A Pilot Study of Smoking Cessation within an Iranian Addiction Recovery Community

Tobacco dependence is ubiquitous among people seeking treatment for other substance use disorders, compromises recovery outcomes, and elevates long-term morbidity and mortality of people recovering from other addictions. The present study (1) identifies the organizational and personal motivators for smoking cessation within a recovery community (Congress 60) in the Islamic Republic of Iran, (2) describes a novel method of smoking cessation that combines prolonged nicotine replacement therapy (NRT) with a broad spectrum of psychosocial supports to achieve sustained smoking cessation and improved health and quality of life (HQoL), and (3) presents preliminary follow-up data on the first 100 individuals who participated in this pilot effort. The high retention rate, low reported nicotine cravings during and following NRT, high one-year post-NRT abstinence rates, and reported improvements in HQoL of study participants warrant further evaluation and potential replication of the smoking cessation methods used within Congress 60.     

Bupropion-SR for Smoking Cessation in Early Recovery from Alcohol Dependence: A Placebo-Controlled,Double-Blind Pilot Study

We conducted a double-blind pilot study involving 11 alcohol- and nicotine-dependent patients randomized to receive either bupropion or placebo. Four of six patients on bupropion and one of five patients on placebo were abstinent from smoking at the end of medication phase. Those in the bupropion group reported significantly less craving (p < .02) and less exposure to cigarette smoke over time (expired carbon monoxide; p < .01). There were no serious adverse events and no main effects of medication group on either per subject or total number of adverse events. All those who completed treatment remained abstinent from alcohol.     

Smoking Cessation Treatment among Patients in Community-Based Substance Abuse Rehabilitation Programs: Exploring Predictors of Outcome as Clues Toward Treatment Improvement

Background: Predictors of smoking cessation (SC) treatment outcome were explored in a multisite clinical trial of SC treatment at community-based, outpatient, substance abuse rehabilitation programs affiliated with the National Drug Abuse Treatment Clinical Trials Network. Objectives: To explore baseline demographic and clinical predictors of abstinence during treatment. Methods: Cigarette smokers from five methadone maintenance programs and two drug and alcohol dependence treatment programs were randomly assigned to SC treatment as an adjunct to substance abuse treatment as usual or to substance abuse treatment as usual. SC treatment consisted of group counseling (weeks 1–8) plus transdermal nicotine patch treatment (21 mg/day, weeks 1–6; 14 mg/day, weeks 7–8). Demographic and clinical predictors of smoking abstinence were evaluated among those patients assigned to the active SC condition (N = 153) using logistic regression. Results: Abstinence during treatment was positively associated with younger age, Hispanic or Caucasian (as opposed to African American) ethnicity/race, employment or student status, fewer cigarettes per day at baseline, lower severity of the primary substance problem at baseline, and higher methadone doses (among the subsample in methadone treatment). Conclusions and Scientific Significance: During future efforts to improve SC treatments among drug- and alcohol-dependent patients, consideration should be given to adequate treatment to reduce the severity of the primary drug or alcohol problem, tailoring treatments for patients with greater severity of smoking and of the primary substance problem, and culturally sensitive interventions. Analysis of predictors of outcome may be a useful tool for treatment development.     

The Modified Reasons for Smoking Scale: factorial structure, gender effects and relationship with nicotine dependence and smoking cessation in French smokers

Aims To assess the validity of the French version of the Modified Reasons for Smoking Scale (MRSS), and to identify which smoking patterns differentiate male and female smokers, which are related to tobacco dependence (as assessed by the Fagerström Test for Nicotine Dependence, FTND), to mood (Beck Depression Inventory II), to affect (Positive and Negative Affect Schedule) and which are predictors of successful quitting. Participants Three hundred and thirty smokers [(mean ± SD) aged 40 ± 9 years, 145 (44%) women, mean FTND score: 6.2 ± 2], candidates for a smoking cessation programme and smoking at least 15 cigarettes/day. Findings Factor analysis of the 21‐item scale gave the optimal fit for a seven‐factor model, which accounted for 62.3% of the total variance. The following factors were identified: ‘addictive smoking’, ‘pleasure from smoking’, ‘tension reduction/relaxation’, ‘social smoking’, ‘stimulation’, ‘habit/automatism’ and ‘handling’. The ‘addictive smoking’ score increased in a dose‐dependent manner with number of cigarettes smoked per day; the ‘habit/automatism’ score was significantly higher, with more than 20 cigarettes per day than with ≤ 20 cigarettes per day. The reasons for smoking were different for males and females: females scored higher on ‘tension reduction/relaxation’, ‘stimulation’ and ‘social smoking’. A high level of dependence (FTND ≥ 6) was associated with significantly higher scores only on ‘addictive smoking’, the association being stronger in females. Time to first cigarette after awakening was associated with higher ‘addictive smoking’ and ‘habit/automatism’ (P < 0.001). In a multivariate logistic regression, failed quitting was predicted by higher habit/automatism score (odds ratio = 1.44, 95% CI = 1.06–1.95, P = 0.02) and greater number of cigarettes smoked per day (odds ratio = 1.03, 95% CI = 1.01–1.06, p = 0.03). Conclusions The questionnaire yielded a coherent factor structure; women smoked more for tension reduction/relaxation, stimulation and for social reasons than men; addictive smoking and automatic smoking behaviour were similar in both sexes and were associated strongly with a high level of nicotine dependence; the ‘habit/automatism’ score predicted failure to quit over and above cigarettes per day.     

A Computerized Aid to Support Smoking Cessation Treatment for Hospital Patients

Background  Hospital-based interventions promote smoking cessation after discharge. Strategies to deliver these interventions are needed, especially now that providing smoking cessation advice or treatment, or both, to inpatient smokers is a publicly reported quality-of-care measure for US hospitals. Objective  To assess the effect of adding a tobacco order set to an existing computerized order-entry system used to admit Medicine patients to 1 hospital. Design  Pre-post study. Measurements and Main Results  Proportion of admitted patients who had smoking status identified, a smoking counselor consulted, or nicotine replacement therapy (NRT) ordered during 4 months before and after the change. In 4 months after implementation, the order set was used with 76% of Medicine admissions, and a known smoking status was recorded for 81% of these patients. The intervention increased the proportion of admitted patients who were referred for smoking counseling (0.8 to 2.1%) and had NRT ordered (1.6 to 2.5%) (p < .0001 for both). Concomitantly, the hospital’s performance on the smoking cessation quality measure improved. Conclusions  Adding a brief tobacco order set to an existing computerized order-entry system increased a hospital’s provision of evidence-based tobacco treatment and helped to improve its performance on a publicly reported quality measure. It provides a model for US hospitals seeking to improve their quality of care for inpatients.     

Smoking Cessation and Coronary Artery Calcification in CKD

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Smoking Cessation Programs for Seniors:A Group Model That Works

We describe an intensive group program for older adults, facilitated by a tobacco cessation specialist and a geriatric social worker, designed to focus on factors that maintain smoking behavior. Integral components dealt with issues specific to the older adult such as social isolation or economic need. Pharmacological therapy was provided. Participants with a mean age of 67 years who smoked an average of 19 cigarettes per day completed the program. Sixty-six percent of participants had been treated or were in treatment for depression and/or anxiety. Follow-up was completed at 1, 3, 6, and 12 months. The cessation rate across follow-up points was 68%. This program shows that older adults can maintain smoking cessation when provided with programs designed to address their issues.     

Smoking, nicotine dependence and mental health among young adults: a 13-year population-based longitudinal study

Aims   To investigate prospectively the associations between daily smoking and nicotine dependence and anxiety, depression and suicide attempts.
Methods   Data were from the Young in Norway Longitudinal Study. A population-based sample ( n  = 1501) was followed for 13 years from ages 13–27 years. Data were gathered on smoking patterns and nicotine dependence; and depression, anxiety and parasuicide. Extensive information on socio-demographic factors, parental and family conditions, parental rearing practices, educational career, conduct problems, alcohol problems and use of illegal substances was also collected.
Results   Young adults who were nicotine-dependent had clearly elevated rates of anxiety, depression and parasuicide. These rates declined after controlling for a previous history of mental health problems and potential confounding factors. After adjustment, nicotine dependence was still associated with anxiety, depression and parasuicide. There was also a significant association with later depression in the group of non-dependent daily smokers. Measures of reduced mental health did not predict later smoking initiation or the development of nicotine dependence.
Conclusions   Mental health was reduced more seriously in nicotine-dependent smokers than in non-dependent smokers. These findings are consistent with the hypothesis that smoking, in particular nicotine dependence, influences mental health.     

Smoking cessation therapy with varenicline

Smoking cessation is the only available intervention proven to halt progression of chronic obstructive pulmonary disease (COPD). The authors discuss the current existing treatment modalities and the role of a newly approved agent, varenicline, in promotion of smoking cessation. Varenicline is a novel agent that is a centrally acting partial nicotinic acetylcholine receptor agonist. It has both agonistic and antagonistic properties that together are believed to account for reduction of craving and withdrawal as well as blocking the rewarding effects of smoking. Its targeted mechanism of action, better efficacy and tolerability makes varenicline a useful therapeutic option for smoking cessation. In this article, we discuss presently available options for smoking cessation and review the literature on efficacy of varenicline.     

Family Support and Employment as Predictors of Smoking Cessation Success: A Randomized,Double-Blind,Placebo-Controlled Trial of Nicotine Sublingual Tablets in Chinese Smokers

Background: The purpose of this study is to assess social support and demographic factors that influence the success of smoking cessation aided with sublingual nicotine tablets in a Han Chinese population. Methods: We randomly allocated 211 Beijing residents who smoked ≥ 10 cigarettes a day for at least 1 year into a double-blind, placebo-controlled 3-month randomized smoking cessation trial using sublingual nicotine replacement therapy (NRT). Self-reports of sustained smoking cessation were verified during the study by expired carbon monoxide concentrations and urine-cotinine concentrations. Logistic regression analysis used an intent to treat sample for sociodemographic associations with abstinence and reduction in smoking. Results: The abstinence rates at the end of treatment for NRT vs. placebo were 52 % vs .19%, and smoking reduction (reduced to at least 50% of baseline) rates for NRT vs. placebo were 43% vs .15% for a total response rate with NRT of 95% for either stopping completely or reducing smoking by 50%. The only factor strongly associatedwith successful smoking cessation after 3 months of sublingual NRT was being married (adjusted odds ratio 2.18; 95%confidence interval 1.10–4.33). Smoking association, on the other hand, was associated with being married and with employment as a white collar worker (2.24; 1.03 to 4.86). Conclusions: These findings suggest the need for a more in-depth examination of the impact of being married and employment as a white collar worker (rather than manual laborer) in order to develop better targeted interventions for improving smoking cessation interventions.     

Diagnosis and treatment of nicotine dependence with emphasis on nicotine replacement therapy. A status report.

Tobacco use is a global health care problem. Repetitive exposure to nicotine produces neuroadaptation resulting in nicotine dependence. Cigarette smoking is particularly addictive due to the repeated delivery of bolus doses of nicotine to the bloodstream. Although compulsive tobacco use is sustained by nicotine addiction, it is the toxic combustion products in tobacco smoke such as carbon monoxide and oxidant gases that adversely affect the cardiovascular system. Smoking cessation produces significant health benefits and is a very cost-effective intervention. Evidence that nicotine is the addictive component of tobacco provides the rationale for using nicotine replacement therapy to aid cessation. Nicotine replacement therapy doubles successful smoking cessation rates and evidence-based guidelines for the treatment of tobacco addiction recommend routine use of nicotine replacement therapy, particularly in heavily dependent smokers. Success rates of up to 40% can be achieved in specialist clinics. Despite early concerns regarding the safety of nicotine replacement therapy in smokers with heart disease, it is now clear that the health risks of using nicotine replacement therapy to assist such patients to stop, or significantly reduce, smoking far outweigh any treatment-related risks.     

Cessation of Smoking in Patients with Intermittent Claudication

ABSTRACT The effects of cessation of smoking were studied in 343 patients with intermittent claudication. One year after the initial examination 39 (11%) had stopped smoking and 304 (89%) continued to smoke. The outcome in these two groups was compared. They were comparable regarding baseline characteristics. Rest pain did not develop in any of the non-smokers. In smokers the cumulative proportion with rest pain was 16% after seven years (p<0.05). The cumulative proportions with myocardial infarctions after 10 years were 11 and 53%; the cumulative rates of cardiac deaths 6 and 43%; and the 10-year survival 82 and 46% among non-smokers and smokers, respectively. In multivariate Cox regression analyses the association between smoking and infarction (p<0.05) and cardiac death (p<0.05) was significant. The survival curves deviated and when they were compared after one year's follow-up the association between smoking and mortality was significant (p<0.05). The findings provide further evidence for the fact that it is of utmost importance that patients with intermittent claudication stop smoking.     

Smoking cessation in primary care clinics

OBJECTIVES: To document smoking cessation rates achieved by applying the 1996 Agency for Health Care Policy and Research (AHCPR) smoking cessation guidelines for primary care clinics, compare these quit rates with historical results, and determine if quit rates improve with an additional motivational intervention that includes education as well as spirometry and carbon monoxide measurements. DESIGN: Randomized clinical trial. SETTING: Two university-affiliated community primary care clinics. PATIENTS: Two hundred five smokers with routinely scheduled appointments. INTERVENTION: All smokers were given advice and support according to AHCPR guidelines. Half of the subjects received additional education with spirometry and carbon monoxide measurements. MEASUREMENTS AND MAIN RESULTS: Quit rate was evaluated at 9-month follow-up. Eleven percent of smokers were sustained quitters at follow-up. Sustained quit rate was no different for intervention and control groups (9% vs 14%; [OR] 0.6; 95% [CI] 0.2, 1.4). Nicotine replacement therapy was strongly associated with sustained cessation (OR 6.7; 95% CI 2.3, 19.6). Subjects without insurance were the least likely to use nicotine replacement therapy ( p =.05). Historical data from previously published studies showed that 2% of smokers quit following physician advice, and additional support similar to AHCPR guidelines increased the quit rate to 5%. CONCLUSIONS: The sustained smoking cessation rate achieved by following AHCPR guidelines was 11% at 9 months, which compares favorably with historical results. Additional education with spirometry did not improve the quit rate. Nicotine replacement therapy was the strongest predictor of cessation, yet was used infrequently owing to cost. These findings support the use of AHCPR guidelines in primary care clinics, but do not support routine spirometry for motivating patients similar to those studied here.     

Smoking cessation among inner-city African Americans unsing the nicotine transdermal patch

OBJECTIVE: To determine the efficacy of the transdermal nicotine patch for smoking cessation in inner-city African Americans. DESIGN: Double-blind, placebo-controlled, randomized trial. SETTING: Outpatient in an inner-city hospital. PATIENTS AND PARTICIPANTS: A computer-generated random numbers table with a block size set at 20 was used to randomize 410 patients to one of two study arms. INTERVENTIONS: The transdermal nicotine patch for 10 weeks as an adjunct to brief counseling. MEASUREMENTS AND MAIN RESULTS: Of the 410 patients randomized, mean age was 48 years, 65% were female, 41% had less than a high school education, 51% had an annual household income of less than $8,000, and the average number of cigarettes smoked per day was 20. Quit rates at 10 weeks were 21.5% (44/205) with the nicotine patch, and 13.7% (28/205) with the placebo patch (p=.03). At 6 months, quit rates were 17.1% (35/205) with the nicotine patch, and 11.7% (24/205) with the placebo patch (p=.08). After adjusting for baseline differences in age and educational attainment, differences remained significant at 10 weeks (p=.04), but were not significant at 6 months (p=.14). Compliance rates for return visits were 83%, 78%, 55%, and 52%, at 1, 2, 6, and 10 weeks, respectively. CONCLUSIONS: The nicotine patch significantly improves short-term quit rates in inner-city African Americans who are interested in trying to quit smoking. Efforts should be made to reach underserved populations through smoking cessation programs, and to assist in maintaining abstinence. Presented in part at the annual meeting of the Society of General Internal Medicine, San Giego, Calif., May 6, 1995. Supported by an American Cancer Society Career Development Award to Dr. Ahluwalia, an unrestricted grant from Marion Merrell Dow, Inc., and the Emory Medical Care Foundation.     

Weight change after smoking cessation using variable doses of transdermal nicotine replacement

OBJECTIVE: Examine weight change in subjects receiving variable doses of transdermal nicotine replacement for smoking cessation. DESIGN: Randomized, double-blind clinical trial. SETTING: One-week inpatient treatment with outpatient follow-up through 1 year. INTERVENTION: This report examines weight change after smoking cessation for 70 subjects randomized to placebo or to 11, 22, or 44 mg/d doses of transdermal nicotine. The study included 1 week of intensive inpatient treatment for nicotine dependence with active patch therapy continuing for another 7 weeks. Counseling sessions were provided weekly for the 8 weeks of patch therapy and with long-term follow-up visits at 3, 6, 9, and 12 months. MEASUREMENTS AND MAIN RESULTS: Forty-two subjects were confirmed biochemically (i.e., by expired carbon monoxide) to be nonsmokers at all weekly visits during patch therapy. Their 8-week weight change from baseline was 3.0±2.0 kg. For these subjects, 8-week weight change was found to be negatively correlated with percentage of cotinine replacement (r=−.38, p=.012) and positively correlated with baseline weight (r=0 .48, p=.001), and age (r=.35, p=.025). Men had higher (p=.003) 8-week weight gain (4.0±1.8 kg) than women (2.1±1.7 kg). Of the 21 subjects who abstained continuously for the entire year, 20 had their weight measured at 1-year follow-up. Among these 20 subjects, 1-year weight change was not found to be associated with gender, baseline weight, baseline smoking rate, total dose of transdermal nicotine, or average percentage of cotinine replacement during the 8 weeks of patch therapy. CONCLUSIONS: This study suggests that higher replacement levels of nicotine may delay postcessation weight gain. This effect is consistent for both men and women. We could not identify any factors that predict weight change with long-term abstinence from smoking. Presented at the American Society of Addiction Medicine 8th national conference on Nicotine Dependence, Toronto, Ont., Canada, October 12–15, 1995. Supported by a grant from Lederle Laboratories, Pearl River, NY.     

Randomized Controlled Trial of a Computer-Based,Tailored Intervention to Increase Smoking Cessation Counseling by Primary Care Physicians

OBJECTIVE: The primary care visit represents an important venue for intervening with a large population of smokers. However, physician adherence to the Smoking Cessation Clinical Guideline (5As) remains low. We evaluated the effectiveness of a computer-tailored intervention designed to increase smoking cessation counseling by primary care physicians. METHODS: Physicians and their patients were randomized to either intervention or control conditions. In addition to brief smoking cessation training, intervention physicians and patients received a one-page report that characterized the patients' smoking habit and history and offered tailored recommendations. Physician performance of the 5As was assessed via patient exit interviews. Quit rates and smoking behaviors were assessed 6 months postintervention via patient phone interviews. Intervention effects were tested in a sample of 70 physicians and 518 of their patients. Results were analyzed via generalized and mixed linear modeling controlling for clustering. MEASUREMENTS AND MAIN RESULTS: Intervention physicians exceeded controls on "Assess" (OR 5.06; 95% CI 3.22, 7.95), "Advise" (OR 2.79; 95% CI 1.70, 4.59), "Assist-set goals" (OR 4.31; 95% CI 2.59, 7.16), "Assist-provide written materials" (OR 5.14; 95% CI 2.60, 10.14), "Assist-provide referral" (OR 6.48; 95% CI 3.11, 13.49), "Assist-discuss medication" (OR 4.72;95% CI 2.90, 7.68), and "Arrange" (OR 8.14; 95% CI 3.98, 16.68), all p values being < 0.0001. Intervention patients were 1.77 (CI 0.94, 3.34,p = 0.078) times more likely than controls to be abstinent (12 versus 8%), a difference that approached, but did not reach statistical significance, and surpassed controls on number of days quit (18.4 versus 12.2, p < .05) but not on number of quit attempts. CONCLUSIONS: The use of a brief computer-tailored report improved physicians' implementation of the 5As and had a modest effect on patients' smoking behaviors 6 months postintervention.