To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/add.12998 or contact your DHB library, or organisational or local library for assistance.

West, R., et al. (2015). Healthcare interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction, 29 May [Epub before print].

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ntr/ntv122 or contact your DHB library, or organisational or local library for assistance.

McRobbie, H., et al. (2015). Complementing the standard multicomponent treatment for smokers with de-nicotinised cigarettes: A randomised trial. Nicotine & Tobacco Research, 4 June [Epub before print].

Thirteen studies were added in this update, giving a total of 47 randomised controlled trials, with 2985 participants included in the data analyses. The studies focused on six chronic illnesses (painful conditions, cancer, diabetes, asthma, traumatic brain injury and eczema) and evaluated four types of psychological therapies (cognitive behavioural therapy, family therapy, problem solving therapy, multisystemic therapy). 

The authors conclude from their analysis that "there is little evidence for the efficacy of psychological therapies that include parents on most outcome domains of functioning, for a large number of common chronic illnesses in children. However, psychological therapies are efficacious for some outcomes. CBT [cognitive behavioural therapy] that includes parents is beneficial for reducing children's primary symptoms, and PST [problem solving therapy] that includes parents improved parent adaptive behaviour and parent mental health. There is evidence that the beneficial effects can be maintained at follow-up for diabetes-related symptoms in children, and for the mental health of parents of children with cancer and parents who received PST".

The authors suggest that the small number of studies in this review means that future studies are likely to impact on the findings.

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD009660.pub3

Eccleston C, Fisher E, Law E, Bartlett J, Palermo TM. (2015). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews, 4, Art. No.: CD009660.

Six articles were included (one randomised controlled trial; four cohort studies; and one case study). The authors conclude that, "although there were a limited number of studies on combined motivational interviewing and cognitive behavioural interventions, five out of six were effective at improving medication adherence. Future studies with large rigorous randomised trials are needed".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/jocn.12738 or contact your DHB library, or organisational or local library for assistance.

Spoelstra, S. L., Schueller, M., Hilton, M. and Ridenour, K. (2015), Interventions combining motivational interviewing and cognitive behaviour to promote medication adherence: a literature review. Journal of Clinical Nursing, 24(9-10), 1163–1173

Twenty-seven randomised controlled trials (RCTs) of interventions with children (aged 5-12) or adolescents (aged 13-18) and families to deter tobacco use were included. 

Based on their analysis, the authors conclude that "there is moderate quality evidence that family-based interventions can prevent children and adolescents from starting to smoke. Intensive programs may be more likely to be successful than those of lower intensity. There is also evidence to suggest that adding a family-based component to a school intervention may be effective. As the interventions and settings in the review differed considerably, it is important that family-based programmes continue to be evaluated".

This article can be read in free full text at:  http://dx.doi.org/10.1002/14651858.CD004493.pub3

Thomas, R.E., et al. (2015). Family-based programmes for preventing smoking by children and adolescents. Cochrane Database of Systematic Reviews, 2, CD004493.

Twenty-eight randomized controlled trials in which motivational interviewing or its variants were offered to tobacco users to assist cessation were included. The authors conclude from their analyais that "motivational interviewing may assist people to quit smoking. However, the results should be interpreted with caution, due to variations in study quality, treatment fidelity, between-study heterogeneity and the possibility of publication or selective reporting bias". 

This review is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD006936.pub3

Lindson-Hawley N, Thompson TP, Begh R. (2015). Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews, 3, CD006936.

This systematic review and meta-analysis examined the effectiveness of behavioural interventions targeting diet, physical activity or smoking in low-income adults.

Based on the findings of this Cochrane review update on tobacco addiction interventions, the authors conclude that "... evidence from 2013 suggests that adding mood management to behavioural support may improve cessation outcomes in smokers with current or past depression and strengthens evidence for previous conclusions, including the safety of varenicline and bupropion and the benefits of behavioural support for smoking cessation in pregnancy".

For futher information, including details on how to give feedback and a link to the guidelines, go to: http://www.nzno.org.nz/home/ctl/articleview/mid/2250/articleid/1774/incident-debriefing

The authors conducted meta-analyses of the main interventions. Among the authors conclusion were the following:

• Strong evidence that some interventions for individual smokers increase the likelihood of quitting smoking (including individual and group counselling, pharmacological treatment to overcome nicotine addiction, and multiple interventions targeting smoking cessation as the primary or only outcome). Self-help interventions and social support are less effective. 
• No effect was detected from comprehensive programmes targeting multiple risk factors.
• Limited evidence that participation can be increased by competitions and incentives organised by the employer.

This article is available to read in full text at:  http://dx.doi.org/10.1002/14651858.CD003440.pub4

Cahill K. & Lancaster T. (2014). Workplace interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2, Art. No.: CD003440.

The guidance includes a range of approaches for people aged 16 and over, from single interventions delivered as the opportunity arises to planned, high intensity interventions that may take place over a number of sessions.

The guidance aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking. These behaviours are linked to health problems and chronic diseases (such as cardiovascular disease, type 2 diabetes and cancer). This means interventions that help people change have considerable potential for improving health and wellbeing.

Access to the full text of this guidance is available at: https://www.nice.org.uk/guidance/ph49

N.B. This guidance was developed for use in England.

Tony Ryall, Jo Goodhew media release, 20 November, 2013

The government is investing an extra $1.6 million into getting the healthy eating message out to Waitemata and Central Auckland’s hardest-to-reach new mums and their families.

Health Minister Tony Ryall says local community health groups and Waitemata and Auckland District Health Boards are working together to encourage families, who are not well linked into health services, to access antenatal, postnatal and infant healthcare.

“One of the ways they will be achieving this is by texting them. Pregnant women and young mothers who have registered for the free service will receive text messages encouraging them to take up healthy and safe lifestyle choices during their pregnancy and postnatal period.

“This will be similar to successful text messaging used for smoking cessation which can double quit rates and has been implemented as a Ministry of Health funded national service,” says Mr Ryall.

Associate Health Minister Jo Goodhew says that being overweight during pregnancy and childbirth not only leads to significant problems for mums, such as preeclampsia and gestational diabetes, but also has significant adverse health outcomes for the child.

“There will be group education programmes at places like marae and churches on topics such as breastfeeding support, shopping on a budget, healthy cooking methods and fun ways to exercise.

“Evidence also suggests the elders of a family or community can have significant influence on the dietary and lifestyle choices made by younger mums – and that they don’t always do so correctly. So radio adverts will run on radio stations to make sure they understand the benefits of healthy eating and exercise for mums and babies,” says Mrs Goodhew.

Mr Ryall says the $1.6 million over two years is just one in a series of investments in Healthy Families that the government is making to help Kiwi families give their children a healthy start.

“Recent international research and advice from the Prime Minister’s Chief Science Advisor Professor Sir Peter Gluckman suggests that preconditions for overweight and obesity are set very early.

“This is why the government is focussing on improving women’s health during their pregnancy and their postnatal period by promoting healthy eating and physical activity for mums, and good nutrition for infants and toddlers,” says Mr Ryall.

Funding for the health promotion programme is from within the Ministry of Health’s existing budget. The $1.6 million announced is initially over two years and the project will be fully evaluated for potential further roll out.

Dr Lawrence is in New Zealand as an advisor to Gravida's new Ministry of Health funded workforce development project. The project is working towards the development of a curriculum that will be offered to those who care for pregnant women and young families. It will cover both the latest scientific evidence in maternal and infant nutrition and physical activity research, as well as a New Zealand-specific adaptation of the "Healthy Conversations" workforce skills training.

A short news summary of this presentation can be viewed at: http://www.gravida.org.nz/news-and-events/news/published-papers-show-healthy-conversations-training-increases-workforce-confidence-and-skills/

A video of Dr Lawrence's 45 minute lecture can also be viewed on Gravida's website at: http://www.gravida.org.nz/video/wendy-lawrence-2013/

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/add.12291 or contact your DHB library, or organisational or local library for assistance.

Hartmann-Boyce, J., Stead, L. F., Cahill, K. and Lancaster, T. (2013). Efficacy of interventions to combat tobacco addiction: Cochrane update of 2012 reviews. Addiction, 108(10), 1711–1721.

This paper reports a longitudinal qualitative interview and observation study of the development and practice of health literacy in people with long-term health conditions, living in South Wales, UK.

To read the full abstract, and for information on how to access the full text, go to: http://onlinelibrary.wiley.com/doi/10.1111/hex.12093/abstract or contact your DHB library, or organisational or local library for assistance.

Edwards, M., et al. (2013). 'Distributed health literacy': longitudinal qualitative analysis of the roles of health literacy mediators and social networks of people living with a long-term health condition. Health Expectations, [published online 17 June 2013].

This review aimed to identify, describe and synthesise currently available evidence on the effectiveness of tobacco use cessation interventions delivered by pharmacy personnel.

To read the full abstract, and for information on how to access the full text, go to: http://www.rsap.org/article/PIIS1551741113000867/abstract or contact your DHB library, or organisational or local library for assistance.

Mdege, N. D. & Chindove, S. (2013). Effectiveness of tobacco use cessation interventions delivered by pharmacy personnel: A systematic review. Research in Social and Administrative Pharmacy, [published online 5 June 2013].

The aim of this randomised controlled trial was to compare the effectiveness of two intervention programmes for reducing cardiovascular risk factors within general practice. The trial was conducted in Belgium between 2007-2010 with 314 highly educated and mainly healthy professionals allocated to a medical or a medical + lifestyle program. The study found that both interventions were effective in reducing cardiovascular risk, and that in the study population the combined medical and lifestyle program was not superior to the medical program.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.biomedcentral.com/1471-2261/13/38/abstract

Claes, N., et al. (2013). Comparing the effectiveness of two cardiovascular prevention programs for highly educated professionals in general practice: A randomised clinical trial. BMC Cardiovascular Disorders, 13:38.

In this paper, the authors present an overview of systematic reviews evaluating the impact of interventions to improve the quality of diabetes care.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.systematicreviewsjournal.com/content/2/1/26/abstract

Worswick, J. (2013). Improving quality of care for persons with diabetes: An overview of systematic reviews - what does the evidence tell us? Systematic Reviews, 2:26.

The intervention involved practice level training in a whole systems approach to self management support. Practices were trained to use a range of resources: a tool to assess the support needs of patients, guidebooks on self management, and a web based directory of local self management resources. Training facilitators were also employed by the health management organisation.

The trial found that the intervention to enhance self management support in routine primary care did not add noticeable value to existing care for long term conditions. The authors concluded that the active components required for effective self management support need to be better understood, both within primary care and in patients’ everyday lives.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.bmj.com/content/346/bmj.f2882

Kennedy, A., et al. (2013). Implementation of self management support for long term conditions in routine primary care settings: Cluster randomised controlled trial. BMJ, 346:f2882.

This case study examines how the use of cessation support by women is encouraged or discouraged by cessation policy, programming and practice; how geographical and sociocultural factors influence provision and uptake of support; and how barriers and challenges can be addressed through a comprehensive approach.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.biomedcentral.com/1471-2458/13/472/abstract

Borland, T., et al (2013). Exploring the adequacy of smoking cessation support for pregnant and postpartum women. BMC Public Health, 13:472.

It encourages workplaces to provide a supportive environment and healthy policies for employees that promote physical activity, healthy eating, smoke-free and mental wellbeing.

Access to the full text of the resource is free online at: http://www.rph.org.nz/content/a87180ef-7077-4465-9bcd-bd8c6c76e882.cmr

Regional Public Health. (2012). A guide to promoting health and wellness in the workplace. Wellington: Regional Public Health.

In 2011, the New Zealand Guidelines Group was commissioned by the Ministry of Health to perform a systematic review to identify the most effective evidence-based theories and programmes for bringing about health behaviour change in people with chronic health conditions.

As a part of this review a number of New Zealand case study interventions were identified, including implementation of the Flinders Program by a Primary Health Organisation in Hawkes Bay. The aim of the project was to improve chronic care management in primary health care by providing purposeful and deliberate self-management support, particularly for patients with comorbidity.

A summary of the programme can be found at: http://www.health.govt.nz/publication/effective-behaviour-change-long-term-conditions

The RapidE process was developed by the Ministry and the NZGG to produce evidence-based guidance for the health sector with a focus on implementation.

The rapidE process produced a suite of documents, including:

RapidE: Chronic Care: A systematic review of the literature on health behaviour change for chronic care

This review identifies, appraises and summarises the most effective evidence-based theories and programmes of health behaviour change for individuals with the following chronic diseases: diabetes, chronic obstructive airways disease, asthma, stroke and hypertension.

Effective Health Behaviour Change in Long-term Conditions: A review of New Zealand and international evidence

This brief paper summarises the results of the review and is intended to inform health practitioners, programme designers and decision makers in New Zealand, as the sector strengthens the support for people with long-term conditions to self-manage by changing health behaviours.

Case studies of five New Zealand interventions

• Case Study 1: The Heart Guide Aotearoa (HGA) Programme
• Case Study 2: The Diabetes Self-management Education Programme
• Case Study 3: Māori Diabetes Self-management Education
• Case Study 4: The Samoan Self-management Education Programme for People with Long-term Health Conditions
• Case Study 5: Implementation of the Flinders Program by a Primary Health Organisation

Health Literacy Interventions: A brief summary

This report provides a brief summary of the main messages from recent health literacy systematic reviews that have a focus on the impact of health literacy interventions for adults with chronic disease/illness. The reviews summarised in this report focus specifically on interventions that aim to increase individual’s knowledge and understanding of chronic disease/diseases of interest and its effective management.

Full-text versions of all the documents can be accessed on the Ministry of Health's website, at: http://www.health.govt.nz/publication/effective-behaviour-change-long-term-conditions

Quit4u combines structured behavioural support and pharmacotherapy with financial incentives for each week (up to a maximum of 12 weeks, spread over a potential 20 weeks) that participants remain quit, as verified by a carbon monoxide (CO) breath test. It was offered to all those living in deprived areas (DEPCATs 5, 6 or 7) of Dundee and aimed specifically to increase take-up of cessation support and quit rates among smokers in deprived areas. 

Using a combination of quantitative and qualitative methods the evaluation found that quit4u was associated with higher quit rates at one, three and 12 months compared with the average quit rates of other NHS cessation services in the rest of Scotland, after adjusting for baseline differences in the characteristics of participants, such as deprivation and smoking intensity. Quit4u also represents a highly cost-effective use of NHS resources. The much higher levels of recorded ‘lost to follow-up’ in other smoking cessation services does, however, make it difficult to assess the exact size of the difference in quit rates between quit4u and other NHS smoking cessation services. 

Elements of quit4u which contribute to the effectiveness of the model in engaging and supporting clients to quit successfully include; the use of CO tests, the use of (rolling) group support, high quality pharmacy support, greater use of varenicline (branded as Champix) and the use of financial incentives.

The report is available to read online at: http://www.healthscotland.com/documents/5827.aspx

Ormston, R., et al. (2012). Evaluation of quit4u: Main report. NHS Health Scotland.

Professor Jonathan Shaw, Associate Professor Anna Peeters, Dr Kathryn Backholer, and Associate Professor Dianna Magliano from the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, examined three different strategy models to avert future diabetes cases that could be averted.

To read the full news item at Medical News Today, go to: http://www.medicalnewstoday.com/articles/245250.php

Four studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with cognitive and behavioural therapies, whilst the remaining two used cognitive and behavioural therapy through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques.

Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention, however following sensitivity analysis a statistically non-significant but clinically significant effect was observed in favour of the intervention.

The authors note that the review "... highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non-Indigenous populations. Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results. The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence. However this evidence base is not strong with a small number of methodologically sound trials investigating these interventions". 

Carson KV, Brinn MP, Peters M, Veale A, Esterman AJ, Smith BJ. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012, Issue 1. doi:10.1002/14651858.CD009046.pub2.

Available to read in full text online at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009046.pub2/abstract

In this study, 14,000 treatments of 5 weeks in duration of either nicotine patch (n=10,000) or nicotine gum (n=4,000) were made available to all eligible adult smokers in Ontario, Canada, who called a toll-free number to register with the STOP (Smoking Treatment for Ontario Patients) Study and receive a single brief intervention. The primary outcome measure was self-reported abstinence rates at 6 months post-treatment among STOP participants. These data were compared with quit rates that were reported in a concurrent no-intervention cohort of Ontario smokers matched for eligibility.

Zawertailo, L. (2012). Reach and effectiveness of mailed nicotine replacement therapy for smokers: 6-month outcomes in a naturalistic exploratory study. Tobacco Control, [Epublished 11 April 2012].

To read the full abstract, and for information on how to access the full text, go to: http://tobaccocontrol.bmj.com/content/early/2012/04/10/tobaccocontrol-2011-050303.short or contact your local or organisational library for assistance.

The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women's experiences of trying to stop smoking, within and outside of a financial incentives scheme.

Thirty-six pregnant smokers were offered standard NHS Stop-Smoking Services, of whom twenty were enrolled in a financial incentives scheme for smoking cessation and sixteen were not. The study authors then interviewed them about (i) their motivation to stop smoking, and (ii) the factors they perceived as influencing their quitting efforts.

The results of the study found that women in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts.

Mantzari, E. et al. (2012). The effectiveness of financial incentives for smoking cessation during pregnancy: Is it from being paid or from the extra aid? BMC Pregnancy and Childbirth, 12:24.

Access to the full text of the article is free online at, http://www.biomedcentral.com/1471-2393/12/24/abstract

This toolkit provides practical tools, resources, programme information and examples to help teams apply evidence and knowledge-based approaches to self-management support for people who have chronic disease or long-term health conditions. Over time, it is hoped this toolkit can be localised for different regions of the country as well as updated, revised and refined to become an essential guide to self-management support for healthcare teams throughout New Zealand.

Access to the toolkit is available from the Health Navigator NZ website: http://www.healthnavigator.org.nz/resourcestoolkit/

In this study, emergency department patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Of the patients in the study who were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Of these interventions, medications were the most popular, followed by linkages to hotlines or other outpatient counseling, then counseling during the emergency department visit. Counseling styles rated most favorably involved individualized feedback, avoidance skill-building, and emphasis on autonomy.

Choo, E. K.  et al. (2012). Patient preferences for emergency department-initiated tobacco interventions: A multicenter cross-sectional study of current smokers. Addiction Science & Clinical Practice, 7:4.

Access to the full text of the article is free online at: http://www.ascpjournal.org/content/7/1/4/abstract

The primary outcome of the trial was self reported smoking cessation for six or more months after the quit date. The secondary outcome was cessation validated by exhaled carbon monoxide measured at six or more months.

The results of the study found that at six months, 17.7% of those offered nicotine replacement therapy reported smoking cessation compared with 20.1% not offered such therapy, and 18.2% offered proactive counselling reported smoking cessation compared with 19.6% offered standard support. Data validated by carbon monoxide readings changed the findings for nicotine replacement therapy only, with smoking cessation validated in 6.6% of those offered nicotine replacement therapy compared with 9.4% not offered such therapy.

Ferguson, J. et al., (2012). Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: Randomised controlled trial. BMJ, 344:e1696.

Access to the full text of the article is free online at, http://www.bmj.com/content/344/bmj.e1696.short?

See also a correction at: http://www.bmj.com/content/345/bmj.e7971

This report - the culmination of a year-long investigation into the way the UK Government tries to influence people’s behaviour using behaviour change interventions – finds that “nudges” used in isolation will often not be effective in changing the behaviour of the population. Instead, it recommends that a whole range of measures – including some regulatory measures – will be needed to change behaviour in a way that will make a real difference to society’s biggest problems.

The report is available in full text at: http://www.publications.parliament.uk/pa/ld201012/ldselect/ldsctech/179/179.pdf

Plain language summary: In many countries, there is enthusiasm for 'healthy heart programmes' that use counselling and educational methods to encourage people to reduce their risks for developing heart disease. These risk factors include high cholesterol, excessive salt intake, high blood pressure, excess weight, a high-fat diet, smoking, diabetes and a sedentary lifestyle. This review is an update of all relevant randomised trials that have evaluated an intervention that aimed to reduce more than one risk factor (multiple risk factor intervention) in people without evidence of cardiovascular disease. The findings are from 55 trials of between six months and 12 years duration conducted in several countries over the course of four decades. The median duration of follow up was 12 months (with a range of six months to 12 years).

Multiple risk factor intervention does result in small reductions in risk factors including blood pressure, cholesterol and smoking. Contrary to expectations, multiple risk factor interventions had little or no impact on the risk of coronary heart disease mortality or morbidity. This could be because these small risk factor changes were not maintained in the long term. Alternatively, the small reductions in risk factors may be caused by biases in some of the studies. The methods of attempting behaviour change in the general population are limited and do not appear to be effective. Different approaches to behaviour change are needed and should be tested empirically before being widely promoted, particularly in developing countries where cardiovascular disease rates are rising. Further trials may be warranted.

Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey Smith G. (2011). Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database of Systematic Reviews, 1. DOI: 10.1002/14651858.CD001561.pub3.

The abstract and full text of the review can be viewed at 

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001561/frame.html