Olfactory and gustatory sensory changes to tobacco smoke in pregnant smokers

Models of smoking behavior change include addiction, social, and behavioral concepts. The purpose of this study was to explore the prevalence of two biologic factors, olfactory and gustatory responses to tobacco smoke, as potentially powerful contributors to smoking behavior change among pregnant women. Data were obtained from 209 pregnant smokers. The majority of women reported olfactory (62%) and gustatory (53%) aversions to tobacco. Aversions first appeared during the first trimester of pregnancy. Women who experienced olfactory aversions were more likely also to experience gustatory aversions. Olfactory aversions were associated with women smoking less. Aversions to tobacco smoke are common among pregnant smokers, are associated with women smoking less, and could help explain pregnant women’s smoking patterns

Nicotine Replacement and Behavioral Therapy for Smoking Cessation in Pregnancy

This study examines whether adding nicotine replacement therapy (NRT) to cognitive behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation

Nicotine Replacement and Behavioral Therapy for Smoking Cessation in Pregnancy

Abstract Background This study examines whether adding nicotine replacement therapy (NRT) to cognitive behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation. Methods An open-label randomized trial (Baby Steps, n = 181) of CBT-only versus CBT+NRT (choice of patch, gum, or lozenge; 1:2 randomization) was used. Data were collected from 2003 through 2005; analyses were conducted in 2006 and 2007. Outcomes were biochemically validated self-reported smoking status at 7-weeks post-randomization, 38-weeks gestation, and 3-months postpartum. Results Women in the CBT+NRT arm were almost three times more likely than women in the CBT-only arm to have biochemically validated cessation at both pregnancy timepoints (after 7 weeks: 24% vs 8%, p = 0.02; at 38-weeks gestation: 18% vs 7%, p =0.04), but not at 3-months postpartum (20% vs 14%, p=0.55). Recruitment was suspended early by an independent Data and Safety Monitoring Board when an interim analysis found a greater rate of negative birth outcomes in the CBT+NRT arm than in the CBT arm. At the final analysis the difference between the arms in rate of negative birth outcomes was 0.09 (p=0.26), adjusted for prior history of preterm birth. Conclusions The addition of NRT to CBT promoted smoking cessation in pregnant women. This effect did not persist postpartum. More data are needed to determine the safety and to confirm the efficacy of NRT use during pregnancy

Immunogenicity and Smoking Cessation Outcomes for a Novel Nicotine Immunotherapeutic

NicVAX®, a nicotine vaccine (3’AmNic-rEPA), has been clinically evaluated to determine if higher antibody concentrations are associated with higher smoking abstinence rates and if doses and frequency of administration are associated with increased antibody response. This randomized, double-blinded, placebo-controlled multicenter clinical trial (N=301 smokers) tested 200 and 400 µg doses administered 4 or 5 times over 6 months compared to placebo. 3’AmNic-rEPA recipients with the highest serum anti-nicotine antibody response (top 30% by AUC) were significantly more likely to attain 8 weeks continuous abstinence from weeks 19 through 26 than the placebo recipients (24.6% vs. 12.0%, p=0.024, OR=2.69, 95% CI, 1.14–6.37). The 5 injection 400 µg dose regimen had the greatest antibody response and had significantly higher abstinence rates than placebo. This study demonstrates proof-of-concept that 3’AmNic-rEPA elicits antibodies to nicotine and is associated with higher continuous abstinence rates, justifying its further development as a treatment for nicotine dependence

Concurrent Brief versus Intensive Smoking Intervention during Alcohol Dependence Treatment

Alcohol dependent smokers (N = 118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-minute counseling session with 5 min follow-up. Intensive intervention consisted of three one-hour counseling sessions plus eight weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath CO, was significantly higher for intensive (27.5%) versus brief (6.6%) treatment at one month post quit date but not at six months when abstinence rates fell to 9.1% and 2.1%. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short term tobacco abstinence, other, perhaps more intensive smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers

Nicotine replacement prescription practices of obstetric and pediatric clinicians

OBJECTIVE: To assess smoking cessation counseling and nicotine replacement therapy prescription and recommendation practices among obstetric and pediatric providers. METHODS: We sent out a self-administered survey to 61 obstetric and pediatric nurse practitioners and physicians at six community health centers in the Boston area. RESULTS: Obstetric providers were more likely to view smoking cessation counseling as their responsibility in treating pregnant women than pediatric providers did in treating infants with mothers who smoked (mean +/- standard deviation [95% confidence interval] 4.5 +/- 0.76 [4.2, 4.8] versus 4.0 +/- 0.8 [3.7, 4.3] on a five-point scale; P CONCLUSION: We found that nicotine replacement therapies are commonly prescribed or recommended to pregnant smokers by obstetric providers, but less commonly to lactating women by pediatric providers