Introduction: Transit workers are a blue-collar occupational group with elevated rates of smoking despite access to free or low-cost cessation services available through their health insurance as a union-negotiated employee benefit. Little is known about the influences on cessation participation in this workforce.

Aims: The purpose of this study is to analyse the factors associated with past-year cessation activities amongst a multiethnic sample of transit workers.

Methods: Cross-sectional tobacco surveys were completed by 935 workers at an Oakland, California, USA-based public transit agency. Data from 190 current smokers (68% African American; 46% female) were analysed. Adjusted odds ratios were calculated to identify factors associated with past-year cessation activity.

Results: Approximately 55% of smokers stopped smoking for one day or longer during the past year in order to quit. Nearly half reported that the most common barrier to quitting was, ‘Not mentally ready to quit because I like smoking’. Workers in the contemplation/precontemplation stage for intention to quit were less likely to have engaged in cessation activities than those in the action/preparation stage (AOR = 0.34). Frequency of coworker encouragement for quitting was positively associated with past-year cessation activities (AOR = 3.25). Frequency of insomnia symptoms was negatively associated with cessation activity participation (AOR = 0.34).

Conclusions: Most transit workers who smoke made a past-year quit attempt. Gaining insight into factors associated with participation in cessation activities can aid worksite efforts to promote cessation and reduce tobacco-related disparities.

Introduction: Weight concerns may inhibit smoking quit attempts and may be more influential amongst African-Americans who are more likely to be overweight.

Aims: To assess if weight perception is associated with readiness to quit and whether this relationship is modified by race.

Methods: We used data from a cohort of current smokers undergoing routine health examinations. Based on differences between ideal and measured BMI, participants’ weight perceptions were classified as within, somewhat above, or far above ideal weight. Logistic regression analysis was used to evaluate adjusted associations of weight perception and race with readiness to quit.

Results: Of 2,831 current smokers, 23% were obese and 38% overweight. Amongst white smokers, those who perceived being far above ideal weight were more likely to be ready to quit (OR: 1.45, 95% CI: 1.03–2.03), but this association was not observed for African-American smokers who perceived themselves to be somewhat or far above their ideal weight (OR: 0.35, 95% CI: 0.10–1.24 and OR: 0.36, 95% CI: 0.11–1.19, respectively).

Conclusions: Perception of being overweight is associated with increased readiness to quit amongst white but not African-American smokers. Smoking cessation programmes may need to culturally tailor interventions based on smokers’ weight perceptions.

Despite a downwards trend in smoking prevalence, smoking remains the UK's biggest preventable cause of premature mortality. Specialist stop smoking support programmes provided by the NHS have helped to reduce smoking prevalence and whilst there has been a vast amount of research investigating the most effective behavioural and pharmacological support models, little is known about the impact of smoking cessation advisor's smoking status and clinical effectiveness on quit rates. This study aimed to identify factors that contribute to NHS stop smoking advisor performance using a quantitative cross-sectional design via an online survey that was completed by 159 participants in 24 London boroughs. Multiple regression analyses revealed that level of training, years practiced, level of advisor education, number of patients supported in a given year, and smoking status had no significant impact on NHS stop smoking advisor quit rate in this sample. However, the model revealed that proportion of time spent delivering smoking cessation support was significantly associated with quit rate. It is imperative that this finding is considered when recruiting, commissioning, and training new smoking cessation advisors or provider organisations.

Aims: This study aimed to evaluate pharmacists’ and physicians’ perception and knowledge of e-cigarettes, including comfort level in counselling patients on these products. The study also assessed if, and to what extent, patient e-cigarette usage is collected as a marker of tobacco use status.

Methods: Surveys were distributed to community pharmacists and family practice physicians for 3 months, and responses were analysed utilising descriptive and inferential statistics.

Results: The majority of respondents reported not feeling fully confident on counselling patients about e-cigarettes, and responses revealed gaps in knowledge in both groups. Mixed results were obtained on the inclusion of e-cigarettes in assessment of patient smoking status.

Conclusions: Pharmacists and physicians would benefit from further information on e-cigarettes. Due to the increasing popularity, healthcare professionals will be called upon to serve as, care providers and informational resources to patients who use these products. This survey provided a consensus that further steps should be taken to increase product training and information dissemination.

Introduction: Adherence to transdermal nicotine patches, one of the most popular and effective treatments for nicotine dependence, remains very low and is a strong predictor of cessation rates.

Aims: This study examined individual factors related to adherence as well as differences over time between adherent (>85% of daily patch use) and non-adherent participants (<85% of daily patch use).

Methods: We analysed data from 440 participants who received 8 weeks of 21 mg transdermal nicotine and four behavioural counselling sessions within an effectiveness trial that examined the effects of long-term treatment. Multiple logistical regression assessed baseline variables associated with patch adherence and generalised estimating equations (GEE) were used to evaluate changes in craving and withdrawal, depressive and anxiety symptoms, substitute and complementary reinforcers, and side effects between participants who were or were not adherent.

Results: Adherence to patch use was strongly associated with smoking cessation at week 8 (p < 0.05). In a logistic regression model, being female, living with a child or children, and higher self-reported anxiety symptoms were predictive of lower patch adherence (p < 0.05). In the GEE analysis, adherence was significantly associated with a greater reduction in craving, a greater engagement in substitute reinforcers, and a greater decrease in complementary reinforcers over time (p < 0.05).

Conclusions: Difficulties adhering to transdermal nicotine patches may be related to psychiatric comorbidity, difficulty managing nicotine craving, and challenges with engaging in substitute reinforcers and reducing exposure to complementary reinforcers. These constructs may serve as targets for interventions designed to increase treatment adherence.

Trial registration: ClinicalTrials.gov Identifier: NCT01047527

Introduction: The efficacy of varenicline as a smoking cessation aid is affected by commonly-occurring issues, such as intolerable adverse events, cravings and withdrawal symptoms, and poor medication adherence. Improvement in quit rates may be achieved through tailoring doses relative to individual smokers’ behaviours, and previous experiences with smoking cessation medications.

Aims: The aim of this review is to evaluate smoking cessation outcomes from published randomised controlled trials that have attempted to improve the efficacy and tolerability of varenicline through modifying its dosage regimen compared to placebo.

Methods: A systematic search of the literature up to June 2016 was conducted to identify randomised controlled trials, where varenicline was administered in a regimen not consistent with the current clinical guidelines. Outcome measures evaluated included continuous abstinence rates, changes in cravings, withdrawal symptoms, smoking behaviours, adverse event rates, and premature therapy discontinuations.

Results: Ten randomised controlled trials, encompassing four different modifications to standard varenicline therapy, matched the eligibility criteria. Modifications such as the extended duration of therapy and the use of a flexible quit date were effective compared to placebo and have been implemented into some clinical guidelines, whereas other modifications do not appear to produce any benefit for smokers, or require further research to ascertain their suitability for clinical practice.

Conclusions: Some varenicline therapy modifications may lead to improvements in efficacy and tolerability. Further research on the effect of modifications such as daily doses higher than 2mg, tapering doses, and the use of extended pre-quit varenicline may advance varenicline therapy outcomes.

Introduction: Text-message-based interventions hold great potential for intervention and are increasingly feasible, given advances in information technology.

Aims: This pilot randomized controlled trial (RCT) aims to compare the efficacy of self-versus expert-authored content delivered via text-messaging for smoking cessation.

Methods: Sixty-two participants aged 25–66 attended laboratory sessions pre- and post-30 days of text-messaging intervention. Participants were randomised to one of two experimental conditions – self-authorship (SA) only and SA with implementation intentions (SA+ii) – or active control. Participants composed 30–60 brief motivational cessation messages for use during their cessation attempt. SA+ii participants were further instructed to anticipate obstacles and form simple if-then plans to overcome them. Experimental groups received their self-authored texts during the intervention phase, whereas control participants received expert-authored messages.

Results: Overall, smoking decreased as measured by change in exhaled carbon monoxide (CO), F(1,59) = 4.43, p = 0.04. The SA+ii group showed slightly greater CO reduction (M = 3.63, SD = 5.39) than control (M = 0.03, SD = 5.80; t(40) = 2.08, p = 0.04). SA alone (M = 1.97, SD = 9.30) was not more effective than control.

Conclusions: SA does not appear to increase efficacy. However, this pilot supports prior research, indicating that text-based interventions can increase smoking cessation success and may decrease psychological symptoms of withdrawal. Much research is needed to identify ways to bolster intervention efficacy.