Addictive Products Research Articles

Supporting cancer patients quit smoking: the initial evaluation of our tobacco cessation intervention program

AbstractBackground:Tobacco is a known addictive consumer product and its use has been reported to be associated with several health problems as well as the leading cause of premature, preventable mortality worldwide. For patients undergoing cancer treatment, tobacco smoking can potentially compromise treatment effectiveness; however, there is sufficient evidence suggesting numerous health benefits of smoking cessation interventions for cancer patients.Methods:The Grand River Regional Cancer Centre (GRRCC) smoking cessation program began in October 2013 to provide evidence-based intensive tobacco intervention to patients. All new patients are screened for tobacco use and those identified as active smokers are advised of the benefits of cessation and offered referral to the program where a cessation nurse offers counseling. Patients’ disease site, initial cessation goal, quit date, number of quit attempts and mode of contact are collected by the cessation nurse. This study reports on the initial evaluation of the smoking cessation program activities at GRRCC.Results:There are 1,210 patients who were screened, accepted a referral and counseled in the program. The referral pattern shows a modest increase every year and most of the patients (58%) indicated readiness to quit smoking. Overall, 29 and 26% of patients either quit or cut-back smoking, respectively. Among 348 patients who quit smoking, 300 (86%) were able to quit at the first attempt. The data indicated that 309 (44%) out of the 698 patients who indicated their initial intent to quit smoking were able to quit, whereas about 242 (35%) were able to cutback. A total of 15 patients out of 32 who indicated initial readiness to ‘cutback’ smoking were able to reduce tobacco use and three patients actually ended up quitting, although their initial goal was ‘ready-to-cut-back’.Conclusions:GRRCC smoking cessation program started in October 2013 to provide evidence-based intensive smoking cessation interventions for patients with cancer. Most patients referred to the program indicated a readiness to quit smoking affirming that if patients become aware of the various risks associated with continual smoking or if they are informed of the benefits associated with cessation with regard to their treatment, they will be more likely to decide to quit. Therefore, it is essential that patients, their partners and families are counseled on the health and treatment benefits of smoking cessation and sustainable programs should be available to support them to quit smoking. It is imperative then, that oncology programs should consistently identify and document the smoking status of cancer patients and support those who use tobacco at the time of diagnosis to quit. Evidence-based smoking cessation intervention should be sustainably integrated into the cancer care continuum in all oncology programs from prevention of cancer through diagnosis, treatment, survivorship and palliative care.

Addiction and Expression

Addictive products—tobacco, alcohol, gambling, and the like—have been considered legitimate regulatory targets for millennia, a tradition into which both Founding-era and modern America comfortably fits. Expressive products—newspapers, books, movies, and video games—on the other hand, have been considered essentially immune from content-based regulation, thanks to the First Amendment. But what if the content of an expressive product makes it addictive? Which tradition must give in: the ancient ability of legislatures to protect society at large from the wide-ranging impacts of addiction, or the legal shield that has generated a thriving culture of artistic independence? This Article is the first to explore the question of how the First Amendment should treat intentionally addictive speech. Social scientists indicate that certain behavioral addictions premised on compulsive use of expressive products—in particular, video games and pornography—are real dysfunctions of the brain, explainable in part by the intentional choices of developers and producers to create addictive products. And regulators are beginning to unsteadily lurch into action, without any evidence that they are taking the First Amendment into account. This Article proposes that, under current doctrine, any such regulation would need to satisfy strict scrutiny. It then argues for a departure and a recognition that intentionally addictive expression does not merit First Amendment coverage.

Toumbak, the New King of Smokeless Tobacco

Objectives: Toumbak, a smokeless tobacco product used in Sudan, is made from the finely ground leaves of Nicotiana rustica, a tobacco species with a particularly high content of nicotine, tobacco-specific nitrosamines, and minor alkaloids. Tobacco is mixed with sodium bicarbonate (about 4:1), water is added, and the mixture becomes one of a high pH (11.0-11.8); nicotine is completely protonated, and the rate of absorption in blood spikes rapidly. It is an extremely addictive and harmful product. Recent reports through consultations, social media, and word of mouth indicate the increasing use of Toumbak within the United States and among American teenagers and young adults. Knowledge about Toumbak must, therefore, be fully developed among oral medicine clinicians and further social awareness protocols initiated.

From problem people to addictive products: a qualitative study on rethinking gambling policy from the perspective of lived experience

BackgroundPrevious research has shown that government and industry discussions of gambling may focus on personal responsibility for gambling harm. In Australia, these discussions have largely excluded people with lived experience of problem gambling, including those involved in peer support and advocacy.MethodsWe conducted 26 in-depth interviews with people with current or previous problem gambling on electronic gaming machines (EGMs) involved in peer support and advocacy activities, using an approach informed by Interpretive Policy Analysis and Constructivist Grounded Theory.ResultsParticipants perceived that government and industry discussed gambling as safe and entertaining with a focus on personal responsibility for problem gambling. This focus on personal responsibility was perceived to increase stigma associated with problem gambling. In contrast, they described gambling as risky, addictive and harmful, with problem gambling resulting from the design of EGMs. As a result of their different perspectives, participants proposed different interventions to reduce gambling harm, including reducing accessibility and making products safer.ConclusionsChallenging the discourses used by governments and industry to describe gambling, using the lived experience of people with experience of gambling harm, may result in reduced stigma associated with problem gambling, and more effective public policy approaches to reducing harm.

Whether to push or pull? Nicotine reduction and non-combusted alternatives - Two strategies for reducing smoking and improving public health

Combustible cigarettes remain the most harmful and addictive tobacco product, and reducing the prevalence of smoking continues to be a critical public health goal. While nicotine is the constituent primarily responsible for addiction to cigarettes, most of the harm associated with smoking comes from byproducts of tobacco combustion. Recently, two different approaches for reducing the harms of smoking have emerged, both of which focus on breaking the link between the addiction to nicotine and the harms caused by smoking. First, the addictive potential of cigarettes could be minimized by requiring a large reduction in the nicotine content of cigarettes. Evidence for a nicotine reduction policy thus far shows that the use of very low nicotine content cigarettes results in a reduction in the number of cigarettes people smoke per day and a reduction in cigarette dependence. Second, emerging alternative nicotine delivery systems (ANDS) like electronic cigarettes may provide sufficient nicotine to act as substitutes for cigarettes while delivering much lower levels of toxicants. Evidence suggests that the emergence of ANDS has increased the percentage of smokers who are able to quit. The present paper will briefly review the evidence for each of these approaches, and consider what contemporary reinforcement and addiction theories can tell us about their likely success. We argue that the most effective endgame approach is one that pursues both nicotine reduction and alternative nicotine delivery systems as complementary.

Does the uptake of wagering inducements predict impulse betting on sport?

Background and aimsMarketing inducements for addictive products, such as wagering, can prompt impulse purchasing by triggering consumption reminders, urges, and cravings. Wagering inducements incentivize betting by providing bonus bets, money-back guarantees, deposits into betting accounts, and discounts. Their promotion during sporting events, push marketing efforts directed at consumers, and ease of uptake at the point-of-sale, may trigger betting on impulse. This study examined whether the uptake of wagering inducements predicted impulse betting on sport.MethodsAustralian sports bettors (N = 1,813) completed an online survey measuring their proportion of planned bets, impulse bets before match commencement, and impulse bets during play; frequency of using wagering inducements; and several psychological, behavioral, and demographic variables.ResultsMore frequent users of wagering inducements had a greater tendency to place impulse in-play bets, which were also predicted by problem gambling, higher buying impulsiveness, higher frequency of watching sports, younger age, and higher educational status. Sports bettors with a greater tendency to place impulse bets before match commencement also tended to have higher buying impulsiveness and to be younger, but they used inducements less frequently, and tended to be female, less-educated and non-problem, moderate risk, or problem gamblers.Discussion and conclusionsUptake of wagering inducements appeared to be particularly effective in stimulating impulse in-play betting among problem gamblers and frequent sports viewers. These results suggest that a more cautious approach to the regulation of both in-play bets and wagering inducements may be required to better protect young adults from gambling problems and harm.

Investigating the Link between Beer Consumption and Economic Conditions in Canada: A Panel Data Analysis

In this paper we examine the link between beer sales, unemployment and other economic variables in Canada using provincial level panel data at monthly frequencies for the period from January 2000 to December 2010. Our panel cointegration test results indicate a stable long-run relationship between beer sales per-capita and the economic variables considered. When we account for this cointegration by specifying panel error correction models we find strong evidence that beer sales in Canada are pro-cyclical with per-capita sales increasing during good economic times as indicated by the levels of unemployment and average hourly earnings. We also find strong evidence of habit persistence in Canadian beer sales as would be expected for an addictive product. The policy implications of these results are discussed.

Smokers' Understandings of Addiction to Nicotine and Tobacco: A Systematic Review and Interpretive Synthesis of Quantitative and Qualitative Research.

Despite the centrality of addiction in academic accounts of smoking, there is little research on smokers' beliefs about addiction to smoking, and the role of nicotine in tobacco dependence. Smokers' perspectives on nicotine's role in addiction are important given the increasing prevalence of nontobacco nicotine products such as e-cigarettes. We conducted a systematic review of studies investigating smokers' understandings and lay beliefs about addiction to smoking and nicotine. We searched PubMed, Embase, CINAHL, and PsycINFO for studies investigating lay beliefs about addiction to smoking. Twenty-two quantitative and 24 qualitative studies met inclusion criteria. Critical interpretive synthesis was used to analyze the results. Very few studies asked about addiction to nicotine. Quantitative studies that asked about addiction to smoking showed that most smokers believe that cigarettes are an addictive product, and that they are addicted to smoking. Across qualitative studies, nicotine was not often mentioned by participants. Addiction to smoking was most often characterized as a feeling of "need" for cigarettes resulting from an interplay between physical, mental, and social processes. Overall, we found that understandings of smoking were more consistent with the biopsychosocial model of addiction than with more recent models that emphasize the biological aspects of addiction. Researchers should not treat perceptions of addiction to smoking interchangeably with perceptions of addiction to nicotine. More research on lay beliefs about nicotine is required, particularly considering the increasing use of e-cigarettes and their potential for long-term nicotine maintenance for harm reduction. Quantitative studies show that most smokers believe that smoking is addictive and that they are addicted. A feeling of "need" for cigarettes was central to qualitative accounts of addiction, but nicotine was not often discussed. Overall, smokers' understandings of addiction reflect a biopsychosocial model rather than a neurobiological one. Given the growing market for e-cigarettes and therapeutic nicotine, more research is required on lay beliefs about nicotine and addiction.

The legalization of dangerous consumption: a comparison of cannabis and gambling policies in three US states

Gambling has been legalized due its capacity to provide tax revenue in times when additional tax revenue is difficult to collect from large corporations and wealthy individuals. Especially state lotteries have been introduced on the premise that they provide additional funding for “good causes”. Given the harm that potentially results from gambling, it is possible to question whether education or other “good causes” truly form a ground for governments to align themselves with the gambling industry. There is no agreement on values in a modern pluralistic society, and although the purpose of education is used in legalization campaigns, after legalization it is possible to derive funds for whatever governments deem appropriate, or where there is a lack of public funds. In the US legalization of marijuana has been accomplished by using gambling as model how to gain acceptance for addictive product, and use of tax revenues seems to follow at least first the pattern developed for lottery proceeds. There is still a lack of research regarding gambling-related harm and the resultant social costs, and the situation is even more pressing with research dealing with harms and costs related to use of cannabis. The legalization of the use of recreational cannabis has occurred on basis that cannabis is relatively harmless, and after using cannabis for relatively limited medical purposes. The harms resulting from the use of cannabis do not necessarily diminish after legalization, and public officials will again face a conflict of interest similar to gambling, when collecting taxes from cannabis industry.

Tobacco habits & Oral Health-A cross-sectional study -

Background: More people use tobacco today than any other time in history. Tobacco is among the most addictive product known and tobacco dependence is progressive, chronic and relapsing disorder. Aim: To assess various tobacco habits, periodontal health & awareness regarding Cigarettes and Other Tobacco Products (COPTA). Materials and Methods: A cross-sectional study was conducted in Govt. Dental College & Hospital, Jamnagar. Patients present to public health department were enrolled for the study. Total 300 patients were enrolled during period of 1st July to 31st August, 2014 Questionnaire related to smokeless and smoking tobacco habits, periodontal status evaluation, presence of oral lesions, awareness about COTPA and willingness to quit the habit were asked to patients. Results: Smokeless tobacco habit practiced more (72.33%) than smoked tobacco (22.33%) while 5.33% patients used both the products. Again, among Smoke Less Tobacco (SLT), Mawa chewing was more prevalent (52.33%) among smokeless tobacco habit whereas Bidi smoking was more prevalent (19%) amongst smoked tobacco habit. Periodontal disease was present in almost all (98.6%) patients. About 73.67% patients did not know anything about COTPA 2003. Total 88.67% patients were willing to quit the habit but 64.67% patients didn‟t know who could help them to quit. Conclusion: More prevalent tobacco habits were Mawa chewing and Bidi smoking. Periodontal condition was jeopardized among tobacco users. Majority of them were unaware of COTPA. Most of them were willing to quit tobacco habits but they did not know from where to seek the help Keywords: Smoke Less Tobacco (SLT), smoking, Cigarettes and Other Tobacco Products (COPTA), tobacco Quitting

Need of Oral Pre Cancer Awareness Initiatives in India.

Need of Oral Pre Cancer Awareness Initiatives in India.

The case for the WHO Advisory Note, Global Nicotine Reduction Strategy

Cigarettes are the most addictive tobacco product and also the most deadly, causing the highest rates of tobacco-caused mortality and morbidity in most areas of the world.1 ,2 Although current...

The FDA's Misplaced Priorities: Premarket Review Under the Family Smoking Prevention and Tobacco Control Act

Among other key objectives, the 2009 Family Smoking Prevention and Tobacco Control Act was designed to end an era of constant product manipulation by the tobacco industry that had led to more addictive and attractive products. The law requires new tobacco products to undergo premarket review by the U.S. Food and Drug Administration (FDA) before they can be sold. To assess the FDA’s implementation of its premarket review authorities, we reviewed FDA actions on new product applications, publicly available data on industry applications to market new products, and related FDA guidance documents and public statements. We conclude that the FDA has not implemented the premarket review process in a manner that prioritizes the protection of public health. In particular, the FDA has: (1) prioritized the review of premarket applications that allow for the introduction of new tobacco products over the review of potentially noncompliant products that are already on the market; (2) misallocated resources by accommodating the industry’s repeated submissions of deficient premarket applications; and (3) weakened the premarket review process by allowing the tobacco industry to market new and modified products that have not completed the required review process.

Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK.

BackgroundPeople of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK.MethodsWe conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine.ResultsThe BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients’ motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content – maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation.ConclusionWe developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3177-8) contains supplementary material, which is available to authorized users.

Tobacco, Alcohol, and Processed Food Industries - Why Do Public Health Practitioners View Them So Differently?

Tobacco, Alcohol, and Processed Food Industries - Why Do Public Health Practitioners View Them So Differently?

FDA's misplaced priorities: premarket review under the Family Smoking Prevention and Tobacco Control Act

Among other key objectives, the 2009 Family Smoking Prevention and Tobacco Control Act was designed to end an era of constant product manipulation by the tobacco industry that had led...

Double standards and arguments for tobacco regulation

Several ethicists recently defended regulations that aim to reduce the harm associated with nicotine and tobacco use. Halliday argues for smoking licences.1 van der Eijk endorses strict limits on access...

Dietary Practices, Addictive Behavior and Bowel Habits and Risk of Early Onset Colorectal Cancer: a Case Control Study.

The abrupt rise of colorectal cancer in developing countries is raising concern in healthcare settings. Studies on assessing relationships with modifiable and non-modifiable risk factors in the Pakistani population have been limited. The present investigation was designed to examine associations of dietary practices, addictive behavior and bowel habits in developing colorectal cancer (CRC) among patients in a low-resource setup. An age-gender matched case control study was conducted from October 2011 to July 2015 in Karachi, Pakistan. Cases were from the surgical oncology department of a public sector tertiary care hospital, while their two pair-matched controls were recruited from the general population. A structured questionnaire was used which included questions related to demographic characteristics, family history, dietary patterns, addictive behavior and bowel habits. A family history of cancer was associated with a 2.2 fold higher chance of developing CRC. Weight loss reduced the likelihood 7.6 times. Refraining from a high fat diet and consuming more vegetables showed protective effects for CRC. The risk of CRC was more than twice among smokers and those who consumed Asian specific addictive products as compared to those who avoid using these addictions (ORsmoking: 2.12, 95% CI: 1.08 - 4.17, ORpan: 2.92, 95% CI: 1.6 - 5.33, ORgutka: 2.13, 95% CI: 1.14 - 3.97). Use of NSAID attenuated risk of CRC up to 86% (OR: 0.14, 95% CI: 0.07 - 0.31). Most of the findings showed concordance with the literature elucidating protective effects of consuming vegetables and low fat diet while documenting adverse associations with family history, weight loss, constipation and hematochezia. Moreover, this study highlighted Asian specific indigenous addictive products as important factors. Further studies are needed to validate the findings produced by this research.

Health Considerations in Regulation and Taxation of Electronic Cigarettes.

The use of electronic cigarettes (e-cigarettes) is experiencing unprecedented growth. This can be contrasted to the use of conventional cigarettes which showed a decrease among adults with the current smoker prevalence dropping from 20.9% in 2005 to 17.8% in 2013. There is some data that e-cigarettes are attracting both former smokers and never smokers, and in particular, young people as users. Currently most states do not tax e-cigarettes. Taxation and regulation may have a similar overall goal of decreasing smoking but regulation tends to focus reduced availability of products. In terms of tobacco control, taxation focuses on the demand side of the equation. Taxation is a distinct strategy from regulation and has been shown to decrease new adopters of conventional cigarettes. A variety of potential taxation strategies can be considered by policymakers based on different assumptions about e-cigarettes and their utility, ranging from untaxed to taxation at moderate levels compared to conventional cigarettes to taxation equal to conventional cigarettes. Until more evidence for the benefits of e-cigarettes is presented, it seems prudent to view them as a potentially harmful and addictive product that ought to be regulated and taxed in an equivalent manner to conventional cigarettes.

Controversial product advertisements in Lebanon

Purpose – The purpose of this paper is to examine the impact of religious sect on the Lebanese consumer’s perception of controversial product advertisements. Design/methodology/approach – The study used a quantitative survey that was administered to a purposive representative sample of respondents from the two main Muslim sects in the country, namely, Sunni and Shiite Muslims. Findings – The results indicated significant differences in perceptions between Sunni and Shiite Muslims with regards to the offensiveness of the advertising of controversial products. Briefly, Sunni Muslims found the advertising of social and political as well as health and care products more offensive, whereas Shiite Muslims found the advertising of gender and sex-related products more offensive, and no significant difference in offensiveness perception between the two sects was found with regards to the advertising of addictive products. Research limitations/implications – Two main limitations faced the researchers: the fact that the respondents were not shown examples of offensive product advertisements; and that religiosity was not measured for the respondents, which could also be a factor in offensiveness perception. Practical implications – The study indicates that a consumer’s religious sect can play a determining role in how he/she perceives product advertisement, thus encouraging marketers to consider the differences between these sects while advertising to ensure no potential consumers are alienated. Originality/value – Although research has looked into the impact of religiosity and religion on the perception of offensive product advertisements, minimal research exists on the impact of religious sects on the perception of offensive product advertisement. The results of this study provide some insights into the consumer behavior differences between the two sects.