Introduction: A new nicotine film that releases nicotine quickly may lead to faster craving relief.

Aims: This study compares the efficacy of 2.5 mg nicotine film with 2 mg nicotine lozenge and 2 mg nicotine gum on relieving provoked craving in low dependence smokers.

Methods: A randomised, open-label, active comparators controlled study was conducted in 120 subjects. Subjects were abstinent from smoking for 4 hours prior to being provoked with smoking cues. After post-provocation craving assessment, subjects were administered one dose of the 3 treatments: nicotine film, lozenge, or gum. Craving intensity was then assessed at 50 seconds, 3, 5, 7, 15, 20, 25 and 30 minutes after administration.

Results/Findings: Three treatments reduced craving with similar maximum effects. The effect was maintained up to 30 minutes. Nicotine film significantly reduced more craving than lozenge at 50 seconds, 3 and 5 minutes. It also significantly reduced more craving than gum at 50 seconds and 3 minutes. There was no significant difference between lozenge and gum.

Conclusions: Nicotine film, lozenge and gum have similar maximum craving relief. Nicotine film significantly reduced more craving than lozenge and gum at early time points. Nicotine film may be particularly useful to provide acute craving relief.

The advent and success of a new Journal seems to be dependent on its originality and a readership that needs and appreciates the content. It still is surprising to me personally that the Journal of Smoking Cessation (JoSC) has succeeded to such a degree since its inception 10 years ago. When I thought about a Journal for our group of the Australian Association of Smoking Cessation Professionals (AASCP), the publishers at Australian Academic Press asked whether there surely was such a journal already and that another might be redundant. When I assured them that there was no such Journal, we embarked upon an enterprise which now has great international interest and credibility. With a small startup grant from the Australian Government I was able to encourage and recruit old friends and colleagues from around the world who were all kind enough to give their names in good faith to an Editorial Board that remains the same today. Their good names and reputations greatly enhanced the credibility of the Journal and I cannot thank them enough for their faith in the Journal and its future. In particular thanks go to Michelle DiGiacomo for volunteering and continuing to volunteer an inordinate amount of time and energy supporting this endeavour.

Hospital surgical services are often reluctant to offer nicotine replacement therapy (NRT) to inpatients due to concerns that nicotine leads to vasoconstriction and impaired wound healing. However, multiple potential health benefits result from offering NRT to hospitalized surgical patients who use tobacco products. A 28-year-old female patient, hospitalized following a motor vehicle accident, experienced severe nicotine withdrawal symptoms and a strong desire to smoke. After a Tobacco Treatment Specialist (TTS) consultation, the Physical Medical and Rehabilitation service at the hospital began her on NRT with positive outcomes. The patient experienced decreased cravings and withdrawal symptoms, as well as an increased desire to remain tobacco free after discharge. More surgical patients may have an increased commitment to remain tobacco free after discharge, if their withdrawal symptoms are treated during hospitalization using NRT.

Smoking prevalence of pregnant Aboriginal and Torres Strait Islander women is quadruple that of pregnant women in the Australian population, and is associated with significant adverse outcomes in pregnancy. While cessation is a priority, there is as yet little evidence for effective interventions. This paper provides a pragmatic approach to addressing the complexities of smoking in pregnant Aboriginal and Torres Strait Islander peoples and informs clinicians about the initiation of nicotine replacement therapy (NRT) in pregnancy. Experts agree that nicotine replacement is safer than continuing to smoke in pregnancy. Although a pharmacotherapy-free attempt is initially recommended, if abstinence is not able to be achieved in the first few days, the women should be offered an accelerated option of NRT starting with oral forms and then, if required, progressing to nicotine patch or combined oral and transdermal therapy. Support should be offered for at least 12 weeks and post-partum. Offering counselling and cessation support to partners and family is also important, as is linking the woman in with appropriate social and community support and Aboriginal specific services. As long as oral forms of NRT are not included in the Pharmaceutical Benefit Scheme for Aboriginal and Torres Strait Islander women a significant and inequitable barrier will remain.

Introduction: Although the teachable moment has been recognised as an important contributor to behaviour change, its role in smoking cessation merits further investigation.

Aim: We prospectively evaluated 116 patients hospitalised with a suspected acute coronary syndrome in two tertiary referral hospitals. The patients comprised 84 men and 32 women, aged 54.2 ± 8.5 years, and the final diagnosis was myocardial infarction in 90 and angina in 26.

Results/Findings: At one month, the self-reported quit rate was 65%, maintained to 61% at 12 months. The quit rate was greater at one and 12 months for those diagnosed with myocardial infarction (70% and 67%) compared with those who had angina (46% and 40%), p<0.05. The strongest motivators for quitting were the heart attack and the consequences of the diagnosis. Of those who quit at 1 month, 77% did so without additional aids.

Conclusions: Hospitalisation with an acute coronary syndrome is associated with a high quit rate, and the diagnosis of heart attack with its potential consequences represents a strong teachable moment to stop smoking. The findings support further investigation of the teachable moment to aid in smoking cessation.

Introduction: The use of applications (apps) on smartphones and tablet devices is a fast growing component of health behaviour change efforts, including smoking cessation. While the content and utility of iPhone apps for smoking cessation have been systematically reviewed, Android apps have not been examined.

Aims: This study reviewed and evaluated free Android apps for smoking cessation available for download from Google Play and Amazon's USA homepage in January 2013.

Methods: Apps were reviewed; those targeting smoking cessation were identified and examined to ensure that they targeted tobacco smoking and were focused on quitting. Remaining apps were independently rated by three reviewers for 24 clinical strategies for smoking cessation. Results: Overall, 284 free apps were identified using the search terms ‘quit smoking’, ‘smoking cessation’, and ‘stop smoking’; 113 apps that targeted smoking cessation were downloaded for further review. Of these, 21 targeted tobacco smoking and were focused on quitting. These apps had moderate to low ratings for the 24 strategies, indicating that they lacked several of the most helpful strategies for quitting smoking. The apps were strongest in helping users track the number of cigarettes smoked. None connected users to on-line sources of support, referred users to smoking cessation counselling, or recommended the use of nicotine replacement therapies.

Conclusions: While Android apps for smoking cessation have some strengths, they would benefit from incorporating a broader range of strategies for helping people quit smoking.

Introduction: Digital smoking cessation aids may benefit pregnant smokers who do not wish to receive face-to-face behavioural support. Healthcare providers (HCPs) who interact with pregnant smokers may have valuable insights into their development and use.

Aims: To explore HCPs’ views of using digital smoking cessation interventions with pregnant women in order to inform the design and delivery of digital smoking cessation interventions.

Methods: Two structured focus groups were conducted with HCPs (n = 16) who provided smoking cessation support for pregnant women in England. Discussions covered participants’ general views about digital smoking cessation interventions, the potential of such interventions for smoking cessation support for pregnant smokers, and recommendations for future intervention development. Transcripts were analysed thematically.

Results: HCPs identified a variety of ways in which digital interventions could benefit pregnant smokers, such as by providing anonymity, offering consistent quality of advice, and being available on demand. The identified limitations of digital smoking cessation interventions included lack of access among those most economically disadvantaged, the need for high levels of self-motivation, and lack of human contact. Addressing pregnant smokers’ negative perceptions of smoking cessation support, providing rewarding experiences, and tailoring the intervention to smokers’ level of confidence were among HCPs’ recommendations.

Conclusions: HCPs indicated that digital interventions offer a range of potential benefits that could make them useful for pregnant smokers. Nonetheless, important limitations and recommendations regarding their design and delivery were identified and these need to be addressed in intervention development.

Introduction: Characterising smoking behaviour in an objective and ecologically valid manner is integral to understanding health complications associated with tobacco use. Smoking topography (ST) provides a representation of the physical attributes of smoking. However, there is no clear guidance on ST data exclusion and reduction techniques and the impact of different techniques.

Methods: A search was conducted using MEDLINE, PubMed, and Scopus and limited to studies published between 2001‒2012. The search identified 23 studies using the CReSS device.

Results: Few studies reported data reduction (n = 9) and exclusion (n = 4) criteria. Four data reduction techniques emerged and were applied to an existing dataset (n = 193, Mage = 38.98, FTND = 5.19, mean 17.23 cigarettes/day). Using repeated measures ANOVA, there were significant (p < 0.05) differences among all techniques for puff volume, peak flow, puff duration and interpuff interval, which were attenuated upon controlling for puff count.

Conclusions: This review highlights the inconsistency in the literature regarding the disclosure of smoking topography data treatment and provides clear evidence that outcomes vary depending on the technique used. Greater transparency is needed and consideration should be given by researchers to the potential impact of methodological decisions on study findings.

Introduction: Physicians in training must be able to counsel their patients on smoking cessation, however, little is known about the barriers that they face to counselling their patients.

Aims: The study sought to identify barriers to smoking cessation counselling specific to physicians in training.

Methods: Qualitative interviews in the form of focus groups were conducted with 30 medical residents. Focus groups were audio taped, transcribed verbatim and coded by two independent reviewers. Similar codes were grouped to form categories and then aggregated to form themes.

Results: Seven themes emerged describing resident barriers to provision of smoking cessation counselling : (1) Lack of self-efficacy for providing counselling; (2) their perception that patients are not willing to change; (3) a lack of available resources/information for providers and patients; (4) differences in supervising physician's recommendations; (5) perceived lack of time; (6) a perception of lack of continuous care; and (7) a lack of practical skills in counselling.

Conclusions: This study highlighted residents’ perceived barriers to providing smoking cessation counselling. These barriers are similar to those encountered by other providers. Additional barriers specific to residency exist and more training is necessary.

Practice Implications: The barriers that physicians encounter to smoking cessation counselling must be addressed early on in residency training.

Smoking prevalence amongst service users from the mental health and addictions sectors is higher than the general population. Cross-sectional web- or paper-based surveys comprising open and closed response options were used to examine changes in prevailing attitudes and practices amongst non-government mental health service staff and users. Thematic analysis was used to interpret and present open response answers. Multi-variate logistic models were used to investigate which factors are associated with smoke-free attitudes and practices. Staff who smoke were found to be less likely to provide cessation support to clients (AOR 0.51, 95% CI 0.31–0.82) and gave significantly lower estimates of the percentage of clients who wish to stop smoking (30% vs 44%, p < 0.0001). Those who had completed cessation training also had more positive views about the importance of providing cessation support and service user desire to stop smoking. Staff who had not completed cessation training had significantly lower odds of reporting they carried out quit smoking support often and routinely (AOR 0.33, 95% CI 0.23–0.47) The results suggest that continuing improvement will be enabled by increasing rates of cessation training amongst staff of mental health and addictions non-government organisations. In addition, there is a need for increased incentive and support for staff who smoke to quit.

Introduction: Women who are younger in age are more likely to smoke during pregnancy and postpartum and tend to have less success with cessation/reduction. There is an unmet need for interventions targeted to pregnant and postpartum young women that provide them with support to quit/reduce long-term into the postpartum period and beyond.

Aims: Our study aimed to gain an in-depth understanding of the perspectives of young pregnant and postpartum women of text messaging (TM) as a conduit for smoking cessation/reduction, and to determine the appropriate content, frequency, duration and unique features needed for an effective cessation/reduction TM programme.

Methods: Six focus groups and six telephone interviews were convened with 36 pregnant and postpartum women 16–30 years of age.

Results: Three main themes were identified: 1) topic areas that women would like TM to focus on; 2) the need for messages to be tailored; and 3) the importance for the programme to take a woman-centered approach.

Conclusions: Respondents supported the idea of a TM cessation/reduction intervention and had clear programme recommendations. A personalised, woman-centered TM programme that meets a young woman's unique needs and addresses her concerns through her participation and direction is likely to empower and support her to quit/reduce.

Introduction: Single-session group smoking cessation interventions have received little attention in the literature.

Aims: This study aimed to test the feasibility and outcomes of a single-session large group smoking cessation intervention in a rural area of New South Wales.

Methods: Participants from a smoking cessation course (N = 42) were asked about cigarette consumption, quit attempts, and readiness and confidence to quit at registration and six months. The two-hour intervention occurred in a group setting and comprised of cognitive behaviour therapy and pharmacotherapy advice.

Results: The analysis revealed a 26.2% (N = 11) quit rate based on self-report and/or carbon monoxide validation at 6 months (intention to treat). Those who quit all used pharmacotherapy: eight (73%) Nicotine Replacement Therapy (NRT); two (18%) varenicline and one (9%) bupropion with NRT. Seven people (17%) used medicines to reduce consumption of cigarettes. A paired samples t test of those still smoking showed a statistically significant decrease in the numbers of cigarettes smoked per day (p<.001).

Conclusion: The quit rate of 26.2% from this large single-session smoking cessation course is comparable to that expected from groups having multiple sessions. As a pilot study, these data suggest that a multi-faceted single-session two-hour smoking cessation intervention can successfully support quit attempts in a rural location.

Background: It is assumed that smokers rarely quit without ‘attempting’ to do so but the assumption does not appear to have been adequately tested. This study assessed the prevalence of reporting having stopped without reporting a quit attempt and the reasons given for this discrepancy.

Methods: Data were collected from ex-smokers who said they had quit within the last 12 months during nationally representative household surveys conducted monthly between 2006–12.

Results: Of the 1,892 ex-smokers who said that they had quit within the last 12 months, 13.9% (95%CI = 12.4%–15.5%) reported having made no serious quit attempts in that period. In a sub-group of 24 smokers who were asked why they had reported stopping without also reporting an attempt, nine cited inconsistency over timing; three reported stopping without attempting to do so; four did not consider it an ‘attempt’ because they had succeeded; and six had not ruled out the occasional cigarette in the future.

Conclusions: A substantial minority of people who report having stopped in the past year may fail to report a corresponding quit attempt. However, quitting smoking without considering that one has tried appears to be rare. Instead, the most common reason for the discrepancy is inconsistent reporting of the timing of quit attempts.

Background: It is well established that tobacco use in the form of shisha has adverse effects similar to cigarette smoking. Medical-practitioners can play an important role in spreading awareness regarding health hazards associated with shisha smoking. Misconception about shisha is an important factor responsible for its increasing use, the need to evaluate medical practitioner's knowledge about shisha is an important step in controlling the growing epidemic.

Objectives: To investigate the knowledge, attitudes and practices of shisha smoking among different designations of medical practitioners in Karachi.

Methodology: A self-administered questionnaire was distributed to interns, postgraduate-trainees, medical-officers and consultants in various teaching hospitals of Karachi, Pakistan.

Results: A total of 343 medical practitioners participated in the study including 38.2% interns, 43.1% postgraduate trainees, 12% medical-officers and 6.7% consultants. Of the total study population 29.5% of the medical practitioners admitted using shisha at some point in their life. Significant results were obtained when knowledge of medical practioners regarding shisha containing tobacco and its harmful effects on health were judged with p-values of 0.001 and <0.003 respectively. Knowledge regarding hazards of passive shisha exposure was found to be varying with 25.2% interns, 40.5% postgraduates, 34.1% medical-officers and 69.6% consultants being aware of association of neonatal deaths with passive shisha exposure (p-value <0.001) while 51.9% house physicians, 64.2% postgraduates, 53.7% medical officers and 87% consultants believed that shisha exposure during pregnancy can lead to Sudden Infant Death Syndrome (p value 0.001).

Conclusions: There is a lack of knowledge among medical practitioners, especially house physicians, regarding contents used in shisha and its hazards.

Recent systematic reviews have concluded that a single session of exercise ameliorates cravings and tobacco withdrawal symptoms; however, smoking behaviour (topography) has not been adequately addressed in the literature. This study examined the effect of an acute bout of exercise on smoking topography following a temporary period of smoking abstinence. Forty-eight adult smokers (Nfemale = 34, Mage = 43.14), who had been smoking for an average of 23.90 years, were randomised to an acute (10 minutes) bout of exercise (N = 23) or passive sitting (control) group. Cigarette cravings were assessed at baseline and immediately pre and post treatment condition during a 15-hour smoking abstinence period. Smoking topography which included puff count, puff volume, puff duration, inter-puff interval, and total cigarette duration was assessed at baseline and post treatment. Although exercise reduced cravings, compared to the control group, smoking topography remained unchanged across time between groups. Furthermore, craving reduction was unrelated to any smoking topography variables. Although there is evidence that exercise can delay time to first cigarette, this study demonstrates that the change to smoking topography is negligible when participants are invited to smoke.

Introduction: Despite smoking fewer cigarettes per day, African American smokers have greater difficulty quitting compared to Caucasian smokers. Further elucidating the impact of smoking motivations on smoking behaviour would contribute to understanding the factors that maintain smoking.

Aims: This study examined the factor structure of a brief assessment examining smoking dependence motives among a sample of African American light smokers.

Methods: Data from a double-blind, placebo-controlled randomised smoking cessation trial involving 540 participants. Results were analysed using an exploratory factor analysis (EFA) and a randomly split EFA.

Results/Findings: Findings from the initial EFA analysis produced an eight-factor model, explaining 69% of the variation in responses. The overall Measure of Sampling Adequacy (MSA) was 0.88 with item level MSA ranging 0.68–0.94 across the 30 items. Results from the randomly split EFA replicated the findings of the original EFA; with the exception of the item ‘I smoke within the first 30 minutes of awakening in the morning’.

Conclusions: These findings support the hypothesis of a multidimensional approach to conceptualising nicotine dependence, and provide information regarding characteristics of nicotine dependence in African American light smokers which may be helpful in identifying targets for cessation treatment in this population of smokers.

Introduction: Not enough smokers access existing stop smoking services (SSS). Developing more accessible and effective SSS is important, particularly for smokers from socioeconomically disadvantaged groups where smoking is more prevalent.

Aims: To consider smokers’ reasons for accessing a community-based mobile SSS (MSSS) for initial and follow-up consultations, and to explore their experiences of the service over time.

Methods: The MSSS was delivered in socioeconomically disadvantaged areas of Nottingham (UK). Thirty-six smokers were interviewed, and 11 of these also completed follow-up interviews four to six weeks after their quit date. Interviews were analysed using the framework approach.

Results: Many participants had considered quitting before they had knowledge of the MSSS. Features of the MSSS participants found appealing for both initial and follow-up consultations included the drop-in format, convenient times and locations that fit around their existing routines, and that the service was informal and held in a non-health setting. Participants found visiting standard SSS, particularly clinics held in health settings, stressful and formal resulting in them feeling uncomfortable discussing smoking in these settings.

Conclusions: Developing instantly accessible and convenient SSS that can be delivered in familiar and informal settings within smokers’ communities may facilitate access and help to retain service users over time.

Introduction: Junior doctors are ideally placed to assist smokers quit yet little is known about their knowledge and practices.

Aims: To determine knowledge and practices in providing smoking cessation support, among junior doctors in a Malaysian teaching hospital.

Methods: In 2012, all junior doctors at University Malaya Medical Centre were invited to complete a self-administered questionnaire. The data were collated and analysed using standard descriptive methods.

Results/Findings: Seventy per cent (n = 122/173) of those eligible completed the questionnaire, 71% reporting cessation training at medical school. Most (90%) asked patients their smoking status but only 52% asked about quitting. Sixty-one per cent lacked confidence in providing assistance to quit, especially female doctors (70.8%, p<0.01). Most (80%) were unaware of local cessation clinics, and over half (59%) were unaware of the existence of guidelines for smoking cessation (p<0.001).

Conclusions: Asking about smoking was undertaken at satisfactory levels, but low knowledge, confidence and skills among this group of junior doctors indicates that cessation education should be included in undergraduate and in postgraduate curriculum training programmes. Awareness of specialist services and guidelines should be raised. Our findings are unlikely to be unique to this hospital, suggesting the need for a nationally consistent approach.