Smoking cessation has been the primary goal for those of us working in tobacco treatment for many decades. However, we have all noticed that in countries where there is a strong anti-smoking climate, there seems to be an increasing percentage of smokers, willing and motivated to quit, who, despite all efforts on our part, find it very difficult to achieve this. ‘Harm reduction’ or ‘harm minimisation’ strategies have become part of our agenda and is now offered routinely to smokers in these circumstances. As these strategies invariably incorporate concurrent smoking with nicotine-containing products, there is the dilemma of on-going nicotine usage, or ‘therapeutic/medicinal nicotine’ for extended periods of time (though evidently better and safer than smoking alone).

Detailed descriptions of effective intervention protocols for Asian smokers are uncommon which makes it difficult for others to successfully implement a protocol that has been proven to be effective. This article fills a gap by detailing such a protocol, specifically a telephone counselling intervention for Asian smokers. The protocol was tested in a large randomised trial with Chinese-, Korean-, and Vietnamese-speaking smokers and was shown to significantly increase quit rates. The article describes the approach used to develop the protocol and critical components of the intervention. In addition, the paper compares data on programme participation and satisfaction among Chinese-, Korean-, and Vietnamese-speaking smokers with those for English- and Spanish-speaking smokers from two studies conducted in the US and shows that the former are no less likely to engage in counselling and no less likely to be satisfied with the process.

Since its launch as a smoking cessation aid, varenicline use has been linked to a number of serious adverse events, notably the exacerbation of pre-existing psychiatric illness, depressed mood and suicidal ideation. Regulators’ fears have been somewhat allayed by varenicline's status as a prescription only medication. The purpose of this study was to examine the care provided by physicians – or general practitioners – and pharmacists to varenicline users under real-world conditions. Participants were 141 patients who had filled a prescription for varenicline at a participating pharmacy within the previous six-months. Identified patients were mailed a survey to complete that included items on interactions with their physician and pharmacy staff, and knowledge of treatment side-effects. Most participants reported that their physician encouraged them to set a quit date (82.5%) and provided additional cessation materials (57.2%). While most (79.0%) physicians discussed whether varenicline was appropriate for the patient, fewer asked about psychiatric illness (40.1%), or asked to be informed about mood or behaviour change during treatment (48.1%). Participants (78.4%) reported that their physician had discussed a follow-up consultation, but only 59.4% of patients who had finished treatment at the time of the survey reported having one. Most reported discussing potential drug side-effects with their physician (71.0%) and or pharmacist (52.9%); when probed, knowledge was variable. These results suggest that many patients do not receive the level of support that physicians and pharmacists are assumed to provide.

This study sought to obtain a preliminary assessment of whether a new model of behaviour change (SNAP) could provide a useful conceptual framework for classifying smokers’ reports of their beliefs and feelings about the process of stopping smoking. Eight smokers’ clinic attendees in Malaysia underwent semi-structured interviews before and four weeks after the start of their quit attempt. A variant of Template Analysis found support for the view that smokers’ inferred identities could be reliably classified in the terms Smoker, Non-smoker, Attempter or Planner (SNAP) using self-statements about their motivation and behaviour as well as identity. There was evidence for wide variation in the coherence of smokers’ beliefs and feelings defined in terms of the proportion that fitted their modal SNAP category. As would be expected there was a shift in SNAP categories pre- to post-quit in those who were not smoking but only so far as ‘attempter’. An important next step is to assess how far lack of coherence in a given identity predicts transitions to other categories.

Introduction: While numerous barriers to smoking cessation in pregnancy have been identified, less is known about the role of pregnant smokers’ beliefs in promoting and inhibiting abstinence. This study explored these beliefs and how they might interact with psychosocial factors related to pregnancy and antenatal care.

Methods: In-depth face-to-face semi-structured interviews were conducted with 20 women with experience of prenatal smoking. Grounded theory and the constant comparative approach guided the analysis towards a theoretical explanation of the women's experiences.

Results: Cognitive dissonance generated by the discrepancy between smoking-related prenatal harm beliefs and continued smoking was a strong motivator to quit. However, difficulty in quitting led many to resolve this dissonance by endorsing disengagement beliefs which downplayed the threat of smoking. Four main types of disengagement belief were identified. The tendency to endorse disengagement beliefs appeared to be influenced by two factors: uncertainty about how smoking caused foetal harm and reassurance from health professionals and others that reduced smoking was sufficient for harm minimisation.

Conclusions: Disengagement belief endorsement is common among pregnant smokers and enables the justification of continued smoking, potentially hindering efforts to quit. Increased promotion of complete abstinence by antenatal care professionals and health education interventions targeting risk comprehension and disengagement belief endorsement should be considered to promote greater efforts to quit among pregnant smokers.

Introduction: The ability of Swedish snus to serve as a smoking cessation aid has been documented in several observational, population surveys from Scandinavia, but randomised clinical trials provide more reliable information on efficacy. Aims: To perform a systematic review and meta-analysis of randomised clinical trials of Swedish snus as an aid to smoking cessation. Methods: Literature searches were conducted in MedLine, Cochrane Library, and Embase to identify relevant clinical trials. The primary outcome was defined as biologically confirmed smoking cessation during around six months. Meta-analyses based on primary subject data tested for effect of allocated treatment as well as selected baseline characteristics. Results: There were two relevant clinical trials, one conducted at five sites in the US (n = 250), the other at two sites in Serbia (n = 319). Based on the primary outcome, success was higher in the treated group in both Serbia (5.7% vs 1.9%) and the US (4.0% vs 1.6%). Meta-analysis estimated the relative success rate at 2.83 (95% CI 1.03–7.75), which was of borderline significance (exact p = 0.06, chi-squared p = 0.03). For smoking cessation in the last 4 weeks of each study, rates were 12.4% for snus and 6.6% for placebo (RR 1.86, 95% CI 1.09-3.18). Efficacy of snus was not clearly related to any baseline characteristic. Conclusions: Swedish snus increased quit rates similarly in US and Serbia. These results confirm and extend previous information based on observational population surveys.

Aims: To review population surveys to assess (a) prevalence of the use of NRT for smoking reduction (SR) and temporary abstinence (TA) and (b) how far this is associated with attempts to stop smoking, smoking cessation and reduction in cigarette consumption.

Methods: An electronic search was undertaken of EMBASE, MEDLINE, Web of Science and PsycINFO. Articles were selected if they (1) assessed whether smokers had used or were currently using NRT for SR and/or TA; (2) involved smokers who had not taken part in a harm reduction programme; and (3) assessed prevalence and/or association of SR and/or TA with reductions in cigarette consumption and/or attempts to stop smoking and/or with smoking cessation. Twelve studies met the inclusion criteria and results were extracted independently by two researchers.

Results: Data were available from five countries (US, UK, Canada, Switzerland and Australia). Between 1% and 23% of smokers reported having ever used NRT for smoking reduction and between 2% and 14% during periods of temporary abstinence. Use of NRT for SR and/or TA was associated with little or no reduction in cigarette consumption. There was some evidence that it was positively associated with attempts to stop smoking and smoking cessation.

Conclusion: In smoking populations use of NRT to aid SR and in situations where smoking is not permitted appears to be having little effect on achieving a reduction in cigarette consumption but does not undermine cessation and may promote it.

It is not uncommon for staff of mental health facilities to have diverging opinions regarding the tobacco use of their patients. Surveys have shown that a significant proportion of staff believe that the smoke free policies are harsh and difficult to implement in health facilities where patient compliance is a matter of serious concern (Lawn, 2004, Wye et al., 2010). Intra-staff disputes and arguments with patients as to how to implement these policies, if at all, occur frequently. This protocol was developed at the request of staff at a mental health facility for HIV AIDS patients afflicted with dementia. Staff were concerned about imminent smoke-free regulations that would impact on their unit.

Carbon monoxide-validated four-week smoking abstinence from 167,487 treatment episodes among patients from 42 UK National Health Service Stop Smoking Services (1 April 2009, to 30 June 2011) showed smoking abstinence rates were higher with varenicline than combination nicotine replacement therapy (43.5% vs. 36.9%) but systematic variation in medication effect across clinical services and differences in predictors of outcome between medications resulted in a small mean advantage for varenicline (odds ratio, 1.080; 95% CI, 1.003–1.163; difference, 1.86%; 95% CI, 0.07%–3.67%; P = .04).