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Introduction Chatbots emulate human-like interactions and may usefully provide on-demand access to tailored smoking cessation support. We have developed a prototype smartphone application-based smoking cessation chatbot, named Quin, grounded in real-world, evidence-, and theory-based smoking cessation counseling sessions. Methods Conversation topics and interactions in Quitline counseling sessions (N  = 30; 18 h) were characterized using thematic, content, and proponent analyses of transcripts. Quin was created by programming this content using a chatbot framework which interacts with users via speech to text. Reiterative changes and additions were made to the conversation structure and dialogue following regular consultation with a multidisciplinary team from relevant fields, and from evidence-based resources. Results Chatbot conversations were encoded into initial and scheduled follow-up "appointments." Collection of demographic information, and smoking and quit history, informed tailored discussion about pharmacotherapy preferences, behavioral strategies, and social and professional support to form a quit plan. Follow-up appointments were programmed to check in on user progress, review elements of the quit plan, answer questions, and solve issues. Quin was programmed to include teachable moments and educational content to enhance health literacy and informed decision-making. Personal agency is encouraged through exploration and self-reflection of users' personal behaviors, experiences, preferences, and ideas. Conclusions Quin's successful development represents a movement toward improving access to personalized smoking cessation support. Qualitative foundations of Quin provide greater insight into the smoking cessation counseling relationship and enhances the conversational ability of the technology. The prototype chatbot will be refined through beta-testing with end users and stakeholders prior to evaluation in a clinical trial. Implications Our novel study provides transparent description of the translation of qualitative evidence of real-world smoking cessation counseling sessions into the design and development of a prototype smoking cessation chatbot. The successful iterative development of Quin not only embodies the science and art of health promotion, but also a step forward in expanding the reach of tailored, evidence based, in-pocket support for people who want to quit smoking. [ABSTRACT FROM AUTHOR]

Telephone-based services are a practical and effective behavioral support for smoking cessation, yet no in-depth analyses of this counseling have been conducted. Understanding the general content of Quitline conversations can help to improve current practices and may inform future interventions. Therefore, we aimed to independently explore conversation themes, topics, and client questions during Quitline counseling sessions with Quitline clients in Queensland, Australia. A purposive sample of 30 recorded counseling sessions, completed between January and March 2019, were de-identified, transcribed, and thematically analyzed. Seven themes, encompassing 35 topics, were derived from 26 initial calls and four follow-up calls: (1) Client details and building rapport; (2) Client history and motivation to quit; (3) Pharmacotherapy; (4) Behavioral aspects of quitting and relationship with smoking; (5) Understanding nicotine dependence and other important considerations; (6) Additional support and smoking cessation resources; and (7) Planning, goal setting and follow-up. Three themes emerged from 18 client questions including (1) Pharmacotherapy safety and contraindications; (2) Pharmacotherapy instructions and mechanism of action; and (3) Physiology of nicotine dependence. This is the first qualitative analysis of the content of Quitline counseling sessions in Australia. Counselors collect and deliver a breadth of information to provide tailored, evidence-based health care, while building rapport and trust. Findings may be translatable into personalized self-help interventions that are more accessible or appealing to people reluctant to contact Quitline. Harnessing educational opportunities regarding pharmacotherapy adherence and misconceptions can improve client confidence in the product and smoking cessation outcomes. Further research will map conversations to motivational interviewing and behavior change techniques. [ABSTRACT FROM AUTHOR]

BackgroundAlthough many smoking cessation smartphone apps exist, few have been independently evaluated, particularly in older populations. In 2017, of the 112 commercially available smoking cessation apps in Australia, only 6 were deemed to be of high quality, in that they partially adhered to Australian guidelines. Mobile health (mHealth) apps have the potential to modify smoking behavior at a relatively low cost; however, their acceptability in older smokers remains unknown. Rigorous scientific evaluation of apps is thus urgently needed to assist smokers and clinicians alike. ObjectiveWe conducted a pilot randomized controlled trial to evaluate the feasibility of a large-scale trial to assess the use and acceptability of a high-quality smoking cessation app in older smokers. MethodsAdult inpatient and outpatient smokers with computer and smartphone access were recruited face to face and via telephone interviews from Metropolitan Hospitals in Brisbane, Australia. Participants were randomized 1:1 to the intervention (requested to download the “My QuitBuddy” smoking cessation app on their smartphone) or the control group (provided access to a tailored smoking cessation support webpage [Quit HQ]). The My QuitBuddy app is freely available from app stores and provides personalized evidenced-based smoking cessation support. Quit HQ offers regular email support over 12 weeks. No training or instructions on the use of these e-resources were given to participants. Outcomes at 3 months included recruitment and retention rates, use and acceptability of e-resource (User Version of the Mobile App Rating Scale [uMARS]), changes in quitting motivation (10-point scale), and self-reported smoking abstinence. ResultsWe randomized 64 of 231 potentially eligible individuals (27.7%). The mean age of participants was 62 (SD 8). Nicotine dependence was moderate (mean Heaviness of Smoking Index [HSI] 2.8 [SD 1.2]). At 3 months the retention rate was (58/64, 91%). A total of 15 of 31 participants in the intervention arm (48%) used the app at least once, compared with 10 of 33 (30%) in the control arm. uMARS scores for e-resource use and acceptability were statistically similar (P=.29). Motivation to quit was significantly higher in the intervention arm compared with the control arm (median 6 [IQR 4-8] versus 4 [IQR 4-5], respectively, P=.02). According to the intention-to-treat analysis, smoking abstinence was nonsignificantly higher in the intervention group (4/31 [13%], 95% CI 4%-30%, versus 2/33 [6%], 95% CI 1%-20%; P=.42). The estimated number needed to treat was 14. ConclusionsInternet and mHealth smoking cessation resources appear acceptable to a minority of older smokers. Smokers who engaged with the allocated e-resources rated them equally, and there were trends toward greater uptake, increased motivation, and higher abstinence rates in the app group; however, only the change in motivation reached statistical significance (median score 6 versus 4, respectively, P=.02). This results of this pilot study suggest that apps may improve quit outcomes in older adults who are willing to use them. Further research into user–app interactions should be undertaken to facilitate improvements in app design and consumer engagement. These favorable trends should be explored in larger trials with sufficient statistical power. Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12619000159156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376849&isReview=true

Tobacco control policies reinforce a health imperative that positions citizens as duty-bound to manage their health by abstaining from or quitting smoking. Limited attention is paid to the repercussions – especially for lung screening – of anti-smoking rhetoric emphasising individual responsibility. Drawing on interviews with 27 long-term smokers involved in an international lung screening trial, this study analysed Australian smokers' narratives of smoking. By attending to stigma and the use of public health rhetoric within personal narratives, we show how narratives underscoring individual responsibility for quitting were layered with conflicting explanations of biological responsibility and normative expectations. Ironically, narratives of individual responsibility potentially undermine smoking cessation. In positioning smokers as responsible for their own healthy choices, such rhetoric also positions smokers as responsible for managing their emotional health, which some did through smoking. Thus, anti-smoking campaigns pit the neoliberal imperative of health against the happiness imperative. These findings have implications for the design and delivery of lung screening campaigns. They also support calls to move beyond health messaging emphasising individual choice, towards acknowledging the moral power of structures and public health campaigns to discipline citizens in unintended ways. [ABSTRACT FROM AUTHOR]

Background: Smoking cessation is an important screening component, but the evidence base to inform implementation is lacking. We report longitudinal smoking behavior in an Australian screening cohort and examine predictor variables associated with continued smoking. Methods: Healthy current or former smokers (quit less than 15 years and ≥30‐pack year smoking history) aged 60–74 years underwent CT screening at baseline, year 1 and year 2. Participants received brief smoking cessation advice and generic Quitline materials. Smoking status was self‐reported every 6 months for 5 years. Mediators of smoking behavior, adjusted for sociodemographic, health and scan variables were explored using logistic regression modeling. Results: Two hundred thirty‐five participants were analyzed. One hundred eight (46%) were current smokers at enrolment. At baseline, current smokers' mean Fagerström Test for Nicotine Dependence was 4.9, and they had higher levels of lung cancer‐specific distress and passive smoke exposure than former smokers. At 36 months, 33% of baseline smokers achieved sustained (≥6 months) smoking abstinence. Five (4%) former smokers relapsed at any point during the study. Continued smoking was positively associated with greater nicotine dependence and smoking pack‐years, and negatively associated with cardiovascular disease, stroke, and lung cancer family history. Conclusions: This study provides the first data on smoking cessation rates in Australian lung cancer screenees and supports screening as a teachable moment. We identify several factors that identify smokers who may require more intensive smoking cessation interventions and could be used to develop effective smoking cessation as part of lung cancer screening, tailored to individual risk profiles. [ABSTRACT FROM AUTHOR]

Motivational interviewing (MI) is a common approach for smoking cessation counselling, yet little is known about the use of MI techniques in practice. This qualitative content analysis applied a published classification of content and relational MI techniques to a sample of 30 Quitline transcripts (January-March 2019) from Queensland, Australia. Overall, 36 MI techniques (94.7%) were identified at least once within the total sample. On average, 20 techniques (52.6%) were used in an individual conversation with a small difference observed between initial and follow-up calls. Techniques most frequently applied across conversations were largely relational, while techniques addressing client ambivalence/resistance were less frequently/never applied. Variability in techniques between individual initial and follow-up calls highlights the high degree of personalisation when applying MI to smoking cessation. Further investigations exploring associations of individual techniques and cessation outcomes are warranted. The classification may prove useful for assessments of fidelity for training and monitoring activities. [ABSTRACT FROM AUTHOR]

Mycobacterium lentiflavum organisms are nontuberculous mycobacteria (NTM) first identified in 1996 (1). M. lentiflavum is slow growing at 22°C-37°C and has yellow pigmentation, negative tests for Tween 80 hydrolysis, nicotinic [...]

Introduction: Mobile smoking cessation (mCessation) apps have the potential to complement and enhance existing interventions, but many are of low quality. Exploring app reviews can provide a broader understanding of user experiences and engagement, to enhance the quality, acceptability, and effectiveness of future developments.Methods: Publicly available user reviews and ratings of smoking cessation apps were mined from Google Play and the App Store via a targeted two-stage search strategy. English language smoking cessation apps with at least 20 consumer reviews between 2011 and 2020 were included. User reviews were thematically analyzed using Braun and Clarke's framework. Apps were independently scored using the Mobile Apps Rating Scale (MARS) and compared to average user star ratings.Results: Forty-eight versions of 42 apps, encompassing 1414 associated reviews, met eligibility criteria. Inductive coding of reviews produced 1084 coding references including reviews coded across multiple nodes. Themes generated included: (1) supportive characteristics/tools; (2) useability; (3) influence on smoking behavior; (4) benefits of quitting; and (5) role as a supplementary tool for quitting. The mean MARS score of 36 free and accessible apps was 3.10 (SD 0.71) with mean scores ranging from 2.00 to 4.47. An inverse relationship between MARS scores and average user star ratings was observed.Conclusions: App personalization, relationality, functionality, and credibility were important to users, and should be considered as key design components for future apps. Differences between user star ratings and MARS scores may illustrate competing priorities of consumers and researchers, and the importance of a codesign development method.Implications: This is the first study to use unsolicited user reviews from a large population to understand the general mCessation user experience in relation to making a quit attempt. Our findings highlight specific features favored and disliked by users, including their influence on engagement, and supports previous findings that mCessation applications need to be highly tailorable, functional, credible, and supportive. We recommend a consumer-driven, co-design approach for future mCessation app developments to optimize user acceptability and engagement. [ABSTRACT FROM AUTHOR]