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Introduction: E-cigarettes may be positively used in tobacco cessation treatments. However, neither the World Health Organization nor the American Food and Drug Administration has recognized them as effective cessation aids. Data about the efficacy and safety of e-cigarettes are still limited and controversial.Methods: This was a double-blind randomized controlled study. The main focus of this article is on a secondary outcome of the study, that is, the assessment of effectiveness and safety of e-cigarettes in achieving smoking cessation in a group of chronic smokers voluntarily involved in long-term lung cancer screening. Participants were randomized into three arms with a 1:1:1 ratio: e-cigarettes (Arm 1), placebo (Arm 2), and control (Arm 3). All subjects also received a low-intensity counseling.Results: Two hundred ten smokers were randomized (70 to nicotine e-cigarettes, 70 nicotine-free placebo e-cigarettes, and 70 to control groups). About 25% of participants who followed a cessation program based on the use of e-cigarettes (Arm 1 and Arm 2) were abstinent after 3 months. Conversely, only about 10% of smokers in Arm 3 stopped. A Kruskal-Wallis test showed significant differences in daily cigarettes smoking across the three arms (K-W = 6.277, p = .043). In particular, participants in Arm 1 reported a higher reduction rate (M = -11.6441, SD = 7.574) than participants in Arm 2 (M = -10.7636, SD = 8.156) and Arm 3 (M = -9.1379, SD = 8.8127).Conclusions: Our findings support the efficacy and safety of e-cigarettes in a short-term period. E-cigarettes use led to a higher cessation rate. Furthermore, although all participants reported a significant reduction of daily cigarette consumption compared to the baseline, the use of e-cigarettes (including those without nicotine) allowed smokers to achieve better results.Implications: E-cigarettes increased the stopping rate as well as the reduction of daily cigarettes in participants who continued smoking. In fact, although all participants reported a significant reduction of tobacco consumption compared to the baseline, the use of e-cigarettes allowed smokers to achieve a better result. It could be worthwhile to associate this device with new ICT-driven models of self-management support in order to enable people to better handle behavioral changes and side effects. This is true for ready-to-quit smokers (such as our participants) but can also be advantageous for less motivated smokers engaged in clinical settings. [ABSTRACT FROM AUTHOR]

Objective: To explore the understandings of and engagement with e-cigarettes, of young adults from disadvantaged backgrounds, and how these may have an impact on existing smoking identities.Methods: Twenty-two small group and 11 individual qualitative interviews were conducted in Central Scotland with 72 16-24 year olds between September 2015 and April 2016. Participants were mostly smokers and ex-smokers from socioeconomically disadvantaged backgrounds.Results: Although most participants had tried e-cigarettes, they generally held ambivalent views about e-cigarettes and vaping. Two overarching themes were identified which helped in understanding this. Firstly, e-cigarettes were understood by the participants in relation to their existing smoking identities. Vaping was viewed as less controllable and more addictive than smoking, which did not fit with their self-identity as controlled smokers. Secondly, they felt that vaping could not replace the social and cultural importance that smoking had in their lives.Conclusion: This study suggests that though young adults from disadvantaged areas are trying e-cigarettes for various reasons, vaping is rarely sustained. Through their own experiences of vaping and their observations of others vaping, the participants perceive the behavior as endangering an existing acceptable and controlled smoking identity. Additionally, e-cigarettes were considered to be a jarring presence in existing social situations where smoking was valued. This study, therefore, provides insights into how young adults may be rationalizing their continued smoking in the face of potentially less harmful alternatives.Implications: As new and novel nicotine delivery devices, and due to their similarity to smoking, e-cigarettes have the potential to help smokers in their quit attempts. However, the findings from this study raise questions about whether e-cigarettes are regarded as having this potential by young adult smokers from disadvantaged socioeconomic environments where smoking is more commonplace and acceptable. [ABSTRACT FROM AUTHOR]

Introduction Inadequate smoking cessation interventions by physicians have been attributed to lack of training, and it is generally thought that additional education will improve patient care. However, interventions aimed at increasing knowledge and practical skills only address one determinant of behavior (capability). This prospective study assessed how much a teaching session for general practitioner (GP) trainees enrolled in Vocational Training Schemes in England also affected two other determinants (motivation and opportunity) specified by the COM-B theory of behavior. Methods Between October and December 2015, GP trainees were given a 3.5-h training session in the theory and practice of smoking cessation. Questionnaires addressed motivation, capability, and opportunities to provide evidence-based brief advice to smokers at the beginning and end of the session, and 3 months later. They also looked at the recollection of previous teaching as well as knowledge, skills, intervention frequency, and perceived barriers against providing interventions. Results Participants (n = 123) remembered little previous training on the subject and self-reported presession knowledge was minimal. Motivation was high throughout while capability and opportunity increased considerably during the session. No further change in these parameters was noted at 3 months. The proportion of participants stating they provided evidence-based brief advice to >50% of smokers increased from 25.2% before the session to 57.7% at follow-up. Lack of time remained a commonly cited barrier. Conclusions Training elicited an immediate and sustained effect on capability, perceived opportunity, and behavior itself. While perceived barriers referring to capability were greatly reduced, barriers referring to opportunity (eg, lack of time) persisted. Implications This is the first study evaluating a GP training session on smoking cessation with regard to the COM-B model. In a pre-post design with 3-month follow-up, we observed substantial and sustained changes in GP trainees' perceived capability and opportunity to provide evidence-based very brief advice, and these increases were paralleled by favorable changes in practice behavior. [ABSTRACT FROM AUTHOR]

Introduction: Three-quarters of homeless people smoke cigarettes. Financial incentives for smoking abstinence have appeared promising in nonexperimental studies of homeless smokers, but randomized controlled trial (RCT) data are lacking.Methods: We conducted a pilot RCT of financial incentives for homeless smokers. Incentive arm participants (N = 25) could earn escalating $15-$35 rewards for brief smoking abstinence (exhaled carbon monoxide <8 parts per million) assessed 14 times over 8 weeks. Control arm participants (N = 25) were given $10 at each assessment regardless of abstinence. All participants were offered nicotine patches and counseling. The primary outcome was a repeated measure of brief smoking abstinence across 14 assessments. The secondary outcome was brief abstinence at 8 weeks. Exploratory outcomes were self-reported 1-day and 7-day abstinence from (1) any cigarette and (2) any puff of a cigarette. Other outcomes included 24-hour quit attempts, nicotine patch use, counseling attendance, and changes in alcohol and drug use.Results: Compared to control, incentive arm participants were more likely to achieve brief abstinence overall (odds ratio 7.28, 95% confidence interval 2.89 to 18.3) and at 8 weeks (48% vs. 8%, p = .004). Similar effects were seen for 1-day abstinence, but 7-day puff abstinence was negligible in both arms. Incentive arm participants made more quit attempts (p = .03). Nicotine patch use and counseling attendance were not significantly different between the groups. Alcohol and drug use did not change significantly in either group.Conclusions: Among homeless smokers, financial incentives increased brief smoking abstinence and quit attempts without worsening substance use. This approach merits further development focused on promoting sustained abstinence.Registration: ClinicalTrials.gov (NCT02565381).Implications: Smoking is common among homeless people, and conventional tobacco treatment strategies have yielded modest results in this population. This pilot RCT suggests that financial incentives may be a safe way to promote brief smoking abstinence and quit attempts in this vulnerable group of smokers. However, further development is necessary to translate this approach into real-world settings and to promote sustained periods of smoking abstinence. [ABSTRACT FROM AUTHOR]

Introduction: Smartphone applications (apps) for smoking cessation are becoming increasingly available, but their efficacy remains to be demonstrated. We conducted a pilot study of SmokeBeat, a novel app designed for use with smartwatches and wristbands. SmokeBeat is powered by a data analytics software platform that processes information from the sensors embedded in wearables. It relies on an original algorithm to identify in real time the hand-to-mouth gestures that characterize smoking a cigarette. We examined whether merely monitoring and notifying smokers on smoking episodes in real time via the SmokeBeat app would lead to reduction in smoking.Methods: Forty smokers (9 women and 31 men) who expressed a wish to reduce or quit smoking were randomly assigned to using the SmokeBeat app for 30 days or to a wait-list control group. All participants completed questionnaires at baseline and at the end of the study, including their level of smoking. Smokers in the experimental condition were notified whenever the SmokeBeat system detected a smoking episode and were asked to confirm or deny it.Results: The SmokeBeat algorithm correctly detected over 80% of the smoking episodes and produced very few false alarms. According to both self-report and detection of smoking episodes by the SmokeBeat system, smokers in the experimental condition showed a significant decline in smoking rate over the 30-day trial (p < .001). There was no change in the smoking rate of the control group.Conclusion: These preliminary results suggest that automatic monitoring of smoking episodes and alerting the smoker in real time may facilitate smoking reduction in motivated smokers.Implications: Raising the awareness of smokers to the act of smoking in real time, as the SmokeBeat app is able to do, can counter the automaticity of the smoking habit. Bringing smoking under conscious awareness may benefit smokers who are motivated to reduce or quit smoking to gain better control of their smoking behavior and reduce cigarette intake. [ABSTRACT FROM AUTHOR]

Introduction: Disparities in receiving advice to quit smoking and other tobacco use from health professionals may contribute to the continuing gap in smoking prevalence among priority populations. Under the Affordable Care Act (ACA), beginning in 2010, tobacco cessation services are currently covered in private and public health insurance plans. Providers and hospitals are also incentivized through the Meaningful Use of Electronic Health Records (EHRs) to screen and document patients' tobacco use and deliver brief cessation counseling. This study analyzes trends and correlates of receiving health professionals' advice to quit and potential disparities among US adult smokers from 2010 to 2015.Methods: Data were from the National Health Interview Survey in 2010 and 2015. We analyzed the weighted prevalence of smokers' receipt of advice to quit smoking and other tobacco use from a health professional in 2010 and 2015 and correlates of receiving advice to quit.Results: Prevalence of receiving advice to quit from a health professional increased from 51.4% in 2010 to 60.6% in 2015. This positive trend was observed across tobacco disparity population groups. Survey year (2015), age (older), ethnicity (non-Hispanic), region (Northeast), poverty level (above 100% poverty level), past quit attempt, daily smoking, cigarettes per day (11+ per day), and psychological distress were associated with higher odds of receiving advice to quit.Conclusion: Based on national level data, receipt of advice to quit from health professionals increased between 2010 and 2015. However, disparities in receiving advice to quit from health professionals persist in certain populations.Implications: This study provides important data on the national trends in receipt of health professional advice to quit smoking and other tobacco use in the context of the ACA and Meaningful Use implementation and whether these policies helped to narrow the gaps in receipt of health professional advice among vulnerable populations. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration has announced the potential for mandated lowering of nicotine levels in combustible cigarettes. The World Health Organization has recommended a lowering of cigarette filler nicotine levels to below 0.4 mg/g. To devise appropriate nicotine control strategies, regulators must consider technical feasibility, timelines for compliance, and potential impediments to implementation. Outlined here is previously unsummarized information on genetic approaches that might be used to reduce nicotine levels in cured tobacco leaves. For the benefit of regulators, altered alkaloid or toxicant profiles that might result by implementation of some of these methodologies are discussed. Also mentioned are potential licensing or regulatory impediments to use of some of the technologies per se. Implications: An understanding of technical feasibility of plant-based nicotine reduction technologies, along with the potential for corresponding alterations in alkaloid or toxicant profiles, is needed by regulators to develop effective nicotine control strategies with minimal impediments or undesirable consequences. [ABSTRACT FROM AUTHOR]