Nicotine Replacement Therapy Research Articles

Positive effects from the introduction of fully subsidised nicotine replacement therapy in Ireland

Abstract Smoking remains a leading cause of preventable death in the Europe. Despite recent declines in prevalence, the adverse health and economic effects of smoking are felt disproportionately by disadvantaged groups. Nicotine replacement therapy (NRT) is well established as an effective smoking cessation aid; however, its financial cost may act as a barrier to uptake. In February 2023, eligibly for fully subsidised NRT was expanded to all users of smoking cessation services in Ireland. This study evaluated the impact of universal access to NRT on smoking cessation. This study utilised secondary analysis of routinely collected data from service users attending Irish smoking cessation services. Individuals were followed for twelve weeks. Changes in self-reported quit status and NRT use were analysed before (January 2021 - February 2023) and after (March 2023 - December 2023) the introduction of fully subsidised NRT. Logistic regression modelling identified factors associated with smoking cessation. The total number of participants was 19,717. There was higher uptake of NRT among service users who were eligible for free NRT (59% vs 40%, p < 0.001) and higher quit rates at four (41% vs 29%, p < 0.001) and twelve (29% vs 20%, p < 0.001) weeks. Logistic regression models demonstrated that NRT use was significantly associated with smoking cessation at four (aOR 1.88, 95%CI 1.47 - 2.41) and twelve (aOR 1.76, 95%CI 1.37 - 2.28) weeks. This study confirms the effectiveness of NRT in an Irish context and illustrates the benefits of universal access to this life saving medicine. Targeted interventions are required to intensify services offered to disadvantages groups if the ambitious objectives of Tobacco Endgame are to be achieved. These findings represent an urgent call to action for European policy makers to deliver equitable access to NRT across the continent. Such action can transform the public health landscape and help bring us closer to achieving a tobacco free Europe. Key messages • This study confirms the real-world effectiveness of NRT use as a smoking cessation aid. • The removal of financial barriers is associated with increased NRT use and successful smoking cessation.

Understanding smoking cessation process in Tunisia from 2020 to 2023: description of quit attempts

Abstract Background Many smokers attempt multiple cessation methods before seeking specialist intervention. This study aims to describe these prior cessation attempts and identify relapse factors to enhance support for these individuals. Methods Data from 440 patients consulting the Department of Epidemiology Statistics at Abderrahman Mami Hospital from 2020 to 2023 were analyzed. It included information on previous quit attempts, methods used, longest duration of abstinence, number of attempts, reaction to cessation, and reasons for relapse. Statistical description was conducted using IBM SPSS 25. Results Among participants, More than half of the smokers had previously attempted to quit smoking 63,4%, with an average of 2 attempts ± 1,7 (0-10 attempts) per patient. The majority of patients (86.8%) quit smoking without using substitution methods. Among those who resorted to substitution, nicotine replacement therapy was the most frequently used method (n = 30; 6.8%). The longest duration of abstinence averaged 8 years. The main reaction to smoking cessation among patients was an improvement in their health (9,1%). The most common reasons for relapse were psychosocial problems (5.5%), followed by relapses during social events (4.3%), and withdrawal symptoms (3%). Conclusions This study emphasizes the importance of considering each patient’s journey during their smoking cessation process. Analyzing these factors will enable better management of the cessation program with the patient, as well as a deeper understanding of their feedback regarding our program, ensuring long-term cessation success. Key messages • Failed spontaneous quit attempts prior to NRT initiation are prevalent among smoking patients. • Understanding failed spontaneous cessation attempts can guide the development of more effective strategies.

04 Care for adolescents with substance use: A national survey of paediatric hospitals

Abstract Background Substance use is a recognized Paediatric health care issue. More than 9 in 10 individuals receiving treatment for substance use disorders report that their first use of substances occurred by young adulthood. The Canadian Institute for Health Information reported that 5% of hospital stays among Canadian youth in 2017-2018 were related to harmful substance use. In a study of youth with a first-time emergency department visit for a mental health problem between 2010 and 2014, most visits were due to substance related disorders. Despite this, little is known about practices relating to substance use in children's hospitals. Objectives 1. To describe how adolescents who present to Paediatric hospitals with substance use disorders or substance-related health issues are identified, assessed, and treated. 2. To identify best-practices that can inform national standards of care. Design/Methods An online questionnaire was utilized to obtain information on: 1. Clinical practices in the emergency department, inpatient services and ICU; 2. Hospital policies and practice guidelines; and 3. Hospital and community programs and resources. Recruitment emails were sent to hospital leaders (CEO or equivalent) at all 13 Paediatric hospitals. Leaders were asked to identify one individual to complete the survey on behalf of their hospital with input from relevant stakeholders in the various clinical areas. The survey was developed iteratively by a national group of 9 adolescent medicine clinicians and 2 Paediatric trainees. The survey was piloted at a single Paediatric hospital and refined. The survey was administered via RedCap technology. Results Survey response rate was 70% (9/13 hospitals). The mean number of contributors to each survey was 9 (range of 1-35). Overall, few hospitals utilized best practices consistently. There was inconsistency in the use of validated screening tools, use of clinical practice guidelines for monitoring and ongoing care and prescribing of nicotine replacement therapy and opioid agonist therapy. These inconsistencies were noted within each clinical setting (emergency department, inpatient services, and ICU), across services in each hospital, and between hospitals. With respect to hospital services, 5/9 had some type of consult team related to substance use (e.g., adolescent medicine), 4/9 had specialized substance use outpatient services, and 2/9 offered partial hospitalization/day treatment for patients with substance use issues. Local community-based substance use resources were identified as insufficient to address needs by 8/9 hospitals. Conclusion Inconsistencies in the care of adolescents with substance use disorders or substance-related health issues highlights the need for national guidelines for Paediatric hospital-based assessment and care, and enhanced coordination between services and systems of care for this patient population.

E-Cigarettes in Smoking Cessation and Harm Reduction: A Comprehensive Review of Recent Evidence and Potential Risks

The global prevalence of tobacco use has significantly decreased over the years, with projections indicating further decline. However, the rise of new nicotine products suggests that nicotine addiction will remain a major public health issue. Electronic cigarettes (e-cigarettes) are increasingly recognized as potential tools for smoking cessation and harm reduction. This review evaluates the safety and effectiveness of e-cigarettes both as standalone treatments and in combination with other therapies, such as nicotine replacement therapy (NRT), varenicline, cytisine, and behavioral approaches. A comprehensive analysis of studies published over the past decade, including systematic reviews, meta-analyses, and randomized controlled trials, shows that e-cigarettes can enhance smoking cessation rates and reduce tobacco-related harm. They exhibit comparable short-term efficacy to traditional treatments, with promising results in alleviating withdrawal symptoms and lowering smoking rates. However, the long-term safety and effectiveness of combining e-cigarettes with other therapies remain uncertain and require further investigation. Despite their potential benefits, e-cigarettes pose significant safety concerns, underscoring the need for ongoing research to refine cessation strategies and ensure their safe, long-term use. Rigorous evaluation and regulatory oversight are essential to optimize e-cigarettes' role in reducing tobacco harm.

Effectiveness of varenicline versus nicotine replacement therapy in smoking cessation: A systematic review

Effectiveness of varenicline versus nicotine replacement therapy in smoking cessation: A systematic review

Implementation of a Telehealth Smoking Cessation Program in Primarily Socioeconomically Disadvantaged Black Patients: Courage to Quit Rolling-Virtual (CTQ-RV).

Preliminary data indicate that smoking cessation offered in a rolling group format is feasible and effective. The current study evaluated theimplementation and outcomes of the remote Courage to Quit-Rolling Virtual (CTQ-RV) smoking group treatment compared to its precursor in-person format (Courage to Quit-Rolling, CTQ-R). Virtual materials for CTQ-RV were adapted from in-person evidence-based programming, thus content in both groups was similar but delivered via videoconference or in-person. We used an interrupted time series design to examine feasibility by comparing attendance, monthly enrollment, and program completion between those who attended CTQ-R (July 2018-March 2020) versus CTQ-RV (April 2020-December 2022). There were 611 patients enrolled in tobacco cessation (N = 221 CTQ-R, N = 390 CTQ-RV). The average age was 59.4 years and most patients reported Black/African American race (81%) and female sex (69.5%). CTQ-RV proved feasible relative to CTQ-R, with higher rates of attendance (5.5 vs. 2.7 sessions, respectively), program completion (39.4% vs. 19%) and increased enrollment across each year (from 44.6 sessions per month in CTQ-R vs. 72.3 in CTQ-RV). CTQ-RV patients requested nicotine replacement therapy (NRT) at substantially higher rates (81.4%) than CTQ-R members (42.1%). Self-reported smoking abstinence at final session was higher in CTQ-RV compared with CTQ-R (33.3% vs. 15.7%). Within CTQ-RV, more than half (57%) of patients attended by video format, with outreach improving rates of video attendance each year. Results show that a transition to virtual rolling enrollment smoking group treatment is feasible and can augment treatment outcomes, such as engagement, NRT use, and self-reported cessation.

Identification of Specific Hemoglobin Adduct Patterns in Users of Different Tobacco/nicotine Products by Nontargeted GC-MS/MS Analysis.

Tobacco smoke contains several electrophilic constituents which are capable of forming adducts with nucleophilic sites in DNA and proteins like hemoglobin (Hb) and albumin. New nicotine and tobacco products are discussed as less harmful forms of tobacco use compared to smoking combustible cigarettes (CC) due to reduced exposure to harmful constituents. Hence, the adduct profile in users of various tobacco/nicotine products is expected to differ characteristically. In this article, we present a novel nontargeted screening strategy using GC-MS/MS for Hb adducts based on the analysis of the respective derivatized N-terminal valine adducts after modified Edman degradation. We analyzed blood samples from a clinical study with habitual users of CCs, electronic cigarettes, heated tobacco products (HTPs), oral tobacco, nicotine replacement therapy products and nonusers of any tobacco/nicotine products. Our nontargeted approach revealed significant differences in the Hb adduct profiles of the investigated tobacco/nicotine product user groups. Adduct identification was performed by means of an internal database, retention time estimations based on the theoretical boiling points, as well as in-house synthesized reference compounds. Several chemicals that form adducts with Hb could be identified: methylating and ethylating agents, ethylene oxide, acrylonitrile, acrylamide, glycidamide and 4-hydroxybenzaldehyde. Levels were elevated in smokers compared to all other groups for Hb adducts from methylating agents, ethylene oxide, acrylonitrile, acrylamide and glycidamide. Our approach revealed higher concentrations of Hb adducts formed by ethylation, acrylamide and glycidamide in users of HTPs compared to nonusers. However, concentrations for the latter two were still lower than in smokers. Due to their long half-lives, Hb adducts related to acrylonitrile, acrylamide (glycidamide), and ethylene oxide exposure may be useful for the biochemical verification of subjects̀ compliance in longitudinal and cross-sectional studies with respect to smoking and HTP use/abstinence.

A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour.

This preregistered systematic review and meta-analysis (PROSPERO: CRD 42022311392) aimed to synthesize the effectiveness of all available population-level tobacco policies on smoking behaviour. Our search across 5 databases and leading organizational websites resulted in 9,925 records, with 476 studies meeting our inclusion criteria. In our narrative summary and both pairwise and network meta-analyses, we identified anti-smoking campaigns, health warnings and tax increases as the most effective tobacco policies for promoting smoking cessation. Flavour bans and free/discounted nicotine replacement therapy also showed statistically significant positive effects on quit rates. The network meta-analysis results further indicated that smoking bans, anti-tobacco campaigns and tax increases effectively reduced smoking prevalence. In addition, flavour bans significantly reduced e-cigarette consumption. Both the narrative summary and the meta-analyses revealed that smoking bans, tax increases and anti-tobacco campaigns were associated with reductions in tobacco consumption and sales. On the basis of the available evidence, anti-tobacco campaigns, smoking bans, health warnings and tax increases are probably the most effective policies for curbing smoking behaviour.

A Pilot Feasibility Study of Delivering a Quit & Win Tobacco-Free Contest in Community Mental Health Programs.

Quit & Win contests are a community-based tobacco cessation strategy that has demonstrated success in supporting tobacco cessation efforts in the general population. However, such contests have not been implemented and evaluated among people living with mental illnesses (MIs). This pilot study aimed to evaluate the feasibility of implementing Quit & Win contests in terms of program delivery, engagement, and cessation outcomes among people with MIs. A single-group posttest design to evaluate the feasibility of Quit & Win contests conducted at three community mental health programs. Flyers introducing the contest were posted at study sites 2 weeks prior to recruitment. Recruitment occurred on 2 days over a 2-week period. Eligible participants received a pamphlet with information about tobacco treatment resources. At the follow-up, postsurveys and expired CO levels were obtained. Participants (N = 28) were mostly male, Non-Hispanic White, with a high school or higher education, unemployed, and 46.4% had a primary substance use disorder diagnosis. Among those who engaged in the program, seven (25.0%) returned for the follow-up, of which three (42.9%) successfully stopped cigarette use. Four (57.1%) described using nicotine replacement therapy in their attempt to stop using cigarettes. Challenges to cessation included difficulty finding available tobacco treatment programs, limited access to treatment medications, and experiencing nicotine withdrawal symptoms. Our findings suggest the feasibility of Quit & Win interventions in community mental health settings. Further efforts are required to enhance recruitment, engagement, and retention, and to support access to community-based tobacco treatment resources.

Vaping to quit smoking: Qualitative study of people receiving opioid agonist treatment.

Most patients receiving opioid agonist treatment (OAT) smoke tobacco. Approved cessation interventions are less effective in this group than the wider population. We investigated how people on OAT experience nicotine vaping to quit smoking. Patients on OAT randomised to the vaping arm of a smoking cessation trial were invited to participate in structured interviews incorporating broad pre-determined themes. A qualitative descriptive approach employing template analysis was used. Four authors coded transcripts, discussed discrepancies, modified the template using both inductive and deductive approaches. Authors made explicit their starting orientations and independent authors sought disconfirmatory data in a subsequent round of analysis. Four women and eight men (median age 44 years) participated, including four who identified as Aboriginal. Participants reported vaping as cheaper, more acceptable and less stigmatising than smoking but expressed concerns about ongoing accessibility due to the Australian prescription access model. Some found it technically challenging at first, but not more so than standard nicotine replacement therapies. Participants gave accounts of craving and withdrawal experiences, including supplementary use of nicotine patches, and compulsions to vape frequently and intensely, potentially indicating need for higher nicotine dosage. Participants generally reported that vaping helped them quit smoking, though some worried about swapping nicotine addictions. Others were glad to be using a lower-risk alternative. This group reported varied experiences of nicotine vaping but were mainly optimistic that it could help them and others quit smoking. This was despite initial nicotine cravings and concerns about remaining addicted long-term.

Efficacy of a smoking cessation program for patients with lung cancer.

357 Background: Smoking cessation improves overall mortality and cancer-specific mortality in patients with lung cancer. However, cessation is rarely successful without medical assistance, indicating a need for focused intervention in patients with lung cancer. Referrals for formal counseling can facilitate access to smoking cessation resources and serve as an impetus for cessation. In this study, we analyzed the efficacy of the smoking cessation program at our institution’s cancer center and identified opportunities for improvement in patient outreach, education, recruitment, and retention. Methods: A retrospective chart review of patients at our institution's cancer-dedicated smoking cessation center was conducted between January 1, 2022, to August 31, 2023. All referred patients with primary lung cancer or documented lung metastasis were included. Patient demographic and medical information were collected from the electronic medical record. Data was analyzed with descriptive (frequency, mean, median, interquartile ranges (IQR), 95% confidence interval) and inferential (t-test, Chi-Squared/Fisher’s Exact) statistics. P-value <0.05 was deemed significant. Results: 138 patients were referred for smoking cessation counseling, 24 (17.4%) attended counseling, and 14 (58.3%) attended ≥2 visits. Patients had a median time from referral to first session of 14 days (IQR=8.5). All counseled patients were prescribed nicotine replacement therapy (NRT) with 19 receiving multiple modalities. Of the 23 patients actively smoking at first meeting, 19 (82.6%) saw some reduction in packs/day (PPD) compared with 55 (51.9%, n=106) in actively smoking non-counseled patients (p=0.006). Counseled patients saw improvement in packs/day smoking with a mean reduction of 0.66 PPD (p=0.0001, [0.36, 0.95 95% CI]). Patients who attended >2 meetings saw a mean PPD reduction of 1.13 (p=0.004, [0.49, 1.78 95% CI]). In patients who did not attend counseling, 82 (71.9%, n=114) were never successfully contacted. There was no significant difference in age, gender, race, or insurance between patients who attended or did-not-attend counseling. Conclusions: Our smoking cessation program demonstrates effectiveness in facilitating a significant decrease in PPD. However, low utilization presents an opportunity for quality improvement to identify barriers to engagement and improve patient outreach. Proposed interventions include strategies such as patient-portal mediated outreach, provider reminders in the EMR, and utilization of referral and scheduling at initial oncology appointment as quality metrics. Smoking cessation program. Program Efficacy Number of Visits Mean Packs/Day Decrease [95% CI] 1 (n=9) 0.31 [-0.12, 0.73] 2 (n=6)* 0.56 [0.20, 0.91] >2 (n=8)** 1.13 [0.49, 1.78] Total (n=23)*** 0.66 [0.36, 0.95] Attended Counseling n (%) Did Not Attend Counseling n (%) Patients with Any Decrease in Packs/Day* 19 (82.6) 55 (51.9) Patients Attaining Relapse Free Cessation 9 (37.5) 26 (22.8) *p<0.05, **p<0.005, ***p<0.0005.

Call to quit: Results of a remote, longitudinal tobacco cessation program.

356 Background: Tobacco cessation counseling remains suboptimal for patients with cancer. The current iteration of the Dana-Farber Cancer Institute Tobacco Cessation Program was established in 2021 to provide virtual, longitudinal tobacco session counseling to patients with cancer. Here, we report the Program’s experience. Methods: The DFCI Tobacco Cessation Program data from 2021 to 2023 was analyzed. Descriptive statistics summarized demographics and tobacco cessation experiences from baseline and follow-up visits. Results: Of 227 patients referred to the Program and included in the analysis (Table 1), 161 declined participation. 63 participants attended a baseline visit, of whom the median age for first cigarette was 15 years (range: 10-32) and the median age for regular tobacco use was 17 years (range: 10-61). Prior to baseline, most participants (n=43) indicated using tobacco daily; the median number of daily cigarettes was 11-15. Many (n=41) reported smoking within 30 minutes of waking up, and most considered tobacco use to be an addiction (n=50). Though a considerable number of participants (n=27) reported quitting smoking to be extremely important to them, confidence in quitting varied; the most frequently selected confidence level was 5/10 (n=14). Past use of tobacco cessation drugs was reported by one-third of participants (n=22); past use of nicotine replacement therapy was reported by nearly half (n=30). The most frequently reported perceived benefit of quitting smoking was better health (n=48). 51 participants had at least one follow-up visit (median: 4, range: 1-23). At the time of first follow-up, 10 reported decreasing the number of cigarettes smoked per day, 20 reported no change, and 3 reported an increase. However, among 24 participants who attended a fifth visit, 8 reported a decrease and 6 reported no change. Of 11 patients who had attended at least 10 visits, 5 reported decreasing their number of daily cigarettes. 13/63 (20.6%) of all participants reported quitting smoking after enrolling, with a median time from baseline assessment to smoke-free status of 34 days. Conclusions: Remote, longitudinal tobacco cessation programs provide an effective way to increase access to tobacco cessation counseling for patients with cancer. However, limitations include high decline rates and loss to follow up. Future analysis of our program will help better understand tobacco cessation efforts. Demographics Approached (n=227) Attended Baseline (n=63) Median Age 60 62 Sex Female 130 (57.3%) | Male 94 (41.4%) |Prefer not to say/Unknown 3 (1.3%) Female 36 (57.1%) |Male 26 (41.3%) |Prefer not to say 1 (1.6%) Cancer Lung 80 (35.2%) |Breast 46 (20.3%) |Head & Neck 27 (11.9%) |GI 24 (10.6%) Lung 22 (34.9%) |Breast 9 (14.3%) |Head & Neck 11 (17.5%) |Lymphoma 6 (9.5%) Race: White 191 (84.1%) 52 (82.5%) Black 17 (7.5%) 4 (6.3%) Asian 4 (1.8%) 1 (1.6%) Other/Prefer not to say 15 (6.6%) 6 (9.5%) Hispanic 8 (3.6%) 3 (5.1%)

A randomized controlled trial evaluation of a smoking cessation and physical activity intervention delivered via telemedicine in the Norton Sound region of Alaska

ObjectivesTobacco use disproportionately affects Alaska Native people. Physical activity may aid quitting smoking and provides health benefits. We tested telemedicine-delivered heart health interventions in Alaska’s Norton Sound region. MethodsAlaska Native adults (N = 299, 51.5 % male, 60.5 % Inupiaq) with hypertension and/or hypercholesterolemia who smoked daily were randomized to intervention on smoking and physical activity (group 1) or traditional diet and medication adherence (group 2). Intention to change was not required for participation. Stage-tailored mailed workbooks and personalized reports were supported by telehealth counseling at baseline, 3, 6, and 12 months. Study outcomes were assessed at baseline, 3-, 6-, 12-, and 18-months (i.e., 6-months after the final counseling session). Smoking outcomes were self-reported 7-day point prevalence abstinence (7d-PPA),11Abbreviations:7d-PPA: 7-day point prevalence abstinenceMET: Metabolic equivalent of taskMVPA: Moderate-to-vigorous physical activityNRT: Nicotine replacement therapy. bioconfirmed with urine anabasine; 24-hour quit attempts; and 50 % reduction in smoking. Self-reported physical activity outcomes were metabolic equivalent of task (MET) minutes and meeting moderate-to-vigorous physical activity (MVPA) guidelines. ResultsAt baseline, participants averaged 12.4 (SD = 10.0) cigarettes/day, with 19.4 % prepared to quit smoking, and 81.6 % meeting MVPA guidelines. During the study, most (70.2 % group 1; 63.5 % group 2) reported a 24-hr quit attempt (p = 0.219), and Group 1 (53.6 %) was more likely than Group 2 (28.4 %) to use nicotine replacement therapy (NRT), OR = 2.92, p < 0.001. At 18-months, 40.5 % (group 1) and 32.5 % (group 2) had reduced their smoking by half or more (p = 0.343), and 10.8 % vs. 7.9 % (group 1 vs. 2) reported 7d-PPA with 4 % vs. 6 % (group 1 vs. 2) bioconfirmed. Time and baseline stage of change predicted 7d-PPA (p’s≤.015), with no group effect (p = 0.325). Activity levels did not significantly differ by group or time. ConclusionsTelemedicine counseling supported NRT use but did not significantly affect behavioral outcomes.

Abstract B042: Gender-affirming cessation support for LGBTQ+ tobacco users: Establishing TheQuitAlliance

Abstract Background. The LGBTQ+ community faces various stressors, including stigma, discrimination, and harassment, which are linked to their sexual orientation or gender identity. Additionally, they are targeted by tobacco companies through marketing, which increases tobacco use and other health problems. LGB adults use commercial tobacco products at a higher rate than the general population (25.1% versus 18.8%), and tobacco use is even higher among transgender adults according to the CDC. Without peer support, counseling, nicotine replacement therapy (NRT), and community resources to address barriers to quitting, tobacco users are less likely to succeed in quitting. Research has shown that gender-affirming tobacco cessation interventions can be highly effective in helping LGBTQ+ individuals quit tobacco; however, little is known about its effectiveness in Latinx communities and other groups with intersectional identities. Methods. To improve access to culturally tailored and gender-affirming cessation resources that acknowledge the unique experiences and stressors faced by our community, Cedars-Sinai Cancer COE developed TheQuitAlliance, a LGBTQ+ focused tobacco cessation program. This multi-level approach involved web-based resources, information and presentation to the community. A series of gender affirming support groups facilitated by trained Spanish speaking tobacco cessation specialists who are members of the LGBTQ+ community was offered to tobacco users. The first steps involved improving their knowledge on how tobacco affects specific populations, such as transgender, non-binary, gender non-conforming individuals, people living with HIV, youth, and the types of nicotine replacement therapies available. RESULTS: In 2023, our partners The Wall Las Memorias and Latino Equality Alliance implemented a screening tool using the Ask, Advise, and Refer model, expanded outreach efforts, and successfully identified N=242 LGBTQ+ tobacco users who were referred to our virtual gender affirming support group. Among current smokers who participated in a series of three support groups, 85% (17 of 20) indicated positive attitudes towards the importance of changing their smoking behaviors, readiness to change, and having control over their ability to make positive change right now, while 90% are committed to taking steps towards change right now (18 of 20). In 2024, The Wall Las Memorias reached 500 LGBTQ+ community members and linked 70 tobacco users to cessation support groups. Conclusion. Our survey indicated that participating in a gender affirming cessation intervention can increase self-efficacy to take steps towards quitting tobacco. Through safe spaces created by The Quit Alliance, we found that LGBTQ+ tobacco users are also able to make connections with others to be supported in their journey to becoming tobacco free. Citation Format: Victor Crisanto, Alexandra Caro, Reener Balingit, Zul Surani. Gender-affirming cessation support for LGBTQ+ tobacco users: Establishing TheQuitAlliance [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B042.

Delivering smoking cessation interventions in NHS primary dental care - lessons from the ENHANCE-D trial

AbstractIntroduction Smoking is a major contributor to health inequalities in the UK. The ENHANCE-D trial is evaluating three smoking cessation interventions (nicotine replacement therapy [NRT], electronic cigarettes [ECs] or ‘very brief advice') delivered in NHS primary dental care. This qualitative study aimed to provide insight into the factors that could influence the adoption of the interventions in these settings.Methods Interviews were conducted at two timepoints. Purposive maximum variation sampling was used to recruit and interview a total of 24 dental patients, 12 dental professionals and three NHS dental commissioners. Thematic analysis was carried out using normalisation process theory as an analytical framework.Results Dental settings were perceived as an appropriate location to deliver smoking cessation interventions. Patients had several motivating and demotivating factors regarding use of NRTs or ECs; they often had negative preconceptions. Financial considerations were major influencers for both patients and dental teams. The time pressures for dental practices were identified as a major barrier. Some practical issues, such as procurement and stock supply, would need to be considered if the ENHANCE-D interventions were to be implemented in routine practice.Conclusion Primary dental care teams are well-placed to deliver smoking cessation interventions. However, a number of facilitators and deterrents have been identified and strategic changes are needed for successful implementation.

Nicotine replacement therapy and oral health: a network meta-analysis of adverse effects in randomized trials

Nicotine replacement therapy and oral health: a network meta-analysis of adverse effects in randomized trials

Cost-effectiveness analysis of e-cigarettes compared to nicotine replacement therapy for smoking cessation among Medicaid users in California.

Smoking is the leading preventable cause of death and disability in the United States (US). A 2019 randomized controlled trial found e-cigarettes are more effective than nicotine replacement therapy (NRT) in achieving abstinence when both are combined with behavioral counselling. Few cost-effectiveness studies have been performed regarding e-cigarettes as an adjunct to cessation efforts, and none in a US context. This study evaluated the cost-effectiveness of e-cigarettes compared to NRT, both with counselling, as cessation aids for Medicaid smokers in California. A cost-effectiveness analysis from a US societal perspective comparing e-cigarettes with NRT was constructed. Using a lifetime horizon, smokers were followed to different health states to their expected lifespan. Costs were expressed in 2020 US dollars and health outcomes in quality-adjusted life years. All costs and outcomes were discounted at a 3% annual rate and model findings were assessed with a series of sensitivity analyses. Using US willingness-to-pay thresholds, e-cigarettes were more cost-effective than NRT, with an incremental cost-effectiveness ratio of $11,454 per additional QALY gained over smokers' lifetimes. Results were sensitive to smokers' healthcare costs, model start ages, discount rate, and QALY weights. E-cigarettes used as a cessation treatment by smokers are more cost-effective relative to NRT. However, e-cigarettes as a treatment are currently unapproved by the Food and Drug Administration (FDA). Despite lack of FDA approval, e-cigarettes are a popular choice among smokers trying to quit. Policymakers should consider whether providing financial support for e-cigarettes as a harm reduction strategy is worth pursuing. As e-cigarettes grow in popularity and are an increasingly preferred choice of smoking cessation aid among smokers attempting to quit, it is important to examine the inclusion of these products in tobacco policy, research, and practice. Several countries have now adopted or are in the process of adopting e-cigarettes as a medically licensed and regulated smoking cessation aid. Future smoking cessation strategies by US policymakers may consider the adoption of e-cigarettes as a cost-effective harm reduction tool for use by current smokers seeking to quit.

Smoking cessation pharmacotherapy; varenicline or bupropion?

Tobacco smoking is a worldwide health problem and one of the leading causes of premature deaths in last years. As there are lots of researches focusing on cessation strategies with attention to pharmacotherapy and behavioral counseling, the aim of this study was to compare two of the first-line FDA-approved pharmacotherapies for smoking cessation; varenicline and bupropion. This writing is an overview of researches published in Pubmed database from 2012 to 2022 with "Varenicline" and "Bupropion" as key words. Among the researches that were found, 24 articles were selected which mainly focused on comparison of these two medicines. Varenicline and bupropion are known as non-nicotinic pharmacotherapy and have been used in addition to nicotine replacement therapy for smoking cessation. Varenicline is partial agonist for α4β2 nicotinic acetyl choline receptors while bupropion, classified as an atypical antidepressant, is actually a norepinephrine and dopamine reuptake inhibitor. Although these treatments can result in some adverse effects including nausea, insomnia, anxiety, irritability, fatigue and abnormal dreams, their efficacy in reduction of craving and also maintenance of abstinence is well been studied and approved by FDA. Moreover, adverse effects are usually mild to moderate clinical symptoms which can be tolerated and also easily managed and prevented in cases. The efficacy and tolerability of varenicline and bupropion as treatments for smoking cessation is well understood. However, studies have shown that varenicline seems to be more effective in maintaining of abstinence and also reducing craving than bupropion and NRT.

Aboriginal and Torres Strait Islander people who smoke and want to quit - a cohort profile from the Koori Quit Pack study.

Reducing the prevalence of smoking is a national priority, however there is limited evidence on what smoking cessation supports are utilised, accessible, and effective among Aboriginal and Torres Strait Islander people. This paper describes a cohort profile of Aboriginal and Torres Strait Islander people who smoke and want to quit to inform tailored smoking cessation interventions. Aboriginal and Torres Strait Islander people residing in New South Wales (NSW), Australian Capital Territory (ACT), and Victoria, who were smokers wanting to quit, were recruited through health services and online advertisements from May to October 2022. Descriptive and inferential statistics were used to summarise participant characteristics and explore factors associated with previous use and adherence to Nicotine Replacement Therapy (NRT) and intention to use Quitline services. 165 participants were recruited. Almost all (93.9%) had made at least one previous quit attempt, and 40.6% had used behavioural support. The majority believed NRT was safe (80.6%), effective (70.3%) and tried NRT previously (89%). Preferred forms of NRT for current quit attempts were nicotine patches (85.5%) and inhalers (69.7%). Intention to use Quitline was found to be higher among participants aged 31-45 years compared to participants under 30 years (AOR=3.12, 95%CI, 1.01-9.76). Aboriginal and Torres Strait Islander people are highly motivated to be smoke-free. However, efforts to enhance access and adherence to cessation supports are needed. The rapid recruitment and interest in the mailout cessation support should be scaled up to support Aboriginal and Torres Strait Islander peoples to quit. The Australian Government has recently launched a national tobacco strategy which includes targets for reducing smoking prevalence to less than 27% among Aboriginal and Torres Strait Islander peoples. In order to meet these targets Aboriginal and Torres Strait Islander people who smoke and want to quit should have access to culturally safe and responsive support. We found that Aboriginal and Torres Strait Islander people have made quit attempt, accessed evidence-based smoking cessation care, and have positive attitudes towards NRT. However, acknowledging relapse, further evidence is required to understand the factors associated with sustained quitting.

Effectiveness of mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling at outdoor smoking hotspots: A cluster randomized controlled trial.

To evaluate the effectiveness of mobile smoking cessation (SC) treatment with 1-week nicotine replacement therapy (NRT) sampling on recruitment and quitting outcomes. Two-arm cluster RCT (1:1 ratio), single-blinded, at 244 recruitment sessions in Hong Kong outdoor smoking hotspots from October 2018-December 2019. Participant were recruited by ambassadors and treated at the mobile SC truck. 834 adult (≥18 years, male 81.3%) daily smokers, Chinese-speaking, non-NRT users in the past month, consented after nurse-led intervention in mobile SC truck were randomized to the experimental (n = 482 male 79.5%) and the control group (n = 352, male 83.8%). The experimental group received a 1-week free NRT sample, an NRT instruction card, and mobile SC treatment including onsite nurse-led brief medication advice (about 15 minutes) and referral to SC clinics. The control group received the same mobile SC treatment. Primary outcome was self-reported quit attempts at 1-month follow-up. Secondary outcomes included SC service use at 1month, and biochemically validated abstinence (exhaled carbon monoxide < 4ppm; or saliva cotinine < 10ng/ml) at 6-month follow-up. Additionally, a post-hoc cost analysis was conducted. By intention-to-treat, the two groups showed similar prevalence of quit attempts (44·4% versus 43·5%, risk ratio (RR) = 1·04, 95% confidence interval (CI) = 0·79-1·37, P = 0·79). Compared with the control group, the experimental group showed lower SC service use at clinics (32·4% versus 44·9%, RR = 0·72, 95%CI = 0·57-0·91, P = 0·006), but no significant difference in validated abstinence (4·6% versus 2·8%, RR = 1·64, 95%CI = 0·76-3·50, P = 0·21). The experimental recruitment sessions recruited more smokers for onsite medication advice than the control session (mean 6·7 vs 5·0, adjusted incident rate ratio = 1·30, 95%CI = 1·08-1·56, P = 0·005). Mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling did not increase quit attempts or abstinence outcomes among recruited daily smokers in Hong Kong. The intervention increased smokers' uptake of onsite medication advice but reduced subsequent smoking cessation service use at clinics.