Background. Tobacco use is a significant health concern in Southeast Asia, particularly in Bangladesh, where the greatest incidence of tobacco consumption occurs in a number of forms smoking, smokeless, and indigenous. The WHO Framework Convention on Tobacco Control (FCTC) requires tobacco product packaging to include adequate health warnings (text and visual). The study’s objective is to investigate the effects of graphic health warnings on tobacco packs among Bangladeshi low socioeconomic groups. Study Design. Cross-sectional study. Methods. The study was conducted with 400 participants (low socioeconomic people) by using the systematic sampling technique through a semistructured questionnaire in Demra and Tongi industrial areas of Dhaka city in Bangladesh during September 2019-November 2020. Descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential analysis (i.e., chi-square tests) were performed by Statistical Package for Social Sciences (SPSS version 25.0) to explore the relationship between the graphic warning and the use of tobacco. Results. This study illustrates that 89% of respondents smoke only cigarette or bidi, where 95.1% were daily smokers. About 72.2% reported pictorial warning message was more understandable while 90.8% reported the existing text warnings explicitly visualize the health harms. It has been found that there was a significant association between the respondent’s opinion on the text warning that encouraged the respondent to quit tobacco use and the text messages “smoking causes throat and lung cancer” (p < 0.001) and “smoking causes respiratory problems” (p < 0.001). Around 96.7% knew about the graphic health warnings on the cigarette packets where 99.2% reported graphic warning explicitly visualizes the health harms. In graphical warnings, text messages have a great influence on quitting smoking where “smoking causes throat and lung cancer” (p < 0.001) and “smoking causes stroke” (p < 0.001). Nearly 79.2% of respondents thought the color of the graphic warning should be “Red” and a significant association between the color and the education level of the respondents explored here (p < 0.05). Conclusions. GHWs are more understandable on tobacco packets, and it has significant impacts on being aware of health consequences from tobacco consumption.

Background. Persons with HIV (PWH) smoke cigarettes at much higher rates than the general population in the US, and smoking is now the leading cause of death in US PWH. Efforts to control the tobacco use epidemic in PWH have met with limited success, and the factors associated with successful cessation are not well delineated. There is a particular dearth of knowledge regarding PWH ex-smokers who have successfully quit smoking cigarettes for the long term. Methods. We pooled data from three separate sources of PWH smokers and ex-smokers (reporting complete abstinence for ≥ one year with biochemical verification at the time of data collection) from New York City, collected sociodemographic and behavioral information from them in structured interviews, and obtained their DNA samples. Univariate and rigorous multivariate analytic strategies were employed to determine the sociobehavioral and genetic factors that distinguished PWH smokers from ex-smokers. Results. We compared 142 current/recent smokers to 52 biochemically confirmed ex-smokers. The mean age of the participants was 53.3 ± 9.9 years, 49.5% were female, and 76.3% were Black/African American. Successful quitters had significantly lower anxiety scores and were less likely to report hazardous alcohol use or to use marijuana or cocaine. On multivariate analysis utilizing a conservative analytic approach, of 156 single nucleotide variants (SNV) within 12 a priori candidate genes, only the 37148248 T->C variant of gene SLC25A21 on chromosome 14 was associated with long-term cessation. Conclusions. In this study, we report behavioral variables associated with long-term abstinence in PWH ex-smokers, and we also report the first genetic correlation of successful cessation in a PWH population yet described.

Objectives. To investigate the effectiveness of a smoking cessation program (FINE program) in community pharmacies. Methods. A cluster-randomized controlled trial was conducted in 11 community pharmacies in Japan. The participants were randomly assigned to a pharmacist-led structured smoking cessation program (intervention group) or pharmacist-led usual care (control group). The intervention group was followed up over the telephone on the third day of smoking cessation, and ongoing follow-up and advice were provided according to the original smoking cessation guidebook developed for the current study based on a behavioral change approach. The control group received brief advice and ready-made pamphlets on smoking cessation from pharmacists upon their visit to these community pharmacies. The primary outcome was continued smoking cessation as determined by self-reporting and carbon monoxide monitoring with a microsmokerlyzer after 3 months. Results. Five hundred and seventy-two smokers who met the eligibility criteria visited the pharmacies included in the study. Of these individuals, 24 patients agreed to participate in the study. The quit rates were 45.5% and 18.2% in the intervention and control groups, respectively (P = 0.380, effect size = 0.60). Conclusion. Based on the effect size values, the FINE program may be effective to some extent, but the difference was not significant. We speculate that this is related to the small sample size due to difficulty in recruiting. Further studies with an effective recruitment method and larger sample sizes are needed to accurately verify the effectiveness of this program.

Background. With over 25 million tobacco users, Pakistan has one of the largest smoking populations in the world. Tobacco addiction comes with grave health consequences, especially for the poor and marginalized. Objective. This study explores barriers to smoking cessation in marginalized communities of Islamabad and the possibility of their use of Harm Reduction Products (HRPs), primarily e-cigarettes. Methodology. The study has used primary data of 48 respondents from marginalized communities. Several domains have been employed to evaluate the barriers to smoking cessation in these communities. Using qualitative technique, data was organized and categorized into objective themes. Conclusion. The experience of combustible smoking usually occurs in the 10-20 years’ age bracket. Regular smokers in marginalized areas of Islamabad smoke 20 cigarettes or a pack per day. Their choice of cigarette brand is largely driven by affordability. Most smokers have made at least one attempt to quit smoking. Peer pressure and friendship are major barriers to smoking cessation. Lack of knowledge seems to be the major reason for not seeking medical assistance for quitting smoking. Knowledge about HRPs, especially e-cigarettes, can best be described as vague. Higher prices of the alternatives to combustible smoking are a major hurdle preventing their use for smoking cessation.

Introduction. Recent research has established a link between childhood abuse and later drug abuse. For waterpipe smoking (WPS), such a role has not been adequately clarified. Aims. To explore the mediating effect of resilience and mindfulness on the association between childhood abuse and current WPS among college students. Methods. A cross-sectional study was conducted among a consecutive sample (n = 776) of college students in Kerman, Iran. The Adverse Childhood Experiences Abuse Short Form, the 14-item Resilience Scale, and the Freiburg Mindfulness Inventory were used. Structural equation modeling was used to examine the complex associations between variables. Results. Nearly 95% of participants were aged between 18 and 27 years, and the mean (SD) age of students was 22.2 (3.1). Most of them were single (84.4), and 52.7% were female. Prevalence of lifetime and current WPS among students was 49.6% and 33.4%, respectively. Less than one-third (n = 228) of lifetime users first tried smoking by the age of 18. The risk of current WPS was significantly higher in males than females (β = 0.25, P < 0.001). Childhood abuse was directly associated with current WPS (β = 0.20, P < 0.001) and resilience (β = −0.12, P < 0.05). Adverse childhood experiences were also indirectly (mediated by the effect of the resilience, path coefficient = 0.06, P < 0.001) associated with the risk of WPS. No relationship was seen between trait mindfulness and current WPS (β = −0.02, P = 0.393). Resilience was negatively associated with current WPS (β = −0.47, P < 0.001). Conclusion. The study revealed the potential importance of childhood abuse and low resilience as risk factors precipitating the onset of WPS. Further studies are warranted to examine the implications of this study for quitting WPS.

Introduction. Individuals with psychotic-spectrum disorders may smoke due to the ameliorating effect of nicotine on the cognitive deficits that accompany these illnesses. Metacognitive remediation therapy (MCR) has been shown to produce improvements in cognitive functioning among individuals with psychotic-spectrum disorders and provides a foundation for a novel smoking cessation intervention for this population. Aims. To complete an open investigation of pharmacotherapy and a modified version of MCR [MCR to Quit (MCR-Q)] in promoting smoking cessation among individuals with psychotic-spectrum disorders. Methods. Forty-nine individuals with a psychotic-spectrum disorder and who currently smoke cigarettes participated in MCR-Q while also receiving evidence-based smoking cessation pharmacotherapy. Tobacco use was assessed as follows: (i) prior to MCR-Q, (ii) immediately after completing MCR-Q, and (iii) six weeks after completion of MCR-Q. Results/Findings. During participation in MCR-Q, nearly 80% of participants made a 24-hour quit attempt. Following the completion of MCR-Q, participants experienced reductions in level of nicotine dependency and exhaled carbon monoxide, with reductions in nicotine dependency sustained six weeks after completion of MCR-Q. Over the course of their participation in MCR-Q, participants reported strong therapeutic alliance with their MCR-Q therapist and high levels of intrinsic motivation with regard to completing MCR-Q exercises. Conclusions. The results from the current study suggest cautious optimism with regard to the use of MCR-Q in combination with medication for individuals with psychotic-spectrum disorders who want to quit smoking.

The pharmacological therapy for smoking cessation recommended by National Institute for Health and care Excellence (NICE) guidelines is nicotine replacement therapy such as gum, inhalator, lozenge, nasal spray, oral spray, sublingual tablet, and transdermal patch. Medications such as bupropion and varenicline are also used. Varenicline is the only established drug used to alleviate symptoms of craving as it acts as a partial nicotine agonist. Galantamine has a similar mechanism of action where it is an acetylcholinesterase inhibitor and nicotinic receptor agonist. However, varenicline is the only recommended drug. There are not many studies to illustrate the effectiveness of galantamine for smoking cessation. This article explores the possibility of potential use of galantamine in alleviating the symptoms of nicotine withdrawal.

Purpose. To determine the percentage of parents who report quitting spontaneously and examine the factors associated with these quits. Methods. As part of a cluster randomized control trial addressing parental smoking in a pediatric outpatient setting, 12-month follow-up survey data were collected from parents who had self-identified as smokers when exiting from 10 control practices. Parents were considered to have made a spontaneous quit if they reported not smoking a cigarette, even a puff, in the last 7 days and chose the statement “I did not plan the quit in advance; I just did it” when describing how their quit attempt started. Results. Of the 981 smoking parents enrolled at baseline, 710 (72%) completed the 12-month follow-up. Of these, 123 (17%) reported quitting, of whom 50 (41%) reported quitting spontaneously. In multivariable analysis, parents who reported smoking on some days vs. every day (OR 3.06 (95% CI 1.42, 6.62)) and that nobody had smoked in their home/car vs. someone had smoked in these settings in the past 3 months (OR 2.19 (95% CI 1.06, 4.54)) were more likely to quit spontaneously. Conclusions. This study shows that, of parents who quit smoking, a substantial percentage report quitting spontaneously and that intermittent smoking and smoke-free home/car policies are associated with reports of quitting spontaneously. Promoting smoke-free home/car policies, especially when parents are not willing to make a plan to quit smoking, might increase the likelihood that parents decide to quit without advance planning. Pediatric healthcare providers are uniquely positioned to use the child’s visit to motivate parents to quit smoking and eliminate their child’s exposure to tobacco smoke, regardless of the frequency of smoking or a readiness to plan a quit attempt. Clinical Trial Registration. This trial is registered with NCT01882348.

Smoking-related diseases (e.g., lung cancer) are the leading cause of mortality in HIV-infected patients. While many PLWH who smoke report a desire to quit, a majority of them have low readiness to quit. This study used logistic and linear regression to examine the relations among two (continuous vs. binary) measures of readiness to quit, smoking cessation self-efficacy (SE), quality of life (QoL), and perceived vulnerability (PV) using baseline data from 100 PLWH who smoke who participated in a clinical trial. Results showed no significant main effects (SE, QoL, and PV) or interaction effects (SE × QoL and SE × PV) on a continuous measure of readiness to quit. However, a follow-up analysis revealed that SE had a curvilinear effect on readiness to quit such that self-efficacy was positively associated with readiness to quit except at the highest levels of self-efficacy where readiness to quit declined. Greater SE significantly increased the likelihood of reporting readiness to quit (yes/no) among those with low QoL or high PV. For PLWH who smoke, improving self-efficacy may increase readiness to quit especially among those with lower quality of life. Psychoeducation tailored to PLWH designed to reduce unrealistic invulnerability to smoking-related diseases along with interventions that target self-efficacy may improve readiness to quit.

Introduction. Smoking prevalence is disproportionately high among Asian American immigrant men with limited English proficiency. Understanding the role of family support may provide insights into culturally acceptable strategies to promote smoking cessation. Aims. This study examined how family support was associated with readiness to consider smoking cessation among Chinese and Vietnamese American male daily smokers. Methods. We analyzed baseline data (N = 340) from a cluster randomized trial of a family-based healthy lifestyle intervention. We assessed the frequency of receiving family support in various forms (encouraging use of cessation resources, praising efforts, checking in, and reminding of familial role). Multiple regression analysis was used to determine associations between family support areas and readiness to consider smoking cessation, controlling for covariates. Results/Findings. Reporting a higher frequency of receiving praise and encouragement for one’s efforts to quit was positively associated with readiness to consider cessation. Other areas of family support were not significant. Conclusions. These findings provide evidence to explore specific areas of family support in enhancing Asian American smokers’ readiness to consider cessation. As there is high interest from Asian American family members to support their smokers for quitting, culturally specific and acceptable strategies are needed to promote smoking cessation among Asian Americans.

Background. Bladder cancer (BC) is the second most reported cancer in Lebanon and the fifth in Jordan. Its risk factors are mainly smoking and occupational exposure to aromatic amines. In these countries where smoking and bladder cancer are highly prevalent, the role of waterpipe smoking (WPS) in bladder cancer is less investigated. We aim to compare two sets of patients between Lebanon and Jordan, focusing on their smoking habits, WP use, occupational exposure, and the grade/invasiveness of their bladder cancer. Methods. This is a cross-sectional study that compares the smoking culture between two sets of populations with bladder cancer, from two different countries. We recruited 274 bladder cancer patients over the 18 years of age at the American University of Beirut Medical Center (AUBMC), and 158 bladder cancer patients over the age of 18 years at the King Hussein Cancer Center (KHCC). Results. 7.7% of Lebanese patients had significantly more positive family history of bladder cancer compared to 13.9% of Jordanian patients (p = 0.045). Another significant finding is that the majority of Lebanese patients 70.7% reported being frequently exposed to secondhand smoking, mainly cigarettes, versus only 48.6% of Jordanian patients (p < 0.001). The increasing smoking trend among Lebanese females is remarkably the highest in the region, which contributed to the overall increase in smoking rates in the country. 17.1% of the Lebanese smoking patients are mainly but not exclusively WP smokers of which 6.3% are daily WP smokers, similarly 17.1% of the Jordanian patients of which 3.2% are daily WP smokers. There were 71.5% of Lebanese patients who had a noninvasive BC versus 40% of Jordanian patients (p < 0.001), and more than one-third reported an occupational exposure to one of the risk factors of BC in both groups. Conclusions. Bladder cancer incidence is on the rise in both Jordan and Lebanon along with different smoking types. It is necessary to impose prevention policies to prevent and control the high smoking prevalence. Bladder cancer invasiveness is higher in Jordan compared to universal data.

Objective. Environmental factors, such as household smoking restrictions (HSR), may impact a range of smoking-related outcomes. The current study examined the effects of various levels of HSR on smoking behaviors, including the number of cigarettes smoked per day and levels of nicotine dependence in a population of adult smokers. (1) Having specific HSR reduces the urges to smoke (path A); (2) having specific HSR reduces CPD (path B); (3) having specific HSR results in lower overall nicotine addiction (path C), and later, TTFC will be associated with (4) lower urges to smoke in the morning (path A’), (5) fewer CPD (path B’), and (6) lower levels of nicotine addiction (path C’). Method. Regression models using self-reported data from the Pennsylvania Adult Smoking Study (N = 353) were used. TTFC was measured minutes between waking and the first cigarette of the day. Household smoking restrictions were measured as follows: (1) full ban on smoking in the home, (2) partial ban, or (3) no ban. Results. Subjects with no household smoking restrictions had lower incomes and education than those with at least some household smoking restrictions; those with full bans smoked less and had an earlier TTFC than those with at least some household smoking restrictions. Smokers with a full ban had a later TTFC, mediated by fewer cigarettes per day and lower cravings. Among those with partial bans, there is no reduction in cigarettes per day and an increase in urges to smoke. Conclusions. Partial household smoking restrictions are no better than no household smoking restrictions with regard to cigarettes per day and TTFC, and may cause an increase in urges to smoke in the morning.

Introduction. We evaluate whether a combination of financial incentives and deposit contracts improves cessation rates among low- to moderate-income smokers. Methods. We randomly assigned 311 smokers covered by Medicaid at 12 health clinics in Connecticut to usual care or one of the three treatment arms. Each treatment arm received financial incentives for two months and either (i) nothing further (“incentives only”), (ii) the option to start a deposit contract with incentive earnings after the incentives ended (“commitment”), or (iii) the option to precommit any earned incentives into a deposit contract starting after the incentives ended (“precommitment”). Smoking cessation was confirmed biochemically at two, six, and twelve months. Results. At two, six, and twelve months after baseline, our estimated treatment effects on cessation are positive but imprecise, with confidence intervals containing effect sizes estimated by prior studies of financial incentives alone and deposit contracts alone. At two months, the odds ratio for quitting was 1.4 in the incentive-only condition (95% CI: 0.5 to 3.5), 2.0 for incentives followed by commitment (95% CI: 0.6 to 6.1), and 1.9 for incentives and precommitment (95% CI: 0.7 to 5.3). Conclusions. A combined incentive and deposit contract program for Medicaid enrollees, with incentives offering up to $300 for smoking cessation and use of support services, produced a positive but imprecisely estimated effect on biochemically verified cessation relative to usual care and with no detectable difference in cessation rates between the different treatment arms.

Introduction. An increasing number of parents use both e-cigarettes and cigarettes (dual users). Previous studies have shown that dual users may have higher rates of contemplating smoking cessation than parents who only smoke cigarettes. This study was aimed to assess the delivery of tobacco cessation treatment (prescription for nicotine replacement therapy and referral to the quitline) among parents who report being dual users vs. cigarette-only smokers. Methods. A secondary analysis of parent survey data collected between April and October 2017 at 10 pediatric primary care practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was conducted. Parents were considered to be dual users of cigarettes and e-cigarettes if they reported smoking a cigarette, even a puff, in the past seven days and using an e-cigarette within the past 30 days. Parents were asked if they received a prescription for nicotine replacement therapy and referral to the quitline to help them quit from their child’s clinician. Multivariable logistic regression examined factors (dual use, insurance status, relationship to the child, race, and education status of the parent) associated with delivery of smoking cessation treatment (receiving prescriptions and/or enrollment in quitline) to smoking parents. Further, we compared the rates of tobacco cessation treatment delivery to dual users in the usual-care control practices vs. intervention practices. Results. Of 1007 smokers or recent quitters surveyed in the five intervention practices, 722 parents reported current use of cigarettes-only and 111 used e-cigarettes. Of these 111 parents, 82 (73.9%) reported smoking cigarettes. Parents were more likely to report receiving any treatment if they were dual users vs. cigarette-only smokers (OR 2.43, 95% CI 1.38, 4.29). Child’s insurance status, parents’ sex, education, and race were not associated with parental receipt of tobacco cessation treatment in the model. No dual users in the usual-care control practices reported receiving treatment. Discussion. Dual users who visited CEASE intervention practices were more likely to receive treatment than cigarette-only smokers when treatments were discussed. An increased uptake of tobacco cessation treatments among dual users reinforces the importance of discussing treatment options with this group, while also recognizing that cigarette-only smokers may require additional intervention to increase the acceptance rate of cessation assistance. This trial is registered with ClinicalTrials.gov, Identifier: NCT01882348.

Objective. To investigate the knowledge and practice of tobacco cessation and counseling (TCC) among dental practitioners and their attitude and perceived barriers. Methods. A cross-sectional study targeted licensed dental practitioners in Jeddah, Saudi Arabia. Participants answered a pretested and validated self-administered questionnaire consisted of demographic data; smoking status; knowledge of tobacco hazards, attitude, and practice; and perceived barriers of tobacco cessation counseling. Result. Among the total sample of 529, response rate was 72.2% (mean age (34.20 ± 9.38 years), males (42.4%), and current smokers (23.8%)). Only 13.2% received formal training on TCC. Around (57.1%) reported smoking of dental team as an obstacle for TCC. Half of the participants (49.9%) reported patient’s resistance as barrier to TCC. Others (45%–48%) reported insufficient time, knowledge, or training for TCC. Professional responsibility and willingness to provide cessation services constituted the highest median. Conclusion. The majority showed willingness to participate in TCC. Lack of training, smoking status of providers, females, inadequate materials, and patients’ resistance were the most common barriers. Education and training on TCC are recommended and should be allowed as a routine practice in dentistry.

Introduction. The 5As model is a standard component of most guidelines for tobacco treatment. Unfortunately, provider adherence to this model is modest. Aims. Providing physicians with adjunctive tools to adhere to 5As guidelines may serve as a catalyst for brief advice delivery. Methods. This was a secondary data analysis of a cluster randomized clinical trial assessing the uptake and impact of free nicotine replacement therapy (NRT) sampling versus standard care in primary care. Patients reported receipt of separate elements of the 5As model, assessed one month following a baseline visit. Analyses compared patients who recalled receipt of brief advice among those who received NRT vs. standard care. Additional analyses examined demographic predictors of receiving brief advice. Results/Findings. Medication sampling did not improve compliance with ask, advise, or assess. Receipt of “assistance” was significantly higher among NRT recipients (70%) (p ≤ 0.0001). The NRT sampling group was more likely to have received all components (p = 0.004). As age increased, being asked (p = 0.006), advised (p = 0.05), and assessed (p = 0.003) decreased. Non-Whites reported higher rates of assessment (p = 0.02). Conclusions. Provision of NRT sampling increased provider compliance with some elements of the brief advice model, thus enhancing the impact of cessation advice within primary care. Trial Registration. This trial is registered with ClinicalTrials.gov NCT02096029.

Introduction. Those coping with significant mental illness smoke at a high prevalence rate. Increasingly, behavioral health clinicians (BHCs) are being asked to provide tobacco-dependence interventions. In this context, it is important to measure their success at doing so. While the Working Alliance Inventory (WAI) is a well-established measurement of the effectiveness of therapeutic alliance, it is not specific to tobacco-dependence interventions. The Working Alliance Inventory for Tobacco (WAIT-3) has been found valid for tobacco cessation counselors (health providers who address tobacco), but its validity has not been established when BHCs address tobacco cessation as part of addressing all other needs of their patients. The purpose of this study was to examine the validity of the WAIT-3 in the context of behavioral health clinicians. Methods. Wisconsin Community Support Programs and Comprehensive Community Services programs distributed an anonymous, brief (14 items) survey to 1,930 of their clients. Measured variables included smoking status, behavioral intentions regarding quitting, and perception of help received from their clinic. Respondents could enter a chance to win a gift card as a thank you. Results. WAIT-3 scores were correlated with quitting-related variables. Compared to those with lower WAIT-3 scores, those with higher scores reported more attempts to quit, were more motivated to quit, were more likely to have a smoking cessation/reduction goal in their general treatment plan, had more conversations about quitting with their BHC, and wanted more help from their BHC to quit. Conclusions. The WAIT-3 may be a valid way to measure the effectiveness of BHCs to address the tobacco use of their patients. Next steps include establishing its predictive validity.

In addition to traditional smoking cessation methods like nicotine replacement therapy (NRT), new methods such as mobile applications and e-cigarettes have been added to the toolbox. The purpose of this study was to examine which methods smokers currently use in quit or reduction attempts and map characteristics of users of the various methods. In this study, participants were smokers who visited a website or called a quit line for smoking cessation and who were currently in quit or reduction attempts (N = 740). Data were collected in Norway in 2013–2017 through a web survey. Most smokers were currently trying to quit, and the most frequently used methods were a smoking cessation app for mobile phones, nicotine replacement therapies (NRTs), and e-cigarettes. Logistic regression analyses identified older daily smokers with high cigarette consumption as NRT users, while the users of a cessation app were younger females. The use of e-cigarettes was associated with older, low educated smokers with low cigarette consumption. The use of the mobile phone app was associated with having made several recent quit attempts. The study provides insight into help-seeking smokers’ preferences for smoking cessation methods and user characteristics. This knowledge is relevant for further work in smoking cessation planning and policies.

Introduction. It is critical to accurately identify individuals who continue to smoke even after treatment, as this may prompt the use of more intensive and effective treatment strategies to help them attain complete abstinence. Aims. This study examined optimal cutoffs for exhaled carbon monoxide (CO) and salivary cotinine to identify smokers among Korean Americans in a smoking cessation clinical trial. Methods. CO and cotinine were measured three to four times over 12 months from the quit day. Statistical analysis was conducted using Receiver Operating Characteristic (ROC) curves. Results. A CO cutoff of 5 parts per million provided robust sensitivity (80.8-98.3%) and perfect specificity (100%), and a salivary cotinine cutoff of level 2 (30-100 ng/ml) provided the best sensitivity (91.2-95.6%) and perfect specificity (100%). Using these cutoffs, the agreement between self-reports and the two biomarkers ranged from 88.6% to 97.7%. The areas under ROC curves (AUCs) of exhaled CO ranged from 0.90 to 0.99, all of which were significant (all p values < 0.001), and the AUCs of salivary cotinine ranged from 0.96 to 0.98 (all p values < 0.001). Conclusion. Exhaled CO and salivary cotinine are complementary, and they should be used together to verify smoking abstinence for smokers in a clinical trial.

Tobacco smoking has a significant role in health deterioration worldwide; it can lead to many dangerous diseases. Tobacco smoking among medical students is common worldwide, but the prevalence and determinants vary from one community to another. Data from medical students in Saudi Arabia is limited. This study was conducted to estimate the prevalence and determinants of smoking among medical students at the College of Medicine, Jazan University, Saudi Arabia. A cross-sectional study using a self-administered electronic survey was conducted to estimate tobacco smoking’s prevalence and characteristics among medical students at Jazan University. The survey includes information on the gender, academic year, academic performance, type of tobacco smoking, and age of onset of the participants’ tobacco smoking. Other data, like the prevalence of passive smoking and social factors, were considered, too. The sample size was 354, 51.7% males and 48.3% females, students with a response rate of 38.02%. The prevalence of smoking among medical students was 12.4%, while passive smoking prevalence was 39.9% of all medical students. The research shows that 18.6% of male and 5.9% of female medical students were active smokers. Regarding the type of tobacco, we found that 47% of male smokers used waterpipe, while the percentage among female smokers using waterpipe reached 77.8%. The age of onset of smoking for 34.9% of the smokers was between 18 and 21 years old. The prevalence of smoking is inversely proportional to the GPA. Additionally, 71.1% of the smokers did not have a smoker friend, and only 13.3% of the smokers were motivated to quit. University age is critical for smoking habits, and the smoking cessation rate was low. More campaigns should be done in universities to increase smoking cessation awareness, and smoking cessation clinics should be activated at universities.