Interventions for smokeless tobacco use cessation

Department of Primary Care Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota, USA, 55905.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2011; 2(2):CD004306. DOI: 10.1002/14651858.CD004306.pub4
Source: PubMed


Use of smokeless tobacco (ST) can lead to nicotine addiction and long-term use can lead to health problems including periodontal disease, cancer, and cerebrovascular and cardiovascular disease.
To assess the effects of behavioural and pharmacologic interventions for the treatment of ST use.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, Dissertation Abstracts Online, and Scopus. Date of last search: October 2010.
Randomized trials of behavioural or pharmacological interventions to help users of ST to quit with follow up of at least six months.
Two authors independently extracted data. We summarised as odds ratios. For subgroups of trials with similar types of intervention and without substantial statistical heterogeneity, we estimated pooled effects using a Mantel-Haenszel fixed-effect method.
Data from one study suggest that varenicline increases ST abstinence rates (Odds Ratio [OR] 1.6, 95% Confidence Interval (CI) 1.08 to 2.36) among Swedish snus users.Two trials of bupropion SR did not detect a benefit of treatment at six months or longer (OR 0.86, 95% CI 0.47 to 1.57). Nicotine replacement therapy (patch, gum, and lozenge) was not observed to increase tobacco abstinence rates (OR 1.14, 95% CI: 0.91 to 1.42). There was statistical heterogeneity among the 14 trials of behavioural interventions; seven of them reported statistically and clinically significant benefits, four suggested benefit but with wide CIs, whilst two had similar intervention and control quit rates and relatively narrow CIs. Heterogeneity was not explained by the design (individual or cluster randomization), whether participants were selected for interest in quitting, or specific intervention components. Most trials included either telephone counselling, an oral examination and feedback about any ST induced mucosal changes, or both. In a post-hoc subgroup analysis there was some evidence that behavioural interventions which include telephone counselling might increase abstinence rates more than interventions with less contact. In one trial an interactive website increased abstinence more than a static website.
Varenicline and behavioural interventions may help ST users to quit. Behavioural interventions incorporating telephone counselling or an oral examination are likely to increase abstinence rates.

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    • "Cigarette smoking is the leading cause of preventable death and disability and tobacco QLs have been a major contributor to smoking cessation across the nation (Fiore et al., 2008). More recently, the efficacy of QLs for ST users has been established (Boyle et al., 2008; Ebbert et al., 2011; Severson et al., 2014), but studies of QL interventions for other non-cigarette TNCPs have not been reported (Maziak, Ward, & Eissenberg, 2007). QL providers have the opportunity to implement novel protocols in the near future that may be efficacious for electronic cigarette users (Gromov, 2014), but 91.9% of quit lines are treating these "
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    ABSTRACT: Use of non-cigarette tobacco and nicotine containing products (TNCPs) is increasing in the US. Telephone tobacco quit lines (QLs) are one of the most widely disseminated tools for providing cessation services to cigarette smokers, but the range of QL treatment services offered to non-cigarette TNCP users needs to be determined. We surveyed QLs across 50 US states, Washington D.C., and Guam for the number of treatment protocols offered, products they were intended to treat, and how telephone counselors triaged patients reporting the use of non-cigarette TNCPs. Thirteen organizations provided US QL interventions of which eleven agreed to be interviewed regarding their treatment services (84.6%). Seven of the eleven QL providers (63.6%) used a single intervention protocol adapted to the type of non-cigarette TNCP used. Two of the eleven QLs (18.2%) referred hookah users to another provider and one QL (9.1%) referred electronic cigarette users to third party resources for cessation support; otherwise a single intervention protocol was used for all other TNCP users. Only one QL (9.1%) had a specialized protocol for smokeless tobacco users in addition to a standard protocol for all other callers. QL providers do not have access to tailored protocols for non-cigarette TNCP users, and it remains uncertain whether a common tobacco protocol will be efficacious for these users. Future research should both validate potential common protocols for non-cigarette TNCP users and address the need for and the development of specialized QL interventions for TNCP users to help them quit. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Feb 2015 · Addictive Behaviors
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    ABSTRACT: Background Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of any of the above products. Results Daily use of all the substances except chaalia was higher among males compared to females. Chaalia use was higher among adolescents than adults while non-married consumed both chaalia and gutka more than married. Mohajir ethnicity had higher prevalence of paan, gutka and tumbaku use while Pathans had higher prevalence of niswar use. Conclusion Prevalence of use of chewable products is high in Pakistan with particularly high use of certain substances related with socio-demographic profiles. Industrially prepared products, chaalia and gutka, are gaining popularity among youth. Policies and focused interventions can be developed taking into consideration the preferred use of products among different socio-demographic groups.
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    ABSTRACT: No pharmacotherapies have been shown to increase long-term (≥6-month) abstinence rates among smokeless tobacco (ST) users. Available evidence suggests that underdosing may occur with standard-dose nicotine replacement therapy (NRT) in ST users. We investigated the effect of high-dose nicotine therapy on tobacco withdrawal symptoms among ST users in a randomized, controlled clinical pilot study. A total of 42 ST users using at least 3 cans or pouches per week were randomized to nicotine patch doses of 63, 42, or 21 mg/day or placebo for 8 weeks. Multiple daily assessments of tobacco withdrawal and nicotine toxicity were obtained with an electronic diary. During the first week of nicotine patch therapy, we observed a dose-response relationship such that higher nicotine patch doses were associated with less decreased arousal (x2=6.87,p=.009), less negative affect (x2=3.85,p=.05), and less restlessness (x23.90, p=.048). During the second week, higher nicotine patch doses were associated with less decreased arousal (x2=6.77,p=.009). Overall, the frequency of nicotine toxicity symptoms did not differ by dose group. Of specific symptoms, nausea was observed to be more frequent in the 63 mg/day dose group compared with placebo (p=.035). In conclusion, high-dose nicotine patch therapy resulted in a greater reduction of tobacco withdrawal symptoms among ST users using at least 3 cans per week. High-dose nicotine patch therapy is safe and well tolerated in this population of tobacco users.
    Full-text · Article · Feb 2007 · Nicotine & Tobacco Research
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