Closing Perspective on the Special Issue on JUUL.

Objective: This article provides an overview of this theme issue of the American Journal of Health Behavior dedicated to electronic nicotine delivery systems (ENDS), with a special focus on JUUL. Methods: The author summarizes key findings from included papers and offers an evaluative perspective on ENDS as tools for smoking cessation versus the prospect of their appeal to previous non-smokers. Results: Delineation of certain metrics (eg, defining who is a smoker) and clarification about an acceptable level of unintended consequences weighed against harm reduction confound conclusions about the public health role of ENDS/JUUL. Conclusion: Until agreement on key definitions and performance of well-controlled studies, a system that promotes ENDS/JUUL use among smokers but discourages their use by never-smokers is a regulatory challenge.

Efficacy of varenicline to prompt quit attempts in smokers not currently trying to quit: a randomized placebo-controlled trial.

INTRODUCTION: Nicotine replacement therapy to aid smoking reduction increases the probability of a future quit attempt among smokers not currently planning to quit smoking. We tested whether varenicline, a partial nicotine agonist, would also increase future quit attempts. METHODS: This randomized, placebo-controlled trial recruited 218 smokers who were interested in quitting but had no plans to quit in the next month. Participants used varenicline (2 mg/day) or placebo for 2-8 weeks plus received brief counseling on methods to reduce cigarettes/day. The primary measure was the incidence of a quit attempt within 6 months of study entry. Secondary measures were point prevalence abstinence, motivation to stop smoking, and reduction in cigarettes/day. RESULTS: Varenicline increased the incidence of a quit attempt more than placebo at the Nebraska site (73% vs. 41%; p < .001) but not at the Vermont site (45% vs. 51%; p = .45). Varenicline increased most other measures of quit attempts, motivation and abstinence, independent of site. The beneficial effects of varenicline in quit attempts appeared to be mediated by greater reductions in cigarettes/day, dependence, craving, and cigarette satisfaction. Varenicline had a greater effect on quit attempts in less-dependent smokers, in minority smokers, and in those who had less prior cessation or reduction activity. Adverse events were minimal. CONCLUSIONS: Varenicline increased quit attempts in smokers who are not currently trying to quit at one of the two study sites and improved most all secondary outcomes independent of site. This appeared to be due to decreasing cigarettes/day and level of dependence.

Recomendaciones para el tratamiento farmacológico del tabaquismo. Propuestas de financiación / Recommendations for pharmacological tobacco cessation treatments: proposals for financing

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Can reduced smoking be a way for smokers not interested in quitting to actually quit?

The predominating way to stop smoking is to do it abruptly. At every given time, the large majority of smokers are not motivated or willing to try and give up. Some smokers are entirely happy with their smoking, a larger group would like to smoke less and a third group wants to quit. With the abrupt quitting message we are only addressing those wanting to quit. Maybe not even all, since some of them may have tried many times already and learned that they cannot quit abruptly. They may have given up on giving up. Some interesting results are given in recent studies that have recruited smokers not motivated to quit but interested in reducing their smoking. From nine randomized placebo-controlled trials where smokers were given behavioural support and pharmacological assistance, motivation to quit seemed to have increased, and in each trial, a proportion of these unmotivated smokers gave up smoking. It is suggested that for smokers unable or not interested in giving up abruptly, a softer and more gradual approach should be considered. Such an approach may bring new smokers into treatment, produce more people wanting to quit and improve public health.

Intentions to quit smoking change over short periods of time.

To assess the stability of intention to quit smoking, 115 US and Swedish smokers were randomized to complete Stage of Change (SOC) or ladder scales of intentions to quit at either 0, 7, 14 and 30 days or at 0 and 30 days in the absence of intervention. The four-assessment group had more progression in intention to quit than the two-assessment group. Depending on the measure, 12-17% of smokers changed their intention to quit over 7 days, 15-25% changed over 14 days and 17-34% changed over 30 days. Results were similar in Swedish and US participants and replicate the results of prior studies. We conclude intention to quit often spontaneously changes over short periods of time, especially with repeated testing.