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The reciprocal relationship between psychiatric and substance use disorders is well-known, yet it remains largely unknown whether mental health morbidity causally leads to addictive behaviours. This paper utilises a fixed effects instrumental variables model, which is identified by time-varying sources of plausibly exogenous variations in mental health, and a nationally representative panel dataset from Australia to present robust evidence on the causal impact of mental distress on cigarette smoking and alcohol drinking behaviours. We find that mental distress significantly increases the prevalence and intensity of either cigarette or alcohol consumption. Further analysis reveals that mental distress also substantially increases household monetary expenditures on either tobacco or alcohol. The impact is greater for lower educated individuals or children of smokers, and is slightly higher for males. Our findings highlight the importance of mental health screening and treatment programs, especially among lower educated individuals or children of smokers, to assist in the prevention of addictive activities. [ABSTRACT FROM AUTHOR]

Objectives: Smoke-free environments have been one of the great success stories in tobacco control in Australia. In this paper, we describe the current situation with respect to smoke-free environments in Australia, identify opportunities for extending and/or strengthening smoke-free environments, and discuss the challenges alternative nicotine delivery devices such as e-cigarettes pose to the traditional notion of ‘smoke-free’. Type of program: Smoke-free environments are an essential element in a comprehensive approach to tobacco control. They are recognised in the World Health Organization Framework Convention on Tobacco Control and in the Australian National Tobacco Strategy. Results: There is strong evidence that smoke-free environments support smokers to make a quit attempt, support ex-smokers to maintain their resolve, and protect the health of non-smokers and ex-smokers alike. [ABSTRACT FROM AUTHOR]

Aims: This paper presents updated prevalence estimates of awareness, ever‐use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. Design, Setting, Participants and Measurements: A cross‐sectional analysis of adult (≥ 18 years) current smokers and ex‐smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013–17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country‐specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non‐daily). Findings NVP awareness and use were lowest in NRP countries. Generally, ever‐ and current use of NVPs were lower in MRP countries (ever‐use = 7.1–48.9%; current use = 0.3–3.5%) relative to LRP countries (ever‐use = 38.9–66.6%; current use = 5.5–17.2%) and RP countries (ever‐use = 10.0–62.4%; current use = 1.4–15.5%). NVP use was highest among high‐income countries, followed by upper–middle‐income countries, and then by lower–middle‐income countries. Conclusions: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products. [ABSTRACT FROM AUTHOR]

Introduction and Aims: The introduction of standardised packaging (SP) in Australia in December 2012 has heightened interest in how image and branding might affect smoking. This paper tests the hypothesis that brand awareness and identification among smokers will decline after the introduction of SP.Design and Methods: Longitudinal study of three waves of smokers in Australia, conducted between October 2011-February 2012 (pre-SP) (n = 1104), February-May 2013 (post-SP1) (n = 1093) and August-December 2014 (post-SP2) (n = 1090). We explored the extent of changes in two variables, brand awareness (noticing others with the brand of cigarettes you smoke) and brand identification (perceiving something in common among smokers of your brand), and examined change in a number of other measures of brand appeal, brand characteristics and determinants of brand choice.Results: Brand awareness 'at least sometimes' reduced from 45.3% pre-SP to 26.9% at post-SP2 [odds ratio (OR) 0.35 (0.27-0.45)]. Brand identification also decreased from 18.2% to 12.7% [OR 0.62 (0.42-0.91)]. Significant decline was also found in measures of perceived brand prestige [OR 0.51 (0.39-0.66)] and choice of brand for health reasons [OR 0.45 (0.32-0.63)]. Liking the look of the pack was strongly associated with brand identification, but only post-SP (P = 0.02 for interaction across the three waves).Discussion and Conclusions: The introduction of SP of tobacco products in Australia has been associated with reductions in brand awareness and identification, and changes in related measures. The findings support the notion that SP has reduced the capacity for smokers to use pack branding to create and communicate a desired identity. [Balmford J, Borland R, Yong H-H. Impact of the introduction of standardised packaging on smokers' brand awareness and identification in Australia. Drug Alcohol Rev 2015;00:000-000]. [ABSTRACT FROM AUTHOR]

As governments consider policy action to reduce smoking, a key factor in creating political will is the level of public support, particularly among smokers who are most affected by the policies. The goal of this paper is to assess and compare the level of support in Canada, the United States, England, and Australia for five smoking control policies: 1) banning menthol in cigarettes, 2) banning cigarette additives, 3) reducing nicotine in cigarettes to make them less addictive, 4) raising the minimum age to purchase cigarettes to 21 years and older, and 5) requiring pictorial warning labels on cigarette packs (examined in the US only). Data for these analyses come from 8165 daily cigarette smokers who responded to the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. In all countries, the highest level of support was for raising the legal age for purchase to 21 years and older (62-70%) and reducing the nicotine content of cigarettes to make them less addictive (57-70%). Smokers who were less dependent on cigarettes and those expressing interest in quitting were more likely to support all policies. When asked how they would respond to a nicotine reduction policy, the most common response given was to try the non-nicotine cigarettes to see how they liked them (42-48%), with the next most common response being to quit smoking entirely (16-24%). The high level of support for these proposed policies among daily smokers provides important evidence for policymakers to counteract claims that such policies would be unpopular. [ABSTRACT FROM AUTHOR]

Aims: To determine whether a simple combination of level of smoking and level of vaping results in a useful typology for characterizing smoking and vaping behaviours. Methods: Cross‐sectional data from adults (≥ 18 years) in the 2016 wave 1 ITC Four Country Smoking and Vaping Survey in the United States (n = 2291), England (n = 3591), Australia (n = 1376) and Canada (n = 2784) were used. Participants who either smoked, vaped or concurrently used both at least monthly were included and divided into eight groups based on use frequency of each product (daily, non‐daily, no current use). This resulted in four concurrent use groups (predominant smokers, dual daily users, predominant vapers and concurrent non‐daily users). These groups were compared with each other and with the four exclusive use groups, on socio‐demographics, nicotine dependence, beliefs and attitudes about both products, and quit‐related measures using data weighted to reference population surveys in each country. Results: Of the sample, 10.8% were concurrent users, with daily smokers vaping non‐daily (predominant smokers), constituting 51.6% of this group. All eight categories differed from other categories on at least some measures. Concurrent daily nicotine users reported higher levels of indicators of nicotine dependence, and generally more positive attitudes toward both smoking and vaping than concurrent non‐daily users. Among daily nicotine users, compared with exclusive daily smokers, reports of interest in quitting were higher in all concurrent use groups. Dual daily users had the most positive attitudes about smoking overall, and saw it as the least denormalized, and at the same time were equally interested in quitting as other concurrent users and were most likely to report intending to continue vaping. Conclusions: In Australia, Canada, England and the United States in 2016, daily nicotine users differed considerably from non‐daily nicotine users. Among daily nicotine users, dual daily users (those who smoke and vape concurrently) should be treated as a distinct grouping when studying relationships between smoking and vaping. The eight‐level typology characterizing concurrent and exclusive use of smoking and vaping should be considered when studying both products. [ABSTRACT FROM AUTHOR]

Background and Aims: Debate exists about whether health professionals (HPs) should advise smokers to use nicotine vaping products (NVPs) to quit smoking. The objectives were to examine in four countries: (1) the prevalence of HP discussions and recommendations to use an NVP; (2) who initiated NVP discussions; (3) the type of HP advice received about NVPs; and (4) smoker's characteristics related to receiving advice about NVPs. Design Cross‐sectional study using multivariable logistic regression analyses on weighted data from the 2016 ITC Four Country Smoking and Vaping Survey (ITC 4CV1). Setting: Four countries with varying regulations governing the sale and marketing of NVPs: 'most restrictive' (Australia), 'restrictive' (Canada) or 'less restrictive' (England and United States). Participants: A total of 6615 adult smokers who reported having visited an HP in the last year (drawn from the total sample of 12 294 4CV1 respondents, of whom 9398 reported smoking cigarettes daily or weekly). Respondents were from the United States (n = 1518), England (n = 2116), Australia (n = 1046), and Canada (n = 1935). Measurements Participants' survey responses indicated if they were current daily or weekly smokers and had visited an HP in the past year. Among those participants, further questions asked participants to report (1) whether NVPs were discussed, (2) who raised the topic, (3) advice received on use of NVPs and (4) advice received on quitting smoking. Findings Among the 6615 smokers who visited an HP in the last year, 6.8% reported discussing NVPs with an HP and 2.1% of smokers were encouraged to use an NVP (36.1% of those who had a discussion). Compared with Australia (4.3%), discussing NVPs with an HP was more likely in the United States [8.8%, odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.41–3.29] and Canada (7.8%, OR = 1.87, 95% CI = 1.26–2.78). Smokers in Australia were less likely to discuss NVPs than smokers in England (6.2%), although this was not statistically significant (OR = 1.47, 95% CI = 0.98–2.20). Overall, the prevalence of HPs recommending NVPs was three times more likely in the United States than in Australia (OR = 3.07, 95% CI = 1.45–6.47), and twice as likely in Canada (OR = 2.28, 95% CI = 1.06–4.87) than in Australia. Australia and England did not differ (OR = 1.76, 95% CI = 0.83–3.74). Just over half (54%) of respondents brought up NVPs themselves; there were no significant differences among countries. Conclusions: Discussions in Australia, Canada, England, and the United States between smokers and health professionals about nicotine vaping products appear to be infrequent, regardless of the regulatory environment. A low percentage of health professionals recommended vaping products. This was particularly evident in Australia, which has the most restrictive regulatory environment of the four countries studied. [ABSTRACT FROM AUTHOR]

Objectives: Smoking rates in people with mental illness in Australia remain alarmingly high whilst they have been declining in the general population. This study reviews a smoking cessation programme in a mental health service, as a pilot for future studies and program development. We aim to assess the effectiveness of this intervention and the ease of implementation after upskilling the clinical workforce.Methods: Part A - a retrospective analysis of patients attending the Smokers' Clinic, (n = 44) over a period of 18 months. Part B - survey of ease of implementation and change in practice of the resident medical officers (RMOs; n = 8) following their clinical placement.Results: For the entire clinic population, the mean reduction in expired carbon monoxide was approximately 43%, with 34% of patients achieving abstinence. Females were 3.4 times more likely to be successful than males. Seventy-five per cent of RMOs found learning about nicotine dependence and smoking cessation 'easy', and 88% continued to offer smoking cessation after their placement.Conclusions: The Smokers' Clinic was successful in helping tobacco smokers with mental illness to reduce or cease smoking. Specialist skill and experience is not required to manage smoking cessation in a mental health setting. [ABSTRACT FROM AUTHOR]

Introduction: Addiction is increasingly defined as a "brain disease" caused by changes to neurochemistry. While nicotine addiction has historically been excluded in the brain disease model of addiction (BDMA), it is beginning to be labeled a chronic brain disease. We investigated whether Australian smokers endorse brain-based explanations of smoking, and whether these beliefs are associated with quitting self-efficacy or treatment intentions.Method: Cross-sectional study of Australian smokers (N = 1538) who completed a survey measuring their agreement with statements on the brain's role in smoking. Logistic regressions tested associations between these items and socio-demographic variables, quitting self-efficacy and intention to use cessation medications.Results: The majority (57.9%) agreed that smoking changed brain chemistry and 34.4% agreed that smoking was a brain disease. Younger participants and those with more education were more likely to endorse brain-based understandings of smoking. Participants who agreed smoking changed brain chemistry were more likely to report an intention to use cessation medicines (OR 1.5, 95% CI = 1.0-2.2) as were those who agreed that smoking was a brain disease (OR 1.5, 95% CI = 1.1-2.1). Self-efficacy did not differ between those who agreed and disagreed that smoking changed brain chemistry. However, those who agreed that smoking was a brain disease had higher self-efficacy than those who disagreed (OR 1.7, 95% CI = 1.3-2.3).Conclusion: A neurobiological view of smoking does not dominate public understandings of smoking in Australia. Endorsement of neurobiological explanations of smoking were associated with increased intention to use cessation aids, but were not associated with reduced self-efficacy.Implications: Explaining tobacco dependence in neurobiological terms is unlikely to induce feelings of fatalism in relation to smoking cessation. Those who endorse biomedical explanations of smoking may be more open to using cessation pharmacotherapies. Describing smoking in terms of alterations in brain chemistry may be more acceptable to smokers than labeling smoking a "brain disease" or "brain disorder." [ABSTRACT FROM AUTHOR]

Background: Within alcohol and other drug (AOD) services, staff attitudes and beliefs are important influences determining provision of smoking cessation care. This study of AOD staff aimed to examine: a) current attitudes toward smoking cessation care; b) service and staff characteristics associated with unsupportive smoking cessation care attitudes, and c) perceived barriers to providing smoking cessation care.Methods: Between July-October 2014, 506 staff from 31 Australian AOD services completed an online cross-sectional survey which assessed agreement with 6 attitudinal statements (supportive and unsupportive) and 10 perceived barriers to smoking cessation care in the AOD setting. Logistic regressions examined service (sector) and staff (age, gender, smoking status and number of years in AOD field) characteristics associated with unsupportive smoking cessation care attitudes.Results: A large proportion agreed with supportive statements: Smoking cessation care should be part of usual care (87%), smoking cessation care is as important as counselling about other drugs (72%) and staff have the organisational support to provide smoking cessation care (58%). Some respondents agreed with unsupportive statements: AOD clients are not interested in addressing their smoking (40%), increasing smoking restrictions would lead to client aggression (23%), smoking is a personal choice and it is not the service's role to interfere (16%). Respondents from non-government managed services, current tobacco smokers (compared to ex-smokers) and those with less AOD experience had higher odds of agreeing with unsupportive smoking cessation care statements. The most frequently identified barriers to providing smoking cessation care were: client inability to afford cessation medicines, insufficient funding and lack of a coordinated treatment approach (all 61%).Conclusions: Overall, staff hold largely supportive smoking cessation care attitudes but perceive a large number of barriers to providing smoking cessation care. [ABSTRACT FROM AUTHOR]

Introduction: The principal aim of this study was to assess the accessibility of subsidized cessation medications to socioeconomically disadvantaged smokers, including smokers living in regional and remote communities.Methods: Analyses used baseline questionnaire and linked Pharmaceutical Benefits Scheme data for 18 686 regular smokers participating in the 45 and Up Study, a large-scale Australian cohort study of people aged 45 years and older. Participants who were dispensed nicotine replacement therapy, varenicline, or bupropion were identified from the Pharmaceutical Benefits Scheme data, which provide an essentially complete record of participants' access to subsidized pharmaceuticals. Associations between the supply of each pharmacotherapy and a range of sociodemographic and health-related variables were evaluated using multiple logistic regression.Results: The odds that participants were supplied with a cessation medication declined markedly with increasing age for participants older than 60 years and were substantially higher for participants who smoked 20 or more cigarettes/day than for participants who smoked fewer than 10 cigarettes/day. Participants with no formal qualification and those residing in socioeconomically disadvantaged areas had higher odds of receiving nicotine replacement therapy or varenicline than university-educated participants and participants living in the least disadvantaged areas. There was no evidence that participants residing in regional and remote communities had lower odds of receiving a cessation medication than participants residing in major cities.Conclusions: Older Australian smokers' access to cessation pharmacotherapies is determined predominantly by age and daily cigarette consumption and does not appear to be limited by educational achievement, socioeconomic disadvantage, or remoteness.Implications: Promoting the use of cessation medications is a principal measure proposed to achieve Australia's National Tobacco Strategy 2012-2018 goal of reducing cigarette consumption among socioeconomically disadvantaged smokers. The results of this large-scale cohort study indicate that access to cessation pharmacotherapies is determined primarily by age and daily cigarette consumption, and is not limited by socioeconomic circumstances, providing some reassurance that existing government subsidies are sufficient to ensure that pharmaceutical aids are accessible to all Australian smokers. [ABSTRACT FROM AUTHOR]

Aims To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Design Prospective cohort with approximately annual waves. Mixed-effect logistic regressions tested whether time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether time 1 (T1) symptoms moderated this relationship. Setting Waves 5-8 of the Four-Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, the United States, the United Kingdom and Australia. Participants A total of 6978 smokers who participated in telephone surveys. Measurements T1 and T2 depressive symptoms in the last 4 weeks were assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: (1) no attempt since T1; (2) attempted and relapsed; and (3) attempted and abstinent at T2. Findings Compared with no attempt, relapse was associated with reporting T2 symptoms [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.33, 1.59]). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was associated positively with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI = 1.45, 2.03) and those with T1 symptoms (OR = 1.45, 95% CI = 1.23, 1.70). Abstinence was associated positively for those without T1 symptoms (OR = 1.37, 95% CI = 1.10, 1.71) and negatively for those with T1 symptoms (OR = 0.74, 95% CI = 0.59, 0.94). Age moderated these associations significantly. Relapse did not predict T2 symptoms for those aged 18-39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18-39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40-55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged more than 55 (OR =1.97, 95% CI = 1.35, 2.87). Conclusions Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people aged more than 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking. [ABSTRACT FROM AUTHOR]

Objectives: Many e-cigarette advertisements (ads) are reminiscent of ads for cigarettes. This study explored the effects of e-cigarette ad exposure among former smokers in 2 countries with different e-cigarette regulation contexts. Methods: In an online study, 408 US and 405 Australian former smokers from survey panels were randomized to one of 14 e-cigarette or 2 control ads. Analyses examined effects of ad condition, and interactions by country and relapse susceptibility. Results: Effects were generally consistent across countries. Compared to control ads, those exposed to e-cigarette ads not only were more likely to have some urge or susceptibility to use e-cigarettes, but also were more likely to be reminded of smoking and have some desire to smoke cigarettes; US former smokers were less likely to be confident to abstain from smoking. These effects were especially pronounced among those susceptible to relapse. E-cigarette ad exposure was not associated with estimates of e-cigarette prevalence or perceptions of quitting ease. Conclusions: Exposure to e-cigarette ads can increase former smokers' desire to smoke and weaken their confidence to abstain. Regulators may need to consider the potential population impact of allowing former smokers to be exposed repeatedly to e-cigarette advertising. [ABSTRACT FROM AUTHOR]

Background: Persons with a mental illness are less likely to be successful in attempts to quit smoking. A number of smoking and environmental characteristics have been shown to be related to quitting behaviour and motivation of smokers generally, however have been less studied among smokers with a mental illness. This study aimed to report the prevalence of smoking characteristics and a variety of physical and social environmental characteristics of smokers with a mental illness, and explore their association with quitting behaviour and motivation.Methods: A cross-sectional descriptive study was undertaken of 754 smokers admitted to four psychiatric inpatient facilities in Australia. Multivariable logistic regression analyses were undertaken to explore the association between smoking and environmental characteristics and recent quitting behaviour and motivation.Results: Participants were primarily daily smokers (93 %), consumed >10 cigarettes per day (74 %), and highly nicotine dependent (51 %). A third (32 %) lived in a house in which smoking was permitted, and 44 % lived with other smokers. The majority of participants believed that significant others (68-82 %) and health care providers (80-91 %) would be supportive of their quitting smoking. Reflecting previous research, the smoking characteristics examined were variously associated with quitting behaviour and motivation. Additionally, participants not living with other smokers were more likely to have quit for a longer duration (OR 2.02), and those perceiving their psychiatrist to be supportive of a quit attempt were more likely to have had more quit attempts in the past six months (OR 2.83).Conclusions: Modifiable characteristics of the physical and social environment, and of smoking, should be considered in smoking cessation interventions for persons with a mental illness. [ABSTRACT FROM AUTHOR]

Background: Smoking tobacco products is one of the largest preventable health risk factors for older people. Greek-Australians have the highest prevalence of cigarette use in Australia for older people, but there is a lack of knowledge about Greek-Australian's perspectives on smoking cessation. The purpose of this exploratory, qualitative study was to progress the knowledge base in this area. Methods: A qualitative study was designed to gather information on participants' perspectives about, and understanding of, their reasons for smoking and their attitudes to quitting. A snowball sampling technique was used to identify twenty Greek-Australian current smokers, aged ⩾50 years. Semi-structured, face-to-face interviews were conducted with the assistance of a Greek translator. The audio-taped interviews were transcribed and then qualitative content analysis was used to categorise responses to the questions. Results: Participants' perspectives on three broad topics were identified in the interviews: perceived benefits of smoking, perceptions of smoking and its effect on health, and barriers to cessation. Smoking behaviour was described as contributing to tiredness, and stress, and yet also was also a source of enjoyment. Level of knowledge about smoking-related diseases and the risks of smoking was very low. The number of cigarettes smoked each day, type of smoking (i.e. pipe rather than cigarettes), and previous family history of smoking were identified as indicators that limited harm flows from smoking. Most participants had a positive attitude towards smoking and described their own life experience and cultural norms as supporting smoking acceptability. Low confidence in quitting was linked to advanced age. Conclusion: Smoking among older Greek-Australian smokers has been associated with a number of influences and these need to be addressed in smoking cessation efforts targeted at this group. Promoting knowledge about the health impacts of smoking, changing attitudes towards smoking, and ultimately, decreasing tobacco consumption are critical to the maintenance of health among older Greek Australians. Cultural and experiential influences may increase the difficulty associated with changing these outcomes, but may also serve as a framework from which to develop and implement an educational intervention tailored for older Greek-Australians. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this research was to examine the use of quit smoking services and support options in Australia with national survey data to determine whether use of quit smoking services and pharmacotherapy contributes to socioeconomic status (SES) differences in smoking. Methods: Analyses were performed with data from 4 waves of the Australian National Drug Strategy Household Survey between 2001 and 2010. The primary outcomes were the use of quit smoking services or pharmacotherapy. The main predictor variables used were measures of SES including the Socio-Economic Indexes for Areas, income, and education. Other sociodemographic variables were also examined. Results: There was no systematic SES difference in the use of services or support options, with some used more by high SES and some used more by low SES. Those with university education (odds ratio [OR] = 0.72; 95% CI = 0.56–0.93) were less likely to use prescription medication. Conversely, those with higher incomes were more likely to use patches, gum, or an inhaler (OR = 1.13; 95% CI = 1.01–1.27). Prescription medication was significantly associated with increased odds for recent cessation, although only among those with lower levels of education (OR = 2.50; 95% CI = 1.94–3.23). Those with higher SES had the greatest odds for recent cessation. Conclusions: The evidence suggests that low-SES smokers use quit services and support options equally compared with high-SES smokers; thus, access does not drive the SES differential in smoking. However, the findings are positive, suggesting that increasing the uptake of prescription medication may help increase cessation rates among low-SES smokers. [ABSTRACT FROM PUBLISHER]