Cigarette smoke contains polycyclic aromatic hydrocarbons (PAHs) that activate the expression of cytochrome P450 family 1 (CYP1) enzymes in liver and other tissues; this process is dependent on the aryl hydrocarbon receptor (AhR) transcription factor. An important CYP1 enzyme, CYP1A2, has a critical role in the oxidation of drugs such as clozapine, olanzapine and theophylline; these drugs exhibit a high incidence of adverse effects that are linked to plasma concentrations. This article reviews the impact of smoking and smoking cessation on therapy with toxic drugs that undergo CYP-mediated elimination. PAHs in cigarette smoke activate the AhR and upregulate CYP1A2, which enhances the clearance of these drugs, diminishes their efficacy and necessitates the use of higher doses. However, smoking cessation decreases PAH exposure, which leads to a decline in clearance of CYP1A2 substrate drugs. Dose reductions and close therapeutic monitoring for such drugs are recommended in patients who cease smoking.

The hypotheses that smokers hold misconceptions around nicotine replacement therapy (NRT) safety, and that these concerns limit the use of NRT, was tested with two large face-to-face surveys of current smokers in Great Britain in 2004 (N = 605) and 2006 (N = 1,434). In both studies, participants were questioned regarding the safety of nicotine and NRT products, their past experience with NRT and anticipated future use. Across both surveys, approximately two thirds of smokers believed that, or were unsure whether, NRT was as harmful as cigarette smoking. Combining information across surveys, smokers with safety misconceptions reported being less likely to want to quit in the future (63% vs. 73%; p < .001), and, among those who were interested in quitting, were less likely to report an intention to use NRT during their next quit attempt. The majority of smokers were misinformed about the safety of NRT products, and smokers with safety misconceptions were less likely to report that they plan to use NRT during future quit attempts, suggesting that safety concerns are a barrier to NRT utilisation.

The purpose of the study was to develop a smoking cessation online service (SCOS) for cigarette smokers. The SCOS website was developed via Flash Professional® program version 9.0 with software that included Mozilla™, Java®, and Windows™. Twenty-five volunteers accessed SCOS. Five trained hospital pharmacists were responsible for the online counselling service. Most volunteers were males with a history of smoking of at least ten years, were aged between 21 to 30 years, and were in the low income bracket. Twenty-five per cent of the volunteers stated that they were ready to quit smoking. The most common method of smoking cessation was to give up smoking at once (48%). Results showed that attitudes towards smoking perceptions were positively high with a mean score of 28.52 out of 30. Volunteers also stated they thought SCOS was interesting and useful. They liked the functions of the program as well as its benefits. Recommendations included the extension of the study into different areas, the continuation of SCOS as an alternative for quitting smoking and the evaluation of the effectiveness of SCOS alongside current methods of smoking cessation, such as face-to-face counselling, home visits and phone calls.

Research consistently demonstrates that a bout of moderate exercise alleviates cravings to smoke among abstaining smokers. This pilot study examined the effects of an acute bout of brisk walking on cigarette cravings and smoking topography. Using a within-subject, crossover design, two 10-minute treatment sessions were conducted on separate days by 19 participants (M age = 24.6 years): passive (i.e., sitting) and brisk walking conditions. Participants rated cravings at baseline, midcondition, and at 0-, 10-, and 20-minutes postcondition and objective measures of smoking topography (puff count, puff duration, puff volume, interpuff interval [IPI], time to first puff [TTFP]) were obtained with the first cigarette smoked postcondition. A 2 (condition) × 4 (time) ANCOVA indicated lower desire to smoke (p < .05) during the walking condition than the passive condition. After the brisk walking condition, a series of ANOVAs demonstrated a significantly increased delay to first puff in comparison to the passive condition. Posthoc analyses (controlling for abstinence period) indicated significant lower puff volume and a trend for shorter puff duration following brisk walking in comparison to the passive sitting condition. A greater reduction in cravings was associated with a longer delay to first puff. In addition to reducing cravings, these results suggest that a bout of brisk walking may also change an individual's smoking behaviour.

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, 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.

Introduction: The tobacco epidemic is surging in developing countries. While the determinants of tobacco use are well known, it is less certain whether they are similar in developed and developing countries. This has important ramifications for the implementation of interventions locally. This qualitative study explored the determinants and importance of context on tobacco use in Pakistan. Methods: Focus group discussions were conducted in two districts with doctors, nurses and patients from local tuberculosis clinics. Results: Peer influence, social acceptability, affordability and visibility of tobacco, public understanding and personal perception of risks influence tobacco use. Individual factors, such as personal curiosity, adversity and stress, also affected tobacco uptake and use. Patients were willing to pay for effective cessation treatment provided the costs were comparable to their expenditure on tobacco. Discussion: Factors such as peer and social influences are similar to those reported elsewhere. However, local variations exist in the degree of sociocultural acceptability, visibility of tobacco use, public understanding of risks and individual situational factors that influence tobacco use. Patients are prepared to pay for treatment, but there are gender differences in what can be afforded. For tobacco cessation interventions to be effective, local adaptations are essential to ensure cultural and contextual appropriateness.

Heartwatch is an Irish primary care-delivered secondary prevention program for patients with established coronary artery disease (CAD). We aimed to describe the patterns of smoking cessation in Heartwatch and examine the associates of successful smoking cessation. Participants with established CAD were invited to baseline and three-monthly clinic visits. Data on all persons reporting tobacco use at baseline were examined. Associations between smoking cessation and baseline factors were examined using logistic regression models. Data were available on 1,679 Heartwatch patients who were smoking at first visit. One third of smokers (581 participants: 34.6%) achieved smoking cessation during the study period (2003 to 2007), 80.4% of whom remained nonsmokers at end of follow-up. Positive associates of successful smoking cessation included increasing age, male sex, a body mass index > 25 and increasing number of study visits. Negative associates included having a means-tested general medical services allocation, being unemployed, and documentation of stop-smoking advice. All factors except employment status retained statistical significance when examined in a multivariable model. In conclusion, high levels of smoking cessation were achieved in this secondary prevention population of persistent smokers. Associates of successful smoking cessation were identified. Specific stop-smoking strategies should be considered for those subpopulations less likely to quit.

Objective: State smoking cessation telephone quitlines have become an integral part of the U.S. public health strategy for helping smokers quit. It is unclear whether these quitlines meet the needs of smokers with a mental illness, who have unique challenges during the quitting process and may benefit from more intensive treatment compared to smokers without mental illness. We conducted a needs assessment survey of U.S. state quitlines (N = 51 including Washington DC) to learn how they work with mentally ill callers. Methods: Quitline representatives were asked whether they have, or perform, six services chosen to represent basic elements of treatment access, process and structure for mentally ill smokers. Findings: We had a 96% response rate to our survey. All surveyed quitlines accept calls from mentally ill smokers, and all either train their counsellors in mental health or their counsellors have past mental health training. In addition, all quitlines encourage mentally ill callers to discuss quitting with their regular healthcare providers for safety reasons. However, only eight surveyed quitlines (16%) screen callers for mental illness, few (18%) use specific counselling protocols for mentally ill callers, and even fewer (6%) have self-help materials tailored for the mentally ill. Conclusions: Future studies are needed to analyse these variations in state quitline operations to identify the most effective approaches to providing telephone-based treatment for smokers with mental illness.

Background: Efficacious smoking cessation interventions exist, yet few smokers utilise available resources such as psychosocial treatment programs and pharmacotherapy. The goals of the present study were to (1) identify perceived barriers to entering smoking cessation treatment programs among socioeconomically disadvantaged smokers, who are presently underrepresented in smoking cessation interventions; (2) determine what variables are most important in predicting the barriers identified (i.e., age, gender, ethnicity, income, nicotine dependence level, smoking rate, years smoking, stage of change, presence of smoking-related illness and medical insurance status). Methods: Responses from socioeconomically disadvantaged smokers (N = 343) were collected in 2004–2005 and analysed to develop the Treatment Barriers Questionnaire, a 40-item measure of reasons for not entering smoking cessation programs. Study methods were approved by the Institutional Review Board of Louisiana State University; informed consent procedures were employed. Results: Principal components analysis yielded seven scales named for their theme: (1) Preparedness to Quit Smoking; (2) Work and Time Constraints; (3) Smokers Can or Should Quit on Own; (4) Opinions about Professional Assistance; (5) Mobility Limitations; (6) Insurance Limitations and (7) Misinformation about Professional Assistance. Gender, ethnicity, daily smoking rate, nicotine dependence and stage of change were significant predictors in regression analyses for scales 1, F(10, 201) = 7.83, p < .001, R2 = .29, 2 F(10, 201) = 2.30, p < .05, R2 = .11, and 3, F(10, 201) = 3.58, p < .001, R2 = .16. Conclusions: Results can inform efforts to facilitate entry and retention of smokers in cessation programs.