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Objective: To summarize findings from qualitative studies on factors associated with smoking cessation among adolescents and young adults., Data Sources: We searched Pubmed, Psychinfo, CINAHL, Embase, Web of Science, and SCOPUS databases, as well as reference lists, for peer-reviewed articles published in English or French between January 1, 2000, and November 18, 2020. We used keywords such as adolescents, determinants, cessation, smoking, and qualitative methods., Study Selection: Of 1724 records identified, we included 39 articles that used qualitative or mixed methods, targeted adolescents and young adults aged 10-24, and aimed to identify factors associated with smoking cessation or smoking reduction., Data Extraction: Two authors independently extracted the data using a standardized form. We assessed study quality using the National Institute for Health and Care Excellence checklist for qualitative studies., Data Synthesis: We used an aggregative meta-synthesis approach and identified 39 conceptually distinct factors associated with smoking cessation. We grouped them into two categories: (1) environmental factors [tobacco control policies, pro-smoking norms, smoking cessation services and interventions, influence of friends and family], and (2) individual attributes (psychological characteristics, attitudes, pre-quitting smoking behavior, nicotine dependence symptoms, and other substances use). We developed a synthetic framework that captured the factors identified, the links that connect them, and their associations with smoking cessation., Conclusions: This qualitative synthesis offers new insights on factors related to smoking cessation services, interventions, and attitudes about cessation (embarrassment when using cessation services) not reported in quantitative reviews, supplementing limited evidence for developing cessation programs for young persons who smoke., Implications: Using an aggregative meta-synthesis approach, this study identified 39 conceptually distinct factors grouped into two categories: Environmental factors and individual attributes. These findings highlight the importance of considering both environmental and individual factors when developing smoking cessation programs for young persons who smoke. The study also sheds light on self-conscious emotions towards cessation, such as embarrassment when using cessation services, which are often overlooked in quantitative reviews. Overall, this study has important implications for developing effective smoking cessation interventions and policies that address the complex factors influencing smoking behavior among young persons., (© The Author(s) 2023. 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: Quitting smoking by the mid-30 s conveys important health benefits. Yet, although many smokers attempt to quit, few succeed. Identification of the characteristics of adolescent smokers most likely to continue smoking between ages 30 and 40 could help target early cessation efforts. Our objectives in this study were to (i) describe the course of smoking in a population-based sample of high school smokers into their 20 s and 30 s, and (ii) identify distal predictors of past-year cigarette smoking at age 31., Methods: Data at ages 17 (in 11th grade), 20, 24 and 31 were drawn from a 20-year longitudinal study of students ages 12-13 at inception, from 10 high schools in Montréal, Canada. Associations between 11 smoking-related characteristics measured in 11th grade and past-year smoking at age 31 were estimated in multivariable logistic regression models., Results: Among 244 11th grade smokers (67.4% female; 41% daily smokers), past-year smoking was reported by 71% at age 20, 68% at age 24, and 52% at age 31. Only 12% reported abstinence at ages 20, 24 and 31. Females were less likely than males to smoke at age 31. Parental smoking while the smoker was in 11th grade, use of other tobacco products, longer time since smoking onset, weekly or daily smoking, monthly cigarette consumption, and perceived nicotine addiction predicted past-year smoking at age 31., Conclusions: In addition to preventive interventions, cessation programs targeting novice smokers in high school as soon as they begin smoking, are warranted., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose: To update a systematic review published in 2012 that identified predictors of cigarette smoking cessation among adolescents., Methods: The PubMed and Web of Science databases were searched for relevant articles published between September 2010 and January 2018, using the following keywords: smoking OR tobacco OR cessation; quit OR stop; longitudinal OR prospective OR cohort. Our search identified 3,399 articles. Inclusion criteria included longitudinal studies (intervention and cohort studies) evaluating cigarette smoking cessation in young people (aged 10-24 years). After screening, in total, 34 articles were included in the review., Results: In total, 63 predictors of smoking cessation among adolescents were identified, with 36 new predictors that were not identified in the previous review: nine sociodemographic factors, 13 psychosocial factors, five behavioral factors, 19 social influences factors, eight smoking related variables, six environmental factors, 2 health related variables, and one genetic factor., Conclusions: To increase the probability of successful smoking cessation, strategies targeting young smokers should consider both individual and environmental predictors of cessation., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Because there are few proven smoking cessation approaches for young adults, it is critical to consider the potential of e-cigarettes as an option. Evidence from 2012 to 2013 in the United States (U.S.) suggested that current e-cigarette use was associated with a higher probability of daily smoking and a lower probability of quitting among young adults. This study examines the associations between e-cigarette use frequency and cigarette smoking in more recent data. Data on e-cigarette use were available for 32,656 current smokers and 9,565 past-year quitters ages 18-34 in the 2016-2018 U.S. Behavioral Risk Factor Surveillance System. Participants were categorized as "daily", "non-daily", "former", or "never" e-cigarette users. Adjusted prevalence ratios were estimated to test the associations between e-cigarette use and each of daily smoking and past-year cessation. With e-cigarette never-users as the reference: 1) daily e-cigarette users were 30% (95%CI 0.61-0.79) less likely to be daily smokers; non-daily and former e-cigarette users were 8% (95%CI 1.02-1.15) and 16% (95%CI 1.11-1.21) more likely to be daily smokers, respectively; 2) daily e-cigarette users were 54% (95%CI 1.38-1.73) more likely to have quit in the past year; non-daily and former e-cigarette users were 50% (95%CI 0.42-0.59) and 21% (95%CI 0.73-0.86) less likely to have quit in the past year, respectively. The findings suggest that non-daily e-cigarette use was associated with greater frequency of smoking and less quitting whereas daily e-cigarette use was associated with a lower frequency of smoking and more quitting among young adults in 2016-18., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Although most young adult smokers want to quit smoking, few can do so successfully. Increased understanding of reasons to quit in this age group could help tailor interventions, but few studies document reasons to quit in young adults or examine reasons to quit by smoker characteristics., Methods: In 2011-12, 311 current smokers (age 22-28, M=24.1; 48.9% male, 51.1% female; 50.4% daily smokers) from the Nicotine Dependence in Teens Study completed the Adolescent Reasons for Quitting scale. We assessed differences in the importance of 15 reasons to quit by sex, education, smoking frequency, quit attempt in the past year, perceived difficulty in quitting, and motivation to quit. We also examined differences between participants who discounted the importance of long-term health risks and those who acknowledged such risks., Results: Concerns about getting sick or still smoking when older were considered very important by >70% of participants. Median scores were higher among daily smokers, those who had tried to quit or who expressed difficulty quitting, and those with strong motivation to quit. Discounters (14.5% of participants) were primarily nondaily, low-consumption smokers. Their Fagerström Test for Nicotine Dependence scores did not differ from non-discounters', and 11% (vs. 35.7% of non-discounters) were ICD-10 tobacco dependent., Conclusions: Novel smoking cessation interventions are needed to help young adult smokers quit by capitalizing on their health concerns. Discounters may need educational intervention to better understand the impact of even "light" smoking on their health before or in conjunction with quit interventions., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Previous trials examining the use of bupropion for smoking cessation therapy after myocardial infarction (MI) have been inconclusive. To understand better the observed lack of effectiveness of bupropion in this population, we examined abstinence rates by level of adherence across treatment groups., Methods: We used data from a randomized, double-blind, placebo-controlled trial of bupropion in smokers (n = 388) hospitalized with MI to study the association of interest. Patients were classified as being fully adherent if they reported taking 2 pills/d; partially adherent if they reported 0, 1, and/or 2 pills/d; and nonadherent if they reported 0 and/or 1 pill/d throughout the 9-week treatment period. Abstinence was assessed by 7-day biochemically validated self-report at 4 and 9 weeks and 6 and 12 months., Results: A total of 156 patients were fully adherent to the study medication (66 bupropion and 90 placebo), 149 were partially adherent (76 and 73, respectively), and 83 were nonadherent (46 and 37, respectively). Regardless of treatment group, patients who were fully or partially adherent reported greater abstinence than did nonadherent patients. Among partially adherent patients, bupropion conferred an important benefit at 12 months (% difference 13.3, 95% CI 1.3-25.3). At 12 months, patients who were fully adherent were more likely to be abstinent compared with those who were nonadherent (adjusted odds ratio 7.6, 95% CI 3.2-17.6)., Conclusions: Adherence to study medication, regardless of assigned treatment, is associated with a substantial increase in abstinence. Patients who are motivated to quit smoking should be targeted for smoking cessation treatment after MI., (Copyright © 2015 Elsevier Inc. All rights reserved.)

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: Current guidelines recommend smoking cessation and weight management for secondary prevention in patients post-myocardial infarction. However, little is known about the effects of smoking cessation on weight change post-myocardial infarction., Methods: We examined patterns of weight change and its effects on blood pressure and glycemic control using data from a randomized trial investigating the effect of bupropion on smoking cessation in patients post-myocardial infarction. Weight change was compared among 3 groups of patients: those who were completely abstinent (n = 92), those who smoked intermittently (n = 49), and those who smoked persistently (n = 38) during the 12-month follow-up. Analyses were restricted to patients who attended all follow-up visits., Results: The median weight at baseline was 77.1 kg (interquartile range [IQR], 66.0, 87.5), and 64.3% of patients were overweight/obese (body mass index ≥25.0 kg/m(2)). The median weight gain at 12 months was 4.0 kg (IQR, 0-7.0), with more than one third gaining >5 kg. The proportion of patients who were overweight/obese increased by approximately 10%, and 23.2% of patients moved up a body mass index category. Abstainers gained a median of 4.8 kg (IQR, 1.0, 8.6), intermittent smokers gained a median of 2.0 kg (IQR, -2.0, 5.0), and persistent smokers gained a median of 3.0 kg (IQR, -0.8, 6.0). Weight gain was associated with an increase in blood pressure and requirements for hypoglycemic medications at 12 months., Conclusions: The majority of patients attempting to quit smoking gain weight 12 months post-myocardial infarction, with abstainers gaining more weight than those who return to smoking. Weight gain was associated with an increased prevalence of hypertension and diabetes., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: The use of bupropion, a smoking cessation aid, has been associated with improved health-related quality of life (HRQOL) in the general population of smokers; but, its effect on HRQOL in post-myocardial infarction (MI) patients remains unknown., Objectives: To examine the effect of bupropion on HRQOL in post-MI patients who are attempting to quit smoking., Methods: To accomplish this objective, we used data from a randomized, double-blind, placebo-controlled trial in 392 hospitalized post-MI patients. Treatment duration was 9 weeks, and follow-up was 12 months. HRQOL was assessed via the EuroQol-5D (EQ-5D) questionnaire, which includes 5 dimensions (mobility, self-care, daily activities, pain/discomfort, and anxiety/depression). Analyses were restricted to patients (n=225) who completed the EQ-5D at baseline, 6 months, and 12 months., Results: Patients randomized to bupropion (n=109) and those randomized to placebo (n=116) experienced similar improvements in HRQOL during follow-up (difference in change in EQ-5D index from baseline to 6 months = 0.02, 95% confidence interval [CI] = -0.04, 0.08; from baseline to 12 months = 0.02, 95% CI = -0.04, 0.08). No between-group differences were observed in any of the 5 dimensions. Similar improvements in HRQOL were observed between patients who remained abstinent and those who relapsed. Lower baseline HRQOL, defined as having a HRQOL that was less than the median value, was associated with decreased smoking abstinence at 12 months follow-up (odds ratio OR =0.39, 95% CI = 0.22, 0.68)., Conclusions: Bupropion does not improve HRQOL among patients attempting to quit smoking post-MI.

Introduction: To determine if smoking cessation counseling practices and related psychosocial characteristics improved among pharmacists between 2005 and 2010., Methods: Data were collected in 2005 and 2010 from randomly selected pharmacists in Québec, Canada. Participants completed mailed self-report questionnaires on cessation counseling practices and psychosocial characteristics (i.e., belief that counseling is the role of pharmacists, self-efficacy, barriers, and knowledge of community resources). The association between each of year and training (either during or after undergraduate studies) and each outcome was investigated in each sex separately with multiple linear regression models using pooled data across 2005 and 2010., Results: Among female pharmacists, cessation counseling for patients ready to quit improved over time. Training during and after undergraduate studies was significantly associated with higher self-efficacy, better knowledge of community resources, and improved counseling for patients ready and not ready to quit. Also, training after studies was significantly associated with more advantageous beliefs about counseling. Among male pharmacists, knowledge of community resources and perceived barriers to counseling improved over time, but there were no significant differences in cessation counseling. Training during and after undergraduate studies was significantly associated with higher self-efficacy. Training during undergraduate studies was also associated with higher counseling score in patients ready to quit, and training after studies was associated with better knowledge of community resources., Conclusion: Smoking cessation counseling for patients ready to quit improved from 2005 to 2010 among female pharmacists but not among male pharmacists. Training is generally associated with improved counseling and improved cessation-related psychosocial characteristics.

Objective: We assessed whether smoking cessation counseling practices and related psychosocial characteristics among respiratory therapists (RTs) improved between 2005 and 2010., Methods: Data were collected in mailed self-report questionnaires in 2005 and in 2010, in random independent samples of active licensed RTs in Québec, Canada., Results: The response proportion was 67.6% in 2005 and 59.9% in 2010. There were no substantial differences in mean cessation counseling scores according to year of survey. RTs who reported that they had received cessation counseling training during their studies or after their studies (when they were in practice) had statistically significantly better counseling practices for both patients ready and patients not ready to quit than untrained RTs. In addition, their self-efficacy to provide effective counseling was higher and they perceived fewer knowledge-related barriers to cessation. Further, RTs trained after their studies perceived fewer patient-related and time barriers to cessation counseling, and had better knowledge of community resources., Conclusions: Although the proportion of RTs trained in smoking cessation counseling during and after studies increased between 2005 and 2010 (from 3% to 14%, and from 17% to 29%, respectively), sustained efforts are needed to increase the number of trained RTs, so that this translates into positive observable changes in counseling practices.

Variation in the CYP2A6 gene, which decreases the rate of nicotine metabolic inactivation, is associated with higher adult smoking cessation rates during clinical trials. We hypothesized that slow metabolism is associated with increased quitting during adolescence. White adolescent smokers (N=308, aged 12-17, 36.3% male) from a cohort study were genotyped for CYP2A6, resulting in 7.8% slow, 14.0% intermediate and 78.2% normal metabolizers. Overall, 144 smokers quit smoking, as indicated by being abstinent for at least 12 months. In logistic regression analyses, the odds ratio for quitting was 2.25 (95% confidence interval 1.05, 4.80; P=0.037) for slow metabolizers relative to normal metabolizers. A linear trend toward increased quitting with decreasing CYP2A6 activity was also observed (odds ratio=1.44, 95% confidence interval 1.02, 2.01; P=0.034). Thus, CYP2A6 slow metabolism is associated with increased adolescent smoking cessation, indicating that even early in the smoking history, genetic variation is influencing smoking cessation.

Objectives: The purpose of this study was to examine smoking cessation rates among smokers with AMI to determine whether bupropion, started in-hospital, is safe and can improve cessation rates at 1 year., Background: Bupropion doubles quit rates in otherwise healthy smokers and patients with stable cardiovascular disease. Although 2 previous trials examined the use of bupropion in patients hospitalized with acute cardiovascular disease, these studies have been inconclusive with respect to its safety and efficacy in patients with acute myocardial infarction (AMI)., Methods: We conducted a multicenter, double-blind, placebo-controlled, randomized trial in smokers hospitalized with AMI. Participants received bupropion or placebo for 9 weeks and were followed for 12 months. Both groups received low-intensity counseling. Point prevalence abstinence was assessed by 7-day recall and biochemical validation of expired carbon monoxide., Results: A total of 392 patients were randomized (mean age 53.9 ± 10.3 years); 83.5% were male; 64.9% had ST-segment elevation myocardial infarction). Patients smoked a mean of 23.2 ± 10.6 cigarettes/day for a mean of 32.9 ± 12.4 years. At 12 months, point prevalence abstinence rates were 37.2% in the bupropion group and 32.0% in the placebo group (p = 0.33; % difference after adjusting for between center differences 3.9%). Continuous abstinence rates were 26.8% and 22.2%, respectively (p = 0.34). Major adverse cardiac event rates were similar (13.0% vs. 11.0%, respectively; p = 0.64)., Conclusions: Two-thirds of patients return to smoking by 12 months after AMI. Bupropion is well tolerated and seems to be safe to use in the immediate post-AMI period. However, bupropion is not effective for smoking cessation in patients post-AMI., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the determinants of self-initiated smoking cessation of duration of at least 6 months as identified in longitudinal population-based studies of adolescent and young adult smokers., Methods: A systematic search of the PubMed and EMBASE databases using smoking, tobacco, cessation, quit and stop as keywords was performed. Limits included articles related to humans, in English, published between January 1984 and August 2010, and study population aged 10-29 years. A total of 4502 titles and 871 abstracts were reviewed independently by 2 and 3 reviewers, respectively. Nine articles were retained for data abstraction. Data on study location, timeframe, duration of follow-up, number of data collection points, sample size, age/grade of participants, number of quitters, smoking status at baseline, definition of cessation, covariates and analytic method were abstracted from each article. The number of studies that reported a statistically significant association between each determinant investigated and cessation were tabulated, from among all studies that assessed the determinant., Results: Despite heterogeneity in methods across studies, five factors robustly predicted quitting across studies in which the factor was investigated: not having friends who smoke, not having intentions to smoke in the future, resisting peer pressure to smoke, being older at first use of cigarette and having negative beliefs about smoking., Conclusions: The literature on longitudinal predictors of cessation in adolescent and young adult smokers is not well developed. Cessation interventions for this population will remain less than optimally effective until there is a solid evidence base on which to develop interventions.

The neurobiology of tobacco use is poorly understood, possibly in part because the relevant mechanisms might differ depending on past nicotine exposure and degree of addiction. In the present study we investigated whether these factors might affect the role of dopamine (DA). Using the acute phenylalanine/tyrosine depletion method (APTD), DA synthesis was transiently decreased in three groups of abstinent smokers (n=47): (1) early low-frequency smokers, who had smoked a maximum of five cigarettes per day for less than one year, (2) stable low-frequency smokers smoking at the same level as early low-frequency smokers for at least 3 years, and (3) stable high-frequency smokers, who smoked a minimum of 10 or more cigarettes per day for at least 5 years. Motivation to obtain tobacco was measured using a progressive ratio breakpoint schedule for nicotine-containing and de-nicotinized cigarettes. Compared with a nutritionally balanced control mixture, APTD decreased the self-administration of nicotine-containing cigarettes, and this occurred in all three groups of smokers. The results suggest that DA influenced the willingness to sustain effort for nicotine reward, and this was seen in participants at all three levels of cigarette addiction. In the transition from sporadic to addicted use, the role of DA in the motivation to seek drug may change less than previously proposed.

Background: Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive., Objective: To conduct a meta-analysis of RCTs examining counselling in pregnant smokers., Search Strategy: We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling., Selection Criteria: We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date., Data Collection and Analysis: Overall estimates were derived using random effects meta-analysis models., Main Results: Our search identified eight RCTs (n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84-1.40). There was no evidence to suggest that efficacy differed by counselling type., Conclusions: Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population., (© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.)

Objective: Smoking cessation counseling practices may differ between physicians who smoke and those who have quit or never smoked., Method: Of 917 general practitioners (GP) in Montreal mailed self-report questionnaires in 2000 and 2004, 610 provided data on their smoking status and counseling practices., Results: Seven percent were current smokers, 32% were former smokers, and 61% were never-smokers. Current smokers were more interested than never- or former smokers in learning about counseling methods (64%, 56%, 45%, respectively; p = 0.018). In multivariable analyses, current smokers were less likely than never-smokers to ascertain the smoking status of their patients (OR 0.6, 95% CI 0.2-1.6); to provide advice on how to quit (OR 0.6, 0.3-1.3); and to provide complete cessation counseling coverage (OR 0.5, 0.2-1.1). Former smokers were more likely to provide adjunct support (OR 1.5, 1.0-2.4)., Conclusion: GP smoking status was associated with the content of their cessation interventions with patients who smoke. Taking physician smoking status into consideration in the design of cessation training programs may improve cessation counseling interventions.

Introduction: Several meta-analyses have examined the efficacy of smoking cessation therapies in the general population. However, little is known about the efficacy of these therapies in cardiac patients. Therefore, a meta-analysis of randomized controlled trials (RCTs) was performed to determine the efficacy of behavioural therapy and pharmacotherapy for smoking cessation in cardiac patients., Methods: The medical literature was systematically reviewed to identify smoking cessation RCTs in cardiac patients. Only RCTs that reported smoking abstinence at six or 12 months were included. Smoking abstinence was examined based on the 'most rigorous criterion', defined as the most conservative outcome reported in any given RCT., Results: Eleven behavioural therapy RCTs that enrolled 2105 patients and four pharmacotherapy RCTs that enrolled 1542 patients were identified. RCTs differed in the type of behavioural therapy administered as well as the total length and duration of the intervention. RCTs differed in the type of pharmacotherapy administered (one nicotine patch RCT, one nicotine gum RCT and two bupropion RCTs). Behavioural therapy was associated with a significantly higher proportion of smoking abstinence than usual care (OR 1.97 [95% CI 1.37 to 2.85]). Pharmacotherapies were more efficacious than placebo (pooled OR 1.72 [95% CI 1.15 to 2.57])., Conclusions: Both behavioural therapy and pharmacotherapy are more efficacious than usual care for smoking cessation in cardiac patients. The present meta-analysis highlights the need for head-to-head RCTs to identify which smoking cessation therapy is preferred in cardiac patients as well as RCTs examining the efficacy of combined behavioural and pharmacotherapies.

Objective: To evaluate the impact of a smoke-free class competition in elementary schools in Québec, Canada before widespread dissemination of the program across the province., Methods: In a quasiexperimental study design, 843 students in 27 schools exposed to "Mission TNT.06" were compared to 1213 students in 57 matched comparison schools. Baseline data were collected in grade 6 prior to implementation of the program. Follow-up data were collected in grade 7 after students had transitioned to secondary school., Results: The program improved knowledge about the harmful effects of second-hand smoke, but had no impact on knowledge about the harmful effects of smoking, attitudes about the acceptability of cigarettes, beliefs about the tobacco industry, or self-efficacy to resist peer pressure to smoke. After exposure to the program, intervention students were more likely to misreport their smoking status and to report unfavourable attitudes about classmates who smoke., Conclusion: Mission TNT.06 may encourage young smokers to misreport their smoking status and to marginalise classmates who smoke. These findings prompted recommendations to conduct more in-depth evaluation of the smoke-free class competition before widespread dissemination of the program across the province.

Introduction: Smoking cessation counseling by health professionals is an effective approach to increase cessation rates among smokers. To guide the development of training and educational interventions, we surveyed six health professional groups including general practitioners (GPs), pharmacists, dentists, dental hygienists, nurses, and respiratory therapists, in order to describe current practices and identify the correlates of smoking cessation counseling., Methods: Self-administered questionnaires were mailed to 500 persons randomly selected from the membership lists of active licensed professionals in each health professional group in Québec., Results: Response proportions ranged from 52% (nurses) to 70% (dental hygienists). Compared with other groups, GPs and pharmacists undertook more counseling with patients ready to quit. GPs and respiratory therapists undertook more counseling with patients not ready to quit. Three factors emerged consistently across most groups as positively associated with counseling, including the belief that counseling is the role of health professionals, perceived self-efficacy to engage in effective counseling, and knowledge of community cessation resources., Discussion: The correlates of cessation counseling are similar across health professional groups. Interventions that address beliefs that cessation counseling is the role of health professionals, self-efficacy to provide effective counseling, and knowledge of community resources may result in improved cessation counseling practices among health professionals.

Aims: Widely varying estimates of treatment effects have been reported in randomized controlled trials (RCTs) investigating the efficacy of behavioural interventions for smoking cessation. Previous meta-analyses investigating behavioural interventions have important limitations and do not include recently published RCTs. We undertook a meta-analysis of RCTs to synthesize the treatment effects of four behavioural interventions, including minimal clinical intervention (brief advice from a healthcare worker), and intensive interventions, including individual, group, and telephone counselling., Methods and Results: We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline, and PsycINFO databases. We included only RCTs that reported biochemically validated smoking cessation outcomes at 6 and/or 12 months after the target quit date. Outcomes were aggregated using hierarchical Bayesian random-effects models. We identified 50 RCTs, which randomized n = 26 927 patients (minimal clinical intervention: 9 RCTs, n = 6456; individual counselling: 23 RCTs, n = 8646; group counselling: 12 RCTs, n = 3600; telephone counselling: 10 RCTs, n = 8225). The estimated mean treatment effects were minimal clinical intervention [odds ratio (OR) 1.50, 95% credible interval (CrI) 0.84-2.78], individual counselling (OR 1.49, 95% CrI 1.08-2.07), group counselling (OR 1.76, 95% CrI 1.11-2.93), and telephone counselling (OR 1.58, 95% CrI 1.15-2.29)., Conclusion: Intensive behavioural interventions result in substantial increases in smoking abstinence compared with control. Although minimal clinical intervention may increase smoking abstinence, there is insufficient evidence to draw strong conclusions regarding its efficacy.

Objectives: We sought to document the sequence and timing of milestones in the process of smoking cessation by prospectively studied cessation milestones among novice adolescent smokers., Methods: Participants, aged 12 to 13 years in 1999 (n = 1293), completed self-report questionnaires every 3 months during the school year over 5 years. We ascertained time after first puff to attain 5 cessation milestones among 319 participants who initiated cigarette smoking during follow-up., Results: The cumulative probability of first reports of a serious desire to quit and perceived permanent cessation was 25% at 1.5 months (95% confidence interval [CI] = 1.5, 2.5) after the first puff. The first serious quit attempt occurred at 2.5 months (95% CI = 2.5, 5.4), lack of confidence about quitting followed at 18.4 months (95% CI = 18.4, 26.8), and awareness of the difficulty of quitting occurred at 32.2 months (95% CI = 19.2, 38.4)., Conclusions: Desire and attempts to quit began soon after smoking onset. Novice smokers progressed through several stages in their perception of the difficulty of quitting. Increased understanding of the cessation process may help in developing effective tobacco control interventions for novice smokers.

Background: Many placebo-controlled trials have demonstrated the efficacy of individual pharmacotherapies approved for smoking cessation. However, few direct or indirect comparisons of such interventions have been conducted. We performed a meta-analysis to compare the treatment effects of 7 approved pharmacologic interventions for smoking cessation., Methods: We searched the US Centers for Disease Control and Prevention's Tobacco Information and Prevention database as well as MEDLINE, EMBASE and the Cochrane Library for published reports of placebo-controlled, double-blind randomized controlled trials of pharmacotherapies for smoking cessation. We included studies that reported biochemically validated measures of abstinence at 6 and 12 months. We used a hierarchical Bayesian random-effects model to summarize the results for each intervention., Results: We identified 70 published reports of 69 trials involving a total of 32 908 patients. Six of the 7 pharmacotherapies studied were found to be more efficacious than placebo: varenicline (odds ratio [OR] 2.41, 95% credible interval [CrI] 1.91-3.12), nicotine nasal spray (OR 2.37, 95% CrI 1.12-5.13), bupropion (OR 2.07, 95% CrI 1.73-2.55), transdermal nicotine (OR 2.07, 95% CrI 1.69-2.62), nicotine tablet (OR 2.06, 95% CrI 1.12-5.13) and nicotine gum (OR 1.71, 95% CrI 1.35-2.21). Similar results were obtained regardless of which measure of abstinence was used. Although the point estimate favoured nicotine inhaler over placebo (OR 2.17), these results were not conclusive because the credible interval included unity (95% CrI 0.95-5.43). When all 7 interventions were included in the same model, all were more efficacious than placebo. In our analysis of data from the varenicline trials that included bupropion control arms, we found that varenicline was superior to bupropion (OR 2.18, 95% CrI 1.09-4.08)., Interpretation: Varenicline, bupropion and the 5 nicotine replacement therapies were all more efficacious than placebo at promoting smoking abstinence at 6 and 12 months.

Objective: To synthesise estimates of the prevalence of cessation attempts among adolescent smokers generally, and according to age and level of cigarette consumption., Data Sources: PubMed, ERIC, and PsychInfo databases and Internet searches of central data collection agencies., Study Selection: National population-based studies published in English between 1990 and 2005 reporting the prevalence, frequency and/or duration of cessation attempts among smokers aged >or=10 to <20 years., Data Extraction: Five reviewers determined inclusion criteria for full-text reports. One reviewer extracted data on the design, population characteristics and results from the reports., Data Synthesis: In total, 52 studies conformed to the inclusion criteria. The marked heterogeneity that characterised the study populations and survey questions precluded a meta-analysis. Among adolescent current smokers, the median 6-month, 12-month and lifetime cessation attempt prevalence was 58% (range: 22-73%), 68% (range 43-92%) and 71% (range 28-84%), respectively. More than half had made multiple attempts. Among smokers who had attempted cessation, the median prevalence of relapse was 34, 56, 89 and 92% within 1 week, 1 month, 6 months, and 1 year, respectively, following the longest attempt. Younger (age<16 years) and non-daily smokers experienced a similar or higher prevalence of cessation attempts compared with older (age >or=16 years) or daily smokers. Moreover, the prevalence of relapse by 6 months following the longest cessation attempt was similar across age and smoking frequency., Conclusions: The high prevalence of cessation attempts and relapse among adolescent smokers extends to young adolescents and non-daily smokers. Cessation surveillance, research and program development should be more inclusive of these subgroups.

Objectives: To describe gender differences in smoking cessation counseling practices among general practitioners (GPs), and to investigate the association between training for cessation counseling and counseling practices according to gender., Methods: Data were collected in two cross-sectional mail surveys conducted in independent random samples of GPs in Montreal, the first in 1998, and the second in 2000., Results: Respondents included 653 GPs (71% of 916 eligible). All indicators of smoking cessation counseling practices were more favorable among female GPs. Higher proportions of female GPs had received training (28% vs. 17%, p=0.002), and were aware of mailed print educational materials related to cessation counseling (81% vs. 57%, p<0.0001). Training among male GPs was associated with higher scores for ascertainment of smoking status (odds ratio (OR) (95% confidence interval)=1.69 (0.97, 2.96)), provision of advice (OR=2.20 (1.23, 3.95)), and provision of adjunct support (OR=2.86 (1.58, 5.16)). Training was not associated with counseling practices among female GPs., Conclusions: Female GPs may not benefit from formal cessation counseling training to the same extent as male GPs, possibly because they read and integrate the content of (easily available) print educational materials into their clinical practice to a greater extent than male GPs. The gender-specific impact of print educational material and formal training on cessation counseling should be evaluated among GPs.

The analysis reported in this paper was conducted to further explore initially negative findings of a study intended to help orient the development, implementation, and evaluation of smoking cessation programs for junior college students. A total of 69 students (39 males and 30 females) participated in nine focus group discussions held at one French-speaking and one English-speaking college in central Montreal. Three groups consisted of ex-smokers, and the remainder were current smokers. Group participants were asked to react to a series of proposed smoking cessation interventions identified from the literature. Qualitative analysis was undertaken of verbatim transcriptions of five of the focus group discussions, with input from the four others. Second-level analysis of the focus group data suggested that the students' reactions to proposed smoking cessation interventions could be understood using Eriksonian developmental theory, in particular how the cessation programs could contribute to the process of consolidating personal and social identity. Implications for the design of cessation programs were then identified. The results of these exploratory analyses suggested that to attract and maintain participation of college students, smoking cessation interventions should not necessarily be centered on smoking but rather (a) provide opportunities and support for exploration of, and commitment to, personal and social identities that exclude smoking, (b) target naturally occurring social groups while responding to students' needs for social support and validation, and (c) help students cope with stress and life demands and not add to these.

Background: Despite the cost-effectiveness of physician smoking cessation counseling, many physicians do not adhere to current clinical practice guidelines., Methods: A cross-sectional mail survey was conducted in a random sample of general practitioners in Montreal to document cessation-counseling practices and identify correlates of these activities., Results: Of 440 eligible general practitioners, 337 (77%) completed the questionnaire. Despite favorable beliefs/attitudes about cessation counseling, only 10.5% of general practitioners provided "thorough" counseling. While high proportions of general practitioners ascertained smoking status and encouraged patients to quit, relatively few offered adjunct support (i.e., for patients preparing to quit, 49.8% offered follow-up visits; 42.5% offered educational material; 20% referred patients to community resources). Correlates of counseling completeness included high self-efficacy to provide counseling (odds ratio (OR) = 2.0, 95% confidence interval (1.1-3.6)) and favorable beliefs/attitudes about counseling (OR = 3.6 (2.0-6.4)). Correlates of ascertaining smoking status included female gender (OR = 2.3 (1.5-3.5)), high self-efficacy (OR = 3.5 (2.0-5.9)), and favorable beliefs/attitudes (OR = 2.7 (1.6-4.5)). Correlates of offering adjunct support included female gender (OR = 1.9 (1.1-3.2)), awareness of stages of change (OR = 2.4 (1.3-4.4)), and knowledge of community resources to help patients quit (OR = 2.3 (1.3-3.9))., Conclusion: Support, training, and intervention programs to overcome lack of awareness and knowledge, unfavorable beliefs/attitudes, and low self-efficacy could increase and enhance cessation counseling practices among general practitioners., (Copyright 2001 American Health Foundation and Elsevier Science.)

In 1997 the Direction de la santé publique de Montréal-Centre initiated "Physicians Taking Action Against Smoking," a 5-year intervention program to improve the smoking cessation counselling practices of general practitioners (GPs) in Montreal. Program development was guided by the precede-proceed model. This model advocates identifying factors influencing the outcome, in this case counselling practices. These factors are then used to determine the program objectives, to develop and tailor program activities and to design the evaluation. Program activities during the first 3 years included cessation counselling workshops and conferences for GPs, publication of articles in professional interest journals, publication of clinical guidelines for smoking cessation counselling and dissemination of educational material for both GPs and smokers. The program also supported activities encouraging smokers to ask their GPs to help them stop smoking. Results from 2 cross-sectional surveys, conducted in 1998 and 2000, of random samples of approximately 300 GPs suggest some improvements over time in several counselling practices, including offering counselling to more patients and discussing setting a quit date. More improvements were observed among female than male GPs in both psychosocial factors related to counselling and specific counselling practices. For example, improvements were noted among female GPs in self-perceived ability to provide effective counselling and in the belief that it is important to schedule specific appointments to help patients quit; in addition, the perceived importance of several barriers to counselling decreased among female GPs. A greater proportion of the female respondents to the 2000 survey offered written educational material than was the case in 1998, and a greater proportion of the male GPs devoted more time to counselling in 2000 than in 1998; however, among male GPs the proportion who discussed the pros and cons of smoking with patients in the pre-contemplation stage declined between 1998 and 2000, as did the proportion who referred patients in the preparation stage to community resources. Our experience suggests that an integrated, theory-based program to improve physicians' counselling practices could be a key component of a comprehensive strategy to reduce tobacco use.

The objectives were to evaluate the impact of "Yes, I Quit" (a smoking cessation course tailored for women in a low income, low education community), and to identify baseline predictors of short and longer-term self-reported cessation. The impact was evaluated in a before-after study design with no comparison group. Baseline data were collected in self-administered questionnaires at the beginning of the first session of the course. Follow-up data were collected in telephone interviews at one, three and six months after the designated Quit Day. Self-reported quit rates among 122 participants were 31.1%, 24.7% and 22.3% at one, three and six months. Non-quitters reduced their consumption by 10.3, 8.3, and 7.1 cigarettes per day at one, three and six months. Multivariate logistic regression analyses showed that being in excellent/good health was significantly associated with cessation at one month (odds ratio (OR) = 2.4). Being married (OR = 13.0) and no other smokers in the household (OR = 3.6) were associated with three-month cessation. Only being married was associated with six-month cessation (OR = 6.8). "Yes, I Quit" produced quit rates among low income, low education participants comparable to those reported for cessation programs directed at the general population of smokers. Good health is associated with early cessation, while support from a spouse is important to maintaining a non-smoking status among quitters.

A contest to encourage smokers to quit and to remain nonsmokers for at least six weeks was held in a low income neighbourhood in Montreal. The contest was one of many activities for a multifactorial community-based heart health promotion program. The objective of this article is to describe the intervention and its evaluation and to reflect on its relative successes. Thirty-one persons registered for the contest, seven stopped smoking during the six-week contest, and six persons remained abstinent two weeks after the end of it. Concrete recommendations regarding the contest and implementation of a smoking cessation program are discussed.

Please cite this paper as: Filion K, Abenhaim H, Mottillo S, Joseph L, Gervais A, O'Loughlin J, Paradis G, Pihl R, Pilote L, Rinfret S, Tremblay M, Eisenberg M. The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials. BJOG 2011;118:1422-1428. Background Pregnant smokers are often prescribed counselling as part of multicomponent cessation interventions. However, the isolated effect of counselling in this population remains unclear, and individual randomised controlled trials (RCTs) are inconclusive. Objective To conduct a meta-analysis of RCTs examining counselling in pregnant smokers. Search strategy We searched the CDC Tobacco Information and Prevention, Cochrane Library, EMBASE, Medline and PsycINFO databases for RCTs evaluating smoking cessation counselling. Selection criteria We included RCTs conducted in pregnant women in which the effect of counselling could be isolated and those that reported biochemically validated abstinence at 6 or 12 months after the target quit date. Data collection and analysis Overall estimates were derived using random effects meta-analysis models. Main results Our search identified eight RCTs ( n = 3290 women), all of which examined abstinence at 6 months. The proportion of women that remained abstinent at the end of follow up was modest, ranging from 4 to 24% among those randomised to counselling and from 2 to 21% among control women. The absolute difference in abstinence reached a maximum of only 4%. Summary estimates are inconclusive because of wide confidence intervals, albeit with little evidence to suggest that counselling is efficacious at promoting abstinence (odds ratio 1.08, 95% confidence interval 0.84-1.40). There was no evidence to suggest that efficacy differed by counselling type. Conclusions Available data from RCTs examining the isolated effect of smoking cessation counselling in pregnant women are limited but sufficient to rule out large treatment effects. Future RCTs should examine pharmacological therapies in this population. [ABSTRACT FROM AUTHOR]