Comparative Evaluation of the Effect of Laser Therapy and Behavioral Counseling in Tobacco Cessation: A Randomized Controlled Trial

In the United States and around the world, nicotine dependence is a leading cause of preventable death. Smoking cessation results in immediate and enduring health benefits. A wide range of clinical interventions have been shown to facilitate smoking cessation and to have a favorable cost-benefit profile. Practice guidelines and national reports have issued calls to action and have made smoking cessation resources readily available. Yet utilization of smoking cessation interventions and resources is lagging. Health care systems and providers have a shared responsibility to ensure that all smokers are offered appropriate interventions. This article summarizes the epidemiology and pathophysiology of nicotine dependence as a background for reviewing the central components of clinical evidence-based smoking cessation interventions: screening, assessment, advice, assistance, and follow-up. Specific patient populations are discussed, as well as emerging strategies to address nicotine dependence.

ObjectivesThe aim of the current study was to compare urinary cotinine levels, nicotine dependence and physical effects related to smoking in smokers before and after laser auricular acupuncture, psychological counselling and a combination of laser treatment with counselling.MethodsThis study was carried out from February to July 2019 in India. A total of 60 smokers were randomly allocated to three interventional groups. Urinary cotinine levels, nicotine dependence and physical effects due to smoking were evaluated using NicAlert strips (Nymox Pharmaceutical Corp., Quebec, Canada) the Fagerström questionnaire and a visual analogue scale, respectively, at baseline and one month post-intervention. Pearson’s chi-square, Kruskal Wallis analysis of variance and Wilcoxon sign rank tests were used for statistical analyses.ResultsThere was a significant reduction in urinary cotinine levels and nicotine dependence and significant improvement in behaviour and physical effects related to smoking in all groups post-intervention (P <0.05). Reduction in nicotine dependence was significantly higher in the laser group (4.4 ± 1.66) compared to other groups (P <0.01). Reduction in urinary cotinine levels was highest in the laser with counselling group (0.85 ± 0.3) compared to the other groups. There was a significant reduction in irritability, headache, craving for smoking, tiredness and anxiety as well as a substantial increase in calmness, unpleasant taste of smoking, the ability to concentrate and appetite in the laser auricular acupuncture group compared to the other groups (P <0.01)ConclusionLaser auricular acupuncture alone and in combination with psychological counselling can reduce nicotine dependence among smokers.

Nicotine dependence and smoking frequency are critical factors for smoking cessation. The aims of this study are (1) to determine if nicotine dependence Fagerström Test for Nicotine Dependence (FTND) scores are associated with urinary levels of nicotine metabolites, (2) to assess the relationship of hydroxycotinine/cotinine ratio with FTND score and cigarettes smoked per day (CPD), and (3) to identify significant predictors of cigarettes per day among biomarker concentrations and individual FTND items. Urine samples and questionnaire data of 239 daily smokers were obtained. Nicotine, cotinine and hydroxycotinine urinary levels were determined by UPLC MS/MS.Multiple linear regression models were developed to explore the relationship between nicotine, cotinine, hydroxycotinine levels and separate FTND scores (for all six items). We found significant correlations between the different urinary biomarker concentrations, and the FTND score. The time before the first cigarette after waking (TTFC) was significantly associated with the nicotine, cotinine and hydroxycotinine concentrations. No association was found between the ratio of hydroxycotinine to cotinine and either the FTND or the CPD. A model including four FTND questions, sex, age, and the cotinine concentration, accounted for 45% of the variance of CPD. There are significant relationships between urinary levels of nicotine, cotinine, and hydroxycotinine and the FTND score. Especially the FTND question about TTFC is relevant for explaining the biomarker concentrations. CPD (below 15) was significantly explained by four FTND dependence items and urinary cotinine levels in a regression model. We investigated associations between urinary levels of nicotine, cotinine, and hydroxycotinine in daily smokers and the FTND scores for nicotine dependence. We did not find association between the hydroxycotinine/cotinine ratio and CPD. We developed a model that explains the cigarettes smoked daily (CPD) in a group of light smokers by combining FTND items, urinary cotinine levels, sex, and age. Our results might be of importance for clinical use or future studies on larger smoking populations.

Effectiveness of smoking cessation program for male adolescents in South Korea

Although nicotine dependence plays a role as a main barrier for smoking cessation, there is still a lack of solid evidence on the validity of biomarkers to determine nicotine dependence in clinical settings. This study aimed to investigate whether urinary cotinine levels could reflect the severity of nicotine dependence in active smokers. Data regarding general characteristics and smoking status was collected using a self-administered smoking questionnaire. The Fagerstrom test for nicotine dependence (FTND) was used to determine nicotine dependence of the participants, and a total of 381 participants were classified into 3 groups of nicotine dependence: low (n=205, 53.8%), moderate (n=127, 33.3%), and high dependence groups (n=49, 12.9%). Stepwise multiple linear regression model and receiver operating characteristic (ROC) curves analyses were used to determine the validity of urinary cotinine for high nicotine dependence. In correlation analysis, urinary cotinine levels increased with FTND score (r=0.567, P<0.001). ROC curves analysis showed that urinary cotinine levels predicted the high-dependence group with reasonable accuracy (optimal cut-off value=1,000 ng/mL; AUC=0.82; P<0.001; sensitivity=71.4%; specificity=74.4%). In stepwise multiple regression analysis, the total smoking period (β=0.042, P=0.001) and urinary cotinine levels (β=0.234, P<0.001) were positively associated with nicotine dependence, whereas an inverse association was observed between highest education levels (>16 years) and nicotine dependence (β=-0.573, P=0.034). The results of this study support the validity of using urinary cotinine levels for assessment of nicotine dependence in active smokers.

Cotinine levels in women who smoke during pregnancy

We aimed to evaluate the association between environmental tobacco smoke (ETS) exposure and urinary cotinine levels in current adolescent smokers and nonsmokers. The secondary objective was to explore the association between ETS exposure and nicotine dependence in adolescent smokers. Using the results from a validation study for the 2012 Global Youth Tobacco Survey in Mexico, we quantified urinary cotinine levels in adolescent smokers and nonsmokers. We fitted a multivariate regression model to assess the association between household exposure to ETS and cotinine levels in adolescent smokers and nonsmokers. In addition, using the questionnaire's answers for morning cravings, we fitted a multivariate Poisson regression model to explore the association between household ETS exposure and nicotine dependence in adolescent smokers. For each day of household ETS exposure, cotinine levels increase by 5% in adolescent smokers compared to a 2% increase in nonsmokers, adjusting for the number of cigarettes smoked per week, age and sex (exp(β) 1.05; 95% confidence interval [CI] [1.00, 1.10]; p = .041). Morning cravings increase 11% for each day of household ETS exposure adjusting for the number of cigarettes smoked per week, age and sex (prevalence ratio [PR] 1.11; 95% CI [0.99, 1.25]; p = .064). There is an association between ETS exposure and cotinine levels, and ETS may contribute to nicotine dependence in adolescent smokers. If confirmed, avoiding ETS exposure could prove helpful for addiction control and quitting in adolescents. Evidence suggests that ETS increases cotinine levels in nonsmokers and adult smokers. However, no study has explored the association between ETS exposure and cotinine levels and addiction in adolescent smokers. This paper provides evidence of an association between ETS exposure and cotinine levels in adolescent smokers: each day of environmental tobacco smoke exposure at home increased cotinine levels by 5% among smokers. In addition, morning cravings in adolescent smokers increased 11% for every day of ETS exposure. ETS exposure is a significant source of nicotine for adolescent smokers and could play an important role in addiction.

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Anti-smoking legislation and its effects on urinary cotinine and cadmium levels

Background: Vitamin D deficiency is today acknowledged as a pandemic. Vitamin D deficiency and insufficiency are associated with many chronic diseases, including common cancers, cardiovascular diseases, metabolic syndrome, and infectious and autoimmune diseases. Objective: This study aims to investigate the relationship between the cotinine level in urine and Vitamin D. Methods: This study employed a descriptive and relational screening design. It was conducted with 74 smoking university students between January 2019 and March 2020. Data were collected through socio-demographic form and Fagerstrom test for nicotine dependence. Besides, the participating students’ blood and urine samples were taken in a suitable environment. Results: The average age of the participating students was 21.50±2.09. Of all the students, 71.6% were males, 62.2% were exposed to the sun between 12 p.m. and 2 p.m., and the average number of cigarettes smoked daily was 13.52±8.22. The average Vitamin D level in blood was 32.4±15.3 (ng/mL), and the average cotinine level in urine was 1.60 ± .32 (ng/L). No statistically significant relationships were found between the Vitamin D level and the cotinine level (p&lt;0.05). Conclusion: Smoking causes diseases and death in many people, and it is a changeable risk factor. Nursing practices on the struggle against smoking are effective. No significant relationships were found between the Vitamin D level in blood and cotinine level in urine. Similar studies are recommended to be conducted with larger groups and participants from different age groups.

Smoking prevention and cessation programme in cystic fibrosis: Integrating an environmental health approach

Background & objectives:Cardiovascular disease (CVD), the leading cause of death worldwide is responsible for over 17 million deaths globally, of which 10 per cent deaths have been expected due to consumption of tobacco. The association between CVD and chewing of tobacco is limited and remains arguable. The aim of this study was to find out the correlation between urinary cotinine level and cardiovascular autonomic function tests of tobacco chewers.Methods:In the present study, 600 participants, 300 smokeless tobacco chewers (STC) and 300 non-tobacco chewers (NTC), between 18 and 65 yr were selected. Various parameters such as anthropometric, systolic blood pressure (SBP), diastolic blood pressure (DBP), autonomic function tests and urinary cotinine levels were measured.Results:Significant difference (P<0.001) was noted in STC and NTC for anthropometric parameters, SBP, DBP and urinary cotinine levels. Sympathetic and parasympathetic autonomic function test showed significant difference on comparison in STC and NTC groups, except in Valsalva ratio. Correlations with urinary cotinine levels were significant for sympathetic autonomic functions, SBP fall (r=0.138, P=0.016), DBP rise (r=−0.141, P≤0.014); parasympathetic autonomic function, heart rate (HR) response to standing (r=−0.208, P≤0.003), deep breathing (r=−0.473, P≤0.001) and Valsalva ratio (r=−0.396, P≤0.0001).Interpretation & conclusions:Correlation between urinary cotinine levels and autonomic function tests elucidates the linkage involving autonomic nervous system damage which can be considered as an important associated relationship for early diagnosis of CVD health risk factors among smokeless tobacco (ST) users.

Shisha smoking has been prevalent in Indonesia because of the assumption that shisha is safe and harmless compared with cigarettes. Urinary cotinine and exhaled air carbon monoxide (CO) are indicators of cigarette smoke exposure. The aim of this study was to measure the level of urinary cotinine and exhaled air CO levels. We performed cross-sectional study on shisha smokers after using shisha. Respondents were grouped into groups of shisha smokers and non-smokers based on smoking status and shisha use status. Data obtained from questionnaires, urine samples, and exhaled air CO before and 30 min after using shisha. The urinary cotinine levels were measured by enzyme-linked immunosorbent assay (ELISA) and exhaled air CO levels were measured by smokelyzer test. Ninety-six respondents were enrolled in this study, consisted of 48 shisha smokers and 48 non-smokers. The level of urinary cotinine and exhaled air CO level after shisha smoking in shisha smokers were higher than non-smokers (median 162.7 vs. 6.5 ng/mL; p < 0.05 and 85 ppm vs. 1 ppm, p < 0.05). There was an increase in urinary cotinine level and exhaled air CO level after shisha smoking with percentage increase of 3% and 270%. Smoking status affects urinary cotinine levels in shisha smokers, and the type of inhalation affects exhaled air CO levels after shisha smoking.

IntroductionUrinary nicotine and cotinine levels are often measured as biomarkers for tobacco smoke exposure. However, these biomarkers are not appropriate to evaluate the effects of quitting smoking for several days, because of their short half-lives. In this study, we focused on the changes in the urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels of 55 patients in a smoking cessation program, because of the long half-life. At the same time, urinary 7-methylguanine (m7Gua) and 8-hydroxy-2′-deoxyguanosine (8-OHdG), as DNA damage markers of cigarette smoking, were also measured.ResultsIn the subjects who completed the quit-smoking program (18 subjects out of 55), the urinary nicotine and cotinine levels decreased to 1.7 and 0.2% at 8 weeks after the first visit to the clinic. By contrast, the NNAL levels decreased to 12.3% at 8 weeks after quitting smoking. During the same period, the urinary m7Gua levels significantly decreased, from 27.32 μg/mg creatinine to 14.17 μg/mg creatinine by the elimination of subjects who showed increased levels of NNAL during the smoking cessation program. The 8-OHdG levels were also reduced within the same period, but were not significantly different. From the all data analysis, the urinary levels of cotinine and NNAL positively correlated with the level of m7Gua.ConclusionsNNAL may be an appropriate exposure marker for evaluating the smoking status of patients in a smoking cessation program. The urinary cotinine and NNAL levels positively correlated with the m7Gua levels.

A preliminary investigation of early smoking initiation and nicotine dependence in Korean adults