Nicotine Replacement Therapy Products Research Articles

The implementation of a smoking cessation and alcohol abstinence intervention for people experiencing homelessness

BackgroundIn the United States, eighty percent of the adult homeless population smokes cigarettes compared to 15 percent of the general population. In 2017 Power to Quit 2 (PTQ2), a randomized clinical trial, was implemented in two urban homeless shelters in the Upper Midwest to address concurrent smoking cessation and alcohol treatment among people experiencing homelessness. A subset of this study population were interviewed to assess their experiences of study intervention. The objective of this study was to use participants’ experiences with the intervention to inform future implementation efforts of combined smoking cessation and alcohol abstinence interventions, guided by the Consolidated Framework for Implementation Research (CFIR).MethodsQualitative semi-structured interviews were conducted with 40 PTQ2 participants between 2016–2017 and analyzed in 2019. Interviews were audio-recorded, transcribed, and analyzed using a socially constructivist approach to grounded theory.ResultsParticipants described the PTQ2 intervention in positive terms. Participants valued the opportunity to obtain both counseling and nicotine-replacement therapy products (intervention characteristics) and described forming a bond with the PTQ2 staff and reliance on them for emotional support and encouragement (characteristics of individuals). However, the culture of alcohol use and cigarette smoking around the shelter environment presented a serious challenge (outer setting). The study setting and the multiple competing needs of participants were reported as the most challenging barriers to implementation (implementation process).ConclusionThere are unique challenges in addressing smoking cessation with people experiencing homelessness. For those in shelters there can be the difficulty of pro-smoking norms in and around the shelter itself. Considering pairing cessation with policy level interventions targeting smoke-free spaces, or pairing cessation with housing support efforts may be worthwhile.. Participants described a discord in their personal goals of reduction compared with the study goals of complete abstinence, which may pose a challenge to the ways in which success is defined for people experiencing homelessness.Trial registrationClinicaltrials.gov, NCT01932996, registered 08/30/2013.

PCR46 A Mixed-Methods Study Using Cognitive Debriefing to Assess the Content Validity of a New Health and Functioning Measure for Tobacco and/or Nicotine Product Users

To inform tobacco harm reduction strategies, a new consumer reported outcome measure (CROM) was developed to assess perceived Health and Functioning (H&F) among users of tobacco and/or nicotine products (TNP). This study assessed the face, content validity, and early measurement properties of the draft H&F CROM. Cognitive debriefing interviews were conducted in two waves in the UK and US with adult users of: cigarettes (n=20), e-cigarettes (n=20), heated tobacco products (IQOSTM) (n=20), smokeless tobacco products (n=10), and nicotine replacement therapy products (n=10). Participants completed the draft measure (195 items) electronically through a “think-aloud” process. Different response options were tested. Transcripts were analyzed thematically using Atlas.ti. Exploratory psychometric analysis was conducted by Rasch Measurement Theory (RMT) analysis. Expert panel meetings were held to inform result interpretation and updating the CROM after each wave. The participants generally endorsed the content of the CROM, while the interim analysis allowed for some early item and scale refinements. The RMT analysis largely supported the scales’ reliability, sample-to-scale targeting, and discrimination potential across the TNP user groups. Conceptual overlap between some items was identified through both qualitative and quantitative evidence. Mixed-methods evidence was used to guide the selection of response scale, e.g., severity difficulty or frequency that could better match the underlying concept of each scale, while the 7-day recall period was found to have less of a ceiling effect. This study provides early supporting evidence of the new H&F CROM’s content relevance, clarity, and ease of completion. It comprises ten scales (146 items) covering different health concepts (including oral, lung, and general health and breathing difficulty), appearance, bother with TNP smell, as well as different functioning concepts (including work, social, and well-being). A psychometric validation study is being conducted to inform the item content, scoring structure, and measurement properties of the CROM.

Effect of Tobacco Cessation Aids on Smoking Cessation and Duration of Abstinence : a French Population-Based Study

IntroductionAlthough smoking prevalence has been decreasing worldwide, sustained tobacco cessation remains a challenging goal for many smokers. Nicotine replacement therapy (NRT) products remain among the most widespread type of cessation tobacco aids, along with the more recently introduced electronic cigarette, the efficiency of which is still a matter of debate in the public health community.ObjectivesThis study aims to contribute to the ongoing discussion about effective ways of encouraging tobacco cessation and in particular evaluating the role of the two aforementioned tobacco cessation aids with regard to lasting smoking abstinence in real-life settings.MethodsThe study is based on the French 2017 Health Barometer, a cross-sectional survey conducted by Santé Publique France. Two distinct outcomes related to tobacco cessation were used: smoking status at 6 months follow-up (yes vs. no) and the duration of smoking abstinence. These two study outcomes were examined respectively among N1 = 2783 and N2 = 1824 participants. All results were weighted based on inclusion probability weights and controlled for propensity scores via overlap weighting (OW), which is appropriate when exposure groups are disparate.ResultsAfter adjusting on potential confounders, tobacco cessation at 6 months remains significantly associated with e-cigarette use (OR: 1.50 (1.12-1.99)) and e-cigarette use combined with NRT (OR:1.88 (1.15-3.07)). This association did not reach statistical significance in the long-term analysis, nor did the results of NRT use alone in both analyses.ConclusionsOverall, while electronic cigarette use alone and combined with NRT is associated with an increase in the likelihood of smoking cessation, the long-term effects are probably limited.DisclosureNo significant relationships.

Different Times Call for Different Measures: Using Retail Sales to Monitor the Tobacco Product Landscape

Different Times Call for Different Measures: Using Retail Sales to Monitor the Tobacco Product Landscape

A randomised study to assess the nicotine pharmacokinetics of an oral nicotine pouch and two nicotine replacement therapy products

Nicotine replacement therapies (NRTs) are intended for short-term use to help cigarette smokers to quit. Some smokers find NRTs ineffective or seek a more satisfactory source of nicotine. Tobacco-free oral nicotine pouch (NP) products have emerged as a potential reduced risk product compared with cigarettes and other tobacco products. In a randomised crossover clinical study, thirty-four healthy adult smokers were enrolled and their nicotine Cmax and AUC0-T determined for three 4 mg nicotine products (NP, gum, lozenge) under fasting conditions. The NP, lozenge and gum mean Cmax values were 8.5, 8.3 and 4.4 ng/mL, AUC0-T values were 30.6, 31.5 and 14.3 ng*h/mL, respectively. The NP showed similar nicotine bioavailability to the lozenge (p = 0.6526 (Cmax), p = 1.0000 (AUC0-T)), and superior bioavailability to the gum (p < 0.0001 for Cmax and AUC0-T). Compared with the lozenge, the NP demonstrated greater product satisfaction with a higher number of positive responses to subjective satisfaction questions. All products were judged to be well-tolerated; the incidence of minor adverse events was lower for the NP (18.2%) than the lozenge (33.3%) or gum (18.8%). In summary, NPs may provide smokers with a more satisfying alternative nicotine source as compared to the reference NRTs.Study Registry/Registered Trial No: ISRCTN/ISRCTN65708311.

Do Smokers' Perceptions of the Harmfulness of Nicotine Replacement Therapy and Nicotine Vaping Products as Compared to Cigarettes Influence Their Use as an Aid for Smoking Cessation? Findings from the ITC Four Country Smoking and Vaping Surveys.

IntroductionThis study examined whether smokers’ harm perceptions of nicotine replacement therapy (NRT) and nicotine vaping products (NVPs) relative to cigarettes predicted their subsequent use as smoking cessation aids during their last quit attempt (LQA).Aims and MethodsWe analyzed data from 1,315 current daily smokers (10+ cigarettes per day) who were recruited at Wave 1 (2016), and who reported making a quit attempt by Wave 2 (2018) of the International Tobacco Control Four Country Smoking and Vaping Surveys in Australia, Canada, England, and the United States. We used multinomial logistic regression models to examine prospective associations between harm perceptions of (a) NRT and (b) NVPs and their use at LQA, controlling for socio-demographic and other potential confounders.ResultsSmokers who perceive that (a) NRT and (b) NVPs are much less harmful than cigarettes were more likely to subsequently use the respective product as an aid than using no aid or other aids during LQA (adjusted relative risk ratio [aRRR] = 3.79, 95%CI = 2.16–6.66; and aRRR = 2.11, 95%CI = 1.29–3.45, respectively) compared to smokers who perceive these products as equally or more harmful. Additionally, those who perceive NVPs as much less harmful than cigarettes were less likely to use NRT as a quit aid (aRRR = 0.34, 95%CI = 0.20–0.60). No country variations for these associations were found.ConclusionsThis study found that smokers’ perceptions of the harmfulness of (a) NRT and (b) NVPs relative to cigarettes predicted the respective product use when trying to quit smoking. Corrective education targeting misperceptions of nicotine products’ relative harmfulness may facilitate their use for smoking cessation.ImplicationsNicotine replacement therapy and nicotine vaping products are two commonly used smoking cessation aids. This study demonstrates that misperceptions of the harms of nicotine products relative to cigarettes influence their use for smoking cessation. Believing that nicotine vaping products are much less harmful than cigarette smoking may lead some smokers to prefer these products over nicotine replacement therapy to aid smoking cessation. Education targeting misperceptions of nicotine products’ harmfulness relative to cigarettes may enable smokers to make informed choices about which are appropriate to aid smoking cessation.

Knowledge, attitude, practice and perceived barriers towards smoking cessation services among community pharmacists.

Introduction:With more than one billion current smokers, 80% of them living in low and middle-income countries, tobacco smoking is considered a global public health problem. Jordan has one of the highest estimate rates of tobacco use in the region and world. Still, tobacco use interventions, that could significantly reduce the number of smoking-related diseases and reduce health care costs, are scarce. While such interventions could be carried out by community pharmacists, given their unique position to counsel patients and provide effective cessation interventions, the role of community pharmacists in tobacco control services in Jordan has never been fully investigated.Objective:This study aimed at assessing the community pharmacists’ knowledge, attitudes, and practice towards smoking cessation and identifying their perceived barriers for smoking cessation counselling utilizing a sample of community pharmacists in Northern Jordan.Method:A cross-sectional study was conducted among community pharmacies in Irbid city, North of Jordan, between April and August 2018. A random sample of 95 pharmacies was selected using the multistage random sampling technique. A structured English questionnaire, consisting of 5 parts, was used. The Survey assessed pharmacists’ socio-demographics, knowledge, attitude, practice and perceived barriers related to tobacco use cessation services.Results:One hundred and fifty pharmacists completed the survey. Their mean age was 30.71±10.10 years. The mean of pharmacists’ knowledge score was 3.74±0.38, while their positive and negative attitude were 3.87±0.43 and 3.18±0.66 respectively. Pharmacists’ mean smoking cessation practice was 2.01+0.64. Barriers to providing cessation interventions included the lack of training on nicotine replacement therapy products (86%), the lack of smoking cessation programs (84%) and low demands from smokers (83.3%).Conclusion:While knowledge related to tobacco use cessation services among the community pharmacists was sub-optimal, a good positive attitude and a low practice levels were observed. The lack of educational materials, low patients’ demand, knowledge deficits, low training and the lack of cessation programs have been identified as barriers hindering the provision of smoking cessation services. Furthermore, the study identified factors that will increase community pharmacists’ participation in smoking cessation, help in raising pharmacists’ awareness of smoking as a public health problem and the importance of their role.

Assessment of the Exposure to Tobacco-Specific Nitrosamines and Minor Tobacco Alkaloids in Users of Various Tobacco/Nicotine Products.

Tobacco-specific nitrosamines (TSNAs), in particular, the human carcinogens 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N'-nitrosonornicotine (NNN), are important toxicants in tobacco and also (as contaminants) in nicotine products. In a clinical study comprising a period of 74 h under confinement, we investigated the exposure to NNK, NNN, N'-nitrosoanabasine (NAB), and N'-nitrosoanatabine (NAT) as well as to the minor tobacco alkaloids anabasine (AB) and anatabine (AT) by measuring suitable biomarkers in habitual users of combustible cigarettes (CCs), electronic cigarettes (ECs), heated tobacco products (HTPs), oral tobacco (OT), and nicotine replacement therapy products (NRTs). Non-users (NU) of any tobacco/nicotine products served as the (negative) control group. Smokers exhibited the highest levels for all biomarkers measured, except for AB in urine, which was found to be highest in OT users. Somewhat elevated levels compared to NU, EC, and NRT groups were also observed in the users of HTPs. In the users of tobacco-containing products (CC, HTP, and OT), most frequently the biomarkers significantly correlated with the dose markers such as daily consumption, urinary nicotine equivalents (Nequ), and plasma cotinine (CotP). In conclusion, except for smokers (CC) and OT users, exposure of users of ECs, HTPs, and NRTs to TSNAs as well as the minor tobacco alkaloids AB and AT is marginal and statistically not distinguishable from that of NU. Finally, our results for NNN in the saliva provide preliminary evidence for the formation of NNN from the precursor nornicotine in the presence of thiocyanate as a catalyst. The latter hypothesis requires experimental verification.

Nicotine and Nicotine Replacement Therapy Use During Myocardial Perfusion Imaging.

Myocardial perfusion imaging (MPI) is commonly used to assess the presence and severity of coronary artery disease (CAD). A radiopharmaceutical is used before and after patients undergo either exercise-induced stress via a treadmill or medication-induced stress. While certain therapies that are known to influence the accuracy of results are avoided prior to conducting MPI, it is currently unknown whether nicotine and nicotine replacement therapy (NRT) should be avoided, even though they may have significant effects on coronary circulation. Nicotine has been demonstrated to have both vasoconstrictive and vasodilatory properties. However, in patients with underlying CAD, vasoconstrictive properties appear to predominate and can allow the disease to appear more severe than it is during MPI. Similarly, NRT products may cause vasoconstriction but to a lesser degree given the lower concentration of nicotine present. Due to the lack of robust studies, the clinical impact of these findings on clinician diagnosis and patient management remains unclear. Based on the available data, nicotine and NRT should ideally be avoided prior to MPI. The specific time frame in which they would be stopped before conducting MPI differs based on the pharmacokinetics of each product. More studies are needed to analyze the impact of nicotine and NRT on the accuracy of MPI using medication.

Assessment of nicotine delivery and uptake in users of various tobacco/nicotine products

Today various tobacco and nicotine products are available, many of them can be regarded as potentially risk-reduced products when compared to the most frequently used product, combustible cigarettes (CCs). A commonality of these products is that they deliver nicotine, although in quite different amounts and uptake routes, the most common of which are inhalation through the lung and absorption through the oral mucosa. Product-specific nicotine delivery as well as the subject-related use patterns are important factors which determine the pharmacokinetics and achieved internal dose levels of the alkaloid. The latter two parameters are highly relevant for the long-term product loyalty and, consequently, for the implicated health risks, since the risk-reduced products will replace CCs in the long-term only when users will experience a similar level of satisfaction. We measured nicotine and its major metabolites in plasma, saliva and urine samples collected in a controlled clinical study with habitual users (10 per group) of CCs, electronic cigarettes (ECs), heated tobacco products (HTP), oral tobacco (OT), and nicotine replacement therapy (NRT). Non-users (NU) of any tobacco/nicotine products served as (negative) control group. Moderate to strong correlations were observed between the daily consumption and the urinary nicotine equivalents (comprising nicotine and its 10 major metabolites, Nic + 10) or plasma and saliva cotinine concentrations. The average daily nicotine dose as measured by the urinary excretion of Nic + 10 (reflecting approximately 95 % of the absorbed nicotine) amounted to 17 and 22 mg/24 h for smokers (CC) and OT users, respectively, while it was in the range of 6–12 mg/24 h for users of ECs, HTP and NRT products, with high inter-individual variations in each user group. The individual daily nicotine intake, which was calculated by applying product-specific models, showed none to good agreement with the corresponding internal nicotine dose measured by Nic + 10 excretion. Possible reasons for the observed deviations between calculated and objectively measured nicotine doses are discussed.

Intake and Uptake of Chemicals Upon Use of Various Tobacco/Nicotine Products: Can Users be Differentiated by Single or Combinations of Biomarkers?

Summary With increasing use of new generation tobacco/nicotine products (TNPs) instead or in addition to conventional cigarettes (CCs), the question arises, whether the user of these new TNPs and CCs can be distinguished on the basis of their exposure in terms of intake and uptake of specific chemicals. For this purpose, the exposure to chemicals for users of 5 product types including CCs, HNB (heat-not-burn products), electronic cigarettes (ECs), oral tobacco products (OT, with the focus on snus), nicotine replacement therapy (NRT) products (only nicotine gum (NG) was considered in this study) was evaluated on the basis of published data. For both intake and biomarker-based uptake, 4 relative exposure levels with the assigned values from 1 (lowest exposure) to 4 (highest exposure) were defined resulting in exposure level patterns. Unique single-biomarker-based exposure levels were found for smokers (11 chemicals), vapers (1 chemical) and non-users (NU, 1 chemical). A few selected biomarkers (usually with relative levels of 3–4) were found to be sufficient for unequivocal differentiation of one user/NU group from the other 5 groups. The impact of dual-product use is also briefly discussed. [Contrib. Tob. Nicotine Res. 30 (2021) 167–198]

Smoking cessation strategies used by former menthol cigarette smokers after a menthol ban

IntroductionMenthol cigarettes were banned in Ontario, Canada on January 1st, 2017. We used concept mapping, a mixed-method approach, to describe how menthol cigarette smokers quit smoking after the Ontario menthol ban. MethodsPre-ban daily and non-daily menthol cigarette smokers who reported smoking abstinence 24 months after the ban (n = 62; 53.2% women; mean age = 43.6, SD = 12.5) generated statements describing reasons and strategies for smoking cessation/reduction after the menthol ban. Participants sorted a final list of 57 statements into groups of similar content and rated statements on how true each statement was for them and multidimensional scaling analysis identified thematic clusters. ResultsSix clusters were identified: Mental and Environment Changes, Direct Ban Impacts, Health Reasons, Cues to Action, Family and Friends, and Cessation Strategies. The highest rated statements (i.e., most true) suggested many participants were motivated to quit smoking before or after the ban and 30.7% of participants believed the menthol ban helped with smoking cessation. Some of the lowest rated statements included using nicotine replacement therapy products, medication (i.e., Champix), or other tobacco products suggesting these strategies were less common. Statement ratings suggested many smokers quit without using replacement products or medication, but modifying cognitions and avoiding smoking cues were common. ConclusionsThe menthol ban aided some menthol smokers to quit, while others reported the ban did not play a role in smoking cessation. These data suggest the menthol ban had direct and indirect effects on smoking reduction behavior. Campaigns supporting similar bans that target both types of effects will likely be most effective for smoking reduction.

Smoking cessation using preference-based tools: a mixed method pilot study of a novel intervention among smokers with low socioeconomic position

BackgroundCompared to smokers with favorable socio-economic position (SEP), those with low SEP are less likely to have a successful smoking cessation attempt. Tailored approaches are therefore needed, and general practitioners could help reaching and assisting usually hard-to-reach population.MethodSTOP (Sevrage Tabagique à l’aide d’Outils dédiés selon la Préférence) is a pilot study, examining the feasibility, acceptability and potentiality of a smoking cessation intervention centered on smoker’s preference. Smokers with low SEP, wishing to quit, were recruited in six healthcare centers in the Greater Paris area. They were asked to choose between different types of nicotine replacement therapy (NRT) products and/or e-cigarette with liquids delivered free of charge to aid their smoking cessation attempt. We describe the characteristics of recruited participants, their perception of smoking cessation aids, and the evolution of their smoking status 4 to 6 weeks after recruitment.ResultsWe recruited 49 participants, of which 29% chose an e-cigarette, 29% chose NRT and 42% chose both an e-cigarette and NRT. The intervention was shown to be acceptable by participants and health professionals. Among the 24 participants followed for at least one month, 14 (28% of all participants) stopped smoking, and 9 (18%) considerably reduced their consumption.ConclusionThe STOP intervention is feasible and acceptable, even if more efforts should be made to limit lost-to-follow-up. This preference-based intervention also shows interesting prospect in helping smokers with low SEP quit smoking. We will test the efficacy of this preference-based intervention in a randomized controlled trial.

Differences in Quit Attempts, Successful Quits, Methods, and Motivations in a Longitudinal Cohort of Adult Tobacco Users by Sexual Orientation.

Sexual minority (SM) tobacco users are less likely to successfully quit than heterosexuals, yet little evidence describes cessation behaviors in this population over time. Our study investigated quit motivations, attempts, and methods in a longitudinal cohort of adult tobacco users by sexual orientation. Participants (N = 1177) completed interviews every 6 months through 48 months and reported quit attempts (24-hour tobacco free), successful quits (7-day point prevalence abstinence), motivations, and methods. Chi-squared and Fisher's exact tests assessed differences by heterosexual and SM orientation, gender, and quit outcome (attempt-only vs. successful quit). Quit rates were similar for heterosexual and SM adults. Over half attempted to quit at least once over 48 months, but few remained abstinent (SM: 16.9%; heterosexual: 12.1%). Most used nicotine replacement therapy (SM: 31.9%; heterosexual: 26.1%) or tobacco product substitution (SM: 27.7%; heterosexual: 21.2%). Few used quitlines (SM: 4.3%; heterosexual: 1.3%) or Internet-based programs (SM: 6.4%; heterosexual: 1.3%). Quit motivations included health concerns, family, and physical fitness. Participants reporting a successful quit were more likely to report a household member quit smoking than 24-hour quit attempters. Among participants reporting a successful quit, more SM than heterosexual participants reported that a coworker quit smoking (55.6% vs. 33.1%, p = .009). We found few differences between heterosexual and SM tobacco users in our sample. Many repeatedly attempt to quit, yet few used evidence-based methods. Leveraging online quit programs, health messages, and family members in tailored cessation interventions may help SM and heterosexual tobacco users successfully quit. SM and heterosexual tobacco users evidenced few differences in quit behaviors. Over 4 years, a majority attempted to quit, with over a third making repeated quit attempts. Nicotine replacement therapy and tobacco product substitution were mostly used during quit attempts; however, more SM than heterosexual men reported using web-based quit programs. Personal health and family concerns were universal motivations to quit, yet SM women also cited physical fitness as a primary motivation. Tobacco users reporting that a household member stopped smoking were more likely to successfully quit. More SM than heterosexual men reported that a coworker quit smoking.

Chemical characterization of tobacco-free “modern” oral nicotine pouches and their position on the toxicant and risk continuums

As compared with cigarette smoking, use of Swedish snus is associated with significantly fewer health risks. Nicotine pouches (NPs), a new form of oral nicotine product, are smokeless and tobacco-free, comprising a nicotine-containing cellulose matrix inside a fiber pouch. NPs are similar in appearance/use to snus, but without tobacco, have the potential to further reduce tobacco-related harm. This study aimed to evaluate toxicant levels of NPs to estimate their position on the tobacco/nicotine product continuums of toxicant delivery and risk. NPs, snus and nicotine replacement therapy products (NRTs) were analyzed for 24–26 compounds applicable to oral tobacco, and their levels were compared. Twenty of these compounds were further used to compare the toxicant profile of NPs, as well as estimated daily toxicant exposure from NP use, with that of tobacco/nicotine products spanning the risk continuum. Of the compounds measured, 22 (NPs), 22 (lozenge NRT), 20 (gum NRT), and 11 (snus) were not quantifiable. Compared with snus, NPs had lower levels of 10 HPHCs and comparable/undetectable levels of a further 13. Across the product categories, NPs and NRTs had the lowest toxicant profiles and estimations of relative toxicant exposure. Based on the present chemical analysis and estimated exposure, use of NPs appears likely to expose users to lower levels of toxic compounds than Swedish snus, which is recognized to offer reduced levels of harm than associated with tobacco smoking. We conclude that NPs should be placed close to NRTs on the tobacco/nicotine product toxicant delivery continuum, although further studies will be needed to confirm this.

Self-Reported Quit Aids and Assistance Used By Smokers At Their Most Recent Quit Attempt: Findings from the 2020 International Tobacco Control Four Country Smoking and Vaping Survey.

IntroductionThis study retrospectively describes smoking cessation aids, cessation services, and other types of assistance used by current and ex-smokers at their last quit attempt in four high-income countries.Aims and MethodsData are from the Wave 3 (2020) International Tobacco Control Four Country Smoking and Vaping Survey in Australia, Canada, England, and the United States (US). Eligible respondents were daily smokers or past-daily recent ex-smokers who made a quit attempt/quit smoking in the last 24-months, resulting in 3614 respondents. Self-reported quit aids/assistance included: nicotine vaping products (NVPs), nicotine replacement therapy (NRT), other pharmacological therapies (OPT: varenicline/bupropion/cytisine), tobacco (noncombustible: heated tobacco product/smokeless tobacco), cessation services (quitline/counseling/doctor), other cessation support (e.g., mobile apps/website/pamphlets, etc.), or no aid.ResultsAmong all respondents, at last quit attempt, 28.8% used NRT, 28.0% used an NVP, 12.0% used OPT, 7.8% used a cessation service, 1.7% used a tobacco product, 16.5% other cessation support, and 38.6% used no aid/assistance. Slightly more than half of all smokers and ex-smokers (57.2%) reported using any type of pharmacotherapy (NRT or OPT) and/or an NVP, half-used NRT and/or an NVP (49.9%), and 38.4% used any type of pharmacotherapy (NRT and/or OPT). A quarter of smokers/ex-smokers used a combination of aids. NVPs and NRT were the most prevalent types of cessation aids used in all four countries; however, NRT was more commonly used in Australia relative to NVPs, and in England, NVPs were more commonly used than NRT. The use of NVPs or NRT was more evenly distributed in Canada and the US.ConclusionsIt appears that many smokers are still trying to quit unassisted, rather than utilizing cessation aids or other forms of assistance. Of those who did use assistance, NRT and NVPs were the most common method, which appears to suggest that nicotine substitution is important for smokers when trying to quit smoking.ImplicationsClinical practice guidelines in a number of countries state that the most effective smoking cessation method is a combination of pharmacotherapy and face-to-face behavioral support by a health professional. Most quit attempts however are made unassisted, particularly without the use of government-approved cessation medications. This study found that about two in five daily smokers used approved cessation medications (nicotine replacement therapy (NRT) or other approved pharmacotherapies, such as varenicline). Notably, nicotine substitution in the form of either NRT and nicotine vaping products (NVPs) were the most common method of cessation assistance (used by one in two respondents), but the proportion using NRT and/or NVPs varied by country. Few smokers who attempted to quit utilized cessation services such as stop-smoking programs/counseling or quitlines, despite that these types of support are effective in helping smokers manage withdrawals and cravings. Primary healthcare professionals should ask their patients about smoking and offer them evidence-based treatment, as well as be prepared to provide smokers with a referral to trained cessation counselors, particularly when it comes to tailoring intensive treatment programs for regular daily smokers. Additionally, healthcare providers should be prepared to discuss the use of NVPs, particularly if smokers are seeking advice about NVPs, wanting to try/or already using an NVP to quit smoking, have failed repeatedly to quit with other cessation methods, and/or if they do not want to give up tobacco/nicotine use completely.

An adapted smoking-cessation intervention for Turkish-speaking migrants in Switzerland: Predictors of smoking outcomes at one-year follow-up.

BackgroundMigrant populations usually report higher smoking rates. Among those migrant populations, Turkish- and Kurdish-speaking migrants are often overrepresented. Providing equal access to health services is one of the major challenges of our time. The need for adapted smoking-cessation treatments for Turkish-speaking populations to achieve equity in health led, in 2006, to the development and implementation of the Tiryaki-Kukla smoking-cessation program. The aims of the current study were to evaluate one-year quit rates for smoking-cessation courses held from 2006–2018 and investigate whether certain characteristics predict long-term smoking cessation or reduction.MethodsProgram evaluation included a pre/post questionnaire (session 1/ 3 months after the quit day) and a follow-up telephone call twelve months after the quit day. To elucidate factors associated with long-term smoking cessation and reduction, Cox regression analysis and Weighted Generalized Equation Models were used.ResultsOf the 478 who participated in smoking-cessation courses, 45.4% declared themselves non-smokers at one-year follow-up. This quit rate is higher than that achieved during the preliminary evaluation of the program involving 61 participants (37.7%). Predictors of long-term smoking cessation were course length (eight vs. six sessions) (95% CI = 1.04–1.36, p = .01), adherence to the course (95% CI = 0.98–0.99, p<0.01), use of pharmacotherapy or nicotine replacement therapy products (95% CI = 0.74–0.98, p = .02), and time passed in the morning until the first cigarette is smoked (95% CI5min = 1.17–1.77, p<0.001; 95% CI30min = 1.09–1.65, p<0.01). Predictors of change in cigarettes smoked per day among smokers were—the time passed until the first cigarette in the morning (5min p < .001; 30min p < .001; 60min p < .01)-, gender (p < .001), and level of motivation to quit at baseline (p = .04).ConclusionsOur findings are consistent with existing evidence supporting adapted smoking cessation interventions to reduce health inequity in migrant populations. However, achieving harm reduction in smokers with higher dependence scores remains challenging.

Smoking and tobacco: working towards the endgame as a vital part of post-COVID-19 recovery

Smoking and tobacco: working towards the endgame as a vital part of post-COVID-19 recovery

Nicotine Population Pharmacokinetics in Healthy Smokers After Intravenous, Oral, Buccal and Transdermal Administration.

BackgroundIn 4 decades, numerous nicotine replacement therapy products have been developed. Population pharmacokinetic models can support exposure–response modeling and inform nicotine replacement therapy product development, but only limited model-based cross-study population pharmacokinetic analyses for nicotine replacement therapy products have been published.ObjectivesThe aim of this retrospective analysis was to assess the population pharmacokinetics of nicotine across intravenous, oral, transdermal and oromucosal (mouth spray, chewing gum, lozenge and inhaler) routes and formulations in healthy smoking subjects.MethodsData on 930 unique subjects (46,016 observations) from 29 single- and repeated-dose studies with multiple formulations across intravenous, oral, transdermal and oromucosal routes of administration were included. Data from intravenous and extravascular routes of administration were modelled separately for run efficiency reasons. For developing extravascular models, clearance and disposition parameters and their inter-individual variabilities were fixed to the estimates for intravenously delivered nicotine. Detectable pre-dose nicotine concentrations were modelled as a hypothetical nicotine bolus into the central compartment at the start of wash-out. Modelling repeated-dose oral and buccal administrations required a time-dependent increase in clearance or decrease in bioavailability to describe the data adequately.ResultsDisposition of intravenous nicotine was best described by a three-compartment model with initial and terminal half-lives of 7 min and 4.5 h, respectively, and the absorption of single oral doses was best described with a first-order absorption rate constant of 1.55 h−1. The data of buccal formulations were modelled with parallel oromucosal absorption and gastrointestinal absorption of a part of the dose that is swallowed. For transdermal nicotine, parallel zero- and first-order release from the patch and a transit-compartment absorption model best described the data. Key pharmacokinetic parameters were reliably estimated, with typical values for clearance (67 L/h for a 70-kg subject), volume of distribution (4.3 L/kg), oral bioavailability (40%) and transdermal bioavailability (76%) within expected ranges. The estimated fraction of the dose swallowed for buccal formulations ranged from 55% (gum) to 69% (lozenge).ConclusionsRobust population pharmacokinetic models were developed for five nicotine replacement therapy product types and for intravenous and oral nicotine. These population pharmacokinetic models are used in exposure–response analyses and simulation-based nicotine replacement therapy product design.Electronic supplementary materialThe online version of this article (10.1007/s40262-020-00960-5) contains supplementary material, which is available to authorized users.

Do e-cigarette sales reduce the demand for nicotine replacement therapy (NRT) products in the US? Evidence from the retail sales data

Despite mixed evidence, many smokers use e-cigarettes to quit smoking. With the substantial growth of e-cigarette sales in recent years, it is important to understand how it may affect FDA-approved nicotine replacement therapy (NRT) products in the US. This study aims to investigate the impact of e-cigarette prices and TV advertising on the demand for NRT products. Quarterly (2010 Q1–2017 Q4) retail sales and price data of e-cigarettes and NRT gum and patch, compiled from Nielsen retail store scanner database, were linked with contemporaneous quarterly television rating data for e-cigarettes and NRT products, compiled from Kantar Media, using state and county identifier. Market, year, and quarter fixed effects models were used to estimate the impact of NRT price and TV advertising, as well as e-cigarette price and TV advertising, on the demand for NRT gum and patch. NRT gum price elasticity was estimated to be −0.91. Higher patch price was found to decrease gum sales (cross-price elasticity −0.96). Higher e-cigarette prices were found to decrease NRT gum sales. Higher cigarette prices were found to increase NRT gum sales. NRT patch price elasticity was estimated to be −2.05. Higher gum price was found to increase patch sales (cross-price elasticity 0.97). E-cigarette TV advertisement was positively associated with NRT gum sales. NRT gum appeared to be complements for e-cigarettes. Recent growth in e-cigarette sales may have increased the demand for NRT gum. More studies are needed to understand the differential behavioral patterns of NRT gum users and NRT path users.