Forms Of Nicotine Replacement Therapy Research Articles

Temporal associations linking alcohol and cannabis use to cigarette smoking in young adults engaged in a tobacco cessation and relapse monitoring study

Young adulthood remains a developmental period in which cigarette smoking initiation and progression to dependence and regular use is common. Moreover, co-use of alcohol and/or cannabis with tobacco is common in this age group and may have detrimental effects on tobacco use rates and cessation outcomes. Although young adults are interested in quitting smoking, achieving abstinence remains difficult, even with evidence-based treatment strategies. Understanding proximal associations between other substance use (e.g., alcohol and cannabis) and smoking may have important treatment implications. This exploratory analysis investigated the role of alcohol and/or cannabis use in contributing to smoking events on the same day or next day among young adults engaged in a smoking cessation and relapse monitoring study. We used ecological momentary assessment (EMA) data from 43 young adults (ages 18–25; 932 observations) who smoked cigarettes daily and agreed to participate in a 5-week study that included a 2-day smoking quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence (incentives were provided only during the 2-day quit attempt). We tested multilevel time-series models of daily associations between alcohol use, cannabis use, and smoking. Consistent with hypotheses, days on which participants were more likely to drink alcohol predicted increased likelihood of smoking the next day (OR = 2.27, p =.003). This effect was significant after controlling for both the one-day lagged effect of smoking (i.e., autoregression) and the concurrent (i.e., same day) effects of drinking and cannabis use. Although there was a positive concurrent effect of cannabis use on smoking (OR = 12.86, p =.003), the one-day lagged effect of cannabis use and the concurrent effect of drinking was not significant, contrary to hypotheses. Results indicate that alcohol use presents a potential threat to successful smoking cessation that extends to the following day. This suggests a risk-window in which treatment could be supplemented with just-in-time interventions and extending the focus on co-use to include this lagged impact on cessation outcomes.

Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study.

Technological advancements to study young adult smoking, relapse, and to deliver interventions remotely offer conceptual appeal, but the incorporation of technological enhancement must demonstrate benefit over traditional methods without adversely affecting outcomes. Further, integrating remote biochemical verification of smoking and abstinence may yield value in the confirmation of self-reported smoking, in addition to ecologically valid, real-time assessments. The goal of this study was to evaluate the impact of remote biochemical verification on 24-hour self-reported smoking and biochemical verification agreement, retention, compliance with remote sessions, and abstinence during a brief, 5-week cessation attempt and relapse monitoring phase. Participants (N=39; aged 18-25 years; mean age 21.6, SD 2.1 years; n=22, 56% male; n=29, 74% White) who smoked cigarettes daily engaged in a 5-week cessation and monitoring study (including a 48-hour quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence during the 2-day quit attempt only). Smoking (cigarettes per day) was self-reported through ecological momentary assessment (EMA) procedures, and participants were randomized to either (1) the inclusion of remote biochemical verification (EMA + remote carbon monoxide [rCO]) 2× per day or (2) in-person, weekly CO (wCO). Groups were compared on the following outcomes: (1) agreement in self-reported smoking and breath carbon monoxide (CO) at common study time points, (2) EMA session compliance, (3) retention in study procedures, and (4) abstinence from smoking during the 2-day quit attempt and at the end of the 5-week study. No significant differences were demonstrated between the rCO group and the wCO (weekly in-person study visit) group on agreement between 24-hour self-reported smoking and breath CO (moderate to poor), compliance with remote sessions, or retention, though these outcomes numerically favored the wCO group. Abstinence was numerically higher in the wCO group after the 2-day quit attempt and significantly different at the end of treatment (day 35), favoring the wCO group. Though study results should be interpreted with caution given the small sample size, findings suggest that the inclusion of rCO breath added to EMA compared to EMA with weekly, in-person CO collection in young adults did not yield benefit and may have even adversely affected outcomes. Our results suggest that technological advancements may improve data accuracy through objective measurement but may also introduce barriers and burdens and could result in higher rates of missing data. The inclusion of technology to inform smoking cessation research and intervention delivery among young adults should consider (1) the research question and necessity of biochemical verification and then (2) how to seamlessly incorporate monitoring into personalized and dynamic systems to avoid the added burden and detrimental effects to compliance and honesty in self-report.

Implementation of Quitline Financial Incentives to Increase Counseling Sessions Among Adults Who Use Menthol Tobacco Products.

Since 2017, the Vermont Tobacco Control Program (VTCP) has worked to reduce the impact of flavored tobacco products on Vermonters. With the proposed U.S. Food and Drug Administration (FDA) rules banning menthol cigarettes and flavored cigars and proposed legislation banning sales of all menthol and flavored tobacco products in Vermont, VTCP prioritized resources to support cessation among Vermonters who use menthol tobacco products. In March 2021, VTCP began offering a tailored quitline protocol for adults who use menthol tobacco, including financial incentives, for completed coaching sessions. From March 2021 to May 2022, 66 quitline callers enrolled in the menthol incentive protocol, representing 8% of all quitline callers and 25% of participants in the state's quitline incentive programs. A greater proportion of callers in the menthol incentive program completed three or more quitline calls (58% vs. 38%) and enrolled in phone and text support (61% vs. 32%). Quitline callers enrolled in any incentive protocols (menthol, Medicaid/uninsured, or pregnant) were more likely to request one or two forms of nicotine replacement therapy (NRT). Quitlines remain an effective, evidence-based method of tobacco cessation, especially in reaching vulnerable populations. Given the targeted marketing of menthol brands to Black and African American populations, LGBTQ+ populations, youth, and neighborhoods with lower incomes, addressing menthol cigarette use is key to improving health equity and health of Vermonters. Early data indicates that the use of financial incentives can increase engagement with a state quitline among menthol tobacco users through greater completion of cessation coaching calls, enrollment in text message support, and NRT usage.

APA’s Government, Policy, and Advocacy Update (March 2023)

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy Update (March 2023)Search for more papers by this authorPublished Online:26 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.67APA Expresses Support for Efforts to Increase Naloxone AccessIn a letter to the Food and Drug Administration (FDA), APA expressed its support for the FDA’s preliminary assessment that naloxone nasal spray and autoinjector formulations are safe and effective for over-the-counter use. The letter, signed by APA CEO and Medical Director Saul Levin, M.D., M.P.A., was written in response to the FDA’s request for comments on the use of naloxone for nonprescription use.In the letter, APA encouraged the FDA to add naloxone nasal spray to the list of FDA Essential Medications. “This would open federal resources and prioritize investment in long-term domestic manufacturing.” Further, APA emphasized the importance of education on the use of naloxone so individuals can appropriately identify and respond to an overdose. Finally, APA addressed the cost barriers associated with naloxone, noting that some forms of nicotine replacement therapy are not covered by Medicare because they are over the counter. APA encouraged the FDA to work with the Centers for Medicare and Medicaid Services and other payers to keep costs down for the most vulnerable populations.APA's Letter to Food and Drug Administration (FDA) Mental Health Liaison Group Provides Feedback on CONNECT for Health ActAPA and its partner organizations, members of the Mental Health Liaison Group Telehealth Work Group, sent a letter Sen. Brian Schatz (D-Hawaii) and Rep. Mike Thompson (D-Calif.) providing suggestions for the reintroduction of the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act.The groups wrote that any reintroduction of the CONNECT Act should eliminate the in-person requirement for telemental health services under Medicare as a prerequisite for coverage of a telehealth service, which was included in the Consolidated Appropriations Act of 2021. This provision is “inequitable for individuals with mental health conditions,” the letter stated. The letter emphasized the groups’ support for in-person care when clinically appropriate or desired by the patient.“Given the immense need for mental health services combined with acute behavioral health workforce shortages, the in-person telemental health provision is counter to the intent of ensuring more Americans receive life-changing care and, in fact, could further exacerbate our nation’s growing mental health crisis,” the letter stated.APA and Mental Health Liaison Group Telehealth Work Group (MHLG) letter to Sen. Brian Schatz (D-Hawaii) and Rep. Mike Thompson (D-Calif.) APA Provides Comments on SUD Patient RecordsIn a letter to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of Civil Rights, APA provided input to the proposed changes to the Confidentiality of Substance Use Disorder (SUD) Patient Records under 42 CFR Part 2 (referred to as Part 2), which protects patients’ privacy and records concerning treatment related to SUD.The goals of the proposed changes are to improve coordination among professionals and increase protections for patients concerning records disclosure to avoid discrimination in treatment, according to a SAMHSA news release.However, APA cautioned that the proposed rule, as written, does not do enough to mitigate data segregation and segmentation, which challenge care coordination efforts. For example, the regulation does not ease the burden of data management in integrated and collaborative care settings. “At best, psychiatrists and other specialists may have significant administrative burden added to manage and maintain patient data in separate platforms, all without the intended outcome of coordination with colleagues to support shared patients,” APA’s letter stated.APA offered numerous recommendations, including that SAMHSA should provide one-on-one technical assistance to clinicians or facilities wanting to ensure compliance with the rule, delay the rule’s finalization, and implement public education around SUD data to empower patients when consenting to data disclosures. ■Letter to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of Civil Rights ISSUES NewArchived

Smoking Cessation: An Update

Intervention for smoking cessation has become on urgent need because of increasing tobacco use and health hazards, especially in developing countries. Smoking cessation will be at different states of readiness. The states may be: (i) not ready (pre-contemplation), (ii) unsure (contemplation), (iii) ready (preparation), (iv) action, and (v) maintenance. Counselling and behavioural management is important. The '5 A's-based intervention in the form of Ask, Advise, Assess, Assist and Arrange is implemented. Pharmacologic management is based on first-line treatment in the form of nicotine replacement therapy, bupropion and varinicline and second-line treatment as clonidine and nortriptalin. Every health professional has obligation to help their patients to quit and the intervention should be diagnostic and therapeutic. The best results are obtained by behavioural and social support combined with pharmacotherapy whenever needed. The paper highlights the important component of intervention in smoking cessation.

'Strong certainty' that e-cigarettes are better than other nicotine replacement therapy for quitting smoking, review finds

A Cochrane review, published on 17 November 2022, has concluded that there is a “strong certainty” that people who use nicotine-containing e-cigarettes to help them stop smoking are more likely to quit than those who use other forms of nicotine replacement therapy. Researchers from the international Cochrane Collaboration reviewed current evidence and included 78 studies […]

The INITIATE trial protocol: a randomized controlled trial testing the effectiveness of a \u201cquit card\u201d intervention on long-term abstinence among tobacco smokers presenting to the emergency department

BackgroundSmoking cessation interventions implemented in emergency department (ED) settings have resulted in limited success, owing to factors such as lack of time, motivation, and incentives. A dynamic yet simple and effective approach that addresses the fast-paced nature of acute-care ED settings is needed. This study proposes a multi-center randomized controlled trial (RCT) to compare the effectiveness of an easy to deliver proactive, multi-component tobacco treatment intervention to usual care in the ED setting.MethodsThis will be a prospective four-site, single-blind, blinded-endpoint (PROBE) RCT. Participants will be recruited directly in the ED and will be approached strictly in order of arrival time. Those randomized to the Quit Card Intervention (QCI) group will receive a “quit kit” which will include: a “Quit Card” worth $300 that can be used at any Canadian pharmacy to purchase any form of nicotine replacement therapy (NRT); a self-help booklet; and proactive enrolment in 6 months of telephone follow-up counseling. The usual care (UC) group will receive a “quit kit” which will include a brochure for a local smoking cessation program. Quit kits for both groups will be delivered in opaque, sealed envelopes, and identical in size and weight so to conceal group allocation from the blinded research coordinator. Randomization will be stratified by site and by the Canadian Triage Acuity Scale (CTAS), a value assigned to each ED patient based on the severity of the condition. An equal number of quit kits will be prepared for each CTAS level. The primary outcome will be bio-chemically verified smoking abstinence at 26 weeks. Secondary outcomes include smoking behavior at weeks 4, 52, and 104 as well as mortality and health care utilization outcomes. Investigators, outcome assessors, and data analysts will be blinded to group allocation until after primary analyses are completed. It is hypothesized that the QCI group will have higher a abstinence rate, improved health outcomes, and decreased healthcare utilization.DiscussionThere are few examples of hospital EDs in Canada that systematically initiate tobacco cessation interventions for patients who smoke. Given the high smoking prevalence among ED patients and the relation of tobacco smoking to the majority of ambulatory care sensitive conditions, EDs are a missed opportunity in the initiation of tobacco treatment interventions. We have designed and will test an evidence-based tobacco treatment intervention that is simple and highly scalable.Trial registrationClinicalTrials.govNCT04163081. Registered on November 14, 2019

Update on pharmacotherapy for smoking cessation

Cigarette smoking is the leading preventable cause of death, and smoking cessation is the only way to reduce the risk of developing and dying from smoking-related diseases. The binding of nicotine to <i>α</i>4<i>β</i>2 nicotinic acetylcholine receptors in the ventral tegmental area causes transmission of signals to nuclear accumbens, where neurotransmitters, such as dopamine, are released. Euphoric feelings and satisfaction acquired due to the released neurotransmitters make smokers reach for a cigarette once again after a short while, thereby completing a repeating cycle of addiction. Medications for smoking cessation, such as nicotine replacement therapy (NRT), bupropion, and varenicline, are designed to cope with nicotine addiction. NRT provides nicotine to ameliorate withdrawal symptoms, and all forms of NRT are equally effective in smoking cessation than placebo. Bupropion, originally developed as an antidepressant, decreases craving, leading to smoking cessation, which makes it one of the first-line drugs for smoking cessation. Many studies have shown that varenicline is the most effective agent for smoking cessation. No significant long-term adverse events have been reported for NRT, bupropion, or varenicline. However, bupropion should not be used in patients with an increased risk for seizure.

Sparking the Discussion about Vaping and Anesthesia: Comment.

I agree with Drs. Feinstein and Katz that little is known about perioperative vaping.1 The authors refer to an outbreak of 53 cases of e-cigarette and vaping–related lung injury, in which 84% of the cases admitted to the use of tetrahydrocannabinol products. The remaining 16% may have concealed the use of an illegal product, or not known what they were using. In those cases of e-cigarette and vaping–related lung injury where bronchoalveolar lavage was performed, 100% of the specimens were positive for vitamin E acetate, a dangerous contaminant in tetrahydrocannabinol oil.2 This outbreak is troubling but it is unrelated to the use of legal nicotine-based vaping products.They also refer to a letter that raises the hypothetical possibility that an anxious preoperative patient might vape “lavishly” to the point of nicotine intoxication, which could destabilize the cardiovascular system.3 However, they do not report any such cases.Vaping does not involve inhaling smoke, and it is tobacco-free. (Vaping supplies are legally categorized as “tobacco products” only because they may contain nicotine, usually derived from tobacco.) Public Health England estimates that the risk from vaping is unlikely to be more than 5% of the risk of smoking.4 In assessing the perioperative risks of vaping, anesthesiologists should be aware that vape may contain no nicotine, or it may contain an amount that produces similar blood nicotine levels to cigarette smoke. Vape does not contain carbon monoxide, and the levels of other toxins are 82 to 99% lower than in tobacco smoke.5Preoperatively, anesthesiologists should ask patients about smoking, vaping, and the use of cannabis and illegal drugs. Current vapers may have quit smoking but still suffer residual ill health due to their previous tobacco use. There is evidence that smokers benefit from switching to nicotine replacement therapy 6 to 8 weeks before surgery. Vaping can be considered a form of nicotine replacement therapy and therefore may be beneficial for smokers undergoing surgery. Patients who are addicted to nicotine, either from smoking or from vaping, should be offered nicotine replacement therapy while they are confined to a “No Smoking/No Vaping” area such as a hospital.E-cigarettes were patented in 2004, and there are now 42 million vapers globally, but I have been unable to find any reports of anesthesia complications due to vaping. Research is needed so that we can base our discussion of the risks of perioperative vaping on real data rather than supposition.The author declares no competing interests.

Nicotine Replacement Therapy and Healthy Lifestyle Psychoeducation for Smoking Reduction in Acute Psychiatric Inpatients: A Cluster-Randomized Parallel Study.

Effectiveness of nicotine replacement therapies in acute psychiatric inpatient settings remains under-researched. The aim of this study was to compare effectiveness and acceptability of 3 different forms of nicotine replacement therapy in achieving smoking reduction among acute psychiatric inpatients. This cluster-randomized, parallel study compared effectiveness and acceptability of nicotine inhalers, nicotine gum, and nicotine patches for smoking reduction in the acute psychiatric inpatient setting. The primary outcome was the exhaled breath carbon monoxide (CO) level change from baseline at weeks 4 and 8. Secondary outcomes included changes in nicotine withdrawal symptoms and psychiatric symptom severity. Three hundred ten inpatients on the acute care wards were randomly assigned to nicotine inhalers (n = 184), gum (n = 71), and patches (n = 55). Only the nicotine inhaler group showed statistically significant reduction in CO level from baseline at both weeks 4 and 8 (P < 0.001 and P = 0.032, respectively). The nicotine inhaler and the patch group showed significant decrease in nicotine withdrawal symptoms from baseline at both weeks 4 and 8. Meanwhile, the nicotine inhaler and the gum group showed significant decrease in psychiatric symptom severity from baseline at both weeks 4 and 8. Post hoc comparisons revealed that the inhaler group had a greater decrease in psychiatric symptom severity compared with the patch group. Nicotine inhalers may be an effective choice for smoking reduction in acute psychiatric inpatient settings given its significant effects on CO level, withdrawal symptoms, and psychiatric symptom severity, particularly during the first 4 weeks of treatment.

The role of dentists in nicotine replacement therapy.

Dear Editor, We read the article titled “Nicotine replacement therapy: A friend or foe” with great interest.[1] As authors pointed out smoking is one of the greatest causes of premature death and preventable illness in both developed and developing countries. Health-care professionals, especially dentists, can play an important role in assisting their patients with tobacco cessation.[2] We would like to share few more literature regarding the role of dentists in nicotine replacement therapy (NRT). Though most of the dental curriculums around the world don't have structured modules to train dentists in specific smoking cessation strategies, multiple studies exploring knowledge, attitude, and practice regarding tobacco cessation methods among dental practitioners have provided encouraging insights. Rajput et al. explored the attitudes, practices, and perceived barriers in Tobacco cessation counseling (TCC) among dental practitioners in India and found that seventy-three percent of the dentists agreed that TCC is their responsibility.[3] Moreover, Madhu et al. studied the attitude and practice of the dental students toward tobacco cessation methods using a cross-sectional design and found that almost 50% preferred to recommend nicotine replacement therapies (NRT) as a tobacco cessation advises to the patients.[4] Existing literature supports the fact that dental practitioners have the motivation and knowledge base to support tobacco cessation in their patients. It is the need of the hour for establishing tobacco cessation clinics in dental clinics especially in rural areas where a dentist does the behavioral counseling during which patients are advised to stop the tobacco use, with structured counseling methods.[5] There are no standardized tobacco intervention model for dental care settings. However, the American Dental Hygienists Association recommends a three-steP “AAR” brief tobacco intervention model for dental care settings: Ask every patient about tobacco use, Advise all tobacco users to quit, and Refer tobacco users to nationally available tobacco quitlines via fax or electronic referral.[6] Moreover, dentists can also assess the severity of tobacco addiction using Fagerstrom scale, i.e., the patient is asked a series of 6 questions and scores are given based on the patient's responses and based on the scoring, the patient can be prescribed pharmacotherapy in the form of nicotine replacement therapy (NRT).[5] There are multiple ways in which a dentist can assist their patient with NRT. One potential model for incorporating the provision of NRT in dental practices is NRT sampling (NRTS), in which a short starter course (e.g., 2 weeks) of NRT is given to all medically eligible smokers irrespective of their motivations to quit or seek treatment. Another specific area were dentists can contribute is in modifications NRT practices such as nicotine replacement therapy with tooth-whitening agents. Availability of NRT with stain removal or tooth-whitening activity would provide an opportunity for dentists to illustrate some early measurable benefits of smoking cessation, reinforce smokers’ commitment to quit, and support them on the path to a stable state of not smoking. Dentists can also play a key role in maximizing the benefits of NRT by educating the public regarding the relative safety of NRT when compared to smoking, as most of the studies from around the world indicate that the public incorrectly believes that nicotine is responsible for most of the cancer caused by smoking. Considering the need of the hour and the multiple role a dentist can play in tobacco cessation, the dental councils should consider including tobacco cessation training modules in the curriculum at the BDS level.[5] Furthermore, conferences, workshops, and CDEs regarding tobacco cessation services also should be promoted among dentists to educate and motivate them to start or continue their tobacco cessation services to their patients.[4] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

National Academies Report Details Health Impact of E-Cigarettes

Back to table of contents Previous article Next article Professional NewsFull AccessNational Academies Report Details Health Impact of E-CigarettesNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:13 Mar 2018https://doi.org/10.1176/appi.pn.2018.3a12AbstractAmong the 47 conclusions reached by the expert committee are items related to smoking cessation and the harm reduction potential of e-cigarettes.A comprehensive new report from the National Academies of Sciences, Engineering, and Medicine (NASEM) provides some mixed signals in relation to a central question about the public health impact of electronic cigarettes: do they have a value in helping people quit smoking?The report cited strong evidence to suggest that electronic cigarettes, or e-cigarettes, contain fewer harmful compounds than traditional cigarettes and that smokers who completely switch to e-cigarettes can reduce their health risks in the short term. However, there is no substantive evidence that e-cigarettes can actually aid in smoking cessation. The role of e-cigarettes in smoking cessation has been a topic of much debate since these devices first came on the market. Some health professionals, for example, believe they can be a form of nicotine replacement therapy just like patches, while others worry that their resemblance to regular cigarettes reinforces negative smoking behaviors that make it harder to quit. As noted in the NASEM report—which included the results of over 800 peer-reviewed studies—there are some data from observational studies that suggest e-cigarettes can promote smoking cessation, but evidence from more controlled studies is lacking. The report identified just a handful of randomized clinical studies, and most of these showed only that e-cigarettes that contain nicotine are more effective at promoting smoking cessation than e-cigarettes without nicotine. There are insufficient data to know how these devices compare with current FDA-approved cessation products such as varenicline or nicotine patches.People who completely transition from traditional cigarettes to e-cigarettes appear to have improved health outcomes in the short term (one year or less), the report concluded. Douglas Ziedonis, M.D., M.P.H., a professor of psychiatry at the University of California, San Diego, was cautiously optimistic about this finding: “The short-term benefits are encouraging, but remember that addiction is a long-term issue,” he told Psychiatric News.Ziedonis said that while the concept of reducing harm in patients by encouraging switching to e-cigarettes is laudable, there are not enough data on the long-term behaviors of smokers who made the switch. “Many smokers, for example, will just flip-flop between tobacco products, and that is not helpful for their health,” he said. Until more evidence about cessation efficacy and long-term health outcomes becomes available, Ziedonis recommends that psychiatrists continue to focus on cessation strategies with their patients, though the use of e-cigarettes as part of the process can and should be a topic of conversation. Ziedonis said he believes the objective NASEM report will be a great resource for mental health professionals, even those who do not specialize in addiction psychiatry. “Smoking is associated with psychiatric disorders, and questions about e-cigarettes are only going to get more common in psychiatry offices,” he said. ■“Public Health Consequences of E-Cigarettes” can be accessed here. ISSUES NewArchived

Terapia de reemplazo de nicotina

All commercially available forms of nicotine replacement therapy (NRT) (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/pills) can help to quit smoking successfully. NRT increases the cessation rate by 50 to 70%. The combination of a nicotine patch with a rapid dosage form of NRT is more effective than a single type of NRT. There is no difference in efficacy between NRT and bupropion, the combination of NRT and bupropion is more effective than bupropion alone. The effects are largely independent of the duration of therapy, the intensity of the support provided or the setting in which the NRT was offered. According to Chilean experts, NRT can be used in adolescents, as chewing gum 2 mg adding behavioral therapy. If a pregnant woman expresses a clear desire to use NRT, it is suggested (i) discuss the associated risks and benefits with her, (ii) use it only if the cessation fails with non-pharmacological measures and iii) use the professional approach when deciding whether to offer the prescription of NRT, considering the level of addiction of the pregnant woman and the presence of comorbidities. TRN exists in Chile, but is not currently available in the public health system.

Smoking, Quitting, and the Provision of Smoking Cessation Support: A Survey of Orthopaedic Trauma Patients.

This study investigates orthopaedic trauma patients smoking cessation history, intentions to quit, receipt of smoking cessation care during hospital admission, and patient-related factors associated with receipt of smoking cessation care. An online cross-sectional survey of orthopaedic trauma patients was conducted in 2 public hospitals in New South Wales, Australia. Prevalence of smoking and associated variables were described. Logistic regressions were used to examine whether patient characteristics were associated with receipt of smoking cessation care. Eight hundred nineteen patients (response rate 73%) participated. More than 1 in 5 patients (21.8%) were current smokers (n = 175). Of the current smokers, more than half (55.3%) indicated making a quit attempt in the last 12 months and the majority (77.6%) were interested in quitting. More than a third of smokers (37.4%) were not advised to quit; 44.3% did not receive any form of nicotine replacement therapy; and 24.1% reported that they did not receive any of these 3 forms of smoking cessation care during their admission. Provision of care was not related to patient characteristics. The prevalence of smoking among the sample was high. Respondents were interested in quitting; however, the provision of care during admission was low. Smoking cessation interventions need to be developed to increase the provision of care and to promote quit attempts in this Australian population. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Are electronic cigarettes saviors or new culprits

Electronic cigarette (EC) usage in the world is increasing. It might outsell the other tobacco products in the future with this rate of selling increase. Promoters of EC argue that using them will bring additional benefits in the fight against tobacco. By switching from cigarettes to ECs, smokers will not be exposed to a number of dangerous substances thus; morbidity and mortality of smoking would decrease. This may cause major epidemiologic changes. Opponents argue that none of these claims are proven. Nicotine itself is not only addictive but also a harmful substance. Besides it may disseminate tobacco use young people into nicotine addiction with its new harmless image. These devices imitate the hits of nicotine, therefore feed the addiction rather than prevent it. People simply may continue smoking and use EC where cigarettes are socially or legally unacceptable. The solutions of nicotine carry the risk of using unhealthy mixtures and inappropriate nicotine dosing. Users simply may abuse these devices to use other substances such as cocaine. ECs are not recognized as a form of nicotine replacement therapy. In fact most health authorities are negative on ECs. Legal issues like using ECs in public places are not clear. Health professionals are increasingly facing the questions regarding EC usage and fail to provide satisfactory answers.

A debate: Can we recommend electronic cigarettes to our patients? Opinion 1.

A discussion about disadvantages of electronic cigarettes (e-cigarettes) has recently broken out. There are even opinions that they are as harmful as regular cigarettes. However, this has not been proved, and theoretical premises suggest that e-cigarettes should be definitely less harmful as while using them, tobacco is not burned and harmful substances, in particular carcinogens are not produced. Certain premises assume that e-cigarettes may be used as a new form of nicotine replacement therapy, but this has not been confirmed yet. Therefore, further research into harmfulness and safety of the use of e-cigarettes is required. This paper presents solely reasons for the possibility of recommending e-cigarettes to people addicted to nicotine.

Varenicline for Smoking Cessation: a Review

Tobacco use is the leading cause of preventable death and disability in the world. Although gradually declining in most developed countries, the prevalence of tobacco use has increased among developing countries. Nicotine is an addictive chemical that is inhaled from the tobacco present in the cigarettes. It acts on neuronal nicotinic acetylcholine receptors within the ventral tegmental area of the brain, causing dopamine release in the nucleus accumbens which reinforces nicotine-seeking behavior. Reward through the dopaminergic system is a common thread among many drugs of addiction. According to the National Anti-Tobacco Communication Campaign Strategy for Nepal smoking prevalence in Nepal is higher (38.4%) than the smoking prevalence in the world (29%). Smoking attributable annual deaths in Nepal is estimated at nearly 14,000 (9,000 male deaths and 5,000 female deaths) for population aged 35 and over. First-line pharmacotherapies for smoking cessation are varenicline, sustained-release bupropion and various forms of nicotine replacement therapy (i.e., patch, gum, lozenge, inhaler, nasal spray). These drugs can be used as monotherapy or combination therapy for the treatment of smoking cessation. After studying the outcome of many clinical trials and meta-analysis, it is concluded that cigarette smokers taking varenicline have the most success quitting smoking as compared with those taking other first-line pharmacotherapies for treating smoking cessation. Health Renaissance 2014;12(3): 215-220

Nicotine Replacement Therapy

Nicotine Replacement Therapy

Smoking cessation should be an integral part of serious mental illness treatment.

Smoking cessation should be an integral part of serious mental illness treatment.

The current literature regarding the cardiovascular effects of electronic cigarettes.

Smoking is the leading cause of preventable morbidity and mortality globally. Electronic cigarettes are marketed both as nicotine substitutes and recreational devices. The popularity of electronic cigarettes has superseded other forms of nicotine replacement therapy. They are also popular in 'never smokers'. This review summarizes the available data regarding the cardiovascular effects of electronic cigarettes. The existing literature is limited and short term with a lack of high-quality studies and adequate follow-up. The available literature suggests that electronic cigarettes have sympathomimetic effects related to nicotine exposure, however, electronic cigarettes also contain other chemicals that require further investigation. Sparse data suggest vascular injury may be another concern. Further research is needed before broad recommendations can be made.