Significant Reductions In Smoking Research Articles

Prevalence of tobacco consumption among working population after the law 42/2010, Spain

The aim of this study was to analyze the impact on tobacco consumption among working population of the Law 42/2010, which amends smoking regulations in Spain. Data were obtained from 413,473 Occupational Health check-ups, conducted between July of 2009 and June of 2011, in the Society for Prevention of a Mutual Insurance Company. We analyzed changes in the biannual percentage of smokers and the magnitude of tobacco consumption among smokers in the overall set of medical check-ups, by gender, age, occupational level (manual vs. non-manual workers), and in the specific occupational subgroup of waiters, barmen and similar workers (chi-square test). In the overall set of medical check-ups, the percentage of smokers decreased by 5% (from 40.3% to 35.3%) over the period of study (p <0.001) and the group of smokers with lower daily consumption (< 10 cigarettes) became the most frequent (p <0.001). In the group of waiters, barmen and similar workers the differences in the biannual percentage of smokers did not reach statistical significance (p =0.07). In this group, smokers of < 10 cigarretes/ day also became the most common consumption group (increasing from 40.5% to 48.8%) and the percentage of 21-40 cigarretes/day decreased from 10.6% to 4% (p =0.008). These results suggest that the new regulation has been accompanied by a significant reduction in smoking among Spanish workers and strongly support population-level measures against tobacco consumption.

Smoking cessation interventions among individuals in methadone maintenance: A brief review

Background Individuals in methadone maintenance treatment are motivated to quit smoking and are interested in smoking cessation treatment. However, few studies have assessed the efficacy of smoking cessation treatment for individuals undergoing methadone maintenance. The purpose of this article is to review interventions for tobacco use cessation among individuals in methadone maintenance with a particular emphasis on the components of such interventions and their effect on smoking cessation/reduction and drug use. Methods A comprehensive search of six databases in June 2008 retrieved 584 research studies, which addressed smoking cessation interventions among individuals in substance use treatment. Of the retrieved articles, eight studies addressed smoking cessation among individuals undergoing methadone maintenance treatment. These studies were examined for effect of intervention on smoking cessation/reduction, gender differences in treatment outcomes, and the effect of the smoking cessation intervention on substance use behaviors. Results Few studies demonstrated successful smoking abstinence among individuals in methadone maintenance treatment. Most interventions were associated with significant smoking reduction from baseline. Few studies assessed differences between men and women in smoking cessation treatment outcome. Smoking cessation treatment was not associated with increased substance use. Conclusions To date, interventions among individuals in methadone treatment have been largely unsuccessful in achieving sustained smoking abstinence. However, smoking cessation treatment does not worsen substance use. Future studies are necessary to determine intervention designs and components that can enhance smoking cessation among individuals in methadone maintenance.

Interventions for promoting smoking cessation during pregnancy.

Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness. To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2008), the Cochrane Tobacco Addiction Group's Trials Register (June 2008), EMBASE, PsycLIT, and CINAHL (all from January 2003 to June 2008). We contacted trial authors to locate additional unpublished data. Randomised controlled trials where smoking cessation during pregnancy was a primary aim of the intervention. Trials were identified and data extracted by one person and checked by a second. Subgroup analysis was conducted to assess the effect of risk of trial bias, intensity of the intervention and main intervention strategy used. Seventy-two trials are included. Fifty-six randomised controlled trials (over 20,000 pregnant women) and nine cluster-randomised trials (over 5000 pregnant women) provided data on smoking cessation outcomes.There was a significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I(2) > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I(2) = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse.Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and preterm birth (RR 0.86, 95% CI 0.74 to 0.98), and there was a 53.91g (95% CI 10.44 g to 95.38 g) increase in mean birthweight. There were no statistically significant differences in neonatal intensive care unit admissions, very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power. Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.

Stroke Incidence and Mortality Rates 1987 to 2006 Related to Secular Trends of Cardiovascular Risk Factors in Gothenburg, Sweden

Stroke incidence rates were unchanged whereas fatality rates declined during the period 1971 to 1987 in Gothenburg (Göteborg), Sweden. For the period 1987 to 2006, we now report on trends in stroke incidence and mortality with concurrent risk factor trends in the same population. Since 1976 the incidence of myocardial infarction decreased by 50%. Through the National Hospital Discharge Register linked with the Cause of Death Register, 12 904 males and 15 250 females with first strokes were detected for the period 1987 to 2006. Cardiovascular risk factor data were available for random population samples of men and women aged 50 years from 1963 to 2003. Incidence and mortality rates for all-stroke were unchanged. Rates for subarachnoid hemorrhage declined for the age group 45 to 54 in men, but not significantly in any other age group of men or women. Mortality rates of intracerebral hemorrhage declined for women aged 65 to 74, with no significant changes in any other age group. Ischemic stroke incidence did not change, but mortality increased for men and women aged 75 and older, whereas mortality declined for the age group 20 to 44 for men. In the general population there were significant reductions in smoking, total cholesterol, and blood pressure levels in both men and women, whereas diabetes prevalence, body weight, and BMI increased among both sexes, and triglycerides increased in men. Contrary to myocardial infarction, stroke incidence and mortality did not change. Monitoring of cardiovascular risk factors in the community is important.

P01-27 Acetylcholinesterase-inhibitors in the treatment of tobacco dependence

Background:Although alcohol-dependent smokers represent an important group for applying smoking interventions, sufficient pharmacotherapy has not been established in this high-risk group so far. Acetylcholinesterase-inhibitors inhibit the breakdown of Ach. The retention time of this neurotransmitter is prolonged and thereby the efficiency of cholinergic neurotransmission at nAChRs is enhanced. Thus, we suppose a possible substitution of neuronal nicotine effects.Method:In order to examine the effect of acetylcholinesterase-inhibitors on tobacco dependence, we performed clinical-pharmacological studies on alcohol and tobacco dependent patients who had already completed an alcohol detox. We investigated galantamine (with positive allosteric modulation, n=114, randomized placebo controlled over 24 weeks) and rivastigmine (without allosteric modulation, n=26, randomized, placebo controlled over 12 weeks) and assesses smoking behavior (diaries, FTND, CO measurements) as well as craving for tobacco (QSU) and alcohol (AUQ).Results:Galantamine (Diehl et al., 2006) as well as rivastigmine (Diehl et al., 2008) led to a significant smoking reduction (galantamine: -20% after 24 weeks, rivastigmine: -30% after 12 weeks) without compromising the alcohol abstinence. Patients taking rivastigmine also experienced a significant reduction of nicotine craving (-20%), without any other specific pharmacological or psychotherapeutical action to support the smoking cessation.Conclusion:Our preliminary data indicate an effect of galantamine and rivastigmine on tobacco craving and consumption in alcohol dependent smokers. These pilot studies encourage further investigation of acetylcholinesterase-inhibitors as a promising treatment approach regarding tobacco dependence.

Tabac et schizophrénie : aspects thérapeutiques

Although patients with have low motivations to quit smoking, smoking cessation treatment can be effective for these patients. Patients schizophrenia who achieve significant smoking reduction during a treatment intervention can at least maintain that level of reduction at 2 years. Cigarette smoking by patients with frequently goes unaddressed, contributing to excess mortality in this population. Behavioural interventions improve smoking cessation in schizophrenia patients. Nicotine replacement can substantially reduce withdrawal symptoms. Bupropion enhances smoking abstinence rates. Bupropion is well-tolerated and safe for use in schizophrenia patients: bupropion does not worsen clinical symptoms of schizophrenia. Atypical antipsychotics may reduce smoking consumption in schizophrenia patients, in particular clozapine. Atypical antipsychotic medication, in combination with the nicotine transdermal patch, significantly enhance the rate of smoking cessation. Interactions between smoking and antipsychotic medication - Smoking increases the metabolism of the antipsychotic medications by inducing the cytochrome P450 1A2 isoform. Smoking lowers the blood levels of typical or atypical antipsychotic medication, in particular haloperidol, chlorpromazine, olanzapine and clozapine. -Abstinence can increase many psychotropics' blood levels. Accordingly, smoking appears to reduce neuroleptic-induced parkinsonism. In contrast, smoking is a risk factor for tardive dyskinesia, independent of neuroleptic exposure.

Effects of high dose transdermal nicotine replacement in cigarette smokers

Rationale Nicotine replacement therapies (NRT) have been evaluated to facilitate cigarette smoking reduction in smokers unwilling or unable to quit. In most of these studies, only conventional doses of NRT have been tested and higher doses may be required to result in significant reductions in smoking and in biomarkers of exposure. Objective To determine if higher NRT doses in conjunction with smoking are safe and may promote significant reductions in cigarette smoking and biomarkers of exposure. Methods A dose-ranging, within-subject design was implemented to evaluate the effects of 15, 30 and 45 mg nicotine-patch treatment on measures of safety and the extent of smoking reduction and biomarker exposure per cigarette in smokers ( N = 20 completers) not immediately interested in quitting. Results Concurrent smoking and NRT were generally tolerated and resulted in no changes in blood pressure or heart rate. Slightly less than 10% of the study sample was not given the highest dose of NRT due to side effects. Self-reported cigarette smoking decreased with increasing doses of nicotine replacement and significant reductions were observed for total NNAL (a carcinogen biomarker) and carbon monoxide. However, even at the 45 mg dose, increased carbon monoxide and total NNAL per cigarette occurred, even though cotinine levels increased on average, 69.3% from baseline. Conclusions The present results suggest that the use of high dose NRT is safe, leads to significant reductions in smoking (− 49%), significant but less reductions in total NNAL (− 24%) and carbon monoxide (− 37%) due to compensatory smoking.

Relationship of DSM‐IV‐Based Depressive Disorders to Smoking Cessation and Smoking Reduction in Pregnant Smokers

This study investigated DSM-IV depressive disorders as predictors of smoking cessation and reduction in 81 pregnant smokers participating in a smoking cessation trial. Thirty-two percent of the sample met criteria for current dysthymia, major depressive disorder in partial remission, or minor depression. There was no significant reduction in smoking among women with or without current depressive disorders. Unexpectedly, as compared to women without depressive disorders, women with dysthymia significantly increased the mean number of cigarettes smoked (from 8 to 23 cigarettes per day during the 2 to 30 days post-targeted quit date period) and were smoking significantly more cigarettes at 30 days. A main effect approaching significance suggested that women with current depressive disorders were less likely to be abstinent than women without current depressive disorders (OR = 6.3; 3.9% vs. 12.7% at 30 days post-targeted quit date; 0% vs. 6.2% at 30 days post-partum). Results add to previous findings indicating a correlation between depressive symptoms and continued smoking in pregnant women. Further investigation of mood-focused smoking cessation interventions may be warranted.

Studienbesprechung – Auricular Acupuncture, Education, and Smoking Cessation: A Randomized, Sham-Controlled Trial

OjectivesThis study examined the effect of acupuncture alone and in combination with education on smoking cessation and cigarette consumption. MethodWe prospectively studied 141 adults in a quasi-factorial design using acupuncture, sham acupuncture, and education. ResultsAll groups showed significant reductions in smoking and posttreatment cigarette consumption, with the combined acupuncture-education group showing the greatest effect from treatment. The trend continued in follow-up; however, significant differences were not maintained. Greater pack-year history (i.e. the number of years smoking multiplied by baseline number of cigarettes smoked per year, divided by 20 cigarettes per pack) negatively correlated with treatment effect. Trend analysis suggested 20 pack-years as the cutoff point for this correlation. ConclusionsAcupuncture and education, alone and in combination, significantly reduced smoking; however, combined they showed a significantly greater effect, as seen in subjects with a greater pack-year history.

Tax, price and cigarette smoking: evidence from the tobacco documents and implications for tobacco company marketing strategies

Objective: To examine tobacco company documents to determine what the companies knew about the impact of cigarette prices on smoking among youth, young adults, and adults, and to evaluate how...

Interventions for promoting smoking cessation during pregnancy.

Smoking remains one of the few potentially preventable factors associated with low birthweight, very preterm birth and perinatal death. The objective of this review was to assess the effects of smoking cessation programs implemented during pregnancy on the health of the fetus and infant, on the mother and on the family. We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Tobacco Addiction Group trials register. Randomised and quasi-randomised trials of smoking cessation programs implemented during pregnancy. Trial quality was assessed and data were extracted independently by two reviewers. Forty-four trials were identified: 37 trials including 16,916 women provided data on smoking cessation and/or perinatal outcomes, as did one cluster-randomised trial including 3000 women. Over 800 women were included in trials of smoking relapse prevention. There was substantial variation in the intensity of the intervention and the extent of reminders and reinforcement through pregnancy. Based on 34 trials there was a significant reduction in smoking in the intervention groups (odds ratio 0.53, 95% confidence interval 0. 47 to 0.60), an absolute difference of 6.4% women continuing to smoke. The eight trials with validated smoking cessation, a high intensity intervention and a high quality score had an odds ratio of 0.53, 95% confidence interval 0.44 to 0.63 and an absolute difference in continued smoking of 8.1%. The subset of trials with information on fetal outcome revealed a reduction in low birthweight (odds ratio 0.80, 95% confidence interval 0.67 to 0.95), a reduction in preterm birth (odds ratio 0.83, 95% confidence interval 0.69 to 0. 99) and an increase in mean birthweight of 28g (95% confidence interval 9 to 49). There were no differences in very low birthweight or perinatal mortality. Five trials of smoking relapse prevention showed no significant difference. The single large cluster-randomised trial showed no evidence of a decrease in continued smoking or adjusted mean birthweight. Smoking cessation programs in pregnancy appear to reduce smoking, low birthweight and preterm birth, but no effect was detected for very low birthweight or perinatal mortality.

Community-wide cardiovascular disease prevention in young people

The Class of 1989 Study, as part of the Minnesota Heart Health Program, examines 2 cohorts of adolescents in 2 communities in northcentral US. The goal of the study was to reduce the risk of cardiovascular disease among young people in one of the cohorts through changes in smoking, eating patterns and physical activity levels. Because of its importance as a health behaviour, alcohol use was also addressed, even though it was not a specific target of the Minnesota Heart Health Program. The behaviour patterns of both cohorts were surveyed annually in schools from 1983 to 1989. One cohort additionally was exposed to 5 years of behavioural health education in their schools, peer leadership and a community-wide programme for adults. The behaviour health education curricula focused on skills, competencies, role models and norms for healthier behaviour. Students in the educated cohort demonstrated significant reductions in smoking from 1984 to 1989. Females in the educated cohort also consistently reported significantly healthier eating habits and physical activity patterns than the reference cohort. Short-term changes in alcohol use were also noted among both males and females, consistent with the results of other research studies of school-based programmes. Results for eating patterns and physical activity patterns with males were not as robust as with females. Nevertheless, behavioural health programmes in schools coordinated with community-wide education and campaigns with adults appears promising.

A Comparison of Thought Stopping and Covert Sensitization Techniques in the Treatment Of Smoking: A Brief Report

11 Ss who smoked 24 cigarettes per day were divided into 3 treatment groups, Thought-Stopping, Covert Sensitization, and Attention-Placebo, for a 10-session program to eliminate smoking. Significant reductions were found for both the Thought Stopping and Covert Sensitization groups immediately after the program was terminated. The Ss in The Attention Placebo group and a no-contact control group did not reduce cigarette consumption. A 4-month follow-up did not indicate significant reduction in smoking in any of the groups.

Aversive control of smoking behavior in a group context

Summary Two procedures designed to modify smoking behavior were compared. Each involved the self-administration of an aversive taste substance contingent upon and concomitant with the smoking response. For one of the treatment groups, Ss received supervision and support through periodic group meetings while Ss in the other treatment group did not receive this group contact. Two control groups, one consisting of Ss who applied for but did not receive treatment and another of Ss who did not seek treatment, were used to evaluate extra-therapeutic and motivational factors. The smoking behavior of these groups was evaluated at the termination of treatment and at one and six-month follow-ups. At the termination of the clinic the group-aversive, individual-aversive and the apply control Ss all displayed a significant reduction in their smoking behavior, with the group-aversive Ss showing a reliably greater reduction than the latter two groups. At the one and six-month follow-ups the two treatment and the apply control groups, which still showed a significant reduction in smoking, were no longer reliably different from each other. In contrast, Ss who lid not apply for treatment showed no changes in their smoking behavior during the study. The importance of the S motivation factor in self-control of smoking was discussed.

Comparison of smoking treatments

Differential effects on smoking behavior for three treatments (covert sensitization, self-control, and placebo-attention) were tested after three weekly sessions and a 1 month follow-up. Analysis of the 24 subjects who completed treatment indicated significant smoking reduction over time and a significant interaction between the treatment conditions and time. The results also revealed a dependency between the treatment condition and number of subjects who quit, antecedents of smoking, and follow-up effectiveness. Because of the support for differential treatment effects and the difficulty in selecting meaningful placebo-attention conditions completely devoid of specific treatment effects, the need for internal-control process studies was proposed as an alternative method of assessing particular treatment effects.

The modification of smoking behavior: A search for effective variables

A smoking withdrawal clinic procedure employing social pressure was compared to an attention placebo condition and other control conditions designed to subtract “non-active” variance due to such factors as mere contact with an experimenter and individual effort, with and without the expectation of future help. Both Social Pressure and Placebo Ss responded to treatment with significant reduction in smoking, but did not differ. Subjects asked to quit smoking on their own, displayed significant gains only if future aid was not expected, and the behavior of subjects who were unaware of their participation in an experiment remained essentially unchanged. Data on suggestibility, internal vs. external control of reinforcement, extroversion and emotionality were collected in Experiment 3, but failed to correlate significantly (within treatment conditions) with success in quitting smoking.

Modification of chronic smoking behavior: A comparison of three approaches

Three procedures designed to modify smoking behavior were compared ; each being administered in group situations by trained non-professional leaders. One procedure provided information regarding the harmful effects of smoking; a second involved an aversive conditioning experience ; and a third, a means for learning self-control behavior. A non-treated control group was included to assess whether extra-therapeutic variables were operating. All three treatment procedures led to significant reduction in smoking at a one week followup. Despite remission on the part of all treatment groups there was still significant reduction in their smoking behavior after a three month followup. Surprisingly, however, the control group also showed reduction in smoking and was not reliably different from the treatment groups at the three month followup.