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BackgroundWe investigated the association between paternal smoking, avoidance behaviors and maternal protective actions and smoke-free home rules with infant's saliva cotinine in Hong Kong.MethodsSix hundred and seventy-five non-smoking mothers (mean age 32.6 years) who attended the maternal-child health clinics with their newborns aged ≤18 months completed a questionnaire about paternal smoking and avoidance behaviors, maternal protective actions, smoke-free rules at home, and infant's second-hand smoke (SHS) exposure. Three hundred and eighty-nine infants provided saliva sample and its cotinine was tested.ResultsThe geometric mean of infant's saliva cotinine was 1.07 ng/ml (95% confidence interval (CI): 0.98, 1.16). Infants living in smoking families with SHS exposure had significantly higher cotinine level than in non-smoking families (adjusted β=0.25, 95% CI: 0.16, 0.33). Paternal smoking near infants (within 1.5 m) was associated with higher cotinine level (adjusted β=0.60, 95% CI: 0.22, 0.98), which was not reduced by avoidance behaviors (e.g., smoking in kitchen or balcony). Even fathers smoking ≥3 m away from infants was associated with higher cotinine level than non-smoking families (adjusted β=0. 09, 95% CI: 0.01, 0.16). Maternal protective actions and smoke-free home rules were not significantly associated with reduced cotinine level.ConclusionPaternal smoking avoidance, maternal protective actions, and smoke-free policy at home did not reduce infant's saliva cotinine.

Objective: To examine if there were changes in the proportion of hardcore smokers and factors associated with hardcore smoking before and after implementation of smoke-free legislation, and warning labels on cigarette packets in Hong Kong in January 2007., Study Design: Repeated cross-sectional surveys of the general population in Hong Kong., Methods: Data from all daily smokers aged ≥ 15 years in the population-based Thematic Household Surveys from 2005 (n = 3740) and 2008 (n = 2958) were used to estimate the prevalence of hardcore smokers before and after implementation of smoke-free legislation. A logistic regression model was used to identify the factors associated with hardcore smoking, and to examine if there were any changes in their associations with the likelihood of hardcore smoking after implementation of smoke-free legislation., Results: The proportion of hardcore smokers among current daily smokers increased significantly from 22.5% [95% confidence interval (CI) 21.1-23.8%] in 2005 to 28.3% (95% CI 26.7-29.9%) in 2008. Change in the strength of the association of hardcore smoking with three factors was observed. The strength of the association between hardcore smoking and 'necessity in social functions' [odds ratio (OR) 0.54, 95% CI 0.31-0.95) and 'necessity for killing time' (OR 0.56, 95% CI 0.36-0.89) decreased, while the association between hardcore smoking and 'necessity as refreshment' increased (OR 3.02, 95% CI 1.43-6.39) after implementation of smoke-free legislation and warning labels on cigarette packets. 'Smoking had become a habit' was the factor associated most strongly with hardcore smoking (OR 4.88, 95% CI 4.02-5.93)., Conclusions: The proportion of hardcore smokers remained stable in Hong Kong from 2005 to 2008. While the implementation of the two tobacco control measures may have provided an environment to reduce social smoking in hardcore smokers, addiction appeared to be the most important factor associated with hardcore smoking. More effective and tailor-made cessation services that target this group of smokers are needed., (Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Introduction: Young smokers often report depressive symptoms while receiving smoking cessation counseling. This study examines time patterns in the quitting process among young smokers with or without notable depressive symptoms., Methods: The quitting trajectories of young smokers aged 12 to 25 (n = 578) who called the Youth Quitline in Hong Kong between March 2006 and May 2011 were recorded and analyzed through multiple telephone sessions over periods of up to 6 months. The time patterns of young smokers who had or did not have notable depressive symptoms were compared using nonparametric Kaplan-Meier methods with log-rank tests., Results: Among young smokers with low levels of nicotine dependence, those who had notable depressive symptoms were less likely to initiate a quit attempt within 28 days after their baseline telephone intervention (probability = .38 vs. .60; P value = .04). Furthermore, young smokers who had notable depressive symptoms were less likely to remain abstinent from smoking for 2 days after starting a quit attempt (probability = .50 vs. .64; P value = .012). Young adults aged 18 or above were more likely to relapse into smoking (adjusted HR = 1.50, 95% CI = 1.01, 2.22)., Conclusions: Depressive symptoms may delay young smokers from initiating quit attempts and shorten their abstinence. A baseline screening process is suggested for identifying youths with co-occurring depressive disorder and nicotine dependence. Further studies should examine a collaborative model of smoking cessation that involves both counselors and physicians in preventing young smokers from rapid relapses after they make quit attempts., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To evaluate the effectiveness of varenicline for smoking cessation in Chinese smokers in a real world cessation clinic practice., Design: A prospective observational study., Setting: Beijing, China., Participants: A total of 924 smokers (883 men and 41 women) who attended a smoking cessation clinic of a large general hospital were assessed with data from structured questionnaires at baseline and follow-up at 1, 3 and 6 months. Trained physician counsellors provided free individual counselling for all subjects and follow-up interviews with brief counselling. 332 subjects additionally prescribed varenicline according to their own choice were compared with those without varenicline., Main Outcome Measures: Primary outcomes were self-reported 7-day point prevalence abstinence rate and 3-month continuous abstinence rate at 6-month follow-up. Secondary outcomes were 7-day point prevalence abstinence rates at 1 and 3-month follow-up, and 1-month continuous abstinence rate at 3-month follow-up., Results: By intention-to-treat, the 7-day point prevalence abstinence rate with varenicline and counselling at 6 months was significantly higher than counselling only (37.0% vs 23.1%; OR, 1.75; 95% CI 1.46 to 2.62; p=0.001). The 3-month continuous abstinence rate at 6 months was higher with varenicline (33.1% vs 18.4%; OR, 2.04; 95% CI 1.61 to 2.99; p<0.001). Varenicline also showed better secondary outcomes., Conclusions: Varenicline prescription in the smoking cessation clinic appeared to be effective with doubling of quit rates in Chinese smokers in a real world cessation clinic practice., Clinical Trial Registration: NCT01935505; Results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: The evidence on the effect of secondhand smoke (SHS) on Health Related Quality of Life (HRQoL) is limited. We examined the relation between SHS and HRQoL among Chinese in Hong Kong., Methods: Adult never smokers from a probability sample of three cross-sectional waves (2010, 2012, 2013) of The Hong Kong Family and Health Information Trends Survey who completed the Cantonese-version of Short-Form 12 Health Survey Questionnaire (SF12v2) were included in the data analysis conducted in 2014. Models were used to examine associations of SHS with SF12 domains and summary scores of Physical (PCS12) and Mental Component (MCS12) with subgroups analysis by SHS locations., Results: After adjustments, SHS was associated with lower scores on all SF12 domains except physical functioning. PCS12 (regress coefficient=-0.76, 95% CI -1.34 to -0.17) and MCS12 (regress coefficient=-1.35, 95% CI -2.06 to -0.64) were lower in those with SHS exposure than those non-exposed. Those exposed to SHS in outdoor public places had lower scores on most SF12 domains and PSC12 and MCS12. SHS exposure in one's home and workplace was associated with lower scores on role physical, body pain and role emotional while SHS exposure in friends' homes was additionally associated with lower social functioning and mental health scores. Lower MCS12 was associated with SHS exposure at all locations except one's home., Conclusions: Our study showed that SHS exposure, particularly in outdoor public places, was associated with decreased HRQoL. It can provide new evidence for stronger smoke-free policies on public places and promoting smoke-free homes., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Aims and Objectives: To investigate the smoking behaviours, perceptions about quitting smoking and factors associated with intention to quit in patients with type 2 diabetes mellitus., Background: Smoking causes type 2 diabetes mellitus. There has been limited research on the needs and concerns of smokers with type 2 diabetes mellitus about quitting smoking., Design: The study used a qualitative design., Methods: Patients diagnosed with type 2 diabetes mellitus who had a history of smoking were recruited at the outpatient diabetic clinics of two major local hospitals in Hong Kong for a semi-structured interview (n = 42), guided by the theory of planned behaviour., Results: At data saturation, 22 current smokers and 20 ex-smokers with type 2 diabetes mellitus were recruited. The current smokers reported they had not quit smoking because of satisfaction with present health status, and misconceptions about the association between diabetes and smoking, and the perceived hazards of quitting. In contrast, ex-smokers had a positive opinion about quitting smoking, accepted advice about quitting from health professionals and received more family support than current smokers. Psychological addiction and weight gain after cessation made quitting challenging., Conclusions: Satisfaction with health status, inadequate knowledge about the relationship between type 2 diabetes mellitus and smoking, and misconceptions about quitting smoking resulted in negative attitudes toward quitting by type 2 diabetes mellitus smokers. Smoking peers, psychological addiction and post-cessation weight gain hindered the quitting process., Relevance to Clinical Practice: Education on the causal link between smoking, type 2 diabetes mellitus and its complications is important to raise health awareness and counter misconceptions about quitting smoking. Behavioural counselling with weight control strategies should be part of a comprehensive smoking cessation intervention for type 2 diabetes mellitus smokers., (© 2015 John Wiley & Sons Ltd.)

Background: Despite smoking cessation can largely improve cancer prognosis and quality of life, many patients continued smoking after the diagnosis of cancer. This study aims to test the effectiveness of a smoking cessation intervention using risk communication approach to help cancer patients quit smoking, and to improve their health related quality of life., Methods: A cluster randomized controlled trial will be employed. Cancer patients who continued smoking after the diagnosis of cancer and have medical follow-up at the out-patient clinics of the five acute hospitals in Hong Kong will be invited to participate. Subjects in the experimental group will receive (1) health warnings of smoking based on a special designed leaflet; and (2) a patient-centred counseling from nurse counselors with emphasis on risk perceptions of smoking to cancer prognosis. Additionally, they will receive two more telephone counseling at 1-week and 1-month. Control group receive standard care and a generic self-help smoking cessation booklet. Outcomes measure include (a) self-reported and the biochemically validated quit rate, (b) patient's smoking reduction by at least 50% compared to baseline, (c) quit attempt(s), (d) change in the intention to quit, (e) change in risk perceptions of smoking, and (f) change in health related quality of life., Discussion: This study will make an important contribution to evidence-based practice by testing the effectiveness of a tailored smoking cessation intervention for cancer patients. The results will support the development of clinical practice guidelines to promote smoking cessation in cancer patients to improve their prognosis and quality of life., Trial Registration: ClinicalTrials.gov NCT01685723. Registered 9 November 2012.

Background: The numbers of women smoking have risen 72.5% since 1990 with the increasing population - from 56,100 to 96,800 in 2012, reflecting an alarming situation in Hong Kong. The study aimed to describe the smoking behaviour, attitudes and associated factors among women in Hong Kong., Methods: A qualitative cross-sectional study involving semi-structured interview was conducted with Chinese women from five community centres in different districts in Hong Kong in 2010. A purposive sample of 73 female participants (24 current smokers, 20 ex-smokers and 29 never-smokers) were recruited. The 73 women were classified by their smoking status and age to form 15 focus groups., Results: Most informants knew about the general health hazards of smoking, such as cancer and heart or respiratory diseases, but not about the female-specific health consequences of smoking. A few smokers considered smoking to be a weight control strategy, fearing a gain in weight if they gave up. Moreover, a few relied on smoking as a coping strategy to relieve negative emotions and stress. Additionally, a few smokers had misconceptions about giving up: that a loss of concentration would result, that continued smoking would not further affect their health as they had become desensitised to the chemicals in tobacco smoke or that quitting would harm their health., Conclusions: This study generates new knowledge about the behavior, attitudes, and experiences related to smoking of current female smokers, ex-smokers and non-smokers in Hong Kong, which is unique as a Chinese but highly westernized community but with a very low female smoking prevalence.

Background: Evidence shows that smoking is a major cause of cancer, and cancer patients who continue smoking are at greater risk for all causes of mortality, cancer recurrence, and second primary cancers. Nevertheless, many cancer patients still smoke and are not willing to quit. This study aimed at understanding the needs and concerns of current and ex-smoking cancer patients, including their risk perceptions, and the behavior and attitudes related to smoking., Methods: A qualitative research was conducted in an oncology outpatient clinic. A one-to-one semi-structured interview was conducted with current Chinese smokers and ex-smokers after they had been diagnosed with cancer. Data saturation was achieved after interviewing a total of 20 current smokers and 20 ex-smokers., Results: A total of 241 patients who were smokers prior to their diagnosis of cancer were identified. Of 241 patients, 208 (86.31%) quitted and 33 (13.69%) continued smoking after receiving a cancer diagnosis. In general, patients who refused to quit smoking subsequent to a cancer diagnosis thought that the perceived barriers to quitting outweighed the perceived benefits of quitting. In contrast, most cancer patients who quit after their cancer diagnoses thought that the perceived benefits of quitting greatly outweighed the perceived barriers to quitting., Conclusions: It is vital that healthcare professionals should help cancer patients to quit smoking. Understanding how current smokers and ex-smokers perceive the risks of smoking, and their behavior, attitudes, and experiences related to smoking is an essential prerequisite for the design of an effective smoking cessation intervention., (Copyright © 2014 John Wiley & Sons, Ltd.)

Aim: To investigate the cross-sectional association between smoking and happiness in Chinese adults in Hong Kong., Design, Setting and Participants: Telephone surveys were conducted between 2009 and 2012, with 4553 randomly sampled Chinese adults (male 54%, mean age 58.3 years) in Hong Kong., Measurements: Happiness was measured using the four-item Subjective Happiness Scale (SHS) and single-item Global Happiness Item (GHI). Smoking status was categorized as current smokers (7.7%%), ex-smokers (6.5%, 93% quit for >6 months) and never smokers (85.8%). Linear and ordinal logistic regressions were used to calculate adjusted β-coefficients for SHS and proportional adjusted odds ratios (aOR) for GHI in relation to smoking., Findings: Compared with current smokers, ex-smokers enjoyed greater happiness according to both SHS (adjusted β = 0.16, P < 0.05) and GHI (aOR = 1.52, P < 0.05) measurements, but current and never smokers were similar. Among current smokers, the number of cigarettes smoked was not associated with happiness, but the lack of any attempt to quit was associated significantly with greater happiness (adjusted β = 0.31 for SHS, aOR = 1.82 for GHI) compared with smokers who had tried to quit but not succeeded. Smokers not intending to quit in the next 6 months had higher odds of happiness (GHI) than those wanting to quit within 6 months (aOR = 1.86, P < 0.05)., Conclusions: Ex-smokers in Hong Kong are happier than current smokers and never smokers, whose happiness measurements are similar. Causal associations have yet to be established., (© 2014 Society for the Study of Addiction.)

Purpose: Youth smoking is a global public health concern. Health educators are increasingly using Internet-based technologies, but the effectiveness of Internet viral marketing in promoting health remains uncertain. This prospective pilot study assessed the efficacy of an online game-based viral marketing campaign in promoting a smoke-free attitude among Chinese adolescents., Methods: One hundred and twenty-one Hong Kong Chinese adolescents aged 10 to 24 were invited to participate in an online multiple-choice quiz game competition designed to deliver tobacco-related health information. Participants were encouraged to refer others to join. A zero-inflated negative binomial model was used to explore the factors contributing to the referral process. Latent transition analysis utilising a pre- and post-game survey was used to detect attitudinal changes toward smoking., Results: The number of participants increased almost eightfold from 121 to 928 (34.6% current or ex-smokers) during the 22-day campaign. Participants exhibited significant attitudinal change, with 73% holding negative attitudes toward smoking after the campaign compared to 57% before it. The transition probabilities from positive to negative and neutral to negative attitudes were 0.52 and 0.48, respectively. It was also found that attempting every 20 quiz questions was associated with lower perceived smoking decision in future (OR = 0.95, p-value <0.01)., Conclusions: Our online game-based viral marketing programme was effective in reaching a large number of smoking and non-smoking participants and changing their attitudes toward smoking. It constitutes a promising practical and cost-effective model for engaging young smokers and promulgating smoking-related health information among Chinese adolescents.

Four hundred and thirty-five Chinese smokers who had attended the first smoking cessation clinic and received stage-matched individualized cessation counseling in Hong Kong during the period of August 2000 to January 2002 were successfully followed-up between February and August 2008. Some 38% of the participants (165/495) had stopped smoking during the 12-month follow-up after treatment. Participants with higher conscientiousness score (OR = 1.65, 95% CI: 1.09 - 2.48) and lower openness to experience score (OR = 0.64, 95% CI: 0.45 - 0.92) showed a greater likelihood of quitting smoking after controlling the effect of daily cigarettes smoked and stage of readiness at baseline. The study suggests an important role of conscientiousness and openness to experience on long-term quitting behaviors following treatment, and provides useful information for the development of matched intervention for smoking cessation among Chinese smokers.

This study examined if 2-week free nicotine replacement therapy (NRT) would be more effective than 1-week free NRT to help smokers quit smoking at 6 and 12 months. In a single-blinded randomized controlled trial design, 562 Chinese smokers who attended a smoking cessation clinic in Hong Kong, China, were randomly allocated into two groups (A1 and A2): A1 (n = 284) received behavioural counselling with free NRT for 1 week; A2 (n = 278) received similar counselling with free NRT for 2 weeks. All subjects received printed self-help materials to support their quitting efforts. A structured questionnaire was used for data collection, including pattern of NRT use and self-reported 7-day point prevalence quit rate at 6 months and 12 months. Among the participants, the mean number of cigarettes smoked per day was 18.8 (SD = 10.9). By intention-to-treat analysis, 7-day point prevalence quit rates were not significantly different between A1 and A2 groups at 6-month (27.5% versus 27.3%; P = 0.97) and 12-month (21.1% versus 21.2%; P = 0.98) followup. The findings suggest that two-week free NRT was not more effective than 1-week free NRT to increase smoking cessation rate among Chinese smokers.

Introduction: The smoking patterns of youth remain unknown after they have received smoking cessation counseling. This study aims to examine the quitting trajectories of Chinese youth smokers after they have received quitline services and to examine factors to predict their quitting trajectories., Methods: A total of 402 Chinese youth smokers (aged 12-25 years) called a quitline and participated in telephone follow-ups at 1 week, 1 month, and 3 and 6 months after initial telephone counseling. Finite mixture modeling was employed to examine the quitting trajectories by the SAS Proc Traj group-based modeling procedure. Hierarchical multinomial logistic regression was used to compare the baseline intention to quit smoking, prosmoking attitudes, social influences, self-efficacy to quit, smoking profile, quitting history, and demographic characteristics among the trajectory groups., Results: Three distinct quitting trajectory groups were identified: quitters, reducers, and persistent smokers. Both quitters and reducers dramatically reduced the level of their cigarette consumption immediately after initial counseling. Youth smokers who were intended to quit at baseline, perceived confidence to quit, and perceived importance of quitting were more likely to have successfully quit smoking at six-month follow-up. Those who had prosmoking attitudes were less likely to quit smoking., Conclusion: The findings reveal the profiles of youth smokers who can quit successfully and can guide the development of better and relevant interventions based on the psychosocial characteristics of youth smokers. Short-term goals such as an abrupt quit attempt or immediately reducing cigarette consumption by half may be the key to help youth smokers quit successfully.

Background: Whether the association between smoking and erectile dysfunction is causal is uncertain. No RCTs have been previously conducted on cessation counseling and additional nicotine replacement therapy (NRT) adherence counseling among smokers with erectile dysfunction., Purpose: The aim of the study was to determine if smoking-cessation counseling in conjunction with NRT increases quitting and NRT adherence compared to usual care, and if stopping smoking would improve erectile function among Chinese erectile dysfunction patients who smoke., Design: An RCT was conducted. Data were collected in 2004-2007 and analyzed in 2008., Setting/participants: The sample included 719 Chinese adult erectile dysfunction patients who smoked at least 1 cigarette per day, intended to quit smoking within the next 7 days, and would use NRT., Interventions: Group A1 received 15-minute smoking-cessation and 3-minute NRT adherence counseling at baseline, 1 week, and 4 weeks with free NRT for 2 weeks. Group A2 received the same treatment, except for the adherence counseling. Group B received 10 minutes of quitting advice. All subjects received a self-help quitting booklet at first contact., Main Outcome Measures: Self-reported 7-day tobacco abstinence at 6 months, 4-week NRT adherence at 1 month, and improvement in erectile dysfunction condition at 6 months., Results: The intervention groups (A1+A2) achieved higher rates of abstinence, both self-reported (23% vs 12.8%, RR=1.79, 95% CI=1.22, 2.62) and biochemically validated (11.4% vs 5.5%, RR=2.07, 95% CI=1.13, 3.77), than the control group. The NRT adherence rate did not differ between Groups A1 and A2 (13.7% vs 12.7%, RR=1.08, 95% CI=0.69, 1.69). An improvement in erectile dysfunction status from baseline to 6 months was associated with self-reported quitting at 6 months but not with intervention status., Conclusions: Although quitting smoking was associated with improvement in erectile dysfunction, this study found significant outcome differences among the means used to achieve smoking cessation., Trial Registration: ISRCTN13070778., (2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Smoking causes heart disease, the major cause of death in China and Hong Kong. Stress is one major trigger of smoking and relapse, and understanding stress among smoking cardiac patients can therefore help in designing effective interventions to motivate them to quit. The objective of this study was to examine the psychometric properties of the Perceived Stress Scale (PSS), and to compare the appropriateness of the three versions of the scale (PSS-14, PSS-10, and PSS-4) among Chinese cardiac patients who were also smokers., Methods: From March 2002 to December 2004, 1860 cardiac patients who smoked were recruited at the cardiac outpatient clinics of ten acute hospitals in Hong Kong, and 1800 questionnaires were analysed. Participants completed a questionnaire including the PSS, nicotine dependence and certain demographic variables. The psychometric properties of the PSS were investigated: construct validity using confirmatory factor analysis, reliability using Cronbach's alpha and concurrent validity by examining the relationship with smoking- and health-related variables., Results: For all the three versions of the PSS, confirmatory factor analyses corroborated the 2-factor structure of the scale, with the positive and negative factors correlating significantly and negatively to a moderate extent (r < -0.5), and high Cronbach's alpha values for the two subscales (alpha > 0.5). All the correlations of the two subscales and the smoking- and health-related variables were statistically significant and in the expected directions although of small magnitudes, except daily cigarette consumption., Conclusions: The findings confirmed the satisfactory psychometric properties of all three Chinese versions of PSS. We recommend the use of PSS-10 for research which focuses on the two components of perceived stress, as it shows a higher reliability; and the use of PSS-4 if such partition is not essential and space for multiple measures is limited.

Background: Smoking cessation programs are well established in the West, but reports on smoking cessation clinics (SCCs) from China are lacking. On the basis of the Hong Kong experience and with strong support from Guangzhou Health Bureau, we established the first SCC in Guangzhou, China. The objective was to describe the characteristics of smokers, measure quit rates and examine predictors of successful quitting., Methods: During 2006-08, 220 smokers received individual counseling following the five A's and five R's. No medications were used., Results: At baseline, the mean (SD) age was 40 (14) years. Most (96%) were males, married (73%), currently employed (75%), college educated or above (54%); 77% had previous quitting attempts. By 14 May 2008, 195 reached the 6 months follow-up period. Of them, 79% (151/195) were successfully followed up, and 46 had quit. By intention to treat, the 6-month 7-day point prevalence quit rate was 24% [95% confidence interval (CI) 18-30%]. Smokers with more confidence in quitting or were at action stage were more successful in quitting with adjusted odds ratio of 2.39 (95% CI 1.01-5.30) and 5.50 (95% CI 1.08-28) respectively., Conclusions: A pilot-model clinic free of charge and with systemic data collection, follow-up and evaluation should be a starting point for smoking cessation program in low-income countries.

Objective: The aim of the present study was to explore the rate of cigarette smoking and its sociodemographic and clinical characteristics in Chinese schizophrenia patients., Methods: In a multicentre, randomized, controlled, longitudinal study, 374 clinically stable patients with schizophrenia were interviewed at entry using standardized assessment instruments, and followed up for 1-2 years., Results: The rate of cigarette smoking was 13.9% in the whole sample, and 26.2% in men and 3.5% in women. On univariate analysis, male sex, unemployment, alcohol consumption, older age, older age at onset, longer duration of illness, more frequent admissions, more severe hostility-excitement at entry and less deterioration in hostility-excitement over the study period were significantly associated with cigarette smoking. On multivariate analysis, male sex, unemployment, alcohol consumption, more frequent admissions, less severe positive and negative symptoms at entry, smaller decline in negative symptoms and more deterioration in disorganized thoughts over the study period were independently associated with cigarette smoking., Conclusion: The rate of cigarette smoking in Chinese schizophrenia patients is considerably lower than most figures reported in the Western literature.

Introduction: New smoke-free legislation implemented in Hong Kong on 1 January 2007, prohibited smoking in the vast majority of indoor workplaces and public places. Experiences of western countries indicated that the need for smoking cessation services would increase after enactment of the smoke-free legislation, but no systematic study of this issue has been undertaken in Southeast Asia. The present study aimed to examine the impact of smoke-free legislation in promoting smoking cessation through a local quitline., Methods: The present study reports the results of a telephone survey using interrupted time-series analysis. We operated a toll-free smoking cessation hotline (quitline) for the general public from August 2005 to September 2007. The present study measured the percent change in the number of telephone calls received and handled before and after the smoke-free legislation., Results: We evaluated the quitline for 9-month periods before (January-September 2006) and after (January-September 2007) the smoke-free legislation was implemented. The call rate in the initial period was 27.6 per month compared with 34.9 per month after enactment of the legislation, a 26% increase. Based on interrupted time-series models, the initial impact of the smoke-free legislation was to increase the number of telephone calls received and handled per week (p < .001), but the impact was temporal and deteriorated within 6 months., Discussion: Implementation of the new smoke-free legislation had a short-term effect in promoting the utilization of a smoking cessation quitline in Hong Kong. A systematic and long-term tobacco control campaign should be combined with smoke-free legislation to promote and sustain smokers' interests in smoking cessation.

Smoking cessation can reduce both morbidity and mortality among patients who have heart disease. China has the largest number of smokers in the world, and most smokers have low motivation to quit. Regular smoking cessation services are almost nonexistent in China, and little is known about the psychometric properties of instruments in assessing smoking self-efficacy in Chinese, whose cultures differ greatly from those of Westerners. The present study tested the psychometric properties of the Chinese version of the Smoking Self-Efficacy Questionnaire (SEQ-12) among 1,841 Chinese smokers who had heart disease, including (a) factorial structure using confirmatory factor analysis, (b) reliability with Cronbach's alpha, (c) concurrent validity, and (d) predictive validity of successful quitting. Confirmatory factor analysis of the SEQ-12 revealed a modified two-factor model that provided a good fit to the data; item 6 ("urge to smoke") was an indicator for the external stimuli subscale rather than for the internal stimuli subscale. Internal consistency coefficients (.77 for external stimuli and .88 for internal stimuli) were acceptable. Baseline self-efficacy scores were significantly associated positively with stage of readiness to quit, and negatively with cigarettes smoked per day and Fagerstrom Test for Nicotine Dependence (FTND) score. Multivariate logistic regression analysis showed that successful quitting at 1 month and at 3 months were predicted by higher external stimuli score, fewer cigarettes smoked per day, lower FTND scores, and being in the intervention group. We concluded that the Chinese version of the SEQ-12 is a valid and reliable instrument for Chinese cardiac patients who smoke. The SEQ-12 can be used to assess smokers' self-efficacy so that appropriate smoking cessation interventions can be provided.

Background: Smoking prevalence among Chinese males is the highest in the world and its morbidity and mortality is growing. Previous studies suggested nurses are inadequately prepared to treat tobacco use and dependence., Objectives: To examine the inclusion and organization of tobacco control content in the undergraduate nursing curriculum of Hong Kong and Mainland China; and the smoking status of faculty and students., Design: Cross-sectional survey., Methods: Deans of 32 nursing schools in Hong Kong and China with an undergraduate programme (representing over 12000 students) completed a self-administered questionnaire., Results: Most schools included the health hazards of tobacco (56.3-100%), but few covered tobacco cessation theory (31.3-62.5%), or behavioural (9.4-56.3%) and pharmacological (3.1-34.4%) interventions in the curriculum. Most curricula covered less than 1h of tobacco content per year of study. Nearly all schools (93.1%) reported smoking among faculty but only half reported access to smoking cessation programmes., Conclusions: This is the first known study to examine the extent of tobacco control education in the nursing curriculum in China. Results suggested deficiencies in the coverage and clinical practice in smoking and smoking cessation, and recommendations were made to strengthen the curriculum.

We sought to determine the association of four categories (chunks) of variables: (1) demographic characteristics, (2) family and friends smoking and other drug use, (3) psychosocial factors and attitude, and (4) lifestyle factors to current smoking as compared to never smoking among Canadian young adults. A cohort of 1270 young adults, followed for 10 years, completed a self-administered questionnaire. In multivariable analyses, the best final model for both genders did not include the psychosocial and attitudinal categories, but did contain variables in the demographic, family and friends, and lifestyle categories. Interventions for reducing smoking among young adults may be similar for males and females, a conclusion that differs from conclusions based on findings from younger age groups.

Purpose: To (a) identify Chinese nurses' tobacco-related knowledge, attitude, and practice (KAP), including perception of competency in smoking-cessation interventions; (b) identify barriers and facilitators to smoking cessation interventions to patients; and (c) assess the learning needs and smoking status of nurses., Design: A cross-sectional survey was conducted in four major cities (Beijing, Shanghai, Guangzhou, and Chongqing) in China from November to December 2003., Methods: 2,888 registered nurses working in hospitals affiliated with five university schools of nursing in these cities were invited to complete a questionnaire. An instrument used to assess tobacco-related KAP in Hong Kong was translated into Chinese and pilot tested to ensure reliability and validity., Findings: 2,179 questionnaires were returned and after exclusion of the grossly incomplete questionnaires, 1,690 were included in the present analysis. Only 2% of participants were current and 1% were former smokers; most had not received training for smoking-cessation interventions as part of their nursing education program. Two-thirds recognized smoking as a leading cause of preventable death and that smoking cessation was the most cost effective intervention, but only a third routinely assisted patients' quit attempts. Nurses who received training reported greater competence in providing smoking-cessation intervention, and more frequent practice of cessation interventions., Conclusions: Chinese nurses had some knowledge about the health effects of tobacco use, but seldom practiced smoking-cessation interventions. Those who had prior training had greater competence and more practice. Including tobacco control, especially smoking cessation, in nursing curricula in China has the potential to save millions of lives.

In Asia there is widespread smoking among men; smoking among women and youth is increasing, and quitting tobacco use is rare. The involvement of nurses, as the largest group of healthcare professionals, in tobacco control efforts is essential. The findings of this survey of 282 (69% response rate) baccalaureate nursing programs in 4 countries in Asia (China, Japan, Korea, and the Philippines) revealed that the majority included content on health risks of smoking (92%), but almost half (49%) did not provide smoking cessation content, and 94% did not cover it in-depth. Only 11% of programs included supervised cessation practice with patients. Fewer than 10% reported in-depth coverage of cessation interventions and few reported opportunities for clinical practice of cessation skills. Most schools surveyed delivered < 1 hour of instruction each year on tobacco control. Further educational efforts are needed to prepare future nurses to assist smokers with smoking cessation. Tobacco use is one of the leading causes of death worldwide, and tobacco-induced deaths in Asia continue to rise. The Western Pacific accounts for one-third of the cigarettes smoked in the world (25% in China alone) and 20% of the 5 million annual deaths from tobacco. China is expected to lead the world in tobacco-related deaths by 2025. Countries in Asia have widespread smoking, especially among men. There is a disturbing increase in smoking among women and youth, quitting tobacco use is rare, and exposure to second-hand smoke is common. Considering the immensity of the problem, all health care professionals throughout the world need to be actively engaged in tobacco control measures, including prevention, cessation, and reduction of exposure to second-hand smoke. Training health care professional students about these issues can have a profound impact on public health. In recognition of the importance of involvement of health care professionals, the World Health Organization (WHO) highlighted their role in tobacco control during "World No Tobacco Day" on May 31, 2005. The involvement of nurses, as the largest group of health care professionals, could boost these efforts. Thus, education of nurses regarding the multiple aspects of tobacco control has strategic implications in controlling global tobacco use and promoting health.

This study assessed the gender and age differences in smoking cessation among the Chinese youth and identified factors associated with quitting smoking. This was a clinic based cross-sectional study with longitudinal components among 129 Chinese young smokers. All services in the clinic including one week's supply of nicotine replacement therapy (NRT) were free. We used structured questionnaires at baseline and at 1, 3 and 12 months. The analysis was by intention-to-treat basis. At 12 month follow up, the 7 day point prevalence quit rate (abstinence from tobacco smoking during the 7 days preceding the follow up) was 19% (25/129) and 36% (25/69) among all the attendees and among those who were successfully followed up, respectively. There was no significant gender or age differences in the quitting outcome but females and the older youth reported more withdrawal symptoms. Not reporting any withdrawal symptoms at 3 months follow up and adherence to use NRT for at least 4 weeks were significant predictors of quitting. A clinic-based smoking cessation service among Chinese young smokers produced an acceptable quit rate with no gender and age difference, indicating that a more general quit smoking approach could be taken for the youth.

Background: Since 1989 when health warning labels appeared on Canadian cigarette packages, the labels have changed from text only covering less than one quarter of the package to text and graphics covering over half the package. This study examines how Canadians in their 20s feel about the current graphic warning labels and their potential to prevent smoking and encourage quitting., Methods: Participants between 20 and 24 years of age were part of a 10-year cohort study begun when the group was in Grade 6, with the purpose of examining factors that may affect smoking. Five questions about warning labels were added to the 2002 questionnaire requesting information on perceptions of the labels and their potential impact on smoking behaviours of young adults. One item had been included in previous questionnaires., Results: 32.8% (n = 1267) of the respondents were smokers, with males (35.6%) being more likely to smoke than females (30.4%). Current smokers were less likely than experimental/ex-smokers to believe that warning labels with stronger messages would make people their age less likely to smoke. Female current smokers were more likely to think about quitting., Conclusion: Despite the efforts taken in developing the labels, some young adults are skeptical about their effects. Warning labels may have to be modified to target issues that are relevant to young adults; gender differences are important in this modification. Warning labels can offer an additional component to a comprehensive tobacco control program, in that they provide health information.

Background: Specific hypotheses regarding putative mechanisms by which stressful life events might be related to smoking initiation among adolescents have been tested cross-sectionally on a cohort of 1598 grade 6 students in Scarborough, Canada. The purpose of this study was to examine the utility of these cross-sectional models in accounting for current smoking as compared to never smoking when this cohort was in grades 8 and 11., Methods: Current smoking was defined as reported regular or occasional smoking. Logistic regression and multiple regression models were tested separately for each gender and grade with variables entered in prespecified steps., Results: Current smoking is more strongly related to psychosocial variables and environmental variables among older male adolescents as compared to younger ones. In older female adolescents, current smoking appears to be more strongly related to attitude variables and less strongly related to psychosocial variables than among younger female adolescents. There is some evidence that grade 11 males may use cigarettes as a coping strategy for depression., Conclusions: Male and female students differ in how stress and a range of psychosocial factors are interrelated with regards to current smoking and these relationships appear to change over time.

It has been speculated that body weight and concern about body weight are important factors in initiation of tobacco use among adolescents, particularly females. An examination of studies that have explored these relationships can provide important information on possible underlying mechanisms that could be used for prevention interventions. This review summarizes recent studies examining weight concerns and youth smoking, with a focus on gender differences. These studies were integrated with the few studies that have examined the relationship between actual body weight and smoking among adolescents. A total of 55 primary research articles met inclusion criteria for the review. Of these, 19 studies assessed the relationship between body weight and smoking, and 50 studies addressed weight concerns and smoking. Some evidence indicated a positive relationship between smoking and body weight among adolescents, although not all studies found a positive association. In terms of the relationship between weight concerns and adolescent smoking, the amount of evidence supporting a positive association differed depending on the dimension of weight concern considered, with the strongest evidence for dieting behaviors. For dieting behaviors, disordered eating symptoms, and some aspects of general weight concerns, the positive relationship with smoking was more consistent among female adolescents than among male adolescents. Possible explanations for these findings are discussed, and priorities for future research are identified.