Smoking Cessation Aids

As any listener to PodMed knows, I am a rabid antismoking advocate and given the chance to implement only one public health mandate, would instantly abolish tobacco products of all types.  I firmly believe that subsequent generations will reflect upon ours with astonishment that something as wholly detrimental as cigarettes are actually sold and used legally. Since revoking legality is unlikely, now come two studies in the Lancet, one describing the role of e-cigarettes in comparison to other methods for smoking cessation, and the other a hard-hitting advertisement campaign undertaken by the US government for the same purpose.  After reflecting on the fact that if smoking was simply made illegal this problem would not exist, Rick and I applaud these efforts to help people make the choice to forgo smoking. Let's look at the ad campaign first.

The 'Tips" campaign was developed by the federal Centers for Disease Control and Prevention to deliver messages from former smokers that graphically depict suffering caused by smoking in real people.  Having seen a couple of the spots myself, I can attest that they most definitely underscored very deleterious consequences of smoking, including amputation and loss of the ability to speak normally. The spots were broadcast for three months beginning in March 2012 on television.  After that period, data from smokers and nonsmokers and estimated population data indicated that significantly more smokers attempted to quit after having seen the ads, and more remained nonsmokers after ceasing smoking.   The campaign was also effective in getting nonsmokers talking about the issue and recommending to smokers that they should attempt cessation.

While this appears to be a step in the right direction, the study reveals that the CDC spent $54 million on the campaign, compared to $8 billion the tobacco industry spends annually.  Talk about David and Goliath! One strategy Rick and I recommend is employing the constellation of graphic ads, including those on cigarette packaging as seen in other countries, to inform people of the dire consequences of smoking.  Now what about the other study?

Three groups of smokers who desired to quit were randomized to three groups:  one group got 16mg nicotine e-cigarettes, one group got 20mg nicotine patches, and the third e-cigarettes with placebo.  7.3% of those who used the e-cigarettes, 5.8% of those who used the patches, and 4.1% of those who received the placebo e-cigarettes were verified abstinent at six months.  Again, very interesting and thought-provoking.  Of course the rate of cessation is unacceptably low and better methods, perhaps multifactorial, must be devised.  But also fascinating that a decent percentage of those who received the placebo cigarette achieved cessation, underscoring the behavioral aspect of smoking that clearly motivates many.  Finally, Rick points out in the podcast, e-cigarettes are available OTC, as patches are not, so they may help more people to quit while keeping the rest of us free from noxious and toxic exposures due to others smoking.  Rick and I would love to hear thoughts from readers/listeners on e-cigarettes since they are garnering their share of controversy.

Other topics this week include pertussis vaccination among the very young in JAMA Pediatrics, and screening for mild cognitive impairment in the BMJ.  Until next week, y'all live well.

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