Transdermal nicotine does not cause a significant increase in cardiovascular events in high-risk outpatients with cardiac disease. However, the efficacy of transdermal nicotine as an aid to smoking cessation in such patients is limited and may not be sustained over time.

No abstract

Abnormalities in the dopaminergic reward pathways have frequently been implicated in substance abuse and addictive behaviors. Recent studies by Self and coworkers have suggested an important interaction between the dopamine D 1 and D 2 receptors in cocaine abuse. To test the hypothesis that the DRD1 gene might play a role in addictive behaviors we examined the alleles of the Dde I polymorphism in three independent groups of subjects with varying types of compulsive, addictive behaviors -Tourette syndrome probands, smokers and pathological gamblers. In all three groups there was a significant increase in the frequency of homozygosity for the DRD1 Dde I 1 or 2 alleles in subjects with addictive behaviors. The DRD1 11 or 22 genotype was present in 41.3% of 63 controls and 57.3% of 227 TS probands (P = 0.024). When 23 quantitative traits were examined by ANOVA those carrying the 11 genotype consistently had the highest scores. Based on these results, we examined the prevalence of the 11 genotype in controls, TS probands without a specific behavior, and TS probands with a specific behavior. There was a progressive, linear increase, significant at ␣ Յ 0.005 for scores for gambling, alcohol use and compulsive shopping. Problems with three additional behaviors, drug use, compulsive eating and smoking were significant at ␣ Յ 0.05. All six variables were related to addictive behaviors. In a totally separate group of controls and individuals attending a smoking cessation clinic, and smoking at least one pack per day, 39.3% of the controls versus 66.1% of the smokers carried the 11 or 22 genotype (P = 0.0002). In a third independent group of pathological gamblers, 55.8% carried the 11 or 22 genotype (P = 0.009 vs the combined controls). In the TS group and smokers there was a significant additive effect of the DRD1 and DRD2 genes. The results for both the DRD1 and DRD2 genes, which have opposing effects on cyclic AMP, were consistent with negative and positive heterosis, respectively. These results support a role for genetic variants of the DRD1 gene in some addictive behaviors, and an interaction of genetic variants at the DRD1 and DRD2 genes.

A majority of US medical school graduates are not adequately trained to treat nicotine dependence. The major deficit is the lack of smoking cessation instruction and evaluation in the clinical years. A model core tobacco curricula that meets national recommendations should be developed and implemented in all US medical schools.

Objective To identify the demographic characteristics of current tobacco users in Cambodia, particularly women, and to explore the reasons for current tobacco use in demographic subgroups of the Cambodian population. Methods We used a stratified three-stage cluster sample of 13 988 adults aged 18 years and older from all provinces in [2005][2006]. Participants completed an interviewer-administered survey that contained items on all forms of tobacco use and on health and lifestyle variables. Multivariable regression analysis was performed to identify demographic predictors of tobacco use. Findings Cigarette smoking occurred among 48.0% of men and 3.6% of women. We estimated that 560 482 women (95% confidence interval, CI: 504 783 to 616 180) currently chewed tobacco (typically as a component of betel quid) and that the prevalence more than doubles with each decade of adulthood up to the point that about half of all older women chew tobacco. Both men and women cited the influence of older relatives as their primary reason for starting to use tobacco. About one out of five rural women who used chewing tobacco started their habit for relief from morning sickness. The highest prevalence of chewing tobacco among women was seen among midwives (67.9%) and traditional healers (47.2%). High rates (66.8%) of cigarette and pipe tobacco use occurred among ethnic minorities who represent hill tribes found throughout south-east Asia. Conclusion The tobacco epidemic in Cambodia extends far beyond cigarette smoking in men. Tobacco control that focuses only on cigarettes will not address the health burden from smokeless tobacco use in women that may be an integral part of cultural, familial, and traditional medicine practices.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬