The 2008 UK National Smoking Cessation Conference (UKNSSC) included a number of oral and poster presentations on the theme of smoking during pregnancy. This is a challenging area of research and practice and one in which new evidence — both about the effects of smoking in pregnancy and about smoking cessation interventions — is regularly emerging. Papers at UKNSCC explored why few women access support to stop (Felix Naughton), how best to refer women to specialist services (Joan Braithwaite), social marketing approaches (Deborah Richardson and Wendy Dudley) and physical activity for smoking cessation during pregnancy (Michael Ussher). The conference opened with a plenary presentation that explored the extent of smoking during pregnancy and women's accounts of quit attempts, cessation and relapse. It also examined what more could be done to improve access to stop smoking services for pregnant women and increase the proportion of women who quit. This article reviews some of the evidence presented at UKNSSC, focusing in particular on the need for improved identification, referral, engagement and treatment of pregnant smokers.

Therapeutic nicotine (TN) has been a mainstay of evidence-based smoking cessation treatment for many years, with established patterns of application. Yet recent research and practice indicates that innovations in how TN is used and applied to new populations can substantially enhance its efficacy and reach, improving upon established approaches to TN use. In this article, we address innovations how TN is used, discussing evidence that starting treatment before the quit day, combining patch with acute TN forms, and continuing TN treatment after a lapse, all substantially improve treatment outcomes compared to current TN practices, with effects sizes in the same range as the basic effect of TN versus placebo. We also review the use of TN in populations interested in smoking reduction as a path to quitting, discussing evidence that TN improves success rates in quitting by gradual reduction, and can also be used for reduction among smokers who are not yet ready to quit, leading to increased cessation rates. The evidence suggests that innovations in how TN is used can have substantial effects on the efficacy and reach of smoking cessation treatment.

While developed countries have enjoyed a decreasing incidence of smoking over the last 30 years, in the developing world there are still reports of rapid smoking take-up. It seems that in developing countries tobacco smoking remains the number one cause of preventable death well into the future. To combat this costly habit, many governments have employed smoking cessation strategies since the 1960s. These programs have involved advertising the negative health impacts of smoking, increased taxation, targeted legislation, and even clinical counselling. This project aimed to explore and critically review the body of literature related to smoking cessation strategies in Saudi Arabia and assess their effectiveness. The project also aimed to use the data gathered to recommend legislative changes to smoking cessation programs. For the Saudi Arabian context, the results of the project found that the smoking cessation strategies, despite being revolutionary in many regards, still lacked depth, and that both males and females, particularly adolescents, were adopting smoking in increasing numbers. The recommendations of the project were for Saudi Arabian authorities to review a number of the current initiatives, and initiate further approaches to smoking cessation, such as stringent requirements for health warnings on cigarette packets.

Smoking is one of the major causes of premature death and its negative effects on a person's health are a global issue. Therefore, the United Kingdom has introduced new policies aimed at reducing the proportion of smokers from 26% in 2005 down to 21% by 2010. One mechanism to meet this policy target is the provision of stop smoking services. This article aims to estimate the Leeds smoking population at the small area level and especially to highlight the distribution of hard-to-reach groups such as heavy smokers (> 20 cigarettes/day) and pregnant women who smoke. Then optimal location strategies are discussed in relation to stop smoking services. The findings show the importance of adding a spatial component to find out where the smoking population or specific subgroups of smokers are to support policymakers or healthcare planners who are responsible for the planning process of the services.

Background: Cessation-related weight gain and weight concerns are common among smokers and have a negative impact on quitting. Obese smokers tend to gain more than the average amount of weight and also have lower quit rates. This article describes the prevalence of obesity and weight concerns among smokers calling a state quitline in the United States. Results: Among 3972 smokers using a state quitline, 33.3% were obese, 30.2% overweight, 33.3% normal weight and 3.2% under-weight; a total of 60.6% were concerned about cessation-related weight gain. Compared with non-obese callers, obese callers were more likely to be female, Hispanic, non-White and heavier smokers. Conclusions: This is the first study to report data on body weight and weight concerns of smokers calling a national quitline. Given the lower quit rates among obese and weight-concerned smokers, and the burden of smoking and obesity, there is an opportunity to develop new treatment approaches for this at-risk population.

This study evaluated the association between psychological variables, measured by questionnaire at the start of a smoking cessation treatment, and smoking abstinence, 8 years after treatment. A total of 124 patients presenting at the stop-smoking clinic of the University Hospital in Ghent, Belgium, were included. Besides the Reasons for Smoking Scale (RSS), Fagerstrom Test for Nicotine Dependence (FTND), and smoking status, a psychological questionnaire (NEO PI-R) was presented at baseline. A postal survey after 8 years was executed in order to assess smoking status and smoke-free survival. In 2008, 103/124 answered the postal survey. 66/103 (64.1%) had relapsed. More men then women were smoke-free (46.2% vs. 18.4%; p = .004). Several associations between psychological baseline characteristics and smoking status at follow-up were detected: lower abstinence at follow-up was associated with lower self-discipline (p = .001), lower goal-directedness (p = .03), higher score on symptoms of depression (p = .03), higher anxiety score (p = .01), higher score on the variable shame (p = .02). Some of these associations are confirmed by Kaplan-Meier survival scores that show borderline significance in case of depression (p = .06), statistically significance in case of self-discipline (p = .05) and shame (p = .05) and clear statistical significance in case of anxiety (p = .007). An association between psychological variables at the start of a smoking cessation treatment and smoking abstinence, even after 8 years, can be accepted.

Objectives: Although the benefits of smoking cessation are well established, long-term abstinence from cigarettes is difficult for many smokers to achieve. We aimed to examine quit attempts, years since quitting and factors associated with long-term abstinence among former smokers. Methods: Data were from the 2006 Canadian Tobacco Use Monitoring Survey. Descriptive analyses were performed and logistic regression models were used to examine factors associated with long-term abstinence (more than 5 years) among former smokers. Results: In 2006, over one in four Canadians (27.1%, n = 7,200,000) aged 15 and older was a former smoker. The prevalence of former smoking was higher among men (30.9%) in comparison to women (23.4%). Former smokers who quit in the past 3 years or earlier were more likely to be older as well as have children younger than 15 in the household. Logistic regression analyses revealed that older age was a significant predictor of long-term abstinence from smoking. Conclusion: Our findings suggest that there are modifiable characteristics associated with long-term smoking abstinence that could be addressed by relapse prevention programming. Longitudinal data are warranted to further clarify the relationship between certain characteristic of former smokers and the duration of abstinence.

Water pipe (WP) smoking is prevalent in several countries and is emerging as a major international public health issue. This article reviews the literature on WP smoking practices and its health effects. Water pipe smoking in the Middle East is more common in women compared to cigarette smoking. WP smoking has harmful effects similar to cigarette smoking, and the nicotine and tar content of WP smoke is higher than that of cigarettes. Still, many users believe that WP is less harmful than cigarettes and are unaware of the damage that WP can cause to their health. There is limited literature on WP smoking, highlighting the need for research in several areas including: epidemiology of WP smoking, sociological dimensions and tobacco control. The unique social and traditional role of WP smoking renders forgiving, culture-sensitive and patient approach.

We conducted a sensitivity analysis under four scenarios using data from three Asian studies conducted with low dropout rates to evaluate the efficacy of varenicline in smoking cessation within a scenario where dropouts from the study are dealt with in a manner as unfavourable as possible to varenicline. Pooled odds ratio of continuous abstinence at week 24 was 1.55 (95% confidence interval: 1.03–2.35, random-effect model) under the scenario where dropouts from the varenicline group were dealt with as smokers and those from the placebo group as successful quitters. From the present study, the efficacy of varenicline has been firmly established in the Asian population.

Background: Few smoking cessation interventions have made extensive use of e-mail. Objective: This study set out to document how the e-mail component of an e-mail-based smoking cessation program was received by college smokers. Methods: Participants were randomised after enrolment to receive either a moderately intensive, e-mail-based intervention — the X-Pack Group — or a less intensive program based on a widely available smoking cessation guidebook. Participants were assessed at baseline and 3 months post-enrolment. This analysis is limited to those in the X-Pack Group (n = 48). Results: Twelve e-mails on average were sent out to each participant over the course of 6 months. Ninety-one per cent of participants reported reading all or most of the e-mails and 73% replied to at least one of the e-mails they received. On average, participants were positive about the e-mails received and most reported that they had liked the e-mails because of the social support and encouragement provided. The average time for counsellors to write and send each e-mail from the templates was 12 minutes, with a range from 2 to 60 minutes. Conclusions: These findings offer evidence of feasibility of an e-mail-based smoking cessation intervention in a college population.

This article describes a culturally and linguistically relevant, physician-led smoking cessation intervention that was delivered to the Chinese American community in New York City. Data were collected from a convenience sample of 115 participants (94% male) at a clinical site of a community health centre. The smoking intervention program included pharmacological treatments and brief cessation counselling, education and support by the physician and the health educator. Process data included the drop-out rate, number of visits completed and use of pharmacotherapy. Outcome data included self-reported and biochemically verified (expired carbon monoxide) smoking status at week 12. In the process evaluation, valuable information about the components of interventions that worked well and challenges participants faced during their quit attempts was gathered from participants, doctors and the health educator. Sixteen participants (13.9%) successfully quit smoking. Chinese male smokers face many daunting challenges that prevent them from regularly attending a smoking cessation program. Despite these challenges, they appeared to benefit from brief interventions, although the cessation rate was modest at best. This information should be incorporated into future design of smoking cessation programs to address required behavioural change in this population.

We evaluated the effect of feedback after opportunistic spirometry in general practice on motivation for smoking cessation using stage change in the transtheoretical model. A total of 328 smokers aged over 35 years were given immediate feedback on the presence or absence of lung damage due to smoking, plus brief standard cessation advice. At 3 months, 99 (30.2%) smokers reported making an attempt to quit and 17 (5.2%) smokers reported moving into action stage for cessation. Of 297 (80.5%) successfully followed up, 81 (27.3%) smokers demonstrated forward shift and 35 (11.8%) smokers demonstrated backward shift. Feedback on the presence of lung damage was not significantly associated with reporting a quit attempt (p = .31) or moving into action stage for cessation (p = .30). Odds of forward or backward shift were not independently associated with either feedback on the presence of lung damage or normal lung function. Odds of backward shift with feedback on lung damage depended on participants' assessments of quit benefits, which were correlated with their prior self-assessment of lung damage. Our findings suggest that feedback to smokers after spirometry about the absence of lung damage is not harmful. However, eliciting personal health attitudes is also important so cessation advice can be tailored especially for smokers who believe they already have lung damage from smoking.

Introduction: Buerger's disease (BD) is a chronic peripheral vascular disease that affects the young smokers from low socioeconomic backgrounds. The only effective therapy for this disease is smoking cessation; otherwise the outcome of BD will be several amputations. Aims & Methods: Via 12 sessions, an elective pattern of group therapy was designed and tried with six volunteer patients. The therapy commenced with motivation, mixed with a behavioural and cognitive model appropriate to the patients' socioeconomic and educational status. Two extra training sessions of apposite and supporting behaviour were allocated for their family members. Urine cotinine level was measured before and after the group therapy. The aim of study was to lead the patients towards a self-help group. Results: A partial remission of the disease in one patient and a complete remission in four patients were the consequences of the present study. The average decline of urine cotinine level was about two ranks. One patient was not helped. Conclusion: Although the study faced major loss of subjects, in regards to dramatic changes in urine cotinine level, this plan of group therapy seems to be an effective and cost-effective option for clinical improvement in patients with BD, as a chronic and smoking-related disease.

The Bedouin are Muslim Arabs who have inhabited the Negev desert region of Israel under nomadic and seminomadic conditions for centuries. Today, the majority are living in urban settings with high levels of unemployment, poverty, and problem behaviour. Limited research exists of Bedouin youth, specifically their smoking attitudes and behaviour. This study examined 293 male and female high school-age youth with the WHO-CDC Global Youth Tobacco Survey instrument. Chi square and regression analyses were performed. Parent smoking behaviour, smoking if offered a cigarette, likelihood of smoking during the next 12 months and 5 years, and smoking behaviour among friends are significant factors that influence smoking regardless of gender status. Regression analysis shows cigarette use is influenced by gender status, parent(s) smoking behaviour, smoking behaviour among friends, being offered a cigarette by a friend, and the perception of males who smoke as being a positive social image. Smoking is a public health problem and cessation interventions are needed for Bedouin youth. Additional research with practical implications should focus on the high rate of tobacco use among males, the relation between psychosocial factors and smoking behaviour in urban and rural settings and the impact of formal education and community-based activities on smoking prevention and cessation.

Self-perceived difficulty not smoking during a quit attempts is potentially an important factor mediating ability to remain abstinent during quit attempts. We investigated how far this could be explained by specific withdrawal symptoms (e.g., irritability, depressed mood, hunger etc.), strength of the urges to smoke and the time spent with urges to smoke. Thirty-five male and female smokers, who smoked at least 15 cigarettes per day were required to abstain overnight and attended the laboratory the next day and completed the Mood and Physical Symptoms Scale (MPSS), a validated questionnaire assessing cigarette withdrawal symptoms and urges to smoke. They also rated how difficult they had found it not smoking. Difficulty not smoking was independently and strongly predicted by both strength of urges to smoke and time spent with urges, but not by other withdrawal symptoms. The results support the idea that both time spent with urges and strength of urges to smoke are what primarily makes it difficult for smokers to abstain early in a quit attempt and that other withdrawal symptoms play a more modest role. Further research is needed to confirm this finding and examine how far difficulty not smoking mediates failure of quit attempts.