Smoking Cessation Aid Research Articles

‘Vaping is a break from all of that’: Exploring attitudes, harm perceptions, cessation barriers and social dynamics among people who vape

Objective: Vaping, initially a smoking cessation aid, is now a widespread recreational activity sometimes associated with perceived health concerns. This study explored attitudes, harm perceptions and cessation barriers in the context of participants’ vaping behaviours, guided by the theoretical lens of fundamental social causes. Design and Setting: The study focused on a subset of 571 current adult vapers from a larger survey investigating vaping attitudes. It analysed open-text survey responses relating to vaping behaviours. To analyse the responses, we employed layered analyses, using deductive conceptual mapping to inform an inductive thematic content analysis. Results: Participants mentioned nuanced vaping risks, citing cancer and respiratory concerns, often comparing them to tobacco’s well-known harmful effects. Despite acknowledging vaping’s potential harms, participants perceived the practice to be less harmful than smoking, emphasising relative safety. Some viewed vaping positively for former smokers, contingent on regulated products. This complex attitude balance reflected the intricate interplay between health concerns and social dynamics. Recurrent vaping symbolised consistent engagement, with cravings and widespread availability associated with quitting challenges. Conclusions: Participants’ nuanced perceptions of health risks reflect a harm duopoly, resembling illicit drug harm tiering. There is a complex interplay between health knowledge and social influences in the context of vaping behaviours. Study findings underscore the need for messaging interventions discouraging vaping among those who do not smoke tobacco to consider these health and social dynamics, leveraging collaborative design.

Understanding use of e-cigarettes for smoking cessation among a sample of US adults.

Many adults who smoke cigarettes report trying e-cigarettes to quit smoking. Understanding the use of e-cigarettes for smoking cessation and the type of support that adults desire when trying to quit smoking is important for supporting cessation attempts and maximizing smoking abstinence. In summer 2021, an online survey of 857 adults who reported a history of regular cigarette smoking and endorsed using e-cigarettes in a recent smoking cessation attempt was conducted. Survey items assessed reasons for using e-cigarettes to quit smoking, what was helpful about e-cigarettes, and what information participants desired when using e-cigarettes to quit smoking. Common reasons for using e-cigarettes to quit smoking included beliefs that vaping would be helpful for quitting (53.6%), vaping is safer than smoking (50.5%), and favorable comparisons relative to other nicotine replacement treatment (NRT) like nicotine patches and gum (24.7%). 23.8% selected e-cigarettes because they were cheaper than other smoking cessation aids. 89% of participants reported still smoking cigarettes at the time of survey. The most common information people wanted when quitting was advice on how to gradually reduce nicotine over time to become nicotine-free (46.3%), how different vaping devices work (39.7%), and what nicotine concentration to start with (37.7%). Findings identified common beliefs about e-cigarettes as a smoking cessation aid and how they compare to other treatments including NRT. Understanding factors that support cessation are critical especially due to high relapse rates. Results may help to inform support programs, especially for individuals who are interested in using e-cigarettes to quit smoking. Despite greater reporting, there is a limited understanding of e-cigarette use for quitting among those who smoke cigarettes.Our study highlights the reasons for using e-cigarettes among those who have recently tried e-cigarettes for quitting smoking, and the components of e-cigarette that were helpful.We also examined the desired support in a program designed to use e-cigarettes for quitting smoking. Majority of participants who attempted to quit smoking using an e-cigarette relapsed to smoking, indicating the gap in cessation support that can be filled with greater understanding of the desired support.

Sensors for Smoking Detection in Epidemiological Research: Scoping Review.

The use of wearable sensors is being explored as a challenging way to accurately identify smoking behaviors by measuring physiological and environmental factors in real-life settings. Although they hold potential benefits for aiding smoking cessation, no single wearable device currently achieves high accuracy in detecting smoking events. Furthermore, it is crucial to emphasize that this area of study is dynamic and requires ongoing updates. This scoping review aims to map the scientific literature for identifying the main sensors developed or used for tobacco smoke detection, with a specific focus on wearable sensors, as well as describe their key features and categorize them by type. According to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, an electronic search was conducted on the PubMed, MEDLINE, and Web of Science databases, using the following keywords: ("biosensors" OR "biosensor" OR "sensors" OR "sensor" OR "wearable") AND ("smoking" OR "smoke"). Among a total of 37 studies included in this scoping review published between 2012 and March 2024, 16 described sensors based on wearable bands, 15 described multisensory systems, and 6 described other strategies to detect tobacco smoke exposure. Included studies provided details about the design or application of wearable sensors based on an elastic band to detect different aspects of tobacco smoke exposure (eg, arm, wrist, and finger movements, and lighting events). Some studies proposed a system composed of different sensor modalities (eg, Personal Automatic Cigarette Tracker [PACT], PACT 2.0, and AutoSense). Our scoping review has revealed both the obstacles and opportunities linked to wearable devices, offering valuable insights for future research initiatives. Tackling the recognized challenges and delving into potential avenues for enhancement could elevate wearable devices into even more effective tools for aiding smoking cessation. In this context, continuous research is essential to fine-tune and optimize these devices, guaranteeing their practicality and reliability in real-world applications.

Smoking cessation medicines and e-cigarettes in smokers with obesity

Abstract Purpose The interaction between obesity and smoking is complex. Aim of this study is to compare the abstinence rates of smoking cessation pharmacotherapies vs electronic cigarettes in obese smokers. Methods 57 obese smokers (aged 41±8 years, BMI: 33.8 ±2.4 Kg/m2) visiting our unit from January 2016 to November 2022 were randomized into three smoking cessation therapy groups: 1. NRT (nicotine patch), 2. NRT + bupropion (NRT+bupr) and 3. Electronic cigarette (EC). Results There were not significant differences in severity of nicotine dependence and cigarette consumption (pack-years) between the three treatment groups. Furthermore, the three groups had similar age and prevalence of traditional risk factors. At the end of treatment period (3 months), 5/19 (26 %) and 9/19 (47%) of subjects under therapy with NRT alone and NRT + bupropion combination respectively, were abstinent from smoking while 10/19 (53%) of individuals using EC did not smoke combustible cigarettes. Left plot shows the continuous abstinence rates at 6 months. Continuous abstinence rates were similar in the NRT and NRT+bupropion group at 6 months compared to 3 months (end of treatment), while 8/19 (42%) of individuals using EC did not smoke. Interestingly , at 6 months among users of EC 6 continued vaping nicotine alone, 7 continued to smoke tobacco cigarettes while vaping and 4 continued smoking cigarettes alone. Nevertheless only 2 out of 19 participants in that group stayed abstinent from both combustible cigarette smoking and vaping. Blood pressure remained unchanged in all groups while weight decreased in the group treated with the combination of bupropion and NRT compared to NRT alone and EC groups (right plot, P<0.01). Conclusions Our preliminary data indicate that continuous abstinence rates at 6 months were higher in obese smokers receiving NRT+bupropion combination therapy compared to those of individuals who used NRT alone. There is also a low abstinence rate of both cigarette smoking and vaping among individuals using EC as an aid for smoking cessation. The NRT+bupropion combination therapy was associated with a favorable effect on weight change in obese smokers.EC vs pharmacotherapy in obese smokers

Positive effects from the introduction of fully subsidised nicotine replacement therapy in Ireland

Abstract Smoking remains a leading cause of preventable death in the Europe. Despite recent declines in prevalence, the adverse health and economic effects of smoking are felt disproportionately by disadvantaged groups. Nicotine replacement therapy (NRT) is well established as an effective smoking cessation aid; however, its financial cost may act as a barrier to uptake. In February 2023, eligibly for fully subsidised NRT was expanded to all users of smoking cessation services in Ireland. This study evaluated the impact of universal access to NRT on smoking cessation. This study utilised secondary analysis of routinely collected data from service users attending Irish smoking cessation services. Individuals were followed for twelve weeks. Changes in self-reported quit status and NRT use were analysed before (January 2021 - February 2023) and after (March 2023 - December 2023) the introduction of fully subsidised NRT. Logistic regression modelling identified factors associated with smoking cessation. The total number of participants was 19,717. There was higher uptake of NRT among service users who were eligible for free NRT (59% vs 40%, p < 0.001) and higher quit rates at four (41% vs 29%, p < 0.001) and twelve (29% vs 20%, p < 0.001) weeks. Logistic regression models demonstrated that NRT use was significantly associated with smoking cessation at four (aOR 1.88, 95%CI 1.47 - 2.41) and twelve (aOR 1.76, 95%CI 1.37 - 2.28) weeks. This study confirms the effectiveness of NRT in an Irish context and illustrates the benefits of universal access to this life saving medicine. Targeted interventions are required to intensify services offered to disadvantages groups if the ambitious objectives of Tobacco Endgame are to be achieved. These findings represent an urgent call to action for European policy makers to deliver equitable access to NRT across the continent. Such action can transform the public health landscape and help bring us closer to achieving a tobacco free Europe. Key messages • This study confirms the real-world effectiveness of NRT use as a smoking cessation aid. • The removal of financial barriers is associated with increased NRT use and successful smoking cessation.

Relationship between perception of body image on obesity and smoking status by age group in women: Findings of a seven-year Korean National Survey.

This descriptive study examined the relationship between body image perception and smoking status among women aged 19-64 years in Korea, using data from the Korea National Health and Nutrition Examination Survey (KNHANES). This study is a secondary analysis of data gathered from the KNHANES between 2014 and 2020, encompassing 12515 women aged 19-64 years. The final study group consisted of 742 current smokers (CS), 132 hidden smokers (HS), and 11641 non-smokers (NS). Hidden smokers were defined as participants who reported being non-smokers but had urine cotinine levels >50 ng/mL. The participants were divided into three age categories: 19-29, 30-49, and 50-64 years. A multiple logistic regression analysis was used to assess the relationship between body image perception and smoking status, by age group. Baseline statistics indicated that smokers (both CS and HS) generally had a lower socioeconomic status across all age groups. The highest rate of obesity perception was observed in the CS group, followed by the HS group, in both groups of women aged 19-29 and 30-49 years. However, only women aged 19-29 years in the CS group were more likely to perceive themselves as obese than those in the NS group (AOR=2.60; 95% CI: 1.49-4.52; p=0.001). Furthermore, factors such as current smoking status (AOR=2.32; 95% CI: 1.28-4.23; p=0.006), higher body mass index (AOR=2.95; 95% CI: 2.59-3.37; p<0.001), and perceived health status as poor (AOR=3.82; 95% CI: 2.11-6.92; p<0.001), significantly influenced the perception of obesity in this age group. This study identified a notable relationship between obesity perception and smoking among women aged 19-29 years only. These findings suggest that interventions aimed at weight reduction or modifying the perception of obesity, could potentially aid smoking cessation efforts in young women.

Perceptions of the Use of Mobile Technologies for Smoking Cessation: Focus Group Study With Individuals of Low Socioeconomic Status Who Smoke.

The use of mobile technologies to deliver behavioral health interventions, including smoking cessation support, has grown. Users' perceptions are important determinants of the adoption and use of new technologies. However, little is known about users' perceptions of mobile technologies as smoking cessation aids, particularly among disadvantaged individuals who smoke. This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke. In total, 38 current cigarette smokers, 18 to 29 years old, who wanted to quit and did not have a 4-year college degree nor were enrolled in a 4-year college, participated in 12 semistructured digital focus groups. The moderation guide was guided by the Unified Theory of Acceptance and Use of Technology. Discussions were audio recorded, transcribed verbatim, and coded for the Unified Theory of Acceptance and Use of Technology constructs (ie, effort expectancy, facilitating conditions, performance expectancy, and social influence), sentiment (ie, negative, neutral, and positive), and purpose of using mobile technologies (ie, lifestyle and health management and smoking cessation) following a deductive thematic analysis approach. Participants had positive experiences using mobile technologies for lifestyle and health management, primarily for fitness and dietary purposes. Salient themes were facilitating conditions of use (44/80, 55%), with prior experiences and costs subthemes, followed by perceived usefulness of mobile technologies in helping users attain health goals (22/80, 27.50%), which were generally positive. Ease of use (11/80, 13.75%) and social influences (3/80, 3.75%) were minimally discussed. Conversely, participants had limited awareness of smoking cessation uses of mobile technologies, which was the primary barrier under facilitating conditions discussed (33/51, 64.70%). Participants expressed skepticism about the usefulness of mobile technologies in helping them quit smoking (14/51, 27.45%). Effort expectancy was not discussed, given participants' limited prior use. Social influences on mobile technology use for smoking cessation were minimally discussed (4/51, 7.84%). The use of mobile technologies for smoking cessation was unknown to young adults with low socioeconomic status who smoke. To reduce cigarette smoking and associated health disparities, increasing awareness and use of evidence-based mobile-based smoking cessation interventions are needed. Smoking cessation interventions should incorporate features perceived as useful and easy to use to capitalize on positive user experiences and the acceptability of mobile technologies for lifestyle and health management.

Combining Default Choices and an Encounter Decision Aid to Improve Tobacco Cessation in Primary Care Patients: A Pragmatic, Cluster-Randomized Trial.

Primary care providers (PCPs) prescribe less often treatments for smoking cessation than for other major risk factors. We assessed the effect of training PCPs to offer smoking cessation treatments to current smokers as the default choice using an encounter decision aid (DA) on smoking cessation. Pragmatic, cluster-randomized controlled trial with PCPs in private practice in Switzerland and France. The intervention was a half-day course teaching PCPs the default choice approach using a DA. Control PCPs received a 1-h refresher training on smoking cessation aids. PCPs recruited daily smokers seen for routine care. The primary outcome was self-reported, 7-day, point prevalence smoking abstinence at 6 months. Secondary outcomes were quit attempts and use of smoking cessation aids at 3 weeks, 3 months, and 6 months, and a patient-reported measure of shared decision-making (CollaboRATE scale 1-10, higher scores = more involvement). Forty-two PCPs completed the training (76% Swiss) and recruited 287 current smokers (105 intervention group, 182 control group), with 51% women, mean age 48 (SD, 2.6), 77% who smoked <20 cigarettes/day, and 221 who responded at 6 months follow-up (77%). The intervention did not affect self-reported smoking abstinence rate at 6 months (9.5% intervention and 10.4% control groups, respectively; OR 0.88 (95%CI 0.37-2.10). It did however increase the number of quit attempts at 3 weeks (OR 2.09, 95%CI 1.04-4.20) and the use of smoking cessation aids at the 3-week and 3-month follow-ups (OR 2.57, 95%CI 1.21-5.45 and OR 2.00, 95%CI 1.11-3.60, respectively). The mean CollaboRATE score was 8.05/10 in the intervention group and 7.28/10 in the control group (p=0.02), reflecting more patient involvement in decision-making. Training PCPs to use a decision aid did not improve smoking abstinence rate, despite short-term increases in quit attempts and use of smoking cessation aids. It improved patient involvement in decision-making. ClinicalTrials.gov identifier: NCT04868474.

New image, same tactics: global tobacco and vaping industry strategies to promote youth vaping.

E-cigarette use (or vaping) is widespread in young people and is a rapidly growing public health problem. While the tobacco and vaping industry has promoted vaping as a smoking cessation aid for adults, the industry has strategically targeted young people through marketing and appealing designs to orientate a new generation of consumers to use their products. These strategies are not new and replicate what we have previously seen employed by the tobacco industry in past decades to maintain and grow their tobacco profits. We review the evidence on tobacco and vaping industry interference, highlighting the calculated and strategic use of interference tactics as a discourse to curb tobacco control efforts. We demonstrate how these tried and tested strategies are now being purposefully re-used in the context of vaping. As Australia is currently undergoing significant policy reforms for the access and retail of vaping products, we also provide a case study of the industry response played out in this contemporary landscape. Government and public health advocates are in a key position to be one step ahead in proactively tackling the vaping crisis. We recommend that continued monitoring of industry activities and strategies, achieving political transparency and tightening loopholes in current regulations are all needed to identify and eliminate the tobacco and vaping industry's influence on policymaking. Given their previous track record, we emphasize the need to counter industry interference tactics with urgency to prevent a new generation of nicotine dependence and to support and protect future action in tobacco control.

Nicotine acute impact on RNFL: a comparative analysis of smoking cessation aids including nicotine gum and electronic cigarettes

Purpose To investigate the immediate impact of nicotine consumption on Retinal Nerve Fiber Layer (RNFL) thickness in healthy young individuals, comparing nicotine gum and electronic cigarette (vaping) as delivery methods. Materials and Methods Twenty participants underwent RNFL measurements at baseline, 30, and 60 minutes after consuming 4 mg of nicotine, based on product labeling and specifications. Measurements were obtained using optical coherence tomography (OCT) (Topcon 3D OCT-1 Maestro System). Nicotine was delivered through either nicotine gum or vaping. Results Both nicotine gum and vaping led to a statistically significant increase in RNFL thickness, with no significant difference between the two methods. The analysis revealed that area, time, and visit factors significantly affected RNFL scores. Stratification by smoking type (tobacco, vaping, dual) demonstrated significant effects for area, time, and visit factors, with an interaction effect among these factors. Conclusions The findings highlight the acute impact of nicotine intake on RNFL thickness in young healthy smokers. Researchers and clinicians should account for recent nicotine exposure when evaluating RNFL thickness, particularly within the first hour post-smoking. The observed significant effects warrant further research, especially in older or health-compromised populations, to improve clinical protocols and diagnostic evaluations across different demographics.

Associations of close social connections with smoking and vaping: a population study in England.

Studies consistently demonstrate smoking is a socially contagious behaviour, but less is known about the influence of social connections on vaping. This study examined associations between having close social connections who smoke or vape and relevant smoking and vaping outcomes. This was a representative cross-sectional survey of adults (≥16y) in England. Participants (n=1,618) were asked how many people they discuss important matters with (i.e., close social connections) and how many of them smoke/vape. We tested associations between (i) smoking and (ii) vaping among close social connections and participants' own smoking and vaping status; harm perceptions of e-cigarettes (among current smokers); attempts and success in quitting smoking (among past-year smokers); and use of e-cigarettes as a smoking cessation aid (among past-year smokers who tried to quit). Adults with ≥1 close social connection who smoke were more likely than those with none to smoke themselves (32.8% vs. 9.4%; ORadj=7.23[95%CI 4.74-11.0]) and had an uncertain lower likelihood to quit (12.2% vs. 19.8%; ORadj=0.46[0.17-1.23]). Those with ≥1 close social connection who vape were more likely than those with none to vape themselves (29.6% vs. 6.3%; ORadj=5.16[3.15-8.43]) and to use e-cigarettes in their most recent attempt to quit (57.0% vs. 27.9%; ORadj=18.0[1.80-181]), and had an uncertain higher likelihood to perceive e-cigarettes as less harmful than cigarettes (30.8% vs. 12.2%; ORadj=2.37[0.82-6.90]). In England, we replicated well-established associations with smoking and found similar evidence for vaping. People were much more likely to vape and to use e-cigarettes to quit smoking if they had close social connections who vaped. The cross-sectional design means it is not clear whether smoking/vaping among close social connections influences people to smoke/vape themselves, or whether people who smoke/vape select to form close social connections with others who similarly smoke/vape. Further research is required to establish causality. If the associations we observed are causal, interventions that encourage smokers to switch to vaping may have positive spillover effects on social connections' perceptions of e-cigarettes and use of these products to support smoking cessation.

Smoked, smokeless, and poly-tobacco use during pregnancy in relation to infant mortality in Cambodia: Findings from a nationwide sample.

Maternal cigarette smoking during pregnancy is an established risk factor for adverse maternal, fetal, and infant outcomes. In contrast, maternal smokeless tobacco use (i.e. e-cigarettes, snus, betel quid, iqmik) during pregnancy has a more complex risk profile due to its potential use as a smoking cessation aid or to reduce the harm from smoking tobacco. The overall aim of this study was to investigate the association between smoked, smokeless, and poly-tobacco (smoked + smokeless) use during pregnancy and infant mortality, in a national sample of women in Cambodia. The study used data from the National Adult Tobacco Survey of Cambodia (NATSC) that employed sampling methods and tobacco survey items from the CDC Global Adult Tobacco Survey but also included a supplement on reproductive health and birthing history. We selected 5342 women of the NATSC who reported complete data on at least one pregnancy, and our unit of analysis was the 15998 pregnancies from these women. We conducted a multivariable logistic regression to relate tobacco use to infant mortality. Taylor linearized variance estimators were used to account for clustering by sampling unit and mother. We found that smokeless tobacco in the form of a betel quid was the most common form of tobacco used during pregnancy. In multivariable logistic regression, we found increased odds of infant death for all tobacco use categories (smoked, smokeless), but that the strongest effects were seen for habits that included smokeless tobacco (relative to never use of tobacco in any form): exclusive use of smokeless tobacco (adjusted odds ratio, AOR=2.08; 95% CI: 1.15-3.76), and poly-tobacco use (AOR=5.68; 95% CI: 1.03-31.46). In more detailed analyses that considered the composition of the betel quid (tobacco, areca nut/leaf, slaked lime), we found that even chewing of tobacco leaves with no processing or additives was associated with a three-fold increase in odds of infant death relative to a never user (AOR=3.05; 95% CI: 1.45-6.45). We found that even among those pregnant women who limited their nicotine habit to chewing tobacco leaves with no processing or additives, there remained higher odds of fetal or infant death from that pregnancy.

Patterns and perceptions of vaping among adults living in social housing: a representative survey in Great Britain, 2023

BackgroundVaping products are effective for helping people to stop smoking and may therefore offer a potential means to reduce high rates of smoking in socioeconomically disadvantaged groups. This study aimed to examine current patterns and perceptions of vaping among people living in social housing in Great Britain compared with those living in other housing types.MethodsData were from the Smoking Toolkit Study; a nationally-representative survey conducted in 2023 (n = 23,245). Logistic regression tested cross-sectional associations between living in social (vs. other) housing and current vaping among adults; vaping frequency, device type, nicotine concentration, and source of purchase among current vapers; use of vaping products as a smoking cessation aid among past-year smokers who tried to quit; and harm perceptions of vaping products relative to cigarettes among current smokers.ResultsCurrent vaping prevalence was twice as high among adults living in social housing (19.4%) compared with those in other housing types (10.4%; OR = 2.07, 95%CI = 1.84–2.33). This was partly explained by differences in sociodemographic characteristics and smoking status; after adjustment, the odds of being a current vaper were 33% higher (ORadj=1.33, 95%CI = 1.14–1.54). Among vapers, there were no notable differences by housing tenure in vaping frequency, main device type used, usual nicotine concentration, usual source of purchase, or use as a smoking cessation aid. However, current smokers living in social housing were more likely to think vaping is more harmful than cigarettes (31.6% vs. 21.8%; ORadj=1.61, 95%CI = 1.30–1.99).ConclusionsIn Great Britain, adults who live in social housing are more likely to vape than those who live in other housing types, even after accounting for their younger age and higher smoking rates. However, misperceptions about the relative harms of vaping products and tobacco are common among smokers living in social housing. Interventions addressing these misperceptions could help encourage more people living in social housing to switch from smoking to vaping and reduce smoking-related health inequalities.Pre-registrationThe study protocol and analysis plan were pre-registered on Open Science Framework (https://osf.io/n3mvs/).

Cost-effectiveness analysis of e-cigarettes compared to nicotine replacement therapy for smoking cessation among Medicaid users in California.

Smoking is the leading preventable cause of death and disability in the United States (US). A 2019 randomized controlled trial found e-cigarettes are more effective than nicotine replacement therapy (NRT) in achieving abstinence when both are combined with behavioral counselling. Few cost-effectiveness studies have been performed regarding e-cigarettes as an adjunct to cessation efforts, and none in a US context. This study evaluated the cost-effectiveness of e-cigarettes compared to NRT, both with counselling, as cessation aids for Medicaid smokers in California. A cost-effectiveness analysis from a US societal perspective comparing e-cigarettes with NRT was constructed. Using a lifetime horizon, smokers were followed to different health states to their expected lifespan. Costs were expressed in 2020 US dollars and health outcomes in quality-adjusted life years. All costs and outcomes were discounted at a 3% annual rate and model findings were assessed with a series of sensitivity analyses. Using US willingness-to-pay thresholds, e-cigarettes were more cost-effective than NRT, with an incremental cost-effectiveness ratio of $11,454 per additional QALY gained over smokers' lifetimes. Results were sensitive to smokers' healthcare costs, model start ages, discount rate, and QALY weights. E-cigarettes used as a cessation treatment by smokers are more cost-effective relative to NRT. However, e-cigarettes as a treatment are currently unapproved by the Food and Drug Administration (FDA). Despite lack of FDA approval, e-cigarettes are a popular choice among smokers trying to quit. Policymakers should consider whether providing financial support for e-cigarettes as a harm reduction strategy is worth pursuing. As e-cigarettes grow in popularity and are an increasingly preferred choice of smoking cessation aid among smokers attempting to quit, it is important to examine the inclusion of these products in tobacco policy, research, and practice. Several countries have now adopted or are in the process of adopting e-cigarettes as a medically licensed and regulated smoking cessation aid. Future smoking cessation strategies by US policymakers may consider the adoption of e-cigarettes as a cost-effective harm reduction tool for use by current smokers seeking to quit.

“I’m both smoking and vaping”: a longitudinal qualitative study of US young adults who tried to quit smoking cigarettes by using electronic cigarettes

ObjectiveTo describe how young adults use electronic cigarettes (electronic nicotine delivery systems (ENDS)) for smoking cessation and reasons why they may or may not successfully quit smoking.MethodsLongitudinal qualitative data were...

Development and application of a rapid research prioritisation process for identifying health research priorities in low- and middle-income countries: the RAPID-RP stakeholder analysis

Background Health research should be locally prioritised by key stakeholders to ensure the best use of available resources, maximum likelihood of research leading to uptake into policy and practice and relevance to the needs of the potential beneficiaries. Established approaches are complex and time-consuming, therefore not feasible in settings where prioritisation is uncommon and time is limited. Objectives We developed and applied a simple, rapid research prioritisation approach to elicit the views of stakeholders. Setting and participants This was a collaboration between a multidisciplinary group of United Kingdom academics, the International Primary Care Respiratory Group and primary care respiratory researchers from four low- and middle-income countries: Brazil, China, Georgia and North Macedonia. We identified 10 topics for research prioritisation through workshops involving 26 topic, methods and local context experts, and considering the programme remit, to develop, adapt and evaluate culturally appropriate community and behavioural approaches for the prevention, early identification and management of chronic obstructive pulmonary disease in primary care. Design and methods In each setting, local research teams convened stakeholder groups of patients, clinicians, managers/policymakers and researchers. Each group briefly discussed the 10 potential research study topics. Discussions were facilitated using short vignettes for each topic, and participants were encouraged to consider importance, feasibility and equity. Individual participants rated each study on a three-point traffic light scale, then ranked them following a facilitated discussion on what drove the ratings. The research team rated then ranked each study considering three further criteria (international novelty, potential for future funding and capacity building on a five-point scale). Within each group, ranks were summed to create a final rank order which guided our research programme and provided insight for future projects. Results In each country, four to eight members attended each stakeholder group. The engagement process was completed in less than 4 hours and feedback was very positive, especially from patients who valued the opportunity to contribute to research decision-making about their own condition. Ranking varied to some extent between groups and settings, but there was consistency around topics that were prioritised among the top five in all groups (identifying efficient chronic obstructive pulmonary disease screening test strategies, evaluations of lung age to aid smoking cessation, feasibility of locally adapted pulmonary rehabilitation, clinical education for primary care staff) and study topics that consistently ranked low (use of e-cigarettes for smoking cessation, weight management to improve chronic obstructive pulmonary disease symptoms and handwashing to reduce infections). Limitations Despite attempts to maximise inclusivity and diversity, stakeholders were mainly limited geographically to the centres where researchers were based, potentially limiting generalisability of views across the countries. Facilitator styles varied and may have influenced some of the discussions and potentially the ranking. Conclusions Despite some limitations, we demonstrated the feasibility and acceptability of the rapid research prioritisation approach stakeholder analysis for identifying locally relevant research priorities in low- and middle-income country settings. Future work Further validation is needed for aspects of the process. We have identified some useful lessons from our evaluation of the process, to facilitate future use of this approach. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/95.

Perspectives of Hospital Staff on Barriers to Smoking Cessation Interventions among Drug-Resistant Tuberculosis Patients in a South African Management Hospital.

Drug-resistant tuberculosis (DR-TB) remains a major cause of illness and death, with personal and non-addiction-related barriers. This study aimed to explore the perspectives of hospital staff on barriers to smoking cessation interventions (SCIs) for in-patients at a DR-TB management hospital in Durban, KwaZulu-Natal, South Africa. In-depth interviews were conducted with a purposive sample of eighteen hospital staff (HS), and the data were analyzed using NVivo 10. Three core themes were identified: patients' barriers (addiction to tobacco, relapse after improvement in health, and non-disclosure of smoking status to HS), staff personal barriers (poor knowledge of smoking's effect on treatment outcomes and smoking cessation aids), and institutional barriers (staff shortage, time constraints, lack of pharmacological smoking cessation aids, access to cigarettes around hospital premises, and SCIs not prioritized and not assigned to a specific category of HS). Training on SCIs for HS, assigning SCIs to specific HS, integrating SCIs within existing services, and banning access to cigarettes within the hospital premises are assumed to assist DR-TB patients in smoking cessation, improving their response to TB treatment and overall health outcomes.

Metabolic Changes Following Smoking Cessation in Patients with Type 2 Diabetes Mellitus.

Smoking cessation is crucial for reducing complications of type 2 diabetes mellitus (T2DM), but associated weight gain can worsen glycemic control, discouraging quitting attempts. Varenicline, a partial agonist of α4β2 nicotinic receptors, aids smoking cessation. This study examines the effects of varenicline on body weight and metabolic parameters in patients with T2DM and prediabetes. Fifty-three patients were enrolled, of which 32 successfully quit smoking after a three-month course of varenicline and were examined after an additional month with no medication. Measurements taken at baseline, 2.5 months, and 4 months included body weight, blood pressure, resting metabolic rate (RMR), glycated hemoglobin (HbA1c), fasting glucose, blood lipids, C-reactive protein (CRP), appetite-related hormones, and physical activity. Post-treatment, there were no significant changes in body weight, blood pressure, RMR, or glycemic control. Total (CHOL) and low-density lipoprotein (LDL-C) cholesterol decreased significantly at 4 months of the study (from 168 to 156 mg/dL, p = 0.013, and from 96 to 83 mg/dL, p = 0.013, respectively). Leptin levels increased (from 11 to 13.8 ng/dL, p = 0.004), as did glucagon-like peptide-1 (GLP-1) levels (from 39.6 to 45.8 pM, p = 0.016) at 4 months of follow-up. The percentage of participants who reported moderate-intensity activity increased from 28% to 56%, while those reporting high-intensity activity increased from 19% to 22%, respectively (p = 0.039). Our study showed that smoking cessation with varenicline in smokers with T2DM and prediabetes led to significant improvements in lipid profile, significant increase in plasma leptin and GLP-1 levels, and increased physical activity, without significant weight gain. Thus, smoking cessation without weight gain or deteriorated glycemic control is feasible for these smokers, with added benefits to lipid profiles, GLP-1 regulation, and physical activity.

Perceptions of nicotine vaping products among Australians living with HIV

ABSTRACT People living with HIV (PLHIV) are two to three times more likely to smoke tobacco compared to the general community. Evidence from the general population suggests that nicotine vaping products (NVPs) can be acceptable and effective smoking cessation aids, but there is limited evidence on the extent to which this is the case among PLHIV. This manuscript reports findings from the Tobacco Harm Reduction with Vaporised Nicotine (THRiVe) trial, a mixed-methods study investigating the feasibility of NVPs as smoking cessation aids among 29 PLHIV who smoked tobacco. Surveys and semi-structured interviews explored participants’ experiences and perceptions of NVPs, their features and functions, and support for various NVP regulatory policy options. Participants described seven reasons why NVPs were acceptable cessation aids: they satisfied nicotine cravings; differences between NVPs and cigarettes facilitated habit breaking; fewer adverse effects compared to traditional cessation aids; NVPs allowed for a “weaning process” rather than requiring abrupt abstinence; tobacco became increasingly unpleasant to smoke; NVPs provided an increased sense of control; and participants experienced a deeper understanding of personal smoking behaviours. This study provides valuable insight into the preferred features of NVPs among PLHIV and reasons why NVPs may be effective for promoting smoking cessation among PLHIV.

Exercise and Smoking Cessation.

Smoking is a public health crisis, leading to a multitude of health complications. Exercise is associated with numerous health benefits and is accepted by health professionals and smokers as a potentially effective smoking cessation aid. This chapter discusses the extant literature on the relation between exercise and smoking, including cross-sectional studies, experiments, and randomized clinical trials. There is robust evidence for exercise's efficacy in reducing cigarette craving, tobacco withdrawal symptoms, and negative affect. Further, exercise-based interventions appear to boost short-term abstinence yet may fall short of facilitating long-term abstinence. Methodological limitations of extant work are reviewed. We conclude with a discussion of the next steps in this line of work to fine-tune exercise interventions and their application for smoking cessation.