Quit Aid Research Articles

The Role of Nicotine Dependence in E-Cigarettes' Potential for Smoking Reduction.

E-cigarettes (Electronic Nicotine Delivery Systems, or ENDS) are an increasingly popular tobacco product among youth. Some evidence suggests that e-cigarettes may be effective for harm reduction and smoking cessation, although these claims remain controversial. Little is known about how nicotine dependence may contribute to e-cigarettes' effectiveness in reducing or quitting conventional smoking. A cohort of young adults were surveyed over 4 years (approximately ages 19-23). Varying-coefficient models (VCMs) were used to examine the relationship between e-cigarette use and conventional smoking frequency, and how this relationship varies across users with different nicotine dependence levels. Lifetime, but not recent, e-cigarette use was associated with less frequent concurrent smoking of conventional cigarettes among those with high levels of nicotine dependence. However, nondependent e-cigarette users smoked conventional cigarettes slightly more frequently than those who had never used e-cigarettes. Nearly half of ever e-cigarette users reported using them to quit smoking at the last measurement wave. For those who used e-cigarettes in a cessation attempt, the frequency of e-cigarette use was not associated with reductions in future conventional smoking frequency. These findings offer possible support that e-cigarettes may act as a smoking reduction method among highly nicotine-dependent young adult cigarette smokers. However, the opposite was found in non-dependent smokers, suggesting that e-cigarette use should be discouraged among novice tobacco users. Additionally, although a substantial proportion of young adults used e-cigarettes to help them quit smoking, these self-initiated quit attempts with e-cigarettes were not associated with future smoking reduction or cessation. This study offers potential support for e-cigarettes as a smoking reduction tool among highly nicotine-dependent young adult conventional smokers, although the extent and nature of this remains unclear. The use of e-cigarettes as a quit aid was not associated with reductions in conventional smoking, consistent with most other quit aids in this sample except for nicotine replacement therapy, which was only effective for the most dependent smokers. Notably, these findings highlight the necessity of accounting for smokers' nicotine dependence levels when examining tobacco use patterns.

Tobacco Harm Reduction with Vaporised Nicotine (THRiVe): The Study Protocol of an Uncontrolled Feasibility Study of Novel Nicotine Replacement Products among People Living with HIV Who Smoke.

Smoking is a leading cause of morbidity and premature mortality among people living with HIV (PLHIV), who have high rates of tobacco smoking. Vaporised nicotine products (VNPs) are growing in popularity as a quit aid and harm reduction tool. However, little is known about their acceptability and use among PLHIV. Using a pragmatic, uncontrolled, mixed methods design this exploratory clinical trial aims to examine the feasibility of conducting a powered randomised clinical trial of VNPs as a smoking cessation and harm reduction intervention among vulnerable populations, such as PLHIV who smoke tobacco. Convenience sampling and snowball methods will be used to recruit participants (N = 30) who will receive two VNPs and up to 12 weeks’ supply of nicotine e-liquid to use in a quit attempt. Surveys will be completed at weeks 0 (baseline), 4, 8, 12 (end of treatment) and 24 (end of the study) and qualitative interviews at weeks 0 and 12. As far as we are aware, this feasibility study is the first to trial VNPs among PLHIV for smoking cessation. If feasible and effective, this intervention could offer a new approach to reducing the high burden of tobacco-related disease among PLHIV and other vulnerable populations.

Predictors of Continued Smoking and Interest in Cessation Among Older Female Smokers.

Older female smokers are highly vulnerable, yet little is known about their attitudes, beliefs, and behaviors regarding smoking cessation. Southeast region Women's Health Initiative participants identified as smokers on at least one prior assessment were surveyed in 2012 regarding current tobacco use. Most of these current and former smokers ( N = 409, 63% response) were non-Hispanic White (81.7%) and had some college (80%), with mean age of 75.1 years. Current smoking was confirmed by 56%, and while 61% of these reported a past-year quit attempt, less than half used quit aids. Of current smokers, 57.5% intended to quit within 6 months (26.6% within 30 days), and 68% were interested in joining a cessation study. Older female smokers were highly motivated to quit, yet profoundly underutilized proven quit aids. Results support high acceptability of cessation interventions for this undertreated population.

Perceptions of emerging tobacco products and nicotine replacement therapy among pregnant women and women planning a pregnancy.

The increasing availability of emerging non-combusted tobacco products (snus, dissolvables, and electronic nicotine delivery systems or ENDS) may have implications for pregnant women and women of reproductive age. We conducted 15 focus groups to explore how women perceive emerging non-combusted tobacco products and nicotine replacement therapy (NRT) in general, and during pregnancy. Sessions were held in 2013 in four U.S. cities. Participants were 18–40 years old and were pregnant smokers, pregnant quitters, or smokers planning a pregnancy. Responses were coded and analyzed to identify key themes using NVivo 10.0 qualitative software (QSR).Several themes emerged from focus groups. Participants generally found snus unappealing, but viewed dissolvables as a discreet and stigma-free way to use tobacco during pregnancy. Participants perceived NRT as ineffective and having undesired side effects. ENDS were thought to offer advantages over cigarettes, including use in smoke-free areas, lower cost, appealing flavors, and fewer health effects, and were seen by some as a potential quit aid. Some participants, however, worried that the lack of natural stopping point could lead to excessive use. Many participants felt that the use of any tobacco or NRT product is harmful during pregnancy.Women seeking to reduce health risks or stigma related to smoking during pregnancy may perceive advantages of using some emerging products over cigarettes. These findings can inform future public health efforts to reduce risks associated with tobacco product use among women of reproductive age.

Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm.

E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs. An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function. An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco (18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks. Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches.

Associations with E-cigarette use among Asian American and Pacific Islander young adults in California.

With attention to the rapidly growing market of electronic nicotine delivery systems (ENDS/e-cigarettes) and the fastest growing US ethnic minority group, the current study explored associations between awareness, perceived risks, and use of ENDS among Asian American and Pacific Islander (AAPI) young adults.AAPI young adults (ages 18–25) in California were recruited via social media, college classes, listservs for AAPI-serving non-profits, and snowball sampling to complete an anonymous survey between 2014 and 2015.The sample (N = 501) was 57% women, 15% LGBTQIA; with a mean age of 21; 26% foreign-born; identifying as Filipino (29%), Chinese (24%), Vietnamese (14%), mixed-AAPI heritage (13%), or 21% other. Nearly half the sample (44%) reported ever ENDS use; 11% were current users. Current ENDS use was twofold greater for: Filipino and Vietnamese compared to Chinese respondents; men versus women; LGBTQIA-identified respondents; those vocationally trained; and employed. Awareness of ENDS from peers/friends was most common and was associated with ever though not current ENDS use. Most respondents perceived ENDS as harmful (62%); low compared to high risk perception was associated with a three-fold greater likelihood of ever use and six-fold greater likelihood of current use. Popular flavors were fruit (49%, e.g., lychee, taro) and candy/sweets (26%). Current users viewed ENDS as a healthier alternative or quit aid for conventional cigarettes (42%); recreation/social use (33%) also was common.Findings indicate ENDS visibility among AAPI young adults in California with affinity for flavors and many engaging in trial and current use for harm reduction and recreational/social aims.

Consumer preferences for electronic cigarettes: results from a discrete choice experiment

IntroductionE-cigarettes present a formidable challenge to regulators given their variety and the rapidly evolving nicotine market. The current study sought to examine the influence of e-cigarette product characteristics on consumer...

Smoking among U.S. Hispanic/Latino adults: the Hispanic community health study/study of Latinos.

Prior national surveys capture smoking behaviors of the aggregated U.S. Hispanic/Latino population, possibly obscuring subgroup variation. To describe cigarette use among Hispanic/Latino adults across subgroups of age, gender, national background, SES, birthplace, and degree of acculturation to the dominant U.S. culture. A cross-sectional survey of 16,322 participants in the Hispanic Community Health Study/Study of Latinos aged 18-74 years, recruited in Bronx NY, Chicago IL, Miami FL, and San Diego CA, was conducted during 2008-2011. Prevalence of current smoking was highest among Puerto Ricans (men, 35.0%; women, 32.6%) and Cubans (men, 31.3%; women, 21.9%), with particularly high smoking intensity noted among Cubans as measured by pack-years and cigarettes/day. Dominicans had the lowest smoking prevalence (men, 11.0%; women, 11.7%). Individuals of other national backgrounds had a smoking prevalence that was intermediate between these groups, and typically higher among men than women. Non-daily smoking was common, particularly although not exclusively among young men of Mexican background. Persons of low SES were more likely to smoke, less likely to have quit smoking, and less frequently used over-the-counter quit aids compared to those with higher income and education levels. Smoking was more common among individuals who were born in the U.S. and had a higher level of acculturation to the dominant U.S. culture, particularly among women. Smoking behaviors vary widely across Hispanic/Latino groups in the U.S., with a high prevalence of smoking among population subgroups with specific, readily identifiable characteristics.

Beliefs and Experimentation with Electronic Cigarettes

Previous cross-sectional studies found that positive beliefs about electronic nicotine delivery systems (commonly known as electronic cigarettes or e-cigarettes) were associated with use of these products. However, the prospective association between these beliefs and subsequent use of e-cigarettes is unclear. To identify the beliefs predicting subsequent use of e-cigarettes. A total of 1379 young adults (mean age=24.1 years) from the Minnesota Adolescent Community Cohort who reported never using e-cigarettes at baseline (collected Oct 2010-Mar 2011) and completed follow-up data collection (during Oct 2011-Mar 2012) were included in this analysis. Participants' beliefs about e-cigarettes (potential as quit aids, harmfulness and addictiveness relative to cigarettes) were asked at baseline (yes/no). At follow-up, participants were asked if they had ever used e-cigarettes. Logistic regression models were used to assess the associations between beliefs about e-cigarettes and subsequent experimentation. Analysis was conducted in 2012. At follow-up, 7.4% of the sample reported ever using e-cigarettes (21.6% among baseline current smokers, 11.9% among baseline former smokers, and 2.9% among baseline nonsmokers). Participants who believed e-cigarettes can help people quit smoking and perceived e-cigarettes to be less harmful than cigarettes at baseline were more likely to report experimenting with e-cigarettes at follow-up (p<0.05). These associations did not differ by smoking status. Given that young adults are still developing their tobacco use behaviors, informing them about the lack of evidence to support e-cigarettes as quit aids and the unknown health risk of e-cigarettes may deter young adults from trying these products.

Young adult former ever smokers: The role of type of smoker, quit attempts, quit aids, attitudes/beliefs, and demographics

ObjectiveYoung adults who smoke are often nondaily users who either quit or transition into dependent smokers. Further, this age group often has been considered an extension of the adult population. This study aims to examine young adult former ever smokers to understand factors associated with their stopping smoking. MethodTelephone interviews were conducted in 2010 with 4401 young adults in Florida. We examined the association between former ever smokers and sociodemographics, smoking behavior, quit attempts, quit aids, and attitudes/beliefs about smoking. ResultsThirty-seven percent of young adults were former smokers, 20% were current smokers, and 43% were never smokers. Former smokers were more likely to be female, situational smokers (compared to occasional or established), more likely to have stopped smoking without acknowledging making a quit attempt, less likely to have used a quit aid, and less likely to display pro-tobacco attitudes/beliefs. ConclusionYoung adult former and current smokers have unique patterns of smoking and stopping smoking. Young adults may require novel intervention techniques to promote prevention and cessation based on these unique smoking patterns. Future research is needed to understand motivations to quit smoking among young adults.

Awareness, perceptions and use of snus among young adults from the upper Midwest region of the USA

BackgroundSince its introduction in 2006, snus has been aggressively marketed by tobacco companies. However, little is known about the awareness, perceptions and use of snus among young adults after Camel...

Young Adults’ Favorable Perceptions of Snus, Dissolvable Tobacco Products, and Electronic Cigarettes: Findings From a Focus Group Study

We explored young adults' perceptions of snus (spitless moist snuff packed in porous bags), dissolvable tobacco products, and electronic cigarettes and intention to try these products. We conducted 11 focus group discussions involving a total of 66 young adults (18-26 years old) on these new tobacco products (e.g., harmfulness, potential as quit aids, intention to try) held between July and December 2010. We analyzed discussions using a thematic approach. Participants generally reported positive perceptions of the new products, particularly because they came in flavors. Few negative perceptions were reported. Although some participants believed these products were less harmful than cigarettes and helpful in quitting smoking, others thought the opposite, particularly regarding electronic cigarettes. Participants also commented that these products could be gateways to cigarette smoking. Half of the participants, including a mix of smokers and nonsmokers, admitted they would try these products if offered by a friend. Young adults perceive the new tobacco products positively and are willing to experiment with them. Eliminating flavors in these products may reduce young adults' intentions to try these products.

Smoking, smoking cessation and smoking relapse patterns: a web-based survey of current and former smokers in the US

The aim of this study was to characterise the natural course of smoking cessation behaviour in a web-based survey of current and former cigarette smokers (CS and FS) in the United States. A web-based survey of CS and FS was conducted in April 2009; demographic and socioeconomic characteristics and smoking history (including the number of lifetime and length of latest quit attempts, aids used and time to relapse) were collated. The surveyed cohort was selected from prescreened CS and FS panellists and matched for age, race and education, to be representative of the US population. Descriptive statistics and time-to-event analyses using Kaplan-Meier curves were applied in the analysis of this report. The final cohort comprised 512 CS and 566 FS (n = 1078). A larger proportion of FS than CS reported a longest smoke-free period of > 1 year (78.8% vs. 22.4%, respectively). As a greater variety of smoking cessation products became available over time, the proportion of unassisted quit attempts decreased from 76.1% prior to 1983 to 43.9% after 2006 for CS and from 79.3% to 50.3% for FS. The cumulative proportion of subjects relapsing was 31.3% by 1 week and 79.3% by 6 months. The estimated median time to next quit attempt was approximately 360 days. These data confirm that relapse is common and that as the variety of cessation modalities increase, the proportion of unassisted quit attempts decreases. Self-help or cold-turkey methods still provide significant alternatives even when pharmacotherapy is available. This study provides data related to the smoking history and smoking cessation patterns of a large, nationally representative sample of CS and FS.

Planned quit attempts among Ontario smokers: impact on abstinence

To examine the use and role of planned quit attempts by smokers and their impact on abstinence. Retrospective, using longitudinal data from the Ontario Tobacco Survey. Ontario, Canada. A total of 551 adult smokers who reported having made a quit attempt during 2007-08. Reported planning of the most recent quit attempt (i.e. unplanned or planned some time in advance), engaging in preparatory behaviours believed to be related to planning (i.e. use of quit aids such as pharmacotherapy, formal support or health professionals) and abstinence at 1 week and 1 month following the attempt. Of the smokers, 73.6% planned their quit attempt in advance. Reported planning was more likely among those who thought they were very addicted, compared with those who were less addicted [odds ratio (OR)=2.22, 95% confidence interval (CI): 1.15-4.28]. Smokers who planned a quit attempt were much more likely to use a quit aid (OR=3.50, 95% CI: 1.80-6.79), particularly pharmacotherapy (OR=6.13, 95% CI: 3.05-12.34). The odds of abstaining for 1 week were lower among those who planned (OR=0.45, 95% CI: 0.22-0.89), independent of perceived addiction. No significant difference was observed for abstinence lasting 1 month. Other factors associated with abstinence were smoking fewer cigarettes per day and having personal support. Although most quit attempts were planned and planners had higher odds of using quit aids, planning did not increase the likelihood of success.

Racial/ethnic differences in menthol cigarette smoking, population quit ratios and utilization of evidence‐based tobacco cessation treatments

This study examines the relationship between menthol cigarette smoking and the population quit ratio and whether menthol smokers differ in utilization of evidence-based smoking cessation aids among a nationally representative sample of US adult smokers. Secondary data analysis of cross-sectional data from the 2005 National Health Interview Survey (NHIS) Cancer Control Supplement. The NHIS is a nationally representative survey of US households conducted annually. The main outcome variables of interest were (1) the population quit ratio and (2) use of smoking quit aids. All analyses were conducted using SAS version 9.2 with SUDAAN, which corrects for the complex sampling design of the study. Univariate analyses were used to determine variables that differed significantly by menthol status and utilization of types of quit aids. Multiple logistic regression analysis modeled the relationship between menthol smoking status, demographic characteristics and smoking-related characteristics on the population quit ratio and utilization of quit aids. We observed significant differences in the population quit ratio for menthol versus non-menthol among African American smokers (34% versus 49%, P < 0.001), but not among whites (52% versus 50%). In multiple logistic regression analysis, there was a significant interaction between race and menthol smoking status. African American menthol smokers were significantly less likely than white non-menthol smokers to have quit smoking (adjusted odds ratio: 0.72, 95% confidence interval: 0.53, 0.97) after controlling for age group, sex, marital status, region and average number of cigarettes smoked per day. Menthol smoking status was not associated with differences in utilization of quit aids. African Americans have the highest rates of menthol cigarette smoking of all racial and ethnic groups in the United States. Menthol cigarette smoking is associated negatively with successful smoking cessation among African Americans.

Use of mentholated cigarettes: what can we learn from national data sets?

Use of mentholated cigarettes: what can we learn from national data sets?

Immunophenotype similarity and high frequency of co-existence of columnar cell lesions, lobular neoplasia, and low grade DCIS with invasive tubular carcinoma and invasive lobular carcinoma

The increasing availability of emerging non-combusted tobacco products (snus, dissolvables, and electronic nicotine delivery systems or ENDS) may have implications for pregnant women and women of reproductive age. We conducted 15 focus groups to explore how women perceive emerging non-combusted tobacco products and nicotine replacement therapy (NRT) in general, and during pregnancy. Sessions were held in 2013 in four U.S. cities. Participants were 18–40 years old and were pregnant smokers, pregnant quitters, or smokers planning a pregnancy. Responses were coded and analyzed to identify key themes using NVivo 10.0 qualitative software (QSR).Several themes emerged from focus groups. Participants generally found snus unappealing, but viewed dissolvables as a discreet and stigma-free way to use tobacco during pregnancy. Participants perceived NRT as ineffective and having undesired side effects. ENDS were thought to offer advantages over cigarettes, including use in smoke-free areas, lower cost, appealing flavors, and fewer health effects, and were seen by some as a potential quit aid. Some participants, however, worried that the lack of natural stopping point could lead to excessive use. Many participants felt that the use of any tobacco or NRT product is harmful during pregnancy.Women seeking to reduce health risks or stigma related to smoking during pregnancy may perceive advantages of using some emerging products over cigarettes. These findings can inform future public health efforts to reduce risks associated with tobacco product use among women of reproductive age.

Effectiveness of Hospital-Based Smoking Cessation

Smoking cessation for current smokers is a health-care imperative. It is not clear which approaches to smoking cessation are the most effective in the hospital setting and which factors predict long-term abstinence. We hypothesized that a hospital-based smoking cessation program involving behavioral modification and support would provide an effective intervention for smoking cessation. Prospective cohort study. Smoking cessation clinics in a tertiary referral, cardiothoracic hospital. Two hundred forty-three smokers and 187 never-smoker control subjects. Smokers underwent specific sessions of individual counseling on behavioral modification, including written information, advice about quit aids, and support during the quit attempt. Abstinence was confirmed by exhaled carbon monoxide measurements. Compared to never-smoker control subjects, smokers were more likely to have grown up with a smoking father or siblings, and to currently live or socialize with other smokers. Two hundred sixteen smokers attended at least two sessions of the smoking cessation program. Of these, 25% were unavailable for follow-up at 12 months and were assumed to be smoking. The point prevalence abstinence rate at 12 months was 32%. Independent factors associated with abstinence at 12 months were self-belief in quitting ability, having a heart condition, growing up without siblings who smoked, and increasing number of pack-years. This prospective study has demonstrated that this hospital-based smoking cessation program was as effective as programs in other settings. Social and psychological factors were associated with a greater chance of abstinence.

Frequency of Physician-Directed Assistance for Smoking Cessation in Patients Receiving Cessation Medications

Little is known about current physician-patient interactions regarding smoking cessation when a prescription is given for cessation medications. We identified 1360 health plan members who were smokers and had filled prescriptions for bupropion hydrochloride or nicotine replacement products from March 26, 2002, through April 8, 2003. These members were surveyed 3 months after the order was filled to learn about the physician encounter that produced these prescriptions and the role of the physician in selecting the medication, supporting cessation, and achieving desirable outcomes. Among the 1035 eligible complete responses (adjusted response rate, 78%), only 36.4% reported being asked to set a specific quit date; 25.3%, to use cessation counseling; and 23.3%, to have any type of follow-up. The only physician action associated with the use of the medication was asking to set a quit date (90.7% vs 83.5%; P = .001) and no action was significantly associated with cessation. Smokers with tobacco-related chronic conditions were more likely to report physician influence but less likely to report receiving information on using the quit aid (60.6% vs 66.5%; P = .048) or being asked to set a quit date (31.7% vs 41.4%; P = .001). Despite the evidence-based guideline recommendations for more support for cessation, physician support actions for those receiving prescriptions appear to be relatively infrequent and to have little influence on the use of medication by smokers or on their smoking cessation. Other environmental changes may be needed to facilitate more thorough support.

Aids to Quitting Tobacco Use: How Important Are They Outside Controlled Trials?

Background. Although there is good evidence that several pharmacotherapies and counseling can effectively facilitate smoking cessation, there is little information about the use or effectiveness of these or any other quit aids outside of controlled trials.Methods. A mailed survey with phone follow-up documented the use of various quit aids among 3,122 health plan members who smoke. A multilevel statistical modeling technique controlled for potentially confounding variables.Results. Nearly half (1,513) of these smokers reported a quit attempt during the preceding 6 months. Although 1,036 (33.2%) reported using some type of aid to quitting, primarily nicotine products or bupropion, 10–26% of these “users” did not report an actual quit attempt. Ninety percent of the medication users had a personal cost, averaging $53–$87. Fully 26.9% of those reporting a quit without any type of aid quit for at least 7 days. This rate equals that of users of all types of aids except for nicotine patches and bupropion, both of which had associated 7 or more day quit rates of about 46% (95% CI 39.3–52.2).Conclusions. Pharmacotherapeutic quit aids are being widely used, even in the absence of significant insurance coverage.