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Introduction: Most smoking quit attempts end in relapse, and interventions focused on relapse prevention are lacking. Helpers Stay Quit (HSQ) is a novel behavioral relapse prevention intervention that teaches newly abstinent smokers to offer a "helping conversation" (HC) to help others quit tobacco., Methods: Pre-post intervention feasibility study with state quitline participants ≥14 days abstinent. Measures at baseline, 3 months, and 6 months included smoking status, offering HCs, and cessation self-efficacy. Primary outcomes: self-reported 7-day point prevalence abstinence; offering HCs. Cox models explored association of HCs with relapse. Preliminary effects analysis using propensity score matching compared 30-day abstinence of quitline clients with study sample at 7 months., Results: Participants (N = 104) were as follows: mean age of 53 years (SD 13.9 years), 48.1% male, mean of cigarettes smoked/day of 16.2 (SD 9.7). Compared with participants who remained abstinent (n = 82), relapsers (n = 22) had fewer HCs over 6 months (2.6 vs 7.2; 95% confidence interval [CI]: 1.4, 7.8, p = .006). Using adjusted Cox regression, the hazard ratio of relapse for each HC was 0.85 (95% CI: 0.74, 0.99, p = .03). Compared with a matched sample of quitline clients not exposed to HSQ, study participants were 49% more likely to report 30-day abstinence at 7-month quitline follow-up (95% CI: 40%, 59%, p < .0001)., Conclusions: HSQ, delivered to newly abstinent smokers who received standard quitline treatment, was associated with less self-reported relapse. These promising preliminary study results warrant further research to evaluate HSQ as a novel behavioral intervention to prevent smoking relapse., Implications: To date, behavioral interventions for smoking relapse prevention that teach abstainers cessation skills to apply to themselves have not shown effectiveness. This feasibility study examines the preliminary efficacy of a conceptually novel, "help others" behavioral intervention approach for relapse prevention in newly abstinent smokers recruited from a state quitline. HSQ teaches the newly abstinent smoker communication and listening skills to encourage other smokers in their personal social network to quit. Exploratory analysis using propensity score matching suggests that participants exposed to HSQ were significantly more likely to self-report 30-day abstinence at quitline 7-month follow-up than other quitline clients., (© The Author(s) 2020. 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.)

Introduction: Despite progress in reducing tobacco use within the general population, high prevalence of tobacco use continues in individuals with mental health and substance use disorders ("clients"). Tobacco use persists as the leading cause of premature mortality in this population. While behavioral health providers have frequent contacts with this population, they lack training in tobacco cessation counseling., Methods: We conducted multimethod formative data collection consisting of key informant interviews with providers, field observations at clinical sites, and structured group interviews with behavioral health providers, and, separately, clients. Activities were conducted at 4 behavioral health agencies with 9 behavioral health clinic sites in southern Arizona. Recurring phrases and level of repetition were quantified to identify themes. These themes were then used to adapt the method of training delivery and revise the curriculum content for providers at the participating sites., Results: Results indicated that providers had "training fatigue" and low satisfaction with multiple, online trainings. Further, providers noted issues including time constraints, competing clinical priorities, and low access to tobacco-cessation materials. Clients demonstrated high self-awareness around the importance of quitting smoking and professed frustration at being unable to quit, despite multiple attempts. Finally, both providers and clients agreed that a personal, supportive approach to cessation counseling was preferred., Conclusions: Using results from this formative research to revise delivery and content of existing smoking-cessation training for behavioral health providers may address barriers to assisting clients with smoking cessation. Additional research to determine the efficacy of the adapted training is needed.

Introduction: While many medications can be effective aids to quitting tobacco, real world adherence to smoking cessation medications may render a potentially effective medication ineffective. The present study investigated the role of adherence on treatment outcomes in a bupropion dose-response study among adolescent smokers trying to quit smoking., Methods: Three hundred twelve adolescent boys (n = 143) and girls (n = 169) between the ages of 14-17 were enrolled in the study, and were randomly assigned to use either 300 mg, 150 mg or placebo bupropion to quit smoking. Among the eligibility criterion, participants had to smoke at least six cigarettes per day, be motivated to quit smoking (self report), have an exhaled carbon monoxide level greater than or equal to 10 ppm, and report at least two previous quit attempts. Adherence to medication was determined by both self-report and actual counts of unused medication and empty medication packaging. Smoking status was determined by a combination of self-report and biochemical verification (breath carbon monoxide and urine cotinine)., Results: Cotinine-confirmed quit rates were significantly higher as a function of high adherence (20.69%) relative to low adherence (0.00%) in the 300-mg Bupropion Sustained Release group. Overall adherence in all study conditions in this highly controlled study was high (74%), but was significantly lower in non-white participants., Conclusions: Effectiveness of bupropion for adolescent smoking cessation is contingent on achieving high rates of medication adherence, but considerable variations in adherence impacted outcomes., Implications: Few studies have assessed the safety and efficacy of medications to help adolescent smokers quit, and we conducted one such study assessing bupropion. In this analysis of that original study, we assess the role of adherence in use of medication and quit rates. We found that adherence was related to outcomes, particularly in the 300-mg dose of bupropion., (© 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.)

Objective: Adolescent overweight and obesity and smoking continue to be very important health challenges because of their lasting effects on overall health. Weight gain after smoking cessation is a barrier to quitting as well as a negative consequence to health. This study reports changes in the body mass index (BMI) z-scores of adolescent smokers participating in a dose-ranging clinical trial of bupropion SR (150 mg/day and 300 mg/day) for smoking cessation., Methods: A total of N = 296 adolescent smokers (placebo n = 100, 150 mg/day n = 101, 300 mg/day n = 95) with a BMI z-score of 0.5 (sd: 1.4), 0.5 (sd: 1.3), and 0.5 (sd: 1.2) in the placebo, 150 mg/day, and 300 mg/day groups, respectively, were followed for 6 months., Results: Adolescents in the 300 mg/day group had a significant reduction in BMI z-score 6 weeks after quitting (β = -0.16, CI = (-0.29, -0.04), P-value = 0.01). This result was not sustained at the 6-month follow-up., Conclusions: A reduction in BMI z-score during smoking cessation with bupropion has important implications for the future of adolescent smoking cessation. These results are particularly relevant for adolescents who have either overweight or obesity or who have reservations about quitting for fear of gaining weight or BMI., (© 2015 The Obesity Society.)

Tobacco use and tobacco smoke exposure are among the most important preventable causes of premature disease, disability, and death and therefore constitute a major pediatric health concern. The pediatric primary care setting offers excellent opportunities to prevent tobacco use in youth and to deliver cessation-related treatment to youth and parents who use tobacco. This report updates a "state-of-the-art" article published a decade ago on office-based interventions to address these issues. Since then there has been marked progress in understanding the nature, onset, and trajectories of tobacco use and nicotine addiction in youth with implications for clinical practice. In addition, clinicians need to remain abreast of emerging nicotine delivery systems, such as electronic cigarettes, that may influence uptake or continuation of smoking. Although evidence-based practice guidelines for treating nicotine addiction in youth are not yet available, research continues to build the evidence base toward that goal. In the interim, practical guidelines are available to assist clinicians in addressing nicotine addiction in the pediatric clinical setting. This article reports current practices in addressing tobacco in pediatric primary care settings. It reviews our increasing understanding of youth nicotine addiction, summarizes research efforts on intervention in the past decade and additional research needed going forward, and provides practical guidelines for pediatric health care providers to integrate tobacco use prevention and treatment into their clinical practice. Pediatric providers can and should play an important role in addressing tobacco use and dependence, both in the youth they care for and in parents who use tobacco., (Copyright © 2015 by the American Academy of Pediatrics.)

Background: Tobacco use remains the leading cause of morbidity and mortality in the US. Effective tobacco cessation aids are widely available, yet underutilized. Tobacco cessation brief interventions (BIs) increase quit rates. However, BI training has focused on conventional medical providers, overlooking other health practitioners with regular contact with tobacco users. The 2007 National Health Interview Survey found that approximately 20% of those who use provider-based complementary and alternative medicine (CAM) are tobacco users. Thus, CAM practitioners potentially represent a large, untapped community resource for promoting tobacco cessation and use of effective cessation aids. Existing BI training is not well suited for CAM practitioners' background and practice patterns, because it assumes a conventional biomedical foundation of knowledge and philosophical approaches to health, healing and the patient-practitioner relationship. There is a pressing need to develop and test the effectiveness of BI training that is both grounded in Public Health Service (PHS) Guidelines for tobacco dependence treatment and that is relevant and appropriate for CAM practitioners., Methods/design: The CAM Reach (CAMR) intervention is a tobacco cessation BI training and office system intervention tailored specifically for chiropractors, acupuncturists and massage therapists. The CAMR study utilizes a single group one-way crossover design to examine the CAMR intervention's impact on CAM practitioners' tobacco-related practice behaviors. Primary outcomes included CAM practitioners' self-reported conduct of tobacco use screening and BIs. Secondary outcomes include tobacco using patients' readiness to quit, quit attempts, use of guideline-based treatments, and quit rates and also non-tobacco-using patients' actions to help someone else quit., Discussion: CAM practitioners provide care to significant numbers of tobacco users. Their practice patterns and philosophical approaches to health and healing are well suited for providing BIs. The CAMR study is examining the impact of the CAMR intervention on practitioners' tobacco-related practice behaviors, CAM patient behaviors, and documenting factors important to the conduct of practice-based research in real-world CAM practices.

Interventions tailored to individual smoker characteristics have increasingly received attention in the tobacco control literature. The majority of tailored interventions are generated by computers and administered with printed materials or web-based programs. The purpose of this study was to examine the tailoring activities of community lay health influencers who were trained to perform face-to-face brief tobacco cessation interventions. Eighty participants of a large-scale, randomized controlled trial completed a 6-week qualitative follow-up interview. A majority of participants (86%) reported that they made adjustments in their intervention behaviors based on individual smoker characteristics, their relationship with the smoker, and/or setting. Situational contexts (i.e., location and timing) primarily played a role after targeted smokers were selected. The findings suggest that lay health influencers benefit from a training curriculum that emphasizes a motivational, person-centered approach to brief cessation interventions. Recommendations for future tobacco cessation intervention trainings are presented.

Objective: To identify types of health influencers in tobacco cessation based on the frequency and characteristics of brief intervention activities., Methods: Longitudinal qualitative interviews were completed with 28 individuals posttraining., Results: Four individuals were categorized as Rarely Active, 5 as Active With Family and Friends, 9 as Active in the Workplace, and 10 as Proactive in Multiple Settings. Unique motivators, intervention behaviors, and barriers were documented. Some individuals displayed high levels of self-efficacy necessary for expanding the reach of community-based interventions., Conclusion: Training programs need to address the impact of contextual factors on initiating and sustaining intervention activities.

The authors present findings from a community-based tobacco cessation project that trained lay health influencers to conduct brief interventions. They outline four major lessons regarding sustainability. First, participants were concerned about the impact that promoting cessation might have on social relationships. "Social risk" must be addressed during training to ensure long-term sustainability. Second, formal training provided participants with an increased sense of self-efficacy, allowed them to embrace a health influencer identity, and aided in further reducing social risk. Third, material resources functioned to mediate social tensions during health intervention conversations. A variety of resources should be made available to health influencers to accommodate type of relationship, timing, and location of the interaction. Finally, project design must be attentive to the creation of a "community of practice" among health influencers as an integral part of project sustainability. These lessons have broad implications for successful health promotion beyond tobacco cessation.

The 3 aims of Project Quit Tobacco International are to design a tobacco curriculum for medical colleges, develop culturally appropriate approaches to clinic and community-based tobacco cessation, and to build tobacco research and training networks within India and Indonesia as a prototype for other countries. This article describes pilot interventions being launched in 10 medical colleges in these 2 countries to (a) integrate tobacco into their 4-year training programs, ( b) establish illness-specific cessation clinics, and (c) involve colleges in community outreach efforts to promote smoke-free households. This article reports on lessons learned, challenges faced, and successes realized to date.

Objectives: To assess the feasibility of delivering brief and disease-centred smoking cessation interventions to patients with diabetes mellitus in clinical settings., Methods: We conducted a feasibility study involving two interactive smoking cessation interventions: doctor's advice and visual representation of how tobacco affects diabetes (DA) and DA plus direct referral to a cessation clinic (CC). Follow-up was at 3 and 6 months post intervention. Primary outcome was 7-day-point prevalence abstinence. The study involved male patients recruited from two referral diabetes clinics in Yogyakarta Province, Indonesia during January 2008 to May 2009. Of the 71 patients who smoked during the last month, 33 were randomized to the DA group and 38 to the CC group., Results: At 6 months follow-up, DA and CC groups had abstinence rates of 30% and 37%, respectively. Of those continuing to smoke, most reported an attempt to quit or reduce smoking (70% in DA and 88% in CC groups). Patients in both groups had increased understanding of smoking-related harm and increased motivation to quit smoking., Conclusions: This study demonstrates the feasibility of disease-centred doctors' messages about smoking cessation for patients with diabetes, supported by the presence of a CC motivating clinicians to routinely give patients cessation messages.

Background: Quitlines and worksite-sponsored cessation programs are effective and highly accessible, but limited by low utilization. Efforts to encourage use of cessation aids have focused almost exclusively on the smoker, overlooking the potential for friends, family, co-workers, and others in a tobacco user's social network to influence quitting and use of effective treatment., Methods: Longitudinal, observational pilot feasibility study with 6-week follow-up survey., Setting/participants: Employees of three national corporations, with a combined target audience of 102,100 employees., Intervention: The Helpers Program offers web-based, brief intervention training to activate social networks of tobacco users to encourage quitting and use of effective treatment. Helpers was offered from January 10 to March 31, 2008, as a treatment engagement strategy, together with Free & Clear's telephone/web-based cessation services., Main Outcome Measures: Website utilization, training completion, post-training changes in knowledge and self-efficacy with delivery of brief interventions, referrals to Free & Clear, and use of brief intervention training., Results: There were 19,109 unique visitors to the Helpers website. Of these, 4727 created user accounts; 1427 registered for Helpers Training; 766 completed training. There were 445 visits to the referral page and 201 e-mail or letter referrals generated. There were 67 requests for technical support. Of follow-up survey respondents (n=289), 78.9% reported offering a brief intervention., Conclusions: Offering the Helpers Program website to a large, diverse audience as part of an employer-sponsored worksite health promotion program is both feasible and well accepted by employees. Website users will participate in training, encourage quitting, and refer smokers to quitline services., (2010. Published by Elsevier Inc.)

Issues: Cessation programs are essential components of comprehensive tobacco control. Health-care providers, especially physicians, have major responsibility for role modeling and promoting cessation. For successful, sustainable cessation training programs, countries need health-care professionals with knowledge and skills to deliver and teach tobacco cessation., Approach: Review literature relevant to faculty development in tobacco cessation and discuss its strategic potential in tobacco control., Key Findings: Faculty development is essential for sustainable tobacco cessation training programs, and a potentially powerful strategy to shift professional and societal norms towards cessation and support of comprehensive tobacco control in countries with normative tobacco use and underdeveloped tobacco control programs., Implications: Medical faculty are in a key position to influence tobacco cessation and control programs because of their roles as educators and researchers, receptivity to innovation and, influence on competencies and standards for medical education and practice. Faculty development programs must consider the number and type of faculty, and tobacco cessation curricula needed. Faculty development fosters the ability to institutionalise cessation education for students and community practitioners. Academic faculty are often leaders in their professional disciplines, influential in establishing clinical practice standards, and technical experts for government and other key health organisations., Conclusion: Training health-care professional faculty to become knowledgeable and committed to tobacco cessation opens opportunities to promote cessation and shift professional and societal norms away from tobacco use.

The authors present findings from a qualitative study on postpartum smoking among low-income women ( N = 44) who had been smokers at the onset of pregnancy. Interview data collected after delivery at Months 1, 3, and 6 postpartum are discussed to explore contextual factors contributing to smoking abstinence, relapse, and harm-reduction practices. By 6 months postpartum, 10 women (23%) had completely quit, 21 women (48%) had reduced their smoking by 50% of their prepregnancy levels, and 7 women (16%) had reduced their smoking by one third of their prepregnancy levels. Thus, the majority of the women were engaging in significant harm-reduction efforts despite being entrenched in high-risk smoking environments where they were provided with few messages to quit. Many mothers were concerned about their moral identity as a smoker and expressed concerns that their child might initiate smoking at an early age. Future programs targeting this population should acknowledge women's harm-reduction efforts in environments where smoking is normative.

Objective: To assess the safety and efficacy of sustained-release bupropion hydrochloride for adolescent smoking cessation., Design: Prospective, randomized, double-blind, placebo-controlled, dose-ranging trial., Setting: Metropolitan areas of Tucson and Phoenix, Arizona., Participants: Adolescents (N = 312) recruited through media and various community venues from March 1, 1999, through December 31, 2002, who were aged 14 to 17 years, smoked 6 or more cigarettes per day, had an exhaled carbon monoxide level of 10 ppm or greater, had at least 2 previous quit attempts, and had no other current major psychiatric diagnosis., Intervention: Sustained-release bupropion hydrochloride, 150 mg/d (n = 105) or 300 mg/d (n = 104), or placebo (n = 103) for 6 weeks, plus weekly brief individual counseling. Subjects were followed up at 12 weeks (by telephone call) and 26 weeks., Main Outcome Measure: Confirmed 7-day point prevalence abstinence at 6 weeks and 30-day prolonged abstinence (carbon monoxide level < 10 ppm at each visit; urinary cotinine level < or = 50 microg/L at weeks 2 and 6)., Results: Cotinine-confirmed 7-day point prevalence abstinence rates at 6 weeks were as follows: placebo, 5.6%; 150 mg, 10.7%; and 300 mg, 14.5% (P = .03, 300 mg vs placebo). At 26 weeks, confirmed point prevalence abstinence rates were as follows: placebo, 10.3%; 150 mg, 3.1%; and 300 mg, 13.9% (P = .049). During treatment, confirmed point prevalence rates were significantly higher for 300 mg than placebo at every week except week 4., Conclusions: Sustained-release bupropion hydrochloride, 300 mg/d, plus brief counseling demonstrated short-term efficacy for adolescent smoking cessation. Abstinence rates were lower than those reported for adults, with rapid relapse after medication discontinuation., Trial Registration: clinicaltrials.gov Identifier: NCT00344695.

This article presents findings from a qualitative study of 53 low-income women who were smokers at the onset of pregnancy. Study participants were interviewed during pregnancy to document smoking trajectories and factors contributing to, or undermining, harm reduction and quit attempts. Thirty percent of women quit smoking completely, 43% engaged in sustained harm reduction, and 26% reduced their smoking levels intermittently. Case studies of women are presented to illustrate reasons for quitting, harm reduction practices, and factors influencing relapse and smoking continuation. Women's motivations to quit are highlighted. Moral identity as a mother was found to be a key motivating factor behind women's quit attempts. Future programs targeting this population would do well to acknowledge moral identity as an issue and recognize the challenges of quitting for women with limited social support and little control over their immediate environment.

Objective: To explore Indonesian physician's smoking behaviours, their attitudes and clinical practices towards smoking cessation., Design: Cross-sectional survey., Setting: Physicians working in Jogjakarta Province, Indonesia, between October and December 2003., Subjects: 447 of 690 (65%) physicians with clinical responsibilities responded to the survey (236 men, 211 women), of which 15% were medical faculty, 35% residents and 50% community physicians., Results: 22% of male (n = 50) and 1% of female (n = 2) physicians were current smokers. Approximately 72% of physicians did not routinely ask about their patient's smoking status. A majority of physicians (80%) believed that smoking up to 10 cigarettes a day was not harmful for health. The predictors for asking patients about smoking were being male, a non-smoker and a medical resident. The odds of advising patients to quit were significantly greater among physicians who perceived themselves as sufficiently trained in smoking cessation., Conclusions: Lack of training in smoking cessation seems to be a major obstacle to physicians actively engaging in smoking cessation activities. Indonesian physicians need to be educated on the importance of routinely asking their patients about their tobacco use and offering practical advice on how to quit smoking.

Objectives: To describe characteristics of health influencers (HIs) prior to training in brief tobacco cessation interventions (BI)., Methods: HIs (n=910) in Arizona were recruited for a randomized controlled trial comparing training modalities., Results: Typically middle-aged (M=43, SD=14), non-Hispanic white (68%), female (77%), non-tobacco users (93%), most identified personal (89%) rather than job-related (3%) motivators for becoming cessation interveners. Confidence about intervention ability was high (93%); knowledge scores, however, were low (M=55%, SD=13%)., Conclusions: HIs exhibiting high motivation to intervene but lacking knowledge about BI strategies may be an untapped resource for tobacco cessation and a variety of other health promotion interventions.

Although spousal support predicts the success of a smoker's cessation efforts, "social-support" interventions based on teaching partners better support skills have had consistently disappointing results. We examined the potential utility of a family consultation (FAMCON) intervention based on family-systems principles in a treatment-development project involving 20 couples in which one partner (the primary smoker) continued to smoke despite having or being at significant risk for heart or lung disease. The 50% rate of stable abstinence achieved by primary smokers over at least 6 months exceeds benchmark success rates reported in the literature for other comparably intensive interventions, suggesting that a couple-focused intervention different in concept and format from social-support interventions tested in the past may hold promise for health-compromised smokers. The FAMCON approach appeared particularly well suited to female smokers and smokers whose partner also smoked--two subgroups at high risk for relapse.

The Society for Research on Nicotine and Tobacco (SRNT) has a critical role to play in advancing tobacco research globally. To date SRNT has sponsored a number of successful initiatives including meetings held by the society's European affiliate, establishment of the Global Network Committee in 1999, and the 2003 and 2005 global tobacco pre-conferences. The most recent SRNT conference was held for the first time outside of North America and attracted over 900 participants from 50 countries. SRNT also has sponsored workshops, provided member scholarships to researchers from low- and middle-income countries, and partnered with the World Health Organization to host www.treatobacco.net. Although these initiatives are impressive, SRNT can further support global tobacco research by (a) working with other organizations to support global tobacco science and policy (this is especially timely given the recent coming into force of the Framework Convention on Tobacco Control), (b) providing more resources including increased funding and access to online journals for those in low- and middle-income countries, (c) increasing the representation of science at world and national tobacco conferences, and (d) expanding the role of the Training Committee to place increased emphasis on mentoring tobacco scientists from low- and middle-income countries. Science will be crucial in addressing the global tobacco pandemic, and SRNT is uniquely positioned to further tobacco science and research capacity on a global basis.

Many smokers are not ready to quit but are interested in changing their smoking behavior, particularly if such a change is associated with a reduction in health risk. The present study evaluated the efficacy of the nicotine inhaler in reducing smoking. Exploratory studies assessed whether reduction in smoking was associated with reduction in markers of disease risk. A total of 429 healthy smokers (smoking at least 20 cigarettes/day) were randomly assigned to either nicotine-containing or placebo inhalers, which subjects were allowed to use ad libitum for up to 1 year. The nicotine inhaler was significantly superior to placebo in achieving reduction in daily cigarette consumption by at least 50% after 4 months, compared with baseline (18% vs. 8%, p = .004). Active treatment promoted smoking cessation: 8% of subjects in the nicotine group and 1% in the placebo group were abstinent at month 15. Throughout the study, smoking reduction, per se, independent of treatment group, was associated with a statistically significant decrease in exhaled carbon monoxide and serum cotinine and thiocyanate. Smoking reduction also improved established risk markers for cardiovascular disease over 4 months. The incidence of adverse events did not differ significantly between the active and placebo groups. The most common treatment-related adverse events were throat irritation and cough. In conclusion, the nicotine inhaler can help smokers who are unable or unwilling to quit to reduce daily cigarette consumption, which may be a health benefit on its own and may further promote quitting.

Parental tobacco use is a serious health issue for all family members. Child health care clinicians are in a unique and important position to address parental smoking because of the regular, multiple contacts with parents and the harmful health consequences to their patients. This article synthesizes the current evidence-based interventions for treatment of adults and applies them to the problem of addressing parental smoking in the context of the child health care setting. Brief interventions are effective, and complementary strategies such as quitlines will improve the chances of parental smoking cessation. Adopting the 5 A's framework strategy (ask, advise, assess, assist, and arrange) gives each parent the maximum chance of quitting. Within this framework, specific recommendations are made for child health care settings and clinicians. Ongoing research will help determine how best to implement parental smoking-cessation strategies more widely in a variety of child health care settings.

Objective: To evaluate the effectiveness of the Nicotrol nicotine inhaler as an aid to smoking cessation in over-the-counter (OTC) versus health-care-provider (HCP) conditions., Methods: Five hundred twenty healthy smokers were randomized to the treatment conditions and followed for a year., Results: At most follow-up visits, abstinence rates for the HCP group were 2 to 3 times those observed in the OTC group. Abstinence at 1 year was.77% in the OTC condition versus 3.08% in the HCP condition [P<.01]. Inhaler use was low., Conclusions: OTC nicotine inhaler appears to be ineffective, though quit rates are improved with HCP assistance.

Nicotine replacement therapy relieves withdrawal symptoms, significantly improving smoking cessation rates. Oral transmucosal nicotine (OT-NIC) is a novel nicotine delivery system consisting of a lozenge (OT-NIC unit) containing 4 mg of nicotine, which is dissolved in the cheek pouch, releasing nicotine for absorption through the buccal mucosa. Theoretical advantages of OT-NIC include that it does not require special chewing methods or interfere with dental work, it provides sensory oral effect, and it can be dosed to effect. This study aimed to determine the preliminary safety and efficacy of OT-NIC for suppression of nicotine withdrawal symptoms over 8 days of smoking abstinence and to assess flavor preference, sensory characteristics, and acceptability. In an open-label, within-subjects design, 11 smokers used three different flavors of OT-NIC ad lib in response to withdrawal symptoms and craving. On days 1 and 8, withdrawal symptoms were measured with pre- and postadministration scores for each of the first three OT-NIC units used (three different flavors presented in random order). Flavor preference, desire to smoke, sensory characteristics, acceptability, and overall OT-NIC performance were rated at the end of each day. A generalized estimating equation analysis was conducted to account for the repeated-measures design. Use of OT-NIC resulted in a significant decrease in a composite withdrawal score aggregating scores from all eight symptoms (decline of.57 units in a possible range of 4, p<.01). Withdrawal scores for anxiety, craving, difficulty concentrating, impatience, and restlessness significantly decreased. Depressed mood, increased appetite, and irritability did not change. Order of flavor preference was peppermint over cinnamon over plain. Acceptability and ratings for sensory characteristics were favorable, and OT-NIC was well tolerated with no serious adverse effects. In conclusion, OT-NIC showed promise as a potential new aid for smoking cessation.

Background: This article presents findings from qualitative interviews conducted as part of a research study that trained Acupuncture, Massage, and Chiropractic practitioners' in Arizona, US, to implement evidence-based tobacco cessation brief interventions (BI) in their routine practice. The qualitative phase of the overall study aimed to assess: the impact of tailored training in evidence-based tobacco cessation BI on complementary and alternative medicine (CAM) practitioners' knowledge and willingness to implement BIs in their routine practice; and their patients' responses to cessation intervention in CAM context. Methods: To evaluate the implementation of skills learned from a tailored training program, we conducted semi- structured qualitative interviews with 54 CAM practitioners in Southern Arizona and 38 of their patients. Interview questions focused on reactions to the implementation of tobacco cessation BIs in CAM practice. Results: After participating in a tailored BI training, CAM practitioners reported increased confidence, knowledge, and motivation to address tobacco in their routine practice. Patients were open to being approached by CAM practitioners about tobacco use and viewed BIs as an expected part of wellness care. Conclusions: Tailored training motivated CAM practitioners in this study to implement evidence-based tobacco cessation BIs in their routine practice. Results suggest that CAM practitioners can be a valuable point of contact and should be included in tobacco cessation efforts. [ABSTRACT FROM AUTHOR]

Background: Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners - that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. Methods: Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. Results: CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. Conclusions: The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner's role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners' work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners' clinical behavior is underway. [ABSTRACT FROM AUTHOR]

Purpose. To provide a snapshot of provider-based complementary and alternative medicine (pbCAM) use among adult smokers and assess the opportunity for these providers to deliver tobacco cessation interventions. Design. Cross-sectional analysis of data from the 2002 and 2007 National Health Interview Surveys. Setting. Nationally representative sample. Subjects. A total of 54,437 (31,044 from 2002; 23,393 from 2007) adults 18 years and older. Measures. The analysis focuses on 10 types of pbCAM, including acupuncture, Ayurveda, biofeedback, chelation therapy, chiropractic care, energy therapy, folk medicine, hypnosis, massage, and naturopathy. Analysis. The proportions of current smokers using any pbCAM as well as specific types of pbCAM in 2002 and 2007 are compared using SAS SURVEYLOGISTIC. Results. Between 2002 and 2007, the percentage of recent users of any pbCAM therapy increased from 12.5% to 15.4% (p = .001). The largest increases occurred in massage, chiropractic, and acupuncture. Despite a decrease in the national average of current smokers (22.0% to 19.4%; p = .001), proportions of smokers within specific pbCAM disciplines remained consistent. Conclusion. Complementary and alternative medicine (CAM) practitioners, particularly those in chiropractic, acupuncture, and massage, represent new cohorts in the health care community to promote tobacco cessation. There is an opportunity to provide brief tobacco intervention training to CAM practitioners and engage them in public health efforts to reduce the burden of tobacco use in the United States. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of tobacco cessation brief-intervention (BI) training for lay "health influencers," on knowledge, self-efficacy and the proportion of participants reporting BI delivery post-training. Methods: Randomized, community-based study comparing In-person or Web-based training, with mailed materials. Results: In-person and Web-training groups had significant post-training cessation knowledge and self-efficacy gains. All groups increased the proportion of individuals reporting BIs at follow-up, with no significant between-group differences. Irrespective of participants' prior intervention experience, 80%-86% reported BIs within the past 90 days; 71%- 79% reported ≥1 in the past 30. Conclusions: Web and In-person training significantly increase health influencer cessation knowledge and self-efficacy. With minimal prompting and materials, even persons without BI experience can be activated to encourage tobacco cessation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of the Nicotrol® nicotine inhaler as an aid to smoking cessation in over-the-counter (OTC) versus health-care-provider (HCP) conditions. Methods: Five hundred twenty healthy smokers were randomized to the treatment conditions and followed for a year. Results: At most follow- up visits, abstinence rates for the HCP group were 2 to 3 times those observed in the OTC group. Abstinence at 1 year was .77% in the HCP condition versus 3.08% in the HCP condition [P<.01]. In. baler use was low. Conclusions: OTC nicotine inhaler appears to be ineffective, though quit rates are improved with HCP assistance. [ABSTRACT FROM AUTHOR]

Provides further groundwork for a systemic, couple-focused intervention with high-risk, change-resistant smokers. Review and critique of cessation literature; Family consultation approach to intervention; Vignettes from work with change-resistant smokers that illustrate couple-level ironic patterns.

This study examined nicotine replacement effects and pre-quit smoking characteristics with respect to post-cessation weight gain in a primarily Mexican-American sample of Hispanic smokers. Hispanic smokers (108) were randomly assigned to receive either nicotine transdermal patch or placebo patch for 10 weeks, during which time smoking status and weight change were measured. The overall weight gain experienced by the successful quitters was greater than that experienced by non-quitters. Differences between quitters and non-quitters were significant for both females (2.0 vs. 0.86 kg; p < 0.05) and for males (2.3 vs. 1.2 kg; p < 0.05) at 6 weeks post-randomization. At the end of the 10-week treatment, only the females showed a significant difference in weight gain between the quitters and non-quitters (2.8 vs. 1.1; p < 0.01). Results of the random effects regression models for quitters indicated that the active group gained weight at a significantly lower rate than the placebo group (p = 0.047) for females, but not for males (p = 0.87). Years of smoking (p = 0.001) but not baseline cigarettes (p = 0.13) were significant predictors of weight for females, but not for males (p = 0.24 and 0.72, respectively). The use of nicotine patch treatment for smoking cessation effectively attenuated weight gain for successful female quitters compared with placebo-treated quitters. Identification of pre-quit smoking characteristics may prove useful in predicting who is most likely to gain weight when quitting smoking. [ABSTRACT FROM AUTHOR]

Introduction: Brief behavioral intervention (BI) is a tobacco-cessation best practice well established among conventional healthcare practitioners. Complementary and alternative medicine (CAM) practitioners treat significant numbers of tobacco users, but do not systematically receive BI training. The CAM Reach study developed and evaluated a tobacco cessation BI training program/practice system intervention adapted specifically for CAM practitioners, and evaluated in real-world CAM practices.Study Design: Single-arm intervention. Data were collected in 2010-2014 and analyzed in 2015.Setting/participants: Private practices of 30 chiropractors, 27 acupuncturists, 42 massage therapists (N=99), in metropolitan Tucson, Arizona.Intervention: Eight-hour tobacco cessation BI continuing education workshop, in-office BI skills practice/assessment, and system intervention. Training tailored to the CAM practice setting addressed tobacco cessation best practices from the U.S. Public Health Service Guidelines.Main Outcome Measures: Seventeen items (assessing practitioner behavior, motivation, and self-efficacy with tobacco cessation) comprising three factors, Tobacco Cessation Activity, Tobacco Cessation Motivation, and Non-CAM Tobacco Cessation Comfort, were assessed at baseline and 3, 6, 9, and 12 months post-training by practitioner self-report. Research staff visited practices at approximately the same intervals to directly observe changes in clinical practice systems.Results: At 3 months, there were significant increases in practitioners' tobacco cessation activities, motivation and confidence in helping patients quit tobacco, and comfort with providing information and referrals for guideline-based tobacco cessation aids (p<0.0001). Practitioners significantly increased rates of discussing cessation medications with patients (AOR=3.76, 95% CI=1.84, 7.68), and routinely asking about tobacco use in clinical practice (AOR=2.62, 95% CI=1.11, 6.20). Increases occurred across all three practitioner types and were sustained at 12 months-despite heterogeneity in professional training, practice patterns/organization, and practice business models.Conclusions: Results suggest CAM practitioners are willing and able to offer BIs, and are an important, yet overlooked channel for promoting tobacco cessation and use of evidence-based cessation aids. [ABSTRACT FROM AUTHOR]

Background: Complementary and alternative medicine (CAM) practitioners, such as chiropractors, acupuncturists, and massage therapists, are a growing presence in the US health care landscape and already provide health and wellness care to significant numbers of patients who use tobacco. For decades, conventional biomedical practitioners have received training to provide evidence-based tobacco cessation brief interventions (BIs) and referrals to cessation services as part of routine clinical care, whereas CAM practitioners have been largely overlooked for BI training. Web-based training has clear potential to meet large-scale training dissemination needs. However, despite the exploding use of Web-based training for health professionals, Web-based evaluation of clinical skills competency remains underdeveloped. Objective: In pursuit of a long-term goal of helping CAM practitioners integrate evidence-based practices from US Public Health Service Tobacco Dependence Treatment Guideline into routine clinical care, this pilot protocol aims to develop and test a Web-based tobacco cessation training program tailored for CAM practitioners. Methods: In preparation for a larger trial to examine the effect of training on CAM practitioner clinical practice behaviors around tobacco cessation, this developmental study will (1) adapt an existing in-person tobacco cessation BI training program that is specifically tailored for CAM therapists for delivery via the Internet; (2) develop a novel, Web-based tool to assess CAM practitioner competence in tobacco cessation BI skills, and conduct a pilot validation study comparing the competency assessment tool to live video role plays with a standardized patient; (3) pilot test the Web-based training with 120 CAM practitioners (40 acupuncturists, 40 chiropractors, 40 massage therapists) for usability, accessibility, acceptability, and effects on practitioner knowledge, self-efficacy, and competency with tobacco cessation; and (4) conduct qualitative and quantitative formative research on factors influencing practitioner tobacco cessation clinical behaviors (eg, practice environment, peer social influence, and insurance reimbursement). Results: Web-training and competency assessment tool development and study enrollment and training activities are complete (N=203 practitioners enrolled). Training completion rates were lower than expected (36.9%, 75/203), necessitating over enrollment to ensure a sufficient number of training completers. Follow-up data collection is in progress. Data analysis will begin immediately after data collection is complete. Conclusions: To realize CAM practitioners' potential to promote tobacco cessation and use of evidence-based treatments, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors (eg, social influence and insurance reimbursement). Given marked differences between conventional and CAM practitioners, extant knowledge about factors influencing conventional practitioner adoption of tobacco cessation behaviors cannot be confidently extrapolated to CAM practitioners. The potential impact of this study is to expand tobacco cessation and health promotion infrastructure in a new group of health practitioners who can help combat the continuing epidemic of tobacco use. [ABSTRACT FROM AUTHOR]

Objective: In this project we developed and evaluated a mobile health app to improve adherence to tobacco cessation medication.Methods: The study was conducted in three phases: (1) Create app with input from our consultant, focus groups and user testing; (2) Test feasibility of the app; and (3) Develop and user-test the barcode scanner.Results: Focus group feedback was instrumental in developing content and creating the user interface. User testing helped to identify problems and refine the app. The feasibility trial provided "real world" testing. We experienced challenges in recruitment due to the inclusion criteria. We had high attrition due to technical issues, medication side effects, enrollment procedures, and lack of personal contact. Among the five retained participants, use of the app was associated with good medication adherence and high consumer satisfaction.Conclusion: The small sample size limits the generalizability of the findings and the conclusions that can be drawn from the study. However, the feasibility trial enabled the team to identify ways to improve the conduct of this and other mHealth studies.Practical Implications: We should expand RxCoach to include all prescription and over-the-counter tobacco cessation medications, and re-test for feasibility using lessons learned to improve recruitment and retention. [ABSTRACT FROM AUTHOR]