{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:26Z","timestamp":1792787306250,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","funder":[{"name":"Health Care and Promotion Scheme of the Health Medical Research Fund, Food and Health Bureau","id":[{"id":"https:\/\/ror.org\/03qh32912","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Hong Kong SAR Government","award":["01170418"],"award-info":[{"award-number":["01170418"]}]},{"name":"Hong Kong SAR Government","award":["15163001"],"award-info":[{"award-number":["15163001"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2026,8,16]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To examine whether smoking cessation outcomes among Chinese-speaking adults who smoked and used community-based smoking cessation services in Hong Kong differed before and after early-stage COVID-19 policy changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analysis of two randomised controlled trials, comprising one individually randomised trial and one cluster randomised trial, conducted in Hong Kong between 2018 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Participants who used a community-based smoking cessation service were recruited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1762 Chinese-speaking adults who smoke or recently quit smoking (80.5% male).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>The primary outcome was the 6-month biochemically validated abstinence rate before and after the first major policy change on 25 January 2020, when the COVID-19 emergency response level was raised. Secondary outcomes were self-reported 7-day point prevalence abstinence at 3-month and 6-month follow-ups. Sensitivity analyses were conducted for subsequent policy changes on 8 February and 28 March 2020. Modified Poisson regression models with cluster-robust SEs, adjusted for group allocation, trial, age, gender, baseline smoking intensity and intervention type, were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>After the 25 January 2020 policy cut-off, the 6-month biochemically validated abstinence rate significantly decreased from 12.3% before the cut-off to 6.8% (risk ratio (RR) (95% CI) 0.55 (0.40 to 0.76), p&lt;0.001) after the cut-off. Self-reported 7-day abstinence rates were also lower after the policy change at the 3-month (49.1% vs 31.3%, 0.60 (0.51 to 0.71), p&lt;0.001) and 6-month (41.0% vs 32.2%, 0.78 (0.69 to 0.88), p&lt;0.001) follow-ups. Sensitivity analyses using the 8 February and 28 March cut-off points showed generally consistent reductions in abstinence outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early-stage COVID-19 policy changes in Hong Kong were associated with significantly lower tobacco abstinence rates among adults using or being referred to community-based smoking cessation services. Rapidly adaptable cessation support, including telehealth counselling and continuity of pharmacotherapy, is needed to sustain quit attempts during public health emergencies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tc-2025-059954","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:20:54Z","timestamp":1789752054000},"page":"tc-2025-059954","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association of early-stage COVID-19 policy changes with smoking cessation outcomes: secondary analysis of two randomised trials in Hong Kong"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6187-1748","authenticated-orcid":false,"given":"Aaron Wan Jia","family":"He","sequence":"first","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medcine, The University of Hong Kong, Hong Kong SAR, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1001-5079","authenticated-orcid":false,"given":"Nga Ting","family":"Wong","sequence":"additional","affiliation":[{"name":"Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4000-2388","authenticated-orcid":false,"given":"Man Ping","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medcine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6349-3717","authenticated-orcid":false,"given":"Sophia Siu Chee","family":"Chan","sequence":"additional","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medcine, The University of Hong Kong, Hong Kong SAR, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5850-5349","authenticated-orcid":false,"given":"Yee Tak Derek","family":"Cheung","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medcine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"2026091810203243000_tc-2025-059954v1.1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.25149","article-title":"Changes in Smoking Cessation-Related Behaviors Among US Adults During the COVID-19 Pandemic","volume":"5","author":"Bandi","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026091810203243000_tc-2025-059954v1.2","unstructured":"World Health Organization . 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