Immediate, Remote Smoking Cessation Intervention in Participants Undergoing a Targeted Lung Health Check
2022; Elsevier BV; Volume: 163; Issue: 2 Linguagem: Inglês
10.1016/j.chest.2022.06.048
ISSN1931-3543
AutoresParris Williams, Keir E.J. Philip, Navjot Kaur Gill, Deirdre Flannery, Sara C Buttery, Emily Bartlett, Anand Devaraj, Samuel V. Kemp, Jamie Addis, Jane Derbyshire, Michelle Chen, R. Katie Morris, Anthony A Laverty, Nicholas S Hopkinson,
Tópico(s)Smoking Behavior and Cessation
ResumoBackgroundLung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective.Research QuestionDoes an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)?Study Design and MethodsIn a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression.ResultsThree hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention.InterpretationImmediate provision of an intensive telephone-based smoking cessation intervention including pharmacotherapy, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months.Trial RegistryISRCTN registry; No.: ISRCTN12455871; URL: www.IRSCN.com Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective. Does an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)? In a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression. Three hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention. Immediate provision of an intensive telephone-based smoking cessation intervention including pharmacotherapy, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months. ISRCTN registry; No.: ISRCTN12455871; URL: www.IRSCN.com Take-home PointsStudy Question: Does an immediate telephone smoking cessation intervention (TSI) increase quit rates compared with usual care (UC) among a population enrolled in a targeted lung health check?Results: Self-reported quit rates were higher in the intervention arm compared with the UC arm: TSI, 21.1% vs UC, 8.9%.Interpretation: Immediate provision of an intensive TSI, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months. Study Question: Does an immediate telephone smoking cessation intervention (TSI) increase quit rates compared with usual care (UC) among a population enrolled in a targeted lung health check? Results: Self-reported quit rates were higher in the intervention arm compared with the UC arm: TSI, 21.1% vs UC, 8.9%. Interpretation: Immediate provision of an intensive TSI, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months. Targeted screening programs using low-dose CT (LDCT) imaging have been proposed as a solution to reduce the impact of lung cancer by diagnosing it at an earlier, potentially curable, stage. Large randomized controlled trials have demonstrated that this approach can reduce mortality resulting from lung cancer by between 20% and 60%,1Aberle D.R. Adams A.M. et al.National Lung Screening Trial Research TeamReduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (7640) Google Scholar,2de Koning H.J. van der Aalst C.M. de Jong P.A. et al.Reduced lung-cancer mortality with volume CT screening in a randomized trial.N Engl J Med. 2020; 382: 503-513Crossref PubMed Scopus (1569) Google Scholar and LDCT scan screening is now recommended by the United States Preventative Services Taskforce.3United States Preventative Services TaskforceLung cancer: screening 2021. United States Preventative Services Taskforce website.https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screeningGoogle Scholar In 2019, the National Health Service (NHS) England launched targeted lung health check (TLHC) pilot projects at various sites across the United Kingdom to investigate the feasibility and effectiveness of LDCT scan screening within the United Kingdom.4NHS EnglandNews NHS to rollout lung cancer scanning trucks across the country 2019. National Health Service website.https://www.england.nhs.uk/2019/02/lung-trucks/Google Scholar More recently, the National Screening Committee began a public consultation regarding a national rollout of TLHC across the United Kingdom.5United Kingdom National Screening CommitteeAdult screening programme. Lung cancer 2022. United Kingdom National Screening Committee website.https://view-health-screening-recommendations.service.gov.uk/lung-cancer/Google Scholar Tobacco smoking is among the largest causes of morbidity and mortality, and thus, smoking cessation is a key aspect of the prevention and treatment both of respiratory disease and many conditions occurring beyond the lungs.6World Health OrganizationTobacco 2021. World Health Organization website.https://www.who.int/news-room/fact-sheets/detail/tobaccoGoogle Scholar Lung cancer screening eligibility criteria targets high-risk individuals who smoke, who differ in certain ways from the general smoking population, being older, often with multiple comorbidities and a longer smoking history, and having greater tobacco dependence.1Aberle D.R. Adams A.M. et al.National Lung Screening Trial Research TeamReduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (7640) Google Scholar,7Kathuria H. Detterbeck F.C. Fathi J.T. et al.Stakeholder research priorities for smoking cessation interventions within lung cancer screening programs. An official American Thoracic Society research statement.Am J Respir Crit Care Med. 2017; 196: 1202-1212Crossref PubMed Scopus (25) Google Scholar LDCT scan screening trials have demonstrated higher quit rates in intervention than control arms, and thus, the screening process can be considered to be a so-called teachable moment for smoking cessation.8Brain K. Carter B. Lifford K.J. et al.Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial.Thorax. 2017; 72: 912-918Crossref PubMed Scopus (86) Google Scholar,9Ashraf H. Tønnesen P. Pedersen J.H. Dirksen A. Thorsen H. Døssing M. Effect of CT screening on smoking habits at 1-year follow-up in the Danish Lung Cancer Screening Trial (DLCST).Thorax. 2009; 64: 388-392Crossref PubMed Scopus (130) Google Scholar Making the best use of this is crucial, and the provision of evidence-based smoking cessation within screening programs has been advocated.10Joseph A.M. Rothman A.J. Almirall D. et al.Lung cancer screening and smoking cessation clinical trials. SCALE (Smoking Cessation Within the Context of Lung Cancer Screening) collaboration.Am J Respir Crit Care Med. 2018; 197: 172-182Crossref PubMed Scopus (93) Google Scholar The effectiveness of different approaches remains a key question for research to establish which specific approaches should be used to maximize the value and impact of the lung health check.11Clark M.M. Cox L.S. Jett J.R. et al.Effectiveness of smoking cessation self-help materials in a lung cancer screening population.Lung Cancer. 2004; 44: 13-21Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar, 12Taylor K.L. Hagerman C.J. Luta G. et al.Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: a randomized clinical trial.Lung Cancer. 2017; 108: 242-246Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 13Tremblay A. Taghizadeh N. Huang J. et al.A randomized controlled study of integrated smoking cessation in a lung cancer screening program.J Thorac Oncol. 2019; 14: 1528-1537Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar, 14Marshall H.M. Courtney D.A. Passmore L.H. et al.Brief tailored smoking cessation counseling in a lung cancer screening population is feasible: a pilot randomized controlled trial.Nicotine Tob Res. 2016; 18: 1665-1669Crossref PubMed Scopus (32) Google Scholar In the Quit Smoking Lung Intervention Trial (QuLIT) initial phase (QuLIT 1), we demonstrated a significant increase in 3-month quit rate (29.9% vs 11%) for TLHC participants randomized to receive immediate face-to-face cessation support and pharmacotherapy compared with usual care (UC). The latter consisted of very brief advice (VBA) to quit and signposting to smoking cessation support.15Buttery S.C. Williams P. Mweseli R. et al.Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial.BMJ Open Respir Res. 2022; 9: e001030Crossref PubMed Scopus (11) Google Scholar Because of the COVID-19 pandemic, face-to-face support was suspended in March 2020 and the study was modified to investigate, in a discrete second phase (QuLIT 2), whether remote delivery of the smoking cessation intervention also was effective compared with UC. QuLIT 2 was a single-masked, randomized controlled trial comparing the effectiveness of an immediate, intensive telephone smoking cessation intervention (TSI) compared with VBA to quit and signposting delivered in the context of a TLHC. People living in the London boroughs of Sutton, Hillingdon, and Hammersmith and Fulham who were 55 to 75 years of age with a recorded history of smoking were invited for a TLHC assessment, as described previously.15Buttery S.C. Williams P. Mweseli R. et al.Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial.BMJ Open Respir Res. 2022; 9: e001030Crossref PubMed Scopus (11) Google Scholar All current smokers who took part in the TLHC were included in the study (current smokers were defined as any person self-reporting smoking tobacco, including cigarettes, pipes, and cigars, at the time of the TLHC). All participants who smoked were included in the study population, regardless of readiness or motivation to quit. The Healthy Lung Project is an investigational lung cancer screening pilot delivered by the Royal Brompton Hospital, supported by RM Partners, the West London Cancer Alliance, and the NHS funded through the National Cancer Transformation Fund. Because of the COVID-19 pandemic, in 2021, all initial prescan TLHC appointments were changed to a remote telephone delivery model. They included an in-depth discussion of participants' current or historical smoking behavior, medical and occupational history, and familial cancer history. If participants were deemed at high risk of lung cancer according to the Prostate, Lung, Colorectal and Ovarian Trial or Liverpool Lung Project screening risk models,16Cassidy A. Myles J.P. van Tongeren M. et al.The LLP risk model: an individual risk prediction model for lung cancer.Br J Cancer. 2008; 98: 270-276Crossref PubMed Scopus (358) Google Scholar,17Ten Haaf K. Jeon J. Tammemägi M.C. et al.Risk prediction models for selection of lung cancer screening candidates: a retrospective validation study.PLoS Med. 2017; 14e1002277Crossref Scopus (193) Google Scholar they were invited for an LDCT scan. The study was approved by the South Central—Oxford C Research Ethics Committee and the Health Research Authority (Reference: 18/SC/0236). The requirement for individual consent was waived by the ethics committee because obtaining this would itself have been an intervention and would have influenced outcomes in the control group. The initial QuLIT 1 and the amended study reported here, QuLIT 2, were registered prospectively online (ISRCTN12455871). Participants in the trial attended the TLHC appointment between April 1 and June 31, 2021. Half of the days during that period were allocated by random number generation as TSI days and half as UC days. Appointments for the TLHC were allocated by an administrator who was unaware of to which study arm the days had been allocated. Participants in the TSI group received a telephone call from the smoking cessation practitioner after the initial TLHC appointment. To capitalize on this so-called teachable moment, the smoking cessation practitioners attempted to call the participants on the same day that they underwent the TLHC. If they were unable to reach participants, they would call the them the next day. Participants were offered six sessions of telephone behavioral counselling support in addition to pharmacotherapy (varenicline or nicotine replacement therapies). Counselling sessions were based on the National Centre for Smoking Cessation and Training and Kick-It programs18Kick-ItHealthcare professionals 2018. Kick-It website.https://kick-it.org.uk/healthcare-professionals/Google Scholar,19National Center for Smoking Cessation and TrainingOnline training 2021. National Center for Smoking Cessation and Training website.https://elearning.ncsct.co.uk/Google Scholar and followed a structure of six sessions conducted once weekly. The timing of each phone visit was arranged between the participant and counselling staff. The initial session included a discussion of participants' smoking history, involving an assessment of dependence, information about available pharmacotherapy, including medication history to ensure that no interactions or contraindications occurred, and information about the program. The session would finish with a summary of the pharmacotherapy chosen and a commitment from the participant to engage with the program. Before a varenicline prescription was made, the nurses discussed the patients' medical and drug history with a medical doctor (K. E. J. P. or N. S. H.), who then prescribed the medication or suggested an alternative. All pharmacotherapies were prescribed by the trial team and were despatched via the hospital's pharmacy. We sent the chosen pharmacotherapy to participants directly by mail immediately after the first session, typically arriving within 48 h. The second session included preparing the participant to set a quit date, ensuring that they knew how to use or take their chosen pharmacotherapy, and a discussion around typical withdrawal symptoms. Sessions 3 through 6 were delivered after the set quit date and included support with withdrawal symptoms, pharmacotherapy reviews, commitment to the "not a puff" rule for participants who had quit and further behavioral support for participants who relapsed or were unable to commit to the quit date. All sessions were delivered over the phone by two specialist research nurses who had undergone the National Centre for Smoking Cessation Training and KickIT training programs.18Kick-ItHealthcare professionals 2018. Kick-It website.https://kick-it.org.uk/healthcare-professionals/Google Scholar,19National Center for Smoking Cessation and TrainingOnline training 2021. National Center for Smoking Cessation and Training website.https://elearning.ncsct.co.uk/Google Scholar People in the intervention arm also were signposted to the London Stop Smoking portal (https://london.stopsmokingportal.com/), local smoking cessation services, or both if they did not wish to engage with, or withdrew from, the smoking cessation program. Those attending on UC days received VBA to quit ("Stopping smoking is the most important thing that you can do to improve your health now and reduce the risk of health problems in the future.") as outlined by the National Centre for Smoking Cessation and Training.20National Center for Smoking Cessation and Training. Very brief advice 2021. Accessed June 17, 2022. https://www.ncsct.co.uk/publication_very-brief-advice.phpGoogle Scholar They were directed to the London Stop Smoking online portal, which provides information to smokers about how to engage with local stop smoking services, as well as a a quit smoking telephone support line. Participants living in the London borough of Sutton were advised to contact their general practitioner for stop smoking support because no specialist smoking cessation support was available in this borough. VBA to quit and signposting were delivered by the specialist respiratory nurses who administered the TLHC clinics and occurred at the end of the appointment. Three months after the TLHC appointment, participants were called by a researcher (K. E. J. P. or P. J. W.) who was masked to study allocation. The content of the call was structured on a set of short, predefined questions. This included the primary outcome measure, which was self-reported 7-day point prevalence smoking abstinence, with a successful quit defined as no smoking or other tobacco product use within the last 7 days. Data relating to secondary outcome measures also were collected, including quit attempts made and pharmacotherapy used. Quit attempts were defined as an attempt to stop smoking that lasted for 1 day and are presented as the number of individuals who made at least one quit attempt during the previous 3-month period. If participants did not pick up on the first call, two more calls were made at different times of the day. If the participant did not pick up on the third call, a voicemail was left requesting a call back. In the event that the participant did not call back within the week (or had no voicemail facility) they were classed as lost to follow-up. The primary outcome was self-reported 7-day point prevalence abstinence from smoking 3 months after randomization compared between groups. The sample size was calculated using the findings of two studies: the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) trial,21Anthenelli R.M. Benowitz N.L. West R. et al.Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial.Lancet. 2016; 387: 2507-2520Abstract Full Text Full Text PDF PubMed Scopus (674) Google Scholar which found a 38% quit rate in the pharmacology arm, and the United Kingdom Lung Cancer Screening Study,8Brain K. Carter B. Lifford K.J. et al.Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial.Thorax. 2017; 72: 912-918Crossref PubMed Scopus (86) Google Scholar which found a 14% quit rate in the arm undergoing CT scan screening. Based on these rates, a superiority study (1:1 randomization) with 90% power at a 5% significance level required 136 participants (calculator at Sealed Envelope: https://www.sealedenvelope.com/power/binary-superiority/). To improve the power of exploratory analyses comparing different subgroups (eg, those with or without positive CT scan results), we intended to recruit as many participants from the clinical screening program as possible. Simple logistic regression analysis (unadjusted) was used to assess primary and secondary end points. We ran two models in the adjusted logistic regression analysis: model 1 adjusted for sex, age, and CT scan result, and model 2 adjusted for sex, age, and baseline demographics (age, sex, and smoking characteristics); intervention, age, and sex were retained in both models. As a sensitivity analysis, we assumed that all individuals lost to follow-up were still smoking. Analysis was based on intention to treat, and a P value of < .05 was taken as statistically significant. All data were analyzed using SPSS version 27 software (SPSS Institute). Baseline participant characteristics at the time of enrolment were well matched (Table 1).22Ministry of Housing, Communities and Local Government. The English indices of deprivation 2019 (IoD 2019). Government Document 2019 20/09/2021Google Scholar A total of 315 individuals who smoke underwent a TLHC during the study period and were enrolled into the study: 163 attended on days allocated to UC and 152 attended on days allocated to TSI. Figure 1 represents the flow of patients through the trial.Table 1Baseline Demographic CharacteristicsCharacteristicUC (n =163)Intervention (n = 152)Age, y63.0 ± 5.461.3 ± 4.8Sex Female84 (51.5)68 (44.7) Male79 (48.5)84 (55.3)EthnicityaGroupings as recommended by the Prostate, Lung Colorectal and Ovarian Screening Trial. White138 (84.6)131 (86) Black9 (5.6)6 (4.0) Asian12 (7.3)9 (6.0) Other3 (1.9)5 (3.3) Prefer not to say1 (0.6)1 (0.7)Education < GCSE64 (39.3)59 (38.9) GCSE63 (38.7)49 (32.2) A level23 (14.2)17 (11.1) Some university2 (1.3)7 (4.6) Degree plus postgraduate work11 (6.5)20 (17.2)IMD quintilebIndex: quantile 1 = most deprived areas in England; quantile 5 = least deprived areas in England.22 1 (most deprived)9 (5.5)15 (9.9) 219 (11.7)19 (12.5) 340 (24.5)26 (17.1) 465 (39.9)52 (34.2) 5 (least deprived)30 (18.4)40 (26.3)Baseline smoking characteristics Age started smoking, y18.1 ± 6.318.0 ± 5.9 Average No. of cigarettes per day12.6 ± 7.912.5 ± 7.7 Duration of smoking, y42.5 ± 9.540.9 ± 9.0CT scan results No scan neededcParticipant did not meet CT scan criteria according to the Prostate, Lung Colorectal and Ovarian Screening Trial and Liverpool Lung Project risk models.16,1759 (36.2)52 (34.2) NegativedResults were clear, no evidence of nodules or incidental findings.55 (33.7)60 (39.4) PositiveeNodules requiring 3-, 6-, or 12-month follow-up scan, suspicious lesions, nodular consolidation, or incidental findings.49 (30.1)40 (26.4)Data are presented as No. (%) or mean ± SD. GCSE = General Certificate of Secondary Education; IMD = index of multiple deprivation; UC = usual care.a Groupings as recommended by the Prostate, Lung Colorectal and Ovarian Screening Trial.b Index: quantile 1 = most deprived areas in England; quantile 5 = least deprived areas in England.22Ministry of Housing, Communities and Local Government. The English indices of deprivation 2019 (IoD 2019). Government Document 2019 20/09/2021Google Scholarc Participant did not meet CT scan criteria according to the Prostate, Lung Colorectal and Ovarian Screening Trial and Liverpool Lung Project risk models.16Cassidy A. Myles J.P. van Tongeren M. et al.The LLP risk model: an individual risk prediction model for lung cancer.Br J Cancer. 2008; 98: 270-276Crossref PubMed Scopus (358) Google Scholar,17Ten Haaf K. Jeon J. Tammemägi M.C. et al.Risk prediction models for selection of lung cancer screening candidates: a retrospective validation study.PLoS Med. 2017; 14e1002277Crossref Scopus (193) Google Scholard Results were clear, no evidence of nodules or incidental findings.e Nodules requiring 3-, 6-, or 12-month follow-up scan, suspicious lesions, nodular consolidation, or incidental findings. Open table in a new tab Data are presented as No. (%) or mean ± SD. GCSE = General Certificate of Secondary Education; IMD = index of multiple deprivation; UC = usual care. Of the 152 participants attending on days randomized to TSI, 80 participants (52%) declined to engage with the smoking cessation support, explicitly asking not to be contacted by our cessation nurses. Of the remaining 72 participants in the TSI arm, 57 of 72 participants (79%) were enrolled into the full cessation program and 16 of 72 participants (21%) dropped out after the initial session. Reasons given for dropping out were being unable to commit to the "not a puff" rule or not being ready to commit to the program (committing to the "not a puff" rule and the program are essential components of the smoking cessation set out by KickIT and the National Centre for Smoking Cessation and Training,18Kick-ItHealthcare professionals 2018. Kick-It website.https://kick-it.org.uk/healthcare-professionals/Google Scholar,19National Center for Smoking Cessation and TrainingOnline training 2021. National Center for Smoking Cessation and Training website.https://elearning.ncsct.co.uk/Google Scholar,23Kick-ItHealthcare professionals 2018. Kick-It website.https://kick-it.org.uk/healthcare-professionals/Google Scholar which our intervention was based on). The average number of sessions completed by the participants was 5.1, with 61% of participants completing the full six sessions. The average length of time for the telephone sessions was 27 min. Three-month follow-up data were available for 227 of 315 participants (72%; UC group, 115/163 participants [70%]; TSI group, 112/152 participants [73%]). Quit rates were higher in the intervention arm: 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.60; P = .002) (Table 2). The numbers reporting quit attempts, including successful and unsuccessful attempts, also was higher in the TSI group (57/152 participants [37.5%] vs 36/163 participants [22.0%]; OR, 2.11; 95% CI, 1.29-3.47; P = .003) (Table 2, Fig 2). We explored whether undergoing the CT scan itself influenced quit rates among the study arms. Within the UC arm, undergoing a CT scan did not influence quit rates: UC without CT scan, 4/59 participants [6.7%] vs UC with CT scan, 10/104 participants [9.5%]; OR, 0.68; 95% CI, 0.20-2.28; P = .53). This was similar within the TSI study arm: among TSI participants who did not undergo a CT scan, 14 of 52 participants (26.9%) quit compared with 18 of 100 participants (18%) among TSI participants who underwent a CT scan (OR, 1.67; 95% CI, 0.75-3.72; P = .23).Table 2Smoking Cessation and Quit Attempts at 3 MoVariableTSI (n = 152)UC (n = 163)OR (95% CI)P ValueSeven-d smoking abstinence. . . Yes32 (21)14 (8.9)2.83 (1.44-5.61)002 No120 (79)149 (91.1). . .. . .Individuals reporting a quit attemptaIncludes both successful and unsuccessful quit attempts.. . . Yes57 (37.5)36 (22.0)2.11 (1.29-3.47)003 No95 (62.5)127 (78.0). . .. . .Pharmacotherapy aids used to support quit attempts. . . Varenicline16 (28.0)1 (2.7)13.65 (1.72-108.24)01 Single-item NRT12 (21.0)2 (5.5)4.53 (0.95- 21.61)05 Dual-item NRT21 (37.0)3 (3.8)6.41 (1.75-23.51)005 E-cigarette8 (14.0)11 (30.5)0.37 (0.13-1.04)05 None0 (0)19 (57.5)0.06 (0.0-0.27)004Data are presented as No. (%), unless otherwise indicated. NRT = nicotine replacement therapy; TSI = telephone smoking cessation intervention; UC = usual care.a Includes both successful and unsuccessful quit attempts. Open table in a new tab Data are presented as No. (%), unless otherwise indicated. NRT = nicotine replacement therapy; TSI = telephone smoking cessation intervention; UC = usual care. The use of all types of pharmacotherapies (varenicline, single-item nicotine replacement therapy, and dual-item nicotine replacement therapy) during quit attempts was more common in the TSI group (OR, 20.90; 95% CI, 6.98-62.55; P ≤ .001) (Table 2). By contrast, participants in the UC group were more likely to report use of e-cigarettes to aid quit attempts (TSI, 14.0% vs UC, 30.5%). Of note, in the UC arm only three of 36 participants attempting to quit accessed behavioral support via their local service (two quit successfully) and one of 36 participants used the NHS stop smoking smartphone app. Results from the two logistic regression models are displayed in Table 3; data from participants who did not undergo a CT scan were excluded from model 2. Personal demographic features (sex, age), CT scan results (positive or negative), and smoking characteristics (average number of cigarettes per day, age started smoking, and number of years smoking) had no effect on quit rates at 3 months within the cohort.Table 3Logistic Regression Models of Covariates Associated With Smoking Abstinence at 3 MoVariableModel 1: Sex, Age, and CT Scan Results (n = 315)Model 2: Sex, Age, and Baseline Smoking Characteristics (n = 315)Intervention2.80 (1.42-5.53)2.62 (1.32-5.24)Sex (men vs women)1.00 (0.581-1.44)1.00 (0.57-1.43)Age (continuous)1.00 (0.90-0.98)1.01 (0.90-1.01)CT scan resultsNegative1.46 (0.77-2.72)...PositiveaNodules requiring 3-, 6-, or
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