Tobacco addiction

Perceptions of a reduced nicotine policy and predictors of policy support: A nationally representative U.S. survey

BACKGROUND

The U.S. Food and Drug Administration is considering a policy to reduce nicotine in cigarettes to non-addictive levels. Although current evidence supports the public-health benefits of a reduced-nicotine policy, almost half of people who smoke (∼ 40%) do not support the policy. This study estimates the factors most strongly associated with support or opposition toward the policy, including tobacco use status, perceived effects of a reduced nicotine policy, trust in the FDA, and psychological distress. The study aims to inform messaging campaigns and policy makers.

METHODS

Data were collected in 2021 with nationally representative samples of U.S. adults (n = 1763). After receiving information about the reduced nicotine policy, participants indicated their beliefs and support for or opposition to the policy, along with other individual difference characteristics. Univariate population parameters and multinomial logistic regression coefficients were estimated.

RESULTS

In adjusted models, people who formerly or never smoked were less likely to oppose the policy compared to those who currently smoke; people with higher psychological distress and those who believe the policy will promote switching to e-cigarettes were more likely to oppose the policy. In addition, people were more likely to support the policy if they believed it would make quitting easier or that the FDA is trustworthy.

CONCLUSIONS

Educational campaigns about reduced nicotine policy should expect higher impact by targeting prevalent perceptions and those more strongly associated with policy sentiment. In anticipation of the policy rollout, there may be a critical window to shape public opinion.

Cigarette Use and Secondhand Smoke Exposure Among Secondary School Students - China, 2023

What is already known about this topic?

In 2021, the prevalence of experimental and current cigarette use among secondary school students in China stood at 16.7% and 4.7%, respectively. Additionally, 39.9% of these students were exposed to secondhand smoke at school.

What is added by this report?

In comparison to 2021, the prevalence of current cigarette use remained unchanged at 4.2% in 2023, whereas experimental use declined to 13.7%. Notably, rates were significantly higher among vocational senior high school (VSHS) students relative to their peers in senior high school (SHS) and junior high school (JHS). Furthermore, exposure to secondhand smoke in schools decreased to 35.4% in 2023 from previously recorded levels, with more pronounced reductions observed in JHS and SHS populations and no notable change among VSHS students.

What are the implications for public health practice?

Targeted tobacco control policies are imperative for secondary school students, including the establishment of smoke-free school environments. Additionally, it is crucial to pay close attention to the needs of VSHS students.

Messaging about very low nicotine cigarettes (VLNCs) to influence policy attitudes, harm perceptions and smoking motivations: a discrete choice experiment

BACKGROUND

To reduce smoking and the harms it causes, countries, including the USA, are considering policies to reduce nicotine in combustible tobacco to minimally addictive levels. Effective messages about very low nicotine cigarettes (VLNCs) and this policy are crucial in combating misperceptions threatening the policy's effectiveness.

DATA AND METHODS

A discrete choice experiment assessed messages about VLNCs. Participants were 590 adults who smoked exclusively, 379 adults who both smoked and used e-cigarettes, 443 adults who formerly smoked and 351 young adults who never smoked (total n=1763). Seven message attributes were varied systematically (source, harm, chemicals, nicotine, satisfaction, addictiveness and quitting efficacy). Outcomes were selection of messages that generated the most positive attitude towards reduced nicotine policy, the greatest perceived harmfulness of VLNCs, and most strongly motivated quitting and initiating behaviour for VLNCs.

RESULTS

Information about specific harms and chemicals of VLNCs had the largest effects on selection of messages as eliciting more negative attitudes towards VLNCs policy, increasing perceived VLNC harmfulness, increasing motivation to quit VLNCs and decreasing motivation to try VLNCs. Messages with information about quitting efficacy were selected as more motivating to quit among those who smoke, but also more motivating to try VLNCs among those who do not smoke.

CONCLUSION

Harm and chemical information can be prioritised to ensure VLNCs are not misperceived as less harmful than regular cigarettes. Messages about increased quitting efficacy and reduced addictiveness associated with VLNCs may backfire if presented to those who do not smoke.

Smoking Susceptibility and Trends Among Nonsmoking Adolescents: An International Study

OBJECTIVES

Smoking susceptibility is defined as a lack of firm decision against smoking, usually starts in the preparation and/or initiation stages of smoking behavior, and is a strong predictor of smoking experimentation during adolescence. However, the recent global prevalence and trends in smoking susceptibility among adolescents are not well documented. This study assessed global smoking susceptibility and secular trends among nonsmoking adolescents.

METHODS

Smoking susceptibility was analyzed using the most recent data from the Global Youth Tobacco Survey from 129 countries, where the data from each country were drawn from at least 1 survey conducted at any time between 1999 and 2020. Moreover, data from 82 countries were used to assess the average annual rate of change (AARC) in smoking susceptibility over time.

RESULTS

Smoking susceptibility among nonsmoking adolescents was 19.6%. A U-shaped relationship was observed between susceptibility and a country's economic level. Most countries showed no changes in susceptibility over time. Countries with a significant upward trend in susceptibility were primarily high-income and upper middle-income countries in the American region. At the World Health Organization regional level, susceptibility significantly decreased in the European region (AARC: -3.5%; 95% confidence interval, -5.8 to -0.8); however, it significantly increased in the American region (AARC: 2.2%; 95% confidence interval, 1.3-3.1).

CONCLUSIONS

Smoking susceptibility remains a serious public health challenge among adolescents worldwide. More public health policies are needed to reduce susceptibility and to control its upward trend in the American region and high-income countries.

Tobacco smoking, second-hand smoking exposure in relation to psychotic-like experiences in adolescents

BACKGROUND

Previous literature supports that tobacco smoking and second-hand smoking (SHS) exposure were strongly associated with poor mental health in the general population. However, there is a lack of empirical data on the relationship between tobacco smoking, SHS exposure and psychotic-like experiences (PLEs). This study conducted a cross-sectional survey to explore PLEs and the associations of PLEs with tobacco smoking and SHS exposure among adolescents in China.

METHODS

A total sample of 67 182 Chinese adolescents were recruited from Guangdong province in China (53.7% boys, mean age = 12.79 years) from December 17 to 26, 2021. All adolescents have completed self-reported questionnaires on demographic characteristics, smoking status, SHS exposure and PLEs.

RESULTS

Within the sample, only 1.2% of participants had an experience of tobacco smoking while approximately three-fifths reported being exposed to SHS. 10.7% of adolescents reported frequent PLEs over the past month. Adolescents who smoked showed a higher prevalence of PLEs than in non-smoking samples. After controlling for confounders, SHS exposure was a robust risk factor for PLEs with or without the effect of tobacco smoking.

DISCUSSION

These findings support the importance of smoke-free legislation, and anti-smoking measures in educational settings directed at both adolescents and their caregiver, which may decrease occurring rates of PLEs among adolescents.

Nicotinic receptors in airway disease

With continued smoking of tobacco products and expanded use of nicotine delivery devices worldwide, understanding the impact of smoking and vaping on respiratory health remains a major global unmet need. Although multiple studies have shown a strong association between smoking and asthma, there is a relative paucity of mechanistic understanding of how elements in cigarette smoke impact the airway. Recognizing that nicotine is a major component in both smoking and vaping products, it is critical to understand the mechanisms by which nicotine impacts airways and promotes lung diseases such as asthma. There is now increasing evidence that α7 nicotinic acetylcholine receptors (α7nAChRs) are critical players in nicotine effects on airways, but the mechanisms by which α7nAChR influences different airway cell types have not been widely explored. In this review, we highlight and integrate the current state of knowledge regarding nicotine and α7nAChR in the context of asthma and identify potential approaches to alleviate the impact of smoking and vaping on the lungs.

Do tobacco 21 laws work?

Tobacco 21 (T-21) laws raise the minimum legal purchasing age for all tobacco products to 21. This study is the first to examine the impact of statewide T21 laws on teenage and young adult cigarette and electronic cigarette (e-cigarette) use. Using survey data from the Behavioral Risk Factor Surveillance System (BRFSS) and a difference-in-differences approach, we find that statewide adoption of a T-21 law is associated with a 2-to-4 percentage-point decline in smoking participation among 18-to-20-year-olds. Supplemental analyses using the State Youth Risk Behavior Surveys (YRBS) show that frequent e-cigarette use among 18-year-olds also fell following the adoption of T21 laws, though this effect was partially because teens turned to informal social sources to obtain e-cigarettes (i.e., borrowing or bumming). Finally, we find that T-21 laws generate spillover effects, including (2) reductions in cigarette use among 16-to-17-year-olds, a group that relies heavily on informal social markets in high school, and (2) reductions in marijuana use and days of alcohol use among some teens.

Cigarette Coupon Receipt and Smoking Relapse by Duration of Smoking Abstinence

INTRODUCTION

It is unknown whether and to what extent the duration of smoking abstinence may modify the association between receiving cigarette coupons and smoking relapse in the U.S. This study aims to fill this gap.

METHODS

Data were from the Population Assessment of Tobacco and Health study Wave 4 (December 2016-January 2018, baseline) and Wave 5 (December 2018-November 2019, follow-up) surveys. Analysis was conducted in May 2022. The study sample was participants who formerly smoked cigarettes at baseline (N=5,186). The exposure was past 12-month receipt of cigarette coupons (yes/no) at baseline, and the outcome was cigarette smoking relapse (yes/no) at follow-up. A potential modifier was the duration of smoking abstinence (within/>1 year) at baseline. Baseline single-wave weights were applied, and a multivariable logistic regression model was used to estimate the adjusted association. Interaction between cigarette coupon receipt and duration of smoking abstinence was examined to explore potential modification effects.

RESULTS

Participants who received cigarette coupons at baseline were more likely to relapse at follow-up (AOR=1.63, 95% CI=1.15, 2.32). This association was significantly stronger among participants who quit within 1 year than among participants who quit >1 year at baseline (AOR for the interaction term=2.77, 95% CI=1.22, 6.25). Subgroup analysis shows that receipt of cigarette coupons was significantly associated with smoking relapse among participants who quit within 1 year (AOR=2.10, 95% CI=1.39, 3.17), and this association was not statistically significant among participants who quit >1 year (AOR=0.76, 95% CI=0.36, 1.63).

CONCLUSIONS

Policies restricting cigarette coupons may help adults who recently quit sustain abstinence.

Tobacco Use and Tobacco Dependence Management

Tobacco use is a major public health problem and the leading cause of preventable deaths in the United States and worldwide. Tobacco dependence determines tobacco use and is largely due to nicotine addiction. Such dependence is a disease resulting in a strong desire or compulsion to take tobacco, with difficulty in cessation of tobacco, along with persistent use despite overtly harmful consequences.

Virtual reality cue exposure therapy for tobacco relapse prevention: a comparative study with standard intervention

BACKGROUND

Successful interventions have been developed for smoking cessation although the success of smoking relapse prevention protocols has been limited. Cognitive behavioural therapy (CBT) in particular has been hampered by a high relapse rate. Because relapse can be due to conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality cue exposure therapy (VRCE) can be a potential tool to generate 3D interactive environments that simulate risk situations for relapse prevention procedures.

METHODS

To assess the effectiveness of VRCE with CBT, a comparative trial involving 100 smoking abstinent participants was designed with all required virtual environments (VE) created with an inexpensive graphic engine/game level editor.

RESULTS

Outcome measures confirmed the immersive and craving eliciting effect of these VEs. Results demonstrated that more participants in the VRCE group did not experience smoking relapse and that VRCE is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rate in the VRCE group was noticeably lower than the CBT group. Aside from mood scores, no significant differences were found regarding the other scales.

CONCLUSION

The present clinical trial provides evidence that VRCE was effective in preventing smoking relapse. Improvement in technology and methodology for future research and applications is delineated.

Comparing Smokeless Tobacco Use between Male-to-Female and Female-to-Male Transgender Adults in the United States

Background: The shifted gender social norms and tobacco cessation advice associated with estrogen therapy as a result of thrombosis risk could be responsible for the tobacco use differences between Male-to-Female (MTF) and Female-to-Male (FTM) transgender adults. Research has established this disparity in cigarette smoking, but none has looked at smokeless tobacco. Aim: This study aimed to compare smokeless tobacco use MTF and FTM transgender adults in the United States. Furthermore, it assessed the other potential determinants of smokeless tobacco use among the transgender population. Methods: The study analyzed data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS), which included 1,070 transgender individuals aged 18 and above (382 MTF and 688 FTM). Gender identity (MTF vs. FTM) was used to predict smokeless tobacco use using logistic regression, adjusting for other socio-demographic and behavioral determinants. Results: The prevalence of smokeless tobacco use among the transgender population was 5.7%, 3.8% among MTF, 6.3% among FTM, and 6.7% among gender non-conforming transgender individuals. FTM transgender individuals were 2.23 times more likely to use smokeless tobacco than MTF transgender individuals. Smokeless tobacco use among MTF and FTM transgender individuals was also significantly associated with being older than 54 years (OR = 1.94), having a high school education or lower (OR = 1.98), living with at least a child (OR = 2.17), a current smoker (OR = 1.78) and a current e-cigarette user (OR = 2.97). Discussion: This study found a significant difference in smokeless tobacco use among transgender subgroups and addressed a critical tobacco knowledge gap among this population.

Nicotine dependence of cigarette and heated tobacco users in Japan, 2019: a cross-sectional analysis of the JASTIS Study

OBJECTIVES

Japan is currently the biggest market of heated tobacco products (HTPs) in the world. Little is known about nicotine dependence among HTP users. Thus, the objective was to assess the association of type of tobacco use and time-to-first-use, a marker of nicotine dependence.

METHODS

A cross-sectional analysis of the 2019 data from an internet cohort study was conducted. The analytical sample consisted of 2147 current (≥1 day use in the past 30 days) HTP and/or conventional cigarette users, aged 25+ years. Marginal structural binomial regression was used to estimate nicotine dependence prevalence ratios (PRs) for each category of tobacco use (exclusive daily cigarette, exclusive HTP (≥1 day), dual HTP+daily cigarette, dual HTP+non-daily cigarette), relative to exclusive, non-daily cigarette smoking.

RESULTS

Using a 5 min cut-off for time-to-first-use, the prevalence of nicotine dependence was higher among dual users of HTP and daily cigarettes (PR=1.38; 95% CI: 1.05 to 1.82) and exclusive, daily cigarette users (PR=1.48; 95% CI: 1.15 to 1.91), relative to exclusive, non-daily cigarette users. However, nicotine dependence among exclusive HTP users, and dual HTP+non-daily cigarette users, did not differ from that of exclusive, non-daily cigarette users. When using 15 and 30 min cut-offs, all types of users, including exclusive HTP, had higher levels of nicotine dependence relative to exclusive, non-daily cigarette users.

CONCLUSIONS

Regardless of HTP use, daily cigarette users had higher prevalence of nicotine dependence compared with non-daily cigarette users. Exclusive HTP users had similar (or potentially higher) dependence compared with exclusive, non-daily cigarette users. Longitudinal studies are needed to interrogate the public health implications of growing HTP use worldwide.

Association between Smoking and Sugar-Sweetened Beverage Consumption, Tooth Brushing among Adolescents in China

The study aimed to investigate the relationship between smoking, Sugar-Sweetened Beverage (SSB) consumption and tooth brushing among adolescents in China. A valid sample of 6084 middle school students from the Zhejiang province was included. Participants were questioned about smoking status, SSB consumption, tooth brushing, and oral health-related quality of life (OHRQoL). Among the participants, smoking prevalence was 1.9% and nearly half of the students consumed SSBs. The demographic factors associated with smoking were gender, place of residence, and parental level of education. There are co-variations between smoking status, SSB consumption, and tooth brushing. Logistic regression showed that smoking adolescents were more likely to brush their teeth less than once per day (OR = 1.74, p < 0.05), consume soft drinks once or more per day (OR = 2.18, p < 0.01) and have a higher score on the Child Oral Health Impact Profile (OR = 1.05, p < 0.05) after adjusting for demographic factors. The findings provide compelling evidence for governments and related stakeholders to intervene in the lifestyle of adolescents. Future studies are needed to understand the interaction effects of such behaviors, and should help to inform appropriate interventions.

Efficacy of non-invasive brain stimulation interventions in reducing smoking frequency in patients with nicotine dependence: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

Nicotine is a highly addictive substance in tobacco products that dysregulates several neurotransmitters in the brain and impairs executive function. Non-invasive brain stimulation (NIBS) methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are promising treatments for nicotine dependence. We investigated the efficacy and acceptability of NIBS in managing smoking cessation through a systematic review and network meta-analysis (NMA).

METHODS

We conducted a systematic review to identify randomized controlled trials (RCTs) that investigated the efficacy of NIBS for smoking cessation. All pairwise meta-analyses and NMA procedures were conducted using random-effects and frequentist models. The co-primary outcomes were (1) the change in number of cigarettes smoked per day (change in frequency of smoking) in patients with nicotine dependence after NIBS and (2) acceptability (the dropout rate). The effect sizes for co-primary outcomes of change in frequency of smoking and acceptability were assessed according to standardized mean difference (SMD) and odds ratio, respectively.

RESULTS

Twelve RCTs with 710 participants (mean age: 44.2 years, 31.2% female) were included. Compared with the sham control, 10-Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) was associated with the largest changes in smoking frequency [SMD = -1.22, 95% confidence interval (95% CI) = -1.77 to -0.66]. The 2-mA bifrontal tDCS (SMD = -0.97, 95% CI = -1.32 to -0.62) and 10-Hz deep rTMS over the bilateral DLPFC with cue provocation (SMD = -0.77, 95% CI = -1.20 to -0.34) were associated with a significantly larger decrease in smoking frequency versus the sham. None of the investigated NIBSs was associated with dropout rates significantly different from those of the sham control groups.

CONCLUSION

Prefrontal non-invasive brain stimulation interventions appear to reduce the number of cigarettes smoked with good acceptability.

Health behaviour and its determinants in elderly patients with chronic diseases: evidence from Jiangsu Province, China

Background

Chronic disease is a major cause of mortality among elderly individuals in China, and treatment is a substantial public health burden. However, behavioural interventions may be more important than mere clinical treatment of these chronic diseases.

Objective

The paper aimed to assess the health behaviour of a sample of elderly individuals with chronic diseases in Jiangsu Province, China and to identify how demographic characteristics influence health behaviour. Furthermore, the group that would likely need the most health intervention was identified.

Design

A version of the Health Promoting Lifestyle Profile II (HPLP-II) was adapted to Chinese to evaluate health behaviours in six dimensions: nutrition, tobacco and alcohol use, physical activity, stress management, health responsibility, and spiritual growth. Multistage random sampling was conducted from October 2020 to May 2021. Questionnaires incorporating the adapted HPLP-II were distributed to 900 elderly patients (i.e., aged 60 and above) with chronic diseases in the three sampled prefectures of Jiangsu Province; of these questionnaires, 791 were completed. Univariate t tests, principal component analysis, and multivariate linear regressions were employed in the analysis.

Results

The average total score of respondents on health behaviour was 73.73. The dimensions (ordered from highest to lowest scores) are as follows: “nutrition”, “tobacco and alcohol use”, “health responsibility”, “spiritual growth”, “stress management”, and “physical activity”. The multivariate linear regression suggested that the determinants (P < 0.05) of health behaviour (total score) were income, sex, age, relationship status, residence, and education.

Conclusions

Elderly patients with chronic diseases in Jiangsu Province generally behaved in a healthy manner. “Physical activity”, “stress management”, and “spiritual growth” were the dimensions that would most benefit from health intervention, while elderly single/divorced/widowed patients with lower income and less education should be the target group for health intervention.

Smokeless tobacco and cigarette smoking: chemical mechanisms and cancer prevention

Tobacco products present a deadly combination of nicotine addiction and carcinogen exposure resulting in millions of cancer deaths per year worldwide. A plethora of smokeless tobacco products lead to unacceptable exposure to multiple carcinogens, including the tobacco-specific nitrosamine N'-nitrosonornicotine, a likely cause of the commonly occurring oral cavity cancers observed particularly in South-East Asian countries. Cigarettes continue to deliver a large number of carcinogens, including tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons and volatile organic compounds. The multiple carcinogens in cigarette smoke are responsible for the complex mutations observed in critical cancer genes. The exposure of smokeless tobacco users and smokers to carcinogens and toxicants can now be monitored by urinary and DNA adduct biomarkers that may be able to identify those individuals at highest risk of cancer so that effective cancer prevention interventions can be initiated. Regulation of the levels of carcinogens, toxicants and nicotine in tobacco products and evidence-based tobacco control efforts are now recognized as established pathways to preventing tobacco related cancer.

Antecedents and Consequences of Smoking Cessation Intention in the Context of the Global COVID-19 Infodemic

A growing body of scientific studies has been published to inform responses to the ongoing coronavirus pandemic, and some have claimed that cigarette smoking has a beneficial or mixed effect on the prevention and treatment of COVID-19. The presentation of such findings, unfortunately, has created an infodemic. This study integrated the theory of planned behavior and the health belief model and incorporated findings on addiction from the medical literature to predict cessation intention and support for tobacco control measures in the context of the COVID-19 infodemic. The study found that cessation intention partially mediated the effect of perceived severity and fully mediated the effects of perceived benefits, self-efficacy, and addiction on support for control measures. In addition, a positively-valenced message of the effect of smoking on the prevention and treatment of COVID-19 vs. a mixedly-valenced message was significant in predicting cessation intention, and the positively-valenced message of smoking indirectly predicted support for tobacco control measures. Perceived susceptibility, barriers, and subjective norms, however, exerted neither direct nor indirect effects on the two outcome variables.

Prevalence and trends in tobacco use among adolescents aged 13-15 years in 143 countries, 1999-2018: findings from the Global Youth Tobacco Surveys

BACKGROUND

Tobacco use is a leading preventable cause of morbidity and mortality worldwide. Little is known about recent prevalence and trends in tobacco use among adolescents globally. We aimed to assess the recent global prevalence of tobacco use in young adolescents and the secular trends in prevalence between 1999 and 2018.

METHODS

We used the most recent Global Youth Tobacco Surveys data on adolescents aged 13-15 years from 143 countries or territories that had done at least one survey between Jan 1, 2010, and Dec 31, 2018, to assess the recent prevalence of tobacco use; and data from 140 countries that had done two or more surveys between Jan 1, 1999, and Dec 31, 2018, to assess the trends in the prevalence of tobacco use.

FINDINGS

530 234 adolescents were included from the 143 countries that had done at least one survey between 2010 and 2018. 1 192 312 adolescents were included from the 140 countries that had done two or more surveys between 1999 and 2018. The most recent global prevalence of cigarette smoking was 11·3% (95% CI 10·3-12·3) in boys and 6·1% (5·6-6·6) in girls, based on cigarette smoking on at least 1 day during the past 30 days, 6·0% (5·5-6·6) and 2·6% (2·4-2·9) based on smoking on at least 3 days, and 4·2% (3·8-4·6) and 1·6% (1·4-1·8) based on smoking on at least 6 days. The most recent prevalence of the use of tobacco products other than cigarettes (eg, chewing tobacco, snuff, dip, cigars, cigarillos, pipe, electronic cigarettes) on at least 1 day during the past 30 days was 11·2% (9·9-12·6) in boys and 7·0% (6·4-7·7) in girls. The most recent prevalence of any tobacco use on at least 1 day during the past 30 days was 17·9% (16·1-19·6) in boys and 11·5% (10·5-12·4) in girls. The prevalence of cigarette smoking on at least 1 day during the past 30 days decreased between the first and last surveys in 80 (57·1%) of 140 countries, was unchanged in 39 countries (27·9%), and increased in 21 countries (15·0%). However, the prevalence of the use of tobacco products other than cigarettes was unchanged or increased in 81 (59·1%) of 137 countries.

INTERPRETATION

The global prevalence of tobacco use among adolescents aged 13-15 years was substantial. Although the prevalence of cigarette smoking decreased over time in the majority of countries, the prevalence of the use of other tobacco products increased or did not change in the majority of countries during the past two decades. These findings re-emphasise the need to strengthen tobacco control efforts among young adolescents globally.

FUNDING

Shandong University.

Validity and reliability of the Korean version of the Wisconsin Smoking Withdrawal Scale

BACKGROUND/AIMS

This study evaluated the validity and reliability of the Korean version of the Wisconsin Smoking Withdrawal Scale (WSWS-K) for use in clinical practice and research on Korean smokers.

METHODS

The Wisconsin Smoking Withdrawal Scale was translated into Korean and then back-translated into English. The authors reviewed the translation and back-translation and approved the final questionnaire draft. The validity and reliability of the WSWS-K were evaluated based on data collected from 300 participants. Construct validity was evaluated with a confirmatory factor analysis. Criterion-related validity was assessed by examining the relationships between the subscales of the WSWS-K and the matched items of the Korean version of the Minnesota Nicotine Withdrawal Scale (MNWS-K).

RESULTS

The participants were predominantly male (93.6%) and the mean age was 59.23 ± 15.19 years. The confirmatory factor analysis revealed that fit indices (namely, the goodness-of-fit index, adjusted goodness-of-fit index, comparative fit index, and the normed fit index) exceeded or approached 0.9. Cronbach's alpha for the entire scale was 0.87. The total score of the WSWS-K had a statistically significant positive correlation with that of the MNWS-K (Pearson's correlation coefficient, 0.768; p < 0.01). Additionally, we performed linear regression between the WSWS-K and MNWS-K scores after adjusting for age, gender, comorbidity, and smoking history. After this adjustment, the p value of the WSWS- K was < 0.001.

CONCLUSION

The WSWS-K had satisfactory validity and reliability. The WSWS- K can be used with acceptable validity and reliability in research and clinical evaluation of Korean smokers.

Nicotine Prevents Oxidative Stress-Induced Hippocampal Neuronal Injury Through α7-nAChR/Erk1/2 Signaling Pathway

Oxidative stress-induced neuronal damage has been implicated to play a dominant role in neurodegenerative disorders, such as Alzheimer’s disease (AD). Nicotine, a principal additive compound for tobacco users, is thought as a candidate to attenuate amyloid-β-mediated neurotoxicity and NMDA-induced excitotoxicity. Previous studies demonstrated that nicotine exerted this neuroprotective action on oxidative stress. However, the mechanisms underlying how nicotine contributes on oxidative injury in immortalized hippocampal HT-22 cells remain largely unknown. Therefore, in this study we investigated that the potential effects of nicotine on hydrogen peroxide (H₂O₂)-induced oxidative injury and underlying mechanisms in HT-22 cells. We found that pretreatment with nicotine at low concentrations markedly recovered the cell cycle that was arrested at the G2/M phase in the presence of H₂O₂ through reduced intracellular ROS generation. Moreover, nicotine attenuated H₂O₂-induced mitochondrial dysfunctions. Mechanistically, the application of nicotine significantly upregulated the levels of phosphorylated Erk1/2. The neuroprotective effects of nicotine, in turn, were abolished by PD0325901, a selective Erk1/2 inhibitor. Further obtained investigation showed that nicotine exerted its neuroprotective effects via specifically activating α7 nicotinic acetylcholine receptors (α7-nAChRs). A selective inhibitor of α7-nAChRs, methyllycaconitine citrate (MLA), not only completely prevented nicotine-mediated antioxidation but also abolished expression of p-Erk1/2. Taken together, our findings suggest that nicotine suppresses H₂O₂-induced HT-22 cell injury through activating the α7-nAChR/Erk1/2 signaling pathway, which indicates that nicotine may be a novel strategy for the treatment of neurodegenerative disorders.

Tobacco-related cancers in Europe: The scale of the epidemic in 2018

BACKGROUND

Tobacco smoking is the major preventable cause of cancer. Despite the longstanding decline in smoking prevalence, lung cancer remains one of the most frequently diagnosed cancers in both sexes. We aimed to estimate the current cancer burden attributable to smoking in Europe.

METHODS

Smoking-related cancer incidence by country, cancer type, sex and age in Europe was estimated from GLOBOCAN 2018. We applied a modified version of the indirect method to estimate the population attributable fraction (PAF) for lung cancer and applied Levin's formula to estimate the PAF for other smoking-related cancer sites.

RESULTS

In Europe in 2018, 572,000 and 186,000 cancer cases were attributable to tobacco smoking in males and females respectively, accounting for 28% (males) and 10% (females) of all cancer cases. By region, the largest and the lowest PAF due to smoking in males occurred in Eastern Europe (35% of all cancer cases) and Northern Europe (21%), respectively. Among women, this pattern was reversed (16% in Northern Europe and 6% in Eastern Europe). Lung cancer accounted for more than half of the total cancer burden attributable to smoking (382,000). Other major contributors to the total PAF were lip, oral cavity and pharynx, bladder and laryngeal cancers in men (27% out of total PAF) and colorectal, pancreatic, oral cavity and pharyngeal cancers (21%) in women.

CONCLUSIONS

Tobacco smoking was responsible for one in five cancer cases in Europe in 2018. The introduction and robust implementation of tobacco control programmes are critical to reduce this cancer burden in the future.

Intranasal delivery of a nicotine vaccine candidate induces antibodies in mouse blood and lung mucosal secretions that specifically neutralize nicotine

OBJECTIVE

Cigarette smoking is one of the leading causes of death in the world. The majority of the smokers have tried to quit, but only a few of them were able to achieve long-term abstinence, due to the high addictiveness of nicotine. Nicotine-specific antibodies have the potential to block the euphoric effect of nicotine by forming antibody-antigen complexes in the blood circulation. Since nicotine is taken largely by inhalation, inducing anti-nicotine antibodies in lung and nasal mucosal secretions, in addition to blood circulation, is expected to be beneficial.

SIGNIFICANCE

The importance of this study is to establish the feasibility of inducing nicotine-neutralizing antibodies not only in the blood, but also in the lung and nasal mucosal secretions, by intranasal administration of a nicotine vaccine candidate.

METHODS

Nicotine-keyhole limpet hemocyanin conjugate (Nic-KLH) was prepared and mixed with monophosphoryl lipid A (MPL) as an adjuvant. Nic-KLH/MPL was given intranasally or subcutaneously to mice, and the titers, affinity, and specificity of the nicotine-specific antibodies in nasal and lung mucosal secretions and blood samples were determined using (competitive) ELISA.

RESULTS

Nasal Nic-KLH/MPL immunization elicited robust nicotine-specific neutralizing IgA in mouse nasal and lung secretions, in additional to anti-nicotine IgG in blood circulation. The nicotine-specific IgG level in mice nasally immunized with Nic-KLH/MPL was lower than in mice subcutaneously immunized with the same Nic-KLH/MPL, but a heterologous prime-boost immunization strategy helped to increase it.

CONCLUSION

Intranasal immunization with a nicotine vaccine candidate can induce systemic and mucosal antibodies that specifically neutralize nicotine.

Effectiveness of Mindfulness-Based Relapse Prevention Program as an Adjunct to the Standard Treatment for Smoking: A Pragmatic Design Pilot Study

INTRODUCTION

Posttreatment relapse is a major roadblock to stemming the global epidemic of tobacco-related illness. This article presents results from a pilot trial evaluating the feasibility and initial efficacy of Mindfulness-Based Relapse Prevention (MBRP) as an adjunct to standard relapse prevention treatment (ST) for smoking cessation.

AIMS AND METHODS

Smokers (n = 86) in the maintenance phase of treatment were randomized to receive either ST plus MBRP (MBRP) (n = 44) or ST alone (ST) (n = 42). Data were collected at baseline and at 4-, 12-, and 24-week follow-up points. We evaluated the feasibility of the protocol with frequency analysis, and the efficacy with both intention to treat and complete case analyses of the effects of MBRP on abstinence. Secondary outcomes included mindfulness, craving, depression, anxiety, and positive/negative affect.

RESULTS

High adherence suggested MBRP is acceptable and feasible. Participants in the MBRP group reported increases in mindfulness (M = -7.833, p = .016), and reductions in craving (M = 17.583, p = .01) compared with the ST group. Intention to treat analysis found that, compared with MBRP (36.4%), ST (57.1%) showed trend-level superiority in abstinence at Week 4 (Prevalence Ratio = 0.63, p = .06); however at Week 24, the ST group (14.3%) demonstrated a twofold greater decrease in abstinence, compared with the MBRP group (20.1%) (Prevalence Ratio = 2.25, p = .08). Therefore, the MBRP group maintained a higher abstinence rate for longer. Reported effects were greater in the complete case analysis.

CONCLUSIONS

MBRP holds promise for preventing relapse after aided tobacco quit attempts.

IMPLICATIONS

Findings suggest that MBRP is acceptable, feasible, and valued by participants. At 24-week follow-up, there was a large effect size and a statistical trend toward fewer MBRP patients relapsing compared with ST patients. MBRP conferred ancillary benefits including reductions in craving and increases in levels of mindfulness. MBRP for tobacco cessation is highly promising and merits further research.

TRIAL REGISTRATION

clinicaltrials.gov.

IDENTIFIER

NCT02327104.

Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster-randomized controlled trial

AIM

Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8 weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow-up.

DESIGN

Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015-March 2016.

SETTING

Thirty-two eligible services (provided face-to-face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician.

PARTICIPANTS

Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow-up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%).

INTERVENTION

Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care.

MEASUREMENTS

Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent.

FINDINGS

At 8 weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5-5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8-0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9-1.02, P = 0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use.

CONCLUSIONS

Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking.

Nicotine Dependence and Factors Related to Smoking Cessation among Physicians in Estonia

Smoking withdrawal can be difficult due to nicotine dependence (ND). The study objective was to describe ND and to analyze the association between ND and factors related to smoking cessation among daily smoking physicians in Estonia. Data was collected in 2014, using cross-sectional postal survey sampling all practicing physicians (n = 5666) in Estonia, of whom 2939 responded (corrected response rate 53.1%). The study sample was restricted to daily smoking physicians (n = 171). Results of the Fagerström Test for Nicotine Dependence (FTND) were described and ND scores calculated. Logistic regression was used to determine the association of ND (at-least-moderate vs. low) with factors related to smoking cessation. Crude and fully adjusted ORs with 95% CIs were calculated. The mean FTND score was 2.8 ± 2.1. The odds of having at-least-moderate ND decreased significantly with each year postponing smoking initiation (OR = 0.82, 95% CI 0.72–0.94). After adjustment, ND was no longer associated with the desire to quit smoking and motives to quit. In conclusion, more than half of daily smoking physicians had low ND. Higher ND was associated with younger age of smoking initiation. Knowledge of ND and factors related to smoking cessation is useful in the prevention of smoking and in development of cessation counselling tailored for physicians.

Platelet-Activating Factor as an Effector for Environmental Stressors

Environmental stressors exert a profound effect on humans. Many environmental stressors have in common the ability to induce reactive oxygen species. The goal of this chapter is to present evidence that the potent lipid mediator platelet-activating factor (PAF) is involved in the effects of many stressors ranging from cigarette smoke to ultraviolet B radiation. These environmental stressors can generate PAF enzymatically as well as PAF-like lipids produced by free radical-mediated attack of glycerophosphocholines. Inasmuch as PAF exerts both acute inflammation and delayed immunosuppressive effects, involvement of the PAF system can provide an explanation for many consequences of environmental stressor exposures.

Prevalence of Some Genetic Risk Factors for Nicotine Dependence in Ukraine

Tobacco smoking is known to be a strong risk factor for developing many diseases. The development and severity of smoking dependence results from interaction of environmental and lifestyle factors, psycho-emotional predispositions, and also from genetic susceptibility. In present study, we investigated polymorphic variants in genes contributed to nicotine dependence, as well as to increased impulsivity, known to be an important risk factor for substance use disorders, in Ukraine population. The genotype frequencies at CYP2A6, DNMT3B, DRD2, HTR2A, COMT, BDNF, GABRA2, CHRNA5, and DAT1 polymorphisms were determined in 171 Ukraine residents, and these data were compared with data for several other European populations and main ethnic groups. It has been found that genotype frequencies for all studied loci are in Hardy-Weinberg equilibrium in the Ukrainian population and correspond to the respective frequencies in European populations. These findings suggest a similar impact of these loci on nicotine dependence in Ukraine. Further studies with larger sample sizes are, however, needed to draw firm conclusions about the effect size of these polymorphisms.

Functional benefit of smoking cessation in severe COPD patients undergoing bronchial valve implantation

INTRODUCTION

Tobacco smoke is the leading cause of chronic obstructive pulmonary disease. The aim of this study is to highlight the effectiveness of smoking cessation along with bronchial valve implantation in subjects with severe COPD.

METHODS

A sample of 25 patients, current smokers, affected by severe COPD and heterogeneous emphysema who quit smoking were compared with a group of 15 patients who did not quit smoking.

MEASUREMENTS AND MAIN RESULTS

Patients performed plethysmography, 6 minute walking test (WT), haemogasanalysis, exhaled CO test (eCO), COPD assessment test (CAT) together with the mMRC test. A clearer improvement of examined parameters was registered in the group of patients who quit smoking by varenicline and counselling. In particular, we observed a significant increase of FEV1 by 350 ml in the abstainers group compared with 100 ml increase in the non-abstainers(p < .05) group. We noticed that the RV% decreased by 30% compared with the 10% in the non-abstainers(p < .001). The CAT value decreased by 20 compared with 10 in current smokers(p < .001) as well as the mMRC score (p < .001) was more improved in abstainers. The total resistances were reduced by 30% versus 10% (p < .01)and notably there was a higher improvement of walking test (30 m versus 5) (p < .001). The eCO was clearly reduced in abstainers, 14 versus 8 (p < .002),. PaO2 increased by 4 mmHg versus 1(p < .0001).

CONCLUSIONS

Smoking cessation treatment by varenicline strengthens the effects of bronchial valve implantation and shows up its crucial therapeutic role in severe COPD.

Further psychometric analysis of the 20-item Partner Interaction Questionnaire in an adult sample of smokers

The 20-item Partner Interaction Questionnaire (PIQ-20) is frequently used to assess social support for adults wanting to stop smoking. Given that social support may play a significant role in quitting success, there is a need to understand the structure and psychometric properties of assessment instruments designed to measure the construct of partner support. The current study examined the psychometric properties of the PIQ-20 when used to assess the frequency of partner behaviors. The study participants included 380 adult volunteers (M age = 41 years, SD = 12; 58% male). To assess internal consistency, we used both the traditional coefficient-alpha and the latent variable modeling composite reliability (coefficient-ρ) procedures. We conducted independent factor analytic methods to address issues of dimensionality and scoring of responses to the PIQ-20 items. Also, we used an item response theory modeling procedure to examine the specificity of scores on the items. Reliability estimates for the PIQ-20 subscale scores were adequate (values ≥.70). The bifactor analysis supported deriving a total score for each subscale. Item response theory modeling demonstrated that the discrimination (a-slope) parameter for each subscale item was significantly different from zero. The majority of items were associated strongly with their respective subscales. Twelve items were identified that could be adopted as a potential short form of the PIQ-20. The PIQ-20 or short form provides an opportunity for assessing positive and negative partner support simultaneously. There is empirical support for the dimensional structures and scoring of responses for both versions of the instrument. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Real-Time fMRI Neurofeedback in Patients With Tobacco Use Disorder During Smoking Cessation: Functional Differences and Implications of the First Training Session in Regard to Future Abstinence or Relapse

One of the most prominent symptoms in addiction disorders is the strong desire to consume a particular substance or to show a certain behavior (craving). The strong association between craving and the probability of relapse emphasizes the importance of craving in the therapeutic process. Former studies have demonstrated that neuromodulation using real-time fMRI (rtfMRI) neurofeedback (NF) can be used as a treatment modality in patients with tobacco use disorder. The aim of the present project was to determine whether it is possible to predict the outcome of NF training plus group psychotherapy at the beginning of the treatment. For that purpose, neuronal responses during the first rtfMRI NF session of patients who remained abstinent for at least 3 months were compared to those of patients with relapse. All patients were included in a certified smoke-free course and took part in three NF sessions. During the rtfMRI NF sessions tobacco-associated and neutral pictures were presented. Subjects were instructed to reduce their neuronal responses during the presentation of smoking cues in an individualized region of interest for craving [anterior cingulate cortex (ACC), insula or dorsolateral prefrontal cortex]. Patients were stratified to different groups [abstinence (N = 10) vs. relapse (N = 12)] according to their individual smoking status 3 months after the rtfMRI NF training. A direct comparison of BOLD responses during the first NF-session of patients who had remained abstinent over 3 months after the NF training and patients who had relapsed after 3 months showed that patients of the relapse group demonstrated enhanced BOLD responses, especially in the ACC, the supplementary motor area as well as dorsolateral prefrontal areas, compared to abstinent patients. These results suggest that there is a probability of estimating a successful withdrawal in patients with tobacco use disorder by analyzing the first rtfMRI NF session: a pronounced reduction of frontal responses during NF training in patients might be the functional correlate of better therapeutic success. The results of the first NF sessions could be useful as predictor whether a patient will be able to achieve success after the behavioral group therapy and NF training in quitting smoking or not.

Violation of the Tobacco Control Law by Drivers in Vehicles in Two Streets in İzmir: A Descriptive Study

OBJECTIVES

After signing and approving the Framework Convention on Tobacco Control (FCTC), Turkey amended laws on tobacco control in 2008 and also expanded the smoking ban in 2013 to include drivers in all vehicles. Four years later, this amendment does not seem as effective. The aim of this study was to observe violation of the law by the drivers and to analyze the association between gender of the driver, type of the vehicle, approximate age group definition of the passenger (either child or adult), and the law violation in two streets in Konak district, İzmir, Turkey.

MATERIALS AND METHODS

In this cross-sectional study, two observer teams were located in two different busy streets on the same afternoon and they collected data on the violation of the law, gender of the driver, approximate age group definition of the passengers (either adult or child), and type of the vehicle (special, taxi, or other commercial). Logistic regression for the violation of the law was conducted.

RESULTS

Law violation prevalence is 7.2%. In univariate analysis, the gender of the driver and having at least one child as a passenger were associated with the violation of the law. In multivariate analysis, not having children increases (OR: 8.4) the risk of the violation of the law.

CONCLUSION

The violation of the law was high, but the drivers seemed to be aware of the harms of smoking by looking at the increased risk of the violation in vehicles, in which no child was carried as passengers.

Short-term benefit of smoking cessation along with glycopirronium on lung function and respiratory symptoms in mild COPD patients: a retrospective study

INTRODUCTION

Tobacco smoke is the leading cause of chronic obstructive pulmonary disease (COPD). Smoking cessation can change the natural history of COPD, as we know from the GOLD guidelines. Little is known about the short-term clinical and functional effects of smoking cessation treatment combined with anti-muscarinic bronchodilators.

OBJECTIVE

To determine whether quitting smoking, obtained by smoking cessation treatment combined with the use of a new long-acting muscarinic antagonist bronchodilator (LAMA), can improve lung function tests and respiratory symptoms more than the use of LAMA alone.

METHODS

We evaluated, in a retrospective analysis, the functional and clinical data, collected in one year, of 120 patients who were current smokers affected by mild COPD and who quit smoking using smoking cessation treatment combined with glycopirronium. We compared them with a group of 80 patients with mild COPD undergoing the same treatment but who did not quit smoking. All patients underwent functional and clinical tests at baseline and at a third-month check.

MEASUREMENTS AND MAIN RESULTS

The two groups were homogeneous in terms of demographic data without significant differences. All patients used varenicline for smoking cessation. They all performed the following tests: a spirometry with detection of resistances, the 6 min walking test, haemogasanalysis, the exhaled CO test, the COPD assessment test (CAT) and finally the modified Medical Research Council test (mMRC). A significant improvement in the functional tests at the third-month check was found in both groups-quitters and non-quitters. However, a notable increase in the examined parameters was registered in the group of patients who quit smoking, in particular, we observed a significant increase at the third-month check of the parameter forced expiratory volume in 1 s (FEV1) of more than 200 ml with p < 0.001. A comparison between quitters and non-quitters revealed a major benefit derived from smoking cessation in terms of functional changes and symptom relief. In particular, not only FEV1 but also forced expiratory flow at 25%-75% of vital capacity (FEF 25-75) (p < 0.01) and CAT (p < 0.001) were found to be significantly improved in patients who quit than in patients who did not at the check time point.

CONCLUSIONS

Smoking cessation treatment obtained by varenicline was confirmed as a crucial therapeutic option, especially when combined with bronchodilator in mild COPD. Patients who quit smoking could already benefit from both treatments in the short term, improving lung function and respiratory symptoms and therefore improving their quality of life.

The safety and efficacy of nicotine replacement therapy in the intensive care unit: a randomised controlled pilot study

Background

Studies evaluating nicotine replacement therapy (NRT) to prevent nicotine withdrawal symptoms in ICU patients have yielded conflicting results. We performed a randomised controlled double-blind pilot study to assess the safety and efficacy of NRT in critically ill patients. Mechanically ventilated patients admitted to two medical–surgical intensive care units and smoking more than 10 cigarettes per day before ICU admission were enrolled in this study. Participants were randomised to transdermal NRT (14 or 21 mg per day) or placebo until ICU discharge or day 30. Smoking status was confirmed by the biomarkers serum cotinine and urinary NNAL. The primary endpoint was 30-day mortality. Among secondary endpoints and post hoc endpoints, 90-day mortality, safety, time spent without delirium, sedation and coma, and patient destination at day 30 were addressed.

Results

We enrolled 47 patients. No differences were found between NRT and control group patients concerning 30-day mortality (9.5 vs. 7.7%, p = 0.84) and 90-day mortality (14.3 vs. 19.2%, p = 0.67). The number of serious adverse events was comparable between groups (NRT: 4, control: 11, p = 0.13). At day 20, average time alive without delirium, sedation and coma was 16.6 days among NRT patients versus 12.6 days among control patients (p = 0.03). At day 30, more NRT group patients were discharged from the ICU or hospital compared with controls (p = 0.03).

Conclusions

NRT did not affect mortality or the number of (serious) adverse events compared with placebo. Time alive without delirium, sedation and coma at day 20 in NRT patients was longer than in control patients. An adequately powered randomised controlled trial to further study safety and efficacy of NRT in ICU patients seems feasible and is warranted.

Trial registration ClinicalTrials.gov, number NCT01362959, registered 1 June 2011

Electronic supplementary material

The online version of this article (10.1186/s13613-018-0399-1) contains supplementary material, which is available to authorized users.

The Relationship between Body Mass Index and Smoking Cessation Plans in Korean Adults

Background

Concerns regarding weight gain after smoking cessation may interfere with quitting smoking. This study investigated the association between smoking cessation plans and body mass index (BMI, kg/m²) in Korean adult smokers.

Methods

Using data from the sixth Korea National Health and Nutrition Examination Survey (2013–2015), 3,000 current smokers aged 19 years or older were selected and divided into four weight groups. The cohorts included an underweight group (BMI, <18.5 kg/m²), normal weight group (BMI, ≥18.5 to <23 kg/m²), overweight group (BMI, ≥23 to <25 kg/m²), and obese group (BMI, ≥25 kg/m²). The relationship between BMI and smoking cessation plans in Korean adults was analyzed using multiple logistic regression analysis.

Results

Multiple logistic regression analysis showed sex (odds ratio [OR], 0.723; 95% confidence interval [CI], 0.556–0.939), high-risk drinking (OR, 0.796; 95% CI, 0.634–0.998), aerobic physical activity (OR, 1.326; 95% CI, 1.092–1.612), and hypertension (OR, 1.387; 95% CI, 1.034–1.860) were the significant factors related to smoking cessation plans. According to the BMI categories, the ORs of smoking cessation plans were numerically higher in the normal weight group than the other three groups. However, the difference was not statistically significant.

Conclusion

Normal weight subjects tended to have a greater number of smoking cessation plans than the other three weight groups, but the difference was not statistically significant. In the clinic, it is necessary to consider not only BMI but also other factors associated with a smoking cessation plans.

Unaided Smoking Cessation in Healthy Employees

BACKGROUND

According to guidelines, behavioral and pharmacological assistance should be offered to all smokers willing to quit. However, a large proportion of ex-cigarette smokers are self-quitters.

OBJECTIVES

To identify characteristics of long-term, unaided self-quitters, as compared to recurrent smokers among health care employees.

METHODS

University hospital employees (n = 5,218) were addressed through a 17-question questionnaire inquiring about past and current smoking behavior. Questions included daily cigarette consumption, pack-years, previous quit attempts, smoking-free period, and utilization of pharmacological therapies and counseling.

RESULTS

2,574 (49.3%) questionnaires were returned. 791 subjects declared to have successfully quit smoking. A complete data set was available for 763 cases. Patients remained smoking free for a mean period of 11.8 ± 9.7 years. The most common smoking cessation method in these subjects was unaided (77.2%), followed by alternative approaches (15.4%), nicotine replacement therapy (4.5%), counseling (1.7%), and bupropion (1.2%). Smoking cessation was achieved with 1 attempt in 53% of the cases, 2 in 19%, 3 in 13%, and more than 3 attempts in 15%, respectively. On average, 2.4 ± 3.02 attempts led to successful smoking cessation. After 2 or more unsuccessful attempts, the odds ratio for a further unsuccessful smoking cessation was 2.58 (95% CI 1.94-3.45).

CONCLUSION

The majority of the ex-smokers quitted smoking without any behavioral or pharmacological support. The chance to successfully quit smoking without any help in a first or second attempt is considerably high. The risk for smoking recurrence after 2 ineffective quit attempts is markedly increased (OR 2.58).

Electrogustometry Thresholds, Tongue Tip Vascularization, Density, and Form of the Fungiform Papillae Following Smoking Cessation

The objective of this study was to evaluate differences in gustatory function and in shape, density, and vascularization of the fungiform papillae (fPap) of smokers' tongue before and after smoking cessation. In 24 smokers (19 males, 5 females; median age: 54.6 ± 2.9 years) electrogustometry (EGM) thresholds at the chorda tympani area, at the soft palate area and at the area of the vallate papillae were recorded bilaterally. Morphology and density of the fungiform papillae (fPap) and blood vessels' density and morphology at the tip of the tongue were examined using contact endoscopy (CE). Follow-up exams (EGM and CE) were performed on average 3.2 months after smoking cessation. Findings were compared between the 2 conditions as well as to those of a group of 24 non-smokers (median age: 55.2 ± 3.4 years; 19 males, 5 females). After smoking cessation, EGM thresholds decreased significantly (P = 0.02 or P = 0.03 depending on the tested area) but nonetheless still were quite different from those of non-smokers (P = 0.05 or 0.04 depending on the site of EGM measurement). Under CE the fPap density was higher after quitting smoking (P = 0.05) and the shape and vascularization of fPap also exhibited a trend to improvement (P = 0.05) after smoking cessation. Chronic exposure to cigarette smoke infers long lasting, although to a large extent reversible, alterations in morphology of taste buds in fungiform papillae, but rather irreversible EGM-related functional gustatory compromise, suggesting a profound physiologic effect on human peripheral taste organs.

The Effects of Acceptance and Commitment Therapy on Man Smokers' Comorbid Depression and Anxiety Symptoms and Smoking Cessation: A Randomized Controlled Trial

BACKGROUND

Besides physical problems, cigarette smoking is associated with a high prevalence of comorbid depression and anxiety symptoms. One of the reasons behind high post-cessation smoking lapse and relapse rates is inattentiveness to these symptoms during the process of cessation. The aim of this study was to examine the effects of acceptance and commitment therapy (ACT) on male smokers' comorbid depression and anxiety symptoms and smoking cessation.

METHODS

This two-group pre-test-post-test randomized controlled trial was done on a random sample of seventy male smokers. Participants were randomly and evenly allocated to an intervention and a control group. Patients in these groups received either acceptance or commitment therapy or routine psychological counseling services include cognitive behavior therapy, respectively. Study data were collected through a demographic questionnaire, the Structural Clinical Interview (SCI) for Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) disorders, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Micro Smokerlyzer carbon monoxide monitor. The SPSS software was employed to analyze the data.

FINDINGS

After the intervention, depression and anxiety scores and smoking cessation rate in the intervention group were respectively lower and higher than the control group (P < 0.050).

CONCLUSION

ACT can significantly improve comorbid depression and anxiety symptoms and smoking cessation rate. Thus, it can be used to simultaneously manage depression, anxiety, and cigarette smoking.

Construction of an enantiopure bivalent nicotine vaccine using synthetic peptides

Clinical outcomes of anti-nicotine vaccines may be improved through enhancements in serum antibody affinity and concentration. Two strategies were explored to improve vaccine efficacy in outbred mice: the use of enantiopure haptens and formulation of a bivalent vaccine. Vaccines incorporating natural (-) nicotine haptens improved relative antibody affinities >10-fold over (+) haptens, stimulated a two-fold boost in nicotine serum binding capacity, and following injection with 3 cigarette equivalents of nicotine, prevented a larger proportion of nicotine (>85%) from reaching the brain. The activity of a bivalent vaccine containing (-) 3’AmNic and (-) 1’SNic haptens was then compared to dose-matched monovalent groups. It was confirmed that antisera generated by these structurally distinct haptens have minimal cross-reactivity and stimulate different B cell populations. Equivalent antibody affinities were detected between the three groups, but the bivalent group showed two-fold higher titers and an additive increase in nicotine serum binding capacity as compared to the monovalent groups. Mice immunized with the bivalent formulation also performed better in a nicotine challenge experiment, and prevented >85% of a nicotine dose equivalent to 12 cigarettes from reaching the brain. Overall, enantiopure conjugate vaccines appear to improve serum antibody affinity, while multivalent formulations increase total antibody concentration. These findings may help improve the performance of future clinical candidate vaccines.

The Effect of Physicochemical Modification on the Function of Antibodies Induced by Anti-Nicotine Vaccine in Mice

Smoking remains one of the major causes of morbidity and mortality worldwide. One approach to assisting smoking cessation is via anti-nicotine vaccines, composed of nicotine-like haptens conjugated to a carrier protein plus adjuvant(s). We have previously shown that the carrier, hapten, linker, hapten load, degree of conjugate aggregation, and presence of adducts can each influence the function (nicotine-binding capacity) of the antibody (Ab) induced. Herein, we extend those findings and show that tertiary structure is also critical to the induction of functional immune responses and that this can be influenced by conjugation conditions. We evaluated immunogenicity in mice using six lots of NIC7-CRM, a conjugate of 5-aminoethoxy-nicotine (Hapten 7), and a single point (glycine 52 to glutamic acid) mutant nontoxic form of diphtheria toxin, cross-reactive material 197 (CRM₁₉₇), which were synthesized under different reaction conditions resulting in conjugates with equivalent molecular characteristics (hapten load, aggregates, adducts), but a different tertiary structure. When tested in mice, better functional responses (reduced nicotine in the brain of immunized animals relative to non-immunized controls) were obtained with conjugates with a more closed structure than those with an open conformation. These studies highlight the need for a better understanding of the physicochemical properties of small molecule conjugate vaccines.

Cav1.2, but not Cav1.3, L-type calcium channel subtype mediates nicotine-induced conditioned place preference in mice

Nicotine use is one of the most common forms of drug addiction. Although L-type calcium channels (LTCCs) are involved in nicotine addiction, the contribution of the two primary LTCC subtypes (Ca_v1.2 and 1.3) is unknown. This study aims to determine the contribution of these two LTCC subtypes to nicotine-induced conditioned place preference (CPP) responses by using transgenic mouse models that do not express Ca_v1.3 (Ca_v1.3^-/-) or contain a mutation in the dihydropyridine (DHP) site of the Ca_v1.2 (Ca_v1.2DHP^-/-). We found a hyperbolic dose dependent nicotine (0.1-1mg/kg; 0.5mg/kg optimum) effect on place preference in wild type (WT) mice, that could be prevented by the DHP LTCC blocker nifedipine pretreatment. Similarly, Ca_v1.3^-/- mice showed nicotine-induced place preference which was antagonized by nifedipine. In contrast, nifedipine pretreatment of Ca_v1.2DHP^-/- mice had no effect on nicotine-induced CPP responses, suggesting an involvement of Ca_v1.2 subtype in the nicotine-induced CPP response. Nifedipine alone failed to produce either conditioned place aversion or CPP in WT mice. These results collectively indicate Ca_v1.2, but not Ca_v1.3 LTCC subtype regulates, at least in part, the reinforcing effects of nicotine use.

Combination nicotine replacement therapy: strategies for initiation and tapering

Several studies and meta-analyses have demonstrated the efficacy of combination nicotine replacement therapy (NRT) for patients who wish to quit smoking. However, there is limited guidance with respect to initiation and tapering of combination NRT. We attempt to review the evidence and rationale behind combination NRT, present the dosing used in combination NRT studies, and propose a step-down approach for tapering of combination NRT with integration of behavioral strategies.

Human polymorphisms in nicotinic receptors: a functional analysis in iPS-derived dopaminergic neurons

Tobacco smoking is a public health problem, with ∼5 million deaths per year, representing a heavy burden for many countries. No effective therapeutic strategies are currently available for nicotine addiction, and it is therefore crucial to understand the etiological and pathophysiological factors contributing to this addiction. The neuronal α5 nicotinic acetylcholine receptor (nAChR) subunit is critically involved in nicotine dependence. In particular, the human polymorphism α5D398N corresponds to the strongest correlation with nicotine dependence risk found to date in occidental populations, according to meta-analysis of genome-wide association studies. To understand the specific contribution of this subunit in the context of nicotine addiction, an efficient screening system for native human nAChRs is needed. We have differentiated human induced pluripotent stem (iPS) cells into midbrain dopaminergic (DA) neurons and obtained a comprehensive characterization of these neurons by quantitative RT-PCR. The functional properties of nAChRs expressed in these human DA neurons, with or without the polymorphism in the α5 subunit, were studied with the patch-clamp electrophysiological technique. Our results in human DA neurons carrying the polymorphism in the α5 subunit showed an increase in EC₅₀, indicating that, in the presence of the polymorphism, more nicotine or acetylcholine chloride is necessary to obtain the same effect. This human cell culturing system can now be used in drug discovery approaches to screen for compounds that interact specifically with human native and polymorphic nAChRs.-Deflorio, C., Blanchard, S., Carisì, M. C., Bohl, D., Maskos, U. Human polymorphisms in nicotinic receptors: a functional analysis in iPS-derived dopaminergic neurons.

Remission from substance use disorders: A systematic review and meta-analysis

OBJECTIVE

This paper presents a systematic review and meta-analysis of available evidence on remission rates for substance use disorders (SUDs), providing weighted mean estimates of SUD remission rates. The review also explores study-level characteristics that may explain variations in remission rates across studies.

METHODS

A comprehensive search strategy identified studies published between 2000 and 2015 with follow-up periods of at least three years or reported lifetime remission outcomes for potential inclusion in the review. Remission was defined as not meeting diagnostic criteria for abuse or dependence for a minimum period of six months, as of final follow-up. A single-group summary meta-analysis was performed. Pooled estimated annual remission rates (PEARRs) were calculated. Meta-regression techniques and subgroup analyses were used to explore the association between study remission rates and key selected variables.

RESULTS

Of 8855 studies identified, 21 met the eligibility criteria. The results suggested that 35.0% to 54.4% of individuals with SUDs achieved remission, and this occurred after a mean follow-up period of 17 years. The PEARRs projected few cases of SUD remission, between 6.8% and 9.1% in any given year. Studies that reported higher remission rates had longer follow-up periods, and lower sample retention rates.

CONCLUSIONS

Results support the contention that SUDs are more likely to be "chronic" or long term disorders than acute disorders for a substantial number of individuals. However, more longitudinal research is required. Treatment geared to chronicity, such as assertive community treatment and intensive case management, needs to be more readily available for SUD populations.

Self-efficacy in treating tobacco use: A review article

Globally, tobacco use continues to be a major health care concern. Despite strong recommendations to quit smoking, tobacco users are experiencing difficulties in quitting. The purpose of this integrative review is to discuss self-efficacy theory as an important behavioral therapy for treating tobacco use and nicotine dependence. Moreover, the paper proposes a literature-derived model that employs self-efficacy as a central component for treating tobacco use and nicotine dependence. Eleven relevant articles were included in this review. Self-efficacy has an important role in smoking cessation. Improving self-efficacy enhances the individual’s success in quitting tobacco use and preventing relapse. Moreover, incorporating self-efficacy as a cognitive behavioral intervention has shown various degrees of success for treating tobacco use and nicotine dependence. In order to offer guidance to health care providers assisting in quitting tobacco, a model that integrates self-efficacy as a central component of the quitting process is proposed.

Repeated nicotine exposure modulates prodynorphin and pronociceptin levels in the reward pathway

BACKGROUND

Nicotine dependence is maintained by neurobiological adaptations in the dopaminergic brain reward pathway with the contribution of opioidergic circuits. This study assessed the role of opioid peptides and receptors on the molecular changes associated with nicotine dependence. To this aim we analysed nicotine effects on opioid gene and receptor expression in the reward pathway in a nicotine sensitization model.

METHODS

Sprague-Dawley rats received nicotine administrations for five days and locomotor activity assessment showed the development of sensitization. The mRNA expression of prodynorphin (pdyn), pronociceptin (pnoc) and the respective receptors was measured by quantitative PCR in the ventral midbrain (VM), the nucleus accumbens (NAc), the caudate-putamen (CPu), the pre-frontal cortex (PFCx), and the hippocampus.

RESULTS

A significant positive effect of sensitization on pdyn mRNA levels was detected in the CPu. This effect was supported by a significant and selective correlation between the two parameters in this region. Moreover, chronic but not acute nicotine treatment significantly decreased pdyn mRNA levels in the NAc and increased expression in the PFCx. Pnoc mRNA was significantly increased in the VM and the PFCx after sub-chronic administration of nicotine, whereas no alterations were observed after acute treatment. No treatment associated changes were detected in κ-opioid receptor or nociceptin receptor mRNAs.

CONCLUSIONS

This experiment revealed an effect of nicotine administration that was distinguishable from the effect of nicotine sensitization. While several pnoc and pdyn changes were associated to nicotine administration, the only significant effect of sensitization was a significant increase in pdyn in the CPu.

Time controlled pulsatile transdermal delivery of nicotine: A phase I feasibility trial in male smokers

Nicotine substitution is a mainstay component in smoking cessation schemes. Current products including patches are poorly effective mainly because they do not give smokers the same pharmacokinetic profile of nicotine as cigarette consumption. This work evaluates a new computer operated delivery system for time controlled pulsatile transdermal administration of nicotine in a phase I clinical trial with twelve heavy smoking male volunteers. The device was affixed to the ventral side of the leading lower arm of the subjects and was programmed to deliver two pulses of drug within 16h with three delivery rates in a consecutive dose escalation study. Tolerability of the three increasing doses of nicotine was established. Plasma concentration of nicotine exhibited two peaks and one trough and reached therapeutically effective levels that behaved linearly with the drug load concentration of the device. In vivo input rate, delivered amount and elimination kinetics were deduced by pharmacokinetic modeling to analyze device performance. Timing, dose and duration of delivery were controlled by system operation parameters. Hence, feasibility of controlled pulsatile delivery of nicotine at predetermined intervals was demonstrated. After additional optimization, preprogrammed or on demand administration to meet individualized and circadian replacement needs should improve smoking cessation efficacy.

Virtual reality cue exposure for the relapse prevention of tobacco consumption: a study protocol for a randomized controlled trial

Background

Successful interventions have been developed for smoking cessation, but the success of smoking relapse prevention interventions has been limited. In particular, cognitive behavioural therapy (CBT) has been hampered by a high relapse rate. Because relapses can be due to the presence of conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality exposure therapy (VRET) can generate synthetic environments that represent risk situations for the patient in the context of relapse prevention. The primary objective of this study is to evaluate the effectiveness of CBT coupled with VRET, in comparison to CBT alone, in the prevention of smoking relapse. The secondary objectives are to assess the impact of CBT coupled with VRET on anxiety, depression, quality of life, self-esteem and addictive comorbidities (such as alcohol, cannabis, and gambling). A third objective examines the feasibility and acceptability of VR use considering elements such as presence, cybersickness and number of patients who complete the VRET program.

Method/design

The present study is a 14-month (2 months of therapy followed by 12 months of follow-up), prospective, comparative, randomized and open clinical trial, involving two parallel groups (CBT coupled with VRET versus CBT alone). The primary outcome is the proportion of individuals with tobacco abstinence at 6 months after the end of the therapy. Abstinence is defined by the total absence of tobacco consumption assessed during a post-test interview and with an apparatus that measures the carbon monoxide levels expired. A total of 60 individuals per group will be included.

Discussion

This study is the first to examine the efficacy of CBT coupled with VRET in the prevention of smoking relapse. Because VRET is simple to use and has a low cost, this interactive therapeutic method might be easily implemented in clinical practice if the study confirms its efficacy.

Trial registration

ClinicalTrials.gov Identifier: NCT02205060 (registered 25 July 2014).

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1224-5) contains supplementary material, which is available to authorized users.