Hillel Kuttler

BALTIMORE – U.S. soldiers in Iraq and Afghanistan smoke to relieve boredom and stress in an environment that fosters smoking, according to focus group research sponsored by the Department of Veterans Affairs.

The favorable smoking environment also pervades monthly drill exercises once they've returned home, and even encourages nonsmokers to smoke.

The poster was based on interviews with members of the Minnesota Army National Guard who had served in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) and had smoked while deployed.

“The most important thing [learned] is that there's a very strong culture of tobacco use in the military, and it encourages people to start smoking and to continue it,” said Rachel Widome, Ph.D., core investigator at the VA Center for Chronic Disease Outcomes Research (CCDOR).

Concern for the effects of secondhand smoke on their children deterred smoking at home, Dr. Widome said. But the 1-weekend-a-month, 1-week-a-year drill exercises altered their habits.

Interviewees said that “it's not a problem to stay tobacco free at home, but when they get to the drill weekend, they smoke,” she said.

Dr. Widome highlighted the following responses from focus group participants:

▸ “While deployed, tobacco was a way to deal with stress, anger, boredom, and lack of control, and was a way to connect with others.”

▸ “It's such a camaraderie thing. At the drill, you can start up again if you quit before. The guys will give you crap about quitting and call you a quitter.”

▸ “Now that I'm at home and not around smokers, I have successfully quit, although I still smoke three packs a day on drill weekend … Even the nonsmokers smoke on drill weekends.”

▸ “I know people who smoke just because they get breaks every hour.”

“Innovative strategies and policies are needed” to promote smoking cessation among military members, Dr. Widome wrote in the poster, adding that focus group findings will be used to address the needs of returning soldiers at the Minneapolis VA Medical Center.

BALTIMORE – U.S. soldiers in Iraq and Afghanistan smoke to relieve boredom and stress in an environment that fosters smoking, according to focus group research sponsored by the Department of Veterans Affairs.

The favorable smoking environment also pervades monthly drill exercises once they've returned home, and even encourages nonsmokers to smoke.

The poster was based on interviews with members of the Minnesota Army National Guard who had served in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) and had smoked while deployed.

“The most important thing [learned] is that there's a very strong culture of tobacco use in the military, and it encourages people to start smoking and to continue it,” said Rachel Widome, Ph.D., core investigator at the VA Center for Chronic Disease Outcomes Research (CCDOR).

Concern for the effects of secondhand smoke on their children deterred smoking at home, Dr. Widome said. But the 1-weekend-a-month, 1-week-a-year drill exercises altered their habits.

Interviewees said that “it's not a problem to stay tobacco free at home, but when they get to the drill weekend, they smoke,” she said.

Dr. Widome highlighted the following responses from focus group participants:

▸ “While deployed, tobacco was a way to deal with stress, anger, boredom, and lack of control, and was a way to connect with others.”

▸ “It's such a camaraderie thing. At the drill, you can start up again if you quit before. The guys will give you crap about quitting and call you a quitter.”

▸ “Now that I'm at home and not around smokers, I have successfully quit, although I still smoke three packs a day on drill weekend … Even the nonsmokers smoke on drill weekends.”

▸ “I know people who smoke just because they get breaks every hour.”

“Innovative strategies and policies are needed” to promote smoking cessation among military members, Dr. Widome wrote in the poster, adding that focus group findings will be used to address the needs of returning soldiers at the Minneapolis VA Medical Center.

BALTIMORE – U.S. soldiers in Iraq and Afghanistan smoke to relieve boredom and stress in an environment that fosters smoking, according to focus group research sponsored by the Department of Veterans Affairs.

The favorable smoking environment also pervades monthly drill exercises once they've returned home, and even encourages nonsmokers to smoke.

The poster was based on interviews with members of the Minnesota Army National Guard who had served in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) and had smoked while deployed.

“The most important thing [learned] is that there's a very strong culture of tobacco use in the military, and it encourages people to start smoking and to continue it,” said Rachel Widome, Ph.D., core investigator at the VA Center for Chronic Disease Outcomes Research (CCDOR).

Concern for the effects of secondhand smoke on their children deterred smoking at home, Dr. Widome said. But the 1-weekend-a-month, 1-week-a-year drill exercises altered their habits.

Interviewees said that “it's not a problem to stay tobacco free at home, but when they get to the drill weekend, they smoke,” she said.

Dr. Widome highlighted the following responses from focus group participants:

▸ “While deployed, tobacco was a way to deal with stress, anger, boredom, and lack of control, and was a way to connect with others.”

▸ “It's such a camaraderie thing. At the drill, you can start up again if you quit before. The guys will give you crap about quitting and call you a quitter.”

▸ “Now that I'm at home and not around smokers, I have successfully quit, although I still smoke three packs a day on drill weekend … Even the nonsmokers smoke on drill weekends.”

▸ “I know people who smoke just because they get breaks every hour.”

“Innovative strategies and policies are needed” to promote smoking cessation among military members, Dr. Widome wrote in the poster, adding that focus group findings will be used to address the needs of returning soldiers at the Minneapolis VA Medical Center.

Major Finding: At 12 months follow-up, 22% of all smokers in the intervention group had abstained for the past 6 months, compared with 18% in the control group.

Data Source: Sixty-five percent of 1,058 adolescents identified as smokers by a classroom survey in 25 schools in Washington completed at least one telephone conversation with trained smoking cessation counselors and were compared with 1,093 in a control group.

Disclosures: The work was supported by a grant from the National Cancer Institute. Ms. Kealey said she had no conflicts relevant to the study to disclose.

BALTIMORE – Proactively reaching out to adolescent smokers through their high schools is both an effective and cost-effective way of achieving smoking cessation, researchers in a Washington State study found.

The findings demonstrate that “modest investments in effective interventions can accelerate declines in smoking prevalence,” Kathleen Kealey said.

“The cost is much less than the cost to society of smoking,” said Ms. Kealey, who serves as administrative program manager at the Fred Hutchinson Cancer Research Center, Seattle.

“An investment of under $100 to get a teen to quit can save billions of dollars in health care costs and lost productivity.”

The randomized trial involved smokers in 25 high schools in Washington who were eligible for the intervention on the basis of parental consent or being at least age 18 years.

In the intervention group, 691 of 1,058 people (65%) identified as smokers by a classroom survey completed at least one telephone conversation with trained smoking cessation counselors; 47% (499) completed all planned telephone counseling calls.

No intervention was offered to the 1,093 students who identified themselves as smokers and served as a control group.

Surveys conducted at 12 months follow-up indicated that 22% of all smokers in the intervention group had abstained for the past 6 months, compared with 18% in the control group.

Among daily smokers, 10% of the intervention group had abstained for the past 6 months, compared with 6% in the control group.

Rather than recruit high school students with notices directed at smokers, the researchers removed what they considered the stigma of smoking, and a barrier to participation, by surveying all students–smokers and nonsmokers–for their views, according to Ms. Kealey. Without revealing whether the child smoked, researchers called students' parents to obtain consent. That approach was meant to preserve students' privacy, Ms. Kealey explained.

Letters then were sent to students to ask for their participation in the study.

Counselors were trained in motivational interviewing and cognitive-behavioral skills training. The sessions aimed to provide an opportunity for students to discuss their views of smoking in a nonjudgmental environment, Ms. Kealey said. If students wished to quit smoking, telephone counseling on smoking cessation was provided.

The study also focused on calculating the cost of the intervention per targeted smoker, including those adolescents who did not proceed to have any telephone counseling sessions.

Expenses included counselors' salary and benefits, data entry of students' telephone numbers, telephone calls and mailings, and the cost of quit kits.

Researchers calculated that $226 was spent per targeted smoker, and that disseminating the intervention to 10,000 smokers in a target population would cost an estimated $87 per targeted smoker.

The costs of intervention-attributable to smoking cessation at 1 year were $3,018, $3,329, or $5,659 per additional 7-day, 1-month, and 6-month prolonged quit, respectively.

Getting a teenager to quit smoking involves a small investment with a huge payoff, Ms. Kealey said.

Compared with the study's one-time cost of $5,659 per-person to achieve abstinence at 6 months, the Centers for Disease Control and Prevention estimates that smoking costs society $4,447 per smoker annually in medical bills and lost productivity, she said.

“If we reach out, we'll get agreement and participation,” Ms. Kealey emphasized.

“Teenagers don't seek out any formal [smoking cessation] help because they think it's not a serious enough problem to get help, and they're not aware that help is available.”

Major Finding: At 12 months follow-up, 22% of all smokers in the intervention group had abstained for the past 6 months, compared with 18% in the control group.

Data Source: Sixty-five percent of 1,058 adolescents identified as smokers by a classroom survey in 25 schools in Washington completed at least one telephone conversation with trained smoking cessation counselors and were compared with 1,093 in a control group.

Disclosures: The work was supported by a grant from the National Cancer Institute. Ms. Kealey said she had no conflicts relevant to the study to disclose.

BALTIMORE – Proactively reaching out to adolescent smokers through their high schools is both an effective and cost-effective way of achieving smoking cessation, researchers in a Washington State study found.

The findings demonstrate that “modest investments in effective interventions can accelerate declines in smoking prevalence,” Kathleen Kealey said.

“The cost is much less than the cost to society of smoking,” said Ms. Kealey, who serves as administrative program manager at the Fred Hutchinson Cancer Research Center, Seattle.

“An investment of under $100 to get a teen to quit can save billions of dollars in health care costs and lost productivity.”

The randomized trial involved smokers in 25 high schools in Washington who were eligible for the intervention on the basis of parental consent or being at least age 18 years.

In the intervention group, 691 of 1,058 people (65%) identified as smokers by a classroom survey completed at least one telephone conversation with trained smoking cessation counselors; 47% (499) completed all planned telephone counseling calls.

No intervention was offered to the 1,093 students who identified themselves as smokers and served as a control group.

Surveys conducted at 12 months follow-up indicated that 22% of all smokers in the intervention group had abstained for the past 6 months, compared with 18% in the control group.

Among daily smokers, 10% of the intervention group had abstained for the past 6 months, compared with 6% in the control group.

Rather than recruit high school students with notices directed at smokers, the researchers removed what they considered the stigma of smoking, and a barrier to participation, by surveying all students–smokers and nonsmokers–for their views, according to Ms. Kealey. Without revealing whether the child smoked, researchers called students' parents to obtain consent. That approach was meant to preserve students' privacy, Ms. Kealey explained.

Letters then were sent to students to ask for their participation in the study.

Counselors were trained in motivational interviewing and cognitive-behavioral skills training. The sessions aimed to provide an opportunity for students to discuss their views of smoking in a nonjudgmental environment, Ms. Kealey said. If students wished to quit smoking, telephone counseling on smoking cessation was provided.

The study also focused on calculating the cost of the intervention per targeted smoker, including those adolescents who did not proceed to have any telephone counseling sessions.

Expenses included counselors' salary and benefits, data entry of students' telephone numbers, telephone calls and mailings, and the cost of quit kits.

Researchers calculated that $226 was spent per targeted smoker, and that disseminating the intervention to 10,000 smokers in a target population would cost an estimated $87 per targeted smoker.

The costs of intervention-attributable to smoking cessation at 1 year were $3,018, $3,329, or $5,659 per additional 7-day, 1-month, and 6-month prolonged quit, respectively.

Getting a teenager to quit smoking involves a small investment with a huge payoff, Ms. Kealey said.

Compared with the study's one-time cost of $5,659 per-person to achieve abstinence at 6 months, the Centers for Disease Control and Prevention estimates that smoking costs society $4,447 per smoker annually in medical bills and lost productivity, she said.

“If we reach out, we'll get agreement and participation,” Ms. Kealey emphasized.

“Teenagers don't seek out any formal [smoking cessation] help because they think it's not a serious enough problem to get help, and they're not aware that help is available.”

Major Finding: At 12 months follow-up, 22% of all smokers in the intervention group had abstained for the past 6 months, compared with 18% in the control group.

Data Source: Sixty-five percent of 1,058 adolescents identified as smokers by a classroom survey in 25 schools in Washington completed at least one telephone conversation with trained smoking cessation counselors and were compared with 1,093 in a control group.

Disclosures: The work was supported by a grant from the National Cancer Institute. Ms. Kealey said she had no conflicts relevant to the study to disclose.

BALTIMORE – Proactively reaching out to adolescent smokers through their high schools is both an effective and cost-effective way of achieving smoking cessation, researchers in a Washington State study found.

The findings demonstrate that “modest investments in effective interventions can accelerate declines in smoking prevalence,” Kathleen Kealey said.

“The cost is much less than the cost to society of smoking,” said Ms. Kealey, who serves as administrative program manager at the Fred Hutchinson Cancer Research Center, Seattle.

“An investment of under $100 to get a teen to quit can save billions of dollars in health care costs and lost productivity.”

The randomized trial involved smokers in 25 high schools in Washington who were eligible for the intervention on the basis of parental consent or being at least age 18 years.

In the intervention group, 691 of 1,058 people (65%) identified as smokers by a classroom survey completed at least one telephone conversation with trained smoking cessation counselors; 47% (499) completed all planned telephone counseling calls.

No intervention was offered to the 1,093 students who identified themselves as smokers and served as a control group.

Surveys conducted at 12 months follow-up indicated that 22% of all smokers in the intervention group had abstained for the past 6 months, compared with 18% in the control group.

Among daily smokers, 10% of the intervention group had abstained for the past 6 months, compared with 6% in the control group.

Rather than recruit high school students with notices directed at smokers, the researchers removed what they considered the stigma of smoking, and a barrier to participation, by surveying all students–smokers and nonsmokers–for their views, according to Ms. Kealey. Without revealing whether the child smoked, researchers called students' parents to obtain consent. That approach was meant to preserve students' privacy, Ms. Kealey explained.

Letters then were sent to students to ask for their participation in the study.

Counselors were trained in motivational interviewing and cognitive-behavioral skills training. The sessions aimed to provide an opportunity for students to discuss their views of smoking in a nonjudgmental environment, Ms. Kealey said. If students wished to quit smoking, telephone counseling on smoking cessation was provided.

The study also focused on calculating the cost of the intervention per targeted smoker, including those adolescents who did not proceed to have any telephone counseling sessions.

Expenses included counselors' salary and benefits, data entry of students' telephone numbers, telephone calls and mailings, and the cost of quit kits.

Researchers calculated that $226 was spent per targeted smoker, and that disseminating the intervention to 10,000 smokers in a target population would cost an estimated $87 per targeted smoker.

The costs of intervention-attributable to smoking cessation at 1 year were $3,018, $3,329, or $5,659 per additional 7-day, 1-month, and 6-month prolonged quit, respectively.

Getting a teenager to quit smoking involves a small investment with a huge payoff, Ms. Kealey said.

Compared with the study's one-time cost of $5,659 per-person to achieve abstinence at 6 months, the Centers for Disease Control and Prevention estimates that smoking costs society $4,447 per smoker annually in medical bills and lost productivity, she said.

“If we reach out, we'll get agreement and participation,” Ms. Kealey emphasized.

“Teenagers don't seek out any formal [smoking cessation] help because they think it's not a serious enough problem to get help, and they're not aware that help is available.”

BALTIMORE — Codeine combined with ibuprofen did not relieve pain from pediatric acute musculoskeletal injuries any more effectively than ibuprofen alone; however, the combination therapy was associated with fewer side effects, according to findings from a small, randomized controlled trial.

Pain management in children generally tends to be poor, and children presenting with a limb trauma need to receive an opioid, and possibly one that's stronger than codeine, “to better relieve their pain and bring it down to below [a Visual Analog Scale score of] 4,” Sylvie Le May, Ph.D., said.

The study involved 83 children (aged 6–17 years) who presented to the emergency department at CHU Sainte-Justine University Hospital Center, Montreal, with limb fractures, sprains, and contusions between March 2008 and October 2009. At baseline, the children reported having moderate to severe pain (4–10 on the VAS).

In all, 42 patients were randomized to receive codeine and ibuprofen, whereas 41 patients in the control group received ibuprofen and placebo. The children's pain levels were measured at triage, then at the 60-, 90-, and 120-minute marks afterward.

Children in the experimental group had a mean score of 5.9 VAS at triage, then 4.2, 4.0, and 3.5, respectively; those in the control group had mean scores of 5.7, 3.9, 4.1, and 3.8.

Dr. Le May explained that she undertook the study because, in her experience as a nurse, children “with this kind of pain [from] limb trauma should receive an opioid. That's the standard, but physicians are not following the standard.”

Dr. Le May said that her 2005–2007 study of 150 charts of children presenting to EDs with severe sprains, fractures, burns, deep lacerations, and abdominal pain found that only 3% of children received an opioid for their pain.

Disclosures: Dr. Le May reported having no conflicts of interest.

BALTIMORE — Codeine combined with ibuprofen did not relieve pain from pediatric acute musculoskeletal injuries any more effectively than ibuprofen alone; however, the combination therapy was associated with fewer side effects, according to findings from a small, randomized controlled trial.

Pain management in children generally tends to be poor, and children presenting with a limb trauma need to receive an opioid, and possibly one that's stronger than codeine, “to better relieve their pain and bring it down to below [a Visual Analog Scale score of] 4,” Sylvie Le May, Ph.D., said.

The study involved 83 children (aged 6–17 years) who presented to the emergency department at CHU Sainte-Justine University Hospital Center, Montreal, with limb fractures, sprains, and contusions between March 2008 and October 2009. At baseline, the children reported having moderate to severe pain (4–10 on the VAS).

In all, 42 patients were randomized to receive codeine and ibuprofen, whereas 41 patients in the control group received ibuprofen and placebo. The children's pain levels were measured at triage, then at the 60-, 90-, and 120-minute marks afterward.

Children in the experimental group had a mean score of 5.9 VAS at triage, then 4.2, 4.0, and 3.5, respectively; those in the control group had mean scores of 5.7, 3.9, 4.1, and 3.8.

Dr. Le May explained that she undertook the study because, in her experience as a nurse, children “with this kind of pain [from] limb trauma should receive an opioid. That's the standard, but physicians are not following the standard.”

Dr. Le May said that her 2005–2007 study of 150 charts of children presenting to EDs with severe sprains, fractures, burns, deep lacerations, and abdominal pain found that only 3% of children received an opioid for their pain.

Disclosures: Dr. Le May reported having no conflicts of interest.

BALTIMORE — Codeine combined with ibuprofen did not relieve pain from pediatric acute musculoskeletal injuries any more effectively than ibuprofen alone; however, the combination therapy was associated with fewer side effects, according to findings from a small, randomized controlled trial.

Pain management in children generally tends to be poor, and children presenting with a limb trauma need to receive an opioid, and possibly one that's stronger than codeine, “to better relieve their pain and bring it down to below [a Visual Analog Scale score of] 4,” Sylvie Le May, Ph.D., said.

The study involved 83 children (aged 6–17 years) who presented to the emergency department at CHU Sainte-Justine University Hospital Center, Montreal, with limb fractures, sprains, and contusions between March 2008 and October 2009. At baseline, the children reported having moderate to severe pain (4–10 on the VAS).

In all, 42 patients were randomized to receive codeine and ibuprofen, whereas 41 patients in the control group received ibuprofen and placebo. The children's pain levels were measured at triage, then at the 60-, 90-, and 120-minute marks afterward.

Children in the experimental group had a mean score of 5.9 VAS at triage, then 4.2, 4.0, and 3.5, respectively; those in the control group had mean scores of 5.7, 3.9, 4.1, and 3.8.

Dr. Le May explained that she undertook the study because, in her experience as a nurse, children “with this kind of pain [from] limb trauma should receive an opioid. That's the standard, but physicians are not following the standard.”

Dr. Le May said that her 2005–2007 study of 150 charts of children presenting to EDs with severe sprains, fractures, burns, deep lacerations, and abdominal pain found that only 3% of children received an opioid for their pain.

Disclosures: Dr. Le May reported having no conflicts of interest.

BALTIMORE – Using a nicotine patch or bupropion with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking, according to a prospective study of 1,504 smokers.

The therapies were “significantly better than placebo in promoting initial abstinence” and were effective int preventing relapse, reported Sandra Japuntich, Ph.D., a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study's importance lies in its examination of the effects of each therapy closer to the smokers' targeted quit dates, she said.

The placebo-controlled trial sought to identify the effects on smoking cessation milestones of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a lozenge, 86% on bupropion with a lozenge, 81% on bupropion, 81% on a lozenge, and 88% on a nicotine patch.

Of those who initially abstained, 83% on placebo lapsed, compared with 70% those using a patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion, 73% on a lozenge, and 76% on a patch.

Of those who lapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The strongest treatment effects happened in the first week or two, she said. Those patients who do not stay abstinent might need to try another therapy.

Dr. Japuntich reported no conflicts of interest. One coinvestigator has served on research projects sponsored by a number of pharmaceutical companies.

BALTIMORE – Using a nicotine patch or bupropion with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking, according to a prospective study of 1,504 smokers.

The therapies were “significantly better than placebo in promoting initial abstinence” and were effective int preventing relapse, reported Sandra Japuntich, Ph.D., a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study's importance lies in its examination of the effects of each therapy closer to the smokers' targeted quit dates, she said.

The placebo-controlled trial sought to identify the effects on smoking cessation milestones of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a lozenge, 86% on bupropion with a lozenge, 81% on bupropion, 81% on a lozenge, and 88% on a nicotine patch.

Of those who initially abstained, 83% on placebo lapsed, compared with 70% those using a patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion, 73% on a lozenge, and 76% on a patch.

Of those who lapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The strongest treatment effects happened in the first week or two, she said. Those patients who do not stay abstinent might need to try another therapy.

Dr. Japuntich reported no conflicts of interest. One coinvestigator has served on research projects sponsored by a number of pharmaceutical companies.

BALTIMORE – Using a nicotine patch or bupropion with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking, according to a prospective study of 1,504 smokers.

The therapies were “significantly better than placebo in promoting initial abstinence” and were effective int preventing relapse, reported Sandra Japuntich, Ph.D., a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study's importance lies in its examination of the effects of each therapy closer to the smokers' targeted quit dates, she said.

The placebo-controlled trial sought to identify the effects on smoking cessation milestones of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a lozenge, 86% on bupropion with a lozenge, 81% on bupropion, 81% on a lozenge, and 88% on a nicotine patch.

Of those who initially abstained, 83% on placebo lapsed, compared with 70% those using a patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion, 73% on a lozenge, and 76% on a patch.

Of those who lapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The strongest treatment effects happened in the first week or two, she said. Those patients who do not stay abstinent might need to try another therapy.

Dr. Japuntich reported no conflicts of interest. One coinvestigator has served on research projects sponsored by a number of pharmaceutical companies.

Baltimore — Utilizing a nicotine patch or bupropion together with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking behaviors, according to a prospective study of 1,504 smokers.

All five therapies were “significantly better than placebo in promoting initial abstinence” from cigarette smoking, Sandra Japuntich, Ph.D., reported at the meeting.

The therapies also were effective at preventing relapse, said Dr. Japuntich, a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study was important because it examined the effects of each therapy closer to the smokers' targeted quit dates than previous studies have done, Dr. Japuntich said.

The placebo-controlled trial sought to identify the effects on milestones of smoking cessation of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a nicotine lozenge, 86% on bupropion with a lozenge, 81% on bupropiona alone, 81% on a lozenge alone, and 88% on a nicotine patch alone.

Among the smokers who initially abstained, 83% on placebo lapsed, compared with 70% of smokers who used a nicotine patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion alone, 73% on a lozenge alone, and 76% on a nicotine patch alone.

Of the smokers who relapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The study's method provided understanding into the “more precise timing about when medications have effects,” Dr. Japuntich said. “That's important, because it informs treatment.

“According to our study, the strongest treatment effects are happening in the first week or two,” she said. “We should know whether medication is working [by then]. If you get past the first week or two on medication and you haven't lapsed, then the medication is working.”

On the other hand, for those who do not stay abstinent, “it could be that lapsing and relapsing is an indication that the medication isn't working, and that the patients might need to try something else,” she said.

Disclosures: Dr. Japuntich had no conflicts of interest to report. One of her coinvestigators, Timothy B. Baker, Ph.D., has served on research projects sponsored by pharmaceutical companies including Pfizer, Glaxo Wellcome, Sanofi, and Nabi Pharmaceuticals.

Baltimore — Utilizing a nicotine patch or bupropion together with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking behaviors, according to a prospective study of 1,504 smokers.

All five therapies were “significantly better than placebo in promoting initial abstinence” from cigarette smoking, Sandra Japuntich, Ph.D., reported at the meeting.

The therapies also were effective at preventing relapse, said Dr. Japuntich, a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study was important because it examined the effects of each therapy closer to the smokers' targeted quit dates than previous studies have done, Dr. Japuntich said.

The placebo-controlled trial sought to identify the effects on milestones of smoking cessation of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a nicotine lozenge, 86% on bupropion with a lozenge, 81% on bupropiona alone, 81% on a lozenge alone, and 88% on a nicotine patch alone.

Among the smokers who initially abstained, 83% on placebo lapsed, compared with 70% of smokers who used a nicotine patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion alone, 73% on a lozenge alone, and 76% on a nicotine patch alone.

Of the smokers who relapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The study's method provided understanding into the “more precise timing about when medications have effects,” Dr. Japuntich said. “That's important, because it informs treatment.

“According to our study, the strongest treatment effects are happening in the first week or two,” she said. “We should know whether medication is working [by then]. If you get past the first week or two on medication and you haven't lapsed, then the medication is working.”

On the other hand, for those who do not stay abstinent, “it could be that lapsing and relapsing is an indication that the medication isn't working, and that the patients might need to try something else,” she said.

Disclosures: Dr. Japuntich had no conflicts of interest to report. One of her coinvestigators, Timothy B. Baker, Ph.D., has served on research projects sponsored by pharmaceutical companies including Pfizer, Glaxo Wellcome, Sanofi, and Nabi Pharmaceuticals.

Baltimore — Utilizing a nicotine patch or bupropion together with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking behaviors, according to a prospective study of 1,504 smokers.

All five therapies were “significantly better than placebo in promoting initial abstinence” from cigarette smoking, Sandra Japuntich, Ph.D., reported at the meeting.

The therapies also were effective at preventing relapse, said Dr. Japuntich, a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study was important because it examined the effects of each therapy closer to the smokers' targeted quit dates than previous studies have done, Dr. Japuntich said.

The placebo-controlled trial sought to identify the effects on milestones of smoking cessation of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a nicotine lozenge, 86% on bupropion with a lozenge, 81% on bupropiona alone, 81% on a lozenge alone, and 88% on a nicotine patch alone.

Among the smokers who initially abstained, 83% on placebo lapsed, compared with 70% of smokers who used a nicotine patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion alone, 73% on a lozenge alone, and 76% on a nicotine patch alone.

Of the smokers who relapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The study's method provided understanding into the “more precise timing about when medications have effects,” Dr. Japuntich said. “That's important, because it informs treatment.

“According to our study, the strongest treatment effects are happening in the first week or two,” she said. “We should know whether medication is working [by then]. If you get past the first week or two on medication and you haven't lapsed, then the medication is working.”

On the other hand, for those who do not stay abstinent, “it could be that lapsing and relapsing is an indication that the medication isn't working, and that the patients might need to try something else,” she said.

Disclosures: Dr. Japuntich had no conflicts of interest to report. One of her coinvestigators, Timothy B. Baker, Ph.D., has served on research projects sponsored by pharmaceutical companies including Pfizer, Glaxo Wellcome, Sanofi, and Nabi Pharmaceuticals.

BALTIMORE — Small cigars known as cigarillos, snus, and electronic nicotine delivery systems appeal to young people and are marketed to them, underscoring the need for far more data on their associated health risks, experts emphasized at the annual meeting of the Society for Research on Nicotine and Tobacco.

The lack of clarity in defining and classifying each product complicates government's regulatory capability as well as efforts to educate smokers on the risks, said Jennifer Cullen, Ph.D., director of research at the American Legacy Foundation in Washington, an outreach and education organization created and funded by the 1998 tobacco Master Settlement Agreement.

Cigar use showed a 0.75% increase annually during 2002-2007 among non-Hispanic whites aged 18-25-years, according to Dr. Cullen's analysis of data from the National Survey on Drug Use and Health. Across all years in that age group, cigarillos were the most popular cigars. White and black non-Hispanic males showed the greatest prevalence of cigar smoking during the past 30 days. More research is needed on the factors that contribute to their popularity, she said.

In a separate survey of 4,067 smokers conducted in eight cities, Lois Biener, Ph.D., senior research fellow at the Center for Survey Research at the University of Massachusetts, Boston, found that 29% of smokers aged 18-24 years used snus, teabag-like pouches of tobacco that are placed under the lip. Snus tend to appeal more to men than women and they appeal to young smokers, who are not planning to quit anytime soon, she observed.

“Snus may be old news for a lot of people, but we still don't have a lot of information on them from a population standpoint,” Dr. Biener said. For example “we don't know how many triers went on to regular or repeated snus use,” she said, so “we do need some targeted research on youth and the use of this product.”

Electronic nicotine delivery systems (ENDS), or e-cigarettes, contain a battery, heating element, and nicotine that is sometimes flavored, explained Dr. Nathan Cobb of the Schroeder Institute for Tobacco Research and Policy Studies, a part of the American Legacy Foundation. They deliver nicotine to the mouth and lungs when sucked and emit a mist that resembles smoke, he said.

E-cigarettes are imported primarily from China and are available online and at mall kiosks, he said. Refill solutions contain up to 36 mg of nicotine.

Dr. Cobb said that he has policy concerns over such terms as ENDS, electronic cigarettes, and e-cigarettes because manufacturers might be seeking to evade classification as cigarettes. Still, “we can't assume that the risks and harms are the same” as for cigarettes, he said. There may be significant safety risks associated with exposure to chemicals, and it has yet to be seen whether e-cigarettes can be employed in ways to help people with smoking cessation.

About 29% of smokers, aged 18-24, used snus, according to a survey.

Source Fippzor/Fotolia.com

BALTIMORE — Small cigars known as cigarillos, snus, and electronic nicotine delivery systems appeal to young people and are marketed to them, underscoring the need for far more data on their associated health risks, experts emphasized at the annual meeting of the Society for Research on Nicotine and Tobacco.

The lack of clarity in defining and classifying each product complicates government's regulatory capability as well as efforts to educate smokers on the risks, said Jennifer Cullen, Ph.D., director of research at the American Legacy Foundation in Washington, an outreach and education organization created and funded by the 1998 tobacco Master Settlement Agreement.

Cigar use showed a 0.75% increase annually during 2002-2007 among non-Hispanic whites aged 18-25-years, according to Dr. Cullen's analysis of data from the National Survey on Drug Use and Health. Across all years in that age group, cigarillos were the most popular cigars. White and black non-Hispanic males showed the greatest prevalence of cigar smoking during the past 30 days. More research is needed on the factors that contribute to their popularity, she said.

In a separate survey of 4,067 smokers conducted in eight cities, Lois Biener, Ph.D., senior research fellow at the Center for Survey Research at the University of Massachusetts, Boston, found that 29% of smokers aged 18-24 years used snus, teabag-like pouches of tobacco that are placed under the lip. Snus tend to appeal more to men than women and they appeal to young smokers, who are not planning to quit anytime soon, she observed.

“Snus may be old news for a lot of people, but we still don't have a lot of information on them from a population standpoint,” Dr. Biener said. For example “we don't know how many triers went on to regular or repeated snus use,” she said, so “we do need some targeted research on youth and the use of this product.”

Electronic nicotine delivery systems (ENDS), or e-cigarettes, contain a battery, heating element, and nicotine that is sometimes flavored, explained Dr. Nathan Cobb of the Schroeder Institute for Tobacco Research and Policy Studies, a part of the American Legacy Foundation. They deliver nicotine to the mouth and lungs when sucked and emit a mist that resembles smoke, he said.

E-cigarettes are imported primarily from China and are available online and at mall kiosks, he said. Refill solutions contain up to 36 mg of nicotine.

Dr. Cobb said that he has policy concerns over such terms as ENDS, electronic cigarettes, and e-cigarettes because manufacturers might be seeking to evade classification as cigarettes. Still, “we can't assume that the risks and harms are the same” as for cigarettes, he said. There may be significant safety risks associated with exposure to chemicals, and it has yet to be seen whether e-cigarettes can be employed in ways to help people with smoking cessation.

About 29% of smokers, aged 18-24, used snus, according to a survey.

Source Fippzor/Fotolia.com

BALTIMORE — Small cigars known as cigarillos, snus, and electronic nicotine delivery systems appeal to young people and are marketed to them, underscoring the need for far more data on their associated health risks, experts emphasized at the annual meeting of the Society for Research on Nicotine and Tobacco.

The lack of clarity in defining and classifying each product complicates government's regulatory capability as well as efforts to educate smokers on the risks, said Jennifer Cullen, Ph.D., director of research at the American Legacy Foundation in Washington, an outreach and education organization created and funded by the 1998 tobacco Master Settlement Agreement.

Cigar use showed a 0.75% increase annually during 2002-2007 among non-Hispanic whites aged 18-25-years, according to Dr. Cullen's analysis of data from the National Survey on Drug Use and Health. Across all years in that age group, cigarillos were the most popular cigars. White and black non-Hispanic males showed the greatest prevalence of cigar smoking during the past 30 days. More research is needed on the factors that contribute to their popularity, she said.

In a separate survey of 4,067 smokers conducted in eight cities, Lois Biener, Ph.D., senior research fellow at the Center for Survey Research at the University of Massachusetts, Boston, found that 29% of smokers aged 18-24 years used snus, teabag-like pouches of tobacco that are placed under the lip. Snus tend to appeal more to men than women and they appeal to young smokers, who are not planning to quit anytime soon, she observed.

“Snus may be old news for a lot of people, but we still don't have a lot of information on them from a population standpoint,” Dr. Biener said. For example “we don't know how many triers went on to regular or repeated snus use,” she said, so “we do need some targeted research on youth and the use of this product.”

Electronic nicotine delivery systems (ENDS), or e-cigarettes, contain a battery, heating element, and nicotine that is sometimes flavored, explained Dr. Nathan Cobb of the Schroeder Institute for Tobacco Research and Policy Studies, a part of the American Legacy Foundation. They deliver nicotine to the mouth and lungs when sucked and emit a mist that resembles smoke, he said.

E-cigarettes are imported primarily from China and are available online and at mall kiosks, he said. Refill solutions contain up to 36 mg of nicotine.

Dr. Cobb said that he has policy concerns over such terms as ENDS, electronic cigarettes, and e-cigarettes because manufacturers might be seeking to evade classification as cigarettes. Still, “we can't assume that the risks and harms are the same” as for cigarettes, he said. There may be significant safety risks associated with exposure to chemicals, and it has yet to be seen whether e-cigarettes can be employed in ways to help people with smoking cessation.

About 29% of smokers, aged 18-24, used snus, according to a survey.

Source Fippzor/Fotolia.com

BALTIMORE — Utilizing a nicotine patch or bupropion together with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking, according to a prospective study of 1,504 smokers.

All five therapies were “significantly better than placebo in promoting initial abstinence,” Sandra Japuntich, Ph.D., reported at the annual meeting of the Society for Research on Nicotine and Tobacco.

The therapies also were effective at preventing relapse, said Dr. Japuntich, a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study's importance lies in its examination of the effects of each therapy closer to the smokers' targeted quit dates, Dr. Japuntich said.

The placebo-controlled trial sought to identify the effects on smoking cessation milestones of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a nicotine lozenge, 86% on bupropion with a lozenge, 81% on bupropion, 81% on a lozenge, and 88% on a nicotine patch.

Among those who initially abstained, 83% on placebo lapsed, compared with 70% of smokers who used a nicotine patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion, 73% on a lozenge, and 76% on a patch.

Of those who lapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The study's method provided understanding into the “more precise timing about when medications have effects,” Dr. Japuntich said. “That's important, because it informs treatment.

“According to our study, the strongest treatment effects are happening in the first week or two,” she said. “We should know whether medication is working [by then]. If you get past the first week or two on medication and you haven't lapsed, then the medication is working.”

On the other hand, for those who do not stay abstinent, “it could be that lapsing and relapsing is an indication that the medication isn't working, and that the patients might need to try something else,” she said.

Dr. Japuntich had no conflicts of interest to report. One of her coinvestigators, Timothy B. Baker, Ph.D., has served on research projects sponsored by pharmaceutical companies including Pfizer Inc., Glaxo Wellcome Inc., Sanofi Inc., and Nabi Pharmaceuticals Inc.

BALTIMORE — Utilizing a nicotine patch or bupropion together with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking, according to a prospective study of 1,504 smokers.

All five therapies were “significantly better than placebo in promoting initial abstinence,” Sandra Japuntich, Ph.D., reported at the annual meeting of the Society for Research on Nicotine and Tobacco.

The therapies also were effective at preventing relapse, said Dr. Japuntich, a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study's importance lies in its examination of the effects of each therapy closer to the smokers' targeted quit dates, Dr. Japuntich said.

The placebo-controlled trial sought to identify the effects on smoking cessation milestones of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a nicotine lozenge, 86% on bupropion with a lozenge, 81% on bupropion, 81% on a lozenge, and 88% on a nicotine patch.

Among those who initially abstained, 83% on placebo lapsed, compared with 70% of smokers who used a nicotine patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion, 73% on a lozenge, and 76% on a patch.

Of those who lapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The study's method provided understanding into the “more precise timing about when medications have effects,” Dr. Japuntich said. “That's important, because it informs treatment.

“According to our study, the strongest treatment effects are happening in the first week or two,” she said. “We should know whether medication is working [by then]. If you get past the first week or two on medication and you haven't lapsed, then the medication is working.”

On the other hand, for those who do not stay abstinent, “it could be that lapsing and relapsing is an indication that the medication isn't working, and that the patients might need to try something else,” she said.

Dr. Japuntich had no conflicts of interest to report. One of her coinvestigators, Timothy B. Baker, Ph.D., has served on research projects sponsored by pharmaceutical companies including Pfizer Inc., Glaxo Wellcome Inc., Sanofi Inc., and Nabi Pharmaceuticals Inc.

BALTIMORE — Utilizing a nicotine patch or bupropion together with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking, according to a prospective study of 1,504 smokers.

All five therapies were “significantly better than placebo in promoting initial abstinence,” Sandra Japuntich, Ph.D., reported at the annual meeting of the Society for Research on Nicotine and Tobacco.

The therapies also were effective at preventing relapse, said Dr. Japuntich, a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.

The study's importance lies in its examination of the effects of each therapy closer to the smokers' targeted quit dates, Dr. Japuntich said.

The placebo-controlled trial sought to identify the effects on smoking cessation milestones of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.

The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.

A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a nicotine lozenge, 86% on bupropion with a lozenge, 81% on bupropion, 81% on a lozenge, and 88% on a nicotine patch.

Among those who initially abstained, 83% on placebo lapsed, compared with 70% of smokers who used a nicotine patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion, 73% on a lozenge, and 76% on a patch.

Of those who lapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.

The study's method provided understanding into the “more precise timing about when medications have effects,” Dr. Japuntich said. “That's important, because it informs treatment.

“According to our study, the strongest treatment effects are happening in the first week or two,” she said. “We should know whether medication is working [by then]. If you get past the first week or two on medication and you haven't lapsed, then the medication is working.”

On the other hand, for those who do not stay abstinent, “it could be that lapsing and relapsing is an indication that the medication isn't working, and that the patients might need to try something else,” she said.

Dr. Japuntich had no conflicts of interest to report. One of her coinvestigators, Timothy B. Baker, Ph.D., has served on research projects sponsored by pharmaceutical companies including Pfizer Inc., Glaxo Wellcome Inc., Sanofi Inc., and Nabi Pharmaceuticals Inc.

BALTIMORE — Minnesota's passage of a ban on smoking in bars and restaurants made smokers 4.1% more likely to quit, compared with pre-ban smokers.

The state's 2007 enactment of the Freedom to Breathe Act had a significant effect on abstinence, although it was not as strong a factor as a smoker having a high level of confidence in quitting (12.3%), degree of utilization of cessation programs (7.8%–18.4%), and use of nicotine replacement therapy (7.5%) and other medications, according to a poster presented at the annual meeting of the Society for Research on Nicotine and Tobacco.

The cross-sectional study surveyed 2,917 people enrolled in four tobacco cessation programs conducted by ClearWay Minnesota, a nonprofit smoking cessation research and public outreach group.

The study data reflect the period 2 years prior to the 2007 enactment and 1 year afterward. Data were collected at each participant's time of enrollment in the cessation program and then each individual was surveyed 7 months later.

The study, conducted by Professional Data Analysts (PDA), a Minneapolis firm, found that the statewide ban's influence was “diluted” in areas that already had a ban—for each year of living in such areas, smokers were 2.5% less likely to have the ban affect their decision to remain abstinent.

Julie Rainey, PDA's vice president, surmised that smokers who had already been living under a local ban had by then adapted their behaviors by stepping outside to smoke or by not smoking at all.

The statewide ban further affected social norms, because “smoking was more stigmatized,” she said.

BALTIMORE — Minnesota's passage of a ban on smoking in bars and restaurants made smokers 4.1% more likely to quit, compared with pre-ban smokers.

The state's 2007 enactment of the Freedom to Breathe Act had a significant effect on abstinence, although it was not as strong a factor as a smoker having a high level of confidence in quitting (12.3%), degree of utilization of cessation programs (7.8%–18.4%), and use of nicotine replacement therapy (7.5%) and other medications, according to a poster presented at the annual meeting of the Society for Research on Nicotine and Tobacco.

The cross-sectional study surveyed 2,917 people enrolled in four tobacco cessation programs conducted by ClearWay Minnesota, a nonprofit smoking cessation research and public outreach group.

The study data reflect the period 2 years prior to the 2007 enactment and 1 year afterward. Data were collected at each participant's time of enrollment in the cessation program and then each individual was surveyed 7 months later.

The study, conducted by Professional Data Analysts (PDA), a Minneapolis firm, found that the statewide ban's influence was “diluted” in areas that already had a ban—for each year of living in such areas, smokers were 2.5% less likely to have the ban affect their decision to remain abstinent.

Julie Rainey, PDA's vice president, surmised that smokers who had already been living under a local ban had by then adapted their behaviors by stepping outside to smoke or by not smoking at all.

The statewide ban further affected social norms, because “smoking was more stigmatized,” she said.

BALTIMORE — Minnesota's passage of a ban on smoking in bars and restaurants made smokers 4.1% more likely to quit, compared with pre-ban smokers.

The state's 2007 enactment of the Freedom to Breathe Act had a significant effect on abstinence, although it was not as strong a factor as a smoker having a high level of confidence in quitting (12.3%), degree of utilization of cessation programs (7.8%–18.4%), and use of nicotine replacement therapy (7.5%) and other medications, according to a poster presented at the annual meeting of the Society for Research on Nicotine and Tobacco.

The cross-sectional study surveyed 2,917 people enrolled in four tobacco cessation programs conducted by ClearWay Minnesota, a nonprofit smoking cessation research and public outreach group.

The study data reflect the period 2 years prior to the 2007 enactment and 1 year afterward. Data were collected at each participant's time of enrollment in the cessation program and then each individual was surveyed 7 months later.

The study, conducted by Professional Data Analysts (PDA), a Minneapolis firm, found that the statewide ban's influence was “diluted” in areas that already had a ban—for each year of living in such areas, smokers were 2.5% less likely to have the ban affect their decision to remain abstinent.

Julie Rainey, PDA's vice president, surmised that smokers who had already been living under a local ban had by then adapted their behaviors by stepping outside to smoke or by not smoking at all.

The statewide ban further affected social norms, because “smoking was more stigmatized,” she said.

Use of rosiglitazone in physicians' office-based treatment of diabetes patients fell 60%, while pioglitazone use showed just a 9% drop during a 16-month period that included three Food and Drug Administration advisories in 2007 about the drugs' cardiovascular risks.

That gap “is noteworthy,” and “considerable evidence supports the greater safety” of pioglitazone over rosiglitazone, Andrew Cohen and his colleagues wrote in an investigation that was published online.

The investigators studied IMS Health's National Disease and Therapeutic Index monthly figures on oral diabetic therapies that were utilized during office treatment visits from January 2003 to June 2009.

Data on the use of the glitazone drug class for diabetic patients aged 35 years and older who did not have type 1 diabetes were analyzed in four time frames: January 2003–January 2005; February 2005–January 2007, a period when safety concerns were first revealed; February 2007–May 2008, when the FDA issued the advisories on cardiovascular risks and 6 months thereafter; and June 2008–June 2009, wrote Mr. Cohen of the University of Chicago, and his colleagues.

Following the publication of safety concerns that linked glitazone use to serious cardiovascular episodes, but prior to the FDA's advisories, overall glitazone use had begun declining from 34% of type 2 diabetes patients' office treatment visits to 29% (Diabetes Care 2010 Jan. 26 [doi:10.2337/dc09-1834]).

Rosiglitazone use showed a “sharp decline” following reports—scientific evidence, the FDA's advisories, and media coverage—of the cardiovascular risks of glitazone; however, pioglitazone use “did not similarly decline” in light of the FDA's class-wide advisory, the authors stated.

“Decreases in rosiglitazone and pioglitazone use occurred non-selectively, rather than among those at highest cardiovascular risk,” they said, adding that the changes “are important because glitazones were widely adopted into practice following their market debut despite questions regarding their potential safety.”

Although glitazone use showed “rapid increases” from the class's debut—growing at an annual rate of 22%, and peaking at 34% (11.2 million) of all treatment visits among patients with type 2 diabetes—it decreased at a 29% rate during the FDA advisory period before leveling off to a statistically nonsignificant decline of 2%, the investigators found.

In the latter period, rosiglitazone constituted 23% (1.8 million office visits) and pioglitazone 77% (5.8 million visits) of glitazone use.

The “continuing uncertainty” over the drugs' cardiovascular risks “suggests the importance of the routine inclusion of cardiovascular end points in studies that are used to seek FDA approval for diabetes therapies” and “their limited role as monotherapy for diabetes or use in patients at elevated risk of congestive heart failure or ischemic heart disease,” Mr. Cohen and his associates concluded.

The study was funded through a career development award from Robert Wood Johnson Physician Foundation and the Agency for Healthcare Research and Quality to Dr. G. Caleb Alexander, the principal investigator, also of the University of Chicago. No disclosures were reported.

Use of rosiglitazone in physicians' office-based treatment of diabetes patients fell 60%, while pioglitazone use showed just a 9% drop during a 16-month period that included three Food and Drug Administration advisories in 2007 about the drugs' cardiovascular risks.

That gap “is noteworthy,” and “considerable evidence supports the greater safety” of pioglitazone over rosiglitazone, Andrew Cohen and his colleagues wrote in an investigation that was published online.

The investigators studied IMS Health's National Disease and Therapeutic Index monthly figures on oral diabetic therapies that were utilized during office treatment visits from January 2003 to June 2009.

Data on the use of the glitazone drug class for diabetic patients aged 35 years and older who did not have type 1 diabetes were analyzed in four time frames: January 2003–January 2005; February 2005–January 2007, a period when safety concerns were first revealed; February 2007–May 2008, when the FDA issued the advisories on cardiovascular risks and 6 months thereafter; and June 2008–June 2009, wrote Mr. Cohen of the University of Chicago, and his colleagues.

Following the publication of safety concerns that linked glitazone use to serious cardiovascular episodes, but prior to the FDA's advisories, overall glitazone use had begun declining from 34% of type 2 diabetes patients' office treatment visits to 29% (Diabetes Care 2010 Jan. 26 [doi:10.2337/dc09-1834]).

Rosiglitazone use showed a “sharp decline” following reports—scientific evidence, the FDA's advisories, and media coverage—of the cardiovascular risks of glitazone; however, pioglitazone use “did not similarly decline” in light of the FDA's class-wide advisory, the authors stated.

“Decreases in rosiglitazone and pioglitazone use occurred non-selectively, rather than among those at highest cardiovascular risk,” they said, adding that the changes “are important because glitazones were widely adopted into practice following their market debut despite questions regarding their potential safety.”

Although glitazone use showed “rapid increases” from the class's debut—growing at an annual rate of 22%, and peaking at 34% (11.2 million) of all treatment visits among patients with type 2 diabetes—it decreased at a 29% rate during the FDA advisory period before leveling off to a statistically nonsignificant decline of 2%, the investigators found.

In the latter period, rosiglitazone constituted 23% (1.8 million office visits) and pioglitazone 77% (5.8 million visits) of glitazone use.

The “continuing uncertainty” over the drugs' cardiovascular risks “suggests the importance of the routine inclusion of cardiovascular end points in studies that are used to seek FDA approval for diabetes therapies” and “their limited role as monotherapy for diabetes or use in patients at elevated risk of congestive heart failure or ischemic heart disease,” Mr. Cohen and his associates concluded.

The study was funded through a career development award from Robert Wood Johnson Physician Foundation and the Agency for Healthcare Research and Quality to Dr. G. Caleb Alexander, the principal investigator, also of the University of Chicago. No disclosures were reported.

Use of rosiglitazone in physicians' office-based treatment of diabetes patients fell 60%, while pioglitazone use showed just a 9% drop during a 16-month period that included three Food and Drug Administration advisories in 2007 about the drugs' cardiovascular risks.

That gap “is noteworthy,” and “considerable evidence supports the greater safety” of pioglitazone over rosiglitazone, Andrew Cohen and his colleagues wrote in an investigation that was published online.

The investigators studied IMS Health's National Disease and Therapeutic Index monthly figures on oral diabetic therapies that were utilized during office treatment visits from January 2003 to June 2009.

Data on the use of the glitazone drug class for diabetic patients aged 35 years and older who did not have type 1 diabetes were analyzed in four time frames: January 2003–January 2005; February 2005–January 2007, a period when safety concerns were first revealed; February 2007–May 2008, when the FDA issued the advisories on cardiovascular risks and 6 months thereafter; and June 2008–June 2009, wrote Mr. Cohen of the University of Chicago, and his colleagues.

Following the publication of safety concerns that linked glitazone use to serious cardiovascular episodes, but prior to the FDA's advisories, overall glitazone use had begun declining from 34% of type 2 diabetes patients' office treatment visits to 29% (Diabetes Care 2010 Jan. 26 [doi:10.2337/dc09-1834]).

Rosiglitazone use showed a “sharp decline” following reports—scientific evidence, the FDA's advisories, and media coverage—of the cardiovascular risks of glitazone; however, pioglitazone use “did not similarly decline” in light of the FDA's class-wide advisory, the authors stated.

“Decreases in rosiglitazone and pioglitazone use occurred non-selectively, rather than among those at highest cardiovascular risk,” they said, adding that the changes “are important because glitazones were widely adopted into practice following their market debut despite questions regarding their potential safety.”

Although glitazone use showed “rapid increases” from the class's debut—growing at an annual rate of 22%, and peaking at 34% (11.2 million) of all treatment visits among patients with type 2 diabetes—it decreased at a 29% rate during the FDA advisory period before leveling off to a statistically nonsignificant decline of 2%, the investigators found.

In the latter period, rosiglitazone constituted 23% (1.8 million office visits) and pioglitazone 77% (5.8 million visits) of glitazone use.

The “continuing uncertainty” over the drugs' cardiovascular risks “suggests the importance of the routine inclusion of cardiovascular end points in studies that are used to seek FDA approval for diabetes therapies” and “their limited role as monotherapy for diabetes or use in patients at elevated risk of congestive heart failure or ischemic heart disease,” Mr. Cohen and his associates concluded.

The study was funded through a career development award from Robert Wood Johnson Physician Foundation and the Agency for Healthcare Research and Quality to Dr. G. Caleb Alexander, the principal investigator, also of the University of Chicago. No disclosures were reported.