Quit Attempts Research Articles

Effectiveness of the Offer of the Smoke Free Smartphone App Compared With No Intervention for Smoking Cessation: Pragmatic Randomized Controlled Trial.

Digital technologies offer the potential for low-cost, scalable delivery of interventions to promote smoking cessation. We aimed to evaluate the effectiveness of the offer of Smoke Free-an evidence-informed, widely used app-for smoking cessation versus no support. In this 2-arm randomized controlled trial, 3143 motivated adult smokers were recruited online between August 2020 and April 2021 and randomized to receive an offer of the Smoke Free app plus follow-up (intervention arm) versus follow-up only (comparator arm). Both groups were shown a brief message at the end of the baseline questionnaire encouraging them to make a quit attempt. The primary outcome was self-reported 6-month continuous abstinence assessed 7 months after randomization. Secondary outcomes included quit attempts in the first month post randomization, 3-month continuous abstinence assessed at 4 months, and 6-month continuous abstinence at 7 months among those who made a quit attempt. The primary analysis was performed on an intention-to-treat (ITT) analysis basis. Sensitivity analyses included (1) restricting the intervention group to those who took up the offer of the app, (2) using complete cases, and (3) using multiple imputation. The effective follow-up rate for 7 months was 41.9%. The primary analysis showed no evidence of a benefit of the intervention on rates of 6-month continuous abstinence (intervention 6.8% vs comparator 7.0%; relative risk 0.97, 95% CI 0.75-1.26). Analyses of all secondary outcomes also showed no evidence of a benefit. Similar results were observed on complete cases and using multiple imputation. When the intervention group was restricted to those who took up the offer of the app (n=395, 25.3%), participants in the intervention group were 80% more likely to report 6-month continuous abstinence (12.7% vs 7.0%; relative risk 1.80, 95% CI 1.30-2.45). Equivalent subgroup analyses produced similar results on the secondary outcomes. These differences persisted after adjustment for key baseline characteristics. Among motivated smokers provided with very brief advice to quit, the offer of the Smoke Free app did not have a detectable benefit for cessation compared with follow-up only. However, the app increased quit rates when smokers randomized to receive the app downloaded it. ISRCTN ISRCTN85785540; https://www.isrctn.com/ISRCTN85785540. RR2-https://onlinelibrary.wiley.com/doi/full/10.1111/add.14652.

Prevalence and characteristics of smokers interested in using virtual reality for encouraging smoking cessation: a representative population survey in Great Britain

Abstract Background Cigarette smoking is one of the leading causes of morbidity in the world. Virtual reality (VR) has been used to encourage and support quit attempts. However, interest in VR may differ according to sociodemographic characteristics. This study aimed to estimate the proportion and associated characteristics of smokers in Great Britain who were interested in using VR for smoking cessation. Methods Data were collected from 6,858 adults between February to April 2023, from the Smoking Toolkit Study—a monthly, nationally representative, cross-sectional survey of adults in Great Britain. Of these, 873 were smokers (unweighted). Prevalence of interest was assessed descriptively and associations between interest and sociodemographic and smoking characteristics were analysed with weighted logistic regression models. Results Of 905 (weighted) smokers, 34.6% (95% Confidence Interval (CI):31.0%-38.5%) were interested in using VR for smoking cessation. Smokers had greater odds of reporting interest in VR for smoking cessation who were: highly motivated to quit (Odds Ratio (OR):2.41, 95% CI:1.59–3.65), had made a quit attempt in the past year (OR:1.95, 95% CI:1.37–2.77), currently trying to cut down (OR:1.90, 95% CI:1.34–2.67) and interested in VR generally (OR:10.42, 95% CI:6.97–15.57). Those ≥ 65 years old (OR:0.29, 95% CI:0.15–0.57) and women (OR:0.69, 95% CI:0.49–0.97) were less likely to report interest. Conclusions The results of this study indicate that up to a third of adult smokers may be interested in using VR to support a quit attempt. However, the potential reach of a VR smoking cessation intervention may be lower in certain subgroups such as women, adults 65 years or older, and adults less motivated to quit. From a health equity perspective, it is recommended that non-digital but effective interventions should be made readily available for adults at risk of digital exclusion due to lack of interest. However, as VR grows in popularity and its technological potential becomes fully realised, future research could also focus on strategies to reduce digital exclusion and increase interest. For example, by involving these subgroups in co-design activities and using novel dissemination strategies.

Factors Related to Tobacco Cessation Attempts Among Turkish Adolescents: A Structural Equation Model Analysis.

The Turkish Global Youth Tobacco Survey (GYTS) 2017 revealed that 17.9% of students aged 13-15 used tobacco products and 7.7% smoked cigarettes. Given the high prevalence of smoking, it is important to evaluate the factors associated with quit attempts among adolescents. This study aimed to identify the factors associated with Turkish adolescents' attempts to quit smoking using Structural Equation Model (SEM) analyses. This study utilized the data from GYTS 2017, which is a cross-sectional, nationally representative, schoolbased study carried out below 18-year-olds. The study population (n = 18 985) consisted of students who had smoked cigarettes within the past year. After excluding inconsistent responses, 9735 students remained for the analysis. The outcome was an attempt to quit smoking within the past year. Structural Equation Model (SEM) was used for data analysis. The model had good fit (CFI = 0.917, TLI = 0.900, RMSEA = 0.032). Of the 9735 students, 66.4% were male. In the past 12 months, 56.3% (95%CI: 55.3%-57.3%) of smokers attempted to quit. Exposure to anti-tobacco policies (β = 0.114. P < .001) had positive direct effects, whereas sociodemographic factors (β = -0.086. P < .001), nicotine dependency (β = -0.037. P = .008) and exposure to second-hand smoke (β = -0.051. P < .001) had negative direct effects on quit attempts. More than half of the smokers attempted to quit, and nicotine dependence predicted quit attempts. Exposure to secondhand smoke decreased cessation attempts. Anti-tobacco policies such as sale restrictions and warnings of the dangers of tobacco products should be given high priority and enforced fully since they are the strongest predictors of quit attempts.

An Exploration of the Barriers and Facilitators Shaping Vaping Cessation Among Australian Young Adults

This study of 18–24-year-old young adults (YAs) in Australia who use, or used to use, nicotine vape products (NVPs) sought to explore their experiences when attempting to quit vaping to understand the barriers and identify facilitators of cessation. We analysed data from a survey (n = 532) of 422 YAs who vape and 110 YAs who used to vape, as well as interactive workshops (n = 12) and semi-structured interviews (n = 3), which included 7 YAs using and 8 no longer using NVPs. Social Cognitive Theory informed the data collection, with open-ended questions exploring how personal, environmental and behavioural factors shaped vaping cessation. Qualitative analyses revealed 11 themes shaping vaping cessation, including the normalisation of vaping, easy access and a desire to fit in. Vaping cessation was complicated by using NVPs to manage symptoms of mental ill-health. Additionally, former vapers reported using combustibles to replace vaping, highlighting the risk of health impacts from smoking. Potential support sources included friends and general practitioners, or family doctors. Support service development must consider de-normalising vaping, addressing underlying mental health issues and providing effective campaigns around the health risks of vaping and smoking. The findings highlight the need to invest in vaping cessation, and they can inform the design of vaping cessation programs to better support those trying to quit and ensure the success of their quit attempts.

Change in vaping, smoking and dual-use identities predicts quit success and cigarette usage: A prospective study of people quitting smoking with electronic cigarette support.

Electronic cigarettes (ECs) are an efficacious support for some but not all people wishing to stop using tobacco. While advice and practical support have been identified as increasing quit success, little research has explored the role of changes in smoking and EC-related social identities. A prospective study following 573 people attempting to quit smoking with EC support. Self-report measures of identification with being a smoker, non-smoker, vaper and dual user (people using ECs and tobacco products) were taken prior to the quit attempt and at a 12-week follow-up. Baseline identifications with being a smoker, non-smoker or dual user were not associated with smoking outcomes. Baseline vaper identity baseline was linked to more frequent tobacco abstinence at follow-up and lower levels of cigarette smoking. Levels of social identification at follow-up were consistently linked with outcomes, with vaper identity and non-smoking identities being protective and dual user identity being related to lower abstinence rates but decreased tobacco usage. Changes in identity over time were the most consistent predictor of outcomes. Findings have implications for smoking cessation practice, informing how and when identity-based interventions may be effective and our understanding of how identity transitions occur.

Examination of a hope- and fear-based message targeting older adults who smoke: A randomized trial

Older adults who smoke are half as likely to make a quit attempt, but more likely to maintain abstinence using evidence-based treatments. Awareness of the increased risk of dementia among people who currently smoke may motivate cessation in this population, but messages have not been tested. 820 adults who smoke, ages 50–80, with no history of dementia completed an online survey examining one of three randomly assigned messages (Control N = 266, Fear N = 274, Hope N = 280) on motivation and intentions to quit. Fear and Hope messages were based on the link between smoking and dementia. Fear increased motivation to quit [t(813) = 2.818, p = 0.005] more than Control. Hope did not differ from Control [t(813) = 1.908, p = 0.057] or Fear [t(813) = 0.937, p = 0.349] in change in motivation to quit. There were no differences between messages in change in intention to quit, F(2, 817) = 0.825, p = 0.439. Future work should examine feasibility and acceptability of fear-based motivational messages on quitting success.

Use, perceptions, and effectiveness of e-cigarettes for smoking cessation among older adults in England: a population study, 2014–2024

BackgroundThis study aimed to characterise patterns of tobacco smoking and vaping among older adults (≥ 65 years) in England, to explore harm perceptions of e-cigarettes among those who smoke, and to estimate the real-world effectiveness of e-cigarettes for helping older adults to stop smoking.MethodsData were collected as part of a representative monthly cross-sectional household survey in England between April 2014 and April 2024 (n = 197,219). We analysed differences between older (≥ 65 years) and younger/middle-aged adults (18–64 years) in (a) time trends in tobacco smoking and vaping, (b) harm perceptions of e-cigarettes vs. cigarettes (adjusting for gender, socioeconomic position, and vaping status), and (c) the real-world effectiveness of e-cigarettes for smoking cessation (adjusting for gender, socioeconomic position, characteristics of the quit attempt, and use of other evidence-based cessation aids).ResultsTobacco smoking prevalence remained relatively unchanged over time among older adults (at ~ 9%; 9.5% [8.5–10.6%] in April 2014 and 8.7% [7.7–9.8%] in April 2024) but vaping prevalence increased (from 2.1% [1.6–2.7%] to 3.7% [3.0–4.6%], respectively). These trends differed from those observed among younger/middle-aged adults, among whom there was a clear decline in smoking (from 21.8% [21.0–22.7%] to 18.2% [17.3–19.0%]) and a larger increase in vaping (from 5.6% [5.2–6.1%] to 16.2% [15.3–17.0%]). Older adults were consistently less likely than younger/middle-aged adults to use e-cigarettes to support attempts to quit smoking (26.8% [17.2–39.3%] vs. 43.7% [39.6–48.0%] in April 2024). Older smokers reported greater uncertainty about the harms of e-cigarettes compared with cigarettes (ORadj = 2.48 [2.28–2.69]). E-cigarettes appeared to be effective for helping older adults to stop smoking (ORadj = 1.50 [0.96–2.34]); whether effectiveness was lower than for younger/middle-aged adults was inconclusive.ConclusionsOver the past decade, smoking prevalence has remained stable among older adults while decreasing among the rest of the adult population in England. Older adults are more unsure about the relative harms of e-cigarettes and less likely to use them to support attempts to quit smoking, despite evidence that they are effective for smoking cessation in this population.

Regional and social disparities in cessation behavior and motivation to quit among U.S. adult current smokers, Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey 2014-15 and 2018-19.

Variation in smoking cessation behaviors and motivators across the United States may contribute to health disparities. This study investigates regional differences over time in two key cessation motivators (quit interest and doctor's advice to quit) and two cessation behaviors (past-year quit attempts and recent successful cessation) across diverse demographic factors. Data were analyzed from two releases of the Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey (TUS-CPS) for the years 2014-15 and 2018-19. The analysis included sex, age, race and ethnicity, education, marital status, employment status, and household income. Findings from 2018 to 2019 TUS-CPS revealed that quit interest was highest in the Northeast and lowest in the Midwest, while doctor's advice to quit was most prevalent in the Northeast and least in the West. Past-year quit attempts were most common in the Northeast and least in the South. Recent successful cessation (defined as quitting for 6 to 12 months) was highest in the Northeast and Midwest, with the South showing the lowest rates. Compared to the 2014-15 survey, 14 demographic groups (7 in the Midwest, 6 in the South, and 1 in the West) showed decreases in both quit interest and actions to quit. Notably, the Asian non-Hispanic group in the Northeast experienced a significant decrease in quit interest (-17.9%) but an increase in recent successful cessation (+369.2%). Overall, the study indicates that while quit interest was highest in the West, the South exhibited the lowest rates of quit attempts and successful cessation. Significant differences were also noted between age groups. These findings highlight the need for further research into cessation behaviors at more granular levels to inform policies aimed at reducing smoking-related health disparities among populations facing the greatest challenges in cessation.

Tobacco use and readiness to treat tobacco users among primary healthcare professionals in Soweto.

Despite its hampering influence on the willingness of healthcare professionals (HCPs) to implement tobacco cessation treatments, the tobacco use status of these professionals remains understudied in South Africa. This cross-sectional study, which sampled 444 HCPs, was conducted in five community health centres in Soweto. A self-administered questionnaire collected information on socio-demography, tobacco use, quit attempts and readiness to implement tobacco cessation treatments for their patients. The mean age was 41 years. Most were female, 80% (n= 355); single, 54.1% (n= 240) and black professionals, 91.6% (n= 405). About 22% (n= 96) were ever-users of tobacco, 12.6% (n= 56) current users and 9% (n= 40) ex-users. About 56.6% (n= 30) of current users had contemplated quitting in the past year. Approximately 68% (n= 300) and 82.2% (n= 365) of respondents were ready and willing to implement tobacco cessation treatments, respectively. Only 32% (n= 143) of respondents had received any training on tobacco use and cessation treatments. There was no significant association between tobacco use and readiness to implement cessation treatments (p= 0.50). Tobacco use is prevalent among HCPs and does not influence the implementation of cessation treatments in South African primary health care. Although most reported readiness and willingness to quit tobacco use, more training is required in both formal education and continued professional development.Contribution:This study demonstrates the alarming rate of tobacco product use among primary health care professionals in South Africa. While there is a strong willingness to implement tobacco cessation treatments for their patients, most healthcare professionals still require training to enhance their self-efficacy.

Understanding smoking cessation process in Tunisia from 2020 to 2023: description of quit attempts

Abstract Background Many smokers attempt multiple cessation methods before seeking specialist intervention. This study aims to describe these prior cessation attempts and identify relapse factors to enhance support for these individuals. Methods Data from 440 patients consulting the Department of Epidemiology Statistics at Abderrahman Mami Hospital from 2020 to 2023 were analyzed. It included information on previous quit attempts, methods used, longest duration of abstinence, number of attempts, reaction to cessation, and reasons for relapse. Statistical description was conducted using IBM SPSS 25. Results Among participants, More than half of the smokers had previously attempted to quit smoking 63,4%, with an average of 2 attempts ± 1,7 (0-10 attempts) per patient. The majority of patients (86.8%) quit smoking without using substitution methods. Among those who resorted to substitution, nicotine replacement therapy was the most frequently used method (n = 30; 6.8%). The longest duration of abstinence averaged 8 years. The main reaction to smoking cessation among patients was an improvement in their health (9,1%). The most common reasons for relapse were psychosocial problems (5.5%), followed by relapses during social events (4.3%), and withdrawal symptoms (3%). Conclusions This study emphasizes the importance of considering each patient’s journey during their smoking cessation process. Analyzing these factors will enable better management of the cessation program with the patient, as well as a deeper understanding of their feedback regarding our program, ensuring long-term cessation success. Key messages • Failed spontaneous quit attempts prior to NRT initiation are prevalent among smoking patients. • Understanding failed spontaneous cessation attempts can guide the development of more effective strategies.

Level of tobacco dependence and beliefs towards heated tobacco products

Abstract Nicotine dependence affects not only behaviors related directly to smoking, quit attempts or looking for alternative products but also beliefs about smoking. We sought to assess whether the level of tobacco dependence is associated with beliefs and feelings towards heated tobacco products (HTP) and to assess the relationship between tobacco dependence and the motivators to quit HTP use. Random population sample of Polish citizens aged 18+ years, former smokers, current HTP users was recruited. Tobacco dependence was assessed using 5 question; participants were classified into two groups of tobacco dependence (low or high) using a two-stage cluster analysis. An extensive questionnaire on beliefs on HTP use was administered. The χ2 test and logistic regression were used. There were 2,500 participants (62.6% women) of median age=36 years (Q1=29, Q3=45). The median number of years of smoking was 10 (Q1=5, Q3=15) and median number of years of HTP use was 2 (Q1=1, Q3=3). High tobacco dependence was found in 958 (38,3%) participants. Compared to low dependence, high tobacco dependence was related with feeling of strong need for HTP use (69.7% vs. 47.6%, p &amp;lt; 0,001). High level of tobacco dependence was positively related to perceived social pressure against smoking (72.9% vs. 44.9%, p &amp;lt; 0,001), but it did not differentiate perceived social pressure against HTP use. Compared to low tobacco dependence, participants with high tobacco dependence more often indicated fear of illness OR = 1,73 95%CI=1,46-2,07, own resolution OR = 1,32 95%CI =1,12-1,55 and price OR = 1,34 95%CI=1,13-1,59 as possible motivators to quit HTP use. Level of tobacco dependence in former smokers shaped beliefs and feelings towards HTP use. High tobacco dependence contributed to strong need to use HTP and also increased perception of social pressure against smoking, but not against using HTP. It also increased the importance of fear of illness, price and one’s own resolution as motivators to quit HTP use. Key messages • High level of tobacco dependence in former smokers results in stronger perceived social pressure against smoking but not against HTP use. • High tobacco dependence in former smokers is related with stronger need to use HTP.

Quitting with pride: Differences in smoking behaviour across sexual identity groups in Ireland

Abstract Background As smoking prevalence reduces, smoking inequalities across population groups is emerging as a key challenge. Despite recognition of specific needs among members of the Lesbian, Gay, Bisexual, Transexual Plus (LGBT+) community, differences in smoking across sexual identity groups is uncharted in Ireland and the community is not represented in tobacco policy agenda setting. This study aimed to measure and compare the prevalence of smoking, quitting intention and quitting behaviour across sexual identify groups in Ireland. Methods Secondary analysis of the 2023 “Healthy Ireland” cross sectional survey of health status was conducted (n = 7,411). For the first time, this survey included a question on self-reported sexual identify, along with standard questions on smoking prevalence, quitting intention and quitting behaviour. Prevalence of smoking, quitting intention and quitting behaviour were calculated with 95% Confidence Intervals (CI) and compared across groups with Chi Square tests. Results In total, 2.3% (95% CI 2.0-2.7%) of respondents reported an LGB+ identity. Compared to those reporting straight identity, LGB+ respondents reported higher smoking prevalence (17.6% versus 21.4% respectively); intention to quit was similar across groups, however, LBG+ respondents also reported a higher prevalence of making at least one quit attempt in the previous 12 months (51.3% versus 78.0% respectively, p &amp;lt; 0.0001). Conclusions While this study highlighted tobacco-use as a health challenge for the LGB+ community in Ireland, it also identified an opportunity for tailored stop smoking approaches to support quit success. As a consequence, an innovative Fulbright-sponsored policy dialogue was convened between leaders in tobacco control, LGBT+ community leaders, health services and academia across Ireland and the USA to explore solutions, underlining the important role equity stratifiers and population surveillance play in agenda setting for public health. Key messages • Including sexual identity in the national population health survey enabled tobacco-use needs across sexual identity groups in Ireland delineated for the first time. • Equity-stratified population health surveillance informed a policy dialogue to better represent needs of LGBT+ community in public health agenda setting.

Tradition to Concern: Health Risks and Nicotine Dependence of Midwakh Use in Young Males in the UAE

Abstract Background Midwakh smoking, a traditional practice, poses a growing public health concern in the Middle East region. Despite global efforts to curb tobacco use, smoking rates, particularly among young men, remain high. This study explores nicotine dependency, assesses acute health effects, and measures carbon monoxide levels among midwakh smokers. Methods A quasi-experimental before-and-after study involved 103 young male midwakh smokers in the UAE. Data collection included surveys featuring the Hooked-on Nicotine checklist (HONC), clinical measurements, and pre/post-smoking saliva samples. Statistical analyses, including descriptive, paired samples, correlation, and regression, assessed associations between midwakh smoking, dependency, and health outcomes. Results Preliminary findings found that 33% of midwakh smokers were under 21 years, 68% had below undergrad education, and household incomes over 15,000 AED monthly. Smoking initiation was as early as 10 years. Smoking habits revealed 37% exclusive midwakh, 54% midwakh with e-cigarettes, 21% with shisha, and 34% with cigarettes. Post-smoking clinical measurements showed significant increases in blood pressure, heart, pulse and respiratory rates, and carbon monoxide levels (p ≤ 0.05). Significant differences in pre- (134.6 ng/ml) and post-smoking (154.4 ng/ml) saliva cotinine levels (p ≤ 0.05) were observed. Regression analysis identified predictors of nicotine dependency: initiation age (β= -.315; -0.579,0.0512), household income (β = 1.221; 0.297,2.146), multiple tobacco use (β = 0.576; 0.129,1.024), quit attempts (β = 1.555; 0.519,2.590) and smoking risk perception (β = 3.420; 1.950,4.890) Conclusions Midwakh smoking adversely affects clinical measurements, with early start correlating with higher nicotine dependency, worsened by using multiple tobacco products. Urgent action is needed, including tailored prevention campaigns and support systems to aid youth cessation and raise awareness of midwakh smoking’s harmful effects. Key messages • Midwakh smoking is deeply ingrained in UAE tradition but poses significant adverse health outcomes and nicotine dependency. • There is a need to establish specialized cessation programs offering support and resources to midwakh users, addressing both the health consequences and addictive nature of midwakh.

Discrete Choice Experiment on Financial Incentives for Engaging Young Adults in Vaping Cessation Programs

Introduction Contingency management involves rewarding individuals based on objective evidence of behavioral changes. This study explores preferences for financial incentives in vaping cessation programs. Methods A discrete choice experiment (DCE) was conducted among young adult current e-cigarette users aged 19-29. DCE attributes (and levels) included reward amount ($100, $300), reward schedule (consistent value, escalating value), reward procedure (gain-framed, loss-framed), vaping education modules (yes, no), text messaging support (yes, no), and cost ($30, $100). Participants were randomized into one of the four blocks, each containing four choice sets. Each choice set presented two hypothetical vaping cessation programs. Choice data (n × choice sets × alternative programs = 154 × 4 × 2 = 1,232 observations) were analyzed using generalized estimation equation models. Results Participants showed a preference for vaping cessation programs offering a higher reward amount (odds ratio [OR] = 11.5; 95% CI,7.0-19.2), gain-framed rewards for sustained abstinence (OR = 1.4; 95% CI,1.0-1.8), text messaging support (OR = 1.9; 95% CI,1.4-2.5), and a lower program cost (OR = 2.6; 95% CI,1.8-3.8). Interaction tests showed significant effects of the rewards procedure among daily e-cigarette users (adjusted OR [AOR] = 2.1; 95% CI,1.3-3.5), but not some-day users; and among those with no quit attempts in the past six months (AOR = 2.7; 95% CI,1.5-4.7), but not those with previous quit attempts. Female participants preferred text messaging support (AOR = 3.6; 95% CI,2.3-5.4), whereas male participants did not show this preference. Conclusion A multifaceted vaping cessation intervention augmented with financial incentives might improve participation and engagement among young adults. Future studies should investigate how these attributes can enhance program reach and vaping abstinence outcomes in real-world settings.

Sociodemographic inequalities in smoking cessation: a population survey from Flanders, Belgium

Abstract Background Flanders’ decline in daily tobacco use will not reach the aim of a 5% prevalence by 2040. A faster reduction necessitates, especially among low-educated and socially vulnerable groups, as in these groups the decline goes slower. Towards future smoking cessation interventions within these specific target groups, this study examined prevalence and sociodemographic inequalities in different indicators of smoking cessation in Flanders. Methods Data from the 2022 Prevention Barometer, a probability-based survey from Flanders, were used (N = 4011, 18+). Prevalence in ever smokers was calculated overall and by age, sex, educational attainment, making ends meet and employment status. Daily smokers reported their past-year quit smoking attempts, upcoming-year quit smoking intentions and intentions to use cessation aids. Former smokers reported successful cessation and use of cessation aids. Multivariate logistic regressions, including all demographic variables, aimed to uncover inequalities. Results Quit smoking attempts in daily smokers (26.5%) were lower for low education (vs. middle and high education). Quit smoking intentions in daily smokers (41.0%) were lower for low vs. middle and low vs. high education. Daily smokers had lower intentions to use cessation aids (48.5%) when having difficulties in making ends meet. Among ever smokers, being older, having high education (vs. middle and low education), having no difficulties in making ends meet and being retired (vs. working and not working) was associated with higher odds for successful quitting (73.2%). Among former smokers, people being retired (vs. working and not working) had higher odds of using cessation aids (15.3%). Conclusions Low educated daily smokers are less likely to quit smoking. Former smokers limitedly use cessation aids to quit smoking and the use varies regarding one’s sociodemographic profile. Encouraging quit attempts and equitable access to cessation aids are public health priorities. Key messages • Low-educated smokers in Flanders face barriers in quitting, highlighting the need for targeted cessation support. • Socioeconomic disparities impact cessation aid utilization, underlining the importance of equitable access to aid for all demographics.

Factors influencing smoking cessation: Insights from Singapore's nationwide health and lifestyle survey.

Singapore has implemented an evidence-based smoking cessation framework to support smokers in quitting. Our study investigated the prevalence and correlates of (1) quit attempts (QA) and quit intentions (QI) among current smokers, and (2) smoking cessation (SC) among ever-smokers in Singapore. Data was collected from a nationwide survey conducted between 2020 and 2022. QA was defined as attempting to stop smoking at least once in the past 12 months, while QI was defined as planning to quit smoking within the next 30 days or the next 6 months. SC referred to individuals who quit smoking over 6 months ago. Sociodemographic factors, doctor's advice to quit and perceived harm from smoking were assessed using logistic regression among current smokers (n=1024) and ever-smokers (n=1457). Among current smokers, 31.3% and 41.2% reported QI and QA, respectively. Smokers with secondary or pre-tertiary education were less likely to report QI compared to those with a degree or higher. Doctor's advice to quit was associated with a higher likelihood of QA. Among ever-smokers, 25.3% reported SC, and this was more likely when they perceived smoking 1 or more packs of cigarettes daily as posing a moderate or high health risk. Educational campaigns should focus on simplifying messages for individuals with lower literacy levels. Smoking cessation training can be incorporated into medical education, and graphic health warnings on cigarette packs can help effectively communicate the dangers of smoking.

Wanting to be "accepted and heard": Perspectives about cessation messages from LGBTQ+ individuals who dual use cigarettes and e-cigarettes.

Dual use of cigarettes and e-cigarettes is especially prevalent among lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) adults in the US. This is concerning as health risks of dual use may be as high or higher than exclusive smoking. We sought to learn about people who dual use and identify as LGBTQ+'s perspectives about dual use, quitting, and cessation ads. Nineteen LGBTQ+ adults who dual use participated in virtual semi-structured interviews in North Carolina in 2022. We asked about perceptions of smoking and vaping in LGBTQ+ communities, their thoughts about quitting, and their opinions on four cessation ads. The ads advocated quitting one or both products. Transcripts were coded using ATLAS.ti and reviewed using a thematic content analysis approach. Participants described how within LGBTQ+ communities, smoking and vaping are common and accepted and are used to cope or to socialize. Most participants made past quit attempts. Many said they were not ready to quit both products, but some were open to quitting smoking. Some thought e-cigarettes may be as harmful as cigarettes, reducing their motivation to quit smoking cigarettes due to the lack of perceived health benefits. Participants sought cessation ads that explicitly address dual use and are representative and supportive. They disliked ads that felt stereotypical or patronizing. Dual use in LGBTQ+ communities appears driven by both internal and external pressures. Participants were generally open to quitting cigarettes, and LGBTQ+ smoking cessation may be best encouraged with authentic ads that explicitly address both products. These qualitative findings about smoking and vaping among LGBTQ+ individuals provide guidance for communication ad campaign design to help reduce the high dual use rates among LGBTQ+ young adults.

Combining Default Choices and an Encounter Decision Aid to Improve Tobacco Cessation in Primary Care Patients: A Pragmatic, Cluster-Randomized Trial.

Primary care providers (PCPs) prescribe less often treatments for smoking cessation than for other major risk factors. We assessed the effect of training PCPs to offer smoking cessation treatments to current smokers as the default choice using an encounter decision aid (DA) on smoking cessation. Pragmatic, cluster-randomized controlled trial with PCPs in private practice in Switzerland and France. The intervention was a half-day course teaching PCPs the default choice approach using a DA. Control PCPs received a 1-h refresher training on smoking cessation aids. PCPs recruited daily smokers seen for routine care. The primary outcome was self-reported, 7-day, point prevalence smoking abstinence at 6 months. Secondary outcomes were quit attempts and use of smoking cessation aids at 3 weeks, 3 months, and 6 months, and a patient-reported measure of shared decision-making (CollaboRATE scale 1-10, higher scores = more involvement). Forty-two PCPs completed the training (76% Swiss) and recruited 287 current smokers (105 intervention group, 182 control group), with 51% women, mean age 48 (SD, 2.6), 77% who smoked <20 cigarettes/day, and 221 who responded at 6 months follow-up (77%). The intervention did not affect self-reported smoking abstinence rate at 6 months (9.5% intervention and 10.4% control groups, respectively; OR 0.88 (95%CI 0.37-2.10). It did however increase the number of quit attempts at 3 weeks (OR 2.09, 95%CI 1.04-4.20) and the use of smoking cessation aids at the 3-week and 3-month follow-ups (OR 2.57, 95%CI 1.21-5.45 and OR 2.00, 95%CI 1.11-3.60, respectively). The mean CollaboRATE score was 8.05/10 in the intervention group and 7.28/10 in the control group (p=0.02), reflecting more patient involvement in decision-making. Training PCPs to use a decision aid did not improve smoking abstinence rate, despite short-term increases in quit attempts and use of smoking cessation aids. It improved patient involvement in decision-making. ClinicalTrials.gov identifier: NCT04868474.

Home environment and cigarette quitting behaviors among rural Black/African American women caregivers.

This cross-sectional study described the home tobacco environment and its association with quitting behaviors among Black/African American women caregivers who smoke cigarettes and live in rural, low-resourced areas. A baseline survey was administered to caregivers enrolled in a randomized trial from 2020 to 2022 (n = 147). Logistic regressions identified the associations between the independent variables (home cigarette smoking bans, caregiver restrictions on child cigarette access, number of people in the home who smoked around the caregiver during the past week, and who smoked in the caregiver's home) and three outcome variables: lifetime quit attempt, past-year quit attempt and use of evidence-based cessation strategies during a last quit attempt. Caregivers have multiple generations of family smoking in their homes, including caregivers' children/nieces/nephews (21%) and their parents (36%). Young family members smoking in the home was related to the caregiver's parents (p = .046) and grandparents (p = .03) smoking in the home. The number of people smoking around the caregiver was associated with lower odds of a lifetime quit attempt (odds ratio, OR = 0.63, confidence interval, CI [0.47, 0.85]; adjusted OR = 0.61, CI [0.45, 0.84]). No independent variables were significantly related to past-year quit attempts in unadjusted or adjusted models. Caregivers with young family members smoking in the home were more likely to have used evidence-based cessation strategies versus those without young family smoking (OR = 16.96, CI [1.01, 283.68]). Black/African women caregivers who smoke and live in rural, low-resourced areas are exposed to numerous family members smoking in their homes which may affect quitting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A randomized controlled trial evaluation of a smoking cessation and physical activity intervention delivered via telemedicine in the Norton Sound region of Alaska

ObjectivesTobacco use disproportionately affects Alaska Native people. Physical activity may aid quitting smoking and provides health benefits. We tested telemedicine-delivered heart health interventions in Alaska’s Norton Sound region. MethodsAlaska Native adults (N = 299, 51.5 % male, 60.5 % Inupiaq) with hypertension and/or hypercholesterolemia who smoked daily were randomized to intervention on smoking and physical activity (group 1) or traditional diet and medication adherence (group 2). Intention to change was not required for participation. Stage-tailored mailed workbooks and personalized reports were supported by telehealth counseling at baseline, 3, 6, and 12 months. Study outcomes were assessed at baseline, 3-, 6-, 12-, and 18-months (i.e., 6-months after the final counseling session). Smoking outcomes were self-reported 7-day point prevalence abstinence (7d-PPA),11Abbreviations:7d-PPA: 7-day point prevalence abstinenceMET: Metabolic equivalent of taskMVPA: Moderate-to-vigorous physical activityNRT: Nicotine replacement therapy. bioconfirmed with urine anabasine; 24-hour quit attempts; and 50 % reduction in smoking. Self-reported physical activity outcomes were metabolic equivalent of task (MET) minutes and meeting moderate-to-vigorous physical activity (MVPA) guidelines. ResultsAt baseline, participants averaged 12.4 (SD = 10.0) cigarettes/day, with 19.4 % prepared to quit smoking, and 81.6 % meeting MVPA guidelines. During the study, most (70.2 % group 1; 63.5 % group 2) reported a 24-hr quit attempt (p = 0.219), and Group 1 (53.6 %) was more likely than Group 2 (28.4 %) to use nicotine replacement therapy (NRT), OR = 2.92, p < 0.001. At 18-months, 40.5 % (group 1) and 32.5 % (group 2) had reduced their smoking by half or more (p = 0.343), and 10.8 % vs. 7.9 % (group 1 vs. 2) reported 7d-PPA with 4 % vs. 6 % (group 1 vs. 2) bioconfirmed. Time and baseline stage of change predicted 7d-PPA (p’s≤.015), with no group effect (p = 0.325). Activity levels did not significantly differ by group or time. ConclusionsTelemedicine counseling supported NRT use but did not significantly affect behavioral outcomes.