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Ask-Advise-Connect (AAC) efficiently links smokers in healthcare settings with evidence-based Quitline-delivered tobacco treatment through training clinic staff to systematically ask patients about smoking status, advise smokers to quit, and connect patients with state Quitlines using the electronic health record. This study utilized a mixed-methods approach, guided by the RE-AIM framework, to evaluate the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving primarily low-socioeconomic status (SES) Latinos and Latinas. Results are presented within the RE-AIM conceptual framework which includes dimensions of reach, effectiveness, adoption, implementation, and maintenance. Quantitative patient-level outcomes of reach, effectiveness, and Impact were calculated. Post-implementation, in-depth interviews were conducted with clinic leadership and staff (N = 9) to gather perceptions and inform future implementation efforts. During the implementation period, 12.0% of GNHC patients who reported current smoking both agreed to have their information sent to the Quitline and were successfully contacted by the Quitline (Reach), 94.8% of patients who spoke with the Quitline enrolled in treatment (Effectiveness), and 11.4% of all identified smokers enrolled in Quitline treatment (Impact). In post-implementation interviews assessing RE-AIM dimensions, clinic staff and leadership identified facilitators and advantages of AAC and reported that AAC was easy to learn and implement, streamlined existing procedures, and had a positive impact on patients. Staff and leadership reported enthusiasm about AAC implementation and believed AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. Clinic staff at a FQHC serving primarily low-SES Latinos and Latinas viewed the ACC implementation process positively. Findings have implications for streamlining clinical smoking cessation procedures and the potential to reduce tobacco-related disparities.

Low health literacy is one of the social health determinants associated with cancer-related disparities. The aim of this study is to explore the relationships between health literacy and theory of planned behavior in performance of cancer screening tests by person undercover of rural health centers in Fasa, Fars Province, Iran in 2018. In this cross-sectional study, 850 persons older than 18 years of age were selected with cluster sampling. Data were collected by a questionnaire consisting of four sections evaluating demographic information, cancer screening behaviors, subjects’ health literacy and constructs of theory of planned behavior. The frequency of acceptable health literacy was respectively in Comprehension (39.41%), Reading (37.41%), Decision making (36.70%), Availability (36.23%) and Evaluation (35.76%). 37.65% of subjects (n = 320) had an acceptable health literacy level (n = 320), 46% (n = 391) had medium level and 16.35% (n = 139) had weak level. Results indicated that, there is significant relationship between health literacy and undergoing breast self-examination, Pap smear test, prostate specific antigen test (PSA) and Fecal occult blood test (FOBT). Also, theory of planned behavior predicted 41% variance in breast cancer screening behavior, 39% in cervical cancer screening, 40% PSA, 37% in mammography and 42% in FOBT. In each four cases, the role of behavioral intention was considerable. This study confirmed the correlation between cancer screening behaviors, health literacy and constructs of theory of planned behavior. Therefore, for promoting cancer screening behaviors and health literacy, theory of planned behavior can be used as a principle in health education and promotion programs.

PURPOSE: This study examined differences in Quitline treatment enrollment, engagement, and smoking cessation outcomes among primary care patients preferring Spanish and English using the evidence-based tobacco treatment Ask-Advise-Connect. METHODS: Ask-Advise-Connect was implemented April 2013 through February 2016 in a large safety-net health system to connect smokers with treatment via a link in the electronic health record. Rates of treatment enrollment, engagement, acceptance of nicotine replacement therapy, and smoking abstinence (self-reported and biochemically confirmed) were compared at 6 months among patients who received treatment in Spanish and English using χ(2) tests. Logistic regression examined language and nicotine replacement therapy and their interaction as predictors of abstinence. RESULTS: The smoking status of 218,915 patients was assessed and recorded in the electronic health record. Smoking prevalence was 8.4% among patients preferring Spanish and 27.0% among those preferring English. Spanish-preferring patients were less likely to enroll in treatment (10.7% vs 12.0%, χ(2) = 12.06, P = .001) yet completed more counseling calls when enrolled (median = 2 vs 1, P

The efficacy of tobacco treatment delivered by state quitlines in diverse populations is well-supported, yet little is known about associations between treatment dose and cessation outcomes following the implementation of Ask-Advise-Connect (AAC), an electronic health record-based systematic referral process that generates a high volume of proactive calls from the state quitline to smokers. The current study is a secondary analysis of a 34-month implementation trial evaluating ACC in 13 safety-net clinics in Houston, TX. Treatment was delivered by a quitline and comprised up to five proactive, telephone-delivered multi-component cognitive-behavioral treatment sessions. Associations between treatment dose and abstinence were examined. Abstinence was assessed by phone six months after treatment enrollment, and biochemically confirmed via mailed saliva cotinine. Among smokers who enrolled in treatment and agreed to follow-up (n = 3704), 29.2% completed no treatment sessions, 35.5% completed one session, 16.4% completed two sessions, and 19.0% completed ≥three sessions. Those who completed one (vs. no) sessions were no more likely to report abstinence (OR: 0.98). Those who completed two (vs. no) sessions were nearly twice as likely to report abstinence (OR: 1.83). Those who completed ≥three (vs. no) sessions were nearly four times as likely to report abstinence (OR: 3.70). Biochemically-confirmed cessation outcomes were similar. Most smokers received minimal or no treatment, and treatment dose had a large impact on abstinence. Results highlight the importance of improving engagement in evidence-based treatment protocols following enrollment. Given that motivation to quit fluctuates, systematically offering enrollment to all smokers at all visits is important., Highlights • The majority of smokers received minimal or no evidence-based tobacco treatment. • Smokers who completed 0 or 1 treatment sessions were unlikely to achieve abstinence. • Completion of 2 calls doubled the likelihood of abstinence at 6 months. • Completion of ≥3 calls was associated with a near quadrupling of abstinence rates. • Improving engagement in evidence-based treatment protocols is a research priority.

Smokers who enrolled in treatment via Ask Advise Connect reported abstinence rates that were consistent with other quitline treatment studies, yet biochemically confirmed abstinence was dramatically lower., Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.

Introduction Given that people living with HIV (PLWH) are disproportionately burdened by tobacco-related morbidity and mortality, it is critically important to understand the degree to which evidence-based cessation interventions are utilized by and are effective among PLWH. Aims and Methods This secondary data analysis aimed to examine differences in Quitline treatment enrollment and 6-month cessation outcomes among smokers seeking care at 1 HIV clinic and 12 non-HIV clinics that were part of a large healthcare system in the greater Houston, Texas metropolitan area, United States. Data were from a 34-month (April 2013–February 2016) one-group implementation trial that evaluated the Ask-Advise-Connect (AAC) approach to linking smokers with Quitline treatment. Primary outcomes included (1) treatment enrollment and (2) 6-month self-reported and biochemically confirmed abstinence. Results The smoking status of 218 915 unique patients was recorded in the electronic health record; 5285 (2.7%) of these patients were seen at the HIV clinic where the smoking prevalence was 45.9%; smoking prevalence at the non-HIV clinics was 17.9%. The proportion of identified smokers who enrolled in treatment was 10.8% at the HIV clinic and 11.8% at the non-HIV clinics. The self-reported abstinence rate was 18.7% among HIV clinic patients and 16.5% among non-HIV clinic patients. Biochemically confirmed abstinence was lower at 4.2% and 4.5%, respectively (all ps > .05). Conclusions AAC resulted in rates of Quitline treatment enrollment and abstinence rates that were comparable among patients seen at an HIV clinic and non-HIV clinics. Findings suggest that AAC should be considered for widespread implementation in HIV clinics. Implications PLWH were as likely as other patients to enroll in evidence-based tobacco cessation treatment when it was offered in the context of a primary care visit. Cessation outcomes were also comparable. Therefore, standard care for PLWH should include routine screening for smoking status and referrals to cessation treatment.

OBJECTIVE: Smoking tobacco cigarettes after a cancer diagnosis increases risk for several serious adverse outcomes. Thus, patients can significantly benefit from quitting smoking. Electronic cigarettes are an increasingly popular cessation method. Providers routinely ask about combustible cigarette use, yet little is known about use and communication surrounding e-cigarettes among patients with cancer. This study aims to describe patterns, beliefs, and communication with oncology providers about e-cigarette use of patients with cancer. METHODS: Patients with cancer (N = 121) who currently used e-cigarettes were surveyed in a cross-sectional study about their patterns and reasons for use, beliefs, and perceptions of risk for e-cigarettes, combustible cigarettes, and nicotine replacement therapies. Patient perspectives on provider communication regarding e-cigarettes were also assessed. RESULTS: Most participants identified smoking cessation as the reason for initiating (81%) and continuing (60%) e-cigarette use. However, 51% of patients reported current dual use of combustible cigarettes and e-cigarettes, and most patients reported never having discussed their use of e-cigarettes with their oncology provider (72%). Patients characterized e-cigarettes as less addictive, less expensive, less stigmatizing, and less likely to impact cancer treatment than combustible cigarettes (Ps < .05), and more satisfying, more useful for quitting smoking, and more effective at reducing cancer-related stress than nicotine replacement therapies (Ps < .05). CONCLUSIONS: Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation. This study also highlights the need for improved patient-provider communication on the safety and efficacy of e-cigarettes for smoking cessation.

Smoking-related illnesses are the leading causes of death among Hispanics/Latinos. Yet there are few smoking cessation interventions targeted for this population. The goal of this study was to “transcreate” an existing, previously validated, English language self-help smoking cessation intervention, titled Forever Free(®): Stop Smoking for Good, for Spanish-speaking smokers. Rather than simply translating the materials, our transcreation process involved culturally adapting the intervention to enhance acceptability and receptivity of the information. We utilized a multi-phase qualitative approach (focus groups and learner verification interviews) to develop a linguistically and culturally relevant intervention for the diverse sub-ethnic groups of Hispanic/Latino smokers. Focus group findings indicated a need to underscore several additional cultural characteristics and themes such as the need to address familism and unique stressors faced by immigrants and to provide information regarding nicotine replacement therapy. Learner verification findings indicated a need to further emphasize financial and social benefits of quitting smoking and to discuss how family and friends can support the quit attempt. These steps led to the development of a Spanish-language smoking cessation intervention titled, Libre del cigarillo, por mi familia y por mí: Guía para dejar de fumar, that is currently being tested in a national randomized controlled trial.

Introduction Relapse is a common factor within the behavior change process. However, there is scarce and limited knowledge of smoking relapse situations in population-based samples. The aim of this study was to identify smoking relapse situations among a sample of Spanish relapsers from the general population. Methods A sample of 775 relapsers was recruited among the general population using a snowball method. Participants completed a survey including sociodemographic, smoking-related and psychopathology variables. Smoking relapse situations were identified through specific questions assessing different aspects related to the last relapse episode. Results The majority of smoking relapse situations were attributed to positive affect (36.6%) and negative affect (34.3%), followed by lack of control (10.1%), smoking habit (6.7%), craving or nicotine withdrawal (6.3%), and social pressure (5.9%). Being unemployed and having a mental disorder in the past increased the likelihood of relapse in situations of negative affect. Being single and having quit smoking to save money were associated with an increased likelihood of relapse in situations of positive affect. Conclusions Affect plays a significant role in smoking relapse among a community sample of unassisted Spanish smokers. Relapse may be much more of an affective and situational process than a habit, physiological or social pressure. Findings from this study may help develop tailored community smoking relapse prevention strategies or programs.

Most users of electronic cigarettes (e-cigarettes) report initiating use to quit combustible cigarettes. Nevertheless, high levels of dual use (i.e., using both combustible cigarettes and e-cigarettes) occur among adults. Using formative data from in-depth interviews and employing learner verification, we adapted an existing, validated self-help smoking-cessation intervention (Stop Smoking for Good, SSFG) to create a targeted intervention for dual users, If You Vape: A Guide to Quitting Smoking (IYV). In Phase I, in-depth interviews (n = 28) were conducted to assess relevance of the existing SSFG materials (10 booklets, nine pamphlets) and identify new content for the booklets. Next, for Phase II, learner verification interviews (n = 20 dual users) were conducted to assess their appeal and acceptability. Several key themes emerged from the Phase I in-depth interviews. Findings led to the inclusion of e-cigarette-specific strategies used by successful quitters such as gradually reducing nicotine levels, switching from tobacco flavor to alternative flavors, and limiting e-cigarette use to places one would normally smoke (i.e., not expanding use). Suggestions from Phase II learner verification included broadening the visual appeal for a younger, more diverse demographic, expanding tips for quitting smoking via e-cigarettes, and expanding terminology for e-cigarette devices. Beginning with an efficacious self-help intervention, we used a systematic process to develop a version specifically for dual users.

The integration of smoking cessation interventions (SCIs) within the context of lung cancer screening programs is strongly recommended by screening guidelines, and is a requirement for Medicare coverage of screening in the US. In Europe, there are no lung cancer screening guidelines, however, research trials are ongoing, and prominent professional societies have begun to recommend lung cancer screening. Little is known about the types and efficacy of SCIs among patients receiving low-dose computed tomography (LDCT) screening. This review addresses this gap. Based on a systematic search, we identified six empirical studies published prior to July 1, 2015, that met inclusion criteria for our review: English language, SCI for LDCT patients, and reported smoking-related outcomes. Three randomized studies and three single-arm studies were identified. Two randomized controlled trials (RCTs) evaluated self-help SCIs, whereas one pilot RCT evaluated the timing (before or after the LDCT scan) of a combined (counseling and pharmacotherapy) SCI. Among the single-arm trials, two observational studies evaluated the efficacy of combined SCI, and one retrospectively assessed the efficacy of clinician-delivered smoking assessment, advice, and assistance. Given the limited research to date, and particularly the lack of studies reporting results from RCTs, assumptions that SCIs would be effective among this population should be made with caution. Findings from this review suggest that participation in a lung screening trial promotes smoking cessation and may represent a teachable moment to quit smoking. Findings also suggest that providers can take advantage of this potentially teachable moment, and that SCIs have been successfully implemented in screening settings. Continued systematic and methodologically sound research in this area will help improve the knowledge base and implementation of interventions for this population of smokers at risk for chronic disease.

Introduction Although quitting motivation predicts smoking cessation, there have been inconsistent findings regarding motivation predicting long-term maintenance of abstinence. Moreover, most such research has been conducted in North America and the United Kingdom. The aim of this study was to examine motivation to quit as a predictor of smoking cessation and of abstinence maintenance in a Spanish sample. Method The sample comprised 286 Spanish smokers undergoing psychological treatment for smoking cessation. Motivation to quit was assessed pre-treatment and post-treatment with the Readiness to Quit Ladder. Abstinence post-treatment and at 6 month follow-up was biochemically verified. Results Participants with higher levels of pre-treatment and post-treatment motivation were more likely to be abstinent at the end of the treatment (OR = 1.36) and at 6 month follow-up (OR = 4.88). Among abstainers at the end of the treatment (61.9%), higher levels of motivation to quit post-treatment predicted maintaining abstinence at 6 months (OR = 2.83). Furthermore, participants who failed to quit smoking reported higher levels of motivation to quit post-treatment than they had pretreatment (p Conclusions Motivation to quit smoking predicted short and long-term cessation, and also predicted long-term maintenance of abstinence. These results have implications for understanding motivational processes of smoking cessation in general, while extending research to Spanish smokers. They may also help in the design of cessation and relapse-prevention interventions. Specifically, the results suggest that motivational enhancement is important throughout the cessation and maintenance periods.

Most quitlines offer treatment in Spanish. However, little is known about the long-term efficacy of quitline-delivered treatment among Spanish-speaking smokers. This study is a secondary analysis of a 34-month implementation trial evaluating Ask-Advise-Connect (AAC)—an electronic health record (EHR)-based approach designed to facilitate enrollment in quitline-delivered treatment—in 13 community clinics serving low-income, racially/ethnically diverse patients in Houston, TX. Our goal was to compare treatment engagement, counseling dose received, and smoking abstinence among individuals who received treatment in Spanish versus English. Clinic staff were trained to Ask all patients about their smoking status, Advise all smokers to quit, and offer to immediately Connect smokers with treatment through a link within the EHR. Quitline treatment consisted of up to 5 proactive counseling calls. Outcomes included treatment engagement (i.e., enrollment in treatment), treatment dose (i.e., number of counseling calls completed), and biochemically confirmed, self-reported abstinence six months after enrollment. The smoking status of 218,915 unique patients was assessed and recorded in the EHR. The preferred language for 95.2% of patients assessed was Spanish (n=102,146) or English (n=106,312). Among Spanish speakers, smoking prevalence was 8.4% (8,602/102,146). Among English speakers, smoking prevalence was 29.4% (31,264/106,312). The proportion of Spanish-speaking smokers who enrolled in treatment was 10.7% (924/8,602), and 78.5% of these individuals (725/924) agreed to be contacted for the 6-month follow-up. The proportion of English-speaking smokers who enrolled in treatment was 12.1% (3,785/31,264), and 78.1% of these individuals (2,957/3,785) agreed to be contacted for follow-up. Outcomes were examined among the subset of individuals who agreed to be contacted for follow-up. Among those who received treatment in Spanish, the median number of counseling calls completed was 2.26. Among those who received treatment in English, the median number of counseling calls completed was 1.20. Among those who received treatment in Spanish, self-reported 7-day point prevalence abstinence was 25.1% (182/725), and biochemically confirmed abstinence was 7.6% (55/725). Among those who received treatment in English, self-reported abstinence was 14.5% (429/2,957) and biochemically confirmed abstinence was 3.7% (110/2,957). Those who received treatment in Spanish were twice as likely to be abstinent at 6 months (self-report: OR: 1.98; 95% CI: 1.62, 2.40; biochemically confirmed: OR: 2.13; 95% CI: 1.52, 2.97). Findings indicate that streamlined, automated approaches such as AAC have great potential to engage Spanish-speaking smokers in treatment. Once engaged, Spanish speakers completed more counseling calls and were twice as likely to be abstinent at 6 months. It is also notable that large discrepancies were observed between self-reported and biochemically confirmed abstinence. Citation Format: Bárbara Piñeiro, Damon J. Vidrine, David W. Wetter, Diana S. Hoover, Summer Frank-Pearce, Nga Nguyen, Susan M. Zbikowski, Jennifer I. Vidrine. Quitline treatment enrollment, dose, and cessation outcomes among safety net patients linked with treatment via Ask-Advise-Connect: Differential efficacy among Spanish- vs. English-speaking smokers [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A032.

Objective The goal of the current study was to develop and examine the feasibility and acceptability of a self-help smoking cessation intervention targeted to the teachable moment of smokers undergoing low-dose computed tomography (LDCT) lung cancer screening. Materials and methods We used a multi-phase qualitative approach, including focus groups (N = 15) and learner verification interviews (N = 16) to develop a targeted intervention for patients receiving a LDCT screening, by extending and modifying a previously validated, self-help intervention. The new intervention was then tested in a feasibility study for acceptability and receptivity by smokers (N = 18) receiving a LDCT screening. Results The main themes that emerged from the focus group findings included a need to address the counterproductive thoughts regarding a negative lung screen result, the desire to enjoy a healthy and smoke-free retirement, the need to increase self-efficacy regarding smoking cessation, and the desire to see statistics regarding survival after quitting smoking. Learner verification findings showed that participants responded favorably to most booklet and pamphlet changes. Minor changes were made to improve comprehension and enhance self-efficacy. Formative findings led to the development of a new initial booklet titled, “Lung Cancer Screening & Quitting Smoking: Taking Control of Your Health,” as well as modifications of the existing self-help cessation intervention. The intervention was designed to be initiated at the LDCT appointment, prior to receipt of scan results, and with minimal disruption of clinic work-flow. Results from the feasibility study indicated that acceptability and satisfaction with the new intervention were high. Conclusion A validated self-help smoking-cessation intervention was modified for smokers receiving LDCT screening for lung cancer based on formative research guided by the teachable moment concept. The new intervention is ready for testing in a randomized controlled trial.

Distintos estudios muestran que cuando se utiliza la entrevista motivacional (EM) añadida a un tratamiento estándar, con el objetivo de aumentar la motivación, mejoran los resultados del tratamiento. El objetivo del presente estudio fue analizar si los fumadores que reciben una intervención con EM antes de un tratamiento psicológico cognitivo conductual para dejar de fumar mejoran la adherencia y la eficacia del tratamiento y reducen la recaída en los seguimientos, en comparación con fumadores que únicamente reciben un tratamiento psicológico cognitivo conductual para dejar de fumar. Se comparó en 58 fumadores (46.6% hombres y 53.4% mujeres) la eficacia de añadir o no EM a un tratamiento psicológico para dejar de fumar. El grupo experimental recibió 2 sesiones de EM antes del comienzo de las 6 sesiones del tratamiento psicológico, mientras que el grupo de con-trol recibió únicamente las 6 sesiones del tratamiento. Los resultados no mostraron diferencias estadísticamente significativas entre los 2 grupos en la adherencia al tratamiento, resultados al final del tratamiento y en los seguimientos a los 6 y 12 meses. Concluimos que la intervención con EM no produce mejores resultados en comparación con la aplicación de un tratamiento psicológico cognitivo conductual solo Several studies show that when using motivational interviewing (MI) added to standard treatment, in order to increase motivation, treatment outcomes improve. The aim of this study was to examine whether smokers who receive an intervention with MI before a cognitive-behavioral psychological treatment to quit smoking they improve adherence and treatment effectiveness, and they reduce the risk of relapse at follow-up compared with smokers who only receive cognitive-behavioral psychological treatment for smoking cessation. We compared the effectiveness of adding or not MI to a psychological treatment to quit smoking in a sample of 58 smokers (46.6% men and 53.4% women). The experimental group received 2 sessions of MI before the beginning of the 6 sessions of the psychological treatment, while the control group received only 6 sessions of treatment. The results showed no statistically significant differences between the two groups in adherence to treatment, and treatment outcomes at the end of treatment and at 6- and 12-month follow-ups. We conclude that intervention with MI does not produce better results compared to the application of cognitive-behavioral psychological treatment alone SI

Introduction Although it has been suggested that persons with psychopathological disorders experience greater difficulty in quitting smoking, the few studies that have analyzed personality disorders in smokers have failed to produce conclusive results. The aim of this study was to examine whether the presence of probable personality disorders was associated with the achievement of abstinence at the end of a smoking cessation treatment, as well as the maintenance of abstinence at 6 and 12 months of follow-up. Methods The sample comprised 290 smokers (41% men and 59% women) who participated in a psychological smoking cessation treatment and who were followed for a year. Abstinence was tested by measuring carbon monoxide in exhaled air. Results Participants with a probable borderline, antisocial or avoidant personality disorder were less likely to quit smoking at the end of the treatment, whereas probable schizoid personality disorder predicted better maintenance of abstinence at 6 and 12 months. In addition, smoking 25 or more cigarettes before starting the treatment decreased the likelihood of maintaining abstinence at 6 and 12 months of follow-up. Conclusions This study revealed differential (and opposing) relationships between specific personality disorders and smoking cessation outcomes, illustrating the need to consider Axis II disorders separately when predicting treatment outcomes.

The present study examined whether personality disorders (PDs) are associated with cigarette smoking, and the possible influence of nicotine dependence, sociodemographic variables, and the presence of any lifetime Axis I mental disorder in these relationships. The sample was made up of 1,081 adult participants from the Spanish general population and was stratified by smoking status (519 smokers and 562 nonsmokers). PDs were assessed by means of the International Personality Disorder Examination Questionnaire, Module DSM-IV. Results indicated that participants with a paranoid, a narcissistic, a borderline, an antisocial, or an obsessive-compulsive PD had a higher probability for being smokers and for being nicotine-dependent. The only exception was the schizoid PD, because participants with this Axis II disorder had a lower probability for being nicotine-dependent smokers. The association between PDs and smoking was maintained even after adjusting for all covariates. Findings are discussed in relation to the influence of Axis II disorders on smoking cessation interventions.

Introduction Given the rapid increase in e-cigarette use, it is important to understand factors that may contribute to their initiation and maintenance. Because gender differences in tobacco use, product preferences, and expectancies are well established, similar gender differences may exist with e-cigarettes. The aim of this study was to identify gender differences among e-cigarette users in patterns of use, reasons for initiation and maintenance, and outcome expectancies regarding e-cigarettes. Methods Participants (N = 1815) completed an online survey from August through November, 2013. We assessed sociodemographics, smoking and e-cigarette history and use, and expectancies about e-cigarettes. Results We found gender differences in type of e-cigarette used, flavors used, nicotine dosage, source of information about e-cigarettes, place of purchase, and use of e-cigarettes where smoking is prohibited. In addition, males were more likely to report initiating e-cigarette use to quit smoking due to health concerns, whereas females were more likely to report initiation based on recommendations from family and friends. Males reported higher attributions for maintenance of e-cigarette use related to positive reinforcement (enjoyment), whereas females reported higher negative reinforcement attributions (stress reduction or mood management). Males reported more positive expectancies about e-cigarettes, including taste, social facilitation, and energy, whereas women rated e-cigarettes higher for weight control. Males also reported greater addiction-related e-cigarette expectancy than females. Conclusions Many of the gender differences with e-cigarettes parallel those previously found with traditional cigarette smoking. Although effect sizes associated with these differences were small, the results may help advance research and intervention development with respect to e-cigarette initiation, maintenance and cessation.

There is a dearth of evidence-based smoking-cessation interventions for Hispanic/Latino smokers, especially for individuals with limited or no English proficiency. Hispanics/Latinos make up 17% of the national population, and in some Hispanic sub-ethnic groups, such as Puerto Ricans and Cubans, smoking prevalence rates are over 30% (greatly exceeding rates of non-Hispanic Whites at 18.1%). Thus, we sought to transcreate our existing validated English-language “Stop Smoking for Good” self-help smoking cessation intervention for Spanish-speaking smokers. The transcreation process involves a series of steps involving translating the text into another language, as well as infusing culturally relevant context, photos, and themes. To begin, focus groups were conducted to assess reactions to the existing English-language materials (10 booklets and 9 pamphlets), and to gather suggestions to adapt content for the intended audience. Specifically, we aimed to identify culturally relevant smoking cessation barriers as well as elements that would increase acceptability in this population. Focus group participants (N=23) were bilingual Hispanic/Latino smokers representing diverse sub-ethnic groups. A key theme that emerged was familism, defined by the sense of attachment, loyalty and collective well-being among the nuclear as well as extended family. This finding prompted us to develop an additional booklet aimed at providing family and friends with the tools necessary to support their loved one's quit attempt. Other findings included: religion and spirituality as a coping mechanism; the role of coffee as a trigger for smoking; and difficulties for immigrants that serve as stressors for smoking, such as language barriers, being separated from one's family, and financial problems. Format change suggestions were also reported by participants and included a desire for color images, preference for a bright color palette, and interactive activities. Focus group findings then informed the development of a Spanish-language version of the booklets entitled, “Libre del cigarrillo, por mi familia y por mí.” Subsequently, learner verification interviews (N=10) were conducted with Spanish-speaking Hispanic/Latino smokers who preferred their health education materials in Spanish to assess the appeal and acceptability of the revised content and visual modifications. Overall, participants responded favorably to the revised content. The learner verification process also revealed a need to: expand the explanation of quitting aids, include additional culturally salient daily stressors, and further emphasize the financial benefits of quitting smoking. We will present additional qualitative results from the focus groups and learner verification interviews as well as the finalized Spanish-language version of the booklets. The final version of the Spanish-language materials will be tested in a randomized controlled trial. Citation Format: Diana B. Díaz, Luis M. Monsalve, Thomas H. Brandon, Bárbara Piñeiro, Lauren R. Meltzer, Cathy D. Meade, Karen O. Brandon, Marina Unrod, Vani N. Simmons. Transcreating self-help smoking cessation intervention materials for Hispanic/Latino smokers: Focus group and learner verification findings. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A09.

Craving and nicotine withdrawal syndrome (NWS) are components of the tobacco use disorder in DSM-5. They both appear after smoking cessation or an abrupt reduction in tobacco use, and they are associated with both short and long-term smoking-cessation outcomes. The aim of the present study was to examine the association of craving and withdrawal with smoking cessation at the end of the treatment and relapse at 3 months follow-up in a Spanish sample of smokers. The sample comprised 342 smokers (37.7% men; 62.3% women) receiving a cognitive-behavioral treatment for smoking cessation. The assessments of craving and withdrawal were conducted using the Minnesota Nicotine Withdrawal Scale. Abstainers at the end of the treatment, compared to non abstainers, showed significantly lower post-treatment withdrawal, and post-treatment craving. Furthermore, they had lower scores in pre-treatment nicotine dependence. Among abstainers, craving decreased significantly from pre-cessation levels, while in those participants who did not quit smoking it remained on the same levels. High nicotine dependence was a predictor of smoking at the end of the treatment, whereas high nicotine withdrawal predicted relapse at 3 months. Findings support the robust role of craving and NWS in smoking cessation and relapse, although they differ in their specific patterns of change over time.

Cigarette smoking is associated with a range of cancers and is related to five of seven leading causes of death in Puerto Rico. Minimal self-help interventions have shown promising results in reaching participants and preventing relapse from smoking. Specifically, a collection of eight self-help booklets has demonstrated efficacy (Brandon et al., 2000; 2004). Those booklets have been transcreated into Spanish, with efforts to make them culturally appropriate across a range of Hispanic cultures. We conducted a pilot study in Ponce, Puerto Rico, to evaluate the Spanish version of our smoking relapse-prevention booklets. Qualitative, semi-structured interviews were conducted with 20 current and former smokers. Interviews were conducted to elicit feedback regarding the booklet’s content, cultural appropriateness, dissemination, and perceived availability of smoking cessation resources in Puerto Rico. Interviews were audiotaped and transcribed verbatim. Transcripts were coded using content analysis, with a priori codes based on the interview guide. Emergent themes were examined. Overall, participants liked the booklets’ content, perceived them to be culturally appropriate, easy to read and understand. Regarding dissemination, it was recommended that the booklets be disseminated by physicians and advertised through television. Most importantly, participants reported the best way to distribute and complement the booklets would be through support groups. Participants also reported having limited knowledge about resources provided in the community to aid smoking cessation. Overall, this pilot study was able to show the cultural acceptability of the booklets and highlights the need for the dissemination of these materials among current and former smokers in Puerto Rico.

Few studies have investigated the relationship between smoking and health-related quality of life (HRQOL), and the results are not consistent. The aim of this study is to explore the association between smoking and HRQOL.Cross-sectional study of 714 Spanish adults (44.7% never smokers and 55.3% smokers) without diagnosis of physical or mental disorder. Each participant provided information about different sociodemographic variables and data on HRQOL. Smokers also reported smoking-related information about smoking-related variables.Nicotine dependence was not associated with the physical dimension of HRQOL, but in the mental component, nicotine dependent smokers showed worse HRQOL than never smokers (p = 0.004) and than non-nicotine dependent smokers (p = 0.014). There were no differences between no-nicotine dependent smokers and never smokers. Smoking status (non smokers vs. smokers), number of cigarettes smoked per day, stage of change, quit attempts in the past year or age of smoking onset were not related to HRQOL.In subjects without physical or mental diseases, only nicotine dependent smokers showed a significant impairment in the mental component of HRQOL. Therefore, it is important to consider nicotine dependence in the relationship between smoking and HRQOL.

Relapse is common during the process of giving up smoking. The aim of the present study is to explore the relapse situations, according to Marlatt’s relapse taxonomy, in a sample of 428 smokers (43.9% men and 56.1% women) who participated in a cognitive-behavior psychological treatment for quitting smoking. At the end of the treatment, 221 participants were abstinent, of whom 119 (41.2% men and 58.8% women) relapsed in the course of the 12-month follow-up, the majority in the first 3 months (69.74%). Most of the relapses were attributed to intrapersonal and environmental determinants (61.33%), the most common of which were “coping with negative emotional states” (38.65%), followed by “giving in to temptations or urges” (9.24%) and “testing personal control” (8.40%). Interpersonal determinants occurred in 38.66% of relapses, this percentage being made up mostly of “social pressure”, which was the relapse situation in 34.46% of all relapses. These results, similar to those of Marlatt’s original studies and others, contribute to improving our knowledge of the relapse situations process, with a view to interventions that may help to avoid it.

Background The lack of conclusive results and the scarce use of the Millon Clinical Multiaxial Inventory-III (MCMI-III) in the study of the relationship between smoking and personality are the reasons that motivated the study reported here. The aim of the present study was to analyze the influence of personality patterns, assessed with the MCMI-III, and of nicotine dependence on treatment outcomes at the end of the treatment and at 12 months follow-up in men and women smokers receiving cognitive-behavioral treatment for smoking cessation. Methods The sample was made up of 288 smokers who received cognitive-behavioral treatment for smoking cessation. Personality patterns were assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Abstinence at the end of the treatment and at 12-month follow-up was validated with the test for carbon monoxide in expired air. Results The results showed significant differences by personality patterns that predict nicotine dependence (Narcissistic and Antisocial in men and Schizoid in women). At the end of the treatment it is more likely that quit smoking males with a Compulsive pattern and less likely in those scoring high in Depressive, Antisocial, Sadistic, Negativistic, Masochistic, Schizotypal and Borderline. In women, it is less likely that quit smoking those with the Schizoid pattern. At 12 months follow-up it is more likely that continue abstinent those males with a high score in the Compulsive pattern. Furthermore, nicotine dependence was an important variable for predicting outcome at the end of the treatment and smoking status at 12 months follow-up in both men and women. Conclusions We found substantial differences by gender in some personality patterns in a sample of smokers who received cognitive-behavioral treatment for smoking cessation. We should consider the existence of different personality patterns in men and women who seek treatment for smoking cessation Funding for this study was provided by the Spanish Ministry of Science and Innovation (Ministerio de Ciencia e Innovación) (National Basic Research Projects). Project reference: PSI2008-02597/PSIC. Bárbara Piñeiro is the beneficiary of a Pre-Doctoral Research Training Grant (FPI) from the Ministry of Science and Innovation; reference BES-2009-012929 SI

The aim of the present study is to examine the relationship between cigarette smoking and personality patterns in the general population, taking into account the possible influence of nicotine dependence. We used a stratified random sample of 1,081 adults from the general population (519 smokers and 562 non-smokers) in the region of Galicia (Spain). Personality patterns were assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). The results indicated that nicotine-dependent smokers had a higher probability of obtaining a PREV > 75 in the histrionic and antisocial personality patterns and non-nicotine-dependent smokers are more likely to present a PREV > 75 in paranoid personality pattern than non-smokers. On the contrary, non-smokers are more likely to have a PREV > 75 on the compulsive personality scale. Our findings suggest that there are different personality patterns according to smoking status (smoker/non-smoker) and according to the presence of nicotine dependence. We concluded that it is necessary to identify the personality characteristics of smokers, since these characteristics could be key variables in increased risk of being a smoker and of difficulties for quitting smoking.

The relationship between smoking and lung cancer is well established. The leading known cause of lung cancer is the consumption of tobacco, which is responsible for 90% of lung cancer cases. In this article we present the case of a smoker who has had lung cancer in the past (survivor of lung adenocarcinoma a total of twelve years), who requires treatment to stop smoking, motivated by the fear of suffering from lung cancer again and dying from diseases related to the consumption of tobacco. He was given the cognitive-behavioral psychological treatment “Smoking Cessation Program.” It describes the assessment, treatment and subsequent follow-ups over twelve months. The result of this treatment shows that it is possible to quit smoking and remain abstinent from it during a year. This case highlights the physical and psychological benefits of quitting smoking, as well as the increase of health-related quality of life. La relación entre fumar y el cáncer de pulmón está bien establecida. La principal causa conocida del cáncer de pulmón es el consumo de tabaco, que es el responsable del 90% de los casos de cáncer de pulmón. En el presente artículo presentamos el caso de un fumador que ha tenido un cáncer de pulmón en el pasado (superviviente de doce años de un adenocarcinoma de pulmón), que demanda tratamiento para dejar de fumar por el miedo a padecer otro cáncer de pulmón y a morir por las enfermedades relacionadas con el consumo de tabaco. Se le aplicó el tratamiento psicológico cognitivo-conductual “Programa Para Dejar de Fumar”. Se describe la evaluación, tratamiento y seguimientos realizados durante doce meses. El resultado del tratamiento muestra que es posible dejar de fumar y mantenerse abstinente a lo largo de un año. También manifiesta claros beneficios del abandono del tabaco a nivel físico, psicológico y en su aumento de la calidad de vida relacionada con la salud

La relación entre fumar y el cáncer de pulmón está bien establecida. La principal causa conocida del cáncer de pulmón es el consumo de tabaco, que es el responsable del 90% de los casos de cáncer de pulmón. En el presente artículo presentamos el caso de un fumador que ha tenido un cáncer de pulmón en el pasado (superviviente de doce años de un adenocarcinoma de pulmón), que demanda tratamiento para dejar de fumar por el miedo a padecer otro cáncer de pulmón y a morir por las enfermedades relacionadas con el consumo de tabaco. Se le aplicó el tratamiento psicológico cognitivo-conductual “Programa Para Dejar de Fumar”. Se describe la evaluación, tratamiento y seguimientos realizados durante doce meses. El resultado del tratamiento muestra que es posible dejar de fumar y mantenerse abstinente a lo largo de un año. También manifiesta claros beneficios del abandono del tabaco a nivel físico, psicológico y en su aumento de la calidad de vida relacionada con la salud The relationship between smoking and lung cancer is well established. The leading known cause of lung cancer is the consumption of tobacco, which is responsible for 90% of lung cancer cases. In this article we present the case of a smoker who has had lung cancer in the past (survivor of lung adenocarcinoma a total of twelve years), who requires treatment to stop smoking, motivated by the fear of suffering from lung cancer again and dying from diseases related to the consumption of tobacco. He was given the cognitive-behavioral psychological treatment “Smoking Cessation Program.” It describes the assessment, treatment and subsequent follow-ups over twelve months. The result of this treatment shows that it is possible to quit smoking and remain abstinent from it during a year. This case highlights the physical and psychological benefits of quitting smoking, as well as the increase of healthrelated quality of life SI

Motivational Interviewing (MI) has proved to be effective with a wide range of addictive behaviors. However, in the case of tobacco smoking it is more difficult to demonstrate its effectiveness. MI provides specific motivational strategies for each stage of change. The aim of this paper is to review studies investigating the use of MI in the treatment of smoking in order to provide an update on its effectiveness. To this end, we reviewed the most important research published internationally and in Spain. A review of 33 selected studies leads us to conclude that it is very difficult to assess and compare the results of the studies in view of their variability and heterogeneity. Hence, it is in this area that we see the most contradictory results on its effectiveness. We therefore need more research in order to determine its reliability and possible explanations for the discrepant findings observed in studies of smoking cessation. Finally, we strongly suggest the need to know which treatment location is best, how MI functions in treatment programs and which conditions may affect its effectiveness.

La Entrevista Motivacional (EM) ha demostrado su eficacia en un amplio rango de conductas adictivas. Sin embargo, con el tabaco es donde resulta más difícil demostrar su eficacia. La EM proporciona estrategias motivacionales específicas para cada estadio de cambio. El objetivo de este trabajo es revisar los estudios que investigan el uso de la EM en el tratamiento del tabaquismo con el fin de ofrecer una actualización de su eficacia. Para ello, se han revisado las investigaciones más importantes, publicadas a nivel internacional y en España. La revisión de los 33 estudios seleccionados nos lleva a concluir que es muy difícil evaluar y comparar los resultados de los estudios entre sí, debido a la variabilidad y heterogeneidad de los mismos. De ahí que sea en este campo donde se muestren los resultados más contradictorios sobre su eficacia. Se necesita, por lo tanto, más investigación para determinar la fiabilidad y las posibles explicaciones para los hallazgos discrepantes observados en el tabaquismo. Finalmente se sugiere la necesidad de conocer dónde y cómo interviene la EM dentro del tratamiento y qué condiciones podrían afectar a su eficacia Motivational Interviewing (MI) has proved to be effective with a wide range of addictive behaviors. However, in the case of tobacco smoking it is more difficult to demonstrate its effectiveness. MI provides specific motivational strategies for each stage of change. The aim of this paper is to review studies investigating the use of MI in the treatment of smoking in order to provide an update on its effectiveness. To this end, we reviewed the most important research published internationally and in Spain. A review of 33 selected studies leads us to conclude that it is very difficult to assess and compare the results of the studies in view of their variability and heterogeneity. Hence, it is in this area that we see the most contradictory results on its effectiveness. We therefore need more research in order to determine its reliability and possible explanations for the discrepant findings observed in studies of smoking cessation. Finally, we strongly suggest the need to know which treatment location is best, how MI functions in treatment programs and which conditions may affect its effectiveness SI

ObjectiveTo estimate smoking-related mortality and its contribution to educational inequalities in life expectancy in Spain.DesignNationwide, observational study from 2016 to 2019. Population-attributable fractions were used to estimate age, sex and education-specific cause-of-death smoking-attributable mortality. Life table techniques and decomposition methods were used to estimate potential gains in life expectancy at age 35 and the cause-specific contributions of smoking-related mortality to life expectancy differences across educational groups.SettingSpain.ParticipantsWe use cause-specific mortality data from population registers and smoking prevalence from the National and the European Health Survey for Spain from 2017 and 2019/2020, respectively.ResultsWe estimated 219 086 smoking-related deaths during 2016–2019, equalling 13% of all deaths, 83.7% of those in men. In the absence of smoking, potential gains in male life expectancy were higher among the low-educated than the high-educated (3.1 vs 2.1 years). For women, educational differences were less and also in the opposite direction (0.6 vs 0.9 years). The contribution of smoking to life expectancy differences between high-educated and low-educated groups accounted for 1.5 years among men, and −0.2 years among women. For men, the contribution of smoking to these differences was mostly driven by cancer in middle age, cardiometabolic diseases at younger ages and respiratory diseases at older ages. For women, the contribution to this gap, although negligible, was driven by cancer at older ages among the higher educated.ConclusionsSmoking remains a relevant preventable risk factor of premature mortality in Spain, disproportionately affecting life expectancy of low-educated men.