Dataset Information

Association between smoking cessation and short-term health-care use: results from an international prospective cohort study (ATTEMPT).

ABSTRACT:

Background and aims

Previous studies have found that smoking cessation is associated with a short-term increase in health-care use. This may be because 'sicker' smokers are more likely to stop smoking. The current study assessed the association between smoking cessation and health-care use, adjusting for pre-cessation physical and mental health conditions.

Design/setting

Data came from the ATTEMPT cohort, a multi-national prospective survey of smokers in the United States, Canada, United Kingdom, France and Spain, that lasted 18 months (with follow-ups every 3 months).

Participants

A total of 3645 smokers completed the baseline questionnaire. All participants smoked at least five cigarettes per day, intended to quit smoking within the next 3 months and were between 35 and 65 years of age.

Measurements

Participants were asked questions about their socio-demographic and smoking characteristics, as well previous smoking-related morbidities. Participants were also asked to report their health-care use in the previous 3 months i.e. emergency room (ER) visits, hospitalization, whether hospitalization required surgery, and health-care appointments.

Findings

A total of 8252, 4779 and 1954 baseline episodes of smoking were available for 3, 6 and 12 months, respectively. Of these, 2.8% (n = 230), 0.9% (n = 40) and 0.7% (n = 14) were followed by 3, 6 and 12 months of abstinence. No significant differences were found among 3, 6 or 12 months of abstinence and ER visits, hospitalization and whether hospitalization required surgery or health-care visits. However, 6-month smoking cessation episodes were associated with higher odds of reporting an appointment with a dietician.

Conclusion

Smoking cessation does not appear to be associated with a substantial short-term increase or decrease in health-care use after adjusting for pre-cessation morbidities.

SUBMITTER: Beard E

PROVIDER: S-EPMC4282030 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association between smoking cessation and short-term health-care use: results from an international prospective cohort study (ATTEMPT).

Beard Emma E Shahab Lion L Curry Susan J SJ West Robert R

Addiction (Abingdon, England) 20130814 11

<h4>Background and aims</h4>Previous studies have found that smoking cessation is associated with a short-term increase in health-care use. This may be because 'sicker' smokers are more likely to stop smoking. The current study assessed the association between smoking cessation and health-care use, adjusting for pre-cessation physical and mental health conditions.<h4>Design/setting</h4>Data came from the ATTEMPT cohort, a multi-national prospective survey of smokers in the United States, Canada, ...[more]

PMID: 23795578

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Project description:Background: Epigenetics is involved in various human diseases. Smoking is one of the most common environmental factors causing epigenetic changes. The DNA methylation changes and mechanisms after quitting smoking have not yet been defined. The present study examined the changes in DNA methylation level before and after short-term smoking cessation and explored the potential mechanism. Methods: Whole blood and clinical data were collected in 8 patients before and after short-term smoking cessation, DNA methylation was assessed, and differentially methylated sites were analyzed, followed by a comprehensive analysis of the differentially methylated sites with clinical data. GO/KEGG enrichment and protein-protein interaction (PPI) network identified the hub genes. The differentially methylated sites were detected by GEO2R between former smoking and current smoking in GSE50660 from the GEO database. Then, a Venn analysis was carried out using the differentially methylated sites. GO/KEGG enrichment analysis was performed on the genes corresponding to the common DNA methylation sites, the PPI network was constructed, and hub genes were predicted. The enriched genes associated with the cell cycle were selected, and the gene expression was analyzed in pan-cancer based on the TCGA database. Results: Most of the DNA methylation levels were decreased after short-term smoking cessation; a total of 694 hypermethylated CPG sites and 3184 hypomethylated CPG sites were identified. The DNA methylation levels altered according to the clinical data (body weight, expiratory, and tobacco dependence score). Enrichment analysis, construction of PPI network, and pan-cancer analysis suggested that smoking cessation may be involved in various biological processes. Conclusions: Smoking cessation leads to epigenetic changes, mainly observed in the decline of most DNA methylation levels. Bioinformatics further identified the biologically relevant changes after short-term smoking cessation.

Project description:Relative effectiveness of smoking cessation medications-varenicline, bupropion and nicotine replacement therapy (NRT)-remains unclear among smokers in real-world settings. Evidence in females and smokers with light/moderate nicotine dependence is particularly insufficient. This study compared the effectiveness of varenicline, bupropion or NRT gum relative to NRT patch, in achieving abstinence among recent quitters.In a national smoking cessation program in Taiwan (2012-2015), a cohort of 11,968 participants received varenicline (n = 5,052), bupropion (n = 823), NRT gum (n = 1944) or NRT patch (n = 4,149). The 7-day, 1-month or 6-month point-prevalence was calculated based on self-reported last smoking event via telephone interview after 6 months. Logistic regression modellings estimated odds ratios (OR) and 95% confidence intervals (CI) for achieving abstinence using different modalities (NRT patch as referent). Models included age, sex, education, marital status, geographic region, smoke-years, nicotine-dependence level, medical institution, number of clinic visits and medication use duration. Analyses were further stratified by sex and dependence severity.Participants were predominantly male (83%) with a mean age of 43.7±12.6 years. Varenicline users were more likely than NRT patch users to achieve abstinence, based on 7-day point-prevalence (OR = 1.30, CI: 1.19-1.44), 1-month point-prevalence (OR = 1.36, CI: 1.24-1.50) or 6-month point-prevalence (OR = 1.30, CI: 1.14-1.47). Compared with NRT patch, varenicline was associated with greater odds of being abstinent in women (OR = 1.29, CI: 1.01-1.65), men (OR = 1.31, CI: 1.18-1.46), those with light/moderate dependence (OR = 1.42, CI: 1.24-1.63) or smokers with severe dependence (OR = 1.19, CI: 1.04-1.37), based on 7-day point-prevalence. Differences in effectiveness were not observed between users of bupropion, NRT gum and NRT patch.In smoking cessation clinics in Taiwan, varenicline users reported higher abstinence rates than NRT patch users after 6 months. Women and smokers with light/moderate nicotine dependence may also benefit from varenicline in actual clinical practice.

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Project description:Evidence-based smoking cessation guidelines recommend nicotine replacement therapy (NRT), bupropion SR and varenicline as first-line therapy in combination with behavioural interventions. However, there are limited data to guide clinicians in recommending one form over another, using combinations, or matching individual smokers to particular forms.To develop decision rules for clinicians to guide differential prescribing practices and tailoring of pharmacotherapy for smoking cessation.A Delphi approach was used to build consensus among a panel of 37 international experts from various health disciplines. Through an iterative process, panellists responded to three rounds of questionnaires. Participants identified and ranked "best practices" used by them to tailor pharmacotherapy to aid smoking cessation. An independent panel of 10 experts provided cross-validation of findings.There was a 100% response rate to all three rounds. A high level of consensus was achieved in determining the most important priorities: (1) factors to consider in prescribing pharmacotherapy: evidence, patient preference, patient experience; (2) combinations based on: failed attempt with monotherapy, patients with breakthrough cravings, level of tobacco dependence; (3) specific combinations, main categories: (a) two or more forms of NRT, (b) bupropion + form of NRT; (4) specific combinations, subcategories: (1a) patch + gum, (1b) patch + inhaler, (1c) patch + lozenge; (2a) bupropion + patch, (2b) bupropion + gum; (5) impact of comorbidities on selection of pharmacotherapy: contraindications, specific pharmacotherapy useful for certain comorbidities, dual purpose medications; (6) frequency of monitoring determined by patient needs and type of pharmacotherapy.An algorithm and guide were developed to assist clinicians in prescribing pharmacotherapy for smoking cessation. There appears to be good justification for "off-label" use such as higher doses of NRT or combination therapy in certain circumstances. This practical tool reflects best evidence to date of experts in tobacco cessation.

Dataset Information

Association between smoking cessation and short-term health-care use: results from an international prospective cohort study (ATTEMPT).

Background and aims

Design/setting

Participants

Measurements

Findings

Conclusion

Publications

Association between smoking cessation and short-term health-care use: results from an international prospective cohort study (ATTEMPT).

Similar Datasets

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