Quit Attempts Research Articles

Effects of in vivo NRT sampling on smoking abstinence and NRT adherence: A randomized clinical trial

BackgroundNicotine replacement therapy (NRT) is an effective treatment but is associated with poor adherence during smoking cessation attempts. This study aimed to determine if In Vivo Sampling, an experiential intervention that includes sampling of NRT in-session, increases NRT adherence and smoking abstinence compared to standard smoking cessation behavioral counseling. MethodsEligible participants were under community corrections supervision and smoked five or more cigarettes per day for the past year. Participants were randomly assigned to receive either In Vivo Sampling or standard smoking cessation behavioral counseling. Both interventions involved four 30-minute sessions and received 12 weeks of combination NRT. Self-reported NRT adherence, quit attempts, and carbon monoxide (CO)-verified smoking cessation were measured at one, three-, and six-months post-intervention. ResultsFrom 2017–2022, 515 participants were enrolled and randomized. The In Vivo Sampling group had significantly greater mean adherence to patch and lozenge NRT regimens (71 % vs. 60 %, OR: 1.63, 95 % CI: 1.36–1.96, p<.001). The In Vivo group had a significantly higher likelihood of quit attempts across time (61 % vs. 53 %, OR: 1.4, 95 % CI: 1.05–1.87, p=.021). Groups did not significantly differ on the percent of participants who had quit smoking at 6 months post-intervention (17 % In Vivo Sampling vs. 13 % standard counseling, OR: 1.43, p=.24). ConclusionIn Vivo Sampling demonstrated better NRT adherence and quit attempts but similar cessation rates to standard behavioral counseling. The In Vivo Sampling intervention represents a novel approach that increased behaviors typically associated with successful cessation over standard behavioral counseling.

Factors influencing tobacco quitting: findings from National Tobacco-Quitline Services, Mumbai, India.

The Government of India established National Tobacco Quitline Services (NTQLS) to provide free and effective telephonic counselling to help people quit tobacco. The objective of the paper is to present the data of tobacco quitters who quit tobacco through NTQLS, Mumbai, in the years 2021-2022 and the factors that influenced tobacco quitting. This is a prospective study where individuals willing to quit tobacco utilised NTQLS. Effective counselling was provided and was followed up. Multiple logistic regression analysis was conducted. Tobacco quitting is the dependent variable while sociodemographic characteristics, tobacco consumption habits, previous quit attempts, alcohol consumption, other substance use and co-morbidity were independent variables. In the years 2021-2022, a total of 448,893 calls hit the system. Of these, 127,163 (28.3%) calls were attended. Of the attended calls, a quit date was set for 21,504 calls (16.9%); of these, 8,276 (38.5%) callers quit tobacco. Individuals with no previous quit attempts [OR: 1.48, 95% confidence interval (CI): 1.25-1.75], never consumed alcohol (OR: 1.37, 95%CI: 1.2-1.56), consumed tobacco within 6-30 minutes (OR: 1.29, 95% CI: 1.12-1.49) and 30-60 minutes after waking up (OR: 1.26, 95% CI: 1.05-1.51) had higher quitting rates. While, female callers (OR: 0.59, 95% CI: 0.35-0.99), private sector workers (OR: 0.70, 95% CI: 0.61-0.81), individuals consuming more than ten tobacco units/packets (OR: 0.70, 95% CI: 0.61-0.79), tobacco use more than 10 years (OR: 0.85, 95% CI: 0.73-0.97), expenditure of more than 5,000 rupees on tobacco (OR: 0.58, 95% CI: 0.44-0.77) and those with no known co-morbid conditions (OR: 0.8, 95% CI: 0.71-0.91) were less likely to quit tobacco. Reduced tobacco consumption will inadvertently reduce the non-communicable disease (NCD) burden and help in achieving the sustainable development goals related to tobacco control and NCD. Quitline plays an important role in tobacco control.

Nicotine addiction and the influence of life adversity and acute stress on PYY: Prediction of early smoking relapse.

Early life adversity (ELA) is associated with earlier initiation and maintenance of tobacco smoking and with a greater risk of subsequent relapse. There is growing evidence that appetite hormones, including peptide YY (PYY), which modulates craving and satiety responses, play a role in stress and addiction processes. This study employed a quasi-experimental design to examine the association between ELA and circulating PYY stress responses in smokers and nonsmokers (N = 152, ages 19-73 years) to examine the effects of nicotine addiction. Smokers initiated a quit attempt as part of the study and were classified as either abstinent smokers or relapsed smokers based on their nicotine use during the follow-up period. PYY levels were measured at five timepoints during three lab sessions and compared between nonsmokers and the two smoking groups (abstainers, relapsers): while smokers were using nicotine adlibitum, 24 h after smokers initiated a quit attempt, and 4 weeks after smokers initiated a quit attempt. Multivariate analyses showed the main effects of time on PYY, which decreased over time within each session. The main effects of ELA during the first (ad libitum smoking) and second (24-h post-cessation for smokers) sessions indicated that experiencing ELA was associated with lower PYY. No systematic effect of nicotine addiction or relapse was observed in this study. These findings suggest that adults with higher ELA may experience lower PYY. Additional research is needed to further explore the role of PYY in stress and addiction processes.

Exercise as add-on therapy for smoking cessation in people with mental illness

Introduction &amp; Purpose The prevalence of smoking among people with mental illness is two to four times higher than in the general population. Unsuccessful quit attempts, often due to low confidence in their ability to quit, suggest that smokers with mental illness may benefit from additional smoking cessation strategies (Mann-Wrobel et al., 2011). Exercise as an adjunct treatment for smoking cessation in healthy individuals is increasingly recommended in the literature (Ussher et al., 2019), but there is limited data for people with mental illness. Therefore, the aim of this study is to evaluate the effectiveness of an exercise program as an add-on therapy for smoking cessation in people with mental illness. Methods 66 smokers with a diagnosed mental illness or mood disorders were included in a randomized controlled trial and received a standardized group smoking cessation program. Out of these 66 smokers, 38 individuals additionally participated in an exercise group (Nordic walking) and 28 in a control group (social contact group discussing health issues). Outcome variables were assessed by questionnaires at baseline (data available for 59 participants: 32 exercise group, 27 control group), during (after 3 weeks), and at the end of the program (5 weeks). Results The study had a dropout rate of 32%. At the end of the program, the abstinence rate was 19% in the exercise group and 30% in the control group (intention-to-treat analysis). There were no significant time-by-group interaction effects for any outcome variables. Significant group differences were found after 3 weeks for internal stimuli of self-efficacy (smokers’ confidence to resist smoking in certain situations; p = 0.026, ƞ² = 0.121) and after 5 weeks for frequency (p = 0.003, ƞ² = 0.210) and intensity (p = 0.007, ƞ² = 0.174) of cigarette craving. The control group showed higher self-efficacy and lower frequency and intensity of cigarette craving compared to the exercise group. Main effects over time were observed in both groups with improvement in several outcome variables (e.g., self-efficacy, positive affect, frequency, and intensity of cigarette craving). Discussion Group differences may be explained by pre-existing differences in cigarette dependence, motivation to quit, and BMI at baseline. It is known from the literature that higher cigarette dependence can lead to less successful quitting and higher relapse rates (Gierisch et al., 2012). Participants also had difficulty integrating program content into their daily lives and had low attendance rates. According to Zhou et al. (2023), a higher adherence rate would lead to a higher quit rate. Since the study was conducted in groups, the influence of group dynamics on motivation to quit smoking needs to be considered. Conclusion An additional effect of exercise as an adjunctive therapy in smoking cessation could not be confirmed, since the control group showed better outcome scores. Due to the high dropout rate, further studies with larger samples are needed. Improving access to smoking cessation programs, developing additional strategies, integrating evidence-based treatment into existing settings, and training health care professionals to engage people with mental illness in smoking cessation remain important areas for improvement (Falcaro et al., 2021). References Falcaro, M., Osborn, D., Hayes, J., Coyle, G., Couperthwaite, L., Weich, S., &amp; Walters, K. R. (2021). Time trends in access to smoking cessation support for people with depression or severe mental illness: A cohort study in English primary care. BMJ Open, 11(12), Article e048341. https://doi.org/10.1136/bmjopen-2020-048341 Gierisch, J. M., Bastian, L. A., Calhoun, P. S., McDuffie, J. R., &amp; Williams, J. W. (2012). Smoking cessation interventions for patients with depression: A systematic review and meta-analysis. Journal of General Internal Medicine, 27(3), 351–360. https://doi.org/10.1007/s11606-011-1915-2 Mann-Wrobel, M. C., Bennett, M. E., Weiner, E. E., Buchanan, R. W., &amp; Ball, M. P. (2011). Smoking history and motivation to quit in smokers with schizophrenia in a smoking cessation program. Schizophrenia Research, 126(1-3), 277–283. https://doi.org/10.1016/j.schres.2010.10.030 Ussher, M. H., Faulkner, G. E. J., Angus, K., Hartmann-Boyce, J., &amp; Taylor, A. H. (2019). Exercise interventions for smoking cessation. The Cochrane Database of Systematic Reviews, 2019(10), Article CD002295. https://doi.org/10.1002/14651858.CD002295.pub6 Zhou, Y., Feng, W., Guo, Y., &amp; Wu, J. (2023). Effect of exercise intervention on smoking cessation: A meta-analysis. Frontiers in Physiology, 14, Article 1221898. https://doi.org/10.3389/fphys.2023.1221898

Abstract A091: Beliefs and behaviors regarding non-cigarette tobacco use cessation care differ between providers at substance use treatment centers and community health centers serving rural and/or medically underserved areas of Texas

Abstract Purpose: Cancer mortality rates are higher in rural versus urban areas of the US, partly due to elevated tobacco use (including non-cigarette tobacco products (NCTPs); e.g., dip, snuff, vapes). Clinical practice guidelines call for tobacco use screening and brief intervention at every patient contact. Limited literature examines actual practices with respect to NCTP use in healthcare centers in rural and/or medically underserved areas (MUAs). This study examines if providers at substance use treatment centers (SUTCs) and community health centers (CHCs; e.g., Federally Qualified Health Centers) in such areas of Texas view NCTP cessation counseling as an important part of their job and if they use the 5As (Ask, Advise, Assess, Assist, Arrange) and motivational interventions to address their patients’ NCTP use. Methods: Providers from 21 healthcare centers (12 SUTCs, 9 CHCs) that had been solicited to later receive resources to improve their tobacco cessation care responded to face-valid survey items about their tobacco use screening and intervention delivery over the last month, along with their view on whether NCTP cessation counseling is an important part of their job. In total, 347 providers from SUTCs (n=174) and CHCs (n=173) serving 126 of Texas’ 254 counties responded. Linear mixed models and generalized linear mixed models were used to assess the differences between SUTCs and CHCs for continuous and binary variables, respectively. Results: Only 52% of providers agreed that NCTP cessation counseling is an important part of their job, with a significantly greater percentage (p=0.0023) agreeing at CHCs (63%) than at SUTCs (40%). Providers Asked 62% of their patients whether they used NCTPs. Of patients who endorsed use (20%), providers Advised 58% to quit and Assessed 53% about their interest in quitting. However, providers only Assisted 34% of use-endorsing patients in making a quit attempt and only Arranged follow-up for 23% of them. A significantly greater percentage (p=0.0025) of those patients were Advised to quit at CHCs (72%) than at SUTCs (44%). Providers delivered brief motivational interventions to 74% of patients who were not ready to quit, with significantly greater percentages advising patients to consider quitting in the future (p=0.0365) and telling patients they would revisit the topic at the next visit (p=0.0264) at CHCs (63% and 37%, respectively) than at SUTCs (45% and 24%, respectively). However, providers encouraged only 39% of use-endorsing patients to stop NCTP use completely, with a significantly greater percentage (p=0.0010) doing so at CHCs (50%) than at SUTCs (28%). Conclusion: Providers surveyed at healthcare centers in rural and/or MUAs of Texas were more likely to deliver evidence-based NCTP cessation care at CHCs than at SUTCs. Patients at both CHCs and SUTCs would benefit from their providers placing greater value on NCTP cessation care and more consistently delivering such care per guidelines. These data will inform healthcare centers’ implementation of best practices in treating their patients’ NCTP use. Citation Format: Brian J. Carter, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Ammar D. Siddiqi, Teresa Williams, Kathleen Casey, Hector Sanchez, Sriya Kakarla, Lorraine R. Reitzel. Beliefs and behaviors regarding non-cigarette tobacco use cessation care differ between providers at substance use treatment centers and community health centers serving rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A091.

Abstract A095: Differences in providers’ perceived preparedness and actual delivery of screening and intervention practices for patients who smoke cigarettes between two types of healthcare centers serving rural and/or medically underserved areas of Texas

Abstract Introduction: Rural populations in the US bear a disproportionate burden of cancer mortality. This is partly due to their elevated tobacco use rates. Best practice guidelines promote tobacco use screening and brief intervention at every patient contact; however, limited literature evaluates compliance in healthcare centers in rural and/or medically underserved areas (MUAs). Here, we examine providers’ use of the 5As (Ask, Advise, Assess, Assist, Arrange) and motivational interventions (for those not ready to quit; e.g., 5Rs: Relevance, Risks, Rewards, Roadblocks, Repetition) with their patients in substance use treatment centers (SUTCs) and medical healthcare centers (MHCs; e.g., Federally Qualified Health Centers) located in rural and/or MUAs in Texas to identify screening and intervention gaps. Methods: Providers from participating healthcare centers (12 SUTCs, 9 MHCs) responded to a solicitation assessing interest in (later) receiving tobacco use intervention training and resources. In total, 347 providers from SUTCs (n=174) and MHCs (n=173) serving 126 counties responded to an anonymized survey about their smoking screening and intervention delivery over the last month, along with their rating of how prepared they thought their healthcare center’s provider workforce was to help patients stop using tobacco (completely or somewhat prepared vs neutral, somewhat unprepared, or not at all prepared). Linear mixed models and generalized linear mixed models were used to assess the differences between SUTCs and MHCs for continuous and binary variables, respectively. Results: Overall, providers Asked 68.31% of their last-month patients whether they smoked cigarettes. Of patients who endorsed smoking (23.94%), providers Advised 58.68% to quit and Assessed 51.90% about their interest in quitting. However, providers only Assisted 35.87% of patients who endorsed smoking in making a quit attempt and 22.79% in Arranging a follow-up. A significantly greater percentage of patients were Asked (p=.0226) and Advised (p=.0025) to quit at MHCs (Ask=77.21%, Advise=72.35%) than at SUTCs (Ask=59.57%, Advise=45.34%). Providers delivered brief motivational interventions to 70.16% of patients who were not ready to quit smoking, with no significant differences between SUTCs and MHCs. Finally, 56.07% of providers at MHCs reported their workforce was prepared to help their patients quit tobacco, significantly greater than the 40.80% reported at SUTCs (p=.0268). Conclusion: Patients at MHCs were more likely to receive comprehensive tobacco cessation care than those at SUTCs in this sample of healthcare centers serving rural and/or MUAs in Texas. However, providers at both types of healthcare centers would benefit from greater workforce preparation to enable the provision of consistent tobacco use screening and brief intervention delivery in line with best practice guidelines. Future work will use these data for intervention and implementation strategy planning to improve centers’ capacity to comprehensively address their patients’ tobacco use. Citation Format: Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Brian J. Carter, Teresa Williams, Kathleen Casey, Kim Skeene, Hector Sanchez, Sriya Kakarla, Lorraine R. Reitzel. Differences in providers’ perceived preparedness and actual delivery of screening and intervention practices for patients who smoke cigarettes between two types of healthcare centers serving rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A095.

Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study.

In the United States, e-cigarettes, or vapes, are the second most-commonly used tobacco product. Despite abundant smartphone app-based cigarette cessation programs, there are few such programs for vaping and even less supporting data. This exploratory, prospective open-label, single-arm, remote, initial cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. The aim was to establish early data in each of these areas to inform program improvements and future study design. U.S. adults aged ≥ 21 years who vape daily, report ≥ 5 vape sessions per day, and plan to quit vaping in the next 6 months were recruited online. Participants completed an online screening form, screening call, electronic informed consent, registration, and onboarding before beginning Pivot. Data were self-reported via app and web-based questionnaires. Outcomes focused on engagement and retention (i.e., weeks in the program, number of Pivot app openings, number of messages sent to coach); vaping attitudes (i.e., success to quit, difficulty to stay quit); vaping behavior (i.e., quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point prevalence abstinence [PPA], continuous abstinence [defined as ≥ 7-day PPA at 12 weeks + 30-day PPA at 26 weeks + 0 vaping sessions since 12 weeks]); and participant feedback. Seventy-three participants completed onboarding (intention-to-treat [ITT] sample); 68/73 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Success to quit and difficulty to stay quit (scale 1-10) improved from baseline to 12 weeks: 4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively; both P < .001. Most participants (64/73, 88%) made ≥ 1 quit attempt. At 26 weeks, ITT 7-day PPA, 30-day PPA and continuous abstinence rates were: 35/73 (48%), 33/73 (45%), and 22/73 (30%), respectively. Thirty-three participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5) (mean change -3.2, SD 3.9, P < .001); almost half (16/33, 48%) had improvement in e-cigarette dependence category. At 2 weeks, 51/71 (72%) reported using Pivot increased their motivation to quit vaping; at 4 weeks, 55/70 (79%) reported using Pivot decreased the amount they vape per day. In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90%, average program engagement duration was approximately 14 weeks and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements. ClinicalTrials.gov NCT05642598; https://clinicaltrials.gov/study/NCT05642598.

Prevalence and disparities in receiving medical advice to quit tobacco use in the US adult population.

Evidence suggests that advice from health care professionals (HCP) increases the likelihood of quit attempts and successful quitting of tobacco use. However, previous studies primarily focussed on cigarette smoking and did not include all forms of tobacco products. This study aimed to investigate the prevalence and disparities in receiving HCP's advice to quit tobacco use (combustible or noncombustible) in the US adult population. Using the 2022 National Health Information Survey (NHIS) data, we examined 4,424 adults who reported (i) any tobacco product use within the past 12 months and (ii) having seen an HCP within the past 12 months. The outcome variable included the receipt of advice to quit tobacco use from an HCP, and predictors included sociodemographic variables. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. Over 38% of tobacco users who visited an HCP were advised to quit. The odds of receiving such advice were lower among Hispanics (AOR: 0.625; 95% confidence interval (CI) [0.464-0.843];p = 0.002), males (AOR: 0.767; 95% CI [0.659-0.893], p = 0.001), those above the poverty level (AOR: 0.795; 95% CI [0.641-0.987];p = 0.037), foreign-born (AOR: 0.664; 95% CI [0.496-0.888]; p = 0.006), those with a bachelor's degree or higher educational level (AOR: 0.477; 95% CI [0.349-0.653]; p < 0.001) and those aged less than 45 years (AOR: 0.404; 95% CI: [0.344-0.473]; p < 0.001). The prevalence of receiving HCP's advice to quit tobacco use remains suboptimal and disparate among sociodemographic groups. Our findings call for strategic implementation of the USPHS's recommendation on treating tobacco use and taking further actions to equip HCPs with the training and resources needed to provide appropriate advice to quit tobacco.

Effectiveness of mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling at outdoor smoking hotspots: A cluster randomized controlled trial.

To evaluate the effectiveness of mobile smoking cessation (SC) treatment with 1-week nicotine replacement therapy (NRT) sampling on recruitment and quitting outcomes. Two-arm cluster RCT (1:1 ratio), single-blinded, at 244 recruitment sessions in Hong Kong outdoor smoking hotspots from October 2018-December 2019. Participant were recruited by ambassadors and treated at the mobile SC truck. 834 adult (≥18 years, male 81.3%) daily smokers, Chinese-speaking, non-NRT users in the past month, consented after nurse-led intervention in mobile SC truck were randomized to the experimental (n = 482 male 79.5%) and the control group (n = 352, male 83.8%). The experimental group received a 1-week free NRT sample, an NRT instruction card, and mobile SC treatment including onsite nurse-led brief medication advice (about 15 minutes) and referral to SC clinics. The control group received the same mobile SC treatment. Primary outcome was self-reported quit attempts at 1-month follow-up. Secondary outcomes included SC service use at 1month, and biochemically validated abstinence (exhaled carbon monoxide < 4ppm; or saliva cotinine < 10ng/ml) at 6-month follow-up. Additionally, a post-hoc cost analysis was conducted. By intention-to-treat, the two groups showed similar prevalence of quit attempts (44·4% versus 43·5%, risk ratio (RR) = 1·04, 95% confidence interval (CI) = 0·79-1·37, P = 0·79). Compared with the control group, the experimental group showed lower SC service use at clinics (32·4% versus 44·9%, RR = 0·72, 95%CI = 0·57-0·91, P = 0·006), but no significant difference in validated abstinence (4·6% versus 2·8%, RR = 1·64, 95%CI = 0·76-3·50, P = 0·21). The experimental recruitment sessions recruited more smokers for onsite medication advice than the control session (mean 6·7 vs 5·0, adjusted incident rate ratio = 1·30, 95%CI = 1·08-1·56, P = 0·005). Mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling did not increase quit attempts or abstinence outcomes among recruited daily smokers in Hong Kong. The intervention increased smokers' uptake of onsite medication advice but reduced subsequent smoking cessation service use at clinics.

Aboriginal and Torres Strait Islander people who smoke and want to quit - a cohort profile from the Koori Quit Pack study.

Reducing the prevalence of smoking is a national priority, however there is limited evidence on what smoking cessation supports are utilised, accessible, and effective among Aboriginal and Torres Strait Islander people. This paper describes a cohort profile of Aboriginal and Torres Strait Islander people who smoke and want to quit to inform tailored smoking cessation interventions. Aboriginal and Torres Strait Islander people residing in New South Wales (NSW), Australian Capital Territory (ACT), and Victoria, who were smokers wanting to quit, were recruited through health services and online advertisements from May to October 2022. Descriptive and inferential statistics were used to summarise participant characteristics and explore factors associated with previous use and adherence to Nicotine Replacement Therapy (NRT) and intention to use Quitline services. 165 participants were recruited. Almost all (93.9%) had made at least one previous quit attempt, and 40.6% had used behavioural support. The majority believed NRT was safe (80.6%), effective (70.3%) and tried NRT previously (89%). Preferred forms of NRT for current quit attempts were nicotine patches (85.5%) and inhalers (69.7%). Intention to use Quitline was found to be higher among participants aged 31-45 years compared to participants under 30 years (AOR=3.12, 95%CI, 1.01-9.76). Aboriginal and Torres Strait Islander people are highly motivated to be smoke-free. However, efforts to enhance access and adherence to cessation supports are needed. The rapid recruitment and interest in the mailout cessation support should be scaled up to support Aboriginal and Torres Strait Islander peoples to quit. The Australian Government has recently launched a national tobacco strategy which includes targets for reducing smoking prevalence to less than 27% among Aboriginal and Torres Strait Islander peoples. In order to meet these targets Aboriginal and Torres Strait Islander people who smoke and want to quit should have access to culturally safe and responsive support. We found that Aboriginal and Torres Strait Islander people have made quit attempt, accessed evidence-based smoking cessation care, and have positive attitudes towards NRT. However, acknowledging relapse, further evidence is required to understand the factors associated with sustained quitting.

Pharmacist E-script transcription service initiated nicotine replacement therapy uptake in pre-admission clinic: A pilot study.

Pharmacist-led smoking cessation programs in pre-admission clinics (PAC) have shown to increase quit attempts and achieve abstinence by the day of surgery (DOS). To evaluate the feasibility of Pharmacist E-script Transcription Service (PETS) initiated nicotine replacement therapy (NRT) in PAC, including smoking cessation on DOS. A single centre, pre and post-intervention pilot study conducted at an Australian public hospital PAC. In a two-month intervention period, PAC nursing staff invited smokers (≥1 cigarette/day) to see a smoking cessation PET pharmacist. Pharmacist-initiated NRT and Quitline© referrals were offered. Cessation outcomes were compared with the preceding two-month control period. feasibility of intervention. DOS smoking abstinence rates and three-months post-surgery. PAC nurses identified 112 smokers over 4 months; 53 during pre-intervention period, and 59 during intervention period. Twenty-two intervention patients (37%) accepted seeing the pharmacist, with 16 subsequent Quitline© referrals (73%) and 11 NRT prescriptions (50%) written. The median nursing smoking status documentation time increased in the intervention period (1 min vs. 4, p < .001). The intervention did not impact pharmacist's workload. Verified abstinence increased from 8.5% (4/47) pre-intervention to 9.4% (5/53) post-intervention, p =1.00. Relapse rates in the intervention period increased (20% vs. 50%) at three-months post-surgery. A PETS-initiated NRT program in PAC is feasible and increased preoperative use of NRT and Quitline© with minimal impact on smoking cessation. SO WHAT?: This study has highlighted the importance of implementing a multidisciplinary smoking cessation program in PAC however, larger studies are needed to determine the true impact of the program on smoking cessations.

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.

Financial Strain and Smoking Cessation and Relapse Among U.S. Adults Who Smoke: A Longitudinal Cohort Study

IntroductionThis study examines the prospective association between financial strain and smoking cessation and smoking relapse among US adults with established smoking. MethodsDiscrete-time survival models were fit to nationally representative data in Waves 1-5 (2013-2019) of the US Population Assessment of Tobacco and Health Study for smoking cessation (n=6,972) and smoking relapse (n=1,195). Models were adjusted for demographics (age, sex, race and ethnicity), socioeconomic positioning (education, income, health insurance status), and tobacco-related confounders (quit attempts, coupon receipt, and nicotine dependence). Data were collected between 2013 and 2019, and the analysis was conducted in 2023-2024. ResultsAmong adults with established cigarette smoking, financial strain was associated with a reduced likelihood of cigarette smoking cessation (HR: 0.81, 95% CI: 0.72, 0.92) and an increased likelihood of cigarette smoking relapse (HR: 1.56, 95% CI: 1.24, 1.96) in multivariable models. Results were robust to sensitivity analyses varying confounder control, sample restrictions, and survey weights used. ConclusionsThe results from this study suggest that financial strain is a barrier to cigarette smoking without relapse, which may be due to stress and coping processes. Smoking cessation interventions would benefit from considering the role that financial strain plays in inhibiting smoking cessation without relapse.

Understanding cancer patients' desire to quit tobacco without assistance: A mixed-methods study.

While many cancer patients who use tobacco try to quit post-diagnosis, some prefer to quit without using tobacco treatment, despite evidence against unassisted quit attempts. This study aimed to understand the rationale for some cancer patients' desire to quit tobacco without assistance. Thirty-five adult cancer patients who currently used tobacco and declined tobacco treatment because of the desire to quit unassisted provided data via a standardized questionnaire and a semi-structured interview. The sample was predominately White, non-Hispanic (85.71%) and female (68.57%). The most common cancer site was gynecological. Key themes that emerged from the interviews were: self-reliance, willpower, social norms, and negative attitudes toward tobacco treatment. The most frequently endorsed barrier to tobacco treatment was "I know others who have quit without tobacco treatment" (82.86%). This study with cancer patients identified affective, cognitive, and personality factors related to quitting unassisted, and social and systemic reasons to not use tobacco treatment.

A National Dental Practice-Based Research Network phase II, cluster-randomized clinical trial assessing nicotine replacement therapy sampling in dental settings: study protocol for the Free Samples for Health (FreSH) study

BackgroundCigarette smoking has major detrimental effects on oral health. Tobacco interventions in dental settings are effective, but rarely delivered. The American Dental Hygienists Association recommends that oral health providers: Ask patients about tobacco use, Advise quitting tobacco use, and Refer to state quitlines (Ask-Advise-Refer; AAR). While AAR connects patients to counseling, it does not directly connect patients to medication. Nicotine replacement therapy sampling (NRTS) is an empirically supported intervention to provide starter packs of nicotine replacement therapy (NRT) to people who smoke. NRTS combined with AAR could be an effective tobacco treatment intervention for dental settings.MethodsThis manuscript describes the study protocol for the Free Samples for Health (FreSH) study, a group randomized clinical trial testing the effectiveness of NRTS + AAR vs. AAR alone on long-term smoking abstinence. Fifty dental practices in the Midwest and Northeast nodes of the National Dental Practice-Based Research Network are randomly assigned to provide AAR and either a 2-week supply of 14-mg nicotine patches and 4-mg nicotine lozenges (NRTS condition) or an electric toothbrush (ET condition). Approximately 1,200 patients who currently smoke—regardless of interest in quitting— are recruited during dental visits. Participants complete a baseline survey in-person, then after visit, 1-, 3-, and 6-month follow-up surveys remotely. The primary outcome is carbon monoxide-confirmed 7-day point prevalence abstinence from combustible tobacco measured at 6 months post-enrollment. Secondary outcomes include: 24-h intentional quit attempts, change in cigarettes smoked per day, NRT utilization, attitudes toward NRT, intention to use NRT, and intention to quit smoking. A key informant process evaluation and cost effectiveness analysis will provide information for future implementation of NRTS.DiscussionThis is the first clinical trial to assess the effectiveness of NRTS on promoting smoking cessation in dental settings. If effective, this treatment could be implemented to increase the provision of smoking cessation interventions in dental settings to provide an additional treatment access point for people who smoke.Trial Registration.Registered at ClincalTrials.gov (NCT05627596) on 11/25/2022.

Sex differences in tobacco use, attempts to quit smoking, and cessation among dual users of cigarettes and e-cigarettes: Longitudinal findings from the US Population Assessment of Tobacco and Health Study

SignificanceA growing number of adults use more than one tobacco product, with dual use of cigarettes and e-cigarettes being the most common combination. Monitoring sex disparities in tobacco use is a public health priority. However, little is known regarding whether dual users differ by sex. MethodsData came from Waves 4–6 (12/2016–11/2021) of the Population Assessment of Tobacco and Health Study, a US nationally-representative longitudinal survey. This analysis included current adult dual users of cigarettes and e-cigarettes. We used weighted generalized estimating equations to assess the association between sex and (1) making a cigarette quit attempt (n = 1882 observations from n = 1526 individuals) and (2) smoking cessation (n = 2081 observations from n = 1688 individuals) across two wave pairs, adjusting for age, education, ethnicity, time-to-first cigarette after waking, and e-cigarette use frequency. ResultsAmong US dual users, 14.1% (95% Confidence Intervals [Cl] = 11.9–16.4) of females and 23.4% (20.0–26.9) of males were young adults (aged 18–24), 11.7% (9.2–14.2) of females and 14.4% (11.6–17.2) of males had <high school education, and 82.2% (79.4–84.5) of females and 78.7% (75.1–82.4) of males were white. Overall, 44.9% (41.6–48.1) of females compared with 37.4% (33.5–41.3) of males made an attempt to quit smoking between a baseline and follow-up wave (Adjusted Risk Ratio [ARR] = 1.23, 1.05–1.45). In contrast, there were no apparent differences between females (22.1%, 19.0–25.2) and males (24.3%, 21.5–27.1) in smoking cessation (ARR = 1.06, 0.84–1.35). ConclusionUS females who dually use e-cigarettes and cigarettes were more likely to attempt to quit smoking, but not more likely to succeed at quitting, than males.

Association between current cigarette prices and cessation behaviors among male adult smokers: findings from 2018 to 2020 ITC Vietnam surveys

BackgroundThis study evaluated the impact of the tax increase in January 2019 on changes in intention to quit and the effect of cigarette prices on quit attempts and successful quitting among male cigarette smokers in Vietnam.MethodsData were derived from the ITC project in Vietnam, which included 1585 adult smokers at baseline (Wave 1, Aug-Oct 2018) followed up to waves 2 (Sep-Nov 2019) and 3 (Sep-Dec 2020). Generalized estimating equations regression was performed to estimate changes in the intention to quit. Multiple logistic regression analysis was used to evaluate the cigarette price of a cigarette pack in relation to quit attempts and successful quitting.ResultsThe increase in cigarette tax in 2019 did not significantly increase the likelihood of the intention to quit. After the tax increase, 63.6% of participants who smoked made a quit attempt, and 27.6% successfully quit smoking in the follow-up waves. However, the price of a cigarette pack was not significantly associated with quit attempts and successful quitting. The study did not observe a significant impact of cigarette prices on quit attempts and successful quitting in all subgroups of household income. Factors associated with quit attempts included the number of cigarettes smoked and the intention to quit, while those associated with successful quitting included age, dual use of cigarettes and other tobacco products, and the intention to quit.ConclusionCurrent cigarette prices were not associated with cessation behaviors even within the lowest household income group. Therefore, a sharp rise in cigarette tax is required to incentivize smokers to quit smoking.

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...

Factors Associated with Past 12-month Quit Attempt of Electronic Cigarette Use in Malaysian Adults

Factors Associated with Past 12-month Quit Attempt of Electronic Cigarette Use in Malaysian Adults

Recall of Flavor at First E-cigarette Use and Its Association with E-cigarette Progression: The Mediating Effects of First Sensory Experience

To test whether the association between flavor at first vape and continued use is mediated through subjective experience at first vape. In a 2020 cross-sectional survey, 955 young adult ever-vapers recalled their first flavor vaped, subjective experiences at first use, current vaping behavior, nicotine dependence, and quit attempts. A latent class model grouped first-use subjective experiences into classes. Two-part negative binomial hurdle models for each vaping behavior evaluated whether the association of first flavor used with vaping outcomes was mediated by positive experience. Four latent classes (positive, positive and negative, negative, and minimal experience) were further reduced to "any positive experience" (only positive, positive and negative) vs "no positive experience" (negative or minimal). Class membership mediated the association of first flavor used (mint/menthol/ice [ie, "cooling"] or sweet vs other) with each vaping outcome. For example, cooling flavor (vs. other) was associated with positive class membership (OR=3.5; 95% CI: 1.5, 8.1), which was then associated with any past 30-day vaping (OR=3.9; 95% CI: 2.7, 5.8) and greater number of vaping days among current vapers (RR=1.9; 95% CI: 1.3, 2.7) in the two-part hurdle model. Similar results were observed for nicotine dependence and quit attempts, and for sweet (vs other) flavor for any dependence or quit attempts, but not number of dependence symptoms or quit attempts. Use of a cooling or sweet flavor at first use was associated with having a positive first vaping sensory experience, and then greater likelihood as a young adult of reporting past 30-day vaping, more vaping days, and greater risk for nicotine dependence, suggesting a key mediating role of first use experience.