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Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial

Jiang, Nan; Nguyen, Nam; Siman, Nina; Cleland, Charles M; Nguyen, Trang; Doan, Hue Thi; Abroms, Lorien C; Shelley, Donna R
BACKGROUND:Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. OBJECTIVE:The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. METHODS:The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. RESULTS:Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. CONCLUSIONS:The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541.
PMID: 34623318
ISSN: 2291-5222
CID: 5031592

Physicians' very brief (30-second) intervention for smoking cessation on 13,671 smokers in China: A pragmatic randomized controlled trial

Cheung, Yee Tak Derek; Jiang, Nan; Jiang, Chao Qiang; Zhuang, Run Sen; Gao, Wen Hui; Zhou, Jian; Lu, Jin Hong; Li, Hui; Wang, Jun Feng; Lai, Yi Sheng; Sun, Jun Sheng; Wu, Jiu Chang; Ye, Chiang; Li, Na; Zhou, Gang; Chen, Jing Ying; Ou, Xiu Yan; Liu, Liu Qing; Huang, Zhuang Hong; Ho, Sai Yin; Li, Ho Cheung William; Su, Sheng Hua; Yang, Yan; Jiang, Yuan; Zhu, Wei Hua; Yang, Lie; Lin, Peiru; He, Yao; Cheng, Kar Keung; Lam, Tai Hing
BACKGROUND AND AIMS/OBJECTIVE:Three to ten minutes of smoking cessation advice by physicians is effective to increase quit rates but not routinely practised. We examined the effectiveness of physicians' very brief (about 30 seconds) smoking cessation intervention on quit rates among Chinese outpatient smokers. DESIGN/METHODS:A pragmatic, open-label, individually randomized controlled trial. SETTING/METHODS:Seventy-two medical outpatient departments of hospitals and/or community health centers in Guangdong, China. PARTICIPANTS/METHODS:Chinese adults who were daily cigarette smokers (N = 13,671, 99% males) were invited by their physician to participate during outpatient consultation. Smokers who were receiving smoking cessation treatment or were judged to needed specialist treatment for cessation were excluded. INTERVENTIONS/METHODS:The intervention group (n = 7,015) received a 30-second intervention including physician's very brief advice, a leaflet with graphic warnings, and a card with contact information of available cessation services. The control group (n = 6,656) received a very brief intervention on consuming vegetables and fruits. A total of 3,466 participants in the intervention group were further randomized to receive a brief booster advice from trained study personnel through telephone one month following their doctor visit. MEASUREMENTS/METHODS:The primary outcome was self-reported 7-day point prevalence abstinence in the intervention and control group at the 12-month follow-up. Secondary outcomes included self-reported 30-day abstinence and biochemically validated abstinence at 12-month follow-up. FINDINGS/RESULTS:By intention-to-treat, the intervention (vs. control) group had greater self-reported 7-day abstinence (9.1% vs. 7.8%; odds ratio (OR) 1.14; 95% Confidence Interval (CI) 1.03-1.26; P = .008) and 30-day abstinence (8.0% vs. 6.9%; OR 1.14 95% CI 1.03-1.27; P=0.01) at 12-month follow-up. The effect size increased when only participants who received the intervention from compliant physicians were included (7-day PPA OR = 1.42; 1.11-1.74). The group difference in biochemically validated abstinence was small (0.8% vs. 0.8%; OR 1.00 95% CI 0.71-1.42; P=0.99). CONCLUSION/CONCLUSIONS:A 30-second smoking cessation intervention increased self-reported abstinence among mainly male smokers in China at 12-month follow-up (risk difference = 1.3%) and should be feasible to provide in most settings and delivered by all healthcare professionals.
PMID: 32918512
ISSN: 1360-0443
CID: 4601292

Implementing the Federal Smoke-Free Public Housing Policy in New York City: Understanding Challenges and Opportunities for Improving Policy Impact

Jiang, Nan; Gill, Emily; Thorpe, Lorna E; Rogers, Erin S; de Leon, Cora; Anastasiou, Elle; Kaplan, Sue A; Shelley, Donna
ORIGINAL:0015371
ISSN: 1660-4601
CID: 5053362

Evaluation of Secondhand Smoke Exposure in New York City Public Housing After Implementation of the 2018 Federal Smoke-Free Housing Policy

Thorpe, Lorna E; Anastasiou, Elle; Wyka, Katarzyna; Tovar, Albert; Gill, Emily; Rule, Ana; Elbel, Brian; Kaplan, Sue A; Jiang, Nan; Gordon, Terry; Shelley, Donna
Importance/UNASSIGNED:Secondhand smoke (SHS) exposure is associated with many health conditions in children and adults. Millions of individuals in the US are currently exposed to SHS in their homes. Objective/UNASSIGNED:To investigate whether a federal ban on smoking in public housing settings was associated with a decrease in indoor SHS levels in New York City public housing developments 12 months after the policy's implementation. Design, Setting, and Participants/UNASSIGNED:This cohort study tracked indoor air quality longitudinally from April 2018 to September 2019 and used difference-in-differences analysis to examine SHS exposure before vs after implementation of the 2018 federal smoke-free housing (SFH) policy in 10 New York City Housing Authority (NYCHA) buildings vs 11 matched low-income buildings not subject to the SFH policy (ie, Section 8 buildings). Exposures/UNASSIGNED:Federal SFH policy implementation, beginning July 30, 2018. Main Outcomes and Measures/UNASSIGNED:Comparison of nicotine concentration levels from passive, bisulfate-coated filters before vs 12 months after implementation of the federal SFH policy. Secondary outcomes included changes in particulate matter less than 2.5 μm in diameter, measured with low-cost particle monitors, and counts of cigarette butts in common areas. Results/UNASSIGNED:Air quality was measured repeatedly in a total of 153 NYCHA and 110 Section 8 nonsmoking households as well as in 91 stairwells and hallways. Before the SFH policy implementation, air nicotine was detectable in 19 of 20 stairwells (95.0%) in NYCHA buildings and 15 of 19 stairwells (78.9%) in Section 8 buildings (P = .19) and in 17 of 19 hallways (89.5%) in NYCHA buildings and 14 of 23 hallways (60.9%) in Section 8 buildings (P = .004). Nicotine was detected less frequently inside nonsmoking apartments overall (26 of 263 [9.9%]) but more frequently in NYCHA apartments (20 of 153 [13.1%]) than in Section 8 apartments (6 of 110 [5.5%]) (P = .04). One year after policy implementation, there was no differential change over time in nicotine concentrations measured in stairwells (DID, 0.03 μg/m3; 95% CI, -0.99 to 1.06 μg/m3) or inside nonsmoking households (DID, -0.04 μg/m3; 95% CI, -0.24 to 0.15 μg/m3). Larger decreases in nicotine concentration were found in NYCHA hallways than in Section 8 hallways (DID, -0.43 μg/m3; 95% CI, -1.26 to 0.40 μg/m3). Conclusions and Relevance/UNASSIGNED:The findings suggest that there was no differential change in SHS in NYCHA buildings 12 months after SFH policy implementation. Additional support may be needed to ensure adherence to SFH policies.
PMCID:7645700
PMID: 33151318
ISSN: 2574-3805
CID: 4684142

Chinese immigrant smokers' access barriers to tobacco cessation services and experience using social media and text messaging

Jiang, Nan; Zhang, Yidan; Qian, Xiaokun; Thorpe, Lorna; Trinh-Shevrin, Chau; Shelley, Donna
INTRODUCTION/BACKGROUND:Smoking rates remain disproportionately high among Chinese immigrants in the US, particularly in males. Community-based smoking cessation services and quitlines have low engagement rates. Social media and text messaging programs can be effective in promoting quit rates and improving treatment engagement. This study examined Chinese immigrant smokers' barriers to accessing available smoking cessation services and patterns of using social media platforms and mobile phone text messaging. METHODS:We conducted in-depth interviews (n=30) and a brief survey (n=49) with adult Chinese immigrant smokers leaving in New York City in 2018. Qualitative interviews explored smokers' challenges with smoking cessation, barriers to accessing and using smoking cessation services, and experience using social media and text messaging. The quantitative survey assessed smoking and quitting behaviors, and social media and text messaging use patterns. RESULTS:Qualitative data revealed that participants faced various barriers to accessing cessation services, including the lack of awareness about services, skepticism about treatment effects, reliance on willpower for cessation, and time constraints. WeChat was mainly used to maintain social networking and acquire information. Participants rarely used text messaging or other social media platforms. Quantitative data showed that 55% of participants had no plan to quit smoking. Among those who reported past-year quit attempts (45%), 55% used cessation assistance. WeChat was the most frequently used platform with 94% users. CONCLUSIONS:WeChat has potential to serve as an easily accessible platform for delivering smoking cessation treatment among Chinese immigrant populations. Research is warranted to explore the feasibility and efficacy of employing WeChat in smoking cessation treatment.
PMCID:7552855
PMID: 33083680
ISSN: 2459-3087
CID: 4637332

Effectiveness of village health worker delivered smoking cessation counseling in Viet Nam

Jiang, Nan; Siman, Nina; Cleland, Charles M; VanDevanter, Nancy; Nguyen, Trang; Nguyen, Nam; Shelley, Donna
Introduction/UNASSIGNED:Smoking prevalence is high in Viet Nam, yet tobacco dependence treatment (TDT) is not widely available. Methods/UNASSIGNED:We conducted a quasi-experimental study that compared the effectiveness of health care provider advice and assistance (ARM 1) vs. ARM 1 plus village health worker (VHW) counseling (ARM 2) on abstinence at 6-month follow-up. This study was embedded in a larger two-arm cluster randomized controlled trial (RCT) conducted in 26 community health centers (CHCs) in Viet Nam. Subjects (N=1,318) were adult patients who visited any participating CHC during the parent RCT intervention period and were self-identified as current tobacco users (cigarettes and/or waterpipe). Results/UNASSIGNED:At 6-month follow-up, abstinences rates in ARM 2 were significantly higher than ARM 1 (25.7% vs. 10.5%; p<.001). In multivariate analyses smokers in ARM 2 were almost three times more likely to quit compared with those in ARM 1 (adjusted odds ratio [AOR]=2.96, 95% confidence interval [CI]=1.78-4.92). Compared to cigarette-only smokers, waterpipe-only smokers (AOR=0.4, 95% CI=0.26-0.62) and dual users (AOR=0.62, 95% CI=0.45-0.86) were less likely to achieve abstinence, however the addition of VHW counseling (ARM 2) was associated with higher quit rates compared with ARM 1 alone for all smoker types. Conclusion/UNASSIGNED:A team approach in TDT programs that offers a referral system for health care providers to refer smokers to VHW-led cessation counseling is a promising and potentially scalable model for increasing access to evidence-based TDT and increasing quit rates in LMICs. TDT programs may need to adapt interventions to improve outcomes for waterpipe users.
PMID: 30335180
ISSN: 1469-994x
CID: 3400912

Perceptions and use of e-cigarettes among young adults in Hong Kong

Jiang, Nan; Cleland, Charles M; Wang, Man Ping; Kwong, Antonio; Lai, Vienna; Lam, Tai Hing
BACKGROUND:Little is known about the risk and addiction perceptions of e-cigarettes among Asian populations. We examined e-cigarette perceptions among young adults in Hong Kong and the association between the perceptions and e-cigarette use patterns. METHODS:An online survey was administered to a convenience sample of Hong Kong residents aged 18-35 (N = 1186). Measures of e-cigarette perceptions included perceived harm and addictiveness of e-cigarettes, perceived harm of secondhand e-cigarette aerosol, and perceived popularity of e-cigarette use among peers. Separate multinomial logistic regression models were conducted to examine the associations between the four perceptions and former and current use of e-cigarettes relative to never use, controlling for demographics and current cigarette smoking status. Interactions of e-cigarette perceptions and current cigarette smoking were assessed in all models. Among current e-cigarette users, bivariate exact logistic regression models were used to examine the relationships between each of the perceptions and frequent e-cigarette use (≥3 days in past 30-day vs. 1-2 days). Among participants who had never used e-cigarettes, separate multivariable logistic regression models were conducted to examine the associations between e-cigarette perceptions and susceptibility to e-cigarette use. RESULTS:Overall, 97.2% of participants were aware of e-cigarettes, and 16.1% had tried e-cigarettes (11.3% former users; 4.8% current users). Young adults perceived e-cigarettes (and aerosol) as less harmful, less addictive, and less popular than cigarettes. Current cigarette smokers reported significantly lower perceived harmfulness and addictiveness of e-cigarettes, lower perceived harmfulness of e-cigarette aerosol, and higher perceived popularity than nonsmokers. The lower degree of harm and addiction perceptions, and higher levels of popularity perceptions were associated with greater odds of e-cigarette use, and these relationships were generally stronger among nonsmokers compared to current cigarette smokers. E-cigarette perceptions were not associated with frequent e-cigarette use. Perceiving e-cigarettes (and aerosol) as less harmful and less addictive were associated with greater susceptibility to e-cigarette use. Compared to nonsmokers, current smokers were more likely to report e-cigarette use and susceptibility. CONCLUSIONS:Continued monitoring of e-cigarette use and perceptions is needed. Educational programs should emphasize the potential harmful and addictive properties of e-cigarettes and the risks of secondhand exposure to e-cigarette aerosol.
PMCID:6697992
PMID: 31420031
ISSN: 1471-2458
CID: 4063892

Perceptions about the Federally Mandated Smoke-Free Housing Policy among Residents Living in Public Housing in New York City

Jiang, Nan; Thorpe, Lorna; Kaplan, Sue; Shelley, Donna
Background: To assess residents' attitudes towards the United States (U.S.) Department of Housing and Urban Development's new smoke-free public housing policy, perceptions about barriers to policy implementation, and suggestions for optimizing implementation. Methods: In 2017, we conducted 10 focus groups among 91 residents (smokers and nonsmokers) living in New York City public housing. Results: Smokers and nonsmokers expressed skepticism about the public housing authority's capacity to enforce the policy due to widespread violations of the current smoke-free policy in common areas and pervasive use of marijuana in buildings. Most believed that resident engagement in the roll-out and providing smoking cessation services was important for compliance. Resident expressed concerns about evictions and worried that other building priorities (i.e., repairs, drug use) would be ignored with the focus now on smoke-free housing. Conclusions: Resident-endorsed strategies to optimize implementation effectiveness include improving the access to cessation services, ongoing resident engagement, education and communication to address misconceptions and concerns about enforcement, and placing smoke-free homes in a larger public housing authority healthy housing agenda.
PMID: 30241291
ISSN: 1660-4601
CID: 3301172

Correlates of Burnout in Small Independent Primary Care Practices in an Urban Setting

Blechter, Batel; Jiang, Nan; Cleland, Charles; Berry, Carolyn; Ogedegbe, Olugbenga; Shelley, Donna
BACKGROUND:Little is known about the prevalence and correlates of burnout among providers who work in small independent primary care practices (<5 providers). METHODS:We conducted a cross-sectional analysis by using data collected from 235 providers practicing in 174 small independent primary care practices in New York City. RESULTS:= .034). CONCLUSION/CONCLUSIONS:The burnout rate was relatively low among our sample of providers compared with previous surveys that focused primarily on larger practices. The independence and autonomy providers have in these small practices may provide some protection against symptoms of burnout. In addition, the relationship between adaptive reserve and lower rates of burnout point toward potential interventions for reducing burnout that include strengthening primary care practices' learning and development capacity.
PMID: 29986978
ISSN: 1558-7118
CID: 3192272

Quality of Cardiovascular Disease Care in Small Urban Practices

Shelley, Donna; Blechter, Batel; Siman, Nina; Jiang, Nan; Cleland, Charles; Ogedegbe, Gbenga; Williams, Stephen; Wu, Winfred; Rogers, Erin; Berry, Carolyn
PURPOSE/OBJECTIVE:We wanted to describe small, independent primary care practices' performance in meeting the Million Hearts ABCSs (aspirin use, blood pressure control, cholesterol management, and smoking screening and counseling), as well as on a composite measure that captured the extent to which multiple clinical targets are achieved for patients with a history of arteriosclerotic cardiovascular disease (ASCVD). We also explored relationships between practice characteristics and ABCS measures. METHODS:We conducted a cross-sectional, bivariate analysis using baseline data from 134 practices in New York City. ABCS data were extracted from practices' electronic health records and aggregated to the site level. Practice characteristics were obtained from surveys of clinicians and staff at each practice. RESULTS:= .011) than practices with multiple clinicians. CONCLUSION/CONCLUSIONS:Achieving targets for ABCS measures varied considerably across practices; however, small practices were meeting or exceeding Million Hearts goals (ie, 70% or greater). Practices were less likely to meet consistently clinical targets that apply to patients with a history of ASCVD risk factors. Greater emphasis is needed on providing support for small practices to address the complexity of managing patients with multiple risk factors for primary and secondary ASCVD.
PMCID:5891310
PMID: 29632222
ISSN: 1544-1717
CID: 3036762