Introduction: Spousal support predicts smoking cessation. China is the world's largest consumer of tobacco, with drastic differences in smoking prevalence among men and women. Thus, understanding marital interactions around husbands’ smoking has implications for cultures with similarly large gender disparities in smoking.

Aims: We examined interactions among family members regarding husbands’ smoking in homes with small children in Shanghai.

Methods: In Spring 2013, we conducted in-person semi-structured interviews among 13 male smokers and 17 female nonsmokers recruited from an urban and a suburban community in Shanghai.

Results/Findings: To encourage husbands’ cessation or reduction, some women reported intervening either directly or indirectly through their children, emphasizing the health consequences for the smoker and the family. Some women reported not conversing about cessation due to concern about conflict, tolerance, or resignation. Women reported that their husbands’ responses to anti-smoking messages from family members included promises to quit in the future or noting the strength of the nicotine addiction and the disadvantages of quitting. Men reported the importance of smoking in work/culture and argued against the research about the harms of smoking.

Conclusions: Interventions targeting motivators for cessation among men and to support women in encouraging their husbands’ cessation should be developed.

Introduction: Few trials of exercise interventions for smoking cessation have included a qualitative evaluation of the intervention from the participants' perspective.

Aims: To determine the perceptions of participants who received a 6-month telephone counselling exercise intervention to aid smoking cessation.

Methods: Participants in the Fit2Quit study intervention group were asked to take part in a semi-structured phone interview. All interviews were digitally recorded and transcribed verbatim, and a general inductive approach to data analysis was followed.

Results/Findings: Twenty participants from the intervention group completed an interview. The following themes emerged from the analyses: (1) The support people were genuinely interested in what I was achieving, (2) new awareness, new attitude, new lifestyle: I could see the benefits, (3) lack of time, willpower and money stopped me from changing and (4) I would have preferred a “more hands on” approach: Recommendations for future programmes.

Conclusions: A telephone counselling intervention to enhance exercise for smoking cessation was well received. Aspects of the intervention, particularly the provision of support and encouragement from the participant support person, were beneficial. Suggested improvements were greater tailoring of the call schedule, greater face-to-face contact and provision of a buddy system or support group. Such improvements may increase adherence and, therefore, effectiveness of exercise interventions for smoking cessation.

Treating tobacco dependence is paramount for global tobacco control efforts, but is often overshadowed by other policy priorities. As stated by Jha (2009), “cessation by current smokers is the only practical way to avoid a substantial proportion of tobacco deaths worldwide before 2050.” Its importance is codified in Article 14 of the Framework Convention on Tobacco Control (FCTC), and in the WHO's MPOWER package of effective country-level policies. Unfortunately, only 15% of the world's population have access to appropriate cessation support (WHO, 2015). Moreover, parties to the FCTC have implemented only 51% of the indicators within Article 14, on average, which is far lower than many other articles (WHO, 2014). Further, commenting on the use of “O” measures (Offer help to quit tobacco use) in the MPOWER acronym, WHO recently concluded, “while there has been improvement in implementing comprehensive tobacco cessation services, this is nonetheless a most under-implemented MPOWER measure in terms of the number of countries that have fully implemented it” (WHO, 2015). To the detriment of global tobacco control efforts, only one in eight countries provides comprehensive cost-covered services, only one in four provide some cost coverage for nicotine replacement therapy, and fewer than one third provide a toll-free quit line (WHO, 2015).

Introduction: Individuals with substance use disorders (SUDs) and mental health disorders (MHDs) have greater prevalence of smoking and suffer greater tobacco-related morbidity and mortality. Varenicline is the latest FDA-approved smoking-cessation agent and few studies have investigated the use of varenicline in this difficult-to-treat population.

Aims: This study examines the smoking cessation outcomes and tolerability of varenicline when used to help quit smoking in 16 patients enroled in both psychiatric and substance abuse programme.

Methods: A retrospective chart review was conducted on 16 patient charts. Patient demographics, psychiatric disorder diagnoses, substance use history, dosing, side effects, number of cigarettes used pre/post varenicline use and the number of complete smoking cessation outcomes were tabulated.

Results: After varenicline intervention, 25% of those who completed treatment completely quit smoking. Thirty-one per cent were able to substantially cut back the amount that they smoked to one cigarette per day. The average reduction in cigarettes was 16 per day (64%), and all but one patient tolerated varenicline.

Conclusions: The authors observed reasonable clinical benefit when varenicline was used to help quit smoking in patients with comorbid SUDs and MHDs. Better-controlled future studies with larger sample sizes will help further determine clinical utility of varenicline in this difficult-to-treat nicotine-dependent population.

Introduction: Smokers’ treatment expectancies may influence their choice of a particular medication as well as their medication experience.

Aims: This study examined the role of smokers’ treatment expectancies to their smoking cessation outcomes in a completed, randomized, placebo-controlled trial of naltrexone for smoking cessation, controlling for perceptions of treatment assignment.

Methods: Treatment-seeking cigarette smokers (N = 315) were randomized to receive either naltrexone (50 mg) or placebo in combination with nicotine patch and behavioural counselling. Expectancies for naltrexone as a smoking cessation aid were assessed at baseline and four weeks after the quit date.

Results: More positive baseline medication expectancies predicted higher quit rates at one month in the naltrexone group (OR = 1.45, p = 0.04) but were associated with lower quit rates in the placebo group (OR = 0.66, p = 0.03). Maintaining and/or increasing positive medication expectancies in the first month of treatment was associated with better pill adherence during this interval in the naltrexone group (ps < 0.05). Positive baseline medication expectancies were also associated with the perception of having received naltrexone over placebo among all participants.

Conclusions: Positive medication expectancies in smokers may contribute to better treatment response. Assessing treatment expectancies and attempting to maintain or improve them may be important for the delivery, evaluation, and targeting of smoking cessation treatments.

The Associate Editor for this themed issue (Deborah Ossip) also wishes to express her appreciation on behalf of the Journal of Smoking Cessation to Dr Kenneth Ward for his outstanding job as Guest Editor to provide this compendium of lessons learned from LMICs around the globe regarding tobacco cessation research.

Introduction: Evaluating a new health service is different from evaluating a new drug, as the former depends on the local delivery structure and culture. No data are available on the effectiveness of the existing pharmacist-managed quit smoking clinic (PM-QSC) in Malaysia. We evaluated the effectiveness in terms of the quit and default rate, the cost per quitter, cost per patient and the number of days of the patient remained in the managed care of the pharmacist.

Methods: The patients’ medical records at the PM-QSC in a tertiary hospital in Melaka, Malaysia, were examined retrospectively from January 2009 to December 2010. Patients were grouped into current smokers, attempted to quit and quitters. Costs were calculated per patient visit on the basis of resource used (smoking cessation agents (SCAs)) and the personnel involved (time spent by the pharmacist). This study was reviewed and approved by the Malaysia Research Ethics Committee (MREC).

Results: The quit rate between January 2009 and December 2010 was 5.8%, and the default rate was 71.8%. The average quit period for all smokers enrolled was 298 days. From the health provider perspective, the average costs per quitter, per patient and per quit attempt were MYR 953.28 (USD 308), MYR 55.71 (USD 18) and MYR 34.74 (USD 11), respectively.

Conclusion: The pharmacist delivery of cessation services at a public-funded QSC was associated with a high default rate. The pharmacist could not be dismissed entirely as an ineffective health care professional (HCP) for the provision of the cessation service based solely on this preliminary data, but these findings stress the need to address the high default rate prior to the expansion of the service.

Introduction: With evidence to support the use of text messaging for smoking cessation, some quitlines in North America have incorporated text messaging into their service offerings.

Aims: This study sought to evaluate whether integrated phone counselling and text messaging services are acceptable to quitline callers, and to identify strategies for improving text messaging services in the context of a quitline.

Methods: Thirty-five adult callers of the New Mexico state quitline who had enrolled in multi-call phone counselling and Text2Quit, a text messaging programme, were interviewed by phone. Interviews assessed use and acceptability of the phone counselling and text messaging interventions.

Results: Use of phone counselling and text messaging was generally high among participants. While most participants reported that they would highly recommend Text2Quit (75.8%) or phone counselling (78.8%) individually, a relatively higher proportion indicated they would highly recommend the combined services (93.9%). Suggestions for improvement focused on increased customisation and personalisation.

Conclusions: This study provides preliminary evidence for the acceptability of integrated phone counselling and text messaging services. Research is needed that explores the impact of these widely-used integrated services on smoking cessation.

Introduction: Large disparities exist in smoking rates during pregnancy by racial/ethnic status. Aims: The current review examined controlled studies that predominantly included racial/ethnic-minority pregnant smokers for providing smoking cessation treatment. Methods: Two authors independently conducted the literature searches in the standard databases using a combination of the keywords with minority, pregnancy, smoking and cessation identifiers. Results: The searches identified nine articles that met the inclusion criteria. Only two studies exclusively targeted specific minority groups. Most of them provided some form of brief smoking cessation counselling, with two combining with incentives and one combining with pharmacotherapy. Two studies provided intensive cognitive interventions. Pregnant smokers of American Indian or Alaska Native, Hispanic subgroups, and Asian or Pacific Islander are under-studied. Conclusions: Future studies to treat minority pregnant smokers could target under-studied minority groups and may need to directly and intensely target smoking behaviour, address cultural and psychosocial issues in an individualised and comprehensive manner, and analyse the cost-benefit of an intervention.

The tobacco epidemic is increasingly concentrated in low- and middle-income countries (LMICs) (WHO, 2008). These countries often have very limited resources and infrastructure to confront this epidemic. Public knowledge of tobacco health harms may be quite limited and, unfortunately, this is often true for health professionals as well (Nichter, 2006). Clinical practice guidelines have identified effective tobacco cessation interventions (Clinical Practice Guideline, 2008), but these have been focused primarily upon high-income countries. Approaches that have been successful in high-income countries may not be directly applicable in low-resource settings. Thus, for example, medications may not be readily accessible and infrastructure to support quit line programs may be minimal or non-existent.

Background: Smoking cessation is most needed but, least accessible public health intervention in developing countries. Practicality of smoking cessation interventions determines their feasibility to implement in resource-limited setting.

Objectives: This review aimed at identifying strategic mechanisms to launch accessible smoking cessation services within primary health care settings of developing countries.

Methods: The efficacy of smoking cessation methods were reviewed in Cochrane reviews and clinical trials. Relevant research with an outcome of smoking cessation for six months and articles published after 2000 indexed in the PubMed database were reviewed. The practicality of each intervention was narratively appraised with further reviewing relevant effectiveness trials and observational studies.

Finding and discussion: Contemporary evidence favours multi-components smoking cessation strategy combining more than one efficacy-proven methods such as brief advice, nicotine replacement therapy (NRT) and nursing intervention. Future trials to evaluate social and family influences on smoking behaviour in combination with above interventions are necessary. Moreover, training health care professionals in primary health care to implement smoking cessation intervention may overcome human resource insufficiency and ensure smokers’ access to cessation service within the community setting.

Introduction: Smoking is associated with the development of coronary artery disease and influences negatively the prognosis of patients undergoing myocardial revascularization procedures. However, the rate of smoking cessation after these procedures is not well established in the literature. We aimed to evaluate the rate of smoking cessation in patients undergoing revascularization procedures, immediately and after 12 months of follow-up.

Methods: We examined smoking patients from a unique cardiology center who underwent myocardial revascularization procedures between January 2010 and December 2011. These patients were allocated to two groups according to the revascularization procedure performed: Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Interventions (PCI). Data related to cessation or maintenance of smoking were obtained at subsequent clinical appointments or telephone calls.

Results: Among 173 patients selected, 118 (68.2%) underwent PCI and 55 (31.8%) underwent CABG. After revascularization procedures, the total rate of smoking cessation was 79.3%. Furthermore, there was no significant difference between the two groups (83.6% – CI 95%: 71.2–92.2% for CABG, and 79.3% – CI 95%: 70.8–86.3% for PCI). The maintenance of smoking cessation after one year was 53.2%, similar between groups (52.7% for CABG and 53.4% for PCI). Nevertheless, the average time of smoking cessation was significantly higher in the CABG group (6.9 months versus 4.5 months for PCI).

Conclusions: Coronary interventions add important value to smoking cessation, and the smoking cessation rates were similar, independent of the procedure executed.

Introduction: Smokers unmotivated to quit are neglected by smoking cessation research. Free-text comment analysis is a potentially useful way to gain insight into this group's beliefs.

Aims: To analyse the free-text comments provided by smokers unmotivated to quit as part of a randomized controlled trial of computer-tailored feedback for smoking cessation.

Method: A random sample of 58,660 smokers were sent a smoking behaviour questionnaire (SBQ). The responses and follow-up outcomes of those providing free-text comments were compared to those who did not to assess the representativeness of the former group of smokers. The comments of participants unmotivated to quit (631) were thematically analysed.

Results: Those who provided a comment differed from those who did not on variables including education level and quit attempts at six-month follow-up. Emergent themes included; justification of smoking and restricting smoking instead of quitting.

Conclusions: The findings illustrate the value of free-text comments in identifying issues important to respondents. The identified themes highlight areas for future research in smokers unmotivated to quit including cutting down as a path to quitting and explicit messages regarding the inability of positive health behaviours to balance out the negative impact of smoking on health.

Trial registration: Current Controlled Trials ISRCTN05385712.

Evidence highlights that an acute bout of exercise can contribute to reductions in cravings and withdrawal symptoms. However, it is unknown how low in intensity or movement one can go before these effects no longer exist. The current study examined if exercise imagery could contribute to reductions in smoking cravings and withdrawal symptoms after a short period of abstinence (CO≤6ppm). Regular smokers (N = 29) were randomized into one of three treatment groups: exercise imagery, moderate intensity exercise, or control. Each completed questionnaires including: the Strength of Desire to Smoke item (primary outcome) and the Mood and Physical Symptoms Scale (Secondary outcomes) pre- and post-treatment. A 3 (Condition) by 2 (Time) repeated measures ANOVA showed a medium non-significant interaction effect (partial η2 = .06) favouring the exercise group for reductions in desire to smoke. A large significant interaction effect (partial η2 = .24) was found for tension. Medium-to-large non-significant interaction effects favouring the exercise group were found for various withdrawal symptoms. These data, taken together, suggest that exercise imagery is not as powerful as moderate intensity exercise in reducing cravings and withdrawal symptoms following temporary abstinence. Implications and future directions are discussed.

For over half a century, the U.S. National Cancer Institute (NCI) has supported research on tobacco and health, which has contributed to reductions in tobacco-caused morbidity and mortality in the U.S. But while tobacco use has been slowly declining in most high-income nations, including the US, it has continued to increase in other parts of the globe. Of the 800 million adult men who currently smoke cigarettes, over 80% are in low- and middle-income countries (LMICs), and these countries will bear an increasing share of the health and economic burden of tobacco use. At the same time, there are additional challenges to implementing tobacco control programs in LMICs, including a diversity of tobacco products, limited capacity and resources for tobacco control, and competing health priorities. While a large body of evidence has been generated around tobacco dependence treatment and other measures in high-income countries, this work is only partly applicable to many LMICs. In this paper we focus on research needs and opportunities around tobacco cessation interventions for LMICs, highlighting four areas: understanding diverse tobacco products, development of low-cost cessation interventions, integrating tobacco cessation into health systems, and understanding tobacco use behaviors across different contexts. Expanding tobacco control research and research capacity in LMICs is crucial to reducing tobacco use and cancer rates worldwide. Furthermore, research conducted in countries around the world can yield important insights for understanding tobacco use behaviors and the effectiveness of tobacco control interventions in the US.

Introduction: This study examined factors predicting nicotine withdrawal symptoms following quitting among Korean American smokers who were receiving counseling and nicotine replacement therapy.

Methods: The sample comprised 90 Korean American smokers selected from a two-arm randomised controlled trial of a smoking cessation intervention (culturally adapted versus treatment as usual). Nicotine withdrawal symptoms were assessed weekly for the first four weeks from the target quit day, using the Minnesota Nicotine Withdrawal Scale (MNWS). Only those who participated in two or more weekly assessments of the symptoms were included.

Results: Among the nine withdrawal symptoms listed in the MNWS, craving and disturbed sleep decreased over time whereas the remaining symptoms had no significant effect of time. Women or individuals who perceived greater risks of quitting smoking reported more withdrawal symptoms after controlling for abstinence status. Although withdrawal symptoms did not change, on average, with time, the rates of change varied randomly across individuals. Women reported more withdrawal symptoms in the first week after quitting and showed a higher rate of decline of the symptoms over time than men.

Conclusions: Korean American smokers who are women or who perceive greater risks of quitting smoking may require more intensive treatment to effectively deal with post-quit withdrawal symptoms.

Objective: This study aims to systematically review the existing literature on the current developments and impact of smoking cessation interventions targeted toward adult smokers in low and middle income countries (LMICs).

Methods: Major databases were searched with the following selection criteria: (1) studies based on empirical findings that demonstrate the impact of smoking cessation interventions in LMICs; (2) studies conducted in or focused on LMICs; (3) studies targeted at the adult smoking population; (4) studies focused on smoking cessation component of tobacco control; (5) studies that reported on the capacity for smoking cessation intervention and current developments in LMICs; (6) published in peer review journals between 2003 and April, 2013; (7) studies written or transcribed in English.

Results: A total of 23 articles (23 studies) were included in the review. Six studies assessed the effectiveness and cost-effectiveness of smoking cessation intervention types in some LMICs. Four studies explored the reach, adoption and institutionalisation of cessation interventions. Six studies assessed physicians’ capacity to provide cessation interventions, and seven studies provided insights on current developments.

Conclusion: Smoking cessation interventions are not readily available and affordable in LMICs. Extensive research is needed to determine the most cost-effective and culturally appropriate smoking cessation interventions for adult smokers in LMICs.

Introduction: Global Bridges, hosted at Mayo Clinic since 2010, is the only international network of healthcare professionals dedicated to tobacco dependence treatment. Globally, fewer resources have been dedicated to treatment than to other evidence-based tobacco control policies. The Global Bridges network seeks to aid in filling this gap in tobacco control.

Aims: This paper identifies ways to advance tobacco dependence treatment, as well as tobacco control, through efficient and effective use of a global health care provider network.

Methods: Observation and critical analysis of lessons learned, project outcomes to date, and network analysis.

Results/Findings: The initiative has built a strong global foundation, with training curricula developed and delivered in a number of countries, including low- and middle-income countries. While basic evaluation of content mastery and learner satisfaction has been conducted, more intensive evaluation and follow-up to confirm public health impact are essential needs. Finally, program analysis and application of management theory can be used in aiding future activities aimed at providing support for health care providers in the delivery of tobacco dependence treatment and in similar global public health endeavors.

Conclusions: The Global Bridges healthcare professional network, now in its sixth year, has developed training curricula and expanded evidence-based tobacco dependence education among healthcare professionals. Global Bridges comprises a unique and important component of the broader tobacco control community, and can play an integral role in furthering global tobacco control progress.

Each year, tobacco use causes over 6 million deaths and is responsible for hundreds of billions of dollars in health care and economic costs in the world (WHO, 2011). If current trends continue, tobacco is expected to kill over 1 billion people in the 21st century, making it one of the single greatest causes of preventable death and disease in history (WHO, 2011). Long-term abstinence from tobacco use dramatically improves individuals’ health, reduces the incidence of tobacco-related disease, and is clearly responsible for saving lives (Anthonisen et al., 2005). Most tobacco users express a desire to achieve long-term abstinence from tobacco use and make numerous unsuccessful quit attempts over the course of many years (Borland, Partos, Yong, Cummings, & Hyland, 2012; CDC, 2011). Evidence-based treatments for tobacco use and dependence greatly improve the chances that quit attempts result in long-term abstinence (Chambless & Hollon, 1998; Chambless et al., 1998; Compas, Haaga, Keefe, Leitenberg, & Williams, 1998; Fiore et al., 2008; Zwar et al., 2004). Increasing the availability of high-quality evidence-based treatment for tobacco use and dependence will make it more likely that tobacco users use evidence-based treatments and that quit attempts translate into long-term abstinence. The professionalisation of treatment for tobacco dependence by the development of a rigorous, unified Tobacco Treatment Specialist (TTS) certification process will increase the availability of high-quality evidence-based treatment for tobacco use and dependence for all tobacco users.

Introduction: Effective interventions for smoking cessation are critically needed. Yoga has only begun to be evaluated for smoking cessation.

Aims: The primary aim was to assess participant satisfaction and perceived benefit of Hatha yoga. Secondary aims were to test evaluation tools, recruitment and retention techniques, and to generate preliminary effect size for a randomized trial.

Methods: This was a non-randomized, single-group, pilot study. Thirty-one participants entered the study and received group behavioural therapy followed by 30 minutes of Hatha yoga instruction. Participant satisfaction was assessed at the conclusion of eight sessions. Point prevalence smoking abstinence was assessed at the end of the intervention period.

Results: Participants were 36% male with an average age of 47 years (range 22–72) and a mean of 12.7 ± 5.6 cigarettes per day. Mean duration of smoking was 26.1 ± 15 years. Participant satisfaction was very high (88% very satisfied). Smoking abstinence at the end of the intervention was 29%.

Conclusions: Hatha yoga is acceptable and feasible to aid in smoking cessation. A regimen that includes breathing, postures, and meditation has been developed for testing in a randomized trial.