Introduction: Over 2.6 million Hispanic/Latino construction workers (CWs) live in the US; 91% of South Florida CWs are Hispanic/Latino. CWs have higher smoking and lower cessation rates than other workers. Limited access to cessation services, worksite turnover, and lack of interventions tailored to culture/occupation hinder cessation. Partnering with worksite food trucks to deliver unique cessation interventions may improve these efforts.

Aims: To explore a novel cessation approach, assess worker/worksite acceptability, and seek input into intervention development.

Methods: In 2016, we conducted five semi-structured focus groups with 37 smoking Hispanic/Latino CWs. Constant comparative analysis was used to examine a priori themes regarding smoking behaviours, cessation treatments, intervention delivery, cultural adaptation, and quit interest.

Results: CWs reported tremendous job stress. Most smoking occurred during the workday and most CWs did not use nicotine replacement therapy with past quit attempts. Most CWs were open to a worksite face-to-face group cessation intervention before work (many underutilize breaks and feel pressure to keep working). CWs felt it unnecessary to tailor the intervention to Hispanics/Latinos indicating smokers are the same regardless of race/ethnicity.

Conclusions: Findings demonstrate the need to consider work environments, job demands/stress, and worker preferences when developing accessible and acceptable cessation interventions.

Introduction: Each year about two thirds of U.S. smokers make a quit attempt. Yet, less than 5% remain abstinent three months post-quit date. One factor that may affect abstinence is negative feelings about the self-associated with being a smoker (disequilibrium), particularly if smoking is important to the sense of self and one is trying to quit.

Aims: We evaluated a multivariate structural equation model proposing that smoking's subjective importance to a smoker would influence carbon monoxide verified smoking abstinence at 24 weeks (post-quit date). Further, we assessed whether the relation would be moderated by the smoker's experience of disequilibrium.

Methods: Participants were 440 regular smokers taking part in a clinical trial assessing the effectiveness of different durations of nicotine replacement therapy use. Participants completed the subjective importance of smoking survey at baseline and were assessed for carbon monoxide verified seven-day point prevalence abstinence at 24 weeks

Results: Using exploratory structural equation modelling, the subjective importance of smoking was associated with point prevalence abstinence at 24 weeks, but only for smokers with high disequilibrium.

Conclusions: The results of this study suggest that experiencing negative feelings about being a smoker could motivate smokers to remain abstinent, despite the importance of smoking to the smoker's sense of self.

Introduction: The use of quitlines for smoking cessation has contracted, with service providers adapting through the development of comprehensive interactive online smoking cessation services. The primary aim of this review is to investigate the continuum of online cessation services, innovations in design and service components, measures used in formative, process and outcome evaluations, as well as evidence of effectiveness.

Methods: This review includes the peer-reviewed literature, scholarly articles and the grey literature material. Databases searched included: PubMed, Google Scholar, SCOPUS and the Cochrane Collaboration.

Results/findings: 56 academic journal articles and the 5 grey literature reports met the inclusion criteria for this review. Developmental stages of online/combination services included: static websites, tailored feedback, email and text services, interactive components, social media, pharmacological offers; as well as social and professional support mechanisms. Innovations in online smoking cessation include: chat rooms, new recruitment strategies, mobile apps, service tailoring and messaging support groups. Online cessation services were significantly cheaper and more popular than quitlines; however, abstinence rates appear higher amongst quitline users.

Conclusions: Three likely catalysts for the shift from quitlines to online services are the rapid development of technology, increased internet access and the general movement of the goods and services sector to digital channels. The challenge for online cessation service providers is to leverage their comparative cost advantage and develop strategies that keep pace, engage users and increase service effectiveness.

Implications: Our paper synthesises a wide-range of the literature that evaluates the effectiveness and scope of online smoking cessation programs. Through applying this literature to the stages of evaluation framework, we also provide one of the first detailed roadmaps towards developing comprehensive evaluation methodology for online smoking cessation services.

Introduction: Smoking is one of the most important risk factors for cardiovascular disease (CVD). Electronic cigarettes (e-cigarettes) are becoming increasingly popular. However, little is known regarding their patterns of use in patients with established CVD.

Aims: We aimed to assess the perceptions and patterns of use of e-cigarettes in patients presenting to a vascular clinic.

Methods: We performed a qualitative study to identify perceptions and beliefs about e-cigarettes. Semi-structured interviews of consecutive patients consenting to participate were performed over five-months. Individuals were recruited from a vascular surgery outpatient clinic. Initial interviews were based on a questionnaire. Further structured interviews were conducted with patients currently using e-cigarettes, which were transcribed and analysed to assess perceptions and patterns of use.

Results/Findings: Four overarching themes emerged: attraction to e-cigarettes as a harm reduction/smoking cessation strategy; uncertainty regarding the risks of e-cigarettes; use of various types of smoking cessation strategies; dual use and often complete relapse to tobacco products.

Conclusions: Patients with established CVD view e-cigarettes as a means of smoking cessation; however, many relapse to tobacco products or use both simultaneously. Further research is necessary regarding the role of e-cigarettes in smoking cessation in this high-risk group.

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.

Introduction: Many countries are enacting tobacco treatment training, guidelines and policies in order to fulfil Framework Convention on Tobacco Control (FCTC) treaty agreements. This study tapped the perspectives of international treatment providers to identify challenges and recommendations for improvement.

Methods: The cross-sectional survey included closed- and open-ended items. Distribution included professional listservs (ATTUD; Global Bridges; ENSH Global) and word-of-mouth. The survey collected data using an open-source platform (Enketo Smart Paper/Ona). We used R for quantitative analysis and Google Sheets to categorize open-ended responses.

Results: There were 155 respondents from 49 countries. Most (78.6%) provided direct services. Almost half (48.1%) reported receiving less than 6 hours of tobacco treatment training; respondents from low and lower-middle income countries (LMICs) received significantly less training (Fisher's p < 0.014). Likewise, among all respondents, 43% rated poor access to treatment; this rose to 100% among LMICs (Fisher's p < 0.001). To improve treatment and training, respondents suggested increasing government funding for pharmacotherapy and behavioural services; providing training in local languages and in the treatment of smokeless tobacco forms; trainee certification and access to online support for providers.

Conclusions: Globally, half of front-line treatment providers reported having poor access to training; this was true for all providers in LMICs and most in upper middle-income countries. Existing online trainings, available mainly in English, could be migrated to open-access formats to permit countries to tailor them to their local needs and languages. Countries in geographical proximity or historical linguistic/political alliances could forge cross-country mentoring relationships and mutual support for training.

Introduction: Dual-smoker couples are a highly prevalent group who report low motivation to quit smoking.

Aims: This study tested the effect of a messaging intervention (couples- vs. individual-focused smoking outcomes) on motivation to quit among dual-smoker couples and examined the moderating effect of perceived support.

Methods: A total of 202 individuals in 101 dual-smoker couples were randomized by dyad using a 2 (frame: gain/loss) by 2 (outcome focus: individual/couple) factorial design. Participants reviewed scenarios of either positive or negative outcomes of quitting versus not quitting as they applied to either the individual or the couple. Participants then reported their own motivation to quit and motivation for their partner to quit. The main outcome was motivation to quit smoking.

Results: No main effects of framing or message focus emerged. Significant interactions between message focus and negative support predicted motivation for self and partner to quit. Individuals who reported lower negative support reported greater motivation for self to quit and less motivation for partner to quit after reviewing couple- (vs. individual-) focused messages.

Conclusions: Individuals in dual-smoker couples typically report low motivation to quit smoking. Couple-focused messages may increase motivation to quit among individuals who are not receiving negative support from their partners.

Objectives: Examine correlates of initiation of e-cigarette use among smokers and determine the impact of e-cigarette use on cessation among smokers in a national U.S. consumer panel.

Methods: This study used the Nielsen Homescan Panel data from 2011 to 2013, augmented with state-specific measures of tobacco control activities, to examine (1) correlates of single and repeat e-cigarette purchasing among panellists currently purchasing cigarettes; and (2) correlates of ‘cessation’. Participating panellists scanned all retail purchases, and Nielsen recorded over 3 million product types. The key explanatory variable for cessation was e-cigarette purchase. Parallel analysis was conducted for conventional nicotine replacement therapy (NRT) purchase. Cessation was defined as no purchases for at least 6 months and no subsequent purchases until the end of 2013. Analysis was conducted in 2015. E-cigarettes tracked by Nielsen during this period were cig-a-like products resembling tobacco cigarettes in appearance.

Results: Single e-cigarette purchase was associated with whether the panellist resided in a single person male household and bought a higher volume of cigarettes. Repeat purchase was associated with higher state cigarette taxes, less stringent state public smoke-free policies, lower cigarette prices, and more frequent cigarette purchasing. Cessation was associated with repeat e-cigarette purchasing, repeat NRT purchasing, younger age, lower monthly cigarette volume, less frequent purchasing of cigarettes, less recent cigarette purchase at baseline, and single e-cigarette purchase before baseline.

Conclusions: Both individual and policy variables were associated with e-cigarette use. Repeat e-cigarette purchase was associated with cigarette purchase discontinuation, as were various smoking intensity measures.

Introduction: Many UK smokers use e-cigarettes as a quitting aid; however, a substantial number discontinue use of the e-cigarette and revert to smoking. Understanding why this may happen is important both for individuals and for stop smoking services.

Aims: To explore young adult smokers’ experiences of use and discontinued use of the e-cigarette.

Methods: Semi-structured interviews were conducted with six participants who tried e-cigarettes for at least seven days and returned to smoking. Data was transcribed and analysed using interpretative phenomenological analysis.

Results: Findings suggested participants held conflicting attitudes about using e-cigarettes, which undermined attempts to quit smoking, and led to the discontinuation of the e-cigarette. These conflicts centred on participants’ discomfort with the e-cigarette or vaping identity, lack of abstinence self-efficacy and navigation of barriers to e-cigarette use. The complex interplay of these factors may have led to an underestimation of the individual effort required to continue vaping and reinforced participants’ perception of the e-cigarette as an inferior product to the cigarette.

Conclusions: Future research should focus on the role of identity, self-efficacy, control and smokers’ expectations of e-cigarettes on smoking cessation as these may be important factors to consider for a more tailored service for e-cigarette users.

Previous research suggests that persistence, an individual difference characteristic representing the ability and willingness to maintain engagement in challenging or aversive contexts, may relate to smoking relapse. Improving understanding of the persistence-relapse risk association could guide improvements in behavioural interventions. We explored whether persistence and gender related to change in smoking urges across multiple cue exposure trials (an analogue of extinction learning and relapse risk). Participants included abstinent smokers who completed 12 massed, 5-minute smoking cue exposure trials using guided imagery as well as olfactory, tactile, visual and motor cues associated with smoking. We used multilevel logistic growth curve modelling to explore predictor associations with change in urge. Results suggested that gender related to urge whereby males showed greater initial and sustained reactivity than females. Persistence was not associated with female urge trajectories. However, compared to males with high persistence, males with low persistence evidenced sustained urge reactivity over time. Results suggest that greater persistence relates to reduction of conditioned responding (e.g., urges) among abstinent male smokers when exposure trials include complex cues most closely related to nicotine self-administration. Because persistence is modifiable, males with low persistence may benefit from interventions that include elements designed to increase persistence in urge eliciting situations.