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American Society for Testing and Materials

BACKGROUND: The aim of nicotine replacement therapy (NRT) is to replace nicotine from cigarettes. This reduces withdrawal symptoms associated with smoking cessation thus helping resist the urge to smoke cigarettes. OBJECTIVES: The aims of this review were to determine the effectiveness of the different forms of nicotine replacement therapy (chewing gum, transdermal patches, nasal spray, inhalers and tablets) in achieving abstinence from cigarettes, or a sustained reduction in amount smoked; to determine whether the effect is influenced by the clinical setting in which the smoker is recruited and treated, the dosage and form of the NRT used, or the intensity of additional advice and support offered to the smoker; to determine whether combinations of NRT are more effective than one type alone; and to determine its effectiveness compared to other pharmacotherapies. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register in July 2002. SELECTION CRITERIA: Randomized trials in which NRT was compared to placebo or no treatment, or where different doses of NRT were compared. We excluded trials which did not report cessation rates, and those with follow-up of less than six months. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the dose and duration and form of nicotine therapy, the outcome measures, method of randomization, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model (Peto). MAIN RESULTS: We identified 110 trials; 96 with a non NRT control group. The odds ratio for abstinence with NRT compared to control was 1.74 (95% confidence interval 1.64 - 1.86), The odds ratios for the different forms of NRT were 1.66 for gum, 1.74 for patches, 2.27 for nasal spray, 2.08 for inhaled nicotine and 2.08 for nicotine sublingual tablet/lozenge. These odds were largely independent of the duration of therapy, the intensity of additional support provided or the setting in which the NRT was offered. In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2mg gum (odds ratio 2.67, 95% confidence interval 1.69 - 4.22). There was weak evidence that combinations of forms of NRT are more effective. Higher doses of nicotine patch may produce small increases in quit rates. Only one study directly compared NRT to another pharmacotherapy, in which bupropion was significantly more effective than nicotine patch or placebo. REVIEWER'S CONCLUSIONS: All of the commercially available forms of NRT (nicotine gum, transdermal patch, the nicotine nasal spray, nicotine inhaler and nicotine sublingual tablets/lozenges) are effective as part of a strategy to promote smoking cessation. They increase quit rates approximately 1.5 to 2 fold regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT. There is promising evidence that bupropion may be more effective than NRT (either alone or in combination). However, its most appropriate place in the therapeutic armamentarium requires further study and consideration.

Nicotine replacement therapy for smoking cessation.

Quasi-experimentation - design and analysis issues for field settings - cook,td, campbell,dt

Significance Electronic cigarettes, also known as e-cigarettes, are devices designed to imitate regular cigarettes and deliver nicotine via inhalation without combusting tobacco. They are purported to deliver nicotine without other toxicants and to be a safer alternative to regular cigarettes. However, little toxicity testing has been performed to evaluate the chemical nature of vapour generated from e–cigarettes. The aim of this study was to screen e-cigarette vapours for content of four groups of potentially toxic and carcinogenic compounds: carbonyls, volatile organic compounds, nitrosamines and heavy metals. Materials and methods Vapours were generated from 12 brands of e-cigarettes and the reference product, the medicinal nicotine inhaler, in controlled conditions using a modified smoking machine. The selected toxic compounds were extracted from vapours into a solid or liquid phase and analysed with chromatographic and spectroscopy methods. Results We found that the e-cigarette vapours contained some toxic substances. The levels of the toxicants were 9–450 times lower than in cigarette smoke and were, in many cases, comparable with trace amounts found in the reference product. Conclusions Our findings are consistent with the idea that substituting tobacco cigarettes with e-cigarettes may substantially reduce exposure to selected tobacco-specific toxicants. E-cigarettes as a harm reduction strategy among smokers unwilling to quit, warrants further study. (To view this abstract in Polish and German, please see the supplementary files online.)

/pdf/levels-of-selected-carcinogens-and-toxicants-in-vapour-from-cjl8sfic96.pdf

Levels of selected carcinogens and toxicants in vapour from electronic cigarettes

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

BACKGROUND
Nutrition labels on pre-packaged foods are an important source of nutrition information; however, differences in comprehension of varying label formats may limit their use and effectiveness.


OBJECTIVES
This study examined levels and correlates of consumers' self-reported understanding of Nutrition Facts tables (NFt) and Front-of-Package (FOP) labels, as well as functional NFt understanding.


METHODS
Adults (≥18 years) in Australia (n = 3901), Canada (n = 4107), Mexico (n = 4012), United Kingdom (UK) (n = 5121), and the United States (US) (n = 4445) completed online surveys in November-December 2018. Descriptive statistics summarized sample profiles by country. Linear regression models examined the association between label understanding (self-reported NFt and FOP, functional NFt) and consumer dietary behaviours, functional nutrition knowledge, and sociodemographic characteristics. NFt understanding was measured in all countries, with FOP labelling assessed only in Mexico, Australia, and the UK.


RESULTS
Self-reported and functional NFt understanding was significantly higher in the US and Canada (P < 0.0001). In adjusted analyses, functional NFt understanding was significantly higher among women than men (P < 0.0001); respondents from the 'majority' ethnic group in their respective countries compared to minority ethnic groups (P < 0.0001); those with higher education levels (P < 0.0001) and functional nutrition knowledge compared to their lower education and nutrition knowledge counterparts (P < 0.0001), respectively; and those making efforts to consume less sodium, sugar or fat compared to those not reporting dietary efforts (P < 0.0001). Self-reported FOP label understanding was significantly higher for interpretive labelling systems in Australia (Health Star Ratings) and the UK (Traffic Lights) compared with Mexico's Guideline Daily Amounts (GDA) (P < 0.0001).


CONCLUSIONS
Nutrition labels requiring greater numeracy skills (i.e., NFt, GDA) were more difficult for consumers to understand than interpretive FOP labels (i.e., Traffic Lights). Differences in NFt and FOP label understanding by income adequacy and education suggest potential disparities in labelling policy effects among vulnerable subgroups.

Correlates of Self-reported and Functional Understanding of Nutrition Labels across Five Countries in the 2018 International Food Policy Study.

Tobacco industry research on smoking and cigarette toxicity.

Use of Nutritional Information in Canada: National trends between 2004 and 2008

Introduction - As the tobacco industry has been stripped of most of the marketing mix, the cigarette pack has become an increasingly important marketing tool. It is possible however to reduce the attractiveness of the pack through plain packaging, which involves removing the pack design elements and leaving only the health warning and brand name in standardised font and size. Method - To investigate this tool, a quantitative study based on face to face interviews was conducted in France among a representative sample of 836 individuals (smokers and non smokers, aged 18 and above). A current cigarette pack and a plain pack of the French leading brand were compared. Results - Results indicated that plain packaging reduces the appeal of the pack (dull appearance, reduces the desire to buy). Compared to a current pack, the plain pack was associated with greater awareness of smoking danger and reported to facilitate intentions to reduce consumption, to quit, or not to start among non-smokers. Discussion - Our study highlights that the tobacco pack is an effective promotion tool. The plain packaging certainly has the potential to reduce the attractiveness of tobacco industry products and to help fighting against tobacco use.

Perception de l'efficacité des paquets de cigarettes standardisés

New measures close loopholes that facilitate non-therapeutic use

David Hammond

Papers

Correlates of Self-reported and Functional Understanding of Nutrition Labels across Five Countries in the 2018 International Food Policy Study.

Tobacco industry research on smoking and cigarette toxicity.

Use of Nutritional Information in Canada: National trends between 2004 and 2008

Perception de l'efficacité des paquets de cigarettes standardisés

Australia tightens its prescription-only regulation of e-cigarettes