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OBJECTIVE: Tobacco smoking is a major driver of premature mortality in people with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder). This systematic literature review described randomized control trials of psychosocial smoking cessation interventions for people with SMI, rated their methodological rigor, evaluated the inclusion of racial/ethnic and sexual/gender minorities, and examined smoking cessation outcomes. METHODS: Eligible studies included peer-reviewed articles published between 2009 and 2020 that examined psychosocial smoking cessation interventions in people with SMI. We used the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines to conduct our review and the Methodological Quality Rating Scale to evaluate methodological rigor. RESULTS: Eighteen studies were included. Ten were categorized as high methodological rigor given their study characteristics (e.g., longer follow-up) and eight as lower methodological rigor based on their characteristics (e.g., not intent-to-treat). Racial/ethnic and sexual/gender minorities were underrepresented in these studies. A range of psychosocial interventions were examined including motivational enhancements, smoking cessation education, cognitive behavioral strategies, and contingency management. Most studies also provided smoking cessation medications (e.g., NRT, bupropion), although provision was not always uniform across treatment conditions. Nine studies found the intervention condition achieved significantly higher smoking abstinence or reduction compared to the comparison group. CONCLUSIONS: The most promising psychosocial smoking cessation interventions seemed to be initiated in inpatient psychiatric units and employed either a transtheoretical approach (i.e., stage-tailored, decisional balance) or individually-tailored telephone behavioral smoking counseling using a motivational-interviewing framework. Clinical trial designs (e.g., SMART, factorial) that control for the provision of psychosocial medications and allow for the identification of optimal psychosocial treatments are needed. Future studies should also ensure greater inclusion of racial/ethnic and sexual/gender minorities and should be culturally/linguistically adapted to improve treatment engagement and study outcomes.

Background Child exposure to cigarette smoke is harmful. It should be reduced through parental smoking cessation interventions. The aim of our study was to determine the impact of simple advice provided by the pediatrician on the smoking habits of parents of children with cystic fibrosis (CF), diabetes mellitus (DM) and infants hospitalized for bronchiolitis. Methods Parents were interviewed on their smoking habits. Smoking cessation advice was provided by the pediatrician. A new smoking habits assessment was done at three months by phone interviews. Results Two hundred and sixty parents were interviewed (91 in the CF group, 136 in the DM group and 33 in the bronchiolitis group). Seventy parents were active smokers: 33% of parents of children with CF, 23.5% of parents of children with DM and 24.2 % for those with infants hospitalized for bronchiolitis (p = 0.42). In the CF group, smoking cessation had been significantly more frequently discussed with the medical team previously. Sixty-seven smoking parents (95.7%) answered the 3-month assessment: 29.8% reported having started a smoking cessation process; 10.4% had quit smoking. The quitting rate was significantly higher in the groups of patients followed for a respiratory disorder (37.5% for bronchiolitis, 15% for CF versus 0% for DM, p= 0.005). Conclusion This study shows the important role that information and simple advice from pediatricians can have in initiating smoking cessation in parents of patients followed in specialized clinics or who are hospitalized, with a greater efficiency in parents of patients suffering from lung disorders. This article is protected by copyright. All rights reserved.

Objective We describe primary care providers’ current practice patterns related to smoking cessation counseling and lung cancer screening (LCS). Methods Family, internal medicine, and pulmonary medicine providers from two medical centers were asked to complete an electronic survey to report their practice patterns. Results Of 52 participating providers, most reported initiating three major components of a smoking cessation intervention often or very often: advise to quit (50, 96%), assess willingness to quit (47, 90%), and assist with counseling or pharmacotherapy (49, 94%). However, other components were less commonly initiated such as arranging follow‐ups (only 11 providers indicated recommending them often or very often, 21%) and less than half of providers reported that they often or very often recommend cessation counseling or pharmacotherapy of any type (except varenicline), though family medicine providers were more likely to recommend pharmacotherapy compared to the other specialists (p, The purpose of this study was to compare current practice patterns related to smoking cessation counseling and screening for lung cancer among family, internal and pulmonary medicine providers. Our findings indicate differences in lung cancer screening practice based on specialty, suggesting interventions to increase the fidelity of key lung cancer screening components may need to target specific provider types.

Despite its importance, underreporting of the active content of experimental and comparator interventions in published literature has not been previously examined for behavioural trials. We assessed completeness and variability in reporting in 142 randomised controlled trials of behavioural interventions for smoking cessation published between 1/1996 and 11/2015. Two coders reliably identified the potential active components of experimental and comparator interventions (activities targeting behaviours key to smoking cessation and qualifying as behaviour change techniques, BCTs) in published, and in unpublished materials obtained from study authors directly. Unpublished materials were obtained for 129/204 (63%) experimental and 93/142 (65%) comparator groups. For those, only 35% (1200/3403) of experimental and 26% (491/1891) of comparator BCTs could be identified in published materials. Reporting quality (#published BCTs/#total BCTs) varied considerably between trials and between groups within trials. Experimental (vs. comparator) interventions were better reported (B(SE) = 0.34 (0.11), p

Background U.S. Hispanic/Latino construction workers constitute a large and historically underserved group in terms of smoking cessation services. Using formative research, we developed a worksite smoking cessation intervention tailored to the life/work circumstances of these workers. Aims This study aims to examine the feasibility, acceptability, and potential efficacy of the developed intervention “Enhanced Care” (EC; one group behavioral counseling session provided around the food truck + fax referral to tobacco quitline [QL] + 8-week nicotine replacement treatment [NRT]) compared with “Standard Care” (SC; fax referral to tobacco QL + 8-week NRT) in a pilot, two-arm, cluster randomized controlled trial. Method In collaboration with construction site safety managers, a sample of 17 construction sites (EC: nine sites/65 smokers; SC: eight sites/69 smokers) was enrolled. Participants received two follow-ups at 3 and 6 months after enrollment. Feasibility outcomes were enrollment rate, adherence to treatment, and 6-month retention rates. The primary efficacy outcome was 6 months prolonged abstinence verified by expired carbon monoxide Results Enrollment rate was high (85.9%). Six-month follow-up rates were acceptable (EC = 76.9%, SC = 66.6%). Adherence to treatment was better in the EC group (received worksite intervention: EC = 93.8%, SC = 88.4%; contacted by QL: EC = 49.2%, SC = 40.6%). Abstinence rates were 27.7% for the EC and 20.3% for the SC ( p = .315). Discussion The developed intervention was feasible and acceptable, and it substantially improved abstinence among Hispanic/Latino workers. The involvement of safety managers was essential to the implementation of the intervention. Training safety managers to deliver the intervention has great potential to implement a sustainable smoking cessation service in the construction sector.

Introduction Annual lung cancer screening with low-dose computed tomography is recommended for adults aged 55 to 80 years with a greater than or equal to 30 pack-year smoking history who currently smoke or quit within the past 15 years. The 50% who are current smokers should be offered cessation interventions, but information about the impact of adding cessation to screening is limited. Methods We used an established lung cancer simulation model to compare the effects on mortality of a hypothetical one-time cessation intervention and annual screening versus annual screening only among screen-eligible individuals born in 1950 or 1960. Model inputs were derived from national data and included smoking history, probability of quitting with and without intervention, lung cancer risk and treatment effectiveness, and competing tobacco-related mortality. We tested the sensitivity of results under different assumptions about screening use and cessation efficacy. Results Smoking cessation reduces lung cancer mortality and delays overall deaths versus screening only across all assumptions. For example, if screening was used by 30% of screen-eligible individuals born in 1950, adding an intervention with a 10% quit probability reduces lung cancer deaths by 14% and increases life years gained by 81% compared with screening alone. The magnitude of cessation benefits varied under screening uptake rates, cessation effectiveness, and birth cohort. Conclusions Smoking cessation interventions have the potential to greatly enhance the impact of lung cancer screening programs. Evaluation of specific interventions, including costs and feasibility of implementation and dissemination, is needed to determine the best possible strategies and realize the full promise of lung cancer screening.

Background: Effective smoking cessation interventions (SCIs) are indicated, particularly among the working population, where a higher than expected prevalence of smoking continues. Occupational health nurses’ (OHN) self-efficacy can affect SCI but current scientific literature is limited. The purpose of this integrative literature review was to determine factors that affect OHN self-efficacy and motivation for providing SCI and to guide research needed to enhance SCI programs. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted an integrative literature review. The strategy was an electronic data search of PubMed conducted between 2013 and 2018 and included peer-reviewed manuscripts written in English that addressed self-efficacy and its relationship to SCI. Findings: In total, 15 research articles met the inclusion criteria and two referred specifically to OHNs. Common themes revealed factors which positively and negatively influenced nurses’ self-efficacy, including training, academic preparation, as well as nurse attitudes and personal/social influence. Studies specific to OHNs identify self-efficacy as the most influential factor affecting nurse implementation of SCI. Organizational support and theory-based training are more effective in overcoming personal and social barriers affecting OHN self-efficacy. Conclusion/Application to Practice: The results of this review revealed attitude, innovation, perceived social influence, and self-efficacy were factors for nurses’ intention to implement SCI. Changes in the organizational environment supporting cessation programs and educational development, particularly theory-based training, should be further studied. Our findings suggest that designing programs utilizing these research findings to improve OHN self-efficacy could guide changes in clinical practice for motivating smokers to quit.

Smoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain.The economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding.Smoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was €1753 with a benefit of €503, achieving a net economic benefit of €4·8 million per year. Given the annual cost of the intervention (€17·4 million, of which €5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to €1·29 per €1 of investment.From the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs.Ser fumador activo hasta el momento de la cirugía se asocia con complicaciones postoperatorias. Se ha descrito una disminución de las complicaciones durante la hospitalización al abandonar el hábito de fumar antes de la cirugía. Este trabajo analizó si una intervención preoperatoria para dejar de fumar es económicamente beneficiosa cuando se financia por el Sistema Nacional de Salud (SNS) en España. MÉTODOS: En el análisis económico se consideraron tantos los costes como los beneficios de la intervención para el SNS, en euros, correspondientes al año 2016. La población que se beneficiaría eran fumadores adultos dispuestos a dejar de fumar, en los que se programase una intervención quirúrgica con hospitalización. La intervención, una combinación de asesoramiento médico y tratamiento farmacológico para dejar de fumar, se llevó a cabo a las 12 semanas antes de la cirugía, considerando únicamente un intento para dejar de fumar. Los beneficios fueron los costes evitados por una reducción en la tasa de complicaciones postoperatorias en los casos en los que se hubiese conseguido la eliminación del hábito. El análisis comparó el resultado económico neto (beneficio menos coste de la intervención) y el retorno de la inversión (return on investment, ROI), cuando la intervención era financiada por el SNS en comparación con la situación actual sin financiamiento público.La tasa de abandono del hábito tabáquico aumentó en un 21,8%; 32,5% cuando se financiaba frente al 10,7% sin financiación, consiguiendo un extra de 9.611 personas que dejaron de fumar. El coste por fumador rescatado fue de €1753 con un beneficio de €503, por lo que el beneficio económico neto conseguido fue de €4,8 millones por año. Dado que el coste anual de la intervención (€17,4 millones, de los cuales €5,6 millones corresponden a fármacos (32%)), el ROI anual fue del 28,7% con un beneficio de €1,29 por cada €1 de inversión. CONCLUSIÓN: Desde la perspectiva del SNS español, los beneficios de financiar el abandono del hábito de fumar en el preoperatorio de los pacientes, en términos de ahorro de costes parecen ser muy superiores a los costes de la intervención.

Background: Communication with indigenous patients is often a problem for health staff in Australia. Aim: This paper examines the barriers and enablers in communication between health staff and Indigenous carers of paediatric patients in a hospital, about advice to help reduce exposure of children to second-hand smoke (SHS). Methods: Non-indigenous health staff and Indigenous carers, were recruited from a paediatric ward of a regional hospital in the Northern Territory. A constructivist grounded theory with multiphase case study design and semi-structured interviews was used. Results: Health staff and carers had different perceptions about raising the issue of smoking. Health staff lacked confidence to talk about smoking and questioned the cultural appropriateness of doing so. In contrast, carers expected to talk about smoking while in the hospital., and perceived it as part of a caring and protective relationship by health staff. English being a second language for carers was considered a significant communication barrier by staff; carers, however, felt that health staff needed to modify their communication styles. The possible misperceptions about carers' lack of response to messages, led to health staff dropping the subject, when, in fact, carers were struggling with health workers communication styles. Conclusions: Health staff and carers perceive discussion around smoking differently. Cross-cultural communication education may empower staff to provide effective smoking cessation interventions in this setting. Impact statement: Improving communication between health staff will help ensure the optimal provision of smoking cessation support to carers. Refereed/Peer-reviewed

OBJECTIVES To examine smoking behavior and social contexts related to smoking among dual-smoker couples. DESIGN Cross-sectional online survey study. SAMPLE A convenience sample of 183 dual-smoker couples. MEASUREMENTS Investigator-developed survey on smoking and related social contexts. RESULTS Participants smoked 16.0 cigarettes daily for 14.2 years; 48.4% shared more than half of their smoking time with their spouse. More than half made quit attempts in the past year individually (M = 5.3) and jointly (M = 2.5). Couples sharing more smoking time were more likely to be motivated to quit (p = .002), make quit attempts (p

Background: Previous studies have shown that smoking tobacco significantly increases both incidence and mortality rates for many diseases. Social media has become one of the most influential platforms for various smoking cessation interventions. However, results from smoking cessation interventions have differed from study to study. Limited studies have summarised cessation outcomes from social media–based interventions. Therefore, the objective of this review is to explore the effectiveness of using social media for smoking cessation. Methods: We searched PubMed, MEDLINE, PsycINFO, and CINAHL for articles between June 2008 and June 2018, and also assessed the references of selected articles. We included studies that used social media as intervention platforms, provided a baseline assessment before the intervention, and provided smoking cessation outcomes after the intervention. Results: We identified 13 original studies that enrolled between 16 and 1698 participants; 7-day Point Prevalence Abstinence (PPA) rate was the most frequently used measure of abstinence, with a range of 7%–75%, regardless of the measurement time, study design, and analysis methods. Social media–based smoking cessation interventions were effective, because (1) smokers reported higher 7-day PPA rates after intervention compared to baseline and (2) smokers reported higher 7-day PPA rates in intervention groups than in control groups. Moreover, at each time point, approximately half of all smokers in studies reporting abstinence were found to be biochemically abstinent. There were no significant differences in the effectiveness of smoking cessation outcomes between those that used existing popular social networking platforms (e.g. Pechmann et al’s studies) and those that used individually designed interactive platforms (e.g. MyLastDip, iQuit system, Quitxt system). Conclusions: This review highlights the effectiveness of social media–based smoking cessation intervention studies. Due to the widespread use of social media, as well as its low cost, we suggest embedding smoking cessation interventions within existing popular social media platforms.

Introduction This study examined the predictive relationships between biomarkers of nicotine exposure and 16-item self-reported level of tobacco dependence (TD) and subsequent tobacco use outcomes. Aims and Methods The Population Assessment of Tobacco and Health (PATH) Study surveyed adult current established tobacco users who provided urine biospecimens at Wave 1 (September 2013–December 2014) and completed the Wave 2 (October 2014–October 2015) interview (n = 6872). Mutually exclusive user groups at Wave 1 included: Cigarette Only, E-cigarette Only, Cigar Only, Hookah Only, Smokeless Tobacco Only, Cigarette Plus E-cigarette, multiple tobacco product users who smoked cigarettes, and multiple tobacco product users who did not smoke cigarettes. Total Nicotine Equivalents (TNE-2) and TD were measured at Wave 1. Approximate one-year outcomes included frequency/quantity used, quitting, and adding/switching to different tobacco products. Results For Cigarette Only smokers and multiple tobacco product users who smoked cigarettes, higher TD and TNE-2 were associated with: a tendency to smoke more, smoking more frequently over time, decreased likelihood of switching away from cigarettes, and decreased probability of quitting after one year. For other product user groups, Wave 1 TD and/or TNE-2 were less consistently related to changes in quantity and frequency of product use, or for adding or switching products, but higher TNE-2 was more consistently predictive of decreased probability of quitting. Conclusions Self-reported TD and nicotine exposure assess common and independent aspects of dependence in relation to tobacco use behaviors for cigarette smokers. For other product user groups, nicotine exposure is a more consistent predictor of quitting than self-reported TD. Implications This study suggests that smoking cigarettes leads to the most coherent pattern of associations consistent with a syndrome of TD. Because cigarettes continue to be prevalent and harmful, efforts to decrease their use may be accelerated via conventional means (eg, smoking cessation interventions and treatments), but also perhaps by decreasing their dependence potential. The implications for noncombustible tobacco products are less clear as the stability of tobacco use patterns that include products such as e-cigarettes continue to evolve. TD, nicotine exposure measures, and consumption could be used in studies that attempt to understand and predict product-specific tobacco use behavioral outcomes.

Objective: Smoking cessation interventions that use implementation intentions have shown promising results. Implementation intentions are if-then plans that specify certain behaviour within a situational context. This study examines whether dyadic planning (i.e., involving a non-smoking partner) is more effective than individual planning in quitting smoking. Design: This longitudinal single-blind randomized controlled trial involves a baseline questionnaire, end-of-day measurements for three weeks, and a follow-up questionnaire after three months. Single-smoking couples were randomized to a dyadic or individual planning condition. After the intervention, which 176 couples received, smokers attempted to quit smoking, and the diary measurements started. Main Outcome Measures: smoking abstinence, number of cigarettes smoked and relationship satisfaction. Results: At follow-up, both planning groups showed similar quit rates (33%, dyadic; 30%, individual) and a similar significant decline in number of cigarettes smoked (almost 50%). For most smokers, the smoking pattern shown in the diary seemed to be indicative of smoking behaviour at follow-up. Relationship satisfaction declined minimally, in both intervention groups and in both smokers and partners. Conclusion: The involvement of a non-smoking partner in the planning did not increase its effectiveness. However, couple participation and daily measurements during a quit attempt could be important components of future interventions.

Smoking cessation interventions are effective, but they are not easily accessible for all treatment-seeking smokers. Mobile health (mHealth) apps have been used in recent years to overcome some of these limitations. Smoking cessation apps can be used in combination with a face-to-face intervention (FFSC-Apps), or alone as general apps (GSC-Apps). The aims of this review were (1) to examine the effects of FFSC-Apps and GSC-Apps on abstinence, tobacco use, and relapse rates; and (2) to describe their features. A systematic review was conducted following the internationally Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of the total 6016 studies screened, 24 were included, of which nine used GSC-Apps and 15 FFSC-Apps. Eight studies reported significant differences between conditions in smoking cessation outcomes, with three of them being in favor of the use of apps, and two between different point-assessments. Concerning Apps features, most GSC-Apps included self-tracking and setting a quit plan, whereas most of the FFSC-Apps included self-tracking and carbon monoxide (CO) measures. Smartphone apps for smoking cessation could be promising tools. However, more research with an adequate methodological quality is needed to determine its effect. Nevertheless, smartphone apps’ high availability and attractiveness represent a great opportunity to reach large populations This research was supported by the Spanish Ministerio de Ciencia e Innovación (Project PID2019-109400RB-100) and co-financed by FEDER (European Regional Development Fund) SI

Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource-intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long-term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking-cessation interventions into hospitals and to reap and sustain the benefits for people who smoke.

OBJECTIVE To explore sequential steps of employee engagement in wellness interventions and the impact of wellness interventions on employee health. METHODS Using previously collected survey data from 23,667 UK employees, we tabulated intervention availability, awareness, participation, and associated health improvement and compared engagement by participation and risk status. RESULTS Employees' awareness of wellness interventions at their workplaces was often low (mean 43.3%, range 11.6%-82.3%). Participation was highest in diet/nutrition initiatives (94.2%) and lowest in alcohol counseling and smoking cessation interventions (2.1%). Employees with health risks were less likely than lower-risk employees to report awareness, participation, and health improvements from wellness interventions addressing the relevant health concern. CONCLUSION Employers and policymakers should consider variation in intervention engagement as they plan and implement wellness interventions. Engaging employee populations with higher health risks requires a more targeted approach.

Although smoking is seen as a major health problem by most clinicians, few are able to provide evidence based smoking cessation interventions to their patients. Most individuals who smoke actually want to quit. Unfortunately, smoking is still seen as a vice or lifestyle choice, when it is actually a chronic disease which often starts in adolescence. Nicotine dependence is complex and must be quantified and treated differently for each patient in order to achieve high quit rates. Smoking has a significant impact on the development and progression of cardiovascular disease. Smoking cessation is a cost effective and often overlooked prevention tool which improves both short- and long-term outcomes. There are both pharmacological and non-pharmacological strategies for smoking cessation that can be applied in clinical practice. Brief advice, specialized counseling including therapeutic education and behavioral support, and first- and second-line pharmacological interventions have been proven to be effective to help smokers quit. Although classically tobacco dependence was seen in relation to smoking, since the early 2000s, new nicotine delivery systems have appeared on the market, which despite being marketed as "healthy" alternatives, can often complicate smoking cessation efforts and act as gateway devices for new generations of smokers. In this article we review the results of several large systematic reviews and meta-analyses, which have shown that many cessation strategies are effective. We also offer practical tips on providing brief cessation advice and how pharmacotherapy can be prescribed and incorporated into clinical practice in both primary and secondary cardiovascular prevention.

Background Facebook can be a suitable platform for public health interventions. Facebook users can express their reaction to the given social media content in many ways using interaction buttons. The analysis of these interactions can be advantageous in increasing reach and engagement of public health interventions. Objective This research aimed at understanding how Facebook users’ interactions correlate with organic reach and engagement regarding the same smoking cessation support contents. Methods The study population consisted of Facebook users who were reached by a public smoking cessation support page without advertising. We included 1025 nonpaid Facebook posts (N=1025) which used smoking cessation strategies based on a motivational interviewing counseling style. The following data were collected from the “Post Details”: the number of people who saw the given nonpaid content (organic reach) which consisted of fan and nonfan reach according to previous “page like” activity; each rate of “engagement indicators” (such as the symbols of “like,” “love,” “haha,” “wow,” “sad,” “angry”; or other interactions: “shares,” “comments,” “clicks”); and the rate of negative Facebook interactions (eg, “post hides” or “unlike of page”). Overall, these data were analyzed with the Spearman correlation method. Results Surprisingly, we found a significant negative correlation between organic reach and the “like” reaction (rs=–0.418; P Conclusions This study has shown that it is possible to hypothesize a disadvantage of the “like” reaction and advantages of other interactions (eg, the “haha” reaction or “comments”) in content algorithmic ranking on Facebook. In addition, the correlational analysis revealed a need of a further categorization to fan-specific interactions (eg, “haha” or “love” reactions) and nonfan-specific interactions (eg, “shares” and “clicks”). Regarding the direction of the correlations, these findings suggest that some interactions (eg, negative Facebook interactions, “wow,” “sad,” and “angry” reactions) may decrease the engagement, while other interactions (“like,” “love,” “haha” reactions, “shares,” and “clicks”) may increase the engagement during Facebook-based smoking cessation interventions. This hypothesis-generating research offers an important insight into the relationship between organic reach, engagement, and Facebook users’ interactions for public health professionals who design Facebook-based interventions.

Background: Declines in smoking prevalence among low-income adults lag behind national samples. Understanding the influence of social context factors such as gender, and normative influence on smoking attitudes and behaviors, can inform smoking cessation interventions. Objective: This study explored how gender, smoking dependence, and cessation norms influenced the likelihood of current quit attempts among urban-dwelling, predominately African American adults. Methods: Participants answered questions about their current quit attempts, smoking dependence (heaviness of smoking index [HSI]), and cessation norms (descriptive: having friends who quit smoking; injunctive: friends disapproving of smoking) as a part of a parent study exploring social and environmental factors in tobacco use. Logistic regression stratifying by gender and adjusting for demographics examined main and interaction effects of norms and HSI on odds of having a current quit attempt. Results: Among men, having a higher smoking dependence was associated with a reduced likelihood of trying to quit (AOR = 0.30 [0.15-0.59]), but this effect was moderated by having friends who had quit smoking (AOR = 2.40 [1.20-4.78]). When accounting for the effect of friends quitting smoking, men were not influenced by friends disapproving of smoking. Among women, currently attempting to quit was predicted by neither smoking dependence nor norms. Conclusions/Importance: Cessation norms and smoking dependence influenced the likelihood of quit attempts for men, but not women, in this study. This highlights the importance of conducting gender stratification in smoking cessation research so as to better understand how social and environmental factors differently impact cessation outcomes for men and women.

Objectives To evaluate the "Quit Happens" program launched to reduce tobacco use in low-income populations in a federally qualified nonprofit health center with clinics in Washington and Idaho. Quit Happens was implemented in 2015 and involved a public health nurse, patient, provider, clinic, health system, and community components. Design and sample This smoking cessation program was assessed using a pre-post evaluation design. Nine clinics in a single system of federally qualified nonprofit health centers participated in this program. Intervention The Quit Happens program was implemented across nine clinics in Washington and Idaho. A specialized public health nurse led the tobacco cessation training of all clinic staff and assisted with development of the smoking cessation program. The 5A model was used as the framework for the training. Measurements The proportion of patients identifying as a current or former smoker was measured using data extracted from electronic health records. Results Declines in patient reports of currently smoking were observed between 2016 and 2018. The percent of current smokers identified in electronic health records decreased 18.7% and percent of former smokers doubled. Conclusion This community-based tobacco cessation program had wide clinic and community support and self-reported smoking behavior declined over time. A public health nurse's leadership in offering training and program development around tobacco cessation to a local community organization can contribute to reductions in smoking rates.

OBJECTIVE: To test the feasibility of a university health center-delivered smoking cessation intervention that adds a 6–week course of text messaging to brief advice and nicotine patch therapy. PARTICIPANTS: Young adult cigarette smokers (n=40) from 2 universities from January 2015-May 2016. METHODS: Randomized controlled trial comparing brief advice, nicotine patch therapy and: 1) a 6-week text messaging intervention (n=20); or 2) no text messaging (n=20). Primary outcomes included enrollment, retention and satisfaction. RESULTS: Forty participants enrolled (38% of those screened). Retention rates were 98% and 92.5% at 6- and 12-weeks. Of those who completed the text intervention (n=16), 64.3% felt the texts were “helpful”, however they reported desire for tailoring and concern that texts triggered smoking. Biochemically-confirmed abstinence rates did not significantly differ between text and control arms. CONCLUSIONS: These feasibility data suggest that text messaging may need to be modified to better engage and motivate college-age smokers.

INTRODUCTION: Cigarette purchasing behavior may reflect quitting intentions. Little is known about how income could modify the association between cigarette purchasing behaviors and quit attempts among smokers experiencing homelessness. METHODS: Homeless, current smokers completed a questionnaire on the amount spent weekly on cigarettes (≤ $20/week versus > $20/week), source of cigarettes (store versus other source), quantity of cigarettes purchased (< pack versus ≥ pack), and past-year quit attempts. The association of participant income and these cigarette purchasing behaviors were examined. The relationship between cigarette purchasing behaviors and quit attempts was also examined and monthly income (none versus any) was explored as a potential moderator of this relationship. RESULTS: Of the 472 currently smoking individuals, 55% reported spending > $20/week on cigarettes, 83% reported purchasing cigarettes from a store, and 86% reported purchasing ≥ pack during their last purchase. Those who reported an income spent a third of their monthly income on cigarettes, and were more likely to spend > $20/week on cigarettes. The amount spent weekly on cigarettes and the source of cigarettes was not associated with quit attempts, nor did income moderate these relationships. Persons without an income who bought a pack or more of cigarettes made fewer quit attempts (β = −0.4, 95% CI −0.7, −0.2), whereas the association between quantity of cigarettes purchased and quit attempts was not significant for those with an income (β = −0.2, 95% CI −0.4, 0.1). CONCLUSIONS: Current smokers experiencing homelessness and who are without an income may find it particularly challenging to engage in attempts to quit smoking. Smoking cessation interventions that highlight relief of financial hardship as a potential benefit of successfully quitting smoking may be useful among this population.

INTRODUCTION: Sexual and gender minority (SGM) young adults have higher smoking prevalence than their non-SGM peers. Less is known about differences in smoking characteristics within the SGM community. METHODS: Participants were SGM young adult smokers age 18–25 (N=165, M age=21.8) enrolled in a clinical trial of the Put It Out Project, a Facebook smoking cessation intervention for SGM young adults. Analyses tested differences between 1) sexual orientation groups, and 2) gender identity groups, on the following smoking characteristics: cigarettes/day, daily smoker (yes/no), social smoker (yes/no), years of smoking, number of close friends who smoke (out of 5), age of initiation, age began smoking regularly, time to first cigarette (30 minutes or less/more than 30 minutes), lifetime quit attempts, past-year quit attempts, and stage of change for quitting smoking (precontemplation, contemplation, preparation). RESULTS: Participants were 55% bi/pansexual, 18% gay, 18% lesbian, 9% other (e.g., asexual, queer). The gender identity of the sample was 64% cisgender, 25% transgender, 11% gender non-binary. Lesbian women began smoking at an older age (M=18.0, SD=2.0) than “other” sexual orientation participants (M=15.9, SD=2.6), p

Background The dual-process theory is central to several models of addiction, implying the importance of automatic processes in the maintenance and development of addiction. Implicit beliefs are traces of previous experience which relate to the representation in cognition. Implicit behavioral tendencies are traces of previous experience which relate to the representation in behavioral tendencies. In this study, we aim to provide behavioral evidence for implicit beliefs and implicit behavioral tendencies towards smoking-related cues among Chinese male smokers and non-smokers. We also examine the relationships among implicit beliefs, implicit behavioral tendencies and smoking behaviors of smokers. Methods In order to achieve these goals, we used an implicit association test (IAT) to measure implicit beliefs and implicit behavioral tendencies simultaneously. Thirty-nine smokers and twenty-five non-smokers were tested, using smoking-related words and images, as well as neutral words and images as stimuli. Results Our analysis shows significant differences in smokers’ and non-smokers’ implicit beliefs and behavioral tendencies (t62 = 3.494, p

The aim of the current study was to assess the perceived treatment effectiveness and beliefs with respect to the best advisor who could conduct smoking cessation treatment or counseling among socially disadvantaged light and heavy smokers. This could be crucial for implementation of a successful smoking cessation intervention among this vulnerable population.The current assessments were based on the data collected during the second wave of a cross-sectional study performed in the Piotrkowski District among 1668 adults aged 18-59, entitled to social aid from welfare institutions. Face-to-face interviews were conducted to collect the relevant data.The current daily smoking status was declared by 31% of the participants. About 23% of the study sample (74% of daily smokers) admitted to being heavy smokers with a meaningful difference between men and women (p0.05). About 29% of the daily smokers indicated that medications/pharmacotherapy could be a good method for giving up the habit. Fifteen percent of the participants shared the opinion that a smoking cessation specialist is the best advisor for counseling, and only about 7% would choose a general practitioner or pharmacist, and even fewer a nurse, as a person who could provide help to smokers. There were no statistically significant differences in any of the evaluated perceptions between the light and heavy smokers (p0.05).A high share of heavy smokers among socially disadvantaged people, and their perception that medications/pharmacotherapy would be a good solution to quit smoking, underline the need for stronger support for this method, including relevant financing resources and training. However, this method should be applied along with behavioral counseling. Int J Occup Med Environ Health. 2019;32(4):527-36.

Smoking cessation interventions for nondaily smokers are needed. The current study explores the fit of the text-messaging intervention SmokefreeTXT for nondaily smokers.Adult nondaily smokers (N = 32; mean age = 35 ± 12, 64% female, 53% non-Hispanic White) were enrolled in SmokefreeTXT. SmokefreeTXT usage data were recorded passively, theorized mechanisms of change were assessed at baseline and 2, 6, and 12 weeks after the chosen quit day, and EMA protocols captured real-time cigarette reports at baseline, and during the first two weeks after the quit day.Most participants completed the SmokefreeTXT program and responded to system-initiated inquiries, but just-in-time interaction with the program was limited. In retrospective recall at treatment end, content of the text-messages was rated as "neutral" to "helpful." Within-person change was observed in theorized mechanisms, with less craving (p 0.01), increased abstinence self-efficacy (external: p 0.01; internal: p 0.01), and poorer perceptions of pros of smoking (psychoactive benefits: p 0.01, pleasure p 0.01; and pros: p 0.01) reported after SmokefreeTXT initiation compared to baseline. Exploratory analyses of real-time reports of smoking (225 cigarette reports in N = 17 who relapsed) indicated that cigarettes smoked in the first two weeks after quitting were more likely to occur to reduce craving (OR = 2.21[1.21-3.72]), and less likely to occur to socialize (OR = 0.06[0.01-0.24]), between 19:00 and 23:00 (OR = 0.34[0.17-0.66]), and on Saturdays (OR = 0.59[0.35-0.99]) than prior to quitting.While well accepted by nondaily smokers, SmokefreeTXT could potentially be improved by targeting cons of smoking, enhancing engagement with the just-in-time component of SmokefreeTXT, and tweaking the timing of text-messages.

When trying to quit, women are less likely than men to achieve long-term smoking abstinence. Identifying the neuropsychological mechanisms underlying women’s higher relapse vulnerability will help clinicians to develop effective tailored smoking cessation interventions. Here we used event-related potentials (ERPs), a direct measure of brain activity, to evaluate the extent to which neurophysiological responses to cigarette-related and other emotional stimuli differ between female and male smokers. Both women and men showed similar patterns of brain reactivity across all picture categories; pleasant and unpleasant images prompted larger Late Positive Potentials (LPPs, a robust measure of motivational relevance) than neutral images in both groups, and cigarette-related images prompted lower LPPs than high arousing emotional images in both groups. Unlike previous studies, there were no differences between male and female smokers with regard to LPP responses to cigarette-related images. This suggests that the LPP may not be ideally suited to discriminate neurophysiological gender differences or that there are simply no gender differences in the neurophysiological responses to cigarette-related stimuli. We collected ERPs from 222 non-nicotine-deprived smokers (101 women) while they watched a slideshow that included high and low emotionally arousing pleasant and unpleasant pictures, cigarette-related, and neutral pictures. We used the mean amplitude of the LPP to assess the affective significance that participants attributed to these pictures.

Objective: Several studies have offered evidence of the importance of nursing-led interventions in smoking cessation. However, other studies have found that negative perceptions and smoking among nurses were barriers to them providing such interventions. The purpose of this study is to investigate smoking prevalence among nursing students and the demographic predictors of smoking, as well as perceptions about their roles with regard to smoking behaviour. Methods: A cross-sectional, self-administered, anonymous survey was conducted with all nursing students of the Maranatha School of Health Science in Indonesia. Smoking status, individual and familial characteristics including socio-economic status, and smoking cessation-related knowledge and attitudes were examined. Result: From the population of 313 students, 197 (62.9%) completed questionnaires were included in the analysis. The prevalence of current smoking for participants overall (25.9%) and males (52.4%) were similar to general population smoking rates in East Nusa Tenggara Province (25.9% overall and 52% for males) but lower than national rates (39% and 75.2%). However, the smoking rate among female participants (7%) was higher than national (2.9%) and regional (0.8%) female smoking rates. The majority of participants were aware of smoking health-related risk (87.3%) and supportive of giving smoking cessation advice (96.4%). In terms of seeing themselves as role models by not smoking at all, approximately 97% non-smokers agreed whereas only 60.8% of smokers agreed. Gender and being supportive of being role models by not smoking at all were significant predictors of the smoking status. Conclusion: This study suggests that smoking prevalence among nursing students is high. Despite most of the students having good smoking-related knowledge and having supportive attitudes towards providing smoking cessation services, high smoking prevalence is known to be an impediment to being effective in delivering cessation services. Personal smoking behaviour among nurses needs to be addressed to encourage critical nursing-led smoking cessation interventions.

Introduction The purpose of the present study was to examine whether self-regulation strategies can further extend the effect of moderate intensity exercise on smoking delay. Method Participants were 40 adult smokers who were randomly assigned into two groups: control and self-regulation. A repeated measures design was adopted including a neutral condition (20 min video) and an exercise condition (20 min moderate intensity exercise). Results The results showed that smoking delay increased significantly for both groups; however, the increase for the self-regulation group was significantly larger than that of the control group. Conclusions The results support the anti-smoking effects of acute exercise; furthermore, they highlight the usefulness of self-regulation strategies, and in particular goal setting, in extending smoking delay. The present findings provide important evidence for the exercise and smoking literature and useful directions for the development of smoking cessation interventions.

Aims To systematically summarize seminal studies on the design and effectiveness of smoking cessation interventions targeted at patients with chronic diseases through a critical appraisal of the literature. Design A systematic review. Data sources This review included literature identified through a search of six databases up to June 2020. Review methods This review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. The literature search was limited to English-language articles on the effectiveness of smoking cessation interventions for smokers who were aged ≥18 years and diagnosed with chronic diseases. Data were extracted using the Cochrane Data collection form for intervention reviews of randomized controlled trials and non-randomized controlled trials. The articles were subjected to a quality assessment. Results Ten relevant articles were identified. The designs of the interventions were highly heterogeneous, and only six articles reported a significant increase in smoking abstinence among patients with chronic diseases. In the target population, an intervention delivered by healthcare professionals on an intensive schedule was shown to more effectively induce smoking cessation, compared with minimal counselling. However, methodological flaws were identified in most of the included studies. Conclusion The findings of this review suggest that additional efforts are needed to design smoking cessation interventions for patients with chronic diseases and that further examination of the effectiveness and feasibility of these interventions is warranted. Impact What problem did the study address? This review evaluated the effectiveness of smoking cessation interventions targeted at patients with chronic diseases. What were the main findings? An intervention with an intensive schedule that was delivered by healthcare professionals was shown to more effectively induce smoking cessation in patients with chronic diseases, compared with minimal counselling. More attention and resources should be directed towards smokers with no intention to quit, especially those with chronic diseases. There is an urgent need for generic smoking cessation interventions that use novel approaches to address the unique needs of this population and to integrate such evidence-based interventions into routine care. Where and on whom will the research have impact? The findings of this review may guide nurses, who play a prominent role in raising the issue of smoking cessation with patients, to design appropriate smoking cessation interventions for patients with chronic diseases. The resulting improvements in patients' health would not only benefit patients themselves but also reduce the burden of chronic diseases on healthcare systems.

Preliminary data suggest that cigarette smokers could have an increased mortality risk from the novel coronavirus (SARS-CoV-2), and that certain factors (e.g., increased age, medical comorbidities) can also increase risk of poor coronavirus disease (COVID-19) outcomes. Between April 30(th), 2020 and May 28(th), 2020, we evaluated self-reported changes in recent smoking patterns and motivation to quit smoking among current daily cigarette smokers (N = 103) on Amazon Mechanical Turk. We also assessed the relationship of these outcomes to age, medical comorbidity status, and fear of COVID-19. Most participants (68.9%) reported smoking less frequently than usual in the last 28 days. Among daily smokers, increased fear of COVID-19 predicted increased motivation to quit smoking and actual smoking reductions (ps < .05). Endorsement of one or more medical comorbidities, but not increased age, predicted increased motivation to quit smoking (p < .05). These data suggest the potentially greater relevance of psychological factors (e.g., fear of COVID-19) over external risk factors (e.g., medical comorbidity, increased age) on motivation to quit smoking and actual reductions in smoking patterns, and may reflect that the pandemic is a suitable time for offering smoking cessation intervention.

The purpose of this pilot study was to assess the feasibility and acceptability of a mobile smoking cessation intervention in Puerto Rico. This was a single-arm pilot study with 26 smokers in Puerto Rico who were enrolled in Decídetexto, a mobile smoking cessation intervention. Decídetexto incorporates three integrated components: (1) a tablet-based software that collects smoking-related information to develop an individualized quit plan, (2) a 24-week text messaging counseling program with interactive capabilities, and (3) pharmacotherapy support. Outcome measures included self-reported 7-day point prevalence abstinence at Months 3 and 6, pharmacotherapy adherence, satisfaction with the intervention, and changes in self-efficacy. The average age of the participants was 46.8 years (SD 12.7), half of them (53.8%) were female. Most participants (92.3%) smoked daily and half of them (53.8%) used menthol cigarettes. All participants requested nicotine patches at baseline. However, only 13.0% of participants used the patch &gt, 75% of days. At Month 3, 10 participants (38.4%) self-reported 7-day point prevalence abstinence (88.5% follow-up rate). At Month 6, 16 participants (61.5%) self-reported 7-day point prevalence abstinence (76.9% follow-up rate). Most participants (90%, 18/20) reported being satisfied/extremely satisfied with the intervention at Month 6. Self-efficacy mean scores significantly increased from 40.4 (SD 12.1) at baseline to 57.9 (SD 11.3) at Month 3 (p &lt, 0.01). The study suggests that Decídetexto holds promise for further testing among Puerto Rican smokers.

BackgroundAssessing benefits and harms of health interventions is resource-intensive and often requires feasibility and pilot trials followed by adequately powered randomised clinical trials. Data from feasibility and pilot trials are used to inform the design and sample size of the adequately powered randomised clinical trials. When a randomised clinical trial is conducted, results from feasibility and pilot trials may be disregarded in terms of benefits and harms.MethodsWe describe using feasibility and pilot trial data in the Trial Sequential Analysis software to estimate the required sample size for one or more trials investigating a behavioural smoking cessation intervention. We show how data from a new, planned trial can be combined with data from the earlier trials using trial sequential analysis methods to assess the intervention’s effects.ResultsWe provide a worked example to illustrate how we successfully used the Trial Sequential Analysis software to arrive at a sensible sample size for a new randomised clinical trial and use it in the argumentation for research funds for the trial.ConclusionsTrial Sequential Analysis can utilise data from feasibility and pilot trials as well as other trials, to estimate a sample size for one or more, similarly designed, future randomised clinical trials. As this method uses available data, estimated sample sizes may be smaller than they would have been using conventional sample size estimation methods.

Background: WHO supports the harnessing of mobile technologies to improve access to smoking cessation services. PharmQuit, a smartphone app, was developed to support smoking cessation efforts by pharmacists taking into consideration the design of the app according to the needs of smokers. This study evaluated the effectiveness of smoking cessation services conducted by community pharmacists using PharmQuit compared with standard care.Methods: An open-label prospective, randomized, controlled trial was conducted. Stratified random sampling by sex, age, and nicotine addiction was used to allocate participants to either the intervention group or control group. Eligible participants were smokers 18 years old or older who smoked at least one cigarette daily for a month, were ready to quit, willing to participate, and had a smartphone. The study was performed at seven community pharmacies situated in three provinces in Thailand. In the intervention group, participants received smoking cessation services by community pharmacists using PharmQuit. The control group received standard care delivered by community pharmacists. Both groups were scheduled follow-ups at day 7, 14, 30, 60, 120, and 180. The primary outcomes were quit rate and number of cigarettes smoked per day. Secondary outcomes were exhaled carbon monoxide levels, adherence rate to the program, and satisfaction with PharmQuit. Analysis using the intent-to-treat principle was carried out. Results: A total of 156 smokers were randomly assigned to either the intervention (n=78) or control (n=78) group. Smoking cessation rates and the number of cigarettes smoked per day were significantly better over the follow-up visits in both groups (p0.05). Relapse rate was found to be lower in the intervention group as compared to the control group (28.6% vs 71.4%). Conclusions: The results showed obvious benefits of the community pharmacist’s contribution in helping smokers quit smoking. PharmQuit was not better than just pharmacist’s counselling but it might help to obtain better adherence to smoking cessation programs, and have less likelihood of relapse. Trial registration: Thai Clinical Trials Registry: TCTR20200925004. Registration date September 25, 2020 – Retrospectively registered, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=6841

Introduction We investigated the influence of COVID-19 on smoking patterns in Pakistan. Methods In a longitudinal survey, we asked cigarette smokers in Pakistan about their smoking behaviors before and since COVID-19. Smokers were recruited before COVID-19 using two-stage random probability sampling. Since COVID-19, three subsequent waves were conducted over the telephone, asking additional questions on social determinants, mental health, and well-being. Based on the first two waves, we estimated the proportion of smokers who stopped, decreased, maintained, or increased smoking. We also explored any factors associated with the change in smoking patterns. In those who stopped smoking soon after COVID-19, we estimated the proportion relapsed in subsequent waves. We estimated all proportions based on complete-case analysis. Results We recruited 6014 smokers between September 2019 and February 2020; of these, 2087 (2062 reported smoking outcomes) were followed up in May 2020 after COVID-19. Since COVID-19, 14% (290/2062) smokers reported quitting. Among those who continued smoking: 68% (1210/1772) reduced, 14% (239/1772) maintained, and 18% (323/1772) increased cigarette consumption; 37% (351/938) reported at least one quit attempt; 41% (669/1619) were more motivated; while 21% (333/1619) were less motivated to quit. Changes in smoking patterns varied with nicotine dependence, motivation to quit, and financial stability since COVID-19. Among those reporting quitting soon after COVID-19, 39% (81/206) relapsed in the subsequent months (June–July 2020). Conclusions There have been significant bidirectional changes in smoking patterns since COVID-19 in Pakistan. Although many people stopped, reduced, or tried quitting smoking, some increased smoking and some relapsed after quitting. Implications We observed significant and complex changes in people’s smoking patterns, which are likely to be attributable to the COVID-19 pandemic and replicated in similar events in the future. Assessing these changes is essential for most low- and middle-income countries like Pakistan, where the vast majority of tobacco users live, but cessation support is still rudimentary. If provided routinely, smoking cessation interventions can potentially support millions of highly motivated individuals in quitting successfully both in general and in global events like COVID-19, in particular.

Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer deaths by early detection. The United States Preventive Services Task Force recommends lung cancer screening with LDCT in adults of age 50 years to 80 years who have at least a 20 pack-year smoking history and are currently smoking or have quit within the past 15 years. The implementation of a lung-cancer-screening program is complex. High-quality screening requires the involvement of a multidisciplinary team. The aim of a screening program is to find balance between mortality reduction and avoiding potential harms related to false-positive findings, overdiagnosis, invasive procedures, and radiation exposure. Components and processes of a high-quality lung-cancer-screening program include the identification of eligible individuals, shared decision-making, performing and reporting LDCT results, management of screen-detected lung nodules and non-nodule findings, smoking cessation, ensuring adherence, data collection, and quality improvement.

The use of evidence-based smoking cessation interventions (SCIs) can significantly increase the number of successful smoking cessation attempts. To obtain an overview of the knowledge and viewpoints on the effectiveness and use of SCIs, a three-round online Delphi study was conducted among researchers and primary care professionals (PCPs). The four objectives of this study are to gain an overview of (i) the criteria important for recommending SCIs, (ii) the perceptions of both groups on the effectiveness of SCIs, (iii) the factors to consider when counseling different (high-risk) groups of smokers and (iv) the perceptions of both groups on the use of e-cigarettes as an SCI. We found a high level of agreement within groups on which smoker characteristics should be considered when recommending an SCI to smokers. We also found that PCPs display a lower degree of consensus on the effectiveness of SCIs. Both groups see a value in the use of special protocols for different (high-risk) groups of patients, but the two groups did not reach consensus on the use of e-cigarettes as a means to quit. Making an inventory of PCPs’ needs regarding SCIs and their usage may provide insight into how to facilitate a better uptake in the primary care setting.

Smoking cigarettes with substantially lower nicotine than conventional cigarettes prior to a quit attempt may reduce the reinforcing effects of smoking, which could facilitate smoking cessation through extinction learning. This paper describes the development of a smoking cessation intervention designed to optimize extinction processes using reduced nicotine cigarettes, as well as the design and methods for an ongoing randomized controlled trial (RCT) to evaluate this intervention. Qualitative methods and pilot testing were conducted to develop the novel facilitated extinction (FE) intervention, with a key focus on maximizing opportunities for extinction learning during a five-week pre-quit period. The primary aims of the RCT are to test the effects of the FE intervention versus a standard (cognitive-behavioral) intervention, while also comparing two nicotine reduction schedules for providing very low nicotine content (VLNC) cigarettes. The efficacy of the intervention is currently being evaluated with treatment-seeking smokers (n = 208) randomly assigned to one of four conditions crossing FE versus standard intervention with immediate versus gradual transition to VLNC cigarettes.

Introduction Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smoking. Methods We present results from a proof-of-concept pilot study designed to evaluate the feasibility and acceptability of a cue-based smoking cessation intervention targeted to light daily and intermittent smokers. Participants were randomized to one of two arms: Arm 1) standard smoking cessation treatment or Arm 2) standard smoking cessation treatment + enhanced cue-based treatment that included interactive texting to extend cue exposure treatment to real-world settings and cue management counseling. Outcomes included feasibility (number of participants who were recruited and who completed the intervention), acceptability (intervention ratings), and preliminary efficacy (7-day point prevalence abstinence). Results We randomized 24 English and Spanish-speaking light smokers, 13 to the treatment arm and 11 to the control arm. Across both arms, 77% attended all counseling sessions, 90% rated these sessions as very useful and 100% said that they would recommend the intervention to a friend. 15% in the treatment arm had biochemically-validated smoking abstinence compared to 0% in the standard counseling arm. Conclusions Results from this proof-of-concept study demonstrated that a cue-based intervention is feasible and acceptable among light smokers and suggests the need for a fully powered study to assess this approach. Trial registration This study is registered at www.clinicaltrials.gov NCT03416621.

Background There is a pressing need to address the unacceptable disparities and underrepresentation of racial and ethnic minority groups, including Hispanics or Latinxs, in smoking cessation trials. Objective Given the lack of research on recruitment strategies for this population, this study aims to assess effective recruitment methods based on enrollment and cost. Methods Recruitment and enrollment data were collected from a nationwide randomized controlled trial (RCT) of a Spanish-language smoking cessation intervention (N=1417). The effectiveness of each recruitment strategy was evaluated by computing the cost per participant (CPP), which is the ratio of direct cost over the number enrolled. More effective strategies yielded lower CPPs. Demographic and smoking-related characteristics of participants recruited via the two most effective strategies were also compared (n=1307). Results Facebook was the most effective method (CPP=US $74.12), followed by TV advertisements (CPP=US $191.31), whereas public bus interior card advertising was the least effective method (CPP=US $642.50). Participants recruited via Facebook had lower average age (P=.008) and had spent fewer years in the United States (P Conclusions Facebook was the most effective method for recruiting Hispanic or Latinx smokers in the United States for this RCT. However, using multiple methods was necessary to recruit a more diverse sample of Spanish-preferring Hispanic or Latinx smokers.

Background: In Costa Rica, the leading cause of preventable death is smoking. Adults spend one third of their lives at work making the workplace an optimal site for smoking cessation interventions. Therefore, we developed a workplace smoking cessation pilot program among Costa Rican Justice Department government employees based on key Costa Rican values and best practices. Methods: First, focus groups were conducted among exsmokers and smokers. Participants in the focus groups and in the subsequent smoking cessation pilot study were invited to take part in the study through flyers, information sheets, and announcements from the Justice Department. The focus groups revealed that social factors were fundamental to quitting. Therefore, based on these results two programs (14 participants) were conducted consisting of seven sessions encouraging employees to utilize their family and exsmokers. Data were collected before and after the seven sessions on smoking behavior, social influence, and other factors. Findings: Five of 14 (36%) quit smoking. None of the quitters lived with a smoker, as compared with 56% of nonquitters who lived with a smoker. Also, quitters were less likely to have friends (40% vs. 67%) and coworkers (20% vs. 33%) who smoked compared with nonquitters. Conclusion/Application to Practice: Workplace smoking cessation programs should help smokers to increase their social contacts with nonsmokers/exsmokers. Smoking cessation programs should assess not only smoking patterns, but also social contacts, such as family, friends, and coworkers. Based on these assessments, smokers should be encouraged to seek-out nonsmokers/exsmokers to assist them in quitting.

Background Changes in smoking habits and predictors of smoking cessation were examined in the randomized ITALUNG lung cancer screening trial. Methods In three centers, eligible smokers or ex-smokers (55–69 years, ≥20 pack-years in the last 10 years) were randomized to receive annual invitation for low-dose computed tomography for 4 years or usual care. At invitation, subjects received written information for a free smoking cessation program. Quitting outcome was assessed at year 4. Results Among participants who completed baseline assessments and year 4 screening, higher quitting (20.8% vs. 16.7%, p = .029) and lower relapse (6.41% vs. 7.56%, p = .50) rates were observed in the active screening group as compared to the usual-care control group. Corresponding figures in the intention-to-treat analysis were as follows: 16.04% versus 14.64% (p = .059) and 4.88% versus 6.43% (p = .26). Quitting smoking was significantly associated to male gender, lower pack-years, and having pulmonary nodules at baseline. Center-specific analyses showed a threefold statistically significant higher probability to quit associated with participating in the smoking cessation program. A subsample of smokers of the scan group from one center showed higher quitting rates over 12-month follow-up as compared to matched controls from the general population who underwent the same smoking cessation program. Conclusions Consistently with previous reports, in the ITALUNG trial, screened subjects showed significantly higher quit rates than controls, and higher quit rates were associated with both the presence of pulmonary nodules and participating in a smoking cessation program. Maximal effect on quitting outcome was observed with the participation in the smoking cessation program. Implications Participating in lung cancer screening promotes smoking cessation. An effective “teachable moment” may be achieved when the smoking cessation intervention is structured as integral part of the screening clinical visits and conducted by a dedicated team of health care professionals. Standardized guidelines for smoking cessation interventions in lung cancer screening are needed.

BACKGROUND: Text messaging interventions have shown promise in helping people quit smoking. Texting programs periodically survey participants about their smoking status. This study examined the consistency of participant self-reported smoking between external surveys and internal program text message assessments. METHODS: Participants in Text2Quit program were surveyed about their past 7-day smoking at one, three, and six months post-enrollment using different survey modes (external surveys and internal program text message assessments) and responses were compared for consistency. The first set of analyses was conducted for participants responding on both modes (n = 45 at one month; n = 50 at three months; n = 42 at six months). Additional analyses, assuming missing = smoking, were conducted with the full sample of 262 smokers (68.7% female, mean age = 35.8 years) and compared to saliva-confirmed abstinence rates. RESULTS: Participants responding to both modes consistently reported smoking status at one (88.9%), three (88.0%) and six (88.1%) months post-enrollment, with fair to substantial levels of agreement (one month: κ = 0.24; three months: κ = 0.63; six months: κ = 0.66). Participants responding to both modes reported high rates of abstinence. In missing = smoking analyses, significant differences in abstinence rates reported across modes were detected at each timepoint (one month: external = 30.5%, internal = 16.4%; three months: external = 33.2%, internal = 16.0%; six months: external = 31.7%, internal = 12.2%; all p < .001). Moderate levels of agreement were found between the two modes. At 6 months, abstinence rates obtained via internal data were closer to those biochemically verified (15.7%) compared to external surveys. CONCLUSIONS: Results provide initial support for the use of internal program assessments in text messaging programs with missing = smoking assumptions in order to gather outcome data on smoking behavior.

Among people who inject drugs (PWIDs) the prevalence of tobacco smoking exceeds 80%; making smoking cessation intervention a priority for this population. This study aims to examine staff and client perspectives from a supervised injecting facility regarding: i) whether an organizational change intervention increased rates of smoking cessation care delivery (pre- to post-intervention); and ii) acceptability of the intervention.A pre-and-post intervention pilot study in a supervised injecting facility was conducted in Sydney, Australia between July 2014-December 2015. The intervention employed an organizational change approach and included six components. Cross-sectional samples of staff (pre n = 27, post n = 22) and clients (pre n = 202, post n = 202) completed online surveys pre and post intervention.From pre to post-intervention staff reported smoking cessation practices significantly increased for the provision of verbal advice (30% to 82%; p 0.001), offer of free or subsidized nicotine replacement therapy (30% to 91%; p 0.001), referral to a general practitioner (19% to 64%; p = 0.001), and follow-up to check on quit smoking progress (18.5% to 64%; p = 0.001). Significantly more clients reported receiving all smoking cessation strategies post-intervention. Over 85% of staff agreed that it was acceptable to address client smoking as part of usual care and 95% of clients agreed that it was acceptable to be asked by staff about their tobacco smoking.Increasing the provision of smoking cessation care using an organizational change approach is both feasible for staff and acceptable to staff and clients of supervised injecting facilities.

There are many studies on how smoking cigarettes is harmful to health, but research on how smoking cessation improves mental health is insufficient. The purpose of this study was to examine long-term effects of smoking cessation on depressive symptoms, resilience, coping skills, and serotonin levels in Korean adults. This was a longitudinal study that followed up on periodically participants for 2 years after the initial smoking cessation intervention. A total of 164 smokers participated within this study. Of these, 15 maintained smoking cessation for 504.93 ± 182.82 days. On the other hand, 148 participants failed to maintain smoking cessation. Depressive symptoms decreased and resilience increased significantly over 2 years in the 15 abstainers. Smoking cessation, in total, decreased depressive symptoms by 32.9% (p = .015) and also increased resilience by 37.5% (p = .012). Smoking cessation also explained for 9% of total positive interpretation at the 1-year follow-up, and 7.3% of total self-criticism at the 2-year follow-up. Serum serotonin did not change over the course of 2 years in both abstainers and smokers but did decrease in the short-term for those who maintained smoking cessation. Platelet serotonin increased over 6 months among smokers.

Despite the negative health consequences associated with smoking, most smokers find it difficult to quit. This is especially true for smokers with elevated social anxiety. One factor that may play a role in maintaining smoking with elevated anxiety is false safety behavior (FSB), behaviors geared toward decreasing anxiety short-term but that maintain or increase anxiety long-term. The present study tested whether FSB explained the relation of social anxiety severity with smoking among 71 current smokers. Avoidance-related FSB was the only type of FSB related to cigarettes smoked per day (CPD) and it was robustly related to more CPD. Further, social anxiety was related to CPD indirectly via FSB-Avoidance. Findings suggest that more frequent use of avoidance behaviors to manage anxiety may maintain smoking and may partially explain the high rates of smoking among those with elevated social anxiety. Thus, FSB may be a promising target in smoking cessation interventions, especially among those with elevated social anxiety.

Previous research has shown reductions in cigarette consumption during the pre-quit period of exercise-aided smoking cessation interventions. Smoking topography and sensation patterns during this period is unknown and may provide valuable insight into compensation and cessation readiness.Female smokers (N = 236, M age = 43, M cigarettes/day = 17.0) enrolled in an exercise-aided smoking cessation intervention self-reported daily cigarette use and cigarette sensory experiences. Breath carbon monoxide and smoking topography data were collected during the period leading up to the targeted quit date (i.e., baseline, week 1, and week 3), which was set for week 4.Repeated measures ANOVAs revealed that cigarette consumption (p 0.001, eta = 0.32), carbon monoxide (p 0.001, eta = 0.14), puff duration (p = 0.01, eta = 0.05), smoking satisfaction (p 0.001, eta = 0.34), psychological reward (p 0.001, eta = 0.43), enjoyment of respiratory tract sensations (p 0.001, eta = 0.29), and craving (p 0.001, eta = 0.39) decreased, whereas average puff flow (p = 0.01, eta = 0.05) increased.This is the first study to establish that regular exercise during the pre-quit period served as a conduit for facilitating behavioral and sensory harm reduction with cigarettes. Furthermore, the pattern of change observed between cigarette consumption and smoking topography does not support compensation. These findings imply that female smokers who exercise prior to a quit attempt are in a favourable state to achieve cessation.