Cigarette smoking and the risk of supraventricular and ventricular tachyarrhythmias in high-risk cardiac patients with implantable cardioverter defibrillators

Introduction: Nicotine elevates serum catecholamine concentration and is therefore potentially arrhythmogenic. However, the effect of cigarette smoking on arrhythmic risk in coronary heart disease patients is not well established.
Methods and Results: The risk of appropriate and inappropriate defibrillator therapy by smoking status was analyzed in 717 patients who received an implantable cardioverter defibrillator (ICD) in the Multicenter Automatic Defibrillator Implantation Trial-II. Compared with patients who had quit smoking before study entry (past smokers) and patients who had never smoked (never smokers), patients who continued smoking (current smokers) were significantly younger and generally had more favorable baseline clinical characteristics. Despite this, the adjusted hazard ratio (HR) for appropriate ICD therapy for fast ventricular tachycardia (at heart rates ≥180 b.p.m) or ventricular fibrillation was highest among current smokers  (HR = 2.11 [95% CI 1.11–3.99])  and intermediate among past smokers  (HR = 1.57 [95% CI 0.95–2.58])  , as compared with never smokers (P for trend = 0.02). Current smokers also exhibited a higher risk of inappropriate ICD shocks  (HR = 2.93 [95% CI 1.30–6.63])  than past  (HR = 1.91 [95% CI 0.97–3.77])  and never smokers (P for trend = 0.008).
Conclusions: In patients with ischemic left ventricular dysfunction, continued cigarette smoking is associated with a significant increase in the risk of life-threatening ventricular tachyarrhythmias and inappropriate ICD shocks induced by rapid supraventricular arrhythmias. Our findings stress the importance of complete smoking cessation in this high-risk population.     

A cohort study to examine whether time and risk preference is related to smoking cessation success

Aim   To identify whether time and risk preference predicts relapse among smokers trying to quit.
Design   A cohort study of smokers who had recently started to quit. Time and risk preference parameters were estimated using a discrete choice experiment (DCE).
Participants   A total of 689 smokers who began quitting smoking within the previous month.
Measurements   Time discount rate, coefficient of risk-aversion measured at study entry and duration of smoking cessation measured for 6 months.
Findings   In the unadjusted model, Cox's proportional hazard regression showed that those with a high time discount rate were more likely to relapse [hazard ratio: 1.18, 95% confidence interval (CI): 1.11–1.25]. A high coefficient of risk-aversion reduced the hazard of relapse (0.96, 0.96–0.97). When adjusted for other predictors of relapse (age, gender, self-efficacy of quitting, health status, mood variation, past quitting experience, the use of nicotine replacement therapy, nicotine dependence), the hazard ratios of time discount rate and the coefficient of risk-aversion is 1.17 (95% CI: 1.10–1.24) and 0.98 (95% CI: 0.97–0.99), respectively.
Conclusions   Those who emphasize future rewards (time–patient preference) and those who give more importance to rewards that are certain (higher risk-aversion) were significantly more likely to continue to abstain from smoking.     

A comparison of the effectiveness of group-based and pharmacy-led smoking cessation treatment in Glasgow

Aim   To compare the characteristics and outcomes of users accessing pharmacy and group-based smoking treatment.
Design   Observational study of administrative information linked with survey data.
Setting   Glasgow, Scotland.
Participants   A total of 1785 service users who set a quit date between March and May 2007.
Intervention   Smoking treatment services based in pharmacies providing one-to-one support, and in the community offering group support.
Measurements   Routine monitoring data included information about basic demographic characteristics, deprivation category of residence, nature of intervention and smoking status at 4-week follow-up determined by carbon monoxide (CO) readings ≤10. These data were supplemented by information about socio-economic status and smoking-related behaviours obtained from consenting service recipients by treatment advisers.
Findings   In the pharmacy-based service 18.6 % of users ( n  = 1374) were CO-validated as a quitter at 4 weeks, compared with 35.5 % ( n  = 411) in the group-based service. In a multivariate model, restricted to participants ( n  = 1366) with data allowing adjustment for socio-demographic and behavioural characteristics and including interaction terms, users who accessed the group-based services were almost twice as likely (odds ratio 1.980; confidence interval 1.50–2.62) as those who used pharmacy-based support to have quit smoking at 4-week follow-up.
Conclusions   Specialist-led group-based services appear to have higher quit rates than one-to-one services provided by pharmacies but the pharmacy services treat many more smokers. More research is needed to determine what can be done to bring the success rates of pharmacy services up to those of specialist-led groups and how to expand access to group-based services.     

Self-help smoking cessation interventions in pregnancy: a systematic review and meta-analysis

Aims   Self-help smoking cessation interventions for pregnant smokers are of importance due to their potential to be wide-reaching, low-cost and their appeal to pregnant smokers who are interested in quitting smoking. To date, however, there has been no systematic assessment of their efficacy. This systematic review aimed to assess the efficacy of self-help interventions for pregnant smokers and to investigate whether self-help material intensity, type or delivery are associated with cessation.
Methods   The literature was searched for randomized and quasi-randomized controlled trials of self-help smoking cessation interventions for pregnant smokers without significant cessation counselling. Fifteen trials met the inclusion criteria and relevant data were extracted independently.
Results   The primary meta-analysis pooled 12 trials comparing usual care (median quit rate 4.9%) with self-help (median quit rate 13.2%) and yielded a pooled odds ratio (OR) of 1.83 [95% confidence interval (CI) 1.23–2.73], indicating that self-help interventions on average nearly double the odds of quitting compared with standard care. However, a further meta-analysis failed to find evidence that intervention materials of greater intensity increase quitting significantly over materials of lesser intensity (pooled OR = 1.25, 95% CI 0.81–1.94). There was insufficient evidence to determine whether the tailoring of materials or levels of one-to-one contact were related to intervention efficacy.
Conclusions   Self-help interventions appear to be more effective than standard care although, due mainly to a lack of trials, it is unclear whether more sophisticated and intensive approaches increase intervention effectiveness.     

Smoking cessation patterns and predictors of quitting smoking among the Japanese general population: a 1-year follow-up study

Aim   To examine the percentage of Japanese adult smokers who make quit attempts and succeed in smoking cessation over a 1-year period, and to identify predictors of attempts to stop and successful smoking cessation.
Design and setting   This study used Ipsos JSR Company's access panel, whose sampling framework is based on the Basic Resident Register in Japan. We tracked and monitored a selected sample of smokers who were at least 20 years of age through a baseline postal questionnaire survey in 2005 and a follow-up survey 1 year later.
Participants   The original response rate was 72.1% (1874 of 2600 smokers). There were 1627 current smokers in the baseline survey, and of those, 1358 were followed-up 1 year later.
Findings   Among the current smokers, 23.0% reported that they had attempted to quit smoking at least once in the past year. Of those who made quit attempts, 25.6% had achieved 1-week abstinence successfully and 13.5% reported having achieved sustained 6-month abstinence successfully at the time of the follow-up survey. The predictors associated with quit attempts were non-daily smoker, higher motivation to quit and previous attempts to stop smoking. Among smokers who made quit attempts, only 13.5% used nicotine replacement therapy. Higher nicotine dependence was associated with lower probability of success in quitting.
Conclusions   Japanese smokers attempt to quit at a lower rate than smokers in the United Kingdom and United States, but factors that predict attempts (primarily markers of motivation) and success of attempts (primarily dependence) are similar to those found in western samples.     

Probabilities of alcohol high-risk drinking,abuse or dependence estimated on grounds of tobacco smoking and nicotine dependence

Aims  To estimate probabilities of alcohol high-risk drinking, alcohol abuse and alcohol dependence on grounds of smoking-behaviour related variables and single nicotine dependence criteria.
Design  Cross-sectional population-based study.
Setting  Adult population of a region in north Germany.
Participants  Cigarette smokers ( n  = 2437) among a random sample of 4075 females and males aged 18–64, drawn in 1996.
Measurement  Smoking, nicotine dependence according to the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV) and the Fagerström Test for Nicotine Dependence (FTND); increasing alcohol-related harm (ARH): high-risk drinking, DSM-IV alcohol abuse, remitted and current alcohol dependence diagnosed by the Composite International Diagnostic Interview (CIDI).
Findings  Having smoked 30 cigarettes or more per day, onset of smoking at the age of 17 or younger, nicotine dependence and single nicotine dependence criteria revealed odds ratios higher than 4.0 for alcohol dependence. For alcohol dependence, a logistic regression model showed an increased odds ratios for male gender, smoking for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems, craving for nicotine, withdrawal experience 1 day or longer, smoking first cigarette in the morning 5 minutes or less after waking. The probability of increasing ARH was more likely in males, smokers for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems and smoking first cigarette in the morning 5 minutes or less after waking.
Conclusions  Gender and single nicotine dependence criteria show particularly high probabilities of alcohol dependence and increasing ARH. Interventions need to take these connections into account.     

Cigarettes and social differentiation in France: is tobacco use increasingly concentrated among the poor?

Aims   This paper aimed to assess whether the increase of social differentiation of smoking is observed in France.
Design and setting   Five cross-sectional telephone surveys conducted in France between 2000 and 2007.
Participants   The surveys were conducted among national representative samples of French subjects aged 18–75 years ( n  = 12 256, n  = 2906, n  = 27 499, n  = 2887, n  = 6007 in 2000, 2003, 2005, 2006 and 2007, respectively). We focused on three groups: executives, manual workers and the unemployed.
Measurements   Time trends of smoking prevalence were assessed, and socio-economic factors (especially occupation and job status) associated with smoking were identified and compared in 2000 and 2005. We also computed respondents' equivalized household consumption (EHI) and their cigarette budget to assess the financial burden of smoking.
Findings   Between 2000 and 2007, smoking prevalence decreased by 22% among executive managers and professionals and by 11% among manual workers, and did not decrease among the unemployed. Indicators of an underprivileged social situation were associated more markedly with smoking in 2005 than in 2000. In addition, the falling-off of smoking initiation occurred later and was less marked among manual workers than it was among executive managers and professionals. Finally, in 2005 15% of French smokers devoted at least 20% of their EHI to the purchase of cigarettes, versus only 5% in 2000, and smoking weighted increasingly heavily on the poorest smokers' budgets.
Conclusions   While these results point out an increased social differentiation in tobacco use, they underline the need to design and implement other forms of action to encourage people to quit, in particular targeting individuals belonging to underprivileged groups.     

Varenicline in prevention of relapse to smoking: effect of quit pattern on response to extended treatment

Aim   While older behavioural and pharmacological approaches to preventing relapse to smoking show little efficacy, a recent randomized trial of an extended course of varenicline reported positive results. In this secondary analysis, trial data were examined to see whether smokers who manage to achieve abstinence only later in the original course of treatment are more likely to benefit from having the course extended.
Methods   A total of 1208 patients abstinent for at least the last week of 12 weeks' treatment with varenicline were randomized to 3 months continued varenicline or placebo. Overall, 44% of the 12-week abstainers were abstinent from the target quit date (TQD), while the rest stopped smoking later. We examined the relationship between quit pattern and the varenicline versus placebo difference in continuous abstinence rates at week 52 and contributions of baseline patient characteristics.
Results   With increasing delay in initial quitting, 12-month success rates declined. Participants who had their last cigarette at week 11 of open-label treatment had quit rates at 52 weeks of 5.7% compared with 54.9% in those who last smoked in week 1 [odds ratio (OR) 20.3 (6.3, 65.9); P  < 0.0001]. Patients who failed to initiate abstinence in the first week benefited more from extended treatment than patients continuously abstinent from week 1 [OR 1.7 (1.2, 2.4); P  = 0.0015 versus OR 1.1 (0.8, 1.5); P  = 0.6995, respectively; with the interaction of the quit pattern with treatment effect reaching borderline significance ( P  = 0.0494)]. No other patient characteristics were related to treatment effect.
Conclusions   Compared with smokers who quit smoking on their TQD, those who have an initial delay in achieving sustained abstinence have increased risk of relapse even several months later, and may be more likely to benefit from extended treatment with varenicline.     

Sex differences in the effects of stressful life events on changes in smoking status

Aims   Stressful life events known to be associated with substance use were examined to determine if there were sex-specific responses to stress resulting in changes in smoking status.
Participants and measurements   A community-based sample of ever smokers from the Americans' Changing Lives study ( n  = 1512, 45% female based on sample weights) was used to examine the interactive effects of sex and stressful life events on the likelihood of two outcomes; relapse among former smokers and failure to quit among current smokers. Logistic regression procedures were used to calculate odds ratios. Factors known to be associated with smoking status (e.g. depression, self-esteem, social support) were assessed as control variables.
Findings   In the sample of former smokers ( n  = 729) interpersonal loss events were associated with continued abstinence, whereas change of residence and adverse financial events were associated with increased occurrence of relapse. Women were more likely than men to relapse in response to a financial event. In the sample of current smokers ( n  = 783), financial events were associated with continued smoking, whereas health events were associated with increased likelihood of quitting. Women were more likely than men to continue smoking in the presence of an adverse financial event and less likely than men to quit in response to an adverse health event.
Conclusions   Overall, stressful life events appear to have a greater deleterious effect on continued abstinence and the ability to quit smoking for women when compared to men. In particular, health and financial events are important risk factors for women and tobacco use.     

Online support for smoking cessation: a systematic review of the literature

Aim   To examine the efficacy and acceptability of online, interactive interventions for smoking cessation and to identify treatment effect moderators and mediators.
Methods   A systematic review and meta-analysis of the literature (1990–2008) was conducted, finding 11 relevant randomized controlled trials. Data were extracted and risk ratios and risk differences estimated with a random effects model.
Results   There was no evidence of publication bias. Included trials were of variable methodological quality. Web-based, tailored, interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4–2.3] increasing 6-month abstinence by 17% (95% CI 12–21%). No overall effect of interactive compared with static web-based interventions was detected but there was significant heterogeneity, with one study obtaining a clear effect and another failing to find one. Few moderating or mediating factors were evaluated in studies and those that were had little effect. Pooled results suggest that only interventions aimed at smokers motivated to quit were effective (RR 1.3, 95% CI 1.0–1.7). Fully automated interventions increased smoking cessation rates (RR 1.4, 95% CI 1.0–2.0), but evidence was less clear-cut for non-automated interventions. Overall, the web-based interventions evaluated were considered to be acceptable and user satisfaction was generally high.
Conclusion   Interactive, web-based interventions for smoking cessation can be effective in aiding cessation. More research is needed to evaluate the relative efficacy of interactive web-based interventions compared with static websites.     

Parents who quit smoking and their adult children's smoking cessation: a 20-year follow-up study

Aims   Extending our earlier findings from a longitudinal cohort study, this study examines parents' early and late smoking cessation as predictors of their young adult children's smoking cessation.
Design   Parents' early smoking cessation status was assessed when their children were aged 8 years; parents' late smoking cessation was assessed when their children were aged 17 years. Young adult children's smoking cessation, of at least 6 months duration, was assessed at age 28 years.
Setting   Forty Washington State school districts.
Participants and measurements   Participants were 991 at least weekly smokers at age 17 whose parents were ever regular smokers and who also reported their smoking status at age 28. Questionnaire data were gathered on parents and their children (49% female and 91% Caucasian) in a longitudinal cohort (84% retention).
Findings   Among children who smoked daily at age 17, parents' quitting early (i.e. by the time their children were aged 8) was associated with a 1.7 times higher odds of these children quitting by age 28 compared to those whose parents did not quit [odds ratio (OR) 1.70; 95% confidence interval (CI) 1.23, 2.36]. Results were similar among children who smoked weekly at age 17 (OR 1.91; 95% CI 1.41, 2.58). There was a similar, but non-significant, pattern of results among those whose parents quit late.
Conclusions   Supporting our earlier findings, results suggest that parents' early smoking cessation has a long-term influence on their adult children's smoking cessation. Parents who smoke should be encouraged to quit when their children are young.     

Unplanned attempts to quit smoking: missed opportunities for health promotion?

Objectives   To investigate the occurrence, determinants and reported success of unplanned and planned attempts to quit smoking, and sources of support used in these attempts.
Design   Cross-sectional questionnaire survey of 3512 current and ex-smokers.
Setting   Twenty-four general practices in Nottinghamshire, UK.
Participants   Individuals who reported making a quit attempt within the last 6 months.
Measurements   Occurrence, triggers for, support used and success of planned and unplanned quit attempts.
Results   A total of 1805 (51.4%) participants returned completed questionnaires, reporting 394 quit attempts made within the previous 6 months of which 37% were unplanned. Males were significantly more likely to make an unplanned quit attempt [adjusted odds ratio (OR) 1.60, 95% confidence interval (CI) 1.04–2.46], but the occurrence of unplanned quit attempts did not differ significantly by socio-economic group or amount smoked. The most common triggers for unplanned quit attempts were advice from a general practitioner or health professional (27.9%) and health problems (24.5%). 5.4% and 4.1% of unplanned quit attempts used National Health Service cessation services on a one to one and group basis, respectively, and more than half (51.7%) were made without any support. Nevertheless, unplanned attempts were more likely to be reported to be successful (adjusted OR 2.01, 95% CI 1.23–3.27, P  < 0.01).
Conclusions   Unplanned quit attempts are common among smokers in all socio-demographic groups, are triggered commonly by advice from a health professional and are more likely to succeed; however, the majority of these unplanned attempts are unsupported. It is important to develop methods of providing behavioural and/or pharmacological support for these attempts, and determine whether these increase cessation rates still further.     

Overweight and perception of overweight as predictors of smokeless tobacco use and of cigarette smoking in a cohort of Swedish adolescents

Aims   To study the association between measured or perceived overweight in adolescence and subsequent uptake of cigarette smoking and of the Swedish smokeless tobacco 'snus' (oral moist snuff).
Design   Population-based prospective cohort study with 7 years' follow-up.
Setting   Self-administered questionnaires and school nurses' visits.
Participants   A total of 2922 children of both sexes and mean age 11.6 years at recruitment, resident in the Stockholm region, Sweden.
Measurements   Tobacco use was self-reported at baseline and on six subsequent surveys. Subjects' height and weight were measured by school nurses during the first 4 years, self-reported thereafter. Overweight perception was self-reported at the age of 15 years.
Findings   Overweight and perception of overweight were not associated with subsequent uptake of either smoking or snus among males. Among females, overweight at baseline was associated with uptake of smoking [adjusted hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.09–1.63], but not of snus. A similar pattern was found with overweight status during follow-up. Among girls with low-educated parents, overweight at baseline predicted the uptake of both snus and smoking. Among 15-year-old females who never used tobacco perceived overweight was associated with subsequent uptake of smoking (adjusted HR 1.71, 95% CI 1.20–2.46), but not of snus.
Conclusions   In Sweden, adolescent girls with actual or perceived overweight are at increased risk to start smoking, while indications that this increased risk applies to smokeless tobacco (snus) are limited to girls of low socio-economic status.     

Tobacco Industry Research on Smoking Cessation

BACKGROUND:  Smoking rates are declining in the United States, except for young adults (age 18 to 24). Few organized programs target smoking cessation specifically for young adults, except programs for pregnant women. In contrast, the tobacco industry has invested much time and money studying young adult smoking patterns. Some of these data are now available in documents released through litigation.
OBJECTIVE:  Review tobacco industry marketing research on smoking cessation to guide new interventions and improve clinical practice, particularly to address young adult smokers' needs.
METHODS:  Analysis of previously secret tobacco industry documents.
RESULTS:  Compared to their share of the smoking population, young adult smokers have the highest spontaneous quitting rates. About 10% to 30% of smokers want to quit; light smokers and brand switchers are more likely to try. Tobacco companies attempted to deter quitting by developing products that appeared to be less addictive or more socially acceptable. Contrary to consumer expectations, "ultra low tar" cigarette smokers were actually less likely to quit.
CONCLUSIONS:  Tobacco industry views of young adult quitting behavior contrast with clinical practice. Tobacco marketers concentrate on recapturing young quitters, while organized smoking cessation programs are primarily used by older smokers. As young people have both the greatest propensity to quit and the greatest potential benefits from smoking cessation, targeted programs for young adults are needed. Tobacco marketing data suggest that aspirational messages that decrease the social acceptability of smoking and support smoke-free environments resonate best with young adult smokers' motivations.     

The effect of retail cigarette pack displays on impulse purchase

AIMS: To assess the extent to which point-of purchase (POP) cigarette displays stimulate impulse purchases. DESIGN: Telephone-administered population survey. SETTING: Victoria, Australia. PARTICIPANTS: A total of 2996 adults, among whom 526 smoked factory-made cigarettes and 67 were recent quitters (quit in the past 12 months). MEASUREMENTS: Reported cigarette purchase behaviour; perceived effect on smoking of removing cigarettes from view in retail outlets; reported urges to buy cigarettes as a result of seeing the cigarette display. FINDINGS: When shopping for items other than cigarettes, 25.2% of smokers purchased cigarettes at least sometimes on impulse as a result of seeing the cigarette display. Thirty-eight per cent of smokers who had tried to quit in the past 12 months and 33.9% of recent quitters experienced an urge to buy cigarettes as a result of seeing the retail cigarette display. One in five smokers trying to quit and one in eight recent quitters avoided stores where they usually bought cigarettes in case they might be tempted to purchase them. Many smokers (31.4%) thought the removal of cigarette displays from stores would make it easier for them to quit. CONCLUSIONS: POP cigarette displays act as cues to smoke, even among those not explicitly intending to buy cigarettes, and those trying to avoid smoking. Effective POP marketing restrictions should encompass cigarette displays.     

The association between exposure to point-of-sale anti-smoking warnings and smokers' interest in quitting and quit attempts: findings from the International Tobacco Control Four Country Survey

Aims This study aimed to examine the associations between reported exposure to anti‐smoking warnings at the point‐of‐sale (POS) and smokers' interest in quitting and their subsequent quit attempts by comparing reactions in Australia where warnings are prominent to smokers in other countries. Design A prospective multi‐country cohort design was employed. Setting Australia, Canada, the United Kingdom and the United States. Participants A total of 21 613 adult smokers who completed at least one of the seven waves (2002–08) of the International Tobacco Control Four Country Survey were included in the analysis. Measurements Reported exposure to POS anti‐smoking warnings and smokers' interest in quitting at the same wave and quit attempts over the following year. Findings Compared to smokers in Canada, the United Kingdom and the United States, Australian smokers reported higher levels of awareness of POS anti‐smoking warnings, and this difference was consistent over the study period. Over waves in Australia (but not in the other three countries) there was a significantly positive association between reported exposure to POS anti‐smoking warnings and interest in quitting [adjusted odds ratio = 1.139, 95% confidence interval (CI) 1.039–1.249, P < 0.01] and prospective quit attempts (adjusted odds ratio = 1.216, 95% CI 1.114–1.327, P < 0.001) when controlling for demographics, smoking characteristics, overall salience of anti‐smoking information and awareness of anti‐smoking material from channels other than POS. Conclusions Point‐of‐sale health warnings about tobacco are more prominent in Australia than the United Kingdom, the United States or Canada and appear to act as a prompt to quitting.     

Varenicline for smoking cessation: A placebo-controlled, randomized study

Background and objective:   Varenicline tartrate, a novel, selective, nicotinic acetylcholine receptor partial agonist, has been developed specifically as a smoking cessation drug. This study evaluated the efficacy of a standard regimen of varenicline compared with placebo for smoking cessation in 333 subjects in China, Singapore and Thailand.
Methods:   This 24-week, randomized, double-blind, placebo-controlled trial of varenicline, 1 mg bd, consisted of a 12-week treatment period followed by a 12-week non-treatment follow-up period. The primary study end-point was the 4-week continuous abstinence rate defined as the proportion of subjects who reported total abstinence from smoking and other nicotine products from weeks 9–12. A key secondary end-point was the continuous abstinence rate from weeks 9–24, defined as the proportion of subjects who achieved the primary end-point as well as total abstinence from all tobacco products from weeks 13–24.
Results:   Both end-points were achieved by a significantly higher proportion of subjects in the varenicline group than in the placebo group. The 4-week continuous abstinence end-point was achieved by 50.3% and 31.6% in the varenicline and placebo groups, respectively ( P  = 0.0003), while continuous abstinence from weeks 9–24 was achieved by 38.2% and 25.0% of subjects, respectively ( P  = 0.0080). The treatment effect was generalizable by treatment centre and country. Varenicline was safe and appeared to be well tolerated by most subjects.
Conclusion:   Varenicline was significantly more efficacious for smoking cessation than placebo over a 12-week treatment period and a further 12-week non-treatment follow-up period in smokers from China, Singapore and Thailand. No significant side-effects were noted.     

Prevalence of alcohol use disorders and associated factors: a population-based study using AUDIT in southern Brazil

Aims   To assess the prevalence of potential alcohol use disorders and associated factors using the Alcohol Use Disorders Identification Test (AUDIT).
Design   Cross-sectional study.
Setting   A town in southern Brazil.
Participants   A representative sample of 1260 people aged 15 and over.
Measurements   Demographic, socioeconomic, smoking habit and mental health data were collected. Logistic regression was used in the multivariate analysis, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
Findings   Overall prevalence of alcohol use disorder was 7.9%, with 14.5% prevalence among men and 2.4% among women. The risk of alcohol misuse increased across social class ( P linear trend = 0.03) and compared with the highest classes (A and B), groups C through E had ORs of 1.48, 1.51 and 2.36, respectively. Males had an OR of 6.89 (CI 3.61–13.16) compared with women. A linear trend was found ( P  = 0.001) between smoking categories, and smokers (OR 3.27; CI 1.91–5.58) and ex-smokers (OR 1.30; CI 0.56–2.98) were at higher risk than non-smokers. Those with minor psychiatric disorders had a 2.48 OR (CI 1.35–4.56) of presenting a positive test.
Conclusions   The AUDIT detected a high prevalence of potential alcohol use disorders in the population sampled. Those identified are potential targets for preventive measures implemented through health policies.     

Association of tobacco dependence and quit attempt duration with Rasch-modeled withdrawal sensitivity using retrospective measures

Aim   To examine whether Rasch modeling would yield a unidimensional withdrawal sensitivity measure correlating with factors associated with successful smoking cessation.
Design   The psychometric Rasch modeling approach was applied to estimate an underlying latent construct (withdrawal sensitivity) in retrospective responses from 1644 smokers who reported quitting for 3 or more months at least once.
Setting   Web-based, passcode-controlled self-administered computerized questionnaire.
Participants   Randomly selected convenience sample of 1644 adult members of an e-mail invitation-only web panel drawn from consumer databases.
Measurements   Lifetime Tobacco Use Questionnaire, assessing tobacco use across the life-span, including demographics and respondent ratings of the severity of withdrawal symptoms experienced in respondents' first and most recent quit attempts lasting 3 or more months.
Findings   Rasch-modeled withdrawal sensitivity was generally unidimensional and was associated with longer periods of smoking cessation. One latent variable accounted for 74% of the variability in symptom scores. Rasch modeling with a single latent factor fitted withdrawal symptoms well, except for increased appetite, for which the fit was marginal. Demographic variables of education, gender and ethnicity were not related to changes in sensitivity. Correlates of greater withdrawal sensitivity in cessation attempts of at least 3 months included younger age at first quit attempt and indicators of tobacco dependence.
Conclusion   The relationship between tobacco dependence symptoms and Rasch-model withdrawal sensitivity defines further the relationship between sensitivity and dependence. The findings demonstrate the utility of modeling to create an individual-specific sensitivity measure as a tool for exploring the relationships among sensitivity, dependence and cessation.