Effectiveness of Nicotine Withdrawal Symptoms Management Program Using LINE Application to Increase Self-Efficacy for Industrial Workers

Background: Smoking is a risk factor for chronic diseases. A combination of tobacco use with occupational hazards among industrial workers could increase the risk of occupational disease and injury. Nicotine is known to be highly addictive. It is difficult not only to maintain the decrease in smoking but also to continue quitting tobacco use. Moreover, nicotine withdrawal can be challenging and lead to failure in the smoking cessation process. Self-efficacy theory has been used recently for the development of effective smoking cessation programs. Objective: To develop an online nicotine withdrawal symptoms management program based on self-efficacy theory and examine its effectiveness. Materials and Methods: A quasi-experimental design with a control group pretest-posttest design was used. The sample consisted of male employees working in a consumer product manufacturing industry in Bangkok. An intervention group (n=28) received an online nicotine withdrawal symptoms management program via LINE application based on self-efficacy theory for one month. In comparison, participants in the control group (n=29) received a conventional smoking cessation program. The effectiveness of the intervention on nicotine withdrawal symptoms, cigarette craving, self-efficacy perception of nicotine withdrawal management, cigarette rolls per day, nicotine dependence level, exhaled carbon monoxide level, and smoking cessation behavior the first and fourth week were examined using a repeated-measures analysis of variance. Results: At one-month follow-up, there were significant differences between the two groups on nicotine withdrawal symptoms score, cigarette craving level, self-efficacy perception of nicotine withdrawal management, cigarette rolls per day, nicotine addiction level, exhaled carbon monoxide level, and smoking cessation behaviors (p<0.001). In addition, there was a significant difference in the self-reported nicotine withdrawal symptoms score in terms of irritability, anger, anxiety, concentration deficit, depression, and insomnia (p<0.001) between groups, between times, and between times and groups (p<0.001). Conclusion: Nicotine withdrawal symptoms management program using LINE application is effective in encouraging smoking cessation. Keywords: Smoking cessation; Nicotine withdrawal symptoms; LINE application; Industrial workers

Effects of electronic cigarette e-liquid flavouring on cigarette craving

BackgroundE-liquid flavour restrictions may discourage electronic cigarette (e-cigarette) uptake among youth. However, possible unintended consequences may include reduced appeal and effectiveness of e-cigarettes for smoking cessation. Non-tobacco flavours appear to be important for smoking cessation, but how and why are currently unclear.MethodsWe conducted an experimental study in a UK sample of adult daily smokers using an independent groups design (N=84). Participants were randomised to use an e-cigarette with nicotine-containing fruit/sweet-flavoured e-liquid (blackcurrant, strawberry, vanilla, caramel) or unflavoured e-liquid for 1 week. The primary outcomes were average, peak and cue-elicited cigarette craving (the latter was assessed using a cue exposure task). The secondary outcomes were smoking lapse occurrence, enjoyment of the e-cigarette, ease of transitioning from smoking to using an e-cigarette, intentions to continue using an e-cigarette, intentions and motivation to quit smoking, return to smoking, and continuation of e-cigarette use.ResultsE-liquid flavouring did not appear to have an effect on average cigarette craving (b 0.18, 95% CI −0.44 to 0.79, p=0.57), peak cigarette craving (b −0.12, 95% CI −0.59 to 0.35, p=0.62) or cue-elicited cigarette craving (b −0.21, 95% CI −3.86 to 3.43, p=0.91). We did not find evidence of a difference in secondary outcomes.ConclusionsWe did not find evidence to suggest that nicotine-containing fruit/sweet-flavoured and unflavoured e-liquids have different effects on cigarette cravings after 1 week of use. Further research is needed to establish if differences emerge over longer periods of exposure and extend to smoking cessation outcomes.

Effects of Electronic Cigarette E-Liquid Flavouring on Cigarette Craving

Several countries have implemented policies restricting flavoured e-cigarette products, although the impact on smokers is unclear. Here, smokers randomised to use an e-cigarette with flavoured (fruit/sweet) or unflavoured nicotine-containing e-liquids for one week did not differ in cigarette craving, experiences of using e-cigarettes, or smoking cessation intentions/motivations. Further research is needed to establish if differences emerge over longer periods of exposure, and whether there is any effect on smoking cessation. These findings suggest that, during an initial switch from smoking to using e-cigarettes, there may be little impact of using unflavoured e-liquids on cigarette craving if fruit/sweet-flavoured e-liquids are restricted.

Sex Differences in the Association of Cigarette Craving with Insula Structure

Background Cigarette craving, which can negatively impact smoking cessation, is reportedly stronger in women than in men when they initiate abstinence from smoking. Identifying approaches to counteract craving in people of different sexes may facilitate the development of personalized treatments for Tobacco Use Disorder, which disproportionally affects women. Because cigarette craving is associated nicotine dependence and structure of the insula, this study addressed whether a person’s sex influences these associations. Methods The research participants (n=99, 48 women) reported daily cigarette smoking and provided self-reports of nicotine dependence. After overnight abstinence from smoking, they underwent structural MRI scanning to determine cortical thickness of the left and right anterior circular insular sulcus, and self-rated their cigarette craving before and after their first cigarette of the day. Results Women reported stronger craving than men irrespective of smoking condition (i.e., pre- or post-smoking) (p=0.048), and smoking reduced craving irrespective of sex (p&lt;0.001). A three-way interaction of sex, smoking condition, and right anterior circular insular sulcus thickness on craving (p=0.033) reflected a negative association of cortical thickness with pre-smoking craving in women only (p=0.012). No effects of cortical thickness in the left anterior circular insular sulcus were detected. Nicotine dependence was positively associated with craving (p&lt;0.001) across groups and sessions, with no sex differences in this association. Conclusions A negative association of right anterior insula thickness with craving in women only suggests that this region may be a relevant therapeutic target for brain-based smoking cessation interventions in women.

Effects of Visual Exposure to IQOS Use on Smoking Urge and Behavior

Objectives: In this study, we examined whether visual exposure to the heated tobacco product (HTP) IQOS, which was authorized for sale by the US Food and Drug Administration in 2019, acts as a cue to increase cigarette craving and smoking behavior among smokers. Methods: Young adult smokers (N = 105) were randomly assigned to view a video depicting use of either IQOS or bottled water. Main outcomes were changes in cigarette and e-cigarette desire and latency to smoke between the groups. We also examined participants' attitudes about the actors using IQOS and drinking water in the videos. Results: Exposure to the use of IQOS acutely increased observers' ratings of smoking urge and desire for a cigarette and an e-cigarette. The IQOS cue, compared with the water cue, also produced a marginally significant shorter latency to smoke. Participants perceived actors as less likeable and friendly when using IQOS than when drinking water. Conclusions: Results showed that exposure to IQOS produced smoking urge and behavior in young adult smokers, implicating IQOS use as a smoking and vaping cue. As HTPs gain popularity, product impact on passive observers should be included in their risk-benefit profile.

Level of abstinence mediates heart-rate response to cue-elicited craving in smokers

The subjective and autonomic components of nicotine craving were examined in abstinent and non-abstinent smokers using a cue reactivity paradigm. A cigarette abstinent condition was used to examine how smoking deprivation mediates the activity of positive and negative reinforcement mechanisms. Levels of craving and physiologic responses were monitored during the presentation of videotaped neutral and smoking stimuli. Relative to the neutral material, smoking stimuli increased several indices of subjective craving in both abstinent and non-abstinent smokers. Autonomic responses to the smoking stimuli however, appeared to be mediated by the level of abstinence. Non-deprived smokers showed an increase in heart rate during the first minute of the smoking stimuli presentation relative to the first minute of the control video, while abstinent smokers showed no change. The autonomic responses of cigarette craving may be dependent on the perceived reinforcing value of cigarettes, which can be modulated by cigarette abstinence. These findings are consistent with the hypothesis that increased heart rate may be a marker for incentive motivation, but also strongly support a multi-dimensional model of nicotine craving. Furthermore, they stress the importance of recognising the condition of the smoker as a critical determinant in craving responses.