This article gives an insight into some possible intervention strategies using the basic principles of hypnotherapy. An excerpt of a treatment is described, showing the main effect with this individual person. The therapist applied the idea of unconscious seedings by narrating other clients' strategies. At the end, he supports the search of individual strategies. Abstinence was controlled one year after the last meeting by self-report and CO-measurement.

While health warnings are present on cigarette packs around the world, the nature of the warnings varies considerably between countries. In the United States, a small text warning citing the dangers of cigarette smoking is found on the side of all packs. This pilot study sought to determine whether graphic cigarette warning images, like those found in the United Kingdom and Canada, were better at decreasing cravings to smoke than existing text warnings found on cigarette packs in the United States. Twenty-five smokers seeking treatment to quit at a specialty tobacco treatment program were administered the Brief Questionnaire of Smoking Urges (QSU — BRIEF), a validated measure of craving, prior to and following exposure to cigarette pack warning images. The graphic cigarette warning images reduced cravings to smoke (6.20 point decrease) more than neutral images (3.36 point decrease) and current text warnings used in the United States (5.75 point decrease), although this difference was not statistically significant. Based on these pilot data, a larger study could further examine the effectiveness of graphic warning images and whether such warnings hold an advantage over the currently used text warnings.

Smoking prevalence, at any point in time, accounts for the balance of smokers ending the habit and people starting or returning to smoking. Very different scenarios can result in the same prevalence, and each can have different implications for health services. Therefore understanding the degree of churn in the smoking population is essential. This is an area where there is little or no data. In such circumstances, Delphi methods utilising expert opinion can provide robust forecasts for planning purposes. A Delphi survey, involving 300+ general practitioners (GPs) in Northern England, projected a modest 2.2% reduction in smoking prevalence over 10 years, but this involved a reduction of nearly 30% in the existing cohort of smokers, countered by new/returning smokers equivalent to 21% of the cohort. Different age groups showed different patterns. The findings suggest that approximately 1 in 6 smokers need to set a quit date each and every year to achieve even a 2.2% reduction. Currently, 1 in 16 smokers set a quit date each year. Although ‘early wins’ may have been achieved, the challenges to achieve continuing reductions in smoking prevalence are considerable. Preventing young people starting to smoke is key.

The purpose of this study was to develop a theoretical explanation of the process of becoming a father and how this impacted on smoking behaviours of men during their partner's pregnancy. Grounded theory method and constant comparative analysis was used to explain data from interviews with 23 men from rural Midwest USA. Becoming a father prompted participants to seek ways to protect their partners and babies from the effects of cigarette smoking. First-time fathers were particularly receptive to quitting smoking early in their partner's pregnancy, whereas motivation to quit declined as pregnancy progressed for first-time fathers and other fathers. Although protecting their families from cigarette smoke remained constant, men's smoking goals and behaviours became increasingly focused on minimising harm rather than quitting as their partner's pregnancy progressed. Findings support the view that the transition to fatherhood is an opportune time in which to encourage and support smoking behaviour change for male partners. Theoretical insights provide understanding of why and when expectant fathers attempt to quit smoking and reduce harm to their families. Future research should focus on appropriate and timely interventions to maximise the success of men to quit smoking when they are naturally motivated to do so.

This article reviews the literature to compare differential outcomes among men and women after smoking cessation, assess barriers they may face during cessation and provide recommendation to address gender-specific challenges in smoking cessation interventions. There is some evidence that women achieve lower abstinence rates than men after a quit attempt with nicotine replacement therapy, as well as without pharmacotherapy, and several underlying mechanisms were discussed to account for these findings. These include: (a) women have specific genetic variants that affect pharmacokinetics and pharmacodynamics of the medication, (b) hormonal influences increase nicotine metabolism and withdrawal symptoms, (c) women are more responsive to nonpharmacological aspects of smoking than men, (d) women are more vulnerable to depression and negative mood than men, (e) weight concerns are greater barriers for women than for men and (g) women receive less effective social support than men during a quit attempt. Gender-specific counselling that accounts for these factors and addresses the different needs of men and women may be a promising approach to improve long-term abstinence rates. However, more research is required to identify gender-related underlying mechanisms of differential smoking cessation outcomes, develop tailored interventions that account for gender differences and study the implementation and outcomes of gender-responsive treatment approaches.

Smoking is widely known as an architect of well-documented, negative health outcomes. The advent of legislated actions to ban work- and public-place smoking has reduced the overall smoking prevalence in Canada and around the world. However, what is often overlooked are patients with psychiatric illness who are confined in psychiatric institutions and are not able to take advantage of designated smoking areas. The aim of this commentary is to raise awareness of potential inequitable conditions that are inherent in workplace smoking restrictions particularly for psychiatric patients. A biological and social equity perspective will frame the discourse of the issue.

In the plethora of international research on smoking relapse there are findings that suggest distinct ethnocultural differences in relapse predictors. This study aimed to uncover cognitive and affective factors that contribute to relapse in a sample of Filipino adult smokers (N = 115). Using discriminant function analysis, results suggest that self-efficacy, outcome expectancy, craving and the subdomains of motivation to change contemplation and action are accurate relapse predictors, whereas negative emotional states are not. An integrative framework was used in the discussion to account for inconsistencies in the results. Implications for understanding the relapse cycle, the connection between smoking relapse and substance use, as well as suggestions for future studies on smoking relapse, are also discussed.

Objectives: To determine whether the cost of a statewide smoking cessation program in Pennsylvania could be justified by the benefits. Methods: A cost-benefit analysis of statewide access to smoking cessation programs. We compared three treatment alternatives, both with and without counselling: nicotine replacement therapy, bupropion and varenicline. Results: While the retail price of a pack of cigarettes in Pennsylvania is on average US$4.72, the combined medical costs and productivity losses in Pennsylvania attributable to each pack of cigarettes sold are approximately US$23.78 per pack of cigarettes. The ratio of benefits to cost varied from US$0.97 to US$2.76 saved per dollar spent on smoking cessation programs, depending upon the type of intervention. Conclusions: For most smoking cessation treatments, the benefits of a statewide smoking cessation program in Pennsylvania would greatly outweigh its costs.

Homework assignments have been a key component of cognitive behavioural therapy (CBT) for decades, but very few studies examined the effect of compliance on outcome in regard to smoking behaviour. To fill this gap in the existing literature, the present report evaluated the role of homework compliance on short-term outcome in the context of evidence-based care for smoking cessation. Compliance with out-of-session assignments was assessed in a four-session CBT-nicotine replacement therapy protocol for smoking cessation among adult daily smokers (n= 94). Consistent with expectation, homework compliance was associated with better short-term outcomes, including amount of cigarettes consumed as well as abstinence. Importantly, these effects remained after controlling for a wide range of potentially confounding variables (e.g., motivation to quit, nicotine dependence at intake, attendance problems, and in-session participation). Estimates of quantity versus quality of homework compliance did not differentially predict outcomes. Out-of-session homework assignments incrementally predict short-term smoking abstinence in the context of evidence-based care for smoking cessation.

Introduction:The aim of the current study was to assess the impact of an intervention aimed at communicating the negative reinforcement explanation for smoking, a set of ideas derived from popular self-help books, upon participants' cognitions and urges to smoke. Methods: Smokers (n = 205) undergoing standard stop-smoking treatment were randomised to receive either the experimental intervention, a brief intervention aimed at communicating the explanation or a control intervention, a video on the health risks of smoking. Outcomes were participants' acceptance of the negative reinforcement explanation for smoking, positive outcome expectations for smoking, self-efficacy and urges to smoke reported at one week post-cessation. Results: Post-cessation urges to smoke were similar in the two groups (Adjusted expt. group mean = 2.50, Control group mean = 2.75, F(1,60) = 0.98, p = .33). Other cognitive measures were also unchanged. Conclusions: The brief cognitive intervention offered as an adjunct to standard care failed to reduce urges to smoke or alter smokers' cognitions. Changing smokers' cognitions may be as challenging as changing their behaviours. Suggestions are provided for further research.

Tobacco smoking perpetuates the disadvantages experienced by Aboriginal and Torres Strait Islander people in Australia. Tobacco smoking is a risk factor for poor maternal and infant outcomes in pregnancy. Over half of Aboriginal and Torres Strait Islander women smoke during pregnancy and few successfully quit. Aboriginal and Torres Strait Islander women face many intrinsic barriers to quitting such as low socioeconomic disadvantage and patterns of use in family networks. There are also several extrinsic hurdles surrounding current practice guidelines and policy that may limit success in reducing smoking rates among Aboriginal and Torres Strait Islander women during pregnancy: the use of the Stages of Change (SOC) model; delay in the use of nicotine replacement therapy (NRT); and the absence of subsidised intermittent NRT. A more proactive approach towards smoking cessation for pregnant Aboriginal and Torres Strait Islander women may be necessary, including moving away from the SOC model approach and subsidised provision of intermittent NRT. Comprehensive programs that take into account the family network and wider social context are also recommended.

Introduction:Proschaska's transtheoretical model (TTM) of behaviour change suggests that a population of smokers varies along many dimensions, including readiness to quit and the presence of other risk factors. This study examines whether smokers contemplating quitting are more likely to be contemplating another change (e.g., Pap testing and physical activity). Methods:The study used self-reported cross-sectional data (n= 2,873) from the Canadian Community Health Survey (CCHS) Cycle 4.1 2007/2008. The association between the smoking stage of change (SOC) and Pap testing behaviour was assessed. Control variables included sociodemographic and behavioural characteristics (e.g. doctor visits and number of cigarettes smoked). The distribution of health behaviours (e.g., dietary changes and exercise) by smoking SOC among women with recent Pap tests was also examined. Results:Female smokers contemplating or preparing to quit smoking had higher odds of having a recent Pap test, OR = 1.40, 95% CI (1.19, 1.65), and OR = 1.82, 95% CI (1.47, 2.25) respectively, compared to smokers who had no intention of quitting. This association remained statistically significant after adjusting for confounders, AOR = 1.28, 95% CI (1.08, 1.52), and AOR = 1.63, 95% CI (1.31, 2.04) respectively. Fruit and vegetable consumption, physical activity, and recent dental visit were associated with advanced smoking SOC among women with recent Pap tests (P< .05). Conclusions:Advanced smoking SOC was associated with the increased likelihood of having a recent Pap test and engaging in other healthy behaviours. These findings show that targeting several health behaviours simultaneously may be an effective health promotion strategy.

Background: Little is known about the extent to which smokers attending stop-smoking clinics experience conflicting motivations about their quit attempt, whether such conflict can be understood in terms of a single dimension and if this ‘conflict about quitting’ differs from motivation to stop smoking and is associated with a smoker's choice of method to stop smoking (stopping gradually or abruptly). Method: Sociodemographic, smoking and quit attempt characteristics as well as measures relating to conflict about stopping smoking were recorded in a cross-sectional survey of 198 smokers attending five quit smoking clinics in Malaysia. Results: Five measures (having seriously thought about quitting before, being happy about becoming a non-smoker, being strongly motivated to stop, intending to stop smoking completely and believing in stopping for good this time) were loaded onto a single factor that could be labelled ‘conflict about quitting’. The resultant scale had moderate internal reliability (Cronbach's α= .625). Most smokers exhibited conflicting motivations about stopping smoking, with over half (52.0%, 95% CI 45.1–59.1) scoring 2 or higher on the 5-point conflict scale. ‘Conflict about quitting’ was significantly associated with the decision to stop smoking gradually rather than abruptly controlling for other variables (OR 1.36, 95% CI 1.05–1.76) and was more strongly associated with the choice of smoking cessation method than motivation to stop smoking. Conclusions: ‘Conflict about quitting’ can be conceptualised as a single dimension and is prevalent among smokers voluntarily attending stop-smoking clinics. The finding that smokers who display greater conflict about quitting are more likely to choose gradual cessation may explain contradictory findings in the literature regarding the effectiveness of different methods of smoking cessation.

Despite substantial efforts to decrease its prevalence, it is estimated that more than 20% of French women continue to smoke during pregnancy. The aim of this study was to assess the perceived stress and coping strategies used by pregnant smokers when they seek help to stop smoking. Eighty pregnant women were involved. Pregnant women who stated their intention to quit smoking (n= 40) were compared with pregnant nonsmokers (n= 40). All participants filled out the Brief Cope (BC), the Perceived Stress Scale (PSS) and the Hospital Anxiety Depression Scale (HADS). In addition to these self-report scales, pregnant smokers completed the Fagerström Tolerance Questionnaire (FTQ). The results show that pregnant women who smoked used less active coping, planning, and positive framing, considered a good adaptive strength, and had significantly elevated scores on perceived stress and anxiety scales than nonsmokers. This research is the first to provide Brief Cope results for pregnant smokers seeking help to stop smoking linked to perceived stress. The results obtained contribute to the well-known psychosocial factors in maintaining smoking during pregnancy and will be used in the implementation of more effective intervention programs among pregnant women.

Background: Awareness programs are highly recommended to educate smokers and help them to quit. The aim of this study is to evaluate dental professionals' awareness and utilisation of the 5As in the Eastern Province of Saudi Arabia. Material and Methods: A survey was conducted in Saudi Arabia on 102 dental care providers (DCPs) in 2010 to assess awareness of 5As. Many factors were included in the survey such as demographic characteristics, working place, years of experiences, level of education and country of graduation. Results: Only 23 (22.5%) of our sample know about the 5As (Ask, Advise, Assess, Assist and Arrange), and less than 7% of DCPs assist their patients to quit smoking. In addition, 19 (18.6%) of DCPs were smokers, and of them 6 (31.6%) smoked in front of their patients. Conclusion: Most of the dental practitioners were not aware of the 5As for smoking cessation. Most of them they did not pay attention to the willingness of their patients to quit smoking.

Overview:Many U.S. hospitals use fax-referral to quitlines to provide outpatient follow-up. It is important to understand whether it is better to refer all smokers, or only those ready to quit, to quitline services. The purpose of this pilot project was to evaluate the feasibility and intermediate out-comes of a proactive (offering fax referral to all smokers) versus a reactive (pre-screening for readiness to quit within the next 30 days) approach to quitline fax-referral. Method:We employed a pre-test, post-test comparison group design in which a script-based reactive approach was employed over a two-week period and a script-based proactive approach was employed in the following two-week period. Scripts were inserted into the counselling protocols of a pre-existing inpatient treatment program. Major Findings:We enrolled 45 patients — 25 during the reactive, and 20 during the proactive block. In the reactive group, 12 (48%) indicated that they were ready to quit smoking and accepted fax-referral to the quitline. Nine (75%) were successfully contacted and enrolled in the quitline, for an overall quitline enrolment rate of 36% (9/25). In the proactive group, all accepted fax-referral to the quitline and 11 were successfully contacted and enrolled by the quitline for an overall enrolment rate of 55% (11/20). Quitlines were able to reach and enrol a higher proportion of patients referred to them, when patients were pre-screened for readiness to quit. Offering quitline referral, regardless of readiness to quit, potentially expands the reach and possibly the impact of quitline counselling.

This study reports client satisfaction in five UK National Health Service (NHS) Stop Smoking Services (SSS) and examines the impact of satisfaction on outcome four weeks postquit. Six services were selected on the basis of perceived ability to run the study from a pool of 11 who responded to a mailshot to volunteer. Advisors made one of two satisfaction surveys available to their clients two weeks after quitting smoking. The two surveys were a ‘brief’ three-item survey and a ‘full’ survey containing those items plus 19 others about specific aspects of the service. There were two key items: how satisfied respondents were with the support they received to stop smoking and would they recommend the service to another smoker. Surveys were completed anonymously but had unique identification numbers so they could be linked to individual demographic and outcome data. Overall 10% (554/5520) of treated smokers in the services completed a survey, 7% (390/5520) completed the ‘full’ survey. Responses were a strong endorsement of the participating services, with 93% (505/542) satisfied or very satisfied with the service and 99% (548/552) prepared to recommend the service. The sample was unrepresentative of the population of treated smokers in terms of eligibility for free prescriptions, ethnicity, age, type of treatment experienced, the type of advisor seen, medication use and end of treatment outcome. Satisfaction at week two was not related to abstinence at four weeks postquit. Limitations of the study and suggestions for service delivery are discussed.

Background and Objectives:Tobacco smoke contains many substances that are harmful and induce cancerogenesis. Carbon monoxide (CO) is the parameter commonly monitored by smoking cessation centres. The purpose of this study was to analyse other parameters and risk factors, including respiratory function and CEA (serum carcinoembryonic antigen) levels, in patients undergoing smoking cessation. Methods:One hundred and eighty current smoking patients current smokers were recruited from the outpatients for smoking cessation. Sociodemographic and lifestyle analyses were performed on them. They were also studied for respiratory function parameters and CEA (serum carcinoembryonic antigen) levels. A control group of 171 former smoking patients were also studied for functional and clinical parameters. Current smokers were also monitored for several parameters in the first 3 months after starting therapy with nicotine inhaler and varenicline, in addition to the behaviour therapy. Results:Some functional and clinical differences were found between the smokers and the former smokers groups. In the smokers' group we found no significant differences in sociodemographic and lifestyle between females and males. Regarding the response to varenicline-nicotine treatment combined with minimal advice, 56% of patients stopped smoking after 3 months of therapy; 30% of these had a level of severe bronchial obstruction. Operating parameters and the level of CEA at the beginning of the therapy were evaluated after 3 months, showing significant differences. Carboxyhemoglobin was reduced by 1.06%, oxyhemoglobin increased by 2.94%, FEF 25/75% increased by 16%. Conclusions:We can say that smoking cessation leads quickly to the improvement of clinical, functional and laboratory parameters. Patients with severe obstruction are more motivated to stop smoking.

Aims: A history of either a substance use disorder (SUD) or psychiatric disorder (PD) is associated with tobacco use. However, there is limited information available on tobacco dependence treatment outcomes among individuals with co-occurring SUD and PD. Methods: Data from 202 participants enrolled in a tobacco dependence treatment program in an outpatient clinic setting were analysed. Findings: In multivariate analysis, having a history of SUD only (OR =.11, 95% CI = .02–.76) and having a co-occurring SUD and PD (OR = .13, 95% CI = .02–.81), as compared to having neither, were significant predictors of a lower likelihood of achieving smoking abstinence. Conclusions: A history of SUD and PD is an important predictor of poor smoking cessation outcomes; however, using more intensive, tailored approaches to tobacco dependence treatment appears to be promising. Future studies may need to further address the nature of tobacco dependence treatment in settings were PDs and other SUDs are managed in order to achieve optimal outcomes.