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Background and Aims: Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco. Method: We searched MEDLINE, PsychInfo, Embase and Cochrane Central Register from inception to 21 June 2023 for randomized controlled trials (RCTs) of community‐based, primary care or web‐based interventions for smoking cessation in adults who smoked tobacco, with measurement of smoking abstinence or reduction at least 3 months following baseline. We examined comparisons between either an intensity‐matched culturally tailored intervention and a non‐tailored intervention or a standard non‐tailored intervention and the same intervention plus a culturally tailored adjunct. We sub‐grouped studies according to the level of tailoring and performed subgroup analyses where appropriate. We assessed risk of bias and certainty of evidence. Results: We identified 43 studies, 33 of which were meta‐analyzed (n = 12 346 participants). We found moderate certainty evidence, limited by heterogeneity, that intensity‐matched culturally tailored cessation interventions increased quit success when compared with non‐tailored interventions at 3‐month follow‐up or longer (n = 5602, risk ratio [RR] = 1.29 95% confidence interval [CI] 1.10, 1.51, I2 = 47%, 14 studies). We found a positive effect of adding a culturally tailored component to a standard intervention compared with the standard intervention alone (n = 6674, RR = 1.47, 95% CI 1.10, 1.95, I2 = 74%, 18 studies), but our certainty in this effect was low due to imprecision and substantial statistical heterogeneity. Conclusion: Culturally tailored smoking cessation interventions may help more people to quit smoking than a non‐tailored intervention. Adapting or adding cultural components to smoking cessation interventions originally developed for majority populations could improve cessation rates in populations who do not fully identify with majority cultural norms. [ABSTRACT FROM AUTHOR]

Aims, Design and Setting: The aim of this study was to determine which combination(s) of five e-cigarette-orientated intervention components, delivered on-line, affect smoking cessation. An on-line (UK) balanced five-factor (2 x 2 x 2 x 2 x 2 = 32 intervention combinations) randomized factorial design guided by the multi-phase optimization strategy (MOST) was used. Participants: A total of 1214 eligible participants (61% female; 97% white) were recruited via social media. Interventions: The five on-line intervention components designed to help smokers switch to exclusive e-cigarette use were: (1) tailored device selection advice; (2) tailored e-liquid nicotine strength advice; (3): tailored e-liquid flavour advice; (4) brief information on relative harms; and (5) text message (SMS) support. Measurements: The primary outcome was 4-week self-reported complete abstinence at 12 weeks post-randomization. Primary analyses were intention-to-treat (loss to follow-up recorded as smoking). Logistic regressions modelled the three- and two-way interactions and main effects, explored in that order. Findings: In the adjusted model the only significant interaction was a two-way interaction, advice on flavour combined with text message support, which increased the odds of abstinence (odds ratio = 1.55, 95% confidence interval = 1.13-2.14, P = 0.007, Bayes factor = 7.25). There were no main effects of the intervention components. Conclusions: Text-message support with tailored advice on flavour is a promising intervention combination for smokers using an e-cigarette in a quit attempt. [ABSTRACT FROM AUTHOR]

Aims: For smokers unmotivated to quit, we assessed the effectiveness and cost‐effectiveness of behavioural support to reduce smoking and increase physical activity on prolonged abstinence and related outcomes. Design: A multi‐centred pragmatic two‐arm parallel randomised controlled trial. Setting: Primary care and the community across four United Kingdom sites. Participants: Nine hundred and fifteen adult smokers (55% female, 85% White), recruited via primary and secondary care and the community, who wished to reduce their smoking but not quit. Interventions: Participants were randomised to support as usual (SAU) (n = 458) versus multi‐component community‐based behavioural support (n = 457), involving up to eight weekly person‐centred face‐to‐face or phone sessions with additional 6‐week support for those wishing to quit. Measurements Ideally, cessation follows smoking reduction so the primary pre‐defined outcome was biochemically verified 6‐month prolonged abstinence (from 3–9 months, with a secondary endpoint also considering abstinence between 9 and 15 months). Secondary outcomes included biochemically verified 12‐month prolonged abstinence and point prevalent biochemically verified and self‐reported abstinence, quit attempts, number of cigarettes smoked, pharmacological aids used, SF12, EQ‐5D and moderate‐to‐vigorous physical activity (MVPA) at 3 and 9 months. Intervention costs were assessed for a cost‐effectiveness analysis. Findings Assuming missing data at follow‐up implied continued smoking, nine (2.0%) intervention participants and four (0.9%) SAU participants achieved the primary outcome (adjusted odds ratio, 2.30; 95% confidence interval [CI] = 0.70–7.56, P = 0.169). At 3 and 9 months, the proportions self‐reporting reducing cigarettes smoked from baseline by ≥50%, for intervention versus SAU, were 18.9% versus 10.5% (P = 0.009) and 14.4% versus 10% (P = 0.044), respectively. Mean difference in weekly MVPA at 3 months was 81.6 minutes in favour of the intervention group (95% CI = 28.75, 134.47: P = 0.003), but there was no significant difference at 9 months (23.70, 95% CI = −33.07, 80.47: P = 0.143). Changes in MVPA did not mediate changes in smoking outcomes. The intervention cost was £239.18 per person, with no evidence of cost‐effectiveness. Conclusions: For United Kingdom smokers wanting to reduce but not quit smoking, behavioural support to reduce smoking and increase physical activity improved some short‐term smoking cessation and reduction outcomes and moderate‐to‐vigorous physical activity, but had no long‐term effects on smoking cessation or physical activity. [ABSTRACT FROM AUTHOR]

Background and Aims: Clinicians could promote e‐cigarettes for harm reduction to people who smoke but cannot stop, but many clinicians feel uneasy doing so. In a randomized controlled trial (RCT), primary care clinicians offered free e‐cigarettes and encouraged people with chronic diseases who were unwilling to stop smoking to switch to vaping. We interviewed clinicians and patients to understand how to adopt harm reduction in routine practice. Design Qualitative analysis nested within an RCT, comprising thematic analysis of semi‐structured interviews with primary care clinicians who delivered the trial intervention, and patients who took part. Setting: Primary care clinics in England. Participants/Cases: Twenty‐one patients and 11 clinicians, purposively sampled from an RCT. Measurements We qualitatively explored patients' and clinicians' experiences of: being offered/offering an e‐cigarette, past and current perceptions about e‐cigarettes and applying a harm reduction approach. Findings Four themes captured clinicians' and patients' reported perspectives. These were: (1) concepts of safety/risk, with clinicians concerned about recommending a product with unknown long‐term risks and patients preferring the known risks of cigarettes; (2) clinicians felt they were going out on a limb by offering these as though they were prescribing them, whereas patients did not share this view; (3) equating quitting with success, as both patients and clinicians conceptualized e‐cigarettes as quitting aids; and (4) unchanged views, as clinicians reported that training did not change their existing views about e‐cigarettes. These themes were united by the higher‐order concept: 'The old and familiar meets the new and unknown', as a contradiction between this new approach and long‐established methods underpinned these concerns. Conclusions: A qualitative analysis found barriers obstructing clinicians and patients from easily accepting e‐cigarettes for harm reduction, rather than as aids to support smoking cessation: clinicians had difficulty reconciling harm reduction with their existing ethical models of practice, even following targeted training, and patients saw e‐cigarettes as quitting aids. [ABSTRACT FROM AUTHOR]

Aims: To assess the effectiveness of intervention components designed to increase quit attempts and promote abstinence in patients initially unwilling to quit smoking. Design A four‐factor, randomized factorial experiment. Setting: Sixteen primary care clinics in southern Wisconsin. Participants: A total of 577 adults who smoke (60% women, 80% White) recruited during primary care visits who were currently willing to reduce their smoking but unwilling to try to quit. Interventions Four factors contrasted intervention components administered over a 1‐year period: (i) nicotine mini‐lozenge versus none; (ii) reduction counseling versus none; (iii) behavioral activation (BA) counseling versus none; and (iv) motivational 5Rs counseling versus none. Participants could request cessation treatment at any time. Measurements The primary outcome was 7‐day point‐prevalence abstinence at 52 weeks post enrollment; secondary outcomes were point‐prevalence abstinence at 26 weeks and making a quit attempt by weeks 26 and 52. Findings No abstinence main effects were found but a mini‐lozenge × reduction counseling × BA interaction was found at 52 weeks; P = 0.03. Unpacking this interaction showed that the mini‐lozenge alone produced the highest abstinence rate (16.7%); combining it with reduction counseling produced an especially low abstinence rate (4.1%). Reduction counseling decreased the likelihood of making a quit attempt by 52 weeks relative to no reduction counseling (P = 0.01). Conclusions: Nicotine mini‐lozenges may increase smoking abstinence in people initially unwilling to quit smoking, but their effectiveness declines when used with smoking reduction counseling or other behavioral interventions. Reduction counseling decreases the likelihood of making a quit attempt in people initially unwilling to quit smoking. [ABSTRACT FROM AUTHOR]

Background and aims: Reducing temporal discounting may help smokers to reduce their smoking by improving inhibitory control. This study aimed to assess whether viewing pictures of natural versus urban scenes would cause participants to smoke fewer cigarettes mediated by lower temporal discounting. Design: A single‐factor (natural scene, urban scene and control) between‐subjects design was employed. Setting: Laboratory at Kaohsiung Medical University, Taiwan. Participants: A community sample of 93 daily smokers. Intervention and comparator: Participants were exposed to pictures of natural or urban scenes or no images (control). Measurements: The discounting measure was implemented after the landscape exposure manipulation. Participants expressed their preferences related to winning a lottery by answering a series of nine binary choice questions, opting either to receive a certain amount of money immediately or varying amounts of money 1 year in the future. The dependent measure was cigarette consumption during an ostensible survey. Findings: Participants exposed to pictures of natural scenes smoked fewer cigarettes [mean = 1.1 cigarettes, 95% confidence interval (CI) = 0.7, 1.6] than did those exposed to pictures of urban scenes (mean = 2.1 cigarettes, 95% CI = 1.7, 2.6, 0.002) and control participants (mean = 1.8 cigarettes, 95% CI = 1.4, 2.3, 0.029). The discounting rate mediated the association between exposure to nature and the amount of smoking (B = −0.62, 95% CI = −1.07, −0.20, P < 0.01). Conclusions: Exposing smokers to pictures of natural landscapes may lead to reduced smoking by lowering temporal discounting. [ABSTRACT FROM AUTHOR]

Aims To determine the effectiveness and safety of varenicline in treating tobacco dependence in patients with severe mental illness. Design A systematic reviewand meta-analysis of randomised controlled trials that compared varenicline with a placebo or an alternative intervention for smoking cessation or reduction. Setting Both in- and out-patient settings in any country. Participants Adult patients aged 18 years and over with any type of severe mental illness. The systematic review included eight studies comprising 398 participants. Measures Primary outcome measures were (1) smoking cessation, (2) smoking reduction measured by changes in the number of cigarettes smoked per day and (3) number of psychiatric adverse events, which were collected at the end of treatment. Findings The random-effect pooled estimates from the five studies that reported smoking-related outcomes found that varenicline is statistically superior to placebo in smoking cessation [risk ratios 4.33; 95% confidence interval (CI)=1.96-9.56], and smoking reduction was higher in varenicline groups (mean reduced daily cigarettes was 6.39; 95% CI=2.22-10.56). There is no significant difference regarding neuropsychiatric and other adverse events. Conclusions Varenicline appears to be significantly more effective than placebo in assisting with smoking cessation and reduction in people with severe mental illness. There appears to be no clear evidence that varenicline was associated with an increased risk of neuropsychiatric or other adverse events compared with placebo. [ABSTRACT FROM AUTHOR]

Aims To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit. Design A balanced, four-factor, randomized factorial experiment. Setting Eleven primary care clinics in southern Wisconsin, USA. Participants A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit. Interventions Four factors contrasted intervention components designed to reduce smoking and promote abstinence: (1) nicotine patch versus none; (2) nicotine gum versus none; (3) motivational interviewing (MI) versus none; and (4) behavioral reduction counseling (BR) versus none. Participants could request cessation treatment at any point during the study. Measurements The primary outcome was percentage change in cigarettes smoked per day at 26 weeks post-study enrollment; the secondary outcomes were percentage change at 12 weeks and point-prevalence abstinence at 12 and 26 weeks post-study enrollment. Findings There were few main effects, but a significant four-way interaction at 26 weeks post-study enrollment ( P = 0.01, β = 0.12) revealed relatively large smoking reductions by two component combinations: nicotine gum combined with BR and BR combined with MI. Further, BR improved 12-week abstinence rates ( P = 0.04), and nicotine gum, when used without MI, increased 26-week abstinence after a subsequent aided quit attempt ( P = 0.01). Conclusions Motivation-phase nicotine gum and behavioral reduction counseling are promising intervention components for smokers who are initially unwilling to quit. [ABSTRACT FROM AUTHOR]

Aims Inadequate self-control has been linked to behavioural and impulse-control problems such as overeating, alcohol and drug abuse and smoking. Construal-level theory ( CLT) suggests that a high-level construal (highlighting central goals associated with an event), relative to a low-level construal (highlighting means and resources), promotes self-control. Inspired by CLT, we examined whether smokers primed with a high-level (versus low-level) construal mind-set would show reductions in smoking that might be mediated by improved self-control. Design A single-factor (construal level: high, low, control) between-subjects design was employed. We used a widely employed why/how paradigm to induce high/low construal levels, whereby participants were asked to respond to questions about 'why' or 'how' they would maintain good physical health. Setting Laboratory at Kaohsiung Medical University, Taiwan. Participants A community sample consisting of 102 daily smokers participated in this experiment. Measurements The Stroop task measuring self-control was implemented after the construal-level manipulation. The dependent measure was actual cigarette consumption during an ostensible survey. Findings Participants in a high-level construal mind-set smoked fewer cigarettes [mean = 1.3, 95% confidence interval ( CI): 0.9, 1.7] than those in a low-level construal mind-set (mean = 2.6, 95% CI: 2.2, 3.0; P < 0.01). A bootstrapping analysis supported for the role of self-control ( B = −1.14, 95% CI: −1.65, −0.74, P < 0.01) as a mechanism underlying this effect. Conclusions Smokers primed with a high-level construal mind-set (i.e. cognitive abstraction) may induce greater self-control that leads to reduced cigarette consumption. Thus, reminding smokers to think abstractly about health may be an effective strategy that could help them to smoke fewer cigarettes. [ABSTRACT FROM AUTHOR]

To examine the effectiveness of smoking reduction counselling plus free nicotine replacement therapy (NRT) for smokers not willing to quit. A total of 1154 Chinese adult smokers not willing to quit but who were interested in reducing smoking were allocated randomly to three arms. Intervention group A1 ( n = 479) received face-to-face counselling on smoking reduction and adherence to NRT at baseline, 1 week and 4 weeks with 4 weeks of free NRT. Group A2 ( n = 449) received the same intervention, but without the adherence intervention. Control group B ( n = 226) received simple cessation advice at baseline. Self-reported 7-day point prevalence of tobacco abstinence and reduction of cigarette consumption (≥50%) at 6 months and continuous use of NRT for 4 weeks at 3 months. Using intention-to-treat analysis, compared to control group B, the intervention groups (A1 + A2) had achieved higher 6-month tobacco abstinence (17.0% versus 10.2%, P = 0.01) and reduction rates (50.9% versus 25.7%, P < 0.001). There was no significant difference in the 4-week NRT adherence rate at 3 months, but group A1 achieved a higher abstinence rate than group A2 at 6 months (20.9% versus 12.9%; P = 0.001). In smokers with no immediate plans to quit, smoking reduction programmes with behavioural support and nicotine replacement therapy are more effective than brief advice to quit. Current guidelines recommend advice to quit on medical grounds as the best clinical intervention in this group of smokers, but smoking reduction programmes offer an alternative and effective option. [ABSTRACT FROM AUTHOR]

To assess the prevalence of nicotine replacement therapy (NRT) use for smoking reduction (SR) and temporary abstinence (TA), the association between the two and the strength of the association between NRT use for SR or TA and socio-demographic characteristics, cigarette consumption and past quit attempts. Cross-sectional monthly surveys. England. A total of 11 414 smokers. Participants were asked (i) whether they were reducing the amount they smoked: if so, whether they used NRT; and (ii) whether they used NRT for TA. Demographic characteristics, daily cigarette consumption and whether a quit attempt had been made in the past 12 months were also assessed. Of the participants, 56% were attempting SR, 14% were using NRT for SR and 14% were using NRT for TA. Use of NRT for SR and TA were highly correlated. The nicotine patch was the most commonly used form of NRT. The use of NRT for SR, compared with unassisted SR, was more common among older smokers, while the use of NRT for TA was more common among women. Cigarette consumption was higher in those using NRT for SR than those attempting SR without NRT. The use of NRT for SR and TA was associated positively with past quit attempts. Nicotine replacement therapy use for smoking reduction and temporary abstinence is common in England. The use of NRT for SR and TA does not appear to be associated with lower cigarette consumption relative to SR or TA without NRT, but is associated with a higher rate of past quit attempts. [ABSTRACT FROM AUTHOR]

Background: Chronic cough can be the first sign of chronic obstructive disease. A few, and mostly selected, studies exploring the effect of reduced daily tobacco consumption have shown a small effect on pulmonary symptoms. Aim: The aim of this study was to examine if smoking reduction (SR) (≥50% of daily tobacco consumption) or smoking cessation (SC) had an effect on chronic cough and phlegm. Methods: A total of 2408 daily smokers were included in a Danish population-based intervention study, Inter99. In the analyses, we included smokers with self-reported chronic cough or phlegm at baseline who also attended the 1-year follow-up. We investigated if SR or SC had improved the self-reported pulmonary symptoms, using logistic regression analyses. Results: Almost 34% of the smokers had chronic cough at baseline and 24.5% had chronic phlegm. Thirty-seven persons with cough at baseline and 24 with phlegm at baseline achieved substantial SR at 1-year follow-up. The corresponding numbers for SC were 63 and 39, respectively. In adjusted analyses, quitting or reducing smoking was associated with less reporting of cough [odds ratio (OR): 14.2; 95% confidence interval (CI): 5.9–34.4] and (OR: 3.7; 95% CI: 1.7–8.0), respectively, compared with unchanged smoking habits. It was also significantly more likely not to report phlegm at 1-year follow-up for those who had quit (OR: 7.1; 95% CI: 2.8–18.0), whereas SR was not significantly associated with termination of phlegm (OR: 2.5; 95% CI: 0.9–6.4) when compared with continuous smoking. Conclusion: SC significantly improved self-reported chronic cough and phlegm as expected. Substantial SR was achieved by few smokers but had a significantly positive effect on chronic cough. Please cite this paper as: Pisinger C, Godtfredsen NS and Jørgensen T. Smoking reduction and cessation reduce chronic cough in a general population: the Inter99 study. The Clinical Respiratory Journal 2008; 2: 41–46. [ABSTRACT FROM AUTHOR]

Aims To test if goals indicate motivation to quit smoking and predict which smokers will make a quit attempt. Design A 28-day natural history feasibility study of smoking cessation and reduction. Setting The study was conducted via telephone calls and mailings. Participants A total of 186 cigarette smokers. Measurements At baseline participants reported one of the following goals for the next 30 days: to quit abruptly, quit gradually, reduce but not quit, or not change their smoking. They also reported motivation to quit smoking on an Intention to Quit Ladder. Throughout the study they reported their cigarette consumption via daily telephone messages. Findings Self-reported motivation to quit differed among goals ( F = 286.6, df = 3, P < 0.01). Goals significantly predicted the likelihood of making a quit attempt in the 28 days of the study. In comparison to smokers with the goal of not changing, smokers with a goal of quitting abruptly were more likely to make a quit attempt [relative risk (RR) = 9.6, P < 0.01], as were those with a goal of quitting gradually (RR = 4.5, P = 0.01). Those with a goal of reducing only appeared to be more likely to make a quit attempt than those with a goal of not changing, but the difference was not statistically significant (RR = 3.1, P = 0.15). Smokers with a goal of quitting abruptly were more likely to make a quit attempt than those with a goal of quitting gradually (RR = 2.1, P < 0.05). Conclusions Goals indicate not only preferred method of change but also motivation. Differences in gradual versus abrupt cessation outcomes may be due to motivational rather than methodological differences. Those who plan to quit gradually or reduce only may need additional motivational interventions. [ABSTRACT FROM AUTHOR]

Aims To measure reduction in exposure to smoke in two population-based studies of self-reported smoking reduction not using nicotine replacement. Design Cross-sectional analyses of biomarkers and smoking. Setting Data from two time-points in the Copenhagen City Heart Study (CCHS), 1981/83 and 1991/94, and the Copenhagen Male Study (CMS) in 1976 and 1985/86, respectively. Participants There were 3026 adults who were smokers at both time-points in the CCHS and 1319 men smoking at both time-points in the CMS. Measurements Smoking status and tobacco consumption were assessed by self-completion questionnaire. Measurements of biomarkers of smoke intake were taken at the second time-point in the two studies: expired-air carbon monoxide (CO) in the CCHS and serum cotinine in the CMS. Biomarker levels in medium (15–29 g tobacco/day) and heavy (> 30 g/day) smokers at the first time-point who later reported a reduction in cigarettes per day of 50% or more without quitting were compared with continuing medium, heavy and light smokers (1–14 g/day) using linear regression. Sex (CCHS only), age, self-reported inhalation of smoke, duration of smoking, type of tobacco and amount smoked were included as covariates in multivariate models. Findings Heavy smokers who reduced did not show lower levels of biomarkers at follow-up. Medium smokers who reduced showed a reduction in cotinine but not CO. The reduction in cotinine was not commensurate with the reported reduction in consumption. Conclusions Long-term reductions in self-reported tobacco smoking are probably associated with, at best, modest reductions in smoke exposure. [ABSTRACT FROM AUTHOR]

To test the effect of nicotine gum and placebo in smokers not motivated or not able to quit smoking with regard to smoking reduction and smoking cessation. This randomized study evaluated nicotine gum versus placebo for up to 1 year in 411 healthy smokers highly motivated to reduce cigarette use. Smoking reduction was defined as self-reported daily smoking less than 50% of baseline and any decrease (1 p.p.m. or more) in carbon monoxide. Pulmonary department, Copenhagen, Denmark. The overall success rate for sustained smoking reduction was significantly higher at all time-points for active versus placebo gum (6.3% versus 0.5% after 24 months). Nicotine gum achieved significantly higher point prevalence cessation rates than placebo at 12 and 24 months [11.2% versus 3.9% (odds ratio = 3.1; 95% CI, 1.4–7.2 and 9.3% versus 3.4% (odds ratio = 2.9; 95% CI, 1.2–7.1), respectively]. There was a linear relationship between decrease in number of daily cigarettes and decrease in plasma cotinine, exhaled carbon monoxide and plasma thiocyanate, with significantly greater reduction in the nicotine gum group after 4 and 12 months (maximum treatment duration) but not after 24 months. The decrease in toxin intake was smaller than the decline in daily cigarette consumption, suggesting that compensatory smoking occurred. Nicotine gum promoted cessation in this population of smokers unwilling to quit. Among reducers, the toxin intake correlated with reduced cigarette consumption although some compensatory smoking occurred. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To assess to what extent snus has been used as an aid to stop smoking among Swedish smokers. Design A random telephone retrospective survey of Swedish smokers and ex-smokers. Setting Survey conducted in November–December 2000. Participants A national sample of 1000 former and 985 current daily smokers aged 25–55 years. Measurements Smoking status, date and method of quitting by self-report. Findings Thirty-three per cent of former smokers and 27% of current smokers had ever used snus . The difference was larger among men (55% versus 45%, P = 0.003). Current smokers who made use of snus smoked on average fewer cigarettes per day than non-users of snus . The mean duration of abstinence among former smokers was not influenced by snus use. Conditionally on age, education and use of nicotine replacement therapy there was an increased probability of being a former rather than a current smoker with ever use (OR 1.72, 95% CI = 1.30–2.28) or current use (OR 1.81, 95% CI = 1.31–2.53) of snus . Having used snus at the latest quit attempt increased the probability of being abstinent by about 50% (OR 1.54, 95% CI = 1.09–2.20). Conclusions Our study suggests that by using snus , Swedish male smokers may increase their overall chances of abstinence. However, 71% of the men in this sample who quit smoking did so without using snus and the duration of abstinence was not affected by snus use. This suggests that snus is not a necessary component of smoking cessation at the population level. Snus use was very rare among women. [ABSTRACT FROM AUTHOR]

The article discusses whether cigarette smokers who are not ready to quit are likely to stop smoking after participating in a brief smoking reduction intervention, and it mentions the article "Very Brief Physician Advice and Supplemental Proactive Telephone Calls to Promote Smoking Reduction and Cessation in Chinese Male Smokers with No Intention to Quit: A Randomized Trial" by L. Wu and others which appears in the same issue of the journal. Abstinence is addressed.

Background and Aims: Proactive brief cessation advice by a lay counsellor combined with a referral to a smoking cessation service (active referral) is effective in increasing service use and quitting in community smokers. We compared the effect of two modified approaches to referrals on the cessation outcomes in community smokers., Design: Three-arm cluster-randomized trial., Setting: General community in Hong Kong., Participants: Daily cigarette smokers (n = 1163; 77.7% male)., Interventions: Participants were randomized to receive on-site active referral (OSR, n = 395), where lay counsellors helped participants make appointments with a smoking cessation service of their choice plus tailored reminders; mobile text messaging referral (TMR, n = 385), where participants were encouraged to use a smoking cessation service via text messages; or brief cessation advice only (control, n = 383)., Measurements: The primary outcome was a self-reported 7-day point-prevalence abstinence at 6 months post-treatment initiation. Secondary outcomes included 7-day point-prevalence abstinence at 3 and 18 months, biochemically validated abstinence, smoking reduction and the use of cessation services at 3, 6 and 18 months., Findings: Using intention-to-treat analysis, the OSR (17.7%) and TMR (17.1%) groups had significantly higher self-reported abstinence than the control (12.0%) group at 6 months [odds ratio (OR) for OSR versus control = 1.58, 95% confidence interval (CI) = 1.06-2.36; OR for TMR versus control = 1.52, 95% CI = 1.01-2.28; both P < 0.05]. The corresponding validated abstinence rates at 6 months were 7.6, 7.8 and 3.9% (OR for TMR versus control = 2.02, 95% CI = 1.07-3.81; OR for TMR versus control = 2.07, 95% CI = 1.10-3.92; both P < 0.05). Self-reported and validated abstinence were similar at 18 months. OSR groups had higher rates of smoking cessation service use than the control group at all follow-ups (all P < 0.001). The smoking reduction rates were similar in continuing smokers., Conclusions: Simple active referrals (in person or via text messaging) to smoking cessation services increased abstinence rates among smokers in Hong Kong compared with general brief cessation advice. On-site active referral increased the use of smoking cessation services compared with general brief cessation advice., (© 2020 Society for the Study of Addiction.)

Aim: A previous study showed significantly greater reductions in number of cigarettes smoked and biomarkers of toxicant and carcinogen exposure in smokers assigned to immediate reduction of nicotine in cigarettes to very low levels versus gradually over time or continued smoking of normal nicotine content cigarettes. This study examines the effects of these approaches on selected biomarkers associated with harmful biological effects., Design: Three-arm, randomized controlled trial., Setting: Ten United States academic institutional sites., Participants: Daily smokers uninterested in quitting smoking with a mean age of 45.1 [standard deviation (SD) = 13.4)] years and smoking 17.1 (SD = 8.5) cigarettes/day; 43.9% (549 of 1250) female; 60.6% (758 of 1250) white ethnicity., Interventions: (1) Smoking cigarettes where nicotine content was immediately reduced to very low levels (n = 503); (2) smoking cigarettes where nicotine content was gradually reduced, with dose changes occurring monthly (n = 498); and (3) continued smoking with normal nicotine content cigarettes (n = 249)., Measurements: Smokers were assessed at baseline while smoking their usual brand cigarettes, and again at 4, 8, 12, 16 and 20 weeks. Outcomes were areas under the concentration time curve (AUC) for the period of study of biomarkers of inflammation, oxidative stress and hematological parameters., Findings: No consistent significant differences were observed across groups (Bayes factors showing data to be insensitive), with the only exception being red blood cell size variability, which was observed to be lower in the immediate versus gradual nicotine reduction [mean difference =  -0.11; 95% confidence interval (CI) = -0.18, -0.04, P = 0.004] and normal nicotine control groups (mean difference = - 0.15, 95% CI = -0.23, -0.06, P = 0.001)., Conclusion: It remains unclear whether switching to very low nicotine cigarettes leads to a short-term reduction in biomarkers of tobacco-related harm., (© 2019 Society for the Study of Addiction.)

Background and Aims: Due to concerns about increased exposure to nicotine, pregnant women using nicotine replacement therapy (NRT) to stop smoking are usually advised to stop using NRT if they relapse to smoking. This study investigated whether this is justified. We compared changes in saliva cotinine from baseline to 2 weeks post-target quit date pregnant smokers who relapsed to smoking and continued to use their patches having been assigned to use nicotine patches or placebo., Design and Setting: Controlled pre-post design stratified by intervention condition from the 'Study of Nicotine Patch in Pregnancy', a randomized, placebo-controlled trial., Participants: A sample of 268 pregnant women, assigned placebo (n = 122) or nicotine (n = 146) patches, who returned for further supplies of patches and who reported any smoking in the week prior to a visit at 2 weeks after their target quit date., Measurements: Saliva cotinine concentrations were measured at baseline and 2 weeks after participants' target quit dates. Any smoking in the previous week was assessed by self-report, validated by expired air carbon monoxide (CO)., Findings: There was no change in saliva cotinine concentrations between baseline and 2 weeks post-target quit date in saliva cotinine concentration in the nicotine patch group [ratio of geometric means = 0.94, 95% confidence interval (CI) = 0.83 to 1.07; P = 0.37, Bayes factor = 0.15]. However, there was a reduction in reported number of cigarettes smoked/day (mean difference -6, 95% CIs -7 to -5, P < 0.001) and in CO concentrations (mean difference -3.0 parts per million, 95% CIs -4.2 to -1.9, P < 0.001). These changes were not significantly different from changes in the placebo group except for cigarette consumption, which reduced more in the nicotine group (P = 0.046)., Conclusions: In women trying to stop smoking with the aid of a nicotine patch but having smoked at 2 weeks post-target quit, their nicotine concentration did not change from baseline, but they reported smoking fewer cigarettes and had lower carbon monoxide concentrations., (© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

The article presents advice on the promotion of smoking cessation during the Islamic month of Ramadan.

The article discusses ethical issues surrounding electronic nicotine delivery systems (ENDS). It responds to the article "Ethical Issues Raised By A Ban on the Sale of Electronic Nicotine Devices" by Wayne Hall, Coral Gartner, and Cynthia Forlini, which appears elsewhere in the issue. It is suggested that since the safety and effectiveness of ENDS are largely unknown, they are an inadequate basis for the formation of ethical imperatives. Harm reduction and youth smoking are discussed.

In this article the author reflects on the usage of Ramadan period as a catch to encourage smoking cessation by many public health authorities. It is stated that Ramdan is a period during which Muslims should not eat, drink, and smoke from dawn to dusk. He highlights some potential disadvantages of encouraging abrupt cessation at the start of Ramdan, like attending smoking cessation clinics.

Aims: Brands are critical to tobacco marketing. Industry stakeholders predicted that plain packaging, by removing key tangible branding dimensions, would restrict new products and brand differentiation. However, manufacturers respond innovatively to limit regulatory impact. This study investigates brand strategy following plain packaging's introduction to Australia., Methods: Brand portfolios were determined using 2006-15 tobacco ingredient reports. These detail the brand and variant names sold and are provided annually as part of a voluntary agreement between the Australian Government and leading manufacturers. Post-plain packaging brand ranges were verified using retail price lists and a supermarket retail audit using a method used previously to verify a period of pre-plain packaging data., Results: The verification process identified some data inaccuracies from one manufacturer which resulted in the issuing of corrected data. After plain packaging the leading manufacturers continued with extensive brand ranges differentiated by price. All launched new products. While total brand numbers fell from 29 to 24, the mean number of variants for the leading 12 brands grew from 8.9 to 9.7. Substantial variant name modifications occurred with 50 new or modified names in 2012-13. Among leading brands, the incidence of variant colour names increased from 49.5 to 79.3%., Conclusions: New brands and variants were not inhibited by the introduction of plain packaging in Australia. After plain packaging, leading brand variant numbers expanded by 9 to 116 and colour variant names increased by 73.6% and became the norm-lighter colours (blue, gold and silver) dominated, perpetuating notions of less harmful cigarettes. [Correction added on 09 September 2016, after first online publication: The figures in the last sentence of the Abstract are now corrected from 'expanded by 116' to 'expanded by 9 to 116'.]., (© 2016 Society for the Study of Addiction.)