One of the first things I teach students about tobacco use is that it is best considered a disease, not a risk factor (Stephen Hamann, 2004).

Background: Parental smoking remains a significant risk to the preterm infant both pre and post delivery. Pharmacologically supported interventions have been previously contraindicated in this group during the perinatal period and during breastfeeding. We designed an evidence-based intervention for use in our high-risk population. This report assesses our outcomes after one year. Method: Questionnaire administered a median of 6 months after intervention. Results: There was no significant difference between those participants who returned the survey (n = 42) versus the group as a whole (n = 70). A total of 33% ceased smoking, p < .0001. If no nonresponders ceased smoking then this gives an overall success rate of 20%, p < .0001. Successful quitters had been smoking for a mean of 11 (SD = 7) years. Self-reported light smokers (< 10 cigarettes per day) were significantly more likely to quit (p < .01). Purchase of follow-on nicotine patches was a significant predictor of success in quitting (p = .02). If relapse occurred, it appeared to happen early and was mainly associated with current stressors. Conclusions: We have designed and applied a multidisciplinary intervention for parents and carers to be used in the perinatal period to decrease the postnatal risk for neonatal intensive care graduates. Our rates of successful smoking cessation are as good as, or better than, many published rates for opportunistic intervention. We suggest that randomised trials be focused on ways to further improve interventions at this time of opportunity for these infants and their families.

The prevalence of cigarette smoking among young people is a cause for concern. College health care providers (HCPs) can provide evidence-based interventions but frequently do not, in part, because of concerns that tobacco interventions might alienate their young patients. Six hundred and eighty-four college student patients were interviewed as they exited a college health centre. The patients were asked about smoking status, about discussions with their provider regarding tobacco and to rate their satisfaction with the visit. Of the students who smoked, 48.6% reported the HCP discussed tobacco use and 38.6% reported that the HCP provided advice to quit. Mean ranked satisfaction was significantly higher among students who received tobacco discussions and/or advice to quit. This study should encourage college providers to intervene with smoking college students without fear that this will alienate patients.

The construct of emotional awareness refers to attending to, identifying, differentiating, and labelling emotions in oneself and in others. Forty-two smokers were evaluated before they stopped smoking and also filled out the Levels of Emotional Awareness Scale (LEAS), the Toronto Alexithymia Scale (TAS-20), and the Sensation Seeking Scale (SSS). Subjects had low levels of emotional awareness and their scores on the emotional components of the TAS-20 were high in comparison to the general French population. No relationship was found between TAS-20 and LEAS, which confirms that these scales measure complementary dimensions of emotional processing that are only partially linked. Whereas sensation seeking was lower in self-rated alexithymic subjects, high scores on Boredom Susceptibility and total SSS among women were related to low LEAS scores. The results highlighted impairment of emotion processing in these subjects. Their state versus trait status is discussed, as well as their defensive functions. Treatment targeting emotional abilities enhancement for these subjects, as in other addictions, may help improve treatment of tobacco dependence.

Background/Aims: Physicians' reluctance to promoting smoking cessation reduces the effectiveness of evidence-based recommendations resulting in suboptimal patient outcomes. Primary aim: to draw together findings from studies that addressed physicians' perceived barriers to promoting smoking cessation. Secondary aim: to assess whether interventions for reducing such perceived barriers impact on smoking cessation rates. Methods: Literature search in peer-reviewed journals focused on physicians' perceived barriers to addressing smoking cessation or on intervention studies aimed at alleviating these barriers. Results: The most frequently reported perceived barriers were: time constraints, high workload, lack of training, lack of reimbursement of smoking cessation interventions and the physician's own smoking status. Low outcome expectancy, lack of self-efficacy, fear of losing patients, being uncomfortable to discuss smoking hazards, dissatisfaction with professional activity were also reported. Smoking quit rates of intervention studies aimed to reduce perceived barriers varied according to the barrier targeted. Conclusion: Primary care physicians report a great number of perceived barriers to addressing smoking cessation. Results of intervention studies designed to reduce specific barriers with the purpose of increasing quit rates, remain conflicting. Multilevel intervention studies seem to be needed to assess the efficacy of alleviating perceived barriers to addressing smoking cessation.

This study evaluated a cessation of smoking program for older (≥ 65 years) smokers. We recruited 215 community-dwelling smokers who selected either an intervention (n = 165) (brief intervention, telephone support, access to nicotine replacement therapy [NRT]) or ongoing smoking (continuing smokers) (n = 50). Primary outcomes at 12 and 24 months were (a) total abstinence and (b) cessation for the previous 30+ days, all validated via expired carbon monoxide (ECO). We interviewed 183 (85%) participants at 12 months and 165 (77%) at 24 months. Total abstinence was reported by 29 (18%) and 21 (13%) of the intervention group and none of the continuing smokers at 12 and 24 months. At 12 months, a greater prevalence of 30+ day cessation was observed for the intervention (24.2%) than the continuing smokers (4.0%): by 24 months this difference was 23.6% versus 12.0%. Those totally abstinent for 24 months predominantly used NRT (81%). Of the 30+ day quitters at 24 months, 74% of the intervention group used NRT and 100% of the continuing smokers used ‘cold turkey’. Cessation programs can be successfully delivered to older smokers, with outcomes comparable to the general population. NRT is commonly used by successful quitters, but ‘cold turkey’ can also be successful.

Guidelines recommend that general practitioners (GPs) should advise all smoking patients to quit and provide additional stop-smoking interventions as appropriate. This study aimed to improve our understanding of how this recommendation can be achieved. General practitioners (N = 26) from London completed a questionnaire about their stop-smoking interventions and psychological factors that might affect these. Thirty-one per cent of the patients recognised as smokers by GPs did not receive an intervention and two-thirds of these were judged to be inappropriate for receipt of an intervention. Psychological factors that predicted behaviour were perceptions that doing this was ‘normative’, making an effort to make it happen, and feeling that the behaviour was easy to enact. Strategies to improve guideline implementation may be more effective if they addressed the above psychological factors.

This preliminary laboratory study investigated nicotine absorption rates of seven current nicotine replacement therapy (NRT) products and a new wide-bore nicotine delivery device (the ‘Nicotine Cannon’). The nicotine products (Cannon, inhalator, nasal spray, microtab, 2 mg and 4 mg gum and 2 mg and 4 mg lozenge) were used for ten minutes by two non-nicotine tolerant subjects. Blood was taken at frequent intervals for the next 60 minutes and plasma nicotine concentrations assessed. Of current NRT products investigated the 4 mg lozenge performed best with the highest blood nicotine levels at each time point, the 2 mg gum delivered the lowest concentrations at each time point. The nicotine nasal spray delivered nicotine the fastest of all the products. The Cannon delivered the highest blood nicotine concentration (mean 8.95 ng/ml) of all products one minute after device use had stopped, and the highest concentration (11 ng/ml) five minutes after termination of use. The Cannon showed it could deliver nicotine relatively rapidly in a manner that was readily tolerated by users.

Postcessation weight gain is common and a frequent cause of relapse. Although interventions to address weight gain and weight gain concerns exist, the experience of telephone cessation counsellors in addressing weight concerns is unknown. We surveyed 134 cessation counsellors providing quitlines for 30 states regarding their experiences and attitudes about how to address weight gain concerns among smokers trying to quit. Counsellors estimated they discuss weight in 40% of their calls, primarily discussing concerns about gaining weight. Counsellors estimated that smokers gain about 4.1 kg after quitting and about 48% gain more than 2.3 kg. Most counsellors believed that exercise, education about weight gain and preparing smokers for weight gain would help people quit, which is consistent with current science. A total of 51% of counsellors believed that dieting while quitting would reduce weight gain and only 35% correctly identified that dieting reduces a smokers' ability to quit. Some counsellors believed they needed more training in weight management and may need to be reassured that they are currently following treatment guidelines when confronted with smokers who have concerns about postcessation weight gain.

Objective: To explore the attitudes of hospital doctors towards current smokers with Chronic Obstructive Pulmonary Disease (COPD). Methods: We surveyed 184 hospital doctors of all grades regarding their attitudes to four patient scenarios including: current excess alcohol drinker, current smoker limited by angina, current intravenous drug user and current smoker limited by COPD. Doctors scored to what degree they felt the patients were at fault for their condition and in control of their future health. Results: Most doctors agreed/strongly agreed that current smokers with COPD were the most ‘at fault’ for their condition and when asked to rank the four patients from most to blame to least to blame for their own ill health, 80% doctors ranked smokers with COPD more to blame than smokers with angina. In the last 2 weeks almost all doctors had managed smokers, but only two thirds had offered any form of cessation advice. Comment: A significant proportion of doctors believe that patients with COPD are at fault for their condition; however, they appear to believe there is scope for change in smokers and other addicted patients. By implementing smoking cessation training, doctors can improve the care offered to smokers and avoid the negative attitude towards smokers with COPD.

The pharmacological, stimulus expectancy, and response expectancy effects of light cigarettes (0.60 mg yield of nicotine) compared with virtually nicotine-free cigarettes (less than 0.05 mg yield of nicotine) were examined using a between-subjects design. A total of 103 college student smokers completed tests of cognition before and after smoking one type of cigarette, which was evaluated on a number of dimensions. Cigarettes with nicotine were preferred on most dimensions, and stimulus expectancy partially mediated the relationship between nicotine and subjective effects of the cigarettes. Stimulus expectancy also mediated the effect of nicotine on tension reduction immediately after smoking, but not near the end of the experiment. Response expectancy effects of nicotine were related to predicted and actual recall performance, such that participants who performed well tended to attribute the effect to the cigarette they smoked. Implications for smoking cessation and research studies using non-nicotine cigarettes are discussed.

Purpose: To report a case of adverse reaction to nicotine gum in a Chinese female with poor nicotine metabolic status after chewing a piece of 2 mg nicotine gum (NG). Background: NG is prescribed in smoking cessation programs to help individuals stop smoking. In smoking cessation treatment, the dose of NG should control withdrawal symptoms but avoid adverse effects. Case results: We describe a case of an adverse reaction following the administration of 2 mg NG to a female Chinese subject. This study compared a single dose of 2 mg NG with a single low dose cigarette (0.7 mg nicotine). Blood (5mL) was collected at baseline and 2h post exposure to NG. Blood pressure and pulse rate were also recorded. Nicotine metabolic rate was determined by calculation of the ratio of plasma cotinine (ng/mL)/plasma nicotine (ng/mL). The subject developed nausea and severe vomiting with raised blood pressure and pulse rate following administration of NG. The ratio of plasma cotinine/nicotine was 0.4 indicative of poor nicotine metabolic rate. Exposure to nicotine using the subject's normal cigarette did not produce similar adverse effects. Conclusion: NG may be associated with adverse reactions in smokers with low nicotine metabolic rate. Physicians in smoking cessation programs should be aware that some individuals may not tolerate this form of pharmacological treatment.