Assess Tobacco Use Research Articles

The Epidemiology of Tobacco Use among Khat Users: A Systematic Review.

Khat, an “amphetamine-like green leaf,” may influence the consumption of tobacco. This study reviews the epidemiology of tobacco use among khat users. Electronic database searches using appropriate keywords/terms were conducted to identify observational studies of khat use. Assessment of quality and risk of bias of all included studies was conducted, and the results were synthesised descriptively. Nine eligible cross-sectional studies were identified. All assessed self-reported tobacco among khat users and were carried out in Africa and the Middle East. Eight reported cigarettes and one reported waterpipes as the mode of use. Methods of tobacco use prevalence assessment varied. Prevalence of “current” tobacco use among students and university teachers ranged from 29 to 37%; “lifetime” tobacco use in university teachers was 58% and “undefined” tobacco use in nonspecific adults and students ranged from 17 to 78%. Daily tobacco use among adults was reported as 17% whilst simultaneous tobacco and khat use was reported as between 14 and 30% in students. In conclusion, tobacco prevalence among khat users appears significant. Findings should be interpreted cautiously due to self-reported tobacco use, diversity in questions assessing tobacco use, and type of tobacco consumption. Future research should address the methodological shortcomings identified in this review before appropriate policy interventions can be developed.

Knowledge, Attitude and Practice Regarding Tobacco Cessation Among Indian Dentists.

To assess the knowledge, attitude and practice regarding tobacco cessation among dentists in Hyderabad city, India. A cross-sectional questionnaire study was conducted among 264 dentists registered in the local Indian Dental Association branch, Hyderabad, Andhra Pradesh, India. The questionnaire comprised of 35 items and used a five-point Likert scale to assess tobacco use prevention and cessation counseling. The majority of the study participants were females (55.7%) with a mean age of 29.9 ± 7.5 years. No significant gender difference was observed for any of the mean domain scores. A statistically significant difference was noted between age groups in the 'Knowledge' domain, 'professional role and identity' item (P = 0.03) vs the 'Practice' domain, 'social influences' item (P = 0.05) with 40+ years having a higher mean score (6.5 ± 1.5). In terms of the education, those possessing Bachelor's of Dental Science had a significantly higher mean score (10.8 ± 2.2) for the 'Attitude' question 'belief about consequences' (P = 0.05) than did those with a Master's degree. The reported barriers were insufficient reimbursement (48.1%), lack of tobacco-related self-help material/pamphlets for patients (46.5%) and lack of patient motivation to receive tobacco cessation counseling (43.6%). In the present study, although dentists possessed knowledge about tobacco cessation, it was not adequate. Dental professionals play an important role in educating patients regarding the oral health risks of tobacco use and motivating them to quit.

Tobacco use and smoking cessation among third-year dental students in southern Brazil

The aim of the present cross-sectional study was to assess tobacco use and smoking cessation among third-year dental students in southern Brazil. The Global Health Professions Student Survey questionnaire was used in eight dental schools in Rio Grande do Sul state, Brazil. Of the 663 eligible students, 576 (87%) participated. The prevalence of current smoking was 19.1% [95% confidence interval (CI): 12.9-25.3%], and 61.6% (95% CI: 54.9-68.3%) of students reported having smoked at least once in their lifetime. The prevalence of dental students who had smoked ≥ 100 cigarettes in their lifetime was 17.1% (95% CI: 12.5-21.7%). Being frequently exposed to other smokers at home or in other places (second-hand smoke) increased the likelihood of current smoking by two- to threefold. Approximately 6.1% (95% CI: 3.5-8.7%) of the students reported that they currently wanted to stop smoking and 7.5% (95% CI: 5.3-9.6%) had tried to stop smoking in the last year. Friends and family were the most frequent sources of help or counselling, and only a limited proportion of students received help from health professionals. Tobacco use and exposure to second-hand smoking is widespread among dental students in southern Brazil. Smoking-cessation initiatives targeting health care students are urgently needed.

Health care provider advice for adolescent tobacco use: results from the 2011 National Youth Tobacco Survey.

Health care providers play an important role in promoting tobacco use abstinence among adolescents. This study aimed to provide nationally representative data on the prevalence of provider tobacco use screening and advice delivered to adolescents. Cessation behaviors and correlates of past year quit attempts among current smokers are also explored. Data came from the 2011 National Youth Tobacco Survey, a nationally representative school-based survey of adolescents in grades 6 through 12 (n = 18385). Provider screening and advice were assessed by smoking status and demographic characteristics. Logistic regression was used to assess the association between advice and past year quit attempt. The overall prevalence of current tobacco use was 16.6%; 10.8% were current cigarette smokers (3.6% were established smokers, 7.2% were nonestablished smokers); 17.3% were former smokers; and 71.9% were never smokers (22.6% high susceptibility, 77.4% low susceptibility). Among all respondents, the prevalence of being asked about tobacco use by a health care provider was 32.2%; the prevalence of being advised to quit or avoid tobacco was 31.4%. Established smokers were more likely than other groups to report provider assessment of tobacco use and advice. Receipt of advice was associated with a higher adjusted odds of having made a past year quit attempt (odds ratio: 1.47, 95% confidence interval: 1.18-1.82). Less than one-third of adolescents report being asked about tobacco use or being advised not to use tobacco. Increased tobacco use intervention by health care providers is needed to prevent initiation and increase cessation.

Adoption of cardiovascular risk reduction guidelines: a cluster-randomized trial.

Cardiovascular disease (CVD) and underlying atherosclerosis begin in childhood and are related to CVD risk factors. This study evaluates tools and strategies to enhance adoption of new CVD risk reduction guidelines for children. Thirty-two practices, recruited and supported by 2 primary care research networks, were cluster randomized to a multifaceted controlled intervention. Practices were compared with guideline-based individual and composite measures for BMI, blood pressure (BP), and tobacco. Composite measures were constructed by summing the numerators and denominators of individual measures. Preintervention and postintervention measures were assessed by medical record review of children ages 3 to 11 years. Changes in measures (pre-post and intervention versus control) were compared. The intervention group BP composite improved by 29.5%, increasing from 49.7% to 79.2%, compared with the control group (49.5% to 49.6%; P < .001). Intervention group BP interpretation improved by 61.1% (from 0.2% to 61.3%), compared with the control group (0.4% to 0.6%; P < .001). The assessment of tobacco exposure or use for 5- to 11-year-olds in the intervention group improved by 30.3% (from 3.4% to 49.1%) versus the control group (0.6% to 21.4%) (P = .042). No significant change was seen in the BMI or tobacco composites measures. The overall composite of 9 measures improved by 13.4% (from 48.2% to 69.8%) for the intervention group versus the control group (47.4% to 55.2%) (P = .01). Significant improvement was demonstrated in the overall composite measure, the composite measure of BP, and tobacco assessment and advice for children aged 5 to 11 years.

Sex Differences in the Association of Psychological Distress and Tobacco Use

To examine sex differences in the relationship between serious psychological distress (SPD) and tobacco use. The 2010 National Health Interview Survey data (N = 26,907) were examined to assess tobacco use among adults with and without SPD. Prevalence and odds ratios (OR) were calculated. The possible moderating effect of sex was examined. Lifetime and current use of cigarettes, cigars and smokeless tobacco (SLT) was more prevalent among those with SPD. Sex interaction terms were significant when modeling lifetime and current cigar and SLT use. The adjusted OR for all tobacco outcomes was greater for women than for men. Findings suggest a stronger association of SPD and tobacco use for women.

Standardizing measurement of tobacco use in cancer clinical trials.

9550 Background: ASCO and AACR recommend assessment of tobacco use (TU) for all cancer patients, but there is little consensus regarding approaches for reliable, valid, and clinically meaningful TU...

Tobacco use and some characteristics of tobacco users. Preliminary results of “Kardiovize Brno 2030”

AimTo assess tobacco use and some characteristics of tobacco users (including electronic cigarette users) relevant to cardiovascular disease in a representative population sample of the city of Brno. MethodsA cross-sectional survey of cardiovascular risk factors was conducted using the methodology of the Czech post-MONICA Study, in the city of Brno, Czech Republic in 2013. This preliminary report of the first 965 randomly selected volunteers (including 512 women) aged 25–64, focuses on tobacco use, its prevalence in different subgroups as well as on the attitudes towards smoke-free policies. ResultsThis preliminary analysis involves 965 individuals with a mean age of 47.3±11.40 years. The prevalence of smoking was 26.7%, with daily tobacco use 23.3%, less than once daily 3.4%; 19.9% of the sample are ex-smokers. A total of 34.0% of the survey population reported exposure to passive smoking. Electronic cigarette use was observed in 3.5% of respondents, more common in men (5.1%) than in women (2.1%; p=0.020). Concomitant use of electronic cigarettes and smoking was observed in 2.07% of the population. ConclusionThe prevalence of tobacco use in the productive-age population of Brno City district is 26.70%, still a high figure.

Fear of recurrence impacts health-related quality of life and continued tobacco use in head and neck cancer survivors.

To examine the impact of fear of recurrence (FOR) on health-related quality of life (HRQOL) and tobacco use among head and neck cancer (HNC) survivors. A cross-sectional subset of patients (N = 138) from a large, prospective study of oncologic outcomes in HNC was assessed for FOR, in addition to the parent study's ongoing assessments of HRQOL and tobacco use. FOR was measured using the Fear of Cancer Recurrence Inventory and HNC-specific HRQOL was assessed with the Head and Neck Cancer Inventory (HNCI). Tobacco use was patient-reported as "Current," "Previous," or "Never." After controlling for relevant clinical and demographic variables, hierarchical regression analyses revealed that higher FOR significantly predicted lower HRQOL across all HNCI domains (eating (p < .05), aesthetics (p < .01), speech (p < .01), and social disruption (p = .001)) and increased tobacco use (p < .01). A total of 60.1% of the sample expressed clinically significant levels of FOR. These patients reported lower HRQOL (eating: p < .05, aesthetics: p < .05, social disruption: p < .05) and were more likely to be using tobacco compared with patients with subclinical FOR (26.6% and 4.9%, respectively; p < .01). Results suggest that FOR is prevalent among HNC survivors and is related to decreased HRQOL and increased tobacco use.

Self-Report of Tobacco Use Status: Comparison of Paper-Based Questionnaire, Online Questionnaire, and Direct Face-to-Face Interview—Implications for Meaningful Use

Identifying tobacco use status is essential to address use and provide resources to help patients quit. Being able to collect this information in an electronic format will become increasingly important, as the Centers for Medicare and Medicaid Services has included the assessment of tobacco use as part of its Stage 1 Meaningful Use criteria. The objective was to compare the accuracy of online vs. paper assessment methods to ascertain cigarette smoking status using a face-to-face structured interview as the gold standard. This was a retrospective analysis of a stratified opportunity sample of consecutive patients, reporting in 2010 for a periodic health evaluation, who completed either a scannable paper-based form or an online questionnaire and underwent a standardized rooming interview. Compared with face-to-face structured interview, the overall observed agreement and kappa coefficient for both methods combined (paper and online) were 97.7% and 0.69 (95% confidence interval (CI) 0.51-0.86) . For the online form they were 97.4% and 0.61 (95% CI 0.33-0.90), and for the paper form they were 97.9% and 0.75 (95% CI 0.54-0.96). There was no statistically significant difference in agreement between the online and paper-based methods (P=0.76) compared with a face-to-face structured interview. Online assessment of tobacco use status is as accurate as a paper questionnaire, and both methods have greater than 97% observed agreement with a face-to-face structured interview. The use of online assessment of tobacco use status has several advantages and more widespread use should be explored.

Nurses’ Knowledge, Attitudes and Practice in Anti-Smoking Campaigns in Morocco

Background: Health professionals have a major role in tobacco control efforts, as they are generally considered to be role models in communities. Nurses in particular, being usually the largest group of health care workers, are ideally placed to promote smoking cessation. The aim of this study was to assess tobacco use of nurses and their knowledge, attitudes and practice on tobacco control in the region of Fez in Morocco. Methods: A cross-sectional study focused on public practicing nurses, over a period of 2 months in 2009, in the university hospital and in the primary health care centres of the region of Fez in Morocco. Results: In total, 120 nurses participated in the study. Mean age was 42.2 years (11.8 years SD; from 22 to 64 years). There were 13.4% smokers, among whom 9.2% daily smokers. Men considered themselves better trained in tobacco cessation activities than women (84.8% vs. 60.0%, p = 0.02). Women considered the role of nurses in tobacco prevention as important, and were more convinced of the anti-tobacco effectiveness actions (90.0% vs. 52.1%, p < 0.001). No-smokers were significantly more convinced in general in the effectiveness of anti-tobacco measures, with a significant difference on interdicts to smoke in public places (20.0% vs. 3.1%, p = 0.03). Conclusion: Nurses in the region of Fez in Morocco would be motivated to contribute to tobacco control programs if they had appropriate resources. Their interest offers an important opportunity to strengthen their knowledge, attitudes and practices as smoking cessation supporters.

Tobacco Use and Quit Behaviour Assessment in the Global Adult Tobacco Survey (GATS): Invalid Responses and Implications

Tobacco use and quit attempts are two key indicators of the Global Adult Tobacco Survey (GATS) that assess quit attempts among current as well as former tobacco users. The relevant data have inherent policy implications for tobacco cessation programme evaluation. This study aimed to review the concepts of quit attempt assessment and quantifying invalid responses considering GATS-India data. GATS assessment of tobacco use and quit attempts were examined in the current literature. Two categories of invalid responses were identified by stratified analysis of the duration of last quit attempt among current users and duration of abstinence among former users. Category A included absolute invalid responses when time- frame of assessment of current tobacco use and less than former tobacco use were violated. Category B included responses that violated the unit of measurement of time. Current daily use, current less than daily use and former use in GATS were imprecisely defined with overlapping of time-frame of assessment. Overall responses of 3,102 current smokers, 4,036 current smokeless users, 1,904 former smokers and 1,343 former smokeless users were analyzed to quantify invalid responses. Analysis indicated overall 21.2% (category A: 7.32%; category B: 17.7%) and 22.7% (category A: 8.05%; category B: 18.1%) invalid responses among current smokers and smokeless users respectively regarding their duration of last quit attempt. Similarly overall 6.62% (category A: 4.7%; category B: 2.3%) and 10.6% (category A: 8.6%; category B: 3.5%) invalid responses were identified among former smokers and smokeless users respectively regarding their duration of abstinence. High invalid responses for a single assessment are due to the imprecise definition of current use, former use and quit attempt; and failure to utilize opportunity of direct data entry interface use during the survey to validate responses instantly. Redefining tobacco use and quit attempts considering an appropriate timeframe would reduce invalid responses.

Trends in use of electronic nicotine delivery systems by adolescents

Electronic nicotine delivery systems (ENDS) have been gaining in popularity. The few prevalence studies in adults have found that most ENDS users are current or former smokers. The objectives of this study were to estimate the prevalence of ENDS usage in adolescents, and examine the correlates of use. Self-administered written surveys assessing tobacco use behaviors were conducted in multiple waves as part of a larger intervention study in two large suburban high schools. The prevalence of past-30day ENDS use increased from 0.9% in February 2010 to 2.3% in June 2011 (p=0.009). Current cigarette smokers had increased odds of past-30day ENDS use in all study waves. When adjusted for school, grade, sex, race and smoking status, students in October 2010 (Adjusted OR 2.12; 95% confidence interval (CI): 1.12–4.02) and June 2011 (Adjusted OR 2.51; 95% CI: 1.17–4.71) had increased odds past-30day ENDS use compared to February 2010. The prevalence of ENDS use doubled in this sample of high school students, and current cigarette smoking is the strongest predictor of current use. Continued monitoring of ENDS is needed to determine whether it increases the likelihood of cigarette smoking initiation and maintenance in youth.

Integrating smoking cessation into substance use disorder treatment for military veterans: Measurement and treatment engagement efforts

Military personnel and veterans smoke at higher rates than the general population, compromising physical performance readiness and health (Committee on Smoking Cessation in Military and Veteran Populations & Institute of Medicine, 2009). While efforts are being made within both the Department of Defense and the Veterans' Administration (VA) hospitals to prevent onset, change the smoking culture, and promote smoking cessation; smoking rates are increasing among combat deployed service members, and smoking rates are particularly high among veterans with mental health and other substance use disorders (McFall, 2006). Recent research supports making smoking cessation widely available and integrated with other forms of care (Gierisch et al., 2012; McFall et al., 2010). This paper describes the efforts of one VA substance use disorder (SUD) treatment program to integrate smoking cessation in routine care, including assessment of tobacco use and motivation and intention to quit via the proposed Nic-BAM assessment. Our team was 100% successful in incorporating the Nic-BAM into our regular assessment of treatment program participants. This suggests that staff members are amenable to assessing for tobacco addiction alongside other substance addictions. Although smoking did not decrease according to the Nic-BAM, an increase in the use of nicotine-replacement products suggests that participants are willing to initiate a quit attempt during SUD treatment. The availability of new evidence-based approaches for integration of tobacco cessation with mental health and SUD treatment may help to enhance programmatic efforts. Environmental changes are needed to fully incorporate tobacco recovery into SUD programming, and additional resources may include peer support specialists.

Prevalence of tobacco use among adult and adolescent females in Egypt

Egypt assessed tobacco use among young people and adults through implementation in 2009 of the Global Youth Tobacco Survey (GYTS) among school students aged 13-15 years and the nationally representative Global Adult Tobacco Survey (GATS) among adults aged 15+ years. Both surveys employed cluster sampling to produce nationally representative samples and used standard core questionnaires with optional, country-specific questions. The results indicated that a higher percentage of adolescent girls in Egypt used tobacco than did adult females. Overall, 3.8% of girls aged 13-15 years used some form of tobacco compared with 0.6% of women aged 15+ years. Adolescents were over 14 times more likely than adult women to currently smoke cigarettes and 11 times more likely to smoke waterpipes. Moreover, the prevalence of cigarette smoking among adolescent girls had increased from 1.4% in the 2005 GYTS to 2.8% in 2009, indicating that social and cultural norms may be changing.

Increasing access to tobacco cessation support for cancer patients: Results of an institution-wide screening and referral program in an NCI-designated comprehensive cancer center.

1566 Background: Guidelines from ASCO and other national organizations recommend assessment of tobacco use and structured tobacco cessation support for cancer patients. However, most oncology providers fail to provide cessation assistance to cancer patients who use tobacco. Reported are results of a systematic approach to assessing tobacco use and delivering cessation support for cancer patients in a comprehensive cancer center. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an automated electronic medical record based system delivered by nursing at initial consult and follow-up. Patients eligible for tobacco cessation support (i.e. patients self-reporting tobacco use within 30 days) were automatically referred to a dedicated tobacco cessation service providing primarily phone based cessation support. Results: Of approximately 11,900 patients screened over 26 months, 2,978 patients were automatically triaged for cessation support. Contact priority was given to newly diagnosed patients in tobacco related disease sites. Using 1.25 full time cessation specialists, 1,531 received only a standard tobacco cessation mailing and no further contacts were attempted by the cessation service. In 1447 patients with attempted phone contact by the cessation service, 1189 (82.2%) were reached within 5 contact attempts. In 1,189 patients contacted, 52 (4.4%) were inappropriate referrals, 245 (20.6%) were in an active quitting phase, 465 (39.1%) were willing to prepare, and only 24 (2.0%) refused any intervention at initial contact. At the most recent follow-up, 44 patients (3.7%) requested no further contact and 90 additional patients (7.6%) were lost to follow-up. In the 1,045 remaining patients, 338 (32.3%) reported quitting tobacco use. Notably, in the 1,531 patients with no phone contact by the cessation service, only 14 proactively contacted the cessation service for assistance. Conclusions: An institution wide program to automate the delivery of tobacco cessation services was feasible with high patient contact rates, low patient refusal, and moderately high tobacco cessation rates.

Addressing tobacco use and cessation in cancer patients: Practices, perceptions, and barriers reported by oncology providers.

1561 Background: Tobacco use is associated with adverse outcomes in cancer patients, but there are limited data on tobacco cessation support by oncology providers. Methods: Duplicate surveys were sent to the membership of the International Association for the Study of Lung Cancer (IASLC) and the American Society of Clinical Oncology (ASCO) asking about tobacco assessment and cessation practices, perceptions of tobacco use by cancer patients, and barriers to implementing tobacco cessation. The results of 1,507 responses from IASLC and 1,197 responses from ASCO are reported. Results: At initial consult, most respondents asked about tobacco use (90% in both surveys), asked if smokers would quit tobacco use (79-80%), advised patients to stop smoking (81-82%). Most respondents felt that tobacco affects cancer outcomes (87-92%) and that tobacco cessation should be a standard part of clinical care (86-90%). However, few discussed medication options (40-44%) or actively provided smoking cessation assistance (39% in both surveys). Fewer respondents asked about tobacco use at follow-up and few reported adequate tobacco cessation training (29-33%). Dominant barriers to providing cessation interventions included patient resistance to cessation treatment (67-74%) and inability to get patients to quit tobacco use (58-72%), but very few believed tobacco cessation was a waste of time (8-12%). Lack of time, reimbursement, lack of training, and lack of resources were reported as barriers in less than 50% of respondents. Conclusions: Oncology providers feel tobacco affects cancer outcomes and cessation should be a standard part of clinical care. Most assess tobacco use, but few discuss medication options or provide active cessation support. Efforts are needed to improve cessation methods in cancer patients and to improve access to tobacco cessation support for cancer patients.

Tobacco and Lung Cancer: Risks, Trends, and Outcomes in Patients with Cancer

Tobacco use, primarily associated with cigarette smoking, is the largest preventable cause of cancer mortality, responsible for approximately one-third of all cancer deaths. Approximately 85% of lung cancers result from smoking, with an additional fraction caused by secondhand smoke exposure in nonsmokers. The risk of lung cancer is dose dependent, but can be dramatically reduced with tobacco cessation, especially if the person discontinues smoking early in life. The increase in lung cancer incidence in different countries around in the world parallels changes in cigarette consumption. Lung cancer risks are not reduced by switching to filters or low-tar/low-nicotine cigarettes. In patients with cancer, continued tobacco use after diagnosis is associated with poor therapeutic outcomes including increased treatment-related toxicity, increased risk of second primary cancer, decreased quality of life, and decreased survival. Tobacco cessation in patients with cancer may improve cancer treatment outcomes, but cessation support is often not provided by oncologists. Reducing the health related effects of tobacco requires coordinated efforts to reduce exposure to tobacco, accurately assess tobacco use in clinical settings, and increase access to tobacco cessation support. Lung cancer screening and coordinated international tobacco control efforts offer the promise to dramatically reduce lung cancer mortality in the coming decades.

Assessing Tobacco Use by Cancer Patients and Facilitating Cessation: An American Association for Cancer Research Policy Statement

When diagnosed with cancer, patients can immediately make a meaningful positive impact on their health by stopping their tobacco use. Scientific evidence clearly shows that tobacco use in patients with cancer leads to poorer outcomes. The specific biological processes driving tobacco consumption's interference in cancer therapy are the subject of continuing research, but the evidence is clear that tobacco use in patients with cancer leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, increased treatment-related toxicity, and increased risk of cancer recurrence and second primary tumors. Data suggest that tobacco cessation can improve outcomes and survival in patients with cancer, yet full execution of evidence-based cessation interventions is infrequent in oncology settings. Therefore, both improved provision of cessation assistance to all patients with cancer who use tobacco or have recently quit and further study of the deleterious effects of tobacco use and benefits of tobacco cessation on cancer progression and treatment are needed and recommended by the American Association for Cancer Research. Progress on both fronts begins with universal assessment and documentation of tobacco use as a standard of quality cancer care regardless of treatment setting and will be further facilitated through the development of reliable, valid, and standard measures of tobacco use, incorporation of evidence-based procedures into quality and accreditation procedures, and the development of appropriate training, clinical infrastructure, and incentives for delivery of tobacco cessation interventions.

Improving cancer clinical trial design and clinical practice: the case for tobacco use in cancer patients

Substantial data support the causative nature of tobacco on the development of several cancers [1]. Unfortunately, most cancer studies do not include tobacco use as a variable to consider in the interpretation of outcomes. Increasing evidence demonstrates that tobacco use during cancer treatment is associated with poor outcomes including decreased treatment response, increased treatment-related toxicity, increased noncancer comorbidity, increased risk of second primary cancer, decreased quality of life and increased mortality from cancerand noncancer-related causes [2–7]. The effects of smoking affect both tobacco-related cancers (e.g., head/neck and lung cancer), as well as traditionally non-tobacco-related cancers (e.g., prostate cancer). In fact, data suggest that in cancers with long expected survival, such as prostate cancer, smoking may be a dominant risk factor for overall mortality due to increased risk of cardiovascular disease and death from other tobacco-related disease [8]. A history of ‘ever smoking’ decreases survival in several disease sites [2], but ‘current smoking’ at diagnosis is associated with increased overall and disease-specific mortality compared with those who have never smoked, former smokers (patients who quit ≥12 months prior to diagnosis) and recent quitters (patients who quit during the 12 months prior to diagnosis) [2]. These data suggest that a smoking history is not a fixed variable that affects outcome, but rather suggest that the effects of smoking may be reversible. There are limited studies on the effects of smoking cessation after diagnosis on cancer outcomes; however, available studies indicate that smoking cessation may reverse some of the effects of smoking on cancer outcomes [9–11]. To precisely understand the effects of tobacco on cancer patient outcomes, accurate assessments of current and former tobacco use are necessary. Unfortunately, the overwhelming majority of published literature that reports on the effects of smoking on cancer relies upon nonstandardized tobacco assessments and/or reviews of clinician-based assessments obtained in the medical record [9]. Recommendations for the systematic collection of tobacco use in cancer clinical trials have been proposed and include smoking history, current smoking status and amount, nicotine dependence, readiness to stop smoking, other tobacco use and exposure to secondhand smoke [12]. Cancer patients often report high tobacco quit rates at cancer diagnosis or the beginning of cancer treatment but later show high relapse rates [13]. Due to these unique trends in tobacco use among cancer patients, tobacco status should be collected at cancer diagnosis and treatment intake, as well as throughout treatment and follow up. Failure to assess tobacco use at all patient encounters may miss clinically meaningful changes in tobacco-use status that can dramatically influence cancer treatment response and outcomes. Thus, prospective assessment of tobacco use at multiple time points throughout cancer clinical trials can substantially enhance understanding of the precise impact of tobacco use on cancer treatment outcomes.