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Objectives: This paper describes the effects of non-tobacco, physical cigarette design features on smoke emissions, product appeal, and smoking behaviors - 3 factors that determine smoker's exposure and related health risks. Methods: We reviewed available evidence for the impact of filter ventilation, new filter types, and cigarettes dimensions on toxic emissions, smoker's perceptions, and behavior. For evidence sources we used scientific literature and websites providing product characteristics and marketing information. Results: Whereas filter ventilation results in lower machine-generated emissions, it also leads to perceptions of lighter taste and relative safety in smokers who can unwittingly employ more intense smoking behavior to obtain the desired amount of nicotine and sensory appeal. Filter additives that modify smoke emissions can also modify sensory cues, resulting in changes in smoking behavior. Flavor capsules increase the cigarette's appeal and novelty, and lead to misperceptions of reduced harm. Slim cigarettes have lower yields of some smoke emissions, but smoking behavior can be more intense than with standard cigarettes. Conclusions: Physical design features significantly impact machine-measured emission yields in cigarette smoke, product appeal, smoking behaviors, and exposures in smokers. The influence of current and emerging design features is important in understanding the effectiveness of regulatory actions to reduce smoking-related harm. [ABSTRACT FROM AUTHOR]

Aims To estimate the prevalence and predictors of failed biochemical verification of self-reported abstinence among participants enrolled in trials of hospital-initiated smoking cessation interventions. Design Comparison of characteristics between participants who verified and those who failed to verify self-reported abstinence. Settings Multi-site randomized clinical trials conducted between 2010 and 2014 in hospitals throughout the United States. Participants Recently hospitalized smokers who reported tobacco abstinence 6 months post-randomization and provided a saliva sample for verification purposes ( n = 822). Measurements Outcomes were salivary cotinine-verified smoking abstinence at 10 and 15 ng/ml cut-points. Predictors and correlates included participant demographics and tobacco use; hospital diagnoses and treatment; and study characteristics collected via surveys and electronic medical records. Findings Usable samples were returned by 69.8% of the 1178 eligible trial participants who reported 7-day point prevalence abstinence. The proportion of participants verified as quit was 57.8% [95% confidence interval (CI) = 54.4, 61.2; 10 ng/ml cut-off] or 60.6% (95% CI = 57.2, 63.9; 15 ng/ml). Factors associated independently with verification at 10 ng/ml were education beyond high school education [odds ratio (OR) = 1.51; 95% CI = 1.07, 2.11], continuous abstinence since hospitalization (OR = 2.82; 95% CI = 2.02, 3.94), mailed versus in-person sample (OR = 3.20; 95% CI = 1.96, 5.21) and race. African American participants were less likely to verify abstinence than white participants (OR = 0.64; 95% CI = 0.44, 0.93). Findings were similar for verification at 15 ng/ml. Verification rates did not differ by treatment group. Conclusions In the United States, high rates (40%) of recently hospitalized smokers enrolled in smoking cessation trials fail biochemical verification of their self-reported abstinence. [ABSTRACT FROM AUTHOR]

Introduction: Few hospitals treat patients' tobacco dependence. To be effective, hospital-initiated cessation interventions must provide at least 1 month of supportive contact post-discharge.Study Design: Individually randomized clinical trial. Recruitment commenced July 2011; analyses were conducted October 2014-June 2015.Setting/participants: The study was conducted in two large Midwestern hospitals. Participants included smokers who were aged ≥18 years, planned to stay quit after discharge, and spoke English or Spanish.Intervention: Hospital-based cessation counselors delivered the intervention. For patients randomized to warm handoff, staff immediately called the quitline from the bedside and handed the phone to participants for enrollment and counseling. Participants randomized to fax were referred on the day of hospital discharge.Main Outcome Measures: Outcomes at 6 months included quitline enrollment/adherence, medication use, biochemically verified cessation, and cost effectiveness.Results: Significantly more warm handoff than fax participants enrolled in quitline (99.6% vs 59.6%; relative risk, 1.67; 95% CI=1.65, 1.68). One in four (25.4% warm handoff, 25.3% fax) were verified to be abstinent at 6-month follow-up; this did not differ significantly between groups (relative risk, 1.02; 95% CI=0.82, 1.24). Cessation medication use in the hospital and receipt of a prescription for medication at discharge did not differ between groups; however, significantly more fax participants reported using cessation medication post-discharge (32% vs 25%, p=0.01). The average incremental cost-effectiveness ratio of enrolling participants into warm handoff was $0.14. Hospital-borne costs were significantly lower in warm handoff than in fax ($5.77 vs $9.41, p<0.001).Conclusions: One in four inpatient smokers referred to quitline by either method were abstinent at 6 months post-discharge. Among motivated smokers, fax referral and warm handoff are efficient and comparatively effective ways to link smokers with evidence-based care. For hospitals, warm handoff is a less expensive and more effective method for enrolling smokers in quitline services. [ABSTRACT FROM AUTHOR]

Objective. In 2002, the First Conference on Menthol Cigarettes brought together researchers from diverse backgrounds to summarize what is known about menthol cigarettes and the people who smoke them, and to identify areas of needed research on menthol cigarettes. Since the conference, PubMed reports 24 articles, including the conference proceedings, on menthol cigarettes and African Americans. Many of the articles address epidemiological or biomedical topics. While there has been some focus on social influences and marketing issues, more research and a greater focus on this topic are needed. Design. To stimulate research on a population disproportionately burdened by the health effects of smoking, we conducted small-group discussions in 2005 with adult African American smokers in Atlanta, Georgia. Each group discussion focused on a different topic: smoking behavior and preferences, perceptions of social influences, health effects and perceived harmfulness of menthol, quitting menthol cigarette smoking, or the influence of marketing and advertising of menthol cigarettes. Results. Themes emerged from the discussions: (1) emulation of black culture by white youth and racial integration of neighborhoods and communities may have modified the perception that African Americans smoke menthol cigarettes and whites smoke non-menthol cigarettes; (2) non-menthol cigarette smokers were thought to be 'hardcore' smokers with less interest in quitting; (3) switching to non-menthol cigarettes was discussed as a way of quitting cigarettes for habitual menthol smokers; and, (4) smoking menthol cigarettes was thought to lead to fewer negative health effects. Conclusion. Some topics suggested by the participants warrant further investigation. More research is needed to assess the pervasiveness of these beliefs and their potential utility for smoking cessation interventions. [ABSTRACT FROM AUTHOR]

Pharmacotherapy is a critical adjunct to smoking cessation therapy. Little is known about relative preferences for these agents among smokers in primary care settings. In the context of a population-based clinical trial, we identified 750 smokers in primary care practices and independent of their readiness to quit offered them a free treatment course of either bupropion or transdermal nicotine replacement (TNR). Smokers opting for pharmacotherapy completed standardized contraindication screens that were reviewed by the patient's primary care physician. Most participants (67%) requested pharmacotherapy. Use of pharmacotherapy was positively associated with higher nicotine dependence and readiness to quit. Of the smokers requesting pharmacotherapy, 51% requested bupropion and 49% requested TNR. Choice of bupropion was related to no history of heart disease and no previous use of bupropion. Although potential contraindications to treatments were identified for 21.7% of bupropion and 6.6% of TNR recipients, physicians rarely felt that these potential contraindications precluded the use of these agents. When cost is removed as a barrier, a large proportion of rural smokers are eager to use smoking cessation pharmacotherapy, especially agents that they have not tried before. Although some comorbid conditions and concurrent drug therapies were considered contraindications, particularly to bupropion, physicians rarely considered these clinically significant risks enough to deny pharmacotherapy. [ABSTRACT FROM AUTHOR]

Objective: To describe adult smokers' reactions to PREP print advertisements and promotional materials. Methods: Focus groups with adult smokers. Participants reacted to print advertisements and promotional materials for Omni®, Accord®, Advance Lights®, Ariva®, and Eclipse®. Results: Images and text in PREP product advertising and promotional materials influence participants' decision to try PREPs. Participants believed the PREP ads target smokers who are trying to quit or smokers who are health conscious. Conclusion: Tracking and monitoring the reactions of smokers to novel products, their perceptions about them, and their use of these products are necessary for the design of effective health communication strategies. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To examine tobacco use, readiness to quit, and interest in smoking cessation interventions among methadone maintenance patients. Methods: Cross-sectional survey of outpatients enrolled in four urban methadone maintenance clinics. Stage of readiness to quit was determined for all smokers, and factors associated with both readiness to quit and interest in attending an on-site smoking cessation program were determined. Results: Among 389 patients, 83% were current smokers. Nearly half (48%) of smokers were contemplating quitting, and an additional 22% were in the preparation stage of readiness to quit. In multivariate analyses, lower nicotine dependence, prior use of smoking cessation pharmacotherapy, and lower methadone dose were associated with being in the preparation stage. Patients with more education, Hispanics/Latinos, and patients who had used smoking cessation pharmacotherapy or were in the preparation or contemplation stages of behavior change were more interested in attending an on-site smoking cessation program. Conclusions: Tobacco use is highly prevalent among methadone maintenance patients, but we also observed a high level of readiness to quit and interest in smoking cessation. Targeted smoking cessation interventions, including on-site programs, should be developed for methadone maintenance patients. [Copyright &y& Elsevier]

Most substance abuse treatment facilities do not routinely treat cigarette smoking even though most of their clients smoke and many will die from tobacco-related illness. This study is a secondary analysis of a national survey of the prevalence and type of tobacco treatment services available in methadone maintenance treatment. It presents qualitative and quantitative information on provider attitudes regarding tobacco treatment in drug treatment. One clinic leader (either a medical director, head nurse, or clinic director) from all 697 U.S. facilities was invited to participate in the study. Most (38%) clinic leaders thought the best time to treat patients for nicotine dependence was whenever the patient wanted treatment. One in four clinic leaders reported they or one of their staff had advised patients to delay quitting smoking cigarettes. Fewer (14%) believed that patients in some way benefited from cigarette smoking; these benefits included managing mood disturbances (calming, reducing anxiety, depression, stress, anger) and substituting for illicit drug abuse. This suggests that some providers might rely on cigarettes in lieu of psychotherapy or prescription medications to address patients' mood disorders such as depression, anger, and anxiety. One tactic for disseminating tobacco treatment in drug treatment might involve identifying the purported benefits of tobacco and training providers in alternative methods for delivering these benefits. [ABSTRACT FROM AUTHOR]

Objective: To explore risk perceptions of traditional and nontraditional tobacco products (NTPs) among young adult smokers. Methods: Focus groups with African Americans, non-Hispanic whites, and Hispanics. Risk ratings of light, regular, and menthol cigarettes and of NTPs and marijuana and cigarettes were compared. Results: Participants tended to view light cigarettes as safer than regular cigarettes. Shisha and herbal products were rated as safer than traditional cigarettes, but there were differences in ratings by race/ethnicity, related to preferred cigarette variety. Conclusions: Health communication messages about the use of cigarettes and NTPs should consider risk perceptions about the products and racial/ethnic differences. [ABSTRACT FROM AUTHOR]

Background: Airway epithelial goblet cell hyperplasia is known to occur in chronic smokers. Although the epidermal growth factor receptor has been implicated in this process, neither ErbB receptor expression nor the mucosecretory phenotype of the epithelium have been characterised in current smokers. Methods: Bronchial biopsies obtained from non-smokers (n =10) and current smokers, with or without chronic obstructive pulmonary disease (n = 51), were examined immunohistochemically to measure the expression of epidermal growth factor receptor, ErbB2, ErbB3, ErbB4 and mucin subtypes (MUC2, MUC5AC and MUC5B) in the bronchial epithelium. The results were correlated with neutrophil counts measured in the airway wall and induced sputum. Results: Epidermal growth factor receptor, ErbB3 and MUC5AC expression, in addition to PAS staining, were significantly increased in all smokers compared with non-smokers, irrespective of the presence of chronic obstructive pulmonary disease. MUC5AC expression was significantly associated with both PAS staining and ErbB3 expression; no correlation was observed between either mucin or ErbB receptor expression and neutrophil counts. Conclusions: The results suggest that long term current smoking induces enhanced epidermal growth factor receptor, ErbB3, and MUC5AC expression in vivo; these increases are not associated with the presence of neutrophilic inflammation. ErbB receptors may contribute to epithelial responses to cigarette smoke. [ABSTRACT FROM AUTHOR]

Aims People who use illicit drugs are thought to have high rates of cigarette smoking; however, few population-based studies have been reported. We describe smoking patterns among illicit drug users, assess whether cigarette smoking is more prevalent among illicit drug users than it is among non-users and explore how smoking relates to level and type of drug use. Design, setting, participants We used adult responses to the 1997 National Household Survey on Drug Abuse (n = 16 661). Multivariate analyses used SUDAAN to adjust standard errors for the sampling design and controlled for age, race, sex, education, depression, treatment history and alcohol. Measurements Smoking rates, cessation rates and smoking levels. Findings Seventy-one per cent of recent illicit drug users smoked cigarettes at least once in the past month. Their adjusted odds of being a smoker were much greater than for the general population (OR = 3.07, P < 0.0001). Their quit rate, although substantial, was half that of non-users (23% versus 56%, P = 0.0001). Odds of being a smoker were higher for poly- versus monodrug users (OR = 2.35, P = 0.0020) and rose with increased drug use (OR = 1.36, P = 0.0374). Illicit drug users who perceived smoking to be risky were four times less likely to smoke (OR = 0.23, P = 0.0008). Conclusions Although most recent illicit drug users smoke, some are able to quit. Better understanding of concurrent cigarette and illicit drug use may provide impetus for policy change and shed light on underlying mechanisms of addiction. Clinicians, policy makers and user advocates should address tobacco use in drug treatment and in harm reduction interventions. [ABSTRACT FROM AUTHOR]

PURPOSE: Recruitment is often the rate-limiting step in conducting clinical trials among ethnic minorities. Little is known about participants who consent and enroll into a trial, but do not return for randomization. Why participants fail to return for randomization is largely unknown.METHODS: We compared 287 enrolled African American smokers who did not return for randomization, to the 500 who returned and were randomized to participate in a clinical trial for smoking cessation in African Americans. Analyses were conducted to identify variables associated with not returning for randomization.RESULTS: Univariate comparisons found the nonrandomized group to be significantly different from those randomized. Logistic regression showed younger age, less readiness to quit, having been proactively recruited, lacking a regular source of health care, believing that they will be smoking in 6 months, less church attendance, and a lower literacy level to be jointly related with not returning for randomization.CONCLUSIONS: African American participants who did not return for randomization into a clinical trial were different from those who did. Better understanding of these factors may allow researchers to target recruitment efforts resulting in enhanced accrual in clinical trials and increased efficiency. [Copyright &y& Elsevier]

Conclusions. The quit ratio among methadone maintenance treatment clients was l 2%, compared with 50% nationwide. To reduce morbidity and mortality, cessation interventions must be developed and disseminated. (Am J Public Health. 2001 ;91:296-299) [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the pattern of electronic cigarette (e-cigarette) use over time or among smokers with medical comorbidity. Methods: We assessed current cigarette smokers’ use of e-cigarettes during the 30 days before admission to 9 hospitals in 5 geographically dispersed US cities: Birmingham, AL; Boston, MA; Kansas City, KS; New York, NY; and Portland, OR. Each hospital was conducting a randomized controlled trial as part of the NIH-sponsored Consortium of Hospitals Advancing Research on Tobacco (CHART). We conducted a pooled analysis using multiple logistic regression to examine changes in e-cigarette use over time and to identify correlates of e-cigarette use. Results: Among 4,660 smokers hospitalized between July 2010 and December 2013 (mean age 57 years, 57% male, 71% white, 56% some college, average 14 cigarettes/day), 14% reported using an e-cigarette during the 30 days before admission. The prevalence of e-cigarette use increased from 1.1% in 2010 to 10.3% in 2011, 10.2% in 2012, and 18.4% in 2013; the increase was statistically significant (p < .0001) after adjustment for age, sex, education, and CHART study. Younger, better educated, and heavier smokers were more likely to use e-cigarettes. Smokers who were Hispanic, non-Hispanic black, and who had Medicaid or no insurance were less likely to use e-cigarettes. E-cigarette use also varied by CHART project and by geographic region. Conclusions: E-cigarette use increased substantially from 2010 to 2013 among a large sample of hospitalized adult cigarette smokers. E-cigarette use was more common among heavier smokers and among those who were younger, white, and who had higher socioeconomic status. [ABSTRACT FROM AUTHOR]

Abstract: Background: Most drug treatment patients smoke cigarettes, yet few data exist on the prevalence and outcomes of varenicline treatment among smokers with comorbid substance use and psychiatric disorders. Methods: We reviewed all patient charts of opioid-dependent smokers prescribed varenicline between May 2006 and December 2009 in two urban methadone clinics that also provide on-site medical and psychiatric care. We assessed prevalence, adverse events, and effectiveness of varenicline treatment in this cohort. Results: We identified 575 smokers among 690 patients (83.3%), and assessed 82 courses of varenicline treatment prescribed to 70 smokers. Both cardiovascular risk factors and psychiatric illness were highly prevalent among those prescribed varenicline: hypertension, 51%; hyperlipidemia, 23%; diabetes, 20%; depression, 53%; anxiety, 30%; psychotic disorders, 10%; bipolar disorder, 8.6%. Of 82 varenicline courses, nine (11%) were discontinued due to adverse events and two due to depressive symptoms. One patient initiated new psychiatric medications within six months of initiating varenicline, but did not discontinue varenicline. There were no reports of suicidal ideation, agitation prompting clinical intervention, or psychiatric hospitalization. There were no incident cardiac or vascular events within six months of varenicline prescription. Some (8.6%) varenicline-treated smokers quit smoking, and cessation was significantly associated with varenicline treatment duration. Conclusions: Despite substantial comorbidity, opioid-dependent smokers receiving integrated substance abuse, medical and psychiatric care had few documented adverse events with varenicline treatment. Methadone patients will likely experience little harm and a great deal of benefit from treatment with varenicline for smoking cessation. [Copyright &y& Elsevier]

Abstract: The present cross-sectional study evaluated whether people who engage in vigorous-intensity exercise are better able to regulate negative affective states, thereby changing core maintenance factors of smoking. Participants were a community sample of adults (n =270) who completed self-report measures of physical activity, cigarette smoking, anxiety sensitivity, and negative affect. Consistent with hypothesis, vigorous-intensity exercise was related to lower levels of cigarette smoking, accounting for 10% of the variance in smoking. Additionally, negative affect mediated the relationship between vigorous-intensity physical activity and cigarette smoking, accounting for about 12% of this relation. Furthermore, these relationships were stronger for individuals with high anxiety sensitivity than for those with low anxiety sensitivity; including anxiety sensitivity as a moderator of the mediated relationship increased the amount of variance accounted for by negative affect to 17%. The findings are discussed in relation to developing further scientific insight into the mechanisms and pathways relevant to understanding the association among vigorous-intensity exercise, smoking, and emotional vulnerability. [Copyright &y& Elsevier]

The molecular events leading to emphysema development include generation of oxidative stress and alveolar cell apoptosis. Oxidative stress upregulates ceramides, proapoptotic signaling sphingolipids that trigger further oxidative stress and alveolar space enlargement, as shown in an experimental model of emphysema due to VEGF blockade. As alveolar cell apoptosis and oxidative stress mutually interact to mediate alveolar destruction, we hypothesized that the oxidative stress generated by ceramide is required for its pathogenic effect on lung alveoli. To model the direct lung effects of ceramide, mice received ceramide intratracheally (Cer[sub12:0] or Cer[sub8:0]; 1 mg/kg) or vehicle. Apoptosis was inhibited with a general caspase inhibitor. Ceramide augmentation shown to mimic levels found in human emphysema lungs increased oxidative stress, and decreased, independently of caspase activation, the lung superoxide dismutase activity at 48 h. In contrast to their wild-type littermates, transgenic mice overexpressing human Cu/Zn SOD were significantly protected from ceramide-induced superoxide production, apoptosis, and air space enlargement. Activation of lung acid sphingomyelinase in response to ceramide treatment was abolished in the Cu/Zn SOD transgenic mice. Since cigarette smoke-induced emphysema in mice is similarly ameliorated by the Cu/Zn SOD overexpression, we hypothesized that cigarette smoke may induce ceramides in the mouse lung. Utilizing tandem mass spectrometry, we documented increased lung ceramides in adult mice exposed to cigarette smoke for 4 wk. In conclusion, ceramide-induced superoxide accumulation in the lung may be a critical step in ceramide's proapoptotic effect in the lung. This work implicates excessive lung ceramides as amplifiers of lung injury through redox-dependent mechanisms. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study was to estimate the prevalence and determinants of cigarette smoking cessation treatment in U.S. outpatient substance abuse treatment (OSAT) units. Methods: Program directors and clinical supervisors from a national sample of 550 OSAT units in the United States were surveyed in 2004–2005. Supervisors reported the availability of cigarette smoking assessment, and individual or group counseling and pharmacotherapy for smoking cessation. This analysis examines whether institutional and resource factors influence the delivery of these services. Results: Of OSAT programs in the United States, 41% offer smoking cessation counseling or pharmacotherapy, 38% offer individual/group counseling, and 17% provide quit-smoking medication. In multivariate models, hospital affiliation, service breadth, the priority given to physical health, the availability of medication to treat addictive problems, assessment of cigarette smoking, and a greater perception of the proportion of patients who smoke were associated with the delivery of smoking cessation services. Program size and medical staffing also influenced the availability of quit-smoking medication. Conclusions: Of U.S. OSAT programs, two in five offer behavioral treatment for smoking cessation, but fewer than one in five provide access to pharmacotherapy. Substance abuse treatment programs that are medically oriented, provide more comprehensive services, and recognize the burden of tobacco smoking among their patients are more likely to deliver evidence-based smoking cessation services. [Copyright &y& Elsevier]

Background: Although several epidemiological studies have examined the mortality among users of spit tobacco, none have compared mortality of former cigarette smokers who substitute spit tobacco for cigarette smoking ("switchers") and smokers who quit using tobacco entirely. Methods: A cohort of 116 395 men were identified as switchers (n=4443) or cigarette smokers who quit using tobacco entirely (n= 111 952) when enrolled in the ongoing US American Cancer Society Cancer Prevention Study II. From 1982 to 31 December 2002, 44 374 of these men died. The mortality hazard ratios (HR) of tobacco-related diseases, including lung cancer, coronary heart disease, stroke and chronic obstructive pulmonary disease, were estimated using Cox proportional hazards regression modelling adjusted for age and other demographic variables, as well as variables associated with smoking history, including number of years smoked, number of cigarettes smoked and age at quitting. Results: After 20 years of follow-up, switchers had a higher rate of death from any cause (HR 1.08, 95% confidence interval (CI) 1.01 to 1.15), lung cancer (HR 1.46, 95% CI 1.24 to 1.73}, coronary heart disease (HR 1.13, 95% CI 1.00 to 1.29) and stroke (HR 1.24, 95% CI 1.01 to 1.53) than those who quit using tobacco entirely. Conclusion: The risks of dying from major tobacco-related diseases were higher among former cigarette smokers who switched to spit tobacco after they stopped smoking than among those who quit using tobacco entirely. [ABSTRACT FROM AUTHOR]

Context: Cotinine, a metabolite of nicotine, is a marker of exposure to tobacco smoke. Previous studies suggest that non-Hispanic blacks have higher levels of serum cotinine than non-Hispanic whites who report similar levels of cigarette smoking.Objective: To investigate differences in levels of serum cotinine in black, white, and Mexican American cigarette smokers in the US adult population.Design: Third National Health and Nutrition Examination Survey, 1988-1991.Participants: A nationally representative sample of persons aged 17 years or older who participated in the survey.Outcome Measures: Serum cotinine levels by reported number of cigarettes smoked per day and by race and ethnicity.Results: A total of 7182 subjects were involved in the study; 2136 subjects reported smoking at least 1 cigarette in the last 5 days. Black smokers had cotinine concentrations substantially higher at all levels of cigarette smoking than did white or Mexican American smokers (P<.001). Serum cotinine levels for blacks were 125 nmol/L (22 ng/mL) (95% confidence interval [CI], 79-176 nmol/L [14-31 ng/mL]) to 539 nmol/L (95 ng/mL) (95% CI, 289-630 nmol/L [51-111 ng/mL]) higher than for whites and 136 nmol/L (24 ng/mL) (95% CI, 85-182 nmol/L [15-32 ng/mL]) to 641 nmol/L (113 ng/mL) (95% CI, 386-897 nmol/L [68-158 ng/mL]) higher than for Mexican Americans. These differences do not appear to be attributable to differences in environmental tobacco smoke exposure or in number of cigarettes smoked.Conclusions: To our knowledge, this study provides the first evidence from a national study that serum cotinine levels are higher among black smokers than among white or Mexican American smokers. If higher cotinine levels among blacks indicate higher nicotine intake or differential pharmacokinetics and possibly serve as a marker of higher exposure to cigarette carcinogenic components, they may help explain why blacks find it harder to quit and are more likely to experience higher rates of lung cancer than white smokers. [ABSTRACT FROM AUTHOR]

The article discusses the longitudinal cohort study on the impact of repeated cycles of pharmacotherapy on smoking cessations. It outlines the method of the study which examines the impact of the repeated cycles of pharmacotheraphy on smokers who had failed to quit during their prior medication-assisted attempts. The study found out that cessation rates were consistently higher for pharmacotherapy user and proposes the need for insurance programs treatment limitations to reexamine policies.

Introduction: Although studies have suggested that implicit attitudes may predict smoking-related decisions, evidence that changes in implicit attitudes toward smoking are related to changes in smoking behavior is lacking. Using data from a trial comparing interventions to induce quit attempts among unmotivated smokers, this study examined whether changes in implicit attitudes were associated with quit attempts and cessation after controlling for explicit motivation.Methods: Daily smokers recruited from the community completed measures of implicit attitudes (Implicit Association Test) and explicit measure of motivation to smoke at baseline, mid-intervention (week 12 [W12]) and follow-up (week 26 [W26]). Quit attempts and cessation were assessed at follow-up, and cessation was biochemically verified.Results: As hypothesized, Implicit Association Test scores became more negative from baseline to W12, a change that was sustained at follow-up. Logistic regression analyses in which implicit attitudes were used to predict smoking outcomes revealed that negative changes in implicit attitudes from baseline to W12 and from baseline to W26 were significantly related to quit attempts (OR = 0.71, 95% CI [0.52, 0.97], p < .05 for both) independent of explicit motivation. Negative changes in implicit attitudes from baseline to W26 were significantly related to cessation (OR = 0.50, 95% CI [0.25, 1.00], p < .05).Conclusions: Negative changes in implicit attitudes were associated with positive changes in smoking behavior independent of explicit motivation. This result indicates that smoking cessation interventions may be enhanced by incorporating strategies to change implicit attitudes, and that changes in implicit attitudes are also potentially important intervention outcomes.Implications: Smoking cessation interventions may be improved by going beyond the current focus on explicit psychological constructs and targeting automatic cognitive processes such as implicit attitudes. The results are encouragement to examine how best to manipulate smokers' implicit attitudes as well as to determine the effect on their smoking behavior. [ABSTRACT FROM AUTHOR]

Introduction: Despite limitations in evidence, the current Clinical Practice Guideline advocates Motivational Interviewing for smokers not ready to quit. This study evaluated the efficacy of Motivational Interviewing for inducing cessation-related behaviors among smokers with low motivation to quit.Design: Randomized clinical trial.Setting/participants: Two-hundred fifty-five daily smokers reporting low desire to quit smoking were recruited from an urban community during 2010-2011 and randomly assigned to Motivational Interviewing, health education, or brief advice using a 2:2:1 allocation. Data were analyzed from 2012 to 2014.Intervention: Four sessions of Motivational Interviewing utilized a patient-centered communication style that explored patients' own reasons for change. Four sessions of health education provided education related to smoking cessation while excluding elements characteristic of Motivational Interviewing. A single session of brief advice consisted of brief, personalized advice to quit.Main Outcomes Measures: Self-reported quit attempts; smoking abstinence (biochemically verified); use of cessation pharmacotherapies; motivation; and confidence to quit were assessed at baseline and 3- and 6-month follow-ups.Results: Unexpectedly, no significant differences emerged between groups in the proportion who made a quit attempt by 6-month follow-up (Motivational Interviewing, 52.0%; health education, 60.8%; brief advice, 45.1%; p=0.157). Health education had significantly higher biochemically verified abstinence rates at 6 months (7.8%) than brief advice (0.0%) (8% risk difference, 95% CI=3%, 13%, p=0.003), with the Motivational Interviewing group falling in between (2.9% abstinent, 3% risk difference, 95% CI=0%, 6%, p=0.079). Both Motivational Interviewing and health education groups showed greater increases in cessation medication use, motivation, and confidence to quit relative to brief advice (all p<0.05), and health education showed greater increases in motivation relative to Motivational Interviewing (Cohen's d=0.36, 95% CI=0.12, 0.60).Conclusions: Although Motivational Interviewing was generally more efficacious than brief advice in inducing cessation behaviors, health education appeared the most efficacious. These results highlight the need to identify the contexts in which Motivational Interviewing may be most efficacious and question recommendations to use Motivational Interviewing rather than other less complex cessation induction interventions.Trial Registration: This study is registered at www.clinicaltrials.gov NCT01188018. [ABSTRACT FROM AUTHOR]

Introduction In rural America cigarette smoking is prevalent, few cessation services are available, and healthcare providers lack the time and resources to help smokers quit. This paper describes the design and participant characteristics of Connect2Quit (C2Q), a randomized control trial (RCT) that tests the effectiveness and cost-effectiveness of integrated telemedicine counseling delivered by 2-way webcams mounted on desktop computers in participant's physician office examining rooms (ITM) versus quitline counseling delivered by telephone in participant's homes (Phone) for helping rural smokers quit. Methods/design C2Q was implemented in twenty primary care and safety net clinics. Integrated telemedicine consisted of real-time video counseling, delivered to patients in their primary care physician's (PCP) office. Phone counseling, was delivered to patients in their homes. All participants received educational materials and guidance in selecting cessation medications. Results The 566 participants were predominantly Caucasian (92%); 9% were Latino. Most (65%) earned < 200% of Federal Poverty Level. One out of three lacked home internet access, 40% were not comfortable using computers, and only 4% had been seen by a doctor via telemedicine in the past. Hypertension, chronic lung disease, and diabetes were highly prevalent. Participants smoked nearly a pack a day and were highly motivated to quit. Discussion C2Q is reaching a rural low-income population, with comorbid chronic diseases, that would benefit greatly from quitting smoking. ITM is a good delivery model, which integrates care by holding counseling sessions in the patient's PCP office and keeps the primary care team updated on patients' progress. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to obtain descriptions of tobacco treatment services across different substance abuse treatment settings. We conducted mixed-method assessments in eight facilities among eight directors, 25 staff, 29 clients, and 82 client charts. Measures included systems assessment, chart reviews, and semistructured interviews. Although many programs reported they offer key components of evidence-based treatment, few actually provided any treatment and none did so systematically. Many addressed tobacco as part of drug education or part of a health promotion session. Chart reviews suggested that provision of tobacco treatment is rare. By many reports, clients had to specifically request treatment and few staff reported encouraging unmotivated smokers to quit. Systems to facilitate consistent, evidence-based tobacco treatment and to implement quality improvement were nonexistent. The findings imply that drug treatment facilities may need to build capacity in several domains to deliver care that is consistent with national guidelines. [Copyright &y& Elsevier]

Cigarettes vary in tobacco blend, filter ventilation, additives, and other physical and chemical properties, but little is known regarding potential differences in toxicity to a smoker’s airway epithelia. We compared changes in gene expression and cytokine production in primary normal human bronchial epithelial cells following treatment for 18 h with cigarette smoke condensates (CSCs) prepared from five commercial and four research cigarettes, at doses of ∼4 μg/ml nicotine. Nine of the CSCs were produced under a standard International Organization for Standardization smoking machine regimen and one was produced by a more intense smoking machine regimen. Isolated messenger RNA (mRNA) was analyzed by microarray hybridization, and media was analyzed for secreted cytokines and chemokines. Twenty-one genes were differentially expressed by at least 9 of the 10 CSCs by more than twofold, including genes encoding detoxifying and antioxidant proteins. Cytochrome P450, family 1, subfamily A, polypeptide 1 (CYP1A1) and NAD(P)H dehydrogenase, quinone 1 (NQO-1) were selected for validation with quantitative real-time PCR (qRT-PCR) and Western blot analyses. NQO-1 expression determined with microarrays, qRT-PCR, and Western blotting differed among the CSC types, with good correlation among the different assays. CYP1A1 mRNA levels varied substantially, but there was little correlation with the protein levels. For each CSC, the three most induced and three most repressed genes were identified. These genes may be useful as markers of exposure to that particular cigarette type. Furthermore, differences in interleukin-8 secretion were observed. These studies lay the foundation for future investigations to analyze differences in the responses of in vivo systems to tobacco products marketed with claims of reduced exposure or reduced harm. [ABSTRACT FROM PUBLISHER]

Abstract: 4-Hydroxy-l-(3-pyridyl)-l-butanone (HPB)-releasing adducts are formed by metabolic activation of N′-nitrosonornicotine and 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone and have been proposed as specific biomarkers for exposure to tobacco smoke. However, in several studies hemoglobin adducts releasing HPB were on average less than threefold higher in smokers compared to nonsmokers. Using an improved analytical method we have recently found a sevenfold difference in DNA adduct levels in the lung from smoking and nonsmoking lung cancer patients. In the present study we extended the determination of HPB-releasing DNA adducts by gas chromatography–negative ion chemical ionization-mass spectrometry (GC–NICI-MS) to samples of peripheral lung, lower esophagus and cardia from tumor-free sudden death victims (primarily road traffic accidents, suicide and sudden cardiac arrest). The donors were classified as either current smokers or nonsmokers based on cotinine in either blood or urine (cut-off values for active smoking: >15ng cotinine/ml blood or >100ng cotinine/ml urine). Contrary to our expectation, DNA adduct levels (fmol HPB/mg DNA) in lung tissue from tumor-free smokers (N =32, 92±148) were not significantly different from values in nonsmokers (N =56, 61±66). The values in tumor-free smokers were on average more than fourfold lower compared to smoking lung cancer patients in our previous study. Adduct levels in the mucosa of esophagus (N =82; 133±160) and cardia (N =30; 108±102) of sudden death victims did not show any difference according to the current smoking status. HPB-releasing DNA adduct levels in cardia and esophagus were significantly correlated (N =29; Spearman r =0.609; p <0.001). In contrast, adduct levels in lung did not correlate with either esophagus (77 cases) or cardia (28 cases). Further studies are necessary to elucidate the discrepancies in lung DNA adduct levels in smokers with or without lung cancer and to identify obvious additional sources other than tobacco for these adducts. [Copyright &y& Elsevier]

This work was performed while Drs. Okuyemi and Ahluwalia were affiliated with the University of Kansas Medical Center.This study, which tested two motivational interviewing treatment approaches, assessed the feasibility of conducting a community‐based smoking cessation intervention among homeless smokers. Participants ( N = 46) were recruited from multiple facilities in the Kansas City area and were randomized to two counseling conditions in which they received five individual motivational interviewing sessions, six group meetings, and their choice of 8 weeks of 21‐mg nicotine patch or 4‐mg nicotine lozenge. The two counseling conditions consisted of motivational interviewing targeted either to smoking behaviors exclusively (smoking only) or to smoking and other addictions or life events that could affect ability to quit (smoking plus). Group meetings were designed to provide educational information and social support. Measures of feasibility assessed included the proportion of participants who returned for randomization among those eligible, adherence to prescribed nicotine replacement therapies, retention rates at the week 26 final study visit, and biochemically verified 7‐day abstinence at week 26. Most participants (69.6%) chose nicotine patches, and 32% of those participants reported using at least four patches per week. Carbon monoxide verified 7‐day abstinence rates in the smoking‐only and smoking‐plus groups were 13.04% and 17.39% ( ns ), respectively, at week 8 and 8.70% and 17.39% ( ns ), respectively, at week 26. Participants who used at least four patches per week were more likely to have quit at 8 weeks than were those who used fewer patches (33.3% vs. 10.5%, p = .30). Results support the feasibility of conducting a smoking cessation intervention among homeless smokers. Findings also show promising effects for nicotine replacement therapy and counseling in this population. Developing programs to improve smoking cessation outcomes in underserved populations is an essential step toward achieving national health objectives and for ultimately reducing tobacco‐related health disparities. [ABSTRACT FROM AUTHOR]

Smoking prevalence among homeless persons is approximately 70%, yet little is known about tobacco use patterns or smoking cessation practices in this population. We assessed smoking attitudes and behaviors, psychosocial and environmental influences on smoking, barriers to and interest in quitting, and preferred methods for cessation among some homeless smokers. Six 90‐min focus groups of current smokers ( N = 62) were conducted at homeless service facilities. Participants had a mean age of 41.5 years ( SD = 9.3), were predominantly male (69.4%) and African American (59%), and smoked an average of 18.3 cigarettes/day. Although most reported that they were motivated to quit, a number of barriers to quitting were identified. Participants reported that the pervasiveness and social acceptance of tobacco use in homeless settings contributed to smoking more cigarettes per day, adopting alternative smoking behaviors such as smoking cigarette butts and making their own cigarettes, and experiencing difficulty in quitting. High levels of boredom and stress also were cited as reasons for continued smoking. Smoking frequently occurred in combination with alcohol or illicit drug use or to achieve a substitute “high.” Most participants (76%) reported that they planned to quit smoking in the next 6 months. Many were interested in using pharmacotherapy in combination with behavioral treatments. Results suggest that, although motivated to quit smoking, homeless smokers are faced with unique social and environmental barriers that make quitting more difficult. Interventions must be flexible and innovative to address the unique needs of homeless smokers. Smoking restrictions at homeless service facilities and funding for smoking cessation assistance in this underserved population may help to reduce prevalence. [ABSTRACT FROM AUTHOR]

Approximately one-fourth of all cigarettes sold in the United States are mentholated. An understanding of the consequences, patterns, and correlates of menthol cigarette use can guide the development and implementation of strategies to reduce smoking prevalence and smoking-attributable morbidity and mortality. This paper summarizes the literature on the health effects of mentholated cigarettes and describes various patterns of use as indicated by consumption and survey data from the United States and other nations. The epidemiological literature on menthol cigarettes and cancer risk is inconclusive regarding whether these cigarettes confer a risk for cancer above that of nonmentholated varieties. Available data indicate that mentholated cigarettes are at least as dangerous as their nonmentholated counterparts. In addition, because mentholation improves the taste of cigarettes for a substantial segment of the smoking population and appears to mask disease symptoms, this additive may facilitate initiation or inhibit quitting. Menthol market share is high in the Philippines (60%), Cameroon (35%-40%), Hong Kong (26%), the United States (26%), and Singapore (22%). Newport has become the leading menthol brand in the United States. Surveys from four nations indicate that menthol use among adult smokers is more common among females than males. Among U.S. smokers, 68.9% of Blacks, 29.2% of Hispanics, and 22.4% of Whites reported smoking a mentholated variety. Research is needed to better explain factors that may influence menthol preference, such as marketing, risk perceptions, brand formulation, and taste preferences. Such research would guide the development of potentially more effective programs and policies. [ABSTRACT FROM AUTHOR]

Tobacco-specific nitrosamines (TSNAs) are one of the major classes of carcinogens found in tobacco products. As part of collaborative efforts to reduce tobacco use and resulting disease, the U.S. Centers for Disease Control and Prevention (CDC) carried out a two-phase investigation into the worldwide variation of the levels of TSNAs in cigarette tobacco. In the first phase, representatives of the World Health Organization (WHO) purchased cigarettes; scientists from the CDC subsequently measured the levels of TSNAs in tobacco from 21 different countries. Although the data collected from this initial survey suggested that globally marketed U.S.-brand cigarettes typically had higher TSNA levels than locally popular non-U.S. cigarettes in many countries, the number of samples limited the statistical power of the study. To improve statistical power and to ensure adequate sampling, the CDC conducted a second survey of 14 countries. In addition to the United States, the CDC selected the world's 10 most populous countries and three additional countries, so that at least two countries from each of the six WHO regions were represented. For each country, the CDC compared 15 packs of Marlboro cigarettes, which is the world's most popular brand of cigarettes, with 15 packs of a locally popular non-U.S. brand in the study country. Marlboro cigarettes purchased in 11/13 foreign countries had significantly higher tobacco TSNA levels than the locally popular non-U.S. brands purchased in the same country. The findings suggest that TSNA levels in tobacco can be substantially reduced in some cigarettes. [ABSTRACT FROM AUTHOR]

Abstract: A study was performed to determine whether cigarettes were smoked more intensely outside of public venues in Scotland, compared to indoors, after introduction of the public place smoking (PPS) ban. It was conducted in three waves: before the ban, immediately after and 6months after introduction. The study included 322 regular smokers of four cigarette brand variants. Filter analysis measurements were used to estimate the human-smoked yields of tar and nicotine from cigarettes smoked predominantly inside (before the ban) or outside (after the ban) public venues. Self-reported cigarette consumption data were also collected. Numbers of cigarettes smoked indoors in public places fell dramatically after the ban. There was a corresponding rise in smoking incidence in outdoor public locations. The ban did not significantly affect the total number of cigarettes smoked by the subjects over the weekends investigated. Human-smoked yields of tar and nicotine decreased slightly after the introduction of the ban and some reductions were significant. Therefore, smoking outdoors at public venues, following the PPS ban, did not increase smoking intensity. Any changes in smoking behaviour that may have occurred had little effect on mainstream smoke exposure or cigarette consumption for those that continued to smoke. [Copyright &y& Elsevier]