MedWorm: Nicotine Replacement Therapy

Use of nicotine replacement therapy during pregnancy and stillbirth: a cohort study

BJOG: An International Journal of Obstetrics and Gynaecology — Fri, 22 Aug 2008 04:00:00 +0100

Objective The objective of this study was to examine whether the use of nicotine replacement therapy (NRT) during pregnancy increases the risk of stillbirth.Design Cohort study with prospective data.Setting Denmark 1996[ndash]2002.Population A total of 87 032 singleton pregnancies enrolled in the Danish National Birth Cohort for which information on NRT use as well as smoking was available.Methods Outcome of pregnancy was identified by register linkage, with (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

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Bjog release: using nicotine replacement therapy during pregnancy

Health News from Medical News Today — Thu, 21 Aug 2008 09:00:00 +0100

Smoking during pregnancy is known to increase the risk of stillbirth and pregnancy complications. To assist in smoking cessation, nicotine replacement therapy (NRT) is commonly prescribed but there is little information about the effects of NRT on a pregnant woman and her baby. (Source: Health News from Medical News Today)

Confusion about nicotine may stop smokers from kicking the habit

Health News from Medical News Today — Wed, 20 Aug 2008 11:00:00 +0100

Over two thirds of smokers incorrectly believe that nicotine replacement therapy (NRT) products, like NiQuitin, are just as harmful as cigarettes, and this misconception may even be stopping them from getting the support they need to give up smoking. (Source: Health News from Medical News Today)

Smoking: a deadly pleasant habit--is there a way out?

Angiology — Mon, 18 Aug 2008 04:00:00 +0100

It was not until 1958 that the first major epidemiologic study demonstrated a strong correlation between smoking and cardiovascular disease. Although not providing definitive evidence that tobacco smoke was responsible for the increased coronary risk, it prompted the first anti-smoking measures by the US Surgeon General in his 1964 report. Smoking is a highly addictive (biological and psychological) habit. The severity of withdrawal symptoms that patients find distressing can be reduced by nicotine replacement therapy. Bupropion SR was the first nonnicotine medication shown to be effective for smoking cessation. Its possible mechanisms of action include blockade of neuronal reuptake of dopamine and norepinephrine and blockade of nicotinic acetylcholinergic receptors. Varenicline, a nicotine receptor partial agonist, is the most recently developed nonnicotine preparation. The odds of smoking cessation after 12 weeks of 1 mg twice-daily varenicline treatment was approximately twice that achieved with 150 mg twice-daily bupropion and nearly 4-fold greater than with placebo. (Source: Angiology)

In vitro tooth whitening effect of two medicated chewing gums compared to a whitening gum and saliva

BioMed Central — Mon, 11 Aug 2008 04:00:00 +0100

Background: Extrinsic staining of teeth may result from the deposition of a variety of pigments into or onto the tooth surface, which originate mainly from diet or from tobacco use. More recently, clinical studies have demonstrated the efficacy of some chewing gums in removing extrinsic tooth staining. The aim of this study was to assess the effectiveness of two nicotine medicated chewing gums (A and B) on stain removal in an in vitro experiment, when compared with a confectionary whitening chewing gum (C) and human saliva (D). Methods: Bovine incisors were stained by alternating air exposure and immersion in a broth containing natural pigments such as coffee, tea and oral microorganisms for 10 days. Stained enamel samples were exposed to saliva alone or to the test chewing gums under conditions simulating human mastication. The coloration change of the enamel samples was measured using a spectrophotometer. Measurements were obtained for each specimen (average of three absorbances) using the L*a*b scale: lightness (L*), red-green (a) and yellow-blue (b). Results: Medicated chewing gums (A and B) removed a greater amount of visible extrinsic stain, while the confectionary chewing gum with a whitening claim (C) had a milder whitening effect as evaluated by quantitative and qualitative assessment. Conclusions: The tested Nicotine Replacement Therapy (NRT) chewing gums were more effective in the removal of the extrinsic tooth stain. This visible improvement in tooth whitening appearance could strengthen the smokers' motivation to quit smoking. (Source: BioMed Central)

Trends in employer-sponsored health insurance coverage for tobacco-dependence treatments.

American Journal of Preventive Medicine — Sat, 09 Aug 2008 04:00:00 +0100

Trends in Employer-Sponsored Health Insurance Coverage for Tobacco-Dependence Treatments.

Am J Prev Med. 2008 Aug 9;

Authors: McMenamin SB, Halpin HA, Shade SB

BACKGROUND: Nearly 1.8 million smokers in California receive their health insurance benefits through their employer. The extent to which these workers have coverage for tobacco-dependence treatments (TDTs) through their employer-sponsored health care is unknown. METHODS: This research used the 2000 and 2005 data from the California Employer Health Benefits Surveys to determine coverage for TDTs by private firms. The overall response rates of firms to the survey were 41% and 36%, respectively. The samples used in this analysis are limited to private firms in California that offered employee health benefits in 2000 (n=729) or in 2005 (n=745). RESULTS: This research found that among private firms offering health insurance coverage, there was a significant increase from 2000 to 2005 in the percentage of workers covered for any TDTs (44% to 57%). Rates of coverage for all three forms of TDTs (nicotine replacement therapy, Zyban((R)), counseling) doubled from 11% to 22% over the 5-year time period. CONCLUSIONS: Although coverage levels have improved, they still fall short of the recommendations made in the U.S. Public Health Service guidelines as well as in the Healthy People2010 objectives. Given the effectiveness, cost effectiveness, public demand for coverage, and relatively low cost of covering TDTs-estimated to be $3-$6 per member per year-it is difficult to understand why such coverage is not more widely available in California.

PMID: 18692982 [PubMed - as supplied by publisher]

(Source: American Journal of Preventive Medicine)

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Varenicline may be better than transdermal nicotine replacement to quit smoking

Medscape Medical News Headlines — Thu, 07 Aug 2008 21:00:00 +0100

A randomized, open-label trial shows that patients who use varenicline vs transdermal nicotine replacement therapy have higher abstinence rates from cigarette smoking. Medscape Medical News (Source: Medscape Medical News Headlines)

Which drug to be used in smoking cessation? - tønnesen p.

SafetyLit: All (Unduplicated) — Mon, 04 Aug 2008 09:50:23 +0100

There are 3 first-line medications for smoking cessation i.e. nicotine replacement therapy (NRT), varenicline (a partial nicotine receptor agonist) and slow-release (SR) bupropion. All 3 agents approximately double 1-year quit rates when used for 3 months,... (Source: SafetyLit: All (Unduplicated))

Patterns of motivations and ways of quitting smoking among polish smokers: a questionnaire study

BMC Public Health - Latest articles — Mon, 04 Aug 2008 04:00:00 +0100

Background: The majority of Polish smokers declare their will to quit smoking and many of them attempt to quit. Although morbidity and mortality from tobacco-related diseases are among the highest in the world, there is a lack of comprehensive cessation support for smokers. We aimed to investigate how Poles, including the medically ill, cope with quitting cigarettes and what their motivations to quit are. Methods: Convenience sampling was used for the purpose of the study. Individuals attending several health care units were screened for a history of quit attempts. Ex-smokers were defined as smoking previously at least one cigarette/day but who have no longer been smoking for at least one month. Attempts at quitting were defined as abstaining from cigarettes for at least one day. Data on socio-demographics, tobacco use, quitting behaviors and reasons to quit from 618 subjects (385 ex- and 233 current smokers) who fulfilled these criteria were collected with the use of a questionnaire. For the comparison of proportions, a chi-square test was used. Results: In the entire study population, 77% of smokers attempted to quit smoking on their own and a similar proportion of smokers (76%) used the cold turkey method when quitting. Current smokers were more likely than former smokers to use some form of aid (p=0.0001), mainly nicotine replacement therapy (68%). The most important reasons for quitting smoking were: general health concern (57%), personal health problems (32%) and social reasons (32%). However, 41% of smokers prompted to quitting by personal health problems related to tobacco smoking did not see the link between the two. A small proportion of ex-smokers (3%) abstaining from cigarettes for longer than a year were not confident about their self-efficacy to sustain abstinence further. Conclusions: The majority of Polish smokers, including patients with tobacco-related diseases, attempt to quit without smoking cessation assistance, thus there is a need for a broader professional help for them. There is also a lack of general information on hazards related to tobacco and further anti-tobacco campaigns in media are needed. Finally, former smokers should be given more attention and periodic inquiries regarding the smoking habit are worthwhile. (Source: BMC Public Health - Latest articles)

Free nicotine replacement therapy would be popular

MedWire News - Respiratory — Thu, 31 Jul 2008 00:00:00 +0100

Over half of current smokers would be interested in using nicotine replacement therapy if it was offered free of charge, Canadian researchers report. (Source: MedWire News - Respiratory)

"cut down to quit" -- new designation for nicotine replacement therapy: a best evidence review

Medscape PublicHealth Headlines — Tue, 29 Jul 2008 16:00:00 +0100

Can cutting back while still taking NRT lead to successful smoking cessation? How does this newly licensed use expand options for current smokers and their clinicians? Medscape Family Medicine (Source: Medscape PublicHealth Headlines)

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[smoking] varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial

Thorax — Mon, 28 Jul 2008 04:00:00 +0100

Background: Varenicline, a new treatment for smoking cessation, has demonstrated significantly greater efficacy over placebo and sustained release bupropion (bupropion SR). A study was undertaken to compare a 12-week standard regimen of varenicline with a 10-week standard regimen of transdermal nicotine replacement therapy (NRT) for smoking cessation. Methods: In this 52-week, open-label, randomised, multicentre, phase 3 trial conducted in Belgium, France, the Netherlands, UK and USA, participants were randomly assigned (1:1) to receive varenicline uptitrated to 1 mg twice daily for 12 weeks or transdermal NRT (21 mg/day reducing to 7 mg/day) for 10 weeks. Non-treatment follow-up continued to week 52. The primary outcome was the biochemically confirmed (exhaled carbon monoxide <=10 ppm) self-reported continuous abstinence rate (CAR) for the last 4 weeks of the treatment period in participants who had taken at least one dose of treatment. Secondary outcomes included CAR from the last 4 weeks of treatment through weeks 24 and 52, and measures of craving, withdrawal and smoking satisfaction. Results: A total of 376 and 370 participants assigned to varenicline and NRT, respectively, were eligible for analysis. The CAR for the last 4 weeks of treatment was significantly greater for varenicline (55.9%) than NRT (43.2%; OR 1.70, 95% CI 1.26 to 2.28, p<0.001). The week 52 CAR (NRT, weeks 8–52; varenicline, weeks 9–52) was 26.1% for varenicline and 20.3% for NRT (OR 1.40, 95% CI 0.99 to 1.99, p = 0.056). Varenicline significantly reduced craving (p<0.001), withdrawal symptoms (p<0.001) and smoking satisfaction (p<0.001) compared with NRT. The most frequent adverse event was nausea (varenicline, 37.2%; NRT, 9.7%). Conclusions: The outcomes of this trial established that abstinence from smoking was greater and craving, withdrawal symptoms and smoking satisfaction were less at the end of treatment with varenicline than with transdermal NRT. Trial registration number: NCT00143325. (Source: Thorax)

Intentions of smokers to use free nicotine replacement therapy.

cmaj — Tue, 15 Jul 2008 04:00:00 +0100

Intentions of smokers to use free nicotine replacement therapy.

CMAJ. 2008 Jul 15;179(2):145-6

Authors: Cunningham JA, Selby PL

Public health initiatives to distribute nicotine replacement therapy free of charge as a means of promoting smoking cessation are ongoing. Are there enough smokers interested in using nicotine replacement therapy to have a substantial impact on the prevalence of smoking if this aid were distributed free to all interested smokers? We conducted a telephone survey of 825 randomly selected daily smokers aged 18 years or older who had smoked at least 10 cigarettes per day at some point in their lives. Overall, 58.9% of the respondents said they would be interested in nicotine replacement therapy if it were offered for free. Of those interested, almost all (93.8%) said that they would use the nicotine replacement therapy to help them quit for good. There were differences in the levels of interest: smokers who intended to quit were more interested in using the nicotine replacement therapy than those who planned to reduce or maintain their smoking.

PMID: 18625985 [PubMed - in process]

(Source: cmaj)

Nicotine patches and uninsured quitline callers a randomized trial of two versus eight weeks.

American Journal of Preventive Medicine — Sun, 13 Jul 2008 09:44:13 +0100

Nicotine patches and uninsured quitline callers a randomized trial of two versus eight weeks.

Am J Prev Med. 2008 Aug;35(2):103-10

Authors: McAfee TA, Bush T, Deprey TM, Mahoney LD, Zbikowski SM, Fellows JL, McClure JB

BACKGROUND: State-level tobacco quitlines are integrating nicotine replacement therapy (NRT) into service. Because of funding limitations some provide short courses of NRT. No randomized trial has evaluated the relative benefit of short versus standard treatment. DESIGN: A two-cell randomized trial comparing 2 weeks of NRT to 8 weeks. SETTING/PARTICIPANTS: Uninsured callers to the Oregon Quit Line during a free-patch initiative from October 18, 2004, to May 5, 2005, who were 18 years or older, smoked five or more cigarettes per day, did not have a medical contraindication to NRT use, and were interested in quitting in 30 days. Data were collected from April to November 2005, and analyzed in 2006-2007. INTERVENTION: Participants were eligible for two phone counseling sessions. 1154 participants were randomized to receive via the mail either 2 or 8 weeks of nicotine patches. MEASURES: Primary outcome was self-reported complete abstinence from tobacco for 30 or more days at the 6-month phone survey. Secondary outcomes were 7-day point prevalence and 90-day abstinence, satisfaction, and patch use. ORs and CIs were computed. Cost per quit and incremental cost per additional quit were computed based on program costs. RESULTS: Intent-to-treat 30-day abstinence was 14.3% in the 2-week group, and 19.6% in the 8-week group (OR 1.45 [CI=1.01, 2.12]). Average cost per quit was $1156 for 2 weeks and $1405 for 8 weeks, with an incremental cost effectiveness of $2068. Satisfaction increased from 90% to 97% with 8 weeks. Those receiving 8 weeks of NRT took more calls (2.0 vs 1.6) and used more patches (6.3 weeks vs 4.3 weeks), but were less likely to purchase patches (16.2% vs 39.3%). CONCLUSIONS: Eight weeks of patches improved quit rates compared with 2 weeks, and was cost effective.

PMID: 18617079 [PubMed - in process]

(Source: American Journal of Preventive Medicine)

Nicotine replacement therapy to be launched in japan.

Inpharma Weekly — Thu, 03 Jul 2008 08:09:37 +0100

Page: 19 (Source: Inpharma Weekly)

What are the most effective ways you can help patients stop smoking?

The Journal of Family Practice — Tue, 01 Jul 2008 04:00:00 +0100

What are the most effective ways you can help patients stop smoking?

J Fam Pract. 2008 Jul;57(7):478-479

Authors: Shah ZH, Rao S, Mayo HG, Fashner J

Brief counseling, nicotine replacement therapy, antidepressants, and varenicline all work well. Physician intervention should begin with routine assessment of smoking status for all patients. Brief (3 minutes or less) smoking cessation counseling improves quit rates. Nicotine replacement therapy (NRT), antidepressants (bupropion and nortriptyline), and the nicotine receptor partial agonist varenicline are effective and should be offered to help smokers quit.

PMID: 18625173 [PubMed - as supplied by publisher]

(Source: The Journal of Family Practice)

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Nicotine replacement therapy to be launched in japan.

Inpharma — Mon, 30 Jun 2008 07:15:27 +0100

(Source: Inpharma)

Maternal tobacco smoking, nicotine replacement and neurobehavioural development

Acta Paediatrica — Sat, 28 Jun 2008 04:00:00 +0100

The adverse effects of prenatal cigarette smoke exposure on human reproductive outcomes are a major scientific and public health concern. In the United States, approximately 25% of women of childbearing age currently smoke cigarettes, and only a small percentage of these individuals quit after learning of their pregnancy. Women interested in smoking cessation during pregnancy have a number of options, including behavioural and pharmacological aids, but nicotine replacement therapy (NRT) is by far the most common approach. While NRT avoids exposure to the myriad compounds present in tobacco smoke, nicotine itself causes damage to the developing nervous system. The purpose of this article is to review the detrimental effects of developmental tobacco smoke exposure on short- and long-term outcomes with particular emphasis on neurobehavioural consequences. In conclusion based on the clear, adverse effects of nicotine on brain development observed in human and animal studies, we suggest that safer alternatives for smoking cessation in pregnancy are badly needed. (Source: Acta Paediatrica)

Scheme in dundee will see smokers paid to quit

NeLM Headline News — Mon, 23 Jun 2008 00:00:00 +0100

According to a report by NetDoctor, a £500,000 joint scheme between the Scottish government and local authorities in Dundee will see 900 smokers in poor communities paid as an incentive to help them quit. In the 12-week scheme, they will be given an electronic card with a weekly credit balance of £12.50 that can be exchanged for groceries at local supermarkets (excluding alcohol or cigarettes). Participants will receive Nicotine Replacement Therapy (NRT) during the course of the treatment and will be able to access local counselling, support groups and exercise facilities. They will have to undergo weekly tests to ensure they haven't resumed smoking. (Source: NeLM Headline News)

Use of nicotine replacement therapy among never smokers in the 1999-2006 national health and nutrition examination surveys.

Drug and Alcohol Dependence — Fri, 20 Jun 2008 04:00:00 +0100

Use of nicotine replacement therapy among never smokers in the 1999-2006 National Health and Nutrition Examination Surveys.

Drug Alcohol Depend. 2008 Jun 20;

Authors: Gerlach KK, Rohay JM, Gitchell JG, Shiffman S

Nicotine replacement therapies (NRT) have been available without a prescription in the United States since 1996. Given that nicotine, at least as it is delivered through tobacco products, is addictive, we examined whether NRT was being used by individuals who have never smoked cigarettes. Adults (n=18,986) and adolescents (n=9187) who participated in the in-home survey and physical examination components of the 1999-2006 National Health and Nutrition Examination Surveys were assessed for cigarette smoking status, other tobacco use or exposure, and use of NRT. Among the 8415 adults (ages 20 and older) who reported never having smoked 100 cigarettes and who provided a blood sample during their physical exam, 3 (0.08%; 95% CI=0.02-0.28%) reported using NRT within the 5 days prior to being examined. Among the 5510 adolescents (aged 12-19 years) who reported never smoking and who provided a blood sample, 5 (0.12%; 95% CI=0.04%-0.36%) reported using NRT. Analyses of cotinine (a metabolite of nicotine) from their blood samples, along with analysis of their other survey responses regarding additional nicotine exposures suggest that it is unlikely that any of the adults were never smokers using NRT and perhaps 2 adolescents may have been never smokers who used NRT. Based on these assessments, the re-estimated prevalence of NRT use by never smokers would be 0% among adults and 0.05% (95% CI=0.01-0.27%) among adolescents.

PMID: 18572330 [PubMed - as supplied by publisher]

(Source: Drug and Alcohol Dependence)

Genetic variation in the serotonin pathway and smoking cessation with nicotine replacement therapy: new data from the patch in practice trial and pooled analyses.

Drug and Alcohol Dependence — Mon, 16 Jun 2008 04:00:00 +0100

Genetic variation in the serotonin pathway and smoking cessation with nicotine replacement therapy: New data from the Patch in Practice trial and pooled analyses.

Drug Alcohol Depend. 2008 Jun 16;

Authors: David SP, Johnstone EC, Murphy MF, Aveyard P, Guo B, Lerman C, Munafò MR

The serotonin pathway has been implicated in nicotine dependence and may influence smoking cessation. Therefore, 792 cigarette smokers from the Patch in Practice trial were genotyped for the tryptophan hydroxylase (TPH1 A779C), serotonin transporter (SLC6A45-HTTLPR), and 5-HT(1A) (HTR1A C-1019G) polymorphisms. Cox regression analysis did not demonstrate significant effects of any of the three genotypes on relapse to smoking: TPH1 (Reference AA; AC: hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.78, 1.24, p=0.90; CC: HR 0.93, 95% CI 0.73, 1.18, p=0.55); 5-HTTLPR (Reference LL; SL: HR 1.01, 95% CI 0.85, 1.20, p=0.90; SS: HR 1.13, 95% CI 0.91, 1.39, p=0.27); HTR1A (Reference CC; CG: HR 1.04, 95% CI 0.86, 1.25, p=0.70; GG: HR 1.01, 95% CI 0.82, 1.24, p=0.93). Moreover, pooled analyses of data from all three extant pharmacogenetic NRT trials (N=1398) found no significant effect of 5-HTTLPR genotype on continuous abstinence at 12-week (Reference LL; SL: odds ratio (OR)=1.25, 95% CI 0.89, 1.74, p=0.19; SS: OR=1.31, 95% CI 0.86, 1.98, p=0.21) or 26-week follow-up (Reference LL; SL: OR=0.93, 95% CI 0.64, 1.33, p=0.68; SS: OR=1.00, 95% CI 0.63, 1.58, p=1.00). These data do not support a statistically or clinically significant moderating effect of these specific 5-HT pathway genetic variants on smoking cessation. However, the possibility remains that other variants in these or other 5-HT genes may influence NRT efficacy for smoking cessation in treatment seeking smokers.

PMID: 18562131 [PubMed - as supplied by publisher]

(Source: Drug and Alcohol Dependence)

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Clusters of genetic variants linked to distinct treatment responses for smoking cessation

Smoking / Quit Smoking News From Medical News Today — Mon, 02 Jun 2008 23:00:00 +0100

Scientists have identified distinct clusters of genetic markers associated with the likelihood of success or failure of two smoking cessation treatments, nicotine replacement therapy (NRT) and the medication bupropion (Zyban). This study, supported by the National Institute on Drug Abuse (NIDA) and the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), was published in the June issue of the journal Archives of General Psychiatry. (Source: Smoking / Quit Smoking News From Medical News Today)

Gene variants may guide selection of smoking cessation treatment

Medscape Pathology Headlines — Mon, 02 Jun 2008 21:15:00 +0100

"Quit-success" genes are specific to an individual's likelihood of success with bupropion or nicotine replacement therapy. Medscape Medical News (Source: Medscape Pathology Headlines)

Clusters of genetic variants linked to distinct treatment responses for smoking cessation

National Institutes of Health (NIH) News Releases — Mon, 02 Jun 2008 20:00:00 +0100

Original article: molecular genetics of successful smoking cessation: convergent genome-wide association study results

Archives of General Psychiatry — Mon, 02 Jun 2008 04:00:00 +0100

Context Smoking remains a major public health problem. Twin studies indicate that the ability to quit smoking is substantially heritable, with genetics that overlap modestly with the genetics of vulnerability to dependence on addictive substances. Objectives To identify replicated genes that facilitate smokers' abilities to achieve and sustain abstinence from smoking (hereinafter referred to as quit-success genes) found in more than 2 genome-wide association (GWA) studies of successful vs unsuccessful abstainers, and, secondarily, to nominate genes for selective involvement in smoking cessation success with bupropion hydrochloride vs nicotine replacement therapy (NRT). Design The GWA results in subjects from 3 centers, with secondary analyses of NRT vs bupropion responders. Setting Outpatient smoking cessation trial participants from 3 centers. Participants European American smokers who successfully vs unsuccessfully abstain from smoking with biochemical confirmation in a smoking cessation trial using NRT, bupropion, or placebo (N = 550). Main Outcome Measures Quit-success genes, reproducibly identified by clustered nominally positive single-nucleotide polymorphisms (SNPs) in more than 2 independent samples with significant P values based on Monte Carlo simulation trials. The NRT-selective genes were nominated by clustered SNPs that display much larger t values for NRT vs placebo comparisons. The bupropion-selective genes were nominated by bupropion-selective results. Results Variants in quit-success genes are likely to alter cell adhesion, enzymatic, transcriptional, structural, and DNA, RNA, and/or protein-handling functions. Quit-success genes are identified by clustered nominally positive SNPs from more than 2 samples and are unlikely to represent chance observations (Monte Carlo P< .0003). These genes display modest overlap with genes identified in GWA studies of dependence on addictive substances and memory. Conclusions These results support polygenic genetics for success in abstaining from smoking, overlap with genetics of substance dependence and memory, and nominate gene variants for selective influences on therapeutic responses to bupropion vs NRT. Molecular genetics should help match the types and/or intensity of antismoking treatments with the smokers most likely to benefit from them. (Source: Archives of General Psychiatry)

Outcome from a community-based smoking cessation program for persons with serious mental illness.

Community Mental Health Journal — Sun, 01 Jun 2008 04:00:00 +0100

Outcome from a Community-based Smoking Cessation Program for Persons with Serious Mental Illness.

Community Ment Health J. 2008 Jun;44(3):187-94

Authors: Currie SR, Karltyn J, Lussier D, de Denus E, Brown D, El-Guebaly N

Six and 12-month outcomes are reported on 79 mentally ill persons attending either a 4- or 8-session community-based smoking cessation group. Quit rates at post, 3-, 6-, and 12-month follow-ups were 16, 19, 16, and 19%, respectively, with no significant effect of program length. These success rates are comparable to outcomes reported following group-based treatment with mentally healthy smokers. The majority of quitters used nicotine replacement therapy. Psychotropic medication dosages did not vary over time in quitters or non-quitters. No reductions in smoking were observed among non-quitters. Quitting smoking had no untoward effects on symptoms of mental illness or general functioning.

PMID: 18049896 [PubMed - in process]

(Source: Community Mental Health Journal)

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Varenicline in the treatment of tobacco dependence

Neuropsychiatric Disease and Treatment — Wed, 21 May 2008 15:11:34 +0100

Karl Fagerström1, John Hughes21Smokers Information Centre, Fagerström Consulting AB, Berga Alle 1, 25452 Helsingborg, Sweden; 2University of Vermont, Burlington, Vermont, USAAbstract: Varenicline, a partial agonist of α4β2 nicotinic acetylcholine receptors, is the most recently approved drug for smoking cessation. This paper reviews the outcomes of Phase 2 and Phase 3 clinical trials that assess the efficacy of varenicline in comparison to placebo and other smoking cessation pharmacotherapies, ie, sustained-release bupropion (bupropion SR) and nicotine transdermal patch. Varenicline has higher abstinence rates than placebo and the alternative active treatments at the end of standard regimen treatment periods. Significantly higher abstinence rates were also found with varenicline in comparison to both placebo and bupropion SR at the end of a 40-week non-treatment follow-up period. Varenicline typically tripled the abstinence rates compared with placebo. In addition, varenicline reduced craving and withdrawal symptoms as well as some of the positive experiences associated with smoking to a greater extent than placebo, bupropion SR, and nicotine replacement therapy (NRT). These findings are consistent with the proposed agonist/antagonist effects of varenicline. Preliminary studies assessing individual variables such as smoking dependency level and smoking reinforcement types provide justification to examine further the effects of varenicline according to these individual factors. Outcomes from such research could improve our understanding of varenicline’s mechanism of action and could ultimately help clinicians to develop individualized smoking cessation programs. Also, given varenicline’s ability to reduce the reward from smoking, it might be helpful to use it before cessation to motivate or prepare smokers for a quit attempt.Keywords: varenicline, smoking cessation, nicotinic partial agonist (Source: Neuropsychiatric Disease and Treatment)

Nicotine replacement therapy does help smokers to quit

The Medscape Journal of Medicine Latest — Thu, 15 May 2008 12:56:43 +0100

Dr. George Lundberg discusses the benefits of nicotine replacement therapy. The Medscape Journal of Medicine (Source: The Medscape Journal of Medicine Latest)

Does the use of nicotine replacement therapy during pregnancy affect pregnancy outcomes?

Maternal and Child Health Journal — Wed, 14 May 2008 06:17:27 +0100

Abstract Objectives Although nicotine replacement therapies (NRT) may assist with smoking cessation, little is known about the safety of NRT use during pregnancy. Our purpose was two-fold: to determine characteristics of women prescribed or recommended NRT during pregnancy and to investigate whether NRT prescription/recommendation was associated with adverse pregnancy outcomes using data from the 2004 Pregnancy Risk Assessment Monitoring System. Methods Smoking and NRT referral was self-reported by 5,716 women. Information on pregnancy outcomes was obtained from birth certificates. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results Smokers <35 years of age and of Hispanic, Non-Hispanic Black, and Asian/Pacific Islander race/ethnicity were less likely to be prescribed or recommended NRT during pregnancy. After adjustment for age, marital status, education, and race/ethnicity, women recommended NRT had twice the risk of low birthweight as compared to nonsmokers (OR = 1.95, 95% CI: 1.10, 3.46) while smokers had 1.31 times the risk of low birthweight (95% CI: 0.92, 1.87). Results for preterm birth were similar after adjustment for the same confounding variables (NRT: OR = 2.04, 95% CI: 1.14, 3.63 and smoking: OR = 1.09, 95% CI: 0.74, 1.61). Conclusions Risks of low birthweight and preterm birth were highest for women prescribed or recommended NRT. These findings may be related to frequency of maternal smoking. While heavier smokers may be more likely to be recommended NRT, they also may have the most difficulty with cessation. Greater efforts should be made to ensure that these women do successfully cease smoking. Content Type Journal ArticleDOI 10.1007/s10995-008-0361-1Authors Kimberly H. Gaither, The University of North Carolina at Charlotte Department of Public Health Sciences 9201 University City Boulevard Charlotte NC 28223-0001 USALarissa R. Brunner Huber, The University of North Carolina at Charlotte Department of Public Health Sciences 9201 University City Boulevard Charlotte NC 28223-0001 USAMichael E. Thompson, The University of North Carolina at Charlotte Department of Public Health Sciences 9201 University City Boulevard Charlotte NC 28223-0001 USAYvette M. Huet-Hudson, The University of North Carolina at Charlotte Department of Biology Charlotte NC USA Journal Maternal and Child Health JournalOnline ISSN 1573-6628Print ISSN 1092-7875 (Source: Maternal and Child Health Journal)

Increased pancreatic beta-cell apoptosis following fetal and neonatal exposure to nicotine is mediated via the mitochondria

Toxicological Sciences — Wed, 07 May 2008 04:00:00 +0100

In Canada, nicotine replacement therapy is recommended as a safe smoking cessation aid for pregnant women. However, we have shown in an animal model that fetal and neonatal nicotine exposure causes increased beta-cell apoptosis and loss of beta-cell mass, which leads to the development of postnatal dysglycemia and obesity. The goal of this study was to determine whether the observed beta-cell apoptosis is mediated via the mitochondrial and/or death receptor pathway. Female Wistar rats were given saline (control) or nicotine bitartrate (1 mg/kg/day) via sc injection for 2 weeks prior to mating until weaning (postnatal day 21). At weaning, pancreas tissue was collected for Western blotting, electron microscopy (EM), and immunohistochemistry. Key markers of each apoptotic pathway were examined in whole pancreas homogenates and mitochondrial/cytosolic pancreas fractions. In the death receptor pathway, Fas and soluble Fas ligand (FasL) protein were significantly increased in the nicotine-exposed offspring compared to control animals; there was no difference in the ratio of inactive/active caspase-8 or membrane-bound FasL expression. In the mitochondrial pathway, there was a significant increase in the ratio of Bcl2/Bax, Bax translocation to the mitochondria, cytochrome c release to the cytosol, and the ratio of active/inactive caspase-3 in nicotine-exposed offspring relative to control animals. Furthermore, increased mitochondrial swelling was observed by EM in the pancreatic beta cells of nicotine-exposed offspring. Taken together, these data suggest that beta-cell apoptosis following developmental nicotine exposure is mediated via the mitochondria. (Source: Toxicological Sciences)

Improving alcohol and tobacco history taking by junior medical officers

Alcohol and Alcoholism — Sat, 03 May 2008 04:00:00 +0100

Aims: We aimed to determine the effectiveness of individual feedback and group feedback in improving recording, assessment, and management of risky alcohol use and of tobacco smoking by Junior Medical Officers (JMOs). Method: Medical records of patients admitted by JMOs were examined for recording of alcohol use, alcohol withdrawal, intervention for alcohol, a consultation with the Drug and Alcohol team, tobacco use, and prescription of nicotine replacement therapy (NRT). In year 1, JMOs from hospital 1 received printed individual feedback on their own and their group's performance, while JMOs at hospital 2 attended a presentation of their group feedback. The following year, they reversed roles. Results: A total of 3025 patient records were examined for 130 JMOs. After individual feedback, the percentage of alcohol histories that were quantified rose significantly, from 69% to 82%. More smokers were detected, and NRT prescribing rates rose significantly. Group feedback showed no change. Logistic regression showed that JMOs were significantly more likely to record an alcohol history if located at the smaller hospital and in first year of hospital practice, if the patient was admitted during business hours, was male, and/or was younger than the median age of 70 years; JMOs were significantly more likely to quantify alcohol consumption after individual feedback, but this had no effect on tobacco history recording. Conclusion: Our study suggests that individual feedback on performance with education about desired standards is effective in improving the quality of recording of alcohol histories by Junior Medical Officers. (Source: Alcohol and Alcoholism)

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What do mothers think about concurrent breast-feeding and smoking?

Ambulatory Pediatrics — Thu, 01 May 2008 04:00:00 +0100

What Do Mothers Think About Concurrent Breast-Feeding and Smoking?

Ambul Pediatr. 2008 May;8(3):200-204

Authors: Bogen DL, Davies ED, Barnhart WC, Lucero CA, Moss DR

OBJECTIVE: According to newer policies of the American Academy of Pediatrics, smoking is not contraindicated with breast-feeding, yet smokers initiate and maintain breast-feeding less often than nonsmokers. We sought to describe maternal knowledge and attitudes regarding concurrent breast-feeding and smoking or nicotine replacement therapy (NRT) and to evaluate the association between maternal smoking and infant feeding practices. METHODS: Mothers bringing children <13 months old for an appointment completed a 24-item anonymous survey that addressed knowledge, attitudes, and practices about concurrent breast-feeding and smoking/NRT. RESULTS: Among 204 survey completers, 63% were African American, 52% had never breast-fed, and 54% had never smoked. Regardless of smoking status, 19% were aware of the recommendation to smoke after breast-feeding; most did not know that nicotine gum (42%) or patch (40%) transfers less or about the same amount of nicotine into breast milk than smoking a pack per day. Most mothers (80%) believed that women should not smoke any cigarettes if breast-feeding; current smokers (25%) were more likely than former (10%) or never smokers (11%) to find it acceptable to smoke one or more cigarettes per day (P = .03). Only 2% found it acceptable to use NRT while breast-feeding. Among ever breast-feeders, 10% stopped breast-feeding because of smoking. Over half of recent or current smokers reported that smoking affected their infant feeding decision. CONCLUSIONS: Mothers in this sample believe that women who smoke or take NRT should not breast-feed. Smoking status affected women's infant feeding practices. Correction of misinformation could increase breast-feeding rates.

PMID: 18501868 [PubMed - as supplied by publisher]

(Source: Ambulatory Pediatrics)

A review of the efficacy of smoking-cessation pharmacotherapies in nonwhite populations.

Clinical Therapeutics — Thu, 01 May 2008 04:00:00 +0100

A review of the efficacy of smoking-cessation pharmacotherapies in nonwhite populations.

Clin Ther. 2008 May;30(5):800-12

Authors: Robles GI, Singh-Franco D, Ghin HL

Background: Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States. Research suggests that behavioral support strategies and pharmacotherapy can improve abstinence rates. However, both approaches, especially pharmacotherapy, have been understudied in nonwhite US populations. Objective: The aim of this review was to evaluate the efficacy of smoking-cessation pharmacotherapy in nonwhite US populations. Methods: Using search terms smoking cessation, nicotine replacement therapy, bupropion SR, varenicline, minority, ethnicity, African American, black, Hispanic, American Indian, and Alaska Native, a literature search was conducted to identify English-language studies that evaluated the use of smoking-cessation pharmacotherapies in nonwhite patients in MEDLINE (1966\2-December 2007), International Pharmaceutical Abstracts (1980\2-January 2008), Database of Abstracts of Reviews of Effectiveness (1990\2-December 2007), and EMBASE Drugs & Pharmacology (1991\2-third quarter 2007). Results: Nine studies were identified and assessed. Six studies looked at smoking-cessation pharmacotherapy in black smokers, 1 in Hispanic smokers, 1 in Native American smokers, and 1 in white and nonwhite smokers. In black smokers (N = 410; mean cigarettes per day [cpd], 20.4) who received the nicotine patch versus placebo, the 30-day self-reported abstinence rates were 21.5% versus 13.7% (P = 0.03) at 10 weeks and 17.1% versus 11.7% (P = NS) at 6 months. In black smokers (N = 600; mean [SD] cpd, 16.1 [7.5]) who received sustained-release (SR) bupropion 150 mg BID versus placebo for 7 weeks, the 7-day biochemically verified abstinence rates at weeks 6 and 26 were 36.0% versus 19.0% (Delta, 17%; 95% CI, 9.7\2-24.4; P < 0.001) and 21.0% versus 13.7% (Delta, 7.3%; 95% CI, 1.0\2-13.7; P = 0.02). Predictors of smoking cessation included use of bupropion SR (abstinence rate, 41.5% vs 21.1%; P<0.001); smoking nonmentholated cigarettes (abstinence rate, 28.3% in mentholated smokers [n = 417] vs 41.5% in nonmentholated smokers [n = 118]; P = 0.006); not smoking within 30 minutes of awakening (abstinence rate, 26.4% [n = 420] in those who did vs 48.7% [n = 115] in those who did not; P < 0.001); and lower baseline salivary cotinine levels (256.8 [137.0] ng/mL in those who became abstinent vs 305.6 [143.4] ng/mL in those who remained smokers; P < 0.001). In black light (</=10 cpd) smokers (N = 753) who received nicotine gum 2 mg, the biochemically verified 7-day abstinence rates at weeks 8 and 26 in mentholated versus nonmentholated smokers were 22.6% versus 26.8% (P = NS) and 11.2% versus 18.8% (P = 0.015), respectively; at week 26, the abstinence rates in those who received gum + mentholated cigarettes (n = 309) versus gum + nonmentholated cigarettes (n = 67) were 14% versus 24% (P = 0.031). In Hispanic smokers (N = 108; mean [SD] cpd, 18.8 [10.2]) who received nicotine patch versus placebo for 10 weeks, 46% versus 26% (chi(2) = 4.01; P = 0.05) were abstinent from weeks 2 to 10 (completed all doses of patch); patients who were more acculturated and received active treatment had a higher abstinence rate than less acculturated patients (63% vs 47%; P value not provided). In Native American smokers (N = 252; cpd not provided) who received nicotine patch + counseling and were followed up at 3, 6, 9, and 12 months, selfreported abstinence rates were 31% (49/156), 30% (21/71), 24% (13/55), and 21% (4/19), respectively (P values not provided). In a 6-month study in white (n = 191) and nonwhite (n = 108) smokers (mean [SD] cpd, 21 [11]) randomized to receive a nicotine patch (n = 144) versus nasal spray (n = 155) for 8 weeks, the carbon monoxide\2-verified 7-day abstinence rates were 34.7% versus 29.0%; at 6 months, these rates were 18.1% versus 15.5% (P = NS). In nonwhite patients, logistic regression analysis at 6 months found that a higher proportion of patients randomized to receive nasal spray did not smoke for >/=7 consecutive days (odds ratio, 0.20; 95% CI, 0.05-0.77; P = 0.02). Conclusions: Data from the studies in this review support the use of smoking-cessation pharmacotherapy (nicotine patch and bupropion SR) in nonwhite patients. Black patients, who smoked within 30 minutes of awakening, smoked mentholated cigarettes, and had high salivary cotinine levels may have difficulty quitting regardless of the number of cigarettes smoked per day; therefore, determining the type of cigarettes smoked (mentholated vs nonmentholated) and salivary cotinine levels may be helpful in assessing the severity of smoking addiction and guide pharmacotherapy (eg, starting at higher doses of nicotine-replacement therapy in a light smoker). Other than smoking-cessation behavioral studies, there is a lack of congruent smoking-cessation pharmacotherapy studies in American Indian/Alaska Native, Hispanic, and other ethnic populations.

PMID: 18555928 [PubMed - in process]

(Source: Clinical Therapeutics)

[articles] review of smoking cessation treatments for people with mental illness

Advances in Psychiatric Treatment — Wed, 30 Apr 2008 04:00:00 +0100

This article reviews the current literature regarding treatments for smoking cessation in both the general population and in those with mental health problems. The gold-standard treatment for the general population is pharmacotherapy (nicotine replacement therapy, bupropion or varenicline) coupled with individual or group psychological support. This is also effective in helping people with mental illness to reduce or quit smoking, but care must be taken to avoid adverse medication interactions and to monitor antipsychotic medication in particular as cigarette consumption reduces. (Source: Advances in Psychiatric Treatment)

More than 40% of smokers tried to quit in 2007

Nursing in Practice — Tue, 29 Apr 2008 10:16:57 +0100

Half of those who tried to quit used methods such as nicotine replacement therapy (Source: Nursing in Practice)

Nortriptyline and nrt both effective for smoking cessation, but combination is no more effective

NeLM Headline News — Mon, 28 Apr 2008 00:00:00 +0100

Either nortriptyline or nicotine replacement therapy (NRT) is useful in helping smokers to quit, but combining the two seems to be less effective than either alone according to a controlled trial. The authors of the study note that treatments aimed at smoking cessation are among the most cost-effective in healthcare, however the long-term effectiveness of any single treatment episode is low. There is a need, therefore, for better interventions. NRT and nortriptyline are both effective in improving smoking cessation rates. All effective interventions are considered to reduce the severity of withdrawal symptoms, however the mechanisms are thought to vary. As NRT and nortriptyline are thought to differ in mechanism of action, it may be logical to combine the two. This study compared the efficacy of nortriptyline plus NRT to placebo plus NRT: smaller studies have given equivocal results, so this trial was intended to be large enough to provide robust evidence. Participants were adults who were trying to stop smoking and were attending a NHS specialist stop smoking service clinic. They were allowed to chose their preferred method of NRT and randomised to receive either nortriptyline or placebo. Nortriptyline was provided in 25mg capsules and participants took one capsule daily for three days, then two daily for four days, then three daily for six weeks. They then tailed the dose over a further week. Primary outcome was complete abstinence at six months, confirmed using salivary cotinine or exhaled carbon monoxide measurements. A total of 901 people were randomised to treatment (nortriptyline n=445, placebo n=456); 26 (9 and 17 respectively) did not attend for follow-up and were counted as treatment failures. Follow-up at six months was good, with data available for 91% of those in the nortriptyline group and 86% of those in the placebo group. At this point, prolonged abstinence rates were 16% and 12% respectively (relative risk 1.34; 95% CI, 0.97 to 1.86). Nortriptyline use reduced rats of depression and anxiety. Those taking nortriptyline were more likely to report dry mouth and constipation, however rates of these were high in both groups. Differences in other adverse effects were small. The authors conclude that adding nortriptyline to NRT, while reducing symptoms of depression and anxiety, does not significantly improve smoking cessation rates. Their study, with three times as many participants as other trials combined, does not indicate a large benefit from the addition of nortriptyline to NRT although the results are compatible with a small benefit. Overall, however, the effect of the combination is less than the sum of the effects of the individual components. They therefore conclude that this therapy is not suitable for routine use, although it may be helpful in specific patients. (Source: NeLM Headline News)

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[research] nortriptyline plus nicotine replacement versus placebo plus nicotine replacement for smoking cessation: pragmatic randomised controlled trial

BMJ Online First — Sun, 27 Apr 2008 04:00:00 +0100

Objective To test the efficacy of nortriptyline plus nicotine replacement therapy compared with placebo plus nicotine replacement therapy for smoking cessation. Design Pragmatic randomised controlled trial. Setting National Health Service stop smoking service clinics. Participants 901 people trying to stop smoking. Interventions Participants chose their nicotine replacement product, including combinations of nicotine replacement therapy, and received behavioural support. Nortriptyline was started one to two weeks before quit day, with the dose increased from 25 mg to 75 mg daily for eight weeks and reduced if not tolerated. Main outcome measures Primary outcome was prolonged confirmed abstinence at six months. Secondary outcomes were prolonged abstinence at 12 months, drug use, severity of side effects, nicotine withdrawal symptoms, and urges to smoke. Results 72 of 445 (16%) people using nortriptyline and 55 of 456 (12%) using placebo achieved prolonged abstinence at six months (relative risk 1.34, 95% confidence interval 0.97 to 1.86). At 12 months the corresponding values were 49 (11%) for nortriptyline and 40 (9%) for placebo (1.26, 0.84 to 1.87). 337 (79%) people in the nortriptyline arm and 325 (75%) in the placebo arm were taking combination treatment on quit day, median 75 mg per day in both groups. More people in the nortriptyline arm than in the placebo arm took lower doses. The nortriptyline arm had noticeably higher severity ratings for dry mouth and constipation than the placebo arm, with slightly higher ratings for sweating and feeling shaky. Both groups had similar urges to smoke, but nortriptyline reduced depression and anxiety. Overall, withdrawal symptom scores did not differ. Conclusions Nortriptyline and nicotine replacement therapy are both effective for smoking cessation but the effect of the combination is less than either alone and evidence is lacking that combination treatment is more effective than either alone. Trial registration Current Controlled Trials ISRCTN57852484. (Source: BMJ Online First)

Statistics on nhs stop smoking services in england april to december 2007

NeLM news - Mental Health — Thu, 17 Apr 2008 00:00:00 +0100

This quarterly report presents provisional results from the monitoring of the NHS Stop Smoking Services for the period April to December 2007, and for the first time this year, provides information on the use of varenicline (Champix®). The key results show that in England April to December 2007: • 462,690 people set a quit date through NHS Stop Smoking Services, an increase of 23% over the same period in 2006/07 and 17% over the same period in 2005/06. • At the 4 week follow-up 234,060 people had successfully quit (based on self-report), 51% of those setting a quit date. This compares with 192,527 successful quitters in the same period in 2006/07 (an increase of 22%), and 208,878 successful quitters in 2005/06 (12% increase). • The majority of those setting a quit date received Nicotine Replacement Therapy (NRT) only (72%). A further 13% received varenicline only, 4% received bupropion (Zyban®) only and less than 1% received both NRT and bupropion. Six per cent of people setting a quit date did not receive any smoking cessation aid. • Of those who used varenicline, 63% successfully quit, compared with 54% who received bupropion only, and 48% who received NRT. • Expenditure on NHS Stop Smoking Services was £41.3 million compared to £36 million in the same period in 2006/07. The cost of the NHS Stop Smoking Services per quitter was £177, compared with £187 during the same period in 2006/07. (Source: NeLM news - Mental Health)

Nicotine replacement therapy

Journal of General Internal Medicine — Tue, 08 Apr 2008 07:28:37 +0100

Abstract AIM: To determine the association between daily smoking and use of nicotine replacement therapy (NRT), and to determine predictors of greater NRT use among methadone-maintained smokers. INTERVENTION: Assignment to free nicotine patch (8 to 12 weeks) plus either (1) a baseline-tailored brief motivational intervention, a quit date behavioral skills counseling session, and a relapse prevention follow-up session (max), or (2) brief advice using NCI’s 4 A’s model (min). SETTING: Five methadone maintenance treatment centers. PARTICIPANTS: Of the 383 methadone-maintained smokers enrolled, 309 (80.6%) set a specific quit date (received NRT) and were located for assessments. Participants were 51.8% male, 78.6% Caucasian, and smoked 26.6 (SD=12.2) cigarettes/day. OUTCOME: Use of NRT and smoking behaviors during the 180-day follow-up period assessed by the Timeline follow-back method. FINDINGS: On the day following their quit day, 86.4% of participants used NRT. The percentage of participants using NRT was 52.3%, 27.1%, and 10.4% on day 30, day 60, and day 90, respectively. Participants used NRT on 44.1% of the days through the 90 days of the treatment protocol. The estimated odds of smoking abstinence was 7.1 (P<.001) times higher on days when NRT was used than on days when NRT was not used, and cigarettes/day was also significantly lower on NRT days (14.93 vs 4.65; P<.001). CONCLUSION: Nicotine replacement therapy use was inconsistent following an initial quit attempt among methadone-maintained smokers. On days when NRT was used, individuals were likely to smoke at reduced levels or not at all. Content Type Journal ArticleCategory Original ArticlesDOI 10.1111/j.1525-1497.2006.00504.xAuthors Michael D. Stein, Brown Medical School Departments of Medicine and Psychiatry Providence RI USABradley J. Anderson, Brown Medical School Departments of Medicine and Psychiatry Providence RI USARaymond Niaura, Brown Medical School Departments of Medicine and Psychiatry Providence RI USA Journal Journal of General Internal MedicineOnline ISSN 1525-1497Print ISSN 0884-8734 Journal Volume Volume 21 Journal Issue Volume 21, Number 7 / July, 2006 (Source: Journal of General Internal Medicine)

Meta-analysis: starting nrt before quit date improves smoking cessation outcomes?

NeLM news - Mental Health — Mon, 07 Apr 2008 00:00:00 +0100

Starting nicotine replacement therapy (NRT) as a transdermal patch before the target quit date doubles success rates according to a meta-analysis, although only four studies of varied design were eligible for analysis. The authors of the analysis note that starting NRT before the quit date might improve smoking cessation rates by acclimatising users and separating nicotine intake from smoking. This approach has been most studied using transdermal patches, however trials have varied in size and duration. The aim of this analysis was to determine from the trial data whether a clear benefit had been shown. The authors searched for randomised controlled trials in which the effects of pre-quit treatment were compared directly with treatment starting on the target quit day. Eligible studies recruited smokers who were interested in quitting (rather than reduction), where all participants received NRT from the target quit date, where participants were randomised to receive pre-quit NRT or control (placebo or no NRT), and where cessation was verified 4 to 6 weeks later by biochemical analysis. Primary end-point for the analysis was continuous abstinence for at least 28 days assessed at 6 weeks following quit day, or the nearest reported outcome where this was not available; outcomes at six months were examined as secondary endpoints. Four trials (n=755) were available and eligible for analysis, all involving nicotine patches: two trials involving nicotine gum were also located, however one was ineligible as a different pre-quit dose was used, and the second had not yet completed. The trials had different designs and durations, and two (n=176) also included treatment with mecamylamine (a nicotinic antagonist). Three studies originated from the same research team. Analysis found that pre-quit treatment approximately doubled the quit rate at six weeks compared to starting NRT on the quit day (odds ratio 1.91; 95% CI, 1.31 to 2.93). A similar pattern was seen with results at six months (OR 2.17; 95% CI, 1.46 to 3.22). Co-administration of mecamylamine seemed to make no significant difference to the results. There was no evidence that one study was significantly influencing the pooled result - exclusion of each from analysis made little difference to the overall result. Based on their analysis, the authors conclude that starting NRT patch therapy before the target quit date roughly doubles the chance of success, both in the short-term and up to six months. Although the studies differed widely in their design, the authors consider that the analysis suggests a consistent effect. They note that where the information was collected, there was spontaneous pre-quit reduction in smoking by subjects in the pre-quit group although none were instructed to do this. They discuss possible mechanisms for the effect including pharmacodynamic effects, effects on learned associations involved in smoking, and on extinction of smoking reinforcement. [Editor's comment: an interesting analysis that appears to have been carefully done, but some cautions remain: the number of participants was relatively small, and it is a slight concern that most of the data came from one research team. This technique would not be covered by current NICE guidance on smoking cessation, and it is uncertain whether it would fit with the current product licences for NRT patches.] (Source: NeLM news - Mental Health)

The case for treating tobacco dependence as a chronic disease.

Annals of Internal Medicine — Tue, 01 Apr 2008 04:00:00 +0100

The case for treating tobacco dependence as a chronic disease.

Ann Intern Med. 2008 Apr 1;148(7):554-6

Authors: Steinberg MB, Schmelzer AC, Richardson DL, Foulds J

Smoking remains the leading cause of preventable death in the United States, yet it is still regarded by many as merely a bad habit. Most smokers want to quit but find it difficult. Behavioral counseling and pharmacotherapies are available, safe, and effective in the treatment of tobacco dependence. Nicotine replacement therapy effectively delivers nicotine in safer doses without exposure to the toxins and chemicals in cigarette smoke. The optimal duration of tobacco dependence treatment is unknown, and some smokers may require extended courses. For smokers using long-term cessation medications, health care providers should encourage treatment and insurance carriers should cover it. Both tobacco dependence and such conditions as diabetes are similar in their potential to exacerbate other diseases, their behavioral components of treatment, and their effectiveness of medications. Despite these similarities, treatments for diabetes are well covered by insurance, whereas tobacco dependence treatments are often limited. Tobacco dependence should share the status of other chronic illnesses, with effective treatments given as long as is necessary to achieve successful clinical outcomes.

PMID: 18378950 [PubMed - in process]

(Source: Annals of Internal Medicine)

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The effectiveness of the provision of free nicotine replacement therapy on quit rates among health staff.

Australian and New Zealand Journal of Public Health — Tue, 01 Apr 2008 04:00:00 +0100

The effectiveness of the provision of free nicotine replacement therapy on quit rates among health staff.

Aust N Z J Public Health. 2008 Apr;32(2):184-5

Authors: Wallace C, Bedford K, Rissel C, Carroll T, Hua M, Maunsell T

PMID: 18412695 [PubMed - in process]

(Source: Australian and New Zealand Journal of Public Health)

Update on pharmacologic options for smoking cessation treatment.

The American Journal of Medicine — Wed, 26 Mar 2008 23:54:22 +0100

Update on pharmacologic options for smoking cessation treatment.

Am J Med. 2008 Apr;121(4 Suppl 1):S20-31

Authors: Nides M

Although the proportion of the adult population in the United States that smokes has decreased steadily, the rate of successful quit attempts is still low. Smokers develop nicotine dependence that resembles other addictions, and may require multiple attempts and long-term treatment to sustain abstinence. Currently available first-line agents for smoking cessation therapy include nicotine replacement therapy, which is available in several formulations, including transdermal patch, gum, nasal spray, inhaler, and lozenge; bupropion, an atypical antidepressant; and varenicline, a partial agonist of the alpha(4)beta(2) nicotinic acetylcholine receptor that was recently developed and approved specifically for smoking cessation therapy. Second-line agents are nortriptyline, a tricyclic antidepressant agent, and clonidine, an antihypertensive drug. With the exception of varenicline, which has been shown to offer significant improvement in abstinence rates over bupropion, all of the available treatments appear similarly effective. However, the adverse event profiles of nortriptyline and clonidine make them more appropriate for second-line therapy, when first-line treatments have failed or are not tolerated. Rimonabant, a cannabinoid-1 receptor antagonist that was being developed for smoking cessation, received a nonapprovable letter from the FDA in 2006 and there is no further information as to whether development for this indication is continuing for this agent. Nicotine vaccines are under investigation and offer promise, especially for relapse prevention. Ultimately, selection of pharmacologic agent should be based on the patient's comorbidities and preferences, as well as on the agent's adverse event profile.

PMID: 18342163 [PubMed - in process]

(Source: The American Journal of Medicine)

Efficacy and safety of varenicline for smoking cessation.

The American Journal of Medicine — Wed, 26 Mar 2008 23:54:14 +0100

Efficacy and safety of varenicline for smoking cessation.

Am J Med. 2008 Apr;121(4 Suppl 1):S32-42

Authors: Hays JT, Ebbert JO, Sood A

Effective treatment of nicotine addiction is essential for reducing the substantial current and predicted morbidity and mortality associated with tobacco smoking. Despite the availability of effective treatments for smoking cessation, such as nicotine replacement therapy and bupropion sustained-release (SR), abstinence rates remain less than optimal. Varenicline is the first in a new class of agents for smoking cessation, the alpha(4)beta(2) nicotinic acetylcholine receptor (nAChR) partial agonists. Nicotine addiction is mediated by stimulation of central alpha(4)beta(2) nAChRs by nicotine, which causes the release of dopamine, ultimately leading to the pleasurable effects of smoking. As a nAChR partial agonist, varenicline attenuates the craving and withdrawal symptoms that occur with abstinence from nicotine and also reduces the rewarding effects of nicotine obtained from smoking in patients who lapse. Thus, varenicline offers a new therapeutic option for the treatment of nicotine addiction. Clinical trials have demonstrated superior efficacy of this agent over placebo and bupropion-SR for achieving abstinence from smoking, and varenicline has also been shown to significantly delay smoking relapse. As the newest agent approved for smoking cessation, the mechanism of action, efficacy, and safety of varenicline.

PMID: 18342165 [PubMed - in process]

(Source: The American Journal of Medicine)

Nicotine and brain development

Birth Defects Research Part C: Embryo Today: Reviews — Wed, 26 Mar 2008 04:00:00 +0100

Preclinical studies, using primarily rodent models, have shown acetylcholine to have a critical role in brain maturation via activation of nicotinic acetylcholine receptors (nAChRs), a structurally diverse family of ligand-gated ion channels. nAChRs are widely expressed in fetal central nervous system, with transient upregulation in numerous brain regions during critical developmental periods. Activation of nAChRs can have varied developmental influences that are dependent on the pharmacologic properties and localization of the receptor. These include regulation of transmitter release, gene expression, neurite outgrowth, cell survival, and synapse formation and maturation. Aberrant exposure of fetal and neonatal brain to nicotine, through maternal smoking or nicotine replacement therapy (NRT), has been shown to have detrimental effects on cholinergic modulation of brain development. These include alterations in sexual differentiation of the brain, and in cell survival and synaptogenesis. Long-term alterations in the functional status and pharmacologic properties of nAChRs may also occur, which result in modifications of specific neural circuitry such as the brainstem cardiorespiratory network and sensory thalamocortical gating. Such alterations in brain structure and function may contribute to clinically characterized deficits that result from maternal smoking, such as sudden infant death syndrome and auditory-cognitive dysfunction. Although not the only constituent of tobacco smoke, there is now abundant evidence that nicotine is a neural teratogen. Thus, alternatives to NRT should be sought as tobacco cessation treatments in pregnant women. Birth Defects Research (Part C) 84:30-44, 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part C: Embryo Today: Reviews)

Reducing harm from tobacco smoke exposure during pregnancy

Birth Defects Research Part C: Embryo Today: Reviews — Wed, 26 Mar 2008 04:00:00 +0100

In addition to the health risks that maternal tobacco smoke exposure in pregnancy poses to women, this is a cause of substantial fetal morbidity and mortality. In pregnancy, maternal tobacco smoke exposure can arise because women either smoke or are passively exposed to environmental tobacco smoke as a consequence of other's smoking. This article discusses the scope for clinicians to help reduce both types of tobacco smoke exposure in pregnancy, with a specific focus on available and effective interventions for smoking cessation by pregnant women. Behavioral support with smoking cessation is the only intervention that has been proven to encourage smoking cessation in pregnancy and reduces smoking rates in late pregnancy by 6 to 7%. There are physiological reasons to suspect that nicotine replacement therapy (NRT) will be less or (in)effective for smoking cessation in pregnancy when compared with its use by nonpregnant smokers. However, there are also strong theoretical reasons to suspect that NRT is likely to be safer than continued smoking in pregnancy. Consequently, this article reviews evidence for the safety and effectiveness of NRT when used for smoking cessation in pregnancy and recommendations concerning the use of NRT in pregnancy are presented. Birth Defects Research (Part C) 84:73-79, 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part C: Embryo Today: Reviews)

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The barriers to smoking cessation in swiss methadone and buprenorphine-maintained patients

BioMed Central — Tue, 18 Mar 2008 04:00:00 +0100

Background: Smoking rates in methadone-maintained patients are almost three times higher than in the general population and remain elevated and stable. Due to the various negative health effects of smoking, nicotine dependence contributes to the high mortality in this patient group. The purpose of the current study was to investigate Swiss methadone and buprenorphine-maintained patientsa willingness to stop smoking and to clarify further smoking cessation procedures. Methods: Substance abuse history, nicotine dependence, and readiness to stop smoking were assessed in a sample of 103 opiate-dependent patients in the metropolitan area of Zurich, Switzerland. Patients were asked to document their smoking patterns and readiness to quit. Results: Only a small number of patients were willing to quit smoking cigarettes (10.7%) and, even though bupropione or nicotine replacement therapy was included in the fixed daily treatment care, only one patient received nicotine replacement therapy for smoking cessation. A diagnosis of depression in patientsa clinical records was associated with readiness to stop smoking. No significant associations were found between readiness to quit smoking and age, methadone treatment characteristics, and presence of co-dependencies. Conclusions: The current prescription level of best medicine for nicotine dependence in Swiss methadone and buprenorphine-maintained patients is far from adequate. Possible explanations and treatment-relevant implications are discussed. (Source: BioMed Central)

Rapid appraisal of trial comparing varenicline to transdermal nicotine now available

NeLM news - Mental Health — Fri, 14 Mar 2008 00:00:00 +0100

The Regional Drug and Therapeutics Centre in Newcastle has produced a rapid appraisal of a trial recently published early online in the journal Thorax. The randomised, open label trial compared varenicline to nicotine replacement therapy (NRT). In summary this appraisal concludes (direct from source): “This study demonstrates that the medium-term (52-week) efficacy of varenicline is not significantly improved compared with NRT when both are combined with a high level of support and contact. Since greater medium- or long-term efficacy of varenicline over NRT has not been demonstrated, NRT should remain the first-line treatment option for patients who are motivated and have expressed a desire to quit smoking.” (Source: NeLM news - Mental Health)

Discontinuation of nicotine replacement therapy among smoking-cessation attempters.

American Journal of Preventive Medicine — Sat, 01 Mar 2008 05:00:00 +0100

Discontinuation of nicotine replacement therapy among smoking-cessation attempters.

Am J Prev Med. 2008 Mar;34(3):212-5

Authors: Burns EK, Levinson AH

BACKGROUND: Nicotine replacement therapy (NRT) doubles successful quitting, but more than half of NRT users do not comply with optimal treatment regimens. METHODS: From the 2005 Colorado state tobacco survey, quit attempters who utilized NRT (N=366) were analyzed in spring 2007. Descriptive and regression analyses were used to examine reasons for discontinuing NRT, length of time on NRT, and quit intentions. RESULTS: The reasons for discontinuing NRT were resuming smoking (34%), side effects (17%), NRT not helping with quitting (14%), quitting smoking (10%), and cost (5%). Poverty, age, and non-Latino minority status were associated with reasons for discontinuation other than quitting smoking. Having side effects was associated with a short duration of NRT use and 95% lower odds of intending to quit in the next month. CONCLUSIONS: In the first population-level study examining reasons for discontinuing NRT, general-population smokers who initiate NRT use when attempting to quit are highly likely to discontinue NRT prematurely. Age and culturally-appropriate medication management interventions may increase NRT compliance and improve cessation outcomes.

PMID: 18312809 [PubMed - in process]

(Source: American Journal of Preventive Medicine)

Tobacco and pregnancy: overview of exposures and effects

Birth Defects Research Part C: Embryo Today: Reviews — Sat, 01 Mar 2008 05:00:00 +0100

This opening article will review the epidemiology of the effects of cigarette smoking and other forms of tobacco exposure on human development. Sources of exposure described include cigarettes and other forms of smoked tobacco, secondhand (environmental) tobacco smoke, several forms of smokeless tobacco, and nicotine from nicotine replacement therapy. Exposure is immense and worldwide, most of it due to smoking, but in some parts of the world and in some populations, smoking is exceeded by smokeless tobacco use. Nicotine and carbon monoxide exposure are of large concern, but cigarette smoke contains over 4000 chemical constituents and additives including known carcinogens, toxic heavy metals, and many chemicals untested for developmental toxicity. The impact of tobacco on human development will be reviewed. Fertility, conception, survival of the conceptus, most phases and aspects of development studied to date, as well as postnatal survival and health are adversely impacted by maternal tobacco use or exposure. Effects in surviving offspring are probably life-long, and are still being elucidated. It is hoped that this review and those to follow in this issue will serve to keep a focus on the critical and continuing problem of tobacco use impacting human development. Brith Defects Research (Part C) 84: 1-15, 2008. Published 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part C: Embryo Today: Reviews)