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Benmarhnia T, Pierce JP, Leas E, White MM, Strong DR, Noble ML, Trinidad DR. Can E-Cigarettes and Pharmaceutical Aids Increase Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally Representative Cohort of American Smokers. Am J Epidemiol 2018; 187:2397-2404. [PMID: 29955810 PMCID: PMC6211241 DOI: 10.1093/aje/kwy129] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
Many smokers believe that electronic nicotine delivery systems (ENDS) and pharmaceutical cessation aids can help them quit smoking or reduce cigarette consumption, but the evidence for e-cigarettes to aid quitting is limited. Examining 3,093 quit attempters in the nationally representative US Population Assessment of Tobacco and Health (PATH) Study, using data from 2013-2015, we evaluated the influence of ENDS and pharmaceutical cessation aids on persistent abstinence (≥30 days) from cigarettes and reduced cigarette consumption, using propensity score matching to balance comparison groups on potential confounders and multiple imputation to handle missing data. At PATH Wave 2, 25.2% of quit attempters reported using ENDS to quit during the previous year, making it the most popular cessation aid in 2014-2015. More quit attempters were persistently cigarette abstinent than were persistently tobacco abstinent (15.5% (standard error, 0.8) vs. 9.6% (standard error, 0.6)). Using ENDS to quit cigarettes increased the probability of persistent cigarette abstinence at Wave 2 (risk difference (RD) = 6%, 95% confidence interval (CI): 2, 10), but using approved pharmaceutical aids did not (for varenicline, RD = 2%, 95% CI: -6, 13; for bupropion, RD = 4%, 95% CI: -6, 17; for nicotine replacement therapy, RD = -3%, 95% CI: -8, 2). Among quit attempters who relapsed, ENDS did not reduce the average daily cigarette consumption (cigarettes per day, -0.18, 95% CI: -1.87, 1.51).
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Affiliation(s)
- Tarik Benmarhnia
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Epidemiology, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - John P Pierce
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Health Policy, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Eric Leas
- Stanford Prevention Research Center, Stanford University, Palo Alto, California
| | - Martha M White
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - David R Strong
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Behavioral Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Madison L Noble
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Dennis R Trinidad
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Health Policy, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
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Fix BV, O’Connor RJ, Benowitz N, Heckman BW, Cummings KM, Fong GT, Thrasher JF. Nicotine Metabolite Ratio (NMR) Prospectively Predicts Smoking Relapse: Longitudinal Findings From ITC Surveys in Five Countries. Nicotine Tob Res 2017; 19:1040-1047. [PMID: 28387850 PMCID: PMC5896535 DOI: 10.1093/ntr/ntx083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/05/2017] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The ratio of trans 3'-hydroxycotinine (3HC) to cotinine (nicotine metabolite ratio [NMR]) is a biomarker of the rate of nicotine metabolism, with higher NMR indicating faster metabolism. Higher NMR has been found to be associated with higher daily cigarette consumption and less success stopping smoking in cessation trials. This study examines differences in NMR among population-based samples of smokers in the five countries and explores the relationship between NMR and smoking abstinence. METHODS Participants (N = 874) provided saliva samples during International Tobacco Control (ITC) surveys in the United States, United Kingdom, Mauritius, Mexico, and Thailand conducted in 2010/2011 with follow-up surveys in 2012/2013. When all samples were received, they were sent to a common laboratory for analysis using liquid chromatography and tandem mass spectroscopy. RESULTS There was significant variation in NMR across countries (F = 15.49, p < .001). Those who reported smoking at follow-up had a mean NMR of 0.32, compared to a mean NMR of 0.42 in participants who reported that they had stopped (F = 8.93; p = .003). Higher mean NMR values were also associated with longer quit duration (p = .007). There was no substantial difference in NMR between current smokers who made a failed quit attempt and those who made no attempt-both had significantly lower NMR compared to those who quit and remained abstinent. Smokers with a higher NMR were more likely to report that they stopped smoking compared to those with a lower NMR (odds ratio = 2.67; 95% confidence interval: 1.25 to 5.68). CONCLUSIONS These results suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking. IMPLICATIONS Results of this study suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking.
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Affiliation(s)
- Brian V Fix
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia SC; Department of Tobacco Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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