Changes In Smoking Behavior Research Articles

Analyzing Impact of Mouthpiece-based Puff Topography Devices on Smoking Behavior using Wearable Sensors.

Detailed assessment of smoking topography (puffing and post-puffing metrics) can lead to a better understanding of factors that influence tobacco use. Research suggests that portable mouthpiece-based devices used for puff topography measurement may alter natural smoking behavior. This paper evaluated the impact of a portable puff topography device (CReSS Pocket) on puffing & post-puffing topography using a wearable system, the Personal Automatic Cigarette Tracker v2 (PACT 2.0) as a reference measurement. Data from 45 smokers who smoked one cigarette in the lab and an unrestricted number of cigarettes under free-living conditions over 4 consecutive days were used for analysis. PACT 2.0 was worn on all four days. A puff topography instrument (CReSS pocket) was used for cigarette smoking on two random days during the four days of study in the laboratory and free-living conditions. Smoke inhalations were automatically detected using PACT2.0 signals. Respiratory smoke exposure metrics (i.e., puff count, duration of cigarette, puff duration, inhale-exhale duration, inhale-exhale volume, volume over time, smoke hold duration, inter-puff interval) were computed for each puff/smoke inhalation. Analysis comparing respiratory smoke exposure metrics during CReSS days and days without CReSS revealed a significant difference in puff duration, inhale-exhale duration and volume, smoke hold duration, inter-puff interval, and volume over time. However, the number of cigarettes per day and number of puffs per cigarette were statistically the same irrespective of the use of the CReSS device. The results suggested that the use of mouthpiece-based puff topography devices may influence measures of smoking topography with corresponding changes in smoking behavior and smoke exposure.

Evaluation of Japanese university students' perception of smoking, interest in quitting, and smoking behavior: An examination and public health challenges during the COVID-19 pandemic.

This study examined college students' perceptions of the association between smoking and novel coronavirus disease 2019 (COVID-19), changes in smoking behavior, and interest in quitting categorized by smoking device, to identify public health challenges. A questionnaire survey was conducted among 8,547 students in a Japanese university in March and April 2021. In response to "Awareness of the increased risk of COVID-19 infection due to smoking and the tendency to develop severe disease", current smokers (70.2%) were more aware of the risk than non-smokers (49.8%) (p < 0.001), with no significant difference according to smoking device (p = 0.213). "Interest in quitting smoking" (p = 0.323), and "Changes in smoking behavior during the COVID-19 pandemic" (p = 0.146) did not differ by smoking device. However, approximately 50% of the respondents answered that they were not interested in quitting smoking, while two-thirds reported that the number of cigarettes they smoked did not change during the pandemic. During the COVID-19 pandemic, college students were found to be less interested in quitting and not likely to change their smoking behavior, despite the knowledge of the increased risk of COVID-19 transmission and severity of disease from smoking, regardless of smoking device.

Changes in Smoking Behavior and Related Factors after an Increase in Tobacco Prices: Findings from the Korean Welfare Panel Study

Changes in Smoking Behavior and Related Factors after an Increase in Tobacco Prices: Findings from the Korean Welfare Panel Study

Mixed methods evaluation of the 'real-world' implementation of group-based behavioral stop smoking support through Facebook.

INTRODUCTIONWhile promising evidence from trials of social-media-based stop smoking support informs service-planning, there is a need for more prospective, observational studies of smoking cessation interventions to build ‘real-world’ evidence. Specifically, user experiences have been under-explored with qualitative methods to date. This mixed-method evaluation of a closed Facebook group-based behavioral stop smoking support program, which was conducted in Ireland in 2018, aimed to address these issues.METHODSPre- and post-program surveys measured smoking abstinence (self-reported 7-day point prevalence), changes in smoking attitudes and behavior, and participant experiences. Engagement with Facebook was measured through counting ‘likes’ and comments, and was used to categorize groups as ‘more active’ and ‘less active’ over a 12-week period of support. Thematic content analysis of semi-structured participant interviews explored program experience in depth.RESULTSIn total, 13 of 52 participants reported smoking abstinence post-program (25.0%, 95% CI: 14.0–39.0). Participant engagement with Facebook was variable and decreased over the program. Membership of a ‘more active’ group was associated with better reported participant experience (e.g. 90.9% agreeing ‘Facebook group helped me to quit or reduce smoking’, versus 33.3% in the ‘less active’ group, p<0.05). Qualitative analysis identified three over-arching themes: importance of social interactions; perception of health information; and appeal of online support.CONCLUSIONSFacebook can be used to deliver group-based behavioral stop smoking support in the real world. In Ireland, the one-month post-program abstinence outcomes achieved by other stop smoking services is approximately 50%, and while the outcomes for this service was lower (25%), it is still better than outcomes estimated for unassisted quitting. Engagement and peer-to-peer interactivity should be maximized to support positive participant experience.

Real-time feedback of air quality in children's bedrooms reduces exposure to secondhand smoke.

INTRODUCTIONSecondhand smoke (SHS) exposure creates health risks for non-smokers and is especially detrimental to children. This study evaluated whether immediate feedback in response to poor indoor air quality in children’s bedrooms can reduce the potential for SHS exposure, as measured by adherence to a World Health Organization (WHO) indoor air standard.METHODSHomes that contained children and an adult who regularly smoked inside (n=298) had an air particle monitor installed in the child’s bedroom. These devices measured the concentration of particulate matter (PM2.5) for approximately three months and, for half of the participants, immediately provided aversive feedback in response to elevated PM2.5. Hierarchical linear models were fit to the data to assess whether the intervention increased the probability that: 1) a given day was below the WHO guideline for daily exposure, and 2) a household established and maintained a smoke-free home (SFH), operationalized as achieving 30 consecutive days below the WHO guideline. The intervention’s impact was calculated as group-by-time effects.RESULTSThe likelihood that a child’s bedroom met the WHO indoor air quality standard on a given day increased such that the baseline versus post-baseline odds ratio (OR) of maintaining indoor PM2.5 levels below the WHO guideline was 2.38 times larger for participants who received the intervention. Similarly, the baseline versus post-baseline OR associated with achieving an SFH was 3.49 times larger for participants in the intervention group.CONCLUSIONSThe real-time intervention successfully drove clinically meaningful changes in smoking behavior that mitigated indoor PM2.5 levels in children’s bedrooms and thereby reduced SHS exposure. These results demonstrate the effectiveness of targeting sensitive microenvironments by giving caregivers actionable information about children’s SHS risks. Future extensions should examine additional microenvironments and focus on identifying the potential for SHS exposure before it occurs.

Evaluating the impact of menthol cigarette bans on cessation and smoking behaviours in Canada: longitudinal findings from the Canadian arm of the 2016–2018 ITC Four Country Smoking and Vaping Surveys

ObjectiveTo evaluate the impact of menthol cigarette bans in seven Canadian provinces between 2016 and 2018.MethodsLongitudinal data from the Canadian arm of the 2016 and 2018 ITC Four Country Smoking...

Adolescent Substance Use Behavior Change Through School Intervention Is Improved by Teacher and School Implementation Support Together, Especially for Girls.

An earlier trial of a school-based, preventative intervention, HealthWise South Africa, demonstrated some efficacy in preventing adolescent drinking and smoking in the Western Cape, South Africa. This was followed by the current implementation trial, which examined how implementation support conditions influenced adolescent drinking and smoking behavior change in the HealthWise intervention. The hybridized implementation-effectiveness trial included 34 schools (n = 2175 students) that provided student data at four waves through Grades 8 to 10. Implementation support conditions included a combination of two components (enhanced school environment and teacher consultation), resulting in four conditions: enhanced school environment, teacher consultation, both components, and standard delivery. Using configural frequency analysis, we examined how drinking and smoking behavior change differed across four configurations of intervention support longitudinally and by gender. For baseline non-smokers, results indicated sustained differences in abstention from smoking and smoking initiation between schools that received both support components and schools in the standard delivery condition. These results were primarily driven by girls. For baseline drinkers and smokers in the both components condition, changes in drinking were delayed until Grade 9 and smoking decayed by Grade 10. Results suggest that providing both school and teacher implementation support synergistically facilitates improved intervention outcomes both immediately following intervention and 2years later across schools with diverse resource levels. Future iterations of HealthWise, and other interventions, may benefit from a multilevel implementation support strategy to improve student outcomes. More research is needed to understand how to improve HealthWise effectiveness among boys.

P.095 Smoking behaviour change is associated with altered functional brain connectivity in older adults

Background: Smoking is the leading cause of preventable morbidity worldwide and therefore developing effective smoking cessation strategies is a public health priority. However, what brain networks support maintenance of smoking cessation in the long term remains unexplored. Methods: We analyzed the baseline resting-state fMRI data acquired in 23 smokers (Mage = 61.52 ± 3.7) who were followed longitudinally in a cohort of cognitively normal older adults. Self-reported smoking status and amount were recorded at baseline and repeated after 4 years. We investigated the effect of smoking behaviour change on functional brain connectivity using seed-to-voxel approach. We examined a-priori regions of interest (ROIs) including the reward network (ventromedial prefrontal cortex (vMPFC) and ventral striatum) and the right insula. These ROIs are promising target mechanisms given prior behavioural research linking it to smoking cessation. Results: Our results revealed that reduced smoking was associated with reduced connectivity between ventral striatum and middle frontal gyrus and enhanced connectivity between right insula and middle temporal gyrus (voxel p &lt;0.001, cluster p&lt;0.05 FDR corrected). However, change in smoking did not reveal any significant effects in the vMPFC. Conclusions: Our findings suggest that successful smoking behaviour change is associated with altered reward network and insular functional connectivity in the long term.

Risk perception of smokers on graphic warning labels: a qualitative study in East Nusa Tenggara, Indonesia

The Indonesian government has mandated Graphic warning labels (GWLs) on cigarette packages to achieve more comprehensive tobacco control interventions. However, smoking prevalence remains a public health issue in Indonesia. This current qualitative research aimed to explore the effect of cigarette GWLs on smokers’ perceptions about smoking and cigarette packaging in East Nusa Tenggara (NTT) and its influence on smoking behavior. The study participants consisted of 15 current smokers who were individually interviewed by using a semi-structured interview guide. Data were analyzed using a thematic analysis technique. Most participants perceived smoking as health-risk behavior yet lowered their risk perceptions of smoking-related diseases due to positive feelings of perceived current benefits of smoking and personal justification for smoking. None expressed any intention to quit or showed smoking behavior changes due to GWLs exposure on cigarette packages. Participants also implicitly expressed themselves as victims willing to quit but unable and unconfident to act due to smoking addiction and other stressors. In contrast, others perceived themselves as risk-taker who enjoyed smoking. Further research is still needed to provide robust evidence on GWLs effectiveness on smoking perception and smokers’ cognitive and behavioral responses. Behavior change interventions should address positive feelings experienced and rationalization made by smokers to provide effective risk communication.

Smoking patterns during COVID-19: Evidence from Serbia.

INTRODUCTIONRecent research shows that in many countries, smokers who increased smoking during the COVID-19 pandemic outnumbered those who decreased it, despite higher exposure to COVID-19 severity and death. In this study, we compared changes in smoking behavior in the initial and later stages of the pandemic and factors associated with lower smoking intensity.METHODSWe conducted two survey rounds on representative samples, the first in the initial stage of the pandemic (11–19 May 2020) and the second in the latter stage (4–11 June 2021), in Serbia. Multinomial logistic regression was run to estimate associations between smokers’ characteristics and lower smoking intensity. In contrast to most studies that assess psychological factors affecting smoking in the pandemic, we focused on factual determinants of the change in smoking intensity.RESULTSThe share of smokers who claimed to smoke more increased significantly, from 22.7% in May 2020 to 35.2% in June 2021. The share of smokers who reported a decrease in smoking only slightly increased, from 11.7% to 13.3%. The persistence of the pandemic considerably increased intentions to cease smoking, from 26.3% to 40%. Higher education (adjusted odds ratio, AOR=2.11; 95% CI: 1.08–4.13), income fall (AOR=2.14; 95% CI: 1.11–4.11), occasional smoking (AOR=4.24; 95% CI: 2.26–7.96) and recovery from COVID-19 (AOR=2.38; 95% CI: 1.23–4.60) increased the odds to reduce smoking during the pandemic.CONCLUSIONSMost smokers are unaware that consuming tobacco products increases exposure to health risks related to COVID-19, but those who get coronavirus infected tend to reduce smoking. This research highlights that tobacco control policy needs to be more proactive in creating public campaigns which demonstrate the severity of COVID-19 impact on smokers’ health. Such campaigns should mainly target those groups of smokers who are less able to curb their smoking intensity.

The burden of nicotine-dependent smokers in China: The role of primary healthcare providers

The burden of nicotine-dependent smokers in China: The role of primary healthcare providers

The Effect of Peer Group Support on Motivation to Quit Smoking Among Adolescents

Adolescents use cigarettes without considering the consequences and lack awareness about the dangers of using cigarettes. Peer group support potentially motivates to quit smoking in adolescents. It can empower group members by providing a role model to increase motivation. This paper analyzes the effect of peer group support on motivation to quit smoking among adolescents. It was quasi-experimental research with a post-test and pre-test one-group design. The population was smoking adolescents. In addition, there were 37 respondents with purposive sampling. The inclusion criteria were male teenagers aged 12-16 years and active smokers. The independent variable was peer group support, and the dependent variable was motivation to quit smoking. The instrument to assess motivation to quit smoking was the Richmond Test. Data analysis utilized paired t-test with α=0.05. There was an increase in the mean value of motivation to quit smoking before and after the intervention. In addition, paired t-tests obtained p=0.030 (p&lt; 0.05), indicating a significant difference in pre-test and post-test. Thus, there was an effect of peer group support on adolescents' motivation to quit smoking. In conclusion, peer group support can increase adolescents' motivation to quit smoking. Nurses could enhance motivation for smoking cessation through peer support interventions so there is a change in smoking behavior in adolescents. Further study should use a control group and a larger sample size.

Characterization of Salivary Progesterone in Female Smokers.

Fluctuations in ovarian hormones have been associated with changes in cigarette smoking behavior, which can be measured through both serum or less invasive salivary procedures. The primary aim of this exploratory study is to characterize the progesterone profiles of salivary progesterone measurements and to compare that with the profiles estimated from a previously measured serum sample. Nontreatment-seeking, cigarette smoking women (n = 82; ages 18-45 years) provided daily salivary hormone samples every morning for 14 consecutive days. Time-dependent random effects functions were used to approximate daily salivary progesterone (ng/mL) levels over the course of a standardized menstrual cycle. Serum measures of progesterone from a previous study of female cigarette smokers were examined for consistency with established profiles and compared with the salivary profile using the same methodology. The salivary model fit exhibits relative stability during the follicular phase and a clear unimodal peak during the luteal phase. Parameter estimates from the non-linear function show correspondence to serum data. Although the profiles estimated from salivary and serum data agree in functional form, we observed larger between-subject heterogeneity both in the follicular level and the peak luteal level in salivary measures. The pattern of salivary and serum progesterone measured across the menstrual cycle is similar in form, which is noteworthy given that the saliva and serum samples were drawn from independent sample of female smokers. Inter- and intra-individual variation in salivary measures may be greater than in serum measures. Measuring progesterone level variation across the menstrual cycle via saliva samples has several benefits relative to serum sampling methods in that they are easily obtained, noninvasive, and low-cost. Inter- and intra-individual variation in measurements may be greater than those in serum measurements. However, the functional form of the salivary progesterone profile is isomorphic to serum progesterone.

Tobacco smoking changes during the first pre-vaccination phases of the COVID-19 pandemic: A systematic review and meta-analysis

SummaryBackgroundGlobally, tobacco smoking remains the largest preventable cause of premature death. The COVID-19 pandemic has forced nations to take unprecedented measures, including ‘lockdowns’ that might impact tobacco smoking behaviour. We performed a systematic review and meta-analyses to assess smoking behaviour changes during the early pre-vaccination phases of the COVID-19 pandemic in 2020.MethodsWe searched Medline/Embase/PsycINFO/BioRxiv/MedRxiv/SSRN databases (January–November 2020) for published and pre-print articles that reported specific smoking behaviour changes or intentions after the onset of the COVID-19 pandemic. We used random-effects models to pool prevalence ratios comparing the prevalence of smoking during and before the pandemic, and the prevalence of smoking behaviour changes during the pandemic. The PROSPERO registration number for this systematic review was CRD42020206383.Findings31 studies were included in meta-analyses, with smoking data for 269,164 participants across 24 countries. The proportion of people smoking during the pandemic was lower than that before, with a pooled prevalence ratio of 0·87 (95%CI:0·79–0·97). Among people who smoke, 21% (95%CI:14–30%) smoked less, 27% (95%CI:22–32%) smoked more, 50% (95%CI:41%-58%) had unchanged smoking and 4% (95%CI:1–9%) reported quitting smoking. Among people who did not smoke, 2% (95%CI:1–3%) started smoking during the pandemic. Heterogeneity was high in all meta-analyses and so the pooled estimates should be interpreted with caution (I2>91% and p-heterogeneity<0·001). Almost all studies were at high risk of bias due to use of non-representative samples, non-response bias, and utilisation of non-validated questions.InterpretationSmoking behaviour changes during the first phases of the COVID-19 pandemic in 2020 were highly mixed. Meta-analyses indicated that there was a relative reduction in overall smoking prevalence during the pandemic, while similar proportions of people who smoke smoked more or smoked less, although heterogeneity was high. Implementation of evidence-based tobacco control policies and programs, including tobacco cessation services, have an important role in ensuring that the COVID-19 pandemic does not exacerbate the smoking pandemic and associated adverse health outcomes.FundingNo specific funding was received for this study.

THE EFFECT OF SPIRITUAL EMOTIONAL FREEDOM TECHNIQUE (SEFT) THERAPY METHODS ON CHANGES IN ADOLESCENT SMOKING BEHAVIOR

Smoking behavior in adolescents is a difficult behavior to change. In cigarettes there are addictive ingredients that make dependence on the wearer. The phenomenon obtained in Bendungan Village, there are 42 teenagers aged 15-19 years who have smoking behavior due to invitations from friends, curiosity, often seeing parents smoking and the desire of teenagers themselves. The Spiritual Emotional Freedom Technique (SEFT) method by tapping 2 fingers on 18 key points in the body's 12 energy pathways. The purpose of this study was to determine the effect of the SEFT therapy method on changes in smoking behavior in adolescents in Bendungan Village, Pabelan District, Semarang Regency.&#x0D; The research design used is a quantitative method using a pre-experimental type with a one group pretest-posttest design. The sampling technique used 30 respondents. The research instrument is a questionnaire that has been tested for validity in research (Anggraeni, 2019) with the title "Peer Peer Relationships with Smoking Behavior in Early Adolescents" the number of respondents in this assessment is 15 people with an r value of 0.518 provided that the value of r product moment &gt; r table (0.514), then it is declared valid. The analytical method used is Paired Sample T-test.&#x0D; The results showed that smoking behavior before SEFT therapy was in the moderate category (86.7%) than after being given SEFT therapy in the good category (63.3%). The results of the analysis with the Paired Sample T-test test obtained p value = 0.000 means p value

Changes in Smoking Habits and Behaviors Following the Introduction and Spread of Heated Tobacco Products in Japan and Its Effect on FEV1 Decline: A Longitudinal Cohort Study.

BackgroundHeated tobacco product (HTP) use in Japan has rapidly increased. Despite this rapid spread, little is known about the health effects of HTP use. We conducted a longitudinal cohort study to investigate the change in smoking habits following the spread of HTP use and its effect on forced expiratory volume in 1 second (FEV1) decline.MethodsParticipants consisted of a resident population (n = 2,612; mean age, 67.7 years) with FEV1 measurement in 2012–2014 and 2018–2019, and a worksite population (n = 722; mean age 49.3 years) without FEV1 data. Participants were categorized as combustible cigarette-only smokers, HTP-only users, dual users, past smokers, and never smokers. The association between smoking group and the change in smoking consumption over a mean 5.6 years was examined. Differences in annual FEV1 change between smoking groups were examined in the resident population.ResultsPrevalence of HTP-only and dual users in 2018–2019 was 0.8% and 0.6% in the resident population, and 5.0% and 1.9% in the worksite population, respectively. The overall number of tobacco products smoked/used increased in dual users compared to baseline, but not in others. Annual FEV1 decline in dual users tended to be greater than that in cigarette-only smokers (16; 95% confidence interval, −34 to 2 mL/year after full adjustment). Participants switching to HTP-only use 1.7 years before had a similar FEV1 decline as cigarette-only smokers.ConclusionsHTP use, including dual use, is prevalent even in a rural region of Japan. Dual users appear to smoke/use tobacco products more and have a greater FEV1 decline. Tobacco policy should consider dual use as high-risk.

Changes in Smoking Status and Behaviors After the First 10 Months of COVID-19 Pandemic in Indonesia.

There remains inconclusive evidence on potential changes in smoking status and behaviors during the coronavirus disease 2019 (COVID-9) pandemic, especially in developing countries. This study explores the direction of changes in smoking status and behaviors after 10 months of the COVID-19 pandemic in Indonesia as well as examining the association between economic shocks and changes in smoking behaviors. Primary data were gathered through a phone survey targeting productive-age mobile-phone users in Indonesia (n = 1082). Descriptive analysis was employed to determine changes in smoking status and behaviors 10 months into the pandemic, while logistic regression analysis was used to investigate how employment shocks, financial strain, COVID-19-related indicators, and demographic characteristics were associated with smoking behaviors of people who continue smoking. Respondents experiencing changes in smoking status were dominated by people who persistently smoked during the pandemic, while those who quit, relapsed, and started smoking, was extremely small. Nevertheless, a considerable portion of people who continue smoking adjusted their smoking behaviors: 40.3% reduced smoking intensity and 25.3% switched to lower-price cigarettes. Multivariable regression analysis revealed that, among people who continue smoking, those who experienced financial strain during the pandemic had higher odds of reducing smoking intensity, while those who switched to lower job status had higher odds of switching to cheaper cigarettes. The research has shown that smoking status and behaviors of people who continue smoking mostly remained unchanged after 10 months of the COVID-19 pandemic. Changes in employment and financial conditions during the pandemic were associated with modified smoking behaviors. This study is the first to determine the direction and analyze the factors of changes in smoking during the COVID-19 pandemic in Indonesia. This new understanding should help improve predicting the trends in smoking in future crises or pandemics in developing countries, specifically Indonesia. The discovered patterns on smokers' reaction to an exogenous shock may provide evidence to support tobacco control policies in Indonesia.

Measuring young adult appeal for menthol and non-menthol cigarettes: protocol of a clinical trial using both laboratory and intensive longitudinal methods (PRISM)

IntroductionAlthough the Food and Drug Administration banned other characterising flavours in cigarettes, menthol cigarettes are still available to consumers. Young adult new smokers are initiating with menthol cigarettes, such that...

Exploring Factors Contributing to the Smoking Behaviour among Hong Kong Chinese Young Smokers during COVID-19 Pandemic: A Qualitative Study.

COVID-19 has significant impacts on young smokers in their smoking behaviors. This qualitative study summarises the lived experience of young smokers during COVID-19. Moreover, through their lived experience, we aim to understand how the COVID-19 pandemic influence tobacco use behaviours in this population. A purposive sampling of 48 smokers aged between 17–25 years old is individually interviewed for 30 to 45 min. All interviews are transcribed in verbatim and analysed by two researchers separately using Colaizzi’s method of descriptive phenomenology. The results reveal the following six important themes, which could explain the mixed pattern of smoking behaviour changes in young smokers: (1) perceptions of COVID-19 and its association with smoking, (2) more time at home, (3) taking masks off to smoke, (4) the effects of COVID-19 on smokers’ financial status and academic performance, (5) reduced social gatherings, and (6) restricted access to tobacco products. To conclude, this pandemic and the anti-pandemic measures, i.e., mask mandates, stay-at-home and work-from-home orders, and class suspension, result in both new obstacles and new advantages for smoking cessation among young people. More studies should be performed to monitor any transition of tobacco products and the trajectory of use in this population during this pandemic, thus informing public health policy making.

A Comprehensive Tobacco Control Policy Program in a Mining Industry in Indonesia: Did It Work?

BackgroundRisk factor controls, including smoking cessation and prevention, impact health costs. This study aimed to describe the Kaltim Prima Coal (KPC), one of Indonesia's largest coal mining operations, comprehensive tobacco control policy program in 2015 and its impact on smoking behavior among the employees.MethodA survey among 404 employees was conducted to assess the impact of the smoke-free KPC programs. In addition to the descriptive analysis, logistic regression was used to measure the association of intention to the smoking behavior change and the association between intention and the determinants using the Theory of Planned Behavior in 102 smokers.ResultsA series of tobacco control programs: advocacy, health education, brief interventions for smoking cessation, peer counselor training, media campaigns, and policy regulations were implemented. About 95.5% of the respondents attended the KPC Smoke-Free 2015 programs, and 97.8% reported they already knew that KPC is a total smoke-free area. Nearly 50% of the respondents expressed that the staff complied with the rules and no longer smoked in KPC. Majority of smokers (76.6%) reduced their consumption, and 5.6% of them quit smoking. Among smokers, we found that attitude toward smoking cessation, subjective norm, and perceived control for quitting were related to the intention to stop smoking.ConclusionsThe KPC smoke-free policy has been comprehensively implemented. Regulations on smoking and tobacco controls should be maintained, and monitoring should be consistently done. Media campaigns on the regulations and the availability of trained peer educators for smoking cessation help need to be applied continuously.