Financial incentive interventions for smoking cessation among Chinese smokers: study protocol for a cluster randomised controlled trial.

INTRODUCTION: There is an urgent issue to relieve the burdens caused by tobacco use through feasible and effective smoking cessation interventions, particularly in a middle-income country with less accessible smoking cessation services and high demand for quitting smoking. Financial incentives have shown effective in changing health behaviours, thus needing to test its portability to a wider implementation and effectiveness of increasing smoking cessation rates. METHODS AND ANALYSIS: This is a three-arm cluster randomised controlled trial. 462 eligible participants will be assigned to 2 financial incentive groups-rewards or deposits, or the control group. All participants including those in the control group will receive text messages to help quitting smoking developed by the US National Cancer Institute over a 3-month intervention period. In addition to text messages, reward group participants will be rewarded with CNY200 and CNY400 (CNY100 approximately US$15) for sustained smoking abstinence at 1 month and 3 months follow-up assessments; participants in the deposit group will accumulate CNY200 and CNY600 in the deposit accounts after verified smoking abstinence at 1 month and 3 months follow-up assessments, and all the deposits will be given at once right after the 3-month follow-up visit. The primary outcome is biochemically verified smoking abstinence rate sustained for 6 months after enrolment. ETHICS AND DISSEMINATION: This trial protocol has been approved by the Ethics Committee of Peking University Health Science Centre (date: 23 February 2023; ethical approval number: IRB00001052-22172). Results and findings of this trial will be disseminated in peer-reviewed journals and professional conferences. TRIAL REGISTRATION NUMBER: ChiCTR-IOR-2300069631.

Development and psychometric assessment of Health Action Process Approach (HAPA) in terms of smoking cessation among Chinese smokers.

The Health Action Process Approach (HAPA) is a two-stage (pre-intentional and post-intentional) behavioral change model that distinguishes between motivation and volition in behavior change process. This study aims to develop HAPA-based assessments for smoking cessation among current smokers. The HAPA-based measures were developed and the draft measures included nine constructs, namely, risk perception in smoking-induced cancer, risk perception in smoking-induced systemic disease, positive outcome expectancy, negative outcome expectancy, self-efficacy in quitting smoking, self-efficacy in maintaining, self-efficacy in re-initiating, quitting planning and coping planning in smoking cessation, with a total of 26 items. A cross-sectional survey was conducted in China in 2022. Principal Component Analysis was used for Exploratory Factor Analysis (EFA). Cronbach's α coefficient was calculated to evaluate the internal consistency. Variables such as severity of smoking addiction were selected to evaluate the correlation between the HAPA scale and these variables. Of the 928 participants, 76.4% (709/928) were male and the median age was 35 years. Five factors were extracted by EFA. The factor loadings of each item were all greater than 0.60, and the cumulative variance contribution rate was 90.15%. The Cronbach's α coefficient of each HAPA-based subscales was 0.929-0.986. The HAPA-based measurements are comprehensive, reliable and valid in the assessment of smokers' smoking cessation cognition, which can be used to guide the design and implementation of intervention and the development of theory.

Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial.

Importance: Electronic cigarettes (ECs) are often used by smokers as an aid to stopping smoking, but evidence is limited regarding their efficacy compared with nicotine replacement therapy (NRT), and no evidence is available on how their efficacy compares with that of varenicline. Objective: To evaluate whether ECs are superior to NRT and noninferior to varenicline in helping smokers quit. Design, Setting, and Participants: This was a randomized clinical trial conducted at 7 sites in China and including participants who were smoking at least 10 cigarettes per day and motivated to quit, not using stop-smoking medications or EC, and willing to use any of the study products. Participants were first recruited in May 2021, and data analysis was conducted in December 2022. Interventions: A cartridge-based EC (30 mg/mL nicotine salt for 2 weeks and 50 mg/mL after that), varenicline (0.5 mg, once a day for 3 days; 0.5 mg, twice a day for 4 days; and 1 mg, twice a day, after that), and 2 mg (for smokers of ≤20 cigarettes per day) or 4 mg (>20 cigarettes per day) nicotine chewing gum, all provided for 12 weeks and accompanied by minimal behavioral support (an invitation to join a self-help internet forum). Main Outcomes and Measures: The primary outcome was sustained abstinence from smoking at 6 months as validated by an expired-air carbon monoxide reading (<8 parts per million). Participants lost to follow-up were included as nonabstainers. Results: Of 1068 participants, 357 (33.5%) were female, and the mean (SD) age was 33.9 (3.1) years. A total of 409 (38.3%), 409 (38.3%), and 250 (23.4%) participants were randomized to the EC, varenicline, and NRT arms, respectively. The 6-month biochemically validated abstinence rates were 15.7% (n = 64), 14.2% (n = 58), and 8.8% (n = 22) in the EC, varenicline, and NRT study arms, respectively. The quit rate in the EC arm was noninferior to the varenicline arm (absolute risk reduction, 1.47%; 95% CI, -1.41% to 4.34%) and higher than in the NRT arm (odds ratio, 1.92; 95% CI, 1.15-3.21). Treatment adherence was similar in all study arms during the initial 3 months, but 257 participants (62.8%) in the EC arm were still using ECs at 6 months, with no further use in the 2 other study arms. The most common adverse reactions were throat irritation (32 [7.8%]) and mouth irritation (28 [6.9%]) in the EC arm, nausea (36 [8.8%]) in the varenicline arm, and throat irritation (20 [8.0%]) and mouth irritation (22 [8.8%]) in the NRT arm. No serious adverse events were recorded. Conclusions and Relevance: The results of this randomized clinical trial found that when all treatments were provided with minimal behavior support, the efficacy of EC was noninferior to varenicline and superior to nicotine chewing gum. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2100048156.

Correlation analysis between physical activity and depressive tendencies among occupational groups: an isotemporal substitution approach.

OBJECTIVES: Sedentary behaviour (SB) and physical activity (PA) have been shown to be associated with depression. However, behaviours, such as PA, occupy a portion of an individual's 24-h day. Thus, an increase in time for one behaviour takes away time from another. Previous evidence suggests that it would be more appropriate to shift the focus to the importance of reallocating time spent in sedentary behaviour to time spent in physical activity. The aim of this study was to analyse the mutual replacement effect of different health behaviours on depressive tendencies by isotemporal substitution modelling (ISM) under the objective condition of considering a limited 24-h day. Second, we aimed to further explore the potential association between excessive or insufficient sleep duration and depressive symptoms. METHODS: A total of 10656 employees from 79 companies in four provinces of China participated in this survey. The Center for Epidemiological Studies Depression Scale (CES-D) was used to measure workers' depressive tendencies. The duration of various types of physical activity was self-reported by workers based on the International Physical Activity Questionnaire (IPAQ). ISM was used to assess the associations of time spent in different activities on displacement of equivalent time spent on other activities with depression risk. RESULTS: A total of 10656 participants (89.5% of the sample) were included in the analysis. The ISM found that a 30-min unit of SB replaced with walking (OR, 95% CI: 0.83, 0.77-0.88), sleep (≤ 8 h) (OR, 95% CI: 0.77, 0.74-0.79), moderate physical activity (MPA) (OR, 95% CI: 0.87, 0.81-0.93) and vigorous physical activity (VPA) (OR, 95% CI: 0.91, 0.84-0.99) was significantly and negatively associated with the risk of depressive tendencies. When sleep duration was less than 8 h, each additional half hour of sleep time was significantly associated with a lower risk of depressive tendencies, and this association was no longer significant after 8 h. CONCLUSION: Prolonged SB is common in the current workplace in China. Replacing an average of 30 min per day of SB with VPA and MPA, even walking is associated with less depression among workers. In addition, insufficient daily sleep is also an important risk factor for workers' depressive tendencies. These findings provide valuable evidence to promote mental health among occupational groups and support the development of healthy workplaces.

Efficacy of personalised text message intervention in reducing smoking frequency and amount for non-abstinent smokers: A double-blind, randomised controlled trial.

Background: Emerging evidence supports the efficacy of mobile phone interventions for smoking cessation. However, behaviour changes of smokers who fail to reach abstinence and the related psychological mechanism are still understudied. We aimed to evaluate the efficacy of a behaviour change theory-based smoking cessation intervention delivered through personalised text messages from the perspective of smokers who fail to reach abstinence. Methods: We conducted a two-arm, double-blind, randomised controlled trial, with the intervention group receiving personalised text messages developed specifically for this study, and the control group receiving non-personalised ones related to smoking cessation. These messages were sent over a period of three months. We looked at three outcomes: changes in smoking frequency, in smoking amount, and in protection motivation theory (PMT) construct scores. Results: We obtained smoking cessation results for 722 participants who went through the randomisation process (intervention: 360, control: 362; block randomisation design). Overall, 32.3% of baseline daily smokers in the intervention group and 20.0% in the control group changed to weekly smokers during the follow-up period (P < 0.001), while 43.4% of consistent daily smokers in the intervention group and 32.8% in the control group continuously reduced their smoking amount (P < 0.001). We observed associations between the intrinsic rewards of smoking and changes from daily to weekly smoking, the perceived severity of smoking and reductions in smoking amount, as well as the self-efficacy of quitting and changes from daily to weekly smoking/reductions in smoking amount. Conclusions: We found that a personalised text message-based intervention was more likely to decrease the frequency and amount of smoking in smokers who failed to reach abstinence compared to a non-personalised one. We also explored the possible psychological mechanism of such positive effects. Here we provide evidence for countries to consider the promotion of smoking cessations using behaviour theory-driven personalised text messages, which may be more cost-effective than traditional approaches. Registration: Peking University: ChiCTR2100041942.

Defining indicators for the scoping stage of health impact assessment to evaluate tobacco control policy in the city of Beijing.

INTRODUCTION: Beijing initiated the nation's most comprehensive tobacco control program that adheres to the WHO Framework Convention on Tobacco Control. This study aimed to identify a set of indicators for the scoping of an Health Impact Assessment (HIA) to assess this policy. METHODS: This study used a modified Delphi process. It proposed a tobacco control health impact framework based on the Driving forces- Pressure- State- Exposure- Effect- Action model and the Determinants of Health Theory. After a review of current surveillance system and literature, a working group of 13 experts with multidisciplinary background was established to formulate indicator evaluation criteria and conduct indicator scoring. Each indicator was scored by experts according to four evaluation criteria chosen. Indicators that obtained a total score above 80% and with standard error less than 5 were selected as the final set of indicators. Kendall's coefficient of concordance was calculated. RESULTS: Twenty-three out of 36 indicators were selected. Smoking prevalence, mortality rate, hospital admission rate, tobacco consumption and hospital admission fees of smoking related diseases achieved more than 90% of total scores and ranked as the top five. Kendall's concordance coefficient was 0.218 for all indicators. For all model composition, Kendall's concordance coefficients were statistically significant. CONCLUSION: This study identified a set of twenty-three indicators for scoping of HIA of a comprehensive tobacco control policy in Beijing based on a tobacco control health impact conceptual framework. The set of indicators achieved high scores and statistically significant consistency and has great potential to promote the evaluation of tobacco control policy in a global city. Further study might use the set of indicators for HIA on tobacco control policy to analyze empirical data.

Psychiatric symptoms and intentions to quit smoking: How regularity and volume of cigarette consumption moderate the relationship.

INTRODUCTION: Smoking prevalence is disproportionately higher in those with psychiatric symptoms. Smokers with psychiatric symptoms are less likely to have an intention to quit smoking and attain eventual smoking abstinence. This study presents the relationship between depressive/anxiety symptoms and the intention to quit smoking and related influencing factors. METHODS: A cross-sectional study recruited 931 current smoking individuals covering two provinces in China in July 2022. The online survey comprised questions concerning sociodemographic characteristics, smoking conditions and psychiatric symptoms. Chi-squared analyses and moderation analyses were applied. RESULTS: The proportion of smokers who had the intention to quit smoking within six months was 46.1%. In comparison with subjects without depressive/anxiety symptoms, individuals who had both psychiatric symptoms were less likely to have the intention to quit smoking (39.3% vs 49.8%, χ2=9.130, p=0.028). As for the moderating model of depression, the interaction term of depressive symptoms and smoking regularly was significant (ß=0.554, t=3.260, p=0.001). For those who were occasional smokers, depressive symptoms significantly lowered their quitting intentions. The regularity of smoking similarly moderated the effect of anxiety symptoms on quitting intentions. When the number of cigarettes used weekly served as the moderator, the interaction of this number and depressive symptoms was significant, as well as for anxiety (p<0.001), indicating that the volume of cigarette consumption moderated the relationship between depressive/anxiety symptoms and intention to quit smoking. CONCLUSIONS: Psychiatric symptoms were significant factors in reducing the willingness of smokers to quit smoking, and the effects were moderated by smokers' cigarette consumption conditions. Interventions are urged to enhance quitting intentions of these vulnerable smokers.

A randomized controlled trial of personalized text messages for smoking cessation, China.

Objective: To describe a tobacco cessation intervention using personalized mobile phone text messages based on behaviour change theory and to assess why the intervention was effective. Methods: We conducted a two-arm, double-blind, randomized controlled trial in five cities in China from April to July 2021. We recruited daily or weekly smokers aged 18 years or older. The 90-day intervention was delivered using a mobile phone chat application. At different stages of quitting, intervention group participants received personalized text messages based on analyses of the strength of their intention to quit, their motivation to quit and their self-reported success at quitting. Control group participants received non-personalized text messages. The primary outcome was the biochemically verified 6-month abstinence rate. Secondary outcomes were changes in scores on the components of protection motivation theory. All analyses were by intention to treat. Findings: We randomly assigned 722 participants to intervention or control groups. Biochemically verified continuous abstinence at 6 months was 6.9% (25/360) in the intervention group and 3.0% (11/362) in the control group. Smokers who received the personalized intervention had lower scores on intrinsic rewards of smoking and response costs of quitting in the protection motivation theory analysis. These two variables were also determinants of sustained abstinence, thus explaining why the intervention group had a higher quitting rate. Conclusion: The study confirmed the psychological determinants of long-term abstinence from smoking and provided a framework to explore why such an intervention is effective. This approach may be applicable to the development or analysis of interventions targeting other health behaviours.

A Personalized Mobile Cessation Intervention to Promote Smokers From the Preparation Stage to the Action Stage: Double-blind Randomized Controlled Trial.

BACKGROUND: Most mobile cessation studies have found that such interventions have a higher quitting rate than interventions providing minimal smoking cessation support. However, why such interventions are effective has been almost unstudied by researchers. OBJECTIVE: This paper describes the principles of the personalized mobile cessation intervention-based WeChat app and used generalized estimated equations to assess why a personalized mobile cessation intervention was more likely to promote smokers from the preparation stage to the action stage than a nonpersonalized intervention. METHODS: This is a 2-arm, double-blind, randomized controlled trial in five cities in China. The intervention group received a personalized mobile cessation intervention. The control group received a nonpersonalized SMS text message smoking cessation intervention. All information was sent by the WeChat app. The outcomes were the change in protection motivation theory construct scores and the change in transtheoretical model stages. RESULTS: A total of 722 participants were randomly assigned to the intervention or control group. Compared with those who received the nonpersonalized SMS text message intervention, smokers who received the personalized intervention presented lower intrinsic rewards, extrinsic rewards, and response costs. Intrinsic rewards were determinants of stage change, thus explaining why the intervention group was more likely to promote smokers from the preparation stage to the action stage (odds ratio 2.65, 95% CI 1.41-4.98). CONCLUSIONS: This study identified the psychological determinants at different stages to facilitate smokers moving forward to the next stage of quitting behavior and provides a framework to explore why a smoking cessation intervention is effective. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100041942; https://tinyurl.com/2hhx4m7f.

Assessment of a Text Message-Based Smoking Cessation Intervention for Adult Smokers in China: A Randomized Clinical Trial.

Importance: Successful smoking cessation strategies are an important part of reducing tobacco use. However, providing universal smoking cessation support can be a challenge for most countries because it requires sufficient resources. One way to expand access is to use mobile technologies to provide cessation support. Objective: To assess the efficacy of a behavior change theory-based smoking cessation intervention using personalized text messages. Design, Setting, and Participants: This study was a 2-arm double-blind randomized clinical trial conducted in 5 cities in China. Daily or weekly smokers 18 years or older were eligible for inclusion if they owned a mobile phone and used the WeChat social media app. A total of 722 participants were randomized to the intervention or control group between April 1 and July 27, 2021. Interventions: Intervention group participants received a personalized text message-based smoking cessation intervention that was based on the transtheoretical model and protection motivation theory and developed by this study's investigators. Control group participants received a nonpersonalized text message-based smoking cessation intervention developed by the US National Cancer Institute. Both groups received 1 to 2 text messages per day for 3 months through the app. Main Outcomes and Measures: The primary outcome was the biochemically verified 6-month sustained abstinence rate, defined as the self-report of no smoking of any cigarettes after the designated quit date, which was validated biochemically by an expired air carbon monoxide level of less than 6 ppm at each follow-up point. Results: A total of 722 participants (mean [SD] age, 41.5 [12.7] years; 716 men [99.2%]; all of Chinese ethnicity) were randomly assigned to the intervention group (360 participants) or the control group (362 participants). Biochemically verified continuous abstinence at 6 months was 6.9% in the intervention group and 3.0% in the control group (odds ratio [OR], 2.66; 95% CI, 1.21-5.83). Among smokers with low nicotine dependence, the intervention group had significantly better abstinence rates for most of the indicators after adjusting for covariates (eg, biochemically verified 24-hour point prevalence of abstinence at 1 month: adjusted OR, 2.15; 95% CI, 1.05-4.38). Among smokers with moderate and high nicotine dependence, only the biochemically verified 24-hour point prevalence of abstinence at 6 months was statistically significant (adjusted OR, 4.17; 95% CI, 1.34-3.00). The pattern was similar for quitting intention, and the personalized text message-based intervention was more effective for smokers who had strong quitting intention than for those who had weak quitting intention. Conclusions and Relevance: In this study, the behavior change theory-based smoking cessation intervention using personalized text messages was more effective than an intervention using nonpersonalized text messages. The intervention was most effective among smokers with low nicotine dependence and strong quitting intention. This study's findings also provide further evidence regarding the potential benefits of mobile health interventions for other behaviors. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2100041942.

Identification of DNA methylation and genetic alteration simultaneously from a single blood biopsy.

BACKGROUND: High-throughput sequencing of blood cell-free DNA (cfDNA) techniques offer an opportunity to characterize and monitor cancer rapidly in a non-invasive and real-time manner. Nonetheless, there lacks a tool within therapeutic arsenal to identify multi-omics alterations simultaneously from a single biopsy. In current times, bisulfite-based sequencing detects 5mC and 5hmC at single-base resolution is the golden standard of DNA methylation, while the degradation of DNA and biased sequencing data are the problems of this method. OBJECTIVE: To identify the consistency analysis of methylation and genetic variation with single library, we presented a platform detecting multi-omics data simultaneously from a single blood biopsy using bisulfite-free method of genomic methylation sequencing (GM-seq) mediated by TET enzyme. METHODS: We detected methylomic and genetic changes simultaneously from a single blood biopsy in NA12878 and randomly chose ten blood biopsies from colorectal cancer or lung cancer patients to validate the ability of GM-seq. RESULTS: Similar cytosine methylation level between whole genome bisulfite sequencing (WGBS) and GM-seq were identified in NA12878. Moreover, longer insert size, CpGs coverage and GC distribution were outperformed than WGBS. In addition, the comparison of the single nucleotide polymorphism (SNP), insertion-deletion (Indel) and copy number variation (CNV) in NA12878 or ctDNA from liver cancer between GM-seq and whole genome sequencing (WGS) show a good consistency, indicating that this method is feasible for detecting genetic variation in blood. CONCLUSION: In conclusion, our work demonstrated a method for identification of the methylated modification and genetic variations simultaneously from a single blood biopsy.

Identification of heritable rare variants associated with early-stage lung adenocarcinoma risk.

Background: In East Asia, the number of patients with adenocarcinoma, especially those presenting with ground-glass nodules (GGNs), is gradually increasing. Family aggregation of pulmonary GGNs is not uncommon; however, genetic predisposition in these patients remains poorly understood and identification of genes involved in the cause of these early-stage lung cancers might contribute to understanding of the underlying mechanisms and potential prevention strategies. Methods: Fifty patients with early-stage lung adenocarcinoma (LUAD) presenting as GGNs and a first-degree family history of lung cancer (FHLC) from 34 independent families were enrolled into this study. Germline mutations of these patients were analyzed with whole exome sequencing (WES) and compared with age- and sex-matched 39 patients with sporadic lung cancer and 689 local healthy people. We used a stepwise variant filtering strategy, gene-based burden testing, and enrichment analysis to investigate rare but potentially pathogenic heritable mutations. Somatic tumor mutations were analyzed to consolidate germline findings. Results: In total, 1,571 single nucleotide variants (SNVs) and 238 frameshifts with a minor allele frequency (MAF) <0.01, which were rare, recurrent, and potentially damaging candidates, were finally identified through the filtering in the GGN cohort. Pathway analysis showed the extracellular matrix to be the top dysregulated pathway. Gene-based burden testing of these highly disruptive risk-conferring heritable variants showed that MSH5 [odds ratio (OR), 9.28, 95% confidence interval (CI): 2.49-35.87], MMP9 (OR, 8.11, 95% CI: 2.22-28.43), and CYP2D6 (OR, 8.09, 95% CI: 2.68-24.92) were significantly enriched in our cohort (P<0.05). The number of rare damaging germline variants in non-smoking patients was significantly higher than that of smoking-affected patients (Spearman's ρ=-0.39, P=0.02). Conclusions: Heritable, potentially deleterious, and rare candidate variants of MSH5, MMP9 and CYP2D6 were significantly associated with early-stage LUAD presenting with GGNs. Nonsmoking patients likely have a higher genetic predisposition to this type of cancer than smoking-affected patients. These results have extended our understanding of the underlying mechanisms of early-stage LUAD.

Factors Related to Diabetes Self-Management Among Patients with Type 2 Diabetes: A Chinese Cross-Sectional Survey Based on Self-Determination Theory and Social Support Theory.

Purpose: Self-management behavior (SMB) plays a significant role in glycemic control. This study aimed to explore the factors related to SMB among patients with type 2 diabetes and how these factors interacted with each other. Patients and Methods: Patients diagnosed with type 2 diabetes were recruited from 18 community healthcare stations (CHSs) from six community healthcare centers (CHCs) in Beijing, China from April to May in 2017. Motivation, competence, autonomy support, social support, self-management skills, adherence to self-monitoring of blood glucose (SMBG) and haemoglobin A1c (HbA1c) measurement were tested by questionnaire. Correlation analysis and path analysis were performed so as to identify the factors associated with patients' SMB. Results: A total of 532 participants completed this study. Participants who have good compliance to SMBG got higher scores in social support (F = 7.68, p = 0.01), competence (F = 10.47, p = 0.01), and skills (F = 12.34, p < 0.01). Higher competence (ß = 0.03, P < 0.001), higher social support (ß = 0.01, P < 0.001), better skills(ß = 0.01, P < 0.001) directly led to better adherence to SMBG. Social support had a positive effect on autonomy support (ß = 0.69, P < 0.001), motivation (ß = 0.45, P < 0.001), competence (ß = 0.28, P < 0.001), skills (ß = 0.14, P < 0.001), which was also indirectly linked to better adherence to SMBG. Better self-management skills directly led to better adherence to HbA1c measurement (ß = 0.03, P < 0.001). Social support had a positive effect on autonomy support (ß = 0.69, P < 0.001), motivation (ß = 0.45, P < 0.001), competence (ß = 0.28, P < 0.001), skills (ß = 0.14, P < 0.001), which was also indirectly linked to better adherence to HbA1c measurement. Conclusion: Self-determination theory and social support theory were practical in explaining SMB in Chinese population. Competence, motivation and social support played an important role in diabetic self-management. Paying attention to the promotion of individual's intrinsic motivation and self-efficacy may be able to help patients maintain self-management behavior in the long-term routine.

Protection motivation theory and smoking quitting intention: findings based on structural equation modelling and mediation analysis.

OBJECTIVE: Although many smoking cessation strategies have been implemented, only a few strategies at the population level are grounded in theory. Even in those interventions based on specific theories, most studies have focused only on the outcome. The main objective of this study was to demonstrate the utility of protection motivation theory (PMT) in explaining smoking quitting behaviour among adults, with the goal of providing valuable evidence for further intervention strategies. METHOD: This was a cross-sectional study. Participants were randomly selected on the street from 26 provinces in mainland China. Data were collected via face-to-face interviews. Cronbach's alpha coefficient and the interclass correlation coefficient (ICC) were used to assess the reliability of the individual PMT constructs. We applied structural equation modelling (SEM) to test how well the PMT constructs predicted intention. A bootstrap test was performed to test the potential mediators. RESULTS: The Cronbach's alpha coefficients of all the subscales ranged from 0.71 to 0.74. Greater intentions were significantly associated with higher threat appraisal (Coef. = 0.18, P < 0.01) and coping appraisal (Coef. = 0.24, P < 0.01). Threat appraisal was significantly associated with higher perceived severity and vulnerability but inversely associated with extrinsic rewards and intrinsic rewards. Coping appraisal was significantly associated with higher self-efficacy and response efficacy but inversely associated with response cost. The R2 of quitting intention was 0.12, which means that 12% of quitting intention was predicted by PMT constructs. For threat appraisal, approximately 19.8% of the effects on lower threat appraisal were mediated by higher extrinsic rewards. For coping appraisal, approximately 42.8% of the effects on higher coping appraisal were mediated by higher response efficacy. CONCLUSION: This study finds that PMT is a sound theoretical framework for predicting smoking quitting intention among adults. Coping appraisal has a stronger effect than threat appraisal for predicting quitting intention. Mediation analyses confirmed that extrinsic rewards and response efficacy mediated the relationship between PMT constructs and quitting intention. Our findings are essential for understanding quitting behaviour among adults and support more effective smoking cessation activities.

The characteristics and patterns of e-cigarette use and its association with cigarette cessation intention in a Chinese smoking population: A mediation analysis.

INTRODUCTION: The use of e-cigarettes has become more common in China, but the research on e-cigarettes in China, while growing, is still limited. This study examined the characteristics and patterns of e-cigarette use, and analyzed the possible mediators between cigarette cessation intention and e-cigarette use in a Chinese smoking population. METHODS: This was a cross-sectional study conducted in mainland China. By convenience sampling method, the participants were recruited from 85 major commercial streets of several large cities in China. The study interviewers completed face-to-face interviews and uploaded the completed questionnaires into the online survey platform. The participants were contacted for clarification if any problems were detected. Logistic regression yielded adjusted odds ratios (ORs) for ever use of e-cigarettes. We further conducted a mediation analysis to estimate the effect of possible mediators. RESULTS: From July to August 2020, a total of 738 smokers were invited to participate in this study; 613 smokers were identified as eligible and 609 smokers were included in this analysis. Of them, 24 (3.94%) participants were currently using e-cigarettes, and 165 (27.09%) participants have ever used e-cigarettes. The participants with younger age were more likely to have ever used e-cigarettes, ranging from 37.5% in the 18-29 years age group to 6.5% in the 60-69 years age group. After controlling for demographic characteristics and nicotine dependence, the ever use of e-cigarettes was significantly associated with younger age, higher education level, higher monthly income, previous smoking cessation attempts and quitting intention. With the mediation analysis, the education level is confirmed as a mediating factor, and approximately 42.86% of the effects were mediated through the channel of higher socioeconomic status. CONCLUSIONS: This is the first study to examine the possible mediators between cigarette cessation intention and e-cigarette use in a Chinese smoking population. The findings revealed that high socioeconomic status, particularly higher education level, was a major mediating factor.

The association of workplace smoke-free policies on individual smoking and quitting-related behaviours.

BACKGROUND: Our study aims to provide information about workplace smoke-free (SF) policy coverage in mainland China and to assess the relationship between workplace SF policies and secondhand smoke (SHS) exposure, current smoking, smoking harm awareness and quitting intention among smokers. METHOD: Data from the 2018 Asia Best Workplace Mainland China programme were used to address these aims. This cross-sectional study included 14,195 employees from the 2018 survey and 14,953 employees from the 2019 survey. Logistic regression with year-fixed effects was applied to these data. The dependent variables were SHS exposure, smoking or smoking harm awareness. The explanatory variable was the SF workplace policy. RESULTS: A total of 21,275 participants (73.0%) reported working under SF policies. The overall prevalence of smoking and SHS exposure were 20.3% and 52.5%, respectively. The workplace SF policy was significantly associated with lower SHS exposure (OR: 0.48, 95% CI: 0.45-0.51), lower current smoking employees (OR: 0.81, 95% CI: 0.76-0.87) and higher awareness of smoking harm (OR: 1.76, 95% CI: 1.61-1.91). However, workplace SF policy was not significantly associated with quitting intention (OR: 0.99, 95% CI: 0.84-1.16). CONCLUSION: Our study identified that although most companies had established workplace SF policies, the overall prevalence of SHS exposure remained very high. Workplace SF policy is associated with lower SHS exposure, lower overall current smoking and higher awareness of smoking harm. These findings provide valuable evidence to promote such policies in all workplaces.

Tensor Network-Encrypted Physical Anti-counterfeiting Passport for Digital Twin Authentication.

The trend of digitalization has produced rapidly increasing data interaction and authentication demand in today's internet of things ecosystem. To face the challenge, we demonstrated a micro-scale label by direct laser writing to perform as a passport between the physical and digital worlds. On this label, the user information is encrypted into three-dimensional geometric structures by a tensor network and then authenticated through the decryption system based on computer vision. A two-step printing methodology is applied to code the randomly distributed fluorescence from doped quantum dots, which achieved physical unclonable functions (PUFs) of the passport. The 105 bits/mm2 data storage density enables abundant encrypted information from physical worlds, for example, the biometric data of human users. This passport guarantees the strong correlation between the user's privacy data and the PUF-assisted codes, successfully overcoming the illegal transfer of authentication information. Due to its ultra-high security level and convenience, the printed passport has enormous potential in future digital twin authentication anytime anywhere, including personal identity, valuable certificates, and car networking.

Tobacco dependence affects determinants related to quitting intention and behaviour.

This study uses protection motivation theory (PMT) to examine the quitting intentions and behaviours of smokers who have varying levels of nicotine dependence. Our goals are to identify the psychological factors that influence smoking cessation and to provide valuable evidence to promote theory-guided interventions. This is a cross-sectional study that was conducted from July to August 2020. Participants were randomly selected on the streets of 26 provinces on mainland China. Data were collected via face-to-face interviews. Our analysis was conducted in three steps. First, we employed descriptive statistics to present the overall characteristics of our sample. Second, we analysed the association between PMT constructs and quitting intentions stratified by nicotine dependence. Third, we tested how quitting intentions were associated with quitting behaviours in each subgroup using logistic regression models. For intention, almost all the PMT constructs were significantly associated with quitting intention in the low-dependence group. For the moderate- and high-dependence groups, only perceived vulnerability (coefficient = 0.35, P = 0.04) was positively associated with quitting intention. For behaviour, we found a stronger association between quitting intention and behaviour in the low-dependence group (Coef. = 1.67, P = 0.00) than for the other groups. We found a significant association between e-cigarette use and quitting behaviour only in the low-dependence group (Coef. = 1.34, P = 0.00). Coefficients for the moderate- and high-dependence groups were not statistically significant. Smokers at various levels of nicotine dependence have different psychological factors that influence their intentions to stop smoking. Quitting intention was more significantly associated with quitting behaviour for the low nicotine-dependence group than for the other groups. More convincing research is necessary to determine how e-cigarette use affects quitting behaviour in the long term.

The association of workplace health education with smoking-related behaviour and unequal gains by job position in China: ABWMC programme findings.

BACKGROUND: Although the Chinese government has introduced a series of regulations to promote tobacco-related health education in workplaces, their implementation has been far from satisfactory. The aim of the present study was to explore the association of company-level tobacco-related health education and employee smoking behaviour. METHODS: Data from the 2018 Asia Best Workplace Mainland China programme were used to address these aims. This was a cross-sectional study that included 14,195 employees from 79 companies in mainland China. Spearman correlation tests were used to examine unadjusted correlations between the study variables, and binary logistic regression was used for multivariable analysis. The dependent variables included smoking-related variables or health information-seeking behaviour. The explanatory variable was the company-level tobacco-related health education. RESULTS: Tobacco-related health education was associated with better smoking harm awareness (OR = 2.23; 95% CI = 1.94-2.56), lower second-hand smoke exposure (OR = 0.73; 95% CI = 0.66-0.81), better perception of the workplace environment (OR = 2.04; 95% CI = 1.84-2.26) and positive health information-seeking behaviour (OR = 2.07; 95% CI = 1.86-2.30). Job position interacted with health education, suggesting that the positive association of health education was lower for general employees than employees who held an administrative position. CONCLUSIONS: Tobacco-related health education is not only associated with lower SHS exposure but also related to more positive environmental perceptions and health attitudes, and these effects are significant for higher-ranking employees. Policy makers should recognize and reduce these potential health disparities.

Tuberculosis recurrence over a 7-year follow-up period in successfully treated patients in a routine program setting in China: a prospective longitudinal study.

OBJECTIVES: To determine tuberculosis (TB) recurrence in previously successfully treated patients in a routine program setting and baseline characteristics associated with TB recurrence. METHODS: A prospective longitudinal study in Jiangxi Province, China. Patients, ≥14 years old, were consecutively registered and were followed up for seven years to assess TB recurrence against a patients' individual baseline data that had been entered into a database at TB registration. RESULTS: There were 800 TB patients registered at baseline, and 634 (79.2%) of them completed anti-TB treatments. Fifty-nine (9.3%) died, and 21 (3.3%) were lost to follow-up over the follow-up period. There were 96 patients with recurrent episodes (total incidence 15.2% or annual incidence 2,200/100,000). Of the recurrent cases, 53 (55.2%) happened within 2-year after completion of anti-TB treatments. After controlling confounding factors, the risk of TB recurrence was significantly higher in the age range 34-73 years (P<0.01) and current smokers (P<0.01). CONCLUSIONS: Overall recurrence rate among previously treated TB patients was much higher than the initial incidence in the same population (61-98/100,000) and settings with similar TB incidence. TB programs should consider closer monitoring of these patients for early detection of recurrence. Particular attention should be given to those between 34-73 years and those who use tobacco products.