Karl Fagerström

Independent Researcher

The single dose pharmacokinetics of a novel, non-tobacco-based nicotine pouch, ZYN®, 3 and 6 mg, were compared to 8 mg General snus (Part 1) and ZYN® 8 mg was compared to 18 mg Longhorn moist snuff (Part 2). Methods: A single-dose randomized cross-over design was used. In-vivo extraction and pharmacokinetic parameters were determined. Results:...

Background and objectives: This is the first study to assess the appeal and interest among adults in a new consumer tobacco product, ZYN. We also describe ZYN users, patterns of use, and reasons for use. Methods: Two data sets, consisting of a ZYN-naive consumer panel (n = 5179) and ZYN users (n = 1266), were provided by Swedish Match North Amer...

Objective: Varenicline, a selective partial agonist of the α4β2 nicotinic acetylcholine receptor, is a smoking cessation pharmacotherapy that more than doubles the chance of quitting smoking at 6 months compared with placebo. This article reviews salient knowledge of the discovery, pharmacological characteristics, and the efficacy and safety of var...

Introduction: The Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) are the gold standard measures to assess cigarette dependence. However, FTCD reliability and factor structure have been questioned and HSI psychometric properties are in need of further investigations. The present study examined the psychomet...

Harm reduction;publication bias;tobacco control;tobacco regulation

The U.S. FDA can require changes in warning statements for modified risk tobacco products (MRTP). We report an independent analysis of a consumer perception survey sponsored by Swedish Match as part of an Modified Risk Tobacco Product application to change warning labels for Swedish snus products. The survey exposed each of 4,324 daily exclusive ci...

Background Concerns about postcessational weight gain might hamper rather than encourage smokers to quit smoking. Methods We conducted a comprehensive multi-institutional smoking cessation program for health care and industrial workers (n = 654) employed at University Hospital Basel (Switzerland) and two local health industry companies (Novartis I...

Nicotine is naturally found in the plants belonging to the Solanaceae family. Concentrations high enough to have a pharmacological effect are seen only in the tobacco sub-family, approximately 2% of dry weight and in Duboisia Hopwoodii that has been used by Australian aborigines ( http://en.wikipedia.org/wiki/Duboisia_hopwoodii ). It is also presen...

Introduction: Time to the first cigarette after waking up in the morning is the most validated measure of dependence among smokers, and its complement is also a good indicator of dependence for smokeless tobacco (ST) users. However, no studies have directly compared these measures. Methods: We used a multivariate logistic regression model to com...

Background: An international expert panel convened by the Independent Scientific Committee on Drugs developed a multi-criteria decision analysis model of the relative importance of different types of harm related to the use of nicotine-containing products. Method: The group defined 12 products and 14 harm criteria. Seven criteria represented har...

A drug doesn't necessarily have the same dependence potential independent of vehicle, not even if the dose is fixed. Examples where the effects of the drugs differ among vehicles are coca tea, coca leaf chewing, intra-venous cocaine and smoking crack cocaine. Another example is with THC from marijuana and haschis. The dependence potential to drugs...

Over the last 50years, the concept of tobacco harm reduction has been well established. It is now understood that nicotine itself is not very harmful and nicotine replacement therapy products have been widely used as an aid to quit, reduce to quit or temporarily abstain from smoking for many years. The popularity of the unlicensed electronic cigare...

Background: The effectiveness of worksite interventions to reduce smoking is debatable. Objectives: A comprehensive smoking cessation intervention was implemented in a community of more than 17,000 employees at three different health care companies. The primary endpoint was abstinence at 24 months (self-reported and confirmed by exhaled carbon m...

Introduction: A nicotine vaccine could prevent relapse to smoking by hindering blood nicotine from reaching the brain. Niccine® is a nicotine hapten tetanus-toxoid conjugate vaccine. The present study evaluated the clinical efficacy of Niccine for tobacco smoking relapse prevention. Methods: Cigarette smokers (n = 355) aged 25-50 years were enro...

Because stopping smoking is such a pressing necessity for COPD smokers physicians should use smoking cessation treatments aggressively. For optimal efficacy smoking cessation in COPD smokers should combine behavioral and pharmacological treatments. Three types of pharmacological treatments are proven to be safe and effective: Nicotine Replacement T...

Smoking cessation is the only therapeutic intervention that can prevent COPD smokers from the chronic progression of their disorder. The most important intervention for helping these smokers to quit is a combination of counseling plus pharmacological treatment. The characteristics of the counseling should be different depending if this intervention...

Introduction: We explored the relationship between the Fagerström Test for Nicotine Dependence (FTND) and smoking abstinence rates in 10 randomized, double-blind placebo-controlled Phase 2-4 varenicline studies. Methods: Participants were adult smokers (≥10 cigarettes/day) who were motivated to quit. Efficacy end points included continuous absti...

The International Classification of Diseases and the Diagnostic and Statistical Manual for diagnosing tobacco/nicotine dependence emphasize the dependence-producing drug nicotine. These diagnostic tools have been challenged on grounds of poor predictive validity, and they do not differentiate across various forms of nicotine-containing products. In...

To the Editors: The study by Caponnetto et al. [1] in the November 2011 issue of the European Respiratory Journal addresses the behavioural part of smoking. The purpose of this comment is to offer a constructive review of the research and suggestions for further research. In this study at a smokers’ clinic, 120 smokers were given pharmacological...

There are today several therapies for aiding smoking cessation, both behavioural and pharmacological. This paper focuses on the more pharmacological approaches. The licensed medications are bupropion, nicotine replacement and varenicline. The results from clinical trials of these treatments can probably be improved upon by: selecting the best optio...

Snus is a low-nitrosamine smokeless product that appears to be safer than other smokeless products. Evidence indicates that snus has been used as an effective smoking cessation aid in Scandinavia. No randomized controlled trial has directly tested the efficacy of snus for smoking cessation. This randomized, double-blind, placebo-controlled multicen...

When the first version (the Tolerance Questionnaire, Fagerstrom, 1978) of the Fagerstrom Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991) was developed, tobacco smoking was not regarded as an addiction. Nevertheless, evidence that this might be the case was beginning to appear, and some researchers became incr...

Smokeless tobacco (SLT) is used in a variety of forms throughout the world. Long-term SLT use is associated with adverse health consequences. Effective pharmacotherapies are needed to treat SLT users who want to achieve tobacco abstinence. In the current review, we discuss the pharmacological interventions identified in a recent meta-analysis of in...

It is essential that medical students are adequately trained in smoking cessation. A web-based tobacco abstinence training program might supplement or replace traditional didactic methods. One-hundred and forty third-year medical students were all provided access to a self-directed web-based learning module on smoking cessation. Thereafter, they we...

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. This randomized, placebo-controlled trial recruited 218 smokers who were interested in qui...

Appendix 1: Baseline scores on modified Fagerström test for nicotine dependence

Appendix 2: Continuous abstinence rates for all participants for weeks 9-12 and weeks 9-26 by modified Fagerström test and salivary cotinine concentrations

To assess the efficacy and safety of varenicline (a licensed cigarette smoking cessation aid) in helping users of smokeless tobacco to quit. Double blind, placebo controlled, parallel group, multicentre, randomised controlled trial. Medical clinics (mostly primary care) in Norway and Sweden. Men and women aged ≥18 who used smokeless tobacco at leas...

A pooled analysis to evaluate the efficacy and safety of varenicline versus placebo for smoking cessation in Asian populations. A secondary objective was to compare the data to pooled trials among predominantly Western populations. Smokers (n = 893) in three randomized, double-blind, placebo-controlled, multicenter, phase IIb or III trials conducte...

Tobacco dependence is a relapsing and addictive chronic disorder and the leading preventable cause of death in the world. Health professionals must diagnose and treat smokers to help them to quit. Smokers who are preparing to quit should receive 2 types of treatments: (1) counseling, aimed at combating their psychologic dependence, and (2) pharmaco...

Oförklarliga ångestproblem hos en ung kvinna relateras till en traumatisk våldtäktsupplevelse som hon helt glömt att hon varit med om. Det beskrivs hur våldtäkten rekonstrueras och aterupplevs och vilka konsekvenser detta fått för kvinnans ångestproblem.

Författaren har arbetat med rökavvänjning på Uppsala läns landstings rökavvänjningsmottagning vid Ulleråkers Sjukhus i Uppsala sedan mottagningen öppnades 1976. Parallellt med det kliniska arbetet har författaren bedrivit forskning med inriktning på tobaksrökning och beteendemedicin. Hans doktorsavhandling Tobacco Smoking, Nicotine Dependence and S...

There is a close relationship between tobacco smoking and psychiatric disorders, and a higher proportion of individuals with mental health conditions smoke compared with the general population. Due to the increased smoking prevalence in this population, patients with psychiatric conditions are at greater risk of smoking-related morbidity and mortal...

Smoking status Usually a direct question is enough. If the patient claims to be a nonsmoker but the therapist is uncertain, CO in exhaled air, cotinine from saliva, urine or blood, and inspection of the patient's fingers and breath can yield valuable information. Smoking status should be noted prominently in the patient's record, including the type...

There are currently three licensed therapies for smoking cessation: nicotine replacement (NR), bupropion and varenicline. NR can be indicated for: 1) aid in abrupt cessation; 2) gradual reduction in order to quit smoking; 3) temporary abstinence; and 4) smoking reduction maintenance. A meta-analysis has found that the relative risk of abstinence fo...

To examine the correlation between the Fagerström Test for Nicotine Dependence (FTND) score and smoking prevalence across countries. Cross-sectional study. Fifteen studies from 13 countries with FTND score data. Samples of smokers were identified through systematic literature searches, web queries and colleagues. Smokers were considered representat...

Varenicline, a partial agonist of alpha(4)beta(2) nicotinic acetylcholine receptors, is the most recently approved drug for smoking cessation. This paper reviews the outcomes of Phase 2 and Phase 3 clinical trials that assess the efficacy of varenicline in comparison to placebo and other smoking cessation pharmacotherapies, ie, sustained-release bu...

Varenicline, a partial agonist of α4β2 nicotinic acetylcholine receptors, is the most recently approved drug for smoking cessation. This paper reviews the outcomes of Phase 2 and Phase 3 clinical trials that assess the efficacy of varenicline in comparison to placebo and other smoking cessation pharmacotherapies, ie, sustained-release bupropion (bu...

Many cancer patients continue to smoke past diagnosis and treatment, even though smoking in some cases may cause more side effects and increase the risk of treatment failure. We developed and evaluated a nurse-led smoking cessation programme on 50 patients with head and neck (H&N) cancer undergoing radiotherapy (RT) with 1-year follow-up. To evalua...

Smoking is recognized as a chronic and recurrent addictive disease. It is the leading preventable cause of death in the world and kills 4 million people worldwide annually. Because of the high morbidity and mortality associated with tobacco use and the substantial benefits of cessation, it is vital that all physicians encourage their patients who s...

With more medications available for smoking cessation treatment the need to diagnose the tobacco dependence for better tailoring of treatment is growing. It has been suggested that smokers can be peak seekers or trough maintainers vis-à-vis blood nicotine concentrations (Russell, 1990), or smoking predominantly for coping with withdrawal or smoking...

Smoking cessation is the one of the most important ways to improve the prognosis of patients with respiratory disease. The Task Force on guidelines for smoking cessation in patients with respiratory diseases was convened to provide evidence-based recommendations on smoking cessation interventions in respiratory patients. Based on the currently avai...

The role of tobacco smoking as a cause of cardiovascular disease is now unequivocal and well-documented in literally hundreds of epidemiologic and biomedical studies over the past 50 years. Cessation of smoking, on the other hand, swiftly and profoundly reduces the risks of a cardiovascular event. Thus, smoking cessation should be seen as perhaps t...

With the number of smokers worldwide currently on the rise, the regular failure of smokers to give up their tobacco addiction, the direct role of smoke (and, to a much lesser extent, nicotine) in most tobacco-related diseases, and the availability of less toxic (but still addictive) oral tobacco products, the use of oral tobacco in lieu of smoking...

Smoking Cessation: Problems and Opportunities and Future Perspectives - Volume 1 Issue 1 - Karl Fagerström, Ernest Groman, Carlos Andres Jimenez Ruiz

Tobacco use is dominated by cigarette smoking. Most toxicity due to cigarette smoking is related to the burning process. Several observations suggest that unburned or oral tobacco is less harmful than cigarette smoking. Up to now, physicians have advised a policy based on two ideas: (i) young people should not start smoking and (ii) the only choice...

This review considers some of the novel therapies that are under development for the treatment of tobacco dependence, outlines their efficacy in clinical studies and explains their mechanisms of action in terms of contemporary theories for the psychobiology of the dependence. It focuses on three treatments with differing mechanisms of action that a...

The tobacco control policy tools developed in a few rich countries in the 1970s, 1980s, and 1990s are currently being implemented widely in many poorer countries, thanks in part to the astonishing success of the Framework Convention on Tobacco Control (FCTC). With smoking rates already high in most of the Third World, however, the projections for t...

Tobacco--particularly smoked products--has been associated with great harm and growing public disapproval and can be expected to suffer in the marketplace. This situation has created opportunities for other less harmful nicotine-containing products such as smokeless tobacco and nicotine replacement products, which are gaining public support. Little...

Global tobacco deaths are high and rising. Tobacco use is primarily driven by nicotine addiction. Overall tobacco control policy is relatively well agreed upon but a long term nicotine policy has been less well considered and requires further debate. Reaching consensus is important because a nicotine policy is integral to the target of reducing tob...

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...

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 wan...

To review the evidence on the effects of moist smokeless tobacco (snus) on smoking and ill health in Sweden. Narrative review of published papers and other data sources (for example, conference abstracts and internet based information) on snus use, use of other tobacco products, and changes in health status in Sweden. Snus is manufactured and store...

Rationale: This statement is an updated version of one released by the same authors in February 2003. The statement was produced to follow up the Royal College of Physicians (RCP) Tobacco Advisory Group report "Protecting smokers, saving lives: the case for a tobacco and nicotine regulatory authority", which argued for an evidence based regulatory...

The very low smoking prevalence in Sweden has received considerable attention. Sweden was the only country in Europe to reach the World Health Organizations' goal of less than 20% daily smoking prevalence among adults by year 2000. Only 17% of Swedish men smoke. Some have argued that this has been achieved because Swedes use another form of tobacco...

INTRODUCTION. Nicotine replacement therapies (NRT) are effective for smoking cessation. After having received over-the-counter (OTC) status in Germany, concerns grew about effectiveness, increased risks, especially of adverse cardiovascular reactions, and inappropriate use of NRT. Thus, a pharmacy-based cohort study was launched. OBJECTIVES. To ass...

Positive- and negative-reinforcement consequences of smoking were assessed using a self-report inventory. Data from 429 current smokers (348 women, 81 men) were subjected to an exploratory factor analysis, with concurrent validation of resulting scales in 288 current smokers (235 women, 53 men), controlling for sex and age. The solution with three...

Tobacco dependance treatment is a long lasting journey that is now approaching the fifty-years landmark. Beginning with lobeline in the late Fifties, and passing through the development of nicotine replacement therapy, the pharmacological therapy of nicotine dependance has now reached a new phase of intense and florishing research. The purpose of t...

There is now little doubt that the majority of people who smoke tobacco do so to experience the psychopharmacological properties of the nicotine present in the smoke and that a significant proportion of habitual tobacco users become addicted to the drug nicotine. In the US some 80% and in Europe (Germany) 39% of smokers have been classified as depe...

Due to the profound mortality associated with tobacco use, effective treatments for tobacco dependence are needed. Currently, the most widely available pharmacotherapy is nicotine replacement therapy (NRT). This paper will review the state of the science and public health policy regarding NRT.Several formulations have been developed for delivering...

This study investigated the long term use of Eclipse, a cigarette-like device that heats rather than burns tobacco, and the Nicorette oral inhaler, a nicotine replacement product, in a group of smokers not interested in quitting smoking. Subjects were recruited from a previous four-week controlled trial with the Eclipse and the inhaler (Fagerström,...

Tobacco use is the single most important preventable health risk in the developed world, and an important cause of premature death worldwide. Smoking causes a wide range of diseases, including many types of cancer, chronic obstructive pulmonary disease, coronary heart disease, stroke, peripheral vascular disease, and peptic ulcer disease. In additi...

Tobacco smoking is a common pathogen in the chest unit. There is evidence that patients with COPD are more dependent and have more difficulties in achieving abstinence than healthy smokers. This paper suggests a protocol that can help the chest physician to manage the smokers. It is presented in the form of an algorithm that gives clear practical a...

This paper reviews the data on blood nicotine or saliva cotinine concentrations with concomitant smoking and use of nicotine replacement (NR) products. Eleven studies that provided data on blood nicotine concentrations, carbon monoxide in exhaled air, and number of cigarettes smoked were reviewed. At least one day had to be spent on concurrent use...

Tobacco use is the single most important preventable health risk in the developed world, and an important cause of premature death worldwide. Smoking causes a wide range of diseases, including many types of cancer, chronic obstructive pulmonary disease, coronary heart disease, stroke, peripheral vascular disease, and peptic ulcer disease. In additi...

The most powerful means to reduce the diseases caused by tobacco use are to prevent the initiation of use and to help users to achieve complete and lasting abstinence. For tobacco users who are unwilling or unable to completely give up their tobacco use, the possibility is increasingly being considered that such persons might be able to reduce thei...

Currently available nicotine replacement therapy (NRT) medications provide effective treatment for tobacco dependence, typically doubling success rates compared with placebo. A strategy for further improving the efficacy of NRT is to combine one medication that allows for passive nicotine delivery (e.g. transdermal patch) with another medication th...