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.

Objectives: To examine the feasibility of detecting adverse events through record review in British hospitals and to make preliminary estimates of the incidence and costs of adverse events. Design: Retrospective review of 1014 medical and nursing records. Setting: Two acute hospitals in Greater London area. Main outcome measure: Number of adverse events. Results: 110 (10.8%) patients experienced an adverse event, with an overall rate of adverse events of 11.7% when multiple adverse events were included. About half of these events were judged preventable with ordinary standards of care. A third of adverse events led to moderate or greater disability or death. Conclusions: These results suggest that adverse events are a serious source of harm to patients and a large drain on NHS resources. Some are major events; others are frequent, minor events that go unnoticed in routine clinical care but together have massive economic consequences

https://www.bmj.com/content/bmj/322/7285/517.full.pdf

Adverse events in british hospitals: preliminary retrospective record review

Neighborhood Environments: Disparities in Access to Healthy Foods in the U.S.

OBJECTIVE: To review the relationship between literacy and health outcomes DATA SOURCES: We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resources Information Center (ERIC), Public Affairs Information Service (PAIS), Industrial and Labor Relations Review (ILLR), PsychInfo, and Ageline from 1980 to 2003 STUDY SELECTION: We included observational studies that reported original data, measured literacy with any valid instrument, and measured one or more health outcomes Two abstractors reviewed each study for inclusion and resolved disagreements by discussion DATA EXTRACTION: One reviewer abstracted data from each article into an evidence table; the second reviewer checked each entry The whole study team reconciled disagreements about information in evidence tables Both data extractors independently completed an 11-item quality scale for each article; scores were averaged to give a final measure of article quality DATA SYNTHESIS: We reviewed 3,015 titles and abstracts and pulled 684 articles for full review; 73 articles met inclusion criteria and, of those, 44 addressed the questions of this report Patients with low literacy had poorer health outcomes, including knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources Patients with low literacy were generally 15 to 3 times more likely to experience a given poor outcome The average quality of the articles was fair to good Most studies were cross-sectional in design; many failed to address adequately confounding and the use of multiple comparisons CONCLUSIONS: Low literacy is associated with several adverse health outcomes Future research, using more rigorous methods, will better define these relationships and guide developers of new interventions

/pdf/literacy-and-health-outcomes-4pmopsjgz6.pdf

Literacy and health outcomes

Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies.

Smoking onset has 4 levels, with a "susceptibility" level preceding early experimentation. This study assessed the predictive validity of smoking susceptibility in a longitudinal study of a nationally representative sample of 4,500 adolescents who at baseline reported never having puffed on a cigarette. At follow-up 4 years later, 40% of the sample had experimented with smoking, and 8% had established a smoking habit. Baseline susceptibility to smoking, defined as the absence of a firm decision not to smoke, was a stronger independent predictor of experimentation than the presence of smokers among either family or the best friend network. However, susceptibility to smoking was not as important as exposure to smokers in distinguishing adolescents who progressed to established smoking from those who remained experimenters at follow-up.

Validation of susceptibility as a predictor of which adolescents take up smoking in the United States.

Context.—Whether tobacco advertising and promotion increases the likelihood that
youths will begin smoking has important public policy implications.Objective.—To evaluate the association between receptivity to tobacco advertising
and promotional activities and progress in the smoking uptake process, defined
sequentially as never smokers who would not consider experimenting with smoking,
never smokers who would consider experimenting, experimenters (smoked at least
once but fewer than 100 cigarettes), or established smokers (smoked at least
100 cigarettes).Design.—Prospective cohort study with a 3-year follow-up through November 1996.Setting and Participants.—A total of 1752 adolescent never smokers who were not susceptible to
smoking when first interviewed in 1993 in a population-based random-digit
dial telephone survey in California were reinterviewed in 1996.Main Outcome Measure.—Becoming susceptible to smoking or experimenting by 1996.Results.—More than half the sample (n=979) named a favorite cigarette advertisement
in 1993 and Joe Camel advertisements were the most popular. Less than 5% (n=92)
at baseline possessed a promotional item but a further 10% (n=172) were willing
to use an item. While having a favorite advertisement in 1993 predicted which
adolescents would progress by 1996 (odds ratio [OR] =1.82; 95% confidence
interval [CI], 1.04-3.20), possession or willingness to use a promotional
item was even more strongly associated with future progression (OR=2.89; 95%
CI, 1.47-5.68). From these data, we estimate that 34% of all experimentation
in California between 1993 and 1996 can be attributed to tobacco promotional
activities. Nationally, this would be over 700000 adolescents each year.Conclusion.—These findings provide the first longitudinal evidence to our knowledge
that tobacco promotional activities are causally related to the onset of smoking.

https://jamanetwork.com/journals/jama/articlepdf/187258/joc71624.pdf

Tobacco Industry Promotion of Cigarettes and Adolescent Smoking

Aims To determine whether the probability of future current established smoking among adolescents is related to both previous smoking experience and cognitions regarding future smoking Design, setting and participants The analyses used two principal datasets: (1) a US longitudinal sample of 7960 adolescents 12-18 years old in 1989 reinterviewed at 15-22 years in 1993, (2) a California longitudinal sample of 3376 adolescents 12-17 years old in 1993 reinterviewed at 15-20 years in 1996 Measures Previous smoking experience was categorized as never smoked, puffed, non-recent or recent experimenting, and non-recent or current established smoking (≥ 100 cigarettes in life-time) Smoking intentions and efficacy expectations were used to classify adolescents as having low- or high-risk cognitions Findings High-risk cognitions (HRCs) increased the probability of future current established smoking (FCES) within each level of previous smoking experience over low-risk cognitions (LRCs); the probability of FCES for those with LRCs was about the same as those in the previous experience group with HRCs In the US sample, the 4-year probability of FCES ranged from 56% for committed never smokers (with LRCs) to 830% for current established smokers with HRCs Development of HRCs among middle-school never smokers occurred rapidly through age 14 years However, current established smoking did not increase until age 14 years and stabilized by age 19 years Where sample size was sufficient, these findings were validated in the California sample Conclusions Effective prevention programs should aim to convert HRCs to LRCs regardless of past behavior, particularly among middle-school never smokers and high-school experimenters

Determining the probability of future smoking among adolescents.

Which adolescent experimenters progress to established smoking in the united states

Objective. To evaluate factors related to the development and persistence of adolescent sleep problems. Methods. In this longitudinal, population-based study, the Teenage Attitudes and Practices Survey was administered by telephone to 7960 adolescents (3921 girls and 4039 boys) 12 to 18 years old in 1989 and at follow-up in 1993. Sleep problems at both time points were assessed using a single item on the Teenage Attitudes and Practices Survey. Those who responded that they “often or sometimes” had trouble going to sleep or staying asleep during the past 12 months were categorized as reporting sleep problems, whereas those who responded “often” were categorized as having frequent sleep problems. Multiple logistic regression analyses were used to identify baseline characteristics predictive of the development and persistence of sleep problems or frequent sleep problems, respectively, from baseline to follow-up. Results. Of the 4866 adolescents without sleep problems at baseline, 28% developed sleep problems by 1993, and 9% developed frequent sleep problems. Of the 3094 adolescents who reported sleep problems at baseline, 52% reported sleep problems in 1993, and 21% reported frequent sleep problems. Female sex and notable depressive symptoms were associated with the development and persistence of sleep problems and frequent sleep problems at follow-up. Cigarette smoking status showed a dose–response relationship with development of sleep problems and frequent sleep problems, and with persistence of frequent sleep problems at follow-up. Conclusion. The reduction of depressive symptoms and cigarette smoking among adolescents are important factors to consider in prevention and treatment efforts focused on adolescent sleep problems.

https://pediatrics.aappublications.org/content/pediatrics/106/2/e23.full.pdf

Won S. Choi

Papers

Validation of susceptibility as a predictor of which adolescents take up smoking in the United States.

Tobacco Industry Promotion of Cigarettes and Adolescent Smoking

Determining the probability of future smoking among adolescents.

Which adolescent experimenters progress to established smoking in the united states

Depressive Symptoms and Cigarette Smoking Predict Development and Persistence of Sleep Problems in US Adolescents