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Background: Remote work allows one to work free from workplace policy, but it may negatively affect health-related behaviors such as tobacco product use and alcohol drinking. Our study aimed to investigate the association of remote work with tobacco dependence and hazardous alcohol use. Methods: This nationwide Internet-based survey was conducted in Japan in February 2023. Using the data of 8,292 workers aged 18 – 64, frequency of remote work (0, < 1, ≥ 1 day per week), tobacco dependence based on the scores of the Tobacco Dependence Screener ≥ 5, hazardous alcohol use based on the scores of the Alcohol Use Disorders Identification Test ≥ 8 were assessed. Then, the associations of frequency of remote work with tobacco dependence and hazardous alcohol use were examined using a multivariable Poisson regression model. Results: The percentages of remote work 0, < 1, ≥ 1 day per week were 56.6%, 9.9%, and 33.5%, respectively, whereas those of tobacco dependency and hazardous alcohol use were 11.3% and 17.9%, respectively. Remote work < 1 day per week (adjusted prevalence ratio [aPR] 1.30, 95%CI 1.07 – 1.57), and ≥ 1 per week (aPR 1.29, 95%CI 1.13 – 1.47) were associated with tobacco dependence. Further, remote work < 1 day per week (aPR 1.43, 95%CI 1.25 – 1.65), and ≥ 1 per week (aPR 1.40, 95%CI 1.27 – 1.55) were associated with hazardous alcohol use. Conclusions: Remote workers showed higher prevalence of tobacco dependence and hazardous alcohol use. The health behavior of remote workers should be carefully monitored. [ABSTRACT FROM AUTHOR]

Background: Although there is a very high comorbidity between tobacco dependence and other addictive disorders, there are only few studies examining the implementation and outcomes of a tobacco cessation program in patients with addictive diseases. Therefore, the aim of this study is to investigate to what extent a standardized tobacco cessation program leads to improvements regarding psychological/physical parameters in patients with addiction undergoing therapy and whether there is a reduction in tobacco consumption. Methods: The study took place in a therapeutic community specialized in addiction therapy. A total sample of 56 participants were non-randomly assigned to an intervention group (IG; n = 31) and a treatment as usual group (TAUG; n = 25). The IG participated in a 6-week tobacco cessation program, while the TAUG received no additional treatment. Both groups were assessed for changes in primary outcomes (tobacco dependence, smoked cigarettes per day (CPD), and general substance-related craving) and secondary outcomes (heart rate variability (HRV): root mean square of successive differences, self-efficacy, and comorbid psychiatric symptoms) at two measurement time points (pre- and post-treatment/6 weeks). Results: We observed significant improvements in self-efficacy (F(1,53) = 5.86; p <.05; ηp2 =.11) and decreased CPD in the IG (β = 1.16, ρ <.05), while no significant changes were observed in the TAUG. No significant interaction effects were observed in psychiatric symptoms, general substance-related craving, and HRV. Conclusions: The results highlight the potential benefit of an additional tobacco cessation program as part of a general addiction treatment. Although no improvements in the physiological domain were observed, there were significant improvements regarding self-efficacy and CPD in the IG compared to the TAUG. Randomized controlled trials on larger samples would be an important next step. Trial registration: ISRCTN15684371 [ABSTRACT FROM AUTHOR]

Background: There has been a noticeable relative increase in psychiatric comorbidities among smokers as opposed to the general population. This is likely due to comparatively slower decrease in smoking prevalence among individuals with mental health conditions. This study aims to assess the prevalence trend of past or current mental health disorders in individuals seeking specialized smoking cessation assistance. Methods: We conducted a retrospective single-centre observational study to assess the presence of mental disorders such as anxiety, depression, bipolar affective disorder, or schizophrenia in personal history of 6,546 smokers who sought treatment at the Centre for Treatment of Tobacco Dependence in Prague, Czech Republic between 2006 and 2019. The study examined the impact of gender, age, and the effect of successive years on the prevalence of the mental disorders using Poisson distribution regression. Results: In the studied cohort, 1,743 patients (26.6%) reported having one or more mental disorders. Compared to patients without a psychiatric disorder, they exhibited similar levels of carbon monoxide in expired air (mean 17 ppm, SD 11 ppm) and scored one point higher on the Fagerström Test of Cigarette Dependence. Among smokers with a mental disorder, women were more prevalent (62%) than men (38%). The prevalence of mental disorders increased on average by 4% every year, rising from 23% in 2006 to 35% in 2019. Conclusions: Consistent with the observation that the prevalence of smoking among people with any mental disorder is higher and declining at a slower rate than in the general population, there is a steadily increasing percentage of these patients seeking specialized treatment over time. Professionals who offer tobacco dependence treatment should be aware of the upward trend in psychiatric disorders among smokers, as more intensive treatment may be needed. Similarly, psychiatric care should pay attention to smoking of their patients. [ABSTRACT FROM AUTHOR]

Background: Tobacco use is the leading cause of many preventable diseases, resulting in premature death or disease. Given that the majority of adult who smoke want to stop, this health burden could be significantly reduced if the success rate of tobacco cessation can be improved. In addition, most adults planning to quit were interested in trying complementary approaches to facilitating tobacco cessation, which is currently lacking. Therefore, there is an unmet and urgent need for novel interventions to improve the success of tobacco cessation. If such an intervention can reduce tobacco-associated lung carcinogenesis, that will be more desirable. The goal of this project is to develop a safe and effective kava-based intervention to enable tobacco cessation and reduce lung cancer risk, which will improve the health of smokers. Methods: A randomized controlled trial will enroll 80 adults who currently smoke at least 10 cigarettes daily and randomize 1:1 into the placebo and AB-free kava arms, being exposed for 4 weeks, with a total of six visits (weeks 0, 1, 2, 4, 8, and 12) to evaluate the compliance and potential issues of AB-free kava use among the participants, explore the potential effect of the AB-free kava intervention on tobacco dependence, tobacco use, and lung carcinogenesis biomarkers. Participants will be enrolled during their primary care clinic visit. Discussion: Primary care settings play a critical role in tobacco-related disease screening, counseling, and early intervention, as the majority of adults who smoke visit their physicians annually. Building upon our promising pilot human trial results in conjunction with ample compelling lab animal results, and consistent with evidence of kava's benefits from epidemiological data, this trial will evaluate the compliance of AB-free kava among adults who currently smoke with no intention to quit. The other exploratory aims include (1) whether AB-free kava intervention can reduce tobacco use and tobacco dependence; (2) whether AB-free kava use suppresses tobacco-induced carcinogenesis; and (3) the potential of the mechanism-based noninvasive biomarkers in precision AB-free kava intervention. The positive results from this study are expected to provide a great opportunity to effectively reduce smoking rates and tobacco-related diseases. Trial registration: ClinicalTrials.gov with the identifier: NCT05081882. Registered on October 18, 2021. [ABSTRACT FROM AUTHOR]

Background: Acupuncture combined with auricular acupressure has been used as a complementary and alternative treatment for smoking cessation in Hong Kong for over 10 years. This study aimed to investigate the success rates of smoking cessation posttreatment, and to evaluate treatment effects on tobacco dependence, smoking behavior, anxiety levels, and sleep disturbances between successful and unsuccessful quit smokers in Hong Kong. Methods: This prospective, multicenter clinical study conducted between September 2020 and February 2022 in Hong Kong was part of the Guangdong-Hong Kong-Macau Greater Bay Area project on smoking cessation. Thirty eligible current smokers (mean age 47.10 years; 40% female) were recruited and received a combination of standardized acupuncture and auricular acupressure treatments twice weekly for 8 weeks. The primary outcome was the success rate of smoking cessation at week 24. The secondary outcomes were the success rates of smoking cessation at weeks 8 and 16, exhaled carbon monoxide (CO) levels, and changes in scores on the Fagerström Test for Nicotine Dependence (FTND), Autonomy Over Smoking Scale (AUTOS), Hamilton Anxiety Rating Scale (HAM-A), Self-rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI). Adverse events were also recorded. Results: Of 30 eligible participants, 28 completed 6 or more treatment sessions; all completed follow-up assessments. At week 24, the success rate of smoking cessation was 46.67%. The successfully quit rates at weeks 8 and 16 were 36.67% and 43.33%, respectively. The overall change in mean FTND scores from baseline improved significantly from weeks 2 to 24 (P < 0.05), with the successful quit group showing significantly greater improvement between weeks 8 and 24 (P < 0.01). Compared with baseline values, there were significant reductions in mean AUTOS scores from weeks 6 to 24 (P < 0.001), with the successful quit group showing greater improvement at weeks 16 (P = 0.04) and 24 (P < 0.001). No significant changes were detected in exhaled CO levels or HAM-A, SAS, and PSQI scores. No study-related adverse events were observed. Conclusions: Acupuncture combined with auricular acupressure could be an effective alternative treatment for smoking cessation and reduction of tobacco dependence among Hong Kong smokers. Trial registration Chinese Clinical Trial Registry, No. ChiCTR2000033650. Registered on June 7, 2020. http://www.chictr.org.cn/showproj.aspx?proj=54866 [ABSTRACT FROM AUTHOR]

Background: The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project aims to provide a comprehensive offer of both pharmacotherapy and specialist support for tobacco dependence to all smokers admitted to hospital and after discharge. CURE was recently piloted within a single trust in Greater Manchester, with preliminary evidence suggesting this intervention may be successful in improving patient outcomes. Plans are currently underway to pilot a model based upon CURE in other sites across England. To inform implementation, we conducted a qualitative study, which aimed to identify factors influencing healthcare professionals' implementation behaviour within the pilot site.Methods: Individual, semi-structured telephone interviews were conducted with 10 purposively sampled health professionals involved in the delivery and implementation of the CURE project pilot. Topic guides were informed by the Theoretical Domains Framework (TDF). Transcripts were analysed in line with the framework method, with data coded to TDF domains to highlight important areas of influence and then mapped to the COM-B to support future intervention development.Results: Eight TDF domains were identified as important areas influencing CURE implementation; 'environmental context and resources' (physical opportunity), 'social influence' (social opportunity), 'goals', 'professional role and identity' and 'beliefs about consequences' (reflective motivation), 'reinforcement' (automatic motivation), 'skills' and 'knowledge' (psychological capability). Most domains had the potential to both hinder and/or facilitate implementation, with the exception of 'beliefs about consequences' and 'knowledge', which were highlighted as facilitators of CURE. Participants suggested that 'environmental context and resources' was the most important factor influencing implementation; with barriers most often related to challenges integrating into the wider healthcare context.Conclusions: This qualitative study identified multi-level barriers and facilitators to CURE implementation. The use of theoretical frameworks allowed for the identification of domains known to influence behaviour change, and thus can be taken forward to develop targeted interventions to support future service implementation. Future work should focus on discussing these findings with a broad range of stakeholders, to ensure resultant intervention strategies are feasible and practicable within a healthcare context. These findings complement wider evaluative work to support nationwide roll out of NHS funded tobacco dependence treatment services in acute care trusts. [ABSTRACT FROM AUTHOR]

Background: Life expectancy is 10-20 years lower among people with a severe mental health disorder. Most of these early deaths are due to chronic conditions, including cardiovascular and respiratory diseases. Smoking is a major risk factor for these conditions and introducing smokefree policies has been recommended to mental health service providers in England by the National Institute for Health and Care Excellence (NICE), in their Public Health Guideline 48: Smoking: acute, maternity and mental health services. This paper reports a process evaluation of introducing these policy recommendations, which were updated in 2013.Method: Process data were collected through semi-structured interviews with staff (n = 51), members of partnering organisations (n = 5), service users (n = 7) and carers (n = 2) between November 2016 - April 2017. Normalization Process Theory (NPT) was used to design the data collection tools and analyse the data. A framework approach was taken with the analysis, using the four concepts of NPT: coherence, cognitive participation, collective action and reflexive monitoring.Results: The policy made sense to some staff, patients and carers (coherence) who 'bought-into' the idea (cognitive participation) but other participants disagreed. Although smokefree policies were operationalised (collective action), sometimes they were opposed. Progress was made, especially in some units, but continued to be resisted in others. Informal appraisal of progress (reflexive monitoring) presented a varied picture.Conclusion: Some progress has been made in terms of changing an entrenched, smoking culture into one that is smokefree on Trust sites across the region. Perseverance and resourcing over the long-term is required to establish a non-smoking culture in on-site provision of mental health services. [ABSTRACT FROM AUTHOR]

Background: Smartphone-based support can reach thousands of smokers and help those who would otherwise try to quit smoking by themselves with little chance of success. Nicotine medications double the chances of quitting smoking, but few smokers use them, and they often use them for too short a time and at an insufficient dose. It is therefore important to increase access to support for smoking cessation and compliance with nicotine therapy. The objectives of this study are to assess whether the Stop-Tabac application (app) is effective for smoking cessation and to examine whether the outcome is influenced by the personal characteristics of participants.Methods: Trial design: this is a two-arm, parallel-group, superiority, individually randomized, "placebo" controlled trial in 5200 smokers, with follow up after 1 week, 1 month and 6 months. The participants are adult daily smokers (N = 5200) enrolled on the Internet, living in France or Switzerland. The intervention is the Stop-tabac fully-automated app for smartphones, which was launched in 2012 and continuously improved thereafter. It includes fact sheets; calculators of cigarettes not smoked, money saved, and years of life gained; an interactive "coach" that provides automated, individually tailored counseling messages based on the user's personal profile, sent regularly for 6 months; immediate feedback during episodes of craving and tobacco withdrawal symptoms; a discussion forum ("The Tribe") where participants provide and receive social support; a quiz that informs users in a playful way; and a module on nicotine therapy that includes personalized feedback and follow up. The outcome is self-reported smoking cessation after 6 months (no puff of tobacco in the past 4 weeks), and after 1 week and 1 month (no puff in the past 7 days). Participants will be randomized automatically based on a list of random numbers. Participants, assistants in charge of collecting follow-up data and data analysts will be blinded to allocation. Funding is provided by the Swiss National Science Foundation, CHF 194,942 (EUR 182,200, USD 200,700), grant 32003_179369. JFE's salary is paid by the University of Geneva, YK's salary is paid by the Lausanne University Hospitals.Discussion: There is little evidence from randomized trials of the impact of health apps in general and of smoking cessation apps in particular. This study will fill this gap.Trial Registration: ISRCTN Registry: ISRCTN11318024. Registered on 17 May 2018. [ABSTRACT FROM AUTHOR]

Background: The rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness.Methods/design: One hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life.Discussion: This study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy.Trial Registration: Trial registration number: NCT04013724. Name of registry: ClinicalTrials.gov. URL of registry: https://register.clinicaltrials.gov Date of registration: 9 July 2019 (retrospectively registered). Date of enrolment of the first participant to the trial: 5th September 2017. Protocol version: 2.0. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking is a health care issue in developed as well as in developing countries. Tobacco smoking among people with mental illness is significantly higher than in the general population. Tobacco smoking has negative effects on physical, mental and financial well-being of people with mental illness but little is known about tobacco dependence among mental health service users in sub-Saharan African countries, including Ethiopia. Therefore, this study attempted to assess the prevalence of tobacco dependence and associated factors among mental health service users at Jimma University teaching hospital. Methods: A cross-sectional study was conducted among 305 male and 117 female mental health service users at Jimma University teaching Hospital in 2014. The Fagerstrom Test for Nicotine Dependence (FTND) was used to assess tobacco dependence. Logistic regression analysis was used for bivariate and multivariate analysis. Variables with a P value of <0.05 were considered to be associated with tobacco dependence in the final model. Results: The prevalence of current tobacco dependence among the study participants was 18.5%. Amongst people with tobacco dependence, 57.7, 29.5 and 12.8% had moderate, high and very high level of tobacco dependence respectively. All mental health service users with tobacco dependence were males. There was a significant association between tobacco dependence and high school education (AOR 3.02, 95% CI 1.07, 8. 48), alcohol use disorder (AOR 4.14, 95% CI = 1.54, 11.11), daily khat chewing (AOR 13.51, 95% CI = 4.27, 42.74), chewing khat 2-3 times per week (AOR 5.09, 95% CI = 1.37,18.95), chewing khat once a week (AOR 4.31, 95%CI = 1.04,17.78), having friends who smoke tobacco (AOR 4.88, 95% CI = 2.12, 11.25) and being diagnosed with schizophrenia compared to a diagnosis of major depression (AOR 5.26, 95% CI = 2.07, 13.37). However, daily attendance at a place of worship (AOR 0.46, 95% CI = 0.22, 0.95) was associated negatively with tobacco dependence. Conclusion: In this study, there was a high prevalence of tobacco dependence among mental health services users. There is a pressing need to increase availability of psychological and pharmacological interventions to reduce tobacco dependence and tobacco-related medical illness in this vulnerable group. [ABSTRACT FROM AUTHOR]

Background: Intensive smoking cessation interventions initiated during hospitalisation are effective, but currently not widely available. Strategies are needed to integrate smoking cessation treatment into routine inpatient care. Pharmacist-led interventions for smoking cessation are feasible and efficacious in both ambulatory and community pharmacy settings. However, there is a lack of evidence from large scale studies of the effectiveness of pharmacist guided programs initiated during patient hospitalisation in achieving long-term abstinence. This study aims to evaluate the effectiveness of a pharmacist-led system change intervention initiated during hospitalisation in Australian public hospitals. Methods/design: A multi-centre, randomised controlled trial will be conducted with 12 months follow-up. Smokers, 18 years or older, will be recruited from the wards of three Victorian public hospitals. Participants will be randomly assigned to a usual care or intervention group using a computer generated randomisation list. The intervention group will receive at least three smoking cessation support sessions by a trained pharmacist: the first during the hospital stay, the second on or immediately after discharge and the third within one month post-discharge. All smoking cessation medications will be provided free of charge during the hospital stay and for at least one week after discharge. Participants randomised to usual care will receive the current care routinely provided by the hospital. All measurements at baseline, discharge, one, six and 12 months will be performed by a blinded Research Assistant. The primary outcome measures are carbon monoxide validated 7-day point prevalence abstinence at six and 12 months. Discussion: This is the first large scale study to develop and test a pharmacist-led system change intervention program initiated during patient hospitalisation. If successful, the program could be considered for wider implementation across other hospitals. [ABSTRACT FROM AUTHOR]

Plain Language Summary: The PROMPT study is a community-based research project designed to understand the factors which affect smoking as well as ways to manage, reduce and quit smoking among people who use drugs in Ottawa. There is strong medical evidence that smoking tobacco is related to more than two dozen diseases and conditions. Smoking tobacco remains the leading cause of preventable death and has negative health impacts on people of all ages. Although Ottawa has one of the lowest smoking rates in Ontario (12 %), major differences exist, with approximately a 96 % smoking rate among those who use drugs in the city of Ottawa. To address this inequity, we recruited and trained four community research peers who were representative of the study target population (ex- or currently homeless, insecurely housed or multi-drug users). We designed the ten-step Ottawa Citizen Engagement and Action Model (OCEAM) for the PROMPT study. In this paper we have described this process in a step-by-step fashion, as used in the PROMPT study. The eighty PROMPT participants are being followed for six months and are being provided with free and off-label Nicotine Replacement Therapy (NRT)., Abstract: Objectives The PROMPT study, Participatory Research in Ottawa, Management and Point-of-care of Tobacco, is a prospective cohort study which utilizes community-based participation and social network-based approaches to address tobacco dependence in inner city Ottawa. The project was designed to: facilitate retention of participants; to understand the barriers and facilitators of smoking; optimize ways to manage, reduce, and quit tobacco use among people who use drugs in Ottawa, Canada. The purpose of this paper is to describe the processes utilized in citizen or patient engagement in academic research, through our tobacco dependence management project in the inner city population in Ottawa, Canada. Background Tobacco smoking is inequitably distributed in Canada with rates at 12 % in Ottawa, as compared to 18 % in rest of Canada. However, the PROUD Study (Participatory Research in Ottawa: Understanding Drugs) demonstrated that 96 % of the inner city population, of Ottawa currently smoke tobacco. This distinct inequity in tobacco use translates into inequitable distribution of health outcomes, such morbidity and mortality in this population. Consequently, a community-based participatory, peer-led research project was conducted in the inner city population of Ottawa. Methods We recruited and trained four community research peers who were representative of the study target population. We conceived, designed and operationalized the ten-step Ottawa Citizen Engagement and Action Model (OCEAM) for the PROMPT study. The peers have co-led all aspects of the project from conceptualizing the study question to participating in knowledge translation. Each step of the project had defined objectives and outcome measures. Discussion The involvement of peers in recruitment ensured representation of tobacco and drug users-individuals truly representative of the intended target population. Peer, participant engagement and trust was established from the conception of the project. For historical and self-evident reasons, trust and engagement is rarely found in this population. Peers successfully participated in all ten steps of the Citizen Engagement and Action model. The PROMPT study utilized the CBPR (Community Based Participatory research) approach to encourage engagement and build trust in a difficult to reach and hard to treat, inner city population. The ten-step OCEAM model was conceived, designed and operationalized and the PROMPT study will continue to follow the eighty PROMPT participants for six months to understand the optimal ways to manage, reduce, and quit smoking within an inner city population.

Background: The question of whether mentholation of cigarettes enhances tobacco dependence has generated conflicting findings. Potential mediating factors in a putative relationship between menthol use and tobacco dependence may include race and gender. While an association between menthol use and dependence is mixed, research on the role of race solely among women smokers is scarce. This study examined whether women menthol smokers have higher tobacco use and dependence than non-menthol smokers. Further, the study investigated differences between White and African American smokers. Methods: A cross-sectional study was conducted among 928 women seeking tobacco dependence treatment in Boston, Massachusetts. Measures obtained included preferred brand and menthol content, dependence markers (cigarettes per day (CPD); time to first cigarette in the morning; number of and longest previous quit attempts) and smoking history (age of initiation; years smoking; menthol or non-menthol cigarette preference). Analysis of variance (ANOVA) was used to detect interactions between menthol preference by race for continuous variables, and Pearson’s chi-squared test was used for analyses with dichotomous variables. Results: A greater proportion of menthol smokers smoked their first cigarette within five minutes of waking (p < 0.01) and were less likely to have a previous quit attempt longer than 90 days (p < 0.01). ANOVAs revealed no main effects for menthol preferences. However, African American smokers smoked fewer CPD (p<.001), started smoking later in life (p= .04), and had been smoking the same brand for longer (p= .04). Conclusions: Women menthol smokers showed signs of greater tobacco dependence than non-menthol smokers. African Americans smoked fewer CPD but nevertheless had evidence of greater dependence.