Subsequent Quit Attempts Research Articles

New converts and seasoned campaigners: the role of social identity at different stages in the addiction recovery journey

Social identities associated with recovery are protective of relapse from addiction. How such identities develop and differentially link to outcomes at different points of the recovery journey and across multiple recovery attempts is relatively unknown. The current study utilised a pre-existing cross-sectional dataset (n = 237 Alcoholics Anonymous (AA) members, 50% male, 49.4% female and 0.6% female-to-male, aged between 19 and 71 years) to explore these issues. Relationships between AA identity, quit efficacy (a proxy for recovery maintenance) and AA meeting attendance (over the last month) were tested. The moderating effects of length of AA attendance during the current recovery episode and first vs. subsequent quit attempts on the identity-efficacy link were also tested. Levels of social identity were stable amongst those in the early in their current recovery through to those who have more experience, but the relationships between identity and efficacy differed. While those early on in their current AA attendance showed a positive relationship between identities and frequency of attending meetings, those with more long-standing attendance reported social identification unrelated to involvement. Our results suggest that social identities may be particularly protective for those who are on their first quit, suggesting recovery formation and transition may be a priority.

Reducing pediatric exposure to environmental tobacco smoke: The effects of pediatric exposure to environmental tobacco smoke and the role of pediatric perioperative care.

Exposure to environmental tobacco smoke (ETS) has deleterious effects on a child's general health and their perioperative risk; specifically, it doubles a child's perioperative risk of adverse respiratory events, particularly laryngospasm. It increases the risk of sudden infant death syndrome, bacterial meningitis, middle ear infection, asthma, and lower respiratory tract infection. The preoperative assessment of children presenting for procedures under general anesthesia is an opportune moment to screen for exposure to ETS and give information about the risks and cessation support (if applicable). This can be described as a "teachable moment"; there is a documented need for this public health education and it aligns with the NHS Long Term Plan, aiming to embed public health information into every consultation a patient or family has with a healthcare practitioner. The period preceding and following surgery is a time when patients or their families are motivated to make a behavioral change. It has been shown that parents who smoke are more likely to attempt smoking cessation if their child has had recent surgery but not to maintain their abstinence; however, we know that subsequent quit attempts increase the likelihood that a smoker will succeed in permanently abstaining so aiming for a quit attempt rather than permanent abstinence is a valid aim. A suggested screening method would be to firstly ask all parents or carers in the preoperative health screening questionnaire about their child's exposure to ETS, accepting this lacks both the sensitivity and specificity of a valid screening tool. This can be augmented by measuring exhaled carbon monoxide in any child who is able to comply with the test; exhaled carbon monoxide has been shown to be a valid screening tool for exposure to ETS in adolescents but not children under 12years of age, perhaps because smaller children may not be able to cooperate with the test which requires a vital capacity maneuver to provide an adequate endtidal sample. A suggested model for smoking cessation intervention is called Very Brief Advice and comprises three parts: Ask about a child's exposure to ETS with/without exhaled carbon monoxide measurement Advise about the risks to the child's general and perioperative health and the health of the smoker and wider family plus the benefits of smoking cessation Act on the response by referring to local smoking cessation support. Referral to local smoking cessation services should be along established pathways. Thus, recording a household smoking status and referring to local smoking cessation services targets a public health measure with benefits beyond the individual patient and planned anesthetic. There is no evidence in the literature of the effect of environmental exposure to electronic cigarettes ("vaping") on a child's perioperative health. Further research is needed to establish if preoperative reduction in or removal from exposure to ETS reduces the risk of respiratory adverse events in the child.

Cessation Conversations and Quit Attempts: Differences by Ethnicity and Language Preference.

Objectives: Conversations about pictorial cigarette health warning labels (HWLs) encourage quit attempts, and prior research suggests prevalence of these conversations varies by ethnicity. We assessed the frequency of conversations about text-only HWLs among Latino and non-Latino white smokers and the relationship between conversations and subsequent quit attempts. Methods: Latino and non-Latino white adult smokers in the United States (N = 4403) were surveyed every 4 months over 2 years. Surveys queried smoking behaviors, recent quit attempts, HWL responses, including HWL conversations, and socio-demographic variables. Negative binomial generalized estimating equation (GEE) models regressed the frequency of HWL conversations on study variables. Logistic GEE models regressed quit attempts at follow-up surveys on responses from the prior wave, including frequency of HWL conversations and their interaction with ethnicity. Results: Spanish preference Latinos reported the most HWL conversations (85%), followed by English preference Latinos (59%), and non-Latino Whites (35%). More frequent HWL conversations predicted subsequent quit attempts (AOR = 1.74, 95% CI = 1.32, 2.30), but ethnicity did not moderate this effect. Conclusions: Latinos appear to talk more frequently about HWLs than non-Latino Whites but are no more likely to quit as a result. Cessation campaigns should use messages that encourage conversations about quitting.

If at first you don’t succeed, when should you try again? A prospective study of failed quit attempts and subsequent smoking cessation

ObjectiveTo assess the association between likelihood of success of smoking cessation attempts and time since most recent attempt. MethodsProspective study of 823 smokers who reported a failed quit attempt in the last 12 months at baseline and ≥1 quit attempt over 6-month follow-up. The input variable was time in months between the end (and in an exploratory analysis, the start) of the most recent failed quit attempt reported retrospectively at baseline and start of the first attempt made during the 6-month follow-up period. The outcome variable was success in the latter quit attempt. ResultsSuccess rates for failed quitters who waited <3, 3–6, and 6–12 months between their failed quit attempt ending and making a subsequent quit attempt were 13.8%, 17.5%, and 19.0% respectively. After adjustment for covariates, the odds of cessation relative to those who made a subsequent quit attempt within 3 months were 1.42 (95%CI 0.79–2.55) and 1.52 (95%CI 0.81–2.86) for those who waited 3–6 and 6–12 months respectively before trying again. Bayes factors indicated the data were insensitive. The exploratory analysis showed the odds of cessation were 1.55 (95%CI 0.78–3.08), 1.92 (95%CI 0.94–3.92), and 2.47 (95%CI 1.04–5.83) greater for those with an interval of 3–6, 6–12, and 12–18 months respectively than those who tried again within 3 months. ConclusionsWhile pre-planned analyses were inconclusive, exploratory analysis of retrospective reports of quit attempts and success suggested the likelihood of success of quit attempts may be positively associated with number of months since beginning a prior quit attempt. However, only the longest inter-quit interval examined (12–18 months) was associated with significantly greater odds of quit success relative to a <3 month interval in fully adjusted models; all other comparisons were inconclusive.

Smokers’ identity and quit advice in general practice: General practitioners need to focus more on female smokers

ObjectiveWe examined smoker and non-smoker self-identities among smokers visiting their general practitioner (GP) for other reasons than smoking cessation counselling. We determined whether identity impacted on patients’ appreciation of GP-initiated conversations about smoking and quit advice, and subsequent quit attempts, and examined the role of gender. MethodsSecondary analyses of a cluster-randomised controlled trial in which baseline and 12-month follow-up data were collected among 527 daily (n=450) and non-daily smokers (n=77). ResultsParticipants identified more with smoking than non-smoking. Participants with stronger non-smoker self-identities were more often female, appreciated the conversation about smoking more, were more likely to receive quit-advice and to have attempted to quit at 12-month follow-up. Participants with stronger smoker self-identities were also more often female, and appreciated the conversation more. Men with stronger non-smoker self-identities were more often asked about smoking and advised to quit, and appreciated the conversation more than women. ConclusionNon-smoker identity was more important for receiving quit-advice, appreciation, and quit attempts than smoker identity. Future research needs to unravel why female smokers appreciated the conversation less than male smokers. Practice implicationsWe suggest to incorporate an identity-component in smoking cessation interventions. GPs should increase their focus on female patients who smoke.

Development and initial validation of a cessation fatigue scale

BackgroundSmoking cessation fatigue, or tiredness of attempting to quit smoking, has been posited as a latent construct encompassing loss of motivation, loss of hope in cessation success, decreased self-efficacy, and exhaustion of self-control resources. Despite the potential clinical impact of characterizing cessation fatigue, there is currently no validated measure to assess it. Using a rational scale development approach, we developed a cessation fatigue measure and examined its reliability and construct validity in relation to a) smokers’ experience of a recently failed quit attempt (QA) and b) readiness to engage in a subsequent QA. MethodsData were drawn from an online cross-sectional survey of 484 smokers who relapsed from a QA within the past 30days. ResultsExploratory factor analysis identified three factors within the 17-item Cessation Fatigue Scale (CFS), which we labeled: emotional exhaustion, pessimism, and devaluation. High internal consistency was observed for each factor and across the full scale. As expected, CFS overall was positively associated with withdrawal severity and difficulty quitting. CFS was negatively associated with previously validated measures of intention to quit, self-efficacy, and abstinence-related motivational engagement, even after adjusting for nicotine dependence. ConclusionsFindings provide initial validation for a new tool to assess cessation fatigue and contribute needed information on a theory-driven component of cessation-related motivation and relapse risk.

Effectiveness of Switching Smoking-Cessation Medications Following Relapse

Nicotine dependence is a chronic disorder often characterized by multiple failed quit attempts (QAs). Yet, little is known about the sequence of methods used across multiple QAs or how this may impact future ability to abstain from smoking. This prospective cohort study examines the effectiveness of switching smoking-cessation medications (SCMs) across multiple QAs. Adult smokers (aged ≥18 years) participating in International Tobacco Control surveys in the United Kingdom, U.S., Canada, and Australia (N=795) who: (1) completed two consecutive surveys between 2006 and 2011; (2) initiated a QA at least 1 month before each survey; and (3) provided data for the primary predictor (SCM use during most recent QA), outcome (1-month point prevalence abstinence), and relevant covariates. Analyses were conducted in 2016. Five SCM user classifications were identified: (1) non-users (43.5%); (2) early users (SCM used for initial, but not subsequent QA; 11.4%); (3) later users (SCM used for subsequent, but not initial QA; 18.4%); (4) repeaters (same SCM used for both QAs; 10.7%); and (5) switchers (different SCM used for each QA; 14.2%). Abstinence rates were lower for non-users (15.9%, OR=0.48, p=0.002), early users (16.6%, OR=0.27, p=0.03), and repeaters (12.4%, OR=0.36, p=0.004) relative to switchers (28.5%). Findings suggest smokers will be more successful if they use a SCM in QAs and vary the SCM they use across time. That smokers can increase their odds of quitting by switching SCMs is an important message that could be communicated to smokers.

A pilot trial of In vivo NRT sampling to increase medication adherence in community corrections smokers

BackgroundIndividuals in the criminal justice system demonstrate high rates of cigarette use (70–80%) and low adherence to smoking cessation medication. Educational approaches have not been shown to promote adherence or cessation, though medication sampling has boosted both use and cessation. The objective of the present study was to determine whether In vivo nicotine replacement therapy (NRT) sampling approach increases NRT adherence among criminal justice smokers during a subsequent quit attempt. MethodsWe conducted a pilot study with 43 community corrections smokers randomized to a 4-session (one 30-min session per week) precessation intervention of either In vivo NRT sampling (Session 1: patch; Session 2: gum; Session 3: combination NRT (cNRT); Session 4: review) vs. 4 time-matched sessions of standard smoking cessation with cNRT started after Session 1. Both groups received an additional 8weeks of cNRT following the four intervention sessions. ResultsDuring the in vivo administration of NRT, total withdrawal and craving severity significantly decreased from pre- to post-session compared to Control participants. In vivo participants evinced greater patch use at Session 4 and greater gum use through Week 8 relative to Controls. DiscussionIn vivo NRT sampling may increase NRT adherence relative to standard counseling sessions among criminal justice smokers. A larger trial of this novel intervention appears to be warranted.

Impact of graphic pack warnings on adult smokers' quitting activities: Findings from the ITC Southeast Asia Survey (2005-2014).

Malaysia introduced graphic health warning labels (GHWLs) on all tobacco packages in 2009. We aimed to examine if implementing GHWLs led to stronger warning reactions (e.g., thinking about the health risks of smoking) and an increase in subsequent quitting activities; and to examine how reactions changed over time since the implementation of the GHWLs in Malaysia and Thailand where GHWL size increased from 50-55% in 2010. Data came from six waves (2005-2014) of the International Tobacco Control Southeast Asia Survey. Between 3,706 and 4,422 smokers were interviewed across these two countries at each survey wave. Measures included salience of warnings, cognitive responses (i.e., thinking about the health risks and being more likely to quit smoking), forgoing cigarettes, and avoiding warnings. The main outcome was subsequent quit attempts. Following the implementation of GHWLs in Malaysia, reactions increased, in some cases to levels similar to the larger Thai warnings, but declined over time. In Thailand, reactions increased following implementation, with no decline for several years, and no clear effect of the small increase in warning size. Reactions, mainly cognitive responses, were consistently predictive of quit attempts in Thailand, but this was only consistently so in Malaysia after the change to GHWLs. In conclusion, GHWLs are responded to more frequently, and generate more quit attempts, but warning wear-out is not consistent in these two countries, perhaps due to differences in other tobacco control efforts.

Interpersonal communication about pictorial health warnings on cigarette packages: Policy-related influences and relationships with smoking cessation attempts

This study evaluated the relationship between interpersonal communication about cigarette health warning labels (HWLs), psychological responses to HWLs, and smoking cessation attempts. Data were analyzed from online consumer panels of adult smokers in Australia, Canada and Mexico, during implementation of new pictorial health warning labels (HWLs) on cigarette packs. Approximately 1000 adult smokers were surveyed in each country every four months (September 2012, January 2013, May 2013, September 2013, January 2014). Only smokers followed for at least two waves were included in the analytic sample. Participants reported the frequency of talking about HWLs in the last month (in general, with family members, and with friends). For each country, poisson generalized estimating equation (GEE) models were estimated to assess the bivariate and adjusted correlates of talking about HWLs. Logistic GEE models regressed having attempted to quit by the subsequent wave on HWL talk, sociodemographics and psychological responses to HWLs. The frequency of HWL talk gradually decreased in Canada (48%–36%) after new HWLs were implemented; an increase (30%–58%) in Australia corresponded with implementation of new HWLs, after which talking stabilized; and the frequency of HWL talk in Mexico was stable over time, where new HWLs are implemented every six months. Talk about HWLs was an independent predictor of subsequent quit attempts in Canada (AOR = 1.50; 95% CI = 1.11–2.02), Australia (AOR = 1.41; 95% CI = 1.05–1.89), and Mexico (AOR = 1.53; 95% CI = 1.11–2.10), as was cognitive responses to HWLs (Australia AOR = 1.66; 95% CI = 1.22–2.24; Canada AOR = 1.56; 95% CI = 1.15–2.11; Mexico AOR = 1.30; 95% CI = 0.91–1.85). No interaction between talk and cognitive reactions to HWLs were found. These results suggest that interpersonal communication about HWLs influences smoking cessation attempts independent of other established predictors of smoking cessation, including cessation-related HWL responses. Future research should determine ways to catalyze interpersonal communication about HWLs and thereby potentiate HWL effects.

The effect of exposure to media campaign messages on adult cessation

IntroductionNumerous studies have examined the relationship between antitobacco mass-media campaigns and quit attempts. However, less is known about the effect of these campaigns on relapse. This paper evaluates the effect of media exposure on smokers' quit attempts and relapse. MethodsWe used data from the Florida Adult Cohort Survey, a telephone follow-up survey of adult smokers and recent quitters, who completed the Florida Adult Tobacco Survey. For this study, 1823 unique smokers and recent quitters from baseline first observed between July 2008 and October 2012 were surveyed through up to seven follow-up interviews between October 2009 and October 2013. Media exposure during this period primarily represents exposure to Florida's Tobacco Free Florida (TFF) campaign, although it also includes exposure to the Centers for Disease Control and Prevention's Tips From Former Smokers media campaign in 2012–2013. A multiple-spell discrete-time survival model was estimated using logistic regression. Each spell represents a quit attempt or relapse event. ResultsThe odds of the first observed quit attempt are higher at higher levels of target rating points (TRPs) (aOR=1.02, p=0.023). The odds ratio for relapse and second quit and second relapse was not statistically significant. ConclusionsThe results suggest that exposure to media campaign messages in Florida has led to increases in quit attempts. Although the estimates were not statistically significant for relapse or the second spell of quit attempts or relapse, the results suggest that media messages might also influence subsequent quit attempts or relapses after an initial quit attempt.

Quitting activity and tobacco brand switching: findings from the ITC‐4 Country Survey

ObjectiveAmong Australian smokers, to examine associations between cigarette brand switching, quitting activity and possible causal directions by lagging the relationships in different directions. MethodsCurrent smokers from nine waves (2002 to early 2012) of the ITC‐4 Country Survey Australian dataset were surveyed. Measures were brand switching, both brand family and product type (roll‐your‐own versus factory‐made cigarettes) reported in adjacent waves, interest in quitting, recent quit attempts, and one month sustained abstinence. ResultsSwitching at one interval was unrelated to concurrent quit interest. Quit interest predicted switching at the following interval, but the effect disappeared once subsequent quit attempts were controlled for. Recent quit attempts more strongly predicted switching at concurrent (OR 1.34, 95%CI=1.18–1.52, p<0.001) and subsequent intervals (OR 1.31, 95%CI=1.12–1.53, p=0.001) than switching predicted quit attempts, with greater asymmetry when both types of switching were combined. One month sustained abstinence and switching were unrelated in the same interval; however, after controlling for concurrent switching and excluding type switchers, sustained abstinence predicted lower chance of switching at the following interval (OR=0.66, 95%CI=0.47–0.93, p=0.016). ConclusionsThe asymmetry suggests brand switching does not affect subsequent quitting. ImplicationsBrand switching does not appear to interfere with quitting.

Mediational pathways of the impact of cigarette warning labels on quit attempts.

To test and develop, using structural equation modeling, a robust model of the mediational pathways through which health warning labels exert their influence on smokers' subsequent quitting behavior. Data come from the International Tobacco Control Four-Country Survey, a longitudinal cohort study conducted in Australia, Canada, the United Kingdom, and the United States. Waves 5-6 data (n = 4,988) were used to calibrate the hypothesized model of warning label impact on subsequent quit attempts via a set of policy-specific and general psychosocial mediators. The finalized model was validated using Waves 6-7 data (n = 5065). As hypothesized, warning label salience was positively associated with thoughts about risks of smoking stimulated by the warnings (β = .58, p < .001), which in turn were positively related to increased worry about negative outcomes of smoking (β = .52, p < .001); increased worry in turn predicted stronger intention to quit (β = .39, p < .001), which was a strong predictor of subsequent quit attempts (β = .39, p < .001). This calibrated model was successfully replicated using Waves 6-7 data. Health warning labels seem to influence future quitting attempts primarily through their ability to stimulate thoughts about the risks of smoking, which in turn help to raise smoking-related health concerns, which lead to stronger intentions to quit, a known key predictor of future quit attempts for smokers. By making warning labels more salient and engaging, they should have a greater chance to change behavior.

Smoking-related thoughts and microbehaviours, and their predictive power for quitting

BackgroundNegative attitudes to smoking are well-established predictors of intentions to quit and quit behaviours, but less attention has been given to whether quitting is influenced by smoking-related thoughts and microbehaviours...

Reported Exposures to Anti-smoking Messages and Their Impact on Chinese Smoker's Subsequent Quit Attempts

It is important to monitor whether anti-smoking messages (if any) are noticed by the public in China and whether they have any impact on smokers’ quitting behaviours over time. This study aimed to examine Chinese smokers' exposure to anti-smoking messages in a range of channels and to determine if exposure was associated with subsequent quit attempts. A prospective cohort design was employed. Participants were 6,509 adult smokers who completed at least one of the first three waves (2006-2009) of the International Tobacco Control (ITC) China Survey sampled from six Chinese cities. The main measures were reported exposure to anti-smoking messages in a range of channels and smokers' subsequent quit attempts. Generalized Estimating Equations (GEE) modelling was used to combine respondents from all three waves while accounting for inherent within-person correlation. The overall exposure levels to anti-smoking messages were low and varied between cities and from one channel to another. Television was the medium with the greatest overall exposure (over 50% in almost all the cities across all the waves). After controlling for a range of covariates, higher level of combined exposure were positively related to higher subsequent quit attempts (adjusted odds ratio=1.03, 95% CI 1.02~1.05, p <.001); among the individual channels, exposures in newspapers and on posters were significant in their own right. The findings suggest that anti-smoking warning messages have the potential to stimulate Chinese smokers to make quit attempts, but they also indicate that the levels and strength of warning messages in China need to be increased. China should consider adopting proven international practices, including mandating pictorial health warnings on cigarette packages, adopting prominent point-of-sale warnings, and carrying out strong and ongoing mass media campaigns.

Stronger pack warnings predict quitting more than weaker ones: finding from the ITC Malaysia and Thailand surveys

BackgroundWe examined the impact of cigarette pack warning labels on interest in quitting and subsequent quit attempts among adult smokers in Malaysia and Thailand.MethodsTwo overlapping cohorts of adults who reported smoking factory- made cigarettes from Malaysia and Thailand were interviewed face-to-face (3189 were surveyed at baseline and 1781 re-contacted at Wave 2; 2361 current smokers were surveyed at Wave 2 and 1586 re-contacted at Wave 3). In Thailand at baseline, large text only warnings were assessed, while at Wave 2 new large graphic warnings were assessed. In Malaysia, during both waves small text only warnings were in effect. Reactions were used to predict interest in quitting, and to predict making quit attempts over the following inter-wave interval.ResultsMultivariate predictors of “interest in quitting” were comparable across countries, but predictors of quit attempts varied. In both countries, cognitive reactions to warnings (adjusted ORs; 1.57 & 1.69 for Malaysia at wave 1 and wave 2 respectively and 1.29 & 1.19 for Thailand at wave 1 and wave 2 respectively), forgoing a cigarette (except Wave 2 in Malaysia) (adjusted ORs; 1.77 for Malaysia at wave 1 and 1.54 & 2.32 for Thailand at wave 1 and wave 2 respectively), and baseline knowledge (except wave 2 in both countries) (adjusted ORs; 1.71 & 1.51 for Malaysia and Thailand respectively) were positively associated with interest in quitting at that wave. In Thailand only, “cognitive reactions to warnings” (adjusted ORs; 1.12 & 1.23 at wave 1 and wave 2 respectively), “forgoing a cigarette” (adjusted OR = 1.55 at wave 2 only) and “an interest in quitting” (adjusted ORs; 1.61 & 2.85 at wave 1 and wave 2 respectively) were positively associated with quit attempts over the following inter-wave interval. Salience was negatively associated with subsequent quit attempts in both Malaysia and Thailand, but at Wave 2 only (adjusted ORs; 0.89 & 0.88 for Malaysia and Thailand respectively).ConclusionWarnings appear to have common mechanisms for influencing quitting regardless of warning strength. The larger and more informative Thai warnings were associated with higher levels of reactions predictive of quitting and stronger associations with subsequent quitting, demonstrating their greater potency.

The role of desire, duty and intention in predicting attempts to quit smoking

Motivation to quit smoking predicts quit attempts, although little is known about the role played by its different aspects. This study assessed the predictive value of desire, duty and intention to quit, three different aspects of motivation. A longitudinal study was conducted involving a nationally representative sample of smokers assessed at baseline and 3 and 6 months later. Baseline assessment took place by face-to-face computer-assisted interviews; follow-up assessments by postal questionnaires. England. From April 2008 to June 2009, a total of 5593 adult smokers were recruited; 1263 were followed-up at 3 months and 1096 at 6 months. Three dichotomous measures of motivation to quit (wanting to quit, believing one ought to quit, intention to quit soon) were taken at baseline. Whether a subsequent quit attempt was made was recorded at 3- and 6-month follow-up. More smokers believed they ought to quit smoking than wanted to or intended to soon (39.0, 29.3 and 23.5%, respectively). Desire and intention were independent predictors of quit attempts at both follow-ups, whereas combining them did not add predictive value and duty was not a predictor. While the predictive value of desire or intention alone disappeared when accompanied by duty, their combination was robust against its negative effect. Desire and intention independently positively predict quit attempts, while duty appears to mitigate their effect. It would be worth monitoring all three aspects of motivation when evaluating the impact of smoking cessation interventions on motivation to quit.

Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerström Test for Nicotine Dependence and its components

Measuring the strength of urges to smoke during a normal smoking day among smokers in a culture where smoking is restricted could provide a good measure of the severity of cigarette dependence. An important criterion for a measure of cigarette dependence is how well it predicts failure of attempts to stop smoking. This study compared ratings of Strength of Urges to Smoke (SUTS) with the Fagerström Test of Nicotine Dependence (FTND) and its components, including the Heaviness of Smoking Index (HSI). A longitudinal study involving a household survey of a representative sample of adult smokers at baseline and 6-month follow-up by postal questionnaire. England. A total of 15,740 smokers aged 16 and over underwent the baseline interview; 2593 were followed-up 6 months later, of whom 513 reported having made a quit attempt following the baseline survey but at least 1 month prior to the follow-up. SUTS, FTND, HSI, cigarettes per day, time to first cigarette, age, social grade and gender were measured at baseline. Quit attempts since the baseline assessment and self-reported abstinence were measured at 6-month follow-up. In logistic regressions, all dependence measures predicted success of subsequent quit attempts, but SUTS had the strongest association (beta for SUTS, FTND and HSI: 0.41: P < 0.001, 0.13: P = 0.005, and 0.19: P = 0.003, respectively). In multiple logistic regressions when SUTS was entered as a predictor of abstinence, together with other dependence measures, it remained as the only predictive dependence measure. A simple rating of strength of urges on a normal smoking day appears to be a good predictor of at least short-term quit success in English smokers and as such may be a useful measure of cigarette addiction.

Effect of clinician advice and patient preparedness to quit on subsequent quit attempts in hospitalized smokers

Although smoking cessation counseling for cardiac inpatients is a quality measure, little data exist regarding postdischarge quit attempts in a primarily urban, African American, underserved population. This study aimed to assess preparedness to quit smoking and quit behaviors. Smokers on the cardiology service were asked to rate preparedness using the 10-step Contemplation Ladder. During phone surveys given 30-days postdischarge, patients reported whether they made quit attempts, method and success of attempts, and recall of receiving advice to quit. From February 2006 through July 2007, 2906 of 3364 of inpatients were interviewed. Fifteen percent (436/2906) were current smokers and 415/436 completed the inpatient assessment. Of these, 75% (310/415) indicated they were prepared to quit. At the 1-month follow-up, 67% (276/415) were interviewed and 71% of those patients (195/276) reported making a quit attempt, with most (76%) reporting quitting "cold turkey" (without aid). Compared with less prepared patients, prepared patients were more likely to report making a quit attempt after discharge (77% [163/212] vs. 50% [32/64], P < 0.001) and were successful in that attempt (43% [90/212] vs. 25% [16/64], P = 0.010). The majority of smokers hospitalized with cardiac disease reported being prepared to quit smoking. Those prepared, and who received advice to quit, were more likely to make a quit attempt and report abstinence than those less prepared. However, most quit attempts were made using the least effective methods. Future studies in a population of primarily African American patients should assess preparedness to quit and target prepared patients with more effective interventions.

Recommendations for the Use of Pharmacological Smoking Cessation Strategies in Pregnant Women

Maternal smoking during pregnancy causes significant fetal morbidity and is a public health problem, as 36% of women in the UK and 11% of those in the US smoke during pregnancy. Behavioural support for smoking cessation, provided outside of routine antenatal care, is effective for promoting smoking cessation by pregnant women, but relatively few pregnant women access such support. Effective pharmacological aids to smoking cessation, which have been trialled in nonpregnant populations, include nicotine replacement therapy (NRT), bupropion and varenicline; however, there is very little evidence to justify the use of these drugs in pregnancy. Also, for safety reasons, it is doubtful that definitive trials investigating the effectiveness of either bupropion or varenicline for smoking cessation will be conducted in pregnant women in the foreseeable future. In the short to medium term, research information relating to the use of these drugs in pregnancy is, therefore, likely to be derived from observational studies that are more difficult to interpret than clinical trials. This article assesses the evidence for the effectiveness and safety of using NRT, bupropion and varenicline for smoking cessation during pregnancy. The principle recommendations made are that NRT may be safer than smoking in pregnancy, and pregnant women who have unsuccessfully tried to stop smoking without pharmacotherapy may consider using NRT in subsequent quit attempts after informed discussion with their doctor. There is no evidence, however, that NRT is actually effective for smoking cessation in pregnancy. With currently available evidence, bupropion and varenicline cannot be recommended in pregnancy for smoking cessation.