Smoking cessation: the potential role of risk assessment as motivational triggers. Postgrad Med J

Department of Medicine, Auckland Hospital, Auckland, New Zealand.
Postgraduate medical journal (Impact Factor: 1.45). 01/2010; 86(1011):26-33; quiz 31-2. DOI: 10.1136/pgmj.2009.084947
Source: PubMed


Smoking is the most important and preventable cause of morbidity and premature mortality in developed and developing countries. To date, efforts to reduce the burden of smoking have focused on non-personalised strategies. Anxiety about ill health, especially lung cancer and emphysema, is the foremost concern for smokers and a major reason for quitting. Recent efforts in cessation management focus on behaviour change and pharmacotherapy. The '3 Ts' (tension, trigger, treatment) model of behaviour change proposes that at any one time a smoker experiences varying degrees of motivational tension, which in the presence of a trigger may initiate or enhance quitting. Smokers' optimistic bias (ie, denial of one's own vulnerability) sustains continued smoking, while increasing motivational tension (eg, illness) favours quitting. The 1 year quit rates achieved when smokers encounter a life threatening event, such as a heart attack or lung cancer, are as much as 50-60%. Utilising tests of lung function and/or genetic susceptibility personalises the risk and have been reported to achieve 1 year quit rates of 25%. This is comparable to quit rates achieved among healthy motivated smokers using smoking cessation drug therapy. In this paper we review existing evidence and propose that identifying those smokers at increased risk of an adverse smoking related disease may be a useful motivational tool, and enhance existing public health strategies directed at smoking cessation.

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Available from: Robert P Young
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    • "In the United States, 84.5% of adults visiting a primary care clinician are overweight, smoke cigarettes, or fail to exercise at the recommended levels [5]. The label " teachable moment " (TM) has been applied to health behavior change messages that leverage the salient features of a patient's particular circumstance to create powerful or persuasive advice [6] [7] [8] for patients in the primary care setting [9] [10] [11]. Initially conceived as serendipitous events caused by a constellation of emergent factors [12] [13] [14], recent work has examined TMs as opportunities created through the patient-clinician interaction and utilized by patients and physicians to encourage health behavior change [15] [16] [17]. "
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    ABSTRACT: Objective Teachable moments (TM) are opportunities created through physician-patient interaction and used to encourage patients to change unhealthy behaviors. We examine the effectiveness of TMs to increase patients’ recall of advice, motivation to modify behavior, and behavior change. Method A mixed-method observational study of 811 patient visits to 28 primary care clinicians used audio-recordings of visits to identify TMs and other types of advice in health behavior change talk. Patient surveys assessed smoking, exercise, fruit/vegetable consumption, height, weight, and readiness for change prior to the observed visit and 6-weeks post-visit. Results Compared to other identified categories of advice (i.e. missed opportunities or teachable moment attempts), recall was greatest after TMs occurred (83% vs. 49%-74%). TMs had the greatest proportion of patients change in importance and confidence and increase readiness to change; however differences were small. TMs had greater positive behavior change scores than other categories of advice; however, this pattern was statistically non-significant and was not observed for BMI change. Conclusion TMs have a greater positive influence on several intermediate markers of patient behavior change compared to other categories of advice. Practice implications TMs show promise as an approach for clinicians to discuss behavior change with patients efficiently and effectively.
    Full-text · Article · Jul 2014 · Patient Education and Counseling
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    • "When compared with previous studies using telephone counselling alone [17] (Figure 2), there is a 20-25% improvement in smoking cessation with the Respiragene test (Table 1). The improvement in intention to quit increases from 56% before testing to 67% in smokers with an average smokers risk of lung cancer or 89% in smokers with a high risk of lung cancer [18]. "
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    ABSTRACT: Background A gene-based estimate of lung cancer risk in smokers has been shown to act as a smoking cessation motivator in hospital recruited subjects. The objective of this trial is to determine if this motivator is as effective in subjects recruited from an NHS primary care unit. Method/Design Subjects will be recruited by mailings using smoking entries on the GP electronic data-base (total practice population = 32,048) to identify smokers who may want to quit. Smoking cessation clinics based on medical centre premises will run for eight weeks. Clinics will be randomised to have the gene-based test for estimation of lung cancer risk or to act as controls groups. The primary endpoint will be smoking cessation at eight weeks and six months. Secondary outcomes will include ranking of the gene-based test with other smoking cessation motivators. Discussion The results will inform as to whether the gene-based test is both effective as motivator and acceptable to subjects recruited from primary care. Trial registration Registered with Clinical, Registration number: NCT01176383.
    Full-text · Article · May 2014 · BMC Pulmonary Medicine
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    • "This is important as smokers understand their risk of a smoking-related disease is partly genetically determined and not " negative. " We suggest that such a beneficial effect might occur because gene-based testing helps increase motivational tension and undermine unrealistic optimism (Weinstein et al., 2005; Young et al., 2010a) in many smokers. "
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    ABSTRACT: Lung cancer is the leading cause of cancer death worldwide and nearly 90% of cases are attributable to smoking. Quitting smoking and early diagnosis of lung cancer, through computed tomographic screening, are the only ways to reduce mortality from lung cancer. Recent epidemiological studies show that risk prediction for lung cancer is optimized by using multivariate risk models that include age, smoking exposure, history of chronic obstructive pulmonary disease (COPD), family history of lung cancer, and body mass index. It has also been shown that COPD predates lung cancer in 65-70% of cases, conferring a four- to sixfold greater risk of lung cancer compared to smokers with normal lung function. Genome-wide association studies of smokers have identified a number of genetic variants associated with COPD or lung cancer. In a case-control study, where smokers with normal lungs were compared to smokers who had spirometry-defined COPD or histology confirmed lung cancer, several of these variants were shown to overlap, conferring the same susceptibility or protective effects on both COPD and lung cancer (independent of COPD status). In this perspective article, we show how combining clinical data with genetic variants can help identify heavy smokers at the greatest risk of lung cancer. Using this approach, we found that gene-based risk testing helped engage smokers in risk mitigating activities like quitting smoking and undertaking lung cancer screening. We suggest that such an approach could facilitate the targeted selection of smokers for cost-effective life-saving interventions.
    Preview · Article · Oct 2012 · Frontiers in Genetics
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