Do components of current 'hardcore smoker' definitions predict quitting behaviour?

AIMS: It has been hypothesized that the smoking population is represented by an increasingly 'hardcore' group of smokers who are resistant to quitting. Many definitions of 'hardcore smokers' have been used, but their predictive validity is unknown. To evaluate whether 'hardcore smoker' definition components predict quitting behaviours and which combinations of 'hardcore' components are most predictive. DESIGN, SETTING AND PARTICIPANTS: Longitudinal, random telephone survey of a representative sample of adult smokers in Ontario, Canada (n = 4130, recruited 2005-08 and followed for 1 year). MEASUREMENTS: Multiple logistic regression models were compared to evaluate the predictive ability of 'hardcore' components (high daily cigarette consumption, high nicotine dependence, being a daily smoker, history of long-term smoking, no quit intention and no life-time quit attempt) on three outcomes [continued smoking, not attempting to quit and having unsuccessful quit attempt(s)]. FINDINGS: All 'hardcore' components predicted having no quit attempt and continued smoking during follow-up (P < 0.05), except for history of long-term smoking and no life-time quit attempt (for continued smoking). Among respondents who made 1 + quit attempts during follow-up, only high nicotine dependence, high daily cigarette consumption and being a daily smoker were predictive of quitting failure (P < 0.01). The best combination of components depended on the outcome. CONCLUSIONS: Measures of 'hardcore' include a mixture of motivational, dependence and behavioural variables. As found previously, motivational and behavioural measures, such as intention to quit, predict failure to make quit attempts. However, dependence components best predicted continued smoking and thus would be best for further exploring the hardening hypothesis.

Strategies to increase the delivery of smoking cessation treatments in primary care settings: a systematic review and meta-analysis.

OBJECTIVES: A systematic review and meta-analysis was conducted to evaluate evidence-based strategies for increasing the delivery of smoking cessation treatments in primary care clinics. METHODS: The review included studies published before January 1, 2009. The pooled odds-ratio (OR) was calculated for intervention group versus control group for practitioner performance for "5As" (Ask, Advise, Assess, Assist and Arrange) delivery and smoking abstinence. Multi-component interventions were defined as interventions which combined two or more intervention strategies. RESULTS: Thirty-seven trials met eligibility criteria. Evidence from multiple large-scale trials was found to support the efficacy of multi-component interventions in increasing "5As" delivery. The pooled OR for multi-component interventions compared to control was 1.79 [95% CI 1.6-2.1] for "ask", 1.6 [95% CI 1.4-1.8] for "advice", 9.3 [95% CI 6.8-12.8] for "assist" (quit date) and 3.5 [95% CI 2.8-4.2] for "assist" (prescribe medications). Evidence was also found to support the value of practice-level interventions in increasing 5As delivery. Adjunct counseling [OR 1.7; 95% CI 1.5-2.0] and multi-component interventions [OR 2.2; 95% CI 1.7-2.8] were found to significantly increase smoking abstinence. CONCLUSION: Multi-component interventions improve smoking outcomes in primary care settings. Future trials should attempt to isolate which components of multi-component interventions are required to optimize cost-effectiveness.

Prevalence and correlates of purchasing contraband cigarettes on First Nations reserves in Ontario, Canada.

AIMS: Non-First Nations people purchasing cigarettes on First Nations reserves do not pay applicable taxes. We estimated prevalence and identified correlates of purchasing contraband cigarettes on reserves; we also quantified the share of contraband purchased on reserves relative to reported total cigarette consumption and the associated financial impact on taxation revenue. DESIGN: Data from the Ontario Tobacco Survey, a regionally stratified representative population telephone survey that over-samples smokers. SETTING: Ontario, Canada. PARTICIPANTS: A total of 1382 adult current smokers. MEASUREMENTS: Reported status of purchasing cigarettes on reserves and the quantity of cigarettes bought on reserves. The prevalence of purchasing cigarettes on reserves was assessed with descriptive statistics. A two-part model was used to analyse correlates of having recently purchased contraband. FINDINGS: A total of 25.8% reported recent purchasing and 11.5% reported usual purchasing. Heavy smoking, having no plans to quit and lower education were correlated with recent purchasing. Heavy smoking and not having plans to quit were also correlated with buying more packs of cigarettes on reserves. Contraband purchases on reserves accounted for 14.0% of the reported total cigarette consumption and resulted in an estimated tax loss of $122.2 million. CONCLUSIONS: There was substantial purchasing of contraband cigarettes on reserves in Ontario, resulting in significant losses in tax revenues. The availability of these cheap cigarettes undermines the effectiveness of tobacco taxation to reduce smoking. Wherever indicated, governments should strengthen their contraband prevention and control measures, as recommended by the Framework Convention on Tobacco Control, to ensure that tobacco taxation achieves its intended health benefits and that tax revenues are protected.

A practical, cost-effective method for recruiting people into healthy eating behavior programs.

INTRODUCTION: The population impact of programs designed to develop healthy eating behaviors is limited by the number of people who use them. Most public health providers and researchers rely on purchased mass media, which can be expensive, on public service announcements, or clinic-based recruitment, which can have limited reach. Few studies offer assistance for selecting high-outreach and low-cost strategies to promote healthy eating programs. The purpose of this study was 1) to determine whether classified newspaper advertising is an effective and efficient method of recruiting participants into a healthy eating program and 2) to determine whether segmenting messages by transtheoretical stage of change would help engage individuals at all levels of motivation to change their eating behavior. METHODS: For 5 days in 1997, three advertisements corresponding to different stages of change were placed in a Canadian newspaper with a daily circulation of 75,000. RESULTS: There were 282 eligible people who responded to newspaper advertisements, and the cost was Can $1.11 (U.S. $0.72) per recruit. This cost compares favorably with the cost efficiency of mass media, direct mail, and other common promotional methods. Message type was correlated with respondent's stage of change, and this correlation suggested that attempts to send different messages to different audience segments were successful. CONCLUSION: Classified advertisements appear to be a highly cost-efficient method for recruiting a diverse range of participants into healthy eating programs and research about healthy eating.

Senior student smoking at school, student characteristics, and smoking onset among junior students: a multilevel analysis.

BACKGROUND: Current research on the etiology of tobacco use has largely focused on identifying the influential psychosocial characteristics of individual students; the influences of characteristics in the school environment are generally ignored. The purpose of this study was to simultaneously examine how school and individual student characteristics were related to smoking onset. METHOD: Multilevel logistic regression analysis was used to examine how the senior student smoking rate at a school and the psychosocial characteristics of students were able to differentiate tried-once smokers from experimental smokers in a sample of 4850 grade 9, 10, and 11 students from the School Smoking Profile (SSP) project. RESULTS: Each 1% increase in smoking rate among high school seniors increased the odds that a junior student was an experimental smoker vs. a tried-once smoker (OR 1.07, 95% CI 1.03-1.12). A significant contextual interaction was identified where the senior student smoking rate at a school moderates the negative influence of having close friends who smoke. Influential student characteristics were also identified. CONCLUSIONS: The smoking prevalence of older students at a school is directly related to smoking onset among younger students at that school. Prevention programs should target schools that put students at-risk.

A low-cost, practical method for increasing smokers' interest in smoking cessation programs.

BACKGROUND: Low participation rates reduce the public health impact of smoking cessation programs. Two barriers for improving participation are the cost of media campaigns and the proportion of smokers motivated to quit smoking. The objective of this study was to examine the feasibility of using classified newspaper ads and messages aimed at each stage of change to enhance participation in smoking cessation programs. METHODS: Three classified ads were run concurrently in a local daily newspaper for five consecutive days. The ads were designed to engage smokers in each of Prochaska's five stages of change. Each ad invited smokers or former smokers to call the local health department to participate in a paid focus group to design a new health department program. RESULTS: Calls were received from 181 eligible smokers, including 124 who provided data for the study. Thirty-seven, 34, and 29 percent of smoking respondents were in precontemplation, contemplation and preparation respectively. Half of ex-smokers were in the action stage. Ads cost 174 dollars (Cdn), thus the cost per recruit was less than a dollar. CONCLUSION: Classified ads can recruit smokers from all stages of change. Compared to traditional mass media, classified ads may also be a highly cost-efficient promotional strategy. Results provide justification for further research.