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PubMed2007

Non-nicotinic therapies for smoking cessation.

Cigarette smoking is the primary cause of numerous preventable diseases; as such, the goals of smoking cessation are both to reduce health risks and to improve the quality of life. Currently, the first-line smoking cessation therapies include nicotine replacement products and bupropion. The nicotinic receptor partial agonist varenicline has recently been approved by the FDA for smoking cessation. A newer product currently under development and seeking approval by the FDA are nicotine vaccines. Clonidine and nortriptyline have demonstrated some efficacy but side effects may limit their use to second-line therapeutic products. Other therapeutic drugs that are under development include rimonabant, mecamylamine, monoamine oxidase inhibitors, and dopamine receptor D3 antagonists. Inhibitors of nicotine metabolism are also promising candidates for smoking reduction and cessation. In conclusion, promising new therapeutic products are emerging and they will provide smokers additional options to assist in achieving smoking cessation.

Benzazepines↗

PubMed1999

The health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers.

BACKGROUND: Health related quality-of-life is recognized as an important health outcome measure; how ever, it may also have a significant application in smoking reduction and cessation programs. METHODS: Representative population data (n = 3010) was used to compare the quality-of-life status of differ ent smoking categories with never smokers. RESULTS: Statistically significant differences in mean quality-of-life scores, as measured by the SF-36 health status questionnaire, were observed between never smokers, as the reference group, ex-smokers, all smokers, and light, moderate, and heavy smokers. Heavy smokers also scored significantly lower than both other groups of smokers, scoring as low as the 29th percentile of the population on the general health dimension and lower than the 36th percentile of the population on all the mental health dimensions. CONCLUSIONS: The design of public health smoking cessation programs should consider the varying characteristics of different segments of the smoking population. The advantages of improved quality-of-life may strengthen the argument for encouraging heavier smokers to become light smokers as a precursor to total cessation.

Adolescent↗

PubMedDate not supplied

Clinical interventions and smoking ban methods to reduce infants' and children's exposure to environmental tobacco smoke.

Environmental tobacco smoke (ETS) exposure is a serious health threat to infants and children. Clinical efforts, primarily educational, have been associated with modest improvements in ETS reduction. Smoking bans may provide a much larger impact but have yet to be systematically evaluated. Home smoking bans are also surrounded by social, economic, legal, and political challenges. Nurses, as health care providers, play a critical role in this comprehensive health promotion effort.

Child↗

PubMed2005

Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction.

OBJECTIVES: To determine the safety and efficacy of the nicotine patch and gum for adolescents who want to quit smoking. DESIGN: Double-blind, double-dummy, randomized, 3-arm trial with a nicotine patch (21 mg), nicotine gum (2 and 4 mg), or a placebo patch and gum; all participants received cognitive-behavioral group therapy. SETTING: Inner-city, outpatient clinic on the East Coast. Subjects. Thirteen- to 17-year-old adolescents who smoked > or =10 cigarettes per day (CPD), scored > or =5 on the Fagerstrom Test of Nicotine Dependence, and were motivated to quit smoking. Intervention. Twelve weeks of nicotine patch or gum therapy with cognitive-behavioral therapy, with a follow-up visit at 6 months (3 months after the end of treatment). MAIN OUTCOME MEASURES: Safety assessed on the basis of adverse event reports for all 3 groups, prolonged abstinence, assessed through self-report and verified with exhaled carbon monoxide (CO) levels of < or =6 ppm, in intent-to-treat analyses, and smoking reduction (CPD and thiocyanate concentrations) among trial completers. RESULTS: A total of 120 participants were randomized (72% white, 70% female; age: 15.2 +/- 1.33 years; smoking: 18.8 +/- 8.56 CPD; Fagerstrom Test of Nicotine Dependence score: 7.04 +/- 1.29) from 1999 to 2003. Participants started smoking at 11.2 +/- 1.98 years of age and had been smoking daily for 2.66 +/- 1.56 years; 75% had at least 1 current psychiatric diagnosis. Mean compliance across groups was higher for the patch (mean: 78.4-82.8%) than for the gum (mean: 38.5-50.7%). Both the patch and gum were well tolerated, and adverse events were similar to those reported in adult trials. Changes in mean saliva cotinine concentrations throughout treatment were not statistically significant. Intent-to-treat analyses of all randomized participants showed CO-confirmed prolonged abstinence rates of 18% for the active-patch group, 6.5% for the active-gum group, and 2.5% for the placebo group; the difference between the active-patch and placebo arms was statistically significant. There was no significant effect of patch versus gum or gum versus placebo on cessation outcomes. Abstinence rates at the 3-month follow-up assessment were sustained but were not significantly associated with treatment group. Mean smoking rates, but not CO or thiocyanate concentrations, decreased significantly in all 3 arms but not as a function of treatment group. CONCLUSIONS: Nicotine patch therapy combined with cognitive-behavioral intervention was effective, compared with placebo, for treatment of tobacco dependence among adolescent smokers. Decreases in the numbers of cigarettes smoked appeared to be offset by compensatory smoking. Additional study of nicotine gum, with enhanced instructional support, is needed to assess its efficacy among adolescent smokers.

Administration, Cutaneous↗

PubMed2003

Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review.

CONTEXT: As more interventions become available for the treatment of coronary heart disease (CHD), policy makers and health practitioners need to understand the benefits of each intervention, to better determine where to focus resources. This is particularly true when a patient with CHD quits smoking. OBJECTIVE: To conduct a systematic review to determine the magnitude of risk reduction achieved by smoking cessation in patients with CHD. DATA SOURCES: Nine electronic databases were searched from start of database to April 2003, supplemented by cross-checking references, contact with experts, and with large international cohort studies (identified by the Prospective Studies Collaboration). STUDY SELECTION: Prospective cohort studies of patients who were diagnosed with CHD were included if they reported all-cause mortality and had at least 2 years of follow-up. Smoking status had to be measured after CHD diagnosis to ascertain quitting. DATA EXTRACTION: Two reviewers independently assessed studies to determine eligibility, quality assessment of studies, and results, and independently carried out data extraction using a prepiloted, standardized form. DATA SYNTHESIS: From the literature search, 665 publications were screened and 20 studies were included. Results showed a 36% reduction in crude relative risk (RR) of mortality for patients with CHD who quit compared with those who continued smoking (RR, 0.64; 95% confidence interval [CI], 0.58-0.71). Results from individual studies did not vary greatly despite many differences in patient characteristics, such as age, sex, type of CHD, and the years in which studies took place. Adjusted risk estimates did not differ substantially from crude estimates. Many studies did not adequately address quality issues, such as control of confounding, and misclassification of smoking status. However, restriction to 6 higher-quality studies had little effect on the estimate (RR, 0.71; 95% CI, 0.65-0.77). Few studies included large numbers of elderly persons, women, ethnic minorities, or patients from developing countries. CONCLUSIONS: Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD. This risk reduction appears to be consistent regardless of age, sex, index cardiac event, country, and year of study commencement.

Cohort Studies↗

PubMedDate not supplied

Estimating the causal effects of smoking.

An important application of statistics in recent years has been to address the causal effects of smoking. There is little doubt that there are health risks associated with smoking. However, more general issues concern the causal effects due to the alleged misconduct of the tobacco industry or due to programmes designed to curtail tobacco use. To address any such causal question, assumptions must be made. Although some of the issues are well known in the statistical and epidemiological literature, there does not appear to be a unified treatment that provides prescriptive guidance on the estimation of these causal effects with explication of the needed assumptions. A 'conduct attributable fraction' is derived, which allows for arbitrary changes in smoking and non-smoking health care expenditure related factors in a counterfactual world without the alleged misconduct, and therefore generalizes the traditional 'smoking attributable fraction'. The formulation presented here, although described for the problem of estimating excess health care expenditures due to the alleged misconduct of the tobacco industry, is more general. It can be applied to any outcome, such as mortality, morbidity, or income from excise taxes, as well as to any situation in which consequences due to alleged misconduct (for example, of two entities, such as the tobacco and the asbestos industries) or due to hypothetical programmes (for example, extra smoking reduction initiatives) are to be estimated.

Delivery of Health Care↗

PubMed2004

Adolescent smoking cessation.

PURPOSE OF REVIEW: Approximately 25% of high school students report current cigarette use, 85% of adolescents think about quitting, and around 80% of current smokers made a quit attempt in the past year. This review analyzes recent additions to the adolescent smoking cessation literature from June 1, 2003 to May 1, 2003. RECENT FINDINGS: Adolescent attitudes toward smoking cessation are largely affected by their smoking history. Youth cessation interventions largely focus on behavioral interventions, and research concerning these interventions has yielded mixed results. Little data exist about the effectiveness of nicotine replacement therapy in adolescents, but there is growing evidence that youth use this pharmacotherapy. Recent research has explored the use of nicotine replacement therapy as an adjunct for enhanced smoking reduction in adults, and future research may focus on this tactic for youth as well. Internet cessation adjuncts and telephone quit lines also serve as future frontiers for adolescent smoking cessation research. SUMMARY: Information concerning adolescent smoking behaviors, effective interventions, and smoking cessation therapy continue to grow and provide data that improve our understanding of adolescent smoking cessation. Although we cannot directly extrapolate the adult findings to this population, adult cessation research continues to inform future adolescent cessation efforts.

Adolescent↗

PubMed2005

Expressive writing intervention for young adult cigarette smokers.

This investigation examined the feasibility and magnitude of the effect of a stress management intervention involving expressive writing as an adjunct to brief office smoking cessation intervention for young adults. Participants aged 18-21 years were randomized to brief office intervention (N=30) or expressive writing plus brief office intervention (N=30). Biochemically confirmed 30-day point-prevalence tobacco abstinence, smoking reduction, perceived stress, negative affect, and treatment compliance were assessed at 4, 12, and 24 weeks post randomization. The expressive writing adjunct was not found to be effective. The 30-day smoking abstinence rates were 0% versus 0% ( p=1.000) at week 4, 20% versus 3% ( p=0.103) at week 12, and 20% versus 10% ( p=0.472) at week 24 for the brief office intervention only versus expressive writing plus brief office intervention groups, respectively. Participants stated they benefited most from the support and structure associated with the brief office intervention. Enthusiasm was lacking for the expressive writing treatment adjunct.

Adolescent↗

PubMedDate not supplied

Media and community campaign effects on adult tobacco use in Texas.

The present study reports on the effects on adult tobacco cessation of a comprehensive tobacco-use prevention and cessation program in the state of Texas. Differences in cessation rates across treatment conditions were measured by following a panel of 622 daily smokers, recruited from the original cross-sectional sample, from baseline to follow-up. The adult media campaign combined television, radio, newspaper and billboard advertisements featuring messages and outreach programs to help adults avoid or quit using tobacco products. The ads also promoted quitting assistance programs from the American Cancer Society Smokers' Quitline, a telephone counseling service. The cessation component of the intervention focused on increasing availability of and access to cessation counseling services and pharmacological therapy to reduce nicotine dependence. Both clinical and community-based cessation programs were offered. Treatment areas which combined cessation activities with high level media campaigns had a rate of smoking reduction that almost tripled rates in areas which received no services, and almost doubled rates in areas with media campaigns alone. Analyses of the dose of exposure to media messages about smoking cessation show greater exposure to television and radio messages in the areas where high level media was combined with community cessation activities than in the other areas. Results also show that exposure to media messages was related to processes of change in smoking cessation and that those processes were related to the quitting that was observed in the group receiving the most intensive campaigns.

Adolescent↗

PubMed2005

Anxiety sensitivity: Concurrent associations with negative affect smoking motives and abstinence self-confidence among young adult smokers.

The present study evaluated the association between the lower-order facets of Anxiety Sensitivity construct (Physical, Mental Incapacitation and Social Concerns) and theoretically relevant cognitive-based smoking processes. Participants were 151 young adult daily smokers (63 females); mean number of cigarettes/day = 12.3 [S.D. = 5.6]). Both AS Physical and Mental Incapacitation Concerns were significantly associated with greater negative affect reduction smoking motives and lower levels of self-confidence in remaining abstinent from smoking when emotionally distressed. The observed effects were over and above the variance accounted for by nicotine dependence, smoking rate, and gender. Results are discussed in relation to better understanding cognitive-based smoking processes among individuals at heightened risk for panic psychopathology.

Adolescent↗

PubMed2004

Can support and education for smoking cessation and reduction be provided effectively by midwives within primary maternity care?

OBJECTIVE: To test the hypothesis that appropriate interventions delivered by midwives within usual primary maternity care, can assist women to stop or reduce the amount they smoke and facilitate longer duration of breast feeding. DESIGN, SETTING AND PARTICIPANTS: In a cluster randomised trial of smoking education and breast-feeding interventions in the lower North Island, New Zealand, midwives were stratified by locality and randomly allocated into a control group and three intervention groups. The control group provided usual care. Midwives in the intervention groups delivered either a programme of education and support for smoking cessation or reduction, a programme of education and support for breast feeding or both programmes. Sixty-one midwives recruited a total of 297 women. INTERVENTIONS: Structured programmes provided by midwives. FINDINGS: Women receiving only the smoking cessation or reduction programme were significantly more likely to have reduced, stopped smoking or maintained smoking changes than women in the control group, at 28 weeks and 36 weeks gestation. Women receiving both the smoking cessation and breast-feeding education and support programmes were significantly more likely than women in the control group to have changed their smoking behaviour at 36 weeks gestation. There was no difference in rates of cessation or reduction between the groups in the postnatal period. There was no difference in rates of full breast feeding between the control and intervention groups for women who planned to breast feed. KEY CONCLUSIONS: Education and support by midwives, as part of primary midwifery, can facilitate smoking cessation and reduction during pregnancy.

Breast Feeding↗

PubMed2001

Measurement of self reported active exposure to cigarette smoke.

STUDY OBJECTIVE: The number of cigarettes smoked per day is an imprecise indicator of exposure to cigarette smoke, and biochemical assessment of exposure is not always feasible. The aim of this study was to develop more accurate measures of self reported active exposure to cigarette smoke. DESIGN: Mail survey in 386 smokers, retest at one month in 94 participants (24%), analysis of saliva cotinine in 98 participants (25%), collection of empty cigarette packs in 214 participants (55%), collection of cigarette butts in 107 participants (28%). Ten questions and items intended to assess active exposure to cigarette smoke were tested and compared with saliva cotinine, the Fagerström test for nicotine dependence, and self rated dependence. SETTING: A population sample in Geneva, Switzerland, in 1999. PARTICIPANTS: 323 daily smokers and 63 occasional smokers. MAIN RESULTS: Measures that were associated with saliva cotinine included the number of cigarettes smoked per day (r(2)=0.36), smoking intensity (r(2)=0.40), the type of cigarettes smoked (regular versus light) (r(2)=0.04), smoking when ill (r(2)=0.15) and a single item rating of the total quantity of smoke inhaled (r(2)=0.27). A multivariate model combining the first four items explained the largest proportion of the variance in cotinine (r(2)=0.63), substantially more than was explained by the number of cigarettes per day alone, by 75% in all smokers and by 110% in daily smokers. CONCLUSIONS: The study identified measures of exposure to smoke that reflect saliva cotinine better than the number of cigarettes per day. These measures can be used in studies of the dose related risk of smoking and in smoking reduction studies.

Adolescent↗

PubMed2005

Expired air carbon monoxide concentration in mothers and their spouses above 5 ppm is associated with decreased fetal growth.

BACKGROUND: Smoking during pregnancy is associated with reduced birthweight; this relation can be reversed by smoking cessation. Some but not all previous studies have shown that smoking reduction (measured as cigarettes/day or urinary cotinine) may also improve birthweight. The relationship between maternal and spouses' expired air carbon monoxide (CO) concentrations (EACO) on fetal growth has not yet been evaluated. METHODS: Eight hundred fifty-six smoking and nonsmoking pregnant women were followed during their pregnancy. Their EACO was determined in the first trimester and during delivery. The spouses' EACO were also measured at delivery. The main outcome measure was the infants' birthweight. Secondary measures included head circumference, Apgar score, and heart rate at delivery. Cord blood fetal carboxyhemoglobin (FCOHb) served as internal control. RESULTS: Birthweight dose-dependently and significantly decreased with increasing level of maternal (0-5: 3406 +/- 32; 6-10: 3048 +/- 57; 11-20: 2858 +/- 54; >20 ppm: 2739 +/- 34 g, P < 0.0001) or spouses' EACO (0-5: 3546 +/-25; 6-10: 3484 +/- 51; 11-20: 3309 +/- 47; >20 ppm: 3190 +/- 57 g, P < 0.0001). Even the birthweight of newborns whose mother had EACO between 6 and 10 ppm was significantly lower than the birthweight of newborns whose mother had an EACO between 0 and 5 ppm. Spouses' EACO of delivering women with EACO of 0-5 ppm showed similar effect. Head circumference, Apgar score, and normal term gestational age decreased also significantly with increasing maternal or spouses' EACO. CONCLUSIONS: Both maternal and spouses' EACO measured during delivery, a proxy of EACO during pregnancy, were dose-dependently and inversely associated with fetal growth. Even low maternal (6 to 10 ppm) or spouses' (11 to 20 ppm) EACO may be associated with significantly lower birthweight.

Adolescent↗

PubMed1990

Tobacco-specific nitrosamines in European and USA cigarettes.

More than 170 types of commercial cigarettes from several European countries and the USA were analyzed for tobacco-specific nitrosamines (TSNA) in tobacco and mainstream smoke as well as for nitrate in tobacco. The cigarettes included filter and nonfilter cigarettes with different tar and nicotine yields. The observed range for N'-nitrosonornicotine (NNN) was from 4 to 1353 ng/cigarette in mainstream smoke and from 45 to 12454 ng/cigarette in tobacco. For 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) the values were between not detected (less than 4 ng/cigarette) and 1749 ng/cigarette in mainstream smoke and between not detected (less than 50 ng/cigarette) and 10745 ng/cigarette in tobacco. Nitrate levels ranged from 0.6 to 19.4 mg/cigarette. The TSNA levels for the cigarettes from the different countries investigated were in a similar range with the exception of few individual brands. The results demonstrated that there is no correlation between TSNA and tar deliveries in mainstream smoke. The TSNA deliveries in mainstream smoke depend on the amount or preformed TSNA in the actual tobacco composition, which is influenced by the nitrate level of the tobacco and the tobacco type. According to these results the tar delivery, although crucial, is not a sufficient index for the biological activity and the carcinogenic potential of cigarette smoke. Reduction of TSNA exposure can be achieved by selecting tobaccos with low levels of preformed TSNA in tobacco, which means a low nitrate content and reduction of the amount of Burley tobaccos and stems in blended cigarettes.

Chromatography, Gas↗

PubMed2005

Self-efficacy and outcome expectations for quitting among adolescent smokers.

Relatively little is known about smoking cessation self-efficacy and outcome expectations for quitting smoking in adolescent smokers. In this study, we created measures of these two constructs and conducted factor analyses with data from a diverse sample of 1126 adolescent smokers. Results yielded a two-factor solution for the self-efficacy measure, and a four-factor solution for the outcome expectations scale. In a subset of the original sample (n=515), we re-administered the measures one year later and also examined the longitudinal associations between the baseline sub-scale scores and cigarettes smoked per week at follow-up. Results revealed significant relationships between the negative affect sub-scales of the self-efficacy and outcome expectations measures and weekly smoking level. These associations remained when adjusting for baseline smoking level and other sub-scales. The findings lend support for the possible role of affect regulation in smoking reduction in adolescents.

Adolescent↗

PubMedDate not supplied

Trends in smoking by birth cohort for births between 1940 and 1975: a reconstructed cohort analysis of the 1990 Ontario Health Survey.

BACKGROUND: Smoking patterns have changed markedly over the past 70 years. Previous studies have shown that examination of smoking patterns within birth cohorts can identify important changes in tobacco adoption and cessation. This paper examines temporal trends in the prevalence of smoking and the age of smoking adoption and cessation for birth cohorts born between 1940 and 1975. METHODS: The underlying data were obtained from the Ontario Health Survey (conducted in 1990), which used a multistage stratified area sampling strategy to obtain interviews on 29,843 people age 12 or older. Self-reported smoking histories were used as the basis for a reconstructed cohort analysis of prevalence rates. A life events methodology was employed to examine the age at starting smoking and the time of smoking cessation. RESULTS: There has been a steady drop in peak smoking prevalence for men. This trend appears to be continuing among the most recent cohorts. However, for women, peak smoking prevalence increased until the 1960 birth cohort, after which time the peak prevalence has been dropping. Prevalence of smoking was much higher for men then for women among the earlier birth cohorts but, by the 1960 cohort, the prevalence for men and women was essentially the same. Examination of the age of smoking onset reveals that there was a statistically significant interaction between sex and birth cohort on the relative risk of starting smoking. The rate of smoking cessation has increased uniformly across all birth cohorts among both men and women. CONCLUSIONS: This study confirms recent trends in smoking reduction and provides no evidence to suggest a diminution of the effect. Trends in recent birth cohorts of women are encouraging. There is a clear need for public health initiatives directed at older children and teenagers in order to further reduce the onset of smoking. Efforts to prohibit advertising directed toward minors, sponsorship of sporting and cultural events, and the sale of tobacco to minors should receive high priority.

Adolescent↗

PubMed2002

Light smokers: issues and recommendations.

Although the overall prevalence of tobacco smoking in the United States is decreasing, the proportion of light smokers is increasing and is as high as 50% among some groups. There is growing evidence that light smokers experience significantly higher health risks compared to nonsmokers, and they are often unable to quit smoking on their own. The prevalence of light smoking differs among subpopulations in the US and is particularly common among adolescents, college students, pregnant women, and some ethnic minorities. Characteristics of light smokers in these subpopulations vary, as do the underlying reasons for smoking, barriers to cessation, and treatment issues. Unfortunately, the paucity of research to develop and test effective cessation aids is common across all groups of light smokers. Given the substantial portion of light smokers in these populations, development and dissemination of effective behavioral and pharmacological interventions for light smokers is likely to result in substantial smoking reduction rates in the general population.

Adolescent↗

PubMed2005

ACOG committee opinion. Number 316, October 2005. Smoking cessation during pregnancy.

Smoking is one of the most important modifiable causes of poor pregnancy outcomes in the United States. An office-based protocol that systematically identifies pregnant women who smoke and offers treatment has been proven to increase quit rates. For pregnant women who are light to moderate smokers, a short counseling session with pregnancy-specific educational materials often is an effective intervention for smoking cessation. The 5 A's is an office-based intervention developed for use by trained practitioners. Techniques for smoking reduction, pharmacotherapy, and health care support systems can help smokers quit.

Directive Counseling↗