Long-term effect of a low-intensity smoking intervention embedded in an adherence program for patients with hypercholesterolemia: Randomized controlled trial

ObjectiveWe evaluated the long-term effect of a smoking intervention embedded in an adherence program in patients with an increased risk for cardiovascular disease.MethodSecondary analysis of a randomized controlled trial: In 2002–2004, 8108 patients with hypercholesterolemia were enrolled from general practices in Germany. Patients received a 12-month adherence program and statin medication (intervention) or statin medication only (control). The program aimed to improve adherence to medication and lifestyle by educational material, mailings, and phone calls. Smoking was self-reported at baseline and every 6 months during the 3-year follow-up.ResultsIn total, 7640 patients were analyzed. At baseline, smoking prevalence was 21.7% in the intervention and 21.5% in the control group. Prevalence decreased in both groups to 16.6% vs. 19.5%, 15.3% vs. 16.8%, and 14.2% vs. 15.6% at the 12-, 24-, and 36-month follow-up. The intervention had a beneficial effect on smoking differing over time (group × time: P = 0.005). The effect was largest after 6 and 12 months [odds ratios (95% confidence intervals): 0.67 (0.54–0.82) and 0.63 (0.51–0.78)]. The effect decreased until the 18-month follow-up [0.72 (0.58–0.90)] and was not significant after 24 months.ConclusionA low-intensity smoking intervention embedded in an adherence program can contribute to smoking cessation although the intervention effect diminished over time.Trial Registration: ClinicalTrials.gov (www.clinicaltrials.gov): NCT00379249.     

Online smoking cessation program for Korean Americans: Randomized trial to test effects of incentives for program completion and interim surveys

IntroductionSmoking is prevalent among Korean American men. Quitting is Winning, an Internet-based, cognitive-behavioral smoking cessation program, was developed using community-based participatory research principles.MethodsA randomized controlled trial was used to evaluate whether participants were more likely to complete the program and quit smoking at 6-months of follow-up with additional reinforcement. The main outcomes were the proportion of participants who completed the online program and the proportion who quit smoking for at least 30 days, 26 weeks after enrollment, among those randomized into the high-reinforcement (HR) condition compared with those in the low-reinforcement (LR) condition.ResultsThe study achieved a final enrollment of 403 participants including 56 women. Program completion was greater for the HR as compared to the LR condition (17% vs. 10%, p = .035). There was no significant difference in 30-day smoking cessation (intent-to-treat [ITT]) between the HR and LR conditions (9% vs. 8%, ns). Smoking cessation was greater among program completers as compared to those who did not complete the program (28% vs. 5%, p < .001).ConclusionsThe addition of interim surveys and financial incentives for interim survey completion and program completion significantly increased the likelihood of program completion. Moreover, program completers were significantly more likely to quit smoking. Although smoking cessation rates did not significantly differ between the HR and LR conditions, the results suggest that future studies should explore the efficacy of larger financial incentives for program completion (Clinical Trial #NCT02584127).     

Design and conduct of a pragmatic randomized controlled trial to enhance smoking-cessation outcomes with exercise: The Fit2Quit study

BackgroundMost smokers want to stop smoking and many try to quit. However abstinence rates are low and most smokers do not manage to abstain for even a week. Relapse to smoking can be related to the occurrence of tobacco withdrawal symptoms (e.g., sleep disturbance, irritability, and craving) and weight gain. If regular exercise mitigates these effects it could have potential as an aid to smoking cessation. The aim of the Fit2Quit study is to determine the effects of a home and community-based exercise intervention on smoking abstinence at six months when used as an adjunct to usual care (telephone smoking-cessation counseling and nicotine replacement therapy; NRT).Methods/designA prospective parallel two-arm randomized controlled trial. Participants (n = 1400, 700 per arm) will be randomized to a structured home and community-based exercise program plus usual care (behavioral counseling and NRT) or to usual-care alone. It is targeted that at least 25% of the sample will be of Māori ethnicity (New Zealand indigenous). Outcomes to be measured using intention-to-treat analysis include: seven-day point prevalence of smoking abstinence verified by salivary cotinine (primary outcome); 6 months continuous abstinence; body mass index (BMI); cardio-respiratory fitness; physical activity levels; and cost effectiveness.DiscussionThe Fit2Quit study is an example of a large, pragmatic randomized controlled trial in a community setting. Specific components of the exercise intervention are outlined in detail.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12609000637246.     

Tolerance for and potential indicators of second-hand smoke exposure among nonsmokers: A comparison of self-reported and cotinine verified second-hand smoke exposure based on nationally representative data

ObjectiveWe assessed the extent to which self-reported exposure to SHS underestimates the actual exposure to SHS and what factors are associated with a tolerance for SHS exposure in the Korean setting where the smoke-free policy is incomplete.MethodsInformation on socio-demographic characteristics, alcohol drinking and smoking was collected for 7948 nonsmokers aged ≥ 19 years from the fourth Korea National Health and Nutrition Examination Survey, 2008–2009. Self-reported and cotinine verified SHS exposures were compared. Potential factors associated with cotinine verified but not self-reported SHS exposures were assessed using a logistic regression model.ResultsSelf-reported SHS exposure significantly underestimated the actual SHS exposure as determined by cotinine verification (kappa coefficient: 0.1066). At younger age, frequent alcohol drinking in females and a longer smoking duration in males were positively associated with cotinine verified exposure but not with the self-reported SHS exposure; they were also positively associated with cotinine verified exposure irrespective of self-reported SHS exposure.ConclusionsOur findings show a tolerance for smoking in Korea. The current partial ban on smoking does not fully protect people from exposure to SHS. Smoking should be banned in all public places. In addition, efforts to de-normalize smoking in the Korean culture need to be strengthened.     

Abstinence rates among college cigarette smokers enrolled in a randomized clinical trial evaluating Quit and Win contests: The impact of concurrent hookah use

ObjectiveTo examine baseline characteristics and biochemically verified 1-, 4-, and 6-month tobacco quit rates among college students enrolled in a Quit and Win cessation trial, comparing those who concurrently smoke both hookah and cigarettes with those who deny hookah use.MethodsAnalyses were conducted on data from 1217 college students enrolled in a Quit and Win tobacco cessation randomized clinical trial from 2010–2012. Multivariable logistic regression (MLR) analyses examined group differences in baseline characteristics and cotinine verified 30-day abstinence at 1, 4, and 6-month follow-up, adjusting for baseline covariates.ResultsParticipants smoked 11.5(± 8.1) cigarettes per day on 28.5(± 3.8) days/month, and 22% smoked hookah in the past 30 days. Hookah smokers (n = 270) were more likely to be male (p < 0.0001), younger (p < 0.0001), report more binge drinking (p < 0.0001) and score higher on impulsivity (p < 0.001). MLR results indicate that hookah users, when compared to non-users, had a 36% decrease in odds of self-reported 30-day abstinence at 4-months (OR = 0.64, 95% CI = 0.45–0.93, p = 0.02) and a 63% decrease in odds in biochemically verified continuous abstinence at 6-months (OR = 0.37, CI = 0.14–0.99, p = 0.05).ConclusionCollege cigarette smokers who concurrently use hookah display several health risk factors and demonstrate lower short and long-term tobacco abstinence rates.     

Effect of a smoking cessation intervention for women in subsidized neighborhoods: A randomized controlled trial

ObjectiveTo evaluate the effectiveness of a community based participatory research (CBPR) developed, multi-level smoking cessation intervention among women in subsidized housing neighborhoods in the Southeastern US.MethodsA total of n = 409 women in 14 subsidized housing neighborhoods in Georgia and South Carolina participated in this group randomized controlled trial conducted from 2009 to 2013. Intervention neighborhoods received a 24-week intervention with 1:1 community health worker contact, behavioral peer group sessions, and nicotine replacement. Control neighborhoods received written cessation materials at weeks 1, 6, 12, 18. Random coefficient models were used to compare smoking abstinence outcomes at 6 and 12 months. Significance was set a p < 0.05.ResultsThe majority of participants (91.2%) were retained during the 12-month intervention period. Smoking abstinence rates at 12 months for intervention vs. control were 9% vs. 4.3%, p = 0.05. Additional analyses accounting for passive smoke exposure in these multi-unit housing settings demonstrated 12 month abstinence rates of 12% vs. 5.3%, p = 0.016. However, in the multivariate regression analyses, there was no significant effect of the intervention on the odds of being a non-smoker (OR = 0.44, 95% CI: 0.18–1.07). Intervention participants who kept coach visits, attended group sessions, and used patches were more likely to remain abstinent.ConclusionsThis CBPR developed intervention showed potential to engage smokers and reduce smoking among women in these high-poverty neighborhoods. Effectiveness in promoting cessation in communities burdened with fiscal, environmental and social inequities remains a public health priority.     

Participant-level meta-analysis of mobile phone-based interventions for smoking cessation across different countries

With meta-analysis, participant-level data from five text messaging-based smoking cessation intervention studies were pooled to investigate cessation patterns across studies and participants. Individual participant data (N = 8315) collected in New Zealand (2001–2003; n = 1705), U.K. (2008–2009; n = 5792), U.S. (2012; n = 503; n = 164) and Turkey (2012; n = 151) were collectively analyzed in 2014. The primary outcome was self-reported 7-day continuous abstinence at 4 weeks post-quit day. Secondary outcomes were: (1) self-reported 7-day continuous abstinence at 3 months and (2) self-reported continuous abstinence at 6 months post-quit day. Generalized linear mixed models were fit to estimate the overall treatment effect, while accounting for clustering within individual studies. Estimates were adjusted for age, sex, socioeconomic status, previous quit attempts, and baseline Fagerstrom score. Analyses were intention to treat. Participants lost to follow-up were treated as smokers. Twenty-nine percent of intervention participants and 12% of control participants quit smoking at 4 weeks (adjusted odds ratio [aOR] = 2.89, 95% CI [2.57, 3.26], p < .0001). An attenuated but significant effect for cessation for those in the intervention versus control groups was observed at 3 months (aOR = 1.88, 95% CI [1.53, 2.31]) and 6 months (aOR = 2.24, 95% CI [1.90, 2.64]). Subgroup analyses were conducted but few significant findings were noted. Text messaging-based smoking cessation programs increase self-reported quitting rates across a diversity of countries and cultures. Efforts to expand these low-cost and scalable programs, along with ongoing evaluation, appear warranted.     

Tasas de abstinencia de vareniclina frente a bupropión y terapia sustitutiva con nicotina en la cesación del tabaco en atención primaria

ObjectiveThe objective of this study was to estimate the continuous abstinence rates of varenicline, bupropion and nicotine replacement therapy (NRT) in smoking cessation in 2 Primary Care (PC) External Support Units.DesignObservational, multicentre, longitudinal study using a retrospective review of medical records.SettingSix Primary Care Centres.ParticipantsPatients > 18 years, who began smoking cessation treatment between 1/01/2006 and 1/12/2008 with varenicline, bupropion or NRT were included in the analysis.ContinuationPatient follow-up was conducted from time-baseline (day 1) and assessed at 6 and 12 months. Main variables: comorbidities, effectiveness (continuous abstinence) and pharmacological tolerability. Statistical analysis: logistic regression models and Kaplan-Maier survival curves; P < .05.ResultsA total of 957 smokers treated with NRT (53.0%), bupropion (25.1%) and varenicline (21.9%) were included in the analysis. Mean age: 47.6 (11.3) years; 58.6% men. 32.0% of smokers attended due to physical dependence. Average duration of smoking: 19.5 (6.7) years. At 6 months, 61.2% (95% CI: 54.6-67.8%) of participants in the varenicline group continuously abstained from smoking compared with 56.9% (95% CI: 50.6-63.2%) in the bupropion group, and 52.3% (95% CI: 48.0-56.6%) in the NRT group; P = .003. At 12 months, the rate of continuous abstinence was 57.4% (95% CI: 50.7-64.1%) in the varenicline group compared with 52.9% (95% CI: 46.6-59.2%) in the bupropion group and 47.1% (95% CI: 42.8-51.4%) in the NRT group; P = .002.ConclusionOne year-follow up results suggest that varenicline is an appropriate alternative compared with bupropion and NRT on smoking cessation in the PC setting.     

Working with cancer: health and disability disparities among employed cancer survivors in the U.S

IntroductionApproximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer.MethodsCross-sectional data pooled from the 1997–2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n = 22,952) and those without (n = 358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors.ResultsRelative to workers with no cancer history, cancer survivors were more likely (OR; 95%CI) to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor–fair health (0.25; 0.24–0.26) and (2.06; 1.96–2.17) respectively, and ≥ 2 functional limitations (0.37; 0.35–0.38) and (1.72; 1.64–1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers.ConclusionBlue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers.     

Stages of change, smoking characteristics, and cotinine concentrations in smokers: setting priorities for smoking cessation

ObjectiveWe assessed whether the salivary cotinine content of daily smokers varied with the readiness to quit and smoking characteristics.MethodsThis cross-sectional study was conducted in Barcelona, Spain (n = 1245) in 2004–2005. We administered a questionnaire to assess smoking behaviour and collected saliva to determine the cotinine content. We determined the distribution of 278 adult daily smokers across different stages of change and categorised them by individual and smoking characteristics. We used medians and interquartile ranges (IQR) to relate cotinine concentrations to different stages of change, tobacco consumption, and nicotine dependence based on the Fagerström Test for Nicotine Dependence (FTND).ResultsAround 68%, 22%, and 11% of smokers were in precontemplation, contemplation, and preparation stages, respectively. A mean of 17.0 cigarettes was smoked daily, with no differences among stages of change. The median cotinine concentration was 151.3 ng/ml (IQR: 83.2–227.8 ng/ml), with no differences among stages of change. The cigarette consumption scores, FTND, and time to first cigarette of the day were positively associated with cotinine concentration.ConclusionsThe cotinine concentration was similar among the stages of change, but varied within each stage according to the number of cigarettes smoked, time to first cigarette of the day, and nicotine dependence.     

The tobacco cessation consultation of the Salah-Azeiz Tunis cancer center: one year results

BackgroundTo reduce tobacco smoking is, in Tunisia, a public health priority. The tobacco cessation consultation is one of the interventions to fight against the tobacco epidemic; it is a new activity developed in the Salah-Azeiz Tunis cancer centre. The objective of this work is to evaluate the impact of the consultation on the smokers after one year of activities and to analyse the prognostic factors of tobacco cessation in order to improve the efficacy of such an activity in the future, in Tunisia.MethodsThe cessation methods were based on cognitive and behavioral therapies associated with nicotine patch, delivered free of charge. During one year (July 2003 to June 2004), 340 smokers were attended. Data on their smoking status and psychological characteristics were collected using a standardized questionnaire.ResultsThe patients were mostly men (79%), these smokers did not present important anxiodepressive troubles, 68% thought that they were able to quit easily. The majority (57%) smoked more than 20 cigarettes a day and was nicotinodependant (Fagenström > 7). Half of this population had already intended to stop, they declared to smoke mostly because of stress. The global cessation rate after a median follow-up of 32 weeks is 27%. The cessation rate lasting six months for 83 patients followed regularly was 23%. The good prognostic factors of cessation, after multivariate analysis, were (when taking out from the model the regular follow-up), to be confidant on the possibility to stop (OR = 0.87 [0.78–0.97]). On the contrary, a high score (>7) for Fagerström test (OR = 1.9 [1.1–3.4), the use of smoking to fight against stress (OR = 1.08 [1.0–1.2) and a smoking environment at home (OR = 4.5 [1.1–18.9]) were prognostic of a failure in quitting smoking.ConclusionThese results show that the cessation rate, which is still too low as compared with the literature, could be increased by a better follow-up of smokers associated with an information campaign on the existing possibilities to quit smoking in Tunisia.     

Are secondhand smoke-related diseases of children associated with parental smoking cessation? Determinants of parental smoking cessation in a population-based cohort study

ObjectiveLittle is known about whether secondhand smoke (SHS)-related diseases of young children, such as asthma, induce parental smoking cessation during the early child-rearing period. Our objective was therefore to show the association in addition to other potential determinants of parental cessation.MethodsWe analyzed data from the Longitudinal Survey of Newborns in the 21st Century in Japan, from 0.5 years (N = 47,015) to 4.5 years (N = 39,817), having selected participants whose parents smoked at baseline (maternal smoking N = 8,037; paternal smoking N = 28,486). Multivariable log-binomial regression models were used to calculate the prevalence ratios for parental smoking cessation according to the onset of SHS-related diseases of their children, using inverse probability weight to account for non-response at follow-up.ResultsA total of 16.7% of smoking mothers and 14.5% of smoking fathers had stopped smoking at follow-up. The onset of SHS-related children's diseases was not statistically significantly associated with either maternal or paternal smoking cessation after multivariable adjustments. Strong determinants were, for example, number of cigarettes smoked per day and partner's smoking status during follow-up.ConclusionSHS-related children's diseases were not associated with parental smoking cessation. It may therefore be necessary to provide additional support for parental smoking cessation within their child's medical care setting.     

Clinician advice to quit smoking among seniors

ObjectiveLittle smoking research in the past 20 years includes persons 50 and older; herein we describe patterns of clinician cessation advice to US seniors, including variation by Medicare beneficiary characteristics.MethodIn 2012–4, we analyzed 2010 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Medicare beneficiaries over age 64 (n = 346,674). We estimated smoking rates and the proportion of smokers whose clinicians encouraged cessation.Results12% of male and 8% of female respondents aged 65 and older smoke. The rate decreases with age (14% of 65–69, 3% of 85 +) and education (12–15% with no high school degree, 5–6% with BA +). Rates are highest among American Indian/Alaskan Native (16%), multiracial (14%), and African–American (13%) seniors, and in the Southeast (14%). Only 51% of smokers say they receive cessation advice “always” or “usually” at doctor visits, with advice more often given to the young, those in low-smoking regions, Asians, and women. For all results cited p < 0.05.ConclusionsSmoking cessation advice to seniors is variable. Providers may focus on groups or areas in which smoking is less common or when they are most comfortable giving advice. More consistent interventions are needed, including cessation advice from clinicians.     

Les facteurs prédictifs de la bonne motivation de cesser de fumer chez les fumeurs marocains consultant pour une symptomatologie pulmonaire en 2008

BackgroundMotivations for cessation of smoking should be studied to determine which factors have an impact. Educational messages can then be developed to help smokers become more successful in adopting healthy behavior. The objective of our work was to determine the factors influencing the quality of motivation for smoking cessation among patients attending a lung disease clinic.MethodsBetween March and June 2008, patients attending the outpatient clinical of the Moulay Youssef Hospital Department of Pneumology in Rabat were studied. Data on the smoking status and motivation to stop smoking (Richmond's test) were collected using a standardized questionnaire. A logistic regression model was developed to analyze the quality of their motivation to quit smoking.ResultsThe median age for smoking the first cigarette was low (< 20 years); pharmacological dependence on nicotine was low (Fagerström score < 8 in 71.8%). More than a third of patients (36.6%) had already intended to cease smoking. According to the Richmond test, only 46.0% were well motivated (score ≥ 8). At multivariate analysis, factors predictive of a good motivation to quit smoking were a previous attempt to stop smoking (OR = 5.4 [2.5–11.7]), severe disease (OR = 3.7 [1.6–8.2]). Beginning the tobacco addiction before the age of 18 years was predictive of poor motivation (OR = 2.7 [1.4–5.3]).ConclusionOur investigation provides evidence in favor of searching for different factors which might affect motivation to stop smoking among patients seeking care in a lung disease clinic. Lung specialists, who manage the large majority of these patients should be particularly active in this area.     

Public opinion about financial incentives for smoking cessation

ObjectiveThe aim of this study is to assess public support for a smoking cessation policy involving financial incentives.MethodsWe conducted a randomized controlled trial using an experimental survey design. One of four questionnaire versions was distributed to participants. Each version described a smoking cessation treatment costing $750 per success, including an unspecified treatment, medication, or financial incentive paid to the smoker. Participants indicated whether they would support a $25 increase in their annual health insurance premium to pay for the treatment. Questionnaires were distributed to adults waiting at public transportation depots in Philadelphia between May and August 2010.Results1010 individuals completed the questionnaires about willingness to support the policy: 53% female, 27% African-American, 18% current smokers, and 46% with a household income below $40,000. The response rate was greater than 50%. Overall support for all smoking cessation treatments was 41.6%. The financial incentive version received the lowest support (39.3%) but that support did not statistically differ from the treatment (45.8%, p = 0.14) or medication (41.7%, p = 0.58) versions.ConclusionsFinancial incentives were perceived no differently than currently used medications for smoking cessation. Most participants did not support any smoking cessation treatment options.     

Determinants of use of smoking cessation aids in 27 European countries

ObjectiveTo identify determinants of use of smoking cessation aids among current and former smokers in the European Union (EU).MethodsData from n = 9921 current and ex-smokers from 27 European countries (Eurobarometer 77.1, February–March 2012) were analysed. Multivariate binary logistic regression was used to assess for correlates of use of any recommended aid with proven efficacy, defined as use of pharmacotherapy or psychosocial counselling (p < 0.05). The regression analyses assessed for socio-demographic characteristics, EU region, as well as scope of national smoking cessation policies.ResultsAmong current smokers who had made a quit attempt and ex-smokers, 19.9% had used any recommended aid with proven efficacy. Respondents from Northern (adjusted odds ratio [aOR] = 1.90), Western (aOR = 3.21) and Eastern Europe (aOR = 1.69) were more likely to have used an efficacious smoking cessation aid compared to respondents from Southern Europe (all p < 0.05). Respondents in countries with comprehensive tobacco cessation programmes that offered cost-covered national quit lines, medication, and other cessation services had increased likelihood of using efficacious cessation aids (OR = 1.29; 95% Confidence Interval: 1.07–1.55).ConclusionsThese findings underscore the need for enhanced and sustained efforts to ensure increased access to cessation services and aids as part of a comprehensive tobacco control programme.     

The relation of tobacco use during hospitalization to post-discharge smoking cessation among US veterans

ObjectiveThe objective of this study was to determine if tobacco use while in the hospital was associated with post-discharge cessation rates.MethodsDuring 2006–2008, smokers from three Veterans Affairs hospitals (n = 354) were surveyed during their hospitalization and again 6 months later. Data analysis was conducted in 2009.ResultsWhile veterans smoked an average of 19 cigarettes per day, prior to admission, the average was 6–7 cigarettes per day during hospitalization. About 40% (n = 140) were able to quit smoking for more than 24 h and the median days quit was 29. The 6-month self-reported quit rate was 15% (n = 53). Multivariate analyses showed that veterans who quit tobacco use during their hospitalization had nearly 4 times increased odds of quitting smoking for more than 24 h and 2.7 times increased odds of quitting at 6 months post-hospitalization as compared to veterans that did not quit using tobacco during hospitalization.ConclusionMany veterans quit tobacco use during hospital admissions and those who do not quit, tended to decrease their use. Veterans who quit tobacco use were more likely to be abstinent at 6-month follow-up. State-of-the-art cessation interventions need to be provided to smokers hospitalized in Veterans Affairs hospitals.     

Smoking cessation and receipt of cessation advice from health professionals among older smokers in Taiwan

ObjectivesTo examine the prevalence and correlates of smoking cessation and receiving professional cessation advice among older smokers in Taiwan.MethodsCross-sectional data from the 2008–2010 and 2012 Taiwan Adult Smoking Behavior Survey was used to form a sample of 4081 recent active smokers aged 50 +, comprising current smokers and former smokers who quit smoking within the past 12 months. We examined three outcome variables: quit attempt in the past 12 months, successful cessation for at least 3 months, and receipt of health professional cessation advice. Multivariate logistic regressions were used to identify significant correlates.ResultsDuring the study period, the annual quit attempt rate was 41.4%, annual successful cessation rate was 4.7%, and prevalence of receiving cession advice among smokers who visited health professionals within the past 12 months was 72.3%. After controlling for other covariates, quit attempts were significantly higher in 2009 and positively associated with higher education, poorer health status, smoke-free homes, and receipt of cessation advice. Successful cessation was significantly higher in 2009, positively associated with older age, higher income, and smoke-free homes, and negatively associated with receiving cessation advice. Receipt of cessation advice was significantly lower in 2010 and 2012, positively associated with male gender, older age, and poorer health status, and negatively associated with higher education.ConclusionsOur results suggest that targeting lower educated and lower income subgroups, adopting effective strategies to increase voluntary smoke-free home rules, and improving professional cessation advice will have great potential to further reduce smoking prevalence in older smokers.     

School bullying and susceptibility to smoking among never-tried cigarette smoking students

IntroductionBullying involvement has been linked with substance use; however, less is known about its relationship with pre-initiation stages of adolescent cigarette smoking behavior. This study examined the association between bullying involvement and smoking susceptibility among never tried or experimented with cigarette smoking students. Susceptibility to cigarette smoking in adolescence is a strong predictor of subsequent smoking initiation.MethodsA cross-sectional data on Canadian adolescent and youth were drawn from the 2012/2013 Youth Smoking Survey (n = 28,843). Logistic regression analysis was used to examine the association between bullying and smoking susceptibility among never-smoking students.ResultsAbout 21% self-reported involvement in bullying (as a bully, victim or both). Middle school students (grades 6–8) reported more involvement in bullying (24%) than those in grades 9–12 (16%). The multivariable analyses showed that the association between bullying and smoking susceptibility was significantly different by grade level. Middle school students involved in bullying had higher odds of smoking susceptibility compared to uninvolved students (bully, adjusted odds ratio [AOR] = 2.54, 95% CI = 1.73–3.74; victim, AOR = 1.29, 95% CI = 1.11–1.48; bully–victim, AOR = 2.19, 95% CI = 1.75–2.74). There were no significant associations between all subgroups of bullying and smoking susceptibility for grades 9–12 students.ConclusionsStudents involved in bullying were more susceptible to smoking, although patterns of association varied by grade level. In particular, the findings highlight that non-smoking middle school students involved in bullying were susceptible to future smoking.     

Primary care physician smoking screening and counseling for patients with chronic disease

BackgroundEvidence-based guidelines recommend smoking cessation treatment, including screening and counseling, for all smokers, including those with chronic diseases exacerbated by smoking. Physician treatment improves smoking cessation. Little data describes smoking treatment guideline uptake for patients with chronic cardiopulmonary smoking-sensitive diseases.ObjectiveDescribe U.S. primary care physician (PCP) smoking cessation treatment during patient visits for chronic cardiopulmonary smoking-sensitive diseases.MethodsThe National (Hospital) Ambulatory Medical Care Survey captured PCP visits. We examined smoking screening and counseling time trends for smokers with chronic diseases. Multivariable logistic regression assessed factors associated with smoking counseling for smokers with chronic smoking-sensitive diseases.ResultsFrom 2001–2009 smoking screening and counseling for smokers with chronic smoking-sensitive cardiopulmonary diseases were unchanged. Among smokers with chronic smoking-sensitive diseases, 50%–72% received no counseling. Smokers with chronic obstructive pulmonary disease (COPD) (odds ratio (OR) = 6.54, 95% confidence interval (CI) 4.85–8.83) and peripheral vascular disease (OR = 4.50, 95% CI 1.72–11.75) were more likely to receive smoking counseling at chronic/preventive care visits, compared with patients without smoking-sensitive diseases. Other factors associated with increased smoking counseling included non-private insurance, preventive and longer visits, and an established PCP. Asthma and cardiovascular disease showed no association with counseling.ConclusionsSmoking cessation counseling remains infrequent for smokers with chronic smoking-sensitive cardiopulmonary diseases. New strategies are needed to encourage smoking cessation counseling.