frank Masao and Gad Kilonzo
Substance use is among the risk factors associated with both HIV/AIDS and non communicable diseases (NCDs). The aim of this paper is to describe the development of the medication…
Abstract
Purpose
Substance use is among the risk factors associated with both HIV/AIDS and non communicable diseases (NCDs). The aim of this paper is to describe the development of the medication assisted therapy (MAT) in the treatment of substance use disorders and opportunities for further interventions in Tanzania.
Design/methodology/approach
A review of MAT pilot project documentation, existing published and grey literature on substance misuse in Tanzania was used to describe the scope of this paper. MAT as a program focuses on the treatment of opiod dependent individuals using methadone in a national hospital in Tanzania. It is delivered by a team of trained interprofessionals coordinating with community partners.
Findings
The findings indicate an uptake of pharmacotherapy in the treatment of substance use disorders as an adjunct to traditional counseling approaches in low resource settings. Program acceptability and reach within a short period of time by the opiod dependent individuals is shown.
Practical implications
National buy‐in is critical for developments of new interventions. Given adequate resources, it is feasible to integrate MAT for the treatment of substance use disorders within health care systems in poor resource settings. To ensure the success of the program, sustainable efforts and scaling up to include alcohol and tobacco dependence treatment is crucial. The local capacity building is required including a need for designing appropriate policies to address alcohol and tobacco use in Tanzania.
Originality/value
The intervention is the only one in sub‐Saharan Africa. MAT may serve as a practice model for other countries in the region.
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Seamus Allison, M. Bilal Akbar, Claire Allison, Karla Padley and Stephen Wormall
This study aims to demonstrate the evaluation of an incentive scheme to encourage pregnant people to set a quit-smoking date.
Abstract
Purpose
This study aims to demonstrate the evaluation of an incentive scheme to encourage pregnant people to set a quit-smoking date.
Design/methodology/approach
The paper outlines a collaborative approach, working with pregnant people, clinicians, tobacco dependency practitioners and academics to gain insights into their perspectives and experiences. Quantitative and qualitative data were analysed.
Findings
The incentive scheme and appropriate support from clinicians have been shown to encourage pregnant people to set a quit date. The tobacco dependency practitioners helped remove barriers, such as the perception of the stigmatisation of smoking when pregnant. The practitioners also helped pregnant people make informed decisions to support successful behaviour change. The impact of the scheme resulted in improved infant health indicators. The scheme’s evaluation also supported establishing stakeholder knowledge exchange and learning processes.
Research limitations/implications
This is a single-site study among a relatively small group of people designed to achieve a specific evaluation objective. Caution in generalising to wider settings should be exercised.
Practical implications
This study highlights the efficacy of an incentive scheme, complemented with support from clinicians, and the significance of knowledge exchange and collaboration between stakeholders in health care with significance in similar settings.
Originality/value
The paper details the incentive scheme input, actions, output, outcomes and impact involving a wider range of stakeholders, including the emotional consequences for participants, clinicians and academics.
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Although smoking is a major health problem among forensic psychiatric inpatient populations, a multitude of factors (motivational, environmental, procedural and psychiatric…
Abstract
Although smoking is a major health problem among forensic psychiatric inpatient populations, a multitude of factors (motivational, environmental, procedural and psychiatric) militate against effective treatment. Despite this, few studies have reported on the use of population‐appropriate treatment approaches. This pilot study reports the results of group and individual treatments involving combination nicotine replacement therapy (NRT), motivational enhancement therapy (MET) and cognitive behavioural treatment. The importance of selecting patients with some skills in emotional regulation is highlighted, along with ways of reducing institutional obstacles to change and maximising environmental support for quit attempts.
This article examines the relationship between tobacco control and tobacco harm reduction, illuminating the differences and similarities between them.
Abstract
Purpose
This article examines the relationship between tobacco control and tobacco harm reduction, illuminating the differences and similarities between them.
Design/methodology/approach
Drawing on published sources, the author conducts a critical analysis of the prevailing discourses on tobacco control and tobacco harm reduction.
Findings
Although tobacco control and tobacco harm reduction differ in their views on the resolutions to the tobacco “problem”, they manifest similar underlying assumptions about the nature of “the smoker” and are equally silent on the topic of pleasure.
Originality/value
This article emphasises the need for tobacco harm reduction to take pleasure seriously and highlights the limitations of approaches focused exclusively on risk and harm reduction.
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Geoffrey C. Williams, Kathryn M. Markakis, Deborah Ossip‐Klein, Scott McIntosh, Scott Tripler and Tana Grady‐Weliky
To provide a rationale regarding the importance of physician behavior change counseling. To describe the double helix behavior change curriculum at the University of Rochester…
Abstract
Purpose
To provide a rationale regarding the importance of physician behavior change counseling. To describe the double helix behavior change curriculum at the University of Rochester (UR). To provide initial evidence that the curriculum is effective.
Design/methodology/approach
Evidence that physician use of the 5A's model is effective in changing important patient health behaviors is summarized. The behavior change curriculum is described. Initial evidence assessing knowledge, attitudes and skills for behavior change counseling is reviewed.
Findings
Physicians will be better prepared to intervene to improve their patients quality and quantity of life if they consistently counsel patients using a brief standard model (the 5A's) that integrates biological, psychological, and social aspects of disease and treatment. Past efforts in the UR's curriculum have demonstrated that students adopt broader “biopsychosocial values” when the curriculum supports their learning needs. Initial evidence demonstrates that double helix curriculum students learn this model well and are able to provide the counseling in a patient‐centered style.
Research limitations/implications
These results are limited by the observational design, and the reliance on student self‐reports and standardized patient observations of student behavior rather than change in patient behavior.
Practical implications
Strong evidence exists that physicians can be effective in providing behavior change counseling. Additional research is called for to create, implement, and fully evaluate behavior change counseling curricula for medical students.
Originality/value
An example of a behavior change curriculum is provided for medical educators, and initial evidence of its effectiveness is provided.
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Laura MacPherson, Anahi Collado, Carl W. Lejuez, Richard A. Brown and Matthew T. Tull
Cigarette smoking remains the primary preventable cause of mortality and morbidity globally. The overarching goal of the paper is to disseminate the Behavioral Activation Treatment…
Abstract
Purpose
Cigarette smoking remains the primary preventable cause of mortality and morbidity globally. The overarching goal of the paper is to disseminate the Behavioral Activation Treatment for Smoking (BATS), which integrates behavioral activation principles with standard treatment guidelines to assist individuals in achieving short- and long-term smoking cessation. Through a series of sequential steps, BATS guides individuals who wish to quit smoking to increase their engagement in healthy, pleasurable, and value-consistent activities.
Design/methodology/approach
The document provides the BATS rationale and contains an abridged manual for use by clinicians and/or researchers in the context of clinical trials. Findings: BATS is accruing empirical evidence that suggests its ability to promote successful smoking cessation outcomes while decreasing any associated depressive symptoms.
Findings
BATS is accruing empirical evidence that suggests its ability to promote successful smoking cessation outcomes while decreasing any associated depressive symptoms.
Practical implications
A description of key components, forms, and strategies to address common treatment barriers are included.
Originality/value
BATS’s strong roots in learning theories and its idiographic nature allow for the intervention to be implemented flexibly across a wide range of settings and smoking populations. The treatment may also be combined seamlessly with pharmacotherapies. BATS targets both cigarette smoking and depressive symptoms, which constitute a significant barrier to cessation, through a common pathway: increasing rewarding activities. The treatment offers a parsimonious complement to standard smoking cessation treatments.
Marewa Glover, Pooja Patwardhan and Kyro Selket
This paper aims to investigate the extent to which three subgroups – people with mental health conditions, people belonging to sexual minority and gender groups and Indigenous…
Abstract
Purpose
This paper aims to investigate the extent to which three subgroups – people with mental health conditions, people belonging to sexual minority and gender groups and Indigenous peoples – have been “left behind” by countries implementing the World Health Organization’s Framework Convention on Tobacco Control.
Design/methodology/approach
A general review of electronic bibliographical databases to provide an overview of smoking prevalence among the three groups and interventions designed specifically to reduce their smoking rates.
Findings
Although explanations and specific rates differ, two trends are consistent across all three groups. First, information reported in the past two decades suggests that smoking prevalence is disproportionately high among people with mental health conditions, and in the rainbow and indigenous communities. Second, most cessation programmes are targeted at majority politically dominant groups, missing opportunities to reduce smoking rates in these minority communities.
Research limitations/implications
There is a general dearth of data preventing detailed analysis. Better data collection efforts are required. Trials to identify effective smoking reduction interventions for marginalised groups are needed.
Social implications
It is socially unjust that these groups are being systematically ignored by tobacco control initiatives. A failure to equitably reduce tobacco harms among all groups across society has contributed to the perceived concentration of smoking in some subgroups. The increasing stigmatisation of people who smoke then adds a marginality, compounding the negative effects associated with belonging to a marginalised group. Ongoing marginalisation of these groups is an important determinant of smoking.
Originality/value
Cross-case analysis of neglected subgroups with disproportionately high smoking rates suggests social marginalisation is a shared and important determinant of smoking prevalence.
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The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the WHO. This study aims to describe progress…
Abstract
Purpose
The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the WHO. This study aims to describe progress toward the framework’s goals, setbacks and strategies to update its articles to optimize outcomes.
Design/methodology/approach
A review of relevant literature, including papers in this special issue, forms the basis for identifying steps necessary to amplify the impact of the FCTC.
Findings
The WHO suggests that there are 1.3 billion users of tobacco globally. The expected deaths associated with tobacco use could be dramatically reduced by hundreds of millions between now and 2060 through measures that improve cessation and harm reduction support among adults. Additional steps needed to achieve the goals of the FCTC include developing new initiatives to address areas of profound neglect (for example, women); investing in global research and innovation; addressing the needs of vulnerable populations; and establishing a mechanism to fund priority actions required by low- and middle-income countries, including support for alternative livelihoods for smallholder farmers.
Practical implications
In November 2020, the WHO FCTC Parties will host their next Conference of the Parties (COP9) in the Netherlands. This paper aims to contribute to the needed policy decisions related to this meeting. Since acceptance of this article, the WHO FCTC team announced that doe to the COVID-19 pandemic COP9 has been rescheduled till November 2021.
Originality/value
There exists a need to prioritize the goals of tobacco control and offer clear strategies for its execution. This paper fills this niche via a thorough and up-to-date analysis of how to amend and enforce the FCTC.
Jatuporn Chalermrueangrong and Sunida Preechawong
The purpose of this paper is to compare the outcome of a smoking cessation program based on the protection motivation theory and a brief intervention among Royal Thai Air Force…
Abstract
Purpose
The purpose of this paper is to compare the outcome of a smoking cessation program based on the protection motivation theory and a brief intervention among Royal Thai Air Force (RTAF) officers, with non-communicable disease (NCD) risks.
Design/methodology/approach
This quasi-experimental study involved sixty RTAF officers, with NCD risks. The first 30 participants were assigned to a control group and the latter 30 to an experimental group. The control group received brief advice on quitting smoking while the experimental group took part in an eight-week motivational program. The primary outcome was biochemically verified seven-day point prevalence abstinence from smoking. A measurement of carbon monoxide (CO)<8 ppm in exhaled breath was considered indicative of abstinence.
Findings
Most participants were non-commissioned officers, with an age range of 21–59 years and a mean age of 38.27 years (SD=10.59). No significant difference in the Fagerström test for nicotine dependence scores between control and experimental groups was observed. The proportion of the participants reporting the seven-day point prevalence abstinence verified by exhaled CO was significantly higher in the experiment group than in the control group (20.0 percent vs 3.3 percent; p<0.05). Numbers of cigarettes per day decreased from 12.87±7.23 and 10.53 ± 7.45 at the baseline to 7.23 ± 5.90 and 8.83 ± 6.13 at the end of study in experimental and control group, respectively.
Originality/value
This motivation-based program to quit smoking had a promising outcome in terms of smoking abstinence and smoking reduction.
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