Cessation Programs Research Articles

Sex-Age Interplay Among Young Aged Egyptians With First Acute Myocardial Infarction.

The burden of modifiable risk factors in young Egyptian adults presenting with first acute myocardial infarction (AMI), sex differences, sex-age interplay, and its relationship with demographic, angiographic characteristics, and type of AMI is a good topic for discussion. The study enrolled 165 young (≤45 years old) consecutive, eligible patients diagnosed with first AMI (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction), for their demographic, angiographic, echocardiographic, and laboratory investigations and gender differences. Our population were 29-45 years old and 12.1% were females, most of whom had ST-elevation myocardial infarction; obesity in females and smoking in males were the most prevalent; and the younger the age of females presenting with AMI the more aggressive underlying risk factors and the more reduction in left ventricular ejection fraction. Most of the female culprit lesions were thrombotic and the severity of atherosclerotic culprit lesions correlated positively with blood pressure. The age paradox in young females (regarding left ventricular ejection fraction and the traditional risk factors) and the thrombotic nature of the culprit lesion mandate early intensive 1-year and 2-year preventive strategies against coronary heart disease (CHD) with special concern for obesity as the main trigger early in life with proper control of blood pressure. In males, smoking cessation programs are the main target to ameliorate the progress of CHD hand in hand with the other 1-year and 2-year preventive strategies of CHD.

Exploring Blood Lead Level Determinants in Refinery Workers: A Cross-Sectional Study.

Occupational lead exposure poses a significant risk to workers in industrial settings, especially in petroleum refineries. The study aimed to examine the prevalence and determinants of high blood lead concentrations among refinery workers in Kirkuk, Iraq. It has also been aimed to provide evidence-based approaches to identify associated risk factors. A cross-sectional study was conducted among 187 workers from three departments (transportation, storage, and production) in a petroleum refinery from August 2023 to April 2024. Blood lead levels (BLLs) were measured using graphite furnace atomic absorption spectroscopy (GFAAS)(Agilent, Santa Clara, CA). The elevated BLLs were defined as lead levels in blood samples greater than 10 µg/dL. Data on demographic characteristics, such as occupations, smoking habits, and drinking milk, were collected using a researcher-developed information sheet. Statistical analyses included the Kruskal-Wallis test and Pearson Chi-Square test, and logistic regression was used to address the determinants of elevated BLLs. The corresponding associations were reported using odds ratios (OR) and adjusted OR(AOR) along with 95% confidence intervals (CIs). Eighty-five percent of the workers had high BLLs, with a median BLL of 17.11 µg/dL. The findings revealed that workers employed in outdoor settings had 4.25 times higher AOR(95% CI: 1.24-14.48) of experiencing high BLLs compared to those working indoors, after adjusting for other factors. This was especially true for workers who spent nine to 16 hours outdoors. Additionally, age and smoking were also found to be associated with an increased risk of high BLLs. On the other hand, the analysis indicated that drinking milk had a protective effect against high BLLs. The high prevalence of elevated BLLs among refinery workers in Kirkuk underscores the urgency for immediate interventions. Regular monitoring of BLLs, improved training, dietary adjustments (e.g., consuming calcium and phosphate-rich milk, which can help lower BLLs), and smoking cessation programs are recommended to reduce lead exposure and safeguard workers' health. Furthermore, the results suggest that drinking milk could potentially reduce BLLs among petroleum refinery workers. Additional research is necessary to evaluate the effectiveness of these interventions and to continue monitoring exposure levels.

Improving delivery of smoking cessation assistance for patients with cancer: Results of the Beyond ASK quality improvement.

11011 Background: Smoking by cancer patients and survivors causes adverse health outcomes, and quitting smoking after a cancer diagnosis can improve survival. However, assistance with smoking cessation is not regularly provided to cancer patients. Reported are results of the national 2023 Beyond ASK quality improvement initiative to increase and sustain delivery of smoking cessation assistance across participating sites. Methods: In 2023, American College of Surgeons Commission on Cancer (CoC) accredited sites were invited to participate in the Beyond ASK quality improvement initiative to increase evidence-based smoking cessation assistance delivery to cancer patients who report current smoking. Participating sites were required to monitor and periodically report on provider performance (e.g., assist rate = number of patients assisted with smoking cessation / number of patients who smoke), resource utilization, barriers, and facilitators. Educational resources, webinars, toolkits, and online data collection were facilitated by CoC. Results: Among 306 participating programs who completed the Beyond ASK initiative (94% of baseline programs), high rates of asking patients about and documenting smoking status were maintained at 88-92% from the baseline to final survey. During the 12-month project period, overall rates of assisting with smoking cessation increased from 53% to 67%. Referral to state quitlines increased from 31% to 49%, and referral to ‘in house’ smoking cessation programs increased from 15% to 28%. Rates of providing brief in office counseling more than tripled from 20% at baseline to 66% at final. The most frequently reported components that contributed to programs’ success were educational webinars (30.6%), structured data collection (28.2%), and smoking cessation toolkit (21.2%). The leading logistical barriers were extracting clinical data from the EHR and making changes to the clinical workflow, reported by 36.5% and 28.2% of respondents, respectively. Overall, 95.3% of respondents “agreed” or “strongly agreed” that identifying patients who smoke and assisting patients with cessation was sustainable. Conclusions: Increasing smoking cessation assistance through a national accreditation organization is feasible with substantial improvements in assisting patients. Results support delivery of smoking cessation as an achievable national quality component of cancer care.

Outcome analysis of the traditional therapeutic approach in patients with bronchopulmonary cancer and advanced anesthetic-surgical risk

Background. Lung cancer exhibits high global incidence and mortality rates. Surgical resection remains crucial to diagnosis, staging, and treatment of non-small cell lung cancer (NSCLC). However, advanced stages often require multimodal approaches. Prehabilitation, innovative perioperative techniques, and the exploration of immunotherapy hold promise for improving outcomes. Materials and methods. This two-phase observational cohort study included a retrospective arm (100 patients, traditional treatment) and a prospective arm (100 patients, innovative perioperative management, and risk stratification). Descriptive and inferential statistics were used to evaluate data, identify risk factors, and compare the 2-year survival between treatment groups. Results. Despite advances, lung cancer prognosis remains poor, with limited cure rates. Mean survival in the traditional approach was 1.3 years with a 5-year survival of only 1%. While prehabilitation and innovative techniques showed potential, no statistically significant differences in survival times were observed between the treatment groups. Patients with stage III (Charlson score 0-4) and stage I-II (Charlson score 5-12) demonstrated comparable outcomes, highlighting the importance of comorbidity burden. Conclusions. Targeted screening protocols are of paramount importance for early detection and intervention. Populationwide smoking cessation programs, environmental protection measures, and the promotion of healthy lifestyles are vital for prevention and reducing incidence. Standard chemotherapy and radiotherapy offer limited therapeutic benefits in advanced lung cancer. This highlights a pressing need for breakthroughs in basic research to develop novel treatment paradigms that significantly improve outcomes. While this study did not reveal statistically significant survival differences between traditional and innovative perioperative approaches, prehabilitation and optimization techniques hold promise and deserve further research. The development of anti-tumor immunotherapy offers a significant potential in non-surgical lung cancer treatment, especially given the limitations in advanced-stage disease management. Harnessing the immune system to fight cancer represents a promising new frontier.

Flavored Tobacco Sales Restrictions and Youth E-cigarette Behavior: Impact by Tobacco Retailer Density in Diverse Communities in California.

Factors that impact flavored tobacco sales restriction (flavor restrictions) effectiveness on youth e-cigarette behavior are unclear. Tobacco retailer density (retailer density) is a health equity issue with greater retailer density in high-minority, low-income areas. We examined the association between flavor restrictions and youth e-cigarette behavior by retailer density across diverse communities in the California Bay Area. We analyzed data from the California Healthy Kids Survey using a difference-in-differences (DID) strategy. We compared pre- and post-policy changes in e-cigarette access and use one-year post-implementation among high school students in the Bay Area with a flavor restriction (n = 20 832) versus without (n = 66 126). Separate analyses were conducted for students in cities with low and high retailer density, with a median cutoff of 3.3 tobacco retailers/square mile. Students with high retailer density were more likely to identify as a minority and have parents with lower education. Among students with low retailer density, flavor restrictions were associated with 24% lower odds in the pre- to post-policy increase in ease of access relative to unexposed students (DID = 0.76, 95% CI: 0.58, 0.99). Among students with high retailer density, flavor restrictions were associated with 26% higher odds in ease of access (DID: 1.26, 95% CI: 1.02, 1.56) and 57% higher odds of current use (DID = 1.57, 95% CI: 1.31, 1.87). Flavor restrictions had positive impacts on youth e-cigarette access in low, but not high retailer density cities. From a health equity perspective, our results underscore how flavor restrictions may have uneven effects among vulnerable groups. In diverse communities in the California Bay Area, our results suggest a protective association between flavored tobacco sales restrictions and youth access to e-cigarettes in low, but not high tobacco retailer density cities one-year post-implementation. These results underscore how flavor restrictions may have uneven effects, and when implemented in high retailer density areas, may disproportionately place already vulnerable groups at heightened exposure to e-cigarette use and access. In high retailer density areas, additional tobacco control efforts may need to be included with flavor restriction implementation, such as increased education, youth prevention and cessation programs, policies to reduce tobacco retailer density, or stronger tobacco retailer enforcement or compliance monitoring.

Unveiling the psychological mechanisms of mutual help groups for addiction recovery: The role of social identity factors.

The effectiveness of mutual help groups (MHGs) in promoting addiction recovery has been widely acknowledged. However, the psychological mechanisms underlying the impact of MHGs remain somewhat uncertain. Drawing on a social identity perspective, this study investigated a sequential mediation model in which social support is posited as a driving factor that enhances abstinence maintenance through group identification, recovery identity, and self-efficacy. A sample of 820 smokers, participating in a 6-month collective smoking cessation programme which included access to an online help group, completed measures of social support, group identification, smoker/ex-smoker identity, and self-efficacy at the programme's outset. Smoking abstinence was assessed 6 and 9 months later. The findings supported the proposed model, indicating that social support was positively associated with MHG identification, which, in turn, was related to a stronger recovery identity. Subsequently, recovery identity was associated with increased self-efficacy, and indirectly, with smoking abstinence at both measurement times. Additional analyses testing alternative mediation models further supported the validity of the proposed model. These findings suggest that social identity factors play significant roles in accounting for the effectiveness of MHGs for addiction recovery.

"It's the Wild West Out There": A Qualitative Study of the Views and Preparedness of Health Professionals in Helping Young Adult E-cigarette Users to Quit.

Young adults (YA) are attempting to quit vaping, with many accessing smoking cessation programs with a lack of reported efficacy, highlighting the need for targeted vaping cessation support. Young people report seeing health professionals (HPs) as potential sources of support in the quitting process. Additionally, the current changing regulatory landscape around vaping in Australia potentially increases the number of those seeking health professional help for cessation. However, limited research exists on HPs' views and preparedness to assist YA with their vaping cessation; thus, this exploratory study aimed to gain insights into their readiness to support YA in quitting vaping. Data were gathered via eight co-design workshops (two groups each of two hours duration and six semi-structured interviews of 1-hour duration), facilitated online with 12 HPs. Data underwent thematic analysis. HPs expressed a need for more information in supporting YA to quit vaping, with them presently relying on informal pathways of support and information for their practice. Participants reported a lack of evidence-based guidelines and a reluctance to prescribe nicotine vapes, expressing conflict with the changing regulatory landscape in Australia. Our findings identify a significant gap in health professional preparedness in supporting vaping cessation. HPs are working within a rapidly evolving regulatory environment and are feeling unprepared to address the widely spread issue of vaping, especially among young people. We demonstrate the critical need for guidelines and training of HPs to enable them to better support young people in quitting vaping. This qualitative study offers unique insights into the views and readiness of Australian HPs to support young people to quit vaping, specifically in the context of recent regulatory reforms. The results highlight the need for evidence-based guidance and training for HPs to inform their vaping cessation support practice.

Factors associated with intentions to quit vaping and quit attempts among Adolescents: A structural equation modeling approach

ObjectivesPrevious youth tobacco research has identified multiple factors relating to intentions to quit vaping and quit attempts among current e-cigarette users in adolescents. The pathways in the complex associations with vaping cessation behaviors remain unclear. MethodsUsing data from the 2022 National Youth Tobacco Survey (NYTS) (grades 6–12), structural equation models (SEMs) are developed to examine the associations of social environment, vaping risk perceptions, e-cigarette marketing, vaping characteristics, and demographics with two outcome measures – intentions to quit vaping and past year quit attempts among current e-cigarette users. ResultsThe national sample of current e-cigarette users (n = 2,701) consisted of 52.7 % females, 47.0 % non-Hispanic Whites, 80.1 % high school students, and 56.2 % heterosexual individuals. Among them, 70.2 % reported intentions to quit vaping and 66.3 % reported past year quit attempts. The protective factor for quit intentions was vaping risk perceptions (p < 0.001). Risk factors included e-cigarette marketing (p = 0.04), dual use of e-cigarettes and other tobacco products (p = 0.003), vaping due to feeling anxious or stressed (p = 0.01), vaping for nicotine buzz (p = 0.002), nicotine dependence (p = 0.02), identifying as Gay or Lesbian (p < 0.001), bisexual (p = 0.03), or Hispanic (p = 0.04). Similar associations were observed with quit attempts except that e-cigarette marketing, vaping due to feeling anxious or stressed, vaping dependence, and identifying as Hispanic were not significant. Besides, high vaping frequency (p < 0.001), grade level (p < 0.001) and not sure about sexual orientation (p = 0.01) were also negatively associated with quit attempts. ConclusionsThis study provided insights into factors influencing vaping cessation outcomes among adolescent current e-cigarette users. Developing tailored vaping cessation programs based on these findings could enhance quit success.

Edukasi Bahaya Rokok Pada Anak Usia Dini di SD Lempeh Sumbawa Besar

Smokers in Indonesia are ranked third in the world. More than 60 million Indonesians smoke. Cigarette consumption in 2008 reached 240 billion cigarettes or 658 million cigarettes per heart. This means money worth around Rp. 330 billion are "burned" by smokers in a day (TCSC-IAKMI, 2012). In Indonesia, 36.2% of boys and 4.3% of girls (i.e. 20.3% of all students) are users of smoked and/or smokeless tobacco. The initial age of smoking initiation for 43.2% was 12-13 years. Of smokers, 81.8% stated that they had tried to quit smoking in the last 12 months. Of the 88.2% of smokers who want to quit, only 24% have received help from a smoking cessation program or professional (WHO-SEARO, 2014). This community service activity was carried out on Saturday, April 18 2024 from 08.30 to 11.00 WITA. The service process is carried out using a collective counseling mechanism using education and socialization methods with lectures and joint discussions. This service also involved 10 fourth semester students. The conclusion of this community service is that by providing education to children about the harmful effects of tobacco, it can increase caregivers' knowledge and it is hoped that caregivers can prevent children from being exposed to cigarette smoke. Other service providers are advised to develop training topics and training models to increase public awareness, especially about smoking prevention.

Investigating the socio-demographic characteristics and smoking cessation incidence among smokers accessing smoking cessation services in primary care settings of Qatar, a Historical Cohort Study

BackgroundTobacco dependence is a chronic disease that often requires repeated interventions and multiple attempts to quit. Cigarette smoking is the leading preventable cause of mortality. Globally, an estimated 1.3 billion people smoke.In Qatar, Smoking cessation services (SCSs) are provided free of charge to citizens and at a minimal cost to non-citizens. This study aimed to measure the effectiveness of the smoking cessation program adopted by the Primary Health Care Corporation (PHCC) of Qatar. This was achieved through calculating the percentage of smoking cessation service users (survival probabilities) who maintained the non-smoking status after selected follow up periods. Moreover, the study highlighted the possible association of selected explanatory variables with smoking cessation survival probabilities.MethodsIn this historical cohort study 490 participants were recruited by simple random sampling who attended the smoking cessation clinics (SCCs) in PHCC prior to 30/06/2021. The participants were contacted by phone and invited to participate in the study. The participants who agreed to participate in the study were interviewed utilizing a structured questionnaire.ResultsInitially 311 (63.5%) of the participants quitted smoking after receiving SCSs. There were statistically significant differences between quitting smoking and the nationality and the educational level of participants (p ≤ 0.001 and 0.02 respectively). About one fourth (23.3%) of individuals who initially quitted smoking relapsed and resumed smoking as early as 6 months after completing their SCC visits. This relapse rate increased to 38.7, 47.2 and 51.1% after 12, 24 and 36 months respectively. Less than a half (45.8%) maintained the non-smoking status after 42 months from their initially quitting.Conclusion and recommendationsThe findings of the study substantiate the effectiveness of SCSs designed within PHCC both in short- and long-term basis. Younger individuals, smokers with Arab ethnicity, smokers falling within high income and education groups were identified as high-risk groups and need highest focus. The accessibility to the service among the local population can be increased by upscaling the advertisement of the existing services.

Lung cancer screening: new frontiers

Lung cancer is the leading cause of cancer-related deaths worldwide. In early, asymptomatic stages, curative treatment is possible, but the disease is often diagnosed too late. Lung cancer screening (LCS) using low-dose computed tomography (LDCT) helps to detect potentially malignant lesions in early stages and to reduce lung cancer mortality. The application of artificial intelligence (AI) algorithms enables amore precise analysis of LDCT scans. Ameta-analysis of eight LCS studies revealed astatistically significant 12% relative reduction in lung cancer mortality. Based on strong scientific evidence, arecommendation for astructured lung cancer screening program using LDCT for the high-risk population in Germany was issued. The holistic LCS program requires aclear definition of the high-risk population, individual risk assessment, qualified personnel for conducting and reading examinations, verification of all diagnostic and therapeutic steps, central documentation and quality assurance, as well as the integration of tobacco cessation programs.

Prevalence and predictors of cigarette smoking among people with HIV in Western Jamaica

ABSTRACT With highly active antiretroviral therapy, HIV infection has become a treatable chronic disease. However, modifiable risk factors such as cigarette smoking continue to impact the morbidity and mortality of people with HIV (PWH). We assessed the prevalence and factors associated with cigarette smoking and motivation to quit among PWH in Western Jamaica. A cross-sectional study was conducted in which 392 adults seeking HIV care at health facilities in Western Jamaica completed an interviewer-administered questionnaire. Current smoking prevalence among participants was 17.4%. Current smoking was significantly associated with being male (OR = 2.99), non-Christian/non-Rastafarian (OR = 2.34), living or working with another smoker (aOR =1.86), being moderate to severely depressed (OR = 3.24), having an alcohol drinking problem (OR = 1.84), and never being asked by a healthcare provider if they smoked (OR = 3.24). Among the PWH who currently smoke, 36.7% are moderately to highly dependent on nicotine. One-third of people who smoke (33.8%) started smoking for the first time after HIV diagnosis, while 66.2% initiated smoking before; 88% were willing to quit smoking. These findings provide baseline information for designing and implementing a comprehensive smoking cessation program that considers the needs of PWH in Jamaica, with the potential of becoming a replicable model for other HIV-specialized healthcare settings in the Caribbean.

Associations between tobacco inhalation and semen parameters in men with primary and secondary infertility: a cross-sectional study.

To examine the impact of tobacco smoking on seminal parameters in men with both primary and secondary infertility. This cross-sectional study analyzed 1938 infertile men from China who were categorized as nonsmokers (n=1,067) and smokers (n=871), with the latter group further divided into moderate smokers (1-10 cigarettes per day) (n=568) and heavy smokers (>10 cigarettes per day) (n=303). We assessed semen volume, concentration, total sperm count, progressive motility, and normal morphology following World Health Organization (WHO 2010) guidelines. A logistic regression model was used to analyze the relationships between smoking and seminal parameters while also controlling for lifestyle factors. The analysis demonstrated a statistically significant correlation between smoking and adverse seminal parameters in both primary and secondary infertility patients. Specifically, primary infertile men who smoked had a lower semen concentration, with heavy smokers showing a median sperm concentration of 59.2×10^6/ml compared to 68.6×10^6/ml in nonsmokers (P=0.01). The secondary infertile men who smoked exhibited reduced forward sperm motility, with heavy smokers demonstrating a median progressive motility of 44.7%, which was significantly lower than the 48.1% observed in nonsmokers (P=0.04). Smoking is significantly associated with detrimental effects on seminal parameters in infertile men, thus highlighting the need for cessation programs as part of fertility treatment protocols. Encouraging smoking cessation could substantially improve semen quality and fertility outcomes in this population.

Efficacy of the QuitSure App for Smoking Cessation in Adult Smokers: Cross-Sectional Web Survey.

Cigarette smoking remains one of the leading causes of preventable death worldwide. A worldwide study by the World Health Organization concluded that more than 8 million people die every year from smoking, tobacco consumption, and secondhand smoke. The most effective tobacco cessation programs require personalized human intervention combined with costly pharmaceutical supplementation, making them unaffordable or inaccessible to most tobacco users. Thus, digital interventions offer a promising alternative to these traditional methods. However, the leading smartphone apps available in the market today have either not been studied in a clinical setting or are unable to match the smoking cessation success rates of their expensive offline counterparts. We would like to understand whether QuitSure, a novel smoking cessation app built by Rapidkart Online Private Limited, is able to bridge this efficacy gap and deliver affordable and effective smoking cessation at scale. Our objective was to do an initial exploration into the engagement, efficacy, and safety of QuitSure based on the self-reported experiences of its users. Outcomes measured were program completion, the effect of program completion on smoking behavior, including self-reported cessation outcomes, and negative health events from using the app. All QuitSure registered users who created their accounts on the QuitSure app between April 1, 2021, and February 28, 2022, were sent an anonymized web-based survey. The survey results were added to their engagement data on the app to evaluate the feasibility and efficacy of the app as a smoking cessation intervention. The data were analyzed using descriptive statistics (frequencies and percentages) and the χ2 test of independence. In total, 1299 users who had completed the QuitSure program submitted the survey and satisfied the inclusion criteria of the study. Of these, 1286 participants had completed the program more than 30 days before filling out the survey, and 1040 (80.1%, 95% CI 79.1%-82.6%) of them had maintained prolonged abstinence for at least 30 days after program completion. A majority of participants (770/891, 86.4%) who were still maintaining abstinence at the time of submitting the survey did not experience any severe nicotine withdrawal symptoms, while 41.9% (373/891) experienced no mild withdrawal symptoms either. Smoking quantity prior to completing the program significantly affected quit rates (P<.001), with heavy smokers (>20 cigarettes per day) having a lower 30-day prolonged abstinence rate (relative risk=0.91; 95% CI 90.0%-96.2%) compared to lighter smokers. No additional adverse events outside of known nicotine withdrawal symptoms were reported. The nature of web-based surveys and cohort selection allows for extensive unknown biases. However, the efficacy rates of survey respondents who completed the program were high and provide a case for further investigation in the form of randomized controlled trials on the QuitSure tobacco cessation program.

Incidence of Ischemic Heart Disease (IHD) in Smokeless Tobacco/Naswar Users Versus Non-Users Following Coronary Interventions

Background: Ischemic heart disease (IHD) is a significant health concern globally, with various risk factors affecting the outcomes of therapeutic interventions like percutaneous coronary interventions (PCIs) and coronary artery bypass grafting (CABG). The use of smokeless tobacco products such as SLT (snus, loose snuff) and Naswar is prevalent in South Asia and poses additional risks due to its cardiovascular implications. Objective: This study aims to assess the impact of smokeless tobacco (SLT/Naswar) use on the incidence of IHD following coronary interventions, highlighting the need for tailored healthcare strategies to address this modifiable risk factor. Methods: A prospective observational study was conducted from July 1, 2023, to January 1, 2024, involving 200 participants aged 18 to 80 years diagnosed with IHD. Data collection involved structured interviews and comprehensive reviews of health records. Statistical analyses included Chi-square tests and logistic regression to evaluate the association between SLT/Naswar usage and IHD incidence post-intervention, with SPSS software utilized for all computations. Results: Among the participants, 40.5% were users of SLT/Naswar. Post-coronary intervention, SLT/Naswar users showed a 66% incidence rate of IHD compared to 48% in non-users, with a statistically significant difference (P=0.032). Successful intervention rates were 62% in SLT/Naswar users versus 78% in non-users. Complication rates such as re-stenosis were higher in SLT/Naswar users (29% vs. 16%). Conclusion: The study demonstrates that SLT/Naswar use significantly impacts the outcomes of coronary interventions, with a higher incidence of IHD and complications among users. These findings underscore the importance of integrating smokeless tobacco cessation programs into cardiovascular care protocols.

Koori Quit Pack: A feasibility study of a multi-component mailout smoking cessation support for Aboriginal and Torres Strait Islander people: "I would recommend it to anybody. It's just so much easier".

Smoking is the leading cause of preventable death among Aboriginal and Torres Strait Islander people. The Koori1 Quit Pack study aimed to assess the feasibility of a multi-component mailout smoking cessation intervention to reduce smoking among Aboriginal and Torres Strait Islander people. A non-randomised, single-group feasibility study conducted among Aboriginal and Torres Strait Islander people who reported current smoking. The intervention package included information pamphlets and resources on quitting, referral offer to Aboriginal Quitline and optional free Nicotine Replacement Therapies (NRT). Follow-up was conducted at 2-weeks, 6-weeks, 10-weeks and 6-months post recruitment. Feasibility outcomes were recruitment and retention rates, uptake of intervention components and smoking abstinence at 6-week follow-up (primary end point). Cessation outcomes were analysed using both a complete case analysis and intention-to-treat approach. 165 participants were recruited, 111 (67.3%), 79 (47.9%), 59 (35.8%), and 94 (57%) participants completed the 2-week, 6-week, 10-week, and 6-month follow-up. At 10-week follow-up, 40.7% of participants used pamphlets and booklets, 13.6% used Quitline and > 90% used NRT. At 6-week follow-up, 87.3% reported a quit attempt and 46.8% sustained quitting. 46.8% were continuously smoke-free at the 6-week timepoint. The complete case analysis and the intention-to-treat analysis at 6-month shows a 7-day self-reported point prevalence abstinence of 34% and 19.4% respectively. The Koori Quit Pack mailout smoking cessation program was feasible to support Aboriginal and Torres Strait Islander people. The intervention resulted in a high smoking cessation rate and should be upscaled, implemented and evaluated nationally. Aboriginal and Torres Strait Islander people are disproportionately impacted by tobacco related harms, however the majority want to quit or wish they never took up smoking. Mailout cessation support is feasible, overcomes access barriers to evidence-based support and increases quitting success. We recommend a national mailout smoking cessation program is implemented for, and by Aboriginal and Torres Strait Islander people to accelerate declines in smoking prevalence to eliminate tobacco related death and disease.

Economic Considerations for Implementing Tobacco Cessation Programs in Cancer Care Settings.

Increasingly, research demonstrates economic benefits of tobacco cessation in cancer care, as seen in a new study by Kypriotakis and colleagues of the MD Anderson cessation program, demonstrating median health care cost savings of $1,095 per patient over 3 months. While the cost-effectiveness of tobacco cessation programs from a hospital perspective is important, implementation decisions in a predominantly fee-for-service system, such as in the United States, too often insufficiently value this outcome. Economic barriers, stakeholder disincentives, and payment models all impact program implementation. Combining economic evaluation with implementation research, including assessment of return-on-investment, may enhance sustainability and inform decision-making in cancer care settings. See related article by Kypriotakis et al., p. 217.

Abstract 2026: Assessing The Global Burden And Trends Of Stroke Attributable To Smoking In 38 Oecd Countries From 1990 To 2019: A Benchmarking Analysis

Introduction: Stroke has remained a 2 nd leading cause of both mortality and disability among cardiovascular diseases (CVD) on a global scale. Smoking is responsible for 12.27% of CVD-related deaths in countries belonging to the Organization for Economic Cooperation and Development (OECD). Method: Using Global burden of disease tool, we analyzed deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to Stroke attributable to Smoking by age, sex, year and location across the 38 OECD countries. Results: The total number of deaths attributed to smoking-related strokes saw a notable reduction of 45% (with a 95% uncertainty interval of 42-48%), while DALYs decreased by 41% (with a range of 38-44%). However, YLDs showed a marginal 1% decrease (with a range of 2-5%). Regarding age-standardized rates, Latvia recorded the highest death rate in 2019 at 12.42 deaths per 100,000 person-years, followed by Hungary with 9.72 deaths. Conversely, Australia had the lowest rate at 1.97 deaths, while the United States reported 4.45 deaths per 100,000 person-years. In terms of specific age groups, the 80-84 age group witnessed the highest number of deaths, with 16,069 fatalities, while the 60-64 age group had the highest DALYs, totaling 392,824 in 2019. Over the past three decades, males consistently bore a greater burden compared to females. Conclusion: From a public health policy perspective, the significant decline in smoking-related stroke deaths and DALYs signals the success of anti-smoking efforts, yet the varying rates among countries underscore the need for tailored strategies. Clinicians should take heed of the enduring higher burden in males, emphasizing early intervention and smoking cessation counseling, especially for vulnerable age groups. Integrating prevention and smoking cessation programs into stroke care is pivotal to further mitigating smoking's impact on stroke outcomes.

The effectiveness of a standardized tobacco cessation program on psychophysiological parameters in patients with addiction undergoing long-term rehabilitation: a quasi-experimental pilot study.

Although there is a very high comorbidity between tobacco dependence and other addictive disorders, there are only few studies examining the implementation and outcomes of a tobacco cessation program in patients with addictive diseases. Therefore, the aim of this study is to investigate to what extent a standardized tobacco cessation program leads to improvements regarding psychological/physical parameters in patients with addiction undergoing therapy and whether there is a reduction in tobacco consumption. The study took place in a therapeutic community specialized in addiction therapy. A total sample of 56 participants were non-randomly assigned to an intervention group (IG; n = 31) and a treatment as usual group (TAUG; n = 25). The IG participated in a 6-week tobacco cessation program, while the TAUG received no additional treatment. Both groups were assessed for changes in primary outcomes (tobacco dependence, smoked cigarettes per day (CPD), and general substance-related craving) and secondary outcomes (heart rate variability (HRV): root mean square of successive differences, self-efficacy, and comorbid psychiatric symptoms) at two measurement time points (pre- and post-treatment/6weeks). We observed significant improvements in self-efficacy (F(1,53) = 5.86; p < .05; ηp2 = .11) and decreased CPD in the IG (β = 1.16, ρ < .05), while no significant changes were observed in the TAUG. No significant interaction effects were observed in psychiatric symptoms, general substance-related craving, and HRV. The results highlight the potential benefit of an additional tobacco cessation program as part of a general addiction treatment. Although no improvements in the physiological domain were observed, there were significant improvements regarding self-efficacy and CPD in the IG compared to the TAUG. Randomized controlled trials on larger samples would be an important next step. ISRCTN15684371.

Use of Electronic Nicotine Delivery Systems and Age of Asthma Onset Among US Adults and Youths.

The association of use of electronic nicotine delivery systems (ENDS) with the age of asthma onset is unknown. To explore the association of past 30-day ENDS use with the age of asthma onset in adults and youths who did not have asthma or chronic obstructive pulmonary disease and never used cigarettes. This cohort study was a secondary analysis of waves 1 to 6 of the US nationally representative Population of Tobacco and Health Study (2013-2021). Eligible participants included adults (≥18 years) and youths (12-17 years) who did not have asthma or chronic obstructive pulmonary disease at the first wave of participation. Data analysis was conducted from September 2022 to April 2024. Past 30-day ENDS use at the first wave of participation in the study preceding the onset of asthma. Lower and upper age limits were estimated using the age reported at the first wave of participation and the number of weeks between follow-up waves until asthma was first reported or censored. The association of past 30-day ENDS use with the age of asthma onset was estimated using weighted interval-censoring Cox regression. The cumulative hazard function for the age of asthma onset was estimated using interval-censoring survival analysis. A total of 24 789 participants were included, with 7766 adults (4461 female [weighted percentage, 59.11%] and 3305 male [weighted percentage, 40.89%]), representing 80.0 million adults, and 17 023 youths (8514 female [weighted percentage, 50.60%] and 8496 male [weighted percentage 49.32%]), representing 33.9 million youths. By age 27 years, 6.2 per 1000 adults reported asthma incidence (hazard ratio [HR], 0.62%; 95% CI, 0.46%-0.75%). While controlling for covariates, there was a 252% increased risk of the onset of asthma at earlier ages for adults who used ENDS in the past 30 days vs adults who did not (adjusted HR, 3.52; 95% CI, 1.24-10.02). For youths, there was no association of ENDS use in the past 30 days with age of asthma onset (adjusted HR, 1.79; 95% CI, 0.67-4.77), which could be due to a lack of statistical power. In this cohort study, past 30-day ENDS use among adults was associated with earlier ages of asthma onset. These findings suggest that prevention and cessation programs directed to adults who use ENDS are needed to educate the public, protect public health, prevent adverse health outcomes, and motivate users to stop. Furthermore, modifying symptom-screening asthma guidelines, resulting in earlier asthma detection and treatment, may reduce morbidity and mortality due to asthma.