Impact of additional counselling sessions through phone calls on smoking cessation outcomes among smokers in Penang State, Malaysia

Ali Qais Blebil 0 1 Syed Azhar Syed Sulaiman 1 Mohamed Azmi Hassali 2 Juman Abdulelah Dujaili 1 Alfian Mohamed Zin 3 0 Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI university , Jalan Menara Gading, UCSI Heights, 56000 Kuala Lumpur , Malaysia 1 Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia , 11800 Penang , Malaysia 2 Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia , 11800 Penang , Malaysia 3 Quit Smoking Clinic, Penang General Hospital , Jalan Residensi, 10990 Penang , Malaysia Background: Studies all over the world reported that smoking relapses occur during the first two weeks after a quit date. The current study aimed to assess the impact of the additional phone calls counselling during the first month on the abstinence rate at 3 and 6 months after quit date among smokers in Penang, Malaysia. Methods: The study was conducted at Quit Smoking Clinic of two major hospitals in Penang, Malaysia. All the eligible smokers who attended the clinics between February 1st and October 31st 2012 were invited. Participants were randomly assigned by using urn design method either to receive the usual care that followed in the clinics (control) or the usual care procedure plus extra counselling sessions through phone calls during the first month of quit attempt (intervention). Results: Participants in our cohort smoked about 14 cigarettes per day on average (mean = 13.78 7.0). At 3 months, control group was less likely to quit smoking compared to intervention group (36.9% vs. 46.7%, verified smoking status) but this did not reach statistical significance (OR = 0.669; 95% CI = 0.395-1.133, P = 0.86). However, at 6 months, 71.7% of the intervention group were successfully quit smoking (bio-chemically verified) compared to 48.6% of the control group (P < 0.001). The control group were significantly less likely to quit smoking (OR = 0.375; 95% CI = 0.217-0.645, P < 0.001). Conclusions: Smoking cessation intervention consisting of phone calls counselling delivered during the first month of quit attempt revealed significantly higher abstinence rates compared with a standard care approach. Therefore, the additional counselling in the first few weeks after stop smoking is a promising treatment strategy that should be evaluated further. Trial registration: TCTR20140504001 2014 Blebil et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. - Background There is no specific method or technique that has been confirmed as the best way to improve the abstinence rates of smoking. Numerous studies have tried to find the most effective and feasible method to assist and support smokers who want to quit smoking. In Malaysia, the majority (80.3%) of tobacco users tried to stop smoking without assistance. Furthermore, 9% of them used pharmacotherapy followed by counselling (4.4%) or quitline and others (7.6%) (Such as traditional medicines, switching to smokeless tobacco) [1]. Several studies reported that up to 70% of the tobacco users who quit smoking cigarettes had relapsed within the first two weeks of their quit dates [2-4]. Thus, the initial two weeks are considered a window period prior to the achievement of long-term abstinence. After this critical era, curves of relapse of the treatment and control groups in intervention studies become parallel [5-7]. Thus, the prevention of relapse in the first two weeks might enhance the probability of successful long-term abstinence [8]. The majority of smokers prefer to cease using tobacco products, avoiding attendance at counselling sessions or group programmes (person-to-person contact) [9-11]. Counselling through phone calls has been paid more attention as an alternative for the delivery of services [12-15]. There are numerous potential benefits of smoking cessation telephone counselling including the ease of use, whenever required and wherever the tobacco user is located; cost-effective delivery and scalability to a large number of people, regardless of location; the ability to tailor messages to key user characteristics (such as age, sex, ethnicity); providing a content that can distract the smoker from craving; and linking the smokers with others for social support [16]. Therefore, in order to provide a more comfortable and feasible intervention and to assess additional counselling sessions during the first month after the quit date, it has been interesting to evaluate the effectiveness of this type of counselling using telephone calls. The results will help to explore and assess the benefits of using loading counselling sessions using telephone calls to support people who want to quit, and to compare this method with the usual provisions in Malaysian health care settings regarding the abstinence rate. Methods Setting and participants The study was carried out at the Quit Smoking Clinic of two major hospitals in Penang state, Pulau Pinang and Seberang Jaya Hospitals. All eligible cigarettes smokers who attended the clinics between February 1st and October 31st of 2012 were invited. Inclusion and exclusion criteria All individuals who attended the clinics during the period under review were invited to participate in the research. Inclusion criteria involved: (1) New registered smokers who attend the Quit Smoking Clinic (either walk-in, referred from the outpatient clinics from the same hospital, or referred from outside primary clinics), (2) Male or female aged 18 years old, (3) Willing to stop smoking. In addition, all outpatient clinics of both hospitals were contacted to refer any smoker patient willing to stop smoking to Quit Smoking Clinic. While the exclusion criteria consisted of: (1) Any inpatient referred to the Quit Smoking Clinics, (2) Recent (three months or below) history of serious cardiac arrhythmia, angina pectoris, myocardial infarction, or other medical conditions that from researchers' view participants might not be commitment with the study, (3) Currently using NRT or other smoking cessation treatments (bupropion or varenicline) within the last 12 months before study enrolment, (4) Use tobacco products other than cigarettes, (5) Pregnant, lactation or intend to be pregnant, (6) Use of Psychoactive drugs, (7) Suspected drug or alcohol abuse, (8) Patients who continue to buy nicotine gum after the first 2 weeks of treatment (as a normal policy in these hospitals, the patients are supplied free nicotine gum for 2 weeks only after that if the patients wan (...truncated)