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INTRODUCTION Maternal smoking constitutes a significant risk to the fetus and is associated with multiple adverse pregnancy outcomes. Despite this, an estimated 6–19% of women in Europe smoke during pregnancy. We conducted a pilot study to examine the feasibility and effectiveness of the clinical practice recommendations of the 2017 Tobacco Cessation Guidelines for High-Risk Groups (TOB-G) for pregnant and postpartum women in an outpatient obstetrics setting. METHODS The guideline recommendations were tested on a sample of 67 pregnant women recruited from obstetrics outpatient visits. Pregnant women who smoked received three behavioural counselling sessions through a combination of face-toface and telephone consultations by a midwife trained in the TOBG tobacco treatment recommendations. Smoking status was assessed at 1 month and at 6 months follow-up via self-report. RESULTS Seventy-one per cent of pregnant smokers screened agreed to participate in the counselling intervention. Pregnant women participants (mean age, M=31.73 years, SD±6.09) smoked for an average of 12.2 (SD±6.55) years. Women reported smoking an average of 4.82 (SD±4.14) cigarettes per day with 51% reporting smoking within 30 minutes of waking, an indicator of higher levels of nicotine addiction. Rates of smoking abstinence among pregnant women undergoing the counselling intervention were 43.9% and 45.6% at the 1 month and at 6 months follow-up, respectively. Replacing those participants with missing data as smokers, the quit rates were 26.9% and 38.8% at the 1 month and 6 months follow-up, respectively. CONCLUSIONS The counselling intervention delivered to pregnant women who smoke was feasible to implement in a manner that was consistent with the TOB-G guideline recommendations in an outpatient obstetrics setting. Future work should focus on increasing uptake of evidence-based tobacco treatment recommendations in outpatient obstetrics settings.

Introduction: Despite the magnitude of the risks associated with tobacco use during pregnancy, an estimated 6-19% of woman in Europe will continue to smoke during pregnancy and a large portion of woman who quit will return to smoking following pregnancy. The purpose of the pilot study was toexamine the effectiveness of the Tobacco Cessation Guidelines for High-risk Groups (TOB-G) for Pregnant and Post-Partum women on aiding cessation during pregnancy Methods: The intervention was based on the TOB-G project guidelines d in a sample of 67 pregnant women recruited from obstetrics outpatient visitsand was delivered based on an adaptation of the 5As models for smoking cessation. A research assistant contacted participants by phone at 1 and 6-months to document smoking status. Participants received three behavioural counselling sessions through a combination of face-to-face and telephone consultation. Results: A significant increase in self-reported smoking abstinence was documented following the intervention with 43.9% and 45.6% of participants abstinent at the 1 and 6-month follow-up respectively. In a conservative analysis if we assume missing data for participants we were unable to reach for follow-up as active smokers the quit rates are 26.9% and 38.8% at the 1 and 6-month follow-up respectively. Conclusion: The counselling intervention based on the TOB-G guidelines was associated with significant increase in smoking abstinence among pregnant women. Further research with larger sample sizes is needed.

Introduction Smoking cessation is the most effective intervention to stop disease progression in high risk categories of smokers like cardiovascular (CVD), diabetes and COPD patients. The “TOB G” project has implemented a set of specialized guidelines in a pilot program for such patients, developed in the Clinical Hospital of Pulmonary Diseases of Iasi, Romania. Aim and objective: To determine the real world effectiveness and barriers of the TOB-G guideline recommendations among 150 smokers enrolled in the pilot TOB G running in Romania. Material and Methods Smokers with CVD, diabetes and COPD willing to quit smoking were recruited from the hospital’database and enrolled in the pilot TOB G. They were delivered a smoking cessation counselling intervention consisting of 4 sessions either in-person or by telephone. Abstinence rate was assessed at 1, 2 and 6 months, with careful observation of the barriers and inconvenients arising from pilot implementation in a real life clinical setting. Results 150 patients were enrolled. Smoking abstinence was documented at the 6-month follow-up with 36.0% abstinent in the CVD group (biochemically validated in 22%), 63.3% (40.8% validated) in the diabetes group and 64% ( 51.6% validated ) in COPD group, respectively. The major pilot implementation barriers were observed in the severe COPD smokers, in smokers with mild CVD and in smokers uncompliant to diabetes care. Conclusions The TOBG Guidelines for CVD, diabetes and COPD patients proved feasible to implement and produced significant increases in patient smoking abstinence and in disease outcomes. Future research is needed to improve the guidelines applicability in real life clinical settings. Funding The research describes activity performed in the TOB-G EU project Grant Agreement Number 664292

Introduction: The Tobacco Cessation Guidelines for High-risk Groups (TOB-G) published by the European Network for Smoking and Tobacco Prevention (ENSP) in 2017 were addressed to health care professionals (HCP) in charge with high risk smokers. Aim: To test feasibility of TOB-G guidelines implementation in real life clinical settings by exposing HCP to a one day smoking cessation (SC) training based on TOB-G guidelines for smokers with cardiovascular disease, diabetes and chronic obstructive pulmonary disease. Methods: A pre-post pilot study was conducted among HCP attending the SC training. All participants received an electronic or written copy of the TOB-G guideline for smokers with CVD, COPD and diabetes, prior to the training day. The one-day training session focussed on the key clinical practice recommendations from the TOB G guidelines. Outcome measurement occurred via survey before, immediately following and 6-months after exposure to the training. Results: 48 HCP (84.0% female, 78% never trained in SC) participated in the TOB-G training session. High rates of participants satisfaction were documented (Exceeded expectations=47.7%;Met their expectations to a great extent=52.3%). Significant increases in participants knowledge related to tobacco treatment were documented immediately following and 6-months after exposure to the TOB-G training session. As well for self-efficacy and attitudes. Lower knowledge and confidence were documented for aspects of treatment related to pharmacotherapy. Conclusions: Exposure to the specifically developed TOB-G guideline and training determined positive changes into the delivery of tobacco treatment knowledge and skills among HCP.

Introduction Smoking cessation is a key clinical intervention for reducing progressive lung destruction and lung function deterioration in patients with Chronic Obstructive Pulmonary Disease (COPD). Specialised Tobacco Cessation Guidelines for High-risk Groups (TOB-G) were developed and published in 2017 that present evidence-based recommendations to support smoking cessation in COPD patients. The purpose of this pilot study was to examine the real world effectiveness of the TOB-G guideline recommendations among a sample of COPD patients. Methods A pilot study was conducted among a sample of COPD patients who smoke and were interested in quitting. Participants were recruited from inpatient and outpatient hospital admissions between October and December 2016 in Iasi, Romania. The intervention program was designed based on the recommendations of the TOB-G guidelines for COPD patients. Patients received a total of four contacts: at baseline, 1, 2, and 6 months. The primary outcome measure was biochemically validated point prevalence smoking abstinence measured at 6 months. Results Fifty patients (74% male; age mean±SD = 60.2±7.8) with diagnosed COPD took part in the pilot study. Self-reported rates of point prevalence smoking abstinence were 30.6%, 44.9% and 64.6% at the 1-, 2-, and 6-month follow-up, respectively. Carbon monoxide testing was completed with 51.6% of the sample at 6 months. The biochemically verified abstinent rate was 33.3% at the 6-month follow-up. Conclusions This pilot testing of the TOB-G Clinical Practice Guidelines for COPD patients was associated with high rates of patient smoking abstinence, which are of clinical importance. Further research is needed to evaluate the guidelines large-scale effectiveness in clinical practice.

Introduction The 2017 Tobacco Cessation Guidelines for High-risk Groups (TOB-G) is a comprehensive document on best practices for smoking cessation in clinical practice. The purpose of this pilot study was to assess physician satisfaction and changes in tobacco-related knowledge, selfefficacy and attitudes following exposure to training in the TOB-G guidelines for patients with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or diabetes. Methods A pre-post pilot study was conducted. All participating physicians received an electronic or printed copy of the TOB-G guidelines for patients with CVD, COPD or diabetes. Physicians were also exposed to a one-day training focused on the key clinical practice recommendations from the TOB.g guidelines. Outcome measurement occurred via survey before, immediately following and 6 months after exposure to the training. Results Fifty physicians participated in the TOB.g training session. High rates of participant satisfaction were documented (exceeded expectations 47.7%; met expectations to a great extent 52.3%). Significant increases in physician knowledge and self-efficacy were documented immediately following and 6 months after exposure to the guideline training session. Exposure to the training was associated with positive changes in some but not all tobacco-related treatment attitudes, however these were no longer significant at the 6-month follow-up. Lower knowledge, confidence and unfavourable attitudes were documented for aspects of treatment related to pharmacotherapy. Conclusions Positive changes in previously reported barriers to the delivery of tobacco treatment among physicians were documented following exposure to the TOB.g guidelines and training for patients with CVD, COPD or diabetes.

Introduction: Tobacco use is the major risk factor in chronic obstructive pulmonary disease and has an important contribution to premature lung ageing(1). Aim: To assess the impact of “lung age” measurement on cessation rates in COPD smokers, in a personalized smoking cessation (SC) intervention versus standard of care. Methods: Current smokers with COPD were enrolled in a SC program in Group 1 (50 patients) receiving standard of care intervention(baseline evaluation, counseling, biochemical validation, follow-up)and Group 2 (50 patients) who attended a pilot SC intervention (personalized evaluation and counseling with “lung age” measures, biochemical validation, follow-up) based on the EU TOB G project guideline for high risk populations. No pharmacological SC therapy was provided. Results: Self-reported smoking abstinence was significantly increased at the 1, 2, and 6-month follow-up in Group 2 (30.6%, 44.0% and 64.0% abstinent) versus 16%, 24% and 40%, respectively in Group 1. Carbon monoxide validation was achieved in 20% of Group 1 and in 51.6% of Group 2. The bio-chemically verified abstinent rate at 6 months follow-up was significantly higher in Group 2 (33.3%, p Conclusions: The “lung age” tool adds value in a personalized non-pharmacological smoking cessation intervention for COPD patients, by urging intention to quit. (1) Trofor A.,Petris O.,Trofor L.,Man M.A.,Filipeanu D.,Miron R. Biochemistry in assessing tobacco exposure-smokers versus non-smokers-correlations with clinical practice. Revista de Chimie.2017.68(5):1002-1006.