Genome-Wide Association for Smoking Cessation Success in a Trial of Precessation Nicotine Replacement Genome-wide association for smoking cessation success: participants in the Patch in Practice trial of nicotine replacement. Pharmacogenetic smoking cessation intervention in a health care setting: a pilot feasibility study. An intervention study of smoking cessation with feedback on genetic cancer susceptibility in Japan. Smoking quit success genotype score predicts quit success and distinct patterns of developmental involvement with common addictive substances A comparison of nursing interventions for smoking cessation in adults with cardiovascular health problems. Smoking and Parkinson disease Supporting health behaviour change in chronic obstructive pulmonary disease with telephone health-mentoring: insights from a qualitative study Sociodemographic predictors of success in smoking intervention Personality risk factors associated with trajectories of tobacco use. Nicotine abstinence genotyping: assessing the impact on smoking cessation clinical trials Interplay of genetic risk factors (CHRNA5-CHRNA3-CHRNB4) and cessation treatments in smoking cessation success. Patient characteristics and the effect of three physician-delivered smoking interventions. A Novel Recruitment Message to Increase Enrollment Into a Smoking Cessation Treatment Program: Preliminary Results From a Randomized Trial Study protocol of a Dutch smoking cessation e-health program Smoking cessation intervention in a large randomised population-based study. The Inter99 study. Maternal Smoking and Child Psychological Problems: Disentangling Causal and Noncausal Effects
Abilities to successfully quit smoking display substantial evidence for heritability in classic and molecular genetic studies . Genomewide association ( GWA ) studies have demonstrated single-nucleotide polymorphisms ( SNPs ) and haplotypes that distinguish successful quitters from individuals who were unable to quit smoking in clinical trial participants and in community sample s. Many of the subjects in these clinical trial sample s were aided by nicotine replacement therapy ( NRT ) . We now report novel GWA results from participants in a clinical trial that sought dose/response relationships for “ precessation ” NRT . In this trial , 369 European-American smokers were r and omized to 21 or 42 mg NRT , initiated 2 wks before target quit date s. Ten-week continuous smoking abstinence  was assessed on the basis of self-reports and carbon monoxide levels . SNP genotyping used Affymetrix 6.0 arrays . GWA results for smoking cessation success provided no P value that reached “ genome-wide ” significance . Compared with chance , these results do identify ( a ) more clustering of nominally positive results within small genomic regions , ( b ) more overlap between these genomic regions and those identified in six prior successful smoking cessation GWA studies and ( c ) sets of genes that fall into gene ontology categories that appear to be biologically relevant . The 1,000 SNPs with the strongest associations form a plausible Bayesian network ; no such network is formed by r and omly selected sets of SNPs . The data provide independent support , based on individual genotyping , for many loci previously nominated on the basis of data from genotyping in pooled DNA sample s. These results provide further support for the idea that aid for smoking cessation may be personalized on the basis of genetic predictors of outcome AIMS To confirm and extend to primary care setting s prior genome-wide association results that distinguish smokers who successfully quit from individuals who were not able to quit smoking in clinical trials . MATERIAL S & METHODS Affymetrix 6.0 Arrays were used to study DNA from successful quitters and matched individuals who did not quit from the Patch in Practice study of 925 smokers in 26 UK general practice s who were provided with 15 mg/16 h nicotine-replacement therapy and varying degrees of behavioral support .  RESULTS Only a few SNPs provided results near ' genome-wide ' levels of significance . Nominally significant ( p < 0.01 ) SNP results identify the same chromosomal regions identified by prior genome-wide association studies to a much greater extent than expected by chance . CONCLUSION Ability to change smoking behavior in a general practice setting appears to share substantial underlying genetics with the ability to change this behavior in clinical trials , though the modest sample sizes available for these studies provides some caution to these conclusions INTRODUCTION There is increasing evidence that response to pharmacological treatment for nicotine dependence may be moderated by genetic polymorphisms . However , the feasibility , acceptability , and impact of genetically tailoring treatment in real-world clinical setting s are unknown . METHODS We conducted a multiphased , mixed- methods feasibility study with current smokers to develop and evaluate a patient-centered , theoretically grounded personalized medicine treatment protocol . The initial research phase included formative work to develop intervention material s. The second phase included a r and omized pilot trial to evaluate the intervention . Trial participants ( n = 36 ) were genotyped for ANKK1 rs1800497 and were r and omized to receive genetic feedback ( GF ) plus st and ard behavioral counseling ( BC ) for smoking cessation or BC without GF . All participants received genetically tailored pharmacotherapy ( nicotine patch or bupropion ) . RESULTS The intervention was feasible to implement and was acceptable to participants based on satisfaction ratings and objective measures of participation . There was no evidence that the GF result ed in adverse psychological outcomes ( e.g. , depression , fatalism , reduced perceived control over quitting , differential motivation for quitting ) based on quantitative or qualitative outcomes . CONCLUSIONS Study results suggest that it is feasible to offer treatment within a health care setting that includes genetically tailored pharmacotherapy and doing so had no apparent adverse psychological impacts . Further evaluation of pharmacogenetically tailored smoking cessation interventions appears warranted BACKGROUND To evaluate whether feedback of genetic information regarding an L-myc polymorphism , identified as impacting on tobacco-related cancer risk , has an influence on smoking cessation , an intervention study was conducted . METHODS We recruited smokers from first-visit out patients at Aichi Cancer Center Hospital . Six hundred and seventeen participated and were allocated into two groups : the biomarker feedback group ( BF ) and the follow-up smoking status group ( FS ) . The subjects were asked for their smoking status at enrolment and at 3- and 9-month follow-ups . BF subjects were notified about their L-myc genotype . RESULTS The smoking cessation rate at 9-month follow-up was essentially the same for both BF and FS cases , at 18.8 % and 17.0 % , respectively ( P = 0.798 ) . However , a difference in the rate was evident with non-cancer subjects ( 12.7 % and 8.4 % , respectively , P = 0.237 ) , especially in females ( 15.0 % and 4.2 % , respectively , P = 0.024 ) . The non-cancer subjects informed of their genotype were more likely to quit smoking than the FS patients ; particularly in those having a risky genotype , this was significant ( odds ratio : 2.87 , P = 0.003 ) . Again it was most prominent in females . CONCLUSION Feedback regarding an L-myc polymorphism did not impact on smoking cessation overall but appeared to benefit smokers without cancer . In addition , gender could affect the response to the feedback Genotype scores that predict relevant clinical outcomes may detect other disease features and help direct prevention efforts . We report data that vali date a previously established v1.0 smoking cessation quit success genotype score and describe striking differences in the score in individuals who display differing developmental trajectories of use of common addictive substances . In a cessation study , v1.0 genotype scores predicted ability to quit with P=0.00056 and area under receiver-operating characteristic curve 0.66 . About 43 % vs 13 % quit in the upper vs lower genotype score terciles . Latent class growth analyses of a developmentally assessed sample identified three latent classes based on substance use . Higher v1.0 scores were associated with ( a ) higher probabilities of participant membership in a latent class that displayed low use of common addictive substances during adolescence ( P=0.0004 ) and ( b ) lower probabilities of membership in a class that reported escalating use ( P=0.001 ) . These results indicate that : ( a ) we have identified genetic predictors of smoking cessation success , ( b ) genetic influences on quit success overlap with those that influence the rate at which addictive substance use is taken up during adolescence and ( c ) individuals at genetic risk for both escalating use of addictive substances and poor abilities to quit may provide especially urgent focus for prevention efforts OBJECTIVE To examine the relative effectiveness of three different presentations of a smoking cessation program on the smoking behavior of adults with cardiovascular health problems . DESIGN A 2 x 2 x 2 x 4 experimental design with stratification by sex , smoking history , and a cardiovascular event , and r and omization to Individual , Group , Written , or No Intervention groups . SETTING Six community hospital classrooms . SUBJECTS 255 nonhospitalized adults . THEORETIC FRAMEWORK : Interaction Model of Client Health Behavior . MEASUREMENTS Study Intake : Professional referral form , demographic question naire , smoking habits question naire , health history , perceived threat survey , perceived health status . Follow up : smoking cessation and health question naire , saliva thiocyanate testing .  RESULTS At 12-month follow-up , a  nurse-client interaction  was more effective than written self-help material s ; however , smoking cessation rates were highest in the No Intervention control group , possibly related to having had coronary artery bypass graft surgery . Variables positively related to quitting were being male and married and having a higher income . With baseline factors considered , a quitter was most likely to be male and less than 48 years of age , have a high degree of perceived threat relative to medical diagnosis , and be in the individual intervention group . Only partial support for the study hypotheses was found Objective To investigate whether cigarette smoking interacts with genes involved in individual susceptibility to xenobiotics for the risk of Parkinson disease ( PD ) . Methods Two French population -based case-control studies ( 513 patients , 1,147 controls ) were included as a discovery sample to examine gene-smoking interactions based on 3,179 single nucleotide polymorphisms ( SNPs ) in 289 genes involved in individual susceptibility to xenobiotics . SNP – by – cigarette smoking interactions were tested in the discovery sample through an empirical Bayes ( EB ) approach . Nine SNPs were selected for replication in a population -based case-control study from California ( 410 patients , 845 controls ) with st and ard logistic regression and the EB approach . For SNPs that replicated , we performed pooled analyses including the discovery and replication data sets and computed pooled odds ratios and confidence intervals ( CIs ) using r and om-effects meta- analysis . Results Nine SNPs interacted with smoking in the discovery data set and were selected for replication . Interactions of smoking with rs4240705 in the RXRA gene and rs1900586 in the SLC17A6 gene were replicated . In pooled analyses ( logistic regression ) , the interactions between smoking and rs4240705-G and rs1900586-G were 1.66 ( 95 % CI 1.28–2.14 , p = 1.1 × 10−4 , p for heterogeneity = 0.366 ) and 1.61 ( 95 % CI 1.17–2.21 , p = 0.003 , p for heterogeneity = 0.616 ) , respectively . For both SNPs , while smoking was significantly less frequent in patients than controls in AA homozygotes , this inverse association disappeared in G allele carriers . Conclusions We identified and replicated suggestive gene-by-smoking interactions in PD . The inverse association of smoking with PD was less pronounced in carriers of minor alleles of both RXRA-rs4240705 and SLC17A6-rs1900586 . These findings may help identify biological pathways involved in the inverse association between smoking and PD Background Adoption and maintenance of healthy behaviours is pivotal to chronic disease self-management as this influences disease progression and impact . This qualitative study investigated health behaviour changes adopted by participants with moderate or severe chronic obstructive pulmonary disease ( COPD ) recruited to a r and omised controlled study of telephone-delivered health-mentoring . Methods Community nurses trained as health-mentors used a patient-centred approach with COPD patients recruited in general practice to facilitate behaviour change , using a framework of health behaviours ; ‘ SNAPPS ’ Smoking , Nutrition , Alcohol , Physical activity , Psychosocial well-being , and Symptom management , through regular phone calls over 12 months . Semi-structured interviews in a purposive sample sought feedback on mentoring and behaviour changes adopted . Interviews were analysed using iterative thematic and interpretative content approaches by two investigators . Results Of 90 participants allocated to health-mentoring , 65 ( 72 % ) were invited for interview at 12-month follow up . The 44 interviewees , 75 % with moderate COPD , had a median of 13 mentor contacts over 12 months , range 5–20 . Interviewed participants ( n = 44 , 55 % male , 43 % current smokers , 75 % moderate COPD ) were representative of the total group with a mean age 65 years while 82 % had at least one additional co-morbid chronic condition . Telephone delivery was highly acceptable and enabled good rapport . Participants rated ‘ being listened to by a caring health professional ’ as very valuable . Three participant groups were identified by attitude to health behaviour change : 14 ( 32 % ) actively making changes ; 18 ( 41 % ) open to and making some changes and 12 ( 27 % ) more resistant to change . COPD severity or current smoking status was not related to group category . Mentoring increased awareness of COPD effects , helping develop and personalise behaviour change strategies , even by those not actively making changes . Physical activity was targeted by 43 ( 98 % ) participants and smoking by 14 ( 74 % ) current smokers with 21 % reporting quitting . Motivation to maintain changes was increased by mentor support . Conclusions Telephone delivery of health-mentoring is feasible and acceptable to people with COPD in primary care . Health behaviours targeted by this population , mostly with moderate disease , were mainly physical activity and smoking reduction or cessation . Health-mentoring increased motivation and assisted people to develop strategies for making and sustaining beneficial change . Trial registration AIM To examine the role of sociodemographic factors as predictors of sustained smoking cessation for the population who volunteer to participate in intervention programmes . METHOD Data for the 3575 smokers who participated in the CEASE ( collaborative European anti-smoking evaluation ) trial , a European multicentred study that used transdermal nicotine patches as an adjunct to smoking cessation in the chest clinic , were analysed . The effects of age , sex , smoking habit , socioeconomic status ( housing conditions , education , and employment ) , disease , smoking habits of relatives , and baseline markers of tobacco use on sustained smoking cessation ( self-reported abstinence and expired carbon monoxide < 10 parts per million ) were assessed using logistic regression modelling ( odds ratio ( OR ) , 95 % confidence interval ( CI ) ) . RESULTS 477/3575 smokers were sustained abstainers one year after the intervention ( overall success rate 13.3 % ) . In the univariable logistic regression models an effect of active treatment on smoking cessation was observed ( OR 1.50 , 95 % CI 1.15 to 1.96 ) , and additional effects on outcome were found for age ( OR 1.02 , 95 % CI 1.01 to 1.03 ) , sex ( menv women : OR 1.38 , 95 % CI 1.14 to 1.68 ) , housing conditions ( OR 1.43 , 95 % CI 1.25 to 1.65 ) , current respiratory ( OR 0.79 , 95 % CI 0.67 to 0.92 ) or cardiac disease ( OR 0.46 , 95 % CI 0.28 to 0.75 ) , and markers of tobacco use ( cigarettes per day : OR 0.79 , 95 % CI 0.69 to 0.90 ; expired carbon monoxide : OR 0.98 , 95 % CI 0.97 to 0.99 ) . Education and employment did not have a significant effect on the outcome . The effect of the variables associated with success in smoking cessation persisted after adjustment for covariates . CONCLUSION Age , sex , and housing conditions have a major effect on smoking cessation in European smokers participating in smoking cessation programmes The purpose of this longitudinal , prospect i ve study was to evaluate trajectories of smoking in a cohort of African-American and Puerto Rican young adults and describe personality and behavioral factors associated with specific smoking trajectory group membership . Participants consisted of African-American and Puerto Rican male and female young adults ( N = 451 , mean age 26 ) from an inner-city community . Data were collected at four time points over a period of 13 years using structured interviews . Interviews took place within the schools and the participants ' homes . Scales with adequate psychometric properties were adapted from previously vali date d measures . Variables that were examined for this study came from the domains of internalizing behaviors , externalizing behaviors , drug use , and demographic information . Data were analyzed using latent growth mixture modeling to explore discrete smoking trajectories . Logistic regression analyses were then used to examine the risk factors associated with the various smoking trajectory groups . Four trajectory groups were determined to best fit the data : nonsmokers , maturing-out smokers , late-starting smokers , and early-starting continuous smokers . Subjects who were unconventional , experienced intrapersonal distress , and used alcohol and illegal drugs were more likely to belong to one of the smoking trajectory groups than to the nonsmoking group . The early-starting continuous group scored highest on these personal risk attributes . The long-term impact of unconventional behavior , intrapersonal distress , and drug use on developmental trajectories of smoking support the importance of early intervention and prevention Twin studies document substantial heritability for  successful abstinence from smoking .  A genome-wide association study has identified markers whose allele frequencies differ with nominal P<0.005 in nicotine-dependent clinical trial participants who were successful vs unsuccessful in abstaining from smoking ; many of these results are also supported by data from two additional sample s. More study is required to precisely determine the variance in quitting success that can be accounted for by the single-nucleotide polymorphisms that are currently identified and to precisely classify individuals who may display varying degrees of genetic vs environmental effects into quitters or nonquitters . However , the data at h and do allow us to model the effects of genotypic stratification in smoking cessation trials . We identify relationships between the costs of identifying and genotyping prospect i ve trial participants vs the costs of performing the clinical trials . We quantitate the increasing savings that result from genetically stratified design s as recruiting/genotyping costs go down and trial costs increase . This model helps to define the circumstances in which genetically stratified design s may enhance power and reduce costs for smoking cessation clinical trials OBJECTIVE Smoking is highly intractable , and the genetic influences on cessation are unclear . Identifying the genetic factors affecting smoking cessation could eluci date the nature of tobacco dependence , enhance risk assessment , and support development of treatment algorithms . This study tested whether variants in the nicotinic receptor gene cluster CHRNA5-CHRNA3-CHRNB4 predict age at smoking cessation and relapse after an attempt to quit smoking . METHOD In a community-based , crosssectional study ( N=5,216 ) and a r and omized comparative effectiveness smoking cessation trial ( N=1,073 ) , the authors used Cox proportional hazard models and logistic regression to model the relationships of smoking cessation ( self-reported quit age in the community study and point-prevalence abstinence at the end of treatment in the clinical trial ) to three common haplotypes in the CHRNA5-CHRNA3-CHRNB4 region defined by rs16969968 and rs680244 . RESULTS The genetic variants in the CHRNA5-CHRNA3-CHRNB4 region that predict nicotine dependence also predicted a later age at smoking cessation in the community sample . In the smoking cessation trial , haplotype predicted abstinence at end of treatment in individuals receiving placebo but not among individuals receiving active medication . Haplotype interacted with treatment in affecting cessation success . CONCLUSIONS Smokers with the high-risk haplotype were three times as likely to respond to pharmacologic cessation treatments as were smokers with the low-risk haplotype . The high-risk haplotype increased the risk of cessation failure , and this increased risk was ameliorated by cessation pharmacotherapy . By identifying a high-risk genetic group with heightened response to smoking cessation pharmacotherapy , this work may support the development of personalized cessation treatments BACKGROUND This paper investigates individual patient characteristics predicting differential response to each of three physician-delivered smoking interventions after 6 months . METHODS Participants were 1,286 currently smoking patients seen by 196 medical and family practice residents in five primary care clinics affiliated with the University of Massachusetts Medical School . Of the participants , 57 % were female , 92 % were white , their average age was 35 years , and they smoked an average of 23 cigarettes per day . Physicians were trained to provide the following interventions : advice only ( AO ) , a brief ( < 10 min ) patient-centered counseling intervention ( CI ) , and counseling plus prescription of the nicotine-containing gum Nicorette ( CI+NCG ) . The CI+NCG condition included NCG only when appropriate and if acceptable to the patient . Patients were r and omized to one of these three physician-delivered intervention conditions . RESULTS Overall , stratified univariate analyses revealed that AO produced consistently lower cessation rates across most subgroups ( generally 9 - 13 % ) but was somewhat more effective for certain groups of lighter smokers . Relative to AO , CI was somewhat more effective ( about 20 - 24 % ) for less addicted smokers , for those with more previous quit attempts , and for those with fewer close associates who smoke , but generally failed to produce higher quit rates for harder core smokers or for women . CI+NCG had an overall pattern of greater effectiveness for both more addicted and less addicted smokers , with the highest absolute levels of cessation ( about 27 - 30 % ) among less dependent smokers . Women in this group had cessation rates ( 20.6 % ) comparable to those of men ( 23.6 % ) . Condition-stratified logistic regression analyses , controlling for a wide range of covariates , revealed associations similar to those observed in the univariate analyses : An overall logistic model in which intervention conditions were fitted as dummy variables produced the following significant main effects : sex , years smoked , contact with other smokers , symptoms , and  CI+NCG condition . Significant interactions were observed for both CI and CI+NCG and smoking when feeling too ill to continue normal activities and CI+NCG and amount smoked . CONCLUSIONS We observed significant main effects on cessation of variables related to addiction , sex , social factors , and physician counseling interventions . Specific interactions were observed between reported smoking when feeling ill and each of the counseling interventions as well as by amount smoked in the CI+NCG condition Most smokers do not utilize approved interventions for nicotine dependence , reducing the probability of cessation . Smoking cessation programs typically use recruitment messages emphasizing the health threats of smoking . Augmenting this threat message by describing the genetic aspects of nicotine addiction may enhance enrollment into a cessation program . During telephone recruitment , 125 treatment-seeking smokers were r and omized to receive by phone either a st and ard threat message or a threat plus genetic prime message and were offered open-label varenicline and counseling . There was a greater rate of enrollment into the cessation program  for the threat plus genetic prime participants ( 51.7 % ) versus the threat-only participants ( 37.7 % ; p = .03 ) . Smokers who self-identified from racial/ethnic minority groups were less likely to enroll in the cessation program ( p = .01 ) versus smokers who self-identified as Caucasian . These preliminary data suggest that a simple , affordable , and transportable communication approach enhances enrollment of smokers into a smoking cessation program . A larger clinical trial to evaluate a genetic prime message for improving recruitment into smoking cessation programs is warranted Background The study aims to test the differential effects of a web-based text and a web-based video-driven computer-tailored approach for lower socio-economic status ( LSES ) and higher socio-economic status ( HSES ) smokers which incorporate multiple computer-tailored feedback moments . The two programs differ only in the mode of delivery ( video- versus text-based messages ) . The paper aims to describe the development and design of the two computer-tailored programs . Methods / design Respondents who smoked at the time of the study inclusion , who were motivated to quit within the following six months and who were aged 18 or older were included in the program . The study is a r and omized control trial with a 2 ( video/text ) * 2(LSES/HSES ) design . Respondents were assigned either to one of the intervention groups ( text versus video tailored feedback ) or to the control group ( non-tailored generic advice ) . In all three conditions participants were asked to fill in the baseline question naire based on the I-Change model . The question naire assessed socio-demographics , attitude towards smoking , knowledge , self-efficacy , social influence , depression , level of addiction , action planning , goal actions , intention to quit smoking , seven-day point prevalence and continued abstinence . Follow-up measurements were conducted at six and twelve months after baseline . Discussion The present paper describes the development of the two computer-tailored smoking cessation programs , their components and the design of the study . The study results reveal different working mechanisms of multiple tailored smoking cessation interventions and will help us to gain more insight into effective strategies to target different subgroups , especially smokers with a lower socio-economic status . Trial registration Dutch Trial Register BACKGROUND Several large and well-conducted community interventions have failed to detect an effect on prevalence of smoking . METHODS Two thous and four hundred eight daily smokers in all motivational stages were actively recruited and included in a r and omised population -based intervention study in Copenhagen , Denmark . All smokers completed a question naire and underwent a health examination and a lifestyle consultation . Daily smokers in the high intensity intervention group were offered assistance to quit in smoking cessation groups . RESULTS The vali date d abstinence rate at 1-year follow-up was 16.3 % in the high intensity group and 12.7 % in the low intensity group compared with a self-reported abstinence rate of 7.3 % in the background population . The adjusted odds ratio of abstinence in the high intervention group was significantly higher , OR = 2.2 ( 1.6 - 3.0 ) than in the background population , also in the ' intention-to-treat ' analyses , OR = 1.5 ( 1.1 - 2.0 ) . Higher socioeconomic status , higher age at onset of daily smoking , and a higher wish to quit were predictors of success . CONCLUSION In a population -based setting , using active recruitment and offering assistance to quit , it was possible to include many smokers and to achieve a significantly higher vali date d abstinence in the high intensity intervention than in the background population , even when using ' intention-to-treat ' analyses OBJECTIVE : To explore associations of  maternal prenatal smoking and child psychological problems and determine the role of causal intrauterine mechanisms . PATIENTS AND METHODS :  Maternal smoking and child psychological problems were explored in 2 birth cohorts in Pelotas , Brazil ( n = 509 , r and om sub sample ) , and the Avon Longitudinal Study of Parents and Children ( ALSPAC ) in Britain ( n = 6735 ) . Four approaches for exploring causal mechanisms were applied : ( 1 ) cross- population comparisons between a high-income and a middle-income country ; ( 2 ) multiple adjustment for socioeconomic and parental psychological factors ; ( 3 ) maternal-paternal comparisons as a test of putative intrauterine effects ; and ( 4 ) search ing for specific effects on different behavioral subscales . RESULTS : Socioeconomic patterning of maternal prenatal smoking was stronger in the ALSPAC compared with the Pelotas cohort . Despite this difference in a key confounder , consistency in observed associations was found between these cohorts . In both cohorts , unadjusted maternal smoking was associated with greater offspring hyperactivity , conduct/externalizing problems , and peer problems but not with emotional/internalizing problems . After adjusting for confounders and paternal prenatal smoking , only the association with conduct/externalizing problems persisted in both cohorts ( conduct problems in the ALSPAC cohort , odds ratio [ OR ] : 1.24 [ 95 % confidence interval ( CI ) : 1.07–1.46 ] , P = .005 ; externalizing problems in the Pelotas cohort , OR : 1.82 [ 95 % CI : 1.19–2.78 ] , P = .005 ; ORs reflect ordinal odds ratios of maternal smokers having offspring with higher scores ) . Maternal smoking associations were stronger than paternal smoking associations , although statistical evidence that these associations differed was weak in 1 cohort . CONCLUSION : Evidence from 4 approaches suggests a possible intrauterine effect of maternal smoking on offspring conduct/externalizing problems
Results : We confirmed the importance of the 4 main factors influencing SC : ( 1 ) environmental factors , ( 2 ) genomic factors , ( 3 ) gene-environment interactions , and ( 4 ) evidence -based interventions .
The model demonstrates the complex network of factors influencing SC .
Background : Smoking behaviour is a major public health problem worldwide .
Several sources have confirmed the implication of genomic factors in smoking behaviour .
These factors interact both with environmental factors and interventions to develop a certain behaviour .
Objectives : Describing the environmental and genomic factors as well as the interventions influencing smoking cessation  ( SC ) and developing a working model incorporating the different factors influencing SC were our main objectives .