Sains Malaysiana 49(8)(2020): 1995-2003

http://dx.doi.org/10.17576/jsm-2020-4908-22

Effects of Aided Smoking Cessation Counselling with Exhaled Carbon Monoxide Measurement versus Conventional Counselling on Smokers' Intention to Quit and Cigarette Consumption

(Kesan Bantuan Kaunseling Berhenti Merokok dengan Ukuran Hembusan Karbon Monoksida berbanding Kaunseling Konvensional terhadap Niat Perokok untuk Berhenti dan Penggunaan Rokok)

NOORSYARIDA SHADAN¹, HIZLINDA TOHID²*, CHAI-ENG TAN², NURAIDA BAHARUDDIN², NOOR AZIMAH MUHAMMAD² & SHAMSUL AZHAR SHAH³

¹Klinik Kesihatan Seberang Jaya, Ministry of Health Malaysia, Jalan Perpustakaan, 13700 Butterworth, Pulau Pinang, Malaysia

²Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

³Department of Public Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

Received: 26 November 2019/Accepted: 6 April 2020

ABSTRACT

Feedback on exhaled carbon monoxide (CO) levels may potentially improve smokers’ motivation to quit. However, evidence to support its use is still lacking. This study aimed to examine how providing feedback on exhaled CO measurement affected smokers’ intention to quit and cigarette consumption short term. This non-randomised controlled trial was conducted at a government health clinic. The control group (n=132) received conventional counselling using the 5A approach and pamphlets, whereas the intervention group (n=132) received similar counselling along with feedback on exhaled CO measurements. Subjects’ intention to quit in the next month and current cigarette consumption were assessed at baseline and again four weeks post-counselling. At the baseline, there were significant differences between the groups in terms of gender (p=0.002), ethnicity (p=0.004), marital status (p=0.002), age of smoking initiation (p<0.001), nicotine dependence (p=0.001) and quit intention (p<0.001). Compared to the control group, those who received intervention started smoking at a younger age and had greater nicotine dependence, but they had stronger quit intentions. One month post-counselling, there were no differences in quit intention (p=0.389) and cigarette consumption (p=0.902) between the groups. However, within-group analysis shows both a significant improvement in quit intention (p<0.001 for both groups) and a reduction in cigarette consumption (p<0.001 for both groups) after the counselling. None of the participants quit smoking at follow-up. In conclusion, both conventional smoking cessation counselling and counselling with feedback on exhaled carbon monoxide levels were similarly effective in improving smokers’ quit intention and reducing cigarette consumption. However, this enhanced motivation was inadequate to make them quit.

Keywords: Carbon monoxide; counselling; intention; smoking cessation; tobacco use

ABSTRAK

Maklum balas mengenai paras karbon monoksida (CO) yang dihembus perokok berpotensi untuk mempengaruhi motivasi perokok untuk berhenti merokok tetapi keberkesanan kaedah ini masih kekurangan bukti. Kajian ini bertujuan untuk meneliti bagaimana maklum balas terhadap ukuran hembusan CO dapat menyebabkan perokok berniat untuk berhenti merokok dan mengurangkan pengambilan rokok dalam jangka pendek. Kajian terkawal yang tidak rawak telah dijalankan di klinik kesihatan kerajaan. Kumpulan terkawal (n=132) menerima kaunseling konvensional menggunakan kaedah 5A dan risalah manakala kumpulan intervensi (n=132) menerima kaunseling yang sama dan maklum balas terhadap ukuran hembusan CO. Subjek yang berniat untuk berhenti merokok pada bulan berikutnya dan pengambilan rokok yang dihisap telah dinilai pada permulaan kajian dan dinilai sekali lagi empat minggu selepas kaunseling. Pada permulaan kajian, terdapat perbezaan yang ketara antara kumpulan daripada segi jantina (p=0.002), bangsa (p=0.004), status perkahwinan (p=0.002), umur mula merokok (p<0.001), kebergantungan kepada nikotin (p=0.001) dan niat untuk berhenti merokok (p<0.001). Berbanding dengan kumpulan terkawal, mereka yang menerima intervensi mula merokok pada usia yang muda dan mempunyai kebergantungan nikotin yang tinggi, tetapi mereka mempunyai niat untuk berhenti merokok yang lebih tinggi. Sebulan selepas sesi kaunseling, tiada perbezaan dari segi antara niat perokok untuk berhenti merokok (p=0.389) dan bilangan rokok yang dihisap (p=0.902) antara kumpulan intervensi dengan kumpulan kawalan. Namun, analisis dalam kumpulan menunjukkan bahawa kedua-dua kumpulan ini mempunyai peningkatan yang ketara dari segi niat untuk berhenti merokok (p<0.001 untuk kedua-dua kumpulan) dan pengurangan pengambilan rokok (p<0.001 untuk kedua-dua kumpulan) selepas sesi kaunseling. Pada penilaian susulan selepas sebulan, tiada perokok yang telah berjaya berhenti merokok. Kesimpulannya, kedua-dua kaedah kaunseling biasa dan pemberian maklum balas berkenaan paras karbon monoksida dalam nafas yang dihembus adalah sama-sama berkesan untuk meningkatkan niat berhenti merokok dan mengurangkan bilangan rokok yang dihisap. Namun, peningkatan niat berhenti merokok ini masih belum berjaya untuk menggerakkan perokok untuk berhenti merokok.

Kata kunci: Berhenti merokok; karbon monoksida; kaunseling; keinginan; penggunaan tembakau

REFERENCES

Aveyard, P., Begh, R., Parsons, A. & West, R. 2011. Brief opportunistic smoking cessation interventions: A systematic review and meta-analysis to compare advice to quit and offer of assistance. Addiction 107: 1066-1073.

Bize, R., Burnand, B., Mueller, Y., Rège-Walther, M., Camain, J.Y. & Cornuz, J. 2012. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 12: CD004705.

Cahill, K., Stevens, S., Perera, R. & Lancaster, T. 2013. Pharmacological interventions for smoking cessation: An overview and network meta-analysis. Cochrane Database of Systematic Reviews 5: CD009329.

Choi, W.Y., Kim, C.H. & Lee, O.G. 2013. Effects of brief smoking cessation education with expiratory carbon monoxide measurement on level of motivation to quit smoking. Korean Journal of Family Medicine 34(3): 190-198.

DiClemente, C.C., Prochaska, J.O., Fairhurst, S.K., Velicer, W.F., Velasquez, M.M. & Rossi, J.S. 1991. The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology 59: 295-304.

Institute for Public Health (IPH). 2015. National Health and Morbidity Survey 2015 - Report on Smoking Status among Malaysian Adults. http://www.moh.gov.my/moh/resources/NHMS2015-VolumeV.pdf. Accessed on 23 June 2019.

Institute for Public Health (IPH). 2012. Report of the Global Adult Tobacco Survey (GATS) Malaysia, 2011. Kuala Lumpur: Ministry of Health Malaysia.

Institute of Public Health (IPH). 1997. National Health and Morbidity Survey (NHMS II). Volume 15: Smoking. Kuala Lumpur, Malaysia: Ministry of Health Malaysia.

Krishnan, K., Elf, J.L., Chon, S. & Golub, J.E. 2018. COach2Quit: A pilot randomized controlled trial of a personal carbon monoxide monitor for smoking cessation. Nicotine & Tobacco Research 21(11): 1573-1577.

Li, L., Borland, R., Yong, H.H., Fong, G.T., Bansal-Travers, M., Quah, A.C.K., Sirirassamee, B., Omar, M., Zanna, M.P. & Fotuhi, O. 2010. Predictors of smoking cessation among smokers in Malaysia and Thailand: Findings from the International Tobacco Control Southeast Asia Survey. Nicotine & Tobacco Research 12(1): S34-S44.

Lim, K.H., Teh, C.H., Pan, S., Ling, M.Y., Yusoff, M.F.M., Ghazali, S.M., Kee, C.C., Lim, K.K., Chong, K.H. & Lim, H.L. 2018. Prevalence and factors associated with smoking among adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015. Tobacco Induced Diseases 16: 1-12.

McClure, J.B., Ludman, E., Grothaus, L., Pabiniak, C., Richards, J. & Mohelnitzky, A. 2009. Immediate and short-term impact of a brief motivational smoking intervention using a biomedical risk assessment: The get PHIT trial. Nicotine & Tobacco Research 11(4): 394-403.

Pignone, M. & Salazar, R. 2011. Disease prevention & health promotion. In Current Medical Diagnosis & Treatment 2011. 15th ed, edited by Papadakis, M.A., McPhee, S.J. & Rabow, M.W. New York: The McGraw-Hill Companies Inc. p. 9.

Sanders, D., Fowler, G., Mant, D., Fuller, A., Jones, L. & Marzillier, J. 1989. Randomized controlled trial of anti-smoking advice by nurses in general practice. Journal of the Royal College of General Practitioners 39: 273-276.

Shahab, L., West, R. & McNeill, A. 2011. A randomized, controlled trial of adding expired carbon monoxide feedback to brief stop smoking advice: Evaluation of cognitive and behavioral effects. Health Psychology 30(1): 49-57.

Stead, L.F., Buitrago, D., Preciado, N., Sanchez, G., Hartmann-Boyce, J. & Lancaster, T. 2013. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013(5): Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4.

Tobacco, T.C.P.G.T. 2008. A clinical practice guideline for treating tobacco use and dependence: 2008 update: A US public health service report. American Journal of Preventive Medicine 35(2): 158-176.

Vasthare, R., Kumar, S. & Arron, L.Y. 2018. Carbon monoxide breath analyzers and its role in tobacco cessation: A narrative review of literature. Journal of International of Oral Health 10: 71-76.

World Health Organization (WHO). 2018. WHO Global Report on Trends in Prevalence of Tobacco Smoking 2000-2025. 2nd ed. Geneva: World Health Organization. https://www.who.int/tobacco/publications/surveillance/trends-tobacco-smoking-second-edition/en/. Accessed on 23 June 2019.

Zwar, N., Richmond, R., Borland, R., Peters, M., Litt, J., Bell, J., Caldwell, B. & Ferretter, I. 2011. Supporting Smoking Cessation: A Guide for Health Professionals. Melbourne: The Royal Australian College of General Practitioners.

*Corresponding author; email: hizlinda2202@gmail.com