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Anxiety sensitivity has been implicated as a potential risk factor for post-quit withdrawal symptoms. The present study examined relations between the extent of change in anxiety sensitivity and the course of nicotine withdrawal symptoms experienced during the initial two weeks of a quit attempt among treatment-seeking smokers. The sample consisted of 29 adult daily smokers (34% female; Mage = 47.7, SD = 13.1) who successfully quit and maintained their abstinence. After adjusting for the effects of gender, treatment condition, use of nicotine replacement therapy, nicotine dependence, alcohol use problems, baseline levels of anxiety sensitivity, and reductions in negative affect, greater reductions in anxiety sensitivity were related to faster decreases in withdrawal symptoms. The current data suggest that there may be merit to employ anxiety sensitivity reduction methods for the management of emergent withdrawal symptoms in smoking cessation treatment. [ABSTRACT FROM AUTHOR]

Few studies have evaluated treatment for co-occurring cannabis and tobacco use. The objective of this pilot study was to evaluate the feasibility and preliminary effectiveness of varenicline for co-occurring cannabis and tobacco use. Participants who reported cannabis use on ≥5 days per week were recruited from an urban, outpatient opioid treatment program (OTP). Participants were randomized to either four weeks of standard OTP clinical care (SCC; medication-assisted treatment for opioid use disorder and individual behavioral counseling), followed by four weeks of SCC plus varenicline (SCC+VT), or to four weeks of SCC+VT followed by four weeks of SCC. All participants contributed feasibility and outcome data during both study phases. Of 193 persons screened, seven were enrolled. Retention at eight weeks was 100%. No adverse effects prompted varenicline discontinuation. Participants reported lower cannabis craving during the SCC+VT phase compared to baseline, and lower frequencies and quantities of cannabis use compared to both baseline and the SCC alone phase. In the SCC+VT phase, participants also reported fewer cigarettes per day. Among persons with co-occurring cannabis and tobacco use, varenicline is well-tolerated and may reduce cannabis craving, cannabis use, and tobacco use. [ABSTRACT FROM AUTHOR]

Concurrent use of tobacco and alcohol or psychostimulants represents a major public health concern, with use of one substance influencing consumption of the other. Co-abuse of these drugs leads to substantial negative health outcomes, reduced cessation, and high economic costs, but the underlying mechanisms are poorly understood. Epidemiological data suggest that tobacco use during adolescence plays a particularly significant role. Adolescence is a sensitive period of development marked by major neurobiological maturation of brain regions critical for reward processing, learning and memory, and executive function. Nicotine exposure during this time produces a unique and long-lasting vulnerability to subsequent substance use, likely via actions at cholinergic, dopaminergic, and serotonergic systems. In this review, we discuss recent clinical and preclinical data examining the genetic factors and mechanisms underlying co-use of nicotine and alcohol or cocaine and amphetamines. We evaluate the critical role of nicotinic acetylcholine receptors throughout, and emphasize the dearth of preclinical studies assessing concurrent drug exposure. We stress important age and sex differences in drug responses, and highlight a brief, low-dose nicotine exposure paradigm that may better model early use of tobacco products. The escalating use of e-cigarettes among youth necessitates a closer look at the consequences of early adolescent nicotine exposure on subsequent alcohol and drug abuse. [ABSTRACT FROM PUBLISHER]

This paper summarizes The American Journal of Drug and Alcohol Abuse special issue and offers suggestions for future steps. People who use alcohol or other addictive substances are much more likely to use tobacco. Yet, clinicians and scientists have long regarded these addiction categories as separate and unrelated. The resultant benign neglect of tobacco use has had disastrous consequences on patients. This special issue is an important step toward remedying that situation. It has reviewed what is known and what more needs to be discovered regarding the co-occurrence of tobacco use disorder (TUD) and other substance use disorders (SUDs). The timing of this special issue occurs at a moment when smoking rates among both adults and youth are at a modern low. But not all segments of the population have benefited from this improvement. In particular, those with a SUD smoke two to four times the rate of the general population and thus suffer disproportionately from the myriad tobacco-induced diseases. The multi-disciplinary contributors to this special issue have reviewed various aspects of the co-occurring disorders. What emerges is a complex portrait. In some categories, the facts are stark, such as the strong association between SUDs and tobacco use and the toll they both extract. In others, such as the emerging new electronic nicotine delivery devices, there are intriguing associations that warrant further investigation. What is clear is that the historic schism between smoking and other addictions needs to be breached in order to improve the health of the public. This special issue should be viewed as a call to action for breaching that schism. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorders and tobacco use contribute significant risk to the global burden of disease, and each are major public health concerns. Together, alcohol and tobacco use are highly comorbid and have multiplicative health risks when used concurrently, underscoring the importance of examining alcohol-tobacco interactions in the human laboratory.Objective: The aims of this review were to summarize the state of research examining alcohol-tobacco interactions in the human laboratory.Methods: We reviewed human laboratory evidence for alcohol and tobacco/nicotine interactions, including 1) craving in drinkers and smokers exposed to smoking or drinking cues, 2) fixed-dosing of alcohol or nicotine in smokers and drinkers, and 3) smoking and alcohol influences on self-administration behaviors. The interactive effects of tobacco/nicotine with other drugs of abuse are also briefly discussed.Results: Overall, results identified that alcohol and tobacco have reciprocal influences on potentiating craving, subjective responses to fixed-dose alcohol or nicotine administration, and self-administration. The literature identified that alcohol increases craving to smoke, decreases time to initiate smoking, and increases smoking self-administration. Similarly, tobacco and nicotine increase alcohol craving, decrease subjective effects of alcohol, and increase alcohol consumption.Conclusion: Future studies should continue to focus on alcohol and tobacco/nicotine interactions in individuals with a wide scope of drinking and smoking histories, different states of alcohol and nicotine deprivation, and influences of either drug on craving, subjective responses, and consumption over the course of the blood alcohol curve. This work could have important implications for the impact of alcohol-tobacco interactions on guiding clinical practice, as well as in the changing landscape of addiction. [ABSTRACT FROM AUTHOR]

While the co-morbidity of alcohol (ethanol) and tobacco (nicotine) dependence is well described, the processes that underpin this strong connection are still under debate. With the increasing popularity of electronic cigarettes (e-cigarettes), it is now becoming more important to look to the neurobiological mechanisms involving alcohol and nicotine interactions to effectively treat a new generation of co-dependent individuals. Researchers have already recognized that the neuropathology produced by the combination of nicotine and ethanol is likely to produce an addictive nature very different to that of either one alone, and are employing a mixture of pre-clinical techniques to establish and investigate every stage in the development of both nicotine and ethanol-seeking behaviors. While it is agreed that multiple pathways orchestrate the complex reward profile of alcohol and nicotine co-addiction, several lines of evidence suggest the convergent site of action is within the mesolimbic dopaminergic system, at neuronal nicotinic acetylcholine receptors (nAChRs). A whole host of strategies are currently being employed to discover and unravel previously unknown or ill understood neurobiological processes in the brain, contributing greatly toward the development of novel pharmacotherapies with the aim of improving patient outcomes. This review intends to shed some light on the most influential and most recent pre-clinical work that is leading the charge in modeling this complicated relationship. [ABSTRACT FROM PUBLISHER]

Background: The increasing popularity of non-cigarette nicotine products, especially among youth, highlights the need for greater attention to their potential risks, including nicotine addiction and other substance use and addiction.Objectives: To examine the extent to which nicotine product use co-occurs with other substance use and addiction among youth and adults, describe the demographic groups and types of nicotine products associated with an increased risk of such co-occurrence, and discuss implications for research, prevention, clinical practice, and policy.Methods: Analyzing 2014 data from two nationally representative US surveys, the National Survey on Drug Use and Health (NSDUH) and the Monitoring the Future (MTF) study, we examined the co-occurrence between nicotine product use and alcohol and other drug use and addiction.Results: Individuals of all ages who reported using nicotine products of any kind were significantly more likely than nonusers to report alcohol, marijuana, other drug, and poly-substance use and to meet diagnostic criteria for a substance-use disorder. Users of multiple nicotine products generally were the most likely to engage in alcohol and other drug use and to be addicted to these other substances.Conclusions: The substantial co-occurrence of all forms of nicotine use and other substance use and addiction underscores the need to control the growing use of non-cigarette nicotine products among youth and to incorporate all forms of nicotine product use into substance use and addiction research, prevention, clinical practice, and policy efforts. [ABSTRACT FROM AUTHOR]

Background: Text2Quit, an interactive text-messaging program aimed at smoking cessation, has been shown to increase quit rates, but engagement has not been thoroughly explored. Understanding the program features associated with engagement and behavior change is integral for effective program design.Objectives: This study explored participants' interaction with the Text2Quit text-messaging program and associations between engagement and smoking cessation.Methods: The study included the 262 participants who received the Text2Quit intervention. Self-reported engagement measures, primarily usage of Text2Quit keywords and survey responses, were collected through computer records of participant use. Demographic variables and self-reported smoking abstinence were recorded in surveys at baseline and 6-month assessment.Results: The majority of participants (73%) maintained their subscription during the 6-month intervention. On average, participants received 210.51 text messages, 23.75 emails, and logged into the web portal 1.94 times. Being female was predictive of engagement with the program (β = 15.39). Program engagement, measured by the keyword PLEDGE (p = .002) and the Smokefree Status at 7 Days survey (p < .001) were associated with 6-month abstinence; use of keywords SMOKED (p < .001), RELAPSE (p = .007), and STOP (p = .023) were inversely related to abstinence. While abstainers (N = 83, 31%) stayed enrolled longer and engaged with the program more frequently, program "dose" was not predictive of smoking cessation.Conclusions: Using interactive tools such as pledges and reporting on smoking status were predictive of cessation. Further study of program features is required to understand how to optimally design text messaging programs. [ABSTRACT FROM AUTHOR]

Background: Tobacco is the leading cause of preventable death in the world. Current cessation medications include nicotine replacement therapy (NRT), varenicline, and bupropion, while combination therapy primarily entails NRT with either varenicline or bupropion. However, recent studies have examined varenicline and bupropion in combination.Objectives: A systematic review assessing the efficacy and safety of combination varenicline and bupropion was conducted.Methods: PubMed and Clinicaltrials.gov were searched using terms: “varenicline combination”, “bupropion combination”, “bupropion AND varenicline”, and “bupropion AND varenicline combination smoking cessation”, yielding four studies including 1193 total patients.Results: Combination therapy yielded greater efficacy than varenicline monotherapy in two randomized controlled trials and one retrospective outcomes study. One single-arm Phase II trial provided additional efficacy and safety data. Of the prospective trials, one displayed a greater 4-week smoking abstinence for weeks 8–11 with combination (39.8%) versus monotherapy (25.9%) (OR = 1.89; 95% CI = 1.07–3.35). The other demonstrated greater prolonged abstinence (continuous abstinence from week 2) at 12 weeks (OR = 1.49; 95% CI = 1.05–2.12) and 26 weeks (OR = 1.52; 95% CI = 1.04–2.22), though results were not significant at 52 weeks in this study. The retrospective study displayed higher success rates (continuous abstinence rates at 52 weeks) with combination varenicline and bupropion (55.0%; compared to varenicline monotherapy (32.1%),p< 0.001). Subgroup analyses suggest that this combination may be more beneficial in males and patients with higher baseline nicotine dependence.Conclusion: To the authors’ knowledge, this is the first review conducted to compile current literature on this novel pharmacotherapy combination for smoking cessation. Combination bupropion SR and varenicline displayed greater efficacy in smoking cessation than varenicline monotherapy, though further safety analysis is warranted to rule out additive psychiatric adverse effects. [ABSTRACT FROM PUBLISHER]

Studies that investigate time-based complex prospective memory (PM) functioning in participants with substance use disorders (SUD) in consideration of different PM-phases (planning, retention, initiation, execution) are lacking. This study was designed to investigate performance of young adults with DSM-5 tobacco use disorder (TUD) and healthy controls (HC) in different phases of complex PM. Community participants aged 18–35 (N = 43) completed the modified Six Elements Test that includes the PM-phases planning, retention, initiation, and execution of a time-based complex PM-task (with delay phases and background activities). TUD participants were current daily smokers and fulfilled at least two DSM-5 TUD criteria. TUD did not differ significantly from HC in task planning errors and timely task initiation. No group differences showed in rule adherence and completeness during task conduction (execution). During execution, TUD showed significantly more deviations (Coef. 0.45; p = 0.005) from their originally remembered plans than HC. Young adults with relatively mild TUD do not show general impairments in all phases of short-term, complex, and time-based PM. Future research may investigate whether a greater risk of deviation from originally remembered plans in TUD could play a role in the progression and cessation of smoking behavior. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUDs) are prevalent among veteran populations. Adjunctive treatments for SUDs are warranted for many reasons, including high relapse rates. Physical exercise has broad health benefits as well as mood-enhancing, anxiolytic, and withdrawal-reducing effects, but veterans with SUDs report low rates of regular exercise. Evaluating exercise-based interventions that incorporate evidence-based behavior change strategies tailored to meet the unique needs of veterans with SUDs is warranted. This article describes the formative research conducted to evaluate the following information among veterans receiving treatment for SUDs: (1) interest in an adjunctive exercise program to supplement their current SUD treatment; and (2) exercise program design considerations. A survey and small group interviews were conducted to obtain both quantitative and qualitative data. Results suggested that veterans with SUDs are interested in exercise, and participants provided perceptive suggestions for modifying an existing evidence-based program. These findings will be used to design an exercise-based treatment program tailored specifically for veterans with SUDs. [ABSTRACT FROM AUTHOR]

Background: Varenicline has been shown to reduce cigarette craving during a quit attempt. Objectives: Use BOLD fMRI to explore differences in smoking cue reactivity at baseline and after five weeks of varenicline smoking cessation treatment. Methods: Treatment-seeking nicotine-dependent adult smokers underwent BOLD fMRI scans with block presentation of visual smoking, neutral, and rest cues under two conditions: craving or resisting the urge to smoke at baseline and following 5 weeks of standard varenicline therapy. Data were analyzed using FMRI Expert Analysis Tool, version 5.98 of Functional Magnetic Imaging of the Brain Software Library focused on the smoking vs. neutral cue contrast at the individual and group level, Z>2.3 with cluster threshold p=0.05. Results: Twenty-one participants were scanned at baseline and 16 completed the study; 10 were abstinent at the 2nd session, confirmed with urinary cotinine. In the Crave Condition no significant differences were found between the abstinent and non-abstinent groups at either time point. During the baseline Resist Condition, the abstinent group compared to the non-abstinent group demonstrated activation in a distributed network involved in alertness, learning and memory. Additionally, within the abstinent group, increased activation of the superior frontal gyrus was found at baseline compared to week 5. Conclusion: Successful smoking cessation with varenicline is associated with increased activation, prior to a quit attempt, in brain areas related to attentiveness and memory while resisting the urge to smoke Scientific Significance: Varenicline may exert effects by both reducing craving and enhancing resistance to smoking urges during cue-elicited craving. [ABSTRACT FROM AUTHOR]

Background. Tobacco reduction is a major priority in Canadian Inuit communities. However, many Inuit frontline health workers lacked the knowledge, confidence and support to address the tobacco epidemic. Given vast distances, high costs of face-to-face training and previous successful pilots using distance education, this method was chosen for a national tobacco reduction course. Objective. To provide distance education about tobacco reduction to at least 25 frontline health workers from all Inuit regions of Canada. Design. Promising practices globally were assessed in a literature survey. The National Inuit Tobacco Task Group guided the project. Participants were selected from across Inuit Nunangat. They chose a focus from a "menu" of 6 course options, completed a pre-test to assess individual learning needs and chose which community project(s) to complete. Course materials were mailed, and trainers provided intensive, individualized support through telephone, fax and e-mail. The course ended with an open-book post-test. Follow-up support continued for several months post-training. Results. Of the 30 participants, 27 (90%) completed the course. The mean pre-test score was 72% (range: 38-98%). As the post-test was done using open books, everyone scored 100%, with a mean improvement of 28% (range: 2-62%). Conclusions. Although it was often challenging to contact participants through phone, a distance education approach was very practical in a northern context. Learning is more concrete when it happens in a real-life context. As long as adequate support is provided, we recommend individualized distance education to others working in circumpolar regions. [ABSTRACT FROM AUTHOR]

Although several studies of highly developed countries find tobacco control efforts impact obesity rates, whether such results extend to less developed countries is unclear. Accordingly, this study re-examines this issue by using data from countries that lie across the development spectrum. Similar to the existing literature, evidence suggests higher cigarette prices increase the per cent of the population that is overweight or obese. Yet, other tobacco control efforts have less influence. A number of other factors, including health-care expenditure, urban concentration and undernourishment, are also found to influence population weight. [ABSTRACT FROM AUTHOR]

Context: Nicotine, a bioactive component of tobacco, is highly addictive. Numerous therapies have been developed or are currently under investigation for smoking cessation, and all have met with limited success and/or side effects, indicating the need for additional therapies. Objective: This study examines the ability of a commerically-available aqueous extract of Passiflora incarnata Linn. ( Passifloraceae) to ameliorate the signs of nicotine sensitization using a rat model. Materials and methods: Rats were administered 0.4 mg/kg nicotine or vehicle once a day for four consecutive days. Nicotine adminstration produces sensitization of locomotor activity, a phenomenon implicated in the development of nicotine dependence. On the fifth day, locomotor activity of the subjects was monitored as rats from each treatment group were administered 800 mg/kg of Passiflora incarnata extract (or its vehicle) followed by a challenge dose of 0.4 mg/kg nicotine. Results: When given to rats sensitized to nicotine for 4 days, the challenge dose of nicotine increased locomotor activity by more than 2-fold over activity following nicotine challenge in rats treated with vehicle during the sensitization phase. The difference was significant from 15-40 min after nicotine administration. Rats sensitized to nicotine then treated with Passiflora incarnata extract prior to the nicotine challenge exhibited a level of locomotor activity the same as the vehicle-treated controls. Discussion: Passiflora incarnata extract did antagonize the expression of nicotine locomotor sensitization. Conclusion: Passiflora incarnata extract should be examined in future studies to evaluate its potential for treating nicotine addiction in humans. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the largest single cause of death among people with severe mental disorders, such as schizophrenia and bipolar disorder. Smoking rates are very high among people with severe mental disorders, considerably increasing their risk of CVD. In addition, many people with such disorders also suffer from obesity related to inactivity, unhealthy diets, excessive alcohol consumption and some psychiatric medications. Despite increasing recognition of the widespread impact that smoking and other unhealthy behaviours have on increased morbidity and mortality, treatment of physical health problems is often neglected among people with severe mental disorders. Research evaluating interventions seeking to change multiple health behaviours indicates that these are feasible and effective. In this context, studies evaluating the effectiveness of a multi-component healthy lifestyle intervention for smoking and CVD risk behaviours among people with severe mental disorders are needed. A healthy lifestyles intervention is described. [ABSTRACT FROM AUTHOR]

This study evaluates the effectiveness of a smoking cessation course tailored to meet the needs of the lesbian, gay, bisexual, and transgender (LGBT) community. Of the 44 individuals who participated, 36 were in attendance in the final class, and 88.9% of those had successfully quit smoking. The study found an increase in importance to having cessation classes in gay-identified contexts, high ratings of the cultural appropriateness of the course content, and decreasing anxiety across the classes. Participants' assessment of their health shifted differentially based on whether they were successful at quitting. [ABSTRACT FROM AUTHOR]

Annually, tobacco-related illnesses claim the lives of millions of women worldwide. Women have more difficulty in quitting than men, and smokers in general are more physically inactive than nonsmokers-further contributing to morbidity and mortality. Exercise represents a treatment option that may be particularly suitable for women trying to quit smoking. It may address several known barriers to cessation by promoting emotional well-being and maintenance of healthy body weight and by providing a socially supportive environment. Further, exercise participation is inversely related to other cardiovascular risk factors. Currently, there is a paucity of research testing the effectiveness of exercise as an aid for smoking cessation. Methodological flaws have plagued many of these studies and adherence to exercise interventions has been poor. This paper reviews effectiveness of exercise in treating tobacco dependence in women, including findings from published and ongoing clinical trials. Consequently, several relationships and hypothesized mechanisms between exercise and smoking cessation are discussed. Given the widely established benefits of exercise on women's health, and lack of adequate exercise trials for women smokers, further research is warranted regarding the potential role of exercise as treatment and the harm reduction intervention in the field of tobacco dependence. [ABSTRACT FROM AUTHOR]

Client questionnaires from 38 gender-specific substance abuse facilities throughout Ohio were analyzed to explore smoking prevalence, quit attempts, and readiness to quit cigarette use. The analysis revealed 79.7% of women used cigarettes at the time of the survey, 33.5% of current smokers had made at least one quit attempt within the past 12 months, and 55.2% of current smokers reported either contemplating or preparing to make a quit attempt. A multinomial logistic regression revealed that clients who experienced a past quit attempt were more likely to be in the contemplation and preparation stages and clients who smoked 30 out of the past 30 days were least likely to be in the preparation stage. Clients who reported smoking between 10-15 cigarettes a day were more likely to be in the contemplation stage than those who reported smoking <10 cigarettes a day. A three-pronged approach that examines the physiological, emotional, and social components of addiction is recommended. [ABSTRACT FROM AUTHOR]

Much research has documented the significant influence of self-efficacy on smoking cessation, but considerably less is known as to what health communicators can do to promote or address barriers to self-efficacy. This study investigated personal, social, and cultural correlates of smoking self-efficacy. A survey of college smokers was done in South Korea, where the current smoking rate among males is over 56%. At the personal level, the perceived successfulness of the last quit trial positively predicted self-efficacy. At the social level, interpersonal communication with friends was positively associated with self-efficacy. The cultural orientation of independent self-construal was positively associated with self-efficacy. These results indicate that factors affecting smokers' self-efficacy are operative in multiple domains and levels. Future communication programs should promote positive perceptions about prior quit trials, and segment the audience in terms of their self-construal to effectively enhance self-efficacy. [ABSTRACT FROM AUTHOR]

Modern neuroimaging techniques offer the opportunity to noninvasively study neuroanatomical and neurofunctional correlates of nicotine dependence and its treatment. In the present review, the most widely used neuroimaging techniques—magnetic resonance imaging (MRI), positron emission tomography, and functional MRI—are briefly described and their strengths and limitations discussed. The use of these techniques has resulted in new insights into the neuropharmacology of tobacco addiction. Studies comparing smokers and nonsmokers have shown that smokers have less grey matter density in frontal brain regions and greater concentrations of nicotinic receptors. Research on the effects of smoking a cigarette confirms that smoking leads to the release of dopamine in brain reward areas and to nicotinic receptor binding. Studies of smoking abstinence have identified functional brain correlates of increased reactivity to smoking-related cues, and worsening of concentration. To date, neuroimaging studies of nicotine dependence among individuals with mental illness have focused almost exclusively on schizophrenia. A conceptual/methodological framework for studying dual diagnosis using neuroimaging measures is provided, with the aim of spurring additional research in this area. [ABSTRACT FROM AUTHOR]

We sought to determine whether different social, psychological, emotional, and physiological experiences associated with quitting smoking related to people's satisfaction with cessation systematically, and whether the strength of the relations changes at different points during the cessation process and for different people (e.g., optimists). Using data from smokers enrolled in a cessation program, we used mixed models to assess the average longitudinal relation between people's experiences and satisfaction measured at seven time points and whether the relations were moderated by key variables. Eight of nine experiences were related to people's satisfaction (ps < 0.05) and the models accounted for 39-44% of the within-person variance in satisfaction. Current smoking behavior was more strongly related to people's satisfaction during their early efforts to quit, whereas some experiences (e.g., feedback from others) had a stronger relation with satisfaction during people's later efforts to quit or maintain abstinence (ps < 0.05). Individual differences in optimism and prior cessation experience moderated some of the relations (ps < 0.05). The findings mark the first evidence of factors that might influence how people determine their satisfaction with smoking cessation. The implications for tailoring interventions and potentially increasing the likelihood that people maintain abstinence are discussed. [ABSTRACT FROM AUTHOR]

Smoking cessation clinics based in doctors' surgeries are considered a cost effective means of improving health by helping people to quit smoking. This exploratory study was prompted by the observation in one GP practice that the non-attendance at first appointments was high, possibly owing to inappropriate referrals. A screening questionnaire was devised by a multidisciplinary team and given to patients requesting an appointment with the Stop Smoking Service (SSS). Appointments or brief phone intervention were given based on the responses. The main outcome measure was the proportion of missed first appointments (DNA rate). Audit figures from a practice with a similar record concerning their SSS were used for comparison. The findings showed that the practice using the questionnaire had a decreased DNA rate over the study period compared with the previous 6 month and 12 month periods whilst that of the control practice increased. The difference did not reach statistical significance, possibly due to the small and unequal numbers involved. The reduction in DNAs was, however, considered a clinically significant improvement to the efficiency of the service. A larger study is required to test generalisability of any effect of using a screening questionnaire and to ascertain whether it can predict likelihood of a successful quit attempt. [ABSTRACT FROM AUTHOR]

Two hundred eight psychiatrically complex military veterans (97% male; n = 201) were recruited as part of a study investigating the differential efficacy of three brief (one-session) motivational interviewing (MI) interventions to yield changes in smoking behavior. Participants were randomly assigned to one of three MI interventions:MI alone, MI plus breathing instruction, or MI plus incentive spirometry (a tool for feedback about lung function and an inexpensive form of biofeedback. Results suggested that smoking behavior, measured by self-reported number of cigarettes per day and confirmed by expired carbon monoxide levels, decreased across groups over time. However, there were no differences among treatment conditions on cigarettes per day or measures of tobacco dependence. Implications for harm reduction in this challenging population are discussed. [ABSTRACT FROM AUTHOR]

Data on the perceived sources of cessation information and the reasons why alternative school students would attend a smoking cessation program were collected from 302 students at an alternative high school who were surveyed through the Safer Decisions Program in Houston, Texas. Data collection took place between September 2006 and January 2007. Logistic regression identified that non-smokers were more likely to believe it was important to receive cessation information from doctors (4.93 adjusted odds ratio [AOR]; 95% confidence interval [CI]= 1.96; 12.40), health educators (4.70 AOR; 95% CI = 1.46; 15.10), people who have been affected by smoking (3.20 AOR; 95% CI= 1.04; 9.80), teachers (2.73 AOR; 95% CI = 1.3; 5.60), and celebrities (2.44 AOR; 95% CI = 1.21; 4.92) compared to smokers. In addition, persons who had smoked in the past 30 days were twice as likely to report embarrassment (1.86 AOR; 95% CI = 1.00; 3.44) and feel that it was not right to smoke (2.24 AOR; 95% CI = 1.00; 5.00) compared to respondents who had not smoked during the past 30 days. While the relationships tested in this study are exploratory, they provide initial evidence for understanding the importance of smoking cessation recruitment strategies that may impact minority alternative school youth. [ABSTRACT FROM AUTHOR]

Tobacco dependence is common among Korean American men and yet, there have been few reports or studies on treating this population. They may have difficulty accessing existing smoking cessation treatment programs because of both language and cultural barriers. This case report describes a clinical tobacco dependence treatment program (the Korean Smoking Cessation Class Program) that was developed specifically for Korean Americans. Supportive group therapy was offered with brief individual counseling along with pharmacotherapy. Twenty-six individuals (25 men and 1 woman) attended, and 19 (73%) completed the 8-week program. Of the completers, 13 (68%) reported abstinence at the end of the program. This care report summarizes the clinicans' perceptions of what worked in this pilot program and suggest helpful strategies for tobacco dependence treatment for this population. [ABSTRACT FROM AUTHOR]

The efficacy of behavioral treatment for smoking cessation is clear, whether applied individually or in groups. However, group intervention is more cost-effective, basically because it makes better use of the therapist's time. The aims of this article are to demonstrate the utility and advantages of group-behavior therapy in smokers, and to report our clinical and experimental experience in this area, focusing on key aspects to be taken into account, and summarizing some results obtained. We conclude that group intervention should be used in treatments for smoking cessation wherever possible, as it is generally more efficient that individual intervention. [ABSTRACT FROM AUTHOR]

Behavioral healthcare providers are increasingly using integrated approaches to identify and treat co-occurring severe and persistent mental illness (SPMI) and substance-related disorders, as well as discriminating among specific substances of abuse, e.g., alcohol, marijuana, cocaine, opiates, and methamphetamine, as well as poly-substance abuse or dependence. Although people with serious psychiatric disorders are significantly over-represented among those with tobacco dependence, nicotine dependence is rarely considered nor treated as a co-occurring substance disorder for this population in the context of behavioral healthcare. The authors outline elements of an intervention for people with SPMI and co-occurring nicotine dependence that adapts the evidence based practice Integrated Dual Disorders Treatment (IDDT) for use in community mental health settings. [ABSTRACT FROM AUTHOR]

The development of medications for the treatment of nicotine dependence in patients with schizophrenia is a public health priority due to its high prevalence rates, devastating medical consequences, and difficulty to treat. It has been hypothesized that the high prevalence of nicotine dependence among patients with schizophrenia may be due to a shared neurobiological vulnerability. This shared vulnerability has been evidenced in reports showing that nicotine improves neuropsychological deficits associated with schizophrenia such as in the P50 evoked auditory potentials, spatial working memory, and attention. The common pathophysiologic pathways of smoking and schizophrenia may serve as the basis for the pharmacological evaluation of medications for the treatment of these concurrent disorders. Currently, little research of medications for the treatment of this comorbidity has been conducted. Studies have evaluated the efficacy of smoking cessation medications in patients with schizophrenia. These include the nicotine replacement therapy (patch, nasal spray) and sustained release bupropion. Others have evaluated the anti-smoking effect of medications (e.g., clozapine, haloperidol) used for the treatment of schizophrenia. In both cases, the results have not been conclusive. Newer smoking cessation approaches such as varenicline, selegiline, rimonabant, and nicotine vaccine, among others, have yet to be tested in this population. The purpose of this article is to review the results of the studies conducted to date and propose some potential pharmacotherapies based on the current knowledge of the pathophysiology of both disorders. doi:10.1300/J374v03n03_09 [ABSTRACT FROM PUBLISHER]

While the underutilization of psychosocial treatments for tobacco dependence may be problematic in general, it is especially problematic in smokers with schizophrenia who may need more assistance than those in the general population. Psychosocial approaches are important for motivating ambivalent smokers with schizophrenia to make a quit attempt (i.e., via motivational interviewing) and for providing the smoker with the tools necessary for a successful quit attempt. This paper discusses psychosocial treatment approaches available to the general population, those used in published clinical trials of tobacco dependence for smokers with schizophrenia, and an ongoing clinical trial comparing a high vs. moderately intensive psychosocial treatment for tobacco dependence in smokers with schizophrenia. We also discuss a new consumer advocacy program for smokers with schizophrenia and make recommendations for using psychosocial approaches to treat tobacco dependence in smokers with schizophrenia. doi:10.1300/J374v03n03_08 [ABSTRACT FROM PUBLISHER]

This exploratory study investigated the efficacy and feasibility of a contingency management (CM) protocol for adolescent smokers that included use of a reduction phase. Using a within-participants design, 19 adolescents completed three 7-day phases: (1) reinforcement for attendance and provision of breath samples (RA) phase, (2) a washout phase, (3) a CM phase, with order of CM and RA counterbalanced. In addition, participants were randomized to one of two reinforcement conditions during the CM phase: (1) CM-Abstinence condition (n = 9), wherein participants earned reinforcement only for carbon monoxide levels (CO) indicating abstinence; (2) CM-Reduction condition (n = 10), wherein participants earned reinforcement for reductions from baseline CO levels for the first half of the CM phase, followed by an abstinence contingency for the remainder of the phase. Compared with CM-Abstinence, adolescents in CM-Reduction demonstrated trends for more abstinent readings and had a significantly higher percentage of readings meeting criteria for reinforcement during the CM phase. Adolescents who received the RA phase first had lower CO readings during the subsequent CM phase than those who received CM first. Future research is warranted on the effects of introducing RA and other control conditions prior to administration of CM, on strengthening the magnitude of the reinforcement, on instituting reinforcement schedules that program more reinforcers and with longer duration to maximize the efficacy of CM-based interventions, and on increasing the exportability of CM for smoking through advances in biochemical data collection and assessment techniques. [ABSTRACT FROM AUTHOR]

Acupuncture is applied, especially in treatment of pain, hemiplegia, obesity, and psychological illnesses including addiction. Recently, ear and body acupuncture have been frequently used in the treatment of smoking. An increase in levels of endorphin, enkephalin, epinephrine, norepinephrine, serotonin, and dopamine in the central nervous system and plasma has been reported as the most important mechanism of acupuncture. That is, acupuncture application may increase the levels of endorphin, enkephalin, epinephrine, norepinephrine, serotonin, and dopamine in the central nervous system and plasma. The authors think that acupuncture application provides the patients with deterioration in the taste of smoking, decrease in desire of smoking, and the obstruction of psychological symptoms that appear as a result of smoking cessation. Because of these effects it is presumed that acupuncture application may be used as an important method for smoking cessation treatment. [ABSTRACT FROM AUTHOR]

Varenicline is a selective α4β2 nicotinic acetylcholine receptor partial agonist and the first non-nicotine-containing medication developed with the sole purpose of treating nicotine addiction. To date, four published clinical trials have demonstrated the efficacy and safety of varenicline for smoking cessation in healthy adults who were ready to make a quit attempt. One additional trial found that extended use of varenicline effectively reduced relapse to smoking. One trial to date published as a poster documented the 1-year safety of the drug. Varenicline was more efficacious than bupropion 24 weeks after randomization to a 12-week treatment course and 1 year after randomization in an identical trial. It has no contraindications except hypersensitivity and is well tolerated. This article reviews the available information on varenicline and discusses its clinical use. [ABSTRACT FROM AUTHOR]

Many adolescents want to quit and have specific ideas on how they want to go about it. This study extended the search for factors related to different aspects of quitting. Four cross-sectional surveys of Queensland (Australia) secondary schools every three years over the past decade (1993, 1996, 1999, and 2002). A total of 9993 school students in grades 8 to 12 completed the survey. The data for 2451 students who had smoked in the last week (51% female) were used for the analysis of smoking cessation outcomes. The outcome measures for the study represented various smoking cessation outcomes, such as a desire to quit, attempts to quit, quitting for a week or more, and an intention not to be smoking in the following year. More than 60% of adolescent smokers are involved in the process of smoking cessation. The strongest predictor of cessation was whether or not students had actively influenced other students not to smoke. This finding supports the concept of involving adolescents more actively in prompting their peers to try quitting and supporting their efforts to quit smoking. [ABSTRACT FROM AUTHOR]

Objective: Auricular acupuncture was first introduced in the United States in 1974 in for use in outpatient detoxification and substance abuse treatment. We began offering, auricular acupuncture in an inpatient dual diagnosis treatment program for patients with substance abuse and mental illness to help with nicotine withdrawal, since the program is totally tobacco free. This paper reports on a study to determine Which patients volunteered to receive needles and to compare outcome measures for those who participated in the acupuncture with those who did not. Method: This was a naturalistic study including all 440 patients treated over a three-year period who were offered the use of auricular acupuncture as an additional treatment modality during a relaxation group five days per week. The individuals who volunteered to receive needles (n = 367) were compared with those who participated in the group for relaxation but did not receive needles (n = 73). During the first year of the study we analyzed the daily symptom self-report of 96 subsequent admissions over the first five weeks of their treatment in the program and compared the report of those who received needles (n = 75) with those who did not (n = 21). Results: We were unable to discover any variable that could predict who would participate in the acupuncture. Length of stay in the program was significantly longer for those who participated in the acupuncture. For the patients who received needles, those who successfully completed the program participated in significantly more needling sessions. Patients receiving needles reported significant improvement in anger, concentration, sleep, energy and pain management compared with those not receiving needles. Conclusion: Auricular acupuncture is a useful and cost effective addition to dual diagnosis treatment that appears to improve retention and participation. [ABSTRACT FROM AUTHOR]

Almost 15 years ago, Niaura, Goldstein, and Abrams (Niaura 1991,593-97) described the bioinformational model of tobacco dependence, and suggested that the model could serve as a mechanism by which to integrate research and advance scientific progress. In addition to the research implications highlighted by Niaura and colleagues, the bioinformational model may be applied to the treatment of tobacco dependence, and may be particularly useful in understanding tobacco dependence within psychiatric patients (in which rates of tobacco dependence are elevated and smoking cessation is impeded). In this paper, we provide a brief overview of the problem of tobacco dependence and psychiatric comorbidity, and highlight tobacco science data within the bioinformational framework and as relevant to understanding and treating psychiatric smokers. [ABSTRACT FROM AUTHOR]

The aim of this study is to quantify the effect of a smoke-free workplace policy on smoking decision, smokers’ cigarette consumption, and smoking cessation. The data used in the analysis were gathered from the original Japanese household surveys of 2001. A two-part model was estimated for all workers during the survey period and probit model and difference-in-differences for smokers at workplaces without the smoke-free policy at the time of hiring. The results suggest that total smoking prohibition or a separation of smoking areas reduces smoking prevalence and smokers’ cigarette consumption and causes smokers to quit smoking. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare short-term effects of smoking cessation on blood oxidant/antioxidant status, cholesterol levels, and paraoxonase activity. Sixteen healthy, asymptomatic long-term cigarette smokers (mean age: 35 ± 9 yr) participated in the study in the smoking cessation program. After and before smoking cessation, subjects were examined for oxidant/antioxidant status, cholesterol level, paraoxonase activity, breath carbon monoxide levels, and blood carboxyhemoglobin values. When compared to previous values, subjects were revealed statistically significant decreases in malondialdehyde and carbon monoxide levels 4 wk after smoking cessation. The ratio of high-density lipoprotein (HDL) low-density lipoprotein (LDL) cholesterol was found to be increased. Significantly increased to paraoxonase activity was also observed in the bood samples obtained after cigarette cessation period. It was concluded that all these changes observed after smoking cessation might be of importance in the reduction of cardiovascular risk parameters in the smokers. [ABSTRACT FROM AUTHOR]

Objective. To evaluate an intervention programme on smoking cessation in patients with diabetes mellitus in primary healthcare. Design. Regional controlled intervention study. Setting. Seventeen primary healthcare centres in Sweden. Intervention. In the intervention centres, nurses with education in diabetes were given one half-day of training in motivational interviewing and smoking cessation. An invitation to participate in a smoking cessation group was mailed to patients from the intervention centres followed by a telephone call from the patient's diabetes nurse. The nurses who intervened were specially educated in smoking cessation. The control group received a letter containing advice to stop smoking and information about a one-year follow-up. Patients. Daily smokers with diabetes mellitus, 30–75 years of age. In the intervention centres 241 patients fulfilled the criteria and in the control centres 171 patients. Main outcome measures. Self-reported smoking habits after one year. Results. In total, 21% of the smokers accepted group treatment. After 12 months, 20% (42/211) in the intervention centres reported that they had stopped smoking and 7% (10/140) in the control centres; 40% (19/47) of the smokers who had participated in group treatment reported that they had stopped smoking. Conclusion. A computerized record system for patients in primary healthcare was used to identify diabetic patients who were smokers. The selected group was invited to a stop smoking programme. At a one-year follow-up significantly more patients in the intervention centres had stopped smoking compared with patients in the control centres. [ABSTRACT FROM AUTHOR]

Although some optimists may be accurate in their positive beliefs about the future, others may be unrealistic—their optimism is misplaced. Research shows that some smokers exhibit unrealistic optimism by underestimating their relative chances of experiencing disease. An important question is whether such unrealistic optimism is associated with risk-related attitudes and behavior.We addressed this question by investigating if one's perceived risk of developing lung cancer, over and above one's objective risk, predicted acceptance of myths and other beliefs about smoking. Hierarchical regressions showed that those individuals who were unrealistically optimistic (i.e., whose perceived risk was less than their objective risk) were more likely to endorse beliefs that there is no risk of lung cancer if one only smokes for a few years and that getting lung cancer depends on one's genes. Unrealistic optimists were also more likely to believe that a greater number of lung cancer patients are cured, but they were less likely to identify smoking cessation/avoidance as a way to reduce cancer risk. Most importantly, unrealistic optimists were less likely to plan on quitting smoking. Taken together, these data suggest that in the smoking arena, unrealistic optimism is a potentially costly cognitive strategy. [ABSTRACT FROM AUTHOR]

Objective . To evaluate whether smoking cessation after a coronary event improves quality of life, and to assess whether quality of life is a predictor of smoking cessation. Design . Health-related quality of life at baseline and at 12 months follow up were measured in a randomised smoking cessation trial of 240 smokers aged under 76 years admitted for myocardial infarction, unstable angina or coronary bypass surgery. At 12 months follow up 101 had managed to give up smoking (quitters), and 117 were smokers (sustained smokers). Results . The quitters and sustained smokers had similar improvements in all quality of life domains from baseline to 12 months follow up. Further, after adjustment for differences in baseline characteristics, the quality of life was not significantly different in the quitters compared to the sustained smokers neither at baseline nor at 12 months follow up. Conclusions . Smoking cessation did not improve quality of life compared to sustained smoking after a coronary event in a 12 month follow up. Quality of life was not a significant predictor of smoking cessation. [ABSTRACT FROM AUTHOR]

A promising option in substance abuse treatment is the Community Reinforcement Approach (CRA). The opioid antagonist naltrexone (NTX) may work in combination with nicotine replacement therapy (NRT) to block the effects of smoking stimuli in abstinent smokers. Effects of lower doses than 50 mg/dd. have not been reported. A study was conducted in Amsterdam in 2000/2001 with the objective to explore the effects of the combination NTX (25/50-mg dd.), NRT, and CRA in terms of craving and abstinence. In a randomized open label, 2 × 2 between subjects design, 25 recovered spontaneous pneumothorax (SP) participants received 8 weeks of treatment. Due to side effects, only 3 participants were compliant in the 50-mg NTX condition. Craving significantly declined between each measurement and there was a significant interaction between decline in craving and craving measured at baseline. The abstinence rate in the CRA group was nearly double that in the non-psychosocial therapy group (46% vs. 25%; NS) at 3 months follow-up after treatment. [ABSTRACT FROM AUTHOR]

Cigarette smoking among youths has long been documented as a national problem affecting health and economic status in the United States. A number of studies have documented that cigarette-smoking initiation occurs primarily between late childhood and young adolescence. This evidence has brought about the need for awareness among community health nurses to find and deliver effective antismoking programs to reduce the prevalence of youth smoking initiation. Generally, community health nurses are in an excellent position to help the nation achieve its goals in terms of reducing the incidence of youth smoking initiation. However, current knowledge about community health nursing practice and smoking initiation interventions is limited. This article raises awareness about smoking initiation prevention in youth and the need to implement effective smoking prevention programs in practice settings and encourages community health nurses to increase their involvement in antismoking initiation research and interventions. [ABSTRACT FROM AUTHOR]

Both nicotine replacement and sustained-release buproprion double the odds of achieving short- and moderate-term abstinence from nicotine. However, questions remain about the efficacy of combining pharmacotherapies. Our purposes were to review the evidence for (1) combined pharmacotherapy and (2) multimodal treatment combining pharmacotherapy and behavioral treatment and to recommend combinations of treatments to reduce nicotine dependence. Combining first-line pharmacotherapies with each other or with investigational drugs shows little benefit. In contrast, trials combining specific behavioral treatments with first-line pharmacotherapies show enhanced smoking cessation rates, but benefits are not seen in all populations. We recommend future directions for research, including better specification of behavioral components and further examination of the length and timing of treatment. [ABSTRACT FROM AUTHOR]

The objective of this study1 is to evaluate the feasibility, recall, and acceptability of an evidence-based intervention using home-health nurses to provide smoking relapse prevention skills to new mothers. The design of this study is process evaluation. Setting and participants include women who had delivered a normal newborn at a university hospital, who quit smoking during pregnancy, were smoke free for 7 days, and had saliva cotinine of less than or equal to 14 nanogram/ml. The intervention is a multicomponent cognitive-behavioral intervention, including inpatient contact, a home-health visit, and 2 follow-up phone calls. Results are as follows: 121 participants enrolled, and the intervention was implemented in 78 home visits. Nurses discussed tobacco issues for an average of 12.0 min. Almost all participants recalled the home visit; nearly two thirds recalled discussing tobacco use. Only 4% reported negative feelings toward discussing tobacco issues. In 87% of home visits, nurses implemented all 5 intervention components with self-reported nonsmokers. The conclusion is as follows: A nurse-delivered smoking relapse prevention intervention for new mothers was feasible and acceptable. [ABSTRACT FROM AUTHOR]

We examined motivation for cessation and plans to quit among 945 high school students in 2001 at three levels of smoking frequency (regular, occasional, and infrequent). Surveys were completed at six Illinois high schools. In multivariate models, females (compared to males) and white students (compared to nonwhite students) were more likely to plan to quit, but plans to quit did not differ by smoking level. In multivariate models to predict motivation for cessation, regular smokers were significantly less motivated to quit than were occasional and infrequent smokers, and occasional smokers were less motivated than infrequent smokers; demographic variables were nonsignificant. Infrequent and occasional smokers are motivated to quit and intend to quit soon, making them an attractive target for cessation programs. [ABSTRACT FROM AUTHOR]

This research examined the approach and avoidance goals that people hold when attempting to quit smoking and the behavioral consequences of holding these goals. We predicted that in the domain of smoking cessation, avoidance goals would be beneficial. A community sample of smokers (N = 591) reported their personal goals for quitting smoking prior to participating in an 8-week smoking cessation program. We found that smokers reported a greater percentage of avoidance goals than previously found in educational settings and smokers with a higher proportion of avoidance goals were more likely to quit smoking. The beneficial effect of avoidance goals was largely due to a particular type of avoidance goal, one in which the person is trying to cure a current negative state. This research highlights the value of studying the consequences of avoidance goals in multiple contexts to examine the impact of different types of avoidance goals. [ABSTRACT FROM AUTHOR]

The present study examined the relative contribution of nicotine dependence, self-efficacy, and stages of change variables in predicting the initial abstinence of 102 smokers enrolled in a smoking cessation program. Over half the participants were female, the majority were White, and about half were married or living with a partner. Data were collected between 2000 and 2002. When smoking abstinence was defined as having a breath carbon monoxide (CO) level <4 ppm within 24 hours of enrollment in the study, low nicotine dependence and a higher level of contemplation both predicted abstinence. When other potentially confounding variables were included in the analysis, neither nicotine dependence nor contemplation was predictive of abstinence. When abstinence was defined as the number of study baseline days in which the participant had a breath CO level <4 ppm, multiple-regression analysis revealed that self-efficacy predicted abstinence. Self-efficacy remained predictive when other potentially confounding variables were included in the analysis. These results suggest that all three types of constructs are useful in predicting initial smoking abstinence. [ABSTRACT FROM AUTHOR]

To reverse the present stagnation in progress toward reduced smoking rates, new widely accessible treatment methods jar smoking cessation must be developed and evaluated with large groups of smokers. We tested the feasibility of conducting a smoking cessation study over the Internet using a brief self-help educational intervention. Through a direct e-mail sent from a large health information web site (Web MD), and with our presence on the Internet, we recruited 538 adult smokers to the study. Most participants (90.5%) completed all baseline questionnaires. Questionnaires showed acceptable to good reliability and were comparable with studies using [ABSTRACT FROM AUTHOR]

Constructs from the Health Beliefs Model and Social Cognitive theory were used to predict intentions to quit in three disparate sub-samples (medical workers, teachers and factory workers) of male Chinese smokers (n=631). The intention to quit smoking was directly predicted by the importance the smoker places in quitting (change incentive) and their self-efficacy (accounting for 74% of the variance). Self-efficacy, in turn, was predicted by perceived barriers and by change incentive. Change incentive was predicted by self-efficacy, outcome expectancy and importance of benefits of quitting (outcome incentive). Health belief model variables susceptibility and severity were predictors of both outcome expectancy and outcome incentive. The results were largely replicated with each of the three sub-samples. We conclude that these models of health behaviour apply to Chinese smokers, with constructs from the Social Cognitive theory being primary. [ABSTRACT FROM AUTHOR]