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Richard D Hurt - One of the best experts on this subject based on the ideXlab platform.
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Tobacco Dependence treatment grants a collaborative approach to the implementation of who Tobacco control initiatives
Journal of Environmental and Public Health, 2018Co-Authors: Margaret B Nolan, Richard D Hurt, Katherine E. Kemper, Thomas J. Glynn, Taylor J HaysAbstract:The number of global Tobacco-related deaths is projected to increase from about 6 million to 8 million annually by 2030, with more than 80% of these occurring in low- and middle-income countries (LMICs). The World Health Organization Framework Convention on Tobacco Control (FCTC) came into force in 2005 and Article 14 relates specifically to the treatment of Tobacco Dependence. However, LMICs, in particular, face several barriers to implementing Tobacco Dependence treatment. This paper is a descriptive evaluation of a novel grant funding mechanism that was initiated in 2014 to address these barriers. Global Bridges. Healthcare Alliance for Tobacco Dependence Treatment aims to create and mobilize a global network of healthcare professionals and organizations dedicated to advancing evidence-based Tobacco Dependence treatment and advocating for effective Tobacco control policy. A 2014 request for proposals (RFP) focused on these goals, particularly in LMICs, where funding for this work had been previously unavailable. 19 grants were awarded by Global Bridges to organizations in low- and middle-income countries across all six WHO regions. Virtually all focused on developing a Tobacco Dependence treatment curriculum for healthcare providers, while also influencing the political environment for Article 14 implementation. As a direct result of these projects, close to 9,000 healthcare providers have been trained in Tobacco Dependence treatment and an estimated 150,000 patients have been offered treatment. Because most of these projects are designed with a “train-the-trainer” component, two years of grant funding has been a tremendous catalyst for accelerating change in Tobacco Dependence treatment practices throughout the world. In order to foster such exponential growth and continue to maintain the impact of these projects, ongoing financial, educational, and professional commitments are required.
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Developing, Managing, and Sustaining an Effective International Tobacco Dependence Treatment Partnership
Journal of Smoking Cessation, 2016Co-Authors: Katherine E. Kemper, J. Taylor Hays, Richard D Hurt, Thomas J. Glynn, Karla L. WysockiAbstract:Introduction: Global Bridges, hosted at Mayo Clinic since 2010, is the only international network of healthcare professionals dedicated to Tobacco Dependence treatment. Globally, fewer resources have been dedicated to treatment than to other evidence-based Tobacco control policies. The Global Bridges network seeks to aid in filling this gap in Tobacco control. Aims: This paper identifies ways to advance Tobacco Dependence treatment, as well as Tobacco control, through efficient and effective use of a global health care provider network. Methods: Observation and critical analysis of lessons learned, project outcomes to date, and network analysis. Results/Findings: The initiative has built a strong global foundation, with training curricula developed and delivered in a number of countries, including low- and middle-income countries. While basic evaluation of content mastery and learner satisfaction has been conducted, more intensive evaluation and follow-up to confirm public health impact are essential needs. Finally, program analysis and application of management theory can be used in aiding future activities aimed at providing support for health care providers in the delivery of Tobacco Dependence treatment and in similar global public health endeavors. Conclusions: The Global Bridges healthcare professional network, now in its sixth year, has developed training curricula and expanded evidence-based Tobacco Dependence education among healthcare professionals. Global Bridges comprises a unique and important component of the broader Tobacco control community, and can play an integral role in furthering global Tobacco control progress.
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Preventing Lung Cancer by Treating Tobacco Dependence
Clinics in chest medicine, 2011Co-Authors: Richard D Hurt, J. Taylor Hays, Jon O. Ebbert, David D. McfaddenAbstract:Tobacco use is a chronic medical disorder. Providing evidence-based treatment of Tobacco-dependent patients is a challenge, and a team approach provides an efficient treatment model. Tobacco treatment specialists could expand the collective Tobacco treatment expertise in the medical setting. Effective Tobacco Dependence treatment frequently requires tailoring and intensifying of interventions to meet the needs of the individual patient. Stopping smoking reduces the risk of lung cancer and many other cancers, cardiovascular disease, stroke, peripheral vascular disease. Treating Tobacco Dependence is one of the most cost-effective therapies in medicine and it deserves adequate reimbursement for it to be more widely available.
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Treating Tobacco Dependence: Review of the best and latest treatment options
Journal of Thoracic Oncology, 2007Co-Authors: Jon O. Ebbert, J. Taylor Hays, Lowell C Dale, Amit Sood, Richard D HurtAbstract:Globally, an estimated 85% of lung cancer in men and 47% of lung cancer in women is attributable to Tobacco smoking. Tobacco Dependence treatment remains the most cost-effective way to prevent morbidity and mortality from lung cancer. Several effective pharmacotherapies are available to treat Tobacco Dependence. However, the long-term effectiveness of these treatments has been limited because the majority of smokers who attempt to stop smoking eventually relapse. Approaching the treatment of Tobacco use and Dependence as a chronic disease and the development of innovative drug therapies offer new hope for the treatment of Tobacco-dependent patients. The diagnosis of lung cancer provides a teachable moment to motivate patients to attempt Tobacco abstinence on which clinicians should capitalize. We review the currently available pharmacologic approaches to the treatment of Tobacco Dependence.
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A Prospective, Case-control Study of Tobacco Dependence in Thromboangiitis Obliterans (Buerger’s Disease)
Angiology, 2006Co-Authors: Leslie T. Cooper, Stavonnie S. Henderson, Karla V. Ballman, Kenneth P. Offord, Tak Sun Tse, David R. Holmes, Richard D HurtAbstract:Thromboangiitis obliterans (TAO) is often cited as an extreme phenotype of vasculopathy and Tobacco Dependence. Although Tobacco exposure is essential to progression of arterial ischemia in TAO, expert opinion differs regarding the degree of Tobacco Dependence in this population. The authors designed a prospective, case-control study to test the hypothesis that subjects with TAO have a greater degree of Tobacco Dependence than control subjects with coronary atherosclerosis (coronary artery disease [CAD]) do. Subjects with TAO (n=218, confirmed by angiography, biopsy, or noninvasive arterial testing) or CAD (n=343, diagnosed by coronary angiography) were mailed a standardized questionnaire regarding Tobacco use, to which 103 and 273 responded, respectively. The degree of Tobacco Dependence in each group was ascertained by several methods, including the Fagerstrom Test for Nicotine Dependence Questionnaire. The TAO group was younger at index date (year of first diagnosis for TAO patients, year of percutaneo...
Jon O. Ebbert - One of the best experts on this subject based on the ideXlab platform.
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Emerging drugs for the treatment of Tobacco Dependence: 2014 update.
Expert opinion on emerging drugs, 2014Co-Authors: Muhamad Y. Elrashidi, Jon O. EbbertAbstract:Introduction: Tobacco Dependence remains a global epidemic and the largest preventable cause of morbidity and mortality around the world. Smoking cessation has benefits at all ages but remains challenging for several reasons, among which are the complexities of nicotine addiction and limitations of available pharmacotherapies. Areas covered: This review summarizes current and emerging pharmacotherapies for the treatment of Tobacco Dependence, including first- and second-line recommended agents. Medications with alternative primary indications that have been investigated as potential treatments for Tobacco Dependence are also discussed. Articles reviewed were obtained through searches of PubMed, Ovid MEDLINE, ClinicalTrials.gov and the Pharmaprojects database. Expert opinion: Current evidence suggests that the two most effective pharmacotherapies to treat Tobacco Dependence are varenicline and combination nicotine replacement therapy. Alternative agents investigated demonstrate mixed rates of success in ac...
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Pharmacologic Agents for Tobacco Dependence Treatment: 2011 Update
Current atherosclerosis reports, 2011Co-Authors: J. Taylor Hays, David D. Mcfadden, Jon O. EbbertAbstract:Tobacco use remains the most important worldwide cause of preventable death due mainly to cancer, cardiovascular disease, and chronic lung disease. If the current Tobacco pandemic continues for another 20 years, the annual global Tobacco-attributable mortality will exceed 8 million. In the US and many European countries, public health and Tobacco control efforts combined with effective Tobacco Dependence treatment using combined behavioral treatment and pharmacotherapy have contributed significantly to steadily declining rates of Tobacco use. Subsequent declines in cardiovascular disease and lung cancer death rates are directly attributable to these lower rates of Tobacco use. Despite smoking bans, health warnings and effective pharmacotherapy, one in five Americans continue to smoke. Continued research in Tobacco Dependence treatment has resulted in newer and more effective pharmacotherapy. In this review, we provide a current update of pharmacologic agents for Tobacco Dependence treatment and a discussion of recent controversy regarding adverse effects of some these medications.
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Preventing Lung Cancer by Treating Tobacco Dependence
Clinics in chest medicine, 2011Co-Authors: Richard D Hurt, J. Taylor Hays, Jon O. Ebbert, David D. McfaddenAbstract:Tobacco use is a chronic medical disorder. Providing evidence-based treatment of Tobacco-dependent patients is a challenge, and a team approach provides an efficient treatment model. Tobacco treatment specialists could expand the collective Tobacco treatment expertise in the medical setting. Effective Tobacco Dependence treatment frequently requires tailoring and intensifying of interventions to meet the needs of the individual patient. Stopping smoking reduces the risk of lung cancer and many other cancers, cardiovascular disease, stroke, peripheral vascular disease. Treating Tobacco Dependence is one of the most cost-effective therapies in medicine and it deserves adequate reimbursement for it to be more widely available.
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Emerging drugs for the treatment of Tobacco Dependence.
Expert opinion on emerging drugs, 2009Co-Authors: Jon O. EbbertAbstract:Background: Tobacco use is a worldwide epidemic expected to cause 10 million annual deaths by 2020 globally. Newer pharmacotherapy increases the specificity of Tobacco Dependence treatment by affecting receptors mediating nicotine effects. Objective: To review current and emerging pharmacotherapy for the treatment of Tobacco use. Methods: Articles retrieved with searches conducted through PubMed, Pharmaprojects database, Datamonitor, the Internet, and the author's personal files. Results/conclusions: Traditional drug therapy for Tobacco Dependence has treated Tobacco Dependence by replacing nicotine or mediating nicotine withdrawal and craving through neurotransmitter modulation. Varenicline, an α4β2 nAChR partial agonist, is an emerging drug therapy that modifies Tobacco use behavior by acting directly on nicotine receptors in the reward centers of the central nervous system. Available data suggests that varenicline is the most effective pharmacotherapy currently available. Drug development in the area o...
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Treatment of Tobacco Dependence
Mayo Clinic proceedings, 2008Co-Authors: Michael V. Burke, Jon O. Ebbert, J. Taylor HaysAbstract:Cigarette smoking continues to cause substantial death and disability, but more than 1 in 5 adults smoke despite the desire among most smokers to stop and the availability of effective treatments. A systematic process to identify all smokers is crucial. Because Tobacco Dependence is characterized by relapses and remissions, clinicians should be ready to engage smokers and reengage relapsed smokers with options for new medication strategies and additional counseling resources.
J. Taylor Hays - One of the best experts on this subject based on the ideXlab platform.
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Developing, Managing, and Sustaining an Effective International Tobacco Dependence Treatment Partnership
Journal of Smoking Cessation, 2016Co-Authors: Katherine E. Kemper, J. Taylor Hays, Richard D Hurt, Thomas J. Glynn, Karla L. WysockiAbstract:Introduction: Global Bridges, hosted at Mayo Clinic since 2010, is the only international network of healthcare professionals dedicated to Tobacco Dependence treatment. Globally, fewer resources have been dedicated to treatment than to other evidence-based Tobacco control policies. The Global Bridges network seeks to aid in filling this gap in Tobacco control. Aims: This paper identifies ways to advance Tobacco Dependence treatment, as well as Tobacco control, through efficient and effective use of a global health care provider network. Methods: Observation and critical analysis of lessons learned, project outcomes to date, and network analysis. Results/Findings: The initiative has built a strong global foundation, with training curricula developed and delivered in a number of countries, including low- and middle-income countries. While basic evaluation of content mastery and learner satisfaction has been conducted, more intensive evaluation and follow-up to confirm public health impact are essential needs. Finally, program analysis and application of management theory can be used in aiding future activities aimed at providing support for health care providers in the delivery of Tobacco Dependence treatment and in similar global public health endeavors. Conclusions: The Global Bridges healthcare professional network, now in its sixth year, has developed training curricula and expanded evidence-based Tobacco Dependence education among healthcare professionals. Global Bridges comprises a unique and important component of the broader Tobacco control community, and can play an integral role in furthering global Tobacco control progress.
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Pharmacologic Agents for Tobacco Dependence Treatment: 2011 Update
Current atherosclerosis reports, 2011Co-Authors: J. Taylor Hays, David D. Mcfadden, Jon O. EbbertAbstract:Tobacco use remains the most important worldwide cause of preventable death due mainly to cancer, cardiovascular disease, and chronic lung disease. If the current Tobacco pandemic continues for another 20 years, the annual global Tobacco-attributable mortality will exceed 8 million. In the US and many European countries, public health and Tobacco control efforts combined with effective Tobacco Dependence treatment using combined behavioral treatment and pharmacotherapy have contributed significantly to steadily declining rates of Tobacco use. Subsequent declines in cardiovascular disease and lung cancer death rates are directly attributable to these lower rates of Tobacco use. Despite smoking bans, health warnings and effective pharmacotherapy, one in five Americans continue to smoke. Continued research in Tobacco Dependence treatment has resulted in newer and more effective pharmacotherapy. In this review, we provide a current update of pharmacologic agents for Tobacco Dependence treatment and a discussion of recent controversy regarding adverse effects of some these medications.
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Preventing Lung Cancer by Treating Tobacco Dependence
Clinics in chest medicine, 2011Co-Authors: Richard D Hurt, J. Taylor Hays, Jon O. Ebbert, David D. McfaddenAbstract:Tobacco use is a chronic medical disorder. Providing evidence-based treatment of Tobacco-dependent patients is a challenge, and a team approach provides an efficient treatment model. Tobacco treatment specialists could expand the collective Tobacco treatment expertise in the medical setting. Effective Tobacco Dependence treatment frequently requires tailoring and intensifying of interventions to meet the needs of the individual patient. Stopping smoking reduces the risk of lung cancer and many other cancers, cardiovascular disease, stroke, peripheral vascular disease. Treating Tobacco Dependence is one of the most cost-effective therapies in medicine and it deserves adequate reimbursement for it to be more widely available.
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Treatment of Tobacco Dependence
Mayo Clinic proceedings, 2008Co-Authors: Michael V. Burke, Jon O. Ebbert, J. Taylor HaysAbstract:Cigarette smoking continues to cause substantial death and disability, but more than 1 in 5 adults smoke despite the desire among most smokers to stop and the availability of effective treatments. A systematic process to identify all smokers is crucial. Because Tobacco Dependence is characterized by relapses and remissions, clinicians should be ready to engage smokers and reengage relapsed smokers with options for new medication strategies and additional counseling resources.
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Treating Tobacco Dependence: Review of the best and latest treatment options
Journal of Thoracic Oncology, 2007Co-Authors: Jon O. Ebbert, J. Taylor Hays, Lowell C Dale, Amit Sood, Richard D HurtAbstract:Globally, an estimated 85% of lung cancer in men and 47% of lung cancer in women is attributable to Tobacco smoking. Tobacco Dependence treatment remains the most cost-effective way to prevent morbidity and mortality from lung cancer. Several effective pharmacotherapies are available to treat Tobacco Dependence. However, the long-term effectiveness of these treatments has been limited because the majority of smokers who attempt to stop smoking eventually relapse. Approaching the treatment of Tobacco use and Dependence as a chronic disease and the development of innovative drug therapies offer new hope for the treatment of Tobacco-dependent patients. The diagnosis of lung cancer provides a teachable moment to motivate patients to attempt Tobacco abstinence on which clinicians should capitalize. We review the currently available pharmacologic approaches to the treatment of Tobacco Dependence.
Jack E. Henningfield - One of the best experts on this subject based on the ideXlab platform.
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Rational Basis for Chemotherapy of Tobacco Dependence
2016Co-Authors: R. Nemeth-coslett, Jack E. Henningfield, Ph. DAbstract:The forms of Tobacco use are many, and it is likely that their number is matched by equally varied controlling variables. All the usual forms of Tobacco use, however, share at least one commonality: nicotine is extracted from the Tobacco and ingested in a manner that permits its distribution to the central nervous system. The Tobacco cigarette is the prevalent means of nicotine self-administration in Western society, and cigarette smoking is the primary form of Tobacco use addressed by legislative, research, and treatment efforts. In 1983, the United States Public Health Service categorized cigarette smoking as a form of drug Dependence in which nicotine was held to be the critical substance (USPHS 1983). Consistent with the drug Dependence model of cigarette smoking, in 1984 a pharmacotherapeutic aid (nicotine gum) for the treatment of Tobacco Dependence was approved by the Food and Drug Administration. This paper will briefly review nicotine Dependence and its implications for the use of chemotherapy in the treatment of Tobacco Dependence with respect to cigarette smoking. Tobacco Dependence: A DECEPTIVELY COMPLEX PHENOMENON At first brush. Tobacco Dependence would seem readily amenable to study. In the form of cigarette smoking. the behavior is public, practiced by many, and appears to involve a simple act with a simple product. However, cigarette smoking has resisted many attempts at quantitative study, and studies have yielded data which often appears contradictory at the most elemental levels. For instance, the role of dose in the control of cigarette smoking has remained unclear despite decades of study. Since dose-response relations are arguably the most critical quantitative relations to be assessed in pharmacologic studies, the absence of consensual agreement as to the nature of dose-response relations has undoubtedly hindered the understanding and treatment of cigarette smoking. There are specific reasons for some of the ambiguity concerning the role of dose in cigarette smoking. Table 1 provides a partial list of factors which obscure quantitation of dose-response functions
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Pharmacotherapy for Tobacco Dependence.
Handbook of experimental pharmacology, 2009Co-Authors: Reginald V. Fant, August R. Buchhalter, Albert C. Buchman, Jack E. HenningfieldAbstract:Pharmacotherapy can provide effective treatment of Tobacco Dependence and withdrawal, and thereby facilitate efforts to achieve and sustain Tobacco abstinence. Currently approved medications for smoking cessation are nicotine replacement medications (NRT), including nicotine patch, gum, lozenge, sublingual tablet, inhaler and nasal spray, the antidepressant bupropion, and the nicotinic partial agonist varenicline. This review discusses the pharmacological basis for the use of these medications, and the properties that might contribute to their efficacy, safety, and abuse liability. The review also discusses how pharmacological principles can be used to improve existing medications, as well as assist in the development of new medications.
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Novel Pharmacological Approaches for Treating Tobacco Dependence and Withdrawal
Drugs, 2008Co-Authors: August R. Buchhalter, Reginald V. Fant, Jack E. HenningfieldAbstract:Increasing the diversity and availability of medications for the treatment of Tobacco Dependence and/or withdrawal, to aid in the achievement of smoking cessation, is crucial to meet the diverse needs of Tobacco users. Despite a general awareness that smoking is harmful and widespread interest in smoking cessation, nearly 50 million adults in the US and 1.3 billion worldwide continue to smoke. Nicotine replacement therapies are effective in the treatment of Tobacco Dependence and withdrawal, but do not meet the needs of all Tobacco users. Improvement of Tobacco Dependence and/or withdrawal treatments is likely to rely on novel pharmacological approaches that include new chemical entities and new formulations of current drugs. In addition, new indications for treating Tobacco Dependence and withdrawal show promise for reducing Tobacco use and associated disease. This article focuses on a range of novel pharmacological approaches for the treatment of Tobacco Dependence and/or withdrawal, including oral and pulmonary nicotine delivery and the following non-nicotinic medications: antidepressants, an α4β2 nicotine partial agonist, an α_2-noradrenergic agonist, cytochrome P450 (CYP) 2A6 inhibitors, opioid antagonists and GABAergic medications. In addition to existing medications, this article addresses novel medications in the clinical development stage and those that have been evaluated previously. Novel medications in the clinical development stage include at least three nicotine vaccines and the cannabinoid receptor acting drug rimonabant. Medications evaluated previously include lobeline, mecamylamine and an anticholinergic drug regimen comprising atropine, scopolamine and chlorpromazine. Having not been approved by major drug regulatory authorities for the treatment of Tobacco Dependence and/or withdrawal, these medications have been evaluated in an experimental capacity.
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Novel pharmacological approaches for treating Tobacco Dependence and withdrawal: current status.
Drugs, 2008Co-Authors: August R. Buchhalter, Reginald V. Fant, Jack E. HenningfieldAbstract:Increasing the diversity and availability of medications for the treatment of Tobacco Dependence and/or withdrawal, to aid in the achievement of smoking cessation, is crucial to meet the diverse needs of Tobacco users. Despite a general awareness that smoking is harmful and widespread interest in smoking cessation, nearly 50 million adults in the US and 1.3 billion worldwide continue to smoke. Nicotine replacement therapies are effective in the treatment of Tobacco Dependence and withdrawal, but do not meet the needs of all Tobacco users. Improvement of Tobacco Dependence and/or withdrawal treatments is likely to rely on novel pharmacological approaches that include new chemical entities and new formulations of current drugs. In addition, new indications for treating Tobacco Dependence and withdrawal show promise for reducing Tobacco use and associated disease.
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Realignment of the nation’s Tobacco agenda: The need to treat Tobacco Dependence
Preventive medicine, 2001Co-Authors: John M. Pinney, Michael C. Fiore, Dorothy K. Hatsukami, Jasjit S. Ahluwalia, Thomas J. Glynn, Elaine Arkin, Susan J. Curry, Joe G. Gitchell, Jessie C. Gruman, Jack E. HenningfieldAbstract:Tobacco use remains the leading cause of preventable death in the United States. Although comprehensive Tobacco control has a number of essential components, support for cessation services can yield the largest short-term public health benefit. While effective treatments for Tobacco Dependence do exist, they are not currently available to many of the Tobacco users who want and need them. Finding cost-effective, science-based strategies for reducing Tobacco Dependence in the United States should be a national priority. Late in 1997 a group of experts in the science of Tobacco control was convened by the Center for the Advancement of Health to develop recommendations regarding the use of federal funds for treating Tobacco Dependence. These recommendations were prepared based on the priority of the actions and the estimated cost and effort required to implement them. Following the Master Settlement Agreement in 1998, the recommendations were adapted to address the needs of state policy makers. Effective treatments for Tobacco Dependence do exist; however, our nation currently lacks the capacity to deliver these services to the many millions who require them. There is a compelling need for funding from a variety of sources to create this capacity. The priority must be to develop the systems, competencies, and resources needed to deliver, and to monitor the delivery of, evidence-based treatments to Tobacco users. Treatment must be delivered in an integrated manner, consistent with the needs of Tobacco users. Additionally, financial barriers to treatment must be reduced, and consistent, high-quality treatment services must be ensured for all Tobacco users who seek them. Copyright 2001 American Health Foundation and Academic Press.
Michael B. Steinberg - One of the best experts on this subject based on the ideXlab platform.
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Treating Tobacco Dependence as a chronic illness and a key modifiable predictor of disease.
International journal of clinical practice, 2009Co-Authors: Jonathan Foulds, Amy C. Schmelzer, Michael B. SteinbergAbstract:Tobacco smoking is unique among modifiable risk factors in that it has a causal effect on serious diseases affecting every organ system. Yet clinicians frequently fail to assess and treat Tobacco Dependence. Now that we have effective treatments, clinicians should refocus on aggressively treating Tobacco Dependence as a serious life-threatening chronic disease.
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The Case for Treating Tobacco Dependence as a Chronic Disease
Annals of internal medicine, 2008Co-Authors: Michael B. Steinberg, Amy C. Schmelzer, Donna L. Richardson, Jonathan FouldsAbstract:Smoking remains the leading cause of preventable death in the United States, yet it is still regarded by many as merely a bad habit. Most smokers want to quit but find it difficult. Behavioral counseling and pharmacotherapies are available, safe, and effective in the treatment of Tobacco Dependence. Nicotine replacement therapy effectively delivers nicotine in safer doses without exposure to the toxins and chemicals in cigarette smoke. The optimal duration of Tobacco Dependence treatment is unknown, and some smokers may require extended courses. For smokers using long-term cessation medications, health care providers should encourage treatment and insurance carriers should cover it. Both Tobacco Dependence and such conditions as diabetes are similar in their potential to exacerbate other diseases, their behavioral components of treatment, and their effectiveness of medications. Despite these similarities, treatments for diabetes are well covered by insurance, whereas Tobacco Dependence treatments are often limited. Tobacco Dependence should share the status of other chronic illnesses, with effective treatments given as long as is necessary to achieve successful clinical outcomes.
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Midwives' knowledge, perceptions, beliefs, and practice supports regarding Tobacco Dependence treatment.
Journal of midwifery & women's health, 2007Co-Authors: Diane J. Abatemarco, Michael B. Steinberg, Cristine D. DelnevoAbstract:Clinical practice guidelines and evidence-based reviews confirm the efficacy of Tobacco Dependence treatment for pregnant women. The purpose of this study was to examine Tobacco Dependence treatment practices among certified nurse-midwives who treat pregnant women who smoke. Midwives were surveyed to determine knowledge, perceptions, and beliefs about Tobacco cessation treatment and to identify practice environmental factors that support treatment practices. Half of all midwives had not heard of the US Public Health Service Guidelines (5 A's) to assist smokers in cessation treatment. We found varying levels of adherence to the clinical practice guidelines. Nearly all midwives routinely ask, advise, and assess; while fewer encourage patients to set a quit date or discuss medication options (assist) and perform follow-up activities (arrange). Barriers significantly associated with clinical Tobacco treatment practice are lack of training and competing priorities in the visit. One-office support, a system in place to provide smoking cessation information and resources, was associated with increased practice. In summary, midwives believe they should be providing Tobacco Dependence treatment, yet they identify a need for training. The findings of this study also indicate that sustained practice change, which includes the entire practice environment, should be targeted to enhance Tobacco Dependence treatment.
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Developments in pharmacotherapy for Tobacco Dependence: past, present and future
Drug and alcohol review, 2006Co-Authors: Jonathan Foulds, Jill M. Williams, Michael B. Steinberg, Douglas M. ZiedonisAbstract:In the mid-1970s there were no effective pharmacological treatments for Tobacco Dependence. The invention of nicotine gum was a major treatment advance and also greatly helped our understanding of the nature of Tobacco Dependence. There are now eight effective pharmacotherapies (nicotine gum, patch, nasal spray, inhaler, lozenge/tablet, bupropion, nortriptyline and clonidine) available to aid smoking cessation. Other non-nicotine agents that show promise are under investigation, including glucose, rimonabant, selegiline and varenicline. Greater knowledge of the mechanisms of action of the effective non-nicotine agents should lead to better understanding of the nature of Tobacco Dependence. Future research into optimal treatments should examine long-term combination pharmacotherapy combined with improved psychosocial support that is partly designed to enhance medication compliance. In addition, there is a need for studies designed to evaluate the efficacy of pharmacotherapies in populations such as youth, ...
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Pharmacotherapy and smoking cessation at a Tobacco Dependence clinic.
Preventive medicine, 2005Co-Authors: Michael B. Steinberg, Donna L. Richardson, Jonathan Foulds, Michael V. Burke, Pooja ShahAbstract:Background. Tobacco Dependence medications are effective, and combinations may offer advantages. This study evaluates abstinence rates among smokers treated in a Tobacco specialist clinic with individual and/or group counseling plus combination pharmacotherapy. Methods. 790 smokers treated at the Tobacco Dependence Clinic in New Jersey from 2001–2003 and contacted 4 weeks after quit-date were studied. Patients received medications and behavioral interventions. Abstinence over the previous 7 days was evaluated at 4 weeks and 6 months. Patients lost to 6-month follow-up were considered still smoking. Results. Overall, 36% of patients were abstinent at 6 months (20% who used no medications, 37% using one medication, 37% using 2 medications, 42% using 3 medications, and 42% using 4+ medications) (P = 0.017). 27% still used medications at 6 months, and had higher abstinence rates (65%) than those who stopped their medications (27%) (P < 0.001). Number of medications predicted abstinence at 4 weeks [adjusted odds ratios = 2.30 (95% CI; 1.27–4.18) for 1 medication, 4.78 (2.72–8.40) for 2 medications, 5.83 (2.98–11.40) for 3 medications, and 11.80 (4.10–33.95) for 4+ medications]. Increasing age, increasing level of education, longer time after waking to first cigarette, more than 7 clinical contacts, and more medications used were related to higher abstinence at 6 months. Conclusions. Smokers attending a specialist Tobacco Dependence treatment clinic who used more medications and for longer duration had higher abstinence rates.
