Smoking cessation intervention in a large randomised population-based study. The Inter99 study

Research Centre for Prevention and Health, Nordre Ringvej, DK-2600 Glostrup University Hospital, Glostrup, Denmark.
Preventive Medicine (Impact Factor: 3.09). 04/2005; 40(3):285-92. DOI: 10.1016/j.ypmed.2004.06.001
Source: PubMed


Several large and well-conducted community interventions have failed to detect an effect on prevalence of smoking.
Two thousand four hundred eight daily smokers in all motivational stages were actively recruited and included in a randomised population-based intervention study in Copenhagen, Denmark. All smokers completed a questionnaire and underwent a health examination and a lifestyle consultation. Daily smokers in the high intensity intervention group were offered assistance to quit in smoking cessation groups.
The validated abstinence rate at 1-year follow-up was 16.3% in the high intensity group and 12.7% in the low intensity group compared with a self-reported abstinence rate of 7.3% in the background population. The adjusted odds ratio of abstinence in the high intervention group was significantly higher, OR = 2.2 (1.6-3.0) than in the background population, also in the 'intention-to-treat' analyses, OR = 1.5 (1.1-2.0). Higher socioeconomic status, higher age at onset of daily smoking, and a higher wish to quit were predictors of success.
In a population-based setting, using active recruitment and offering assistance to quit, it was possible to include many smokers and to achieve a significantly higher validated abstinence in the high intensity intervention than in the background population, even when using 'intention-to-treat' analyses.

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    • "The quit rates in primary health care settings, particularly when health workers approach clients to quit, are likely to be lower than in settings where clients have specifically sought help [2]. Motivation to quit prior to being involved in an intervention did not predict success in quitting [14,15]. Several RCTs have demonstrated that 5-22% of participants who were not interested in quitting at the start of their participation had quit smoking at the follow-up (reviewed in [16]). "
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    ABSTRACT: Australian Aboriginal peoples and Torres Strait Islanders (Indigenous Australians) smoke at much higher rates than non-Indigenous people and smoking is an important contributor to increased disease, hospital admissions and deaths in Indigenous Australian populations. Smoking cessation programs in Australia have not had the same impact on Indigenous smokers as on non-Indigenous smokers. This paper describes the protocol for a study that aims to test the efficacy of a locally-tailored, intensive, multidimensional smoking cessation program. This study is a parallel, randomised, controlled trial. Participants are Aboriginal and Torres Strait Islander smokers aged 16 years and over, who are randomly allocated to a 'control' or 'intervention' group in a 2:1 ratio. Those assigned to the 'intervention' group receive smoking cessation counselling at face-to-face visits, weekly for the first four weeks, monthly to six months and two monthly to 12 months. They are also encouraged to attend a monthly smoking cessation support group. The 'control' group receive 'usual care' (i.e. they do not receive the smoking cessation program). Aboriginal researchers deliver the intervention, the goal of which is to help Aboriginal peoples and Torres Strait Islanders quit smoking. Data collection occurs at baseline (when they enrol) and at six and 12 months after enrolling. The primary outcome is self-reported smoking cessation with urinary cotinine confirmation at 12 months. Stopping smoking has been described as the single most important individual change Aboriginal and Torres Strait Islander smokers could make to improve their health. Smoking cessation programs are a major priority in Aboriginal and Torres Strait Islander health and evidence for effective approaches is essential for policy development and resourcing. A range of strategies have been used to encourage Aboriginal peoples and Torres Strait Islanders to quit smoking however there have been few good quality studies that show what approaches work best. More evidence of strategies that could work more widely in Indigenous primary health care settings is needed if effective policy is to be developed and implemented. Our project will make an important contribution in this area. Australian New Zealand Clinical Trials Registry (ACTRN12608000604303).
    BMC Public Health 03/2012; 12(1):232. DOI:10.1186/1471-2458-12-232 · 2.26 Impact Factor
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    • "Several studies have linked unemployment with a decreased likelihood of successful smoking cessation (Businelle et al., 2010; Foulds et al., 2006; Pisinger et al., 2005; Waldron & Lye, 1989). Low income may influence health through decreased access to resources such as high quality healthcare and medical treatments; and perhaps through increased distress due to stressors such as financial concerns. "
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    ABSTRACT: African Americans suffer disproportionately from the adverse health consequences of smoking, and also report substantially lower socioeconomic status than Whites and other racial/ethnic groups in the U.S. Although socioeconomic disadvantage is known to have a negative influence on smoking cessation rates and overall health, little is known about the influence of socioeconomic status on smoking cessation specifically among African Americans. Thus, the purpose of the current study was to characterize the impact of several individual- and area-level indicators of socioeconomic status on smoking cessation among African Americans. Data were collected as part of a smoking cessation intervention study for African American smokers (N = 379) recruited from the Houston, Texas, metropolitan area, who participated in the study between 2005 and 2007. The separate and combined influences of individual-level (insurance status, unemployment, education, and income) and area-level (neighborhood unemployment, education, income, and poverty) indicators of socioeconomic status on continuous smoking abstinence were examined across time intervals using continuation ratio logit modeling. Individual-level analyses indicated that unemployment was significantly associated with reduced odds of smoking abstinence, while higher income was associated with greater odds of abstinence. However, only unemployment remained a significant predictor of abstinence when unemployment and income were included in the model together. Area-level analyses indicated that greater neighborhood unemployment and poverty were associated with reduced odds of smoking abstinence, while greater neighborhood education was associated with higher odds of abstinence. However, only neighborhood unemployment remained significantly associated with abstinence status when individual-level income and unemployment were included in the model. Overall, findings suggest that individual- and area-level unemployment have a negative impact on smoking cessation among African Americans. Addressing unemployment through public policy and within smoking cessation interventions, and providing smoking cessation treatment for the unemployed may have a beneficial impact on tobacco-related health disparities.
    Social Science [?] Medicine 02/2012; 74(9):1394-401. DOI:10.1016/j.socscimed.2012.01.013 · 2.89 Impact Factor
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    • "Based on the personal risk estimate, each participant had individual lifestyle counselling. All smokers were encouraged to quit (described in details elsewhere) [11] [15] [16]. In addition to the individualised lifestyle counselling , high-risk individuals (including all smokers) in the intervention group were offered lifestyle counselling in groups. "
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    ABSTRACT: To investigate whether the effect of an individualised multi-factorial lifestyle intervention on dietary habits differs across socioeconomic groups. The study was an individualised multi-factorial lifestyle intervention study with a control group, Inter99 (1999-2006), Copenhagen, Denmark. Participants in the intervention group (n=6 091) received lifestyle intervention during a five-year period. The control group (n=3 324) was followed by questionnaires. Multilevel regression analyses were used, including interaction term between intervention effect and socioeconomic position (SEP) and analysed separately for men and women. SEP was measured as length of education and employment status and dietary habits were measured by a validated food frequency questionnaire. Men with a short education improved their dietary habits more (net-change [95% confidence interval]) (0.25 points [-0.01;0.52]) than men with longer education (0.02 points [-0.09;0.14]), (interaction: p=0.02). Furthermore, unemployed women improved their dietary intake more (0.33 points [0.05;0.61]) than employed women (0.01 points [-0.10;0.11]), (interaction: p=0.03). Similar results were found for fruit intake, whereas no significant interactions were found for fish, fat and vegetable intake. Individualised dietary interventions do not increase and may even decrease or hinder further widening of the social inequalities in health due to unhealthy dietary habits among socially disadvantaged individuals.
    Preventive Medicine 01/2012; 54(1):88-93. DOI:10.1016/j.ypmed.2011.10.005 · 3.09 Impact Factor
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