The goal of this study was to evaluate the Adolescent Smoking Cessation Escaping Nicotine and Tobacco (ASCENT) program, a multifaceted smoking cessation intervention for teens, aged 14 to 18. Seven schools were randomised into either an intervention group (n = 61) or a comparison control group (n = 44). Findings suggested that 67% of the teens in the experimental group reported they did not smoke daily in the past 12 months, compared to 42% of the control group (p < .05). In addition, experimental (treated) youth reduced their smoking from an average of 8 cigarettes a day at baseline to 6 cigarettes a day (p < .05). Although not statistically significant, the overall 1-year quit rate for both groups was higher than the average rate for youth cessation programs (12%). The results of this study suggest that, with appropriate interventions, it is feasible to reduce youth smoking.

One of the first things I teach students about tobacco use is that it is best considered a disease, not a risk factor (Stephen Hamann, 2004).

The aim was to determine the factors that contribute to behavioural change in smokers, and to assess differences in the distribution of these factors between those in lower and higher stages of behavioural change using the transtheoretical model (TTM). A total of 112 participants were recruited from smoking cessation clinics in six local health authorities in North Wales, United Kingdom into a cross-sectional study; 46% of the participants were in the lower stages of the TTM (Precontemplation and Contemplation). The odds of being in the higher stage of behavioural change were not significantly associated with any of the factors considered (p > 0.05). In open-ended questions, the main factors reported to influence the decision to quit smoking were related to health and expenditure on cigarettes. The findings of this study suggest that in addition to the existing health strategy of promoting knowledge of the health impact of smoking, understanding factors influencing smokers to take steps towards quitting is also important.

Background: Parental smoking remains a significant risk to the preterm infant both pre and post delivery. Pharmacologically supported interventions have been previously contraindicated in this group during the perinatal period and during breastfeeding. We designed an evidence-based intervention for use in our high-risk population. This report assesses our outcomes after one year. Method: Questionnaire administered a median of 6 months after intervention. Results: There was no significant difference between those participants who returned the survey (n = 42) versus the group as a whole (n = 70). A total of 33% ceased smoking, p < .0001. If no nonresponders ceased smoking then this gives an overall success rate of 20%, p < .0001. Successful quitters had been smoking for a mean of 11 (SD = 7) years. Self-reported light smokers (< 10 cigarettes per day) were significantly more likely to quit (p < .01). Purchase of follow-on nicotine patches was a significant predictor of success in quitting (p = .02). If relapse occurred, it appeared to happen early and was mainly associated with current stressors. Conclusions: We have designed and applied a multidisciplinary intervention for parents and carers to be used in the perinatal period to decrease the postnatal risk for neonatal intensive care graduates. Our rates of successful smoking cessation are as good as, or better than, many published rates for opportunistic intervention. We suggest that randomised trials be focused on ways to further improve interventions at this time of opportunity for these infants and their families.

The prevalence of cigarette smoking among young people is a cause for concern. College health care providers (HCPs) can provide evidence-based interventions but frequently do not, in part, because of concerns that tobacco interventions might alienate their young patients. Six hundred and eighty-four college student patients were interviewed as they exited a college health centre. The patients were asked about smoking status, about discussions with their provider regarding tobacco and to rate their satisfaction with the visit. Of the students who smoked, 48.6% reported the HCP discussed tobacco use and 38.6% reported that the HCP provided advice to quit. Mean ranked satisfaction was significantly higher among students who received tobacco discussions and/or advice to quit. This study should encourage college providers to intervene with smoking college students without fear that this will alienate patients.

The aim of this cross-sectional study is to explore, in a sample of 380 college students, if there are any differences between regular, occasional and ex-smokers regarding health value, perceived health competence and self-efficacy to refrain from smoking. Stages of change are also assessed according to the transtheoretical model. There were no significant differences between groups regarding the health value. However, perceived health competence and self-efficacy (to refrain from smoking) were significantly different for the different smoking status and several stages of change. These findings provide new insights into how college student's health-related perceptions relate to smoking behaviour, which may help in the elaboration of smoking cessation interventions for this population.

This is an open study, with 5 years follow-up, of 502 smokers who received treatment according to their degree of physical nicotine dependence. Those least dependent (BCG) were not given nicotine replacement therapy (NRT), while those with the highest level of dependence (NRTG) used nicotine patches during a 12-week period. A total of 267 subjects completed a 5-year period of followup; 123 were from the BCG and 144 from the NRTG. The abstinence was greater for those who used NRT than for those in the BCG: 29.9% as opposed to 24.4%, for intermittent abstinence (OR 0.93; CI 95 %: 0.53–1.62), and 20.1% as opposed to 15.4% for continual abstinence (OR 1.41; IC 95 %: 0.75–2.66). The 74.4% of subjects who achieved 5 years of abstinence and belonged to the NRTG had correctly completed the pharmacological therapy and 25.6% had not done so. Of those who were not able to achieve nonsmoking status at 5 years, 37.6% had correctly completed the therapy and 62.4% had not done so (p < .05). At the 5-year follow-up 20.1% of subjects who used NRT for 3 months remained abstinent, while only 15.4% of those without patches remained abstinent. Those patients who were more likely to achieve abstinence were those who were older and who were male.

The construct of emotional awareness refers to attending to, identifying, differentiating, and labelling emotions in oneself and in others. Forty-two smokers were evaluated before they stopped smoking and also filled out the Levels of Emotional Awareness Scale (LEAS), the Toronto Alexithymia Scale (TAS-20), and the Sensation Seeking Scale (SSS). Subjects had low levels of emotional awareness and their scores on the emotional components of the TAS-20 were high in comparison to the general French population. No relationship was found between TAS-20 and LEAS, which confirms that these scales measure complementary dimensions of emotional processing that are only partially linked. Whereas sensation seeking was lower in self-rated alexithymic subjects, high scores on Boredom Susceptibility and total SSS among women were related to low LEAS scores. The results highlighted impairment of emotion processing in these subjects. Their state versus trait status is discussed, as well as their defensive functions. Treatment targeting emotional abilities enhancement for these subjects, as in other addictions, may help improve treatment of tobacco dependence.

Background/Aims: Physicians' reluctance to promoting smoking cessation reduces the effectiveness of evidence-based recommendations resulting in suboptimal patient outcomes. Primary aim: to draw together findings from studies that addressed physicians' perceived barriers to promoting smoking cessation. Secondary aim: to assess whether interventions for reducing such perceived barriers impact on smoking cessation rates. Methods: Literature search in peer-reviewed journals focused on physicians' perceived barriers to addressing smoking cessation or on intervention studies aimed at alleviating these barriers. Results: The most frequently reported perceived barriers were: time constraints, high workload, lack of training, lack of reimbursement of smoking cessation interventions and the physician's own smoking status. Low outcome expectancy, lack of self-efficacy, fear of losing patients, being uncomfortable to discuss smoking hazards, dissatisfaction with professional activity were also reported. Smoking quit rates of intervention studies aimed to reduce perceived barriers varied according to the barrier targeted. Conclusion: Primary care physicians report a great number of perceived barriers to addressing smoking cessation. Results of intervention studies designed to reduce specific barriers with the purpose of increasing quit rates, remain conflicting. Multilevel intervention studies seem to be needed to assess the efficacy of alleviating perceived barriers to addressing smoking cessation.

Objective: To report on the use of the New Zealand Quitline for recruiting participants to a smoking cessation trial. Methods: Analysis of data on trial recruitment and randomisation. Results: 68% of 26,369 callers to the New Zealand Quitline over 12 months indicated an interest in taking part in research, 28% of whom met eligibility criteria for a cessation intervention trial, assessed on the data routinely collected at Quitline registration. Of these, 1317 (26%) were contacted by call back with 1027 (78%) agreeing to take part in the trial. After further eligibility checking 851 people were randomised. Weighting of calls ensured that 25% of participants were Maori. Conclusions: Quitlines have good potential to be an effective means of randomising participants into cessation trials and ensuring adequate representation of underrepresented population groups.

This study evaluated a cessation of smoking program for older (≥ 65 years) smokers. We recruited 215 community-dwelling smokers who selected either an intervention (n = 165) (brief intervention, telephone support, access to nicotine replacement therapy [NRT]) or ongoing smoking (continuing smokers) (n = 50). Primary outcomes at 12 and 24 months were (a) total abstinence and (b) cessation for the previous 30+ days, all validated via expired carbon monoxide (ECO). We interviewed 183 (85%) participants at 12 months and 165 (77%) at 24 months. Total abstinence was reported by 29 (18%) and 21 (13%) of the intervention group and none of the continuing smokers at 12 and 24 months. At 12 months, a greater prevalence of 30+ day cessation was observed for the intervention (24.2%) than the continuing smokers (4.0%): by 24 months this difference was 23.6% versus 12.0%. Those totally abstinent for 24 months predominantly used NRT (81%). Of the 30+ day quitters at 24 months, 74% of the intervention group used NRT and 100% of the continuing smokers used ‘cold turkey’. Cessation programs can be successfully delivered to older smokers, with outcomes comparable to the general population. NRT is commonly used by successful quitters, but ‘cold turkey’ can also be successful.

Health care professionals (HCPs) in New Zealand have access to free smoking cessation training that enables them to deliver smoking cessation support and provide Government subsidised nicotine replacement therapy (NRT). However, it is unknown how many trainees go on to provide cessation services or what level of smoking cessation support activity they undertake. A questionnaire was sent to 1183 HCPs to assess this and also enquire about barriers to establishing and/or providing a cessation service. Despite a low response rate (11%) a number of important issues were identified; 84% of respondents had provided smoking cessation treatment and the majority of these (92%) were still providing treatment. The most frequent barriers reported were lack of dedicated time and funding to provide treatment. Support in establishing smoking cessation treatment and ongoing training support were the 2 main trainee needs. Smoking cessation specialists are a relatively new group of HCPs whose numbers are likely to grow. Smoking cessation training should address the needs of HCPs and a range of barriers to implementing treatment.

Guidelines recommend that general practitioners (GPs) should advise all smoking patients to quit and provide additional stop-smoking interventions as appropriate. This study aimed to improve our understanding of how this recommendation can be achieved. General practitioners (N = 26) from London completed a questionnaire about their stop-smoking interventions and psychological factors that might affect these. Thirty-one per cent of the patients recognised as smokers by GPs did not receive an intervention and two-thirds of these were judged to be inappropriate for receipt of an intervention. Psychological factors that predicted behaviour were perceptions that doing this was ‘normative’, making an effort to make it happen, and feeling that the behaviour was easy to enact. Strategies to improve guideline implementation may be more effective if they addressed the above psychological factors.

The purpose of this study was to extend research regarding the perceptions smokers have of the advantages and disadvantages of using potential reduced exposure products (PREPs). Five focus groups with female current smokers were conducted in the Appalachian region of Ohio. The semistructured discussion guide was developed to capture information on reasons why women smoke, why and how they quit smoking, and reasons why women would switch to PREPs. The results suggest that these smokers did not express enthusiasm for using PREPs as an aid to smoking cessation or as a harm reduction product. In general, the concept of harm reduction in the sense of reducing disease risks did not engage the participants. Early in the discussion the women had identified some problems caused by their smoking and later PREPs were viewed as reducing these. The results suggest that PREPs may be attractive to some smokers because they offer benefits that other products lack.

This preliminary laboratory study investigated nicotine absorption rates of seven current nicotine replacement therapy (NRT) products and a new wide-bore nicotine delivery device (the ‘Nicotine Cannon’). The nicotine products (Cannon, inhalator, nasal spray, microtab, 2 mg and 4 mg gum and 2 mg and 4 mg lozenge) were used for ten minutes by two non-nicotine tolerant subjects. Blood was taken at frequent intervals for the next 60 minutes and plasma nicotine concentrations assessed. Of current NRT products investigated the 4 mg lozenge performed best with the highest blood nicotine levels at each time point, the 2 mg gum delivered the lowest concentrations at each time point. The nicotine nasal spray delivered nicotine the fastest of all the products. The Cannon delivered the highest blood nicotine concentration (mean 8.95 ng/ml) of all products one minute after device use had stopped, and the highest concentration (11 ng/ml) five minutes after termination of use. The Cannon showed it could deliver nicotine relatively rapidly in a manner that was readily tolerated by users.

A community-based cross-sectional study was undertaken in a rural community of West Bengal, India among 329 adult males, during April to June, 2004 to find out the prevalence, characteristics of smoking and attitude of smokers towards quitting. 29.8% (98), 61.7% (203) and 8.5% (28) were found to be current, never and former smokers respectively. Among current smokers, 79.4% had started smoking before the age of 24 years. 23% of smokers cited the reason for smoking was to concentrate at work and to relieve anger and frustration. 53.8% wanted to quit smoking but lack of willpower (28.2%) became the major hindrance to quitting. 58.9% were uncertain about continuing smoking. Smoking is commonly practised in rural area of West Bengal, starting at quite an early age; hence awareness and health education needs to be stressed, so that prevention can be initiated.

The prevalence of smoking is much higher among the poor, marginalised and disenfranchised. Those who are dependent on alcohol and other drugs, suffering mental illness, and Indigenous people are among the heaviest smokers and are least likely to quit. This article describes a smallscale evaluation of a smoking cessation program, which used tailored nicotine replacement therapy (NRT) aimed at these groups, between 2004 to 2006. A mixed methodology approach to data collection was employed. The quantitative data indicated that a low level of success was achieved by program participants. The qualitative data provided rich accounts of peoples' experiences in the program. These could be used to develop more effective programs that take a full account of the complex issues that shape participants' responses to smoking cessation and provide greater levels of sustained motivation. Several issues related to the conduct of rigorous evaluation studies in this context are highlighted.

Postcessation weight gain is common and a frequent cause of relapse. Although interventions to address weight gain and weight gain concerns exist, the experience of telephone cessation counsellors in addressing weight concerns is unknown. We surveyed 134 cessation counsellors providing quitlines for 30 states regarding their experiences and attitudes about how to address weight gain concerns among smokers trying to quit. Counsellors estimated they discuss weight in 40% of their calls, primarily discussing concerns about gaining weight. Counsellors estimated that smokers gain about 4.1 kg after quitting and about 48% gain more than 2.3 kg. Most counsellors believed that exercise, education about weight gain and preparing smokers for weight gain would help people quit, which is consistent with current science. A total of 51% of counsellors believed that dieting while quitting would reduce weight gain and only 35% correctly identified that dieting reduces a smokers' ability to quit. Some counsellors believed they needed more training in weight management and may need to be reassured that they are currently following treatment guidelines when confronted with smokers who have concerns about postcessation weight gain.