Increases in hyperactive-impulsive symptoms predict relapse among smokers in nicotine replacement therapy

Inattention and hyperactive–impulsive symptoms have been associated with nicotine dependence. In an open-label randomized trial (N = 454) of transdermal nicotine versus nicotine nasal spray, we examined whether increases in inattention and hyperactive–impulsive symptoms measured by self-report in the first quit week predicted relapse at the end of 8 weeks of treatment (EOT). During the first quit week, 166 (37%) participants reported an increase whereas 288 (63%) reported no change/decrease in total symptoms; changes were not influenced by treatment type. In a logistic regression model of abstinence, an increase in total symptoms in the first quit week significantly reduced odds of abstinence at EOT (continuous change score: OR = 0.94, 95% CI = 0.91–0.98, p = .002; dichotomized change score: OR = 0.57, 95% CI = 0.37–0.87, p = .009). Early increases in inattention and hyperactive–impulsive symptoms following quit date during nicotine replacement therapy predicted relapse to smoking, suggesting that treatments targeting these symptoms in the first quit week may facilitate abstinence.     

Naltrexone augments the effects of nicotine replacement therapy in female smokers

BACKGROUND: There is increased recognition that gender differences may influence outcomes and may modify vulnerability to tobacco addiction, severity of course and response to different treatments. We hypothesized that naltrexone, which has been used to successfully treat opioid and alcohol dependence, when combined with nicotine replacement therapy (NRT) and psychosocial therapy (PT) may enhance smoking cessation rates in women. METHODS: Forty-four adult female smokers meeting DSM-IV criteria for nicotine dependence with expired carbon monoxide content of > or = 15 ppm were randomly assigned in a double blind placebo controlled clinical trial of naltrexone 50 mg + NRT patch + psychosocial therapy (N + NRT + PT)(N = 12) or placebo + NRT patch + psychosocial therapy (P + N + PT)(N=12) for 12 weeks. RESULTS: Twelve weeks of treatment was completed by 54.5%. Smoking cessation among females who completed the 12 weeks for N + NRT + PT was 91.7% (11/12) and for P + NRT + PT was 50% (6/12). CONCLUSION: Naltrexone combined with NRT and psychosocial therapy appears to have a positive cessation effect on women and may be a new treatment option for recidivist female smokers.     

Adherence to nicotine replacement therapy versus quitting smoking among Chinese smokers: a preliminary investigation

Rationale There are over 300 million Chinese smokers, but use of nicotine replacement therapy (NRT) is rare. On the other hand, data on the factors associated with quitting and adherence to NRT use are scarce in the East.Objectives To describe adherence and other predictors of quitting smoking at the 12-month follow-up amongst Chinese smokers in Hong Kong.Methods Chinese smokers (1186) who attended the Smoking Cessation Health Centre from August 2000 through January 2002 were studied. Trained counsellors provided individual counselling and carried out follow-up interviews. We used structured questionnaires at baseline and at 1, 3 and 12 months and an intention-to-treat approach for analysis.Results Among those who received NRT (1051/1186), the prevalence of adherence (self-reported NRT use for at least 4 weeks) was 16% (95% confidence interval 14–18%). The 7-day point prevalence quit rate at 12 months (not smoking any cigarette during the past 7 days at the 12 month follow-up) was 27% (95% CI, CI 24–29%). Stepwise logistic regression model showed that adherence to NRT use, a higher income, good perceived health and having more confidence in quitting were significant predictors of quitting. The quit rate in the adherent group (40%) was greater than that of the non-adherent group (25%) (P<0.001). Older age, male, higher education, experience of NRT use, perceiving quitting as more difficult and willingness to pay were significant predictors of adherence.Conclusions Clinically significant smoking cessation rates can be achieved among Chinese smokers in a clinic-based smoking cessation service. The NRT adherence was low and low adherence was associated with a lower quit rate. Trials of interventions to improve adherence and increase quit rates are needed.Professor A.J. Hedley (Chair Professor, Department of Community Medicine, The University of Hong Kong; Former Chairman, Hong Kong Council on Smoking and Health, COSH), Professor T.H. Lam (Head, Department of Community Medicine, The University of Hong Kong; Vice Chairman, COSH), Dr. A.S. M Abdullah, (Director, Hong Kong Smoking Cessation Health Centre; Research Assistant Professor, Department of Community Medicine, The University of Hong Kong), Dr. S.C. Chan (Head, Department of Nursing Studies, The University of Hong Kong), Mr. Marcus Yu and Dr. Raymond LM Ho (Former and current Executive Director, COSH), Dr. W.L. Lo (Council Member, COSH), Mr. Alfred Chan (Former Senior Project Manager, COSH), Professor Edith Lau, (Professor, Department of Community and Family Medicine, Chinese University of Hong Kong; Council Member, COSH), Dr. J.L. Tang (Associate Professor, Department of Community and Family Medicine, Chinese University of Hong Kong), Dr. S.Y. Chan (Associate Professor, Department of Community and Family Medicine, Chinese University of Hong Kong), Dr. H.C. Ma (Chief Executive, Ruttonjee Hospital), Dr. C.W. Lam (Head of Respiratory Medicine, Ruttonjee Hospital), Dr. Y.K. Lau (Head of Cardiology Division, Ruttonjee Hospital).     

Stroke risk among menthol versus non-menthol cigarette smokers in the United States: Analysis of the National Health and Nutrition Examination Survey (NHANES)

Though available evidence is relatively consistent in showing no additional health effects among smokers due to menthol in cigarettes, two studies reported conflicting results for stroke risk using different subsets of NHANES data. We investigated reasons for the differences in these reports by analyzing NHANES cycles conducted between 1999 and 2012, combined and in subsets. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) from three different survey logistic regression models compare risk of reported stroke diagnoses among menthol and non-menthol cigarette smokers. Depending on timeframe, about 1150 to 8000 U.S. adults (aged ≥ 20 years) who smoked on ≥ 1 of the last 30 days had complete data for cigarette type and all covariates included in each model. Results were not much affected by which covariates were included in the models, but depended strongly on the NHANES cycles included in the analysis. Using NHANES 1999–2012 data combined, AORs and 95% CIs for stroke comparing menthol with non-menthol cigarette smokers were 0.95 (95% CI: 0.65, 1.37), 0.85 (95% CI: 0.59, 1.23) or 0.86 (95% CI: 0.59, 1.25). Collectively, findings illustrate the need for fully reporting research and analytical methods, especially when analyses are meant to develop evidence intended for regulatory decision-making.     

Long-term trends in drinking habits among Swedish teenagers: National School Surveys 1971-1999

The purpose of the study is to describe the long-term trends in drinking habits among Swedish students aged 15-16 years. Data were collected from 1971 to 1999, using self-administered questionnaires from nationally representative random cluster samples of school classes, totalling on average 6000 students per year.The highest proportion of alcohol consumers among both boys and girls, about 90%, was seen in the 1970s; this percentage decreased to about 80% in the 1980s and remained at that level through the 1990s. The estimated average annual consumption of pure alcohol was 4 litres for boys in 1977. It fell to 2.1 litres in 1988 and rose to 3.9 litres in 1999. The tendency was similar for girls, with 3.5 litres consumed in 1977, about 1.5 litres in the 1980s and 2.3 litres in 1999. Also frequent binge drinking and intoxication were reported by the largest proportions in the 1970s; the figures decreased in the 1980s and rose again among both boys and girls in the first part of the 1990s. Hence, although fewer of the students in this age group are alcohol consumers at the end of the 1990s compared with the 1970s, those who drink are approaching the high consumption levels of the 1970s. The beverages of choice are beer and spirits.     

Use of nicotine replacement therapy in situations involving temporary abstinence from smoking: A national survey of English smokers

Aims

This study aimed to assess the prevalence of nicotine replacement therapy (NRT) use in a range of situations involving temporary abstinence (TA), and the rated helpfulness of NRT. It also aimed to determine whether associations existed between reported helpfulness of NRT and use of NRT in different situations, with previous attempts to quit smoking and cigarette consumption.

Method

Smokers aged 16 + were interviewed in a national household survey in England. Participants were asked whether they used NRT (i.e. patch, gum, lozenges/tablets, inhalator (inhaler) and nasal spray) for TA in the office, at home, in a pub, restaurant and/or while travelling. Rated helpfulness of NRT and quit attempts in the previous 12 months were also assessed.

Results

Thirteen percent of smokers reported using NRT for TA. Forty-one percent of these used NRT at home, 40% while travelling, 22% in bars, 20% in an office and 16% in restaurants. The inhalator and patch received higher helpfulness ratings than the gum. The use of NRT in all situations was associated with increased odds of a previous attempt to quit smoking compared with smokers not using NRT for TA. Ratings of the helpfulness of NRT were not associated with either recent attempts to quit smoking or cigarette consumption.

Conclusion

One in eight smokers reported the use of NRT for TA. The most common occasions being the use at home and while travelling. Use of NRT in situations when one is unable to smoke may increase propensity to quit smoking regardless of the specific type of situation and whether NRT is rated by the smoker as helpful in that situation.     

The relationships between blood lead levels and serum follicle stimulating hormone and luteinizing hormone in the National Health and Nutrition Examination Survey 1999-2002

The relationships between blood lead levels and serum follicle stimulating hormone and luteinizing hormone were assessed in a nationally representative sample of women, 35-60 years old, from the National Health and Nutrition Examination Survey 1999-2002. The blood lead levels of the women ranged from 0.2 to 17.0 μg/dL. The estimated geometric mean was 1.4 μg/dL, and the estimated arithmetic mean was 1.6 μg/dL. As the blood lead level increased, the concentration of serum follicle stimulating hormone increased in post-menopausal women, women who had both ovaries removed, and pre-menopausal women. The concentration of luteinizing hormone increased as blood lead level increased in post-menopausal women and women who had both ovaries removed. The lowest concentrations of blood lead at which a relationship was detected were 0.9 μg/dL for follicle stimulating hormone and 3.2 μg/dL for luteinizing hormone. Lead may act directly or indirectly at ovarian and non-ovarian sites to increase the concentrations of follicle stimulating hormone and luteinizing hormone.     

Nicotine replacement therapy use among a cohort of smokers

BACKGROUND: Nicotine replacement therapy (NRT) has been shown to assist smokers to stop smoking in randomized trials, but little is known about its use in the general population. METHODS: As part of ongoing follow-up of a cohort established in 1989 in Washington County, Maryland, a questionnaire mailed in 1998 included a question about ever use of the two NRT products then available over-the-counter: nicotine gum and nicotine patch. This study reports on ever use of NRT among the 1,954 respondents who were current smokers in 1989 and subsequently provided data on NRT use and smoking habits in 1998. RESULTS: Overall, 36% of the smokers in 1989 had ever used NRT in some form by 1998; 10% used gum only, 16% used patch only, and 10% used both gum and patch. Number of cigarettes smoked per day at baseline was the strongest predictor of ever use of NRT (ptrend < 0.001). Compared to nonusers, ever users of NRT were more likely to have more than 12 years of education (p < 0.01) and be 25-54 years old at baseline (p < 0.001). When NRT use was assessed in relation to smoking status in 1998, 30% of NRT ever users compared to 39% of nonusers had quit smoking (p < 0.01). Among persistent smokers, the likelihood of reducing the number of cigarettes smoked per day was similar between NRT ever users (40%) and nonusers (41%). CONCLUSIONS: Ever use of NRT was common among this cohort of smokers, particularly among heavy smokers. Compared to nonusers, ever users of NRT were less likely to have stopped smoking and equally likely to cut down the frequency of smoking. This may reflect a tendency to turn to NRT for help after failing to quit by other means.     

Neurobehavioral test performance in the third National Health and Nutrition Examination Survey

The third National Health and Nutrition Examination Survey (NHANES III) contained three computerized neurobehavioral tests from the Neurobehavioral Evaluation System (NES): simple reaction time, symbol–digit substitution and serial digit learning. The neurobehavioral data that were collected came from a nationally representative sample of adults 20–59 years old. Performance on the tests was related to sex, age, education level, family income and race-ethnicity. Performance decreased as age increased, and increased as education level and family income increased. Differences in performance between sexes, levels of education and racial-ethnic groups tended to decrease as family income increased. The relationship between age and performance on the symbol–digit substitution test varied by education level and by racial-ethnic group. The relationship between age and performance on the serial digit learning test varied by racial-ethnic group. Questionnaire variables that were related to performance on one or more of the tests included the reported amount of last night's sleep, energy level, computer or video game familiarity, alcoholic beverages within the last 3 h and effort. Persons who took the tests in English or Spanish performed differently on the symbol–digit substitution and serial digit learning tests. Performance on all the tests decreased as test room temperature increased.     

Effects of high dose transdermal nicotine replacement in cigarette smokers

RATIONALE: Nicotine replacement therapies (NRT) have been evaluated to facilitate cigarette smoking reduction in smokers unwilling or unable to quit. In most of these studies, only conventional doses of NRT have been tested and higher doses may be required to result in significant reductions in smoking and in biomarkers of exposure. OBJECTIVE: To determine if higher NRT doses in conjunction with smoking are safe and may promote significant reductions in cigarette smoking and biomarkers of exposure. METHODS: A dose-ranging, within-subject design was implemented to evaluate the effects of 15, 30 and 45 mg nicotine-patch treatment on measures of safety and the extent of smoking reduction and biomarker exposure per cigarette in smokers (N=20 completers) not immediately interested in quitting. RESULTS: Concurrent smoking and NRT were generally tolerated and resulted in no changes in blood pressure or heart rate. Slightly less than 10% of the study sample was not given the highest dose of NRT due to side effects. Self-reported cigarette smoking decreased with increasing doses of nicotine replacement and significant reductions were observed for total NNAL (a carcinogen biomarker) and carbon monoxide. However, even at the 45 mg dose, increased carbon monoxide and total NNAL per cigarette occurred, even though cotinine levels increased on average, 69.3% from baseline. CONCLUSIONS: The present results suggest that the use of high dose NRT is safe, leads to significant reductions in smoking (-49%), significant but less reductions in total NNAL (-24%) and carbon monoxide (-37%) due to compensatory smoking.     

Lead and cognitive function in VDR genotypes in the third National Health and Nutrition Examination Survey

The relationship between the blood lead concentration and cognitive function in children and adults with different VDR genotypes who participated in the third National Health and Nutrition Examination Survey was investigated. The relationship between blood lead and serum homocysteine concentrations was also investigated. In children 12 to 16 years old, performance on the digit span and arithmetic tests as a function of the blood lead concentration varied by VDR rs2239185 and VDR rs731236 genotypes. Decreases in performance occurred in some genotypes, but not in others. In adults 20 to 59 years old, performance on the symbol-digit substitution test as a function of the blood lead concentration varied by VDR rs2239185–rs731236 haplotype. In the 12 to 16 year old children and adults 60 or more years old, the relationship between the serum homocysteine and blood lead concentrations varied by VDR genotype. The mean blood lead concentrations of the children and adults did not vary by VDR genotype.     

吸烟的危害与尼古丁替代疗法

吸烟是引起死亡的主要原因之一,全球每年有500余万人死于吸烟。它已成为严重的公共卫生问题。研究显示,烟雾中含有4000余种化合物,其中至少有43种为致癌物。长期吸烟可致多种疾病如癌症、肺气肿、心脏病及脏器损害,并可引起依赖性（成瘾）。依赖性主要由烟草含有的尼古丁所致。经常吸烟者大多对尼古丁成瘾。因此,经常吸烟者停止吸烟可出现尼古丁戒断症状,表现为烦躁、焦虑、头晕、头昏、头痛、失眠及注意力不集中。大多数吸烟者戒烟失败主要与尼古丁成瘾有关。鉴此,推出了尼古丁替代疗法（nicotine replacement therapy,NRT）。NRT是一种不经吸烟而使尼古丁缓慢进入体内的方法。该法不仅能消除或减轻尼古丁戒断症状,并且能避免吸烟的危害。研究结果表明,NRT能明显提高戒烟的成功率,而且其成瘾风险低。NRT常用制剂有咀嚼胶、贴剂、吸入剂、鼻喷剂等。这些制剂均能引起一些不良反应,反应的程度均较轻,但反应类型各制剂有所不同。NRT制剂可安全地用于心血管病患者。NRT不宜用于孕妇、乳母及未成年人。总之,NRT对吸烟者而言是一种安全有效的戒烟方法,NRT制剂在很多国家已作为OTC使用多年,值得推荐。     

Lead and cognitive function in ALAD genotypes in the third National Health and Nutrition Examination Survey

The relationship between the blood lead concentration and cognitive function in children and adults with different ALAD genotypes who participated in the third National Health and Nutrition Examination Survey was investigated. The relationship between blood lead and serum homocysteine concentrations was also investigated. In children 12 to 16 years old, no difference in the relationship between cognitive function and blood lead concentration between genotypes was found. In adults 20 to 59 years old, mean reaction time decreased as the blood lead concentration increased in the ALAD rs1800435 CC/CG group. This represents an improvement in performance. In adults 60 years and older, no difference in the relationship between cognitive function and blood lead concentration between genotypes was found. The serum homocysteine concentration increased as the blood lead concentration increased in adults 20 to 59 years old and 60 years and older, but there were no differences between genotypes. The mean blood lead concentration of children with the ALAD rs1800435 CC/CG genotype was less than that of children with the GG genotype.     

Postintervention effect of nicotine replacement therapy on smoking reduction in smokers who are unwilling to quit: randomized trial

The objective of this study was to assess the post-intervention effect of nicotine replacement therapy on reduction of cigarette consumption 1.5 years after the end of a 6-month treatment. Heavy smokers who had no intention of quitting smoking were recruited from the general population and were randomly assigned to a treatment of nicotine (choice of a 15-mg nicotine patch, a 4-mg nicotine gum, and/or a 10-mg nicotine inhaler, n = 265), matching placebo products (n = 269), or no intervention (n = 389). Products were sent to participants by mail. Education was limited to a booklet. Of 923 participants, 879 (95%) were followed 6 months after randomization and 846 (92%) were followed after 26 months. Mean baseline consumption was 30 cigarettes/day in all groups. After 6 months, cigarette consumption had decreased by a mean of 10.9 cigarettes/day in the nicotine group, 8.7 in the placebo group, and 4.9 among controls (P < or = 0.02 for all pairwise comparisons). After 26 months, compared with baseline, cigarette consumption had decreased by a mean of 9.8 cigarettes/day in the nicotine group, 7.7 in the placebo group, and 7.7 among controls (nicotine vs. placebo or control: P < or = 0.03). After 2 years, smoking cessation rates did not differ significantly among groups (nicotine 11.7%, placebo 9.3%, control, 10.0%; P = 0.6). Thus, a slight effect of nicotine replacement therapy on reduction of cigarette consumption was maintained 1.5 years after the end of the 6-month treatment, but the initially observed placebo effect was not maintained. Nicotine replacement therapy for smoking reduction had no deleterious impact on smoking cessation.     

Study of cardiovascular disease biomarkers among tobacco consumers. Part 3: evaluation and comparison with the US National Health and Nutrition Examination Survey

Abstract

Cardiovascular disease (CVD) biomarkers of biological effect (BoBE), including hematologic biomarkers, serum lipid-related biomarkers, other serum BoBE, and one physiological biomarker, were evaluated in adult cigarette smokers (SMK), smokeless tobacco consumers (STC), and non-consumers of tobacco (NTC). Data from adult males and females in the US National Health and Nutrition Examination Survey and a single site, cross-sectional study of healthy US males were analyzed and compared. Within normal clinical reference ranges, statistically significant differences were observed consistently for fibrinogen, C-reactive protein (CRP), hematocrit, mean cell volume, mean cell hemoglobin, hemoglobin, white blood cells, monocytes, lymphocytes, and neutrophils in comparisons between SMK and NTC; for CRP, white blood cells, monocytes, and lymphocytes in comparisons between SMK and STC; and for folate in comparisons with STC and NTC. Results provide evidence for differences in CVD BoBE associated with the use of different tobacco products, and provide evidence of a risk continuum among tobacco products and support for the concept of tobacco harm reduction.     

Perceived drug assignment and treatment outcome in smokers given nicotine patch therapy

This study assessed the relationship between treatment outcome and perceived drug assignment in smokers (nicotine patch [NP] or placebo) using abstinence and relapse status. Smokers (N = 424) were randomly assigned to receive either NP or placebo as part of a study that examined the effects of combining NP with self-help programs. Beliefs about drug assignment, assessed at the 12-month follow-up, were obtained from 384 participants. Beliefs were related to abstinence at the 2-month, p < .05, and 6-month follow-ups, p < .05, for the NP group, but not the placebo. Beliefs were not related to abstinence at 12 months for either group. Survival analysis assessing relapse revealed that beliefs were related to relapse status, regardless of actual group assignment. Our results suggest that there is a relationship between perceived drug assignment and treatment outcome. Future studies using multiple treatment outcome measures and assessments of beliefs over time are warranted.