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Most population studies that evaluate the relationship between nicotine vaping and cigarette cessation focus on limited segments of the smoker population. We evaluated vaping uptake and smoking cessation considering differences in smokers' plans to quit.Longitudinal International Tobacco Control (ITC) Four Country Smoking and Vaping Surveys were conducted in 2016, 2018 and 2020.This study was conducted in the United States, Canada, England and Australia.Participants of this study were adult daily cigarette smokers who had not vaped in the past 6 months at baseline and had participated in two or more consecutive waves of the ITC Four Country Smoking and Vaping Surveys (n = 2815).Plans to quit cigarette smoking was assessed at baseline (within 6 months, beyond 6 months, not planning to quit) and at follow-up (within 6 months vs not within 6 months), cigarette smoking cessation was assessed at follow-up (smoking less than monthly [including complete cessation] vs daily/weekly/monthly smoking) and inter-wave vaping uptake was assesed between baseline and follow-up (none, only non-daily vaping and any daily vaping). Generalized estimating equations were used to evaluate whether inter-wave vaping uptake was associated with smoking cessation at follow-up and with planning to quit at follow-up, each stratified by plans to quit smoking at baseline.Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR], 8.58; 95% CI, 5.06-14.54). Among smokers planning to quit, smoking cessation rates were similar between those who did and did not take up daily vaping (25.1% vs 16.8%; AOR, 1.91; 95% CI, 0.91-4.00), although we could not account for potential use of cessation aids. Daily vaping uptake was associated with planning to quit smoking at follow-up among those initially not planning to quit (AOR,6.32; 95% CI, 4.17-9.59).Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers.

To assess whether offering free mailed nicotine replacement therapy (NRT) and telephone counselling to smokers on elective surgery waiting lists increases quitting before surgery.Randomised, controlled trial at Frankston Hospital, a public tertiary referral hospital in Melbourne.Adult smokers added to elective surgery waiting lists for operations at least ten days in the future, 1 April 2019 - 3 April 2020.In addition to normal care, intervention participants received a brochure on the risks of low frequency smoking, an offer of Quitline call-back registration, and an offer of mailed NRT according to reported daily smoking: 1-9 cigarettes/day, 2 mg lozenges; 10-15/day, 7-14 mg patches [three weeks] and 2 mg lozenges; 15/day, 7-21 mg patches [five weeks] and 2 mg lozenges.Primary outcome: quitting at least 24 hours before surgery, verified by exhaled carbon monoxide testing.quitting at least four weeks before surgery, adverse events, and (for those who had quit before surgery) abstinence three months after surgery.Of 748 eligible participants (control, 363; intervention, 385), 516 (69%) had undergone elective surgery when the trial was terminated early (for COVID-19-related reasons) (intervention group, 274; control group, 242). 122 of the 385 intervention participants (32%) had accepted the offer of cessation support. The proportions of intervention participants who quit at least 24 hours before surgery (18% v 9%; odds ratio [OR], 1.97; 95% CI, 1.22-3.15) or at least four weeks before surgery (9% v 4%; OR, 2.20; 95% CI, 1.08-4.50) were larger than for the control group. Three months after surgery, 27 of 58 intervention (47%) and 12 of 25 control participants (48%) who quit before surgery reported not smoking in the preceding seven days. No major adverse events were reported.Uptake of free mailed NRT and Quitline support by smokers on elective surgery waiting lists was good, and offering additional support was associated with higher proportions of smokers quitting before surgery.Australian New Zealand Clinical Trials Registry, ACTRN12619000032156 (prospective).

BACKGROUND AND AIMS: Past research has found that young smokers are more likely to make quit attempts; however, there are conflicting findings regarding age and quit success. This study examined the degree to which smoker age is related to making quit attempts and quit success. DESIGN: Ten waves of the International Tobacco Control Policy Cohort survey (ITC-4C) collected between 2002 and 2014, with nine wave-to-wave transitions with predictors at the first wave predicting quit attempts and success by the next wave. SETTING: Canada, the United States, the United Kingdom and Australia. PARTICIPANTS: Data from 15 874 smokers categorized into four age groups at baseline (18-24, 25-39, 40-54 and 55+ years). MEASUREMENTS: Age, quit attempts and success (defined as ≥ 30 days abstinence confirmed, if possible, on a third wave for recent attempts). FINDINGS: Older smokers were more likely to smoke daily (χ2 = 1557.86, r = 0.136, P

In this brief article, we review the evidence on whether easier access to vaping could help lower smoking rates in Australia. To make a convincing case for vaping the following conditions need to be met: that vaping assists in smoking cessation; that the prevalence of vaping is high enough to produce measurable effects at a population level; and that the decline in smoking prevalence is slower in countries where vaping is less common. The evidence suggests that these criteria are satisfied.

Men with prostate cancer experience side effects for which a supportive social environment may be beneficial. We examined the association between four measures of social connectedness and mortality after a prostate cancer diagnosis. Male participants in the Melbourne Collaborative Cohort Study in 1990-1994, who developed incident prostate cancer and attended follow-up in 2003-2007, were eligible for the study. Information on social connectedness, collected at follow-up, included (i) living arrangement; (ii) frequency of visits to friends/relatives and (iii) from friends/relatives; (iv) weekly hours of social activities. A total of 1,421 prostate cancer cases was observed (338 all-cause deaths, 113 from prostate cancer), including 867 after follow-up (150 all-cause deaths, 55 from prostate cancer) and 554 before follow-up (188 all-cause deaths, 58 from prostate cancer). Cox models stratified by tumour Gleason score and stage, and sequentially adjusted for socioeconomic, health- and lifestyle-related confounders, were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between social connectedness and all-cause mortality after prostate cancer. Men who reported living alone before diagnosis had higher overall mortality (HR = 1.6, 95% CI: 1.0-2.5), after adjustment for socioeconomic, health and lifestyle confounders. Lower mortality was observed for men with more social activities (p-trend = 0.07), but not in comprehensively adjusted models. Consistent with these findings, men living alone after prostate cancer diagnosis had higher mortality (HR = 1.3, 95% CI: 0.9-1.9). Lower mortality was observed with increasing socializing hours in the age-adjusted model (p-trend = 0.06) but not after more comprehensive adjustment. Our findings suggest that living with someone, but not other aspects of social connectedness, may be associated with decreased mortality for men with prostate cancer.

BACKGROUND AND AIMS: It has been proposed that many smokers switch to vaping because their nicotine addiction makes this their only viable route out of smoking. We compared indicators of prior and current cigarette smoking dependence and of relapse in former smokers who were daily users of nicotine vaping products ('vapers') or who were not vaping at the time of survey ('non-vapers'). DESIGN: Cross-sectional survey-based comparison between vaping and non-vaping former smokers, including a weighted logistic regression of vaping status onto predictor variables, adjusting for covariates specified below. SETTING: United States, Canada, Australia and England. PARTICIPANTS: A total of 1070 people aged 18+ years from the 2016 International Tobacco Control (ITC) Four Country Smoking and Vaping Wave 1 Survey who reported having ever been daily smokers but who stopped less than 2 years ago and who were currently vapers or non-vapers. MEASUREMENTS: Dependent variable was current vaping status. Predictor variables were self-reported: (1) smoking within 5 minutes of waking and usual daily cigarette consumption, both assessed retrospectively; (2) current perceived addiction to smoking, urges to smoke and confidence in staying quit. Covariates: country, sample sources, sex, age group, ethnicity, income, education, current nicotine replacement therapy use and time since quitting. FINDINGS: Vapers were more likely than non-vapers to report: (1) having smoked within 5 minutes of waking [34.3 versus 15.9%, adjusted odds ratio (aOR) = 3.74, 95% confidence interval (CI) = 1.99, 7.03), χ2 = 16.92, P 10 cigarettes/day (74.4 versus 47.2%, aOR = 4.39, 95% CI = 2.22, 8.68), χ2 = 18.18, P

AIMS: To examine whether norms towards nicotine vaping product (NVP) use varied between Australia, Canada, England and the United States and by sociodemographics, smoking and NVP status. DESIGN: Cross-sectional data from the 2016 ITC Four Country Smoking and Vaping Survey. SETTING: Four countries with distinct regulatory policies relating to the sale and advertising of NVPs: Australia (most restrictive), Canada (restrictive), England and United States (least restrictive). PARTICIPANTS: 10,900 adult (age 18+) current smokers, former smokers, or at least weekly NVP users. Respondents were from Australia (n=1,366), Canada (n=3,309), England (n=3,835) and the United States (n=2,390). MEASUREMENTS: Questions permitted the categorization of respondents as current smokers, former smokers, NVP users and sociodemographic categories (sex, age, country, ethnicity, income and education). Further questions were asked regarding the frequency of exposure to NVPs in public, whether they had a partner or close friends who vaped and whether they believed society or those considered important to them approved of NVPs. FINDINGS: Adjusting for relevant covariates, compared to Australian respondents, those in England, Canada and United States were more likely to report frequent exposure to NVPs in public (83.1%, 57.3% and 48.3% respectively, compared to 19.8% in Australia; p

Aims To examine current and ex-smokers' reasons for continuing or discontinuing regular use of nicotine vaping products (NVPs). Design and participants Cross-sectional study of 2722 current daily/weekly, and 921 ex-daily/weekly, adult vapers who were either current or ex-cigarette smokers when surveyed. Setting 2016 ITC Four Country Smoking and Vaping wave 1 (4CV1) surveys conducted in the United States (n = 1159), England (n = 1269), Canada (n = 964) and Australia (n = 251). Measurements Current vapers were asked about the following reasons for regular NVP use: less harmful to others, social acceptance, enjoyment, use in smoke-free areas, affordability and managing smoking behaviour. Ex-vapers were asked about the following reasons for discontinuing regular NVP use: addiction concerns, affordability, negative experiences, perceived social unacceptability, safety concerns, product dissatisfaction, inconvenience, unhelpfulness for quitting, unhelpfulness for managing cravings and not needed for smoking relapse prevention. Possible correlates of NVP use and discontinuation, including smoking status, smoking/vaping frequency, quit duration (ex-smokers only), country, age and type of NVP device used, were examined using multivariate logistic regression models. Findings For current smokers, the top three reasons for current regular NVP use were: helpful for cutting down smoking (85.6%), less harmful to others (77.9%) and helpful for quitting smoking (77.4%). The top three reasons for discontinuing vaping were: not being satisfying (77.9%), unhelpfulness for cravings (63.2%), and unhelpfulness for quitting smoking (52.4%). For ex-smokers, the top three reasons for current vaping were: enjoyment (90.6%), less harmful to others (90%) and affordability (89.5%); and for discontinuing were: not needed to stay quit (77.3%), not being satisfying (49.5%) and safety concerns (44%). Reported reasons varied by user characteristics, including age, country and NVP device type. Conclusions Regular use of nicotine vaping products is mainly motivated by its perceived benefits, especially for reducing or quitting smoking, whereas its discontinuation is motivated by perceived lack of such benefits, with some variation by user characteristics.

BACKGROUND: Our study explores the relationships between cigarette smoking and nicotine vaping product (NVP) use in the US by emphasizing the role of explicit (i.e., price) and implicit (i.e., use restrictions in public places) costs of nicotine products. We investigate the associations between prices, use restrictions in public places and use patterns of cigarettes and NVPs (i.e. NVP use, concurrent use, and complete switch to NVPs). DESIGN/METHODS: Data came from the Wave 1 (2016) US data of the ITC Four Country Smoking and Vaping Survey (ITC US 4CV1) and Nielsen Scanner Track database. A multiple logistic regression model was applied to estimate the likelihoods of NVP use (vaping at least monthly), cigarette/NVP concurrent use (vaping and smoking at least monthly), and switch from cigarettes to NVPs (had quit smoking < 24 months and currently vape) among ever smokers, conditioning upon cigarette/NVP prices, use restrictions and socio-demographics. RESULTS: Living in places where vaping is allowed in smoke-free areas was significantly associated with an increase in the likelihood of vaping (Marginal Effect, M.E. = 0.17; p0.05). Higher cigarette prices were associated with greater likelihood of cigarette and NVP concurrent use (P>0.05). Working in places where vaping is banned is associated with lower likelihood of vaping and NVP and cigarette concurrent use (P>0.05). CONCLUSIONS: Higher NVP prices and vaping restrictions in public places were associated with less NVP use and less concurrent use of vaping and smoking. Public policies that work to increase the prices paid for vaping devices and supplies (i.e., regulations, taxes) and restrict where vaping is allowed are likely to suppress vaping as an alternative to cigarettes.

INTRODUCTION AND AIMS: The national prevalence of daily smoking among the Aboriginal and Torres Strait Islander population is 39% but falling. We explore factors associated with starting and sustaining quit attempts, and reasons given for quitting. DESIGN AND METHODS: We analysed data from the nationally representative quota sample of 759 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012-October 2013) who completed a follow-up survey a year later (August 2013-August 2014). RESULTS: Having made more quit attempts, more recent quit attempts in the past, motivational attitudes, having been encouraged to quit by a health professional and having noticed tobacco advertising were associated with making a quit attempt between surveys. Having made longer quit attempts in the past, non-daily smoking and quit self-efficacy were associated with sustaining abstinence. But neither having made more quit attempts in the past nor dependence was associated with sustaining abstinence. Health concerns, price and setting an example to children were the most common reasons given by smokers and ex-smokers for quitting. DISCUSSION AND CONCLUSIONS: Different factors predict making and sustaining quit attempts among Aboriginal and Torres Strait Islander smokers. We need to rethink current messages that just encourage Aboriginal and Torres Strait Islander smokers to keep making quit attempts by increasing motivation to quit, as motivation and making more quit attempts does not predict eventual success. We could focus more on increasing smokers' confidence that they can successfully quit.

Background and Aims: The presence and content of health warning labels (HWLs) on nicotine vaping products (NVPs), such as electronic cigarettes, varies by country and manufacturer. We compared proportions of people who report (i) noticing HWLs on NVPs and (ii) feeling concerned having noticed HWLs, by country and by smoking or vaping status. We also examined recall of HWL content and whether this varies by country. Design: Cross-sectional survey. Setting: Australia (AU), Canada (CA), England (EN) and the United States (US). At the time of data collection, HWLs on NVPs were only mandatory in EN. Participants: A total of 11 561 respondents from the following samples in the 2016 International Tobacco Control Four Country Project: (1) re-contacted smokers and quitters who had participated in the previous wave of the project; (2) newly recruited current smokers and recent quitters; and (3) newly recruited current vapers from CA, EN and US. Measurements: Outcomes included: (1) having noticed HWLs on NVPs, (2) feeling concerned having noticed HWLs, and (3) recall of HWL message content. Findings: Compared with respondents in EN, respondents in CA were more likely to report having noticed HWLs [odds ratio (OR) = 1.58, P = 0.02], whereas respondents in AU (OR = 0.76, P = 1.00) and the US (OR = 1.54, P = 0.09) were not significantly more or less likely to report having noticed HWLs. Compared with concurrent smokers and vapers, daily smokers, non-daily smokers and quitters were less likely to report having noticed HWLs (ORs = 0.21, 0.33 and 0.19, respectively, all P

Aim To assess (1) how far smoking patterns, depression and smoking-related beliefs and intentions predict vaping uptake, current vaping and vaping frequency among daily smokers; and (2) how far the aforementioned predictors and baseline vaping frequency predict current vaping among those who reported ever vaped. Design Analysis of data from six waves of a longitudinal survey over 8 years. Longitudinal associations between predictors and outcomes were examined using multi-level models. Setting United Kingdom, United States, Canada and Australia. Participants A total of 6296 daily smokers (53% females) who contributed data to at least two consecutive survey waves. Measurements The outcome variables were vaping uptake, vaping frequency and current vaping at follow-up. The key predictor variables, measured in previous waves, were time to first cigarette, cigarettes smoked per day, depressive symptoms, intention to quit smoking, quitting self-efficacy and worry about adverse health effects of smoking. Findings Number of cigarettes smoked daily was associated with (1) subsequent vaping uptake [odds ratio (OR) = 1.69, 95% confidence interval (CI) = 1.19, 2.39 for 30+ cigarette per day; reference category: 0-10 cigarettes] and (2) a higher frequency of current vaping (OR = 1.97, 95% CI = 1.36, 2.85 for 30+ cigarettes). Intention to quit was associated with a higher frequency of current vaping (OR = 1.48, 95% CI = 1.21, 1.82). Among those who reported ever vaped, higher baseline vaping frequency (OR = 11.98, 95% CI = 6.00, 23.93 for daily vaping at baseline; reference category: vaped less than monthly) predicted current vaping. Conclusion Among daily smokers, amount smoked and intention to quit smoking appear to predict subsequent vaping uptake. Vaping frequency at baseline appears to predict current vaping at follow-up.

AIMS To estimate predictors of time to smoking relapse and test if prediction varied by quit duration. DESIGN Longitudinal cohort data from the International Tobacco Control Four-Country survey with annual follow up collected between 2002 and 2015. SETTING Canada, United States, United Kingdom and Australia. PARTICIPANTS A total of 9171 eligible adult smokers who had made at least one quit attempt during the study period. MEASUREMENTS Time to relapse was the main outcome. Predictor variables included pre-quit baseline measures of nicotine dependence, smoking and quitting-related motivations, quitting capacity and social influence, and also two post-quit measures, use of stop-smoking medications and quit duration (1-7 days, 8-14 days, 15-31 days, 1-3 months, 3-6 months, 6-12 months, 1-2 years and 2+ years), along with socio-demographics. FINDINGS All factors were predictive of relapse within the first 6 months of quitting but only wanting to quit, quit intentions and number of friends who smoke were still predictive of relapse in the 6-12-month period of quitting [hazard ratios (HR) = 1.20, P < 0.05; 1.13, P < 0.05; and 1.21, P

This paper provides a brief introduction to CEOS theory, a comprehensive theory for understanding hard to maintain behaviour change. The name CEOS is an acronym for Context, Executive, and Operational Systems theory. Behaviour is theorised to be the result of the moment by moment interaction between internal needs (operational processes) in relation to environmental conditions, and for humans this is augmented by goal-directed, executive action which can transcend immediate contingencies. All behaviour is generated by operational processes. Goal-directed behaviours only triumph over contingency-generated competing behaviours when operational processes have been sufficiently activated to support them. Affective force can be generated around executive system (ES) goals from such things as memories of direct experience, vicarious experience, and emotionally charged communications mediated through stories the person generates. This paper makes some refinements and elaborations of the theory, particularly around the role of feelings, and of the importance of stories and scripts for facilitating executive action. It also sketches out how it reconceptualises a range of issues relevant to behaviour change. CEOS provides a framework for understanding the limitations of both informational and environmental approaches to behaviour change, the need for self-regulatory strategies and for taking into account more basic aspects of human functioning.

The use of vaporized nicotine products (VNPs), especially e-cigarettes and, to a lesser extent, pressurized aerosol nicotine products and heat-not-burn tobacco products, are being adopted increasingly as an alternative to smoking combusted products, primarily cigarettes. Considerable controversy has accompanied their marketing and use. We propose a framework that describes and incorporates patterns of VNP and combustible cigarette use in determining the total amount of toxic exposure effects on population health. We begin by considering toxicity and the outcomes relevant to population health. We then present the framework and define different measures of VNP use; namely, trial and long-term use for exclusive cigarette smokers, exclusive VNP and dual (cigarette and VNP) use. Using a systems thinking framework and decision theory we considered potential pathways for current, former and never users of VNPs. We then consider the evidence to date and the probable impacts of VNP use on public health, the potential effects of different policy approaches and the possible influence of the tobacco industry on VNP and cigarette use.

Aims To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Design Prospective cohort with approximately annual waves. Mixed-effect logistic regressions tested whether time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether time 1 (T1) symptoms moderated this relationship. Setting Waves 5–8 of the Four-Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, the United States, the United Kingdom and Australia. Participants A total of 6978 smokers who participated in telephone surveys. Measurements T1 and T2 depressive symptoms in the last 4 weeks were assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: (1) no attempt since T1; (2) attempted and relapsed; and (3) attempted and abstinent at T2. Findings Compared with no attempt, relapse was associated with reporting T2 symptoms [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.33, 1.59]). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was associated positively with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI = 1.45, 2.03) and those with T1 symptoms (OR = 1.45, 95% CI = 1.23, 1.70). Abstinence was associated positively for those without T1 symptoms (OR = 1.37, 95% CI = 1.10, 1.71) and negatively for those with T1 symptoms (OR = 0.74, 95% CI = 0.59, 0.94). Age moderated these associations significantly. Relapse did not predict T2 symptoms for those aged 18–39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18–39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40–55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged more than 55 (OR =1.97, 95% CI = 1.35, 2.87). Conclusions Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people aged more than 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking.

Aims To determine whether signs of current depression predict attempts to quit smoking, and short-term abstinence among those who try, and to test moderating effects of gender and cessation support (pharmacological and behavioural). Design Prospective cohort with approximately annual waves. Among smokers at one wave we assessed outcomes at the next wave using mixed-effects logistic regressions. Setting Waves 5–8 of the Four Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, USA, UK and Australia. Participants A total of 6811 tobacco smokers who participated in telephone surveys. Measurements Three-level depression index: (1) neither low positive affect (LPA) nor negative affect (NA) in the last 4 weeks; (2) LPA and/or NA but not diagnosed with depression in the last 12 months; and (3) diagnosed with depression. Outcomes were quit attempts and 1-month abstinence among attempters. Findings Depression positively predicted quit attempts, but not after controlling for quitting history and motivational variables. Controlling for all covariates, depression consistently negatively predicted abstinence. Cessation support did not moderate this effect. There was a significant interaction with gender for quit attempts (P = 0.018) and abstinence (P = 0.049) after controlling for demographics, but not after all covariates. Depression did not predict abstinence among men. Among women, depressive symptoms [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.49–0.81] and diagnosis (OR = 0.46, 95% CI = 0.34–0.63) negatively predicted abstinence. Conclusions Smokers with depressive symptoms or diagnosis make more quit attempts than their non-depressed counterparts, which may be explained by higher motivation to quit, but they are also more likely to relapse in the first month. These findings are stronger in women than men.

Introduction and Aims The introduction of standardised packaging (SP) in Australia in December 2012 has heightened interest in how image and branding might affect smoking. This paper tests the hypothesis that brand awareness and identification among smokers will decline after the introduction of SP. Design and Methods Longitudinal study of three waves of smokers in Australia, conducted between October 2011–February 2012 (pre-SP) (n = 1104), February–May 2013 (post-SP1) (n = 1093) and August–December 2014 (post-SP2) (n = 1090). We explored the extent of changes in two variables, brand awareness (noticing others with the brand of cigarettes you smoke) and brand identification (perceiving something in common among smokers of your brand), and examined change in a number of other measures of brand appeal, brand characteristics and determinants of brand choice. Results Brand awareness ‘at least sometimes’ reduced from 45.3% pre-SP to 26.9% at post-SP2 [odds ratio (OR) 0.35 (0.27–0.45)]. Brand identification also decreased from 18.2% to 12.7% [OR 0.62 (0.42–0.91)]. Significant decline was also found in measures of perceived brand prestige [OR 0.51 (0.39–0.66)] and choice of brand for health reasons [OR 0.45 (0.32–0.63)]. Liking the look of the pack was strongly associated with brand identification, but only post-SP (P = 0.02 for interaction across the three waves). Discussion and Conclusions The introduction of SP of tobacco products in Australia has been associated with reductions in brand awareness and identification, and changes in related measures. The findings support the notion that SP has reduced the capacity for smokers to use pack branding to create and communicate a desired identity. [Balmford J, Borland R, Yong H-H. Impact of the introduction of standardised packaging on smokers' brand awareness and identification in Australia. Drug Alcohol Rev 2015;00:000–000]

Background and Aims Reducing smoking prevalence among smokers from low socio-economic status (SES) is a preventative health priority. Financial stress (e.g. shortage of money or inability to pay bills) may be a major barrier to quitting smoking. This study evaluates the efficacy of a financial education and support programme coupled with pharmacotherapy at improving cessation rates at 8-month follow-up among Australian low SES smokers (people receiving a government pension or allowance). Design A two-group parallel block randomized (ratio 1:1) open-label clinical trial (RCT) with allocation concealment will be conducted. Allocation will be concealed to interviewers at data collection-points. Setting The study will be conducted primarily by telephone with baseline, follow-up interviews and telephone-based support sessions. Nicotine replacement therapy (NRT) delivery will be mail-based. Participants Daily smokers who are interested in quitting smoking and are currently in receipt of government benefits (n=1046) will be recruited through study advertisements placed in newspapers, posters placed in government social assistance agencies and Quitline telephone-based cessation support services. After completion of a baseline computer-assisted telephone interview, participants will be allocated randomly to control or intervention group using a permuted block approach. Intervention and Comparator Participants in both groups will receive 8 weeks of free combination NRT plus Quitline support. Participants in the intervention group will also receive four telephone-delivered financial education and support sessions. Measurements The primary outcome measure will be prolonged abstinence (at 8-month follow-up) assessed using Russell Standard criteria and biochemically verified (urine cotinine). Comments This is the first intervention study to evaluate the potential of co-managing financial stress as a means of enhancing smokers' capacity to quit smoking. Such an intervention may provide a scalable intervention to help low SES smokers to quit.

Background This study aimed to measure the effects of sending a smoking cessation ‘quit-pack’ to all patients placed on the elective surgical waiting list. Method Questionnaire-based study before intervention (mid-2011, 177 patients) and after (2012/13, 170 patients) conducted on day of surgery. All were identified as adult smokers at time of waiting list placement at an outer metropolitan Melbourne public hospital. The intervention was a quit-pack consisting of educational brochure containing cessation advice and focused on perioperative risks of smoking, together with Quitline referral form and reply-paid envelope. The primary outcome measure was proportion of smokers who quit on waiting list for ≥1 month before surgery, considered a clinically meaningful duration to reduce surgical complications. Results An 8.6% improvement in waiting list smokers achieving the target ≥1 month abstinence at day of surgery (P = 0.03). The number needed to treat of 12 (95% confidence interval 6–240) meant 12 smokers receiving intervention would create one additional episode of clinically meaningful quitting on wait list. Conclusion Smoking cessation outcomes before elective surgery are significantly improved by systematic application of a printed intervention delivered at time of wait list placement that encourages and supports perioperative quitting.

Background Available evidence suggests that quitting smoking does not alter alcohol consumption. However, smoking cessation medications may have a direct impact on alcohol consumption independent of any effects on smoking cessation. Using an international longitudinal epidemiological sample of smokers, we evaluated whether smoking cessation medications altered alcohol consumption independent of quitting smoking. Methods Longitudinal data were analyzed from the International Tobacco Control Four Country (ITC-4) Survey between 2007 and 2008, a telephone survey of nationally representative samples of smokers from the United Kingdom, Australia, Canada, and the United States (n = 4,995). Quantity and frequency of alcohol consumption, use of smoking cessation medications (varenicline, nicotine replacement [NRT], and no medications), and smoking behavior were assessed across 2 yearly waves. Controlling for baseline drinking and changes in smoking status, we evaluated whether smoking cessation medications were associated with reduced alcohol consumption. Results Varenicline was associated with a reduced likelihood of any drinking compared with nicotine replacement (OR = 0.56; 95% CI = 0.34 to 0.94), and consuming alcohol once a month or more compared to nicotine replacement (OR = 0.43; 95% CI = 0.27 to 0.69) or no medication (OR = 0.63; 95% CI = 0.41 to 0.99). Nicotine replacement was associated with an increased likelihood of consuming alcohol once a month or more compared to no medication (OR = 1.14; 95% CI = 1.03 to 1.25). Smoking cessation medications were not associated with more frequent drinking (once a week or more) or typical quantity consumed per episode. Medication effects on drinking frequency were independent of smoking cessation. Conclusions This epidemiological investigation demonstrated that varenicline was associated with a reduced frequency of alcohol consumption. Continued work should clarify under what conditions nicotine replacement therapies may increase or decrease patterns of alcohol consumption.

Aims To test the population impact of offering automated smoking cessation interventions via the internet and/or by mobile phone. Design Pragmatic randomized controlled trial with five conditions: offer of (i) minimal intervention control; (ii) QuitCoach personalized tailored internet-delivered advice program; (iii) onQ, an interactive automated text-messaging program; (iv) an integration of both QuitCoach and onQ; and (v) a choice of either alone or the combined program. Setting Australia, via a mix of internet and telephone contacts. Participants A total of 3530 smokers or recent quitters recruited from those interested in quitting, and seeking self-help resources (n = 1335) or cold-contacted from internet panels (n = 2195). Measurements The primary outcome was self-report of 6 months sustained abstinence at 7 months post-recruitment. Findings Only 42.5% of those offered one of the interventions took it up to a minimal level. The intervention groups combined had a non-significantly higher 6-month sustained abstinence rate than the control [odds ratio (OR) = 1.48; 95% confidence interval (CI): 0.98–2.24] (missing cases treated as smokers), with no differences between the interventions. Among those who used an intervention, there was a significant overall increase in abstinence (OR = 1.95; CI: 1.04–3.67), but not clearly so when analysing only cases with reported outcomes. Success rates were greater among those recruited after seeking information compared to those cold-contacted. Conclusions Smokers interested in quitting who were assigned randomly to an offer of either the QuitCoach internet-based support program and/or the interactive automated text-messaging program had non-significantly greater odds of quitting for at least 6 months than those randomized to an offer of a simple information website.

Aim To evaluate the population effectiveness of stop-smoking medications while accounting for potential recall bias by controlling for quit attempt recency. Design Prospective cohort survey. Setting United Kingdom, Canada, Australia and the United States. Participants A total of 7436 adult smokers (18+ years) selected via random digit dialling and interviewed as part of the International Tobacco Control Four Country Survey (ITC-4) between 2002 and 2009. Primary analyses utilized the subset of respondents who participated in 2006 or later (n = 2550). Measurements Continuous abstinence from smoking for 1 month/6 months. Findings Among participants who recalled making a quit attempt within 1 month of interview, those who reported using varenicline, bupropion or nicotine patch were more likely to maintain 6-month continuous abstinence from smoking compared to those who attempted to quit without medication [adjusted odds ratio (OR) 5.84, 95% confidence interval (CI) (2.12–16.12), 3.94 (0.87–17.80), 4.09 (1.72–9.74), respectively]; there were no clear effects for oral NRT use. Those who did not use any medication when attempting to quit tended to be younger, to be racial/ethnic minorities, to have lower incomes and to believe that medications do not make quitting easier. Conclusions Consistent with evidence from randomized controlled trials, smokers in the United Kingdom, Canada, Australia and the United States are more likely to succeed in quit attempts if they use varenicline, bupropion or nicotine patch. Previous population studies that failed to find an effect failed to control adequately for important sources of bias.

Introduction and Aims. While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS). Design and Methods. We used data from wave 7 (2008–2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS. Results. In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P

Introduction. Area-level indicators of socio-economic variation are frequently included in models of individual health outcomes. Area disadvantage is linearly related to smoking prevalence, but its relation to cessation outcomes is less well understood. Aims. To explore the relationship between area-level disadvantage and prospective data on smoking cessation. Design and Methods. The Australian cohort of the International Tobacco Control Four-Country Survey (N = 3503) was used to prospectively examine the contribution of area-level socio-economic disadvantage to predicting three important smoking-cessation outcomes: making a quit attempt, achieving 1 month abstinence and achieving 6 month abstinence from smoking, while controlling for individual-level socio-economic indicators and other individual-level covariates related to smoking cessation. Results. Only two independent associations were observed between socio-economic disadvantage and cessation outcomes. Area-level disadvantage was related to 1 month abstinence in a non-linear fashion, and the individual experience of smoking-induced deprivation was associated with a lower likelihood of making quit attempts. Discussion. Despite the documented higher prevalence of smoking among the more disadvantaged and in more disadvantaged areas, socio-economic disadvantage was not consistently related to making quit attempts, nor to medium-term success. Nevertheless, indirect effects of disadvantage, like its impact on psychological distress, cannot be ruled out, and considering smokers' individual psychosocial circumstances is likely to aid cessation efforts. Conclusion. Socio-economic disadvantage, particularly at the area level, poses few direct barriers to smoking cessation.[Partos TR, Borland R, Siahpush M. Socio-economic disadvantage at the area level poses few direct barriers to smoking cessation for Australian smokers: Findings from the International Tobacco Control Australian cohort survey. Drug Alcohol Rev 2012;31:653–663]

Managing “wicked” issues like the tobacco epidemic is addressed using a combination of Open Systems Thinking (OST) and Actor–Network Theory (ANT). OST was used to construct a model of the tobacco problem as a management system acting in a broader environment. This highlighted several problems with the current system but provided no mechanism for reform. ANT, the “sociology of translation,” was used for understanding how change occurs. Unlike systems thinking, ANT focuses the contest for change on heterogeneous networks of human and nonhuman actors that must be constructed through a process of defining and defending models of change, building alliances, gaining public acceptance, and finally achieving institutional acceptance of the reform (or of some compromise). We then show how this dual approach can shed light on a current challenge in controlling tobacco, the issue of product regulation, and the broader issue of harm reduction versus harm elimination.

Aims To document accurately the amount of quitting, length of quit attempts and prevalence of plans and serious thought about quitting among smokers. Design We used longitudinal data from 7 waves of the International Tobacco Control Policy Evaluation Four Country Survey (ITC-4). We considered point-prevalence data and cumulative prevalence over the 7 years of the study. We also derived annual estimates of quit activity from reports of quit attempts starting only within more recent time-frames, to control for biased recall. Setting Australia, Canada, the United Kingdom and the United States. Participants A total of 21,613 smokers recruited across seven waves. Measurements Reported life-time quit attempts, annual quit attempts, length of attempts, time since last attempt started, frequency of aborted attempts, plans to quit and serious thought about quitting. Findings Around 40.1% (95% CI: 39.6-40.6) of smokers report attempts to quit in a given year and report an average of 2.1 attempts. Based on free recall, this translates to an average annual quit attempt rate of 0.82 attempts per smoker. Estimates derived only from the preceding month to adjust for recall bias indicate an annual rate of approximately one attempt per smoker. There is a high prevalence of quit-related activity, with more than a third of smokers reporting thoughts or actions related to quitting in a given month. More than half the surveyed smokers eventually succeeded in quitting for at least 1 month, and a majority of these for over 6 months. Conclusions Smokers think a great deal about stopping and make many unsuccessful quit attempts. Many have been able to last for extended periods and yet they still relapsed. More attention needs to be focused on translating quit-related activity into long-term abstinence.

Aims This study aimed to examine the associations between reported exposure to anti-smoking warnings at the point-of-sale (POS) and smokers’ interest in quitting and their subsequent quit attempts by comparing reactions in Australia where warnings are prominent to smokers in other countries.

Aims To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support. Design Use of the InternationalTobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary). Settings Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States. Participants Samples of smokers from 15 countries. Measurements Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits. Findings Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (

Aims To identify the predictors of attempts to stop smoking and the predictors of quit attempt success in adult general population samples. Methods We performed an electronic search of EMBASE, Pubmed, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group specialized register for articles that examined, in prospective adult general population samples, predictors of quit attempts and the success of quit attempts. Experts were contacted for knowledge of other relevant studies. Eight studies met the inclusion criteria and results were extracted independently by two researchers. Results There was considerable methodological heterogeneity between studies. Motivational factors dominated the prediction of quit attempts, whereas only cigarette dependence consistently predicted success after an attempt had been made. Social grade also appeared to predict success but was only examined in two studies. None of the other socio-demographic factors consistently predicted making a quit attempt or success. Conclusions Population-level studies from a number of countries show that past quit attempts and measures of motivation to stop are highly predictive of quit attempts, whereas only measures of dependence are consistently predictive of success of those attempts. Gender, age and marital status and educational level are not related consistently to quit attempts or quit success across countries.

Aim This paper examines how smokers' beliefs about ‘light/mild’ cigarettes in Australia, Canada and the United Kingdom were affected by the removal of misleading ‘light/mild’ terms from packs. Design, setting and participants The data come from the first seven waves (2002–09) of the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey, an annual cohort telephone survey of adult smokers in Canada, the United States, the United Kingdom and Australia (21 613 individual cases). ‘Light’ and ‘mild’ descriptors were removed in 2003 in the United Kingdom, in 2006 in Australia and in 2007 in Canada. We compare beliefs about ‘light’ cigarettes both before and after the bans, with those of smokers in the United States serving as the control condition. Measures Smokers' beliefs about ‘light’ cigarettes were assessed using a set of statements rated on a five-point ‘agree’–‘disagree’ scale. Findings The proportions of respondents reporting misperceptions about light cigarettes declined between 2002 and 2009 in all four countries. There were marked temporary reductions in reported misperceptions in the United Kingdom and Australia, but not in Canada, following the removal of ‘light/mild’ descriptors. Conclusions Removal of ‘light/mild’ descriptors and tar, nicotine and carbon monoxide yield information from cigarette packs is insufficient to effectively eliminate false beliefs. The combination of alternative descriptors and design features that produce differences in taste strength and harshness, independent of actual intakes, are sufficient to produce or sustain the same misbeliefs.

Aims To examine predictors of quitting behaviours among adult smokers in China, in light of existing knowledge from previous research in four western countries and two southeast Asian countries.

Aims To examine perceptions of risk related to type of cigarette brand. Design and setting Cross-sectional findings from wave 5 of the ITC Four Country Survey, conducted with nationally representative samples of smokers in 2006. Participants A total of 8243 current and former adult (18 years) smokers from Canada (n = 2022), the United States (n = 2034), the United Kingdom (n = 2019) and Australia (n = 2168). Measurements Outcomes included beliefs about the relative risks of cigarettes, including perceptions of ‘own’ brand. Correlates included sociodemographic, smoking-related covariates and brand characteristics. Findings One-fifth of smokers believed incorrectly that ‘some cigarette brands could be less harmful’ than others. False beliefs were higher in both the United States and United Kingdom compared to Canada and Australia. Smokers of ‘light/mild’, ‘slim’ and 100 mm/120 mm cigarettes were more likely to believe that some cigarettes could be less harmful [odds ratio (OR) = 1.29, 95% confidence interval (CI) = 1.12‐1.48 and that their own brand might be a little less harmful (OR = 2.61, 95% CI = 2.01‐3.41). Smokersof ‘gold’,‘silver’,‘blue’or‘purple’brandsweremorelikelytobelievethattheir‘ownbrandmightbealittleless harmful’ compared to smokers of ‘red’ or ‘black’ brands (OR = 12.48, 95% CI = 1.45‐107.31). Conclusions Despite current prohibitions on the words ‘light’ and ‘mild’, smokers in western countries continue to falsely believe that some cigarette brands may be less harmful than others. These beliefs are associated with descriptive words and elements of package design that have yet to be prohibited, including the names of colours and long, slim cigarettes.

of an oral presentations that was presented at the Thoracic Society of Australia & New Zealand and the Australian & New Zealand Society of Respiratory Science 2014 Annual Scientific Meetings, 4-9 April 2014, Adelaide Convention Centre, Adelaide, Australia. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Zwar, N., Richmond, R., Halcomb, E., Furler, J., Smith, J., Hermiz, O., Blackberry, I., Jayasinghe, U. & Borland, R. (2014). Supporting smoking cessation in primary care: results of the quit in general practice study. Respirology, 19 (Suppl. S2), 23-23. Authors Nicholas Zwar, Robyn Richmond, Elizabeth J. Halcomb, John Furler, Julie Smith, Oshana Hermiz, Irene Blackberry, Upali Jayasinghe, and Ron Borland This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/1936 PRIMARY CARE SIG – ORAL PRESENTATIONS

In a study aiming to determine public knowledge about moles and melanomas 590 residents of Victoria aged 14 and over were interviewed in a face-to-face household survey. The majority believed that moles were primarily raised lesions. Recognition of the term melanoma was high (91 per cent), but many held misconceptions about key characteristics. Many thought an early melanoma was raised (20 per cent) or could be raised (42 per cent), compared with only 10 per cent who thought it was flat. Fifty per cent of respondents thought being ugly was a common characteristic. In response to photographs of skin lesions, a late melanoma, seborrhoeic keratosis and a squamous cell carcinoma were most likely to be identified as needing to be seen by a doctor, while a normal raised mole and two early melanomas were least likely. The data suggest that a large proportion of the community have misconceptions about the early signs of melanoma. Education programs are needed to inform the public that most early melanomas are flat. Strategies which might confuse this message, such as likening melanoma to moles, should be avoided.

Aim To explore predictors of smoking relapse and how predictors vary according to duration of abstinence. Design, setting and participants A longitudinal survey of 1296 ex-smokers recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, United Kingdom and United States). Measurements Quitters were interviewed by telephone at varying durations of abstinence (from 1 day to approximately 3 years) and then followed-up approximately 1 year later. Theorized predictors of relapse (i.e. urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) and nicotine dependence were measured in the survey. Findings Relapse was associated with lower abstinence self-efficacy and a higher frequency of urges to smoke, but only after the first month or so of quitting. Both these measures mediated relationships between perceived benefits of smoking and relapse. Perceived costs of smoking and benefits of quitting were unrelated to relapse. Conclusions Challenging perceived benefits of smoking may be an effective way to increase abstinence self-efficacy and reduce frequency of urges to smoke (particularly after the initial weeks of quitting), in order to reduce subsequent relapse risk.

Aim To describe the process surrounding the creation of the first organization in the world to be funded from an earmarked tax on tobacco products, the Victorian Health Promotion Foundation (VicHealth), and to outline briefly its subsequent history. Description The genesis of VicHealth came from an interest of the Minister for Health in the Victorian State Government to address the tobacco problem, and the strategic capacity of Dr Nigel Gray from the Anti-Cancer Council of Victoria to provide a vehicle and help the government to muster support for its implementation. Success involved working with government to construct a Bill it was happy with and then working with the community to support the implementation and to counter industry attempts to derail it. The successful Bill led to the creation of VicHealth. VicHealth has played a creative and important role in promoting health not only in Victoria (Australia), but has been a stimulus for similar initiatives in other parts of the world. Conclusions Enacting novel advances in public policy is made easier when there is a creative alliance between advocates outside government working closely with governments to develop a proposal that is politically achievable and then to work together to sell it. Health promotion agencies, once established, can play an important role in advancing issues like tobacco control.

Objectives To examine prospectively the impact of health warnings on quitting activity. Design Five waves (2002- 06) of a cohort survey where reactions to health warnings at one survey wave are used to predict cessation activity at the next wave, controlling for country (proxy for warning differences) and other factors. These analyses were replicated on four wave-to-wave transitions.Settingandparticipants Smokers from Australia, Canada, the United Kingdom and the United States. Samples were waves 1-2: n = 6525; waves 2-3: n = 5257; waves 3-4: n = 4439; and waves 4-5: n = 3993.Measures Warning salience, cognitive responses (thoughts of harm and of quitting), forgoing of cigarettes and avoidance of warnings were examined as predictors of quit attempts, and of quitting success among those who tried (1 month sustained abstinence), replicated across four wave-to-wave transitions. Results All four responses to warnings were independently predictive of quitting activity in bivariate analyses. In multivariate analyses, both forgoing cigarettes and cognitive responses to the warnings predicted prospectively making quit attempts in all repli- cations. However, avoiding warnings did not add predictive value consistently, and there was no consistent pattern for warning salience. There were no interactions by country. Some, but not all, the effects were mediated by quitting intentions. There were no consistent effects on quit success.Conclusions This study adds to the evidence that forgoing cigarettes as a result of noticing warnings and quit-related cognitive reactions to warnings are consistent prospective predictors of making quit attempts. This work strengthens the evidence base for governments to go beyond the Framework Convention on Tobacco Control to mandate health warnings on tobacco products that stimulate the highest possible levels of these reactions.

Introduction and Aims The QuitCoach (www.quitcoach.org.au) is a tailored, Internet-delivered smoking cessation advice program. This paper compares QuitCoach users both with smokers in general, and with callers to a telephone-based smoking cessation service (the Victorian Quitline). It also explores patterns of QuitCoach usage by time of year and day of the week.

Aims To measure the prevalence and correlates of nicotine replacement therapy (NRT) use for reasons other than quitting smoking among smokers in four countries. Design and setting Population-based, cross-sectional telephone survey with nationally representative samples of adult smokers in Canada, the United States, the United Kingdom and Australia, conducted in 2005. Participants A total of 6532 adult daily smokers in Canada (n = 1660), the United States (n = 1664), the United Kingdom (n = 1617) and Australia (n = 1591). Measurements Survey questions included demographics, smoking behaviour, use of NRT and reasons for NRT use, as well as access and availability of NRT. Findings Approximately 17% of smokers surveyed had used NRT in the past year. Among NRT users, approxi- mately one-third used NRT for a reason other than quitting smoking, including temporary abstinence or reducing the number of cigarettes smoked. The prevalence of non-standard NRT use was remarkably consistent across countries. UsingNRTforreasonsotherthanquittingwasassociatedwithhighereducationlevel,heaviersmoking,havingnoquit intentions, having no past-year quit attempts, the type of NRT product used and accessing NRT without a prescription. Conclusions The use of NRT for purposes other than quitting smoking is fairly common and may help to explain the difficulty in detecting significant quitting benefits associated with NRT use in population studies. Tobacco control policies, including the accessibility of NRT, may have important implications for patterns of NRT use.

To report on the prevalence of attitudes and beliefs about the importance of wanting to quit and need for use of cessation assistance, that may act as barriers to quitting smoking and adopting cessation assistance.National telephone survey of 802 randomly selected adults (685 smokers, 117 recent quitters).Seventy per cent of smokers believed that 'wanting to quit' was both a necessary and sufficient condition for being able to quit. While only one-third of smokers believed that they were too addicted to be able to quit, only a quarter believed they could quit any time they want to. Belief that use of cessation assistance is a sign of weakness was endorsed by 35% of participants, and related to stage of change.Beliefs about the importance of wanting to quit are commonly held. Many smokers appear to believe that a rational, unambivalent desire to quit is needed before it is worthwhile trying. Short-term impulses to act are not perceived as sufficient. The role of cessation assistance in helping smokers form a rational desire to quit appears to be poorly understood by the majority of smokers. There is a need to engender greater understanding of the potential value of cessation aids to smokers experiencing ambivalence about wanting to quit.

Quitlines are increasingly becoming a core smoking cessation resource. This paper canvasses the potential of quitlines and briefly reviews the evidence for their utility. Quitlines can be an effective means of helping smokers quit. They can provide a triage service helping to direct smokers to the most appropriate assistance, and they can provide cessation help, either one-off sessions or systematic programmes of call-back counselling. Quitlines have features that uniquely place them to provide effective, accessible and affordable cessation help to large numbers and they can be modified readily to meet the needs of groups with special needs, including the capacity to act as part of co-ordinated care with face-to-face services. Quitlines are likely to become an even more important part of tobacco control infrastructure over the next few years.

Aims Despite the existence of effective cessation methods, the vast majority of smokers attempt to quit on their own. To date, there is little evidence to explain the low adoption rates for effective forms of cessation assistance, including pharmaceutical aids. This study sought to assess smokers’ awareness and perceived effectiveness of cessation methods and to examine the relationship of this knowledge to cessation behaviour. Design A random-digit-dial telephone survey (response rate = 76%) with 3month follow-up was conducted with 616 adult daily smokers in SouthWestern Ontario, Canada. Measurements A baseline survey assessed smoking behaviour, as well as smokers’ awareness and perceived effectiveness of cessation assistance. A follow-up survey measured changes in smoking behaviour and adoption of cessation assistance at 3 months. Findings Participants demonstrated a poor recall of cessation methods: 45% of participants did not recall nicotine gum, 33% did not recall the nicotine patch and 57% did not recall bupropion. Also, many participants did not believe that the following cessation methods would increase their likelihood of quitting: nicotine replacement therapies (36%), bupropion (35%), counselling from a health professional (66%) and group counselling/quit programmes (50%). In addition, 78% of smokers indicated that they were just as likely to quit on their own as they were with assistance. Most important, participants who perceived cessation methods to be effective at baseline, were more likely to intend to quit (OR = 1.80, 95% CI: 1.12‐2.90), make a quit attempt at follow-up (OR = 1.80, 95% CI: 1.03‐3.16) and to adopt cessation assistance when doing so (OR = 3.62, 95% CI: 1.04‐12.58). Conclusions This research suggests that many smokers may be unaware of effective cessation methods and most underestimate their benefit. Further, this lack of knowledge may represent a significant barrier to treatment adoption.