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Costantino C, Bonaccorso N, Minutolo G, Sciortino M, Ripoli G, Berardi M, Gallo M, Nastasi S, Serra S, Trapani E, Busalacchi E, Ficano P, Siciliano S, Immordino P, Mazzucco W, Restivo V, Vitale F, Casuccio A. Prevalence of smoking habits, attitudes and knowledge on counteractive strategies among a sample of healthcare employees: results of the smoking-free health environments project in the province of Palermo, Italy. Front Public Health 2024; 12:1335937. [PMID: 38375336 PMCID: PMC10875051 DOI: 10.3389/fpubh.2024.1335937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Tobacco use is responsible for over 7 million deaths annually, making smoking the leading cause of preventable mortality globally. Over the last two decades in Italy, the prevalence of smoking among physicians has consistently decreased, while it remains higher and is gradually decreasing among non-physician healthcare workers. The aim of this study was to investigate the Prevalence of smoking habits, attitudes, and knowledge on counteractive strategies among employees in the Primary Healthcare Facilities in the Province of Palermo, Italy. Methods A cross-sectional survey was conducted between June 2020 and December 2020 through a previously validated anonymous questionnaire structured in four sections including 34 items. Data were analyzed using Stata/MP 12.1 statistical software. Results Overall, 2,645 participants answered the questionnaire. The prevalence of either current or former smokers was 18.6%. Based on the multivariable analysis conducted, a significantly higher frequency of current smokers was observed among male participants (AdjOR: 1.29; CI95%: 1.02-1.64) and those belonging to the Surgical Unit (AdjOR: 1.92; CI95%: 1.27-2.90). Conversely, the prevalence of current smokers was significantly lower among those with at least one child (AdjOR: 0.67; CI95%: 0.49-0.91), with an educational qualification equal to or greater than a graduation degree (AdjOR: 0.56; CI95%: 0.43-0.73), those who considered second-hand smoke harmful (AdjOR: 0.06; CI95%: 0.008-0.60), those who had observed smoking or detected the smell of smoke in their workplace (AdjOR: 0.64; CI95%: 0.45-0.91). Furthermore, the prevalence of current smokers was significantly lower among participants who believed that healthcare professionals could play a crucial role in influencing their patients' lifestyles (AdjOR: 0.67; CI95%: 0.50-0.90) and among those who recommend their patients to quit smoking (AdjOR: 0.35; CI95%: 0.24-0.51). Discussion The results of the current research demonstrate that, despite the decline in smoking prevalence among physicians, the rate of smokers among healthcare facility employees remains unacceptably high. This underscores the need to re-evaluate current anti-tobacco strategies in the workplace.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
- Palermo Local Health Authority, Palermo, Italy
- Dedalus Unit - Palermo Local Health Authority, Palermo, Italy
- University Hospital - UH - “P. Giaccone” of Palermo, Palermo, Italy
| | - Nicole Bonaccorso
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giuseppa Minutolo
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Martina Sciortino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | | | | | | | | | | | | | | | | | | | - Palmira Immordino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
- Palermo Local Health Authority, Palermo, Italy
- Dedalus Unit - Palermo Local Health Authority, Palermo, Italy
- University Hospital - UH - “P. Giaccone” of Palermo, Palermo, Italy
| | | | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
- Palermo Local Health Authority, Palermo, Italy
- Dedalus Unit - Palermo Local Health Authority, Palermo, Italy
- University Hospital - UH - “P. Giaccone” of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
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Livingstone-Banks J, Siddiqui F, Croucher R, Mehrotra R, Vidyasagaran A, Siddiqi K. Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev 2022; 2022. [PMCID: PMC8772273 DOI: 10.1002/14651858.cd015314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Affiliation(s)
| | - Faraz Siddiqui
- Department of Health Sciences and Hull York Medical School; York University; York UK
| | - Ray Croucher
- Department of Health Sciences and Hull York Medical School; York University; York UK
| | - Ravi Mehrotra
- Department of Health Sciences and Hull York Medical School; York University; York UK
- Centre for Health Policy and Innovation; New Delhi India
| | | | - Kamran Siddiqi
- Department of Health Sciences and Hull York Medical School; York University; York UK
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Massage and touch-based therapy : Clinical evidence, neurobiology and applications in older patients with psychiatric symptoms. Z Gerontol Geriatr 2021; 54:753-758. [PMID: 34812896 PMCID: PMC8609249 DOI: 10.1007/s00391-021-01995-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/21/2021] [Indexed: 01/07/2023]
Abstract
Background Massage and touch-based treatment are popular despite limited evidence from high quality clinical trials. This article reviews the rationale and evidence of treating older patients with psychiatric symptoms by touch-based therapy. Methods Narrative literature review, based on Medline search with the following key words: massage, social touch, affective touch, clinical trial, meta-analysis. Citations of identified articles were searched for additional relevant studies. Results Evidence from clinical trials in adult patients with mainly chronic disorders of the musculoskeletal system suggests that massage therapy results in significant short-term improvement of symptoms; however, treatment effects appear not to be sustained. In addition, conclusions are difficult to draw owing to very heterogeneous study interventions, difficulties with definition of control conditions and treatment outcomes. There appears to be better evidence for improvement of psychological variables and subjective symptoms, such as pain and quality of life. A neuronal system of affective and social touch has been identified with specific afferents from C‑fibre coupled low threshold mechanoreceptors projecting into the insular cortex and the limbic system. This system may also mediate effects of massage in adult patients. Positive clinical trials for depressive symptoms of dementia and for behavioral symptoms of advanced dementia are available with encouraging results. Conclusion The neuronal system of social and affective touch suggests a potential mechanism of action of touch-based interventions in geriatric psychiatry. In addition, it provides a rationale for applying and designing novel touch-based treatment strategies as adjunctive treatment for psychiatric disorders of old age.
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Gaunkar RB, Nagarsekar A, Carvalho KM, Jodalli PS, Mascarenhas K. COVID-19 in Smokeless Tobacco Habitués: Increased Susceptibility and Transmission. Cureus 2020; 12:e8824. [PMID: 32742838 PMCID: PMC7384704 DOI: 10.7759/cureus.8824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 12/15/2022] Open
Abstract
As the coronavirus disease (COVID-19) pandemic continues to sweep across the globe, the world is responding by implementing public awareness campaigns, social distancing measures, and other preventive strategies to arrest the spread of this lethal disease. Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exacts a heavy toll on patients with existing comorbidities. Smokeless tobacco (SLT) consumption is of particular concern in countries in South Asia with high population densities, as it facilitates exposure to SARS-CoV-2 within or between communities by the act of public spitting. Salivary droplets generated in this act are a potential threat because they can transmit this airborne infection. Moreover, large gatherings at tobacco retail outlets, frequent hand-to-mouth contact, and sharing of apparatus by SLT habitués could also aid in increasing the spread of SARS-CoV-2. SLT-induced higher expression of angiotensin-converting enzyme 2 receptors along with the presence of furin in the oral mucosa and dysfunctional immune responses among SLT habitués increase viral dissemination and an individual's susceptibility to COVID-19. Issuing rigorous regulations to restrict the use of various forms of SLT products and the obnoxious act of spitting in public can assist in arresting the spread of COVID-19. Widespread education campaigns enlightening the community regarding the adverse effects of SLT consumption and its relationship with COVID-19, along with providing effective assistance to quit for those who are addicted, would decrease the spread of COVID-19.
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Affiliation(s)
| | | | - Karla M Carvalho
- Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Goa, IND
| | - Praveen S Jodalli
- Public Health Dentistry, Yenepoya Dental College and Hospital, Mangalore, IND
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Moghbel N, Ryu B, Cabot PJ, Ratsch A, Steadman KJ. In vitro cytotoxicity of Nicotiana gossei leaves, used in the Australian Aboriginal smokeless tobacco known as pituri or mingkulpa. Toxicol Lett 2016; 254:45-51. [PMID: 27178269 DOI: 10.1016/j.toxlet.2016.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/12/2016] [Accepted: 05/09/2016] [Indexed: 11/29/2022]
Abstract
The Aboriginal population of Central Australia use endemic Nicotiana species to make a smokeless tobacco product known usually as pituri or mingkulpa. Nicotiana leaves are masticated with wood ash into a 'quid' that is chewed/sucked for absorption of nicotine. In addition to nicotine, smokeless tobacco products contain a spectrum of biologically active compounds that may contribute to effects on health. The objective of this study was to quantify nicotine, and related alkaloids and tobacco specific nitrosamines (TSNAs), in Nicotiana leaves used in pituri, and compare in vitro toxicity of pure nicotine with Nicotiana leaf extract at the same concentration of nicotine. An aqueous extract of dry leaves of Nicotiana gossei and a reference smokeless tobacco (CORESTA CRP2) were quantified for major pyridine alkaloids and TSNAs using HPLC-UV and LC-MS/MS. A range of extract concentrations and corresponding concentrations of nicotine standard were tested using an MTS assay to measure human lung epithelium cell (A549) survival. Cells treated for 24h with the maximum concentration of 1.5mg/ml of nicotine resulted in 77% viability. In contrast, extracts from N. gossei leaves and CRP2 containing a similar concentration of nicotine (1.3mg/ml) resulted in remarkably lower viability of 1.5 and 6%, respectively. Comparison of cytotoxicity of pure nicotine with that of the extracts revealed that nicotine was not the source of their cytotoxicity. Other biologically active compounds such as the known carcinogens NNK and NNN, derived from nicotine and nornicotine and found to be present in the smokeless tobacco extracts, may be responsible.
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Affiliation(s)
- Nahid Moghbel
- School of Pharmacy, The University of Queensland, Brisbane, Qld 4072, Australia
| | - BoMi Ryu
- School of Pharmacy, The University of Queensland, Brisbane, Qld 4072, Australia
| | - Peter J Cabot
- School of Pharmacy, The University of Queensland, Brisbane, Qld 4072, Australia
| | | | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, Qld 4072, Australia.
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Abstract
BACKGROUND Use of smokeless tobacco (ST) can lead to tobacco dependence and long-term use can lead to health problems including periodontal disease, cancer, and cerebrovascular and cardiovascular disease. OBJECTIVES To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group specialised register in June 2015. SELECTION CRITERIA Randomized trials of behavioural or pharmacological interventions to help users of ST to quit with follow-up of at least six months. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by the Cochrane Collaboration. We summarised outcomes as risk ratios (RRs). For subgroups of trials with similar types of intervention and without substantial statistical heterogeneity, we estimated pooled effects using a Mantel-Haenszel fixed-effect method. MAIN RESULTS We identified 34 trials that met the inclusion criteria, of which nine were new for this update, representing over 16,000 participants. There was moderate quality evidence from two studies suggesting that varenicline increases ST abstinence rates (risk ratio [RR] 1.34, 95% confidence interval (CI) 1.08 to 1.68, 507 participants). Pooled results from two trials of bupropion did not detect a benefit of treatment at six months or longer (RR 0.89, 95% CI 0.54 to 1.44, 293 participants) but the confidence interval was wide. Neither nicotine patch (five trials, RR 1.13, 95% CI 0.93 to 1.37, 1083 participants) nor nicotine gum (two trials, RR 0.99, 95% CI 0.68 to 1.43, 310 participants) increased abstinence. Pooling five studies of nicotine lozenges did increase tobacco abstinence (RR 1.36, 95% CI 1.17 to 1.59, 1529 participants) but confidence in this estimate is low as the result is sensitive to the exclusion of three trials which did not use a placebo control.Statistical heterogeneity was evident among the 17 trials of behavioural interventions: eight of them reported statistically and clinically significant benefits; six suggested benefit but with wide CIs and no statistical significance; and three had similar intervention and control quit rates and relatively narrow CIs. Heterogeneity was not explained by study design (individual or cluster randomization), whether participants were selected for interest in quitting, or specific intervention components. In a post hoc subgroup analysis, trials of behavioural interventions incorporating telephone support, with or without oral examination and feedback, were associated with larger effect sizes, but oral examination and feedback alone were not associated with benefit.In one trial an interactive website increased abstinence more than a static website. One trial comparing immediate cessation using nicotine patch versus a reduction approach using either nicotine lozenge or brand switching showed greater success for the abrupt cessation group. AUTHORS' CONCLUSIONS Varenicline, nicotine lozenges and behavioural interventions may help ST users to quit. Confidence in results for nicotine lozenges is limited. Confidence in the size of effect from behavioural interventions is limited because the components of behavioural interventions that contribute to their impact are not clear.
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Affiliation(s)
- Jon O Ebbert
- Mayo ClinicDivision of Primary Care Internal Medicine200 1st Street SouthwestRochesterUSA55905
| | - Muhamad Y Elrashidi
- Mayo ClinicDivision of Primary Care Internal Medicine200 1st Street SouthwestRochesterUSA55905
| | - Lindsay F Stead
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Hatsukami DK, Jensen J, Anderson A, Broadbent B, Allen S, Zhang Y, Severson H. Oral tobacco products: preference and effects among smokers. Drug Alcohol Depend 2011; 118:230-6. [PMID: 21515003 PMCID: PMC3164739 DOI: 10.1016/j.drugalcdep.2011.03.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/26/2011] [Accepted: 03/28/2011] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recently, oral tobacco products have been marketed specifically towards cigarette smokers. These products come in different nicotine doses and formulations (snus vs. lozenge). To date, little research has been conducted to determine how smokers respond to these products. The goal of this study was to examine if smokers prefer certain oral tobacco products based on their specific characteristics. METHODS Smokers interested in quitting underwent a sampling phase and a treatment phase. The sampling phase consisted of testing five different products varying in nicotine dose (high vs. moderate vs. low) and formulation (snus vs. lozenge): General Snus, Camel Snus, Marlboro Snus, Stonewall and Ariva. Each product was sampled in the natural environment on separate days. At the end of the sampling period, subjects chose which product they would use during the 2-week cigarette abstinence phase. RESULTS General Snus (high nicotine) was not preferred by any smoker. No significant differences in preferences were observed across the other tobacco products. During the smoking cessation phase, Camel Snus was generally associated with greater craving relief and satisfaction, reduced use of cigarettes, and greater abstinence during follow-up compared to other products. CONCLUSION There were no differences in preferences for four of the five oral tobacco products but higher nicotine oral tobacco products were associated with better cessation outcomes among smokers who chose these products.
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Affiliation(s)
- Dorothy K. Hatsukami
- Department of Psychiatry, University of Minnesota, 717 Delaware SE, Minneapolis, MN 55414
| | - Joni Jensen
- Department of Psychiatry, University of Minnesota, 717 Delaware SE, Minneapolis, MN 55414
| | - Amanda Anderson
- Department of Psychiatry, University of Minnesota, 717 Delaware SE, Minneapolis, MN 55414
| | - Berry Broadbent
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403
| | - Sharon Allen
- Department of Family Medicine and Community Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Yan Zhang
- Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455
| | - Herb Severson
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403
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Abstract
BACKGROUND Use of smokeless tobacco (ST) can lead to nicotine addiction and long-term use can lead to health problems including periodontal disease, cancer, and cerebrovascular and cardiovascular disease. OBJECTIVES To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Dissertation Abstracts Online, and Scopus. Date of last search: October 2010. SELECTION CRITERIA Randomized trials of behavioural or pharmacological interventions to help users of ST to quit with follow up of at least six months. DATA COLLECTION AND ANALYSIS Two authors independently extracted data. We summarised as odds ratios. For subgroups of trials with similar types of intervention and without substantial statistical heterogeneity, we estimated pooled effects using a Mantel-Haenszel fixed-effect method. MAIN RESULTS Data from one study suggest that varenicline increases ST abstinence rates (Odds Ratio [OR] 1.6, 95% Confidence Interval (CI) 1.08 to 2.36) among Swedish snus users.Two trials of bupropion SR did not detect a benefit of treatment at six months or longer (OR 0.86, 95% CI 0.47 to 1.57). Nicotine replacement therapy (patch, gum, and lozenge) was not observed to increase tobacco abstinence rates (OR 1.14, 95% CI: 0.91 to 1.42). There was statistical heterogeneity among the 14 trials of behavioural interventions; seven of them reported statistically and clinically significant benefits, four suggested benefit but with wide CIs, whilst two had similar intervention and control quit rates and relatively narrow CIs. Heterogeneity was not explained by the design (individual or cluster randomization), whether participants were selected for interest in quitting, or specific intervention components. Most trials included either telephone counselling, an oral examination and feedback about any ST induced mucosal changes, or both. In a post-hoc subgroup analysis there was some evidence that behavioural interventions which include telephone counselling might increase abstinence rates more than interventions with less contact. In one trial an interactive website increased abstinence more than a static website. AUTHORS' CONCLUSIONS Varenicline and behavioural interventions may help ST users to quit. Behavioural interventions incorporating telephone counselling or an oral examination are likely to increase abstinence rates.
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Affiliation(s)
- Jon Ebbert
- Department of Primary Care Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota, USA, 55905
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Jepson RG, Harris FM, Platt S, Tannahill C. The effectiveness of interventions to change six health behaviours: a review of reviews. BMC Public Health 2010; 10:538. [PMID: 20825660 PMCID: PMC2944371 DOI: 10.1186/1471-2458-10-538] [Citation(s) in RCA: 214] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 09/08/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Several World Health Organisation reports over recent years have highlighted the high incidence of chronic diseases such as diabetes, coronary heart disease and cancer. Contributory factors include unhealthy diets, alcohol and tobacco use and sedentary lifestyles. This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e.g. for drug or alcohol dependency). METHODS The Cochrane Library, Database of Abstracts of Reviews of Effectiveness (DARE) and several Ovid databases were searched for systematic reviews of interventions for the six behaviours (updated search 2008). Two reviewers applied the inclusion criteria, extracted data and assessed the quality of the reviews. The results were discussed in a narrative synthesis. RESULTS We included 103 reviews published between 1995 and 2008. The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e.g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e.g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours.Generally, the evidence related to short-term effects rather than sustained/longer-term impact and there was a relative lack of evidence on how best to address inequalities. CONCLUSIONS Despite limitations of the review of reviews approach, it is encouraging that there are interventions that are effective in achieving behavioural change. Further emphasis in both primary studies and secondary analysis (e.g. systematic reviews) should be placed on assessing the differential effectiveness of interventions across different population subgroups to ensure that health inequalities are addressed.
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Affiliation(s)
- Ruth G Jepson
- Department of Nursing and Midwifery, University of Stirling, Stirling, FK9 4LA, UK
| | - Fiona M Harris
- Nursing Midwifery & Allied Health ProfessionsResearch Unit, University of Stirling, Stirling, UK
| | - Stephen Platt
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Carol Tannahill
- Glasgow Centre for Population Health, 94 Elmbank Street, Glasgow, G2 4DL, UK
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Severson HH, Peterson AL, Andrews JA, Gordon JS, Cigrang JA, Danaher BG, Hunter CM, Barckley M. Smokeless tobacco cessation in military personnel: A randomized controlled trial. Nicotine Tob Res 2009; 11:730-8. [DOI: 10.1093/ntr/ntp057] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ebbert JO, Glover E, Shinozaki E, Schroeder DR, Dale LC. Predictors of smokeless tobacco abstinence. Am J Health Behav 2008; 32:735-40. [PMID: 18442352 PMCID: PMC2947084 DOI: 10.5555/ajhb.2008.32.6.735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES To investigate predictors of tobacco abstinence among smokeless tobacco (ST) users. METHODS Logistic regression analyses assessed characteristics associated with tobacco abstinence among ST users receiving bupropion SR. RESULTS Older age was associated with increased tobacco abstinence in both placebo and bupropion SR groups at end of treatment and one year. Abstinence was lower at one year for subjects with a history of major depression. At end-of-treatment, a 2-way interaction was detected suggesting bupropion SR may be efficacious for subjects with other household tobacco users. CONCLUSIONS Younger ST users and those with a history of depression are less likely to quit ST use.
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Affiliation(s)
- Jon O. Ebbert
- Assistant Professor of Medicine, Mayo Clinic College of Medicine; Mayo Clinic, 200 1 Street Southwest, Rochester, MN 55905; ; Telephone: (507) 266-1944; Fax: (507) 266-7900
| | - Elbert Glover
- Professor & Chair Department of Public & Community Health (PCH) Director, Center for Health Behavior Research (CHBR); University of Maryland School of Public Health, 2387 HHP Building, College Park, MD 20742; ; Telephone: (301) 405-2029; Fax: (301) 314-9167(PCH)
| | - Eri Shinozaki
- Mayo Clinic, 200 1 Street Southwest, Rochester, MN 55905; ; Telephone: (507) 266-1944; Fax: (507) 266-7900
| | - Darrell R. Schroeder
- Professor of Biostatistics; Mayo Clinic College of Medicine; Mayo Clinic, 200 1 Street Southwest, Rochester, MN 55905; ; Telephone: (507) 284-3437; Fax: (507) 266-7900
| | - Lowell C. Dale
- Associate Professor of Medicine, Mayo Clinic College of Medicine; Mayo Clinic, 200 1 Street Southwest, Rochester, MN 55905; ; Telephone: (507) 266-1948; Fax: (507) 266-7900
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Kozlowski LT. Effect of smokeless tobacco product marketing and use on population harm from tobacco use policy perspective for tobacco-risk reduction. Am J Prev Med 2007; 33:S379-86. [PMID: 18021913 DOI: 10.1016/j.amepre.2007.09.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 08/02/2007] [Accepted: 09/19/2007] [Indexed: 10/22/2022]
Abstract
This article presents policy perspectives on the marketing of smokeless tobacco products to reduce population harm from tobacco use. Despite consensus that smokeless tobacco products as sold in the United States are less dangerous than cigarettes, there is no consensus on how to proceed. Diverse factions have different policy concerns. While the tobacco industry is exempted from U.S. Food and Drug Administration (FDA) oversight, the pharmaceutical industry whose nicotine replacement therapy (NRT) medicines compete with smokeless tobacco as noncombustible nicotine-delivery systems are regulated by the FDA. Some public health experts support smokeless tobacco use to reduce population harm from tobacco; other public health experts oppose promoting smokeless tobacco for harm reduction. Adult consumers can freely purchase currently-marketed smokeless tobacco products and even more-deadly cigarettes. Concerns with and advantages of smokeless tobacco products are discussed. In that noncombustible medicinal nicotine-delivery systems have been proven to be effective smoking-cessation aids, smokeless tobacco, as another source of psychoactive doses of nicotine, could be used similarly, in a dose-response fashion as a smoking-cessation aid (consistent with FDA principles for evaluating generic versions of drugs). Price measures should be used on tobacco products to make costs to consumers proportional to product health risks (which would make smokeless tobacco much cheaper than cigarettes), and smokeless tobacco should be encouraged as an option for smoking cessation in adult smokers, particularly for those who have failed to stop smoking using NRT or other methods.
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Affiliation(s)
- Lynn T Kozlowski
- Department of Health Behavior, State University of New York-Buffalo, Buffalo, New York 14214-3079, USA.
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Ebbert JO, Montori V, Vickers KS, Erwin PC, Dale LC, Stead LF. Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev 2007:CD004306. [PMID: 17943813 DOI: 10.1002/14651858.cd004306.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Use of smokeless tobacco (ST) can lead to nicotine addiction and long-term use can lead to health problems including periodontal disease and cancer. OBJECTIVES To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Dissertation Abstracts Online, and Scopus. Date of last search: March, 2007. SELECTION CRITERIA Randomized trials of behavioural or pharmacological interventions to help users of ST to quit with follow up of at least six months. DATA COLLECTION AND ANALYSIS Two authors independently extracted data. MAIN RESULTS Two trials of bupropion SR did not detect a benefit of treatment at six months or longer (Odds Ratio (OR) 0.86, 95% Confidence Interval (CI): 0.47 to 1.57). Four trials of nicotine patch did not detect a benefit (OR 1.16, 95% CI: 0.88 to 1.54), nor did two trials of nicotine gum (OR 0.98, 95% CI: 0.59 to 1.63). There was statistical heterogeneity among the results of 12 behavioural interventions included in the meta-analyses. Six trials showed significant benefits of intervention. In post-hoc subgroup analyses, behavioural interventions which include telephone counselling or an oral examination may increase abstinence rates more than interventions without these components. AUTHORS' CONCLUSIONS Behavioural interventions should be used to help ST users to quit and telephone counselling or an oral examination may increase abstinence rates. Pharmacotherapies have not been shown to affect long-term abstinence.
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Affiliation(s)
- J O Ebbert
- Mayo Clinic, Department of Internal Medicine, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Dale LC, Ebbert JO, Glover ED, Croghan IT, Schroeder DR, Severson HH, Hurt RD. Bupropion SR for the treatment of smokeless tobacco use. Drug Alcohol Depend 2007; 90:56-63. [PMID: 17353101 PMCID: PMC1994655 DOI: 10.1016/j.drugalcdep.2007.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 02/09/2007] [Accepted: 02/09/2007] [Indexed: 02/02/2023]
Abstract
BACKGROUND No pharmacotherapies have been shown to increase long-term (> or = 6 months) tobacco abstinence rates among smokeless tobacco (ST) users. Bupropion SR has demonstrated potential efficacy for ST users in pilot studies. We conducted a multicenter, randomized, double-blind, placebo-controlled, clinical trial to assess the efficacy and safety of bupropion SR for tobacco abstinence among ST users. METHODS Adult ST users were randomized to bupropion SR titrated to 150 mg twice daily (N=113) or placebo (N=112) for 12 weeks plus behavioral intervention. The primary endpoint was the 7-day point-prevalence tobacco abstinence rate at week 12. Secondary outcomes included prolonged and continuous tobacco abstinence rates, craving and nicotine withdrawal, and weight gain. RESULTS The 7-day point-prevalence tobacco abstinence rates did not differ between bupropion SR and placebo at the end treatment (53.1% versus 46.4%; odds ratio (OR) 1.3; p=0.301). The 7-day point-prevalence abstinence did not differ at weeks 24 and 52. The prolonged and continuous tobacco abstinence rates did not differ at weeks 12, 24, and 52. A time-by-treatment interaction was observed in craving over time with greater decreases in the bupropion SR group. At 12 weeks, the mean (+/-S.D.) weight change from baseline among abstinent subjects was an increase of 1.7 (+/-2.9)kg for the bupropion SR group compared to 3.2 (+/-2.7)kg for placebo (p=0.005). CONCLUSIONS Bupropion SR did not significantly increase tobacco abstinence rates among ST users, but it significantly decreased craving and weight gain over the treatment period.
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Affiliation(s)
- Lowell C Dale
- Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Kotlyar M, Mendoza-Baumgart MI, Li ZZ, Pentel PR, Barnett BC, Feuer RM, Smith EA, Hatsukami DK. Nicotine pharmacokinetics and subjective effects of three potential reduced exposure products, moist snuff and nicotine lozenge. Tob Control 2007; 16:138-42. [PMID: 17400953 PMCID: PMC2598476 DOI: 10.1136/tc.2006.018440] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 12/14/2006] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare nicotine pharmacokinetics and subjective effects of three new smokeless tobacco potential reduced exposure products (PREPs; Ariva, Revel and Stonewall) with moist snuff (Copenhagen) and medicinal nicotine (Commit lozenge). METHODS 10 subjects completed a randomised, within-subject, crossover study. Subjects used one product for 30 min at each of the five laboratory sessions. Maximal nicotine concentration (Cmax) was determined and area under the concentration time curve (AUC) was calculated for a 90-min period (during use and 60 min after use). Nicotine craving, withdrawal symptoms and ratings of product effects and liking were measured during product use. RESULTS Nicotine AUC and Cmax were higher for Copenhagen than for any other product (p<0.002) and higher for Commit than for either Ariva or Revel (p<0.001). Cmax for Commit was also higher than for Stonewall (p = 0.03). Craving was lowest during use of Copenhagen (p<0.03). Craving during use of Stonewall, Ariva and Commit was lower than during use of Revel (p<0.05). Withdrawal symptom score during use of Copenhagen was lower than during use of Revel (p = 0.009). Copenhagen scores were higher (p<0.005) than all other products in several measures of drug effects and liking (feel good effects, satisfaction, liking and desire for product, and strength of product). CONCLUSION The new smokeless tobacco PREPs result in lower nicotine concentrations and equivalent or lower reductions in subjective measures compared with medicinal nicotine. Since health effects of PREPs are largely unknown, medicinal nicotine should be preferentially encouraged for smokers or smokeless tobacco users wishing to switch to lower-risk products.
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Affiliation(s)
- Michael Kotlyar
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
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Mazahir S, Malik R, Maqsood M, Merchant KA, Malik F, Majeed A, Fatmi Z, Khawaja MR, Ghaffar S. Socio-demographic correlates of betel, areca and smokeless tobacco use as a high risk behavior for head and neck cancers in a squatter settlement of Karachi, Pakistan. Subst Abuse Treat Prev Policy 2006; 1:10. [PMID: 16722535 PMCID: PMC1475829 DOI: 10.1186/1747-597x-1-10] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 04/26/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of any of the above products. RESULTS Daily use of all the substances except chaalia was higher among males compared to females. Chaalia use was higher among adolescents than adults while non-married consumed both chaalia and gutka more than married. Mohajir ethnicity had higher prevalence of paan, gutka and tumbaku use while Pathans had higher prevalence of niswar use. CONCLUSION Prevalence of use of chewable products is high in Pakistan with particularly high use of certain substances related with socio-demographic profiles. Industrially prepared products, chaalia and gutka, are gaining popularity among youth. Policies and focused interventions can be developed taking into consideration the preferred use of products among different socio-demographic groups.
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Affiliation(s)
- Samia Mazahir
- Class of 2006, Aga Khan University – Medical College, Karachi 74800, Pakistan
| | - Rabia Malik
- Class of 2006, Aga Khan University – Medical College, Karachi 74800, Pakistan
| | - Maria Maqsood
- Class of 2006, Aga Khan University – Medical College, Karachi 74800, Pakistan
| | | | - Farida Malik
- Class of 2006, Aga Khan University – Medical College, Karachi 74800, Pakistan
| | - Atif Majeed
- Class of 2006, Aga Khan University – Medical College, Karachi 74800, Pakistan
| | - Zafar Fatmi
- Assistant Professor, Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | | | - Shehzad Ghaffar
- Senior Instructor, Department of Surgery (ENT, Head & Neck division), Aga Khan University, Karachi 74800, Pakistan
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