Serving Substance Abuse Professionals Since 1993

Last Update: 01.07.07

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Smoking Cessation

68 citations. January 2007 to present

Prepared: June 2007

Ames SC; Patten CA; Werch CE; Schroeder DR; Stevens SR; Fredrickson PA et al. Expressive writing as a smoking cessation treatment adjunct for young adult smokers. Nicotine & Tobacco Research 9(2): 185-194, 2007. (35 refs.)

This investigation evaluated the efficacy of expressive writing as a treatment adjunct to a brief office smoking cessation intervention plus nicotine patch therapy in young adults. Participants aged 18-24 years were randomized to a brief office intervention (n=99) or to an expressive writing plus brief office intervention (n=97). Both conditions received four individual visits plus 6 weeks of nicotine patch therapy, which began on the quit date following the week 2 visit. Participants in the expressive writing plus brief intervention condition wrote for 2 consecutive days before and 3 consecutive days after the quit date. The brief office intervention group completed a control writing assignment. At end of treatment (week 8), biochemically confirmed 7-day point-prevalence abstinence for the expressive writing plus brief office intervention condition was significantly greater than for the brief office condition (33% vs. 20%, p=.043, OR=2.0, 95% CI=1.0-3.7, from a logistic regression adjusting for gender). At 24 and 52 weeks, abstinence rates were similar for the brief office intervention versus expressive writing plus brief office intervention (12% vs. 11% at 24 weeks; 11% vs. 11% at 52 weeks). The results suggest that expressive writing has promise as a smoking cessation treatment adjunct for young adults. Lengthier interventions or the use of boosters should be tested to extend treatment effects. However, participants reported a low level of enthusiasm for the expressive writing, which may be a barrier to implementing it over a longer time frame. Therefore, other modes of delivering expressive writing to young adult cigarette smokers should be explored.

Andersen S. Adding addiction to the transtheoretical model for smoking cessation. Addictive Behaviors 32(5): 1099-1104, 2007. (10 refs.)

Addiction is important to account for when designing smoking cessation interventions as withdrawal symptoms impede quitting. Ameliorating symptoms may increase those successfully quitting. A two-group, two-time, five-week, multi-site experimental design using the Transtheoretical Model examined whether addiction predicted post-intervention smoking behavior (point prevalence and stage of change), controlling for NRT (nicotine replacement therapy use) in adult FreshStart participants (N= 109). The intervention group self-designated an Indigenous Helper (IH) Indentified from their social network; the control group did not. The Fagerstrom Test for Nicotine Dependence (FTND) and the Stage of Change questionnaire were completed at baseline and 4 weeks. NRT use, but not the FTND, predicted smoking behavior. There is a need for an accurate nicotine addiction measure. Future smoking cessation studies should include NRT as a covariate.

Anderson S. Community pharmacists and tobacco in Great Britain: From selling cigarettes to smoking cessation services. Addiction 102(5): 704-712, 2007. (33 refs.)

Aims: To illustrate the ways in which community pharmacists in Great Britain have been able to benefit from a close association with tobacco and moking from its initial importation to the present time. Design: An analysis of relevant texts and documents, together with brief transcripts from an oral history investigation of community pharmacy in Great Britain. Setting Community pharmacies in Great Britain during the 20th century. Participants: Retired and practising community pharmacists with experience of the sale of tobacco products during the period. Measurements Oral testimony of retired and practising community pharmacists about the use and sale of tobacco products, and quantitative analysis of commercially available products designed to help people stop smoking during the period. Findings: Community pharmacists have been involved continuously with the tobacco habit since its first introduction into Britain. During the course of the 20th century the emphasis shifted from the sale of tobacco products to the sale of medicines intended to help people to give up smoking. Smoking cessation initiatives continue to be an important part of the business of many pharmacies. Conclusions The paper illustrates the continuing tension that exists between pharmacy as business and pharmacy as profession. The sale of tobacco products and, more recently, products to help people give up smoking, has been a small but significant part of the business of many community pharmacists throughout the centuries.

Audrain-McGovern J; Halbert CH; Rodriguez D; Epstein LH; Tercyak KP. Predictors of participation in a smoking cessation program among young adult smokers. Cancer Epidemiology, Biomarkers & Prevention 16(3): 617-619, 2007. (33 refs.)

This study investigated the predictors of participation in a smoking cessation trial for young adults ages 18 to 30 years old. Eligible smokers (n = 164) completed a telephone survey that measured demographic, smoking history, and psychosocial variables before the initiation of smoking cessation treatment. Young adult smokers who attended at least one smoking cessation session were compared with those who did not attend any sessions. Logistic regression analysis indicated that race and age were statistically significant multivariate predictors of participation. Caucasians were over six times (odds ratio, 6.03; 95% confidence interval, 2.41-15.05) more likely to participate in the smoking cessation program compared with non-Caucasians (61% versus 19%). For every SD increase in age (SD, 2.45), there was about a 2-fold increase in the likelihood that a young adult smoker participated in the smoking cessation program (odds ratio, 1.82; 95% confidence interval, 1.23-2.71). Future research should investigate how to promote participation in smoking cessation programs among smokers in emerging adulthood and among non-Caucasian young adult smokers to prevent a lifelong habit associated with disproportionate morbidity and mortality.

Baker A; Richmond R; Haile M; Lewin TJ; Carr VJ; Taylor RL et al. Characteristics of smokers with a psychotic disorder and implications for smoking interventions. Psychiatry Research 150(2): 141-152, 2007. (50 refs.)

Despite high rates of smoking among people with psychotic disorders, and the associated health and financial burden, few studies have investigated the characteristics of this group of smokers. This paper reports data from 298 smokers with an ICD-10 psychotic disorder residing in the community (56.7% with schizophrenia or schizoaffective disorder), including an examination of their demographic and clinical characteristics, smoking behaviours, severity of nicotine dependence, stage of change, and reasons for smoking and for quitting. Standardized self-report instruments were used, in conjunction with structured interviews, as part of the first phase of a randomized controlled trial. On average, participants smoked 30 cigarettes per day, commenced smoking daily at about 18 years of age (5 years before illness onset), and had made 2-3 quit attempts in their lifetime. Higher levels of nicotine dependence and concurrent hazardous use of alcohol or cannabis were associated with a younger age at smoking initiation. The present sample was also more likely to report stress reduction, stimulation and addiction as reasons for smoking, compared to a general sample of smokers. Males, precontemplators and participants with concurrent hazardous substance use cited fewer reasons for quitting smoking. These and other subgroup differences in smoking characteristics are used to illustrate potential implications for the nature and timing of smoking interventions among people with a psychotic disorder.

Barnhart J; Lewis V; Houghton JL; Charney P. Physician knowledge levels and barriers to coronary risk prevention in women: Survey results from the women and heart disease physician education initiative. Women's Health Issues 17(2): 93-100, 2007. (53 refs.)

Background. Few studies have examined whether physician knowledge, attitudes, or practice patterns might contribute to gender disparities in the primary prevention of coronary heart disease (CHD), including among physicians caring for the largest number of reproductive-age women, obstetricians and gynecologists (OB/GYNs). We sought to identify barriers affecting the provision of recommended coronary risk factor therapies in women. Methods. We surveyed internists and OB/GYNs who attended Grand Rounds presentations developed for the New York State Women and Heart Disease Physician Education Initiative. This program was designed to improve screening and management of coronary risk factors in women. Attendees were asked to complete a 7-minute questionnaire. Results. The mean age of the 529 respondents was 40.3 years (standard deviation = 12.3), 75.1% were internists (n = 378), and 42.7% (n = 226) were women. Physicians correctly responded to 71.5% of the 13 questions assessing knowledge of coronary risk prevention (range, 4-13). Almost one third of internists and half of the OB/GYNs did not know that tobacco use was the leading cause of myocardial infarction in young women. For patients who smoked tobacco, only two thirds of internists and 55.4% of OB/GYNs reported suggesting a quit date (p =.007). After controlling for covariates, physicians who did not perceive time as a barrier were more likely to discuss smoking cessation (odds ratio = 1.7 [1.1-2.7]). Conclusions. Among the internists and OB/GYNs surveyed, time was perceived as a barrier to implementing risk prevention. These physicians also underestimated the impact of tobacco use as a risk factor for CHD in young women. To lessen gender disparities in CHD prevention, both specialties need time-efficient educational programs that reflect specialty differences.

Barron J; Petrilli F; Strath L; McCaffrey R. Successful interventions for smoking cessation in pregnancy. American Journal of Maternal-Child Nursing 32(1): 42-47, 2007. (24 refs.)

The purpose of this article is to evaluate research regarding beneficial approaches to smoking cessation interventions during pregnancy. Research about nicotine replacement, nurse-managed counseling sessions, hypnosis, and behavioral modifications are presented. One of the most useful types of program for smoking cessation in pregnancy (as measured by cotinine-validated abstinence) described in the literature thus far has been the nurse-managed smoking cessation program, which includes a 15-minute individualized counseling session combined with a telephone contact 7-10 days after the prenatal visit. More research is needed in this important area of nursing practice.

Bell JF; Zimmerman FJ; Mayer JD; Almgren GR; Huebner CE. Associations between residential segregation and smoking during pregnancy among urban African-American women. Journal of Urban Health 84(3): 372-388, 2007. (77 refs.)

Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born African-American women (n = 403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important socio-demographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

Bellows NM; McMenamin SB; Halpin HA. Adoption of system strategies for tobacco cessation by state Medicaid programs. Medical Care 45(4): 350-356, 2007. (25 refs.)

Background: The Public Health Service's Clinical Practice Guideline for treating tobacco dependence recommends 6 system-wide strategies for health administrators, insurers, and purchasers to support tobacco cessation. Methods: A 24-question survey was sent to each state Medicaid program office in the fall of 2005, including questions to assess whether each state Medicaid program adopted 4 of the 6 system strategies most relevant to Medicaid contracting. Results: The number of system strategies adopted by state Medicaid programs in 2005 ranged from 0 to 4 of the 4 strategies examined. Oregon, Pennsylvania, and West Virginia adopted all 4 systems strategies for cessation in their Medicaid programs. Seven states adopted 3 strategies, and 14 states adopted 2. Seventeen states adopted only I of the system strategies, and 10 state Medicaid programs had not adopted any of the recommended system strategies for tobacco cessation. The most frequently adopted strategy was Medicaid coverage for tobacco dependence treatments, with 75% of the states covering at least I recommended treatment under their Medicaid program. Conclusions: Although most state Medicaid programs have made efforts to adopt at least one of the recommended system strategies to support tobacco cessation, there remains substantial room for improvement. More research is needed regarding the barriers to Medicaid program adoption of comprehensive system strategies to promote cessation among their enrolled populations.

Bentz CJ; Bayley KB; Bonin KE; Fleming L; Hollis JF; Hunt JS et al. Provider feedback to improve 5A's tobacco cessation in primary care: A cluster randomized clinical trial. Nicotine & Tobacco Research 9(3): 341-349, 2007. (42 refs.)

The electronic health record (EHR) may be an effective tool to help clinicians address tobacco use more consistently. To evaluate the impact of EHR-generated practice feedback on rates of referral to a state-level tobacco quitline, we conducted a cluster randomized clinical trial (feedback versus no feedback) within 19 primary care clinics in Oregon. Intervention clinics received provider-specific monthly feedback reports generated from EHR data. The reports rated provider performance in asking, advising, assessing, and assisting with tobacco cessation compared with a clinic average and an achievable benchmark of care. During 12 months of follow-up, EHR-documented rates of advising, assessing, and assisting were significantly improved in the intervention clinics compared with the control clinics (p<.001). A higher case-mix index and presence of a clinic champion were associated with higher rates of referral to a state-level quitline. EHR-generated provider feedback improved documentation of assistance with tobacco cessation. Connecting physician offices to a state-level quitline was feasible and well accepted.

Berrettini WH; Wileyto EP; Epstein L; Restine S; Hawk L; Shields P et al. Catechol-O-Methyltransferase (COMT) gene variants predict response to bupropion therapy for tobacco dependence. Biological Psychiatry 61(1): 111-118, 2007. (39 refs.)

Background: Although bupropion is efficacious for smoking cessation, only a minority of smokers are able to quit. Pharmacogenetic research may improve treatment outcomes through discovery of DNA sequences predictive of successful pharmacotherapy for subgroups of smokers. We investigated variants in the catechol-O-methyltransferase (COMT) gene in a smoking cessation trial of bupropion.MethodsA double-blind, placebo-controlled, 10-week trial of bupropion and counseling (with a 6-month follow-up period) was conducted at two university-based smoking cessation research programs. Abstinence was biochemically verified at the end of treatment and at 6 months after the target quit date.ResultsAt the end of the treatment phase, statistically significant interaction effects indicated that COMT haplotypes of two SNPs (rs737865 and rs165599) predicted the efficacy of bupropion compared with placebo. This interaction effect was attenuated at 6-month follow-up. Conclusions: COMT haplotypes at rs737865 and rs165599 may predict a favorable outcome for bupropion treatment for smoking cessation. European-American smokers with a G allele at both SNPs may not benefit from bupropion treatment. Small numbers of some COMT haplotypes limit interpretation of response. If study findings are confirmed in additional large studies, COMT genotyping could be applied to identify likely responders to bupropion treatment for smoking cessation.

Blumenthal DS. Barriers to the provision of smoking cessation services reported by clinicians in underserved communities. Journal of American Board of Family Medicine 20(3): 272-279, 2007. (41 refs.)

Purpose: This qualitative study describes barriers to the provision of smoking cessation services among primary care providers serving medically underserved populations in the state of Georgia. Methods: Eighty-two health care professionals, including clinicians, nurses, administrators, and support staff, participated in 10 focus groups. All sessions were audiotaped and transcribed. A line-by-line analysis of each transcript was conducted. Results: Barriers were grouped into 5 major themes: lack of time, patient unreadiness to change, inadequate patient resources, inadequate provider resources, and inadequate cessation clinical skills. Within this framework, a number of barriers were identified that are of special importance when caring for the underserved. Examples included the tendency of patients to present in "crisis" rather than on an appointment basis; patients' inability to pay out-of-pocket expenses for drug therapy; patients' inability to take time from work for cessation services; limited prescribing authority for clinicians in certain settings; inadequate availability of patient education materials, especially non-English materials; and the need for additional training in smoking cessation for providers. Conclusion: "Safety net" providers encounter barriers to providing smoking cessation services that are similar to barriers faced by clinicians serving more affluent and nonminority populations, but also encounter additional barriers that apply most particularly to the underserved.

Campbell J; Mays MZ; Yuan NP; Muramoto ML. Who are health influencers? Characterizing a sample of tobacco cessation interveners. American Journal of Health Behavior 31(2): 181-192, 2007. (32 refs.)

Objectives: To describe characteristics of health influencers (HIs) prior to training in brief tobacco cessation interventions. Methods: HIs (n=910) in Arizona were recruited for a randomized controlled trial comparing training modalities. Results:Typically middle-aged (M=43, SD=14), non-Hispanic white (68%), female (77%), non-tobacco users (93%), most identified personal (89%) rather than job-related (3%) motivators for becoming cessation interveners. Confidence about intervention ability was high (93%); knowledge scores, however, were low (M=55%, SD=13%). Conclusions: HIs exhibiting high motivation to intervene but, lacking knowledge about BI strategies may be an untapped resource for tobacco cessation and a variety of other health promotion interventions.

Chaiton MO; Cohen JE; McDonald PW; Bondy SJ. The Heaviness of Smoking Index as a predictor of smoking cessation in Canada. Addictive Behaviors 32(5): 1031-1042, 2007. (39 refs.)

Nicotine addiction is believed to be a major impediment for many people in quitting smoking, but measures of nicotine dependence such as the Heaviness of Smoking Index (HSI) have had mixed success in predicting cessation. Using the National Population Health Survey, the relationship between HSI at baseline in cycle 2 (1996-1997) and successful smoking cessation at cycle 3 (1998-1999) and cycle 4 (2000-2001) was examined in 2938 Canadian adult smokers. A logistic regression model was developed for HSI as a predictor of smoking cessation, and then tested for interaction and confounding. The odds ratio of not smoking in cycle 3 was 2.08 (95% Cl: 1.51, 2.86; p < 0.001) for low HSI (< 2) compared to medium HSI. When the period of follow-up was extended, individuals with both high (> 4) HSI scores (OR 2.16; 95% CI: 1.11, 4.21; p=0.02) and low scores (OR 2.22; 95% CI: 1.41, 3.49) had higher odds of not smoking at both cycle 3 and cycle 4 than those with medium HSI scores. The likelihood of reporting cessation was higher than expected in the Canadian population among highly dependent smokers, particularly among older smokers, those with middle or greater income adequacy, and those with no intention to quit smoking. There were no substantial changes to the results when those lost-to-follow-up were treated as continuing smokers. These findings indicate that nicotine dependence is only one factor in succeeding at a quit attempt. Individual and population strategies for smoking cessation may need to consider other influences such as cognitive, affective and environmental factors.

Chandra S; Shiffman S; Scharf DM; Dang Q; Shadel WG. Daily smoking patterns, their determinants, and implications for quitting. Experimental and Clinical Psychopharmacology 15(1): 67-80, 2007. (48 refs.)

In this article, the authors examine daily temporal patterns of smoking in relation to environmental restrictions on smoking and cessation outcomes. Time-series methods were used for analyzing cycles in 351 smokers who monitored their smoking in real time for 2 weeks. The waking day was divided into 8 "bins" of approximately 2 hr, cigarette counts were tallied for each bin, and temporal patterns of smoking and restriction were analyzed. Cluster analyses of smoking patterns by time of day resulted in 4 Clusters: daily decline (n = 30; 9%), morning high (n = 43; 12,70), flatline (n = 247 70%), and daily dip-evening incline (n = 3 1; 9%). Clusters differed in baseline demographic, smoking, and psychosocial variables. Results suggest that smoking behavior can be M characterized by regular patterns of smoking frequency during the waking day: Smoking in the flatline Cluster was within +/- 0.5 standard deviation at all times. For the other clusters, smoking was high in the morning (daily dip-evening incline: +1.7 standard deviations; morning high: +2.8 standard deviations; daily decline: +1.7 standard deviations); moderate (morning high: -0.8 standard deviations; daily decline: +0.3 standard deviations) or low (daily dip-evening incline: -1.0 standard deviations) midday and high (daily dip-evening incline: +2.0 standard deviations), moderate (morning high: +0.5 standard deviations), or low (daily decline: -1.5 standard deviations) in the evening. Daily smoking patterns were related to environmental smoking restrictions, but the strength of this relationship differed among clusters and by time of day. Clusters differed in lapse risk.

Coleman T; Lewis S; Hubbard R; Smith C. Impact of contractual financial incentives on the ascertainment and management of smoking in primary care. Addiction 102(5): 803-808, 2007. (28 refs.)

Background: The April 2004 contract for UK general practitioners (GPs) is an ambitious attempt to produce substantial changes in clinical practice. We investigated the impact of this on delivery of primary care smoking cessation interventions. Methods We analysed data from patients' medical records that were held within a large database called The Health Improvement Network (THIN). We calculated for each year between 1990 and 2005 and for each quarter-year from 2003 the incidence of recording of smoking status in medical records and, in smokers, the receipt of GPs' smoking cessation advice and prescriptions for nicotine addiction treatments. Findings: Recording of smoking status increased temporarily around 1993-4 and then rose gradually from the year 2000. This rise was more marked from 2003, with an 88% increase between the first quarters of 2003 and 2004. The latter quarter was just prior to the introduction of the GP contract and higher rates of recording smoking status were sustained for the subsequent year. In smokers, there was a broadly similar pattern for the proportion recorded as having received brief cessation advice. However, while there was a sharp increase in prescriptions for nicotine addiction treatments from 2000, no comparable acceleration in this trend from 2003 was apparent. Interpreation The 2004 GP contract increased primary care rates of smoking status ascertainment and recording of advice against smoking. The public health impact of this contract could be maximized if it also improved GPs' prescribing of nicotine addiction treatments.

Curry SJ; Emery S; Sporer AK; Mermelstein R; Flay BR; Berbaum M et al. A national survey of tobacco cessation programs for youths. American Journal of Public Health 97(1): 171-177, 2007. (26 refs.)

Objectives. We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. Methods. We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. Results. We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was $2000. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. Conclusions. There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence.

Dalia D; Palmer RM; Wilson RF. Management of smoking patients by specialist periodontists and hygienists in the United Kingdom. Journal of Clinical Periodontology 34(5): 416-422, 2007. (39 refs.)

Objective: To assess the management of patients who are current smokers in dental practice. Materials and methods: A postal questionnaire to the 243 periodontists on the UK specialist register and 239 randomly selected hygienists on the General Dental Council register. Results: Eighty per cent of both groups responded. There were significant demographic differences between the two groups of respondents: 88% of periodontists were in specialist practice and/or hospital or university departments, while 89% of hygienists were in general dental practice. Periodontists routinely asked their patients about smoking 99% of the time, hygienists 89%. More than 5 min. was spent advising a smoker patient by 35% of periodontists and 19% of hygienists. A proportion of both groups claimed to have had some recognized training in quit smoking (44% and 39%). When asked about the oral conditions of their smoking patients, 26% of periodontists stated that these patients did not have poorer oral hygiene, while 67% of hygienists thought that they did. While the majority of both groups discussed the oral effects of smoking, less than two-thirds discussed methods of giving up. Conclusion: Both periodontists and hygienists are generally aware of the problems of treating smokers, and accordingly ask and advise their patients. However, lack of time and poor patient response may inhibit active involvement in assisting patients to quit smoking.

Dallery J; Glenn IM; Raiff BR. An Internet-based abstinence reinforcement treatment for cigarette smoking. Drug and Alcohol Dependence 86(2/3): 230-238, 2007. (60 refs.)

Although voucher reinforcement has been shown to promote abstinence from smoking, more practical methods are needed to obtain objective evidence of smoking status on a frequent and sustained basis. Using a within-subject reversal design, the present study tested an Internet-based method to obtain objective evidence of smoking status and to deliver voucher incentives for evidence of abstinence. Twenty (10 females) heavy smokers completed this 4-week study. Twice daily, participants made video recordings of themselves providing a breath carbon monoxide (CO) sample with a web camera. The video was made at home and sent electronically to the smoking clinic. Participants could earn vouchers for gradual reductions in breath CO during a 4-day shaping condition, and then for achieving abstinence (CO <= 7 ppm) during a 10-day abstinence induction phase. Vouchers could be exchanged for merchandise at select Internet vendors. Relative to baseline conditions, significant decreases in CO were observed during treatment, and many participants achieved sustained periods of abstinence. The study suggests that an Internet-based voucher reinforcement program is a feasible and effective method to promote abstinence from cigarette smoking.

Donny, EC; Houtsmuller, E.; Stitzer, ML. Smoking in the absence of nicotine: Behavioral, subjective and physiological effects over 11 days. Addiction 102(2): 324-334, 2007. (32 refs.)

Aims: Sensorimotor stimuli associated with tobacco smoking influence smoking behavior; however, current research has focused almost exclusively on the effects of brief, laboratory-based exposure to smoking-related stimuli. The purpose of this experiment was to characterize the effects of smoking stimuli delivered in the absence of nicotine over an extended (11-day) exposure. Design, setting and participants: Thirty adult regular smokers participated in an in-patient study. After assessing preferred brand smoking, participants were assigned randomly to one of three groups corresponding to subsequent smoking conditions: nicotine-containing cigarettes, de-nicotinized cigarettes or no smoking. Measurements: Measures of smoking reinforcement, subjective effects, physiological effects, withdrawal/craving and puff topography were taken repeatedly during both periods of free access and controlled assessments during abstinence. Findings: Daily de-nicotinized cigarette use declined immediately by 1.7 cigarettes/day compared to the preferred brand baseline and declined by another 3.5 cigarettes over time; participants smoking de-nicotinized cigarettes also demonstrated a 31% decline in the number of puffs earned on a progressive ratio, a measure of the motivation to smoke, during the study. Subjective ratings of smoking were largely negative throughout the study in the de-nicotinized group, while the nicotine-containing condition reported increasingly positive subjective effects with repeated exposure. Acute craving suppression following smoking remained evident throughout the study regardless of nicotine content. Conclusions: These effects highlight the importance of non-nicotinc sensorimotor stimuli as determinants of the maintenance of smoking behavior and suggests that extinction of conditioned reinforcement in the absence of nicotine progresses slowly.

El Sony A; Slama K; Salieh M; Elhaj H; Adam K; Hassan A et al. Feasibility of brief tobacco cessation advice for tuberculosis patients: a study from Sudan. International Journal of Tuberculosis and Lung Disease 11(2): 150-155, 2007. (13 refs.)

SETTING: Twenty-four health care centres in Sudan. OBJECTIVE: To examine the feasibility of introducing a tobacco cessation intervention into tuberculosis (TB) treatment programmes. DESIGN: A feasibility study of a tobacco cessation intervention for new cases of pulmonary tuberculosis (PTB) in men compared survey centres (controls) and tobacco cessation intervention centres. Feasibility was evaluated by examining 1) acceptance by health staff and 2) the impact of additional tasks on TB treatment outcomes. A secondary assessment looked at rate of stopping tobacco use among those enrolled in the intervention condition. RESULTS: Staff members did not differ in personal use of tobacco, in enforcing rules banning the use of tobacco at health centres or in rates of recruitment into the study. A total of 513 patients (44% of those eligible) were enrolled. Differences in TB treatment success were found between patients who were enrolled and those who were not: respectively 83% and 59% were cured or completed treatment. Of identified tobacco users undergoing the cessation intervention, 66% reported abstinence at the end of their TB treatment. CONCLUSION: Although differences existed between patients enrolled or not enrolled, the intervention was demonstrated to be feasible to implement and effective for those enrolled within routine TB services.

Etter JF; Burri M; Stapleton J. The impact of pharmaceutical company funding on results of randomized trials of nicotine replacement therapy for smoking cessation: A meta-analysis. Addiction 102(5): 815-822, 2007. (24 refs.)

Aim To assess whether source of funding affected the results of trials of nicotine replacement therapy (NRT) for smoking cessation. Methods We reviewed all randomized controlled trials included in the Cochrane review. There were insufficient non-industry trials of the newer products for these to be included. We included 90 trials of either the nicotine gum (52) or nicotine patch (38). They comprised 18 238 treatment and 16 235 control participants. Forty-nine showed evidence of industry support (18 gum, 31 patch). Results Industry (31 of 49, 63%) compared with non-industry (seven of 41, 17%, P < 0.001) supported a higher proportion of nicotine patch studies and had larger sample sizes (479 versus 268, P = 0.04). Twenty-five (51%) industry trials reported statistically significant (P < 0.05) results, compared with nine (22%) non-industry trials (OR = 3.70, 95% CI = 1.46-9.35). This difference was not explained by trial characteristics. Industry-supported trials had a pooled odds ratio of 1.90 (1.67-2.16), compared with 1.61 (1.43-1.80) for other studies (chi(2) = 3.6, P = 0.058). There was evidence of funnel-plot asymmetry among industry trials (t = 4.35, P < 0.001), but not among other trials, indicating that several small null-effect industry trials may not have reached publication. After imputation adjustment, the odds ratio for industry trials reduced to 1.64 (1.43-1.89) and the overall NRT odds ratio reduced from 1.73 (1.60-1.90) to 1.62 (1.49-1.77). Conclusions: Compared with independent trials, industry-supported trials were more likely to produce statistically significant results and larger odds ratios. These differences persisted after adjustment for basic trial characteristics. Although we had no data on the amount of funding for each trial, it is possible that more resources led to higher treatment compliance and therefore greater efficacy in industry-supported trials. Differences can also possibly be explained by publication bias with several small, null-effect industry studies not having reached publication. After adjustment for this possible bias, results for industry trials were lower and similar to non-industry results. Similarly, the overall estimate of the net effect for these products reduces to about 5% attributable 1-year successes. This remains of considerable public health benefit. Registration of clinical trials has become mandatory in many countries since most of the trials considered here were conducted, and this should reduce the potential for publication bias in future.

Fagan P; Shavers V; Lawrence D; Gibson JT; Ponder P. Cigarette smoking and quitting behaviors among unemployed adults in the United States. Nicotine & Tobacco Research 9(2): 241-248, 2007. (63 refs.)

Little is known about factors associated with smoking among the unemployed. This study estimated the prevalence of smoking and examined sociodemographic factors associated with current, former, and successful quitting among unemployed adults aged 18-64. Cross-sectional data on 13,480 participants in the 1998-1999 and 2001-2002 Tobacco Use Supplements to the Current Population Surveys were analyzed. Multivariate logistic regression analyses were used to examine factors associated with study outcomes (current vs. never, former vs. current, successful quitter vs. other former smoker). Among the unemployed, 35% were current smokers and 13% were former smokers. Of the former smokers, 81% quit successfully for at least 12 months. Participants with family incomes of less than US$25,000 were more likely than those with incomes of $50,000 or more to currently smoke (OR=2.13, 95% CI=1.85-2.46). Service workers and blue-collar workers were less likely than white-collar workers to report former smoking. Participants unemployed for 6 months or more were twice as likely as those unemployed for less than 6 months to quit successfully (OR=2.05, 95% CI=1.07-3.95). Unemployed blue-collar workers had a greater odds ratio of successfully quitting than white-collar workers (OR=1.83, 95% CI=1.17-2.87). Smoking rates were high among the unemployed, and quitting behaviors varied by sociodemographic factors and length of unemployment. Studies are needed to examine the feasibility of cessation interventions for the unemployed.

Font-Mayolas S; Planes M; Gras ME; Sullman MJM. Motivation for change and the pros and cons of smoking in a Spanish population. Addictive Behaviors 32(1): 175-180, 2007. (9 refs.)

Decisional balance and the stage of change have been used to understand the motivation for giving up the habit of smoking. The objective of this study was to find out whether the associations between the pros and the cons of smoking, taking into account the magnitude and delay parameters, and stages of change, can be demonstrated in a sample of Spanish smokers and ex-smokers using a cross-sectional design. The results are compared with the patterns of pros and cons of smoking found in samples of American, Swiss and Dutch smokers. The data confirms that amongst Spanish smokers it is also in the stages of contemplation and preparation that the crossover in the valuation of the pros and cons of smoking takes place: the cons hold more weight than the pros. On the other hand, unexpectedly, the pros of smoking are more highly valued in the stages of action and maintenance than in the rest of the stages.

Fuller BE; Guydish J; Tsoh J; Reid MS; Resnick M; Zammarelli L et al. Attitudes toward the integration of smoking cessation treatment into drug abuse clinics. Journal of Substance Abuse Treatment 32(1): 53-60, 2007. (44 refs.)

This article examines the variables associated with the presence of smoking cessation interventions in drug abuse treatment units, as well as staff attitudes toward the integration of smoking cessation services as a component of care. Surveys were administered to 106 organizations, 348 treatment clinics, and 3,786 employees in agencies that participated in the National Drug Abuse Treatment Clinical Trials Network. Organizational factors, attributes of the treatment setting, and staff attitudes toward smoking cessation treatment were assessed. Use of smoking cessation interventions was associated with the number of additional services offered at clinics, residential detoxification services, and attitudes of the staff toward smoking cessation treatment. Staff attitudes toward integrating smoking cessation services in drug treatment were influenced by the number of pregnant women admitted, the number of ancillary services provided, the attitudes of staff toward evidence-based practices, and whether smoking cessation treatment was offered as a component of care.

Glenn IM; Dallery J. Effects of Internet-based voucher reinforcement and a transdermal nicotine patch on cigarette smoking. Journal of Applied Behavior Analysis 40(1): 1-13, 2007. (57 refs.)

Nicotine replacement products are commonly used to promote smoking cessation, but alternative and complementary methods may increase cessation rates. The current experiment compared the short-term effects of a transdermal nicotine patch to voucher-based reinforcement of smoking abstinence on cigarette smoking. Fourteen heavy smokers (7 men and 7 women) completed the four 5-day phases of the study: baseline, patch treatment, voucher treatment, and return to baseline. The order of the two treatment phases was counterbalanced across participants. In the patch treatment condition, participants wore a 14-mg transdermal nicotine patch every day. In the voucher treatment condition, participants received vouchers contingent on abstinence from smoking, defined as producing carbon monoxide (CO) readings of <= 4 parts per million. Participants e-mailed two video clips per day showing them breathing into a CO monitor and the resulting CO reading to clinic staff. In the voucher treatment, 24% of samples were negative, and 5% of samples were negative in the patch treatment. Results suggest that contingent vouchers were more effective than transdermal nicotine patches in promoting abstinence.

Glover ED; Laflin MT; Schuh KJ; Schuh LM; Nides M; Christen AG et al. A randomized, controlled trial to assess the efficacy and safety of a transdermal delivery system of nicotine/mecamylamine in cigarette smokers. Addiction 102(5): 795-802, 2007. (22 refs.)

Aims: To determine the efficacy and safety of nicotine transdermal therapy co-administered with the nicotine antagonist, mecamylamine, compared to a nicotine transdermal patch alone (21 mg nicotine + 6 mg mecamylamine, 21 mg nicotine + 3 mg mecamylamine, and 21 mg nicotine + 0 mg mecamylamine). Design Multi-center (n = 4), double-blind, randomized, parallel group, repeat-dose study. Setting Clinical laboratory. Participants: A total of 540 subjects were enrolled into the study-135 from each of four sites; 180 patients in each of three treatment arms. Intervention: Treatment was administered for the first 6 weeks of the 8-week study. Patients were instructed to continue smoking for the first 2 weeks of treatment. Measurements: The primary efficacy parameter was 4-week continuous abstinence after the quit date, confirmed with an expired carbon monoxide of < 10 parts per million. Findings Analysis of the 4-week continuous abstinence for the intent-to-treat population showed overall rates of 29% (nicotine + 6 mg mecamylamine), 29% (nicotine + 3 mg mecamylamine) and 23% (nicotine only) using the slip definition which allows smoking in the first 2 weeks after the quit date. Statistical analyses revealed no significant treatment differences. Analyses using the strict definition (no smoking after the quit date) yielded similar non-significant group differences (29%, 27%, 26%). Conclusion: If adding mecamylamine to nicotine replacement therapy (NRT) improves the chances of success at stopping smoking, the results of this study suggest that the effect is very small.

Hall WD. A research agenda for assessing the potential contribution of genomic medicine to tobacco control. Tobacco Control 16(1): 53-58, 2007. (79 refs.)

This paper identifies research priorities in evaluating the ways in which "genomic medicine'' -- the use of genetic information to prevent and treat disease -- may reduce tobacco-related harm by: ( 1) assisting more smokers to quit; ( 2) preventing nonsmokers from beginning to smoke tobacco; and ( 3) reducing the harm caused by tobacco smoking. The method proposed to achieve the first aim is "pharmacogenetics'', the use of genetic information to optimise the selection of smoking- cessation programmes by screening smokers for polymorphisms that predict responses to different methods of smoking cessation. This method competes with the development of more effective forms of smoking cessation that involve vaccinating smokers against the effects of nicotine and using new pharmaceuticals (such as cannabinoid antagonists and nicotine agonists). The second and third aims are more speculative. They include: screening the population for genetic susceptibility to nicotine dependence and intervening ( eg, by vaccinating children and adolescents against the effects of nicotine) to prevent smoking uptake, and screening the population for genetic susceptibility to tobacco- related diseases. A framework is described for future research on these policy options. This includes: epidemiological modelling and economic evaluation to specify the conditions under which these strategies are cost-effective; and social psychological research into the effect of providing genetic information on smokers' preparedness to quit, and the general views of the public on tobacco smoking.

Halpern MT; Dirani R; Schmier JK. Impacts of a smoking cessation benefit among employed populations. Journal of Occupational and Environmental Medicine 49(1): 11-21, 2007. (32 refs.)

Objective: The objective of this study was to project the health and economic impacts of providing a workplace smoking cessation benefit. Methods: The authors conducted an update of a previously published outcomes model using recently published data and clinical trial results. Results: In four example workplace types evaluated, coverage of a cessation benefit resulted in greater numbers of successful cessations and decreased rates of smoking-related diseases. Total savings from benefit coverage (decreased healthcare and workplace costs) exceeded costs of the benefit within 4 years. Total savings per smoker ranged from $350 to $582 at 10 years and $1152 to $1743 at 20 years. Internal rate of return ranged from 39% to 60% at 10 years. Conclusion: Providing a workplace smoking cessation benefit results in substantial health and economic benefits with economic savings exceeding the cost of the benefit within a relatively short period. Clinical Significance: Providing a workplace smoking cessation benefit is projected to increase the rate of smoking cessation as well as decrease the incidence of smoking-related conditions and healthcare costs. In addition, workplace cessation benefits can result in decreased absenteeism, increased productivity, and net cost savings within 4 years.

Ham OK. Stages and processes of smoking cessation among adolescents. Western Journal of Nursing Research 29(3): 301-315, 2007. (30 refs.)

The purpose of this study was to identify the stages and processes of change related to smoking cessation among vocational technical high school students to provide baseline data for smoking cessation programs. Cross-sectional data were collected in April and May, 2004, from 300 mate students at three vocational technical high schools in Korean metropolitan areas. The survey instruments included: decisional balance; self-efficacy; nicotine dependence; stages and processes of change; and knowledge related to smoking. The results indicated that 31.7%, 39.2%, and 29.1% of current smokers were in the precontemplation, contemplation, and preparation stages, respectively, and that 42.6% and 57.4% of former smokers were in the action and maintenance stages, respectively. Decisional balance, self-efficacy, and nicotine dependence were significantly associated with the stages of change. Regarding the processes of change, only behavioral processes were significantly associated with the stages of change, with experiential processes showing no significant relationship. The study results suggest that smoking cessation programs should emphasize behavioral strategies to help students progress through the stages.

Hegaard HK; Kjaergaard H; Moller LF; Wachmann H; Ottesen B. Determination of a saliva cotinine cut-off to distinguish pregnant smokers from pregnant non-smokers. Acta Obstetricia et Gynecologica Scandinavica 86(4): 401-406, 2007. (20 refs.)

Background. Objective validation of smoking status is necessary. Earlier studies have used saliva cotinine concentrations between 14.2 and 30 ng/ml as cut-off values to distinguish pregnant smokers from non-smokers. However, these cut-offs derive from studies including men and non-pregnant women. This constitutes a problem, as recent studies have reported an accelerated metabolism in pregnant smokers. The aim of this study was to determine the optimum cut-off cotinine level distinguishing pregnant smokers from pregnant non-smokers. Methods. An observational study of 620 pregnant women, 359 self-reported smokers and 261 self-reported non-smokers, with complete data on smoking status and saliva cotinine. The study was conducted at a large university hospital in Copenhagen, Denmark. Saliva was sampled at the first antenatal visit to the midwife and analyzed for cotinine level by gas chromatography. Participants completed a questionnaire immediately after the first visit. Results. A saliva cotinine cut-off level of 13 ng/ml, corresponding to a sensitivity of 0.99 and specificity 0.98, was found to be the optimum cut-off value separating pregnant smokers from non-smokers. The sum of the sensitivity and specificity was at its maximum, 1.981. A 95% bootstrap confidence interval for the optimum cut-off was (8 - 14 ng/ml). Conclusion. From the present data we recommend that in future studies on smoking cessation and pregnancy a cut-off level of 13 ng/ml should be applied to distinguish between pregnant smokers and non-smokers.

Hesketh T; Lu L; Jun YX; Mei WH. Smoking, cessation and expenditure in low income Chinese: Cross sectional survey. BMC Public Health 7: article 29, 2007. (34 refs.)

Background: This study was carried-out to explore smoking behaviour and smoking expenditure among low income workers in Eastern China to inform tobacco control policy. Methods: A self-completion questionnaire was administered to 1958 urban workers, 1909 rural workers and 3248 migrant workers in Zhejiang Province, Eastern China in 2004. Results: Overall 54% of the men and 1.8% of all women were current smokers (at least 1 cigarette per day). Smoking was least common in migrant men (51%), compared with 58% of urban workers and 64% rural inhabitants (P < 0.0001). Forty-nine percent of rural males smoke more than 10 cigarettes/day, and 22% over 20/day. The prevalence of smoking increased with age. Overall 9% of the males had successfully quit smoking. Reasons for quitting were to prevent future illness (58%), current illness (31%), family pressures (20%) and financial considerations (20%). Thirteen percent of current smokers had ever tried to quit (cessation for at least one week) while 22% intended to quit, with migrants most likely to intend to quit. Almost all (96%) were aware that smoking was harmful to health, though only 25% were aware of the dangers of passive smoking. A mean of 11% of personal monthly income is spent on smoking rising to a mean of 15.4% in rural smokers. This expenditure was found to have major opportunity costs, including in terms of healthcare access. Conclusion: The prevalence of smoking and successful quitting suggest that smoking prevalence in low income groups in Eastern China may have peaked. Tobacco control should focus on support for quitters, on workplace/public place smoking restrictions and should develop specific programmes in rural areas. Health education messages should emphasise the opportunity costs of smoking and the dangers of passive smoking.

Hughes JR. Depression during tobacco abstinence. (review). Nicotine & Tobacco Research 9(4): 443-446, 2007. (26 refs.)

Many clinicians and scientists believe smoking cessation increases the risk of major depressive disorder , especially among those with a past history of the disorder. This literature review located seven empirical tests of this belief. All seven had significant methodological limitations. The incidence of major depressive disorder over 7-64 weeks postcessation was 0%-14% among all smokers who tried to stop, 3%-24% among smokers with a past history of MDD who tried to stop, and 1%-31% among smokers who became abstinent. Smokers with a past history of major depressive disorder were more likely to have postcessation major depressive disorder. Although some within-study comparisons suggest abstinence increased the incidence of major depressive disorder, a definitive conclusion cannot be made. Whether treatment with antidepressants prevented postcessation major depressive disorder also was unclear. This review makes methodological recommendations for more definitive studies.

Kealey KA; Ludman EJ; Mann SL; Marek PM; Phares MM; Riggs KR et al. Overcoming barriers to recruitment and retention in adolescent smoking cessation. Nicotine & Tobacco Research 9(2): 257-270, 2007. (51 refs.)

Participant recruitment and retention have been identified as challenging aspects of adolescent smoking cessation interventions. Problems associated with low recruitment and retention include identifying smokers, obtaining active parental consent, protecting participants' privacy, respecting participants' autonomy, and making participation relevant and accessible to adolescents. This paper describes nine strategies for minimizing these recruitment and retention problems via a proactive telephone counseling intervention, and reports on their simultaneous implementation among 1,058 smokers from 25 high schools in Washington state. Results are as follows: (a) 85.9% of parents of minor-age seniors provided active consent for their teen's participation, (b) 89.8% of eligible smokers were successfully contacted by counselors, (c) 86.5% of contacted smokers consented to participate in the cessation counseling, (d) 93.8% of consented smokers participated in smoking cessation counseling calls, and (e) 72.2% of participating smokers completed their full intervention. These results demonstrate that older teens who smoke, and their parents, are receptive to confidential cessation counseling that is personally tailored, supportive of their autonomy, and proactively delivered via the telephone.

Kirchner TR; Sayette MA. Effects of smoking abstinence and alcohol consumption on smoking-related outcome expectancies in heavy smokers and tobacco chippers. Nicotine & Tobacco Research 9(3): 365-376, 2007. (43 refs.)

Smoking cessation interventions often target expectancies about the consequences of smoking. Yet little is known about the way smoking-related expectancies vary across different contexts. Two internal contexts that are often linked with smoking relapse are states associated with smoking abstinence and alcohol consumption. This report presents a secondary analysis of data from two experiments designed to examine the influence of smoking abstinence, and smoking abstinence combined with alcohol consumption, on smoking-related outcome expectancies among heavy smokers and tobacco chippers (smokers who had consistently smoked no more than 5 cigarettes/day for at least 2 years). Across both experiments, smoking abstinence and alcohol consumption increased expectancies of positive reinforcement from smoking. In addition, alcohol consumption increased negative reinforcement expectancies among tobacco chippers, such that the expectancies became more similar to those of heavy smokers as tobacco chippers' level of subjective alcohol intoxication increased. Findings suggest that these altered states influence the way smokers evaluate the consequences of smoking, and provide insight into the link between smoking abstinence, alcohol consumption, and smoking behavior.

Kotz D; Wagena EJ; Wesseling G. Smoking cessation practices of Dutch general practitioners, cardiologists, and lung physicians. Respiratory Medicine 101(3): 568-573, 2007. (23 refs.)

Study objectives: To assess and compare the smoking cessation practices and smoking behavior of Dutch general practitioners (GPs), cardiologists, and lung physicians. Methods: We conducted questionnaire surveys among a random sample of 2000 Dutch GPs, all Dutch cardiologists (N = 594), and all Dutch lung physicians (N = 375). Results: In total, 834 GPs (41.7%), 300 cardiologists (50.5%), and 258 lung physicians (68.8%) filled out and returned the questionnaire. The prevalence of current smokers was 8.2% among GPs, 4.3% among cardiologists, and 3.5% among lung physicians. Of the pharmacological aids for smoking cessation, physicians recommended bupropion most frequently, followed by nicotine patches and nicotine gum. More lung physicians recommended the use of these three aids (67.0%, 36.3% and 18.2%, respectively) than GPs (65.7%, 18.7% and 9.8%, respectively), and than cardiologists (31.6%, 19.7% and 13.2%, respectively). A higher proportion of lung physicians (69.3%) had referred at least one smoker to a nurse for smoking cessation treatment than cardiologists (25%), and than GPs (11.3%). Conclusions: Based on this national survey, one may conclude that the prevalence of current smoking among Dutch physicians is relatively tow and has further decreased since 1988. Dutch GPs, cardiologists, and lung physicians mainly use interventions for smoking cessation that are easy to administer and are not very time consuming. Furthermore, more lung physicians than GPs and cardiologists recommend the use of bupropion, nicotine patch, and nicotine gum. When designing interventions for smoking cessation, one should take into account that physicians are often reluctant to provide interventions which demand much time. Therefore, intensive counseling of smokers who want to quit smoking may be more feasible for trained non-physicians, such as nurses.

Krishnan-Sarin S; Reynolds B; Duhig AM; Smith A; Liss T; McFetridge A et al. Behavioral impulsivity predicts treatment outcome in a smoking cessation program for adolescent smokers. Drug and Alcohol Dependence 88(1): 79-82, 2007. (16 refs.)

Objective: To examine the relationship between impulsivity and smoking cessation treatment response among adolescents. Methods: Thirty adolescent smokers participated in a high school based smoking cessation program combining contingency management and cognitive behavioral therapy. Self-report (Barratt impulsiveness scale (BIS-II); Kirby delay discounting measure (DDM)) and behavioral (experiential discounting task (EDT); continuous performance task (CPT)) measures of impulsivity were assessed at treatment onset. Results: Sixteen participants (53%) were abstinent from smoking at completion of the four-week study. Compared to abstinent adolescents, those not achieving abstinence discounted monetary rewards more on the EDT and committed more commission errors on the CPT. Group differences were not observed on the BIS-II or DDM. Conclusions: These preliminary results suggest that specific behavioral measures of impulsivity may be associated with the ability to initiate and/or maintain abstinence from smoking among adolescent smokers.

Lawrence WT; Haslam C. Smoking during pregnancy: Where next for stage-based interventions? Journal of Health Psychology 12(1): 159-169, 2007. (55 refs.)

Pregnancy is a 'window of opportunity' for encouraging positive behaviour change, such as quitting smoking. Associations have been shown between smoking stage of change and other health behaviour during pregnancy. For example, women in the precontemplative stage have poorer assessment of risks associated with smoking, feel less personally responsible for their unborn child's health and in turn are less likely to adopt health-promoting behaviour. Stage of change models are a popular tool within the health services, but the results of stage-based smoking cessation interventions are mixed. Identifying the crucial components of effective interventions is an important imperative for research in this area. This article reviews the literature to ascertain these components and makes recommendations for designing effective interventions.

Le Foll B; Goldberg SR; Sokoloff P. Dopamine D-3 receptor ligands for the treatment of tobacco dependence. Expert Opinion on Investigational Drugs 16(1): 45-57, 2007. (116 refs.)

This review considers the potential use of the dopamine D-3 receptor (DRD3) as a novel therapeutic target for the treatment of tobacco dependence. Among the 5 dopamine receptors identified, the DRD3 is located in the nucleus accumbens, ventral tegmental area and amygdala: 3 brain structures that are implicated in the motivational control of drug-seeking behaviour and drug-conditioning processes. Although it has been proposed that modulating dopamine transmission would be effective in the treatment of drug dependence, no validation has been provided in humans so far. Several highly selective DRD3 ligands have recently been evaluated in preclinical models of drug dependence. These ligands act as DRD3 antagonists in vivo and are able to decrease the motivation to take various drugs of abuse and reduce the influence of associated drug-conditioned behaviour. Of note is that these effects have been found with nicotine-seeking behaviour and nicotine relapse in rodents, suggesting a potential use of these ligands for the treatment of tobacco smokers. In contrast to nicotine replacement therapy, varenicline and bupropion (which are currently used for the treatment of smokers), DRD3 antagonists do not seem to produce nicotine-like effects in experimental animals and, therefore, may not substitute for nicotine or alleviate nicotine withdrawal symptoms in human smokers. This behavioural profile, which was also reported recently with cannabinoid CB, receptor antagonists, may result from effects on specific brain pathways that express DRD3 receptors and are involved in relapse and conditioning processes. These preclinical studies suggest that the clinical evaluation of DRD3 ligands should be performed with clinical trials designed specifically to evaluate the relapse phenomena.

Leung GM; Chan SSC; Johnston JM; Chan SKK; Woo PPS; Chi I et al. Effectiveness of an elderly smoking cessation counseling training program for social workers: A longitudinal study. Chest 131(4): 1157-1165, 2007. (30 refs.)

ground: To achieve greater coverage of the elderly smoking population, the provider/client interface could be broadened to include other professional groups who work with the elderly. We evaluated the effectiveness of a 9-h smoking cessation counseling training program for social workers. Methods: We recruited 177 social workers and used a preintervention/postintervention longitudinal design, analyzed by multilevel, multivariable modeling to adjust for between-subjects covariables and within-subjects correlation in repeated measurements at baseline, 3 months, 6 months, and 12 months after training. Results: Overall,, knowledge improved from a mean score of 6.70 +/- 1.03 (+/- SD) at baseline to 7.35 +/- 0.75 at 12 months (range, 0 to 8 correct responses), attitude from 2.84 +/- 0.41 to 3.10 +/- 0.48, and self-perceived competence from 2.49 +/- 0.38 to 2.85 +/- 0.36 (range, 1 to 4, where 4 is best). On multilevel modeling, three of the four "A"s (ask, advice, assist, arrange as per the Agency for Healthcare Research and Quality framework) registered significant gains from baseline to 12 months overall, whereas "advice" did not show any appreciable change. Conclusion: These findings demonstrate that our smoking cessation training program achieved sustained effectiveness in the first year after training in enhancing knowledge, positively shifting attitudes, boosting self-perceived competence, and increasing the self-reported frequency of practicing three of the four As in their routine interaction with elderly clients.

McRobbie H; Hajek P. Effects of rapid smoking on post-cessation urges to smoke. Addiction 102(3): 483-489, 2007. (30 refs.)

Context: Rapid smoking (RS) is a smoking cessation technique with sufficient indications of promise to warrant further investigation. The main presumed effect of RS is on reducing desire to smoke. Aim: To evaluate the effect of a single session of RS immediately prior to quitting smoking on urges to smoke over the first week of abstinence. Design: Randomized controlled trial. Setting: Specialist smoking cessation clinic (SSCC). Participants A total of 100 smokers attending the quit day session. Intervention: Participants in the rapid smoking group underwent a single session of RS immediately prior to quitting smoking. Participants in the control group watched a health promotion video on giving up smoking. Primary outcome measures: Ratings of urges to smoke in the first 24 hours and 1 week of abstinence. Findings: The RS procedure was well tolerated. It led to significantly lower urges to smoke compared to the control procedure during the first 24 hours (mean rating of 2.6 versus 3.2, P < 0.001) and the first week of abstinence (1.8 versus 2.5, P < 0.01). In patients abstinent for 4 weeks, urges to smoke were low and the difference was no longer significant (1.4 versus 1.8). Conclusion: RS has an 'active ingredient' (craving reduction) and its effects on smoking cessation may merit further examination using modern rigorous methodology.

Meinke L; Chitkara R; Krishna G. Advances in the management of chronic obstructive pulmonary disease. (review). Expert Opinion on Pharmacotherapy 8(1): 23-37, 2007. (150 refs.)

Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death, seems to be increasing in worldwide prevalence, and carries with it a significant health and economic burden. Smoking cessation is the only available intervention proven to halt disease progression. The authors discuss the role of the newly approved agent, varenicline, in promotion of smoking cessation. The remainder of presently available therapies treat the symptoms of COPD, but do not impact progression of disease. As the understanding of the pathogenesis of COPD improves, new targets for therapies are emerging. Given the large number of potential targets and the results of recent studies, it seems unlikely that a single new agent will result in a cure. Rather, management of COPD should involve a multi-pronged approach including smoking cessation, bronchodilators, treatment of infection, and eventual targeting of inflammatory pathways and genetic predispositions. In this article, the authors discuss presently available therapies as well as agents under development.

Messer K; Pierce JP; Zhu SH; Hartman AM; Al-Delaimy WK; Trinidad DR et al. The California tobacco control program's effect on adult smokers: (1) smoking cessation. Tobacco Control 16(2): 85-90, 2007. (50 refs.)

Objectives: To estimate national population trends in long-term smoking cessation by age group and to compare cessation rates in California (CA) with those of two comparison groups of states. Setting: Retrospective smoking history of a population sample from the US: from CA, with a comprehensive tobacco-control programme since 1989 with the goal of denormalising tobacco use; from New York and New Jersey (NY & NJ), with similar high cigarette prices but no comprehensive programme; and from the tobacco-growing states (TGS), with low cigarette prices, no tobacco-control programme and social norms relatively supportive of tobacco use. Participants: Respondents to the Current Population Survey-Tobacco Use Supplements (1992 - 2002; n = 57 918 non-Hispanic white ever-smokers). Main outcome measures: The proportion of recent ever-smokers attaining long-term abstinence (quit >= 1 year) and the successful-quit ratio (the proportion of all ever-smokers abstinent >= 1 year). Results: Nationally, long-term cessation rates increased by 25% from the 1980s to the 1990s, averaging 3.4% per year in the 1990s. Cessation increased for all age groups, and by > 40% (p < 0.001) among smokers aged 20 - 34 years. For smokers aged 50 years, higher cigarette prices were associated with higher quitting rates. For smokers aged,35 years, quitting rates in CA were higher than in either comparison group (p < 0.05). Half of the ever-smokers had quit smoking by age 44 years in CA, 47 years in NY & NJ, and by age 54 years in TGS. Conclusion: Successful smoking cessation increased by 25% during the 1990s in the US. Comprehensive tobacco-control programmes were associated with greater cessation success than were with high cigarette prices alone, although both effects were limited to younger adults.

Miles H; Dutheil L; Welsby I; Haider D. 'Just Say No': A preliminary evaluation of a three-stage model of integrated treatment for substance use problems in conditions of medium security. Journal of Forensic Psychiatry & Psychology 18(2): 141-159, 2007. (53 refs.)

Preliminary outcome data evaluating a three-stage model of integrated treatment for substance use problems in conditions of medium security are presented to address the lack of previous research in this area. Stage 1 and Stage 2 are 12-week treatment groups, supporting participants in becoming and remaining substance free, respectively, through motivational interviewing, psycho-education, and relapse prevention approaches. 'Just Say No' (JSN) is a participant-led social group to support continued abstinence throughout admission and up to six months post-discharge. Case notes of all in-patients in 2005 were screened, revealing that 32 (74%) of inpatients had a prior history of substance use problems. Of the 19 who received treatment, 14 (74%) became abstinent by the end of 2005, rising to 15 (79%, missing 3) by the end of June 2006. However five refused, of whom three (60%) became abstinent, and eight were not referred due to unstable mental state or imminent discharge. There was a significant effect of treatment on whether or not in-patients became drug-free, although only JSN attendance had a significant effect on whether they remained drug-free. By the end of treatment (and maintained at six-month follow-up), participants' self-reported insight and confidence to make changes to their substance use had increased, and there was a trend towards participants reporting more adaptive beliefs about substances and less craving for cannabis. Participants were also satisfied with the treatment intervention.

Mitrouska I; Bouloukaki I; Siafakas NM. Pharmacological approaches to smoking cessation. (review). Pulmonary Pharmacology & Therapeutics 20(3): 220-232, 2007. (144 refs.)

Smoking, the most prominent nongenetic factor contributing to mortality, remains the major public health problem throughout the world. There are nearly 1.1 billion users of nicotine and tobacco products worldwide while approximately one third to half of them will die from smoking-related disease. The habit of smoking is mainly propelled by nicotine, a strongly addictive substance, to which the vast majority of smokers fall victim. Except for the general and specific support and counseling strategies there are now effective treatments for nicotine addiction. Two types of pharmacological therapies have been approved and are now licensed for smoking cessation. The first therapy consists of nicotine replacement, substituting the nicotine from cigarettes with safer nicotine formulations. The second therapy is bupropion, an antidepressant of the aminoketone class, which has been demonstrated to be effective in smoking cessation. However, although some cigarette smokers are able to quit, many are not, and standard medications to assist smoking cessation are ineffective. Several agents used for other indications (e.g. neurological diseases, depression, alcoholism) might be used to treat this subgroup. In conclusion, new more effective drugs are needed in order to fight the panepidemic of smoking globally.

Naqvi NH; Rudrauf D; Damasio H; Bechara A. Damage to the insula disrupts addiction to cigarette smoking. Science 315(5811): 531-534, 2007. (29 refs.)

A number of brain systems have been implicated in addictive behavior, but none have yet been shown to be necessary for maintaining the addiction to cigarette smoking. We found that smokers with brain damage involving the insula, a region implicated in conscious urges, were more likely than smokers with brain damage not involving the insula to undergo a disruption of smoking addiction, characterized by the ability to quit smoking easily, immediately, without relapse, and without persistence of the urge to smoke. This result suggests that the insula is a critical neural substrate in the addiction to smoking.

O'Gara C; Stapleton J; Sutherland G; Guindalini C; Neale B; Breen G et al. Dopamine transporter polymorphisms are associated with short-term response to smoking cessation treatment. Pharmacogenetics and Genomics 17(1): 61-67, 2007. (31 refs.)

Objectives: To examine the association between polymorphisms in the dopamine transporter gene (SLCIGA3, DAT1) and treatment outcome in smokers attempting to quit using either nicotine replacement therapy or bupropion. Methods: The sample consisted of 583 smokers recruited from a smoking cessation clinic, and followed throughout the 4 weeks of post-cessation treatment with behavioural support and either nicotine replacement therapy or bupropion. Results At 1 week after smoking cessation, the 3' untranslated region (3'UTR) variable number of tandem repeats (VNTRs) and the 30-bp intron 8 VNTR DAT1 genotypes were associated with the ability to stop smoking (3'UTR VNTR, odds ratio=2.0, 95% confidence interval = 1.2-3.5, novel intron 8 VNTR, odds ratio = 1.8, 95% confidence interval= 1.0-2.9), controlling for potential confounders. The results were weaker and no longer significant at a 4-week follow-up. Conclusions: We find evidence, although modest, of a medium-sized effect of DAT1 genotype on the ability to stop smoking early in a smoking cessation attempt. If the effect is real, and is strongest in the very early stages of smoking cessation, this suggests that the primary utility of DAT1 screening in this field will be in the identification of those most at risk of early relapse after quitting.

Orr ST; Newton ER; Weismiller DG. Prenatal smoking cessation among Black and White women in eastern North Carolina. American Journal of Health Promotion 21(3): 192-195, 2007. (10 refs.)

Purpose. Limited information is available about Black-White disparities in prenatal smoking cessation, and the results of prior research are inconsistent. We analyzed smoking cessation and factors associated with cessation (attitudes, environment, and nicotine addiction) in a sample (of pregnant Black and While women. Methods. Women were interviewed at the first prenatal visit at two hospital-based clinics. Results. Among former and current smokers, there were no significant differences in the percentage of former smokers between Black (46.8 %) and White (43.3 %) pregnant women, or in the percentage of "spontaneous quitters" (i.e., those who quit after learning that they were pregnant) for Blacks (36 %) and Whites (28 %). Both Black and White spontaneous quitters had evidence of occasional relapses to smoking. For Black and White women, smoking more than a pack a day prior to pregnancy was associated with smoking during pregnancy. Discussion. Among current and former smokers, spontaneous cessation was about the same for Black and While women, and about two thirds of women who were smokers when they learned of the pregnancy continued to smoke during pregnancy. Nicotine addiction contributed to continued smoking.

Pbert L; Jolicoeur D; Reed G; Gammon WL. An evaluation of tobacco treatment specialist counseling performance using standardized patient interviews. Nicotine & Tobacco Research 9(1): 119-128, 2007. (26 refs.)

In the United States, tobacco treatment specialists are professionals from a variety of backgrounds trained to deliver moderate to intensive evidence-based tobacco treatment in a variety of settings across the country. This paper reports the results of a study that examined the extent to which specialists participating in a larger study adhered to clinical practice guidelines for tobacco dependence using standardized patient assessments. A total of 64 tobacco treatment specialists completed a survey and two audiotaped standardized patient interviews. Overall, 41% and 31% of tobacco treatment specialists demonstrated 80% or more of session content and interviewing skills assessed, respectively, when required to demonstrate the skill in both standardized patient interactions. These rates increased to 85% and 56%, respectively, when using the less stringent criteria of demonstrating the skill in at least one of the two standardized patient interactions. Tobacco treatment specialists who had attended a greater number of types of tobacco treatment training exhibited both greater coverage of session content (p < .06) and greater interviewing skills (p < .02). Those who had achieved certification as a tobacco treatment specialist exhibited greater coverage of session content (p < .02), and those perceiving more positive support from their agency for their services exhibited greater interviewing skills (p = .02). Although the tobacco treatment specialists evaluated appear to have the necessary skills to deliver guideline-based intervention, they demonstrated only moderate adherence to the guidelines when expected to do so consistently across multiple assessments. Findings suggest specific components of tobacco treatment and interviewing skills that would benefit from strengthening through training and support.

Price JH; Sidani JE; Price JA. Child and adolescent psychiatrists' practices in assisting their adolescent patients who smoke to quit smoking. Journal of the American Academy of Child and Adolescent Psychiatry 46(1): 60-67, 2007. (40 refs.)

Objective: This national study examined the practices and perceptions of smoking cessation activities among child and adolescent psychiatrists. Method: A random sample of child and adolescent psychiatrists was identified from the membership list of the American Academy of Child and Adolescent Psychiatry and was mailed a valid and reliable 34-item questionnaire. Results: A total of 184 responses (47%) were received. A plurality (48%) of psychiatrists reported being self-taught in smoking cessation techniques. A majority (67%) of psychiatrists were in the maintenance stage for asking about smoking status. However, only 19% consistently made attempts to assess willingness to quit, and 30% consistently gave messages urging the smoker to quit. The perceived number of barriers for addressing smoking was negatively correlated with psychiatrists' levels of confidence (r = -0.35, p < .001) and preparedness (r = -0.39, p < .001) in addressing smoking cessation. Estimations by the psychiatrists of youths who smoked were 61% of those with conduct disorders, 46% of those with schizophrenia, and 40% of those with attention-deficit/hyperactivity disorder. Conclusion: Considering the perceived high rate of patient smoking and the lack of formal training in smoking cessation, more postgraduate education is needed to adequately prepare child and adolescent psychiatrists for addressing tobacco cessation.

Shiffman S. Use of more nicotine lozenges leads to better success in quitting smoking. Addiction 102(5): 809-814, 2007. (22 refs.)

Aims and design: The finding that smokers who used more pieces of nicotine gum achieved better treatment outcomes has been interpreted to indicate that the use of more pieces of gum leads to better treatment outcomes. However, these correlational findings are subject to at least three alternate explanations: (1) reverse causation; (2) a confounding third variable; or (3) behavioral processes. We tested these alternative explanations in secondary analyses of data from a clinical trial of nicotine lozenges. Participants and methods: Subjects (n = 1030) who quit smoking for at least 2 weeks in a placebo-controlled trial of nicotine lozenges were studied. Lozenge use was recorded daily; outcome was assessed as carbon monoxide (CO)-verified 28-day continuous abstinence at 6 weeks. Findings To refute the reverse causation hypothesis we analyzed data on compliance during a period when subjects were abstinent: high use of active lozenge was associated with greater success; for each additional lozenge used, the odds of success increased by 10%. The third variable and behavioral processes hypotheses both predict that high lozenge use will be associated with improved outcomes even in the placebo condition. However, our analyses showed that this was not the case. Further, greater use of lozenges increased the active-placebo difference, as would be expected under a pharmacological explanation of compliance effects. Conclusion: The analyses rebut the alternative explanations, and suggest that use of more nicotine lozenges is causally associated with better quit rates.

Siahpush M; Wakefield M; Spittal M; Durkin S. Antismoking television advertising and socioeconomic variations in calls to Quitline. Journal of Epidemiology and Community Health 61(4): 298-301, 2007. (34 refs.)

Objective: To assess the socioeconomic variations in call rates to the Quitline (Victoria, Australia) and in the impact of anti-tobacco television advertising on call rates. Design: The outcome measure was the number of calls to the Quitline in Victoria for each week for each socioeconomic group for the period January 2001 to March 2004. Socioeconomic status (SES) was derived from the caller's postcode using the Index of Socioeconomic Disadvantage provided by the Australian Bureau of Statistics. The exposure measure was weekly Target Audience Rating Points (TARPs, a standard measure of television advertising weight) for anti-tobacco advertising broadcast in Victoria over the same period. Negative binomial regression was used to examine the interaction of SES and TARPs in their effect on the number of Quitline calls. Results: SES and call rates were positively associated. Adjusted call rate was 57% (95% CI 45% to 69%) higher in the highest than the lowest SES quintile. SES differences in call rates were stable over time. In the study period, the effect of the presence or increasing levels of antismoking TARPs on call rates did not vary across categories of SES. Conclusions: In the study period, different SES groups had a similar level of responsiveness to antismoking television advertisements, at least as measured by the rate of calls to the Quitline. However, the present media campaigns are not likely to diminish SES differences in call rates, and more needs to be done to encourage disadvantaged groups to call the Quitline.

Staten RR; Ridner SL. College students' perspective on smoking cessation: "If the message doesn't speak to me, I don't hear it". Issues in Mental Health Nursing 28(1): 101-115, 2007. (22 refs.)

The purpose of this study was to document the smoking cessation experiences of three groups of 18-24-year-old college students and explore their ideas for cessation. Focus group interviews were conducted with former smokers (n = 7), smokers struggling to quit (n = 7), and smokers with no desire to quit (n = 5). Participants indicated a need for smoking cessation programs that would help the students understand the immediate physiological impact of smoking, addictive nature of nicotine, and benefits of using nicotine replacement therapy. They believed emotional and cognitive strategies for coping with cravings and environmental cues to smoking should be included in smoking cessation programs. Students indicated that cost and convenience were important considerations for smoking cessation programs. They stated that the media messages were for teens and older adults and did not relate to them as college students or young adults.

Stein MD; Anderson BJ; Niaura R. Smoking cessation patterns in methadone-maintained smokers. Nicotine & Tobacco Research 9(3): 421-428, 2007. (48 refs.)

To determine predictors of smoking cessation duration in a randomized clinical trial, we assigned participants to nicotine patch (8-12 weeks) plus either (a) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session, and a relapse prevention follow-up session, or (b) brief advice using the National Cancerer Institute's 4A's model. A total of 383 smokers from five methadone maintenance treatment centers in Rhode Island were enrolled, of whom 312 (82%) completed 6-month follow-up assessments. The primary outcome was longest period of self-reported abstinence during follow-up. Participants were on average 40.5 years of age; 51.9% were male, and 77.6% were White. In multivariate analysis controlling for demographics, nicotine dependence, depressive symptoms, and smoking-related symptoms, we found longer periods of abstinence in persons reporting at least one 24-hr quit attempt in the year prior to baseline (OR=1.97, p=.003), in those anticipating success in cessation (OR=1.33, p=.024), and in those with a greater percentage of nicotine patch use days (OR=2.78, p,. 001). Past quit attempts, self-efficacy, and constant nicotine replacement were associated with duration of abstinence among methadone-maintained smokers. Attention to these domains in future intervention studies may improve treatment success.

Sussman S; Dent CW. Five-year prospective prediction of self-initiated quitting of cigarette smoking of high-risk youth. Addictive Behaviors 32(5): 1094-1098, 2007. (7 refs.)

This paper provides a 5-year replication-extension of a previous 1-year follow-up study of the same sample of southern California alternative high school youth. Demographic, behavioral, psychosocial, and emerging adult function predictors of adolescent self-initiated smoking cessation were investigated. Based on the first (1-year) prospective study and this follow-up, one may speculate that smoking cessation programs for adolescents should include counteraction of problem-prone attitudes, assistance with job aspirations and information about drug-free workplaces, motivation to quit strategies, and assistance with overcoming withdrawal symptoms.

Tait RJ; Hulse GK; Waterreus A; Flicker L; Lautenschlager NT; Jamrozik K et al. Effectiveness of a smoking cessation intervention in older adults. Addiction 102(1): 148-155, 2007. (36 refs.)

To: (a) identify characteristics of older smokers considering cessation of smoking; (b) evaluate a cessation intervention plus access to nicotine replacement therapy (NRT); (c) identify predictors of those who successfully quit; and (d) evaluate the effectiveness of the intervention in those aged >= 75 years. Self-selection of: (a) a cessation of smoking programme; or (b) ongoing smoking. Teaching hospital, Perth, Western Australia. A larger study recruited smokers and never smokers: from this the 215 community-dwelling smokers (>= 5 cigarettes/day) aged >= 68 years (171 males) were enrolled. Brief intervention with telephone support and access to NRT versus no intervention. (a) Profile of older adults planning to quit smoking compared with continuing smokers; (b) cessation at 6 months defined as 30-day point prevalence validated via expired carbon monoxide; and (c) factors predictive of successful cessation. There were 165 intervention participants. Compared with the 50 continuing smokers, participants in the intervention were younger and had significantly less years of regular smoking, more previous quit attempts and greater nicotine dependence scores. At 6 months, the point prevalence of ex-smokers was 25% (n = 42) with 20% (n = 33) being abstinent throughout the study. No continuing smoker had ceased smoking. Among the intervention group, logistic regression showed that those who used NRT (OR 4.36), were male (OR 3.17), had higher anxiety (OR 1.67) or rejected 'more colds and coughs' as a reason for quitting (OR 2.91) were more likely to be successful quitters. Of those aged >= 75 years (n = 77), 25% matched cessation criteria. Older smokers can be engaged successfully in a brief intervention plus NRT as aids to cessation of smoking. The intervention was also effective in the older subgroup of participants. Social factors may provide an additional means of motivating older smokers to quit.

Taylor KL; Cox LS; Zincke N; Mehta L; McGuire C; Gelmann E. Lung cancer screening as a teachable moment for smoking cessation. Lung Cancer 56(1): 125-134, 2007. (34 refs.)

Background: Lung cancer screening may serve as a 'teachable moment' for smoking cessation, a brief period in which motivation to stop smoking is enhanced. Within the context of two NCI-funded randomized lung screening trials, we conducted an ancillary study to explore the impact of screening on smoking cessation and readiness to stop smoking. Methods: We accrued a sample of current and former smokers participating at the Georgetown University site of the Lung Screening Study (LSS; N = 144) and of the National Lung Screening Trial (NLST; N = 169). In each sample, we assessed reasons for trial participation, interest in smoking cessation interventions, motivations for stopping smoking, and the impact of undergoing screening on tobacco use and readiness to stop smoking. Telephone interviews were conducted prior to screening, and 1-month following receipt of the screening result. The samples were analyzed separately due to differences in age and level of nicotine dependence. Results: The majority of the findings were consistent across the two samples. Frequently endorsed reasons for trial participation among both current and former smokers included psychological reasons (e.g., wanting peace of mind about lung cancer) and altruism (e.g., wanting to make a contribution to science). Nicotine replacement therapy and free counseling were the cessation methods that were of most interest, and fear of lung health problems was the most frequently endorsed motivation for quitting smoking. Regarding readiness to stop smoking, approximately 20% were ready to stop in the next 30 days, 45% were ready to stop in the next 6 months, white 35% were not thinking of stopping. At the follow-up, 7% of current smokers at baseline reported abstinence, and 4% of former smokers at baseline reported having relapsed. The findings differed across the two samples when considering the readiness to quit outcome. At the 1-month follow-up of the NLST sample, participants became more ready to stop smoking (p < .05). Screening result did not moderate this finding. In the LSS sample, among younger participants (<= 64), an abnormal screening result was significantly associated with becoming more ready to stop smoking, whereas a normal result was associated with becoming less ready to stop smoking (p = .02). Conclusions: The current findings demonstrated the feasibility of enrolling lung screening participants into a smoking-related research study, as well as the high level of interest in stopping smoking and in smoking cessation interventions. These data indicate that lung cancer screening may serve as a teachable moment for smoking cessation, and suggest that a smoking cessation trial within the context of lung cancer screening is feasible.

Thompson B; Coronado G; Chen L; Thompson LA; Halperin A; Jaffe R et al. Prevalence and characteristics of smokers at 30 Pacific Northwest colleges and universities. Nicotine & Tobacco Research 9(3): 429-438, 2007. (25 refs.)

College is an important transition period during which young adults explore tobacco use. Few large-scale studies have been conducted among college students regarding tobacco use. We initiated a study examining tobacco use in 30 colleges and universities in the Pacific Northwest. We conducted a baseline survey among students. Sample size varied by the school size; for the 14 largest schools, we drew a random sample of all students, oversampling freshmen (n approximate to 750) so that we could recruit and follow a cohort to assess smoking onset during the college years. Of the remaining students, we sampled equivalent numbers of sophomores, juniors, and seniors (n=200 each). For the 16 schools with fewer than 1,350 students, we surveyed all students. We found overall smoking rates of 17.2%. Males (18.6%) were more likely to smoke than females (16.6%; p=.03), and public college students were more likely to smoke (20.5%) than those who attended private independent schools (18.9%; p=.61), whose rates were higher than those of private religious schools (11.6%; p=.001). Overall, college students are light smokers who do not smoke every day of the month. Further, they tend not to be highly dependent on tobacco, do not consider themselves regular smokers, and plan to quit before they graduate (56.8%). School type should be considered when estimating smoking rates among 4-year college students. Data indicate that college smokers wish and plan to quit before graduation, suggesting that efforts to assist smokers in quitting during the college years may be fruitful.

Thuerauf N; Lunkenheimer J; Lunkenheimer B; Sperling W; Bleich S; Schlabeck M et al. Memantine fails to facilitate partial cigarette deprivation in smokers: No role of memantine in the treatment of nicotine dependency? Journal of Neural Transmission 114(3): 351-357, 2007. (50 refs.)

The efficacy of Memantine in the treatment of nicotine dependency in humans remained to be evaluated. The aims of our pilot study were to investigate (1) the effectiveness of Memantine in facilitating smoking reduction and (2) the influence of memantine on the perception of nicotine. In order to achieve these aims we conducted a placebo controlled double-blind parallel group study in smokers (n = 20 per group). Before the beginning of the treatment-phase (10/20mg Memantine per day) all participants were instructed to reduce smoking (partial deprivation). Before and during partial deprivation we registered the daily cigarette consumption and craving estimates. Following nasal stimulation with nicotine enantiomers hedonic and intensity estimates and the discrimination ability were assessed. Memantine failed to facilitate smoking reduction and did not influence the perception of nicotine with the exception of a weak reduction of olfactory intensity estimates reaching statistical significance for one nicotine enantiomer only.

Ton TG; Rossing MA; Bowen DJ; Wilkerson HW; Farin FM. Cholecystokinin C-45T polymorphism and smoking cessation in women. Nicotine & Tobacco Research 9(1): 147-151, 2007. (21 refs.)

In view of the effect of cholecystokinin (CCK) on dopaminergic neurons in the mesolimbic "reward" pathway of the brain, its gene has been a focus in studies of dopamine-related conditions and behaviors, including smoking. We assessed the association between the CCK C-45T polymorphism and smoking cessation among women who participated in a randomized clinical trial of d,l-fenfluramine conducted in the Seattle area in 1993-1994. Several years later (Mdn = 3.3 years, range = 2.4-6.9 years), 593 women provided a biological specimen and updated information about smoking habits. We defined short-term quitting as not smoking for at least 7 days immediately preceding the final (12-month) clinical trial visit, and long-term quitting as not smoking for at least the 6-month interval before the later recontact. CCK C-45T was not associated with either short-term (relative risk [RR] associated with the presence of T allele = 0.9, 95% CI = 0.6-1.4) or long-term (RR = 1.0, 95% CI = 0.6-1.5) smoking cessation. Also, we observed no association of this polymorphism with smoking cessation in subgroups of women defined by age or body mass index. No clear differences were found in smoking cessation rates associated with the presence of the T allele among women treated with d,l-fenfluramine versus those randomized to placebo. Our results fail to support prior evidence of an association of the CCK C-45T polymorphism with the ability to quit smoking.

Twardella D; Brenner H. Effects of practitioner education, practitioner payment and reimbursement of patients' drug costs on smoking cessation in primary care: A cluster randomised trial. Tobacco Control 16(1): 15-21, 2007. (26 refs.)

Objective: To evaluate new strategies to enhance the promotion of smoking cessation in general practice. Design: Cluster randomised trial, 262 factorial design. Setting: 82 medical practices in Germany, including 94 general practitioners. Participants: 577 patients who smoked at least 10 cigarettes per day ( irrespective of their intention to stop smoking) and were aged 36 - 75 years. Interventions: Provision of a 2- h physician group training in smoking cessation methods and direct physician payments for every participant not smoking 12 months after recruitment ( TI, training+ incentive); provision of the same training and direct participant reimbursements for pharmacy costs associated with nicotine replacement therapy or bupropion treatment ( TM, training+ medication). Main outcome measure: Self-reported smoking abstinence obtained at 12 months follow- up and validated by serum cotinine. Results: In intention- to-treat analysis, smoking abstinence at 12 months follow- up was 3% ( 2/ 74), 3% ( 5/ 144), 12% ( 17/ 140) and 15% ( 32/ 219) in the usual care, and interventions TI, TM and TI+ TM, respectively. Applying a mixed logistic regression model, no effect was identified for intervention TI ( odds ratio ( OR) 1.26, 95% confidence interval ( CI) 0.65 to 2.43), but intervention TM strongly increased the odds of cessation ( OR 4.77, 95% CI 2.03 to 11.22). Conclusion: Providing cost-free effective drugs to patients along with improved training opportunities for general practitioners could be an effective measure to achieve successful promotion of smoking cessation in general practice.

Uhl GR; Liu QR; Drgon T; Johnson C; Walther D; Rose JE. Molecular genetics of nicotine dependence and abstinence: whole genome association using 520,000 SNPs. BMC Genetics 8: article 10, 2007. (57 refs.)

Background: Classical genetic studies indicate that nicotine dependence is a substantially heritable complex disorder. Genetic vulnerabilities to nicotine dependence largely overlap with genetic vulnerabilities to dependence on other addictive substances. Successful abstinence from nicotine displays substantial heritable components as well. Some of the heritability for the ability to quit smoking appears to overlap with the genetics of nicotine dependence and some does not. We now report genome wide association studies of nicotine dependent individuals who were successful in abstaining from cigarette smoking, nicotine dependent individuals who were not successful in abstaining and ethnically-matched control subjects free from substantial lifetime use of any addictive substance. Results: These data, and their comparison with data that we have previously obtained from comparisons of four other substance dependent vs control samples support two main ideas: 1) Single nucleotide polymorphisms (SNPs) whose allele frequencies distinguish nicotine-dependent from control individuals identify a set of genes that overlaps significantly with the set of genes that contain markers whose allelic frequencies distinguish the four other substance dependent vs control groups (p < 0.018). 2) SNPs whose allelic frequencies distinguish successful vs unsuccessful abstainers cluster in small genomic regions in ways that are highly unlikely to be due to chance (Monte Carlo p < 0.00001). Conclusion: These clustered SNPs nominate candidate genes for successful abstinence from smoking that are implicated in interesting functions: cell adhesion, enzymes, transcriptional regulators, neurotransmitters and receptors and regulation of DNA, RNA and proteins. As these observations are replicated, they will provide an increasingly-strong basis for understanding mechanisms of successful abstinence, for identifying individuals more or less likely to succeed in smoking cessation efforts and for tailoring therapies so that genotypes can help match smokers with the treatments that are most likely to benefit them.

Unrod M; Smith M; Spring B; DePue J; Redd W; Winkel G. Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians. Journal of General Internal Medicine 22(4): 478-484, 2007. (39 refs.)

OBJECTIVE: The primary care visit represents an important venue for intervening with a large population of smokers. However, physician adherence to the Smoking Cessation Clinical Guideline (5As) remains low. We evaluated the effectiveness of a computer-tailored intervention designed to increase smoking cessation counseling by primary care physicians. METHODS: Physicians and their patients were randomized to either intervention or control conditions. In addition to brief smoking cessation training, intervention physicians and patients received a one-page report that characterized the patients' smoking habit and history and offered tailored recommendations. Physician performance of the 5As was assessed via patient exit interviews. Quit rates and smoking behaviors were assessed 6 months post-intervention via patient phone interviews. Intervention effects were tested in a sample of 70 physicians and 518 of their patients. Results were analyzed via generalized and mixed linear modeling controlling for clustering. MEASUREMENTS AND MAIN RESULTS: Intervention physicians exceeded controls on "Assess" (OR 5.06; 95% CI 3.22, 7.95), "Advise" (OR 2.79; 95% CI 1.70, 4.59), "Assist-set goals" (OR 4.31; 95% CI 2.59, 7.16), "Assist provide written materials" (OR 5.14; 95% CI 2.60, 10.14), "Assist-provide referral" (OR 6.48; 95% CI 3.11, 13.49), "Assist-discuss medication" (OR 4.72; 95% CI 2.90, 7.68), and "Arrange" (OR 8.14; 95% CI 3.98, 16.68), all p values being < 0.0001. Intervention patients were 1.77 (CI 0.94, 3.34, p = 0.078) times more likely than controls to be abstinent (12 versus 8%), a difference that approached, but did not reach statistical significance, and surpassed controls on number of days quit (18.4 versus 12.2, p < .05) but not on number of quit attempts. CONCLUSIONS: The use of a brief computer-tailored report improved physicians' implementation of the 5As and had a modest effect on patients' smoking behaviors 6 months postintervention.

Wadland WC; Holtrop JS; Weismantel D; Patbak PK; Fadel H; Powell J. Practice-based referrals to a tobacco cessation quit line: Assessing the impact of comparative feedback vs general reminders. Annals of Family Medicine 5(2): 135-142, 2007. (36 refs.)

PURPOSE We undertook a study to assess the impact of comparative feedback vs general reminders on practice-based referrals to a tobacco cessation quit line and estimated costs for projected quit responses. METHODS We conducted a group-randomized clinical trial comparing the impact of 6 quarterly (18 months) feedback reports (intervention) with that of general reminders (control) on practice-based clinician referrals to a quit-line service. Feedback reports were based on an Achievable Benchmark of Care approach using baseline practice, clinician, and patient survey responses, and referrals per quarter. Comparable quit responses and costs were estimated. RESULTS Three hundred eight clinicians participated (171 family medicine, 88 internal medicine, 49 obstetrics-gynecology) from 87 primary care practices in Michigan. After 18 months, there were more referrals from the intervention than from the control practices (484 vs 220; P < .001). Practice facsimile (fax) referrals (84%, n = 595) exceeded telephone referrals (16%, In = 109), but telephone referrals resulted in greater likelihood of enrollment (77% telephone vs 44% fax, P < .001). The estimated number of smokers who quit based on the level of services utilized by referred smokers was 66 in the feedback and 36 in the gentle reminder practices. CONCLUSION Providing comparative feedback on clinician referrals to a quit-line service had a modest impact with limited increased costs.

Walsh PM; Carrillo P; Flores G; Masuet C; Morchon S; Ramon JM. Effects of partner smoking status and gender on long term abstinence rates of patients receiving smoking cessation treatment. Addictive Behaviors 32(1): 128-136, 2007. (19 refs.)

Aims: To assess the effect of partner smoking status on the success of a cessation program. Design: Prospective cohort. Setting: Smoking Cessation Unit in Hospital of Bellvitge (Hospitalet de Llobregat, Barcelona). Participants: A total of 1516 smokers of 10 or more cigarettes who started a smoking cessation program between January 1995 and December 2001 were included. Measurements: All patients gave information about smoking history and smoking partner status. Abstinence was determined by carbon monoxide exhaled. Findings: Significant differences were found in the abstinence rates at 12 months by smoking partner status: abstinence was achieved by 28.3% of patients with smoking partner, and by 46.5% of patients without smoking partner (p < 0.001). Subjects whose partner was smoking at the beginning of the program appear to be more likely to relapse than subjects without smoking partners (p < 0.001) and this is more pronounced in women than in men. However no significant gender differences were found in any group of smoking partner status. Conclusions: Having a smoking partner is a determinant of relapse 1 year after the beginning of the cessation program. Interacting not just with the smoker, but also with his or her partner, could neutralize interpersonal influences making smokers more accessible to behavioural and pharmacological techniques.

Weinberger AH; Sacco KA; Creeden CL; Vessicchio JC; Jadow PI; George TP. Effects of acute abstinence, reinstatement, and mecamylamine on biochemical and behavioral measures of cigarette smoking in schizophrenia. Schizophrenia Research 91(1-3): 217-225, 2007. (54 refs.)

Background: Schizophrenics have higher rates of smoking than the general population, and more difficulty with smoking cessation. However, there has been little study of differences between schizophrenics and controls with respect to biochemical and behavioral indices of smoking. We compared smokers with schizophrenia (SS; n=27) and control smokers (CS; n=26) on smoking and psychiatric outcomes at baseline, during acute smoking abstinence and reinstatement, and with pre-treatment using the nicotinic acetylcholine receptor (nAChR) antagonist mecamylamine (MEC) in a human laboratory setting. Methods: Biochemical (e.g., plasma nicotine) and behavioral (e.g., craving, withdrawal) outcomes were assessed at baseline, after overnight abstinence, and after smoking reinstatement during three consecutive test weeks. Each week, participants received one of three doses of MEC (0.0, 5.0, or 10.0 mg/day x 3 days) in a randomized, counterbalanced manner. Results: Compared to CS, SS displayed similar levels of craving and withdrawal, but higher plasma nicotine and cotinine levels, and cotinine/CPD ratio. During reinstatement, SS consumed significantly more cigarettes than CS, but MEC did not significantly alter indices of smoking, psychiatric symptoms, or cigarette consumption during reinstatement. Conclusions: 1) The reinforcing effects of smoking may be increased in SS versus CS after overnight abstinence; 2) the lack of effects of nAChR antagonism may suggest that non-nicotinic components of cigarettes may contribute to the behavioral effects of smoking in both SS and CS; and 3) consistent with previous studies, SS may exhibit higher baseline levels of nicotine and cotinine, and greater extraction of nicotine per cigarette than CS.

West R. The clinical significance of 'small' effects of smoking cessation treatments. (editorial). Addiction 102(4): 506-509, 2007. (20 refs.)

Zierler-Brown SL; Kyle JA. Oral varenicline for smoking cessation. Annals of Pharmacotherapy 41(1): 95-99, 2007. (26 refs.)

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of varenicline and provide a review of relevant clinical data. DATA SOURCES: A MEDLINE search (2001-December 2006) was conducted using the key words varenicline and nicotine replacement therapy for clinical trials limited to human subjects and published in English. STUDY SELECTION AND DATA EXTRACTION: All available human trials of varenicline were selected for review. References cited in identified articles were used for additional citations. DATA SYNTHESIS: Varenicline selectively targets the alpha(4)beta(2) nicotine receptors in the brain that are responsible for cravings and withdrawal associated with nicotine use and dependence. Maximal plasma concentration occurs within 3-4 hours after administration and, after multiple doses, a steady-state concentration is reached within 4 days. Varenicline has a half-life of 24 hours. Oral bioavailability is not affected by food or time of administration. It exhibits linear pharmacokinetics; and low plasma protein binding (<= 20%) regardless of a patient's age and renal status. It can be administered once daily. Dosage adjustments are not required in patients with hepatic insufficiency, but adjustments may be necessary in patients with severe renal insufficiency. Clinically significant drug-drug interactions have not been observed with varenicline or co-inhibitors of the human organic cation transporter, which mediates renal secretion of varenicline. Substrates such as warfarin, digoxin, cimetidine, metformin, bupropion, and transdermal nicotine do not alter pharmacokinetic parameters when coadministered with varenicline. In vitro studies have not demonstrated alterations in cytochrome P450 enzyme parameters. Varenicline's safety with coadministration of nicotine replacement products has not been well established. CONCLUSIONS: Varenicline is an effective oral agent for smoking cessation.