Tobacco Cessation

This parallel, randomized, open-ended clinical trial tested the impact of nicotine replacement pharmacotherapy during the course of methadone treatment among opiate abusers. A total of 424 men entered the study at 4 drug treatment centres in Tehran, Islamic Republic of Iran. The intervention group received a 6-week regimen of nicotine replacement pharmacotherapy at no charge. After 6 months, 211 persons (99.5%) in the control group continued to smoke and 1 person (0.5%) had quit. In the intervention group, 117 (55.1%) persons smoked, 15 (7.1%) persons had quit and 80 (37.7%) had reduced by more than 50% the number of cigarettes they smoked at the start of the study (P < 0.0001). The findings suggest that the use of nicotine replacement pharmacology in tandem with methadone maintenance treatment can lead to dramatically improved efficacy for treatment of dual addictions.

“Hookah,” which is also known as “Narghileh,” “Maassel,”
or “Shisha,” is a form of waterpipe smoking. Hookah is
composed of a tobacco bowl known as the head where tobacco
(that is processed and flavored) is placed, a body, a water bowl,
a hose, and a mouthpiece. Charcoal is positioned on the top
of the head that contains tobacco. When the smoker inhales
through the hose, the air is drawn into and around the charcoal.
The generated heated air passes through heated tobacco to
produce the mainstream smoke aerosol. This smoke aerosol
passes through the water bowl producing bubbles and goes
through the hose to the smoker. The average hookah smoking
session consists of 171 inhalations (each approximately 0.5 L)
of 2.6 s duration at a frequency of 2.8 inhalations/min.

Bangladesh, for the first time in history, has fulfilled the eligibility criteria set by the United Nations to be recognized as a developing country, crossing over from the list of least developed countries (LDCs). Bangladesh has reached the second phase after meeting the eligibility criteria of CDP – now it is a matter of time for the country to emerge from the LDC list to the list of developing countries. Though having a little development in the industrial sector the tobacco industry with full of modern manufacturing equipment and marketing strategies are growing like a monster and making large profits year after year. Although they pay a large number of taxes and create opportunities to develop a prestigious career there for high professionals, it is also creating various social and economic challenges. This report draws an insight into tobacco industry situation in Bangladesh. There is variety tier of cigarette brands. Along with this smokeless tobacco products are also available. This industry is creating quite a lot of controversies earns a huge proportion of national revenue from Tobacco industry hence, finds it difficult to take an ultimate step against it concerning health hazards. According to various reports, in the developed countries smoking is on the declining trend, but due to the socio-economic condition of the developing countries like Bangladesh, the trend is absent here. Again, it is facing severe difficulties in reducing the number of smokers. The social impact caused by this tobacco industry is controversial. Although a number of anti-smoking, policies are being implemented effectiveness of such campaigns are not sufficient. The socio-economic condition of Bangladesh is also another major factor leading to the growth of the Tobacco Industry and consumers. This report also examines the Social Impact Assessment of Tobacco industry which includes economic, environmental and other variable assessment.

In healthcare, continuing professional development is deemed by many health institutions, regulation bodies and organizations as an essential tool to safeguard best clinical practice, patient safety, efficient health delivery and staff satisfaction.  To ensure staff participation, many organizations over the last 20 years have made continuing professional development (CPD) mandatory.  There has been much research regarding the motivation of individuals to participate in continuing professional development, but rarely is the leadership or leadership style assessed in this motivation.  The purpose of the paper is to explore the potential impact of two main leadership styles: transactional and transformational and their influence on motivation and participation in continuing education.  Transactional leadership styles will likely increase participation through extrinsic motivation, although it may not result in long-term behaviour change.  In contrast, a transformational leadership style encourages and supports an increase in intrinsic motivation which may, in turn, result in higher lasting participation in professional development change in clinical practice.  The literature demonstrates that the correct leadership style is predicated upon the needs of the environment in which it is implemented.  When an immediate increase in participation due to mandates or a correction of critical errors is needed, a transactional leadership style is ideal.  Transformational styles should be implemented in situations where lifelong learning and improved patient care are desired.

Psychedelic drugs are some of the most powerful tools in the world for personal healing and psychological growth. Research at major medical centers over the past few years have shown remarkable results in the treatment of conditions such as depression, post-traumatic stress disorder (PTSD), and anxiety. Psychedelic drugs provide a path of treatment that is often more effective and rapid than other methods, and with many fewer side effects than pharmaceutical options. This paper will be focusing on hallucinogens such as lysergic acid diethylamide (LSD), and psilocybin and entheogens such as ayahuasca and ibogaine.

Approaching tobacco from the perspective of users, producers, and objectors, Smoking under the Tsars provides an unparalleled view of Russia’s early adoption of smoking. Tricia Starks introduces us to the addictive, nicotine-soaked Russian version of the cigarette—the
papirosa—and the sensory, medical, social, cultural, and gendered
consequences of this unique style of tobacco use.

Tobacco addiction is a disease that affects oral and systemic health. Dentists should encourage smokers to tobacco cessation trough explaining oral diseases caused by smoking and suggesting the proven successful methods.
Key words: addiction, smoker, tobacco, cessation, oral health.


Resumen:
La adicción al tabaquismo es una enfermedad que produce efectos adversos en la salud sistémica y bucal. Debe existir el compromiso de los dentistas con los pacientes fumadores a enfatizar sobre los efectos dañinos que el fumar tabaco ocasiona en la salud oral y sugerir alternativas para erradicar la adicción al tabaquismo.
Palabras clave: adicción, fumador, tabaquismo, tabaco, cesación, salud oral.

Tobacco is a plant product derived from a variety of plants belonging to the genus Nicotiana. The alkaloid nicotine present in the plant leafs is a stimulant and has an addictive effect. The tobacco plants have been historically grown and used for recreational purposes by the American local population. The dried tobacco leaves are consumed as chewing tobacco, snuff, and smoked in a variety of dispensations. Tobacco use (TU) has an adverse effect on various body systems and is a determinant for different diseases ranging from cancers to atherosclerosis. TU is a modifiable environmental risk factor for various diseases. Hence, with public health education and behavior modification, its burden can be reduced in a given society. Thus, the understanding of the incidence and prevalence of its use is necessary. This review attempts to sum up the significance and determinants of TU.

Solar photovoltaic (PV) technology represents a promising method to prevent dangerous global climate change, however full solar penetration demands substantial surface areas, possibly encroaching on arable land. To avoid repeating the mistakes of previous attempts to convert agricultural land to energy, arable land currently used for crops with known health hazards can be considered for conversion. Tobacco is the leading cause of avoidable death globally, and despite increasingly stringent controls on tobacco, economics provides an incentive to continue tobacco production. However, with the economics of PV ever improving, this study investigates the potential economic benefits of photovoltaic conversion of farms during tobacco's decline. This study analyzes key factors influencing conventional tobacco farming economics in the U.S. over a sensitivity of realistic future values. Then tobacco crop profit is compared to a sensitivity analysis covering the profits of solar PV farming on the same land. The results show that considering existing electric prices, escalation rates, and installed costs, PV farm substitution for tobacco farming makes economic sense in many U.S. cases already. In a case study of North Carolina, 30GW of PV power capacity was found to be economically viable on existing tobacco farms and if conversion took place over 2,000 premature deaths could be prevented from pollution reduction alone. This meets the State's peak summer loads. Land use policies are discussed to facilitate such land use conversions for the benefit of the economy, the environment and human health.

Celebrities endorsing e-cigarette brands on social media may exert a strong influence on e-cigarette uptake. Using a between-subject experiment, this study examines the effects of endorser type (celebrities, non- celebrities and products only) in e-cigarette brand Instagram advertisements on e-cigarette attitudes and smoking intentions. Results showed that celebrity endorsers significantly increased positive attitudes towards e-cigarettes and smoking intentions, compared to non-celebrities or products only. Celebrity endorsers also rated significantly higher on trustworthiness, expertise, goodwill and attractiveness, compared to non- celebrities. Additionally, identification, social comparison, health consciousness and social networking site use moderated between endorser type and key dependent measures. Implications for e-cigarette marketing regulation are discussed.

Busting the myths around tobacco products and tax increase With the Annual Budget of the Union Government approaching, a nationwide campaign has picked up driven by young people seeking a raise in taxes on tobacco products in India. The Young India Network of Nada recently held a Youth Parliament in Delhi demanding an increase in tobacco taxes and to pass the COTPA Amendment 2020 Bill at the earliest possible opportunity with stringent measures to control the tobacco menace in the country. Evidently, the Economics of Tobacco Consumption is today a thought provoking discussion among the academic and research community in the country too. Anjali Mathur talked to Dr. Anandajit Goswami, Professor, MRIIRS (Manav Rachna International Institute of Research and Studies) to underline some thought provoking views on the subject as well as to clear some popular myths surrounding it.

“Th’ abstract of poison in a stinking weed”

Daniel Defoe.

This is the catalogue piece written for the exhibition The Last Bound Sheaf, WASPS project space, Hanson St Glasgow, 2016.

‘The Last Bound Sheaf’ is a site-responsive exhibition at Wasps Studios, Hanson Street, which was originally built as a factory for Imperial Tobacco in the 1950s.  The surrounding area of Alexander parade was once known as Tobacco Road. 2016 marks the ten year anniversary of the Smoking, Health and Social Care Act (Scotland) banning smoking in enclosed public spaces, and sees the introduction of new laws and restrictions on the sale and display of tobacco products. Smith makes use of this occasion to explore the complicated relationship the people of Glasgow had and have with the tobacco plant.

This non-native plant is an invasive species in urban lives through its use. It was or is a source of livelihood, social ritual, pleasure, addiction, and poison. Smith has spoken with ex workers, communities and ‘stop smoking’ specialists in Glasgow to discover the experiences and changing attitudes of local people to the product.  Tobacco’s ubiquitous presence manifests as a history of control, with humanity and plant struggling for power; mans attempt to harness the potency of the weed, or to free themselves from the dominion it holds over them.

Smith borrows symbolism from ancient Scottish traditions of nature worship and the Clyack Sheaf, where agricultural workers, more aware of their interdependence with herbage, made explicit their reverence to crops and attempted to exert control over the unpredictability of nature. By utilising these archetypes and tropes Smith frames tobacco as a potent weed, creating idols that represent the many facets of tobacco as deity, the rituals surrounding it and sentiments of the local communities it has dominated.

Introduction: The possibility of successful smoking cessation is increased by early initiation. Therefore, promoting
smoking cessation at early age (especially among 14–35-year-olds) has a key role in reducing tobacco use prevalence.
Facebook is one of the most popular websites among adolescents and young adults which can be used for age-specific smoking cessation support.

Aim: Our research seeks to reveal the effects of a Facebook page on smoking habits, smoking cessation knowledge
and attitudes among 14–35-year-olds.

Method: An online survey was conducted among the 3278 followers of the author’s Facebook page. The questionnaire was completed by 332 people among 14–35-year-olds. We analysed demographic data, smoking habits, the
usage frequency and duration of the Facebook page as well as changes in smoking habits, smoking cessation knowledge and attitudes.

Results: The average age was 22.57 ± 5.08 years. The examined population consisted of 65% currently smokers, 12%
former smokers and 23% non-smokers. Significantly more people reported a positive change in their smoking habits
and smoking cessation attitudes among smokers who used the Facebook page more frequently and with longer duration (p<0.05). The habit and attitude changes were significantly higher among smokers who plan to quit smoking (p<0.01). Nevertheless, we also observed attitude changes between 12–25% among smokers who did not plan to
quit. Among non-smokers, the positive attitude changes were significantly higher in the low-educated population
who live in villages (p<0.01).

Conclusion: This Facebook page had a positive effect on smoking habits, smoking cessation knowledge and attitudes
among 14–35-year-olds. The contents of the Facebook page could be used to prevent smoking and support smoking
cessation among 14–35-year-olds

Introduction: Increased consumption of tobacco can lead to various oral mucosal lesions. The study was done to assess the oral mucosal lesions among tobacco users. Materials & Methods: This cross-sectional study was conducted on 5240 subjects who found to have a history of tobacco usage. Subjects with presence of oral mucosal lesions were subjected to vital tissue staining with toluidine blue dye (TB). Factors such as socioeconomic status, occupation, type of tobacco usage, education status and type of lesions were recorded. Results: Hyperkeratosis was seen in 562 patients followed by smoker's melanosis in 360, leukoplakia in 252 patients, squamous cell carcinoma in 190 patients, smoker's palate in 130 patients, erythroplakia in 96, lichen planus in 80 and OSMF in 70 patients. Cases were due to Cigarette/bidi, were due to gutkha usage, 252 (14.4%) due to hookah, hukli and 214 (12.2%) due to zarda/pan masala. Oral mucosal lesions were significantly higher in patients with the habit of smoking cigarette/beedi 974 (55.9%) compared to those patients that were chewing gutkha 300(17.2%) or panmasala 214 (12.2%) (P < 0.05). There was significantly maximum lesions seen in buccal mucosa (812) followed by the retromolar pad area in 302, floor of mouth in 199, palate in 176, gingiva in 128, tongue in 90 and lip in 33 cases (P < 0.05). Conclusion: Authors found that most common oral mucosal lesion was hyperkeratosis followed by leukoplakia and smokers melanosis. Most common type of tobacco use was cigarette/bidi and gutkha.

The objective of this study was to assess the effectiveness of the 5A's smoking cessation intervention (5A's) to that of brief advice (BA) conducted by dentists. A single-blinded randomized controlled trial was designed to compare the effectiveness of the interventions. Six Dental Public Health specialists were recruited, randomized and trained to participate in this trial. Two hundred and fifty patients were required on both arms. The main outcome measures were biochemically validated self-reported abstinence and behaviour change at 6-months follow-up. The odd of quitters in 5A's intervention was 3.81 (95% CI: 1.87-7.76; p=0.00) times higher compared to BA. After controlling other factors, the odds ratio for the 5A's was 1.90 (95% CI: 0.652-5.547; p=0.24) higher compared to BA. The 5A's was found to be more effective in initiating positive behaviour change compared to BA. However, after controlling other factors, there was no difference in the effectiveness although the odds ratio was slightly higher in 5A's.

Smoking is a worldwide problem affecting large number of people with serious consequences. Fighting with this addiction requires involvement of all health professionals regardless of their specialty and working posts. This study is designed to investigate the difference and similarities between internal and surgery specialty residents regarding the smoking frequency, cessation knowledge, attitudes and beliefs. 121 internal and 30 surgery specialty residents volunteered for the study. They filled a questionnaire of 35 items about smoking status (The addiction level if they smoke), knowledge about cessation and beliefs. While 15.8% (n=24) smoked, 12 (7.9%)were ex-smokers. Internal specialty residents had more right answers compared to surgery residents (t=7.425, p=0.002). Although 92% of the residents said that providing smoking cessation services are important only 33 (21.9%) of them were provided smoking counseling services. Residents who participated in our study believe that neither their under graduate (72.9%) nor post graduate medical training (62.9%) was satisfactory in this topic.

INTRODUCCIÓN: El tabaquismo es la principal causa
prevenible de morbi-mortalidad. Produjo cerca de 6 millones de muertes
en 2014, además de enfermedades y discapacidades derivadas de su
consumo. Entre las diferentes estrategias para reducir el consumo están
los tratamientos farmacológicos. En Argentina, hay poca información
sobre su efectividad y financiamiento. OBJETIVOS: Determinar cuáles
son las intervenciones más costo-efectivas para disminuir el consumo
de tabaco en Argentina. MÉTODOS: Se realizó un estudio cuantitativo,
utilizando el modelo de análisis de costo-efectividad. Se calcularon
costos de los tratamientos recomendados en la Guía de Práctica Clínica
Nacional de Tratamiento de la Adicción al Tabaco, para la población
fumadora de 15 años en adelante, sin cobertura explícita de salud y con un
intento de cesación con método farmacológico en los últimos 12 meses.
Se construyeron indicadores de años de vida saludable y se estimaron
los costos necesarios para la atención médica de patologías asociadas al
tabaquismo. RESULTADOS: La inversión en cesación tabáquica genera
un ahorro de $779,5 millones de pesos en los costos de atención médica
de las patologías seleccionadas. Por cada peso invertido en tratamientos farmacológicos se ahorran $26,4. CONCLUSIONES: Una intervención
centrada en la provisión gratuita de tratamientos farmacológicos para la
cesación tabáquica demuestra ser costo-efectiva.

INTRODUCTION Approximately 3.1 million people use tobacco in Nigeria contributing to the burden of tobacco-related morbidity and mortality. However, many tobacco users who have tried to quit have been unable to do so at the first try, but may succeed or give up after multiple attempts. The transtheoretical model helps by classifying those with quit intentions into preparation, contemplation and precontemplation stages. These assist in the development of targeted interventions towards smokers in each stage for more effective results. There is limited evidence about cessation and quitting behaviour in the Nigerian context. This study aimed to explore the factors related to the intention to quit among current tobacco smokers in Nigeria using the transtheoretical model. METHODS The study was a secondary data analysis of the Nigeria 2012 Global Adult Tobacco Survey (GATS). The survey included non-institutionalized men and women aged ≥15 years. Data were analysed using SPSS version 21. The primary outcome variable was smoking quit intention. The correlates of quit intentions were determined for a p<0.05. RESULTS A total of 429 current smokers were mostly in precontemplation (64.7%) while 14.9% were in the preparation stage. Exposure to anti-tobacco media messages was associated with increased quit attempts, however, knowledge about the harmful effects of tobacco was associated with fewer quit intentions. Very few had access to cessation therapy and none had accessed a quitline. Male respondents were 9 times more likely to have a quit intention compared to females (OR=9.615; 95% CI: 1.449-1.478). Respondents with primary education were nearly three times more likely to have quit intentions than those with tertiary education (OR=2.991; 95% CI: 2.930-3.053). CONCLUSIONS While attention is on smoking prevention, most smokers in Nigeria are not considering quitting. There is a need for targeted interventions to reach smokers at various stages.

Games for health, including digital videogames and gaming-based approaches, are increasingly being used in health promotion research and practice. Recently published research has shown that videogames have significant potential to promote healthy behaviors among youth and adolescents. Yet, there is a lack of available evidence-based resources to guide practitioners on the integration of games into tobacco prevention and smoking cessation interventions. To address this gap, expert researchers and game developers were interviewed to further define games for health, explore the current research, and provide recommendations for developing, evaluating, and promoting effective anti-tobacco games.
Nationally recognized experts on game development, games for health, tobacco, and health behavior were asked to participate. A qualitative analysis of 25 in-depth individual interviews using a constant comparative approach for emerging themes was conducted.
Main themes that emerged from the data analysis included the following: (1) the current state of games for health research to facilitate health behavior change, (2) strategies for how to develop and evaluate games for quality and impact, and (3) recommendations for how to effectively design tobacco prevention and smoking cessation educational videogames that engage youth and adolescents.
The synthesized findings identified through these expert interviews offer stakeholders strategies for how to incorporate games for health within their current and future work. Specific recommendations are presented for developers and researchers to consider when developing and evaluating videogames for tobacco prevention and smoking cessation targeted at youth and adolescents.

introduction: This study examined changes in smokers' readiness and confidence to quit smoking, smoking behavior, nicotine withdrawal symptoms, and tobacco product preference following electronic cigarette (EC) experimentation and 1 week of ad libitum use.

Combining the insights of leading legal scholars and public health experts, this timely book provides up-to-date analysis of the various legal problems emerging at different levels of governance (international, European and national) in the context of the regulation of e-cigarettes.

Expert contributors investigate the possible application of the precautionary and harm reduction principles in this area, examining the legal constraints imposed on states by international and European rules, as well as the regulatory approaches currently in place in selected national jurisdictions. This ground-breaking book offers an interdisciplinary approach to the topic, combining insights from medical, public health and legal perspectives.

The Regulation of E-cigarettes will be essential reading for both legal and public health scholars and students. Providing a comprehensive and in depth assessment of the regulatory solutions applied to e-cigarettes, it will also be a key resource for governmental officials, NGO’s and public health advocates.

The book is available on the EE webpage: https://www.e-elgar.com/shop/the-regulation-of-e-cigarettes. You may also access (free of charge) the introduction to the book at: https://www.elgaronline.com/view/edcoll/9781788970457/9781788970457.xml

PURPOSE/OBJECTIVES:
To explore the influence of lung cancer diagnosis on interpersonal dynamics in families in which one or more members continue to smoke following diagnosis.

RESEARCH APPROACH:
Descriptive, qualitative.

SETTING:
Three cancer care sites in western Canada.

PARTICIPANTS:
16 participants from 8 family dyads.

METHODOLOGIC APPROACH:
Patients with lung cancer receiving treatment and immediate family members were recruited to participate in individual or conjoint semistructured interviews. Thematic analysis was conducted on transcribed interviews.

MAIN RESEARCH VARIABLES:
Intrafamily interaction patterns, smoking and smoking cessation, lung cancer diagnosis.

FINDINGS:
Following diagnosis, patients with lung cancer experienced considerable distress as they struggled to understand family members' continued smoking. Patient orientations to family members who smoked included preserving relationships (maintaining harmony and connection with family members took priority over directly intervening with smokers) and risking relationships (patients repeatedly confronted family members about continued smoking to influence their cessation despite the impact on relationships). Neither pattern was successful in engaging relatives in smoking reduction or cessation, and the risking relationships approach resulted in conflict and strained family relationships.

CONCLUSIONS:
The findings provide additional support for examining family dynamics related to tobacco reduction and cessation as well as directions for future research.

INTERPRETATION:
Nurses should encourage tobacco reduction as a supportive intervention for patients with lung cancer and their families to eliminate smoking-related distress.

Menurut penelitian terkait, status merokok, keinginan berhenti merokok, dan faktor sosial demografi berpengaruh terhadap upaya berhenti merokok dan keberhasilan berhenti merokok. Data yang dipakai adalah GATS (Global Adult Tobacco Survey) tahun 2010 yang dilaksanakan oleh WHO bekerja sama dengan BPS dan Kementerian Kesehatan. Mengapa GATS? Karena survey ini mencakup pertanyaan dan variabel yang dibutuhkan dan disinyalir berpengaruh.
Proposal Skripsi ini merupakan proposal yang tidak jadi saya pakai. Saya sangat ingin menulisnya suatu saat. Bila ada yang ingin menulis hal serupa, dengan senang hati saya mau diajak berdiskusi mengenai topik ini.

This paper examines two major Soviet anti-smoking campaigns—
one in the 1920s and the other in the late 1970s. Each occurs
in a period of demographic crisis as part of larger public health efforts. Each ultimately fails. In 1920, the leader of the People’s Commissariat of Health, N. Semashko, began a campaign against tobacco with the support of V. I. Lenin. He proposed restrictions on access, use, and production of tobacco. Faced with the needs of the new state for economic stability, government officials abandoned the plan by 1921. In 1970, internal demographic
concerns and increasing international evidence led the Ministry
of Health to again attempt to stamp out tobacco. While policy was made, implementation was weak and the economic dislocations of the 1980s saw the vast importation of foreign brands to stabilize the government and the collapse of this second campaign against tobacco.

Background: This paper describes a pioneering effort to introduce smoking cessation into Indonesia's medical school curriculum, and the first ever attempt to fully integrate tobacco control in all four years of medical school anywhere in Southeast Asia. The development, pretesting, and piloting of an innovative modular tobacco curriculum are discussed as well as the challenges that face implementation. Methods: In-depth interviews were conducted with medical school administrators and faculty in four medical colleges to determine interest in and willingness to fully integrate tobacco cessation into the college curriculum. A tobacco focused curriculum review, student focus groups, and a survey of medical students (n = 579) assessed current exposure to information about tobacco and interest in learning cessation skills. A modular tobacco curriculum was developed and was pretested, modified, piloted, and evaluated. Qualitative research was conducted to identify potential challenges to future curriculum implementation. Results: Fifteen modules were successfully developed focusing on the relationship between tobacco and specific organ systems, diseases related to smoking, the impact of tobacco on medication effectiveness, and information on how to explain to patients about effects of tobacco on their health condition. Lecturers and students positively evaluated the curriculum as increasing their competency to support cessation during illness as a teachable moment. Systemic challenges to implementing the curriculum were identified including shifts in pedagogy, decentralized curriculum decision-making, and frequent lecturer turnover. Discussion: A fully integrated tobacco curriculum for medical schools was piloted and is now freely available online. An important lesson learned in Indonesia was that a tobacco curriculum must be flexible enough to be adjusted when shifts in medical education take place. The curriculum is a resource for medical colleges and expert committees in Southeast Asia deliberating how best to address lifestyle factors undermining population health.

Health professionals have adopted proactive testing for early evidence of disease. Researchers have identified that this leads to enumerated understandings and shapes behavior in productive ways. Smoking-cessation advisors regularly test clients for carbon monoxide (CO), but client views of this had not previously been explored. We interviewed 23 clients of a United Kingdom-based stop-smoking service regarding their experiences of CO testing. The majority of participants were successful quitters. We used ATLAS.ti 7 as a data-management tool during structured qualitative analysis. Our findings reveal that clients believed the results of their CO tests. Many became enumerated in their understanding, and thus placed themselves in a hierarchy with other members of their group. Almost all clients found that knowing their CO test score was motivating. We conclude that additional research is needed to understand the experiences of CO testing among clients who do not quit.