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CORK Bibliography: Smoking Cessation

52 citations. January 2011 to present

Prepared: June 2011

Abroms LC; Padmanabhan N; Thaweethai L; Phillips T. iPhone apps for smoking cessation: A content analysis. American Journal of Preventive Medicine 40(3): 279-285, 2011. (20 refs.)

Background: With the proliferation of smartphones such as the iPhone, mobile phones are being used in novel ways to promote smoking cessation. Purpose: This study set out to examine the content of the 47 iPhone applications (apps) for smoking cessation that were distributed through the online iTunes store, as of June 24, 2009. Methods: Each app was independently coded by two reviewers for its (1) approach to smoking cessation and (2) adherence to the U. S. Public Health Service's 2008 Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Each app was also coded for its (3) frequency of downloads. Results: Apps identified for smoking cessation were found to have low levels of adherence to key guidelines in the index. Few, if any, apps recommended or linked the user to proven treatments such as pharmacotherapy, counseling, and/or a quitline. Conclusions: iPhone apps for smoking cessation rarely adhere to established guidelines for smoking cessation. It is recommended that current apps be revised and future apps be developed around evidence-based practices for smoking cessation.

Asbridge M; Cartwright J. The relationship of home smoking bans to the physical and mental health of smokers. Nicotine & Tobacco Research 13(2): 70-77, 2011. (52 refs.)

The aim of this study is to examine whether the adoption of home smoking bans is associated with the physical and mental health of smokers. Two potential pathways that link home smoking bans to smoker's health are analyzed. The first argues that home smoking bans are positively related to physical health by encouraging smoking cessation while reducing daily cigarette consumption. The second suggests that home smoking bans have a negative relationship to smokers' mental health by increasing marginalization and social isolation. Data on 28,887 Canadian smokers were analyzed from the Canadian Community Health Survey, a nationally representative sample of Canadians adults. Logistic regression models analyzed the impact of home smoking bans on subjective assessments of smoker's physical and mental health. Separate analyses were conducted on daily and occasional smokers, and additional analyses tested interactions between the presence of a home smoking ban and key socioeconomic (gender and low household income) and structural (dwelling ownership, living alone, and dwelling type) covariates. Home smoking bans were not associated with smoker's physical health and were positively associated with smokers' mental health. These findings were consistent for daily smokers and occasional smokers. No significant interactions between smoking bans and socioeconomic or structural covariates were observed. Findings are considered with respect to the internal and external constraints that shape smoker's behavior, particularly the influence of social norms around environmental tobacco smoke exposure and good citizenship and the role of family relationships. The implications of study findings are considered with respect to public health policy.

Bauld L; Boyd KA; Briggs AH; Chesterman J; Ferguson J; Judge K et al. One-year outcomes and a cost-effectiveness analysis for smokers accessing group-based and pharmacy-led cessation services. Nicotine & Tobacco Research 13(2): 135-145, 2011. (45 refs.)

An observational study examining 1-year follow-up of clients of two National Health Service smoking cessation services in Glasgow was used to inform a cost-effectiveness analysis. One service involved 7 weeks of group-based support (n = 411) and the other consisted of up to 12 weeks of one-to-one counseling with pharmacists (n = 1,374). Pharmacological aids to quitting (e.g., nicotine replacement therapy) were available to all clients. Quit rates were calculated for each service at 52 weeks after the quit date, and these were used for an economic evaluation of both the annual and the lifetime cost-effectiveness of the pharmacy- and group-based interventions in comparison with a baseline "self-quit" scenario. The annual cost-effectiveness model established the incremental cost per 52-week quitter, while a Markov model was developed for the lifetime analysis to estimate the potential lifetime outcomes in terms of cost per quality-adjusted life years (QALY) gained, to account for the benefits quitters will receive in terms of extended life years and improvements in quality of life from smoking cessation. The proportion of carbon monoxide-validated quitters from both services combined fell from 22.5% at 4-week follow-up to 3.6% at 52 weeks. The group service achieved a higher quit rate (6.3%) than the pharmacy service (2.8%) but was more intensive and required greater overhead costs. The lifetime analysis resulted in an incremental cost per QALY of 4,800 pound for the group support and 2,600 pound for pharmacy one-to-one counseling. Despite disappointing 1-year quit rates, both services were considered to be highly cost-effective.

Beard E; McNeill A; Aveyard P; Fidler J; Michie S; West R. Use of nicotine replacement therapy for smoking reduction and during enforced temporary abstinence: a national survey of English smokers. Addiction 106(1): 197-204, 2011. (25 refs.)

Aims: To assess the prevalence of nicotine replacement therapy (NRT) use for smoking reduction (SR) and temporary abstinence (TA), the association between the two and the strength of the association between NRT use for SR or TA and socio-demographic characteristics, cigarette consumption and past quit attempts. Design: Cross-sectional monthly surveys. Setting: England. Participants: A total of 11 414 smokers. Measurements: Participants were asked (i) whether they were reducing the amount they smoked: if so, whether they used NRT; and (ii) whether they used NRT for TA. Demographic characteristics, daily cigarette consumption and whether a quit attempt had been made in the past 12 months were also assessed. Findings: Of the participants, 56% were attempting SR, 14% were using NRT for SR and 14% were using NRT for TA. Use of NRT for SR and TA were highly correlated. The nicotine patch was the most commonly used form of NRT. The use of NRT for SR, compared with unassisted SR, was more common among older smokers, while the use of NRT for TA was more common among women. Cigarette consumption was higher in those using NRT for SR than those attempting SR without NRT. The use of NRT for SR and TA was associated positively with past quit attempts. Conclusions: Nicotine replacement therapy use for smoking reduction and temporary abstinence is common in England. The use of NRT for SR and TA does not appear to be associated with lower cigarette consumption relative to SR or TA without NRT, but is associated with a higher rate of past quit attempts.

Bonevski B; Paul C; D'Este C; Sanson-Fisher R; West R; Girgis A. RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population. BMC Public Health 11: e-article 70, 2011. (51 refs.)

Background: Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population. Methods/Design: A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client-centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up. Discussion: This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited.

Butler KM; Rayens MK; Zhang M; Hahn EJ. Motivation to quit smoking among relatives of lung cancer patients. Public Health Nursing 28(1): 43-50, 2011. (26 refs.)

Objective: The purpose of this study was to determine the factors related to motivation to quit among smoking family members of lung cancer patients. Design and Sample: Relatives of multidisciplinary lung cancer clinic patients were recruited during family members' treatment. Participants (N=29) were primarily female and Caucasian. Measures: The items assessed included the effect of their relative's disease on motivation to quit, intent to quit in the next 6 months, stage of change, perceived risk from smoking, and attitudes about being approached about cessation. Results: Most indicated that their relative's disease had increased motivation to quit smoking (71%); 72% planned to quit within 6 months. One fourth (28%) were in precontemplation stage of change; 65% in contemplation; and 7% in preparation. The average perceived risk of developing lung cancer was 6.3. Two thirds were glad or very glad that someone had talked with them about quitting; 91% thought it was somewhat or very appropriate to talk about cessation with family members of lung cancer patients. Motivation to quit smoking was positively correlated with stage of change and perceived lung cancer risk. Conclusions: Public health nurses who interact with families of lung cancer patients may be able to promote cessation in an at-risk group that is motivated to quit smoking.

Chen PL; Huang WG; Chao KY. Factors associated with Taiwanese junior high school personnel advising students to quit smoking. Journal of School Health 81(2): 91-99, 2011. (35 refs.)

METHODS: School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. RESULTS: Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. CONCLUSIONS: To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel.

Cropsey KL; Jackson DO; Hale GJ; Carpenter MJ; Stitzer ML. Impact of self-initiated pre-quit smoking reduction on cessation rates: Results of a clinical trial of smoking cessation among female prisoners. Addictive Behaviors 36(1-2): 73-78, 2011. (26 refs.)

Objectives: This study examined differences in cessation success based on smokers self-initiated pre-quit reductions in cigarettes per day (cpd) Methods: The study utilized data from a nicotine replacement + behavioral therapy smoking cessation intervention conducted in a female prison facility with 179 participants who were wait-listed for 6 months prior to intervention We compared two groups of smokers based on whether they self-selected to reduce smoking prior to their cessation attempt (n = 77) or whether they increased smoking or did not reduce (n = 102) General Estimating Equations (GEE) were used to model smoking cessation through 12 month follow-up. Results: Examination of pre-cessation cpd showed that those who reduced were heavier smokers at baseline relative to those who did not reduce (p<0 001) By the week prior to the quit attempt (week 3) heavier smokers at baseline smoked significantly fewer cigarettes (p<0 001) and had lower CO levels (p<0 05) compared to baseline lighter smokers GEE analyses showed that individuals who reduced prior to their quit attempt had significantly higher quit rates during early treatment but these gains were not sustained by follow-up points. Conclusions: Participant initiated pre-cessation smoking reduction may be initially helpful in preparing to quit smoking or may serve as a marker for participant motivation to quit smoking but these differences do not sustain over time. More intensive interventions are still needed for successful cessation.

DiClemente CC; Delahanty JC; Kofeldt MG; Dixon L; Goldberg R; Lucksted A. Stage movement following a 5A's intervention in tobacco dependent individuals with serious mental illness (SMI). Addictive Behaviors 36(3): 261-264, 2011. (20 refs.)

Smoking among individuals with serious mental illness (SMI) creates significant health problems. This study explored stage of change transitions over time among smokers with serious mental illness (SMI) and how dose of a brief intervention and other psychosocial variables were related to stage transitions. Participants were a subsample of 110 patients who participated in a larger controlled trial (Dixon, et al., 2009) examining whether psychiatrists in mental health clinics implementing the "5A's" (Ask, Advise, Assess, Assist, and Arrange) significantly reduced smoking among persons with SMI. Participants were classified into one of the Transtheoretical Model (TTM) Stages of Change for Smoking Cessation as well as classified into groups based upon the pattern of stage status transitions over time (i.e., Regressors, Stable, Inconsistent, Progressors with and without a successful quit). Modest quit rates for this brief intervention were found at one-year (6.4%) and the dose of the intervention was meaningfully related to positive stage transitions. Cessation outcomes from the controlled trial (Dixon,et al., 2009) indicated a small effect on smoking cessation, which is confirmed in this stage transition secondary analysis with a subset of these smokers. However, these results suggest that a brief intervention delivered by psychiatrists in a mental health treatment setting does seem to make an impact on these smokers.

DiGiacomo M; Davidson PM; Abbott PA; Davison J; Moore L; Thompson SC. Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: Elements of effective interventions. (review). International Journal of Environmental Research and Public Health 8(2): 388-410, 2011. (76 refs.)

Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990-2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations.

Ferguson SG; Shiffman S; Rohay JM; Gitchell JG; Garvey AJ. Effect of compliance with nicotine gum dosing on weight gained during a quit attempt. Addiction 106(3): 651-656, 2011. (24 refs.)

Aim: Using nicotine gum can reduce the amount of weight gained when quitting. Here we examine the relationship between weight gain and use of adequate amounts of gum. To mitigate the confounders associated with correlational analyses, we contrast the effects of active gum and placebo, and analyze outcomes prospectively. Design and setting Randomized double-blind placebo-controlled trial of nicotine gum. Participants were instructed to use nine to 15 pieces of gum/day for the first 2 months of treatment. Participants: Participants (n = 103) were randomized to either active (2 mg or 4 mg) or placebo gum. Measurements: We examined the effect on weight gain of the interaction between treatment (active versus placebo) and daily gum use [>= 9 pieces/day (compliant use) versus < 9 pieces/day]. Findings: After 30 days of abstinence, smokers treated with active gum had not gained significantly less weight than those on placebo (1.1 kg versus 1.6 kg, P = 0.175). However, a significant compliance-treatment interaction was observed (P = 0.005): active gum users who used >= 9 pieces/day during the first 14 days of treatment had gained less weight at follow-up (0.6 kg versus 1.6 kg for those who used < 9 pieces/day, P = 0.017), but participants randomized to the placebo group saw no such benefit from compliant use. A similar compliance-treatment interaction (P = 0.046) was also observed when the effect of compliance was examined within active treatment (2 mg versus 4 mg). Conclusions: When smokers are quitting, those who use more pieces of nicotine gum experience less weight gain in the first 30 days. This relationship is not seen for smokers on placebo gum.

Fix BV; Hyland A; Rivard C; McNeill A; Fong GT; Borland R; Hammond D et al. Usage patterns of stop smoking medications in Australia, Canada, the United Kingdom, and the United States: Findings from the 2006-2008 International Tobacco Control (ITC) Four Country Survey. International Journal of Environmental Research and Public Health 8(1): 222-233, 2011. (26 refs.)

Varenicline is a new prescription stop smoking medication (SSM) that has been available in the United States since August 1, 2006, in the United Kingdom and other European Union countries since December 5, 2006, in Canada since April 12, 2007, and in Australia since January 1, 2008. There are few population-based studies that have examined use rates of varenicline and other stop smoking medications. We report data from the ITC Four Country survey conducted with smokers in the US, UK, Canada, and Australia who reported an attempt to quit smoking in past year in the 2006 survey (n = 4,022 participants), 2007 (n = 3,790 participants), and 2008 surveys (n = 2,735 participants) Respondents reported use of various stop smoking medications to quit smoking at each survey wave, along with demographic and smoker characteristics. The self-reported use of any stop smoking medication has increased significantly over the 3 year period in all 4 countries, with the sharpest increase occurring in the United States. Varenicline has become the second most used stop smoking medication, behind NRT, in all 4 countries since being introduced. Between 2006 and 2008, varenicline use rates increased from 0.4% to 21.7% in the US, 0.0% to 14.8% in Canada, 0.0% to 14.5% in Australia, and 0.0% to 4.4% in the UK. In contrast, use of NRT and bupropion remained constant in each country. Males and non-whites were significantly less likely to report using any SSM, while more educated smokers were significantly more likely to use any SSM, including varenicline. Our findings suggest that the introduction of varenicline led to an increase in the number of smokers who used evidence-based treatment during their quit attempts, rather than simply gaining market share at the expense of other medications. From a public health perspective, messages regarding increased success rates among medication users and the relative safety of stop smoking medications should be disseminated widely so as to reach all smokers of all socioeconomic classifications equally.

Gadomski A; Adams L; Tallman N; Krupa N; Jenkins P. Effectiveness of a combined prenatal and postpartum smoking cessation program. Maternal and Child Health Journal 15(2): 188-197, 2011. (22 refs.)

Women frequently quit smoking during pregnancy but then relapse postpartum. The BABY & ME-Tobacco Free program combines prenatal and postpartum smoking cessation counseling and biomarker feedback with monthly postpartum incentives. The settings included 22 sites (WIC offices and prenatal clinics) in upstate New York. A quasi-experimental design was used to evaluate this intervention, that included four face-to-face prenatal sessions with a counselor who did smoking cessation counseling, carbon monoxide testing and random saliva cotinine testing. For 1 year postpartum, mothers were biochemically tested every 3-4 weeks and, if negative, were issued a voucher for diapers. Three implementation models were studied: multi-tasking counselors at fixed sites (Models 1 and 2) versus itinerant smoking cessation specialists (Model 3). Outcomes included biochemically validated abstinence rates during pregnancy and postpartum. Logistic regression was used to identify predictors of postpartum abstinence and program dropout. Proportional hazards regression was used to compare implementation models. Of the 777 pregnant women who enrolled in the program, 588 were eligible for the postpartum program. The intention to treat pregnancy quit rate was 60%. Postpartum, Model 3 showed consistently better quit outcomes than the other models. Predictors of abstinence at 6 months postpartum are: older age (OR = 1.07, 95% C.I. 1.02-1.12), lower baseline carbon monoxide level (OR = 0.69, 95% C.I. 0.49-0.97), Model 3 (OR = 4.60, 95% C.I. 2.80-7.57) and attending more prenatal sessions (OR = 3.52; 95% C.I. 2.19-5.65). The BABY & ME-Tobacco Free program is an effective smoking cessation program for pregnant and parenting women.

Graham AL; Cobb NK; Papandonatos GD; Moreno JL; Kang H; Tinkelman DG et al. A randomized trial of internet and telephone treatment for smoking cessation. Archives of Internal Medicine 171(1): 46-53, 2011. (36 refs.)

Background: This study aimed to determine the relative effect of Internet and Internet plus telephone treatment for smoking cessation on smoking abstinence among US adults. A priori hypotheses were that Internet enhanced with tailored content and social support would outperform basic Internet (BI) and that enhanced Internet (EI) plus proactive telephone counseling would outperform the other conditions. Methods: The Quit Using Internet and Telephone Treatment (iQUITT) study used a 3-group randomized controlled design comparing BI, EI, and EI and telephone combined (EI+P). The trial was conducted from March 8, 2005, through November 30, 2008. Current adult smokers in the United States who smoked 5 or more cigarettes per day were recruited via search engines. Characteristics of the 2005 participants include mean (SD) age of 35.9 (10.8) years, 51.1% women, and 86.5% white. The follow-up assessment rate at 18 months was 68.2%. The main outcome measure was 30-day point prevalence abstinence measured at 3, 6, 12, and 18 months after randomization using intent-to-treat analysis. Results: At 18 months, the 30-day multiple point prevalence abstinence rate across all follow-up intervals was 3.5% (BD, 4.5% (EI), and 7.7% (EI+P), with EI + P significantly outperforming BI and EI. At 18 months, 30-day single point prevalence abstinence rates were 19.0% (BI), 17.4% (EI), and 19.6% (EI+P) and did not differ among the groups. Conclusions: Combined Internet and telephone treatment outperforms static and dynamic Internet interventions.

Gray KM; Carpenter MJ; Baker NL; Hartwell KJ; Lewis AL; Hiott DW et al. Bupropion SR and contingency management for adolescent smoking cessation. Journal of Substance Abuse Treatment 40(1): 77-86, 2011. (46 refs.)

There is a significant need for evidence-based treatments for adolescent smoking cessation. Prior research, although limited, has suggested potential roles for bupropion sustained-release (SR) and contingency management (CM), but no previous studies have assessed their combined effect. In a double-blind, placebo-controlled design, 134 adolescent smokers were randomized to receive a 6-week course of bupropion SR + CM, bupropion SR + non-CM, placebo + CM, or placebo + non-CM, with final follow-up at 12 weeks. The primary outcome was 7-day cotinine-verified point prevalence abstinence, allowing for a 2-week grace period. Combined bupropion SR + CM treatment yielded significantly superior abstinence rates during active treatment when compared with placebo + non-CM treatment. In addition, combined treatment showed greater efficacy at multiple time points than did either bupropion SR + non-CM or placebo + CM treatment. Combined bupropion SR and CM appears efficacious, at least in the short-term, for adolescent smoking cessation and may be superior to either intervention alone.

Hebert KK; Cummins SE; Hernandez S; Tedeschi GJ; Zhu SH. Current major depression among smokers using a state quitline. American Journal of Preventive Medicine 40(1): 47-53, 2011. (43 refs.)

Background: Smokers seeking treatment to quit smoking are generally not assessed for current depression, yet depression among smokers may influence quitting outcome. Purpose: This study aims to formally assess current major depression among smokers calling a state tobacco quitline. Methods: A total of 844 smokers calling the California Smokers' Helpline in 2007 were screened for depression by the mood module of the Patient Health Questionnaire (PHQ-9). The Social Functioning Questionnaire (SFQ) also was administered to these callers. Two months after the screening, follow-up evaluations were conducted to assess cessation outcome. Results: In all, 24.2% of smokers met criteria for current major depression and 16.5% reported symptoms indicating mild depression. Callers with current major depression were more likely to be heavy smokers and on Medicaid. Moreover, 74.0% of smokers with current major depression had substantial social and occupational functioning deficits. Two months later, those with major depression at baseline were significantly less likely to have quit smoking (18.5% vs 28.4%). Conclusions: Almost one in four smokers who called the California Smokers' Helpline met criteria for current major depression. More than 400,000 smokers call state quitlines in the U. S. for help with quitting each year, which means that as many as 100,000 smokers with serious depressive symptoms are using these services annually. The large number of depressed smokers who seek help suggests a need to develop appropriate interventions to help them quit successfully.

Japuntich SJ; Leventhal AM; Piper ME; Bolt DM; Roberts LJ; Fiore MC et al. Smoker characteristics and smoking-cessation milestones. American Journal of Preventive Medicine 40(3): 286-294, 2011. (63 refs.)

Background: Contextual variables often predict long-term abstinence, but little is known about how these variables exert their effects. These variables could influence abstinence by affecting the ability to quit at all, or by altering risk of lapsing, or progressing from a lapse to relapse. Purpose: To examine the effect of common predictors of smoking-cessation failure on smoking-cessation processes. Methods: The current study (N = 1504, 58% female, 84% Caucasian; recruited from January 2005 to June 2007; data analyzed in 2009) uses the approach advocated by Shiffman et al. (2006), which measures cessation outcomes on three different cessation milestones (achieving initial abstinence, lapse risk, and the lapse-relapse transition) to examine relationships of smoker characteristics (dependence, contextual and demographic factors) with smoking-cessation process. Results: High nicotine dependence strongly predicted all milestones: not achieving initial abstinence, and a higher risk of both lapse and transitioning from lapse to complete relapse. Numerous contextual and demographic variables were associated with higher initial cessation rates and/or decreased lapse risk at 6 months post-quit (e. g., ethnicity, gender, marital status, education, smoking in the workplace, number of smokers in the social network, and number of supportive others). However, aside from nicotine dependence, only gender significantly predicted the risk of transition from lapse to relapse. Conclusions: These findings demonstrate that (1) higher nicotine dependence predicted worse outcomes across every cessation milestone; (2) demographic and contextual variables are generally associated with initial abstinence rates and lapse risk and not the lapse-relapse transition. These results identify groups who are at risk for failure at specific stages of the smoking-cessation process, and this may have implications for treatment.

Khara M; Okoli CTC. The tobacco-dependence clinic: Intensive tobacco-dependence treatment in an addiction services outpatient setting. American Journal on Addictions 20(1): 45-55, 2011. (33 refs.)

We present outcomes from an intensive tobacco-dependence treatment program for addiction services clients at three different sites. Data from 202 participants were analyzed. For individuals who completed the program, the abstinence rate was 43%. Not having a primary substance use history and a lower carbon monoxide (CO) level at intake predicted abstinence; whereas being female, the particular site of intervention, receiving both nicotine replacement therapy (NRT) and oral medication, and having a lower CO level at baseline predicted program completion. Drug treatment clients can successfully quit smoking at rates similar to the general population when given access to intensive tobacco-dependence treatment.

Kim A; Kamyab K; Zhu JS; Volpp K. Why are financial incentives not effective at influencing some smokers to quit? Results of a process evaluation of a worksite trial assessing the efficacy of financial incentives for smoking cessation. Journal of Occupational and Environmental Medicine 53(1): 62-67, 2011. (22 refs.)

Objective: Process evaluation of a worksite intervention in which employees were offered $750 to complete a cessation program and to quit smoking. Methods: Awareness and attitudes about financial incentives were assessed following a randomized controlled trial of 878 smokers at a US-based company. Results: Cessation program attendance was higher in incentive group versus control (20.2% vs 7.1%, P < 0.01). Most quitters (69.8%) in the incentive group who were already motivated to quit and reported that they would have quit for less money, said incentives were "not at all" or only "somewhat" important. Most nonquitters in the incentive group reported that even $1500 would not have motivated them to quit. Conclusions: Financial incentives are ineffective at motivating some smokers to quit. Internal motivation and readiness to quit need to be sufficiently high for relatively modest incentives to be effective.

Ladapo JA; Jaffer FA; Weinstein MC; Froelicher ES. Projected cost-effectiveness of smoking cessation interventions in patients hospitalized with myocardial infarction. Archives of Internal Medicine 171(1): 39-45, 2011. (47 refs.)

Background: As many as 70% of smokers with acute myocardial infarction (AMI) continue to smoke after hospital discharge despite high rates of inpatient smoking cessation counseling. Supportive contact after discharge improves quit rates but is rarely used. Methods: Using data from a meta-analysis of randomized trials of smoking cessation interventions and other published sources, we developed a Monte Carlo model to project health and economic outcomes for a hypothetical US cohort of 327 600 smokers hospitalized with AMI. We compared routine care, consisting of advice to quit smoking, with counseling with supportive follow-up, consisting of routine care and follow-up telephone calls from a nurse after discharge. Primary outcomes were number of smokers, AMIs, and deaths averted; health care and productivity costs; cost per quitter; and cost per quality-adjusted life-year. Results: Implementation of smoking cessation counseling with follow-up contact for the 2010 cohort of hospitalized smokers would create 50 230 new quitters, cost $27.3 million in nurse wages and materials, and prevent 1380 nonfatal AMIs and 7860 deaths. During a 10-year period, it would save $22.1 million in reduced hospitalizations but increase health care costs by $166.4 million, primarily through increased longevity. Productivity costs from premature death would fall by $1.99 billion and nonmedical expenditures would increase by $928 million, for a net positive value to society of $894 million. The program would cost $540 per quitter considering only intervention costs. Cost-effectiveness would be $5050 per quality-adjusted life-year. Results were sensitive to the utility and incidence of nonfatal AMI and the potential effect of pharmacotherapies. Conclusion: Smoking cessation counseling with supportive contact after discharge is potentially cost-effective and may reduce the incidence of smoking and its associated adverse health events and social costs.

Leung J; Gartner C; Dobson A; Lucke J; Hall W. Psychological distress is associated with tobacco smoking and quitting behaviour in the Australian population: Evidence from national cross-sectional surveys. Australian and New Zealand Journal of Psychiatry 45(2): 170-178, 2011. (52 refs.)

Objective: To investigate the association between levels of psychological distress and smoking and quitting behaviours. Method: Data were from two large Australian national household surveys of individuals over 20 years of age. Level of psychological distress was measured by the Kessler 10 scale. Tobacco smoking measures included current smoking status (never, former, current); ex-smokers 'time since quitting; current smokers 'abstinent period in the last 12 months, cigarettes smoked per day, reasons for smoking, and self-report of factors that would motivate quitting; and self-report of factors that motivated smokers to quit in the last 12 months. Multinomial logistic regression was used to assess the relationships between smoking behaviours and psychological distress, while controlling for socio-demographic factors. Results: Current smokers, especially those who smoke more cigarettes per day and those who report less success at quitting or reducing smoking, had higher levels of psychological distress. Ex-smokers were also more likely to experience psychological distress than those who never smoked, but the association weakened with more years since quitting. Current smokers with psychological distress were just as, or more likely, to report planning to quit as those without psychological distress. Smokers who did not plan to quit due to addiction, past failure at quitting, and using smoking for relaxation or to deal with stress were more likely to report psychological distress than those who did not report these reasons. Conclusions: Current smoking and unsuccessful quit attempts in the Australian community were strongly associated with symptoms of psychological distress. Quitting aspirations and influence from general public health interventions were not associated with the smokers 'level of psychological distress.

Lycett D; Munafo M; Johnstone E; Murphy M; Aveyard P. Associations between weight change over 8 years and baseline body mass index in a cohort of continuing and quitting smokers. Addiction 106(1): 188-196, 2011. (39 refs.)

Aim: To examine the association between weight change and baseline body mass index (BMI) over 8 years in a cohort of continuing and quitting smokers. Design: Prospective cohort. Setting: Oxfordshire general practices nicotine patch/placebo trial with 8-year follow-up. Participants: Eighty-five participants were biochemically proven abstinent at 3, 6, 12 months and 8 years (abstainers). A total of 613 smoked throughout the 8 years (smokers), 26 quit for a whole year but were smoking again by 8 years (relapsed); 116 smoked for the first year but were abstinent at 8 years (late abstainers). Measurements: Weight and BMI was measured at baseline and at 8 years. Regression models were used to examine weight gain by smoking status and the association of BMI at the time of quitting. Findings: Abstainers gained 8.79 kg [standard deviation (SD) 6.36; 95% confidence interval (CI) 7.42, 10.17]. Smokers gained 2.24 kg (SD 6.65; 95% CI 1.7, 2.77). Relapsed smokers gained 3.28 kg (SD 7.16; 95% CI 0.328, 6.24). Late abstainers gained 8.33 kg (SD 8.04; 95% CI 6.85, 9.81). The association between baseline BMI and weight change was modified by smoking status. In smokers there was a negative linear association of BMI, while in abstainers a J-shaped curve fitted best. These models estimated weight change over 8 years in abstainers of +9.8 kg, +7.8 kg, +10.2 kg, +19.4 kg and in smokers of +3.9 kg, +2.6 kg, 1.0 kg and -0.8 kg, where BMI was 18, 23, 29 and 36, respectively. Conclusion: Obese smokers gain most weight on quitting smoking, while obese continuing smokers are likely to remain stable or lose weight. Obese quitters have the greatest need for interventions to ameliorate weight gain.

Magnus A; Cadilhac D; Sheppard L; Cumming T; Pearce D; Carter R. Economic benefits of achieving realistic smoking cessation targets in Australia. American Journal of Public Health 101(2): 321-327, 2011. (30 refs.)

Objectives. We estimated the economic impact of reductions in the prevalence of tobacco smoking on health, production, and leisure in the 2008 Australian population. Methods. We selected a prevalence target of 15%. Cohort lifetime health benefits were modeled as fewer incident cases of tobacco-related diseases, deaths, and disability-adjusted life-years. We estimated production gains by comparing surveyed participation and absenteeism rates of adult smokers and ex-smokers valued according to the human capital and friction cost approaches. We estimated household production and leisure gains from time use surveys and valued these gains with the appropriate proxy. Results. In the 2008 Australian population, an absolute reduction in smoking prevalence of 8% would result in 158000 fewer incident cases of disease, 5000 fewer deaths, 2.2 million fewer lost working days, and 3000 fewer early retirements and would reduce health sector costs by AUD 491 million. The gain in workforce production was AUD 415 million (friction cost) or AUD 863 million (human capital), along with gains of 373000 days of household production and 23000 days of leisure time. Conclusions. Lowering smoking prevalence rates can lead to substantial economic savings and health benefits.

Matten P; Morrison V; Rutledge DN; Chen T; Chung E; Wong SF. Evaluation of tobacco cessation classes aimed at hospital staff nurses. Oncology Nursing Forum 38(1): 67-73, 2011. (23 refs.)

Purpose/Objectives: To evaluate a three-hour smoking cessation program and its effect on nurse knowledge, counseling behaviors, and confidence in counseling behaviors. Design: Program evaluation. Setting: A Magnet (R)-designated, 500-bed community hospital in Southern California. Sample: 107 nurses. Methods: Program content included behavior counseling and pharmacotherapy along with role playing. Investigator-developed self-report surveys were completed on the clay of the class and at 3, 6, and 12 months. Main Research Variables: Short- and long-term changes in nurse knowledge, attitudes, and behaviors about tobacco cessation efforts. Findings: Knowledge significantly increased from baseline to post-test. Counseling skills improved. Nurses who completed all surveys exhibited no significant changes about asking patients to quit smoking but did demonstrate significant changes at three months regarding advising patients, assessing quit readiness, and providing assistance. Changes were maintained over the year. Nurses' average ability to counsel patients was rated "good or very good" after one year. At 3, 6, and 12 months, most respondents reported providing cessation counseling or referrals to at least one patient. Conclusions: These findings support tobacco cessation programs for bedside nurses as useful in enhancing nurse confidence in patient-counseling skills. Implications for Nursing: Study findings demonstrated' benefits to using the developed curriculum. Additional research is needed on tobacco cessation programs for hospital nurses, particularly with longitudinal outcomes and actual nurse behaviors.

Michie S; Churchill S; West R. Identifying evidence-based competences required to deliver behavioural support for smoking cessation. Annals of Behavioral Medicine 41(1): 59-70, 2011. (34 refs.)

No systematic basis has yet been published for specifying competences needed to underpin behavioural support for smoking cessation. The purpose of this study was to develop and apply a system for identifying competences required for the delivery of individual and group-based behavioural support for smoking cessation. Sets of recommended competences for behavioural support were identified from a range of guidance documents. Where possible, these were compared with ones based on behaviour change techniques identified within behavioural support programmes found to be effective in randomised controlled trials (RCTs) and, for individual behavioural support, ones associated with higher success rates in the English Stop Smoking Services. Ninety-four competences were identified (71 individual and 23 additional group competences), of which 59 were cited in at least two guidance documents (51 and 8, respectively). Fourteen of the individual competences and three of the group competences were supported by RCT evidence and, for individual competences, nine were supported by evidence from the services. It is possible to identify competences recommended for behavioural support for smoking cessation and subsets supported by different types of evidence. This approach can form the basis for the development of assessment and training of stop smoking practitioners and is currently doing so in a national programme in England. With further research, the list of evidence-based competences is likely to be extended.

Minami H; McCarthy DE; Jorenby DE; Baker TB. An Ecological Momentary Assessment analysis of relations among coping, affect and smoking during a quit attempt. Addiction 106(3): 641-650, 2011. (41 refs.)

Aims: This study used Ecological Momentary Assessment (EMA) data from smokers trying to quit to assess relations among coping, positive affect, negative affect and smoking. The effects of stress coping on affect and smoking were examined. Design: Data from a randomized clinical trial of smoking cessation treatments were submitted to multi-level modeling to test the effects of coping with stressful events on subsequent affect and smoking. Setting: Center for Tobacco Research and Intervention, Madison, Wisconsin. Participants: A total of 372 adult daily smokers who reported at least one stressful event and coping episode and provided post-quit data. Measurements: Participants' smoking, coping and affect were assessed in near real time with multiple EMA reports using electronic diaries pre- and post-quit. Findings: Multi-level models indicated that a single coping episode did not predict a change in smoking risk over the next 4 or 48 hours, but coping in men was associated with concurrent reports of increased smoking. Coping predicted improved positive and negative affect reported within 4 hours of coping, but these affective gains did not predict reduced likelihood of later smoking. Pre-quit coping frequency and gender moderated post-quit stress coping relations with later positive affect. Men and those with greater pre-quit coping frequency reported greater gains in positive affect following post-quit coping. Conclusions: Coping responses early in a quit attempt may help smokers trying to quit feel better, but may not help them stay smoke-free.

Moorhouse MD; Pomeranz JL; Barnett TE; Yu NS; Curbow BA. Tobacco cessation intervention for people with disabilities: Survey of center for independent living directors. Rehabilitation Counseling Bulletin 54(2): 118-121, 2011. (11 refs.)

People with disabilities (PWD) are 50% more likely to smoke compared with the general population, yet interventions tailored to the needs of PWD remain limited. The authors surveyed directors from a leading disability service organization to assess their delivery of tobacco cessation interventions. Although tobacco cessation was identified as a high priority, directors reported that they are ill-equipped to deliver tobacco cessation interventions. To properly address the unique challenges that PWD face when quitting tobacco, disability sensitive cessation interventions are needed.

Murin S; Rafii R; Bilello K. Smoking and smoking cessation in pregnancy. Clinics in Chest Medicine 32(1): 75-+, 2011. (90 refs.)

Smoking during pregnancy is among the leading preventable causes of adverse maternal and fetal outcomes. Smoking prevalence among young women is the primary determinant of smoking prevalence during pregnancy. Smoking among women of childbearing age is associated with reduced fertility, increased complications of pregnancy, and a variety of adverse fetal outcomes. There is increasing evidence of lasting adverse effects on offspring. Guidelines for smoking cessation during pregnancy have been developed. This article reviews the epidemiology of smoking during pregnancy, the adverse effects of smoking on the mother, fetus, and offspring, and recommended approaches to smoking cessation for pregnant women.

Nieva G; Ortega LL; Mondon S; Ballbe M; Gual A. Simultaneous versus delayed treatment of tobacco dependence in alcohol-dependent outpatients. European Addiction Research 17(1): 1-9, 2011. (53 refs.)

Introduction: There is a high prevalence of smoking among heavy drinkers, which is often forgotten even though it has important health consequences. Aim: To evaluate the effects that providing an intensive tobacco cessation treatment simultaneously with alcohol dependence treatment versus delayed treatment (first alcohol and 6 months later tobacco) has on alcohol and tobacco consumption. Methods: Ninety-two alcohol-dependent smokers were randomized into either a simultaneous group, in which treatment was given concurrently for quitting both alcohol and tobacco, or a delayed group, in which help to quit smoking was given after 6 months. Results: No differences were found in alcohol abstinence rates in time-to-first relapse or in cumulative abstinence at 6 months. Smoking cessation rates were low overall, but better at 3 months in the simultaneous group, although differences later disappeared. Discussion: Participation in a smoking cessation program does not impair alcohol outcomes, at least during the first 6 months.

O'Connell KA; Shiffman S; DeCarlo LT. Does extinction of responses to cigarette cues occur during smoking cessation? Addiction 106(2): 410-417, 2011. (41 refs.)

Aims: This study investigated whether Pavlovian extinction occurs during smoking cessation by determining whether experience abstaining from smoking in the presence of cigarette cues leads to decreased probability of lapsing and whether this effect is mediated by craving. Design: Secondary analyses were carried out with data sets from two studies with correlational/observational designs. Setting: Data were collected in smokers' natural environments using ecological momentary assessment techniques. Participants: Sixty-one and 207 smokers who were attempting cessation participated. Measurements: Multi-level path models were used to examine effects of prior experience abstaining in the presence of available cigarettes and while others were smoking on subsequent craving intensity and the probability of lapsing. Control variables included current cigarette availability, current exposure to others smoking, number of prior lapses and time in the study. Findings: Both currently available cigarettes [odds ratios (OR) = 36.60, 11.59] and the current presence of other smoking (OR = 5.00, 1.52) were powerful predictors of smoking lapse. Repeated exposure to available cigarettes without smoking was associated with a significantly lower probability of lapse in subsequent episodes (OR = 0.44, 0.52). However, exposure to others smoking was not a reliable predictor, being significant only in the smaller study (OR = 0.30). Craving functioned as a mediator between extinction of available cigarettes and lapsing only in the smaller study and was not a mediator for extinction of others smoking in either study. Conclusions: This study showed that exposure to available cigarettes is a large risk factor for lapsing, but that this risk can also be reduced over time by repeated exposures without smoking. Smoking cessation interventions should attempt to reduce cigarette exposure (by training cigarette avoidance) but recognize the potential advantage of unreinforced exposure to available cigarettes.

Piper ME; Cook JW; Schlam TR; Jorenby DE; Baker TB. Anxiety diagnoses in smokers seeking cessation treatment: Relations with tobacco dependence, withdrawal, outcome and response to treatment. Addiction 106(2): 418-427, 2011. (51 refs.)

Aims: To understand the relations among anxiety disorders and tobacco dependence, withdrawal symptoms, response to smoking cessation pharmacotherapy and ability to quit smoking. Design: Randomized placebo-controlled clinical trial. Participants received six 10-minute individual counseling sessions and either: placebo, bupropion SR, nicotine patch, nicotine lozenge, bupropion SR + nicotine lozenge or nicotine patch + nicotine lozenge. Setting: Two urban research sites. Participants: Data were collected from 1504 daily smokers (> 9 cigarettes per day) who were motivated to quit smoking and did not report current diagnoses of schizophrenia or psychosis or bupropion use. Measurements: Participants completed baseline assessments, the Composite International Diagnostic Interview and ecological momentary assessments for 2 weeks. Findings: A structured clinical interview identified participants who ever met criteria for a panic attack (n = 455), social anxiety (n = 199) or generalized anxiety disorder (n = 99), and those who qualified for no anxiety diagnosis (n = 891). Smokers with anxiety disorders reported higher levels of nicotine dependence and pre-quit withdrawal symptoms. Those ever meeting criteria for panic attacks or social anxiety disorder showed greater quit-day negative affect. Smokers ever meeting criteria for anxiety disorders were less likely to be abstinent at 8 weeks and 6 months post-quit and showed no benefit from single-agent or combination-agent pharmacotherapies. Conclusions: Anxiety diagnoses were common among treatment-seeking smokers and were related to increased motivation to smoke, elevated withdrawal, lack of response to pharmacotherapy and impaired ability to quit smoking. These findings could guide treatment assignment algorithms and treatment development for smokers with anxiety diagnoses.

Pisinger C; Aadahl M; Toft U; Jorgensen T. Motives to quit smoking and reasons to relapse differ by socioeconomic status. Preventive Medicine 52(1): 48-52, 2011. (22 refs.)

Objective. To investigate motives, strategies and experiences to quit smoking and reasons to relapse as a function of socioeconomic status. Methods. A population-based study, Inter99, Denmark. Two thousand six hundred twenty-one daily smokers with a previous quit attempt completed questionnaires at baseline. Cross-sectional baseline-data (1999-2001) were analysed in adjusted regression analyses. Results. Consistent findings across the three indicators of socioeconomic status (employment, school education, higher education/vocational training): smokers with low socioeconomic status were significantly more likely than smokers with high socioeconomic status to report that they wanted to quit because smoking was too expensive (OR: 1.85 (1.4-2.4), for school education) or because they had health related problems (OR: 1.75 (1.4-2.2)). When looking at previous quit attempts, smokers with low socioeconomic status were significantly more likely to report that it had been a bad experience (OR: 1.41 (1.1-1.8)) and that they had relapsed because they were more nervous/restless/depressed (OR: 1.43 (1.1-1.8)). Conclusions. This study shows that smokers with low socioeconomic status have other motives to quit and other reasons to relapse than smokers with high socioeconomic status. Future tobacco prevention efforts aimed at smokers with low socioeconomic status should maybe focus on current advantages of quitting smoking, using high cost of smoking and health advantages of quitting as motivating factors and by including components of mental health as relapse prevention.

Ramstrom L. Commentary on Lund, et al. (2011): Consolidating the evidence on effectiveness of snus for smoking cessation - implications for public health. (editorial). Addiction 106(1): 168-169, 2011. (16 refs.)

Rigotti NA. Integrating comprehensive tobacco treatment into the evolving US health care system: It's time to act. (editorial). Archives of Internal Medicine 171(1): 53-55, 2011. (21 refs.)

Ross H; Blecher E; Yan L; Hyland A. Do cigarette prices motivate smokers to quit? New evidence from the ITC survey. Addiction 106(3): 609-619, 2011. (23 refs.)

Aims: To examine the importance of cigarette prices in influencing smoking cessation and the motivation to quit. Design: We use longitudinal data from three waves of the International Tobacco Control Policy Evaluation Survey (ITC). The study contrasts smoking cessation and motivation to quit among US and Canadian smokers and evaluates how this relationship is modified by cigarette prices, nicotine dependence and health knowledge. Different price measures are used to understand how the ability to purchase cheaper cigarettes may reduce the influence of prices. Our first model examines whether cigarette prices affect motivation to quit smoking using Generalized Estimating Equations to predict cessation stage and a least squares model to predict the change in cessation stage. The second model evaluates quitting behavior over time. The probability of quitting is estimated with Generalized Estimating Equations and a transition model to account for the 'left-truncation' of the data. Settings US and Canada. Participants: 4352 smokers at Wave 1, 2000 smokers completing all three waves. Measurements: Motivation to quit, cigarette prices, nicotine dependence and health knowledge. Findings: Smokers living in areas with higher cigarette prices are significantly more motivated to quit. There is limited evidence to suggest that price increases over time may also increase quit motivation. Higher cigarette prices increase the likelihood of actual quitting, with the caveat that results are statistically significant in one out of two models. Access to cheaper cigarette sources does not impede cessation although smokers would respond more aggressively (in terms of cessation) to price increases if cheaper cigarette sources were not available. Conclusions: This research provides a unique opportunity to study smoking cessation among adult smokers and their response to cigarette prices in a market where they are able to avoid tax increases by purchasing cigarettes from cheaper sources. Higher cigarette prices appear to be associated with greater motivation to stop smoking, an effect which does not appear to be mitigated by cheaper cigarette sources. The paper supports the use of higher prices as a means of encouraging smoking cessation and motivation to quit.

Rothrauff TC; Eby LT. Counselors' knowledge of the adoption of tobacco cessation medications in substance abuse treatment programs. American Journal on Addictions 20(1): 56-62, 2011. (37 refs.)

This study assessed counselors' knowledge of the adoption of evidence-based tobacco cessation medications (TCMs)-varenicline, bupropion, and five nicotine replacement therapies (NRTs)-and predictors of adoption in diverse substance abuse treatment settings. We used Managing Effective Relationships in Treatment Services (MERITS I) data from 658 counselors working in 26 programs. Adoption of varenicline was reported by 16% of counselors, bupropion by 11%, and NRTs by 27%. Knowledge of the adoption of all types of TCMs was more likely to be reported by counselors who worked in treatment programs that adhered less to a 12-step orientation and restricted outdoor smoking for employees. Several additional unique predictors of varenicline and NRTs were identified.

Schnoll RA; Martinez E; Tatum KL; Glass M; Bernath A; Ferris D et al. Increased self-efficacy to quit and perceived control over withdrawal symptoms predict smoking cessation following nicotine dependence treatment. Addictive Behaviors 36(1-2): 144-147, 2011. (23 refs.)

Aim To examine changes in nicotine withdrawal nicotine craving self-efficacy to quit smoking and perceived control over withdrawal symptoms as predictors of smoking cessation following behavioral counseling and nicotine replacement therapy in a sample of smokers. Design and setting: The data were ascertained from a randomized effectiveness trial comparing nicotine patch to nicotine lozenge Predictors of smoking cessation were assessed at baseline and 5 weeks post-baseline and 24-hour point prevalence abstinence biochemically confirmed was assessed at the end of-treatment (week 15) and 6 months after a target quit date (week 27). Participants: 642 treatment-seeking smokers randomized to 12 weeks of nicotine patch or nicotine lozenge. Findings: Participants who showed a greater Increase in self efficacy to quit smoking (OR=1 09 95% CI 1 02-1 16 p=01) and perceived control over withdrawal symptoms (OR=1 02 95% CI 1 00-1 04 p=05) were significantly more likely to have quit smoking at week 15. Participants who showed a greater Increase in self-efficacy to quit smoking (OR=1 04 95% CI 1 01-106 p = 01) were significantly more likely to have quit smoking at week 27. Changes in withdrawal symptoms and craving were not related to week 15 or week 27 abstinence rates. Conclusions: The results highlight two relatively under-studied potential psychological predictors of abstinence following treatment for nicotine dependence. Behavioral counseling interventions to promote smoking cessation should help smokers develop confidence in their ability to quit smoking and increase their sense of control over withdrawal symptoms to increase their chances for cessation.

Schnoll RA; Shields AE. Physician barriers to incorporating pharmacogenetic treatment strategies for nicotine dependence into clinical practice. (editorial). Clinical Pharmacology & Therapeutics 89(3): 345-347, 2011. (5 refs.)

Advances in genomics research may improve health outcomes by tailoring treatment according to patients' genetic profiles. The treatment of nicotine dependence, in particular, may soon encompass pharmacogenetic treatment models. Realizing the benefits of such treatment strategies may depend on physicians' preparedness to incorporate genetic testing into clinical practice. This article describes barriers to clinical integration of pharmacogenetic treatments that will need to be addressed to realize the benefits of individualized smoking-cessation treatment.

Schnoz D; Schaub M; Schwappach DL; Gross CS. Developing a smoking cessation program for Turkish-speaking migrants in Switzerland: Novel findings and promising effects. Nicotine & Tobacco Research 13(2): 127-134, 2011. (32 refs.)

Recent studies show that smoking prevalence in the Turkish-speaking migrant population in Switzerland is substantially higher than in the general population. A specific group treatment for Turkish-speaking migrants was developed and tested in order to provide the migrant population with equal access to smoking cessation programs and to improve the migration-sensitive quality of such programs by sociocultural targeting. The evaluation of the program included quantitative (questionnaires t1 and t2 and follow-up by telephone) and qualitative methods (participant observation and semi-structured interviews). The results showed that 37.7% of the 61 participants were smoke free at the 12-month follow-up. The factors of being in a partnership and using nicotine replacement products during the program were positively associated with successful cessation. We also demonstrated the importance of "strong ties" (strong relationships between participants) and the sensitivity of the program to sociocultural (e.g., social aspects of smoking in Turkish culture, which were addressed in relapse prevention), socioeconomic (e.g., low financial resources, which were addressed by providing the course for free), and migration-specific (e.g., underdeveloped access to smoking cessation programs, which was addressed using outreach strategy for recruiting) issues. Overall, the smoking cessation program was successfully tested and is now becoming implemented as a regular service of the Swiss Public Health Program for Tobacco Prevention (by the Swiss Association for Smoking Prevention).

Sheffer CE; Barone C; Anders ME. Training nurses in the treatment of tobacco use and dependence: Pre- and post-training results. Journal of Advanced Nursing 67(1): 176-183, 2011. (36 refs.)

Aim. This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses. Background. Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing the number of nurses who deliver brief evidence-based interventions for tobacco use and dependence, such as that prescribed by the Public Health Service Clinical Practice Guideline in the United States of America, is likely to expose more tobacco users to evidence-based treatments and lead to more successful quit attempts. Effective training is key to improving provider proficiency in delivering evidence-based interventions for tobacco use and dependence. Method. A 1-hour didactic training was delivered to 359 nurses from 2006 to 2007, including 54 Advanced Practice Nurses, 250 Registered Nurses and 55 Licensed Practical Nurses. Pre- and post-training tests assessed attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. Results. Statistically significant increases on nearly all measures were achieved, with Registered Nurses and Licensed Practical Nurses realizing the largest gains. Conclusion. Given the overwhelming impact of tobacco use on patients, all nurses should be provided with training in the delivery of brief, evidence-based interventions for tobacco use. As the most trusted healthcare provider group with an extended reach into the tobacco using population, nurses have a large potential impact on the prevalence of tobacco use.

Stoops WW; Poole MM; Vansickel AR; Hays KA; Glaser PEA; Rush CR. Methylphenidate increases choice of cigarettes over money. Nicotine & Tobacco Research 13(1): 36-40, 2011. (24 refs.)

Introduction: Stimulants increase cigarette smoking in the naturalistic environment and laboratory. The effects of methylphenidate on a 9-trial, discrete cigarette versus money ($0.25) choice task were tested to elucidate the mechanisms underlying stimulant-induced increases in smoking. Methods: Eleven participants who reported smoking 10-20 cigarettes/day completed the study. Four doses of methylphenidate (0, 10, 20, and 40 mg) were administered across 5 experimental sessions, with placebo administered twice. One hour following medication administration and at 30-min intervals thereafter, participants chose between smoking a cigarette and receiving US$0.25. The primary behavioral outcome measure was number of cigarette choices. Results: Methylphenidate increased the number of cigarette choices over money. Puffs per session and carbon monoxide levels increased significantly and caloric intake decreased significantly following methylphenidate administration relative to placebo. Conclusions: The results of this study suggest that methylphenidate increases the relative reinforcing efficacy of cigarette smoking. Stimulant use may thus be an important consideration for individuals attempting to quit smoking.

Thompson AB; Moon-Howard J; Messeri PA. Smoking cessation advantage among adult initiators: Does It apply to black women? Nicotine & Tobacco Research 13(1): 22-28, 2011. (36 refs.)

Smokers who initiate as adults are more likely to quit than those who initiate as adolescents. Black women are more likely than White women to initiate smoking in adulthood and are less likely to quit. There is a paucity of research examining whether the smoking cessation advantage among adult initiators applies to Black women. The study objective is to examine race differences in the effect of developmental stage of smoking initiation on number of years until cessation among Black and White women. Data were extracted from the National Longitudinal Survey of Young Women, a national cohort of women between the ages of 49 and 61 years in 2003. The analytic sample comprised 1,008 White women and 271 Black women with a history of smoking. Survival analysis procedures were utilized to address the study objective. Racial disparities in smoking cessation were most evident among women who initiated smoking as adults. White young adult initiators had a 31% increased hazard of smoking cessation advantage (adjusted hazards ratio [HR]: 1.31, 95% CI: 1.04-1.65) over adolescent initiators, whereas Black young adult initiators had no smoking cessation advantage (adjusted HR: 0.85, CI: 95% 0.55-1.30) over adolescent initiators. Prior observations that smoking initiation in adulthood is associated with high rates of cessation do not apply to black women. To contribute to the reduction of disparities in women's cessation efforts to prevent initiation should target young adult women, particularly Black young adult women.

Tonstad S; Holme I; Tonnesen P. Dianicline, a novel alpha 4 beta 2 nicotinic acetylcholine receptor partial agonist, for smoking cessation: A randomized placebo-controlled clinical trial. Nicotine & Tobacco Research 13(1): 8-13, 2011. (11 refs.)

Dianicline is a alpha 4 beta 2 nicotinic acetylcholine receptor partial agonist, a class of drugs that includes varenicline and cytisine. Varenicline is efficacious for smoking cessation, while cytisine has not been studied systematically. The efficacy of dianicline has not been previously tested in an adequately powered study. In a randomized, double-blind, parallel group placebo-controlled trial, 602 generally healthy cigarette smokers were assigned to dianicline (n = 300) or placebo (n = 302) for 7 weeks followed by a 19-week off drug follow-up period. Exhaled carbon monoxide and cotinine-confirmed continuous abstinence rates for Weeks 4-7 were 24.0% for dianicline versus 20.5% for placebo (odds ratio 1.22; 95% CI, 0.83-1.80; p = .307). For Weeks 4-26, the abstinence rates were 16.7% for dianicline versus 13.9% for placebo (odds ratio 1.24; 95% CI, 0.79-1.93; p = .366). Craving for a cigarettes was reduced by dianicline compared with placebo after 7 weeks (p = .0175). Nicotine withdrawal symptoms measured by the Hughes and Hatsukami Minnesota Withdrawal Scale were lower for dianicline compared with placebo in the first 3 weeks of treatment during which time quit rates were also higher in the dianicline-treated group. Dianicline did not increase cigarette smoking abstinence rates beyond the initial phase of treatment. However, self-reported craving and nicotine withdrawal symptoms were reduced.

Vallone DM; Duke JC; Cullen J; McCausland KL; Allen JA. Evaluation of EX: A national mass media smoking cessation campaign. American Journal of Public Health 101(2): 302-309, 2011. (28 refs.)

Objectives. We used longitudinal data to examine the relationship between confirmed awareness of a national, branded, mass media smoking cessation campaign and cessation outcomes. Methods. We surveyed adult smokers (n=4067) in 8 designated market areas ("media markets") at baseline and again approximately 6 months later. We used multivariable models to examine campaign effects on cognitions about quitting, quit attempts, and 30-day abstinence. Results. Respondents who demonstrated confirmed awareness of the EX campaign were significantly more likely to increase their level of agreement. on a cessation-related cognitions index from baseline to follow-up (odds ratio [OR]=1.6; P=.046). Individuals with confirmed campaign awareness had a 24% greater chance than did those who were not aware of the campaign of making a quit attempt between baseline and follow-up (OR=1.24; P=.048). Conclusions. A national, branded, mass media smoking cessation campaign can change smokers' cognitions about quitting and increase quit attempts. We strongly recommend that federal and state governments provide funding for media campaigns to increase smoking cessation, particularly for campaigns that have been shown to impact quit attempts and abstinence.

Walker NK; Howe C; Bullen C; Grigg M; Glover M; McRobbie H et al. Study protocol for a randomised trial of nicotine-free cigarettes as an adjunct to usual NRT-based cessation practice, in people who wish to stop smoking. BMC Public Health 11: e-article 37, 2011. (14 refs.)

Background: Current smoking cessation treatments focus on addressing the pharmacological dependence of smokers on nicotine. However, new strategies are needed that address both nicotine dependence and the psychological dependence on cigarettes as the source of nicotine. Evidence from a number of small smoking cessation studies suggests that the use of cigarettes with reduced nicotine content, in combination with nicotine replacement therapy (NRT), may help reduce withdrawal symptoms and increase quit rates. This paper describes the protocol for a large randomised-controlled trial to test the effect of using nicotine-free cigarettes together with NRT on long-term quit rates. Methods/design: This single-blind, randomised trial aims to recruit 1,410 participants through the national telephone-based Quitline service in New Zealand. Participants in the treatment arm will be asked to stop smoking nicotine-containing cigarettes on their chosen Quit day and smoke ad libitum nicotine-free (Quest 3) cigarettes for six weeks. At the same time people in this group will be asked to start using NRT patches, gum and/or lozenges (as recommended by Quitline) for eight weeks. Participants in the control arm will be asked to stop smoking completely on their chosen Quit day and start using NRT patches, gum and/or lozenges (as recommended by Quitline) for eight weeks. Data collection will occur at baseline, three and six weeks, and three and six months after Quit day. The primary outcome is the proportion of participants who self-report seven-day point prevalence abstinence at six months since Quit date. Discussion: Smoking prevalence in New Zealand has changed little in recent years (particularly in Maori, the indigenous people of New Zealand) and additional options for smokers who want to quit are needed. Although a variety of methods are available to help, many are expensive, have side effects, and despite their use most quit attempts still fail. This trial will test the balance of benefits and risks of a new strategy for people to overcome nicotine dependence. Since smoking is the leading cause of lost healthy life years in New Zealand, if proven effective this strategy is likely to have substantial public health benefits.

Walls NE; Wisneski H. Evaluation of smoking cessation classes for the lesbian, gay, bisexual, and transgender community. Journal of Social Service Research 37(1): 99-111, 2011. (49 refs.)

This study evaluates the effectiveness of a smoking cessation course tailored to meet the needs of the lesbian, gay, bisexual, and transgender (LGBT) community. Of the 44 individuals who participated, 36 were in attendance in the final class, and 88.9% of those had successfully quit smoking. The study found an increase in importance to having cessation classes in gay-identified contexts, high ratings of the cultural appropriateness of the course content, and decreasing anxiety across the classes. Participants' assessment of their health shifted differentially based on whether they were successful at quitting.

Wee LH; West R; Bulgiba A; Shahab L. Predictors of 3-month abstinence in smokers attending stop-smoking clinics in Malaysia. Nicotine & Tobacco Research 13(2): 151-156, 2011. (32 refs.)

Introduction: Much is known about the predictors of success in quitting smoking. In particular, nicotine dependence, but not strength of motivation to stop, appears to predict abstinence. However, to date, studies have come almost exclusively from Western countries. More data are needed on the cross-cultural generalizability of these findings. Methods: One hundred and ninety-eight smokers attending 5 stop-smoking clinics in Malaysia completed a questionnaire prior to their target quit date and were followed up 3 months after this date. Predictors included sociodemographic variables, smoking patterns, past history of quitting, characteristics of current quit attempt, and smoking motives as well as nicotine dependence (Fagerstrom Test for Nicotine Dependence [FTND]) and self-rated strength of motivation of stop. Results: At 3-month follow-up, 35.4% (95% CI: 28.7-42.0) of participants reported being abstinent. A backward elimination multiple logistic regression identified a number of significant predictors of success, including strength of motivation to stop (adjusted odds ratio [OR]: 3.05, 95% CI: 1.28-7.25). FTND did not predict success. Conclusions: Motivation and nicotine dependence may play different roles in explaining variation in ability to stop smoking in different cultures.

Whittaker R; Dorey E; Bramley D; Bullen C; Denny S; Elley CR et al. A theory-based video messaging mobile phone intervention for smoking cessation: Randomized controlled trial. Journal of Medical Internet Research 13(1): 58-69, 2011. (45 refs.)

Background: Advances in technology allowed the development of a novel smoking cessation program delivered by video messages sent to mobile phones. This social cognitive theory-based intervention (called "STUB IT") used observational learning via short video diary messages from role models going through the quitting process to teach behavioral change techniques. Objective: The objective of our study was to assess the effectiveness of a multimedia mobile phone intervention for smoking cessation. Methods: A randomized controlled trial was conducted with 6-month follow-up. Participants had to be 16 years of age or over, be current daily smokers, be ready to quit, and have a video message-capable phone. Recruitment targeted younger adults predominantly through radio and online advertising. Registration and data collection were completed online, prompted by text messages. The intervention group received an automated package of video and text messages over 6 months that was tailored to self-selected quit date, role model, and timing of messages. Extra messages were available on demand to beat cravings and address lapses. The control group also set a quit date and received a general health video message sent to their phone every 2 weeks. Results: The target sample size was not achieved due to difficulty recruiting young adult quitters. Of the 226 randomized participants, 47% (107/226) were female and 24% (54/226) were Maori (indigenous population of New Zealand). Their mean age was 27 years (SD 8.7), and there was a high level of nicotine addiction. Continuous abstinence at 6 months was 26.4% (29/110) in the intervention group and 27.6% (32/116) in the control group (P = .8). Feedback from participants indicated that the support provided by the video role models was important and appreciated. Conclusions: This study was not able to demonstrate a statistically significant effect of the complex video messaging mobile phone intervention compared with simple general health video messages via mobile phone. However, there was sufficient positive feedback about the ease of use of this novel intervention, and the support obtained by observing the role model video messages, to warrant further investigation.

Wong DCN; Chan SSC; Fong DYT; Leung AYM; Lam DOB; Lam TH. Patterns and predictors of quitting among youth quitline callers in Hong Kong. Nicotine & Tobacco Research 13(1): 14-21, 2011. (47 refs.)

To examine the time patterns and predictors of initiating a quit attempt and subsequent sustained abstinence among youth smokers after receiving a telephone smoking cessation intervention. This was a longitudinal study of 408 current youth smokers aged 12-25 years who called a smoking cessation hotline in Hong Kong. Telephone surveys were conducted at baseline; 1week; and 1, 3, and 6 months to assess smoking status and other risk factors. Nonparametric Kaplan-Meier methods and hierarchical Cox's proportional odds models were applied to explore the time patterns and predictors of the quitting process. Half of the youth smokers initiated a quit attempt within 1 month after receiving the baseline telephone intervention, while the likelihood of further quit attempts decreased over time. Two thirds relapsed within the first 7 days after starting a quit attempt. Intention to quit, previous quit attempts, perceived physical unfitness, and other factors could predict the initiation of a quit attempt. Sustained abstinence was facilitated by making an immediate attempt to quit, adopting self-help strategies, and a perceived improvement in physical health. Our findings support the "catastrophic" pathway of youth smokers initiating a quit attempt. Counselors should capture the quitting momentum and motivate youth smokers to quit immediately. Interventions should include a health assessment and discussion of smokers' physical fitness. During the first week of abstinence, intensive monitoring of withdrawal symptoms, together with booster counseling, is helpful in preventing smoking relapse and could remotivate those who fail to sustain their quit attempt.

Xue F; Willett WC; Rosner BA; Hankinson SE; Michels KB. Cigarette smoking and the incidence of breast cancer. Archives of Internal Medicine 171(2): 125-133, 2011. (57 refs.)

Background: Tobacco smoke contains carcinogens, which may increase the risk of breast cancer (BC). Conversely, cigarette smoking also has antiestrogenic effects, which may reduce the risk of BC. The association between smoking and BC remains controversial. Methods: Prospective cohort study of 111 140 participants of the Nurses' Health Study from 1976 to 2006 for active smoking and 36 017 women from 1982 to 2006 for passive smoking. Results: During 3 005 863 person-years of follow-up, 8772 incident cases of invasive BC were reported. After adjustment for potential confounders, the hazard ratio (HR) of BC was 1.06% (95% confidence interval [CI], 1.01%-1.10%) for ever smokers relative to never smokers. Breast cancer incidence was associated with a higher quantity of current (P for trend=.02) and past (P for trend=.003) smoking, younger age at smoking initiation (P for trend=.01), longer duration of smoking (P for trend=.01), and more pack-years of smoking (P for trend=.005). Premenopausal smoking was associated with a slightly higher incidence of BC (HR, 1.11; 95% CI, 1.07-1.15 for every increase of 20 pack-years), especially smoking before first birth (1.18; 1.10-1.27 for every increase of 20 pack-years). Conversely, the direction of the association between postmenopausal smoking and BC was inverse (0.93; 0.85-1.02 for every increase of 20 pack-years). Passive smoking in childhood or adulthood was not associated with BC risk. Conclusion: Active smoking, especially smoking before the first birth, may be associated with a modest increase in the risk of BC.

Young C; Skorga P. Reduction versus abrupt cessation in smokers who want to quit: A review summary. Public Health Nursing 28(1): 54-56, 2011. (0 refs.)

This synopsis is of a Cochrane systematic review by Lindson et al. ( 2010) containing meta-analysis of 10 clinical trials evaluating the effects and side effects of abruptly quitting smoking versus reducing and then quitting smoking. Side effects were described through narrative. A meta-analysis of 10 studies indicated that there were no statistically significant differences in abstinence from smoking between intervention (abrupt quit group) and comparison groups (reduced quit group). The results remained nonsignificant regardless of whether pharmacotherapy, self-help therapy, or behavioral support were included in the intervention. Researchers were unable to draw conclusions about the differences in adverse events between interventions due to the difference in reporting. Symptoms occurring related to the use of nicotine gum most frequently from both groups were malaise, constipation, and diarrhea.

Zaborowski DE; Dedert EA; Straits-Troster K; Lee S; Wilson SM; Calhoun PS et al. Public health clinical demonstration project for smoking cessation in American veterans who served since September 11, 2001. Journal of Addiction Medicine 5(1): 79-83, 2011. (17 refs.)

Objective: The purpose of this clinical demonstration project was to increase the reach of effective treatments, such as pharmacotherapy and telephone or web-based support, by offering these treatments in a low cost and convenient manner to a population of Veterans. Methods: Six hundred nine veteran smokers who had served in the military since September 11, 2001 were contacted by invitational letters. Veterans indicating interest in further contacts received telephone calls using standardized scripts that offered referral to the National Cancer Institute's Smoking QuitLine, web-based counseling, and local Department of Veteran Affairs pharmacologic treatment for smoking cessation. Results: Seven percent of survey recipients participated in the clinical program. At follow-up, 23% of participants providing follow-up information reported maintaining smoking abstinence. This clinical demonstration project was associated with a reach of 8.6% (number of smokers who accessed the intervention/the number of targeted smokers), an efficacy of 26% (number of abstinent smokers at follow-up/number who accessed the intervention), and a 24-hour abstinence impact rate of 2.2% (number of smokers with 24-hour abstinence/number of targeted smokers). Conclusions: Results suggested that this project enhanced access to care and promoted short-term smoking cessation in Veterans who have served since September 11. 2001.