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PubMed2003

Smoking cessation or reduction in pregnancy treatment methods: a meta-evaluation of the impact of dissemination.

Active and passive exposure to tobacco smoke during pregnancy and infancy is the most serious and preventable cause of adverse maternal, fetal, and infant outcomes in the United States. The multiple risks of tobacco exposure to mothers and infants are definitive, and the clinical and economic benefits of cessation have been documented. This article provides a synopsis of the state of the science and art in this specialized area and reviews the evidence for validity of patient assessment methods and the effectiveness of smoking cessation/reduction treatments for pregnant women. A synthesis of 4 topics is presented: (1) the validity of patient reports of smoking status and recent trends during pregnancy and postpartum; (2) definition of "Best Practice" smoking cessation methods for pregnant women; (3) the effect of dissemination of effective clinical practice methods among the 800,000+ pregnant US smokers each year; and (4) the evidence for the cost-benefit of improved maternal and infant outcomes from cessation.

Clinical Trials as Topic↗
PubMed2002

Gender and smoking-related risk reduction of periodontal disease with variant myeloperoxidase alleles.

Myeloperoxidase (MPO) is an oxidative enzyme expressed in polymorphonuclear leukocytes. It is involved in the defence against periodontal bacteria, and is also able to mediate inflammatory tissue destruction in periodontal disease. A G/A polymorphism in the promoter region of the MPO gene at position -463 has been assumed to exert profound effects on the expression of the enzyme. It is the aim of this study to evaluate whether this polymorphism may influence the risk of periodontal diseases. A total of 3148 subjects were randomly selected from the general population in the SHIP study (Study of Health in Pomerania). Periodontal status, health-related and socio-economic items were assessed. All subjects aged 40-60 years (n = 1103) were included in this study, and 1083 genotyped for the MPO -463 G/A polymorphism by PCR and RFLP methods. The genotype frequencies determined were homozygous wild type G/G 65.9% (95% CI 63.5-68.6), heterozygous A/G 31.4% (28.8-34.4), and homozygous variant A/A 2.7% (2.0-3.8). Only female subjects have a significantly reduced risk of severe periodontal disease when bearing the variant genotypes A/G or A/A. In female subjects the reduction in periodontal risk was significant for non-smokers (OR = 0.48; 95% CI 0.23-0.96); the smoke-related increase in risk was also reduced (OR = 0.50; 95% CI 0.22-1.10). When adjusted for age, smoking, and education the odds ratios were calculated as 0.52 (P = 0.01) and 0.97 (P = 0.90) for female and male subjects, respectively. The results of this study confirm the assumption that the MPO -463A allele variants are protective in the pathogenesis of periodontal diseases. This holds true only with women but not with men. The results are discussed with respect to the known influences of sexual hormones on MPO activity.

Adult↗
PubMed1995

The tar reduction study: randomised trial of the effect of cigarette tar yield reduction on compensatory smoking.

BACKGROUND: Observational and short term intervention studies have reported that smokers of low tar cigarettes inhale more deeply (that is, compensate) than those who smoke high tar cigarettes. To quantify this effect a long term randomised trial was conducted on the effects of switching to low tar cigarettes. METHODS: The trial was carried out between April 1985 and March 1988 among cigarette smokers in the British Civil Service, measuring blood carboxyhaemoglobin (COHb) levels and serum cotinine levels as markers of tobacco smoke intake. Volunteers first switched to a cigarette brand yielding around 10% less tar than their usual brand to identify smokers able to change brand. The 434 subjects who successfully switched were then randomly allocated to one of three groups: (a) "fast reduction" group which changed to a brand of cigarettes with a tar yield of about half that of their usual brand; (b) "slow reduction" group which reduced to the same level in steps over several months; and (c) a control group which continued smoking cigarettes with a tar yield 10% lower than their usual brand. RESULTS: Over the course of the trial cigarette consumption declined slightly in all three groups. In both the "fast reduction" and the "slow reduction" groups, intake of COHb and cotinine was reduced, though not to the same extent as the yield reduction. Comparison of the results before randomisation with those at the end of the trial showed that a reduction in carbon monoxide yield of 45% was associated with a decrease in carbon monoxide intake of 19% (95% confidence interval 14% to 24%) and that a reduction in nicotine yield of 40% was associated with an 11% (6% to 16%) reduction in nicotine intake, reflecting relative intakes of about 1.5 for both carbon monoxide and nicotine in the "fast reduction" group. Results were similar in the "slow reduction" group with a 42% reduction in carbon monoxide yield, a 16% (11% to 22%) reduction in carbon monoxide intake, a 37% reduction in nicotine yield, and a 6% (0% to 13%) reduction in nicotine intake. Estimates of compensation derived from these results were 65% for carbon monoxide, 79% for nicotine, and 62% for tar. CONCLUSIONS: Compensation, demonstrated when switching from a high tar cigarette to a low tar one, was incomplete. Advising people who have failed to give up smoking to switch to low tar cigarettes will reduce the intake of smoke constituents to a small extent. This would be expected to decrease their risk of smoking-related diseases, although by a smaller amount than would be achieved by giving up smoking altogether.

Adaptation, Psychological↗
PubMed2005

Reduction in amount smoked predicts future cessation.

The goal of this article is to determine whether reducing cigarette consumption increases the likelihood of future cessation. Data from 3,385 participants who originally took part in the Community Intervention Trial for Smoking Cessation completed detailed tobacco use phone surveys in 1988, 1993, and 2001. Between 1988 and 1993, 15% of smokers reduced their daily cigarette consumption by 50% or more, and 9% of the entire baseline sample maintained this reduction in 2001. Those who reduced more than 50% were 1.7 times more likely to quit smoking by 2001 compared with those who did not reduce. Few smokers are able to reduce their consumption by 50% or more, although those who do are more likely to quit compared with those who do not.

Adult↗
PubMed1992

Tax harmonization and the reduction of European smoking rates.

Amidst growing optimism that smoking in Europe can be greatly reduced by the year 2000, this paper simulates the possible impacts of European tax harmonization in the context of rising incomes. A range of price and income elasticities are chosen from econometric studies which use micro information. This is justified by the aggregation problems associated with studies in the smoking literature which use aggregate data. Using micro elasticities, the simulations reported in this paper show that the aims of fiscal harmonization are at variance with the aims of health promotion.

Costs and Cost Analysis↗
PubMed1998

Non-aversive reduction of cigarette smoking in two adult men in a residential setting.

Two middle-aged men with mental retardation, addicted to smoking cigarettes, operated spinners that determined the probability with which they could obtain cigarettes and other items. Absence of several maladaptive behaviors permitted the operation of the spinners hourly (i.e., DRO 60 min), 16 h per day, 7 days per week. The actual frequencies of obtaining cigarettes followed the theoretical probabilities of obtaining cigarettes in all phases of the study. Presumed smoking frequencies were reduced by about 50% with associated medical benefits. Low frequencies of maladaptive behaviors were maintained throughout.

Behavior Therapy↗
PubMedDate not supplied

Testing the causal role of expectancies in smoking motivation and behavior.

The causal role of outcome expectancies in smoking motivation and behavior was tested in a laboratory experiment. Two expectancy manipulations-Health Consequences Expectancy Increase (HC) and Mood Management Expectancy Challenge (MM)-were crossed in a 2 x 2 factorial design. One hundred twenty-three heavy smokers were randomly assigned to the conditions and shown videotaped interviews of smokers and exsmokers followed by an interview that personalized the information. Both manipulations produced changes in targeted expectancies on at least one of two expectancy instruments. As predicted, only the HC manipulation produced increases in motivation to quit smoking and a reduction in smoking 3 months later. This study provides initial evidence that smoking expectancies play a causal role in smoking motivation, consistent with previous research with alcohol.

Adult↗
PubMed1985

Evaluation of the North Carolina Risk Reduction Program for smoking and alcohol.

Seventh grade students in two school systems in rural North Carolina were subjects for a program designed to reduce health risks associated with use/abuse of tobacco and alcohol. One school system was located in the central area of the state, and the other in the western mountains. Both groups were assessed before and after introduction of novel teaching programs dealing with alcohol and tobacco. Knowledge about smoking and alcohol increased in both sites (p less than .05). Attitudes toward alcohol did not change. Attitudes toward smoking eroded in both sites, with attitudes at one site showing a severe erosion (p less than .05). Smoking education in these communities may have conflicted strongly with ambient attitudes toward smoking, eliciting a "boomerang" effect.

Adolescent↗