Smoking Cessation Options Research Articles

Connecting veterans with smoking cessation services in less than 3 minutes.

Veterans smoke disproportionately higher (nearly 1.3 times greater) than the general population and puts them at greater risk for tobacco-related illnesses. Annual screenings by the primary care providers are conducted at Veterans Health Administration (VHA) primary care clinics, but this practice may be inadequate to overcome the chronicity of smoking. The Ask, Advise, Refer strategy for smoking cessation was integrated in the workflow and implemented by the nursing staff at a VHA outpatient surgery clinic. Nurses established smoking status, advised smokers to quit, and for those interested, provided the smoker a list of resources Department of Veterans Affairs' approved smoking cessation options (telephone, text, and web-based interventions). All the smokers took a referral card containing a list of resources to help them quit smoking. During the follow-up phone calls after the clinic visit, 19% of patients reported using at least one of the resources listed on the card. Each clinical encounter should be viewed by health care providers as a window of opportunity to promote smoking cessation. The simplicity of the AAR strategy is effective in promoting smoking cessation especially in busy outpatient settings.

Connectivity of Real-Time Video Counselling Versus Telephone Counselling for Smoking Cessation in Rural and Remote Areas: An Exploratory Study.

This study compared the connectivity of video sessions to telephone sessions delivered to smokers in rural areas and whether remoteness and video app (video only) were associated with the connectivity of video or telephone sessions. Participants were recruited into a randomised trial where two arms offered smoking cessation counselling via: (a) real-time video communication software (201 participants) or (b) telephone (229 participants). Participants were offered up to six video or telephone sessions and the connectivity of each session was recorded. A total of 456 video sessions and 606 telephone sessions were completed. There was adequate connectivity of the video intervention in terms of no echoing noise (97.8%), no loss of internet connection during the session (88.6%), no difficulty hearing the participant (88.4%) and no difficulty seeing the participant (87.5%). In more than 94% of telephone sessions, there was no echoing noise, no difficulty hearing the participant and no loss of telephone line connection. Video sessions had significantly greater odds of experiencing connectivity difficulties than telephone sessions in relation to connecting to the participant at the start (odds ratio, OR = 5.13, 95% confidence interval, CI 1.88–14.00), loss of connection during the session (OR = 11.84, 95% CI 4.80–29.22) and hearing the participant (OR = 2.53, 95% CI 1.41–4.55). There were no significant associations between remoteness and video app and connectivity difficulties in the video or telephone sessions. Real-time video sessions are a feasible option for smoking cessation providers to provide support in rural areas.

Investigating gender differences for effectiveness and side effects of varenicline during smoking cessation treatment.

Varenicline is a useful pharmacological option for smoking cessation. Unfortunately, there is a lack of studies on its effectiveness, retention, and side effects in low- and middle-income countries. The present study aimed to investigate gender differences regarding these outcomes in a Brazilian clinical sample (n = 124). The 12-week treatment protocol included six consultations with a psychiatrist and six sessions of cognitive-behavioral therapy. All subjects received varenicline on the first evaluation, following the standard posology for 12 weeks and instructions to stop smoking after the second week of treatment. Both Mini-International Neuropsychiatric Interview (MINI) Plus and Fagerstrom Test for Nicotine Dependence were applied at baseline. The UKU-Side Effects Rating Scale was administered at weeks 3, 7, and 11, and the Questionnaire of Smoking Urges-Brief at weeks 1, 5, and 9 to ascertain the side effects of the medication and craving, respectively. At the end of the 12-week treatment, abstinence was biochemically assessed. At months 6 and 12 after the treatment, follow-up telephone interviews were conducted to access nicotine abstinence. Short- and long-term abstinence and retention rates did not differ between genders. However, women presented more side effects than men, especially in the second half of the treatment. Increased dream activity, reduced duration of sleep, constipation, and weight loss were the most notable side effects. Despite women reporting more side effects than men, this difference did not influence the treatment success rates.

Assessing the immunogenicity and toxicity of the AFPL1-conjugate nicotine vaccine using heterologous and homologous vaccination routes.

Despite the increased risks of cancers and cardiovascular related diseases, tobacco smoking continues to be prevalent in the population due largely in part to the addictive nature of nicotine. Nicotine vaccines are an attractive alternative to the current smoking cessation options but have yet to be successful enough in clinical trials to reach the market due to a lack of neutralizing antibodies and inconsistent results. Using AFPL1 derived from the Cuban meningococcal vaccine as an adjuvant, we have previously published promising results with an intranasally administered nicotine vaccine. In order to examine the immunogenicity and safety of this vaccine in mice we set up a pilot trial administering the vaccine either intranasally, intramuscularly or utilizing both routes simultaneously and evaluated immune responses and clinical symptoms throughout the duration of the vaccination protocol and post-mortem. These data further demonstrate the ability of the AFPL1 nicotine conjugate vaccine to be a safe and potential candidate for clinical use.

Existing and emerging smoking cessation options for people with schizophrenia spectrum disorders

Tobacco cigarette addiction is a deeply entrenched behavior among people with Schizophrenia Spectrum Disorders, and consequently these individuals die an average of 25 years earlier than the general population. The aim of this review was to evaluate the state-of-the-science focused on cessation and reduction interventions for people with SSD. We searched peer-reviewed articles from medline, psycinfo, web of science, scopus, and cochrane library, about cessation interventions for people with SSD. The search was carried out by combining an exhaustive list of terms denoting schizophrenic disorder and smoking cessation treatment. The review search period was limited from January 2000–November 2018, 260 studies were identified and a total of 24 of studies were included in the final review. This review demonstrates the vulnerability of smokers with SSD and underscores the need for research in these areas with large enough sample sizes to detect treatment effects: 1) outcomes using and comparing standard treatments 2) long-term cessation/reduction outcomes 3) flexible treatment options 4) more research to develop the evidence-base for e-cigarettes intervention.

Novel Mineral-Vitamin Treatment for Reduction in Cigarette Smoking: A Fully Blinded Randomized Placebo-Controlled Trial.

Many smokers do not achieve abstinence using current smoking cessation options. This randomized controlled trial (RCT) investigated a novel nutritional supplement to assist with quitting smoking. Following a baseline phase where cigarettes per day and nicotine dependence were measured, participants (n = 107) were randomized to placebo (n = 50) or micronutrient conditions (n = 57). A 4-week pre-quit phase permitted titration up to 12 capsules/day. During the quit phase (12 weeks), participants were registered with a public Quitline while consuming micronutrients or placebo. Carbon monoxide levels were measured to confirm smoking cessation. Forty-five (42%) participants completed the trial. Treatment and placebo groups did not differ on the primary outcome of continuous abstinence at 12 weeks using intention-to-treat analysis; however, 28% of the micronutrient-treated group had quit versus 18% for placebo (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 0.71 to 4.48), with number needed to treat = 10. Comparison of cigarette consumption (cigarettes per day) between micronutrient and placebo groups showed that those taking micronutrients reported reduced consumption throughout the trial, notably at pre-quit weeks 1 and 4, and at quit phase week 4. There were no serious adverse events, blinding was successful, and there were no substantive group differences in side effects or dropout rate. This is the first RCT investigating the impact of micronutrients on smoking reduction, finding that micronutrients reduced harm through reduction in number of cigarettes smoked relative to placebo. The small sample and high dropout rate limit confidence in the conclusions and generalizability of the study; however, assessed by number needed to treat, micronutrients are comparable to other smoking cessation treatments but with fewer side effects. Future research using larger and longer trials including cost-effectiveness and biomarker measures is encouraged. Micronutrients are being increasingly studied for the treatment of psychiatric conditions, but direct application of micronutrients as a treatment for addictions is novel. There is extensive evidence that micronutrients alleviate stress. Given that tobacco smoking is often used to cope with stress, taking micronutrients may moderate the stress of withdrawal and increase the chance of a successful quit attempt. This study is the first known RCT to investigate the use of micronutrients to support smoking cessation. Treatments that are safe, effective, relatively inexpensive, and readily available are needed and micronutrient supplements offer one such possible alternative.

Closing the medical mortality gap in patients with major psychiatric conditions.

This article discusses options for closing the mortality gap between the general population and people with major psychiatric conditions such as psychosis, autism, learning disability and dementia. Most of the mortality (85%) involves physical disease, with most deaths occurring in general hospitals or care homes, so is relevant to all doctors. The main focus of psychiatric treatments has been to reduce suicide, although there is no evidence that they achieve this. This article calls for psychiatrists to collaborate with medical colleagues to help reduce excess deaths from physical causes. The practicalities of combined physical and mental health monitoring and prescribing clinics are discussed, based on experience in Whitby. Potential national solutions are summarized including options for smoking cessation, sugar restriction, nutritional supplementation and flu vaccination.

Journal Digest

Journal Digest

Practice Patterns Among Eye Care Providers at US Teaching Hospitals With Regard to Assessing and Educating Patients About Smoking

To investigate practice patterns of eye care providers at academic medical centers in the United States (US) with regard to assessing patients' smoking status and exposure, educating patients regarding ocular risks of smoking, and counseling patients about smoking cessation. Cross-sectional survey. An anonymous survey including multiple choice and Likert-style questions was constructed on http://www.surveymonkey.com and emailed to the coordinators of all 113US ophthalmology residency programs, with a request to forward to all faculty, fellows, residents, and optometrists at their institution. Main outcome measures include proportion of eye care providers who assess patients' smoking status, educate patients regarding ocular risks of smoking, and discuss with patients smoking cessation options. Of the 292 respondents, 229 (78%) "always" or "periodically" ask patients about their smoking status, 251 (86%) "seldom" or "never" ask patients about secondhand smoke exposure, 245 (84%) "always" or "periodically" educate patients about ocular diseases associated with smoking, 142 (49%) "seldom" or "never" ask patients who smoke about their willingness to quit smoking, and 249 (85%) "seldom" or "never" discuss potential methods and resources to assist with smoking cessation. Most eye care providers assess patients' smoking status and educate patients regarding ocular risks of smoking. However, approximately half do not ask, or seldom ask, about patients' willingness to quit smoking, and most do not discuss smoking cessation options.

What are the best pharmacologic smoking cessation options for patients with mental health conditions?

EVIDENCE-BASED ANSWER Bupropion, with or without nicotine replacement therapy (NRT), as well as fluoxetine and paroxetine have no long-term effect on smoking cessation in patients with depression. Similarly, bupropion, with or without transdermal nicotine patches, and varenicline have no long-term effect on smoking cessation in patients with schizophrenia, even though rates of cessation may be higher at the conclusion of active treatment (SOR: A, meta-analyses of RCTs).

Development and application of culturally appropriate decision aids for smoking cessation in Korea: a pragmatic clustered randomization crossover trial.

IntroductionIn Asian countries, reluctance to seek pharmacological intervention is a major barrier for smoking cessation. Culturally appropriate decision aids are expected to help people in the decision making for the use of smoking cessation medication.ObjectiveThe aim of this study was to develop a culturally tailored decision aid for smoking cessation and evaluate its effect on the use of smoking cessation medication.Patients and methodsA 7-minute video on smoking cessation information and options was developed. Physicians were randomized into intervention and control groups. The decision aid was provided to patients in the intervention group, and they watched it, while those in the control group were provided usual medical care for smoking cessation. The primary outcome was the proportion of smokers who were prescribed smoking cessation medication within 1 month after consultation. The secondary outcomes were abstinence rate and use of smoking cessation medication within 6 months. A logistic regression analysis was used to assess the effect of the decision aid on the outcomes.ResultsIn total, 414 current smokers (intervention group: 195; control group: 219) were enrolled. The mean age of the participants was 48.2 years, and 381 subjects (92%) were males. In total, 11.8% of the participants in the intervention group and 10.5% in the control group were prescribed smoking cessation medications within 1 month. The odds ratio was 1.02 (95% CI: 0.40–2.63) after adjustment for baseline characteristics. Within 6 months, 17.4% of the participants in the intervention group and 15% in the control group were prescribed medication (adjusted odds ratio 1.12, 95% CI: 0.59–2.13).ConclusionThe culturally tailored smoking cessation decision aid developed in this study did not show a significant impact on the decision to use smoking cessation medication. Further research to develop more effective and more interactive interventions is expected.

Correlates of Co-Occurring Diabetes and Obesity Among Community Mental Health Program Members With Serious Mental Illnesses.

This study examined the prevalence and correlates of co-occurring obesity and diabetes among community mental health program members. Medical screenings of 457 adults with serious mental illnesses were conducted by researchers and peer wellness specialists in four U.S. states. Body mass index was measured directly. Diabetes was assessed via glycosylated hemoglobin and interview self-report. Multivariable logistic regression analysis examined associations with known predictors. In the sample, 59% were obese, 25% had diabetes, and 19% had both conditions. When gender, diagnosis, and site were controlled, co-occurring diabetes and obesity was almost three times as likely among African Americans (OR=2.93) as among participants from other racial groups and half as likely among smokers as among nonsmokers (OR=.58). Older persons and those with poorer self-rated physical health also were more likely to have these co-occurring conditions. Results support the need for culturally competent treatment and for smoking cessation options with sensitivity to the potential for weight gain.

Journal of Addictive Behaviors,Therapy & Rehabilitation

Background: Nicotine is an addictive substance present in cigarette smoke that causes a great number of health effects and is a leading cause of preventable death. Objective: This article provides information regarding the addictive nature of nicotine, adverse health effects, current detection methods, alternative approaches, and smoking cessation. Results and Discussion: An average cigarette allows a person to absorb approximately 1 mg of nicotine, which produces euphoria and establishes addiction. Nicotine binds to nicotinic receptors and activates cell signaling cascade leading to dopamine and other neurotransmitter release resulting in euphoria and pleasure. After exposure to nicotine for some time the receptors become unresponsive/desensitized. Later the receptors become responsive again due to abstinence, which is believed to play a role in dependence. A process called neuro adaptation also generates more nicotinic receptors in response to desensitization. Cigarette smoking produces harmful effects including cancer, cardiovascular disease, COPD, and congenital defects. Detection methods for nicotine include HPLC, HPLC MS/MS, semi-quantitative dipstick, liquid chromatographytandem mass spectrometry (LCTMS), and gas chromatography mass spectrometry (GCMS). Alternative products/approaches to smoking include cigars, pipe smoking, hookah, and e-cigarettes. Currently there is conflicting evidence comparing cigars, pipe smoking, and cigarettes on their effect on mortality. Many studies demonstrate modest efficacy for e-cigarettes as a smoking cessation tool; however, current guidelines recommend use of other forms of nicotine replacement, bupropion SR, or Varenicline. Implications: This article provides an overview of nicotine addiction through cigarette smoke, their health effects and detection methods. This article discusses the effects of alternative tobacco products and e-cigarettes compared to cigarettes. It also provides current treatment options for smoking cessation.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Pharmacological Options for Smoking Cessation in Heavy-Drinking Smokers.

There is a high prevalence of comorbid tobacco use and alcohol use disorder (AUD), affecting more than 6 million people in the US. Globally, tobacco and alcohol use rank fourth and fifth, respectively, for disability-adjusted life-years lost. Levels of alcohol use are higher in smokers than nonsmokers, and the prevalence of smoking is higher in heavy drinkers compared with nondrinkers. This relationship is driven by many different factors, including genetics, neurobiological mechanisms, conditioning processes, and psychosocial influences. Although this unique population tends to experience more negative health consequences, more severe AUD, and poorer response to treatment than those with either AUD or tobacco use disorder alone, there are currently no available treatment protocols tailored to this comorbid condition. In this review, we provide a comprehensive review of ongoing clinical research into smoking cessation options for heavy-drinking smokers (HDS) through an evaluation of the effect of promising novel pharmacotherapies as well as combination therapies, including varenicline, naltrexone, the combination of varenicline and naltrexone, and the combination of naltrexone and nicotine replacement therapy (NRT). These treatments are considered in light of the standard of care for smoking cessation, and seek to improve upon the available guidelines for this sizeable subgroup of smokers, namely those smokers who drink heavily.

Effect of a D3 receptor antagonist on context-induced reinstatement of nicotine seeking.

Despite the existence of several treatment options for smoking cessation, the rate of relapse after treatment is very high. We and others have proposed that targeting the dopamine D3 receptor (DRD3) may be a good strategy for treatment of nicotine dependence. In human participants, reintroduction to an environment previously associated with drug-taking may induce relapse. In animals, such phenomenon can be studied using the context-induced reinstatement paradigm. As the role of DRD3 in context-induced reinstatement of nicotine-seeking has not yet been explored, we investigated the effects of different doses of the selective DRD3 antagonist SB-277011-A on this reinstatement. Sprague-Dawley adult rats were first trained to self-administer nicotine and subsequently underwent extinction in a second context for 5-7 days. We evaluated the effect of 1, 3 or 10mg/kg of SB-277011-A administered prior to the reintroduction to the training context. We used two different designs: 1) a between-subjects design with a unique reinstatement test; and 2) a counterbalanced within-subjects design, with 4 reinstatement tests. Our findings indicate that, in the within-subjects design, the magnitude of responding induced by the context-induced reinstatement of nicotine seeking was robust during the first reinstatement test, but significantly decreased with repeated testing. SB-277011-A (10mg/kg) blocked context-induced reinstatement of nicotine-seeking at first exposure to the context (between-subjects design), but not after repeated context exposure which produced weaker reinstatement over days. Our results support a role for DRD3 mediating context-induced reinstatement of nicotine seeking, but these effects may not be sustained over time. Further studies should explore this in human participants for validation.

Pharmacological options for smoking cessation in youths

SMOKING The effective prescribing of nicotine replacement therapy and nurse support can help young people quit smoking, explains Darush Attar-Zadeh

Smoking and Cellular Telephone Use Among Pregnant Women Seeking Prenatal Care: Opportunities for Intervention.

Although smoking during pregnancy is associated with poor pregnancy outcomes, many women continue to smoke throughout pregnancy. Behavioral interventions for smoking cessation yield modest benefits, particularly in lower socioeconomic groups. Pharmacotherapy, a first-line option for smoking cessation, has not shown clear benefits for pregnant smokers, partly due to limited adherence. We evaluated the feasibility of conducting a pharmacotherapy trial for smoking cessation in pregnant women, using text messaging to enhance medication adherence. We surveyed 724 predominantly minority pregnant women to examine the prevalence and correlates of smoking and the use of cellular telephones and text messaging. Nearly 18% of the respondents were current smokers, with a majority (67.7%) expressing interest in participating in a smoking cessation trial. Only about 6% of women with a smoking history ever received nicotine dependence treatment. Smokers were significantly more likely to be depressed than non-smokers. The vast majority of respondents (92.1%) owned cell phones, with 93.2% having an unlimited text-messaging plan. These data support the feasibility of conducting a pharmacotherapy smoking cessation trial and using text messaging to enhance medication adherence in a predominantly minority population of pregnant smokers.

Clearing the air: Chronic respiratory illnesses and smoking cessation in the adult psychiatric population

Objective: To review current practice guidelines in the treatment of asthma and chronic obstructive pulmonary disease (COPD), review therapeutic options for smoking cessation, and apply current evidence to management of these conditions in the psychiatric population.Background: Chronic respiratory illnesses and nicotine dependence are frequently encountered conditions in the psychiatric population. Psychiatric illness itself may contribute to or be affected by these conditions; medication therapy may additionally be linked to alterations in mental status. However, it is well established that when left untreated or improperly managed, chronic respiratory illness and tobacco use can negatively affect patients' quality of life and lead to increased healthcare utilization.Methods: Current practice guidelines, literature reviews, and primary data pertaining to management of patients with asthma, COPD, and nicotine dependence were examined. Additional data regarding patients with psychiatric illness was reviewed and commented upon.Conclusions: Management of this particular population can pose significant clinical challenges. Regardless of what factors may contribute to the disease states and their treatment, it is important for clinicians to identify and take steps to manage both respiratory and psychiatric concerns as they are able. Identification, evidence-based treatment with appropriate medication therapy, and continuing patient education should be used together to help improve patient outcomes.

Development of a Smoking Cessation Algorithm for Primary Care Providers

The primary care setting is an ideal location to promote smoking cessation through counseling and pharmacological aids. Effective smoking cessation options should be offered by primary care providers (PCPs) at each office visit. Smokers report receptiveness to smoking cessation advice given by PCPs. The US Preventive Services Task Force recommends asking about tobacco use in all adults. Counseling using the 5-A model can be performed during a visit. This article discusses development of an evidence-based algorithm using the 5-A model to help PCPs implement a smoking cessation protocol.