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What is already known about this topic?: Most Chinese smokers have not accessed professional help due to a lack of sufficient smoking cessation services. Mobile health (mHealth) can mitigate obstacles related to time and transportation, thereby providing effective support for smokers seeking to quit. What is added by this report?: This study offers real-world evidence supporting the effectiveness of mHealth-based comprehensive smoking cessation interventions. The findings indicate that these modalities can significantly enhance abstinence rates, albeit to a lesser extent compared to traditional clinic-based treatments. Adherence to the intervention was identified as a critical factor influencing the effectiveness of smoking cessation strategies. What are the implications for public health practice?: The mHealth-based comprehensive smoking cessation modalities, with or without mailing cessation medications, present a promising approach to enhancing access to and utilization of smoking cessation services. This strategy addresses the significant challenge of limited smoking cessation resources in China.

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Background: Smoking is responsible for 80 % of cases of Chronic Obstructive Pulmonary Disease (COPD), while the prognosis is improved by smoking cessation (SC). We examined clinical factors associated with SC among smokers with COPD comparing women and men. Methods: The study comprised a cohort of 1470 smokers who visited a SC service and completed at least 28-day of follow-up visits. The outcome was smoking status at follow-up (abstinence, reduction, no change). Abstinence was defined as continuous abstinence for at least 28 days, validated by the measurement of expired Carbon Monoxide. Reduction was defined as a halving of the baseline tobacco consumption. Results: The average age of the population was 53 (±11) years and 58.2 % were women. Men were 2 years younger than women and consulted more likely after a hospital contact, whereas women consulted on their own initiative. Women more often had a depression history, whereas men had medical comorbidities and co-addictions. There was no significant difference by sex regarding the abstinence rate (41.0 % in women vs 40.7 in men, p > 0.9). The factors significantly associated with higher abstinence rates in both sexes were: at least one previous quit attempt and number of follow-up visits ≥4. The factors negatively associated with quitting in women were diabetes, intake of mood stabilizers and consuming more than 10 cigarettes per day while having a chronic bronchitis, taking antidepressants and having consumed cannabis in the last 30 days hampered SC in men. Conclusions: Concerning factors associated with SC, few differences were found between female and male smokers suffering from COPD. However, due to the different medical and smoking behavior characteristics according to sex, it might be important to take these differences into account in order to provide tailored SC management.

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INTRODUCTION: In Thailand, smoking cessation services have been developed to reach smokers who want to quit. However, in universities, smoking cessation services are still limited. This study aimed to identify smokers' opinions on smoking and customized cessation, and to synthesize a cessation model in the university context using the Health Belief Model. METHODS: A qualitative research method was designed. In-depth interviews with semi-structured questions following the Health Belief Model framework were conducted with students, teachers, and supporting staff who were current smokers. The study was conducted from January to March 2022 at a Thai public university comprising schools of health sciences. Purposive sampling and a snowball technique were applied until data saturation was reached. Interview questions were constructed and validated for content. Verbatim transcriptions were used to perform thematic analysis with investigator triangulation. RESULTS: Forty-three participants were included in this study. Of six main themes and 19 subthemes, most subthemes were consistent between groups except in economic-related themes and customized cessation services. Perceptions of harm showed positive awareness of self-harm and harm to others. Barriers included addiction, being around smokers, social norms, not trusting the counseling services, and having no information about the services. Self-efficacy to quit smoking was found in a few participants. Customized cessation services varied among groups and included convenient services with 24/7 services, services units, generous counselors, communication with an application, online counseling, and medications for cessation. Moreover, the cessation services in a university were mentioned including a quit-smoking community, more activity areas, fewer smoking areas, alliance counselors from schools, and more public relations for cessation units. CONCLUSIONS: The perception and self-awareness of harm ranged from relaxed to being serious. Because of barriers, smoking cessation was hard to achieve, and it was hard to reach smokers. Strategies to support cessation were suggested by providing health education programs, promoting facilities and activities on campus, and designing easily accessible and customized cessation services.

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BACKGROUND: Tobacco use remains a leading cause of premature death. To combat tobacco use, the Ministry of Health (MOH) improved access to smoking cessation clinics (SCCs) by developing fixed SCCs and mobile SCCs, which move based on demand across locations. The goal of this study was to investigate awareness and utilization of SCCs among tobacco users in Saudi Arabia and the factors that influence their awareness and utilization. METHOD: This cross-sectional study used the 2019 Global Adult Tobacco Survey. Three outcome variables were employed, including tobacco users' awareness of fixed SCCs, mobile SCCs, and utilization of fixed SCCs. Several independent variables were examined, including sociodemographic characteristics and tobacco use. Multivariable logistic regression analyses were performed. RESULTS: One thousand six hundred sixty-seven tobacco users were included in this study. There were 60%, 26%, and 9% of tobacco users who were aware of fixed SCCs, aware of mobile SCCs, and visited fixed SCCs, respectively. The likelihood of being aware of SCCs increased among users residing in urban areas (fixed SCCs: OR = 1.88; 95% CI = 1.31-2.68; mobile SCCs: OR = 2.09; CI = 1.37-3.17) while it decreased among those reported self-employed (fixed SCCs: OR = 0.31; CI = 0.17-0.56; mobile SCCs: OR = 0.42; CI = 0.20-0.89). The likelihood of visiting fixed SCCs increased among educated tobacco users aged 25-34 (OR = 5.61; CI = 1.73-18.21) and 35-44 (OR = 4.22; CI = 1.07-16.64) while the odds of visiting SCCs decreased among those who were working in the private sector (OR = 0.26; CI = 0.09-0.73). CONCLUSION: The decision to quit smoking must be supported by an effective healthcare system that provides accessible and affordable smoking cessation services. Knowing the factors that influence the awareness and utilization of SCCs would help policymakers dedicate efforts targeting those who desire to quit smoking yet face limitations in using SCCs.

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Smoking, a common behavior that causes health risks among adults around the world, is closely associated with the risks of developing various kinds of cancers. Nevertheless, the impact of smoking on preoperative risks and postoperative outcomes of cancer surgeries has been largely overlooked. Extensive basic medical and clinical research findings and prognosis data demonstrate that smoking is associated with increased risks of multiple perioperative complications, and that smoking affects the general prognosis of patients. Smoking cessation during the preoperative and perioperative periods effectively reduces these risks and improves the long-term postoperative outcomes of cancer patients. At present, health workers and patients are not giving adequate attention to smoking cessation interventions and the quality of interventions available is poor. Herein, we discussed the necessity of comprehensive and standardized smoking cessation services and made recommendations regarding the implementation of comprehensive and standardized smoking cessation services, providing support for cancer patients to access evidence-based care during the perioperative period.

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Although South Korea has implemented various smoking cessation services, women who are emotional laborers, as well as parcel delivery, transportation, and construction workers, have poor access to these services. This study evaluated the smoking-related characteristics of workers in these four occupations as well as the awareness of and need for smoking cessation services. In total 808 workers in these four occupations aged 19 years and above were recruited nationwide and had their data analyzed. The participants' age, marital status, number of work hours per week, job-related stress, age when they started smoking, average number of cigarettes a day, types of tobacco products, close relationships to others who smoke, number of attempts to quit smoking, plans to quit smoking, awareness of cessation services, prior utilization of cessation services, and need for cessation services were surveyed. Compared with parcel delivery workers, female emotional laborers and transportation and construction workers had more attempts to quit smoking, plans to quit smoking, and prior utilization of smoking cessation services, moreover, construction workers had a significantly lower awareness of smoking cessation services. Parcel delivery workers need smoking cessation programs, mobile applications to help them quit smoking, and improvements in their work environments. Cessation services and education should be promoted at workplaces and among managers.

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BACKGROUND: This study aimed to evaluate the successful smoking cessation across different national smoking cessation services. METHODS: This study included data that had been previously entered into the integrated information system for smoking cessation services and comprised 144,688 participants after excluding missing data. These clinics provide face-to-face counseling, phone calls, text messages, and e-mail services for six months and nine sessions. RESULTS: The women-only program had the lowest success rate (11.3%). Compared with the women-only program, the six-month success rate of smoking cessation clinic at public health centers (OR = 3.72, CI = [3.52, 3.92]), visiting-type smoking cessation clinics (OR = 2.97, CI = [2.79, 3.16]), the residential 4 -night 5-day program (OR = 7.79, CI = [6.49, 9.35]), and a program for inpatients (OR = 2.36, CI = [1.89, 2.94]) showed a significant increase. CONCLUSIONS: Emotional labor workers who participated in the women-only program had low smoking cessation success rates, while those who participated in the residential 4-night 5-day program had high success rates.

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INTRODUCTION: In November 2016, France implemented "Mois sans tabac", with the objective of promoting smoking cessation in November for at least one month. This study consisted of: (1) the description of the characteristics of smokers registered in the French cessation database during November 2014-2015 compared to November 2016-2017; (2) the comparison of abstinence factors between the two periods. METHODS: We used data from CDTnet with 4659 registered adults' smokers who came for a first visit in November from 2014 to 2017 and were followed up at least one month. Our endpoint was 1 month-validated abstinence among the 1943 smokers followed up. We performed descriptive analyses of smokers, and predictors of abstinence were determined using a logistic regression model. RESULTS: A 6.9% significant increase of first visits was observed during "Mois sans tabac" versus before Mois sans tabac (P<0.001). Furthermore, more women (56.3% vs. 52.2%) as well as more light smokers (28.7% vs. 23.7%) sought help between these two periods. Finally, in 2016-2017, more smokers consulted by personal initiative than were hospital-referred (45.8% vs. 36.3%) in comparison with 2014-2015. Nevertheless, there was no significant difference of cessation rate between the 2014-2015 group (44.6%) and the 2016-2017 group (45.6%). In multivariate logistic regression, being a light smoker was the only factor that increased the chances of abstinence in 2016-2017 compared to 2014-2015 (OR: 1.68 [1.03-2.75]). CONCLUSION: It seems important to refer smokers to cessation services during Mois sans tabac to reach high rates of abstinence.

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BACKGROUND: Given that smoking results in poor physical and mental health, reducing tobacco harm is of high importance. Recommendations published by the National Institute for Health and Care Excellence to reduce smoking harms included provision of support, use of nicotine containing products and commissioning of smoking cessation services. AIMS: This report explores the difficulties in obtaining such support, as observed in a recently conducted randomised controlled trial in patients with severe mental ill health, and outlines suggestions to improve facilitation of provision. METHOD: Data collected during the Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+) (trial Registration ISRCTN72955454), was reviewed to identify the difficulties experienced, across the trial, with regards to access and provision of nicotine replacements therapy (NRT). Actions taken to facilitate access and provision of NRT were collated to outline how provision could be better facilitated. RESULTS: Access to NRT varied across study settings and in some instances proved impossible for patients to access. Difficulty in access was irrespective of a diagnosis of severe mental ill health. Where NRT was provided, this was not always provided in accordance with NICE guidelines. CONCLUSIONS: Availability of smoking cessation support, and NRT provision would benefit from being made clearer, simpler and more easily accessible so as to enhance smoking cessation rates.

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BACKGROUND: Nicotine addiction through cigarette use is highly prevalent among individuals suffering from alcohol and other drug (AOD) problems and remains a prominent risk factor for morbidity, mortality, and healthcare utilization. Whereas most people agree that providing smoking cessation services (SCS) to this vulnerable population is vitally important, the timing of such service provision has been hotly debated, including whether such services should be excluded, available (but not offered), offered, or fully integrated into AOD treatment settings. Important stakeholders in this debate are those in recovery from AOD problems who, in addition to having often been AOD treatment patients themselves, frequently hold influential clinical, research or policy positions and thus can influence the likelihood of SCS provision. This study sought to understand the attitudes of this important stakeholder group in providing SCS in AOD treatment settings. METHOD: We assessed a national cross-sectional sample of individuals in recovery from an AOD problem (n = 1973) on whether SCS should be: a. excluded; b. available; c. offered; or d. integrated into AOD services. We estimated associations between participants' demographic, clinical, and recovery support service use history, and SCS attitude variables, using multinomial logistic regression. RESULTS: Roughly equal proportions endorsed each attitudinal position (23.5% excluded, 25% available, 24.6% offered; 26.9% integrated). Correlates of holding more positive SCS implementation attitudes were Black race; primary substance other than alcohol, greater intensity of former or recent smoking, and less mutual-help organization participation; older individuals achieving recovery between 30 and 40 years ago also had more positive attitudes toward integrating SCS. CONCLUSIONS: About half of those sampled were either against SCS inclusion in AOD settings or were in favor of making it "available" only, but not in offering it or integrating it. This oppositional pattern was accentuated particularly among those with primary alcohol problem histories and those participating in mutual-help organizations. Given the universally well-known negative health effects of smoking, understanding more about the exact reasons why certain groups of recovering persons may endorse such positions is an area worthy of further investigation, as it may uncover potential barriers to SCS implementation in AOD treatment settings.

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In Italy, the National Health Service offers specialized evidence-based support to smokers who would like to quit through smoking cessation (SC) services. We conducted a two-year prospective study, involving all 288 subjects treated for smoking cessation at the SC service of Reggio Emilia, to assess the association of referral sources and waiting times with the risk of treatment failure, by following participants up to one year after the quit date. We performed Cox-regression analysis, including demographic and smoking-related characteristics as confounding variables. The treatment failure rate at 12 months was 59.4% (171/288), including only 12 subjects lost to follow-up. The main mode of entry was self-referral (42.4%), followed by 32.6% from general practice, 17.4% from hospital and 7.6% from other sources. Only 27.8% participants were involved in the SC-program within 60 days of the first contact, as the guidelines suggest. The risk of treatment failure at 12 months showed little association with the type of referral source, while it correlated with waiting times ≥ 60 days (hazard ratio = 1.59; 95% confidence interval 1.10⁻2.29). This study provides evidence of long-term high quit rates from a SC service, with few subjects lost to follow-up and biochemical verification of almost all abstinent subjects. Timeliness in care provision could further improve the outcome.

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The purpose of this article is to introduce smoking cessation services in the community to which physicians can refer their patients. There are three types of services: smoking cessation clinics at public health centers, regional smoking cessation centers, and quitlines. Smoking cessation clinics were established in 2005 at public health centers to reduce the smoking rate. Tailored counseling, nicotine replacement therapy, and drug treatment can improve the success rate of smoking cessation in clinical settings, and behavioral therapy can promote smoking cessation in the community. Quitlines have been launched and operated throughout the world as effective cessation services that guarantee confidentiality, accessibility, convenience, and cost-effectiveness. Tailored information and intervention programs for smoking prevention and smoking cessation have been offered through the telephone, multimedia messaging services, social networking services, and chatting in Korea. Referrals from other national cessation programs for maintaining cessation are also available. Since 2015, regional smoking cessation centers have administered two types of camps. The target group of intensive-care smoking cessation camps includes heavy smokers, who should receive inpatient care at the regional smoking cessation center for 5 days. The general support smoking cessation camps target smokers who wish to quit or who have unsuccessfully quit, and provide education and consulting programs over 1 to 2 days. These three types of services provide different services and programs to smokers in the community. If physicians refer to their patients to these services, they may prove to be excellent resources for increasing smoking cessation.

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BACKGROUND: There is a need for population-based smoking cessation interventions targeting female smokers in Hong Kong. This study describes the development of a community-based network to promote smoking cessation among female smokers in Hong Kong. METHODS: Local women's organizations collaborated to launch a project to provide gender-specific smoking cessation services. In the first phase of the project, the Women Against Tobacco Taskforce (WATT) was created. In the second phase, a smoking cessation training curriculum was developed and female volunteers were trained. The third and final phase included the provision of gender-specific smoking cessation counseling services in Hong Kong. RESULTS: A need assessment survey with 623 workers and volunteers of WATT members was carried out to develop a gender-specific smoking cessation training curriculum. A 1-day training workshop to 28 WATT affiliates who provided brief cessation counseling in the community was organized. Fourteen organizations (69 service units) agreed to form a network by joining WATT to promote smoking cessation and increase awareness of the specific health risks among female smokers. CONCLUSIONS: The community-based network to promote smoking cessation was effective in helping female smokers to quit smoking or reduce their cigarette consumption. The results also suggest that this community model of promoting gender-specific smoking cessation services is feasible. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT02968199 (Retrospectively registered on November 16, 2016).

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The purpose of this study was to identify factors predicting occupational health nurses' provision of smoking cessation services. Data were collected via a self-administered questionnaire distributed to 254 occupational health nurses in Thailand. Analysis by structural equation modeling revealed that self-efficacy directly and positively influenced smoking cessation services, and mediated the relationship between workplace factors, nurse factors, and smoking cessation services. The final model had good fit to the data, accounting for 20.4% and 38.0% of the variance in self-efficacy and smoking cessation services, respectively. The findings show that self-efficacy is a mediator that influences provision of smoking cessation services by occupational health nurses. Interventions to enhance nurses' self-efficacy in providing smoking cessation services are expected to promote provision of smoking cessation services to workers.

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The UK is a global leader in stop-smoking support-providing free behavioral support and cessation medication via stop smoking services (SSS) without charge to smokers. This study aimed to explore the client and service characteristics associated with abstinence 52 weeks after quitting. A prospective cohort study of 3057 SSS clients in nine different areas of England who began their quit attempt between March 2012 and March 2013 was conducted. Important determinants of long-term quitting were assessed through quit rates and multivariable logistic regression. Our results showed that the overall weighted carbon monoxide validated quit rate for clients at 52 weeks was 7.7% (95% confidence interval (CI) 6.6-9.0). The clients of advisors, whose main role was providing stop-smoking support, were more likely to quit long-term than advisors who had a generalist role in pharmacies or general practices (odds ratio (OR) 2.3 (95% CI 1.2-4.6)). Clients were more likely to achieve abstinence through group support than one-to-one support (OR 3.4 (95% CI 1.7-6.7)). Overall, one in thirteen people who set a quit date with the National Health Service (NHS) Stop-Smoking Service maintain abstinence for a year. Improving abstinence is likely to require a greater emphasis on providing specialist smoking cessation support. Results from this study suggest that over 18,000 premature deaths were prevented through longer-term smoking cessation achieved by smokers who accessed SSS in England from March 2012 to April 2013, but outcomes varied by client characteristic and the type of support provided.

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BACKGROUND: Maternal smoking can cause health complications in pregnancy. Particulate matter (PM2.5) metrics applied to second hand smoke (SHS) concentrations provide indoor air quality (IAQ) measurements and have been used to promote smoking behaviour change among parents of young children. Here, we present the qualitative results from a study designed to use IAQ measurements to help pregnant women who smoke to quit smoking. METHODS: We used IAQ measurements in two centres (Aberdeen and Coventry) using two interventions: 1. In Aberdeen, women made IAQ measurements in their homes following routine ultrasound scan; 2. In Coventry, IAQ measurements were added to a home-based Stop Smoking in Pregnancy Service. All women were invited to give a qualitative interview to explore acceptability and feasibility of IAQ measurements to help with smoking cessation. A case study approach using grounded theory was applied to develop a typology of pregnant women who smoke. RESULTS: There were 39 women recruited (18 in Aberdeen and 21 in Coventry) and qualitative interviews were undertaken with nine of those women. Diverse accounts of smoking behaviours and experiences of participation were given. Many women reported changes to their smoking behaviours during pregnancy. Most women wanted to make further changes to their own behaviour, but could not commit or felt constrained by living with a partner or family members who smoked. Others could not envisage quitting. Using themes emerging from the interviews, we constructed a typology where women were classified as follows: 'champions for change'; 'keen, but not committed'; and 'can't quit, won't quit'. Three women reported quitting smoking alongside participation in our study. CONCLUSIONS: Pregnant women who smoke remain hard to engage,. Although providing IAQ measurements does not obviously improve quit rates, it can support changes in smoking behaviour in/around the home for some individuals. Our typology might offer a useful assessment tool for midwives.

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OBJECTIVE: France is one the few European countries offering a national quit line along with partially cost-covered nicotine replacement therapy (NRT) and cessation services. This study assesses outcomes and predictors of continued abstinence in French smoking cessation services. METHOD: The French national smoking cessation registry (CDTnet) included 23,810 adult smokers followed-up between 2011 and 2013. We assessed 1-month continued abstinence among 10,161 who initiated a quit attempt before or during follow-up. Predictors of abstinence were determined using multivariable regression model. RESULTS: Among quitters, 45.2% achieved CO-validated abstinence. Prescription of pharmacotherapy was associated with abstinence rates as high as 47% for combination NRT and 53% for varenicline. The effect of behavioural support associated with combination NRT versus behavioural support alone increased with attendance: OR 1.11 (95% CI 0.89-1.39) for 2-3 visits, OR 1.43 (95% CI 1.13-1.80) for 4-6 visits, OR 1.60 (95% CI 1.21-2.12) for ≥7 visits. Unemployed participants were as likely to be successful as participants in employment (OR 0.88; 95% CI 0.75-1.04). High cigarette dependence also did not significantly hinder abstinence. Young adults achieved the lowest abstinence rates. Predictors that significantly reduced odds of abstinence were: being aged 18 to 24 and a history of alcohol abuse. CONCLUSION: With adapted treatment, even the more dependent or less affluent maintained abstinence. Our findings suggest that French cessation services have been successful in providing cessation support. Nevertheless, there is room for improvement in tailoring treatment for some subgroups of smokers.

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BACKGROUND: The Taiwanese government increased financial subsidies for smoking cessation services in 2012. We aimed to evaluate the effects of this new policy on smoking cessation services from the physician's perspective. METHODS: This was a cross-sectional nationwide survey. Physicians who provided smoking cessation services for more than ten patient encounters in the preceding year of the new policy (February 2011 to March 2012) were recruited. The questionnaire was developed by two experts and was validated by a committee consisting of 11 delegates. RESULTS: We sent a total of 1,319 questionnaires. The response rate was 45.9 %. The majority of respondents were male (88.4 %), middle-aged (65.3 %), and worked as family physicians (56.1 %). Most physicians agreed that the new policy had increased the number of patients seeking smoking cessation, increased patients' willingness to adopt pharmacotherapy, helped physicians to prescribe medications, improved patients' adherence to medications, and improved quality of care. These changes were most prominent in medical centers. Changes in the practice of the 5As (ask, advise, assess, assist, arrange) were moderate. Among different medical settings, the most significant change was an increase in the expenditure on smoking cessation medications. CONCLUSIONS: The new subsidization policy in Taiwan has improved smoking cessation services. Overall, physicians reported positive effects of the new policy. Further study is warranted to evaluate the long-term influence of the policy.

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This investigation is aimed at providing information about structural and organizational characteristics of smoking cessation services (SCS) set up within the Italian National Health Service. Local health units and hospitals are the main institutions connected with SCS which are mainly located within the Department of Drug Addiction and the Department of Lung and Breath Care. SCS provide different tobacco-use cessation programs. Although pharmacotherapy is always used, a combination of therapeutic treatments is highly preferred. This study shows the importance of maintaining a national coordination among different SCS supporting their activity and encouraging the start up of additional services throughout the country.

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BACKGROUND: There are limited data regarding smoking cessation treatment by physicians in Korea. Thus, we investigated the attitude to smoking cessation intervention and services among Korean physicians. METHODS: This survey was conducted in 987 participating physicians who had experiences in smoking cessation services. The subjective difficulties of smoking cessation services and its causes and the presumptive reasons for failure of smoking cessation among their patients were investigated using questionnaires. RESULTS: Overall smoking rate among Korean physicians who participated in this survey was 12.6%. Most participating physicians had a difficulty in smoking cessation services and its causes were high cost of medication for smoking cessation due to non-imbursement (50.7%) and the absence of a medical fee on smoking cessation services (34.8%). The high cost of medication for smoking cessation due to non-imbursement (29.5%) also ranked high in the presumptive reasons for failure of smoking cessation among their patients. CONCLUSION: The smoking rate of Korean physicians in this survey was lower than those of the general population. Most participating physicians had a difficulty in offering smoking cessation services. And the most common cause for the difficult was non-imbursement of their services and medication.

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