Background: Tobacco addiction is the leading cause of preventable morbidity and mortality worldwide, but only 1 in 20 cessation attempts is supervised by a health professional. The potential advantages of mobile health (mHealth) can circumvent this problem and facilitate tobacco cessation interventions for public health systems. Given its easy scalability to large populations and great potential, chatbots are a potentially useful complement to usual treatment. Objective: This study aims to assess the effectiveness of an evidence-based intervention to quit smoking via a chatbot in smartphones compared with usual clinical practice in primary care. Methods: This is a pragmatic, multicenter, controlled, and randomized clinical trial involving 34 primary health care centers within the Madrid Health Service (Spain). Smokers over the age of 18 years who attended on-site consultation and accepted help to quit tobacco were recruited by their doctor or nurse and randomly allocated to receive usual care (control group [CG]) or an evidence-based chatbot intervention (intervention group [IG]). The interventions in both arms were based on the 5A’s (ie, Ask, Advise, Assess, Assist, and Arrange) in the US Clinical Practice Guideline, which combines behavioral and pharmacological treatments and is structured in several follow-up appointments. The primary outcome was continuous abstinence from smoking that was biochemically validated after 6 months by the collaborators. The outcome analysis was blinded to allocation of patients, although participants were unblinded to group assignment. An intention-to-treat analysis, using the baseline-observation-carried-forward approach for missing data, and logistic regression models with robust estimators were employed for assessing the primary outcomes. Results: The trial was conducted between October 1, 2018, and March 31, 2019. The sample included 513 patients (242 in the IG and 271 in the CG), with an average age of 49.8 (SD 10.82) years and gender ratio of 59.3% (304/513) women and 40.7% (209/513) men. Of them, 232 patients (45.2%) completed the follow-up, 104/242 (42.9%) in the IG and 128/271 (47.2%) in the CG. In the intention-to-treat analysis, the biochemically validated abstinence rate at 6 months was higher in the IG (63/242, 26%) compared with that in the CG (51/271, 18.8%; odds ratio 1.52, 95% CI 1.00-2.31; P=.05). After adjusting for basal CO-oximetry and bupropion intake, no substantial changes were observed (odds ratio 1.52, 95% CI 0.99-2.33; P=.05; pseudo-R2=0.045). In the IG, 61.2% (148/242) of users accessed the chatbot, average chatbot-patient interaction time was 121 (95% CI 121.1-140.0) minutes, and average number of contacts was 45.56 (SD 36.32). Conclusions: A treatment including a chatbot for helping with tobacco cessation was more effective than usual clinical practice in primary care. However, this outcome was at the limit of statistical significance, and therefore these promising results must be interpreted with caution. Trial Registration: Clinicaltrials.gov NCT 03445507; https://tinyurl.com/mrnfcmtd International Registered Report Identifier (IRRID): RR2-10.1186/s12911-019-0972-z

We do have very effective and efficient interventions to help our patients to stop smoking. The strategy that has more evidence and consensus in primary care is the 5 A's, that is, ask, advise, assess willingness to try to quit smoking, helping those who want to try and make follow-up visits. However, we intervene lot less than we should. The available protocols oversized interventions, and propose elements without scientific evidence or therapeutic effect. It is therefore necessary to develop more simple, useful and evidence-based interventions to assist us in carrying out our work interventions, and stop doing those that dońt contribute. In this article we will use as an example a critical review of Smoker Care Service Portfolio of Madrid Health Service, and we will propose a number of alternatives to allow a simple, effective and evidence-based intervention.

En el contexto del estudio “Efectividad de un bot conversacional para dejar de fumar en población adulta: ensayo clínico pragmático en Atención Primaria (Déj@lo)” (PI17/01942) que evalúa la efectividad de una intervención para ayudar a los fumadores a abandonar el tabaco a través de un bot conversacional para teléfonos inteligentes en comparación con el manejo habitual en Atención Primaria de Salud debíamos construir un chatbot sobre el que no existen aún unos estándares de calidad y nos basamos en los existentes para aplicaciones. Un bot (o chatbot) es una aplicación informática dotada de inteligencia artificial (IA) capaz de generar una conversación bidireccional entre un ser humano y una máquina (robot) a través de un interfaz conversacional o chat. En este trabajo presentamos la herramienta utilizada y los criterios que hemos seguido para su construcción y elaboración de contenidos.

Introduction: Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of ‘Subsidized pharmacological...

EVICT project has noted the increase in cannabis use in the Spanish youth population, and has studied its association with tobacco, concluding that: It has an influence in the learning to smoke process: The beginning can be combined and with bi-directional influence. It has an influence on dependence the development of dependence Their interaction is relevant in the development of dependence. It has an influence on toxicity: Smoking tobacco and cannabis generates greater problems than smoking tobacco alone. And, therefore, the EVICT team issues some considerations: Prevention considerations. Differentiate between therapeutic and recreational use. Smoking cannabis is not therapeutic nor innocuous, and can affect the development of nicotine dependence, or, less frequently, cannabis dependence. Approach and treatment considerations. In A first option of cessation of both must be proposed in people who consume tobacco and cannabis Harm Reduction. To those that only consume tobacco/cannabis: Harm Reduction programs should be more applicable to those in whom consumption is considered more problematic.

Introduction: Electronic nicotine delivery systems may lead to challenges for public health. This study described the use of electronic cigarettes (EC) and dual consumption in the Spanish population. Material and Methods: Descriptive cross-sectional study of the 2022 Survey on Alcohol and Other Drugs in the General Population in Spain (EDADES), aged 15-64. Variables: sociodemographic, dual consumption (EC and conventional tobacco, daily and/or within the last 30 days), and perceived health status. Analysis: descriptive, multinomial logistic regression. Results: 26,337 participants, (51% men). The prevalence of dual consumers in the population was 1.55% (95%CI: 1.40-1.70). For every year increase in age, the likelihood of being an exclusive tobacco smoker increased with an OR:1.04, (IC95%:1.03-1.05). Having an income between 1,000-1,499€ and 1,500-2,499€ associated exclusive tobacco versus dual use, OR 1.52 (95% CI:1.01-2.27) and 1.92 (95% CI:1.30-2.84), respectively. Dual use associated a ‘fair’ perceived health status compared to exclusive EC users (OR:0.26; 95%CI:0.12–0.57) and exclusive conventional tobacco (OR:0.60; 95%CI:0.45–0.80), and a ‘poor/very poor’ health status compared to exclusive tobacco (OR:0.42; 95%CI:0.23–0.77). Among former EC smokers, 71% now smoked conventional tobacco exclusively. Conclusion: The prevalence of dual consumers in Spain was 1.55%. Smoking EC might lead to an increase of tobacco smokers.