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...on Nicotine
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www.ProjectCork.org
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Fall 2012
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Review of perinatal partner-focused smoking cessation interventions. (review).
Duckworth AL; Chertok IRA. American Journal of Maternal-Child Nursing 37(3): 174-181, 2012. (30 refs.)
One of the primary barriers to smoking cessation among pregnant women who smoke is having a partner who smokes. Prenatal tobacco exposure has been demonstrated to negatively affect infant health outcomes. Many smoking cessation interventions have been targeted at women who smoke in pregnancy, although research has indicated that one of the main barriers to cessation is lack of partner support. The family systems theory frames prenatal smoking cessation interventions in an inclusive manner for the woman and her partner. The aim of this article is to review smoking cessation intervention studies for partners of pregnant women. Efforts to promote smoking cessation among pregnant women should be inclusive of partners, recognizing that partners influence maternal prenatal health behaviors. Copyright 2012, Lippincott, Williams & Wilkins.
The co-occurring use and misuse of cannabis and tobacco: A review. (review).
Agrawal A; Budney AJ; Lynskey MT. Addiction 107(7): 1221-1233, 2012. (127 refs.)
Aims: Cannabis and tobacco use and misuse frequently co-occur. This review examines the epidemiological evidence supporting the life-time co-occurrence of cannabis and tobacco use and outlines the mechanisms that link these drugs to each other. Mechanisms include (i) shared genetic factors; (ii) shared environmental influences, including (iii) route of administration (via smoking), (iv) co-administration and (v) models of co-use. We also discuss respiratory harms associated with co-use of cannabis and tobacco, overlapping withdrawal syndromes and outline treatment implications for co-occurring use. Methods: Selective review of published studies. Results: Both cannabis and tobacco use and misuse are influenced by genetic factors, and a proportion of these genetic factors influence both cannabis and tobacco use and misuse. Environmental factors such as availability play an important role, with economic models suggesting a complementary relationship where increases in price of one drug decrease the use of the other. Route of administration and smoking cues may contribute to their sustained use. Similar withdrawal syndromes, with many symptoms in common, may have important treatment implications. Emerging evidence suggests that dual abstinence may predict better cessation outcomes, yet empirically researched treatments tailored for co-occurring use are lacking. Conclusions: There is accumulating evidence that some mechanisms linking cannabis and tobacco use are distinct from those contributing to co-occurring use of drugs in general. There is an urgent need for research to identify the underlying mechanisms and harness their potential etiological implications to tailor treatment options for this serious public health challenge. Copyright 2012, Wiley-Blackwell.
Brief opportunistic smoking cessation interventions: A systematic review and meta-analysis to compare advice to quit and offer of assistance. (review).
Aveyard P; Begh R; Parsons A; West R. Addiction 107(6): 1066-1073, 2012. (57 refs.)
Aims: This study aimed to assess the effects of opportunistic brief physician advice to stop smoking and offer of assistance on incidence of attempts to stop and quit success in smokers not selected by motivation to quit. Methods: We included relevant trials from the Cochrane Reviews of physician advice for smoking cessation, nicotine replacement therapy (NRT), varenicline and bupropion. We extracted data on quit attempts and quit success. Estimates were combined using the MantelHaentszel method and heterogeneity assessed with the I2 statistic. Study quality was assessed by method of randomization, allocation concealment and follow-up blind to allocation. Results: Thirteen studies were included. Compared to no intervention, advice to quit on medical grounds increased the frequency of quit attempts [risk ratio (RR) 1.24, 95% confidence interval (CI): 1.161.33], but not as much as behavioural support for cessation (RR 2.17, 95% CI 1.523.11) or offering NRT (RR 1.68, 95% CI: 1.481.89). In a direct comparison, offering assistance generated more quit attempts than giving advice to quit on medical grounds (RR 1.69, 95% CI: 1.242.31 for behavioural support and 1.39, 95% CI: 1.251.54 for offering medication). There was evidence that medical advice increased the success of quit attempts and inconclusive evidence that offering assistance increased their success. Conclusions: Physicians may be more effective in promoting attempts to stop smoking by offering assistance to all smokers than by advising smokers to quit and offering assistance only to those who express an interest in doing so. Copyright 2012, Wiley-Blackwell.
Training health professionals in smoking cessation. (review).
Carson KV; Verbiest MEA; Crone MR; Brinn MP; Esterman AJ; Assendelft WJJ et al. Cochrane Database of Systematic Reviews 5: e-article CD000214, 2012. (145 refs.)
Background: Cigarette smoking is one of the leading causes of preventable death world wide. There is good evidence that brief interventions from health professionals can increase smoking cessation attempts. A number of trials have examined whether skills training for health professionals can lead them to have greater success in helping their patients who smoke. Objectives: To determine the effectiveness of training health care professionals in the delivery of smoking cessation interventions to their patients, and to assess the additional effects of training characteristics such as intervention content, delivery method and intensity. Search methods: The Cochrane Tobacco Addiction Group's Specialised Register, electronic databases and the bibliographies of identified studies were searched and raw data was requested from study authors where needed. Searches were updated in March 2012. Selection criteria: Randomized trials in which the intervention was training of health care professionals in smoking cessation. Trials were considered if they reported outcomes for patient smoking at least six months after the intervention. Process outcomes needed to be reported, however trials that reported effects only on process outcomes and not smoking behaviour were excluded. Data collection and analysis: Information relating to the characteristics of each included study for interventions, participants, outcomes and methods were extracted by two independent reviewers. Studies were combined in a meta-analysis where possible and reported in narrative synthesis in text and table. Main results: Of seventeen included studies, thirteen found no evidence of an effect for continuous smoking abstinence following the intervention. Meta-analysis of 14 studies for point prevalence of smoking produced a statistically and clinically significant effect in favour of the intervention (OR 1.36, 95% CI 1.20 to 1.55, p= 0.004). Meta-analysis of eight studies that reported continuous abstinence was also statistically significant (OR 1.60, 95% CI 1.26 to 2.03, p= 0.03). Healthcare professionals who had received training were more likely to perform tasks of smoking cessation than untrained controls, including: asking patients to set a quit date (p< 0.0001), make follow-up appointments (p< 0.00001), counselling of smokers (p< 0.00001), provision of self-help material (p< 0.0001) and prescription of a quit date (p< 0.00001). No evidence of an effect was observed for the provision of nicotine gum/replacement therapy. Authors' conclusions: Training health professionals to provide smoking cessation interventions had a measurable effect on the point prevalence of smoking, continuous abstinence and professional performance. The one exception was the provision of nicotine gum or replacement therapy, which did not differ between groups. Copyright 2012, Wiley-Blackwell.
Clinical correlates of co-occurring cannabis and tobacco use: A systematic review. (review).
Peters EN; Budney AJ; Carroll KM. Addiction 107(8): 1404-1417, 2012. (91 refs.)
Aims: A growing literature has documented the substantial prevalence of and putative mechanisms underlying co-occurring (i.e. concurrent or simultaneous) cannabis and tobacco use. Greater understanding of the clinical correlates of co-occurring cannabis and tobacco use may suggest how intervention strategies may be refined to improve cessation outcomes and decrease the public health burden associated with cannabis and tobacco use. Methods A systematic review of the literature on clinical diagnoses, psychosocial problems and outcomes associated with co-occurring cannabis and tobacco use. Twenty-eight studies compared clinical correlates in co-occurring cannabis and tobacco users versus cannabis- or tobacco-only users. These included studies of treatment-seekers in clinical trials and non-treatment-seekers in cross-sectional or longitudinal epidemiological or non-population-based surveys. Results: Sixteen studies examined clinical diagnoses, four studies examined psychosocial problems and 11 studies examined cessation outcomes in co-occurring cannabis and tobacco users (several studies examined multiple clinical correlates). Relative to cannabis use only, co-occurring cannabis and tobacco use was associated with a greater likelihood of cannabis use disorders, more psychosocial problems and poorer cannabis cessation outcomes. Relative to tobacco use only, co-occurring use did not appear to be associated consistently with a greater likelihood of tobacco use disorders, more psychosocial problems or poorer tobacco cessation outcomes. Conclusions: Cannabis users who also smoke tobacco are more dependent on cannabis, have more psychosocial problems and have poorer cessation outcomes than those who use cannabis but not tobacco. The converse does not appear to be the case. Copyright 2012, Society for the Study of Addiction to Alcohol and Other Drugs.
Quitlines and nicotine replacement for smoking cessation: Do we need to change policy? (review).
Pierce JP; Cummins SE; White MM; Humphrey A; Messer K. Annual Review of Public Health 33: 341+, 2012. (96 refs.)
In the past 20 years, public health initiatives on smoking cessation have increased substantially. Randomized trials indicate that pharmaceutical cessation aids can increase success by 50% among heavier smokers who seek help, and use of these aids has increased markedly. Quitlines provide a portal through which smokers can seek assistance to quit and are promoted by tobacco control programs. Randomized trials have demonstrated that telephone coaching following a quitline call can also increase quitting, and a combination of quitlines, pharmaceutical aids and physician monitoring can help heavier smokers to quit. While quit attempts have increased, widespread dissemination of these aids has not improved population success rates. Pharmaceutical marketing strategies may have reduced expectations of the difficulty of quitting, reducing success per attempt. Some policies actively discourage unassisted smoking cessation despite the documented high success rates of this approach. There is an urgent need to revisit public policy on smoking cessation. Copyright 2012, Annual Reviews.
Interventions for smoking cessation in hospitalised patients. (review).
Rigotti NA; Clair C; Munafo MR; Stead LF. Cochrane Database of Systematic Reviews 5: e-article CD001837, 2012. (169 refs.)
Background: Smoking contributes to reasons for hospitalisation, and the period of hospitalisation may be a good time to provide help with quitting. Objectives: To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. Search methods: We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PsycINFO in December 2011 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted. Selection criteria: Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted to facilities that primarily treat psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow-up of less than six months. Both acute care hospitals and rehabilitation hospitals were included in this update, with separate analyses done for each type of hospital. Data collection and analysis: Two authors extracted data independently for each paper, with disagreements resolved by consensus. Main results: Fifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (risk ratio (RR) 1.37, 95% confidence interval (CI) 1.27 to 1.48; 25 trials). A specific benefit for post-discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post-discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. Adding nicotine replacement therapy (NRT) to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non-significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period. These trials were all conducted in acute care hospitals. A comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials). Authors' conclusions: High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals. There was no evidence of effect for interventions of lower intensity or shorter duration. This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone. There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone. Copyright 2012, Wiley-Blackwell.
A review of multicomponent interventions to prevent and control tobacco use among college students. (review).
Rodgers KC. Journal of American College Health 60(3): 257-261, 2012. (18 refs.)
Objective: Multicomponent tobacco control programs have been implemented at the state and community levels and have led to a reduction in tobacco use. The purpose was to review the public health research literature on tobacco prevention and control programs on college campuses and derive evidence-based implications for comprehensive program implementation. Methods: MEDLINE, PsycINFO, ERIC, and PubMed databases were used to search the research literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009. Results: No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least. Conclusion: The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components. Copyright 2012, Taylor & Francis.
Effectiveness of testing for genetic susceptibility to smoking-related diseases on smoking cessation outcomes: A systematic review and meta-analysis. (review).
Smerecnik C; Grispen JEJ; Quaak M. Tobacco Control 21(3): 347-354, 2012. (63 refs.)
Objective: To examine whether genetic testing for smoking-related diseases benefits smoking cessation. Data sources PubMed, EMBASE, ERIC, PsycINFO, PsychArticles, CiNAHL and socINDEX databases, the search engine Google Scholar, and key-author and reference list searches. Study selection: Randomised controlled smoking cessation interventions using genetic testing for smoking-related diseases. Data extraction Consistent with the Cochrane guidelines, two reviewers completed the review process (initial n = 139) in three phases, title selection (n = 56), abstract selection (n = 28) and whole paper selection (n = 9). From these nine studies, each reviewer extracted information about outcome measures and statistical and methodological quality. Data synthesis Relevant data were abstracted from included papers and were subsequently subjected to meta-analysis. Results: Interest in genetic testing was relatively high with 60-80% of smokers reporting to be interested. The authors observed positive short-term effects on risk perception, motivation to quit smoking and smoking cessation, but these effects fade at longer follow-ups. Importantly, the authors did not find any evidence of adverse effect of testing negative on the risk-predisposing gene. Conclusions: This systematic review does not provide solid evidence for the proposed beneficial effects of genetic testing for smoking-related diseases on smoking cessation, but does suggest the presence of an immediate motivational effect, such that genetic testing resulted in higher risk perception and more motivation to quit smoking. Copyright 2012, BMJ Publishing.
Which interventions against the sale of tobacco to minors can be expected to reduce smoking? (review).
DiFranza JR. Tobacco Control 21(4): 436-442, 2012. (70 refs.)
Objective: Signatories of the Framework Convention on Tobacco Control have committed themselves to prohibiting the sale of tobacco to minors. The tobacco industry has a long history of legal challenges to such restrictions claiming that they cannot be expected to reduce youth smoking. The object of this study was to determine if disrupting the sale of tobacco to minors can be expected to reduce tobacco use by youths. Methods: A comprehensive literature search was conducted for studies that evaluated the impact on youth tobacco use of efforts to disrupt the sale of tobacco to youths. Results: There was little evidence that merely enacting a law without sufficient enforcement had any impact on youth tobacco use. There was no evidence that merchant education programmes had any impact on youth older than 12 years of age. There was no evidence that enforcement efforts that failed to reduce the sale of tobacco to minors had any beneficial impact. All enforcement programmes that disrupted the sale of tobacco to minors reduced smoking among youth. Conclusions: Government officials can expect that enforcement programmes that disrupt the sale of tobacco to minors will reduce adolescent smoking. Copyright 2012, BMJ Publishing Group.
Waterpipe tobacco products: Nicotine labelling versus nicotine delivery.
Vansickel AR; Shihadeh A; Eissenberg T. Tobacco Control 21(3): 377-379, 2012. (18 refs.)
Background: Waterpipe tobacco package labelling typically indicates "0.0% tar" and "0.05% or 0.5% nicotine". Objective: To determine the extent to which nicotine labeling is related to nicotine delivery. Methods: 110 waterpipe smokers engaged in a 45-minute waterpipe smoking session. Puff topography and plasma nicotine were measured. Three waterpipe tobacco brands were used: Nakhla (0.5% nicotine), Starbuzz (0.05% nicotine), and Al Fakher (0.05% nicotine). Data were analyzed by one-way ANOVA. Results: Topography did not differ across brands. Peak plasma nicotine varied significantly across brands. Al Fakher had the highest nicotine delivery (11.4 ng/ml) followed by Nakhla (9.8 ng/ml) and Starbuzz (5.8 ng/ml). Conclusions: Nicotine labelling on waterpipe tobacco products does not reflect delivery; smoking a brand with a "0.05% nicotine" label led to greater plasma nicotine levels than smoking a brand with a "0.5% nicotine" label. Waterpipe tobacco products should be labelled in a manner that does not mislead consumers. Copyright 2012, BMJ Publishing.
Clinical laboratory assessment of the abuse liability of an electronic cigarette.
Vansickel AR; Weaver MF; Eissenberg T. Addiction 107(8): 1493-1500, 2012. (37 refs.)
Aims: To provide an initial abuse liability assessment of an electronic cigarette (EC) in current tobacco cigarette smokers. Design: The first of four within-subject sessions was an EC sampling session that involved six, 10-puff bouts (30 seconds inter-puff interval), each bout separated by 30 minutes. In the remaining three sessions participants made choices between 10 EC puffs and varying amounts of money, 10 EC puffs and a varying number of own brand cigarette (OB) puffs, or 10 OB puffs and varying amounts of money using the multiple-choice procedure (MCP). The MCP was completed six times at 30-minute intervals, and one choice was reinforced randomly at each trial. Setting Clinical laboratory. Participants: Twenty current tobacco cigarette smokers. Measurements: Sampling session outcome measures included plasma nicotine, cardiovascular response and subjective effects. Choice session outcome was the cross-over value on the MCP. Findings: EC use resulted in significant nicotine delivery, tobacco abstinence symptom suppression and increased product acceptability ratings. On the MCP, participants chose to receive 10 EC puffs over an average of $1.06 or three OB puffs and chose 10 OB puffs over an average of $1.50 (P < 0.003). Conclusions: Electronic cigarettes can deliver clinically significant amounts of nicotine and reduce cigarette abstinence symptoms and appear to have lower potential for abuse relative to traditional tobacco cigarettes, at least under certain laboratory conditions. Copyright 2012, Society for the Study of Addiction to Alcohol and Other Drugs.
Trends in alternative tobacco use among light, moderate, and heavy smokers in adolescence, 1999-2009.
Nasim A; Khader Y; Blank MD; Cobb CO; Eissenberg T. Addictive Behaviors 37(7): 866-870, 2012. (37 refs.)
Objective: To examine trends in alternative tobacco product (ATP) use (smokeless tobacco, cigars, and bidis/cloves) among a national sample of adolescent cigarette smokers (light, moderate, and heavy) during 1999-2009. Method: A secondary analysis of data from the 1999-2009 National Youth Tobacco Survey was performed to investigate the tobacco behaviors of 6th through 12th graders enrolled in public and private schools in the United States. Long-term trends in ATP use were analyzed using logistic regression - controlling for sex, grade, and race/ethnicity - and simultaneously assessing linear and higher order time effects and their interaction with cigarette smoking status. Results: During 1999-2009, increases in smokeless tobacco use and decreases in bidis/cloves use were observed across all smoking groups. For cigars, declines were observed for heavy and moderate smokers, but levels returned to baseline levels in 2009. Cigar use among light smokers was less variable. Rates of any ATP were highest among heavy smokers and lowest among light smokers. Conclusion: Trends in cigarette and SLT use increased dramatically in the past decade, and this increase is evident across all cigarette smoker types. Implications for tobacco surveillance, prevention and cessation programs, and tobacco control policies are discussed. Copyright 2012, Elsevier Science.
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