Maintaining Smoking Cessation Research Articles

Assessing the impacts of smoking cessation and resumption on back pain risk in later life.

This study aimed to assess the impacts of smoking cessation and resumption over 4 years on the risk of back pain at the 6-year follow-up among older adults in England. We analysed 6467 men and women aged ≥50 years in the English Longitudinal Study of Aging. Self-reported smoking status, assessed in waves 4 (2008-2009) and 6 (2012-2013), was used as exposure for the study, whereas self-reported back pain of moderate or severe intensity, assessed in wave 7 (2014-2015), was used as the outcome. A targeted minimum loss-based estimator was used with longitudinal modified treatment policies to adjust for baseline and time-varying covariates. Regarding the estimation of the effects of changes in smoking status on the risk of back pain, during the follow-up, individuals who resumed smoking within 4 years had a higher risk of back pain than those who avoided smoking for over 4 years, and the relative risk (RR) (95% confidence interval [CI]) was 1.536 (1.214-1.942). Regarding the estimation of effects of smoking cessation on the risk of back pain, smoking cessation over 4 years was associated with a significantly lower risk of back pain, as indicated by the originally observed data, and the RR (95% CI) was 0.955 (0.912-0.999). Older adults who avoided smoking for over 4 years had a lower risk of back pain. However, those who resumed smoking within 4 years had a higher risk of back pain. Older adults who avoided smoking for over 4 years had a lower risk of back pain. However, those who resumed smoking within 4 years had a higher risk of back pain. Our study data suggest the importance of maintaining smoking cessation to reduce the risk of back pain in the older population.

Electronic Cigarettes for Smoking Cessation: The Gap Between Behavior in Smokers and Medical Education.

E-cigarettes have engendered a great deal of controversy within the public health and medical communities. Methods: Two cross-sectional surveys were administered. First, patients at an annual lung cancer screening appointment whoself-identified as former smokers were asked about strategies for achieving and maintaining smoking cessation with open-ended questions. Second, medical students at a single university reported their opinion and knowledge of combustible cigarettes and e-cigarettes. Among the n=102 in the patient survey indicating that they used e-cigarettes or over-the-counter (OTC) nicotine replacement productsfor smoking cessation, 34.3% (35/102) vaped e-cigarettes, making it the second most common next to patches (47.1% {48/102}). By comparison, n=48 reported using medication. Medical student participants (n=168) were mixed regarding whether a patient should switch from traditional to electronic cigarettes (56.0% yes; 44.0% no) and reported receiving education about traditional cigarettes (92.3%) at a much higher rate than for e-cigarettes (46.4%), p<.001. Many former heavy smokers undergoing a lung cancer screen used e-cigarettes to achieve smoking cessation. However, nearly half of medical students surveyed do not think patients should switch from traditional to e-cigarettes.

Factors associated with long-term smoking relapse in those who succeeded in smoking cessation using regional smoking cessation programs.

It is known that approximately 10% of successful quitters relapse annually. This study aimed to investigate the factors related to long-term smoking relapse in individuals who succeeded in maintaining smoking cessation for 6 months after attending a regional smoking cessation program.This study enrolled 943 individuals registered for the regional smoking cessation program at the Busan Smoking Cessation Center in 2018–2019 who maintained smoking cessation for 6 months. A survey was conducted using a smartphone link or through phone calls, and the data for 305 participants who finally completed the survey were analyzed. The questionnaire addressed individual, inter-individual, organizational, and community-level factors related to smoking relapse. Multivariate logistic regression analysis was performed to evaluate the factors associated with smoking relapse by period. The Cox proportional hazard regression model was used for the factors associated with smoking relapse for the entire period.The smoking relapse rate at the time of the survey was 25.4%. In the analysis of smoking relapse by period, relapse was associated with the belief that smoking relieves stress, the number of single-person households, and poor subjective health status. In the analysis of smoking relapse during the entire period, we observed a significant association with the belief that smoking relieves stress (hazard ratio [HR]: 2.65, 95% confidence interval [CI]: 1.52–4.61), single-person households (HR: 1.95, 95% CI: 1.16–3.26), and high levels of emotional stress (HR: 1.72, 95% CI: 1.04–2.85).Long-term follow-up is necessary to prevent smoking relapse in single-person households, individuals who believe that smoking relieves stress, and those experiencing high levels of subjective emotional stress. Interventional therapies for stress relief and awareness improvement in smokers need to be developed.

My quitting stories: A qualitative study exploring Aboriginal women’s experiences of smoking cessation and preventing relapse in the context of pregnancy

BackgroundMost women who give up smoking during pregnancy relapse to smoking postnatally. Evidence on strategies that are helpful in maintaining smoking cessation during and beyond pregnancy is limited. AimThis paper aims to explore Aboriginal women’s experiences of quitting smoking, relapsing, and preventing relapse, focusing on the strategies they applied for attaining and maintaining abstinence and the support they received. MethodsQualitative interviews were conducted between October 2020 and June 2021, in urban New South Wales, Australia, with 12 Aboriginal women who either smoked tobacco or quit smoking and had been pregnant in the last five years. Aboriginal Research Assistants recruited participants, participated in data collection and data analysis. Data were thematically analysed. ResultsMajor themes that emerged from the data include: a) aspiration to be abstinent; b) strong mindset; c) strategies to stay smoke-free; d) supports received; and e) service and policy recommendations. Protecting children from second-hand smoke had salience for the maintenance of abstinence. Having a strong mindset was perceived as a prerequisite to staying smoke-free. Use of multiple coping strategies in combination was frequently expressed. Knowledge about tobacco-related harms, the way nicotine dependence works, and the available support options was empowering and enabled informed decision making and actions around smoking cessation. ConclusionThis qualitative study conducted with 12 Aboriginal women revealed that Aboriginal women employ multiple strategies (cognitive, behavioural and social) to quit smoking and stay smoke-free. The strategies warrant further exploration with different Aboriginal communities across Australia and consideration of inclusion in smoking cessation care.

Cohabitation with a smoker and efficacy of cessation programmes: the mediating role of the theory of planned behaviour

Objective The present research sought to examine whether cohabitation with a smoker undermines smoking cessation among people engaged in a cessation programme and whether the components of the Theory of Planned Behaviour (TPB) act as mediating mechanisms. Design A prospective longitudinal study with online questionnaires was conducted among smokers living in Switzerland who enrolled in a 6-months smoking cessation programme. Main outcome measures Cohabitation with a smoker and the TPB constructs were assessed 10 days after the start of the programme (T1; N = 820). Smoking abstinence was measured at T1, and at 3-months (T2; N = 624) and 6-months follow-ups (T3; N = 354). Results Results showed that living with a smoker decreased the odds that smokers remained abstinent throughout the cessation programme. Furthermore, we found that cohabitation was negatively associated with subjective norm. Afterwards, subjective norm predicted intention to maintain smoking cessation, which, in turn, predicted smoking abstinence. Such mediation effects persisted at each time point. Conclusion The present research provided evidence that living with other smokers at home can lead to greater risks of relapsing among people engaged in a cessation programme. We discussed the role of smoking-related norms in the efficacy of cessation interventions. Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2041638 .

A Pragmatic Randomized Comparative Trial of e-Cigarettes and Other Nicotine Products for Quitting or Long-Term Substitution in Smokers.

Tobacco harm reduction has potential to improve individual and population health. However, little research exists on low-intensity interventions, such as encouraging longer-term NRT or e-cigarette use. We aimed to determine whether: (1) encouraging use of nicotine products as long-term tobacco substitutes is more effective for smoking abstinence than standard treatment, and (2) offering e-cigarettes is more effective than NRT. An open-label, parallel-group randomized trial was conducted in Australia between 2014 and 2015, with 1563 adult daily smokers, randomized to: (A) standard cessation advice and NRT: advice to use NRT short-term, (B) quit or substitute advice and NRT: advice to use NRT as a longer-term substitute for smoking if required to maintain smoking cessation, or (C) Quit or substitute advice and NRT and/or e-cigarettes. Participants were offered an initial supply of products they could then purchase for up to 7 months. The primary outcome was self-reported continuous smoking abstinence at 7 months. Point prevalence, dual use, and cigarette reduction were secondary outcomes. At 7 months, 2.8% (N = 9) of group A (N = 324) were abstinent, compared with 1.8% (N = 11) in B (N = 620) and 1.3% (N = 8) in C (N = 619) (adjusted odds ratio [ORs]: B vs. A 0.66, 95% confidence interval [CI]: 0.27-1.63; C vs. A 0.46, 95% CI: 0.17-1.21; C vs. B 0.69, 95% CI 0.27-1.73). There were no suspected unexpected serious adverse reactions associated with trial products. A free trial of NRT and first generation e-cigarettes and advice on long-term substitution was no better for smoking abstinence than usual care. The trial was registered with the Australian Therapeutic Goods Administration under their Clinical Trials Notification scheme and the Australian and New Zealand Clinical Trials Registry (ACTRN12612001210864). This pragmatic trial allowed the comparison of existing and alternative policy options under semi-realistic conditions, such as product choice and financial cost. All trial arms had low rates of smoking cessation. The findings suggest that providing unflavored cigalike e-cigarettes without additional support may not increase quitting compared with advice to use standard NRT in a general population of Australians who smoke. More intensive support and education, and/or opportunity to try a range of e-cigarette products, may be required to motivate quit attempts using e-cigarettes.

Smoking cessation adherence:recurrent cardiovascular events after five years of first manifestation

Abstract Background Smoking is an established risk factor for cardiovascular events, such as myocardial infarction, stroke and cardiovascular death. Although the harmful effects of smoking on health are widely known. Smoking is highly addictive and cessation can be extremely difficult, even after a life-threatening vascular event. Objective The present study aimed to assess the relation between smoking status and risk of recurrent Cardiovascular events 5 years after the first hospitalization for acute coronary syndrome. Methods A cross sectional study was conducted in the Smoking Cessation Service at University Hospital of Monastir, Tunisia during February 2020. The smoking status and recurrent cardiovascular events were assessed 5 years after the first hospitalization for acute coronary syndrome by phone call among patients attended the tobacco cessation consultation. The statistical analysis was conducted with SPSS software, version 21.0. A p value of &amp;lt; 0.05 was considered statistically significant. Results A total of 112 patients were included in our study. All participants were male and the mean age was 56 ±10 years. Most patients (67%) had a high level of nicotine dependence. The rate of smoking abstinence declined from 35.7% at one year to 21.1% at 5 years. During the study period, 4 patients died(3.5%) and 17 (15.17%) had a recurrent cardiovascular event. The recurrent cardiovascular event occurred more in smoking patients but the difference was not significant. Conclusions Smoking cessation after a first cardiovascular event should be a key objective for both patients and physicians to reduce the risk for recurrent vascular events. More efforts are needed to maintain smoking cessation in patients at very high cardiovascular risk. Key messages Smoking cessation consultation can increase adherence to smoking cessation and helps in reducing the excess risk of recurrent cardiovascular events. Smoking is highly addictive and cessation can be extremely difficult, even after a life-threatening vascular event.

Cost-effectiveness analysis of treatment with varenicline for nicotine dependence compared with smoking cessation without pharmacotherapy in the real world.

Smoking is an important public health issue. Although measures to support smoking cessation have been implemented worldwide, smokers often fail to quit smoking after receiving pharmacotherapies for nicotine dependence. The present study evaluated the cost-effectiveness of varenicline for smoking cessation compared with no pharmacotherapy using actual paid medical cost data in Japan. This was a retrospective cohort study of 3657 subjects who had quit smoking with varenicline or no pharmacotherapy. We extracted health examination and medical claim data from a health insurer database for the period 2012-2015. We calculated the incremental cost-effective ratio (ICER) of varenicline using actual paid medical costs for nicotine dependence and the number needed to treat to maintain smoking cessation compared with no pharmacotherapy, considering sex, age, income, and occupation. The 1- and 2-year smoking cessation maintenance rates were 69.7% and 62.4%, respectively. We found that 8.8% of subjects who quit smoking used varenicline for nicotine dependence and the cost per person was Japanese Yen (JPY) 52 177 (U.S. dollars [USD] 474; USD 1=JPY 110). The ICER of varenicline was dominant when comparing 2-year cessation with 1-year cessation. Male, age <40 years, low income, and manufacturing workers were the most cost-effective variables. The cost-effective variables of varenicline in the real world were investigated. The results of this study strengthen the evidence regarding which type of people should be targeted for measures to support smoking cessation using varenicline.

Natural and synthetic estrogens specifically alter nicotine demand and cue-induced nicotine seeking in female rats

Women have more difficulty maintaining smoking cessation than men, and experience greater withdrawal symptomatology as well as higher prevalence of relapse. Further, currently available treatments for smoking cessation, such as the nicotine patch and varenicline, have been shown to be less effective in women. Fluctuations in ovarian hormones across the menstrual cycle can affect craving and smoking relapse propensity. In addition, many women who smoke use some form of oral contraceptives, which most often contain ethinyl estradiol (EE), a synthetic, orally bio-available estrogen that is currently prescribed to women chronically and has been shown to alter smoking reward in women. The current study examined the impact of 17β-estradiol (E2), the prominent endogenous form of the steroid hormone estrogen, as well as EE, on nicotine self-administration, demand, and reinstatement following ovariectomy (OVX) or sham surgery. OVX vehicle-treated female rats consumed less nicotine, had lower intensity of demand, and reinstated less compared to sham vehicle-treated female rats. OVX-E2 and OVX-EE treatment groups showed a rebound of nicotine intake later in training, and Q0 levels of consumption were partially rescued in both groups. Further, E2 but not EE reversed the abolishment of reinstated nicotine seeking induced by OVX. Taken together, these results demonstrate that natural and synthetic estrogens play a critical role in mediating the neurobehavioral effects of nicotine, and future studies are essential for our understanding of how synthetic hormones contained within oral contraceptives interact with smoking.

Effectiveness of a perioperative smoking cessation program evaluated over one-year follow-up

ABSTRACT Objectives: To analyze the effects of an intervention protocol for perioperative smoking cessation on short- and long-term smoking abstinence of patients. Methods: A total of 115 patients who were scheduled for ENT surgery were included in the study. The participants of the smoking cessation program were included in the study group, and subjects who smoke but have not heard about this program were included in the control group. Subjects who refused to participate in the smoking cessation program were included in the refusal group. The proportion of smoking cessation in each group was compared during the one-year follow-up. Results: The trends of failure rate during the one-year follow-up were approximately the same among the groups, but the failure at 1 month postoperatively in the control group was more prominent than that in the study group. In the study group, subjects who maintained and did not maintain smoking cessation at 1 year postoperatively did not show any significant differences in terms of demographic data, smoking history, and perioperative parameters. Conclusions: Results show that the smoking cessation program was effective, particularly in the early postoperative period. However, another program is needed for patients who failed to maintain smoking cessation during long-term follow-up.

Smoking behavior after coronary artery bypass surgery: Quit, relapse, continuing.

Objective:Tobacco smoking represents a major risk factor for coronary artery disease. Our study aimed to investigate whether Coronary Artery Bypass Graft (CABG) surgery could act as a motivating factor to enforce smoking cessation. Specifically, we observed the success rate in individuals who quitted smoking, along with the number and reasons of relapse(s) at least one year after the operation.Methods:The pre-operative characteristics, pre-operative tobacco exposure, socioeconomic factors and perioperative complications in patients who underwent isolated Coronary Artery Bypass Graft surgery in our Department from June 2012 to September 2016 were reviewed. Our survey was conducted via phone interview and using a standardized questionnaire. Only patients who were current smokers at the time of surgery were interviewed.Results:Our study group consisted of a total of 120 patients, 91 (75.8%) reported initially quitting tobacco smoking. Because of relapse(s), one year after the procedure the number of patients who were still non-smokers dropped to 69 (57.5%). Smoking cessation attempts were not supported by professional assistance.Conclusions:Our findings demonstrate that there is a desire from CABG patients to quit smoking, as indicated by the high percentage of initial attempts in early postoperative period. However, a year after the procedure, only 57.5% of CABG patients were able to achieve or maintain smoking cessation. Patients who were retired or who were unemployed at the time of the surgery, found it easier to stop smoking than patients who were active employees. Patients who lived alone at the time of surgery also found it harder to stop smoking. Finally, patients with COPD also found quitting smoking harder in the post-operative period.

What makes an effective antismoking campaign - insights from the trenches.

This paper describes traditionally effective approaches for anti-smoking mass media advertising and explores challenges and future directions for campaign planning. The changing characteristics of the current smoking population and media landscape are examined. Type of program or service: Anti-smoking mass media advertising campaigns. We present a commentary on the established creative and media strategies proven to be effective in prompting quit attempts among smokers, discuss new challenges facing anti-smoking campaign managers today and propose considerations for the future. Although evidence of effective approaches for tobacco control messaging and execution remains clear, the media landscape in Australia has changed dramatically in recent years with some audiences moving away from frequent and heavy television consumption towards online platforms and digital media channels. In addition, as smoking rates continue to fall, characteristics of current smokers are becoming increasingly relevant considerations for anti-smoking messaging and placement within a media environment that is becoming more expensive and fragmented. Funding anti-smoking advertising at the levels required to effectively prompt and maintain smoking cessation remains a high priority considering the extensive social and economic costs of smoking. Although it is known that hard-hitting, emotional and/or testimonial anti-smoking advertisements can be effective in prompting quit attempts, optimal media channel selection and media mix for reaching and engaging audience segments is dynamic in an ever-changing media landscape. Targeting media channels popular with lower socio-economic status (SES) smokers can efficiently achieve wide population exposure as well as effectively reaching population groups with higher smoking prevalence. A collaborative approach between health professionals, researchers, creative directors and media buyers is required to ensure advertising materials are communicating the right message for the audience, and that it is being delivered effectively.

Long-Term Effects of Smoking Cessation on Depressive Symptoms, Resilience, Coping Skills, and Serotonin.

There are many studies on how smoking cigarettes is harmful to health, but research on how smoking cessation improves mental health is insufficient. The purpose of this study was to examine long-term effects of smoking cessation on depressive symptoms, resilience, coping skills, and serotonin levels in Korean adults. This was a longitudinal study that followed up on periodically participants for 2years after the initial smoking cessation intervention. A total of 164 smokers participated within this study. Of these, 15 maintained smoking cessation for 504.93 ± 182.82days. On the other hand, 148 participants failed to maintain smoking cessation. Depressive symptoms decreased and resilience increased significantly over 2years in the 15 abstainers. Smoking cessation, in total, decreased depressive symptoms by 32.9% (p = .015) and also increased resilience by 37.5% (p = .012). Smoking cessation also explained for 9% of total positive interpretation at the 1-year follow-up, and 7.3% of total self-criticism at the 2-year follow-up. Serum serotonin did not change over the course of 2years in both abstainers and smokers but did decrease in the short-term for those who maintained smoking cessation. Platelet serotonin increased over 6months among smokers.

Using a nominal group technique to approach consensus on a resilience intervention for smoking cessation in a lower socioeconomic population

BackgroundSmoking prevalence remains inequitably high for lower SES (socioeconomic status) populations. The psychosocial interactive model of resilience theorises that resilience might be ‘switched on’ in order to support and/or maintain smoking cessation for these populations. This study aimed to develop a Resilience Intervention for Smoking Cessation (RISC) through reviewing the extant literature around efficacious interventions for smoking cessation. Deliberative democracy principles were then used to understand lay perspectives regarding this potential smoking cessation program.MethodsPublic health databases were searched to find efficacious psycho-social resilience interventions in the peer-reviewed literature for smoking cessation amongst lower SES populations. Potential components for RISC were selected based on evidence within the literature for their effectiveness. We then employed the Nominal Group Technique (NGT) to create discussion and consensus on the most socially appropriate and feasible components from the perspective of smokers from low SES areas. The NGT included 16 people from a lower SES population in southern metropolitan Adelaide who indicated they were seriously contemplating quitting smoking or had recently quit. Data were collected from multiple Likert ratings and rankings of the interventions during the NGT workshop and analysed descriptively. The Wilcoxon signed-ranked test was used where appropriate. Qualitative data were collected from participant reflections and group discussion, and analysed thematically.ResultsSix smoking cessation interventions, likely to enhance resilience, were selected as potential constituents for RISC: mindfulness training; setting realistic goals; support groups; smoke free environments; mobile phone apps; and motivational interviewing. Consensus indicated that mindfulness training and setting realistic goals were the most acceptable resilience enhancing interventions, based on perceived usefulness and feasibility.ConclusionsThis research applied principles from deliberative democracy in order to illuminate lay knowledge regarding an appropriate and acceptable smoking cessation resilience program for a lower SES population. This process of collaborative and complex knowledge-generation is critically important to confront inequities as an ongoing challenge in public health, such as smoking cessation for disadvantaged groups. Further research should involve development and trial of this resilience program.

Exploring Efficacy of a Serious Game (TOBBSTOP) for Smoking Cessation in Pregnant Women: Pilot Case-Control Study

Background: Tobacco use entails, during pregnancy, a serious risk to the mother and harmful effects on the development of the child. Europa has the highest tobacco smoking prevalence (19.3%) as compared to a worldwide mean of 6.8%. Twenty to thirty percent of pregnant women used tobacco during pregnancy worldwide. These data emphasize the urgent need for community education and implementation of prevention strategies focused on risks associated to tobacco use during pregnancy. Objective: This study aims to investigate the possibility to address this problem through a serious game (TOBBSTOP), something that has proven efficient as a tool for learning in many situations. By using a game for smoke cessation during pregnancy, we aim to maintain cessation and interest pregnant smokers in learning about health care and effects of tobacco by playing a game that helps them to achieve their challenge. Methods: A pilot case-control study enrolls 44 women who were visited in two primary care centers in Spain between March 2015 and November 2016. All participants were pregnant smokers over the age of 17 years attending consultation to a midwife during the first trimester of pregnancy who expressed their desire to stop smoking. We recruited the intervention group (n=22) among the attended on the centers and instructed them to install the game on their smartphone or tablet and use it for 3 months. Until the delivery, all participants had to respond to a questionnaire, assessing their stage on smoke cessation during their follow-up midwife consultations. The selected control group participants (n=22), matched for age, level of tobacco-dependence and number of smoking attempts. We tested the amount of CO at each visit with a carboxymeter during the entire intervention period to assess the abstinence. Results: Pregnant women from the intervention group, with 80.0% (12/15), had significant higher rates of cessation until delivery than control group (χ2=8.4; P=.004). Logistic regression analyses revealed that game’s use was associated with an increased likelihood to maintain smoking cessation during the intervention period compared with those not using the game (odds ratio 4.0; 95% CI 1.3-12.2). Additionally, a Mantel-Cox means’ analysis revealed that the use of the game was associated with an increased number of days without smoking, with an average of 139.7 days (95% CI 97.1-182.4) in the intervention group (χ2=13.912; P<.001). Conclusions: Pregnancy is an ideal opportunity to intervene and control tobacco use among future mothers. On the other hand, serious games is an emerging technology, growing in importance, which is shown as a good tool to assist in maintaining women without smoking and help behavior change during pregnancy. However, due to study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study.

Shared and divergent neural reactivity to non-drug operant response outcomes in current smokers and ex-smokers

Addiction to cigarettes presents with considerable health risks and induces high costs on healthcare resources. While the majority of cigarette smokers endorse the desire to quit, only a small percentage of quit attempts lead to full abstinence. Failure to achieve abstinence may arise from maladaptive reactivity in fronto-striatal regions that track positive and negative valence outcomes, thus biasing the choice to smoke in the presence of alternative, non-drug reinforcement. Alternatively, long-term nicotine abstinence may reveal neural substrates of adaptive valence outcome processing that promote and maintain smoking cessation. The present study set out to examine the neural correlates of operant response outcomes in current smokers, ex-smokers and matched controls using a monetary incentive delay task during functional MRI. Here we report that compared to controls, both current smokers and ex-smokers showed significantly less activation change in the left amygdala during positive response outcomes, and in the anterior cingulate cortex, during both positive and negative response outcomes. Ex-smokers, however, demonstrated significantly greater activation change compared to smokers and controls in the right amygdala during negative response outcomes. Activation change in the anterior cingulate cortex and middle frontal gyrus of smokers was significantly negatively correlated with nicotine dependence and cigarette pack-years. These results suggest a pattern of shared and divergent reactivity in current smokers and ex-smokers within corticolimbic regions that track both positive and negative operant response outcomes. Exaggerated adaptive processing in ex-smokers may promote long-term smoking cessation through amplified negative valence outcome monitoring.

The experiences of smoking cessation among patients with chronic obstructive pulmonary disease in Australian general practice: a qualitative descriptive study.

It is important to understand the experiences surrounding smoking cessation among patients with chronic obstructive pulmonary disease (COPD) to improve the likely success of future smoking cessation programs. To explore the personal experiences surrounding smoking cessation among general practice patients with COPD. A purposive sample of 33 general practice patients with COPD, 28 ex-smokers and 5 smokers, participated in the semi-structured telephone interviews. Thematic analysis was conducted using a predominantly deductive approach guided by the Behaviour Change Wheel framework. Three inter-related themes were generated: the motivation, opportunities and capabilities among the participants to quit and maintain smoking cessation. Most quit attempts occurred without explanation or prior planning, though some attempts were motivated by the participants' family, peers or GP. Internet-based smoking cessation support programs led by general practices and involving the practice nurse were perceived as opportunities to engage in quit attempts. Most participants, both ex-smokers and smokers, demonstrated capacity to engage in multiple quit attempts. However, for many smokers, boredom, mood disturbances, the strong sense of identity as a smoker, peer reinforcement, irritability, cravings, hunger and weight gain limited capability to maintain smoking cessation. Patients with COPD have motivation to quit and have demonstrated capacity to engage in multiple quit attempts. GPs and other primary care practitioners need to recognize the patients' spontaneity around quit attempts and to meet the needs of the individual patient by being ready to offer support for each attempt once the patient has made their decision to quit.

Smoking Cessation 1 Year or More: Experiences of Successful Quitters.

There is a paucity of research focused on the experience of maintaining cessation for a year or longer, and recidivism rates for smoking cessation are estimated at 50% to 97%. As cigarette smoking is one of the leading causes of death worldwide, there is a critical need for more knowledge about maintaining smoking cessation. Therefore, this study was undertaken to explore the lived experience of maintaining cigarette smoking cessation for a year or more. Using Streubert's nurse-developed descriptive phenomenological method, seven adults who sustained cessation for 1.5 to 18 years, after repeated relapses, were interviewed about their experience of sustaining cessation. Data collection included interviews, field notes, and a reflexive journal. Phenomenological analysis involved dwelling intensely with the data, extracting parts of the transcript, and identifying codes and themes, defined by Streubert as essences, common to all participants' descriptions of the experience of sustained cessation. Through this inductive process, the investigator ascertained relationships among the essences, forming the basis for a formalized, exhaustive description of the experience. Six essences captured participants' experiences of maintaining cigarette smoking cessation: (a) breaking free, (b) developing an olfactory aversion, (c) reframing, (d) learning through relapse, (e) reclaiming acceptance, and (f) self-transformation. The findings suggest that maintaining cessation for a year or more is shaped by biological, psychological, and social conditions, as reflected in the essences. The essences coalesced to a tipping point of motivation and conditions leading to sustained behavior change, allowing participants to maintain cessation.

Social Factors Related to Smoking among Rural, Low-Income Women: Findings from a Systematic Review.

This systematic review of the literature assesses congruency of findings from descriptive, qualitative, and association studies focusing on factors influencing smoking and smoking cessation with findings from smoking cessation interventions that included low-income rural women. Six databases relevant to the health and social sciences were searched in this systematic review using combinations of select keyword terms, specific inclusion criteria, and studies between 1997 and 2012. Descriptive studies on this population of smokers provide economic, environmental, and social factors related to smoking patterns. Qualitative studies found social support received from an individual's social network was viewed as most beneficial when considering or maintaining smoking cessation while randomized controlled trials included in this review implemented social support through peripheral resources or resources with little personal connection to the sample and failed to produce significant results. Few studies have focused on the specific needs and difficulties of smoking cessation among rural low-income women and interventions have not targeted the complex social network of this population. Incongruence in study findings supports the need for smoking assessment and cessation interventions that incorporates the unique social and cultural meanings of smoking in rural low-income women.

Validity of subjective smoking status in orthopedic patients.

PurposeIn this level 1 diagnostic study, we analyzed the validity of subjective smoking status and, as secondary research question, the smoking cessation adherence in orthopedic patients during a routine hospital stay of nonunion patients by measuring serum cotinine.MethodsWe included patients undergoing revision surgery due to nonunion of long bones. Patients were interviewed about their smoking status. Blood samples were taken from all the patients prior to surgery and for an additional 6 weeks following surgery. Serum levels of cotinine were measured, and coherence between subjective smoking status and objective cotinine analysis was evaluated.ResultsBetween March 2012 and August 2014, we enrolled 136 patients. Six of the 26 “previous smokers” (23%) and four of the 65 “nonsmokers” (6%) had serum cotinine above cutoff levels. In self-labeled smokers, serum cotinine levels averaged at 2,367.4±14,885.9 ng/mL (with a median of 100 ng/mL), whereas in previous smokers the levels averaged at 4,270±19,619.4 ng/mL (with a median of 0 ng/mL) and in the nonsmokers group the levels averaged at 12±53.9 ng/mL (with a median of 0.03 ng/mL). Overall, the subjective smoking status matched serum cotinine testing in 88% of the cases. Sensitivity was 79.6% and specificity was 93.1%. Ninety-one percent of the patients with preoperative positive serum values were still positive at follow-up.ConclusionIn this study, we could show that subjective smoking status in orthopedic patients is predominantly reliable as validated by objective cotinine measurements; however, patients who declare themselves as “previous smokers” are at elevated risk for underreporting continued smoking and patients who smoked preoperatively are at high risk for continuing their habit. In the future, caregivers should consider introducing effective treatments for smoking cessation to smokers and furthermore offer effective treatments to maintain smoking cessation in previous smokers during their routine consultation prior to orthopedic and trauma surgery.