Community interventions for preventing smoking in young people.

This review of studies has highlighted the paucity of data that exist to support the use of NPPV in patients in status asthmaticus. As such this course of treatment remains controversial despite its continued use in current clinical practice. Larger, prospective randomised controlled trials of rigorous methodological design are needed to determine the role of NPPV in patients with asthma.

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Background Tobacco use in Indigenous populations (people who have inhabited a country for thousands of years) is often double that in the non-Indigenous population. Addiction to nicotine usually begins during early adolescence and young people who reach the age of 18 as non-smokers are unlikely to become smokers thereafter. Indigenous youth in particular commence smoking at an early age, and a disproportionate burden of substance-related morbidity and mortality exists as a result. Objectives To evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research. Search methods The Cochrane Tobacco Addiction Group Specialised Register was searched in November 2011, with additional searches run in MEDLINE. Online clinical trial databases and publication references were also searched for potential studies. Selection criteria We included randomized and non-randomized controlled trials aiming to prevent tobacco use initiation or progression from experimentation to regular tobacco use in Indigenous youth. Interventions could include school-based initiatives, mass media, multi-component community level interventions, family-based programmes or public policy.

Smoking cessation interventions in outpatient settings have been clearly demonstrated to be one of the most cost effective RATIONALE: strategies available in reducing disease burden. Given the evidence of superior benefits with varenicline over nicotine replacement therapy, we aimed to evaluate its benefit when initiated in the setting in combination with counselling for smokers admitted inpatient with acute smoking related events.Adult patients (n=236, 20-75 years) admitted with smoking related illnesses recruited from the Respiratory, Cardiology, METHODS: Neurology, Vascular and general medical wards of The Queen Elizabeth Hospital, Lyell McEwin Health Service and the Royal Adelaide Hospital were randomised to receive either varenicline tartrate (VT) plus Quit SA counselling (n=119) or Quit SA counselling alone, (n=117).Preliminary analysis shows that after six months of follow-up, smoking abstinence was achieved by 29.1% in the control and RESULTS: 42.0% in the intervention group, (p=0.042).Preliminary subgroup analysis indicates that cardiac patients, (n=114) have gained the most benefit with 48.3% obtaining continuous abstinence. Based on intention to treat analysis over the study period to date, the highest percent of self reported adverse events has been Nausea with 16.94% in the VT plus counselling group compared with 1.61% in the counselling alone group. Other noteworthy adverse events include Insomnia (5.4% vs. 2.15%), Headache (4.92% vs. 2.69%), Vomiting (4.86% vs. 0.53%) and Abnormal Dreams (3.83% vs. 1.08%) in the VT plus counselling and counselling alone groups respectively. Eight mortalities have occurred during the study period, of which n=6 were in the VT and counselling arm compared with n=2 in the counselling alone arm. All of these subjects had known or developed underlying co-morbidities including cancer n=3, stroke n=1, cardiac arrest n=3, and multiple organ failure n=1.The combined use of VT plus counselling for the inpatient setting has produced a sustained smoking cessation benefit at CONCLUSIONS: 6-month follow-up. The highest reported side effect is nausea however it is important to acknowledge that the target population are inpatients admitted with serious illness episodes. As such a combination of their illness and amendments or new additions to their medications may also increase the likelihood of adverse events. Whilst all study participants have underlying co-morbidities the mortality rate for the VT plus counselling arm is higher than counselling alone, however this is neither clinically or statistically significant. This abstract is funded by: None Am J Respir Crit Care Med 183;2011:A5445 Internet address: www.atsjournals.org Online Abstracts Issue

Consumer guidelines for chronic disease management.

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