Biomedical Risk Assessment as an Aid for Smoking Cessation

Department of Ambulatory Care and Community Medicine & Clinical Epidemiology Centre, University of Lausanne, Bugnon 44, Lausanne, Switzerland, CH-1011.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2009; 12(2):CD004705. DOI: 10.1002/14651858.CD004705.pub3
Source: PubMed


Biomedical risk assessment is the process of giving smokers feedback on the physical effects of smoking using physiological measurements (for example: exhaled carbon monoxide measurement or lung function tests). It has been considered as a tool to encourage smokers to quit. This review includes 15 studies. Of them, only two found that biomedical risk assessment significantly increased long term quitting. In one study, smokers who had their lung function tested and the results explained in terms of lung age compared to their actual age were more likely to quit than people given the same test but without the explanation. In another study, light smokers who were shown images of their arteries were more likely to quit than those who were not shown images. Mixed quality evidence does not suggest that other types of biomedical risk assessment increase a smoker's chance of successfully quitting compared with standard treatments.

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Available from: Yolanda Kathrin Mueller, May 13, 2015
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    • "A 2012 updated review of the Cochrane Collaboration [19] found little scientific evidence of an effect on quitting smoking for most biomedical tests. Out of the 15 studies included, only 2 of them detected a significant effect: a trial based on ultrasound of carotid and femoral arteries and another on spirometry combined with information on test results in terms of “lung age” [20] which found a significant improvement in the smoking cessation success rate compared to the control group that did not receive the spirometry test report (RR 2.12; CI 95% 1.24 to 3.62). "
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    ABSTRACT: Smoking is the main preventable cause of morbidity and mortality in our region, it being the main causative agent of chronic obstructive pulmonary disease. There still is no consensus on the use of spirometry as a strategy for smoking cessation, given that there is insufficient scientific evidence from high quality studies to recommend the use of this technique.Methods/design: This is to be a randomized, multicentre, open-label clinical trial. A total of 444 smokers over 40 years of age will be recruited by 39 general practitioners from 22 health centers.Primary objective of this study is to assess the effectiveness of spirometry together with information regarding the test for smoking cessation after 1 year in smokers over 40 years of age with a more than 10 pack-year history and no previous diagnosis of chronic obstructive pulmonary disease.Groups of 45 patients who smoke will be randomly selected from the lists of the participating doctors. The names will be sent to the corresponding doctors who will contact candidate patients and assess whether they meet the selection criteria. Patients who meet these criteria will be randomly allocated to an intervention or control group.For patients in both groups, a nurse will conduct an interview and perform a spirometry test to measure forced vital capacity. Then, all patients will be referred for an appointment with their doctor for brief anti-smoking intervention, patients from the intervention group additionally being informed about the result of the spirometry test.After 1 year, smoking status will be assessed and, in those who report that they have quit smoking, abstinence will be confirmed by co-oximetry. Data will be analyzed on an intention-to-treat basis using the chi-squared test for outcomes and binary logistic regression if it is considered to be necessary to adjust for confounding variables. Performing a spirometry test and providing information on pulmonary function may increase awareness of the effect of smoking among smokers who are asymptomatic or have few symptoms and make them decide to quit. Specifically, in patients with chronic obstructive pulmonary disease it might increase levels of motivation to quit smoking in early stages of the disease. If this strategy were to be effective, it could be included in the health promotion activities offered in primary care.Trial registration: Identifier: NCT01821885.
    Full-text · Article · Dec 2013 · BMC Family Practice
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    • "If this is the case, it may be possible to improve smoking cessation rates by furthering service providers' training and ensuring delivery of regular monitoring and progress-related feedback, rather than providing incentives. However, while there is some evidence to suggest the effectiveness of NRT in reducing smoking in pregnancy [14], biochemical risk assessment, including CO measurement and feedback, does not appear to aid smoking cessation [51]. This finding could be taken as an indication that incentivised women's perceptions of the beneficial influence of monitoring and feedback provision, in reality, may not have necessarily affected their cessation success. "
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    ABSTRACT: Financial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women’s experiences of trying to stop smoking, within and outside of a financial incentives scheme. Thirty-six (n = 36) UK-based pregnant smokers (n = 36), offered standard NHS Stop-Smoking Services, of whom twenty (n = 20) were enrolled in a financial incentives scheme for smoking cessation (n = 20) and sixteen (n = 16) were not, were interviewed about (i) their motivation to stop smoking, and (ii) the factors they perceived as influencing their quitting efforts. Framework Analysis was used to analyse the data. Women in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts. Women participating in a financial incentives scheme to stop smoking reported greater engagement with the Stop-Smoking Services, from which they described receiving more help in quitting than women who were not part of the scheme. These results highlight the complexity of financial incentives schemes and the intricacies surrounding the ways in which they operate to affect smoking cessation. These might involve influencing individuals’ motivation and self-regulation, changing engagement with and provision of support services, or a combination of these.
    Full-text · Article · Apr 2012 · BMC Pregnancy and Childbirth
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    • "It was the experience of the authors that the immediate return of results to clients often started conversations about smoking and quitting, suggesting a potential role for BCO as a clinical tool to educate and motivate low SES smokers who are not motivated to quit. While there is currently no strong evidence that biofeedback increases cessation attempts [31], BCO may be an acceptable and non-threatening way to engage hard-to-reach groups with smoking cessation and prompt advice and referral, especially given the high prevalence of smoking identified in this setting. "
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    ABSTRACT: Self report of smoking status is potentially unreliable in certain situations and in high-risk populations. This study aimed to determine the accuracy and acceptability of computer administered self-report of smoking status among a low socioeconomic (SES) population. Clients attending a community service organisation for welfare support were invited to complete a cross-sectional touch screen computer health survey. Following survey completion, participants were invited to provide a breath sample to measure exposure to tobacco smoke in expired air. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Three hundred and eighty three participants completed the health survey, and 330 (86%) provided a breath sample. Of participants included in the validation analysis, 59% reported being a daily or occasional smoker. Sensitivity was 94.4% and specificity 92.8%. The positive and negative predictive values were 94.9% and 92.0% respectively. The majority of participants reported that the touch screen survey was both enjoyable (79%) and easy (88%) to complete. Computer administered self report is both acceptable and accurate as a method of assessing smoking status among low SES smokers in a community setting. Routine collection of health information using touch-screen computer has the potential to identify smokers and increase provision of support and referral in the community setting.
    Full-text · Article · Nov 2011 · BMC Medical Research Methodology
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