Kicking butts: smoking cessation update.
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Tobacco is one of the most commonly abused drugs in the history of mankind. Smoking cessation has occupied a significant amount of research to help smokers quit to avoid the health risks. In this paper, we will discuss the methods available for smoking cessation. An evidence based approach will be used in a form directed towards both physicians and patients. We will review methods ranging from cold turkey to the latest addition to smoking cessation (varenicline).Keywords:
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In 2007, Romania implemented a national program for smoking cessation, providing medication and counseling, entirely for free. The present study focuses on the results of the program among participating smokers treated in three smoking cessation centers from three main cities of Romania: Iasi, Targu Mures and Cluj. Telephone interviews of 832 subjects from three databases of the Romanian cessation clinics of Iasi, Cluj and Targu Mures cities were conducted. These interviews were based on a standard Romanian guideline follow-up questionnaire. At 3 months follow up, abstinence was quite high (53.4%); at 12 months post quit date the study found 18.6% still abstinent subjects. More severely addicted smokers have quit with varenicline and the most difficult category of patients was represented by heavy smokers with respiratory co-morbidities. 61.5% of smokers and 97.2% of non-smokers were willing to receive relapse prevention counseling. Many subjects achieved a long duration partial abstinence (154 days ± 180 SD abstinence days). This is the first study in Romanian smoking cessation centers to analyze the long term impact of fully reimbursed smoking cessation, covering three months pharmacotherapy and counseling. Providing smoking cessation for free had a positive long term impact on program participants.
Varenicline
Guideline
Romanian
Nicotine replacement therapy
Pharmacotherapy
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Varenicline
Cross-sectional study
Nicotine replacement therapy
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Aims and background According to recent assessments from the Italian Istituto Superiore della Sanità, information and assistance to smokers are still far from satisfactory. We evaluated the impact of a new smoking cessation service located in pharmacies. Smokers' individual characteristics were also considered. Material and Methods A 1-year pilot study was carried out from October 2010 to September 2011. Five pharmacies in Milan were selected. A psychologist with experience in smoking cessation was present in each pharmacy one afternoon per week, and pharmacists were trained by a team from the Antismoking Center of the Fondazione IRCCS Istituto Nazionale dei Tumori. Each pharmacy was equipped with informative material, carbon monoxide analyzers, and motivational and nicotine dependence questionnaires, in addition to a clinical briefcase. Counseling sessions were also arranged upon request. Results In the first 12 months of activity, 216 persons asked for a consultation. The sample, aged 15–79 years, reported the following median values: 30 pack/years, 14 ppm CO, and a Fagerström Test of Nicotine Dependence score of 5. More than one-third of the sample (40.3%) had one pathology and 25% had more than one. In some cases (15.7%), people just wanted information about what the service offered. For those who tried to quit, smoking cessation rates were 33.3% at 3 months, 28% at 6 months, and 24.6% at 1 year. Three kinds of pharmacologic therapies were suggested to smokers: nicotine replacement therapy (75.5%), varenicline (17.5%), and bupropion (7%). Conclusions The results show that an accessible and free smoking cessation service is considered useful by smokers as demonstrated by the large number of requests compared with other smoking centers in Italy. Increased involvement of pharmacists in supporting smoking cessation makes this a promising initiative for the near future.
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Nicotine replacement therapy
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As is well known, cigarette smoking is one of the greatest catastrophes of public health worldwide.In 2004, it was estimated that one third of all cancer mortality in Korean men was attributed to cigarette smoking; smoking is also among main risk factors of varying serious diseases, including cardiovascular and respiratory diseases.These diseases have caused 20 million premature deaths in the United States within the last 50 years. 1,2)Lowering the smoking rate has, therefore, been an important public health goal for primary prevention of diseases.
Teachable moment
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Objective: Smoking is one of the leading causes of preventable death worldwide. The main drugs that act as an aid to smoking cessation include nicotin ereplacement, varenicline and bupropion. In this study, it was aimed to evaluate the knowledge and attitudes of internal department assistants of a medical faculty about smoking cessation treatment and to compare them with similar studies.
Methods: A questionnaire with 33 questions was developed, questioning the attitudes of physicians about smoking cessation and their knowledge about smoking cessation treatments. The questionnaires were applied to 60 internal department assistants on a voluntary basis. Mann-Whitney U test was used in two-level comparisons between groups, and Kruskal Wallis test was used in three-level comparisons. Spearman correlation analysis was used to examine the relationships between continuous variables. The analyzes were made in SPSS.23 program and p ,05). 52 (86.7%) of the assistants questioned whether patients smoke or not, 58 (96.7%) recommended thatt hey stop smoking if they smoke, and 43 (71.7%) asked the patients to quit smoking. He stated that he directed.
Conclusion: Doctors have important duties and responsibilities in the fight against smoking. The data obtained from the study suggest that, the level of knowledge of residents about smoking cessation treatment is not sufficient. It is an important approach in the fight against smoking that the vast majority of resident doctors question their patients' smoking status and advise them to quit smoking.
Varenicline
Bupropion
Quit smoking
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Relatively low proportion of ex-smokers and high rates of smoking-related diseases are estimated in Lithuania. The aim of this survey was to assess the extent of smoking cessation assistance among family doctors in Lithuania, and to identify factors associated with cessation interventions.Data were collected using a questionnaire addressing family doctors' cessation assistance practice; knowledge of smoking epidemiology and health effects; knowledge of cessation assistance guidelines; smoking status; and attendance on Courses/Conferences on Smoking and smoking cessation Assistance (CCSA). The study included 718 family doctors in Lithuania in 2014.The results show that 23% of family doctors always ask their patients about smoking habits. Although 59% of family doctors always advise smoking patients to quit smoking, only 26% recommend a follow-up appointment, 22% refer for a specialized smoking cessation treatment, 15% prescribe nicotine replacement therapy, and 6% prescribe Varenicline or Bupropion. The study demonstrated limited knowledge of family doctors in relation to epidemiological aspects of tobacco use and effective cessation assistance methods. Cessation assistance is influenced by family doctors' age, smoking status, knowledge of cessation assistance guidelines and CCSA attendance.Effective training of family doctors' in smoking epidemiology, health hazards and in smoking cessation assistance is warranted in Lithuania. In addition, coordinated efforts in primary health care institutions are required to improve help for smokers who intend to quit.
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Patient adherence to smoking cessation medications can impact their effectiveness. It is important to understand the extent to which prescribed medications are actually taken by smokers, how this influences smoking cessation outcomes, and what factors may influence adherence. Smokers recruited from a large health plan were randomized to receive different modes of cessation counseling in combination with varenicline (Swan, G. E., McClure, J. B., Jack, L. M., Zbikowski, S. M., Javitz, H. S., Catz, S. L., et al. 2010.Behavioral counseling and varenicline treatment for smoking cessation. American Journal of Preventive Medicine, 38, 482–490). One thousand one hundred and sixty-one participants were mailed a 28-day varenicline supply when they set a quit date and were able to request up to two refills from the health plan pharmacy at no cost. Pharmacy fill records were obtained and telephone surveys completed at baseline, 21 days, 12 weeks, and 6 months post target quit date. Good adherence to varenicline (≥80% of days taken) was associated with a twofold increase in 6-month quit rates compared with poor adherence (52% vs. 25%). Smokers were more likely than nonsmokers to stop varenicline early. Purposeful nonadherence was associated with smoking at 12 weeks and was predicted in multivariate analyses by age, gender, adherence self-efficacy, and initial medication side effect severity. Innovative methods for increasing adherence to smoking cessation medications are needed, particularly early in the quit process. Simple metrics of adherence such as number of days cessation medication is taken can and should be routinely incorporated in effectiveness trials and reported to advance future attempts to understand and reduce nonadherence.
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Health plan
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Varenicline
Bupropion
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According to recent assessments from the Italian Istituto Superiore della Sanità, information and assistance to smokers are still far from satisfactory. We evaluated the impact of a new smoking cessation service located in pharmacies. Smokers' individual characteristics were also considered.A 1-year pilot study was carried out from October 2010 to September 2011. Five pharmacies in Milan were selected. A psychologist with experience in smoking cessation was present in each pharmacy one afternoon per week, and pharmacists were trained by a team from the Antismoking Center of the Fondazione IRCCS Istituto Nazionale dei Tumori. Each pharmacy was equipped with informative material, carbon monoxide analyzers, and motivational and nicotine dependence questionnaires, in addition to a clinical briefcase. Counseling sessions were also arranged upon request.In the first 12 months of activity, 216 persons asked for a consultation. The sample, aged 15-79 years, reported the following median values: 30 pack/years, 14 ppm CO, and a Fagerström Test of Nicotine Dependence score of 5. More than one-third of the sample (40.3%) had one pathology and 25% had more than one. In some cases (15.7%), people just wanted information about what the service offered. For those who tried to quit, smoking cessation rates were 33.3% at 3 months, 28% at 6 months, and 24.6% at 1 year. Three kinds of pharmacologic therapies were suggested to smokers: nicotine replacement therapy (75.5%), varenicline (17.5%), and bupropion (7%).The results show that an accessible and free smoking cessation service is considered useful by smokers as demonstrated by the large number of requests compared with other smoking centers in Italy. Increased involvement of pharmacists in supporting smoking cessation makes this a promising initiative for the near future.
Varenicline
Nicotine replacement therapy
Bupropion
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Medicaid Coverage of Smoking Cessation Counseling and Medication Is Underutilized for Pregnant Women
Abstract Introduction: Policies to promote smoking cessation among Medicaid-insured pregnant women have the potential to assist a significant proportion of pregnant smokers. In 2010, Kansas Medicaid began covering smoking cessation counseling for pregnant smokers. Our aim was to evaluate the use of smoking cessation benefits provided to pregnant women as a result of the Kansas Medicaid policy change that provided reimbursement for physician-provided smoking cessation counseling. Methods: We examined Kansas Medicaid claims data to estimate rates of delivery of smoking cessation treatment to Medicaid-insured pregnant women in Kansas from fiscal year 2010 through 2013. We analyzed the number of pregnant women who received physician-provided smoking cessation counseling indicated by procedure billing codes (ie, G0436 and G0437) and medication (ie, nicotine replacement therapy, bupropion, or varenicline) located in outpatient managed care encounter and fee-for-service claims data. We estimated the number of Medicaid-insured pregnant smokers using the national smoking prevalence (14%) in this population and the number of live births reported in Kansas. Results: Annually from 2010 to 2013, approximately 27.2%–31.6% of pregnant smokers had claims for nicotine replacement therapy, bupropion, or varenicline. Excluding claims for bupropion, a medication commonly prescribed to treat depression, claims ranged from 9.3% to 11.1%. Following implementation of Medicaid coverage for smoking cessation counseling, less than 1% of estimated smokers had claims for counseling. Conclusions: This low claims rate suggests that simply changing policy is not sufficient to ensure use of newly implemented benefits, and that there probably remain critical gaps in smoking cessation treatment. Implications: This study evaluates the use of Medicaid reimbursement for smoking cessation counseling among low-income pregnant women in Kansas. We describe the Medicaid claims rates of physician-provided smoking cessation counseling for pregnant women, an evidence-based and universally recommended treatment approach for smoking cessation in this population. Our findings show that claims rates for smoking cessation benefits in this population are very low, even after policy changes to support provision of cessation assistance were implemented. Additional studies are needed to determine whether reimbursement is functioning as intended and identify potential gaps between policy and implementation of evidence-based smoking cessation treatment.
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