National Cancer Institute's Smoking Research Articles

A Randomized Trial of Telephone-Based Smoking Cessation Treatment in the Lung Cancer Screening Setting.

Lung cancer mortality is reduced via low-dose computed tomography screening and treatment of early-stage disease. Evidence-based smoking cessation treatment in the lung screening setting can further reduce mortality. We report the results of a cessation trial from the National Cancer Institute's Smoking Cessation at Lung Examination collaboration. Eligible patients (n = 818) aged 50-80 years were randomly assigned (May 2017-January 2021) to the intensive vs minimal arms (8 vs 3 phone sessions plus 8 vs 2 weeks of nicotine patches, respectively). Bio-verified (primary) and self-reported 7-day abstinence rates were assessed at 3, 6, and 12 months post random assignment. Logistic regression analyses evaluated the effects of study arm. All statistical tests were 2-sided. Participants reported 48.0 (SD = 17.2) pack-years, and 51.6% were not ready to quit in less than 30 days. Self-reported 3-month quit rates were statistically significantly higher in the intensive vs minimal arm (14.3% vs 7.9%; odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.26 to 3.18). Bio-verified abstinence was lower but with similar relative differences between arms (9.1% vs 3.9%; OR = 2.70, 95% CI = 1.44 to 5.08). Compared with the minimal arm, the intensive arm was more effective among those with greater nicotine dependence (OR = 3.47, 95% CI = 1.55 to 7.76), normal screening results (OR = 2.58, 95% CI = 1.32 to 5.03), high engagement in counseling (OR = 3.03, 95% CI = 1.50 to 6.14), and patch use (OR = 2.81, 95% CI = 1.39 to 5.68). Abstinence rates did not differ statistically significantly between arms at 6 months (OR = 1.2, 95% CI = 0.68 to 2.11) or 12 months (OR = 1.4, 95% CI = 0.82 to 2.42). Delivering intensive telephone counseling and nicotine replacement with lung screening is an effective strategy to increase short-term smoking cessation. Methods to maintain short-term effects are needed. Even with modest quit rates, integrating cessation treatment into lung screening programs may have a large impact on tobacco-related mortality.

Study protocol for a telephone-based smoking cessation randomized controlled trial in the lung cancer screening setting: The lung screening, tobacco, and health trial

Lung cancer mortality can be reduced by 20% via low dose CT lung cancer screening (LCS) and treatment of early-stage disease. Providing tobacco use treatment to high risk cigarette smokers in the LCS setting may result in health benefits beyond the impact of LCS. As one of the nine trials in the National Cancer Institute's Smoking Cessation at Lung Examination (SCALE) collaboration, the goal of the Lung Screening, Tobacco, and Health (LSTH) trial is to develop a scalable and cost-effective cessation intervention for subsequent implementation by LCS programs. Guided by the RE-AIM Framework, the LSTH trial is a two-arm RCT (N = 1330) enrolling English- and Spanish-speaking smokers registered for LCS at one of seven collaborating sites. Participants are randomly assigned to Usual Care (UC; three proactive telephone counseling sessions/two weeks of nicotine patches) vs. Intensive Telephone Counseling (ITC; eight proactive sessions/eight weeks of nicotine patches, plus discussion of the LCS results to increase motivation to quit). Telephone counseling is provided by tobacco treatment specialists. To increase continuity of care, referring physicians are notified of participant enrollment and smoking status following the intervention. Outcomes include: 1) self-reported 7-day, 30-day, and sustained abstinence, and biochemically-verified at 3-, 6-, and 12-months post-randomization, 2) reach and engagement of the interventions, and 3) cost-effectiveness of the interventions. The Cancer Intervention and Surveillance Modeling Network (CISNET) will model long-term impacts of six SCALE trials on the cost per life year saved, quality-adjusted life years saved, lung cancer mortality reduction, and population mortality. Clinical trials registrationThe trial is registered at clinical trials.gov: NCT03200236.

Abstract CN03-02: Modeling past and future smoking patterns in the U.S

Abstract To evaluate the impact of tobacco control interventions on smoking-related mortality it is essential to develop smoking histories over the life course of different birth cohorts. Analyses that extend the detail beyond prevalence in order to also include initiation, cessation and intensity has received limited attention. US National Health Interview Surveys conducted from 1965-2009 provided cross-sectional information on current smoking behavior. Some of these surveys also provided additional detail on age at initiation and cessation, and smoking intensity. Age-period-cohort models with constrained natural splines were adjusted for survival differences by smoking status to obtain estimates of the prevalence of current, former and never smokers for ages 35-99 in cohorts beginning in 1890. This approach also yielded yearly estimates of initiation, cessation and smoking intensity for each birth cohort which were projected forward through 2050 based on recent trends. These summaries show clear trends by gender, cohort and age over time. If current patterns persist, a slow decline in smoking prevalence is projected from 2010 through 2040. This new method of generating smoking histories has been included in the National Cancer Institute's Smoking History Generator which can be used in micro-simulation models to assess the impact of alternative tobacco control strategies. Citation Format: Theodore R. Holford. Modeling past and future smoking patterns in the U.S. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr CN03-02.

Public health clinical demonstration project for smoking cessation in american veterans who served since september 11, 2001.

The purpose of this clinical demonstration project was to increase the reach of effective treatments, such as pharmacotherapy and telephone or web-based support, by offering these treatments in a low cost and convenient manner to a population of Veterans. Six hundred nine veteran smokers who had served in the military since September 11, 2001 were contacted by invitational letters. Veterans indicating interest in further contacts received telephone calls using standardized scripts that offered referral to the National Cancer Institute's Smoking QuitLine, web-based counseling, and local Department of Veteran Affairs pharmacologic treatment for smoking cessation. Seven percent of survey recipients participated in the clinical program. At follow-up, 23% of participants providing follow-up information reported maintaining smoking abstinence. This clinical demonstration project was associated with a reach of 8.6% (number of smokers who accessed the intervention/the number of targeted smokers), an efficacy of 26% (number of abstinent smokers at follow-up/number who accessed the intervention), and a 24-hour abstinence impact rate of 2.2% (number of smokers with 24-hour abstinence/number of targeted smokers). Results suggested that this project enhanced access to care and promoted short-term smoking cessation in Veterans who have served since September 11. 2001.

Public health clinical demonstration project for smoking cessation in veterans with posttraumatic stress disorder

Veterans with posttraumatic stress disorder are at high risk for smoking and experience difficulty with smoking cessation. We designed this clinical demonstration project to provide a low-cost, feasibly implemented smoking cessation intervention that would maximize the number of smokers who accessed the intervention. Five hundred eighty-four veteran smokers were contacted by invitational letters. Interested veterans received follow-up telephone calls using standardized scripts offering three intervention resources: 1) a referral to the National Cancer Institute's Smoking Quitline, 2) web-based counseling, and 3) local Veteran Affairs pharmacologic treatment for smoking cessation. Twenty-three percent of survey recipients participated in the clinical program. Two months after these resources were offered by phone, follow-up phone calls indicated that 25% of participants providing follow-up information reported maintaining smoking abstinence. This clinical demonstration project was associated with a 2.6% impact (i.e., reach [31.1% of smokers accessed intervention] by efficacy [8.4% of those accessing intervention quit]), meaning that 2.6% of the total number of targeted smokers reported 8 week abstinence. Results suggested that this brief, low-cost intervention was feasible and promoted smoking cessation in veterans with posttraumatic stress disorder.

Preliminary Findings from a Clinical Demonstration Project for Veterans Returning from Iraq or Afghanistan

Military veterans are at high risk for nicotine dependence. This clinical demonstration project used invitational letters, referral to the National Cancer Institute's Smoking Quitline, and local Veteran Affairs prescriptions for tobacco cessation to evaluate whether this low-cost method would potentially reduce smoking in separated veterans who served in Afghanistan and Iraq. Three cohorts (500 each) of recently separated veterans from Afghanistan and Iraq were contacted by survey letters. Interested veterans received follow-up telephone calls using standardized scripts. They were referred to the National Cancer Institute's Smoking Quitline (1-877-44U-QUIT) and offered local Veteran Affairs pharmacologic treatment for smoking cessation. Forty-three percent of respondents who were smokers were interested in the clinical program; of these, 77% participated. At 2 months follow-up, 38% of participants self-reported maintained smoking abstinence. Results suggested that the intervention was feasible and assisted the small number of veterans who participated.

Lessons from the history of tobacco harm reduction: The National Cancer Institute's Smoking and Health Program and the “less hazardous cigarette”

Scientists and public health practitioners are sharply divided today over the risks and benefits of tobacco harm-reduction strategies. At the same time, a range of novel tobacco products is being marketed with claims of reduced exposure or risk. Current scientific efforts to study tobacco products and harm reduction should be informed by past experience. During the 1960s and 1970s, there was substantial support within government and academia, as well as among voluntary health organizations, for efforts to modify tobacco products to reduce harm. This paper analyzes the former National Cancer Institute (NCI) Smoking and Health Program, which, between 1968 and 1980, pursued the development of "less hazardous" cigarettes as its primary goal. During this period, the program spent over dollar 50 million on contract research, of which 74% went toward biological and chemical analysis of modified cigarettes, 9.6% to epidemiological studies of risk factors, and only 1.4% to studies evaluating smoking cessation or prevention programs. NCI officials predicted during the mid-1970s that new "low-tar" cigarette brands would substantially reduce smoking-related mortality, but by 1978 the research agenda began to change in response to a reorganization of NCI research activities, modification of government antismoking efforts, and an emerging understanding of nicotine addiction that challenged key scientific assumptions. In retrospect, the program suffered from significant weaknesses that severely limited the likelihood that it would generate knowledge beneficial to public health, including a research agenda that failed to include surveillance and behavioral research, tobacco industry influence of the research agenda, and a lack of access to information about the characteristics of products on the market. There exists today a need for a public health-oriented research agenda on tobacco products and harm reduction, but current efforts should include input from a diverse range of disciplines, collect data on users' behavior, and limit the involvement of industry scientists.

Smoking Cessation Counseling With Young Patients

To investigate family physicians' and pediatricians' practice of and perceived barriers to smoking cessation counseling among patients 18 years and younger. Cross-sectional mail survey conducted between November 1, 1997, and January 31, 1998. A stratified random sample selected from the 1997 American Medical Association Physician Masterfile of 1000 family physicians and pediatricians who practice in urban California, work at least 10% of the time in ambulatory care, and have at least 10% of patients 18 years and younger. Physicians' adherence to 5 components of the National Cancer Institute's smoking cessation counseling recommendations (anticipate, ask, advise, assist, and arrange) and their perceived barriers to smoking cessation counseling. A total of 429 physicians participated in the study. Physicians of both specialties were more likely to anticipate, ask, and advise patients about smoking than to assist with and arrange cessation activities. Family physicians were more likely than pediatricians to assist and arrange, including scheduling follow-up visits to discuss quitting (25.1% vs 11.7%; odds ratio [OR], 3.07; 95% confidence interval [CI], 1.22-7.73) and directing nursing staff to counsel patients (17.1% vs 10.9%; OR, 3.70; 95% CI, 1.30-10.60). The most common perceived barrier to counseling was the belief that children would provide inaccurate responses due to either the presence of parents (86.4%) or the fear that parents would be notified of their answers (74.0%). Pediatricians reported lack of counseling skills as a barrier to providing smoking interventions in greater proportion than did family physicians (24.9% vs 54.8%; OR, 0.29; 95% CI, 0.14-0.63; P<.001). Improvement in smoking cessation counseling skills and practices is needed among physicians treating children and adolescents.

Smoking Assessment and Intervention: An Essential Part of Disease Treatment

Approximately 45.8 million Americans smoke. Smoking is a leading cause of preventable disease, disability, and death. The Wellness Division of VNA Care Plus, recognizing the relationship between tobacco use and disease, now empowers smokers to progress toward cessation. It has adapted the National Cancer Institute Smoking Cessation Model for Primary Care Sites. The agency's assessment tool and benefits and barriers survey affecting tobacco use are included. The profile of smokers and "Tips for Treating Elder Smokers" are described. Recommendations include standardized protocol, consistent interventions from providers, and suggestions for further study.

Intervention research: A model from the National Cancer Institute's smoking and tobacco control program

Intervention research: A model from the National Cancer Institute's smoking and tobacco control program

Intervention research: a model from the National Cancer Institute's Smoking and Tobacco Control Program.

Recognizing that the scientific method is as critical to cancer control as it is to basic laboratory research, the National Cancer Institute (NCI) established a well-defined, systematic strategy for attaining its cancer control goals and objectives. This strategy, operationalized in the early 1980s as a five-phase process, emphasized cancer control as a research science rather than a demonstration science. The five phases of NCI's cancer control research strategy progress from hypothesis development, to methods development, to controlled intervention trials, to defined population studies, and finally to demonstration and implementation programs. This research base provides the foundation for nationwide prevention and health services programs. The application of this five-phase approach to NCI's efforts to reduce morbidity and mortality attributable to tobacco use is described, and some of the challenges that faced the Institute in this process are identified. These experiences provide an important framework for other disciplines faced with the challenge of translating science into practice.

The National Cancer Institute's Smoking, Tobacco, and Cancer Program

Unlike the days following the 1964 report of the Surgeon General on the health consequences of smoking, the NCI's emphasis is no longer on the definition of the problem and the accumulation of evidence linking smoking and tobacco use to cancer. The emphasis now is on reducing the prevalence of tobacco use throughout the US. The cancer control objectives for the nation now specify that we need to reduce the percentage of adults who smoke from the 34% rates found in 1983 to 15% or less by the year 2000, and reduce the percentage of youths who smoke by age 20 from 36% characteristic in 1983 also to 15% or less. By doing so, the NCI will contribute to the continued gain in reduced incidence of cancer.

Socially Tolerable Cigarette Smoke?-Reply

The first issue raised by Dr Homburger on our recent article inThe Journalis the possible alteration in the proportion of toxic smoke constituents of today's cigarettes compared with pre-1960 cigarettes. The formulation of today's low tar and low nicotine cigarettes is carried out by processes that reduce quantitatively, and largely nonselectively, the amount of smoke produced in both the particulate phase (which contains tar, nicotine, and water) and the gas phase (which contains the other smoke constituents). Table 3 of our article suggests this overall quantitative reduction, in that the six constituents addressed are reduced for each of the cigarette brands listed. The constituents considered were chosen because these have been implicated in human disease incidence. These and other constituents have been addressed by the National Cancer Institute's Smoking and Health Program, where over 130 types of experimental cigarettes have been tested for potentially lower toxicity.

Toward Less Hazardous Cigarettes-Reply

We appreciate Dr Warner's perceptive comments on our recent article inThe Journal. Dr Warner states that it is unreasonable to assume that the majority of two-a-day smokers inhale. Scientific data on inhalation practices of two-a-day smokers are sparse, because of relatively few such smokers in the general population. However, an ongoing epidemiologic study sponsored by the National Cancer Institute's Smoking and Health Program in eight US cities 1 has found that of 274 two-a-day smokers, 157 (57%) inhale. A similar study in Western Europe 2 has thus far identified only 47 two-a-day smokers, but 29 (62%) of them inhale. Although the sample sizes of these studies are small, we believe they represent some of the most comprehensive data available on the inhalation practices of two-a-day smokers. Further, respondents to tobacco questionnaires frequently understate their tobacco consumption practices, so the actual percentage of inhalers is likely to be larger