WeQuit: Pilot Results for a Couple-Based Smoking Cessation Web App.

To examine the benefits of a culturally targeted compared with a nontargeted smoking cessation intervention on smoking cessation outcomes among lesbian, gay, bisexual, and transgender (LGBT) smokers. A prospective randomized design was used to evaluate the added benefits of an LGBT culturally targeted Courage to Quit (CTQ-CT) smoking cessation treatment (N = 172) compared with the standard intervention (CTQ; N = 173). The smoking cessation program consisted of six treatment sessions combined with 8 weeks of nicotine replacement therapy. The primary smoking cessation outcome was 7-day point prevalence quit rates. Secondary outcomes examined included changes in nicotine dependence, nicotine withdrawal, cigarettes per day, smoking urges, self-efficacy, and readiness to quit. Overall quit rates were 31.9% at 1 month, 21.1% at 3 months, 25.8% at 6 months, and 22.3% at 12 months. Quit rates did not differ between treatment groups [1 month OR = 0.81 (0.32, 2.09), 3 months OR = 0.65 (0.23, 1.78), 6 months OR = 0.45 (0.17, 1.21), 12 months OR = 0.70 (0.26, 1.91)]. Compared with baseline levels, all secondary smoking cessation outcomes measured were improved at 1 month and were maintained at 12-month follow-up. Compared with the CTQ, the CTQ-CT intervention was more highly rated on program effectiveness (d = 0.2, p = .011), intervention techniques (d = 0.2, p = .014), the treatment manual (d = 0.3, p < .001), and being targeted to the needs of LGBT smokers (d = 0.5, p < .0001). LGBT smokers receiving the CTQ intervention achieved smoking cessation outcomes in the range reported for other demographic groups. Cultural targeting improved the acceptability of the intervention but did not confer any additional benefit for smoking cessation outcomes. Study results have implications for understanding the benefits of culturally targeted compared with nontargeted smoking cessation interventions for improving smoking cessation outcomes among LGBT smokers. Shorter and longer term 7-day point prevalence quit rates associated with the targeted and nontargeted interventions were modest but comparable with other group-based interventions delivered in a community setting. Although cultural targeting improved the overall acceptability of the intervention, no added benefits were observed for the culturally targeted intervention on either the primary or secondary outcomes.

BackgroundCigarette smoking is highly concentrated among individuals with lower socioeconomic status (SES) who often lack access to smoking cessation services. Thus, smoking cessation in lower SES adults remains a critical public health concern that warrants further study and attention. Smokers attempting to quit are at the highest risk for lapse within the first weeks of their quit attempt, and an initial lapse is highly likely to lead to full relapse. It is essential to identify and understand behavioral factors that may increase or decrease the likelihood of successful smoking cessation among lower SES adults during a quit attempt (pre-and post-quit). Recently, sleep dysregulation, such as insufficient sleep duration, has been considered as a potential intervention target to address smoking behaviors (e.g., number of cigarettes smoked per day) and improve smoking cessation outcomes (e.g., abstinence). Recent studies have found that lower SES is associated with higher rates of poor sleep. Thus, SES should be accounted for when assessing sleep dysregulation during smoking cessation attempts. Although previous studies have examined the relationship between sleep dysregulation and smoking behavior and/or cessation outcomes, they have several methodological limitations, including the use of retrospective survey methods, use of cross-sectional study designs, relying solely on laboratory-based data collection, not assessing integrated sleep health dimensions (usually only sleep duration or quality is assessed), omitting lower SES adults who smoke, and focusing on a single pathway rather than bidirectional associations.MethodsThis study will use a real-time data capture approach among lower SES adults who are attempting to quit smoking. This approach will involve a granular examination of the bidirectional and temporal associations between daily sleep dysregulation and smoking cession processes (pre- and post-quit) using smartphone-based ecological momentary assessment (EMA) and wearable sensors. Specifically, we aim to identify bidirectional and temporal associations between daily smoking abstinence and sleep dysregulation via EMA and wrist-worn sensors during the first four weeks of a smoking cessation attempt.DiscussionFindings from this study will yield preliminary data that will be used to develop and implement a Just-in-Time-Adaptive Intervention (JITAI) that aims to improve sleep health during smoking cessation.

BackgroundSmoking cessation during pregnancy and the postpartum period by both women and their partners offers multiple health benefits. However, compared to pregnant/postpartum women, their partners are less likely to actively seek smoking cessation services. There is an increased recognition about the importance of tailored approaches to smoking cessation for expectant and new fathers. While Behavior Change Interventions (BCIs) are a promising approach for smoking cessation interventions, evidence on effectiveness exclusively among expectant and new fathers are fragmented and does not allow for many firm conclusions to be drawn.MethodsWe conducted a systematic review on effectiveness of BCIs on smoking cessation outcomes of expectant and new fathers both through individual and/or couple-based interventions. Peer reviewed articles were identified from eight databases without any date or language restriction.Two independent reviewers screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using a predeveloped data extraction sheet.ResultsWe retrieved 1222 studies, of which 39 were considered for full text screening after reviewing the titles and abstracts. An additional eight studies were identified from reviewing the reference list of review articles picked up by the databases search. A total of nine Randomised Control Trials were included in the study. Six studies targeted expectant/new fathers, two targeted couples and one primarily targeted women with an intervention component to men. While the follow-up measurements for men varied across studies, the majority reported biochemically verified quit rates at 6 months. Most of the interventions showed positive effects on cessation outcomes. BCI were heterogenous across studies. Findings are suggestive of gender targeted interventions being more likely to have positive cessation outcomes.ConclusionsThis systematic review found limited evidence supporting the effectiveness of BCI among expectant and new fathers, although the majority of studies show positive effects of these interventions on smoking cessation outcomes. There remains a need for more research targeted at expectant and new fathers. Further, there is a need to identify how smoking cessation service delivery can better address the needs of (all) gender(s) during pregnancy.

Since the outbreak of the COVID-19 pandemic, tobacco research has delivered new evidence on the harmfulness of smoking in the context of SARS-CoV-2 infection and the course of the COVID-19 disease. More and more research proves that smoking is an important risk factor contributing to increased risk of mortality among COVID-19 patients. The aim of this study was to assess whether and how the COVID-19 pandemic impacted decisions about quitting smoking. A total of 4072 records of anonymized data were obtained from the Polish National Quitline. Between 15 April 2020 and 31 May 2021, the callers were asked about the COVID-19 pandemic and its influence on their decisions on smoking continuation or cessation. Our results indicate that smokers are very receptive to communication concerning COVID-19 and smoking risk. This phenomenon can possibly be connected to the immediate potential health consequences of smoking and COVID-19 virus infection. Results may indicate that putting emphasis on arguments combined with short-term health consequences of smoking may result in better outcomes in smoking cessation. There is a need for further and constant education on tobacco-related health harm. Our results showed that an irregular and mass communication on health consequences may result in high effectiveness in smoking cessation.

Objective: This study assesses the effects of a 2005 increase in funding for smoking cessation services on provider participation, patient utilisation of smoking cessation services and cessation outcome at a...

Chronic pain often co-occurs with tobacco dependence. Nicotine's acute analgesic effects may increase the reward value of cigarettes and patients report smoking to cope with pain. These factors may hinder smoking cessation outcomes for individuals experiencing chronic pain; however, research on smoking cessation outcomes in this population has been limited. This study examined whether self-reported chronic pain diagnosis was associated with smoking cessation outcome among primary care patients seeking treatment to quit smoking. A secondary analysis was conducted using data from 48 573 patients who enrolled in a primary care-based smoking cessation program in Ontario between 2016 and 2019. We compared baseline and treatment characteristics of patients with and without a self-reported lifetime chronic pain diagnosis and used logistic generalized estimating equations to assess the association between chronic pain diagnosis at enrolment and 30-day point prevalence smoking abstinence at 6months. Approximately one-third of the sample (34.6%, n= 16 793) reported having a chronic pain diagnosis, of whom 72.2% (n= 11 369) were currently using medication for this condition. Those who reported a chronic pain diagnosis had a lower probability of past 30-day smoking abstinence at 6-month follow-up: unadjusted, 20.1% (19.4%-20.8%) vs. 24.7% (24.1%-25.3%), OR = 0.77, 95% CI = 0.73 to 0.82, p < .001; adjusted, 20.7% (19.8%-21.6%) vs. 22.4% (21.6%-23.2%), AOR = 0.90, 95% CI = 0.85 to 0.96, p = .001. Self-reported lifetime chronic pain diagnosis was associated with a modest decrease in response to treatment with nicotine replacement therapy combined with behavioral support. Further research is needed to clarify how and for whom chronic pain impacts cessation outcomes. The findings of this study suggest that primary care patients with a self-reported chronic pain diagnosis experience significantly worse smoking cessation outcomes following treatment with nicotine replacement therapy, and that opioid use is also independently associated with poorer quit outcomes. These associations were still significant after controlling for important potential confounding factors such as cannabis and alcohol use, heaviness of smoking, psychiatric comorbidity, and confidence in quitting. Further work is needed to establish whether addressing smoking cessation and pain management together may improve smoking cessation outcomes and reduce the burden of smoking-related health issues in this population.

Background The perinatal period is an optimal time to intervene for achieving smoking cessation in expectant parents and offers multiple health benefits for women and the newborn. While Behavior Change Technique (BCT) interventions are a promising approach to support pregnant smokers to quit smoking, effectiveness of these interventions among expectant and new fathers is not equally well documented. Better understanding of the potential utility of these BCT interventions for this group is important for the development of effective gender-sensitive programmes. Methods This systematic review examines the existing evidence on effectiveness of BCTs on smoking cessation outcomes when offered to expectant and new fathers (child &amp;lt; 1 year) both through individual and/or couple-based interventions. Eight databases were searched for peer-reviewed articles. Studies were subjected to systematic retrieval and quality-assessment by two independent reviewers. Results We identified 9 randomised control trial studies (including 4,681 men) that fulfilled the inclusion criteria. In terms of quit outcome data, 8 studies reported biochemically verified quit rates for men. While 5 BCT interventions targeted expectant/new fathers, 3 were directed to couples and 1 primarily focused on women with a component directed at men. Though most of the interventions were found to be effective, they showed small significant positive effects on cessation outcomes. Findings are suggestive of gender specific interventions being more likely to have positive outcomes. High heterogeneity across the studies made it difficult to determine the most effective BCT approach. Conclusions This review suggests that use of BCT interventions for smoking cessation among expectant and new fathers is effective in achieving positive quit rates; however, these studies are limited. Further research is needed to determine the most effective BCT approach associated with smoking cessation among this group. Key messages • BCT interventions for smoking cessation among expectant and new fathers are a promising approach to increase quit rates. • Future research needs to develop evidence based BCT interventions for smoking cessation specifically targeting expectant and new fathers to inform policy and practice.

Background and Objectives:Tobacco use is a major global health concern, contributing to six of the eight most common causes of death worldwide. In Turkey, the average number of cigarettes smoked per day by individuals over 15 years old surpasses the global average. To mitigate this public health issue, it is crucial to develop strategic education models and state policies. Additionally, closely monitoring patients who seek smoking cessation services can improve outcomes by identifying specific smoking patterns and tailoring treatments accordingly. This study aimed to analyze the smoking behavior, characteristics, and cessation outcomes of patients aged 25-65 years who visited the smoking cessation outpatient clinic.Methods:This cross-sectional prospective study included 307 patients. We collected socio-demographic data, prior smoking cessation experiences, addiction levels, and conducted medical examinations to assess health status and medical history. This information was used to develop personalized treatment and follow-up plans.Results:The mean age of the patients was 42±11 years, with 74% being married and 55% being male. At the end of a three-month period, the smoking cessation rate was 49% for women and 33% for men. Notably, patients who started smoking at a median age of 19±5 years had higher cessation rates compared to those who started at 17±4 years. The most common reasons cited for starting smoking were environmental, social, and curiosity factors.Conclusion:Our findings suggest that a personalized approach to smoking cessation, which takes into account factors such as age, gender, and comorbidities, may be more effective in helping patients quit smoking. Future research should focus on long-term outcomes and the impact of specific interventions tailored to individual patient characteristics.

S09-01 - Nicotine dependence, psychological distress, personality traits as possible predictors of smoking cessation. Results of a double-blind study with nicotine patch

Though rates of tobacco smoking have decreased consistently over the past 3 decades, cigarette use remains the top preventable cause of premature death in North America. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is a medical clinic-based intervention that systematically screens parents for tobacco use and offers them direct access to evidence-based smoking cessation services. While the effectiveness of CEASE for parents who smoke has already been demonstrated in the United States, the CEASE model has not yet been tested in Canada, among parents who use e-cigarettes, or among adolescents who use cigarettes and e-cigarettes. We aim to demonstrate the feasibility and evaluate the preliminary effectiveness of the CEASE program for parental smoking cessation and its adapted version for adolescent smoking cessation and adolescent and parental vaping cessation. We will approach parents or guardians of children aged between 0 and 17 years, as well as adolescent patients aged between 14 and 17 years, from a tertiary care pediatric hospital in Montreal, Quebec, Canada, for participation in this single-blinded, pilot randomized controlled trial. Eligible participants are those who report using tobacco cigarettes or e-cigarettes at least once in the last 7 days and present to an outpatient pediatric clinic for a scheduled appointment. Our recruitment target is 100 participants: 50 parents or guardians of children aged 17 years or younger, and 50 adolescents aged between 14 and 17 years. The feasibility of implementation of the CEASE model will be measured by recruitment and retention rates for all 4 participant groups (stratified as follows: parents who use cigarettes, parents who use e-cigarettes exclusively, adolescents who use cigarettes, and adolescents who use e-cigarettes exclusively). Parent and adolescent participants within each group are randomized to the intervention and control groups using a 1:1 ratio through a computer-generated randomization list. Preliminary effectiveness outcomes include self-reported smoking and e-cigarette cessation, use of cessation resources, changes in smoking and e-cigarette use, motivation to quit, and quit attempts among participants. Participants complete electronic questionnaires on a tablet in the clinic at baseline as well as electronic follow-up questionnaires at 1, 3, and 6 months. Individuals reporting successful quit attempts are invited to provide a urine sample for cotinine testing to biochemically confirm quit. Analyses include descriptive statistics as well as exploratory trajectory analyses of smoking, e-cigarette use, and motivation to quit. Research activities began in June 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 15 months. There is a strong need for effective and cost-effective smoking and vaping cessation interventions for parents and adolescents. If successful, this study will help inform the preparation of a fully powered randomized controlled trial of CEASE in Canada in these populations. Clinicaltrials.gov NCT05366790; https://www.clinicaltrials.gov/study/NCT05366790. DERR1-10.2196/47978.

Many marginalized groups smoke at higher rates and have greater difficulty quitting than less marginalized groups. Most research on smoking cessation inequities has focused on a single sociodemographic attribute (eg, race or socioeconomic status), yet individuals possess multiple attributes that may increase risk. The current study used an intersectionality framework to examine how the interplay between multiple marginalized attributes may impact smoking cessation outcomes. A diverse sample of 344 adults enrolled in a smoking cessation program and reported on sociodemographic attributes (eg, race/ethnicity, gender, income) and continuous smoking abstinence on their quit date and at 1, 2, and 4 weeks postquit date. A Cox proportional hazard regression model was used to estimate whether intersectional links among race/ethnicity, gender, and income were related to smoking cessation outcomes. Lower household income may be related to higher risk of smoking cessation failure. There were no significant interactions among race/ethnicity, gender, and income in predicting relapse. Pairwise intersectional group differences suggested some groups may be at higher risk of relapse. Number of marginalized sociodemographic attributes did not predict relapse. Intersectionality may be a promising framework for addressing health inequities, and may help elucidate how to best design and target intervention efforts for individuals characterized by sociodemographic intersections that concur particularly high risk for poor tobacco cessation outcomes. Despite an overall decline in smoking rates, socioeconomic inequities in smoking prevalence and cancer mortality are widening. Efforts targeting tobacco cessation should incorporate new theory to capture the complex set of factors that may account for tobacco cessation inequities (eg, multiple aspects of identity that may influence access to tobacco cessation treatment and exposure to certain stressors that impede cessation efforts). Intersectionality may be a promising framework for addressing health inequities in tobacco use and cessation and may help elucidate how to best design and target intervention efforts for individuals that concur particularly high risk for poor tobacco cessation outcomes.

Taking regular exercise, whether cardiovascular-type exercise or resistance exercise, may help people to give up smoking, particularly by reducing cigarette withdrawal symptoms and cravings, and by helping to manage weight gain. To determine the effectiveness of exercise-based interventions alone, or combined with a smoking cessation programme, for achieving long-term smoking cessation, compared with a smoking cessation intervention alone or other non-exercise intervention. We searched the Cochrane Tobacco Addiction Group Specialised Register for studies, using the term 'exercise' or 'physical activity' in the title, abstract or keywords. The date of the most recent search was May 2019. We included randomised controlled trials that compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme alone or another non-exercise control group. Trials were required to recruit smokers wishing to quit or recent quitters, to assess abstinence as an outcome and have follow-up of at least six months. We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison, as either smoking cessation or relapse prevention. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group-based cardiovascular-type exercise supplemented by a home-based exercise programme and combined with a multi-session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi-session cognitive behavioural smoking cessation programme alone. Overall, we judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. Among the 21 studies analysed, we found low-certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). We excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular-type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular-type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when we excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, we found very low-certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long-term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions.

There are currently more than 1.3 billion tobacco smokers in the world according to the World Health Organization (WHO) (1). It has been demonstrated that cigarette smoking is the most important risk factor for the development and progression of chronic obstructive pulmonary disease (COPD), and accounts for about 80% of COPD cases (2, 3). COPD, a term referring to two respiratory system diseases: chronic bronchitis and emphysema, is characterized by an airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and related to the abnormal inflammatory response of the lungs to inhaled noxious particles or gases (4, 5). It has been reported that 10% to 15% of all smokers (6) and up to 26% of heavy smokers develop COPD (7). As the prevalence of smoking has risen among females and decreased slightly among males, the sexual distribution of COPD deaths has shifted from 19% female in 1970 to 38.5% in 1993 (8). Cigarette smoking, especially heavy smoking, long duration of smoking, and smoking of high-tar cigarettes accounts for important factors that contribute to the progression of COPD (9). Cigarette smoke contains more than 4000 deleterious chemical compounds, of which 200 are very toxic, and 1017 free radicals/oxidants per puff (10). In general, it has been accepted that the treatments available for COPD reduce the number and severity of exacerbations and restablish symptoms. However, available treatment do not aide in tackling the cause and ongoing problems of the disease, and have a limited effect on slowing down the progression of lung damage and inflammation (11). Smoking cessation is considered as the first treatment in patients with chronic COPD. Its effect on airway inflammation in COPD is not well described, although cross-sectional studies suggest ongoing inflammation in ex-smokers (12). So far, smoking cessation is considered the only effective treatment for avoiding or reducing the progression of COPD (13). There are several smoking cessation medications and devices available commercially. However, there are contradictory observations regarding the effect of smoking cessation on airway inflammation and remodeling associated with COPD including the use of smoking cessation medications and devices. Studies in COPD patients indicated that smoking cessation improves respiratory symptoms, reduces loss of pulmonary function and decreases lung inflammation and oxidative stress (14–19), whilst some studies indicated that smoking cessation fails to reverse the chronic airway inflammation (19–21). Unfortunately, there is insufficient observation available regarding the effects of smoking cessation on pro-inflammatory mediators levels, which do play a pivotal role in the pathogenesis of COPD. In the following sections, recent studies on the potential role of cigarette smoke cessation on the progression and development of COPD is summarized. Evidence of animal modeling of lung emphysema As indicated earlier, there is contradictory data available on the role of quitting cigarette smoking as it relates to the development of lungs injury and inflammation. This is due to the insufficient evidence on the effects of smoking cessation and the release of inflammatory mediators, which do play an important role in airway inflammation and tissue remodeling seen in COPD. Therefore, an animal model of cigarette smoke-induced lung emphysema usually is practical. In this regard, the severity of airway remodeling and inflammation was assessed by analyzing the alveolar enlargement, heart hypertrophy, and inflammatory cells in the BALF and lung tissue and by determining the profiles of cytokine and chemokine in the BALF of animals. Wright et al. (22) and March et al. (23), for the first time demonstrated that emphysema was still present in guinea pigs and mice after smoke exposure followed by a smoking cessation period. Thereafter, Vernooy et al (24) found that the long-term LPS exposure results in irreversible alveolar enlargement in mice. Recently Braber et al described the alveolar enlargement and right ventricle heart hypertrophy in smoke-exposed mice remained unchanged, however the neutrophilic inflammation of BALF was decreased, and levels of IL-12 in BALF remained at high levels after smoking cessation. It has been shown that cigarette smoke-enhanced VEGF levels did not significantly change after smoking cessation (25). In conclusion, animal models of CS-induced lung emphysema could partially regressed after smoke-cessation/stopping the CS exposures.

Drinking is a common unhealthy behaviour among youth smokers aged 25 or below. However, the effects of drinking on smoking cessation outcomes are not well understood. This study aimed to explore the impact of drinking on smoking cessation outcomes among Hong Kong Chinese youth smokers who received smoking cessation counselling. This study adopted a cross-sectional design at the Youth Quitline, which is the only government-funded hotline providing telephone smoking cessation counselling to Hong Kong smokers aged 25 or younger. Of the 142 participants at the six-month follow-up, 75 were in the drinking group and 67 in the non-drinking group. Multiple logistic regression analyses were performed to identify any significant differences in self-reported quit rates, smoking reduction by at least 50%, quit attempts, and biochemically validated quit rates between the drinking and non-drinking groups. The results showed a significant difference in self-reported quit rate between the two groups at 6-month, but no significant difference in smoking reduction by at least 50%, quit attempts, and biochemically validated quit rate. Alcohol drinking and male were identified as significant factors decreasing self-reported quit rate at 6 months. The study revealed that drinking could decrease quit rates among young smokers who received counselling, but not their smoking reduction or quit attempts. Given the negative impact of drinking on smoking abstinence and the increased popularity of drinking among the youth, assessment of alcohol use and brief advice on smoking are recommended to be an integral part of smoking cessation counselling for youth smokers.

Few studies have evaluated predictors of smoking cessation outcomes in smokers with attention-deficit/hyperactivity disorder (ADHD), which could help to improve suboptimal treatment outcomes in this population. The purpose of this study was to examine pretreatment thoughts about smoking abstinence (i.e., desire to quit, perceived difficulty quitting, and expected success in quitting) as predictors of smoking cessation outcomes in smokers with ADHD and to determine the extent to which treatment adherence mediates these relationships. Participants were adult smokers with ADHD (n = 255), who were enrolled in a multisite smoking cessation study and received either osmotic-release oral system methylphenidate (OROS-MPH) or placebo in combination with transdermal nicotine replacement and brief cessation counseling. Bootstrapped logistic regression models were generated to test main effects of thoughts about abstinence on smoking cessation outcomes and to examine treatment adherence as a mediator of these relationships. Desire to quit and expected success in quitting, but not perceived difficulty quitting, predicted smoking cessation outcomes, as did all of the treatment adherence variables (i.e., percent sessions attended, counselor ratings of counseling adherence, and percent patch adherence). Counseling adherence partially mediated the relationship between smoking cessation outcomes and both pretreatment desire to quit and expected success. Smokers with ADHD who have higher self-efficacy (i.e., expected success) and motivation (i.e., desire) to quit are more adherent to smoking cessation counseling and have better smoking cessation outcomes. Additional research is needed to determine whether treatment-seeking smokers with ADHD would benefit from an intervention designed to increase self-efficacy and motivation to quit.