Relationship between menthol cigarettes and smoking cessation among African American light smokers

AIMS: To determine whether African American light smokers who smoked menthol cigarettes had lower cessation when treated with nicotine replacement therapy and counseling. DESIGN: Data were derived from a clinical trial that assessed the efficacy of 2 mg nicotine gum (versus placebo) and counseling (motivational interviewing counseling versus Health Education) for smoking cessation among African American light smokers (smoked < or = 10 cigarettes per day). PARTICIPANTS: The sample consisted of 755 African American light smokers. MEASUREMENTS: The primary outcome variable was verified 7-day point-prevalence smoking cessation at 26 weeks follow-up. Verification was by salivary cotinine. FINDINGS: Compared to non-menthol smokers, menthol smokers were younger and less confident to quit smoking (P = 0.023). At 26 weeks post-randomization, 7-day verified abstinence rate was significantly lower for menthol smokers (11.2% versus 18.8% for non-menthol, P = 0.015). CONCLUSIONS: Among African American light smokers, use of menthol cigarettes is associated with lower smoking cessation rates. Because the majority of African American smokers use menthol cigarettes, a better understanding of the mechanism for this lower quit rate is needed.     

Ability of smokers to reduce their smoking and its association with future smoking cessation

Aims. We examined whether cigarette smokers in the United States can significantly reduce their smoking and maintain this reduction and, if so, whether this predicts an increase or decrease in the probability of smoking cessation in the future. Design. Longitudinal observation study. Setting. The 22 US cities of the Community Intervention Trial for smoking cessation (COMMIT). Participants. The 1410 subjects who smoked at both baseline and at 2-year follow-up. Intervention. Public health efforts to prompt cessation in half the communities. Measurements. Self-reported cigarettes/day and abstinence at baseline, 2-year and 4-year follow-ups. Findings. At 2-year follow-up. 60% of the subjects had either not changed or increased their smoking, 17% had decreased their smoking by 5-25%, 15% by 24-49% and 8% by 50%. Among the 40% who had reduced 5% at 2-year follow-up, 52% reported maintaining that reduction at 4-year follow-up. Reduction in smoking at year 2 did not prospectively predict an increase or decrease in the probability of making a quit attempt; nor did it predict eventually quitting by year 4. Conclusions. A substantial minority of US smokers are able to reduce their smoking and maintain this for long periods of time. Smoking reduction neither promotes nor undermines cessation.     

Relationship between weight change and the reduction or cessation of cigarette smoking

To determine the relationship between body weight and reduction or cessation of cigarette smoking, body weight and height as well as serum thiocyanate concentration were measured in 107 persons before and after participation in smoking-cessation programs. Body weight increased in only 67.3 percent of cases, but increases in body weight were associated with the greater reduction in cigarette consumption while the absence of weight gain was associated with a small reduction in cigarette consumption. Body weight increases after participation in the program were significantly (P less than 0.05) greater in men than in women despite the absence of a significant difference in the reduction of cigarette consumption between men and women. Analysis of variance failed to show a significant deviation from linearity in the significant relationship between reduction in tobacco consumption and increase in body weight. A number of variables assessed at entry into the study, such as age, age at starting smoking, cigarette consumption, initial body weight or anxiety level (Manifest Anxiety Scale) did not correlate with the change in weight in men or women. These data suggest that the most important determinant of weight gain is the amount of reduction in cigarette consumption and that there are important sex differences in response of body weight to reduction of tobacco consumption.     

Practical experiences in smoking reduction and cessation

Tobacco use is a major cause of cardiovascular, respiratory and oncological disease. Quitting smoking significantly benefits health, but for highly dependent smokers, unable to overcome their nicotine dependence, the concept of smoking reduction as a method of harm reduction is gaining ground. The University Hospital of Basle, Switzerland, has run double-blind, placebo-controlled smoking cessation and smoking reduction studies: the CEASE trial evaluated the efficacy of the nicotine patch in achieving abstinence, and the Rosette study is evaluating the efficacy and tolerability of the nicotine oral inhaler in smokers who do not wish to quit. Smokers were instructed either to quit smoking (CEASE) or to reduce cigarette consumption by > 50% (Rosette). In both studies, success rates for active treatment versus placebo at 4 months demonstrated that nicotine replacement therapy (NRT) is effective in achieving both smoking cessation and reduction. Current approaches to smoking cessation and reduction at our clinic are discussed. Combination NRT rather than monotherapy is commonly used to achieve both smoking reduction and cessation. Treatment appears to be most effective if subjects are allowed to select their preferred NRT product. There are clear differences in patient populations aiming to quit or reduce, the cessation population being more motivated. Smoking cessation remains the ultimate aim but, if unfeasible, a significant reduction in cigarette consumption is a valid goal.     

Predictors of smoking cessation in a sample of Italian smokers.

In this study we identify several pretreatment characteristics which predict abstinence at 6 months. Moreover, the persistence of withdrawal discomfort and of an increased frequency of night awakenings during the first month of abstinence, together with a tendency to "slip" during Weeks II-IV, strongly predicted relapse. Our results suggest that: 1) Predictors of outcome cannot be automatically extended from one cultural context to another; 2) a careful assessment of certain variables, made while the patient is still under treatment, provides significant prognostic hints; 3) ex-smokers' sleeping and dreaming function has been ignored by the literature, whereas they may well be involved into the maintenance of the drug-free state.     

Hospital- and clinic-based smoking cessation interventions for smokers with cardiovascular disease

Cigarette smoking is the leading preventable cause of death in the United States and a major risk factor for cardiovascular disease (CVD). Large observational epidemiologic studies conducted in diverse populations have demonstrated a strong association between smoking and CVD morbidity and mortality. Observational epidemiologic studies have also demonstrated a substantial benefit of smoking cessation on cardiovascular morbidity and mortality. Smoking cessation after myocardial infarction reduces subsequent cardiovascular mortality by nearly 50%. Therefore, the use of effective strategies to reduce the prevalence of tobacco use is a high priority for both the primary and secondary prevention of CVD. Effective smoking cessation interventions have been identified in randomized controlled trials in the general population of smokers. These methods, which include behavioral counseling and pharmacotherapy, are incorporated into clinical practice guidelines for physicians in the United States and Great Britain. A smaller but still substantial body of evidence demonstrates the efficacy of these interventions in hospital- and clinic-based settings for smokers with CVD. This evidence is sufficient to support the routine implementation of these smoking cessation methods in inpatient and outpatient settings for smokers with CVD. Copyright 2003, Elsevier Science (USA). All rights reserved.     

Smoking cessation rates in elderly and nonelderly smokers after participating in an intensive care smoking cessation camp

Since it is a widely known fact that smoking cessation is beneficial physically and cognitively, efforts should be made to enable smokers to quit smoking through policy. Intensive care smoking cessation camps generally show a high smoking cessation success rate, but research is needed to determine which smokers should be admitted due to costeffectiveness. Although many studies have been conducted to find factors related to smoking cessation success, there is still controversy about the will and success rate of smoking cessation of elderly smokers. We performed this study to determine behavior characteristics and smoking cessation success rates in nonelderly and elderly smokers who participated in an intensive care smoking cessation camp.Heavy smokers participating in an intensive care smoking cessation camp at Chonnam National University Hospital between the August 2015 and December 2017 were classified into elderly (age ≥65 years old) or nonelderly (age <65 years old) groups after excluding missing data. Smokers were followed up at 4 weeks, 6 weeks, 12 weeks, and 6 months from the start of abstinence by self-report, measurement of carbon monoxide expiration levels or cotinine testing.A total of 351 smokers were enrolled in the study. At the 6-month follow-up, 56 of 107 (52.3%) elderly smokers and 109 of 244 (44.7%) nonelderly smokers continued to abstain from smoking. Elderly smokers showed a higher smoking cessation rate than that of nonelderly smokers, but it was not statistically significant (OR = 1.36, 95%CI: 0.862, 2.145). The most common causes of cessation failure in both groups were stress and temptation, followed by withdrawal symptoms.Smoking cessation rates in the elderly are comparable to that in the nonelderly after an intensive care smoking cessation camp. Intensive care smoking cessation camps can help both elderly and nonelderly smokers who intend to quit smoking by providing motivation, education and medication. Smoking cessation should be strongly recommended regardless of age.     

The reduction of tuberculosis risks by smoking cessation

Background  

Smoking is known to aggravate tuberculosis (TB), but such information has been ignored in clinical practice, as it was not thought to be relevant. The aim of this study is to assess the benefits of smoking cessation on TB mortality reduction.     

Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease

PURPOSES: To compare an intensive smoking cessation intervention against usual care in hospitalized high-risk smokers with acute cardiovascular disease. METHODS: A total of 209 hospitalized smokers were randomized to the intensive intervention (n = 109) or to usual care (n = 100). Usual care consisted only of counseling and printed educational material provided prior to hospital discharge. Intensive treatment consisted of a minimum of 12 weeks of behavior modification counseling and individualized pharmacotherapy provided at no cost to the participant. Smoking status in all subjects was confirmed biochemically (ie, by measuring expired carbon monoxide) at 3, 6, 12, and 24 months after randomization. Outcomes included point prevalence and continuous abstinence smoking cessation rates, hospitalizations, and all-cause mortality. RESULTS: At each follow-up interval, point prevalence and continuous abstinence smoking cessation rates were significantly greater in the intensive-treatment group compared to the usual-care group. At 24 months, continuous abstinence smoking cessation rates were 33% in the intensive-treatment group and 9% in the usual-care group (p < 0.0001). Over the 2-year follow-up period, 41 patients in the usual-care group were hospitalized compared to 25 patients in the intensive-treatment group (relative risk reduction [RRR], 44%; 95% confidence interval [CI], 16 to 63%; p = 0.007). The all-cause mortality rate was 2.8% in the intensive-treatment group and 12.0% in the usual-care group (RRR, 77%; 95% CI, 27 to 93%; p = 0.014). The absolute risk reduction in mortality was 9.2% with a number needed to treat of 11. CONCLUSION: Hospitalized smokers, especially those with cardiovascular disease, should undergo treatment with a structured intensive cessation intervention. The duration of the initial treatment should be 3 months.     

Small airway function improvement after smoking cessation in smokers without airway obstruction

OBJECTIVE: Studying smokers with normal spirometry requires monitoring tools of the peripheral lung. A validated multiple breath washout technique was used to assess possible recovery of smoking-induced small airway malfunction in acinar and conductive lung zones. METHODS: Eighty-seven smokers with a smoking history of at least 10 pack-years but absence of spirometric airflow obstruction were invited for assessment of lung function and small airway function at baseline and after 1 wk, 3 mo, 6 mo, and 12 mo of smoking cessation. A control group of 16 persistent smokers was studied at the same time intervals. MEASUREMENTS AND MAIN RESULTS: Of the 87 smokers, 66, 32, 28, and 21% successfully ceased smoking for 1 wk, 3 mo, 6 mo, and 12 mo, respectively. Lung function parameters remained essentially unaffected by smoking cessation. Ventilation heterogeneity showed transient improvements after 1 wk in the acinar lung compartment with a return to baseline afterwards. By contrast, there were persistent improvements in the conductive airway compartment; for example, smokers who successfully quit smoking for 12 mo (n=18) showed a 30 and 42% reduction of conductive airways abnormality after 1 wk and 1 yr, respectively. CONCLUSIONS: Smokers with early signs of small airway malfunction who successfully quit smoking show sustained improvements of conductive airway malfunction. In contrast, acinar airway malfunction quickly returns to baseline after a transient improvement.     

Effects of smoking cessation on lung function and airway inflammation in smokers with asthma

RATIONALE: Active smoking in asthma is associated with worsening of symptoms, accelerated decline in lung function, and impaired response to corticosteroids. OBJECTIVES: To examine the short-term effects of smoking cessation on lung function, airway inflammation, and corticosteroid responsiveness in smokers with asthma. METHODS AND MEASUREMENTS: Smokers with asthma were given the option to quit or continue smoking. Both groups underwent spirometry and induced sputum at baseline and at 1, 3, and 6 wk. Cutaneous vasoconstrictor response to topical beclometasone, airway response to oral prednisolone, and sensitivity of peripheral blood lymphocytes to corticosteroids were measured before smoking cessation and at 6 wk. MAIN RESULTS: Of 32 subjects recruited, 11 opted to continue smoking (smoking control group). Of 21 subjects who opted for smoking cessation, 10 quit smoking for 6 wk (quit group). In the comparison of quitters with smokers at 6 wk, the mean (confidence interval [CI]) difference in FEV(1) was 407 ml (21, 793), p = 0.040, and the proportion of sputum neutrophils was reduced by 29 (51, 8), p = 0.039. Total cutaneous vasoconstrictor response score to topical beclometasone improved after smoking cessation with a mean (CI) difference of 3.56 (0.84, 6.28), p = 0.042, between quitters and smokers. There was no change in airway corticosteroid responses after smoking cessation. CONCLUSIONS: By 6 wk after smoking cessation, subjects who quit smoking had achieved considerable improvement in lung function and a fall in sputum neutrophil count compared with subjects who continued to smoke. These findings highlight the importance of smoking cessation in asthma.