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.

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.

Prevalence and disparities in receiving medical advice to quit tobacco use in the US adult population.

Introduction: Evidence suggests that advice from health care professionals (HCP) increases the likelihood of quit attempts and successful quitting of tobacco use. However, previous studies primarily focussed on cigarette smoking and did not include all forms of tobacco products. This study aimed to investigate the prevalence and disparities in receiving HCP's advice to quit tobacco use (combustible or noncombustible) in the US adult population. Methods: Using the 2022 National Health Information Survey (NHIS) data, we examined 4,424 adults who reported (i) any tobacco product use within the past 12 months and (ii) having seen an HCP within the past 12 months. The outcome variable included the receipt of advice to quit tobacco use from an HCP, and predictors included sociodemographic variables. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. Results: Over 38% of tobacco users who visited an HCP were advised to quit. The odds of receiving such advice were lower among Hispanics (AOR: 0.625; 95% confidence interval (CI) [0.464-0.843];p = 0.002), males (AOR: 0.767; 95% CI [0.659-0.893], p = 0.001), those above the poverty level (AOR: 0.795; 95% CI [0.641-0.987];p = 0.037), foreign-born (AOR: 0.664; 95% CI [0.496-0.888]; p = 0.006), those with a bachelor's degree or higher educational level (AOR: 0.477; 95% CI [0.349-0.653]; p < 0.001) and those aged less than 45 years (AOR: 0.404; 95% CI: [0.344-0.473]; p < 0.001). Conclusion: The prevalence of receiving HCP's advice to quit tobacco use remains suboptimal and disparate among sociodemographic groups. Our findings call for strategic implementation of the USPHS's recommendation on treating tobacco use and taking further actions to equip HCPs with the training and resources needed to provide appropriate advice to quit tobacco.

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.

Examining Quitting Experiences on Quit Vaping Subreddits From 2015 to 2021: Content Analysis.

BACKGROUND: Despite the prevalence of vaping nicotine, most nicotine cessation research remains focused on smoking cigarettes. However, the lived experience of quitting smoking is different from quitting vaping. As a result, research examining the unique experiences of those quitting vaping can better inform quitting resources and cessation programs specific to e-cigarette use. Examining Reddit forums (ie, subreddits) dedicated to the topics of quitting vaping nicotine can provide insight into the discussion around experiences on quitting vaping. Prior literature examining limited discussions around quitting vaping on Reddit has identified the sharing of barriers and facilitators for quitting, but more research is needed to investigate the content comprehensively across all subreddits. OBJECTIVE: The objective of this study is to examine content across quit vaping subreddits since their inception to better understand quitting vaping within the context of the expanding nicotine market. METHODS: All posts from January 2015 to October 2021 were scraped from all quit vaping subreddits: r/QuittingJuul, r/QuitVaping, r/quit_vaping, and r/stopvaping (N=7110). Rolling weekly average post volume was calculated. A codebook informed by a latent Dirichlet allocation topic model was developed to characterize themes in a subsample of 695 randomly selected posts. Frequencies and percentages of posts containing each coded theme were assessed along with the number of upvotes and comments. RESULTS: Post volume increased across all subreddits over time, spiking from August - September of 2019 when vaping lung injury emerged. Just over 52% of posts discussed seeking social support and 16.83% discussed providing social support. Posts providing support received the most positive engagements (i.e. upvotes) of all coded categories. Posts also discussed physical and psychological symptoms of withdrawal (30.65% and 18.85%, respectively), strategies for quitting including: quitting cold turkey (38.33%), using alternative nicotine products (17%), and tapering down nicotine content (10.50%). Most posts shared a personal narrative (92.37%) and some discussed quit motivation (28.20%) and relapse (14.99%). CONCLUSIONS: This work identifies a desire for peer-to-peer support for quitting vaping, which reinforces existing literature and highlights characteristics of quitting vaping specific to a changing nicotine product environment. Given that posts providing social support were the most upvoted, this suggests that subreddit contributors are seeking support from their peers when discussing quitting vaping. Additionally, this analysis shows the sharing of barriers and facilitators for quitting, supporting findings from prior exploration of quit vaping subreddits. Finally, quitting vaping in an ever-growing nicotine market has led to the evolution of vaping-specific quit methods such as tapering down nicotine content. These findings have direct implications for quit vaping product implementation and development.

The impact of specific health warning messages on Chinese young people's perception of smoking risks and quitting intentions.

INTRODUCTION: Although a substantial body of research has analyzed the effectiveness of cigarette package warning labels in tobacco control, the very general health warnings messages (HWMs) on cigarette packaging in China have shown limited effectiveness in deterring youth from smoking. Therefore, this study investigates the impact of specific and more detailed warning text messages on Chinese young people's risk perception of smoking and their intention to quit. METHODS: We employed a randomized survey experiment to examine the impact of specific text-based warning labels on Chinese young people's risk perception of smoking and intention to quit. The total effective sample size was 1064 participants. The subjects were divided into three groups: the first group served as the control group, which was shown the existing cigarette package warning labels; the second group was shown cigarette package warning labels related to cardiovascular, digestive, and respiratory diseases; and the third group was shown cigarette package warning labels related to sexual dysfunction. RESULTS: The respiratory disease-related warnings significantly increased young people's awareness of smoking-related respiratory risks (p<0.01). The impact of warning labels for the three common diseases on enhancing young people's overall risk perception of smoking (p<0.05) and their intention to quit exhibited only weak statistical significance (p<0.05). In contrast, warning labels related to sexual dysfunction significantly increased young people's risk perception of smoking (p<0.001) and their intention to quit (p<0.001), with a much higher level of statistical significance compared to those related to the other three common diseases. CONCLUSIONS: Detailed descriptions of the risks associated with all four diseases were positively correlated with awareness of smoking-related harm and the intention to quit. However, warnings related to sexual dysfunction had a greater level of statistical significance compared to those related to the other three common diseases. This stronger significance may be attributed to young people's heightened concern about sexual dysfunction.

Mobile chat messaging for preventing relapse among people who recently quit smoking: Study protocol for a randomized controlled trial.

Objective: Most smokers who achieve short-term abstinence relapse even when aided by evidence-based cessation treatment. Mobile health presents a promising but largely untested avenue for providing adjunct behavioral support for relapse prevention. This paper presents the rationale and design of a randomized controlled trial aimed at evaluating the effectiveness of personalized mobile chat messaging support for relapse prevention among people who recently quit smoking. Methods: This is a two-arm, assessor-blinded, randomized controlled trial conducted in two clinic-based smoking cessation services in Hong Kong. An estimated 586 daily tobacco users who have abstained for 3 to 30 days will be randomized (1:1) to intervention group or control group. Both groups receive standard-of-care smoking cessation treatment from the services. The intervention group additionally receives 3-month relapse prevention support via mobile chat messaging, including cessation advice delivered by a live counselor and access to a supportive chatbot via WhatsApp. The control group receives text messaging on generic cessation advice for 3 months as attention control. The primary outcome is tobacco abstinence verified by an exhaled carbon monoxide of <5 parts per million or a negative salivary cotinine test at 6 months after randomization. Secondary outcomes include self-reported 6-month prolonged tobacco abstinence, 7-day point-prevalent abstinence, and relapse rate. The primary analyses will be by intention-to-treat, assuming participants with missing data are non-abstinent. This trial is registered with ClinicalTrials.gov (NCT05370352) and follows CONSORT-EHEALTH. Conclusion: This trial will provide new evidence on the effectiveness of mobile chat messaging as a scalable and accessible intervention for relapse prevention.

Characteristics of Waterpipe Smokers Who Are Willing to Quit: Population-Based Findings from Syria.

Background: Many waterpipe users are willing to quit but have difficulty doing so. Little is known about the characteristics of those who are willing to quit. Methods: Using two-stage cluster sampling, we conducted a secondary analysis of a population-based household survey of 2038 adults in Aleppo, Syria. We examined the prevalence of, and reasons for, willingness to quit and compared users who were willing with those were not willing to quit based on sociodemographic, psychosocial, tobacco-related, and health-related characteristics. Findings: Twelve percent of adults smoked waterpipe (n=248), of these, 56% were willing to quit, and 25% had made a quit attempt in the past year. Friends/socializing (69%) and boredom/free time (16%) were the most reported obstacles to quitting. Those who were willing to quit walked more frequently (odds ratio [OR]=1.85; 95% confidence interval [CI]=1.24-2.77), ate less fruit (OR=0.56; CI=0.42-0.73), and were more likely to experience sneezing/blocked nose (OR=2.55, CI=1.22-5.34). Compared to users who did not also smoke cigarettes, dual users who were willing to quit cigarettes were more likely to be willing to quit waterpipe (OR=2.32; CI=1.24-4.34), whereas dual users who were not willing to quit cigarettes were less likely to be willing to quit waterpipe (OR=0.24; CI=0.10-0.58). Conclusion: Many waterpipe users are willing to quit and perceive the loss of positive social functions as a major obstacle. Very few sociodemographic, tobacco-related, psychosocial, or health-related characteristics are associated with willingness to quit. However, quitting efforts may benefit from targeting dual users who are motivated to quit using all tobacco products.

Examination of a hope- and fear-based message targeting older adults who smoke: A randomized trial.

Older adults who smoke are half as likely to make a quit attempt, but more likely to maintain abstinence using evidence-based treatments. Awareness of the increased risk of dementia among people who currently smoke may motivate cessation in this population, but messages have not been tested. 820 adults who smoke, ages 50-80, with no history of dementia completed an online survey examining one of three randomly assigned messages (Control N = 266, Fear N = 274, Hope N = 280) on motivation and intentions to quit. Fear and Hope messages were based on the link between smoking and dementia. Fear increased motivation to quit [t(813) = 2.818, p = 0.005] more than Control. Hope did not differ from Control [t(813) = 1.908, p = 0.057] or Fear [t(813) = 0.937, p = 0.349] in change in motivation to quit. There were no differences between messages in change in intention to quit, F(2, 817) = 0.825, p = 0.439. Future work should examine feasibility and acceptability of fear-based motivational messages on quitting success.

The impact of changing exposure to PM2.5 on mortality for US diplomats with multiple international relocations: a modelling study.

BACKGROUND: Current evidence linking long-term exposure to fine particulate matter (PM2.5) exposure and mortality is primarily based on persons that live in the same residence, city and/or country throughout the study, with few residential moves or relocations. We propose a novel method to quantify the health impacts of PM2.5 for United States (US) diplomats who regularly relocate to international cities with different PM2.5 levels. METHODS: Life table methods were applied at an individual-level to US mortality statistics using the World Health Organization's database of city-specific PM2.5 annual mean concentrations. Global Burden of Disease concentration-response (C-R) functions were used to estimate cause-specific mortality and days of life lost (DLL) for a range of illustrative 20-year diplomatic assignments for three age groups. Time lags between exposure and exposure-related mortality risks were applied. Sensitivity analysis of baseline mortality, exposure level, C-R functions and lags was conducted. The effect of mitigation measures, including the addition of air purifiers, was examined. RESULTS: DLL due to PM2.5 exposure for a standard 20-year assignment ranged from 0.3 days for diplomats' children to 84.1 days for older diplomats. DLL decreased when assignments in high PM2.5 cities were followed by assignments in low PM2.5 cities: 162.5 DLL when spending 20 years in high PM2.5 cities compared to 62.6 DLL when spending one of every four years (5 years total) in a high PM2.5 city for older male diplomats. Use of air purifiers and improved home tightness in polluted cities may halve DLL due to PM2.5 exposure. The results were highly sensitive to lag assumptions: DLL increased by 68% without inception lags and decreased by 59% without cessation lags for older male diplomats. CONCLUSION: We developed a model to quantify health impacts of changing PM2.5 exposure for a population with frequent relocations. Our model suggests that alternating assignments in high and low PM2.5 cities may help reduce PM2.5-related mortality burdens. Adding exposure mitigation at home may help reduce PM2.5 related mortality. Further research on outcome-specific lag structures is needed to improve the model.

Breaking chains of tobacco: empowering African American churches in West Virginia for a healthier future.

Across West Virginia, tobacco use continues to be a significant public health challenge. Specifically, tobacco use is linked to high poverty across the state and disproportionately affects African Americans. A faith-based tobacco prevention network was formed to address these concerns and increase education and cessation. The West Virginia African American Tobacco Prevention Network (WVAATPN) was formed in 2021 and since then has expanded its reach across the state, involving 22 congregations. The Network's model includes annual training for lay leaders on various tobacco-related topics, tailored educational curriculum for congregations, and collaboration with national experts to enhance program efficacy. The Network has run educational and cessation workshops and promoted events such as No Menthol Sunday. Workshops have yielded positive outcomes among participants, including increased awareness of tobacco marketing tactics, higher cessation rates, and improved understanding of the health impacts of tobacco. The WVAATPN continues to expand its reach and effectiveness by advocating for policy change, enhancing community engagement, and fostering partnerships to combat tobacco-related disparities in West Virginia's African American communities.

Can switching from cigarettes to heated tobacco products reduce consequences of pulmonary infection?

RATIONALE: While tobacco industry data suggests that switching from combustible cigarettes to heated tobacco products (HTPs), like IQOS, may reduce the users' exposure to respiratory toxicants, it is not known if using HTPs impacts the outcomes of acute respiratory infections. OBJECTIVES: Does switching from cigarettes to HTPs improve responses to pulmonary infection. METHODS: We conducted experiments in which 3 groups of mice were pre-exposed to cigarette smoke for 8 weeks, followed by 8-week exposure to (1) HTPs (tobacco product switching), (2) air (smoking cessation), or (3) continued exposure to cigarette smoke. Pulmonary bacterial clearance and surrogate markers of lung damage were assessed as study outcomes. MAIN RESULTS: Significantly compromised clearance of bacteria from the lungs post-acute challenge occurred in both the switching group and in mice continuously exposed to cigarette smoke. Bacterial clearance, inflammatory T-cell infiltration into the lungs, and albumin leak improved at 12 h post-acute challenge in the switching group compared to mice continuously exposed to cigarette smoke. Bacterial clearance, total lung immune-cell infiltration, inflammatory T-cell infiltration into the lungs, the content of total proteins in the BAL, and albumin leak measured post-acute challenge were compromised in the switching group compared to mice in the cessation group. Switching from cigarettes to HTPs did not improve lung myeloperoxidase and neutrophil elastase levels (markers for lung inflammation and damage), which, however, were significantly reduced in the cessation group. CONCLUSIONS: This study reveals only a modest improvement in respiratory infection outcomes after switching exposure from cigarettes to HTPs and significantly compromised outcomes compared to a complete cessation of exposure to all tobacco products.

Online social platform engagement by young treatment seekers in a digital vaping cessation intervention: Effects on confidence in the ability to quit vaping and vaping abstinence.

Background: The evidence-based vaping cessation program, This is Quitting (TIQ), has been found to be effective in promoting abstinence among young people who use e-cigarettes. Purpose: To estimate acceptability and engagement with Discord among treatment seeking youth and young adults and assess the benefit of adding an online social platform via Discord to TIQ. Methods: Between February and March 2023, 527 TIQ participants (aged 13-24 years) were invited to join Discord with other TIQ users (TIQ Discord). Participants completed two online surveys, at baseline and 1-month post study enrollment. Descriptive statistics were used to describe acceptability and engagement with TIQ Discord. Chi-square, Fisher's exact, and t-tests were used to compare changes in confidence in ability to quit and vaping abstinence across those who joined and engaged with TIQ Discord, compared to those receiving TIQ only. Results: Among the n = 319 who were invited to TIQ Discord and provided follow-up data, 57.4 % joined. Among those who joined (n = 183), 61.7 % engaged with TIQ Discord by contributing at least one message or reaction. The mean number of contributed messages was 4.0 (median = 1, range = 1 to 51) and reactions was 0.31 (median = 0, range = 0 to 14). Engaging with TIQ Discord was positively associated with increased confidence in quitting at follow-up (p-value = 0.02), but vaping abstinence at follow-up did not differ (p-value = 0.87). Discussion: Over half of participants who were invited to TIQ Discord joined - indicating high acceptability and an uptake rate that is higher than what is typically observed for online cessation communities. Engagement was positively associated with proximal outcomes, but self-selection prevents causal attribution. Pilot study results suggest acceptability of Discord for providing digital cessation support to young people in combination with a text-message cessation intervention.

Factors influencing tobacco quitting: findings from National Tobacco-Quitline Services, Mumbai, India.

The Government of India established National Tobacco Quitline Services (NTQLS) to provide free and effective telephonic counselling to help people quit tobacco. The objective of the paper is to present the data of tobacco quitters who quit tobacco through NTQLS, Mumbai, in the years 2021-2022 and the factors that influenced tobacco quitting. This is a prospective study where individuals willing to quit tobacco utilised NTQLS. Effective counselling was provided and was followed up. Multiple logistic regression analysis was conducted. Tobacco quitting is the dependent variable while sociodemographic characteristics, tobacco consumption habits, previous quit attempts, alcohol consumption, other substance use and co-morbidity were independent variables. In the years 2021-2022, a total of 448,893 calls hit the system. Of these, 127,163 (28.3%) calls were attended. Of the attended calls, a quit date was set for 21,504 calls (16.9%); of these, 8,276 (38.5%) callers quit tobacco. Individuals with no previous quit attempts [OR: 1.48, 95% confidence interval (CI): 1.25-1.75], never consumed alcohol (OR: 1.37, 95%CI: 1.2-1.56), consumed tobacco within 6-30 minutes (OR: 1.29, 95% CI: 1.12-1.49) and 30-60 minutes after waking up (OR: 1.26, 95% CI: 1.05-1.51) had higher quitting rates. While, female callers (OR: 0.59, 95% CI: 0.35-0.99), private sector workers (OR: 0.70, 95% CI: 0.61-0.81), individuals consuming more than ten tobacco units/packets (OR: 0.70, 95% CI: 0.61-0.79), tobacco use more than 10 years (OR: 0.85, 95% CI: 0.73-0.97), expenditure of more than 5,000 rupees on tobacco (OR: 0.58, 95% CI: 0.44-0.77) and those with no known co-morbid conditions (OR: 0.8, 95% CI: 0.71-0.91) were less likely to quit tobacco. Reduced tobacco consumption will inadvertently reduce the non-communicable disease (NCD) burden and help in achieving the sustainable development goals related to tobacco control and NCD. Quitline plays an important role in tobacco control.

A pilot randomised controlled trial of a multidomain lifestyle intervention for outpatients with chronic or severe mental illness.

Lifestyle-related problems are common in people with mental illness, contributing to a decreased life expectancy and high societal and personal burden. This study aimed to investigate the feasibility, acceptability, and preliminary effectiveness on recovery of a multidomain lifestyle intervention in patients with severe or chronic mental illnesses. Twenty transdiagnostic outpatients were 1:1 randomised in intervention or control. The lifestyle intervention consisted of 11 three-hour group sessions about physical activity, nutrition, relaxation, sleep, substance use, and purpose and meaning. Self-report questionnaires, physical measurements, diary questions, and accelerometers were administered at baseline, halfway and post intervention. Outcomes included attrition, retention rates, protocol deviations, quantitative evaluations and effectiveness. Both the intervention and research protocol appeared feasible and acceptable, with relaxation, purpose and meaning and nutrition as highest appreciated themes. Intervention simplification and deepening was necessary to suit the heterogeneous participants. Preliminary effects were found in all recovery domains, with biggest effects in societal recovery and smallest effects in clinical recovery. To prevent dropout and match the outpatient population, small intervention adaptations are recommended. Effects can be expected in all domains of recovery and should be measured accordingly. Research with greater sample sizes is necessary.

Prevalence of Oral Potentially Malignant Lesions, Tobacco use, and Effect of Cessation Strategies among Solid Waste Management workers in Northern India: a pre-post intervention study.

BACKGROUND: India bears the highest global burden of oral cancer, despite having an operational tobacco cessation framework. Occupational groups like solid waste management personnel face significant health challenges due to prevalent tobacco use, leading to oral potentially malignant lesions and oral cancer. Enhanced tobacco control strategies are essential for these groups. METHODS: A pre-post interventional, community-based study enrolled 1200 municipal workers in Varanasi, India, from July 2022 to August 2023. 858 tobacco users underwent screening and were randomly assigned to one of three interventions: Very Brief Advice, Individual Behavioral Counseling, or Group Behavioral Therapy. Follow-up was conducted one year after the baseline interventions Effectiveness was measured by nicotine dependence reduction using the Fagerstrom Test for Nicotine Dependence (FTND) scores and cessation rates defined as at least 6-month abstinence. Appropriate statistical tests assessed the burden of tobacco use, oral potentially malignant lesions, and pre-post differences in FTND scores within and between groups. A p-value of < 0.05 was considered statistically significant. RESULTS: Municipal workers exhibited a high prevalence (71.5%) of smokeless tobacco (SLT) use. One-third (32.9%) of the participants screened positive for oral potentially malignant lesions and oral cancer. Leukoplakia was the most common lesion. Screened positivity correlated with significant nicotine dependence. Among 494 follow-up participants, 47.1% reported a significant reduction in nicotine dependence across all intervention groups. Quade's ANCOVA indicated significant differences in post-test FTND scores, with individual behavioral counselling showing the greatest reduction. However, no cessation was achieved in any group despite the significant decline in dependence. CONCLUSION: Solid waste management personnel in Varanasi show heightened SLT use and associated oral potentially malignant lesions. The persistent tobacco use in these high-risk occupational populations undermines government tobacco control efforts and highlights the need for robust policy and implementation strategies. The study demonstrated a significant reduction in nicotine dependence following interventions, though tobacco cessation was not achieved. More frequent interventions and addressing quitting barriers-such as cultural norms, lack of awareness, easy accessibility, and adverse working conditions-are crucial. Developing a tailored workplace model to tackle tobacco use in occupational settings may facilitate cessation. CLINICAL TRIAL REGISTRATION NUMBER: Trial registration Clinical Trials Registry India CTRI/2020/07/026479. Date of registration 10/07/2020.

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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.

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.

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.

Examining Homeless-Experienced Adults' Smoking Cessation Treatment Use Pre- and Post-Entry into Permanent Supportive Housing.

Background: Homeless-experienced adults smoke at rates 5 times that of the general adult population, and often have limited access to cessation treatments while homeless. Permanent Supportive Housing (PSH) can be a catalyst for cessation treatment utilization, yet little is known about use of these treatments following PSH entry, or how to tailor and implement cessation care that meets homeless-experienced adults' vulnerabilities. Methods: Using Department of Veterans Affairs (VA) administrative data, we assessed smoking status (ie, current, former, non/never) among a cohort of homeless-experienced Veterans (HEVs) housed in Los Angeles-based PSH. We compared cessation treatment use rates (ie, nicotine replacement therapies, cessation medications, psychosocial counseling) pre- and post-housing using Chi-square tests. Predisposing (ie, demographics), enabling (eg, primary care, benefits), and need characteristics (ie, health, mental health, substance use diagnoses) were examined as correlates of cessation treatment utilization pre- and post-housing in univariable and multivariable logistic regression models. Results: Across HEVs (N = 2933), 48.6% were identified as currently-smoking, 17.7% as formerly-smoking, and 14.0% as non/never smoking. Among currently- and formerly-smoking HEVs (n = 1944), rates of cessation treatment use post-housing were significantly lower, compared to pre-housing, across all treatment types. Health, mental health, and substance use was more prevalent among currently- and formerly-smoking HEVs compared to non/never-smoking HEVs, and most diagnoses were positively associated with utilization univariably. However, in multivariable models, cessation clinic referrals and primary care engagement were the only significant (P < .001) predictors of pre-housing and post-housing cessation treatment utilization. Conclusion: Among HEVs, we found high smoking rates and low cessation treatment utilization pre- and post-PSH entry. Efforts to educate providers about this population's desire to quit smoking, support primary care engagement, and increase cessation clinic referrals may bolster their utilization. For homeless-experienced adults, optimizing cessation treatment accessibility by embedding cessation services within PSH and homeless service settings may reduce utilization impediments.