Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. Objectives To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters were used. Sixty-five trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, >24,000 participants, risk ratio (RR) for cessation at longest follow up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Two studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that provided access to a hotline two detected a significant benefit and one did not. Telephone counselling not initiated by calls to helplines also increased quitting (44 studies, >24,000 participants, RR 1.29, 95% CI 1.20 to 1.38). In the subgroup of studies offering 1-2 calls the effect was small and not significant. A further seven studies were too diverse to contribute to meta-analyses and are discussed separately.

Telephone counselling for smoking cessation.

Background—Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. Methods and Results—For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change...

Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association

Lung cancer is the leading cause of cancer-related death in the United States, with an average five-year survival rate of 15 percent. Smoking remains the predominant risk factor for lung cancer. Lung cancers are categorized as small cell carcinoma or non-small cell carcinoma (e.g., adenocarcinoma, squamous cell carcinoma, large cell carcinoma). These categories are used for treatment decisions and determining prognosis. Signs and symptoms may vary depending on tumor type and extent of metastases. The diagnostic evaluation of patients with suspected lung cancer includes tissue diagnosis; a complete staging work-up, including evaluation of metastases; and a functional patient evaluation. Histologic diagnosis may be obtained with sputum cytology, thoracentesis, accessible lymph node biopsy, bronchoscopy, transthoracic needle aspiration, video-assisted thoracoscopy, or thoracotomy. Initial evaluation for metastatic disease relies on patient history and physical examination, laboratory tests, chest computed tomography, positron emission tomography, and tissue confirmation of mediastinal involvement. Further evaluation for metastases depends on the clinical presentation. Treatment and prognosis are closely tied to the type and stage of the tumor identified. For stages I through IIIA non-small cell carcinoma, surgical resection is preferred. Advanced non-small cell carcinoma is treated with a multimodality approach that may include radiotherapy, chemotherapy, and palliative care. Chemotherapy (combined with radiotherapy for limited disease) is the mainstay of treatment for small cell carcinoma. No major organization recommends screening for early detection of lung cancer, although screening has interested researchers and physicians. Smoking cessation remains the critical component of preventive primary care.

Lung Cancer: Diagnosis and Management

Smokefree policies to reduce tobacco use. A systematic review.

Our primary objective was to test the effectiveness of stage-based interventions in helping smokers to quit. Conclusions: Based on four trials using direct comparisons, stage-based self-help interventions (expert systems and/or tailored materials) and individual counselling were neither more nor less effective than their non-stage-based equivalents. Thirty-one trials of stage-based self help or counselling interventions versus any control condition demonstrated levels of effectiveness which were comparable with their non-stage-based counterparts. Providing these forms of practical support to those trying to quit appears to be more productive than not intervening. However, the additional value of adapting the intervention to the smoker's stage of change is uncertain. The evidence is not clear for other types of staged intervention, including telephone counselling, interactive computer programmes and training of physicians or lay supporters. The evidence does not support the restriction of quitting advice and encouragement only to those smokers perceived to be in the preparation and action stages.

Stage‐based interventions for smoking cessation

Energy system optimization models often incorporate climate change impacts to examine different energy futures and draw insights that inform policy. However, increased risk of extreme weather events from climate change has proven more difficult to model. Here, we present an energy system optimization model that incorporates hurricane risks by combining storm probabilities with infrastructure fragility curves, and demonstrate its utility in the context of Puerto Rico, an island territory of the United States that had its energy system severely damaged by Hurricane Maria in 2017. The model assesses the potential to change grid architecture, fuel mix and grid hardening measures considering hurricane impacts as well as climate mitigation policies. When hurricane trends are included, 2040 electricity cost projections increase by 32% based on historical hurricane frequencies and by 82% for increased hurricane frequencies. Transitioning to renewables and natural gas reduces costs and emissions independent of climate mitigation policies. In order to assess the impact of climate change on energy systems, models need to incorporate the increased risk of extreme weather events. Here, Bennett et al. provide a framework to integrate increasing extreme event risk in grid expansion planning models and apply the method to hurricane risks in Puerto Rico.

Extending energy system modelling to include extreme weather risks and application to hurricane events in Puerto Rico

Smoking markedly increases the risk of asbestos-related lung cancer. We conducted a randomized pilot trial of a telephone-based smoking cessation intervention in asbestos workers. Fifty-nine smokers were assigned to either a control or telephone-based smoking cessation treatment group and were followed-up at 6 months. Intent-to-treat analysis revealed a 16.7% quit rate at 6 months for the intervention group compared to 6.9% for the control group (P = 0.25). Treatment-received quit-rates were 33% for the intervention group and 6.9% for the control group (P = 0.05). The intervention group was twice as likely to use smoking cessation medicines and progressed further along the stage of change continuum compared with the control group. Incorporating telephone-based smoking cessation treatment into medical screening activities for asbestos workers is feasible and the intervention is effective in increasing quit rates at 6 months.

A pilot study of telephone-based smoking cessation intervention in asbestos workers.

Background

Smoking restrictions provide opportunities to modify smoking behavior. A large insurance company implemented a smoke-free grounds policy at two of their office complexes in January, 2000.



Methods

This cohort study evaluated the impact of the smoke-free grounds policy on abstinence among 128 employees who participated in a tobacco dependence treatment program.



Results

The overall quit rate at 6 months was 44.5%. The larger complex showed a trend for higher quit rates compared to the smaller complex (46.5 vs. 28.6%). Post-ban participants had higher quit rates than pre-ban participants (52.4 vs. 43.0%). The probability of abstinence at 6 months follow-up was higher for post-ban compared to pre-ban participants (P = 0.03). Post-ban participants were 80% less likely to relapse than pre-ban participants. Non-quitters decreased their consumption by 6.6 cigarettes/day (39.1% decrease).



Conclusions

A “smoke-free grounds” policy encourages abstinence and may play a significant role in harm reduction among continuing tobacco users. Am. J. Ind. Med. 46:180–187, 2004. © 2004 Wiley-Liss, Inc.

Efficacy of tobacco dependence treatment in the context of a "smoke-free grounds" worksite policy: a case study

The study of disaster-specific leadership of female university students has been largely neglected, especially during on-campus emergency eviction and evacuation. Based on the COVID-19-triggered, on-campus evictions across Canada and the United States, this cross-national partnership examined the out-of-province/state and international female university students’ leadership during the entire eviction process. Through in-depth interviews, this study revealed the female university students’ leadership behaviors during three stages: (1) pre-eviction: their self-preparedness formed an emotional foundation to support others; (2) peri-eviction: their attitude and leadership behavior enabled them to facilitate (psychologically and physically) their peers’ eviction process; and (3) post-eviction: they continued to support their peers virtually and raised the general public’s awareness regarding the plight of vulnerable and marginalized populations. This article argues that the female university students’ leadership that emerged during the eviction process became complementary to and even augmented the universities’ official efforts and beyond. This leadership represents empirical evidence that contributes to the existing literature on gender and leadership by demonstrating female youth as empowered stakeholders rather than as merely passive victims. Future studies could develop detailed stratification of gender and age dimensions in order to portray a more comprehensive picture of the younger generation’s leadership in hazards and disaster research and practice.

/pdf/empowered-stakeholders-female-university-students-leadership-36cz5fdstg.pdf

Marla Perez-Lugo

Papers

Extending energy system modelling to include extreme weather risks and application to hurricane events in Puerto Rico

A pilot study of telephone-based smoking cessation intervention in asbestos workers.

Efficacy of tobacco dependence treatment in the context of a "smoke-free grounds" worksite policy: a case study

Empowered Stakeholders: Female University Students’ Leadership During the COVID-19-Triggered On-campus Evictions in Canada and the United States