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Pharmacotherapy for the Treatment of Tobacco Dependence. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Leone FT, Zhang Y, Evers-Casey S, Evins AE, Eakin MN, Fathi J, Fennig K, Folan P, Galiatsatos P, Gogineni H, Kantrow S, Kathuria H, Lamphere T, Neptune E, Pacheco MC, Pakhale S, Prezant D, Sachs DPL, Toll B, Upson D, Xiao D, Cruz-Lopes L, Fulone I, Murray RL, O’Brien KK, Pavalagantharajah S, Ross S, Zhang Y, Zhu M. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e5-e31. [PMID: 32663106 PMCID: PMC7365361 DOI: 10.1164/rccm.202005-1982st] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.
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Abstract
Interest in electronic cigarette (EC) use, or vaping, to help control weight is increasing. Many American Indian (AI) populations have a high prevalence of smoking, obesity, and EC use, but their perceptions of EC use for weight control are unknown. In Oklahoma in 2016, 375 AI adults who smoke completed a survey including perceptions about smoking and EC effects on weight control. Only 24% believed that smoking helps control weight, and 8% believed that vaping helps control weight. Perceptions differed by EC use, with ever users more often than never users perceiving that smoking (30% vs 12%, respectively; p < .01) and vaping (10% vs 5%; p = .04) help to control weight. Sex, age group (18-44 years vs 45 + years), education (high school graduate/equivalent vs less than high school), smoking cessation attempt in past year, and likelihood to quit in 6 months were not associated with weight control perceptions for either smoking or vaping. Uncertainty regarding EC effects on weight control was less common among EC ever users compared to never users (41% vs 53%, respectively; p = .04). Most people who did not believe or were uncertain that smoking controls weight also did not believe or were uncertain that vaping controls weight. However, only a minority (29%) of people who believed smoking controls weight also believed that vaping controls weight. Among adult AI who smoke, both smoking and vaping were infrequently perceived as helping to control weight, but such perceptions were reported more frequently among those who ever used ECs.
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Santus P, Radovanovic D, Raiteri D, Pini S, Spagnolo G, Maconi G, Rizzi M. The effect of a multidisciplinary approach for smoking cessation in patients with Crohn's disease: Results from an observational cohort study. Tob Induc Dis 2020; 18:29. [PMID: 32336967 PMCID: PMC7177387 DOI: 10.18332/tid/119161] [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: 10/08/2019] [Revised: 01/09/2020] [Accepted: 03/17/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Cigarette smoking is the most important risk factor for Crohn’s disease (CD). The effectiveness of smoking cessation programs (SCPs) in patients with CD is still poorly understood. METHODS This was a retrospective, observational, single-centre, cohort study of 136 active smokers with mean age 55 years (SD=11), 58% males, including 27 (19.8%) patients with CD who entered the multidisciplinary SCP of the Luigi Sacco University Hospital of Milan from January 2017 through January 2019. A pulmonologist was responsible for the clinical and pharmacological management, while a psychiatrist and a psychologist conducted the counselling and assessed the motivation to quit, anxiety and depression using the Brief Psychiatric Rating Scale (BPRS) and the nicotine dependence with the Fagerström test. Patients were defined as quitters after 12 months. RESULTS Demographic and clinical characteristics, and Fagerström score, did not differ in patients with and without CD. At baseline, patients with CD had a higher BPRS (median: 27, IQR: 22–32; vs 25 and 22–28.5; p=0.03), and a lower motivation to quit score (median: 10, IQR: 9–13; vs 14 and 12–15; p<0.001). After 12 months, the quitting rate of smokers with CD was significantly lower (14.8% vs 36.7%; p<0.022) and the chance of quitting was negatively associated with the baseline BPRS (r=-0.256; p<0.003). Varenicline and nicotine replacement therapy tended to be less effective in patients with CD. CONCLUSIONS The lower efficacy of SCPs in patients with CD might be secondary to a higher prevalence of anxiety and depression. Psychological issue recognition and support should be enhanced to increase SCP effectiveness in CD.
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Affiliation(s)
- Pierachille Santus
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | - Dejan Radovanovic
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | - Davide Raiteri
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | - Stefano Pini
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Spagnolo
- Department of Medical and Surgical Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Maconi
- Division of Gastroenterology, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | - Maurizio Rizzi
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
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Graydon MM, Corno CM, Schacht RL, Knoblach DJ, Wiprovnick AE, Thrash ST, Petersen AA, DiClemente CC. A statewide initiative to train behavioral health providers in smoking cessation. Transl Behav Med 2018; 8:855-866. [PMID: 30202855 DOI: 10.1093/tbm/iby086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Individuals with mental health and substance use disorders smoke at rates two to four times higher than the general population and account for over half of smoking-related deaths. Building capacity of behavioral health providers to provide smoking cessation treatment may decrease smoking prevalence in these groups. The present study evaluated a statewide rollout of a capacity building training program to teach behavioral health providers to deliver a manualized smoking cessation group intervention for patients with mental health and substance use disorders. Behavioral health treatment providers (N = 333) participated in a day-long training. Pretraining and posttraining evaluations were conducted on the day of training to assess changes in confidence, attitudes, and knowledge regarding smoking cessation and possible barriers to implementing the smoking cessation curriculum in treatment programs. These constructs were reassessed in follow-up surveys conducted online 2 and 6 months posttraining. A subset of providers participated in follow-up telephone calls to discuss implementation of smoking cessation programming. Posttraining evaluations indicated that trainees' confidence, attitudes, and knowledge of smoking interventions improved. Follow-up surveys indicated that these gains decreased but were maintained above baseline. Over one-half of survey respondents reported taking at least one implementation step. Interviewees reported that agency and staff-level barriers such as difficulty coordinating a group, staff turnover, and inadequate time with clients precluded more widespread implementation. Training for behavioral health providers is effective in improving confidence, attitudes, and knowledge regarding smoking cessation interventions. Consistent implementation requires ongoing support and agency problem solving to address common barriers.
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Affiliation(s)
- Meagan M Graydon
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD
| | - Catherine M Corno
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD
| | - Rebecca L Schacht
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD
| | - Daniel J Knoblach
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD
| | - Alicia E Wiprovnick
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD
| | | | | | - Carlo C DiClemente
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD
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Tuovinen EL, Saarni SE, Kinnunen TH, Ollila H, Ruokolainen O, Patja K, Männistö S, Jousilahti P, Kaprio J, Korhonen T. Weight concerns as a predictor of smoking cessation according to nicotine dependence: A population-based study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2018; 35:344-356. [PMID: 32934537 PMCID: PMC7434149 DOI: 10.1177/1455072518800217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Nicotine-dependent smokers find it difficult to quit smoking. Additionally,
smoking-specific weight concerns may affect smoking cessation although the
evidence is controversial. We investigated whether smoking-specific weight
concerns predict the probability of cessation and, if so, whether the effect
varies according to the level of nicotine dependence. Methods: The study was conducted with a population-based sample of 355 adult daily
smokers who participated in the baseline examination in 2007 and in the 2014
follow-up. Baseline nicotine dependence was classified as low or high
(Fagerström Test for Nicotine Dependence; 0–3 vs. 4–10 points). Within these
groups, we examined whether baseline weight concerns predict smoking status
(daily, occasional, ex-smoker) at follow-up by using multinomial logistic
regression with adjustment for multiple covariates. Results: Among low-dependent participants at baseline, 28.5% had quit smoking, while
among highly dependent participants 26.1% had quit smoking. The interaction
between weight concerns and nicotine dependence on follow-up smoking status
was significant. Among participants with low nicotine dependence per the
fully adjusted model, greater weight concerns predicted a lower likelihood
of both smoking cessation (relative risk ratio 0.93 [95% CI 0.87–1.00]) and
smoking reduction to occasional occurrence (0.89 [95% CI 0.81–0.98]). Weight
concerns were not associated with follow-up smoking status among
participants with high nicotine dependence. Conclusions: Weight concerns are associated with a smaller likelihood of quitting among
smokers with low nicotine dependence. Weight concerns should be addressed in
smoking cessation interventions, especially with smokers who have low
nicotine dependence.
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Affiliation(s)
| | | | - Taru H Kinnunen
- University of Helsinki, Finland; and Behavioral Science Consulting, North Andover, MA, USA
| | - Hanna Ollila
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Satu Männistö
- National Institute for Health and Welfare, Helsinki, Finland
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Postcessation weight gain concern as a barrier to smoking cessation: Assessment considerations and future directions. Addict Behav 2018; 76:250-257. [PMID: 28865363 DOI: 10.1016/j.addbeh.2017.08.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/01/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Concern about postcessation weight gain may be one potential barrier to quitting smoking. In this 'mini-review' of recent literature, we summarize findings on the relationship between postcessation weight gain concern and smoking cessation, and evaluate varied use of postcessation weight gain concern assessments and potential moderators of the postcessation weight gain concern-cessation association. METHODS We conducted a search using the terms "smoking" OR "smoking cessation" AND "weight concern" for articles published between January 1, 2011 and December 31, 2016. We identified 17 studies assessing postcessation weight gain concern, seven of which evaluated the postcessation weight gain concern-cessation association. RESULTS The relationship between postcessation weight gain concern and smoking cessation was mixed. Recent studies varied in their assessments of postcessation weight gain concern, many of which were not validated and assessed correlates of this construct. Studies varied in their adjustment of demographic (e.g., sex), smoking-specific (e.g., smoking level), and weight-specific (e.g., body mass index) variables. CONCLUSIONS The use of non-validated assessments and variability in testing covariates/moderators may contribute to conflicting results regarding the postcessation weight gain concern-cessation relationship. We recommend validating an assessment of postcessation weight gain concern, maintaining vigilance in testing and reporting covariates/moderators, and investigating trajectories of this construct over time and by smoking status to inform future assessment and intervention efforts.
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Rogers ES, Vargas EA. Tobacco retail environment near housing programmes for patients with mental health conditions in New York City. Tob Control 2017; 27:526-533. [PMID: 28855299 DOI: 10.1136/tobaccocontrol-2016-053590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The current study sought to characterise the tobacco retail environment of supportive housing facilities for persons with mental health (MH) conditions in New York City (NYC) and to estimate the potential impact of a tobacco retail ban near public schools on the retail environment of MH housing in NYC. METHODS Texas A&M Geocoding Services was used to geocode the addresses of housing programmes for patients with MH conditions, non-MH residences, public schools and tobacco retailers in NYC. ESRI ArcMap was used to calculate the number of tobacco retailers within a 500-foot radius around each housing programme and school address point, and the Euclidean distance to the nearest retailer. Generalised linear models were used to compare retail counts and distance between MH and non-MH residences. RESULTS The mean number of tobacco retailers within 500 feet of an MH housing programme was 2.9 (SD=2.3) and the mean distance to nearest tobacco retailer was 370.6 feet (SD=350.7). MH residences had more retailers within 500 feet and a shorter distance to the nearest retailer compared with non-MH residences in Brooklyn, the Bronx and Staten Island (p<0.001). Banning tobacco licences within 350, 500 or 1000 feet of a school would significantly improve the tobacco retail environment of MH housing programmes and reduce disparities between MH and non-MH residences in some boroughs. CONCLUSIONS People with MH conditions residing in supportive housing in NYC encounter a heavy tobacco retail environment in close proximity to their home, and in some boroughs, one worse than non-MH residences. Implementing a ban on tobacco retail near public schools would improve the tobacco retail environment of MH housing programmes in NYC.
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Affiliation(s)
- Erin S Rogers
- Department of Population Health, New York University School of Medicine, New York City, New York, USA.,Research Service, VA New York Harbor Healthcare System, New York City, New York, USA
| | - Elizabeth A Vargas
- Department of Population Health, New York University School of Medicine, New York City, New York, USA.,Research Service, VA New York Harbor Healthcare System, New York City, New York, USA
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Asnaani A, Farris SG, Carpenter JK, Zandberg LJ, Foa EB. The Relationship between Anxiety Sensitivity and Posttraumatic Stress Disorder: What is the Impact of Nicotine Withdrawal? COGNITIVE THERAPY AND RESEARCH 2015; 39:697-708. [PMID: 26560135 DOI: 10.1007/s10608-015-9685-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Anxiety sensitivity (AS) is related to the development and maintenance of posttraumatic stress disorder (PTSD) among cigarette smokers, and is also implicated in the amplification of acute nicotine withdrawal symptoms. The present study sought to examine the role of nicotine withdrawal in moderating the association between AS and PTSD symptom severity among a sample of treatment-seeking smokers with PTSD. METHOD Participants (n = 117) were enrolled in a randomized controlled trial for the treatment of PTSD and nicotine dependence. Cross-sectional data were randomly sampled from three different study time points. A series of multiple regression models were tested. RESULTS Results revealed main effects of both AS and withdrawal severity on PTSD severity after controlling for gender, assessment time-point, negative affectivity, and biochemically verified smoking (expired carbon monoxide). The interaction of AS and withdrawal was also significant, and appeared to be specific to PTSD avoidance and hyperarousal symptoms. However, contrary to expectations, the association between AS and PTSD symptoms was only significant at relatively lower levels of nicotine withdrawal. CONCLUSIONS These findings highlight the complex interplay between AS, nicotine withdrawal, and their synergistic effect in terms of the exacerbation of PTSD symptomology.
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Affiliation(s)
- Anu Asnaani
- University of Pennsylvania, Philadelphia, PA
| | | | - Joseph K Carpenter
- University of Pennsylvania, Philadelphia, PA ; Boston University, Boston, MA
| | | | - Edna B Foa
- University of Pennsylvania, Philadelphia, PA
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