Motivational enhancement therapy for high-risk adolescent smokers. Feasibility, cost, and cost-effectiveness of a telephone-based motivational intervention for underserved pregnant smokers. Evaluation of a motivational smoking cessation intervention for women in public health clinics. Improving the rates of quitting smoking for veterans with posttraumatic stress disorder. Effects of motivational interviewing on smoking cessation in adolescents with psychiatric disorders Smoking cessation intervention for female prisoners: addressing an urgent public health need. Using tailored interventions to enhance smoking cessation among African-Americans at a community health center. Effectiveness of a cognitive behaviour therapy self-help programme for smokers in London, UK. Evaluation of a smoking cessation intervention for pregnant women in an urban prenatal clinic. Pediatric-based smoking cessation intervention for low-income women: a randomized trial. Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. Baby BEEP: A Randomized Controlled Trial of Nurses’ Individualized Social Support for Poor Rural Pregnant Smokers A controlled study of a cigarette smoking cessation intervention for adolescents in substance abuse treatment. Feasibility of an exercise counseling intervention for depressed women smokers. Smoking and its correlates in an Australian prisoner population. Smoking cessation using mobile phone text messaging is as effective in Maori as non-Maori. Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students. Enhancing smoking cessation of low-income smokers in managed care. Comparison of two intensities of tobacco dependence counseling in schizophrenia and schizoaffective disorder. Combining community participatory research with a randomized clinical trial: the Protecting the Hood Against Tobacco (PHAT) smoking cessation study. Tobacco cessation via public dental clinics: results of a randomized trial. A Randomized Controlled Trial of a Smoking Cessation Intervention for Pregnant Adolescents A brief smoking cessation intervention for women in low-income planned parenthood clinics. Treatment for cigarette smoking among depressed mental health outpatients: a randomized clinical trial. Closing tobacco-related disparities: Using community organizations to increase consumer demand. Smoking cessation in homeless populations: a pilot clinical trial. A Comparison of Smoking Cessation Treatments for Persons with Schizophrenia and Other Serious Mental Illnesses Cognitive-behavioral treatment for depression in smoking cessation. Is implementation of the 5 A's of smoking cessation at community mental health centers effective for reduction of smoking by patients with serious mental illness? A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. A Preliminary Study of the Use of Peer Support in Smoking Cessation Programs for Pregnant Adolescents Cost-Effectiveness of Motivational Interviewing for Smoking Cessation and Relapse Prevention Among Low-Income Pregnant Women: A Randomized Controlled Trial Pathways to Health: A Cluster Randomized Trial of Nicotine Gum and Motivational Interviewing for Smoking Cessation in Low-Income Housing
The majority of regular adult smokers begin smoking in adolescence and there is a clear need for youth-targeted smoking cessation interventions . The present r and omized , controlled trial tested the effectiveness of motivational enhancement therapy ( MET ) to reduce  smoking among 81 adjudicated adolescents . Participants received either MET or an education control .  Smoking abstinence , quantity , and frequency were assessed at 1 and 6 months post treatment . Results suggest that although between-group differences on outcome measures were not significant at follow-up , smoking behavior decreased in both groups with approximately 10 % achieving 1-month smoking abstinence at 6-month follow-up . Furthermore , participant response to MET varied by level of alcohol use and impulsivity such that participants with lower levels of alcohol use and impulsivity had significantly greater response to MET . In contrast , participants who endorsed higher rates of alcohol use and impulsivity responded better to the control than the MET condition . Results suggest that MET may be an effective intervention for some adolescent smokers but may be contraindicated for adolescents who have concomitant problems with alcohol use or impulsivity This study reports on the evaluation of the feasibility , cost , and cost-effectiveness of a proactively provided telephone-based motivational smoking cessation intervention to an underserved population of pregnant smokers who may or may not receive ongoing prenatal care . As part of the New Engl and SCRIPT r and omized clinical trial comparing the efficacy of three types of smoking cessation interventions for pregnant smokers , one-third of the women ( n = 358 ) received a motivational telephone counseling intervention ( MI ) delivered by trained counselors using a semistructured protocol . Although this population was very mobile , the MI counselors were able to reach 86 % of the women with at least one call and 46 % received all three calls . The group receiving three MI calls had a cotinine-confirmed quit rate of 23 % . Cost-effectiveness analyses for those women receiving telephone counseling supported the net benefit in favor of the three phone calls compared with the women who did not receive any telephone calls , with an effectiveness to cost ratio of 1:US dollars 84 . Our results suggest that telephone-based motivational smoking cessation counseling may be a feasible and cost-effective method for low-income pregnant smokers enrolled in prenatal care BACKGROUND A multicomponent motivational smoking cessation intervention was evaluated in 33 prenatal , family planning , and pediatric services in 12 public health clinics .  Clinic-based intervention components were implemented by clinic personnel as part of routine medical visits . METHODS The evaluation design included pre- and postintervention measurements of multiple study outcomes in a baseline ( all clinics prior to the start of the intervention ) and an experimental period ( matchedpair r and om assignment of clinics to intervention or control conditions ) . Subjects were 683 ( baseline ) and 1,064 ( experimental ) smokers with measurements of smoking outcomes at both times . Mixed-effects regressions analyzed individual outcomes clustered within clinics and services . RESULTS Control and intervention clinics had similar outcomes in the baseline period . In the experiment , outcomes improved in the intervention but not in the control clinics . Compared to controls , smokers exposed to the intervention were more likely to have quit ( 14.5 versus 7.7 % ) or take actions toward quitting and had higher mean action , stage of readiness , and motivation to quit scores . These positive effects persisted when clustering within clinics and services was controlled . CONCLUSIONS This intervention , implemented by clinic personnel as part of routine medical visits , was effective under these natural conditions across different types of clinic service OBJECTIVE Smoking is highly prevalent and refractory among people with posttraumatic stress disorder ( PTSD ) . This study aim ed to improve the rate of quitting smoking for veterans with PTSD by integrating treatment for nicotine dependence into mental health care . METHOD Smokers undergoing treatment for PTSD ( N=66 ) were r and omly assigned to 1 ) tobacco use treatment delivered by mental health providers and integrated with psychiatric care ( integrated care ) versus 2 ) cessation treatment delivered separately from PTSD care by smoking-cessation specialists ( usual st and ard of care ) . Seven-day point prevalence abstinence was the primary outcome , measured at 2 , 4 , 6 , and 9 months after r and om assignment . Data were analyzed by using a generalized estimating equations approach following the intent-to-treat principle . RESULTS Subjects assigned to integrated care were five times more likely than subjects undergoing the usual st and ard of care to abstain from smoking across follow-up assessment intervals ( odds ratio=5.23 ) . Subjects in the integrated care condition were significantly more likely than subjects in usual st and ard of care to receive transdermal nicotine and nicotine gum . They also received a greater number of smoking-cessation counseling sessions . Stopping smoking was not associated with worsening symptoms of PTSD or depression . CONCLUSIONS Smoking-cessation interventions can be safely incorporated into routine mental health care for PTSD and are more effective than treatment delivered separately by a specialized smoking-cessation clinic . Integrating cessation treatment into psychiatric care may have the potential for improving smoking quit rates in other population s of chronically mentally ill smokers Objective : To test the hypothesis that among adolescent smokers hospitalised for psychiatric and substance use disorders , motivational interviewing ( MI ) would lead to more and longer quit attempts , reduced smoking , and more abstinence from smoking over a 12 month follow up . Design : R and omised control trial of MI versus brief advice ( BA ) for smoking cessation , with pre- and post-intervention assessment of self efficacy and intentions to change , and smoking outcome variables assessed at one , three , six , nine , and 12 month follow ups . Setting : A private , university affiliated psychiatric hospital in Providence , Rhode Isl and , USA . Patients or other participants : Consecutive sample ( n = 191 ) of 13–17 year olds , admitted for psychiatric hospitalisation , who smoked at least one cigarette per week for the past four weeks , had access to a telephone , and did not meet DSM-IV criteria for current psychotic disorder . Interventions : MI versus BA . MI consisted of two , 45 minute individual sessions , while BA consisted of 5–10 minutes of advice and information on how to quit smoking . Eligible participants in both conditions were offered an eight week regimen of transdermal nicotine patch upon hospital discharge . Main outcome measures : Point prevalence abstinence , quit attempts , changes in smoking rate and longest quit attempt . Proximal outcomes included intent to change smoking behaviour ( upon hospital discharge ) , and self efficacy for smoking cessation . Results : MI did not lead to better smoking outcomes compared to BA . MI was more effective than BA for increasing self efficacy regarding ability to quit smoking . A significant interaction of treatment with baseline intention to quit smoking was also found . MI was more effective than BA for adolescents with little or no intention to change their smoking , but was actually less effective for adolescents with pre-existing intention to cut down or quit smoking . However , the effects on these variables were relatively modest and only moderately related to outcome . Adolescents with comorbid substance use disorders smoked more during follow up while those with anxiety disorders smoked less and were more likely to be abstinent . Conclusions : The positive effect of MI on self efficacy for quitting and the increase in intention to change in those with initially low levels of intentions suggest the benefits of such an intervention . However , the effects on these variables were relatively modest and only moderately related to outcome . The lack of overall effect of MI on smoking cessation outcomes suggests the need to further enhance and intensify this type of treatment approach for adolescent smokers with psychiatric comorbidity OBJECTIVES We tested the efficacy of a combined pharmacologic and behavioral smoking cessation intervention among women in a state prison in the southern United States . METHODS The study design was a r and omized controlled trial with a 6-month waitlist control group . The intervention was a 10-week group intervention combined with nicotine replacement therapy .  Two hundred and fifty participants received the intervention , and 289 were in the control group .  Assessment s occurred at baseline ; end of treatment ; 3 , 6 , and 12 months after treatment ; and at weekly sessions for participants in the intervention group . RESULTS The intervention was efficacious compared with the waitlist control group . Point prevalence quit rates for the intervention group were 18 % at end of treatment , 17 % at 3-month follow-up , 14 % at 6-month follow-up , and 12 % at 12-month follow-up , quit rates that are consistent with outcomes from community smoking-cessation interventions . CONCLUSIONS Female prisoners are interested in smoking cessation interventions and achieved point-prevalence quit rates similar to community sample s. Augmenting tobacco control policies in prison with smoking cessation interventions has the potential to address a significant public health need This prospect i ve r and omized study examined the impact of three tailored intervention approaches to increase quitting rates among African-American smokers who were clients of a community health center that serves primarily low-income and indigent persons . Smokers were r and omized to one of three groups : ( 1 ) health care provider prompting intervention alone , ( 2 ) health care provider prompting intervention with tailored print communications , and ( 3 ) health care provider prompting intervention with tailored print communications and tailored telephone counseling . Among the 160 smokers who completed the study , 35 ( 21.8 % ) had quit smoking at follow-up . Smokers who received the provider prompting intervention with tailored print material s were more likely to report having quit than smokers who received the provider intervention alone ( 32.7 % vs. 13.2 % , p < 0.05 ) . Smokers who received all three intervention components were not more likely to report having quit at follow-up than those who only received the provider intervention ( 19.2 % vs. 13.2 % ) . Smokers who at baseline were less educated , smoked less than half a pack of cigarettes per day , had a stronger desire to quit , felt more efficacious , and had thought about quitting were more likely to report having quit at follow-up . These results provide support for continued refinement of tailored communications to aid smoking cessation among African-American smokers One of the key goals of health promotion strategies in the UK and other developed countries is to reduce the prevalence of cigarette consumption . While overall smoking rates in the UK have fallen over the last few decades , they have barely fallen for the least advantaged adults ( Department of Health , 1998a ) . There is a need for interventions that are suitable for lower socio-economic status ( SES ) smokers that have undergone rigorous evaluation . This study describes a r and omized controlled trial of cognitive behaviour therapy ( CBT ) with smokers from a deprived area of London . At 6 months follow-up , 21 ( 17.2 % ) of 122 participants receiving therapy were abstinent and 14 ( 11.5 % ) had reduced cigarette consumption by at least 25 % of pre-treatment level . Six ( 5.6 % ) of 107 participants in the control group were abstinent and none had reduced consumption . These results suggest that this self-help CBT intervention has the potential to reduce the prevalence of smoking among lower SES smokers A smoking cessation and relapse prevention intervention was tested in an urban , prenatal clinic serving predominantly low-income , African-American women . At their first prenatal visit , 391 smokers were r and omly assigned to an experimental ( E ) group to receive usual clinic information plus a prenatal and postpartum intervention or to a control ( C ) group to receive only usual clinic information . The intervention consisted of individual skills instruction and counseling by a peer health counselor on the use of a self-help cessation guide and routine clinic reinforcement . Among the E group ( n = 193 ) , 6.2 % were cotinine-confirmed quitters at third trimester and among the C group ( n = 198 ) the quit rate was 5.6 % . Quitters were light smokers at entry into prenatal care . Many had tried to quit smoking at least once prior to pregnancy BACKGROUND Continued high rates of smoking among socioeconomically disadvantaged women lead to increases in children 's health problems associated with exposure to tobacco smoke . The pediatric clinic is a " teachable setting " in which to provide advice and assistance to parents who smoke . OBJECTIVE To evaluate a smoking cessation intervention for women . DESIGN Two-arm ( usual care vs intervention ) r and omized trial . SETTING Pediatric clinics serving an ethnically diverse population of low-income families in the greater Seattle , Wash , area . INTERVENTION During the clinic visit , women received a motivational message from the child 's clinician , a guide to quitting smoking , and a 10-minute motivational interview with a nurse or study interventionist . Women received as many as 3 outreach telephone counseling calls from the clinic nurse or interventionist in the 3 months following the visit . PARTICIPANTS Self-identified women smokers ( n = 303 ) whose children received care at participating clinics . MAIN OUTCOME MEASURE Self-reported abstinence from smoking 12 months after enrollment in the study , defined as not smoking , even a puff , during the 7 days prior to assessment . RESULTS Response rates at 3 and 12 months were 80 % and 81 % . At both follow-ups , abstinence rates were twice as great in the intervention group as in the control group ( 7.7 % vs 3.4 % and 13.5 % vs 6.9 % , respectively ) . The 12-month difference was statistically significant . CONCLUSIONS A pediatric clinic smoking cessation intervention has long-term effects in a socioeconomically disadvantaged sample of women smokers . The results encourage implementation of evidence -based clinical guidelines for smoking cessation in pediatric practice OBJECTIVE Depressive symptoms are associated with poor smoking cessation outcomes , and there remains continued interest in behavioral interventions that simultaneously target smoking and depressive symptomatology . In this pilot study , we examined whether a behavioral activation treatment for smoking ( BATS ) can enhance cessation outcomes . METHOD A sample of 68 adult smokers with mildly elevated depressive symptoms ( M = 43.8 years of age ; 48.5 % were women ; 72.7 % were African American ) seeking smoking cessation treatment were r and omized to receive either BATS paired with st and ard treatment ( ST ) smoking cessation strategies including nicotine replacement therapy ( n = 35 ) or ST alone including nicotine replacement therapy ( n = 33 ) . BATS and ST were matched for contact time and included 8 sessions of group-based treatment . Quit date was assigned to occur at Session 4 for each treatment condition . Participants completed a baseline assessment ; furthermore , measures of smoking cessation outcomes ( 7-day verified point-prevalence abstinence ) , depressive symptoms ( Beck Depression Inventory-II ; Beck , Steer , & Brown , 1996 ) , and enjoyment from daily activities ( Environmental Reward Observation Scale ; Armento & Hopko , 2007 ) were obtained at 1 , 4 , 16 , and 26 weeks post assigned quit date . RESULTS Across the follow-ups over 26 weeks , participants in BATS reported greater smoking abstinence ( adjusted odds ratio = 3.59 , 95 % CI [ 1.22 , 10.53 ] , p = .02 ) than did those in ST . Participants in BATS also reported a greater reduction in depressive symptoms ( B = -1.99 , SE = 0.86 , p = .02 ) than did those in ST . CONCLUSIONS Results suggest BATS is a promising intervention that may promote smoking cessation and improve depressive symptoms among underserved smokers of diverse background Objectives We tested the effect of nurse-delivered telephone individualized social support ( “ Baby BEEP ” ) and eight mailed prenatal smoking cessation booklets singly and in combination ( 2 × 2 factorial design ) on smoking cessation in low-income rural pregnant women ( N = 695 ; 75 % participation ) . Methods Participants r and omized to Baby BEEP groups ( n = 345 ) received weekly calls throughout pregnancy plus 24 - 7 beeper access .  Saliva cotinine sample s were collected monthly from all groups by other nurses at home visits up to 6 weeks post-delivery . Primary outcomes were point prevalence abstinence ( cotinine < 30 ng/ml ) in late pregnancy and post-delivery . Results Only 47 women were lost to follow-up . Intent-to-treat analyses showed no difference across intervention groups ( 17–22 % , late pregnancy ; 11–13.5 % , postpartum ) , and no difference from the controls ( 17 % , late pregnancy ; 13 % , postpartum ) . Post hoc analyses of study completers suggested a four percentage-point advantage for the intervention groups over controls in producing early and mid-pregnancy continuous abstainers .  Partner smoking had no effect on late pregnancy abstinence ( OR = 1.7 , 95 % CI = 0.95 , 3.2 ) , but post-delivery , the effect was pronounced ( OR = 3.2 , 95 % CI = 1.8 , 5.9 ) . Conclusions High abstinence rates in the controls indicate the power of biologic monitoring and home visits to assess stress , support , depression , and intimate partner violence ; these elements plus booklets were as effective as more intensive interventions . Targeting partners who smoke is needed Tobacco use is prevalent among youth with alcohol and other drug problems , yet this issue has received limited research and clinical attention . This study reports on a controlled evaluation of a cigarette smoking intervention with 54 adolescents in treatment for substance abuse , ages 13 - 18 ( 22 % female ) . Participants were assessed at 4 time points . A greater proportion of participants in the treatment condition ( n = 26 ) reported cessation attempts and point abstinence than did control participants ( n = 28 ) at all time points . However , significant differences were found only for point abstinence at a 3-month follow-up . These findings provide initial support for the efficacy of a  smoking cessation intervention delivered in the context of adolescent substance abuse treatment INTRODUCTION Depressive symptoms negatively impact smoking abstinence . However , few interventions have been targeted to smokers with current depression .  Exercise improves mood and may benefit depressed smokers . This pilot study investigated the feasibility of an exercise intervention for depressed female smokers ( Center for Epidemiological Studies Depression Scale [ CES-D ] score > or = 16 ) . METHODS Participants ( M = 41 years , 98 % White ) were r and omized to 10 weeks of individually delivered exercise counseling ( n = 30 ) or a health education contact control condition ( n = 30 ) . All participants received nicotine patch therapy and behavioral counseling for smoking cessation . RESULTS The intervention was feasible as indicated by ability to recruit participants , exercise counseling session attendance ( M = 7.6 of 10 sessions attended ) , and significant increase in exercise frequency and stage of change from baseline to end of treatment ( EOT ) ( Week 10 ) . Participant attrition rate was 35 % by Week 10 but did not differ significantly between groups . Smoking abstinence rates at Week 10 , using intention-to-treat analysis , were 17 % for exercise counseling participants and 23 % for health education participants ( p = .75 ) . DISCUSSION An exercise counseling intervention was found to be feasible for depressed women smokers . More intensive intervention may be needed to increase smoking abstinence rates , and methods should be refined to reduce participant burden and attrition Despite evidence of high rates of smoking among prisoners , there has been limited research that describes smoking patterns and risk factors associated with smoking in this group . This study describes inmate smokers and identifies factors associated with smoking in prison , using a survey comprising a cross-sectional r and om sample of inmates stratified by sex , age and Aboriginality . A total of 914 adult inmates ( 747 men , 167 women ) were recruited from 29 New South Wales ( Australia ) correctional centres . Information on the prevalence of smoking , smoking history , smoking behaviours and other risk factors were collected . Of the participants , 79 % were current smokers ( 78 % men , 83 % women ) . Younger inmates were more likely than older inmates to smoke ( 86 % vs. 64 % ) . Most individuals smoked between 11 and 20 cigarettes a day and a median of 50 grams per week . In the previous year , over half ( 52 % ) of current smokers had attempted to quit or reduce the amount they smoked . At the time of the survey , 58 % of smokers had plans to quit ; 21 % within 3 months . Independent predictors of current smoking in the multivariate analysis were past use of cannabis and a history of illicit drug use . The prevalence of smoking in prison is extraordinarily high and exceeds that of the general community . Despite this , the majority of prisoners report plans to quit . Readily available smoking cessation advice , support and treatment are needed to assist those wanting to quit in this stressful environment . As the prevalence of smoking within the general community declines , assisting cessation in groups containing a disproportionate number of smokers will become increasingly important . Despite high levels of tobacco dependence , many prisoners intend to quit and health planners and custodial authorities need to encourage and support inmates who do attempt to quit AIMS To determine whether a smoking cessation service using mobile phone text messaging is as effective for Maori as non-Maori . METHODS A single-blind r and omised controlled trial was undertaken with recruitment targeted to maximise the participation of young Maori . The intervention included regular , personalised text messages providing smoking cessation advice , support , and distraction . Maori text messages related to Maori language , support messages ( in Maori and English ) and information on Maori traditions . Text messaging was free for 1 month . After 6 weeks , the number of messages reduced from 5 per day to 3 per week until the 26-week follow-up . RESULTS Participants included 355 Maori and 1350 non-Maori . Maori in the intervention group were more likely to report quitting ( no smoking in the past week ) at 6 weeks ( 26.1 % ) than those in the control group ( 11.2 % ) RR 2.34 , 95 % CI : 1.44 - 3.79 . There was no significant difference between the RR for Maori and that for non-Maori ( RR : 2.16 , 95%CI : 1.72 - 2.71 ) . CONCLUSIONS A mobile phone-based cessation programme was successful in recruiting young Maori , and was shown to be as effective for Maori as non-Maori at increasing short-term self-reported quit rates . This shows clear potential as a new public health initiative Few studies have examined the long-term efficacy of  computer-based smoking prevention and cessation programs . We analyzed the long-term impact of A Smoking Prevention Interactive Experience ( ASPIRE ) , a theoretically sound computer-based smoking prevention and cessation curriculum for high school students . Sixteen predominantly minority , inner-city high schools were r and omly assigned to receive the ASPIRE curriculum or st and ard care ( receipt of the National Cancer Institute 's Clearing the Air self-help booklet ) .  A total of 1160 students , 1098 of whom were nonsmokers and 62 smokers at baseline , were included . At 18-month follow-up , among baseline nonsmokers , smoking initiation rates were significantly lower in the ASPIRE condition ( 1.9 % vs. 5.8 % , p < .05 ) . Students receiving ASPIRE also demonstrated significantly higher decisional balance against smoking and decreased temptations to smoke . Differences between groups in self-efficacy and resistance skills were not significant . There was a nonsignificant trend toward improved smoking cessation with ASPIRE , but low recruitment of smokers precluded conclusions with respect to cessation . ASPIRE demonstrated the potential for an interactive multimedia program to promote smoking prevention . Further studies are required to determine ASPIRE 's effects on cessation BACKGROUND Although office-based and telephone support services enhance the rate of smoking cessation in managed care systems , it is not clear whether such services are effective for very low-income smokers . We evaluated the comparative effectiveness of usual care ( physician-delivered advice and follow-up ) and usual care enhanced by 6 computer-assisted telephonic-counseling sessions by office nurses and telephone counselors  for  smoking cessation in very low-income smokers in Medicaid managed care . METHODS A r and omized clinical trial comparing the 2 approaches was conducted in 3 Michigan community health centers . All clinicians and center staff received st and ard training in usual care . Selected nurses and telephone counselors received special training in a computer-assisted counseling program focusing on relapse prevention . RESULTS The majority of the study population ( 233 adult smokers with telephones ) were white ( 64 % ) women ( 70 % ) with annual incomes of less than $ 10,000 ( 79 % ) and with prescriptions of nicotine replacement therapy ( > 90 % ) . At 3 months , quit rates ( smoke-free status verified by carbon monoxide monitors ) were 8.1 % in the usual-care group and 21 % in the telephonic-counseling group ( P=.009 ) by intention-to-treat analysis . Special tracking methods were successful in maintaining participants in treatment . CONCLUSIONS Smoking cessation rates are enhanced in a population of very low-income smokers if individualized telephonic-counseling is provided . State and Medicaid managed care plans should consider investing in both office-based nurse and central ized telephonic-counseling services for low-income smokers Compared to the general population , smokers with schizophrenia ( SCZ ) have reduced success in quitting smoking with usual approaches . This study tested two manualized behavioral counseling approaches-Treatment of Addiction to Nicotine in Schizophrenia ( TANS ) or Medication Management (MM)-for  smokers who were motivated to quit .  Individual counseling sessions were provided by mental health clinicians in mental health setting s , along with nicotine patch . The two treatments varied in intensity and frequency of sessions . Eighty-seven subjects were r and omized and attended at least one treatment session . Twenty-one percent ( n = 18 ) of participants had continuous abstinence at 12 weeks after the target quit date , which was not significantly different between conditions ( 15.6 % TANS vs. 26.2 % MM , chi(2 ) = 1.50 , p = .221 ) . Smokers in both groups significantly reduced smoking as measured by cigarettes per day and expired carbon monoxide . Findings support that mental health clinicians can be trained to effectively help smokers with SCZ maintain tobacco abstinence BACKGROUND This article describes the process and results of a smoking cessation intervention r and omized clinical trial ( RCT ) that was conducted as a community-based participatory research project . This RCT tested whether outcomes are improved by adding social justice and tobacco industry targeting messages to a smoking cessation program conducted among African American adults within a low-income community in San Francisco , California . This study provides lessons for future similar research projects that focus on urban low-income population s. METHODS Participants were r and omly allocated to receive a smoking-cessation program ( control group [ CG ] ) or CG care plus tobacco industry and media ( IAM ) messages . Primary interventions were behavioral . At intake , participants reporting severe withdrawal or smoking > or = 25 cigarettes daily were offered free nicotine replacement therapy . Baseline data were from an in-person interview . Outcome measures included self-reported smoking status ; validation of quitting was by salivary cotinine assays . RESULTS Of 87 participants providing baseline data , 31 % ( 27 ) did not join the RCT .  Proportions quitting in the CG and IAM group were 11.5 % and 13.6 % at 6 months and 5.3 % and 15.8 % at 12 months , respectively . CONCLUSION African Americans in underserved inner-city neighborhoods can be recruited into RCTs with community participatory approaches . Differences between the CG and IAM in proportions who quit were 2.1 % and 10.5 % at 6 and 12 months , respectively . More than 3 years with adequate funding , high staffing ratios , and intense outreach and follow-up schedules are needed to achieve recruitment and study goals OBJECTIVES We sought to compare the effectiveness of a dental practitioner advice and brief counseling intervention to quit tobacco use versus usual care for patients in community health centers on tobacco cessation ,  reduction in tobacco use , number of quit attempts , and change in readiness to quit . METHODS We r and omized 14 federally funded community health center dental clinics that serve diverse racial/ethnic groups in 3 states ( Mississippi , New York , and Oregon ) to the intervention ( brief advice and assistance , including nicotine replacement therapy ) or usual care group .  RESULTS We enrolled 2549 smokers . Participants in the intervention group reported significantly higher abstinence rates at the 7.5-month follow-up , for both point prevalence ( F(1,12 ) = 6.84 ; P < .05 ) and prolonged abstinence ( F(1,12 ) = 14.62 ; P < .01 ) than did those in the usual care group . CONCLUSIONS The results of our study suggest the viability and effectiveness of tobacco cessation services delivered to low-income smokers via their dental health care practitioner in community health centers . Tobacco cessation services delivered in public dental clinics have the potential to improve the health and well-being of millions of Americans Background : The smoking prevalence rate among pregnant adolescents has been estimated at 59 - 62 % , and 60 - 80 % of these adolescents continue to smoke throughout their pregnancies . Objectives : The aim of this study was to evaluate the short- and long-term effects of smoking cessation strategies tailored to the pregnant adolescent to attain and maintain abstinence . The specific aim was to examine differences in short- and long-term smoking behaviors among three groups : Teen FreshStart ( TFS )  ,  Teen FreshStart Plus Buddy ( TFS-B ) , and  Usual Care ( UC ) control . Methods : In this r and omized controlled intervention study , a3-group ( TFS , TFS-B , and UC ) by 3-occasion ( baseline , 8 weeks postr and omization , and 1-year following study entry ) design was used . The study included 142 pregnant adolescents who were aged 14 to 19 years . Both self-reported smoking status collected on the Smoking History Question naire and saliva cotinine levels were used to identify smoking behaviors . Results : There were no significant differences among the three treatment groups at baseline in terms of the racial distribution , age , gestational age , age of menses initiation , number in family household , number of family members who smoked , or tobacco use . A significant difference between the UC group and the TFS-B group ( p = .010 ) was seen in smoking behaviors measured 8 weeks following treatment initiation . At 1 year following study entry , however , there were no differences between the groups in smoking behaviors . Discussion : The TFS-B intervention was more effective in attaining short-term smoking cessation in the pregnant adolescent than TFS or UC . Findings suggest that the peer-enhanced programming had a limited effect but could not sustain the participant beyond postpartum ( 1 year following study entry ) . Future studies should include relapse prevention to sustain smoking abstinence into the postpartum period OBJECTIVES The purpose of this study was to evaluate a brief  smoking cessation intervention for women 15 to 35 years of age attending Planned Parenthood clinics . METHODS Female smokers ( n = 1154 ) were r and omly assigned either to advice only or to a brief intervention that involved a 9-minute video , 12 to 15 minutes of behavioral counseling , clinician advice to quit , and follow-up telephone calls . RESULTS Seventy-six percent of those eligible participated . Results revealed a clear , short-term intervention effect at the 6-week follow-up ( 7-day self-reported abstinence : 10.2 % vs 6.9 % for advice only , P < .05 ) and a more ambiguous effect at 6 months ( 30-day biochemically vali date d abstinence : 6.4 % vs 3.8 % , NS ) . CONCLUSIONS This brief , clinic-based intervention appears to be effective in reaching and enhancing cessation among female smokers , a traditionally underserved population OBJECTIVES Using a brief contact control , we tested the efficacy of a staged care intervention to reduce cigarette smoking among psychiatric patients in outpatient treatment for depression . METHODS We conducted a r and omized clinical trial that included assessment s at baseline and at months 3 , 6 , 12 , and 18 . Three hundred twenty-two patients in mental health outpatient treatment who were diagnosed with depression and smoked > or = 1 cigarette per day participated . The desire to quit smoking was not a prerequisite for participation . Staged care intervention participants received computerized motivational feedback at baseline and at 3 , 6 , and 12 months and were offered a 6-session psychological counseling and pharmacological cessation treatment program . Brief contact control participants received a self-help guide and referral list of local smoking-treatment providers . RESULTS As we hypothesized , abstinence rates among staged care intervention participants exceeded those of brief contact control participants at months 12 and 18 . Significant differences favoring staged care intervention also were found in occurrence of a quit attempt and stringency of abstinence goal . CONCLUSION The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient setting BACKGROUND Individuals living in poverty are more likely to smoke , and they suffer disproportionately from tobacco use . Strategies used to deliver tobacco-cessation interventions often fail to reach smokers living in poverty . Providing tobacco interventions to smokers when they present to community organizations is a potential strategy , but the acceptability and effectiveness of such interventions is unknown . METHODS In this 2007 pilot study , 295 smokers seeking emergency assistance from the Salvation Army in Wisconsin were r and omly assigned to either a very brief ( 30-second ) smoking intervention condition or to a control no-intervention condition . All participants completed a follow-up survey at the end of their visit assessing their satisfaction with the community agency , interest in quitting , and motivation to quit . RESULTS This brief intervention increased the likelihood that smokers would seek help when they decided to quit ( 61 % vs 44 % , p<0.05 ) but did not affect intention to quit in the next 6 months or perceived difficulty of quitting . The intervention was well received by both participants and Salvation Army staff . CONCLUSIONS Smokers in this pilot study found it acceptable to have their smoking addressed when seeking services from a community agency . Such interventions may need to be more intense than the one used in this study in order to achieve the goal of increased motivation to quit . Community agencies should consider including brief tobacco-dependence interventions as a secondary mission to improve their clients ' health This study , which tested two motivational interviewing treatment approaches , assessed the feasibility of conducting a  community-based smoking cessation intervention  among homeless smokers . Participants ( N = 46 ) were recruited from multiple facilities in the Kansas City area and were r and omized to two counseling conditions in which they received five individual motivational interviewing sessions , six group meetings , and their choice of 8 weeks of 21-mg nicotine patch or 4-mg nicotine lozenge . The two counseling conditions consisted of motivational interviewing targeted either to smoking behaviors exclusively ( smoking only ) or to smoking and other addictions or life events that could affect ability to quit ( smoking plus ) . Group meetings were design ed to provide educational information and social support . Measures of feasibility assessed included the proportion of participants who returned for r and omization among those eligible , adherence to prescribed nicotine replacement therapies , retention rates at the week 26 final study visit , and biochemically verified 7-day abstinence at week 26 . Most participants ( 69.6 % ) chose nicotine patches , and 32 % of those participants reported using at least four patches per week . Carbon monoxide verified 7-day abstinence rates in the smoking-only and smoking-plus groups were 13.04 % and 17.39 % ( ns ) , respectively , at week 8 and 8.70 % and 17.39 % ( ns ) , respectively , at week 26 . Participants who used at least four patches per week were more likely to have quit at 8 weeks than were those who used fewer patches ( 33.3 % vs. 10.5 % , p = .30 ) . Results support the feasibility of conducting a smoking cessation intervention among homeless smokers . Findings also show promising effects for nicotine replacement therapy and counseling in this population . Developing programs to improve smoking cessation outcomes in underserved population s is an essential step toward achieving national health objectives and for ultimately reducing tobacco-related health disparities Abstract Adults with any DSM-IV diagnosed mental illness smoke nearly half of the cigarettes consumed in the U.S. ( Lasser et al. 2000 ) . This study compared two smoking cessation interventions for persons with schizophrenia or other serious mental illness because national data suggests that : ( 1 ) they smoke at two to three times the rate of the general population ; ( 2 ) cessation interventions for this population are understudied ; ( 3 ) most cessation studies exclude persons with serious mental illness ; and ( 4 ) cessation results in public health care savings and disposable income savings for clients . This study included a large number of persons with serious mental illness ( N = 181 ) who were r and omly assigned to one of three groups : contingent reinforcement ( CR ) , CR plus nicotine patch ( 21 mg , CR+NRT ) for 16 weeks , and a minimal intervention , self-quit control group . These participants were followed for 36 weeks . CR was accomplished with escalating financial compensation for achieving and maintaining abstinence as verified by expired carbon monoxide ( CO ) . Quit rates , as measured by expired CO , were higher and discordant with saliva cotinine quit rates . Cotinine showed lower quit rates and small differences between intervention and control partici pants at weeks 20 and 36 . There was , however , evidence of reduced smoking and importantly , no evidence of psychiatric exacerbation Cigarette smokers with past major depressive disorder ( MDD ) received 8 group sessions of st and ard , cognitive-behavioral smoking cessation treatment ( ST ; n = 93 ) or st and ard , cognitive-behavioral smokiig cessation treatment plus cognitive-behavioral treatment for depression ( CBT-D ; n = 86 ) . Although abstinence rates were high in both conditions ( ST , 24.7 % ; CBT-D , 32.5 % , at 1 year ) for these nonpharmacological treatments , no main effect of treatment was found . However , secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking ( > or = 25 cigarettes a day ) at baseline . Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST ( odds ratios = 2.3 and 2.6 , respectively ) . Results suggest that CBT-D provides specific benefits for some , but not all , smokers with a history of MDD We tested whether implementing the " 5 A 's " ( Ask , Advise , Assess , Assist , Arrange ) at six mental health centers reduces  smoking among persons with serious mental illness . One hundred and fifty six patients were evaluated just before initiating the 5 A 's and after six and 12 months . A delayed control condition evaluated 148 patients six months before 5 A 's implementation , just before and then after six months . Six months of the 5 A 's produced no effect . Modest cessation and reduction benefits were noted after 12 months . Implementing the 5 A 's at community mental health centers may have modest benefit after twelve months OBJECTIVE Despite extremely high rates of smoking among individuals with psychotic disorders and the associated financial and health costs , few studies have investigated the efficacy of smoking cessation interventions among this group . The purpose of this study was to compare an integrated psychological and nicotine replacement therapy intervention for people with a psychotic disorder with routine care alone . METHOD The authors recruited 298 regular smokers with a psychotic disorder residing in the community and r and omly assigned them to a routine care comparison condition ( N=151 ) or an eight-session , individually administered smoking cessation intervention ( N=147 ) , which consisted of nicotine replacement therapy , motivational interviewing , and cognitive behavior therapy . Outcome variables included continuous and point-prevalence abstinence rates , smoking reduction status , and changes in symptoms and functioning . RESULTS While there were no overall differences between the treatment group and comparison group in abstinence rates , a significantly higher proportion of smokers who completed all treatment sessions stopped smoking at each of the follow-up occasions ( point-prevalence rates : 3 months , 30.0 % versus 6.0 % ; 6 months , 18.6 % versus 4.0 % ; and 12 months , 18.6 % versus 6.6 % ) . Smokers who completed all treatment sessions were also more likely to have achieved continuous abstinence at 3 months ( 21.4 % versus 4.0 % ) . There was a strong dose-response relationship between treatment session attendance and smoking reduction status , with one-half of those who completed the intervention program achieving a 50 % or greater reduction in daily cigarette consumption across the follow-ups , relative to less than one-fifth of the comparison subjects . There was no evidence of any associated deterioration in symptoms or functioning . CONCLUSIONS These findings demonstrate the utility of a nicotine replacement therapy plus motivational interviewing/cognitive behavior therapy smoking cessation intervention among individuals with a psychotic disorder . Further development of more efficacious interventions is required for those who do not respond to existing interventions & NA ; This article describes preliminary findings of an experimental , r and omized , three‐group , controlled design examining the effectiveness of a smoking cessation  intervention for pregnant teens . The three groups are  : Teen FreshStart with a buddy program ( TFSB ) , a Teen FreshStart program ( TFS ) without peer support , and the Usual Care ( UC ) control group . Forty‐six subjects completed the  post‐intervention assessment of smoking status . The TFSB group consistently achieved greater smoking cessation across all measures when compared to the subjects in the other two groups . These results indicate that the use of peer support may be an effective adjunct in smoking cessation programs for pregnant adolescents OBJECTIVES Low-income women have high rates of smoking during pregnancy , but little is known about the costs , benefits , and cost-effectiveness of motivational interviewing ( MI ) , focused on the medical and psychosocial needs of this population , as an intervention for smoking cessation and relapse prevention . METHODS A sample of 302 low-income pregnant women was recruited from multiple obstetrical sites in the Boston metropolitan area into a r and omized controlled trial of a motivational intervention for smoking cessation and relapse prevention versus usual care ( UC ) . The findings of this clinical trial were used to estimate the costs , benefits , and cost-effectiveness of the intervention from a societal perspective , incorporating published quality -adjusted life-year ( QALY ) and life-year ( LY ) estimates . Outcomes included smoking cessation and relapse , maternal and infant outcomes , economic costs , LYs and QALYs saved , and incremental cost-effectiveness ratios . RESULTS The cost-effectiveness of MI for relapse prevention compared to UC was estimated to be $ 851/LY saved and $ 628/QALY saved . Including savings in maternal medical costs in sensitivity analyses result ed in cost savings for MI for relapse prevention compared to UC . For smoking cessation , MI cost more but did not provide additional benefit compared to UC . In one-way sensitivity analyses , the incremental cost-effectiveness of MI versus UC would have been $ 117,100/LY saved and $ 86,300/QALY saved if 8 % of smokers had quit . In two-way sensitivity analyses , MI was still relatively cost-effective for relapse prevention ( $ 17,300/QALY saved ) even if it cost as much as $ 2000/participant and was less effective . For smoking cessation , however , a higher level of effectiveness ( 9/110 ) and higher cost ( $ 400/participant ) result ed in higher incremental cost-effectiveness ratios ( $ 112,000/QALY ) . CONCLUSIONS Among low-income pregnant women , MI helps prevent relapse at relatively low cost , and may be cost-saving when net medical cost savings are considered . For smoking cessation , MI cost more but provided no additional benefit compared to UC , but might offer benefits at costs comparable to other clinical preventive interventions if 8 - 10 % of smokers are induced to quit Despite high smoking rates among those living in poverty , few cessation studies are conducted in these population s. This cluster-r and omized trial tested nicotine gum plus motivational interviewing ( MI ) for smoking cessation in 20 low-income housing developments ( HDs ) . Intervention participants ( 10 HDs , n = 66 ) received educational material s , 8 weeks of 4 mg nicotine gum , and 5 MI sessions on quitting smoking . Comparison participants ( 10 HDs , n = 107 ) received 5 MI sessions and educational material s addressing fruit and vegetable consumption . Participants had a mean age of 46.3 years and were predominantly female ( 70 % ) and African American ( 83 % ) .  Biochemically-verified 7-day abstinence rates at 8 weeks were 6.1 % and 5.6 % in the intervention and comparison arms , respectively ( p = ns ) ; and at 26 weeks were 7.6 % and 9.3 % , respectively ( p = ns ) . Results suggest that nicotine gum plus MI were not effective for smoking cessation in low-income housing . Programs are needed to enhance the effectiveness of pharmacotherapy and counseling in underserved population
AIMS A systematic review and meta- analysis was conducted to assess the method ological quality and effectiveness of  behavioural smoking cessation interventions targeted at six disadvantaged groups ; the homeless , prisoners , indigenous population s , at-risk youth , individuals with low socio-economic status and individuals with a mental illness .