Patterns of motivations and ways of quitting smoking among Polish smokers: a questionnaire study

Unveiling the Tapestry of Tobacco Consumption: Exploring the Sociodemographic Factors Impacting Smokers at Smoking Cessation Clinics in Jeddah

Background The World Health Organization (WHO) has identified tobacco smoking as a global epidemic, causing an estimated three million deaths annually. This study aims to examine the sociodemographic characteristics and smoking-related behaviors among individuals attending smoking cessation clinics in Jeddah during 2022. By identifying these factors, appropriate interventions can be developed to combat the smoking epidemic. Methodology The study enrolled male and female participants who visited the Smoking Cessation Clinics in Jeddah from January 2022 to December 2022. Eligible participants were between 18 and 60 years old and agreed to take part in the study. Data on smoking status, medical history, previous attempts at quitting, and medication use were collected. Statistical analysis, including chi-square tests and P-values, was conducted to assess the associations between participants' medical history and smoking cessation attempts. Results A total of 5,869 participants were included in the study. The findings revealed that approximately one-fifth of the participants had previously attempted to quit smoking, while the majority 4,780 (81.4%) had not made any cessation attempts. Among those who had made quit attempts, the majority had tried quitting between one and four times 968 (16.5%). The duration of successful cessation reported by participants was generally short, with the majority 4,781 (81.5%) not experiencing any extended period of quitting. Common reasons for relapse included cravings, social influences, mood changes, stress, and withdrawal symptoms. The study also found significant associations between specific medical conditions and smoking cessation attempts. Conclusions The study identified significant associations between male gender, older age group (51-60 years), divorced marital status, intermediate educational levels, higher income levels, retired status, extreme body mass index (BMI) categories, and previous attempts at smoking cessation. Healthcare providers and policymakers should consider these findings when developing and implementing smoking cessation programs. The insights gained from this research can contribute to the development of targeted interventions to reduce smoking rates and improve public health outcomes.

Abrupt versus gradual smoking cessation with pre-cessation varenicline therapy for Chinese treatment-seeking smokers: A retrospective, observational, cohort study

INTRODUCTION

This study aimed to explore the efficacy of abrupt and gradual smoking cessation with pre-cessation varenicline therapy.

METHODS

A total of 278 smokers who experienced moderate-to-severe nicotine dependence and visited a Chinese smoking cessation outpatient clinic from March 2017 to February 2021 were enrolled. This was a retrospective, observational, cohort study. Participants were divided into two groups by the cessation strategy they received: the abrupt cessation group (n=139, tobacco was not controlled during the first 3 weeks before the target cessation date and smoking was entirely discontinued on the 22nd day) and the gradual cessation group (n=139, tobacco was gradually reduced in the first 3 weeks before the target cessation date and smoking was discontinued on the 22nd day). The abstinence rates were compared between groups (7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment; and 1-month and 3-month continuous abstinence rates of 6-month follow-up). Possible factors that influence efficacy, reasons for smoking cessation failure, and associated adverse events were also analyzed.

RESULTS

No significant difference in the 7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment was observed between the groups (p>0.05). The 1-month continuous abstinence rate of the gradual cessation group was higher than that of the abrupt cessation group (51.1% vs 31.7%; χ²=10.812, p=0.001). The 3-month continuous abstinence rate of the gradual cessation group was also higher than that of the abrupt cessation group (42.4% vs 27.3%; χ²=6.983, p=0.008). Abrupt cessation was a risk factor for successful smoking cessation than gradual cessation (AOR=2.39; 95% CI: 1.15–3.85, p=0.013),the motivation of ‘prevention and treatment of own diseases’ reduced the risk of incomplete abstinence (AOR=0.87; 95% CI: 0.38–0.99, p=0.049). The incidence of adverse events was higher in the abrupt cessation group than in the gradual cessation group. The incidence rates of nausea and insomnia were statistically significant differences.

CONCLUSIONS

Compared with abrupt cessation, gradual smoking cessation with pre-cessation varenicline therapy produced higher abstinence rates and relatively milder withdrawal symptoms.

Factors associated with quit attempt and successful quitting among adults who smoke tobacco in Ethiopia: Global Adult Tobacco Survey (GATS) 2016

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

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.

Factors motivating smoking cessation: a cross-sectional study in a lower-middle-income country

INTRODUCTION

Only one-quarter of smokers in Pakistan attempt to quit smoking, and less than 3% are successful. In the absence of any literature from the country, this study aimed to explore factors motivating and strategies employed in successful smoking cessation attempts in Pakistan, a lower-middle-income country.

METHODS

A survey was carried out in Karachi, Pakistan, amongst adult (≥ 18 years) former smokers (individuals who had smoked ≥100 cigarettes in their lifetime but who had successfully quit smoking for > 1 month at the time of survey). Multivariable logistic regression, with number of quit attempts (single vs. multiple) as the dependent variable, was performed while adjusting for age, sex, monthly family income, years smoked, cigarettes/day before quitting, and having suffered from a smoking-related health problem.

RESULTS

Out of 330 former smokers, 50.3% quit successfully on their first attempt with 62.1% quitting "cold turkey". Only 10.9% used a cessation aid (most commonly nicotine replacement therapy: 8.2%). Motivations for quitting included self-health (74.5%), promptings by one's family (43%), and family's health (14.8%). Other social pressures included peer-pressure to quit smoking (31.2%) and social avoidance by non-smokers (22.7%). Successful smoking cessation on one's first attempt was associated with being married (OR: 4.47 [95% CI: 2.32-8.61]), employing an abrupt cessation mode of quitting (4.12 [2.48-6.84]), and telling oneself that one has the willpower to quit (1.68 [1.04-2.71]).

CONCLUSION

In Pakistan, smoking cessation is motivated by concern for self-health and family's health, family's support, and social pressures. Our results lay a comprehensive foundation for the development of smoking-cessation interventions tailored to the population of the country.

IMPLICATIONS

Little is known about the patterns and strategies employed by smokers who are attempting to quit smoking, especially in lower-middle-income countries like Pakistan. Likewise, there are very few smoking cessation programs designed to assist in quitting. Our study will allow for a better understanding of the culture-specific motivating factors and strategies that most contributed to successful quit attempts. Based on these results, evidence based smoking cessation interventions can be developed tailored to the socioeconomic demographic of our country and region, including smoking cessation clinics and public outreach and media campaigns highlighting key elements of successful smoking cessation.

Smoking Characteristics and Readiness-to-Quit Status Among Smokers Attending Preoperative Assessment Clinic - A Prospective Cohort Study

Background

Perioperative smoking is associated with an increased incidence of general postoperative morbidity and mortality. The perioperative period is recognized as an important “teachable moment” that can motivate patients to adopt health changing behaviors.

Objective

In this study, we aimed to determine the prevalence of smokers among elective surgical patients in an Asian tertiary hospital. We also investigated their smoking characteristics, previous quitting attempts, readiness-to-quit status as well as knowledge of smoking-related postoperative complications.

Methods

We conducted a single-center prospective cohort study among all patients who attended a preoperative assessment clinic within a 2-month period (August to September 2020) using a preoperative smoking questionnaire.

Results

A total of 3362 patients participated in the study, of which 348 (10.4%) were current smokers. More than half (65.6%) of the smokers had previously attempted to quit smoking, with most (78%) having made more than one attempt. Forty-nine percent of current smokers were in the pre-contemplation stage of quitting and thirty-one percent were in the contemplation stage. Only twenty-one percent were in the preparation stage of quitting. Thirty-eight percent of patients recognized the importance of smoking cessation perioperatively but only twenty-eight percent were confident of quitting perioperatively. Less than sixty percent of smokers were aware of at least one type of smoking-related postoperative complication. Less than half of the patients (45%) had ever received advice on perioperative smoking cessation from the surgeons.

Conclusion

A thorough understanding of smokers’ smoking characteristics, barriers to quit and readiness-to-quit status are crucial to establishing a successful multidisciplinary perioperative smoking cessation program. Counselling should address knowledge deficits and be tailored to a patient’s stage-of-change in order to seize this precious perioperative “teachable moment”.

Reasons for and Scenarios Associated with Failure to Cease Smoking: Results from a Qualitative Study Among Polish Smokers Who Had Unsuccessfully Attempted to Quit

PURPOSE

Most smokers attempt to quit smoking, but few are successful. Data regarding the reasons for this relapse and the course of the relapse process may be helpful for determining efficient methods of smoking cessation. This study aimed to identify the causes of and scenarios associated with smoking relapse after effective smoking cessation.

PATIENTS AND METHODS

We conducted 20 semi-structured interviews with smokers who had previously unsuccessfully attempted to quit. The data underwent qualitative content analysis.

RESULTS

Three major themes were identified: reasons for smoking relapse; smoking relapse scenarios; and perception of the influence of personal environments, including family and physicians, on refraining from smoking after cessation. The first theme comprised the following subthemes: insufficient willpower and self-discipline, contact with smokers, exposure to stressful situations, lack of family support, weight gain, and insufficient improvement in one's mental and physical well-being. The second theme contained enjoyable social events, professional life, critical events, and encouragement to smoke from family members. The respondents frequently emphasized the large role of interaction with other smokers.

CONCLUSION

The predominant factors underlying smoking relapse include insufficient willpower and self-discipline and exposure to stress. The most frequent relapse scenario concerned experiencing negative or positive emotions when interacting with other smokers.

"Are We Gonna Talk About It or Not?" Thoracic Oncology Provider Perspectives on Smoking Cessation

BACKGROUND

Tobacco use is the greatest preventable cause of death and disease in the United States. Despite recommendations from the Centers for Disease Control and Prevention, United States Preventive Task Force, and major professional societies that all health-care providers provide smoking-cessation counseling, smoking-cessation interventions are not consistently delivered in clinical practice. We sought to identify important barriers and facilitators to the utilization of smoking-cessation interventions in a thoracic oncology program.

MATERIALS AND METHODS

We conducted 14 semistructured interviews with providers including thoracic surgeons (n = 3), interventional pulmonologists (n = 1), medical oncologists (n = 3), radiation oncologists (n = 2), and nurses (n = 5). Interviewees were asked about prior and current smoking-cessation efforts, their perspectives on barriers to successful smoking cessation, and opportunities for improvement. Responses were analyzed inductively to identify common themes.

RESULTS

All interviewees report discussing smoking cessation with their patients and realize the importance of a smoking-cessation counseling; however, smoking-cessation interventions are inconsistent and often lacking. Providers emphasized five domains that impact their delivery of smoking-cessation interventions: patient willingness and motivation to quit, clinical engagement and follow-up, documentation of smoking history, provider education in smoking cessation, and the availability of additional smoking-cessation resources.

CONCLUSIONS

Providers recognize the need for more efficient and consistent smoking-cessation interventions. Therefore, the development of interventions that address this need would not only be easily taught to providers and delivered to patients but also be welcomed into clinics.

Exposure to Environmental Tobacco Smoke (ETS) among Employees of Hospitality Venues in the Light of Changes in Anti-Tobacco Legislation in Poland

Introduction: Numerous studies conducted in Europe and worldwide have indicated that employees of hospitality venues are the most exposed professional group to environmental tobacco smoke (ETS) in the workplace. The purpose of this study was to assess the exposure of employees of hospitality venues to ETS in the light of changes in anti-tobacco legislation in Poland. Materials and methods: The study consisted of two stages. The first stage was conducted in 2010, while the second in 2015. The study was conducted among employees of 300 randomly selected hospitality venues in the city of Łódź (Poland). In total, 2607 questionnaires were analysed. The study used two survey questionnaires created and recommended by the Institute for Global Tobacco Control to study exposure to ETS. Statistical analysis was made with Statistica 13.1 PL (StatSoft, Poland). Results: In the group of all nonsmoking employees, individuals exposed to ETS at work in 2010 accounted for 72.6%; while in 2015 it was 51.8%. Factors affecting exposure to ETS in the workplace included, among others: age, marital status, education, position held, presence of a smoking room on the premises, and noncompliance with the provisions of the anti-tobacco laws. Conclusions: The prevalence of tobacco smoking among employees of hospitality venues decreased in 2010–2015, however, it remained high. More than half of nonsmoking employees were exposed to ETS at work.

"Stages of change, smoking behavior and acceptability of a textmessaging intervention for tobacco cessation among cigarette, dokha and shishasmokers: A qualitative research study."

OBJECTIVES

To explore: (A) the underlying motivators and barriers to smoking cessation among young Arabic speaking smokers and (B) to examine the suitability and preferences for tobacco cessation interventions (specifically text messages) and study the possibility of enrollment methods for a randomised controlled study using text messages as an intervention for tobacco cessation.

DESIGN

Qualitative research using focus group discussions and content analysis.

SETTINGS

Two universities, one of them is the first and foremost comprehensive national university in the United Arab Emirates (UAE). The third setting is the largest hospital in the UAE and the flagship institution for the public health system in the emirate of Abu Dhabi.

PARTICIPANTS

Six focus group discussions with a total of 57 participants. Forty-seven men and 10 women. Fifty-three of them were current smokers.

RESULTS

The analysis of six focus groups was carried out. Main themes arose from the data included: preferences for tobacco cessation interventions and acceptability and feasibility of text messaging as tobacco cessation intervention. Different motives and barriers for quitting smoking including shisha and dokha were explored.

CONCLUSION

Interventions using text messaging for smoking cessation have not been used in the Middle East and they could potentially be effective; however, tailoring and closely examining the content and acceptability of text messages to be used is important before the conduction of trials involving their use. Social media is perceived to be more effective and influential, with a higher level of penetration into communities of young smokers.

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.

Tobacco Health Risk Awareness among Socially Disadvantaged People-A Crucial Tool for Smoking Cessation

The goal of this cross-sectional survey was to assess the level of knowledge on harmful effects of environmental tobacco smoke (ETS) exposure and active smoking among socially-disadvantaged people in Poland. The study was conducted among 1817 respondents aged 18–59 years, who used aid services from local social care institutions in Piotrkowski district. Majority of the participants were aware of the fact that smoking may cause serious diseases and lung cancer (92%). However, those percentages were lower for awareness of ETS and health risk (69.4%) and for awareness of smoking/ETS-associated risk of stroke and heart attack (57%, 68%). The male respondents and smokers had much higher odds of lacking knowledge that smoking causes serious diseases and lung cancer compared to the females (OR = 1.47 and OR = 1.86; p < 0.05) and non-smokers (OR = 2.35 and OR = 2.31; p < 0.001). In addition, those with temporary jobs and the unemployed had a higher risk of lack of knowledge on smoking and lung cancer risk (OR = 2.14 and OR = 1.66; p < 0.05) as well as ETS and the risk of stroke (OR = 1.52 and OR = 1.51; p < 0.05) as compared to those with permanent jobs. The smokers who were aware of four health consequences of smoking indicated an intention to quit smoking within the next month more frequently when compared to those who did not have the knowledge on all of the analyzed harmful effects of tobacco use (19.7% vs. 13.1%; p < 0.05). There is a need to improve knowledge on the dangers associated with active and passive smoking among socially disadvantaged populations.

Predictors of and reasons for attempts to reduce alcohol intake: A population survey of adults in England

OBJECTIVE

This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption.

METHOD

Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so.

RESULTS

Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn't know why they were cutting down (β -0.25, p<0.05).

CONCLUSIONS

Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking.

Etiological theories of addiction: A comprehensive update on neurobiological, genetic and behavioural vulnerability

Currently, about 246 million people around the world have used an illicit drug. The reasons for this use are multiple: e.g. to augment the sensation of pleasure or to reduce the withdrawal and other aversive effects of a given substance. This raises the problem of addiction, which remains a disease of modern society. This review offers a comprehensive update of the different theories about the etiology of addictive behaviors with emphasis on the neurobiological, environmental, psychopathological, behavioural and genetic aspects of addictions, discussed from an evolutionary perspective. The main conclusion of this review is that vulnerability to drug addiction suggests an interaction between many brain systems (including the reward, decision-making, serotonergic, oxytocin, interoceptive insula, CRF, norepinephrine, dynorphin/KOR, orexin and vasopressin systems), genetic predisposition, sociocultural context, impulsivity and drugs types. Further advances in biological and psychological science are needed to address the problems of addiction at its roots.

Dental patients' perceptions and motivation in smoking cessation activities

OBJECTIVE

The aim of the present study was to investigate smokers' perceptions of and motivation for smoking cessation activities in dentistry. MATERIALS AND METHODS PATIENTS: who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists.

RESULTS

The sample consisted of 167 adult patients (≥ 20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR = 3.0, 95% CI = 1.03-8.55).

CONCLUSIONS

This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.

Prevalence and factors associated with hardcore smoking in Poland: findings from the Global Adult Tobacco Survey (2009-2010)

Background

Estimating the prevalence of hardcore smoking and identifying linked factors is fundamental to improve planning and implementation of effective tobacco control measures. Given the paucity of data on that topic, we aimed to assess the prevalence of and factors associated with hardcore smoking in Poland.

Methods

We used data from the Global Adult Tobacco Survey (GATS). GATS is a representative, cross-sectional, household based survey conducted in Poland between 2009 and 2010. Binary logistic regression analysis was used to explore the associations of socio-demographic and smoking related variables with hardcore smoking among daily smokers.

Results

The prevalence of hardcore smoking was 10.0% (13.0% among men and 7.3% among women) in the whole population of Poland at age 26 years and above. Hardcore smokers constitute 39.9% (41.6% among men and 37.7% among women) of all daily smokers in analyzed age frame. Being older, having started smoking at earlier ages, living in large cities (in women only), being less aware of negative health effects of smoking, having less restrictions on smoking at home was associated with higher risk of being hardcore smoker. Educational attainment and economic activity were not associated with hardcore smoking among daily smokers.

Conclusions

High prevalence of hardcore smokers may be a grand challenge for curbing non-communicable diseases epidemic in Poland. Our findings should urge policy makers to consider hardcore smoking issues while planning and implementing tobacco control policies. Prevention of smoking uptake, education programs, and strengthening cessation services appeared to be the top priorities.

The insula: a critical neural substrate for craving and drug seeking under conflict and risk

Drug addiction is characterized by the inability to control drug use when it results in negative consequences or conflicts with more adaptive goals. Our previous work showed that damage to the insula disrupted addiction to cigarette smoking-the first time that the insula was shown to be a critical neural substrate for addiction. Here, we review those findings, as well as more recent studies that corroborate and extend them, demonstrating the role of the insula in (1) incentive motivational processes that drive addictive behavior, (2) control processes that moderate or inhibit addictive behavior, and (3) interoceptive processes that represent bodily states associated with drug use. We then describe a theoretical framework that attempts to integrate these seemingly disparate findings. In this framework, the insula functions in the recall of interoceptive drug effects during craving and drug seeking under specific conditions where drug taking is perceived as risky and/or where there is conflict between drug taking and more adaptive goals. We describe this framework in an evolutionary context and discuss its implications for understanding the mechanisms of behavior change in addiction treatments.

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).

Effectiveness of individual counseling for smoking cessation in smokers with chronic obstructive pulmonary disease and asymptomatic smokers

Few studies have examined the effect of individual counseling for smoking cessation in China. The present study evaluated the efficacy of individual counseling in patients with chronic obstructive pulmonary disease (COPD) and asymptomatic smokers. This prospective randomized study evaluated 85 smokers with COPD and 105 asymptomatic smokers with normal lung function. The individuals were randomly allocated to intervention and control groups. Subjects in the intervention group were provided with individual cognitive counseling based on face-to-face individual consultation, self-help materials and nine telephone follow-ups. Subjects in the control group were provided with simple smoking cessation advice. The smoking status for all subjects and the St. George’s Respiratory Questionnaire (SGRQ) for COPD patients were assessed at baseline, week 4 and month 6. The COPD patient exacerbations during the 6 months were recorded. In the total study population, individual counseling resulted in higher abstinence rates compared with those in the control: Intervention vs. control, 23.4 vs. 10.4% (P=0.007), respectively. Similar results were observed in the smokers with COPD: Intervention vs. control, 40.5 vs. 18.6% (P=0.027), respectively. However, for asymptomatic smokers, the effect of individual counseling was identified to be statistically insignificant: Intervention vs. control, 9.6 vs. 3.8% (P=0.230), respectively. SGRQ scores and COPD exacerbations were significantly improved in patients who abstained from smoking compared with those in the patients who failed to stop smoking. Airway obstruction, quitting motivation and individual counseling were predictors associated with smoking cessation. Airway obstruction was the most significant predictor of smoking cessation (odds ratio, 4.215; 95% confidence interval, 2.215–7.865). The results of the present study show that individual counseling is an effective method for smoking cessation, particularly in COPD patients. However, its efficacy in asymptomatic smokers requires confirmation in further studies.

"What kind of general practitioner do I need for smoking cessation?" Results from a qualitative study in Poland

BACKGROUND

Cigarette smoking remains the leading preventable cause of death and disease. Thus, all activities aiming to reduce smoking play an important role in improving population health. The positive role of the general practitioner (GP) in smoking cessation could increase the success rate for quitting smoking, if compared with unassisted cessation. The aim of this study was to determine what kind of general practitioner smokers need in order to stop smoking.

METHODS

Four focus groups with 12 current and 12 former smokers (aged 20-59, 11 women and 13 men), were arranged in the city of Toruń, Poland, with a view to describe their opinions on the GP's role in smoking cessation. The data were subjected to descriptive qualitative content analysis.

RESULTS

Two major themes emerged in the analysis: the smokers' positive and negative experiences of the GP in smoking cessation and their expectations regarding the role of the GP in smoking cessation. The first theme embraced the following subthemes: (1) GP's passivity, (2) routine questions about the patient's smoking during the visit, (3) lack of time during the visit, and (4) the role model of the GP in smoking cessation. Within the second theme, the respondents identified the following subthemes: (1) bringing up the topic of smoking cessation, even in situations when the patient is unprepared for this; (2) the necessity of a tailored approach to the patient; (3) access to information and evidence confirming the harms of smoking tobacco; (4) prescription of pharmacological and other treatment; and (5) referral to specialists in smoking cessation.

CONCLUSIONS

Patients expect their GP to actively participate in smoking cessation through a more tailored approach to the patient's needs. The patients' experiences did not match their expectations: the smokers rarely got advice on smoking cessation from their GPs. Finally, they emphasized the importance of the GP as a role model in smoking cessation.

Predictors of long-term smoking cessation: results from the global adult tobacco survey in Poland (2009-2010)

Background

Expanding the information on determinants of smoking cessation is crucial for developing and implementing more effective tobacco control measures at the national as well as European levels. Data on smoking cessation and its social correlates among adults from middle-income countries of Central and Eastern Europe are still poorly reported in the literature. The aim of the study was to analyze the association of socio-demographic indicators with long term tobacco smoking cessation (quit smoking for at least one year prior to interview) among adults. Moreover, we evaluated motives for giving up smoking from former smokers.

Methods

Data on former as well as current smokers’ socio-demographic and smoking-related characteristics were derived from the Global Adult Tobacco Survey (GATS). GATS is a cross-sectional, nationally representative household survey implemented in Poland between 2009 and 2010. GATS collected data on a representative sample of 7,840 individuals including 1,206 individuals who met the criteria of long-term smoking cessation and 2,233 current smokers. Smoking cessation rate was calculated as the number of former smokers divided by the number of ever smokers. Logistic regression analyses were used to obtain odds ratios (ORs) and 95% confidence interval (CI) of the broad number of variables on successful cessation of smoking.

Results

Among females the quit rate was 30.4% compared to 37.9% in males (p < 0.01). Former smokers declared concerns about the health hazard of smoking (60.8%) and the high price of cigarettes (11.6%) as primary reasons for smoking cessation. Older age, high education attainment, awareness of smoking health consequences was associated with long-term quitting among both genders. Also employed males had over twice the probability of giving up smoking compared with unemployed, and being religious did not contribute to successful smoking cessation.

Conclusion

Results indicated that smoking cessation policies focused on younger age groups are vital for curbing tobacco epidemic in Poland and should become a public health main concern. There is also the need for interventions to raise awareness on smoking health risks and quitting benefits are crucial to increase cessation potential among adult smokers. Nevertheless further effort needs to be done to prevent smoking uptake.

Assessment of variables associated with smoking cessation in Crohn's disease

BACKGROUND

Patients with Crohn's disease (CD) who smoke have a more complicated disease course.

AIMS

Our primary objective was to assess smoking related variables that were associated with smoking cessation versus continued smoking in patients with CD.

METHODS

A multi-center study identified CD patients who were seen at the University of Chicago and University of Calgary IBD clinics. Patients were categorized into three subgroups: lifetime non-smokers, current smokers, or ex-smokers. Participants completed questionnaires assessing their cigarette smoking behavior. Current smokers were prospectively followed for 6 months to assess smoking status and attempts to quit. Logistic regression analysis was performed to identify factors associated with smoking cessation.

RESULTS

Three hundred patients were enrolled with 148 identifying themselves as lifetime non-smokers, 70 as current smokers, and 82 as ex-smokers. Patients who reported their first cigarette within 5 min of waking were more likely to be current smokers (OR = 21; 95% CI 3.94-107.3) as compared to patients who waited greater than 60 min. Current smokers were more likely to have one or more household members who smoked compared to ex-smokers (P < 0.05). Nearly half (49%) of the current smokers were in the precontemplation stage of change (i.e. no intention to quit smoking). At the 6-month follow-up, only 11% reported they quit smoking.

CONCLUSIONS

Patients who report a short time to first cigarette in the morning may have more difficulty in smoking cessation. Current smokers were more likely to have another smoker in the household compared to ex-smokers. Current smokers had low levels of motivation to quit smoking and consequently with no intervention, very few quit 6 months after the baseline assessment.

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.

Determinants of heavy smoking: results from the global adult tobacco survey in Poland (2009-2010)

OBJECTIVE

The aim of current analysis was to identify socio-demographic correlates of heavy smoking.

MATERIALS AND METHODS

Global Adult Tobacco Survey (GATS), a nationally representative household study was implemented in Poland between 2009 and 2010. We used data on representative sample of 1915 adults, age 25 years and older. The Odds Ratios (OR) and 95% Confidence Intervals (CI) for heavy smoking to the broad number of variables including age, age at smoking onset, education, occupational classification, living conditions, place of residence, place of residence at age about 14 years, awareness of smoking health consequences were tested in logistic regression model.

RESULTS

Among daily smokers the rate of heavy smokers was 63% in males and 45% in females (p < 0.001). The present study indicated that three characteristics: age, early age at smoking onset and lack of awareness of smoking health consequences were significantly associated with heavy smoking among both genders. Significantly higher risk of heavy smoking was observed among the 50-59 years of age population compared to the youngest group. The heavy smoking rate was highest among males who started smoking under age 14 years (OR = 3.1; 95% CI: 1.4-6.7; p < 0.001) and females that started smoking at age 14-17 years (OR = 2.3; 95% CI: 1.5-3.5; p < 0.0001) compared to those who started smoking at age 21 years or older. Heavy smoking was significantly correlated to lack of awareness of adverse health consequences of smoking (OR = 1.5; 95% CI: 1.1-2.03; p < 0.01 and OR = 1.5; 95% CI: 1.0-2.2; p < 0.01 for men and women, respectively) compared to aware respondents.

CONCLUSIONS

These outcomes should be taken into account while developing tobacco control measures. Among other things, educational interventions to increase knowledge of adverse tobacco health effects should be widely implemented.

Tobacco: a product like any other?

Legislation in most countries regulates trade in poisons and highly addictive products, such as narcotics. The statements that (1) tobacco harms health and (2) causes addiction are established as facts in international and national law. Yet in Russia, and in many other countries, there is a contradiction between the open sale of this addictive poison and basic laws, such as those on product safety. Provisions in both the Russian constitution and the criminal code can be interpreted as making the sale of tobacco illegal, setting out severe penalties for those involved. Yet, remarkably, tobacco is treated quite differently from other products. In this paper, we describe the experience so far in seeking to enforce this legislation in Russia. Attempts to persuade the police to enforce the legislation have been unsuccessful, although they accept that there is a prima facie case for action but, in private, express fear of taking it. The case for action is currently being argued before the Russian Supreme Court but this could take many years to reach a conclusion. In the mean time, new legislation on the regulation of tobacco production has been passed by the State Duma, with the support of the tobacco industry, which implicitly assumes that tobacco is a lawful product, thereby creating legal confusion. We argue that the only way to redress this situation is to recognize that tobacco production and sales must be regulated in the same way as any other harmful and addictive substance.

Socioeconomic position and abrupt versus gradual method of quitting smoking: findings from the International Tobacco Control Four-Country Survey

INTRODUCTION

Our aim was to investigate the association between socioeconomic position (income and education) and abrupt versus gradual method of smoking cessation.

METHODS

The analysis used data (n = 5,629) from Waves 1 through 6 (2002-2008) of the International Tobacco Control Four-Country Survey, a prospective study of a cohort of smokers in the United States, Canada, the United Kingdom, and Australia.

RESULTS

Logistic regression analyses using generalized estimating equations showed that higher income (p < .001) and higher education (p = .011) were associated with a higher probability of abrupt versus gradual quitting. The odds of adopting abrupt versus gradual quitting were about 40% higher among respondents with high income ($60,000 and more in the United States/Canada/Australia and £30,000 and more in the United Kingdom) compared with those with low income (less than $30,000 in the United States/Canada/Australia; £15,000 and less in the United Kingdom). Similarly, the odds of abrupt versus gradual quitting were about 30% higher among respondents with a high level of education (university degree) compared with those with a low level of education (high school diploma or lower).

DISCUSSION

Higher socioeconomic position is associated with a higher probability of quitting abruptly rather than gradually reducing smoking before quitting.

Knowledge and beliefs about smoking and cancer among women in five European countries

BACKGROUND

Lung cancer mortality in women is increasing across Europe, reflecting the alarming increase in smoking prevalence. Understanding women's perception of smoking may help to identify ways to reduce its prevalence and prevent uptake of smoking. The aim of this study was to examine factors associated with knowledge and beliefs about smoking and cancer among European women.

METHODS

A cross-sectional landline telephone survey on health attitudes and knowledge was conducted in five European countries: France, Ireland, Italy, the Czech Republic, and Sweden. A general linear modeling was used to explore the factors related to knowledge and beliefs about smoking and cancer.

RESULTS

A total of 5,000 women were interviewed (1,000 women from each country). The mean knowledge and belief scores about smoking and cancer were lower in current smokers than those of never and former smokers (P < 0.05). Women with above-the-median income (P = 0.001) and women who held skilled occupations seemed to be more knowledgeable about tobacco health risks (P < 0.001). The number of friends and family who smoked was inversely associated with knowledge on the harmful effects of tobacco (P = 0.001). Swedish women were the most knowledgeable about tobacco-related cancer risk, whereas in France and Italy, current smokers were less knowledgeable.

CONCLUSIONS

Knowledge and beliefs about cancer and smoking varied significantly by smoking status.

IMPACT

Results emphasize the need to develop health education programs that enhance cancer knowledge among women who currently smoke and are in low socioeconomic groups.

Premorbid tobacco smoking is associated with later age at onset in schizophrenia

Rates of cigarette smoking in individuals with schizophrenia well exceed those in the general population and in other mental illnesses. In the present study, we examined the relationship between smoking status, clinical characteristics and cognitive functions in 230 male Chinese schizophrenia patients. They were interviewed by experienced psychiatrists using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (SCID-P). Clinical symptoms were rated using the Positive and Negative Syndrome Scale (PANSS), and the Revised Tolerance Questionnaire (RTQ) used to evaluate the severity of nicotine dependence. Nine neuropsychological tests were used to assess cognitive function. We found that never-smokers had a younger age at examination and earlier onset and longer duration of illness than smokers and ex-smokers. The age of initiation of regular smoking in patients was significantly earlier than their age of illness onset. We found that longer duration of illness was significantly associated with higher RTQ scores. Ex-smokers with schizophrenia performed significantly more poorly on the Stroop C test than smokers. The results imply that smoking may affect cognitive function and illness onset time in patients with schizophrenia.

Epidemiologic determinants affecting cigarette smoking cessation: a retrospective study in a National Health System (SSN) treatment service in Rome (Italy)

This retrospective study aims to evaluate epidemiologic characteristics of patients attending stop smoking courses, based on group therapy, testing their influence on smoking cessation in univariate and multivariate model. A total of 123 patients were included in this study. Mean age was 53 (±11). Sixty-seven percent were women. At the end of the courses 66% of patients stopped smoking, after 12 months only 39% remained abstinent. Patients younger than 50 years statistically tended to continue smoking 6 months (P = .02–R.R. = 1.49, C.I. 95%: 1.06–2.44) and 12 months (P = .03–R.R. = 1.37, C.I. 95%: 1.02–2.52) after the end of the courses. A low self-confidence in quitting smoking was significantly related to continuing tobacco consumption after 6 months (P = .016–R.R. = 1.84, C.I. 95%: 1.14–2.99). Low adherence to therapeutic program was statistically associated to maintenance of tobacco use at 6 months (P = .006–R.R. = 1.76, C.I. 95%: 1.32–2.35) and 12 months (P = .050–R.R. = 1.45, C.I. 95%: 1.11–1.88). This association was confirmed at 6 months in the analysis performed on logistic regression model (P = .013).

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

BACKGROUND

Despite increasing governmental anti-smoking measures, smoking prevalence remains at a high level in France.

METHODS

The objectives of this panel study were (1) to estimate smoking prevalence in France, (2) to identify smokers' profiles according to their perceptions, attitudes and behaviour in relation to smoking cessation, (3) to determine predictive factors of quit attempts, and (4) to assess tobacco-related behaviours and their evolutions according to the changes in the smokers' environments. A representative sample of French population was defined using the quota method. The identified cohort of smokers was assessed, in terms of smoking behaviour, previous quit attempts, and intention to quit smoking.

RESULTS

A response rate of 66% for the screening enabled to identify a representative sample of the French population (N = 3 889) comprising 809 current smokers (21%). A majority of current smokers (63%) had made an attempt to quit smoking. Main reasons for having made the last attempt were cost (44%), social pressure (39%), wish to improve physical fitness (36%), fear of a future smoking-related disease (24%), and weariness of smoking (21%). Few attempts (16%) were encouraged by a physician. In those who used some kind of support (38%), NRT was the mostly used. Relapse was triggered by craving (45%), anxiety/stress (34%), a significant life event (21), weight gain (18%), and irritability (16%). Depression was rarely quoted (5%). Forty percent of smokers declared they intended to quit smoking permanently. Main reasons were cost (65%), physical fitness improvement (53%), fear of a future smoking-related disease (43%), weariness of tobacco (34%), and social pressure (30%). Using a smoking cessation treatment was considered by 43% of smokers that intended to quit. Barriers to smoking cessation were mainly fear of increased stress (62%), irritability (51%), and anxiety (42%), enjoying smoking (41%), and weight concerns (33%).

CONCLUSION

Smoking prevalence and smoking cessation attempts rate were lower in this survey than in previous reports. Cost and social pressure were the main reasons for quitting smoking, maybe an effect of dramatic tax increases and smoking ban.