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Aims To estimate the prevalence and predictors of failed biochemical verification of self-reported abstinence among participants enrolled in trials of hospital-initiated smoking cessation interventions. Design Comparison of characteristics between participants who verified and those who failed to verify self-reported abstinence. Settings Multi-site randomized clinical trials conducted between 2010 and 2014 in hospitals throughout the United States. Participants Recently hospitalized smokers who reported tobacco abstinence 6 months post-randomization and provided a saliva sample for verification purposes ( n = 822). Measurements Outcomes were salivary cotinine-verified smoking abstinence at 10 and 15 ng/ml cut-points. Predictors and correlates included participant demographics and tobacco use; hospital diagnoses and treatment; and study characteristics collected via surveys and electronic medical records. Findings Usable samples were returned by 69.8% of the 1178 eligible trial participants who reported 7-day point prevalence abstinence. The proportion of participants verified as quit was 57.8% [95% confidence interval (CI) = 54.4, 61.2; 10 ng/ml cut-off] or 60.6% (95% CI = 57.2, 63.9; 15 ng/ml). Factors associated independently with verification at 10 ng/ml were education beyond high school education [odds ratio (OR) = 1.51; 95% CI = 1.07, 2.11], continuous abstinence since hospitalization (OR = 2.82; 95% CI = 2.02, 3.94), mailed versus in-person sample (OR = 3.20; 95% CI = 1.96, 5.21) and race. African American participants were less likely to verify abstinence than white participants (OR = 0.64; 95% CI = 0.44, 0.93). Findings were similar for verification at 15 ng/ml. Verification rates did not differ by treatment group. Conclusions In the United States, high rates (40%) of recently hospitalized smokers enrolled in smoking cessation trials fail biochemical verification of their self-reported abstinence. [ABSTRACT FROM AUTHOR]

The World Health Organization estimates that 1 billion people will die from tobacco-related illnesses this century. Most health-care providers, however, fail to treat tobacco dependence. This may be due in part to the treatment 'default'. Guidelines in many countries recommend that health-care providers: (i) ask patients if they are 'ready' to quit using tobacco; and (ii) provide treatment only to those who state they are ready to quit. For other health conditions-diabetes, hypertension, asthma and even substance abuse-treatment guidelines direct health-care providers to identify the health condition and initiate evidence-based treatment. As with any medical care, patients are free to decline-they can 'opt out' from care. If patients do nothing, they will receive care. For tobacco users, however, the treatment default is often that they have to 'opt in' to treatment. This drastically limits the reach of tobacco treatment because, at any given encounter, a minority of tobacco users will say they are ready to quit. As a result, few are offered treatment. It is time to change the treatment default for tobacco dependence. All tobacco users should be offered evidence-based care, without being screened for readiness as a precondition for receiving treatment. Opt-out care for tobacco dependence is warranted because changing defaults has been shown to change choices and outcomes for numerous health behaviors, and most tobacco users want to quit; there is little to no evidence supporting the utility of assessing readiness to quit, and an opt-out default is more ethical. [ABSTRACT FROM AUTHOR]

Aims To test the efficacy and safety of varenicline as an aid to smoking cessation in methadone-maintained smokers. Design Multicenter, randomized, double-blind, placebo-controlled trial with random assignment to 12 weeks of varenicline 1 mg twice daily (n = 57) or matched placebo (n = 55), with in-person and telephone counseling. Setting Urban methadone programs in the Bronx, New York City, New York, USA. Participants Methadone maintenance patients, smoking ≥5 cigarettes/day, interested in quitting, stable in methadone treatment, without current Axis I psychiatric disorders, suicidal ideation or recent suicide attempts. Measurements Seven-day point prevalence abstinence verified by expired carbon monoxide (CO) < 8 parts per million at week 12 (primary outcome); carbon monoxide (CO)-verified abstinence, cigarettes/day, incident Axis I psychiatric illness, suicidal ideation or serious adverse events (SAEs) at weeks 2, 4, 8, 12 or 24 (secondary outcomes). Findings Baseline demographic, smoking and clinical factors were similar between groups. Retention at 24 weeks was 90%. Subjects receiving varenicline were more likely than those receiving placebo to achieve abstinence (10.5 versus 0%, P = 0.03; effect size 10.5%, 95% confidence interval (CI) = 4.4–19.3%) and to reduce smoking (median five versus two cigarettes/day, P < 0.001) at 12 weeks. These effects were not maintained after drug treatment ceased. Incident psychiatric illness (OR= 0.84, 95% CI = 0.16, 4.4) and suicidality [odds ratio (OR) = 0.88, 95% CI 0.2, 3.9] were not different between groups. There were no psychiatric or cardiac SAEs. Conclusions Varenicline can aid short-term smoking abstinence in methadone-maintained smokers. [ABSTRACT FROM AUTHOR]

Overview:Many U.S. hospitals use fax-referral to quitlines to provide outpatient follow-up. It is important to understand whether it is better to refer all smokers, or only those ready to quit, to quitline services. The purpose of this pilot project was to evaluate the feasibility and intermediate out-comes of a proactive (offering fax referral to all smokers) versus a reactive (pre-screening for readiness to quit within the next 30 days) approach to quitline fax-referral. Method:We employed a pre-test, post-test comparison group design in which a script-based reactive approach was employed over a two-week period and a script-based proactive approach was employed in the following two-week period. Scripts were inserted into the counselling protocols of a pre-existing inpatient treatment program. Major Findings:We enrolled 45 patients - 25 during the reactive, and 20 during the proactive block. In the reactive group, 12 (48%) indicated that they were ready to quit smoking and accepted fax-referral to the quitline. Nine (75%) were successfully contacted and enrolled in the quitline, for an overall quitline enrolment rate of 36% (9/25). In the proactive group, all accepted fax-referral to the quitline and 11 were successfully contacted and enrolled by the quitline for an overall enrolment rate of 55% (11/20). Quitlines were able to reach and enrol a higher proportion of patients referred to them, when patients were pre-screened for readiness to quit. Offering quitline referral, regardless of readiness to quit, potentially expands the reach and possibly the impact of quitline counselling. [ABSTRACT FROM AUTHOR]

The authors focus on a commentary concerning whether to change the treatment default for smoking cessation. They suggest that assessing treatment goals or willingness to quit prior to discussing treatment options could result in poor decision making. They state that when medical providers discuss tobacco treatment options, they provide patients with the information needed to make informed decisions and can improve doctor-patient relations.