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Background: Commit to Quit II is a 4-year randomized controlled trial comparing the efficacy of a cognitive-behavioral smoking cessation treatment plus moderate-intensity physical activity with the same cessation treatment plus contact control.Methods: Sedentary women smokers (n = 217) were randomized to receive 8 weeks of treatment followed by 12 months of follow-up. This article outlines the study design, presents baseline data about the sample, and compares the sample to national samples and to our previous study examining vigorous-intensity exercise as an aid to smoking cessation.Results: Married and white participants reported significantly higher levels of nicotine dependence than unmarried and minority participants. Higher levels of nicotine dependence were also significantly related to lower smoking cessation self-efficacy and higher levels of self-reported depression, anxiety, and perceived stress. Additionally, participants smoked significantly more cigarettes (mean 20.6) than a national sample of female smokers (mean 16.1). On average, participants were significantly older, weighed significantly more, and scored significantly higher on a measure of anxiety than participants in our previous trial.Conclusions: Our sample consisted of women who were heavier smokers than national samples seeking treatment. It remains to be determined how this will impact their ability to attain cessation in the present study. [ABSTRACT FROM AUTHOR]

Tobacco control has made strides in prevention and cessation, but deaths will not decline rapidly without massive behavior change. Currently, inhaled smoke from combusting tobacco is chiefly responsible for prematurely killing 7.2 million people worldwide and 530,000 in the United States annually. An array of noncombustible nicotine products (NNPs) has emerged and has disrupted the marketplace. Saving lives more speedily will require societal acceptance of locating a "sweet spot" within a three-dimensional framework where NNPs are simultaneously: 1. Less toxic, 2. Appealing (can reach smokers at scale), and 3. Satisfying (adequate nicotine delivery) to displace smoking. For this harm minimization framework to eliminate smoking, a laser focus on "smoking control" (not general tobacco control) is needed. By adopting these economically viable NNPs as part of the solution, NNPs can be smoking control's valued ally. Synthesis of the science indicates that policy and regulation can sufficiently protect youth while speeding the switch away from smoking. Despite some risks of nicotine dependence that can be mitigated but not eliminated, no credible evidence counters the assertion that NNPs will save lives if they displace smoking. But scientific evidence and advocacy has selectively exaggerated NNP harms over benefits. Accurate communication is crucial to dispel the misperception of NNPs harms and reassure smokers they can successfully replace smoking cigarettes with NNPs. Saving more lives now is an attainable and pragmatic way to call for alignment of all stakeholders and factions within traditional tobacco control rather than perpetuate the unrealized and unrealizable perfection of nicotine prohibition., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: The purpose of this paper is to examine the characteristics of smokers who adhere to a hospital smoking ban, compared to those who do not., Design: The data presented in this paper are baseline and discharge survey data collected among hospitalized smokers., Setting: This study was conducted in two teaching hospitals in a northeastern city., Patients/participants: The subjects were 358 smokers who participated in a larger smoking intervention trial., Main Results: Seventy-six percent of the subjects reported adhering to the smoke-free policy during their hospital stay. In a multivariate model, demographic factors that predicted adherence included being older, having shorter length of stay, not reporting recreational drug use in the previous 12 months, and not having alcohol-related problems. Smoking history variables that predicted adherence included having had at least 24 h of abstinence in the 7 days prior to hospitalization; self-efficacy variables (e.g., confidence in ability to quit smoking in 1 month and less anticipated difficulty refraining from smoking during hospitalization) also predicted adherence., Conclusions: Understanding the factors that predict adherence to health care policies can provide useful information for health promotion interventions in a medical setting. The implications of these findings are discussed.

Background: The Commit to Quit trial was designed to address the methodological problems of prior studies that have examined the contribution of exercise to smoking cessation., Methods: This paper provides an overview of the study design and describes the sample of women who participated in this trial (N = 281). Interrelationships among eating, exercise, and smoking behavior are examined., Results: Subjects randomized into the study compared with the sample of women who completed the initial assessment but were not randomized were more likely to be white, to have at least a high school education, and to smoke fewer cigarettes per day. Overall, the most frequent ineligibility criteria were health-related issues and scheduling conflicts. On average, participants in this study smoked more cigarettes per day than national samples of women smokers. Significant interrelationships include the positive association of motivational readiness for quitting smoking and enhanced levels of dietary restraint and the positive association of motivational readiness for exercise adoption and high levels of weight concern., Conclusions: This study represents the first adequately powered randomized controlled clinical trial comparing the relative efficacy of a cognitive-behavioral smoking cessation treatment plus vigorous exercise with the same treatment plus contact control.

Background: A significant percentage of the U.S. population has multiple poor health behaviors. Understanding the relationship among these behavioral risk factors is important for designing effective multiple risk factor interventions. While there is some evidence suggesting that participation in physical exercise may have a positive impact on smoking cessation, there is much to be learned about the relationships between cognitive-behavioral (self-efficacy, decisional-balance) and motivational mechanisms (stage of change) which have been shown to mediate changes in both exercise and smoking behavior., Methods: The sample comprised 332 smokers employed at two workplaces-a government agency and a medical center-recruited as part of a larger worksite health promotion project and who completed questionnaires on their smoking and exercise behaviors., Results: The results revealed significant relationships between smoking variables and exercise variables. Smokers who rated as important the positive benefits of smoking also rated as important the costs associated with increased physical activity. Similarly, the negative consequences of smoking were significantly associated with the positive benefits of physical activity. Self-efficacy for one behavior was significantly associated with self-efficacy for the other. Significant differences by exercise and smoking stage of change were found on the cross-behavior sets of variables (self-efficacy, pros, cons). Smokers who were contemplating a more active lifestyle reported the negative consequences of smoking to be significantly more important to them than smokers who were not considering adoption of a more active lifestyle. Smokers who were exercising regularly reported significantly more confidence in their ability to refrain from smoking than smokers not exercising regularly. Finally, smokers preparing for quitting reported less confidence in their ability to exercise than smokers who had already taken action to change their smoking behavior., Conclusions: The cognitive mechanisms associated with changes in smoking behavior are related to the cognitive variables which have been shown to predict changes in exercise behavior. Significant relationships in mediating mechanisms including decisional balance and self-efficacy between smoking and exercise provide preliminary information on how change in one risk behavior may relate to change in another. These associations have implications for future intervention research and for methods research on multiple risk factors interactions.

Objectives: A key variable for the design of individual and public health interventions for smoking cessation is Stage of Change, a variable which employs past behavior and behavioral intention to characterize an individual's readiness to change. Reactively recruited samples distort estimates of the stage distribution in the population because such samples attract a disproportionate number of late-stage participants. Three representative samples are described which provide accurate estimates of the stage distribution in the population. These samples are of adequate size to permit within-sample comparisons with respect to sex, age, Hispanic or non-Hispanic origin, race, and education level. The implications of using stage distribution as a tool for planning intervention is discussed., Method: The first sample of 4,144 smokers was from the state of Rhode Island and involved a random-digit-dial survey. The second sample of 9,534 smokers was from the state of California and involved a stratified random-digit-dial survey. The third sample of 4,785 smokers was from a total of 114 worksites located in four different geographic locations., Results: The stage distributions were approximately identical across the three samples, with approximately 40% of the sample in Precontemplation, 40% in Contemplation, and 20% in Preparation. The stage distribution was generally stable across age groups with the exception of the 65 years and older group. Education level did affect the stage distribution with the proportion of the sample in Precontemplation decreasing as education level increased. In all three samples, minor differences in stage distribution were related to Hispanic origin and race, but the pattern was not consistent across the samples., Conclusions: The pattern of stage distribution has important implications for the design of interventions. Existing interventions are most appropriate for the Preparation stage, but the majority of the three samples were in the first two stages, resulting in a likely mismatch between the smoker and the intervention. The stability of distribution across age suggests that interventions that are appropriately matched to stage can be applied across all age groups. The differences found with respect to education, Hispanic origin, and race can serve as a guide to the tailoring of intervention materials.

Background: Individuals who have multiple poor health behaviors account for a disproportionately large percentage of the preventable U.S. health care cost burden. Understanding the relationships between multiple risk factors is important for the design of both individual and public health interventions. There have been few efforts to examine the co-occurrence of psychosocial and motivational mechanisms that mediate smoking, dietary fat intake, and physical activity in a defined population of blue collar workers., Methods: The sample comprised 1,559 manufacturing workers who participated in a self-help physical activity intervention and who completed a computerized assessment battery about their smoking, dietary fat intake, physical activity, and demographic characteristics., Results: Twenty-six percent of the sample were smokers, 51% did not exercise regularly, and 35% consumed more than an estimated 40% of calories per day from fat. Almost half of the sample was in the later stages of readiness for physical activity and dietary fat intake, compared with only 3% for smoking. Only 12% of the smokers had smoking as their only risk factor. Smokers were significantly more likely to engage in poor dietary and physical activity behaviors, compared with nonsmokers. The relationship among smoking status and the other risk factors was apparent both in terms of dietary fat and physical activity behaviors, as well as mediators such as motivation for change. Lower dietary fat intake was associated with an absence of the other two risk factors., Conclusions: The results suggest that there are important mediating mechanisms both within and among workers with one or more risk factors. Smokers are a particularly important target for health promotion interventions, and it may be possible to make initial contact with them through other health programs at the worksite. The role of other lifestyle changes as a gateway to smoking cessation has not yet been explored, but may have potential for reaching smokers who are very low in their motivational readiness to change. The implications of these findings for research and the design of multiple risk factor interventions are discussed.

Background: This study investigated the effect of matching smokers to nicotine replacement therapy (nicotine gum) on the basis of the pretreatment level of nicotine dependence., Methods: One hundred seventy-three smokers, classified as high or low on nicotine dependence using the Fagerstrom Tolerance Questionnaire, were assigned at random to receive nicotine gum (2 mg), chewed ad libitum, or to not receive nicotine gum. All smokers participated concurrently in a 5-week treatment program consisting of four brief counseling sessions combined with a self-help manual provided by the American Lung Association., Results: Results showed that smokers with high levels of nicotine dependence were significantly more likely to quit smoking during treatment if they received nicotine gum (31.9%) than high-dependence smokers who did not receive the gum (12.2%). There was a tendency for smokers with low levels of nicotine dependence to do worse during treatment if they received gum (13.5% quit) than they did when they received no gum (20% quit), although this difference was not statistically significant. The relative differences in outcomes persisted after 1 year of follow-up, but the high overall rate of relapse (92.5%) rendered the absolute size of the differences statistically insignificant., Conclusion: The results of the study are discussed in terms of strategies that might improve the success of treatment-matching approaches with newer forms of nicotine replacement therapies.

BACKGROUND. Few research studies have been conducted on cancer prevention and control at the workplace. This article presents an overview of the largest worksite cancer control trial in the United States--The Working Well Trial--conducted in 114 worksites by four study centers, a coordinating center, and the National Cancer Institute. The trial's organizational structure, research design, dependent measures, and theoretical model for intervention are described. Special features of the trial include using the worksite as the unit of randomization, intervention, and evaluation and a theory-driven conceptual model of intervention that places emphasis on individual and organizational targets for change, uses the transtheoretical stage of change model to guide a sustained 2-year multiple risk factor intervention, and makes use of volunteer resources within the worksite to reduce cost, increase participation, and improve tailoring to individual needs. The trial will have a potential impact on over 25,000 workers. CONCLUSION. The issues raised in this overview have implications for the evaluation and dissemination of cancer prevention and control programs to defined populations.

To evaluate the relationship between self-reported exposure to environmental tobacco smoke and saliva cotinine concentrations, we studied 186 nonsmokers. Each participant completed an exposure questionnaire, kept a daily exposure diary for 7 days, and provided a saliva sample for cotinine analysis. Salivary cotinine concentrations were measured using gas chromatography/mass spectrometry. Of the volunteers, 30% lived with one or more smokers, and 84% were regularly exposed to smokers at work. Eighty-three percent of the volunteers had detectable saliva cotinine concentrations (> or = 0.5 ng/ml) (median = 1.1; range = 0.5-7.4 ng/ml). Cotinine concentrations were related to exposure in the household and at the workplace. Volunteers who lived with smokers had significantly higher cotinine levels (median = 1.0; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-4.7 ng/ml). Volunteers who reported regular exposure at work had higher cotinine levels (median = 0.8; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-3.0 ng/ml). Cotinine concentrations were predicted by a regression equation that included the number of smokers at home and work and the number of minutes of exposure recorded in the daily diary (r2 = 0.29).

Background: Few studies have focused on the motivational characteristics of smokers who do not volunteer for cessation. This study examined the relationship between demographic and selected psychosocial factors and motivation and intention to quit smoking among employed smokers at five worksites. In addition, the distributions of smokers who are at different stages of readiness to change their smoking behavior are presented., Results: Results indicate that, overall, less than 8% of employed smokers are currently ready to quit smoking and that blue-collar workers are lower in motivation than white-collar workers. Predictors of higher levels of motivation to quit smoking included higher socio-economic status, maleness, lower levels of self-reported nicotine dependence, and stronger perceptions that smoking was against the social norms of the workplace., Conclusion: Implications for intervention, evaluation, and policy are discussed in the context of the challenge of making a public health impact on reducing overall smoking prevalence.

The Pawtucket Heart Health program (PHHP) is a federally funded research and demonstration project for the primary prevention of coronary heart disease (CHD) in a community. This article presents a discussion of the first 26 months of this intervention, divided into its three phases. PHHP staff initially approached the intervention city through local organizations to accomplish risk-factor behavior change in the population. After 11 months, PHHP complemented its programs in organizations with activities open to all city residents, in order to accelerate participation by the population. Seven months into this phase, it was decided that community activities should be the major focus of the intervention approach to assure a level of participation adequate to make a measurable impact. The third has shown the greatest percentage of public participation, demonstrating the complementary nature of organization and community interventions and of the translation of social learning theory into principles for primary prevention in a community.