Efficacy of an individual-tailored smoking cessation intervention APP among Chinese smokers: study protocol for a randomized controlled trial.

BACKGROUND AND AIMS: Tobacco use has posed a tremendous public health problem for China. The Chinese government has taken great efforts to curb the tobacco epidemic. However, the existing smoking cessation services available in China are underused and have some limitations. Our research team intends to develop a smartphone smoking cessation application (SSC APP) and integrate it with the existing smoking cessation services. This study aims to assess the efficacy of the SSC APP developed by our research team through a randomized controlled trial (RCT). METHODS: Current smokers who are motivated to quit within 1 month (n = 1000) will be recruited both online and offline, and all potential participants will register and complete the prescreening assessment online. Participants will be randomly assigned to either the intervention group (receiving the SSC APP and a self-help smoking cessation manual) or the control group (receiving a self-help smoking cessation manual only) using a block randomization method. This study will be a two-arm, single-blind, parallel-group RCT. Participants will be followed up after enrollment through online questionnaires or by phone call. The primary outcome is self-reported 6-month continuous abstinence. The main secondary outcomes include self-reported 7-day point-prevalence abstinence at each follow-up; self-reported 3-month continuous abstinence; reduction in the number of cigarettes smoked per day; and the number of recent quit attempts. DISCUSSION: If this SSC APP proves to be effective, it could be integrated with the existing smoking cessation services and further facilitate smoking cessation at the population level in China. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2200062097, Registered July 22, 2022.

A COM-B analysis of facilitators of and barriers to smoking cessation among Chinese smokers: A qualitative study.

INTRODUCTION: Smoking prevalence remains high in China with a low cessation motivation level, despite the government's tobacco control efforts. There is a lack of research specifically examining perceptions, attitudes, and behaviors related to smoking cessation in this region, particularly from a theory-based deductive perspective. Utilizing the COM-B (Capability, Opportunity, Motivation-Behavior) model as a theoretical framework, this study aimed to identify facilitators and barriers to smoking cessation among Chinese smokers. METHODS: The study employed semi-structured individual interviews with 40 participants. Each interview spanned approximately 30 minutes. The participants, constituting both current and former smokers, were all aged ≥18 years (n=40). Interview data were then examined using a directed content analysis approach. RESULTS: Analysis revealed three interrelated themes. Capability: Smokers face challenges when resisting peer pressure and dealing with life after quitting. They also lack knowledge about smoking, quitting techniques, and withdrawal symptoms. Opportunity: Changing societal attitudes towards smoking create opportunities for quitting, but these are hindered by inadequate cessation services and a lack of family support. Motivation: Smokers' motivation to quit is mainly driven by health concerns. Resistance to quitting often stems from the belief that smoking is a personal choice or just a habit. Excessive emphasis on willpower may hinder motivation to quit. CONCLUSIONS: To enhance smoking cessation efforts in China, three key aspects should be considered: capability, opportunity, and motivation. Publicity and educational campaigns should target common misconceptions about smoking as a personal freedom, correct the overemphasis on willpower, and widely promote available cessation services. A crucial aspect is shifting societal norms to foster anti-smoking sentiments. Effective strategies may involve using real-life stories to illustrate smoking's health consequences, disseminating information about cessation services in maternity centers, enhancing services through mobile health initiatives, and empowering families to support smokers in their quit attempts.

Assessing the Effectiveness of a Community-Based Smoking Cessation Intervention - Shenzhen City, Guangdong Province, China, 2022.

What is already known about this topic?: Research on community-based smoking cessation interventions in China is still in its early stages. Most existing studies have focused on a limited number of communities and have primarily examined interventions conducted by study teams rather than broader community initiatives. What is added by this report?: The three-month continuous abstinence rate for the intervention group (21.61%) was significantly higher than that for the control group (8.98%). Comprehensive community-based smoking cessation interventions, administered by trained physicians at community health service centers and supported by community workers, have shown effectiveness in improving a variety of outcomes among community smokers. What are the implications for public health practice?: The feasibility and effectiveness of comprehensive community-based smoking cessation interventions make them a valuable addition to existing cessation services in China. Wider implementation of these interventions should be pursued as a complementary approach to current efforts to reduce smoking rates in China.

Prevalence and associated factors of smoking among chinese adolescents: a school-based cross-sectional study.

BACKGROUND: Shenzhen has made great efforts to address the tobacco epidemic in the past decade. This study aims to evaluate the current status of the tobacco epidemic among adolescent in Shenzhen, China. METHODS: The multi-stage random cluster sampling method was used in the school-based cross-sectional study in 2019 and a total of 7,423 junior and high school (both senior and vocational) students were recruited. Information on cigarette use was collected by the electronic questionnaire. Logistic regression analysis was used to examine the associations between current cigarette use and associated factors. ORs with their 95% CIs were reported. RESULTS: The prevalence of current cigarette use among adolescents was 2.3%, with boys (3.4%) significantly higher than girls (1.0%). Smoking rates in junior high schools, senior high schools, and vocational senior high schools were 1.0%, 2.7%, and 4.1%, respectively. The results of multivariate logistic regression analysis indicated that gender, age, parental smoking, teachers smoking in schools, friends smoking, exposure to tobacco marketing, and misconceptions about cigarette use were associated factors for adolescent smoking behaviour. CONCLUSIONS: The prevalence of current smoking was relatively low among adolescent in Shenzhen, China. Personal characteristics, family, and school were associated with current adolescent smokers.

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.