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...on Nicotine
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www.ProjectCork.org
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Winter 2004
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Role of snus (oral moist snuff) in smoking cessation
and smoking reduction in Sweden.
Gilljam H; Galanti M. Addiction 98(9): 1183-1190,
2003. (27 refs.) Aims: To assess to what extent snus
has been used as an aid to stop smoking among Swedish
smokers. Design: A random telephone retrospective survey
of Swedish smokers and ex-smokers. Setting: Survey conducted
in November-December 2000. Participants: A national sample
of 1000 former and 985 current daily smokers aged 25-55
years. Measurements: Smoking status, date and method
of quitting by self-report. Findings: Thirty-three per
cent of former smokers and 27% of current smokers had
ever used snus. The difference was larger among men (55%
versus 45%, P = 0.003). Current smokers who made use
of snus smoked on average fewer cigarettes per day than
non-users of snus. The mean duration of abstinence among
former smokers was not influenced by snus use. Conditionally
on age, education and use of nicotine replacement therapy
there was an increased probability of being a former
rather than a current smoker with ever use (OR 1.72,
95% CI = 1.30-2.28) or current use (OR 1.81, 95% CI =
1.31-2.53) of snus. Having used snus at the latest quit
attempt increased the probability of being abstinent
by about 50% (OR 1.54, 95% CI = 1.09-2.20). Conclusions
Our study suggests that by using snus, Swedish male smokers
may increase their overall chances of abstinence. However,
71% of the men in this sample who quit smoking did so
without using snus and the duration of abstinence was
not affected by snus use. This suggests that snus is
not a necessary component of smoking cessation at the
population level. Snus use was very rare among women.
Copyright 2003, Society for the Study of Addiction to
Alcohol and Other Drugs.
The impact of smoking cessation on drug abuse treatment outcome.
Lemon SC; Friedmann PD; Stein MD. Addictive Behaviors 28(7): 1323-1331,
2003. (23 refs.)
Although cigarette smoking is endemic among illicit drug users, drug abuse
treatment programs rarely encourage smoking cessation and often discourage
it. The purpose of this study was to determine whether smoking cessation
after entering drug abuse treatment influenced drug use 12 months after
drug abuse treatment. We analyzed 2316 cigarette smokers in the Drug Abuse
Treatment Outcome Study (DATOS), a national, longitudinal study of drug
abuse treatment. Heckman probit selection models assessed the association
of self-reported smoking cessation while in drug abuse treatment on self-reported
drug abstinence in the year after treatment completion, while simultaneously
accounting for possible nonparticipation bias. Controlling for multiple
factors, smoking cessation was associated with greater abstinence from
drug use after completion of drug abuse treatment (P=.04). Despite drug
abuse treatment programs' hesitance to encourage smokers to quit, smoking
cessation does not negatively impact drug use outcomes.
Copyright 2003, Elsevier Science Ltd.
Smoking status identification: Two managed care organizations' experiences
with a pilot project to implement identification systems in independent
practice associations.
Marcy TW; Thabault P; Olson J; Tooze JA; Liberty B; Nolan S. American
Journal of Managed Care 9(10): 672-676, 2003. (14 refs.)
Objective: To determine whether managed care organizations (MCOs) can effectively
promote the sustained use of smoking status identification systems among
independent practice associations. Study Design: Quasi-experimental design
measuring smoking status documentation before and after an intervention.
Methods: A chart review of the MCOs' patients at 4 participating primary
care clinics determined the baseline for smoking status documentation before
intervention. Baseline data were unavailable from a fifth participating
clinic. Two quality improvement personnel were sent by the MCOs to help
the clinics chose and implement a system for identifying smoking status.
All of the clinics chose a sticker system. The change in smoking status
documentation was assessed by chart reviews of patients enrolled in the
MCOs who were seen during the period between 3 and 16 months after implementation
of the system. Results: Following the intervention, a significant increase
in smoking status documentation was noted among participating clinics.
The proportion of patients whose smoking status was identified and documented
by any method increased from 50% to 87% (P < .01) at the 4 clinics with
baseline data. By clinic, the increase varied from 6% to 60%. The sticker
system was the method by which most patients' smoking status was documented
(77%). There were no controls, so the influence of outside factors, including
a regional smoking cessation campaign that coincided with this study, cannot
be quantified. Conclusions: Managed care organizations may be an effective
change agent for implementing the guidelines for tobacco use and dependence
treatment.
Copyright 2003, American Medical Publishing.
Past alcohol problems do not predict worse smoking cessation outcomes.
Hughes JR; Callas PW; High Dose Study Group. Drug and Alcohol Dependence 71(3):
269-273, 2003. (29 refs.)
Whether smokers with a past history of alcohol problems are less able to
stop smoking and have a greater need for nicotine replacement therapy than
smokers without this history is unclear. We conducted a secondary analysis
of a prior study (Nicotine Tobacco Res. 1:169) of 1039 smokers randomized
to 0, 21, 35 or 42 mg/day nicotine patch for smoking cessation. Because
higher dose patches were being tested, only smokers of 30 cigs/day were
included. Although smokers with current alcohol abuse or dependence were
excluded, 15% of the smokers had a past (>1 year ago) Short Alcohol Dependence
Data (SADD) score of 9 suggesting past alcohol problems. Heavy smokers
with a past history of alcohol problems did not relapse sooner, were not
less likely to be abstinent and did not benefit more from nicotine treatment
or from higher doses than heavy smokers without this history. We conclude
that a past history of alcohol problems per se does not predict inability
to stop smoking.
Copyright 2003, Elsevier Scientific Publishers Ireland,
Ltd.
Parental education on passive smoking in infancy does work.
Crone MR; Reijneveld SA; Willemsen MC; Sing RAH. European Journal of
Public Health 13(3): 269-274, 2003. (30 refs.)
Background: Passive smoking is harmful to young children. A protocol has
been developed to allow health care workers to communicate with parents
about preventing passive smoking. The main message was to refrain from
smoking in the presence of the child. The aim of the study was to assess
the effectiveness of this education programme. Method: The prevalence of
smoking in the presence of infants aged 0-10 months was compared before
and after the implementation of the education programme. National samples
of mothers completed questionnaires in 1996 (n = 1,129) and in 1999 (n
= 2,534). Questions were asked about smoking in the living room in the
presence of infants, and about parental smoking, and background characteristics.
Results: The prevalence of passive infant smoking decreased from 41% to
18%. The adjusted odds ratio for passive infant smoking in 1999 compared
to 1996 was 0.34 (0.26-0.44) when none of the parents smoked, 0.19 (0.14-0.27)
when one of the parents smoked, and 0.30 (0.20-0.44) when both parents
smoked. Conclusion: The implementation of this health education programme
seems to have been very successful in reducing passive smoking in children.
Implementation of similar health education programmes in other countries
is recommended.
Copyright 2003, Oxford University Press.
Health care practitioners' motivation for tobacco-dependence counseling.
Williams GC; Levesque C; Zeldman A; Wright S; Deci EL. Health Education
Research 18(5): 538-553, 2003. (24 refs.)
Smoking cessation counseling by practitioners occurs at low rates in spite
of strong evidence that counseling increases quit rates and reduces patient
mortality. In a preliminary study, 1060 New York State physicians completed
a survey concerning use of the Agency for Health Care Policy and Research
(AHCPR) Guidelines, perceived autonomy and perceived competence for counseling,
perceived autonomy support from insurers, and barriers to counseling. Considered
together, perceived autonomy, perceived competence and perceived autonomy
support predicted time devoted to counseling and use of the AHCPR guidelines.
The primary, longitudinal study of 220 health care practitioners who attended
a smoking cessation workshop predicted change in the practitioners' perceived
autonomy and perceived competence for counseling as a function of the degree
to which they experienced the workshop instructor as autonomy-supportive.
In turn, change in perceived autonomy predicted change in time spent counseling
and change in use of the AHCPR guidelines.
Copyright 2003, Oxford University Press.
Why do so many drug users smoke?
McCool RM; Paschall Richter K. Journal of Substance Abuse Treatment 25(1):
43-49, 2003. (25 refs.)
To better understand why most persons in drug treatment smoke, we explored
patients' views of the relationship between their smoking, methadone, and
drug use. Recruiting from four methadone clinics, we held seven focus groups
with 68 current smokers, and 10 individual interviews with former smokers.
Sessions were audio-taped, transcribed, and coded. Participants were 18
years old, smoked 5 cigarettes per day, and had used prescription methadone
for 2 years. Most patients linked smoking, methadone, and drug use in three
ways. First, patients said smoking and drug use were complementary. Examples
included smoking to reduce methadone aftertaste and using drugs to reduce
smoking-related throat pain. Second, smoking and drug use were similar
because they shared cues and withdrawal symptoms. Third, smoking differed
from drug use because it had fewer acute consequences. Because smoking,
methadone, and drug use are closely interrelated, future addictions research
and treatment protocols should address them in combination.
Copyright 2003, Elsevier Science.
Tobacco smoking: Current concepts in etiology and treatment. (review).
Patkar AA; Vergare MJ; Batra V; Weinstein SP; Leone FT. Psychiatry:
Interpersonal and Biological Processes 66(3): 183-199, 2003. (120 refs.)
Tobacco smoking is the most important preventable cause of death and disease.
Despite an increased awareness of the addictive nature of smoking and availability
of effective treatments, smoking continues to be widespread among individuals
with psychiatric disorders. Moreover, mental health professionals remain
reluctant to address smoking among their patients for a variety of reasons.
Recent research has provided a wealth of data that have shaped the concept
of tobacco smoking as a chronic addictive disorder and also demonstrated
the efficacy of smoking cessation interventions. This paper reviews the
important factors that contribute to smoking and the various pharmacological
and psychosocial interventions for smoking cessation from a biopsychosocial
perspective. It also makes recommendations for the rational use of these
interventions to treat nicotine dependence in individuals with psychiatric
disorders.
Copyright 2003, Guilford Publications, Inc.
Effect of smoking reduction on later cessation: A pilot experimental
study.
Carpenter MJ; Hughes JR; Keely JP. Nicotine & Tobacco Research 5(2):
155-162, 2003. (35 refs.)
It is unclear whether reducing the number of cigarettes in smokers not
trying to quit increases or decreases the likelihood of future quitting.
In a pilot study, smokers not currently interested in quitting (n = 67)
were randomized to two groups. Experimental participants received behavioral
treatment and nicotine replacement therapy (choice of gum, patch, or inhaler)
to reduce smoking by 50% over 4 weeks, followed by brief advice to quit.
Usual-care participants received only brief advice to quit and nicotine
replacement if they decided to quit. During the 4-week treatment period,
nonabstaining reduction participants decreased from 23 to 14 cigarettes
per day (p <.01) and maintained their reduction over the 6-month follow-up
period. At the 6-month follow-up, 35% of usual-care and 41% of reduction
participants (nonsignificant [ns]) moved forward in their stage of change.
Over the 6 months, 34% of usual-care participants had at least one 24-h
quit attempt, compared with 25% of reduction participants (ns). A total
of 9% of usual-care participants remained quit at 6 months vs. 13% in the
reduction group (ns). These preliminary results suggest that adding a reduction
option neither increases nor undermines interest. in cessation. Higher
than expected rates of attempted cessation and quitting in the usual-care
group suggest that we recruited smokers whose motivation to quit was above
average. Thus, a replication test in a less-motivated group of smokers
is needed.
Copyright 2003, Carfax Publishing.
Continual smoking of mentholated cigarettes may mask the early warning
symptoms of respiratory disease.
Garten S; Falkner RV. Preventive Medicine 37(4): 291-296, 2003.
(41 refs.)
Background. Continual use of cold preparations including those containing
menthol for relief from congestion, cough, or difficulty in breathing can
mask the early warning symptoms of respiratory dysfunction. These products
usually carry a warning label on the packaging that indicates that they
are not for continuous use and may mask the early warning symptoms of a
more serious condition. Menthol can be delivered in many dosage forms including
the smoke of a mentholated cigarette. Methods. Literature searches were
done for the NLM databases (e.g., MEDLINE from 1966, TOXLINE, OLDMEDLINE
(1958-1965), CANCERLIT), plus tobacco industry documents and hardcopy indices.
The evidence was evaluated with application to mentholated cigarette smoking.
Results. A logical progression is presented to attempt to demonstrate that
the continuous smoking of mentholated cigarettes may also mask the early
warning symptoms of respiratory distress. The early warning symptoms caused
by chronic irritation of the respiratory tract may be reduced in severity
when the menthol found in a mentholated cigarette is continually delivered
to the tract. Conclusion. This masking of the symptoms of an underlying
respiratory disease can lead to delays in seeking medical attention resulting
in a poor prognosis, additional suffering, and eventual death.
Copyright 2003, American Health Foundation.
Naltrexone treatment for alcoholics: Effect on cigarette smoking rates.
Rohsenow DJ; Monti PM; Colby SM; Gulliver SB; Swift RM; Abrams DB. Nicotine & Tobacco
Research 5(2): 231-236, 2003. (33 refs.)
Naltrexone (NTX), by its pharmacological action in the mesolimbic pathways,
should decrease reinforcement from nicotine as well as from alcohol. By
means of this mechanism, NTX could result in temporary increases in smoking
followed by decreased smoking rates among alcoholics not motivated to quit
smoking. The change from pretreatment in smoking rates of 73 recently abstinent
alcoholics in a 12-week clinical trial of NTX vs. placebo during alcoholism
treatment was compared during 8 of the 12 weeks. Only smokers compliant
with NTX were included in the analyses. NTX was associated with decreased
smoking at every time point, but the effect was significant at only one
time point. When alcohol relapsers were excluded, NTX patients showed decreased
smoking at every time point, but the effect was significant at only two
time points, a reduction of about five cigarettes per day. When smoking
stage of change was included in the analyses, NTX showed no significant
main or interaction effects on smoking rate. Pre-contemplators showed significantly
less change in smoking rate than all other patients at the first and last
four time points. Therefore, NTX alone currently does not show promise
for promoting smoking reduction among recently abstinent alcoholics who
have not sought or been given smoking cessation treatment. Further research
is needed on possible effects with smokers motivated to quit smoking and
on other methods of promoting smoking cessation among alcoholics.
Copyright 2003, Carfax Publishing.
Internet sales of cigarettes to minors.
Ribisl KM; Williams RS; Kim AE. Journal of the American Medical Association 29(10):
1356-1359, 2003. (21 refs.)
Context: There is growing concern that the Internet might become a source
of tobacco products for minors. Although researchers have studied tobacco
sales to minors at retail outlets for more than a decade, there are no
published studies of tobacco sales to minors via the Internet. Objective
To determine the proportion of Internet cigarette vendors that will sell
cigarettes to minors. Design, Setting, and Participants: Cross-sectional
study conducted in April-July 2001. Under adult supervision, 4 adolescents
aged 11 to 15 years attempted to purchase cigarettes via 55 Internet cigarette
vendors located in 12 states. These minors made a total of 83 purchase
attempts, paying by credit card (n=47) and by money order (n=36).Main Outcome
Measure: Proportion of Internet cigarette vendors that sold cigarettes
to minors. Results Minors successfully received cigarettes for 93.6% of
credit card purchase attempts and for 88.9% of money order purchase attempts.
Age was never verified for any of these deliveries. Internet vendors sent
a total of 1650 packs of cigarettes to the underage adolescents in this
study. Conclusion: Minors appear to have easy access to cigarettes via
the Internet because many Internet vendors have weak or nonexistent age
verification procedures.
Copyright 2003, American Medical Association.
The effect of parental smoking on lung function and development during
infancy. (review).
Stocks J; Dezateux C. Respirology 8(3): 266-285, 2003. (170 refs.)
While the adverse effects of parental smoking on respiratory health during
childhood are well recognized, its potential impact on early lung development
is less clear. This review summarizes current evidence on the effect of
parental smoking on lung function during infancy. It is difficult to separate
the effects of pre- and postnatal exposure, since the majority of mothers
who smoke in pregnancy (currently around 30% worldwide) continue to do
so thereafter. Nevertheless, measurements undertaken prior to any postnatal
exposure have consistently demonstrated significant changes in tidal flow
patterns in infants whose mothers smoked in pregnancy. While there is,
as yet, no convincing evidence from studies in human infants that smoking
during pregnancy is associated with increased airway responsiveness at
birth, many studies have demonstrated a reduction in forced expiratory
flows (on average by 20%) in infants exposed to parental smoking. While
maternal smoking during pregnancy remains the most significant source of
such exposure and is likely to be responsible for diminished airway function
in early life, continuing postnatal tobacco smoke exposure will increase
the risk of respiratory infections, the combination of both being responsible
for the two- to fourfold increased risk of wheezing illnesses observed
during the first year of life in infants whose parents smoke. These findings
emphasize the need to keep infants in a smoke-free environment both before
and after birth, not least because of growing awareness that airway function
in later life is largely determined by that during foetal development and
early infancy.
Copyright 2003, Blackwell Publishing Asia.
Tobacco- and alcohol-attributable mortality and years of potential
life lost in Germany.
John U; Hanke M. European Journal of Public Health 13(3): 275-277,
2003. (19 refs.)
Aim: To compare the ages of death caused by tobacco smoking and alcohol
risk drinking. Methods: Smoking rates from the largest population survey,
alcohol drinking data from the National Health Survey and data from the
vital statistics from Germany are used and attributable fractions computed.
Results: Alcohol-attributable deaths occurred at the youngest age, followed
by tobacco- plus alcohol-attributable cases, whereas death cases attributable
to tobacco smoking only occur latest. Conclusion: The overlap in the two
substance-use behaviours, has to be taken into account when considering
attributable mortality data.
Copyright 2003, Oxford University Press.
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