Incidence of Cigarette Smoking Relapse Among Individuals Who Switched to e-Cigarettes or Other Tobacco Products.

Importance: Although e-cigarettes are not approved as a cessation device, many who smoke believe that e-cigarettes will help them quit cigarette smoking successfully. Objective: To assess whether people who recently quit smoking and who had switched to e-cigarettes or another tobacco product were less likely to relapse to cigarette smoking compared with those who remained tobacco free. Design, Setting, and Participants: This cohort study analyzed a nationally representative sample of US households that participated in 4 waves of the Population Assessment of Tobacco and Health Study (conducted 2013 through 2017), combining 2 independent cohorts each with 3 annual surveys. Eligible participants were individuals who smoked at baseline, had recently quit at the first follow-up, and completed the second follow-up survey. Exposures: Use of e-cigarettes or alternate tobacco products at follow-up 1 after recently quitting smoking. Main Outcomes and Measures: Weighted percentage of participants with over 12 months abstinence by follow-up 2. Results: Of a total of 13 604 participants who smoked cigarettes at baseline, 9.4% (95% CI, 8.7%-10.0%) recently had quit smoking (mean age, 41.9; 95% CI, 39.7-46.6 years; 641 [43.2%] women) Of these, 22.8% (95% CI, 19.7%-26.0%) had switched to e-cigarettes, with 17.6% (95% CI, 14.8%-20.5%) using them daily. A total of 37.1% (95% CI, 33.7%-40.4%) used a noncigarette tobacco product and 62.9% (95% CI, 59.6%-66.3%) were tobacco free. Rates of switching to e-cigarettes were highest for those who were in the top tertile of tobacco dependence (31.3%; 95% CI, 25.0%-37.7%), were non-Hispanic White (26.4%; 95% CI, 22.3%-30.4%), and had higher incomes (annual income ≥$35 000, 27.5%; 95% CI, 22.5%-32.4% vs <$35 000, 19.3%; 95% CI, 16.3%-22.3%). At follow-up 2, unadjusted relapse rates were similar among those who switched to different tobacco products (for any tobacco product: successfully quit, 41.5%; 95% CI, 36.2%-46.9%; relapsed with significant requit, 17.0%; 95% CI, 12.4%-21.6%; currently smoking, 36.2%; 95% CI, 30.9%-41.4%). Controlled for potential confounders, switching to any tobacco product was associated with higher relapse rate than being tobacco free (adjusted risk difference, 8.5%; 95% CI, 0.3%-16.6%). Estimates for those who switched to e-cigarettes, whether daily or not, were not significant. While individuals who switched from cigarettes to e-cigarettes were more likely to relapse, they appeared more likely to requit and be abstinent for 3 months at follow-up 2 (17.0%; 95% CI, 12.4%-21.6% vs 10.4%; 95% CI, 8.0%-12.9%). Conclusions and Relevance: This large US nationally representative study does not support the hypothesis that switching to e-cigarettes will prevent relapse to cigarette smoking.

Efficacy of Smartphone Applications for Smoking Cessation: A Randomized Clinical Trial.

Importance: Smoking is a leading cause of premature death globally. Smartphone applications for smoking cessation are ubiquitous and address barriers to accessing traditional treatments, yet there is limited evidence for their efficacy. Objective: To determine the efficacy of a smartphone application for smoking cessation based on acceptance and commitment therapy (ACT) vs a National Cancer Institute smoking cessation application based on US clinical practice guidelines (USCPG). Design, Setting, and Participants: A 2-group, stratified, double-blind, individually randomized clinical trial was conducted from May 27, 2017, to September 28, 2018, among 2415 adult cigarette smokers (n = 1214 for the ACT-based smoking cessation application group and n = 1201 for the USCPG-based smoking cessation application group) with 3-, 6-, and 12-month postrandomization follow-up. The study was prespecified in the trial protocol. Follow-up data collection started on August 26, 2017, and ended at the last randomized participant's 12-month follow-up survey on December 23, 2019. Data were analyzed from February 25 to April 3, 2020. The primary analysis was performed on a complete-case basis, with intent-to-treat missing as smoking and multiple imputation sensitivity analyses. Interventions: iCanQuit, an ACT-based smoking cessation application, which taught acceptance of smoking triggers, and the National Cancer Institute QuitGuide, a USCPG-based smoking cessation application, which taught avoidance of smoking triggers. Main Outcomes and Measures: The primary outcome was self-reported 30-day point prevalence abstinence (PPA) at 12 months after randomization. Secondary outcomes were 7-day PPA at 12 months after randomization, prolonged abstinence, 30-day and 7-day PPA at 3 and 6 months after randomization, missing data imputed with multiple imputation or coded as smoking, and cessation of all tobacco products (including e-cigarettes) at 12 months after randomization. Results: Participants were 2415 adult cigarette smokers (1700 women [70.4%]; 1666 White individuals [69.0%] and 868 racial/ethnic minorities [35.9%]; mean [SD] age at enrollment, 38.2 [10.9] years) from all 50 US states. The 3-month follow-up data retention rate was 86.7% (2093), the 6-month retention rate was 88.4% (2136), and the 12-month retention rate was 87.2% (2107). For the primary outcome of 30-day PPA at the 12-month follow-up, iCanQuit participants had 1.49 times higher odds of quitting smoking compared with QuitGuide participants (28.2% [293 of 1040] vs 21.1% [225 of 1067]; odds ratio [OR], 1.49; 95% CI, 1.22-1.83; P < .001). Effect sizes were very similar and statistically significant for 7-day PPA at the 12-month follow-up (OR, 1.35; 95% CI, 1.12-1.63; P = .002), prolonged abstinence at the 12-month follow-up (OR, 2.00; 95% CI, 1.45-2.76; P < .001), abstinence from all tobacco products (including e-cigarettes) at the 12-month follow-up (OR, 1.60; 95% CI, 1.28-1.99; P < .001), 30-day PPA at 3-month follow-up (OR, 2.20; 95% CI, 1.68-2.89; P < .001), 30-day PPA at 6-month follow-up (OR, 2.03; 95% CI, 1.63-2.54; P < .001), 7-day PPA at 3-month follow-up (OR, 2.04; 95% CI, 1.64-2.54; P < .001), and 7-day PPA at 6-month follow-up (OR, 1.73; 95% CI, 1.42-2.10; P < .001). Conclusions and Relevance: This trial provides evidence that, compared with a USCPG-based smartphone application, an ACT-based smartphone application was more efficacious for quitting cigarette smoking and thus can be an impactful treatment option. Trial Registration: ClinicalTrials.gov Identifier: NCT02724462.

Does free nicotine replacement improve smoking cessation rates in cancer patients?

Background: Cigarette smoking is carcinogenic and has been linked to inferior treatment outcomes and complication rates in cancer patients. Here, we report the results of an 18-month pilot smoking cessation program that provided free nicotine replacement therapy (nrt). Methods: In January 2017, the smoking cessation program at our institution began offering free nrt for actively cigarette-smoking patients with cancer. The cost of 4 weeks of nrt was covered by the program, and follow-up was provided by smoking cessation champions. Results: From January 2017 to June 2018, 8095 patients with cancer were screened for cigarette use, of whom 1135 self-identified as current or recent smokers. Of those 1135 patients, 117 enrolled in the program and accepted a prescription for nrt. The rates of patient referral and patients attending a referral appointment were significantly higher in 2018-2018 than they had been in 2015-2016 (100% vs. 80.3%, p < 0.001, and 27.6% vs. 11.3%, p < 0.001, respectively). Median follow-up was 9.0 months (25%-75% interquartile range: 5.7-11.6 months). Of the patients who accepted nrt and who also had complete data (n = 71), 25 (35.2%) reported complete smoking cessation, and 32 (45.1%) reported only decreased cigarette smoking. On univariable analysis, no factors were significantly predictive of smoking cessation, although initial cigarette use (>10 vs. ≤10 initial cigarettes) was significantly predictive of smoking reduction (odds ratio: 5.04; 95% confidence interval: 1.46 to 17.45; p = 0.011). Conclusions: This pilot study of free nrt demonstrated rates of referral and acceptance of nrt that were improved compared with historical rates, and most referred patients either decreased their use of cigarettes or quit entirely.

A Procedure to Standardize Puff Topography During Evaluations of Acute Tobacco or Electronic Cigarette Exposure.

INTRODUCTION: Documenting factors that influence differential sensitivity to acutely inhaled nicotine products requires carefully controlling the amount of exposure (dose), and thus a procedure by which to control such exposure. METHODS: We evaluated consistency of puff volume from intermittent acute exposures to smoked tobacco cigarettes (study 1, n = 45, plus a comparison study of uninstructed use with n = 59) and to vaped electronic cigarettes (e-cigarettes; study 2, n = 27 naive to e-cigarettes) in adult-dependent smokers. All in primary studies 1 and 2 participated in research administering different nicotine levels in each product under blind conditions, one per session using within-subject designs. In both studies, participants followed an automated instructional procedure on a computer monitor standardizing the timing and amount of exposure to each product during a given trial, with four trials per session, each separated by 20 minutes. Puff volume per trial via Clinical Research Support System (CReSS) was the primary dependent measure to determine consistency across trials via intraclass correlation coefficients (ICCs). RESULTS: Control over topography with both inhaled products was demonstrated by highly significant ICCs for puff volume across trials. Instructed control with own brand was generally better in study 1 than with uninstructed smoking in the comparison sample, as expected. As intended, reliability of puff volume generally did not differ by menthol preference or sex in either study, but ICCs in study 2 tended to be lower for some men using the placebo e-cigarette. CONCLUSIONS: This instructional procedure may substantially improve control over amounts of acute exposure to tobacco or e-cigarette use. IMPLICATIONS: Control over topography in studies of acute exposure to these inhaled products can potentially aid validity of research into differential sensitivity to use, so findings can be attributed to factors of interest and not to variable exposure. Our procedure minimized variability in exposure to the same product and between moderate nicotine products, but remaining differences suggest that compensation for very low or no nicotine commercial products may be difficult to totally eliminate with these instructions alone. Further study is needed to determine this procedure's utility with other inhaled products among experienced users and when comparing different products in between-groups analyses.

The E-Cigarette Debate: What Counts as Evidence?

Two major public health evaluations of e-cigarettes-one from the National Academies of Science, Engineering, and Medicine (NASEM), the other from Public Health England (PHE)-were issued back to back in the winter of 2018. While some have read these analyses as broadly consistent, providing support for the view that e-cigarettes could play a role in smoking harm reduction, in every major respect, they come to very different conclusions about what the evidence suggests in terms of public health policy. How is that possible? The explanation rests in what the 2 reports see as the central challenge posed by e-cigarettes, which helped to determine what counted as evidence. For NASEM, the core question was how to protect nonsmokers from the potential risks of exposure to nicotine and other contaminants or from the risk of smoking combustible cigarettes through renormalization. A precautionary standard was imperative, making evidence that could speak most conclusively to the question of causality paramount. For PHE, the priority was how to reduce the burdens now borne by current smokers, burdens reflected in measurable patterns of morbidity and mortality. With a focus on immediate harms, PHE turned to evidence that was "relevant and meaningful." Thus, competing priorities determined what counted as evidence when it came to the impact of e-cigarettes on current smokers, nonsmoking bystanders, and children and adolescents. A new clinical trial demonstrating the efficacy of e-cigarettes as a cessation tool makes understanding how values and framing shape core questions and conclusive evidence imperative.

[Smoking cessation: Pharmacological strategies different from standard treatments]. / Sevrage tabagique : les stratégies pharmacologiques différentes des traitements standards.

INTRODUCTION: Three drugs are used as an aid for smoking cessation: nicotine replacement therapy (NRT), varenicline and bupropion. Standard pharmacological strategies have proven their efficacy but may have poor efficacy, especially among "Hard-core smokers" who display low smoking abstinence rates and high relapse rates. OBJECTIVES: Systematic literature review of data on pharmacological strategies for smoking cessation which are different from standard treatments. RESULTS: Sixteen studies were included. Higher dose of nicotine patchs increases smoking abstinence rates. Increasing varenicline dose in smokers who do not respond to the standard dose is associated with high success rates. Extended treatment with nicotine patchs is associated with higher abstinence rate at 6 months but not in the long term. Results of studies on extended treatment with oral NRT are conflicting. Extended treatment with varenicline increases smoking cessation rates. Results of studies on extended treatment with bupropion are conflicting as regards smoking cessation rates. Combination therapy of varenicline with nicotine patchs or with bupropion are more effective than varénicline alone. Varenicline using a flexible quit date have similar efficacy compared with previous fixed quit date studies. Pre-cessation treatment with nicotine patchs or with varenicline increases abstinence rates. There is no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy and their combination. Similarly, there is no differences in abstinence rates between the active bupropion and nicotine gum and the active bupropion and placebo gum groups. Retreatment with varenicline is efficacious in smokers who have previously taken it. CONCLUSION: Pharmacological strategies different from standard treatments maybe useful for smoking cessation aid.

Effectiveness of Pharmaceutical Smoking Cessation Aids in a Nationally Representative Cohort of American Smokers.

Background: Despite strong efficacy in randomized trials, the population effectiveness of pharmaceutical aids in long-term smoking cessation is lacking, possibly because of confounding (factors that are associated with both pharmaceutical aid use and difficulty quitting). Matching techniques in longitudinal studies can remove this confounding bias. Methods: Using the nationally representative Tobacco Use Supplement to the Current Population Survey (TUS-CPS), we assessed the effectiveness of medications to aid quitting among baseline adult smokers who attempted to quit prior to one year of follow-up in two longitudinal studies: 2002-2003 and 2010-2011. Pharmaceutical aid users and nonusers with complete data (n = 2129) were matched using propensity score models with 12 potential confounders (age, sex, race-ethnicity, education, smoking intensity, nicotine dependence, previous quit history, self-efficacy to quit, smoke-free homes, survey year, and cessation aid use). Using matched data sets, logistic regression models were fit to assess whether use of any individual pharmaceutical aid increased the proportion of patients who were abstinent for 30 days or more at follow-up. Results: Propensity score matching markedly improved balance on the potential confounders between the pharmaceutical aid use groups. Using matched samples to provide a balanced comparison, there was no evidence that use of varenicline (adjusted risk difference [aRD] = 0.01, 95% confidence interval [CI] = -0.07 to 0.11), bupropion (aRD = 0.02, 95% CI = -0.04 to 0.09), or nicotine replacement (aRD = 0.01, 95% CI = -0.03 to 0.06) increased the probability of 30 days or more smoking abstinence at one-year follow-up. Conclusions: The lack of effectiveness of pharmaceutical aids in increasing long-term cessation in population samples is not an artifact caused by confounded analyses. A possible explanation is that counseling and support interventions provided in efficacy trials are rarely delivered in the general population.

Consortium on Methods Evaluating Tobacco: Research Tools to Inform US Food and Drug Administration Regulation of Snus.

Introduction: The US Food and Drug Administration (FDA) has purview over tobacco products. To set policy, the FDA must rely on sound science, yet most existing tobacco research methods have not been designed to specifically inform regulation. The NCI and FDA-funded Consortium on Methods Evaluating Tobacco (COMET) was established to develop and assess valid and reliable methods for tobacco product evaluation. The goal of this article is to describe these assessment methods using a US manufactured "snus" as the test product. Methods: In designing studies that could inform FDA regulation, COMET has taken a multidisciplinary approach that includes experimental animal models and a range of human studies that examine tobacco product appeal, addictiveness, and toxicity. This article integrates COMET's findings over the last 4 years. Results: Consistency in results was observed across the various studies, lending validity to our methods. Studies showed low abuse liability for snus and low levels of consumer demand. Toxicity was less than cigarettes on some biomarkers but higher than medicinal nicotine. Conclusions: Using our study methods and the convergence of results, the snus that we tested as a potential modified risk tobacco product is likely to neither result in substantial public health harm nor benefit. Implications: This review describes methods that were used to assess the appeal, abuse liability, and toxicity of snus. These methods included animal, behavioral economics, consumer perception studies, and clinical trials. Across these varied methods, study results showed low abuse-liability and appeal of the snus product we tested. In several studies, demand for snus was lower than for less toxic nicotine gum. The consistency and convergence of results across a range of multi-disciplinary studies lends validity to our methods and suggests that promotion of snus as a modified risk tobacco products is unlikely to produce substantial public health benefit or harm.

Qualitative Exploration of a Smoking Cessation Trial for People Living With HIV in South Africa.

Introduction: In South Africa, people living with HIV have a high prevalence of smoking, which undermines the beneficial effects of antiretroviral therapy. However, little is known about barriers to smoking cessation and what interventions work for people living with HIV in this setting. Methods: A randomized trial comparing intensive anti-smoking counseling versus counseling and nicotine replacement therapy was recently concluded in Klerksdorp, South Africa. In a post-trial follow-up, 23 in-depth interviews with patients and one focus group discussion with counselors from the trial were conducted. A codebook was developed and codes were applied to the transcripts, which were analyzed using a thematic analysis. Results: Barriers at the economic, social/interpersonal, and individual levels induced stress, which hindered smoking cessation. Economic stressors included unemployment and poverty. Social or interpersonal stressors were lack of social support for quitting smoking and lack of social support due to having HIV. Individual stressors were traumatic life events. Alcohol was used to cope with stress and frequently co-occurred with smoking. Managing cravings was a barrier unrelated to stress. Participants proposed income and employment opportunities, group counseling, and more frequent counseling as solutions to address stressors at different levels. Nicotine replacement therapy was helpful to mitigate cravings. Conclusions: Future smoking cessation interventions need to target barriers at multiple levels. Increasing the supply and duration of nicotine replacement therapy may increase its effectiveness. Other behavioral approaches such as group counseling or peer counseling could hold promise in this setting but need to be tested for efficacy through randomized controlled trials. Implications: To our knowledge, this is the first qualitative study examining barriers to smoking cessation for people living with HIV in South Africa. Smoking is highly prevalent among people with HIV in South Africa and cessation interventions are urgently needed. A better understanding of barriers to smoking cessation that people with HIV face will lead to the development of contextually appropriate interventions. This study also provides feedback on interventions from a recently concluded smoking cessation randomized trial and will help guide the design of future smoking cessation trials.

Effect of Long-term Nicotine Replacement Therapy vs Standard Smoking Cessation for Smokers With Chronic Lung Disease: A Randomized Clinical Trial.

Importance: Smokers with chronic obstructive pulmonary disease (COPD) have particular difficulty quitting. Long-term nicotine replacement therapy (LT-NRT) might offer a strategy for reducing harm from cigarettes and provide a pathway for later cessation. Objective: To compare the effect of LT-NRT vs standard smoking cessation (SSC) on exposure to cigarette smoke, harm related to smoking, and cessation among smokers with COPD. Design, Setting, and Participants: This unblinded, randomized clinical trial recruited smokers who self-reported a diagnosis of COPD at any level of readiness to quit from May 23, 2014, through November 30, 2015. The 12-month follow-up was completed December 6, 2016. Patients were recruited at a clinical research unit of an academic medical center. Analysis was based on intention to treat and performed from March 8 through November 30, 2017. Interventions: Standard smoking cessation treatment included 10 weeks of NRT and 4 follow-up counseling sessions for those willing to make a quit attempt. Long-term NRT included 12 months of NRT and 6 follow-up counseling sessions regardless of initial willingness to quit. Overall, 198 patients were randomized to SSC, and 197 were included in the primary analysis; 200 patients were randomized to LT-NRT, and 197 were included in the primary analysis. Main Outcomes and Measures: The primary outcome was 7-day abstinence verified by carbon monoxide (CO) levels at 12 months. Secondary outcomes included cigarettes smoked per day (CPD), exposure to CO, urinary excretion of 4-methylnitrosamino-1-3-pyridyl-1-butanol (NNAL) (a smoking-related carcinogen), and adverse events. Results: Among 398 patients who were randomized (59.8% female; mean [SD] age, 56.0 [9.3] years), the mean (SD) CPD was 23.1 (12.3). Twelve-month follow-up was completed by 373 participants (93.7%), and 394 (99.0%) were included in the primary analysis. At 12 months, CO-verified abstinence occurred in 23 of 197 participants (11.7%) in the SSC arm and 24 of 197 (12.2%) in the LT-NRT arm (risk difference, 0.5%; 95% CI, -5.9% to 6.9%). Continuing smokers in the SSC and LT-NRT arms had similar, significantly reduced harms caused by smoking, including cigarette consumption by 12.4 and 14.5 CPD, respectively, exhaled CO level by 5.5 and 7.8 ppm, respectively, and mean urinary NNAL excretion by 21.7% and 23.0%, respectively. In multivariate analyses, continuing smokers with greater adherence to NRT experienced less reduction in NNAL exposure. The frequency of major adverse cardiac events was similar in both groups. Conclusions and Relevance: Similar rates of cessation and similar reductions in exposure to tobacco smoke resulted with LT-NRT and SSC. Among continuing smokers, ongoing use of NRT was not associated with reductions in smoke exposure. Trial Registration: ClinicalTrials.gov Identifier: NCT02148445.

Cigarrillo electrónico: ¿otra herramienta para ayudar a dejar de fumar o una nueva estrategia para promover la adicción a la nicotina? / Electronic cigarette: another tool to help quit smoking or a new strategy to promote nicotine addiction?

Los autores de este artículo describen las principales características del cigarrillo electrónico y sus componentes, anali-zan la controversia sobre su potencial uso como terapia de sustitución del tabaco y describen las experiencias regulato-rias de Argentina y de otros países. (AU)

The authors of this article describe the main features of electronic cigarettes and its components, analyze the controversy about its potential use as tobacco substitution therapy, and summarize the regulatory experiences in Argentina and other countries. (AU)

Propuesta de cesación del tabaco para la Atención Primaria de Salud (APS) en Chile, bajo un enfoque costo-beneficio / Smoking cessation proposal for Primary Health Care (PHC) in Chile, under a cost-benefit approach

Objetivo. El propósito de esta investigación fue realizar una evaluación económica costo-beneficio ex ante (evaluación previa) de un programa piloto integral de prevención y tratamiento de cesación tabáquica en los centros de salud familiar (CESFAM) de la Atención Primaria de Salud (APS) de la comuna de Peñalolén, ubicada en el área oriente de Santiago de Chile. Pacientes y método. El estudio corresponde a la evaluación económica del programa piloto integral de prevención y cesación tabáquica, considerando los costos y beneficios que generará el programa, contra la realidad actual de ausencia de programa de cesación tabáquica, incluyéndose a 100 adultos de ambos sexos de 25 a 65 años. Los cálculos se realizaron en un horizonte temporal de 33,77 años con una abstinencia esperada del 30%. Se consideró como costes el uso de espacios en los recintos de salud, gestión del programa, capacitación universal, selectiva e intensiva a los funcionarios de los centros de salud, así como, medicamentos y honorarios profesionales de médicos, psicólogos, kinesiólogos y nutricionistas más utilización de plataforma on-line y aplicaciones en móviles. Resultados. La evaluación social del Programa fue positiva, obteniendo un valor actual neto (VAN) social de 1.113.304 Euros. La sociedad se beneficia con un ahorro de 2.226.873 Euros, siendo el ahorro en gasto de tabaco para los abstinentes, el mayor componente 1.235.978 Euros. Este Programa tiene un beneficio-coste de 14,34, es decir, por cada 1 Euros invertido en el programa se ahorran 4,16 Euros en el sistema de salud y un ahorro personal de 7,96 Euros. Conclusiones. La evaluación económica costo-beneficio del 'Programa de Prevención y Tratamiento Integral de Tabaquismo RespiraLibre' demuestra que este logra liberar recursos en el sistema de salud, en la productividad de las empresas y produce un importante ahorro a quienes dejan de fumar. Sería una ganancia para la comunidad y la red asistencial, al optimizar su uso. Esta investigación aporta evidencia para la realización y posterior expansión de esta estrategia de cesación en la APS en Chile (AU)

Objective. The purpose of the research was to make an ex ante cost-benefit economic evaluation of a comprehensive pilot program of prevention and treatment of smoking cessation in the family health centers (CESFAM) of the Primary Health Care (PHC) of the Peñalolen district, located in the East area of Santiago de Chile. Patients and method. The study corresponds to the economic evaluation of the comprehensive pilot program of smoking prevention and cessation, considering the costs and benefits that the program will generate compared to the current reality of an absence of a smoking cessation program. It includes 100 adults of both genders, aged 25 to 65 years. The calculations were performed in a time frame of 33.77 years with expected abstinence of 30%. Costs were considered as the use of spaces in the health care premises, program management, universal, selective and intensive training of the public employees of the health care centers as well as medications and professional fees of the physicians, psychologists, kinesiologists, and nutritionists used most of the on-line platform and cell phone applications. Results. The social evaluation of the Program was positive, obtaining a social net present value (NPS) of 1,113,304 Euros. The society benefits with a savings of 2,226,873 Euros, the savings being in costs of tobacco for the abstinent, the largest component being 1,235,978 Euros. This program has a cost-benefit of 14.34, that is for every 1 Euros invested in the program, 4.16 Euros was saved in the health care system and a personal savings of 7,96 Euros. Conclusions. The cost-benefit economic evaluation of the 'Comprehensive smoking prevention and Treatment RespiraLibre Program' shows that this is successful in freeing resources in the health care system, in the productivity of companies and produces a significant savings for those who quit smoking. It would be a gain for the community and care network, by optimizing its use. This research provides evidence for the performance and subsequent expansion of this cessation strategy in the PHC in Chile (AU)

A Culturally Adapted Smoking Cessation Intervention for Korean Americans: Preliminary Findings.

Korean Americans have the highest smoking rate within the Asian American population. This study examined the feasibility and acceptability of a culturally adapted telephone cessation intervention for Korean Americans. Participants were recruited from advertisements on a Korean radio station channel in New York City. All received a combination of telephone cessation counseling and nicotine patches. Thirty-one (2 women and 29 men) participated in the study. At 3-month follow-up, 14 (45.2%) reported 7-day point prevalence abstinence and 13 (41.9%) achieved 3-month prolonged abstinence. Except for two who lived alone, self-reported abstinence was corroborated by a family member. The findings point to the direction that a nationally centralized Korean-language quitline service should be established to help Korean Americans quit smoking. Furthermore, the service should be adapted at a deep level of the culture.

Proyecto de Real Decreto por el que se regulan la fabricación, presentación y venta de los productos del tabaco y los productos relacionados / Draft of a Royal Decree which regulates the manufacture, presentation and sale of tobacco and related products

No disponible