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Introduction: Embedded smoking cessation support within lung cancer screening is recommended in the United Kingdom; however, little is known about why individuals decline smoking cessation support in this setting. This study identified psychosocial factors that influence smoking cessation and quit motivation among those who declined support for quitting smoking alongside lung cancer screening., Aims and Methods: Qualitative interviews were conducted between August 2019 and April 2021 with 30 adults with a smoking history, recruited from the Yorkshire Lung Screening Trial. Participants had declined smoking cessation support. Verbatim interview transcripts were thematically analyzed., Results: Fifty percent of participants were male and the majority were from the most deprived groups. Participants reported low motivation and a variety of barriers to stopping smoking. Participants described modifiable behavioral factors that influenced their quit motivation including self-efficacy, perceived effectiveness of stop-smoking services including smoking cessation aids, risk-minimizing beliefs, lack of social support, absence of positive influences on smoking, and beliefs about smoking/smoking cessation. Broader contextual factors included social isolation and stigma, coronavirus disease 2019, and comorbid mental and physical health conditions that deterred smoking cessation., Conclusions: To encourage engagement in smoking cessation support during lung cancer screening, interventions should seek to encourage positive beliefs about the effectiveness of smoking cessation aids and increase confidence in quitting as part of supportive, person-centered care. Interventions should also acknowledge the wider social determinants of health among the lung screening-eligible population., Implications: This study provides an in-depth understanding of the beliefs surrounding smoking and smoking cessation and further potential psychosocial factors that influence those attending lung cancer screening. Many of the barriers to smoking cessation found in the present study are similar to those outside of a lung screening setting however this work offers an understanding of potential facilitators that should be considered in future lung screening programs., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Background: Up to 50% of those attending for low-dose computed tomography screening for lung cancer continue to smoke and co-delivery of smoking cessation services alongside screening may maximise clinical benefit. Here we present data from an opt-out co-located smoking cessation service delivered alongside the Yorkshire Lung Screening Trial (YLST)., Methods: Eligible YLST participants were offered an immediate consultation with a smoking cessation practitioner (SCP) at their screening visit with ongoing smoking cessation support over subsequent weeks., Results: Of 2150 eligible participants, 1905 (89%) accepted the offer of an SCP consultation during their initial visit, with 1609 (75%) receiving ongoing smoking cessation support over subsequent weeks. Uptake of ongoing support was not associated with age, ethnicity, deprivation or educational level in multivariable analyses, although men were less likely to engage (adjusted OR (OR adj ) 0.71, 95% CI 0.56-0.89). Uptake was higher in those with higher nicotine dependency, motivation to stop smoking and self-efficacy for quitting. Overall, 323 participants self-reported quitting at 4 weeks (15.0% of the eligible population); 266 were validated by exhaled carbon monoxide (12.4%). Multivariable analyses of eligible smokers suggested 4-week quitting was more likely in men (OR adj 1.43, 95% CI 1.11-1.84), those with higher motivation to quit and previous quit attempts, while those with a stronger smoking habit in terms of cigarettes per day were less likely to quit., Conclusions: There was high uptake for co-located opt-out smoking cessation support across a wide range of participant demographics. Protected funding for integrated smoking cessation services should be considered to maximise programme equity and benefit., Competing Interests: Conflict of interest: R.L. Murray reports lecture honoraria and travel reimbursement from AstraZeneca, grant funding from Cancer Research UK, Horizon 2020 and UK Prevention Partnership, is a member of the Board of Trustees of and has received consultancy fees from Action on Smoking and Health, and is a member of the Royal College of Physicians, outside the submitted work. P.A.J. Crosbie reports consulting fees and stock options from Everest Detection, lecture honoraria from AstraZeneca, designing a questionnaire for Novartis, and designing a study for North West eHealth, outside the submitted work. D. Baldwin reports lecture honoraria from MSD, AstraZeneca, Roche and BMS, outside the submitted work. J. Britton reports provision of a legal report commissioned by lawyers acting for vape retailers in Canada against a proposed prohibition of vape flavours by the New Brunswick government. The remaining authors have no conflicts of interest relevant to this article to disclose., (Copyright ©The authors 2024.)

Background: Optimising smoking cessation services within a low radiation-dose computed tomography (LDCT) lung cancer screening programme has the potential to improve cost-effectiveness and overall efficacy of the programme. However, evidence on the optimal design and integration of cessation services is limited. We co-developed a personalised cessation and relapse prevention intervention incorporating medical imaging collected during lung cancer screening. The intervention is designed to initiate and support quit attempts among smokers attending screening as part of the Yorkshire Enhanced Stop Smoking study (YESS: ISRCTN63825779). Patients and public were involved in the development of an intervention designed to meet the needs of the target population., Methods: An iterative co-development approach was used. Eight members of the public with a history of smoking completed an online survey to inform the visual presentation of risk information in subsequent focus groups for acceptability testing. Three focus groups (n = 13) were conducted in deprived areas of Yorkshire and South Wales with members of the public who were current smokers or recent quitters (within the last year). Exemplar images of the heart and lungs acquired by LDCT, absolute and relative lung cancer risk, and lung age were shown. Data were analysed thematically, and discussed in stakeholder workshops. Draft versions of the intervention were developed, underpinned by the Extended Parallel Processing Model to increase self-efficacy and response-efficacy. The intervention was further refined in a second stakeholder workshop with a patient panel., Results: Individual LDCT scan images of the lungs and heart, in conjunction with artistic impressions to facilitate interpretation, were considered by public participants to be most impactful in prompting cessation. Public participants thought it important to have a trained practitioner guiding them through the intervention and emphasising the short-term benefits of quitting. Presentation of absolute and relative risk of lung cancer and lung age were considered highly demotivating due to reinforcement of fatalistic beliefs., Conclusion: An acceptable personalised intervention booklet utilising LDCT scan images has been developed for delivery by a trained smoking cessation practitioner. Our findings highlight the benefit of co-development during intervention development and the need for further evaluation of effectiveness., (© 2022. The Author(s).)

Introduction: There is limited research exploring how smoking cessation treatment should be implemented into lung cancer screening in the United Kingdom. This study aimed to understand attitudes and preferences regarding the integration of smoking cessation support within lung cancer screening from the perspective of those eligible., Methods: Thirty-one lung cancer screening eligible individuals aged 55-80 years with current or former smoking histories were recruited using community outreach and social media. Two focus groups (three participants each) and 25 individual telephone interviews were conducted. Data were analysed using the framework approach to thematic analysis., Results: Three themes were generated: (1) bringing lung cancer closer to home, where screening was viewed as providing an opportunity to motivate smoking cessation, depending on perceived personal risk and screening result; (2) a sensitive approach to cessation with the uptake of cessation support considered to be largely dependent on screening practitioners' communication style and expectations of stigma and (3) creating an equitable service that focuses on ease of access as a key determinant of uptake, where integrating cessation within the screening appointment may sustain increased quit motivation and prevent loss to follow-up., Conclusions: The integration of smoking cessation into lung cancer screening was viewed positively by those eligible to attend. Screening appointments providing personalized lung health information may increase cessation motivation. Services should proactively support participants with possible fatalistic views regarding risk and decreased cessation motivation upon receiving a good screening result. To increase engagement in cessation, services need to be person-centred., Patient or Public Contribution: This study has included patient and public involvement throughout, including input regarding study design, research materials, recruitment strategies and research summaries., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: This meta-ethnography investigates how young adults describe their tobacco use, smoking identities and pathways into and out of regular smoking, to inform future smoking prevention and harm reduction interventions., Methods: Eight databases were systematically searched using keywords and indexed terms. Studies were included if they presented qualitative data from young adults aged 16-25 reporting smoking histories and/or smoking identities from countries culturally similar to the UK. A systematic and rigorous meta-ethnographic approach was employed, consistent with Noblit and Hare's methodology., Results: Thirty papers were included. Reasons stated for taking up smoking and becoming a smoker included alleviating stress, transforming one's identity, and coping with the transition to further education, employment or leaving home. Many used smoking to aid acceptance within new peer groups, particularly when alcohol was present. Smoking was also perceived as an act of resistance and a coping mechanism for those with marginalised identities. Barriers to quitting smoking included young adults' minimisation or denial of the health risks of smoking and not identifying with "being a smoker"., Conclusions: This meta-ethnography may provide a blueprint to inform the development of health and wellbeing interventions designed specifically for young adults. Smoking cessation interventions should be co-designed with young adults based on their perceived needs, resonant with their desire to quit in the future at key milestones. Harm reduction interventions should address the social aspect of addiction, without reinforcing stigma, particularly for those with marginalised identities., (© 2022. The Author(s).)

Objectives: To identify psychosocial determinants of quit motivation in older deprived smokers. The evidence may be used to optimise smoking cessation interventions for the target population., Design: Cross-sectional survey using online recruitment methods including Facebook-targeted advertising., Setting: UK, 2019., Participants: Current smokers aged 50 years or older and from a socioeconomically deprived background., Main Outcome Measures: Measures included motivation to stop smoking, smoking history, perceived social support, self-efficacy for quitting, self-exempting beliefs and lung cancer risk perception. Multivariable regression was used to analyse factors associated with quit motivation., Results: Of a total 578 individuals who consented to take part, 278 (48.1%) did not meet the inclusion criteria. Of the 300 eligible participants, most were recruited using Facebook (94.0%), were aged 50-64 years (83.7%) and women (85.7%). Most participants were renting from a housing association (72.0%) and had low education (61.0%). Higher motivation to quit was statistically significantly associated with a higher intensity of previous quit attempts (p=0.03), higher quit confidence (p=0.01), higher smoking self-efficacy (p=0.01), a lower risk-minimising beliefs score (p=0.01) and using traditional nicotine replacement therapy (NRT) when trying to stop smoking or cut down (p<0.001)., Conclusion: Older smokers from deprived backgrounds face complex barriers to quitting smoking. Interventions are needed to increase self-efficacy for quitting, modify risk-minimising beliefs and target elements of previous quit attempts (ie, the use of NRT) that are associated with motivation to stop smoking., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Integration of smoking cessation (SC) into lung cancer screening is essential to optimise clinical and cost effectiveness. The most effective way to use this 'teachable moment' is unclear. The Yorkshire Enhanced Stop Smoking study will measure the effectiveness of an SC service integrated within the Yorkshire Lung Screening Trial (YLST) and will test the efficacy of a personalised SC intervention, incorporating incidental findings detected on the low-dose CT scan performed as part of YLST., Methods and Analysis: Unless explicitly declined, all smokers enrolled in YLST will see an SC practitioner at baseline and receive SC support over 4 weeks comprising behavioural support, pharmacotherapy and/or a commercially available e-cigarette. Eligible smokers will be randomised (1:1 in permuted blocks of random size up to size 6) to receive either an enhanced, personalised SC support package, including CT scan images, or continued standard best practice. Anticipated recruitment is 1040 smokers (January 2019-December 2020). The primary objective is to measure 7-day point prevalent carbon monoxide (CO) validated SC after 3 months. Secondary outcomes include CO validated cessation at 4 weeks and 12 months, self-reported continuous cessation at 4 weeks, 3 months and 12 months, attempts to quit smoking and changes in psychological variables, including perceived risk of lung cancer, motivation to quit smoking tobacco, confidence and efficacy beliefs (self and response) at all follow-up points. A process evaluation will explore under which circumstances and on which groups the intervention works best, test intervention fidelity and theory test the mechanisms of intervention impact., Ethics and Dissemination: This study has been approved by the East Midlands-Derby Research Ethics Committee (18/EM/0199) and the Health Research Authority/Health and Care Research Wales. Results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and via the YLST website., Trial Registration Numbers: ISRCTN63825779, NCT03750110., Competing Interests: Competing interests: PAJC has received consultation fees and share options from Everest Detection., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Introduction: The associations between smoking prevalence, socioeconomic group and lung cancer outcomes are well established. There is currently limited evidence for how inequalities could be addressed through specific smoking cessation interventions (SCIs) for a lung cancer screening eligible population. This systematic review aims to identify the behavioural elements of SCIs used in older adults from low socioeconomic groups, and to examine their impact on smoking abstinence and psychosocial variables., Method: Systematic searches of Medline, EMBASE, PsychInfo and CINAHL up to November 2018 were conducted. Included studies examined the characteristics of SCIs and their impact on relevant outcomes including smoking abstinence, quit motivation, nicotine dependence, perceived social influence and quit determination. Included studies were restricted to socioeconomically deprived older adults who are at (or approaching) eligibility for lung cancer screening. Narrative data synthesis was conducted., Results: Eleven studies met the inclusion criteria. Methodological quality was variable, with most studies using self-reported smoking cessation and varying length of follow-up. There were limited data to identify the optimal form of behavioural SCI for the target population. Intense multimodal behavioural counselling that uses incentives and peer facilitators, delivered in a community setting and tailored to individual needs indicated a positive impact on smoking outcomes., Conclusion: Tailored, multimodal behavioural interventions embedded in local communities could potentially support cessation among older, deprived smokers. Further high-quality research is needed to understand the effectiveness of SCIs in the context of lung screening for the target population., Prospero Registration Number: CRD42018088956., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Smoking cessation was examined among high-risk participants in the UK Lung Cancer Screening (UKLS) Pilot Trial of low-dose CT screening., Methods: High-risk individuals aged 50-75 years who completed baseline questionnaires were randomised to CT screening (intervention) or usual care (no screening control). Smoking habit was determined at baseline using self-report. Smokers were asked whether they had quit smoking since joining UKLS at T 1 (2 weeks after baseline scan results or control assignment) and T 2 (up to 2 years after recruitment). Intention-to-treat (ITT) regression analyses were undertaken, adjusting for baseline lung cancer distress, trial site and sociodemographic variables., Results: Of a total 4055 individuals randomised to CT screening or control, 1546 were baseline smokers (759 intervention, 787 control). Smoking cessation rates were 8% (control n=36/479) versus 14% (intervention n=75/527) at T 1 and 21% (control n=79/377) versus 24% (intervention n=115/488) at T 2 . ITT analyses indicated that the odds of quitting among screened participants were significantly higher at T 1 (adjusted OR (aOR) 2.38, 95% CI 1.56 to 3.64, p<0.001) and T 2 (aOR 1.60, 95% CI 1.17 to 2.18, p=0.003) compared with control. Intervention participants who needed additional clinical investigation were more likely to quit in the longer term compared with the control group (aOR 2.29, 95% CI 1.62 to 3.22, p=0.007) and those receiving a negative result (aOR 2.43, 95% CI 1.54 to 3.84, p<0.001)., Conclusions: CT lung cancer screening for high-risk participants presents a teachable moment for smoking cessation, especially among those who receive a positive scan result. Further behavioural research is needed to evaluate optimal strategies for integrating smoking cessation intervention with stratified lung cancer screening., Trial Registration Number: Results, ISRCTN 78513845., Competing Interests: Competing interests: None declared., (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/.)

Smoking is a key driver of health inequalities and a leading cause of cancer incidence in the UK. Stop Smoking Services (SSS) offer a combination of behavioural and pharmacological support. Individuals who use SSS are three times more likely to successfully quit than those who try to quit unaided, but uptake of services is low, particularly amongst people from low socioeconomic backgrounds. The aim of this qualitative study was to understand the barriers and facilitators to accessing SSS in this population. Qualitative interviews with SSS providers (pharmacists, SSS leads, and advisors; n=22) and potential or current service users from low socioeconomic backgrounds (n=115) across the UK. Interviews were coded thematically using NVivo and analysed using the COM-B model which cites Capability (C), Opportunity (O), and Motivation (M) as factors for changing behaviour (B). Informed consent was obtained verbally prior to interviews. Facilitators to accessing SSS included proximity of services, flexibility of service delivery, and free NRT provision. Barriers included waiting lists, staffing shortages, lack of service visibility and advertisement, and perceived stigma and lifestyle factors. The use of smart phones/apps in service provision was identified as both a barrier and facilitator. Recommendations for service enhancement included improved visibility and awareness of SSS (Capability), enhanced community links to embed services or support referral pathways (Opportunity) and person-centred approaches to SSS delivery (Motivation). Our findings provide evidence on practical solutions for adapting SSS delivery, with potential to increase equitable uptake and improve outcomes. Removing structural barriers through tailored support and targeted promotion of local SSS is essential to maximise service uptake. The use of community outreach services/agencies was identified as an important way of maximising targeted work to improve access to SSS in low socioeconomic settings. This study was funded by Cancer Research UK. [ABSTRACT FROM AUTHOR]