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CORK Bibliography: Smoking Cessation

93 citations. January 2009 to present

Prepared: June 2003

Abrantes AM; Lee CS; MacPherson L; Strong DR; Borrelli B; Brown RA. Health risk behaviors in relation to making a smoking quit attempt among adolescents. Journal of Behavioral Medicine 32(2): 142-149, 2009. (37 refs.)

The primary aim of this study was to examine youth risk behaviors in relation to: (a) making a smoking quit attempt, and (b) successful cessation among adolescent smokers. Data were analyzed from the public use dataset of the 2003 national school-based Youth Risk Behavior Survey. The sample consisted of 2,033 students (weighted mean age of 16.3 years, 49.8% female, 73.6% White) who reported a history of daily smoking. While almost two-thirds (63.5%) of adolescent smokers reported making a quit attempt in the last year, only 10% of those were able to successfully quit. Factors associated with making a quit attempt included depression and participating in sports while high-risk sexual activity and engaging in substance use other than alcohol or marijuana were negatively related to making a quit attempt. Externalizing health behaviors (e.g., fighting, drug use, and high risk sexual activity) were associated with decreased likelihood of cessation. Findings from this study may inform efforts to develop more effective smoking prevention and treatment programs for youth.

Adelman WP. Nicotine nasal spray neither effective nor well-tolerated by adolescent smokers. (editorial). Journal of Pediatrics 154(3): 462-463, 2009. (1 refs.)

Agosti V; Levin FR. Does remission from alcohol and drug use disorders increase the likelihood of smoking cessation among nicotine dependent young adults? Social Psychiatry and Psychiatric Epidemiology 44(2): 120-124, 2009. (39 refs.)

Background: This article tests the hypothesis that remission from substance use disorders is associated with smoking cessation in nicotine dependent young adults. Design and methods: The sample was composed of 976 young adults with lifetime substance use disorders and nicotine dependence who were subjects in the national epidemiologic survey on alcohol abuse and related conditions (NESARC). The Associated Disabilities Interview Schedule-DSM-IV Version was used to assess lifetime and past year psychiatric disorders. Results Past year nicotine cessation was obtained by self-report. Remission from substance use disorders was defined as the past year absence of DSM-IV substance use disorders. This study found that remission from substance use disorders increased the likelihood of smoking abstinence (OR = 1.7). Conclusions: Our study found that remission from substance use disorders increased the likelihood of smoking abstinence in early adulthood. This finding is congruent with results from longitudinal studies.

Alhatem F; Black JE. Varenicline-induced mania in a bipolar patient. (review). Clinical Neuropharmacology 32(2): 117-118, 2009. (13 refs.)

Objective: Varenicline is a novel antismoking agent that reduces cravings and blocks pleasure of nicotine by serving as a partial agonist to the nicotinic receptor. Varencicline was initially described as easily tolerated and without any special psychiatric precautions, but it was studied exclusively in normal populations. We report on a bipolar patient who developed a manic episode after treatment with varenicline. Methods: The patient was interviewed and examined, and additional information was obtained from the medical record. The Naranjo adverse drug reaction scale was applied. Relevant literature was reviewed. Conclusion: Postmarketing reports of neuropsychiatric problems have recently led to a general warning to monitor for such symptoms. The bipolar patient described here became manic shortly after treatment with varenicline. We suggest close observation of patients with bipolar disorder on varenicline and further study varenicline-induced neuropsychiatric symptoms among mentally ill patients.

Allen SS; Allen AM; Pomerleau CS. Influence of phase-related variability in premenstrual symptomatology, mood, smoking withdrawal, and smoking behavior during ad libitum smoking, on smoking cessation outcome. Addictive Behaviors 34(1): 107-111, 2009. (25 refs.)

Emerging evidence suggests that women have a more difficult time quitting smoking than men -- possibly due, in part, to sex hormones. The present study characterized mood, premenstrual symptomatology, and smoking withdrawal, as well as smoking behavior, in the follicular and luteal phases during ad libitum smoking in 25 women intending to quit. We also investigated the possible influence of phase-related variability in these measures on likelihood of study adherence and smoking cessation. We found that premenstrual symptomatology. as well as some measures of mood and smoking withdrawal, were significantly higher during the luteal phase than in the follicular phase. Cigarettes/day did not vary by Menstrual cycle phase. Phase-related variability in premenstrual symptomatology [F(3, 20) = 2.82, p = 0.0650)] and urge to smoke [F(2, 21) = 4.85, p = 0.0186)] were associated with relapse. These data support the inference that sex hormones influence smoking cessation outcome. This knowledge may contribute to the development of more rational and effective smoking cessation interventions for women.

Andersen MR; Simonsen U; Uldbjerg N; Aalkjaer C; Stender S. Smoking cessation early in pregnancy and birth weight, length, head circumference, and endothelial nitric oxide synthase activity in umbilical and chorionic vessels: An observational study of healthy singleton pregnancies. Circulation 119(6): 857-864, 2009. (41 refs.)

Background-Reduced production of the vasodilator nitric oxide (NO) in fetal vessels in pregnant smokers may lower the blood flow to the fetus and result in lower birth weight, length, and head circumference. The present study measured endothelial NO synthase (eNOS) activity in fetal umbilical and chorionic vessels from nonsmokers, smokers, and ex-smokers and related the findings to the fetal outcome. Methods and Results-Of 266 healthy, singleton pregnancies, 182 women were nonsmokers, 43 were smokers, and 41 stopped smoking early in pregnancy. eNOS activity and concentration were quantified in endothelial cells of the fetal vessels. Cotinine, lipid profiles, estradiol, L-arginine, and dimethylarginines that may affect NO production were determined in maternal and fetal blood. Serum cotinine verified self-reported smoking. Newborns of smokers had a lower weight (P <= 0.001) and a smaller head circumference (P <= 0.041) and were shorter (P <= 0.001) than newborns of nonsmokers and ex-smokers. eNOS activity in umbilical veins of smokers was 36% lower (P<0.001), eNOS concentration was 47% lower (P<0.001), and the fetal plasma level of high-density lipoprotein was 18% lower (P<0.001) than those of nonsmokers, whereas the same levels were found in umbilical veins from ex-smokers and nonsmokers. The same patterns in eNOS activity and concentration were found in umbilical arteries and chorionic vessels. Fetal plasma levels of estradiol, L-arginine, dimethylarginines, total cholesterol, and triglycerides were similar for nonsmokers, smokers, and ex-smokers. Conclusions-The findings suggest that maternal smoking reduces eNOS activity in the fetal vascular bed, contributing to retarded fetal growth caused by the reduction of vasodilatory capacity, and suggest that smoking cessation early in pregnancy prevents these effects in newborns.

Au DH; Bryson CL; Chien JW; Sun HL; Udris EM; Evans LE et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. Journal of General Internal Medicine 24(4): 457-463, 2009. (37 refs.)

Smoking cessation has been demonstrated to reduce the rate of loss of lung function and mortality among patients with mild to moderate chronic obstructive pulmonary disease (COPD). There is a paucity of evidence about the effects of smoking cessation on the risk of COPD exacerbations. We sought to examine whether smoking status and the duration of abstinence from tobacco smoke is associated with a decreased risk of COPD exacerbations. We assessed current smoking status and duration of smoking abstinence by self-report. Our primary outcome was either an inpatient or outpatient COPD exacerbation. We used Cox regression to estimate the risk of COPD exacerbation associated with smoking status and duration of smoking cessation. We performed a cohort study of 23,971 veterans who were current and past smokers and had been seen in one of seven Department of Veterans Affairs (VA) primary care clinics throughout the US. In comparison to current smokers, ex-smokers had a significantly reduced risk of COPD exacerbation after adjusting for age, comorbidity, markers of COPD severity and socio-economic status (adjusted HR 0.78, 95% CI 0.75-0.87). The magnitude of the reduced risk was dependent on the duration of smoking abstinence (adjusted HR: quit < 1 year, 1.04; 95% CI 0.87-1.26; 1-5 years 0.93, 95% CI 0.79-1.08; 5-10 years 0.84, 95% CI 0.70-1.00; a parts per thousand yen10 years 0.65, 95% CI 0.58-0.74; linear trend < 0.001). Smoking cessation is associated with a reduced risk of COPD exacerbations, and the described reduction is dependent upon the duration of abstinence.

Aubin HJ. Management of emergent psychiatric symptoms during smoking cessation. (review). Current Medical Research and Opinion 25(2): 519-525, 2009. (46 refs.)

Background: Tobacco smoking is a major risk factor for cardiovascular disease, respiratory disease and cancer and, for current smokers, smoking cessation is one of the most effective therapeutic interventions for reducing the risk of all-cause morbidity and mortality. However, smoking cessation causes nicotine withdrawal syndrome, a condition with symptoms that overlap those of major depression and anxiety disorders. Scope: The objective of this review was to examine the evidence that smoking cessation may be associated with new onset of psychiatric illness, particularly in individuals with no history of psychiatric disease, and to provide recommendations for the management of emergent psychiatric symptoms in smokers attempting cessation. Relevant articles were obtained from a MEDLINE search (articles indexed up to, and including, October 2008, with no historical date limit), and citation review of selected primary and review articles. Findings: There is evidence that smoking cessation can result in new onset of major depressive disorder, even in individuals with no history of depression. It has also been suggested that nicotine may be used as a form of self-medication for depression, and that smoking cessation can reveal a previously undiagnosed condition. There is little evidence of an association between smoking cessation and increased risk for other types of psychiatric illness. The management of emergent psychiatric symptoms in smokers attempting abstinence is discussed. Conclusion: The overall health benefits of quitting smoking undoubtedly outweigh any potential side-effects associated with nicotine withdrawal. However, a well-managed quit attempt must plan for the emergence of nicotine withdrawal, monitor for symptoms of depression and psychiatric disease, and manage these conditions appropriately should they present.

Avila-Tang E; Apelberg BJ; Yamaguchi N; Katanoda K; Sobue T; Samet JM. Modelling the health benefits of smoking cessation in Japan. Tobacco Control 18(1): 10-17, 2009. (20 refs.)

Background: In Japan, tobacco smoking is one of the main avoidable causes of disease and death. Although the benefits of smoking cessation for reducing disease risk and increasing longevity have been extensively documented, a relatively low proportion of Japanese smokers currently express a willingness to quit. This study attempted to quantify future reduction in the burden of smoking-attributable disease that could result from increases in smoking cessation. Methods: A simulation model was developed to project changes in mortality in Japan associated with increased quit attempts and use of nicotine replacement therapy (NRT) among smokers, incorporating data on smoking prevalence, cause-specific mortality rates, quitting behaviour and NRT use and effectiveness. Results: Approximately 46 000 lung cancer deaths and 56 000 cardiovascular disease deaths could be avoided over 20 years if the proportion of smokers making a quit attempt per year gradually increased to current US levels over 20 years. If each of these quit attempts were aided by NRT, the estimates of avoidable deaths would increase to 64 000 for lung cancer and 78 000 for cardiovascular disease. In this model, negligible deaths were avoided due to decreased smoking initiation over the 20-year simulation. Conclusion: Smoking cessation can have measurable short-term impacts on the smoking-related mortality burden in Japan. However, to achieve these gains, tobacco control policies should focus both on increasing smokers' willingness to quit and providing the support and therapies to increase the likelihood that smoking cessation attempts will succeed.

Baca CT; Yahne CE. Smoking cessation during substance abuse treatment: What you need to know. (review). Journal of Substance Abuse Treatment 36(2): 205-219, 2009. (195 refs.)

Patients in substance abuse treatment frequently smoke cigarettes and often die of tobacco-related causes. Substance abuse treatment programs too often ignore tobacco use. Many patients have expressed interest in stopping smoking, although they may be ambivalent about smoking cessation during substance abuse treatment. This article provides a review of tobacco cessation literature and successful methods of intervention. Research supports two key findings: (a) smoking cessation during substance abuse treatment does not impair outcome of the presenting substance abuse problem and (b) smoking cessation may actually enhance outcome success. We will discuss how to incorporate smoking cessation.

Baker A; Richmond R; Castle D; Kulkarni J; Kay-Lambkin F; Sakrouge R et al. Coronary heart disease risk reduction intervention among overweight smokers with a psychotic disorder: Pilot trial. Australian and New Zealand Journal of Psychiatry 43(2): 129-135, 2009. (26 refs.)

Objective: The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing (i) coronary heart disease (CHD) risk; (ii) smoking; and (iii) weight among smokers with psychosis. Secondary dependent variables included physical activity, unhealthy eating, substance use, psychiatric symptomatology, treatment retention, general functioning, and quality of life. Method: This was a feasibility study utilizing a pre-post-treatment design with no control group (n=43). All participants provided written informed consent and were assessed before treatment and again a mean of 19.6 weeks later. The treatment consisted of nine individual 1 h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy, in addition to treatment as usual. Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessments. Results: The intervention was associated with significant reductions in CHD risk scores, smoking and weight. A significant improvement was also reported in level of moderate physical activity, and a small change in the unhealthy eating index was reported. No improvement in biological measures (cholesterol and blood pressure) was evident. Conclusions: A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term. A randomized controlled trial replicating and extending these findings is warranted.

Barnett R; Pearce J; Moon G. Community inequality and smoking cessation in New Zealand, 1981-2006. Social Science & Medicine 68(5): 876-884, 2009. (75 refs.)

The overall prevalence of smoking in New Zealand reduced from 32% in 1981 to 23.5% in 2006 but rates of smoking cessation have not been consistent among all social, demographic and ethnic groups. The period 1981-2006 also saw macroeconomic changes in New Zealand that resulted in profound increases in social and economic inequalities. Within this socio-political context we address two questions. First, has there been a social polarisation in smoking prevalence and cessation in New Zealand between 1981 and 2006? Second, to what extent can ethnic variation in rates of quitting be explained by community inequality, independently of socio-economic status? We find that smoking behaviour in New Zealand has become socially and ethnically more polarised over the past two decades, with greater levels of smoking cessation among higher socio-economic groups, and among New Zealanders of European origin. Variations in quit rates between Maori and European New Zealanders cannot be fully accounted for by ethnic differences in socio-economic status. Community inequality exerted a significant influence on Maori (but not European) smoking quit rates. The association with community inequality was particularly profound among women, and for particular age groups living in urban areas. These findings extend the international evidence for a relationship between social inequality and health, and in particular smoking behaviour. The research also confirms the importance of considering the role of contextual factors when attempting to elucidate the mechanisms linking socio-economic factors to health outcomes. Our findings emphasise that, if future smoking cessation strategies are to be successful, attention has to shift from policies that focus solely on engineering individual behavioural change, to an inclusion of the role of environmental stressors such as community inequality

Benowitz NL; Dains KM; Hall SM; Stewart S; Wilson M; Dempsey D et al. Progressive commercial cigarette yield reduction: Biochemical exposure and behavioral assessment. Cancer Epidemiology, Biomarkers & Prevention 18(3): 876-883, 2009. (28 refs.)

Background: Mandated reduction of exposure to nicotine and other cigarette toxins has been proposed as a possible national regulatory strategy. However, tapering using lower yield commercial cigarettes may not be effective in reducing nicotine or tar exposure due to compensatory smoking behavior. We examined the effects of gradual reduction of nicotine yield in commercial cigarettes on smoking behavior, with an assessment of nicotine intake and exposure to tobacco smoke toxins. Methods: This 10-week longitudinal study of 20 smokers involved smoking the usual brand followed by different brands with progressively lower machine-determined yields, ranging from 0.9 to 0.1 mg nicotine, each smoked for 1 week. Subjects were followed for 4 weeks after returning to smoking the usual brand (or quitting). Smoking behaviors, biomarkers of tobacco smoke exposure, and cardiovascular effects were measured. Findings: Cotinine and other biomarkers of smoke exposure remained unchanged comparing the usual brand with the 0.4 mg nicotine brands. A 30% to 40% decrease in nicotine, carbon monoxide, and carcinogen exposure comparing 0.1 mg nicotine cigarettes with baseline was observed. Self-efficacy was significantly increased and dependence decreased after tapering. Implications: We confirm prior cross-sectional population and experimental studies showing complete compensation for cigarettes down to the 0.4 mg nicotine range. Nicotine and tobacco toxin exposure were substantially reduced while smoking 0.1 mg nicotine cigarettes. Our data suggest that the degree of nicotine dependence of smokers may be lowered with progressive yield tapering. Gradual tapering of smokers from regular to ultralow nicotine yield commercial cigarettes might facilitate smoking cessation and warrants future research.

Branstetter SA; Horn K; Dino G; Zhang JJ. Beyond quitting: Predictors of teen smoking cessation, reduction and acceleration following a school-based intervention. Drug and Alcohol Dependence 99(1-3): 160-168, 2009. (58 refs.)

There remains a great need for effective, cost-efficient, and acceptable youth smoking cessation interventions. Unfortunately, only a few interventions have been demonstrated to increase quit rates among youth smokers, and little is known about how elements of cessation interventions and participants' psychosocial characteristics and smoking histories interact to influence program outcomes. Additionally, few studies have examined how these variables lead to complete smoking abstinence, reduction or acceleration over the course of a structured cessation intervention. Data for the present investigation were drawn from a sample of teen smokers (n = 5892) who voluntarily participated in either a controlled study or field Study (i.e., no control group) of the American Lung Association's Not On Tobacco (N-O-T) program between 1998 and 2006 in five states. Results suggest that those who reduce smoking (but do not achieve full abstinence) are similar to those who quit on most measures except stage of change. Furthermore, it was found that those who increased smoking were heavier smokers at baseline, more addicted, were more likely to have parents. siblings, and significant others who smoked and reported less confidence in and less motivation for quitting than did those who quit or reduced smoking. Finally, a path model demonstrated how peers, siblings and romantic partners affected tobacco use and cessation outcomes differently for males and females, Implications for interventions are discussed.

Breitling LP; Dahmen N; Mittelstrass K; Illig T; Rujescu D; Raum E et al. Smoking cessation and variations in nicotinic acetylcholine receptor subunits alpha-5, alpha-3, and beta-4 Genes. Biological Psychiatry 65(8): 691-695, 2009. (26 refs.)

Background: Evidence has recently accumulated that single nucleotide polymorphisms in the genetic region encoding the nicotinic acetylcholine receptor subunits alpha-5, alpha-3, and beta-4 are associated with smoking and nicotine dependence. We aimed to determine whether these genetic variations are also predictive of smoking cessation. Methods: Lifetime history of smoking was assessed by questionnaire at enrolment into a large epidemiological study of the German elderly population (ESTHER study). Cox proportional hazards modeling was applied in a retrospective cohort approach to determine the associations of individual polymorphisms and haplotypes with smoking cessation probability in 1446 subjects who reported regularly smoking more than 20 cigarettes at some point in their lives. Results: Given the genotype distributions and number of cessation events observed, the power to detect associations ranged from 54% to 97% for hazard ratios of 1.2 to 1.4 in case of the variant with strongest prior evidence (alpha = .05). Nonetheless, neither individual polymorphisms nor inferred multilocus haplotypes were significantly associated with smoking cessation. Conclusions: Although the robust association of the nicotinic acetylcholine receptor subunit genes investigated with smoking-related phenotypes is an apparent success story of genetic epidemiology, the respective variations seem to exert no relevant influence on smoking cessation probability in heavy smokers in the general population.

Cabezas C; Martin C; Granollers S; Morera C; Ballve JL; Zarza E et al. Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): Design of a cluster randomised trial. BMC Public Health 9: e-article 48, 2009. (33 refs.)

Background: There is a considerable body of evidence on the effectiveness of specific interventions in individuals who wish to quit smoking. However, there are no large-scale studies testing the whole range of interventions currently recommended for helping people to give up smoking; specifically those interventions that include motivational interviews for individuals who are not interested in quitting smoking in the immediate to short term. Furthermore, many of the published studies were undertaken in specialized units or by a small group of motivated primary care centres. The objective of the study is to evaluate the effectiveness of a stepped smoking cessation intervention based on a trans-theoretical model of change, applied to an extensive group of Primary Care Centres (PCC). Methods/Design: Cluster randomised clinical trial. Unit of randomization: basic unit of care consisting of a family physician and a nurse, both of whom care for the same population (aprox. 2000 people). Intention to treat analysis. Study population: Smokers (n = 3024) aged 14 to 75 years consulting for any reason to PCC and who provided written informed consent to participate in the trial. Intervention: 6-month implementation of recommendations of a Clinical Practice Guideline which includes brief motivational interviews for smokers at the precontemplation - contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help, and reinforcing intervention in the maintenance stage. Control group: usual care. Outcome measures: Self-reported abstinence confirmed by exhaled air carbon monoxide concentration of <= 10 parts per million. Points of assessment: end of intervention period and 1 and 2 years post-intervention; continuous abstinence rate for 1 year; change in smoking cessation stage; health status measured by SF-36. Discussion: The application of a stepped intervention based on the stages of a change model is possible under real and diverse clinical practice conditions, and improves the smoking cessation success rate in smokers, besides of their intention or not to give up smoking at baseline.

Cahill K; Stead L; Lancaster T. A preliminary benefit-risk assessment of varenicline in smoking cessation. (review). Drug Safety 32(2): 119-135, 2009. (52 refs.)

Varenicline is a recently developed medication for smoking cessation, which has been available on prescription since 2006. It is a selective nicotinic acetylcholine receptor partial agonist, and is designed to reduce withdrawal symptoms and to lessen the rewards of continued smoking. Our objective in this article is to assess the efficacy of varenicline as an aid to smoking cessation and to weigh the potential benefits against the possible risks. We identified ten randomized controlled trials and one cohort study with historical controls. In total there were 7999 participants, 5112 of whom received varenicline. Eight of the trials compared varenicline with placebo for cessation, two compared it with nicotine replacement therapy and one tested extended use for relapse prevention. Three of the varenicline/placebo trials also included a bupropion arm. The recommended dosage of varenicline 1 mg twice daily more than doubled the chances of quitting at 6 months or longer, with a relative risk (RR) compared with placebo of 2.38 (95% CI 2.00, 2.84). It also outperformed bupropion (RR 1.52 [95% CI 1.22, 1.88]) and nicotine replacement (RR 1.31 [95% Cl 1.0 1, 1.71]). A reduced dosage regimen of 1 mg daily also increased cessation (RR 1.88 [95% Cl 1.35, 2.60]). In the trials, varenicline significantly reduced craving and other withdrawal symptoms. The most frequent adverse event was nausea, occurring in 30-40% of varenicline users. However, this was generally reported at mild to moderate levels, diminished over time and was associated with attributable discontinuation rates of between 0.6% and 7.6%. Other commonly occurring adverse events included insomnia, abnormal dreams and headache. Serious adverse events were rare, with no treatment-related deaths during the treatment or follow-up phases. Postmarketing surveillance has raised new questions about the safety of varenicline. In February 2008. the US FDA issued a public health advisory note, reporting a possible association between varenicline and all increased risk of behaviour change, agitation, depressed mood, and suicidal ideation and behaviour. They have required the manufacturers to revise the labelling of varenicline and he Summary of Product Characteristics, and to issue a Medication guide. It is arguable that much of the reported behavioural and mood changes may be associated with nicotine withdrawal, although some effects Occurred in people who continued to smoke while taking the medication. In view of the potential, if unproven, risk that varenicline may be associated with serious neuropsychiatric adverse outcomes, patients attempting to quit smoking with varenicline, and their families and caregivers, should be alerted about the need to monitor for neuropsychiatric symptoms, including changes in behaviour, agitation, depressed mood, suicidal ideation and suicidal behaviour, and to report such symptoms immediately to the patient's healthcare provider.

Campbell CI; Chi F; Sterling S; Kohn C; Weisner C. Self-initiated tobacco cessation and substance use outcomes among adolescents entering substance use treatment in a managed care organization. Addictive Behaviors 34(2): 171-179, 2009. (38 refs.)

Purpose: Adolescents with substance use (SU) problems have high rates of tobacco use, yet SU treatment has historically ignored treatment for tobacco use. Barriers to such efforts include the belief that tobacco cessation Could compromise other SU abstinence. This study examines Self-initiated tobacco cessation and 12-month alcohol and drug abstinence in adolescents entering SU treatment in a private, managed care organization. Results: Self-initiated tobacco cessation at 6 months, and at both 6 and 12 months, were related to higher odds of drug abstinence but not alcohol abstinence. Conclusion: Self-initiated tobacco cessation was not related to poor SU outcomes, and may be important to maintaining drug abstinence. Implementing tobacco cessation efforts in SU treatment can be challenging, but Comprised SU Outcomes may not be a barrier. The positive associations for drug abstinence and lack of associations for alcohol abstinence could be due to differences in motivation, medical conditions, or to the illicit nature of drug use. Tobacco use has serious long-term health consequences, and tobacco cessation efforts in adolescent SU treatment programs need further research.

Collins SE; Eck S; Kick E; Schroter M; Torchalla I; Batra A. Implementation of a smoking cessation treatment integrity protocol: Treatment discriminability, potency and manual adherence. Addictive Behaviors 34(5): 477-480, 2009. (14 refs.)

Testing manual adherence and treatment discriminability and potency have become increasingly important to ensuring the internal validity of treatment studies [Moncher, F.J., & Prinz, RJ., (1991). Treatment fidelity in Outcome Studies. Clinical Psychology Review, 11, 247-266.]. The objective of this study was therefore to implement the treatment integrity protocol based on the standardized framework proposed by Waltz. Addis, Koerner and Jacobson [Waltz, J., Addis, M.E., Koerner, K., & Jacobson, N.S., (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. journal of Consulting and Clinical Psychology, 61, 620-630.] to assess manual adherence and treatment discriminability and potency in a smoking cessation trial. Audio recordings of 15, 6-week smoking cessation groups were randomly selected from a sample of 31 groups and were rated for treatment integrity. Findings offered partial evidence for manual adherence which did not differ according to treatment condition, Analyses also indicated that the treatments were potent yet not highly discriminable across conditions. Despite some challenges, this preliminary application of the Waltz et al. [Waltz, J., Addis, M.E., Koerner, K., & Jacobson, N.S., (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. journal of Consulting and Clinical Psychology, 61, 620-630.] protocol indicated that it is a promising and flexible tool that may be used to examine different aspects of treatment integrity.

Copeland AL; Kulesza M; Hecht GS. Pre-quit depression level and smoking expectancies for mood management predict the nature of smoking withdrawal symptoms in college women smokers. Addictive Behaviors 34(5): 481-483, 2009. (20 refs.)

We assessed smoking withdrawal symptoms over a six-day period of abstinence among 21 female college students who were daily cigarette smokers [M = 20.3 (4.4); cigarettes per day] and were in the preparation stage of change for quitting smoking. We predicted that reported withdrawal symptoms would covary with baseline depression scores and baseline outcome expectancies for cigarette smoking as a mood management tool. Depression scores at baseline significantly predicted mood-related smoking withdrawal symptoms of Depression-Dejection and Vigor from the Profile of Mood States (POMS). Smoking outcome expectancies for relief of negative affect measured at baseline significantly predicted symptoms of Confusion-Bewilderment and Anger-Hostility. Neither baseline depression nor baseline smoking expectancies for mood management predicted smoking withdrawal symptoms measured by the Smoking Withdrawal Questionnaire (SWQ: [Shiffman, S. M., & Jarvik, M. E. (1976). Smoking withdrawal symptoms in two weeks of abstinence. Psychopharmacology, 50, 35-39]). Results imply that women smokers with baseline depressive symptomatology and expectancies for smoking to relieve negative mood endure greater abstinence-induced mood disturbance, but similar levels of other smoking withdrawal symptoms during initial abstinence. These results may inform smoking cessation efforts.

Cosci F; Corlando A; Fornai E; Pistelli F; Paoletti P; Carrozzi L. Nicotine dependence, psychological distress and personality traits as possible predictors of smoking cessation. Results of a double-blind study with nicotine patch. Addictive Behaviors 34(1): 28-35, 2009. (54 refs.)

Aim: Nicotine replacement therapy (NRT) is an effective treatment for smokers who want to quit, however, the rates of successful quitting can be improved even more. In this context, nicotine dependence (assessed via the Fagerstrom Tolerance Questionnaire, FTQ), psychological distress (measured via the Symptom Rating Test, SRT), and personality traits (evaluated via the Adult Eysenck Personality Inventory, AEPI) were evaluated as possible predictors of smoking cessation. Results: A total of 297 cigarette smokers were followed for one year as part of a NRT double-blind, parallel group, randomized trial. Baseline nicotine dependence (weeks 12 and 26: p<0.05),AEPI neuroticism (weeks 12 and 52: p<0.05), and AEPI psychoticism (weeks 12 and 52: p<0.05) scores significantly influenced the outcome of smoking cessation during one-year of follow-up. An increase in psychological distress during follow-up was associated with a lower probability of quitting smoking (p = 0.000). Conclusions: Nicotine dependence, neuroticism, psychoticism and, over time, psychological distress were the main factors influencing the long-term outcome (i.e., up to 12 month,;) of smoking cessation under NRT.

Curry SJ; Mermelstein RJ; Sporer AK. Therapy for specific problems: Youth tobacco cessation. (review). Annual Review of Psychology 60: 229-255, 2009. (155 refs.)

Cigarette smoking is the leading cause of premature morbidity and mortality in the United States. The majority of children smoke their first cigarette in early adolescence, and many older teens have well-established dependence on nicotine. Efforts to promote and support smoking cessation among these youth smokers are critical. The available experimental studies of youth cessation interventions find that behavioral interventions increase the chances of youth smokers achieving successful cessation. Currently there is insufficient evidence for the effectiveness of pharmacological treatments with youth smokers. Many innovative studies have been compromised by challenges in recruiting sufficient numbers of youth, obtaining approval for waivers of parental consent, and high attrition in longitudinal studies. Key areas for future work include bridging the fields of adolescent development and treatment design, matching treatments to developmental trajectories of smoking behavior, better understanding treatment processes and treatment moderators, and building demand for evidence-based cessation treatments.

Dawkins L; Powell JH; Pickering A; Powell J; West R. Patterns of change in withdrawal symptoms, desire to smoke, reward motivation and response inhibition across 3 months of smoking abstinence. Addiction 104(5): 850-858, 2009. (37 refs.)

Aims: We have demonstrated previously that acute smoking abstinence is associated with lowered reward motivation and impaired response inhibition. This prospective study explores whether these impairments, along with withdrawal- related symptoms, recover over 3 months of sustained abstinence. Design Participants completed a 12-hour abstinent baseline assessment and were then allocated randomly to quit unaided or continue smoking. All were re-tested after 7 days, 1 month and 3 months. Successful quitters' scores were compared with those of continuing smokers, who were tested after ad libitum smoking. Setting Goldsmiths, University of London. Participants A total of 33 smokers who maintained abstinence to 3 months, and 31 continuing smokers. Measurements Indices demonstrated previously in this cohort of smokers to be sensitive to the effect of nicotine versus acute abstinence: reward motivation [Snaith-Hamilton pleasure scale (SHAPS), Card Arranging Reward Responsivity Objective Test (CARROT), Stroop], tasks of response inhibition [anti-saccade task; Continuous Performance Task (CPT)], clinical indices of mood [Hospital Anxiety and Depression Scale (HADS)], withdrawal symptoms [Mood and Physical Symptoms Scale (MPSS)] and desire to smoke. Findings SHAPS anhedonia and reward responsivity (CARROT) showed significant improvement and plateaued after a month of abstinence, not differing from the scores of continuing smokers tested in a satiated state. Mood, other withdrawal symptoms and desire to smoke all declined from acute abstinence to 1 month of cessation and were equivalent to, or lower than, the levels reported by continuing, satiated smokers. Neither group showed a change in CPT errors over time while continuing smokers, but not abstainers, showed improved accuracy on the anti-saccade task at 3 months. Conclusion: Appetitive processes and related affective states appear to improve in smokers who remain nicotine-free for 3 months, whereas response inhibition does not. Although in need of replication, the results suggest tentatively that poor inhibitory control may constitute a long-term risk factor for relapse and could be a target for intervention

Dent LA; Harris KJ; Noonan CW. Randomized trial assessing the effectiveness of a pharmacist-delivered program for smoking cessation. Annals of Pharmacotherapy 43(2): 194-201, 2009. (47 refs.)

BACKGROUND: As trained and accessible healthcare professionals, pharmacists are in an ideal position to provide tabacco cessation interventions. Of the 15 studies identified in the literature assessing the effectiveness of tobacco cessation interventions delivered by pharmacists, this is the first randomized controlled trial conducted in the US of a pharmacist-delivered program for smoking cessation using biochemical confirmation. OBJECTIVE: To assess the effectiveness on smoking cessation of a face-to-face group program conducted by the pharmacist team compared with a brief standard care session delivered by a pharmacist over the telephone. METHODS: An open-label, propsective, randomized, controlled trial was conducted at a Veterans Health Administration, community-based outpatient clinic in the Rocky Mountain region. Participants were randomly assigned to receive a 3-session face-to-face group program conducted by the pharmacist team or one 5- to 1-minute standard care session delivered by the pharmacist team over the telephone. Participants in both groups were offered either immediate-release bupropion or nicotine patch at no cost. The primary outcome of self-reported abstience was biochemically confirmed by urinary continne at 6 mother after the date. RESULTS: One hundred one smokers were randomized from October 3, 2005 to March 30, 2007, with the last 6-month follow-up survey completed on November 6, 2007, with the last 6-month follow-up survey completed on November 6, 2007. Analysis of data was completed in December 2007. Using intent-to-treat procedures, confirmed abstience rates at the end of 6 months were 28% in the pharmacist-delivered face-to-face treatment group and 11.8% in the standard care telephone session control group (p < 0.041). CONCLUSION: This study demonstrated that pharmacists are effective providers to tabacco cession interventions. Greater utilization of pharmacists in tabacco cessation efforts could have a significant impact on smoking rates, prevention of tabacco-related diseases, and overall improvement in public health across the U.S.

Dickerson D; Leeman R; Mazure C; O'Malley S. The inclusion of women and minorities in smoking cessation clinical trials: A systematic review. (review). American Journal on Addictions 18(1): 21-28, 2009. (37 refs.)

This study assesses the impact of the 1993 NIH Revitalization Act on the inclusion and subgroup analysis of women and minorities in trials of FDA-approved smoking cessation pharmacotherapy. Female representation, while commensurate with population levels, declined significantly for trials that began recruitment after 1993(M = 47.2% vs. M = 53.9%), and fewer than half reported analyses by gender. Minorities continued to be under-represented in later trials; however, significant improvement in representation (M = 16.1% vs. M = 10%) and analysis by race occurred. Industry-sponsored studies had lower minority representation than NIH funded studies. Recommendations are offered to improve subgroup analyses and minority inclusion.

Downs DS; Feinberg M; Hillemeier MM; Weisman CS; Chase GA; Chuang CH et al. Design of the Central Pennsylvania Women's Health Study (CePAWHS) Strong Healthy Women intervention: Improving preconceptional health. Maternal and Child Health Journal 13(1): 18-28, 2009. (38 refs.)

Considerable evidence suggests that modifiable risk factors for adverse pregnancy outcomes such as preterm birth and low birthweight include obesity, sedentary behavior, and infections. There is a growing consensus that the preconceptional and interconceptional periods may be an ideal time for preventive intervention targeting these risk factors; enhancing health before pregnancy would subsequently reduce the risk for poor pregnancy outcomes. This paper provides an overview of the development of a health behavior intervention, Strong Healthy Women, that aims to improve women's preconceptional and interconceptional health. We describe the rationale, delivery, and targeted outcomes of the program, as well as the design of an ongoing trial currently testing program efficacy. The content areas are also discussed and include pregnancy-conception, stress, physical activity, nutrition, infection, sources of smoke in the home, and substance use. This intervention protocol may offer researchers and healthcare professionals a framework for designing other programs aiming to improve women's preconceptional health.

Ebbert JO; Croghan IT; Sood A; Schroeder DR; Hays JT; Hurt RD. Varenicline and bupropion sustained-release combination therapy for smoking cessation. Nicotine & Tobacco Research 11(3): 234-239, 2009. (27 refs.)

Varenicline and bupropion sustained release (SR) are both safe and effective for the treatment of tobacco dependence and have different mechanisms of action. Combination pharmacotherapy with these agents may increase long-term smoking abstinence rates above what is observed with single-agent therapy. We enrolled cigarettes smokers in an open-label, one-arm, Phase II clinical trial to obtain preliminary data on the potential effectiveness and safety of combination therapy with varenicline and bupropion SR for the treatment of tobacco dependence. Eligible subjects received varenicline titrated to 1.0 mg by mouth twice daily and bupropion SR titrated to 150 mg by mouth twice daily for a total of 12 weeks along with behavioral therapy. Self-reported smoking abstinence was biochemically confirmed with expired carbon monoxide. A total of 38 smokers with a mean age of 49.1 years (SD = 12.4) who smoked an average of 19.9 cigarettes/day (SD = 7.8) for 30 years (SD = 12.3) were enrolled. Seven-day point-prevalent smoking abstinence rates were 71% (95% CI = 54%-85%) at 3 months and 58% (95% CI = 41%-74%) at 6 months. Mean weight change during the medication phase among smoking-abstinent subjects was 1.6 kg (SD = 2.4). For both medications, 74% of subjects took at least 90% of the prescribed doses. The most common side effects were sleep disturbance (26%) and nausea (24%). No increase in depressive symptoms was observed, and no subjects reported suicidal ideation. Combination therapy with varenicline and bupropion SR may be effective for increasing smoking abstinence rates above that observed with monotherapy.

Emmons KM; Puleo E; Mertens A; Gritz ER; Diller L; Li FP. Long-term smoking cessation outcomes among childhood cancer survivors in the Partnership for Health Study. Journal of Clinical Oncology 27(1): 52-60, 2009. (46 refs.)

Purpose: Partnership for Health (PFH) was found to increase smoking cessation among smokers in the Childhood Cancer Survivors Study (CCSS) at the 8- and 12-month postbaseline follow-up. This report provides outcomes at 2 to 6 years postbaseline; the primary outcome is a four-category smoking status variable ( quit at all follow-ups, quit at final follow-up only, smoker at all follow-ups, and smoker at final follow-up only); quit attempts among those who reported smoking at the final follow-up is a secondary outcome. Methods PFH was a randomized control trial with two conditions, peer phone counseling ( PC) and self-help (SH), that involved smokers (n = 796) enrolled in the CCSS cohort. Results: Long-term quit rates were higher in PC versus SH participants. Long-term smoking cessation outcomes were lower among those who were nicotine dependent, of lower educational levels, and among men, and were higher among those who used nicotine replacement therapy and who had higher levels of situational self-efficacy. There were no significant differences in relapse rates between conditions or in quit attempts among continued smokers. Conclusion: Cessation rates continue to be significantly higher among participants in the PC condition versus SH, although the differences were not large. This article highlights differences in long-term engagement with smoking cessation among those who received the intervention.

Fagerstrom K; Aubin HJ. Management of smoking cessation in patients with psychiatric disorders. (review). Current Medical Research and Opinion 25(2): 511-518, 2009. (61 refs.)

Background: There is a close relationship between tobacco smoking and psychiatric disorders, and a higher proportion of individuals with mental health conditions smoke compared with the general population. Due to the increased smoking prevalence in this population, patients with psychiatric conditions are at greater risk of smoking-related morbidity and mortality and experience detrimental effects on their quality of life. However, while the majority of individuals with a history of mental health conditions appreciate that smoking is detrimental to their health, they are less likely to quit smoking and have a lower success rate during quit attempts compared with the general population. Scope: Peer-reviewed articles were identified from PubMed using the inclusive date-range of 1990-October 2008 and the search terms; depression, mental health, psychiatric disorders, schizophrenia, and smoking cessation. Articles were selected from the search results to provide a general overview of some of the main issues for smokers with psychiatric disorders in general and specifically, those with schizophrenia and depression. The evidence from smoking cessation trials within these populations was also reviewed. Findings: Nicotine has some positive effects on symptoms of psychiatric disorders and it has been proposed that patients with mental health conditions may smoke as a form of self-medication. Further, several studies have shown that some symptoms of psychiatric disorders may be exacerbated by nicotine withdrawal. Therefore, attempts to quit smoking pose additional problems to patients with mental health problems. Conclusion: Traditional programmes for smoking cessation may not always be suitable for psychiatric patients due to their neuropsychological profile. Preliminary evidence suggests that more flexible, open-ended, combination approaches of pharmacotherapy and counselling may be more successful. In addition, identification and treatment of nicotine addiction remains very low in patients with mental health conditions and far more needs to be done to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems.

Flenady V; Macphail J; New K; Devenish-Meares P; Smith J. Implementation of a clinical practice guideline for smoking cessation in a public antenatal care setting. Australian & New Zealand Journal of Obstetrics & Gynaecology 48(6): 552-558, 2009. (25 refs.)

Despite high level evidence showing that antenatal smoking cessation programs are effective in reducing the number of women who smoke during pregnancy and the number of low birthweight and preterm births, few Australian hospitals have adopted a systematic approach to assist pregnant women to stop smoking. The aim of this study was to assess the effectiveness of a smoking cessation guideline, developed specifically for clinicians providing antenatal care in public maternity hospitals, combined with an implementation program on the uptake of evidence-based practice. A clinical practice guideline was developed and an implementation strategy was tested, using a prospective before-and-after study design, at the Mater Mothers' Hospital in Brisbane. Women were surveyed in late pregnancy, pre- and post-implementation. The primary outcome measures were women's report of appropriate smoking cessation support received, specifically, information brochures and referral to Quitline. Secondary outcome measures included women's report of smoking status in late pregnancy and relapse rates. Post-implementation, more women reported receiving written materials on smoking cessation (76% vs 35%; relative risk (RR) 3.4; 95% confidence interval (CI) 2.7, 4.2) and referral to Quitline (67% vs 14%; RR 4.9; 95% CI 3.0, 8.0). While not statistically significant, fewer women post-implementation reported smoking in late pregnancy (19.5% vs 16.7%) and fewer reported smoking > 10 cigarettes per day (38% vs 25%). Clinical practice guidelines specifically designed for a public maternity care setting combined with an implementation program resulted in an increase in evidence-based practice with some indication of improved smoking behaviour for women.

Floyd AHL; Westmaas JL; Targhetta V; Moyer A. Depressive symptoms and smokers' perceptions of lung cancer risk: Moderating effects of tobacco dependence. Addictive Behaviors 34(2): 154-163, 2009. (37 refs.)

Smokers who acknowledge the personal health risks of smoking are more likely to attempt quitting. Unfortunately, many smokers are unrealistically optimistic about their health risks. Depressed smokers, however, may be more realistic about their risks. These studies examined the relationship between depressive symptoms and risk perceptions among two groups: college-age smokers (N = 128) and smokers from the nationally representative HINTS database (N = 1,246). In the college sample, among highly tobacco dependent smokers, more depressed smokers believed more strongly that quitting eliminates lung cancer risk (b = -.27, p = .01), and they estimated a faster reversal of risk after quitting (b = -.70, p = .03). In the HI NTS sample, among highly tobacco dependent women, the more depressed they were, the higher their perceived risk of developing lung cancer (b = .23. p = .05). In sum, depressive symptoms among some smokers may lead to heightened risk perceptions. However the belief that quitting can reduce risk quickly might encourage smokers to postpone quitting. Cessation programs could benefit from tailoring their programs accordingly.

Free C; Whittaker R; Knight R; Abramsky T; Rodgers A; Roberts IG. Txt2stop: A pilot randomised controlled trial of mobile phone-based smoking cessation support. Tobacco Control 18(2): 88-91, 2009. (14 refs.)

Aim: To conduct a pilot randomised controlled trial of mobile phone-based smoking cessation support intervention for the UK population. Design: Randomised controlled trial (txt2stop). Setting: Community. Participants: 200 participants responding to radio, poster and leaflet-based promotions regarding the trial. Main outcome measures: The response rate for the outcome measures planned for the main trial. Participants' qualitative responses to open-ended questions about the intervention content. Secondary outcomes were the outcomes planned for the main trial including the point prevalence of self-reported smoking at 4 weeks and pooled effect estimate for the short-term results for the STOMP and txt2stop trials. Results: The response rate at 4 weeks was 96% and at 6 months was 92%. The results at 4 weeks show a doubling of self-reported quitting relative risk (RR) 2.08 (95% CI 1.11 to 3.89), 26% vs 12%. The pooled effect estimate combining txt2stop and a previous New Zealand trial in the short term is RR 2.18 (95% CI 1.79 to 2.65). Conclusions: Mobile phone-based smoking cessation is an innovative means of delivering smoking cessation support, which doubles the self-reported quit rate in the short term. It could represent an important, but as yet largely unused, medium to deliver age-appropriate public health measures. The long-term effect of this mobile phone-based smoking cessation support will be established by a large randomised controlled trial currently in recruitment.

Freund M; Campbell E; Paul C; Sakrouge R; Lecathelinais C; Knight J et al. Increasing hospital-wide delivery of smoking cessation care for nicotine-dependent in-patients: A multi-strategic intervention trial. Addiction 104(5): 839-849, 2009. (72 refs.)

Aims, design and intervention: Smoking care provision to in-patients is important in assisting smoking cessation and for management of nicotine withdrawal. Limited studies have reported the effectiveness of interventions designed to increase the hospital-wide provision of such care. A quasi-experimental matched-pair trial, involving two intervention and two control hospitals in NSW, Australia, investigated whether a multi-strategic intervention increased hospital- wide smoking care provision. Participants and measurements Patient surveys (n = 274-347 per experimental condition), medical notes audits (n = 181-228) and health professional surveys (n = 229-302) were used to collect outcome data at baseline and follow-up. Findings Significantly greater increases in intervention hospitals compared to control hospitals were found for patient-reported offer of nicotine replacement therapy (NRT) (intervention 34% versus control 12%), provision of NRT (16% versus 4%) and provision of written resources (11% versus 2%), and for the recording in medical notes of smoking management discussion (13% versus 3%), offer of NRT (24% versus 3%) and provision of NRT (21% versus 5%). Intervention group health professionals reported significantly greater increases in the mean estimate of patients who: had their smoking management discussed (30% versus 17%); were offered or provided with NRT (30% versus 18%); were asked their intention to smoke post-discharge (22% versus 10%); and were provided with discharge NRT (21% versus 4%). Conclusions Implementation of a multi-strategic intervention is effective in increasing hospital smoking care delivery, particularly the provision of NRT. Research is required to identify methods to increase further the delivery of this and other forms of smoking care.

Gandhi KK; Foulds J; Steinberg MB; Lu SE; Williams JM. Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic. International Journal of Clinical Practice 63(3): 360-367, 2009. (25 refs.)

Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes. This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service. 46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non-menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non-menthol smokers. At 4-week follow up, AA, Latino and White non-menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non-menthol counterparts. At 6-month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non-menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9). Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non-menthol smokers within the same ethnic/racial groups.

Garrison GD; Dugan SE. Varenicline: A first-line treatment option for smoking cessation. (review). Clinical Therapeutics 31(3): 463-491, 2009. (51 refs.)

Background: Varenicline acts as a partial agonist/antagonist with affinity and selectivity for alpha(4) beta(2) nicotinic acetylcholine receptors. This activity at the nicotine-receptor level may help patients achieve smoking cessation by reducing cravings/withdrawal symptoms and smoking satisfaction. Objective: This article reviews the literature on the pharmacologic properties, therapeutic efficacy, and tolerability of varenicline for smoking cessation. Methods: Pertinent controlled clinical trials, meta-analyses, meeting abstracts, case reports, and review articles published in English between 1966 and May 2008 were identified through searches of MEDLINE and OVID using the terms varenicline, smoking, tobacco cessation, and CP 526555. Results: Eight clinical trials were identified that compared :<= 12 weeks of varenicline treatment with placebo and/or bupropion sustained release (SR); one of the trials reported follow-up data to 24 weeks, and the remainder reported data to 52 weeks. During treatment with oral varenicline titrated to 1 mg BID, CO-confirmed 4-week continuous quit rates/continuous abstinence rates (CQRs/CARs) in weeks 9 through 12 ranged from 43.9% (odds ratio [OR] = 3.85 [95% CI, 2.69-5.50; P < 0.001 vs placebo]; OR = 1.90 [95% CI, 1.38-2.62; P < 0.001 vs bupropion SR]) to 65.4% (OR = 2.98 [95% CI, 1.78-4.99; P < 0.001 vs placebo]). In 4 of these trials, varenicline 1. mg BID was associated with significantly higher CQRs/CARs compared with placebo at week-52 follow-up, ranging from 21.9% (P < 0.001) to 34.6% (P = 0.036). One trial reported a significantly higher CAR at 52 weeks with varenichne compared with bupropion SR (23.0% vs 14.6%, respectively; P = 0.004), and another reported a significantly higher CAR at 52 weeks with varenicline compared with nicotine replacement therapy (25.9% vs 19.8%, respectively; P = 0.040). In a relapse-prevention study that included a 12-week extension period for participants who were abstinent after the initial 12 weeks of treatment, CARs were significantly improved at 24 weeks with varenicline relative to placebo (70.5% vs 49.6%, respectively; OR = 2.48; 95 % CI, 1.95-3.1.6; P < 0.001). Treatment with varenicline was generally well tolerated in study populations with no major comorbidities. In a pooled analysis of 2 Phase III trials, the most commonly reported adverse events (AEs) with varenicline, bupropion SR, and placebo were nausea (28.8%, 9.9%, and 9.1%, respectively), insomnia (14.2%, 21.5%, and 12.6%), and headache (14.2%, 11.1%, and 12.4%). In a pooled analysis of 2 identically designed Phase III trials, bupropion SR was associated with the highest overall rates of discontinuation due to all-cause AEs compared with varenicline and placebo (13.9%, 9.5%, and 8.2%, respectively) and due to AEs considered related to study drug (12.1%, 7.9%, and 6.4%). In double-blind clinical trials of varenicline, nausea was the most frequently reported AE (16.3%-41.9%). Varenicline treatment should begin 7 days before the proposed smoking quit date; dose titration is recommended to minimize dose-related nausea. Based on postmarketing reports of serious AEs in varenicline-treated patients, caution is recommended when operating vehicles or heavy machinery. Patient education and monitoring for potential AEs are also recommended, particularly in patients with a history of psychiatric illness. Conclusions: Varenicline has a unique mechanism of action compared with other first-line options for smoking cessation. Available clinical-trial data support its use as an effective and generally well-tolerated therapy for smoking cessation in healthy adult smokers, although there is a need for further efficacy and safety evaluation in the general population, particularly those with comorbid conditions.

Girgis S; Adily A; Velasco MJ; Garden FL. Smoking patterns and readiness to quit: A study of the Australian Arabic community. Australian Family Physician 38(3): 154-+, 2009. (24 refs.)

Background: Smoking cessation interventions have typically focused on majority populations who, in Australia, are English speaking. There has been an overall decline in the prevalence of smoking in the Australian community. However, there remains a relative paucity of useful information about tobacco use and the effectiveness of tobacco interventions among specific ethnic minorities. Objective To determine associations of tobacco use and tobacco control indicators for Arabic speakers seen in the Australian general practice setting. Methods: A cross sectional study in a consecutive sample of Arabic patients (n=1371) attending the practices of 29 Arabic speaking general practitioners in Sydney, New South Wales. Results: Twenty-nine (53.7%) of 54 eligible Arabic speaking GPs in southwest Sydney participated in this study. Of 1371 patients seen, 29.7% were smokers. Smokers were more likely to report poorer health (chi(2)=21.7, df=1, p<0.001); 35.7% reported high nicotine dependence. Dependence was more in men (chi(2)=11.7, df=1, p<001) and those who reported poorer health (chi(2)=4.9, df=1, p<0.03); 35.9% had attempted to quit in the previous year; 17% were in preparation stage of change; 42.7% recalled quit advice. Poorer self reported health status (AOR=2.13, 95% CI: 1.14-3.97, p=0.017) and unemployment (AOR=1.69, 95% Cl: 1.51-4.90, p=0.033) were independent predictors of advice from a health professional, most often a GP (71%). Conclusion: Our study confirms previous reports that the proportion of self reported current smokers among the Arabic community is higher than for the Anglo-European majority. There is a need for ethno specific campaigns in tobacco control.

Gratziou C. Respiratory, cardiovascular and other physiological consequences of smoking cessation. (review). Current Medical Research and Opinion 25(2): 535-545, 2009. (73 refs.)

Background: Smoking cessation is associated with substantial reductions in tobacco-related morbidity and mortality. Based on the current literature, the beneficial effects of quitting are particularly evident on pulmonary and cardiovascular function, but the negative physiological effects of cessation are less well documented. Scope: The objective of this article was to review systematically data on the physiological effects of smoking cessation. Articles based upon clinical trials, randomised controlled trials and meta-analyses were selected from titles and abstracts obtained via a MEDLINE search ( May 2003-May 2008). Additional studies were identified from the bibliographies of reviewed literature. Findings: Smoking cessation is associated with improved lung function and a reduction in the presence and severity of respiratory symptoms. These changes, apparent within months of quitting, are sustained with long-term abstinence. The underlying pathophysiologies of smoking-induced airway inflammation and endothelial dysfunction are partially reversed following cessation in healthy ex-smokers, but not in those with chronic obstructive pulmonary disease. Smoking cessation is also associated with substantially improved cardiovascular function and reduced risk of primary and secondary cardiovascular morbidity and mortality. Although the overall long-term health benefits are unquestionable, smoking cessation is also associated with other possible undesirable short-term physiological effects such as weight gain, hypertension, constipation and mouth ulcers; and altered activity of the enzyme cytochrome P450 1A2 (CYP1A2), which metabolises many commonly used drugs. Conclusion: The negative physiological effects of smoking cessation may adversely affect a smoker's attempt to quit, and physicians should provide their smoking patients with motivation and regular encouragement and support when attempting to quit, whilst educating them on the health benefits of abstinence. Additionally, since cigarette smoke is a potent inducer of CYP1A2, patients attempting to quit smoking should have their dosages of drugs metabolised by this enzyme closely monitored.

Grosshans M; Mutschler J; Hermann D; Mann K; Diehl A. Reduced affective symptoms during tobacco dependence treatment with varenicline. Addiction 104(5): 859-861, 2009. (52 refs.)

Background: The nicotinic acetylcholine receptor partial agonist varenicline has been shown to be effective in the treatment of tobacco dependence, but has been reported to induce exacerbations of psychiatric symptoms in subjects with pre-existing psychiatric disorders. Case description: We report a tobacco-dependent patient who developed depression and suicidal tendencies during several cessation attempts, but was finally able to stay nicotine-abstinent by taking varenicline. Conclusion: In this case varenicline did not lead to exacerbation but appeared to improve the affective symptoms.

Handel G; Hannover W; Roske K; Thyrian JR; Rumpf HJ; Fusch C et al. Intention to change smoking in pregnant and postpartum women according to number of pregnancies. European Journal of Public Health 19(2): 218-221, 2009. (24 refs.)

Background: The status of a pregnant woman might add to the motivation to stop smoking. However, little is known about whether women who are pregnant for the first time (primigravidae) show a motivation to quit smoking that is different from women who are pregnant at least the second time (multigravidae). The goal of the current study was to compare smoking status, urge to smoke and intention to change smoking behaviour of primigravidae and multigravidae. We hypothesized that amongst primigravidae there are less current smokers, that the smokers consume less cigarettes per day, have less urge to smoke and that more stop smoking after delivery when compared with multigravidae. Methods: Among 642 women postpartum who had smoked before pregnancy smoking status, the Fagerstrm Test for Nicotine Dependence and intention to change smoking behaviour were assessed. The data were analysed with the Chi-square test, MannWhitneys U-test and the Sign-test. Results: Primigravidae smoked less cigarettes (P 0.01) and showed less urge to smoke (P 0.05) than multigravidae. They did not differ according to the intention to change smoking behaviour (P 0.05). Conclusion: Experience of first pregnancy does not seem to automatically induce more smoking cessation compared to multigravidae. Prevention measures are needed for primigravida women and multigravida women to the same extent.

Handel G; Hannover W; Roske K; Thyrian JR; Rumpf HJ; John U et al. Naturalistic changes in the readiness of postpartum women to quit smoking. Drug and Alcohol Dependence 101(3): 196-201, 2009. (38 refs.)

Background: This study involves a long-term examination of the natural behavioral changes in postpartum women undergoing smoking cessation. The analysis was based on the readiness to quit smoking as assessed using the Transtheoretical Model of intentional behavioral change. This is a secondary data analysis of a randomized controlled trial. Methods: Between May 2002 and March 2003, all women in the maternity wards of six hospitals in the German state of Mecklenburg-West Pomerania were screened for smoking before or during pregnancy. Of the women who answered in the affirmative, 871 (77%) participated in the study. We utilized a questionnaire to classify 345 women into stages of progress regarding their motivation to change their smoking behavior 4-6 weeks postpartum (TO). Participants were followed-up after 6 (T1), 12 (T2), and 18 months (T3). In addition to the descriptive analysis, latent transition analysis was applied as a statistical method to test models of patterns of change and to evaluate transitions in the stages of change over time. Results: During the time interval between consecutive follow-up surveys, 59.1% (T0/T1), 72.3% (T1/T2), and 67.9% (T2/T3) of women remained at the same stage of motivation to change. Most relapses into earlier stages occurred 6 months postpartum (T1) (31.5% of the stage transition). The patterns of change across the first three time points were best described by a model that includes stability, one-stage progressions, and one-to-four-stage regressions. Conclusions: Readiness to quit smoking in study participants did not substantially change over the span of 18 months postpartum.

Hine DW; Marks ADG; O'Neill G. Smoking cessation in adults: A dual process perspective. Addiction Research & Theory 17(2): 220-229, 2009. (39 refs.)

This study applied Cognitive Experiential Self Theory to investigate the role of smoking expectancies and experiential associations with cigarette use in predicting smoking cessation in a sample of 155 Australian adults. Two discrete changes in the cessation process were investigated. The first involved a cognitive transition from not intending to quit smoking to intending to quit, and the second involved a behavioral transition from intending to quit to successful cessation. Multinomial logistic regression analyses suggested that experiential associations played no role in the transition from not intending to intending to quit, but moderated the effects of three types of smoking expectancies (negative consequences, positive reinforcement, and negative reinforcement) on the transition from intending to quit to successful cessation. The facilitative effects of smoking expectancies on cessation were substantially attenuated in participants who possessed more positive experiential associations with smoking.

Horn K; Noerachmanto N; Dino G; Manzo K; Brayboy M. Who wants to quit? Characteristics of American Indian youth who seek smoking cessation intervention. Journal of Community Health 34(2): 153-163, 2009. (41 refs.)

No group is more at-risk for tobacco-related health disparities than are American Indian youth. Little is known about their readiness to quit smoking and the extent to which cessation programs may require cultural tailoring related to recruitment, implementation, or content. This study identifies unique characteristics of American Indian teen smokers who enrolled in a school-based smoking cessation program, Not On Tobacco (called N-O-T). Using data from N-O-T intervention trials conducted in North Carolina between 2001 and 2004, the present study (a) describes the characteristics of American Indian participants (n = 91); (b) determines if basic demographics and smoking history affect intervention readiness; and (c) compares findings with non-Native participants (n = 138) enrolled in N-O-T within the same state. Upon enrollment, 80% of the sample reported that they planned to quit smoking in the next 1-6 months. We found significant differences between American Indian and non-Native youth on smoking history, with non-Natives smoking with greater intensity and frequency. Contrary to previous reports, American Indian youth in this study smoked with less intensity and were more ready to quit smoking than non-Native youth. Results reveal previously unreported characteristics of American Indian teen smokers. Study findings may advance the development of effective marketing, recruitment, and programming among American Indian teen smokers into cessation programs, particularly N-O-T, which is the only teen smoking cessation program which includes an adaptation specifically for American Indians.

Hudson L; White A; Roseby R. Tobacco smoke exposure in hospitalised Aboriginal children in Central Australia. Journal of Paediatrics and Child Health 45(4): 224-227, 2009. (24 refs.)

Child exposure to tobacco smoke is detrimental to health. Australian Aboriginal people have a higher rate of cigarette smoking compared with the national average. Thus, we aim to measure the proportion of children admitted to Alice Springs Hospital who are exposed to tobacco smoke at home, to correlate this with prevalence of regular cough and gauge smokers' interest in quitting. A questionnaire was administered verbally to carers of children admitted to Alice Springs Hospital, November 2006 to January 2007. Main outcome measures were presence of a smoker at home and presence of a regular cough. We measured the interest of carers and speculated interest of other smokers in quitting. Eighty-two questionnaires were completed (60% of children admitted during the study period). Eighty-nine per cent of children were Aboriginal. As so few non-Aboriginal children were included in the study, their results were not included in analysis. Sixty-four per cent of children lived with at least one smoker. Seventy per cent of children exposed to smoke at home lived with more than one smoker. Point prevalence of reported regular cough was 33%. Forty-three per cent of children who lived with at least one smoker had regular cough compared with 13% in those who did not (P = 0.035). The rate ratio for regular cough when living with a smoker versus when not living with a smoker was 2.77 (95% confidence interval: 1.06-7.23). Forty-two per cent of the smokers expressed interest in quitting. It is concerning that the majority of hospitalised children were exposed to tobacco smoke at home, while fewer than half of smokers were interested in quitting.

Hughes JR. Ethical concerns about non-active conditions in smoking cessation trials and methods to decrease such concerns. (review). Drug and Alcohol Dependence 100(3): 187-193, 2009. (53 refs.)

Many have questioned whether it is ethical to assign participants in a research trial to a non-active control condition (e.g., a placebo or attention-only control) when (a) the disorder under Study is serious, (b) validated treatment is available, and (c) harm may occur if treatment is not given. This ethical concern May apply to Studies of controlled trials of treatments for drug dependence. The current paper examines this concern for trials of nicotine dependence because there are multiple validated treatments available. The major harm from assignment to a non-active condition in such a trial could occur if failure to quit discourages smokers from trying to quit again. Whether this harm actually Occurs is unclear. Potential harms from non-active conditions may be mitigated by (a) provision of more explicit information in the consent process, (b) inclusion of only those who have failed optimal treatment, (c) provision of validated treatment via a different Modality, (d) tests of the new treatment as an add-on to standard treatment, (e) use of dose-response design, (f) use of unequal randomization designs, (g) use of stopping rules, (h) provision of optimal therapy to those who fail during the study, or (i) comparison of the experimental treatment vs. standard treatment. Empirical research to inform ethical analysis of non-active conditions in drug abuse research is suggested.

Hughes JR; Marcy TW; Naud S. Interest in treatments to stop smoking. Journal of Substance Abuse Treatment 36(1): 18-24, 2009. (21 refs.)

We surveyed 884 Vermont (VT) tobacco smokers by random digit dialing to determine past and future use of treatment. Among those who had recently attempted to quit, 61% had ever used a treatment, 21% had ever used a psychosocial treatment, and 57% had used a medication. Among those who planned to quit in the next month, 68% stated they would use a treatment, 35% would use a psychosocial treatment, and 62% would use a medication. The major predictors of past or future use of treatment were greater cigarettes per day, older age, being a woman, and seeing a health professional. Although this survey suggests many smokers have used or plan to use a smoking cessation treatment, program data indicate less than 10% of VT smokers who try to quit use the state quitline, counseling, or free medication provision. Why smokers do not use these treatments needs to be determined.

Huizink AC; van Lier PAC; Crijnen AAM. Attention deficit hyperactivity disorder symptoms mediate early-onset smoking. European Addiction Research 15(1): 1-9, 2009. (54 refs.)

Background/Aims: Symptoms of attention deficit hyperactivity disorder (ADHD) have often been associated with early-onset smoking. We hypothesize that reductions in ADHD symptoms due to an intervention have a mediating effect on early-onset smoking. Methods: In a universal, school-based, randomized controlled intervention trial, we examined whether intervention-induced reductions in ADHD symptoms at age 9 mediated the reduced risk of tobacco use onset among these children at age 10 or 11 years. A sample of 477 first-grade boys and girls were randomly assigned to the Good Behavior Game intervention (n = 263), a 2-year (grades 2 and 3) universal classroom-based intervention aimed at reducing disruptive behavior problems, or to a control condition (n = 214). ADHD symptoms were assessed through teacher ratings. Early onset of tobacco use was assessed through self-report. Results: The intervention-induced reductions in ADHD symptoms fully mediated the distal effect of intervention on reductions in early-onset smoking. Conclusions: Our results showed that programs that target ADHD symptoms may protect children from early-onset smoking as well. Further research is needed to examine pathways from ADHD symptoms to tobacco use.

Javelot H; Baratta A; Weiner L; Javelot T; Nonnenmacher C; Westphal JF et al. Two acute psychotic episodes after administration of bupropion: A case of involuntary rechallenge. Pharmacy World & Science 31(2): 238-240, 2009. (15 refs.)

Bupropion is an antidepressant drug also used as a smoking cessation aid, which inhibits norepinephrine and dopamine re-uptake. Given its pharmacological properties, it has been associated with reports on psychosis and acute delirious episodes. Case: We report the case of a patient with schizoaffective disorder who developed two psychotic episodes respectively after a four and a two-day administration of sustained-release (SR) bupropion at a dose of 150 mg/day. To our knowledge, this is the first reported case of involuntary rechallenge with bupropion SR during a smoking cessation program. Conclusion: There is a serious risk of incorrectly identifying bupropion as only a therapy for nicotine withdrawal without taking the precaution of exploring possible psychiatric co-morbidity with addiction. Our case illustrates the problem.

Jockel KH; Lehmann N; Jaeger BR; Moebus S; Moehlenkamp S; Schmermund A et al. Smoking cessation and subclinical atherosclerosis: Results from the Heinz Nixdorf Recall Study. Atherosclerosis 203(1): 221-227, 2009. (40 refs.)

Background: Smoking accounts for more than 5 million years of potential life lost per year in the US alone. Leading causes of smoking attributable mortality are acute atherothrombotic complications of coronary heart disease (CHID). Smoking cessation is a key issue in preventive medicine, but quantitative data on its benefit for the coronary arteries are sparse. Methods: The Heinz Nixdorf Recall Study is an ongoing population-based, prospective cohort study, with 4814 participants aged 45-74 years (49.8% men). Baseline data of 4078 participants without history of established coronary heart disease or stroke are included in this report. Electron beam-computed tomography allows for non-invasive quantification of coronary artery calcium (CAC). We estimate the risk-related ageing of coronary arteries from multivariable regression of CAC on smoking behavior, sex, age and risk factors. Results: Smoking 20 cigarettes per day since the age of 16 is associated with a CAC burden which is found in a person 10 years older who has never smoked (both sexes). Smoking cessation at 45, 55 or 65 leads to CAC at the age of 75 that would have been reached 9, 6 or 3 years earlier, respectively, had smoking been continued. Conclusion.,: In individuals without overt CHID, present smokers are about 10 years older in 'coronary artery age' than never smokers. The accumulation of CAC is accelerated by smoking and slows down after smoking cessation, but advanced CAC is persistent for a long period. These quantitative findings strongly support smoking cessation measures as early as possible, to prevent accelerated arterial ageing.

Kahler CW; Borland R; Hyland A; McKee SA; Thompson ME; Cummings KM. Alcohol consumption and quitting smoking in the International Tobacco Control (ITC) Four Country Survey. Drug and Alcohol Dependence 100(3): 214-220, 2009. (31 refs.)

Although greater alcohol consumption has been associated with decreased odds of quitting smoking in prospective studies, the aspects of drinking most strongly associated with quitting have not been fully explored and examination of potential confounder variables has been limited. Further studies are needed to inform efforts to enhance smoking cessation among the substantial portion of smokers who drink alcohol. The present study examines: (a) drinking frequency, average weekly quantity of alcohol consumption, and frequency of heavy drinking as prospective predictors of quit smoking behaviors, (b) difference across countries in this prediction, and (c) third variables that might account for the association between alcohol consumption and quitting smoking. Data were drawn from the International Tobacco Control Four Country Survey, a prospective cohort study of smokers in Australia, Canada, the UK, and the US. A total of 4831 participants provided alcohol data at one study wave and were re-interviewed I year later. Individuals who drank heavily (4+/5+ drinks for women and men, respectively) more than once a week had significantly lower rates of quitting smoking than all other participants, in part due to the fact that a significantly lower proportion of those making a quit attempt remained quit for more than 1 month at follow-up. The role of frequent heavy drinking did not differ by country or sex and was not accounted for by demographics, smoking dependence, or attitudes regarding quitting smoking. Neither drinking frequency nor weekly quantity of consumption showed robust associations with quitting behaviors. Results indicate further study of interventions to address heavy drinking among smokers is warranted.

Kahler CW; Borland R; Hyland A; McKee SA; Thompson ME; Cummings KM. Alcohol consumption and quitting smoking in the International Tobacco Control (ITC) Four Country Survey. Drug and Alcohol Dependence 100(3): 214-220, 2009. (31 refs.)

Keltner NL; Lillie K. Biological perspectives: Nicotinic receptors, implications for psychiatric care. Perspectives in Psychiatric Care 45(2): 151-155, 2009. (30 refs.)

The article discusses nicotinic receptors in psychiatric care. The use of the drug varenicline (Chantix) for smoking cessation is discussed. Muscarininc and nicotinic acetylcholine receptors are examined. The role of nicotinic receptors in smoking is described, including the excitation of nicotinic receptors in the reward pathway. The role of nicotinic receptors in schizophrenia and attention deficit hyperactivity disorder is also discussed.

Kleinjan M; Engels RCME; van Leeuwe J; Brug J; van Zundert RMP; van den Eijnden RJJM. Mechanisms of adolescent smoking cessation: Roles of readiness to quit, nicotine dependence, and smoking of parents and peers. Drug and Alcohol Dependence 99(1-3): 204-214, 2009. (88 refs.)

Multiple levels of influence should be considered in interventions aimed at the adolescent smoker, including psychological, addiction, peer and parental influences. However, the mechanism by which these variables influence the process of smoking cessation in adolescents is not well elucidated. Therefore, this prospective study tested two models among 850 adolescent smokers, specifying the direct and indirect relations between adolescents' readiness to quit smoking, levels of nicotine dependence, and smoking behavior of their parents and friends. One year later smoking cessation was assessed. Results showed that, among adolescent smokers, readiness to quit was positively associated with quit attempts, while nicotine dependence was inversely associated with successful cessation. Instead of a direct relation, parental and peers' smoking were inversely related to smoking cessation through nicotine dependence. The findings emphasize that interventions should be developed and tested within and outside the school setting, as well as within the family situation. In addition, the strong impact of nicotine dependence on successful cessation indicates that a more direct approach is needed to lower nicotine dependence among adolescents.

Kotz D; Wesseling G; Huibers MJH; van Schayck OCP. Efficacy of confronting smokers with airflow limitation for smoking cessation. European Respiratory Journal 33(4): 754-762, 2009. (42 refs.)

The objective of the present study was to test whether confronting smokers with previously undetected chronic obstructive pulmonary disease (COPD) increases the rate of smoking cessation. In total, 296 smokers with no prior diagnosis of COPD were detected with mild-to-moderate airflow limitation by means of spirometry and randomly allocated to: confrontational counselling by a nurse with nortriptyline for smoking cessation (experimental group); regular counselling by a nurse with nortriptyline (control group 1); or "care as usual" for smoking cessation by the general practitioner (control group 2). Only the experimental group was confronted with their abnormal spirometry (mean forced expiratory volume in one second (FEV1) post-bronchodilator 80.5% predicted, mean FEV1/forced vital capacity post-bronchodilator 62.5%). There was no difference in cotinine-validated prolonged abstinence rate between the experimental group (11.2%) and control group 1 (11.6%) from week 5-52 (odds ratio (OR) 0.96, 95% confidence interval (CI) 0.43-2.18). The abstinence rate was approximately twice as high in the experimental group compared with control group 2 (5.9%), but this difference was not statistically significant (OR 2.02, 95% Cl 0.63-6.46). The present study did not provide evidence that the confrontational approach increases the rate of long-term abstinence from smoking compared with an equally intensive treatment in which smokers were not confronted with spirometry. The high failure rates ( >= 88%) highlight the need for treating tobacco addiction as a chronic relapsing disorder.

Kotz D; West R. Explaining the social gradient in smoking cessation: it's not in the trying, but in the succeeding. Tobacco Control 18(1): 43-46, 2009. (24 refs.)

Objective: Smokers from more deprived socioeconomic groups are less likely to become ex-smokers. This study examined how far this is attributable in England to a social gradient in quit attempts, use of aids to cessation and/or the success of quit attempts. Design: Cross-sectional household survey. Setting: England. Participants: 6950 respondents aged 16+ who had smoked in the past year, of whom 2983 had tried to stop in the past year and 469 reported having stopped at the time of the survey. Main outcome measures: Reported attempts to stop smoking in the past year; the use of stop-smoking medications (nicotine replacement therapy, bupropion or varenicline); use of behavioural support offered by the National Health Service Stop Smoking Services; current smoking status. Results: There was a large difference in success rates of quit attempts: 20.4% in social grade AB versus 11.4% in social grade E of those who made attempts were still not smoking by the time of the survey (p < 0.001). However, there was no difference across social grades in the rate of attempts to stop (42.7% in social grade AB to 41.3% in E), use of medications to aid cessation (46.7% of those making quit attempts in AB to 50.9% in E) or use of NHS Stop Smoking Services (7.0% of those making quit attempts in AB to 4.8% in E). Conclusions: Smokers in more deprived socioeconomic groups are just as likely as those in higher groups to try to stop and use aids to cessation but there is a strong gradient across socioeconomic groups in success, with those in the lowest group being half as likely to succeed compared with the highest. Determining the cause of, and counteracting, this gradient is paramount in reducing health inequalities.

Kouvonen A; Vahtera J; Vaananen A; De Vogli R; Heponiemi T; Elovainio M et al. Relationship between job strain and smoking cessation: the Finnish Public Sector Study. Tobacco Control 18(2): 108-114, 2009. (42 refs.)

Aims: To examine whether job strain (ie, excessive demands combined with low control) is related to smoking cessation. Methods: Prospective cohort study of 4928 Finnish employees who were baseline smokers. In addition to individual scores, coworker-assessed work unit level scores were calculated. A multilevel logistic regression analysis, with work units at the second level, was performed. Results: At follow-up, 21% of baseline smokers had quit smoking. After adjustment for sex, age, employer and marital status, elevated odds ratios (ORs) for smoking cessation were found for the lowest vs the highest quartile of work unit level job strain (OR 1.43, 95% CI 1.17 to 1.75) and for the highest vs the lowest quartile of work unit level job control (OR 1.61, 95% CI 1.31 to 1.96). After additional adjustment for health behaviours and trait anxiety, similar results were observed. Further adjustment for socioeconomic position slightly attenuated these associations, but an additional adjustment for individual strain/control had little effect on the results. The association between job strain and smoking cessation was slightly stronger in light than in moderate/heavy smokers. The results for individual job strain and job control were in the same direction as the work unit models, although these relationships became insignificant after adjustment for socioeconomic position. Job demands were not associated with smoking cessation. Conclusions: Smoking cessation may be less likely in workplaces with high strain and low control. Policies and programs addressing employee job strain and control might also contribute to the effectiveness of smoking cessation interventions.

Krishna S; Boren SA; Balas EA. Healthcare via cell phones: A systematic review. Telemedicine Journal and E-Health 15(3): 231-240, 2009. (46 refs.)

Regular care and informational support are helpful in improving disease-related health outcomes. Communication technologies can help in providing such care and support. The purpose of this study was to evaluate the empirical evidence related to the role of cell phones and text messaging interventions in improving health outcomes and processes of care. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to provide care and disease management support. Searches identified 25 studies that evaluated cell phone voice and text messaging interventions, with 20 randomized controlled trials and 5 controlled studies. Nineteen studies assessed outcomes of care and six assessed processes of care. Selected studies included 38,060 participants with 10,374 adults and 27,686 children. They covered 12 clinical areas and took place in 13 countries. Frequency of message delivery ranged from 5 times per day for diabetes and smoking cessation support to once a week for advice on how to overcome barriers and maintain regular physical activity. Significant improvements were noted in compliance with medicine taking, asthma symptoms, HbA1C, stress levels, smoking quit rates, and self-efficacy. Process improvements were reported in lower failed appointments, quicker diagnosis and treatment, and improved teaching and training. Cost per text message was provided by two studies. The findings that enhancing standard care with reminders, disease monitoring and management, and education through cell phone voice and short message service can help improve health outcomes and care processes have implications for both patients and providers.

Martinez E; Tatum KL; Weber DM; Kuzla N; Pendley A; Campbell K et al. Issues related to implementing a smoking cessation clinical trial for cancer patients. Cancer Causes and Control 20(1): 97-104, 2009. (37 refs.)

Given high rates of smoking among cancer patients, smoking cessation treatment is crucial; yet limited data exist to guide integration of such trials into the oncologic context. In order to determine the feasibility of conducting smoking cessation clinical trials with cancer patients, screening and baseline data from a large randomized placebo-controlled pharmacotherapy trial were analyzed. Descriptive statistics and regression analyses were used to compare enrollees to decliners, describe program enrollees, and assess correlates of confidence in quitting smoking. Out of 14,514 screened patients, 263 (< 2%) were eligible; 43 (16%) refused enrollment. Among the eligible patients, 220 (84%) enrolled. Enrollment barriers included smoking rate, medical history/contraindicated medication, lack of interest, and language. Compared to enrollees, decliners were more likely to have advanced cancer. The trial enrolled a sample of 67 (> 30%) African Americans; participants had extensive smoking histories; many were highly nicotine dependent; and participants consumed about seven alcoholic beverages/week on average. Head and neck and breast cancer were the most common tumors. About 52 (25%) reported depressive symptoms. A higher level of confidence to quit smoking was related to lower depression and lower tumor stage. Integrating a smoking cessation clinical trial into the oncologic setting is challenging, yet feasible. Recruitment strategies are needed for patients with advanced disease and specific cancers. Once enrolled, addressing participant's depressive symptoms is critical for promoting cessation.

McDermott L; Dobson A; Owen N. Determinants of continuity and change over 10 years in young women's smoking. Addiction 104(3): 478-487, 2009. (62 refs.)

To examine prospectively continuity and change in smoking behaviour and associated attributes over a 10-year period. Participants (initially aged 18-23 years) in the Australian Longitudinal Study on Women's Health completed postal questionnaires in 1996, 2000, 2003 and 2006. The analysis sample was 6840 women who participated in all surveys and provided complete smoking data. Outcome variables were transitions in smoking behaviour between surveys 1 and 2, 2 and 3, 3 and 4 and 1 and 4. Attributes that differentiated continuing smokers from quitters, relapsers from ex-smokers and adopters from never smokers were examined for each survey period. Explanatory variables included previous smoking history, demographic, psychosocial, life-style risk behaviour and life-stage transition factors. Over 10 years, 23% of participants either quit, re-started, adopted or experimented with smoking. Recent illicit drug use and risky or high-risk drinking predicted continued smoking, relapse and smoking adoption. Marriage or being in a committed relationship was associated significantly with quitting, remaining an ex-smoker and not adopting smoking. Living in a rural or remote area and lower educational attainment were associated with continued smoking; moderate and high physical activity levels were associated positively with remaining an ex-smoker. Life-style and life-stage factors are significant determinants of young women's smoking behaviour. Future research needs to examine the inter-relationships between tobacco, alcohol and illicit drug use, and to identify the determinants of continued smoking among women living in rural and remote areas. Cessation strategies could examine the role of physical activity in relapse prevention.

Mcvea KLSP; Miller DL; Creswell JW; McEntarrfer R; Coleman MJ. How adolescents experience smoking cessation. Qualitative Health Research 19(5): 580-592, 2009. (32 refs.)

In this study we develop a model of how youth experience smoking cessation attempts. We followed 15 adolescent smokers twice monthly over three months. Through six semistructured interviews, we explored participants' subjective experiences of making a "quit" attempt. We analyzed transcript data using grounded theory procedures, beginning with open coding, axial coding, construction of matrices, and development of a preliminary theory or model of this phenomenon. We found that only emotionally compelling and inescapable quit reasons were truly motivating. Few parents actively supported their child during quit attempts; smoking friends and other peers undermined them. All successful quitters established new, nonsmoking friends and completely redefined themselves. The quit experience was physically uncomfortable, emotionally distressful, and socially isolating. Greater motivation, mature problem-solving skills, and a willingness to supplant their smoking friends characterized successful quitters. Further research is needed to test this model's efficacy in the adolescent population.

Meshack A; Moultry AM; Hu S; McAlister AL. Smoking cessation counseling practices of Texas pharmacists. Journal of Community Health 34(3): 231-238, 2009. (28 refs.)

A cross-sectional study was conducted to determine pharmacists' awareness and education about smoking cessation and their communication with patients about smoking cessation. A survey was mailed to East Texas pharmacists practicing in the areas of hospital or clinical, retail or community, managed care, consultant, or academic pharmacy. Outcome measurements included: measures of the awareness of the 5 A's and 5 R's of smoking cessation, training received in smoking cessation, and communication practices regarding smoking cessation. There were 320 respondents. Approximately 10% of the respondents indicated they had received tobacco cessation counseling education during their formal educational training, 36% during continuing education programs, and 9% during both formal training and continuing education. About 44% reported they had received no tobacco cessation counseling training. Among pharmacists surveyed, 5% responded that they usually or always ask their patients if they smoke cigarettes, pipe, or cigars, 43% reported they sometimes or half of the time ask, and 45% said they never ask. There is a clear relationship between pharmacists awareness and education of smoking cessation techniques and their communication with patients about them. Pharmacy education leaders must continue their movement to include public health in the pharmacy curricula to produce pharmacists who are prepared to better serve the community.

Moore D; Aveyard P; Connock M; Wang DC; Fry-Smith A; Barton P. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: Systematic review and meta-analysis. British Medical Journal 338(article b1024): article b1024, 2009. (34 refs.)

Objective To determine the effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking. Design Systematic review of randomised controlled trials. Data sources Cochrane Library, Medline, Embase, CINAHL, PsychINFO, Science Citation Index, registries of ongoing trials, reference lists, the drug company that sponsored most of the trials, and clinical experts. Review methods Eligible studies were published or unpublished randomised controlled trials that enrolled smokers who declared no intention to quit smoking in the short term, and compared nicotine replacement therapy (with or without motivational support) with placebo, no treatment, other pharmacological therapy, or motivational support, and reported quit rates. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data and these processes were checked by a second reviewer. The primary outcome, six months sustained abstinence from smoking beginning during treatment, was assessed by individual patient data analysis. Other outcomes were cessation and reduction at end of follow-up, and adverse events. Data synthesis Seven placebo controlled randomised controlled trials were included (four used nicotine replacement therapy gum, two nicotine replacement therapy inhaler, and one free choice of therapy). They were reduction studies that reported smoking cessation as a secondary outcome. The trials enrolled a total of 2767 smokers, gave nicotine replacement therapy for 6-18 months, and lasted 12-26 months. 6.75% of smokers receiving nicotine replacement therapy attained sustained abstinence for six months, twice the rate of those receiving placebo (relative risk (fixed effects) 2.06, 95% confidence interval 1.34 to 3.15; (random effects) 1.99, 1.01 to 3.91; five trials). The number needed to treat was 29. All other cessation and reduction outcomes were significantly more likely in smokers given nicotine replacement therapy than those given placebo. There were no statistically significant differences in adverse events (death, odds ratio 1.00, 95% confidence interval 0.25 to 4.02; serious adverse events, 1.16, 0.79 to 1.50; and discontinuation because of adverse events, 1.25, 0.64 to 2.51) except nausea, which was more common with nicotine replacement therapy (8.7% v 5.3%; odds ratio 1.69, 95% confidence interval 1.21 to 2.36). Conclusions Available trials indicate that nicotine replacement therapy is an effective intervention in achieving sustained smoking abstinence for smokers who have no intention or are unable to attempt an abrupt quit. Most of the evidence, however, comes from trials with regular behavioural support and monitoring and it is unclear whether using nicotine replacement therapy without regular contact would be as effective.

Morris CD; Waxmonsky JA; May MG; Giese AA. What do persons with mental illnesses need to quit smoking? Mental health consumer and provider perspectives. Psychiatric Rehabilitation Journal 32(4): 276-284, 2009. (50 refs.)

Objectives: Forty-one percent (41%) of persons in the U.S. who reported having recent mental illnesses also smoke cigarettes. Tobacco use among this population is associated with Up to 25 less years of life and excess medical comorbidity compared to the general population. While research demonstrates that tobacco interventions can be effective for persons with mental illnesses, they are not commonly utilized in clinical practice. The current study explored how to adapt evidence-based tobacco cessation interventions to meet the unique physiological, psychological, and social challenges facing persons with mental illnesses. Methods: Ten focus groups were conducted utilizing a semi-structured discussion; 5 for adult mental health consumers (n = 62) and 5 with mental health clinicians and administrators (n = 22). Content analysis was used to organize themes into categories. Results: Five thematic categories were found: (1) Barriers to treatment, (2) Resources and infrastructure, (3) Negative influences on smoking behavior, (4) Knowledge deficits, and (5) Treatment needs. Conclusions: These findings are instructive in developing appropriate tobacco cessation services for this population. Specifically, these data have been incorporated into a mental health provider toolkit for smoking cessation and have informed the development of a tobacco cessation intervention study.

Moss DR; Cluss PA; Watt-Morse M; Pike F. Targeting pregnant and parental smokers: Long-term outcomes of a practice-based intervention. Nicotine & Tobacco Research 11(3): 278-285, 2009. (42 refs.)

This study aimed to assess the change in obstetric and pediatric provider smoking cessation practices following implementation of a practice guideline-driven office-based program. This pre-post evaluation took place between May 2003 and August 2006 in 1 pediatric and 1 obstetric hospital-based clinic. The intervention involved provider training combined with office system supports. A total of 1,080 exit interviews were collected to measure outcomes of clinic practices at baseline and at 1 month, 6 months, 1 year (obstetric), and 2 years (pediatric) after implementation. Trend analysis was used to assess change in practice rates over time. Following program implementation, pediatric provider "Ask" rates increased (49% before to 86% 2 years after, p < .0001); changes in pediatric "Advise" and "Assist" rates were not significant: 44%-59% (p = .19) and 18%-28% (p = .26), respectively. In the obstetric clinic, whereas no significant changes were detected in provider "Ask" (59%-65% 1 year after, p = .17) or "Advise" (72%-85%, p = .27) rates, "Assist" rates rose from 28% to 62% (p = .0075) 1 year after program implementation. Implementation of the office-based program achieved significantly improved trends in pediatric provider "Ask" rates and obstetric provider "Assist" rates over time. Further research is needed on office strategies to create long-term provider behavior changes in smoking cessation practices.

Muller BCN; van Baaren RB; Ritter SM; Woud ML; Bergmann H; Harakeh Z et al. Tell me why ... The influence of self-involvement on short term smoking behaviour. Addictive Behaviors 34(5): 427-431, 2009. (42 refs.)

Previous studies found that information is more persuasive when self-generated (high self-involvement), rather than when simply read or heard (low self-involvement). In two studies, we investigated whether differences in self-involvement concerning smoking issues would influence immediate smoking behaviour. As predicted, results indicate that participants who developed their own arguments against smoking waited longer before lighting up a cigarette than those who read arguments against smoking that were developed by other participants (Study 1). Further, participants who additionally generated their own arguments were less likely to smoke within 30 min than those who read prepared arguments against smoking (Study 2). In sum, our studies illustrate that personal involvement in generating anti-smoking arguments can reduce short term smoking behaviour.

Nakamura K; Naoata C; Fujii K; Kawachi T; Takatsuka N; Oba S et al. Cigarette smoking and the adult onset of bronchial asthma in Japanese men and women. Annals of Allergy, Asthma, & Immunology 102(4): 288-293, 2009. (22 refs.)

Background: Although smoking is a well-known risk factor for the onset of airway diseases, the associations between smoking and asthma are inconsistent. Objective: To examine the relationship of smoking in adulthood with the occurrence of asthma in Japanese individuals. Methods: A total of 6,674 men and 8,301 women from a population-based cohort in Takayama, Japan, participated in this prospective study. Information on smoking was collected via a baseline questionnaire in 1992. In 2002, development of asthma and the time of physician diagnosis were reported. Results: During, 10-year follow-up, 105 men and 92 women reported the onset of physician-diagnosed asthma. Among men, compared with never smokers, current smokers at baseline had a significantly increased risk of asthma after adjustment for covariates (hazard ratio [HR], 2.79; 95% confidence interval [CI], 1.18-6.55), whereas women with a current or former history of smoking were at an increased but not significant risk of asthma (HR, 1.18; 95% CI, 0.58-2.38). An approximately 2- to 5-fold increased risk of asthma was observed in men who smoked for more than 30 years or more than 21 cigarettes daily, with a nonsignificant linear trend, but there was no dose-response relationship in current-smoking women. Ever-smoking women with husbands who were ever smokers had a hi-her risk of asthma (HR, 2.02; 95% CI, 0.72-5.65) than never-smoking women with husbands who had never smoked either. Conclusion: These data suggest that smoking increases the risk of asthma onset in men.

Nishiura C; Narai R; Ohguri T; Funahashi A; Yarita K; Hashimoto H. The effect of smoking prevalence at worksites on individual cessation behavior. Journal of Occupational Health 51(1): 48-56, 2009. (23 refs.)

The Effect of Smoking Prevalence at Worksites on Individual Cessation Behavior: Chihiro NISHIURA, et al. Department of Safety and Health, Tokyo Gas Co., Ltd.-Objectives: To identify the effect of worksite smoking prevalence on individual cessation behavior. Methods: We conducted a cohort study at a Japanese worksite without a total ban on smoking, but with designated smoking areas. Baseline data were obtained in 2005 through a self-administered questionnaire from 15,229 workers in 322 work units as part of annual health checkups, and followed up in 2006. Data on smoking status, time to first cigarette after waking up, desire to quit, number of cigarettes smoked per day, and respiratory symptoms were obtained. Details like workers' demographics, blue/white-collar workers, night shift duties, administrative position, and work unit codes were obtained from the firm's administrative records. Smoking prevalence in work units was calculated as a ratio, standardized by age, and categorized into quartiles. Multiple logistic regression was used to predict cessation by smoking prevalence, adjusting for individual level variables. Results: In the lowest smoking prevalence quartile compared with the highest, odds ratios (95% CI) of cessation among those who smoked their first cigarette more than 30 min after waking up were 2.32 (1.06, 5.09) in white-collar units and 1.86 (0.98, 3.55) in blue-collar units, and that among those with a moderate desire to quit was 2.05 (0.94, 4.49) in white-collar units. Conclusion: Worksite smoking prevalence affects the likelihood of successful cessation, especially among those with less nicotine dependence and who are in the early stage of behavioral change. This suggests that serious consideration should be placed not only on individual behavior modification but also on modification of worksite conditions.

O'Loughlin J; Gervais A; Dugas E; Meshefedjian G. Milestones in the process of cessation among novice adolescent smokers. American Journal of Public Health 99(3): 499-504, 2009. (16 refs.)

Objectives. We sought to document the sequence and timing of milestones in the process of smoking cessation by prospectively studied cessation milestones among novice adolescent smokers. Methods. Participants, aged 12 to 13 years in 1999 (n = 1293), completed self-report questionnaires every 3 months during the school year over 5 years. We ascertained time after first puff to attain 5 cessation milestones among 319 participants who initiated cigarette smoking during follow-up. Results. The cumulative probability of first reports of a serious desire to quit and perceived permanent cessation was 25% at 1.5 months (95% confidence interval [CI] = 1.5, 2.5) after the first puff. The first serious quit attempt occurred at 2.5 months (95% CI=2.5, 5.4), lack of confidence about quitting followed at 18.4 months (95% CI= 18.4, 26.8), and awareness of the difficulty of quitting occurred at 32.2 months (95% CI = 19.2, 38.4). Conclusions. Desire and attempts to quit began soon after smoking onset. Novice smokers progressed through several stages in their perception of the difficulty of quitting. Increased understanding of the cessation process may help in developing effective tobacco control interventions for novice smokers.

Otsuka F; Kojima S; Maruyoshi H; Kojima S; Matsuzawa Y; Funahashi T et al. Smoking cessation is associated with increased plasma adiponectin levels in men. Journal of Cardiology 53(2): 219-225, 2009. (28 refs.)

Objectives: Low levels of adiponectin, an adipocytokine with anti-diabetic and anti-atherogenic properties, are associated with increased risk of future myocardial infarction in men. Previous studies have demonstrated that cigarette smoking is involved in the development of insulin resistance, and current smokers have been shown to have reduced plasma adiponectin levels. However, the influence of smoking cessation on adiponectin levels remains unknown. We sought to assess whether smoking cessation is associated with increased plasma adiponectin levels in men. Methods: The study includes 72 men (47 non-smokers and 25 current smokers at baseline) with stable angina pectoris who underwent percutaneous coronary intervention and follow-up coronary angiography 6 months later. During the 6-month follow-up period, all 47 non-smokers remained non-smokers, while 15 men of the 25 baseline current smokers successfully quit smoking. We evaluated plasma adiponectin levels at coronary intervention and 6 months later. Results: Plasma adiponectin levels at coronary intervention were comparable to those after 6 months in non-smokers (4.22 [3.15-6.43] vs. 4.58 [3.03-6.26] mu g/mL, P=0.124) and in persistent smokers (4.77 [4.25-10.53] vs. 5.16 [4.11-8.10] mu g/mL, P=0.721). Meanwhile, an increase in adiponectin level was observed in patients who quit smoking for 6 months (4.24 [3.30-5.70] vs. 5.50 [4.03-8.00] mu g/mL, P=0.002). Univariate analysis revealed that the percent increase in adiponectin levels correlated positively with smoking cessation (P=0.003) and negatively with additional use of beta-blockers (P=0.049). In addition, increases in adiponectin levels were closely associated with increase in high-density lipoprotein cholesterol (P=0.148), decrease in triglycerides (P=0.140), and additional use of renin-angiotensin system inhibitors (P=0.069). Multivariate analysis demonstrated that smoking cessation was an independent determinant of the increase in adiponectin (P=0.036). Conclusions: Smoking cessation is associated with increased plasma adiponectin levels in men with stable angina, suggesting that the significance of smoking cessation may be partly explained by the increase in adiponectin level.

Patterson F; Jepson C; Strasser AA; Loughead J; Perkins KA; Gur RC et al. Varenicline improves mood and cognition during smoking abstinence. Biological Psychiatry 65(2): 144-149, 2009. (55 refs.)

Background: Neuronal nicotinic acetylcholine receptors (nAChRs) area key target in medication development for various neuropsychiatric disorders, including nicotine dependence. Varenicline, a partial agonist at the alpha 4 beta 2 nAChRs, is a new, efficacious medication for nicotine dependence. Its effects on the affective and cognitive dimensions of nicotine withdrawal have yet to be well characterized. Methods: Sixty-seven treatment-seeking smokers were administered varenicline (X 21 days) and placebo (X 21 days) in a double-blind within-subject crossover design. Following medication run-up (Days 1-10), there was a 3-day mandatory smoking abstinence phase (Days 11-13) during which subjective symptoms and cognitive performance were assessed. Participants were reexposed to a scheduled smoking lapse (Day 14) and followed for days to lapse (Days 15-21) in each medication period. Results: In the varenicline period, compared with placebo, withdrawal symptoms (p = .04), smoking urges (p < .001), and negative affect (p = .01) during manditory abstinence were significantly lower, and levels of positive affect (p = .046), sustained attention (p = .018), and working memory (p = .001) were significantly greater. Varenicline also significantly reduced subjective rewarding effects of the scheduled smoking lapse (e.g., satisfaction, relief, liking; p = .003). Medication effects on days to lapse following the scheduled smoking lapse were dependent on treatment order (p = .001); among participants who received placebo in the first period, varenicline increased days of abstinence in the follow-up period. Conclusions: These data identify novel affective and cognitive effects of varenicline and may have implications for medication development for other neuropsychiatric conditions.

Ratschen E; Britton J; Doody GA; McNeill A. Smoke-free policy in acute mental health wards: Avoiding the pitfalls. General Hospital Psychiatry 31(2): 131-136, 2009. (23 refs.)

Objective: The objective of this work was to explore the practical implications of, and the problems arising from, the implementation of a comprehensive smoke-free policy in acute adult inpatient mental health wards. Method: This is a qualitative study that uses semistructured interviews with a stratified purposive sample of 16 medical and nonmedical staff of two wards in an acute mental health trust in England that had implemented a smoke-free policy in buildings and grounds in March 2007. Results: The smoke-free policy was viewed ambivalently and was substantially compromised by widespread use of exceptions such as permitting patients to smoke in an outdoor patio and covert indoor smoking. Smoking breaks were described to be a fixation for patients and sometimes disruptive to therapeutic activities. Nicotine dependence and withdrawal were not assessed or supported systematically. Awareness of interactions between smoking and certain antipsychotic medications was anecdotal and did not impact on clinical practice. Conclusions: The implementation of smoke-free policies in these acute mental health wards suffered front the provision of regular institutionalized smoking breaks, a lack of sustained investment in staff training and a lack of comprehensive cessation or abstinence support for patients. These issues need to be addressed; otherwise, the implementation of smoke-free policies in mental health settings may result in unintended adverse effects.

Raw M; Regan S; Rigotti NA; McNeill A. A survey of tobacco dependence treatment services in 36 countries. Addiction 104(2): 279-287, 2009. (17 refs.)

This paper reports the results of a survey of national tobacco dependence treatment services in 36 countries. The objective was to describe the services and discuss the results in the context of Article 14 of the Framework Convention on Tobacco Control, which asks countries to promote adequate treatment for tobacco dependence. A questionnaire on tobacco dependence treatment services was e-mailed to a convenience sample of contacts in 2007. Completed questionnaires were received from contacts in 36 countries. The survey instrument was a 10-item questionnaire asking about treatment policy and practice, including medications. According to our informants, fewer than half the countries in our survey had an official written policy on (44%), or a government official responsible for (49%), treatment. Only 19% had a specialized national treatment system and only 24% said help was easily available in general practice. Most countries (94%) allowed the sale of nicotine replacement therapy (NRT), bupropion (75%) and varenicline (69%) but only 40% permitted NRT on 'general sale'. Very few countries responding to the question fully reimbursed any of the medications. Fewer than half (45%) fully reimbursed brief advice and only 29% fully reimbursed intensive specialist support. Only 31% of countries said that their official treatment policy included the mandatory recording of patients' smoking status in medical notes. Taken together, our findings show that few countries have well-developed tobacco dependence treatment services and that, at a national level, treatment is not yet a priority in most countries.

Reitzel LR; Costello TJ; Mazas CA; Vidrine JI; Businelle MS; Kendzor DE et al. Low-level smoking among Spanish-speaking Latino smokers: Relationships with demographics, tobacco dependence, withdrawal, and cessation. Nicotine & Tobacco Research 11(2): 178-184, 2009. (23 refs.)

Although recent research indicates that many Latino smokers are nondaily smokers or daily smokers who smoke at a low level (<= 5 cigarettes/day), almost no research has investigated the characteristics of low-level smokers because such individuals are typically excluded from clinical trial research. The present study examined the associations of daily smoking level and demographics, tobacco dependence, withdrawal, and abstinence during a specific quit attempt among 280 Spanish-speaking Latino smokers (54% male) who participated in a clinical trial of a telephone counseling intervention. Daily smokers were classified as low-level (1-5 cigarettes/day; n = 81), light (6-10 cigarettes/day; n = 99), or moderate/heavy smokers (>= 11 cigarettes/day; n = 100). Data were collected prior to the quit attempt and at 5 and 12 weeks postquit. Results yielded three key findings. First, smoking level was positively associated with the total score and 12 of 13 subscale scores on a comprehensive, multidimensional measure of tobacco dependence. Low-level smokers consistently reported the least dependence, and moderate/heavy smokers reported the most dependence on tobacco. Second, low-level smokers reported the least craving in pre- to postcessation longitudinal analyses. Third, despite significant differences on dependence and craving, low-level smoking was not associated with abstinence. Smoking level was not associated with demographic variables. This is a preliminary step in understanding factors influencing tobacco dependence and smoking cessation among low-level Spanish-speaking Latino smokers, a subgroup with high prevalence in the Latino population.

Rigotti NA. The future of tobacco treatment in the health care system. (editorial). Annals of Internal Medicine 150(7): 496-497, 2009. (14 refs.)

Rigotti NA; Gonzales D; Dale LC; Lawrence D; Chang Y. A randomized controlled trial of adding the nicotine patch to rimonabant for smoking cessation: Efficacy, safety and weight gain. Addiction 104(2): 266-276, 2009. (32 refs.)

Because smoking cessation rates might be improved by combining drugs and by reducing post-cessation weight gain, we tested the smoking cessation efficacy, safety and effect on body weight of adding the nicotine patch to rimonabant, a cannabanoid type-1 receptor antagonist that reduces body weight. Randomized double-blind placebo-controlled trial. Fifteen US research centers. A total of 755 smokers (>= 15 cigarettes/day). Rimonabant (20 mg daily) was given open-label for 9 weeks. The 735 participants completing week 1 were randomized at day 8 (target quit day) to add a nicotine patch (n = 369) or placebo patch (n = 366) for 10 weeks (21 mg daily for 8 weeks plus a 2-week taper). Participants received weekly smoking counseling and were followed for 24 weeks. Biochemically validated 4-week continuous abstinence at end-of-treatment (weeks 6-9; primary end-point); 7-day point prevalence abstinence at weeks 9 and 24; sustained abstinence (weeks 6-24); change in body weight; and adverse events. Rimonabant plus nicotine patch was superior to rimonabant plus placebo in validated continuous abstinence at weeks 6-9 (39.0% versus 21.3%; odds ratio 2.36, 95% confidence interval: 1.71-2.37; P < 0.01) and in all other efficacy measures. Mean end-of-treatment weight gain among quitters did not differ between groups (0.04 kg for combination versus 0.49 kg for rimonabant only, P = 0.15) and was similar in weight-concerned smokers. Serious adverse event rates did not differ between groups. Depression- and anxiety-related adverse events occurred in 32 (4.2%) and 44 (5.8%) subjects, respectively; eight (1.1%) and nine (1.2%) subjects stopped the drug due to depression and anxiety, respectively. Adding a nicotine patch to rimonabant was well tolerated and increased smoking cessation rates over rimonabant alone. There was little post-cessation weight gain in either group, even among weight-concerned smokers, during drug treatment.

Rosseel JP; Jacobs JE; Hilberink SR; Maassen IM; Allard RHB; Plasschaert AJM et al. What determines the provision of smoking cessation advice and counselling by dental care teams? British Dental Journal 206(7): e-article 13, 2009. (25 refs.)

Objective To investigate determinants of the provision of smoking cessation advice and counselling by various dental professionals in the dental team (dentists, dental hygienists and prevention auxiliaries). Design Cross-sectional design. Setting Sixty-two general dental practices in the Netherlands. Methods Multivariate logistic analyses of self-reported counselling behaviour collected from questionnaires for dentists (n = 72), dental hygienists (n = 31) and prevention auxiliaries (n = 50) in general dental practices. Main outcome measures Stimuli and barriers for smoking cessation counselling and advice behaviour to patients with or without oral health problems. Results Dental hygienists provided more general cessation advice and counselling than dentists. However, when patients had oral complaints, dentists counselled more often compared to prevention auxiliaries. The support from experienced colleagues positively influenced the provision of advice and counselling as well as the perceived self-efficacy for all kinds of dental professionals. Conclusions The provision of general smoking cessation advice to patients with no acute oral complaints can be improved by more involvement of the dentist and/or task delegation to prevention auxiliaries and dental hygienists. Social support is important in encouraging more smoking cessation advice and counselling. Implementation strategies for support of smoking cessation in dental care should focus on creating a positive advice culture among colleagues.

Sadr Azodi O; Lindstrom D; Adami J; Tonnesen H; Nasell H; Gilljam H et al. The efficacy of a smoking cessation programme in patients undergoing elective surgery: A randomised clinical trial. Anaesthesia 64(3): 259-265, 2009. (34 refs.)

It is known that smokers constitute an important risk group of patients undergoing surgery. It is unknown how smoking cessation intervention initiated 4 weeks prior to elective surgery affects the probability of permanent cessation. We randomly assigned 117 patients, scheduled to undergo elective orthopaedic and general surgery, to smoking cessation intervention and control group. The intervention group underwent a programme initiated, on average, 4 weeks prior to surgery with weekly meetings or telephone counselling and were provided with free nicotine replacement therapy (NRT). The control group received standard care. As a result, 20/55 (36%) patients the intervention group vs 1/62 (2%) in the control group became completely abstinent throughout the peri-operative period (p < 0.001). After 1 year, those in the intervention group was most likely to be abstinent (18/55 (33%) vs 9/62 (15%) of the controls (p = 0.03). Level of nicotine dependence and obesity seemed to be a predictor of long-term abstinence (p = 0.02).

Salize HJ; Merkel S; Reinhard I; Twardella D; Mann K; Brenner H. Cost-effective primary care-based strategies to improve smoking cessation: More value for money. Archives of Internal Medicine 169(3): 230-235, 2009. (26 refs.)

Background: Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany. Methods: In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits. Results: Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95% level of certainty of cost-effectiveness against TAU, (sic)9.80 or (sic)6.96, respectively, had to be paid for each additional 1% of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, (sic)92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to (sic)39.10 paid per patient during the trial). In intervention 2, the cost was (sic)82.82, as opposed to (sic)50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; (sic)1 = $1.17.) Conclusions: Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy.

Schroeder SA. A 51-year-old woman with bipolar disorder who wants to quit smoking. Journal of the American Medical Association 301(5): 522-531, 2009. (93 refs.)

Shiffman S; Ferguson SG; Strahs KR. Quitting by gradual smoking reduction using nicotine gum: A randomized controlled trial. American Journal of Preventive Medicine 36(2): 96-104, 2009. (39 refs.)

Background: Many smokers express a desire to quit smoking by gradually reducing the number of cigarettes they smoke until they stop completely. This study tested the efficacy of nicotine gum in facilitating cessation through gradual reduction. Design: This was a multi-center, placebo-con trolled, double-blind RCT of 2- and 4-mg nicotine gum versus Placebo. Setting/participants: 3297 smokers who were interested in quitting gradually. Intervention: Subjects were instructed to gradually reduce their smoking while increasing their gum use over the course of up to 8 weeks. Once they had achieved initial abstinence (no smoking for 24 hours), gum was to be used in accordance with the current FDA-approved directions for cessation. The study was conducted under over-the-counter conditions, with no counseling provided. Continuous abstinence was assessed after 28 days and 6 months. Secondary measures of smoking reduction were also assessed. Analyses were conducted in 1999-2000 and 2007-2008. Main outcome measures: Smokers on active gum were significantly more likely to achieve initial cessation (2 mg: OR=1.42; 4 mg: OR=1.90); 28-day continuous abstinence (2 mg: OR=2.01; 4 mg: OR=4.66); and continuous abstinence at 6 months (2 mg: OR=1.80; 4 mg: OR=5.96). During the reduction phase, active gum aided smoking reduction, and participants who reduced their smoking were more likely to achieve abstinence. Conclusions: These findings demonstrate that smokers who wish to quit smoking by gradual reduction can increase their success by using nicotine gum to facilitate reduction and cessation.

Siru R; Hulse GK; Tait RJ. Assessing motivation to quit smoking in people with mental illness: A review. (review). Addiction 104(5): 719-733, 2009. (12 refs.)

Background: People with mental health (MH) disorders smoke at higher rates, are more nicotine-dependent and suffer greater morbidity and mortality from smoking-related illnesses than the general population. Helping these people to quit smoking is a public health priority; however, many MH professionals assume that those with mental illness are not motivated to quit. Objectives To use predetermined criteria to identify, review critically and evaluate empirically all English language, peer-reviewed data on motivation to quit smoking in MH populations. Methods A systematic search was conducted and key data on subject characteristics, measures of motivation and other variables abstracted. chi(2) analyses were used to compare motivation between MH and general populations, between in-patients and out-patients and between people with depression and people with psychotic disorders. Results: Evidence suggests that people with MH disorders are as motivated to quit smoking as the general population, although those with psychotic disorders may be less motivated than individuals with depression. Although readiness to cease smoking was assessed in 14 studies, only two evaluated motivation to quit smoking in in-patient populations. Conclusions: People with MH disorders are motivated to quit smoking, although more research is needed looking at in-patient populations. The commonly held false belief that people with MH disorders are not motivated to cease smoking means that opportunities to encourage smoking cessation among this disenfranchised group are being missed.

Slatore CG; Au DH; Hollingworth W. Cost-effectiveness of a smoking cessation program implemented at the time of surgery for lung cancer. Journal of Thoracic Oncology 4(4): 499-504, 2009. (41 refs.)

Background: Many patients are active smokers at the time of a diagnosis of surgically resectable lung cancer. Perioperative smoking cessation is associated with improved survival, but the cost-effectiveness of a smoking cessation program initiated immediately before surgery is unknown. Methods: We developed a decision analytic Markov model to evaluate the incremental cost-effectiveness of a formal smoking cessation program. The parameter estimates were taken from the available literature. The model included the cost and effectiveness of the smoking cessation program, cost and incidence of perioperative complications, postoperative mortality, and utility measured in quality adjusted life years (QALY). Dollars per QALY and life year were calculated and one-way sensitivity analyses were performed. Results: The cost/QALY and cost/life year were $16,415 and $45,629 at 1 year after surgery and $2609 and $2703 at 5 years, respectively. Most sensitivity analyses showed the 1 year postsurgery cost/QALY estimates were less than $50,000, and all were less than $12,000 at 5 years. Cost-effectiveness estimates were most sensitive to the frequency of perioperative complications and the estimated short-term utility estimates. Conclusion: A smoking cessation program initiated before Surgical lung resection is cost-effective at both I and 5 years postsurgery. Providers should encourage patients who are still smoking to engage in formal smoking cessation programs.

Stapleton JA. Trial comes too late as psychiatric effects end hope for rimonabant. (commentary). Addiction 104(2): 277-278, 2009. (12 refs.)

The manufacturers tested rimonabant for smoking cessation in the United States and Europe in two large placebo-controlled Phase III trials involving 1049 subjects. Still unpublished, the data were presented at public meetings in 2005 and showed a pooled odds ratio (OR) in favour of rimonabant of 1.61 [95% con?dence interval (CI): 1.12-2.30]. Although in the European trial the effect failed to reach signi?cance (OR 1.31, 95% CI: 0.83-2.09), the overall result was suf?ciently supportive of at least modest ef?cacy. Substantial weight gain was eliminated and a further trial showed a small bene?t in reducing relapse in those abstinent from smoking for 10 weeks. However, in early 2006 the manufacturers postponed the advancement of the smoking indiction following refusal by the US Food and Drug Administration (FDA) to accept rimonabant until a further trial had been completed. In November the manufacturer announced that they had discontinued all requested trial work on the drug. There was concern about the high incidence of side effects such as nausea (about 15%) and, more worryingly, an excess risk of serious psychiatric side effects including depression, anxiety and suicidal behaviour. It is unlikely that the original pivotal trials will ever appear in print, leaving "Addiction" with the historical distinction of being the only journal to publish the full details of a rimonabant trial for smoking cessation. For the record, there was one case of attempted suicide in this trial among the 754 smokers starting treatment and 17 subjects discontinued treatment due to depression or anxiety disorders.

Styn MA; Nukui T; Romkes M; Perkins K; Land SR; Weissfeld JL. The impact of genetic variation in DRD2 and SLC6A3 on smoking cessation in a cohort of participants 1 year after enrollment in a lung cancer screening study. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 150B(2): 254-261, 2009. (33 refs.)

Smoking cessation strategies continue to have disappointing results. By determining the interindividual genetic differences that influence smoking behaviors, we may be able to develop tailored strategies that increase the likelihood of successful cessation. This study attempts to determine genetic influences on the relationship between the dopamine pathway and smoking cessation by examining associations with a variable number tandem repeat variation in SLC6A3 and the DRD2 variants TaqIA (A2 vs. A 1), TaqIB (B2vs. B1), C957T(Cvs. T), and -141CIns/Del (Cvs. Del). Baseline smokers in the Pittsburgh Lung Screening Study who provided information on smoking status 1 year later were evaluated. We frequency-matched those who were not abstinent at 1 year to those who were abstinent at 1 year by gender, decade of age, and time of enrollment (3-month intervals) in a 3:1 ratio (N = 881). Logistic regression was used to identify the effect of genotype on abstinence at 1 year. In a model containing the matching variables and other genotypes, DRD2 TaqIA was significantly associated with being abstinent at 1 year (P=0.01). Compared to participants who were homozygous for the TaqIA major allele (A2A2), participants who carried at least one minor allele (A I) were less likely to quit (Odds Ratio: 0.47, 95% CI: 0.24-0.94). The other dopamine receptor genotypes and the SLC6A3 genotype were not associated with smoking status at 1 year. The association between DRD2 TaqIA and smoking cessation supports the hypothesis that genetic variation in the dopamine pathway influences smoking cessation.

Tonnesen H; Nielsen PR; Lauritzen JB; Moller AM. Smoking and alcohol intervention before surgery: Evidence for best practice. (review). British Journal of Anaesthesia 102(3): 297-306, 2009. (84 refs.)

Smoking and hazardous drinking are common and important risk factors for an increased rate of complications after surgery. The underlying pathophysiological mechanisms include organic dysfunctions that can recover with abstinence. Abstinence starting 3-8 weeks before surgery will significantly reduce the incidence of several serious postoperative complications, such as wound and cardiopulmonary complications and infections. However, this intervention must be intensive to obtain sufficient effect on surgical complications. All patients presenting for surgery should be questioned regarding smoking and hazardous drinking, and interventions appropriate for the surgical setting applied.

Wang C; Xiao D; Chan KPW; Pothirat C; Garza D; Davies S. Varenicline for smoking cessation: A placebo-controlled, randomized study. Respirology 14(3): 384-392, 2009. (27 refs.)

Varenicline tartrate, a novel, selective, nicotinic acetylcholine receptor partial agonist, has been developed specifically as a smoking cessation drug. This study evaluated the efficacy of a standard regimen of varenicline compared with placebo for smoking cessation in 333 subjects in China, Singapore and Thailand. This 24-week, randomized, double-blind, placebo-controlled trial of varenicline, 1 mg bd, consisted of a 12-week treatment period followed by a 12-week non-treatment follow-up period. The primary study end-point was the 4-week continuous abstinence rate defined as the proportion of subjects who reported total abstinence from smoking and other nicotine products from weeks 9-12. A key secondary end-point was the continuous abstinence rate from weeks 9-24, defined as the proportion of subjects who achieved the primary end-point as well as total abstinence from all tobacco products from weeks 13-24. Both end-points were achieved by a significantly higher proportion of subjects in the varenicline group than in the placebo group. The 4-week continuous abstinence end-point was achieved by 50.3% and 31.6% in the varenicline and placebo groups, respectively (P = 0.0003), while continuous abstinence from weeks 9-24 was achieved by 38.2% and 25.0% of subjects, respectively (P = 0.0080). The treatment effect was generalizable by treatment centre and country. Varenicline was safe and appeared to be well tolerated by most subjects. Varenicline was significantly more efficacious for smoking cessation than placebo over a 12-week treatment period and a further 12-week non-treatment follow-up period in smokers from China, Singapore and Thailand. No significant side-effects were noted.

Weimer DL; Vining AR; Thomas RK. Cost-benefit analysis involving addictive goods: Contingent valuation to estimate willingness-to-pay for smoking cessation. Health Economics 18(2): 181-202, 2009. (42 refs.)

The valuation of changes in consumption of addictive goods resulting from policy interventions presents a challenge for cost-benefit analysis. Consumer surplus losses from reduced consumption of addictive goods that are measured relative to market demand schedules overestimate the social cost of cessation interventions. This article seeks to show that consumer surplus losses measured using using a non-addicted demand schedule provide a better assessment of social cost. Specifically, (1) it develops an addiction model that permits an estimate of the smoker's compensating variation for the elimination of addiction; (2) it employs a contingent valuation survey of current smokers to estimate their willingness-to-pay (WTP) for a treatment that would eliminate addiction: (3) it uses the estimate of WTP from the survey to calculate the fraction of consumer surplus that should be viewed as consumer value and (4) it provides an estimate of this fraction. The exercise suggests that, as a tentative first and rough rule-of-thumb only about 75% of the loss of the conventionally measured consumer surplus should be counted as social cost for policies that reduce the consumption of cigarettes. Additional research to estimate this important rule-of-thumb is desirable to address the various caveats relevant to this study.

Wolfenden L; Wiggers J; Campbell E; Knight J; Kerridge R; Spigelman A et al. Providing comprehensive smoking cessation care to surgical patients: The case for computers. Drug and Alcohol Review 28(1): 60-65, 2009. (29 refs.)

Introduction and Aims. The provision of smoking cessation care to surgical patients before admission can reduce post-operative complications and encourage long-term smoking cessation. Our aim was to show how a comprehensive computer-based smoking cessation intervention, developed to enhance smoking cessation care to surgical patients, addresses barriers to care provision. Design and Methods. Consultations with preoperative clinic staff and reviews of the scientific literature were conducted and identified the following barriers to the provision of effective smoking cessation care: a lack of organisational support, perceived patient objection, a lack of systems to identify smokers, a lack of staff time and skill, perceived inability to change care practices, a perceived lack of efficacy of cessation care and the cost of providing care. Based on positive findings of a pilot trial, a comprehensive computer-based smoking cessation intervention was implemented in a preoperative clinic. Data from previous evaluations of the intervention were used to assess the extent to which the intervention addressed clinician barriers to care. Results. The computer-based intervention was found to provide a means to accurately and systematically identify smokers; it required little clinical staff time or skill; it was considered an acceptable form of care by staff and patients; it was effective in encouraging patient cessation and it was inexpensive to deliver relative to other surgical costs. Furthermore, the computer-based intervention continues to operate in the preoperative clinic in the absence of ongoing research support. Discussion and Conclusions. The implementation of such a model of care should be considered by clinical services interested in reducing the smoking related morbidity and mortality of patients.

Wong NCH; Cappella J. Antismoking threat and efficacy appeals: Effects on smoking cessation intentions for smokers with low and high readiness to quit. Journal of Applied Communication Research 37(1): 1-20, 2009. (46 refs.)

This study examined the effects of sequencing different types of antismoking threat and efficacy appeals on smoking cessation intentions for smokers with low and high levels of readiness to quit. An experiment was done to test predictions based on Witte's (1992) Extended Parallel Process Model and research by Cho and Salmon (2006). A national probability sample of 555 adult smokers was recruited to take part in this study. Results found a positive two-way interaction effect between message threat and perceived level of message efficacy on intentions to seek help for quitting. A three-way interaction effect was found between message threat, perceived level of message efficacy, and readiness to quit on quitting intentions. Both threat and efficacy were important for smokers with low readiness to quit, whereas efficacy was most important among smokers with high readiness to quit. Implications of the results for antismoking campaigns are discussed along with limitations and future directions.

Wye PM; Bowman JA; Wiggers JH; Baker A; Knight J; Carr VJ et al. Smoking restrictions and treatment for smoking: Policies and procedures in psychiatric inpatient units in Australia. Psychiatric Services 60(1): 100-107, 2009. (53 refs.)

Objective: Tobacco smoking is the leading preventable cause of death and disease in Australia. Even though smoking prevalence in the general population has been reduced (20% smoke), prevalence rates remain high among psychiatric inpatients (70%-90%). This study aimed to identify smoking policies and procedures in public psychiatric inpatient units in New South Wales, Australia; the provision of "smoking care" in such units (for example, quit-smoking advice or nicotine replacement therapy); and policies and procedures associated with the assessment of smoking status and provision of smoking care. Methods: A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales for completion by nurse unit managers. Results: Of the 131 units, 123 units completed and returned surveys (94%). Over one-third (36%) of respondents reported instances in which inpatients began smoking during their admission. A similar proportion (39%) reported that staff provided cigarettes to patients who smoked when patients' supply was expended. Fifty percent of respondents reported that all patients were assessed for smoking status; however, 70% reported that nicotine dependence was not assessed. Units on which staff adhered to smoking restrictions were three times as likely to assess patients' smoking status as units where staff never adhered to restrictions (odds ratio=3.05, p=.01). Conclusions: Inadequate establishment of nonsmoking environments and of smoking restriction enforcement as well as inconsistencies in the provision of smoking care were evident. The findings suggest that failure of psychiatric services to provide smoking care is systemic and not related to particular types of services (for example acute versus nonacute or regional versus metropolitan).

Xiao Y; Lv Y; Zhang X; Guo Y; Bergstrom T. The pharmacokinetic and tolerability profile of varenicline in healthy Chinese volunteers. International Journal of Clinical Pharmacology and Therapeutics 47(4): 246-254, 2009. (21 refs.)

Objective: Varenicline is a selective, nicotinic alpha(4)beta(2) acetylcholine receptor partial agonist that has been licensed as a smoking cessation drug in more than 70 countries worldwide. The current study was conducted in order to evaluate its pharmacokinetic (PK) properties and tolerability in healthy volunteer Chinese smokers. Methods: This was an open-label, non-randomized study conducted over 17 days at a single center in China. Male and female subjects (18 45 years old) received a single, 1 mg dose of varenicline on days 1 and 10 as well as 1 mg varenicline twice daily (12-h dosing interval) on Days 4 - 9. Results: A total of 14 subjects (50% male) received varenicline as per study protocol for 8 days. The mean maximum plasma concentration of varenicline (C-max) was 1.93-fold larger at steady state (reached on Day 8, after 4 days of repeat dosing) than following a single dose, showing accumulation of varenicline on repeat administration. Median values of t(max) (time of occurrence of C-max) were similar for both dosing regimens (3.0 and 2.5 h following single and multiple dosing, respectively). The mean elimination half-life following single and multiple dosing was 15.2 and 18.3 h, respectively. There was no evidence of time- or concentration-dependence in the PK of varenicline upon repeat dosing as the ratio of the area under the plasma concentration vs time curve (AUC) from time 0 - 12 h at steady state to the AUC from time 0 - 8 on Day I was nearly 1. The 2-sided 95% confidence intervals for this comparison included 1, demonstrating the linearity of the PK of varenicline for the single and multiple doses. Varenicline was safe and well-tolerated, adverse events were mild in severity and there were no abnormal laboratory tests. Conclusions: Varenicline I mg twice daily was safe and well-tolerated in a cohort of healthy male and female, 18- to 45-year-old Chinese smokers and demonstrated PK properties that were stable and reproducible and similar to those observed previously in Western subjects.

Yang TZ; Abdullah ASM; Mustafa J; Chen B; Yang XZ; Feng XX. Factors associated with smoking cessation among Chinese adults in rural China. American Journal of Health Behavior 33(2): 125-134, 2009. (32 refs.)

Objectives: To examine the factors associated with smoking cessation among adult Chinese males in rural China. Methods: The data were collected by face-to-face Interviews at the respondents' household using interviewer-administered questionnaires. Results: The factors associated with quitting were being residents of Guiyang, having received junior or high school education, being unmarried, being a farmer or other job holder, smoking fewer than 20 cigarettes per day, starting smoking late, smoking for shorter duration, and having a high mean score on hedonism seeking. Conclusions: Several predictors of successful quitting were identified that could help improve smoking cessation programs in China. The findings also have implications for the need for future surveys on the quitting process among rural Chinese.

Zhou XL; Nonnemaker J; Sherrill B; Gilsenan AW; Coste F; West R. Attempts to quit smoking and relapse: Factors associated with success or failure from the ATTEMPT cohort study. Addictive Behaviors 34(4): 365-373, 2009. (17 refs.)

Objective: To identify predictors of attempts to stop smoking and predictors of relapse. Methods: This study included 2431 smokers from pre-existing Internet panels in the United States, United Kingdom, Canada, France, and Spain. These panel members are Internet users who have registered Voluntarily and agreed to participate in various online research studies. Respondents were aged 35-65 years, smoked five cigarettes per day and intended to stop smoking in the next 3 months. They were followed every 3 months for up to 18 months via Internet contact on measures relating to quit attempts, smoking status, motivation to quit, nicotine cue, weight and weight concern, health-related factors, withdrawal symptoms, and smoking cessation aids. Results: In this study, recent quit attempts strongly predicted future attempts, but also predicted subsequent relapse. Motivation to quit was predictive of future attempts but not of relapse/abstinence following the attempts. Relapse to smoking was associated with nicotine dependence, exposure to smoking cues, craving, withdrawal symptoms, and lack of smoking cessation aids. Conclusions: The findings lend support to a model of cessation in which level of motivation to stop generates quit attempts but plays little role in relapse. Dependence, social smoking cues, and a recently failed quit attempt are important factors in relapse.

Zhu SH; Wang JB; Hartman A; Zhuang Y; Gamst A; Gibson JT et al. Quitting cigarettes completely or switching to smokeless tobacco: Do US data replicate the Swedish results? Tobacco Control 18(2): 82-87, 2009. (41 refs.)

Background: Swedish male smokers are more likely than female smokers to switch to smokeless tobacco (snus) and males' smoking cessation rate is higher than that of females. These results have fuelled international debate over promoting smokeless tobacco for harm reduction. This study examines whether similar results emerge in the United States, one of few other western countries where smokeless tobacco has long been widely available. Methods: US data source: national sample in Tobacco Use Supplement to Current Population Survey, 2002, with 1-year follow-up in 2003. Analyses included adult self-respondents in this longitudinal sample (n = 15 056). Population-weighted rates of quitting smoking and switching to smokeless tobacco were computed for the 1-year period. Results: Among US men, few current smokers switched to smokeless tobacco (0.3% in 12 months). Few former smokers turned to smokeless tobacco (1.7%). Switching between cigarettes and smokeless tobacco, infrequent among current tobacco users (< 4%), was more often from smokeless to smoking. Men quit smokeless tobacco at three times the rate of quitting cigarettes (38.8% vs 11.6%, p < 0.001). Overall, US men have no advantage over women in quitting smoking (11.7% vs 12.4%, p = 0.65), even though men are far likelier to use smokeless tobacco. Conclusion: The Swedish results are not replicated in the United States. Both male and female US smokers appear to have higher quit rates for smoking than have their Swedish counterparts, despite greater use of smokeless tobacco in Sweden. Promoting smokeless tobacco for harm reduction in countries with ongoing tobacco control programmes may not result in any positive population effect on smoking cessation.