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...on nicotine
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www.ProjectCork.org
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Fall 2007
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Acute effects of a guided relaxation routine (body scan) on tobacco withdrawal symptoms and cravings in abstinent smokers.
Cropley M; Ussher M; Charitou E. Addiction 102(6): 989-993, 2007. (20 refs.)
Aims: To examine the acute effects of a guided relaxation routine (body scan) on desire to smoke and tobacco withdrawal symptoms in overnight abstinent smokers. Design: Experimental. Participants: Thirty individuals reporting to smoke 10 or more cigarettes daily for at least 3 years. Intervention Participants were assigned randomly to complete a 10-minute body scan (experimental group n = 15) or listen to a natural history passage for 10 minutes (control group n = 15). Measurement: Ratings of strength of desire to smoke and smoking withdrawal symptoms were assessed at baseline, immediately after the interventions, and 5, 10 and 15 minutes post-intervention. Findings There was a significant group x time interaction for strength of desire to smoke. The mean desire to smoke rating was significantly lower in the body scan group relative to the control group immediately after the intervention, and 5 minutes post-intervention. The body scan group also reported lower ratings of irritability, tension and restlessness, relative to the controls. Conclusions: A brief body scan intervention reduces strength of desire to smoke and some tobacco withdrawal symptoms in temporarily abstaining smokers. The body scan may be beneficial as a technique for managing cigarette cravings and withdrawal. Copyright 2007, Society for the Study of Addiction to Alcohol and Other Drugs.
Computerized assessment of surgical patients for tobacco use: Accuracy and acceptability.
Wolfenden L; Dalton A; Bowman J; Knight J; Burrows S; Wiggers J. Journal of Public Health 29(2): 183-185, 2007. (10 refs.)
Background: Despite increased risks of postoperative complications among patients who use tobacco, a number of barriers hinder the systematic identification of surgical patients who smoke. The study investigated the accuracy and acceptability of a patient-completed touchscreen computer program, which assessed patient smoking status during attendance at a surgical pre-operative clinic. Methods One thousand and four patients participated in the study and completed a touchscreen computer smoking assessment program. Results: The sensitivity and specificity measures of the computerized assessment were 93% and 95% respectively. Patients, and clinic receptionists, nurses and anaesthetists found the touchscreen computer-based assessment acceptable. Conclusions: The findings suggest that computerized assessment of smoking status is an accurate and acceptable way to identify tobacco users in a pre-operative clinic setting. Copyright 2007, Oxford University Press.
Correlates of severity of smoking among persons with severe mental illness.
Dixon L; Medoff DR; Wohlheiter K; DiClemente C; Goldberg R; Kreyenbuhl J et al. American Journal on Addictions 16(2): 101-110, 2007. (59 refs.)
Individuals with schizophrenia and severe mental illness smoke cigarettes at rates that well exceed the general population. Little is known about the correlates and sequelae of increased smoking severity on persons with severe mental illness. A total of 304 smokers from six community mental health centers were assessed for smoking history, psychiatric symptoms, co-occurring disorders, subjective quality of life, and expired carbon monoxide (CO). Statistical analyses identified correlates of smoking severity, as assessed by number of cigarettes smoked per week. The average number of cigarettes smoked per week was 136 +/- 83. Increased smoking was associated with higher levels of expired CO and being Caucasian, and with a greater likelihood of a current diagnosis of hypertension and oral/gum disease. Greater smoking severity was also associated with greater perceived stress, poorer overall subjective quality of life, and lower satisfaction with finances, health, leisure activities, and social relationships. This study confirms high rates of heavy smoking among persons with severe mental illness. The association of increased quantity of cigarettes smoked with being Caucasian is consistent with previous reports in mentally ill and non-mentally ill populations. The linkage of heavy smoking with poorer quality of life and co-occurring medical disorders suggests the importance of smoking reduction and cessation strategies to reduce smoking and decrease patients' total pack years of smoking. Copyright 2007, Taylor & Francis.
Effectiveness of biomedical risk assessment as an aid for smoking cessation: A systematic review. (review).
Bize R; Burnand B; Mueller Y; Cornuz J. Tobacco Control 16(3): 151-156, 2007. (47 refs.)
Objective: To determine the efficacy of biomedical risk assessment (e.g., exhaled carbon monoxide (CO), or genetic susceptibility to lung cancer) as an aid for smoking cessation. Data sources: Cochrane Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials, Medline (1966-2004) and EMBASE (1980-2004). Study selection: Randomised controlled smoking cessation interventions using biomedical tests with at least 6 months follow-up. Data extraction: Two reviewers independently screened all search results (titles and abstracts) for possible inclusion. Each reviewer then extracted data from the selected studies, and assessed their methodological quality based on the CONSORT ( Consolidated Standards of Reporting Trials) statement criteria. Data synthesis: Of 4049 retrieved references, eight trials were retained for data extraction and analysis. Three trials isolated the effect of exhaled CO on smoking cessation rates resulting in the following ORs and 95% CIs: 0.73 (0.38 to 1.39), 0.93 (0.62 to 1.41) and 1.18 (0.84 to 1.64). Measurement of exhaled CO and spirometry were used together in three trials, resulting in the following ORs (95% CI): 0.60 (0.25 to 1.46), 2.45 (0.73 to 8.25) and 3.50 (0.88 to 13.92). Spirometry results alone were used in one other trial with an OR (95% CI) of 1.21 (0.60 to 2.42). Ultrasonography of carotid and femoral arteries performed on light smokers gave an OR (95% CI) of 3.15 (1.06 to 9.31). Conclusions: Scarcity and limited quality of the current evidence does not support the hypothesis that biomedical risk assessment increases smoking cessation as compared with the standard treatment. Copyright 2007, BMJ Publishing Group.
Is parenting style a context for smoking-specific parenting practices?
Huver RME; Engels RCME; Vermulst AA; de Vries H. Drug and Alcohol Dependence 89(2-3): 116-125, 2007. (74 refs.)
This study examined whether global parenting style can be regarded as a context in which smoking-specific parenting practices relate to adolescent smoking cognitions and behaviors. Data were gathered through self-administered questionnaires from 482 adolescents aged 12-19 years, who participated in the Study of Medical Information and Lifestyles in Eindhoven (SMILE). We assessed parenting style dimensions (support, strict control, psychological control), smoking-specific parenting practices (parent-child communication about smoking, anti-smoking house rules, availability of tobacco products, non-smoking agreement), smoking-related cognitions according to the I-Change Model (attitude, social norm, self-efficacy, intention), and smoking behavior. Structural equation models were computed and compared for adolescents in different parenting climates. Results showed that communication and availability were related to adolescents' attitude towards smoking. Availability was additionally associated with reduced self-efficacy to refrain from smoking. Attitude and self-efficacy were subsequently related to intention to smoke, which in turn was related to smoking behavior. No direct relations were found between anti-smoking parenting practices and adolescent smoking behavior. These results were not dependent on the parenting climate. Parenting style thus did not serve as a context for smoking-specific parenting practices, indicating that these facets of parenting operate independently, and that anti-smoking parenting practices may be effective regardless of parenting climate. Copyright 2007, Elsevier Science.
Is prenatal exposure to tobacco smoking a cause of poor semen quality? A follow-up study.
Ramlau-Hansen CH; Thulstrup AM; Storgaard L; Toft G; Olsen J; Bonde JP. American Journal of Epidemiology 165(12): 1372-1379, 2007. (18 refs.)
A few studies indicate that exposure to maternal smoking during fetal life decreases semen quality in adult life, but the results are inconsistent and retrospectively collected smoking data were used in most studies. From a Danish pregnancy cohort established in 1984-1987, 347 of 5,109 sons were selected according to their exposure to tobacco smoke in fetal life. From February 2005 to January 2006, a semen sample from the 347 men was analyzed for conventional semen characteristics according to standardized criteria by using a mobile laboratory. The authors found an inverse association between maternal smoking during pregnancy and total sperm count (p = 0.002). Men exposed to more than 19 cigarettes daily during pregnancy had approximately 19% lower semen volume (p = 0.04), 38% lower total sperm count (p = 0.11), and 17% lower sperm concentration (p = 0.47) compared with unexposed men. The odds ratio for oligospermia was 2.16 (95% confidence interval: 0.68, 6.87) among exposed men compared with the unexposed. No associations were found for sperm motility or morphology. These results indicate that prenatal exposure to tobacco smoke may have an adverse effect on semen quality and, if these associations are causal, they could explain some of the reported differences between populations and secular changes in semen quality. Copyright 2007, Oxford University Press Inc.
Prenatal smoking exposure and dopaminergic genotypes interact to cause a severe ADHD subtype.
Neuman RJ; Lobos E; Reich W; Henderson CA; Sun LW; Todd RD. Biological Psychiatry 61(12): 1320-1328, 2007. (63 refs.)
Background: In utero exposure to smoking and alcohol are common risk factors that have been associated with attention-deficit/hyperactivity disorder (ADHD) in human beings and animal models. Furthermore, molecular studies have focused on the association between ADHD and DNA polymorphisms in dopamine pathway-related genes. We examined the joint effects of genetic and prenatal substance exposures on DSM-IV and population-defined subtypes of ADHD. Methods: Logistic regression was used to assess the relationship between ADHD subtypes, DAT1 and DRD4 polymorphisms, and prenatal substance exposures in a birth-record sample of male and female twin pairs, aged 7-19 years. Results: Interactions between prenatal exposure to smoking and variations in the DAT1 and DRD4 loci were observed in children with either the DSM-IV or population-defined ADHD combined subtypes. The odds of a diagnosis of DSM-IV combined subtype was 2.9 times greater in twins who had inherited the DAT1 440 allele and who were exposed, than in unexposed twins without the risk allele. The OR was 2.6 in the population-defined subtype. Odds ratios for the DRD4 seven-repeat allele were 3.0 (2.8) in the population-defined (DSM-IV) combined ADHD subtypes. The OR for exposed children with both alleles was 9.0 (95% confidence interval = 2.0-41.5) for the population-defined combined subtypes. Conclusions: Results indicate that smoking during pregnancy is associated with specific subtypes of ADHD in genetically susceptible children. Copyright 2007, Elsevier Science.
Progression from marijuana use to daily smoking and nicotine dependence in a national sample of US adolescents.
Timberlake DS; Haberstick BC; Hopfer CJ; Bricker J; Sakai JT; Lessem JM et al. Drug and Alcohol Dependence 88(2-3): 272-281, 2007. (41 refs.)
Background: While it has been demonstrated that smoking cigarettes in adolescence increases the likelihood of progressing to marijuana use, few studies have considered the reverse scenario in which early use of cannabis leads to greater tobacco smoking. Methods: Participants (n = 5963), who had never smoked cigarettes daily by wave I of the National Longitudinal Study of Adolescent Health, were followed 6 years (waves I-III) from adolescence into young adulthood. Measures of marijuana use (lifetime use, monthly use, age at first use), as assessed at wave I within 12-16 (n = 3712) and 17-21 (n = 2251) year-olds, were separately modeled as predictors of three tobacco-related outcomes: (1) age at onset of daily cigarette smoking, (2) lifetime nicotine dependence, (3) current nicotine dependence. Results: In the older cohort (17-21-year-olds at wave I), lifetime (> 10 times) and past-month marijuana use at wave I were predictive of an earlier initiation into daily cigarette smoking and a greater likelihood of developing nicotine dependence by wave III. Furthermore, age at first use of cannabis was negatively associated with risk of nicotine dependence in the older, but not younger cohort. Conclusion: After controlling for baseline measures of tobacco smoking and other demographic risk factors, the use of marijuana in adolescence was modestly associated with daily cigarette smoking and nicotine dependence in young adulthood. Copyright 2007, Elsevier Science.
Short-term naturalistic treatment outcomes in cigarette smokers with substance abuse and/or mental illness.
Grand RBG; Hwang S; Han J; George T; Brody AL. Journal of Clinical Psychiatry 68(6): 892-898, 2007. (73 refs.)
Objective: The majority of cigarette smokers have a lifetime diagnosis of substance abuse and/or mental illness, and treatment outcomes for smokers with these comorbidities are generally reported to be worse than for smokers without comorbidities. We sought to examine the effect of specific substance abuse/mental illness diagnoses compared to one another on treatment outcomes. Method: A retrospective chart review of naturalistic treatment for nicotine dependence was performed on male smokers (N = 231) who enrolled in the Greater Los Angeles Veterans Affairs Mental Health Clinic Smoking Cessation Program (Los Angeles, Calif.) over a 1.5-year period (January 2004 to June 2005). Subjects in this program, who were diagnosed with nicotine dependence on the basis of a DSM-lV-based interview and a Fagerstrom Test for Nicotine Dependence score of ! 3, underwent comprehensive treatment for nicotine dependence (including, but not limited to, group psychotherapy, nicotine replacement therapy, and bupropion hydrochloride). Quitting smoking was defined as a report of at least I week of abstinence and an exhaled carbon monoxide less than or equal to 8 parts per million at the final clinic visit. Results: Of the total group, 36.4% (84/231) quit smoking at the end of treatment. Quit rates were affected by the presence of specific diagnoses, with smokers with a history of alcohol abuse/dependence or schizophrenia/ schizo-affective disorder having poorer response rates than smokers without such diagnoses. Other substance abuse and mental illness diagnoses did not affect quit rates. Conclusion: Lower quit rates among patients with alcohol abuse/dependence or schizophrenia/ schizoaffective disorder may be due to the severity of these conditions and suggest that specialized treatment is needed for these populations of smokers. Smokers with most comorbid diagnoses are successfully treated with standard treatment methods. Copyright 2007, Physicians Postgraduate Press.
The most addictive drug, the most deadly substance: Smoking cessation tactics for the busy clinician.
Crane R. Primary Care34(1): 117-+, 2007. (43 refs.)
By several measures, nicotine is the world's most highly addictive drug, and tobacco is its most deadly substance. Worldwide, 1 billion people smoke cigarettes. In the United States alone there are more than 46 million nicotine addicts. Their use of smoked tobacco results in nearly 400,000 deaths per year caused by direct use; there are another 50,000 deaths in nonsmokers because of exposure to secondhand smoke. The total number comprises one out of every five deaths in the United States. More than 20% of American adults are current smokers [4], and 23% of US high school students have smoked cigarettes in the last month [5]. Approximately half of all smokers die prematurely from a smoking-related illness. Smoking in the United States accounts for one third of all cancer deaths, one fourth of all cardiovascular deaths, and most deaths from chronic respiratory disease. Smoking produces enormous morbidity and incalculable suffering, with more than 8 million Americans suffering from chronic disease and debilitation because of tobacco use. For these reasons and a healthy dose of social ostracism, most smokers would like to quit, and more than half of them have abstained from smoking for at least 24 hours in the last year. Almost all of them will fail, however, with successful annual cessation rates less than 5%. With repeated efforts, which average eight quit attempts before success, most individuals do eventually quit, often in the face of grave illness. More than 50 million Americans are ex-smokers. A fundamental clinical goal is to achieve cessation before the onset of serious disease. A person who continues to smoke loses on average 10 years of life compared with a nonsmoker; nevertheless, cessation at any age produces positive results. Unfortunately, the American medical community and health authorities at all levels have tragically failed in their attempts to control the effects of the century-long pandemic of nicotine addiction and its attendant holocaust of disease and death. Many physicians are discouraged by frequent relapses with individual patients, and public officials are clearly overmatched by shrewd, ruthless, and well-funded cigarette profiteers. However, substantial data suggest that physicians can play an important role in encouraging the transformation from nicotine addict to recovering ex-addict, and there are clear parallels in our treatment of other drugs of abuse. Copyright 2007, W B Saunders.
Nicotine percentage replacement among smokeless tobacco users with nicotine patch.
Ebbert JO; Post JA; Moyer TP; Dale LC; Schroeder DR; Hurt RD. Drug and Alcohol Dependence 89(2-3): 223-226, 2007. (19 refs.)
To obtain preliminary evidence on the safety and efficacy of high dose nicotine patch therapy among smokeless tobacco (ST) users who consume >= 3 cans of ST per week, we conducted a randomized, placebo-controlled clinical trial with 42 ST users randomized to nicotine patch doses of 21, 42, and 63 mg/day or placebo. Serum nicotine concentrations were measured during ad libitum ST use and nicotine replacement therapy, and percentages of nicotine replacement were calculated. We observed substantial inter-subject variability in nicotine concentrations with ad lib ST use. The mean percentage replacement of ad lib ST use serum nicotine concentrations approximated 100% with the 42 mg/day patch dose (mean S.D., 98.4% +/- 45%). Dosing with the 21 mg/day nicotine patch was associated with mean "under-replacement" (53.2% +/- 17.1%), and the 63 mg/day nicotine was associated with mean "over-replacement" (159.2% +/- 121.9%). We observed symptoms of nausea consistent with nicotine toxicity in two subjects in the 63 mg/day group while no subjects in the 42 mg/day reported these symptoms. We conclude that the use of 42 mg/day nicotine patch therapy is safe and should be considered as initial therapy in the clinical setting among ST users who use >= 3 cans/week. Copyright 2007, Elsevier Science.
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