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Background: Tobacco smoking is the most common preventable cause of morbidity and mortality in the world. In an effort to counteract the harmful consequences of smoking, various tobacco control measures have been implemented, including the use of smoking cessation programmes to reduce the number of new smokers as well as helping current smokers to quit smoking. In Thailand, the SMART Quit Clinic Program (FAH-SAI Clinics) was launched in 2010 to provide smoking cessation services by a multidisciplinary team. There are currently 552 FAH-SAI Clinics established across all 77 provinces of Thailand. Aim: This protocol describes a study aiming to evaluate the SMART Quit Clinic Program (FAH-SAI Clinics) in terms of programme performance and clinical outcomes. We hope that the results of the study could be used to improve the current service model and the programme’s success. Method: A multicentre prospective observational study will be conducted. The study will focus on 24 FAH-SAI Clinics across 21 provinces of Thailand. The primary outcomes are seven-day point prevalence abstinence rate and continuous abstinence rate at three and six months. The outcomes will be measured using a self-reported questionnaire and biochemical validated by exhaled carbon monoxide. Discussion: This study will be the first real-world study that reports the effectiveness of the well-established smoking cessation programme in Thailand. Findings from this study can help improve the quality of smoking cessation services provided by multidisciplinary teams and other smoking cessation services, especially those implemented in low- and middle-income countries.

We evaluate the broader public economic consequences of investments in smoking cessation that change lifetime productivity, which can influence future government tax revenue and social transfer costs and health care spending. The analysis applies a government perspective framework for assessing the intergenerational relationships between morbidity and mortality and lifetime tax revenue and social transfers received. Applying smoking prevalence in Thailand, a cohort model was developed for smoker and former smokers to estimate impact on lifetime direct taxes and tobacco taxes paid. Age-specific earnings for males and wage appropriate tax rates were applied to estimate net taxes for smokers and former smokers. Introducing smoking cessation leads to lifetime public economic benefits of THB13 998 to THB43 356 per person depending on the age of introducing smoking cessation. Factoring in the costs of smoking cessation therapy, an average return on investment of 1.35 was obtained indicating fiscal surplus generated for government from the combined effect of increased tax revenues and of averting smoking-attributable health care costs.

To explore the changes in the prevalence of smoking behavior, attitudes, and cessation training among medical students after the establishment of the Thai Health Professional Alliance against Tobacco (ThaiPAT) and its major campaigns by using the nationwide Global Health Professions Student Surveys (GHPSS).Multiple cross-sectional studies were conducted after three major campaigns were launched between 2007 and 2011, the Deans’ Summit on Tobacco Control, implemented tobacco control into the medical curriculum, and 100% smoke-free hospitals and medical schools. The results of two rounds of GHPSS among third year medical students across the nation in 2006 and 2011 were compared.Overall prevalence of active cigarette smoking remained unchanged at 2.6%. Passive cigarette smoke exposure in public areas appeared to decrease slightly over time. In the most recent national survey, the prevalence of passive smoke exposure was 53.7%. Moreover, the number of student that agreed with the smoking ban in pubs, bars, and nightclubs increased significantly from 80.8 to 90.5%. There was significant improvement in the cessation training among medical students (p0.001). A significant increase in the number of student that agreed that healthcare personnel needed specific training in cessation techniques (p = 0.004) and should always advise their patients to quit smoking (p0.001).Nationwide tobacco control campaigns in Thai medical schools significantly improved the attitudes toward smoking cessation and cessation training among their students, although overall prevalence of active and passive cigarette smoking was unchanged.

Background Treatment for tobacco dependence is not available in many low-resource settings, especially in developing countries. Purpose To test the impact of a novel mix of monetary and social incentives on smoking abstinence in rural communities of Thailand. Design An RCT of commitment contracts and team incentives for rural smokers to quit smoking. Smokers were not blinded to treatment status, although the assessor of the biochemical urine test was. Setting/participants All adult smokers living in the study area were eligible to participate; 215 adult smokers from 42 villages in Nakhon Nayok province, Thailand, participated. Fourteen smokers who lacked teammates were dropped. Intervention A total of 201 smokers were assigned to a two-person team, and then randomly assigned by team (in a 2:1 ratio) with computer-generated random numbers to receive smoking-cessation counseling (control group) or counseling plus offer of a commitment contract, team incentives, and text message reminders for smoking cessation at 3 months (intervention group). Main outcome measures The primary outcome was biochemically verified 7-day abstinence at 6 months, assessed on an intention-to-treat basis. Secondary outcomes include study participation, biochemically verified abstinence at 3 months, self-reported abstinence at 14 months, and the incremental cost per quitter of the intervention, nicotine gum, and varenicline in Thailand. Data were collected in 2010–2011 and analyzed in 2012. Results The trial enrolled 215 (10.5%) of 2055 smokers. The abstinence rate was 46.2% (61/132) in the intervention group and 14.5% (10/69) in the control group (adjusted OR 7.5 [3.0–18.6]) at 3 months; 44.3% (58/131) and 18.8% (13/69) at the primary end point of 6 months (adjusted OR 4.2 [1.8–9.7]); and 42.0% (55/131) and 24.6% (17/69) at 14 months (adjusted OR 2.2 [1.0–4.8]). The purchasing power parity–adjusted incremental cost per quitter from the intervention is $281 (95% CI=$187, $562), less than for nicotine gum ($1780, 95% CI=$1414, $2401) or varenicline ($2073, 95% CI=$1357, $4388) in Thailand. Conclusions The intervention enhanced abstinence by 91%–136% at 6 months, relative to the control group, although self-reports at 14 months suggest tapering of the treatment effect. The intervention may offer a viable, cost-effective alternative to current smoking-cessation approaches in low-resource settings. Trial registration This study is registered at ClinicalTrials.gov NCT01311115.

To determine the efficacy of fresh lime as a smoking cessation aid compared with nicotine gum.A randomized, controlled trial was conducted between March 2009 and September 2009. Only regular smokers aged 18 or older who were willing to quit were randomized to receive either fresh lime (n = 47) or nicotine gum (n = 53). Smokers were excluded if they were using other smoking cessation aids, allergic to citrus, or had dental problems. Exhaled carbon monoxide (CO)-confirmed continuous abstinence rate (CAR) during week 9-12 was measured as the primary outcomes. To grade the severity of craving, a 100-mm visual analogue scale (VAS) was used.There was no significant difference in CO-confirmed CAR between the fresh lime group and the nicotine gum group during weeks 9-12 (61.7% vs. 66.0%; p = 0.65), although 7-day point prevalence abstinence at week 4 of the fresh lime users was statistically significant lower than those using nicotine gum (38.3% vs. 58.5%; p = 0.04). Cravings did not differ significantly between the groups, although fresh lime users tend to report more cravings intensity.Fresh lime can be used effectively as a smoking cessation aid, although not as good as nicotine gum in reducing cravings.

To determine the effectiveness and safety of the novel nicotine polyestex gum for smoking cessation, along with its impact on the quality of life (QOL).A double-blind, placebo-controlled, randomized clinical trial was conducted on 43 smokers. All of them received either nicotine gum or placebo. Only those who could quit completely and continuously by the end of 3 months were considered total abstinence. QOL was also measured using WHO questionnaires.Treatment with nicotine polyestex gum resulted in significantly greater abstinence rate at 3 months compared with placebo (50% vs. 9%; p = 0.003). Adverse events were modest and not encountered more often than those seen in the placebo group. QOL at 3-months improved in both groups, but there was no statistically significant difference between the groups.Nicotine polyestex gum is effective and safe for smoking cessation. It is also associated with significant improvement in the QOL.