Background: The purpose of this study is to assess the long-term perspective and effectiveness of the work of local smoking cessation schools as part of formation a global strategy for quitting tobacco smoking in society.

Material and Methods: The study was conducted in the pulmonological department of Clinical Hospital. Total number of patients was 97, separated in 2 groups. Group 1 included patients with COPD: 1A continue to smoke cigarettes, 1B transferred to THS. Group 2 included patients without respiratory symptoms: 2A continue to smoke cigarettes, 2B transferred to THS. Work of the school included: medical, laboratory, functional examinations, lectures and practical classes. Schools were assessed at 6, 12, 24, and 36 months. Primary endpoint: avoiding smoking cigarette within 6 months. Secondary endpoints: lung function, frequency of exacerbations of COPD during the year, quality of life, level of exercise tolerance.

Results: Primary endpoint reached: in group 1 in 93% at 24 months of observation: 1A 3%, 1B 90%, in group 2 in 72% at 36 months: 2A 5%, 2B 67%. The marker of lack effect from schools was the number of patients dropping out: First 3 months - 12 patients in group 1A; 10 patients in group 2A; in groups B there were no drop-outs for the first 3 months. Total number of drop-outs from the program in the first year: 52 patients.

Conclusions: Continued smoking of cigarettes leads to a rapid decrease in lung function, and progressive increase of broncho-obstructive syndrome, number of exacerbations, and development of neoplasms. Tobacco cessation schools have a positive effect on the health of the population and in the group switching to TSH effectiveness is higher, which has a beneficial effect on reducing frequency of respiratory events.

AUTHOR: Natalya Esaulova

AFFILIATION: Ural Research Institute of Phthisiopulmonology, Ural State Medical University, Russian Federation

Croatian Society for the Harm Reduction in Public Health (HaRPH) was the first in Croatia to seriously point out the lack of a serious comprehensive set of principles, policies, programs and practices and products for reducing the damage associated with tobacco use. According to the results of the independent market research agency during May 2022, smokers of classic cigarettes (58.2%), compared to users of alternative products, are significantly more concerned about their health due to the products they use. 60% of respondents who have tried alternative tobacco products believe that such products are less harmful, while only a quarter of smokers of classic cigarettes believe that alternative products are less harmful compared to cigarettes. Almost half of all respondents believe that the legislation must be less restrictive towards less harmful tobacco products compared to conventional cigarettes. HaRPH is preparing a Croatian budget impact study: “Harm Reduction. Switching from tobacco-based products to heated tobacco-based products in smokers (nicotine addicts) who are unwilling or unable to quit smoking”. The study will calculate, for the first time in Croatia and the EU, the impact on the insurer's budget when people who are unwilling or unable to quit smoking switch from tobacco-based products to heated tobacco-based products, according to the same methodology used by Croatian National Health Insurance Fund for decision-making on the placing of medicinal products and medical devices on the List of medicinal products.

AUTHOR: Ranko Stevanovic

AFFILIATION: HaRPH, Zagreb, Croatia

Background: In Germany, 32.4% of the population smokes, despite the well-known serious health effects. Regardless, smoking rates have been stable or slightly increasing since 2016. The study aims to assess and understand the barriers that may impede adult smokers from quitting cigarette smoking.

Material and Methods: Between October and November 2022, computer-assisted web interviews were conducted in Germany with a representative sample of 1,000 smokers aged 19 years and above. Additionally, 196 adult users of e-cigarettes and heated tobacco products (HTPs) who switched from cigarette smoking were surveyed.

Results: More than half of the smokers surveyed, reported not being motivated to quit cigarette smoking (51%), while 5% expressed a desire to quit within the next month. Older smokers and smokers with a low household income reported no motivation to quit more often. The most frequently reported barriers to quitting cigarette smoking were enjoyment of smoking (50%), difficulties in breaking habits and rituals (41%), and lack of discipline (31%). Roughly a quarter (27%) of smokers assessed the health risks of e-cigarettes and HTPs to be lower than that of cigarettes. Respondents who discontinued cigarette smoking by switching to smoke-free alternatives were significantly better informed on the causes of smoking related harm (85%, p<0.05). Within the sample of e-cigarette and HTP users, 42% reported a period of dual use while switching away from cigarettes. For the vast majority (89%), this period lasted less than a year, with 96% reporting a reduction in cigarette consumption during this period.

Conclusions: The majority of the smokers surveyed were not motivated to quit smoking. The barriers mentioned need to be considered when developing measures to help smokers quit cigarette smoking. Misperceptions about the cause of harm from cigarette smoking and the health risks of smoke-free alternatives in relation to cigarettes are persistent in our smoker sample.

AUTHORS: Nelson Tewes, Christoph Neubert, Alexander K. Nussbaum

AFFILIATION: Philip Morris GmbH

Conflict of Interest: C. Neubert, A. K. Nussbaum & N. Tewes are employees of Philip Morris Germany.

Funding: Philip Morris International is the sole source of funding and sponsor of this research.

Background: People who smoke and who face challenges trying to quit or wish to continue to smoke may benefit by switching from traditional cigarettes to non-combustible nicotine delivery alternatives, such as heated tobacco products (HTPs) and electronic cigarettes (ECs). HTPs and ECs are being increasingly used to quit smoking, but there are limited data about their effectiveness.

Material and Methods: We conducted a 12-week randomized non-inferiority switching trial to compare effectiveness, tolerability, and product satisfaction between HTPs (IQOS 2.4 Plus) and refillable ECs (JustFog Q16) among people who do not intend to quit. The cessation intervention included motivational counseling. The primary endpoint of the study was the carbon monoxide-confirmed continuous abstinence rate from week 4 to week 12 (CAR weeks 4-12). The secondary endpoints included the continuous self-reported ≥50% reduction in cigarette consumption rate from week 4 to week 12 (CRR weeks 4-12) and 7-day point prevalence of smoking abstinence.

Results: A total of 211 participants completed the study. High quit rates (CAR weeks 4-12) of 39.1% (43/110) and 30.8% (33/107) were observed for IQOS-HTP and JustFog-EC, respectively. The between-group difference for the CAR weeks 4-12 was not significant (P=0.20). The CRR weeks 4-12 values for IQOS-HTP and JustFog-EC were 46.4% (51/110) and 39.3% (42/107), respectively, and the between-group difference was not significant (P=0.24). At week 12, the 7-day point prevalence of smoking abstinence values for IQOS-HTP and JustFog-EC were 54.5% (60/110) and 41.1% (44/107), respectively. The most frequent adverse events were cough and reduced physical fitness. A clinically relevant improvement in exercise tolerance was observed after switching to the combustion-free products under investigation. Risk perception for conventional cigarettes was consistently higher than that for the combustion-free study products under investigation.

Conclusions: HTPs may be a useful addition to the arsenal of reduced-risk alternatives for tobacco cigarettes and may contribute to smoking cessation.

AUTHOR: Pasquale Caponnetto

AFFILIATION: University of Catania, Italy

Background: According to official data from the RPORC survey in Russia from 2017 to 2022, the total number of smokers (33%) remained unchanged, while the share of those who answered “I don’t intend to quit” has doubled. Our purpose was to study the effectiveness of individual physician consultation on the motivation to quit smoking in patients with COPD and the need for stepwise approach in patients with low motivation.

Material and Methods: Questionnaire survey of 52 COPD patients with 20 questions about smoking history, personal experience, and physician’s role in smoking cessation.

Results: 40 men (76.9%; mean age, 66.6 years); 12 women (23.1%; mean age, 63.3 years) were included. No differences were found in the “age of smoking initiation” indicator (women-19.7 years; men-17.2 years). 82.6% (43) of patients had at least one attempt to stop smoking. Among smoking patients, 69.2% (36) would stop smoking if it is easy. 7.7% (4) of patients purposefully sought medical advice and 57.7% (30) of patients had individual medical consultation about the tobacco harm when contacting a medical center. There is a positive correlation between “individual doctor's consultation about the dangers of smoking” and “motivation to quit smoking” (p<0.05). There is a positive tendency between the smoking cessation indicators (p=0.07) and the motivation to stop smoking (p=0.08). 25% (13) of the patients are not motivated to stop smoking.

Conclusions: Individual physician consultation is a highly effective part of a COPD patient’s smoking cessation motivation, which is confirmed by the results of this study. All patients, including those with low motivation, should be able to get qualified help, and there should be special approaches for this group, possibly with the use of stepwise approach in smoking cessation and using the concept of “risk modification”.

AUTHORS: Irina Kroshkina, Nataliia Kuzubova, Viktoriia Makhmutova, Ekaterina Pirozhkova, Natalia Refitskaia

AFFILIATION: Saint Petersburg City Multidisciplinary Hospital No. 2, Saint Petersburg, Russian Federation

Background: Our purpose was to study the peculiarities of smoking cessation in COPD patients in outpatient practice.

Material and Methods: 140 smoking COPD patients (mean age 54.5±6.7 years) were examined in the anti-smoking office of City Polyclinic No. 54 in Saint-Petersburg. All patients were assessed on their level of nicotine addiction (Fagerström test) and motivation to quit smoking (Prochaska questionnaire), underwent clinical-laboratory testing, spirometry, and were trained in school on smoking cessation. All participants had moderate airflow limitation and received basic therapy with long-acting bronchodilators according to clinical guidelines. Patients, depending on motivation to quit smoking, were divided into three groups: with initially high (12 people), insufficient (56 people) and low (72 people) motivation.

Results: Group 1 patients had a study period of 3 months, all patients were able to quit tobacco smoking, and after 6 months showed an improvement in FEV1 (2.1±0.58 and 2.44±0.62, respectively, p<0.05). Group 2 patients had a study period of 6 to 15 months, during which their motivation to quit smoking increased and then they quit smoking. Patients in this group had lower FEV1 at the end of the preparatory period compared with group 1 (1.84±0.34, p<0.05), but improved after 6 months of abstinence (2.36±0.52, p<0.05). Group 3 patients with low motivation, after selection of baseline COPD therapy, stopped attending the anti-smoking office and continued smoking.

Conclusions: 1. The study showed that not all patients were motivated to quit smoking, despite individual counseling by physicians and classes in cessation school. 2. Patients in groups 1 and 2 were able to quit smoking, which indicates the effectiveness of the study. 3. In patients unmotivated to quit smoking (group 2 patients during preparatory period of training and group 3 patients given cessation), it is reasonable to apply the harm reduction concept to minimize the harm from smoking.

AUTHORS: Nataliia Shaporova¹, Irina Pelevina², Aleksandr Kakanov²

AFFILIATIONS: ¹First St. Petersburg State Medical University named after academician Ivan Petrovich Pavlov, Saint Petersburg, Russian Federation || ²Saint Petersburg City Polyclinic No. 54, Saint Petersburg, Russian Federation

Background: Endemic in people with mental disorders, smoking increases the risk of morbidity and premature mortality due to tobacco-related diseases. The overarching objective of the present study was to assess the feasibility and acceptability of smoking cessation interventions or tobacco harm reduction strategies among smokers with severe mental illness.

Material and Methods: To assess e-cigarettes as a tobacco harm reduction strategy and its overall impact on participants’ physical and mental health, a pilot randomized controlled trial was conducted in smokers with severe mental disorder (n=43). The study protocol and all procedures were approved by the Ethics and Scientific Committee of the Psychiatric Hospital of Attica and the Research Ethics Committee of the University of West Attica. Using a simple randomization procedure, participants were 1:1 assigned to intervention or control group. The primary outcome was self-reported smoking cessation, biochemically validated by exhaled carbon monoxide levels of below 6 ppm in 6 months. Secondary outcome measures were the Fagerström Test for Nicotine Dependence, the World Health Organization Quality of Life – BREF and the 36-Item Short Form Health Survey. The control group (n=22) and the intervention group (n=21) were given the same behavioral support for at least 3 months. Finally, the intervention group participants received a starter kit (e-cigarette and bottle of nicotine e-liquid) and were encouraged to use it as a smoking cessation tool.

Results: Compared to baseline, a significant reduction in nicotine dependence was observed in both groups in 6 months. However, the intervention group exhibited a remarkably higher quit rate over said period (33.3%) than the control group (13.6%). Overall, the intervention group’s QoL and general health demonstrated significant improvement in 6 months.

Conclusions: Concluding, through a tailored smoking cessation intervention, smokers with mental disorders can acquire skills to manage their nicotine addiction and succeed in quitting smoking or reducing smoking-related harm.

AUTHORS: Georgia Papadosifaki^1,2, Evanthia Sakellari², Areti Lagiou², Anastasia Barbouni²

AFFILIATIONS: ¹Psychiatric Hospital of Attica, Greece || ²Specialized Research Unit in Smoking Behavior, Laboratory of Hygiene and Epidemiology, Department of Public and Community Health, School of Public Health, University of West Attica, Greece

Background: Smoking is the biggest epidemic of our time. According to the World Health Organization (WHO), tobacco causes over 6 million premature deaths every year. The potential of nurses in preventative healthcare has mostly gone untapped. Major barriers to nurses’ involvement in helping patients quit smoking include a lack of time and training. The aim of the program was training nurses of general and psychiatric hospitals in smoking cessation techniques.

Material and Methods: The educational program lasted 3 months and was performed as synchronous and asynchronous distance learning. Twenty-five nurses from 4 hospitals in Athens (2 general and 2 psychiatric hospitals) participated the program.

Results: As part of the program, trainee nurses met specific cases (vignettes), study smoking and its effects and practice smoking cessation techniques. The majority of participants reported that they were completely satisfied with the program in terms of understanding the effects of smoking (64%) and smoking cessation techniques (77%).

Conclusions: Every nurse should speak with their patients about quitting smoking, according to National Institute for Health and Clinical Excellence (NICE) guidelines. This is a crucial public health duty, but to carry it out, nurses must comprehend the causes of and obstacles to quitting smoking. The alternatives accessible to support the patient must also be known by nurses.

AUTHORS: Evmorfia Koukia¹, Polyxeni Mangoulia¹, Maria Topi²

AFFILIATIONS: ¹Faculty of Nursing, National and Kapodistrian University of Athens, Greece || ²Eginitio Hospital, Athens, Greece

Exposure to cigarette smoke contributes to the development of lung cancer. Cigarette products are offered in two distinct systems: cigarettes and e-Cigs. e-Cig products have quickly become the new craze among people. A prevalent fallacy exists regarding the absence of risks associated with e-Cig. Cigarettes and e-Cigs produce free radicals, which cause gene promoter hypermethylation and cancer. Prior studies have primarily examined the impact of e-Cig on the growth of lung carcinoma cells. Hence, this study conducts a comparative analysis to examine the impact of cigarette and e-Cigs exposure on alterations of lung cells’ characteristics. The finding indicates that the effects of ECVE and CSE are similar. The extract was obtained via bubbling media technique. CSE and ECVE reduced lung cell viability in 24 hours and induce morphological alterations. CSE and ECVE induced hypermethylation of the p16 promoter. Numerous factors, such as composition and usage techniques, have an impact on the varying degrees of toxicological effects of CSE and ECVE. As with cigarettes, long-term use of e-cigarettes increases the risk of lung cancer.

AUTHORS: Xylia-Annisa Abelia¹, Ronny Lesmana^2,3,4, Melisa-Intan Barliana^1,4, Riccardo Polosa^5,6

AFFILIATIONS: ¹Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia || ²Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia || ³Physiology Molecular Laboratory, Biological Activity Division, Central Laboratory, Universitas Padjadjaran, Bandung, Indonesia || ⁴Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia || ⁵Centro per la Prevenzione e Cura del Tabagismo (CPCT), University Teaching Hospital “Policlinico-Vittorio Emanuele”, University of Catania, Italy || ⁶Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy