Janine L. Pillitteri

Use of Smoking-Cessation Treatments in the United States

BACKGROUND Health promotion efforts encourage smokers to quit and to use effective cessation treatments. Randomized controlled trials demonstrate that medications and behavioral treatments improve cessation rates, but retrospective surveys have been inconsistent. This study assessed frequency of quit attempts, use of treatments for cessation, and abstinence rates among treatment users and non-users. METHODS Data were analyzed from the 2003 Tobacco Use Special Cessation Supplement to the Current Population Survey. Participants included 29,537 U.S. smokers aged > or =18 years who smoked daily 12 months before the survey. Outcome measures included past-year quit attempts; use of behavioral, pharmacologic, and alternative treatments; receipt of social support; and abstinence for > or =4 weeks at time of survey. RESULTS Approximately 43.5% of smokers reported a quit attempt in the preceding year: 64.2% of attempters used no cessation treatments; 8.8% used behavioral treatment; 32.2% used medication; and 14.1% used more than one treatment. Social support was reported to have been received by 24.1%. More nicotine-dependent smokers were more likely to use medications (OR=3.58; 95% CI=3.04-4.20). At the time of the survey, 19.3% of attempters were abstinent > or =4 weeks. Smokers who sought treatment were less likely to be abstinent (OR=0.75; 95% CI=0.67-0.84), and those who sought multiple treatments were even less likely to be abstinent. CONCLUSIONS Many U.S. smokers make quit attempts, but most do not use behavioral or pharmacologic treatments. More nicotine-dependent smokers were more likely to seek treatment. Smokers who sought treatment were less likely to report abstinence, probably due to biased self-selection and recall. Retrospective survey data are not well-suited to assess the effectiveness of treatment.

Use of dietary supplements for weight loss in the United States: results of a national survey.

We examined dietary supplement use for weight loss and perceptions about safety, efficacy, and regulatory oversight of these products. A random digit‐dialed telephone survey was conducted in 2005–2006, with a representative sample of 3,500 US adults. The survey assessed the beliefs and practices related to weight control. Outcome measures included the prevalence of dietary supplement use for weight reduction, demographic profile of supplement users, and knowledge about safety, efficacy, and regulation of dietary supplements. Of the adults who made a serious weight‐loss attempt (n = 1,444), 33.9% reported ever using a dietary supplement for weight loss. Supplement use was more common among women (44.9%) vs. men (19.8%); those aged 25–34; African Americans (48.7%) or Hispanics (41.6%) vs. whites (31.2%); less educated (38.4% high school degree or less vs. 31.1% some college or more); lower income households (41.8% made <

Smokers' beliefs about “Light” and “Ultra Light” cigarettes

40K vs. 30.3% made ≥

Persistent use of nicotine replacement therapy: an analysis of actual purchase patterns in a population based sample

40K); obese (40.7%) vs. overweight (29.1%); those who made more lifetime weight‐loss attempts (42.0% made ≥3 vs. 22.1% made <3); and those who used more weight‐loss methods (48.2% used ≥4 vs. 25.2% used <4). Many users and non‐users of dietary supplements had misperceptions about these products—many believed they are evaluated for safety and efficacy by the Food and Drug Administration (FDA) before marketing, and that dietary supplements are safer than over‐the‐counter (OTC) or prescription medications. Use of dietary supplements for weight loss is common. More information about dietary supplements is necessary to correct misperceptions and encourage the use of safe and effective weight‐loss methods.

Smoker and ex-smoker reactions to cigarettes claiming reduced risk.

OBJECTIVE To assess beliefs about the tar and nicotine delivery characteristics and health benefits of Light and Ultra Light cigarettes among cigarette smokers. DESIGN Random digit dialed telephone survey conducted in September 1999. SUBJECTS Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA. The sample was weighted to match the US smoker population on age, sex, and ethnicity. MAIN OUTCOME MEASURES Beliefs about Light and Ultra Light cigarettes were summarised on three dimensions: Safety (reduced health risk), Delivery (lowered tar and nicotine delivery), and Sensation (less harsh). RESULTS Most smokers believed Lights and Ultra Lights were less harsh and delivered less tar and nicotine. On average, smokers believed that Lights afforded a 25% reduction in risk, and Ultra Lights a 33% reduction in risk. Light and Ultra Light cigarette smokers evaluated the risks of their own cigarette types more favourably. Light smokers had greater interest in quitting than Ultra Light smokers. Quitting intention was modestly related to beliefs about these cigarettes. Believing that Lights and Ultra Lights delivered less tar and nicotine and that they were less harsh each independently contributed to the belief that these cigarettes were safer. CONCLUSIONS Many Light and Ultra Light smokers believe that smoking these cigarettes impart a substantial health benefit, due in part to their experience that these cigarettes are less harsh and the belief that these cigarettes deliver less tar.

Smokers' Interest in Using Nicotine Replacement to Aid Smoking Reduction

Background: In 1996, the US Food and Drug Administration (FDA) approved switching nicotine gum and patch from prescription to over-the-counter (OTC) status. Some expressed concerns that broader availability and lack of physician control might increase persistent use of nicotine replacement therapy (NRT)—that is, use beyond the period specified by the FDA approved label. Objective: To estimate the incidence of persistent use of OTC nicotine gum and patch for periods of > 3 months, ⩾ 6 months, ⩾ 12 months, and ⩾ 24 months. Design: Analysis of NRT purchase patterns in data from a population based panel of US households that electronically scanned all household purchases between January 1997 and March 2000. Subjects: In a national panel of 40 000 US households, 2690 recorded NRT purchases. Results: Among 805 households that purchased nicotine gum, 2.3% of new purchase incidents led to continuous monthly purchase of gum for ⩾ 6 months. For nicotine patches (2050 households) the percentage was 0.9%. For both gum and patch, the incidence of persistent purchase dropped below 0.4% by 24 months. Allowing one month gaps within a “continuous” purchase run resulted in increased estimates (for gum: 6.7% for ⩾ 6 months and 1.0% for ⩾ 24 months; for patch: 1.7% for ⩾ 6 months and 0.05% for ⩾ 24 months). Conclusion: Persistent use of nicotine gum and patch is very rare and has not increased with the transition to OTC use, despite removal of physician oversight.

Misuse of and dependence on over-the-counter nicotine gum in a volunteer sample

Context: The tobacco industry is introducing modified tobacco products claiming to reduce the risk of smoking (potential reduced exposure products, PREPs). If PREPs are perceived as safe, they may deter smokers from quitting and encourage re-initiation by smokers who have quit. Objective: To assess smokers’ and ex-smokers’ perceptions of PREPs and the impact of PREP claims on interest in quitting (among smokers) or in resuming smoking (ex-smokers). Design: A random-digit-dialled survey of US smokers and ex-smokers. We used Eclipse, a modified PREP cigarette, as an exemplar PREP. During the survey, the interviewer read risk reduction claims made for Eclipse by its manufacturer, assessing smokers’ interest in quitting before and after the exposure. Participants: 1000 current cigarette smokers and 499 ex-smokers (300 quit within the last two years), over 18 years old. Main outcome measures: Perception of risk reduction from Eclipse; interest in using Eclipse; smokers’ interest in quitting was assessed using a stage of change approach (pre- and post-exposure to claims). Results: 91% of smokers thought Eclipse was safer than regular cigarettes. 24% believed Eclipse was completely safe. 57.4% of smokers were interested in using Eclipse; interest was greatest among smokers who were contemplating quitting. Exposure to Eclipse’s claims was followed by reduced interest in quitting. Among all ex-smokers, interest in Eclipse was 6.2%, but interest was 15.2% among young adults (18–25 years) who had stopped smoking within two years. Conclusions: There is substantial risk that smokers will overinterpret reduced risk claims made for modified tobacco products. PREPs appeal to smokers who are contemplating quitting and exposure to reduced risk product claims appears to reduce smokers’ readiness to quit. PREPs also appealed to young adults who had recently stopped smoking. Thus, reduced risk tobacco product claims can undermine adult cessation and youth prevention, possibly resulting in increased harm even if the products are less toxic.

Smoker reactions to a “radio message” that Light cigarettes are as dangerous as Regular cigarettes

In recent years the public health community has considered the risks and benefits of encouraging smokers to reduce their smoking, perhaps with the aid of nicotine replacement therapy (NRT). Little is known, however, about whether smokers themselves are interested in smoking reduction; whether they see reduction as an endpoint, or primarily as a route to cessation; or whether they are receptive to the notion of using NRT to achieve reduction. We conducted a population-based national telephone survey of 1,000 current daily cigarette smokers (499 male, 501 female). Most smokers (57%) reported previously trying to reduce their smoking, and many (26%) said that they plan to reduce within the next year. Almost half of those planning to quit in the next 12 months (44%) preferred to quit via gradual cessation and most (68%) indicated that they would consider using a reduction product or medication. Respondents reported that they would prefer a product with a cessation endpoint rather than a reduction endpoint (63% vs. 21%). Interest in reduction was highest among smokers who were less interested in quitting and among heavier smokers. We conclude that many smokers are interested in gradually reducing prior to quitting and that promoting reduction is unlikely to undermine motivation to quit smoking.

Two behavioral treatments for smoking reduction: a pilot study.

To estimate the amount of misuse of and dependence on nicotine gum in an over-the-counter (OTC) setting, we conducted two telephone surveys of smokers recruited by newspaper ads. Study 1 surveyed 266 U.S. ever-smokers using OTC gum to determine the percentage who used the gum for noncessation reasons or used gum and cigarettes concurrently. In Study 1, 6% initially purchased nicotine gum to reduce smoking and 1% to avoid smoking restrictions. At the time of interview, 35% chewed gum and smoked cigarettes concurrently with a mean of six cigarettes per day and 15 mg/day of nicotine from gum. Among long-term users (>/=90 days), 20% attributed their use to addiction. To determine what proportion of those reporting addiction would meet DSM-IV or ICD-10 criteria for dependence, Study 2 surveyed 100 current and ex-smokers who reported addiction to OTC nicotine gum. In these gum users, 66% met DSM-IV and 74% met ICD-10 criteria for dependence. Combining the results of Studies 1 and 2 with other data suggests very few gum users develop dependence on the gum. We conclude (a) very few people use nicotine gum for noncessation reasons, (b) concurrent use of gum and cigarettes is common but involves a small number of cigarettes and pieces of gum per day, and (c) the incidence of dependence on OTC nicotine gum is very small.

Weight management advice: what do doctors recommend to their patients?

The purpose of this study was to examine in a systematic, controlled fashion the reactions of smokers to scientifically correct information about the risks of smoking Light cigarettes (about 6-15 mg tar by the FTC method). Random-digit dialing, computer-assisted telephone interviews were used to locate daily smokers of Light cigarettes. In an experimental design, smokers were randomly assigned to listen (n = 293) or not (n = 275) to a persuasive simulated radio message on the risks of Light cigarettes; 108 of those who did not listen to the message in the first part of the interview were played the message in the second part, to evaluate some repeated-measures effects. Those who heard the message were more likely to report that one Light cigarette could give a smoker the same amount of tar as one Regular cigarette and that Light cigarettes were more dangerous: 55% said the message made them think more about quitting and 46% said the message increased the amount they wanted to quit; 42% said that after hearing the message they thought Light cigarettes were more dangerous. Using the Theory of Planned Behavior, structural equation modeling analysis indicated that the message acted to increase intention to quit smoking by increasing the desire to quit smoking. Seventy-three per cent of the smokers agreed that it was important to play such messages widely on the radio; 77% agreed that there should be a warning on packs that vent blocking increases tar; 61% agreed that the location of filter vents should be marked. The majority of smokers of Light cigarettes seem to value being informed that Light cigarettes are as dangerous for them as Regular cigarettes, and this information increases their intentions to quit smoking.