The French Observational Cohort of Usual Smokers (FOCUS) cohort: French smokers perceptions and attitudes towards smoking cessation

Determinants of smoking related weight-concern in smokers participating in a community-based cessation program

BACKGROUND

Concern about weight gain is a barrier to smoking-cessation, but determinants of postcessation weight-concern have not been comprehensively assessed in the context of community-based cessation programs.

METHODS

This cross-sectional analysis used baseline data from a cessation trial of 392 adults randomized to physical activity (PA) or general wellness counseling as adjunctive treatment for smoking. Outcomes were 1) smoking behaviors to control weight and 2) anticipating relapse due to weight gain. Independent variables were PA and perceptions, sociodemographics, psychosocial measures, smoking behavior and perceptions, diet, and BMI. From bivariable models examining main and sex interaction effects, significant variables were entered into a linear (control) or logistic (relapse) regression model to identify key determinants.

RESULTS

For both measures, weight-concern was greater (p < .05) for female smokers (standardized b = 0.52, SE = 0.10; OR = 0.29, 95 % CI = 0.17-0.49), White (b = 0.12, SE = 0.05; OR = 0.39, 95 % CI = 0.23-0.66), and less motivated to quit (b = -0.14, SE = 0.05; OR = 0.77, 95 % CI = 0.59-1.0). Higher scores for smoking to control weight were associated with less PA (b = -0.10, SE = 0.05) and higher BMI (b = 0.21, SE = 0.05). For men, higher BMI was associated with greater anticipation of relapse (OR = 2.54, 95 % CI = 1.42-4.56).

CONCLUSIONS

Among adults attempting cessation, women, White smokers, and those less motivated to quit were more likely to smoke for weight control and to relapse due to weight gain. Higher BMI was associated with greater anticipation of relapse for men, but not women. Weight-concerns, for both measures, were not related to smoking history, psychosocial functioning, PA engagement or attitudes, or dietary variables. Results suggest potential cessation intervention targets for weight-concerned smokers.

[The interest of a nurse and dietician pair in smoking cessation]

The Tobacco Coordination Unit of the Caen Normandy University Hospital assists smokers in their efforts to quit or reduce their tobacco consumption. In addition to the usual individual consultations, a consultation with a nurse-dietician pair is offered to patients for whom individual work on smoking and eating behaviors has reached an impasse. This unconventional approach allows for a more effective consultation method that is better adapted to certain types of patients treated in tobaccoology.

A Cross-sectional Study to Assess Factors that Determine Tobacco Habit Initialization and Cessation and Oral Cancer Awareness among General Population of Vikarabad District, Telangana

AIMS

The aim of the study was to assess factors that determine tobacco habit initialization and cessation and oral cancer awareness among the general population of Vikarabad district, Telangana.

MATERIALS AND METHODS

The current study was a cross-sectional study conducted among the general population of the Vikarabad district. All tobacco users satisfying inclusion criteria of age 18-40 years and at least 1 year of tobacco usage were included in the study. Multistage random sampling was followed to select tobacco users and structured, pretested questionnaires were distributed. The populations mean age was 30 years with majority being rural residents and men contributing the majority of the study population.

RESULTS

The mean age at which a person begins to smoke was 20.4 ± 5.7 years among the general population. Peer influence (77%) was reported as one of the major reasons, and habit formation was found to be the major factor (55.6%) for continuing tobacco and also work stress (17%) and relaxation (17%). The primary reason for quitting was fear or awareness of the adverse effects of tobacco. Self-abstinence was reported as a predominant method that they followed to quit tobacco habit during the past year, while 16.3% reported that they did not give it a try. About 58.6% of participants were advised by a health-care provider to quit tobacco, respectively. A major proportion of tobacco users (71%) knew that tobacco causes oral cancer. Half of the study population is unaware of oral cancer's early symptoms, noncontagious progression, lifestyle modification, and early treatment have a good prognosis.

CONCLUSION

Findings of the study highlight the factors to be considered in framing effective antitobacco policies applicable to the rural population.

Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure

BACKGROUND

Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies.

METHODS

This paper presents insights from three research activities from the preparatory phase of the development of a new self-report health and functioning measure. A scoping literature review was conducted to identify the positive and negative impact of TNP use on health and functioning. Focus groups (n = 29) on risk perception and individual interviews (n = 40) on perceived dependence in people who use TNPs were reanalyzed in the context of health and functioning, and expert opinion was gathered from five key opinion leaders and five technical consultants.

RESULTS

Triangulating the findings of the review of 97 articles, qualitative input from people who use TNPs, and expert feedback helped generate a preliminary conceptual framework including health and functioning and conceptually-related domains impacted by TNP use. Domains related to the future health and functioning measurement model include physical health signs and symptoms, general physical appearance, functioning (physical, sexual, cognitive, emotional, and social), and general health perceptions.

CONCLUSIONS

This preliminary conceptual framework can inform future research on development and validation of new measures for assessment of overall health and functioning impact of TNPs from the consumers' perspective.

Establishment of a multimodal protocol combining a motivational interview, subcutaneous injection of NicoSan® and hyper-hydration for the "stopsmoking therapy": A multicentre real-life study'

OBJECTIVES

The StopSmoking Therapy, combins a motivational interview, a subcutaneous injection of NicoSan® and a hyperhydration protocol. The objectives were to evaluate the number of patients declaring cessation and factors related to relapse.

METHODS

In the 18 months following protocol, 554 subjects who consented, responded to the study's questionnaire. Categorical variables are presented as the frequency and percentage, continuous variables are presented as the mean and standard deviation, responses of abstinent subjects and of those who had started smoking again are compared via the chi-square test for categorical variables, and the Student's t-test for continuous variables.

RESULTS

In our sample 92.8% of the subjects reported smoking for 10 years or more. A total of 475 subjects (85.7%) reported a complete cessation (31.2% for more than 6 months and 33.1% for more than a year). Among relapsing subjects, were significantly over-represented: youngest ages, lower motivation, more frequent close friends or family using tobacco, lower dependency scores. No subject reported any significant adverse effects.

CONCLUSION

The multimodal protocol explored seems to have a favorable impact on smoking cessation, which could be enhanced by additional interventions dedicated to the youngest age groups, to people having smoking close friends and family, and should possibly add interventions based on cognitive behavioral therapy. A dedicated support by specialist tobacco addiction in the first weeks after treatment and/or the use of mobile support applications could also be useful. In order to asses efficacy, a prospective randomized double blind controlled versus placebo protocol could be considered.

[Cigarette and e-cigarette use among a sample of French health students]

INTRODUCTION

Smoking is one of the leading causes of preventable death worldwide. Data from the literature show that caregivers and health students have a high prevalence. The purpose of this article was to study the prevalence among health students (medicine, dentistry, physiotherapy, nursing) at a University and a Teaching Hospital in France.

MATERIAL AND METHOD

This was a cross-sectional study using a self-administered questionnaire completed at the start of university meetings. This study was carried out as part of a campaign to combat smoking supported by the Brittany Regional Health Agency.

RESULTS

The participation rate was 76.4%: 1349 respondents out of 1766 health students surveyed. The prevalence of smoking 17.8% and that of vaping 5.6%. Nursing students smoked and vaped more than students in other streams: respectively, for smoking, 21.8% (73/335) vs. 16.5% (167/1014) (P<0.001), for vaping, 10.4% (35/335) vs. 4.0% (39/980) (P<0.001). Students in 3rd year nursing smoked and vaped significantly more than those in the first 2 years (P=0.02 and P<0.001).

CONCLUSION

The smoking rate was high, but comparable to the data for health students. Nursing students were significantly greater smokers, especially in the last year. Their vaping rate was higher than in other studies.

[Smoking cessation: A challenge for cardiologists and pulmonologists]

In addition to public health measures that need to be strongly supported politically, smoking is also a major medical issue. Tobacco dependence is a chronic disease, and, given its extremely addictive nature, treatment for tobacco dependence must be addressed actively by all health professionals. Because smoking is a major contributor to many of the pathologies their specialties address, cardiologists and pulmonologists must be at the forefront of this care. In this review we analyse the current state of smoking cessation treatment and its inadequacies, the limiting impact that doctors' own smoking has, as well as the misconceptions held by smokers and sometimes by doctors as well, which act as brakes on smoking cessation. Smoking cessation must become a treatment delivered in real clinical practice and any doctor must know how to manage it fluently. Do not be satisfied with simply advising smokers to quit. Learn how to approach the subject with smokers effectively, know how the various pharmacotherapies are used and know how to organize smoking cessation follow-up, an essential guarantee of success. If optimal management of this major pathological factor is a role for all doctors, it is of course especially so for our two specialties. It's up to us, cardiologists and pulmonologists, to take up this challenge.

Coping Strategies and Social Support in a Mobile Phone Chat App Designed to Support Smoking Cessation: Qualitative Analysis

Background

Smoking is one of the most significant factors contributing to low life expectancy, health inequalities, and illness at the worldwide scale. Smoking cessation attempts benefit from social support. Mobile phones have changed the way we communicate through the use of freely available message-oriented apps. Mobile app–based interventions for smoking cessation programs can provide interactive, supportive, and individually tailored interventions.

Objective

This study aimed to identify emotions, coping strategies, beliefs, values, and cognitive evaluations of smokers who are in the process of quitting, and to analyze online social support provided through the analysis of messages posted to a chat function integrated into a mobile app.

Methods

In this descriptive qualitative study, informants were smokers who participated in the chat of Tobbstop. The technique to generate information was documentary through messages collected from September 2014 through June 2016, specifically designed to support a smoking cessation intervention. A thematic content analysis of the messages applied 2 conceptual models: the Lazarus and Folkman model to assess participant’s experiences and perceptions and the Cutrona model to evaluate online social support.

Results

During the study period, 11,788 text messages were posted to the chat by 101 users. The most frequent messages offered information and emotional support, and all the basic emotions were reported in the chat. The 3 most frequent coping strategies identified were physical activity, different types of treatment such as nicotine replacement, and humor. Beliefs about quitting smoking included the inevitability of weight gain and the notion that not using any type of medications is better for smoking cessation. Health and family were the values more frequently described, followed by freedom. A smoke-free environment was perceived as important to successful smoking cessation. The social support group that was developed with the app offered mainly emotional and informational support.

Conclusions

Our analysis suggests that a chat integrated into a mobile app focused on supporting smoking cessation provides a useful tool for smokers who are in the process of quitting, by offering social support and a space to share concerns, information, or strategies.

[COPD and smoking cessation: Patients' expectations and responses of health professionals]

The importance of smoking cessation in the management of COPD is well-established: the benefit of quitting smoking as regards morbidity and mortality outcomes in patients, is unquestioned. The smoking cessation in COPD patients is difficult: high levels of consumption, the duration of smoking, high dependence level, psychological co-morbidities such as anxiety and depression, lower socio-economic and intellectual level, constitute barriers. Studies have shown that patients often minimize the risks of smoking, that others do not believe in the benefits of quitting or doubt their ability to quit smoking. The patients' experience, and expectations with regard to smoking cessation are incompletely satisfied: are considered, the smoking characteristics of these patients, the understanding of the tobacco dependence, the beliefs and ideas of smokers, the knowledge of smoking cessation methods, the role of validated aids and alternative treatments, failure management. The answers of the health professionals can be in several directions: establishment of a better communication patient-doctor (empathy), more centered on the needs of the smoker, the role of the motivation and the place of the motivational interview, the understanding of the mechanisms of addiction, a better individualisation of therapeutics, the necessity of a extended follow-up, the contribution of modern technologies, the electronic cigarette, the smoking cessation in respiratory rehabilitation, guidelines that address smoking cessation treatment.

Inpatient smoking cessation therapy: truth or dare?

BACKGROUND

This study aims to answer the question to which extent even very heavy nicotine-dependent smokers can benefit from a 3-week inpatient smoking cessation program. A particular focus lies on analyzing the positive effects, which go above and beyond normally anticipated health benefits.

METHODS

This is a descriptive study observing 270 patients over a 1-year period consisting of recruitment, therapy, and two post-therapy follow-up visits at 6-month interval. Gender differences, changes in body weight, and factors relating to addiction and the nicotine withdrawal process are analyzed. In comparing successful participants-post-therapy nonsmokers-with less successful ones, our analysis identifies benefits and advantages an inpatient smoking cessation therapy can bring to even the heaviest smokers.

RESULTS

At the 12-month post-therapy follow-up visit, 42.6% of participants were identified as nonsmokers. A total of 34.0% of participants took up smoking again. No data is available on the remaining participants. Nonsmokers experienced significant reduction in nicotine craving and withdrawal symptoms. In terms of body weight, increases were found in both, men and women, nonsmokers and smokers.

CONCLUSION

Successful quitters fail to report of an unbearable strong desire to smoke. Such unfounded fear should be communicated. Weight gain remains an undesired side effect. Hence, it is crucial to diagnose individuals more prone to weight gain and offer coping strategies thus reducing the risk of developing obesity. Nevertheless, the outcome of the study should be an encouragement to also heavy smokers and empower them to undertake smoking cessation.

Reasons for smoking cessation attempts among Japanese male smokers vary by nicotine dependence level: a cross-sectional study after the 2010 tobacco tax increase

OBJECTIVES

To examine the association between smoking cessation attempts during the previous 12 months, motivators to quit smoking and nicotine dependence levels among current male smokers after Japan's massive 2010 tobacco tax increase.

DESIGN

Cross-sectional study.

SETTING

A self-reported questionnaire about smoking habits, nicotine dependence levels and factors identified as motivators to quit smoking was administered to 9378 employees working at a company located in Fukuoka Prefecture in Japan (as of 1 October 2011).

PARTICIPANTS

A total of 2251 male current smokers 20-69 years old.

PRIMARY AND SECONDARY OUTCOME MEASURES

Nicotine dependence level assessed by Fagerström Test for Cigarette Dependence (FTCD), smoking cessation attempts during the previous 12 months and motivators for smoking cessation.

RESULTS

The proportion of current smokers who had attempted to quit smoking within the previous 12 months was 40.6%. Nicotine dependence level of current smokers was negatively associated with cessation attempts during the previous 12 months. Motivators for smoking cessation differed by nicotine dependence levels. 'The rise in cigarette prices since October 2010' as a smoking cessation motivator increased significantly at the medium nicotine dependence level (OR 1.44, 95% CI 1.09 to 1.90); however, this association was not statistically significant for individuals with high nicotine dependence (OR 1.24, 95% CI 0.80 to 1.92). 'Feeling unhealthy' was significantly negatively associated for medium (OR 0.42, 95% CI 0.27 to 0.65) and high (OR 0.31, 95% CI 0.14 to 0.71) nicotine dependence levels. Trend associations assessed by assigning ordinal numbers to total FTCD score for those two motivators were statistically significant.

CONCLUSIONS

The efficacy of smoking cessation strategies can be improved by considering the target group's nicotine dependence level. For smokers with medium and high nicotine dependence levels, more effective strategies aimed at encouraging smoking cessation, such as policy interventions including increasing tobacco taxes, are needed.

Associations of Weight Concerns With Self-Efficacy and Motivation to Quit Smoking: A Population-Based Study Among Finnish Daily Smokers

INTRODUCTION

Concerns about weight gain occurring after smoking cessation may affect motivation and self-efficacy towards quitting smoking. We examined associations of smoking-specific weight concerns with smoking cessation motivation and self-efficacy in a population-based cross-sectional sample of daily smokers.

METHODS

Six-hundred biochemically verified (blood cotinine) current daily smokers comprising 318 men and 282 women aged 25-74 years, were studied as part of the National FINRISK (Finnish Population Survey on Risk Factors on Chronic, Noncommunicable Diseases) study and its DIetary, Lifestyle and Genetic factors in the development of Obesity and Metabolic syndrome (DILGOM) sub-study that was conducted in Finland in 2007. Self-reported scales were used to assess weight concerns, motivation and self-efficacy regarding the cessation of smoking. Multiple regression analyses of concerns about weight in relation to motivation and self-efficacy were conducted with adjustments for sex, age (years), body mass index (BMI, [kg/m(2)]), physical activity (times per week), and further controlled for nicotine dependence (Fagerström Test for Nicotine Dependence).

RESULTS

Higher levels of weight concerns were associated with lower self-efficacy (β = -0.07, p < .001) after adjusting for sex and age. The association remained after additional adjustment for BMI and physical activity (β = -0.07, p < .001). After further controlling for nicotine dependence the association became weaker but remained significant (β = -0.04, p = .02). There were no statistically significant associations between concerns about weight and motivation for smoking cessation (β = 0.02, p = 0.16).

CONCLUSIONS

These cross-sectional population-based data do not support earlier findings that suggest that smokers with high levels of weight concerns are less motivated to quit smoking. Our data suggest that daily smokers who are highly concerned about weight may have lower self-efficacy for cessation of smoking.

[Smoking cessation and social deprivation]

Smoking is a major of public health policy issue; one in two lifelong smokers will die from a disease related to tobacco use. In France, smoking is responsible for more than 70,000 deaths every year. The benefits linked to stopping smoking include reduced mortality and morbidity related to the use of tobacco. Recent data show an increase in the prevalence of smoking in the lowest socioeconomic population. Tobacco control needs a better understanding of the determinants of smoking in this population, which are also factors in the failure of cessation attempts. Based on international literature, this review specifies the educational and socioeconomic factors involved in tobacco smoking and in the result of an attempt to quit. Its aim is to propose ways to improve the management of smoking cessation in a socially deprived population.

Once bitten, twice shy: concern about gaining weight after smoking cessation and its association with seeking treatment

BACKGROUND

Concern about weight gain after quitting smoking is often cited as a barrier to smokers making a quit attempt or seeking treatment.

AIM

To identify whether smokers who are non-treatment seekers (NTS) are more concerned about weight gain and have lower confidence to maintain weight after quitting smoking as compared with treatment-seeking smokers (TS).

METHODS

Participants were smokers recruited from Penn State Hershey Medical Center and family practice outpatient clinics. A total of 102 NTS and 186 TS, who participated in a smoking cessation trial, completed a survey regarding tobacco use, weight concern and diet. Stepwise logistic regression was used to identify variables associated with treatment seeking, overall and stratified by those who gained and did not gain weight on a previous quit attempt.

RESULTS

Fifty three per cent of the overall sample (47.1% NTS vs. 56.5% TS, p = 0.127) had gained weight on a prior quit attempt. Among smokers who had gained weight, higher weight gain concern (WGC) and lower confidence in ability to maintain weight were significantly associated with being a NTS after adjusting for other factors.

CONCLUSION

Among smokers who gained weight on a previous quit attempt, NTS had greater concern about gaining weight and less confidence in their ability to maintain their weight after quitting than treatment seekers. Clinicians can identify smokers for whom WGC may be a barrier to seeking treatment by asking if they gained weight on a previous quit attempt. These smokers should be assured that this issue will be addressed in treatment.

Prevalence of unassisted quit attempts in population-based studies: a systematic review of the literature

AIMS

The idea that most smokers quit without formal assistance is widely accepted, however, few studies have been referenced as evidence. The purpose of this study is to systematically review the literature to determine what proportion of adult smokers report attempting to quit unassisted in population-based studies.

METHODS

A four stage strategy was used to conduct a search of the literature including searching 9 electronic databases (PUBMED, MEDLINE (OVID) (1948-), EMBASE (1947-), CINAHL, ISI Web of Science with conference proceedings, PsycINFO (1806-), Scopus, Conference Papers Index, and Digital Dissertations), the gray literature, online forums and hand searches.

RESULTS

A total of 26 population-based prevalence studies of unassisted quitting were identified, which presented data collected from 1986 through 2010, in 9 countries. Unassisted quit attempts ranged from a high of 95.3% in a study in Christchurch, New Zealand, between 1998 and 1999, to a low of 40.6% in a national Australian study conducted between 2008 and 2009. In 24 of the 26 studies reviewed, a majority of quit attempts were unassisted.

CONCLUSIONS

This systematic review demonstrates that a majority of quit attempts in population-based studies to date are unassisted. However, across and within countries over time, it appears that there is a trend toward lower prevalence of making quit attempts without reported assistance or intervention.

Smokers' knowledge about smoking-related health problems in Lebanon

The relationship between smokers' knowledge about smoking related health problems and the motivation to quit smoking in a sample of Lebanese smokers was evaluated. The first group of smokers was composed of hospitalized subjects for a cardiologic or a respiratory health problem (n = 42). The second group was composed of smokers who have not suffered from any smoking-related health problem (n = 69). A positive correlation was found between the Richmond test score and the knowledge level about smoking related health problems (r = .302; p = .0013).

Predicting smoking relapse with a multidimensional versus a single-item tobacco craving measure

BACKGROUND

Research suggests that craving is a predictor of smoking relapse. Craving can be assessed by multiple item or multifactorial scales or by single items. However, no systematic comparisons of their prognostic validity or accuracy have been published.

METHODS

The French versions of the 12-item Tobacco Craving Questionnaire (FTCQ-12) and the single craving item on the Minnesota Nicotine Withdrawal Scale (MNWS) are brief, valid, and reliable self-report measures of tobacco craving. In this secondary study, we analyzed data from French smokers with health-related problems enrolled in the Adjustment of DOses of NIcotine in Smoking (ADONIS) cessation trial. We estimated prediction models for each measure and compared their ability to distinguish correctly participants who relapsed from those who did not at 1-8 weeks after their quit date.

RESULTS

Adjusted for all potential confounders FTCQ-12 risk score (RS; Factor 2, Expectancy plus Factor 4, Purposefulness) and MNWS craving were valid predictors of smoking relapse at endpoints measured 1-7 weeks apart. Prognostic accuracy of FTCQ-12 RS was greatest at 1-2 weeks follow-up compared to only 1 week for MNWS craving. Sensitivity for FTCQ-12 RS and MNWS craving was 85% and 53%, respectively.

CONCLUSIONS

FTCQ-12 RS suggests a relapse process involving urges and desires in anticipation of the positive benefits of smoking linked with intent and planning to smoke. Findings also suggest that FTCQ-12 RS may be a better predictor instrument for smoking relapse than MNWS craving.

Health behaviors among short- and long- term ex-smokers: results from the Thai National Health Examination Survey IV, 2009

BACKGROUND

Although numerous studies have shown the health behaviors of ex-smokers to be better than those in regular smokers, the differences in health behaviors among ex-smokers at varying durations of cessation have not been investigated. This study aims to examine the relationship between different durations of smoking cessation and health behaviors.

METHODS

Data on dietary intake, alcohol consumption, physical activity, and smoking behavior from the Thai National Health Examination Survey IV for subjects aged 15-98 years (n=19 371) were included in the analysis. Trends between health behaviors among regular smokers, ex-smokers with different durations of smoking (<1 year, 1-10 years, >10 years), and never smokers were tested. Logistic regression models adjusted for sex, age, and economic status were used.

RESULTS

The prevalences of regular smoking, ex-smoking, and never smoking were 22.3%, 12% , and 65.7%, respectively. A trend was found for consumption of fruit, beans and meats, dairy and soy milk, whole-grain products, nutritional supplements, and eating habits. Average daily alcohol consumption (g) was lowest among ex-smokers who had quit for>10 years ex-smokers (16.4) followed by 1-10 years ex-smokers (27.2), and <1 year ex-smokers (33.7).

CONCLUSION

A longer duration of smoking cessation correlated with better health behaviors.

Group hypnotherapy versus group relaxation for smoking cessation: an RCT study protocol

Background

A significant number of smokers would like to stop smoking. Despite the demonstrated efficacy of pharmacological smoking cessation treatments, many smokers are unwilling to use them; however, they are inclined to try alternative methods. Hypnosis has a long-standing reputation in smoking cessation therapy, but its efficacy has not been scientifically proven. We designed this randomised controlled trial to evaluate the effects of group hypnosis as a method for smoking cessation, and we will compare the results of group hypnosis with group relaxation.

Methods/Design

This is a randomised controlled trial (RCT) to compare the efficacy of a single session of hypnosis with that of relaxation performed in groups of 8-15 smokers. We intend to include at least 220 participants in our trial. The inclusion criteria include smoking at least 5 cigarettes per day, not using other cessation methods and being willing to quit smoking. The intervention is performed by a trained hypnotist/relaxation therapist. Both groups first receive 40 min of mental preparation that is based on motivational interviewing. Then, a state of deep relaxation is induced in the hypnosis condition, and superficial relaxation is induced in the control condition. Suggestions are made in the hypnosis condition that aim to switch the mental self-image of the participants from that of smokers to that of non-smokers. Each intervention lasts for 40 min. The participants also complete questionnaires that assess their smoking status and symptoms of depression and anxiety at baseline, 2 weeks and 6 months post-intervention. In addition, saliva samples are collected to assess cotinine levels at baseline and at 6 months post-intervention. We also assess nicotine withdrawal symptoms at 2 weeks post-intervention.

Discussion

To the best of our knowledge, this RCT is the first to test the efficacy of group hypnosis versus group relaxation. Issues requiring discussion in the outcome paper include the lack of standardisation of hypnotic interventions in smoking cessation, the debriefing of the participants, the effects of group dynamics and the reasons for dropouts.

Trial registration

Current Controlled Trials, ISRCTN72839675.

Factors affecting commencement and cessation of smoking behaviour in Malaysian adults

Background

Tobacco consumption peak in developed countries has passed, however, it is on the increase in many developing countries. Apart from cigarettes, consumption of local hand-rolled cigarettes such as bidi and rokok daun are prevalent in specific communities. Although factors associated with smoking initiation and cessation has been investigated elsewhere, the only available data for Malaysia is on prevalence. This study aims to investigate factors associated with smoking initiation and cessation which is imperative in designing intervention programs.

Methods

Data were collected from 11,697 adults by trained recording clerks on sociodemographic characteristics, practice of other risk habit and details of smoking such as type, duration and frequency. Smoking commencement and cessation were analyzed using the Kaplan-Meier estimates and log-rank tests. Univariate and multivariate Cox proportional hazard regression models were used to calculate the hazard rate ratios.

Results

Males had a much higher prevalence of the habit (61.7%) as compared to females (5.8%). Cessation was found to be most common among the Chinese and those regularly consuming alcoholic beverages. Kaplan-Meier plot shows that although males are more likely to start smoking, females are found to be less likely to stop. History of betel quid chewing and alcohol consumption significantly increase the likelihood of commencement (p < 0.0001), while cessation was least likely among Indians, current quid chewers and kretek users (p < 0.01).

Conclusions

Gender, ethnicity, history of quid chewing and alcohol consumption have been found to be important factors in smoking commencement; while ethnicity, betel quid chewing and type of tobacco smoked influences cessation.

Smoking, smoking cessation and smoking relapse patterns: a web-based survey of current and former smokers in the US

AIM

The aim of this study was to characterise the natural course of smoking cessation behaviour in a web-based survey of current and former cigarette smokers (CS and FS) in the United States.

METHODS

A web-based survey of CS and FS was conducted in April 2009; demographic and socioeconomic characteristics and smoking history (including the number of lifetime and length of latest quit attempts, aids used and time to relapse) were collated. The surveyed cohort was selected from prescreened CS and FS panellists and matched for age, race and education, to be representative of the US population. Descriptive statistics and time-to-event analyses using Kaplan-Meier curves were applied in the analysis of this report.

RESULTS

The final cohort comprised 512 CS and 566 FS (n = 1078). A larger proportion of FS than CS reported a longest smoke-free period of > 1 year (78.8% vs. 22.4%, respectively). As a greater variety of smoking cessation products became available over time, the proportion of unassisted quit attempts decreased from 76.1% prior to 1983 to 43.9% after 2006 for CS and from 79.3% to 50.3% for FS. The cumulative proportion of subjects relapsing was 31.3% by 1 week and 79.3% by 6 months. The estimated median time to next quit attempt was approximately 360 days.

CONCLUSIONS

These data confirm that relapse is common and that as the variety of cessation modalities increase, the proportion of unassisted quit attempts decreases. Self-help or cold-turkey methods still provide significant alternatives even when pharmacotherapy is available. This study provides data related to the smoking history and smoking cessation patterns of a large, nationally representative sample of CS and FS.

The galanin receptor 1 gene associates with tobacco craving in smokers seeking cessation treatment

Craving for tobacco is a major challenge for people with nicotine dependence (ND) who try to quit smoking. Galanin (GAL) and its receptors (GALRs) can alter addiction-related behaviors and are therefore good candidates for modulators of behavioral parameters associated with smoking. We performed a genetic association study in 486 subjects (432 European American, EA) recruited for smoking cessation trials. Twenty-six candidate genes for ND-related phenotypes were selected based on the literature. Subjects were assessed using the Minnesota Withdrawal Scale (MWS), which included a specific item for craving, the Fagerström Scale of Nicotine Dependence (FTND), and other ND-related instruments. One single-nucleotide polymorphism (SNP) in GALR1, rs2717162, significantly associated with severity of craving in EA samples (p=6.48 × 10(-6)) and in the combined sample (p=9.23 × 10(-6)). Individuals with TT and TC genotypes had significantly higher craving scores than CC subjects. We also observed that SNPs in the CHRNA5 locus, rs16969968 and rs684513, which have been associated with ND-related phenotypes in previous studies, were nominally associated with FTND scores, although these results did not meet Bonferroni-adjusted criteria for experiment-wide significance. Our findings suggest that variation at GALR1 associates with differences in the severity of past craving for tobacco among smokers motivated to quit. Taken together with preclinical evidence, these results, if replicated, suggest that GAL and GALRs may be useful therapeutic targets for the pharmacological treatment of ND. Our results also confirm previously reported associations between variation at CHRNA5 and ND.

Prevalence and factors associated with difficulty and intention to quit smoking in Switzerland

BACKGROUND

Recent data indicate a slight decrease in the prevalence of smoking in Switzerland, but little is known regarding the intention and difficulty to quit smoking among current smokers. Hence, we aimed to quantify the difficulty and intention to quit smoking among current smokers in Switzerland.

METHODS

Cross-sectional study including 607 female and 658 male smokers. Difficulty, intention and motivation to quit smoking were assessed by questionnaire.

RESULTS

90% of women and 85% of men reported being "very difficult" or "difficult" to quit smoking. Almost three quarters of smokers (73% of women and 71% of men) intended to quit; however, less than 20% of them were in the preparation stage and 40% were in the precontemplation stage. On multivariate analysis, difficulty to quit was lower among men (Odds ratio and 95% [confidence interval]: 0.51 [0.35-0.74]) and increased with nicotine dependence and number of previous quitting attempts (OR=3.14 [1.75-5.63] for 6+ attempts compared to none). Intention to quit decreased with increasing age (OR=0.48 [0.30-0.75] for ≥65 years compared to <45 years) and increased with nicotine dependence, the number of previous quitting attempts (OR=4.35 [2.76-6.83] for 6+ attempts compared to none) and among non-cigarette smokers (OR=0.51 [0.28-0.92]). Motivation to quit was inversely associated with nicotine dependence and positively associated with the number of previous quitting attempts and personal history of lung disease.

CONCLUSION

Over two thirds of Swiss smokers want to quit. However, only a small fraction wishes to do so in the short term. Nicotine dependence, previous attempts to quit or previous history of lung disease are independently associated with difficulty and intention to quit.

Photoelectric stimulation of defined ear points (Smokex-Pro method) as an aid for smoking cessation: a prospective observational 2-year study with 156 smokers in a primary care setting

BACKGROUND

Smokex-Pro is a smoking cessation method using a protocol of a standardized consultation and computer-assisted photoelectric stimulation of defined regions in the ear and face.

METHODS

We prospectively enrolled 156 consecutive adult smokers (81 males, 75 females; mean age 43.8 years; body mass index 25.5; daily cigarettes 24.7; Fagerström Test for Nicotine Dependence 5; 30 smoking years). The primary end point was the self-reported continuous abstinence rate.

RESULTS

Participants completed on average only 32% of recommended visits. A total of 76.7% stopped smoking for more than 7 days. Moreover, 53.4% remained free of smoking for more than 90 days. Long-term abstinence rates were 49.3% (1 year) and 47.95% (2 years). Treatment-related side effects were observed in 24.5% of participants. Side effects were mild and resolved within hours.

CONCLUSION

The Smokex-Pro method appears to be an effective aid for smoking cessation. The treatment was well tolerated and showed only mild and temporary side effects. The average cost of treatment is typically less than EUR 90; the total treatment time is typically 60-90 min. These factors make it an attractive alternative compared to traditional smoking cessation methods. Controlled clinical trials will be needed to confirm the results of this study and refine the treatment for maximum efficacy.