Cessation Methods Research Articles

The Effect of a Tobacco Use Reduction Program on the Prevalence of Smoking and Tobacco Use and Quitting Behavior Among People Living With HIV/AIDS in Michigan.

HIV has evolved from a serious infectious disease to a manageable chronic disease. Tobacco use has a devastating effect on the health of people living with HIV/AIDS (PLWH). The Michigan Tobacco Use Reduction Program for PLWH was established in 2015 to learn about tobacco use among PLWH, gather information on entities that provide health care services to PLWH, and improve tobacco treatment services for this population. The program offers evidence-based treatment interventions to all PLWH who are tobacco users, eligible for the Ryan White HIV/AIDS Program, and served by AIDS service organizations in Michigan. This evaluation had 3 primary outcomes: 1) rates of smoking and tobacco use among program clients, 2) the percentage of clients who made a quit attempt in the previous 12 months, and 3) the types of tobacco cessation methods used by clients. All data were self-reported in 3 surveys, one each in 2015, 2017, and 2021. The rate of cigarette smoking overall among clients decreased significantly from 49.5% in 2015 to 41.5% in 2017. The percentage of clients who made a quit attempt increased from 37.0% in 2015 to 41.9% in 2017; in 2021, this rate was 54.4%. By age, in all 3 survey years, the highest rate of tobacco use was among clients aged 35 to 44 years (range, 48.4%-57.4%). Smoking rates declined significantly from 2015 to 2017 among African American (50.5% to 42.8%) and White clients (49.8% to 39.9%). The most frequently used method of tobacco cessation was medications prescribed by a physician (range, 20%-30%). State tobacco control programs are encouraged to collaborate with their state HIV/AIDS bureaus to create similar programs to treat tobacco use among PLWH.

Smoking cessation in Chinese patients undergoing thoracic surgery: A multicenter prospective observational study.

The multicenter CHAMPION study aimed to assess the impact of smoking cessation on post-operative complications (PCs) and smoking cessation patterns in Chinese patients undergoing lung surgery. Patients undergoing elective lung surgery were prospectively enrolled from three major tertiary centers in China. Patients were categorized as smokers or quitters before surgery. Baseline characteristics and smoking status were analyzed. The incidence of PCs and pulmonary PCs (PPCs), smoking relapse rate, and causes within six months post-operatively were investigated. The questionnaire was conducted in all patients and 30 healthcare professionals (HCPs), regarding the awareness and effectiveness of smoking cessation methods. Of the 276 enrolled patients, 213 (77.2%) were smokers and 63 (22.8%) were quitters; 76.4% were diagnosed with primary lung cancer. PCs occurred in 13.8% of patients, with similar proportions in smokers (14.1%) and quitters (12.7%). PPCs occurred in 9.8% of patients with no significant differences between smokers and quitters (9.4% vs 11.1%, p=0.70). At six months, 9.2% of patients relapsed, with a lower rate in quitters compared to smokers (3.3% vs 11.0%, p=0.01). HCPs exhibited higher awareness of smoking cessation methods than patients. Perceived effectiveness of smoking cessation methods from the patients were low. In patients undergoing lung surgery with a low risk of PCs, active smoking does not significantly increase the risk of PCs or PPCs relative to quitters, suggesting that there is likely no need to postpone lung surgery for those who have not yet quit smoking. However, further large-scale studies are necessary to confirm these findings.

Perceived relative harm of e-cigarettes among Ukrainian adults.

Emerging evidence suggests that the use of safer nicotine products (SNPs), such as e-cigarettes and heated tobacco products (HTPs) poses significantly lower health risks than continued smoking, particularly over the short and medium term. However, it remains uncertain whether the public has been adequately informed about these relative risks. This study assesses the perceived relative harm of e-cigarettes compared to conventional cigarettes in Ukraine. Two nationally representative surveys were conducted in February 2021 and December 2022. Participants, irrespective of their smoking status, were asked whether they agreed with the statement that "using e-cigarettes is more harmful than smoking conventional cigarettes". The surveys also included questions about tobacco product usage, the most dangerous substances in cigarettes, and smoking cessation methods. The data were statistically analysed by deriving design-based weighted point estimates and 95% confidence intervals for the proportions within each response category. In 2022, 38.1% (95% CI: 35.3-40.9) of adults believed that e-cigarettes were more harmful than cigarettes and the perception of relative harm remained relatively unchanged between the two surveys. Furthermore, 56.2% (95% CI: 50.0-62.2) of current cigarette smokers agreed with this statement, while only a small percentage of vapers (e-cigarette users) 7.4% (95% CI: 1.5-30.0) perceived e-cigarettes as more harmful than conventional cigarettes. Among non-smokers and dual users the share was 33.4% (95% CI: 30.0-36.9) and 32.7% (95% CI: 25.1-41.5), respectively. Our findings indicate that in Ukraine the perception that e-cigarettes are more harmful than cigarettes, or the lack of knowledge regarding relative risks, prevails. This highlights the importance of accurate risk communication to promote a harm reduction approach to tobacco use.

USERS OF TOBACCO AND NICOTINE PRODUCTS: KEY BEHAVIORAL TYPES

Aim. Establishing the type of tobacco behavior and the main motives and reasons for smoking among consumers of tobacco products.
 Material and Methods. A survey involved 817 individuals aged 18-44 in the Lviv region. Various types of tobacco products were identified among the interviewees: 96 respondents were smokers of electronic nicotine delivery systems (ENDS), 93 respondents were smokers of heated tobacco products (HTPs), and 228 respondents were smokers of classic cigarettes. A sociological survey using Horn's questionnaire was conducted to determine the types of behavior of smokers.
 Results and Discussion. The dominant type of smoking behavior, both among smokers of classic cigarettes or tobacco products for heating (HTP), and among users of nicotine through electronic cigarettes (ENDS) was the "Support" type, the second-ranked - "Playing with a cigarette", the third-ranked - "Thirst". The largest number of smokers by the behavioral type "Playing with a cigarette" was found among HTP smokers - 55.91±5.15 cases per 100 respondents. The "Thirst" type is most typical in smokers of classic cigarettes - 39.91±3.24 cases per 100 respondents. The "Support" type was the leading one for male smokers in the groups of classic cigarette smokers (47.09±3.81 cases per 100 men) and ENDS smokers (47.62±7.71 cases per 100 men), while for HTP smokers - "Playing with a cigarette" (54.55±7.51 cases per 100 men). In the group of female smokers in all studied groups, the "Support" type was the dominant type of behavior. At the same time, among female ENDS smokers, two types of behavior were dominant, namely - "Support" and "Playing with a cigarette" with an identical rate of 44.44±6.76 cases per 100 women.
 Conclusions. Determining the types of behavior of a smoker and the main reasons and motives for smoking will allow choosing a method of smoking cessation and increasing the effectiveness of quitting tobacco and nicotine use.

The Effect of Varenicline, Nicotine Replacement, and Acupuncture for Smoking Cessation

Aim: Various methods are used in the treatment of cigarette addiction. The aim of the study is to compare the smoking cessation status of patients who applied for smoking cessation treatment and received varenicline treatment, nicotine replacement therapy (NRT), and acupuncture treatment. Methods: In the study, 402 individuals who received varenicline treatment, NRT, and acupuncture treatment for smoking cessation were included. The sociodemographic data of the individuals, the results of the Fagerström nicotine dependence test, and the data on smoking cessation obtained during the 6 months after the treatment were retrospectively scanned from the patient files. Results: Of the 402 individuals included in the study, 60.4% (n=243) were treated with varenicline, 28.1% (n=113) received NRT, and 11.4% (n=46) were treated with Acupuncture. 63.4% (n=255) of all the patients, 71.2% (n=173) of the patients treated with varenicline, 56.6% (n=64) of the patients who received NRT, and 39.1% (n=18) of the patients treated with Acupuncture quit smoking. It was found that the smoking cessation rate was higher in the patients treated with varenicline compared to other treatments (p<0.001), and varenicline was more effective than other treatments in very high addiction (p<0.001). Conclusion: Varenicline treatment, NRT, and acupuncture treatment are all effective methods for smoking cessation. Varenicline treatment is more effective in smoking cessation than other treatments, and this efficiency is higher than other treatments for very high addiction.

Unveiling the Path to Liberation: A Comprehensive Review of Methods for Tobacco Cessation

As society becomes increasingly aware of the detrimental effects of tobacco, the quest for effective cessation methods has intensified. This review explores a spectrum of approaches to tobacco cessation, shedding light on their efficacy, challenges, and the promise they hold in fostering a tobacco--free world.

The association between different types of physical activity and smoking behavior

BackgroundSmoking is harmful, which has become a major public health burden. Physical activity may be related to smoking. Physical activity is one of the current methods for smoking control and smoking cessation. Different types of physical activity may have different effect on smoking behavior.ObjectiveThe purpose of this study was to identify the direction and extent of the impact of different types of physical activity above moderate intensity (including work physical activity, recreational physical activity, commuter physical activity and sedentary behavior) on smoking behavior.Materials and methodsIn this study, a total of 2,015 individuals (1,233 males and 782 females, mean age 54.02±17.31 years) was selected from the representative population aged 20 and above in the National Health and Nutrition Survey of the United States from 2017 to 2018. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) ; the tobacco use questionnaire (SMQ) was used to determine whether the sample had smoking behavior at this stage. Binary Logistic regression analysis was performed with various physical activities as independent variables and smoking behavior as dependent variables. All data were analyzed through Statistical Product and Service Solutions (SPSS) 26.0.ResultsAfter adjusted for all confounding variables, physical activity at work was close to significantly associated with smoking behavior (P=0.053), odds ratio (OR) =1.135 (95%Cl: 0.999-1.289). Recreational physical activity was significantly associated with smoking behavior (P < 0.001), OR=0.729 (95%Cl: 0.639-0.832). Commuting physical activity was significantly associated with smoking behavior (P < 0.001), OR=1.214 (95%Cl:1.048-1.405). Sedentary behavior was significantly associated with smoking behavior (P < 0.001), OR=1.363 (95%Cl: 1.154-1.611).ConclusionsGiven that different types of physical activity have different associations with smoking behavior. Therefore, when physical activity is used as a tobacco control measurement, it is necessary to pay attention to the type and environment of physical activity. Recreational physical activities should be appropriately increased, sedentary behavior should be reduced, and smoking prohibit environment should be expanded as far as possible to achieve better clinical intervention effects.

E-cigarette and combustible cigarette cessation patterns, reasons, and methods among adolescents, young adults, and adults

Research is limited regarding adolescents’ and young adults’ (AYA) patterns, methods of, and reasons for cigarette or e-cigarette cessation. Further, while adults may try to use e-cigarettes to quit combustible cigarettes, little is known about how adults then quit e-cigarettes. This study utilizes a national, cross-sectional online survey of 6131 diverse participants aged 13–40 years to examine reasons for quitting e-cigarettes or cigarettes, quit methods, and quit attempt outcomes among AYAs and adults. In our sample, 3137 (51.2%) had ever used an e-cigarette, of whom 2310 (37.7%) were aged 13-24 years and 827 (13.5%) were 25-40 years old; 2387 (38.9%) had ever used a combustible cigarette (1440 [23.5%] were 13-24 years old and 947 [15.4%] were 25-40 years old). Among e-cigarette ever-users, 39.4% of 13–24-year-olds intended to quit in the next 6 months, and 36.9% had a serious plan for quitting in the next 30 days; 25.2% wanted to decrease the amount they used while 34.8% wanted to quit completely. Similar rates were found among e-cigarette ever users aged 25–40 years, as well as past 30-day e-cigarette users, cigarette ever-users, and past 30-day cigarette users across all ages. “Cold turkey” (41.0%) followed by “tried to cut down slowly by vaping/smoking less often or fewer puffs” (25.5%) was the most common quit method among e-cigarette ever-users and cigarette ever-users of all ages. Further study of effective tobacco cessation methods to help both AYAs and adults successfully quit nicotine, whether from cigarettes or e-cigarettes, is urgently needed.

Factors Associated with Smokers Attending More Than One Smoking Cessation Clinic Visit

Smoking remains a primary cause of cancers, cardiovascular and respiratory diseases and death. Globally, efforts have been made to reduce smoking rates, but the addictive nature of nicotine, a key component of tobacco, makes cessation challenging for smokers. Medical interventions including medical advice and pharmacotherapies are effective methods for smoking cessation. The frequency of medical interventions correlates with success in smoking cessation. This study aims to compare the characteristics of the patients who visited the smoking cessation clinic once with those who visited more than once, in order to identify factors that are associated with repeat clinic visits. A total of 81 patients who have visited the smoking cessation clinic in Kangwon National University Hospital were included. Patients answered the questionnaire at their first visit. If the patient visited only once, the outcome was defined as negative and if the patient visited more than once, the outcome was defined as positive. The proportion of patients who answered “within 5 min” to the Fagerstrom Test for Nicotine Dependence’s (FTND) 1st question and answered “yes” to the FTND’s 6th question was higher in the negative outcome group. In the logistic regression, patients who had withdrawal symptoms previously were associated with positive outcomes (adjusted OR 3.466, 95% CI 1.088–11.034 and p value = 0.0354). Withdrawal symptoms during previous attempts were positively related to visiting the clinic more than once.

Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial

The efficacy and safety of varenicline for smoking cessation among individuals who smoke tobacco cigarettes and also use electronic cigarettes (known e-cigarettes or vapes) have not been studied. We aimed to address this knowledge gap and examine predictors for smoking abstinence. In this double-blind, placebo-controlled, single-centre randomised trial in Italy, we enrolled adults who had used an e-cigarette daily for at least 12 months and who also smoked at least one tobacco cigarette per day and had a willingness to quit smoking. 155 participants were randomly assigned to receive either varenicline (n=78) or matched placebo (n=77). Varenicline (1mg, administered twice daily for 12 weeks) was given in combination with smoking cessation counseling in dual users with an intention to quit smoking. Participants in both treatment groups received the same smoking cessation counselling throughout the whole duration of the study. The trial consisted of a 12-week treatment phase followed by a 12-week follow-up. The primary efficacy endpoint was continuous abstinence rate (CAR) in weeks 4-12. Secondary efficacy endpoints were the CAR in weeks 4-24 and 7-day point prevalence of smoking abstinence at weeks 12 and 24. This study is registered in EUDRACT, 2016-000339-42. Between November 2018, and February 2020, 114 participants (61 in the varenicline group and 53 in the placebo group) completed the intervention phase at week 12 and 88 participants (52 in the varenicline group and 36 in the placebo group) completed the follow-up phase at week 24. CARs were significantly higher for the varenicline vs placebo at each time-point: 50.0% vs 16.9% (OR=4.9; 95% CI, 2.3-10.4; P<0.0001) between weeks 4 and 12; and 48.7% vs 14.3% (OR=5.7; 95% CI, 2.6-12.3; P<0.0001) between weeks 4 and 24. The 7-day point prevalence of smoking abstinence was also higher for the varenicline than placebo at each time point. Adverse events were rated as mild or moderate and rarely led to treatment discontinuation. Our findings indicate that inclusion of varenicline in a cessation programme for adults who smoke and use e-cigarettes with an intention to quit smoking could result in smoking abstinence without serious adverse events. In the absence of evidence from other smoking cessation methods, it could be useful to suggest the use of varenicline in cessation programmes specifically designed to help dual users stop smoking. Further research in larger and more generalisable populations is required to strengthen such a suggestion. Global Research Award for Nicotine Dependence, an independently reviewed competitive grants programmeme funded by Pfizer.

Factors Influencing Tobacco Cessation in India: Findings from the Global Adult Tobacco Survey-2.

The study aimed to assess the socio-demographic and other correlates of cessation behavior across tobacco products among the adult population in India. We used data of adults (aged ≥15 years) who were current or former tobacco users (smoking and/or smokeless tobacco) from the Global Adult Tobacco Survey (GATS) India, conducted during 2016-17. The detailed analysis was done for current daily smokers (N=7,647), former daily smokers (N=1,353), and current daily smokeless tobacco users (N=1,2721). Multivariate logistic regression was separately performed to find the associated factors with attempts to quit, successful quitting, different cessation methods of smoking, and smokeless tobacco use. The findings of the study indicated that daily smokers, higher educated, urban residents and employed were more likely to quit smoking compared to their counterparts. Successful quitting of smoking was higher for employed, higher educated, current users of smokeless tobacco and older adults. For smokeless tobacco users, non-daily users, highly educated, urban residents, and employed were more likely to attempt to quit compared to their counterparts. Successful quitting of smokeless tobacco was higher for unemployed, highly educated, urban residents and current non-smokers, and higher age group adults. The findings of this study suggest a need for professionally channelized cessation interventions to reduce the prevalence and relapse of tobacco use and increase the quit rate. Well-designed, large-scale research into specific tobacco cessation methods is needed to establish the association between different tobacco cessation methods and increased quit rates.

Mobile applications (apps) for tobacco cessation: Behaviour change potential and heuristic analysis using the Mobile Application Rating Scale (MARS)

Background Given the high prevalence of tobacco use, India presents a significant challenge in tobacco control. Yet, the support received for tobacco cessation is suboptimal. Hence, the aim was to identify and heuristically evaluate ‘high-quality’ and ‘engaging’ tobacco cessation mobile apps using the Mobile Application Rating Scale (MARS). Also, to categorize and analyse their features with respect to engagement, functionality, aesthetics, and information quality. Methods A systematic search of tobacco cessation apps was done within app stores of prominent smartphone platforms developed by Apple and Android. The following search terms: ‘quit smoking,’ ‘smoking cessation, ‘stop smoking,’ ‘smoking therapy,’ ‘quit tobacco,’ ‘cigarette cessation,’ ‘cold turkey,’ and ‘quit cigarette.’ Pearson’s correlations were used to analyse correlations between app scores (Total score app-quality/mean score) and downloads/ratings and number of downloads with the overall MARS score. A Chi-square test was performed to analyse any association between app focus and app release dates. Results Total MARS scores ranged from 3.1 to 4.9. Quitsure app (4.9), Craving to Quit! app (4.8) and Stop Tobacco Mobile Trainer: Quit Smoking App (4.74) were ranked the highest according to the MARS overall mean score. Older apps focussed more on mere goal setting or substance use, as compared to behaviour change; whereas, recently developed apps are now focussing more on behaviour change. Conclusions The content and functionality of behaviour change-focused apps were of higher quality than those of other app categories. These recently developed mHealth apps can effectively supersede the traditional smoking cessation methods.

Emerging Adults’ Experiences with E-Cigarette Cessation

Background: The use of electronic nicotine delivery systems (ENDS) is one of the most common substance use behaviors in college students, yet most individuals show some interest in quitting. The current study added to the limited literature on ENDS cessation by examining readiness to quit and the use and perceived efficacy of ENDS cessation methods in a heterogeneous sample of college students. Methods: Students 18-24 years in Psychology courses (N = 1563; 73% female) from six US universities completed an online survey between September 2021-April 2022. Results: Nearly half the sample (n = 738, 47%) reported lifetime ENDS use and nearly half of lifetime users (n = 356, 48%) reported a quit attempt. Most ENDS users reported some readiness to quit (n = 251, 67%). Quitting “cold turkey”, using willpower, and replacing ENDS use with another activity were endorsed most frequently; strategies were perceived as more helpful if students had direct experience with them. Social support (e.g., counseling, groups, family/friend support) and nicotine replacement products were perceived as effective but were utilized infrequently. Digital tools (i.e., apps, text messaging) were perceived to be least helpful and were utilized infrequently. Conclusion: Most college students who use ENDS are interested in quitting and have relied on unassisted methods for cessation. Our data suggest a significant opportunity for college personnel and public health officials to further enhance awareness and uptake of ENDS cessation resources for this demographic. Digital tools that integrate social support may be especially effective given their low cost, demonstrated efficacy, and alignment with students’ preferences for social support.

Bladder cancer patient and provider perspectives on smoking cessation

BackgroundSmoking is the most common risk factor for bladder cancer and is associated with adverse clinical and cancer-related outcomes. Increasing understanding of the patient and provider perspectives on smoking cessation may provide insight into improving smoking cessation rates among bladder cancer survivors. We sought to inform strategies for providers promoting cessation efforts and help patients quit smoking. MethodsUsing a modified Delphi process with multidisciplinary input from bladder cancer providers, researchers, and a patient advocate, 2 surveys were created for bladder cancer patients and providers. Surveys included multiple-choice questions and free answers. The survey was administered electronically and queried participants’ perspectives on barriers and facilitators associated with smoking cessation. Survey responses were anonymous, and participants were provided with a $20 Amazon gift card for participating. Patients were approached through the previously established Bladder Cancer Advocacy Network (BCAN) Patient Survey Network, an online bladder cancer patient and caregiver community. Providers were recruited from the Society of Urologic Oncology (SUO) and the Large Urology Group Practice Association (LUGPA). ResultsFrom May to June 2021, 308 patients and 103 providers completed their respective surveys. Among patients who quit smoking, most (64%) preferred no pharmacologic intervention (“cold turkey”) followed by nicotine replacement therapy (28%). Repeated efforts at cessation commonly occurred, and 67% reported making more than one attempt at quitting prior to eventual smoking cessation. Approximately 1 in 10 patients were unaware of the association between bladder cancer and smoking. Among providers, 75% felt that barriers to provide cessation include a lack of clinical time, adequate training, and reimbursement concerns. However, 79% of providers endorsed a willingness to receive continuing education on smoking cessation. ConclusionsBladder cancer patients utilize a variety of cessation strategies with “cold turkey” being the most used method, and many patients make multiple attempts at smoking cessation. Providers confront multiple barriers to conducting smoking cessation, including inadequate time and training in cessation methods; however, most would be willing to receive additional education. These results inform future interventions tailored to bladder cancer clinicians to better support provider efforts to provide smoking cessation counseling.

Adoption of Vaping Cessation Methods by US Adolescent E-Cigarette Users.

A large number of adolescent e-cigarette users intend to quit vaping or have past-year quit attempts. However, it remains unknown which methods they use in their vaping cessation efforts. We analyzed current (past 30-day) e-cigarette users who made ≥1 quit attempt in the past 12 months from the 2021 National Youth Tobacco Survey (NYTS) to examine the prevalence and associations of sociodemographic factors, vaping behaviors, and harm perception with the adoption of different vaping cessation methods. In the 2021 NYTS, there were 1436 current vapers, and 889 (67.9%) had made a past-year quit attempt. Of those, 575 (63.7%) (weighted N = 810 000) reported they did not use any resources (unassisted quitting). Peer support (14.2%), help on the Internet (6.4%), a mobile app or text messaging (5.9%), and parent support (5.8%) were the top 4 cessation methods. Female (versus male) vapers were less likely to solicit parent support (adjusted odds ratio [AOR], 0.2; 95% confidence interval [95% CI], 0.1-0.5), whereas Hispanic (versus White) vapers were more likely to seek friend support (AOR, 2.1; 95% CI, 1.1-3.9) and parent support (AOR, 2.7, 95% CI, 1.2-6.3). Those who perceived vaping to be harmful were less likely to get friend support, but more likely to use a mobile app or text messaging program. Dual users of e-cigarettes and any other tobacco product were more likely to get help from a teacher/coach or a doctor/health care provider and treatment from medical facilities than sole e-cigarette users. There were different correlates with the adoption of vaping cessation methods, highlighting the need for tailored approaches to meet the cessation needs and preferences of the adolescent vaping population.

The effectiveness of Allen Carr's method for smoking cessation: A systematic review.

Allen Carr's (AC) method is a pharmacotherapy-free approach to quit smoking that is delivered through seminars, online courses, or in the form of a book. It has gained popularity, but its effectiveness remains controversial due to a lack of scientific evidence. This systematic review aims to provide an updated overview of the current evidence on the effectiveness of the AC method. We conducted a systematic literature review of all epidemiological studies evaluating the effectiveness of the AC method for smoking cessation, published in PubMed/MEDLINE and Embase up to March 2023. Among 34 original studies identified through the literature search, six met the inclusion criteria. These studies were published between 2006 and 2020, with sample sizes ranging from 92 to 620 participants. Of the six studies, two did not have a comparison group while four, including two randomized control led trials (RCT), had a comparison group. The included studies showed cessation rates for people who attended the seminars from 19% to 51%. An observational study found an odds ratio (OR) of abstinence for those attending AC single-session seminars of 6.52 (95% confidence interval, CI: 3.10-13.72) compared with controls with no treatment. One RCT found higher quit rates for AC single-session seminars compared with the online Irish National service (OR=2.26; 95% CI: 1.22-4.21). Another RCT reported no significant difference between AC single-session seminars and a specialist stopsmoking service. One single study on patients with head and neck disorders analyzed the effectiveness of reading the AC book, showing no significant results. The AC seminar may be an effective intervention for smoking cessation. This approach deserves further RCTs with large sample sizes to strengthen the evidence. Scant data are available on the effectiveness of reading the AC book.

Electronic Cigarette Prevalence and Knowledge Among Medical Students in Saudi Arabia and Bahrain: A Cross-National Study.

Background Electronic cigarettes (e-cigarettes and vapour devices) are the most commonly used form of alternative tobacco products (ATPs). The use of these vapour devices has been dramatically increasing worldwide, especially among current and former traditional cigarette smokers. A strong influence that will affect patients' health attitudes and play a crucial role in tobacco control and smoking cessation are medical students, as they are future physicians. Therefore, in our study, we aimed to determine the prevalence rate of e-cigarettes and the level of knowledge among medical students in Saudi Arabia and Bahrain. Methods We conducted a cross-sectional study of medical students in Saudi Arabia and Bahrain using an online survey.Thiswas distributed through social media platforms such as Twitter, WhatsApp, Telegram, and Facebook.Medical students of all years were included. The questionnaire was adapted fromtwoprevious studies. Results The study enrolled 1730 medical students. The majority of the participants did not recommend the use of e-cigarettes as a method for smoking cessation or believed that these types of ATPs lower the risk of cancer in comparison with traditional cigarettes. The data showed a strong association between gender and e-cigarette smoking, with the majority of current smokers being men (n = 184) and experimental smokers being women (n = 800). Moreover, an educational gap was discovered, as few of the students had received an education in their medical school's curriculum on the use of e-cigarettes. There was a significant association between receiving an education at a medical school and having adequate knowledge of e-cigarettes. Conclusion The increasing number of e-cigarette users among medical students is concerning. Our study showed that students are not receiving a decent education on the use of ATPs during medical school, which urges further adjustment of the curriculum. This will play a huge role in their behaviour and the provision of future treatment plans to patients as physicians.

Value of Diaphragm Ultrasonography for Extubation: A Single-Blinded Randomized Clinical Trial.

Daily evaluation of mechanically ventilated (MV) patients is essential for successful extubation. Proper withdrawal prevents complications and reduces the cost of hospitalization in the intensive care unit (ICU). Diaphragm ultrasonography (DUS) has emerged as a potential instrument for determining whether a patient is ready to be extubated. This study compared the efficacy rate of extubation using a standard withdrawal protocol and DUS in patients with MV. A randomized, parallel, single-blind, controlled study was conducted on ICU patients undergoing MV. Patients were randomly assigned to either the control (conventional weaning protocol) group or intervention (DUS-guided weaning) group in a 1 : 1 ratio. The primary outcome measure was the rate of reintubation and hospital mortality. Forty patients were randomized to the trial. The mean age of the sample was 70 years, representing an older population. The extubation success rate was 90% in both groups. There was no reintubation in the first 48 hours and only two reintubations in both groups between the second and seventh days. The hospital mortality risk in patients with acute kidney injury was positively correlated with age and the need for hemodialysis. Discussion. This study demonstrates the usefulness of DUS measurement protocols for withdrawing MV. The rate of reintubation was low for both cessation methods. As a parameter, the diaphragm thickness fraction comprehensively evaluates the diaphragm function. The results demonstrate that DUS has the potential to serve as a noninvasive tool for guiding extubation decisions. In conclusion, using DUS in patients with respiratory failure revealed no difference in reintubation rates or mortality compared with the conventional method. Future research should concentrate on larger, multicentered, randomized trials employing a multimodal strategy that combines diaphragmatic parameters with traditional clinical withdrawal indices.

Diş Hekimliği Lisans Öğrencilerinin Sigara İçme Sıklığı, Tutum ve Davranışları ile Genel Öz-yeterliklerinin Değerlendirilmesi

Physicians play a crucial role in reducing tobacco use. Besides many studies have shown doctors have a high prevalence of smoking. Dentistry students receive varying levels of education about the negative effects of smoking and tobacco products on general health and the risks of causing systemic and oral diseases. The present study aims to assess the prevalence of smoking, attitudes toward smoking, knowledge on smoking addiction treatments, and general self-efficacy of dentistry students. Utilizing a digital platform, the questionnaire form was constructed. The survey instrument employed in the research comprises two distinct sections: 1.Global Health Professionals Student Survey (GHPSS), 2.General Self-Efficacy Scale. 260 dentistry students were included in the study. The prevalence of smoking was %24.7 for 3rd-grade, %30.0 for 4th grade, and %30.3 for 5th grade. The smoking status of 3rd, 4th, and 5th-grade dentistry students did not vary by educational level(p=0.320). Self-efficacy levels do not differ significantly according to 'never smoked', 'still smoking', or 'quit smoking' status(F=0.317,p=0.729). The majority of dentistry students participating in this study believe they have a responsibility to provide smoking cessation advice(n=228,%88,3) and should receive specialized training on the topic(n=214,%82,9). Attitudes toward smoking was related to general self-efficacy in some questions. In conclusion, the clinical education and self-efficacy levels of dentistry students had no effect on their smoking attitudes, according to the present study. Provisions should be made to increase dentistry students' limited knowledge of smoking cessation methods and treatments, and psychosocial support services should be provided to increase their self-efficacy during undergraduate education.

A Systematic Review of Qualitative Studies on Factors Associated With Smoking Cessation Among Adolescents and Young Adults.

To summarize findings from qualitative studies on factors associated with smoking cessation among adolescents and young adults. We searched Pubmed, Psychinfo, CINAHL, Embase, Web of Science, and SCOPUS databases, as well as reference lists, for peer-reviewed articles published in English or French between January 1, 2000, and November 18, 2020. We used keywords such as adolescents, determinants, cessation, smoking, and qualitative methods. Of 1724 records identified, we included 39 articles that used qualitative or mixed methods, targeted adolescents and young adults aged 10-24, and aimed to identify factors associated with smoking cessation or smoking reduction. Two authors independently extracted the data using a standardized form. We assessed study quality using the National Institute for Health and Care Excellence checklist for qualitative studies. We used an aggregative meta-synthesis approach and identified 39 conceptually distinct factors associated with smoking cessation. We grouped them into two categories: (1) environmental factors [tobacco control policies, pro-smoking norms, smoking cessation services and interventions, influence of friends and family], and (2) individual attributes (psychological characteristics, attitudes, pre-quitting smoking behavior, nicotine dependence symptoms, and other substances use). We developed a synthetic framework that captured the factors identified, the links that connect them, and their associations with smoking cessation. This qualitative synthesis offers new insights on factors related to smoking cessation services, interventions, and attitudes about cessation (embarrassment when using cessation services) not reported in quantitative reviews, supplementing limited evidence for developing cessation programs for young persons who smoke. Using an aggregative meta-synthesis approach, this study identified 39 conceptually distinct factors grouped into two categories: Environmental factors and individual attributes. These findings highlight the importance of considering both environmental and individual factors when developing smoking cessation programs for young persons who smoke. The study also sheds light on self-conscious emotions towards cessation, such as embarrassment when using cessation services, which are often overlooked in quantitative reviews. Overall, this study has important implications for developing effective smoking cessation interventions and policies that address the complex factors influencing smoking behavior among young persons.