Making Quit Attempts Research Articles

Does Self-Reported smoking cessation fatigue predict making quit attempts and sustained abstinence among adults who smoke Regularly?

BackgroundQuitting smoking is difficult and many people who smoke experience cessation fatigue (CF) as a result of multiple failed attempts. This study examined the association of CF with making and sustaining a smoking quit attempt. MethodsData analysed were 4,139 adults (aged 18 years or older) who smoked daily or weekly and participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Surveys (ITC 4CV) conducted in Australia, Canada, England, and the US. CF was assessed at baseline using a single question: “To what extent are you tired of trying to quit smoking?” with response options: “Not at all tired”; “Slightly tired”; “Moderately tired”; “Very tired”; or “Extremely tired”. We used binary logistic regression models to test the hypothesis that baseline CF would predict lower odds of both making a quit attempt and sustaining abstinence for a month or longer at follow-up adjusted for socio-demographic and smoking/vaping-related covariates. ResultsPersons who currently smoked and reported at least some CF were more likely to make a quit attempt, but less likely to sustain abstinence for at least one month, than those who reported no CF. These associations were independent of socio-demographic variables, and they did not differ by country. ConclusionContrary to expectation, CF was positively associated with making a quit attempt and non-linearly associated with lower rates of sustained abstinence at follow-up. While these findings should be replicated, they suggest that people with CF may benefit from targeted support to remain abstinent after a quit attempt.

The impact of tobacco tax increases on cost-minimising behaviours and subsequent smoking cessation in Australia: an analysis of the International Tobacco Control Policy Evaluation Project

ObjectiveWe examined the relationship in Australia from 2007 to 2020 between tobacco tax increases and use of cost-minimising behaviours (CMBs) when purchasing tobacco and: (1) tobacco expenditure and (2) smoking...

Predictors of quitting smoking behavior: evidence from Pakistan.

This study attempts to identify factors that significantly encourage the cessation of smoking in the context of Pakistan. The study distributes a modified questionnaire among 421 respondents (current as well as former smokers) in the capital city of Pakistan, Islamabad. The binary regression method was employed to data for analyzing predictors of making quit attempts and successful smoking cessation. The result indicates that respondents having strong intentions to quit, high socioeconomic status, low nicotine dependency, and past quit attempts, and those having no-smoking friends, are more likely to quit cigarette smoking successfully. On the other hand, factors like social pressure to quit smoking, religious information against smoking, intention to quit smoking, and public regulation on smoking are more likely to encourage smokers to make quit attempts. The study calls for community and school-wide smoking cessation campaigns involving officials, peers and parents, religious leaders, and other influential individuals to inform people about the dangers of smoking. In addition, religious leaders should be encouraged to issue rulings against smoking especially during "Friday Prayer." Furthermore, the government should pronounce more strict and comprehensive regulations on smoking by properly monitoring its implementation to encourage cessation of cigarette smoking.

Socio-demographic Characteristics Associated with Tobacco Consumption among Smokers Attended Ministry of Health Smoking Cessation Clinics in Jeddah, Saudi Arabia during 2018

Introduction: The World Health Organization (WHO) has identified tobacco smoking as a global epidemic, causing an estimated three million deaths annually. This study aims to examine the socio-demographic characteristics and smoking-related behaviours among individuals attending smoking cessation clinics in Jeddah during 2018. By identifying these factors, appropriate interventions can be developed to combat the smoking epidemic.
 Methods: The study enrolled All the clients who visited the Smoking Cessation Clinics in Jeddah from January 2018 to December 2018. Eligible participants were between 18 and 60 years old and agreed to take part in the study. Data on smoking status, medical history, previous attempts at quitting, and medication use were collected. Statistical analysis, including chi-square tests and p-values, were conducted to assess the associations between participants' medical history and smoking cessation attempts.
 Results: A total of 5869 participants were included in the study. The findings revealed that approximately one-fifth of the participants had previously attempted to quit smoking, while the majority (81.4%) had not made any cessation attempts. Among those who had made quit attempts, most had tried quitting between one to four times (16.5%). The duration of successful cessation reported by participants was generally short, with the majority (81.5%) not experiencing any extended period of quitting. Common reasons for relapse included cravings, social influences, mood changes, stress, and withdrawal symptoms.
 Conclusion: There was a significant association between male gender, age group over 51years, divorced marital status, intermediate educational levels, higher income levels, retired status, extreme BMI category, and previous attempts at smoking cessation. Healthcare providers and policymakers should consider these findings when developing and implementing smoking cessation programs. The insights gained from this research can contribute to the development of targeted interventions to reduce smoking rates and improve public health outcomes.

Unveiling the Tapestry of Tobacco Consumption: Exploring the Sociodemographic Factors Impacting Smokers at Smoking Cessation Clinics in Jeddah.

Background The World Health Organization (WHO) has identified tobacco smoking as a global epidemic, causing an estimated three million deaths annually. This study aims to examine the sociodemographic characteristics and smoking-related behaviors among individuals attending smoking cessation clinics in Jeddah during 2022. By identifying these factors, appropriate interventions can be developed to combat the smoking epidemic. Methodology The study enrolled male and female participants who visited the Smoking Cessation Clinics in Jeddah from January 2022 to December 2022. Eligible participants were between 18 and 60 years old and agreed to take part in the study. Data on smoking status, medical history, previous attempts at quitting, and medication use were collected. Statistical analysis, including chi-square tests and P-values, was conducted to assess the associations between participants' medical history and smoking cessation attempts. Results A total of 5,869 participants were included in the study. The findings revealed that approximately one-fifth of the participants had previously attempted to quit smoking, while the majority 4,780 (81.4%) had not made any cessation attempts. Among those who had made quit attempts, the majority had tried quitting between one and four times 968 (16.5%). The duration of successful cessation reported by participants was generally short, with the majority 4,781 (81.5%) not experiencing any extended period of quitting. Common reasons for relapse included cravings, social influences, mood changes, stress, and withdrawal symptoms. The study also found significant associations between specific medical conditions and smoking cessation attempts. Conclusions The study identified significant associations between male gender, older age group (51-60 years), divorced marital status, intermediate educational levels, higher income levels, retired status, extreme body mass index (BMI) categories, and previous attempts at smoking cessation. Healthcare providers and policymakers should consider these findings when developing and implementing smoking cessation programs. The insights gained from this research can contribute to the development of targeted interventions to reduce smoking rates and improve public health outcomes.

Influence of Anti-Substance Advertisements On Users

Smoking is considered a burning issue of today's time, especially due to its widespread use despite compelling proof of health hazards. Smoking has also significantly increased among youth in the past 10 years as they are more vulnerable to peer and societal pressure. Anti-smoking advertisements (e.g., print-based ads on cigarette packets, media ads on television, etc.) rely heavily on emotional reasoning to persuade people not to smoke. Still, the effect of anti-smoking advertisements on smokers is yet to be understood. Hence, this research aims to determine the influence of anti-smoking advertisements on smokers. To achieve this aim, our objectives assessed were the role of anti-smoking advertisements on quit attempts made in the past, reduction in smoking habits, and willingness of an individual to quit smoking. The cigarette was chosen as the substance for this study due to its popularity. The study findings revealed that over 64% of respondents who have made quit attempts in the past year believed that anti-smoking advertisements had played a crucial role in their quit attempts. A similar association was exhibited by the respondents who reduced smoking in the past year. While most smokers in the study revealed the role of anti-smoking advertisements in their smoking change habits, a section continues to smoke even after awareness of anti-smoking advertisements. The unequal pace of decline in smoking is shifting the focus towards the need to improve the effectiveness of anti-substance advertisements through innovation and technology, thus resulting in a higher reduction rate of substance use.

Determinants for tabacco cessation amongst smokers visiting tertiary health care centre in India.

In India, 92.4% of adults believe that smoking causes serious illness. However, only 55.4% of them are either willing or getting ready to quit. This indicates an explicit gap between perception and practice. This study aims to identify individual knowledge, attitude, practices, barriers and motivators for tobacco cessation amongst smokers. A cross-sectional study was carried out amongst the smokers visiting dental outpatient department at tertiary health care centre at Rohtak district of Haryana, India. A structured and validated questionnaire was developed to ascertain knowledge, attitude, practice and nicotine dependence amongst the tobacco smokers. Additionally information about their willingness to quit tobacco, barriers and motivators for tobacco cessation were obtained. The study population was broadly divided into two groups on the basis of any previous attempts made for quitting tobacco use. Among the sample of 371 smokers, 52.4% were found to make quit attempts while 47.6% never attempted to quit. Participants believed that smoking not only helps in socializing but also it is a good way to cope from the stress. Peer pressure was the major reason for initiation of habit of smoking. Those who have attempted to quit but could not do so for more than 6 months were more willing to quit. Concern for health and tobacco addiction was the major facilitator and barriers of tobacco cessation respectively. Comprehending the population before chalking down the tobacco cessation strategies is important. Lower education, higher alcohol consumption, longer duration of tobacco intake, cultural and social acceptability of tobacco use and nicotine dependence was the major roadblocks for tobacco cessation amongst the tobacco smokers. Cold turkey method was the most common choice of tobacco cessation who attempted to quit.

Tobacco Use: Quitting Plan, Attempts and Obstacles for Cessation- A Cross-Sectional Study from A Sub-Urban Neighbourhood of Chennai-Tamil Nadu

Introduction: Tobacco consumption is a preventable public health problem. GATS -2 survey in Tamil Nadu shows that 20% of adults use tobacco, 40% had plans to quit and 48% had made quit attempts. The purpose of the study was to assess factors associated with tobacco use; quitting plan, attempts and identify obstacles for to-bacco cessation. Methods: A Cross-sectional study was done among 300 tobacco users in a suburban neighbourhood of Chennai and data was analysed using SPSS software. Results: Ninety five percent were smokers and 86% smoked cigarettes. 70% knew that it causes cancer and res-piratory diseases. 60% planned to quit, 69% made quit attempts. Those with quit plans and health problems had an increased odds (AOR of 1.02 and 1.004 respectively) of making quit attempts. Advice from health profession-als (48%) and family (52%) triggered quit attempts. Stress and work pressure were obstacles for quitting (70%). Availability of therapy and professional help for tobacco cessation was known only to 49% and 14.7% respec-tively and none availed it. Conclusion: Awareness of health hazards of tobacco use was high. Quit attempts have increased but with high failure rates due to lack of information and access to tobacco cessation services. Provision of community and fa-cility-based tobacco cessation services and integration with existing health programmes is the present need.

Treating Smoking in Cancer Patients: An Essential Component of Cancer Care-The New National Cancer Institute Tobacco Control Monograph.

Continued smoking after the diagnosis of cancer can markedly worsen oncology treatment side effects, cancer outcomes, cancer mortality, and all-cause mortality. Conversely, mounting evidence demonstrates that smoking cessation by patients with cancer improves outcomes. A cancer diagnosis often serves as a teachable moment, characterized by high motivation to quit. However, too few patients with cancer who smoke are offered evidence-based smoking cessation treatment, and too few engage in such treatment. The National Cancer Institute commissioned Tobacco Control Monograph 23, Treating Smoking in Cancer Patients: An Essential Component of Cancer Care, to review and synthesize the evidence that clarifies the need to intervene with smoking in cancer care. Although many patients with newly diagnosed cancer who smoke make quit attempts, many of these are unsuccessful, and among those who successfully quit, relapse is common. Indeed, an estimated 12.2% of adults ever diagnosed with cancer reported they currently smoked (National Health Interview Survey, 2020). Patients with cancer who smoke are likely to benefit from smoking cessation treatments, including counseling and US Food and Drug Administration-approved medications, and there are many effective strategies to increase delivery of smoking cessation treatment in cancer care settings. Smoking cessation is among the most effective treatment options for improving the likelihood of survival, quality of life, and overall health of patients with cancer who smoke. It is important for cancer care clinicians and patients to realize that it is never too late to quit smoking and that there are clear benefits to doing so, regardless of cancer type.

Differences in cessation attempts and cessation methods by race/ethnicity among US adult smokers, 2016–2018

BackgroundAdvice to quit smoking and cessation patterns vary by race/ethnicity in the United States. This study aims to provide the up-to-date prevalence of quit advice, quit attempts and use of smoking cessation methods (particularly e-cigarettes) by race/ethnicity among US adult smokers. MethodsWe used data from Wave 4 (2016–2018) of the Population Assessment of Tobacco and Health (PATH) Study. Using past-12-month and current adult cigarette smokers (n = 9,272), we conducted multivariable models to examine the association between race/ethnicity and advice to quit and quit attempts. Further, using a subset of those who made quit attempts (n = 5,046), we examined the use of smoking cessation methods, including e-cigarettes, by race/ethnicity, controlling for associated factors. ResultsCompared to Non-Hispanic [NH] White smokers, Hispanic smokers were less likely to receive quit advice (aPR [95 % CI] = 0.88 [0.78, 1.00]), but more likely to make quit attempts (1.14 [1.06, 1.23]). NH Black smokers (vs. NH Whites) were more likely to receive quit advice (1.06 [1.00, 1.12]) and more likely to make quit attempts (1.22 [1.15, 1.29]). NH Black smokers (vs. NH Whites) were more likely to use behavioral treatment (e.g., counseling) (1.84 [1.22, 2.77]). Hispanic smokers were less likely to use e-cigarettes to quit smoking than Whites (0.48 [0.33, 0.71]) and use pharmacotherapy (0.62 [0.44, 0.88]). ConclusionsWe found different patterns in cessation attempts and cessation methods by race/ethnicity among US adult smokers. Efforts to eliminate disparities must increase access and use of proven cessation therapies for these groups.

E-cigarette use among high school students in the United States prior to the COVID-19 pandemic: Trends, correlates, and sources of acquisition

Detailed description of the prevalence and sources of e-cigarettes among youth is needed to inform effective regulatory policies. We used the Youth Risk Behavior Surveillance System data (2015–2019) to assess trends in current (past-30-day-use) and frequent (≥10 days in past-30-days) e-cigarette use among United States high schoolers before the COVID-19 pandemic. First, we assessed trends overall and then stratified by participants’ sociodemographic characteristics, use of other tobacco products, and experiences of psychosocial stress. We also evaluated past year quit attempts and the changing sources of e-cigarettes.Our sample size was 41,021 (15,356–2015; 12,873–2017; 12,792–2019). The prevalence of current e-cigarette use increased from 24.0% (95%CI:21.9%–26.3%) in 2015 to 32.7% (30.4%–35.1%) in 2019. The proportion of current users who reported frequent use also increased significantly from 22.6% (20.4%–24.8%) to 45.4% (42.7%–48.2%). Thus, an increasing proportion of US high school students who use e-cigarettes reported frequent use, indicating greater nicotine dependence. The increase in current and frequent e-cigarette use was more pronounced in youth who reported other substance use and psychosocial stressors such as bullying. Between 2017 and 2019, there was a decline in the proportion of youth who bought e-cigarettes online (6.9% to 3.2%) or from convenience stores (22.0% to 16.6%). Conversely, there was an increase in the proportion who borrowed (34.5% to 40.1%) or purchased e-cigarettes through other people (10.7% to 18.0%), indicating that most youth are evading age-related restrictions by obtaining e-cigarettes from other people. Finally, a considerable proportion of youth tobacco users are making quit attempts; 47.6% (45.1%–50.1%) in 2019.

Quit intention and smoking cessation behavior of current smokers aged 15 years and above in China, 2018

Objective: To describe the current situation on quit intention and quit attempts among current smokers aged 15 years and above in China and explore the main factors affecting their smoking cessation behaviors. Methods: The subjects were people aged 15 years and above in China. A stratified multi-phased randomized cluster sampling method was used. The survey covered 200 districts/counties in 31 provinces (autonomous regions and municipalities directly under the central government), including 19 376 people under investigation. The data were weighted with SAS 9.4 for complex sampling analysis, and the frequency and weighted component ratio were used for description. The influencing factors were studied using the Rao Scott χ2 test and unconditional multivariate logistic regression. Results: Among current smokers, 6.63% reported that they planned to quit smoking in the next month, 5.44% for men and 8.49% for women. 17.96% of the current smokers made quit attempts in the past 12 months, with 17.80% men and 22.15% women. People who smoke occasionally (OR=3.42, 95%CI: 2.09-5.59) made quit attempts in the past (OR=4.91, 95%CI: 0.33-0.52) and knew that smoking would lead to three diseases (OR=2.24, 95%CI: 1.48-3.40) had higher quit intention. People who occasionally smoke (OR=1.68, 95%CI: 1.20-2.34) received smoking cessation suggestions from medical staff (OR=1.96, 95%CI: 1.62-2.37), were a ware of that smoking causes three diseases (OR=1.63, 95%CI: 1.32-2.02) and had smoking prohibition regulations in indoor areas of their homes, had a higher rate of quit attempts. Conclusion: Providing effective smoking cessation intervention services and creating a supportive tobacco control environment are significant in promoting smoking cessation behavior.

Smoking cessation behaviors and reasons for use of electronic cigarettes and heated tobacco products among Romanian adults

We report cessation behaviors, reasons for use of electronic cigarettes (EC) and heated tobacco products (HTP) and association of their use with quit attempts and smoking intensity using Romania Global Adult Tobacco Survey 2018. Weighted estimates of EC and HTP by cigarette smoking (CS) status were assessed. Quit attempts, intention to quit, reasons for lack of intention to quit among current CS, and reasons for current use of EC and HTP were estimated. The association of ‘ever use’ of EC and HTP with cigarette smoking intensity and quit attempts was explored using binary logistic regression. Of the total 4571 surveyed, 1243 (27.3%) were current CS, 300 (24.4%) made quit attempts in the past 12 months. Only 38 (12.5%) and 26 (8.6%) had used EC and HTP as an aid to quit. Among current CS, 512 (41.2%) had no intention to quit. Reasons for this were, ‘enjoy smoking’ (86.1%), ‘reduce stress’ (65.9%), and ‘staying alert’ (46.3%). Awareness and use of EC and HTP were significantly higher among current CS. ‘Dual use’ of EC and HTP with CS was manifolds higher than stand-alone use. Reasons for current use of EC and HTP were ‘enjoyment’, and ‘use in places where smoking was prohibited’.

The Predictive Utility of Valuing the Future for Smoking Cessation: Findings from the ITC 4 Country Surveys.

Background: Delay discounting (DD) and time perspective (TP) are conceptually related constructs that are theorized as important determinants of the pursuit of future outcomes over present inclinations. This study explores their predictive relationships for smoking cessation. Methods: 5006 daily smokers at a baseline wave provided 6710 paired observations of quitting activity between two waves. Data are from the International Tobacco Control (ITC) smoking and vaping surveys with samples from the USA, Canada, England, and Australia, across three waves conducted in 2016, 2018 and 2020. Smokers were assessed for TP and DD, plus smoking-specific predictors at one wave of cessation outcomes defined as either making a quit attempt and/or success among those who tried to quit which was ascertained at the subsequent survey wave. Results: TP and DD were essentially uncorrelated. TP predicted making quit attempts, both on its own and controlling for other potential predictors but was negatively associated with quit success. By contrast, DD was not related to making quit attempts, but high DD predicted relapse. The presence of financial stress at baseline resulted in some moderation of effects. Conclusions: Understanding the mechanisms of action of TP and DD can advance our understanding of, and ability to enhance, goal-directed behavioural change. TP appears to contribute to future intention formation, but not necessarily practical thought of how to achieve goals. DD is more likely an index of capacity to effectively generate competing future possibilities in response to immediate gratification.

A multicentric survey among patients with substance use disorders during the COVID-19 lockdown in India.

Background:The unprecedented first wave of the COVID-19 pandemic severely impacted mental health services globally. However, the negative impact of such disruptions on people with substance use disorders (SUD) seeking treatment remains unclear. We aim to explore the behaviors adopted by these individuals to overcome the service disruptions.Materials and Methods:We explored the changes related to substance use behavior (quit attempts, withdrawal experienced, treatment-seeking, and risky behaviors), and behavioral changes in response to COVID-19 lockdown. A cross-sectional survey was conducted among 404 people with SUD seeking treatment from seven centers across India. They were assessed by a specially designed structured questionnaire during the first wave (June–September) of the pandemic.Results:An overwhelming majority experienced withdrawal symptoms, with close to half making quit attempts and seeking treatment during the lockdown. Three-fourth of the sample reported difficulty in accessing treatment services and medications. Patients with opioid use were significantly more likely to think about quitting (χ2 = 20.408, P = 0.000), make attempts (χ2 = 12.436, P = 0.000), seek treatment (χ2 = 7.536, P = 0.006), and self-medicate for withdrawal symptoms (χ2 = 5.885, P = 0.015). In turn, those with alcohol use were more likely to use telepsychiatry services (χ2 = 35.143, P = 0.000) and experience stigma by family members (χ2 = 29.951, P = 0.000) and neighbors (χ2 = 17.725, P = 0.000). Among COVID-19 safety precautions, majority practised wearing masks and social distancing but not others.Conclusion:COVID-19 lockdown led a significant proportion of substance users, especially opioid users, to make quit attempts and seek help. However, these could not be sustained due to difficulty in accessing treatment services. Further, significant proportion failed to adhere to COVID-19 safety precautions.

Homeless women's perspectives on smoking and smoking cessation programs: A qualitative study.

Individuals who are unsheltered or experiencing homelessness are more likely to smoke than those in the general population and have a higher prevalence of tobacco-related illnesses. Those who are unhoused make quit attempts at rates similar to the general population, however rates of successful quitting are much lower. Women bear a higher burden of smoking-related diseases and are less successful in their cessation efforts than men. Despite these increased risks and challenges, cessation programs specifically designed to meet the needs of women experiencing homelessness are extremely rare. To examine perceptions of smoking cessation programs among women who are unstably housed, we conducted in-depth, semi-structured interviews with twenty-nine women experiencing homelessness or unstable housing who had histories of tobacco and substance use. Interviews explored the social context of smoking, as well as interest in, barriers to, and facilitators of quitting. We used a grounded theory approach to analyze the transcripts. Participants reported a number of structural barriers to cessation. They reported obstacles to participating in existing cessation programs, including chronic stress related to experiences of being unsheltered and fear of being exposed to neighborhood violence. These conditions were paired with a strong need to self-isolate in order to maintain personal safety, which runs counter to traditional group-based cessation programs. A dissonance exists between current smoking cessation programs and the needs of women who are unsheltered or unstably housed. Alternative cessation treatment delivery models that address extremely high levels of chronic stress violence, and avoidance of group settings are needed, as are programs that provide options for safe participation.

Smoking Cessation Prevalence and Inequalities in the United States: 2014-2019.

Smoking is a leading cause of premature death and health inequities in the United States. We estimated cross-sectional prevalence of smoking cessation indicators among US adult recent smokers (n = 43602) overall and by sociodemographic subgroups in the Current Population Survey Tobacco Use Supplement 2014-2015 and 2018-2019 timepoints. Respondents reported past-year quit smoking interest, attempts, sustained (successful) cessation for 6 or more months and use of e-cigarettes or behavioral or pharmacological cessation treatments to quit smoking. Past-year quit smoking attempts declined slightly from 2014-2015 (52.9%) to 2018-2019 (51.3%) overall. Quit interest (pooled = 77.1%) and sustained cessation (pooled = 7.5%) did not change across timepoints. Among smokers making past-year quit attempts, 34.4% reported using cessation treatments in 2018-2019, and using e-cigarettes to quit smoking declined from 2014-2015 (33.3%) to 2018-2019 (25.0%). Several non-White (vs White) racial and ethnic groups had higher prevalence of quit interest and attempts but lower prevalence of sustained cessation or using e-cigarettes or treatments to quit. Income, education, employment, and metropolitan residence were positively associated with sustained cessation. Sociodemographic inequalities in sustained cessation and most other outcomes did not change across timepoints. Although about half of US adult smokers made past-year quit attempts from 2014 to 2019, only 7.5% reported sustained cessation, and most who made quit attempts did not report using cessation treatments. Sociodemographic inequalities in cessation were pervasive and not entirely correspondent with sociodemographic variation in motivation to quit. Smoking cessation prevalence and inequalities did not improve from 2014 to 2019. Encouraging quit attempts and equitable access to smoking cessation aids are public health priorities.

Age-Related Interactions on Key Theoretical Determinants of Smoking Cessation: Findings from the ITC Four Country Smoking and Vaping Surveys (2016-2020).

This paper explores whether plans to quit, wanting to quit, and quit efficacy add predictive value over measures of habit strength and dependence in making quit attempts and/or attaining smoking abstinence. We used three waves of the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey conducted in 2016, 2018, and 2020. Baseline daily smokers (N = 6710) who provided data for at least one wave-to-wave transition (W1 to W2, N = 3511 or W2 to W3, N = 3199) and provided outcome data at the next wave (follow-up) formed the analytic sample. Generalized estimating equations (GEE) logistic regression analyses examined predictors of quit attempts and abstinence at follow-up (1- and 6-month sustained abstinence). Wanting and planning to quit were significantly positively associated with making quit attempts, but negatively associated with smoking abstinence. A significant interaction between the Heaviness of Smoking Index and age warranted an age-stratified analysis for both abstinence outcomes. Lower HSI predicted abstinence in only the younger smokers Motivation and plans to quit were positively associated with abstinence in younger smokers, but surprisingly were negatively associated with abstinence in older smokers. Quit efficacy was associated with abstinence in the older, but not the younger smokers. Models of smoking abstinence are significantly improved by including motivational predictors of smoking. Age was an important moderator of the association between abstinence for both dependence and motivational variables. The findings from this large cohort study indicate there are age-related differences in predictors of smoking abstinence but not quit attempts. These associations may reflect differential experiences of older and younger cohorts of smokers, which may have implications for interventions to motivate and assist smokers in quitting.

Implementing a Tobacco Cessation Program for Pregnant Women in an Antenatal Care Setting: A Mixed Methods Study

Background: Tobacco use during pregnancy has deleterious effects on the woman and child. Many pregnant women make quit attempts but few are successful. Antenatal Care (ANC) services create an opportunity to identify tobacco users and provide cessation services. The aim of the study was to assess the feasibility of implementing LifeFirst tobacco cessation services for pregnant women attending ANC clinic. Methods: We used mixed methods study design. All pregnant women attending ANC services during one year were screened verbally for tobacco use. Current tobacco users (last 30 days) registered voluntarily for LifeFirst and a detailed first session was conducted. Telephonic follow-up sessions were conducted over six months. An in-depth interview was conducted with the counselor to identify the influencing factors. Results: Of the 1431 pregnant women screened, 41 were current tobacco users (40 used smokeless) and all enrolled for the service. 56% of them were highly dependent (Fagerstrom score) and 35(85%) had never made a quit attempt. At the end of the intervention, 48% were lost to follow-up mostly due to change in contact phone numbers. All the remaining women self-reported that they had stopped using tobacco. ANC clinic setting and a female counsellor were considered as facilitators. Loss to follow-up, non-implementation of guidelines to screen and offer brief advice and the resultant late tobacco use screening acted as barriers. Social myths added to these complications. Conclusion: Integration of tobacco cessation with ANC services is feasible. Creating awareness about ill-effects of tobacco during pregnancy and providing cessation support is required. Integration through trainings will provide additional benefit.

Tobacco and marijuana co-use in a cohort of young adults: Patterns, correlates and reasons for co-use

BackgroundAs marijuana is legalized in more states, modes of administration that facilitate co-use with tobacco are growing in popularity among young adults. This study examines the prevalence, patterns, correlates, and reasons for co-use so that targeted interventions can be developed to prevent negative consequences associated with tobacco use and co-use. MethodsIn Fall 2019, 1887 young adults, originally recruited in 2010 from 11 colleges in North Carolina and Virginia to participate in a cohort study, completed an online survey. Co-use was defined as self-reported use of marijuana and tobacco in the past month. Tobacco-only, marijuana-only and co-users were compared using regression modeling. ResultsOverall, 9.3% of the sample were co-users, 7.1% tobacco-only, and 15.8% marijuana-only users. Tobacco use was associated with an increased likelihood of marijuana use and vice-versa. Co-users were more likely to use e-cigarettes and blunts to administer marijuana and less likely to use smokeless tobacco products. They were more likely to use cocaine, have less anxiety, and be heavier marijuana users than marijuana-only users. Co-users of e-cigarettes and marijuana were less likely to be daily e-cigarette users and make quit attempts than e-cigarette users that did not use marijuana. Experimentation was the primary reason for co-use of tobacco and marijuana. ConclusionsCo-users were more likely to use modes of administration that facilitate use of both substances and have patterns of use that may impact cessation efforts. These findings highlight the importance of surveillance of co-use and the development of interventions targeting experimentation with these substances by young adults.