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CORK Bibliography: Smoking Cessation



129 citations. January 2012 to present

Prepared: June 2012



Amole J; Heath J; Joshua TV; McLear B. Online tobacco cessation education to optimize standards of practice for psychiatric mental health nurses. Nursing Clinics of North America 47(1): 71-80, 2012. (33 refs.)

This article presents an overview of an online education offering to improve standards of practice for nurses intervening with tobacco-dependent mentally ill populations. Designed as a pilot study and guided by the theory of reasoned action framework, the pretest-posttest educational program was conducted to examine attitudes and beliefs, knowledge, and intentions to integrate tobacco cessation interventions into practice. Although positive attitudes and beliefs were demonstrated, knowledge gaps continued to exist after the online program. Strengths and challenges of the online education offering are presented with recommendations for future research.

Copyright 2012, W B Saunders


Andersson P; Westergren A; Johannsen A. The invisible work with tobacco cessation: Strategies among dental hygienists. International Journal of Dental Hygiene 10(1): 54-60, 2012. (29 refs.)

Objective: This study elucidates dental hygienists' experiences of work with tobacco cessation among patients who smoke or use snuff. Methods: Data were obtained and categorized by interviewing 12 dental hygienists, who worked actively with tobacco cessation interventions. Qualitative content analysis was used for analysis. Results: The latent content was formulated into the core category 'the invisible oral health promotion work'. The informants thought that they had a responsibility to work with tobacco cessation. They perceived the financial system in which they perform the activity as frustrating, because tobacco cessation has no treatment code in the dental care insurance. This was one of several reasons why they had to integrate it in other treatment procedures. The results identified three categories: 'balance in the meeting', 'possibilities and hindrance' and 'procedures'. In the narratives, both positive and negative aspects were displayed. Conclusions: The financial conditions for tobacco cessation interventions need to be reformed and the activity has to be given a higher priority in the organization of dental care. Practical training in performing tobacco cessation interventions is important during the dental hygiene education; otherwise, tobacco cessation interventions will remain invisible in oral health promotion in the future.

Copyright 2012, Wiley-Blackwell


Andrews JO; Newman SD; Heath J; Williams LB; Tingen MS. Community-based participatory research and smoking cessation interventions: A review of the evidence. (review). Nursing Clinics of North America 47(1): 81-96, 2012. (47 refs.)

This article reviews the evidence of the use of community-based participatory research (CBPR) and smoking cessation interventions. An overview of CBPR is provided, along with a description of the search methods and quality scoring. Research questions are explored to determine if CBPR improves the quality of research methods and community involvement in cessation intervention studies and cessation outcomes when using CBPR approaches. Results of the review are provided along with a comprehensive table summarizing all the included studies. Strengths and challenges of the CBPR approach are presented with recommendations for future research.

Copyright 2012, W B Saunders


Antal M; Forster A; Zalai Z; Barabas K; Ramseier C; Nagy K. Attitudes of Hungarian dental professionals to tobacco use and cessation. Central European Journal of Public Health 20(1): 45-49, 2012. (26 refs.)

Smoking is the most preventable cause of death worldwide. The regularity of visits of patients to dental offices offers a valuable contact for health professionals and the healthcare system to initiate anti-smoking activity. However, these contacts remain unutilized and there is little interaction between doctor and patient with regard to prevention of smoking and its consequences. The aim of this study was to evaluate the current situation and attitudes towards smoking and giving up smoking among dental professionals. A survey was carried out in the sample consisting in total of 342 participants, 212 students of dentistry and 130 dentists. Students were asked to complete a questionaire during the enrolment period; dentists were asked to complete the questionnaire while attending an annual compulsory in-service training course at the University of Szeged. The data were analysed statistically using SPSS 10.0 software, significance was tested using the Mann-Whitney U test and results were compared with data from a similar study conducted by the same research group in 2004 in which general knowledge and attitude towards smoking and giving up smoking was measured and evaluated. Results demonstrated that there is a lower number of smokers among dental professionals (dentists: 22.3%; students: 20.3%) than in the Hungarian general population and high interest in encouraging and assisting patients in giving up smoking (dentists: 45%; students: 54%). Comparing the results of this study to earlier data collated in 2004, we find a decreasing ratio of smokers among students (34% in 2004 and 20.3% in 2011). An increasing need for information about smoking cessation, tobacco related health hazards and the lack of detailed knowledge about methods and patient education were identified.

Copyright 2012, National Institue of Public Health, Czech Republic


Asfar T; Ebbert JO; Klesges RC; Klosky JL. Use of smoking reduction strategies among US tobacco quitlines. Addictive Behaviors 37(4): 583-586, 2012. (20 refs.)

Introduction: Tobacco quitlines (QLs) are efficacious and have assisted many smokers in achieving tobacco abstinence. However, most smokers are not able to achieve tobacco abstinence with QL services. QL counseling interventions for smokers who do not quit on their target quit date (TQD) and decline to set a new TQD after missing their TQD have not been systematically evaluated. Methods: A telephone survey of tobacco QLs in the United States (US) was conducted to examine systematic approaches used with smokers who do not quit on their TQD and decline to set a new TQD. Tobacco QLs service providers were identified through the North American Quitline Consortium (NAQC). Results: Fourteen service providers managing QLs of all 50 US states were identified and completed the voluntary survey. All providers recommended setting a new quit TQD if smokers did not achieve smoking cessation by their initial TQD. Six percent of US state QLs used brief motivational interviewing utilizing the "5R's" (relevance, risk, rewards, roadblocks, repetition). However, 90% of QLs had intervention protocols emphasizing smoking rate reduction. Conclusion: Although some US QLs utilized the "5Rs," the majority provided smoking reduction interventions for smokers not achieving tobacco cessation by their initial TQD and declining to set a new TQD. Reseaarch is needed to evaluate the efficacy of smoking rate reduction methods implemented through QLs for increasing smoking abstinence rates.

Copyright 2012, Elsevier Science


Asthana A; Piper ME; McBride PE; Ward A; Fiore MC; Baker TB et al. Long-term effects of smoking and smoking cessation on exercise stress testing: Three-year outcomes from a randomized clinical trial. American Heart Journal 163(1): 81-U110, 2012. (40 refs.)

Background The long-term effects of smoking and smoking cessation on markers of cardiovascular disease (CVD) prognosis obtained during treadmill stress testing (TST) are unknown. The purpose of this study was to evaluate the long-term effects of smoking cessation and continued smoking on TST parameters that predict CVD risk. Methods In a prospective, double-blind, randomized, placebo-controlled trial of 5 smoking cessation pharmacotherapies, symptom-limited TST was performed to determine peak METs, rate-pressure product (RPP), heart rate (HR) increase, HR reserve, and 60-second HR recovery, before and 3 years after the target smoking cessation date. Relationships between TST parameters and treatments among successful abstainers and continuing smokers were evaluated using multivariable analyses. Results At baseline, the 600 current smokers (61% women) had a mean age of 43.4 (SD 11.5) years and smoked 20.7 (8.4) cigarettes per day. Their exercise capacity was 8.7 (2.3) METs, HR reserve was 86.6 (9.6)%, HR increase was 81.1 (20.9) beats/min, and HR recovery was 22.3 (11.3) beats. Cigarettes per day and pack-years were independently and inversely associated with baseline peak METs (P < .001), RPP (P < .01, pack-years only), HR increase (P < .05), and HR reserve (P < .01). After 3 years, 168 (28%) had quit smoking. Abstainers had greater improvements than continuing smokers (all P b.001) in RPP (2,055 mm Hg beats/min), HR increase (5.9 beats/min), and HR reserve (3.7%), even after statistical adjustment (all P < .001). Conclusions Smokers with a higher smoking burden have lower exercise capacity, lower HR reserve, and a blunted exercise HR response. After 3 years, TST improvements suggestive of improved CVD prognosis were observed among successful abstainers.

Copyright 2012, Elsevier Science


Aubin HJ; Rollema H; Svensson TH; Winterer G. Smoking, quitting, and psychiatric disease: A review. (review). Neuroscience and Biobehavioral Reviews 36(1): 271-284, 2012. (244 refs.)

Tobacco smoking among patients with psychiatric disease is more common than in the general population, due to complex neurobiological, psychological, and pharmacotherapeutic mechanisms. Nicotine dependence exposes smokers with co-occurring mental illness to increased risks of smoking-related morbidity, mortality, and to detrimental impacts on their quality of life. The neurobiological and psychosocial links to smoking appear stronger in certain comorbidities, notably depression and schizophrenia. Through its action on the cholinergic system, nicotine may have certain beneficial effects across a range of mental health domains in these patients, including improved concentration and cognition, relief of stress and depressive affect, and feeling pleasurable sensations. Despite the availability of effective smoking cessation pharmacotherapies and psychosocial interventions, as well as increasing evidence that individuals with psychiatric disorders are motivated to quit, nicotine dependence remains an undertreated and under-recognized problem within this patient population. Evidence suggests that provision of flexible and individualized treatment programs may be successful. Furthermore, the complicated relationship observed between nicotine dependence, nicotine withdrawal symptoms, and mental illness necessitates integration of close monitoring in any successful smoking cessation program.

Copyright 2012, Elsevier Science


Aveyard P; Raw M. Improving smoking cessation approaches at the individual level. (editorial). Tobacco Control 21(2): 252-257, 2012. (73 refs.)


Barbouni A; Hadjichristodoulou C; Merakou K; Antoniadou E; Kourea K; Miloni E et al. Tobacco use, exposure to secondhand smoke, and cessation counseling among health professions students: Greek data from the Global Health Professions Student Survey (GHPSS). International Journal of Environmental Research and Public Health 9(1): 331-342, 2012. (18 refs.)

We conducted the GHPSS (Global Health Professions Student Survey) to obtain information regarding health profession students' smoking habits and perceptions, exposure to secondhand smoke (SHS) as well as level of knowledge and training on tobacco use and smoking cessation counseling. GHPSS is a survey for third-year students in the following fields: health visitors, dentistry, medicine, nursing and/or pharmacy. The highest tobacco use prevalence rate and exposure to SHS were recorded among health visitor students with 46.4% and 33.3% respectively. The majority of the respondents believed that their profession serves as a role model for their patients. Formal training on cessation counseling ranged between 10.7% for health visitor students to 22.4% for nursing students. The relatively high percentage of health profession students who currently smoke and the alarmingly high percentage of those exposed to SHS indicate lack of concerted efforts for implementation and effective enforcement of the anti-tobacco policy measures. Despite its significance, formal training on cessation counseling for students is strikingly low. These results indicate the urgent need to train health professional students on tobacco cessation counseling and educate them on the dangers of tobacco use, SHS and the positively influential role they can play to affect their patients' smoking habits.

Copyright 2012, MDPI AG


Berg CJ; Ling PM; Hayes RB; Berg E; Nollen N; Nehl E et al. Smoking frequency among current college student smokers: Distinguishing characteristics and factors related to readiness to quit smoking. Health Education Research 27(1): 141-150, 2012. (61 refs.)

Given the increased prevalence of non-daily smoking and changes in smoking patterns, particularly among young adults, we examined correlates of smoking level, specifically motives for smoking, and readiness to quit smoking among 2682 college undergraduates who completed an online survey. Overall, 64.7% (n = 1736) were non-smokers, 11.6% (n = 312) smoked 1-5 days, 10.5% (n = 281) smoked 6-29 days and 13.2% (n = 353) were daily smokers. Ordinal regression analyses modeling smoking level indicated that correlates of higher smoking level included having more friends who smoke (beta = 0.63, 95% CI 0.57-0.69) and more frequent other tobacco use (beta = 0.04, 95% CI 0.02-0.05), drinking (beta = 0.04, 95% CI 0.02-0.07) and binge drinking (beta = 0.09, 95% CI 0.06-0.13). Bivariate analyses indicated that daily smokers (versus the subgroups of non-daily smokers) were less likely to smoke for social reasons but more likely to smoke for self-confidence, boredom, and affect regulation. Controlling for sociodemographics, correlates of readiness to quit among current smokers included fewer friends who smoke (P = 0.002), less frequent binge drinking (P = 0.03), being a social smoker (P < 0.001), smoking less for self-confidence (P = 0.04), smoking more for boredom (P = 0.03) and less frequent smoking (P = 0.001). Specific motives for smoking and potential barriers to cessation particularly may be relevant to different groups of college student smokers.

Copyright 2012, Oxford University Press


Berg CJ; Thomas JL; An LC; Guo HF; Collins T; Okuyemi KS et al. Change in smoking, diet, and walking for exercise in Blacks. Health Education & Behavior 39(2): 191-197, 2012. (43 refs.)

Positive changes in one health behavior may be accompanied by other constructive health behavior changes. Thus, the authors investigated the association of smoking reduction and cessation to changes in fruit and vegetable (FV) intake and engaging in walking for exercise. This study included 539 Black light smokers (<= 10 cigarettes per day >= 25 days/month) enrolled in a 2 x 2 factorial study (placebo vs. nicotine gum, health education vs. motivational interviewing). Reducing cigarette consumption (p = .02) and quitting smoking (p < .01), as well as receiving the nicotine gum (p = .04), was associated with increased FV intake, after controlling for baseline FV intake. Compared with those who did not reduce their smoking, both reducers (p < .001) and quitters (p < .001) were more likely to walk for exercise at follow-up, after controlling for baseline walking status (p = .01). Thus, addressing one health risk behavior may prompt other positive health behaviors, which may argue for developing interventions targeting multiple health risk behaviors.

Copyright 2012, Sage Publications


Berlin I. Varenicline in stopping long-term nicotine use. American Journal on Addictions 21(2): 182-183, 2012. (6 refs.)

There has been concern about the use of nicotine replacement therapies for longer than intended due to the nicotine dependence. This is a case report of a woman with a long-standing nicotine dependence, who was using buccal absorption nicotine replacement and then turned to nicotine lozenges. She also had a history of serious depression. Under c lose supervision and frequent contact with her physician she began the use of varenicline to cease the use of the nicotine lozenges.

Copyright 2012, American Academy of Addiction Psychiatry


Bock BC; Fava JL; Gaskins R; Morrow KM; Williams DM; Jennings E et al. Yoga as a complementary treatment for smoking cessation in women. Journal of Women's Health 21(2): 240-248, 2012. (74 refs.)

Background: Tobacco smoking remains the leading preventable cause of death among American women. Aerobic exercise has shown promise as an aid to smoking cessation because it improves affect and reduces nicotine withdrawal symptoms. Studies outside the realm of smoking cessation have shown that yoga practice also reduces perceived stress and negative affect. Methods: This pilot study examines the feasibility and initial efficacy of yoga as a complementary therapy for smoking cessation. Fifty-five women were given 8-week group-based cognitive behavioral therapy for smoking cessation and were randomized to a twice-weekly program of Vinyasa yoga or a general health and wellness program (contact control). The primary outcome measure was 7-day point prevalence abstinence at the end of treatment validated by saliva cotinine testing. Longitudinal analyses were also conducted to examine the effect of intervention on smoking cessation at 3- and 6-month follow-up. We examined the effects of the intervention on potential mediating variables (e. g., confidence in quitting smoking, self-efficacy), as well as measures of depressive symptoms, anxiety, and perceived health (SF-36). Results: At end of treatment, women in the yoga group had a greater 7-day point-prevalence abstinence rate than controls (odds ratio [OR], 4.56; 95% CI, 1.1-18.6). Abstinence remained higher among yoga participants through the six month assessment (OR, 1.54; 95% CI, 0.34-6.92), although differences were no longer statistically significant. Women participating in the yoga program also showed reduced anxiety and improvements in perceived health and well-being when compared with controls. Conclusions: Yoga may be an efficacious complementary therapy for smoking cessation among women.

Copyright 2012, Mary Ann Liebert


Bogdanovica I; Murray R; McNeill A; Britton J. Cigarette price, affordability and smoking prevalence in the European Union. Addiction 107(1): 188-196, 2012. (34 refs.)

Aims: To describe current and recent changes in cigarette affordability across the current 27 European Union (EU) Member States, and to assess the impact of these changes on smoking prevalence in countries that were EU members in 2004 (old Member States) compared to countries that have joined since 2004 (new Member States). Design Investigation of cigarette affordability using the minutes of labour measure, and comparisons of changes in affordability, tax and smoking prevalence in old and new EU Member States. Participants Current 27 EU Member States. Settings European Union. Measurements Cigarette prices, overall tax yield and incidence, hourlywages and smoking prevalence in the EU were obtained from published sources, and the affordability of the EU Most Popular Price Category (MPPC) cigarettes estimated as the number of minutes of labour required to earn the price of 20 cigarettes in the years 2003, 2006 and 2009. Findings: The mean [standard deviation (SD)] number of minutes of labour required to purchase 20 MPPC cigarettes in EU Member States in 2009 was 31.3 (SD 10.7), but ranged fourfold across the EU, and was significantly higher in new than old Member States. The number of minutes of labour measure increased more, although not significantly so, between 2003 and 2009 in new [mean (SD) 12.1 (10.9)] than in old [6.7 (4.0)] Member States, largely because of proportionately higher increases in taxation. However, there was no correlation between change in affordability and change in smoking prevalence in recent years. Conclusions: Cigarette affordability varies substantially and cigarettes are generally becoming less affordable in European Union Member States. However, these reductions in affordability do not appear to have impacted substantially on smoking prevalence in recent years.

Copyright 2012, Society for the Study of Addiction


Borland R; Li L; Driezen P; Wilson N; Hammond D; Thompson ME et al. Cessation assistance reported by smokers in 15 countries participating in the International Tobacco Control (ITC) policy evaluation surveys. Addiction 107(1): 197-205, 2012. (19 refs.)

Aims: To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support. Design Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave ( or later, where necessary). Settings Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States. Participants Samples of smokers from 15 countries. Measurements Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits. Findings: Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (< 20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available. Conclusions: There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.

Copyright 2012, Society for the Study of Addiction


Borland R; Partos TR; Yong HH; Cummings KM; Hyland A. How much unsuccessful quitting activity is going on among adult smokers? Data from the International Tobacco Control Four Country cohort survey. Addiction 107(3): 673, 2012. (24 refs.)

Aims: To document accurately the amount of quitting, length of quit attempts and prevalence of plans and serious thought about quitting among smokers. Design We used longitudinal data from 7 waves of the International Tobacco Control Policy Evaluation Four Country Survey (ITC-4). We considered point-prevalence data and cumulative prevalence over the 7 years of the study. We also derived annual estimates of quit activity from reports of quit attempts starting only within more recent time-frames, to control for biased recall. Setting: Australia, Canada, the United Kingdom and the United States. Participants A total of 21 613 smokers recruited across seven waves. Measurements Reported life-time quit attempts, annual quit attempts, length of attempts, time since last attempt started, frequency of aborted attempts, plans to quit and serious thought about quitting. Findings: Around 40.1% (95% CI: 39.6-40.6) of smokers report attempts to quit in a given year and report an average of 2.1 attempts. Based on free recall, this translates to an average annual quit attempt rate of 0.82 attempts per smoker. Estimates derived only from the preceding month to adjust for recall bias indicate an annual rate of approximately one attempt per smoker. There is a high prevalence of quit-related activity, with more than a third of smokers reporting thoughts or actions related to quitting in a given month. More than half the surveyed smokers eventually succeeded in quitting for at least 1 month, and a majority of these for over 6 months. Conclusions Smokers think a great deal about stopping and make many unsuccessful quit attempts. Many have been able to last for extended periods and yet they still relapsed. More attention needs to be focused on translating quit-related activity into long-term abstinence.

Copyright 2012, Society for the Study of Addiction


Bottorff JL; Haines-Saah R; Oliffe JL; Sarbit G. Gender influences in tobacco use and cessation interventions. Nursing Clinics of North America 47(1): 55-70, 2012. (97 refs.)

Smoking rates among and between men and women are in large part a reflection of the influence of gender and its intersections with other social factors including ethnicity, age, and social class that influence tobacco use and, ultimately, tobacco reduction and cessation. In this article, opportunities for developing and delivering gender-sensitive (programs addressing gender) and gender-specific (programs designed for men or women) interventions in the context of tobacco dependence treatment are discussed.

Copyright 2012, W B Saunders


Bousman CA; Rivard C; Den Haese J; Ambrosone C; Hyland A. Alpha-5 and-3 nicotinic receptor gene variants predict nicotine dependence but not cessation: Findings from the COMMIT cohort. American Journal of Medical Genetics. Part B-Neuropsychiatric Genetics 159B(2): 227-235, 2012. (38 refs.)

Smoking many cigarettes per day (CPD) and short interval to first cigarette (TTF) after waking are two of the most heritable smoking phenotypes and comprise the Heavy Smoking Index (HSI). These phenotypes are often used as proxies for nicotine dependence (ND) and are associated with smoking cessation outcomes. Case control and genome-wide association studies have reported links between single nucleotide polymorphisms (SNPs) in the alpha-5 and -3 nicotinic receptor subunit (CHRNA5 and CHRNA3) genes and CPD but few have examined TTF or cessation outcomes. In this study we longitudinally assessed 1301 European-American smokers at four time-points from 1988 to 2005. One CHRNA5 (rs16969968) and two CHRNA3 (rs1051703, rs6495308) SNPs were examined for their ability to predict smokers who ever reported ND based on three phenotypic classifications: (1) 25+ CPD, (2) TTF<10 min, and (3) HSI=4. In a subsample of 1157 quit attempters, we also examined each SNP's ability to predict ever quitting for a period of >6 months. Demographically adjusted logistic regressions showed significant allelic and genotypic associations between all three SNPs and CPD but not TTF, HSI, or smoking cessation. Carriers of both the rs16969968-AA and rs6495308-TT genotypes had approximately twofold greater odds for ND defined using CPD or TTF. Results suggest nicotinic receptor variants are associated with greater odds of ND according to CPD and to a lesser extent TTF. Research examining the effect of nicotinic receptor genetic variation on ND phenotypes beyond CPD is warranted.

Copyright 2012, Wiley-Blackwell


Butler KM; Fallin A; Ridner SL. Evidence-based smoking cessation for college students. Nursing Clinics of North America 47(1): 21-30, 2012. (57 refs.)

Despite a strong stance by the American College Health Association and years of prevention and control efforts on US college campuses, smoking and exposure to secondhand smoke remain a problem among college students. This article provides an overview of what is known about cigarette smoking in this population as well as existing interventions for smoking prevention, cessation, and exposure to secondhand smoke on college campuses. Strategies to reduce tobacco use are presented, many of which have been demonstrated to be effective in the short-term.

Copyright 2012, W B Saunders


Butler KM; Hedgecock S; Record RA; Derifield S; McGinn C; Murray D et al. An evidence-based cessation strategy using rural smokers' experiences with tobacco. Nursing Clinics of North America 47(1): 31-54, 2012. (36 refs.)

Little is known about the most effective strategies to motivate rural smokers to quit. This article describes the personal narratives of current and former smokers living in an economically distressed, rural area of Appalachian Kentucky. Three categories emerged: personal motivators to quit smoking, external influences, pride of place. Capturing personal narratives represents an evidence-based, data-rich strategy for development of culturally sensitive, population-based interventions for rural smokers. Such strategies may be effective in reaching rural smokers and motivating them to quit, thereby reducing tobacco-related disease and premature death in rural, economically distressed communities.

Copyright 2012, W B Saunders


Cahill K; Stead LF; Lancaster T. Nicotine receptor partial agonists for smoking cessation. (review). Cochrane Database of Systematic Reviews 4: article CD006103, 2012. (205 refs.)

Background: Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). Objectives The primary objective of this review is to assess the efficacy and tolerability of nicotine receptor partial agonists, including cytisine, dianicline and varenicline for smoking cessation. Search methods We searched the Cochrane Tobacco Addiction Group's specialised register for trials, using the terms ('cytisine' or 'Tabex' or 'dianicline' or 'varenicline' or 'nicotine receptor partial agonist') in the title or abstract, or as keywords. The register is compiled from searches of MEDLINE, EMBASE, PsycINFO and Web of Science using MeSH terms and free text to identify controlled trials of interventions for smoking cessation and prevention. We contacted authors of trial reports for additional information where necessary. The latest update of the specialised register was in December 2011. We also searched online clinical trials registers. Selection criteria We included randomized controlled trials which compared the treatment drug with placebo. We also included comparisons with bupropion and nicotine patches where available. We excluded trials which did not report a minimum follow-up period of six months from start of treatment. Data collection and analysis We extracted data on the type of participants, the dose and duration of treatment, the outcome measures, the randomization procedure, concealment of allocation, and completeness of follow-up. The main outcome measured was abstinence from smoking at longest follow-up. We used the most rigorous definition of abstinence, and preferred biochemically validated rates where they were reported. Where appropriate we pooled risk ratios (RRs), using the Mantel-Haenszel fixed-effect model. Main results Two recent cytisine trials (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow-up, with a pooled RR of 3.98 (95% confidence interval (CI) 2.01 to 7.87). One trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). Fifteen trials compared varenicline with placebo for smoking cessation; three of these also included a bupropion treatment arm. We also found one open-label trial comparing varenicline plus counselling with counselling alone. We found one relapse prevention trial, comparing varenicline with placebo, and two open-label trials comparing varenicline with nicotine replacement therapy (NRT). We also include one trial in which all the participants were given varenicline, but received behavioural support either online or by phone calls, or by both methods. This trial is not included in the analyses, but contributes to the data on safety and tolerability. The included studies covered 12,223 participants, 8100 of whom used varenicline. The pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.27 (95% CI 2.02 to 2.55; 14 trials, 6166 people, excluding one trial evaluating long term safety). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.09 (95% CI 1.56 to 2.78; 4 trials, 1272 people). The pooled RR for varenicline versus bupropion at one year was 1.52 (95% CI 1.22 to 1.88; 3 trials, 1622 people). The RR for varenicline versus NRT for point prevalence abstinence at 24 weeks was 1.13 (95% CI 0.94 to 1.35; 2 trials, 778 people). The two trials which tested the use of varenicline beyond the 12-week standard regimen found the drug to be well-tolerated during long-term use. The main adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. A meta-analysis of reported serious adverse events occurring during or after active treatment and not necessarily considered attributable to treatment suggests there may be a one-third increase in the chance of severe adverse effects among people using varenicline (RR 1.36; 95% CI 1.04 to 1.79; 17 trials, 7725 people), but this finding needs to be tested further. Post-marketing safety data have raised questions about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation. The labelling of varenicline was amended in 2008, and the manufacturers produced a Medication Guide. Thus far, surveillance reports and secondary analyses of trial data are inconclusive, but the possibility of a link between varenicline and serious psychiatric or cardiovascular events cannot be ruled out. Authors' conclusions Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials. Varenicline at standard dose increased the chances of successful long-term smoking cessation between two-and threefold compared with pharmacologically unassisted quit attempts. Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events. More participants quit successfully with varenicline than with bupropion. Two open-label trials of varenicline versus NRT suggested a modest benefit of varenicline but confidence intervals did not rule out equivalence. Limited evidence suggests that varenicline may have a role to play in relapse prevention. The main adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time. Possible links with serious adverse events, including serious psychiatric or cardiovascular events, cannot be ruled out. Future trials of cytisine may test extended regimens and more intensive behavioural support. There is a need for further trials of the efficacy of varenicline treatment extended beyond 12 weeks.

Copyright 2012, Wiley-Blackwell


Caleyachetty A; Lewis S; McNeill A; Leonardi-Bee J. Struggling to make ends meet: Exploring pathways to understand why smokers in financial difficulties are less likely to quit successfully. European Journal of Public Health 22(Supplement 1): 41, 2012. (33 refs.)

Background: In high-income countries, those with low-to-middle incomes have been observing stagnating median wages and marginal improvements in their living standards. Smokers in financial difficulties appear to be less likely to quit smoking. Understanding the reasons for this is essential to intervening to improve cessation outcomes in this population, and reduce smoking-related health inequalities. Methods: We used longitudinal data from Waves 4 to 7 of the ITC Four Country Survey (ITC-4), and included those with data from at least two consecutive waves. Associations between financial difficulties and making a quit attempt, and quit success were analysed using generalised estimating equations, with adjustment for confounders. Mediation analysis was conducted to identify potential mediators of the observed effects of financial difficulties on cessation outcomes. Results: Having financial difficulties had little impact on making quit attempts (adjusted OR 0.84, 95% CI 0.70-1.01). Smokers with financial difficulties were substantially less likely to succeed at quitting (adjusted OR 0.55, 95% CI 0.39-0.76); an effect which was consistent over the survey years. Among the potential mediators examined, those relating to cognition of health-related and quality of life-related consequences of smoking were the most important mediators, though the proportion of the effect mediated by the largest mediator was small (6.8%). Conclusion: Having financial difficulties remains an important barrier to smokers achieving quit success. This effect does not appear to be due to anticipated factors such as reduced use of cessation services or treatment. Further research is required to determine strong mediators of the financial difficulties effect on quit success and to tailor more effective cessation programmes.

Copyright 2012, Oxford University Press


Carlson LE; Lounsberry JJ; Maciejewski O; Wright K; Collacutt V; Taenzer P. Telehealth-delivered group smoking cessation for rural and urban participants: Feasibility and cessation rates. Addictive Behaviors 37(1): 108-114, 2012. (22 refs.)

Large-group behavioral smoking cessation interventions are effective for helping people quit smoking, but have not been evaluated using videoconferencing technology for rural and remote participants who have no access to in-person cessation programs. The objectives of this study were to provide and evaluate an evidence-based group smoking cessation program for rural/remote smokers wishing to quit through a Telehealth videoconferencing link at their local Health Centre. From September 2005 through April 2008, eight separate eight-session, 4 month long smoking cessation group programs were offered both in person to urban participants in Calgary and at up to six rural sites simultaneously via Telehealth videoconferencing. Quit rates were assessed at program completion, 6 and 12month follow-up. Participants also provided evaluations of the program and technology. 554 smokers participated in the program: 370 in Calgary and 184 at various remote sites. Sixteen Telehealth sites participated from across Alberta and one site from the Northwest Territories. After program completion, continuous abstinence rates using the most conservative intent-to-treat method were 27.5% in Calgary and 25.5% for the rural Telehealth sites. Quit numbers were much higher using only Available Data at 39.2% for Calgary and 37.2% for the rural sites. Similar rates were maintained over the 12-month follow-up. Program evaluations were positive. It is possible to offer effective smoking cessation to small groups of patients in rural or remote locations through Telehealth videoconferencing technology, which produces quit rates similar to in-person groups.

Copyright 2012, Elsevier Science


Carmody TP; Delucchi K; Duncan CL; Banys P; Simon JA; Solkowitz SN et al. Intensive intervention for alcohol-dependent smokers in early recovery: A randomized trial. Drug and Alcohol Dependence 122(3): 186-194, 2012. (66 refs.)

Introduction: The purpose of this study was to investigate the efficacy of an intensive tobacco cessation intervention for alcohol-dependent smokers in early recovery. Methods: A total of 162 alcohol-dependent smokers were randomized to either intensive intervention for smoking cessation or usual care. The intensive intervention consisted of 16 sessions of individual cognitive behavior therapy (CBT) and combination nicotine replacement therapy that lasted 26 weeks. Usual care involved referral to a free-standing smoking cessation program that provided smoking cessation counseling of varying duration and guideline-concordant medications. The primary cessation outcome was verified 7-day point prevalence abstinence (PPA) at 12, 26, 38, and 52 weeks. Results: At 12 and 26 weeks, the verified 7-day point-prevalence quit rate was significantly higher for the intensive intervention group than for the usual care group (both p = 0.03). However, the quit rates for the two treatment groups were not significantly different at 38 or 52 weeks. Verified 30-day alcohol abstinence rates were not significantly different for the two treatment groups at any of the follow-up assessments. Conclusions: The intensive smoking cessation intervention yielded a higher short-term smoking quit rate without jeopardizing sobriety. A chronic care model might facilitate maintenance of smoking cessation during the first year of alcohol treatment and perhaps for longer periods of time. It is hoped that studies such as this will inform the development of more effective interventions for concurrent alcohol and tobacco use disorders.

Copyright 2012, Elsevier Science


Carson KV; Brinn MP; Peters M; Veale A; Esterman AJ; Smith BJ. Interventions for smoking cessation in Indigenous populations. (review). Cochrane Database of Systematic Reviews 1: article CD009046, 2012. (117 refs.)

Background: Tobacco use in Indigenous populations (people who have inhabited a country for thousands of years) is often double that of the non-Indigenous population. A disproportionate burden of substance-related morbidity and mortality exists as a result. Objectives: To evaluate the effectiveness of smoking cessation interventions in Indigenous populations and to summarise these approaches for future cessation programmes and research. Search methods: The Cochrane Tobacco Addiction Group Specialised Register of Trials was searched (April 2011), with additional searches of MEDLINE (May 2011). Online clinical trial databases and publication references were also searched for potential studies. Selection criteria: We included randomized and non-randomized controlled trials for smoking cessation interventions in Indigenous populations. Interventions could include pharmacotherapies, cognitive and behavioural therapies, alternative therapies, public policy and combination therapies. No attempts were made to re-define Indigenous status for the purpose of including a study in this review. Data collection and analysis: Data pertaining to methodology, participants, interventions and outcomes were extracted by one reviewer and checked by a second, whilst methodological quality was extracted independently by two reviewers. Studies were assessed by qualitative narrative synthesis and where possible meta-analysis. The review process was examined by an Indigenous (Aboriginal) Australian for applicability, acceptability and content. Main results: Four studies met all of the eligibility criteria for inclusion within the review. Two used combination therapies consisting of a pharmacotherapy combined with cognitive and behavioural therapies, whilst the remaining two used cognitive and behavioural therapy through counselling, one via text message support and the other delivered via clinic doctors trained in smoking cessation techniques. Smoking cessation data were pooled across all studies producing a statistically and clinically significant effect in favour of the intervention (risk ratio 1.43, 95% CI 1.03 to 1.98, p=0.032), however following sensitivity analysis a statistically non-significant but clinically significant effect was observed in favour of the intervention (risk ratio 1.33, 95% CI 0.95 to 1.85, p=NS). Authors' conclusions: A significant health disparity exists, whereby Indigenous populations, a minority, are over-represented in the burden of smoking-related morbidity and mortality. This review highlights the paucity of evidence available to evaluate the effectiveness of smoking cessation interventions, despite the known success of these interventions in non-Indigenous populations. Due to this lack of published investigations, the external validity of this review is limited, as is the ability to draw reliable conclusions from the results. The limited but available evidence reported does indicate that smoking cessation interventions specifically targeted at Indigenous populations can produce smoking abstinence. However this evidence base is not strong with a small number of methodologically sound trials investigating these interventions. More rigorous trials are now required to assist in bridging the gap between tobacco related health disparities in Indigenous and non-Indigenous populations.

Copyright 2012, Wiley-Blackwell


Chan SSC; Leung DYP; Wong DCN; Lau CP; Wong VT; Lam TH. A randomized controlled trial of stage-matched intervention for smoking cessation in cardiac out-patients. Addiction 107(4): 829-837, 2012. (29 refs.)

Aim To examine the effectiveness of a stage-matched smoking cessation counselling intervention for smokers who had cardiac diseases. Methods: A total of 1860 Chinese cardiac patients who smoked at least one cigarette in the past 7 days and aged 18 years or above recruited from cardiac out-patient clinics in Hong Kong hospitals were allocated randomly to an intervention group or control group. The intervention group (n = 938) received counselling matched with their stage of readiness to quit by trained counsellors at baseline, 1 week and 1 month. The control group (n = 922) received brief counselling on healthy diet at baseline. The primary outcomes were self-reported 7-day and 30-day point prevalence (PP) of tobacco abstinence at 12 months after baseline. The secondary outcome measures included biochemically validated abstinence at 12-month follow-up, self-reported 7-day and 30-day PP abstinence and reduction of cigarette consumption by 50% at 3 and 6 months. Results: By intention-to-treat analysis, the intervention and control groups showed no significant difference in self-reported 7-day PP abstinence (intervention: 26.5% versus control: 25.5%; P = 0.60) and 30-day PP (intervention: 25.4% versus control: 24.2%; P = 0.55), biochemically validated abstinence (intervention: 6.6% versus control: 4.9%; P = 0.14) and overall quit attempts of least 24 hours (intervention: 40.3% versus control: 34.3%; P = 0.007) at the 12-month follow-up, adjusted for the baseline stage of readiness to quit smoking. Conclusions: An intervention, based on the Stages of Change model, to promote smoking cessation in cardiac patients in China failed to find any long-term benefit.

Copyright 2012, Society for the Study of Addiction to Alcohol and Other Drugs


Chapman S; Mackenzie R. Can it be ethical to apply limited resources in low-income countries to ineffective, low-reach smoking cessation strategies? A Reply to Bitton and Eyal. (editorial). Public Health Ethics 5(1): 29-37, 2012. (54 refs.)

Bitton and Eyal's lengthy critique of our article on unassisted cessation was premised on several straw-man arguments. These are corrected in our reply. It also confused the key concepts of efficacy and effectiveness in assessing the impact of cessation interventions and policies in real-world settings; ignored any consideration of reach (cost, consumer acceptability and accessibility) and failed to consider that clinical cessation interventions which fail more than they succeed also may 'harm' smokers by reducing agency. Our article addresses each of these problems, concluding that any consideration of the ethics of promoting smoking cessation in low-income nations should begin and end with the question of whether the strategies to be adopted have any prospect of influencing significant numbers of smokers to quit.

Copyright 2012, Oxford University Press


Chen XG; Ren YJ; Lin F; MacDonell K; Jiang YF. Exposure to school and community based prevention programs and reductions in cigarette smoking among adolescents in the United States, 2000-08. Evaluation and Program Planning 35(3): 321-328, 2012. (52 refs.)

Smoking remains prevalent among US youth despite decades of antismoking efforts. Effects from exposure to prevention programs at national level may provide informative and compelling data supporting better planning and strategy for tobacco control. A national representative sample of youth 12-17 years of age from the National Survey on Drug Use and Health was analyzed. A 3-stage model was devised to estimate smoking behavior transitions using cross-sectional data and the Probabilistic Discrete Event System method. Cigarette smoking measures (prevalence rates and odds ratios) were compared between exposed and non-exposed youth. More than 95% of the sample was exposed to prevention programs. Exposure was negatively associated with lifetime smoking and past 30-day smoking with a dose-response relation. Reduction in smoking was related to increased quitting in 2000-02, to increased quitting and declined initiation in 2003-05, and to initiation, quitting and relapse in 2005-08. Findings of this analysis suggest that intervention programs in the United States can reduce cigarette smoking among youth. Quitting smoking was most responsive to program exposure and relapse was most sensitive to funding cuts since 2003. Health policy and decision makers should consider these factors in planning and revising tobacco control strategies.

Copyright 2012, Elsevier Science


Coleman T; Cooper S; Thornton JG; Grainge MJ; Watts K; Britton J et al. A randomized trial of nicotine-replacement therapy patches in pregnancy. New England Journal of Medicine 366(9): 808-818, 2012. (29 refs.)

Background: Nicotine-replacement therapy is effective for smoking cessation outside pregnancy and its use is widely recommended during pregnancy. We investigated the efficacy and safety of nicotine patches during pregnancy. Methods: We recruited participants from seven hospitals in England who were 16 to 50 years of age with pregnancies of 12 to 24 weeks' gestation and who smoked five or more cigarettes per day. Participants received behavioral cessation support and were randomly assigned to 8 weeks of treatment with active nicotine patches (15 mg per 16 hours) or matched placebo patches. The primary outcome was abstinence from the date of smoking cessation until delivery, as validated by measurement of exhaled carbon monoxide or salivary cotinine. Safety was assessed by monitoring for adverse pregnancy and birth outcomes. Results: Of 1050 participants, 521 were randomly assigned to nicotine-replacement therapy and 529 to placebo. There was no significant difference in the rate of abstinence from the quit date until delivery between the nicotine-replacement and placebo groups (9.4% and 7.6%, respectively; unadjusted odds ratio with nicotine-replacement therapy, 1.26; 95% confidence interval, 0.82 to 1.96), although the rate was higher at 1 month in the nicotine-replacement group than in the placebo group (21.3% vs. 11.7%). Compliance was low; only 7.2% of women assigned to nicotine-replacement therapy and 2.8% assigned to placebo used patches for more than 1 month. Rates of adverse pregnancy and birth outcomes were similar in the two groups. Conclusions: Adding a nicotine patch (15 mg per 16 hours) to behavioral cessation support for women who smoked during pregnancy did not significantly increase the rate of abstinence from smoking until delivery or the risk of adverse pregnancy or birth outcomes. However, low compliance rates substantially limited the assessment of safety.

Copyright 2012, Massachusetts Medical Society


Cui Q; Robinson L; Elston D; Smaill F; Cohen J; Quan C et al. Safety and tolerability of varenicline tartrate (Champix (R)/Chantix (R)) for smoking cessation in HIV-infected subjects: A pilot open-label study. AIDS Patient Care and STDs 26(1): 12-19, 2012. (39 refs.)

The prevalence of smoking in HIV-infected subjects is high. As a smoking cessation aid, varenicline (Champix (R), Pfizer, Saint-Laurent, QC, Canada or Chantix (R), Pfizer, Mission, KS) has not been previously evaluated in HIV-infected smokers. In this multicenter pilot open label study, varenicline 1.0mg was used twice daily for 12 weeks with dose titration in the first week. Adverse events (AEs) during the treatment period were recorded. Changes from baseline in laboratory tests, vital signs, daily cigarette consumption, nicotine dependence, and withdrawal were measured through week 24. Self-reported abstinence was validated by serum cotinine at week 12. We enrolled 36 subjects with a mean of 29 pack-years of smoking and a minimum of 4 cigarettes per day. All but 1 were male, 33 (92%) were white. The most frequently reported AEs were nausea (33%), abnormal dreams (31%), affect lability (19%), and insomnia (19%). Six (17%) subjects discontinued varenicline due to AEs. No grade 3/4 laboratory abnormalities or serious AEs occurred during the study. There was no significant change in HIV viral load. CD4 counts increased by 69 cells/mm(3) (p = 0.001) at week 24. Serum cotinine-verified 4-week continuous abstinence rate through weeks 9-12 was 42% (95% confidence interval [CI]: 26-58%). AEs and abstinence rates were comparable to those in published randomized controlled trials conducted in generally healthy HIV-negative smokers. Varenicline was safe and appears effective among HIV-infected smokers in this exploratory study, although AEs were common. The most common AE was nausea, with no adverse effect on HIV treatment outcome. Close monitoring of liver enzymes and blood pressure is recommended for HIV-positive smokers taking varenicline.

Copyright 2012, Mary Ann Liebert


Curtis B. Understanding tailored internet smoking cessation messages: A reasoned action approach. Annals of the American Academy of Political and Social Science 640(136): 149, 2012. (44 refs.)

Although message tailoring has been shown to produce experimental effects in previous studies, the cognitive mechanisms through which tailoring works have not been sufficiently studied. Using the integrative model to predict intentions to use the nicotine replacement patch among adult smokers, this study examines how tailoring theoretical elements of the integrative model is effective in changing the theoretical mediators. Participants were randomized into one of two conditions. In the experimental condition, participants received messages tailored to some or all of the underlying behavioral, injunctive normative, or self-efficacy beliefs with the expectation that changing the underlying beliefs would result in experimental differences in the integrative model's direct measures. This expectation was confirmed. The integrative model also worked well in predicting intentions to perform the target behavior; attitude, perceived normative pressure, and perceived behavioral control accounted for 53 percent of the variance in intentions. Attitude and normative pressure were the strongest predictors of intention. These results provide support for tailoring messages using a reasoned action approach and provide insight into the mechanism through which message tailoring operates.

Copyright 2012, Sage Publications


Dalum P; Paludan-Muller G; Engholm G; Kok G. A cluster randomised controlled trial of an adolescent smoking cessation intervention: Short and long-term effects. Scandinavian Journal of Public Health 40(2): 167-176, 2012. (20 refs.)

Background: There is a lack of effective smoking cessation interventions which have a high reach among adolescent smokers. Method: We conducted a randomised controlled trial of an adolescent smoking cessation intervention for students aged 15-21 at 22 continuation schools in Denmark. The intervention was a minimal intervention based on events with short counselling and a range of self-help materials. Our 1-month follow up consisted of 514 baseline daily smokers and the 14-month follow up of 369 daily smokers. Results: We found positive short-term effects regarding smoking cessation (adjusted OR 4.50, 95% CI 1.20-16.86), self-efficacy (p=0.01), and intentions to quit (p=0.004). However, none of these effects were maintained at 1-year follow up. The intervention was successful in reaching more than half of all daily smokers in the target group with more than 30% receiving counselling at least once in the intervention period. Conclusions: This trial shows that a "minimal" intervention can produce short-term effects but that this approach is insufficient in producing long-term effects.

Copyright 2012, Sage Publications


Dalum P; Schaalma H; Kok G. The development of an adolescent smoking cessation intervention: An intervention mapping approach to planning. Health Education Research 27(1): 172-181, 2012. (34 refs.)

The objective of this project was to develop a theory- and evidence-based adolescent smoking cessation intervention using both new and existing materials. We used the Intervention Mapping framework for planning health promotion programmes. Based on a needs assessment, we identified important and changeable determinants of cessation behaviour, specified change objectives for the intervention programme, selected theoretical change methods for accomplishing intervention objectives and finally operationalized change methods into practical intervention strategies. We found that guided practice, modelling, self-monitoring, coping planning, consciousness raising, dramatic relief and decisional balance were suitable methods for adolescent smoking cessation. We selected behavioural journalism, guided practice and Motivational Interviewing as strategies in our intervention. Intervention Mapping helped us to develop as systematic adolescent smoking cessation intervention with a clear link between behavioural goals, theoretical methods, practical strategies and materials and with a strong focus on implementation and recruitment. This paper does not present evaluation data.

Copyright 2012, Oxford University Press


Duffy SA; Kilbourne AM; Austin KL; Dalack GW; Woltmann EM; Waxmonsky J et al. Risk of smoking and receipt of cessation services among Veterans with mental disorders. Psychiatric Services 63(4): 325-332, 2012. (60 refs.)

Objective: The purpose of this study was to determine rates of smoking and receipt of provider recommendations to quit smoking among patients with mental disorders treated in U.S. Department of Veterans Affairs (VA) treatment settings. Methods: The authors conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients (N=224,193). Logistic regression was used to determine the independent association of mental health diagnosis and the dependent variables of smoking and receipt of provider recommendations to quit smoking. Results: Patients with mental disorders had greater odds of smoking, compared with those without mental disorders (p<.05). Those with various mental disorders reported similar rates of receiving services (more than 60% to 80% reported receiving selected services), compared with those without these disorders, except that those with schizophrenia had more than 30% lower odds of receiving advice to quit smoking from their physicians (p<.05). Moreover, those who had co-occurring posttraumatic stress disorder or substance use disorders had significantly greater odds of reporting that they received advice to quit, recommendations for medications, and physician discussions of quitting methods, compared with those without these disorders (p<.05). Older patients, male patients, members of ethnic minority groups, those who were unmarried, those who were disabled or unemployed, and those living in rural areas had lower odds of receiving selected services (p<.05). Conclusions: The majority of patients with mental disorders served by the VA reported receiving cessation services, yet their smoking rates remained high, and selected groups were at risk for receiving fewer cessation services, suggesting the continued need to disseminate cessation services.

Copyright 2012, American Psychiatric Association


Dutra SJ; Stoeckel LE; Carlini SV; Pizzagalli DA; Evins AE. Varenicline as a smoking cessation aid in schizophrenia: Effects on smoking behavior and reward sensitivity. Psychopharmacology 219(1): 25-34, 2012. (69 refs.)

Smoking rates are up to five times higher in people with schizophrenia than in the general population, placing these individuals at high risk for smoking-related health problems. Varenicline, an alpha 4 beta 2 nicotinic acetylcholine receptor partial agonist, is a promising aid for smoking cessation in this population. To maximize treatment efficacy while minimizing risks, it is critical to identify reliable predictors of positive response to varenicline in smokers with schizophrenia. Negative symptoms of schizophrenia are related to dysfunctions in the brain reward system, are associated with nicotine dependence, and may be improved by nicotine or nicotinic receptor agonists, suggesting that smoking cessation may be especially difficult for patients with substantial negative symptoms. The purpose of the study was to evaluate negative symptoms as predictors of response to varenicline. Patients with schizophrenia (N = 53) completed a 12-week smoking cessation trial combining varenicline with cognitive behavioral therapy. Negative symptoms were assessed via the Scale for the Assessment of Negative Symptoms (Andreasen 1983). Outcomes included smoking abstinence as assessed by self-report and expired carbon monoxide. Change in performance on a probabilistic reward task was used as an index of change in reward sensitivity during treatment. At week 12, 32 participants met criteria for 14-day point-prevalence abstinence. Patients with lower baseline symptoms of affective flattening (more typical affect) were more likely to achieve smoking abstinence and demonstrated larger increases in reward sensitivity during treatment. These data suggest that affective flattening symptoms in smokers with schizophrenia may predict response to varenicline.

Copyright 2012, Springer


Efraimsson EO; Fossum B; Ehrenberg A; Larsson K; Klang B. Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics. Journal of Advanced Nursing 68(4): 767-782, 2012. (82 refs.)

Aim. This paper is a report of a study to describe to what extent Registered Nurses, with a few days of education in motivational interviewing based communication, used motivational interviewing in smoking cessation communication at nurse-led chronic obstructive pulmonary disease clinics in primary health care. Background. For smokers with chronic obstructive pulmonary disease the most crucial and evidence-based intervention is smoking cessation. Motivational interviewing is often used in healthcare to support patients to quit smoking. Method. The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. Data were collected from March 2006 to April 2007. The nurses smoking cessation communication was analysed using the Motivational Interviewing Treatment Integrity scale. To get an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five indicating best adherence to Motivational Interviewing. Results. Evocation, collaboration, autonomy-support and empathy averaged between 1.31 and 2.23 whereas direction scored five in all consultations. Of communication behaviours, giving information was the most frequently used, followed by closed questions, motivational interviewing nonadherent and simple reflections. Motivational interviewing adherent, open questions and complex reflections occurred rarely. There were no important individual or group-level differences in any of the ratings between the first and the third consultations. Conclusion. In smoking cessation communication the nurses did not employ behaviours that are important in motivational interviewing.

Copyright 2012, Wiley-Blackwell


Emery S; Kim Y; Choi YK; Szczypka G; Wakefield M; Chaloupka FJ. The effects of smoking-related television advertising on smoking and intentions to quit among adults in the United States: 1999-2007. American Journal of Public Health 102(4): 751-757, 2012. (33 refs.)

Objectives. We investigated whether state-sponsored antitobacco advertisements are associated with reduced adult smoking, and interactions between smoking-related advertising types. Methods. We measured mean exposure to smoking-related advertisements with television ratings for the top-75 US media markets from 1999 to 2007. We combined these data with individual-level Current Population Surveys Tobacco Use Supplement data and state tobacco control policy data. Results. Higher exposure to state-sponsored, Legacy, and pharmaceutical advertisements was associated with less smoking; higher exposure to tobacco industry advertisements was associated with more smoking. Higher exposure to state- and Legacy-sponsored advertisements was positively associated with intentions to quit and having made a past-year quit attempt; higher exposure to ads for pharmaceutical cessation aids was negatively associated with having made a quit attempt. There was a significant negative interaction between state- and Legacy-sponsored advertisements. Conclusions. Exposure to state-sponsored advertisements was far below Centers for Disease Control and Prevention recommended best practices. The significant negative relationships between antismoking advertising and adult smoking provide strong evidence that tobacco-control media campaigns help reduce adult smoking. The significant negative interaction between state- and Legacy-sponsored advertising suggests that the campaigns reinforce one another.

Copyright 2012, American Public Health Association


Fagerstrom K; Rutqvist LE; Hughes JR. Snus as a smoking cessation aid: A randomized placebo-controlled trial. Nicotine & Tobacco Research 14(3): 306-312, 2012. (26 refs.)

Snus is a low-nitrosamine smokeless product that appears to be safer than other smokeless products. Evidence indicates that snus has been used as an effective smoking cessation aid in Scandinavia. No randomized controlled trial has directly tested the efficacy of snus for smoking cessation. This randomized, double-blind, placebo-controlled multicentre trial tested the efficacy of snus for smoking cessation. Of the 250 subjects, 125 were randomized to active or placebo snus sachets. Subjects were followed up through 28 weeks after randomization. In total, 5 clinical visits and 8 telephone contacts were scheduled. Primary outcome measure was biologically verified continuous smoking abstinence from Week 6 through 28. The continuous abstinence rate during Weeks 6-28 in the snus and placebo groups was 4.0% and 1.6% (odds ratio [OR]: 2.5, 95% CI: 0.4-27), respectively. The point prevalence abstinence rate at 6 weeks was 18.4% in the snus group versus 8.8% in the placebo group (OR: 2.3, 95% CI: 1.1-5.0, p = .03). At Week 28, the difference in favor of the snus group was not statistically significant (12.8% vs. 7.2%, OR: 1.9, 95% CI: 0.8-4.4). Snus was generally well tolerated. Treatment-related adverse events that were more common in the snus group were generally mild and included nausea, dyspepsia, gingivitis, hiccups, and dizziness. Although the cessation rates generally were low and, at 28 weeks, did not differ between active and placebo, early quit rates suggested that snus was superior and with similar effect sizes to those with nicotine replacement. These results suggest that snus needs to be further researched as a smoking cessation treatment.

Copyright 2012, Oxford University Press


Farley AC; Hajek P; Lycett D; Aveyard P. Interventions for preventing weight gain after smoking cessation. (review). Cochrane Database of Systematic Reviews 1: article CD006219, 2012. (483 refs.)

Background: Most people who stop smoking gain weight. There are some interventions that have been designed to reduce weight gain when stopping smoking. Some smoking cessation interventions may also limit weight gain although their effect on weight has not been reviewed. Objectives: To systematically review the effect of: (1) Interventions targeting post-cessation weight gain on weight change and smoking cessation. (2) Interventions designed to aid smoking cessation that may also plausibly affect weight on post-cessation weight change. Search methods: Part 1 - We searched the Cochrane Tobacco Addiction Group's Specialized Register and CENTRAL in September 2011. Part 2 - In addition we searched the included studies in the following "parent" Cochrane reviews: nicotine replacement therapy (NRT), antidepressants, nicotine receptor partial agonists, cannabinoid type 1 receptor antagonists and exercise interventions for smoking cessation published in Issue 9, 2011 of the Cochrane Library. Selection criteria: Part 1 - We included trials of interventions that were targeted at post-cessation weight gain and had measured weight at any follow up point and/or smoking cessation six or more months after quit day. Part 2 - We included trials that had been included in the selected parent Cochrane reviews if they had reported weight gain at any time point. Data collection and analysis: We extracted data on baseline characteristics of the study population, intervention, outcome and study quality. Change in weight was expressed as difference in weight change from baseline to follow up between trial arms and was reported in abstinent smokers only. Abstinence from smoking was expressed as a risk ratio (RR). We used the most rigorous definition of abstinence available in each trial. Where appropriate, we performed meta-analysis using the inverse variance method for weight and Mantel-Haenszel method for smoking using a fixed-effect model. Main results: Part 1: Some pharmacological interventions tested for limiting post cessation weight gain (PCWG) resulted in a significant reduction in WG at the end of treatment (dexfenfluramine (Mean difference (MD) -2.50kg, 95% confidence interval (CI) -2.98 to -2.02, 1 study), phenylpropanolamine (MD -0.50kg, 95% CI-0.80 to -0.20, N=3), naltrexone (MD -0.78kg, 95% CI-1.52 to -0.05, N=2). There was no evidence that treatment reduced weight at 6 or 12 months (m). No pharmacological intervention significantly affected smoking cessation rates. Weight management education only was associated with no reduction in PCWG at end of treatment (6 or 12m). However these interventions significantly reduced abstinence at 12m (Risk ratio (RR) 0.66, 95% CI 0.48 to 0.90, N=2). Personalised weight management support reduced PCWG at 12m (MD -2.58kg, 95% CI -5.11 to-0.05, N=2) and was not associated with a significant reduction of abstinence at 12m (RR 0.74, 95% CI 0.39 to 1.43, N=2). A very low calorie diet (VLCD) significantly reduced PCWG at end of treatment (MD -3.70kg, 95% CI-4.82 to-2.58, N=1), but not significantly so at 12m (MD -1.30kg, 95% CI-3.49 to 0.89, N=1). The VLCD increased chances of abstinence at 12m (RR 1.73, 95% CI 1.10 to 2.73, N=1). There was no evidence that cognitive behavioural therapy to allay concern about weight gain (CBT) reduced PCWG, but there was some evidence of increased PCWG at 6m (MD 0.74, 95% CI 0.24 to 1.24). It was associated with improved abstinence at 6m (RR 1.83, 95% CI 1.07 to 3.13, N=2) but not at 12m (RR 1.25, 95% CI 0.83 to 1.86, N=2). However, there was significant statistical heterogeneity. Part 2: We found no evidence that exercise interventions significantly reduced PCWG at end of treatment (MD -0.25kg, 95% CI-0.78 to 0.29, N=4) however a significant reduction was found at 12m (MD -2.07kg, 95% CI-3.78 to-0.36, N=3). Both bupropion and fluoxetine limited PCWG at the end of treatment (bupropion MD-1.12kg, 95% CI-1.47 to-0.77, N=7) (fluoxetine MD -0.99kg, 95% CI-1.36 to-0.61, N=2). There was no evidence that the effect persisted at 6m (bupropion MD -0.58kg, 95% CI-2.16 to 1.00, N=4), (fluoxetine MD -0.01kg, 95% CI-1.11 to 1.10, N=2) or 12m (bupropion MD -0.38kg, 95% CI-2.00 to 1.24, N=4). There were no data on WG at 12m for fluoxetine. Overall, treatment with NRT attenuated PCWG at the end of treatment (MD -0.69kg, 95% CI-0.88 to-0.51, N=19), with no strong evidence that the effect differed for the different forms of NRT. There was evidence of significant statistical heterogeneity caused by one study which reported a 4.3kg reduction in PCWG due to NRT. With this study removed, the difference in weight change at end of treatment was -0.45kg (95% CI-0.66 to-0.27, N=18). There was no evidence of an effect on PCWG at 12m (MD -0.42kg, 95% CI-0.92 to 0.08, N=15). We found evidence that varenicline significantly reduced PCWG at end of treatment (MD -0.41kg, 95% CI-0.63 to-0.19, N=11), but this effect was not maintained at 6 or 12m. Three studies compared the effect of bupropion to varenicline. Participants taking bupropion gained significantly less weight at the end of treatment (-0.51kg (95% CI-0.93 to-0.09kg), N=3). Direct comparison showed no significant difference in PCWG between varenicline and NRT. Authors' conclusions: Although some pharmacotherapies tested to limit PCWG show evidence of short-term success, other problems with them and the lack of data on long-term efficacy limits their use. Weight management education only, is not effective and may reduce abstinence. Personalised weight management support may be effective and not reduce abstinence, but there are too few data to be sure. One study showed a VLCD increased abstinence but did not prevent WG in the longer term. CBT to accept WG did not limit PCWG and may not promote abstinence in the long term. Exercise interventions significantly reduced weight in the long term, but not the short term. More studies are needed to clarify whether this is an effect of treatment or a chance finding. Bupropion, fluoxetine, NRT and varenicline reduce PCWG while using the medication. Although this effect was not maintained one year after stopping smoking, the evidence is insufficient to exclude a modest long-term effect. The data are not sufficient to make strong clinical recommendations for effective programmes to prevent weight gain after cessation.

Copyright 2012, Wiley-Blackwell


Fish LJ; Gierisch JM; Stechuchak KM; Grambow SC; Rohrer LD; Bastian LA. Correlates of expected positive and negative support for smoking cessation among a sample of chronically ill veterans. Addictive Behaviors 37(1): 135-138, 2012. (14 refs.)

To examine demographic, relationship, and smoking history factors related to expected positive and negative support for quitting smoking among chronically ill veterans. Data for this report comes from baseline data from a randomized controlled trial of a support-based smoking cessation intervention for veterans with chronic diseases (cancer, cardiovascular disease, hypertension, diabetes, and chronic obstructive pulmonary disease). We used separate multiple linear regression models to analyze relationships between positive and negative support and variables selected for model entry. Veterans in our sample expected high positive and negative support for quitting. Veterans who were married/living as married, had some college education, were female, or named a female support person expected higher levels of positive support. Veterans who named a female or a nonsmoker as a support person expected higher levels of negative support. Males and non-Caucasians also reported higher levels of expected negative support. Individual differences that influence perceptions of expected support are likely to influence intervention participation and engagement. Thus, understanding factors associated with expected positive and negative support is necessary to optimize future implementation of support-based cessation interventions through better treatment matching.

Copyright 2012, Elsevier Science


Flegal KM. The conundrum of smoking cessation and weight gain. (editorial). Preventive Medicine 54(3-4): 193-194, 2012. (31 refs.)


Fronczak A; Polanska K; Usidame B; Kaleta D. Comprehensive tobacco control measures: The overview of the strategies recommended by WHO. Central European Journal of Public Health 20(1): 81-86, 2012. (26 refs.)

According to the World Health Organization, there are more than one billion smokers in the world, and tobacco is said to kill half of its users. The European Region of WHO, with only 15% of the world's population, faces nearly one third of the worldwide burden of tobacco related diseases. Millions of lives could be saved with effective and comprehensive tobacco control strategy. In response to this, the World Health Organization has offered a wide range of information and recommendations to governments, organizations, health-care professionals, and tobacco users and non-users worldwide. This paper is focusing on various activities that governments, organizations or even individuals can undertake to help smokers to quit and decrease percentages of tobacco users and save millions of lives.

Copyright 2012, National Institute of Public Health, Czech Republic


Fu SS; van Ryn M; Sherman SE; Burgess DJ; Noorbaloochi S; Clothier B et al. Population-based tobacco treatment: Study design of a randomized controlled trial. BMC Public Health 12: e-article 159, 2012. (40 refs.)

Background: Most smokers do not receive comprehensive, evidence-based treatment for tobacco use that includes intensive behavioral counseling along with pharmacotherapy. Further, the use of proven, tobacco treatments is lower among minorities than among Whites. The primary objectives of this study are to: (1) Assess the effect of a proactive care intervention (PRO) on population-level smoking abstinence rates (i.e., abstinence among all smokers including those who use and do not utilize treatment) and on utilization of tobacco treatment compared to reactive/usual care (UC) among a diverse population of smokers, (2) Compare the effect of PRO on population-level smoking abstinence rates and utilization of tobacco treatments between African American and White smokers, and (3) Determine the cost-effectiveness of the proactive care intervention. Methods/Design: This prospective randomized controlled trial identifies a population-based sample of current smokers from the Department of Veterans Affairs (VA) electronic medical record health factor dataset. The proactive care intervention combines: (1) proactive outreach and (2) offer of choice of smoking cessation services (telephone or face-to-face). Proactive outreach includes mailed invitation materials followed by an outreach call that encourages smokers to seek treatment with choice of services. Proactive care participants who choose telephone care receive VA telephone counseling and access to pharmacotherapy. Proactive care participants who choose face-to-face care are referred to their VA facility's smoking cessation clinic. Usual care participants have access to standard smoking cessation services from their VA facility (e.g., pharmacotherapy, smoking cessation clinic) and from their state telephone quitline. Baseline data is collected from VA administrative databases and participant surveys. Outcomes from both groups are collected 12 months post-randomization from participant surveys and from VA administrative databases. The primary outcome is self-reported smoking abstinence, which is assessed at the population-level (i.e., among those who utilize and those who do not utilize tobacco treatment). Primary analyses will follow intention-to-treat methodology. Discussion: This randomized trial is testing proactive outreach strategies offering choice of smoking cessation services, an innovation that if proven effective and cost-effective, will transform the way tobacco treatment is delivered. National dissemination of proactive treatment strategies could dramatically reduce tobacco-related morbidity, mortality, and health care costs.

Copyright 2012, BioMed Central


Germain D; Durkin S; Scollo M; Wakefield M. The long-term decline of adult tobacco use in Victoria: Changes in smoking initiation and quitting over a quarter of a century of tobacco control. Australian and New Zealand Journal of Public Health 36(1): 17, 2012. (41 refs.)

Objective: To examine changes in regular smoking prevalence among demographic and socioeconomic groups of Victorian adults from 1984 to 2008. Methods: Data were drawn from face-to-face and telephone surveys of randomly sampled Victorians conducted annually from 1984 to 2008. Results: Regular smoking in Victoria declined from 33.2% in 1984 to 15.5% in 2008, a relative decline of 53%. This change was largely accounted for by significant drops in 'ever smoking' among 18-29 year olds (from 59% to 35%, a relative decline of 41%) and by increased quitting among those aged 30 and older (from a quit proportion [% of those ever smoked who have quit] of 37% to 61% among 30-49 year olds, a relative increase of 64%; and from 53% to 79% among 50+ years, an increase of 48%). Over time, smoking prevalence became more similar between males and females. Regular smoking declined significantly across all socioeconomic status (SES) groups. Victorians living in low SES areas experienced the greatest relative increase in quit proportions of 75% (from 34% to 60%), helping to reduce the gap between low and higher SES groups in terms of smoking prevalence. Conclusions: Regular smoking in Victoria has declined substantially across all demographic groups. Victorians are taking up smoking at much lower levels than 25 years ago, while quit proportions have more than doubled. Implications: The continuation and extension of comprehensive, multi-level approaches to tobacco control is likely to be required for the maintenance of the downward trend in smoking.

Copyright 2012, Wiley-Blackwell


Gierisch JM; Bastian LA; Calhoun PS; McDuffie JR; Williams JW. Smoking cessation interventions for patients with depression: A systemematic review and meta-analysis. (review). Journal of General Internal Medicine 27(3): 351-360, 2012. (55 refs.)

Objectives: We conducted a systematic literature review of smoking cessation interventions for patients with histories of depressive disorders or current significant depressive symptoms. We examined the comparative effectiveness of smoking cessation strategies on abstinence rates, differential effects of cessation strategies by depression status (i.e., history positive vs. current depression), and differential effects by gender. Data Sources: Peer-reviewed literature in MEDLINE, Embase, PsycINFO, and Cochrane Library. Study Eligibility Criteria, Participants, And Interventions: Randomized controlled trials or secondary analysis of RCT data comparing two or more smoking cessation interventions or intervention to control, and reporting cessation outcomes in adults with depression. Study Appraisal And Synthesis Methods: Two trained researchers screened articles for inclusion. When possible, we estimated pooled risk ratios with 95% confidence intervals by using a random effects model with the Mantel-Haenszel method. We synthesized other studies qualitatively. We classified each intervention as antidepressants, nicotine replacement therapy (NRT), brief smoking cessation counseling, smoking cessation behavioral counseling, or behavioral mood management. RESULTS: We identified 16 unique RCTs, of which, only three trials recruited participants with current depression. Meta-analysis demonstrated a small, positive effect of adding behavioral mood management (RR = 1.41, 95% CI 1.01-1.96). All included antidepressant trials showed small, positive effects, but risk ratio summary was not significant (RR = 1.31, 95% CI 0.73-2.34). Three NRT trials demonstrated small, positive effects on smoking cessation rates. We found insufficient evidence to examine gender and depression status moderator effects. Limitations: Few RCTs exist that test smoking cessation interventions among adults with depression. To make meaningful comparisons, we created broad intervention categories that contained heterogeneity. Conclusions And Implications Of Key Findings: Few trials enrolled smokers with current depression. Most of data identified were from subgroup analyses of patients history-positive for depression. However, several promising interventions exist. Healthcare providers should consider encouraging their patients with significant depressive symptoms or depression histories to seek smoking cessation services that include NRT and behavioral mood management.

Copyright 2012, Springer


Gonzalez-Pinto A; Alberich S; de Azua SR; Martinez-Cengotitabengoa M; Fernandez M; Gutierrez M et al. Psychosis and smoking cessation: Difficulties in quitting associated with sex and substance abuse. Psychiatry Research 195(1-2): 45-50, 2012. (45 refs.)

No prospective studies of first psychotic episodes have explored sex differences in smoking cessation. The aim of this study was to determine the influence of sex and substance abuse on smoking cessation during an 8-year follow-up of patients after a first psychotic episode. Logistic regression modeling was used to identify factors associated with smoking cessation by sex. To examine for sex variable interactions, the following two methods were used: 1) for other clinical variables, mixed analyses were calculated; and 2) for use of other substances, logistic regression models were performed only in the substance users. At baseline, 79% of men and 84% of women were current smokers. Lower smoking cessation after 8 years was associated with female sex (odds ratio, OR = 0.30; 95% confidence intervals, CIs = 0.12-0.75) and treatment with typical antipsychotics (OR = 0.30, CIs = 0.10-0.93). In a logistic regression model of alcohol users, those who used alcohol continuously were less likely to stop smoking (adjusted OR = 0.22, CI = 0.05-1.0). Among patients who continued using cannabis, female sex was associated with significant lower smoking cessation (adjusted OR = 0.03, CI = 0.001-0.77). Sex may act as a moderator in smoking cessation after a first psychotic episode. Smoking cessation interventions in these patients should consider sex differences and comorbidity with alcohol and cannabis use.

Copyright 2012, Elsevier Science


Guy MC; Seltzer RGN; Cameron M; Pugmire J; Michael S; Leischow SJ. Relationship between smokers' modes of entry into quitlines and treatment outcomes. American Journal of Health Behavior 36(1): 3-11, 2012. (42 refs.)

Objectives: To assess the relationship between the mode of entry into a quitline service and subsequent tobacco use treatment outcomes. Methods: A retrospective study using logistic regression analysis of 11, 040 Arizona Smokers' Helpline (ASHLine) clients was conducted to determine whether self-or medical referrals were related to 7- and 30-day point prevalence tobacco treatment outcomes at 7 months postquit. Results: Smokers referred to the ASHLine by a health care provider were more likely to quit smoking than were those who self-referred. Conclusions: Mode of entry into a quitline service for smoking cessation is related to treatment outcomes. Reasons for this outcome are uncertain and require additional research.

Copyright 2012, PNG


Guydish J; Ziedonis D; Tajima B; Seward G; Passalacqua E; Chan M et al. Addressing Tobacco Through Organizational Change (ATTOC) in residential addiction treatment settings. Drug and Alcohol Dependence 121(1-2): 30-37, 2012. (75 refs.)

Background: Smoking prevalence among persons in addiction treatment is 3-4 times higher than in the general population. However, treatment programs often report organizational barriers to providing tobacco-related services. This study assessed the effectiveness of a six month organizational change intervention, Addressing Tobacco Through Organizational Change (ATTOC), to improve how programs address tobacco dependence. Methods: The ATTOC intervention, implemented in three residential treatment programs, included consultation, staff training, policy development, leadership support and access to nicotine replacement therapy (NRT) medication. Program staff and clients were surveyed at pre- and post-intervention, and at 6 month follow-up. The staff survey measured knowledge of the hazards of smoking, attitudes about and barriers to treating smoking, counselor self-efficacy in providing such services, and practices used to address tobacco. The client survey measured knowledge, attitudes, and tobacco-related services received. NRT use was tracked. Results: From pre- to post-intervention, staff beliefs became more favorable toward treating tobacco dependence (F(1, 163) = 7.15, p = 0.008), NRT use increased, and tobacco-related practices increased in a non-significant trend (F(1, 123)= 3.66, p = 0.058). Client attitudes toward treating tobacco dependence became more favorable (F(1, 235) = 10.58, p = 0.0013) and clients received more tobacco-related services from their program (F(1,235) = 92.86,p <0.0001) and from their counselors (F(1,235) = 61.59, p <0.0001). Most changes remained at follow-up. Conclusions: The ATTOC intervention can help shift the treatment system culture and increase tobacco services in addiction treatment programs.

Copyright 2012, Elsevier Science


Gyllstrom ME; Hellerstedt WL; Hennrikus D. The association of maternal mental health with prenatal smoking cessation and postpartum relapse in a population-based sample. Maternal and Child Health Journal 16(3): 685-693, 2012. (40 refs.)

To examine the association between mental health factors with smoking cessation during pregnancy and postpartum relapse. We used data from 1,416 women who participated in the Minnesota Pregnancy Risk Assessment Monitoring System survey in 2004-2006 and reported smoking immediately prior to pregnancy. Maternal mood during pregnancy, stressful life events and postpartum depression were the mental health variables. We used multivariate logistic regression to examine the association between these variables and two outcomes, smoking cessation during pregnancy and postpartum relapse. Stressful life events was associated with smoking cessation in multivariate regression models, however maternal mood was not. Smoking cessation was also associated with pre-conception smoking intensity, maternal education, and income. Maternal mood, stressful life events and postpartum depression were not associated with relapse in multivariate regression models. Breastfeeding at the time of the survey was the strongest correlate of relapse, with women who breast fed 60% less likely to resume smoking during the postpartum. Post-hoc analysis suggests that mental health variables may interact with other mitigating factors to influence smoking behavior during pregnancy. Mental health variables may be important to successful prenatal smoking cessation. Further research with larger sample sizes is needed to explore the possibility of interactive relationships between mental health variables and other co-factors on prenatal smoking cessation and postpartum relapse.

Copyright 2012, Springer


Harakeh Z; Vollebergh WAM. The impact of active and passive peer influence on young adult smoking: An experimental study. Drug and Alcohol Dependence 121(3): 220-223, 2012. (27 refs.)

Background: Peers influence adolescent and young adult smoking, but little is known about the underlying mechanisms. It is necessary to understand whether the current assumption of peer pressure is valid, or whether an alternative explanation as imitation is more appropriate. We examined whether passive (imitation) and/or active (pressure) peer influence affects young adult smoking. Methods: An experiment was conducted among 68 daily-smoking students aged 16-24. The actual study aim was masked. Participants had to do a 30-min music task with a confederate. The experiment consisted of a 2 (smoking condition: confederate smokes or not) by 2 (pressure condition: confederate offers the participant a cigarette or not) factorial design, resulting in four conditions: (1) no smoking and no pressure (N= 15); (2) smoking but no pressure (N = 16); (3) pressure but no smoking (N= 20); and (4) smoking and pressure (N = 17). The primary outcome tested was the total number of cigarettes smoked during this music assignment. Results: Peer smoking significantly predicted the total number of cigarettes smoked by young adults while peer pressure did not. The interaction effect of peer pressure and peer smoking was not significant. Conclusions: Peer pressure did not have a significant additional contribution, over and above smoking of the peer. Passive (imitation) peer influence affected young adult smoking rather than active (pressure) peer influence. Thus, smoking cessation efforts should aim at preventing interaction with smoking peers and raising awareness about its impact.

Copyright 2012, Elsevier Science


Hatsukami DK; Biener L; Leischow SJ; Zeller MR. Tobacco and nicotine product testing. (review). Nicotine & Tobacco Research 14(1): 7-17, 2012. (58 refs.)

Introduction: Tobacco product testing is a critical component of the Family Smoking Prevention and Tobacco Control Act (FSPTCA), which grants the Food and Drug Administration the authority to regulate tobacco products. The availability of methods and measures that can provide accurate data on the relative health risks across types of tobacco products, brands, and subbrands of tobacco products, on the validity of any health claims associated with a product, and on how consumers perceive information on products, toxicity or risks is crucial for making decisions on the product's potential impact on public health. These tools are also necessary for making assessments of the impact of new indications for medicinal products (other than cessation) but more importantly of tobacco products that may in the future be marketed as cessation tools. Objective: To identify research opportunities to develop empirically based and comprehensive methods and measures for testing tobacco and other nicotine-containing products so that the best science is available when decisions are made about products or policies. Methods: Literature was reviewed to address sections of the FSPTCA relevant to tobacco product evaluation; research questions were generated and then reviewed by a committee of research experts. Results: A research agenda was developed for tobacco product evaluation in the general areas of toxicity and health risks, abuse liability, consumer perception, and population effects. Conclusion: A cohesive, systematic, and comprehensive assessment of tobacco products is important and will require building consensus and addressing some crucial research questions.

Copyright 2012, Oxford University Press


Haug S; Meyer C; Dymalski A; Lippke S; John U. Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial. BMC Public Health 12: article 51, 2012. (25 refs.)

Background: Particularly in groups of adolescents with lower educational level the smoking prevalence is still high and constitutes a serious public health problem. There is limited evidence of effective smoking cessation interventions in this group. Individualised text messaging (SMS) based interventions are promising to support smoking cessation and could be provided to adolescents irrespective of their motivation to quit. The aim of the current paper is to outline the study protocol of a trial testing the efficacy of an SMS based intervention for smoking cessation in apprentices. Methods/Design: A two-arm cluster-randomised controlled trial will be conducted to test the efficacy of an SMS intervention for smoking cessation in adolescents and young adults compared to an assessment only control group. A total of 910 daily or occasional (>= 4 cigarettes in the preceding month and >= 1 cigarette in the preceding week) smoking apprentices will be proactively recruited in vocational school classes and, using school class as a randomisation unit, randomly assigned to an intervention group (n = 455) receiving the SMS based intervention or an assessment only control group (n = 455). Individualised text messages taking into account demographic data and the individuals' smoking behaviours will be sent to the participants of the intervention group over a period of 3 months. Participants will receive two text messages promoting smoking cessation per week. Program participants who intend to quit smoking have the opportunity to use a more intensive SMS program to prepare for their quit day and to prevent a subsequent relapse. The primary outcome measure will be the proportion of participants with 7-day point prevalence smoking abstinence assessed at 6-months follow-up. The research assistants conducting the baseline and the follow-up assessments will be blinded regarding group assignment. Discussion: It is expected that the program offers an effective and inexpensive way to promote smoking cessation among adolescents and young adults including those with lower educational level and independent of their motivation to quit.

Copyright 2012, BioMed Central


Hays JT; Croghan IT; Baker CL; Cappelleri JC; Bushmakin AG. Changes in health-related quality of life with smoking cessation treatment. European Journal of Public Health 22(2): 224-229, 2012. (28 refs.)

Background: Cigarette smoking causes reduced health-related quality of life (QoL) and smoking abstinence improves health-related QoL. We assessed the effects of treatment for tobacco dependence on the health-related QoL in a 52-week randomized controlled trial of varenicline and bupropion sustained release (SR). Methods: Subjects who smoked 10 cigarettes per day for the past year were randomly assigned to receive varenicline 1 mg twice daily (n = 696), bupropion SR 150 mg twice daily (n = 671) or placebo (n = 685) for 12 weeks and followed post-therapy for an additional 40 weeks. Health-related QoL was assessed using the Smoking Cessation Quality of Life questionnaire at baseline and Weeks 12, 24 and 52. Results: Health transition (perceived health compared with baseline) and self-control were both significantly improved among subjects receiving varenicline and bupropion SR compared with placebo at Weeks 12, 24 and 52. Similarly, varenicline-treated subjects had significantly improved health transition and self-control compared with subjects who received bupropion SR at Weeks 12 and 24, and at Week 52 for health transition. A significant positive association existed between length of continuous abstinence and improved health transition, vitality, self-control, anxiety and overall mental profile. In most instances both a direct and an indirect effect (through continuous smoking abstinence) of each active treatment (vs. placebo) contributed to improved self-control and health transition. Conclusion: Treatment with varenicline and bupropion SR for smoking cessation resulted in improved self-control and health transition that was mediated in large part by continuous smoking abstinence.

Copyright 2012, Oxford University Press


Higashi H; Barendregt JJ. Cost-effectiveness of tobacco control policies in Vietnam: The case of personal smoking cessation support. Addiction 107(3): 658, 2012. (49 refs.)

Aims: To examine the cost-effectiveness of personal smoking cessation support in Vietnam. Design, setting and participants We followed-up the population aged 15 years and over in 2006 to model the costs and health gains associated with five interventions: physician brief advice; nicotine replacement therapy (patch and gum); bupropion; and varenicline. Threshold analysis was undertaken to determine the price levels of pharmaceuticals for the interventions to be cost-effective. A multi-state life table model was constructed such that the interventions affect the smoking cessation behaviour of the age cohorts, and the resulting smoking prevalence defines their health outcomes. A health-care perspective was employed. Measurements Cost-effectiveness is measured in 2006 Vietnamese Dong (VND) per disability-adjusted life year (DALY) averted. We adopted theWorld Health Organization thresholds of being ` cost-effective' if less than three times gross domestic product (GDP) per capita (VND 34 600 000) and ` very cost effective' if less than GDP per capita (VND 11 500 000). Findings: The cost-effectiveness result of physician brief advice was VND 1 742 000 per DALY averted (international dollars 543), which was 'very cost-effective'. Varenicline dominated bupropion and nicotine-replacement therapies, although it did not fall within the range of being 'costeffective' under different scenarios. The threshold analysis revealed that prices of pharmaceuticals must be substantially lower than the levels from other countries if pharmacological therapies are to be cost-effective in Vietnam. Conclusions: Physician brief advice is a cost-effective intervention and should be included in the priority list of tobacco control policy in Vietnam. Pharmacological therapies are not cost-effective, and so they are not recommended in Vietnam at this time unless pharmaceuticals could be produced locally at substantially lower costs in the future.

Copyright 2012, Society for the Study of Addiction


Hunt JJ; Cupertino AP; Garrett S; Friedmann PD; Richter KP. How is tobacco treatment provided during drug treatment? Journal of Substance Abuse Treatment 42(1): 4-15, 2012. (41 refs.)

The purpose of this study was to obtain descriptions of tobacco treatment services across different substance abuse treatment settings. We conducted mixed-method assessments in eight facilities among eight directors, 25 staff, 29 clients, and 82 client charts. Measures included systems assessment, chart reviews, and semistructured interviews. Although many programs reported they offer key components of evidence-based treatment, few actually provided any treatment and none did so systematically. Many addressed tobacco as part of drug education or part of a health promotion session. Chart reviews suggested that provision of tobacco treatment is rare. By many reports, clients had to specifically request treatment and few staff reported encouraging unmotivated smokers to quit. Systems to facilitate consistent, evidence-based tobacco treatment and to implement quality improvement were nonexistent. The findings imply that drug treatment facilities may need to build capacity in several domains to deliver care that is consistent with national guidelines.

Copyright 2012, Elsevier Science


Hwang GS; Jung HS; Yi Y; Yoon C; Choi JW. Smoking cessation intervention using stepwise exercise incentives for male workers in the workplace. Asia-Pacific Journal of Public Health 24(1): 82, 2012. (30 refs.)

The authors developed a stepwise exercise-incentive-based smoking cessation program as one of the workplace health promotion program. The aim of this study is to evaluate the program offered in an electronics company in Korea. A total of 109 electronics company employees were recruited. Participants were surveyed for smoking history, nicotine dependence, and job stress. They received smoking cessation education and were provided with a stepwise fitness center ticket. Of 109 participants, 58 (53.2%) successfully ceased smoking for 3 months. Significant differences between success and fail groups were apparent in cigarettes smoked per day (P = .002) and nicotine dependence score (P = .049). However, there was no significant difference in job stress between success and fail groups. Based on multiple logistic regression analysis, there were no identifiable factors associated with smoking cessation. In conclusion, a stepwise exercise-incentive-based smoking cessation program was highly effective when applied in a workplace setting.

Copyright 2012, Sage Publications


Jones TE; Williams J. Craving control using nicotine replacement therapy in a teaching hospital. Internal Medicine Journal 42(3): 317-322, 2012. (25 refs.)

Background: A period of hospitalisation is perhaps the longest period of enforced temporary abstinence smokers have to endure and hence many crave during their admission. Cravings may result in patients' smoking on hospital premises. Nicotine replacement may reduce cravings, decrease smoking on hospital grounds and increase interest in quitting post-discharge. Aim: The aim of this study was to compare the efficacy of two nicotine formulations in controlling inpatient cravings and enthusiasm for quitting post- discharge. Methods: Inpatients who were smokers were randomised to nicotine patch or inhaler on alternating days. Patients selected their preferred formulation, which was then used for the duration of the hospital stay. Craving control and formulation preference were assessed by visual analogue scales (VAS), and interest in quitting on a 3-point scale. Abstinence was confirmed by exhaled breath CO monitoring. Results: Patches were preferred by 64% of the 367 subjects. Fewer patients went outside to smoke after either formulation (37% before, 5% after enrolment). Cravings were reduced by both nicotine formulations (mean VAS score fell from 7.5 to 1.7). Interest in quitting post- discharge increased. Estimated mean exposure to nicotine was 5 mg/ day (inhaler), 15 mg/ day (transdermal patch) compared with 30 mg/ day (cigarettes) before hospitalisation. Conclusions: Many smokers crave and some smoke outside during a hospital admission. While the patch was the preferred formulation of nicotine replacement therapy, both were effective in reducing cravings, increasing motivation for quitting postdischarge and improving Hospital ` image' by reducing smoking on campus. Nicotine replacement therapy should be made available to inpatients in all hospitals and other places of enforced prolonged abstinence.

Copyright 2012, Wiley-Blackwell


Kaganoff E; Bordnick PS; Carter BL. Feasibility of using virtual reality to assess nicotine cue reactivity during treatment. Research on Social Work Practice 22(2): 159-165, 2012. (26 refs.)

Cue reactivity assessments have been widely used to assess craving and attention to cues among cigarette smokers. Cue reactivity has the potential to offer insights into treatment decisions; however, the use of cue reactivity in treatment studies has been limited. This study assessed the feasibility of using a virtual reality-based cue reactivity assessment approach (VR-NCRAS) during treatment. In a clinical smoking cessation treatment study, 46 treatment-seeking nicotine-dependent adult smokers were assessed for cue reactivity at baseline, Week 4, and Week 10 of treatment. Measures of cue reactivity included subjective craving and attention to cues after exposure to two neutral and two smoking cue environments. Overall, feasibility of using VR-NCRAS was demonstrated and these findings support the use of the cue reactivity assessment during treatment, which can inform treatment decisions.

Copyright 2012, Sage Publications


Katz DA; Weg MWV; Holman J; Nugent A; Baker L; Johnson S et al. The Emergency Department Action In Smoking Cessation (EDASC) Trial: Impact on delivery of smoking cessation counseling. Academic Emergency Medicine 19(4): 409-420, 2012. (83 refs.)

Objectives: The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation interventions in the emergency department (ED). The aim of this study was to 1) determine the effect of an emergency nurseinitiated intervention on delivery of smoking cessation counseling based on the 5As framework (askadviseassessassistarrange) and 2) assess ED nurses and physicians perceptions of smoking cessation counseling. Methods: The authors conducted a prepost trial in 789 adult smokers (five or more cigarettes/day) who presented to two EDs. The intervention focused on improving delivery of the 5As by ED nurses and physicians and included face-to-face training and an online tutorial, use of a charting/reminder tool, fax referral of motivated smokers to the state tobacco quitline for proactive telephone counseling, and group feedback to ED staff. To assess ED performance of cessation counseling, a telephone interview of subjects was conducted shortly after the ED visit. Nurses and physicians self-efficacy, role satisfaction, and attitudes toward smoking cessation counseling were assessed by survey. Multivariable logistic regression was used to assess the effect of the intervention on performance of the 5As, while adjusting for key covariates. Results: Of 650 smokers who completed the post-ED interview, a greater proportion had been asked about smoking by an ED nurse (68% vs. 53%, adjusted odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.3 to 2.9), assessed for willingness to quit (31% vs. 9%, adjusted OR= 4.9, 95% CI = 2.9 to 7.9), and assisted in quitting (23% vs. 6%, adjusted OR = 5.1, 95% CI = 2.7 to 9.5) and had arrangements for follow-up cessation counseling (7% vs. 1%, adjusted OR = 7.1, 95% CI = 2.3 to 21) during the intervention compared to the baseline period. A similar increase was observed for emergency physicians (EPs). ED nurses self-efficacy and role satisfaction in cessation counseling significantly improved following the intervention; however, there was no change in pros and cons attitudes toward smoking cessation in either ED nurses or physicians. Conclusions: Emergency department nurses and physicians can effectively deliver smoking cessation counseling to smokers in a time-efficient manner. This trial also provides empirical support for expert recommendations that call for nursing staff to play a larger role in delivering public health interventions in the ED.

Copyright 2012, Wiley-Blackwell


Kelly DL; Raley HG; Lo S; Wright K; Liu F; McMahon RP et al. Perception of smoking risks and motivation to quit among nontreatment-seeking smokers with and without schizophrenia. Schizophrenia Bulletin 38(3): 543-551, 2012. (44 refs.)

We examined perceived consequences/benefits of cigarette smoking and motivation for quitting in nontreatment-seeking smokers who had schizophrenia or schizoaffective disorder (N = 100) or had no Axis I psychiatric disorder (normals, N = 100). Participants completed questionnaires and provided a breath carbon monoxide (CO) sample 10-15 minutes after smoking 1 preferred-brand cigarette. Primary assessments included the Smoking Consequences Questionnaire-Adult, the Reasons for Quitting Scale, and the Stages of Change. There were no differences between the schizophrenia and control group in mean age of smoking onset (16.2 +/- 5.4 vs 15.6 +/- 5.5 y, P = .44), number of cigarettes daily (17.9 +/- 11.6 vs 17.0 +/- 7.9, P = 0.51), or in breath CO (28.0 +/- 14.5 vs 22.9 +/- 8.0 ppm, P = .61). Compared with normals, people with schizophrenia report greater stimulation/state enhancement (P < .0001) and social facilitation (P < .004) from smoking. People with schizophrenia had less appreciation of health risks associated with smoking than normal controls (P < .0001) and were less motivated to quit smoking than normal controls (P = .002), even though they were as likely to be in the preparation stage of change. Immediate reinforcement (P = .04) and health concerns (P = .002) were rated lower as motivators for considering quitting smoking in schizophrenia than normals. People with schizophrenia reported greater motivation to stop smoking due to social pressure/rewards than normals (P = .047). This study underscores the degree to which people with schizophrenia perceive the state-enhancing effects of smoking and their lower appreciation for health risks of smoking compared with normal controls.

Copyright 2012, Oxford University Press


Kennedy RD; Behm I; Craig L; Thompson ME; Fong GT; Guignard R et al. Outdoor smoking behaviour and support for outdoor smoking restrictions before and after France's national smoking ban. European Journal of Public Health 22(Supplement 1): 29, 2012. (20 refs.)

Background: On January 1, 2008, the French government implemented a national ban on indoor smoking in hospitality venues. Survey results indicate the indoor ban has been successful at dramatically reducing indoor smoking; however, there are reports of an increased number of outdoor hospitality spaces (patios) where smoking can take place. This study sought to understand if the indoor ban simply moved smoking to the outdoors, and to assess levels of support for smoking restrictions in outdoor hospitality settings after the smoke-free law. Methods: Telephone interviews were conducted among 1067 adult smokers before and after the 2008 indoor ban as part of the International Tobacco Control (ITC) France Survey. Among other topics, this survey measures how the smoking ban has influenced smoking behaviour relevant to outdoor sections of hospitality venues. In addition, 414 non-smoking adults and 164 respondents who had quit smoking between waves were also asked about support for outdoor smoking restrictions. Results: Reported smoking outdoors at cafes/pubs/bars increased from 33.6% of smokers at Wave 1 to 75.9% at Wave 2. At restaurants, smoking outdoors increased from 28.9% to 59.0%. There was also an increase in reported non-smoking for both visits to cafes/pubs/bars, and restaurants from 13.4% to 24.7%, and 30.4% to 40.8% respectively. The majority of smokers (74.5%), non-smokers (89.4%) and quitters (74.0%) support a partial or complete ban on smoking in outdoor areas of restaurants. Conclusion: The indoor smoking ban moved smoking to outdoor spaces; however, the ban is also associated with increased non-smoking behaviour. The majority of respondents support outdoor smoking restrictions in patio environments.

Copyright 2012, Oxford University Press


Kennedy RD; Behm I; Craig L; Thompson ME; Fong GT; Guignard R; Beck F. Smoking cessation interventions from health care providers before and after the national smoke-free law in France. European Journal of Public Health 22(Supplement 1): 23, 2012. (24 refs.)

Background: Smoking cessation advice from health care providers (HCP) is well-known to be associated with increased quitting. This study sought to understand the extent to which smokers in France who visited a HCP around the time of the implementation of the national ban on smoking received encouragement to quit from a HCP and what kinds of intervention were provided. HCP may have a unique opportunity during the implementation phase of smoke-free laws to address their patients' smoking behaviours to increase the likelihood of success at a time when smokers' readiness and interest in quitting may be higher. Methods: Telephone interviews were conducted among adult smokers (n = 1067) before and after the two-phase (2007 and 2008) national ban on indoor smoking as part of the International Tobacco Control (ITC) France Survey. In the survey, smokers were asked whether they had visited a HCP in the past 6 months and, if so, whether they had received cessation encouragement, and/or other interventions to support quitting such as prescriptions for stop-smoking medication. Results: Most smokers (61%) reported visiting a HCP in the 6 months prior to the first phase of the national smoke-free ban, and 58% after the time of the hospitality ban. Of these, most reported they did not receive any assistance from a HCP before (54%) or after (64%) the smoke-free law. Among those who reported an intervention, the most common were only encouragement to quit (58% in Wave 1 and 49% in Wave 2), or receiving both encouragement and a pamphlet (31% in both Wave 1 and 2). The combination of prescriptions for stop-smoking medicine and encouragement to quit increased from 8% in 2007 to 22% in 2008. The smokers who received an intervention were more likely (OR 1.9, 95% CI: 1.2-2.9) to report that they were thinking about quitting. Discussion: This study demonstrates that HCP in France are well positioned to provide smoking cessation encouragement and other interventions to a majority of smokers and thus the importance of taking measures to increase their involvement, particularly when population-level tobacco control policies, such as smoke-free laws, are being implemented.

Copyright 2012, Oxford University Press


King DP; Paciga S; Pickering E; Benowitz NL; Bierut LJ; Conti DV et al. Smoking cessation pharmacogenetics: Analysis of varenicline and bupropion in placebo-controlled clinical trials. Neuropsychopharmacology 37(3): 641-650, 2012. (55 refs.)

Despite effective therapies for smoking cessation, most smokers find quitting difficult and most successful quitters relapse. Considerable evidence supports a genetic risk for nicotine dependence; however, less is known about the pharmacogenetics of smoking cessation. In the first pharmacogenetic investigation of the efficacy of varenicline and bupropion, we examined whether genes important in the pharmacodynamics and pharmacokinetics of these drugs and nicotine predict medication efficacy and adverse events. Subjects participated in randomized, double-blind, placebo-controlled smoking cessation clinical trials, comparing varenicline, a nicotinic acetylcholine receptor (nAChR) partial agonist, with bupropion, a norepinephrine/dopamine reuptake inhibitor, and placebo. Primary analysis included 1175 smokers of European ancestry, and 785 single nucleotide polymorphisms from 24 genes, representing 254 linkage disequilibrium (LD) bins (genes included nAChR subunits, additional varenicline-specific genes, and genes involved in nicotine or bupropion metabolism). For varenicline, continuous abstinence (weeks 9-12) was associated with multiple nAChR subunit genes (including CHRNB2, CHRNA5, and CHRNA4) (OR = 1.76; 95% CI: 1.23-2.52) (p<0.005); for bupropion, abstinence was associated with CYP2B6 (OR = 1.78; 95% CI: 1.27-2.50) (p<0.001). Incidence of nausea was associated with several nAChR subunit genes (OR = 0.50; 95% CI: 0.36-0.70) (p<0.0001) and time to relapse after quitting was associated with HTR3B (HR = 1.97; 95% CI: 1.45-2.68) (p<0.0001). These data provide evidence for multiple genetic loci contributing to smoking cessation and therapeutic response. Different loci are associated with varenicline vs bupropion response, suggesting that additional research may identify clinically useful markers to guide treatment decisions.

Copyright 2012, Nature Publishing Group


Kirchner TR; Shiffman S; Wileyto EP. Relapse dynamics during smoking cessation: Recurrent abstinence violation effects and lapse-relapse progression. Journal of Abnormal Psychology 121(1): 187-197, 2012. (52 refs.)

Smoking cessation is a process that unfolds over time and is characterized by intermittent lapses. We used parametric recurrent event survival analyses to better understand the dynamic relationship between a set of Abstinence Violation Effect (AVE, Marlatt & Gordon, 1985) responses to lapsing and subsequent lapse-relapse progression. Participants were 203 smokers who achieved abstinence and responded to items assessing three core components of the AVE (internal attribution, abstinence self-efficacy and guilt) following a total of 1,001 lapse episodes in near real time. Neither self-blame, self-efficacy, nor guilt following participants' first lapse predicted relapse. Controlling for responses to their first lapse, responses to each additional lapse did prospectively predict lapse progression, such that drops in self-efficacy were associated with accelerated progression to a subsequent lapse (HR = 1.09, CI = 1.02-1.15), while increases in internal attributions of blame actually protected against lapsing (HR = 0.98, CI = 0.97-0.99). Treatment with nicotine patches slowed recurrent lapse progression (HR = 0.58, CI = 0.48-0.70), but this effect dissipated over multiple lapses, and was moderated by elevated ratings of postlapse guilt (HR = 1.08, CI = 1.01-1.18), which predicted accelerated progression within the active patch group, while protecting against lapse in the placebo group. Results highlight the dynamic nature of lapse responses during smoking cessation, indicating that self-efficacy predicts progression from one lapse to the next, while attributions of self-blame and guilt influenced progression in unexpected ways.

Copyright 2012, American Psychological Association


Knudsen HK; Studts CR; Studts JL. The implementation of smoking cessation counseling in substance abuse treatment. Journal of Behavioral Health Services & Research 39(1): 28-41, 2012. (51 refs.)

Research on the implementation of smoking cessation counseling within substance abuse treatment organizations is limited. This study examines associations among counselors' implementation of therapy sessions dedicated to smoking cessation, organizational factors, and counselor-level variables. A two-level hierarchical linear model including organization-and counselor-level variables was estimated using survey data collected from 1,794 counselors working in 359 treatment organizations. Overall implementation of smoking cessation counseling was low. In the final model, implementation was positively associated with counselors' knowledge of the Public Health Service's clinical practice guideline, perceived managerial support, and belief that smoking cessation had a positive impact on recovery. Private versus public funding and presence of a formal smoking cessation program were organization-level variables which interacted with these counselor-level effects. These results highlight the importance of organizational contexts as well as counselors' knowledge and attitudes for effective implementation of smoking cessation counseling in substance abuse treatment organizations.

Copyright 2012, Springer


Kotz D; Fidler J; West R. Very low rate and light smokers: Smoking patterns and cessation-related behaviour in England, 2006-11. Addiction 107(5): 995-1002, 2012. (22 refs.)

Aims: There is a growing interest in very low rate [fewer than one cigarette per day (CPD)] and light (one to nine CPD) smokers and in some parts of the world their numbers appear to be increasing. This paper examined changes in prevalence over the past 5 years, cessation patterns, and smoking and demographic characteristics of very low rate, light and moderate-to-heavy (10+ CPD) smokers in England. Design: Cross-sectional and longitudinal data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. Setting England. Participants: A total of 23,245 smokers interviewed between November 2006 and May 2011 and 4147 who provided data at 6-month follow-up. Measurements: We compared the demographic and smoking characteristics between the three groups of smokers at baseline, and the rate of attempts to quit, use of aids to cessation and success of quit attempts at follow-up. Findings: Very low rate smoking remained extremely rare (1.9% of smokers in 2006 to 2.8% in 2011), but light smoking became increasingly common (23.9-32.8%). Compared with moderate-to-heavy smokers, very low rate and light smokers were younger, more often female and from a higher socio-economic background. They were more motivated to quit and enjoyed smoking less. During the 6-month follow-up period, light smokers, but not very low rate smokers, were more likely to attempt to quit than moderate-to-heavy smokers. When they tried to quit, very low rate and light smokers used aids to cessation less than moderate-to-heavy smokers but still used them to a substantial degree: 18%, 31% and 44% used over-the-counter nicotine replacement therapy in their most recent quit attempt for the three types of smoker, respectively. Even very low rate smokers had a substantial failure rate: 65% failed in their most recent quit attempt within 6 months. Conclusions: Very low rate (fewer than one cigarette per day) and light (one to nine cigarettes per day) smokers in England are at least as motivated to quit as heavier smokers. Although they use cessation medication less than heavier smokers and are more likely to succeed, they still use such medication and fail in quit attempts to a substantial degree.

Copyright 2012, Wiley-Blackwell


Kruger TM; Howell BM; Haney A; Davis RE; Fields N; Schoenberg NE. Perceptions of smoking cessation programs in rural Appalachia. American Journal of Health Behavior 36(3): 373-384, 2012. (48 refs.)

Objectives: To identify perspectives on smoking cessation programs in Appalachian Kentucky, a region with particularly high smoking rates and poor health outcomes. Methods: Insufficient existing research led us to conduct 12 focus groups (smokers and nonsmokers) and 23 key informant interviews. Results: Several findings previously not described in this high-risk population include (1) transition from pro-tobacco culture toward advocacy for tobacco cessation approaches, (2) region-specific challenges to program access, and (3) strong and diverse social influences on cessation. Conclusions: To capitalize on changes from resistance to support for smoking cessation, leaders should incorporate culturally appropriate programs and characteristics identified here.

Copyright 2012, PNG


Lazuras L; Chatzipolychroni E; Rodafinos A; Eiser JR. Social cognitive predictors of smoking cessation intentions among smoker employees: The roles of anticipated regret and social norms. Addictive Behaviors 37(3): 339-341, 2012. (14 refs.)

The present study assessed the effects of anticipated regret, social norms, and related social cognitions on smoking cessation intentions among indoor employees in a pro-smoking culture. Overall, 93 daily smokers completed anonymous structured questionnaires assessing attitudinal and health beliefs about tobacco use, social norms, quitting self-efficacy, and anticipated regret. Past quit attempts and tobacco dependence were also measured. Hierarchical linear regression and mediation analyses showed that attitudes toward quitting, self-efficacy and anticipated regret significantly predicted cessation intentions, over and above past quit attempts and tobacco dependence. Unlike in previous studies, tobacco dependence, descriptive norms and smoke-free policies did not directly influence quit intentions in our sample of smokers. Anticipated regret mediated the effects of attitudes and social norms on cessation intentions.

Copyright 2012, Elsevier Science


Leung L; Neufeld T; Marin S. Effect of self-administered auricular acupressure on smoking cessation: A pilot study. BMC Complementary and Alternative Medicine 12: e-article 11, 2012. (37 refs.)

Background: Tobacco smoking is still a worldwide health risk. Current pharmacotherapies have at best, a success rate of no more than 50%. Auricular (ear) acupressure has been purported to be beneficial in achieving smoking cessation in some studies, while in others has been deemed insignificant. We hereby describe the protocol for a three-arm randomised controlled trial to examine the possible benefits of self-administered acupressure for smoking cessation. Methods: Sixty consenting participants with confirmed habit of tobacco smoking will be recruited and randomized into three arms to receive either auricular acupressure at five true acupoints (NADA protocol), auricular acupressure at five sham points, or no auricular acupressure at all. Participants having auricular acupressure will exert firm pressure to each acupoint bilaterally via the bead in the attached plasters whenever they feel the urge to smoke. The treatment phase will last for six weeks during which all participants will be assessed weekly to review their smoking log, state of abstinence, end-exhalation carbon monoxide levels and possible adverse effects including withdrawal reactions and stress levels. At any time, a successful quit date will be defined with continuous abstinence for the following consecutive 7 days. From then on, participants will be evaluated individually for continuous abstinence rate (CAR), end-exhalation carbon monoxide levels and adverse effects of stress and withdrawal at specified intervals up to 26 weeks. Expectancy of treatment will be assessed with a four-item Borkovec and Nau self-assessment credibility scale during and after intervention. Discussion: We incorporate validated outcome measures of smoking cessation into our randomised controlled trial design with the objectives to evaluate the feasibility and possible benefits of self-administered auricular acupressure as a non-invasive alternative to pharmacotherapy for smoking cessation.

Copyright 2012, BioMed Central


Leykin Y; Aguilera A; Torres LD; Perez-Stable EJ; Munoz RF. Interpreting the outcomes of automated internet-based randomized trials: Example of an international smoking cessation study. Journal of Medical Internet Research 14(1): e-article 5, 2012. (45 refs.)

Background: Smoking is one of the largest contributors to the global burden of disease. Internet interventions have been shown to reduce smoking rates successfully. However, improved methods of evaluating effectiveness need to be developed for large-scale Internet intervention trials. Objective: To illustrate a method to interpret outcomes of large-scale, fully automated, worldwide Internet intervention trials. Methods: A fully automated, international, Internet-based smoking cessation randomized controlled trial was conducted in Spanish and English, with 16,430 smokers from 165 countries. The randomized controlled trial replicated a published efficacy trial in which, to reduce follow-up attrition, 1000 smokers were followed up by phone if they did not provide online follow-up data. Results: The 7-day self-reported abstinence rates ranged from 36.18% (2239/6189) at 1 month to 41.34% (1361/3292) at 12 months based on observed data. Given high rates of attrition in this fully automated trial, when participants unreachable at follow-up were presumed to be smoking, the abstinence rates ranged from 13.63% (2239/16.430) at 1 month to 8.28% (1361/16,430) at 12 months. We address the problem of interpreting results with high follow-up attrition rates and propose a solution based on a smaller study with intensive phone follow-up. Conclusions: Internet-based smoking cessation interventions can help large numbers of smokers quit. Large-scale international outcome studies can be successfully implemented using automated Internet sites. Interpretation of the studies' results can be aided by extrapolating from results obtained from subsamples that are followed up by phone or similar cohort maintenance methods.

Copyright 2012, Journal of Medical Internet Research


Li SJ; Delva J. Social capital and smoking among Asian American men: An exploratory study. American Journal of Public Health 102(Supplement 2): S212-S221, 2012. (59 refs.)

Objectives. We examined how different dimensions of social capital (i.e., family and friend connections, neighborhood and family cohesion, family conflict) were associated with smoking behavior among a nationally representative sample of Asian American men and whether the associations varied by ethnic group. Methods. The sample consisted of 998 adult Asian American men who participated in the National Latino and Asian American Survey from 2002 to 2003. We conducted weighted multivariate logistic regressions on data for the sample and for each of 4 ethnic subgroups (Chinese, Vietnamese, Filipino, and Other). Results. Vietnamese American men had the highest prevalence of current smoking; Chinese American men, the lowest. After controlling for sociodemographics, socioeconomic status, acculturation, and perceived discrimination, neighborhood cohesion was inversely associated with smoking among Asian American men, and family and friend connections and family cohesion were not. An exception was family cohesion, which was associated with increased odds of smoking among Filipino American men. Conclusions. The relationship between social capital and smoking among Asian American men varied according to specific dimensions of social capital and was ethnicity specific. These findings highlight the need for smoking prevention and cessation interventions to take into consideration the heterogeneity that exists among Asian Americans.

Copyright 2012, American Public Health Association


Libby DJ; Worhunsky PD; Pilver CE; Brewer JA. Meditation-induced changes in high-frequency heart rate variability predict smoking outcomes. Frontiers in Human Neuroscience 6: e-article 54, 2012. (82 refs.)

Background: High-frequency heart rate variability (HF-HRV) is a measure of parasympathetic nervous system (PNS) output that has been associated with enhanced self-regulation. Low resting levels of HF-HRV are associated with nicotine dependence and blunted stress-related changes in HF-HRV are associated with decreased ability to resist smoking. Meditation has been shown to increase HF-HRV. However, it is unknown whether tonic levels of HF-HRV or acute changes in HF-HRV during meditation predict treatment responses in addictive behaviors such as smoking cessation. Purpose: To investigate the relationship between HF-HRV and subsequent smoking outcomes. Methods: HF-HRV during resting baseline and during mindfulness meditation was measured within two weeks of completing a 4-week smoking cessation intervention in a sample of 31 community participants. Self-report measures of smoking were obtained at a follow up 17-weeks after the initiation of treatment. Results: Regression analyses indicated that individuals exhibiting acute increases in HF-HRV from resting baseline to meditation smoked fewer cigarettes at follow-up than those who exhibited acute decreases in HF-HRV (b = -4.89, p = 0.008). Conclusion: Acute changes in HF-HRV in response to meditation may be a useful tool to predict smoking cessation treatment response.

Copyright 2012, Frontiers Research Foundation


Lim MK; Kim HJ; Yun EH; Oh JK; Park EY; Shin SH et al. Role of quit supporters and other factors associated with smoking abstinence in adolescent smokers: A prospective study on Quit line users in the Republic of Korea. Addictive Behaviors 37(3): 342-345, 2012. (25 refs.)

The aim of this study elucidated the effectiveness of Quitline among adolescent smokers, as well as other factors associated with adolescent smoking cessation in the Republic of Korea. For 642 adolescent Quitline users aged 13-19 years, the information on demographic characteristics, smoking and cessation related factors, and cessation outcome was collected. Cox proportional hazard models were applied. 13.4% of boys and 6.6% of girls maintained smoking cessation for 1 year. Having a high level of self-efficacy had a preventive effect on relapse in both genders. Boys with parents or other family members as quit supporters, and boys with a higher number of past cessation attempts, were more likely to relapse. It was even more pronounced among boys who reported low self-efficacy. Relapse was increased with marginal significance among girls with parents or other family members as quit supporters. It is evident that Quitline is an effective way to encourage adolescent smoking cessation in Korea. Reinforcing self-efficacy and enhancing the cooperative behaviors of parents or other family member quit supporters could be additional contributors for maintaining cessation among adolescent smokers who want to quit.

Copyright 2012, Elsevier Science


Loh WY; Piper ME; Schlam TR; Fiore MC; Smith SS; Jorenby DE et al. Should all smokers use combination smoking cessation pharmacotherapy? Using novel analytic methods to detect differential treatment effects over 8 weeks of pharmacotherapy. Nicotine & Tobacco Research 14(2): 131-141, 2012. (39 refs.)

Combination pharmacotherapy for smoking cessation has been shown to be more effective than monotherapy in meta-analyses. We address the question of whether combination pharmacotherapy should be used routinely with smokers or if some types of smokers show little or no benefit from combination pharmacotherapy versus monotherapy. Two smoking cessation trials were conducted using the same assessments and medications (bupropion, nicotine lozenge, nicotine patch, bupropion + lozenge, and patch + lozenge). Participants were smokers presenting either to primary care clinics in southeastern Wisconsin for medical treatment (Effectiveness trial, N = 1,346) or volunteering for smoking cessation treatment at smoking cessation clinics in Madison and Milwaukee, WI (Efficacy trial, N = 1,504). For each trial, decision tree analyses identified variables predicting outcome from combination pharmacotherapy versus monotherapy at the end of treatment (smoking 8 weeks after the target quit day). All smokers tended to benefit from combination pharmacotherapy except those low in nicotine dependence (longer latency to smoke in the morning as per item 1 of the Fagerstrom Test of Nicotine Dependence) who also lived with a spouse or partner who smoked. Combination pharmacotherapy was generally more effective than monotherapy among smokers, but one group of smokers, those who were low in nicotine dependence and who lived with a smoking spouse, did not show greater benefit from using combination pharmacotherapy. Use of monotherapy with these smokers might be justified considering the expense and side effects of combination pharmacotherapy.

Copyright 2012, Oxford University Press


Lowe JB; Barnes M; Teo C; Sutherns S. Investigating the use of social media to help women from going back to smoking post-partum. Australian and New Zealand Journal of Public Health 36(1): 30, 2012. (18 refs.)

Objective: To investigate the social factors that would help women who had quit smoking due to pregnancy from returning to smoking after delivery of their baby. Methods: Women who attended their first antenatal check-up at a general public hospital were invited to participate in pre- and postpartum interviews. Results: A total of 24 women were interviewed pre- and postpartum. They reported isolation as a factor that influenced how they dealt with stress. This stress was linked to relapse. The use of electronic media through the Internet was a way women could interact with the outside community without having to leave home. Conclusions: Women who had strong family relationships in geographic proximity were not as likely to use the computer to interact with relatives and friends. Women who did not have strong local and family ties that support their desire to not go back to smoking, reported using Facebook and other Internet activities to keep in touch while they stayed at home with their new infant. Implications: The use of electronic media may help facilitate interaction between new mothers, which could prevent isolation and relapse back to smoking after delivery. This mechanism might also be used to enhance skill-development and problem-solving by these women.

Copyright 2012, Wiley-Blackwell


Lund I; Scheffels J. Perceptions of the relative harmfulness of snus among Norwegian general practitioners and their effect on the tendency to recommend snus in smoking cessation. Nicotine & Tobacco Research 14(2): 169-175, 2012. (35 refs.)

Research suggests that health risks associated with the use of Swedish moist snuff (snus) are considerably smaller than health risks associated with cigarette smoking. However, erroneous ideas of approximately equal harm from snus and cigarettes are common in the general population. General practitioners (GPs) have a crucial role in giving information about health and risk to patients, and the objective of this study was to measure their perceptions of the relative harmfulness of cigarettes and snus and how these perceptions related to their tendency to recommend snus as a smoking cessation aid. Approximately 900 GPs completed a questionnaire in 2008 (response rate about 45%). Perceived relative risk was measured by the question: "In terms of health risks, how do you think daily use of snus compares to daily use of cigarettes?" Answer categories ranged from "snus is much more harmful" to "snus is much less harmful." Only 36% of the GPs believed that snus was much less harmful than cigarettes. More than 15% believed that snus was equally or more harmful than cigarettes. GPs who rated snus as much less harmful more often recommended snus as an aid in smoking cessation. Almost two thirds of the GPs had beliefs about the relative risk of snus and cigarettes that were at odds with scientific consensus. The associated limitations in disseminated information about snus as a possible quitting aid can be understood as an unexploited intervention potential.

Copyright 2012, Oxford University Press


Mantzari E; Vogt F; Marteau TM. The effectiveness of financial incentives for smoking cessation during pregnancy: Is it from being paid or from the extra aid? BMC Pregnancy and Childbirth 12: article 24, 2012. (50 refs.)

Background: Financial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women's experiences of trying to stop smoking, within and outside of a financial incentives scheme. Methods: Thirty-six (n = 36) UK-based pregnant smokers (n = 36), offered standard NHS Stop-Smoking Services, of whom twenty (n = 20) were enrolled in a financial incentives scheme for smoking cessation (n = 20) and sixteen (n = 16) were not, were interviewed about (i) their motivation to stop smoking, and (ii) the factors they perceived as influencing their quitting efforts. Framework Analysis was used to analyse the data. Results: Women in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts. Conclusion: Women participating in a financial incentives scheme to stop smoking reported greater engagement with the Stop-Smoking Services, from which they described receiving more help in quitting than women who were not part of the scheme. These results highlight the complexity of financial incentives schemes and the intricacies surrounding the ways in which they operate to affect smoking cessation. These might involve influencing individuals' motivation and self-regulation, changing engagement with and provision of support services, or a combination of these.

Copyright 2012, BioMed Central


Maxson PJ; Edwards SE; Ingram A; Miranda ML. Psychosocial differences between smokers and non-smokers during pregnancy. Addictive Behaviors 37(2): 153-159, 2012. (45 refs.)

Despite the well-established adverse birth and childhood health outcomes associated with maternal smoking, smoking rates among pregnant women remain high. Psychosocial health attributes, including anxiety, depression, perceived stress, self-efficacy, and personality characteristics, have especially important roles in smoking behavior. Understanding who smokes during pregnancy and what factors influence this behavior choice may be key to improving the effectiveness of smoking cessation intervention programs. We use data from a prospective cohort study of pregnant women to understand the psychosocial health profiles of women who choose to smoke during pregnancy compared to the profiles of women who do not smoke or successfully quit smoking during pregnancy. Multinomial logistic regression analyses on 1518 non-Hispanic black and non-Hispanic white women assessed the association between smoking status and psychosocial health while controlling for demographic characteristics. Higher levels of perceived stress, depression, neuroticism, negative paternal support, and perceived racism among non-Hispanic blacks were associated with higher odds of being a smoker than a non-smoker (p<0.05). Higher levels of self-efficacy, extraversion, agreeableness, conscientiousness, interpersonal support, positive paternal support, and perceived social standing were associated with lower odds of being a smoker than a non-smoker (p<0.05). Our analysis indicates that women who smoked during pregnancy experienced a more negative constellation of psychosocial adversities than women who did not smoke. Given the psychosocial needs and personality profiles experienced by smokers, more attention to the psychosocial strengths and weaknesses of these women may allow for more tailored smoking cessation programs, enhancing both the short- and long-term effectiveness of such interventions.

Copyright 2012, Elsevier Science


May J; Andrade J; Willoughby K; Brown C. An attentional control task reduces intrusive thoughts about smoking. Nicotine & Tobacco Research 14(4): 472-478, 2012. (29 refs.)

Attentional control tasks such as body scanning and following isometric exercise instructions have been shown to reduce smoking cravings, apparently by reducing stress (Ussher, M., Cropley, M., Playle, S., Mohidin, R., & West, R. [2009]. Effect of isometric exercise and body scanning on cigarette cravings and withdrawal symptoms. Addiction, 104, 1251-1257. doi:10.1111/j.1360-0443.2009.02605.x). Related work based upon elaborated intrusion theory (Kavanagh, D. J., Andrade, J., & May, J. [2005]. Imaginary relish and exquisite torture: The elaborated intrusion theory of desire. Psychological Review, 112, 446-467. doi:10.1037/0033-295X.112.2.446) has shown that similar tasks can reduce hungry participants' involuntary food-related thoughts (May, J., Andrade, J., Batey, H., Berry, L.-M., & Kavanagh, D. [2010]. Less food for thought: Impact of attentional instructions on intrusive thoughts about snack foods. Appetite, 55, 279-287. doi:10.1016/j.appet.2010.06.014). This study tests the effect of body scanning instructions upon smoking-related thoughts as well as craving. Twenty-seven smokers took part in 2 counterbalanced sessions, on different days, having been asked to abstain from smoking for 2 hr. In each session, they followed audio instructions for three 10-min blocks during which their thoughts were probed 10 times. In the first and third blocks, they were instructed to let their mind wander; during the second block of the control session, they also let their mind wander, but in the experimental session, they followed body scanning instructions. "Smoking thought frequency" was assessed using thought probes; "Craving" was measured using Factor 1 of the Questionnaire on Smoking Urges (Tiffany, S. T., & Drobes, D. J. [1991]. The development and initial validation of a questionnaire on smoking urges. British Journal of Addiction, 86, 1467-1476. doi:10.1111/j.1360-0443.1991.tb01732.x). Participants reported fewer smoking-related thoughts and lower smoking cravings in the body scanning block of the experimental session, whereas they rose in the comparable mind-wandering block of the control session. The reduction in thoughts during the body scanning correlated with the corresponding reduction in craving. Body scanning reduces cravings and reduces the frequency or shortens the duration of smoking thoughts. Attentional control strategies may form a useful part of smoking cessation practices.

Copyright 2012, Oxford University Press


Meyer C; Ulbricht S; Gross B; Kastel L; Wittrien S; Klein G et al. Adoption, reach and effectiveness of computer-based, practitioner delivered and combined smoking interventions in general medical practices: A three-arm cluster randomized trial. Drug and Alcohol Dependence 121(1-2): 124-132, 2012. (43 refs.)

Background: Brief advice for smoking patients has not been sufficiently integrated in routine care. Computer-based interventions emerged as a time saving option that might help to exhaust the potential population impact of the general practice setting. Method: 151 practices were randomly assigned to one of three intervention programs consisting in the delivery of: (1) brief advice by the practitioner; (2) individually tailored computer-generated letters; or (3) a combination of both interventions. We assessed three dimensions of population impact: (1) adoption, i.e., the rate of practices participating in the program; (2) reach, measured as the number of interventions provided within 7 months; (3) effectiveness, measured as smoking abstinence at 12-months follow-up. Results: Among the practices, 70% adopted the program with no significant differences across study groups. Treatment was provided to 3086 adult smokers. Negative binomial regression analysis revealed that the number of interventions provided was higher in practices allocated to the tailored letter and combination intervention groups by 215% (p<.01) and 127% (p=.02), respectively, compared to the brief advice intervention group. Among the patients who received the combination of both intervention, the odds of point abstinence from smoking was increased by 65% (p=.02) and 32% (p=.01) compared to the brief advice and tailored letters intervention respectively. Comparing the number of abstinent patients at follow-up revealed that the tailored letter and combination interventions were superior to the brief advice intervention. Conclusions: Computer-based interventions alone or in addition to conventional practitioner-delivered advice can foster the participation of general medical practices in tobacco control.

Copyright 2012, Elsevier Science


Moore RA; Aubin HJ. Do placebo response rates from cessation trials inform on strength of addictions? International Journal of Environmental Research and Public Health 9(1): 192-211, 2012. (48 refs.)

There is an implied assumption that addictions to different substances vary in strength from weak (easier to stop) to strong (harder to stop), though explicit definitions are lacking. Our hypothesis is that the strength of addictions can be measured by cessation rates found with placebo or no treatment controls, and that a weaker addiction would have a higher cessation rate than a stronger addiction. We report an overview of systematic reviews and meta-analyses of cessation trials, using randomised or quasi-randomised trials and reporting objectively-measured abstinence. The outcome for comparison was quit rates-typically the percentage of participants abstinent according to an objective test of abstinence at six months or longer. Twenty-eight cessation reviews (139,000 participants) were found. Most data came from reviews of smoking cessation in over 127,000 participants, and other reviews each covered a few thousand participants. Few reviews used data from studies shorter than three months, and almost all determined abstinence using objective measures. Cessation rates with placebo in randomised trials using objective measures of abstinence and typically over six months duration were 8% for nicotine, 18% for alcohol, 47% for cocaine, and 44% for opioids. Evidence from placebo cessation rates indicates that nicotine is more difficult to give up than alcohol, cocaine, and opioids. Tobacco is also a severe addiction, with a number of major deleterious health effects in a large number of people.

Copyright 2012, MDPI AG


Murray R; Leonardi-Bee J; Marsh J; Jayes L; Britton J. Smoking status ascertainment and interventions in acute medical patients. Clinical Medicine 12(1): 59-62, 2012. (12 refs.)

Hospital admission provides an opportunity to promote smoking cessation. Clinical guidelines recommend ascertainment of smoking status and delivery of cessation interventions in all consultations. In this article, smoking ascertainment and intervention among all patients admitted to medical wards in a UK hospital over a four-week period in 2010 were audited. Medical records of 767 patients were screened; 96 (13%) were current smokers, 243 (32%) ex-smokers and 233 (30%) non-smokers. There was no record of smoking status in 243 (25%) individuals and this proportion varied between specialties. Of the 96 current smokers, only 23 received documented cessation advice or pharmacological support. Four weeks after discharge, 31% reported that they were abstinent from smoking, representing 50% of those who received support and 20% of those who did not. Ascertainment of smoking status and delivery of cessation support to patients admitted to medical wards was low, suggesting that there is room for improvement in the management of smoking among inpatients.

Copyright 2012, Royal College of Physicians


Myung SK; Seo HG; Cheong YS; Park S; Lee WB; Fong GT. Association of sociodemographic factors, smoking-related beliefs, and smoking restrictions with intention to quit smoking in Korean adults: Findings from the ITC Korea Survey. Journal of Epidemiology 22(1): 21-27, 2012. (20 refs.)

Background: Few studies have reported the factors associated with intention to quit smoking among Korean adult smokers. This study aimed to examine sociodemographic characteristics, smoking-related beliefs, and smoking-restriction variables associated with intention to quit smoking among Korean adult smokers. Methods: We used data from the International Tobacco Control Korea Survey, which was conducted from November through December 2005 by using random-digit dialing and computer-assisted telephone interviewing of male and female smokers aged 19 years or older in 16 metropolitan areas and provinces of Korea. We performed univariate analysis and multiple logistic regression analysis to identify predictors of intention to quit. Results: A total of 995 respondents were included in the final analysis. Of those, 74.9% (n = 745) intended to quit smoking. In univariate analyses, smokers with an intention to quit were younger, smoked fewer cigarettes per day, had a higher annual income, were more educated, were more likely to have a religious affiliation, drank less alcohol per week, were less likely to have self-exempting beliefs, and were more likely to have self-efficacy beliefs regarding quitting, to believe that smoking had damaged their health, and to report that smoking was never allowed anywhere in their home. In multiple logistic regression analysis, higher education level, having a religious affiliation, and a higher self-efficacy regarding quitting were significantly associated with intention to quit. Conclusions: Sociodemographic factors, smoking-related beliefs, and smoking restrictions at home were associated with intention to quit smoking among Korean adults.

Copyright 2012, Japan Epidemiological Association


Nagelhout GE; de Vries H; Boudreau C; Allwright S; McNeill A; van den Putte B et al. Comparative impact of smoke-free legislation on smoking cessation in three European countries. European Journal of Public Health 22(Supplement 1): 4, 2012. (32 refs.)

Background: Little is known about the differential impact of comprehensive and partial smoke-free legislation on smoking cessation. This study aimed to examine the impact of comprehensive smoke-free workplace legislation in Ireland and England, and partial hospitality industry legislation in the Netherlands on quit attempts and quit success. Methods: Nationally representative samples of 2,219 adult smokers were interviewed in three countries as part of the International Tobacco Control (ITC) Europe Surveys. Quit attempts and quit success were compared between period 1 (in which smoke-free legislation was implemented in Ireland and the Netherlands) and period 2 (in which smoke-free legislation was implemented in England). Results: In Ireland, significantly more smokers attempted to quit smoking in period 1 (50.5%) than in period 2 (36.4%) (p < 0.001). Percentages of quit attempts and quit success did not change significantly between periods in the Netherlands. English smokers were significantly more often successful in their quit attempt in period 2 (47.3%) than in period 1 (26.4%) (p = 0.011). In the first period there were more quit attempts in Ireland than in England and fewer in the Netherlands than in Ireland. Fewer smokers quitted successfully in the second period in both Ireland and the Netherlands than in England. Conclusion: The comprehensive smoke-free legislation in Ireland and England may have had positive effects on quit attempts and quit success respectively. The partial smoke-free legislation in the Netherlands probably had no effect on quit attempts or quit success. Therefore, it is recommended that countries implement comprehensive smoke-free legislation.

Copyright 2012, Oxford University Press


Nagler RH; Puleo E; Sprunck-Harrild K; Emmons KM. Internet use among childhood and young adult cancer survivors who smoke: Implications for cessation interventions. Cancer Causes & Control 23(4): 647-652, 2012. (27 refs.)

Objective To identify patterns of Internet use among childhood and young adult cancer survivors who smoke. Methods Baseline assessment data were collected from 2005 to 2008 for the Partnership for Health-2 (PFH-2) study, a web-based smoking cessation intervention for childhood and young adult cancer survivors. Participants were surveyed about their Internet access and use. Sociodemographic, clinical, and psychosocial data also were collected. Results Internet access and use was widespread among PFH-2 participants. However, older, less-educated, and female survivors reported less frequent Internet use, even when they had access to the Internet at home and/or at work. These associations were significant in multivariable analyses. Conclusions Although the digital divide is narrowing, Internet use and engagement remains socially patterned. Web-based prevention interventions are a promising method of reaching this geographically dispersed, high-risk population, but certain subgroups-particularly older and lower socioeconomic status survivors-might be missed by this approach.

Copyright 2012, Springer


Oba S; Noda M; Waki K; Nanri A; Kato M; Takahashi Y et al. Smoking cessation increases short-term risk of type 2 diabetes irrespective of weight gain: The Japan Public Health Center-Based Prospective Study. PLoS ONE 7(2): e-article 17061, 2012. (29 refs.)

Objective: The effect of smoking cessation on the risk of diabetes has been reported previously. However, it is unknown whether the association is influenced by weight gain and other potential risk factors. Methods: The Japan Public Health Center-Based Prospective Study established in 1990 for Cohort I and in 1993 for Cohort II provided data, and 25,875 men and 33,959 women were analyzed. The response rate to the baseline questionnaire was 80.9%, and 68.4% of the respondents participated both the 5- and 10-year follow-up surveys. Smoking cessation was noted during the initial five years and the development of diabetes was reported in the subsequent five years. Results: An increased risk was observed among individuals who newly quit smoking compared with never smokers among men (odds ratio (OR) = 1.42, 95% CI = 1.03-1.94) and women (OR = 2.84, CI = 1.53-5.29). The risk of developing diabetes among male new quitters who gained 3 kg or more during the 5-year follow-up did not substantially differ from the risk among male never smokers with less than 3 kg of weight gain or no weight gain, while an increased risk was observed among male new quitters with less or no weight gain (OR = 1.46, 95% CI 1.00-2.14). An insignificant increased risk was observed among male new quitters with a family history of diabetes compared with male never smokers with a family history of diabetes. The risk was more than twice as high for male new quitters who used to smoke 25 or more cigarettes per day compared with never smokers (OR = 2.15, 95% CI: 1.34-3.47). Discussion: An increased risk of diabetes was implied among individuals who quit smoking. However, the increased risk was not implied among those who gained weight over the 5-years of follow-up. Those who had major risk factors for diabetes or who smoked heavier had a higher risk.

Copyright 2012, Public Library of Science


Ojima M; Hanioka T; Tanaka H. Necessity and readiness for smoking cessation intervention in dental clinics in Japan. Journal of Epidemiology 22(1): 57-63, 2012. (40 refs.)

Background: The necessity and readiness for smoking cessation intervention in dental clinics was assessed by investigating smoking status and stage of behavior change in patients and the attitudes of dentists toward the effects of smoking on their patients, respectively. Methods: A self-administered questionnaire was mailed to 1022 dentists randomly selected from the Japanese Dental Association database. The questionnaire survey consisted of 1 section for dentists and I for patients aged 20 years or older and was scheduled to be completed at the dentists' clinics on a designated day in February 2008. Results: The response rate to the questionnaire was 78.2% from among target dental clinics and 73.7% and 74.7% for patient and dentist questionnaires, respectively. Data from 11 370 patients and 739 dentists were analyzed. The overall smoking prevalence among the patients (25.1%) was similar to that reported by the National Health and Nutrition Examination Survey, and young female patients had a markedly higher smoking prevalence. More than 70% of patients who smoked were interested in quitting. Although the prevalence of current smoking among dentists (27.1%) was significantly higher than that reported among Japanese physicians (15.0%), approximately 70% of dentists were concerned about the effects of smoking on patient health and prohibited smoking inside their clinic. Conclusions: Many smokers who were interested in quitting, particularly young women, visited dental clinics, and most dentists believed that smoking was harmful for their patients. These results indicate that smoking cessation intervention in dental settings is necessary and that dentists are ready to provide such interventions.

Copyright 2012, Japan Epidemiological Association


Oncken C. Nicotine replacement for smoking cessation during pregnancy. (editorial). New England Journal of Medicine 366(9): 845-847, 2012. (13 refs.)


Ondersma SJ; Svikis DS; Lam PK; Connors-Burge VS; Ledgerwood DM; Hopper JA. A randomized trial of computer-delivered brief intervention and low-intensity contingency management for smoking during pregnancy. Nicotine & Tobacco Research 14(3): 351-360, 2012. (48 refs.)

Implementation of evidence-based interventions for smoking during pregnancy is challenging. We developed 2 highly replicable interventions for smoking during pregnancy: (a) a computer-delivered 5As-based brief intervention (CD-5As) and (b) a computer-assisted, simplified, and low-intensity contingency management (CM-Lite). A sample of 110 primarily Black pregnant women reporting smoking in the past week were recruited from prenatal care clinics and randomly assigned to CD-5As (n = 26), CM-Lite (n = 28), CD-5As plus CM-Lite (n = 30), or treatment as usual (n = 26). Self-report of smoking, urine cotinine, and breath CO were measured 10 weeks following randomization. Participants rated both interventions highly (e.g., 87.5% of CD-5As participants reported increases in likelihood of quitting), but most CM-Lite participants did not initiate reinforcement sessions and did not show increased abstinence. CD-5As led to increased abstinence as measured by cotinine (43.5% cotinine negative vs. 17.4%; odds ratio [OR] = 10.1, p = .02) but not for CO-confirmed 7-day point prevalence (30.4% abstinent vs. 8.7%; OR = 5.7, p = .06). Collapsing across CM-Lite status, participants receiving the CD-5As intervention were more likely to talk to a doctor or nurse about their smoking (60.5% vs. 30.8%; OR = 3.0, p = .02). Low-intensity participant-initiated CM did not affect smoking in this sample, but the CD-5As intervention was successful in increasing abstinence during pregnancy. Further research should seek to replicate these results in larger and more diverse samples. Should CD-5As continue to prove efficacious, it could greatly increase the proportion of pregnant smokers who receive an evidence-based brief intervention.

Copyright 2012, Oxford University Press


Patten CA; Hughes CA; Lopez KN; Thomas JL; Brockman TA; Smith CM et al. Web-based intervention for adolescent nonsmokers to help parents stop smoking: A pilot feasibility study. Addictive Behaviors 37(1): 85-91, 2012. (38 refs.)

A novel approach to tobacco control is to engage adolescent nonsmokers in support roles to encourage and help their parents stop smoking. This pilot study examined the feasibility and potential efficacy of a web-based support skills training (SST) intervention for adolescents to help a parent stop smoking. Forty nonsmoking adolescents 13-19 years of age (70% female, 93% White) were enrolled and randomly assigned to a health education (HE) control group (n = 20) or SST (n = 20). Both consisted of written materials and five weekly, 30 min, web-based, counselor-facilitated group sessions. Parents were enrolled for assessments only. Adolescents and parents completed assessments at baseline, week 6 (post-treatment), week 12 and 6-months follow-up. Both interventions were feasible based on treatment acceptability ratings, study retention and treatment compliance. The biochemically confirmed 6-month smoking abstinence rate was higher for parents linked to teens in HE (35%, 7/20) than in SST (10%, 2/20), p = 0.13. About half of parents in each group reported a quit attempt since study enrollment. Teens can be engaged to help parents stop smoking. Future research is warranted on determining effective intervention approaches.

Copyright 2012, Elsevier Science


Peasley-Miklus CE; McLeish AC; Schmidt NB; Zvolensky MJ. An examination of smoking outcome expectancies, smoking motives and trait worry in a sample of treatment-seeking smokers. Addictive Behaviors 37(4): 407-413, 2012. (44 refs.)

The present study examined the role of trait worry in predicting smoking-based cognitive processes (motives, expectancies, and beliefs about quitting) in a sample of 286 treatment-seeking, daily smokers (43.7% female: M-age=37.25: SD=12.83). Consistent with prediction, trait worry was significantly and uniquely associated with smoking outcome expectancies and motives pertaining to negative affect reduction after controlling for other relevant variables such as negative affectivity, gender, smoking rate and tobacco-related disease. Trait worry also was significantly independently related to greater perceived barriers to quitting smoking. The significant effects remained consistent when adjusted for axis I psychopathology. These findings provide initial evidence of the theoretical and clinical importance of trait worry with regard to tobacco-related motives, outcome expectancies, and beliefs about quitting smoking.

Copyright 2012, Elsevier Science


Perkins KA. Subjective reactivity to smoking cues as a predictor of quitting success. (editorial). Nicotine & Tobacco Research 14(4): 383-387, 2012. (29 refs.)

Acutely increased urge to smoke, or craving, in response to smoking cues (i.e., "cue reactivity") is often believed to identify those less able to later quit smoking. Although absolute craving level can predict smoking behavior, smoking cue reactivity per se may not predict cessation outcome. All clinical trials of cue reactivity and cessation outcome published before 2007 were identified and supplemented with a web-based search of clinical studies published after 2006, producing one additional trial. Examined were a total of 6 studies that directly related self-reported craving in response to laboratory-presented smoking cues with subsequent ability to quit smoking. Of the 6 studies, only one found that lower cue reactivity predicted greater quitting success (with nicotine but not placebo patch). Another study found the opposite, that higher cue reactivity was related to greater, rather than less, quitting success (in an unaided attempt). The other studies showed no association between cue reactivity and cessation outcome. This limited research does not clearly support self-reported craving in response to smoking cues per se as a predictor of later quitting success. Lack of consistent results may partly be due to variability in methods of smoking cue assessment, type of cessation treatment, and duration of follow-up assessment. If it is to improve our understanding of an individual's ability to quit smoking, research on cue reactivity needs to show significant and reliable associations with subsequent long-term smoking behavior.

Copyright 2012, Oxford University Press


Phillips JC; Oliffe JL; Ensom MHH; Bottorff JL; Bissell LJL; Boomer J et al. An overlooked majority: HIV-positive gay men who smoke. (review). Journal of Men's Health 9(1): 17-24, 2012. (92 refs.)

Therapeutic advances have dramatically improved health outcomes and life expectancy among persons living with HIV, but gains in life expectancy achieved by antiretroviral therapy may be mitigated by other health risk behaviours. HIV-positive gay men are especially at-risk for smoking and its adverse health risks. This scoping review summarizes evidence related to HIV and smoking, paying particular attention to gay men's masculinities as a means of providing direction for tailored tobacco cessation interventions for this vulnerable group. HIV-positive gay men face challenges with managing a complex disease and its psychological and social issues require tailored tobacco cessation interventions cognisant of the diverse social contexts in which they live. Although tobacco cessation intervention research among these men is limited, we make some recommendations to guide researchers and health care providers who work with these men.

Copyright 2012, Elsevier Science


Pignataro RM; Ohtake PJ; Swisher A; Dino G. The role of physical therapists in smoking cessation: Opportunities for improving treatment outcomes. (editorial). Physical Therapy 92(5): 757-766, 2012. (75 refs.)

Tobacco use constitutes one of the greatest threats to public health worldwide. As a preventable cause of mortality and chronic disease, tobacco use in the United States results in an estimated 443,000 deaths each year through both direct exposure and secondhand smoke. An additional 8,600,000 people across the nation have chronic illness due to smoking. As physical therapists, we must realize that tobacco use affects all areas of our practice, including cardiovascular, musculoskeletal, neurological, and integumentary health throughout the life span. In order to provide optimal care for the clients we serve, it is essential for physical therapists to screen for tobacco use and incorporate cessation strategies as part of our interventions. The authors review the Impact of smoking on the integumentary, musculoskeletal; and neuromuscular systems. It concludes by defining the unique role of physical therapists in smoking cessation intervention.

Pollack HA. Commentary on Higashi & Barendregt (2012): Smoking cessation therapies in Vietnam. (commentary). Addiction 107(3): 671, 2012. (6 refs.)

Copyright 2012, Society for the Study of Addiction


Rabius V; Wiatrek D; McAlister AL. African American participation and success in telephone counseling for smoking cessation. Nicotine & Tobacco Research 14(2): 240-242, 2012. (12 refs.)

Introduction: Quitlines that provide telephone counseling for smoking cessation have been proved to be effective. All 50 states currently provide free quitline access to their residents; however, little research has been published on African American utilization of quitlines or their success rates. Methods: This study evaluated how effectively African Americans are served by telephone counseling (quitline) for smoking cessation based on empirical data from 45,510 callers from Texas, Louisiana, Washington, and District of Columbia and randomized clinical trial data from 3,522 participants. Results: African Americans tended to use a quitline in proportions greater than their proportional representation in the smoking communities in both states and the District. African American quit rates were equivalent to those of non-Hispanic "Whites" as were their levels of satisfaction with the service and the number of counseling sessions they completed. African Americans were more likely to request counseling than non-Hispanic Whites. Conclusions: This study demonstrates that telephone counseling is a promising tool for addressing health disparities related to smoking among African Americans.

Copyright 2012, Oxford University Press


Rich ZC; Xiao SY. Tobacco as a social currency: Cigarette gifting and sharing in China. (review). Nicotine & Tobacco Research 14(3): 258-263, 2012. (44 refs.)

China produces and consumes more tobacco than any other country in the world and as such is at the forefront of the world tobacco epidemic. Many studies have recently emerged that directly or indirectly reference the acts of giving and sharing cigarettes as a major contributor to China's high tobacco usage. The goal of this report is to review relevant literature relating to sharing and gifting cigarettes as well as provide useful historic and cultural contexts. Important differences between the act of giving individual cigarettes and the gifting of packaged cigarettes are explored as well as explanations for how both these practices have influenced current tobacco control efforts. Available Chinese and English sources on gifting and sharing cigarettes in China published between 1991 and 2011 were reviewed and discussed with a cultural and historical background. The practices of gifting and sharing cigarettes strongly contribute to smoking initiation as well as failure to quit smoking among Chinese males. Historical and cultural roots have reinforced these practices and hampered efforts to reduce tobacco use in China. Traditional tobacco control efforts should be combined with culture-specific approaches to reduce tobacco usage in China. The regular exchange of cigarettes normalizes smoking across society and promotes tobacco's acceptability. Great efforts should be taken not only to minimize these practices among males but also to discourage their adoption by females.

Copyright 2012, Oxford University Press


Rosen LJ; Ben Noach M; Winickoff JP; Hovell MF. Parental smoking cessation to protect young children: A systematic review and meta-analysis. (review). Pediatrics 129(1): 141-152, 2012. (89 refs.)

Background: Young children can be protected from much of the harm from tobacco smoke exposure if their parents quit smoking. Some researchers encourage parents to quit for their children's benefit, but the evidence for effectiveness of such approaches is mixed. Objective: To perform a systematic review and meta-analysis to quantify the effects of interventions that encourage parental cessation. Methods: We searched PubMedicine, the Cochrane Library, Web of Science, and PsycINFO. Controlled trials published before April 2011 that targeted smoking parents of infants or young children, encouraged parents to quit smoking for their children's benefit, and measured parental quit rates were included. Study quality was assessed. Relative risks and risk differences were calculated by using the DerSimonian and Laird random-effects model. Results: Eighteen trials were included. Interventions took place in hospitals, pediatric clinical settings, well-baby clinics, and family homes. Quit rates averaged 23.1% in the intervention group and 18.4% in the control group. The interventions successfully increased the parental quit rate. Subgroups with significant intervention benefits were children aged 4 to 17 years, interventions whose primary goal was cessation, interventions that offered medications, and interventions with high follow-up rates (>80%). Conclusions: Interventions to achieve cessation among parents, for the sake of the children, provide a worthwhile addition to the arsenal of cessation approaches, and can help protect vulnerable children from harm due to tobacco smoke exposure. However, most parents do not quit, and additional strategies to protect children are needed.

Copyright 2012, American Academy of Pediatrics


Saladin ME; Gray KM; Carpenter MJ; LaRowe SD; DeSantis SM; Upadhyaya HP. Gender differences in craving and cue reactivity to smoking and negative affect/stress cues. American Journal on Addictions 21(3): 210-220, 2012. (82 refs.)

There is evidence that women may be less successful when attempting to quit smoking than men. One potential contributory cause of this gender difference is differential craving and stress reactivity to smoking- and negative affect/stress-related cues. The present human laboratory study investigated the effects of gender on reactivity to smoking and negative affect/stress cues by exposing nicotine dependent women (n = 37) and men (n = 53) smokers to two active cue types, each with an associated control cue: (1) in vivo smoking cues and in vivo neutral control cues, and (2) imagery-based negative affect/stress script and a neutral/relaxing control script. Both before and after each cue/script, participants provided subjective reports of smoking-related craving and affective reactions. Heart rate (HR) and skin conductance (SC) responses were also measured. Results indicated that participants reported greater craving and SC in response to smoking versus neutral cues and greater subjective stress in response to the negative affect/stress versus neutral/relaxing script. With respect to gender differences, women evidenced greater craving, stress and arousal ratings and lower valence ratings (greater negative emotion) in response to the negative affect/stressful script. While there were no gender differences in responses to smoking cues, women trended towards higher arousal ratings. Implications of the findings for treatment and tobacco-related morbidity and mortality are discussed.

Copyright 2012, Wiley-Blackwell


Schleicher HE; Harris KJ; Campbell DG; Harrar SW. Mood management intervention for college smokers with elevated depressive symptoms: A pilot study. Journal of American College Health 60(1): 37-45, 2012. (43 refs.)

Objective: This pilot study examined smoking reduction and cessation among college smokers with elevated depressive symptomatology participating in a group-based behavioral counseling, mood management, and motivational enhancement combined intervention (CBT). Participants and Methods: Fifty-eight smokers (smoked 6 days in the past 30) were randomized to 6 sessions of CBT (n = 29) or a nutrition-focused attention-matched control group (CG; n = 29). Results: Relative to CG participants, significantly more CBT participants reduced smoking intensity by 50% (chi(2)[1, N = 58] = 4.86, p = .028) at end of treatment. Although CBT participants maintained smoking reductions at 3- and 6-month follow-up, group differences were no longer significant. No group differences in cessation emerged. Finally, participants in both groups evidenced increased motivation to reduce smoking at end of treatment (F[1, 44] = 11.717, p =.001, eta p(2) = .207). Conclusions: Findings demonstrate the utility of this intervention for smoking reduction and maintenance of reductions over time among a population of college students with elevated depressive symptomatology.

Copyright 2012, Taylor & Francis


Schnoll RA; Wileyto EP; Lerman C. Extended duration therapy with transdermal nicotine may attenuate weight gain following smoking cessation. Addictive Behaviors 37(4): 565-568, 2012. (31 refs.)

Aim: People who quit smoking often gain 11-12 lb, on average, which can frequently lead to a relapse to smoking. This study evaluated whether extended vs. standard duration treatment with nicotine patch helps those able to quit smoking to reduce cessation-induced weight gain and explored nicotine patch adherence as a mediator of treatment effects. Design and setting: We examined data from a completed randomized placebo-controlled clinical trial of extended (24 weeks) vs. standard (8 weeks plus 16 weeks of placebo) transdermal nicotine patch therapy. Changes in measured weight over 24 weeks were compared across the two treatment arms, controlling for gender, baseline smoking rate, and previous weight. Adherence to patch use was assessed using self-report of daily use over 24 weeks. Participants: 139 clinical trial participants who were confirmed to be abstinent at weeks 8 and 24. Findings: Compared to participants who received 8 weeks of nicotine patch therapy, participants who received 24 weeks of treatment showed significantly less weight gain from pre-treatment to week 24 (beta = -4.76, 95% CI: -7.68 to -1.84, p = .002) and significantly less weight gain from week 8 to week 24 (beta = -2.31, 95% CI: -4.39 to -0.23, p = .03). Extended treatment increased patch adherence which, in turn, reduced weight gain; patch adherence accounted for 20% of the effect of treatment arm on weight gain. Conclusion: Compared to 8 weeks of transdermal nicotine therapy, 24 weeks of patch treatment may help to reduce the weight gain that is typical among smokers who are able to achieve abstinence from tobacco use. Extended treatment increased nicotine patch adherence which, in turn, reduced weight gain.

Copyright 2012, Elsevier Science


Sekiguchi F; Ando D; Yamakita M; Yamagata Z. An association between the serotonin transporter gene promoter polymorphism and smoking cessation among Japanese males. Asia-Pacific Journal of Public Health 24(2): 288-295, 2012. (21 refs.)

The objective of this study was to replicate the associations between the serotonin transporter genotypes and smoking cessation and between these genotypes and long-term smoking cessation success (for 2 years or more). Two case control designs were used in this study. The first case control design consisted of 47 ex-smokers (cases) and 94 smokers (controls). The second case control design consisted of the 12 ex-smokers who had succeeded in long-term smoking cessation (cases) and the 24 smokers (controls). In the first design, there was no significant difference in allele frequency and genotype distribution between cases and controls. In the second design, the S/S genotype frequency was higher in cases than in controls, but the difference did not reach slightly statistical significance. The present study suggests that individuals with the S/S genotype are more inclined to achieve long-term smoking cessation than others.

Copyright 2012, Sage Publications


Seybold DJ; Broce M; Siegel E; Findley J; Calhoun BC. Smoking in pregnancy in West Virginia: Does cessation/reduction improve perinatal outcomes? Maternal and Child Health Journal 16(1): 133-138, 2012. (31 refs.)

To determine if pregnant women decreasing/quitting tobacco use will have improved fetal outcomes. Retrospective analysis of pregnant smokers from 6/1/2006-12/31/2007 who received prenatal care and delivered at a tertiary medical care center in West Virginia. Variables analyzed included birth certificate data linked to intervention program survey data. Patients were divided into four study groups: < 8 cigarettes/day-no reduction, < 8 cigarettes/day-reduction, more than 8 cigarettes/day-no reduction, and amore than 8 cigarettes/day-reduction. Analysis performed using ANOVA one-way test for continuous variables and Chi-square for categorical variables. Inclusion criteria met by 250 patients. Twelve women (4.8%) quit smoking; 150 (60%) reduced; 27 (10.8%) increased; and 61 (24.4%) had no change. Comparing the four study groups for pre-term births (< 37 weeks), 25% percent occurred in more than 8 no reduction group while 10% occurred in more than8 with reduction group (P = 0.026). The high rate of preterm birth (25%) in the non-reducing group depended on 2 factors: (1) more than 8 cigarettes/day at beginning and (2) no reduction by the end of prenatal care. Finally, there was a statistically significant difference in birth weights between the two groups: more than 8 cigarettes/day with no reduction (2,872.6 g) versus < 8 cigarettes/day with reduction (3,212.4 g) (P = 0.028). Smoking reduction/cessation lowered risk of pre-term delivery (< 37 weeks) twofold. Encouraging patients who smoke more than 8 cigarettes/day during pregnancy to decrease/quit prior to delivery provides significant clinical benefit by decreasing the likelihood of preterm birth. These findings support tobacco cessation efforts as a means to improve birth outcome.

Copyright 2012, Springer


Shahab L; West R. Differences in happiness between smokers, ex-smokers and never smokers: cross-sectional findings from a national household survey. Drug and Alcohol Dependence 121(1-2): 38-44, 2012. (61 refs.)

Background: Happiness has become established as an important psychological dimension and not merely the obverse of depression and anxiety. Ex-smokers report that they are happier than when they were smoking but this could reflect biased recall. To date, no studies have examined happiness as a function of smoking status in ex-smokers of varying length of abstinence compared with current and never smokers. Methods: A cross-sectional household study of a nationally representative sample of adults examined the association between smoking status (never smoker, smoker, ex-smoker <1 year, ex-smoker >= 1 year) and two standard measures of happiness adjusting for sociodemographic characteristics (N=6923). Results: After adjusting for age, gender and social grade, ex-smokers of >= 1 year reported higher levels of happiness than smokers (p<0.001) and similar levels to never smokers. Ex-smokers of <1 year had similar levels to smokers. Smoking to feel less depressed (p<0.001) or anxious (p<0.044) were the only smoking characteristics associated with lower happiness among current smokers. Conclusions: Ex-smokers who have stopped for a year or more are happier than current smokers and similar to never smokers. Whilst these results are cross-sectional and have to be interpreted with caution, this adds to the evidence that smoking may decrease happiness and stopping may increase it.

Copyright 2012, Elsevier Science


Sheffer MA; Baker TB; Fraser DL; Adsit RT; McAfee TA; Fiore MC. Fax referrals, academic detailing, and tobacco Quitline use: A randomized trial. American Journal of Preventive Medicine 42(1): 21-28, 2012. (74 refs.)

Background: Fax referral programs quickly and economically can link smokers' visiting primary care clinics to state-based telephone quitlines. Yet, it is unclear how to optimize use of this strategy. Purpose: To evaluate the potential of enhanced academic detailing in clinics (i.e., on-site training, technical assistance, and performance feedback) to boost utilization of a fax referral program called Fax to Quit. Design: Participants were randomized to one of two intervention conditions. Setting/participants: Participants were drawn from 49 primary care clinics in southeastern Wisconsin. The sample size was based on a power analysis in which the control intervention condition was estimated to generate 0.5 referrals/clinic/month and the experimental condition 2.0 referrals/clinic/month. Interventions: One of two fax referral program interventions was administered: the control condition Fax to Quit-Only (F2Q-Only) or the experimental condition Fax to Quit plus Enhanced Academic Detailing (F2Q+EAD). Main outcome measures: Clinic- and clinician-specific referral and quality referral rates (those resulting in quitline enrollment) were measured for 13 months post-intervention, starting in March 2009. Results: Mean number of post-intervention referrals/clinician to the Wisconsin Tobacco Quitline was 5.6 times greater for F2Q+EAD (8.5, SD=7.0) compared to F2Q-Only (1.6, SD=3.6, p<0.001). The F2Q+EAD (4.8, SD=4.1) condition produced a greater mean number of quality referrals/clinician than did the F2Q-Only (0.86, SD=1.8, p<0.001) condition. Data were analyzed in 2010. Conclusions: Enhanced academic detailing, which included on-site training, technical assistance, and performance feedback, increased the number of referrals more than fivefold over a fax referral program implemented without such enhanced academic detailing.

Copyright 2012, Elsevier Science


Shim JC; Jung DU; Jung SS; Seo YS; Cho DM; Lee JH et al. Adjunctive varenicline treatment with antipsychotic medications for cognitive impairments in people with schizophrenia: A randomized double-blind placebo-controlled trial. Neuropsychopharmacology 37(3): 660-668, 2012. (45 refs.)

The aim of this study is to examine the effects of treatment with varenicline, a partial agonist at the alpha 4 beta 2 and full agonist at the alpha 7 nicotine acetylcholine receptor, on cognitive impairments in people with schizophrenia. In all, 120 clinically stable people with schizophrenia participated in randomized, double-blind, placebo-controlled 8-week trial. Antipsychotic and concomitant medication doses remained fixed throughout the study. Varenicline was titrated up to 1 mg twice daily for weeks 2-8. Neuropsychological, clinical, and safety assessments were administered at baseline and weeks 1, 2, 4, and 8. In the primary analyses of neurocognitive differences at week 8, no varenicline-placebo differences were significant. In secondary longitudinal analyses, varenicline improved compared with placebo on the Digital Symbol Substitution Test (p = 0.013) and the Wisconsin Card Sorting Test non-perseverative errors (p = 0.043). Some treatment effects were different between smokers and non-smokers. In smokers, Continuous Performance Test hit reaction time (p = 0.008) and Stroop Interference (p = 0.004) were reduced for varenicline compared with placebo, while there were no treatment differences in non-smokers. No significant treatment main effects or interactions were noted for total scores on the Positive and Negative Syndrome Scale or the Scale for the Assessment for Negative Symptoms. Our findings suggest beneficial effects of adjunctive varenicline treatment with antipsychotics for some cognitive impairments in people with schizophrenia. In some cases, effects of treatment varied between smokers and non-smokers. Further study is required to assess the functional significance of these changes.

Copyright 2012, Nature Publishing Group


Shin SS; Xiao D; Cao M; Wang C; Li Q; Chai WX; Lindsay RP et al. Patient and doctor perspectives on incorporating smoking cessation into tuberculosis care in Beijing, China. International Journal of Tuberculosis and Lung Disease 16(1): 126-131, 2012. (24 refs.)

SETTING: Tuberculosis (TB) hospital in Beijing, China. OBJECTIVE: To describe perspectives of patients and physicians regarding the incorporation of smoking cessation interventions as part of TB treatment. DESIGN: Seven focus groups were conducted with 39 patients and 17 physicians. RESULTS: Patients were more receptive to physicians' advice to quit smoking due to increased concerns about their health after becoming ill with TB. However, patients indicated that they might start smoking again after they recovered from TB. Patients' attempts to quit smoking may have been inhibited by exposure to smoking at the TB facility. Physicians had low levels of knowledge regarding the effect of smoking on TB. Many doctors, particularly those who smoked, did not view smoking cessation as an integral part of TB treatment. CONCLUSION: Despite the presence of a 'teachable moment', TB patients experience significant barriers to quitting smoking. Patient education in TB treatment programs should address the specific effects of smoking on TB and the general health benefits of cessation. Smoke-free policies should be strictly enforced in TB facilities. Successful integration of smoking cessation interventions within TB treatment regimens may require that providers adopt smoking cessation as an essential part of TB treatment.

Copyright 2012, International Union Against Tuberculosis and Lung Disease


Simmons VN; Litvin EB; Unrod M; Brandon TH. Oncology healthcare providers' implementation of the 5A's model of brief intervention for smoking cessation: Patients' perceptions. Patient Education and Counseling 86(3): 414-419, 2012. (38 refs.)

Objective: Health care providers (HCPs) can play an important role in promoting smoking cessation and preventing relapse. Public Health Service guidelines recommend the "5A's" model of brief intervention. The goal of the current study was to examine cancer patients' perceptions of SA's model implementation by their oncology HCPs. Methods: This study included 81 thoracic and 87 head and neck cancer patients at a large NCl-designated comprehensive cancer center. Patients completed questionnaires assessing perceptions of their oncology HCPs' implementation of the SA's model of brief intervention. Results: Results indicate partial implementation of the 5A's model. The majority of patients reported that their providers had asked about smoking and advised them to quit, however; only half reported that their interest in quitting had been assessed, and few reported assistance in quitting or follow-up. Delivery of the SA's was greater among patients who requested cessation advice from their HCPs. Conclusion: The current findings suggest a need to increase adherence to the 5A's in the oncology setting. Practical implications: Efforts to increase smoking cessation treatment provision by HCPs may improve the rate of cessation among cancer patients, and ultimately translate into better long-term cancer treatment outcomes.

Copyright 2012, Elsevier Science


Smith ML; Colwell B; Ahn S; Ory MG. Factors associated with tobacco smoking practices among middle-aged and older women in Texas. Journal of Women & Aging 24(1): 3-22, 2012. (60 refs.)

This study examines middle-aged and older women's smoking practices and identifies factors associated with tobacco use and cessation in this population. Data of 593 women were analyzed from a seven-county random household sample in Texas. Sequential multinomial logistic regression compared associations with having never smoked, having quit smoking, and currently smoking. Compared to smokers, never smokers and past smokers were significantly more likely to be older, more educated, of better general health, and report past-year physician visits and fewer depressive symptoms. Mental health and smoking are interrelated, indicating the need for addressing depression in smoking-cessation efforts for aging women.

Copyright 2012, Taylor & Francis


Sofuoglu M; Herman AI; Nadim H; Jatlow P. Rapid nicotine clearance is associated with greater reward and heart rate increases from intravenous nicotine. Neuropsychopharmacology 37(6): 1509-1516, 2012. (50 refs.)

The ratio of nicotine metabolites (trans-3'-hydroxycotinine (3HC) to cotinine) correlates with nicotine clearance. In previous studies, high nicotine metabolite ratio (NMR) predicted poor outcomes for smoking cessation treatment with nicotine patch. The underlying mechanisms that associate NMR with treatment outcomes have not been fully elucidated. A total of 100 smokers were divided into quartiles based on their baseline plasma NMR. Following overnight abstinence, smokers received saline followed by escalating intravenous doses of nicotine (0.5 and 1.0 mg/70 kg) given 30 min apart. The effects of nicotine on subjective, plasma cortisol, heart rate, and systolic and diastolic blood pressure measures were obtained. Smokers in the first NMR quartile (slower metabolizers) had lower Fagerstrom Test for Nicotine Dependence (FTND) scores, suggesting lower levels of dependence. In contrast, smokers in the fourth NMR quartile (faster metabolizers) reported greater craving for cigarettes following overnight abstinence from smoking and reported greater ratings of nicotine-induced good drug effects, drug liking, and wanting more drug. Higher NMR was also associated with greater heart rate increases in response to nicotine. These results suggest that enhanced nicotine reward and cigarette craving may contribute to the poor treatment response in smokers with high NMR. These findings warrant further investigation, especially in treatment-seeking smokers undergoing cessation treatment.

Copyright 2012, Nature Publishing Group


Stein JA; Zane JI; Grella CE. Impact of abstinence self-efficacy and treatment services on physical health-related behaviors and problems among dually diagnosed patients. Journal of Dual Diagnosis 8(1): 64-73, 2012. (50 refs.)

Objective: Physical health problems are pervasive among patients with co-occurring substance use and mental disorders. Yet, drug treatment programs often ignore tobacco use and its association with health. Abstinence self-efficacy has been associated with improved outcomes for co-occurring disorders, which in turn may also impact physical health. This study had the goal of assessing whether abstinence self-efficacy for drugs and alcohol and availability and use of services would influence tobacco use and other health-related outcomes among 351 individuals with co-occurring disorders in residential drug treatment. Methods: Structural models tested the impact of baseline abstinence self-efficacy and treatment service characteristics on 6-month outcomes of health problems, functional limitations, health perceptions, and cigarette and heavy alcohol use. Demographics and baseline values for outcome variables were included as covariates. Results: Correlations within time for poor health, cigarette use, and heavy alcohol use were substantial. A longer time in drug treatment was associated with less cigarette and heavy alcohol use at a 6-month follow-up. Baseline health problems were associated with more cigarette use and functional limitations at 6-months. Abstinence self-efficacy did not predict less cigarette use but predicted less heavy alcohol use and fewer functional limitations. Availability of specialized dual diagnosis groups and more on-site psychological services were not directly associated with outcomes but had an impact through indirect effects on more psychological service utilization which predicted better subjective health. Conclusions: Improving overall treatment retention and services utilization among patients with co-occurring disorders may generalize to improved health perceptions, but specific health promotion and smoking-cessation interventions are warranted to improve health outcomes.

Copyright 2012, Taylor & Francis


Taylor T; Cooper TV; Hernandez N; Kelly M; Law J; Colwell B. A smoke-free Paso del Norte: Impact over 10 years on smoking prevalence using the Behavioral Risk Factor Surveillance System. American Journal of Public Health 102(5): 899-908, 2012. (60 refs.)

Objectives. We assessed the impact of a tobacco control initiative over 10 years on cessation and prevention. Methods. We examined 2000-2009 Behavioral Risk Factor Surveillance System cases of a metropolitan statistical area (MSA) with systematic tobacco control efforts throughout the decade (El Paso, TX) and 2 comparison MSAs similar in size and population with less coordinated tobacco control efforts (Austin-Round Rock, TX and San Antonio, TX). Results. Yearly, El Paso exhibited a 6% increase in the prevalence of former smokers, a 6% decrease in prevalence of daily smokers, and a 7% decrease in the prevalence of established smoking (>= 100 cigarettes per lifetime and currently smoking); we did not observe similar trends in the comparison MSAs. There was no change in the prevalence of nondaily smokers in any of the MSAs. Conclusions. The coordinated tobacco control activities in El Paso are related to cessation among daily smokers and prevention of established smoking at the population level but have not stimulated cessation among nondaily smokers. Comprehensive tobacco control should focus more on not only daily smokers but also nondaily smokers.

Copyright 2012, American Public Health Association


Thomas D. National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994-2008. Australian and New Zealand Journal of Public Health 36(1): 24, 2012. (24 refs.)

Objective: To describe the trends in the prevalence of smoking, quitting and initiation among Aboriginal and Torres Strait Islander men and women aged 18 years and over. Methods: Analysis of responses to smoking questions in national Indigenous surveys in 1994, 2002, 2004 and 2008. Results: Male Indigenous smoking prevalence fell significantly from 58.5% in 1994 to 52.6% in 2008, an absolute decrease of 0.4 (CI 0.1-0.7)% per year, with the same decline in remote and non-remote areas. Female smoking fell from 51.0% to 47.4%, with markedly different changes in remote and non-remote areas. In non-remote areas, there was an absolute decrease in female smoking of 0.5 (CI 0.2-0.9)% per year, but in remote areas, female smoking increased by 0.4 (CI 0.0-0.8)% per year. From 2002 to 2008, the percentage of ever-smokers who had quit (quit ratio) increased absolutely by 1% per year in both men and women, remote and non-remote areas. Results about trends in initiation were inconclusive. Conclusions and Implications: Health Minister Roxon has committed to halving the Indigenous smoking prevalence by 2018, and has dramatically increased Indigenous-specific funding and activity in tobacco control. The reported historical trends in this paper are encouraging as they occurred at a time when there was little such tobacco control activity focused on Aboriginal and Torres Strait Islander people. However, to meet the Minister's goal, Indigenous smoking prevalence will need to fall more than six times as quickly as occurred from 1994 to 2008.

Copyright 2012, Wiley-Blackwell


Torchalla I; Okoli CTC; Bottorff JL; Qu A; Poole N; Greaves L. Smoking cessation programs targeted to women: A systematic review. (review). Women & Health 52(1): 32-54, 2012. (67 refs.)

The authors of this systematic review aimed to examine tobacco interventions developed to meet the needs of women, to identify sex-and gender-specific components, and to evaluate their effects on smoking cessation in women. The authors searched electronic databases in the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EBSCO, PsychINFO, CINHAL, and EMBASE; the search was not restricted by publication date. Data was extracted from published peer-reviewed articles on participants, setting, treatment models, interventions, length of follow-up, and outcomes. The main outcome variable was abstinence from smoking. A total of 39 studies were identified. In efficacy studies, therapists addressed weight concerns and non-pharmacological aspects of smoking, taught mood/stress management strategies, and scheduled the quit date to be timed to the menstrual cycle. In effectiveness studies, therapists were peer counselors, provided telephone counseling, and/or distributed gendered booklets, videos, and posters. Among efficacy studies, interventions addressing weight gain/concerns showed the most promising results. If medication can support smoking cessation in women and how it interacts with non-pharmacological treatment also warrant further research. For effectiveness studies, the available evidence suggests that smoking should be addressed in low-income women accessing public health clinics. Further attention should be devoted to identifying new settings for providing smoking cessation interventions to women from disadvantaged groups. Women-specific tobacco programs help women stop smoking, although they appear to produce similar abstinence rates as non-sex/gender specific programs. Offering interventions for women specifically may reduce barriers to treatment entry and better meet individual preferences of smokers. Developing approaches that fully account for the multiple challenges treatment-seeking women face is still an area of research.

Copyright 2012, Taylor & Francis


Travier N; Agudo A; May AM; Gonzalez C; Luan JA; Wareham NJ et al. Longitudinal changes in weight in relation to smoking cessation in participants of the EPIC-PANACEA study. Preventive Medicine 54(3-4): 183-192, 2012. (36 refs.)

Purpose. We assessed the association between smoking cessation and prospective weight change in the European population of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of smoking. Eating out of home And obesity (EPIC-PANACEA) project. Methods. The study involved more than 300,000 healthy volunteers, recruited between 1992 and 2000 in 9 European countries, who provided data on anthropometry and smoking habits at baseline and after a follow-up of 5 years on average. Adjusted mixed-effects linear regression models were used to obtain sex-specific summary estimates of the association between the change in smoking status and the annual change in weight. Results. Smoking cessation tends to be followed by weight gain; when compared to stable smokers, annual weight gain was higher in men (0.44 kg (95%CI: 0.36; 0.52)) and women (0.46 kg (95%CI: 0.41; 0.52)) who stopped smoking during follow-up. When smokers who stopped smoking at least 1 year before recruitment were compared to never smokers, no major differences in annual weight gain were observed. The excess weight gain following smoking cessation appears to mainly occur in the first years following the cessation. Conclusions. When considering the benefits of smoking cessation, such findings strengthen the need for promoting cessation offering information on weight gain control and support to weight-concerned smokers in order to remove a barrier to quitting.

Copyright 2012, Elsevier Science


Ussher MH; Taylor A; Faulkner G. Exercise interventions for smoking cessation. (review). Cochrane Database of Systematic Reviews 1: article CD002295, 2012. (219 refs.)

Background: Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. Objectives: To determine whether exercise- based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone. Search methods: In July 2011, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise'or 'physical activity'. We also searchedMEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL using the terms ' exercise' or 'physical activity' and 'smoking cessation'. Selection criteria: We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme, recruiting smokers or recent quitters, and with a follow up of six months or more. Data collection and analysis: We extracted data on study characteristics and smoking outcomes. Because of differences in studieswe summarized the results narratively, making no attempt at meta- analysis. Main results: We identified 15 trials, seven of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three- month follow up and a benefit for exercise of borderline significance (p = 0.05) at the 12- month follow up. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three- month follow up but not at the end of treatment or 12- month follow up. The other studies showed no significant effect for exercise on abstinence. Author's conclusions: Only one of the 15 trials offered evidence for exercise aiding smoking cessation at a 12- month follow up. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups.

Copyright 2012, Wiley-Blackwell


Van Zundert RM; Ferguson SG; Shiffman S; Engels R. Dynamic effects of craving and negative affect on adolescent smoking relapse. Health Psychology 31(2): 226-234, 2012. (68 refs.)

Objective: This study examined dynamic effects of daily variations in craving and negative affect on the next-day risk of the first lapse and relapse among 149 adolescent daily smokers who achieved at least 24 hr of abstinence. Method: Participants completed real-time assessments of their smoking, craving, and negative affect 3 times per day during the 3 weeks after their quit attempt. The main outcome measures included the first lapse and relapse after at least 24 hr of abstinence from smoking.. Results: Cox regression analyses with time-varying covariates showed that daily increases in craving predicted the risk of lapsing and relapsing on the following day, even after accounting for concurrent smoking and baseline levels of craving and nicotine dependence. Day-to-day variations in negative affect did not predict time to first lapse or relapse. Individual differences in baseline craving, nicotine dependence, and depressive symptoms also did not predict the first lapse or relapse. Conclusions: The findings challenge the significance of adolescents' negative affect during cessation and emphasize the need to assess dynamic effects of craving in addition to baseline ratings of craving and nicotine dependence, as the latter may not be sufficient to explain adolescent smoking cessation outcomes.

Copyright 2012, American Psychological Association


Villanti A; German D; Sifakis F; Flynn C; Holtgrave D. Smoking, HIV status, and HIV risk behaviors in a respondent-driven sample of injection drug users in Baltimore, Maryland: The be sure study. AIDS Education and Prevention 24(2): 132-147, 2012. (40 refs.)

Tobacco use is the largest preventable cause of death in the United States. Associations between cigarette smoking and HIV risk behaviors were examined among 669 injection drug users (IDU) in the 2006 wave of the National HIV Behavioral Surveillance System in Baltimore, Maryland, using respondent-driven sampling. The adjusted prevalence of smoking among IDU was 92.1%, with 32.7% smoking < 1 pack of cigarettes per day (light smoking) and 59.3% smoking >= 1 packs per day (heavy smoking). Self-reported HIV prevalence decreased as smoking frequency increased (p 0.001). In multivariate analysis, heavy smokers were more likely to report painkiller use and binge drinking and less likely to report anal sex or health care use in the past year than light smokers. Results suggest that health care use mediates the relationship between heavy smoking and self-reported HIV. Integrating smoking cessation with HIV prevention services could address unmet health needs in IDU.

Copyright 2012, Guilford Publications


Vinci C; McVay MM; Copeland AL; Carrigan MH. The relationship between depression level and smoking motives in college smokers. Psychology of Addictive Behaviors 26(1): 162-165, 2012. (21 refs.)

While the link between cigarette smoking and depression symptomatology has been well established, more research is needed to determine how smoking motives are related to depression levels in smokers. Specifically, smoking motives related to the friendship-like attachment to smoking (i.e., affiliative attachment) may play an important role in individuals reporting depressive symptomatology. The present study examined the relationship between three smoking motives and depression levels in a sample of 79 mildly nicotine-dependent, college student cigarette smokers. A hierarchical multiple regression analysis was conducted with depression as the dependent variable and gender and cigarettes per day as the independent variables (Step 1), positive and negative reinforcement motives (Step 2), and affiliative attachment motives (Step 3). Results of regression analyses indicated that affiliative attachment motives explained significant variance in participant depression level above and beyond that explained by positive and negative reinforcement motives. These findings suggest that smokers with elevated depression should be assessed for social functioning and affiliative attachment smoking motives, and future research should be conducted to determine if individuals with high levels of affiliative attachment may benefit from smoking cessation treatment programs with an enhanced social support component.

Copyright 2012, American Psychological Association


Weaver KE; Danhauer SC; Tooze JA; Blackstock AW; Spangler J; Thomas L et al. Smoking cessation counseling beliefs and behaviors of outpatient oncology providers. Oncologist 17(3): 455-462, 2012. (44 refs.)

Purpose. Many cancer patients continue to smoke after diagnosis, increasing their risk for treatment complications, reduced treatment efficacy, secondary cancers, and reduced survival. Outpatient oncology providers may not be using the "teachable moment" of cancer diagnosis to provide smoking cessation assistance. Providers and Methods. Physicians and midlevel providers (n = 74) who provide outpatient oncology services completed an online survey regarding smoking cessation counseling behaviors, beliefs, and perceived barriers. Outpatient medical records for 120 breast, lung, head and neck, colon, prostate, and acute leukemia cancer patients were reviewed to assess current smoking cessation assessment and intervention documentation practices. Results. Providers reported commonly assessing smoking in new patients (82.4% frequently or always), but rates declined at subsequent visits for both current smokers and recent quitters. Rates of advising patients to quit smoking were also high (86.5% frequently or always), but < 30% of providers reported frequently or always providing intervention to smoking patients (e. g., nicotine replacement therapy or other medications, self-help materials, and/or referrals). Only 30% of providers reported that they frequently or always followed up with patients to assess progress with quitting. Few providers (18.1%) reported high levels of confidence in their ability to counsel smoking patients. Patients' lack of motivation was identified as the most important barrier to smoking cessation. Conclusions. Although beliefs about providing cessation services to smoking patients were generally positive, few providers reported commonly providing interventions beyond advice to quit. Additional training and clinic-based interventions may improve adherence to tobacco cessation practice guidelines in the outpatient oncology setting.

Copyright 2012, Alphamed Press


Wegmann L; Buhler A; Strunk M; Lang P; Nowak D. Smoking cessation with teenagers: The relationship between impulsivity, emotional problems, program retention and effectiveness. Addictive Behaviors 37(4): 463-468, 2012. (36 refs.)

Aims: This study examines whether individual differences in impulsivity and emotional problems in adolescent smokers are related to initial smoking characteristics of participants, acceptance, retention and outcome of a school-based smoking cessation program. Design: The data was obtained from a feasibility study of a youth-specific, cognitive-behavioral and motivation enhancing program at 22 schools with 139 participating teenage smokers in Germany. A one-group-pre-posttest design was realized. Measurement: Impulsivity levels were assessed by use of the impulsivity scale of the IVE ("Inventar zur Erfassung von Impulsivitat, Risikoverhalten und Empathie", Stadler, Janke, & Schmeck, 2004). To evaluate the extent of emotional problems, the corresponding 5-items scale of the SDQ-Deu ("Strength and difficulties questionnaire", 'Klasen et al., 2000) was applied. Smoking behavior and acceptance of the program were assessed by students' self-reports. Findings: Acceptance and retention did not differ with regard to impulsivity and emotional problems, but initial smoking status did. Cessation rates varied with level of impulsivity: compared to non-impulsive participants, impulsive adolescents succeeded in quitting smoking less often. Emotional problems were not related to the rate of quitting. Conclusions: Impulsive adolescents were similarly compliant to the offered cessation intervention as less impulsive smokers. In spite of their general positive evaluation, impulsive adolescents seem to benefit less from a smoking cessation program than their non-impulsive counterparts. Specific elements supporting impulsive teenage smokers in their goal to quit should be incorporated into youth-specific cessation programs.

Copyright 2012, Elsevier Science


Weiner E; Ball MP; Buchholz AS; Gold JM; Evins AE; McMahon RP et al. Bupropion sustained release added to group support for smoking cessation in schizophrenia: A new randomized trial and a meta-analysis. Journal of Clinical Psychiatry 73(1): 95-102, 2012. (53 refs.)

Objective: To clarify the efficacy and tolerability of bupropion sustained release (SR) for the treatment of cigarette smoking in people with schizophrenia. Method: The first study is a double-blind, placebo-controlled clinical trial with 32 outpatients from the Maryland Psychiatric Research Center. From May 2003 to July 2007, clinically stable people with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder who smoked at least 10 cigarettes per day and who were interested in quitting smoking or cutting down were recruited for participation. All participated in a 9-week support group and were randomly assigned to receive 12 weeks of bupropion SR or placebo. The primary outcome measure was 4 weeks' sustained abstinence over the last 4 study weeks. Secondary outcome measures included decrease in smoking behavior and change in symptoms, neuropsychological performance, and side effects. In the second study, we performed an electronic literature search of MEDLINE in September 2008. Articles in English published between 2003 and 2008 were searched for the terms schizophrenia, bupropion SR, and smoking. Bibliographies of studies identified through the MEDLINE search were also examined. Case reports, open-label studies, crossover studies, and studies using nonstandard dosing of bupropion SR were excluded. In this way, 4 studies similar in methodology to the currently presented clinical trial were identified and the individual data combined in a meta-analysis. A random effects meta-analysis using Comprehensive Meta-Analysis software was used to obtain a pooled estimate of the odds ratio for 4-week smoking abstinence between bupropion SR and placebo. Results: There were no significant results on the primary or secondary smoking measures for the clinical trial, although a numeric advantage favored the bupropion SR group. There were no significant findings for secondary symptom or side effect measures and no significant change in neuropsychological performance. For the meta-analysis totaling 226 subjects, there were significant findings in favor of bupropion SR. The pooled estimate of the odds ratio for 4-week abstinence was 2.7 (95% Cl, 1.3 to 5.7; P=.009), and clinically significant greater smoking reduction in the bupropion SR group, with pooled difference estimates increasing over time between groups, became statistically significant by week 5 of study medication (P<.02). Conclusions: New clinical trial data and a meta-analysis strongly support the tolerability and efficacy of bupropion SR for the treatment of cigarette smoking in people with schizophrenia.

Copyright 2012, Physicians Postgraduate Press


Wilson SJ; Sayette MA; Fiez JA. Quitting-unmotivated and quitting-motivated: Cigarette smokers exhibit different patterns of cue-elicited brain activation when anticipating an opportunity to smoke. Journal of Abnormal Psychology 121(1): 198-211, 2012. (77 refs.)

The authors examined the effects of smoking expectancy on cue-reactivity among those motivated and those unmotivated to quit smoking using functional MRI. Cue-elicited activation was observed in the rostral prefrontal cortex (PFC) in smokers who expected to smoke within seconds, but not in those who expected to have to wait hours before having the chance to smoke, regardless of quitting motivation. For quitting-unmotivated smokers expecting to smoke, rostra( PFC activation was strongly positively correlated with the activation of several areas previously linked to cue-reactivity, including the medial orbitofrontal cortex (OFC) and rostral anterior cingulate cortex (ACC). In contrast, there was a nonsignificant negative relationship between activation of the rostral PFC and activation of the medial OFC/rostral ACC in quitting-motivated smokers expecting to smoke. Results extend previous work examining the effects of smoking expectancy and highlight the utility of examining interregional covariation during cue exposure. Findings also suggest that investigators may need to pay close attention to the motivational contexts associated with their experiments when studying cue-reactivity, as these contexts can modulate not only responses to drug cues, but perhaps also the functional implications of observed activity.

Copyright 2012, American Psychological Association


Wise M; Massi L; Rose M; Nancarrow H; Conigrave K; Bauman A et al. Developing and implementing a state-wide Aboriginal health promotion program: The process and factors influencing successful delivery. Health Promotion Journal of Australia 23(1): 25-29, 2012. (22 refs.)

Issue addressed: The prevalence of smoking among the adult Aboriginal population is almost double that of the non-Aboriginal population. Research shows smoking cessation brief interventions have a positive impact on quit attempts. However, examples of state-wide, Aboriginal-led initiatives that ensure health service delivery of brief intervention to all Aboriginal clients are limited. Methods: Guidance from an Aboriginal chief investigator and key health stakeholders supported the development of the NSW SmokeCheck Program. One component of the program was the establishment of a state-wide network of Aboriginal Health Workers (AHWs) and other health professional participants. Another was a culturally specific training program to strengthen the knowledge, skills, and confidence of participants to provide an evidence-based brief smoking-cessation intervention to Aboriginal clients. The brief intervention was based on the transtheoretical model of behaviour change, adapted for use in Aboriginal communities. Results: SmokeCheck training reached 35.5% of the total NSW AHW workforce over a 15-month period. More than 90% of participants surveyed indicated satisfaction with the curriculum content, workshop structure and training delivery, agreeing that they found it relevant, easy to understand and applicable to practice. Conclusions: An evidence-based approach to designing and delivering an Aboriginal-specific health promotion intervention appears to have facilitated the development of a state-wide network of Aboriginal and non-Aboriginal health professionals and strengthened their capacity to deliver a brief smoking cessation intervention with Aboriginal clients.

Copyright 2012, Australian Health Promotion Association


Yasin SM; Masilamani R; Ming MF; Koh D; Zaki RA. Can initial perceptions about quitting predict smoking cessation among Malaysian smokers? Southeast Asian Journal of Tropical Medicine and Public Health 43(2): 501-509, 2012. (11 refs.)

Perceived risks and benefits of quitting smoking may be important factors in successful treatment. This study examined the association between initial perceived risks and benefits of quitting smoking and outcomes during a two month smoking cessation attempt. Participants (n=185) were treatment-seeking smokers attending two smoking cessation clinics in Klang Valley, Malaysia. They received structured behavioral therapy and free Nicotine Replacement Therapy (NRT). Prior to treatment, a 12 item Perceived Risks and Benefits Questionnaire (PRBQ) was administered. This was used to assess the smoker's initial perceptions during their quit attempt. Participants were re-contacted at the end of two months to determine their smoking status. The results show participants intending to quit demonstrated a greater understanding of the benefits of quitting smoking than the risks of quitting. Those with a higher education level had a greater understanding of the benefits of quitting (p=0.02). PRBQ items, such as perceived risks of quitting (ie weight gain, negative affect, social ostracism, loss of enjoyment and craving) were not associated with abstinence at two months. However, those who perceived a benefit of higher physical attraction post-cessation were less likely to have stopped smoking at two months (OR 0.18; 95%CI 0.08-0.45). Other perceived benefits at baseline, such as health, general well-being, self-esteem, finances and social approval, were not associated with smoking cessation at two months. The results suggest that in our study population, smokers' baseline perceptions of the benefits of cessation of smoking prior to therapy are not associated with quit results at two months. Counseling patients regarding the advantages and disadvantages of quitting may have changed their perceptions during quitting process and should be further explored in future studies.

Copyright 2012, Southeast Asian Ministers Educationation Organization


Yasin SM; Retneswari M; Moy FM; Darus A; Koh D. Job stressors and smoking cessation among Malaysian male employees. Occupational Medicine 62(3): 174-181, 2012. (21 refs.)

Job stressors may reduce the likelihood of quitting smoking. To assess the association between job strain, smoking behaviour and smoking cessation among Malaysian male employees involved in a smoking cessation programme. The study was conducted among employees in two major public universities in Malaysia. All staff from both universities received an invitation to participate in this study. At the start of treatment, participants completed a questionnaire on sociodemographic variables, smoking habits and the Malay version of the Job Content Questionnaire (JCQ). The JCQ consists of scales of job control, job demand, supervisor support, co-worker support, job insecurity, job decision latitude and job skill discretion. Behaviour therapy with free nicotine replacement therapy (NRT) was given as treatment for two months. Participants were contacted at 1 week, 3 months and 6 months to determine their smoking status. One hundred and eighty five staff from both universities responded and voluntarily showed interest in quitting. At three months (OR = 8.96; 95% CI: 1.14-70.76) and six months (OR = 8.9; 95% CI: 1.15-68.65), men with higher co-workers' support demonstrated a higher likelihood of quitting. Smokers in a 'passive job' also demonstrated higher likelihood of quitting compared with those working in the 'low strain' category at six months (OR = 9.92; 95% CI: 1.20-82.68). No meaningful associations were found between other psychosocial job variables and smoking cessation. A positive relationship with and support from co-workers are important factors for workplace smoking cessation.

Copyright 2012, Oxford University Press


Yu H; Scharf D; Engberg J; Schultz D. The effects of Arkansas Master Settlement spending on disparities in smoking. American Journal of Public Health 102(4): 732-738, 2012. (31 refs.)

Objectives. We assessed the effect of Master Settlement Agreement (MSA) spending on smoking disparities in Arkansas, which distinguished itself from other states by investing all of its MSA funds in health-related programs. Methods. In 1996-2009 data from the Behavioral Risk Factor Surveillance System, we specified multivariate logistic models to examine gender and racial/ethnic disparities in smoking rates within Arkansas (a pre-post analysis) and between Arkansas and its 6 neighboring states. Results. Before the MSA programs started in 2001, male Arkansans smoked more than did female Arkansans (P<.05). After the programs, smoking declined significantly among men (but not women), eliminating the gender disparity by 2009. Smoking among men in Arkansas also declined more than it did in neighboring states (P<.05). Hispanics showed a greater decline in smoking than did non-Hispanic Whites in Arkansas (but not in neighboring states). In 2001, Hispanic Arkansans smoked more than did non-Hispanic Whites (P<.05); by 2009, Hispanic Arkansans smoked significantly less than did non-Hispanic Whites (P<.05). Conclusions. MSA-funded programs were more effective in some segments of the Arkansas population than in others. Policymakers should consider targeting future MSA tobacco control programs to populations most resistant to change.

Copyright 2012, American Public Health Association


Zhang CM; Xiao D; West R; Michie S; Troughton R; Hajek P et al. Evaluation of 3-day smoking cessation training course for doctors from 38 cities in China. Chinese Medical Journal 125(7): 1338-1340, 2012. (6 refs.)

Background: The World Health Organization's "Framework Convention on Tobacco Control" came into effect in China in 2006. Since then, a series of tobacco control measures has been undertaken, including the first step to establish a coordinated network of stop-smoking clinics in Chinese hospitals. Training for stop-smoking specialists has been traditionally provided via printed materials. This study evaluated the outcomes of the first two intensive 3-day courses in smoking cessation in China run in collaboration with experts who provide training to UK Specialist Stop Smoking Service. Methods: Eighty-four doctors from 38 cities in China responsible for stop-smoking treatment in 20 provinces and four autonomous regions participated in the training courses. Participants' knowledge competencies and self-efficacy were assessed before and after the authentication training. Results: The training significantly improved participants' knowledge, skills and self-efficacy across different domains. Forty-eight participants were finally certified as "smoking cessation specialist". Conclusions: The UK model of face-to-face training was acceptable and effective in China. A relatively brief intensive training program can generate significant improvements in skills, knowledge, and readiness to engage in smoking cessation activities.

Copyright 2012, Chinese Medical Association


Zhu SH; Cummins SE; Wong SS; Gamst AC; Tedeschi GJ; Reyes-Nocon J. The effects of a multilingual telephone quitline for Asian smokers: A randomized controlled trial. Journal of the National Cancer Institute 104(4): 299-310, 2012. (47 refs.)

Background: Although telephone counseling services (quitlines) have become a popular behavioral intervention for smoking cessation in the United States, such services are scarce for Asian immigrants with limited English proficiency. In this study, we tested the effects of telephone counseling for smoking cessation in Chinese-, Korean-, and Vietnamese-speaking smokers. Methods: A culturally tailored counseling protocol was developed in English and translated into Chinese, Korean, and Vietnamese. We conducted a single randomized trial embedded in the California quitline service. Smokers who called the quitline's Chinese, Korean, and Vietnamese telephone lines between August 2, 2004, and April 4, 2008, were recruited to the trial. Subjects (N = 2277) were stratified by language and randomly assigned to telephone counseling (self-help materials and up to six counseling sessions; n = 1124 subjects) or self-help (self-help materials only; n = 1153 subjects) groups: 729 Chinese subjects (counseling = 359, self-help = 370), 848 Korean subjects (counseling = 422, self-help = 426), and 700 Vietnamese subjects (counseling = 343, self-help = 357). The primary outcome was 6-month prolonged abstinence. Intention-to-treat analysis was used to estimate prolonged abstinence rates for all subjects and for each language group. All statistical tests were two-sided. Results: In the intention-to-treat analysis, counseling increased the 6-month prolonged abstinence rate among all smokers compared with self-help (counseling vs self-help, 16.4% vs 8.0%, difference = 8.4%, 95% confidence interval [CI] = 5.7% to 11.1%, P < .001). Counseling also increased the 6-month prolonged abstinence rate for each language group compared with self-help (counseling vs self-help, Chinese, 14.8% vs 6.0%, difference = 8.8%, 95% CI = 4.4% to 13.2%, P < .001; Korean, 14.9% vs 5.2%, difference = 9.7%, 95% CI = 5.8% to 13.8%, P < .001; Vietnamese, 19.8% vs 13.5%, difference = 6.3%, 95% CI = 0.9% to 11.9%, P = .023). Conclusions: Telephone counseling was effective for Chinese-, Korean-, and Vietnamese-speaking smokers. This protocol should be incorporated into existing quitlines, with possible extension to other Asian languages.

Copyright 2012, Oxford University Press