Quit Success Rates Research Articles

Smoking prevalence following the announcement of tobacco tax increases in England between 2007 and 2019: an interrupted time-series analysis.

AimsThis study aimed to evaluate the impact of announcement of tax increases on factory‐made (FM) and roll‐your own (RYO) cigarettes in England.Design, Setting and ParticipantsAutoregressive integrated moving average with exogeneous input (ARIMAX) time–series modelling in England, UK. Data were aggregated monthly on 274 890 participants between 2007 and 2019 taking part in the Smoking Toolkit Study (STS).MeasurementsThe association of sustained step level changes for tax rises for FM cigarettes and temporary pulse effects for tax rises for RYO cigarettes with smoking, quit attempt and quit success prevalence as well as per‐capita self‐reported cigarette consumption and cost per cigarette was assessed.FindingsA 10% rise in tax on RYO cigarettes was associated with a temporary 21.1% decline [95% confidence interval (CI) = –30.4 to −10.7] in smoking prevalence, and 20.7% decline (95% CI = –32.4 to −7.0) in per‐capita self‐reported cigarette consumption; while a 3% rise of tax on RYO cigarettes was associated with a temporary 20.7% decline (95% CI = –33.3 to −5.8) in the amount paid per RYO cigarette. For tax increases on FM cigarettes, a 5% above inflation tax rise was associated with a step‐level increase of 33.1% (95% CI = 18.4–49.5) in quit success rates. However, some of the findings were sensitive to model specification and temporally specific.ConclusionThe announcements of tax increases for cigarettes in England between 2010 and 2019 were inconsistently associated with temporary reductions in smoking prevalence, per‐capita self‐reported cigarette consumption and improved quit success. Paradoxically, reductions in the cost for roll‐your‐own cigarettes were also found. The results were not robust in all sensitivity analyses.

Latent class analysis of initial nicotine dependence among adult waterpipe smokers.

Waterpipe (WP) tobacco smoking increases the risk of smoking-related health problems. In this study, we sought to identify the unobserved class memberships of WP-associated initial nicotine dependence (ND) symptoms and assess the predictors of each latent class. This cross-sectional study was conducted among a convenience sample of 900 current (past 30-day) WP smokers who were recruited from 94 WP-serving venues surrounding Tehran and Ardebil metropolitans in Iran. All participants completed a self-administrated questionnaire. We performed latent class analysis using PROC LCA in SAS to identify class memberships of initial ND symptoms using 10-item Hooked on Nicotine Checklist. Five latent classes were identified as non-dependent (25.4 %), low dependent (7.1 %), low-moderate dependent (19.6 %), moderate dependent (15.6 %), and high dependent (32.2 %). Using flavored WP tobacco significantly increased the odds of belonging to low-moderate dependent class [adjusted OR (aOR) = 1.89; 95 % confidence interval (CI): 1.07-3.34] compared to non-dependent class. Also, having academic education decreased the odds of belonging to low-moderate dependent (aOR = 0.43; 95%CI: 0.26-0.67) and moderate dependent (aOR = 0.39; 95%CI: 0.23-0.67) class in comparison to non-dependent class. Also, WP smoking initiation at an older age was associated with belonging to high dependent (OR = 2.05; 95%CI: 1.39-3.03) class compared to non-dependent. This study revealed that nearly half of WP smokers fell under moderate and high-dependent classes. Our findings showed that some items of HONC had more role in the clustering of participants based on ND symptoms. The WP-specific cessation programs and targeted clinical trials should consider the diversity of ND levels among smokers to achieve successful quit rates among these smokers. Additionally, limiting flavors would be a strong strategy to limit the rate of ND, especially among young people who are eager to smoke flavored WP tobacco.

Socio-demographic correlates of quit attempts and successful quitting among smokers in India: Analysis of Global Adult Tobacco Survey 2016-17.

MPOWER is a policy package of six components intended to assist in the country-level implementation of effective tobacco control interventions. One of the six components of MPOWER strategy is to offer help to quit tobacco use. Majority of the smokers want to quit, but quitting is difficult due to the addictiveness of nicotine. They make multiple quitting attempts with little success. There is a need to know what proportion of smokers make a quit attempt, and among those who make an attempt, how many become successful quitters and their sociodemographic correlates. Secondary analysis of data from the Global Adult Tobacco Survey (GATS-2) 2016-17, India was done. This nationally representative survey was conducted among persons aged 15 years or older. Weighted estimates were calculated after adjusting for clustering and stratification. A total of 35.5% adults who smoked tobacco during the past 12 months have made a quit attempt in the last 12 months. Around 14.2% of ever daily smokers currently do not smoke (which indicate successful quit rate). The study demonstrated strong associations of sociodemographic characteristics such as age group, educational attainment, caste, religion, geographic region, wealth quintiles, and visit to health care provider with the attempt to quit tobacco and successful quitting. The majority of quit attempts were made without any assistance (71.1%). The study provides robust national evidence on attempts to quit tobacco, the success rates of those attempts, and their sociodemographic correlates. The study highlights the need to provide more cessation support to young, less educated people in the northern part of India.

Evaluation of the London Smoking Cessation Transformation Programme: a time-series analysis.

Background and aimNational social marketing campaigns have been shown to promote smoking cessation in England. There is reason to believe that regional and city‐wide campaigns can play a valuable role in reducing smoking prevalence over and above any national tobacco control activity. This study aimed to assess the impact of the London Smoking Cessation Transformation Programme, a multi‐component citywide smoking cessation programme, on quit attempts and quit success rates.Design and SettingInterrupted time–series analyses, using Autoregressive Integrated Moving Average (ARIMA) and generalized additive models (GAM) of population trends in the difference between monthly quit attempts and quit success rates among smokers who made a quit attempt in London versus the rest of England before and during the first year of the programme.ParticipantsA total of 55 528 past‐year adult smokers who participated in a monthly series of nationally representative cross‐sectional surveys in England between November 2006 and August 2018. Twelve and a half per cent of smokers lived in London (intervention region) and 87.5% lived in the rest of England (control region).MeasurementsMonthly prevalence of quit attempts and quit success rates among smokers who made a quit attempt.FindingsThe monthly difference in prevalence of quit attempts in London compared with the rest of England increased by 9.59% [95% confidence interval (CI) = 4.35–14.83, P < 0.001] from a mean of 0.04% pre‐intervention to 9.63% post‐intervention. The observed increase in success rates among those who tried was not statistically significant (B = 4.72; 95% CI = –2.68 to 12.11, P = 0.21); Bayes factors indicated that these data were insensitive. GAM analyses confirmed these results.ConclusionThe promotion of the London Smoking Cessation Transformation Programme during September 2017 was associated with a significant increase in quit attempts compared with the rest of England. The results were inconclusive regarding an effect on quit success among those who tried.

Effect of Additional Motivational Interviewing on Smoking Abstinence for 1-Year among Korean Adolescents: Results from A Comparative Retrospective Study in Quitline.

The aim of this study was to evaluate the effect of additional motivational enhancement through telephone-based counseling on short- and long-term smoking abstinence among Korean adolescents. Methods: A comparative retrospective study was conducted based on the longitudinal follow up in Quitline from 2010 to 2017. A total of 533 and 178 adolescent smokers voluntarily participated in the 1-year quitting counseling only (group A, who were ready to quit) and the additional 4-week motivational interviewing before 1-year quitting counseling (group B, who were ambivalent about quitting), respectively. The outcomes were self-reported continuous abstinence at 30-day, 6-month, and 1-year follow up. Logistic regression was applied to estimate the effect of potential factors, including motivational enhancement, on cessation outcome. Results: At baseline, adolescents in group B had a lower motivation to quit than those in group A (p < 0.001). The successful quit rates at 30-day, 6-month, and 1-year follow up were 37.2%, 12.8%, and 11.4% in group A and 33.7%, 15.2%, and 11.2% in group B, respectively. After adjusting factors as appropriate, successful quit rates in group B were not significantly different from the rates in group A. Higher self-efficacy increased the successful quit rate at 30-day, 6-month, and 1-year follow up, similar in subgroup analysis by gender. Never-drinking showed significant association with 30-day successful quit in the whole population and among boys. The lower number of smoking triggers was associated with an increased 30-day successful quit rate among boys only. Conclusions: Counseling for motivational enhancement could be a promising approach for better quitting outcomes. Improving self-efficacy and eliminating smoking triggers should be continuously strengthened during the quitting process.

Quit attempts among tobacco users identified in the Tamil Nadu Tobacco Survey of 2015/2016: a 3 year follow-up mixed methods study

ObjectivesTo determine current tobacco use in 2018/2019, quit attempts made and to explore the enablers and barriers in quitting tobacco among tobacco users identified in the Tamil Nadu Tobacco Survey...

Are population trends in high-risk alcohol consumption in smokers associated with trends in quit attempts and quit success? A time-series analysis

ObjectivesMonthly changes in the prevalence of high-risk drinking and smoking in England appear to be positively correlated. This study aimed to assess how far monthly changes in high-risk drinking were...

The Biological Impact of Menthol on Tobacco Dependence.

Mentholated cigarettes have been shown to have greater addictive potential than their nonmentholated counterparts. Evidence is pointing toward multiple mechanisms of action by which menthol may alter tobacco dependence. Understanding menthol's biological functions as it pertains to nicotine dependence will be helpful in crafting novel pharmacotherapies that might better serve menthol smokers. In addition, a better understanding of menthol's pharmacology as it relates to tobacco dependence will be valuable for informing policy decisions on the regulation of mentholated cigarettes.

Association of prevalence of electronic cigarette use with smoking cessation and cigarette consumption in England: a time-series analysis between 2006 and 2017.

AimsTo provide up‐to‐date estimates of how changes in the prevalence of electronic cigarette (e‐cigarette) use in England have been associated with changes in smoking cessation activities and daily cigarette consumption among smokers in England.DesignTime–series analysis of population trends.SettingEngland.ParticipantsParticipants came from the Smoking Toolkit Study, which involves repeated, cross‐sectional household surveys of individuals aged 16 years and older in England. Data were aggregated on approximately 1200 past‐year smokers each quarter (total n = 50 498) between 2007 and 2017.MeasurementsPrevalence of e‐cigarette use in current smokers was used to predict (a) prevalence of quit attempts among last‐year smokers, (b) overall quit rates among last‐year smokers and (c) mean cigarette consumption per day among current smokers. Prevalence of e‐cigarette use during a quit attempt among last‐year smokers was used to predict (a) quit success rate among last‐year smokers and (b) overall quit rates among last‐year smokers.FindingsOverall quit rates increased by 0.054% [95% confidence interval (CI) = 0.032–0.076, P < 0.001] and 0.050% (95% CI = 0.031–0.069, P < 0.001) respectively for every 1% increase in the prevalence of e‐cigarette use by smokers and e‐cigarette use during a quit attempt. Quit success rates increased by 0.060% (95% CI = 0.043–0.078, P < 0.001) for every 1% increase in the prevalence of e‐cigarette use during a quit attempt. No clear evidence was found for an association between e‐cigarette use and either prevalence of quit attempt (BAdj = 0.011, 95% CI = −0.046 to 0.069, P = 0.698) or cigarette consumption (BAdj = 0.019, 95% CI = −0.043 to 0.082, P = 0.542).ConclusionChanges in prevalence of e‐cigarette use in England have been positively associated with the overall quit rates and quit success rates but not clearly associated with the prevalence of quit attempts and mean cigarette consumption.

Smoking behavior and social contexts associated with smoking among dual-smoker couples.

To examine smoking behavior and social contexts related to smoking among dual-smoker couples. Cross-sectional online survey study. A convenience sample of 183 dual-smoker couples. Investigator-developed survey on smoking and related social contexts. Participants smoked 16.0 cigarettes daily for 14.2years; 48.4% shared more than half of their smoking time with their spouse. More than half made quit attempts in the past year individually (M=5.3) and jointly (M=2.5). Couples sharing more smoking time were more likely to be motivated to quit (p=.002), make quit attempts (p<.0001), and be interested in cessation interventions (p=.002); but less likely to implement home smoking bans (p<.001). Among those who reported quit attempts, 41% quit by themselves and 15.3% sought professional assistance. Most common reasons for relapse were chronic stress and crisis, 63.6%, however, were interested in smoking cessation services, preferably technology-based interventions. We found smoking interdependence within dual-smoker couples. Despite high levels of motivation to quit, most did not utilize professional help, leading to low successful quit rates. Technology-based smoking cessation interventions incorporating spousal support and addressing stress/crisis may best assist dual-smoker couples.

Evaluation of the London Smoking Cessation Transformation Programme: a time series analysis

BackgroundIn 2017, a citywide smoking cessation campaign, the London Smoking Cessation Transformation Programme, was launched in London, UK, to boost quitting rates. The campaign involved use of mass media and online marketing, an online portal and a dedicated telephone helpline. This study examined whether the campaign resulted in an increase in quit attempts and in the success rate among smokers who tried to quit in the first year of operation. MethodsThe programme began in September, 2017. We used data from 55 528 past-year adult smokers who participated in a monthly series of nationally representative cross-sectional surveys in England between November 2006, and August 2018. 12·5% of smokers lived in London (intervention region) and 87·5% in the rest of England (control region). We did interrupted time-series analyses, using Autoregressive Integrated Moving Average and Generalised Additive Models (GAM), to model population trends in the difference between monthly quit attempts and quit success rates among smokers who made a quit attempt in London versus the rest of England before and during the first year of the programme. Data were weighted to match the population in England. Ethics approval for the Smoking Toolkit Study was granted by the UCL Ethics Committee (ID 2808/005) and participants provided fully informed consent. FindingsThe monthly difference in prevalence of quit attempts in London compared with the rest of England increased by 9·59% (95% CI 4·35–14·83, p<0·0001) from a mean of 0·04% pre-intervention to 9·63% post-intervention. The observed increase in success rates among those who tried was not significant (4·72% [–2·68 to 12·11], p=0·21); Bayes factors indicated these data were insensitive. GAM analyses confirmed these results, showing a significant step-level change in the monthly prevalence of quit attempts from before to after the intervention that was 1·52 times larger in London than the rest of England (OR 1·52, 95% CI 1·21–1·91, p<0·0001), but no significant difference in change in success of quit attempts (1·22, 0·71–2·10, p=0·48). InterpretationThe promotion of the London Smoking Cessation Transformation Programme during September 2017 was associated with a significant increase in quit attempts compared with the rest of England. This finding supports the view that media campaigns and cessation support can work together to improve quitting rates in large population groups. The programme could provide a blueprint for similar initiatives in other major cities in the UK or overseas. FundingCancer Research UK, Economic and Social Research Council.

Estimates of effectiveness and reach for 'return on investment' modelling of smoking cessation interventions using data from England.

Background and aimsEstimating ‘return on investment’ (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool (http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries.MethodsEstimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys.FindingsQuit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single‐form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster‐acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face‐to‐face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self‐help materials (1%). There was insufficient evidence to obtain reliable, country‐specific estimates for interventions such as websites, smartphone applications and e‐cigarettes.ConclusionsTax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions.

Varenicline’s Release Did Little to Alter National Smoking Cessation Rates

Overall use of smoking pharmacotherapies has gone up only 2.4 percent since the introduction of varenicline in 2006, while successful quit rates have remained flat.

Posting behaviour patterns in an online smoking cessation social network: implications for intervention design and development.

ObjectivesOnline Cessation Support Networks (OCSNs) are associated with increased quit success rates, but few studies have examined their use over time. We identified usage patterns in New Zealand's largest OCSN over two years and explored implications for OCSN intervention design and evaluation.MethodsWe analysed metadata relating to 133,096 OCSN interactions during 2011 and 2012. Metrics covered aggregate network activity, user posting activity and longevity, and between-user commenting. Binary logistic regression models were estimated to investigate the feasibility of predicting low user engagement using early interaction data.ResultsRepeating periodic peaks and troughs in aggregate activity related not only to seasonality (e.g., New Year), but also to day of the week. Out of 2,062 unique users, 69 Highly Engaged Users (180+ interactions each) contributed 69% of all OCSN interactions in 2012 compared to 1.3% contributed by 864 Minimally Engaged Users (< = 2 items each). The proportion of Highly Engaged Users increased with network growth between 2011 and 2012 (with marginal significance), but the proportion of Minimally Engaged Users did not decline substantively. First week interaction data enabled identification of Minimally Engaged Users with high specificity and sensitivity (AUROC = 0.94).ImplicationsResults suggest future research should develop and test interventions that promote activity, and hence cessation support, amongst specific user groups or at key time points. For example, early usage information could help identify Minimally Engaged Users for tests of targeted messaging designed to improve their integration into, or re-engagement with, the OCSN. Furthermore, although we observed strong growth over time on varied metrics including posts and comments, this change did not coincide with large gains in first-time user persistence. Researchers assessing intervention effects should therefore examine multiple measures when evaluating changes in network dynamics over time.

Varenicline and cardiovascular adverse events: a perspective review.

Smoking is a leading preventable cause of mortality and morbidity. Varenicline, a first-line smoking cessation aid, is used widely to achieve successful quit rates in smokers. A number of studies and systematic reviews have evaluated the safety profile of the drug. To date, three systematic reviews by Singh and colleagues, Prochaska and Hilton, and Ware and colleagues, published between 2011 and 2013, have evaluated serious cardiovascular adverse events with varenicline use. Even though all three reviews demonstrated that serious cardiovascular adverse events were nominally more frequent in varenicline-treated patients when compared with placebo, a significantly increased event rate was found only in the review by Singh and colleagues. The three reviews included similar trials but differed in the evaluation of outcomes and performance of summary statistic computation. Though the evidence from the two most recent systematic reviews demonstrated that risk of serious cardiovascular events might not be increased with varenicline use, the US Food and Drug Administration has advised prescription with caution combined with close monitoring and education of patients until more conclusive evidence is available. Results of these reviews cannot be generalized to patients with unstable cardiac conditions.

The Impact of Tobacco Dependence Treatment Coverage and Copayments in Medicaid

The Affordable Care Act (ACA) expands Medicaid's tobacco dependence treatment (TDT) coverage; however, these expansions differ in comprehensiveness based on Medicaid eligibility category. To examine whether more generous Medicaid TDT coverage (in terms of cost-sharing requirements and treatments covered) is associated with greater likelihood of quit attempts and successful quit rates. This study used repeated cross-sections from the Current Population Survey (2001-2011), linked to state-level survey data on Medicaid TDT coverage. The sample included 3,071 adult Medicaid recipients who reported smoking 12 months prior to the survey and resided in 28 states with consistent TDT coverage across Medicaid fee-for-service and managed care. Logistic regression models, conducted in October 2013, examined the relationship between state TDT coverage and Medicaid recipients' successful quits and attempted quit rates, controlling for individual and state characteristics. Forty-one percent of Medicaid recipients attempted to quit smoking in the prior year and 7% quit successfully. Medicaid recipients in states with the most generous coverage (counseling without copayment and pharmacotherapy with copayment) had the highest predicted successful quit rates (8.3%). Those living in states with no TDT or pharmacotherapy-only coverage had lower predicted successful quit rates (range=4.0%-5.6%). These findings suggest that the ACA will increase smoking quit rates among Medicaid recipients. Recipients who have more generous TDT coverage (such as the new Medicaid expansion population and pregnant women) will likely see greater increases in quit rates compared to existing adult Medicaid enrollees.

Utilization of Evidence-Based Smoking Cessation Treatments by Psychiatric Inpatient Smokers With Depression

Although smoking is a major health issue among depressed psychiatric inpatients and interest in quitting is high, successful quit rates remain low among this population. We sought to understand preferences that depressed inpatient smokers may have for cessation treatments. Eighty smokers (60% women, mean age 38.75 ± 11.20) with major depressive disorder and nicotine dependence receiving psychiatric inpatient services provided information on current depressive symptoms, smoking status and nicotine dependence, quit attempts, perceived barriers to quitting, and smoking consequences. Almost half (46%) of participants endorsed a past-year quit attempt. Emotional barriers to quitting were uniquely associated with fewer past-year quit attempts, and depression severity was related to greater emotional barriers to quitting. Nicotine dependence severity was related to a variety of emotional, financial, weight concern, and self-efficacy barriers, but only weight gain concern was associated with decreased odds of making a past-year quit attempt. The number of lifetime quit attempts was positively associated with negative smoking consequences. With regard to interest in smoking cessation treatment, 86% and 92% of smokers reported a willingness to try behavioral counseling and nicotine replacement products, respectively, but fewer smokers reported a willingness to try medication, print or Web-based materials, or an unaided quit attempt. Although half of our sample reported recent quit attempts, many people did not make an attempt using an evidence-based treatment. On the basis of consumer preferences identified herein, clinical recommendations for reinforcing the use of evidence-based smoking cessation treatments for depressed psychiatric inpatient smokers are provided.

A cluster randomized controlled trial of a brief tobacco cessation intervention for low-income communities in India: study protocol

India has 275 million adult tobacco users and tobacco use is estimated to contribute to more than a million deaths in the country each year. There is an urgent need to develop and evaluate affordable, practicable and scalable interventions to promote cessation of tobacco use. Because tobacco use is so harmful, an increase of as little as 1 percentage point in long-term quit success rates can have an important public health impact. This protocol paper describes the rationale and methods of a large randomized controlled trial which aims to evaluate the effectiveness of a brief scalable smoking cessation intervention delivered by trained health professionals as an outreach programme in poor urban communities in India. This is a pragmatic, two-arm, community-based cluster randomized controlled trial focused on tobacco users in low-income communities. The treatment arm is a brief intervention comprising brief advice including training in craving control using simple yogic breathing exercises (BA-YBA) and the control arm is very brief advice (VBA). Of a total of 32 clusters, 16 will be allocated to the intervention arm and 16 to the control arm. Each cluster will have 31 participants, making a total of 992 participants. The primary outcome measure will follow the Russell Standard: self-report of sustained abstinence for at least 6 months following the intervention confirmed at the final follow-up by salivary cotinine. This trial will inform national and international policy on delivery of scalable and affordable brief outreach interventions to promote tobacco use cessation in low resource settings where tobacco users have limited access to physicians and medications.

The Effectiveness of Cigarette Price and Smoke-Free Homes on Low-Income Smokers in the United States

We examined the effectiveness of state cigarette price and smoke-free homes on smoking behaviors of low-income and high-income populations in the United States. We used the 2006-2007 Tobacco Use Supplement to the Current Population Survey. The primary outcomes were average daily cigarette consumption and successful quitting. We used multivariable regression to examine the association of cigarette price and smoke-free home policies on these outcomes. High state cigarette price (pack price ≥ $4.50) was associated with lower consumption across all income levels. Although low-income individuals were least likely to adopt smoke-free homes, those who adopted them had consumption levels and successful quit rates that were similar to those among higher-income individuals. In multivariable analysis, both policies were independently associated with lower consumption, but only smoke-free homes were associated with sustained cessation at 90 days. High cigarette prices and especially smoke-free homes have the potential to reduce smoking behaviors among low-income individuals. Interventions are needed to increase adoption of smoke-free homes among low-income populations to increase cessation rates and prevent relapse.

Smoking Behaviors in a Community-Based Cohort of HIV-Infected Indigent Adults

We conducted a longitudinal study of a community-based cohort of HIV-infected indigent adults to examine smoking behaviors and factors associated with quitting. We assessed "hardcore" smoking behaviors associated with a low probability of quitting. Of the 296 participants, 218 were current smokers (73.6 %). The prevalence of "hardcore" smoking was high: 59.6 % smoked ≥15 cigarettes per day, and 67.3 % were daily smokers. During the study interval, 20.6 % made at least one quit attempt. Of these, 53.3 % were abstinent at 6 months. The successful quit rate over 2 years was 4.6 %. Illegal substance use (adjusted odds ratio, AOR 0.2, 95 % CI 0.1-0.6) and smoking within 30 min of waking (AOR 0.2, 95 % CI 0.1-0.7) were associated with lower likelihood of making a quit attempt. Interventions that reduce nicotine dependence prior to smoking cessation and those that are integrated with substance use treatment may be effective for this population.