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Multidisciplinary tools for improving the efficacy of public prevention measures against smoking

Periodic Reporting for period 2 - SmokeFreeBrain (Multidisciplinary tools for improving the efficacy of public prevention measures against smoking)

Reporting period: 2017-05-01 to 2018-10-31

Smoking is the largest avoidable cause of preventable morbidity and premature mortality worldwide. It causes most of the cases of lung cancer and chronic obstructive pulmonary disease (COPD) and contributes to the development of other lung diseases. Therefore, the control of smoking is considered as a highly important intervention for the prevention of lung diseases.Tobacco consumption is also highly influenced by socioeconomic factors, affecting mostly low- and middle-income countries as well as vulnerable populations within high income countries. Moreover, smoking causes health inequalities between gender and age groups while it significantly elevates the preventable morbidity and premature mortality worldwide.
For the first time, the SmokeFreeBrain project evaluated existing approaches aiming to prevent lung diseases caused by tobacco while at the same time developed new treatments, through five different pilot interventions. The project additionally analysed the contextual adaptability of these interventions to the local and global health care system as affected by recent socioeconomic changes.
In fact, the ultimate goal of SmokeFreeBrain was to address the effectiveness of a multi-level variety of interventions aiming at smoking cessation. The achievements of SmokeFreeBrain were assessed via five interventions (e-cigarette, pharmacological, PSA, neurofeedback, Social-Local-Mobile) in the context of nine pilots located in hospitals and laboratories at eight different countries (Greece, Spain, Italy, Cyprus, UK, Serbia, Bulgaria, Taiwan). A large number of smokers (C.O.P.D. asthma patients, and young unemployed) were involved within real operational scenarios for a duration of 12 months. The evaluation of each treatment was performed through different assessment tools for each intervention, measured before and after its application. This ensured quantified evidence of whether each intervention enables smokers to reduce smoking tobacco cigarettes which inevitably will lead to better quality of life in the long run (lower risk to diseases associated to smoking).
The project developed detailed experimental protocols, registered clinical trials and released of the Social-Local-Mobile application, as open source and available on Google Play store. The application was integrated on a specifically developed intervention protocol based on social media/mobile apps and short text messages (So-Lo-Mo). The intervention evaluated the efficacy of the protocol for smoking cessation compared to the usual care at the Virgen del Rocío University Hospital, in Sevilla, Spain. Results showed a 23.1% increase in smoking abstinence rate, in comparison to the control groups.
The e-cigarette intervention was implemented though a prospective observational and an in vivo study, in the UK at the Clinical Research Facility of St George’s University of London. The study assessed the potential risks or benefit of e-cigarette use over cigarette smoking. Results showed a subtle reduction in urges to smoke and an improvement of sleep quality following the switching from smoking to EC. Importantly, a lower dependence score to EC compared to cigarettes was observed, highlighting the role of e-cigarettes as a smoking cessation aid.

The PSA pilot directly analysed the emotional reaction to particular public announcements at the laboratory of Industrial Neuroscience at the University of Rome Sapienza. Results identified the neurophysiological characteristics that highlight Effective PSAs and can be employed for the testing and the development of efficient and cost-effective anti-smoking campaigns.
Three pharmacological studies took place: the Institute for pulmonary diseases of Vojvodina in Serbia and the Lab of Medical Physics in Greece investigated the effect of bupropion and varenicline accordingly, in smoking cessation in relation to sleep physiology. In Bulgaria, the National association of GPs is using a special tool-kit of questionnaires to assess smokers’ motivation. Varenicline results indicated a statistically significant decreased level of nicotine dependence and a degraded sleep quality. Instead, bupropion results indicated a significant 23.3% cessation rate, with no sleep-related side effects.
Last, two neurofeedback interventions took place: in Greece, the Lab of Medical Physics and the Neurofeedback Centre of Northern Greece investigated the efficacy of combined skin temperature Biofeedback and Alpha-Theta brainwave Neurofeedback up. In Cyprus, the commercial center of Nicosia carried out the same intervention at heavy smoker young and unemployed. Results indicated significant improvements in the degree of nicotine dependence, trait anxiety, self-esteem and quality of sleep.
Assessing the impact of SmokeFreeBrain in terms of cost-effectiveness, the interventions were evaluated, considering the unit cost per country. The results of this analysis indicate that all interventions considered result in higher cost per Quality-Of-Life-Years (QALY) compared to “no intervention”. Among the dominant interventions, the intervention using pharmacological treatment together with the Social-Local-Mobile App is the least costly and most effective intervention.
Additionally, a number of activities ensured maximum awareness of the project and its achievements, including presentations in conferences, scientific articles, two workshops, promotion at TV and radio channels, online and offline newspapers. Finally, synergies and joint actions with relevant projects have also been initiated. Based on all of the above, SmokeFreeBrain developed clearly proposed pathway to embedding the most cost effective intervention into policy and practice providing valuable input in strengthening the European policy regarding the prevention of lung diseases.
SmokeFreeBrain moved beyond the state of the art techniques in toxicology, pulmonary medicine, neuroscience and behavior by evaluating the effectiveness of the interventions. Delivered new knowledge regarding unknown aspects of innovative smoking cessation interventions, advancing our understanding of this complex condition. The result of this work was disseminated by twenty-two (22) SmokeFreeBrain scientific publications and more than forty (40) press releases, participation in more than forty-five (45) conferences, organization of twenty (20) workshops, and participation in more than twenty (20) events/workshops organized by third-party organizations.
The policy suggestions and best practice guide delivered new knowledge regarding the cost effectiveness of innovative smoking cessation interventions and their applicability in low income countries, new knowledge to the societal needs originating from ‘burden of this chronic non-communicable disease’ and valuable input to strengthen the European policies regarding the prevention of lung diseases.
The project’s sustainable approach identified the potential benefit of the produced results for the targeted communities which consists of many different key players including smokers and scientists, industry, institutions, policy makers in the heath field.
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