Effect of Smoking Cessation Program: a review of this public policy for tobacco dependence

Lopes, Fernanda Machado; Moraes, Camila Angelina de; Rodrigues, Gabriela; Cardozo, Louisi; Bezerra, Jozabete Ferreira de Oliveira; Szupszynski, Karen Priscila Del Rio

doi:10.1590/1982-0275202340e210170en

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Brasil

Estudos de Psicologia (Campinas)

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Sumário

DOSSIER | Trends on Behavioral Addictions • Estud. psicol. 40 • 2023 • https://doi.org/10.1590/1982-0275202340e210170en copy

Effect of Smoking Cessation Program: a review of this public policy for tobacco dependence

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Brazil Health Ministry’s guidelines for tobacco control include the Smoking Cessation Program, developed by the Instituto Nacional de Câncer of Brazil. This review aims to describe the studies in which this Program has been applied, reviewing its procedures, effects, potential and limitations.

Method

Articles from PubMed, PsycINFO, Virtual Health Library and Scientific Electronic Library Online, published between 2002 and 2019, were evaluated, using the descriptors “Smoking Cessation Program” and “smoking cessation” in Portuguese, Spanish and English. A total of 1670 articles were pre-selected, of which 15 resulted eligible for final assessment.

Results

The results showed adherence rates from 33% to 100%, success rates from 15% to 85% after the intervention and 21% to 51% six months after treatment completion. This variability may be related to the lack of standardization and poor fidelity in the application of the Program, which intends to treat physical, psychological and behavioral dependence.

Conclusion

Investment in technical training and record monitoring is suggested.

Keywords
Evaluation of the efficacy-effectiveness of interventions; Tobacco use cessation; Tobacco use disorder; Treatment outcome

Authors / Year	Objective	Participants (N)	Instruments	Results
Figueiró et al. (2013)Figueiró, L. R., Bortolon, C. B., Benchaya, M. C., Bish, N. K., Ferigolo, M., Barros, H. M., & Dantas, D. C. (2013). Avaliação de mudanças na dependência da nicotina, motivação e sintomas de ansiedade e depressão em fumantes no processo inicial de redução ou cessação do tabagismo: estudo de seguimento de curto prazo. Trends in Psychiatry and Psychotherapy, 35(3), 212-220. https://doi.org/10.1590/S2237-60892013000300008 https://doi.org/10.1590/S2237-6089201300...	To examine whether smokers who quit smoking showed changes in the intensity of nicotine addiction, in the motivational stage, or in the symptoms of anxiety and depression compared to smokers who had not quit smoking	- Enrolled = 183 - Session 1 = 163 - Session 4 = 54 - Adherence rate: 33% - Mean age 49 years - Women: 64% - FTND = Moderate - Mean cigarettes/day = NI	- FTND - URICA - Contemplation Ladder - BAI and BDI - Urine test (Cross-sectional)	- Out of the 54 full-time adherents, 20 (37%) quit or reduced tobacco use - No use of medication - Those who quit smoking exhibited higher scores in the maintenance stage in the Contemplation Ladder
Kock et al. (2017)Kock, K. S., Arantes, M. W., Santos, C. C., & Castelini, S. S. (2017). Efetividade do programa de controle ao tabagismo em uma cidade do sul do Brasil. Revista Brasileira de Medicina de Família e Comunidade, 12(39), 1-10. https://doi.org/10.5712/rbmfc12(39)1562 https://doi.org/10.5712/rbmfc12(39)1562...	To evaluate the effectiveness of the SCP applied in a PHU in the city of Tubarão (SC).	- Enrolled = 130 - Session 1 = 106 - Session 4 = 73 - Adherence rate: 69% - Mean age 51 years - Women: 65% - FTND = 55% Moderate - Mean cigarettes/day = NI	- Sociodemographic Questionnaire: - FTND (Retrospective)	- Out of the 73 adherents, 55 (75%) quit smoking (the study reported a 51.9% success rate and not 75% because it considered the participants of Session 1) - Medication: 97% patch and 37% bupropion - Female who participated in less than 4 meetings had greater difficulty to quit smoking.
Krinski et al. (2018)Krinski, B. M., Faustino-Silva, D. D., & Schneider, M. (2018). Grupo de cessação de tabagismo na atenção primária à saúde: experiência de uma unidade de saúde de Porto Alegre/RS. Revista de APS, 21(1), 66-76. https://doi.org/10.34019/1809-8363.2018.v21.15867 https://doi.org/10.34019/1809-8363.2018....	To evaluate the frequency and time of smoking cessation in SCP at a PHU in Porto Alegre/RS	- Enrolled = NI - Session 1 = NI - Session 4 = 38 (ex SCP participants) - Adherence rate: NI - Mean age 53 years - Women: 87% - FTND = 63% High - Mean cigarettes/day = NI	- Interview sociodemographic and smoking data. - Questionnaire on the group efficacy - FTND (Cross-sectional)	- Out of the 38 adherents, 20 (53%) quit smoking - Out of the 47% adherents who did not quit smoking, only 33.3% participated in the 4 meetings - In the interview (does not specify follow-up time) 10 out of the 20 (50%) continued not to smoke - 60.5% used medication.
Lopes et al. (2014)Lopes, F. M., Peuker, A. C., Rech, B. E., Gonçalves, R., & Bizarro, L. (2014). Desenvolvimento, divulgação, adesão e eficácia de um Programa de Cessação do Tabagismo oferecido em uma universidade pública. Cadernos Terapia Ocupacional da UFSCar, 22, 5-15. https://doi.org/10.4322/cto.2014.025 https://doi.org/10.4322/cto.2014.025...	To describe the implantation of SCP in a public university, including the evaluation of the dissemination methods, adherence rates and program success.	- Enrolled = 128 - Session 1 = 97 - Session 4 = 69 - Adherence rate: 71% - Mean age 47 years - Women: 69% - FTND = Moderate - Mean cigarettes/day = 20	- Monoximeter - FTND - Survey questionnaire on dissemination methods (Longitudinal)	- Out of the 69 adherents, 13 (19%) quit smoking and 29 (42%) reduced tobacco consumption - After 6 months, 13 (22%) out of the 58 individuals contacted were not smoking and 12 (21%) had reduced smoking - After 1 year, out of the 58 individuals contacted, 15 (26%) were not smoking and 21 (36%) had reduced smoking - No use of medication
Lopes et al. (2013)Lopes, F. M., Peuker, A. C., & Bizarro, L. (2013). Aplicação de um Programa de Cessação do Tabagismo com Rodoviários Urbanos. Psicologia: Ciência e Profissão, 33(2), 490-499. https://doi.org/10.1590/S1414-98932013000200017 https://doi.org/10.1590/S1414-9893201300...	To describe the application of SCP carried out in an urban public transport company that implemented the smoke-free environment policy	- Enrolled = 30 - Session 1 = 16 - Session 4 = 16 - 100% adherence rate (SCP offered during working hours) - Age: NI - Men: 100% - FTND = 50% High - Mean cigarettes/day = NI	- Monoximeter - FTND (30-day follow-up)	- Out of the 16 adherents, 7 (44%) had quit smoking and 9 (56%) had reduced their consumption - After 30 days, the same 7 adherents (44%) remained abstinent; however, only 5 out of the 9 adherents continued with smoking reduction. - No use of medication
Meier et al. (2012)Meier, D. A., Secco, I. A., & Vannuchi, M. T. (2012). Análise de indicadores de programa de controle do tabagismo em município do norte do Paraná. Ciência, Cuidado e Saúde, 11, 129-137. https://doi.org/10.4025/cienccuidsaude.v10i5.17064 https://doi.org/10.4025/cienccuidsaude.v...	To analyze smoking treatment indicators in Cambé-PR.	- Enrolled = 92 - Session 1 = 63 - Session 4 = 48 - Adherence rate: 76% (Rate reported by the authors was 52%, considering those enrolled) - Mean age 50 years - Women: 62% - FTND = 65% High - Mean cigarettes/day = 20	- Sociodemographic questionnaire with tobacco history - FTND (Cross-sectional)	- Out of the 48 adherents, 32 (66.6%) quit smoking - 83.3% used medications.
Mesquita (2013)Mesquita, A. A. (2013). Avaliação de um programa de tratamento do tabagismo. Revista Brasileira de Terapia Comportamental e Cognitiva, 15(2), 35-44. https://doi.org/10.31505/rbtcc.v15i2.601 https://doi.org/10.31505/rbtcc.v15i2.601...	To evaluate the effectiveness of SCP applied in a hospital, based on the guidelines of the National Cancer Institute (INCA).	- Enrolled = NI - Session 1 = 109 - Session 4 = 73 - Adherence rate: 67% - Mean age 43 years - Sex: NI - FTND = NI - Mean cigarettes/day = NI	- Registration form (personal data) - FTND (Longitudinal)	- Out of the adherents, 83,5% quit smoking - After one month, the abstinence rate remained 100% - After four months and six months the abstinence rate dropped by almost half. - All used nicotine patches and/or bupropion
Pawlina et al. (2014)Pawlina, M. M., Rondina, R. C., Espinoza, M. M, & Botelho, C. (2014). Ansiedade e baixo nível motivacional associados ao fracasso na cessação do tabagismo. Jornal Brasileiro de Psiquiatria, 63(2), 113-20. https://doi.org/10.1590/0047-2085000000014 https://doi.org/10.1590/0047-20850000000...	To analyze the association between failure and the sociodemographic characteristics, smoking status, degree of motivation, and levels of anxiety, depression and stress in patients following a SCP in a Hospital and PHU in Cuiabá.	- Enrolled = 216 - Session 1 = 178 - Session 4 = 142 - Adherence rate: 79.8% - 62.5% aged between 40 59 years - Women: 65% - FTND = moderate/high - Mean cigarettes/day = 20	- Sociodemographic Questionnaire, - FTND - URICA - BAI and BDI - LSSI (Cross-sectional)	- Of the 142 adherents, 55 (38.5%) quit smoking - Therapeutic failure was associated with: young age group, shorter time smoking, greater smoking burden, low level of motivation and high level of anxiety. - All used nicotine patches and/or bupropion
Pawlina et al. (2015)Pawlina, M. M. C, Rondina, R. C., Espinoza, M. M, & Botelho, C. (2015). Depressão, ansiedade, estresse e motivação em fumantes durante o tratamento para a cessação do tabagismo. Jornal Brasileiro de Pneumologia, 41(5), 433-439. https://doi.org/10.1590/S1806-37132015000004527 https://doi.org/10.1590/S1806-3713201500...	To assess changes in the levels of anxiety, depression, motivation and stress in patients during the treatment for smoking cessation.	- Enrolled = 216 - Session 1 = 178 - Session 4 = 147 - Adherence rate: 82.5% - 63.4% aged between 40-59 years - Women: 70% - FTND = 69% High - Mean cigarettes/day = NI	- Sociodemographic questionnaire and tobacco history - URICA - BAI and BDI - LSSI and FTND (Cohort, 6-month follow-up)	- Out of the 147 adherents, 81 (55%) quit smoking - After 6 months, of the 142 individuals contacted, 81 (57.04%) continued not smoking. - There was an improvement in the levels of anxiety, depression, motivation and stress between the initial assessment and after 45 days and at the end of 6 months. - All participants used nicotine patches and/or bupropion
Rodrigues et al. (2016)Rodrigues, N. C., Andrade, M. K., O’Dwyer, G., Daumas, R. P., Neves, R. D., Pereira Neto, A. P., Dutra, M. C., Gerardi, A., & Lino, V. T. (2016). Long-term effects of smoking cessation support in primary care: results of a two-year longitudinal study in Brazil. Jornal Brasileiro de Psiquiatria, 65(2), 174-178. https://doi.org/10.1590/0047-2085000000120 https://doi.org/10.1590/0047-20850000001...	To assess the long-term effect of SCP and the factors associated with treatment success.	- Enrolled = 245 Session 1 = NI - After 3 months = 84 - Adherence rate: NI - Mean age 50 years - Women: 73% - FTND = high - Mean cigarettes/day = NI	- Sociodemographic questionnaire and tobacco history - FTND - CAGE (Longitudinal)	- After 3 months, 34 (40.5%) of the 84 individuals evaluated were not smoking - After 6 months, 30 (35.7%) of the 84 individuals evaluated were not smoking - After 1 year, 26 (31.0%) of the 84 individuals evaluated were not smoking - After 2 years, 16 (19.0%) of the 84 individuals evaluated were not smoking - All used nicotine patches
Rossaneis & Machado (2011)Rossaneis, M. A., & Machado, R. C. (2011). Cessação do tabagismo em pacientes assistidos em um ambulatório de tratamento de dependência do tabaco. Ciência, Cuidado e Saúde, 10(2), 306-313. https://doi.org/10.4025/cienccuidsaude.v10i2.15688 https://doi.org/10.4025/cienccuidsaude.v...	To identify the socioeconomic and clinical profile of patients assisted at the Tobacco Control Center of the Londrina State University Hospital Outpatient Clinic.	- Enrolled = NI - Session 1 = NI - Session 4 = 12 - Adherence rate: NI - Median age of 32 years - Men: 58% - FTND = 75% high - Mean cigarettes/day = NI	- Sociodemographic Questionnaire: - Clinical and smoking history - FTND - Hamilton Scale (Cross-sectional)	- Out of the 12 adherents, 8 (66.6%) quit and 4 (33.3%) reduced tobacco consumption - Clinical comorbidities were found in the group of people who were unable to quit smoking. - All smokers showed signs of depression, according to the Hamilton scale. - 50% used medication
Sales et al. (2006)Sales, M. P., Figueiredo, M. R., Oliveira, M. I., & Castro, H. N. (2006). Ambulatório de apoio ao tabagista no Ceará: perfil dos pacientes e fatores associados ao sucesso terapêutico. Jornal Brasileiro de Pneumologia, 32(5), 410-417. https://doi.org/10.1590/S180637132006000-500007 https://doi.org/10.1590/S180637132006000...	To evaluate the profile of patients and factors associated with treatment success performed in an outpatient hospital.	- Enrolled = NI - Session 1 = 320 - After 1 year = 258 - Adherence rate: NI - Mean age 48 years - Women: 65,6% - FTND = 78% moderate high - Mean cigarettes/day = 54% more than 20 cigarettes/ day	- Sociodemographic questionnaire, - Clinical and smoking history - FTND - Radiogram - Spirometry(Retrospective)	- After 1 year, 131 (50.8%) of the 258 participants contacted were not smoking, 46 (17.8%) relapsed and 51 (31.4%) had not quit smoking. - Medication: 68.4% used nicotine patches and 65.5% used bupropion.
Santos et al. (2018)Santos, S. R., Bitencourt, A. R., Engel, R. H., Silva, M. H., Stacciarini, T. S., & Cordeiro, A. L. (2018). Perfil e fatores associados ao sucesso terapêutico de tabagistas atendidos em um serviço público especializado. Revista Enfermagem UERJ, 26, 1-7. https://doi.org/10.12957/reuerj.2018.17381 https://doi.org/10.12957/reuerj.2018.173...	To identify the profile of smokers enrolled in the SCP of the Federal University of Triângulo Mineiro (UFTM) in Uberaba (MG) and list the factors associated with therapeutic success.	- Enrolled = NI - Session 1 = NI - Session 4 = 305 - Adherence rate: NI - Mean age 49 years - Women: 68,5% - FTND = 69% High - Mean cigarettes/day = 25.8	- Clinical evaluation (sociodemographic data and smoking history) - FTND (Retrospective)	- A high rate (84.6%) of treatment abandonment was observed - Out of the 305 adherents, 47 (15.4%) quit smoking - 52.1% used medication (paid by the participants)
Santos et al. (2012)Santos, J. D., Duncan, B. B., Sirena, S. A., Vigo, A., & Abreu, M. N. (2012). Indicadores de efetividade do Programa de Tratamento do Tabagismo no Sistema Único de Saúde em Minas Gerais, Brasil, 2008. Epidemiologia e Serviços de Saúde, 21(4), 579-588. http://dx.doi.org/10.5123/S1679-49742012000400007 https://doi.org/10.5123/S1679-4974201200...	To assess effectiveness indicators of SCP offered by the Brazilian SUS Health System in 60 municipalities in the state of Minas Gerais.	- Enrolled = 7269 - Session 1 = 6304 - Session 4 = 4617 - Adherence rate: 73% - Mean age: NI - Gender: NI - FTND = NI - Mean cigarettes/day = NI	- Sociodemographic data - FTND - Motivational stage assessment (Retrospective)	- Out of the 4617 adherents, 3084 (67%) quit smoking - Over 60% used medication - The program was available in only 7.0% of the municipalities of Minas Gerais.
Zancan et al. (2011)Zancan, N., Colognese, B. T., Ghedini, F., & Both, T. (2011). Intervenções Psicológicas em Grupos de Controle de Tabagismo: relato de experiência. Revista de Psicologia da IMED, 3(2), 534-544. https://doi.org/10.18256/21755027 https://doi.org/10.18256/21755027...	To describe care with a focus on smoking cessation performed at a public health care center in Passo Fundo (RS)	- Enrolled = 47 - Session 1 = 38 - Session 4 = 23 - Adherence rate: 61% - Mean age: NI - Women: 76,6% - FTND = 25% moderate and 30% high - Cigarettes/day = 38% 11 to 20 and 40% more than 20	- Sociodemographic Questionnaire: - Smoking history - FTND (Cross-sectional)	- Of the 23 adherents, 15 (65%) quit smoking and 8 (35%) reduced tobacco consumption (In the original study, the percentiles presented are lower because they used participants’ data in session 1 as a reference and not those in session 4, who concluded the treatment)

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André Luiz Monezi de Andrade