Relighting behaviour among cigarette smokers seeking treatment: implications for tobacco treatment and policy.

AIMS: During the recent economic downturn, trends towards fewer cigarettes smoked per day have emerged along with the practice of extinguishing and relighting cigarettes. Few studies have characterised factors related to relighting cigarettes and none have explored this behaviour in those seeking tobacco treatment. This study describes treatment-seeking patients who relight cigarettes and examines implications on tobacco policy and treatment. METHODS: Data were collected from a cross-sectional sample of 496 patients at a specialty tobacco treatment programme in New Jersey from 2010 to 2012. RESULTS: Forty-six per cent of the sample reported relighting, and those subjects smoked significantly fewer cigarettes per day (CPD), despite similar levels of dependence and exhaled carbon monoxide (CO) values. In unadjusted analyses, significantly higher rates of relighting were found among females, African-Americans, smokers who had a high school diploma or less, and were unemployed, sick or disabled. Relighting was more prevalent among smokers with higher markers of dependence, menthol smoking and night smoking. In multivariate analyses, markers of dependence and economic factors (employment and education) remained significant. CONCLUSIONS: Characteristics linked to economic factors were related to increased relighting. Implications for tobacco treatment include the impact on pharmacotherapy dosing and counselling interventions. The tobacco control community needs to be aware of this phenomenon. Collecting data on 'smoking sessions per day' might be a more accurate depiction of smoking exposure than CPD.

Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic.

BACKGROUND: Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes. AIM: This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service. RESULTS: 46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non-menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non-menthol smokers. At 4-week follow up, AA, Latino and White non-menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non-menthol counterparts. At 6-month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non-menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9). CONCLUSIONS: Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non-menthol smokers within the same ethnic/racial groups.

Waking at night to smoke as a marker for tobacco dependence: patient characteristics and relationship to treatment outcome.

AIM: This study aimed to describe the characteristics of treatment-seeking patients who wake at night to smoke (night-smoking), identify factors that may be associated with night-smoking, and assess the association between night-smoking and treatment outcome. METHODS: A total of 2312 consecutive eligible cigarette smokers who sought treatment at a specialist tobacco-dependence clinic declared a Target Quit Date, provided baseline information at assessment, and were then followed-up 4 and 26 weeks after their target quit date. RESULTS: Of the total sample, 51.1% were identified as night-smokers and 25.1% reported smoking abstinence at 26-week follow-up. Night-smoking was associated with a number of other patient characteristics, including African-American race or Hispanic ethnicity, having smoking-related medical symptoms, having been treated for a behavioural health problem, smoking mentholated cigarettes, smoking within 30 min of waking in the morning, increased cigarettes smoked per day, and not having private health insurance. In multivariate analyses, night-smoking at assessment remained a significant predictor of smoking at 26-week follow-up when controlling for other factors associated with treatment outcome (adjusted odds ratio: 0.77, 95% confidence interval: 0.62-0.96). Night-smokers also experienced a shorter average time to relapse (38.5 vs. 56 days, p<0.0001). CONCLUSIONS: Several socioeconomic and tobacco use characteristics are shared among patients who wake at night to smoke. This behaviour can be assessed by a simple question and used as a marker for tobacco dependence and as an indicator that more intensive and sustained treatment may be required.

Characteristics and smoking cessation outcomes of patients returning for repeat tobacco dependence treatment.

Previous studies of tobacco dependence treatment have reported very low cessation rates among smokers who relapse and return to make a subsequent formal attempt to quit. This retrospective cohort study examined 1745 patients who attended a tobacco dependence clinic between 2001 and 2005, and the characteristics and outcomes of those who relapsed and returned for repeat treatment. Patients who returned for repeat treatment showed higher markers of nicotine dependence and were more likely to have a history of treatment for mental health problems than patients who attended the clinic for only one treatment episode. Among patients who relapsed and returned for repeat treatment, the 26-week abstinence rates were similar for each consecutive quit attempt (23%, 22% and 20%). Clinicians should encourage smokers who relapse after an initial treatment episode to return for treatment, and repeat treatment should focus on addressing high nicotine dependence and potentially co-occurring mental health problems in order to improve cessation outcomes.

Cigar use before and after a cigarette excise tax increase in New Jersey.

OBJECTIVE: To determine whether cigarette smokers in New Jersey substituted cigars following a cigarette excise tax increase. METHODS: We examined data from New Jersey's 2001 and 2002 Adult Tobacco Survey (NJATS). Adjusted odds ratios were generated for ever and current cigar use, controlling for demographics and cigarette smoking status. RESULTS: Males, whites, ever cigarette smokers, and those with higher education reported greater ever and current cigar use in both years. The adjusted odds for cigar use among recent quitters were higher in 2002 than in 2001. CONCLUSIONS: When other tobacco products' excise taxes fail to keep pace with cigarettes, there is a real potential for product substitution. Cessation of all tobacco products is necessary for the best public health outcome.

Alcohol withdrawal.

Alcohol withdrawal syndrome is a significant cause of perioperative morbidity and mortality. Physicians should be able to: (1) identify high-risk patients preoperatively by using the various screening tests, (2) recognize patterns with AWS, and (3) use the appropriate supportive, behavioral, nutritional and pharmacological treatment.