Factors influencing smoking cessation attempts and success in Iranian male adults: national survey data.

BACKGROUND: Smoking cessation is a dynamic process that often involves a series of unsuccessful quit attempts before long-term abstinence is achieved. To implement interventions that lead to long-term abstinence, it will be necessary to understand the determinants of smoking cessation. Therefore, the main objective of the present study was to determine the effect of factors influencing both smoking cessation attempts and successful smoking cessation in the general population of Iran. METHODS: The data of 1293 participants whose information was obtained through a national cross-sectional study entitled "Survey of Risk Factors of Noncommunicable Diseases in 2016" were analyzed. There were three response levels: "quit attempt and successful quit", "quit attempt and unsuccessful quit", and "no quit attempt and unsuccessful quit". A multinomial logistic regression model was used to assess the effect of covariates on response. RESULTS: The mean (sd) age of all participants was 47.21 (13.65) years. According to the results, 883 people (68.29%) did not attempt to quit smoking, and of those who attempted to quit smoking, only 64 (15.61%) men were successful. The factors of living in an urban area (OR = 1.71) and past smoking intensity (OR = 1.967) were associated with no quit attempt and unsuccessful quitting. In addition, physician recommendation to quit smoking was a protective factor for no quit attempt and unsuccessful quit (OR = 0.599). Alcohol consumption was also a protective factor against successful quitting for both attempters (OR = 0.351) and nonattempters (OR = 0.359). CONCLUSIONS: Tobacco control programs should be implemented with a greater focus on heavy smokers and alcohol users. In addition, the role of health professionals in encouraging smokers to quit smoking should not be ignored.

Effect of Ramadan fasting on changes in smoking and vaping behaviors and withdrawal symptoms severity: a cross-sectional study.

BACKGROUND: Ramadan fasting, an obligatory duty for adult Muslims, entails refraining from eating, drinking, smoking, and vaping from dawn until sunset. Throughout Ramadan, people accept major changes to daily routines. Consequently, Ramadan is associated with abstinence symptoms and changes in smoking or vaping behavior. AIM: The study aims to assess the presence of withdrawal symptoms and its severity, as well as smoking or vaping behavior change and its determinants during Ramadan fasting. METHODS: A cross-sectional study was conducted during Ramadan in 2023. Data were collected online using a Google form, including questionnaires assessing socio-demographic data, nicotine dependence using Fagerstrom Test for Nicotine Dependence, vaping and shisha smoking, presence and severity of physiological and psychological withdrawal symptoms and its coping strategies. Smoking and vaping behavioral change during Ramadan and its contributing factors were also evaluated. RESULTS: A total of 251 participants (96% males), mean age ± standard deviation (33 ± 12.1) were surveyed. Withdrawal symptoms were reported among 70.5%, however, their severity was generally low both physiologically and psychologically. Education, nationality, smoking duration, nicotine dependence, and the amount of consumed E-liquid per day were the independent predictors of withdrawal symptoms presence. Attempts to quit smoking and vaping were reported by 54.6% of the participants; young age and higher educational levels were the factors associated with more quitting attempts. CONCLUSIONS: The withdrawal symptoms severity linked to Ramadan fasting is minimal. Many smokers and vapers made attempts to quit during Ramadan. Ramadan presents a chance for smoking and vaping cessation with some behavioral support.

To Investigate the Influence of Smoking Cessation Intention and Common Downstream Variants of HDAC9 Gene on Large Artery Atherosclerotic Cerebral Infarction.

Objective: To investigate the association of smoking cessation intention and single nucleotide polymorphism of HDAC9 gene with LAA-S in Han people in Hainan province. Methods: A case-control study was conducted. Six single nucleotide polymorphisms (SNPS) of HDAC9 gene were genotyped by SNPscan genotyping technique in 248 patients with LAA-S and 237 controls in Hainan Han population. SNP loci (rs10227612, rs12669496, rs1548577, rs2074633, rs2526626, and rs2717344) were genotyped, and the genotype and allele frequencies were compared between the case and control group. At the same time, the distribution of smoking between the case and control group was compared, and the 3-year and 7-year follow-up smoking cessation between the case and control group was compared, so as to find out the effects of smoking cessation intention and HDAC9 SNP on LAA-S. Results: (1) The GT genotype at rs10227612, GG genotype at rs2717344, and GA genotype at rs1548577 in the case group were significantly higher than those in the control group, and the differences were statistically significant. (2) There were significant differences in the distribution of smoking between the case and control group (P < 0.05), and there were significant differences in the smoking cessation after 3 years and 7 years of follow-up between the case and control group (P < 0.05). The intention to quit smoking was positively correlated with the incidence of LAA-S. Conclusion: (1) The rs10227612, rs1548577, rs2074633, rs2717344 of HDAC9 gene may be significantly related to atherosclerotic cerebral infarction of great arteries in Hainan Han population, while rs12669496 and rs2526626 may not be related. (2) According to the statistics of smoking in the case and control group, smoking was related to large artery atherosclerotic cerebral infarction, and the intention to quit smoking was a very important factor affecting the success of smoking cessation.

Efficacy of the QuitSure App for Smoking Cessation in Adult Smokers: Cross-Sectional Web Survey.

BACKGROUND: Cigarette smoking remains one of the leading causes of preventable death worldwide. A worldwide study by the World Health Organization concluded that more than 8 million people die every year from smoking, tobacco consumption, and secondhand smoke. The most effective tobacco cessation programs require personalized human intervention combined with costly pharmaceutical supplementation, making them unaffordable or inaccessible to most tobacco users. Thus, digital interventions offer a promising alternative to these traditional methods. However, the leading smartphone apps available in the market today have either not been studied in a clinical setting or are unable to match the smoking cessation success rates of their expensive offline counterparts. We would like to understand whether QuitSure, a novel smoking cessation app built by Rapidkart Online Private Limited, is able to bridge this efficacy gap and deliver affordable and effective smoking cessation at scale. OBJECTIVE: Our objective was to do an initial exploration into the engagement, efficacy, and safety of QuitSure based on the self-reported experiences of its users. Outcomes measured were program completion, the effect of program completion on smoking behavior, including self-reported cessation outcomes, and negative health events from using the app. METHODS: All QuitSure registered users who created their accounts on the QuitSure app between April 1, 2021, and February 28, 2022, were sent an anonymized web-based survey. The survey results were added to their engagement data on the app to evaluate the feasibility and efficacy of the app as a smoking cessation intervention. The data were analyzed using descriptive statistics (frequencies and percentages) and the χ2 test of independence. RESULTS: In total, 1299 users who had completed the QuitSure program submitted the survey and satisfied the inclusion criteria of the study. Of these, 1286 participants had completed the program more than 30 days before filling out the survey, and 1040 (80.1%, 95% CI 79.1%-82.6%) of them had maintained prolonged abstinence for at least 30 days after program completion. A majority of participants (770/891, 86.4%) who were still maintaining abstinence at the time of submitting the survey did not experience any severe nicotine withdrawal symptoms, while 41.9% (373/891) experienced no mild withdrawal symptoms either. Smoking quantity prior to completing the program significantly affected quit rates (P<.001), with heavy smokers (>20 cigarettes per day) having a lower 30-day prolonged abstinence rate (relative risk=0.91; 95% CI 90.0%-96.2%) compared to lighter smokers. No additional adverse events outside of known nicotine withdrawal symptoms were reported. CONCLUSIONS: The nature of web-based surveys and cohort selection allows for extensive unknown biases. However, the efficacy rates of survey respondents who completed the program were high and provide a case for further investigation in the form of randomized controlled trials on the QuitSure tobacco cessation program.

Impact of switching from cigarette smoking to tobacco heating system use on biomarkers of potential harm in a randomized trial.

BACKGROUND: Smoking cessation reduces the risk of developing smoking-related diseases. Although smoking prevalence has declined, many continue smoking cigarettes. Switching completely to smoke-free alternatives like the Tobacco Heating System (THS) 2.2-a heated tobacco product for which there is evidence demonstrating significantly reduced formation and exposure to harmful chemicals compared to cigarettes-has the potential to reduce the harm caused by continuing to smoke cigarettes. METHODS: We conducted a 6-month clinical study (NCT02396381) with a 6-month extension (NCT02649556), initially randomizing 984 adult smokers to continue smoking or switch to THS (non-mentholated), of which 672 continued into the extension study. Endpoints were evaluated at baseline and at 3, 6, and 12 months. We longitudinally assessed biomarkers of potential harm (BoPHs) known to be reversible upon smoking cessation as indicators of pathways involved in the pathogenesis of cardiovascular or respiratory diseases and carcinogenicity. The need to cough and safety profile were also assessed. Impact on eight key BoPHs was used as a proxy to evaluate harm reduction potential. RESULTS: At 12 months, comparison of BoPH levels between the predominant THS use and cigarette smoking groups showed a positive effect in favor of switching, partially or in full, to THS. CONCLUSION: These results provide additional evidence of the harm reduction potential of THS for smokers who would otherwise continue smoking, but they need to be verified in long-term confirmatory studies. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT0264955. Date of registration: January 7, 2016 https://clinicaltrials.gov/ct2/show/NCT02649556.

Is social media our new quitline? A descriptive study assessing youtube coverage of tobacco cessation.

Background: Tobacco use and exposure are leading causes of morbidity and mortality worldwide. In the past decade, educational efforts to reduce tobacco use and exposure have extended to social media, including video-sharing platforms. YouTube is one of the most publicly accessed video-sharing platforms. Purpose: This cross-sectional descriptive study was conducted to identify and describe sources, formats, and content of widely viewed YouTube videos on smoking cessation. Methods: In August to September 2023, the keywords "stop quit smoking" were used to search in YouTube and identify 100 videos with the highest view count. Results: Collectively, these videos were viewed over 220 million times. The majority (n = 35) were posted by nongovernmental/organization sources, with a smaller number posted by consumers (n = 25), and only eleven were posted by governmental agencies. The format used in the highest number of videos was the testimonial (n = 32 videos, over 77 million views). Other popular formats included animation (n = 23 videos, over 90 million views) and talk by professional (n = 20 videos, almost 43 million views). Video content included evidence-based and non-evidence-based practices. Evidence-based strategies aligned with U.S. Public Health Service Tobacco Treatment Guidelines (e.g. health systems approach in tobacco treatment, medication management). Non-evidence-based strategies included mindfulness and hypnotherapy. One key finding was that environmental tobacco exposure received scant coverage across the videos. Conclusions: Social media such as YouTube promises to reach large audiences at low cost without requiring high reading literacy. Additional attention is needed to create videos with up-to-date, accurate information that can engage consumers.

Behavioral Activation Mobile App to Motivate Smokers to Quit: Feasibility and Pilot Randomized Controlled Trial.

BACKGROUND: Behavioral activation (BA) is an evidence-based treatment for depression that fosters engagement in values-based activities to increase access to positive reinforcement. Depressed mood has been shown to hinder smoking cessation. OBJECTIVE: This study determined the feasibility and preliminary efficacy of a mobile app to motivate smokers to quit by using BA and integrating motivational messages to quit smoking. METHODS: Adult smokers (N=56; mean age 34.5, SD 9.52 years) who were not ready to quit smoking within 30 days were recruited from advertisements and randomized to either 8 weeks of the BA app (set 2 values-based activities per week+motivational messages+feedback on changes in smoking, mood, and values-based activities) or the control group (no app; received resources for quitting smoking). All participants completed the baseline and end-of-treatment web-based questionnaires. Controls also completed weekly web-based assessments, and BA app participants completed assessments through the app. RESULTS: There were no dropouts and only 2 participants in each condition did not complete the end-of-treatment questionnaire. The results demonstrated that it is feasible to recruit smokers who are unmotivated to quit into a smoking cessation induction trial: 86% (57/66) of eligible participants were randomized (BA app: n=27; control: n=29). Participants reported high levels of satisfaction: 80% (20/25) of participants said they would recommend the BA app, there were moderate-to-high scores on the Mobile App Rating Scale, and 88% (22/25) of participants rated the app 3 stars or higher (out of 5). There were high levels of BA app engagement: 96% (26/27) of participants planned activities, and 67% (18/27) of participants planned 7 or more activities. High engagement was found even among those who were at the highest risk for continued smoking (low motivation to quit, low confidence to quit, and high negative affect). The results provided support for the hypothesized relationships between BA constructs: greater pleasant activity completion was associated with greater positive affect (b=0.37, SE 0.21; 95% CI -0.05 to 0.79; P=.08), and greater positive affect tended to predict fewer cigarettes smoked the next day (b=-0.19, SE 0.10; 95% CI -0.39 to 0.01; P=.06). Additionally, a greater number of activities planned was associated with lower negative affect (b=-0.26, SE 0.15; 95% CI -0.55 to 0.04; P=.09). Overall, 16% (4/25) of BA app participants set a quit date versus 4% (1/27) among controls, and there were promising (but not significant) trends for motivation and confidence to quit. CONCLUSIONS: The findings suggest that a mobile app intervention can be made appealing to smokers who are unmotivated to quit by focusing on aspects most important to them, such as mood management. This theory-based intervention has shown some initial support for the underlying theoretical constructs, and further efficacy testing is warranted in a fully powered trial.

Efectos de una Charla Antitabaco en Adolescentes Fumadores de Colegios Públicos y Privados en la Región Metropolitana de Santiago de Chile / Effects of an Anti-Smoking talk on Adolescent Smokers in Public and Private Schools in the Metropolitan Region of Santiago de Chile

Introducción. El tabaquismo es responsable de una gran cantidad de muertes en el mundo, la gran prevalencia del tabaquismo entre adolescentes, así como la baja edad de inicio del consumo, genera preocupación y la necesidad de implementar intervenciones específicas a esta población. Objetivo. Evaluar los efectos de una charla antitabaco en adolescentes de colegios públicos y privados en la Región Metropolitana de Santiago. Métodos. Estudio cuantitativo cuasi-experimental, se realizó una charla antitabaco en dos colegios (público y privado), se evaluó la motivación para dejar de fumar con el Test de Richmond en una muestra de 13 estudiantes pre y post charla. Resultados. hubo una mejora en los puntajes de Richmond post charla en ambos colegios, siendo mayor en el colegio público, sin embargo, la diferencia no fue estadísticamente significativa (p=0,09). Discusión. La evidencia respalda la efectividad de las charlas antitabaco. Existe una relación entre nivel socioeconómico y tabaquismo, sin embargo, no hay otros estudios que comparen la efectividad en los distintos estratos sociales. Se reconocen limitaciones del estudio como el tamaño de la muestra y el muestreo no aleatorio, se recomiendan nuevos estudios que incluyan otras variables. Conclusiones. A pesar de limitaciones del estudio, se respalda la implementación de charlas antitabaco en entornos educativos, enfatizando la necesidad de adaptar estrategias a contextos socioeconómicos específicos para mejorar la salud pública.

Background. Introduction: Smoking is responsible for a significant number of deaths worldwide, and the high prevalence of smoking among adolescents, as well as early age of onset, raises concerns, and the need of targeted interventions for this group. The aim of this study was to assess the effects of an anti-smoking talk on students from public and private schools in the Metropolitan Region of Santiago. Methods. A quasi-experimental quantitative study involving an anti-smoking talk in two schools (public and private) assessed the motivation to quit smoking using the Richmond Test in a sample of 13 students pre and post the talk. Results. There was an improvement in Richmond scores post-talk in both schools, with a greater increase observed in the public school. However, the difference was not statistically significant (p=0.09). Discussion. The evidence supports the effectiveness of anti-smoking talks. A relationship between socioeconomic status and smoking exists, yet there are no studies comparing effectiveness across different socioeconomic strata. Study limitations, such as sample size and non-random sampling, are acknowledged, and further research incorporating additional variables is recommended. Conclusions. Despite study limitations, advocating for the implementation of anti-smoking talks in educational settings is supported, emphasizing the need to adapt strategies to specific socioeconomic contexts to enhance public health.

Prevalence of smoking habits, attitudes and knowledge on counteractive strategies among a sample of healthcare employees: results of the smoking-free health environments project in the province of Palermo, Italy.

Introduction: Tobacco use is responsible for over 7 million deaths annually, making smoking the leading cause of preventable mortality globally. Over the last two decades in Italy, the prevalence of smoking among physicians has consistently decreased, while it remains higher and is gradually decreasing among non-physician healthcare workers. The aim of this study was to investigate the Prevalence of smoking habits, attitudes, and knowledge on counteractive strategies among employees in the Primary Healthcare Facilities in the Province of Palermo, Italy. Methods: A cross-sectional survey was conducted between June 2020 and December 2020 through a previously validated anonymous questionnaire structured in four sections including 34 items. Data were analyzed using Stata/MP 12.1 statistical software. Results: Overall, 2,645 participants answered the questionnaire. The prevalence of either current or former smokers was 18.6%. Based on the multivariable analysis conducted, a significantly higher frequency of current smokers was observed among male participants (AdjOR: 1.29; CI95%: 1.02-1.64) and those belonging to the Surgical Unit (AdjOR: 1.92; CI95%: 1.27-2.90). Conversely, the prevalence of current smokers was significantly lower among those with at least one child (AdjOR: 0.67; CI95%: 0.49-0.91), with an educational qualification equal to or greater than a graduation degree (AdjOR: 0.56; CI95%: 0.43-0.73), those who considered second-hand smoke harmful (AdjOR: 0.06; CI95%: 0.008-0.60), those who had observed smoking or detected the smell of smoke in their workplace (AdjOR: 0.64; CI95%: 0.45-0.91). Furthermore, the prevalence of current smokers was significantly lower among participants who believed that healthcare professionals could play a crucial role in influencing their patients' lifestyles (AdjOR: 0.67; CI95%: 0.50-0.90) and among those who recommend their patients to quit smoking (AdjOR: 0.35; CI95%: 0.24-0.51). Discussion: The results of the current research demonstrate that, despite the decline in smoking prevalence among physicians, the rate of smokers among healthcare facility employees remains unacceptably high. This underscores the need to re-evaluate current anti-tobacco strategies in the workplace.

Factors associated with intentions to quit tobacco use in Lebanon: A cross-sectional survey.

Introduction: The prevalence of tobacco smoking in Lebanon is among the highest globally. This study aims to determine past attempts to quit smoking among adults and identify factors associated with intentions to quit. Methods: A nationally representative telephone survey was conducted between June and August 2022. Eligibility criteria included people aged >=18 years residing in Lebanon. The questionnaire was divided into three components: socio-demographic characteristics, cigarette and waterpipe tobacco use behaviours. Binary logistic regression was used to examine factors associated with intention to quit cigarette and waterpipe tobacco use. Results: A total of 2003 respondents were included in the study. The prevalence of any tobacco product use was 41%, the prevalence of current cigarette smoking was 41% and the prevalence of current waterpipe tobacco use was 20%. Approximately 24% of adults who smoke cigarettes and 26% of those who use waterpipe tobacco had previous quit attempts mainly due to health concerns. Intentions to quit smoking within the next 6 months were reported among 12% of survey respondents. Among adults who smoke, past quit attempts increased the likelihood of intentions to quit cigarette smoking by 5-fold (OR: 5.11; 95% CI: 1.80-14.47, p = 0.002) and waterpipe tobacco use by 7-fold (OR: 6.98, 95% CI: 2.63-18.51, p = <0.001). Age and income were associated with intentions to quit cigarette but not waterpipe tobacco use. Conclusion: Intention to quit smoking was strongly associated with past quitting attempts. Understanding factors associated with intentions to quit can help inform the development of context specific smoking cessation interventions.

Efectos de la estimulación transcraneal con corriente directa (tDCS) sobre el consumo de tabaco, la motivación y la autoeficacia para dejar de fumar / Effects of transcranial direct current stimulation (tDCS) on tobacco use, motivation and self-efficacy to quit smoking

Estudios recientes de estimulación transcraneal con corriente directa (tDCS), aplicada sobre la corteza prefrontal dorsolateral (CPFDL), han demostrado que pueden reducir el craving y el consumo de tabaco. Sin embargo, existen pocas investigaciones que hayan evaluado los efectos del tDCS sobre la motivación y la autoeficacia para dejar de fumar. El objetivo de este estudio fue evaluar los efectos de la tDCS sobre el patrón de consumo, la motivación y la autoeficacia percibida para dejar de fumar en 16 personas con Trastorno por Consumo de Tabaco (TCT). Se utilizó un diseño de series temporales con replicación intrasujeto ABAB. El tratamiento consistió en la aplicación de 10 sesiones repetidas de tDCS a 1.5 mA durante 20 minutos sobre la CPFDL (cátodo F3 y ánodo F4), una sesión diaria durante dos semanas (lunes a viernes). Tras una fase de descanso de un mes, se replicó el tratamiento intrasujeto en idénticas condiciones. La intervención completa duró nueve semanas y fue completada por 10 participantes. Los resultados mostraron una reducción significativa en la dependencia a la nicotina, el número de cigarrillos fumados y los niveles de monóxido de carbono (CO) en el aire espirado. Además, observamos una mejora significativa en la motivación y la autoeficacia percibida para dejar de fumar. Estos hallazgos sugieren que el tDCS, aplicado sobre la CPFDL, puede ser una técnica efectiva para usar como terapia coadyuvante a otras estrategias farmacológicas y/o psicológicas empleadas en las Unidades de Conductas Adictivas (UCAs), u otros centros de atención a las drogodependencias. Sin embargo, se necesitan más estudios que investiguen la interacción entre los efectos de la nicotina y el tDCS para encontrar la estrategia óptima de tratamiento. (AU)

Recent studies of transcranial direct current stimulation (tDCS), applied to the dorsolateral prefrontal cortex (CPFDL), have shown that they can reduce craving and smoking. However, there is little research that has evaluated the effects of tDCS on motivation and self-efficacy to quit smoking. The objective of this study was to evaluate the effects of tDCS on the pattern of consumption, motivation and perceived self-efficacy to quit smoking in 16 people with Tobacco Use Disorder (TUD). A time series design with intrasubject ABAB replication was used. The treatment consisted of applying 10 repeated sessions of tDCS at 1.5 mA for 20 minutes on the CPFDL (cathode F3 and anode F4), one daily session for two weeks (Monday to Friday). After a one-month rest phase, the intra-subject treatment was replicated under identical conditions. The entire intervention lasted nine weeks and was completed by 10 participants. The results showed a significant reduction in nicotine dependence, the number of cigarettes smoked and the levels of carbon monoxide (CO) in the exhaled air. Furthermore, we observed a significant improvement in motivation and perceived self-efficacy to quit smoking. These findings suggest that the tDCS, applied on the CPFDL, may be an effective technique to use as adjunctive therapy to other pharmacological and / or psychological strategies used in the Addictive Behavior Units, or other drug addiction care centers. However, more studies are needed to investigate the interaction between the effects of nicotine and tDCS to find the optimal treatment strategy. (AU)

How do self-exempt beliefs affect intentions to quit smoking? An exploration of the mediating role of threat appraisal and coping appraisal.

Introduction: Numerous smokers are cognizant of the detrimental effects associated with this habit yet exhibit a persistent reluctance to cease their tobacco consumption. Self-exempt beliefs serve as an obstacle to the cessation of this addictive behavior. This research explored the impact of self-exempt beliefs on the readiness to quit smoking based on the Protection Motivation Theory (PMT) model and the mediating roles of threat appraisal and coping appraisal. Methods: Self-exempt beliefs, PMT constructs, and the intention to quit smoking constituted the theoretical model. The questionnaires were collected from 488 Chinese adult male smokers based on snowball sampling. Exploratory Factor Analysis (EFA) was used to examine the underlying factor structure of the pre-designed self-exempt beliefs scale. The reliability, validity, path coefficients, and explanatory power of the model were calculated using Partial Least Squares Structural Equation Modeling (PLS-SEM). Results and discussion: The results showed that : (1) three common factors (skeptic beliefs, bulletproof beliefs, and "worth it" beliefs) with a total of 11 items were retained after EFA; (2) skeptic beliefs and "worth it" beliefs had a significantly negative effect on both threat appraisal and coping appraisal, while bulletproof beliefs did not; (3) bulletproof beliefs had a significantly positive direct impact on intention to quit, "worth it" beliefs had a significantly negative direct impact on intention, while skeptic beliefs had no significantly direct impact on intention; (4) threat appraisal and coping appraisal positively and significantly predicted cessation intention; and (5) threat appraisal and coping appraisal, as two main cognitive processes, acted as full mediations between skeptic beliefs and the intention to quit, as complementary partial mediations between "worth it" beliefs and the intention, and as non-mediation between bulletproof beliefs and the intention. Our findings suggest that efforts to undermine or "prevent" these self-exempt beliefs, particularly "worth it" and skeptic beliefs, may be an effective tactic for health communication interventions for quitting smoking.

The influence of health literacy and knowledge about smoking hazards on the intention to quit smoking and its intensity: an empirical study based on the data of China's health literacy investigation.

OBJECTIVE: This study explored the relationship between smokers' health literacy, knowledge of smoking hazards, and their intention to quit. METHODS: Based on data from the 2019 Health Literacy and Tobacco Use Surveillance among residents of a city in Zhejiang Province, 1120 male smokers were screened. Differential tests were used to analyze whether smokers with varying levels of health literacy and knowledge about smoking hazards differed in their intention to quit smoking and the intensity of their intention. A multi-factor logistic regression model was constructed to explore the extent of these differences. RESULTS: Only 24.8% of smokers had higher health literacy. Among smokers, those with an intention to quit had a higher health literacy level compared to those without such intention (32.7% vs. 17.0%, p < 0.001). Health literacy levels did not differ significantly between groups with different intensity of intention to quit (34.2% vs. 31.9% vs. 30.1%, p = 0.435). About 48.7% of the smokers a higher level of knowledge about smoking hazards. It was more prevalent in the intent to quit group compared to the no intent to quit group (54.0% vs. 43.4%, p < 0.001), and the low intent to quit group had lower knowledge compared to the moderate and high intent to quit groups (49.1% vs. 56.6% vs. 63.4%, p = 0.011). After adjusting for other influences, smokers with lower health literacy were less likely to have intention to quit (OR = 0.659, p = 0.016). And the association between knowledge about smoking hazards and whether smokers have the intention to quit is no longer significant, but it significantly affects the intensity of the intention to quit among smokers who already have the intention (OR = 0.623, p = 0.005). CONCLUSION: General health literacy may play a role in facilitating smokers' progression from the stage of no intent to quit to one of intent to quit, but a more specific understanding of the harms of smoking may be needed to increase the strength of intent to quit.

Smoking cessation policy and treatments derived from the protective motivation of smokers: a study on graphic health warning labels.

Introduction: Smoking is a leading public health risk. Many countries are reducing the demand for tobacco through graphic health warning labels (GHWLs). This study aims to explore smokers' perceptions of GHWLs and analyze the effect of GHWLs on their behavioral intentions to quit smoking. Methods: A theoretical model is designed by synthesizing protection motivation theory, an extension of the extended parallel process model, and the theory of planned behavior. We collected a cross-sectional sample of 547 anonymous smokers through a stratified random sampling strategy. GHWLs published in 2011 by the US Food and Drug Administration were used in the survey to assess smokers' responses to them, and then the hypotheses are validated through structural equation models. Results: The results suggest that perceived severity, perceived vulnerability, response efficacy, and health anxiety have a significant impact on smokers' protection motivation. Furthermore, smokers' protection motivation directly impacts the behavioral intention to quit smoking and indirectly influences intention to quit through attitudes. Discussion: These findings have practical implications for the implementation and improvement of GHWLs policies. Meanwhile, this study enriches the literature on public health protection measures (i.e., GHWLs) and smokers' behavioral intention to quit smoking.

Why women continue to smoke during pregnancy: a qualitative study among smoking pregnant women.

Smoking during pregnancy is a serious public health concern due to its adverse consequences on fetal development and pregnant women's health. For the success of smoking cessation interventions, it is essential to determine why pregnant women continue smoking. The objective of this study is to determine the beliefs, attitudes, and barriers to quitting smoking during pregnancy. We adopted a qualitative research design. The participants consisted of 22 pregnant women who smoke, selected by purposive sampling. We collected data through semi-structured interviews and analyzed it using thematic analysis. We identified six themes namely "Reasons for starting to smoke: family and social environment," "Intention to quit smoking and related factors," "Smoking and emotional well-being," "Smoking and stressful life experiences," "Protective thoughts: reducing smoking to safeguard their babies," and "Belief in a healthy pregnancy and inadequate risk perception." Women expressed the desire to protect their fetus from the harm of smoking. However, they continued to smoke due to a lack of knowledge, inadequate risk perception, psychological difficulties, and lack of motivation. Health professionals should be aware of the difficulties experienced by pregnant women who smoke and should support them in quitting smoking.

Self-reported depression and anxiety and healthcare professional interactions regarding smoking cessation and nicotine vaping: Findings from 2018 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Survey.

INTRODUCTION: People with mental health conditions are disproportionately affected by smoking-related diseases and death. The aim of this study was to assess whether health professional (HP) interactions regarding smoking cessation and nicotine vaping products (NVPs) differ by mental health condition. METHODS: The cross-sectional 2018 International Tobacco Control Four Country (Australia, Canada, England, United States) Smoking and Vaping Survey data included 11040 adults currently smoking or recently quit. Adjusted weighted logistic regressions examined associations between mental health (self-reported current depression and/or anxiety) and visiting a HP in last 18 months; receiving advice to quit smoking; discussing NVPs with a HP; and receiving a recommendation to use NVPs. RESULTS: Overall, 16.1% self-reported depression and anxiety, 7.6% depression only, and 6.6% anxiety only. Compared with respondents with no depression/anxiety, those with depression (84.7%, AOR=2.65; 95% CI: 2.17-3.27), anxiety (82.2%, AOR=2.08; 95% CI: 1.70-2.57), and depression and anxiety (87.6%, AOR=3.74; 95% CI: 3.19-4.40) were more likely to have visited a HP. Among those who had visited a HP, 47.9% received advice to quit smoking, which was more likely among respondents with depression (AOR=1.58; 95% CI: 1.34-1.86), and NVP discussions were more likely among those with depression and anxiety (AOR=1.63; 95% CI: 1.29-2.06). Of the 6.1% who discussed NVPs, 33.5% received a recommendation to use them, with no difference by mental health. CONCLUSIONS: People with anxiety and/or depression who smoke were more likely to visit a HP than those without, but only those with depression were more likely to receive cessation advice, and only those with depression and anxiety were more likely to discuss NVPs. There are missed opportunities for HPs to deliver cessation advice. NVP discussions and receiving a positive recommendation to use them were rare overall.

Gender differences in cigarette smoking cessation attempts among adults who smoke and drink alcohol at high levels: Findings from the 2018-2020 International Tobacco Control Four Country Smoking and Vaping Surveys.

BACKGROUND: This study examined the association between alcohol consumption and smoking cessation behaviour of adults who smoke in four countries. METHODS: Data came from 4275 adults (≥18 years) who smoked tobacco ≥ monthly and participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Surveys (Australia: n = 720; Canada: n = 1250; US: n = 1011; England: n = 1294). The 2018 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) survey data coded into three levels ('never/low', 'moderate' or 'heavy' consumption) were analysed using multivariable logistic regression models to predict any smoking cessation attempts and successful cessation by 2020 survey, and whether this differed by gender and country. RESULTS: Compared to never/low alcohol consumers, only those who drink heavily were less likely to have made a quit smoking attempt (40.4 % vs. 43.8 %; AOR = 0.69, 95 % CI = 0.57-0.83, p < .001). The association differed by gender and country (3-way interaction, p < .001), with females who drink heavily being less likely to attempt to quit smoking in England (AOR = 0.27, 95 % CI = 0.15-0.49, p < .001) and Australia (AOR = 0.38, 95 % CI = 0.19-0.77, p = .008), but for males, those who drink moderately (AOR = 2.18, 95 % CI = 1.17-4.06, p = .014) or heavily (AOR = 2.61, 95 % CI = 1.45-4.68, p = .001) were more likely to make a quit attempt in England only. Alcohol consumption did not predict quit success. CONCLUSION: Heavy alcohol use among adults who smoke appears to only undermine the likelihood of trying to quit smoking with some variation by gender and country of residence, but not their chances of succeeding if they tried.

Comparison of the Smoking Cessation of Heated Tobacco Product Users and Conventional Cigarette Smokers in Korea.

BACKGROUND: Since the introduction of heated tobacco products (HTPs) in Korea in 2017, their annual sales have increased. Several studies have investigated the perceptions of HTPs and smoking cessation behaviors. For the first time, In 2019, questions focused on HTP use were introduced in the Korea National Health and Nutrition Examination Survey (KNHNES). This study aimed to compare smoking cessation behaviors between HTP users and conventional cigarette smokers using KNHANES data. METHODS: Data of 947 current adult smokers from the 8th KNHNES (2019) were analyzed. Current smokers were divided into conventional cigarette (CC)-only, HTP-only, and dual-use groups. The general characteristics of the three groups were investigated. Differences in current intention to quit smoking and past attempts to quit smoking among the three groups were analyzed using multivariate logistic regression analysis by IBM SPSS ver. 25.0. RESULTS: HTP-only users demonstrated fewer future smoking cessation plans (adjusted odds ratio [AOR], 0.398; 95% confidence interval [CI], 0.195-0.813; P=0.012) and fewer smoking cessation attempts in the past year (AOR, 0.533; 95% CI, 0.298-0.954; P=0.034) than CC-only smokers. However, there was no significant difference between dual-use (CC+HTP) and CC-only smokers. CONCLUSION: While dual-use and CC-only smokers showed similar smoking cessation behaviors, HTP-only users had fewer previous attempts to quit smoking and were less likely to be currently ready to quit smoking. These findings can be explained by a decrease in the need to quit smoking due to the convenience of HTP and the perception that HTPs are less harmful than CC.

The association between viewing cigarette health warning labels and intention to quit smoking among Chinese adult smokers: support for including health outcome content and culturally specific messages.

BACKGROUND: Tailored themes of pictorial health warning labels (HWLs) that considers specific cultural dimensions and within a specific policy/historical context can motivate behavior change, such as provoking smokers to think about quitting. Currently in China, the HWLs on cigarettes are text-only. This study designed pictorial HWLs using different themes to explore and examine the association between viewing pictorial HWLs and participants' intention to quit smoking. The themes included: (1) Self-harm from using cigarettes, (2) Harming family or children with secondhand smoke, (3) Complying with existing smoke-free policies, and (4) Cigarette gift giving practices. METHODS: A cross-sectional randomized experimental survey was conducted among 1,625 smokers in Beijing (n = 545), Shanghai (n = 541), and Shenzhen (n = 539) during 2017. Before and after viewing eight pictorial HWLs of one theme, participants were asked if they had plans to quit smoking within the next month, within the next 6 months, beyond the next 6 months, or not at all. Ordinal logistic regression, Wilcoxon and Chi-square tests were used to analyze the data. RESULTS: After viewing the HWLs, 434 participants (26.9%) reported an intention to quit smoking sooner, 987 (61.2%) reported the same intention to quit, and 191 (11.8%) reported an intention to quit later. The pre-post change in intention to quit was statistically significant among all participants and participants under each theme (p > 0.05). Participants who rated the effectiveness of the HWL communicating how secondhand smoke harms children had 1.13 (95% CI 1.01-1.27) greater odds of reporting an intention to quit sooner compared to those viewing labels from the other themes, adjusting for covariates. Female participants and participants with annual household income more than 100,000RMB had 1.39 (95% CI 1.14-1.69) and 1.29 (95% CI 1.04-1.60) greater odds of reporting an intention to quit sooner compared to their counterparts across the entire sample. CONCLUSIONS: Findings of this study provide evidence of an association between all four pictorial HWL themes and smokers' intention to quit smoking. These findings can help inform what HWL themes might be appropriate when China implements pictorial health warning labels.

Efficacy of WeChat-based online smoking cessation intervention ('WeChat WeQuit') in China: a randomised controlled trial.

Background: China has approximately 300 million current smokers, and smoking cessation services are limited. This study aimed to assess the efficacy of a Cognitive Behavioral Theory-based smoking cessation intervention ('WeChat WeQuit') via the most popular social media platform in China, WeChat. Methods: A parallel, single-blind, two-arm randomised controlled trial was conducted via WeChat between March 19, 2020 and November 16, 2022. Chinese-speaking adult smokers (n = 2000) willing to quit within one month were recruited and randomised in a 1:1 ratio. The intervention group (n = 1005) received the 'WeChat WeQuit' program and the control group (n = 955) received control messages for 14 weeks (2-week prequit and 12-week postquit). Participants were followed up to 26 weeks after the quit date. The primary outcome was self-reported continuous smoking abstinence rate, biochemically validated at 26 weeks. The secondary outcomes were self-reported 7-day and continuous abstinence rates at 6 months. All analyses were by intention to treat. The trial is registered at ClinicalTrials.gov (NCT03169686). Findings: By intention-to-treat analysis, the biochemically verified 26-week continuous abstinence rate was 11.94% in the intervention group and 2.81% in the control group (OR = 4.68, 95% CI: 3.07-7.13, p < 0.0001). The self-reported 7-day abstinence rates ranged from 39.70% at week 1-32.04% at week 26 for the intervention group and 14.17%-11.86% in the control group for weeks 1 and 26, respectively; the self-reported continuous abstinence rates at weeks 1 and 26 ranged from 34.33% to 24.28% and 9.65% to 6.13% in the intervention group and the control group respectively (all p < 0.0001). Participants with low nicotine dependence or previous quit attempts were more likely to successfully quit smoking. Interpretation: The 'WeChat WeQuit' intervention significantly increased smoking abstinence rates at 6 months and should be considered for treatment-seeking smokers in China. Funding: The research is supported by the Natural Science Foundation of Hunan Province (2020JJ4794, YLiao), the K.C. Wong Postdoctoral Fellowship for YLiao to study at King's College London, and China Medical Board (CMB) Open Competition Program (grant no. 15-226, 22-485, YLiao).