Reduction In Cigarettes Per Day Research Articles

Switching from cigarettes to IQOS: the relative importance of IQOS-associated reward, reinforcement and abstinence relief

IntroductionThis study investigated whether IQOS, a heated tobacco product, can fully substitute for combustible cigarettes and the factors that promote substitution.MethodsAdults who smoked cigarettes daily (N=90; 21–65 years) completed a...

The impact of perceived risk of COVID-19 from smoking on the change in number of cigarettes smoked

ABSTRACT Introduction Smoking increases the risk of severe illness and mortality from COVID-19. However, the impact of risk perception on smoking over time is unknown. Method Participants (n = 487) who reported having smoked daily or nondaily in February 2020 were recruited through Reddit and completed a cross-sectional survey. Linear regression models examined the impact of perception that smoking increases the risk of COVID-19 on changes in cigarettes per day (CPD). Results The greater perceived risk of smoking on COVID-19 predicted greater decreases in CPD from before the pandemic (December 2019 – February 2020) to March – May 2020, but no change was observed from March – May 2020 to June – August 2020. However, greater perceived risk predicted increases in CPD from June – August 2020 to November 2020 – January 2021. Participants with high levels of perceived risk (>75th percentile) were more likely to reduce their CPD in the beginning of the pandemic compared to those with low perceived risk (≤25th percentile), but more likely to increase their CPD between June – August 2020 to November 2020 – January 2021, even though perceived risk remained stable over time. Conclusion Perceived risk is associated with a reduction in CPD, but participants returned to their pre-COVID smoking behavior within less than a year.

Immediate Switching to Reduced Nicotine Cigarettes in a U.S.-Based Sample: The Impact on Cannabis Use and Related Variables at 20 Weeks.

The FDA proposed rule-making to reduce nicotine in cigarettes to minimally addictive levels. Research suggests decreasing nicotine levels (i.e. very low nicotine content cigarettes [VLNCs]) produced greater quit attempts, reduced smoking, and reduced exposure to harmful constituents among smokers. The impact of long-term VLNC use among people who co-use cigarettes and cannabis on non-tobacco-specific toxicant and carcinogen exposure has not been investigated. This study presents secondary analyses of a controlled clinical trial examining switching to VLNC (versus a normal nicotine cigarettes control group [NNCs]) between people who co-use cigarettes and cannabis (n = 174) versus smoked cigarettes (n = 555). Linear mixed-effects models compared changes in smoking behavior, and tobacco-specific (i.e. total nicotine equivalents [TNE], 4-[methylnitrosamino]-1-[3-pyridyl]-1-butanone [NNK; total NNAL]) and non-tobacco-specific (i.e. carbon monoxide (CO), 2-cyanoethylmercapturic acid [CEMA], phenanthrene tetraol [PheT]) toxicant and carcinogen exposure at week 20 (with random intercept for participants). Cannabis use was measured among co-use groups. CO was significantly lower only among the cigarette-only group assigned VLNCs (interaction: p = .015). Although both VLNC groups demonstrated decreased CEMA, greater decreases emerged among the cigarette-only group (interaction: p = .016). No significant interactions emerged for TNE, cigarettes per day (CPD), NNAL, and PheT (ps > .05); both VLNC groups decreased in TNE, CPD, and NNAL. Only the cigarette-only group assigned VLNCs demonstrated decreased PheT (p < .001). The VLNC co-use group showed increased cannabis use over time (p = .012; 0.5 more days per week by week 20). Those who co-use cannabis and cigarettes may still be at risk for greater exposure to non-tobacco-specific toxicants and carcinogens compared to those who only smoke cigarettes. The present study is the longest longitudinal, prospective comparison study of smoking behavior and exposure to harmful constituents among those who co-use cigarettes and cannabis versus cigarette-only after immediately switching to very low nicotine content cigarettes (VLNC). Those who co-use experienced similar reductions in CPD and tobacco-specific exposure, compared to those who only use cigarettes. However, co-use groups experienced smaller reductions in non-tobacco-specific toxicants and carcinogens compared to the cigarette-only group, potentially because of combustible cannabis use. Additionally, those who co-use and switched to VLNC may be susceptible to slight increases in cannabis use (approximately two more days per year).

E-Cigarette Provision to Promote Switching in Cigarette Smokers With Serious Mental Illness-A Randomized Trial.

High cigarette smoking prevalence and low quit rates in people with serious mental illness (SMI) contribute to disparate rates of chronic disease and premature death. This prospective trial tested the impact of switching to a potentially lower-harm nicotine-containing product on smoking in this population. A total of 240 cigarette smokers with SMI who tried but were currently unwilling to quit were randomly assigned to receive disposable e-cigarettes for 8 weeks or not, with assessments at baseline, 2, 4, 6, 8, 13, and 26 weeks. Generalized linear mixed models examined the effects of e-cigarette provision on e-cigarette appeal, cigarettes per day (CPD), breath carbon monoxide (CO), nicotine dependence, and side effects. Clinical Trial registration: NCT03050853. Self-reported smoking was similar between groups at baseline (mean = 18.7 CPD). By week 2, 79% of the e-cigarette group were using e-cigarettes daily. During weeks 2-8, CPD and CO decreased in the e-cigarette versus assessment-only group (eg, 7.5 CPD [95% CI = 5.9, 9.2] vs. 18.1 CPD [CI = 16.4, 19.8] and 16.4 ppm [CI = 13.4, 19.5] vs. 25.4 ppm [CI = 22.4, 28.9], respectively, at week 2). Additionally, 19%-22% in the e-cigarette group reported smoking no cigarettes in weeks 2-8 compared to 0% in the assessment-only group. By 13 and 26 weeks, group differences in CPD, but not CO, remained significant. Nicotine dependence did not increase and side effects were minor. Providing e-cigarettes for 8 weeks to smokers with SMI resulted in substantial reductions in CPD and CO. Enhancing and maintaining switching from cigarettes to e-cigarettes warrant further study. This was the first prospective study to compare e-cigarette provision with assessments only to evaluate the appeal and impact of e-cigarettes on smoking behavior, carbon monoxide exposure, and nicotine dependence among smokers with SMI who had tried but were unable to quit and were not currently interested in cessation treatment. The finding that e-cigarette provision led to significant reductions in smoking and carbon monoxide without increasing nicotine dependence has implications for reducing harm not only among the millions of smokers with SMI who struggle to quit, but also for other vulnerable smokers who cannot achieve cessation.

Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trial

BackgroundSmoking cessation is the most effective means of slowing the decline of lung function associated with chronic obstructive pulmonary disease (COPD). While effective smoking cessation treatments are available, they are underutilized and nearly half of people with COPD continue to smoke. By addressing both nicotine and behavioral dependence, electronic cigarettes (EC) could help people with COPD reduce the harm of combustible cigarettes (CC) through reductions in number of Cigarettes per Day (CPD) or quitting CC completely. The purpose of this pilot study is to identify barriers and facilitators to the use of and assess the preliminary effectiveness of EC as a harm reduction strategy among people with COPD.MethodsIn an open-label two-arm randomized controlled trial pilot study, 60 patients identified as smokers with a COPD diagnosis via electronic health records from a large urban health center are randomized in a 1:1 ratio to either standard care [counseling + nicotine replacement therapy (NRT)] or counseling + EC. The NRT arm will receive nicotine patches and nicotine lozenges for 12 weeks. The EC arm will receive EC for 12 weeks. Both cohorts will receive counseling from a licensed mental health counselor. Using ecological momentary assessment, participants will report their use of CC in both arms and EC use in the EC arm daily via text message. Primary outcomes will be feasibility and acceptability of intervention, and secondary outcomes will be reduction in CPD and change in COPD symptoms as measured by COPD Assessment Tool (CAT) score at 12-weeks. EC displacement of CC. To explore attitudes towards the use of EC as a harm-reduction strategy for patients with COPD, interviews will be performed with a sample of participants from both study arms.DiscussionDespite decades of availability of smoking cessation medications, nearly half of people with COPD still smoke. This study aims to address the unmet need for feasible and effective strategies for reducing CC use among those with COPD, which has the potential to significantly improve the health of people with COPD who smoke.Trial Registration ClinicalTrials.gov Identifier: NCT04465318.

Effectiveness of a Dyadic Buddy App for Smoking Cessation: Randomized Controlled Trial.

BackgroundTobacco smoking is one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real time. This randomized controlled trial investigated the effectiveness of an app that encourages individuals to quit smoking with the help of a social network member (buddy) in daily life.ObjectiveThe objective of this study is to test the effectiveness of the SmokeFree buddy app compared with a control group with self-reported smoking abstinence and carbon monoxide (CO)–verified smoking abstinence as primary outcomes and self-reports of smoked cigarettes per day (CPD) as a secondary outcome.MethodsA total of 162 adults who smoked participated in this single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Around a self-set quit date (ie, 7 days before the self-set quit date and 20 days after) and 6 months later, participants of the intervention and control groups reported on daily smoking abstinence and CPD in end-of-day diaries. Daily smoking abstinence was verified via daily exhaled CO assessments. This assessment was administered via an app displaying results of exhaled CO, thus addressing self-monitoring in both groups. In addition, participants in the intervention group used the SmokeFree buddy app, a multicomponent app that facilitates social support from a buddy of choice.ResultsA significant reduction in CPD from baseline to the 6-month follow-up was observed among participants in both groups. Multilevel analyses revealed no significant intervention effect on self-reported and CO-verified daily smoking abstinence at the quit date and 3 weeks later. However, CPD was lower at the quit date and 3 weeks later in the intervention group than in the control group. No significant differences between groups were found for any outcome measures 6 months after the quit date. Overall, low app engagement and low perceived usefulness were observed.ConclusionsDespite some encouraging short-term findings on the amount of smoking, the SmokeFree buddy app did not have beneficial effects on smoking abstinence over and above the self-monitoring control condition. Future studies should examine whether and what support processes can be effectively stimulated and how app use can be improved to better achieve this goal.Trial RegistrationISRCTN Registry 11154315; https://www.isrctn.com/ISRCTN11154315 International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-7723-z

Smoking reduction is associated with lower alcohol consumption and depressive symptoms among young adults over one year

BackgroundThis secondary analysis examined whether smoking reduction among young adults participating in a Facebook-based smoking cessation intervention study was associated with corresponding reductions in alcohol consumption and depressive symptoms. MethodsParticipants were young adults who smoked and engaged in heavy episodic drinking (HED). Alcohol consumption (AUDIT-C, days of HED), depressive symptoms (PHQ-2), and past-month cigarettes per day (CPD) were self-reported at baseline and 12 months (N = 150). Linear regression estimated the relationship between the mean change in CPD and mean changes in alcohol consumption and depressive symptoms. ResultsCPD, alcohol consumption, and depressive symptoms decreased significantly between baseline and 12 months. The adjusted mean reduction in CPD was significantly associated with mean reductions in AUDIT-C (Beta [β] = 0.09, 95 % confidence interval [CI] = 0.04−0.14), days of HED (β = 0.17, 95 % CI = 0.04−0.29) and PHQ-2 (β = 0.05, 95 % CI = 0.01−0.08). Smoking abstinence (n = 48) was associated with a significantly larger mean reduction in AUDIT-C compared to a ≥50 % reduction (n = 45) (-2.9 vs -1.7 points, p = 0.03) or <50 % reduction in CPD (n = 57) (-2.9 vs -1.1 points, p < 0.01). The mean reduction in AUDIT-C did not differ between a ≥50 % reduction and <50 % reduction in CPD (-1.7 vs.−1.1 points, p = 0.18). Mean reductions in days of HED and the PHQ-2 did not differ according to the level of reduction in CPD. ConclusionSmoking reduction was associated with reductions in alcohol consumption and depressive symptoms. Reductions appeared to be greater for those who achieved abstinence compared to a reduction in smoking.

Baseline Craving Strength as a Prognostic Marker of Benefit from Smartphone App-Based Mindfulness Training for Smoking Cessation

Mindfulness training for smoking cessation may work by lessening the association between craving and smoking. However, no studies have tested whether baseline craving may be an indicator of individual smokers who might benefit more from receiving mindfulness training. This study evaluated baseline craving strength and frequency as treatment moderators in a randomized controlled trial for smoking cessation comparing mobile (smartphone-based) mindfulness training plus ecological momentary assessment (MMT-EMA) to ecological momentary assessment (EMA). Participants included 325 adult smokers (71.7% female; 81.4% White; mean age = 41.27). Craving strength and frequency were assessed with the Craving Experiences Questionnaire. Smoking was measured as cigarettes per day (CPD) at baseline and six-month follow-up. Moderated regression models were conducted. There was a significant interaction between treatment group and craving strength, but not craving frequency, in the prediction of smoking. Follow-up analyses indicated that baseline craving strength predicted benefit from receiving MMT-EMA, such that higher craving strength at baseline was significantly associated with greater reductions in CPD from baseline to six months in the MMT-EMA group, but not in the EMA group. Findings suggest that baseline craving strength may be a prognostic marker of benefit from smartphone app-delivered mindfulness training for smoking cessation. Future work is warranted for understanding baseline craving as a moderator of mindfulness training for smoking cessation.

Initial Assessment of a Comprehensive Digital Smoking Cessation Program That Incorporates a Mobile App, Breath Sensor, and Coaching: Cohort Study.

BackgroundCigarette smoking is the leading cause of preventable morbidity and mortality, excess health care expenditure, and lost work productivity. Otherwise effective evidence-based treatments have had limited success owing to challenges with access, engagement, and scale. Pivot is a comprehensive digital smoking cessation program that incorporates a Food and Drug Administration–cleared carbon monoxide breath sensor, smartphone app, and text-based human coaching.ObjectiveThis initial evaluation of Pivot aimed to assess participant engagement, changes in attitudes toward quitting, and changes in smoking behavior.MethodsUS cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD) were recruited online. Participants completed a screening call, electronic informed consent, registration, and onboarding before beginning Pivot. Pivot includes 5 sequential stages (Explore, Build, Mobilize, Quit, and Secure), taking 14.5 to 18.5 weeks to complete. Data were collected via app and online questionnaires. Outcomes included engagement and retention (ie, weeks of active engagement and Pivot stage progression); attitudes toward quitting (ie, quit readiness, quit confidence, and expected difficulty maintaining quit); and smoking behavior (ie, quit attempts, cigarette reduction, and abstinence (7- and 30-day point prevalence abstinence [PPA]).ResultsA total of 319 participants completed onboarding (intention-to-treat [ITT] sample); 272/319 participants (85.3%) completed the end-of-Pivot questionnaire (study completer sample). Most (212/319, 66.5%) were not ready to quit in the next 30 days at baseline. On average, participants actively engaged in the program for a mean 12.4 (SD 7.1) weeks. Pivot stage completion rates were Explore: 88.7% (283/319), Build: 57.4% (183/319), Mobilize: 43.6% (139/319), Quit: 41.1% (131/319), and Secure: 39.5% (126/319). Repeated measures linear mixed model analyses demonstrated positive changes in attitudes from baseline to Mobilize (pre-Quit): increased confidence to quit (4.2 to 7.4, P<.001) and decreased expected difficulty maintaining quit (3.1 to 6.8, P<.001).The quit attempt rate (ie, those making ≥1 quit attempt lasting ≥1 day) was 79.4% (216/272, completer). At the end of Pivot, 7-day PPA rates were 32.0% (102/319, ITT) and 37.5% (102/272, completer); 30-day PPA rates were 27.6% (88/319, ITT) and 32.4% (88/272, completer). Moreover, 30-day PPA rates were comparable among those ready and not ready to quit in the next 30 days at baseline. Of those not achieving abstinence, 25.9% (44/170, completer) achieved ≥50% reduction in CPD by study end.ConclusionsThis study evaluated Pivot’s initial performance with comparable quit rates among those ready and not ready to quit in the next 30 days at entry. The present data, considered with the program’s accessibility, innovation, evidence-based foundation, and design for all smokers, suggest Pivot has the potential to address limitations of reach and scale and thereby advance smoking cessation efforts.Trial RegistrationClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643 (Archived by WebCite at http://www.webcitation.org/75TiNe6BE).

Distal Measurements Can Produce False Negative Results: A Prospective Secondary Analysis of a Natural History Study.

Most prospective studies of quit attempts (QAs) or abstinence measure the ability of variables to predict quitting many weeks or months later. This design ignores more proximal fluctuations in the predictor that may be more relevant. The present secondary analysis compares 6-week (distal) and daily (proximal) changes in cigarettes per day (CPD) as predictors of making a QA. Daily smokers reported CPD and QAs nightly throughout a 12-week natural history study. We provided no treatment. In the distal analysis, we tested whether reduction in CPD between baseline and 6 weeks predicted making a QA during the following 6 weeks. In the proximal analysis, we identified episodes of one or more days of ≥10% reduction in CPD and tested whether reduction predicted making a QA on the day immediately after the reduction episode. We tested the following predictors: (1) reduction in CPD of ≥10% (yes/no), (2) percent reduction, (3) absolute magnitude of reduction, and (4) CPD at the end of reduction. In the distal analysis, reduction did not predict making a QA. In the proximal analysis, any reduction (OR = 3.0), greater percent reduction (OR = 1.6), greater absolute reduction (OR = 1.3), and fewer CPD on the final day of an episode (OR = 11.8) predicted making a QA the next day (all p < .001). Relying on distal measurements to identify causes of a behavior may produce false-negative results. Increased use of technological advances will make assessments of the more valid proximal measurements more feasible. This secondary analysis tested distal and proximal predictors of making a quit attempt among the same participants and found that distal tests did not, but proximal tests did predict quit attempts. Relying on distal measurements may result in false negatives.

Reduction in Cigarettes per Day Prospectively Predicts Making a Quit Attempt: A Fine-Grained Secondary Analysis of a Natural History Study.

Reducing cigarettes per day (CPD) aided by medication increases quit attempts (QA) among smokers not trying to quit. If this is due to reducing CPD per se, then a greater reduction should predict making a QA. In this secondary analysis, 132 smokers completed nightly calls to report CPD, intention to quit tomorrow, and QAs over 12 weeks. We provided no treatment. We identified episodes of reduction and tested whether (1) percent reduction in CPD, (2) absolute reduction in CPD, (3) duration of reduction, or (4) CPD on the final day predicted a QA immediately after a reduction episode. We tested this separately among reduction episodes that began with and without an intention to quit. Among the 1179 episodes that began without intention to quit, all four measures of reduction predicted making a QA. Greater percent reduction, longer duration, and fewer CPD on the final day were retained in a multivariate model (all p < .05). Among the 85 episodes that began with intention to quit, greater percent reduction and greater absolute reduction predicted making a QA. Only mean percent reduction was retained in a multivariate model (p < .001). Our results replicate and extend earlier studies by using fine-grained analyses and examining immediately proximal QAs in a sample of self-quitters. Findings suggest that reducing CPD per se increases the probability of a QA among smokers without intention to quit in a dose-related manner. Whether this is the case among smokers who intend to quit remains unclear. Reducing CPD appears to be an effective strategy to increase the probability of making a QA for the majority of smokers who do not intend to quit in the near future. However, our findings are mixed regarding the effectiveness of reducing among smokers who intend to quit. Clinical interventions and policies that promote reducing CPD are likely to be an effective way to increase QAs. Reduction may be especially helpful for smokers who have not responded to traditional advice to stop abruptly.

Commentary on Wu et al. (2017): Do very brief reduction interventions increase quitting among smokers not ready to quit?

Some smokers unready to quit will quit in response to a brief smoking reduction intervention. Whether this is due to their being more likely to try to quit, more likely to succeed, or both, and whether the intervention's effectiveness is due to reduction, advice to quit, or both is unclear. Most smokers are not ready to quit in the near future, but reducing cigarettes per day (CPD) is common in such smokers 1. Interventions to reduce CPD aided by nicotine replacement therapy (NRT) increase quitting among smokers not ready to quit 2, but most smokers do not want to use medications 3. Although greater self-selected reduction in CPD appears to predict quitting 4, only one 5 of three prior randomized controlled trials (RCT) found that a reduction intervention without medication increased abstinence among smokers not ready to quit 5-7. Wu and colleagues’ recent pragmatic RCT contributes to the existing literature with evidence that a very brief reduction intervention (approximately 5 minutes in total) with physician's advice to quit but without medication increases point-prevalence abstinence in comparison to no treatment at a 12-month follow-up (13 versus 7%) 8. We commend the authors for a rigorous test of this important topic in a generalizable setting. One concern is that this study's comparison condition did not include clinician advice to quit smoking, which increases cessation more than no treatment 9. Thus, it is unclear whether the effectiveness of Wu and colleagues’ intervention is due to the reduction intervention, advice to quit, or a combination of the two. This is important, because both prior trials that compared a reduction intervention without medication to advice to quit did not find that reduction increased abstinence 5, 6. It is also unclear if the effectiveness of Wu and colleagues’ reduction intervention was due to an increased number of quit attempts (QA) or the increased success of QA. This is important, because the processes that prompt making a QA differ from those that engender the success of a QA 10. The only prior RCT of a reduction intervention without medication that measured QAs found that a reduction intervention did not predict making a QA 6 but self-selected magnitude of reduction did 11. We know of no trials that have tested the effect of a non-pharmacological reduction intervention on quit success (i.e. abstinence among those who made a QA). An intervention that increases QAs (i.e. initiates behavior) could be useful for those with low motivation to quit or low self-efficacy for quitting. In contrast, an intervention that increases quit success (i.e. maintains behavior) could be useful to overcome barriers to staying quit, such as high dependence, among those already motivated. Knowing which of these was the active ingredient in successful reduction studies is important for knowing who would benefit most from reduction interventions. Importantly, this trial is consistent with the finding that reducing CPD increases abstinence among smokers not ready to quit 2 but does not appear to be effective among those who intend to quit now 12. One explanation for this difference is that reducing CPD could be effective by increasing motivation to quit 11 and thus less impactful for those already motivated to quit. Another explanation is that, among smokers who intend to quit now, reducing CPD delays quitting which could decrease motivation to quit 13. In summary, including Wu and colleagues’ recent finding, two of three trials found reduction interventions without medication for smokers not ready to quit increases cessation in comparison to no treatment 5, 7, 8. Whether this is due to the reduction intervention, advice to quit, or both, and whether this is due to increasing QAs or quit success remains unclear. Nonetheless, Wu and colleagues’ findings suggest that a very brief and feasible reduction intervention can increase substantially the odds of future cessation for smokers not ready to quit now. E.M.K. has nothing to disclose. J.R.H. has received consulting and speaking fees from several companies that develop or market pharmacological and behavioral treatments for smoking cessation or harm reduction and from several non-profit organizations that promote tobacco control. He also consults for Swedish Match.

A Mediation Analysis of Motivational, Reduction, and Usual Care Interventions for Smokers Who Are Not Ready to Quit.

We recently conducted a large randomized controlled trial (RCT) (N = 560) that failed to replicate our initial RCT's findings that brief motivational and reduction interventions increased quit attempts (QA) and point-prevalence abstinence (PPA) in smokers not ready to quit. The present study aimed to test why our interventions were ineffective. A secondary analysis of a 3-arm RCT tested (1) whether telephone-based motivational or reduction interventions changed the following hypothesized mediators more than usual care: cigarettes per day (CPD), dependence, pros of smoking, cons of smoking, self-efficacy, or intention to quit; (2) whether changes in these hypothesized mediators predicted QAs and PPA at a 6-month follow-up, and (3) whether the interventions affected QAs and PPA via the hypothesized mediators. In comparison to usual care, the motivational intervention did not significantly influence the hypothesized mediators. The reduction intervention resulted in a significantly greater decrease in CPD and pros of smoking and increase in self-efficacy and intention to quit than usual care. Decreases in CPD and dependence and increases in self-efficacy and intention to quit were associated with increased QAs. The reduction intervention's influence on QAs was mediated by decreases in CPD and increases in self-efficacy and intention to quit. Findings regarding PPA were similar. Our failure to replicate may be due, in part, to the fact that, compared to usual care, (1) the motivational intervention had no effect on the hypothesized mediators, and (2) the reduction intervention had a statistically significant but clinically insignificant effect on the hypothesized mediators. This study demonstrates that mediation analysis may be useful to understand why an intervention is not more effective than usual care. We identified reductions in CPD and dependence and increases in self-efficacy and intention to quit as predictors of quitting. Further research should focus on developing more effective interventions to target these constructs, and cause clinically significant changes among smokers who are not ready to quit.

A Randomized Trial Comparing the Effect of Nicotine Versus Placebo Electronic Cigarettes on Smoking Reduction Among Young Adult Smokers.

Electronic cigarette (EC) use is growing dramatically with use highest among young adults and current smokers. One of the most common reasons for using ECs is interest in quitting or reducing cigarettes per day (CPD); however there are few randomized controlled trials (RCT) on the effect of ECs on smoking abstinence and reduction. We conducted a two-arm; double-blind RCT. Subjects were randomized to receive 3-weeks of either disposable 4.5% nicotine EC (intervention) or placebo EC. The primary outcome was self-reported reduction of at least 50% in the number of CPDs smoked at week 3 (end of treatment) compared to baseline. Study subjects (n = 99) were young adult (21-35), current smokers (smoked ≥ 10 CPDs) living in NYC. Compared with baseline, a significant reduction in CPDs was observed at both study time periods (1 and 3 weeks) for intervention (P < .001) and placebo (P < .001) groups. Between-group analyses showed significantly fewer CPDs in the intervention group compared to the placebo group at week 3 (P = .03), but not at any other follow-up periods. The logistic regression analysis showed that using a greater number of ECs, treatment condition and higher baseline readiness to quit were significantly associated with achieving at least 50% reduction in CPDs at the end of treatment. A diverse young adult sample of current everyday smokers, who were not ready to quit, was able to reduce smoking with the help of ECs. Further study is needed to establish the role of both placebo and nicotine containing ECs in increasing both reduction and subsequent cessation. Despite the critical need for well-designed clinical trials on the effect of ECs on cessation and cigarette reduction, the majority of studies have been observational or noncomparative intervention designs. Only three RCTs studying ECs as a cessation or reduction intervention have been published, and none were conducted in the United States. The current study adds knowledge to current literature on the feasibility of using ECs to aid smoking reduction among young smokers in US urban populations.

Correspondence between self-reported and biochemical measures of smoking in opioid-dependent pregnant women

Aims: Smoking exacerbates adverse outcomes among opioiddependent pregnant women (e.g., a more severe neonatal abstinence syndrome in exposed neonates). Vermont birth certificate data for opioid-dependent pregnant women indicates a significant decrease in their self-reported smoking rate over the course of pregnancy, from a mean of 17.9 cigarettes per day (CPD) prior to pregnancy to 13.8, 10.9, and 9.7 in the first, second and third trimesters, respectively. This study examined self-reported smoking rate andbiochemicalmeasures of smoking to testwhether self-reported decreases in smokingwere paralleled by decreases in biochemical measures. Methods: Participants were 18 opioid-dependent pregnant women enrolled in clinical trials for smoking cessation. All women continued to smoke throughout their pregnancies. Self-reported CPD prior to pregnancy were collected at the Intake Assessment. CPD, breathCO, andurine cotininewere collected at intake, at a second assessment 1 month later (Early Pregnancy Assessment), and againat theendofpregnancy (≥28weeksgestation; LatePregnancy Assessment). Results: Like birth certificate data, self-reported smoking rates decreased from amean of 22.6 prior to pregnancy to 15.5 at intake. During pregnancy, self-reported CPD decreased significantly from 15.5, 7.5, and 9.0 at Intake and Early and Late Pregnancy Assessments, respectively (p< .001). However, parallel changes were not evident in biochemical measures of smoking. Mean CO was 13.3, 10.0, and 12.3ppm (p= .11) and mean urine cotinine was 1422.8, 1387.8, and 1294.1ng/ml (p= .71) at the three assessments. Conclusions: Discrepancies between self-report and biochemical measures may be explained by misrepresentation of self-reported smoking or reductions in CPD offset by changes in smoking topography (i.e., compensatory smoking). Further research is needed to understand changes in smoking among opioid-dependent pregnant women. Financial support:NICHDR01HD075669, NIDAR01DA014028 and R01 DA031928, and FDA/NIDA P50 DA036114.

Does the Magnitude of Reduction in Cigarettes Per Day Predict Smoking Cessation? A Qualitative Review.

Reduction in cigarettes per day (CPD) aided by nicotine replacement therapy (NRT) increases cessation in smokers; however, it is unclear whether this is due to use of NRT or reduction per se. If the latter, a greater magnitude of reduction in CPD should increase the odds of cessation. The authors searched PubMed, Cochrane, PsychINFO, http://clinicaltrials.gov and their personal libraries for studies on smoking reduction. Seven of the 76 (9%) identified intervention trials and four of 28 naturalistic studies (14%) reported on the magnitude of reduction in relation to the odds of cessation. Five of the seven intervention trials and three of the four naturalistic observational (cohort) studies found that increased reduction in CPD was associated with increased cessation. The intervention trials that reported effect sizes found that every 1% decrease in CPD or carbon monoxide was associated with a 3% to 4% increase in the odds of cessation. The naturalistic studies found that ordinal (eg, quartile) increases in participants' magnitude of reduction in CPD were associated with 50% to 290% increases in the odds of cessation. All of the naturalistic studies and four of the intervention trials included covariates; however, reduction's association with cessation could still be due to its association with NRT use or motivation. Although prospective prediction does not necessarily indicate causality, our findings suggest reduction in CPD is a mechanism of increased cessation in prior NRT-aided reduction studies.

Smoking reduction in psychiatric inpatients is feasible: results from a 12-month prospective study.

BackgroundDespite the fact that smoking is a crucial morbidity factor among psychiatric patients, little progress has been made in order to reduce smoking during psychiatric hospitalization.MethodsWe studied the smoking behaviour of patients admitted to a non-smoking psychiatric ward, after monitoring them for smoking habits and helping them cope in order to modify their smoking behaviour. For a period of 12 months, we conducted a prospective study of simple smoking avoidance measures in the 2nd Department of Psychiatry of Attikon University Hospital in Athens.ResultsFrom 330 admitted patients, 170 (51.5%) were smokers; they were monitored for their smoking habits and encouraged by the nursing staff to reduce smoking. The mean number of cigarettes per day (CPD) at admission was 32.2 (sd 22.1) and upon discharge 14.1 (sd 14.8) (t = 11.7, p < 0.001). Most of the smokers, 142 (83.5%), managed to reduce their cigarette consumption per day. Diagnosis did not affect the reduction or increase in CPD. The only factor that predicted reduction in CPD was the female sex.ConclusionsOur findings indicate that seriously mentally ill psychiatric inpatients despite negative preconceptions and stereotypes respond well to simple measures aiming to reduce their smoking and modify their behaviour.

Are Statewide Restaurant and Bar Smoking Bans Associated With Reduced Cigarette Smoking Among Those With Mental Illness?

Smoke-free air laws have effectively reduced cigarette consumption at the population level; however, the influence of these policies on smoking among those with mental illness is unclear. We examined whether associations between statewide restaurant/bar smoking bans and cigarette smoking varied by psychiatric diagnoses and gender. We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, Wave 1: 2001-2002; Wave 2: 2004-2005; n = 7,317 smokers). All analyses were stratified by gender. We examined whether tobacco cessation was associated with the interaction between ban implementation and Wave 1 psychiatric diagnoses (alcohol use disorder [AUD], anxiety disorder [AD], or mood disorder), adjusting for relevant covariates. Among those who continued to use tobacco at Wave 2, we examined associations between Wave 2 cigarettes per day (CPD) and the diagnoses × ban interactions, controlling for Wave 1 CPD and other relevant covariates. Among men with an AUD and women with an AD, ban implementation was associated with 6% and 10% greater probability of tobacco cessation at Wave 2, respectively. Among men in the overall sample, ban implementation was associated with smoking 0.8 fewer CPD at Wave 2. Associations with CPD were nonsignificant among women. Interactions between ban implementation and psychiatric diagnoses were also nonsignificant when examining CPD, suggesting consistent reductions in CPD among men but not among women. This study provided the first evidence that statewide restaurant/bar smoking bans may be associated with reduced smoking among those with select psychiatric conditions.

Cigarette Smoking Reduction and Changes in Nicotine Dependence

The relationship of nicotine dependence (ND) to smoking behavior and cessation has been well characterized. However, little is known about the association between smoking reduction (SR) and ND. We retrospectively evaluated the lifetime prevalence and extent of SR and whether ND as assessed by a modified Fagerström Test for Nicotine Dependence (FTND) score without cigarettes per day (CPD) and time-to-first cigarette changed with reductions in CPD. As part of the Collaborative Study of the Genetics of Nicotine Dependence (COGEND), 47,777 individuals from 2 mid-Western metropolitan areas were identified for a community-based telephone screening, yielding 6,955 current daily smokers ages 25-44 years (European-American, n = 5,135 and Black, n = 1,820). The FTND was administered to measure current ND and peak ND in respondents whose current daily CPD is lower than their reported lifetime peak. About 44% (n = 3,077) of the sample reported reducing their smoking from their lifetime peak, with a mean reduction of 14.4 CPD (SD = 8.9) or a 54.0% reduction compared with peak smoking. Controlling for peak smoking and years smoked, the magnitude of SR was associated with declines in ND excluding the direct contribution of CPD. Self-reported SR was associated with reduced levels of ND. The impact of this reduction on smoking cessation and health risks and smoking cessation requires further study, particularly given the retrospective nature of the present dataset.

Effects of practitioner-delivered brief counseling and computer-generated tailored letters on cigarettes per day among smokers who do not quit—A quasi-randomized controlled trial

Background It is still unclear how brief counseling for smoking cessation, combined with proactive recruitment of participants, impacts on those smokers not reaching the primary treatment goal of tobacco abstinence. Thus, within a quasi-randomized controlled trial, we examined the effects of (1) practitioner-delivered brief advice and (2) computer-generated tailored letters on cigarettes per day (CPD) among participants not succeeding in quitting. Methods A total of 34 general practices (participation rate 87%) were randomly selected in a German region. Within these practices, 1499 daily smoking patients aged 18–70 years (participation rate 80%) agreed to participate in a smoking cessation intervention trial. Allocation to study condition was based on time of practice attendance. Latent growth analyses were performed on the subsample of 1334 (89%) smokers who did not reach 6-month prolonged abstinence within the 2-year follow-up period. CPD was assessed at baseline and at 6-, 12-, 18-, and 24-month follow-ups. Results Both interventions led to small but significant reductions in CPD, and they did not differ in efficacy. Treatment effects occurred within the first 6 months and could be sustained by the continuing smokers until the 24-month follow-up. Conclusions Present results complement earlier findings of increased abstinence rates in the total sample. It can be concluded that, even if applied to unselected samples of smokers, from which only a minority initially intends to change, both brief counseling strategies are able to significantly decrease tobacco consumption. They hence appear to provide a means to reducing tobacco-related disease among general medical practice patients.