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PubMed1993

Clinical trials using ascorbic acid aerosol to aid smoking cessation.

Sensory aspects of cigarette smoke are important for providing smoking satisfaction. In previous studies, we have found that substitution of the sensory cues of smoking with a citric acid aerosol significantly reduces craving for cigarettes and enhances smoking reduction and cessation with people trying to quit smoking cigarettes. In the current study, we conducted two clinical smoking cessation trials using an ascorbic acid aerosol as a sensory substitute. The cigarette substitute consisted of a cigarette-sized tube which delivered a fine aerosol of ascorbic acid (approx. 1 mg/puff, up to a maximum of 300 mg/day). Study 1 examined the overall effectiveness of the ascorbic acid smoking substitute device. One group of subjects which used the device and received clinical counseling was compared with another group which received only clinical counseling. The group using the device showed significantly greater abstinence rates at 3 weeks post-cessation. After the subjects stopped using the device, no difference in abstinence was detected. Study 2 was conducted to focus specifically on the role of tracheobronchial sensations in relieving craving for cigarettes. Two closely matched ascorbic acid delivery systems were compared. One device delivered fine particles of ascorbic acid that were targeted to reach the trachea, while the other delivered coarser particles of ascorbic acid that were not expected to reach the trachea or lower airways. An initial enhancement in smoking reduction was found for subjects using the fine particle device relative to those using the coarse particle device. However, by the end of treatment (5 weeks) both groups showed similar degrees of smoking reduction. For those who were abstinent from smoking at the end of treatment, craving for cigarettes and negative mood were both significantly lower for those using the fine particle device. Also, hunger for food was significantly lower in the fine particle device group. These results suggest that ascorbic acid delivered from a cigarette substitute may be effective in reducing smoking and promoting smoking abstinence.

Adult↗

PubMed2004

Smoking and longevity: an incompatible binomial?

In Western countries data from clinical and epidemiological studies have induced the public health offices to promote a great deal of advertising and informative campaigning for smoking reduction. Cigarette smoking has been clearly linked to the most common causes of death in the elderly and contributes to the higher death rate and disability rate associated with many chronic illnesses that are common in this age group. The combination of smoking along with other risk factors like hypertension and diabetes increase high frequency diseases, disability as well as adding to an increase in mortality rate. In order to verify if a healthy lifestyle really favors longevity and how much smoking is incompatible with extreme longevity we investigated the prevalence of smokers and the total smoking exposure of a sample of centenarians in relation with residual survival and health conditions. Our sample consists of 157 centenarians living in Rome, 39 males and 118 females (ratio m/f =1:3),mean age being 101.59 +/- 1.8 years (+/-SD), 83.8% of the centenarians have never smoked,13.5 % are former smokers, and 2.7% are active smokers. The average starting age of smoking is 21.2 years, while the average age of quitting is 65.7 years with an average of 44.7 +/- 17.1 smoking years. The average number of smoked cigarettes per day is quite low,less than 10 cigarettes, so that the total average number of smoked cigarettes is 158,045,well under 280,000 which is considered the cut-off point in many studies of when tumors are noticed. There seemed to be a significant difference (p < 0.001) in gender results in smokers: among male centenarians smokers reached 46%, while female smoker centenarians reached only 8.1%. Statistically significant chronic illnesses were noted among centenarian smokers over the age of 65 (p < 0.02). Moreover, Cox's regression has shown in centenarians a lower survival rate (p < 0.05) in smokers (20.7 +/- 11.2 months) than in non-smokers (27.0 +/- 19.0 months). In conclusion, our study evidences that smoking is for all but some exceptional subjects, incompatible with successful aging and compromises life expectancy even in extreme longevity.

Aged↗

PubMed2002

Infant birth weight as a measure of harm reduction during smoking cessation trials in pregnancy.

During pregnancy, a reduction of 50% or more of a biochemical measure of smoking, among continuing smokers, has been proposed by Windsor and colleagues as a new behavioral indicator of harm reduction because it was accompanied by greater infant birth weight compared with that of infants of smokers with lesser reductions. The purpose of the authors' study was to replicate these observations. During a trial of smoking cessation during pregnancy, data on cigarettes per day, urinary cotinine. and infant birth weight were obtained from 240 women. There were no significant differences in average birth weight between infants of women whocontinued to smoke but reduced their cigarette consumption by 50% or more and infants of women with lesser reductions. These results indicate that this birth weight comparison does not provide a valid estimate of the harm reduction associated with a reduction of 50% or more in cigarette consumption during pregnancy.

Adult↗

PubMed1998

Estimated gains in birth weight associated with reductions in smoking during pregnancy.

OBJECTIVE: To compare the estimated effect on birth weight of reductions in maternal cigarette consumption and urinary cotinine during pregnancy. STUDY DESIGN: An observational study of 641 women with complete data on cigarette consumption, urinary cotinine and infant birth weight. Correlation and regression analyses were used to examine relationships between birth weight, cigarette consumption and urinary cotinine at first and last prenatal visits. RESULTS: Correlations of cigarette consumption and urinary cotinine with infant birth weight were -.23 and -.30 (first visit) and -.26 and -.31 (last visit); all P values were < .001. The regression equation relating urinary cotinine concentrations at first and last visits to infant birth weight explained a significantly larger proportion of the variability in birth weight than the equation relating cigarette consumption at these visits to infant birth weight, 11% vs. 7%, P = .04. Among continuing smokers, both equations predicted gains in birth weight in association with reductions in cigarette consumption, but quitting smoking before the first visit was associated with the most weight gain. As compared to the average infant birth weight of a woman who smoked 20 cigarettes per day throughout pregnancy, the estimated gain in birth weight would be 105 g if she cut down by 10 cigarettes per day after the first visit, 210 g if she quit after this visit and 310 g if she quit before the first visit. CONCLUSION: For women still smoking at their first prenatal visit, infant birth weight is already compromised, but subsequent reductions in cigarette consumption are associated with gains in birth weight. For women who cannot quit smoking, these reductions need to be substantial if increases in birth weight of > 100 g are to be achieved.

Adult↗

PubMed2002

Reductions in smoking prevalence and cigarette consumption associated with mass-media campaigns.

This paper examines reductions in smoking prevalence and cigarette consumption associated with state and local mass-media campaigns. We review the findings of the empirical literature on campaigns targeted at the general population. We then discuss the findings on state- and community-level youth-oriented campaigns. The results suggest that well-funded and implemented mass-media campaigns targeted at the general population and implemented at the state level, in conjunction with a comprehensive tobacco control program, are associated with reduced smoking rates among both adults and youth. Studies of youth-oriented interventions specifically have shown more mixed results, particularly for smaller, community-level media programs, but they indicate strong potential to influence underage smoking rates. We conclude by examining issues that warrant additional research. The scale and duration of expenditures, the content of ad messages, and other tobacco control polices are aspects of media programs that may help explain differences among study results. In particular, tobacco control polices that are implemented during the campaign often make it difficult to identify the specific influence of media campaigns alone.

Adolescent↗

PubMed1984

Contingent reinforcement for carbon monoxide reduction: within-subject effects of pay amount.

The relationship between reinforcer amount and daytime smoking reduction in smokers offered money for reduced afternoon breath carbon monoxide (CO) levels was examined. Twenty-three hired regular smokers with average baseline CO levels of about 30 ppm were exposed in random order to five sliding scale payment schedules that changed daily or weekly. Money was available for afternoon CO readings between 0 and 21 ppm with pay amount inversely related to the absolute CO reading obtained. Maximum pay amount for readings below 7 ppm varied among $0, $1.50, $3, $6, and $12 per day. Contingent reinforcement promoted CO and daytime cigarette reduction within individuals with the amount of behavior change related to the amount of payment available. Average CO levels decreased from 30 to 15 ppm as a function of pay amount whereas self-reported daytime cigarettes decreased from 12 to 5 per day. Average minutes of cigarette abstinence prior to the afternoon study contact increased from 62 to 319 minutes as a function of pay amount, whereas the percentage of available money earned increased from 22% to 48%. Nontargeted evening cigarette use also decreased during periods of daytime smoking reduction. The orderly effects of this contingent reinforcement intervention on daytime smoking of regular smoker volunteers suggest that this is a sensitive model for continued evaluation of factors that influence smoking reduction and cessation.

Adult↗

PubMed2005

Effects of smoking cessation and reduction in asthmatics.

The present study examined the effect of smoking reduction and cessation on asthma regulation and biomarkers of exposure to cigarette smoke. In a prospective open design, we allocated 220 asthmatics among three groups: (a) Smoking reduction (reducers), with the aim of smoking fewer than seven cigarettes per day, (b) complete smoking cessation (abstainers), or (c) continuation of usual smoking (continuing smokers). Subjects used nicotine chewing gum or an oral nicotine inhaler to promote reduction and cessation. We monitored changes in the biomarkers carbon monoxide, cotinine, and thiocyanate, and in peak flow, medicine use, bronchial reactivity, and asthma symptoms. The analysis used the three outcome groups, regardless of original allocation to treatment groups. At 4 months, analysis of abstainers (n = 27), reducers (n = 33), and continuing smokers (n = 50) showed marked, statistically significant decreases in expired carbon monoxide of 17 ppm (abstainers) and 15 ppm (reducers); in plasma cotinine of 124 ng/ml (abstainers) and 122 ng/ml (reducers); and in plasma thiocyanate of 5.03 ng/ml (abstainers) and 3.74 ng/m (reducers). For abstainers, we observed improvements in the asthma-specific quality-of-life score, and reductions in self-reported day and night use of rescue beta2-agonists, in doses of inhaled corticosteroids, in daytime asthma symptoms, and in bronchial hyperreactivity. For reducers, smaller improvements occurred for night use of rescue beta2-agonists, doses of inhaled corticosteroids, and bronchial hyperreactivity. Smoking cessation resulted in a marked decrease in three biomarkers of cigarette smoke inhalation and improved asthma regulation, whereas smoking reduction had a less pronounced effect on biomarkers and only a small effect on asthma regulation.

Administration, Inhalation↗

PubMed1968

Behavioral engineering: the reduction of smoking behavior by a conditioning apparatus and procedure.

Recent findings from animal conditioning studies have revealed methods of reducing responses to a very low level with a minimum of aversive by-products. These findings were incorporated into the design of a cigarette case that automatically locked itself for a period of time after a cigarette was removed from it. The next cigarette could be taken at the end of the interval, which was signalled by distinctive stimuli. Five heavy smokers were allowed to become accustomed to using the case. Then, the duration for which the case was locked was gradually increased over a period of weeks to about 1 hr. Smoking gradually decreased to the target level of about one-half of a package of cigarettes per day. Control procedures showed that specific features of the apparatus were responsible for the reduction of smoking. The results indicated that this apparatus was sufficiently effective, convenient, and acceptable to smokers to constitute a practical procedure for reducing smoking to the level considered medically safe. The procedure may also have potential for reducing other habit-forming or addictive behaviors.

Journal Article↗

PubMed2002

Harm reduction--a treatment approach for resistant smokers with tobacco-related symptoms.

Smokers with chronic obstructive pulmonary disease (COPD) appear to represent a hard-core group, and this presents a dilemma for chest physicians. A reduction in cigarette smoking benefits health, and nicotine replacement therapy (NRT) can aid smoking reduction. Hence we studied the efficacy of nicotine gum in helping hard-core smokers with severe COPD to quit. Seventeen smokers with severe COPD (FEV(1) 38-47% of predicted normal) who smoked >30 cigarettes/day but were unable to quit were encouraged to reduce their smoking as much as possible by using 4-mg nicotine gum. Five gradually reduced their daily tobacco consumption and, 18 months after starting NRT, were smoking an average of 6 cigarettes/day while still using nicotine gum. Compared to baseline, their respiratory symptoms had improved, and both FEV(1) and FVC had increased. There was no improvement in pulmonary function in the group of smokers who did not reduce their cigarette consumption. No adverse events relating to nicotine occurred among the patients who used NRT to reduce their smoking. We propose that this reduction approach should be considered for patients with respiratory disease who are unable or unwilling to stop smoking.

Adult↗

PubMed1993

Economics of a reduction in smoking: case study from Heartbeat Wales.

STUDY OBJECTIVE: This study aims to apply economic principles and techniques in evaluating a health promotion programme. DESIGN: This study is an economic appraisal of the Heartbeat Wales no smoking intervention programme. The costs incurred over the four year period 1985-89 have been identified and estimates have been made of the likely future impact of the reduced smoking prevalence within Wales in terms of reduced morbidity and displaced mortality in three disease groups--coronary heart disease, lung cancer, and chronic bronchitis. SETTING: Wales, UK. RESULTS: The net present value of benefits is considerably greater than costs in terms of both the NHS and the economy as a whole in Wales. In addition, the net costs per life year saved shows that the programme generates additional working life years at relatively low cost. Because not all the benefits can be fully attributed to the programme 'impact rates' ranging from 100 to 10% have been applied to the level of benefits. The evidence suggests that even if only 10% of the benefits could be attributed to the programme there is still a positive net present value of benefits. The relative efficiency of this programme has not been considered here. CONCLUSION: Large scale benefits to the NHS and the economy as a whole can be derived from reductions in smoking.

Adolescent↗

PubMed1989

Effects of smoking and changes in smoking habits on the decline of FEV1.

The aim of this study was to examine the effects of cigarette smoking and changes in smoking habits on the decline of forced expiratory volume in the first second of expiration (FEV1). We studied 7,764 men and women for 5 yrs. The subjects were grouped according to self-reported smoking habits during the observation period. We found that persistent cigarette smoking, in particular heavy smoking, accelerated the decline in FEV1. In 310 subjects who quitted smoking during the observation period, the decline of FEV1 was less pronounced than the decline observed in persistent smokers. In subjects younger than 55 yrs of age, smoking reduction was associated with a less pronounced FEV1 decline, while in the elderly subjects smoking reduction had no effect on the FEV1 decline. An increase in the number of cigarettes smoked was generally associated with a more rapid decline of FEV1, while the beginning of smoking during the 5 yrs of observation did not seem to influence the decline of FEV1. We conclude that smoking cessation or reduction may lead to a demonstrable beneficial effect on the FEV1 decline within a few years.

Age Factors↗

PubMed2005

Breast reduction and smoking.

To investigate the influence of smoking on the occurrence of complications in patients undergoing breast reduction, a retrospective case note study was performed. Seventy-one patients who had 118 reduction mammoplasties between April 2001 and March 2002 were analyzed; 15.5% (11/71) of all patients suffered a complication. Ten complications were of infective nature. There was no case of partial or total nipple necrosis. Factors like past medical history, breast history, drug history, age, body weight, and resection weight did not influence the development of complications (P > 0.4, respectively). Smoking, however, was found to be a significant risk (P < 0.05). The risk to develop complications after reduction mammoplasty was calculated to be more than 3 times as high when compared with nonsmokers.

Adolescent↗

PubMedDate not supplied

The impact of incentives and competitions on participation and quit rates in worksite smoking cessation programs.

PURPOSE: The purpose of this review is to determine whether incentive-based programs conducted at worksites increase participation and long-term smoking cessation rates. METHODS: Published studies of workplace smoking cessation programs involving incentives and competition were identified through all available years up to winter of 1992 in MEDLINE (1966-1992), Psychlit (1967-1992), Smoking and Health (1960-1992), and Combined Health Information (1973-1992) computer databases and article reference lists. Programs were considered incentive programs when they involved either cash or other prizes paid to the participant for quitting smoking. Incentive competition programs typically involve groups contesting for prizes by having the greatest smoking cessation rates. Thirty studies were found, out of which 15 quasi-experimental and experimental studies are reviewed. The 15 studies that did not have comparison groups were excluded from this report. RESULTS: Only eight studies had a comparison group in which the effects of incentives and competition were separated from the effects of other interventions. Only one study separated the effects of competition from incentives. Five of these studies evaluated smoking rates after six months, and three after 12 months from the program start. Three of these studies showed that incentives increased participation rates, and five enhanced smoking reduction. No study showed, however, that incentives and/or competition enhanced smoking cessation past six months. CONCLUSIONS: It appears that incentives/competition may be useful for increasing participation and smoking reduction. Further research needs to be conducted to determine whether incentives and/or competition enhance long-term quit rates, and what are the most effective types of incentive procedures.

Follow-Up Studies↗

PubMed2006

Risk reduction: perioperative smoking intervention.

Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation, and offered a smoking intervention programme whenever possible.

Humans↗

PubMed2004

Two-year follow-up of a smoking cessation trial in patients with schizophrenia: increased rates of smoking cessation and reduction.

BACKGROUND: Long-term success rates of smoking cessation programs for patients with schizophrenia are unknown. This study, conducted between June 2001 and November 2002, evaluated the rate of smoking cessation and reduction in patients with schizophrenia (DSM-IV) 2 years after they had participated in a smoking cessation study in order to determine whether subjects who significantly reduced smoking during the original trial resumed their previous level of smoking at 2 years. METHOD: Two years following a double-blind placebo-controlled trial of bupropion sustained release, 150 mg/day, added to cognitive-behavioral therapy for smoking cessation in patients with schizophrenia, subjects were interviewed, medical charts were reviewed, and carbon monoxide in expired air was measured. RESULTS: Seventeen of 18 subjects completed the follow-up assessment. More subjects were abstinent (22% [N = 4]) at the 2-year follow-up than were abstinent at the end of the trial (6% [N = 1]). Subjects who achieved significant smoking reduction during the trial were more likely to be abstinent at 2 years (4/7) than those who did not significantly reduce smoking during the trial (0/11) (chi(2) = 8.1, p <.005). Most subjects who achieved > or = 50% reduction in smoking at the end of the trial maintained at least that level of reduction at 2 years. Smoking reduction during the treatment intervention was correlated with smoking reduction at follow-up (r = 0.60, p =.01). CONCLUSION: The results from this naturalistic study suggest that behavior changes achieved in smoking cessation programs for patients with schizophrenia may be durable and may predict future smoking behavior. We conclude that further investigation into the relationship between smoking reduction and future smoking cessation in special populations is indicated.

Adult↗

PubMed1993

Reduction of secondary smoke exposure in asthmatic children: parent counseling.

Epidemiological evidence shows that children's exposure to secondhand tobacco smoke increases their risk of respiratory illness. This study evaluated five families and their asthmatic children (aged 5-14 years) in an outpatient counseling program for reducing the children's exposure to passive smoking. Intervention included biweekly counseling/instructions for parents to limit their children's tobacco exposure. A multiple-baseline, quasiexperimental design was used for self-reported measures of the children's smoke exposure and the parent's smoking frequency. Counseling was associated with smoke exposure reduction of 40-80% from baseline for each of 5 children, with most improvements sustained during follow-up. This study provides support for the development of tobacco exposure prevention programs for children with pulmonary disease.

Adolescent↗

PubMed2002

Asthma management and environmental tobacco smoke exposure reduction in Latino children: a controlled trial.

OBJECTIVES: This study tested the efficacy of coaching to reduce environmental tobacco smoke (ETS) exposure among asthmatic Latino children. DESIGN: After asthma management education, families were randomly assigned to no additional service (control condition) or to coaching for ETS exposure reduction (experimental condition). SETTING: The study was conducted in San Diego, California. PARTICIPANTS: Two hundred four Latino children (ages 3-17 years) with asthma participated. INTERVENTION: Approximately 1.5 hours of asthma management education was provided; experimental families also obtained 7 coaching sessions ( approximately 45 minutes each) to reduce ETS exposure. OUTCOME MEASURES: Reported ETS exposure and children's urine cotinine were measured. RESULTS: Parents in the coached condition reported their children exposed to significantly fewer cigarettes than parents of control children by 4 months (postcoaching). Reported prevalence of exposed children decreased to 52% for the coached families, but only to 69% for controls. By month 4, mean cotinine levels decreased among coached and increased among control children. Cotinine prevalence decreased from 54% to 40% among coached families, while it increased from 43% to 49% among controls. However, cotinine levels decreased among controls to the same level achieved by coached families by the 13-month follow-up. CONCLUSIONS: Asthma management education plus coaching can reduce ETS exposure more than expected from education alone, and decreases in the coached condition may be sustained for about a year. The delayed decrease in cotinine among controls is discussed.

Adolescent↗

PubMed1999

Research in using mass media to prevent smoking.

Mass media are particularly appropriate for reaching young people in smoking-prevention campaigns; however, past research has placed little emphasis on designing effective interventions. Only a few studies have been conducted to develop and evaluate methods to use media for smoking reduction among youth, and only one quasi-experimental study has demonstrated actual reductions in youth smoking. This research requires the use of large controlled field studies that cross disciplines. These lack an established funding base. Furthermore, campaign approaches seeking to reduce youth demand for tobacco products are currently receiving less attention from anti-tobacco policy makers than approaches restricting the supply of tobacco to youth. Scientists from various health behavior and education disciplines should join with creative media production professionals to develop more effective messages and message delivery systems to reach youth at high risk of smoking. Further efforts should be made to share information among these professionals and producers of entertainment programs for youth, as well as among anti-tobacco policy makers, so that the most effective approaches can be employed to reduce youth smoking on a broad scale.

Adolescent↗