Ahmed Jamal, MBBS; David M. Homa, PhD; Erin O’Connor, MS; Stephen D. Babb, MPH; Ralph S. Caraballo, PhD; Tushar Singh, PhD; S. Sean Hu, DrPH; Brian A. King, PhD
Current Cigarette Smoking Among Adults — United States, 2005–2014.
MMWR Weekly / Vol. 64 / No. 44 November 13, 2015
CDC assessed the most recent national estimates of smoking prevalence among adults aged ≥18 years using data from the 2014 National Health Interview Survey. The findings indicate that the proportion of US adults who smoke cigarettes declined from 20.9% in 2005 to 16.8% in 2014; declines were also observed in the proportions of daily smokers who smoked 20-29 (34.9% to 27.4%) or ≥30 cigarettes per day (12.7% to 6.9%). In 2014, prevalence of cigarette smoking was higher among males, adults aged 25-44 years, multiracial or American Indian/Alaska Natives, and those who have a general education development (GED) certificate, live below the federal poverty level, live in the Midwest, are insured through Medicaid or are uninsured, have a disability or limitation, or are lesbian, gay, or bisexual.
Lemaire RH, Bailey L, Leischow SJ
Meeting the Tobacco Cessation Coverage Requirement of the Patient Protection and Affordable Care Act: State Smoking Cessation Quitlines and Cost Sharing.
Am J Public Health. 2015 Nov;105 Suppl 5:S699-705. doi: 10.2105/AJPH.2015.302869. Epub 2015 Oct 8.
We explored whether various key stakeholders considered cost sharing with state telephone-based tobacco cessation quitlines, because including tobacco cessation services as part of the required essential health benefits is a new requirement of the Patient Protection and Affordable Care Act (ACA). We analyzed qualitative data collected from interviews conducted in April and May of 2014 with representatives of state health departments, quitline service providers, health plans, and insurance brokers in 4 US states.
State health departments varied in the strategies they considered the role their state quitline would play in meeting the ACA requirements. Health plans and insurance brokers referred to state quitlines because they were perceived as effective and free, but in 3 of the 4 states, the private stakeholder groups did not consider cost sharing. If state health departments are going to initiate cost-sharing agreements with private insurance providers, then they will need to engage a broad array of stakeholders and will need to overcome the perception that state quitline services are free.
Jennifer Singleterry, MA; Zach Jump, MA; Anne DiGiulio; Stephen Babb, MPH; Karla Sneegas, MPH; Allison MacNeil, MPH; Lei Zhang, PhD; Kisha-Ann S. Williams
State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Coverage — United States, 2014–2015.
MMWR Weekly October 30, 2015 / 64(42);1194-9
Medicaid enrollees have a cigarette smoking prevalence (30.4%) twice as high as that of privately insured Americans (14.7%), placing them at increased risk for smoking-related disease and death (1
). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)–approved medications are evidence-based, effective treatments for helping tobacco users quit (2
). A Healthy People 2020
objective (TU-8) calls for all state Medicaid programs to adopt comprehensive coverage of these treatments.* However, a previous MMWR
report indicated that, although state Medicaid coverage of cessation treatments had improved during 2008–2014, this coverage was still limited in most states (3
). To monitor the most recent trends in state Medicaid cessation coverage, the American Lung Association collected data on coverage of, and barriers to, accessing all evidence-based cessation treatments except telephone counseling†
in state Medicaid programs (for a total of nine treatments) during January 31, 2014–June 30, 2015. As of June 30, 2015, all 50 states covered certain cessation treatments for at least some Medicaid enrollees. During 2014–2015, increases were observed in the number of states covering individual counseling, group counseling, and all seven FDA-approved cessation medications for all Medicaid enrollees; however, only nine states covered all nine treatments for all enrollees. Common barriers to accessing covered treatments included prior authorization requirements, limits on duration, annual limits on quit attempts, and required copayments. Previous research in both Medicaid and other populations indicates that state Medicaid programs could reduce smoking prevalence, smoking-related morbidity, and smoking-related health care costs among Medicaid enrollees by covering all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting coverage to Medicaid enrollees and health care providers, and monitoring use of covered treatments (2,4–7
Van T. Tong,a,* Lucinda J. England,b Ann Malarcher,b Jeanne Mahoney,c Britta Anderson,c and Jay Schulkinc
Clinicians’ Awareness of the Affordable Care Act Mandate to Provide Comprehensive Tobacco Cessation Treatment for Pregnant Women Covered by Medicaid.
Prev Med Rep. 2015; 2: 686–688. doi: 10.1016/j.pmedr.2015.08.013
The Affordable Care Act (ACA) requires states to provide tobacco-cessation services without cost-sharing for pregnant traditional Medicaid-beneficiaries effective October 2010. It is unknown the extent to which obstetricians–gynecologists are aware of the Medicaid tobacco-cessation benefit. We sought to examine the awareness of the Medicaid tobacco-cessation benefit in a national sample of obstetricians–gynecologists and assessed whether reimbursement would influence their tobacco cessation practice. In 2012, a survey was administered to a national stratified-random sample of obstetricians–gynecologists (n = 252) regarding awareness of the Medicaid tobacco-cessation benefit. Results were stratified by the percentage of pregnant Medicaid patients. Chi-squared tests (p < 0.05) were used to assess significant associations. Analyses were conducted in 2014. Eighty-three percent of respondents were unaware of the benefit. Lack of awareness increased as the percentage of pregnant Medicaid patients in their practices decreased (range = 71.9%–96.8%; P
= 0.02). One-third (36.1%) of respondents serving pregnant Medicaid patients reported that reimbursement would influence them to increase their cessation services. Four out of five obstetricians–gynecologists surveyed in 2012 were unaware of the ACA provision that required states to provide tobacco cessation coverage for pregnant traditional Medicaid beneficiaries as of October 2010. Broad promotion of the Medicaid tobacco-cessation benefit could reduce treatment barriers.
Charlotte A. Schoenborn, M.P.H.; and Renee M. Gindi, Ph.D
Electronic Cigarette Use Among Adults: United States, 2014.
NCHS Data Brief. No. 217. October 2015.
This report provides the first estimates of e-cigarette use among U.S. adults from a nationally representative household interview survey, by selected demographic and cigarette smoking characteristics.
In 2014, 12.6% of adults had ever tried an e-cigarette even one time, with use differing by sex, age, and race and Hispanic or Latino origin. About 3.7% of adults currently used e-cigarettes, with use differing by age and race and Hispanic or Latino origin. Current cigarette smokers and former smokers who quit smoking within the past year were more likely to use e-cigarettes than former smokers who quit smoking more than 1 year ago and those who had never smoked. Among current cigarette smokers who had tried to quit smoking in the past year, more than one-half had ever tried an e-cigarette and 20.3% were current e-cigarette users.
Joel Erblich, Alexandra Michalowski
Impulsivity Moderates the Relationship Between Previous Quit Failure and Cue-induced Craving.
Addictive Behaviors, 2015-12-01, Volume 51, Pages 7-11
Poor inhibitory control has been shown to be an important predictor of relapse to a number of drugs, including nicotine. Indeed, smokers who exhibit higher levels of impulsivity are thought to have impaired regulation of urges to smoke, and previous research has suggested that impulsivity may moderate cue-induced cigarette cravings. To that end, we conducted a study to evaluate the interplay between failed smoking cessation, cue-induced craving, and impulsivity.
Current smokers (n = 151) rated their cigarette cravings before and after laboratory to exposure to smoking cues, and completed questionnaires assessing impulsivity and previous failed quit attempts.
Findings indicated that shorter duration of previous failed quit attempts was related to higher cue-induced cigarette craving, especially among smokers with higher levels of impulsivity.
Results underscore the importance of considering trait impulsivity as a factor in better understanding the management of cue-induced cravings.
Amanda Kaufmann, Brian Hitsman, Patricia M. Goelz, Anna Veluz-Wilkins, Sonja Blazekovic, Lindsay Powers, Frank T. Leone, Peter Gariti, Rachel F. Tyndale, and Robert A. Schnoll
Rate of Nicotine Metabolism and Smoking Cessation Outcomes in a Community-based Sample of Treatment-Seeking Smokers.
Addictive Behaviors, 2015-12-01, Volume 51, Pages 93-99
In samples from controlled randomized clinical trials, a smoker’s rate of nicotine metabolism, measured by the 3-hydroxycotinine to cotinine ratio (NMR), predicts response to transdermal nicotine. Replication of this relationship in community-based samples of treatment-seeking smokers may help guide the implementation of the NMR for personalized treatment for nicotine dependence. Data from a community-based sample of treatment seeking smokers (N = 499) who received 8 weeks of transdermal nicotine and 4 behavioral counseling sessions were used to evaluate associations between the NMR and smoking cessation. Secondary outcomes included withdrawal and craving, depression and anxiety, side effects, and treatment adherence.
The NMR was a significant predictor of abstinence (OR = .56, 95% CI: 0.33-0.95, p
= .03), with faster metabolizers showing lower quit rates than slower metabolizers (24% vs. 33%). Faster nicotine metabolizers exhibited significantly higher levels of anxiety symptoms over time during treatment, vs. slower metabolizers (NMR x Time interaction: F
[3,357] = 3.29, p
= .02). NMR was not associated with changes in withdrawal, craving, depression, side effects, and treatment adherence ( p
’s > .05).
In a community-based sample of treatment-seeking smokers, faster nicotine metabolizers were significantly less likely to quit smoking and showed higher rates of anxiety symptoms during a smoking cessation treatment program, vs. slower nicotine metabolizers. These results provide further evidence that transdermal nicotine is less effective for faster nicotine metabolizers and suggest the need to address cessation-induced anxiety symptoms among these smokers to increase the chances for successful smoking cessation.
Sarah S Dermody, Eric C Donny, Louise A Hertsgaard, Dorothy K Hatsukami
Greater Reductions in Nicotine Exposure While Smoking Low Nicotine Content Cigarettes Predict Smoking Cessation.
Tob Control 2015;24:536-539 doi:10.1136/tobaccocontrol-2014-051797
Reducing the nicotine content of cigarettes is a potential regulatory strategy that may enable cessation. The present study investigated the effect of nicotine exposure while smoking very low nicotine content (VLNC) cigarettes on cessation outcomes. The roles of possible sources of nicotine were also explored, including the VLNC cigarette and co-use of cigarettes with normal nicotine content. A secondary data analysis of two analogous randomised trials of treatment seeking, adult daily smokers (n=112) who were instructed to smoke VLNC cigarettes for 6 weeks and then make a quit attempt. Controlling for baseline demographic and smoking features, the association between reductions in nicotine exposure during the 6-week trial, assessed by urinary total cotinine and biomarker-confirmed smoking abstinence 1 month later, was tested. Subsequent analyses controlled for the effects of the frequency of VLNC and normal nicotine content cigarette use and the nicotine yield of the VLNC cigarette (0.05 vs 0.09 mg).
Greater reductions in nicotine exposure while smoking VLNC cigarettes predicted abstinence independent of individual differences in baseline smoking, cotinine, dependence, gender and study. Nicotine reduction was largest among individuals who were assigned to smoke a VLNC cigarette with lower nicotine yield and who smoked fewer normal nicotine content and VLNC cigarettes. In the context of nicotine regulations and corresponding research, factors that undermine nicotine reduction must be addressed, including the availability and use of cigarettes with normal nicotine content and not sufficiently reducing the nicotine yield of cigarettes. Maximising nicotine reduction may facilitate smoking cessation.
Christine Jackson, PhD, Kim A. Hayes, MPH and Denise M. Dickinson, MPH
Engaging Parents Who Quit Smoking in Antismoking Socialization of Children: A Novel Approach to Relapse Prevention.
Nicotine Tob Res
(2015)doi: 10.1093/ntr/ntv214First published online: September 27, 2015
Data from a randomized controlled trial designed primarily to test the effect of an antismoking socialization parenting program on child initiation of smoking were used to test the subsidiary hypothesis that providing antismoking socialization to children would lower the odds of relapse within a sub-sample of parents who had recently quit smoking. Over 13 months, 11 state Quitlines provided contact information for callers who were parents of 8- to 10-year-old children. Of 1604 parents enrolled in the trial, 689 (344 treatment; 345 control) had quit smoking cigarettes for at least 24 hours after calling a Quitline. Their data were used to test for group differences in 30-day abstinence measured using telephone interviews conducted 7 and 12 months post-baseline. Analyses of parents with complete follow-up data and intent-to-treat analyses incorporating parents lost to follow-up are presented.
Among 465 parents with complete follow-up data, treatment group parents had twice the odds of being abstinent 12 months post-baseline (adjusted OR
= 2.01; P
= .001) relative to controls. Intent-to-treat analysis with all 689 parents, in which those lost to follow-up were coded as having relapsed, showed a smaller though significant treatment effect on 30-day abstinence at 12 months (adjusted OR
= 1.58; P
= .017). This study is the first to observe that engaging parents who have quit smoking in antismoking socialization of children can lower their odds of relapse. Additional research is needed to replicate this finding and to identify the psychological mechanisms underlying the observed effect.
Larry W. Hawk Jr. PhD, Rebecca L. Ashare PhD, Jessica D. Rhodes PhD, Jason A. Oliver MA, Kenneth Michael Cummings PhD, MPH, Martin C. Mahoney MD, PhD
Does Extended Pre Quit Bupropion Aid in Extinguishing Smoking Behavior?
Nicotine & Tobacco Research, 2015, 1377–1384 doi:10.1093/ntr/ntu347
Understanding the mechanisms by which bupropion promotes smoking cessation may lead to more effective treatment. To the extent that reduced smoking reinforcement is one such mechanism, a longer duration of pre quit bupropion treatment should promote extinction of smoking behavior. We evaluated whether 4 weeks of pre quit bupropion (extended run-in) results in greater pre quit reductions in smoking rate and cotinine and, secondarily, greater short-term abstinence, than standard 1 week of pre quit bupropion (standard run-in). Adult smokers (n
= 95; 48 females) were randomized to a standard run-in group (n
= 48; 3-week placebo, then 1-week bupropion pre quit) or an extended run-in group (4-week pre quit bupropion; n
= 47). Both groups received group behavioral counseling and 7 weeks of post quit bupropion. Smoking rate (and craving, withdrawal, and subjective effects) was collected daily during the pre quit period; biochemical data (cotinine and carbon monoxide) were collected at study visits.
During the pre quit period, the extended run-in group exhibited a greater decrease in smoking rate, compared to the standard run-in group, interaction p
= .03. Cigarette craving and salivary cotinine followed a similar pattern, though the latter was evident only among women. Biochemically verified 4-week continuous abstinence rates were higher in the extended run-in group (53%) than the standard run-in group (31%), p
= .033. The extended use of bupropion prior to a quit attempt reduces smoking behavior during the pre quit period and improved short-term abstinence rates. The data are consistent with an extinction-of-reinforcement model and support further investigation of extended run-in bupropion therapy for smoking cessation.
Christopher W. Kahler, PhD, Nichea S. Spillane, PhD, Anne M. Day, PhD, Patricia A. Cioe, PhD, Acacia Parks, PhD, Adam M. Leventhal, PhD and Richard A. Brown, PhD
Positive Psychotherapy for Smoking Cessation: A Pilot Randomized Controlled Trial.
Nicotine Tob Res (2015) 17 (11):1385-1392.doi: 10.1093/ntr/ntv011
Greater depressive symptoms and low positive affect (PA) are associated with poor smoking cessation outcomes. Smoking cessation approaches that incorporate a focus on PA may benefit smokers trying to quit. The purpose of this study was to conduct a pilot randomized clinical trial to compare standard smoking cessation treatment (ST) with smoking cessation treatment that targets positive affect, termed positive psychotherapy for smoking cessation (PPT-S). Smokers who were seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8 weeks of nicotine replacement therapy, either ST (n
= 31) or PPT-S (n
= 35). Seven-day point prevalence smoking abstinence was biochemically confirmed at 8, 16, and 26 weeks.
Compared to ST, a greater percentage of participants in PPT-S were abstinent at 8 weeks, 16 weeks, and 26 weeks, but these differences were nonsignificant. In a more statistically powerful longitudinal model, participants in PPT-S had a significantly higher odds of abstinence (adjusted odds ratio [AOR
] = 2.75; 95% CI = 1.02, 7.42; p
= .046) across follow-ups compared to those in ST. The positive effect of PPT-S was stronger for those higher in PA (OR
= 6.69, 95% CI = 1.16, 38.47, p =
.03). Greater use of PPT-S strategies during the initial 8 weeks of quitting was associated with a less steep decline in smoking abstinence rates over time (OR =
2.64, 95% CI = 1.06, 6.56, p
=.04). This trial suggests substantial promise for incorporating PPT into smoking cessation treatment.
Amy Cohn, PhD, Caroline O. Cobb, PhD, Raymond S. Niaura, PhD, Amanda Richardson, PhD
The Other Combustible Products: Prevalence and Correlates of Little Cigar/Cigarillo Use Among Cigarette Smokers.
Nicotine Tob Res (2015) 17 (12):1473-1481.doi: 10.1093/ntr/ntv022
Despite the increasing consumption of little cigars and cigarillos (LCCs), few studies have examined unique predictors and correlates of LCC use among adult cigarette smokers. This study explored differences between cigarette smokers with and without a history of LCC use on harm perceptions, use of other tobacco products (chewing tobacco, snus, e-cigarettes, and dissolvables), cigarette smoking/cessation-related behaviors/cognitions, and mental health and substance use disorder symptoms. A geographically diverse sample of current cigarette smokers were included in analyses (n
= 1270). Frequencies of LCC use, awareness, purchase, and harm perceptions were examined and logistic regression models investigated differences between LCC ever and never users on a variety of factors, controlling for demographics.
Bivariate analyses showed that LCC users were more likely to be male, younger, have lower income, have tried other tobacco products, perceive LCCs as less harmful than cigarettes, and endorse lifetime substance disorder symptoms. Menthol and other tobacco product use were the only significant correlates of LCC use in logistic regression models. Post-hoc analyses showed that other tobacco product use partially mediated an association between substance use disorder symptoms and LCC use. A third of the sample had tried LCCs, and LCC users were more likely to have experimented with other tobacco products and used menthol. The high degree of co-use of cigarette smoking and LCCs with other tobacco products and the association of LCC use to substance use suggests that these users have unique risk factors and deserve specific targeting in public health campaigns.
Ce Shang, Frank J Chaloupka, Geoffrey T Fong, Mary Thompson, Mohammad Siahpush, William Ridgeway.
Weight Control Belief and Its Impact on the Effectiveness of Tobacco Control Policies on Quit Attempts: Findings From the ITC 4 Country Survey.
Weight concerns are widely documented as one of the major barriers for girls and young adult women to quit smoking. Therefore, it is important to investigate whether smokers who have weight concerns respond to tobacco control policies differently than smokers who do not in terms of quit attempts, and how this difference varies by gender and country. This study aims to investigate, by gender and country, whether smokers who believe that smoking helps control weight are less responsive to tobacco control policies with regards to quit attempts than those who do not. We use longitudinal data from the International Tobacco Control Policy Evaluation Project in the USA, Canada, the UK and Australia to conduct the analysis. We first constructed a dichotomous indicator for smokers who have the weight control belief and then examined the disparity in policy responsiveness in terms of quit attempts by directly estimating the interaction terms of policies and the weight control belief indicator using generalised estimating equations.
We find that weight control belief significantly attenuates the policy impact of tobacco control measures on quit attempts among US female smokers and among UK smokers. This pattern was not found among smokers in Canada and Australia. Although our results vary by gender and country, the findings suggest that weight concerns do alter policy responsiveness in quit attempts in certain populations. Policy makers should take this into account and alleviate weight concerns to enhance the effectiveness of existing tobacco control policies on promoting quitting smoking.