Smoking Cessation Devices Research Articles

E-Cigarette Aerosol Condensate Leads to Impaired Coronary Endothelial Cell Health and Restricted Angiogenesis

Cardiovascular disease (CVD) is a leading cause of mortality worldwide, with cigarette smoking being a major preventable risk factor. Smoking cessation can be difficult due to the addictive nature of nicotine and the withdrawal symptoms following cessation. Electronic cigarettes (e-Cigs) have emerged as an alternative smoking cessation device, which has been increasingly used by non-smokers; however, the cardiovascular effects surrounding the use of e-Cigs remains unclear. This study aimed to investigate the effects of e-Cig aerosol condensate (EAC) (0 mg and 18 mg nicotine) in vitro on human coronary artery endothelial cells (HCAEC) and in vivo on the cardiovascular system using a mouse model of 'e-vaping'. In vitro results show a decrease in cell viability of HCAEC when exposed to EAC either directly or after exposure to conditioned lung cell media (p < 0.05 vs. control). Reactive oxygen species were increased in HCAEC when exposed to EAC directly or after exposure to conditioned lung cell media (p < 0.0001 vs. control). ICAM-1 protein expression levels were increased after exposure to conditioned lung cell media (18 mg vs. control, p < 0.01). Ex vivo results show an increase in the mRNA levels of anti-angiogenic marker, FKBPL (p < 0.05 vs. sham), and endothelial cell adhesion molecule involved in barrier function, ICAM-1 (p < 0.05 vs. sham) in murine hearts following exposure to electronic cigarette aerosol treatment containing a higher amount of nicotine. Immunohistochemistry also revealed an upregulation of FKBPL and ICAM-1 protein expression levels. This study showed that despite e-Cigs being widely used for tobacco smoking cessation, these can negatively impact endothelial cell health with a potential to lead to the development of cardiovascular disease.

Marketing claims on websites of brick-and-mortar vape shops in the Greater Los Angeles area.

INTRODUCTIONBrick-and-mortar vape shops have increased in recent years, but there is limited research on the types of marketing claims consumers are exposed to on their websites – a dominant channel for marketing electronic nicotine delivery systems (ENDS). We investigated the websites of vape shop retailers in the Greater Los Angeles Area to describe their ENDS marketing claims.METHODSData collection occurred between 25 March and 20 June 2020. Of the 104 brick-and-mortar vape shops identified, 37 were found to have active websites. Rules were established to analyze website content. ENDS Marketing Claims were coded as the presence or absence of: 1) a direct claim of ENDS as a quitting aid; 2) a disclaimer that ENDS are not approved as smoking cessation devices (i.e. ENDS products are not FDA-approved for smoking cessation); 3) a direct claim of ENDS as healthier/safer than combustible cigarettes; and 4) direct claims regarding social benefits, including that ENDS are less expensive, can be used in more places, are cleaner or less messy/smelly, and are more socially accepted than combustible cigarettes.RESULTSSmoking cessation-related benefits were claimed most frequently (43%), followed by health-related claims (30%), and disclaimers that ENDS are not approved as smoking cessation devices (24%). More than half (56.4%) of websites had an age restriction, requiring the user to click on a box to state that they were aged ≥21 years to view the site. None required proof or outside verification of age.CONCLUSIONSBrick-and-mortar vape shops in the Greater Los Angeles Area are marketing ENDS on their websites as a healthier alternative to smoking cigarettes. Although half of the websites had an age gate popup that consumers see when they enter the website, action is needed to better enforce age restriction on access to vape shop websites. Utility for smoking cessation was claimed most frequently, followed by the claims of healthier alternatives to smoking cigarettes, and disclaimers that ENDS are not approved as smoking cessation devices. We discuss implications for tobacco regulatory policy.

Critical research gaps in electronic cigarette devices and nicotine aerosols.

Electronic cigarettes (e-cigs) are devices that aerosolize nicotine-containing liquids for delivery as an inhaled vapor. E-cigs are currently marketed as smoking cessation devices, though the emergence and rapid adoption of these devices in recent years has sparked a great deal of concern over their safety. Given the plethora of devices and nicotine solutions available on the market and the lack of regulation and quality control, it is imperative that these devices and nicotine formulations are studied to assess critical operating parameters, the pharmacokinetic profiles of the inhaled nicotine, and the toxicity profiles of the e-cig aerosols. This review aims to deliver an overview of current research regarding electronic cigarette devices, nicotine-containing liquid formulations, pharmacokinetics of nicotine, and toxicology studies in order to highlight areas lacking in research or requiring greater standardization and regulation.

New Zealand tobacco retailers’ understandings of and attitudes towards selling Electronic Nicotine Delivery Systems: a qualitative exploration

IntroductionIn 2017, the New Zealand Government signalled its intent to legalise the widespread sale of Electronic Nicotine Delivery Systems (ENDS), which many New Zealand retailers have actually sold for several...

Well on the way: An exploratory study on occupational health in hospitality

This study conducted a comprehensive review of work conditions and health risks/problems for various hospitality workers and summarized the various health and wellness promotion programs available in the workplace with the aim of identifying the key elements of successful employee wellness programs. In this review, physical health problems, such as musculoskeletal disorders, lung diseases, and dermatologic diseases, as well as mental health problems that are common among hospitality employees were discussed. In addition, different types of wellness programs that may help employees to overcome these health problems were included. In the next stage, interviews with hotel staff holding multiple positions were conducted to identify the most significant health challenges and assess their preference for various types of wellness initiatives. Using MAXQDA Pro, health-related categories and themes were extracted from the interviews. Participants believed that the lack of time, physical challenges and stress are the top three wellness challenges in the hospitality industry. In order to tackle the challenges, they stated that hospitality businesses should provide various wellness initiatives including healthy eating and weight management, smoking cessation, stress management, exercise programs, and fitbits or other wellness tracker devices.

SUN-067 E-cigarettes and High Fat Diet Cause Alteration in Cardiac Structure and Function

Smoking is the major cause of cardiovascular diseases (CVD) and is the single largest cause of death in the USA. Smoking cessation can reduce the mortality from CVD. Electronic cigarettes, also known as electronic nicotine delivery systems (ENDS), have been marketed as a smoking cessation device. In spite of the widespread use of ENDS and the proposed detrimental cardiac and atherosclerotic effects of nicotine, the effects of ENDS on these systems are not well known. Recently, using Apolipoprotein E null mice, we demonstrated that mice exposed to e-cigarettes have decreased cardiac fractional shortening and ejection fraction together with ventricular ultrastructural abnormalities indicative of cardiomyopathy in comparison with controls. In this study, we investigated the detrimental effects of ENDS at doses similar to the clinically relevant concentrations found in habitual smokers and a high fat diet (HFD) on cardiac structure and function in a commonly used model of diet-induced obesity. C57 BL6 mice fed HFD were exposed to ENDS in the presence (2.4%) or absence (0%) of nicotine and saline aerosol for 12 weeks. Mice exposed to ENDS (2.4%) had increased serum free fatty acid levels in comparison with saline and ENDS (0%). Echocardiographic data show that mice treated with ENDS (2.4%) had decreased left ventricular fractional shortening and ejection fraction compared to ENDS (0%) and saline. Transmission electron microscopy revealed that cardiomyocytes of mice treated with ENDS (2.4%) exhibited ventricular abnormalities, including lipid accumulation (ventricular steatosis), myofibrillar derangement and destruction, and mitochondrial hypertrophy. Additionally, ENDS (2.4%) also caused increased cardiac oxidative stress and triggered cardiomyocyte apoptosis. These results demonstrate profound adverse effects of ENDS on ventricular structure and function in obese mice. We surmise that ENDS exposure may cause heart failure and other forms of cardiomyopathy in obese patients. This is important information for patients that use ENDS and regulatory agencies that regulate ENDS.

The Messages Presented in Electronic Cigarette-Related Social Media Promotions and Discussion: Scoping Review.

BackgroundThere has been a rapid rise in the popularity of electronic cigarettes (e-cigarettes) over the last decade, with growth predicted to continue. The uptake of these devices has escalated despite inconclusive evidence of their efficacy as a smoking cessation device and unknown long-term health consequences. As smoking rates continue to drop or plateau in many well-developed countries, transnational tobacco companies have transitioned into the vaping industry and are now using social media to promote their products. Evidence indicates e-cigarettes are being marketed on social media as a harm reduction alternative, with retailers and manufacturers utilizing marketing techniques historically used by the tobacco industry.ObjectiveThis study aimed to identify and describe the messages presented in e-cigarette–related social media (Twitter, YouTube, Instagram, and Pinterest) promotions and discussions and identify future directions for research, surveillance, and regulation.MethodsData sources included MEDLINE, Scopus, ProQuest, Informit, the Journal of Medical Internet Research, and Google Scholar. Included studies were published in English between 2007 and 2017, analyzed content captured from e-cigarette–related social media promotions or discussions, and reported results for e-cigarettes separately from other forms of tobacco and nicotine delivery. Database search ceased in October 2017. Initial searches identified 536 studies. Two reviewers screened studies by title and abstract. One reviewer examined 71 full-text articles to determine eligibility and identified 25 studies for inclusion. This process was undertaken with the assistance of the Web-based screening and data extraction tool—Covidence. The review was registered with the Joanna Briggs Institute (JBI) Systematic Reviews database and followed the methodology for JBI Scoping Reviews.ResultsSeveral key messages are being used to promote e-cigarettes including as a safer alternative to cigarettes, efficacy as a smoking cessation aid, and for use where smoking is prohibited. Other major marketing efforts aimed at capturing a larger market involve promotion of innovative flavoring and highlighting the public performance of vaping. Discussion and promotion of these devices appear to be predominantly occurring among the general public and those with vested interests such as retailers and manufacturers. There is a noticeable silence from the public health and government sector in these discussions on social media.ConclusionsThe social media landscape is dominated by pro-vaping messages disseminated by the vaping industry and vaping proponents. The uncertainty surrounding e-cigarette regulation expressed within the public health field appears not to be reflected in ongoing social media dialogues and highlights the need for public health professionals to interact with the public to actively influence social media conversations and create a more balanced discussion. With the vaping industry changing so rapidly, real-time monitoring and surveillance of how these devices are discussed, promoted, and used on social media is necessary in conjunction with evidence published in academic journals.

Vaping associated with healthy food words: A content analysis of Twitter

E-cigarettes were initially introduced as a less harmful alternative to combustible cigarettes, but marketing efforts may now be exceeding these claims by associating e-cigarettes with words related to healthy foods. These associations could mislead people to assume vaping is a healthy practice. Tweets from January to March 2017 were obtained from the Twitter Streaming Application Programming Interface (API) to assess content about vaping linked to healthy food words. Tweets were classified into one of nine categories along with their source (marketer vs. non-marketer). We content analyzed original English language public postings on Twitter that included vaping-related keywords and at least one of eight co-occurring healthy food-related labels (e.g., ‘natural,’ ‘vitamin,’ ‘vegan,’ and ‘organic’) (N = 1205). Chi-square analyses compared themes by message source. Findings suggest vaping is being marketed in ways that could paradoxically lead consumers to believe that e-cigarettes are health-enhancing. We found more tweets representing vaping as health-enhancing (9%) than referring to it as a smoking-cessation device (1%). The largest category of tweets referred to vaping as harmless (28%) and therefore compatible with a healthy lifestyle. Tweets presenting vaping as harmless or with a sensation theme were more likely to be authored by marketers than by non-marketers. Food and drug regulation needs to be more vigilant to prevent misleading advertising from e-cigarette marketers.

Smokers' knowledge and perception of electronic cigarettes (e-cigarettes): a qualitative study of non-quitting smokers in a North London general practice.

The introduction of electronic cigarettes (e-cigarettes) has provided smokers with an alternative source of nicotine. Interest and use of the device has increased exponentially in the last decade with an estimated 2.9 m adult users in Great Britain. Research so far on the attitudes and perceptions of smokers to this new product has largely focussed on the views of current e-cigarette users, smokers attempting to quit and former cigarette smokers. This study aimed to explore the views of current tobacco smokers who were not using e-cigarettes and not looking for a cessation method, their understanding and knowledge of e-cigarettes, and their views of e-cigarettes as a smoking cessation aid provided by the National Health Service (NHS). Semi-structured in-depth interviews were conducted with 14 patients from a general practice in North London, who smoked conventional tobacco cigarettes on a daily or weekly basis, over 18 years old. An iterative approach allowed for constant data analysis using a thematic approach throughout the data collection stage, and generated four recurring themes. E-cigarettes were primarily seen as a smoking cessation device, with the supply of nicotine viewed as a benefit helping to reduce withdrawal symptoms, although for some participants this supply could also be a hindrance to dealing with their addiction. Despite uncertainty about the components, e-cigarettes were mostly viewed as healthier due to their lack of carcinogens, tar and smoke inhalation. The lack of reliable information and strong evidence for both the effectiveness and the safety of e-cigarettes led participants to be apprehensive about their provision by the NHS, and acted as a barrier to their use as an aid to quitting. The recurring appeal for more information regarding e-cigarettes make it clear that further high-quality research is urgently needed in this field to provide reliable and accurate information to smokers.

A Review on the Safety of Inhalation of Propylene Glycol in E-cigarettes

Electronic cigarette (e-cigarette) are being used as a safe alternative to tobacco smoking, or as a smoking cessation device. However, the FDA presumes that e-cigarettes are as hazardous as conventional cigarettes. The Tobacco Control Task Force of the American Association of Public Health Physicians instead has indicated that e-cigarettes closely resemble Nicotine Replacement Therapy products. Since Propylene glycol (PG) constitutes around 89-90% of the e-cigarettes formulation, the objective here is to review the safety of inhalation of PG. All animal and human studies that analyzed the effect of the inhalation of PG have indicated that, PG does not appear to pose a significant hazard via the inhalation route. In fact, in several of these animal studies the concentrations of PG used were higher compared to the concentration used in e-cigarettes and did not give rise to any toxic effects. However, there are no human studies at the level of e-cigarette concentrations.

Healthcare staff attitudes towards the use of electronic cigarettes (‘e-cigarettes’) compared with a local trust policy

E-cigarette use has risen dramatically in recent years, despite uncertainty over long-term health effects and concerns regarding efficacy as a smoking cessation device. Currently, there is no legislation prohibiting use in public, though many trusts have extended the NHS Smokefree policy to include e-cigarettes. The successful implementation of such policy is, however, unclear. This study examined staff attitudes towards the use of e-cigarettes in a hospital environment with respect to enforcement of a local trust smoking policy. A total of 79 healthcare professionals working at South Tyneside District Hospital, South Shields, completed a written questionnaire regarding use of e-cigarettes, particularly views on use in public and on hospital premises. Factors influencing the likelihood of individuals to challenge the use of e-cigarettes were assessed. In all, 45% of respondents thought that e-cigarettes should be allowed in public places, though a majority (62%) favoured use on hospital grounds compared to within hospital buildings (18%). Over 50% of respondents were unaware of trust policy relating to e-cigarettes and only 25% had ever challenged someone using a device. Roughly, one-third reported that they would still not challenge someone in future, despite being informed of trust policy. Fear of abuse was the most cited reason for not challenging. Expressed concerns of e-cigarette use related to fire risk, 'normalising' smoking behaviour and uncertainty of long-term effects. Most staff do not enforce trust policy regarding e-cigarette use. This reflects variation in opinion over use, poor awareness of the policy itself and perceived barriers to implementation, including fear of abuse. Addressing these issues through staff education sessions may help successful future implementation.

E-Cigarettes and Cardiovascular Disease Risk: Evaluation of Evidence, Policy Implications, and Recommendations

Cardiovascular disease is the major cause of death in smokers. Although new tobacco products such as e-cigarettes do not generate many of the harmful or potentially harmful constituents (HPHCs), present in combustible tobacco products the cardiovascular effects of these devices are unknown and their efficacy in promoting and sustaining cessation remains unclear. Currently, these devices are being marketed as cleaner and safer alternative to smoking that could help smokers quit smoking. Nevertheless, e-cigarette aerosols contain appreciable levels of carbonyls, which within the concentration range reported in e-cigarettes, exert significant cardiovascular toxicity. Moreover, even by itself, nicotine is a sympathomimetic drug that elicits hemodynamic and metabolic changes that could increase the risk of acute cardiovascular events such as arrhythmias or plaque rupture and chronically increase cardiovascular disease risk by inducing dyslipidemia. The dose-response relationship between smoking and cardiovascular mortality is non-linear, suggesting that reduction in HPHC concentrations in e-cigarette aerosols may not result in proportional harm reduction and decreased HPHC exposure may be offset by increased use by individuals who believe that e-cigarettes are safer than conventional cigarettes. Thus, taken together, current evidence does not entirely support the notion that e-cigarettes are reduced harm products or effective smoking cessation devices.

Knowledge about electronic cigarettes and its perception: a community survey, Egypt.

BackgroundElectronic cigarettes are promoted as safer products than traditional cigarettes and as smoking cessation devices. Awareness and perception are key elements for the adoption of new habits. Little is known about electronic cigarettes and public opinions towards it. This study aims to identify the prevalence of knowledge about electronic cigarettes, its perception, and use among Egyptian population.MethodsAn observational cross-sectional study using self-administered questionnaire in Arabic language was conducted between March and April 2015 among a sample of Egyptian population aged 15–75 years (N = 1239). We compared between respondent’s who know e-cigarettes and those who do not know it.ResultsMore than half (57.5 %) of the respondents had heard about e-cigarettes, 51.8 % were non-smokers and nobody of them reported use of e-cigarettes. There were statistically significant differences between those who know and those who do not know e-cigarettes regarding age, educational levels and history of smoking. Among those who know e-cigarettes, 41.6 % believed that e-cigarettes help smoking cessation and 31.9 % believed it is less harmful than traditional cigarettes.ConclusionsA considerable level of knowledge about e-cigarettes is found among young people aged 15–39 years. E-cigarettes were perceived as less harmful than traditional cigarettes or a smoking cessation aid. None of the respondents reported use of e-cigarettes.

What should dentists know and advise about electronic cigarettes to their patients

Electronic cigarettes (e-cigarettes) are battery-powered devices that convert nicotine into a vapor which can be inhaled. The vapors from e-cigarettes are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in e-cigarette vapors is safe. Worldwide use of electronic cigarettes has increased significantly over recent years but varies markedly between countries. The legal status of e-cigarettes is pending in most of the countries which are the need of the hour. The efficacy and effectiveness of e-cigarettes in smoking cessation or reducing the tobacco use are not established. The following review discusses the current data regarding e-cigarette, prevalence of e-cigarette, legislation of e-cigarettes, issues concerned with the use of the e-cigarette, and finally, the dentists being the health caregivers should be prepared to answer the patients' questions about the advisability of using e-cigarettes as a smoking cessation device.

A qualitative assessment of the perceived risks of electronic cigarette and hookah use in pregnancy.

BackgroundStudies reveal that electronic cigarette (e-cigarette) and hookah use are increasing among adolescents and young adults. However, the long-term health effects are unknown, especially with regards to pregnancy. Because of the increased use in women of reproductive age, and the unknown long-term health risks, our primary objectives were to determine the perceived risks of e-cigarette and hookah use in pregnancy, and learn common colloquial terms associated with e-cigarettes. Furthermore, we sought to determine if there is a stigma associated with e-cigarette use in pregnancy.MethodsEleven focus groups including 87 participants were conducted immediately following regularly scheduled CenteringPregnancy® prenatal care with women at three different clinics in the greater Houston area. A minimum of two facilitators led the groups, using ten lead-in prompts, with Spanish translation as necessary. Facilitators took notes which were compared immediately following each group discussion and each group was audio recorded and transcribed. Three facilitators utilized NVivo 9.0 software to organize the transcribed data into nodes to identify major themes. To increase rigor, transcripts were further analyzed by two obstetricians who were instructed to find the major themes.ResultsAnalyses revealed contradicting themes concerning e-cigarette use. In general, e-cigarettes were perceived as safer alternatives to regular tobacco cigarettes, especially if used as smoking cessation devices. A major theme is that use in pregnancy is harmful to the fetus. However, it was perceived that use for smoking cessation in pregnancy may have fewer side effects. We found that a common term for e-cigarettes is “Blu.” In our discussion of hookah use, participants perceived use as popular among teenagers and that use in pregnancy is dangerous for the fetus.ConclusionsAlthough a strong theme emerged against hookah use, we found contradicting themes in our discussions on e-cigarette use in pregnancy. It is possible that e-cigarette use will not carry the same stigma as regular cigarette smoking in pregnancy. In addition, the impression of e-cigarettes as a healthier alternative to smoking may influence use in pregnancy. Clinicians need to be prepared for questions of e-cigarette safety and efficacy as smoking cessation devices from their pregnant patients who smoke, and women who smoke and are planning to become pregnant.

Genetic Factors for Enhancement of Nicotine Levels in Cultivated Tobacco.

Nicotine has practical applications relating to smoking cessation devices and alternative nicotine products. Genetic manipulation for increasing nicotine content in cultivated tobacco (Nicotiana tabacum L.) may be of value for industrial purposes, including the possibility of enhancing the efficiency of nicotine extraction. Biotechnological approaches have been evaluated in connection with this objective, but field-based results are few. Here, we report characterization of two genes encoding basic-helix-loop-helix (bHLH) transcription factors (TFs), NtMYC2a and NtMYC2b from tobacco. Overexpression of NtMYC2a increased leaf nicotine levels in T1 transgenic lines approximately 2.3-fold in greenhouse-grown plants of tobacco cultivar ‘NC 95′. Subsequent field testing of T2 and T3 generations of transgenic NtMYC2a overexpression lines showed nicotine concentrations were 76% and 58% higher than control lines, respectively. These results demonstrated that the increased nicotine trait was stably inherited to the T2 and T3 generations, indicating the important role that NtMYC2a plays in regulating nicotine accumulation in N. tabacum and the great potential of NtMYC2a overexpression in tobacco plants for industrial nicotine production. Collected data in this study also indicated a negative feedback inhibition of nicotine biosynthesis. Further enhancement of nicotine accumulation in tobacco leaf may require modification of the processes of nicotine transport and deposition.

E-cigarette use and intentions to smoke among 10-11-year-old never-smokers in Wales

BackgroundE-cigarettes are seen by some as offering harm reduction potential, where used effectively as smoking cessation devices. However, there is emerging international evidence of growing use among young people, amid...

Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider.

Primary care providers should be aware of two new developments in nicotine addiction and smoking cessation: 1) the emergence of a novel nicotine delivery system known as the electronic (e-) cigarette; and 2) new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as “thirdhand smoke”. The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room. Counseling patients about the hazards of thirdhand smoke may provide additional motivation to quit smoking.

News and Notes

News and Notes

A strategy for evaluating a novel smoking intervention device.

The Victorian Smoking and Health Program (VSHP) was established in 1985 to (1) determine the views of smokers making a quit attempt regarding the acceptability and usefulness of a novel self-help smoking cessation device (the QUITZ pack), (2) define a potential market by determining the correlates of use of the QUITZ pack, and to (3) determine how the QUITZ pack compared to existing resources with proven acceptability and usefulness. Telephone interviews were conducted of 120 smokers who rang the QUITZ office for resources to help in a quit attempt. The results showed that most people found the QUITZ pack to be acceptable, both on first receiving it (68% acceptable) and after they had had the resource for at least a week (61% acceptable). The QUITZ pack was used in some way by 58% of the people to whom it was sent. No significant associations were found between the use of the pack and any of the demographic, smoking history, or motivational factors examined. Around a third of smokers to whom it was sent rated the QUITZ pack as being either quite or very useful in their cessation attempt. Of those who reported using the QUITZ pack, 61% rated it as being quite or very useful. For those who used the pack and made a quit attempt, more respondents rated a self-help guide (the CanQuit book) (87%) and any other personally chosen strategy (87%) as being quite or very useful, than rated any components of the QUITZ pack in this way.(ABSTRACT TRUNCATED AT 250 WORDS)