Evaluation of QuitNow Men: An Online, Men-Centered Smoking Cessation Intervention.

BACKGROUND: Men continue to smoke cigarettes in greater numbers than women. There is growing evidence for the value of developing targeted, men-centered health promotion programs. However, few smoking cessation interventions have been designed for men. A gender-specific website, QuitNow Men, was developed based on focus group interview findings, stakeholder feedback, and evidence-based cessation strategies. The website was designed to incorporate a masculine look and feel through the use of images, direct language, and interactive content. Usability experts and end-users provided feedback on navigation and functionality of the website prior to pilot testing. OBJECTIVES: The objectives of the pilot study were to describe (1) men's use and evaluations of the interactive resources and information on the QuitNow Men website, and (2) the potential of QuitNow Men to engage men in reducing and quitting smoking. METHODS: A one-group, pretest-posttest study design was used. Men who were interested in quitting were recruited and invited to use the website over a 6-month period. Data were collected via online questionnaires at baseline, 3-month, and 6-month follow-up. A total of 117 men completed the baseline survey. Over half of those (67/117, 57.3%) completed both follow-up surveys. RESULTS: At baseline, participants (N=117) had been smoking for an average of 24 years (SD 12.1) and smoked on average 15 cigarettes a day (SD 7.4). The majority had not previously used a quit smoking website (103/117, 88.0%) or websites focused on men's health (105/117, 89.7%). At the 6-month follow-up, the majority of men used the QuitNow Men website at least once (64/67, 96%). Among the 64 users, 29 (43%) reported using the website more than 6 times. The men using QuitNow Men agreed or strongly agreed that the website was easy to use (51/64, 80%), the design and images were appealing (42/64, 66%), they intended to continue to use the website (42/64, 66%), and that they would recommend QuitNow Men to others who wanted to quit (46/64, 72%). Participants reported using an average of 8.76 (SD 4.08) of the 15 resources available on the website. At 6-month follow-up, 16 of the 67 participants (24%) had quit, 27 (40%) had reduced their smoking and 24 (36%) had not changed their smoking habits. Repeated measures general linear model showed a significant decrease in the number of cigarettes smoked between the 3-month and 6-month follow-up (F1,63=6.41, P=.01, eta squared=0.09). Number of resources used on the website, quit confidence, nicotine dependence and age significantly predicted number of quit attempts by those still smoking at 6 months (F4,45=2.73, P=.04), with number of resources used being the strongest predictor (P=.02). CONCLUSIONS: The results of this research support efforts to integrate gender-sensitive approaches in smoking cessation interventions and indicate that this novel Web-based resource has potential in supporting men's smoking cessation efforts.

A qualitative study of Chinese Canadian fathers' smoking behaviors: intersecting cultures and masculinities.

BACKGROUND: China is home to the largest number of smokers in the world; more than half of the male population smoke. Given the high rates of Chinese immigration to Canada and the USA, researchers have explored the effect of immigration on Chinese smokers. Reduced tobacco use among Chinese immigrants has been reported in the United States; however, little is known about the social factors underlying men's smoking practices in settings where tobacco control measures have denormalized smoking, and in the context of fatherhood. The purpose of this Canada-based study was to explore the smoking-related experiences of immigrant Chinese fathers. METHODS: In this qualitative study, semi-structured telephone interviews were conducted with 22 Chinese Canadian fathers who smoked or had recently quit smoking, and had at least one child under the age of five years old. RESULTS: The Chinese fathers had dramatically changed their smoking patterns due to concern for their children's health and social norms and restrictions related to smoking in Canada. The facilitators and barriers for men's smoking were intertwined with idealized masculine provider and protector roles, and diverse Canadian Chinese cultural norms related to tobacco use. CONCLUSIONS: The findings have implications for the development of future smoking cessation interventions targeting Chinese Canadian immigrant smokers as well as smokers in China.

"If I Were Nick": Men's Responses to an Interactive Video Drama Series to Support Smoking Cessation.

BACKGROUND: Men continue to smoke in greater numbers than women; however, few interventions have been developed and tested to support men's cessation. Men tend to rely on quitting strategies associated with stereotypical manliness, such as willpower, stoicism, and independence, but they may lack the self-efficacy skills required to sustain a quit. In this paper, we describe the development of and reception to an interactive video drama (IVD) series, composed of 7 brief scenarios, to support and strengthen men's smoking cessation efforts. The value of IVD in health promotion is predicated on the evidence that viewers engage with the material when they are presented characters with whom they can personally identify. The video dramatizes the challenges unfolding in the life of the main character, Nick, on the first day of his quit and models the skills necessary to embark upon a sustainable quit. OBJECTIVE: The objective was to describe men's responses to the If I were Nick IVD series as part of a study of QuitNow Men, an innovative smoking cessation website designed for men. Specific objectives were to explore the resonance of the main character of the IVD series with end-users and explore men's perceptions of the effectiveness of the IVD series for supporting their quit self-management. METHODS: Seven brief IVD scenarios were developed, filmed with a professional actor, and uploaded to a new online smoking cessation website, QuitNow Men. A sample of 117 men who smoked were recruited into the study and provided baseline data prior to access to the QuitNow Men website for a 6-month period. During this time, 47 men chose to view the IVDs. Their responses to questions about the IVDs were collected in online surveys at 3-month and 6-month time points and analyzed using descriptive statistics. RESULTS: The majority of participants indicated they related to the main character, Nick. Participants who "strongly agreed" they could relate to Nick perceived significantly higher levels of support from the IVDs than the "neutral" and "disagree" groups (P<.001, d=2.0, P<.001, d=3.1). The "agree" and "neutral" groups were significantly higher on rated support from the videos than the "disagree" (P<.001, d=2.2, P=.01, d=1.5). Participants' perception of the main character was independent of participant age, education attainment, or previous quit attempts. CONCLUSIONS: The findings suggest that IVD interventions may be an important addition to men's smoking cessation programs. Given that the use of IVD scenarios in health promotion is in its infancy, the positive outcomes from this study signal the potential for IVD and warrant ongoing evaluation in smoking cessation and, more generally, men's health promotion.

Personal and social determinants sustaining smoking practices in rural China: a qualitative study.

INTRODUCTION: Tobacco use in China is disproportionally distributed among rural and urban populations with rural people smoking more. While there is a wealth of evidence on the association between tobacco use among rural people and their lower socio-economic status (SES), how social structural factors contribute to rural smoking is not well understood. Guided by a socio-ecological model, the objective of this study was to explore the personal and social determinants that play a key role in sustaining smoking practices among Chinese rural people. METHODS: An ethnographic study was conducted in a rural area of Central Jiangsu, China. Participants (n = 29) were recruited from families where there was at least one smoking resident and there were young children. In-depth interviews and unstructured observations were used to collect data, which were then analyzed with an interpretive lens. RESULTS: Although individuals had limited knowledge about the risks of smoking and lack of motivation to quit, social factors were in effect the main barriers to quitting smoking. Cigarette exchange and cigarette gifting permeated every aspect of rural family life, from economic activities to leisure pastimes, in family and wider social interactions. Traditional familism and collectivism interplayed with the pro-smoking environment and supported rural people's smoking practices at the community level. Living in the rural area was also a barrier to quitting smoking because of the lack of information on smoking cessation and the influence of courtyard-based leisure activities that facilitated smoking. CONCLUSION: Development of comprehensive smoking cessation interventions in rural China needs to extend beyond an individual level to take into account the social determinants influencing smoking practices.

Supporting fathers' efforts to be smoke-free: program principles.

There is limited empirical evidence on effective ways to develop, distribute, and evaluate men-centred, gender-sensitive health promotion programs. The purpose of this research was to transition qualitative findings on men's smoking into father-centred cessation interventions. Men's perspectives were gathered in 4 group sessions with 24 new fathers who smoked. The data led to the identification of 3 principles for men's health promotion programs: use positive messaging to promote change without amplifying stigma, guilt, shame, and blame; foster connections between masculine ideals (e.g., strength, decisiveness, resilience, autonomy) and being smoke-free; and privilege the testimonials of potential end-users (e.g., fathers who smoke and want to quit). Experiences drawn from the design and pilot-testing of a booklet and a group program based on these principles are described. The findings can be used to guide nurses in the design and/or delivery of men's health promotion programs.

Strategies for Supporting Smoking Cessation Among Indigenous Fathers: A Qualitative Participatory Study.

There is a need for tailored smoking cessation programs specifically for Indigenous fathers who want to quit smoking.The aim of this study was to engage Indigenous men and key informants in guiding cultural adaptations to the Dads in Gear (DIG) cessation program. In Phase 1 of this qualitative participatory study, Indigenous men were engaged in group sessions and key informants in semistructured interviews to gather advice related to cultural adaptations to the DIG program. These data were used to guide the development of program prototypes. In Phase 2, the prototypes were evaluated with Indigenous fathers who were using tobacco (smoking or chewing) or were ex-users. Data were analyzed inductively. Recommendations for programming included ways to incorporate cultural values and practices to advance men's cultural knowledge and the need for a flexible program design to enhance feasibility and acceptability among diverse Indigenous groups. Men also emphasized the importance of positive message framing, building trust by providing "honest information," and including activities that enabled discussions about their aspirations as fathers as well as cultural expectations of current-day Indigenous men. That the Indigenous men's level of involvement with their children was diverse but generally less prescriptive than contemporary "involved fathering" discourse was also a key consideration in terms of program content. Strategies were afforded by these insights for meeting the men where they are in terms of their fathering-as well as their smoking and physical activity. This research provides a model for developing evidence-based, gender-specific health promotion programs with Indigenous men.

A Qualitative Study on Chinese Canadian Male Immigrants' Perspectives on Stopping Smoking: Implications for Tobacco Control in China.

China has the largest number of smokers in the world; more than half of adult men smoke. Chinese immigrants smoke at lower rates than the mainstream population and other immigrant groups do. This qualitative study was to explore the influence of denormalization in Canada on male Chinese immigrant smoking after migration. Semistructured interviews were conducted with 22 male Chinese Canadian immigrants who were currently smoking or had quit smoking in the past 5 years. The study identified that, while becoming a prospective/father prompted the Chinese smokers to quit or reduce their smoking due to concern of the impacts of their smoking on the health of their young children, changes in smoking were also associated with the smoking environment. Four facilitators were identified which were related to the denomormalized smoking environment in Canada: (a) the stigma related to being a smoker in Canada, (b) conformity with Canadian smoking bans in public places, (c) the reduced social function of smoking in Canadian culture, and (d) the impact of graphic health messages on cigarette packs. Denormalization of tobacco in Canada in combination with collectivist values among Chinese smokers appeared to contribute to participants' reducing and quitting smoking. Although findings of the study cannot be claimed as generalizable to the wider population of Chinese Canadian immigrants due to the small number of the participants, this study provides lessons for the development of tobacco control measures in China to reverse the current prosmoking social environment.

Smoke-Free Men: Competing and Connecting to Quit.

PURPOSE: The purpose of this study was to explore gender-related factors that motivate and support men's smoking reduction and cessation to inform effective men-centered interventions. Approach or Design: Focus group design using a semi-structured interview guide. SETTING: Three communities in British Columbia, Canada. PARTICIPANTS: A total of 56 men who currently smoked and were interested in reducing or quitting or had quit. INTERVENTION: N/A. METHODS: Data collected in 6 focus group discussions were transcribed and analyzed in accord with principles of thematic qualitative methods. RESULTS: We report the results across 4 interconnected themes: (1) the fight to quit takes several rounds, (2) the motivation of supportive competition, (3) challenges and benefits of connecting with smoke-free peers, and (4) playing up the physical and financial gains. CONCLUSIONS: Masculine-based perspectives positioned quitting alongside fighting for self-control, competing, connecting, physical prowess, and having extra cash as motivating components of programs to engage men in efforts to be smoke-free. It may be worthwhile to consider the inclusion of gain-framed and benefit-focused messaging in programs that support men's tobacco cessation.

Chinese immigrant men smokers' sources of cigarettes in Canada: A qualitative study.

BACKGROUND: Immigrants often experience economic hardship in their host country and tend to belong to economically disadvantaged groups. Individuals of lower socioeconomic status tend to be more sensitive to cigarette price changes. This study explores the cigarette purchasing patterns among Chinese Canadian male immigrants. METHODS: Semi-structured in-depth interviews were conducted with 22 Chinese Canadian immigrants who were smoking or had quit smoking in the last five years. RESULTS: Because of financial pressures experienced by participants, the high price of Canadian cigarettes posed a significant challenge to their continued smoking. While some immigrants bought fully-taxed cigarettes from licensed retailers, more often they sought low-cost cigarettes from a variety of sources. The two most important sources were cigarettes imported during travels to China and online purchases of Chinese cigarettes. The cigarettes obtained through online transactions were imported by smoking or non-smoking Chinese immigrants and visitors, suggesting the Chinese community were involved or complicit in sustaining this form of purchasing behavior. Other less common sources included Canada-USA cross border purchasing, roll your-own pouch tobacco, and buying cigarettes available on First Nations reserves. CONCLUSIONS: Chinese Canadian immigrant men used various means to obtain cheap cigarettes. Future research studies could explore more detailed features of access to expose gaps in policy and improve tobacco regulatory frameworks.

Assessing the feasibility, acceptability and potential effectiveness of an integrated approach to smoking cessation for new and expectant fathers: The Dads in Gear study protocol.

BACKGROUND: Evidence related to the effects of tobacco exposure in pregnancy and on infant and child health have focused on women's smoking cessation. Less often addressed is men's smoking, which when continued in fatherhood, reduces the chances of female partners' cessation and can negatively impact children's health as well as men's health. Dads in Gear (DIG) is an innovative program designed specifically for new fathers who want to reduce and quit smoking that includes three components: smoking cessation, fathering, and physical activity. The over-arching purpose of this study is to evaluate the feasibility of the DIG program and provide estimates of program efficacy. The purpose of this article is to describe the rationale and protocol for evaluating the DIG program's feasibility, acceptability and potential effectiveness. METHODS: Using a prospective, non-comparative design, the DIG program will be implemented and evaluated in six communities. The program will be offered by trained facilitators to fathers who currently smoke and want to quit. The RE-AIM framework will guide the evaluation. Open-ended questions in participant surveys, and semi-structured interviews and weekly telephone de-briefs with facilitators will provide data for a process evaluation. Estimates of effectiveness include smoking behavior, fathering and physical activity measures at baseline, end of program, and 3-month follow up. CONCLUSION: The DIG program could support positive changes with respect to smoking cessation, physical activity and overall health for men. These effects could also promote family health. The program might also provide an effective model for engaging men in other health behavior change.

Men's Responses to Online Smoking Cessation Resources for New Fathers: The Influence of Masculinities.

BACKGROUND: Smoking cessation is the single most important step to preventing cancer. Drawing on previous research, Web-based resources were developed to complement a program to support expectant and new fathers to quit smoking. OBJECTIVE: The objectives of this research were to: (1) describe the responses of expectant and new fathers who smoke or had recently quit smoking to the website resources, and (2) explore how masculinities shape men's responses to and experiences with online smoking cessation resources. METHODS: Using semi-structured, individual face-to-face interviews, the Dads in Gear Web-based resources were reviewed and evaluated by 20 new fathers who smoked or had recently quit smoking. The data were transcribed and analyzed using NVivo 8 qualitative data analysis software. RESULTS: We describe the fathers' reactions to various components of the website, making connections between masculinities and fathering within 5 themes: (1) Fathering counts: gender-specific parenting resources; (2) Measuring up: bolstering masculine identities as fathers; (3) Money matters: triggering masculine virtues related to family finances; (4) Masculine ideals: father role models as cessation aids; and (5) Manly moves: physical activity for the male body. CONCLUSIONS: A focus on fathering was an effective draw for men to the smoking cessation resources. The findings provide direction for considering how best to do virtual cessation programs as well as other types of online cancer prevention programs for men.

Smoking cessation in an urban population in China.

OBJECTIVE: To examine smoking cessation among urban-based Chinese. METHODS: Multi-stage random sampling was used to obtain a sample from 21 cities in China. Two logistic regression models were established to identify factors influencing quit intention and smoking cessation. RESULTS: Prevalence of smoking cessation was 10.1%; 45.5% of smokers intended to quit. Women and professionals had higher cessation rates than men and nonprofessionals. Rates of quit intention were highest among managers and clerks, and lowest among those who used gifted tobacco, smoked alone, and reported addiction to nicotine. CONCLUSION: Individual and city level factors are associated with quit intention and smoking cessation among urban-dwelling Chinese smokers. This information should guide smoking cessation programs and inform health policy.

Gender influences in tobacco use and cessation interventions.

Smoking rates among and between men and women are in large part a reflection of the influence of gender and its intersections with other social factors including ethnicity, age, and social class that influence tobacco use and, ultimately, tobacco reduction and cessation. In this article, opportunities for developing and delivering gender-sensitive (programs addressing gender) and gender-specific (programs designed for men or women) interventions in the context of tobacco dependence treatment are discussed.