More reports of relapse curves of self-quitters are needed. Smoking cessation interventions should focus on the first week of abstinence. Interventions that produce abstinence rates of 5-10% may be effective. Cessation studies should report relapse curves.

No abstract

A workgroup formed by the Society for Research on Nicotine and Tobacco reviewed the literature on abstinence measures used in trials of smoking cessation interventions. We recommend that trials report multiple measures of abstinence. However, at a minimum we recommend that trial: (a) report prolonged abstinence (i.e., sustained abstinence after an initial period in which smoking is not counted as a failure) as the preferred measure, plus point prevalence as a secondary measure; (b) use 7 consecutive days of smoking or smoking on > or = 1 day of 2 consecutive weeks to define treatment failure; (c) include non-cigarette tobacco use, but not nicotine medications in definitions of failure; and (d) report results from survival analysis to describe outcomes more fully. Trials of smokers willing to set a quit date should tie all follow-ups to the quit date and report 6- and/or 12-month abstinence rates. For these trials, we recommend an initial 2-week grace period for prolonged abstinence definitions; however, the period may vary, depending on the presumed mechanism of the treatment. Trials of smokers who may not be currently trying to quit should tie follow-up to the initiation of the intervention and should report a prolonged abstinence measure of > or = 6-month duration and point prevalence rates at 6- and 12-month follow-ups. The grace period for these trials will depend on the time necessary for treatment dissemination, which will vary depending on the treatment, setting, and population. Trials that use short-term follow-ups (< or = 3 months) to demonstrate possible efficacy should report a prolonged abstinence measure of > or = 4 weeks. We again recommend a 2-week grace period; however, that period can vary.

No abstract

Multiple potentially reduced exposure products (PREPs) are being introduced to the market, yet little is known about how they will be used and what their public health impact might be. To determine the impact of one such PREP--Accord--on ongoing smoking and toxin exposure, 11 smokers of light cigarettes were required to use increasing amounts of Accord (5, 10, and 15 per day) with the option of using their traditional cigarettes. Accord suppressed ongoing cigarettes per day and carbon monoxide (CO), but not cotinine, in a dose-dependent manner. Smoking 15 Accord per day decreased the number of traditional cigarettes smoked by 32% (-8.6 cigarettes per day) and CO levels by 27% (-5.9 ppm). However, Accord did not function as a perfect (i.e., one to one) substitute for cigarettes because the total number of nicotine products (Accord plus usual brand) per day increased by 24%. Participants believed that Accord was safer than traditional cigarettes but rated Accord as ineffective at suppressing cravings for cigarettes. These findings suggest that use of Accord results in significant decreases in cigarettes smoked and CO exposure. Whether these reductions will translate into health benefits or endure beyond 2 weeks is unknown. Because most PREPs will probably be used along with traditional cigarettes, their net health impact is a function of not only their toxicological profile but also their effect on ongoing smoking.