INTERVENTIONS FOR SMOKING CESSATION

Many smoking cessation interventions have been implemented in developed and developing countries to counteract the adverse health effects, such as noncommunicable diseases (NCDs), attributed to a major extent to tobacco smoking. Some of these interventions along with their impacts are as follows:

• • Smoke-free laws: One year after their implementation, smoke-free laws were shown to reduce hospital admissions due to acute myocardial infarction by an average of 17% in Argentina, Canada, England, France, Ireland, Italy, Scotland, and the United States (Glantz and Gonzalez 2012; Lightwood and Glantz 2009). In Arizona, hospital admissions due to asthma reduced by 22% after smoke-free laws were implemented in workplaces, restaurants, and bars (Herman and Walsh 2011). In Canada, hospital admissions for chronic respiratory disease dropped by 33% 2 years after the enforcement of smoke-free laws in restaurants (Naiman et al. 2010).
• • Advice and assistance from physicians: The National Health Interview Survey (NHIS) in the United States showed a positive correlation between a health-care provider’s advice to quit smoking and the smoker’s wish to quit smoking (Kruger et al. 2012). A meta-analysis of 13 studies showed that physicians offering assistance results in more quit attempts, 69% more for offering behavioral support and 39% more for offering medication, compared with advice to quit smoking on medical grounds (Aveyard et al. 2012).
• • Culturally appropriate quit smoking face-to-face interventions: A systematic review of 17 studies showed that interventions incorporating a package of cultural adaptations that imply high-intensity and embedded family values are more likely to be effective for smoking cessation (Nierkens et al. 2013). Smoking cessation interventions tailored to cultural contexts have been shown to increase quit rates by 2.4 times in a face-to-face intervention group compared with a control group among Indigenous Australians (Marley et al. 2014). In Pakistan, behavioral support intervention and behavioral support combined with bupropion therapy achieved effective smoking cessation among suspected tuberculosis patients (Siddiqi etal. 2013).
• • Nicotine replacement therapy (NRT): A meta-analysis of 53 trials measuring the effectiveness of various forms of NRT (gum, patches, intranasal spray, and inhalers) showed that the odds of abstinence are 71% higher in NRT users compared with the control interventions (Silagy et al. 1994). Another meta-analysis of 12 trials on the long-term efficacy of a singletreatment episode of NRT showed that smoking cessation is enhanced by 99% in NRT users compared with placebo over many years (Etter and Stapleton 2006). The relapse rate for NRT users from 12 months to 2-8 years of follow-up is 30% (Etter and Stapleton 2006).
• • E-cigarettes: Though e-cigarettes have been used as a strategy for quitting cigarette smoking, it is associated with significantly less quitting among smokers. A meta-analysis of 38 studies showed that the odds of quitting cigarette smoking are 28% lower in smokers who use e-cigarettes compared with those who do not use them (Kalkhoran and Glantz 2016).
• • Text messaging-based smoking cessation: Text messages are now being used to help smokers to quit smoking. A pilot study in the United States found that the quit rate at 4 weeks after text-messaging intervention was 3.3 times higher compared with the control group (Ybarra et al. 2013). A systematic Cochrane review of five studies reported that long-term quit rates increase by 71% in cell phone intervention for smoking cessation (Whittaker et al. 2012).
• • Smartphone apps for smoking cessation: Many smartphone applications (apps), both Android- and Apple-based, are available for smoking cessation (Patel et al. 2015). A content analysis of 225 Android smoking cessation apps showed that these apps addressed 2.1 ± 0.9 of the “5As” framework (ask, advise, assess, assist, and arrange follow-up) (Hoeppner et al. 2015), suggested as an effective tobacco cessation counseling tool by the U.S. Public Health Service’s clinical practice guidelines (Fiore etal. 2008). A feasibility study of a smoking cessation app called Quit Advisor showed that it was downloaded the most in the United States, followed by the United Kingdom and Australia. The majority of users of this app had never sought professional help to quit smoking and 77.2% were ready to quit within 30 days (BinDhim et al. 2014). A randomized controlled trial in the United States measured the effectiveness of an acceptance and commitment therapy app for smoking cessation called SmartQuit against the National Cancer Institute’s app for smoking cessation called QuitGuide. It showed that the quit rate was 13% for SmartQuit and 8% for QuitGuide (Bricker et al. 2014).
• • Physical activity: For women, supervised exercise three times per week for 12 months along with a cognitive behavioral smoking cessation program has been shown to lead to smoking abstinence in 19.4% of participants at the end of treatment, 16.4% after 3 months, and 11.9% after 12 months (Marcus et al. 1999). Short bouts of exercise such as 10 min moderate-intensity exercise on a stationary cycle have been shown to reduce the desire to smoke as well as withdrawal symptoms in abstaining smokers (Ussher et al. 2001).
• • Nicotine gum, behavioral therapy, and a very low-calorie diet: An intervention for female smokers consisting of nicotine gum with a behavioral weight control program combined with a very low-calorie diet led to smoking cessation in 50% of the participants after 16 weeks of therapy, and the success rate after 1 year of intervention remained at 28% (Danielsson et al. 1999).