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E-cigarettes are not a safe alternative to cigarettes, and may substantially increase cardiovascular and lung disease risks. Rather than stimulating smokers to switch from conventional cigarettes to e-cigarettes only, most e-cigarette users are dual users. E-cigarettes are prolonging nicotine addiction and expanding the nicotine market by attracting youth., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Given that previous studies demonstrated that smoking-related cues (like cigarette packages) grab the attention of smokers and thereby contribute to craving and tobacco seeking we investigated how pictorial health warnings presented on cigarette packages affect attention allocation towards cigarette packages. The WHO advises the use of pictorial health warnings on cigarette packages. However, at present no experimental studies are available investigating if pictorial warnings modulate incentive properties of cigarette packages. Fifty-nine tobacco smokers and 55 non-smokers performed a visual dot probe task to assess attention allocation towards cigarette packages with and without health warnings. Smokers were divided a priori in a group of light smokers (<20 cigarettes/day; n=39) and heavy smokers (≥20 cigarettes/day; n=20). Psychometric measures on anxiety and nicotine craving were administered. Light smokers showed an attentional bias towards packages without pictorial warnings while no effects were observed in the other groups. In heavy smokers attention allocation towards pictorial health warnings was associated with an increase of craving and anxiety. The results have a potential public health perspective as pictorial health warnings might be an effective strategy to reduce attentional bias towards cigarette packages of light smokers, while counterproductive effects in heavy smokers warrant further investigation., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Aim: Although people with mental illness show a greater severity of nicotine dependence and have a significantly reduced life expectancy because of it, psychiatric staff rarely offer their patients smoking cessation support and are reluctant to encourage patients to quit. In order to improve smoking cessation treatment for psychiatric patients, such staff resistance must be better understood. Subjects and methods: A total of 448 members of staff in eight psychiatric units in Berlin were surveyed in relation to their attitudes towards smoking cessation. Results: Although most participants recognize the importance of smoking cessation in psychiatric patients, they state that they do not adhere to international guidelines which recommend regularly asking patients about their smoking habits and offering cessation support. Staff have little knowledge about how to facilitate smoking cessation treatment and about the influences of smoking on the metabolism of drugs. They also harbor misconceptions about how smoking affects their patients' mental well-being. Many express concern that a quit attempt might thwart psychiatric treatment and lead to aggressive behavior—assumptions unsupported by scientific evidence. The overwhelming majority does not believe it to be realistic that patients can manage to give up smoking during treatment. Conclusions: Staff training should be directed to heighten awareness of the international guidelines and treatment options for smoking cessation and impart knowledge on how smoking impacts both the physical and mental health of psychiatric patients. [ABSTRACT FROM AUTHOR]

Introduction: In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. Methods: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019–2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. Results: In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms. [ABSTRACT FROM AUTHOR]

Rationale: Recently, experimental paradigms have been developed to strengthen automatic avoidance or inhibitory responses for smoking cues. However, these procedures have not yet been directly compared regarding their effectiveness and mechanisms of action. Objective: This study compared the effects of avoidance vs. inhibitory training as an add-on to a brief smoking cessation intervention. The standard Approach-Avoidance-Task (AAT) was adapted for both training types and control conditions. Methods: One hundred twenty-four smokers attended behavioral counseling for smoking cessation and were thereafter randomized to one of four training conditions: avoidance-AAT, sham-avoidance-AAT, inhibition-AAT, sham-inhibition-AAT. During a 2-week training period including five training sessions, smokers in the avoidance-AAT trained to implicitly avoid all smoking-related cues, while smokers in the inhibition-AAT trained to implicitly inhibit behavioral response to smoking cues. During sham training, no such contingencies appeared. Self-report and behavioral data were assessed before and after training. Cigarette smoking and nicotine dependence were also assessed at 4- and 12-week follow-ups. Results: At posttest, avoidance training was more effective in reducing daily smoking than inhibition training. However, this difference was no longer evident in follow-up assessments. All training conditions improved other smoking- and health-related outcomes. Neither training changed smoking-related approach biases or associations, but approach biases for smoking-unrelated pictures increased and Stroop interference decreased in all conditions. Smoking devaluation was also comparable in all groups. Conclusions: Avoidance training might be slightly more effective in reducing smoking than inhibitory training. Overall, however, all four training types yielded equivalent therapy and training effects. Hence, a clear preference for one type of training remains premature. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is a widespread behaviour and associated with increased risk for nicotine dependence, morbidity and mortality. The structured group-based intervention ‘Rauchfrei-Programm’ is effective; however, no study has yet identified psychological factors predicting immediate (within two weeks after smoking cessation), short-term (within 3 months) and middle-term relapse (within 6 months). Methods: This naturalistic pre-post-follow-up phase-3 field study analyses self-reported smoking status, age, gender, percentage of smoking friends and questionnaire scores for self-efficacy, severity of dependence and perceived social support of N = 160 treatment-seeking outpatients (out of N = 555 overall participants) using binary logistic regressions. Results: Immediate relapse (18.8%) was not predicted by any predictor. Short-term relapse (55.6%) was predicted by lower self-efficacy (OR = 0.87), higher percentage of smoking friends (OR = 1.02) and more severe nicotine dependence (OR = 1.19). Middle-term relapse (64.4%) was predicted by lower self-efficacy (OR = 0.90) and higher percentage of smoking friends (OR = 1.02). Conclusions: Results support the standard relapse prediction model, proposing self-efficacy during and after the intervention as an important factor for relapse for up to 6 months after cessation. We recommend a regular assessment of self-efficacy in the ‘Rauchfrei-Programm’ and standardized strategies to intervene with low-esteem participants. Findings might be limited to multimodal and structured group interventions. [ABSTRACT FROM AUTHOR]

Background: Weight gain is a common but only a partially understood consequence of smoking cessation. Existing data suggest modulating effects of the orexigenic peptide ghrelin on food intake. The aim of the present study was to investigate the effect of tobacco withdrawal on plasma concentration of acetylated and total ghrelin. Methods: Fifty four normal-weighted smokers and 30 non-smoking healthy controls were enrolled in our study. Concentrations of acetylated and total ghrelin were measured in blood plasma drawn two hours after a standardized meal and three hours after the smokers smoked their last cigarette. The severity of tobacco addiction was assessed based on cotinine plasma concentration, the Fagerström Test for Nicotine Dependence (FTND) and the number of cigarettes smoked per day. Results: The plasma concentration of acetylated ghrelin, but not total ghrelin, was significantly higher in smokers than in non-smokers. Moreover, we found significant negative correlations between acetylated ghrelin and all measures of the severity of nicotine dependence. Conclusions: Early abstinence from tobacco smoking seems to be associated with increased plasma concentration of the orexigenic peptide acetylated ghrelin. This could be one reason for increased food craving during nicotine withdrawal and subsequent weight gain. Smokers might compensate these effects by increasing tobacco intake. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Regular tobacco smoking occurs in about 35% of the male and 25% of the female German population. Individual attempts to independently quit smoking and to remain abstinent for 1 year have been shown to be successful in less than 5% of cases. This rate can be doubled by means of individual consulting and cognitive-behavioral interventions and additional pharmacological treatment might increase abstinence rates up to 25%. Apart from nicotine substitution (e.g. transdermal, oral and inhalative applications) and bupropion, recent studies have shown beneficial effects of varenicline for smoking cessation and abstinence. Varenicline, a selective partial nicotinergic agonist, has been specifically developed for the purpose of smoking cessation. Currently available data suggest that varenicline is more effective compared to nicotine substitution therapy and bupropion, increasing the abstinence likelihood by a factor of 2.3 compared to a placebo. Recent data regarding anti-nicotine vaccines suggest that this approach might yield a comparable treatment outcome and probably even better relapse-preventing effects than conventional psychopharmacological strategies. The first anti-nicotine vaccines are expected to be approved by national authorities within the forthcoming 1-2 years. [ABSTRACT FROM AUTHOR]

The clinical use of bupropion as an aid for smoking cessation has raised some concern in clinicians and public opinion. Clinical and post-marketing surveillance studies indicate a favourable side effect profile, but spontaneous reports of suspected adverse reactions to medical authorities indicate adverse neuropsychiatric events to be more frequent than previously thought. Except for the risk of seizures, adverse neuropsychiatric events have not been examined systematically. Insomnia has been reported quite frequently. In the placebo-controlled trials, depression scores were unaffected by bupropion treatment. Suspected adverse events reported to medical authorities in the UK or Germany indicate depression to be the most common psychiatric disorder associated with bupropion treatment. Switch to mania or hypomania is very rare, as are psychosis or organic mental disorders. Suicide attempts associated with bupropion use have been reported as possible adverse events. This topic warrants further attention. [ABSTRACT FROM AUTHOR]

Identifying, diagnosing and reducing nicotine use, dependence and related morbidity are considered key responsibilities of primary care physicians. Little is known, however, about the magnitude of the problem in primary care and the extent of treatment in Germany. This paper reports on (1) life-time and point prevalences of smoking and nicotine dependence among unselected consecutive German primary care attendees; (2) associations of smoking status with socio-demographic features and (3) rates of doctors’ recognition and treatment patterns.Data came from the Smoking and Nicotine Dependence Awareness and Screening Study (SNICAS), a nationally representative two-stage epidemiological point prevalence study (stage I: prestudy characterization of a nation-wide sample of 889 primary care doctors; stage II: target day assessment of 28 707 unselected consecutive patients).(1) Of all primary care attendees, 71% reported having ever used a tobacco product (life-time regular smokers 51%; life-time occasional smokers 21.5%.). Point prevalence (4 weeks) of smoking was considerably lower (occasional use 4.7%, regular use 24.9%). The rate of DSM-IV nicotine dependence (13.9%) was highest among the youngest age groups. (2) Rates of regular and dependent smokers decreased markedly with age, mainly as a result of the steadily increasing numbers of male ex-smokers and low numbers of older female life-time ever smokers. Young age, unemployment, being single, divorced, widowed or separated from the partner were associated with higher rates of smoking or nicotine dependence. (3) In about 25% of patients, primary care doctors failed to recognize the patient's current smoking and/or nicotine dependence. Case recognition was highest for nicotine dependence (76%). Among recognized cases, 56% had ever received any kind of advice or counselling about quitting; yet only 12% had ever participated in any smoking cessation programme.Beyond the confirmation of the well-established finding of a high prevalence of smokers in primary care, this paper demonstrates (1) considerable point prevalence of DSM-IV nicotine dependence (14%); (2) that it is noteworthy, however, that the rates are not higher than those in community samples; and (3) a considerable variation by age group with highest rates among the young (22–31%), but considerably lower rates among subjects aged 50 and above (16% to 0.9% in the oldest). This substantial association with age seems to be due mainly to the low smoking rates in older women and the increasing numbers of successful, particularly male, quitters from 40 years onwards. Recognition of primary care patients’ smoking status by primary-care practitioners was moderate, and the frequency of past and current primary care interventions was low. These findings call for systematic investigation into barriers that impede the implementation of smoking cessation interventions in primary care settings. [ABSTRACT FROM AUTHOR]

Little is known about the specific pathways between depression and low self-efficacy to stop smoking, particularly among the general population. The goal was to examine whether depression and nicotine dependence may predict the confidence in the ability to refrain from smoking (CAS). A random population sample aged 18–64 was used from northern Germany. It included 1520 current smokers, who were eligible for a first follow-up after 30 months and a second follow-up after 36 months. The results show that DSM-IV major depression and nicotine dependence, the Fagerström Test for Nicotine Dependence (FTND), the number of cigarettes smoked, the age at onset of daily smoking, and the intention to stop smoking predict the CAS. It is concluded that there may be an additive effect from nicotine dependence and major depression on the CAS. [Copyright &y& Elsevier]

Background. Nicotine dependence might function as a barrier to smoking cessation. Therefore, the goal was to determine whether single symptoms of nicotine dependence are related to the number of quit attempts and smoking status.Methods. In a random population sample of 4075 women and men aged 18–64, drawn from 47 German communities, data about nicotine dependence according to the US Diagnostic and Statistical Manual of Mental Disorders and according to the Fagerstro¨m Test for Nicotine Dependence (FTND), and data on quit attempts and quitting were collected at baseline with an interview and 30 months later with a questionnaire.Results. Nicotine dependence, in particular withdrawal, was related to a high number of quit attempts and to remaining a current smoker. The urgent need for tobacco, craving for nicotine, smoking to avoid withdrawal, and the expectation of increased appetite or weight gain correctly classified smoking status in 72.1% of individuals through logistic regression analysis.Conclusions. Nicotine dependence is a strong factor that may partly explain the failure of a subpopulation of smokers to live abstinent. Population-based interventions should include measures of tobacco control and brief interventions carried out, for example, by experts in health care. [Copyright &y& Elsevier]

The objectives of the Smoking and Nicotine Dependence Awareness (SNICAS) study are to provide nationally representative data on the prevalence of smoking and smoking dependence of primary care patients and the frequency in which smoking cessation interventions are offered and provided in primary care. With the inclusion of both providers' (doctor) and patients' perspectives, the study also attempts to identify the needs and motivational status for smoking cessation as reported by the patients and as perceived by the doctor. The Smoking and Nicotine Dependence Awareness study uses a two-stage epidemiological design. Stage I consists of a pre-study characterization of a nationwide sample of 889 primary care doctors (conservative response rate: 50%). Stage 2 consists of a cross-sectional assessment of unselected consecutive patients (n = 28,707, conservative response rate: 52.8%) on the study's target day, by means of patient questionnaire and a structured clinical appraisal of each patient by the doctor. This paper provides an overview of the design and methods of the study, informs about sampling and response rates, and examines whether the study sample could be considered representative of German primary care doctors. [ABSTRACT FROM AUTHOR]

: BackgroundThe aim of this study was to provide evidence about the individual intention to quit smoking and accompanying characteristics in a country with a low amount of tobacco control (TC) provisions.: MethodsThis study used a random sample of the population aged 18–64 in a German area to make a quantitative estimation of the stages of change to quit smoking among current smokers who had at least one quit attempt (n = 1075).: ResultsThe rate of those who did not intend to stop smoking (precontemplators) was 76.4%, that of those who intended to quit during the next 6 months (contemplators) was 17.0%, and that of those who intended to quit during the next 4 weeks was 6.6%. The three groups did not differ according to gender or age. Of those who had at least 16 years of education, more were contemplators than were those with fewer years of education. Among those who had somatic complaints or nausea from smoking, who had their first cigarette within 1 h or less after awakening, and who had more quit attempts, more were in the contemplation or preparation stage.: ConclusionsNicotine dependence may add to contemplating about quitting. The precontemplation rate was substantially higher than in samples from nations or states which show a large amount of TC provisions. [Copyright &y& Elsevier]

The article reports on warnings by health authorities in Germany of potential health risks from electronic cigarettes (e-cigarettes), with German Cancer Research Center top official Martina Pötschke-Langer calling it one of the major new health issues in Germany and the rest of Europe.