How do perceptions about cessation outcomes moderate the effectiveness of a gain-framed smoking cessation telephone counseling intervention?

The distinction between prevention and detection behaviors provides a useful guideline for appropriately framing health messages in terms of gains or losses. However, this guideline assumes that everyone perceives the outcomes associated with a behavior in a consistent manner, as prevention or detection. Individuals' perceptions of a behavior vary, and so the effects of framed messages may be optimized by considering individuals' perceptions rather than the prevention or detection function of the behavior. The authors tested this message-framing paradigm in a secondary analysis of data from a trial evaluating gain-framed smoking cessation counseling delivered through a state quitline (Toll et al., 2010 ). Smokers (N = 2,032) who called a state quitline received either gain-framed or standard care messages. Smokers' beliefs about the positive consequences of stopping smoking (outcome expectancies) were evaluated at baseline. Smoking status and self-efficacy were assessed at 3 months. Outcome expectancies moderated the framing effects among men but not among women. Men in the gain-framed counseling condition who had positive outcome expectancies were more likely to quit and had more confidence in their ability to quit or to remain abstinent than men who were uncertain of the positive outcome of smoking cessation. Among men, self-efficacy mediated the moderated framing effects of the intervention on quit status. These findings suggest that it may be useful to consider sex and individual differences in outcome expectancies when delivering gain-framed smoking cessation messages in the context of a state quitline.

Role of cigarette sensory cues in modifying puffing topography

BACKGROUND

Human puffing topography promotes tobacco dependence by ensuring nicotine delivery, but the factors that determine puffing behavior are not well explained by existing models. Chemosensory cues generated by variations in cigarette product design features may serve as conditioned cues to allow the smoker to optimize nicotine delivery by adjusting puffing topography. Internal tobacco industry research documents were reviewed to understand the influence of sensory cues on puffing topography, and to examine how the tobacco industry has designed cigarettes, including modified risk tobacco products (MRTPs), to enhance puffing behavior to optimize nicotine delivery and product acceptability.

METHODS

Relevant internal tobacco industry documents were identified using systematic searching with key search terms and phrases, and then snowball sampling method was applied to establish further search terms.

RESULTS

Modern cigarettes are designed by cigarette manufacturers to provide sensory characteristics that not only maintain appeal, but provide cues which inform puffing intensity. Alterations in the chemosensory cues provided in tobacco smoke play an important role in modifying smoking behavior independently of the central effects of nicotine.

CONCLUSIONS

An associative learning model is proposed to explain the influence of chemosensory cues on variation in puffing topography. These cues are delivered via tobacco smoke and are moderated by design features and additives used in cigarettes. The implications for regulation of design features of modified risk tobacco products, which may act to promote intensive puffing while lowering risk perceptions, are discussed.

What would menthol smokers do if menthol in cigarettes were banned? Behavioral intentions and simulated demand

AIMS

  The US Food and Drug Administration must consider whether to ban the use of menthol in cigarettes. This study examines how current smokers might respond to such a ban on menthol cigarettes.

DESIGN

  Convenience sample of adolescent and adult smokers recruited from an online survey panel.

SETTING

  United States, 2010.

PARTICIPANTS

  A total of 471 adolescent and adult current cigarette smokers.

MEASUREMENTS

  Respondents were asked a series of questions about how they might react if menthol cigarettes were banned. In addition, participants completed a simulation purchase task to estimate the demand for menthol and non-menthol cigarettes across a range of prices.

FINDINGS

  Overall, 36.1% of respondents said they always (18.9%) or usually (17.2%) smoked menthol cigarettes. When asked how they might respond to a ban on menthol cigarettes, 35% of current menthol smokers said they would stop smoking, and 25% said they would 'find a way to buy a menthol brand'. Those who reported they might quit tended to have greater current intentions to quit [odds ratio (OR) = 4.47], while those who reported that they might seek illicit menthol cigarettes were far less likely to report current intentions to quit (OR = 0.06). Estimates for demand elasticity for preferred cigarette type were similar for menthol (α = 0.0051) and non-menthol (α = 0.0049) smokers. Demand elasticity and peak consumption were related to usual cigarette type and cigarettes smoked per day, but did not appear to differ by race, gender or age.

CONCLUSIONS

  Preliminary evidence suggests that a significant minority of smokers of menthol cigarettes in the United States would try to stop smoking altogether if such cigarettes were banned.

Support for tobacco control interventions: do country of origin and socioeconomic status make a difference?

OBJECTIVE

To examine the attitudes to various tobacco control regulations among smokers from four different countries and explore differences by country and socioeconomic status.

METHODS

Questions relating to tobacco regulation were asked of adult smokers from the 2007-2008 International Tobacco Control Four Country Survey (ITC4). Measures included attitudes to tobacco industry and product regulation, and measures of socioeconomic status and economic disadvantage.

RESULTS

Overall smokers supported greater regulation of the tobacco industry with least supportive US smokers and most supportive Australian smokers. Reporting smoking-related deprivation and a lower income was independently associated with increased support for regulation of the tobacco industry (both p≤0.01).

CONCLUSIONS

Policy-makers interested in doing more to control tobacco should be reassured that, for the most part, they have the support of smokers, with greatest support in countries with the strongest regulations. Smokers economically disadvantaged by smoking were more supportive of government policies to regulate the tobacco industry suggesting that reactance against regulation is not likely to differentially contribute to lower cessation rates in this group.

Tobacco quitlines need to assess and intervene with callers' hazardous drinking

BACKGROUND

Based on published data showing that daily smokers have high rates of hazardous drinking and higher rates of smoking relapse, we hypothesized that New York State Smokers' Quitline (NYSSQL) callers would exhibit elevated rates of risky drinking and risky drinking callers would report lower rates of smoking cessation.

METHODS

We assessed rates of hazardous drinking among 88,479 callers to the NYSSQL using modified NIAAA guidelines. Using 2 routine NYSSQL short-term follow-up interviews (n = 14,123 and n = 24,579) and a 3-month follow-up interview (n = 2,833), we also compared smoking cessation rates for callers who met criteria for hazardous drinking compared to moderate drinkers and nondrinkers.

RESULTS

At baseline, 56% of callers reported drinking, and 23% reported hazardous drinking using modified NIAAA guidelines. Hazardous drinkers did not differ on measures of smoking cessation outcomes compared to nondrinkers but did have lower smoking cessation rates compared to persons who reported moderate alcohol consumption for the enhanced services program 1-week follow-up (adjusted OR [95% CI] = 1.09 [1.01, 1.17], p = 0.04) and the standard 2-week follow-up (adjusted OR [95% CI] = 1.17 [1.07, 1.29], p = 0.001).

CONCLUSIONS

Nearly a quarter of smokers calling the NYSSQL reported a hazardous drinking pattern, which was associated with lower cessation outcomes compared to those who reported a moderate drinking profile. Given the large number of high-risk drinkers who can be identified through a quitline, tobacco quitlines may provide a venue for providing brief alcohol interventions to these high-risk drinkers. Future studies should evaluate whether a brief alcohol intervention would result in improved smoking cessation rates for hazardous drinking smokers.

Effects of a Fact Sheet on beliefs about the harmfulness of alternative nicotine delivery systems compared with cigarettes

BACKGROUND

This study explored the value of providing information in a Fact Sheet to correct misperceptions about the relative harmfulness of nicotine replacement products (NRT) and smokeless tobacco (ST), when compared to cigarette smoking.

METHODS

Four convenience samples from different countries (Australia, UK, Sweden and USA) were surveyed concerning their beliefs about the relative harmfulness of smokeless tobacco and NRT. Study participants were given the Fact Sheet that explained that nicotine, as used by consumers, is not particularly harmful and explained why. They were resurveyed one week later regarding their beliefs about the relative harmfulness of smokeless tobacco and NRT and future intentions to use the products.

RESULTS

In all four samples knowledge increased by similar amounts and beliefs regarding the lower harmfulness of smokeless tobacco increased. However, misconceptions remained common and responses to belief measures were not always consistent. Likelihood of use of ST increased in all four samples after exposure to the Fact Sheet, but interest in NRT use only increased in the US sample.

CONCLUSIONS

A Fact Sheet such as this one can help address misconceptions about NRT and smokeless tobacco, at least in the short term. However, as is true of most educational interventions, exposure to a single educational session is not sufficient to overcome misperceptions that smokers have about the relative harmfulness of oral versus combustible forms of nicotine delivery.

Tobacco assessment in actively accruing National Cancer Institute Cooperative Group Program Clinical Trials

PURPOSE

Substantial evidence suggests that tobacco use has adverse effects on cancer treatment outcomes; however, routine assessment of tobacco use has not been fully incorporated into standard clinical oncology practice. The purpose of this study was to evaluate tobacco use assessment in patients enrolled onto actively accruing cancer clinical trials.

METHODS

Protocols and forms for 155 actively accruing trials in the National Cancer Institute's (NCI's) Clinical Trials Cooperative Group Program were evaluated for tobacco use assessment at enrollment and follow-up by using a structured coding instrument.

RESULTS

Of the 155 clinical trials reviewed, 45 (29%) assessed any form of tobacco use at enrollment, but only 34 (21.9%) assessed current cigarette use. Only seven trials (4.5%) assessed any form of tobacco use during follow-up. Secondhand smoke exposure was captured in 2.6% of trials at enrollment and 0.6% during follow-up. None of the trials assessed nicotine dependence or interest in quitting at any point during enrollment or treatment. Tobacco status assessment was higher in lung/head and neck trials as well as phase III trials, but there was no difference according to year of starting accrual or cooperative group.

CONCLUSION

Most actively accruing cooperative group clinical trials do not assess tobacco use, and there is no observable trend in improvement over the past 8 years. Failure to incorporate standardized tobacco assessments into NCI-funded Cooperative Group Clinical Trials will limit the ability to provide evidence-based cessation support and will limit the ability to accurately understand the precise effect of tobacco use on cancer treatment outcomes.

Outcomes from an electronic medical record (EMR)-based standardized tobacco assessment and cessation program in a NCI-designated comprehensive cancer center

1529

Background: Tobacco assessment and cessation is advocated by ASCO and national clinical oncology guidelines, but there is little information on large scale clinically efficient models to assess tobacco use and provide cessation in a structured evidence based manner. Automation through the electronic medical record (EMR) could reduce subjective interpretation by clinicians and assist in increasing data tracking accuracy to enhance meaningful use initiatives. Methods: A standard set of evidence based tobacco assessment questions were incorporated into an annotated fixed-variable response system in the EMR delivered by nursing at initial consult and at follow-up. A logic based EMR referral system was developed to determine patient eligibility for mandatory automated referral to a dedicated tobacco cessation service. An evidence based institutional clinical cessation program was developed to provide cessation support to referred patients. The evidence based screening and referral algorithms will be presented. Results: Over 13 months, 677 patients were referred and 529 patients were successfully contacted to date for cessation support. In the 529 patients, 21 (3.9%) were inappropriate referrals (never smokers or long term former smokers), 48 patients (9.1%) did not want to enroll, but wanted to discuss cessation at a later date. Notably, only 18 patients (3.4%) refused any intervention. In a total of 415 patients enrolled in the cessation program, 104 patients (25.1%) were thinking about quitting (contemplation), 134 patients (32.3%) were preparing to quit, 169 patients (40.7%) were quitting (action phase), and 8 patients (1.9%) have relapsed. Tobacco assessments and automated referrals through the EMR took a median of 4 minutes to complete. Conclusions: A large volume of patients were screened and referred to a dedicated cessation program with low patient refusal for intervention without impeding physician workflow. These data suggest that this nursing driven EMR based assessment is a highly efficient clinical model for tobacco assessment and cessation.

Smoking at diagnosis and survival in cancer patients

The effect of smoking on survival in cancer patients is limited by the lack of structured prospective assessments of smoking at diagnosis. To assess the effect of smoking at diagnosis on survival, structured smoking assessments were obtained in a cohort of 5,185 cancer patients within 30 days of a cancer diagnosis between 1982 and 1998. Hazard ratios (HRs) or odds ratios were generated to analyze the effects of smoking at diagnosis on overall mortality (OM) and disease-specific mortality (DSM) in a patient cohort from 13 disease sites containing at least 100 patients in each disease site. With a minimum of 12 years of follow-up, current smoking increased OM risk versus recent quit (HR 1.17), former (HR 1.29) and never smokers (HR 1.38) in the overall cohort. Current smoking increased DSM risk versus former (HR 1.23) and never smokers (HR 1.18). In disease sites with proportionately large (>20%) recent quit cohorts (lung and head/neck), current smoking increased OM and DSM risks as compared with recent quit. Current smoking increased mortality risks in lung, head/neck, prostate and leukemia in men and breast, ovary, uterus and melanoma in women. Current smoking was not associated with any survival benefit in any disease site. Data using prospective structured smoking assessments demonstrate that current smoking increased long-term OM and DSM. Standardized smoking assessment at diagnosis is an important variable for evaluating outcomes in cancer patients.

Trends in roll-your-own smoking: findings from the ITC Four-Country Survey (2002-2008)

OBJECTIVE

To establish the trends in prevalence, and correlates, of roll-your-own (RYO) use in Canada, USA, UK and Australia, 2002-2008.

METHODS

Participants were 19,456 cigarette smokers interviewed during the longitudinal International Tobacco Control (ITC) Four-Country Survey in Canada, USA, UK, and Australia.

RESULTS

"Predominant" RYO use (i.e., >50% of cigarettes smoked) increased significantly in the UK and USA as a proportion of all cigarette use (both P < .001) and in all countries as a proportion of any RYO use (all P < .010). Younger, financially stressed smokers are disproportionately contributing to "some" use (i.e., ≤50% of cigarettes smoked). Relative cost was the major reason given for using RYO, and predominant RYO use is consistently and significantly associated with low income.

CONCLUSIONS

RYO market trends reflect the price advantages accruing to RYO (a product of favourable taxation regimes in some jurisdictions reinforced by the enhanced control over the amount of tobacco used), especially following the impact of the Global Financial Crisis; the availability of competing low-cost alternatives to RYO; accessibility of duty-free RYO tobacco; and tobacco industry niche marketing strategies. If policy makers want to ensure that the RYO option does not inhibit the fight to end the tobacco epidemic, especially amongst the disadvantaged, they need to reduce the price advantage, target additional health messages at (young) RYO users, and challenge niche marketing of RYO by the industry.

Variations in daily cigarette consumption on work days compared with nonwork days and associations with quitting: findings from the international tobacco control four-country survey

INTRODUCTION

We explore whether reported daily cigarette consumption differs between work days and nonwork days and whether variation in consumption between work days and nonwork days influences quitting and abstinence from smoking. We also explore whether effects are independent of measures of addiction and smoking restrictions at work and home.

METHODS

Data were from 5,732 respondents from the first five waves of the International Tobacco Control Four-Country Survey, occurring between 2002 and 2006. Respondents were current smokers employed outside the home. Variation in daily cigarette consumption on work days compared with nonwork days at one wave was used to predict the likelihood of making an attempt and the likelihood of maintaining a quit attempt for at least a month at the next wave. Generalized estimating equations were used to combine data for multiple waves.

RESULTS

Just under half reported smoking more on a nonwork day, a little over a third reported no difference, and around one fifth reported smoking more on a work day. Controlling for possible confounding factors, smoking more on a work day was associated with making quit attempts. Among people who made a quit attempt, variation in consumption did not consistently predict one month's abstinence, being positive in Australia, but negative in the United Kingdom.

CONCLUSION

Those who smoke more on work days try to quit more. Country differences for success may be related to the extent of bans on smoking, with those smoking more on work days more likely to succeed where bans in workplaces and public places were more prevalent, such as Australia at the time.

Abstract 648: Tobacco assessment in actively accruing Cooperative Group clinical trials

Purpose: The lack of accurate prospective tobacco assessments in cancer patients limits the ability to provide tobacco cessation and to accurately evaluate the true impact of tobacco use on cancer treatment outcomes. The purpose of this study was to evaluate tobacco use assessment in patients enrolled in actively accruing cancer clinical trials. Methods: Protocols and forms for 155 actively accruing trials in the NCI's Clinical Trials Cooperative Group program were evaluated for detailed tobacco use assessment at enrollment and through follow-up using a structured coding instrument. Results: Of the 155 clinical trials reviewed, the mean accrual start date was 2008.6 (range 2003-2011), 74.1% were phase III trials, and the total potential accrual population was 106,985 patients. Any form of tobacco use (i.e., cigarette, pipe, cigar, smokeless tobacco, or unspecified “tobacco”) was assessed in 29% of trials (46% of total patient accrual) at enrollment. Current cigarette use at enrollment was assessed in 21.9% of trials and former cigarette use was assessed in 21.3% of trials. Only 4.5% of trials assessed any form of tobacco use during follow-up. Secondhand smoke exposure was captured in 2.6% of trials at enrollment and only 1 trial during follow-up. None of the trials assessed nicotine dependence or interest in quitting at any point during enrollment or treatment. Tobacco assessment varied by type of cancer with a higher proportion of patients being assessed in lung or head and neck cancer trials. Conclusion: Most actively accruing cooperative group clinical trials do not assess tobacco use. Failure to incorporate standardized tobacco assessments into funded national clinical trials will continue to limit the ability to provide evidence based cessation support and will limit the ability to accurately understand the precise impact of tobacco use on cancer treatment outcomes.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 648. doi:1538-7445.AM2012-648

Pathways of change explaining the effect of smoke-free legislation on smoking cessation in The Netherlands. An application of the international tobacco control conceptual model

INTRODUCTION

This study aims to test the pathways of change from individual exposure to smoke-free legislation on smoking cessation, as hypothesized in the International Tobacco Control (ITC) Conceptual Model.

METHODS

A nationally representative sample of Dutch smokers aged 15 years and older was surveyed during 4 consecutive annual surveys. Of the 1,820 baseline smokers, 1,012 participated in the fourth survey. Structural Equation Modeling was employed to test a model of the effects of individual exposure to smoke-free legislation through policy-specific variables (support for smoke-free legislation and awareness of the harm of [secondhand] smoking) and psychosocial mediators (attitudes, subjective norm, self-efficacy, and intention to quit) on quit attempts and quit success.

RESULTS

The effect of individual exposure to smoke-free legislation on smoking cessation was mediated by 1 pathway via support for smoke-free legislation, attitudes about quitting, and intention to quit smoking. Exposure to smoke-free legislation also influenced awareness of the harm of (secondhand) smoking, which in turn influenced the subjective norm about quitting. However, only attitudes about quitting were significantly associated with intention to quit smoking, whereas subjective norm and self-efficacy for quitting were not. Intention to quit predicted quit attempts and quit success, and self-efficacy for quitting predicted quit success.

CONCLUSIONS

Our findings support the ITC Conceptual Model, which hypothesized that policies influence smoking cessation through policy-specific variables and psychosocial mediators. Smoke-free legislation may increase smoking cessation, provided that it succeeds in influencing support for the legislation.

Tobacco expenditure, smoking-induced deprivation and financial stress: results from the International Tobacco Control (ITC) Four-Country Survey

INTRODUCTION AND AIMS

While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS).

DESIGN AND METHODS

We used data from wave 7 (2008-2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS.

RESULTS

In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS.

CONCLUSIONS

Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers.

How much unsuccessful quitting activity is going on among adult smokers? Data from the International Tobacco Control Four Country cohort survey

AIMS

To document accurately the amount of quitting, length of quit attempts and prevalence of plans and serious thought about quitting among smokers.

DESIGN

We used longitudinal data from 7 waves of the International Tobacco Control Policy Evaluation Four Country Survey (ITC-4). We considered point-prevalence data and cumulative prevalence over the 7 years of the study. We also derived annual estimates of quit activity from reports of quit attempts starting only within more recent time-frames, to control for biased recall.

SETTING

Australia, Canada, the United Kingdom and the United States.

PARTICIPANTS

A total of 21,613 smokers recruited across seven waves.

MEASUREMENTS

Reported life-time quit attempts, annual quit attempts, length of attempts, time since last attempt started, frequency of aborted attempts, plans to quit and serious thought about quitting.

FINDINGS

Around 40.1% (95% CI: 39.6-40.6) of smokers report attempts to quit in a given year and report an average of 2.1 attempts. Based on free recall, this translates to an average annual quit attempt rate of 0.82 attempts per smoker. Estimates derived only from the preceding month to adjust for recall bias indicate an annual rate of approximately one attempt per smoker. There is a high prevalence of quit-related activity, with more than a third of smokers reporting thoughts or actions related to quitting in a given month. More than half the surveyed smokers eventually succeeded in quitting for at least 1 month, and a majority of these for over 6 months.

CONCLUSIONS

Smokers think a great deal about stopping and make many unsuccessful quit attempts. Many have been able to last for extended periods and yet they still relapsed. More attention needs to be focused on translating quit-related activity into long-term abstinence.

Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay

BACKGROUND

Stimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt 100% smoke-free national legislation, which ended smoking in all indoor public places and workplaces, including restaurants and bars. The objective of this study was to evaluate trends in hospital admissions for cardiovascular disease 2 years before and 2 years after the policy was implemented in Uruguay.

METHODS

Reports of hospital admissions for acute myocardial infarction (AMI) (International Classification of Disease-10 I21) from 37 hospitals (79% of all hospital admissions in the country), representing the period 2 years before and 2 years after the adoption of a nationwide smoke-free policy in Uruguay (between 1 March 2004 and 29 February 2008), were reviewed. A time series analysis was undertaken to compare the average monthly number of events of hospital admission for AMI before and after the smoke-free law.

RESULTS

A total of 7949 hospital admissions for AMI were identified during the 4-year study period. Two years after the smoke-free policy was enacted, hospital admissions for AMI fell by 22%. The same pattern and roughly the same magnitude of reduction in AMI admissions were observed for patients seen in public and private hospitals, men, women and people aged 40-65 years and older than 65 years.

CONCLUSIONS

The national smoke-free policy implemented in Uruguay in 2006 was associated with a significant reduction in hospital admissions for AMI.

Systematic biases in cross-sectional community studies may underestimate the effectiveness of stop-smoking medications

INTRODUCTION

Randomized, controlled trials typically indicate stop-smoking medications (SSMs: e.g., Varenicline, Bupropion, and over-the-counter nicotine replacement therapies) to be effective, whereas cross-sectional community-based studies have found them to be less effective, ineffective, or even associated with higher risk of relapse. Consequently, some critics have suggested SSMs have no useful applications in "real-world" settings. This discrepancy may, however, be due to systematic biases affecting cross-sectional survey outcomes. Namely, failed quit attempts where SSMs were used may be better recalled than failed unassisted attempts. Moreover, smokers who choose to quit using SSMs may be more addicted and thus less likely to succeed. Either of these factors would lead to an over-representation of failed quit attempts among SSM users in cross-sectional surveys even if there were real benefits.

METHODS

We report on data from the International Tobacco Control 4-country cohort study to examine the relationship between SSM use, level of nicotine addiction, and the reported date since the start of participants' (N = 1,101) most recent quit attempt.

RESULTS

The last quit attempt was reported to have begun longer ago among participants who used SSMs than those who did not. Scores on the Heaviness of Smoking Index, measuring addiction severity, were also higher among SSM users, with no interactions.

CONCLUSION

Better recall of quit attempts and stronger addiction to nicotine are two characteristics found more often among smokers using SSMs compared with self-quitters, which could potentially bias the assessed effects of SSMs on cessation outcomes in cross-sectional surveys.

The effects of extended pre-quit varenicline treatment on smoking behavior and short-term abstinence: a randomized clinical trial

Preclinical research and learning theory suggest that a longer duration of varenicline treatment prior to the target quit date (TQD) would reduce smoking rates before cessation and improve abstinence outcomes. A double-blind randomized controlled trial tested this hypothesis in 60 smokers randomized to either an Extended run-in group (4 weeks of pre-TQD varenicline) or a Standard run-in group (3 weeks of placebo, 1 week of pre-TQD varenicline); all the participants received 11 weeks of post-TQD varenicline and brief counseling. During the pre-quit run-in, the reduction in smoking rates was greater in the Extended run-in group than in the Standard run-in group (42% vs. 24%, P < 0.01), and this effect was greater in women than in men (57% vs. 26%, P = 0.001). The rate of continuous abstinence during the final 4 weeks of treatment was higher among women in the Extended group compared to women in the Standard run-in group (67% vs. 35%). Although these data suggest that extension of varenicline treatment reduces smoking during the pre-quit period and may further enhance cessation rates, confirmatory evidence is needed from phase III clinical trials.

Cessation assistance reported by smokers in 15 countries participating in the International Tobacco Control (ITC) policy evaluation surveys

AIMS

To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support.

DESIGN

Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary).

SETTINGS

Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States.

PARTICIPANTS

Samples of smokers from 15 countries.

MEASUREMENTS

Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits.

FINDINGS

Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (<20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available.

CONCLUSIONS

There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.

Smokers' reactions to FDA regulation of tobacco products: findings from the 2009 ITC United States survey

Background

On June 22, 2009, the US FDA was granted the authority to regulate tobacco products through the Family Smoking Prevention and Tobacco Control Act (FSPTCA). The intent is to improve public health through regulations on tobacco product marketing and tobacco products themselves. This manuscript reports baseline data on smokers' attitudes and beliefs on specific issues relevant to the FSPTCA.

Method

Between November 2009 and January 2010, a telephone survey among a nationally representative sample of n = 678 smokers in the US was performed as part of the International Tobacco Control (ITC) United States Survey. Participants answered a battery of questions on their attitudes and beliefs about aspects of the FSPTCA.

Results

Most smokers were unaware of the new FDA tobacco regulations. Smokers indicated support for banning cigarette promotion and nearly a quarter supported requiring tobacco companies to sell cigarettes in plain packaging. Seventy two percent of smokers supported reducing nicotine levels to make cigarettes less addictive if nicotine was made easily available in non-cigarette form.

Conclusion

Most smokers were limited in their understanding of efforts to regulate tobacco products in general. Smokers were supportive of efforts to better inform the public about health risks, restrict advertising, and make tobacco products less addictive.

Impact of the removal of misleading terms on cigarette pack on smokers' beliefs about 'light/mild' cigarettes: cross-country comparisons

AIM

This paper examines how smokers' beliefs about 'light/mild' cigarettes in Australia, Canada and the United Kingdom were affected by the removal of misleading 'light/mild' terms from packs.

DESIGN, SETTING AND PARTICIPANTS

  The data come from the first seven waves (2002-09) of the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey, an annual cohort telephone survey of adult smokers in Canada, the United States, the United Kingdom and Australia (21 613 individual cases). 'Light' and 'mild' descriptors were removed in 2003 in the United Kingdom, in 2006 in Australia and in 2007 in Canada. We compare beliefs about 'light' cigarettes both before and after the bans, with those of smokers in the United States serving as the control condition.

MEASURES

  Smokers' beliefs about 'light' cigarettes were assessed using a set of statements rated on a five-point 'agree'-'disagree' scale.

FINDINGS

  The proportions of respondents reporting misperceptions about light cigarettes declined between 2002 and 2009 in all four countries. There were marked temporary reductions in reported misperceptions in the United Kingdom and Australia, but not in Canada, following the removal of 'light/mild' descriptors.

CONCLUSIONS

  Removal of 'light/mild' descriptors and tar, nicotine and carbon monoxide yield information from cigarette packs is insufficient to effectively eliminate false beliefs. The combination of alternative descriptors and design features that produce differences in taste strength and harshness, independent of actual intakes, are sufficient to produce or sustain the same misbeliefs.

Accuracy of self-reported tobacco assessments in a head and neck cancer treatment population

Prospective analysis was performed of self-reported and biochemically confirmed tobacco use in 50 head and neck cancer patients during treatment. With 93.5% compliance to complete weekly self-report and biochemical confirmatory tests, 29.4% of smokers required biochemical assessment for identification. Accuracy increased by 14.9% with weekly vs. baseline self-reported assessments. Data confirm that head and neck cancer patients misrepresent true tobacco use during treatment.

Food and Drug Administration evaluation and cigarette smoking risk perceptions

OBJECTIVES

To examine the relationship between a belief about Food and Drug Administration (FDA) safety evaluation of cigarettes and smoking risk perceptions.

METHODS

A nationally representative, random-digit-dialed telephone survey of 1046 adult current cigarette smokers.

RESULTS

Smokers reporting that the FDA does not evaluate cigarettes for safety (46.1%), exhibited greater comprehension of the health risks of smoking and were more likely (48.5%) than other participants (33.6%) to report quit intentions. Risk perceptions partially mediated the relationship between FDA evaluation belief and quit intentions.

CONCLUSIONS

These findings highlight the need for proactive, effective communication to the public about the aims of new tobacco product regulations.

Evaluation of an intervention to enhance the delivery of smoking cessation services to patients with cancer

We describe a brief staff training program to improve the delivery of tobacco cessation services to patients with head and neck cancers. This study utilized a quasi-experimental design to compare the delivery of smoking cessation components and outcomes among patients exposed to either usual care (UC) or an enhanced cessation (EC) program implemented following a 1-h staff education program. Of the 179 subjects enrolled, 112 were recontacted by phone 1 month after their clinic visit. More patients in EC compared to UC reported that they were asked about their smoking status (94.2% vs. 76.6%, p = 0.01), advised to quit (92.3% vs. 72.3%, p = 0.01), prescribed cessation medications (30.8% vs. 3.3%, p < 0.001), and received a support call (53.8% vs. 11.7%, p < 0.001) at the 1-month follow-up. Quit attempts and quit rates between groups were similar. The EC intervention improved the delivery of cessation services in a busy clinical setting, but this failed to increase cessation rates after 1 month.