Expired Carbon Monoxide Levels Research Articles

Real-world tobacco cessation practice in China: findings from the prospective, nationwide multicenter China National Tobacco Cessation Cohort Study (CNTCCS)

BackgroundTobacco cessation is proven to be the most effective and cost-effective strategy for smokers to reduce their risk of smoking-related disease and premature death. Providing effective, efficient, safe, and patient-centred tobacco cessation treatment to reach those who need them is a significant challenge. To date, only a few nationwide studies in China have assessed the overall clinical care practice and treatment outcome of tobacco cessation.MethodsThis a prospective, nationwide, multicenter, cohort study covering all Eastern China, Northwest China, Central China, North China, Southwest China, Northeast China, and South China. Participants who were current smokers aged 18–85 years attending clinic for smoking cessation were included. All the participants were treated with 3-month cessation treatment and followed up for 3 months. Data were collected prospectively using online system. The primary outcome was 7-day point abstinence rate at 24 weeks, validated biochemically by an expired carbon monoxide level of less than 10 ppm. The participants lost to follow-up or not providing validation were included as non-abstainers.FindingsA representative sample of 3557 participants were recruited and 2943 participants were included into this analysis. These participants had mean age of 53.05 years, and 94.8% were males, with 75.8% showing symptoms of tobacco dependence. A total of 965 (32.8%) participants were treated with Bupropion + behavioural counselling, followed by 935 (31.8%) with behavioural counselling, 778 (26.4%) with Varenicline + behavioural counselling, 135 (4.6%) with alternative treatments + behavioural counselling, and 130 (4.4%) with nicotine replacement therapy (NRT) + behavioural counselling. After 3-month treatment and 3-month follow-up, 21.74% of the participants quit smoking at 24 weeks. In the multivariable-adjusted analyses, quitting smoking was significantly associated with female, higher socioeconomic status, poor health condition, different treatment received, and less smoking intensity. The tobacco cessation treatment varied widely across different areas of China. In particular, the areas with higher usage of cessation medication were associated with better cessation treatment outcome.InterpretationThe CNTCCS is the first large-scale nationwide cohort study of smoking cessation in China. Rich data collected from this prospective cohort study provided the opportunity to evaluate the clinical practice of tobacco cessation treatment in China.FundingChinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), Heilongjiang Provincial Science and Technology Key Program (2022ZXJ03C02), and National Key R&D Program of China (grant no. 2017YFC1309400). Tobacco cessation is proven to be the most effective and cost-effective strategy for smokers to reduce their risk of smoking-related disease and premature death. Providing effective, efficient, safe, and patient-centred tobacco cessation treatment to reach those who need them is a significant challenge. To date, only a few nationwide studies in China have assessed the overall clinical care practice and treatment outcome of tobacco cessation. This a prospective, nationwide, multicenter, cohort study covering all Eastern China, Northwest China, Central China, North China, Southwest China, Northeast China, and South China. Participants who were current smokers aged 18–85 years attending clinic for smoking cessation were included. All the participants were treated with 3-month cessation treatment and followed up for 3 months. Data were collected prospectively using online system. The primary outcome was 7-day point abstinence rate at 24 weeks, validated biochemically by an expired carbon monoxide level of less than 10 ppm. The participants lost to follow-up or not providing validation were included as non-abstainers. A representative sample of 3557 participants were recruited and 2943 participants were included into this analysis. These participants had mean age of 53.05 years, and 94.8% were males, with 75.8% showing symptoms of tobacco dependence. A total of 965 (32.8%) participants were treated with Bupropion + behavioural counselling, followed by 935 (31.8%) with behavioural counselling, 778 (26.4%) with Varenicline + behavioural counselling, 135 (4.6%) with alternative treatments + behavioural counselling, and 130 (4.4%) with nicotine replacement therapy (NRT) + behavioural counselling. After 3-month treatment and 3-month follow-up, 21.74% of the participants quit smoking at 24 weeks. In the multivariable-adjusted analyses, quitting smoking was significantly associated with female, higher socioeconomic status, poor health condition, different treatment received, and less smoking intensity. The tobacco cessation treatment varied widely across different areas of China. In particular, the areas with higher usage of cessation medication were associated with better cessation treatment outcome. The CNTCCS is the first large-scale nationwide cohort study of smoking cessation in China. Rich data collected from this prospective cohort study provided the opportunity to evaluate the clinical practice of tobacco cessation treatment in China.

Feasibility, Acceptability, and Preliminary Effects of a Video-Based Intervention for Smoking Cessation Among People with HIV in Kathmandu, Nepal: A Single-Armed Pilot Study.

Despite the evidence of the disproportionate burden of tobacco use among people with HIV (PWH), little effort has been made to design and test smoking cessation interventions for PWH in resource-limited countries. We assessed the feasibility, acceptability, and preliminary effects of a video-based smoking cessation intervention consisting of eleven 3-8-minute sessions among PWH in Nepal, a lower-middle-income country. Guided by the phased-based model, our 3-month intervention focused on setting the quit date, smoking cessation, and abstinence maintenance. We screened 103 PWH over three weeks for our single-arm trial, with 53 considered eligible and 48 recruited (91%). Forty-six participants watched all video clips, while two watched 7-9. All participants were retained at a 3-month follow-up. The 1-week point prevalence abstinence (self-report supported with expired carbon monoxide levels < 5ppm) at 3-month follow-up was 39.6%. Most (90%) participants reported "very much" or "much" comfort with watching the videos on their smartphones, and all would recommend the intervention to other PWH who smoke. Overall, our pilot trial demonstrated the feasibility, acceptability, and high-level efficacy of the video-based smoking cessation intervention highlighting its potential for scaling up in Nepal and other resource-limited countries.

Effect of menthol on nicotine reduction: Pooled results from two double-blind randomized controlled trials

BackgroundMenthol upregulates nicotinic acetylcholine receptors and is associated with tobacco dependence. The effects of menthol when smoking cigarettes with varying low nicotine content up to 98 % (e.g., non-addicting) less than commercial cigarettes is not well understood. The U.S. Food and Drug Administration is considering two tobacco product standards in cigarettes including banning menthol and reducing nicotine content. These new standards have the potential to significantly reduce smoking initiation and maintenance by limiting the mechanistic effects of nicotine and menthol on the brain. MethodsWe conducted two parallel randomized clinical trials of gradually reduced nicotine in cigarettes from 11.6 mg down to 0.2 mg nicotine/cigarette (very low nicotine content; VLNC) vs. usual nicotine content (11.6 mg; UNC) over an 18-week period in people who smoke cigarettes with low socioeconomic status (SES) and mental health conditions. ResultsCompared to UNC, VLNC was associated with significant reductions in cotinine, cigarettes per day, expired carbon monoxide levels, nicotine dependence and symptomology. These associations did not differ between menthol and non-menthol cigarettes, except people who smoke menthol cigarettes had less of a cotinine reduction in the SES trial. The pooled odds ratio of being adherent with using only VLNC study cigarettes in the gradual nicotine reduction arm for people who smoke non-menthol vs. menthol cigarettes was 2.6 (95 % CI:1.0, 6.4; p-value: 0.04). ConclusionsWhen nicotine is lowered to non-addicting levels, the results indicate an independent effect of menthol on the need to sustain nicotine intake in addicted people who smoke cigarettes.

Abstract 11207: Electronic Hookah Vaping with and Without Nicotine: Insights into Vascular Function and Plasma Fibrinogen

Introduction: Electronic nicotine delivery systems (ENDS) are growing quickly in the United States, particularly among youth. Electronic (e-) hookahs are a new category of vaping devices in which the e-bowl is combined with and placed on a traditional waterpipe, allowing the flavored aerosol to pass through a water-filled base before being carried through the hose into the user’s mouth. E-hookah vaping with flavored nicotine acutely impairs endothelial function. However, the relative contribution of flavorings vs. nicotine on e-hookah vaping associated vascular dysfunction is unclear. Methods: In a randomized cross-over design study, we investigated the acute effect of flavored e-hookah with and without nicotine and sham vaping, among a cohort of 9 healthy young adult chronic hookah smokers (27±1 years, mean ±SE), on endothelial function, measured by brachial artery flow-mediated dilation (FMD). Fibrinogen, a major plasma protein coagulation factor, as well as smoking exposure biomarkers (plasma nicotine and expired carbon monoxide levels) were collected before and after the sessions. Results: Vaping e-hookah with nicotine induced an acute reduction in FMD (from 6.9±0.9 to 5.2±0.8%, pre- vs. post- vaping, p&lt;0.001), suggesting impairment in endothelial function and increased plasma fibrinogen (+14.5±4.1 mg/dL, p&lt;0.001). Though vaping e-hookah in the absence of nicotine did not significantly impair endothelial function (p = ns), it significantly induced an increase in plasma fibrinogen levels (+20.9±7.4 mg/dL, p&lt;0.001), higher than levels induced after vaping e-hookah with nicotine. Plasma nicotine concentrations increased 4-fold more after vaping e-hookah with nicotine, whereas no changes were observed after vaping e-hookah without nicotine or sham-vaping (p = ns). Exhaled CO levels did not change across all three vaping sessions. Conclusions: In healthy young adults, our findings to date suggest that while vaping e-hookah with nicotine induces an unfavorable effect on the vasculature, non-nicotine constituents generated from heating the flavored e-hookah aerosol cannot be ignored. Further plans are needed to elucidate the long-term vascular implications of vaping non-nicotine flavored constituents.

Efficacy and Safety of Varenicline for Smoking Cessation in Schizophrenia: A Meta-Analysis.

Objective: Smoking represents a major public health problem among patients with schizophrenia. To this end, some studies have investigated the efficacy of varenicline for facilitating smoking cessation in schizophrenia patients. The present review seeks to synthesize the results of these studies as well as document the reported side effects of using this medication.Methods: An electronic search was performed using five major databases: PubMed, Scopus, EMBASE, Web of Science, and Cochrane Library. Included in the current analysis were randomized clinical trials (RCTs) that have investigated the effect of varenicline in promoting smoking cessation in patients with schizophrenia. Risk of bias among included RCTs was assessed using the Cochrane Collaboration's quality assessment tool.Results: Among the 828 screened articles, only four RCTs, which involved 239 participants, were eligible for meta-analysis. In patients with schizophrenia, varenicline treatment when compared to placebo significantly reduced the number of cigarettes consumed per day [SMD (95% CI) = 0.89(0.57–1.22)] and expired carbon monoxide levels [SMD (95% CI) = 0.50 (0.06–0.94)] respectively.Conclusion: Despite a limited number of studies included in the meta-analysis, our results suggest that varenicline is an effective and safe drug to assist smoking cessation in patients with schizophrenia. Future large-scale well-designed RCTs are required to validate these findings.

Prospective associations of breastfeeding and smoking cessation among low-income pregnant women.

Although low-income pregnant women have high rates of smoking and low rates of breastfeeding, few studies have examined prospective associations between these risk factors in community samples. Doing so may help improve breast-feeding support programs in this population. We used a secondary analysis of 247 low-income pregnant smokers in Memphis, Tennessee, who were interviewed up to 4times (twice during pregnancy and twice through 6months postpartum). Smoking cessation during prepartum and postpartum was defined as a self-report of not smoking for ≥1week and an expired carbon monoxide level of <10ppm. Multivariable logistic regression analyses were used to determine whether intent to breastfeed was associated with smoking cessation and whether smoking cessation was associated with actual breastfeeding. Models were adjusted for sociodemographic, pregnancy-related, and smoking-related confounders. Thirty-nine percent of participants intended to breastfeed, and 38% did so. Women who intended to breastfeed were 2times more likely to quit smoking prepartum (adjusted OR=1.99, 95% CI [1.06, 3.74]), but not postpartum (adjusted OR=1.27, 95% CI [0.57, 2.84]). Quitting smoking at baseline and during pregnancy was associated with subsequent breastfeeding (adjusted OR 2.27, 95% CI [1.05, 4.94] and adjusted OR=2.49, 95% CI [1.21, 5.11]). Low-income women who intended to breastfeed were more likely to quit smoking during pregnancy and those who quit smoking at baseline and prepartum were more likely to breastfeed. Simultaneously supporting breastfeeding and smoking cessation may be very useful to change these important health behaviours among this high-risk population.

Smoking Among Hospitalized Patients at a University Hospital: Seasonal Variation and Gender Differences

SESSION TITLE: Tobacco Cessation SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 29, 2017 at 04:30 PM - 05:30 PM PURPOSE: Accredited U.S. and Brazilian hospitals prohibit smoking inside hospital buildings. Patients are expected to abstain from smoking throughout their hospitalization, but how many do so is unclear. Objective: To determine the prevalence and characteristics of smoking among hospitalized patients at a university hospital, the seasonal variation and gender differences. METHODS: Methods: Cross-sectional population-based study involving adult patients hospitalized for over 24 h at the University Hospital from the State University of Londrina, Brazil conducted from February 2016 to March 2017. Patients were interviewed during four distinct seasons. We collected demographic, socioeconomic data and information regarding smoking, diagnosis at admission, Fagerström Test for Nicotine Dependence and measurement of expired carbon monoxide. Expired carbon monoxide ≥ than 6 ppm was considered a significant indicator of recent smoking. RESULTS: Results: We interviewed 268 patients: 40 (15%) were smokers; 91 (34%) were former smokers and 137 (51%) were never smokers; the mean age of the smokers was 47 ± 16 years, and 17 (42.5%) of the smokers were female. Among smokers, the median age at smoking initiation was 15 years; the mean smoking history was 30 ± 10 pack-years; 35 (87%) was heavy smokers (11 or more cigarettes per day). The mean Fagerström score was 4.4 ± 2.0 and 25% of smokers had a high or very high degree of nicotine dependence. The mean expired carbon monoxide among smokers was 9.15 ± 8.3 ppm. Expired carbon monoxide levels were ≥ than 6 ppm among smokers (55%) although smoking is formally prohibited inside the hospital. Smoking at any time during the hospitalization was reported during the fall in 4/10 (40%), during the spring in 3/7 (43%), during the summer in 5/8 (62%), and smoking during the winter was more often than the rest of the year in 10/15 (67%). CONCLUSIONS: Conclusions: Nearly half of smokers admitted to a smoke-free hospital smoked during their hospital stay. Implementation of a tobacco cessation program (including nicotine replacement therapy) at admission and ongoing monitoring of patients’ nicotine cravings might reduce smoking among inpatients. CLINICAL IMPLICATIONS: Millions of adults who smoke are hospitalized yearly, providing a window of opportunity for smoking cessation interventions. Practice guidelines recommend that these hospitalized patients be offered smoking cessation treatment. Smoking by inpatients may compromise patient safety, clinical outcomes, and hospital efficiency. DISCLOSURE: The following authors have nothing to disclose: Marcos Ribeiro, Ana Maisato, Ana Carneiro, Lorraine Souza, Maria Mortoti, Natalia Adamzuk, Rafaela Costa, Raniel Correia, Isabela Almeida, Nathalia Nassu, Alcindo Neto, Fatima Soares, Olavo Filho, Renata Dip, Nadia Kienen, Regina Cruz, Isabel Scarinci No Product/Research Disclosure Information

Randomized Trial of Reduced-Nicotine Standards for Cigarettes

BackgroundThe Food and Drug Administration can set standards that reduce the nicotine content of cigarettes.MethodsWe conducted a double-blind, parallel, randomized clinical trial between June 2013 and July 2014 at 10 sites. Eligibility criteria included an age of 18 years or older, smoking of five or more cigarettes per day, and no current interest in quitting smoking. Participants were randomly assigned to smoke for 6 weeks either their usual brand of cigarettes or one of six types of investigational cigarettes, provided free. The investigational cigarettes had nicotine content ranging from 15.8 mg per gram of tobacco (typical of commercial brands) to 0.4 mg per gram. The primary outcome was the number of cigarettes smoked per day during week 6.ResultsA total of 840 participants underwent randomization, and 780 completed the 6-week study. During week 6, the average number of cigarettes smoked per day was lower for participants randomly assigned to cigarettes containing 2.4, 1.3, or 0.4 mg of nicotine per gram of tobacco (16.5, 16.3, and 14.9 cigarettes, respectively) than for participants randomly assigned to their usual brand or to cigarettes containing 15.8 mg per gram (22.2 and 21.3 cigarettes, respectively; P<0.001). Participants assigned to cigarettes with 5.2 mg per gram smoked an average of 20.8 cigarettes per day, which did not differ significantly from the average number among those who smoked control cigarettes. Cigarettes with lower nicotine content, as compared with control cigarettes, reduced exposure to and dependence on nicotine, as well as craving during abstinence from smoking, without significantly increasing the expired carbon monoxide level or total puff volume, suggesting minimal compensation. Adverse events were generally mild and similar among groups.ConclusionsIn this 6-week study, reduced-nicotine cigarettes versus standard-nicotine cigarettes reduced nicotine exposure and dependence and the number of cigarettes smoked. (Funded by the National Institute on Drug Abuse and the Food and Drug Administration Center for Tobacco Products; ClinicalTrials.gov number, NCT01681875.)

Smoking cessation outcomes of referral to a specialist hospital outpatient clinic

Hospital visits are an opportunity to engage smokers in tobacco treatment. However, little is known about engagement in follow-up referrals. The purpose of this study is to report the rates of program engagement and smoking cessation outcomes of patients referred to a specialist outpatient tobacco treatment program after a hospital visit or other referral. A retrospective chart review was used to examine the outcomes of 486 participants referred to a hospital-based smoking cessation clinic provided by tobacco treatment specialists. Referral sources, demographics and smoking, medical, psychiatric, and substance use history were obtained. The main outcomes of interest were engagement in the program and 7-day point-prevalence of smoking abstinence. Sixty-eight percent of participants who were referred to the program were considered "engaged," of which 70% were from hospitals, 4% from community programs, 11% were from general practitioners, and 16% were self-referrals. Thirty-percent (98/331) of engagers were abstinent by time of chart review (30% from the hospital, 8% from community programs, 19% from general practitioners, and 39% of self-referrals). Having quit for 1 month or longer at the past quit attempt, greater confidence in quitting smoking, lower expired carbon monoxide levels at baseline, and greater duration in the program were significant predictors of successful smoking cessation. Providing tobacco treatment follow-up and referral for smokers after a hospital visit is important to enhance smoking cessation efforts. Referral to evidence-based tobacco treatment after hospital visits is effective. Models of tobacco treatment based on sources of referral should further be explored.

Varenicline for smoking cessation in bipolar disorder: a randomized, double-blind, placebo-controlled study.

Virtually no clinical trials for smoking cessation have been undertaken in bipolar disorder. Varenicline has shown efficacy for smoking cessation, but warnings about neuropsychiatric adverse events have been issued. We assessed the efficacy and safety of varenicline in euthymic bipolar subjects motivated to quit smoking. Clinically stable adult patients with DSM-IV bipolar disorder (n = 60) who smoked ≥ 10 cigarettes per day were randomized to a 3-month, double-blind, placebo-controlled varenicline trial and a 3-month follow-up. Study enrollment was completed from February 2010 through March 2013. Varenicline was dosed using standard titration, and smoking cessation counseling was provided to all patients. The primary outcome was defined as a 7-day point prevalence of self-reported no smoking verified by expired carbon monoxide level < 10 ppm at 12 weeks. Psychopathology and side-effects were assessed at each visit. At 3 months (end of treatment), significantly more subjects quit smoking with varenicline (n/n = 15/31, 48.4%) than with placebo (n/n = 3/29, 10.3%) (OR = 8.1; 95% CI, 2.03-32.5; P < .002). At 6 months, 6 of 31 varenicline-treated subjects (19.4%) remained abstinent compared to 2 of 29 (6.90%) assigned to placebo (OR = 3.2; 95% CI, 0.60-17.6; P = .17). Psychopathology scores remained stable. Ten serious adverse events occurred (n = 6, varenicline; n = 4, placebo). Abnormal dreams occurred significantly more often in varenicline-treated subjects (n/n = 18/31, 61.3%) than in those receiving placebo (n/n = 9/29, 31%; Fisher exact test, P = .04). Eight varenicline-treated and 5 placebo-assigned subjects expressed fleeting suicidal ideation, a nonsignificant difference. Varenicline shows efficacy for initiating smoking cessation in bipolar patients, but medication trials of longer duration are warranted for maintaining abstinence. Vigilance for neuropsychiatric adverse events is prudent when initiating varenicline for smoking cessation in this patient population. ClinicalTrials.gov identifier: NCT01010204.

Smoking Cessation Outcomes and Predictors Among Individuals With Co-occurring Substance Use and/or Psychiatric Disorders

Objective: Individuals with substance use and psychiatric disorders have a high prevalence of tobacco use disorders and are disproportionately affected by tobacco-related morbidity and mortality. However, it is unclear how having co-occurring disorders affects tobacco cessation. Our aim was to examine smoking cessation outcomes and relevant predictors of smoking cessation among smokers with substance use and/or psychiatric disorders. Methods: Data from medical records of 674 participants in a tobacco treatment program within mental health and addictions services in Vancouver, Canada, were analyzed. The 26-week treatment program included an 8-week structured behavioral counseling group, an 18-week support group, and 26 weeks of no-cost pharmacotherapy. Information on demographics, tobacco use and history, type of pharmacotherapy received, nicotine dependence, importance of and confidence in quitting smoking, expired carbon monoxide level, substance use and psychiatric disorder history, and total program visits were gathered. Results: Approximately 67% (n = 449) of participants had co-occurring substance use and psychiatric disorders, while 20% (n = 136) had substance use disorder only, 10% (n = 67) had psychiatric disorder only, and 3% (n = 22) had tobacco dependence only. Rates of tobacco cessation (i.e., 7-day point prevalence of abstinence verified by expired carbon monoxide of ≤8 ppm) by group in the 522 people who completed treatment were as follows: 38.2% for those with co-occurring disorders, 47.1% for those with tobacco dependence only, 47.1% for those with substance use disorder only, and 41.8% for those with psychiatric disorder only. Length of treatment was a significant predictor of smoking cessation for those with co-occurring disorders and substance use disorder only. In the final stratified multivariate analysis, for individuals with co-occurring disorders, having an opiate use disorder (as compared to an alcohol use disorder) and higher nicotine dependence scores at baseline were predictive of poor cessation outcomes, while greater length of treatment was predictive of successful smoking cessation. Conclusions: Tobacco cessation treatment for individuals with co-occurring substance use and psychiatric disorders is likely to be as effective as for smokers with either disorder alone. Treatment duration predicts success among these smokers so strategies to enhance engagement and retention are needed.

The effect of successful and unsuccessful smoking cessation on short-term anxiety, depression, and suicidality

Research on the mental health effects of quitting smoking is limited. Smokers with mental illness appear to be at a higher risk of unsuccessful smoking cessation. Recent work suggests they are at elevated risk for post-cessation increases in anxiety, depression and suicidal ideation. The current study tested the effects of successful and unsuccessful smoking cessation on short-term psychopathology in 192 community participants. Smoking cessation outcomes were classified using expired carbon monoxide levels that were taken at quit week, 1 and 2week follow-up and 1month follow-up. We found no psychopathology increases in participants who successfully quit smoking. For individuals struggling to quit our results partially supported a recently proposed struggling quitters hypothesis. However, the vast majority of individuals posited to be vulnerable by the struggling quitters hypothesis did not experience clinically significant increases in psychopathology. These findings have implications for clinicians whose clients are interested in smoking cessation.

Escalating Doses of Transdermal Nicotine in Heavy Smokers

Fixed-dose nicotine replacement therapy (NRT) is efficacious for smoking cessation in the general population of smokers. However, it is less effective in populations with psychiatric comorbidities and/or severe tobacco dependence where the percent nicotine replacement is suboptimal. The objective of this pilot study was to determine the effectiveness of nicotine patch dose titration in response to continued smoking in heavily dependent smokers with psychiatric comorbidity. In a single-arm, open-label study adult smokers (mean cigarettes per day, 25.4 ± 13.4; range, 14-43; n = 12) willing to quit were treated with escalating doses of transdermal nicotine and brief counseling intervention if they continued to smoke over a 9-week treatment period. Plasma nicotine and cotinine, along with expired carbon monoxide levels, and the subjective effects of smoking, urge to smoke, demand elasticity, and mood symptoms were also assessed. The mean NRT dose was 32.7 (SD, 16.4) mg/d (range, 7-56 mg/d). Smokers reported significant reductions in both cigarettes per day (mean decrease, 18.4 ± 11.5) confirmed by expired carbon monoxide (mean decrease, 13.5 ± 13.0) with no significant changes in plasma nicotine concentrations during the course of NRT dose titration. There were significant effects on the subjective effects of smoking and measures of smoking behavior. Most commonly reported adverse events were respiratory infections, skin irritation at patch site, nausea, and sleep disturbances, which were generally mild and transient. Titrating doses of NRT to effect with brief intervention hold promise as an effective clinical strategy to assist heavily dependent psychiatrically ill smokers to change their smoking behavior.

Outcomes of a tobacco treatment programme for individuals with severe and persistent mental illness attending a community mental health team

Introduction: Individuals with severe and persistent mental illnesses have a greater prevalence of smoking than the general population and are disproportionately affected by tobacco-related morbidity and mortality. Evidence-based tobacco treatment can aid such populations in their efforts at smoking cessation. Few studies have examined the effectiveness of tobacco treatment programmes within Mental Health and Addictions Services in Canada.Aims: This study examines outcomes from an evidence-based tobacco treatment programme provided within community mental health services in Vancouver, Canada.Methods: A retrospective chart review was conducted of 134 participants (from June 2010 to February 2012). Information on demographics, tobacco use and cessation history, substance use history, psychiatric disorder diagnosis, expired carbon monoxide level, and duration of treatment in the programme were obtained. Programme completion and smoking cessation/reduction were examined.Results: Sixty-seven per cent completed the programme. Of those who completed, 26.7% were abstinent at the end-of-treatment and 50% (of those not achieving abstinence) reduced their consumption to at least 50% of their baseline cigarette consumption. Predictors of smoking cessation included having a social support for smoking cessation and lower nicotine dependence at baseline.Conclusions: Evidence-based tobacco treatment within community mental health services is well received by individuals with severe and persistent mental illness. Such treatment can aid in their efforts towards smoking cessation. Future studies may need to assess factors that can enhance the integration of tobacco treatment within mental health services while providing tailored treatment that addresses the unique needs of smokers who have severe and persistent mental illness.

Characteristics associated with smoking in a Hispanic college student sample

This study examined the smoking related behaviors of Hispanic young adult college students as part of a larger study that assessed characteristics of Hispanic smokers in a metropolitan area on the U.S./México border. One hundred seventy-four English-speaking Hispanic college students completed questionnaires that assessed tobacco use, drug/alcohol use, body mass index, weight concerns, acculturation, depressive symptoms, and expired carbon monoxide level. Of the 74 smoking participants (42.5% of the sample), 77% reported light or intermittent smoking. Univariate analyses and a backward elimination logistic regression model were used to compare smokers' and nonsmokers' characteristics. Significant univariate differences between smokers and nonsmokers were higher reported weekly alcohol use and ever use of marijuana. Logistic regression findings indicated smokers reported heightened odds of being younger, lower acculturation, ever use of drugs, and weekly drinking. These results suggest a drug and alcohol use component is important to cessation interventions targeted toward Hispanic college student smokers.

Association between CHRNA5 genetic variation at rs16969968 and brain reactivity to smoking images in nicotine dependent women

Background Tobacco smoking is the leading preventable cause of death in the developed world. Identifying risk factors for smoking may lead to more effective treatments. Genome wide association studies revealed a relationship between development of nicotine dependence and a single-nucleotide polymorphism (SNP, rs16969968) of the nicotine acetylcholine receptor (nAChR) alpha-5 subunit gene (CHRNA5). The relationship between this SNP and other factors contributing to smoking behavior such as smoking cue reactivity is unclear. Methods We assessed the role of rs16969968 on brain functional MRI (fMRI) reactivity to smoking cues by studying nicotine dependent women with the nicotine dependence ‘risk’ allele (A allele, N = 14) and without the ‘risk’ allele (G/G smokers, N = 10). Nicotine dependence severity, as assessed with the Fagerstrom test for nicotine dependence, smoking pack-years, and expired carbon monoxide levels, were equivalent in these groups. Results We observed a group difference in fMRI reactivity; women without the A allele (G/G smokers) showed greater fMRI reactivity to smoking images in brain areas related to memory and habitual behavior such as the hippocampus and dorsal striatum. Conclusions Our finding suggests that nicotine-dependent smokers lacking the rs16969968 A allele are more likely to recall smoking-related memories and engage in habitual responding to smoking cues than A allele smokers. Although more studies are necessary to determine the mechanism underlying and significance of this cue reactivity difference, these data suggest that smokers may develop and remain nicotine dependent due to different factors including genetics and cue reactivity. This finding may have implications for personalizing smoking treatment.

Sex differences in effects of cigarette smoking and 24-hr abstinence on plasma arginine vasopressin

The present study examined plasma arginine vasopressin (AVP) levels in 18 smokers (10 men, 8 women) and in 22 non-smokers (12 men, 10 women). Non-smokers came to the laboratory once, whereas smokers came twice: while smoking freely and following 24-hr abstinence. Plasma was collected for AVP assessment; salivary cotinine and expired carbon monoxide levels confirmed smoking status. Among non-smokers, men had higher AVP levels than did women ( p < 0.05). Among smokers, however, women displayed higher AVP levels than did men both while smoking and following abstinence ( p's < 0.05). Among men, smoking resulted in lower AVP levels compared to non-smoking men. In contrast, women who smoked displayed higher AVP levels compared to their non-smoking counterparts. AVP levels were not affected by 24-hr abstinence among smokers, regardless of sex, which suggests that dysregulation in AVP levels in tobacco smokers continues even following 24-hr abstinence. Findings are consistent with previous reports of elevated Th1/Th2 immune function among female smokers compared to male smokers and to male and female non-smokers. Data suggest sex-dependent AVP changes during smoking that could contribute to negative impact of smoking on cardiovascular health.

Sex differences in smoking cessation outcomes of a tailored program for individuals with substance use disorders and mental illness

Tobacco use is highly prevalent among individuals with a history of substance use disorders (SUD) and/or mental illness (MI). Despite evidence of differences in smoking cessation (SC) outcomes between women and men, few studies have formally evaluated sex differences among SUD and/or MI populations. For 258 participants (62% male, mean age = 48.6 years) with an SUD and/or MI enrolled in a tobacco dependence clinic (TDC) program, we examined SC outcomes and compared men's and women's predictors of end-of-treatment abstinence. Individuals with an MI, social support for quitting, and a greater number of visits to the TDC program were more likely to be female; whereas males were characterized by having an SUD, older age, smoking a greater number of cigarettes per day, and having higher confidence in quitting smoking. In the intent-to-treat analysis, end-of-treatment smoking cessation was 32.2% (females = 35.4% vs males = 30.2, χ 2 = 0.74, df = 1, p = .390). Among females, baseline expired carbon monoxide (CO) level and a greater number of visits to the program were significantly predictive of SC; among males, having a history of alcohol, heroin and other opioids, and marijuana use were predictive of unsuccessful SC, whereas baseline expired CO level and a greater number of visits to the program were predictive of SC. These factors may be important in the design of enhanced tailored treatments and development of future SC programs for individuals with SUD and MI.

Smoking Cessation Outcomes among Individuals with Substance Use and/or Psychiatric Disorders

Objectives: The population of individuals with substance use (SUD) and/or psychiatric disorders (PD) has a high prevalence of smoking and a consequent increase in tobacco-related morbidity and mortality when compared to the general population. The aim of this study is to examine the outcomes of a program in a real-life setting which takes a tailored approach to smoking cessation among individuals with SUD and/or PD. Methods: A retrospective chart review of tailored tobacco dependence treatment was performed on individuals with histories of SUD and/or PD attending a Tobacco Dependence Clinic (TDC) program in Vancouver, British Columbia, Canada. Participants of the TDC received a combination of behavioural counselling and pharmacotherapy for smoking cessation. Data from 540 participants enrolled in the TDC between September 2007 and May 2011 was reviewed. Outcome measures included seven-day point-prevalence abstinence (validated by expired carbon monoxide) and program completion rates. Results: For individuals who completed the program the abstinence rate was 41.1% (167/406). Significant predictors of successful smoking cessation were: a) a lower expired carbon monoxide level at baseline (OR=.98, 95%CI=.96-1.00), and b) a longer duration of treatment (OR=1.09, 95%CI=1.05-1.12). Significant predictors of program completion were: a) being female (OR=1.86, 95%CI=1.21-2.87). Discussion: Tailored smoking cessation among individuals with SUD and/or PD yields modest end-of-treatment smoking cessation rates and can be an effective approach to reducing the burden of tobacco use in substance use and mental health treatment settings.

Exhaled Carbon Monoxide as a Marker of Hemolysis In Transgenic Mouse Models of Sickle Cell Anemia.

AbstractAbstract 1642Sickle cell disease is characterized by recurring episodes of hemolysis and painful vasoocclusion, which leads to ischemia-reperfusion injury and organ damage. Recently, the roles of heme-induced oxidative stress, nitric oxide consumption, endothelial cell activation, and inflammation in sickle cell disease have been recognized, in part because of the development of transgenic murine models of this condition. These mouse models provide insights into the pathophysiology of human sickle cell disease and the development of new therapeutic approaches. However, hemolytic rates and disease severity vary considerably between mouse models. Ferrous (Fe2+) hemoglobin (Hb) is easily oxidized in circulation to ferric (Fe3+) Hb, which readily releases free heme. Free heme is degraded by heme oxygenase which produces carbon monoxide (CO) as a byproduct. Endogenous CO production has been used as a measure of in vivo hemolysis in humans and mice, but there have been no reports of endogenous CO production in sickle mouse models. VCO was measured in sickle mouse models using a previously described rebreathing technique t (Levitt et al. J Lab Clin Med 113:241-247). Expired CO levels were highest in Hb-S knock-in Townes-SS sickle mice, almost 7-fold higher than normal control Townes-AA mice (p<0.05). Expired CO also was significantly (p<0.05) higher in HbS-BERK mice compared to normal control HbA-BERK. Injection of phenylhydrazine or hemin into normal C57BL/6 mice also raised expired CO levels 24 hours after injection (p<0.05). Expired CO levels were not significantly higher than controls in the New York, S+S-Antilles, het-BERK and Townes-AS models. These data confirm that hemolytic rates differ markedly between models. Additional data will be presented on the effects of inhaled CO on expired CO and the hemolytic rate in the Townes-SS model. Disclosures:Belcher:Sangart: Consultancy, Research Funding. Vercellotti:Sangart: Consultancy, Research Funding.