Background: Rheumatoid arthritis (RA), the chronic autoimmune disease with several opinions about its aetiology, has affected more than 50 million people in the world. The aim of this 2008 study was to investigate the association between smoking and RA in Hamedan, a western city of Iran. Methods: As a case-control study, information from 130 cases and 130 controls, matched for age and sex, were collected by questionnaire and analysed using SPSS (chi-square, phi and Cramer tests). Results: From 130 cases, 80 cases were females and the rest were males. Statistical analysis showed that smoking less or more than 10 cigarettes daily has a significant association with RA in both sexes, together or separately (p < .05). However, there is no significant association between duration of smoking cessation within 2 years or more, and RA in both sexes (p > .05). This means that cigarette cessation at any time can be useful in RA prevention. Conclusion: Considering previous global investigations on this topic and the results of our study, it seems that smoking even low numbers of cigarettes affects the presence of RA and it is never too late to give up smoking.

Cigarette smoke contains polycyclic aromatic hydrocarbons (PAHs) that activate the expression of cytochrome P450 family 1 (CYP1) enzymes in liver and other tissues; this process is dependent on the aryl hydrocarbon receptor (AhR) transcription factor. An important CYP1 enzyme, CYP1A2, has a critical role in the oxidation of drugs such as clozapine, olanzapine and theophylline; these drugs exhibit a high incidence of adverse effects that are linked to plasma concentrations. This article reviews the impact of smoking and smoking cessation on therapy with toxic drugs that undergo CYP-mediated elimination. PAHs in cigarette smoke activate the AhR and upregulate CYP1A2, which enhances the clearance of these drugs, diminishes their efficacy and necessitates the use of higher doses. However, smoking cessation decreases PAH exposure, which leads to a decline in clearance of CYP1A2 substrate drugs. Dose reductions and close therapeutic monitoring for such drugs are recommended in patients who cease smoking.

There are mixed views on whether smoking cessation advisors should focus only on quitting smoking or also promote simultaneous health behaviour changes (e.g., diet, physical activity), but no studies have qualitatively examined the views and vicarious experiences of such health professionals. Semi-structured interviews were conducted with 11 trained smoking cessation advisors who promote physical activity to their clients. The data were categorised into themes using thematic analysis supported by qualitative data analysis software. We report themes that were related to why advisors promote multiple health behaviour change and issues in timing. Physical activity could be promoted as a cessation aid and also as part of a holistic lifestyle change consistent with a nonsmoker identity, thereby increasing feelings of control and addressing fear of weight gain. Multiple changes were promoted pre-quit, simultaneously and post-quit, and advisors asserted that it is important to focus on the needs and capabilities of individual clients when deciding how to time multiple changes. Also, suggesting that PA was a useful and easily performed cessation aid rather than a new behaviour (i.e., structured exercise that may seem irrelevant) may help some clients to avoid a sense of overload.

The hypotheses that smokers hold misconceptions around nicotine replacement therapy (NRT) safety, and that these concerns limit the use of NRT, was tested with two large face-to-face surveys of current smokers in Great Britain in 2004 (N = 605) and 2006 (N = 1,434). In both studies, participants were questioned regarding the safety of nicotine and NRT products, their past experience with NRT and anticipated future use. Across both surveys, approximately two thirds of smokers believed that, or were unsure whether, NRT was as harmful as cigarette smoking. Combining information across surveys, smokers with safety misconceptions reported being less likely to want to quit in the future (63% vs. 73%; p < .001), and, among those who were interested in quitting, were less likely to report an intention to use NRT during their next quit attempt. The majority of smokers were misinformed about the safety of NRT products, and smokers with safety misconceptions were less likely to report that they plan to use NRT during future quit attempts, suggesting that safety concerns are a barrier to NRT utilisation.

The purpose of the study was to develop a smoking cessation online service (SCOS) for cigarette smokers. The SCOS website was developed via Flash Professional® program version 9.0 with software that included Mozilla™, Java®, and Windows™. Twenty-five volunteers accessed SCOS. Five trained hospital pharmacists were responsible for the online counselling service. Most volunteers were males with a history of smoking of at least ten years, were aged between 21 to 30 years, and were in the low income bracket. Twenty-five per cent of the volunteers stated that they were ready to quit smoking. The most common method of smoking cessation was to give up smoking at once (48%). Results showed that attitudes towards smoking perceptions were positively high with a mean score of 28.52 out of 30. Volunteers also stated they thought SCOS was interesting and useful. They liked the functions of the program as well as its benefits. Recommendations included the extension of the study into different areas, the continuation of SCOS as an alternative for quitting smoking and the evaluation of the effectiveness of SCOS alongside current methods of smoking cessation, such as face-to-face counselling, home visits and phone calls.

To study beliefs about smoking and COPD, and motivation for smoking discontinuation we recruited 100 COPD patients during admission for exacerbation. They were asked about motivation to quit smoking and about disease understanding. We compared their survival with that of 324 COPD patients and with survival of age-matched Danes. Forty-five smokers, 50 ex-smokers and five never-smokers were included. Mean value of age was 77.5 years, number of years smoking was 51.8, and FEV1 was 0.79 L. Most patients were not certain about the association between smoking and COPD. Only 16% thought that their smoking had caused COPD and 24% thought that they would not suffer from COPD, had they not smoked. Three out of the six motivation questions could be included in a mutual quantitative scale (alpha = 0.76). Thirty per cent (r = 0.55, p = .005) of the variation in the motivation scale score was explained by number of years with smoking (negative association), number of cigarettes smoked per day (positive association) and BMI (negative association). Mortality was lower than in the reference population (RR = 0.63, p = .005), but higher than in age-matched Danes. Many patients are not certain about the association between smoking and COPD. We developed a smoking cessation motivation scale based on three questions.

Language, culture and not knowing how to access services are barriers to the use of health services for Asian migrants. Asian Smokefree Communities (ASC) pilot-tested a novel Asian-specific service model to address these issues for Asian smokers. Korean- and Chinese-speaking coordinators delivered home-, workplace- or clinic-based interventions to support smokers with cessation and create smoke-free environments with families. A prior planned evaluation investigated the acceptability of the service, quit rates and exposure to second-hand smoke. The methods included analysis of ASC service records, a client satisfaction survey and key informant interviews. Clients were satisfied with factors associated with culture, such as being comfortable when talking to coordinators (88.9%) and family involvement in treatment (79.4%). Appointment attendance was high (97%). The self-reported quit rate for the 93 cessation clients was 72% at 1 month, 53.8 % at 3 months and 40.9 % at 6 months. All homes (100%) were smoke-free after the intervention, an increase of 18% from preintervention levels. The ASC model was acceptable to Asian clients. It helped them stop smoking and increased household protection from second-hand smoke. The model could make an effective contribution to smoke-free services for Asian populations in western countries.

Research consistently demonstrates that a bout of moderate exercise alleviates cravings to smoke among abstaining smokers. This pilot study examined the effects of an acute bout of brisk walking on cigarette cravings and smoking topography. Using a within-subject, crossover design, two 10-minute treatment sessions were conducted on separate days by 19 participants (M age = 24.6 years): passive (i.e., sitting) and brisk walking conditions. Participants rated cravings at baseline, midcondition, and at 0-, 10-, and 20-minutes postcondition and objective measures of smoking topography (puff count, puff duration, puff volume, interpuff interval [IPI], time to first puff [TTFP]) were obtained with the first cigarette smoked postcondition. A 2 (condition) × 4 (time) ANCOVA indicated lower desire to smoke (p < .05) during the walking condition than the passive condition. After the brisk walking condition, a series of ANOVAs demonstrated a significantly increased delay to first puff in comparison to the passive condition. Posthoc analyses (controlling for abstinence period) indicated significant lower puff volume and a trend for shorter puff duration following brisk walking in comparison to the passive sitting condition. A greater reduction in cravings was associated with a longer delay to first puff. In addition to reducing cravings, these results suggest that a bout of brisk walking may also change an individual's smoking behaviour.

The digital therapy intervention for smoking cessation, ‘Happy Ending’, has been shown to be efficacious in two previous randomised controlled trials. The aim of the current article is to disentangle the rationale of the intervention and describe its development. For this purpose, Intervention Mapping is used as a descriptive tool. The intervention is fully automated and delivered by means of the Internet and mobile phones. It is based on self-regulation theory, social cognitive theory, cognitive–behaviour therapy, motivational interviewing and relapse prevention. The ordering of the content is based on a reasoned chronology, modelled according to psychological processes that people experience at certain time points in a process of therapy-supported self-regulation. The design of the intervention is innovative in that it combines four media channels (SMS, IVR, e-mail, and web), and in the combination of just-in-time therapy and a tunnelling strategy based on the natural chronology of quitting. The two forms of just-in-time therapy are a craving helpline (mainly targeting negative affect), and the provision of relapse therapy based on a daily assessment of the target behaviour. The present article meets the recent calls for more thorough descriptions of interventions, and may inform systematic reviews and the development of interventions.

Objectives: To determine whether the cost of a statewide smoking cessation program in Pennsylvania could be justified by the benefits. Methods: A cost-benefit analysis of statewide access to smoking cessation programs. We compared three treatment alternatives, with and without counselling: nicotine replacement therapy, bupropion and varenicline. Results: While the retail price of a pack of cigarettes in Pennsylvania is on average US$4.72, the combined medical costs and productivity losses in Pennsylvania attributable to each pack of cigarettes sold are approximately US$23.78 per pack of cigarettes. The ratio of benefits to cost varied from US$0.97 to US$2.76 saved per dollar spent on smoking cessation programs, depending upon the type of intervention. Conclusions: For most smoking cessation treatments, the benefits of a statewide smoking cessation program in Pennsylvania would greatly outweigh its costs.

Introduction: The tobacco epidemic is surging in developing countries. While the determinants of tobacco use are well known, it is less certain whether they are similar in developed and developing countries. This has important ramifications for the implementation of interventions locally. This qualitative study explored the determinants and importance of context on tobacco use in Pakistan. Methods: Focus group discussions were conducted in two districts with doctors, nurses and patients from local tuberculosis clinics. Results: Peer influence, social acceptability, affordability and visibility of tobacco, public understanding and personal perception of risks influence tobacco use. Individual factors, such as personal curiosity, adversity and stress, also affected tobacco uptake and use. Patients were willing to pay for effective cessation treatment provided the costs were comparable to their expenditure on tobacco. Discussion: Factors such as peer and social influences are similar to those reported elsewhere. However, local variations exist in the degree of sociocultural acceptability, visibility of tobacco use, public understanding of risks and individual situational factors that influence tobacco use. Patients are prepared to pay for treatment, but there are gender differences in what can be afforded. For tobacco cessation interventions to be effective, local adaptations are essential to ensure cultural and contextual appropriateness.

Research has found that an individual's perceived self-efficacy, supported by goals and the acceptance of potential obstacles, has the ability to assist in behaviour modification. By examining the narratives of cardiovascular patients undergoing smoking cessation counselling, this study highlights factors that individuals communicate in their narratives regarding changes to self-efficacy throughout the process of smoking cessation. Narrative analysis is used to establish those factors that cardiovascular patients assert to be the motivating or impeding factors in their smoking cessation efforts, particularly in relation to their initial readiness to quit smoking. The study's findings illustrate the social, physical and psychological barriers and motivating factors that exist for cardiovascular patients in the process of quitting smoking. The current study supplements past research illustrating that in-hospital programs are among the most influential smoking intervention strategies because they can be tailored to each patient's specific health problems and personal and social circumstances. The study concludes that the relationship formed between patients and intervention specialists can assist in raising an individual's self-efficacy to end an addictive behaviour.

Objective: To evaluate the effectiveness of inpatient brief counselling by a smoking cessation nurse compared to usual care (no advice). Methods: The subjects (n = 381, 245 men and 136 women) studied were in-patients, in four Flemish University Hospitals, who were daily smokers. Patients were randomised between 2005 and June 2006. Patients were allocated to an experimental group (EG) or to a control group (CG). Allocation and smoking cessation interventions of patients were stage-matched according to their stage of change as defined by Prochaska and Diclemente. Smoking cessation advice was administered by a qualified smoking cessation nurse. Results: The six-month self-reported continuous abstinence in the EG in 28/178 patients (15.7%) compared to the CG where 14/180 patients were abstinent (7.7%) was significantly better. The effect was most pronounced in the subgroup over 40 years old in the preparation and action stage. In this cohort in the EG, 44% of patients were abstinent at six months compared to 18%in the CG. All patients tended to smoke less after a hospitalisation. Conclusion: The intervention by a smoking cessation nurse during hospitalisation seems effective and is most rewarding in the smokers > 40 years old, and who were well motivated to stop.

Heartwatch is an Irish primary care-delivered secondary prevention program for patients with established coronary artery disease (CAD). We aimed to describe the patterns of smoking cessation in Heartwatch and examine the associates of successful smoking cessation. Participants with established CAD were invited to baseline and three-monthly clinic visits. Data on all persons reporting tobacco use at baseline were examined. Associations between smoking cessation and baseline factors were examined using logistic regression models. Data were available on 1,679 Heartwatch patients who were smoking at first visit. One third of smokers (581 participants: 34.6%) achieved smoking cessation during the study period (2003 to 2007), 80.4% of whom remained nonsmokers at end of follow-up. Positive associates of successful smoking cessation included increasing age, male sex, a body mass index > 25 and increasing number of study visits. Negative associates included having a means-tested general medical services allocation, being unemployed, and documentation of stop-smoking advice. All factors except employment status retained statistical significance when examined in a multivariable model. In conclusion, high levels of smoking cessation were achieved in this secondary prevention population of persistent smokers. Associates of successful smoking cessation were identified. Specific stop-smoking strategies should be considered for those subpopulations less likely to quit.

Objective: State smoking cessation telephone quitlines have become an integral part of the U.S. public health strategy for helping smokers quit. It is unclear whether these quitlines meet the needs of smokers with a mental illness, who have unique challenges during the quitting process and may benefit from more intensive treatment compared to smokers without mental illness. We conducted a needs assessment survey of U.S. state quitlines (N = 51 including Washington DC) to learn how they work with mentally ill callers. Methods: Quitline representatives were asked whether they have, or perform, six services chosen to represent basic elements of treatment access, process and structure for mentally ill smokers. Findings: We had a 96% response rate to our survey. All surveyed quitlines accept calls from mentally ill smokers, and all either train their counsellors in mental health or their counsellors have past mental health training. In addition, all quitlines encourage mentally ill callers to discuss quitting with their regular healthcare providers for safety reasons. However, only eight surveyed quitlines (16%) screen callers for mental illness, few (18%) use specific counselling protocols for mentally ill callers, and even fewer (6%) have self-help materials tailored for the mentally ill. Conclusions: Future studies are needed to analyse these variations in state quitline operations to identify the most effective approaches to providing telephone-based treatment for smokers with mental illness.

Objective: To measure (a) the perceived amount of money saved by ex-smokers after quitting, (b) changes in shopping behaviours and (c) alternative uses of the money saved. Design: A 2006 computer-assisted telephone interview survey of smoking-related behaviours and attitudes in New South Wales, Australia. Main outcome measures: Participants (N = 147) who had quit smoking in the previous 12 months answered items regarding personal expenditure on tobacco smoking. Results: Most (51%) ex-smokers reported spending up to $40 per week on cigarettes when they smoked. Fifty-six per cent of lower socioeconomic status (SES) ex-smokers reported spending over $40 per week on cigarettes compared to 40% of those from higher socioeconomic areas. Almost a third (28%) of respondents reported shopping more or shopping at different locations since quitting. The three highest alternative items purchased since quitting were food (19%). other things not listed (13%) and clothing (10%); however, most respondents reported not changing their spending habits (54%). Conclusion: This study indicates that tobacco is a high-cost product with smokers spending approximately 5% of average weekly income on cigarettes. Those living in lower SES areas report spending more on cigarettes than those in higher SES areas. The majority of quitters could not identify any change in spending or saving as a result of quitting. However, changes in shopping behaviours were noted. It may be useful for quitters to quarantine their cigarette money to increase the salience and power of financial benefit as an incentive to maintain quitting.

Background: Efficacious smoking cessation interventions exist, yet few smokers utilise available resources such as psychosocial treatment programs and pharmacotherapy. The goals of the present study were to (1) identify perceived barriers to entering smoking cessation treatment programs among socioeconomically disadvantaged smokers, who are presently underrepresented in smoking cessation interventions; (2) determine what variables are most important in predicting the barriers identified (i.e., age, gender, ethnicity, income, nicotine dependence level, smoking rate, years smoking, stage of change, presence of smoking-related illness and medical insurance status). Methods: Responses from socioeconomically disadvantaged smokers (N = 343) were collected in 2004–2005 and analysed to develop the Treatment Barriers Questionnaire, a 40-item measure of reasons for not entering smoking cessation programs. Study methods were approved by the Institutional Review Board of Louisiana State University; informed consent procedures were employed. Results: Principal components analysis yielded seven scales named for their theme: (1) Preparedness to Quit Smoking; (2) Work and Time Constraints; (3) Smokers Can or Should Quit on Own; (4) Opinions about Professional Assistance; (5) Mobility Limitations; (6) Insurance Limitations and (7) Misinformation about Professional Assistance. Gender, ethnicity, daily smoking rate, nicotine dependence and stage of change were significant predictors in regression analyses for scales 1, F(10, 201) = 7.83, p < .001, R2 = .29, 2 F(10, 201) = 2.30, p < .05, R2 = .11, and 3, F(10, 201) = 3.58, p < .001, R2 = .16. Conclusions: Results can inform efforts to facilitate entry and retention of smokers in cessation programs.

Aims: Most smokers who quit smoking usually relapse. Smoking relapse prevention programs are thus needed and their optimal content and duration should be therefore studied. The present study aimed to compare the efficacy of two relapse prevention programs designed for subjects who reported to be abstinent after a smoking cessation program and to assess predictors of abstinence 9 months later. Participants and design: Two-hundred and seventy-five adults who reported to be abstinent were randomised in two 9-month relapse prevention programs: Workplace Group Counselling Program (WGC) or Proactive Phone Counselling Program (PPC). Measurements: Assessment included questionnaires (Brief Symptom Inventory, BSI; Dutch Eating Behavior Questionnaire, DEBQ; Life Event Scale; sociodemographic and companies' characteristics; and companies' policy toward smoking), and abstinence measurements (self-report, breath carbon monoxide level and urinary cotinine concentration level). Findings: Quit rates at 9 months were respectively 57.5% in the PPC arm and 61.7% in the WGC arm (p = .552). Regression analysis indicated that urinary cotinine concentration level lower than or equal to 317ng/ml was associated with higher rate of abstinence (OR = 4.75, 95% CI = 1.23–18.30, p = .024). Moreover having higher BSI global severity index (OR = .36; 95% CI = .15–.83; p = .017), DEBQ external eating scores (OR = .67; 95% CI = .45–1.00; p = .050) and a free program (OR = .46; 95% CI = .22–.99; p = .048) were associated with lower rate of abstinence. Conclusions: Efficacy was similar for the two programs. This study underlines the need to monitor distress, eating behaviours, lapses and motivation, and to include in future relapse prevention programs specific psychological and/or pharmacological interventions that consider these dimensions.

Introduction: Cessation efforts and maintained abstinence in smokers have been associated with social support from others (i.e., ‘support persons’). Characteristics of support persons appear to affect the amount and quality of support provided to adults who smoke. In the present investigation, the relationship between support person characteristics and perceived quality and quantity of smoking-specific support provided was examined. Method: College students (N = 244) were asked to identify an adult who smokes about whom they were concerned. Participants reported demographic and smoking-related information about themselves and their identified smoker and perceptions of positive and negative smoking-specific social support provided. Results: Results indicated significant differences in smoking status (p < .05), such that current and ex-smokers reported providing more negative support than never smokers. Additionally, participants romantically involved with their smokers reported providing more positive (p < .05) support than those in other relationships. Discussion: Findings suggest the importance of relationship in the perception of support provided during the cessation process and highlight the need for future research in this area.

The addiction literature contains numerous case reports of individuals dependent on a range of chemical substances, but strong dependence on cigarettes has not been similarly documented. This report attempts to fill this gap by describing two exceptionally dependent smokers. Both suffer with a smoking-related disease and have a very strong motivation to quit. Despite receiving intensive behavioural and pharmacological treatments to help them stop smoking, they have been unable to maintain even a short period of abstinence. The two cases provide reference examples for the assertion that while not all smokers are hopelessly hooked, some are. Such illustrative cases may stimulate research into the area of individual differences in cigarette dependence.