E-visits tested as way to help people to quit smoking

Primary care is the best way to reach smokers, but primary care providers in rural areas – where people are more likely to smoke – are already overwhelmed. A study seeks to use e-visits to bridge the gap

Grant and Award Announcement

MEDICAL UNIVERSITY OF SOUTH CAROLINA

People who live in rural areas are both more likely to smoke and less likely to quit than people in nonrural areas, said MUSC Hollings Cancer Center researcher Jennifer Dahne, Ph.D.

Dahne, a clinical psychologist who focuses on cigarette smoking among vulnerable populations, wants to reach these people and help them to become former smokers – and along the way reduce their risks for a dozen kinds of cancer.

Dahne also serves as the co-director of remote and virtual trials for the South Carolina Clinical & Translational Research Institute based at MUSC. A remote trial, anchored by the primary care providers in their communities whom patients know and trust, looked like a possibility to help people in rural areas to quit smoking.

She’s now leading a team of researchers and clinicians, including primary care providers in communities served by MUSC Health-Florence Division and MUSC Health-Lancaster Division, on a $4.6 million grant from the National Cancer Institute to test whether a proactive electronic visit would help to promote smoking cessation.

Florence Division Chief Medical Officer Rami Zebian, M.D., is excited about the opportunity to get smoking cessation help to more people.

“This is something that's very much needed in our areas,” he said. “The percentage of smokers in Florence and Marion is huge, much higher than Charleston.”

Tobacco has been integral to the Pee Dee economy since the late 19th century. Zebian said he talks to many people who say they put their kids through college on tobacco farming. But they also note that they see the long-term effects of smoking – heart disease, strokes and cancer. As a pulmonologist, Zebian deals with some of those effects, like chronic obstructive pulmonary disease and lung cancer. And he sees a pattern among his patients.

“Every single one of my patients who has quit smoking, they all tell me one thing. They say, ‘I wish I quit sooner.’”

Dahne said that primary care is one of the best places to reach people with smoking cessation aids.

“Every time you go to your doctor, they are screening you for smoking. So, we actually have pretty good data in our electronic health record to identify our patients who smoke. And we know that most adults who smoke in this country receive care for smoking cessation from their primary care providers, and that smokers are visiting primary care providers pretty regularly,” she said.

But primary care providers are swamped.

Dahne said primary care providers have told them that while they really care about helping their patients to quit smoking, they are so busy when they have in-person appointments, managing, for example, hypertension medications, doing diabetic foot exams and everything else, that oftentimes talking about smoking cessation might fall by the wayside.

Edward McCutcheon, M.D., chief medical officer of the Lancaster Division, agreed that fitting it in is a challenge.

“There's just a tremendous number of priorities that have to be addressed in a single physician visit,” he said. “Trying to convince somebody to quit smoking in a matter of minutes just doesn't happen. Patients have become dependent on tobacco, and it’s something that has happened over years. Trying to discuss the physiology and the dependency on nicotine can be a challenge, and then trying to discuss treatment options and therapy requires a lot more time.”

Instead, during this trial, patients who are identified as smokers will receive messages through MyChart inviting them to take part in e-visits for smoking cessation. The e-visits were developed during a pilot trial that showed promising results.

Dahne explained that the e-visits will look like a questionnaire. Patients will answer questions about their smoking histories, how much they smoke and whether and how they’ve tried to quit in the past. An algorithm will then present a recommendation for a smoking cessation treatment for each participant. The algorithm prioritizes the most efficacious FDA-approved medications for smoking cessation, including varenicline, a medication better known by its brand name, Chantix. At that point, patients will have the option to agree with the recommendation or request a different approach.

The computer program doesn’t do the prescribing, though. A record of the entire e-visit will be sent to the patient’s primary care provider to review, and the provider can either prescribe the recommended medication or recommend a different plan based on the patient’s medical history. In addition to medications, all patients are provided with referrals for behavioral support to either the South Carolina Tobacco Quitline or to MUSC’s tobacco treatment program. Plus, Dahne said, the providers will be compensated for the e-visit review, so the program isn’t merely adding paperwork to their days.

At the same time that this clinical trial is running in rural areas, Dahne is running a similar trial with another grant at primary care practices affiliated with MUSC Health Charleston.

“I'm really excited to have these two grants running at the same time,” Dahne said. “We’re evaluating whether this proactive electronic visit approach works to help promote smoking cessation within these rural areas and the unique implementation barriers and facilitators within these rural clinical settings. My guess is that implementation factors are very much going to differ within our rural primary care clinics and clinics that are here as part of MUSC Charleston.”

Zebian said that quitting smoking can improve health and quality of life no matter a person’s age or health status.

“A lot of times people have misconceptions like, ‘Well, my lungs are already damaged. So what's the benefit of quitting now?’” he said. But even people with lung damage can avoid needing to use oxygen if they quit, and even people who need oxygen can add months or years to their lives by quitting. People with cancer – either lung cancer or some other type of cancer – will find their bodies respond better to treatment if they quit smoking.

“We all age. We all lose lung function,” he said. “But how fast we lose lung function is very different in people who are smokers and people who do not smoke.”

For help to quit smoking, contact the MUSC Health Tobacco Treatment Program at 843-792-9101.

About MUSC Hollings Cancer Center

MUSC Hollings Cancer Center is South Carolina’s only National Cancer Institute-designated cancer center, with the largest academic-based cancer research program in the state. The cancer center comprises more than 120 faculty cancer scientists and 20 academic departments. It has an annual research funding portfolio of more than $44 million and is dedicated to preventing and reducing the cancer burden across South Carolina. Hollings offers state-of-the-art diagnostic capabilities, therapies and surgical techniques within multidisciplinary clinics that include surgeons, medical oncologists, radiation therapists, radiologists, pathologists, psychologists and other specialists equipped for the full range of cancer care, including more than 200 clinical trials across South Carolina. For more information, visit hollingscancercenter.musc.edu.

BIG TOBBACCO LOSES

NZ

Survey shows milestone drop in smoking among Pasifika youth

Jan Kohout, Journalist
jan.kohout@rnz.co.nz


Photo: 123rf

A newly-released survey shows daily tobacco smoking rates for New Zealand Pasifika youth are at a record low of less than 2 percent.

With just 1.2 percent of Pasifika smoking daily, that is significantly less than what it used to be in 2017 when it was at 5.3 percent.

Published by Action for Smokefree 2025 (ASH), the survey is one of the largest ongoing youth smoking surveys in the world, with 29,538 Year 10 student participants, aged between 14 and 15.

The survey looks at both vaping and tobacco use.

It found that 45 percent of Pacific Year 10 students had tried vaping, 11 percent vaped daily as opposed to 1.2 percent who were daily tobacco smokers, and 2.6 percent were regular (ie, either daily weekly, monthly) smokers.

ASH director Sir Collin Tukuitonga, who is a strong advocate for Māori and Pacific health, credits the decrease in smoking rates to various smokefree messages throughout the years in Aotearoa and a general acceptance from youth that smoking is not sustainable.

"But I think what has worked generally is the messages to young people that smoking is not cool and they used prominent people to promote that message to really get young people to accept a movement away from smoking."

Tala Pasifika lead for Hapai Te Hauora's National Tobacco Control Advocacy service, Lealailepule Edward Cowley said there was a gap between people already smoking, compared to those in the 14-15 age group who could not legally purchase tobacco which showed not all age groups had stopped smoking.

"It's difficult for young people to access tobacco, which is probably why we see a drop. We really do see an increase from age 18 to 24, so whilst they are at a young age when they are at school we see a decrease when they start working and earning their own money, then are able to access and start to purchase things they want to purchase so we do see an increase in that age group."

Cancer Society medical director George Laking said adults most likely remained smokefree if they had not taken up smoking in their teenage years.

The Cancer Society's Dr George Laking Photo: Supplied

"The initiation of smoking characteristically occurs in youth, if you can get through your teen years without taking up smoking then you are less likely to take it up in general; they've basically missed the opportunity to take it up and they are not especially likely to take up smoking later on."

Dr Laking also said there was a clear decline in tobacco use for both young people and elders - a positive sign for Pacific and Māori youth.

The survey shows a clear decrease in tobacco use this year among year 10 groups which certainly suggests as Dr Laking said that young people in the future would be much less likely to pick up smoking even though some young people were currently picking up the bad habit when they were 18 years old.

However, a smokefree New Zealand in 2025 still looks grim according to Dr Laking who said there was currently a lack of regulation and legislation in place.

Tobacco use was still prevalent in Māori communities which would still take a bit of time to reduce, he said.

"It would be 50-50 chance to get to that point," he said.

The Ministry of Health is hoping to have less than 5 percent smoking rates for each ethnic demographic by that date.

To find out more about the annual ASH Year 10 Survey visit ASH Year 10 Snapshot Survey 2021 NationBuilder.

LA REVUE GAUCHE - Left Comment: Search results for SMOKING 

LA REVUE GAUCHE - Left Comment: Search results for CASABLANCA 

LA REVUE GAUCHE - Left Comment: Search results for AIR POLLUTION LUNG CANCER 

LA REVUE GAUCHE - Left Comment: Search results for LUNG CANCER 

 

 

Unlike other global crises, COVID-19 pandemic did not spark more smoking in its initial stage

UNIVERSITY OF WATERLOO

Research News

Unlike other population-level stressful events such as natural disasters, COVID-19 has not resulted in a net increase in smoking, according to a new study from the International Tobacco Control (ITC) Project, at the University of Waterloo.

The researchers also found that although nearly half of smokers reported that COVID-19 made them think about quitting, the vast majority of smokers did not change their smoking habits during the early phase of the COVID-19 pandemic.

Led by Shannon Gravely, research assistant professor with the ITC Project, the study surveyed 6,870 smokers and vapers in four high-income countries--Australia, Canada, England, and the United States--during the first global wave of COVID-19 between April and June 2020. The team examined the association between COVID-19 and thoughts about quitting smoking, changes in smoking, and factors related to positive changes such as attempting to quit or reducing smoking.

Only 1.1 per cent of smokers in the four countries attempted to quit and 14.2 per cent reduced smoking, but this was offset by the 14.6 per cent who increased smoking, with 70.2 per cent reported no change.

"It is important to note that population-level stressful events, such as 9/11 and natural disasters, have often led to increased smoking," said Geoffrey Fong, professor of psychology at Waterloo and principal investigator of the ITC Project. "So, our findings that there was no net increase in smoking in response to COVID-19 may actually represent a positive result for public health."

The study found that those who thought about quitting smoking because of COVID-19 were predominantly females, ethnic minorities, those with financial stress, current vapers, less dependent smokers, those with greater concern about personal susceptibility of infection, and those who believe COVID-19 is more severe for smokers.

According to Fong, who was a co-author of the study, this latter finding may be the key to why the COVID-19 pandemic has not led to significant increases in smoking, compared to past tragedies.

"Unlike other population stressors such as earthquakes, which are unrelated to smoking, COVID-19 severity is indeed linked to smoking," Fong said. "Public health officials have mentioned the link as yet another reason for smokers to quit, and over 80 per cent of smokers across the four countries believed that smoking made COVID-19 more severe. And this led to the lack of an increase in smoking, unlike what we have seen after other tragedies."

###

The study, Smokers' cognitive and behavioural reactions during the early phase of the COVID-19 pandemic: Findings from the 2020 ITC Four Country Smoking and Vaping Survey, was recently published in the journal PLOS ONE. The authors were Gravely, Fong, Lorraine V. Craig, K. Michael Cummings, Janine Ouimet, Ruth Loewen, Nadia Martin, Janet Chung-Hall, Pete Driezen, Sara C. Hitchman, Ann McNeill, Andrew Hyland, Anne C. K. Quah, Richard J. O'Connor, Ron Borland, Mary E. Thompson, and Christian Boudreau.

The study was funded by Health Canada's Substance Use and Addictions Program.

 

Cost increasingly important motive for quitting smoking for 1 in 4 adults in England

Making much more of potential savings might encourage more people to stub out for good

BMJ

Health concerns are still the primary motive for more than half of those who say they want to stop smoking in England, but cost is now a key factor for more than 1 in 4, finds an analysis of national survey responses, published in the open access journal BMJ Public Health.

Given this shift in thinking, making much more of the potential savings to be had might encourage more people to stub out for good, suggest the researchers.

Health concerns are generally the primary motive for people trying to stop smoking, with social and financial concerns, plus advice from a health professional, also commonly cited reasons, explain the researchers.

But since 2020, England has undergone a period of substantial societal instability, prompted primarily by the COVID-19 pandemic, which might have triggered changes in the reasons smokers give for wanting to ditch tobacco, they suggest.

To find out, the researchers looked at time trends in motives for trying to stop smoking between March 2018 and May 2023, exploring differences by age, sex, socioeconomic status, presence of children in the household and vaping status.

They drew on responses to the ongoing Smoking Toolkit Study, a monthly survey of a representative sample of around 1700 adults in England.

The responses were limited to those who were either current smokers or who had stopped smoking in the past year and had made at least one serious attempt to quit during that time.

Respondents were asked to name the reason(s) behind their most recent quit attempt from among: advice from a health professional; TV advert for a nicotine replacement product; government TV/radio/press advert; a new stop smoking treatment; cost; smoking restrictions; knowing someone else who was quitting; health warning on a cigarette packet; contact from a local NHS stop smoking service; current or future health problems; attending a local stop smoking activity or event; comments by family, friends, children; significant birthday; pregnancy; simple decision to quit; COVID-19 pandemic.

Out of the 101,919 survey respondents between 2018 and 2023, 17,812 reported smoking in the past year. Of these,17,031 (96%) provided data on quit attempts over the past 12 months, 5777 (34%) of whom reported having made at least one serious attempt to do so.

Health concerns were the most frequently cited motives, reported by more than half the sample (52%) across the entire period—especially concerns about future health, reported by more than 1 in 3 (35.5%) compared with 1 in 5 (19%) who were motivated by current health problems.

Cost was the next most frequently cited motive, reported by nearly 1 in 4 (23%), followed by social factors, reported by around 1 in 5 (19%) and advice from a health professional (12%). 

Around 4% said they were motivated by health warnings on a cigarette packet, while smoking restrictions prompted 3.5% to try and stop; a simple decision to quit was cited by just over 3%. The other reasons attracted only around 1% each.

Up to the start of 2020, 1 in 2 quit attempts was motivated by health concerns; 1 in 5 by current health problems (20%), and 1 in 3 by concerns about future health (34%). One in 5 was motivated by social factors (20%) and cost (20%), and 1 in 6 by health professional advice (16.5%).

While there was little overall change in the proportion of quit attempts motivated by health concerns across the entire study period, the proportion of quit attempts motivated by cost increased significantly, rising from just over 19% in March 2018 to just under 25.5% in May 2023.

But the proportion of quit attempts motivated by health professional advice fell significantly over the entire study period, dropping from just over 14% in March 2018 to 8.5% in May 2023.

The COVID-19 pandemic, which began to affect England in March 2020, is likely to have influenced the proportion of respondents reporting health concerns, social factors, and cost as motives for trying to stop smoking, suggest the researchers. 

The proportion of quit attempts motivated by future health concerns increased during 2020 and 2021.“It is likely the pandemic made health concerns (an already prevalent motive) even more salient, particularly during its first year when the virus was spreading rapidly and vaccinations were not yet available,” they write. 

Once the immediate threat of the virus had subsided thanks to the vaccination programme, the proportion of health-related attempts to quit returned to pre-pandemic levels.

The pandemic probably influenced other motives, suggest the researchers, because it prompted loss of income and jobs for many people.

“These economic pressures probably contributed to the rise in cost-motivated attempts to quit around this time. But while the pandemic’s acute risks to health—and, as a result, attempts to quit motivated by concern for health or social factors—waned over time, its economic impacts have been compounded by a cost-of- living crisis,” they explain.

The pandemic’s impact on access to, and availability of, healthcare services may also have contributed to the decline in the proportion of respondents citing healthcare professional advice as a motivating factor, they add.

The researchers acknowledge various caveats to their findings, including that all the study data were self-reported and relied on personal recall, and may not apply to other countries with different attitudes to smoking, tobacco control policies, and provision of smoking cessation services.

But they conclude: “These findings have implications for smoking cessation interventions and clinical practice. ..They indicate that cost is an increasingly important factor motivating people to try to stop smoking. 

“Communicating the potential savings people can make by stopping smoking (even if they switch to alternative nicotine products) could therefore be an effective means for motivating attempts to quit.” 

Notes for editors
Research: Trends in motives for trying to stop smoking: a population study in England, 2018–2023 Doi: 10.1136/bmjph-2023-000420
Journal: BMJ Public Health

External funding: Cancer Research UK

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

---

JOURNAL

BMJ Public Health

DOI

10.1136/bmjph-2023-000420 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Trends in motives for trying to stop smoking: a population study in England, 2018–2023

ARTICLE PUBLICATION DATE

22-Apr-2024

COI STATEMENT

JB has received unrestricted research funding from Pfizer and J&J, who manufacture smoking cessation medications. All authors declare no financial links with tobacco companies, e-cigarette manufacturers, or their representatives

Quitting smoking early linked with improved survival rates for people diagnosed with lung cancer l

Peer-Reviewed Publication

HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH

Key points:

• Among those diagnosed with non-small cell lung cancer—the most common form of lung cancer—current smokers had 68% higher mortality and former smokers had 26% higher mortality compared to never smokers
• The longer a patient had gone without smoking pre-diagnosis, the more improved their odds of survival were
• The study is one of few to examine mortality not just among current and never smokers, but also among former smokers—enabling more robust findings about the impacts of smoking cessation

Boston, MA—Quitting smoking early was associated with higher survival rates following a lung cancer diagnosis, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. Compared to those who never smoked and were being treated for non-small cell lung cancer (NSCLC), current smokers had 68% higher mortality and former smokers had 26% higher mortality.

“Our participants’ smoking histories varied, with some having stopped smoking a few years before their diagnosis and others having stopped several decades before,” said senior author David Christiani, Elkan Blout Professor of Environmental Genetics. “This wide range gave us confidence in our results—that the benefit of pre-diagnosis smoking cessation persists even after lung cancer is diagnosed.”

The study will be published online in JAMA Network Open on May 5, 2023.

While most similar research has compared mortality among current smokers and never smokers, the majority of the study’s participants were former smokers, allowing the researchers to focus on the impacts of smoking cessation.

The study followed 5,594 patients with NSCLC—which accounts for 85% of all lung cancer cases—enrolled in the Boston Lung Cancer Survival Cohort at Massachusetts General Hospital between 1992 and 2022. Of these participants, 795 had never smoked; 3,308 were former smokers; and 1,491 were current smokers. Participants completed questionnaires about their smoking habits and other health and demographic information at baseline, with the researchers checking in on their survival every 12 to 18 months. During the study period, 3,842 of the participants died: 79.3% of the current smokers, 66.8% of the former smokers, and 59.6% of the never smokers.

While never smoking was associated with the best odds of survival after a lung cancer diagnosis, the findings showed significant associations between lower mortality and having quit smoking pre-diagnosis. The longer a patient went without smoking, the more health benefits they accrued: For former smokers, doubling the years of smoking cessation before their lung cancer diagnosis was significantly associated with prolonged survival. Conversely, doubling smoking-pack years was associated with shorter survival among current and former smokers diagnosed with NSCLC.

The researchers noted that associations between survival and smoking history may vary depending on the clinical stage at which lung cancer was diagnosed, and that the study did not account for the different kinds of treatment participants were receiving.

Other Harvard Chan School co-authors included Xinan Wang, Christopher Romero-Gutierrez, and Jui Kothari.

Funding for the study came from National Cancer Institute grant 5U01CA209414.

“Prediagnosis smoking cessation and overall survival among patients with non-small cell lung cancer,” Xinan Wang, Christopher W. Romero-Guttierez, Jui Kothari, Andrea Shafer, Yi Li, David C. Christiani, JAMA Network Open, online May 5, 2023, doi: 10.1001/jamanetworkopen.2023.11966

Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.

###

Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.

---

JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2023.11966 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Prediagnosis smoking cessation and overall survival among patients with non-small cell lung cancer

ARTICLE PUBLICATION DATE

5-May-2023

New Survey Data Cast Further Doubt on the FDA's Opposition to Flavored E-Cigarettes

The "epidemic" of adolescent vaping seems to be fading fast, and vaping is replacing smoking among adults, a harm-reducing trend that regulators seem determined to discourage.

JACOB SULLUM | 8.25.2022 

REASON MAGAZINE

Share on FacebookShare on TwitterShare on RedditShare by emailPrint friendly versionCopy page URL

FDA Commissioner Robert Califf (Michael Brochstein/Zuma Press/Newscom)

A federal appeals court this week sided with several companies whose applications to sell nicotine vaping products in a variety of flavors were rejected by the Food and Drug Administration (FDA). As Reason's Elizabeth Nolan Brown noted yesterday, the U.S. Court of Appeals for the 11th Circuit ruled that the FDA's decisions were "arbitrary and capricious" because the agency ignored marketing and age-verification plans aimed at preventing underage vaping. But as Judge Robin Rosenbaum noted in her dissent, the manufacturers' victory probably will be short-lived, because the FDA seems dead set against allowing the sale of vaping products in flavors other than tobacco.

That position is puzzling, since former smokers who have switched to vaping overwhelmingly prefer nontobacco flavors, and the FDA acknowledges that "electronic nicotine delivery systems" (ENDS) hold great promise as a harm-reducing alternative to cigarettes. But the FDA insists there is no solid evidence that flavor variety makes vaping more appealing to adult smokers, even as it worries that flavor variety makes vaping more appealing to teenagers. So when the FDA reconsiders these applications on remand from the 11th Circuit, it is almost certain to reject them again, notwithstanding the steps that the companies are taking to keep their products away from underage consumers

The FDA's opposition to flavor variety is driven by concern about an "epidemic" of adolescent vaping. But as new survey data from the government-sponsored Monitoring the Future (MTF) study confirm, the surge in electronic cigarette use by teenagers that alarmed the FDA in 2018 and 2019 is already receding, even though adults can still buy flavored ENDS that remain on the market because the FDA has not yet decided whether to allow them or has not taken enforcement action against them. Those data also indicate that adolescent smoking continued to decline as vaping became more popular. The picture is similar for young adults: As vaping continued to rise among 19-to-30-year-olds in 2021, cigarette smoking hit a record low.

These trends suggest that we are seeing precisely the sort of harm-reducing substitution that the FDA claims to want. The data certainly are not consistent with the idea that the availability of ENDS has resulted in more smoking. Yet Judge Rosenbaum, who seems to think the FDA's opposition to flavored ENDS is well-grounded, avers that "vaping has been shown to be a gateway to smoking combustible cigarettes." She cites no evidence to support that claim, which seems highly implausible in light of the continuing decline in smoking among teenagers and adults.

The annual MTF survey, which University of Michigan researchers conducts under contract with the National Institute on Drug Abuse, includes students in the eighth, 10th, and 12th grades. In 2021, it shows, the prevalence of past-month nicotine vaping fell sharply in all three grades.

That rate peaked at 10.5 percent in 2020 among eighth-graders before falling to 7.6 percent last year. Among 10th- and 12th-graders, it peaked at 19.9 percent and 25.5 percent, respectively, in 2019 and had fallen to 13.1 percent and 19.6 percent, respectively, by last year. Between 2019 and 2021, the prevalence of "daily" vaping (defined as use on 20 or more occasions in the previous 30 days) fell from 2 percent to 1.1 percent among eighth-graders, from 6.8 percent to 2.5 percent among 10th-graders, and from 11.6 percent to 5.4 percent among 12th-graders.

These findings are broadly consistent with results from the National Youth Tobacco Survey (NYTS), which is sponsored by the Centers for Disease Control and Prevention (CDC). That survey shows the prevalence of past-month e-cigarette use by high school students peaking at 27.5 percent in 2019 before falling to 11.3 percent in 2021. Even though adults still have access to ENDS in a variety of flavors, the "epidemic" decried by the FDA and the CDC seems to be fading fast.

Neither survey provides any evidence of the "gateway" that Rosenbaum perceives. On the contrary, the downward trend in adolescent smoking continued even when vaping was rising sharply. Among 12th-graders in the MTF survey, the prevalence of past-month cigarette smoking fell from 10.3 percent in 2011 to 2 percent in 2021. During the same period, the prevalence of "daily" cigarette smoking fell from 4.3 percent to 0.8 percent. In the NYTS, the prevalence of past-month cigarette smoking among high school students fell from 15.8 percent in 2011 to 1.9 percent last year.

There is reason to think that ENDS, far from interfering with the decline in adolescent smoking, hastened that downward trend, which accelerated as vaping took off. The replacement of smoking by vaping is indisputably an improvement in terms of "public health," which the FDA claims to be promoting. But the agency instead portrays it as a grave danger to the youth of America. When it comes to teenagers, the FDA refuses even to consider the positive impact of such substitution.

A 2019 analysis of NYTS data found that frequent e-cigarette use was concentrated among teenagers who were current or former smokers. So far the recent decline in adolescent vaping has not led to an uptick in smoking, which makes sense if casual users, rather than teenagers who vape instead of smoking, account for most of the drop. But the FDA should be wary of any policy that makes cigarettes easier to obtain than ENDS or makes ENDS less appealing to people who otherwise would be smoking. Over the long term, the upshot could be more rather than fewer smoking-related deaths.

Logically, that analysis should include teenagers as well as adults. But the FDA insists that the health benefits of substituting ENDS for cigarettes don't count when vapers are younger than 21. So let's consider what the MTF data tell us about the potential cost of refusing to let adults buy the vaping products they demonstrably want.

"Cigarette smoking among young adults has been declining steadily since
2004 and reached new historic lows in 2021," an MTF report notes. "Cigarette use in the past 30 days decreased by more than half in the past decade," from 21.2 percent in 2011 to 9 percent in 2021.

In recent years, that downward trend in smoking by 19-to-30-year-olds has been accompanied by an upward trend in vaping. "Since it was first measured in 2017,
nicotine vaping in the past 30 days has nearly tripled among young adults to 16.1% in 2021," the report says. "Nicotine vaping in the past 12 months was reported by 21.8%, just below the all-time high of 23.6% in 2019."

Between 2017 and 2021, as the prevalence of past-month vaping in this age group rose by 160 percent, the prevalence of past-month cigarette smoking fell by 39 percent. Those trends are not consistent with Rosenbaum's theory that more vaping means more smoking. But they are consistent with the theory that many young adults are choosing to vape instead of smoke.

The FDA ostensibly would like to see more of that. The whole premise of approving the sale of ENDS as "appropriate for the protection of the public health"—the standard the FDA is supposed to apply under the Family Smoking Prevention and Tobacco Control Act—is that it will help reduce tobacco-related morbidity and mortality by offering smokers a much less hazardous way to consume nicotine. Yet the FDA claims to be unpersuaded that flavor variety plays an important role for smokers who have made that potentially lifesaving switch or might be interested in doing so.

The FDA contradictorily insists that flavor variety is important to teenagers. It thinks at least some of them will eschew vaping if tobacco is the only flavor they can find. The possibility that some teenagers therefore will smoke instead does not enter into the FDA's calculations at all. And it dismisses the danger that the same thing will happen among adults, saying ENDS manufacturers have not produced enough evidence to that effect.

Contrary to its legal duty, the FDA has not carefully weighed the costs and benefits of its supposedly youth-protecting policy. Instead, it refuses to admit there are any costs to consider.

Medication may help heavy-drinking smokers improve their health

UCLA study provides evidence that varenicline can aid them in quitting smoking, reducing drinking

UNIVERSITY OF CALIFORNIA - LOS ANGELES

Research News

 

IMAGE: LARA RAY, A UCLA PROFESSOR OF PSYCHOLOGY AND OF PSYCHIATRY AND BIOBEHAVIORAL SCIENCES WHO HOLDS UCLA'S SHIRLEY M. HATOS CHAIR IN CLINICAL NEUROPHARMACOLOGY. view more 

CREDIT: ELENA ZHUKOVA

A recent UCLA clinical trial has shown encouraging results in helping daily smokers who are also heavy drinkers quit smoking and cut down their alcohol intake.

The study of 165 people tested two prescription drugs -- varenicline, for smoking addiction, and naltrexone, which is used to treat alcoholism. Studies have shown that varenicline, marketed under the brand name Chantix, may also be effective in reducing alcohol consumption.

Participants, who ranged in age from 21 to 65, smoked at least five cigarettes a day, with male participants generally consuming more than 14 drinks a week and women more than seven per week.

Over the 12-week study period, each participant received 2 milligrams of varenicline twice a day. Roughly half the group -- 83 participants -- also received a 50-milligram dose of naltrexone daily, while the other 82 received placebo pills. They were all told to quit smoking and drink less.

When researchers followed up 26 weeks after the study's conclusion, they found that nearly 36% -- 59 participants -- had quit smoking.

"The overall smoking quit rate in the trial is impressive," said lead author Lara Ray, a professor of psychology and of psychiatry and biobehavioral sciences who holds UCLA's Shirley M. Hatos Chair in Clinical Neuropharmacology. She noted that previous studies have suggested varenicline has a success rate at six months of about 25% to 30%.

"We exceeded the overall expectation for this medication," she said. "This is especially important in a diverse group of people." Ray said that while some previous studies have shown lower-than-average smoking cessation rates among Black participants, that was not the case in the current trial, in which more than half of participants were Black.

Surprisingly, the researchers said, those who had received varenicline plus a placebo had a significantly higher smoking quit rate (45%, or 37 of 82 participants) than those who were given varenicline and naltrexone (27%, or 22 of 83 participants).

"The quit rate for varenicline alone in this sample is highly encouraging, as this is the first large-scale trial of varenicline efficacy focused solely on heavy-drinking smokers," Ray said.

While participants who received varenicline plus naltrexone had a lower smoking quit rate, they had slightly better success than the placebo group at curbing their drinking. At the start of the study, participants averaged nearly seven drinks per drinking day; those on the varenicline-naltrexone combination reduced their consumption to three drinks per drinking day over the 12-week study period, while those receiving the varenicline-placebo combination cut down to four drinks -- both impressive decreases, Ray said.

"I am excited about both the smoking cessation rates and the drinking reductions," said Ray, who is also a member of UCLA's Brain Research Institute. "These findings suggests that desirable outcomes for smoking cessation and drinking reduction are achievable."

The study, which found no difference in quit and reduction rates between men and women, was published online in the American Journal of Psychiatry June 3 and is scheduled for publication in the journal's September print issue.

Approximately 20% to 25% of smokers are also heavy drinkers. Smoking and heavy drinking are major public health concerns that reduce people's life span and quality of life, and both have also been linked to worse health outcomes for COVID-19.

As with all addictions, quitting smoking and reducing drinking are difficult and complex processes. This study confirms that medications can play a role, Ray said, but she noted that it can be challenging for patients to take more than one prescribed medication.

"Varenicline alone is doing a great job, and this trial indicates that there is not much room for naltrexone to make a difference," Ray said. "But even medications like varenicline have their limitations. Medication is only part of the solution. There remains much research to be done on addictions and how to treat them."

Ray says that those who wish to quit smoking and reduce drinking may consider talking to their doctor about the possibility of using varenicline, and she recommends that they try to quit smoking and reduce their drinking at the same time.

"There is evidence that varenicline can help them with both," Ray said. "Varenicline appears quite effective at reducing drinking and helping people to quit smoking. Given that varenicline has been found to reduce drinking in trials for alcohol use disorder, it is possible that its effects on both drinking and smoking present an optimal alternative for this group of heavy-drinking smokers."

ReJoyce Green, a UCLA doctoral student in clinical psychology who works with Ray, and Karen Miotto, a UCLA clinical professor of psychiatry and the medical director of the clinical trial, are among the study's 14 authors.

The clinical trial and Ray's research are funded by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, both part of the National Institutes of Health.

The study was conducted between July 2015 and December 2019 at an outpatient research facility at UCLA.

###

UVA Health, community pharmacies partner to help Appalachia residents quit smoking

Collaboration tests effectiveness of several smoking cessation approaches

Grant and Award Announcement

UNIVERSITY OF VIRGINIA HEALTH SYSTEM

 

IMAGE: UVA SCHOOL OF MEDICINE RESEARCHER MELISSA LITTLE, PHD, MPH, IS LEADING AN INITIATIVE TO HELP MORE RESIDENTS OF RURAL APPALACHIA QUIT SMOKING. view more 

CREDIT: UVA HEALTH

Fourteen independent community pharmacies will team with UVA Health to help residents of rural Appalachia quit smoking and test the effectiveness of multiple smoking cessation programs, including one based on text messaging. The project ultimately aims to lower the region’s cancer rates, which are among the highest in the country.

Backed by more than $5 million in funding from the National Cancer Institute, 14 pharmacies selected for the program in Virginia, Kentucky, North Carolina, West Virginia and Tennessee will participate in the study. 

“It is clear that publicly available smoking cessation resources are not reaching residents in this region,” said Melissa Little, PhD, MPH, a researcher in the UVA School of Medicine’s Department of Public Health Sciences and the leader of this initiative. “We are hoping that by working with local community pharmacies, we’ll be able to help more smokers interested in quitting who otherwise may not have sought help with their quit attempt.”

The Impact of Smoking in Appalachia

Rural Appalachia has some of the highest smoking rates in the United States. For example, an analysis of data from 2015 to 2019 found the smoking rate in rural Appalachian counties was 20.9%, compared with a statewide smoking rate of 13.3%. Higher rates of cancer in rural Appalachia can be attributed to smoking, Little said, as studies have shown that cigarette smoking is estimated to account for 30% of all cancer deaths and 90% of all lung cancer deaths.

However, residents of rural Appalachia are less likely to take advantage of commonly available resources to quit smoking – such as phone counseling and nicotine-replacement therapy – which Little suspects may be due to the shortage of healthcare providers in the region.

She believes community pharmacists based in rural Appalachia are ideally positioned to help residents quit smoking.

“We conducted a small demonstration study in partnership with Gates Pharmacy, a community pharmacy in Mt. Airy, N.C., to determine the feasibility of the approach,” Little said. “Overall, the project was well received by both participants interested in quitting as well as the Gates pharmacists and technicians.”

“The process of recruiting and enrolling patients was simple, the intervention guides were clear and easy to follow, and our entire staff was able to contribute in their own way to the success of the project,” said Hayley Wood, the pharmacy manager at Gates Pharmacy.

The program will evaluate the effectiveness of different combinations of smoking cessation programs. All 768 participants will receive nicotine replacement therapy through gum, a patch or both. 

Additionally, participants will be randomly selected to participate in one of three programs:

• QuitAid: Participants will have one in-person meeting and five follow-up sessions by phone over a month with a pharmacist, who will provide support and help address any questions or concerns about the nicotine-replacement therapy.
• Tobacco Quitline: Participants will have four 20- to 30-minute phone calls over four weeks from a trained tobacco treatment specialist working on the project to assist them in quitting smoking and preventing relapse.
• SmokefreeTXT: A text messaging program developed by the National Cancer Institute that sends participants three to five text messages per day for seven weeks to assist participants in quitting and preventing relapses.

For More Information

The study is expected to begin in April 2023. Pharmacies and smokers interested in the program can learn more by emailing Quitaid@hscmail.mcc.virginia.edu or by calling study coordinator Taylor Reid at 434.924.8894.