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Combustible tobacco users appear to be at greater risk for serious complications from COVID-19. This study examined cigar smokers' perceived risk of COVID-19, quit intentions, and behaviors during the current pandemic. We conducted an online study between 23 April 2020 to 7 May 2020, as part of an ongoing study examining perceptions of different health effects of cigars. All participants used cigars in the past 30 days (n = 777). Three-quarters of the sample (76.0%) perceived they had a higher risk of complications from COVID-19 compared to non-smokers. The majority of participants (70.8%) intended to quit in the next six months due to COVID-19, and almost half of the sample (46.5%) reported making a quit attempt since the start of the COVID-19 pandemic. Far more participants reported increasing their tobacco use since COVID-19 started (40.9%) vs. decreasing their tobacco use (17.8%). Black or African American participants, participants who reported using a quitline, and participants with higher COVID-19 risk perceptions had higher intentions to quit using tobacco due to COVID-19, and higher odds of making a quit attempt since COVID-19 started. More research is needed to understand how tobacco users are perceiving COVID-19 risks and changing their tobacco use behaviors.

Objectives: This study investigated a) racial/ethnic differences in past-year discrimination experiences and b) associations between discrimination and smoking abstinence., Design: Prospective, longitudinal analysis of smoking status. Perceived past-year discrimination was assessed at baseline. ANCOVAs and intent-to-treat hierarchical logistic regressions were conducted., Setting: Dual-site (Tampa, FL and Miami, FL) randomized controlled trial testing the effects of a group cessation intervention plus pharmacotherapy., Participants: Treatment-seeking adult smokers (N=347; non-Hispanic White, non-Hispanic African American/Black, or Hispanic)., Main Outcome Measures: Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately post-intervention and at 6-month follow-up., Results: After controlling for covariates, African Americans/Blacks reported greater perceived discrimination compared with non-Hispanic Whites (P=.02), and Hispanics (P=.06). Non-Hispanic Whites and Hispanics did not differ in perceived racial/ethnic discrimination experiences over the past year. Irrespective of race/ethnicity, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.97, CI: .95-.99) and at 6-months (AOR=.98, CI: .96-.99). Among African Americans/Blacks, past-year perceived discrimination was inversely associated with 7-day ppa, both post-intervention (AOR=.95, CI: .92-.97) and at 6-months (AOR=.97, CI: .94-.99). Perceived discrimination was unrelated to 7-day ppa among Hispanics. Among non-Hispanic Whites, past-year perceived discrimination was inversely associated with post-intervention 7-day ppa (AOR=.95, CI: .91-.99), but not 6-months., Conclusions: Perceived racial/ethnic discrimination was greater among African American/Black smokers compared with non-Hispanic Whites. Perceived discrimination was negatively associated with tobacco cessation in the full sample, and for African Americans at 6-months post-intervention. These data have implications for intervention delivery and health disparities., Competing Interests: Competing Interests: None declared., (Copyright © 2020, Ethnicity & Disease, Inc.)

Objectives: American Indian/Alaska Native (AI/AN) adults use smokeless tobacco products (eg, chewing and dip tobacco) more often than other racial/ethnic groups do. Although US adults increasingly use potentially reduced exposure tobacco products (PREPs), such as electronic cigarettes and snus, no studies have examined the use of PREPs among AI/AN smokeless tobacco users. We examined associations between current PREPs use and smokeless tobacco-related measures, including cessation attempts and cotinine levels, in a sample of American Indian adults who currently use smokeless tobacco., Methods: We collected survey and tobacco biomarker data from 299 adult American Indian smokeless tobacco users at Cherokee Nation health care facilities and events in 2016 and 2017. We used multivariable analyses to determine associations between current PREPs use and smokeless tobacco-related characteristics., Results: Current PREPs users were younger, less likely to be married or living with a partner, less likely to report a chronic medical condition, and more likely to report other tobacco use than PREPs nonusers. Among participants with annual household incomes ≤$30 000, current PREPs users were less likely than PREPs nonusers to report a definite desire to quit smokeless tobacco ( P = .02). PREPs use was not associated with planning to quit smokeless tobacco, past 12-month smokeless tobacco quit attempts, amount of smokeless tobacco used per week, cotinine levels, or scores on the Fagerström Test for Nicotine Dependence-Smokeless Tobacco., Conclusions: Our study suggests that American Indian smokeless tobacco users may not be using PREPs as a smokeless tobacco cessation aid. Future studies should take this finding into consideration when evaluating the role of PREPs use in smokeless tobacco cessation and in total tobacco cessation in this population.

Research suggests that women may have poorer tobacco cessation outcomes than men; however, the literature is somewhat mixed. Less is known about gender differences in cessation within quitline settings. This study examined gender differences in the utilization of services (i.e., coaching sessions, pharmacotherapy) and tobacco cessation among callers to the Arizona Smokers' Helpline (ASHLine). The study sample included callers enrolled in ASHLine between January 2011 and June 2016. We tracked number of completed coaching sessions. At the 7-month follow-up, callers retrospectively reported use of cessation pharmacotherapy (gum, patch, or lozenge), as well as current tobacco use. Associations between gender and tobacco cessation were tested using logistic regression models. At month 7, 36.4% of women (3,277/9,004) and 40.3% of men (2,960/7,341) self-reported 30-day point prevalence abstinence. Compared to men, fewer women reported using pharmacotherapy (women: 71.4% vs. men: 73.6%, p = .01) and completed at least five coaching sessions (women: 35.1% vs. men: 38.5%, p < .01). After adjusting for baseline characteristics, women had significantly lower odds of reporting tobacco cessation than men (OR = 0.91, 95% CI: 0.84 to 0.99). However, after further adjustment for use of pharmacotherapy and coaching, there was no longer a significant relationship between gender and tobacco cessation (OR: 0.96, 95% CI: 0.87 to 1.06). Fewer women than men reported tobacco cessation. Women also had lower utilization of quitline cessation services. Although the magnitude of these differences were small, future research on improving the utilization of quitline services among women may be worth pursuing given the large-scale effects of tobacco., (© Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Tobacco cessation is an important intervention to reduce mortality from ischemic heart disease, the leading cause of death in India. In this study, we explored facilitators, barriers, and cultural context to tobacco cessation among acute coronary syndrome (ACS, or heart attack) patients and providers in a tertiary care institution in the south Indian state of Kerala, with a focus on patient trajectories. Patients who quit tobacco after ACS expressed greater understanding about the link between tobacco and ACS, exerted more willpower at the time of discharge, and held less fatalistic beliefs about their health compared to those who continued tobacco use. The former were motivated by the fear of recurrent ACS, strong advice to quit from providers, and determination to survive and financially provide for their families. Systemic barriers included inadequate training, infrequent prescription of cessation pharmacotherapy, lack of ancillary staff to deliver counseling, and stigma against mental health services.

Objectives: To compare the tobacco use, exposure, and cessation differences between Bhutanese refugee and non-Hispanic Caucasian tobacco users in a US federally qualified health center tobacco cessation program., Design: A retrospective cohort study reviewing data from 374 patients counseled on tobacco cessation was performed. Demographic information, tobacco use history, exposure to tobacco, and type of tobacco used characterized baseline assessments. The patient record was followed forward in time to evaluate tobacco cessation outcomes as the dependent variable. Data were analyzed using odds ratios and the Mann-Whitney U-test., Results: Data analysis included 318 patients (211 non-Hispanic Caucasian patients and 107 Bhutanese refugee patients). Bhutanese refugees demonstrated a higher likelihood of smokeless tobacco product use than the non-Hispanic Caucasian population (67.3% vs 1%, OR = 214.971, 95% CI 50.429, 916.383), and a greater odds of having household tobacco users (OR = 2.533, 95% CI 1.532, 4.186). Likewise, the non-Hispanic Caucasian population exhibited larger odds of smoking cigarettes vs the Bhutanese population (97.2% vs 26.2%, OR = 96.399, 95% CI 38.449, 241.687), had a higher odds of passive smoke exposure (OR = 12.765, 95% CI 5.36, 30.393), and higher likelihood of a past quit attempt (OR = 9.037, 95% CI 5.180, 15.765). Significant gender differences with regard to type of tobacco used were noted among Bhutanese refugees. Bhutanese refugees demonstrated significantly higher likelihood of tobacco cessation, compared with the non-Hispanic Caucasian population, at all length cutpoints, while showing no difference in number of follow-up visits or median time followed., Conclusion: These culture-specific findings, showing unique tobacco use characteristics and increased cessation among the Bhutanese refugee population, provide novel information helpful to professionals identifying and treating these individuals for tobacco cessation. More research is needed to confirm our results and findings.

Racial/ethnic disparities in tobacco cessation are such that U.S. minorities have greater difficulty quitting compared to White non-Hispanics. Group differences in distress (i.e., perceived stress and depressive symptoms) may contribute to cessation disparities. The allostasis model of health suggests that the toll of chronic stress experienced by racial/ethnic minorities may lead to dysregulation of the physiological stress system and drug use. Previous research suggests that group cognitive behavioral therapy (CBT) for tobacco cessation addresses distress as a modifiable mechanism and has the potential to reduce/eliminate disparities. The present study is a dualsite randomized controlled trial aimed at evaluating the efficacy of group CBT in eliminating racial/ethnic differences in smoking cessation and distress. The study utilizes a [2 (intervention: group CBT or group general health education [GHE]) × 3 (race/ethnicity: African American/Black, Hispanic, White)] factorial design by randomizing 225 adult smokers from the community. Both interventions provide eight counseling sessions and eight weeks of nicotine patch therapy. Assessments occur at the end-of-therapy, and at 3-, 6-, and 12-months. Generalized longitudinal mixed modeling will be used to test our primary abstinence outcome, biochemically-confirmed 7-day point prevalence abstinence at 12-months. We hypothesize that group CBT will reduce or eliminate racial/ethnic differences in perceived stress, depressive symptoms, and smoking cessation compared to group GHE. We also hypothesize that reductions in physiological distress, assessed by salivary cortisol, will mediate racial/ethnic group differences in smoking cessation, particularly among racial/ethnic minorities. This study has implications for eliminating disparities in psychosocial factors related to tobacco use and cessation., Trial Registration: Clinicaltrials.govNCT02511236. Registered on July 27, 2015., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: African Americans suffer disproportionately from tobacco-related illness and have more difficulty quitting smoking than other racial/ethnic groups. Previous research indicates that African American treatment-seekers are high utilizers of tobacco quitlines, yet cessation rates via quitlines are lower relative to whites. The goal of the present study is to test the effectiveness of adding a culturally specific, video-based, adjunct to standard quitline care. It is hypothesized that the integration of an evidence-based intervention (Pathways to Freedom: Leading the Way to a Smoke-Free Community©; PTF) into quitline services will increase cessation and treatment engagement compared to control conditions, and that effects will be moderated by sociocultural factors (e.g., culturally specific intervention expectancies, acculturation, and ethnic identity)., Methods: This study is a 3-arm semi-pragmatic randomized controlled trial (RCT). Participants will be 1050 enrollees in the North Carolina State quitline (QuitlineNC) who self-identify as African American. Usual quitline care includes up to 4 proactive quit coaching calls, website access, and two-weeks of nicotine patch therapy. Eligible study participants will be randomized to receive (1) standard quitline services plus PTF (PTF); (2) quitline services plus a standard tobacco cessation DVD (attention control); or (3) quitline services alone (usual care). Assessments will be conducted at baseline, 3 and 6-months post-enrollment. The primary outcome will be biochemically verified 7 day ppa at 6-months. Generalized linear mixed models (GLMMs) and hierarchical logistic regression will be used to assess the effects of treatment group on cessation outcomes and to test potential moderators., Discussion: This study will answer questions regarding the implementation and effectiveness of integrating a culturally specific video intervention into a real-world, population-level tobacco intervention. It will also aid our understanding of individual-difference variables that are associated with success. If an incremental benefit is found, this trial will have implications for increasing the responsiveness of tobacco quitlines for African Americans, reducing tobacco cessation disparities, and best practices for improving minority health. In addition, the PTF intervention has the potential for widespread disseminated through quitlines, which are available across the United States., Trial Registration: Clinicaltrials.gov NCT03064971 . Registered on February 22, 2017.

Approximately 80,000 New York City smokers are Chinese or Russian speakers. To increase utilization of smoking cessation services among these populations, the Department of Health and Mental Hygiene developed linguistically and culturally tailored outreach strategies to promote and enhance its annual Nicotine Patch and Gum Program. In 2010, online web applications in Chinese and Russian were introduced. In 2011, input was sought from the community to develop Russian-language radio and newspaper ads, and a Russian-speaking liaison provided phone-assisted online enrollment support. In 2012, Chinese newspaper ads were introduced, and a Cantonese- and Mandarin-speaking liaison was hired to provide enrollment support. In 2010, 51 Russian speakers and 40 Chinese speakers enrolled in the program via web application. In 2011, 510 Russian speakers applied via the web application, with 463 assisted by the Russian-speaking liaison; forty-four Chinese speakers applied online. In 2012, 394 Russian speakers applied via the web application; 363 were assisted by the Russian-speaking liaison. Eighty-five Chinese smokers applied online via the web application; seventy were assisted by the Chinese-speaking liaison. Following the implementation of culturally tailored cessation support interventions, ethnic Russian smokers' uptake of cessation support increased tenfold, while Chinese smokers' uptake doubled. Although linguistically appropriate resources are an essential foundation for reaching immigrant communities with high smoking rates, devising culturally tailored strategies to increase quit rates is critical to programmatic success.

To test the efficacy of an intervention to reduce tobacco use among youth (10-19 years old) in slum communities in Delhi, India. This community-based cluster-randomized trial included 14 slums composed of purposely built resettlement colonies and adjacent inhabitant-built Jhuggi Jhopris. Youth in the intervention received a 2 year multiple-component intervention: (a) youth and adult leader training; (b) peer-led interactive activities and outreach; (c) tobacco cessation camps; and (d) enforcement of India's Tobacco Control Law (smoke-free environments and youth access). Overall, no differences between the intervention and control conditions were observed over time; self-reported tobacco use declined in both groups. However, when stratified by type of residence, a significant decrease was observed among youth in the resettlement colonies in the intervention group for overall tobacco use (slope = -0.69) and cigarette and bidi smoking (slope = -0.66), compared to an increase in the control group (slope = 0.24 and 0.12, respectively) (P < 0.001). No differences in smokeless tobacco (SLT) use were observed for either group. Comprehensive community-based interventions that engage youth can be effective in reducing smoking among disadvantaged youth in India. More intensive interventions, like tax increases or large-scale media campaigns, appear warranted for the most marginalized in this context and for SLT products., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

American Indian (AI) and Alaska Native (AN) communities confront some of the highest rates of tobacco use and its sequelae. As part of a formative research project investigating stakeholder understandings, preferences, and needs surrounding the use of pharmacogenetics toward tobacco cessation treatment, we sought to characterize sociocultural issues related to tobacco use and cessation. We used the PEN-3 cultural model to frame the research question and analysis of stakeholder interviews with 20 AI/AN patients, 12 health care providers, and 9 tribal leaders. Our study found high knowledge levels of the negative health effects of tobacco use; however, most patient participants ascribed negative health effects only to regular, heavy tobacco use and not to light use, which is more common in the population. The majority of patient participants did not endorse use of tobacco cessation treatment despite evidence of efficacy among AI/AN adults. Health promotion messaging to target low-tobacco consuming AI/AN people is needed. Additionally, messaging to promote tobacco cessation treatment using successful AI/AN former tobacco users to improve community perception of tobacco cessation treatment is recommended., (© 2016 Society for Public Health Education.)

Unlabelled: This commentary draws on the articles contained in this special African American youth and adult tobacco use supplement to better understand the apparent paradox of low youth smoking rates and high adult smoking rates. Implications for tobacco use prevention and control are discussed., Implications: This commentary introduces the reader to the topics and questions addressed in the supplement and urges an invigorated public health response to address tobacco-caused disease and death in African Americans., (Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: Until recently, in-language telephone quitline services for smokers who speak Asian languages were available only in California. In 2012, the Centers for Disease Control and Prevention (CDC) funded the national Asian Smokers' Quitline (ASQ) to expand this service to all states. The objective of this study was to examine characteristics of ASQ callers, how they heard about the quitline, and their use of the service., Methods: Characteristics of callers from August 2012 through July 2014 were examined by using descriptive statistics. We examined demographics, cigarette smoking status, time to first cigarette, how callers heard about the quitline, and service use (receipt of counseling and medication) by using ASQ intake and administrative data. We analyzed these data by language and state., Results: In 2 years, 5,771 callers from 48 states completed intake; 31% were Chinese (Cantonese or Mandarin), 38% were Korean, and 31% were Vietnamese. More than 95% of all callers who used tobacco were current daily cigarette smokers at intake. About 87% of ASQ callers were male, 57% were aged 45 to 64 years, 48% were uninsured, and educational attainment varied. Most callers (54%) were referred by newspapers or magazines. Nearly all eligible callers (99%) received nicotine patches. About 85% of smokers enrolled in counseling; counseled smokers completed an average of 4 sessions., Conclusion: ASQ reached Chinese, Korean, and Vietnamese speakers nationwide. Callers were referred by the promotional avenues employed by ASQ, and most received services (medication, counseling, or both). State quitlines and local organizations should consider transferring callers and promoting ASQ to increase access to cessation services.

Perceptions of tobacco are a relatively unexplored issue in disadvantaged populations in India and France. The objectives of this study included the following: obtain qualitative information on representations of tobacco use and cessation within two vulnerable populations; identify cultural factors that influence tobacco use and cessation; and acquire information for the development of effective tobacco cessation strategies. A total of 21 focus groups were conducted in India and France. All study participants were disadvantaged adults 18 years old or older. Sixty women resided in South Delhi in India and 163 adults with disabilities resided in the south of France. They were all current tobacco users. Data were collected by focus group and analysed with thematic coding. In both samples, the most relevant reasons of tobacco use were daily life circumstances, which were also a major barrier to quitting. None of the participants reported that quitting difficulties could be due to dependence or nicotine addiction. The data also suggested that whilst some participants wanted to stop, they also anticipated quitting would be extremely challenging. In addition, there were a number of cross-cultural differences between Indian and French disadvantaged people: level of information concerning the health risk related to tobacco use and level of demand for support to quit from health professionals were most often cited. Recommendations are made for a specific approach among disadvantaged people. The paper concludes that in order to facilitate cessation, tobacco control interventions need to focus on coping strategies to deal with feelings of distress, withdrawal symptoms, and the circumstances of everyday life experienced by disadvantaged tobacco users.

Introduction: Certain types of smokeless tobacco (ST) are popular among some people of South Asian origin in England; however, little is known about the contextual factors surrounding use in this population. This systematic review explores the factors associated with ST use among people of South Asian origin in England., Methods: An iterative search strategy in targeted databases and grey literature sources was conducted in the summer of 2011. Data extractions and quality assessments were completed and verified by two reviewers, and results were presented as a narrative., Results: A total of 2,968 references were screened by two reviewers who agreed on the inclusion of 14 studies. ST use is more prevalent among older participants who may have started chewing in India; however, the evidence suggests that some younger English-born South Asians are using ST as well. Reasons for chewing included the use of these products in times of stress, boredom or simply to relax. Traditional health messages and prior held beliefs may lead them to chew these products because of misconceptions about their health benefits, since very few people were aware of the health risks. Many expressed a desire to quit, however found it difficult to go without ST., Conclusion: This review examines the complex factors that underpin and influence ST use among South Asians in England with the potential of informing targeted interventions and health policy.

Introduction: Paan quid with tobacco (PQT) use is common in South Asian populations. Oral pain following a PQT cessation attempt is commonly reported. Factors determining this await full exploration., Methods: This prospective study of PQT chewers used a prepiloted interview and clinical examination. Oral pain, socioeconomic position, oral status, health service use, tobacco use and dependency, and psychological distress measures were collected from U.K.-resident Bangladeshi women before and after their quit attempts. Analysis included descriptive and analytic modeling of oral pain determinants, using multiple logistic regressions and a significance value p ≤ .05., Results: A total of 150 females (mean age 51.2 [SD = 13.7, range = 24-84] years) completed the study. Baseline oral pain prevalence was 39% and 73% at follow-up. Completed education level predicted baseline oral pain (OR = 3.43, 95% CI [1.66, 7.11], p = .001). Follow-up oral pain was predicted by completed education level (OR = 3.74, 95% CI [1.43, 9.79], p = .007), anxiety (OR = 3.52, 95% CI [1.23, 10.07], p = .019), choosing behavioral support alone in the cessation attempt (OR = 3.12, 95% CI [1.26, 8.70], p = .015), failure to stop tobacco chewing during the cessation attempt (OR = 4.16, 95% CI [1.44, 12.04], p = .009), and tooth wear (attrition) (OR = 5.71, 95% CI [1.84, 17.79], p = .003). Lower dependency level (OR = 0.79, 95% CI [0.64, 0.97], p = .023) was protective., Conclusion: Dental care access, nicotine replacement therapy, and anxiety management should be incorporated into cessation service delivery protocols to manage oral pain onset and facilitate successful cessation.

Aim: Emerging racial/ethnic disparities in tobacco use behaviors and resulting long-term health outcomes highlight the importance of developing culturally tailored/targeted tobacco prevention and cessation interventions. This manuscript describes the efficacy and the components of prevention and cessation interventions developed for minority adolescents., Methods: Thirteen studies focused on culturally tailoring and targeting tobacco prevention/cessation interventions were selected and information on intervention design (type, number of sessions), setting (school or community), theoretical constructs, culture-specific components (surface/deep structures), and treatment outcomes were extracted., Results: Of the 13 studies, 5 focused on prevention, 4 on cessation, and 4 combined prevention and cessation, and most of the studies were primarily school-based, while a few used community locations. Although diverse minority groups were targeted, a majority of the studies (n = 6) worked with Hispanic adolescents. The most common theoretical construct examined was the Social Influence Model (n = 5). The overall findings indicated that culturally tailoring cessation interventions did not appear to improve tobacco quit rates among minority adolescents, but culturally tailored prevention interventions appeared to produce lower tobacco initiation rates among minority adolescents than control conditions., Conclusions: The results of review suggest that there is a critical need to develop better interventions to reduce tobacco use among minority adolescents and that developing a better understanding of cultural issues related to both cessation and initiation of tobacco use among minority populations is a key component of this endeavor.

Aim:   To identify predictors of short-term smokeless tobacco cessation in Bangladeshi women resident in the United Kingdom., Design:   Prospective cohort study., Setting:   A tobacco cessation service offering culturally tailored smokeless tobacco cessation support., Participants:   A total of 419 Bangladeshi women chewing paan with tobacco., Measurements:   Demographics, tobacco use and dependence and cessation attempt process and outcomes., Findings:   Client mean age was 48.92 [95% confidence interval (CI) 47.5, 50.34] years and the mean area social deprivation score was 3.65 (95% CI 3.33, 3.97). Mean daily smokeless tobacco intakes, as paan, was 9.96 (95% CI 9.22, 10.7); 69.8% were recruited from primary care, 78.8% received behavioural support and nicotine replacement therapy (NRT) and the remainder behavioural support alone. Self-reported 4-week continuous abstinence was 58.3%, predicted by NRT use [odds ratio (OR) = 4.93, 95% CI 2.02, 12.00], community recruitment (OR = 1.84, 95% CI 1.01, 3.35) and relatively lower social deprivation (IMD) score (OR = 1.98, 95% CI 1.18, 3.33)., Conclusion:   Bangladeshi women in the UK attending clinics to help cessation of paan with tobacco appear to be more likely to be successful in the short term if they use nicotine replacement therapy, are recruited via the community and have relatively lower levels of social deprivation., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

Underuse of evidence-based treatment for smoking cessation, including use of nicotine replacement therapy (NRT), is widespread, particularly among minority smokers. This paper examines perceptions of NRT among and between racially and ethnically diverse groups of smokers. Nine focus groups were held among homogenous groups of African American, European American, and Hispanic smokers (N = 70). Specific themes included perceptions of: (a) the mechanism by which NRT works; (b) NRT development and regulation (ie, purpose and methods of clinical trials, Food and Drug Administration oversight, etc); (c) efficacy; (d) safety; and (e) overall cost effectiveness. Across all groups, there was a general lack of knowledge of NRT effects and its efficacy, with only moderate knowledge of the mechanism by which NRT works. Concerns about NRT safety were expressed in all groups, with particular apprehension about addictive potential and possible interactions with other medications. Among African American smokers in particular, there was strong suspicion of pharmaceutical industry and government oversight, which coincided with the consensus view that there are too many unknowns about NRT. Among Hispanic smokers, there was less suspicion of NRT but a strong cultural belief in personal responsibility for smoking cessation. Results highlight enduring misperceptions about NRT that likely undermine usage. More education about NRT is needed, not only about its efficacy and safety, but also with regard to its development and regulation. Health care professionals, many of whom are viewed as trustworthy sources of health information, have a particularly important role to promote wider use of proven cessation strategies.

Objective: To review available literature addressing the issue of whether smoking status of Indigenous Health Workers (IHWs) impedes provision of health information about smoking tobacco to their communities., Method: Databases were searched for publications that examined IHWs' smoking status or quit support programs for IHWs. Studies were categorised as reviews and commentaries, intervention studies or descriptive research., Results: Fourteen studies met inclusion criteria. Overall, the literature suggests that IHWs' smoking status is a barrier. However, the poor quality of most studies weakens the evidence for this conclusion. The issue of IHWs smoking status as a barrier is peripheral to all but two of the studies. Literature cited and reviewed was often not exhaustive and relied on only a few preceding empirical studies. Most studies were unclear about whether IHWs' views were reported as distinct from views of health staff in general., Conclusions and Implications: The recent COAG investment to Tackling Smoking is an important contribution to Closing the Gap in the health of Indigenous Australians. However, there remain potential barriers faced by IHWs that may undermine efforts to reduce Indigenous smoking. Overcoming these barriers and assisting IHWs to quit smoking may provide an opportunity to address high rates of smoking in Indigenous communities. Further research is required with a balance between descriptive research to assess the issue and intervention research to address it., (© 2011 The Authors. ANZJPH © 2010 Public Health Association of Australia.)

Background: Reducing racial and ethnic disparities in health care is an important national goal. Racial and ethnic differences in the delivery of tobacco-cessation services were examined in the course of visits to primary care physicians., Methods: In 2007, data about tobacco screening were analyzed from 29,470 visits by adult patients to 2153 physicians in the 2001-2005 National Ambulatory Medical Care Survey, a cross-sectional survey. Counseling was examined for visits by patients with known current tobacco use. Logistic regression models included age, gender, visit diagnoses, expected payment source, and past-year visits to the provider., Results: The respective percentages of visits with tobacco screening and counseling were 79.2% and 28.8% for non-Hispanic white patients, 79.3% and 29.2% for non-Hispanic black patients, 80.2% and 30.6% for non-Hispanic Asian patients, and 68.2% and 21.4% for Hispanic patients. In multivariable models, the adjusted difference between Hispanics and non-Hispanic whites in the percentage of visits with screening was -7.9 (95% CI=-15.5, -0.3) and of visits with counseling was -7.6 (95% CI=-15.2, 0.0)., Conclusions: Tobacco screening and counseling were less common at visits made by Hispanics compared to non-Hispanic whites. Traditional barriers to care among Hispanic patients, such as lack of insurance and more new-patient visits, did not explain the observed differences.

Objectives: To describe the development of a comprehensive tobacco cessation program for Alaska Native and American Indian patients in a primary care setting utilizing current evidence-based guidelines., Study Design: Cross-sectional., Methods: A multidisciplinary team was assembled with representation from various departments including customers of the health care system to develop the tobacco cessation program. Feedback and guidance from the team were implemented and quit rates were calculated., Results: In April 2005 the point prevalence of quitting among the 322 patients enrolled in the tobacco cessation program for 6 months was 21.1%., Conclusions: Recognized clinical interventions that reduce tobacco use were effective in reducing tobacco use among the Alaska Native and American Indian patients enrolled in the tobacco cessation program. Initial results with respect to the quit rate and tobacco use screening rate provide a baseline for future work.

This paper examines two major Soviet anti-smoking campaigns -- one in the 1920s and the other in the late 1970s. Each occurs in a period of demographic crisis as part of larger pubic health efforts. Each ultimately fails. In 1920, the leader of the People's Commissariat of Health, N. Semashko, began a campaign against tobacco with the support of V.I. Lenin. He proposed restrictions on access, use, and production of tobacco. Faced with the needs of the new state for economic stability, government officials abandoned the plan by 1921. In 1970, internal demographic concerns and increasing international evidence led the Ministry of Health to again attempt to stamp out tobacco. While policy was made, implementation was weak and the economic dislocations of the 1980s saw the vast importation of foreign brands to stabilize the government and the collapse of this second campaign against tobacco.

Objectives: A large proportion of smokers erroneously believe that low-nicotine/low-tar cigarettes, also called "light cigarettes" or "lights," reduce health risks and are a rational alternative to smoking cessation. However, the availability of light cigarettes may deter smoking cessation., Methods: We analyzed the 32374 responses to the US 2000 National Health Interview Survey. Current and former smokers ("ever-smokers") were asked if they had ever used a lower tar and nicotine cigarette to reduce health risks. Multivariable logistic regression identified determinants of lights use and smoking cessation. Results were weighted to reflect the national population., Results: Of 12285 ever-smokers, 37% (N=4414) reported having used light cigarettes to reduce health risks. Current abstinence was less often reported by ever-smokers who had previously used light cigarettes than by ever-smokers who had never used lights (37% vs 53%, P<.01). Adjusted odds of cessation among ever-smokers who had used light cigarettes relative to those who had never used lights were reduced by 54% (adjusted odds ratio=0.46, 95% confidence interval=0.41, 0.51)., Conclusions: Use of light cigarettes was common and was associated with lower odds of current smoking cessation, validating the concern that smokers may use lights as an alternative to cessation.

This research is designed to share valuable experiences and transferable principles from program staff of the Legacy/Community Voices initiative who have been involved in planning, implementing, evaluating, and sustaining tobacco control activities in underserved communities. Interviews were conducted with 13 front line staff from 9 sites: Alameda County, California; Detroit, Michigan; El Paso, Texas; Ingham County, Michigan; Miami, Florida; New Mexico; North Carolina; Northern Manhattan; and West Virginia. A model emerged from these interviews that places the life cycle of a program in a central position, with many of the identified themes (working with local champions, obtaining support from multiple partners, increasing organizational capacity) repeated throughout, albeit in different forms at different stages. Reflecting upon wisdom gained and identifying best processes for such work may help ensure that tobacco control programs are developed that are culturally safe and effective in meeting the needs of diverse communities throughout the United States.

Objective: The use of smokeless tobacco (ST) (snuff and chewing tobacco) has long been associated with baseball in the USA. This article reviews six years of survey data from major and minor league baseball players to evaluate trends in tobacco use and quitting patterns over time in order to gain insight into the effects of past interventions and to document continued intervention needs., Method: Surveys were distributed by athletic trainers to major and minor league professional baseball players during spring training session in the six years from 1998 to 2003. The surveys were anonymous and identified only by team, level of league, and other self reported demographic data., Results: ST use among professional baseball players remains much higher than among young males in the general population, and use is most prevalent among white non-Hispanic players. There was a significant decrease in ST use among minor league players from 1998 to 2003, with seven day self reported use declining from 31.7% in 1998 to 24.8% in 2003. No significant year to year changes were observed for major league players. Major league players' self reported past week use rates, estimated at 35.9% in 1998 and at 36% in 2003, were consistently higher than those of minor league players. Self reported prevalence of past month cigarette and cigar smoking was much lower than ST use for both major and minor league players., Conclusions: Six years of survey data confirm a continuing high use of ST among professional baseball players. Results suggest that the effects of the broad spectrum ST control efforts launched over the past decade may have been stronger among minor than major league players. Stronger policy interventions at the major league level and multi-level efforts, including programmes to increase the use of effective quitting aids and assistance, at both levels of play are needed. Future research is needed to further clarify changes in ST practices among professional players and set policy intervention directions.

Background: Tobacco dependence interventions developed for Alaska Natives are virtually nonexistent. Alaska Natives residing on the Yukon-Kuskokwim (Y--K) Delta in southwestern Alaska use a unique form of smokeless tobacco (ST) known as Iqmik. This study employed focus group methodology to explore attitudes toward tobacco use and tobacco dependence interventions among Alaska Natives residing on the Y-K Delta., Methods: Twelve focus groups of former and current tobacco users were conducted in four villages in the Y-K Delta. Participants were 35 adults (83% female) and 22 adolescents (27% female). Participants completed a brief demographic and tobacco use history form. Statements from the focus groups were transcribed for content coding and analysis of the major themes., Results: Use of Iqmik in the villages is thought to be ubiquitous. Y-K Delta Alaska Natives are introduced to Iqmik at a very young age. Iqmik is mostly used and prepared by young Alaska Natives and adult women. There are few perceived adverse health effects of Iqmik or other tobacco use. Although there is interest in stopping, there is a perceived lack of availability of tobacco dependence interventions. The major barriers to preventing the initiation of and stopping tobacco use are the social acceptance and widespread use and availability of tobacco., Conclusion: The attitudes toward tobacco and identified barriers to stopping will be useful in developing tobacco dependence interventions for Alaska Natives.

African-Americans experience a disproportionate share of tobacco-related diseases and death and have not received equal access to tobacco cessation and prevention services. The purpose of this study was to describe views of African-American nurses about tobacco control. This was a survey of a convenience sample of attendees of the 2002 annual meeting of the National Black Nurses Association. One hundred and sixty three (N=163) nurses participated in the survey. Eighty-one percent (81%) of these nurses reported that they should be involved in tobacco control efforts; 92% indicated nurses should help patients stop smoking; 63% encountered patients who smoked at least every week, but only 11% of these nurses actually provided counseling for smoking cessation. The majority (89%) of these respondents also noted that nurses needed additional training in tobacco control. African-American nurses can address the significant tobacco-induced health disparities experienced by African-Americans by helping to prevent tobacco use and helping patients stop smoking. The findings of this study support the critical need for nursing education in tobacco control.

This study reports the experience of oral pain and psychological distress following tobacco cessation in Bangladeshi women. A cross-sectional survey was carried out in which telephone interviews were conducted in the Sylheti language by two female Bangladeshi researchers using structured questionnaires. Study participants were 58 Bangladeshi women, aged 22-60 years, who had recently given up chewing paan-with-tobacco. The General Health Questionnaire (GHQ-12) was used to measure psychological distress. A questionnaire on pain description, location, duration, onset, and intensity also was administered. Logistic regression analysis was carried out to explore the relationships between psychological distress and age, chewing characteristics, and the oral pain experience. The response rate was 100%. Of the sample, 22% reported having pain for 2 days and 28% for at least 1 week, 65% reported that the pain started by itself, 69% reported the intensity as mild or discomforting, and 52% experienced psychological distress. Significant predictors for high psychological distress were number of daily paan (odds ratio, OR=1.13), current tooth problem (OR=4.60), pounding pain (OR=6.50), pain onset (OR=3.21), and pain intensity (OR=5.57). The prevalence of oral pain reported for Bangladeshi women following an attempt at chewing tobacco cessation is high. Characteristics of this outcome suggest the pain is of dental origin. These characteristics are correlated to psychological distress. The success of chewing tobacco cessation initiatives in the population may be influenced by oral pain and psychological distress. Further research is needed to explore the etiological factors associated with oral pain in this group of tobacco users.