Background: Internet-based interventions can help smokers to quit compared with brief written materials or no intervention. However, they are not widely used, particularly by more disadvantaged smokers, and there is significant variation in their effectiveness. A new smoking cessation website (‘StopAdvisor’) has been systematically developed on the basis of PRIME theory, empirical evidence, web-design expertise and user-testing with socio-economically disadvantaged smokers. This paper reports the protocol of a randomised controlled trial to evaluate the efficacy of StopAdvisor and determine whether it translates across the social spectrum.

Methods: The trial has two arms with participants randomised to the offer of the interactive ‘StopAdvisor’ website (intervention condition) or a non-interactive, static website (control condition). Participants are adults from the UK, who smoke every day and are willing to make a serious quit attempt within a month of enrolment. At least 4260 participants will be recruited with a minimum of 2130 in each of two socio-economic sub-groups. The intervention comprises a structured quit plan and a variety of theory- and evidence-based behaviour change techniques for smoking cessation. Tailored support is offered in the form of a series of tunnelled sessions and a variety of interactive menus for use up to a month before, and then for one month after quitting (http://www.lifeguideonline.org/player/play/stopadvisordemonstration). The control is a static website that presents brief and standard advice on smoking cessation. Assessments are at baseline and 2-, 4- and 7-months post-enrolment. The primary outcome measure will be Russell Standard 6-months sustained abstinence, defined as self-reported continuous abstinence verified by saliva cotinine or anabasine at 7-month follow-up. Secondary outcome measures will include 7-day point-prevalence abstinence at 7-month follow-up, self-reported abstinence at 2- and 4-month follow-ups, satisfaction ratings of the website and quantitative indices of website interaction. All analyses will be by intention to treat and the main analysis will compare the two conditions on the primary outcome measure using a logistic regression model, adjusted for baseline characteristics. The efficacy of the intervention across the social spectrum will be assessed by a logistic regression focusing on the interaction between condition and socio-economic disadvantage.

Trial registration: ISRCTN99820519.

Tobacco dependence is characterised as a chronic, relapsing disorder that typically requires multiple quit attempts before successful, long-term abstinence is achieved (Steinberg, Foulds, Richardson, Burke, & Shah, 2006). Best practice, evidence-based treatment includes multiple-session counselling and pharmacotherapy, or the combination of both (Fiore et al., 2008). The field has moved past the notion that tobacco dependence is simply a bad habit, a vice, or a moral deficiency that can be overcome by willpower or education alone (Mars & Ling, 2008). However, the language used in discussing treatment has not always been consistent with this evidence. Some words and phrases used lend themselves to varied meanings, and could lead to significant misunderstanding not only among professionals in the field, but also among the general public (O'Brien, 2010; Davis, 1992; Perkins, 1999; Hughes, 2013). In this paper, we discuss some commonly used, problematic terminology, and suggest more appropriate terms (Table 1).

Smoking cessation interventions during routine clinical encounters by health professionals have the potential to reach smokers and facilitate cessation. Although psychologists might appear to be ideal providers of such interventions, international research suggests that their provision is limited. This paper reports the results of a survey conducted in NSW, Australia, of psychologists’ (n = 72) smoking intervention practices, attitudes, and barriers to providing such care. Less than half of the respondents reported assessing smoking status for ‘all or nearly all’ of their clients. Across a range of smoking cessation intervention types, the most frequent response given indicated provision to ‘none or almost none’ of clients who smoked. Only 13% of respondents indicated even ‘advising cessation’ to ‘all or nearly all’ of their smoking clients. Barriers included concern about negative influence on the therapeutic relationship, inadequacy of training and lack of confidence to intervene. Respondents were less likely to provide intervention for smoking than for cannabis, methamphetamine ‘ice’, and alcohol. The study suggests that the potential of Australian psychologists to assist smokers to quit is not being realised, and that there is a need to address the barriers to care provision.

Objectives: To assess the smoking cessation counselling practices of family physicians in Jordan and assess their perception about the availability of smoking cessation resources and about the barriers to effective smoking cessation practices. Methods: A pre-structured questionnaire was distributed to 124 family physicians practicing in teaching and Ministry of Health medical centres in Jordan. All participants were asked about their smoking cessation practices and about the barriers to effective smoking cessation practices. Results: Only 39.8% reported that they assess the willingness of the patients to quit smoking and 28.2% reported that they discuss counselling options with smokers. Considerably fewer percentages of physicians reported that they prepare their patients for withdrawal symptoms (11.6%), discuss pharmacotherapies (4.9%), describe a nicotine patch (5.0%), and provide patients with self-help materials (6.7%). The two factors cited most often by physicians as significant barriers to smoking cessation counselling were lack or too few available cessation programmes (90.3%) and limited training for physicians on tobacco and cessation interventions (90.3%). Conclusion: While a high proportion of Jordanian family physicians reported that they usually ask patients about smoking status and advise them to stop smoking, they do not regularly provide extensive assistance to help their patients to quit smoking. Lack or too few available cessation programmes and limited training for physicians on smoking cessation interventions were identified as the two major barriers to effective smoking cessation counselling.

Background: The issue of tobacco control had almost unanimous support among public health professionals. It is therefore apparent that the dental care system should be involved in tobacco prevention and tobacco cessation. Objective: To assess dental students’ and practicing dentists’ perceptions of tobacco cessation content in curriculum and attitudes concerning their professional responsibility to help users quit tobacco. Methods: The study was conducted with Bachelor of Dental Surgery (BDS) 3rd year students, Interns and practicing dentists of Moradabad city (India). A 17-item questionnaire focused on attitudes of dental fraternity, professional responsibilities, effectiveness and scope of Tobacco Use Cessation (TUC) practice in dental setting. Results: Statically significant difference is seen among responses of dental fraternities, with students having less positive attitudes than practicing dentists (p < 0.001). Conclusion: Attitudes of the participants appear to be positive and encouraging, but they feel unprepared and needed further training in TUC.

Introduction: Nondaily smoking is a growing public health concern, particularly among young adults. Given the lack of existing measures for assessing factors associated with this smoking pattern, the present study aims to develop a measure of motivation to quit among young adult nondaily smokers. Specifically, we developed a scale assessing motivation for nondaily smoking cessation, and examined its reliability, factor structure, and concurrent validity.

Methods: We administered an online survey to 2,000 students at six colleges in the Southeastern US, and 718 (35.9%) returned a completed survey. The current analyses focused on the 95 participants who reported nondaily smoking (i.e., smoking between 1 and 29 days of the past 30 days). In addition to the items created for scale development, measures included sociodemographics, other measures of motivation and confidence/self-efficacy, past smoking/quitting history, readiness to quit, and perceived harm.

Results: The 13-item Nondaily Smoking Cessation Motivation Questionnaire (NSCM) had an average score of 56.95 (SD = 24.33) and high internal consistency (Cronbach's alpha of 0.94). Factor analysis using principal components extraction with varimax rotation extracted three factors accounting for 76.8% of the variance: Controlled motivation, Autonomous motivation, and Amotivation. Concurrent and discriminant validity were documented.

Conclusions: This study provided information about the development and validation of the Nondaily Smoking Cessation Motivation Questionnaire for young adult nondaily smokers. Given the lack of validated measures to assess factors associated with nondaily smoking, this assessment may be critical in informing our intervention strategies and potentially for predicting cessation among nondaily smokers in the young adult population.

Introduction – The potential impact of electronic health records (EHR) in driving tobacco treatment behaviours within healthcare settings has been established. However, little is known about the administrative variables that may undermine effectiveness in real world settings.

Aims – Assist healthcare planners interested in implementing tobacco-EHR systems by identifying an EHR framework that is consistent with published treatment guidelines, and the important organisational variables that can undermine the effectiveness of tobacco-EHR.

Methods – This paper considers the established literature on EHR implementation and physician behaviour change, and integrates this understanding with the observations of an expert workgroup tasked with facilitating tobacco-EHR implementation in Southeastern Pennsylvania.

Results/ Findings – System change in this topic area will continue to be problematic unless attention is paid to several important lessons regarding: 1) the evolving healthcare regulatory environment, 2) the integration of tobacco use treatment into primary care, and 3) the existing social and organisational barriers to uptake of evidence-based recommendations.

Conclusion – Healthcare organisations seeking to reduce the impact of tobacco use on their patients are well served by tobacco-EHR systems that improve care. Managers can avoid sub-optimal implementation by considering several threats to effectiveness before proceeding to systems change.

Background: The mechanism of action of varenicline as a partial agonist may make it useful for cigarette reduction as smokers experience reduced craving and withdrawal at the same time their cigarettes provide reduced reinforcement value.

Case Description: The current case report describes a 51-year-old African American woman using varenicline to reduce her cigarette use. After making a substantial reduction in cigarettes per day (from 25 to 8), the patient unexpectedly began smoking considerably more (from 8 to 20) after 11 days treatment with varenicline.

Conclusions: The temporary increase in smoking while taking varenicline was likely the result of an ‘extinction burst’ where the extinction of a reward (e.g., nicotine's rewarding effects after smoking a cigarette) was temporarily associated with an increase in the behaviour usually associated with the reward (e.g., smoking a cigarette). Once explaining to her that no amount of cigarettes would overcome the feeling of reduced reward she likely felt while taking varenicline, she was able to reduce her smoking again.