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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2020) | Viewed by 56172

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Dr. Karl-Olov Fagerström

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Guest Editor

Fagerström Consulting, Vaxholm, Sweden
Interests: dependence; smoking cessation; harm reduction; nicotine replacement; varenicline; non-combustible tobacco products

Special Issue Information

Dear Colleagues,

Smoking is the leading cause of pre-mature death, at least in the Western world. Stopping smoking is, therefore, of significant importance for public health. Until about 1970, smoking was regarded as a bad habit and the aids and treatments were of a psychological nature. From the 1980s, it was realized by, e.g., the US Surgeon General, that it was a drug dependence on par with illicit drugs. This gave rise to the advent of pharmacological treatments. First, nicotine replacement and there after bupropion and varenicline. Up until recently, almost only abrupt quitting has been prescribed as the stopping method. However, the success rates of licensed therapies have been less than satisfying and new ways have been sought to abstinence. With the insight that pure nicotine without combustion, although not harmless, causes much less harm than smoking, new strategies like, e.g., harm reduction, have been investigated.

In this Special Issue, papers on all methods and approaches from complete abstinence from nicotine to harm reduction by, e.g., stopping smoking and switching to other nicotine products will be considered. Empirical papers are preferred but reviews and theoretical papers will also be considered.

Topics may include:

Clinical trials on existing or new medical or pharmacological treatments
Extended duration of use and increased dose of treatments
Observational population studies
Studies on new tobacco/nicotine products, such as e-cigarettes, snus, and heat but not burn tobacco products
Clinical experience
Tailoring treatment to specific individuals

Dr. Karl-Olov Fagerström
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

smoking cessation
pharmacological, behavioural, electronic cigarettes
smokeless tobacco and other alternative nicotine/tobacco product treatments and tailoring of treatments

Published Papers (11 papers)

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Research

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14 pages, 927 KiB

Open AccessArticle

A Parental Smoking Cessation Intervention in the Pediatric Emergency Setting: A Randomized Trial

by E. Melinda Mahabee-Gittens, Robert T. Ammerman, Jane C. Khoury, Meredith E. Tabangin, Lili Ding, Ashley L. Merianos, Lara Stone and Judith S. Gordon

Int. J. Environ. Res. Public Health 2020, 17(21), 8151; https://doi.org/10.3390/ijerph17218151 - 04 Nov 2020

Cited by 11 | Viewed by 2669

Abstract

We examined the efficacy of a pediatric emergency visit-based screening, brief intervention, and referral to treatment (SBIRT) condition compared to a control condition (Healthy Habits Control, HHC) to help parental smokers quit smoking. We enrolled 750 parental smokers who presented to the pediatric emergency setting with their child into a two-group randomized controlled clinical trial. SBIRT participants received brief cessation coaching, quitting resources, and up to 12-weeks of nicotine replacement therapy (NRT). HHC participants received healthy lifestyle coaching and resources. The primary outcome was point-prevalence tobacco abstinence at six weeks (T1) and six months (T2). The mean (SD) age of parents was 31.8 (7.7) years, and 86.8% were female, 52.7% were Black, and 64.6% had an income of ≤$15,000. Overall abstinence rates were not statistically significant with 4.2% in both groups at T1 and 12.9% and 8.3% in the SBIRT and HHC groups, respectively, at T2. There were statistically significant differences in SBIRT versus HHC participants on the median (IQR) reduction of daily cigarettes smoked at T1 from baseline (−2 [−5, 0] versus 0 [−4, 0], p = 0.0008),at T2 from baseline (−4 [−9, −1] vs. −2 [−5, 0], p = 0.0006), and on the mean (SD) number of quit attempts at T2 from baseline (1.25 (6.5) vs. 0.02 (4.71), p = 0.02). Self-reported quitting rates were higher in SBIRT parents who received NRT (83.3% vs. 50.9%, p = 0.04). The novel use of the pediatric emergency visit to conduct cessation interventions helped parents quit smoking. The near equivalent abstinence rates in both the SBIRT and HHC groups may be due to underlying parental concern about their child’s health. Cessation interventions in this setting may result in adult and pediatric public health benefits. Full article

(This article belongs to the Special Issue Smoking Cessation)

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10 pages, 659 KiB

Open AccessArticle

Nicotine Dependence and Factors Related to Smoking Cessation among Physicians in Estonia

by Mariliis Põld and Kersti Pärna

Int. J. Environ. Res. Public Health 2020, 17(9), 3217; https://doi.org/10.3390/ijerph17093217 - 06 May 2020

Cited by 10 | Viewed by 2525

Abstract

Smoking withdrawal can be difficult due to nicotine dependence (ND). The study objective was to describe ND and to analyze the association between ND and factors related to smoking cessation among daily smoking physicians in Estonia. Data was collected in 2014, using cross-sectional postal survey sampling all practicing physicians (n = 5666) in Estonia, of whom 2939 responded (corrected response rate 53.1%). The study sample was restricted to daily smoking physicians (n = 171). Results of the Fagerström Test for Nicotine Dependence (FTND) were described and ND scores calculated. Logistic regression was used to determine the association of ND (at-least-moderate vs. low) with factors related to smoking cessation. Crude and fully adjusted ORs with 95% CIs were calculated. The mean FTND score was 2.8 ± 2.1. The odds of having at-least-moderate ND decreased significantly with each year postponing smoking initiation (OR = 0.82, 95% CI 0.72–0.94). After adjustment, ND was no longer associated with the desire to quit smoking and motives to quit. In conclusion, more than half of daily smoking physicians had low ND. Higher ND was associated with younger age of smoking initiation. Knowledge of ND and factors related to smoking cessation is useful in the prevention of smoking and in development of cessation counselling tailored for physicians. Full article

(This article belongs to the Special Issue Smoking Cessation)

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13 pages, 323 KiB

Open AccessArticle

The Perception and Intervention of Internship Nursing Students Helping Smokers to Quit: A Cross-Sectional Study in Chongqing, China

by Li Zhang, Yanhan Chen, Yalan Lv, Xia Yang, Qianyu Yin, Li Bai, Yaling Luo, Manoj Sharma and Yong Zhao

Int. J. Environ. Res. Public Health 2019, 16(20), 3882; https://doi.org/10.3390/ijerph16203882 - 13 Oct 2019

Cited by 4 | Viewed by 2668

Abstract

Background: Smoking is among the most preventable causes of death globally. Tobacco cessation can lessen the number of potential deaths. The China Tobacco Cessation Guidelines encourage medical staff to perform the 5As (Ask, Advise, Assess, Assist, Arrange) when delivering tobacco dependence treatments to patients. Nursing students will develop to be nurses in the future and they have to finish 9 months of clinical practicum study in the last year at hospitals or care centers. However, the frequency of behaviors used to help smokers quit among Chinese nursing internship students is unclear. This study analyzed the rate of nurse interns’ performance of the 5As and which demographic characteristics, perceptions of smoking and knowledge predicted higher performance of the 5As. Methods: The cluster sampling method was used to select 13 teaching hospitals among 29. All nursing intern students were expected to finish the questionnaire about their 5As behaviors to help patients quit smoking. Their 5As performances were scored from one to five with 5 being the best and scores were summed. A multivariate linear mixed-effect model was employed to test the differences between their 5As. Results: Participating in the survey were 1358 interns (62.4% response rate). The average scores were as follows—Ask—3.15, Advise—2.75, Assess—2.67, Assist—2.58 and Arrange—2.42. A total of 56.3% students perceived that medical staff should perform the 5As routinely to help patients quit smoking. On the other hand, 52.1% viewed clinical preceptors as role models of the 5As. School education regarding tobacco control, smoking dependence treatment, self-efficacy and positive intentions were predictors of higher performance of the 5As (p < 0.001). Conclusions: Nursing internship students seldom administered tobacco dependence treatments to patients. It is essential to improve the corresponding education, skills and self-efficacy of the 5As. Meanwhile, clinical preceptors should procure more training in the responsibilities and skills related to tobacco cessation. In this way, clinical preceptors can be role models of the 5As and impart positive influences on interns. Full article

(This article belongs to the Special Issue Smoking Cessation)

14 pages, 596 KiB

Open AccessArticle

Proactive Telephone Smoking Cessation Counseling Tailored to Parents: Results of a Randomized Controlled Effectiveness Trial

by Tessa Scheffers-van Schayck, Roy Otten, Rutger C.M.E. Engels and Marloes Kleinjan

Int. J. Environ. Res. Public Health 2019, 16(15), 2730; https://doi.org/10.3390/ijerph16152730 - 31 Jul 2019

Cited by 10 | Viewed by 3490

Abstract

A recent Dutch efficacy trial showed the efficacy of a telephone smoking cessation counseling tailored to smoking parents. Currently, it is unknown whether such telephone counseling would be effective under more real-world conditions. This study aimed to examine the effectiveness of parent-tailored telephone smoking cessation counseling in a two-arm randomized controlled effectiveness trial and whether the effectiveness depended on the recruitment approaches that were used to recruit parents (mass media vs. health care). In total, 87 parents received either telephone counseling (intervention) or a self-help brochure (control). Parents were asked to complete questionnaires at baseline and three months post-intervention. Results showed that the odds of reporting 7-day point-prevalence abstinence at three months post-intervention was 7.54 higher for parents who received telephone counseling than for parents in the control condition (53.3% vs. 13.2%, 95% CI = 2.49–22.84). Because inclusion was lower than anticipated, interaction-effects of condition and recruitment approach could not be interpreted. The present study demonstrates that the parent-tailored smoking cessation telephone counseling is effective in helping parents to quit smoking. Yet, before large-scale implementation, future research should focus on how recruitment of parents via the recruitment approaches could be improved. Full article

(This article belongs to the Special Issue Smoking Cessation)

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13 pages, 296 KiB

Open AccessArticle

Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals

by Ross Thomson, Lisa McDaid, Joanne Emery, Felix Naughton, Sue Cooper, Jane Dyas and Tim Coleman

Int. J. Environ. Res. Public Health 2019, 16(10), 1814; https://doi.org/10.3390/ijerph16101814 - 22 May 2019

Cited by 10 | Viewed by 4464

Abstract

Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking. Full article

(This article belongs to the Special Issue Smoking Cessation)

10 pages, 442 KiB

Open AccessArticle

Feasibility and Acceptability of ‘Opt-In’ Referrals for Stop Smoking Support in Pregnancy

by Katarzyna Anna Campbell, Sophie Orton, Katharine Bowker, Sue Cooper and Tim Coleman

Int. J. Environ. Res. Public Health 2019, 16(8), 1358; https://doi.org/10.3390/ijerph16081358 - 16 Apr 2019

Cited by 6 | Viewed by 3219

Abstract

Background: International guidelines recommend that following an early-pregnancy ‘opt-out’ referral for smoking cessation support, pregnant women who smoke should also be offered referrals at subsequent antenatal appointments (‘opt-in’ referrals). We assessed feasibility and acceptability of introducing ‘opt-in’ self-referral forms to stop smoking services (SSS) in antenatal clinics. Method: A ‘before–after’ service evaluation and qualitative interviews. ‘Opt-in’ self-referral forms were distributed by reception staff to women attending antenatal ultrasound appointments. We collected hospital/SSS data for the study period and a comparison period 12 months prior. Reception staff were interviewed and data analyzed thematically. Results: Over 6500 women entered antenatal care in each period; ~15% smoked and ~50% of those who smoked were referred to SSS at their first appointment. In the study period, 17.4% of women completed ‘opt-in’ forms. Of these 17.3% smoked, and 23.1% of those who smoked requested a referral. The staff thought new procedures had minimal impact on workload, but were easy to forget. They believed the pathway would be better delivered by midwifery staff, with additional information/advice to improve engagement. Conclusions: ‘Opt-in’ referrals in later pregnancy result in significant numbers of women who smoke indicating interest in smoking cessation support. Additional training and support is necessary to motivate reception staff to oversee self-referral pen-and-paper procedures effectively. Full article

(This article belongs to the Special Issue Smoking Cessation)

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18 pages, 787 KiB

Open AccessArticle

When Less is More: Vaping Low-Nicotine vs. High-Nicotine E-Liquid is Compensated by Increased Wattage and Higher Liquid Consumption

by Jorien Smets, Frank Baeyens, Martin Chaumont, Karolien Adriaens and Dinska Van Gucht

Int. J. Environ. Res. Public Health 2019, 16(5), 723; https://doi.org/10.3390/ijerph16050723 - 28 Feb 2019

Cited by 46 | Viewed by 9699

Abstract

(1) Background: Previous research (Van Gucht, Adriaens, and Baeyens, 2017) showed that almost all (99%) of the 203 surveyed customers of a Dutch online vape shop had a history of smoking before they had started using an e-cigarette. Almost all were daily vapers who used on average 20 mL e-liquid per week, with an average nicotine concentration of 10 mg/mL. In the current study, we wanted to investigate certain evolutions with regard to technical aspects of vaping behaviour, such as wattage, the volume of e-liquid used and nicotine concentration. In recent years, much more powerful devices have become widely available, e-liquids with very low nicotine concentrations have become the rule rather than the exception in the market supply, and the legislation has been adjusted, including a restriction on maximum nicotine concentrations to 20 mg/mL. (2) Methods: Customers (n = 150) from the same Dutch online vape shop were contacted (to allow a historical comparison), as well as 274 visitors from the Facebook group “Belgian Vape Bond” to compare between groups from two different geographies and/or vaping cultures. (3) Results: Most results were in line with earlier findings: Almost all surveyed vapers were (ex-)smokers, had started (80%) vaping to quit smoking and reported similar positive effects of having switched from smoking to vaping (e.g., improved health). A striking observation, however, was that whereas customers of the Dutch online vape shop used e-liquids with a similar nicotine concentration as that observed previously, the Belgian vapers used e-liquids with a significantly lower nicotine concentration but consumed much more of it. The resulting intake of the total quantity of nicotine did not differ between groups. (4) Conclusions: Among vapers, different vaping typologies may exist, depending on subcultural and/or geographic parameters. As a consequence of choosing low nicotine concentrations and consuming more e-liquid, the Belgian vapers may have a greater potential to expose themselves to larger quantities of harmful or potentially harmful constituents (HPHCs) released during vaping. Full article

(This article belongs to the Special Issue Smoking Cessation)

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20 pages, 1565 KiB

Open AccessArticle

IQOS^TM vs. e-Cigarette vs. Tobacco Cigarette: A Direct Comparison of Short-Term Effects after Overnight-Abstinence

by Karolien Adriaens, Dinska Van Gucht and Frank Baeyens

Int. J. Environ. Res. Public Health 2018, 15(12), 2902; https://doi.org/10.3390/ijerph15122902 - 18 Dec 2018

Cited by 38 | Viewed by 13632

Abstract

Introduction: Research from Philip Morris International’s science division on its Heat-not-Burn product IQOS^TM focused on its chemical, toxicological, clinical, and behavioral aspects. Independent research on the experiences and behavioral aspects of using IQOS^TM, and how it compares to e-cigarettes, is largely lacking. The current randomized, cross-over behavioral trial tried to bridge the latter gaps. Methods: Participants (n = 30) came to the lab on three consecutive days after being overnight smoking abstinent. During each session, participants used one of three products (cigarette, e-cigarette, or IQOS^TM) for five minutes. Exhaled CO (eCO) measurements and questionnaires were repeatedly administered throughout the session. Results: Smoking a cigarette for five minutes resulted in a significant increase of eCO, whereas using an IQOS^TM resulted in a small but reliable increase (0.3 ppm). Vaping did not affect eCO. Cigarette craving reduced significantly after product use, with the decline being stronger for smoking than for e-cigarettes or IQOS^TM. Withdrawal symptoms declined immediately after smoking or using IQOS^TM, and with some delay after vaping. IQOS^TM scored higher in terms of subjective reward/satisfaction and was slightly preferred to the e-cigarette. Discussion: Short-term use of IQOS^TM has a minimal impact on eCO, is equally effective in reducing cigarette craving and withdrawal symptoms as an e-cigarette, and is slightly preferred. Full article

(This article belongs to the Special Issue Smoking Cessation)

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12 pages, 301 KiB

Open AccessArticle

Tobacco Health Risk Awareness among Socially Disadvantaged People—A Crucial Tool for Smoking Cessation

by Marek Milcarz, Kinga Polanska, Leokadia Bak-Romaniszyn and Dorota Kaleta

Int. J. Environ. Res. Public Health 2018, 15(10), 2244; https://doi.org/10.3390/ijerph15102244 - 13 Oct 2018

Cited by 18 | Viewed by 4859

Abstract

The goal of this cross-sectional survey was to assess the level of knowledge on harmful effects of environmental tobacco smoke (ETS) exposure and active smoking among socially-disadvantaged people in Poland. The study was conducted among 1817 respondents aged 18–59 years, who used aid services from local social care institutions in Piotrkowski district. Majority of the participants were aware of the fact that smoking may cause serious diseases and lung cancer (92%). However, those percentages were lower for awareness of ETS and health risk (69.4%) and for awareness of smoking/ETS-associated risk of stroke and heart attack (57%, 68%). The male respondents and smokers had much higher odds of lacking knowledge that smoking causes serious diseases and lung cancer compared to the females (OR = 1.47 and OR = 1.86; p < 0.05) and non-smokers (OR = 2.35 and OR = 2.31; p < 0.001). In addition, those with temporary jobs and the unemployed had a higher risk of lack of knowledge on smoking and lung cancer risk (OR = 2.14 and OR = 1.66; p < 0.05) as well as ETS and the risk of stroke (OR = 1.52 and OR = 1.51; p < 0.05) as compared to those with permanent jobs. The smokers who were aware of four health consequences of smoking indicated an intention to quit smoking within the next month more frequently when compared to those who did not have the knowledge on all of the analyzed harmful effects of tobacco use (19.7% vs. 13.1%; p < 0.05). There is a need to improve knowledge on the dangers associated with active and passive smoking among socially disadvantaged populations. Full article

(This article belongs to the Special Issue Smoking Cessation)

Review

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12 pages, 444 KiB

Open AccessReview

Smokers’ and Non-Smokers’ Attitudes towards Smoking Cessation in Saudi Arabia: A Systematic Review

by Mansour Tobaiqy, Dennis Thomas, Andrew MacLure and Katie MacLure

Int. J. Environ. Res. Public Health 2020, 17(21), 8194; https://doi.org/10.3390/ijerph17218194 - 06 Nov 2020

Cited by 6 | Viewed by 3561

Abstract

Literature on smoking in Saudi Arabia is extensive. However, studies capturing the attitudes of both smokers and non-smokers towards smoking cessation are few. A PRISMA-P protocol guided systematic searches in MEDLINE and CINAHL on MeSH terms (smoking cessation AND Saudi Arabia). Peer reviewed articles in English were included in the narrative analysis. Screening reduced the 152 articles identified to 15 and independent critical appraisal identified 10 final articles for review. Few adopted validated survey tools or mentioned the best practice to be followed. There was considerable variation in the prevalence of smoking reported (13.7–49.2%) and survey response rates (8.9–100%). There was a paucity of quality evidence but it is clear that the smoking pandemic is still resonant in Saudi Arabia. Despite support for education programs to prevent the uptake of smoking, policy-driven action to reduce environmental second-hand smoking, and provision of support for smoking cessation, more needs to be done. Full article

(This article belongs to the Special Issue Smoking Cessation)

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Other

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17 pages, 675 KiB

Open AccessProject Report

Development of a Complex Intervention for the Maintenance of Postpartum Smoking Abstinence: Process for Defining Evidence-Based Intervention

by Caitlin Notley, Tracey J. Brown, Linda Bauld, Wendy Hardeman, Richard Holland, Felix Naughton, Sophie Orton and Michael Ussher

Int. J. Environ. Res. Public Health 2019, 16(11), 1968; https://doi.org/10.3390/ijerph16111968 - 03 Jun 2019

Cited by 4 | Viewed by 4074

Abstract

Relapse to tobacco smoking for pregnant women who quit is a major public health problem. Evidence-based approaches to intervention are urgently required. This study aimed to develop an intervention to be integrated into existing healthcare. A mixed methods approach included a theory-driven systematic review identifying promising behaviour change techniques for targeting smoking relapse prevention, and qualitative focus groups and interviews with women (ex-smokers who had remained quit and those who had relapsed), their partners and healthcare professionals (N = 74). A final stage recruited ten women to refine and initially test a prototype intervention. Our qualitative analysis suggests a lack, but need for, relapse prevention support. This should be initiated by a trusted ‘credible source’. For many women this would be a midwife or a health visitor. Support needs to be tailored to individual needs, including positive praise/reward, novel digital and electronic support and partner or social support. Advice and support to use e cigarettes or nicotine replacement therapy for relapse prevention was important for some women, but others remained cautious. The resulting prototype complex intervention includes face-to-face support reiterated throughout the postpartum period, tailored digital and self-help support and novel elements such as gifts and nicotine replacement therapy (NRT). Full article

(This article belongs to the Special Issue Smoking Cessation)

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