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Purpose: Smoking is not only one of the main risk factors for the development of most malignant and numerous benign ENT tumours but also has an important influence on therapy and prognosis. Even quitting smoking at the time of diagnosis significantly reduces mortality. Patients have a particularly strong desire to stop smoking when they are diagnosed. The present study investigated to what extent patients were aware of the relationships between smoking and the development and prognosis of tumours and how much information and smoking cessation support they were offered by physicians., Methods: A total of 194 patients (74.7% male, 62.0 ±10.6 a) with malignant primary ENT tumours, pre-cancerous tumours, Reinke's oedema and salivary gland tumours were interviewed., Results: 22.7% were nonsmokers, 49.5% were cigarette smokers and 27.8% were ex-smokers. A total of 57.0% of the smokers said they would have quit before the onset of the disease if they had known about the association. Forty-one percent did not receive information about the association between smoking and the development of their disease, while 45.5% did not receive information about the relationship with their prognosis. The provision of information lasted less than 5 min for 40.4% of the patients and more than 10 min for only 13.5%. In total, 50.7% of the patients were directly requested not to smoke. A total of 7.7% received offers of smoking cessation support from otolaryngologists and 18.2% received such offers from family physicians., Conclusions: There is a pronounced need for improvements in the provision of medical information about the health risks associated with smoking and offers to support patient efforts to stop smoking. In particular, the appointment during which the diagnosis is communicated to the patient should be considered a 'teachable moment' that can lead to smoking cessation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The focus of precision medicine is on decision support, often in the form of dynamic treatment regimes, which are sequences of decision rules. At each decision point, the decision rules determine the next treatment according to the patient's baseline characteristics, the information on treatments and responses accrued by that point, and the patient's current health status, including symptom severity and other measures. However, dynamic treatment regime estimation with ordinal outcomes is rarely studied, and rarer still in the context of interference - where one patient's treatment may affect another's outcome. In this paper, we introduce the weighted proportional odds model: a regression based, approximate doubly-robust approach to single-stage dynamic treatment regime estimation for ordinal outcomes. This method also accounts for the possibility of interference between individuals sharing a household through the use of covariate balancing weights derived from joint propensity scores. Examining different types of balancing weights, we verify the approximate double robustness of weighted proportional odds model with our adjusted weights via simulation studies. We further extend weighted proportional odds model to multi-stage dynamic treatment regime estimation with household interference, namely dynamic weighted proportional odds model. Lastly, we demonstrate our proposed methodology in the analysis of longitudinal survey data from the Population Assessment of Tobacco and Health study, which motivates this work. Furthermore, considering interference, we provide optimal treatment strategies for households to achieve smoking cessation of the pair in the household., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

When it comes to smoking, apprentices are considered a 'vulnerable' population. They have been the subject of targeted approaches based on the assumption of common characteristics. In contrast to most public health studies, that assume homogeneity of vulnerable groups, this article, based on Lahire's 'theory of the plural individual', aims to examine inter- and intra-individual variability in relation to tobacco exposure. It is based on a secondary analysis of 30 interviews with apprentices in France on the stigma attached to their use in their different living environments. Our study confirms that the family and the Centre de Formation des Apprentis, as a whole, encourage smoking. It also provides a better understanding of the mechanisms by which inequalities are perpetuated (permissive rules, loans and gifts of cigarettes, spillover effects, lack of incentives to quit). Nevertheless, it allows us to observe that, in some families and in some companies, smoking is denormalised, even stigmatised. Several apprentice profiles emerge: those who are protected from tobacco and seem to be able to quit easily; those who are permanently confronted with it and for whom it is difficult to consider quitting or reducing; and those who are confronted with a plurality of norms, who seem ambivalent and whose consumption varies significantly. These results will allow us to adapt the interventions according to the profile of the apprentices and by including their entourage. In particular, it will be necessary to propose a 'go-to' approach that goes beyond the school setting and involves the family and the workplace., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Telephone-based services are a practical and effective behavioral support for smoking cessation, yet no in-depth analyses of this counseling have been conducted. Understanding the general content of Quitline conversations can help to improve current practices and may inform future interventions. Therefore, we aimed to independently explore conversation themes, topics, and client questions during Quitline counseling sessions with Quitline clients in Queensland, Australia. A purposive sample of 30 recorded counseling sessions, completed between January and March 2019, were de-identified, transcribed, and thematically analyzed. Seven themes, encompassing 35 topics, were derived from 26 initial calls and four follow-up calls: (1) Client details and building rapport; (2) Client history and motivation to quit; (3) Pharmacotherapy; (4) Behavioral aspects of quitting and relationship with smoking; (5) Understanding nicotine dependence and other important considerations; (6) Additional support and smoking cessation resources; and (7) Planning, goal setting and follow-up. Three themes emerged from 18 client questions including (1) Pharmacotherapy safety and contraindications; (2) Pharmacotherapy instructions and mechanism of action; and (3) Physiology of nicotine dependence. This is the first qualitative analysis of the content of Quitline counseling sessions in Australia. Counselors collect and deliver a breadth of information to provide tailored, evidence-based health care, while building rapport and trust. Findings may be translatable into personalized self-help interventions that are more accessible or appealing to people reluctant to contact Quitline. Harnessing educational opportunities regarding pharmacotherapy adherence and misconceptions can improve client confidence in the product and smoking cessation outcomes. Further research will map conversations to motivational interviewing and behavior change techniques., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Tobacco smoking exacerbates diabetes-related complications; its prevalence is notwithstanding substantial. Persons with diabetes face a number of barriers and challenges to quitting such as multiple lifestyle restrictions; tailored interventions are required for smoking cessation., Objective: To identify research on behavioral interventions for smoking cessation in diabetes., Methods: Studies had to be randomized controlled trials, quasiexperimental or systematic reviews. The behavioral interventions included were: the 5As, Cognitive-Behavioral Therapy, Motivational Interviewing, Contingency Management, Health Coaching and Counselling, as compared to standard care. The outcomes were self-reported and/or biochemically verified smoking cessation. CINAHL Complete, MEDLINE Complete, the Cochrane databases of systematic reviews and randomized controlled trials, PsychInfo and PubMed Central were searched until July, 2023. Keywords used included diabetes, smoking cessation and each of the behavioral interventions included., Results: 1615 papers were identified. Three studies on the 5As/brief advice, 4 on Motivational Intervention and 1 on counseling were retained. The results on the 5As and Motivational Interviewing were conflicting. More intensive interventions appear to be more successful in achieving smoking cessation in smokers with diabetes., Conclusions: Future research should focus on the continued development and evaluation of structured smoking cessation interventions based on the 5As, Motivational interviewing and Cognitive Behavioral Therapy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study examined the association between home tobacco smoke exposure (TSE) status and gastrointestinal problems in the past 12 months among US children. We conducted a secondary analysis of the 2018-2019 National Survey of Children's Health cross-sectional data including 20 149 children aged 4 to 10 years. Weighted logistic regression models unadjusted and adjusted for child and family covariates were fitted. Overall, 12.3% of children had home thirdhand smoke (THS) exposure only and 1.8% had home secondhand smoke (SHS) and THS exposure. Unadjusted (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.32-2.20) and adjusted (adjusted odds ratio [AOR] = 1.51, 95% CI = 1.14-1.99) logistic regression results indicated that relative to children with no home TSE, children with home THS exposure only were at increased odds of having frequent or chronic difficulty with gastrointestinal problems over the past 12 months. Interventions are critically needed to promote smoking cessation among household members who live with children in order to reduce levels of SHS and THS in their homes.

Objective: We aimed to evaluate the impact of a brief smoking cessation intervention among patients with diabetes., Methods: This randomized interventional clinical trial involved patients with diabetes who smoked tobacco and attended the outpatient diabetes clinic at Penang Hospital, Malaysia. Participants were randomized into a control group that usual care for patients with diabetes, or an intervention group that received a 5-minute physician-delivered brief counseling session on tobacco cessation using the 5A's strategy, in addition to usual care. Primary outcome measures were assessed over three visits (every 3-4 months) including mean glycated hemoglobin level, quitting rate, blood pressure, and mean number of cigarettes smoked per day., Results: In total, 126 participants were finally enrolled in the study, with 63 patients each in the intervention and control groups. There was no significant difference between the two groups with respect to glycemic control, blood pressure, and quitting rate. However, patients in both groups reduced their cigarette consumption., Conclusions: The present brief smoking cessation intervention did not result in better glycemic control, blood pressure, or quitting rates among patients with diabetes. This patient group may require more intensive guidance for better outcomes. Trial registration: This study is registered in ClinicalTrials.gov (NCT04864327); https://clinicaltrials.gov/ct2/results?pg=1&load=cart&id=NCT04864327., Competing Interests: Declaration of conflicting interestsThe authors declare that there is no conflict of interest.

The transtheoretical model has been used as a model of behavior change for tobacco users. However, it does not account for perceptions of past behavior that may provide additional guidance toward smoking cessation. No studies have examined associations between the transtheoretical model, content themes of smoking experiences, and counterfactual thoughts (i.e. "If only. . .then. . ."). Mturk participants ( N  = 178; 47.8% female) completed measures of smoking attitudes, behavior, and stage and processes of change use. Participants described a past negative smoking event and an event-related counterfactual thought-listing task. Participants in the precontemplation stage endorsed fewer processes of change. Also, participants in the action stage reported significantly more counterfactuals about cravings (e.g. If only I could have controlled my urge to smoke. . .) inferring that they may be identifying cravings or urges as relevant barriers toward smoking cessation. Identifying these self-relevant thoughts may provide additional ways to address and overcome barriers toward achieving long-term smoking cessation.

The objective was to assess active ingredients, change mechanisms, and fidelity in interventions aiming to increase the quality of smoking cessation care in the Dutch primary healthcare setting. We conducted a systematic review searching five scientific databases on August 2nd, 2019, updated on October 28th, 2021. We included effect data of behavioural interventions aiming at improving the provision of smoking cessation support by Dutch primary care providers to their patients. We excluded studies published before 2000 and those without a behavioural support intervention for primary care providers targeting smoking cessation in their patients. We found 1939 articles and included 15 distinct interventions in the review. We provided an overview of study characteristics, intervention effects, fidelity, active ingredients and change mechanisms using the Behaviour Change Techniques (BCT) Taxonomy and Mechanisms of Action (MoAs) protocols. Interventions seemed more effective when including a face-to-face component, using active learning strategies and providing a tool to help follow the guidelines in practice (e.g., physical cards with information). BCTs, MoAs, and fidelity were overall poorly reported on. To support the application of smoking cessation practices in Dutch primary care, we recommend implementation of face-to-face training programs incorporating active skill training elements combined with practical tools.

Purpose: Cancer patients who remain tobacco users have poorer outcomes, including increased mortality and decreased treatment tolerance; however, cessation post-diagnosis is challenging. Our formative research explored cessation-related perspectives among patients and staff at one National Cancer Institute-designated cancer center, to inform improving cessation services within oncology care., Methods: Using a descriptive phenomenological approach, a purposive sample of current cancer patients (n = 13) and cancer center physicians and cessation program staff (n = 9) were recruited to complete one-on-one audio-recorded in-depth qualitative interviews, to explore experiences providing or receiving cessation support, and perspectives on patients' readiness and needs regarding cessation. Thematic coding utilized Green's predisposing, enabling, and reinforcing framework to identify factors having positive, negative, or mixed impact on delivery of best-practices cessation services (ie, 5As) and patient cessation success., Results: Patients identified cancer diagnosis as a wake-up call, existing health problems, persistent healthcare providers, cost of cigarettes, and societal disapproval of smoking as factors facilitating quitting. Futility of quitting after a cancer diagnosis, cost and logistics of program participation, clinician time constraints, and lifetime addiction made quitting harder. Family, friends, stigma and motivation, and pharmacotherapies played mixed roles. Patients felt survivor-focused cessation programs, including stress management, could better enable quitting. Provider-anticipated problems with implementing cessation counseling included so-called "therapeutic nihilism" (ie, pessimism regarding cessation post-diagnosis), lack of training and standardized approaches, and time and documentation burden. Clinicians saw both policies and peer clinician "champions" as potentially increasing prioritization of cessation within oncology., Conclusions: Findings highlight unmet needs for patients and providers regarding provision of effective cessation care. Despite survival benefit, cessation is still not standard within cancer care. Our results show that many patients would benefit from standardized programs where they are routinely asked about cessation. Providers would benefit from both structural enhancements and professional education to ensure that evidence-based cessation services tailored to cancer patients, are offered throughout treatment and survivorship.

Background: There are remarkably high smoking rates in patients living with mental disorders (PLWMD), and the absence of a specific treatment policy for smoking cessation for these patients worldwide. The present study aimed to (i) investigate the quality of service and commitment to tobacco dependence treatment, and (ii) produce high-quality French versions of the Index of Tobacco Treatment Quality (ITTQ) and Tobacco Treatment Commitment Scale (TTCS)., Methods: ITTQ and TTCS were used to assess French mental health professionals ( n  = 80). Both scales were translated from their original language following standard procedures (i.e. forward translation). Descriptive analysis for total score, each factor and item were calculated for the entire sample, followed by subgroup analysis by gender, and role of the practitioner., Results: Nurses presented higher levels of both treatment commitment and treatment quality in their mental health care units, compared to psychiatrists, and residents. Overall, counseling offering was low and there was a perception that it is unfair to take tobacco away from PLWMD. In the other hand, there were high levels of smoking assessment and perceptions that nicotine dependence should be included in drug treatment programs., Conclusions: There is a gap in tobacco treatment implementation for French PLWMD. The present pilot study alerts about the problem, and should stimulate larger studies validating such measures for wide use with French-speaking mental health professionals. French nurses presented higher levels of both treatment commitment and quality, and could be in a leadership position for such implementation. Encouraging the implementation of tobacco counseling within conventional mental health treatment is critical to improve cessation rates among this population. There is a potential for the sustainability of tobacco treatment interventions since the levels of commitment observed here were higher than in previous studies conducted abroad.

Background: Cigarette smoking is associated with disease progression, poor outcomes, and increased biologic use in Crohn's Disease (CD). In this prospective study, we describe the structure and results of a pharmacist-driven smoking cessation program in an Inflammatory Bowel Disease (IBD) Specialty Medical Home., Methods: One pharmacist designed and implemented a collaborative drug therapy management (CDTM) program, which allowed the pharmacist to initiate and modify smoking cessation aids, monitor medication safety and efficacy, and provide behavioral counseling. Crohn's Disease patients who were current smokers and referred to the program were analyzed. Clinical and demographic data, disease activity, and smoking history were collected. The primary outcome was the proportion of patients in the enrolled group and the declined group who quit smoking at least once during the follow-up period. Secondary outcomes include demographic and clinical differences between enrolled and declined patients, and enrolled quitters and non-quitters., Results: Thirty-two patients were referred to the program and 19 participated. Over a median follow-up period of 305 [264-499] days, 42% (8/19) of enrolled patients quit smoking at least once. Fifteen percent (2/13) of declined patients quit smoking. Patients who continued to smoke had more instances of loss of response to a biologic, need to start a new biologic, or escalation of biologic therapy. The CDTM pharmacist was able to provide all necessary clinical services for smokers enrolled in the program., Conclusions: A pharmacist-led smoking cessation program in a specialty medical home is feasible. It may result in successful quit attempts and may optimize IBD medication use.

Objective: To describe smoking behaviours of patients with incident cancer attending an Italian cancer centre and to examine changes in their smoking habits within 12 months from cancer diagnosis, evaluating determinants of smoking cessation., Methods: A hospital-based prospective cohort included patients hospitalized in an Italian cancer centre (2016-2018). Patients were mostly female (74%) and included a limited proportion of aerodigestive cancers (7%). Face-to-face interviews were performed during hospital stay to gather information on patient characteristics and smoking history. Changes in smoking habits were assessed through telephone interviews at 3, at 6, and at 12 months after cancer diagnosis., Results: Among 1011 enrolled patients, 222 (22%) were current smokers at cancer diagnosis. Smoking prevalence was high in male patients (30%), in patients <50 years old (28%), in those with aerodigestive cancers (50%), and in those diagnosed at advanced stages (26%). Among current smokers at cancer diagnosis, 38% quit smoking after 12 months, 26% reduced intensity, and 36% did not modify smoking habits. Smoking cessation was associated with chemotherapy and, although not statistically significant, with female sex, older age, and advanced cancer stage. Patients with gastrointestinal, breast, or genitourinary cancer and those treated with surgery were less likely to quit smoking., Conclusions: Our results highlighted that 62% of smoking patients with cancer did not quit the habit. Smoking cessation programs targeted to patients with cancer need intensification, particularly for those who may underestimate smoking effects after diagnosis.

There are high rates of tobacco smoking among people who experience mental illness (MI). While videos are an effective method of disseminating health-related information, there is limited research investigating the effectiveness of video-delivered education promoting smoking cessation among people living with MI. This formative study aimed to investigate the effectiveness and acceptability of targeted video resources providing smoking cessation information and advice to smokers with MI. This study used a mixed-method design; 29 Australian smokers living with MI completed a preinterview survey including 12 questions assessing knowledge about smoking cessation, watched six videos developed by the research team providing information about smoking cessation, took part in semistructured interviews about the videos' quality, content, and format, and then completed a postinterview survey identical to the preinterview survey to assess changes in smoking cessation-related knowledge. A Wilcoxon signed rank test was used to calculate changes in cessation-related knowledge, and thematic analysis was used to identify common themes in qualitative data. We found a statistically significant increase in participants' smoking cessation-related knowledge scores after watching the videos. Participants indicated an overall high level of acceptability of the videos' quality, content, and format, and findings from the semistructured interviews reflected these favorable views. This study's findings provide a new understanding of the effectiveness and acceptability of customized video-based education to promote smoking cessation among people living with MI, and can be used to inform the content and focus of video resources aimed at increasing knowledge about smoking cessation for people experiencing MI.

The use of photovoice in men's health promotion research has grown significantly over the past 15 years. Initially mobilized as an elixir for men's talk about health practices and illness experiences, participant-produced photographs and accompanying narratives have grown significantly in reach, influence, and application. The current article highlights the gendered dimensions of photovoice in men's health promotion research across three studies addressing (1) psychosocial prostate cancer care, (2) fathers' tobacco reduction and smoking cessation, and (3) male suicidality. Insights drawn from the psychosocial prostate cancer care project emphasize the plurality of masculinities, and the implications for health promoters treating the common treatment side effect of erectile dysfunction. The relational nature of gender is central to the fathers' tobacco reduction and smoking cessation work whereby the well-being of partners and children strongly influenced men's behavior changes amid guiding adjustments to smoke-free policies. The male suicidality research highlights the unmuting powers of photovoice for making visible the interiority of men's mental illness, and the destigmatizing potentials for sharing participants' accompanying narratives. Evident across the three projects are the gendered dimensions of photovoice processes and products for advancing understandings of, and avenues toward, promoting the health of men and their families. After reflecting on these advances, we offer recommendations for future men's health promotion photovoice work.

American Indian Alaska Native (AIAN) youth have disproportionately higher rates of commercial tobacco product use compared to other racial and ethnic groups in the U.S. These rates underscore a need for commercial tobacco product cessation interventions that are culturally informed. This project studied the development, implementation, and some impact data of an adapted version of Project EX, an evidence-based intervention for teen smoking cessation. Implementation challenges resulted in a change from a three-arm to a single-arm trial with 37 AIAN youth who participated in an eight-week curriculum. Intent-to-treat analysis with biochemical validation results indicated that 32% (N = 12/37) of youth quit smoking at the three-month follow-up. Participants reported being satisfied with the program overall and enjoying the culturally adapted activities. This study detailed the program's adaptation and lessons learned during implementation.

Cancer prevention and control (CPC) behaviors, such as cancer screening, human papillomavirus vaccination, and smoking cessation, are critical public health issues. Evidence-based interventions have been identified to improve the uptake of CPC behaviors; however, they are often inconsistently implemented, affecting their reach and effectiveness. Patient navigation is an evidence-based approach to increasing CPC behaviors. Nevertheless, there are few navigation programs that use systematically developed implementation strategies to facilitate adoption, implementation, and maintenance, which affects uptake and outcomes. This article describes the development of a multifaceted implementation strategy designed to facilitate delivery of a CPC phone navigation program to increase breast, cervical, and colorectal cancer screening; human papillomavirus vaccination; and smoking cessation among 2-1-1 Texas helpline callers. Using implementation mapping, a systematic approach for developing implementation strategies, we designed a strategy that involved training 2-1-1 information specialists to deliver the program, developed online tracking and quality-monitoring (audit and feedback) systems, and developed and distributed protocols and other materials to support training and implementation. Through this iterative process and our collaboration with 2-1-1 Texas call centers, our project resulted in a comprehensive training program with a robust curriculum of pertinent program content, for which we identified core components and appropriate delivery modes that are culturally relevant to the population. The results of this study can be applied to the development of more systematic, transparent, and replicable processes for designing implementation strategies. The study also demonstrates a process that can be applied to other contexts and other CPC program implementation efforts.

Objective: Studies examining the use of smoking cessation treatment and related spending among enrollees with employer-sponsored health insurance are dated and limited in scope. We assessed changes in annual receipt of and spending on cessation medications approved by the US Food and Drug Administration (FDA) among tobacco users with employer-sponsored health insurance from 2010 to 2017., Methods: We analyzed data on 439 865 adult tobacco users in 2010 and 344 567 adult tobacco users in 2017 from the IBM MarketScan Commercial Database. We used a negative binomial regression to estimate changes in receipt of cessation medication (number of fills and refills and days of supply). We used a generalized linear model to estimate spending (total, employers', and out of pocket). In both models, covariates included year, age, sex, residence, and type of health insurance plan., Results: From 2010 to 2017, the percentage of adult tobacco users with employer-sponsored health insurance who received any cessation medication increased by 2.4%, from 15.7% to 16.1% ( P < .001). Annual average number of fills and refills per user increased by 15.1%, from 2.5 to 2.9 ( P < .001) and days of supply increased by 26.4%, from 81.9 to 103.5 ( P < .001). The total annual average spending per user increased by 53.6%, from $286.40 to $440.00 ( P < .001). Annual average out-of-pocket spending per user decreased by 70.9%, from $70.80 to $20.60 ( P < .001)., Conclusions: Use of smoking cessation medications is low among smokers covered by employer-sponsored health insurance. Opportunities exist to further increase the use of cessation medications by promoting the use of evidence-based cessation treatments and reducing barriers to coverage, including out-of-pocket costs.

Background: Animal models are critical to improve our understanding of the neuronal mechanisms underlying nicotine withdrawal. Nicotine dependence in rodents can be established by repeated nicotine injections, chronic nicotine infusion via osmotic minipumps, oral nicotine intake, tobacco smoke exposure, nicotine vapor exposure, and e-cigarette aerosol exposure. The time course of nicotine withdrawal symptoms associated with these methods has not been reviewed in the literature., Aim: The goal of this review is to discuss nicotine withdrawal symptoms associated with the cessation of nicotine, tobacco smoke, nicotine vapor, and e-cigarette aerosol exposure in rats and mice. Furthermore, age and sex differences in nicotine withdrawal symptoms are reviewed., Results: Cessation of nicotine, tobacco smoke, nicotine vapor, and e-cigarette aerosol exposure leads to nicotine withdrawal symptoms such as somatic withdrawal signs, changes in locomotor activity, anxiety- and depressive-like behavior, learning and memory deficits, attention deficits, hyperalgesia, and dysphoria. These withdrawal symptoms are most pronounced within the first week after cessation of nicotine exposure. Anxiety- and depressive-like behavior, and deficits in learning and memory may persist for several months. Adolescent (4-6 weeks old) rats and mice display fewer nicotine withdrawal symptoms than adults (>8 weeks old). In adult rats and mice, females show fewer nicotine withdrawal symptoms than males. The smoking cessation drugs bupropion and varenicline reduce nicotine withdrawal symptoms in rodents., Conclusion: The nicotine withdrawal symptoms that are observed in rodents are similar to those observed in humans. Tobacco smoke and e-cigarette aerosol contain chemicals and added flavors that enhance the reinforcing properties of nicotine. Therefore, more valid animal models of tobacco and e-cigarette use need to be developed by using tobacco smoke and e-cigarette aerosol exposure methods to induce dependence.

The purpose of this study was to explore the feasibility, acceptability, and efficacy of a telephone-based smoking cessation intervention for lung screening patients. Participants ( N  = 39) were enrolled in a single-arm pilot study of a four-session telephone-based intervention. Self-report measures were completed at baseline, post-intervention, and 3-month follow-up. Participants were long-term smokers; 62 percent were not motivated to quit. Twenty-three percent attempted quitting, 29 percent decreased their smoking, and 11 percent reported abstinence. Confidence increased ( p  < .001) and there were trends toward increased importance ( p  = .09) and comparative disease risk ( p  = .02). This intervention was acceptable and associated with improvements in smoking-related beliefs and behaviors.

Introduction: Some studies show that truck drivers use tobacco and other stimulants to stay awake as they drive. Despite their increased risks for many of tobacco-related health disparities, there is limited engagement of truck drivers in smoking cessation programs. The objective of this study was to describe smoking characteristics and identify their preferred smoking cessation methods among truck drivers., Methods: This was a cross-sectional mixed methods study. Participants were truck drivers recruited at trucking companies in Utah in 2019. Participants were either individually interviewed (n = 4), or filled out a survey (n = 33). We conducted qualitative data analysis of the interviews followed by descriptive statistics of smoking and cessation characteristics from the survey., Results: Reasons for smoking included, staying awake, stress reduction, or something to do while driving. Of the drivers surveyed, 68.8% were daily smokers while 97% had smoked at least 100 cigarettes in their life time. The mean number of cigarettes per day (cpd) was 15.7, and 25 among those who had 10 or more cpd. Sixty-one percent had made at least a quit attempt. In addition to counseling or brief advice, 68% reported interest in using Nicotine Replacement Therapy (NRT) either as gum or patch to help them quit. 21% reported interest in telephone text messaging to engage them in treatment., Conclusion: Cigarette smoking is a public health problem among truck drivers. Our findings suggest that truck drivers are interested in quitting smoking. Evidence based interventions tailored to this population are needed to help them quit and reduce their smoking-related morbidity., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

In developing worksite smoking cessation programs in Costa Rica, it is necessary to gain an understanding of smokers and ex-smokers. For smokers, it was necessary to know the barriers to quitting and what they thought may help them. For ex-smokers, we wanted to identify the main factors that helped them to successfully quit. Two separate focus groups were conducted of smokers ( n  = 6) and ex-smokers ( n  = 9) who worked at the Department of Justice. Results indicated that the key factors for both ex-smokers and smokers were social factors-family and coworkers. Participants viewed family support as fundamental to successful quitting. Smokers mentioned that the Justice Department could help them stop smoking by eliciting the support of ex-smoking coworkers. Major barriers to quitting were workplace stress and the presence of other smokers. In conclusion, family members and ex-smoking coworkers can play an important role in worksite smoking cessation programs in Costa Rica.

This 28-day pilot study assessed the feasibility of cell phone ecological momentary assessment in 40 smokers who received emergency department evaluations for acute coronary syndrome. Ecological momentary assessments used familiar touch tone response technology during a cell phone call to capture ratings of illness perceptions, emotion, behavioral intentions, and smoking. Ecological momentary assessments were conducted 1-8 times/day and took 1-2 minutes to complete. The mean ecological momentary assessment call compliance for all 40 subjects was 56.3 percent (standard deviation = 29.4), and during an ecological momentary assessment, 72.5 percent of participants reported a first lapse. We found that first-week call compliance was significantly correlated with subsequent compliance ( r  = 0.55, p  < 0.001).

Tobacco smoking is a well-established risk factor for multiple sclerosis (MS) onset, progression and poor health outcomes in people with MS. Despite smoking being a modifiable risk factor, no research has been undertaken to understand how, or who is best placed, to assess or understand smoking behaviour in people with MS, or how healthcare professionals can best assist people with MS to quit. People with MS may have unique motivators to continue smoking, or unique barriers to smoking cessation, that are not addressed by existing cessation tools. Research is urgently needed in this area if the aim is to maximise health outcomes for all people with MS.

The objective of this study was to identify common themes among women veterans who smoke or recently quit and had used smoking cessation treatment within the Veterans Health Administration (VHA). The study built upon previous research by utilizing in-depth interviews to encourage disclosure of potentially stigmatized topics. Twenty women veterans enrolled in VHA care engaged in a quality improvement project focused on improving smoking cessation services. Qualitative analysis of de-identified interviews used a combination of content analysis and thematic analysis within the sociopharmacological model of tobacco addiction. Findings revealed that participants' smoking was influenced by woman veteran identity and by several gender-related contextual factors, including military sexual trauma and gender discrimination. Findings also highlighted other contextual factors, such as personal autonomy, emotional smoking triggers, and chronic mental health concerns. Findings are interpreted within the context of cultural power imbalances, and recommendations are provided for VHA smoking cessation for women veterans.

Background . Smoking prevalence among Hispanic/Latino construction workers in the United States is very high (31%). Aims. To investigate tobacco use profiles in these minority workers and explore their management's views about implementing sustainable worksite smoking cessation services. Methods. Analysis of baseline data from a smoking cessation trial among Hispanic/Latino construction workers ( n = 134; adult men ≥18 years), and semistructured, 45-minute interviews with 24 key personnel at six construction companies in south Florida were conducted. Interviews were recorded, transcribed, and analyzed thematically. Results . Overall, 43.3% of workers were Cuban, and 81.3% had low acculturation level. Nicotine dependence levels were "high" in 61.8% of workers. Half of the workers had a successful quit attempt but only 9.9% received advice from a physician to quit smoking, 16.7% used medication to quit, and 79.2% did not receive assistance. Participants in the interviews stated that nothing was provided to help smokers quit smoking and considered distributing self-help materials with free medications as the most appropriate service. Challenges to integrating the service were time restriction and cost. Recommendations for implementing the service were local/state government mandate. Discussion. Tailoring tobacco treatment to Hispanic/Latino construction workers' job circumstances and culture is essential to support their cessation efforts. Integrating worksite tobacco treatment services into other available health promotion programs (e.g., safety) and enforcing smoke-free legislation in the construction sector can facilitate its adoption. Conclusion . Involving key stakeholders and mandating the service by the State and local government are necessary to integrate sustainable worksite smoking cessation services in the construction sector.

This pilot study tested the efficacy of an Internet-administered smoking cessation treatment for overweight/obese smokers. Participants were 54 community volunteers with overweight/obesity who were regular smokers. Treatment consisted of 12 weeks of nicotine replacement therapy and randomization to Internet-administered cognitive behavioral treatment or health education. In-person assessments of key outcomes occurred at baseline, post-treatment, and at 24-week follow-up. Cessation rates did not differ across the two treatments (25.9% vs 18.5%). Participants receiving cognitive behavioral treatment gained less weight when abstinent than those receiving the standard treatment. Larger studies are needed to replicate these findings.

Americans spend trillions of minutes in cars annually, tens of billions of minutes traveling to health care providers, and hundreds of millions of minutes ridesharing (e.g., with Uber or Lyft). From July to October 2017, we recruited rideshare users (e.g., Uber or Lyft) to participate in a survey about health messaging during rides. Responses were collected anonymously on tablet devices. We interviewed 170 ridesharers and assessed their interest in health messaging delivered during rides. Participants ranged from 19 to 79 years of age, and most (87%) reported using their smartphones to search for health information. More than 70% expressed interest in health messaging during rides, and 55% of current smokers expressed interest in quit-smoking messaging. The most popular of suggested health topics included healthy eating (61.8%), exercise (60.6%), and weight loss (40.0%), and the preferred message formats were video (33.5%), smartphone apps (33.5%), and online social network (25.3%). Free time spent riding in cars represents an enormous untapped resource, and our findings suggest that riders are receptive to the idea of health messaging delivered during rideshare trips.

Organizations often fail to establish a clear awareness of what employees consider fair when implementing changes to employee benefits in the workplace. In 2016, the Johns Hopkins Health System (JHHS) enhanced their tobacco control efforts. In addition to enhanced smoking cessation benefits, employees were offered an increased reduction in their insurance premiums if they were nonsmokers. To qualify for the reduction, employees participated in testing rather than relying on self-reporting as had been done in the past. The shift to testing prompted a concern by some senior management at JHHS who did not want employees to feel they were not trusted. As the program unfolded at JHHS, the four-component model of procedural justice was applied to provide a framework for reviewing the implementation of the new voluntary tobacco testing at JHHS from a fairness lens. The purpose of this article is to illustrate the application of the four-component procedural model of justice to the tobacco testing process at JHHS. As approximately 75% of employees participated in the program, the experience at JHHS can be instructive to other employers who are looking to implement changes in their workplaces and how to minimize unintended consequences with their employees.

Our global population is aging at an accelerated pace. While the average life expectancy has seen dramatic increases, chronic disease and disability have also increased, with rural America tending to be older, sicker, and poorer. This article examines the implementation and outcomes associated with the community engagement method of the world café that was instrumental in developing a "culture of health" aimed to reduce diabetes-related inequalities for older adults in rural counties of Kentucky. Older residents and the organizations that serve them participated in world cafés, which resulted in collective action due to the wisdom and capacity that evolve from the core element of the method, conversational sharing via multiple small group interactions. Four world cafés were held to explore the desires of the communities related to healthy eating, exercise, smoking cessation, and diabetes care. The world cafés brought a diverse group of community residents and governmental and business leaders to discuss topics that matter to their community, leading to the development of a strategic plan and a scorecard and, ultimately, community empowerment.

Smoking causes various diseases and is a major public health threat worldwide. Therefore, promoting smoking cessation is the most important intervention contributing to maintaining the health of smokers and nonsmokers and saving enormous financial expense. We reviewed existing and emerging smoking-cessation pharmacotherapies from the Cochrane Database of Systemic Reviews, PubMed, Ovid, and ClinicalTrials.gov databases. A literature review revealed that bupropion may be appropriate for patients interested in reducing smoking who dislike, or who have failed, nicotine-replacement therapy (NRT). Additionally, varenicline and NRT are efficacious first-line smoking cessation treatments and should be given to all individuals unless contraindicated. The reviews of this paper are available via the supplementary material section.

The growing prominence of community-based participatory research (CBPR) presents as an opportunity to improve tobacco-related intervention efforts. CBPR collaborations for tobacco/health, however, typically engage only adults, thus affording only a partial understanding of community context as related to tobacco. This is problematic given evidence around age of tobacco use initiation and the influence of local tobacco environments on youth. The CEASE and Resist youth photovoice project was developed as part of the Communities Engaged and Advocating for a Smoke-free Environment (CEASE) CBPR collaboration in Southwest Baltimore. With the broader CEASE initiative focused on adult smoking cessation, CEASE and Resist had three aims: (1) elucidate how youth from a high-tobacco-burden community perceive/interact with their local tobacco environment, (2) train youth as active change agents for tobacco-related community health, and (3) improve intergenerational understandings of tobacco use/impacts within the community. Fourteen youth were recruited from three schools and trained in participatory research and photography ethics/guiding principles. Youth met at regular intervals to discuss and narrate their photos. This article provides an overview of what their work revealed/achieved and discusses how including participatory youth research within traditionally adult-focused work can facilitate intergenerational CBPR for sustainable local action on tobacco and community health.

Background: Rates of tobacco treatment delivery in primary care are suboptimal., Aims: We report on the effectiveness of the TiTAN Crete intervention on rates of patient-reported 4As (ask, advise, assist, arrange) tobacco treatment and general practitioner's (GP) knowledge, attitudes, self-efficacy, and intentions., Methods: A quasi-experimental pilot study with pre-post evaluation was conducted in Crete, Greece (2015-2016). GPs ( n = 24) intervention and control group and a cross-sectional sample of their patients ( n = 841) were surveyed before the implementation of the intervention. GPs in the intervention group received training, practice, and patient tools to support the integration of the 4As treatment into clinical routines. Intervention group GPs ( n = 14) and a second cross-sectional sample of patients ( n = 460) were surveyed 4 months following the intervention to assess changes in outcomes of interest. Multilevel modeling was used to analyze data., Results: Among GPs exposed to the intervention, significant increases in knowledge, self-efficacy, and rates of 4As delivery were documented between the pre- and postassessment and compared with those of the control group. Specifically, the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for 4As delivery between the pre-and postassessment among GPs exposed to the TiTAN intervention were as follows: Ask AOR 3.66 (95% CI [2.61, 5.14]); Advise AOR 4.21 (95% CI [3.02, 5.87]); Assist AOR 13.10 (95% CI [8.83, 19.42]) and Arrange AOR 4.75 (95% CI [2.67, 8.45])., Conclusion: We found significant increases in rates at which GPs delivered evidence-based tobacco treatment following exposure to the TiTAN intervention. Future research should examine methods for supporting broader dissemination of well-designed training interventions in general practice.

Background: Tobacco use contributes to an estimated 14.6% of male and 5.7% of female deaths in Bangladesh., Aims: We examine the determinants of tobacco-related quit attempts among Bangladeshis with and without awareness of the synergized "People Behind the Packs" (PBTP) communication campaign used to support the introduction of pack-based graphic warning labels (GWLs) in 2016., Method: Data from 1,796 adults were collected using multistage sampling and a cross-sectional face-to-face survey. Analyses used a normalized design weight to ensure representativeness to the national population of smokers within Bangladesh., Results: For the overall sample, the multivariable logistic regression model revealed quit attempts were associated with having seen the pack-based GWLs, recalling ≥1 PBTP campaign message, higher levels of self-efficacy to quit, and recognizing more potential side-effects associated with using tobacco products. Conversely, the likelihood of quitting attempts were lower among dual tobacco users (relative to smokers) and those using tobacco at least daily (vs. less than daily). The hierarchical multivariable logistic regression model among those aware of ≥1 PBTP campaign message indicated quitting attempts were positively associated with recalling more of the campaign messages and discussing them with others., Conclusion: This national evaluation of pack-based GWLs and accompanying PBTP campaign within Bangladesh supports the efficacy of using synergized communication messages when introducing such labels. That quit attempts are more likely among those discussing PBTP campaign messages with others and recalling more PBTP campaign messages highlights the importance of ensuring message content is both memorable and engaging.

More people are using electronic cigarettes (e-cigarettes) and fewer people are smoking conventional tobacco cigarettes. A wide variety of e-cigarettes are available and there is emerging evidence that they may help with smoking cessation. This evidence-based clinical review summarises the latest evidence regarding use of e-cigarettes as smoking cessation aids. The ongoing debate surrounding the safety and regulation of e-cigarettes is also discussed., Competing Interests: No conflict of interests declared

Although cigarette smoking is a major contributor to continued health problems after stroke, the majority of stroke survivors do not quit smoking. This may be due in part to the high rate of smoking among committed partners of stroke survivors. This study investigated the experiences of 11 dual-smoker stroke survivor-caregiver dyads, identifying themes which may be useful for understanding this entrenched population: managing the addiction as a dyad; conflicting feelings about whether smoking is an individual versus mutual concern; and dyad-level barriers and facilitators of quitting. We also present specific cessation strategies that dual-smoker dyads participating in the study described.

Objective Higher-intensity counseling sessions increase the smoking abstinence rate. However, counselors are limited in Taiwan. This study was performed to determine whether the addition of one session with a specialist counselor increases the efficacy of a family physician-led smoking cessation program. Methods Participants opted to either visit a family physician for brief counseling and pharmacotherapy (Po) or visit a specialist counselor for an initial session followed by a family physician for brief counseling sessions with pharmacotherapy (P+). The 7-day point prevalence (PP) rate was evaluated at weeks 12 and 24. Results In total, 356 patients were enrolled. In the intention-to-treat analysis, the PP rate at week 12 was higher in the Po than P+ group, but there was no significant difference at week 24. In the per-protocol analysis, the PP rates at weeks 12 and 24 were not significantly different between the Po and P+ groups. The adjusted odds ratios also revealed no significant differences in either the intention-to-treat analysis or the per-protocol analysis between the two groups. Conclusion The addition of one session with a specialist counselor had no benefit over the provision of counseling through a family physician at either 12 or 24 weeks of follow-up.

Introduction: It has been suggested that the effectiveness of nicotine replacement smoking cessation pharmacotherapy may be enhanced by assessing rates of nicotine metabolism using the nicotine metabolite ratio - which reflects differences in the activity of the CYP2A6 hepatic enzyme - and titrating doses appropriately. To date, supporting evidence is equivocal, with little information regarding the assessment and effectiveness of the nicotine metabolite ratio among smokers with psychiatric conditions., Methods: The nicotine metabolite ratio of 499 smokers from the FLEX trial was determined using urine samples obtained at baseline. They were randomized to receive either: standard transdermal nicotine (nicotine replacement therapy); extended nicotine replacement therapy + adjunct nicotine agent; or varenicline. Primary cessation outcomes were seven-day point prevalence at 5, 10, 22, and 52 weeks post-target quit date, comparing across treatment and psychiatric status. Our principal analysis employed logistic regression (outcome: abstinence), using slow metabolizers as the reference category., Results: No differences were observed by nicotine metabolite ratio classification (slow, moderate, fast) with respect to any demographic or smoking-related variables. Nicotine metabolite ratio class did not predict smoking cessation in either the overall sample, or by treatment condition at any time-point (week 52 moderate metabolizers: odds ratio 1.34, 95% confidence interval (0.68-2.63), p=0.394; fast metabolizers: odds ratio 1.04 (0.56-1.91), p=0. 906)., Conclusion: Our results did not find any associations between nicotine metabolite ratio and cessation outcomes among smokers using nicotine replacement therapy or varenicline with and without lifetime psychiatric conditions.

Background: It is a priority to develop population-based strategies for reducing barriers to smoking cessation among low-income populations. Harnessing secondary transmission such as interpersonal communication (IC) has helped to reduce tobacco use, but there is a dearth of quasi-experimental research that examines IC and the full spectrum of smoking cessation behaviors, particularly in the context of population-level programs., Aims: Using quasi-experimental methods, we examined IC in response to a population-level intervention and its impact on the full spectrum of smoking cessation outcomes among low-income smokers., Method: We used propensity score matching; three different propensity score matching procedures were used to estimate and approximate experimental effects. We assessed four cessation outcomes: utilization of a free tobacco quitline (QL), making a quit attempt, and being smoke-free for 7 and 30 days at follow-up. We also examined predictors of IC., Results: IC was significantly related to QL utilization (effect sizes ranging from 0.135 to 0.166), making a quit attempt (effect sizes ranging from 0.115 to 0.147), being smoke-free for 7 days (effect sizes ranging from 0.080 to 0.121), and being smoke-free for 30 days at follow-up (effect sizes ranging from 0.058 to 0.082). Program-related and participant characteristics predicted IC, such as receiving emotional direct mail materials and living with a fellow smoker., Discussion: IC in response to a population-based program affected the cessation process, and IC had a marked impact on sustained cessation., Conclusion: Population-based programs should aim to harness psychosocial dynamics such as IC to promote sustained cessation among low-income populations.

Background: Recent pilot trials suggest feasibility and potential efficacy of psychedelic-facilitated addiction treatment interventions. Fifteen participants completed a psilocybin-facilitated smoking cessation pilot study between 2009 and 2015., Aims: The aims of this study were as follows: (1) to identify perceived mechanisms of change leading to smoking cessation in the pilot study; (2) to identify key themes in participant experiences and long-term outcomes to better understand the therapeutic process., Methods: Participants were invited to a retrospective follow-up interview an average of 30 months after initial psilocybin sessions. Semi-structured interviews were conducted with 12 of the 15 participants. Data were analysed using thematic analysis., Results: Participants reported gaining vivid insights into self-identity and reasons for smoking from their psilocybin sessions. Experiences of interconnectedness, awe, and curiosity persisted beyond the duration of acute drug effects. Participants emphasised that the content of psilocybin experiences overshadowed any short-term withdrawal symptoms. Preparatory counselling, strong rapport with the study team, and a sense of momentum once engaged in the study treatment were perceived as vital additional factors in achieving abstinence. In addition, participants reported a range of persisting positive changes beyond smoking cessation, including increased aesthetic appreciation, altruism, and pro-social behaviour., Conclusions: The findings highlight the value of qualitative research in the psychopharmacological investigation of psychedelics. They describe perceived connections between drug- and non-drug factors, and provide suggestions for future research trial design and clinical applications.

People with low socioeconomic status (SES) in the United States have disparately high rates of smoking and experience disproportionately high burdens of smoking-related disease. Tobacco control media campaigns are a critical strategy for reducing tobacco use prevalence, but evidence is mixed about the optimal use of mass media to reach and promote tobacco use cessation among people with low SES. Improved understanding of the factors influencing how low-SES tobacco users evaluate tobacco control media campaigns may inform development of more effective messages and strategies. Focus groups with primarily low-SES smokers in Connecticut were conducted, finding that participants had seen many tobacco control television ads that used graphic imagery and testimonials, but participants voiced two main themes that limited ad effectiveness: (1) skepticism about the content of ads, the role of the tobacco industry and the government in sponsoring the ads, and the safety and efficacy of cessation supports; and (2) barriers to quitting such as stress, social contexts, and addiction that participants perceived as being underappreciated in the context of the ads. Tobacco control media campaigns targeting low-SES tobacco users may need additional messages, tools, or refinements to more optimally motivate this group to make quit attempts.

This article describes the implementation of the American Indian mHealth Smoking Dependence Study focusing on the differences between what was written in the grant application compared to what happened in reality. The study was designed to evaluate a multicomponent intervention involving 256 participants randomly assigned to one of 15 groups. Participants received either a minimal or an intense level of four intervention components: (1) nicotine replacement therapy, (2) precessation counseling, (3) cessation counseling, and (4) mHealth text messaging. The project team met via biweekly webinars as well as one to two in-person meetings per year throughout the study. The project team openly shared progress and challenges and collaborated to find proactive solutions to address challenges as compared to what was planned in the original grant application. The project team used multiple strategies to overcome unanticipated intervention issues: (1) cell phone challenges, (2) making difficult staffing decisions, (3) survey lessons, (4) nicotine replacement therapy, (5) mHealth text messages, (6) motivational interviewing counseling sessions, and (7) use of e-cigarettes. Smoking cessation studies should be designed based on the grant plans. However, on the ground reality issues needed to be addressed to assure the scientific rigor and innovativeness of this study.

Quitting smoking is the most important element in the therapeutic management of chronic respiratory diseases. Combining pharmacotherapy with behavioral support increases smoking cessation success rates. In addition, hospitalized smokers have increased motivation to quit. We investigated the efficacy on smoking cessation, of varenicline in combination with behavioral support, in smokers hospitalized due to (a) acute exacerbation of chronic obstructive pulmonary disease (COPD), or (b) bronchial asthma attack, or (c) community-acquired pneumonia (CAP). The method used is prospective, open-label, preference-based, parallel group, 52-week trial. Patients chose the smoking cessation intervention they preferred: a standard regimen of varenicline combined with post-discharge advanced behavioral support (group A) or one private consultation session during hospitalization (group B). Follow-up phone calls were scheduled in weeks 1, 2, and 4 and months 3, 6, and 9. The final hospital visit was performed in week 52. Primary outcome was success rate defined as the percentage (%) of smoking abstinence at week 52 and secondary outcomes were (a) changes in quality of life (QoL) indicated by the scores on the Short Form 36 (SF36) questionnaire and (b) predictors of smoking abstinence investigated with multiple binary logistic regression. One hundred one patients were enrolled, 44 (43.6%) in group A and 57 (56.4%) in group B. Respective abstinence rates were 54.5% and 15.8% at week 12 and 52.3% and 14.0% at week 52. Scores on SF36 were statistically significantly increased in both groups. Predictors of smoking abstinence were varenicline (odds ratio (OR) 7.29; 95% confidence interval (CI) 2.15, 24.77; p = 0.001), age (OR 1.07; 95%CI 1.00, 1.15; p = 0.042), Fagerstrom score (OR 0.37; 95%CI 0.20, 0.68; p = 0.001), SF36 domains "vitality" (OR 1.12; 95%CI 1.04, 1.21; p = 0.003), and "social functioning" (OR 0.95; 95%CI 0.90, 1.00; p = 0.041). Varenicline in combination with behavioral support resulted in high abstinence rates inpatients hospitalized for exacerbation of COPD, asthma attack, or CAP, and improved QoL.

Background: Identifying effective relapse prevention interventions is a vital step to help smokers maintain abstinence for the long term., Aims: The purpose of this study is to determine if providing recently quit smokers with self-directed relapse prevention booklets is effective at maintaining abstinence after intensive group smoking cessation treatment., Method: Two hundred and twenty-five participants were randomized to receive Forever Free (FF) relapse prevention booklets or a control booklet (Surgeon General's report, SG) at the end of a 6-week group treatment program. Participants were then contacted by phone to assess whether they had read the materials. Smoking status was assessed 6 months after their target quit date. Primary analyses focused on the 115 participants who quit at the end of treatment., Results: There was no difference in the 6-month quit rate between groups (40.7% quit FF vs. 44.6% quit SG, p = .67). The FF group read a significantly smaller proportion of the materials versus the control booklet (20.0% read most or all of FF vs. 72.0% of SG, p < .001)., Conclusion: Forever Free self-directed relapse prevention booklets did not reduce relapse or enhance cessation over general tobacco and health information when added to intensive group smoking cessation treatment. However, this study lacked power to detect a small but clinically meaningful positive effect.

Psychometrics of the Smoking Cessation Counseling Scale, which measures adherence to evidence-based smoking cessation counseling practice, were originally estimated among rural hospital nurses. The purpose of this study was to estimate the scale's reliability, convergent validity, and factor structure among 289 nurses from 27 acute care Magnet® hospitals. The scale demonstrated acceptable estimates for internal consistency (Cronbach's α = .95, 95% CI = [0.94, 0.96]). Convergent validity was supported by the association with comfort in conducting smoking cessation counseling (coefficient = 3.58, 95% CI = [2.80, 4.37]) and shared vision (coefficient = 0.72, 95% CI = [0.02, 1.42]). A four-factor structure (standard care, basic counseling, advanced counseling, and referral to services) was identified. Findings supported the scale's reliability and convergent validity among Magnet® hospital nurses. Further testing is needed to confirm the four-factor structure and accumulate psychometric evidence among different nursing providers and health care settings to expand the use of the instrument.