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...on Nicotine
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www.ProjectCork.org
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Summer 2012
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Actions speak louder than words: An experiment on the impact of peers discouraging young adult smoking.
Harakeh Z; Vollebergh WAM. European Addiction Research 17(6): 316-320, 2011. (20 refs.)
This study investigates whether antismoking peer pressure and/or nonsmoking peers are protective factors and decrease young adults' likelihood to smoke. An experiment was conducted among 59 daily-smoking young adults aged 16-24 years. The experiment consisted of four conditions. During the session, the confederate and participant sat in a camper van and had to do a 30-min joint music task. The participants' smoking behavior was observed during this task. The results of Poisson log-linear analysis, controlling for participants' carbon monoxide level and gender, showed that young adults smoked fewer cigarettes in the presence of a nonsmoking model pressuring the young adult not to smoke compared to a heavy-smoking model not using any pressure. At the same time, the results of Fisher's exact test indicated that the total number of cigarettes smoked did not differ significantly for nonsmoking peers verbally pressuring the young adult not to smoke compared to nonsmoking peers not verbally pressuring the young adult. Our findings indicate that the protective effect of peer influence merely lies in that the peer does not smoke. Therefore, antismoking programs and policy should focus specifically on reducing exposure to smoking peers. Copyright 2011, Karger.
An assessment of America's tobacco-free colleges and universities.
Plaspohl SS; Parrillo AV; Vogel R; Tedders S; Epstein A. Journal of American College Health 60(2): 162-167, 2012. (20 refs.)
Objective: This study examined the extent to which US campuses identified as "100% tobacco-free" by the American Lung Association of Oregon adhered to the American College Health Association's the most recent guidelines and recommendations promoting tobacco-free environments in colleges and universities. Participants: A key informant from 162 of175 institutions (92.6% response rate) completed an online survey between January 2010 and February 2010. Methods: The variables under study were assessed via a cross-sectional research design. Participants completed a 35-item survey regarding their school's tobacco policies, procedures, and enforcement practices. Results: Although the vast majority of schools had written policies and procedures in place, schools with current policies were the most compliant. Numerous opportunities for improved adherence were identified in the results. Conclusions: Findings from this study may help institutions in the development and implementation of a new tobacco policy, as well as strengthen policies among existing tobacco-free schools. Copyright 2012, Taylor & Francis.
Availability of tobacco and alcohol products in Los Angeles community pharmacies.
Corelli RL; Aschebrook-Kilfoy B; Kim G; Ambrose PJ; Hudmon KS. Journal of Community Health 37(1): 113-118, 2012. (32 refs.)
The availability of tobacco and alcohol products in community pharmacies contradicts the pharmacists' Code of Ethics and presents challenges for a profession that is overwhelmingly not in favor of the sale of these products in its practice settings. The primary aim of this study was to estimate the proportion of pharmacies that sell tobacco products and/or alcoholic beverages and to characterize promotion of these products. The proportion of pharmacies that sell non-prescription nicotine replacement therapy (NRT) products as aids to smoking cessation also was estimated. Among 250 randomly-selected community pharmacies in Los Angeles, 32.8% sold cigarettes, and 26.0% sold alcohol products. Cigarettes were more likely to be available in traditional chain pharmacies and grocery stores than in independently-owned pharmacies (100% versus 10.8%; P < 0.001), and traditional chain drug stores and grocery stores were more likely to sell alcoholic beverages than were independently-owned pharmacies (87.5% vs. 5.4%; P < 0.001). Thirty-four (41.5%) of the 82 pharmacies that sold cigarettes and 47 (72.3%) of the 65 pharmacies that sold alcohol also displayed promotional materials for these products. NRT products were merchandised by 58% of pharmacies. Results of this study suggest that when given a choice, pharmacists choose not to sell tobacco or alcohol products. Copyright 2012, Springer.
Competitions and incentives for smoking cessation. (review).
Cahill K; Perera R. Cochrane Database of Systematic Reviews 4: e-article CD004307, 2011. (126 refs.)
Background: Material or financial incentives may be used in an attempt to reinforce behaviour change, including smoking cessation. They have been widely used in workplace smoking cessation programmes, and to a lesser extent within community programmes. Public health initiatives in the UK are currently planning to deploy incentive schemes to change unhealthy behaviours. Quit and Win contests are the subject of a companion review. Objectives: To determine whether competitions and incentives lead to higher long-term quit rates. We also set out to examine the relationship between incentives and participation rates. Search strategy: We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE, EMBASE, CINAHL and PsycINFO. Search terms included incentive*, competition*, contest*, reward*, prize*, contingent payment*, deposit contract*. The most recent searches were in November 2010. Selection criteria: We considered randomized controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. Data collection and analysis: Data were extracted by one author (KC) and checked by the second (RP). We contacted study authors for additional data where necessary. The main outcome measure was abstinence from smoking at least six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Where possible we performed meta-analysis using a generic inverse variance model, grouped by timed endpoints, but not pooled across the subgroups. Main results: Nineteen studies met our inclusion criteria, covering >4500 participants. Only one study, the largest in our review and covering 878 smokers, demonstrated significantly higher quit rates for the incentives group than for the control group beyond the six-month assessment. This trial referred its participants to local smoking cessation services, and offered substantial cash payments (up to US$750) for prolonged abstinence. In the remaining trials, there was no clear evidence that participants who committed their own money to the programme did better than those who did not, or that contingent rewards enhanced success rates over fixed payment schedules. There is some evidence that recruitment rates can be improved by rewarding participation, which may be expected to deliver higher absolute numbers of successful quitters. Cost effectiveness analysis was not appropriate to this review, since the efficacy of most of the interventions was not demonstrated. Authors' conclusions: With the exception of one recent trial, incentives and competitions have not been shown to enhance long-term cessation rates. Early success tended to dissipate when the rewards were no longer offered. Rewarding participation and compliance in contests and cessation programmes may have potential to deliver higher absolute numbers of quitters. The one trial that achieved sustained success rates beyond the reward schedule concentrated its resources into substantial cash payments for abstinence rather than into running its own smoking cessation programme. Such an approach may only be feasible where independently-funded smoking cessation programmes are already available. Future research might explore the scale and longevity of possible cash reward schedules, within a variety of smoking populations. Copyright 2011, Wiley-Blackwell.
E-cigarettes: Promise or peril?
Riker CA; Lee K; Darville A; Hahn EJ. Nursing Clinics of North America 47(1): 159+, 2012. (54 refs.)
Electronic cigarettes (e-cigarettes) use a heating element to vaporize nicotine and other ingredients, simulating the visual, sensory, and behavioral aspects of smoking without the combustion of tobacco. An ever-growing number of companies around the world manufacture a wide variety of e-cigarette brands, despite scant information on the safety of the ingredients for human inhalation. This article provides an overview of the history, production, and marketing of e-cigarettes, the contents of e-cigarettes and vapor, how they are used, public health concerns, and implications for nursing practice, research, and policy development. Copyright 2012, W B Saunders.
Emergency department-initiated tobacco dependence treatment.
Anders ME; Sheffer CE; Barone CP; Holmes TM; Simpson DD; Duncan AM. American Journal of Health Behavior 35(5): 546-556, 2011. (41 refs.)
Objective: To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients. Methods: The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts. Results: Treatment enrollment was higher in the intervention group (13.5% vs 2.7%). Only the faxed referral was associated with treatment enrollment. Conclusions: An ED intervention is feasible. Faxed referral resulted in a 5-fold increase in tobacco treatment enrollment. The ED may be an opportune setting to facilitate smoking-cessation behavior change among lower income, underserved patients. Copyright 2011, PNG.
Exercise interventions for smoking cessation. (review).
Ussher MH; Taylor A; Faulkner G. Cochrane Database of Systematic Reviews 1: article CD002295, 2012. (219 refs.)
Background: Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain. Objectives: To determine whether exercise- based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone. Search methods: In July 2011, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise'or 'physical activity'. We also searchedMEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL using the terms ' exercise' or 'physical activity' and 'smoking cessation'. Selection criteria: We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme, recruiting smokers or recent quitters, and with a follow up of six months or more. Data collection and analysis: We extracted data on study characteristics and smoking outcomes. Because of differences in studieswe summarized the results narratively, making no attempt at meta- analysis. Main results: We identified 15 trials, seven of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three- month follow up and a benefit for exercise of borderline significance (p = 0.05) at the 12- month follow up. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three- month follow up but not at the end of treatment or 12- month follow up. The other studies showed no significant effect for exercise on abstinence. Author's conclusions: Only one of the 15 trials offered evidence for exercise aiding smoking cessation at a 12- month follow up. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups. Copyright 2012, Wiley-Blackwell.
Implementation of a tobacco-free regulation in substance use disorder treatment facilities.
Brown E; Nonnemaker J; Federman EB; Farrelly M; Kipnis S. Journal of Substance Abuse Treatment 42(3): 319-327, 2012. (34 refs.)
We assessed the impact of a statewide tobacco-free services regulation on facility administrators' attitudes and the integration of tobacco dependence treatment into substance use disorder services. We surveyed substance use disorder treatment facility administrators in New York before (n = 285) and after (n = 205) tobacco-free services regulation implementation about their attitudes, their perceptions of staff and patient attitudes, and the facilities' services. We analyzed data on admissions and tobacco treatment pharmacotherapy administration. We found increased tobacco screening and cessation services offered, increased use of tobacco pharmacotherapy, and increased support for tobacco-free campus policies. Although patient resistance was a challenge, administrators reported a decrease in patient resistance to tobacco-free policies. Patient admissions did not decrease after the regulation went into effect. Tobacco-free services regulations in substance use disorder treatment facilities can be feasibly implemented, which has the potential to decrease the extremely high rates of tobacco use among people with substance use disorders. Copyright 2012, Elsevier Science.
Non-cigarette tobacco products: What have we learnt and where are we headed? (review).
O'Connor RJ. Tobacco Control 21(2): 181-190, 2012. (207 refs.)
A wide variety of non-cigarette forms of tobacco and nicotine exist, and their use varies regionally and globally. Smoked forms of tobacco such as cigars, bidis, kreteks and waterpipes have high popularity and are often perceived erroneously as less hazardous than cigarettes, when in fact their health burden is similar. Smokeless tobacco products vary widely around the world in form and the health hazards they present, with some clearly toxic forms (eg, in South Asia) and some forms with far fewer hazards (eg, in Sweden). Nicotine delivery systems not directly reliant on tobacco are also emerging (eg, electronic nicotine delivery systems). The presence of such products presents challenges and opportunities for public health. Future regulatory actions such as expansion of smoke-free environments, product health warnings and taxation may serve to increase or decrease the use of non-cigarette forms of tobacco. These regulations may also bring about changes in non-cigarette tobacco products themselves that could impact public health by affecting attractiveness and/or toxicity. Copyright 2012, BMJ Publishing.
Persistent heavy smoking as risk factor for major depression (MD) incidence: Evidence from a longitudinal Canadian cohort of the National Population Health Survey.
Khaled SM; Bulloch AG; Williams JVA; Hill JC; Lavorato DH; Patten SB. Journal of Psychiatric Research 46(4): 436-443, 2012. (67 refs.)
Background: Reports of bidirectional associations between smoking and major depression (MD) have been interpreted as providing evidence for confounding by shared-vulnerability factors (SV) that predispose individuals to both conditions. If this is true, then smoking cessation may not reduce the risk of MD. From clinical practice and public health perspectives, the long-term outcomes associated with smoking persistence and cessation are potentially important and deserve exploration. To this end, the 12-year risk of MD in persistent heavy smokers and abstainers who were former-heavy smokers with and without adjustment for potential confounders were compared. Methods: Follow-up data from the National Population Health Survey (NPHS) was used. Multinomial logistic (ML) models were fit to identify potential confounders. Using proportional hazard (PH) models, unadjusted and adjusted hazard ratios (HRs) for MD outcome were estimated for different smoking patterns. Results: The unadjusted HR relating the risk of MD among current-heavy versus former-heavy smokers was 4.3 (95% CI: 2.6-6.9, p < 0.001). Current-heavy smoking predicted onset of MD (HR = 3.1, 95% CI: 1.9 -5.2, p < 0.001) even after adjustment for age, sex and stress the main confounders. However, this was not the case for the never, former-light, and current-light categories. Evidence of decreased risk of MD among former-heavy relative to current-heavy smokers as function of smoking cessation maintenance time was also found. Conclusions: Contrary to common beliefs about the benefits of smoking for mental health, our results suggest that current-heavy rather than ever-heavy smoking is a major determinant of MD risk and point towards the benefits of smoking cessation maintenance. Copyright 2012, Elsevier Science.
Smoke-free air policies: Past, present and future. (review).
Hyland A; Barnoya J; Corral JE. Tobacco Control 21(2): 154-161, 2012. (114 refs.)
Smoke-free policies have been an important tobacco control intervention. As recently as 20 years ago, few communities required workplaces and hospitality venues to be smoke-free, but today approximately 11% of the world's population live in countries with laws that require these places to be smoke-free. This paper briefly summarises important milestones in the history of indoor smoke-free policies, the role of scientific research in facilitating their adoption, a framework for smoke-free policy evaluation and industry efforts to undermine regulations. At present, smoke-free policies centre on workplaces, restaurants and pubs. In addition, many jurisdictions are now beginning to implement policies in outdoor areas and in shared multiunit housing settings. The future of smoke-free policy development depends on credible scientific data that documents the health risks of secondhand smoke exposure. Over the next 20 years smoke-free policies will very likely extend to outdoor and private areas, and changes in the types of tobacco products that are consumed may also have implications for the nature and scope of the smoke-free policies of the future. Copyright 2012, BMJ Publishing.
Smoking and the skin. (review).
Ortiz A; Grando SA. International Journal of Dermatology 51(3): 250-262, 2012. (131 refs.)
Cigarette smoking has been associated with significant morbidity affecting all systems of the body, including the integumentary system. We review the many dermatologic hazards of tobacco use. It is important to distinguish between the effects of tobacco smoke from effects of pure nicotine on the skin. All skin cells express several subtypes of the nicotinic class of acetylcholine receptors, including the a7 receptor. Many chronic dermatoses are affected by smoking either negatively or positively. Elucidation of positive associations with a particular disease can lead to improvement from smoking cessation, whereas inverse correlation may lead to development of a disease-specific treatment with nicotinergic agonists. Copyright 2012, Wiley-Blackwell.
The implementation of smoking cessation counseling in substance abuse treatment.
Knudsen HK; Studts CR; Studts JL. Journal of Behavioral Health Services & Research 39(1): 28-41, 2012. (51 refs.)
Research on the implementation of smoking cessation counseling within substance abuse treatment organiz-ations is limited. This study examines associations among counselors' implementation of therapy sessions dedicated to smoking cessation, organizational factors, and counselor-level variables. A two-level hierarchical linear model including organization-and counselor-level variables was estimated using survey data collected from 1,794 counselors working in 359 treatment organizations. Overall implementation of smoking cessation counseling was low. In the final model, implementation was positively associated with counselors' knowledge of the Public Health Service's clinical practice guideline, perceived managerial support, and belief that smoking cessation had a positive impact on recovery. Private versus public funding and presence of a formal smoking cessation program were organization-level variables which interacted with these counselor-level effects. These results highlight the importance of organizational contexts as well as counselors' knowledge and attitudes for effective implementation of smoking cessation counseling in substance abuse treatment organizations. Copyright 2012, Springer.
Wound healing and infection in surgery the clinical impact of smoking and smoking cessation: A systematic review and meta-analysis. (review).
Sorensen LT. Archives of Surgery 147(4): 373-383, 2012. (150 refs.)
Objectives: To clarify the evidence on smoking and postoperative healing complications across surgical specialties and to determine the impact of perioperative smoking cessation intervention. Data Sources: Cohort studies and randomized controlled trials. Study Selection: Selected studies were identified through electronic databases (CENTRAL, MEDLINE, and EMBASE) and by hand searching. Data Extraction: Multiple data on study characteristics were extracted. Risk of bias was assessed by means of the Newcastle-Ottawa Scale and Jadad score. Healing outcome was classified as necrosis, healing delay and dehiscence, surgical site infection, wound complications, hernia, and lack of fistula or bone healing. Mantel-Haenszel and inverse variance methods for meta-analysis (fixed- and random-effects models) were used. Data Synthesis: Smokers and nonsmokers were compared in 140 cohort studies including 479 150 patients. The pooled adjusted odds ratios (95% CI) were 3.60 (2.62-4.93) for necrosis, 2.07 (1.53-2.81) for healing delay and dehiscence, 1.79 (1.57-2.04) for surgical site infection, 2.27 (1.82-2.84) for wound complications, 2.07 (1.23-3.47) for hernia, and 2.44 (1.66-3.58) for lack of fistula or bone healing. Former smokers and patients who never smoked were compared in 24 studies including 47 764 patients, and former smokers and current smokers were compared in 20 studies including 40 629 patients. The pooled unadjusted odds ratios were 1.30 (1.07-1.59) and 0.69 (0.56-0.85), respectively, for healing complications combined. In 4 randomized controlled trials, smoking cessation intervention reduced surgical site infections (odds ratio, 0.43 [ 95% CI, 0.21-0.85]), but not other healing complications (0.51 [ 0.22-1.19]). Conclusions: Postoperative healing complications occur significantly more often in smokers compared with nonsmokers and in former smokers compared with those who never smoked. Perioperative smoking cessation intervention reduces surgical site infections, but not other healing complications. Copyright 2012, American Medical Association.
Explaining the stress-inducing effects of nicotine to cigarette smokers.
Parrott AC; Murphy RS. Human Psychopharmacology: Clinical and Experimental 27(2): 150-155, 2012. (41 refs.)
Aims: To explain how nicotine dependency causes mood fluctuation and increases daily stress. Methods: Prospective studies show that taking-up smoking leads to higher stress and depression. Cross-sectional studies show that adult smokers report more irritability, stress and depression than non-smokers. Prospective studies show that smoking cessation leads to enduring mood gains. The adverse mood effects of nicotine dependency are explained by the deprivation reversal model. In between cigarettes, most smokers experience subtle abstinence symptoms, and cumulatively these can increase everyday stress. Hence, adolescents who take up smoking become more stressed, and quitting reduces stress. An explanatory leaflet to explain this model was empirically assessed with tobacco smokers. Results: In a cohort study of 82 cigarette smokers, knowledge levels were significantly enhanced by the explanatory leaflet, and this understanding was maintained 1 week later. Hence, normal cigarette smokers can understand the adverse mood consequences of nicotine addiction. The information leaflet could prove useful for tobacco-education packages in schools, and smoking-cessation packages with adults. Conclusions: The deprivation reversal model can be easily described using a simple leaflet. It explains how nicotine dependency can cause mood fluctuation, and outlines the psychological benefits of quitting. Copyright 2012, Wiley-Blackwell.
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