Babalola Faseru

CYP2B6 and Bupropion's Smoking‐Cessation Pharmacology: The Role of Hydroxybupropion

Bupropion is indicated to promote smoking cessation. Animal studies suggest that the pharmacologic activity of bupropion can be mediated by its major metabolite, hydroxybupropion. We measured plasma bupropion and its metabolite levels in a double‐blind, placebo controlled, randomized smoking‐cessation trial. Among the treatment‐adherent individuals, higher hydroxybupropion concentrations (per μg/ml) resulted in better smoking‐cessation outcomes (week 3, 7, and 26 odds ratio (OR) = 2.82, 2.96, and 2.37, respectively, P = 0.005–0.040); this was not observed with bupropion levels (OR = 1.00–1.03, P = 0.59–0.90). Genetic variation in CYP2B6, the enzyme that metabolizes bupropion to hydroxybupropion, was identified as a significant source of variability in hydroxybupropion formation. Our data indicate that hydroxybupropion contributes to the pharmacologic effects of bupropion for smoking cessation, and that variability in response to bupropion treatment is related to variability in CYP2B6‐mediated hydroxybupropion formation. These findings suggest that dosing of bupropion to achieve a hydroxybupropion level of 0.7 μg/ml or increasing bupropion dose for CYP2B6 slow metabolizers could improve bupropions cessation outcomes.

Bupropion for Smoking Cessation in African American Light Smokers: A Randomized Controlled Trial

BACKGROUND Previous research demonstrated the efficacy of sustained release bupropion (bupropion SR) for smoking cessation in whites as well as moderate to heavy (≥10 cigarettes per day [CPD]) African American smokers. We evaluated whether bupropion SR was effective for smoking cessation among African American light smokers (≤10 CPD). METHODS A randomized, double-blind placebo-controlled trial was conducted from December 27, 2007, to May 13, 2010. All participants were African American light smokers (≤10 CPD), aged 18 years or older. Participants were randomly assigned to receive 300 mg bupropion SR (150 mg once daily for 3 days and then 150 mg twice daily) (n = 270 participants) or placebo (n = 270 participants) for 7 weeks, and up to six sessions of health education counseling. Serum cotinine was measured at baseline (week 0). The primary outcome was salivary cotinine-verified 7-day point prevalence smoking abstinence at week 26; a cut point of 15 ng/mL differentiated smokers from nonsmokers. Salivary cotinine-verified smoking abstinence at end of medication treatment at week 7 was also examined. Odds ratios (OR) for smoking abstinence and 95% confidence intervals (CIs) were calculated using logistic regression models. All statistical tests were two-sided. RESULTS Participants at baseline visit (week 0) smoked an average of 8.0 CPD and had a mean serum cotinine level of 275.8 ng/mL (SD = 155.8 ng/mL); most used menthol cigarettes (83.7%) and smoked within 30 minutes of waking (72.2%). After imputing those lost to follow-up as smokers, no statistically significant difference in long-term smoking abstinence rates at week 26 was observed between bupropion SR and placebo groups (13.3% vs 10.0%, OR = 1.39, 95% CI = 0.82 to 2.35, P = .23). Cotinine-verified smoking abstinence rate at end of medication week 7 was higher in the bupropion SR vs placebo group (23.7% vs 9.6%, OR = 2.92, 95% CI = 1.78 to 4.77, P < .001). CONCLUSIONS Bupropion SR was effective in promoting smoking cessation during the medication phase of treatment but showed no effect on long-term smoking cessation among African American light smokers. More research is needed to identify strategies for sustaining abstinence among African American light smokers.

Profile of e-cigarette use and its relationship with cigarette quit attempts and abstinence in Kansas adults.

OBJECTIVE The aim of this study is to describe electronic cigarette use in Kansas adults and its relationship with cigarette cessation. METHODS The Kansas Adult Tobacco Survey (ATS) is a 2012-2013 phone survey of non-institutionalized Kansas adults (N=9656). The ATS was analyzed to create a profile of cigarette and e-cigarette users, and demonstrate associations between e-cigarette use and cigarette cessation attempts and cigarette abstinence. RESULTS In 2013, 45% of adult cigarette smokers had tried e-cigarettes and 14% had used e-cigarettes in the past month. The prevalence of current cigarette smoking was 76.5% among past-month e-cigarette users. Adults who only use e-cigarettes are younger and more affluent than adults who only smoke cigarettes. The prevalence of past-month e-cigarette use among smokers who made a quit attempt in the past year is more than double that of smokers who did not. E-cigarette use was negatively associated with past-month (aPOR=0.21, 95% CI: 0.11-0.38) and past-year cigarette abstinence (aPOR=0.14, 95% CI: 0.10-0.22). CONCLUSIONS E-cigarette use is common among cigarette smokers. E-cigarette use is more common among smokers who made a recent quit attempt and many smokers report using smokeless tobacco or e-cigarettes to help quit. Recent cigarette abstinence, however, is negatively associated with e-cigarette use.

Utility and relationships of biomarkers of smoking in African-American light smokers

Although expired carbon monoxide (CO) and plasma cotinine (COT) have been validated as biomarkers of self-reported cigarettes per day (CPD) in heavy smoking Caucasians, their utility in light smokers is unknown. Further, variability in CYP2A6, the enzyme that mediates formation of COT from nicotine and its metabolism to trans-3′-hydroxycotinine (3HC), may limit the usefulness of COT. We assessed whether CO and COT are correlated with CPD in African-American light smokers (≤10 CPD, n = 700), a population with known reduced CYP2A6 activity and slow COT metabolism. We also examined whether gender, age, body mass index, smoking mentholated cigarettes, or rate of CYP2A6 activity, by genotype and phenotype measures (3HC/COT), influence these relationships. At baseline, many participants (42%) exhaled CO of ≤10 ppm, the traditional cutoff for smoking, whereas few (3.1%) had COT below the cutoff of ≤14 ng/mL; thus, COT seems to be a better biomarker of smoking status in this population. CPD was weakly correlated with CO and COT (r = 0.32-0.39, P < 0.001), and those reporting fewer CPD had higher CO/cigarette and COT/cigarette, although the correlations coefficients between these variables were also weak (r = −0.33 and −0.08, P < 0.05). The correlation between CPD and CO was not greatly increased when analyzed by CYP2A6 activity, smoking mentholated cigarettes, or age, although it appeared stronger in females (r = 0.38 versus 0.21, P < 0.05) and obese individuals (r = 0.38 versus 0.24, P < 0.05). Together, these results suggest that CO and COT are weakly associated with self-reported cigarette consumption in African-American light smokers, and that these relationships are not substantially improved when variables previously reported to influence these biomarkers are considered. (Cancer Epidemiol Biomarkers Prev 2009;18(12):3426–34)

An observational study of seatbelt use among vehicle occupants in Nigeria

Objective The use of seatbelts reduces the likelihood of death and severe injuries to crash-involved vehicle occupants by 45–60%. Several countries, including Nigeria, have laws mandating the use of seatbelts but compliance is not universal. This study was conducted to determine rates of use of seatbelts among vehicle occupants in Ibadan municipality. Design An observational study was conducted. A selected petrol station in each of the five local government areas in Ibadan municipality was used as an observation site. Observations were documented by trained research staff between 08:30 and 18:00 hours over a 6-day period. Results 5757 occupants in 2870 vehicles were observed. Approximately 90% of drivers were men. Driver seatbelts were installed in approximately 90% of vehicles. Overall seatbelt use was 18.7; 31.7% among drivers and 10.3% and 0.4% among front and rear-seated adults, respectively. Only one child (0.7%) was restrained. Significantly more female drivers 47.3% used their seatbelts compared with men, 30.3% (p<0.001). An adult passenger was more likely to be restrained when riding with a female driver (p=0.007) and when the driver was restrained (p=0.000). Conclusions The study showed that seatbelt use among vehicle occupants was low. Further research into reasons for the non-use of restraints needs to be conducted so that these can be incorporated into programmes aimed at improving seatbelt use.

Evaluation of a hospital-based tobacco treatment service: outcomes and lessons learned.

BACKGROUND The efficacy of smoking cessation interventions for hospital patients has been well described, but we know little regarding implementation and outcomes of real-world programs. OBJECTIVE To describe the services provided and outcomes of an academic medical center-based tobacco treatment service (UKanQuit) located in the Midwestern United States. METHOD This is a descriptive observational study. Both quantitative and qualitative data of all patients treated by UKanQuit over a 1-year period were analyzed. RESULTS Among 513 patients served, average interest in quitting was 7.9, standard deviation (SD) 2.9 on a scale of 0 to 10. More than 1 in 4 had been given an in-hospital medication to ameliorate withdrawal prior to seeing a counselor. Counselors recommended medication changes for 1 in 3 patients, helped 73% set a goal for quitting or reducing tobacco use, and fax referred 56% to quitlines. Six-month follow-up (response rate, 46%) found a 7-day abstinence rate of 32% among respondents for an intent-to-treat abstinence rate of 15%. Post-discharge, 74% made at least one serious quit attempt, 34% had used a quit smoking medication, but only 5% of those referred to the quitline reported using it. CONCLUSIONS In a hospital setting, interest in quitting is high among smokers who requested to see a tobacco counselor but administration of inpatient medications remains low. Many smokers are making unassisted quit attempts post-discharge because utilization of cessation medications and quitline counseling were low. Fax-referral to quitline may not, on its own, fulfill guideline recommendations for post-discharge follow-up.

Tobacco use amongst out of school adolescents in a Local Government Area in Nigeria.

IntroductionOut-of-school adolescents are often neglected when planning for tobacco prevention programmes whereas they are more vulnerable. Few studies exist in Nigeria about their pattern of tobacco use to serve as the basis for effective policy formulation.MethodA sub sample of 215 out of school adolescents was analyzed from a descriptive cross sectional study on psychoactive substance use amongst youths in two communities in a Local Government Area in Nigeria which used a multi-stage sampling technique.ResultsMales were 53% and females 47%. Only 20.5% had ever used tobacco while 11.6% were current users. Males accounted for 60% of current users compared to 40% amongst females. Of current users, 84% believed that tobacco is not harmful to health. In addition, the two important sources of introduction to tobacco use were friends 72% and relatives 20%. Use of tobacco amongst significant others were: friends 27%, fathers 8.0%, relatives 4.2% and mothers 0.5%. The most common sources of supply were motor parks 52% and friends 16%.ConclusionThe study showed that peer influence is an important source of introduction to tobacco use while selling of tobacco to adolescents in youth aggregation areas is common. We advocate for a theory based approach to designing an appropriate health education intervention targeted at assisting adolescents in appreciating the harmful nature of tobacco use in this locality. A point-of-sale restriction to prevent adolescent access to tobacco in youth aggregation areas within the context of a comprehensive tobacco control policy is also suggested. However, more research would be needed for an in-depth understanding of the tobacco use vulnerability of this group of adolescents.

Predictors of cessation in African American light smokers enrolled in a bupropion clinical trial

BACKGROUND This is the first study to examine predictors of successful cessation in African American (AA) light smokers treated within a placebo-controlled trial of bupropion. METHODS We analyzed data from a randomized, double-blind, placebo-controlled trial of bupropion and health education for 540 African American light smokers. African American light smokers (≤10 cigarettes per day, cpd) were randomly assigned to receive 150mg bid bupropion SR (n=270) or placebo (n=270) for 7weeks. All participants received health education counseling at weeks 0, 1, 3, 5 and 7. Using chi-square tests, two sample t-tests, and multiple logistic regression analyses, we examined baseline psychosocial and smoking characteristics as predictors of cotinine-verified 7-day point prevalence smoking abstinence among study participants at the end treatment (Week 7) and at the end of follow-up (Week 26). RESULTS Participants who received bupropion were significantly more likely to quit smoking compared to those who received placebo (OR=2.72, 95% CI=1.60-4.62, P=0.0002). Greater study session attendance (OR=2.47, 95% CI=1.76-3.46, P=0.0001), and smoking non-menthol cigarettes increased the likelihood of quitting (OR=1.84, 95% CI=1.01-3.36, P=0.05); while longer years of smoking (OR=0.98, 95% CI=0.96-1.00, P=0.05) and higher baseline cotinine (OR=0.97, 95% CI=0.95-0.99, P=0.002) significantly reduced the odds of quitting at Week 7. Conversely, at the end of follow-up (Week 26), treatment with bupropion vs. placebo (OR=1.14, 95% CI=0.65-2.02, P=0.64) was not significantly associated with quitting and type of cigarette smoked (menthol vs. non-menthol) did not appear in the final logistic regression model. Greater study session attendance (OR=1.96, 95% CI=1.44-2.66, P=0.0001); BMI (OR=1.03, 95% CI=1.00-1.07, P=0.04); and weight efficacy (OR=1.03, 95% CI=1.01-1.05, P=0.01) increased the likelihood of quitting at Week 26. Similar to our findings at Week 7, longer years of smoking (OR=0.96, 95% CI=0.94-0.99, P=0.01) and higher baseline cotinine (OR=0.97, 95% CI=0.95-0.99, P=0.02) significantly reduced the odds of quitting at Week 26. CONCLUSIONS Baseline cotinine levels, number of years smoked and study session attendance are associated with both short- and long-term smoking cessation, while bupropion and the type of cigarette smoked were associated with quitting on short term only.

Using “warm handoffs” to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial

BackgroundPost-discharge support is a key component of effective treatment for hospitalized smokers, but few hospitals provide it. Many hospitals and care settings fax-refer smokers to quitlines for follow-up; however, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. “Warm handoff” is a novel approach to care transitions in which health care providers directly link patients with substance abuse problems with specialists, using face-to-face or phone transfer. Warm handoff achieves very high rates of treatment enrollment for these vulnerable groups.MethodsThe aim of this study—“EQUIP” (Enhancing Quitline Utilization among In-Patients)—is to determine the effectiveness, and cost-effectiveness, of warm handoff versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff. At each site, smokers who wish to remain abstinent after discharge will be randomly assigned to groups. For patients in the fax group, staff will provide standard in-hospital intervention and will fax-refer patients to the state tobacco quitline for counseling post-discharge. For patients in the warm handoff group, staff will provide brief in-hospital intervention and immediate warm handoff: staff will call the state quitline, notify them that a warm handoff inpatient from Kansas is on the line, then transfer the call to the patients’ mobile or bedside hospital phone for quitline enrollment and an initial counseling session. Following the quitline session, hospital staff provides a brief check-back visit. Outcome measures will be assessed at 1, 6, and 12 months post enrollment. Costs are measured to support cost-effectiveness analyses. We hypothesize that warm handoff, compared to fax referral, will improve care transitions for tobacco treatment, enroll more participants in quitline services, and lead to higher quit rates. We also hypothesize that warm handoff will be more cost-effective from a societal perspective.DiscussionIf successful, this project offers a low-cost solution for more efficiently linking millions of hospitalized smokers with effective outpatient treatment—smokers that might otherwise be lost in the transition to outpatient care.Trial registrationClinical Trials Registration NCT01305928

Relationships between sexual violence and chronic disease: a cross-sectional study

BackgroundSexual assault is a traumatic event with potentially devastating lifelong effects on physical and mental health. Research has demonstrated that individuals who experience sexual assault during childhood are more likely to engage in risky behaviors later in life, such as smoking, alcohol and drug use, and disordered eating habits, which may increase the risk of developing a chronic disease. Despite the high prevalence and economic burden of sexual assault, few studies have investigated the associations between sexual violence and chronic health conditions in the US. The purpose of this study is to identify associations between sexual violence and health risk behaviors, chronic health conditions and mental health conditions utilizing population based data in Kansas.MethodsSecondary analysis was done using data from the 2011 Kansas Behavioral Risk Factor Surveillance System sexual violence module (N = 4,886). Crude and adjusted prevalence rate ratios were computed to examine associations between sexual assault and health risk behaviors, chronic health conditions and mental health conditions, overall and after adjusting for social demographic characteristics. Additional logistic regression models were implemented to examine the association between sexual assault and health risk behaviors with further adjustment for history of anxiety or depression.ResultsThere was a significantly higher prevalence of health risk behaviors (heavy drinking, binge drinking and current smoking), chronic health conditions (disability, and current asthma) and mental health conditions (depression, anxiety, and suicidal ideation) among women who ever experienced sexual assault compared to women who did not, even after adjustment for potential confounders.ConclusionsStudy findings highlight the need for chronic disease prevention services for victims of sexual violence. There are important implications for policies and practices related to primary, secondary, and tertiary prevention, as well as collaborations between sexual violence, chronic disease, and health risk behavior programs.