Efficacy of providing free nicotine replacement chewing gum to induce quit attempts in tobacco users- A prospective observational study

To assess the effectiveness of providing free NRT to tobacco users in increasing quit attempts and to assess the perception of adherence, side effects and safety issues related to the usage in increasing quit attempt. A observational study was conducted to motivate tobacco users to have a quit attempt with a nicotine replacement sample among patients visiting out-patient department of a dental college. Baseline evaluation (demographic), Modified Fagerstrom test for Nicotine Dependence (MFTND) to assess nicotine addiction level, “breath analyzer” for the quantitative detection of levels of carbon monoxide were assessed. A free NRT sample was given. Telephonic follow up was done at an interval of 2 weeks, 1 month to assess the reduction in the mean MFTND score and to assess the perception of using NRT sample. All data was entered and analysed in SPSS for Windows version 22. Among the 40 subjects 80% were in the age group of 30-50 years and were males. The levels of carbon monoxide using breath analyser showed 80% of the subjects as heavy and chain smokers. Out of 40 subjects, 29 (72.5%) subjects were having high dependence calculated using MFTND which reduced to 2(5%) after using nicotine chewing gum. The mean and standard deviation of pre MFTND was 7.97±2.35 and for post MFTND it was 5.57±2.14 and the difference was highly significant (p< 0.005).: The results of this study confirm the efficacy of providing free nicotine replacement sample a novel strategy in motivating tobacco users to induce quit attempt.

Nicotine replacement therapy ‘gift cards’ for hospital inpatients who smoke: a prospective before-and-after controlled pilot evaluation

IntroductionA common barrier identified by individuals trying to quit smoking is the cost of cessation pharmacotherapies. The purpose of this evaluation was to: (1) Assess the feasibility of offering nicotine replacement therapy (NRT) ‘gift cards’ to hospitalised smokers for use posthospitalisation; and, (2) Estimate the effect of providing NRT gift cards on 6-month smoking abstinence.MethodsA prospective, quasi-experimental, before-and-after controlled cohort design with random sampling was used to compare patients who had received the Ottawa Model for Smoking Cessation (OMSC) intervention (‘control’) with patients who received the OMSC plus a $C300 Quit Card (‘QCI’), which they could use to purchase any brand or form of NRT from any Canadian pharmacy.Results750 Quit Cards were distributed to the three participating hospitals of which 707 (94.3%) were distributed to patients. Of the cards received by patients, 532 (75.2%) were used to purchase NRT. A total of 272 participants completed evaluation surveys (148 control; 124 QCI).Point prevalence abstinence rates adjusted for misreporting among survey responders were 15.3% higher in the QCI group, compared with controls (44.4% vs 29.1%; OR 1.95, 1.18–3.21; p=0.009). Satisfaction was high among participants in both groups, and among staff delivering the QCI. QCI participants rated the intervention as high in terms of motivation, ease of use and helpfulness.ConclusionsThe NRT gift card appears to be a feasible and effective smoking cessation tool that removes a primary barrier to the use of evidence-based smoking cessation pharmacotherapies, while motivating both patients and health providers.

Smoking Cessation Rate and Its Predictors among Heavy Smokers in a Smoking-Free Hospital in Taiwan

Smoking poses critical risks for heart disease and cancers. Heavy smokers, defined as smoking more than 30 pack-year, are the most important target for smoking cessation. This study aimed to obtain the cessation rate and its predictors among heavy smokers. We collected data from heavy smokers who visited a smoking-free hospital in Taiwan during 2017. All patients were prescribed either varenicline or nicotine replacement therapy (NRT) for smoking cessation, and their smoking status was followed for six months. Successful smoking cessation was defined by self-reported no smoking over the preceding seven days (7-day point abstinence). In total, 280 participants with a mean aged of 53.5 years were enrolled, and 42.9% of participants successfully stopped smoking in 6 months. The results revealed that quitters were older, with hypertension, fewer daily cigarettes, and being prescribed with varenicline. Multiple logistic regressions analyses identified that fewer daily cigarettes and being prescribed with varenicline were predictors of successful smoking cessation. Therefore, we suggest that varenicline use may help heavy smokers in smoking cessation.

Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy within Pregnant Women (Preprint)

BACKGROUND Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended. OBJECTIVE In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT), investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires. METHODS Women aged ≥16, who were daily smokers <25 weeks pregnant, were offered cessation counselling and encouraged to use NRT. Women set quit dates (QD) and, for 28 days afterwards, were asked to report NRT use daily to a smartphone app and to questionnaires administered in-person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 in compensation for time taken providing research data. Data completeness and NRT use reported to app and questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of QD with Day 7 saliva cotinine concentrations. RESULTS Of 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median days submitted=25 [IQR 11]) than completed the Day 28 questionnaire (24/35). Data submitted to the app showed a lower reported duration of NRT use compared to the questionnaire (median days NRT for app=24 [IQR 10.25]; questionnaire=28 [4.75], P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses (mg) between QD and Day 7 were lower when calculated using app data (median mg for app=40 [52.1]; questionnaire=40 [63.1], P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app r=0.184, P=.55; questionnaire r=0.031, P=.92). CONCLUSIONS Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. Although data from neither method was significantly associated with cotinine concentrations, app data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some.

A dohányzásleszokás-támogatás első vonalbeli gyógyszeres terápiájának aktualitásai

Összefoglaló. A dohányzás jelenleg is az egyik legjelentősebb népegészségügyi probléma hazánkban. Az orvosi szakterületek többségében előkerül a dohányzásleszokás-támogatás kérdése. Ezért az orvostársadalom számára az aktuális gyógyszeres terápiás ismeretek összefoglalása hasznos lehet. A jelen közleményben a leszokástámogatás elsődlegesen választandó gyógyszeres terápiáját tekintjük át a legújabb összefoglalók és irányelvek szerint. A gyógyszeres lehetőségek közül jelenleg a vareniklin és a nikotinpótló terápia választandó elsőként, nemcsak a leszokás, hanem az ártalomcsökkentés tekintetében is. A legújabb kutatási eredmények szerint a kis dózisú vareniklin hatékonysága megközelíti a standard adagolás hatékonyságát, ugyanakkor kevesebb mellékhatás jelentkezik. A nikotinpótló kezeléssel kapcsolatban ki kell emelni, hogy egyre több tudományos evidencia áll a transdermalis és oralis készítmények kombinálása mellett, szemben a monoterápiával. A kis dózisú vareniklin, illetve a nikotinpótló terápia akkor is segítséget nyújt a naponta elszívott cigaretták mérséklésében, ha a kliens nem kíván leszokni, de a dohányzás ártalmait csökkentené. A nikotinerg rendszeren kívül más módon ható gyógyszerek szerepe is felmerült. Egyre több összefoglaló támogatja az antidepresszívumok használatát a nikotinfüggőség kezelésében. Ezek közül a bupropion használatával kapcsolatban van a legtöbb adat, amelyről tudjuk, hogy kombinálható a nikotinpótló terápiával és a vareniklinnel is. A gyógyszeres terápiát minden esetben tanácsos magatartásorvoslási módszerekkel, illetve adherenciát fokozó intervenciókkal kombinálni. Ezenkívül a szakellátási szint bevonása is javasolt, hogy a lehető legtöbb segítséget kapja meg a páciens a leszokáshoz. Orv Hetil. 2021; 162(40): 1610–1618. Summary. Smoking is still one of the most significant public health problems in Hungary. The issue of smoking cessation support comes up in most medical specialties. Therefore, a summary of the current pharmacotherapeutic knowledge may prove useful to the medical community. In this paper, we review the first-line pharmacotherapy for smoking cessation based on the latest summaries and guidelines. Regarding the smoking cessation agents, varenicline and nicotine replacement therapy are currently the primary choice, not only in terms of cessation but also in terms of harm reduction. The results of previous studies suggest that the efficacy of low dose varenicline is close to that of standard dosing, with fewer side effects. With regard to nicotine replacement therapy, it should be emphasized that there is an increasing scientific evidence for the combination of transdermal and oral formulations as opposed to monotherapy. Low dose varenicline and nicotine replacement therapy also help reduce the number of cigarettes smoked daily if the client does not want to quit but would reduce the harms of smoking. The role of medications acting in other ways than the nicotinergic system has also emerged. An increasing number of reviews support the use of antidepressants in the treatment of nicotine addiction. Of these, most data are available on the use of bupropion, which is known to be combined with nicotine replacement therapy and varenicline. In all cases, it is advisable to combine pharmacotherapy with behavioral therapy as well as interventions that increase adherence. In addition, it is also recommended to include specific therapeutic interventions in order to get as much help as possible for the patient to quit smoking. Orv Hetil. 2021; 162(40): 1610–1618.