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.     

Strategies for smoking cessation

Cigarette smoking is the leading preventable cause of death in the United States, accounting for more than 400,000 deaths annually. Recent advances in the treatment of smoking cessation and prevention of relapse offer promise to many smokers, especially vulnerable smokers such as those with coronary heart disease and other cardiovascular disease. Varenicline, a newly approved medication for smoking cessation, is a welcome addition to the clinician’s treatment arsenal. Other options for treatment include new uses of traditional nicotine replacement therapy (NRT), such as the simultaneous use of two forms of NRT or starting NRT prior to the quit-smoking date. A combination of pharmacologic and nonpharmacologic strategies is appropriate for most smokers and effectively doubles quit rates compared with rates in smokers who try to quit without the help of a clinician. Drawing appropriately from existing therapeutic options, the clinician should aim to treat smokers at all levels of interest in quitting.     

Perceived barriers to smoking cessation and perceptions of electronic cigarettes among persons living with HIV

Smoking is more prevalent in persons living with HIV than the general population and is linked to increased morbidity and mortality. Some have suggested that based on current knowledge of harms and benefits, it may be feasible to advise smokers who are unable or unwilling to quit to switch to electronic cigarettes (ECs) as a less harmful alternative. We conducted 25 qualitative interviews with HIV-positive current or former smokers to explore perceived barriers to smoking cessation and perceptions of ECs. A high level of nicotine dependence, smoking as a form of stress management, motivational factors (including lack of readiness, low self-efficacy, ambivalence toward quitting), and having a social network of smokers were identified as cessation barriers. Low knowledge of ECs and uncertainty about EC safety and efficacy were barriers to EC uptake. However, current smokers indicated a willingness to try ECs. This study provides evidence that HIV-positive smokers face significant individual and environmental barriers to cessation. ECs may have potential as a harm reduction strategy in this population; however, there is a significant need for education regarding use and relative safety.     

Effective treatment for smoking cessation

An effective method of cigarette smoking cessation using acupuncture is described. From May 1976 to December 1982, 514 patients were treated. Of 339 evaluable patients, 297 stopped smoking, for a success rate of 88 percent. In a two-year follow-up, the rate of relapse was 31 percent. The possible mechanisms by which this technique works are discussed.     

Community resources for smoking cessation

Cigarette smoking continues to be the single largest preventable cause of premature death in the United States. Unfortunately, smoking cessation rates in the United States have stalled despite the availability of effective smoking cessation treatments. Although community-based smoking cessation services delivered in person, via the phone, and via the Internet have been shown to be effective channels of intervention, few smokers actually use the services for smoking cessation treatment. Recent studies suggest that pursuing innovative strategies may lead to increased reach and a potential increase in cessation rates. As such, researchers and clinicians can take advantage of these strategies and programs to help promote smoking cessation resources that can be used to effectively treat nicotine dependence and ultimately reduce cardiovascular disease and cancer.     

Non-nicotine pharmacotherapies for smoking cessation

International chronic obstructive pulmonary disease guidelines recommend that smokers be strongly advised to quit, and should be offered help in doing so. The most effective smoking-cessation interventions combine behavioural support with pharmacotherapies. For smokers who do not wish to use nicotine replacement treatments, bupropion is a safe and effective non-nicotine alternative first-line treatment. Nortriptyline and clonidine have demonstrated efficacy in aiding smoking cessation, but are regarded as second-line therapies. A number of other non-nicotine treatments show promise, but more data are required before these can be recommended in assisting smokers to stop.     

Methods for smoking cessation.

Smoking cessation treatment consists of three phases: preparation, intervention, and maintenance (support and coping strategies). Although most people who quit smoking do so without going through a formal program, many people act on the advice of a health professional. Self-help techniques appear to be cost effective in terms of their minimal use of professionals. The popularity of hypnosis and acupuncture as quitting methods are not warranted by their quit rates. Quit rates can be improved if physicians provide more help to their patients than just simple advice and warnings.     

Public health initiatives for smoking cessation

The prevalence of adult smoking in the United States declined from 42.4% in 1965 to 20.9% in 2005. Much of the success in reducing the prevalence of adult smoking over the past four decades can be attributed to tobacco control policies. This paper provides an overview of public health initiatives for smoking cessation in the United States and provides a review of the existing literature on the effects of these tobacco control initiatives on adult smoking cessation.     

National programs for smoking cessation.

The smoking cessation effort has made tremendous progress since the 1964 Report of the Surgeon General described the health hazards of smoking. The impact of these efforts on smoking is particularly impressive when the current smoking level is compared with levels of smoking projected from trends apparent before that 1964 report, levels that might have been reached if there had been no national stop-smoking campaign. Because of the campaign, an estimated 35 million Americans were nonsmokers in 1985 who would otherwise have been smokers. If these figures are projected to the year 2000, the campaign will have postponed more than 2 million deaths. Therefore, reducing the prevalence of smoking in adults from about 40% in 1964 to 29% in 1987 can be considered a tremendous public health achievement. Among those who did take up smoking, there is also reason for some optimism. By 1987, more than 38 million Americans had quit smoking; this figure represents nearly half of all living adults who ever smoked. The 1990 Report of the Surgeon General gave a positive message to the 50 million Americans who continue to smoke by describing the health benefits of quitting for all the major smoking-related diseases.     

Modern medical support for smoking cessation

In view of the high morbidity and mortality associated with tobacco, smoking cessation is one of the most urgent medical challenges. It is effective when psychosocial support is combined with accompanying medication. In view of the associated rate of occurrence of cardiovascular diseases, COPD/emphysema as well as lung cancer, it is highly cost-effective. The nicotine replacement substances Bupropion and Varenicline used in smoking cessation therapies demonstrate a well-documented increase in effectiveness. Their use is not complicated. An increase in the overall cessation success rate by a factor of 2-3 is obtained when using an accompanying course of medication.     

Nursing strategies for smoking cessation.

The purpose of this article is to provide the staff nurse with an overview of the Agency for Health Care Policy and Research Smoking Cessation guidelines. The authors outline the practical components of the guidelines to enable nurses in any clinical setting to implement various smoking cessation strategies according to individual patient needs. Treatment options, including behavioral modification and a comprehensive review of pharmacological therapy, are discussed.