Globally, India is the second largest consumer of tobacco. However, Indian medical students do not receive adequate training in smoking cessation counseling. Each patient hospitalization is an opportunity to counsel smokers. Medical Student Counseling for Hospitalized patients Addicted to Tobacco (MS-CHAT) is a 2-arm multicenter randomized controlled trial (RCT) that compares the effectiveness of a medical student-guided smoking cessation program initiated in inpatients and continued for two months after discharge versus standard hospital practice. Current smokers admitted to the hospital are randomized to receive either usual care or the intervention. The intervention group receives inpatient counseling and longitudinal postdischarge telephone follow-up by medical students. The control group receives counseling at the discretion of the treating physician. The primary outcome is biochemically verified 7-day point prevalence of smoking cessation at 6 months after enrollment. Changes in medical student knowledge and attitude will also be studied using a pre- and postquestionnaire delivered prior to and 12 months after training. This trial tests a unique model that seeks to provide hands-on experience in smoking cessation counseling to medical students while simultaneously improving cessation outcomes among hospitalized smokers in India.

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.

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.

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.

Introduction. Activities promoting research reproducibility and transparency are crucial for generating trustworthy evidence. Evaluation of smoking interventions is one area where vested interests may motivate reduced reproducibility and transparency. Aims. Assess markers of transparency and reproducibility in smoking behaviour change intervention evaluation reports. Methods. One hundred evaluation reports of smoking behaviour change intervention randomised controlled trials published in 2018-2019 were identified. Reproducibility markers of pre-registration; protocol sharing; data, material, and analysis script sharing; replication of a previous study; and open access publication were coded in identified reports. Transparency markers of funding and conflict of interest declarations were also coded. Coding was performed by two researchers, with inter-rater reliability calculated using Krippendorff’s alpha. Results. Seventy-one percent of reports were open access, and 73% were pre-registered. However, there are only 13% provided accessible materials, 7% accessible data, and 1% accessible analysis scripts. No reports were replication studies. Ninety-four percent of reports provided a funding source statement, and eighty-eight percent of reports provided a conflict of interest statement. Conclusions. Open data, materials, analysis, and replications are rare in smoking behaviour change interventions, whereas funding source and conflict of interest declarations are common. Future smoking research should be more reproducible to enable knowledge accumulation. This study was pre-registered: https://osf.io/yqj5p.

Introduction. Intervention fidelity concerns the degree to which interventions are implemented as intended. Fidelity frameworks propose fidelity is a multidimensional concept relevant at intervention designer, provider, and recipient levels; yet the extent to which it is assessed multidimensionally is unclear. Smoking cessation interventions are complex, including multiple components, often delivered over multiple sessions and/or at scale in clinical practice; this increases susceptibility variation in the fidelity with which they are delivered. This review examined the extent to which five dimensions from the Behaviour Change Consortium fidelity framework (design, training, delivery, receipt, and enactment) were assessed in fidelity assessments of smoking cessation interventions (randomised control trials (RCTs)). Methods. Five electronic databases were searched using terms “smoking cessation,” “interventions,” “fidelity,” and “randomised control trials.” Eligible studies included RCTs of smoking cessation behavioural interventions, published post 2006 after publication of the framework, reporting assessment of fidelity. The data extraction form was structured around the framework, which specifies a number of items regarding assessment and reporting of each dimension. Data extraction included study characteristics, dimensions assessed, data collection, and analysis strategies. A score per dimension was calculated, indicating its presence. Results. 55 studies were reviewed. There was a wide variability in data collection approaches used to assess fidelity. Fidelity of delivery was the most commonly assessed and linked to the intervention outcomes (73% of the studies). Fidelity of enactment scored the highest according to the framework (average of 92.7%), and fidelity of training scored the lowest (average of 37.1%). Only a quarter of studies linked fidelity data to outcomes (27%). Conclusion. There is wide variability in methodological and analytical approaches that precludes comparison and synthesis. In order to realise the potential of fidelity investigations to increase scientific confidence in the interpretation of observed trial outcomes, studies should include analyses of the association between fidelity data and outcomes. Findings have highlighted recommendations for improving fidelity evaluations and reporting practices.

Introduction. Smoking cessation after a cancer diagnosis can significantly improve treatment outcomes and reduce the risk of cancer recurrence and all-cause mortality. Aim. We sought to measure the association between cancer diagnosis and subsequent smoking cessation. Methods. Data was sourced from the Population Assessment of Health and Tobacco (PATH) study, a representative population-based sample of United States adults. Our analytic sample included all adult smokers at Wave I, our baseline. The exposure of interest was either a tobacco-related cancer diagnosis, nontobacco-related cancer diagnosis, or no cancer diagnosis (the referent) reported at Wave II or III. The primary outcome was smoking cessation after diagnosis, at Wave IV. Results/Findings. Our sample was composed of 7,286 adult smokers at the baseline representing an estimated 40.9 million persons. Smoking cessation rates after a diagnosis differed after a tobacco-related cancer (25.9%), a nontobacco-related cancer (8.9%), and no cancer diagnosis (17.9%). After adjustment, diagnosis with a tobacco-related cancer was associated with a higher odds of smoking cessation (OR 1.83, 95% CI 1.00-3.33) compared to no cancer diagnosis. Diagnosis with a nontobacco-related cancer was not significantly linked to smoking cessation (OR 0.52, 95% CI 0.48-1.45). Conclusion. Diagnosis with a tobacco-related cancer is associated with greater odds of subsequent smoking cessation compared to no cancer diagnosis, suggesting that significant behavioral change may occur in this setting.

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.

Introduction. Behavioural counselling is an effective method to improve smoking cessation during pregnancy. Audio recordings of consultations have been used previously to assess fidelity in specialized smoking cessation services, but not in primary care. Aims. The study is aimed at assessing the feasibility of audio-recording smoking cessation counselling as part of an intervention in primary care settings and exploring the number and type of behaviour change techniques (BCTs) delivered. Methods. This study was a nested feasibility study within a larger trial. Health providers (HPs) and pregnant women were asked to agree or decline audio recording their smoking-related consultations. Data collected included percentage providing consent, number of recordings performed, HP type, and date (pre/post intervention). Interviews were conducted to assess the trial procedures’ acceptability. Results. Two services provided seven recordings, all pre-intervention. Of the 22 recruited women, 14 consented to being audio recorded (64%) and five provided recordings; of the 23 recruited HPs, 16 agreed (69%), and two provided recordings. Qualitative data suggest that HPs found audio recording difficult to remember. HPs spent on average two minutes discussing smoking and used few BCTs. Conclusions. Audio recordings of smoking-related counselling were not feasible as planned. Future research will need to explore acceptable methods to assess BCT use in primary care.

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.

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.

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.

We discuss the most recent changes in smoking policies and support for smoking cessation offered to smokers at US workplaces. We used reports of employed adults (n = 112,008) regarding smoking restrictions and support for smoking cessation offered at their indoor workplaces from the 2010–11 and 2014–15 Tobacco Use Supplement–Current Population Survey. The percentage of adults who reported having workplace smoking restrictions was 94% in 2010–11 and 93% in 2014–15 (P = 0.001). There was a decrease in the Northeastern region (P < 0.001) and no significant changes in the other three US regions. The percentages decreased in Hawaii, New York, Oregon, Pennsylvania, and Tennessee and increased in Indiana, Nebraska, and Wyoming. The percentage of employees who reported having workplace support for smoking cessation increased from 24% to 29% (P < 0.001), which was uniform across all US regions but differed across the US states. The percentages decreased in Hawaii and increased in the majority of states. Analysis of smokers' reports (versus all reports) resulted in lower percentages of workplaces with smoking restrictions and support for smoking cessation. It is essential to further enhance support for smoking cessation offered to smokers at US workplaces.

Introduction: We have undertaken four online surveys of Stop Smoking Service (SSS) practitioners in England, between 2011 and 2016, in order to enhance our understanding of e-cigarettes: a fast moving new phenomenon. It is important to understand whether e-cigarettes can ameliorate or exacerbate health inequalities given that smoking is one of the most serious causes of excessive mortality and morbidity among disadvantaged groups globally.

Aims: To update findings of previous surveys and examine socioeconomic status differences in e-cigarette use and efficacy.

Methods: Analysis was undertaken of electronic surveys, particularly, the most recent 2016 survey (n = 514) and 2015/16 SSS client routine monitoring data.

Results: SSS practitioners were becoming more positive about e-cigarettes: 42% agreed that e-cigarettes were a good thing compared with 15% in 2011. Reported use of e-cigarettes among SSS clients was low (about 3%) despite higher quit rates (63% of clients reported being quit at four week follow-up, compared with 51% overall). Where socioeconomic differences in e-cigarettes’ efficacy for quitting were identified, affluent and working smokers were advantaged.

Conclusions: Low use of e-cigarettes by clients and practitioner opinions suggest that further education of SSS staff is needed if they are to adopt the current service recommendations about e-cigarettes.

This study examined the role of social support and behavioural interventions used during the last unsuccessful quit attempt for smokers’ intentions to quit smoking within the next six months, and identified smokers’ attributes associated with the use of social support and behavioural interventions. The analytic sample included 7,195 adult daily smokers who responded to the 2010–2011 Tobacco Use Supplement to the Current Population Survey, conducted in the United States, and indicated having a serious quit attempt in the past 12 months. Smokers who relied on social support from friends and family had higher odds of intending to quit than those who did not (OR = 1.39, 95% CI = 1.22:1.58), and smokers who used interventions had higher odds of intending to quit than those who did not (OR = 1.36, 95% CI = 1.07:1.74). These associations were similar for both sexes, all age groups, and nicotine dependence levels. Both, relying on social support and the use of behavioural interventions were more common among smokers who were female, higher educated, residing in the Western US region, and those who used pharmacological aids for smoking cessation. Social support and behavioural interventions are associated with higher intentions to quit among attempters who relapsed and thus, may aid future smoking cessation.

Introduction: There is wide variation in the success rates of practitioners employed to help smokers to stop, even once a range of potential confounding factors has been taken into account.

Aim: This paper examined whether personality characteristics of practitioners might play a role success rates.

Methods: Data from 1,958 stop-smoking treatment episodes in two stop-smoking services (SSS) involving 19 stop-smoking practitioners were used in the analysis. The outcome measure was clients’ biochemically verified quit status 4 weeks after the target quit date. The five dimensions of personality, as assessed by the Ten-Item Personality Inventory, were included as predictor variables: openness, conscientiousness, agreeableness, extraversion, and neuroticism. A range of client and other practitioner characteristics were used as covariates. A sensitivity analysis was conducted to determine if managers' ratings of practitioner personality were also associated with clients’ quit status.

Results: Multi-level random intercept models indicated that clients of practitioners with a higher extraversion score had greater odds of being abstinent at four weeks (self-assessed: OR = 1.10, 95% CI = 1.01–1.19; manager-assessed: OR = 1.32, 95% CI = 1.21–1.44).

Conclusions: More extraverted stop smoking practitioners appear to have greater success in advising their clients to quit smoking. Findings need to be confirmed in larger practitioner populations, other SSS, and in different smoking cessation contexts. If confirmed, specific training may be needed to assist more introverted stop smoking practitioners.