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Background: An analysis of predictors of smoking behaviour among users of smoking cessation apps can provide useful information beyond what is already known about predictors in other contexts. Therefore, the aim of the present study was to identify the best predictors of smoking cessation, smoking reduction and relapse six months after starting to use the smartphone app Stop-Tabac. Method: Secondary analysis of 5293 daily smokers from Switzerland and France who participated in a randomised trial testing the effectiveness of this app in 2020, with follow-up at one and six months. Machine learning algorithms were used to analyse the data. The analyses for smoking cessation included only the 1407 participants who responded after six months; the analysis for smoking reduction included only the 673 smokers at 6-month follow-up; and the analysis for relapse at 6 months included only the 502 individuals who had quit smoking after one month. Results: Smoking cessation after 6 months was predicted by the following factors (in this order): tobacco dependence, motivation to quit smoking, frequency of app use and its perceived usefulness, and nicotine medication use. Among those who were still smoking at follow-up, reduction in cigarettes/day was predicted by tobacco dependence, nicotine medication use, frequency of app use and its perceived usefulness, and e-cigarette use. Among those who had quit smoking after one month, relapse after six months was predicted by intention to quit, frequency of app use, perceived usefulness of the app, level of dependence and nicotine medication use. Conclusion: Using machine learning algorithms, we identified independent predictors of smoking cessation, smoking reduction and relapse. Studies on the predictors of smoking behavior among users of smoking cessation apps may provide useful insights for the future development of these apps and future experimental studies. Clinical trial registration: ISRCTN Registry: ISRCTN11318024, 17 May 2018. http://www.isrctn.com/ISRCTN11318024. [ABSTRACT FROM AUTHOR]

Background and Aims: NicAlert produces semi‐quantitative assessments of cotinine levels in saliva or urine for verification of smoking abstinence. This study aimed to assess the accuracy of NicAlert readings against a liquid chromatography tandem mass spectrometry assay in smokers who had passed expired‐air carbon monoxide (CO) verification but failed NicAlert verification. Design Comparison of NicAlert readings against readings from a reference assay using liquid chromatography tandem mass spectrometry. Setting: Geneva, Switzerland. Participants: Self‐reported non‐smokers (n = 92) who in previous testing had CO of 0–3 parts per million (indicating no recent smoking) and reported not using any nicotine product, but had NicAlert readings ≥ 1 (indicating smoking). Measurements NicAlert produces readings of 0, 1 and 2+, which are reported by the manufacturer to correspond to saliva cotinine concentrations of 0–10 ng/ml (indicating not smoking), 10–30 ng/ml and 30+ ng/ml, respectively. Liquid chromatography tandem mass spectrometry was used as the reference. Findings For 82 participants with a NicAlert reading of 1, only two of the liquid chromatography tandem mass spectrometry values were within the purported range of 10–30 ng/ml; 71 were below 4 ng/ml and half the values were below 0.5 ng/ml. Two of the eight participants with NicAlert readings of 2 had laboratory values within the designated range. Neither of the two participants with NicAlert readings of 3 had a cotinine value within the designated range. Conclusions: In people who had passed carbon monoxide verification, NicAlert readings yielded a very high false‐positive rate in detecting levels of cotinine indicative of smoking. [ABSTRACT FROM AUTHOR]

• The effects of large financial incentives on motivation to quit smoking in those who fail to quit are not well documented. • In relatively low-income smokers in Switzerland, large financial incentives increased motivation to quit in smokers who failed to quit. • These results should put to rest concerns that financial incentives negatively affect motivation to quit smoking, in particular intrinsic motivation. Financial incentives enhance long-term smoking cessation rates, but their effects on motivation to quit in those who fail to quit are not well documented. To test the effects of large financial incentives on motivation to quit smoking and on cigarette dependence in smokers who failed to quit despite receiving incentives. Low-income smokers in the general population in Geneva, Switzerland, in 2011–2013. A randomised controlled trial with follow-up after three, six and 18 months. Participants were assigned to receive either booklets plus access to a smoking cessation website (control group, n = 404), or the same intervention plus financial incentives (intervention group, n = 401). Incremental financial rewards, to a maximum of CHF 1500 (USD 1650, GBP 1000), were offered for biochemically verified smoking abstinence. No in-person counselling, telephone counselling, or medications were provided. Intrinsic and extrinsic motivation to quit, intention to quit, cigarette dependence. In smokers at 6-month follow-up, intrinsic motivation decreased in the control group (-0.24 SD units, p < 0.001), extrinsic motivation increased in the intervention group (+0.35 SD units, p = 0.001), and twice as many participants in the intervention group (35 %) than in the control group (17 %, p < 0.001) said they intended to quit smoking in the next 30 days. Quit attempts were more frequent and their duration was longer in the intervention group than in the control group. The intervention had no impact on cigarette dependence scores. Large financial incentives increased motivation to quit smoking in smokers who failed to quit smoking despite receiving incentives. [ABSTRACT FROM AUTHOR]

Background: It is not known whether large financial incentives enhance long-term smoking cessation rates outside clinical or workplace settings.Objectives: The goal of this study was to test whether large financial incentives improved long-term smoking cessation rates in low-income smokers, in a general population setting, without face-to-face or telephone counseling.Methods: This was a 2-arm, parallel group, individually randomized controlled trial, with follow-up after 3, 6, and 18 months. Participants were 805 low-income smokers enrolled between 2011 and 2013 from the general population in Geneva, Switzerland. We randomly assigned participants to receive either booklets plus access to a smoking cessation website (control group, n = 404), or the same intervention plus financial incentives (intervention group, n = 401). Incremental financial rewards, to a maximum of U.S. $1,650, were offered for biochemically verified abstinence at 1, 2, and 3 weeks, and 1, 3, and 6 months. No in-person counseling, telephone counseling, or medications were provided. The primary outcome was continuous abstinence between 6 months (end of incentives) and 18 months (12 months after the incentives ended), verified by expired carbon monoxide and salivary cotinine. We also assessed biochemically verified 7-day abstinence at 3, 6, and 18 months.Results: Rates of continuous abstinence between months 6 and 18 were 9.5% in the incentive group and 3.7% in the control group (p = 0.001). Rates of 7-day abstinence were higher in the incentive group than in the control group at 3 (54.9% vs. 11.9%; p < 0.001), 6 (44.6% vs. 11.1%; p < 0.001), and 18 months (18.2% vs. 11.4%; p = 0.006).Conclusions: In low-income smokers who did not receive face-to-face or telephone smoking cessation counseling, large financial incentives increased long-term rates of smoking cessation. (Financial incentives for smoking cessation in low-income smokers; ISRCTN04019434). [ABSTRACT FROM AUTHOR]

Background: It is not clear whether, in established vapers, cotinine levels remain stable or change over time.Methods: We enrolled 98 exclusive users of e-cigarettes on websites and forums dedicated to smoking cessation and to e-cigarettes. We collected saliva vials by mail in 2013-2014 (baseline), and collected a second saliva vial eight months later (follow-up) in the same participants. Participants had not used any tobacco or nicotine medications in the previous five days. Cotinine in saliva was analyzed with liquid chromatography-mass spectrometry. Use of e-cigarettes, tobacco and nicotine medications was self-reported.Results: All participants were former smokers, and 99% were using e-cigarettes daily. They had already been using e-cigarettes for nine months on average at baseline. The median cotinine level was 252ng/mL at baseline (quartiles: 124-421ng/mL) and 307ng/mL at follow-up (114-466ng/mL, W=0.9, p=0.4 for change over time). The median concentration of nicotine in refill liquids was 11mg/mL at baseline (quartiles: 6-15mg/mL) and 6mg/mL at follow-up (5-12mg/mL) (Wilcoxon signed rank test: W=5.2, p<0.001 for change over time). The median volume of e-liquid used per month was 80mL at baseline (quartiles: 50-130mL) and 100mL at follow-up (60-157mL, W=3.3, p=0.001 for change over time).Conclusion: In experienced e-cigarette users enrolled online, cotinine levels were similar to levels usually observed in cigarette smokers. Over time, these users decreased the concentration of nicotine in their e-liquids, but increased their consumption of e-liquid in order to maintain their cotinine levels constant. [ABSTRACT FROM AUTHOR]

Objectives. To assess the knowledge of smokers and ex-smokers about light cigarettes and nicotine yields and their perception of the risk of lung cancer, and to identify the characteristics of smokers of light cigarettes.Methods. Mail survey in a population sample of 494 smokers and exsmokers in Geneva, Switzerland, in 1999.Results. Participants were on average 40 years old, and 49% were men. They estimated that one would have to smoke two light cigarettes or four ultralight cigarettes in order to inhale the same amount of nicotine as that in one regular cigarette. Most participants (60%) answered that the risk of lung cancer was the same, but 27% answered that this risk was lower in smokers of light cigarettes than in smokers of regular cigarettes. The most frequent answer (41% of answers) to an open-ended question on the meaning of the number of milligrams of nicotine printed on cigarette packs was that this number indicated the nicotine content in cigarettes, rather than a machine-determined yield in smoke. In a multivariate model, smoking mild, light, or ultralight (vs regular) cigarettes was associated with females, a lower Fagerstro¨m dependence score, an intention to quit smoking, and an intention to decrease cigarette consumption.Conclusions. Many smokers choose light cigarettes because they think that such cigarettes are safer or less addictive. The public should be further informed of the meaning and purpose of cigarette labels. [Copyright &y& Elsevier]

Abstract: Objective: To assess the acceptability and impact of anti-smoking policies in three prisons in Switzerland. Methods: A before–after intervention study in A) an open prison for sentenced prisoners, B) a closed prison for sentenced prisoners, and C) a prison for pretrial detainees. Prisoners and staff were surveyed before (2009, n=417) and after (2010–2011, n=228) the interventions. Medical staff were trained to address tobacco dependence systematically in prisoners. In prison A, a partial smoking ban was extended. No additional protection against second-hand smoke was feasible in prisons B and C. Results: In prison A, more prisoners reported receiving medical help to quit smoking in 2011 (20%) than in 2009 (4%, p=0.012). In prison A, prisoners and staff reported less exposure to second-hand smoke in 2011 than in 2009: 31% of prisoners were exposed to smoke at workplaces in 2009 vs 8% in 2011 (p=0.001); in common rooms: 43% vs 8%, (p<0.001). No changes were observed in prisons B and C. Conclusions: Reinforcement of non-smoking rules was possible in only one of the three prisons but had an impact on exposure to tobacco smoke and medical help to quit. Implementing anti-smoking policies in prisons is difficult in the absence of appropriate legislation. [Copyright &y& Elsevier]

Although exposure to secondhand smoke (SHS) is reportedly high in prison, few studies have measured this in the prison environment, and none have done so in Europe. We measured two indicators of SHS exposure (particulate matter PM10 and nicotine) in fixed locations before (2009) and after (2010) introduction of a partial smoking ban in a Swiss prison. Access to smoking cessation support was available to detainees throughout the study. Objectives To measure SHS before and after the introduction of a partial smoking ban. Methods Assessment of particulate matter PM10 (suspended microparticles of 10 mm) and nicotine in ambient air, collected by real-time aerosol monitor and nicotine monitoring devices. Results The authors observed a significant improvement of nicotine concentrations in the air after the introduction of the smoking ban (before: 7.0 µg/m³, after: 2.1 µg/m³, difference 4.9 µg/m³, 95% CI for difference: 0.52 to 9.8, p=0.03) but not in particulate matter PM10 (before: 0.11 µg/m³, after: 0.06 µg/m³, difference 0.06 µg/m³, 95% CI for difference of means: -0.07 to 0.19, p=0.30). Conclusions The partial smoking ban was followed by a decrease in nicotine concentrations in ambient air. These improvements can be attributed to the introduction of the smoking ban since no other policy change occurred during this period. Although this shows that concentrations of SHS decreased significantly, protection was still incomplete and further action is necessary to improve indoor air quality. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To assess the profile, utilization patterns, satisfaction and perceived effects among users of electronic cigarettes ('e-cigarettes'). Design and Setting Internet survey in English and French in 2010. Measurements Online questionnaire. Participants Visitors of websites and online discussion forums dedicated to e-cigarettes and to smoking cessation. Findings There were 3587 participants (70% former tobacco smokers, 61% men, mean age 41 years). The median duration of electronic cigarette use was 3 months, users drew 120 puffs/day and used five refills/day. Almost all (97%) used e-cigarettes containing nicotine. Daily users spent $33 per month on these products. Most (96%) said the e-cigarette helped them to quit smoking or reduce their smoking (92%). Reasons for using the e-cigarette included the perception that it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%). Most ex-smokers (79%) feared they might relapse to smoking if they stopped using the e-cigarette. Users of nicotine-containing e-cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non-nicotine e-cigarettes. Conclusions E-cigarettes were used much as people would use nicotine replacement medications: by former smokers to avoid relapse or as an aid to cut down or quit smoking. Further research should evaluate the safety and efficacy of e-cigarettes for administration of nicotine and other substances, and for quitting and relapse prevention. [ABSTRACT FROM AUTHOR]

Aims: To assess changes between 1996 and 2006 in alcohol use and dependence in the general population of Geneva, Switzerland. Methods: Postal surveys of alcohol consumption patterns in representative samples of the general population were compared. The four-item CAGE (Cut down, Annoyed, Guilty, Eye-opener) screener was used to estimate alcohol dependence. Results: There were 742 participants in 1996 (response rate 75%) and 1487 in 2006 (76%). The proportions of daily drinkers (1996: 18%; 2006: 10%; P < 0.001), and of heavy drinkers (>14 drinks/week) decreased between 1996 (13%) and 2006 (7%; P < 0.001). However, decreases in heavy drinking were limited to men aged 30+ and women aged 30–49. The average number of drinks/week decreased from 6.4 in 1996 to 5.0 in 2006 (P < 0.001). Perception of safe drinking levels decreased between 1996 (4 drinks/day) and 2006 (3 drinks/day, P < 0.001). The prevalence of alcohol dependence, defined as a CAGE score ≥2, increased among women (1996: 6%; 2006: 14%; P = 0.001), but not among men (1996: 18%, 2006: 19%). Two of the CAGE items were endorsed more frequently by women in 2006 than in 1996: ‘guilty’ (1996: 9%; 2006: 15%; P = 0.018) and ‘should cut down’ (1996: 12%; 2006: 18%; P = 0.04). Drinking and driving did not change significantly over time (2006: 21% of men, 9% of women). Conclusion: Alcohol consumption, heavy drinking and perceived levels of safe drinking decreased over these 10 years, but not drink driving or alcohol dependence. Paradoxically, alcohol dependence even increased among women, driven by CAGE items ‘guilty’ and ‘should cut down’, suggesting that changes in CAGE scores reflected changes in the social acceptability of drinking rather than changes in dependence. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To assess change between 1996 and 2006 in smoking prevalence, cigarette consumption, quit attempts, motivation to quit and advice received from physicians in Geneva, Switzerland. Methods: Postal surveys in cross-sectional, representative samples of the general population of Geneva in 1996 and 2006. Results: There were 742 participants in 1996 (response rate 75%) and 1487 in 2006 (response rate 76%). Smoking prevalence remained stable between 1996 (28.0%, 95% confidence interval: 24.7 to 31.3%) and 2006 (26.5%, 24.3 to 28.7%, p =0.46). Among smokers, cigarette consumption fell from 15 to 13cig./day between 1996 and 2006 (p =0.003). However, tobacco dependence, as measured by the Heaviness of Smoking Index, remained stable (mean=1.9 vs. 1.7, p =0.18). The proportion of smokers who made a 24-hour quit attempt in the previous year remained stable (29.2% in 1996, 32.1% in 2006, p =0.52), but more smokers reported that they intended to quit in the next 6months in 2006 (39.6%) than in 1996 (29.1%, p =0.045). The association between smoking prevalence and income was stronger in 2006 (chi2 =53.7, p <0.001) than in 1996 (chi2 =10.9, p =0.012). In 2006 (no change since 1996), few smokers reported that, during their last medical visit, their physician told them to quit smoking (27.3%) or offered them help to quit (13.3%). Conclusions: Over these 10years, smoking prevalence, nicotine dependence levels and the frequency of quit attempts remained stable, but smokers'' motivation to quit increased. We observed a growing social gap in smoking prevalence and cigarette consumption. Smoking cessation advice was seldom received during medical visits. [Copyright &y& Elsevier]

The article presents a study regarding the efficacy of nicotine polacrilex gum treatment before smoking cessation among smokers in Switzerland. It mentions that the 314 Swiss smokers who registered for the open randomized study from November 2005 to January 2007 were divided into two groups, the precessation group and the usual care group. The first group of participants were provided with the nicotine gum four weeks before and eight weeks after their target cessation period for a gradual cessation, while the second group received same amount of nicotine gum eight weeks after their due date for an abrupt cessation. Results of the study reveal that nicotine gum treatment before the target cessation period is ineffective treatment for smoking cessation among Swiss smokers.

Abstract: Aim: To assess the properties of the Cigarette Dependence Scale (CDS-12) in various samples of daily smokers and to provide reference scores in a general population sample. Methods: Surveys in 4 samples of daily cigarette smokers: psychiatric out-patients in Geneva, Switzerland (n =226), clients of smoking cessation clinics in France (n =370), visitors of a French-language smoking cessation website (n =13,697) and a representative sample of the general population of Geneva (n =292). Results: In all 4 samples, Cronbach''s alpha coefficients were >0.87 and factor analyses indicated that CDS-12 was unidimensional. CDS-12 was slightly skewed towards higher values, and it was associated with expired carbon monoxide, but this association was not strong (9% of variance explained, p <0.001). CDS-12 scores were highest in clients of smoking cessation clinics (mean=47.7, SD=10.2), followed by psychiatric patients (mean=44.4, SD=8.4), visitors of smoking cessation websites (mean=43.3, SD=11.6) and the general population sample (mean=36.9, SD=12.3). Except for tolerance, each element in the DSM-IV and ICD-10 definitions of dependence is reflected by at least one item in CDS-12, even though the match with these definitions is sometimes indirect. Conclusions: This paper presents reference scores and validity and reliability tests for CDS-12 in a diversity of samples of daily smokers. This information should be useful to clinicians and researchers. [Copyright &y& Elsevier]

Abstract: Objective. : The acceptability and impact of partial smoking bans in psychiatric hospitals are not well documented. We assessed the impact of a partial smoking ban in a psychiatric hospital in Switzerland. Methods. : Before the intervention, smoking was not allowed in bedrooms and dining rooms, but this ban was not enforced. The intervention consisted of banning smoking everywhere, except in dedicated smoking rooms. Patients and staff were surveyed before (October 2003, 49 patients and 57 staff) and 2 months after the smoking ban (April 2004, 54 patients and 54 staff). Analyses included both patients and staff. Results. : Compared with baseline, after the intervention twice as many non-smokers reported that they were “never” exposed to environmental tobacco smoke (ETS) in bedrooms (before=25.0%, after=54.5%, p =0.046), dining rooms (35.5 vs. 65.5%, p =0.037), corridors (10.4 vs. 30.9%, p =0.001) and meeting rooms (36.8 vs. 75.0%, p =0.012). The smoking ban was loosely enforced; although the ban reduced ETS, substantial exposure to ETS remained after it was introduced. Most participants (87%) rejected the idea of a total smoking ban. Conclusion. : The partial smoking ban was well accepted and was associated with less exposure to ETS. However, even a partial ban proved difficult to enforce in this hospital. [Copyright &y& Elsevier]

Aims To compare the distributions of smoking‐related variables and the size of associations between these variables in men and women. Design and participants Mail survey in 2934 daily smokers (1533 women and 1401 men) who volunteered for a smoking cessation trial. Follow‐up after 7 months in 2456 people (84%). Setting Community setting (French‐speaking part of Switzerland, 1998). Findings Women smoked less than men (18 versus 22 cigarettes per day, p < 0.001), had lower confidence in their ability to refrain from smoking, used more frequently the strategy defined as 'coping with the temptation to smoke' and reported more drawbacks of smoking (gender differences ranged between 0.1 and 0.3 standard deviation units on these scales). There was no gender difference in the distribution of smokers by stage of change. At follow‐up, smoking cessation rates were similar in men and women (6% versus 5%, p = 0.3). Intention to quit, quit attempts in the previous year and a more frequent use of self‐change strategies predicted smoking cessation and were associated with tobacco dependence in both sexes. A more frequent use by women of coping strategies suggests that some women are 'self‐restrained' smokers who control their smoking permanently. This could explain lower smoking rates in women. The size of associations between smoking‐related variables was similar in men and women. Conclusions Even though there were gender differences in the distributions of some smoking‐related variables, associations between these variables were similar in men and women. This suggests that smoking behaviour is regulated by similar psychological mechanisms in men and women. [ABSTRACT FROM AUTHOR]

The authors conducted a randomized trial in Geneva, Switzerland, to assess whether response rates to a mailed survey could be increased by printing the questionnaire on green paper. The authors also conducted a meta-analysis of 10 experimental studies that tested the effect of colored questionnaires on response rates. The randomized trial showed no effect (relative risk of responding [RR] = 1.00). The meta-analysis showed that mailing questionnaires on pink paper increased response rates by 12% (RR = 1.12, 95% confidence interval = 1.01 to 1.25, p = 0.04). Other colors had no statistically significant effect (blue: RR = 1.03, p = 0.49; green: RR = 1.02, p = 0.23; yellow: RR = 0.96, p = 0.30). Overall, using colored instead of white paper had no effect (RR = 1.02, p = 0.17). Thus, printing questionnaires on colored paper does not substantially increase response rates in surveys, except for pink paper. [ABSTRACT FROM AUTHOR]

Objectives. In 1992, most members of a Swiss indemnity health insurance plan were automatically transferred into a newly created managed care organization. This study examined whether this semivoluntary change affected enrollees health status and satisfaction with care. Methods. Three groups of enrollees were compared: 332 plan members who accepted the switch (managed care joiners); 186 plan members who opted to maintain indemnity coverage (nonjoiners); and 296 persons: continuously enrolled in another indemnity plan (indemnity plan members). Health status, health-related behaviors, and satisfaction with care received in the previous year were surveyed at baseline and 1 year later. Results. Health status remained unchanged in all three groups. Smoking prevalence decreased among managed care joiners but remained constant in the other groups. Satisfaction with insurance coverage increased between baseline and follow-up in managed care joiners, but decreased in nonjoiners and indemnity plan members. The latter groups had higher satisfaction with health care, particularly with continuity of care. Conclusions. A semivoluntary switch from indemnity health insurance to managed care reduced satisfaction with health care but increased satisfaction with insurance coverage. There were no changes in self-perceived health status. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital in Switzerland. Methods: In 2003, smoking was allowed everywhere in psychiatric units. In 2004, smoking was prohibited everywhere except in smoking rooms. In 2006, smoking rooms were removed and smoking was totally prohibited indoors. Patients and staff were surveyed in 2003 (n =106), 2004 (n =108), 2005 (n =119) and 2006 (n =134). Results: Exposure to environmental tobacco smoke (ETS) decreased after the partial ban and further decreased after the total ban. Among patients, after the total ban, more smokers attempted to quit smoking (18%) relative to before the total ban (2%, odds ratio=10.1, p =0.01). More smokers said that hospital staff gave them nicotine replacement products after the total ban (52%), compared with before (13%, odds ratio=7.6, p <0.001). Many participants (55%) commented that the total ban was too strict, and most (64%) preferred the partial ban. Conclusions: The partial ban decreased exposure to ETS and the total ban further improved the situation and increased the proportion of smokers who attempted to quit smoking and received nicotine medications. The total ban was loosely enforced and was overall acceptable, but most participants preferred a partial ban. [Copyright &y& Elsevier]

Vaporizers (e-cigarettes) are the most common smoking cessation aids in Switzerland, but we do not know what information customers receive in vape shops. We surveyed vape-shop managers to find out what recommendations they make to their customers. An interdisciplinary group developed the questionnaire. Respondents self-reported their smoking history, demographics, and the recommendations they thought they would give to hypothetical customers in clinical vignettes. We also queried if they collaborated with health care professionals. Of those contacted, 53.8% (70/130) of vape-shop managers responded, and 52.3% (68/130) were included in the final analysis. Managers were mostly male and ex-smokers who switched to vaporizers; 60.3% would encourage a hypothetical smoker with high nicotine dependence to start with the highest possible nicotine concentration when switching to vaporizers. For this smoker, 36.9% would recommend high (≥15 mg/mL), 32.3% medium (6-14 mg/mL), and 3.1% low (1-5 mg/mL) nicotine concentrations. The rest adapted their recommendations to fit the customer or device; 76.5% reported that physicians referred customers to them, and 78.8% would attend a course given by experts in the field of vaporizers and smoking cessation. Vape-shop managers varied widely in the recommendations they gave customers. Most reported ongoing collaboration with health care professionals and were interested in improving their counselling skills through training.

Background: Tobacco vaporizers are devices that heat tobacco without burning it. There is currently a scarcity of studies about the addictiveness of tobacco vaporizers or their effects on cigarette withdrawal symptoms., Goals: To assess the perceived dependence of users of tobacco vaporizers and the perceived effects of these products on cigarette withdrawal symptoms., Methods: Enrollment of participants through the internet from 2016 to 2018. Participants were self-selected visitors to an anti-addiction website, current and past users of tobacco vaporizers aged ≥18., Results: We included 139 users of IQOS tobacco vaporizers. All participants were current (49.6%) or former cigarette smokers at the time when they began to use the tobacco vaporizer. Among the 135 current users, the median dependence on vaporizers was 80 on a scale from 0-100 (25th and 75th percentiles: 50 and 90), and 63.6% reported being somewhat to totally afraid of becoming dependent on the vaporizer. Half (51%) reported that they were less dependent on vaporizers than on combustible cigarettes, 43.8% were equally dependent on both products and 5.2% were more dependent on vaporizers than on cigarettes. Only one cigarette withdrawal symptom was reported by participants, "craving" for combustible cigarettes, and among respondents who experienced craving, 83.9% found that the IQOS vaporizer relieved it "a lot" to "totally"., Conclusions: In this self-selected online sample of IQOS users, the perceived dependence on this tobacco vaporizer was relatively high and almost two thirds of respondents were afraid of becoming dependent on IQOS. Most participants perceived that IQOS relieved the craving to smoke combustible cigarettes.

Background: Smartphone-based support can reach thousands of smokers and help those who would otherwise try to quit smoking by themselves with little chance of success. Nicotine medications double the chances of quitting smoking, but few smokers use them, and they often use them for too short a time and at an insufficient dose. It is therefore important to increase access to support for smoking cessation and compliance with nicotine therapy. The objectives of this study are to assess whether the Stop-Tabac application (app) is effective for smoking cessation and to examine whether the outcome is influenced by the personal characteristics of participants., Methods: Trial design: this is a two-arm, parallel-group, superiority, individually randomized, "placebo" controlled trial in 5200 smokers, with follow up after 1 week, 1 month and 6 months. The participants are adult daily smokers (N = 5200) enrolled on the Internet, living in France or Switzerland. The intervention is the Stop-tabac fully-automated app for smartphones, which was launched in 2012 and continuously improved thereafter. It includes fact sheets; calculators of cigarettes not smoked, money saved, and years of life gained; an interactive "coach" that provides automated, individually tailored counseling messages based on the user's personal profile, sent regularly for 6 months; immediate feedback during episodes of craving and tobacco withdrawal symptoms; a discussion forum ("The Tribe") where participants provide and receive social support; a quiz that informs users in a playful way; and a module on nicotine therapy that includes personalized feedback and follow up. The outcome is self-reported smoking cessation after 6 months (no puff of tobacco in the past 4 weeks), and after 1 week and 1 month (no puff in the past 7 days). Participants will be randomized automatically based on a list of random numbers. Participants, assistants in charge of collecting follow-up data and data analysts will be blinded to allocation. Funding is provided by the Swiss National Science Foundation, CHF 194,942 (EUR 182,200, USD 200,700), grant 32003&#95;179369. JFE's salary is paid by the University of Geneva, YK's salary is paid by the Lausanne University Hospitals., Discussion: There is little evidence from randomized trials of the impact of health apps in general and of smoking cessation apps in particular. This study will fill this gap., Trial Registration: ISRCTN Registry: ISRCTN11318024. Registered on 17 May 2018.

New drugs available in a click, plethora of games, new regulations on cannabis, addiction medicine has a lot to do ! In 2018, Switzerland recognized a training certificate in addiction medicine, pathological gambling entered into ICD-11 and vaping, first considered with suspicion, found a place in the pharmacopoeia of the fight against tobacco. That's not all, on the alcohol front, we realized that even a small glass can hurt and the medicine of addictions evolved towards models of recovery that aim to improve quality of life with chronic diseases. Finally, the American opioid prescription epidemic is worrying in Switzerland, even if the situation and the context are very different., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objectives: To describe alcohol and tobacco consumption during pregnancy in women giving birth in a public hospital in Geneva, to evaluate risk factors related to these consumptions and to explore the influence of close relatives on the consumption habits of pregnant women., Methods: A cross-sectional questionnaire survey after delivery in 207 women in the maternity ward of the Geneva University Hospitals in 2008. We used retrospective self-reports of smoking during pregnancy (including temporary smoking), smoking during the entire pregnancy and alcohol drinking during pregnancy (even a single glass)., Results: The proportion of smokers decreased from 31.2% before pregnancy to 21.7% during pregnancy (temporary smoking included), and 9.2% of women smoked continuously until delivery. Major factors associated with tobacco use were living alone, living with a smoker and tobacco consumption of the husband/partner in the presence of the pregnant woman. Regarding alcohol consumption, 62.7% of the participants reported drinking (even occasionally) before pregnancy, and 36.3% of the women drank at least one glass of alcohol during pregnancy. The alcohol consumption of the husband/partner and invitations to drink from other people were associated with alcohol consumption during pregnancy., Conclusions: Among women delivering in a public hospital, tobacco and alcohol consumption during pregnancy was important and significantly influenced by the habits and attitude of close relatives. The involvement of relatives in health promotion interventions should be addressed.

Introduction: Cloninger's neuropsychopharmacological theory identifies four temperament traits and three character traits that are largely heritable and are associated with addictions., Methods: We tested whether these personality traits were associated with smoking behavior and predicted smoking cessation and tobacco withdrawal symptoms. We conducted an Internet cohort study in 2005-2009. The Temperament and Character Inventory (TCI, 226 items, French version) was assessed in 2,993 people (1,593 current, 969 former, and 419 never-smokers). Subsets of participants indicated their smoking status after 30 days (n = 1,452, 48.5%) and answered the TCI again and reported tobacco withdrawal symptoms after 61 days (n = 644, 21.5%)., Results: Compared with never- and former smokers, daily smokers had higher scores of Harm Avoidance (HA) and lower scores of Persistence and Self-Directedness (SD). Daily smokers had higher scores of Novelty Seeking than never-smokers. In daily smokers, the level of tobacco dependence was associated with higher scores of HA and lower scores of SD. In the 60 daily smokers who had stopped smoking after 61 days, after adjustment for tobacco dependence level and baseline tobacco withdrawal ratings, SD predicted lower scores of depressed mood and anxiety at 61-day follow-up and HA predicted higher scores of depressed mood at 61-day follow-up. Personality ratings did not predict smoking cessation at follow-up in daily smokers or relapse in former smokers., Discussion: A consistent association was found between smoking and high HA and low SD. Knowledge about these associations may be useful to clinicians to tailor counseling.

Background: To determine whether the long and short versions of the Cigarette Dependence Scale (CDS), the Fagerström Test for Nicotine Dependence (FTND), the Heaviness of Smoking Index (HSI) and the Nicotine Dependence Syndrome Scale (NDSS) predicted smoking abstinence., Method: We collected data via Internet in 2004-2007 in 2343 current smokers. Follow-up surveys were conducted after 8 days (N=456) and 31 days (N=486). We assessed the ability of dependence ratings to predict smoking abstinence, controlling for confidence and intention to quit smoking., Results: All dependence scales were significant predictors of smoking abstinence at the 8-day follow-up, with the CDS being the best predictor (OR: 3.98 per SD unit, 15% of variance explained). Results were similar but stronger among respondents intending to quit (OR: 6.68, 26% of variance explained). At the 31-day follow-up, only the FTND, HSI and NDSS Continuity subscale were still significant, albeit weak, predictors of abstinence (OR: 1.56, 2% of variance explained)., Conclusion: Among the scales under scrutiny, the CDS had the best predictive validity after 8 days. None of the scales explained more than 2% of the variance in abstinence after 31 days., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

To assess and compare the impact on quit attempts of online computer-tailored smoking cessation counseling reports and untailored reports, we performed a randomized controlled trial on a smoking cessation website in 2007-2008. After answering a questionnaire, current and former smokers were randomly assigned to immediately receiving either an online, individually tailored counseling report or a personalized but untailored generic report. Participants were invited by e-mail to report any smoking in the previous 24 hours, 48 hours after baseline. We used an intention-to-treat analysis, where nonrespondents at follow-up were counted as smokers. There were 2,872 participants at baseline and 2,226 at follow-up (78%). At baseline, there were 76% of current smokers (mean = 18 cigarettes/day) and 24% of recent quitters (median = 7 days of abstinence). The same proportion of smokers in both study groups had made a 24-hour quit attempt at follow-up (12.1%, P = 1.0). In baseline recent quitters, lapse/relapse rates at follow-up were similar in both groups (tailored: 25.1%, untailored: 23.5%, P = 0.64). We conclude that untailored reports were as effective as tailored reports in the short term. Even though these particular computer-tailored reports were not more effective than untailored reports, meta-analyses show that computer-tailored documents are in general more effective than untailored ones.

Background: We assessed change between 1996 and 2006 in the opinions of the general public on priorities for the prevention of health problems., Methods: Postal questionnaire surveys in 1996 and 2006, in representative samples of the general population of Geneva, Switzerland. Participants indicated, for each of 13 health problems, a priority rating for the spending of prevention resources., Results: There were 742 participants in 1996 (response rate 75%) and 1487 in 2006 (response rate 76%). According to participants, in 2006, resources should be spent, with priority, for: the prevention of sexual abuse of children (67% answered 'high priority'), illegal drugs (58%), AIDS (55%), tobacco smoking (45%), road traffic accidents (43%), alcoholism (42%), family violence (42%), suicide in young people (39%), mammography screening for breast cancer (37%), abuse of medications (27%), cannabis use (24%), poor diet (22%) and lack of physical activity (20%). Between 1996 and 2006, the largest change was observed for tobacco smoking (+18.6% answered 'high priority'), poor diet (+11.4%), lack of physical activity (+10.8%) and AIDS (-10.8%, P < 0.001 for all change scores)., Conclusions: Smoking, poor diet and lack of physical activity were more likely to be perceived as priorities in 2006 than in 1996, whereas priority ratings decreased for AIDS. The prevention of sexual abuse of children was perceived as the highest priority by all respondent groups.

Background: We compared the validity of the Cigarette Dependence Scale (CDS-12) and of the Fagerström Test for Nicotine Dependence (FTND) in daily cigarette smokers., Methods: Internet survey in 2004-2007. Eight days and 6 weeks after answering these two dependence questionnaires, participants indicated their smoking status and answered the Cigarette Withdrawal Scale and the Smoking Self-Efficacy Questionnaire. We used the Mini International Neuropsychiatric Interview (MINI) to assess nicotine dependence as defined in DSM-IV., Results: There were 13,697 participants at baseline, 1113 (8%) after 8 days and 435 (3%) after 6 weeks. CDS-12, but not FTND, predicted smoking cessation after 8 days (odds ratio=1.20 per standard deviation unit, p=0.03) and 6 weeks (odds ratio=1.34, p=0.01). In participants who had quit smoking after 8 days, CDS-12 was a better predictor of craving (beta=0.30, p<0.001), than FTND (beta=0.14, p<0.01). After 8 days, self-efficacy in quitters was predicted by CDS-12 (beta=-0.16, p=0.02), but not by FTND (beta=-0.05, p=0.3). CDS-12 was more strongly associated than FTND with DSM-defined dependence measured by MINI: area under the Receiver Operating Characteristic (ROC) curve=0.72 (95% confidence interval=0.70-0.73). For FTND, the area under ROC=0.64 (0.63-0.66)., Conclusions: CDS-12 performed better than FTND on tests of predictive and construct validity.

Objectives: To find out whether educational visits by a nurse to specialist physicians improved their self-reporting of smoking cessation activities; whether these visits increased the percentage of physicians who were aware of and recommended a computer-tailored smoking cessation program and who participated in a training workshop on tobacco dependency treatment., Methods: Specialist private practice physicians (n = 523) working in Geneva, Switzerland were randomly assigned to either receiving (n = 261) or not receiving (n = 262) a single 40-minute visit by a trained nurse in 2003. The physicians answered a postal questionnaire 5 months after the visits indicating the percentage of their patients they counselled or treated for tobacco dependency and we recorded whether physicians took part in the workshop., Findings: Only half (53%) of the physicians agreed to receive a visit. At follow-up more physicians in the intervention group than in the control group were aware of the computer-tailored program (73% vs. 39%, p < 0.001) and more physicians in the intervention group said they recommended the use of this program to more patients (20% vs. 10%, p = 0.009). Among non-smoking physicians only, the proportion of patients who were advised to quit smoking was higher in the intervention than in the control group (69% vs. 54%, p = 0.019, as reported by physicians). The intervention had no impact on physicians' participation in the workshop., Conclusions: Visits by a nurse increased the proportion of physicians who recommended to their patients the use of a computer-tailored smoking cessation program. Among non-smoking physicians only, the intervention increased the proportion of patients who received the advice to quit smoking, as reported by physicians.

Objective: To present a smoking cessation website and a reflection on the use of the Internet as a smoking cessation tool., Methods: A literature review and an Internet survey in 1506 current and former smokers., Results: The Internet may be the only form of smoking cessation support available to many smokers. There is a competition between hundreds of smoking cessation websites, many of which have a similar content. Smoking cessation websites are popular, but little scientific evidence is available on their efficacy. Neither do we know which components of these websites are most effective in motivating and helping smokers quit smoking and avoid relapse. Groups of current and former smokers form spontaneously in discussion forums on the Internet, this is a new feature in the field of addiction treatment. These discussion forums have not yet been the object of much scientific research., Conclusion: Research should be conducted to assess the efficacy of smoking cessation website, to identify which of their components are most effective, and to identify subgroups of current and former smokers for whom websites are most effective.

Background: Research showed that the widely used Fagerstrom test for nicotine dependence (FTND) does not cover important aspects of dependence. A new test, the cigarette dependence scale (CDS-12), covers the main elements in DSM-IV and ICD-10 definitions of dependence. We compared the psychometrics of CDS-12, FTND, and CDS-5 and the heaviness of smoking index (HSI), which are short versions of CDS-12 and FTND, respectively., Methods: Internet survey in 2002-2003. Participants were invited one month after answering the first survey to answer a second survey on smoking status and withdrawal symptoms., Results: Eight hundred two smokers answered both surveys. Cronbach's alpha coefficients were higher for CDS-12 (0.91) and CDS-5 (0.77) than for FTND (0.68) and HSI (0.63). Among 231 smokers who quit smoking at follow-up, higher baseline CDS-12 scores predicted higher withdrawal ratings at follow-up, for all withdrawal symptoms except appetite. FTND and HSI predicted higher craving in quitters, but did not predict the intensity of other withdrawal symptoms. Neither CDS-5, FTND or HSI predicted smoking cessation, but higher CDS-12 scores marginally predicted smoking cessation at follow-up (area under the receiver operating characteristic (ROC) curve = 0.55, 95% confidence interval = 0.51-0.59)., Conclusions: CDS-12 had better content validity and internal consistency than FTND and was a slightly better predictor of withdrawal symptoms. Unexpectedly, higher (not lower) CDS-12 scores predicted subsequent smoking cessation, perhaps because endorsement of some CDS-12 items implies accepting that one is dependent, which in turn could reflect motivation to quit. CDS-12 may represent an alternative to FTND for measuring cigarette dependence.

The authors assessed whether collection by mail of saliva and buccal cells for genetic analysis was feasible in participants recruited through the Internet. In 2003, 14,773 visitors of a smoking cessation website were invited by e-mail to take part in the study. Salivettes (plastic vials containing a cotton roll) were mailed to participants, for collection of saliva and buccal cells. Because of limited resources, the authors stopped recruitment when 392 participants (3% of 14,733) were registered. They received 315 saliva samples back (80% of 392). Salivary cotinine was analyzed in 145 daily smokers. Cotinine concentration could be assessed in 141 samples (97%) (range 0.7-899 ng/ml, median 260 ng/ml). DNA extraction was achieved in all the 285 samples in which it was attempted. Quality of DNA was assessed by optical density measurements and by polymerase chain reaction amplification of a gene coding for the alpha-4 nicotinic receptor, with the detection of a known polymorphism. Successful results were obtained in 235 samples (82% of 285). Thus collecting saliva by mail for cotinine and DNA analysis in participants recruited through the internet produced samples of good quality at a reasonable cost. This approach should be valuable for genetic epidemiology and pharmacogenetic research.

Aims: To compare low-rate daily smokers (one to five cigarettes/day) with other daily smokers, using the Transtheoretical Model of Change as a framework., Design: Mail survey with a follow-up after 7 months., Setting: A randomly selected population sample in French-speaking Switzerland, in 1998., Participants: A total of 2338 daily smokers aged 25 + years, including 95 smokers of one to five cigarettes/day, 324 smokers of six to 10 cigarettes/day, 399 smokers of 11-15 cigarettes/day and 1520 smokers of 16 + cigarettes/day, and 1765 people (75% of 2338) at 7-month follow-up., Findings: Compared with smokers of 16 + cigarettes/day, low-rate smokers of one to five cigarettes/day included more women (67% versus 46%, P < 0.001), were 4 years younger (P < 0.001), were less motivated to quit smoking (62% versus 37% in the 'precontemplation' stage of change, P < 0.001), thought that quitting would be easier (-3.4 points on a 0-10 scale, P < 0.001) and were less bothered by the risk of smoking. Low-rate smokers were taking control more actively over their smoking, e.g. they more often stayed away from places where people smoked, sat in the no-smoking sections in public places and tried to delay as much as they could their first cigarette of the day. Only 45% of low-rate smokers were still in the same category 7 months later., Conclusions: For many smokers, low-rate smoking may result from a conscious effort to limit their cigarette consumption. Being a low-rate smoker was a temporary condition for most people. Low-rate smokers should be considered as a specific, although heterogeneous group.