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Smoking represents a major public health problem because of its high morbidity and mortality rates. Nearly half of the deaths in the lower class are caused by smoking. The socially deprived are physically and psychologically vulnerable. The instability of their situation increases the difficulty to invest in smoking cessation and certain time orientations linked to this social deprivation represent negative factors in the prognosis. Socially deprived populations do not understand the consequences of smoking unless they are in denial of the risks. The motivation to stop is essentially financial. The perception of smoking cessation is taken as a deprivation of pleasure. Independently of the social deprivation factors, taking into account the time perspective conveys necessary information of appropriate care.

Smoking is the primary cause of avoidable deaths in developing countries; it is the principal cause of many illnesses and is risk factor or aggravated cause. Cigarettes or smokeless tobacco have a direct or indirect toxicity effect on practically every organ. The induced diseases are cardiovascular, cancers, respiratory complaints and many consequences less well known but often serious. There is no smoking without risk; however, stopping smoking at any age is beneficial.

Background: Smoking addiction and tobacco dependence are related to social deprivation and time perspective. The objective of this study was to understand how these factors influenced the results of smoking cessation in order to optimize the care of this population., Methods: We included 200 patients from our outpatient clinic from March 1, 2009 to June 30, 2010. This study focused on the impact of social disadvantages and time perspective on smoking cessation. Time perspective was measured with the short version of the Zimbardo Time Perspective Inventory, social disadvantages with Epices scale. Information on each individual's characteristics, smoking addiction, and smoking cessation was collected., Results: One hundred and ninety-two patients (of whom 45% were socially disadvantaged) participated. Socially disadvantaged people tend to lean towards dimensions "Past Negative" (P<0.0001), "Present Fatalistic" (P<0.0001) and are less likely to foresee themselves in the future (P<0.0002) compared with the rest of the population. Their decision to stop smoking reveals they are more motivated for financial reasons (P<0.0001) and their attempts more often end in failure (P=0.006). In addition, they have, more frequently, anxiodepressive problems (P<0.0001) and a higher level of nicotine dependence (P<0.0001)., Conclusion: The results highlight the importance of taking into account the social disadvantages and time perspective in helping these addicted patients to stop smoking., (Copyright © 2011. Published by Elsevier Masson SAS.)

The use of snus (smokeless tobacco) can be detrimental to health. Containing carcinogenic nitrosamines (Swedish snus do not contain nitrosamine). Snus delivers rapidly high doses of nicotine which can lead to dependence. It do not induce bronchial carcinoma differently smoked tobacco. Lesions usually develop in the area of the mouth where the snus is placed. Non-malignant oral lesions include leukoedema, hyperkeratotic lesions of the oral mucosa and localised periodontal disease. The most frequently occurring premalignant lesion is leukoplakia. Studies reveal conflicting evidence about the risk of oral and gastroesophageal cancer with regard to snus users. However, the use of snus has proved to be a risk factor in developing pancreatic cancer and increases the risk of fatal myocardial infarction and ischemic stroke. During pregnancy, snus is associated with an increased risk of pre-eclampsia and premature delivery. Nicotine substitution therapy and bupropion and varenicline reduce withdrawal symptoms and tobacco craving during snus cessation. However, they have not been shown to assist in long-term abstinence. Information concerning potential hazards of using snus products must be incorporated into health educational programmes in order to discourage its use. Snus is not a recommended product to help in stopping to smoke., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Background: Substance and behavioral addictions have already been described separately or in combination in Parkinson's disease. However, no comparisons of the prevalence of addictive behaviors in patients with Parkinson's disease and the general population have been published. The objective of this study was to compare the prevalence and characteristics of addictions (gambling, hypersexuality, tobacco, and alcohol) in patients with Parkinson's disease and in a matched, paired sample from the general population., Methods: After matching for age, sex, and complete field questionnaires on addictions, we had 115 data sets., Results: No difference was observed between Parkinson's disease and control populations concerning pathological gambling (0.87% vs 0.87%, P = .99), tobacco addiction (1.7% vs 1.7%, P = .99), and alcohol dependence (2.6% vs 3.5%, P = .71). The Parkinson's disease group showed 2 cases of sexual addiction (1.7% vs 0, P = .15)., Conclusions: Our results indicate that patients with Parkinson's disease do not have specific profiles for tobacco or alcohol addiction and pathological gambling compared with the general population., (Copyright © 2011 Movement Disorder Society.)

Smoking addiction and smoking behaviour are closely related to social deprivation. The aim of this study was to evaluate the impact of social deprivation and time perspective on smoking cessation in order to improve the support provided to socially deprived persons seeking to quit smoking. The study examined the impact of social disadvantages and time perspective on smoking cessation. 192 patients (including 45% of socially disadvantaged people) participated in the study. Social deprivation was measured using the EPICES scale, while time perspective was measured using the short version of the Zimbardo Time Perspective Inventory. Data relating to individuals' characteristics, smoking addiction, behaviour and smoking cessation were collected as part of this research. Compared to the rest of the population, socially disadvantaged people were found to be more likely to stop smoking for financial reasons (p < 0.0001). The study also found that their attempts to quit smoking are more likely to fail (p = 0,006). In addition, socially disadvantaged people suffer more frequently from anxio-depressive disorders (p < 0.0001) and are also prone to a higher level of nicotine dependence (p < 0.0001). The 'Past-Negative' and ?Present-Fatalistic' dimensions of time perspective, toward which socially disadvantaged people are more likely to lean (p < 0.0001), are associated with failed smoking cessation. The ?Future' dimension, in which socially disadvantaged people are less likely to project themselves (p < 0.0002), is a predictive factor of smoking cessation. The results highlight the importance of taking into account social deprivation and time perspective in helping socially disadvantaged patients to quit smoking.

Aims: To assess the efficacy of nicotine replacement therapies (NRT) when the daily dose was adapted according to saliva cotinine concentrations., Design: Randomized, multi-centre, single-blind, controlled trial., Setting: Twenty-one smoking cessation clinics in France., Participants: A total of 310 smokers with medical comorbidities, motivated to quit, smoking ≥ 10 cigarettes/day, for whom smoking cessation was mandatory. NRT was administered for 3 months. The standard care group received nicotine patches with monthly dose decreases; buccal absorption NRT could be co-administered at the discretion of the investigator. In the dose adaptation group, the aim was a 100 ± 5% nicotine substitution with respect to smoking state based on the determination of saliva cotinine concentrations. NRT daily doses were prescribed according to the previous week's saliva cotinine concentrations in the dose adaptation group; saliva cotinine concentrations were not provided in the standard care group., Measurements: Prolonged abstinence rate (weeks 9-12, main outcome measure), point-prevalence and continuous abstinence rate, saliva cotinine concentration, NRT daily dose, craving for cigarettes., Findings: The median daily prescribed NRT dose was 30 and 31 mg/day in the first study week and 17.25 and 35.5 mg/day during weeks 9-12 in the standard care group and dose adaptation group, respectively. Saliva cotinine remained stable in the dose adaptation group and decreased in the standard care group (P < 0.01) by weeks 9-12. The cotinine substitution rate was significantly lower in the standard care group than in the dose adaptation group. Despite differences in NRT doses and cotinine substitution rates, prolonged (standard care group: 26.4%, dose adaptation group: 30.3%), continuous (standard care group: 8%, dose adaptation group: 12%) and point-prevalence abstinence rates were similar., Conclusions: In smokers with medical comorbidities and highly motivated to quit, adaptation of the nicotine replacement therapy daily dose according to saliva cotinine does not appear to be substantially superior to standard nicotine replacement therapy use., (© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

Tobacco smoking is a well-recognized risk factor for Legionnaires disease. However, it may be potentiated by cannabis use, as there is strong evidence that Δ(9)-tetrahydrocannabinol impairs immune functions in vitro and in vivo. We report herein two out of three cases of severe Legionnaires disease in three men with no overt comorbid illnesses, aged 38, 28, and 48 years, respectively. All of them were heavy cigarette and cannabis smokers.

Objectives: Cigarette smoking induces cardiovascular pathology and worsens arterial stiffness. Arterial stiffness can be assessed noninvasively based on 2 indices: pulse-wave velocity (PWV), indicating aortic stiffness, and the augmentation index (AIx), indicating aortic wave reflection. The impact of smoking cessation (SC) with nicotine replacement therapies (NRT) on arterial stiffness remains unknown., Methods: AIx and PWV were studied prospectively (using a SphygmoCor system) in 26 long-term smokers (>10 cigarettes/day; mean age 43 ± 6 years) before (visit 1) and 28 and 56 days (visit 2 and visit 3) after SC supported by NRT. Abstinence was ascertained when exhaled carbon monoxide (CO) was <10 ppm; the quantity of NRT absorbed was assessed based on the serum cotinine level., Results: Sixteen of 24 patients (67%) were abstinent at the end of the study; 8/24 had cut down on smoking, and 2 were lost to follow-up. CO and serum cotinine levels fell after SC. The mean AIx for the population as a whole was 23.4% at visit 1, with a significant early reduction by visit 2 (16.2%) and visit 3 (13.9%) (ANOVA, p < 0.001). The PWV, peripheral blood pressure, and heart rate were unchanged., Conclusions: The improvement in AIx and the stability of PWV after SC with NRT indicate improved peripheral vascular tone. This impact may account for the early clinical benefit of SC observed even when associated with NRT., (Copyright © 2010 S. Karger AG, Basel.)

Introduction: Varenicline (Champix) was approved in France in 2006 as an aid to smoking cessation treatment. Although there is a consensus on its efficacy, its tolerability is debatable. This article sought to clarify its tolerability profile in current medical practice., Materials and Methods: This retrospective study examined tolerance of varenicline prescribed to smokers who wanted to quit smoking in 10 "Stop-Smoking" consultation centers around France. It included all patients who used varenicline during the one-year (February 12, 2007, to February 12, 2008) study period., Results: At least one adverse event (AE) was reported by 45.9% of the 338 patients, with a total of 343. AE incidence was higher among women (51.5%) than men (40.5%) (OR=1.56, 95% CI: 0.99-2.47, p=0.026). There were 32 unexpected AEs, that is, not listed in the initial new drug application, reported by 23 patients, including 19 psychiatric AEs. Of the 8 serious AEs, 3 were of neurological origin., Conclusion: This retrospective study confirmed the tolerability issues for varenicline, identified during the phase II-phase III development program and confirmed afterwards. It raises the following questions: Should varenicline be prescribed as a second-line therapy? Is there a patient type for which varenicline would be more - or less - appropriate? Can the tolerability profile be improved by reducing dosage while maintaining the level of efficacy or by co-administering symptomatic treatment more systematically? These are questions that new studies evaluating varenicline tolerability should answer., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Introduction: Smoking cessation therapies help well motivated smokers give up and increase the chance of success., Background: Medical, behavioural and cognitive cessation therapies are aimed at relieving the secondary effects of stopping smoking: withdrawal symptoms and the urgent need to smoke. A prolonged follow up helps to prevent relapse., Viewpoint: The education of doctors and the development of new drugs should increase the rate of successful withdrawal., Conclusion: All doctors, particularly respiratory physicians, should be involved in smoking cessation. The aim of this practical guide is to help them in everyday practice.

Active and passive smoking is a health risk and its toxicity during pregnancy is well known; nevertheless, in France, nearly 30% of pregnant women smoke. The aim of this study is to describe the toxic effects of smoking during pregnancy by a review of the international literature. At the outcome of this study, it appears that besides the well known effects of smoking on pregnancy, foetal development and state of health of the mother and child, other effects may be encountered such as neuropsychiatric, infections, endocrine, metabolic and cardiorespiratory events. While complementary studies are necessary to define the nature of the relationship between the observed effects and smoking, this study underlines the fact that the reduction of prevalence of smoking in pregnant women is a major health issue.