Smoking is a leading cause of respiratory disorders. Smoking cessation is crucial for improving and even for curing many respiratory diseases. Smokers with respiratory diseases can suffer from comorbidities and a higher degree of nicotine dependency than ‘healthy smokers’. For this reason, smoking cessation services (SCS) should be an integral part of a chest unit. The SCS must be run by professionals with expertise and must be well-equipped. They should provide cessation support for all patients who smoke, and educational programs for health professionals. They also have a role in investigation of new treatment strategies.

Tobacco treatment specialists (TTS) are essential to developing an adequate system of treatment for smoking. Tobacco cessation treatment should be seen, not solely as a public health or prevention activity, but rather as a clinical activity. TTS should increase their professionalism by embracing evidence-based medicine. TTS should form professional organizations and credentialing bodies to insure a high quality professional identity.

With more medications available for smoking cessation treatment the need to diagnose the tobacco dependence for better tailoring of treatment is growing. It has been suggested that smokers can be peak seekers or trough maintainers vis-à-vis blood nicotine concentrations (Russell, 1990), or smoking predominantly for coping with withdrawal or smoking for pleasure (Juniper et al., 2005). In this article a related concept, smoking for negative reinforcement (NR) or positive reinforcement (PR), is investigated. A simple 1-question assessment of type of reinforcement is suggested. From data from smokers attending smoker's clinics — 2 from Sweden using varenicline and 1 from Spain using nicotine patches — it looks as if smokers smoking predominantly for PR do better than NR smokers when treated with varenicline, while there is no difference when they are treated with nicotine replacement. When degree of nicotine dependence is crossed with type of reinforcement it looks as if NR/low nicotine dependent smokers have the best outcome (64%) compared with 47% (p < .01) for the whole sample treated with nicotine replacement. When varenicline is used, the PR/low dependent group had the best quit rate with 85% compared with 67% (p < .05) for the whole sample. This brief report proposes that smoking for PR or NR, possibly combined with degree of dependence, should be further studied as a tool for tailoring smoking cessation treatments.

Counselling pregnant smokers to quit is as difficult as it is essential. This article discusses a telephone counselling protocol designed to promote tobacco cessation among pregnant smokers. The protocol, validated in a large randomised, controlled trial, addresses three key elements of change for addictive behaviour — motivation, cognition and skill building — in ways tailored to pregnant smokers' unique needs. Details concerning scheduling, counsellor training and broader applicability are also presented.

This article characterises the social support received by a large sample of smokers attempting to stop and the relationship between this and the outcome of their attempt. A survey was conducted of 928 smokers attending a group-based program. Smoking among colleagues and a perception of having someone to turn to predicted outcome at the end of treatment, 4 weeks from the quit date (Odds ratio [OR] = 0.81, p = .008 and OR = 1.31, p = .003 respectively) Among those who abstained for the first week, smoking among colleagues and the frequency with which they had been offered cigarettes predicted outcome at the end of treatment (OR = 0.81, p = .04 and OR = 0.73, p = .01 respectively). There were no significant social support correlates of cessation for 26 weeks. Social support has a role to play in the short-term, but in the context of a group-based treatment program appears not to be related to long-term success.

Objective: To look for evidence of changing nicotine dependency self-reported by new callers to a national quitline in New Zealand between 2001 and 2005. Methods: Levels of self-reported nicotine dependence of new callers were compared across 5 years to determine changes over time. Results: Statistically significant decreases were found in all 3 measures of nicotine dependence over the 5-year period: time to first cigarette (7.9% decline for smoking within 30 minutes of waking), intensity of inhalation (36.8% decline for ‘heavy’ inhalation), and number of cigarettes per day (29.8% decline for 21+ cigarettes per day). Conclusions: The results showed the proportion of callers with high nicotine dependency remains large but decreased continuously during the 5-year period. A decline of highly nicotine dependent callers to the Quitline may indirectly suggest an increased proportion of hard-core smokers in the overall smoking population as this group tends to be less likely to consider quitting smoking. However, the results may also suggest that the overall smoking population was less nicotine dependent in 2005, than it was in 2001, or that the Quitline has become less appealing to heavily nicotine dependent smokers.

Varenicline tartrate (Champix) is the first in a new class of therapy for smoking cessation and has been available on NHS prescription since December 2006. It has received approval from The National Institute for Health and Clinical Excellence (NICE) and the Scottish Medicines Consortium and NICE final guidance was issued in July 2007. Varenicline is a partial agonist of the nicotinic receptor (·4, 2 subtype) and also prevents nicotine from binding to it. Studies comparing safety and efficacy with bupropion (Zyban) have been favourable and efficacy with varenicline has been shown to be greater than that with bupropion. A study comparing the nicotine patch is due for publication this year. Varenicline has a good safety profile with nausea being the most common side effect in about a third of those who take it. Despite the treatment's advantages there have been numerous issues which have affected its use. These include funding and administrative issues and this paper looks at ways of overcoming those barriers to prescribing what is a valuable addition to the range of treatments on offer to smokes who want to stop.

Objective: We assessed exercise levels and psychosocial aspects of exercise among pregnant smokers. Methods: A cross-sectional telephone survey of 88 pregnant smokers assessed levels of participation in exercise and psychosocial aspects of exercise; namely, self-efficacy, beliefs, perceived social support, perceived barriers, intentions and stage of change. Results: The women reported slightly higher levels of physical activity than for the general population of young women. The vast majority of women interviewed reported that exercise was important in their pregnancy, that they intended exercising regularly during pregnancy and were interested in exercise classes as an aid to smoking cessation. Fatigue was the most commonly reported barrier to physical activity during pregnancy, followed by ‘it takes too much time’, ‘uncomfortable when I exercise’ or ‘not sure what to do’. The vast majority of women expressed very little confidence and social support towards exercising. Conclusion: The results suggest that there is potential for using physical activity as an aid to smoking cessation during pregnancy. However, such interventions would need to be sufficiently intensive to address perceived barriers to exercise, lack of social support, low self-efficacy and be tailored to different stages of pregnancy.

The current practice of treating smokers as a homogenous group fails to recognise and adequately address the vast range (10–80ng/mL) of nicotine plasma levels (Russell, 1990) found among smokers. The Bittoun Model (Bittoun, 2006) individualises treatment according to the level of nicotine dependency. A total of 115 participants were enrolled in a 12-month program review based on the Bittoun Combination Nicotine Replacement Therapy (NRT) Algorithm (Bittoun, 2006). Participants found to be non nicotine dependent (Fagerstrom Test for Nicotine Dependence [FTND] = 0) (Heatherton et al., 1991) were excluded from the study. At 3 months, 52% (n = 99) of participants were total abstainers (self-reporting and expired CO ≤ 5ppm). Outcomes at 6 months (n = 58) and 12 months (n = 18; self-reporting) were 48% and 33% respectively. The Bittoun Model of Smoking Cessation offers an efficacious strategy for the assessment, management and delivery of tobacco intervention for the hard to treat smoker.

This article assesses whether the Fagerstrom Test for Nicotine Dependence (FTND), adequately reflects sex, gender and diversity related differences in nicotine dependence. Available studies on the FTND were reviewed and a sex, gender and diversity analysis (SGBA) of this instrument was conducted. Results indicate that sex and gender differences in nicotine dependence may undermine the ability of the FTND to present an adequate picture of dependence. Conducting a SGBA on this Fagerstrom test reveals that sex and gender differences likely limit the ability of this instrument to present an accurate picture of dependence in diverse groups. Further research is needed to enhance the sensitivity of the FTND.

Latino No Fumes: Protege tu Salud was a smoking cessation demonstration project carried out in 2003 to 2004 that recruited Spanish-speaking smokers in 8 Connecticut cities. Recruitment was through radio and TV announcements, by mail, and at clinics and hospitals. 252 current smokers — mainly of Puerto Rican ancestry — signed up for the program; 75% of them attended one or more of the program's 6 weekly, group counselling sessions. One third of the registrants attended at least 5 of the sessions offered. Attendance of one or more sessions was only 55% for summer or winter groups, but 98% for sessions held in the fall. For the summer or winter sessions (only), attendance at one or more sessions was significantly greater in small than in larger cities. At program end, 14% of the participants were verified nonsmokers (self-reported abstinence and carbon monoxide readings < 9 ppm). The reported quit rates were 18% and 13%, respectively, at 3 and 6 months. The amount of attendance was not significantly related to the reported end of program quit-rates. Nearly all nonsmokers at program end had attended groups conducted by just 3 (of the 7) trained counsellors, who were presumably more effective in helping these Latino smokers to quit.

This research examines the prevalence and attitudes of smoking among a Somali population in London. Eight focus groups and 77 assisted questionnaires were conducted. Findings show that there was little knowledge of local smoking cessation services and several themes arose including: the format and ineffective promotion of the United Kingdom National Health Service (NHS) Stop Smoking Services, health prom xotion and ambivalence towards preventative health behaviour. Smoking rates in this Somali population appear to be higher than in the UK general population, and higher still among men over 40 years old and those that regularly use qat. Smoking cessation services for the Somali population may be more popular if there were group clinics and culturally effective promotion of the services. The relationship between qat use and smoking should be considered when targeting services to the Somali population.

The health care setting, and most notably dental clinics, may hold promise in delivering effective tobacco intervention to adolescents. Adolescents between the ages of 14 and 17 were randomly assigned to brief advice from dental hygienists and dentists only or to brief advice plus a motivational interview and follow-up telephone contact from a study hygienist. Due to difficulties in identifying and recruiting subjects, study goals were expanded from cessation only to cessation and prevention. No differences in smoking prevalence were found between treatment conditions at either 3- or 12-month follow-up. Firm conclusions cannot be drawn about the effectiveness of treatment due both to problems in enrolling subjects and limited implementation of the motivational intervention.

Smokers who need help to stop smoking cannot always attend clinical treatment sessions, so it is important for other alternatives to be offered. We report a case study of a smoking cessation intervention administered to a 29-year-old male cigarette smoker who had made no previous attempts to quit and who did not want to stop smoking, but who was obliged to because he was about to undergo a surgical intervention. The intervention was a mailed behavioural program combined with telephone support, administered over a six-week period. The subject quit smoking after 4 weeks, and remained abstinent at 3-, 6-, and 12-month follow-ups. At the 12-month follow-up the carbon monoxide in expired air was used to verify his abstinence.