Current smoking and quit-attempts among US adults following Medicaid expansion.
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SUBMITTER: Valvi N
PROVIDER: S-EPMC6664091 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionLow-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking.MethodsUsing data from CDC's annual Behavioral Risk Factor Surveillance System 2011-2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18-64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL).ResultsRegression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08).ConclusionsExpanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees.
| S-EPMC8336658 | biostudies-literature
Project description:BACKGROUND:Reducing the social acceptability of smoking is associated with lowered smoking prevalence. However, denormalization strategies can also contribute to the stigmatization that some smokers may feel about their smoking. Smoking stigma may be more acute if smokers are also members of other stigmatized groups, such as racial/ethnic minorities. This study examined correlates of smoking self- and felt-stigma and discrimination, among current smokers. METHODS:Participants were recruited in the United States via a national commercial consumer panel to complete a cross-sectional, Web-based survey. Participants were 1528 current cigarette smokers aged 14 and older. Measures included the Internalized Stigma of Smoking Inventory (ISSI), Heaviness of Smoking Index, quit intentions, past-year quit attempts, and current use of electronic cigarettes (e-cigarettes). RESULTS:Self-stigma was significantly associated with higher intent to quit in the next 6 months (odds ratio [OR] = 2.47, P < .01) and in the next 30 days (OR = 4.21, P < .01), relative to no intention to quit, as well as having made 1 or 2 quit attempts in the past year (OR = 1.60, P < .01) or 3 or more quit attempts (OR = 1.74, P < .01) and associated with daily e-cigarette use (OR = 1.73, P < .05). Felt-stigma was positively associated with intent to quit in the next 30 days (OR = 1.54, P < .01), having made 3 or more quit attempts in the past year (OR = 1.35, P < .01), and both daily (OR = 2.05, P < .05) and some-day (OR = 1.30, P < .05) e-cigarette use. Discrimination was associated only with increased odds of daily e-cigarette use (OR = 1.83, P < .05). CONCLUSIONS:Smokers who reported greater feelings of stigmatization about their smoking were more likely to report having made recent quit attempts, report a stronger intention quit smoking in the future, and report use of e-cigarettes, suggesting that feelings of self-and felt-stigmatization are related to greater motivation to stop smoking.
| S-EPMC6319257 | biostudies-literature
Project description:IntroductionMost people who smoke cigarettes are not willing (ie, not ready) to make a quit attempt (QA) at any given time. Unfortunately, interventions intended to increase QAs and the success of QAs are only modestly effective. Identifying processes leading to QAs and quitting success could guide intervention development.Aims and methodsThis is a secondary analysis of a randomized factorial trial of 6 weeks of motivation-phase interventions among primary care patients (N = 517) who were initially unwilling to quit but were willing to reduce their smoking. Using logistic regression, we controlled for treatment condition and tested whether baseline or change in smoking-related constructs after 6 weeks of treatment predicted (1) making an at least 24 h QA between weeks 6 and 26 and (2) quitting success at week 26 (7-day point-prevalence abstinence among those who made a QA). Predictors included cigarettes/day, time to first cigarette, motivation to quit, quitting self-efficacy, anticipated urges to smoke if quit, positive affect, negative affect, and time spent around others who smoke.ResultsIn multivariable models that included all smoking-related constructs, changes in the following variables predicted initiating a QA above and beyond other variables: greater baseline time to first cigarette (odds ratio [OR] = 1.60), increases in time to first cigarette (OR = 1.27), and increases in quitting self-efficacy (OR = 1.14). Increased motivation to quit predicted conversion of a QA into quitting success at 26 weeks (OR = 1.36).ConclusionPredictors of making a QA differed from predictors of quitting success. Predictors of QAs and success could each serve as important treatment targets of motivation-phase interventions.ImplicationsMotivation-phase interventions for people initially unwilling to quit smoking cigarettes may be improved by striving to increase their (1) time to first cigarette and quitting self-efficacy to promote QAs and (2) motivation to quit to promote quit success. Future experimental tests of such interventions are needed to identify causal determinants of QAs and quitting success.
| S-EPMC7443596 | biostudies-literature
Project description:While youth and young adult e-cigarette use has risen in the U.S., few studies have explored e-cigarette cessation behavior. This study estimates quit attempts and intentions among young people (aged 15-36) since the rise of high-nicotine products, and examines factors associated with e-cigarette quit attempts and intentions. Current e-cigarette users (past 30-day use, not already quit) were drawn from a national probability-based cohort sample. Data were collected from September to December 2019 (n = 1158). Weighted proportions of past-year quit attempts, intentions to quit in next 30 days, and general intentions to quit (at some point) were calculated. Models estimated cessation outcomes with respect to harm perceptions, friend use, dependence, use frequency, combustible use and demographic factors. Among current e-cigarette users, 54.2% reported general intentions to quit, 15.3% reported intention to quit within 30 days, and 33.3% reported a past-year quit attempt. Past-year quit attempts were associated with higher levels of harm perceptions (adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.49-2.92), dependence (aOR = 1.92, 95% CI: 1.44-2.56) and daily use (28 + days) compared to infrequent use (1-5 days) (aOR = 0.23, 95% CI: 0.12-0.43). General intentions to quit were positively associated with harm perceptions (aOR = 1.77, 95% CI: 1.23-2.56) and dependence (aOR = 1.89, 95% CI: 1.41-2.52), and negatively associated with daily use compared to infrequent use (aOR = 0.35, 95% CI: 0.19-0.65). Findings indicate that over half of young e-cigarette users want to quit, highlighting a critical need for policies and resources to promote and sustain e-cigarette cessation among young people.
| S-EPMC7808959 | biostudies-literature
Project description:We explored past-year quit attempts, cessation methods used, and associations with sociodemographic, smoking, and health-related characteristics among smoking patients with chronic obstructive pulmonary disease (COPD) in Germany. Cross-sectional survey data of 509 past-year smokers (current smokers and ≤12 months abstinent) with COPD (ICD-10 code J44.x and FEV1/FVC <0.70) from 19 pulmonary primary care practices were used. Associations were explored between age, sex, educational qualification, lung function, urges to smoke, psychological distress, and (a) ≥1 past-year quit attempt (yes/no), (b) use of ≥1 evidence-based smoking cessation method (yes/no). Of all patients, 48.5% (n = 247, 95% confidence interval (CI) 44.2-52.9) reported ≥1 past-year quit attempt. Such an attempt was positively associated with the male sex (Odds Ratio (OR) = 1.50, 95% CI 1.01-2.24) and negatively associated with time spent with urges to smoke (OR = 0.69, 95% CI 0.52-0.91). During the most recent past-year quit attempt, one-third of the patients used ≥1 evidence-based smoking cessation method (31.2%, 95% CI 25.4-37.0), which was positively associated with the strength of urges to smoke (OR = 1.62, 95% CI 1.09-2.41). Combined behavioural and pharmacological treatments were used by 4.0% (n = 10, 95% CI 1.6-6.5). Electronic cigarettes were used most frequently (21.5%, 95% CI 16.3-26.6). Although a high proportion of COPD patients in German pulmonary primary care attempt to quit smoking, only a few of them use evidence-based methods as assistance for quitting.
| S-EPMC9646777 | biostudies-literature
Project description:OBJECTIVES:Pregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women's smoking and quitting behaviour throughout pregnancy and after delivery. DESIGN:Longitudinal cohort survey with questionnaires at baseline (8-26 weeks' gestation), late pregnancy (34-36 weeks) and 3 months after delivery. SETTING:Two maternity hospitals in one National Health Service hospital trust, Nottingham, England. PARTICIPANTS:850 pregnant women, aged 16 years or over, who were current smokers or had smoked in the 3 months before pregnancy, were recruited between August 2011 and August 2012. OUTCOME MEASURES:Self-reported smoking behaviour, quit attempts and quitting intentions. RESULTS:Smoking rates, adjusting for non-response at follow-up, were 57.4% (95% CI 54.1 to 60.7) at baseline, 59.1% (95% CI 54.9 to 63.4) in late pregnancy and 67.1% (95% CI 62.7 to 71.5) 3 months postpartum. At baseline, 272 of 488 current smokers had tried to quit since becoming pregnant (55.7%, 95%?CI 51.3 to 60.1); 51.3% (95% CI 44.7 to 58.0) tried quitting between baseline and late pregnancy and 27.4% (95% CI 21.7 to 33.2) after childbirth. The percentage who intended to quit within the next month fell as pregnancy progressed, from 40.4% (95% CI 36.1 to 44.8) at baseline to 29.7% (95% CI 23.8 to 35.6) in late pregnancy and 14.2% (95% CI 10.0 to 18.3) postpartum. Postpartum relapse was lower among women who quit in the 3 months before pregnancy (17.8%, 95%?CI 6.1 to 29.4) than those who stopped between baseline and late pregnancy (42.9%, 95%?CI 24.6 to 61.3). CONCLUSIONS:Many pregnant smokers make quit attempts throughout pregnancy and postpartum, but intention to quit decreases over time; there is no evidence that smoking rates fall during gestation.
| S-EPMC5695489 | biostudies-literature
Project description:BackgroundTobacco control strategies have engendered overall declines in smoking; however, a large gap remains between people with and without mental health problems, causing substantial health inequalities. Population-level information on barriers and opportunities for improvements is scarce. We aimed to assess mental health status of cigarette smokers and recent ex-smokers ('past-year smokers') in England, and smoking and harm reduction behaviour and quit attempts by mental health status.MethodsData were collected from 5637 current and 434 recent ex-smokers in 2016/17 in household surveys of representative samples of adults. We calculated weighted prevalence of different indicators of mental health problem: a) ever diagnosis, b) none, moderate, serious past-month distress, c) past-year treatment. We compared weighted smoking status, cigarette type, dependence, motivation to stop smoking, cutting down, use of nicotine replacement therapy or e-cigarettes, short-term abstinence, and quit attempts according to mental health status.ResultsAmong past-year smokers: 35.9% ever had a diagnosis; 24.3% had experienced moderate, an additional 9.7% serious, past-month distress; 21.9% had had past-year treatment. Those with an indication of a mental health problem were more highly dependent and more likely to smoke roll-your-own cigarettes but also more likely to be motivated to stop smoking, to cut down, use nicotine replacement therapy or e-cigarettes and to have attempted to quit in the past year.ConclusionsAbout a third of cigarette smokers in England have mental health problems. Interventions should address their increased dependence and leverage higher prevalence of harm reduction behaviours, motivation to stop and attempts to stop smoking.
| S-EPMC7427923 | biostudies-literature
Project description:BackgroundTobacco use is the number one cause of death and disability of women in the United States, and our women Veteran population is disproportionately affected. Despite revisions to the Veterans Affairs' approach to smoking cessation, women continue to smoke at equal or higher rates than men, are prescribed cessation medications less frequently, and are less likely to quit. In this qualitative pilot study, individual interviews with women Veterans revealed their experiences with smoking cessation attempts.MethodsThe lead author conducted semi-structured interviews with 14 women Veterans who were either current or former smokers. Participants gave a narrative account of recent quit smoking attempts. Inductive thematic analysis explored the underlying themes.ResultsFour main themes emerged as important: health and well-being, smoking as an addiction, optimism, and resilience. Health and well-being encompassed physical health, mental health, and financial stability. Women often felt that stability in these key areas made a successful attempt possible. Women with successful quit attempts were more likely to consider tobacco use as an addiction, as well as expressed optimism about their quit attempts. Women with successful quit attempts also demonstrated more resilience to lapses and relapses.ConclusionsWomen Veterans' quit smoking attempts demonstrate four main themes: baseline health and wellbeing, acknowledging smoking as an addiction, the participant's optimism towards quitting, and resilience. Patterns were observed within themes with respect to whether the woman was currently quit or had experienced a prolonged quit attempt in the past. Further research is needed to help women Veterans quit smoking.
| S-EPMC7106739 | biostudies-literature
Project description:Importance:In 2006, a US district court judge ordered tobacco companies to sponsor nationwide antismoking advertising campaigns. This landmark ruling and its subsequent execution represent an unprecedented tobacco control event; however, the association of this campaign with intentions and/or attempts to quit smoking is unknown. Objectives:To assess the reach of the expanded court-ordered tobacco industry antismoking advertisements (via television, newspapers, tobacco company websites, and/or cigarette packages), to examine associations between exposure to industry antismoking advertisements and intentions and/or attempts to quit smoking among cigarette smokers, and to calculate the numbers of US smokers who would have quit intentions associated with exposure to multiple advertisements. Design, Setting, and Participants:Data for this study were obtained from 5309 US adults, including 610 smokers, who responded to the Health Information National Trends Survey, a nationally representative cross-sectional survey conducted from January 22 to April 30, 2019. Respondents were representatives of households selected by equal-probability sampling of a database of US residential addresses. Exposure:Reported exposure to antismoking messages. Main Outcomes and Measures:Cigarette smoking cessation attempt in the past 12 months and intentions to quit cigarette smoking in the next 6 months. Covariates were age, sex, household annual income, race/ethnicity, educational level, and geographical residence. Data were weighted to be nationally representative after applying survey weights specified for the survey cycle. Results:The overall sample of 5309 respondents were a mean (SD) age of 55.6 (19.1) years and included 3073 women (51.2%), 3037 non-Hispanic white respondents (59.1%), 4645 respondents who lived in urban US areas (84.7%), and 610 current smokers (12.5%). Findings indicate that 2464 US adults (45.8%; 95% CI, 43.2%-48.5%) and 410 current smokers (66.8%; 95% CI, 61.1%-72.4%) were exposed to antismoking advertisements. Exposure to multiple antismoking messages was associated with 2.19 (95% CI, 1.10-4.34) greater odds of having intentions to quit cigarette smoking but was not associated with attempts to quit (adjusted odds ratio, 1.31; 95% CI, 0.69-2.52). Furthermore, an examination of the association of cumulative exposure to antismoking messages with cessation intentions revealed that, with each additional exposure to an antismoking message, the odds of smoking cessation intentions increased by 1.21 (95% CI, 1.02-1.44). If all smokers were to be exposed to multiple antitobacco messages, there could be an estimated 3.98 million (95% CI, 492?480-7?223?040) current smokers in the United States with intentions to quit. Conclusions and Relevance:Although the reach of court-ordered industry advertisements increased among smokers, the reach of these advertisements within the general population remains suboptimal. The finding that industry advertisements helped smokers consider quitting highlights their potential to aid smoking cessation. However, the lack of association with actual attempts to quit suggests that the industry antismoking advertisement campaigns were inadequate. The design and content of industry antismoking advertisement campaigns should be enhanced to help smokers quit.
| S-EPMC7341176 | biostudies-literature
Project description:IntroductionHaving a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases.MethodsThis population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses.ResultsSmokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts.ConclusionsAlthough smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit.
| S-EPMC6661851 | biostudies-literature