Programa de controle do tabagismo em Mato Grosso do Sul: oferta, adesão e efetividade / Smoking control program in Mato Grosso do Sul: offer, adherence and effectiveness / Programa de control del tabaquismo en Mato Grosso do Sul: oferta, adherencia y efectividad

Objetivo: O estudo teve por objetivo avaliar o Programa Nacional de Controle do Tabagismo (PNCT) em Mato Grosso do Sul, taxas de cobertura, abandono, cessação, uso de medicamentos, rede de serviços de saúde e as razões pelas quais algumas Equipes de Saúde da Família de Campo Grande ainda não aderiram ao programa. Métodos: Trata-se de uma pesquisa descritiva, com abordagem quantitativa, baseada em dados primários e secundários sobre o PNCT em Mato Grosso do Sul. Os dados primários foram obtidos por meio de questionário aplicado aos profissionais das Equipes de Saúde da Família (ESF) de Campo Grande, sem oferta do programa e avaliados quanto à frequência e presença de correlação entre as variáveis analisadas utilizando V de Cramer e teste de χ2. Os dados secundários foram obtidos do consolidado do Instituto Nacional de Câncer José Alencar Gomes da Silva com os registros produzidos pelos serviços. Resultados: As taxas de adesão, efetividade e apoio farmacológico na capital e interior foram: 66,80 e 59,79%; 20,58 e 34,91%; 32,14 e 99,86%, respectivamente. A oferta do programa ocorreu em 49,37% municípios e 43,85% das Unidades Básicas de Saúde (UBS) estimadas. Houve correlações entre ser capacitado e implantar o programa; treinamento de ingresso e oferta na UBS. As dificuldades relatadas pelos profissionais foram a pandemia de COVID-19, a sobrecarga e/ou equipe pequena e/ou falta de tempo e a ausência de capacitação/treinamento. Conclusões: O PNCT em Mato Grosso do Sul apresenta baixa cobertura e oferta restrita na rede de saúde, além do desempenho mediano de assistência aos tabagistas. Evidencia-se a necessidade de investimento em capacitação/treinamento, prioritariamente para as ESF de Campo Grande, dando-lhes condições de responder às necessidades de promoção da saúde, reconhecendo o programa como de maior custo-efetividade.

Objective: The objective of this study was to evaluate the National Tobacco Control Program (PNCT) in Mato Grosso do Sul, coverage rates, dropout, cessation, use of medication, the health services network and the reasons why Family Health Teams in Campo Grande have not yet joined the program. Methods: This was a descriptive study with a quantitative approach, based on primary and secondary data on the PNCT in Mato Grosso do Sul. The primary data were obtained by means of a questionnaire administered to Family Health Teams (ESF) in Campo Grande, which did not offer the program and evaluated the frequency and presence of correlation between the variables analyzed using Cramer's V test and the χ2 test. The secondary data were obtained from the consolidated records of the José Alencar Gomes da Silva National Cancer Institute with the records produced by the services. Results: The rates of adherence, effectiveness and pharmacological support in the capital and interior were: 66.80 and 59.79%; 20.58 and 34.91%; and 32.14 and 99.86%, respectively. The program was offered in 49.37% of the municipalities and 43.85% of the Basic Health Units (UBS) estimated. There were correlations between being trained and implementing the program and entry training and provision in the UBS. The difficulties reported by professionals were the COVID-19 pandemic, overload and/or a small team and/or lack of time and the absence of training. Conclusions: The PNCT in Mato Grosso do Sul has low coverage and restricted supply in the health network, in addition to average performance in assisting smokers. There is a clear need to invest in capacitation/training, primarily for the ESF in Campo Grande, enabling them to respond to the needs of health promotion, recognizing the program as more cost-effective.

Objetivo: El objetivo de este estudio fue evaluar el Programa Nacional de Control del Tabaco (PNCT) en Mato Grosso do Sul, las tasas de cobertura, el abandono, la cesación, el uso de medicamentos, la red de servicios de salud y las razones por las que los Equipos de Salud de la Familia en Campo Grande aún no se han unido al programa. Métodos: Se trata de un estudio descriptivo con abordaje cuantitativo, basado en datos primarios y secundarios sobre el PNCT en Mato Grosso do Sul. Los datos primarios se obtuvieron por medio de un cuestionario aplicado a los Equipos de Salud de la Familia (ESF) de Campo Grande, que no ofrecían el programa y evaluaron la frecuencia y la presencia de correlación entre las variables analizadas utilizando la V de Cramer y la prueba de la χ2. Los datos secundarios se obtuvieron de los registros consolidados del Instituto Nacional del Cáncer José Alencar Gomes da Silva con los registros producidos por los servicios. Resultados: Las tasas de adherencia, eficacia y apoyo farmacológico en la capital y en el interior fueron: 66,80 y 59,79%; 20,58 y 34,91%; 32,14 y 99,86%, respectivamente. El programa fue ofrecido en el 49,37% de los municipios y en el 43,85% de las Unidades Básicas de Salud (UBS) estimadas. Hubo correlación entre estar capacitado e implementar el programa; capacitación de entrada y oferta en las UBS. Las dificultades relatadas por los profesionales fueron la pandemia del COVID-19, la sobrecarga y/o un equipo pequeño y/o la falta de tiempo y la ausencia de capacitación. Conclusiones: El PNCT en Mato Grosso do Sul tiene baja cobertura y oferta restringida en la red de salud, además de un desempeño medio en la asistencia a los fumadores. Hay una clara necesidad de invertir en la creación de capacidad / formación, principalmente para la ESF en Campo Grande, lo que les permite responder a las necesidades de promoción de la salud, reconociendo el programa como más rentable.

Understanding e-Cigarette Addictiveness: Triangulation of Focus Group and Netnographic Data.

BACKGROUND: Numerous studies have shown that e-cigarettes are addictive. For example, we previously showed that users of e-cigarette online forums discuss experiences of addiction in a netnographic analysis. However, it is unclear what makes e-cigarettes addictive apart from nicotine. In a focus group analysis, we recently identified 3 unique features of e-cigarettes that users linked to experiences of addiction: the pleasant taste, unobtrusiveness, and unlimited usability of e-cigarettes. OBJECTIVE: This study aimed to validate the previously identified features of e-cigarette addictive potential by triangulating data from the netnographic analysis and focus group discussions. METHODS: Drawing on a netnographic analysis of 3 popular, German-language e-cigarette forums, we studied whether experiences of addiction were linked to specific e-cigarette features. We included 451 threads in the analysis that had been coded for addictive experiences in a previous study by our team. First, we conducted a deductive analysis with preregistered codes to determine whether the features of pleasant taste, unobtrusiveness, and unlimited usability were mentioned in relation to the addictive potential of e-cigarettes in the online forums. Second, an inductive approach was chosen to identify further possible addictive features of e-cigarettes. RESULTS: Our deductive analysis confirmed that the features highlighted in our previous focus group study (pleasant taste, unobtrusiveness, and unlimited usability) were also frequently discussed in online forums in connection to addictive symptoms. In addition, our inductive analysis identified nicotine dosage as a significant feature linked to addiction. Users reported varying their nicotine doses for different reasons, leading to the identification of four distinct user types based on dosing patterns: (1) high doses for intermittent, (2) high doses for constant use, (3) low doses for constant use, and (4) switching between high and low doses depending on the situation. CONCLUSIONS: Our comprehensive analysis of online forum threads revealed that users' experiences of addiction are linked to 4 specific features unique to e-cigarettes: pleasant taste, unobtrusiveness, unlimited usability, and nicotine dosage. Recognizing these addictive features of e-cigarettes is crucial for designing cessation programs and informing public health policies to reduce the addictiveness of e-cigarettes.

Feasibility and Engagement of a Mobile App Preparation Program (Kwit) for Smoking Cessation in an Ecological Context: Quantitative Study.

BACKGROUND: Mobile health apps can facilitate access to effective treatment and therapeutic information services. However, the real-world effectiveness of mobile apps for smoking cessation and their potential impact in everyday settings remain unclear. OBJECTIVE: In an ecological context, this study aimed to estimate the engagement rate of a mobile app-based smoking cessation preparation program and its potential impact on users' willingness, ability, and readiness to quit smoking. METHODS: A total of 2331 "organic users" (ie, users who discover and install a mobile app on their own, without any prompts) chose 1 of 2 program versions of the mobile app (Kwit): the basic version or the premium version. Both versions were identical in design, with 4 more evidence-based content items and strategies in the premium version. Outcomes were analyzed based on automated data registered in the app (engagement rate, motivation to quit, motivation type, motivation levels, and satisfaction level). Mann-Whitney and χ2 tests were used to compare the results of both groups. RESULTS: As expected, in the ecological context, a high dropout rate was observed at different moments. A significant difference was observed between the 2 versions (n=2331; χ21=5.4; P=.02), with a proportionally higher engagement rate in the premium version (premium=4.7% vs basic=2%). Likewise, differences were also observed between the 2 groups in terms of reasons to quit (n=2331; χ24=19; P≤.001; V=0.08), motivation type (n=2331; χ27=14.7; P=.04), and motivation level. Users of the app's premium version more frequently reported "well-being" (23.3% vs 17.9%) and "planning a pregnancy" (7.4% vs 4.4%) as their primary reasons for quitting smoking compared to those with the basic version. Moreover, they reported being more likely to be driven in the smoking cessation process by intrinsic motivation (premium=28% vs basic=20.4%), as well as feeling significantly more willing (z score=156,055; P≤.001; Cohen d=0.15), able (z score=172,905; P=.04; Cohen d=0.09), and ready (z score=166,390; P=.005; Cohen d=0.12) to stop smoking than users who had the basic version before completion of the preparation program. Among participants who finished each version of the program (premium: 9/189, 4.8%; basic: 47/2142, 2.19%), significant improvements in motivation levels were observed in both groups, although in different areas for each group (willingness levels for the premium group and ability for the basic group). CONCLUSIONS: These results suggest that even in ecological contexts where engagement rates are meager, the Kwit preparation program can address ambivalence by increasing willingness to change, self-confidence, and readiness to quit among its users, especially those who feel less able to do so. Further development and evaluations are needed to better understand determinants for regular mobile health apps.

Pulmonary and Cardiac Smoking-Related History Improves Abstinence Rates in an Urban, Socioeconomically Disadvantaged Patient Population.

BACKGROUND: Tobacco use continues to take the lives of many, and targeted interventions can counter this health burden. One possible target population is patients who have had a smoking-related diagnosis, as they may have a greater drive to quit. OBJECTIVE: To assess whether patients with previous cardiac or pulmonary conditions directly attributable to smoking have greater rates of abstinence post-discharge from hospitalization in the CHART-NY trial. DESIGN: CHART-NY was a randomized comparative effectiveness trial comparing a more intensive versus a less intensive smoking cessation intervention after hospital discharge. We divided the 1618 CHART-NY participants into a smoking-related history group of 597 and a nonsmoking-related history group of 1021 based on cardiac or pulmonary conditions in a retrospective chart review. We conducted chi-squared analyses on baseline characteristics. Using follow-up survey data, we conducted chi-squared analyses on abstinence outcomes and made logistic regression models for the predictive value of smoking-related conditions on abstinence. PARTICIPANTS: A total of 1059 and 1084 participants in CHART-NY who completed both 2- and 6-month follow-up surveys respectively. MAIN MEASURES: Self-reported 30-day abstinence at 2- and 6-month follow-up and survey data for baseline characteristics. KEY RESULTS: Those abstinent at 6-month follow-up were more likely to have a smoking-attributable history (OR = 1.40, 95% CI 1.09-1.81). When stratified based on intervention, only the intensive counseling group was significant (OR = 1.53, 95% CI 1.08-2.17). The regression model using a smoking-related comorbidity score was significant at 6 months (OR = 1.29, p = 0.03), and the multivariate logistic regression model analyzing each smoking-related condition separately demonstrated significance for myocardial infarction at 6 months (OR = 1.66, p = 0.03). CONCLUSIONS: People who smoke who have experienced smoking-related conditions may be more likely to benefit from smoking cessation interventions, especially intensive telephone-based counseling. Multiple conditions had an additive effect in predicting long-term abstinence after intervention, and myocardial infarction had the greatest predictive value.

Smoking cessation assistance among pneumologists and thoracic surgeons in Switzerland: a national survey.

Objective: Smoking, with a prevalence of about 25%-30% in Switzerland, is proven to cause major systemic, avoidable diseases including lung cancer, increasing societies morbidity and mortality. Diverse strong quitting smoking recommendations have been made available providing advice facilitating smoking cessation globally. In other European countries like Germany, clinical practice guidelines for smoking cessation services have been implemented. However, in Switzerland, there is still no national consensus on a comprehensive smoking cessation program for lung cancer patients nor on the adequate provider. Our primary aim was to assess the current status of smoking cessation practice among specialists, mainly involved in lung cancer care, in Switzerland in order to uncover potential shortcomings. Material and methods: A self-designed 14-items questionnaire, which was reviewed and approved by our working group consisting of pneumologists and thoracic surgeons, on demographics of the participants, the status of smoking cessation in Switzerland and specialists' opinion on smoking cessation was sent to thoracic surgeons and pneumologists between January 2024 and March 2024 via the commercially available platform www.surveymonkey.com. Data was collected and analysed with descriptive statistics. Results: Survey response rate was 22.25%. Smoking cessation was felt to positively affect long term survival and perioperative outcome in lung cancer surgery. While 33 (37.08%) physicians were offering smoking cessation themselves usually and always (35.96%), only 12 (13.48%) were always referring their patients for smoking cessation. Patient willingness was clearly identified as main factor for failure of cessation programs by 63 respondents (70.79%). Pneumologists were deemed to be the most adequate specialist to offer smoking cessation (49.44%) in a combination of specialist counselling combined with pharmaceutic support (80.90%). Conclusion: The development of Swiss national guidelines for smoking cessation and the implementation of cessation counselling in standardized lung cancer care pathways is warranted in Switzerland to improve long-term survival and perioperative outcome of lung cancer patients.

The effect of online motivational interviewing on pregnant women's smoking cessation behaviour: A randomized controlled trial.

PURPOSE: This study aims to examine the effect of online individual motivational interviewing based on the transtheoretical model on pregnant women's smoking cessation behaviour. MATERIAL AND METHOD: Sixty-two pregnant women who did not complete the 16th gestational week and who smoked were randomly assigned to intervention (n = 31) and control (n = 31) groups. While the intervention group was administered model-based motivational individual counselling interventions, the control group was administered no interventions. FINDINGS: The results showed that 58.1% of the pregnant women in the intervention group and 22.6% of the pregnant women in the control group ceased smoking. CONCLUSION: Online motivational interviewing based on the transtheoretical model was found to be effective in pregnant women's smoking cessation.

Vaping to quit smoking: Qualitative study of people receiving opioid agonist treatment.

INTRODUCTION: Most patients receiving opioid agonist treatment (OAT) smoke tobacco. Approved cessation interventions are less effective in this group than the wider population. We investigated how people on OAT experience nicotine vaping to quit smoking. METHODS: Patients on OAT randomised to the vaping arm of a smoking cessation trial were invited to participate in structured interviews incorporating broad pre-determined themes. A qualitative descriptive approach employing template analysis was used. Four authors coded transcripts, discussed discrepancies, modified the template using both inductive and deductive approaches. Authors made explicit their starting orientations and independent authors sought disconfirmatory data in a subsequent round of analysis. RESULTS: Four women and eight men (median age 44 years) participated, including four who identified as Aboriginal. Participants reported vaping as cheaper, more acceptable and less stigmatising than smoking but expressed concerns about ongoing accessibility due to the Australian prescription access model. Some found it technically challenging at first, but not more so than standard nicotine replacement therapies. Participants gave accounts of craving and withdrawal experiences, including supplementary use of nicotine patches, and compulsions to vape frequently and intensely, potentially indicating need for higher nicotine dosage. Participants generally reported that vaping helped them quit smoking, though some worried about swapping nicotine addictions. Others were glad to be using a lower-risk alternative. DISCUSSION AND CONCLUSIONS: This group reported varied experiences of nicotine vaping but were mainly optimistic that it could help them and others quit smoking. This was despite initial nicotine cravings and concerns about remaining addicted long-term.

Identifying the ways in which tobacco cessation interventions have been tailored for sexual and gender minority individuals: A systematic review.

Sexual and gender minority (SGM) individuals smoke at higher rates than their heterosexual and cisgender peers. SGM persons, especially transgender and gender diverse (TGD) individuals, face unique, adverse health effects associated with smoking. As such, SGM individuals may benefit from smoking cessation interventions that are tailored to meet their needs. This systematic review aims to describe the ways in which these interventions have been tailored for SGM individuals and summarize available acceptability and efficacy data. Four databases were searched to identify smoking cessation interventions adapted for SGM populations. Thirteen articles were identified, with tailored aspects focusing on culturally tailored references, SGM-specific psychoeducation, and intra-community support strategies. No clear patterns of efficacy were identified, and only one study included bioverified abstinence. Preliminary evidence suggests that smoking cessation interventions can be acceptably tailored to SGM individuals, however, additional research is needed to determine if SGM-tailored interventions are more efficacious than non-tailored approaches.

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

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04868474.

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

BACKGROUND: 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. OBJECTIVE: This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.

Cigarette Smoking, Mental Health, Depression, Maryland Behavioral Risk Factor Surveillance System Survey, 2020.

Background: Smoking cessation is linked to improved mental health that encompasses the overall well-being and psychological functioning of an individual. Objective: Examine relationships between smoking, mental health, and social connectedness among adults in Maryland, US in 2020. Methodology: This cross-sectional study used data from the Maryland 2020 Behavioral Risk Factor Surveillance System Survey of adults during the onset of COVID-19. Primary outcomes measured include demographics, depression, and number of not good mental health days among individuals with current and former smoking statuses compared to those who have never smoked. Results: Compared to those who never smoked, individuals who currently smoked had an increased relative risk of reporting 14 or more days of not good mental health (RRR = 1.63, 95% CI: 1.35-1.97, P < .001) and a history of depression (RRR = 1.99, 95% CI: 1.69-2.35, P < .001). Individuals with former smoking status also showed elevated risk, with RRR = 1.24 (95% CI: 1.06-1.45, P = .006) for 14 or more days of not good mental health and RRR = 1.46 (95% CI: 1.28-1.66, P < .001) for a history of depression. Widowed, separated, or divorced; unemployed or unable to work; without a high school diploma; or recent physical exam were inclined to have a current or former smoking status. Conclusion: We identify critical subpopulations vulnerable to life-long smoking behaviors amid the COVID-19 pandemic including adults under 35 years old, and those suffering from depression, a lack of social connectedness due to unemployment, changes in marital status, and outdated physical exams. The US Surgeon General's 2023 Advisory on the epidemic of loneliness and the 2021 Youth Mental Health Report emphasize the mental health crises among the young in which these findings serve as a compelling call to action for innovating targeted public health 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.

Aachen smoking cessation and harm reduction (ASCHR) trial study protocol - scientific evaluation of a psychological-telemedical counseling concept for smoking cessation in patients with vascular diseases.

BACKGROUND: Smoking is a major risk factor of cardiovascular diseases, notably peripheral arterial disease (PAD). Despite this link, research on smoking cessation interventions in PAD patients remains scarce and inconclusive regarding the efficacy of such interventions. Therefore, elucidating it is crucial and should address both individuals who smoke that are motivated to quit and individuals who smoke heavily lacking the motivation to quit. METHODS/DESIGN: The Aachen Smoking Cessation and Harm Reduction (ASCHR) trial is a prospective randomized controlled study (RCT) on the benefits of telemedical-psychological support for smoking cessation in patients with PAD, funded by the "Innovation Fund" of the Joint Federal Committee in Germany. This trial aims to scientifically assess the efficacy, feasibility, acceptance, and efficiency of a multi-stage smoking cessation program based on the recommendations of the German guideline for smoking cessation tailored to patients with PAD, compared to a control group receiving no intervention. Central to the program is psychological counseling utilizing motivational interviewing techniques, delivered through telemedicine via video consultations. The primary endpoint of the ASCHR trial is the smoking cessation rate after 8 months of intervention, with a secondary endpoint evaluating sustained abstinence at a further 6 months follow-up. Smoking cessation is defined as a carbon monoxide level in exhaled air of less than 6 ppm. We hypothesize that the group receiving the multi-stage cessation program will yield a cessation rate at least 10 percentage points higher than that of usual care. Anticipating a dropout rate of around 35%, the planned sample size is at least N = 1032 study participants. DISCUSSION: Should the trial demonstrate significant positive outcomes, efforts should be made to integrate the program into routine care in Germany, potentially offering a promising base for future smoking cessation support among PAD patients.

Preliminary Survey Data From an App-Delivered Hypnosis Intervention for Smoking Cessation.

Introduction: Hypnosis-based apps geared toward smoking cessation are among the most downloaded by individuals wanting to reduce or stop smoking. However, to date, there are few evaluations regarding the use or efficacy of hypnosis apps for smoking cessation. Finito is an empirically-based mHealth app developed by Mindset Health designed to provide users with a three-week hypnotherapy program to quit smoking. This study aimed to examine demographic and clinical characteristics of Finito app users and conduct a preliminary analysis of survey data from participants of the program. Method: Finito app users were asked to voluntarily complete an online survey regarding their experience with the program, current smoking habits, app usability, relevant improvement, and demographic information. Retrospective data analyses were conducted to provide descriptive and inferential findings from the responses. Results: A total of 120 individuals responded to the survey. Respondents originated from over five different countries and approximately 72.5% reported completing the full Finito program. Approximately 58.3% of participants reported that they accomplished their goal with Finito with 50.8% of all respondents reporting that they quit smoking and an additional 25.8% reporting that their smoking was reduced. Among a variety of secondary outcomes, saving money was the most frequently reported secondary benefit with 46.7% of respondents endorsing that item. Conclusion: Our preliminary survey results suggest that Finito may be a useful, pleasant, and cost-effective tool in a patient's journey to quit smoking. The majority of app users reported that they achieved their goal with Finito and completion of the program was associated with goal achievement. The Finito app may be effective in the dissemination and delivery of a helpful hypnotherapy intervention across a diverse population.

Trajectories of Breastfeeding-Related Thoughts and Attitudes Among Low-Income Smoke-Exposed Pregnant Women: A Latent Class Growth Analysis.

BACKGROUND: Psychosocial predictors of breastfeeding and changes in those factors during pregnancy, along with the relationship of those changes with both breastfeeding and smoke use and exposure, are not well explored. RESEARCH AIM: The aim of this study was to identify distinct trajectories of psychosocial determinants of breastfeeding and smoking in pregnant women. METHODS: We used a longitudinal study design and data from a randomized controlled trial conducted among smoke-exposed pregnant women and their infants. Participants were recruited early in pregnancy and were surveyed at ≤ 16 and 32 weeks gestation, delivery, 3 and 6 months postpartum for breastfeeding intentions, initiation, continuation, and smoke use and exposure. Psychosocial variables associated with breastfeeding were measured at baseline and 32 weeks gestation using the Mitra index, a structured questionnaire that assesses barriers and facilitators of breastfeeding intentions. Latent class growth analysis was performed using Mitra scores to identify distinct subgroups of participants with different trajectories. Sociodemographic characteristics, breastfeeding, and tobacco smoke use and exposure were compared across classes. RESULTS: Three or four trajectories were identified for each of the six Mitra scores. Trajectories for all Mitra scores were associated with breastfeeding intention and initiation. Overall, Mitra, knowledge, self-efficacy, social support, and time barrier classes all differed by tobacco smoke use or exposure. CONCLUSION: Trajectories of breastfeeding knowledge, self-efficacy, social support, and time to breastfeed/social barriers are associated with tobacco smoke use and exposure during pregnancy. Encouragement to breastfeed and to cease and avoid tobacco smoke should start early in pregnancy, focusing on these determinants to improve health outcomes.

Reaching Youth Smokers Through a Multipronged Approach: Comparison of Three Recruitment Methods of a Youth Quitline in Hong Kong.

PURPOSE: Using multipronged recruitment strategies is crucial for reaching diverse smokers, yet research specifically focusing on youths is lacking. This prospective study compared the characteristics and abstinence outcomes of youth smokers enrolled in a youth-centered cessation service by three different methods. METHODS: From December 2016 to February 2022, the Youth Quitline enrolled 1,197 smokers aged 10-25 (mean = 19.4) years through traditional method (incoming calls or referrals, n = 276), proactive outreach (n = 735), and online method (website or social media platforms, n = 186). Logistic regression was used to calculate the odds ratio (OR) of biochemically validated tobacco abstinence at 6 months by recruitment methods. RESULTS: Proportionally more participants recruited via online method than traditional method and outreach had moderate to heavy nicotine dependence (53.2% vs. 40.9% vs. 27.6%, p < .001), poor self-rated health (27.6% vs. 21.9% vs. 12.3%, p < .001), and risk of depression (51.4% vs. 42.5% vs. 37.4%, p = .003). More participants recruited by outreach (71.6%) had no intention to quit in 30 days than traditional (58.3%) and online (59.7%) methods (p < .001). Compared with traditional method, the 6-month validated abstinence rate was similar in smokers recruited by online method (crude OR 0.77, 95% confidence interval 0.44-1.34) but significantly lower in those recruited by outreach (crude OR 0.44, 95% confidence interval 0.28-0.67). Results were similar after adjusting for sociodemographic and baseline predictors of abstinence. DISCUSSION: Online recruitment can attract youth smokers with greater nicotine dependence and poorer health, whereas outreach can engage those with less motivation to quit. The lower quit rate in outreach-recruited participants indicated the need for more effective interventions.

Tobacco in hotels: A study of smoke exposure and resident risk.

Objectives: Extended-stay hotels (ESH) are a reliable and accessible housing option for low-income, minoritized renters, who are disproportionately exposed to secondhand and thirdhand cigarette smoke (SHS and THS). This study explores ESH residents' perceptions of their SHS and THS exposure, harms related to this exposure, their willingness to mitigate these harms, and the contextual factors associated with smoking in hotels. Methods: Eighty ESH renters from the metropolitan Atlanta region were recruited to complete a survey about the perceived harm and persistence of tobacco smoke, exposure experiences, knowledge, attitudes, self-efficacy, and intentions to protect oneself. Eleven of these participants completed semi-structured interviews, during which they discussed their daily SHS and THS exposure at their ESHs in greater detail. Results: Of the survey respondents, 62% reported being bothered by their level of smoke exposure, and 77% said they believed smoke particulates remained in their rooms even after housekeeping cleaned them. Approximately half of survey respondents had attempted to stop smoking in the 3 months prior to the study, and 29 of these individuals were still on their smoking cessation journeys. Most interview participants agreed that SHS and THS exposure exacerbated their existing chronic illnesses and could possibly result in death in the long term. Participants agreed with the benefits of smoke-free policies, but also acknowledged other priorities for ESH living-affordability, safety, and proximity to the workplace-that overshadowed their desires for such policies. Conclusion: Overall, study findings suggest that ESH renters understand the dangers of smoking and SHS/THS and want to decrease their exposure, but the persistence of cultural and contextual factors prevents them from fully engaging with 100% smoke-free policies.

SR9883 is a novel small-molecule enhancer of α4ß2* nicotinic acetylcholine receptor signaling that decreases intravenous nicotine self-administration in rats.

Background: Most smokers attempting to quit will quickly relapse to tobacco use even when treated with the most efficacious smoking cessation agents currently available. This highlights the need to develop effective new smoking cessation medications. Evidence suggests that positive allosteric modulators (PAM) and other enhancers of nicotinic acetylcholine receptor (nAChR) signaling could have therapeutic utility as smoking cessation agents. Methods: 3-[3-(3-pyridyl)-1,2,4-oxadiazol-5-yl]benzonitrile (NS9283) was used as a starting point for medical chemistry efforts to develop novel small molecule enhancers of α4ß2* nAChR stoichiometries containing a low-affinity agonist binding site at the interface of α4/α4 and α4/α5 subunits. Results: The NS9283 derivative SR9883 enhanced the effect of nicotine on α4ß2* nAChR stoichiometries containing low-affinity agonist binding sites, with EC50 values from 0.2-0.4 µM. SR9883 had no effect on α3ß2* or α3ß4* nAChRs. SR9883 was bioavailable after intravenous (1 mg kg-1) and oral (10-20 mg kg-1) administration and penetrated into the brain. When administered alone, SR9883 (5-10 mg kg-1) had no effect on locomotor activity or intracranial self-stimulation (ICSS) thresholds in mice. When co-administered with nicotine, SR9883 enhanced locomotor suppression and elevations of ICSS thresholds induced by nicotine. SR9883 (5 and 10 mg kg-1) decreased responding for intravenous nicotine infusions (0.03 mg kg-1 per infusion) but had no effect on responding for food rewards in rats. Conclusions: These data suggest that SR9883 is useful for investigating behavioral processes regulated by certain α4ß2* nAChR stoichiometries. SR9883 and related compounds with favorable drug-like physiochemical and pharmacological properties hold promise as novel treatments of tobacco use disorder.

Perspectives of Hospital Staff on Barriers to Smoking Cessation Interventions among Drug-Resistant Tuberculosis Patients in a South African Management Hospital.

Drug-resistant tuberculosis (DR-TB) remains a major cause of illness and death, with personal and non-addiction-related barriers. This study aimed to explore the perspectives of hospital staff on barriers to smoking cessation interventions (SCIs) for in-patients at a DR-TB management hospital in Durban, KwaZulu-Natal, South Africa. In-depth interviews were conducted with a purposive sample of eighteen hospital staff (HS), and the data were analyzed using NVivo 10. Three core themes were identified: patients' barriers (addiction to tobacco, relapse after improvement in health, and non-disclosure of smoking status to HS), staff personal barriers (poor knowledge of smoking's effect on treatment outcomes and smoking cessation aids), and institutional barriers (staff shortage, time constraints, lack of pharmacological smoking cessation aids, access to cigarettes around hospital premises, and SCIs not prioritized and not assigned to a specific category of HS). Training on SCIs for HS, assigning SCIs to specific HS, integrating SCIs within existing services, and banning access to cigarettes within the hospital premises are assumed to assist DR-TB patients in smoking cessation, improving their response to TB treatment and overall health outcomes.

Tobacco and COPD: presenting the World Health Organization (WHO) Tobacco Knowledge Summary.

The WHO recently published a Tobacco Knowledge Summary (TKS) synthesizing current evidence on tobacco and COPD, aiming to raise awareness among a broad audience of health care professionals. Furthermore, it can be used as an advocacy tool in the fight for tobacco control and prevention of tobacco-related disease. This article builds on the evidence presented in the TKS, with a greater level of detail intended for a lung-specialist audience. Pulmonologists have a vital role to play in advocating for the health of their patients and the wider population by sharing five key messages: (1) Smoking is the leading cause of COPD in high-income countries, contributing to approximately 70% of cases. Quitting tobacco is an essential step toward better lung health. (2) People with COPD face a significantly higher risk of developing lung cancer. Smoking cessation is a powerful measure to reduce cancer risk. (3) Cardiovascular disease, lung cancer and type-2 diabetes are common comorbidities in people with COPD. Quitting smoking not only improves COPD management, but also reduces the risk of developing these coexisting conditions. (4) Tobacco smoke also significantly impacts children's lung growth and development, increasing the risk of respiratory infections, asthma and up to ten other conditions, and COPD later in life. Governments should implement effective tobacco control measures to protect vulnerable populations. (5) The tobacco industry's aggressive strategies in the marketing of nicotine delivery systems and all tobacco products specifically target children, adolescents, and young adults. Protecting our youth from these harmful tactics is a top priority.