Smoking Cessation Interventions Research Articles

Identification of different types of nicotine product users: results from a cluster analysis

Abstract Background Smoking cessation interventions often target people that use nicotine products as one homogenous group. However, heterogeneity exists among people who smoke and/or use e-cigarettes. The aim of the current study was to characterize clusters of nicotine product users based on their use and motives. Methods The study included 2000 people who smoke and/or use e-cigarettes aged ≥18 years in the Netherlands. Respondents were recruited from a large survey-panel between August and October 2023. The questionnaire consisted of questions on demographics, product use/frequency, and motives to use nicotine products and motives to quit. A cluster analysis was used to identify the number and nature of subgroups reporting similar product behavior and/or motives. Analyses were weighted to correct for imbalances between the survey sample and the population of the Netherlands. Results Four clusters were identified. Cluster 1 ‘socially-influenced smoker’ (13%) had a greater proportion of men, participants indicated using a variety of products and often try a product if they have seen other people using it. Cluster 2 ‘party smoker’ (5%) was characterized by participants being young, mostly smoke during a social event, and indicated that drinking alcohol is a reason to smoke/use a nicotine product. Participants in cluster 3 ‘coping-driven smoker’ (43%) were more often women, use nicotine products to reduce stress, to relax and regulate mood. Cluster 4 ‘Inveterate smoker’ (39%) mainly contained participants of older age and endorsed smoking due to pleasure and habit and see smoking as part of their identity. The socially-influenced smoker had the highest intention to quit (67%), and the inveterate smoker the lowest (35%). Among all clusters, improving health was reported as most important reason to stop using nicotine products. Discussion Classifying nicotine product users into subgroups based on their use and motives could lead to more appropriate smoking cessation interventions. Key messages • People who use nicotine products are not a homogenous group, but can be divided into different clusters based on their product use and motives. • Classifying people that use nicotine products into subgroups based on their use and motives could lead to more appropriate smoking cessation interventions.

Relationship of anxiety and depression with smoking cessation treatments: a follow-up study

ABSTRACT Background Smoking is known to be closely associated with a stress levels and anxiety. In this study, the effects of smoking cessation treatments were investigated on anxiety/depression. Methods Socio-demographic characteristics The Fagerström/Test/Nicotine/Dependence, the Hospital Anxiety and Depression (HAD) scale were applied at first time. The first group received “varenicline+counseling,” second group “bupropion+counseling,” and third group “counseling only.” The HAD scores were recorded in quit smokers. Anxiety and depression scores were compared between groups and between smokers and ex-smokers in the first and sixth month. Results Firstly, The HAD scores revealed that anxiety was present in 46.8%, depression in 11.2%, anxiety and/or depression in 48.9%. A significant decrease in both anxiety and depression scores was observed in quit smokers at 6 months (47.9% and 37.4%, respectively) (p < .001). At the sixth month, there was a significant decrease in anxiety scores in the varenicline and bupropion groups. In addition, a significant decrease in the depression score was observed in the varenicline group. In the bupropion group, the smoking cessation rate was higher in those with high anxiety and/or depression scores (66.7%). Conclusions Varenicline decreased anxiety/or depression scores in both smokers and quit smokers, whereas quit smoking rate increased in those with anxiety/depression in the bupropion.

Identity in the context of physical activity and smoking: A scoping review among adults aged 45+

Abstract Background Identity (i.e., self-perceptions of oneself) plays an important role in health behaviors such as physical activity (PA) and smoking. This review offers a comprehensive synthesis and comparison of how PA- and smoking-related identity is associated with PA and smoking behavior in adults aged 45+. It further synthesizes and compares identity terminology and measurement tools used to capture identity concerning smoking cessation and PA among adults aged 45+. Where applicable, the role of personal, PA-, and smoking-related characteristics were considered. Methods A thorough search across 11 databases, updated in May 2023, yielded 5801 unique publications. Ensuing careful screening procedures, 45 peer-reviewed empirical studies were systematically reviewed. Experts in the field contributed to validate and structure the narrative. Results The review reveals a complex, enduring connection between identity and behavior in both PA and smoking domains, encompassing processes like identity formation, maintenance, change, and loss. In essence, identities linked to PA and abstaining from smoking emerged as pivotal for promoting active lifestyles and successful smoking cessation. Many parallels but also distinctions emerged within this association, alongside variations in the terminology and measurement tools pertaining to identity. Factors such as gender, age, and behavioral history emerged as influential in shaping identities related to smoking and PA. Conclusions Despite variances, findings suggest that the relationship between identity and behavior, including associated processes, may not fundamentally differ between health-promoting and health-compromising behaviors. There is however need for more unified identity definitions and measurement tools. We propose avenues for future research, including exploring causality between identity and behavior to facilitate the development of identity-related smoking cessation and PA-promotion interventions. Key messages • Identities associated with physical activity and refraining from smoking are associated with a physically active lifestyle and successful smoking cessation. • Despite differences, the relationship between identity and behavior may not fundamentally vary between health-promoting and health-compromising behaviors.

Navigating the complexity of User Engagement: need for normative evaluations in digital interventions

Abstract Digital behavioral change interventions (DBCI), leveraging digital technology to promote cognitive behavioral therapy or positive psychology techniques, can potentially revolutionize health promotion. With applications across a spectrum of health behaviors-from managing common mental health disorders to enhancing physical activity, addressing smoking cessation, alcohol use, and weight management-these interventions offer promise for both healthy and clinical populations. However, their effectiveness hinges significantly on user engagement. Digital interventions are prone to attrition due to their self-help and unguided nature, which impedes their translation from research to real-life settings. This talk discusses the findings of a scoping review to shed light on these complexities. Firstly, we explore the various methodologies used to evaluate engagement across studies, hindering effective comparison and understanding. Secondly, we address the lack of systematic assessment of engagement strategies, advocating for experimental research to fill this gap. Lastly, we emphasize the need to establish an optimal level of engagement for desired outcomes, noting that continuous engagement may not always be conducive to behavioral change interventions, which aim to instill lasting changes in individuals. This underscores the importance of comprehensive assessment using both objective and subjective measures. In conclusion, engagement with digital interventions encompasses both quantitative usage metrics and qualitative subjective experiences, highlighting the need for comprehensive assessment beyond the mere evaluation of frequency or duration. Contrary to common belief, increased engagement does not always lead to better outcomes. Too much engagement can lead to exhaustion, while too little can result in inefficiency. Therefore, designing a DBCI that encourages optimal use is essential, fostering a balance that maximizes effectiveness while minimizing adverse effects.

Development of a first intervention for tobacco cessation for sexual and gender minority individuals in Romania

Abstract Background Data on tobacco use among SGM in Romania indicate high use rates, yet tailored smoking cessation efforts do not exist. We collected data from SGM individuals in Romania on tobacco use and cessation attitudes, facilitators and barriers to quitting, and intervention components acceptability to inform the first smoking cessation intervention for SGM in Romania, adapted from a U.S.-based intervention with mobile app support. Methods SGM individuals (≥ 18 years old, current smokers) recruited through community outreach in March 2024 completed a brief assessment and participated in a focus group regarding tobacco use, attitudes, norms, risks knowledge, facilitators and barriers to quitting, and intervention acceptability. Results Focus groups were held with 36 participants characterized as 45% cis male, 40% gender-diverse, 15% cis female; 40% gay, 33% bisexual, 10% queer, 8% pansexual; 6% lesbian, 3% heterosexual; M age=27, SD = 7.62. 70% smoked daily; median age of first cigarette was 17. Participants reported smoking up to 2 packs a day, with 50%-98% of people in their circles being smokers. Common reasons for smoking included to alleviate stress and “fit in.” Most did not receive support to quit from their social circles or within healthcare. While smoking was communal, quitting was individual and siloed, suggesting a preference for a group-based intervention, along with robust strategies to replace the function of smoking with adaptive habits. The app was evaluated positively, especially for its daily smoking tracking, reminders for alternative healthy activities, positive achievements, and forum for support. Conclusions Findings provide a solid platform for creating a first smoking cessation intervention for SGM individuals in Romania. Next steps include iterative testing of the mobile app to examine comprehension, usability, and satisfaction with content and functionality, in preparation for a randomized controlled trial testing the intervention’s efficacy.

1.O. Scientific session: Trans &amp; Gender-Diverse Individuals’ Mental &amp; Behavioral Health Risks &amp; Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

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

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

Healthcare workers' knowledge, attitudes, and practices towards cardiovascular disease prevention: a multi-national cross-sectional study

Abstract Introduction Prior studies have shown that improved primordial prevention of cardiovascular disease (CVD) may significantly delay its onset. Healthcare workers (HCWs) are well-placed to influence healthy lifestyle habits for CVD prevention. However, it is unclear how well HCWs fare in this role given the multiple demands on their time in clinical practice. Purpose We sought to understand the CVD prevention knowledge, attitudes and practices (KAPs) of HCWs across 25 nations. Insights gained could help inform efforts to optimise CVD prevention by HCWs. Methodology: Data was collected via an anonymous, online questionnaire which consisted of pre-validated CVD prevention and smoking cessation subscales adapted from the Preventive Medicine Attitudes and Activities Questionnaire (PMAAQ). The subscales have been previously validated in a study population of primary care residents in the US, demonstrating validity and reliability. Results 668 HCWs (60% doctors, 28% nurses, 12% medical students) from 25 nations responded to the survey. Overall, 74.86% of HCWs routinely assessed patients’ cardiovascular (CV) risk profiles in clinical practice. 65.65% of HCWs counselled patients who were asymptomatic for CVD on tangible lifestyle changes to improve their CV risk profiles, while 68.22% of HCWs did so when patients were overweight. Of note, only 51.26% of HCWs implemented comprehensive smoking cessation interventions for their patients. Practising HCWs demonstrated higher levels of CVD prevention promotion than medical students in all aspects (Fig 1b), except for self-reported importance of CVD risk factor counselling in primary prevention (Tukey HSD diff: 0.31, p-value: 0.051). Among practising HCWs, there were no significant differences in their promotion of CVD prevention across varying lengths of clinical practice. HCWs from higher income nations[1] tended to fare worse than their lower income counterparts in the promotion of CVD prevention (Fig 1a). Conclusion A large multi-national survey reveals significant gaps in the promotion of CVD prevention by HCWs, highlighting key differences in CVD prevention practices based on national income status. The results also demonstrate significant differences between medical students and practising HCWs’ CVD prevention behaviours, highlighting the role of continuing education for the promotion of long-term positive CVD prevention clinical practices amongst HCWs. Further efforts may target the medical education of early-career HCWs, especially in higher income nations. [1] National income level is defined as per the World Bank's classification, with the exception of Taiwan which is not classified as an independent nation under the World Bank. However, Taiwan is still labelled as a high income nation as her GNI (US$33,565) fits the criterion of the World Bank's definition of a high income nation (GNI per capita of &amp;gt;US$13,846).Table 1:Participant demographicsFigure 1a and 1b

The Concept of a Large Group-Based Approach for Intensive Smoking Cessation: The Gold Standard Program (GSP)

In this study, the effect of the intensive “Quitter” intervention for smoking cessation was examined and compared to the standardized intensive intervention used in Denmark. The Quitter intervention, based on the Gold Standard Program (Q-GSP), involves large groups of approximately 70 participants, while the standardized GSP typically involves groups of 10–15 participants. In total, 105 and 14,289 smokers participated in the Q-GSP and the standardized GSP, respectively, between 2022 and 2023. Data from the Danish STOPbase database were used, with validated information from one municipality for the Q-GSP. Successful smoking cessation was defined as abstinence from smoking at the end of the intervention and continuous abstinence at the 6-month follow-up. The results showed that 73% of the participants in the Quitter group successfully stopped smoking at the end of the interventions, compared to 50% in the standardized I-SCI group. At the 6-month follow-ups, 49% of the Quitter intervention group members maintained abstinence versus 31% of the standardized I-SCI group, with a statistically significant relative risk (RR) of 2.18 (95% CI 1.48–3.22). Compliance and satisfaction were high in both groups. These findings indicate the potential for large group-based interventions to be broadly integrated into public health strategies.

Long-Term Effectiveness of a Quitline for Smoking Cessation: Results of a Randomized Controlled Trial.

Smoking remains a significant global public health issue, leading to numerous preventable deaths and disabilities annually. Telephone counselling is a recommended intervention for smoking cessation, offering accessible support to a wide range of people who smoke. This study aimed to evaluate the long-term effectiveness of the German quitline for smoking cessation. A parallel-group, two-arm, superiority, randomized controlled trial was conducted between October 2021 and November 2023. People who smoked daily and were willing to quit received either up to six telephone counselling calls (intervention group) or a self-help brochure (control group). Seven-day point prevalence abstinence from cigarettes and tobacco at 12 months and prolonged cigarette and tobacco abstinence from 3 to 12 months after the start of the intervention were assessed. Further, the use of additional cessation aids was assessed. A total of n = 905 participants were randomized (intention-to-treat sample). The intervention group (n = 477) exhibited higher rates of prolonged cigarette abstinence (31.7% vs. 17.8%) and prolonged tobacco abstinence (30.8% vs. 15.2%) compared to the control group (n = 428) at 12-month follow-up with corresponding odds ratios of 2.2 (95% CI [1.6, 3.0]) and 2.5 (95% CI [1.8, 3.5]). Seven-day point-prevalence cigarette abstinence was not statistically significant (OR = 1.3, 95% CI [1.0, 1.7]). E-cigarettes were the most commonly used additional cessation aid (46.0%), followed by electronic media (31.0%) and nicotine replacement therapy (26.2%). Telephone counselling provided by the national German quitline for smoking cessation demonstrates effectiveness in promoting long-term abstinence from cigarettes and tobacco. Increased awareness and use of the quitline could promote cessation rates in Germany. Given the rising popularity of novel nicotine consumer products, counselling protocols should incorporate information on their risks and potential as cessation tools.

Efficacy of Smoking Cessation Interventions among People with HIV in Kenya.

People with human immunodeficiency virus (HIV) smoke at much higher rates than the general population, resulting in higher risk for tobacco-related morbidity and mortality. The efficacy of smoking cessation interventions among people with HIV in lower-middle-income countries remains unclear. We conducted a randomized, 2 × 2 factorial design trial based in Nairobi, Kenya, to evaluate the efficacy of bupropion versus placebo, and a culturally tailored behavioral cessation therapy, called Positively Smoke Free (PSF), versus standard of care for people with HIV who smoke. The primary outcome was 7-day point prevalence abstinence confirmed by exhaled carbon monoxide <7 ppm at 36 weeks. Between June 2020 and August 2023, 300 participants were randomly assigned. Most participants were men (71.4%) who were moderately dependent on nicotine (Fagerström Test of Cigarette Dependence, mean [SD]: 4.5 [2.3]; range: 0-10; higher scores represent greater physical dependence on nicotine); nearly all participants (99.7%) were taking antiretroviral medication. At 36 weeks, 31.3% of participants who received bupropion were abstinent from smoking, compared with 13.3% in the placebo group (odds ratio, 2.95; 95% confidence interval [CI], 1.64-5.32, P<0.001). Among participants randomized to receive PSF therapy, 29.5% were abstinent from smoking, compared with 14.9% in the standard of care group (odds ratio, 2.39; 95% CI, 1.34-4.25, P=0.003). The combination of bupropion+PSF was associated with increased abstinence compared with either bupropion (38.9% vs. 23.6%; odds ratio, 2.06; 95% CI, 1.00-4.23) or PSF (38.9% vs. 20.3%; odds ratio, 2.50; 95% CI, 1.20-5.24) alone. Participants randomized to receive bupropion were significantly more likely to report excessive sweating compared with placebo (50.7% vs. 37.6%; P=0.024). Both bupropion and PSF cessation counseling were effective in promoting abstinence from smoking at 36 weeks. The combined intervention was associated with higher abstinence rates than either therapy alone. (The National Cancer Institute provided support for this trial through grant R01CA225419.).

Varenicline: Efficacy, Precaution, and Safety in Smoking Cessation

Varenicline is a medication used to help people quit smoking when used in conjunction with education and counseling. It is the first-line treatment for smoking cessation and is available in 0.5 mg and 1 mg strength oral tablets. Varenicline is primarily eliminated via the kidney through glomerular filtration, and its excretion is via the renal route, so it is important to monitor renal function before and during treatment. Varenicline has been associated with an increased risk of new psychiatric conditions, anxiety, and mood disorders in some individuals. The use of Varenicline should be accompanied by close monitoring and careful consideration of individual patient factors. While Varenicline can be used in a wide range of patients, its use should be carefully considered in patients with heart or blood vessel disease, renal impairment, psychiatric disorder, or seizure.

Mobile phone-based smoking-cessation intervention in patients with chronic diseases in China: a Sequential Multiple Assignment Randomized Trial (SMART).

Mobile phone-based interventions show promise for smoking cessation but often face low engagement. This study assessed the feasibility and preliminary effectiveness of a 2-phase, multi-component mobile phone-based smoking cessation intervention for patients with chronic diseases. This Sequential Multiple Assignment Randomized Trial (SMART) recruited smokers with chronic diseases from hospitals in Zhuhai, China. Participants received brief cessation advice and were randomized to personalized chat support (PCS, n=64) or group chat support (GCS, n=64) for 1 month. At 1-month, PCS non-responders (continuing smokers) were re-randomized to receive either multi-component optional support (MOS) or continued PCS for 2 months. GCS non-responders were re-randomized to receive PCS or continued GCS. Responders continued with their initial intervention for 2 months. Feasibility outcomes included eligibility, participation, retention, intervention engagement, and satisfaction. Preliminary effectiveness was assessed by abstinence rates among non-responders. Of 160 screened, 128 (all male, 46.1% aged≤39 years) participated. At 1-month, 51 and 53 non-responded to PCS and GCS, respectively. Of them, 26 were re-randomized to receive PCS-MOS and 26 to receive GCS-PCS. At 6-month, PCS-MOS showed a non-significant higher validated abstinence rate compared to PCS alone (11.5% vs. 4.2%, odds ratio [OR] 3.13, 95%CI 0.30-32.31, P=0.34), GCS-PCS showed a non-significant lower validated abstinence rate compared to GCS (0% vs. 11.1%, OR 0.50, 95%CI 0.15-1.67, P=0.26). This trial showed the feasibility of leveraging hospital visits as teachable opportunities and integrating mobile phone-based smoking cessation support into chronic disease management in China. Optional treatments alongside mobile support showed preliminary effectiveness.

Prize-based Incentives for Smoking Cessation Among People with HIV: A Sequential Multiple Assignment Randomized Trial (SMART).

Contingency management (CM) is an incentive-based approach that has demonstrated efficacy for smoking cessation in various populations. There is an unmet need for feasible and effective smoking cessation interventions in people with HIV (PWH). The study purpose is to assess efficacy of prize-based CM for smoking cessation in PWH using a Sequential Multiple Assignment Randomization Trial (SMART) design selected to tailor intervention intensity based on early treatment response. During phase 1, 129 participants were randomly assigned to high-magnitude prize CM (HM-CM) or standard of care (SoC) for 4 weeks. Participants who did not reduce smoking were randomized in Phase 2 to continued counseling with HM-CM plus monitoring support or only continued monitoring support for 8 weeks. Participants who reduced smoking were randomized to booster monitoring with low-magnitude CM or no additional care. Outcomes were biochemically-verified smoking reduction and 7-day abstinence prevalence at post-treatment, 6-month and 12-month follow-up. Phase 1 responders (based on biochemical indicators of smoking reduction) were significantly less likely to return to smoking (during treatment and at 6- and 12-months) if they received low-magnitude incentives. Notably, initial exposure to CM vs. SoC did not increase rate of phase 1 response, and high-magnitude incentives later in treatment did not lead to greater smoking cessation for early treatment non-responders. Weekly CM sessions in the first four weeks of smoking cessation intervention did not perform significantly better than SoC. However, brief booster CM sessions aimed at maintaining early smoking cessation hold clinical promise and warrant further investigation. This represents the first trial to examine the use of contingency management for smoking cessation among people with HIV within the context of a Sequential Multiple Assignment, Randomized Trial (SMART) design.

Disparities in Tobacco Smoking by Sex and Employment Status: Results from South Africa’s First Global Adult Tobacco Survey

Background/Objectives: Tobacco smoking is a cause of premature death and illness globally. This study examined the prevalence and factors associated with tobacco smoking among South African adults according to sex, education, and employment status among socio-demographic subgroups. Methods: Data were obtained from the 2021 South African Global Adult Tobacco Survey (a nationally representative household survey using a multi-stage stratified cluster random sampling design). The 6,311 participants were aged 15+ years. Descriptive statistics, chi-square tests, and multiple logistic regression analysis were used to investigate relationships between current smoking and socio-demographic variables. Results: Smoking prevalence was 25.8% (n = 1573) (41.2% among men, 11.5% among women; 29.9% among working individuals, 23.1% among non-working individuals). The multiple logistic regression results showed that males aged 45–64 were twice as likely to be currently smoking than males aged 15–24. Coloured (of mixed race) males were twice as likely to smoke as Black African males. Males with secondary/post-secondary education were less likely to smoke compared to males with no education. Coloured females were seven times and White females were almost five times more likely to smoke than Black African females. Females with post-secondary education were less likely to smoke than those with no formal education. Females earning an income were more likely to smoke compared to those with no income. Non-working participants aged 25–44 and 45–64 were more likely to smoke compared to those aged 15–24 years. Working and non-working Coloured and working White individuals were three times more likely to smoke than working or non-working Black Africans. Conclusion: Groups with higher identified smoking prevalence may indicate where smoking cessation interventions should be targeted to reduce national smoking prevalence.

Perceptions of the Use of Mobile Technologies for Smoking Cessation: Focus Group Study With Individuals of Low Socioeconomic Status Who Smoke.

The use of mobile technologies to deliver behavioral health interventions, including smoking cessation support, has grown. Users' perceptions are important determinants of the adoption and use of new technologies. However, little is known about users' perceptions of mobile technologies as smoking cessation aids, particularly among disadvantaged individuals who smoke. This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke. In total, 38 current cigarette smokers, 18 to 29 years old, who wanted to quit and did not have a 4-year college degree nor were enrolled in a 4-year college, participated in 12 semistructured digital focus groups. The moderation guide was guided by the Unified Theory of Acceptance and Use of Technology. Discussions were audio recorded, transcribed verbatim, and coded for the Unified Theory of Acceptance and Use of Technology constructs (ie, effort expectancy, facilitating conditions, performance expectancy, and social influence), sentiment (ie, negative, neutral, and positive), and purpose of using mobile technologies (ie, lifestyle and health management and smoking cessation) following a deductive thematic analysis approach. Participants had positive experiences using mobile technologies for lifestyle and health management, primarily for fitness and dietary purposes. Salient themes were facilitating conditions of use (44/80, 55%), with prior experiences and costs subthemes, followed by perceived usefulness of mobile technologies in helping users attain health goals (22/80, 27.50%), which were generally positive. Ease of use (11/80, 13.75%) and social influences (3/80, 3.75%) were minimally discussed. Conversely, participants had limited awareness of smoking cessation uses of mobile technologies, which was the primary barrier under facilitating conditions discussed (33/51, 64.70%). Participants expressed skepticism about the usefulness of mobile technologies in helping them quit smoking (14/51, 27.45%). Effort expectancy was not discussed, given participants' limited prior use. Social influences on mobile technology use for smoking cessation were minimally discussed (4/51, 7.84%). The use of mobile technologies for smoking cessation was unknown to young adults with low socioeconomic status who smoke. To reduce cigarette smoking and associated health disparities, increasing awareness and use of evidence-based mobile-based smoking cessation interventions are needed. Smoking cessation interventions should incorporate features perceived as useful and easy to use to capitalize on positive user experiences and the acceptability of mobile technologies for lifestyle and health management.

Preoperative Smoking-Cessation Interventions to Prevent Postoperative Complications: A Quality Assessment and Overview of Systematic Review Evidence.

Multiple systematic reviews have investigated the effectiveness of preoperative interventions for smoking-cessation, although relatively few have focused on the prevention of surgical complications. This overview of systematic reviews aimed to describe the types of smoking interventions studied to prevent postoperative complications, summarize the results, and evaluate the quality of the reviews and strength of evidence to inform clinicians, health practitioners, policy developers, and government bodies. Comprehensive searches of Cochrane Library, MEDLINE, EMBASE, CINAHL, and Johanna Briggs Institute databases were conducted to identify systematic reviews of preoperative smoking-cessation interventions to prevent surgical complications (inception-May 14, 2024). Search results were independently screened by 2 reviewers for articles meeting the eligibility criteria. Data on key review characteristics and included studies were extracted: aim, search strategy, included studies, risk of bias, population, sample size, intervention, comparator, main findings, and conclusions. Quality appraisal of the reviews was undertaken using the AMSTAR 2 tool and evidence certainty was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Sixty-seven full-text articles from 838 citations were screened, resulting in 6 included systematic reviews with 12 primary studies reporting postoperative complications. Four reviews which included all primary studies, provided moderate to high strength of evidence. There was high-certainty evidence suggesting interventions started ≥4 weeks before surgery incorporating multiple behavioral support sessions and pharmacotherapy are needed to prevent postoperative complications, particularly the incidence of surgical site infections. High-certainty evidence also indicates the duration of smoking-cessation is important, with benefits amplified for longer periods. However, medium- to high-certainty evidence suggests interventions initiated <4 weeks before surgery even with multiple behavioral support sessions (with or without pharmacotherapy), and interventions commenced >4 weeks before surgery but with only 1 interventional component, increase quit rates but do not reduce complications. This overview provides the most up-to-date summary and quality assessment of systematic review evidence on the effectiveness of preoperative smoking-cessation interventions to prevent surgical complications. The evidence supports providing smoking-cessation interventions which include multiple behavioral support sessions and pharmacotherapy implemented at least 4 weeks before surgery to reduce postoperative complications. Consequently, anesthesiologists need to work with primary care physicians, consultants, and surgeons to optimize smoking-cessation interventions way in advance of surgery.

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

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

Effectiveness and experience of implementing digital interventions to promote smoking cessation among adults with severe mental illness: A systematic review and meta-analysis.

Digital technology is increasingly used to support interventions targeting smoking cessation in people with severe mental illness (SMI). However, little is known about their implementation and effectiveness in this population. We aimed to determine their effectiveness, stakeholder experiences, factors influencing implementation, and quality of reporting of digital interventions for smoking cessation in adults living with SMI. Five online bibliographic databases were searched for articles published between 31 December 2000 and 31 January 2023. Studies involving adults accessing treatment for alcohol and substance use disorders, neurocognitive disorders and terminal illnesses were excluded. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). A Mantel-Haenszel random-effects meta-analysis of randomized controlled trials (RCTs) was conducted. Participant experience and intervention implementation were explored using a narrative synthesis. Quality of reporting of interventions was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. Thirty-one studies enrolling 3,794 participants were included. Meta-analysis of biochemically verified abstinence at longest follow-up (month-1 to month-6) did not find an overall effect in favour of intervention [risk ratio (RR) = 0.66, 95% confidence interval (CI) = -0.005 - 1.37]. Interventions tailored to people with SMI were perceived as acceptable. Implementation strategies concentrated on overcoming practical challenges at the participant/user level. No evidence of the effectiveness of digital interventions to support smoking cessation in people with SMI was found. The importance of tailoring interventions to the needs of people with SMI is highlighted. Robust reporting of implementation is required to enhance future efforts to support smoking cessation in adults with SMI. The findings of this review add to the emerging evidence on digital interventions to support smoking cessation among people with SMI. We highlight the importance of tailoring interventions to the population, particularly considering the role of mental illness and the side effects of psychotropic medication in the accessibility and usability of digital interventions.

A Scoping Review of Factors Influencing Smoking Cessation in Patients with Chronic Obstructive Pulmonary Disease.

To provide a scoping review of studies on factors affecting smoking cessation in patients with chronic obstructive pulmonary disease (COPD), so as to provide a basis for healthcare professionals to intervene early in the process of cessation of smoking in patients with COPD, and to formulate personalized interventions for smoking cessation. Arksey and O'Malley's scoping review methodology as a framework, searched databases including CNKI, Wanfang Data, VIP, China Biomedical Database, PubMed, Web of Science, Embase, ProQuest, CINAHL, and Cochrane Library to collect literature on factors influencing smoking cessation among COPD patients. The literature was screened, data extracted, and summarized accordingly. A total of 28 papers were included. The socio-demographic related factors affecting smoking cessation in patients with COPD were age, educational level, residence, marital status, occupational status, economic status, race, and sex; tobacco related factors included smoking index, smoking duration (years), cumulative smoking (packs/year), smoking intensity (packs/day), and tobacco addiction; disease related factors included mMRC score, GOLD level, severity of airflow restrictions, symptom, activity limitation due to lung problems, history of deterioration in outpatient care, receipt of COPD medication, receipt of lung CT, receipt of pulmonary function tests, receipt of surgery, and comorbid comorbidities; psychologically related factors included mental health status, quit smoking health beliefs, smoking cessation self-efficacy, motivation to quit smoking, stress, and adverse emotions; environmental/Interpersonal network related factors-included environmental impacts, social support, family support, tobacco control policies, and satisfaction with cessation care; and behavior related factors included alcohol consumption, coffee consumption, eating, physical activity, and have a hobby. Healthcare professionals should avoid critical education of COPD patients in the process of smoking cessation management, pay attention to the adverse effects of medication side effects on patients, emphasize the improvement of patients' health beliefs and self-efficacy in smoking cessation, and help patients to establish a correct cognition of smoking cessation.