Harms Of Smoking Research Articles

Tobacco Litigation, E-Cigarettes, and the Cigarette Endgame

Among his many contributions to the field of public health law, Professor Richard Daynard is perhaps best known for (a) advancing the idea that affirmative litigation, particularly against the tobacco industry, can serve as an effective public health tool, (b) introducing the discussion of an “endgame,” in which the commercial sale of cigarettes—the most deadly form of tobacco use—is phased out. This article unites these two topics and analyzes the potential for affirmative litigation to hasten the end of commercial cigarette sales. In recent years, the major tobacco companies have suggested that they support moving towards a “smoke-free world,” with non-combustible nicotine products such as e-cigarettes gradually replacing more harmful cigarette smoking. Though this rhetoric is deeply cynical—these same companies continue to spend heavily to promote their cigarette brands—it may nonetheless create a window of opportunity for litigants. Past litigation against tobacco companies has foundered on the absence of a “reasonable alternative design” for cigarettes. Today, the tobacco companies’ own statements can be used to show the availability of such alternatives. More importantly, now-public documents from the tobacco industry’s archives help establish the case for treating e-cigarettes as a “reasonable alternative design” for cigarettes. These documents show that the major tobacco companies developed the essential components of e-cigarette technology decades ago, but they chose not to commercialize these products because they feared they would prove to be viable alternatives to cigarettes. This article reviews how the introduction of e-cigarettes may reinvigorate products liability litigation against the manufacturers of conventional cigarettes. Building on the work of Professor Daynard, it also considers how these lawsuits, even if ultimately unsuccessful in court, might nonetheless benefit public health by pressuring the tobacco industry to live up to its public statements and by catalyzing legislative efforts to phase out the sale of cigarettes.

Cigarette smoking quit ratios among adults in the USA with cannabis use and cannabis use disorders, 2002–2016

BackgroundThe prevalence of cigarette smoking is nearly three times higher among persons who use cannabis and have cannabis use disorders (CUDs), relative to those who do not. The current study...

History and Correlates of Smoking Cessation Behaviors Among Smokers With Serious Mental Illness.

Individuals with serious mental illness (SMI) smoke at rates two to three times greater than the general population but are less likely to receive treatment. Increasing our understanding of correlates of smoking cessation behaviors in this group can guide intervention development. Baseline data from an ongoing trial involving smokers with SMI (N = 482) were used to describe smoking cessation behaviors (ie, quit attempts, quit motivation, and smoking cessation treatment) and correlates of these behaviors (ie, demographics, attitudinal and systems-related variables). Forty-three percent of the sample did not report making a quit attempt in the last year, but 44% reported making one to six quit attempts; 43% and 20%, respectively, reported wanting to quit within the next 6 months or the next 30 days. Sixty-one percent used a smoking cessation medication during their quit attempt, while 13% utilized counseling. More quit attempts were associated with lower nicotine dependence and carbon monoxide and greater beliefs about the harms of smoking. Greater quit motivation was associated with lower carbon monoxide, minority race, benefits of cessation counseling, and importance of counseling within the clinic. A greater likelihood of using smoking cessation medications was associated with being female, smoking more cigarettes, and receiving smoking cessation advice. A greater likelihood of using smoking cessation counseling was associated with being male, greater academic achievement, and receiving smoking cessation advice. Many smokers with SMI are engaged in efforts to quit smoking. Measures of smoking cessation behavior are associated with tobacco use indicators, beliefs about smoking, race and gender, and receiving cessation advice. Consideration of factors related to cessation behaviors among smokers with SMI continues to be warranted, due to their high smoking rates compared to the general population. Increasing our understanding of these predictive characteristics can help promote higher engagement in evidence-based smoking cessation treatments among this subpopulation.

Awareness of the Harms of Continued Smoking Among Cancer Survivors

Smoking cessation is an integral part of cancer survivorship. To help improve survivorship education, clinicians need an understanding of patient awareness of the harms of continued smoking. Cancer survivors from Princess Margaret Cancer Centre (Toronto, ON) were surveyed on their awareness of the harms of continued smoking on cancer-related outcomes. Multivariable logistic regression models assessed factors associated with awareness and whether awareness was associated with subsequent cessation among smokers at diagnosis. Among 1118 patients, 23% were current smokers pre-diagnosis and 54% subsequently quit; 25% had lung and 30% head and neck cancers. Many patients reported being unaware that continued smoking results in greater cancer surgical complications (53%), increased radiation side effects (62%), decreased quality of life during chemotherapy (51%), decreased chemotherapy or radiation efficacy (57%), increased risk of death (40%), and increased development of second primaries (38%). Being a current smoker was associated with greater lack of awareness of some of these smoking harms (aORs = 1.53-2.20, P < 0.001-0.02), as was exposure to any second-hand smoke (aORs = 1.45-1.53, P = 0.006-0.04) and being diagnosed with early stage cancer (aORs = 1.38-2.31, P < 0.001-0.06). Among current smokers, those with fewer pack-years, being treated for cure, or had a non-tobacco-related cancer were more likely unaware. Awareness that continued tobacco use worsen quality of life after chemotherapy was associated with subsequent cessation (aOR = 2.26, P = 0.006). Many cancer survivors are unaware that continued smoking can negatively impact cancer-related outcomes. The impact of educating patients about the potential harms of continued smoking when discussing treatment plans should be further evaluated.

Initial development of the Hookah Smoker Scale: Assessing young adults' mental schemas about hookah "smokers".

Many young adult hookah tobacco users do not consider themselves hookah "smokers," but data on this topic are limited. There are no existing measures of young adults' mental schemas of hookah "smokers." We examined the factor structure and reliability of the Hookah Smoker Scale and examined associations with perceived harm and addictiveness and attitudes toward hookah. Two hundred and forty-six young adult (ages 18-30) hookah smokers participated in a cross-sectional online study. Participants completed items assessing schemas characterizing hookah smokers and valid measures of perceived harm and addictiveness of hookah smoking, risk appraisals, and attitudes toward hookah. Exploratory factor analysis using principal axis factoring with oblique rotation extracted a 12-item scale with three dimensions (Regular Use, Social-Enabled Use, and Self-Enabled Use). The scale explained 69.7% of the variance (eigenvalue = 9.2). Cronbach's α for the scale was .89, with Cronbach's α ≥ .80 for four-item subscales. Higher subscale scores indicate stronger beliefs that the dimension characterizes a hookah smoker. Higher Regular Use scores (score variance = 46.9%; eigenvalue = 5.6) were associated with greater perceived harm and addictiveness (β = 0.21, p = .01), greater risk appraisals (β = 0.20, p = .02), and more negative attitudes toward hookah (β = -0.18, p = .03). The Hookah Smoker Scale is a promising measure that can be used to identify targets for preventing and reducing young adults' hookah tobacco use. Findings also suggest young adults associate health risks of hookah with daily smoking, but not with intermittent social smoking patterns.

The Effectiveness of Smoking Prevention Module Towards Knowledge and Smoking Refusal Skills among Adolescents in Kota Bharu, Kelantan, Malaysia.

Objective:To study the effectiveness of the smoking prevention module towards knowledge on smoking and its harmful effects and smoking refusal skills among secondary school students in Kelantan, Malaysia. Methods:A quasi experimental interventional study involving 166 non-smokers adolescents, aged 13 to 14 years old were carried out in two schools located in two different suburbs. Both schools had equal number of participants. One school was given the smoking prevention module for intervention while the control school only received the module after the study had been completed. The knowledge on smoking and its harmful effects and smoking refusal skill score were assessed using a set of validated Malay questionnaires at baseline, two weeks and eight weeks after the intervention. Repeated measure ANCOVA was used to analyse the mean score difference of both groups at baseline and after intervention. Result:Baseline analysis shows no significant difference in knowledge score between the study groups (p = 0.713) while post intervention, it shows significant inclination of knowledge score in intervention group and the difference was significant after controlling the gender [F(df) = 15.96(1.5), p <0.001]. The mean baseline for refusal skills score in the control and intervention groups were 30.89(6.164) and 28.02(6.241) respectively (p= 0.003). Post intervention, there is a significant difference in the crude mean and the estimated marginal means for smoking refusal skills score between the two groups after controlling for sex [F(df) = 5.66(1.8), p = 0.005]. Conclusion:This smoking prevention module increased the level of knowledge on smoking and its harmful effects and smoking refusal skill among the secondary school students. Thus, it is advocated to be used as one of the standard modules to improve the current method of teaching in delivering knowledge related to harmful effects of smoking and smoking refusal skill to the adolescents in Malaysia.

Graphic health warning posters increase some adolescents’ future cigarette use susceptibility by changing normative perceptions of smoking: A case of mediated moderation.

Prior work suggests that exposure to graphic health warning posters (GWPs) at retail point-of-sale may increase future cigarette smoking susceptibility in adolescents who are already at risk for future smoking, but not among committed never-smokers. However, little is known about what psychological mechanisms may account for this effect of GWPs on at-risk youths. Participants (N = 441) aged 11-17 years were randomized to experimental shopping conditions in a life-sized model convenience store, in which GWPs were absent ("status quo"; n = 107) or visibly displayed near the check-out area (n = 334). Participants completed pre- and post- "shopping" measures of future smoking susceptibility, descriptive and injunctive smoking norms, and perceived harms of smoking. A series of linear regression analyses assessed whether norms and harms differentially mediated the effect of experimental condition on future smoking susceptibility in committed never smokers compared with at-risk youths. Tests showed evidence for mediated moderation of the effect of GWP exposure on future smoking susceptibility, such that changes in injunctive norms (i.e., greater perceived social disapproval)-but not descriptive norms or perceived smoking harms-partially accounted for the effect of GWPs on smoking susceptibility in at-risk youths (average causal mediation effect: B = 0.51 [0.14-1.22], p = .02), but not among committed never smokers. For adolescents already at risk of future smoking, GWPs increase perceptions of cigarettes as less socially acceptable, which may increase susceptibility to future smoking in this group. Future work should examine reactance to antismoking messaging among youth at risk for future smoking. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Understandings of the component causes of harm from cigarette smoking in Australia.

To investigate relationships between smoking-related behaviours and knowledge of the disease risks of smoking and the causes of smoking harms, using a four-way division of 'component causes': nicotine, other substances found in unburned tobacco, combustion products of tobacco and additives. The data were collected using an on-line survey in Australia with 1047 participants in three groups; young non-smokers (18 to 25), young smokers (18 to 25) and older smokers (26 and above). Most participants agreed that cancer and heart disease are major risks of smoking but only a quarter accurately quantified the mortality risk of lifetime daily smoking. Very few (two of 1047) correctly estimated the relative contributions of all four component causes. Post-hoc analyses reinterpreting responses as expressions of relative concern about combustion products and nicotine showed that 29% of participants rated combustion products above nicotine. We delineated six relative concern segments, most of which had distinctive patterns of beliefs and actions. However, higher levels of concern about combustion products were only weakly positively associated with harm reducing beliefs and actions. Most smokers do not appear to understand the risks of smoking and their causes well enough to be able to think systematically about the courses of action open to them to reduce their health risk. To facilitate informed decision-making, tobacco control communicators may need to better balance the dual aims of creating fear/negative affect about smoking and imparting knowledge about the health harms and their mechanisms.

What if we combine Quit and win and individual approach to help smokers quit at the community level?

Abstract Issue Tobacco eventually kills up to a half of its users. Helping smokers who wish to quit is one of the six cost effective interventions listed by World Bank to decrease smoking harm. Tobacco Control Scale in 2016, shows diversity in approaches and coverage to help smokers quit across Europe. Comprehensive interventions are most effective. Combining contest, financial incentives, individual approach and triggers (start of Lent or other) could be implemented in other settings. Description of the problem Contest to motivate smokers for a quit attempt and individual help provided, has been conducted yearly since 2015 in a local community in Pozega-Slavonia County in Croatia. Data on all participants from 2015 through 2018 contests were collected by questionnaires and long term smoking status (6 months) evaluated by phone interviewing. Statistical analysis was conducted in SPSS. The objective was to determine how effective in helping smokers quit is a novel combination of evidence-based approaches “Quit and win” and individual support in local setting and to establish certain smokers characteristics as possible predictors of outcome. Results Data for 153 participants were collected. There were more (54%) male participants. Participants mean age was 35.8 years (range 18-67). Short term (30 day) abstinence rate was 73.9% (113/153) and out of those 34.1% (31/91) abstained long term (6 months). Long term follow-up was 80.5% (91/113). Overall, long term quit rate was 23.7% (31/131). There were no statistically significant differences in short and long term quit rates depending on age, sex, education, employment or socio-economic status, pack-year measure or personal success estimates. Lessons Comprehensive contest approach was found to be effective in helping smokers quit. Interest for implementation was shown by several counties and cities in Croatia. Effectiveness regardless of personal and social characteristics of contestants shows potential in different settings. Key messages Comprehensive interventions that include contest, financial incentives, individual approach and triggers in smoking cessation helped one in four involved smokers to quit. This approach has potential for implementation in diverse local communities as no difference in quit rates in different sex, age or socioeconomic groups were detected.

Parental tobacco smoking and risk of childhood leukemia in Costa Rica: A population-based case-control study

IntroductionThe role of environmental and behavioral exposures on childhood leukemia etiology is poorly understood. We examined the association of maternal and paternal tobacco smoking at different time points with the risk of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) in Costa Rican children. Materials and methodsWe conducted a population-based case-control study on childhood leukemia in Costa Rica. Cases (n ALL = 252; n AML = 40) were diagnosed between 1995 and 2000 (aged <15 years at diagnosis) and identified from the Costa Rican Cancer Registry and the National Children's Hospital. A total of 578 frequency-matched population controls were sampled from the National Birth Registry. Parental tobacco smoking was assessed via face-to-face interviews. We used logistic regression models to examine the association of paternal and maternal tobacco smoking before conception, during pregnancy, and after birth with childhood ALL and AML risk, adjusted for child sex, birth year, maternal/paternal age, and parental education. ResultsPaternal smoking before conception, during pregnancy, and after birth was associated with an increased risk of childhood AML (Odds Ratio (OR): 2.51, 95% CI: 1.21–5.17; OR: 3.21, 95% CI: 1.56–6.60; and OR: 2.83, 95% CI: 1.36–5.90, respectively). Maternal smoking during pregnancy was also associated with a modest, but imprecise increase in AML risk. We observed null associations of maternal and paternal smoking with ALL in the offspring. ConclusionOur results suggest an association between parental smoking and risk of AML, but not ALL, in Costa Rican children. These findings add to the established evidence of numerous health risks associated with smoking and highlight the potential harm of smoking during sensitive windows of the development of fetus and child.

Confusion and nutritional backlash from news media exposure to contradictory information about carbohydrates and dietary fats.

To test the effect of news media exposure to contradictory information about carbohydrates and dietary fats on levels of confusion, nutritional backlash and dietary intentions. We conducted an online survey experiment between 11 and 28 February 2018, randomizing participants to one of six experimental conditions. Two 'contradictory information' conditions asked participants to read one news article on the risks of a low-carbohydrate diet and one article on the risks of a low-fat diet. Two 'convergent information' conditions asked participants to read two articles with similar information on the risks of one of these two diets. A fifth 'established health recommendations' control condition asked participants to read two articles on the harms of smoking and sun exposure. A sixth 'no information' condition served as a second control group. We used general linear models to test hypotheses on the effects of exposure on confusion, nutritional backlash and dietary intentions. USA. Adults (n 901) registered with Amazon's Mechanical Turk (M-Turk). Exposure to contradictory information about carbohydrates and dietary fats increased confusion and nutritional backlash compared with exposure to established health recommendations for non-dietary behaviours and a no-exposure control. Exposure to contradictory information also increased confusion compared with exposure to consistent nutrition information regarding carbohydrates and dietary fats. Contradictory nutrition information in the news media can negatively affect consumers' attitudes, beliefs and behavioural intentions. Dietary debates that play out in the media may adversely influence both short-term dietary decisions and future efforts to communicate about unrelated nutrition issues.

Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain

Examine the interrelationship between smoking and pain in the US population. A cross-sectional population-based study. Nationwide survey. Comprehensive pain reports categorically defined as head, spine, trunk, and limb pain; smoking history; demographics; medical history from a total of 2,307 subjects from the 2003-2004 National Health and Nutrition Examination Survey obtained from the Centers for Disease Control were analyzed. Unpaired t tests were used to analyze independent continuous variables, and chi-square tests were used to analyze categorical variables between smoker and nonsmoker groups. Weighted multivariate logistic regression analyses determined the association of current smoking with the presence of pain in various body regions. Smoking is most strongly associated with spine pain (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 2.21-3.77), followed by headache (OR = 2.47, 95% CI = 1.73-3.53), trunk pain (OR = 2.17, 95% CI = 1.45-2.74), and limb pain (OR = 1.99, 95% CI = 1.45-2.73). Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.

A call for Effective Interventions to Curb Shisha Tobacco Smoking among University Students in Eastern Province, Saudi Arabia: Findings from a Cross-Sectional Study

Background:Although the number of cigarettes smoked has been declining due to major public health initiatives, shisha tobacco smoking is gaining popularity around the world, particularly among youth and university students. Methods:A cross-sectional study was conducted among 464 university students in Eastern Province of Saudi Arabia using a structured questionnaire (i) to assess the prevalence of shisha smoking; (ii) to evaluate risk-perception, knowledge and normative belief about shisha smoking, and to compare these among users and non-users of shisha.Results:The study reported a high prevalence (22.8%) of the current use of shisha among the university students with a narrow gender gap and found that STS is getting more popular than other forms of tobacco. A quarter of participants had low risk perception and 30.2% had low knowledge of shisha smoking harm. Importantly, more than two-fifth of them were current users of shisha. Low risk-perception about shisha and social acceptability were significantly contributed to the high prevalence of shisha smoking among the youth. Conclusion:It is important to provide exposure to education related to shisha hazards and increase the awareness of students and the public about the health effects of shisha smoking.

Status quo on smoking and related change pattern of smoking related behavior in past 20 years in urban residents in Tianjin

Objective: To understand the status quo of smoking and change pattern of smoking related behaviors in the past 20 years in the urban adults in Tianjin. Methods: Data was from the study of Chinese Chronic Disease and Risk Factors (2015). Multi stage stratified random sampling method was used to conduct a questionnaire survey in 7 surveillance sites in Tianjin. Results: in the urban residents aged>20 years were compared with those in surveys in 1996 and 2010. Results In 2015, the smoking rate in men and women aged>20 years in Tianjin were 41.1% and 4.5% respectively. The average age of starting smoking was (19.2±4.7) years for men and (24.8±10.9) years for women, showing a younger age trend. Compared with the data from 1996 and 2010, the smoking rate in the urban residents was in decrease, but the rate of successful smoking cessation was in increase in 2015, the differences were significant. Conclusions: Since 1996, the rate of smoking in the urban residents of Tianjin has been in decline, however it is still at a high level, especially in women. The average age of starting smoking remains to be younger. It is necessary to strengthen the health education about harm of smoking in adolescents.

A survey of the prevalence of modifiable health risk behaviours among carers of people with a mental illness

BackgroundFamily carers provide significant support to people with a mental illness; yet may experience poor mental and physical health themselves. Among limited research addressing the physical health of carers, studies of carers of people with dementia and young people with psychosis suggest increased risk of chronic diseases in conjunction with higher levels of potentially modifiable lifestyle risk behaviours. This exploratory study, conducted with carers of people with various mental illnesses, aimed to determine: carer prevalence of health risk behaviours (inadequate fruit and vegetable consumption, inadequate physical activity, harmful alcohol consumption, and tobacco smoking); interest in changing ‘at risk’ behaviours; and potential associations of socio-demographic characteristics with risk status and interest in change.MethodsA cross-sectional survey was conducted among family carers of people with a mental illness (N = 144) residing in New South Wales, Australia. Analyses explored risk behaviour prevalence and interest in change, and associations with socio-demographic variables.ResultsInadequate fruit and vegetable consumption was most prevalent (74.8%), followed by engaging in inadequate amounts of physical activity (57.6%); harmful alcohol consumption (36.3%) and smoking (11.8%). The majority of carers were interested in improving ‘at risk’ behaviours (56.3–89.2%), with the exception of alcohol consumption (41.5%). Previously or never married participants were more likely to consume inadequate amounts of fruits and/or vegetables compared to those married or cohabiting (Odds Ratio [OR]: 4.1, 95% Confidence Interval [CI]: 1.3–12.9, p = .02). Carers in the workforce were more likely to be engaging in inadequate physical activity (OR: 2.6, 95% CI: 1.2–5.7, p = .02); and male participants were more likely to engage in harmful alcohol consumption (OR: 2.9, 95% CI: 1.1–7.9, p = .03). Working carers were approximately five times more likely to report interest in improving their alcohol consumption (OR: 5.1, 95% CI: 1.3–20.5, p = .02) compared to those not currently in the workforce.ConclusionsResults suggest high engagement in health risk behaviours among carers of people with a mental illness, particularly with regards to harmful alcohol consumption. Findings suggest a need to develop and implement chronic disease prevention strategies. Further research with larger representative samples is needed to confirm findings.

Impact of adding and removing warning label messages from cigarette packages on adult smokers’ awareness about the health harms of smoking: findings from the ITC Canada Survey

IntroductionAdding messages to cigarette health warning labels (HWLs) about the harms of smoking increases awareness of these health facts, but little is known about the impact of removing messages. This...

Pictorial health warning labels on the waterpipe device are effective in reducing smoking satisfaction, puffing behaviour and exposure to CO: first evidence from a crossover clinical laboratory study

ObjectivesThis study examined the effect of pictorial health warning labels (HWLs) on the waterpipe (WP) device on smokers’ experience, puffing behaviour, harm perception and exposure to respiratory toxicants.MethodsThirty WP smokers...

Attitudes of Korean smokers towards smoke-free public places: findings from the longitudinal ITC Korea Survey, 2005–2010

ObjectivePrior to December 2012, restaurants in South Korea were required to implement only partial smoking bans. This study documents the changes in Korean smokers’ attitudes towards smoking bans between 2005...

What Low-income Smokers Have Learned from Public Health Pedagogy: A Narrative Inquiry.

Objectives: Health advocates have been working to educate the public about the harms of smoking for more than 50 years. However, smoking rates have reduced more slowly among people with low incomes. The purpose of this study was to evaluate what low-income smokers have learned from a lifetime of exposure to public health education and how this knowledge may have translated into smoking-related behaviors. Methods: We used narrative inquiry and elicitation interview techniques. Interviews were recorded, transcribed verbatim, coded, and organized into themes using the constant comparative method. Results: All participants were aware of smoking-related harms to health but negative experiences with quitting, cessation medications, and healthcare professionals contributed to avoiding or rejecting educational messages. Participants' perceptions of hypocritical societal tobacco control policies also led some to believe that the harms of tobacco use were exaggerated, or were being used to control or manipulate them. This contributed to a distrust of the government, public health advocates, and healthcare providers. Conclusions: Low-income smokers were aware of the harms of smoking and that quitting would improve their health. Public health advocates should consider developing messages that attempt to foster trust in healthcare professionals and are consistent with low-income adult smokers' quitting experiences.

A brief tobacco dependence intervention for people living with HIV in Nepal: results of a quasi-experimental study

AbstractIntroductionThere is evidence of increased morbidity, decreased quality of life, and premature mortality in people living with HIV (PLHIV) who smoke tobacco compared to PLHIV who do not smoke tobacco. Evidence-based screening for tobacco dependence, pharmacological treatment, and treatment monitoring and education into relapse prevention are not readily available in low- and middle-income countries (LMIC). We evaluated the effects of a brief tobacco dependence intervention in improving knowledge on the health effects of smoking and intention to quit smoking in PLHIV in Nepal, a low-income country in south Asia.MethodsUsing a quasi-experimental design, we assigned 59 smokers to participate in the intervention and 67 in the control group. The 1.5 h smoking cessation intervention emphasized harms of smoking, reasons for smoking and quitting, causes of relapse in previous quit attempts, and quitting strategies. We collected data at baseline and immediately post-intervention.ResultsFindings indicate that a brief smoking cessation intervention produced a significant increase in smoking-related knowledge and intention to quit among PLHIV. The positive effects of our intervention remained significant after adjusting for potential confounders.ConclusionsOur brief tobacco dependence intervention was effective in improving knowledge on the health effects of smoking and intention to quit among PLHIV. Further studies are required to evaluate the effectiveness of our intervention in increasing smoking cessation among PLHIV in LMIC.