Introduction: The nicotine–metabolite ratio (NMR) predicts treatment response and is related to treatment side effect severity. Sleep disturbance may be one important side effect, but understanding sleep disturbance effects on smoking cessation is complicated by the fact that nicotine withdrawal also produces sleep disturbance.

Aims: To evaluate the effects of withdrawal and treatment side effects on sleep disturbance.

Methods: This is a secondary analysis of data from a clinical trial (Lerman et al., 2015) of 1,136 smokers randomised to placebo (n = 363), transdermal nicotine (TN; n = 381), or varenicline (n = 392) and stratified based on NMR (559 slow metabolisers; 577 normal metabolisers). Sleep disturbance was assessed at baseline and at 1-week following the target quit date (TQD). We also examined whether sleep disturbance predicted 7-day point-prevalence abstinence at end-of-treatment (EOT).

Results: The varenicline and TN groups exhibited greater increases in sleep disturbance (vs. placebo; treatment × time interaction; p = 0.005), particularly among those who quit smoking at 1-week post-TQD. There was a main effect of NMR (p = 0.04), but no interactions with treatment. TN and varenicline attenuated withdrawal symptoms unrelated to sleep (vs. placebo). Greater baseline sleep disturbance predicted relapse at EOT (p = 0.004).

Conclusions: Existing treatments may not mitigate withdrawal-related sleep disturbance and adjunctive treatments that target sleep disturbance may improve abstinence rates.

The lesbian, gay, bisexual, and transgender (LGBT) communities in the United States are disproportionately impacted by smoking, including incidence rates and a lower rate of cessation success. Previous studies have shown that the emotional impact of social stigma and discrimination have contributed to this pronounced health disparity. Utilising data from three years of quitline callers receiving cessation treatment from National Jewish Health, we examine how LGBT callers differ from straight/heterosexual callers in terms of demographic characteristics, tobacco use history, and the prevalence and consequences of emotional or mental health problems. Findings suggest that the LGBT population begins using tobacco in pre-adolescence at a much higher rate than other quitline callers. The most striking finding is that the LGBT callers report higher rates of mental health issues than other callers. In addition, these individuals feel that their mental health issues negatively impact their ability to have a successful quit attempt. This study contributes to the broader understanding of factors associated with elevated rates of tobacco use in the LGBT community, which may inform potential specialised prevention and cessation efforts for this high-risk population.

Introduction: The time a smoker waits until the first cigarette of the morning is often used as a measure of dependence with the rationale that more dependent smokers will smoke sooner upon waking than will less dependent smokers after going several hours without a cigarette overnight.

Aims: We sought to examine the relationship between time-to-first-cigarette (TTFC) and household smoking restrictions in two independent samples.

Methods: Two samples of smokers, one treatment-seeking community sample (N = 433) and one non-treatment seeking sample of smokers with serious mental illness (i.e., Schizophrenia, Schizoaffective Disorder, or Bipolar I Disorder) (N = 94), provided information on cigarette dependence with the Fagerström Test for Nicotine Dependence (FTND) and on household smoking restrictions.

Results: Half (50%) of smokers with serious mental illness and 36.7% of smokers from the general population reported that there were no limitations to smoking in their home. Household smoking restrictions were significantly and positively related to TTFC in both samples.

Conclusions: These data indicate that greater attention to TTFC may be warranted. The TTFC item is intended to measure dependence based on the premise that greater dependence should be associated with shorter TTFC. If TTFC is related to a household smoking ban, however, this item may not be assessing dependence as intended in some cases.

Rationale: Cigarette smoking has antiestrogenic properties, which may worsen the symptoms and health risks associated with menopause.

Objectives: In the present study, it was hypothesised that menopausal symptoms would improve with smoking abstinence.

Methods: Postmenopausal smokers (n = 76) were assessed with the Kupperman Index (KI) of menopausal symptoms and smoking-related indices of nicotine dependence, cotinine level, cigarettes per day (CPD), and number of years smoking.

Results: Participants were 67% Caucasian, 33% African-American, 52.3(SD = 7.8) mean years of age, follicle stimulating hormone (FSH) level, m = 42.6(SD = 25.7) mlU/ml, mean number of months since last menses was 145.1(SD = 118.9), and mean body mass index (BMI) was 27.4(SD = 6.2). Mean cigarettes smoked per day (CPD) was 20.3(SD = 11.5), for m = 29.4(SD = 10.7) years; m = 6.4(SD = 2.1) Fagerström Test for Nicotine Dependence (FTND), m = 23.8(SD = 13.0) ppm carbon monoxide, and m = 19.7(SD = 12.5) KI total score. Most participants (78.9%) were currently taking hormone therapy (HT). Hierarchical linear regression analyses revealed that FTND (β = 0.48, p = 0.001) and cotinine level (β = −0.27, p = 0.02) predicted KI scores at baseline. Amongst participants (n = 65) who achieved abstinence for 2 weeks, number of years smoking predicted KI scores (β = 0.38, p = 0.01). At 8 weeks postcessation, CPD significantly predicted of KI scores (β = −0.74), p = 0.04).

Conclusions: With abstinence from smoking, the overall severity of menopausal symptoms decreased and shared variance with different smoking-related variables. The temporal and cessation-related symptom course identified in this study will be important in informing cessation interventions with this population of smokers.

Introduction: Smoking cessation among adults is associated with increased happiness. This association has not been measured in parents, a subset of adults who face uniquely stressful and challenging circumstances that can affect happiness.

Aims: The aim of this study was to determine if parental smoking cessation is associated with increased happiness and to identify characteristics of parental quitters who experience increased happiness.

Methods: A total of 1,355 parents completed a 12-month follow-up interview from a U.S. national trial, Clinical Effort Against Secondhand Smoke Exposure (CEASE). Multivariable logistic regression examined if level of happiness was independently associated with quitting smoking and identified characteristics associated with feeling happier after quitting smoking.

Results/Findings: Parents’ level of happiness was independently associated with quitting smoking (aOR = 1.60, 95% CI = 1.42–1.79). Factors associated with increased happiness among quitters include engaging in evidence-based cessation assistance (aOR = 2.69, 95% CI = 1.16–6.26), and adopting strictly enforced smoke-free home (aOR = 2.55, 95% CI = 1.19–5.48) and car (aOR = 3.85, 95% CI = 1.94–7.63) policies. Additionally, parents who believed that being a smoker got in the way of being a parent (aOR = 5.37, 95% CI = 2.61–11.07) and who believed that thirdhand smoke is harmful to children (aOR = 3.28, 95% CI = 1.16–9.28) were more likely to report feeling happier after quitting.

Conclusions: Parents who quit smoking reported being happier than parents who did not quit. Though prospective studies can clarify what factors cause an increase in happiness, letting paediatricians know that most parents who smoke report being happier when quitting may facilitate communication with parents around cessation.

Introduction: Smoking during pregnancy is associated with adverse outcomes. Tobacco cessation in the general population is associated with weight gain. Aims: We sought to compare gestational weight gain (GWG) in women who quit smoking during pregnancy with those who continued smoking and non-smokers in two countries with high smoking prevalence in pregnancy. Methods: This study uses baseline data from a brief cessation intervention clustered randomised controlled trial; data were collected from clinical records and through questionnaires at post-partum hospitalisations during October 2011–May 2012. Women had attended one of 20 selected clusters of publicly funded prenatal care clinics in Argentina and Uruguay. Self-reported cessation was verified biochemically. Results: Of 2636 pregnant women, 29.9% were smokers at the beginning of pregnancy; among them 41.9% quit and 58.1% continued smoking. Most women (60.7%) had a normal pre-pregnancy body mass index (BMI). Adjusted mean weight gain was higher in quitters than in continuing smokers and non-smokers. Cessation increased GWG by 2.4 kg (95% confidence interval 1.3–3.4) after adjusting by pre-pregnancy BMI and other confounders in comparison with women who continued smoking(p < 0.001). Conclusions: GWG was slightly higher in women who quit smoking at any time during pregnancy.

Introduction: Waking at night to smoke can also serve as an indicator of dependence and treatment success.

Aims: We sought to examine whether night smoking is associated with features of smoking behaviour in a non-treatment-seeking sample of adult smokers in the general population.

Methods: Data for this study come from 1,062 current smokers obtained from an opt-in online panel in July 2010. Night smoking and night craving to smoke were assessed by questionnaire, and dependence was assessed by the Fagerstrom Test for Nicotine Dependence (FTND). Relationships were assessed using linear, logistic, and negative binomial regression.

Findings: Overall, 20.6% reported that they woke at night to smoke. FTND scores were substantially higher in those reporting night smoking. Those who reported night cravings were more likely to report quit intentions. Night smokers made 3.6 actual quit attempts (95% CI: 2.8, 4.5) per year, adjusted for other model factors, compared to 2.7 (2.2, 3.2) attempts for night cravers and 2.2 (1.8, 2.7) attempts for smokers who reported neither.

Conclusions: Overall, night smokers reported higher nicotine dependence than cravers and those who experienced neither. The current study adds to a growing literature pointing to the importance of overnight smoking as an indicator of nicotine dependence.

Introduction: The NZ Government has set the goal of a smoke-free country by 2025. Research has shown that NZ dentists engage little in promotion of smoking cessation amongst their patients. The knowledge of, and attitudes towards, smoking cessation interventions of NZ dental students has not previously been reported.

Aims: To investigate smoking cessation intervention practices of clinical dental students and explore perceived barriers to their delivery.

Methods: A survey was conducted of all students in the three clinical years of the 5-year New Zealand dental training programme.

Results: The response rate was 73.7%. At least half of the participants did not recall the inclusion of smoking cessation intervention information in the curriculum. The majority (70.9%) used a routine protocol to identify smokers. Almost two-thirds felt that smoking cessation interventions are important, whilst two-fifths felt it is their duty as a health professional. Lack of knowledge and time were the most common barriers.

Conclusions: Although most dental students identify patients who smoke, the majority provide no cessation intervention services. This appears to be due to a lack of knowledge about available organisations and referral procedures. As future health professionals, dental students need better education in this area.

Introduction: The National Comprehensive Cancer Control Program (NCCCP) and National Tobacco Control Program (NTCP) are both well-positioned to promote the use of population-based tobacco cessation interventions, such as state quitlines and Web-based interventions.

Aims: This paper outlines the methodology used to conduct a comparative effectiveness research (CER) study of traditional and Web-based tobacco cessation and quitline promotion approaches.

Methods: A mixed-methods study with three components was designed to address the effect of promotional activities on service usage and the comparative effectiveness of population-based smoking cessation activities across multiple states.

Results/Findings: The cessation intervention component followed 7,902 smokers (4,307 quitline users and 3,595 Web intervention users) to ascertain prevalence of 30-day abstinence rates seven months after registering for smoking cessation services. User characteristics and quit success was compared across the two modalities. In the promotions component, reach and use of traditional and innovative promotion strategies were assessed for 24 states, including online advertising, state Web sites, social media, mobile applications, and their effects on quitline call volume. The partnership intervention component studied the extent of collaboration among six selected NCCCPs and NTCPs.

Conclusions: This study will guide program staff and clinicians with evidence-based recommendations and best practices for implementation of tobacco cessation within their patient and community populations and establish an evidence base that can be used for decision making.

Introduction: The Medical University of South Carolina (MUSC) hospital implemented an inpatient opt-out smoking-cessation service where smokers received a mandatory smoking-cessation consult and phone follow-up within 1-month post-discharge.

Aim: To examine predictors of patients who opted-out of bedside counselling or follow-up phone calls.

Methods: Eligible adult cigarette smokers admitted to the MUSC hospital were enrolled in the programme. Opting-out of bedside consult or follow-up calls were assessed separately using log-linear modelling where predictors included patient demographics, length of hospitalisation, insurance type, smoking history, and motivation/confidence to quit.

Results: Of the 38,758 admitted patients (February 2014–May 2015), 6,684 reported currently smoking and were automatically referred to bedside-consult. Approximately 26% of smokers made contact with the counselor, most of whom (83%) accepted the consult. Amongst patients eligible for post-discharge follow-up (n = 3485), 49% responded to the calls. Those who opted-out of the bedside-consult were mostly males (RR = 1.29). Those who did not respond to follow-up calls were younger age (RR = 1.33), with Medicaid/no insurance (RR = 1.17), and had not received a bedside consult (RR = 1.32).

Conclusions: An opt-out smoking-cessation programme was feasible and acceptable to most patients and was able to reach 65% of eligible smokers; 17% opted-out of bedside counselling; <1% asked to be removed from further phone calls.

Introduction: The use of electronic nicotine delivery systems (ENDS) such as electronic cigarettes, vapour cigarettes, and vapour/hookah pens is rapidly increasing. The effectiveness of ENDS for smoking cessation and their safety, particularly amongst pregnant women, is largely unknown. Some women who use tobacco products in pregnancy, such as the one described in this case study, switch to ENDS assuming they are a safer alternative to smoking traditional cigarettes. Many obstetric providers do not screen for ENDS use and may miss an opportunity to counsel their patients about ENDS usage, side effects, or alternatives.

Case Description: Motivated by concern for her baby's health, a 28-year-old patient reduced consumption of traditional cigarettes and began using ENDS shortly after learning she was pregnant. Her obstetric team did not screen for ENDS use and was unaware that she had started using ENDS. During the postpartum period, her providers ordered a tobacco cessation consult and the tobacco treatment specialist (TTS) discovered the patient's ENDS use as well as her desire to quit.

Conclusions: In the absence of consistent screening by providers and a lack of safety data regarding ENDS use during pregnancy, women are often given little guidance in deciphering the potential risks and benefits of ENDS use. In this case, the patient turned to ENDS because she thought it was safer than smoking tobacco cigarettes and was unaware that there is limited research on ENDS safety. This case highlights the importance of updating clinical screening tools to include ENDS and the need for further research investigating the safety of ENDS use during pregnancy.

Introduction: Tobacco use is common among people who have been in prison. The relationship between social stressors, risky health behaviours, and smoking cessation has not been studied in people recently released from prison. Studying this relationship could yield information that guides strategic and cost-effective tobacco cessation interventions for an under-resourced population.

Methods: One hundred and forty-three smokers were interviewed 7 to 21 days after they had been released from USA prisons. Independent variables included employment status, housing security, relationship problems, educational achievement, risky drinking behaviour, recent drug use, history of drug dependence, and depression. The primary outcome was ‘trying to quit smoking.’ Data were analysed using Pearson chi-square tests and single and multivariable logistic regression models.

Results: Of those who had to quit smoking due to tobacco-free prison policies, 98% reported relapsing on tobacco after release. Trying to quit smoking was associated with the absence of risky drinking behaviour in the past 30 days (adjusted odds ratio [AOR] 6.44, 95% confidence interval [CI] 2.02–20.48).

Conclusions: The absence of risky drinking behaviour is associated with trying to quit smoking among people recently released from prison. Further research may determine whether interventions addressing risky alcohol use can reduce smoking relapse.

The case study received ethics approval from Sydney Local Health District Ethics Review Committee.

Introduction: The Northern Alliance HARP smoking cessation program provides support to chronic disease participants who desired to quit smoking. This is an individualised program with pharmacotherapy and behavioural support, delivered by specialist clinicians.

Aims: The aims of this descriptive evaluation were to explore factors that affect abstinence rates, record those rates, and describe the impact of anxiety, depression, self-efficacy, quality of life and motivation on quit rates at three months.

Methods: Data was collected prospectively from clients enrolled in the service. Participants were assessed for abstinence at three months, six months and one year by carbon monoxide (CO) monitoring and self-reporting. Factors predictive of quitting were analysed using logistic regression; factors with a p value < 0.05 and 95% CI not containing one were considered statistically significant.

Results: 103 clients were assessed and 86 were enrolled in the program. The odds of successful quitting at three months CO verified was higher amongst completers of the program compared to non-completers (OR = 6.6, 95% CI = 2.03–21.57, p = 0.002). The probability of sustained quitting at one year was over 18 times higher in the group who completed the program (n = 16/21 completers and n = 1/4 non-completers) (OR 18.5, 95% CI, 2.32–147.34, p = 0.006). No other factors predicted quitting.

The rate of quitting was 28.7% at three months, 19.5% at six months and 10.3% at one year, CO verified. Measures of anxiety and depression, self-efficacy, quality of life and motivation did not influence either the quit rate or the likelihood of completing the course of treatment at three months.

Introduction: Both withdrawal severity and smoking cues can trigger lapses. However, the temporal relationship between these two sets of triggers is unknown.

Aims: To explore the time course of lapse triggers during a quit attempt.

Methods: Across two cessation studies, 186 lapsers monitored their smoking in real-time for up to 7 weeks over the course of a quit attempt. During lapses, participants were asked to report the primary trigger of the event; this, including the time of the event relative to quit day, was logged by an electronic diary. Log multinomial regression was used to estimate the probability that each lapse would be withdrawal-triggered or cue-triggered.

Results: Log multinomial regression showed that the probability of a first lapse being triggered by withdrawal rose in the initial days of a quit attempt before dropping as the quit attempt progressed (P < 0.01). The probability of a cue-triggered lapse rose over the course of a quit attempt (P < 0.05).

Conclusions: The results are consistent both with the time course of withdrawal symptoms and with theoretical predictions about the relationship between nicotine dependence and stimulus control. The results have implications for tailoring smoking-cessation treatments; in particular, for the stepwise provision of smoking-cessation assistance over the course of a quit attempt.

Objective: To evaluate the impact of short-term smoking cessation on Metabolic Syndrome (Mets) component risk factors, and hormones related to MetS and human metabolism.

Methods: Smoking veterans with MetS, attending stop smoking class, were followed up close to one year. Paired comparisons between after the follow up and baseline data were made using t-test.

Results: A total of 95 smoking veterans with MetS completed average close to one year follow up. Thirty subjects completely quit for the average of 6 months, while 36 subjects continued smoking during the follow up. At the end of study, quitters average waist circumference increased 2.98 cm (0.69–5.27), weight increased 2.05 kg (−0.03 to 4.13), HDL cholesterol increased 4.17 mg/dl (1.03–7.32), triglyceride decreased 56.17 mg/dl ((−1.96 to 111.20), and MetS prevalence decreased 13% (p = 0.05). The changes in ghrelin were moderately positively associated with duration of quitting smoking (R2 = 43.99, and p < 0.01).

Conclusion: Compared to the baseline, quitters HDL was up, triglyceride was down, and overall MetS prevalence was lower. The longer the duration of quitting, bigger the increase in ghrelin. There were no significant changes in serum leptin, ghrelin, serum insulin, and insulin resistance after quitting smoking.

Introduction: Tobacco use is a chronic, relapsing condition. While there are proven cessation medications and counselling treatments, uptake of available aids is poor and smokers often do not have access to evidence-based services.

Aims: The Association for the Treatment of Tobacco Use and Dependence (ATTUD) is an organisation of tobacco treatment specialists (TTSs) representing a wide array of disciplines and healthcare settings. This case vignette was intended to provide a clinical example of an interdisciplinary approach to tobacco use treatment.

Methods: ATTUD Interdisciplinary Committee members representing tobacco-cessation experts from five professions were asked to respond to the same composite case vignette detailing key areas of clinical consideration and treatment.

Results/Findings: While there were common treatment themes across professions, each provider also offered a unique treatment perspective addressing different facets of the patient's complex care needs, including attention to other chronic illnesses, mental illnesses, and preventive services. Expert responses highlighted that different treatment approaches across a continuum of healthcare settings are complementary.

Conclusions: Responses to this vignette support the need to address tobacco use from an interdisciplinary approach. Existing chronic care and patient-centred models should be utilised to ensure that tobacco users receive a sufficient range of cessation services.

Aims: To examine the prevalence of smoking, motivations for cessation, and impact of tobacco excise tax increases amongst a cohort of Pacific fathers at 11 years after the birth of their child.

Methods: Within the context of broader interviews, 723 Pacific fathers participating in the Pacific Islands Families (PIF) Study were surveyed about their smoking at the 11-year measurement point. Prevalence of smoking was calculated, alongside motivations to quit, and the impact of increases to the excise tax on tobacco.

Results: Smoking prevalence amongst Pacific fathers remains high (38%) at 11 years postpartum, although 81% of smokers disclosed interest in quitting smoking. The strongest motivation to quit smoking was their ‘own health’ (n = 185, 82%), followed by ‘the cost’ (n = 148, 66%), and the impact on ‘their child's health’ (n = 113, 50%). Among smokers, 12% (n = 31) had never attempted to quit, whereas 63% (n = 159) had made multiple attempts. Approximately 70% (n = 191) of smokers indicated the New Zealand Government-initiated tobacco excise tax increases caused them to reduce their tobacco consumption.

Conclusions: High smoking prevalence amongst this cohort raises serious concerns about the risks Pacific families and communities face from smoking. Maintaining a sustained series of tobacco excise tax increases, alongside the utilisation of information on key motivators for Pacific fathers to quit smoking, may prove more effective in supporting Pacific communities to achieve the New Zealand Government's Smokefree 2025 goal.

Introduction: There are limited existing data describing the training methods used to educate tobacco cessation treatment providers around the world.

Aims: To measure the prevalence of tobacco cessation treatment content, skills training, and teaching methods reported by tobacco treatment training programmes around the world.

Methods: Web-based survey in May–September 2013 amongst tobacco cessation training experts across six geographic regions and four World Bank income levels. In total, 104 individual training programmes responded.

Results: Of 104 individual programmes, most reported teaching brief advice (78%) and one-to-one counselling (74%); telephone counselling was uncommon (33%). Overall, teaching of knowledge topics was more commonly reported than skills training. Programmes in lower income countries less often reported teaching about medications, behavioural treatments and biomarkers and less often reported skills-based training about interviewing clients, medication management, biomarker measurement, assessing client outcomes, and assisting clients with co-morbidities. Programmes reported a median 15 hours of training. Face-to-face training was common (85%); online programmes were rare (19%). Almost half (47%) included no learner assessment. Most (65%) offered no continuing education.

Conclusions: Nearly all programmes reported teaching evidence-based treatment modalities in a face-to-face format. Few programmes delivered training online or offered continuing education. Skills-based training was less common amongst low- and middle-income countries (LMICs). There is an unmet need for tobacco treatment training protocols which emphasise practical skills and which are more rapidly scalable than face-to-face training in LMICs.

Introduction: Despite the public health relevance of smoking in adolescents and emerging adults, this group remains understudied and underserved. High technology utilisation among this group may be harnessed as a tool for better understanding of smoking, yet little is known regarding the acceptability of mobile health (mHealth) integration.

Methods: Participants (ages 14–21 years) enrolled in a smoking cessation clinical trial provided feedback on their technology utilisation, perceptions, and attitudes; and interest in remote monitoring for smoking. Characteristics that predicted greater technology acceptability for smoking treatment were also explored.

Results: Participants (N = 87) averaged 19 years old and were mostly male (67%). Technology utilisation was high for smart phone ownership (93%), Internet use (98%), and social media use (94%). Despite this, only one-third of participants had ever searched the Internet for cessation tips or counselling (33%). Participants showed interest in mHealth-enabled treatment (48%) and felt that it could be somewhat helpful (83%). Heavier smokers had more favourable attitudes toward technology-based treatment, as did those with smartphones and unlimited data.

Conclusions: Our results demonstrate high technology utilisation, favourable attitudes towards technology, and minimal concerns. Technology integration among this population should be pursued, though in a tailored fashion, to accomplish the goal of providing maximally effective, just-in-time interventions.