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Introduction: Understanding the characteristics of smokers who enroll in a trial of quitline support and those who decline could guide recruitment approaches and service delivery to better engage smokers and increase successful quitting. However, it is unknown whether factors such as smokers' perceived effectiveness of using quitting aids or self-exempting beliefs are associated with quitline uptake. We compared the sociodemographic characteristics, smoking behaviours, perceived effectiveness of using quitting aids, and self-exempting beliefs of participants and nonparticipants who were actively telephoned and offered quitline support as part of a randomized controlled trial., Methods: Overall, 48,014 telephone numbers were randomly selected from the electronic telephone directory and contacted. A total of 3,008 eligible smokers were identified and invited to participate in a trial of quitline support. Consenting trial participants (n = 1,562) and nonparticipants (n = 500) completed a baseline interview., Results: Multivariate analysis showed that the following factors were associated with trial participation: consumption of 21 or more cigarettes per day (odds ratio [OR] = 1.45 [1.07-1.99]), readiness to quit within 30 days (OR = 4.45 [3.20-6.19]) or 6 months (OR = 3.22 [2.46-4.23]), perceiving that calling the quitline was definitely (OR = 2.34 [1.62-3.39]) or partly effective (OR = 2.15 [1.63-2.83]), believing that using self-help materials was partly effective (OR = 1.50 [1.16-1.94]), thinking that nicotine replacement therapy was partly effective (OR = 1.38 [1.04-1.84]), perceiving that using willpower alone was partly (OR = 1.99 [1.48-2.67]) or not effective (OR = 2.60 [1.95-3.46]), and not holding a self-exempting belief (OR = 1.45 [1.11-1.89])., Conclusions: Increasing smokers' utilization of quitlines is likely to require changing their perceptions of the effectiveness of quitting strategies compared with using willpower alone and addressing self-exempting beliefs.

Aims: Active recruitment of smokers increases the reach of quitlines; however, some quitlines restrict proactive telephone counselling (i.e. counsellor-initiated calls) to smokers ready to quit within 30 days. Identifying characteristics associated with successful quitting by actively recruited smokers could help to distinguish those most likely to benefit from proactive telephone counselling. This study assessed the baseline characteristics of actively recruited smokers associated with prolonged abstinence at 4, 7 and 13 months and the proportion achieving prolonged abstinence that would miss out on proactive telephone counselling if such support was offered only to smokers intending to quit within 30 days at baseline., Design: Secondary analysis of a randomized controlled trial in which the baseline characteristics associated with prolonged abstinence were examined., Setting: New South Wales (NSW) community, Australia., Participants: A total of 1562 smokers recruited at random from the electronic NSW telephone directory., Measurements: Baseline socio-demographic and smoking-related characteristics associated with prolonged abstinence at 4, 7 and 13 months post-recruitment., Findings: Waiting more than an hour to smoke after waking and intention to quit within 30 days at baseline predicted five of the six prolonged abstinence measures. If proactive telephone counselling was restricted to smokers who at baseline intended to quit within 30 days, 53.8-65.9% of experimental group participants who achieved prolonged abstinence would miss out on telephone support., Conclusions: Less addicted and more motivated smokers who are actively recruited to quitline support are more likely to achieve abstinence. Most actively recruited smokers reported no intention to quit within the next 30 days, but such smokers still achieved long-term abstinence., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

Introduction: Only 1%-7% of smokers use quitlines annually. Active telephone recruitment ("cold calling") can enroll about 50% of community smokers to quitline services. However, whether cold-called smokers' characteristics differ from traditional quitline clients is unknown. To assess whether active telephone recruitment reaches new groups of smokers, New South Wales (NSW) Quitline callers were compared with cold-called smokers who received telephone counseling as part of a randomized controlled trial., Methods: Data were extracted from the NSW Quitline database from September 13, 2005, to April 10, 2007, to coincide with the trial's recruitment period. Records (n = 18,584) of first-time quitline callers, who smoked daily, resided in NSW, Australia, and received telephone counseling were included. Cold-called participants who received telephone counseling (n = 695) were recruited by telephone from the electronic NSW telephone directory. Eligibility requirements were daily tobacco use, aged 18 or older, NSW resident, and English speaking. Smokers were eligible regardless of their quitting intention., Results: Male smokers, older age groups, those living in nonmetropolitan areas, smokers who took longer to smoke their first cigarette after waking, consumed fewer cigarettes per day, and were less motivated to quit had greater odds of being referred to the quitline through cold calling., Conclusions: Active telephone recruitment enrolls new groups of smokers to quitlines. The reach of quitlines could be improved if quitlines incorporated cold calling into their recruitment strategies.

Introduction and Aims: The aim of this study was to describe a sample of Australian methadone clients with respect to smoking and cessation-related behaviours and motivations., Design and Methods: A cross-sectional survey was completed by 103 methadone clients in the Hunter Region of New South Wales, Australia., Results: Characteristics of the sample included low socioeconomic status, and high polydrug use and nicotine dependence. Key findings were a high prevalence of smoking (84%) and low likelihood of quitting, including a quit ratio of less than 10%. Over half of smokers were classified as 'Precontemplative', and 34% as 'hard-core' smokers., Discussion and Conclusions: The need for research to develop and test tailored interventions for this population is highlighted, as is the need for methadone services and staff to facilitate client smoking cessation., (© 2011 Australasian Professional Society on Alcohol and other Drugs.)

Background: Systematic reviews demonstrated that proactive telephone counseling increases smoking cessation rates. However, these reviews did not differentiate studies by recruitment channel, did not adequately assess methodological quality, and combined different measures of abstinence., Methods: Twenty-four randomized controlled trials published before December 31, 2008, included seven of active recruitment, 16 of passive recruitment, and one of mixed recruitment. We rated methodological quality on selection bias, study design, confounders, blinding, data collection methods, withdrawals, and dropouts, according to the Quality Assessment Tool for Quantitative Studies. We conducted random effects meta-analysis to pool the results according to abstinence type and follow-up time for studies overall and segregated by recruitment channel, and methodological quality. The level of statistical heterogeneity was quantified by I(2). All statistical tests were two-sided., Results: Methodological quality ratings indicated two strong, 10 moderate, and 12 weak studies. Overall, compared with self-help materials or no intervention control groups, proactive telephone counseling had a statistically significantly greater effect on point prevalence abstinence (nonsmoking at follow-up or abstinent for at least 24 hours, 7 days before follow-up) at 6-9 months (relative risk [RR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43, P < .001, I(2) = 21.4%) but not at 12-15 months after recruitment. This pattern also emerged when studies were segregated by recruitment channel (active, passive) or methodological quality (strong/moderate, weak). Overall, the positive effect on prolonged/continuous abstinence (abstinent for 3 months or longer before follow-up) was also statistically significantly greater at 6-9 months (RR = 1.58, CI = 1.26 to 1.98, P < .001, I(2) = 49.1%) and 12-18 months after recruitment (RR = 1.40, CI = 1.23 to 1.60, P < .001, I(2) = 18.5%)., Conclusions: With the exception of point prevalence abstinence in the long term, these data support previous results showing that proactive telephone counseling has a positive impact on smoking cessation. Proactive telephone counseling increased prolonged/continuous abstinence long term for both actively and passively recruited smokers.

Objectives: Active telephone recruitment ('cold calling') can enroll almost 45 times more smokers to cessation services than media. However, the effectiveness of proactive telephone counselling with cold-called smokers from the broader community is unknown. This study examined whether proactive telephone counselling improved abstinence, quit attempts and reduced cigarette consumption among cold-called smokers., Methods: From 48,014 randomly selected electronic telephone directory numbers, 3008 eligible smokers were identified and 1562 (51.9%) smokers recruited into the randomised controlled trial. Of these, 769 smokers were randomly allocated to proactive telephone counselling and 793 to the control (ie, mailed self-help) conditions. Six counselling calls were offered to intervention smokers willing to quit within a month and four to those not ready to quit. The 4-month, 7-month and 13-month follow-up interviews were completed by 1369 (87.6%), 1278 (81.8%) and 1245 (79.9%) participants, respectively., Results: Proactive telephone counselling participants were significantly more likely than controls to achieve 7-day point prevalence abstinence at 4 months (13.8% vs 9.6%, p=0.005) and 7 months (14.3% vs 11.0%, p=0.02) but not at 13 months. There was a significant impact of telephone counselling on prolonged abstinence at 4 months (3.4% vs 1.8%, p=0.02) and at 7 months (2.2% vs 0.9%, p=0.02). At 4 months post recruitment, telephone counselling participants were significantly more likely than controls to have made a quit attempt (48.6% vs 42.9%, p=0.01) and reduced cigarette consumption (16.9% vs 9.0%, p=0.0002)., Conclusions: Proactive telephone counselling initially increased abstinence and quitting behaviours among cold-called smokers. Given its superior reach, quitlines should consider active telephone recruitment, provided relapse can be reduced., Trial Registration: Australian New Zealand Clinical Trial Registry; ACTRN012606000221550.

Background: Only 1%-7% of adult smokers use quitlines annually. Active telephone recruitment may increase utilization and enroll new groups of quitline users., Purpose: This study aimed to (1) determine the proportion of adult daily smokers actively recruited by telephone to quitline support; (2) calculate the cost per smoker recruited; and (3) compare the characteristics of participants to smokers in the New South Wales (NSW, Australia) general population., Methods: Between September 2005 and April 2007, 1562 adult daily smokers randomly selected from the electronic NSW telephone directory were recruited into an RCT. The proportion of smokers and the cost per smoker recruited were examined. Participants were compared to NSW adult daily smokers from the NSW Population Health Survey and the Centre for Health Research & Psycho-oncology Smoking Community Survey. Analysis was completed in 2008., Results: More than half (52%) of eligible smokers contacted by telephone were recruited into cessation support. The cost per smoker recruited was AU$71 (US$59). Active telephone recruitment successfully enrolled smokers who are currently under-represented among quitline users. For instance, more than two thirds (68%) of participants were not intending to quit within 1 month. Compared with NSW adult daily smokers, participants were significantly more likely to be older; more highly educated; married/living with partner or divorced/separated; a nonmetropolitan resident; more nicotine dependent; more ready to quit; and have fewer household members. Participants were significantly less likely to live with a smoker than were NSW adult daily smokers., Conclusions: Active telephone recruitment has the potential to substantially increase the proportion of smokers using quitline services at a reasonable cost. This method also engages smokers currently under-represented in quitline populations.

Introduction: Passive recruitment strategies relying on smoker-initiated contact probably contribute to particular groups of smokers using quitlines. Compared with the smoking population, smokers who call quitlines are more likely to be female, younger, higher educated, more addicted, quit previously, and motivated to quit. Quitlines could adopt new recruitment approaches such as active telephone recruitment involving recruiter-initiated contact, since this may enroll a broader representation of smokers. This study explored acceptability of active telephone recruitment to quitline support, smokers' use, and acceptability of assistance and predictors of acceptability., Methods: Smokers (N = 1,562) randomly selected from the New South Wales telephone directory were actively recruited by telephone into a randomized controlled trial that offered proactive telephone counseling (n = 769) or self-help materials (control: n = 793). Overall, 1,369 completed the 4-month postrecruitment interview, which examined acceptability., Results: More than 90% of 4-month interview respondents found active telephone recruitment to cessation assistance acceptable. Of smokers allocated to proactive telephone counseling (n = 769), 90% accepted at least one and 65% three or more counseling calls. Of control participants who completed the 4-month interview, 84% read at least some self-help materials. Proactive telephone counseling recipients were significantly more likely than self-help material users to find the advice useful. Few characteristics predicted acceptability of proactive telephone counseling or self-help materials, suggesting that many types of smokers actively recruited by telephone are receptive to support., Discussion: Active telephone recruitment could potentially enroll a broader representation of smokers to quitline services. Given these smokers are receptive to cessation assistance, quitlines should consider active telephone recruitment.

Introduction: Levels of hospital smoking cessation care are less than optimal. This study aimed to synthesize the evidence regarding the effectiveness of interventions in increasing smoking cessation care provision in hospitals., Methods: A review identified relevant studies published between 1994 and 2006. A description of studies, including methodological quality, was undertaken. Intervention effectiveness in increasing smoking cessation care practices was examined for controlled studies using meta-analysis. Care practices examined were assessment of smoking status; advice to quit; counseling or assistance to quit; advising, offering, or providing nicotine replacement therapy (NRT); and follow-up or referral., Results: Of the 25 identified studies, 18 were U.S. based and in inpatient settings. Of the 10 controlled trials, 4 addressed cardiac patients, 5 measured one smoking cessation care practice, and 9 implemented multistrategic interventions (e.g., combining educational meetings with reminders and written resources). The methodology described in these studies was generally of poor quality. Meta-analysis of controlled trials demonstrated a significant intervention effect for provision of assistance and counseling to quit (pooled risk difference = 16.6, CI = 4.9-28.3) but not for assessment of smoking status, advice to quit, or the provision or discussion of NRT. Statistical heterogeneity was indicated for all smoking cessation care practices. An insufficient number of studies precluded the use of meta-analysis for follow-up or referral for further assistance., Discussion: Interventions can be effective in increasing the routine provision of hospital smoking cessation care. Future research should use more rigorous study design, examine a broader range of smoking cessation care practices, and focus on hospital-wide intervention implementation.

Unlabelled: AIMS, DESIGN AND INTERVENTION: Smoking care provision to in-patients is important in assisting smoking cessation and for management of nicotine withdrawal. Limited studies have reported the effectiveness of interventions designed to increase the hospital-wide provision of such care. A quasi-experimental matched-pair trial, involving two intervention and two control hospitals in NSW, Australia, investigated whether a multi-strategic intervention increased hospital-wide smoking care provision., Participants and Measurements: Patient surveys (n = 274-347 per experimental condition), medical notes audits (n = 181-228) and health professional surveys (n = 229-302) were used to collect outcome data at baseline and follow-up., Findings: Significantly greater increases in intervention hospitals compared to control hospitals were found for patient-reported offer of nicotine replacement therapy (NRT) (intervention 34% versus control 12%), provision of NRT (16% versus 4%) and provision of written resources (11% versus 2%), and for the recording in medical notes of smoking management discussion (13% versus 3%), offer of NRT (24% versus 3%) and provision of NRT (21% versus 5%). Intervention group health professionals reported significantly greater increases in the mean estimate of patients who: had their smoking management discussed (30% versus 17%); were offered or provided with NRT (30% versus 18%); were asked their intention to smoke post-discharge (22% versus 10%); and were provided with discharge NRT (21% versus 4%)., Conclusions: Implementation of a multi-strategic intervention is effective in increasing hospital smoking care delivery, particularly the provision of NRT. Research is required to identify methods to increase further the delivery of this and other forms of smoking care.

Despite optimistic predictions when nicotine replacement therapy (NRT) was switched to over-the-counter (OTC) availability, population surveys have failed to demonstrate a positive impact on long-term smoking cessation. This review examined the strength of the evidence from randomised trials and comparison group studies supporting the effectiveness of OTCNRT. Twelve eligible studies were identified: OTCNRT was compared with placebo in four studies and with health professional-delivered NRT in four studies, and four studies involved community-based minimal intervention NRT. These studies were assessed systematically to determine their methodological quality and generalisibility to 'real-world' conditions of NRT use. The review found a number of issues, including provision of free NRT, heavy cigarette intakes (average 25 daily), high levels of personal interactions (7.6 per subject), lack of blindness assessment and failure of most studies to actively follow-up all subjects seriously limit the degree to which studies' results can be applied to non-research OTCNRT users. In addition, several important limitations affecting the meta-analyses of OTCNRT by Hughes et al. were highlighted. The review concluded that the superiority of OTCNRT over unaided smoking cessation has not been demonstrated convincingly. Future directions for research involve more innovative, rigorous controlled trials and prospective cohort studies where nicotine dependence is assessed adequately.

Hospitals are key settings for the provision of smoking cessation care. Limited data are available that describe the prevalence and type of such care delivered routinely in this setting. We reviewed studies conducted in hospitals and published between 1994 and 2005 that reported levels of smoking care delivery. This review describes the proportion of patients receiving, and the proportion of health professionals providing, various smoking cessation care practices. We used both descriptive and meta-analytic methods. According to the meta-analysis, smoking status was assessed in 60% of patients, 42% were advised or counseled to quit, 14% were provided with or advised to use nicotine replacement therapy (NRT), and 12% received referrals or follow-up. Significantly fewer patients received follow-up or referrals than were assessed for smoking status or received advice or counseling to quit. Some 81% of health professionals reported they assessed smoking status, 70% advised or counseled patients to quit, 13% provided NRT or advised its use, and 39% provided referrals or follow-up. Significantly fewer health professionals advised or prescribed NRT than assessed smoking status or advised or counseled patients to quit. Statistical heterogeneity was indicated for all smoking care practices. Levels of smoking cessation care are less than optimal in hospitals, and the levels of some important care practices are particularly low. Future research should identify effective methods for increasing smoking care provision in this setting. In addition, standardized measures of smoking care should be developed. Hospital organizations should enhance and continue to monitor their delivery of smoking care.

Objective: The study aimed to critically appraise the extent and strength of systematic review evidence for, and guideline recommendations regarding hospital smoking cessation interventions., Methods: Systematic reviews of smoking cessation interventions were identified via an electronic search of the Cochrane Library. Meta-analyses from Cochrane reviews were categorised as those that incorporated only studies of hospital based interventions, and those which incorporated interventions which were not hospital based. Smoking cessation guidelines for hospital health professionals were identified via a search of the World Wide Web., Results: The review found that evidence from meta-analyses restricted to hospital studies was insufficient to evaluate a number of specific intervention strategies and at times conflicted with the findings of meta-analyses without such restrictions. The majority of guidelines recommended the provision of brief advice, counseling, nicotine replacement therapy despite the absence of clear supporting evidence., Conclusions: Further hospital-based research addressing specific cessation strategies is required. Furthermore, smoking cessation guidelines for hospital based health professionals should more specifically reflect evidence from this setting.

Introduction and Aims: Increased access for smokers to pharmacotherapies for smoking cessation suggests that pharmacists have a potential role in influencing how these pharmacotherapies are used in the community. This study aimed to identify the extent and type of advice provided by pharmacists to customers purchasing nicotine replacement therapy (NRT) or bupropion and to identify pharmacists' perceptions about the desirability and feasibility of providing such advice., Design and Methods: A sample of 700 pharmacies was selected at random from the NSW Electronic Yellow Pages and a questionnaire was sent by mail, fax or e-mail to the pharmacist in charge., Results: From 665 eligible pharmacies, 375 pharmacists returned completed questionnaires, giving a response rate of 56.4%. Participants reported providing a mean of 5 minutes of advice to both bupropion and NRT purchasers, with 59.5% reporting the provision of behavioural advice to NRT purchasers. Although over 70% of pharmacists perceived the provision of a brochure about NRT or bupropion as desirable and feasible, brochures were provided to less than one-third of NRT purchasers., Discussion and Conclusions: Pharmacists report providing a sizeable amount of advice to purchasers of NRT and bupropion. Recommendations for enhancing the role of pharmacists in influencing the use of cessation pharmacotherapies are discussed briefly.

Issue Addressed: Quitting intentions and behaviours of smokers require monitoring. In particular, assessment of the distribution of smokers on the quitting continuum and of the proportion of hard-core smokers has implications for the design of future quit campaigns., Methods: Cross-sectional survey of 1,509 persons (74.4% consent rate) randomly selected from the New South Wales Electronic White Pages. 1,431 respondents were eligible (aged 18 and over)., Results: Current smokers comprised 19.1% (n=274) and former smokers 28.0% (n=400). Sixty-one per cent of current smokers had quit for at least one day in the last year and 67.1% were in the intermediate or advanced preparation levels of the quitting continuum. Half of the smokers (46.7%) recalled receiving cessation advice during a past-year medical visit. Sixty-four point five per cent (64.5%) of smokers and 63.4% of former smokers reported no use of assistance in their quit attempts. Five point five per cent (5.5%) of smokers aged 26 and over met the hard-core criteria., Conclusion: Most smokers want to quit but when making a quit attempt do not use proven, effective strategies. Relapse rates are high in the immediate post-cessation period.

In Australia, the prevalence of smoking is higher among certain sub-populations compared to the general population. These sub-populations include Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, as well as people with mental and substance use disorders and prisoners. The aims of this paper are to: describe the high prevalence of smoking among these particular sub-populations and harms associated with smoking; explore possible reasons for such high prevalence of smoking; review the evidence regarding the efficacy of existing smoking cessation interventions; and make recommendations for smoking interventions and further research among these groups. In addition to low socio-economic status, limited education and other factors, there are social, systems and psychobiological features associated with the high prevalence of smoking in these sub-groups. General population-based approaches to reducing smoking prevalence have been pursued for decades with great success and should be continued with further developments that aim specifically to affect Aboriginal and Torres Strait Islander people and some cultural groups. However, increasing attention, more specific targeting and flexible goals and interventions are also required for these and other distinct sub-populations with high smoking prevalence. Recommendations include: more funding and increased resources to examine the most appropriate education and treatment strategies to promote smoking cessation among people from Aboriginal and Torres Strait Islander and some culturally and linguistically diverse backgrounds; larger and better-designed studies evaluating smoking cessation/reduction interventions among distinct sub-groups; and system-wide interventions requiring strong leadership among clients and staff within mental health, drug and alcohol and prison settings.

A cross-sectional survey was mailed to all Australian drug and alcohol treatment agencies to assess their smoking cessation policies and practices and related staff attitudes. Barriers to smoking cessation interventions were also examined. Completed questionnaires were returned by 213 managers and 204 other staff representing 260 agencies (59.8% consent rate). Approximately one-quarter of agencies have smoking cessation intervention policies and one-third of clients receive adequate smoking advice. Of 12 intervention strategies, only the recording of smoking status on file occurs in a majority of cases. Concerns about the potential negative impact of smoking interventions and lack of client interest were endorsed as very important barriers by the highest percentage of respondents. 12.6% of managers and 16.5% of other staff agreed that it is occasionally useful for staff to smoke with a client. Smoking cessation receives little systematic attention from drug and alcohol agencies. Training and policy initiatives are needed urgently to address negative staff attitudes impeding progress in this area.

Objective: To explore the information received by NRT users; whether patterns of NRT use are in accordance with recommendations; and to identify the characteristics of those using NRT products., Methods: A cross-sectional, omnibus telephone survey of 1,509 community members was conducted in New South Wales, Australia in 2000. The survey identified 215 current and former smokers who completed additional questions regarding their most recent quit attempt., Results: Of the 215 current and former smokers, 67 (31.2%) had used NRT on their most recent quit attempt. The majority of NRT use (61%) lasted for less than two weeks. More than 40% of NRT users reported receiving no instructions from a doctor or pharmacist on how to use the product. Approximately one-third of NRT use was associated with concomitant smoking, with 10% of NRT use being associated with little or no reduction in reported daily cigarette consumption, Only 41.8% of NRT users reported a doctor had recommended using the product., Conclusions: Despite the small size of the sample, the data suggest a level of inappropriate use of NRT products in the community., Implications: Wider use and effective provision of support and advice to NRT users in the community must be addressed if this product is to achieve its optimal potential in aiding smoking cessation.

This selective review was undertaken in order to highlight the need for alcohol and other drug treatment services to provide intervention for tobacco smoking to their clients. The reasons for the failure of treatment services to date to deal with nicotine addiction within their programmes are discussed and positive suggestions for change are proferred. In addition to the transformation of institutional culture which will be required, managers and staff of alcohol and other drug agencies need to know how best to implement smoking intervention within the treatment setting. The paper concludes with some practical suggestions for the management of intervention for tobacco smoking within treatment settings. These suggestions include: making decisions and formulating policies and procedures with regard to how tobacco smoking will be addressed; considering the particular physical, psychological and social/environmental factors that apply to substance abuse clients; building intervention around a simple structure such as the '5 A's'; encouraging and facilitating the use of nicotine replacement therapies; and allowing flexibility to tailor intervention to the individual. A great deal of further research is required to inform us as to how to intervene most effectively for tobacco smoking among this population group.

This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level. [ABSTRACT FROM AUTHOR]

Background Systematic reviews demonstrated that proactive telephone counseling increases smoking cessation rates. However, these reviews did not differentiate studies by recruitment channel, did not adequately assess methodological quality, and combined different measures of abstinence. Methods Twenty-four randomized controlled trials published before December 31, 2008, included seven of active recruitment, 16 of passive recruitment, and one of mixed recruitment. We rated methodological quality on selection bias, study design, confounders, blinding, data collection methods, withdrawals, and dropouts, according to the Quality Assessment Tool for Quantitative Studies. We conducted random effects meta-analysis to pool the results according to abstinence type and follow-up time for studies overall and segregated by recruitment channel, and methodological quality. The level of statistical heterogeneity was quantified by I2. All statistical tests were two-sided. Results Methodological quality ratings indicated two strong, 10 moderate, and 12 weak studies. Overall, compared with self-help materials or no intervention control groups, proactive telephone counseling had a statistically significantly greater effect on point prevalence abstinence (nonsmoking at follow-up or abstinent for at least 24 hours, 7 days before follow-up) at 6–9 months (relative risk [RR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43, P < .001, I2 = 21.4%) but not at 12–15 months after recruitment. This pattern also emerged when studies were segregated by recruitment channel (active, passive) or methodological quality (strong/moderate, weak). Overall, the positive effect on prolonged/continuous abstinence (abstinent for 3 months or longer before follow-up) was also statistically significantly greater at 6–9 months (RR = 1.58, CI = 1.26 to 1.98, P < .001, I2 = 49.1%) and 12–18 months after recruitment (RR = 1.40, CI = 1.23 to 1.60, P < .001, I2 = 18.5%). Conclusions With the exception of point prevalence abstinence in the long term, these data support previous results showing that proactive telephone counseling has a positive impact on smoking cessation. Proactive telephone counseling increased prolonged/continuous abstinence long term for both actively and passively recruited smokers. [ABSTRACT FROM PUBLISHER]

After a brief overview of adolescent tobacco control, methodological features and content areas of 78 qualitative studies of adolescent smoking published in English prior to September 2002 were assessed. Narrative syntheses of three content areas - peer influences, access/sales issues, and dependence/addiction - were also undertaken. Many studies failed to provide sufficient sampling and subject characterization details and more effort was required to demonstrate data validity and reliability. Syntheses of the content areas revealed important common themes. Relationships to quantitative research were informative and suggested other research questions. The review highlights the heuristic value of qualitative research on adolescent smoking. Funding was provided by The Cancer Council New South Wales and NSW Health/Hunter Medical Research Institute. [ABSTRACT FROM AUTHOR]

A selective review of the literature was conducted to provide evidence-based recommendations for the clinical management of hospitalized smokers. The Cochrane library, in particular the Cochrane review of 'Interventions for smoking cessation in hospitalised patients', was the basis for the review and was supplemented with other clinical and non-clinical literature where the review did not inform clinicians sufficiently. Evidence was reviewed on issues considered by the authors to be of importance to health professionals interested in providing a smoking cessation intervention to their patients. The review suggests that effective hospital interventions: incorporate an in-patient intervention lasting greater than 20 minutes in duration with extended post discharge follow-up; consist of at least five intervention contacts; and be delivered over at least a 3-month period. Furthermore, interventions should include in-patient advice and counselling, the provision of nicotine replacement therapy and extended proactive post discharge telephone support. The review also indicates that cessation interventions are particularly effective when delivered to patients with a cardiovascular diagnosis. All health professionals may be effective in providing cessation treatments; however, the addition of a specialist smoking cessation counsellor appears to improve interventions in this setting. Finally, without the development of supportive systems, routine intervention with smoking patients by health professionals is unlikely. Recommendations for the delivery of effective smoking cessation interventions in hospitals are provided. [Wolfenden L, Campbell E, Walsh RA, Wiggers J. Smoking cessation interventions for in-patients: a selective review with recommendations for hospital-based health professionals. Drug Alcohol Rev 2003;22:437 - 452] [ABSTRACT FROM AUTHOR]

The aim of the research was to investigate the effect of two methods of dissemination on the implementation of a smoking cessation programme and use of smoking cessation interventions in antenatal clinics. A repeated-measures randomized design was used. Hospital antenatal clinics ( n = 23) were randomized to simple or intensive dissemination groups. All clinics in NSW with > 500 births were asked to participate. A survey of all clinical staff ( n = 323) in 23 antenatal clinics was carried out prior to programme dissemination and 18 months after dissemination ( n = 283). The response rate was 63%at baseline and 64% at follow-up. Smoking cessation intervention significantly increased after dissemination. ( F (18,1) = 49.26, p < 0.001). The average number of smoking cessation interventions provided by clinics after programme dissemination increased from 4.5 to 7. 48 (mean difference 2.98, t (19) 7.08, n < 0.001, 95% CI (2.1-3.86). Type of dissemination did not influence the number of programme components used or the number of smoking cessation interventions offered. Also, the estimated proportion of clients offered intervention by clinicians did not vary due to type of dissemination. A simple mail-out of a smoking cessation programme to antenatal clinics for use during pregnancy can increase clinician intervention for smoking. When more intensive methods of dissemination are used, the quality of the interventions implemented by clinicians improves. More research on dissemination methods are required as both methods of dissemination did not produce systematic or sustained use of the programme. \[Cooke M, Mattick RP, Walsh RA. Implementation of the 'Fresh start' smoking cessation programme to 23 antenatal clinics: a randomized controlled trial investigating two methods of dissemination. Drug Alcohol Rev 2001;20:19-28]. [ABSTRACT FROM AUTHOR]

Aims. Two methods of dissemination (simple and intensive) were used to disseminate a smoking cessation programme to doctors and midwives working in antenatal clinics. This paper describes the differential uptake of the smoking cessation programme by doctors and midwives. It investigates whether the number of smoking cessation interventions used differ due to the type of dissemination. It also examines the frequency with which doctors and midwives provide smoking cessation interventions after dissemination. Design. Clinics were randomized to the method of dissemination (simple or intensive). Pre-post test design was used to examine the relationship between dissemination method and professional status at baseline and follow-up. A baseline survey collected data on the use of smoking cessation intervention in the clinics prior to dissemination. A follow-up survey was conducted 18 months after the dissemination. Setting. Twenty-three public hospital antenatal clinics in NSW. Participants. All clinical staff (midwives and doctors) working in the clinic during the 1-2-week survey period prior to dissemination and 18 months after the dissemination were asked to participate. The response rate was 63% (223) at baseline and 64% (182) at follow-up. Only 48% of midwives and doctors at follow-up were working in the original clinic. Measures. The proportion of clinicians who initially adopted the programme; the proportion of clinicians who had used one or more programme components in the last week); the number of types of smoking cessation intervention provided (maximum = 13), and the estimated proportion of clients offered smoking cessation intervention. Findings. More midwives than doctors 'ever used' the programme (76% vs. 25%) and continued to implement (58% vs. 22%) the programme 18 months after dissemination. Both midwives and doctors increased the number of types of smoking cessation intervention offered at follow-up compared to baseline (mean difference 2.8). Midwives provided more smoking cessation interventions than doctors at baseline (mean difference 0.9) and at follow-up (1.6), regardless of method used to disseminate the programme. Midwives' mean estimates of the proportion of clients offered interventions were greater than doctors' (midwives' 59% vs. doctors' 35%) at follow-up. Conclusion. The dissemination of a smoking cessation programme increased the level of smoking cessation interventions used by doctors and midwives. Doctors and midwives differ in their uptake of smoking cessation programmes. This information can be used to plan programme dissemination strategies in the future. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the effectiveness of nicotine replacement therapy (NRT) as part of a smoking cessation program. Public policy with respect to NRT; Justification for deregulating the sale of NRT; Likelihood of quitting of smoking among NRT users against placebo groups.

Objectives. A randomized trial evaluated the impact of smoking cessation interventions on point prevalence and consecutive quit rates at an Australian public prenatal clinic. Methods. Self-reports and urine cotinine tests confirmed patients' smoking status at the midpoint and end of pregnancy and 6 weeks postpartum. Results. At all points, validated abstinence rates were significantly higher in the experimental group than in the control group. The rate of failed biochemical validation was significantly higher in the control group than in the experimental group. Conclusions. Prenatal clinic staff can significantly increase quit rates by using cognitive-behavioral strategies. Brief advice appears to be ineffective. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine recent levels of exposure to smoking in movies, how the community perceived the level of smoking they saw in recently-viewed movies and whether there was community support for any form of regulation. Methods: As part of a 2004 New South Wales survey of smoking-related perceptions and practices, 1,154 adults participated in a computer-assisted telephone interview about perceptions relating to smoking depiction in movies and television. Results: More than one-quarter of those who had seen a recent movie in the cinema (28.5%) or on DVD (33.9%) thought that the movie contained excessive or inappropriate smoking. More than half the sample (59.1%) considered it likely the tobacco industry played a role in the level of smoking depiction, although only 18% of those who thought a recent movie contained excessive smoking attributed this to the tobacco industry. Almost two-thirds of respondents favoured screening anti-tobacco advertisements prior to movies with smoking. Conclusion: Cinema and DVD movies commonly include scenes where there is excessive or inappropriate smoking. It is widely believed that the tobacco industry is contributing to this, and there is strong community support for action to curb the harmful influences this may be having. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the validity of self-reported smoking among women hospital staff in Tunisia. It states that despite the prevalence of smoking in Tunisia, under-reporting of smoking could occur especially among women from cultures where social proscriptions exist. It mentions that the validity of self-reported smoking was the same among subjects from different areas, ages and occupational groups.

Abstract: Relatively little attention has been given to the retail availability of tobacco products despite the likelihood that ubiquitous supply may represent a primary form of tobacco promotion in Australia. This study aimed to explore the number and distribution of tobacco outlets, smokers’ perceptions about the availability of tobacco and the role availability may play in tobacco consumption and quitting attempts in Australia. The study comprised two parts: Part A involved mapping retail tobacco outlets in the Hunter Region of NSW, Australia. Part B involved a statewide telephone survey of 539 current smokers aged 18 years and over in NSW. Part A identified 1270 retail tobacco outlets, giving a density of one outlet per 384 persons aged over 15 years, or one outlet per 77 smokers. Associations between socioeconomic status of areas and retail availability of tobacco were not found. Of the survey respondents in Part B, 87.5% indicated that they would be within walking distance of a retail tobacco outlet during their daily activities. Those who were younger, male and single were more likely to purchase tobacco at convenience-type outlets. We therefore conclude that some groups of smokers appear vulnerable to the availability of tobacco and a reduction in the availability of tobacco is likely to benefit smokers who wish to quit. [ABSTRACT FROM AUTHOR]