Smoking and Mortality — Beyond Established Causes

Carter, Brian D.; Abnet, Christian C.; Feskanich, Diane; Freedman, Neal D.; Hartge, Patricia; Lewis, Cora E.; Ockene, Judith K.; Prentice, Ross L.; Speizer, Frank E.; Thun, Michael J.; Jacobs, Eric J.

doi:10.1056/nejmsa1407211

Cited by 627 publications

(480 citation statements)

References 31 publications

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“…Tobacco smoking remains a leading contributor to preventable disease and death (Carter et al, 2015). Although nicotine is considered the main addictive chemical in cigarette smoke (Henningfield and Keenan, 1993), sensory stimuli (eg, taste, smell, and respiratory-tract sensations) and behavioral aspects of smoking also contribute (Rose and Behm, 1995).…”

Section: Introductionmentioning

confidence: 99%

Reduced-Nicotine Cigarettes in Young Smokers: Impact of Nicotine Metabolism on Nicotine Dose Effects

Faulkner

Ghahremani

Tyndale

et al. 2017

Neuropsychopharmacol

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The use of cigarettes delivering different nicotine doses allows evaluation of the contribution of nicotine to the smoking experience. We compared responses of 46 young adult smokers to research cigarettes, delivering 0.027, 0.110, 0.231, or 0.763 mg nicotine, and conventional cigarettes. On five separate days, craving, withdrawal, affect, and sustained attention were measured after overnight abstinence and again after smoking. Participants also rated each cigarette, and the nicotine metabolite ratio (NMR) was used to identify participants as normal or slow metabolizers. All cigarettes equally alleviated craving, withdrawal, and negative affect in the whole sample, but normal metabolizers reported greater reductions of craving and withdrawal than slow metabolizers, with dose-dependent effects. Only conventional cigarettes and, to a lesser degree, 0.763-mg nicotine research cigarettes increased sustained attention. Finally, there were no differences between ratings of lower-dose cigarettes, but the 0.763-mg cigarettes and (even more so) conventional cigarettes were rated more favorably than lower-dose cigarettes. The findings indicate that smoking-induced relief of craving and withdrawal reflects primarily non-nicotine effects in slow metabolizers, but depends on nicotine dose in normal metabolizers. By contrast, relief of withdrawal-related attentional deficits and cigarette ratings depend on nicotine dose regardless of metabolizer status. These findings have bearing on the use of reduced-nicotine cigarettes to facilitate smoking cessation and on policy regarding regulation of nicotine content in cigarettes. They suggest that normal and slow nicotine metabolizers would respond differently to nicotine reduction in cigarettes, but that irrespective of metabolizer status, reductions to o0.763 mg/cigarette may contribute to temporary attentional deficits.

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Section: Introductionmentioning

confidence: 99%

Reduced-Nicotine Cigarettes in Young Smokers: Impact of Nicotine Metabolism on Nicotine Dose Effects

Faulkner

Ghahremani

Tyndale

et al. 2017

Neuropsychopharmacol

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“…Some reported but controversial protective effects of smoking, such as those regarding Parkinson disease 63, 64, 65, 66, 67, 68, 69, 70, 71, were not accounted for in this model. Some diseases attributable to smoking 5 were also not included in the model, as the true impact of smoking could not be estimated, and some interventions available only in the United Kingdom but not in Germany were also not considered. Another important limitation concerns PSA.…”

Section: Discussionmentioning

confidence: 99%

“…Between 2000 and 2050, it is estimated that smoking will have caused approximately 450 million deaths world‐wide 4. Based on recent findings this number may even be higher, as 17% of excess mortality among smokers may, falsely, not have been attributed to smoking 5. In contrast to males, the mortality rate of lung cancer in females has been rising in Germany for more than three decades, with smoking as the biggest risk factor 6, 7.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

Huber¹,

Präger²,

Coyle

et al. 2017

Addiction

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AimsTo evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany.DesignA Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates.SettingGermany.ParticipantsCohort of current smoking population (18+ years) in Germany.InterventionsInterventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England.MeasurementsEQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment.FindingsThe highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1.ConclusionsIncreasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective.

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“…Long-established and accepted approaches to reduce smoking-related morbidity and mortality include efforts to prevent uptake by youth, reduce exposure to smoke among non-smokers and encourage and support quit attempts among current smokers. Promoting quitting among current smokers has the greatest near-term effect on morbidity and mortality, as current smokers are subject to near-term harms [2,3].…”

Section: Introductionmentioning

confidence: 99%