Predictors for quitting smoking in smoking cessation clinics among female smokers in China.

INTRODUCTION: The number of cessation clinics in China have been increasing ever since the Chinese government supported the establishment of smoking cessation clinics (SCCs) in each province in 2014. Many studies have examined smoking cessation behaviors among male smokers, but few of female smokers. This study aimed to understand female smokers' quitting behaviors in SCCs and identify predictors of successful cessation. METHODS: This study used data of the SCCs Platform in China from 2018 to 2020. The self-reported 7-day point prevalence of abstinence rate (PPAR) at 1 month and at 3 months follow-up and the continuous abstinence rate (CAR) at 3 months follow-up are reported based on smokers' characteristics and intention to treat analysis. A multiple logistic regression model was used to identify predictors of continuous abstinence at 3 months follow-up. RESULTS: The 7-day PPAR of female outpatients in SCCs was 29.20% at 1 month follow-up and 28.36% at 3 months follow-up. The CAR at 3 months follow-up was 19.88%. Female smokers who were prepared to quit within 7 days (AOR=2.86; 95% CI: 1.53-5.32), today (AOR=4.01; 95% CI: 2.35-6.85), had started to quit (AOR=7.11; 95% CI: 4.12-12.27), and used a combination of counseling and drugs (AOR=2.41; 95% CI: 1.73-3.35) were more likely to quit smoking. Associated with lower quitting rates were: living in the central region of China (AOR=0.47; 95% CI: 0.31-0.73) and the west region (AOR=0.48; 95% CI: 0.31-0.73); being aged 30-39 years (AOR=0.39; 95% CI: 0.23-0.64), and 40-49 years (AOR=0.41; 95% CI:0.24-0.69); being unemployed (AOR=0.64; 95% CI: 0.45-0.91); having a fair perceived health status at the first visit (AOR=0.65; 95% CI: 0.47-0.91) and a poor one (AOR=0.37; 95% CI: 0.21-0.64); having a moderate nicotine dependence (AOR=0.64; 95% CI: 0.44-0.92) and a severe one (AOR=0.50; 95% CI: 0.34-0.72). CONCLUSIONS: In our study, the region of residence, age, employment, perceived health status, Fagerström test for nicotine dependence (FTND), readiness to quit, and intervention model were independent predictors of quitting for female smokers. Improving the motivation to quit, providing intensive psychological interventions and equipping SCCs with cessation medication would assist female smokers to quit.

Understanding daily life experiences of women who smoke: The role of smoking-related weight control expectancies.

Smoking-related weight control expectancies are a motivational factor for maintaining cigarette use, particularly among women. Yet, less research has investigated the physiological and behavioral daily life weight-related experiences of women with smoking-related weight control expectancies. Increased research could contribute to understanding of maintenance factors for this group of smokers as well as unique intervention targets. Female smokers completed a baseline survey of smoking-related weight control expectancies and 35-days of ecological momentary assessment of physiological (i.e., smoking-related reduction in hunger, end-of-day perceived weight gain and bloating) and behavioral (i.e., daily exercise and sitting) weight-related experiences. Higher smoking-related weight control expectancies were associated with perceived smoking-related reductions in hunger and end-of-day perceived weight gain. Smoking-related weight control expectancies did not significantly associate with end-of-day bloating, daily exercise, or sitting. Given these findings, smoking-related weight control expectancies may maintain smoking in order to reduce hunger and to cope with perceived fluctuations in weight in daily life. It is critical for smoking cessation programs to assess smoking-related weight control expectancies and implement targeted treatments for these women.

The association between hormonal contraceptive use and smoking, negative affect, and cessation attempts in college females.

Exogenous and endogenous female hormones influence nicotine use and cessation, potentially through mechanisms such as anxiety and negative affect. In the present study, college females using all types of hormonal contraceptives (HC) were compared to those not using HC to determine the potential influence on current smoking, negative affect, and current and past cessation attempts. Differences between progestin-only and combination HC were also examined. Of the 1,431 participants, 53.2% (n = 761) reported current HC use, and 12.3% (n = 176) of participants endorsed current smoking. Women currently using HC were significantly more likely to smoke (13.5%; n = 103) compared to women not using HC (10.9%; n = 73), p = .04. There was a significant main effect of HC use being associated with lower anxiety levels (p = .005), as well as a significant HC use by smoking status interaction, such that women who smoke using HC reported the lowest levels of anxiety among participants (p = .01). Participants using HC were more likely to be making a current attempt to quit smoking than those not using HC (p = .04) and were more likely to have made past quit attempts (p = .04). No significant differences were observed across women using progestin-only, combined estrogen and progestin, and women not using HC. These findings provide evidence that exogenous hormones may be an advantageous treatment target and that they warrant additional study.

Effectiveness of transdermal nicotine patch in premenopausal female smokers is moderated by within-subject severity of negative affect and physical symptoms.

RATIONALE: Nicotine patches may be less effective in female compared with male smokers. However, it is unknown if negative affect and physical symptoms influence transdermal nicotine patch-related effects on smoking behaviors. METHODS: Eighty-one acutely tobacco-abstinent premenopausal female smokers attended three counter-balanced experimental sessions across the menstrual cycle (early follicular, late follicular, and mid-luteal) and were randomized to patch condition (nicotine [21 mg] vs. placebo [0 mg] transdermal patch). Negative affect and physical symptoms were assessed prior to patch administration. The patch was removed 5 h post-administration, and participants completed a smoking reinstatement task. Multilevel linear models tested associations of patch condition, negative affect and physical symptoms, and their interaction on smoking behavior. RESULTS: There was a significant patch condition × Negative Affect and Pain symptoms interaction on the number of cigarettes smoked (p < 0.05). When Negative Affect and Pain were lower-than-usual, females administered a nicotine patch smoked significantly fewer cigarettes than females administered a placebo patch (p < .05), but there were no significant patch differences when Negative Affect and Pain were higher-than-usual. There was also a significant patch condition × Negative Affect interaction on time delay. The effects of patch condition on time delay to smoking were greater during sessions in which Negative Affect was higher-than-usual. CONCLUSIONS: Results suggest that among female smokers transdermal nicotine patch effectiveness may interact with negative affect and pain. Understanding and considering female-specific factors that may impact the efficacy of one of the most commonly used cessation medications is important for improving smoking cessation in female smokers.

Smoking among female daily smokers in Surabaya, Indonesia.

OBJECTIVES: Nationally representative studies suggest 1-2% of Indonesian women (2.3 million) smoke various tobacco products daily; however, in recent years, there has been concern that the tobacco industry has successfully increased female smoking. Our objective was to describe current cigarette smoking behaviors, past quit attempts, and intention to quit of female daily smokers in Surabaya, Indonesia. STUDY DESIGN: Survey. METHODS: Female daily smokers (n = 112) in Surabaya, Indonesia, the country's second largest city, were recruited to participate in a survey during 2018. Convenience sampling was utilized in two malls. Potential participants were intercepted in or near designated smoking areas and invited to the nearby data collection site. Survey items from Global Adult Tobacco Survey and the International Tobacco Control Policy Evaluation Project were utilized. RESULTS: Participants self-reported smoking 13.8 cigarettes per day (7.3 white machine-rolled cigarettes per day, 4.2 kreteks per day, and 2.4 roll-your-own cigarettes per day). Over 75% smoked their first cigarette within 30 min of waking. Over 53% had a heaviness of smoking index score suggesting moderate or high addiction. Approximately half (51%) did not attempt to quit smoking in the previous 12 months, and 55% planned to quit beyond 6 months or not at all. CONCLUSIONS: Our sample smoked five to six more cigarettes per day than female daily smokers in previous national surveys. Relative to previous studies, our data suggest an unexpected preference for white machine-rolled cigarettes and that there could be, at a minimum, pockets of increased smoking and addiction among female daily smokers in Indonesia.

Factors contributing to the upsurge of water-pipe tobacco smoking among Saudi females in selected Jeddah cafés and restaurants: A mixed method study.

BACKGROUND: Despite clear evidence indicating the health hazards of water tobacco smoking (WTS), there is a remarkable increase in the frequency of WTS in the Middle East and the Gulf region, particularly among young girls and women. The objective of this survey was to examine the prevalence of and the reasons for addiction to WTS and study in depth the factors contributing to the increased frequency of WTS among Saudi females. MATERIALS AND METHODS: This study was conducted in different cafés and restaurants in Jeddah using a mixed method approach. A quantitative approach was carried out by a cross-sectional design, in which adult WTS Saudi females (n = 332) were selected from ten cafés. In addition, a qualitative approach was pursued involving five focus group discussions and three in-depth interviews of heavy smokers. Frequencies and percentages were calculated for the categorical variables, and Chi-square test and regression analysis were performed to establish association. Key themes were identified and built upon for the qualitative part. RESULTS: The mean age of female water-pipe (WP) smokers was 32.5 ± 11.9 years. Addicted to WTS were 39.6% of the women. Significant predictors of smokers' addiction to WTS according to regression analysis (p < 0.05) were increased frequency of WTS, perception that it improved mood, and insistence on carrying one's own WP to restaurants and cafés. Smoking frequency increased in pleasant weather (p = 0.025) and better mood (p = 0.033). This study showed that students and working women were more addicted to WTS (p < 0.001). Those who smoked daily preferred to smoke at home especially when alone (p < 0.001), while the preferred place for those who smoked weekly was restaurants in the company of their friends (p < 0.001). Most of the participants in this study believed that WTS was less harmful and less addictive than cigarette smoking. The only driving force to quit WTS was the effects on their beauty/skin. CONCLUSION: WTS is a public health problem, especially among young girls. Peer pressure, view that it is a fashion symbol, carrying one's own WP and wrong belief that WP was less harmful, improved mood, and effect of the weather are main factors leading to unintentional dependency on WTS. The only driving force to stop WTS is the effect it has on beauty/skin. It is important to understand the reasons behind the upsurge of WTS in this group for appropriate policy for intervention for its prevention and cessation.

Predictors of Continued Smoking and Interest in Cessation Among Older Female Smokers.

OBJECTIVES: Older female smokers are highly vulnerable, yet little is known about their attitudes, beliefs, and behaviors regarding smoking cessation. METHODS: Southeast region Women's Health Initiative participants identified as smokers on at least one prior assessment were surveyed in 2012 regarding current tobacco use. RESULTS: Most of these current and former smokers ( N = 409, 63% response) were non-Hispanic White (81.7%) and had some college (80%), with mean age of 75.1 years. Current smoking was confirmed by 56%, and while 61% of these reported a past-year quit attempt, less than half used quit aids. Of current smokers, 57.5% intended to quit within 6 months (26.6% within 30 days), and 68% were interested in joining a cessation study. CONCLUSIONS: Older female smokers were highly motivated to quit, yet profoundly underutilized proven quit aids. Results support high acceptability of cessation interventions for this undertreated population.

Development of a community-based network to promote smoking cessation among female smokers in Hong Kong.

BACKGROUND: There is a need for population-based smoking cessation interventions targeting female smokers in Hong Kong. This study describes the development of a community-based network to promote smoking cessation among female smokers in Hong Kong. METHODS: Local women's organizations collaborated to launch a project to provide gender-specific smoking cessation services. In the first phase of the project, the Women Against Tobacco Taskforce (WATT) was created. In the second phase, a smoking cessation training curriculum was developed and female volunteers were trained. The third and final phase included the provision of gender-specific smoking cessation counseling services in Hong Kong. RESULTS: A need assessment survey with 623 workers and volunteers of WATT members was carried out to develop a gender-specific smoking cessation training curriculum. A 1-day training workshop to 28 WATT affiliates who provided brief cessation counseling in the community was organized. Fourteen organizations (69 service units) agreed to form a network by joining WATT to promote smoking cessation and increase awareness of the specific health risks among female smokers. CONCLUSIONS: The community-based network to promote smoking cessation was effective in helping female smokers to quit smoking or reduce their cigarette consumption. The results also suggest that this community model of promoting gender-specific smoking cessation services is feasible. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT02968199 (Retrospectively registered on November 16, 2016).

Study of the elemental composition of saliva of smokers and nonsmokers by X-ray fluorescence.

Cigarette smoking is a serious public health problem. According to data from the World Health Organization, it is estimated that currently more than 1.2 billion people worldwide do tobacco use and that smoking-related diseases are responsible for about 6 million deaths each. With attention to this, it is necessary to seek preventive and prognostic of trying to reduce these numbers and alert the public in general about the danger and the harm caused by its use. Thus, the objective of the research work undertaken was to evaluate and compare the chemical composition of collected saliva samples of smokers and nonsmokers by X-ray Fluorescence analyses. 32 individuals were selected, 16 of which used cigarette on a daily basis and the other 16 had never smoked. Saliva was collected with the help of a (sterile) disposable Pasteur pipette and samples sent to the Applied Nuclear Physics Laboratory at UNISO (LAFINAU), where analyzes were carried out. Individuals who agreed to participate in the study answered a questionnaire to define their profile of inclusion and signed an informed consent form (CEP Protocol no. 831.753 of 09/10/2014). The results clearly showed that there are differences in the concentrations of chemical elements in the saliva of smokers and non-smokers. The biggest discrepancies were found at concentrations of the chemical elements Sulfur, Phosphorus, Chlorine and Potassium, and smaller differences in the concentration of the elements Calcium, Manganese, Iron, Copper, Titanium, Vanadium and Nickel. In only one saliva sample, and in quite low amounts, arsenic was detected. The results indicate that smoking produces more significant changes in the saliva of women than in men, increasing the concentration of some elements in the saliva of female smokers, much more than in the male smokers. The cigarette usage time also appears to exert a greater influence on the composition of the saliva of women than in men, indicating that the damage caused by cigarette use may in fact be higher in women than in men.

Gender Differences in Relations of Smoking Status, Depression, and Suicidality in Korea: Findings from the Korea National Health and Nutrition Examination Survey 2008-2012.

OBJECTIVE: As mental health problems may play an important role in initiating and maintaining cigarette smoking in females and there are an increasing number of female smokers, we evaluated the relationship between smoking status and mental health problems including depression and suicide ideation in women in Korea. METHODS: We analyzed the 5-year cumulative data (19 years of age or older, n=32,184) from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted from 2008 to 2012. Logistic regression analyses were used to evaluate associations between cigarette smoking status and mental health parameters while controlling for potentially confounding variables. RESULTS: Among current smokers, females showed higher lifetime prevalence in having a depressive episode, a doctor-diagnosed major depression, a current diagnosis of depression, or receiving treatment for depression in comparison with males. In addition, females were more likely to report on having a depressive episode, suicidal ideation and attempts, and psychiatric counselling within the previous year, as compared to males. Female former smokers showed intermediate characteristics in parameters of mental health status within the previous year, ranking between lifetime non-smokers and the current smokers. CONCLUSION: Identifying the factors related to mental health status among current smokers can increase opportunities for an early intervention and help reduce the prevalence of smoking and increase smoking cessation rates particularly in females. Developing adaptive coping strategies other than smoking in female youth is potentially important in reducing the initiation of smoking.

Craving and Withdrawal Symptoms During Smoking Cessation: Comparison of Pregnant and Non-Pregnant Smokers.

Although pregnant smokers are aware of the negative peri- and postnatal health consequences of smoking, the cessation rate in pregnancy is low, raising the question of why pregnant smokers have difficulty quitting. Reasons might be that pregnant smokers experience more intense craving and withdrawal symptoms than non-pregnant smokers. We compared craving and withdrawal in 306 pregnant smokers versus 93 non-pregnant women using data from two smoking cessation trials. Complete data were analyzed using pre-quit and post-quit (2 weeks after quit date) craving and withdrawal measured by the 12-item French Tobacco Craving Questionnaire (FTCQ-12) and French Minnesota Nicotine Withdrawal Scale (FMNWS). Pregnant smokers started smoking and smoked regularly earlier and succeeded far less at quitting smoking by week 2 than the general population of smokers (11% versus 43%). Post-quit date FTCQ-12 general score was higher in pregnant smokers compared to comparison groups, and was driven by elevated emotionality and expectancy. FMNWS decreased significantly less among pregnant smokers than among non-pregnant smokers. Insufficient reduction of craving and withdrawal symptoms in response to a quit attempt may partially explain why pregnant smokers may have more difficulty quitting than non-pregnant smokers. Because this was a historical comparison, findings are preliminary; however, they might foster further investigation of differences in craving and withdrawal symptoms in pregnant versus non-pregnant smokers.