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Ending the Tobacco Problem: A Blueprint for the Nation A Comprehensive Smoking Cessation Policy for All Smokers: Systems Integration to Save Lives and Money David B. Abrams Office of Behavioral and Social Sciences Research National Institutes of Health Abstract In terms of the end points for cessation policy, three outcomes will reduce overall smoking prevalence: (1) reach and motivate more current smokers to make more frequent quit attempts, especially reaching the underserved; (2) ensure quitters know about and use appropriate evidence-based programs; and (3) enact policy that guarantees continuity of delivery of effective services via a comprehensive system of care management for all smokers. Policies that achieve these three goals will save millions of smokers from premature death and the burden of disease and will also save billions of dollars in excess cost to our nation. Research provides evidence that effective smoking cessation interventions exist, including behavioral and pharmacological programs able to reach smokers through many delivery channels. Using evidence-based programs significantly increases success, from almost double to as much as fourfold the cessation rate of quitting on one’s own. Yet less than half of current smokers make serious quit attempts annually, and less than a quarter of those that do try will use proven interventions, and over 95 percent of self-quitters will relapse. Weak dissemination of unappealing cessation products relative to the tobacco industry’s marketing, results in many smokers harboring misinformation about the safety and efficacy of treatments with smokers tending to simultaneously believe that new cigarette products may be less harmful. Having effective cessation programs and services is necessary but not sufficient to reduce population prevalence. The last decade has disproved the adage “if you build it, they will come.” Saving millions of lives and billions of dollars requires nothing short of aggressive, proactive, direct-to-consumer marketing of appealing cessation products. Strong political will is also critical; it is important to put into national policy what is known about effective ways to promote smoking cessation and to support the financial and other resources required to establish a unified delivery system of cessation care management for all smokers. EXECUTIVE SUMMARY For a smoker, it is long and arduous journey from starting to smoke to enjoying smoking in ones carefree youth to wanting to stop. For much of that journey, the smoker is not motivated to quit and does not make any quit attempts at all. Somewhere along the way the smoker may change, either suddenly or gradually over time. Smokers can move from being unmotivated and not making any quit attempts to wanting to quit (over 70 percent say they want to quit) and then
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Ending the Tobacco Problem: A Blueprint for the Nation to making serious quit attempts (about 45 percent try seriously to quit each year). If at first a smoker is not successful at quitting (over 90 percent are not), the arduous journey continues with cycles of trying to quit but relapsing to trying again. Some smokers may give up and feel too exhausted or perhaps even a bit ashamed to keep trying or to risk admission of repeated failure to their family, friends, and relatives. All too often a smoker may use unproven treatments or willpower to quit (over 75 percent do that). There are other barriers that a smoker needs to overcome, such as the cost of formal treatment or a lack of ability to discern ineffective from evidence-based treatments. There is no Consumer Reports or Good Housekeeping Award to guide one’s choice of cessation products and services. Perhaps a lucky smoker may eventually quit on his or her own or with the use of an effective cessation product or service. Finally, the journey ends when the smoker either quits for good or suffers and dies from a smoking related cause (about one third to one half of lifetime smokers will die of a smoking-related disease). Now that research has helped us understand so much of this journey, the challenge is to put what we know into practice and policy, and there is not a moment to lose as over 430,000 of our friends and fellow U.S. citizens die prematurely each year from their smoking addiction (that equals three fully loaded jumbo jets crashing with no survivors every single day, including weekends and holidays). There is substantial room to find more leverage points to improve the overall cessation outcome rate at every step of the way along a smoker’s journey to freedom from their addiction. This opportunity can only be fully realized with strong political will to do the right thing by designing cessation policies that support a comprehensive, systems approach to cessation intervention. This approach should provides aggressive, direct-to-consumer marketing and education campaigns to improve smoker’s health literacy about the dangers of smoking and the best tools for quitting. It should also cover the critical leverage points along the entire smokers’ journey, from being a slave to smoking to eventual freedom from tobacco addiction, and should provide interventions tailored to the smoker’s needs. This can be achieved through cessation policies that support a comprehensive care management network as well as cessation policies that ensure adequate resources and aligned financial incentives at federal, state, and local levels across both the delivery systems within the health care industry and across the broader public health system. Effective cessation programs are available but greatly underutilized, despite the social climate that is making it more difficult to smoke (e.g., bans in worksites, higher taxes). Decades of research, clinical practice guidelines, and meta-analyses provide solid evidence of the efficacy and cost effectiveness of smoking cessation interventions. Interventions include behavioral and pharmacological options ranging in intensity and cost from minimal (e.g., self-help) to maximal (e.g., inpatient treatment). Less than 50 percent of the over 45 million current U.S. smokers make a quit attempt each year. Of those that try to quit, over 75 percent do so on their own without evidence-based programs and, of those, over 95 percent relapse. Using even a minimal intensity/brief cessation program generally doubles the likelihood of success. There is also a dose-response relationship such that use of more intensive programs and use of combined pharmacological and behavioral programs can triple to quadruple the likelihood of success. As indicated by the available scientific evidence and computer simulation modeling (see work of Levy, Appendix J, and Mendez, Appendix K), even a conservative increase in the reach (number or percentage of smokers out of all current smokers who make a quit attempt each year) and a modest improvement in effectiveness (percent of smokers who use evidence-based programs and thereby increase their chances of maintenance of cessation) can play a very significant
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Ending the Tobacco Problem: A Blueprint for the Nation role in the mix of policy components that will reduce overall population prevalence. A more aggressive adoption and implementation of known best practices can make an even larger impact, using policies that reach those smokers who are not motivated to quit, those with the greatest health disparities, the highest smoking rates and those with comorbid complications that make treatment more difficult. In terms of policy, an integrated approach is needed at individual and at systems levels that can capitalize on all the proven cessation components and provide a continuum of care that will address the following three goals: (1) Proactively reach more smokers and create strong consumer knowledge, motivation and demand for cessation. Having effective treatment programs is necessary but not sufficient to reduce population prevalence. The last decade has disproved the assumption “if you build it, they will come.” Different smokers’ knowledge and needs must be targeted using social marketing and other behavioral principles and financial incentives. Smokers have misperceptions and gaps in their health literacy about tobacco product safety and about the value, safety, and efficacy of using proven cessation methods. Innovations must be found to specifically target smokers who are hard to reach and hard to motivate (i.e., smokers at disproportionate risk because they are from lower Socioeconomic Status (SES) groups or minorities, are under- or uninsured, have comorbid psychiatric/substance abuse disorders, or are adolescent or young adult smokers). Bio-behavioral vulnerability, cognitive expectations, and emotional and socio-demographic characteristics at individual and aggregate (e.g., community) levels are some of the critical elements that must be considered to ensure more smokers become: (1.a) more health literate about why and how to quit, (1.b) more motivated to make more frequent quit attempts, and (1.c) more likely to use their knowledge to choose and use the appropriate evidence-based treatments when quitting. (2) Make the full range of proven cessation treatments accessible and freely available in a coordinated, aligned delivery system of comprehensive care management. It is essential to: (2.a) establish and enforce policies for universal financial coverage of evidence-based cessation treatments; and (2.b) ensure service capacity is flexible, accessible, and meets the diverse needs of different smokers to use the appropriate type, intensity, and mode of treatment. A comprehensive care management system means that each smoker will receive continuity of care based on screening and triage into a level and type of treatment that meets their needs to enable smokers to receive the appropriate treatment (e.g., a Stepped Care approach; see Abrams et al. 1993;1996;2003, for details). Treatments can range from minimal/brief intensity (e.g., over the counter nicotine replacement, self help, or Internet-based interventions), to medium intensity (e.g., proactive telephone/brief primary care/managed care-based interventions), to maximum intensity (e.g., outpatient and inpatient multi-session clinical care delivered by specialists trained to treat severe nicotine addiction and comorbid psychiatric/substance abuse disorders). (3) Establish a coherent, unified national policy for the integration of all the effective components that enhance cessation into a comprehensive system of care management.
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Ending the Tobacco Problem: A Blueprint for the Nation Systems integration is arguably the single most critical missing ingredient needed to maximize the as yet unrealized potential to significantly increase population cessation rates. Systems integration includes: (3.a) putting what is known into widespread practice and policy and overcoming the barriers to implementation at every level (national, state, and local) of organizational systems structure, (3.b.) achieving continuity of care delivery via the alignment of the organizational infrastructure and the financial incentives within which health care and public health services are delivered, and (3.c) using quality indicators to ensure fidelity in the adoption and implementation of best cessation practices and continuous quality improvement based on measurable indicators. Key indicators for improving the fidelity of care include: surveillance; program, process and outcomes tracking measures as well as use of public access “report cards” to enhance consumer choice and to improve accountability across providers and their health service delivery organizations. Since smoking is an addiction (a chronic, refractory, relapsing condition), for many smokers effective intervention requires a proactive and coherent strategy of strong care management—the same kind of “chronic disease care management” model being adopted for other expensive life-threatening conditions like diabetes and hypertension. An integrated system of care management with appropriate and aligned financial incentives must become part of the fabric of health care, public health, and policy at local, state, and national levels. An adequately financed system of care must be put in place and must be sustained over decades to cumulatively accelerate the trajectory of smoking prevalence reduction in the entire population within our lifetime. While much is known about each of the successful components that will increase cessation rates, what is lacking is the integration of all the components to support a continuum of care management services. In many respects the single most critical issue for increasing population cessation rates lies in a lack of full “systems integration” of cessation tools and services that are already well known to be effective. Systems integration implies using the integrated knowledge base that we already have to inform the establishment of an overarching policy or set of policies. These policies must, in turn, support a comprehensive, seamless system of intervention care management at every level of societal structure (i.e., governmental, private sector, state and local public health, health care stakeholders, and delivery systems). A comprehensive system of care management will require policies that align incentives, resources and political will for the greater long range good of improving the nation’s health. Full implementation of a comprehensive, integrated “systems approach” to smoking cessation can significantly accelerate population prevalence reduction, saving lives and money. Policies are urgently needed that will result in increases in: (a) all smokers’ interest in and motivation to quit but particularly targetting the underserved and those with comorbid conditions; (b) smokers’ health literacy about the range of safe and effective treatments available and how best to use them; (c) smokers’ demand for and use of proven cessation interventions that are tailored and targeted to their specific profiles; (d) maintenance of cessation (reductions in relapse rates); and (e) access to affordable treatment by restructuring the health and health care delivery systems via aligned financial incentives and policies that support continuity of care as well as the screening and delivery of comprehensive services at federal, state, and local levels (a system of comprehensive care management). The major components of cessation treatment products and services are based on solid scientific evidence. Saving millions of lives and billions of dollars requires nothing short of strong political will to put into national policy what is known about effective ways to promote smoking
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Ending the Tobacco Problem: A Blueprint for the Nation cessation and to make the financial investment required to support a unified system of cessation care management for all smokers. REVIEW OF EVIDENCE This appendix is structured into five sections, which focus selectively on the following areas: Overview and rationale for investing in smoking cessation. Understanding of smoker characteristics to reach more smokers and increase demand for cessation. Evidence for efficacy and effectiveness of cessation interventions. Future directions in cessation research and implementation. Systems integration to increase the cessation rate and the trajectory of reduced prevalence. SECTION 1 OVERVIEW AND RATIONALE FOR INVESTING IN SMOKING CESSATION There are still over 45 million smokers in the US, comprising about 23 percent of the population (CDC 2004b). It is estimated that as many as half the current smokers, over 20 million human beings, will die prematurely of a smoking caused disease (Camenga and Klein 2004). Among the possible investments in preventive or palliative health care services available and reimbursed (e.g., treatment for diabetes, hypertension, cancer), smoking cessation remains one of the most cost-effective interventions per quality-adjusted life year saved (Cromwell et al. 1997; Fiore et al. 2004). Tobacco related diseases are costing over $150 billion each year (CDC 2002) and reduce life expectancy by about 14 years (CDC 2002). While primary prevention of smoking initiation among future generations will have a long term societal benefit, for the immediate future an urgent, aggressive, and vigorous effort directed at helping all current smokers to achieve lifelong cessation will save many lives and much money. Levy and colleagues (2000b), using a simulation model, projected that even if 100 percent of smoking initiation by all youth under 18 years of age was prevented, it would still take decades to reduce smoking prevalence by 50 percent if cessation rates remained at current levels. In another simulation model, Mendez and colleagues (1998) reported that if adoption of smoking at age 18 years remained constant at rates of 20, 25, 30 or 35 percent, then overall population prevalence of smoking would reach a steady state by 2045 of 12.2 percent, 15 percent, 18.4 percent, and 21.5 percent respectively. Another reason to increase cessation is that it will save millions from premature disability and save money. As already demonstrated in California, cancer rates, heart disease, and savings in health care expenditures can be achieved by reducing smoking prevalence (Fichtenberg and Glanz, 2000: Warner et al. 1995; 1999). Nationwide, the overall cancer death rate in the United States has begun to fall for the first time in recorded history, primarily because of reductions in incidence and prevalence of lung cancer. These reductions are a direct result of smoking rates having declined from over 45 percent in the 1960s to under 23 percent in 2003 (CDC 2004a; Cole and Rodu 1996). In fact, Thun and colleagues (2006) reported that about 40 percent of the contribution to overall cancer deaths comes from the dramatic reduction in smoking prevalence since the 1960s. There are other direct and indirect benefits to increasing the cessation rate at the population level. The following benefits are briefly noted. Accelerating smoking cessation among adults
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Ending the Tobacco Problem: A Blueprint for the Nation will, in turn, reduce the number of role models who smoke, the number of children at risk for taking up smoking, the damage to the unborn fetus from maternal smoking during pregnancy (Buka et al. 2003), the amount of second hand smoke exposure to nonsmokers of all ages but especially to children, the risks and damage caused by fires from cigarettes, losses in productivity and absenteeism at work, and other direct and indirect costs of smoking and of passive exposure in terms of health and well being. SECTION 1 SUMMARY Increasing cessation rates to dramatically reduce population prevalence of smoking is possible but challenging. If an aggressive and immediate investment is not made in cessation interventions and policy, the consequences are devastating in terms of lives lost prematurely, reduced quality of life, and hundreds of billions of dollars in unnecessary expenses. Thus much more must be done to increase cessation among current smokers if a dramatic reduction in population smoking prevalence is desired and if millions of current smokers’ lives are to be saved. Failing to act now to implement a nationwide comprehensive smoking cessation system of care is an extraordinary opportunity lost, with devastating consequences. SECTION 2 UNDERSTANDING OF SMOKER CHARACTERISTICS TO REACH MORE SMOKERS AND INCREASE DEMAND FOR CESSATION As outlined above, from a systems perspective, full impact of cessation interventions on the intended target population is a product of the proportion of the population reached and the efficacy of the intervention delivered to them (Impact = Reach × Efficacy; see Abrams et al. 1993; 1996; 2003 for details). There are several ways to improve reach and efficacy from both individual and systems levels of intervention. Glasgow and colleagues (1999; 2003; 2006a) have expanded the concept of impact in their RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) model to include the individual and systems level considerations that reflect the need to measure and improve the fidelity of adoption and implementation of interventions, using measures of key indicators of quality and integrity of program, process, and outcomes evaluation at both the individual level and the delivery system level (see Abrams et al. 1993; 1996; 2003; Dzewaltowski et al. 2004; Glasgow at al. 1999; 2003; 2006a for more details). This section is focused primarily on the issue of reaching diverse groups of smokers, designing programs and services that can anticipate their needs, and planning for the increased demand for resources assuming that we are able to reach more of them and increase their motivation to make quit attempts. Individual Bio-Behavioral Vulnerabilities and Demographics There are a number of important individual and aggregate (i.e., group or population level) smoker characteristics associated with differences in smoking prevalence, motivation to quit, and with some cessation outcomes. Some of these factors are important in considering how best to reach more smokers, motivate them to try to stop smoking—and encourage them to use the best interventions available to ensure success—such as to reduce the high rates of relapse after quit attempts. Selected factors are briefly reviewed here to support the major recommendations of this appendix. A comprehensive critical review is beyond the scope and space limitations of this report. Factors include gender, education, income, SES, racial and ethnic background, and age.
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Ending the Tobacco Problem: A Blueprint for the Nation There are also differences among subgroups of smokers in bio-behavioral variables such as their susceptibility to and their level of dependence on nicotine; the pattern of smoking over the years that they smoked; their motivation to quit; and their knowledge about the risks and benefits of smoking, the value of using smoking cessation programs, as well as the types of treatments available and how best to use them. Dependence is defined by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM IV-R) (APA 1994) using a fixed set of symptoms. Depending on the number of symptoms used to define dependence (Piper et al. 2006) and the response bias in the population of smokers surveyed, the percentage of dependent smokers can be as high as 87 percent (Hale et al. 1993). Withdrawal symptoms are also related to severity of dependence, and these symptoms may increase temptations to smoke to alleviate the withdrawa,l especially in the first 30 days after cessation. Although a “cut point” for dependent versus not dependent is useful for some purposes, it is widely accepted now that there is an underlying continuum of dependence, from mild to severe (Shiffman et al. 1998) among all smokers. Greater nicotine dependence is related to lower motivation to quit; increased difficulty in trying to quit smoking; failure to quit; increase in prevalence of psychiatric of substance abuse comorbidity (e.g., depression, alcoholism) and, in some studies, to better treatment outcome with nicotine replacement therapy (Hughes 1996; Shiffman et al. 1998). However, it is important to note that nicotine replacement, evidence-based behavioral treatments, and now other pharmacological aids (see later in this appendix) increase all smokers’ chances of quitting, regardless of level of dependence. The PHS (public health service) guideline therefore recommends that all smokers be advised to use nicotine replacement therapy (NRT) and other evidence-based treatments when trying to quit, except when nicotine replacement is contraindicated, such as during pregnancy or immediately post myocardial infarction (Fiore et al. 2000). A detailed review of gender and smoking is beyond the scope of this chapter. The U.S. Surgeon General (DHHS 2004b) reported that since 1980, 3 million women have died prematurely from smoking related disease. Women differ from men in their biological responses to nicotine (Perkins et al. 1999). Some studies support the hypothesis that women have more difficulty quitting than men while others do not (Killen et al. 2002; Wetter et al. 1999). Sex-specific variables such as concerns about weight gain, stress reduction, and the need for social support may also underlie differences between men and women smokers. Some research suggests physical activity may help women smokers quit (Marcus et al. 1999). A recent report calls for more research to clarify the differences between men and women to improve treatment of women smokers (DHHS 2004). Differences in demographic characteristics are most evident in smoking rates among those at disproportionate risk due to comorbidity (e.g., psychiatric, alcohol/substance abuse), disparities in SES, and among some racial and ethnic minorities. Smoking is over four times more prevalent (43 percent) in adults with lower educational attainment such as a GED than in those with a graduate degree (8.9 percent). Smoking rates are 17.0 percent for Asian Pacific islanders versus 34.0 percent for Alaskan American natives; 11.6 percent for those with more than 16 years of education versus 35.4 percent for those who did not complete high school; 12 percent for those older than 65 versus 29 percent for those 44 years of age or younger (CDC 1998). Augustson and Marcus (2003) defined hardcore smokers as established smokers over age 25 years, smoking 15 or more cigarettes per day and reporting no recorded history of quit attempts. Hardcore smokers make up 17.6 percent of all smokers, are more likely to be male, unmarried, unemployed, and
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Ending the Tobacco Problem: A Blueprint for the Nation have a lower level of education. This hardcore subgroup may be a significant public health challenge in terms of reaching and treating them (Augustson and Marcus 2003). At the state level of aggregation, Utah has the lowest prevalence (12.7 percent) and Kentucky the highest (32.6 percent) an almost threefold difference. Smoking prevalence is also lower than the national average (23 percent) in those states with strong, visible, comprehensive, and sustained antismoking programs (e.g., 16.4 percent in California and 19 percent in Massachusetts) (CDC 2004a). One population-based study suggests that higher smoking prevalence within a state may be associated with lower motivational levels of readiness to quit, fewer quit attempts, and heavier smoking (Etter 2004). Generally, over 80 percent of adult smokers become regular users before the age of 18 years (CDC 1998). There has been a 32 percent increase in youth adoption of smoking between 1991 and 1997 in the United States (CDC 1998) and a 28 percent increase among college students (Rigotti et al. 2000). A unique window of opportunity exists for early cessation intervention among youth and young adults. This younger cohort of smokers has not received attention. Young smokers are a target population that has “slipped through the cracks” between the prevention and the treatment models of intervention (see Appendix D by Flay and Appendixes by E through H by Halpern-Felsher). The past decade has seen numerous studies document strong relationships between smoking and psychiatric comorbidities. Depression, alcohol and other substance abuse disorders, adult attention deficit/hyperactivity problems, psychotic disorders, and anxiety disorders are associated with increased prevalence of smoking (Hughes 1993). One recent population-based study estimated that 44 percent of persons suffering from current mental illness were smokers (Lasser et al. 2000). Smokers with a history of depression are more likely to be diagnosed as nicotine dependent and to progress to more severe levels of dependence than persons without a history, and are less likely to quit smoking (Glassman 1997; Patten et al. 1998). Smoking rates of over 85 percent are observed in alcoholics, opiate addicts, and poly-drug users (Fertig and Allen 1995). More alcoholics die of tobacco-related causes than from their alcoholism (Hurt et al. 1994). Smokers with a history of alcoholism are more likely to be nicotine dependent. Moreover, psychiatric comorbidities, whether historical or current, appear to significantly impede efforts at smoking cessation (Hughes et al. 1995;1996); conversely, quitting smoking may significantly increase risk of relapse to major depressive disorder, at least among those with such a prior history (Glassman et al. 2001). Studies have been conducted on some populations at disproportionate risk, including racial and ethnic minorities, women, older Americans and a limited number on adolescents and young adults (see Appendix P by Wallace). Preventing relapse among smokers who currently make quit attempts will have a very important impact on reducing population prevalence, along with reaching more smokers and motivating them to try to quit. Those smokers with comorbid complications and bio-behavioral vulnerabilities, such as increased dependence, do tend to relapse more often whether they quit on their own or even in formal evidence-based treatment. Although use of evidence-based interventions improves cessation outcomes for all smokers across the board, smokers who do have comorbidity and smoke more heavily generally do not achieve cessation at the same rates as smokers without such additional risks. While there is little evidence in support of treatment “matching” of smoker characteristics to specific treatment components (e.g., depressed smokers do not generally benefit more from cognitive behavioral treatment for depression (Brown et al. 2001), smokers who are at higher risk due to certain bio-behavioral or socioeconomic vulnerabilities may in-
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Ending the Tobacco Problem: A Blueprint for the Nation deed benefit from more intensive, longer, or specialized clinical interventions (see review below of treatment efficacy). In summary, the full impact of cessation interventions on the intended target population is a product of the proportion of the population reached and the efficacy and fidelity of implementation of the intervention delivered (Impact = Reach × Efficacy; see Abrams et al. 1993; 1996; 2003; Glasgow et al. 2003; 2006a,b for details). Thus, in addition to trying to motivate more smokers to make quit attempts, there is an enormous opportunity to further increase cessation outcomes. The vast majority of smokers who do make quit attempts, as many as 85–98 percent in studies of brief and self-help interventions, will relapse. As reviewed below and in subsequent sections, few smokers know about treatment efficacy, few use any treatments at all, and those who do use an evidence-based program may not use or have access to the best programs to address their individual vulnerabilities. Consequently, overall cessation can be improved by increasing the interest and motivation of smokers to make more quit attempts and to use evidence-based interventions when quitting to improve the likelihood of cessation and to reduce the likelihood of relapse. Increasing Demand for Cessation One way to increase the overall impact of cessation at the population level is to increase the reach of current interventions using social marketing and other behavioral principles to enhance smokers’ motivation and interest in cessation. The following material reviews some of the factors that, in concert with the socio-demographic and bio-behavioral characteristics of smokers presented above, might be considered in making a case for increasing consumer demand for smoking cessation products and services. Characteristics of smokers and patterns of smoking at individual and group levels need to be considered in any plan for marketing and communications strategies to reach more smokers and to increase their motivation to quit and their demand for use of evidence-based cessation. There is an enormous opportunity for improvement in cessation outcomes by reaching and motivating many more smokers to make quit attempts each year, by encouraging the use of proven cessation programs when trying to quit, and by targeting those with disparities in smoking rates and comorbidities. Increasing smoker motivation to make more quit attempts requires a multi-pronged set of intervention strategies targeted at multiple levels: (1) at all nonsmoking individuals and at smokers (e.g., increasing their health literacy, correcting misperceptions about smoking, and disseminating the facts about the safety and efficacy of cessation programs); and (2) at multiple systems levels of social and environmental structures and policies that can make smoking behavior more difficult and quitting easier at the peer, neighborhood, community, state and national levels (e.g., homes, schools, workplace bans; mass media campaigns and free OTC-NRT [over-the-counter nictotine replacement therapy]; tax disincentives). Individual Level Social marketing principles include the tailoring and targeting of campaigns to specific audience characteristics. Social marketing approaches would conceptualize smoking cessation programs as an attractive line of “products” that must be appropriately priced, packaged, positioned, and promoted in a competitive marketplace. In addition to the socio-demographic and bio-behavioral characteristics of smokers reviewed above, a number of other considerations may be
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Ending the Tobacco Problem: A Blueprint for the Nation useful to improve the marketing and the reach of existing smoking cessation programs and services. Effective social marketing to increase consumer demand must be driven by solid and appropriate social marketing principles, theories, and evidence. The marketing approach includes a number of elements such as understanding of each target audience’s needs, characteristics, and perceptions including, for example, the accuracies and inaccuracies in smokers’ knowledge of tobacco use and cessation and various approaches to risk perception, motivational enhancement (see Emmons 2003), and economic incentives. About 43 percent of smokers make a quit attempt per year (Hughes et al. 2003). Thus, although over 70 percent of smokers say they intend to quit, 57 percent do not do so in a given year. Of those that make a quit attempt, some studies report that less than 20 percent of quitters use proven treatments, and relapse after an unaided quit attempt is more than twice as high as when a proven treatment is used (Zhu et al. 2000). Moreover, of smokers motivated to quit, 78 percent believed they were just as likely to quit on their own as with cessation intervention assistance (Zhu et al. 2000). Those participants who did believe cessation methods were effective were more likely to intend to quit (OR 1.8), make a quit attempt (OR 1.8), and to use intervention assistance when quitting (OR 3.62). Zhu and colleagues (2000) also reported that smokers who used an intervention (self-help, counseling and/or NRT versus those who quit on their own were twice as likely to succeed (7 percent vs. 15.2 percent), abstinent at 12-month follow up) and that heavy smokers were more likely to use assistance than light smokers, women more than men, and older more than younger smokers. Thus, there is an enormous opportunity to increase population prevalence of smoking cessation by reaching and motivating the 57 percent of smokers who currently make no quit attempts per year. Among those who do make a quit attempt, their success rate could at least be doubled for those 80 percent who quit on their own if only they used an evidence-based intervention. Reaching and motivating more smokers to make quit attempts each year and having them use proven treatments when they do quit would dramatically increase population cessation rates nationwide. Some smokers come into treatment due to pressure from others. Motivation is best when it is intrinsic (comes from the smoker him/herself) and is tied to a realistic evaluation of the benefits of stopping versus the benefits of continuing to smoke (Curry et al. 1991; Curry et al. 1997). When a smoker is not really ready to quit and lacks self-confidence to try, then it is neither surprising that he or she will fail to quit when asked to try nor that the treatment provider will become discouraged from advising him/her to quit again in the future. Both smokers and their providers often have unrealistic expectations (Abrams et al. 1991; 1993; 1996; 2003). The mismatch between smoker readiness (not ready) and provider enthusiasm (you should quit today) is most evident in settings that require a provider to proactively reach out to smokers who are not seeking treatment for their smoking. Such settings include non-volunteer populations such as all the smoking members of a managed care organization, a worksite, a hospital, or in a substance abuse rehabilitation program (Abrams and Biener 1992; Abrams et al. 1993; 1996; 2003). The Stages of Change (SOC) model (Prochaska and Velicer 2004) lends itself to the development of interventions that are tailored to the smoker’s motivational readiness to change. The SOC model also provide a useful roadmap for smokers in that it provides milestones (pre-contemplation, contemplation, preparation, action, maintenance) and guidelines for processes used at every phase of the journey from smoking initiation to various patterns of use to various efforts at cessation, relapse, and recycling to the ultimate success of permanent maintenance of cessation. Both smokers and the health delivery systems (public health and health care) can
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Ending the Tobacco Problem: A Blueprint for the Nation therefore use metaphors such as the journey from smoking to cessation to develop interventions that take into account continuity of care and the need for a systematic and dynamic approach to management of the cessation process (chronic disease management model; see further in this appendix as well as Abrams et al. 2003). Population surveys show that only a small minority of current smokers (14–28 percent) is motivated to quit in the next 30 days (Abrams and Biener 1992; Velicer et al. 1995). Members of managed care groups such as Health Maintenance Organizations (HMOs) have higher levels of motivational readiness than the general population, with as many as 70 percent planning to quit within 6 months (Hollis et al. 1993). Wewers and colleagues (2003) measured the distributions by readiness to change. Desire or intention to quit, using the Stages of Change measure, was examined from data collected in 3 Tobacco Use Surveys (1992–1993, 1995–1996, and 1998–1999). Results indicated a similar distribution across all three time points indicating very little movement in the stages of readiness to change in the U.S. population during the 1990s. The percent in each stage was 59.1 percent in pre-contemplation (not seriously thinking of stopping within the next 6 months), 33.2 percent in contemplation (planning to stop in the next 6 months but not in the next 30 days or planning to stop in the next 30 days but made no quit attempts in the past 12 months), and 7.7 percent in preparation (planning to stop in the next 30 days and made a quit attempt of at least 24 hours duration in the past 12 months) (Wewers et al. 2003). However, Etter (2004) reported that there was an association between smoking prevalence and stages of change in the United States across the 50 states, such that a higher prevalence of smoking was associated with lower motivation to quit, fewer quit attempts, and higher cigarette consumption. Among youth 55 percent of middle school students and 61 percent of high school students said they wanted to stop smoking, and overall 59 percent of current smokers reported they had tried to stop smoking in the 12 months preceding a national Behavior Risk Factor Survey (CDC 2001). Among middle school students, 80 percent thought secondhand smoke was harmful to them while 89.8 percent of high school students thought secondhand smoke was harmful to them. Research also indicates that 24 percent of young girls aged 12–18 years believed that they could stop smoking whenever they wanted to even if they smoked regularly, and this myth was even more prevalent among girls who were already smokers (41 percent) (Portor Novelli Communication styles 2002). The PHS clinical guide (Fiore et al. 2000) does recommend motivational enhancement interventions for individual smokers who are not motivated to quit (for more details on motivational factors see Emmons 2003). Moreover, the PHS guide (Fiore 2000) recommends that smoking status and then intervention (the five A’s) be made a “vital sign” along with temperature and blood pressure in all encounters between patients and any aspect of the health care delivery system. Evidence is presented that such a system can increase identification of smokers from 38 percent to over 65 percent in a health care setting and that this, in turn, can also double the cessation rate among smokers from 3 to 6.4 percent. If these PHS guidelines were implemented nationwide by all health care providers and all health care organizations, it alone would dramatically increase the number of smokers reached and provide an opportunity to motivate them, educate them about the best ways to stop smoking, and provide them with evidence-based cessation interventions. Smoking prevalence and patterns of uptake, use, and cessation are also strongly influenced by the advertising and targeted marketing of the tobacco industry. The tobacco industry in the United States spent over $15.15 billion in 2003 on marketing its lethal products (FTC 2005). The tobacco industry continues to aggressively promote smoking with attractive new products, novel
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Ending the Tobacco Problem: A Blueprint for the Nation tire smoker’s journey and provides interventions tailored to the smokers’ needs. This can be achieved through cessation policies that support a comprehensive care management network with aligned financial incentives at federal state and local levels across both the health care industry and the public health system.
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Ending the Tobacco Problem: A Blueprint for the Nation Table A-1 Odds Ratios (95 percent Confidence Intervals) for Efficacious Smoking Treatments Relative to Placebo Gum Patch Spray Inhaler Bupropion Clonidine 1.5 (1.3–1.8) 1.9 (1.7–2.2) 2.7 (1.8–4.1) 2.5 (1.7–3.6) 2.1 (1.5–3.0) 2.1 (1.4–3.2)
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Ending the Tobacco Problem: A Blueprint for the Nation REFERENCES Abrams DB, Emmons KM, Niaura RD, Goldstein MG, Sherman CE. 1991. Tobacco dependence: integrating individual and public health prospectives. In Annual Review of Addictions, Treatment and Research. New York: Pergamon. Pp. 391-436. Abrams DB, Niaura R, Brown RA, Emmons KM, Goldstein MG, Monti PM. 2003. The Tobacco Dependence Treatment Handbook. New York: The Guilford Press. Abrams DB, Orleans CT, Niaura R, Goldstein M, Velicer W, Prochaska JO. 1993. Treatment issues: towards a stepped care model. Tobacco Control 2 (Suppl), S17-S37. Abrams DB, Orleans CT, Niaura RS, Goldstein MG, Prochaska JO, Velicer W. 1996. Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care. A Combined stepped-care and matching model. Annals of Behavioral Medicine 18 (4), 290-304. Abrams DB, Biener L. 1992. Motivational characteristics of smokers at the workplace: a public health challenge. Preventive Medicine 21 (6), 679-87. AHIP (America’s Health Insurance Plans). 2004. Making the Business Case for Smoking Cessation Programs. Webpage. Available at: http://www.businesscaseroi.org/roi/apps/execsum.aspx; accessed August 21, 2007. American Cancer Society. 2006. Cancer Facts and Figures. Website. Available at: http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf; accessed August 20, 2007. APA (American Psychiatric Association). 1994. Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington DC: APA Auguston EM, Marcus SE. 2003. Use of the Population Survey to characterize subpopulations of continued smokers: A national perspective on the “hardcore” smoker phenomenon. Nicotine and Tobacco Research 6 (4), 621-629. Backinger C, Leischow S. 2001. Advancing the science of adolescent tobacco use cessation. American Journal of Health Behavior 25, 183-190. Baer JS, Marlatt GA, McMahon RJ. 1993. Addictive Behaviors Across the Life Span: Prevention, Treatment, and Policy Issues. Newbury Park, CA: Sage. Bandura A. 1997. Self-Efficacy: The Exercise of Control. New York: Freeman. Benowitz N. 1998. Nicotine Safety and Toxicity. New York: Oxford University Press. Biener L, Abrams DB. 1991. The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation. Health Psychology 10 (5), 360-365. Blondal T, Gudmundsson LJ, Olafsdottir I, Gustavsson G, Westin A. 1999. Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up. British Medical Journal 318 (7179), 285-288. Bock B, Graham A, Sciamanna C, Krishnamoorthy J, Whitely J, Carmona-Barros R, Niaura R, Abrams D. 2004. Smoking cessation treatment on the Internet: content, quality, and usability. Nicotine and Tobacco Research 6, 1-13. Bohandana A, Nilsson F, Martinet Y. 1999. Nicotine inhaler and nicotine patch: a combination therapy for smoking cessation. Nicotine and Tobacco Research 1, 189. Bohadana A, Nilsson F, Rasmussen T, Martinet Y. 2000. Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial. Archives of Internal Medicine 160(20), 3128-3134. Borland R, Yong HH, King B, Cummings KM, Fong GT, Elton-Marshall T, Hammond D, McNeil A. 2004. Use and beliefs about light cigarettes in four countries: findings from the International Tobacco Control Policy Evaluation Survey. Nicotine and Tobacco Research 6 (Suppl. 3), S311-S321 Boyd NR, Sutton C, Orleans CT, McClatchey MW, Bingler R, Fleisher L, Heller D, Baum S, Graves C, Ward JA. 1998. Quit Today! A targeted communications campaign to increase use of the cancer information service by African American smokers. Preventive Medicine 27 (5 Pt 2), S50-S60 Brandon TH, Herzog TA, Webb MS. 2003. It ain’t over till it’s over: the case for offering relapse-prevention interventions to former smokers. American Journal of Medical Science 326 (4), 197-200. Britton J, Bates C, Channer K, Cuthbertson L, Godfrey C, Jarvis M, McNeill A. 2000. Nicotine Addiction in Britain: A Report by the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians of London. Brown RA, Kahler CW, Niaura R, Abrams DB, Sales SD, Ramsey SE, Goldstein MG, Burgess ES, Miller IW. 2001). Cognitive-behavioral treatment for depression in smoking cessation. Journal of Consulting and Clinical Psychology 69(3), 471-480.
OCR for page 415
Ending the Tobacco Problem: A Blueprint for the Nation Brown RA, Herman KC, Ramsey SE, Stout RL. 1999. Characteristics of Smoking Cessation Participants Who Lapse on Quit Date. Paper presented at the international meeting of the Society for Research on Nicotine and Tobacco, Copenhagen, Denmark. Buka SL, Shenassa ED, Niaura R. 2003. Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study. American Journal of Psychiatry 160 (11), 1978-1984. Camenga DR, Klein JD. 2004. Adolescent smoking cessation. Current Opinion in Pediatrics 16, 368-372 CDC (Centers for Disease Control and Prevention). 2004. State-specific prevalence of current cigarette smoking among adults—United States, 2003. Mortality and Morbidity Weekly Report 53 (44), 1035-1037. CDC. 2004. Cigarette smoking among adults—United States, 2002. Mortality and Morbidity Weekly Report 53, 427-431. CDC. 2004. State medicaid coverage for tobacco-dependence treatments—United States, 1994–2002. Morbidity and Mortality Weekly Report 53 (3):54-57. CDC. 2002. Mortality and Morbidity Weekly Report 51, 300-303. CDC. 2001. Behavior Risk Factor Survey. Mortality and Morbidity Weekly Report 50, 1-84. CDC. 2000. Strategies for reducing exposure to environmental tobacco smoke, increasing tobacco-use cessation, and reducing initiation in communities and health care systems: a report on recommendations of the Task Force on Community Preventive Services. Mortality and Morbidity Weekly Report 49, 1-12. CDC. 1998. Tobacco use among high school students—United States, 1997. Morbidity and Mortality Weekly Report 47 (12), 229-233. Cobb NK, Graham AL, Bock BC, Papandonatos G, Abrams DB. 2005. Initial evaluation of a real-world Internet smoking cessation system. Nicotine and Tobacco Research 7, 207-216 Cokkinides VE, Ward E, Jemal A, Thun MJ. 2005. Under-use of smoking cessation treatments: results from the National Health Interview Survey, 2000. American Journal of Preventive Medicine 28:119–122. Coe JW, Brooks PR, Vetelino MG, Wirtz, MC, Arnold EP, Huang J, Sands SB, Davis TI, Lebel LA, Fox CB, Shrikhande A, Heym JH, Schaeffer E, Rollema H, Lu Y, Mansbach RS, Chambers LK, Rovetti CC, Schulz DW, Tingley FD, O'Neill BT. 2005. Varenicline: an alpha4beta2 nicotinic receptor partial agonist for smoking cessation. Journal of Medicinal Chemistry 48(10), 3474-3477. Colby SM, Monti PM, Barnett NP, Rohsenow DJ, Weissman K, Spirito A, Woolard RH, Lewander WJ. 1998. Brief motivational interviewing in a hospital setting for adolescent smoking: a preliminary study. Journal of Consulting and Clinical Psychology 66 (3), 574-578. Colby SM, Monti PM, Tevyaw TOL, Barnett NP, Spirito A, Rohsenow DJ, Riggs S, Lewander W. 2005. Brief motivational intervention for adolescent smokers in medical settings. Addictive Behaviors 30 (5) 865-874. Cole P, Rodu B. 1996. Declining cancer mortality in the United States. Cancer 78 (10), 2045-2048. COMMIT Research Group. 1995. Community Intervention Trial for Smoking Cessation (COMMIT): I. Cohort results from a four-year community intervention. American Journal of Public Health 85, 183-192. Critchley J, Capewell S. 2003. Smoking Cessation for the Secondary Prevention of Coronary Heart Disease. In the Cochrane Collaboration. Cochrane Library, Issue 4. Oxford: Update Software. Cromwell J, Bartosch WJ, Fiore MC, Hasselblad V, Baker T. 1997. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline of smoking cessation. Agency for Health Care Policy and Research. Journal of the American Medical Association 278 (21), 1759-1766. Cummings KM. 1999. Community-wide interventions for tobacco control. Nicotine and Tobacco Research 1(Suppl 1):113-116. Cummings KM, Hyland A, Bansal MA, Giovino GA. 2004. What do Marlboro Lights smokers know about low-tar cigarettes? Nicotine and Tobacco Research 6 (Suppl. 3), S323–S332. Cummings KM, Hyland A, Giovino GA, Hastrup JL, Bauer JE, Bansal MA. 2004. Are smokers adequately informed about the health risks of smoking and medicinal nicotine? Nicotine and Tobacco Research 6 (Suppl. 3), S333–S340. Cummings KM, Hyland A. 2005. Impact of nicotine replacement therapy on smoking behavior. Annual Review of Public Health Volume 25. Annual Reviews Inc. Cummings KM, Morley CP, Hyland A. 2002. Failed promises of the cigarette industry and its effect on consumer misperceptions about the health risks of smoking. Tobacco Control 11 (Suppl. 1), I110–I116. Curry SJ, Orleans CT. 2005. Addressing tobacco treatment in managed care. Nicotine and Tobacco Research 7 (Suppl. 1), s5-s8. Curry SJ, Orleans CT, Keller P, Fiore M. 2006. Promoting smoking cessation in the healthcare environment 10 years later. American Journal of Preventive Medicine 31 (3), 269-272.
OCR for page 416
Ending the Tobacco Problem: A Blueprint for the Nation Curry SJ, Grothaus LC, McAfee T, Pabiniak C. 1998. Use and cost effectiveness smoking-cessation services under four insurance plans in a health maintenance organization. New England Journal of Medicine 339, 673-679. Curry SJ, Grothaus L, McBride C. Reasons for quitting: extrinsic and intrinsic motivation for smoking cessation in a population-based sample of smokers. Addictive Behavior 22, 737-739. Curry SJ, McBride C, Grothaus LC, Louie D, Wagner EH. 1995. A randomized trial of self-help materials, personalized feedback, and telephone counseling with nonvolunteer smokers. Journal of Consulting and Clinical Psychology 63 (6), 1005-1014. Curry SJ, Wagner EH, Grothaus LC. 1991. Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program. Journal of Consulting and Clinical Psychology 59 (2), 318-324. Dani JA, Heinemann S. 1996. Molecular and cellular aspects of nicotine abuse. Neuron 16, 905-908. Davis, RM. 1998. An overview of tobacco measures. Tobacco Control 7 (Suppl), S36-S40. DHHS (U.S. Department of Health and Human Services). 1994. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: CDC DHHS. 1998. Tobacco Use Among U.S. Racial/Ethnic Minority Groups: A Report of the Surgeon General. Washington DC: Government Printing Office. DHHS. 2000. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: CDC. DHHS. 2004a. The Health Consequences of Smoking. Atlanta, GA: CDC. DHHS. 2004b. Women, Tobacco and Cancer: An Agenda for the 21st Century. National Cancer Institute report, NIH Pub. # 04-5599. Doescher MP, Whinston MA, Goo A, Cummings D, Huntington J, Saver BG. 2002. Pilot study of enhanced tobacco-cessation services for low-income smokers. Nicotine and Tobacco Research 4 (Suppl 1), S19-S24. Dzewaltowski DA, Glasgow RE, Klesges LM, Estabrooks PA, Brock E. 2004. RE-AIM: Evidence-based standards and a web resource to improve translation of research into practice. Annals of Behavioral Medicine 28 (2), 75-80. Emmons. 2003. Motivating Smokers to Quit. The Tobacco Dependence Treatment Handbook. New York: The Guilford Press. Etter JF. 2004. Associations between smoking prevalence, stages of change, cigarette consumption and quit attempts across the United States. Preventive Medicine 38 (3), 369-373. Fagerstrom KO, Schneider NG. 1989. Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine 12, 159–181. Fagerstrom KO. 1994. Combined use of nicotine replacement products. Health Values 18:15-20. Farkas AJ, Gilpin EA, White MM, Pierce JP. 2000. Association between household and workplace smoking restrictions and adolescent smoking. Journal of the American Medical Association 284 (6), 717-722. FDA (Food and Drug Administration). 2006. Labelling Information for Varenicline. Website. Available at: http://www.fda.gov/cder/foi/label/2006/021928lbl.pdf; accessed August 20, 2007. Fertig J, Allen JP. 1995. Alcohol and Tobacco: From Basic Science to Policy. National Institute on Alcohol Abuse and Alcoholism, Monograph 30. Fichtenberg CM, Glanz SA. 2000. Association of the California Tobacco Control Program with declines in cigarette consumption and mortality from heart disease. New England Journal of Medicine 343 (24), 1772-1777. Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, Heyman RB, Jaen CR, Kottke TE, Lando HA, Mecklenburg RE, Mullen PD, Nett LM, Robinson L, Stitzer ML, Tommasello AC, Villejo L, Wewers ME. 2000. Treating Tobacco Use and Dependence: Clinical Practice Guideline. Rockville, MD: DHHS. Fiore MC, Croyle RT, Curry SJ, Cutler CM, Davis RM, Gordon C, Healton C, Koh HK, Orleans CT, Richling D, Satcher D, Seffrin J, Williams C, Williams LN, Keller PA, Baker TB. 2004. Preventing 3 million premature deaths and helping 5 million smokers quit: a national action plan for tobacco cessation. American Journal of Public Health 94 (2), 205-210. Fiore MC, Novotny TE, Pierce JP, Giovino GA, Hatziandreu EJ, Newcomb PA, Surawicz TS, Davis RM. 1990. Methods used to quit smoking in the United States. Do cessation programs help? Journal of the American Medical Association 263 (20), 2760-2765. Fong GT, Hyland A, Borland R, Hammond D, Hastings G, McNeill A, Anderson S, Allwright S, Mulcahy M, Howell F, Clancy L, Thompson ME, Connolly G, Driezen P. 2006. Changes in exposure to tobacco smoke pollution and support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: Findings from the ITC Ireland/UK Survey. Tobacco Control 15 (Suppl. III), iii51-iii58 Frieden TR, Blakeman DE. 2005. The dirty dozen: 12 myths that undermine tobacco control. American Journal of Public Health 95 (9), 1500-1505.
OCR for page 417
Ending the Tobacco Problem: A Blueprint for the Nation Frieden TR, Mostashari F, Kerker BD, Miller N, Hajat A, Frankel M. 2005. Adult tobacco use levels after intensive tobacco control measures—New York City. American Journal of Public Health 95:1016-1023. Friend K, Levy D. 2001. Smoking cessation interventions and policies to promote their use: a critical review. Nicotine and Tobacco Research 2, 299-310. FTC (Federal Trade Commission). 2005. Cigarette Report for 2003. Washington DC: FTC. Garvey AJ, Bliss RE, Hitchcock JL, Heinold JW, Rosner B. 1992. Predictors of smoking relapse among self-quitters: a report from the Normative Aging Study. Addictive Behaviors 17 (4), 367-77. Giardina TD, Hyland A, Bauer UE, Cummings KM. 2004. Which population-based interventions would motivate smokers to think seriously about stopping smoking? American Journal of Health Promotion 18 (6), 405-408. Glassman AM. 1997. Cigarette smoking and its comorbidity. NIDA Research Monograph 172, 52-60. Glassman AH, Covey LS, Stetner F, Rivelli S. 2001. Smoking cessation and the course of major depression: a follow up study. Lancet 357 (9272), 1929-1932. Glasgow RE, Vogt T, Boles SM. 1999. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health 89, 1322-1327. Glasgow RE, Lichtenstein E, Marcus AC. 2003. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy to effectiveness transition. American Journal of Public Health 93(8), 1261-1267. Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. 2006. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Education Research Aug 31; [Epub ahead of print]. Glasgow R, Green L, Klesges L, Abrams D, Fisher E, Goldstein M, Hayman LL, Ockene JK, Orleans CT. 2006. External validity: we need to do more. Annals of Behavioral Medicine, 31(2), 105-108. Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, Watsky EJ, Gong J, Williams KE, Reeves KR. 2006. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. Journal of the American Medical Association 296(1), 47-55. Hajek P, Stead LF, West R, Jarvis M, Lancaster T. 2005. Relapse prevention interventions for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 1. Oxford: Update Software. Hale K, Hughes J, Oliverto A, Helzar JE, Higgins ST, Bickel WK, Cottler LB. 1993. Nicotine Dependence in a Population-Based Sample: Problems of Drug Dependence. NIDA Research Monograph, 132. Hammond D, McDonald PW, Fong GT, Borland R. 2004. Do smokers know how to quit? Knowledge and perceived effectiveness of cessation assistance as predictors of cessation behaviour. Addiction 99(8), 1042-1048. Hammond D, Fong GT, Zanna MP, Thrasher JF, Borland R. 2006. Tobacco denormalization and industry beliefs among smokers from four countries. American Journal of Preventive Medicine 31(3): 225-232 Herrera N, Franco R, Herrera L, Partidas A, Rolando R, Fagerstrom KO. 1995. Nicotine gum, 2 and 4 mg, for nicotine dependence. A double-blind placebo-controlled trial within a behavior modification support program. Chest 108 (2), 447-451. Hey K, Perera R. 2005. Competitions and incentives for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 2. Oxford: Update Software. Hey K, Perera R. 2005. Quit and win contests for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 2. Oxford: Update Software. Hollis JF, Lichtenstein E, Vogt TM, Stevens VJ, Biglan A. 1993. Nurse-assisted counseling for smokers in primary care. Annals of Internal Medicine 118 (7), 521-525. Hopkins DP, Briss PA, Ricard CJ, Husten CG, Carande-Kulis VG, Fielding JE, Alao MO, McKenna JW, Sharp DJ, Harris JR, Woollery TA, Harris KW. 2001. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine 20 (Suppl.1):16-66. Hopkins DP, Husten CG, Fielding JE, Rosenquist JN, Westphal LL. 2001. Evidence reviews and recommendations on interventions to reduce tobacco use and exposure to environmental tobacco smoke: a summary of selected guidelines. American Journal of Preventive Medicine 20 (Suppl. 1): 67-87. Hughes JR, Stead LF, Lancaster T. 2000. Anxiolytics for smoking cessation. 2000. Cochrane Collaboration. Cochrane Library, Issue 4. Oxford: Update Software. Hughes JR. 1995. Clinical implications of the association between smoking and alcoholism. Fertig J, Fuller R. (Eds). Alcohol and tobacco: From basic science to policy, National Institute of Alcohol and Alcoholism Monograph 30, 171-181.
OCR for page 418
Ending the Tobacco Problem: A Blueprint for the Nation Hughes JR. 1996. Pharmacotherapy of Nicotine Dependence. Schuster CR, Kuhar MJ (Eds). Pharmacological aspects of drug dependence: Toward an integrative neurobehavioral approach. pp. 599-626. New York: Springer-Verlag. Hughes JR, Shiffman S, Callas P, Zhang J. 1993. A meta-analysis of the efficacy of over-the-counter nicotine replacement. Tobacco Control 12 (1), 21-27. Hughes JR, Cummings KM, Hyland A. 1999. Ability of smokers to reduce their smoking and its association with future smoking cessation. Addiction 94 (1), 109-114. Hughes JR, Fiester S, Goldstein MG, Resnick MP, Rock N, Ziedonis D. 1996. American Psychiatric Association Practice Guideline for the treatment of patients with nicotine dependence. American Journal of Psychiatry 153, S1-S31. Hughes JR, Goldstein MG, Hurt RD, Shiffman S. 1999. Recent advances in the pharmacology of smoking cessation. Journal of the American Medical Association 281 (1), 72-76. Hughes JR, Shiffman S, Callas P, Zhang J. 2003. A meta-analysis of the efficacy of over-the-counter nicotine replacement. Tobacco Control 12, 21-27. Hughes JR. 1993. Pharmocotherapy for smoking cessation: unvalidated assumptions, anomalies, and suggestions for future research. Journal of Consulting and Clinical Psychology 61 (5), 751-760 Hughes JR, Keely J, Naud S. 2004. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 99, 29-39. Hunt WA, Bespalec DA. 1974. An evaluation of current methods of modifying smoking behavior. Journal of Clinical Psychology 30 (4), 431-438. Hurt RD, Sachs DP, Glover ED, Offord KP, Johnston JA, Dale LC, Khayrallah MA, Schroeder DR, Glover PN, Sullivan CR, Croghan IT, Sullivan PM. 1997. A comparison of sustained–release bupropion and placebo for smoking cessation. New England Journal of Medicine 337 (17), 1195-1202. Hurt RD, Eberman KM, Croghan IT, Offord KP, Davis LJ, Morse RM, Palmen MA, Bruce BK. 1994. Nicotine dependence treatment during inpatient treatment for other addictions: a prospective intervention trial. Alcoholism: Clinical and Experimental Research 18(4), 867-872. Hurt RD, Croghan GA, Beede SD, Wolter TD, Croghan IT, Patten CA. 2000. Nicotine patch therapy in 101 adolescent smokers: efficacy, withdrawl symptom relief, carbon monoxide and plasma cotinine levels. Archives of Pediatric and Adolescent Medicine 154:31-37. Hyland A, Levy DT, Rezaishiraz H, Hughes JR, Bauer JE, Giovino GA, Cummings KM. 2005. Reduction in amount smoked predicts future cessation. Psychology of Addictive Behaviors 19, 221-225. Jackson NW, Howes FS, Gupta S, Doyle JL, Waters E. 2005. Policy interventions implemented through sporting organizations for promoting healthy behavior change. Cochrane Collaboration. Cochrane Library, Issue 2. Oxford: Update Software. Jorenby DE, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, Williams KE, Billing CB, Gong J, Reeves KR. 2006. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. Journal of the American Medical Association 296 (1), 56-63. Jorensby DE, Leischow SJ, Nides MA, Rennard SI, Johnston JA, Hughes AR, Smith SS, Muramoto ML, Daughton DM, Doan K, Fiore MC, Baker TB. 1999. A controlled trial of sustained release buproprion, a nicotine patch, or both for smoking cessation. New England Journal of Medicine 340:685-691 Keller PA, Fiore MC, Curry SJ, Orleans CT. 2005. Systems change to improve health and health care: lessons from addressing tobacco in managed care. Nicotine and Tobacco Research 7 (Suppl.1): s5-s8. Killen JD, Fortmann SP, Varady A, Kraemer HC. 2002. Do men outperform women in smoking cessation trials? Maybe, but not by much. Experimental Clinical Psychopharmacology 10 (3), 295-301. Killen JD, Robinson TN, Ammerman S, Hayward C, Rogers J, Stone C, Samuels D, Levin SK, Green S. 2004. Randomized clinical trial of the efficacy of bupropion combined with nicotine patch in the treatment of adolescent smokers. Consulting and Clinical Psychology 72 (4):729-735. Klesges RC, Johnson KC, Somes G. 2006. Varenicline for smoking cessation: definite promise, but no panacea. Journal of the American Medical Association 296(1), 94-95. Kornitzer M, Boutsen M, Dramaix M, Thijs J, Gustavsson G. 1995. Combined use of nicotine patch and gum in smoking cessation. Preventive Medicine 24:41-47. Kozlowski LT, Yost B, Stine MM, Celebucki C. 2000. Massachusetts’ advertising against light cigarettes appears to change beliefs and behavior. American Journal of Preventive Medicine 18 (4), 339-342. Lancaster T, Stead LF. 2000. Self-help interventions for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 3. Oxford: Update Software.
OCR for page 419
Ending the Tobacco Problem: A Blueprint for the Nation Lando HA, Rolnick S, Klevan D, Roski J, Cherney L, Lauger G. 1997. Telephone support as an adjunct to transdermal nicotine in smoking cessation. American Journal of Public Health 87 (10), 1670-1674. Lando HA, Pirie PL, Roski J, McGovern PG, Schmid LA. 1996. Promoting abstinence among relapsed chronic smokers. American Journal of Public Health 86, 1786-1790. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. 2000. Smoking and mental illness: a population-based prevalence study. Journal of the American Medical Association 284 (20), 2606-2610. Levy DT, Friend K. 2002a. Examing the effects of tobacco treatment policies on smoking rates and smoking related deaths using the SimSmoke computer simulation model. Tobacco Control 11, 47-54. Levy DT, Friend K. 2002b. A simulation model of policies directed at treating tobacco use and dependence. Medical Decision Making 22:6-17. Levy DT, Chaloupka F, Gitchell J, Mendez D, Warner KE. 2004. The use of simulation models for the survelliance, justification and understanding of tobacco control policies. Health Care Management Science 5 (2), 113-120. Levy GT, Chaloupka F, Gitchell J. 2005. The effects of tobacco control policies on smoking rates: a tobacco control scorecard. Journal of Public Health Management and Practice 10 (4): 338-353. Levy DT, Cummings KM, Hyland A. 2000. Increasing taxes as a strategy to reduce cigarette use and deaths: Results of a simulation model. Preventive Medicine 31 (3): 279-286. Levy DT, Cummings KM, Hyland A. 2000b. A simulation of the effects of youth initiation policies on overall cigarette use. American Journal of Public Health 90 (8): 1311-1314. Lloyd-Richardson EE, Niaura R, Brown R, Abrams D. 2001a. Informed Development of Smoking Cessation Interventions: Addressing the Needs of College and Technical School Students. Symposium conducted at the Society for Prevention Research, Developing Effective Tobacco Interventions: Transdisciplinary Research Informing Target, Policy, and Content Decisions, L. Dierker, chairperson, Washington, DC. Lloyd-Richardson EE, Niaura R, Abrams D. 2001b. A survey of smoking among young adults in technical school. Unpublished raw data. Longo DR, Johnson JC, Kruse RL, Brownson RC, Hewett JE. 2001. A prospective investigation of the impact of smoking bans on tobacco cessation and relapse. Tobacco Control 10 (3), 267-272. Lovato C, Linn G, Stead LF, Best A. 2003. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviors. Cochrane Collaboration. Cochrane Library, Issue 3. Oxford: Software Update. Mandel L, Bialous A, Glantz S. 2006. Avoiding “truth”: tobacco industry promotion of life skills training. Journal of Adolescent Health 39 (6), 868-879. Marcus BH, Albrecht AE, King TK, Parisi AF, Pinto BM, Roberts M, Niaura RS, Abrams DB. 1999. The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Archives of Internal Medicine 159 (11),1229-1234. Marlatt GA. 1998. Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors. New York: Guilford Press. McDonald PW. 1999. Population-based recruitment for quit-smoking programs: an analytic review of communication variables. Preventive Medicine 28 (6), 545-557. McMenamin SB, Halpin HA, Ibrahim JK, Orleans CT. 2004. Physician and enrollee knowledge of Medicaid coverage for tobacco dependence treatments. American Journal of Preventive Medicine 26 (2), 99-104. McPhillips-Tangum C, Bocchino C, Carreon R, Erceg C, Rehm B. 2004.. Addressing tobacco in managed care: results of the 2002 Survey. Preventing Chronic Disease 1 (4):A04. Mendez D, Warner KE. 2000. Smoking prevalence in 2010: why the Healthy People goal is unattainable. American Journal of Public Health 90(3), 401-403. Mendez D, Warner KE, Courant PN. 1998. Has smoking cessation ceased? Expected trends in the prevalence of smoking in the United States. American Journal of Epidemiology 148:249-258. Metzger KB, Mostashari F, Kerker BD. 2005. Use of pharmacy data to evaluate smoking regulations’ impact on sales of nicotine replacement therapies in New York City. American Journal of Public Health 95 (6), 1050-1055. Miller N, Frieden TR, Liu SY, Matte TD, Mostashari F, Deitcher DR, Cummings KM, Chang C, Bauer U, Bassett MT. 2005. Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation. Lancet 365 (9474), 1849-1854. Moher M, Hey K, Lancaster T. 2005. Workplace interventions for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 4. Oxford: Update Software. Moller A, Villebro N, Pederson T. 2001. Interventions for preoperative smoking cessation. 2001. Cochrane Collaboration. Cochrane Library, Issue 4. Oxford: Update Software.
OCR for page 420
Ending the Tobacco Problem: A Blueprint for the Nation Moolchan ET, Robinson ML, Ernst M, Cadet JL, Pickworth WB, Heishman SJ, Schroeder JR. 2005. Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction. Pediatrics 115, 407-414. Netemeyer RG, Andrews JC, Burton S. 2005. Effects of antismoking advertising—based beliefs on adult smokers’ consideration of quitting. American Journal of Public Health 95 (6), 1062-1066. Niaura R, Abrams DB. 2002. Smoking cessation: Progress, priorities, and prospectus. Journal of Consulting and Clinical Psychology 70(3), 494-509 Niaura R, Abrams DB. 2003. Assessment of smokers. The Tobacco Dependence Treatment Handbook. New York: The Guilford Press. Niaura R, Jones C, Kirkpatrick P. 2006. Fresh from the pipeline: Varenicline. Nature Reviews Drug Discovery 5: 537-538. Ockene J, Kristeller J, Goldberg R, Amick TL, Pekow P, Hosmer D, Quirk M, Kalan K. 1991. Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial. Journal of General Internal Medicine 6, 1-8. Orleans CT, Alper J. 2003. Helping Addicted Smokers Quit. Issacs S, Knickman J (Eds). To Improve Health and Health Care Vol. VI. New Jersey: Robert Wood Johnson Foundation. Orleans CT, Slade JE. 1993. Nicotine Addiction: Principles and Management. New York: Oxford University Press. Ossip-Klein DJ, McIntosh S. 2003. Quitlines in North America: evidence base and applications. American Journal of Medical Science 326 (4), 201-205. Paretti-Watel P. 2003. I will quit tomorrow—Statistical Portrayals of “dissonant smokers.” Revue d'Épidémiologie et de Santé Publique 51 (2), 215-226. French. Park EW, Schultz JK, Tudiver F, Campbell T, Becker L. 2004. Enhancing partner support to improve smoking cessation.. Cochrane Collaboration. Cochrane Library, Issue 3. Oxford: Update Software. Patten CA, Martin JE, Myers MG, Calfas KJ, Williams CD. 1998. Effectiveness of cognitive-behavioral therapy for smokers with histories of alcohol dependence and depression. Journal of Studies of Alcohol 59 (3), 327-335. Perkins KA, Donny E, Caggiula AR. 1999. Sex differences in nicotine effects and self-administrations: review of human and animal evidence. Nicotine and Tobacco Research 1 (4), 301-315. Pierce JP, Gilpin EA. 2003. A minimum 6-month prolonged abstinence should be required for evaluating smoking cessation trials. Nicotine and Tobacco Research 5(2), 151-153. Piper M, McCarthy D, Baker T. 2006. Assessing tobacco dependence: a guide to measure evaluation and selection Nicotine and Tobacco Research 8 (3) 339-351. Porter Novelli, Communication Styles. 2002. Communications Data Base on Youth Behavior, Washington DC. Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. 1993. Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychology 12 (5):399-405. Prochaska JO, Velicer WF, Fava JL, Ruggiero L, Laforge RG, Rossi JS, Johnson SS, Lee PA. 2001. Counselor and stimulus control enhancements of a stage-matched expert system intervention for smokers in a managed care setting. Preventive Medicine 32 (1):23-32. Prochaska JO, Velicer WF. 2004. Integrating population smoking cessation policies and programs. Public Health Reports 119 (3), 244-252. Prochaska JJ, Rossi JS, Redding CA, Rosen AB, Tsoh JY, Humfleet GL, Eisendrath SJ, Meisner MR, Hall SM. 2004. Depressed smokers and stage of change: implications for treatment interventions. Drug and Alcohol Dependence 76 (2):143-151. Rabius V, McAlister AL, Geiger A, Huang P, Todd R. 2004. Telephone counseling increases cessation rates among young adult smokers. Health Psychology 23 (5), 539-541. Raw M, McNeill A, West R. 1998. Smoking cessation guidelines for health professionals: a guide to effective smoking cessation interventions for the health care system. Thorax 53 (Supple 5)1:S1-S19. Raw M, McNeill A, Coleman T. 2005. Lessons from the English smoking treatment services. Addiction 100 (Suppl. 2), 84–91. Rigotti NA, Lee JE, Wechsler H. 2000. U.S. College students’ use of tobacco products: results of a national survey. Journal of the American Medical Association 284 (6), 699-705. Schauffler HH, Barker DC, Orleans CT. 2001. Medicaid coverage for tobacco-dependence treatments. Health Affairs 20(1), 298-303. Shiffman S. 1989. Trans-situational consistency in smoking relapse. Health Psychology 8 (4), 471-481 Shiffman S, Paty JA, Rohay JM, DiMarino ME, Gitchell J. 2000. The efficacy of computer-tailored smoking cessation material as a supplement to nicotine polacrilex gum therapy. Archives of Internal Medicine 160, 1675-1681.
OCR for page 421
Ending the Tobacco Problem: A Blueprint for the Nation Shiffman SA, Paty JA, Rohay JM, DiMarino ME, Gitchell JG. 2001. The efficacy of computer-tailored smoking cessation material as a supplement to nicotine patch therapy. Drug and Alcohol Dependence 64:35-46 Shiffman S, Gitchell J, Pinney JM, Burton SL, Kemper KE, Lara EA. 1997. Public health benefit of over-the-counter nicotine medications. Tobacco Control 6 (4), 306-310. Shiffman S, Mason KM, Henningfield JE. 1998. Tobacco dependence treatments: review and prospectus. Annual Reviews of Public Health 19, 335-358. Shiffman S, Pillitteri JL, Burton SL, Rohay JM, Gitchell JG. 2001. Smokers’ beliefs about “Light” and “Ultra Light” cigarettes. Tobacco Control (Suppl. 1), i17-i23 Shiffman S, Pillitteri JL, Burton SL, Di Marino ME. 2004. Smoker and ex-smoker reactions to cigarettes claiming reduced risk. Tobacco Control 13 (1), 78-84. Shiffman S, Shumaker SA, Abrams DB, Cohen S, Garvey A, Grunberg NE, Swan GE. 1986. Models of smoking relapse. Health Psychology 5, 13-27. Siahpush M, Borland R, Scollo M. 2003. Factors associated with smoking cessation in a national sample of Australians. Nicotine and Tobacco Research 5(4), 597-602. Siegel M. 2002. The effectiveness of state-level tobacco control interventions: a review of program implementation and behavioral outcomes. Annual Review of Public Health 23:45-71. Silagay C, Lancaster T, Stead L, Mant D, Fowler G. 2002. Nicotine replacement therapy for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 2. Oxford: Update Software. Sinclair HK, Bond CM, Stead LF. 2004. Community pharmacy personnel interventions for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 1. Oxford: Update Software. Smith TA, House RFJ, Croghan IT, Gauvin TR, Colligan RC, Offord KP, Gomez-Dahl, LC, Hurt RD. 1996. Nicotine patch therapy in adolescent smokers. Pediatrics 984(4 (Pt 1)):659-667. Solomon LJ, Scharoun GM, Flynn BS, Secker-Walker RH, Sepinwall D. 2000. Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. Preventive Medicine 31(1), 68-74. Solomon LJ, Marcy TW, Howe KD, Skelly JM, Reinier K, Flynn B. 2005. Does extended proactive telephone support increase smoking cessation among low-income women using nicotine patches? Preventive Medicine 40(3), 306-313. Stead LF, Lancaster T, Perera R. 2003. Telephone counseling for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 1. Oxford: Update Software. Strecher VJ, Shiffman S, West R. 2005. Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapy. Addiction 100 (5), 682-688. Sussman S, Lichtman K, Ritt A, Pallonen U. 1999. Effects of thirty-four adolescent tobacco use and prevention trials on regular users of tobacco products. Substance Use and Misuse 34, 1469-1503. Sussman S. 2001. School-based Tobacco use prevention and cessation: where are we going? American Journal of Health Behavior 25 (3), 191-199. Sutherland G, Stapleton JA, Russell MA, Jarvis MJ, Hajek P, Belcher M, Feyerabend C. 1992. Randomized controlled trial of nasal nicotine spray in smoking cessation. Lancet 340 (8815), 324-329. Sutherland G. 1999. A placebo-controlled double-blind combination trial of nicotine patch and spray. Nicotine and Tobacco Research 1:186-187. Taylor CB, Curry SJ. 2004. Implementations of evidence-based tobacco use cessation guidelines in managed care organizations. Annals of Behavioral Medicine 27(1), 13-21. Thun M, Jemal A. 2006. How much of the decrease in cancer death rates in the United States is attributable to reductions in tobacco smoking? Tobacco Control 15:345-347. Tonneson P, Norregaard J, Mikkelson K, Jorgenson S, Nilsson F. 1993. A double-blind trial of a nicotine inhaler for smoking cessation. Journal of the American Medical Association 269(10), 1268-1271. Tonneson P, Norregaard J, Sawe U, Simonsen K. 1993. Recycling with nicotine patches in smoking cessation. Addiction 88, 533-539. Tonneson P, Mikkelson K, Norregaard J, Jorgenson S. 1996. Recycling hard core smokers with nicotine nasal spray. European Respiratory Journal 9, 1619-1623. Tonstad S, Tonnesen P, Hajek P, Williams KE, Billing CB, Reeves KR. 2006. Effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial. Journal of the American Medical Association 296 (1), 64-71. U.S. Preventive Services Task Force. 2006. Task Force on Community Preventive Services. Guide to Community Preventive Services:Tobacco. Atlanta, GA: CDC. Usher M. 2005. Exercise interventions for smoking cessation. Cochrane Collaboration. Cochrane Library, Issue 1. Oxford: Update Software.
OCR for page 422
Ending the Tobacco Problem: A Blueprint for the Nation Van der Meer RM, Wagena EJ, Ostelo RWJG, Jacobs JE, van Schayck CP. 2001. Smoking cessation for chronic obstructive pulmonary disease. Cochrane Collaboration. Cochrane Library, Issue 1. Oxford: Update Software. Velicer WF, DiClemente CC, Prochaska JO, Abrams DB, Emmons KM, Pierce JP. 1995. Distribution of smokers by stage in three representative samples. Preventive Medicine 24, 401-411. Wagner EH, Curry SJ, Grothaus L, Saunders KW, McBride CM. 1995. The impact of smoking and quitting on health care use. Archives of Internal Medicine 155, 1789-1795. Warner KE, Hodgson TA, Carroll CE. 1999. Medical Costs of smoking in the United States: estimates, their validity, and their implications. Tobacco Control 8 (3), 290-300. Warner KE, Slade J, Sweanor DT. 1997. The emerging market for long-term nicotine maintenance. Journal of the American Medical Association 278 (13), 1087-1092. Warner KE, Mendez D, Smith DG. 2004. The financial implications of coverage of smoking cessation treatment by managed care organizations. Inquiry 41 (1), 57-69. Wechsler H, Rigotti NA, Gledhill-Hoyt J, Lee H. 1998. Increased levels of cigarette use among college students. Journal of the American Medical Association 280 (19), 1673-1678. West R, McNeill A, Raw M. 2000. National smoking cessation guidelines for health professionals: an update. Thorax 55, 987–999. West R, DiMarino ME, Gitchell J, McNeill A. 2005. Impact of UK policy initiatives on use of medicines to aid smoking cessation. Tobacco Control 14 (3): 166-171. Wetter DW, Kenford SL, Smith SS, Fiore MC, Jorenby DE, Baker TB. 1999. Gender differences in smoking cessation. Journal of Consulting and Clinical Psychology 67 (4), 555-562. Wewers ME, Stillman FA, Hartman AM, Shopland, DR. 2003. Distribution of daily smokers by stage of change: current population survey results. Preventive Medicine 36 (6) 710-720. Yong HH, Borland R, Siahpush M. 2005. Quitting-related beliefs, intentions, and motivations of older smokers in four countries: finding from the International Tobacco Control Policy Evaluation Survey. Addictive Behaviors 30 (4), 777-788. Yudkin P, Hey K, Roberts S, Welch S, Murphy M, Walton R. 2003. Abstinence from smoking eight years after participation in randomised controlled trial of nicotine patch. British Medical Journal 327 (7405), 28-29 Zhu SH, Melcer T, Sun J, Rosbrook B, Pierce JP. 2000. Smoking cessation with and without assistance: a population-based analysis. American Journal of Preventive Medicine 18 (4), 305-311. Zhu SH, Anderson CM, Tadeschi GJ, Rosbrook B, Johnson CE, Byrd M, Gutierrez-Terrell E. 2002. Evidence of real-world effectiveness of a telephone quitline for smokers. New England Journal of Medicine 347 (14), 1087-1093.