Smoking prevalence, at any point in time, accounts for the balance of smokers ending the habit and people starting or returning to smoking. Very different scenarios can result in the same prevalence, and each can have different implications for health services. Therefore understanding the degree of churn in the smoking population is essential. This is an area where there is little or no data. In such circumstances, Delphi methods utilising expert opinion can provide robust forecasts for planning purposes. A Delphi survey, involving 300+ general practitioners (GPs) in Northern England, projected a modest 2.2% reduction in smoking prevalence over 10 years, but this involved a reduction of nearly 30% in the existing cohort of smokers, countered by new/returning smokers equivalent to 21% of the cohort. Different age groups showed different patterns. The findings suggest that approximately 1 in 6 smokers need to set a quit date each and every year to achieve even a 2.2% reduction. Currently, 1 in 16 smokers set a quit date each year. Although ‘early wins’ may have been achieved, the challenges to achieve continuing reductions in smoking prevalence are considerable. Preventing young people starting to smoke is key.

This article reviews the literature to compare differential outcomes among men and women after smoking cessation, assess barriers they may face during cessation and provide recommendation to address gender-specific challenges in smoking cessation interventions. There is some evidence that women achieve lower abstinence rates than men after a quit attempt with nicotine replacement therapy, as well as without pharmacotherapy, and several underlying mechanisms were discussed to account for these findings. These include: (a) women have specific genetic variants that affect pharmacokinetics and pharmacodynamics of the medication, (b) hormonal influences increase nicotine metabolism and withdrawal symptoms, (c) women are more responsive to nonpharmacological aspects of smoking than men, (d) women are more vulnerable to depression and negative mood than men, (e) weight concerns are greater barriers for women than for men and (g) women receive less effective social support than men during a quit attempt. Gender-specific counselling that accounts for these factors and addresses the different needs of men and women may be a promising approach to improve long-term abstinence rates. However, more research is required to identify gender-related underlying mechanisms of differential smoking cessation outcomes, develop tailored interventions that account for gender differences and study the implementation and outcomes of gender-responsive treatment approaches.

In the plethora of international research on smoking relapse there are findings that suggest distinct ethnocultural differences in relapse predictors. This study aimed to uncover cognitive and affective factors that contribute to relapse in a sample of Filipino adult smokers (N = 115). Using discriminant function analysis, results suggest that self-efficacy, outcome expectancy, craving and the subdomains of motivation to change contemplation and action are accurate relapse predictors, whereas negative emotional states are not. An integrative framework was used in the discussion to account for inconsistencies in the results. Implications for understanding the relapse cycle, the connection between smoking relapse and substance use, as well as suggestions for future studies on smoking relapse, are also discussed.

Objectives: To determine whether the cost of a statewide smoking cessation program in Pennsylvania could be justified by the benefits. Methods: A cost-benefit analysis of statewide access to smoking cessation programs. We compared three treatment alternatives, both with and without counselling: nicotine replacement therapy, bupropion and varenicline. Results: While the retail price of a pack of cigarettes in Pennsylvania is on average US$4.72, the combined medical costs and productivity losses in Pennsylvania attributable to each pack of cigarettes sold are approximately US$23.78 per pack of cigarettes. The ratio of benefits to cost varied from US$0.97 to US$2.76 saved per dollar spent on smoking cessation programs, depending upon the type of intervention. Conclusions: For most smoking cessation treatments, the benefits of a statewide smoking cessation program in Pennsylvania would greatly outweigh its costs.

Tobacco smoking perpetuates the disadvantages experienced by Aboriginal and Torres Strait Islander people in Australia. Tobacco smoking is a risk factor for poor maternal and infant outcomes in pregnancy. Over half of Aboriginal and Torres Strait Islander women smoke during pregnancy and few successfully quit. Aboriginal and Torres Strait Islander women face many intrinsic barriers to quitting such as low socioeconomic disadvantage and patterns of use in family networks. There are also several extrinsic hurdles surrounding current practice guidelines and policy that may limit success in reducing smoking rates among Aboriginal and Torres Strait Islander women during pregnancy: the use of the Stages of Change (SOC) model; delay in the use of nicotine replacement therapy (NRT); and the absence of subsidised intermittent NRT. A more proactive approach towards smoking cessation for pregnant Aboriginal and Torres Strait Islander women may be necessary, including moving away from the SOC model approach and subsidised provision of intermittent NRT. Comprehensive programs that take into account the family network and wider social context are also recommended.

Background: Little is known about the extent to which smokers attending stop-smoking clinics experience conflicting motivations about their quit attempt, whether such conflict can be understood in terms of a single dimension and if this ‘conflict about quitting’ differs from motivation to stop smoking and is associated with a smoker's choice of method to stop smoking (stopping gradually or abruptly). Method: Sociodemographic, smoking and quit attempt characteristics as well as measures relating to conflict about stopping smoking were recorded in a cross-sectional survey of 198 smokers attending five quit smoking clinics in Malaysia. Results: Five measures (having seriously thought about quitting before, being happy about becoming a non-smoker, being strongly motivated to stop, intending to stop smoking completely and believing in stopping for good this time) were loaded onto a single factor that could be labelled ‘conflict about quitting’. The resultant scale had moderate internal reliability (Cronbach's α= .625). Most smokers exhibited conflicting motivations about stopping smoking, with over half (52.0%, 95% CI 45.1–59.1) scoring 2 or higher on the 5-point conflict scale. ‘Conflict about quitting’ was significantly associated with the decision to stop smoking gradually rather than abruptly controlling for other variables (OR 1.36, 95% CI 1.05–1.76) and was more strongly associated with the choice of smoking cessation method than motivation to stop smoking. Conclusions: ‘Conflict about quitting’ can be conceptualised as a single dimension and is prevalent among smokers voluntarily attending stop-smoking clinics. The finding that smokers who display greater conflict about quitting are more likely to choose gradual cessation may explain contradictory findings in the literature regarding the effectiveness of different methods of smoking cessation.

Background: Awareness programs are highly recommended to educate smokers and help them to quit. The aim of this study is to evaluate dental professionals' awareness and utilisation of the 5As in the Eastern Province of Saudi Arabia. Material and Methods: A survey was conducted in Saudi Arabia on 102 dental care providers (DCPs) in 2010 to assess awareness of 5As. Many factors were included in the survey such as demographic characteristics, working place, years of experiences, level of education and country of graduation. Results: Only 23 (22.5%) of our sample know about the 5As (Ask, Advise, Assess, Assist and Arrange), and less than 7% of DCPs assist their patients to quit smoking. In addition, 19 (18.6%) of DCPs were smokers, and of them 6 (31.6%) smoked in front of their patients. Conclusion: Most of the dental practitioners were not aware of the 5As for smoking cessation. Most of them they did not pay attention to the willingness of their patients to quit smoking.

This study reports client satisfaction in five UK National Health Service (NHS) Stop Smoking Services (SSS) and examines the impact of satisfaction on outcome four weeks postquit. Six services were selected on the basis of perceived ability to run the study from a pool of 11 who responded to a mailshot to volunteer. Advisors made one of two satisfaction surveys available to their clients two weeks after quitting smoking. The two surveys were a ‘brief’ three-item survey and a ‘full’ survey containing those items plus 19 others about specific aspects of the service. There were two key items: how satisfied respondents were with the support they received to stop smoking and would they recommend the service to another smoker. Surveys were completed anonymously but had unique identification numbers so they could be linked to individual demographic and outcome data. Overall 10% (554/5520) of treated smokers in the services completed a survey, 7% (390/5520) completed the ‘full’ survey. Responses were a strong endorsement of the participating services, with 93% (505/542) satisfied or very satisfied with the service and 99% (548/552) prepared to recommend the service. The sample was unrepresentative of the population of treated smokers in terms of eligibility for free prescriptions, ethnicity, age, type of treatment experienced, the type of advisor seen, medication use and end of treatment outcome. Satisfaction at week two was not related to abstinence at four weeks postquit. Limitations of the study and suggestions for service delivery are discussed.

Aims: A history of either a substance use disorder (SUD) or psychiatric disorder (PD) is associated with tobacco use. However, there is limited information available on tobacco dependence treatment outcomes among individuals with co-occurring SUD and PD. Methods: Data from 202 participants enrolled in a tobacco dependence treatment program in an outpatient clinic setting were analysed. Findings: In multivariate analysis, having a history of SUD only (OR =.11, 95% CI = .02–.76) and having a co-occurring SUD and PD (OR = .13, 95% CI = .02–.81), as compared to having neither, were significant predictors of a lower likelihood of achieving smoking abstinence. Conclusions: A history of SUD and PD is an important predictor of poor smoking cessation outcomes; however, using more intensive, tailored approaches to tobacco dependence treatment appears to be promising. Future studies may need to further address the nature of tobacco dependence treatment in settings were PDs and other SUDs are managed in order to achieve optimal outcomes.

Purpose: To determine whether the combination of bupropion SR and varenicline offers improved smoking cessation outcomes compared to varenicline monotherapy or to combination of bupro-pion SR and nicotine patch. Methods: This retrospective chart review included 489 volunteer enrolees in a Veterans Affairs (VA) tobacco cessation clinic who received one of the three treatments upon clinic enrolment. The study endpoints were smoking cessation and clinic completion rates, changes in the number of cigarettes smoked, carbon monoxide (CO) levels, urges to smoke, self-confidence to quit and medication-attributed adverse effects. Results: The relative smoking cessation rates were 33%, 32%, and 40% for bupropion SR and nicotine patch, bupropion SR and varenicline, and varenicline groups, respectively. The 0.21 p value established that no significant cessation rate differences existed between any of the groups. Varenicline alone or in combination was as well tolerated as the combination of bupropion SR and nicotine patch. Conclusions: The combination of bupropion SR and varenicline did not demonstrate any smoking cessation advantage over varenicline monotherapy or the combination of bupropion SR and nicotine patch and therefore do not support the use of bupro-pion SR and varenicline over varenicline monotherapy.

Aim: The purpose of this study is to explore how effective household smoking restrictions (HSRs) are in different age groups in predicting smoking abstinence. Methods: The study analysed the Canadian Community Health Survey (CCHS) cycle, 3.1. Smoking abstinence was defined as individuals who reported to not have smoked greater than 100 cigarettes (n = 1 024 578) and were selected for this analysis. Important covariates include sex, age, education and immigrant status. Logistic regression was used to assess the association between smoking household restrictions and smoking abstinence when taking covariates into consideration. Results: Individuals who implemented HSRs reported to be abstinent from smoking at 12% compared to those with no HSRs at 0.7%. When adjusted for covariates of interest, the odds ratio (OR) for smoking abstinence was 1.43 (95% confidence interval (CI): 1.04, 1.97; P < .026). It was found that age was a strong predictor of smoking abstinence particularly in youths at 3.11 (95% CI: 1.65, 5.84; P < .001) and young adults at 1.92 (95% CI: 1.44, 1.92; P < .001). Conclusion: It is suggested that HSRs is an important anti-tobacco socialisation tool in youths and young adults. Individuals living in a home with HSRs may internalise behavioural norms against the initiation or continuation of smoking.