Association of health literacy with smoking behavior among Chinese men.

Health literacy may constitute a modifiable determinant of smoking behavior and intention to quit. Little is known about the extent to which health literacy affects smoking or quitting smoking. We assessed the nationally representative cross-sectional datasets from the China Health Literacy Surveillance (CHLS) initiated in 2018. Using polytomous logistic regression models, the study investigated the association of health literacy with smoking behavior and the intention to quit smoking among men aged 15-69 in China. After confounding factors were controlled, compared with having below basic health literacy, having adequate health literacy appeared to be an independent protective factor from current smoking [current smoking vs never smoking: adjusted odds ratio [OR], 0.88; 95% confidence interval (CI), 0.81-0.96; p = 0.003; current smoking vs former smoking: adjusted OR, 0.77; 95% CI, 0.64-0.92; p = 0.003], while having intermediate health literacy was associated with current smoking vs never smoking (adjusted OR, 1.09; 95% CI, 1.02-1.17; p = 0.011) or former smoking vs never smoking (adjusted OR, 1.22; 95% CI, 1.06-1.40; p = 0.005). And having adequate health literacy was associated with intending to quit among current smokers (adjusted OR, 1.25; 95% CI, 1.10-1.42; p < 0.001). Findings provide evidence that health literacy may serve as a critical and independent protective factor for reducing poor smoking behavior or enhancing cessation intention among men. Efforts should focus on developing and evaluating intervention to control tobacco use among men with low health literacy level.

Libres de humo: efectividad de un programa de cesación tabáquica en un Centro de Salud Comunitario de la Ciudad Autónoma de Buenos Aires / Smoke-free: effectiveness of a smoking cessation program in a Community Health Center of the Autonomous City of Buenos Aires

Introducción. El consumo de tabaco representa un importante desafío para la salud pública debido a su alta incidencia y mortalidad, y es el principal factor de riesgo modificable para desarrollar enfermedades crónicas no transmisibles. La Residencia de Medicina General y Familiar del Hospital General de Agudos Dr. Teodoro Álvarez desarrolló un programa de cesación tabáquica en el Centro de Salud y Acción Comunitaria N◦34, que forma parte desde 2012 del Programa de Prevención y Control del Tabaquismo del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires, Argentina. Objetivo. Documentar los resultados de la eficacia de este programa y explorar las variables relacionadas con la probabilidad de éxito y recaída. Materiales y métodos. Estudio cuantitativo, de corte transversal analítico, con datos obtenidos de historias clínicas electrónicas entre 2017 y 2020. Fueron incluidos los pacientes que consultaron al menos en dos ocasiones al programa de cesación tabáquica y establecieron un día D al menos 30 días antes del abandono del consumo de tabaco. La eficacia terapéutica fue definida como haber permanecido al menos seis meses sin fumar, y la recaída, como el reinicio de consumo del tabaco luego de haber logrado 24 horas de abstinencia con fecha posterior al día D.Resultados.De 59 pacientes, 24 (40,7 %) lograron la eficacia terapéutica, de los cuales 5 (20,8 %) presentaron recaídas.De los 35 pacientes que no lograron alcanzar la etapa de mantenimiento, 30 (85,7 %) recayeron durante las primeras ocho semanas. El sexo masculino y el consumo de tabaco superior a 20 paquetes-año mostraron una mayor correlación con las recaídas. Conclusiones. El programa presentó una eficacia terapéutica del 40,7 % en el periodo evaluado. Se encontraron asociaciones entre una mayor eficacia terapéutica y ciertas características de los pacientes, pero se requieren más estudios para confirmar esta hipótesis. (AU)

Background. Tobacco consumption represents an important challenge for public health due to its high incidence and mortality and is the main modifiable risk factor for developing chronic non-communicable diseases. The General and Family Medicine Residence of the Hospital General de Agudos Dr. Teodoro Álvarez developed a smoking cessation program in Health and Community Action Centre N◦34. Since 2012 it has been part of the Program for the Prevention and Control of Smoking of the Ministry of Health of the Government of Buenos Aires, Argentina. Objective. To document the results of the effectiveness of the program and explore the variables related to the probability of success and relapse. Materials and methods. Quantitative, analytical cross-sectional study, with data obtained from electronic medical records between 2017 and 2020. Patients who consulted the smoking cessation program at least twice and established a D-day 30 days before quitting tobacco consumption were included. Therapeutic efficacy was defined as having remained at least six months without smoking, and relapse, as the resumption of tobacco consumption after having achieved 24 hours of abstinence with a date after day D. Results. Of 59 patients, 24 (40.7 %) achieved therapeutic efficacy, of which 5 (20.8 %) presented relapses. Among the35 patients who failed to reach the maintenance stage, 30 (85.7 %) relapsed during the first eight weeks. Male sex and tobacco consumption of more than 20 pack per year showed a greater correlation with relapses. Conclusions.The program presented a therapeutic efficacy of 40.7 % in the evaluated period. Associations were found between greater therapeutic efficacy and certain patient characteristics but more studies are required to confirm this hypothesis. (AU)

Correlates of nicotine dependence among patients visiting a tobacco cessation centre in India: A retrospective analysis.

Background We did a retrospective secondary analysis of 1-year data of a tobacco cessation clinic (TCC) to assess correlates of nicotine dependence among tobacco users visiting the TCC at a tertiary care dental hospital. Methods Secondary data were obtained from the records of patients who had visited the TCC from January to December 2019. Of the 1436 records, 1144 were found to contain all the information needed for the study. Patient records were obtained from a pre-validated standard TCC patient assessment sheet (PAS), which included various sections: Sociodemo-graphic items, tobacco use profile items, nicotine dependence status, strategy used for cessation and follow-up details. Results Of the 1144 proformas, 97.1% (n=1111) were of men and 2.9% (n=33) were of women. Around 48.5% had medium nicotine dependence followed by high nicotine dependence (29.7%) and low nicotine dependence (21.8%). The mean (SD) age of initiation of tobacco use was 26.1 (9.44) years and a significantly lower age of initiation was observed in patients with high nicotine dependence. Greater number of years of tobacco use was significantly associated with high nicotine dependence. About 47% of patients had attempted to quit tobacco in the past and the quitting attempts were found to be significantly higher in patients with high dependence. Conclusion We explored crucial determinants of nicotine dependence among tobacco users reporting to the TCC. These factors may be incorporated in routine assessment of the tobacco use status and may be used in tailored cessation counselling strategies.

COMPARISON OF PREVALENCE OF TOBACCO USE AMONG YOUNG PEOPLE IN DIFFERENT COUNTRIES.

OBJECTIVE: The aim: The prevalence analysis of three ways of tobacco use among young adults: traditional (smoking of cigarillos or cigars) and alternative (hookah smoking and use of E-cigarettes) as well as the development of ways of tobacco smoking prevention. PATIENTS AND METHODS: Materials and methods: Cross-section anonymous survey among young adults 18-44 years of age (n=410) has been conducted. The obtained results were compared with the data of the similar studies from different countries. The statistical methods (analysis of the mean and relative values), structural and logical analysis and systemic approach. RESULTS: Results: Among those who were interviewed, aged 18-44 years, there are 24.15±2.11 % of respondents - hookah smokers, 9.02±1.42 % persons prefer the traditional method of tobacco use (smoking of cigarillos or cigars), while 6.34±1.20 % ones use E-cigarettes. Such forms of smoking are more common among males. The smokers of cigarillos, cigars and hookahs have appreciated their high availability when buying - 9 (7;10) points out of 10 possible. The study has found that 11.54±1.58 % of smokers of E-cigarettes and 8.08±1.35 % of hookah smokers consider them safe types of smoking and harmless to their health. CONCLUSION: Conclusions: The prevention methods of smoking prevalence among young people must be based on the tougher rules of tobacco market and latest devices for smoking at the legislative level.

Evolución del hábito tabáquico en embarazadas del Área de Gestión Sanitaria de Jerez / Evolution of smoking habit in pregnant women of the Health Management Area of Jerez

Objetivo.Existe poca información actualizada sobre el consumo de tabaco durante el embarazo. El objetivo de este trabajo fue determinar la prevalencia de tabaquismo durante el embarazo en mujeres que se atienden en los distintos centros de salud dentro del Área de Gestión Sanitaria Jerez, costa noreste y sierra de Cádiz. Material y método.Estudio transversal mediante entrevistas de gestantes captadas en la visita realizada durante el primer trimestre del embarazo. El cuestionario incluía preguntas sobre características sociode mográficas, edad, antecedentes obstétricos, consumo de tabaco anterior al embarazo y abandono durante la gestación, así como hábito tabáquico en la pareja. Resultados. Se obtuvieron respuestas de 1.173 pacientes con edad media de 31 años. Se confesaron fumadoras activas el 31,2% de ellas, siendo exfumadoras el 9,5% y nunca fumadoras el 59,3%. El consumo medio de cigarrillos fue de 11 ± 7 diarios. Al conocer su estado de gestación dejaron su hábito el 50,8% (abandono espontáneo, n = 186). El porcentaje de fumadora durante la gestación asciende a un 15,5% del global,con un consumo medio de cigarrillos de 5 ± 4/día. En cuanto a las parejas el porcentaje de fumadores activos fue del 41,4%. Aunque solo un 12,4% de estas parejas refirieron seguir fumando en el domicilio conyugal,únicamente el 2,07 % consiguió cesar el consumo por completo. La prevalencia de tabaquismo respecto a un estudio previo en 2009 se redujo significativamente (18,9vs. 15,5 %, p < 0,009).Conclusión.Fumar durante el embarazo sigue siendoun comportamiento frecuente en nuestra área sanitaria. A pesar de que las gestantes reducen su consumo, solo la mitad abandona por completo su hábito. Este comportamiento es muy inferior si consideramos a sus parejas, donde el porcentaje de cesación es ínfimo. (AU)

Objetive. There is little up-to-date information on tobacco 11 use during pregnancy. The objective of this work was to determine the prevalence of smoking during pregnancy in women who are cared for in the different Health Centers within the Jerez Health Management Area, northeast coast and sierra of Cadiz. Material and method. Cross-sectional study through interviews of pregnant women enrolled duringthe visit during the first trimester of pregnancy. The questionnaire included questions about sociodemo-graphic characteristics, age, obstetric history, tobacco consumption prior to pregnancy and cessation during pregnancy, as well as smoking habits in the couple. Results. Responses were obtained from 1,173 patients,with a mean age of 31 years. 31.2% of them confessed to being active smokers, 9.5% being ex-smokers and 59.3% never smokers. The average consumption ofcigarettes was 11 ± 7 per day. When knowing theirstate of pregnancy, 50.8% of them quit their habit(spontaneous quitters, n = 186). The percentage ofsmokers during pregnancy amounts to 15.5% of theglobal with an average cigarette consumption of 5 ±4/day. As for couples, the percentage of active smokerswas 41.4%. Although only 12.4% of these couples reported continuing to smoke at their marital home,only 2.07% managed to stop using them completely.The prevalence of smoking compared to a previousstudy in 2009 was significantly reduced (18.9 vs.15.5%, p < 0.009).Conclusion.Smoking during pregnancy continues tobe a frequent behavior in our healthcare area. Despitethe fact that pregnant women reduce their consump-tion, only half abandon their habit completely. Thisbehavior is much lower if we consider their partnerswhere the percentage of cessation is negligible. (AU)

Tobacco Cessation and Referral to the National Quitline.

Background: Smoking is the leading cause of preventable deaths in the United States. The rates of smoking remain elevated in rural, low income populations in comparison with the rest of the United States. Thus, prompting the process improvement project of implementing the Ask-Advise-Connect (AAC) method to the national quitline in a nurse practitioner-managed clinic for an automotive manufacturing plant in rural Tennessee. Methods: Ask-Advise-Connect method was added to the current smoking cessation program. The employees who utilized the clinic were assessed for smoking status at each visit and subsequently counseled on cessation. Individuals interested in cessation were connected to the national quitline with the AAC method. Pharmaceutical options and nicotine replacement therapy was also offered at no cost to the employee. Findings: In the 4-month period, the clinic provided 102 tobacco cessation counseling visits to workers who smoke. Twenty-four employees enrolled in the cessation program. The participants reported a cessation rate of 12.5% and 21% had a significant decrease in the number of cigarettes smoked. Of the participants, 12.5% (n = 3) engaged in behavioral counseling with the quitline. Conclusion/application to practice: The addition of the AAC method as part of the smoking cessation program had limited success. As smoking cessation is difficult to achieve, any success greater than 7% can be considered an achievement. The 12.5% cessation rate of the participants was above the national average. Thus, demonstrating the benefit of having a workplace cessation program and incorporating the AAC method to the current smoking cessation program.

Correlates of tobacco product cessation among youth and adults in the USA: findings from the PATH Study Waves 1-3 (2013-2016).

OBJECTIVE: To report on demographic and tobacco use correlates of cessation behaviours across tobacco products (cigarettes, electronic nicotine delivery systems (ENDS), cigars, hookah and smokeless tobacco) among the US population. DESIGN: Data were drawn from the first three waves (2013-2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth (ages 12-17) and adults (ages 18+) . Past 30-day (P30D) tobacco users at Wave 1 (W1) or Wave 2 (W2) were included (n=1374 youth; n=14 389 adults). Generalised estimating equations were used to evaluate the association between demographic and tobacco use characteristics at baseline, with cessation behaviours at follow-up (discontinuing use, attempting to quit, quitting), over two 1-year periods (W1-W2, W2-Wave 3). RESULTS: Among adult users of each type of tobacco product, frequency of use was negatively associated with discontinuing use. Among adult cigarette smokers, non-Hispanic white smokers, those with lower educational attainment and those with lower household income were less likely to discontinue cigarette use; ENDS use was positively associated with making quit attempts but was not associated with cigarette quitting among attempters; smokeless tobacco use was positively associated with quitting among attempters; tobacco dependence was negatively associated with quitting among attempters. Among youth cigarette smokers, tobacco dependence was negatively associated with making quit attempts. DISCUSSION: Demographic correlates of tobacco cessation behaviours underscore tobacco use disparities in the USA. Use of ENDS and use of smokeless tobacco products are positively associated with some adult cigarette cessation behaviours.

Conquering lung cancer: current status and prospects for the future.

Lung cancer is a major global health problem. Several strategies are required to conquer this cancer. Stricter implementations of tobacco control measures are necessary. Early detection programs should be implemented to decrease lung cancer mortality. Although chemotherapy remains a cornerstone of treatment, targeted therapies and immune checkpoint inhibitors improved treatment of metastatic cancers and are hoped to improve outcome of adjuvant and induction therapies. Novel immunotherapy approaches hold great promise. Better understanding of the molecular biology of lung cancer should lead to rational drug design.

El tabaquismo en embarazadas. ¿Aprovechamos el momento? / Smoking habit in pregnant women. Shall we take advantage of the moment

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Self-reported addiction to and perceived behavioural control of waterpipe tobacco smoking and its patterns in Egypt: policy implications.

BACKGROUND: Studies on waterpipe tobacco dependency are currently limited. AIMS: This study assessed self-reported addiction to waterpipe tobacco smoking among Egyptian waterpipe smokers and identified the associated sociodemographic factors, perceived behavioural control and patterns of waterpipe tobacco smoking. METHODS: Cross-sectional surveys were conducted on Egyptian adults in 2015 and 2017. Data on 1490 current waterpipe smokers were analysed including: sociodemographic characteristics, waterpipe tobacco smoking behaviour (age at starting, frequency, amount, company and place of smoking, and expenditure), perceived harm of waterpipe tobacco smoking, and self-reported addiction to and perceived behavioural control of waterpipe smoking (ability to quit, difficulty in quitting, quit attempts and intention to quit). RESULTS: A quarter (25.8%) of the participants self-reported addiction to waterpipe tobacco smoking (males 27.1%, females 11.6%). Participants who considered themselves addicted reported less confidence in their ability to quit, fewer quit attempts, less intention to quit and less perceived harm of waterpipe smoking than those not addicted (P < 0.001). Variables associated with self-reported addiction were: younger age at starting waterpipe tobacco smoking (ORa = 2.2, 95% CI: 1.7-2.9), daily waterpipe tobacco smoking (ORa = 2.0, 95% CI: 1.1-3.5), smoking alone (ORa = 2.0, 95% CI: 1.4-2.8), being married (ORa = 1.8, 95% CI: 1.2-2.9), and monthly spending on waterpipe smoking of ≥ 150 Egyptian pounds (US$ 8.6) (ORa = 4.1, 95% CI: 2.9-5.6). CONCLUSIONS: Comprehensive waterpipe-specific policies are needed including education on waterpipe tobacco smoking dependency, increased taxation to decrease affordability of waterpipe tobacco and cessation programmes addressing perceived self-efficacy and addiction to waterpipe tobacco smoking.

Living Independent From Tobacco reduces cigarette smoking and improves general health status among long-term tobacco users with disabilities.

BACKGROUND: People with disabilities disproportionately use tobacco and suffer associated negative health consequences. Research is needed to explore tobacco cessation programming for people with disabilities to counter these health disparities. OBJECTIVE: We evaluated the impact of Living Independent From Tobacco on tobacco use, knowledge and attitudes about tobacco use, coping skills, and perceived health status among people with disabilities. We also assessed participants' subjective impressions at post-test. METHODS: Living Independent From Tobacco was evaluated via train the trainer model at three Midwestern sites serving people with disabilities. Outcomes were assessed at four time points: pre- and post-test (n = 30), and again at 1-month (n = 26) and 6-months (n = 13). RESULTS: Long-term tobacco users with disabilities significantly reduced tobacco use from pre-test to post-test (p = 0.003), and, compared to baseline, this reduction continued to be significant 1-month after the intervention (p = 0.02). From pre-test to post-test, perceived health status significantly improved (p = 0.0001). No significant changes were observed across time points for knowledge and attitudes about tobacco use nor for coping skills. Qualitative data revealed the importance of coping skills to mitigate the negative effects of nicotine withdrawal. Peer accountability was also noted as an important source of motivation for tobacco cessation. CONCLUSIONS: Data from the present study provide evidence for the short-term effectiveness of Living Independent From Tobacco to reduce tobacco use and improve health status among people with disabilities. Qualitative data revealed the importance of coping skills and peer accountability to support tobacco cessation. Implications for tobacco cessation programming for people with disabilities are discussed.

Appalachian disparities in tobacco cessation treatment utilization in Medicaid.

BACKGROUND: Kentucky Medicaid enrollees, particularly those in the rural Appalachian region, face disproportionate smoking rates and tobacco-related disease burden relative to the rest of the United States (US). The Affordable Care Act (ACA) mandated tobacco cessation treatment coverage by the US public health insurance program Medicaid. Medicaid coverage was also expanded in Kentucky, in 2013, with laxer income eligibility requirements. This short report describes tobacco use incidence and tobacco cessation treatment utilization, comparing by Appalachian status before and after ACA-mandated cessation treatment coverage. METHODS: The study design was a retrospective cross-sectional analysis from 2013 to 2015. Subjects were Medicaid enrollees with 1) diagnosis of any tobacco use (2013 n = 541,349; 2014 n = 864,183; 2015 n = 1,090,274); and/or (2) procedure claim for tobacco cessation counseling, and/or (3) pharmaceutical claim for varenicline or any nicotine replacement product. Primary measures included tobacco use incidence and proportion of users receiving cessation treatment. Analysis was via chi square testing of change by year. RESULTS: Overall, the proportion of tobacco users utilizing cessation treatment decreased (4.75% tobacco users in 2013; 3.15% in 2015). Tobacco users receiving counseling decreased from 2.06% pre-ACA (2013) to 1.06% post-ACA (2015, p < 0.001), as did the proportion receiving nicotine replacement products post-ACA (2.69% in 2013 to 1.55% by 2015; p < 0.001). More Appalachians received cessation treatment than non-Appalachians in 2013 (2.72% vs. 2.03%), but by 2015 non-Appalachians received more treatment overall (1.50% vs. 1.65%; p < 0.001). Appalachians received more counseling and NRT, but less varenicline, than non-Appalachians. CONCLUSIONS: Utilization of all forms of tobacco cessation treatment throughout Kentucky, and particularly in rural Appalachia, remained limited despite Medicaid enrollment as well as coverage expansions. These findings suggest that barriers persist in access to tobacco cessation treatment for individuals in Medicaid.

Factors associated with successful tobacco use cessation among teachers in Bihar state, India: a mixed-method study.

Although tobacco use is declining in several countries including India (dropping from 35% in 2009-10 to 29% 2016-17 among adults)-it still poses a huge burden on India, as the world's second largest consumer of tobacco products. In Bihar state, with a prevalence of 25%, the Bihar School Teachers Study (BSTS) successfully enlisted teachers as role models for encouraging quitting and changing social norms pertaining to tobacco. The study used a mixed-methods approach to identify factors associated with teachers' quitting. Qualitative data were collected through focus groups with teachers and school principals. Quantitative data were collected through a written survey administered to school personnel post-intervention. Key findings from focus groups were that teachers and principals quit using tobacco and promoted cessation because they wanted to model positive behaviors; specific information about tobacco's harms aided cessation; and the BSTS intervention facilitated a school environment that supported quitting. Survey results indicated teachers who reported knowing people who quit using tobacco in the prior year were far more likely to quit as were teachers who reported that their school's tobacco policy was completely enforced. The combination of qualitative and quantitative data yielded important insights with strong implications for future interventions.

Impact of tax and tobacco-free generation on health-adjusted life years in the Solomon Islands: a multistate life table simulation.

OBJECTIVE: To estimate health-adjusted life years (HALY) gained in the Solomon Islands for the 2016 population over the remainder of their lives, for three interventions: hypothetical eradication of cigarettes; 25% annual tax increases to 2025 such that tax represents 70% of sales price of tobacco; and a tobacco-free generation (TFG). DESIGN: We adapted an existing multistate life table model, using Global Burden of Disease (GBD) and other data inputs, including diseases contributing >5% of the GBD estimated disability-adjusted life years lost in the Solomon Islands in 2016. Tax effects used price increases and price elasticities to change cigarette smoking prevalence. The TFG was modelled by no uptake of smoking among those 20 years and under after 2016. RESULTS: Under business as usual (BAU) smoking prevalence decreased over time, and decreased faster under the tax intervention (especially for younger ages). For example, for 20-year-old males the best estimated prevalence in 2036 was 22.9% under BAU, reducing to 14.2% under increased tax. Eradicating tobacco in 2016 would achieve 1510 undiscounted HALYs per 1000 people alive in 2016, over the remainder of their lives. The tax intervention would achieve 370 HALYs per 1000 (24.5% of potential health gain), and the TFG 798 HALYs per 1000 people (52.5%). By time horizon, 10.5% of the HALY gains from tax and 8.0% from TFG occur from 2016 to 2036, and the remainder at least 20 years into the future. CONCLUSION: This study quantified the potential of two tobacco control policies over maximum health gains achievable through tobacco eradication in the Solomon Islands.

Tobacco Cessation in Affordable Care Act Medicaid Expansion States Versus Non-expansion States.

INTRODUCTION: Community health centers (CHCs) care for vulnerable patients who use tobacco at higher than national rates. States that expanded Medicaid eligibility under the Affordable Care Act (ACA) provided insurance coverage to tobacco users not previously Medicaid-eligible, thereby potentially increasing their odds of receiving cessation assistance. We examined if tobacco users in Medicaid expansion states had increased quit rates, cessation medications ordered, and greater health care utilization compared to patients in non-expansion states. METHODS: Using electronic health record (EHR) data from 219 CHCs in 10 states that expanded Medicaid as of January 1, 2014, we identified patients aged 19-64 with tobacco use status documented in the EHR within 6 months prior to ACA Medicaid expansion and ≥1 visit with tobacco use status assessed within 24 months post-expansion (January 1, 2014 to December 31, 2015). We propensity score matched these patients to tobacco users from 108 CHCs in six non-expansion states (n = 27 670 matched pairs; 55 340 patients). Using a retrospective observational cohort study design, we compared odds of having a quit status, cessation medication ordered, and ≥6 visits within the post-expansion period among patients in expansion versus non-expansion states. RESULTS: Patients in expansion states had increased adjusted odds of quitting (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI]: 1.28-1.43), having a medication ordered (aOR = 1.53, 95% CI: 1.44-1.62), and having ≥6 follow-up visits (aOR = 1.34, 95% CI: 1.28-1.41) compared to patients from non-expansion states. CONCLUSIONS: Increased access to insurance via the ACA Medicaid expansion likely led to increased quit rates within this vulnerable population. IMPLICATIONS: CHCs care for vulnerable patients at higher risk of tobacco use than the general population. Medicaid expansion via the ACA provided insurance coverage to a large number of tobacco users not previously Medicaid-eligible. We found that expanded insurance coverage was associated with increased cessation assistance and higher odds of tobacco cessation. Continued provision of insurance coverage could lead to increased quit rates among high-risk populations, resulting in improvements in population health outcomes and reduced total health care costs.

Predictors of Tobacco Cessation Among American Indian/Alaska Native Adults Enrolled in a State Quitline.

Background: High rates of smoking are documented among some American Indian and Alaska Native (AI/AN) communities, with potential variability by region and urban/rural settings. Quitlines are a cost-effective strategy for providing evidence-based cessation treatment, but little is known about the effectiveness of quitline services for the AI/AN population. Objectives: This study compared demographic characteristics, tobacco use, and cessation and program utilization behaviors between AI/AN (n = 297) and Non-Hispanic White (NHW; n = 13,497) quitline callers. The study also identified predictors of 30-day cessation at 7-month follow-up among AI/AN callers and determined if predictors were different between AI/AN and NHW callers. Methods: Data from callers to the Arizona Smokers' Helpline between January 2011 and June 2016 were analyzed. Results: At enrollment, AI/AN callers were less likely to use tobacco daily and were less dependent on nicotine compared to NHW callers. Both groups reported similar rates of 30-day cessation at 7-month follow-up (37.3% and 39.7% for AI/AN and NHW callers, respectively). For AI/AN callers, 30-day cessation was significantly associated with tobacco cessation medication use (OR = 2.24, 95% CI: 1.02-4.93), number of coaching sessions (OR = 1.14, 95% CI: 1.04-1.26), and other smokers in the home (OR = 0.41, 95% CI: 0.19-0.91). The effect of other smokers in the home was significantly different between AI/AN and NHW callers (p = .007). Conclusions: Different individual characteristics and predictors of cessation among AI/AN callers compared to NHW callers were documented. Findings may be used to inform the development of culturally-tailored strategies and protocols for AI/AN quitline callers.

Efficacy of a group tobacco cessation behavioral intervention among tobacco users with concomitant mental illness in Kenya: protocol for a controlled clinical trial.

BACKGROUND: The rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness. METHODS/DESIGN: One hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life. DISCUSSION: This study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy. TRIAL REGISTRATION: Trial registration number: NCT04013724. Name of registry: ClinicalTrials.gov. URL of registry: https://register.clinicaltrials.gov Date of registration: 9 July 2019 (retrospectively registered). Date of enrolment of the first participant to the trial: 5th September 2017. Protocol version: 2.0.

Comparing in person and internet methods to recruit low-SES populations for tobacco control policy research.

Tobacco use and the associated consequences are much more prevalent among low-SES populations in the U.S. However, tobacco-based research often does not include these harder-to-reach populations. This paper compares the effectiveness and drawbacks of three methods of recruiting low-SES adult smokers in the Northeast. From a 5-year, [funding blinded] grant about impacts of graphic warning labels on tobacco products, three separate means of recruiting low-SES adult smokers emerged: 1) in person in the field with a mobile lab vehicle, 2) in person in the field with tablet computers, and 3) online via Amazon Mechanical Turk (MTurk). We compared each of these methods in terms of the resulting participant demographics and the "pros" and "cons" of each approach including quality control, logistics, cost, and engagement. Field-based methods (with a mobile lab or in person with a tablet) yielded a greater proportion of disadvantaged participants who could be biochemically verified as current smokers-45% of the field-based sample had an annual income of <$10,000 compared to 16% of the MTurk sample; 40-45% of the field-based sample did not complete high school compared to 2.6% of the MTurk sample. MTurk-based recruitment was substantially less expensive to operate (1/14th the cost of field-based methods) was faster, and involved less logistical coordination, though was unable to provide immediate biochemical verification of current smoking status. Both MTurk and field-based methods provide access to low-SES participants-the difference is the proportion and the degree of disadvantage. For research and interventions where either inclusion considerations or external validity with low-SES populations is critical, especially the most disadvantaged, our research supports the use of field-based methods. It also highlights the importance of adequate funding and time to enable the recruitment and participation of these harder-to-reach populations.

Counselling as a Tool for Tobacco Cessation in a Dental Institution: Insights from India.

Background: Tobacco related mortality and morbidity is a growing public health problem world over. Counselling has emerged as an important arsenal in the battle against tobacco. Involving experts other than traditional medical health workers may be critical. Aim of the present study was to explore various aspects related to Tobacco cessation counselling among Indian dental students. Methods: Overall, 241 undergraduate students from Manipal College of Dental Sciences, Mangalore participated in the present investigation. A structured, pretested, self-administered questionnaire was used to ascertain knowledge, attitude, behavior, perceived effectiveness and barriers and socio-demographic details. Willingness to counsel patients and undergo further training counselling was also assessed. Results: Mean knowledge, attitude, behavior, perceived effectiveness and barrier scores were 2.94 (±2.08), 51.84 (±5.63), 19.25 (±8.79), 16.17 (±1.96) and 42.39 (±5.65) respectively. Age was significantly correlated with knowledge; while year of study revealed significant correlations with knowledge and behavior (p<0.05). Lack of motivation, poor attitude of patients; lack of knowledge and skills emerged as barriers. Multiple logistic regression analysis indicated that year of study, attitude, behavior and barrier scores were significant predictors for respondents ever counselled their patients (p<0.05). Conclusions: Knowledge and behavior scores of the respondents towards Tobacco cessation counselling were low, but a majority of the subjects were willing to counsel and undergo training. Year of study, attitude, behavior and barrier scores emerged as significant predictors of counselling for Tobacco use. The present study has important policy implications and highlights curriculum changes in making Tobacco cessation counselling more relevant and effective among Indian dental students.