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Syfte: Att utvärdera vilken rökavvänjnings metod som är mest effektiv vid kronisk obstruktiv lungsjukdom. Det som undersöktes var de förbättringar i patientresultatet av de olika rökavvänjnings metoderna. Mål: Databassökning samt identifiering av relevant litteratur.Bedömning av kvaliteten på de inkluderade studierna ochsammanställning och sammanfattning av dokumentationen respektive resultat. Studie typer: Sammanställningar och systematiska sammanställningar. Källor: MEDLINE, CINAHL och Cochrane Bibliotek. Metoder: Litteratursökning utfördes, sammanställningarna bedömdes med AMSTAR 2 och PRISMA formulären. Informationen sammanställdes i tabell som sammanfattade resultaten. Resultat: 10 systematiska sammanställningar med medel till hög PRISMA och AMSTAR 2 poäng samlades med en variation av 370 – 13000 KOL-patienter. Dödlighet, sjuklighet och livskvalité visade positiva resultat, andel personer som slutade röka visade också signifikanta siffror.Slutsats: Det finns bevis av interventioner som har positiv effekt på KOL-patienter att sluta röka. Intensiv farmakoterapi rådgivning och motiverande samtal visade bästa resultat för en KOL-patient. / Purpose: To evaluate which smoking cessation method is most effective in chronic obstructive pulmonary disease. What was investigated were the improvements in the patient result of different smoking cessation methods. Objective: Database search and identification of relevant literature.Assessment of quality of the included studiescompilation and summary of the documentation and the result. Studies: Reviews and systematic reviews. Sources: MEDLINE, CINAHL and Cochrane Library. Methods: Literature search was performed, the reviews were assessed with AMSTAR 2 and PRISMA. The information was extracted in tables.Results: 10 systematic reviews with high PRISMA and AMSTAR 2 score were collected with a variety of 370-13000 COPD patients. Mortality, morbidity and quality of life showed positive results, the proportion of people who quit smoking also showed significant numbers. Conclusion: There is evidence of interventions that have a positive effect on COPD patients to quit smoking. Intensive pharmacotherapy counseling and motivational interviewing showed the best results for a COPD patient.

The study was designed to find a response on the behavioral level that would be an effective index across subjects for determining when conditioned aversive suppression of a response had been achieved. Ten male volunteers received shock during trials in which they had to smoke. Half of the subjects received a brief but more intense shock when they stopped smoking during a trial. A comparison of these subjects to the others showed their average amount of smoking suppression in pre- and post-treatment rates to be significantly (P < .025) greater. In addition, these subjects showed conditioned emotional responding. It was concluded that this behavioral level response was an effective index for determining when suppression of smoking would occur.

Introduction: Most pregnant smokers report abruptly reducing their cigarettes per day (CPD) by ~50% shortly after learning of pregnancy and of making further smaller reductions over the remainder of their pregnancy. Laboratory and naturalistic studies with non-pregnant smokers have found that these types of reductions often lead to changes in smoking topography (i.e., changes in smoking intensity to maintain a desired blood-nicotine level). 19, 20 If pregnant women engage in compensatory smoking, they may expose themselves and their offspring to the same level of toxicants despite reporting reductions in CPD. Methods: Pregnant and non-pregnant female smokers (n = 17 and 91, respectively) participated. At the experimental session, after biochemical confirmation of acute abstinence, all participants smoked one of their usual brand cigarettes ad lib through a Borgwaldt CReSS Desktop Smoking Topography device. Carbon monoxide (CO) and measures of nicotine withdrawal, craving, and reinforcement derived from smoking were also collected. Results: The two groups did not differ on any demographic or smoking characteristics at screening, except nicotine metabolism rate, which as expected, was faster in pregnant smokers. Analyses suggest that none of the smoking topography parameters differed between pregnant and non-pregnant smokers, although pregnant smokers had a significantly smaller CO boost. Both groups reported similar levels of relief of withdrawal and craving after smoking, but other self-report data suggest that pregnant smoker find smoking less reinforcing than non-pregnant smokers. Conclusions: Pregnant smokers do not smoke cigarettes differently as compared to non-pregnant female smokers, but appear to find smoking less reinforcing.

Objective The purpose of the mixed methods study was to compare barriers and facilitators encountered by low-income African American women who engaged in different infant feeding practices. Methods Using the positive deviance approach and modified Integrated Model as theoretical frameworks, the research began with a qualitative study that informed a survey examining intention, skills, and environmental factors differentiating women’s infant feeding practices. Results Twenty-eight and 190 low-income African American adult women participated in focus groups or interviews and a survey, respectively. In the qualitative study, positive deviants, who breastfed for at least four months, seemed to have stronger breastfeeding intentions, self-efficacy and breastfeeding support than other women. In the final multinomial multiple logistic regression, for a one unit increase in the PBC scale of the revised Breastfeeding Attrition Prediction Tool, there was a 50% (OR 1.5[1.3-1.7]) and an 18% (OR 1.18 [1.03-1.3]) increase in the odds of breastfeeding at least three months (positive deviance) compared to only formula-feeding and breastfeeding for less than three months, respectively. Women who did not smoke postpartum were 4.3 [1.5-12.3] and 5.6 [2.1-15.1] times as likely to be positive deviants; women who had C-sections were 3.6 [1.3-9.6] and 2.9 [1.0-7.8] times as likely to be positive deviants compared to only formula-feeding and breastfeeding for less than three months, respectively. Women who ranked WIC full breastfeeding packages as most valuable were 14.9 [4.8-45.5] and 16.1 [5.3-50.0] times as likely to be positive deviants compared to only formula-feeding and breastfeeding for less than three months, respectively. Discussion High breastfeeding self-efficacy was associated with positive deviance, although the qualitative study findings suggested that general self-efficacy may also influence breastfeeding success. The likelihood of not smoking being associated with longer duration of breastfeeding is consistent with previous research. The C-section results may reflect a longer length of hospital stay leading to increased mastery of breastfeeding prior to discharge. Analysis of participants’ valuation of WIC infant feeding incentives led to the suggestion that WIC incentives be re-examined. Further exploration of these findings and subsequent interventions may lead to improved breastfeeding rates among low-income African American women.

This study examined factors that may protect African-American young adults in college from early onset of cigarette smoking, and factors that may place them at risk for cigarette smoking, using the framework of the Social Cognitive Theory. It was hypothesized that existing regulation of smoking, positive attitude toward academics and school connectedness would be related to low cigarette-smoking rates, while exposure to pro-tobacco promotions would be related to high cigarette smoking rates. A convenience sample of 576 undergraduates at Dillard University of New Orleans completed a Harvard College Alcohol Study survey. Forty six percent (n=269) completed the survey. Ninetyone percent were African American, and 13% of them were ever-smokers. Chi Square analysis was used to test for a statistically significant difference in response rates between eversmokers and non-smokers. Results indicated no significant differences between respondents for any outcome measures. The Social Cognitive Theory constructs were not supported by the findings.The results of this study do not support any of the hypotheses. The Social Cognitive Theory constructs used to examine the hypotheses are not supported by the findings. Future studies should address the limitations of this research by using a random sampling technique, sampling across all academic classification levels, and assessing the validity and reliability of the Harvard College Alcohol Study survey measures for cigarette smoking.

Nos últimos anos, um grande número de estudos tem investigado o consumo de cigarros com base em uma teoria que permeia uma relação entre custos e benefícios, envolvendo trocas entre consequências em curto e longo prazo, que tem sido proposta para explicar porque escolhas insalubres – incluindo exemplos nos âmbitos de poupança, procrastinação, vício e auto-confiança – ocorrem, apesar de refletirem prejuízos. Esta abordagem, aqui definida como preferência de tempo, é um fenômeno conhecido quando os benefícios estão no presente e os custos são projetados para o futuro, permeando a teoria de tomada de decisões ao longo do tempo (escolha intertemporal) – que reflete uma escolha entre uma recompensa menor imediata e uma recompensa maior atrasada. A fim de analisar a relação de escolha entre ganhos e perdas imediatos e atrasados, em diferentes contextos, e os diversos fatores que influenciam essa escolha, um questionário foi desenvolvido a partir de artigos anteriores (Kirby, 2009; Myerson et al., 2016) e aplicado a uma amostra da população de fumantes. O objetivo das análises do presente estudo baseia-se em avaliar a influência de variáveis como domínio, gênero, idade e impulsividade em cada uma das condições do questionário, chegando a conclusões a respeito da influência das mesmas, dependendo de variáveis como contexto, tipo e efeito. Os resultados do estudo comprovam que a preferência de tempo é uma medida válida para predizer o processo de tomada de decisão de consumidores de cigarros, o que significa que fumantes são mais propensos a escolher resultados imediatos em vez de resultados atrasados. Isto indica que, de modo geral, fumantes preferem recompensas imediatas do que benefícios futuros. No entanto, os resultados do estudo apontam que, sob determinadas condições, esse efeito de preferência de tempo se reduz, aumentando a propensão de escolha por resultados atrasados em vez de resultados imediatos. Estas circunstâncias foram encontradas em diferenças relacionadas ao contexto (fumo x genérico), diferenças relacionadas ao efeito de sinal (ganho x perda), diferenças em relação aos domínios (financeiro, saúde, estético e social), diferenças a cerca do modo de comprometimento de participação (pessoal x outros) e diferenças relacionadas às características demográficas dos respondentes (faixa etária e gênero). / In the last past years, a large number of studies have investigated cigarette smoking based on a theory that permeates a relationship between costs and benefits, involving trade-offs between short and long-term consequences, which has been proposed to explain why unhealthy choices, including exemples in the areas of savings, procrastination, addiction and self-confidence - occur, even though they reflect losses. This approach, here defined as time preference, is a known phenomenon when benefits are at the present and costs are projected into the future, permeating a decision-making theory over time (intertemporal choice) - which reflect a choice between a immediate but small reward and a larger but late reward. In order to analyze these choices between immediate and delayed gains and losses in different contexts, and the various factors that influence this choice, a questionnaire was developed based on previous articles (Kirby, 2009, Myerson et al., 2016) and applied into a sample of the population of smokers. The objective of the present study is to evaluate the influence of variables such as domain, gender, age and impulsivity in each of the conditions of the questionnaire, leading to conclusions about their influence, depending on variables such as context, type and effect. The results of the study prove that time preference is a valid measure to predict the decision-making process of smokers, which means that smokers are more likely to choose immediate outcomes rather than late outcomes. This indicates that, overall, smokers prefer immediate rewards than future benefits. However, the study results point out that, under certain conditions, this time preference effect is reduced, increasing the tendency to choose for delayed results rather than immediate results. These circumstances were found in differences related to the context (smoking x generic), differences related to the sign effect (gain x loss), differences in relation to the domains (financial, health, aesthetic and social), differences about the mode of commitment of participation (personal x other) and differences related to the demographic characteristics of the respondents (age rage and gender).

Lung cancer is a particularly devastating disease, accounting for the most deaths among all cancer types in the United States. Despite a reduction in the country’s smoking rates, cigarette smoking remains the number one risk factor for lung cancer. Additionally arsenic exposure, which occurs primarily through contaminated drinking water in the U.S., is associated with increased lung cancer incidence. The nucleotide excision repair (NER) pathway is critical for maintenance of genomic fidelity, removing DNA lesions that could otherwise promote DNA mutations and drive carcinogenesis. Tobacco smoking introduces significant amounts of DNA damage and produces characteristic DNA mutations found in lung cancers of smokers, and arsenic increases lung cancer risk in smokers beyond the risk of smoking along. The contributions of these chemicals to DNA damage and cancer have been well documented, but few studies have examined their effects on DNA repair pathways, particularly the nucleotide excision repair (NER) pathway. Arsenic, while not directly mutagenic, promotes the carcinogenicity of other compounds including agents that produce DNA damage that is repaired by the NER pathway. In this dissertation I investigated the effects of cigarette smoke condensate (CSC, a whole-smoke tobacco surrogate) and arsenic on NER. I observed that CSC or arsenic treatment inhibited NER as measured by a slot-blot assay using UV-induced photolesions as model substrates to measure NER. The abundance of Xeroderma Pigmentosum complementation group C (XPC), a critical NER protein, was significantly reduced in all lines treated with either chemical, while XPA protein was unaffected. CSC and arsenic also affected RNA levels of certain NER genes. Finally, proteasome-regulated XPC turnover was affected by CSC and arsenic treatment, suggesting a potential mechanism for XPC protein inhibition. The observed impairment of NER by CSC is critically important in tobacco cancer etiology – CSC introduces DNA damage, some of which is repaired exclusively by NER, and CSC inhibits the NER pathway as well, providing a two-sided assault on cellular genetic fidelity. I then adapted the NER assay to measure repair in lymphocytes isolated from human subjects of a study investigating the high incidence of lung cancer in Appalachian Kentucky. I observed an age-dependent decline in NER efficiency that was modulated by subject smoking status and a reduced NER efficiency among current smokers in the lung cancer patient population compared to control subjects in the youngest age group, suggesting individual DNA repair capacity measured with this repair assay may be a biomarker for lung cancer susceptibility.

Introduction: Cigarette preference increases as a function of nicotine content, but preference can be shifted by manipulating cigarette cost. The aim of the present study is to model whether the behavioral-economic metric of unit price (cigarette cost/nicotine content) accounts for cigarette preference shifts and whether preference changes to very low nicotine content cigarettes (VLNCs) are associated with corresponding changes in smoking rate. Methods: 169 daily smokers from populations vulnerable to smoking completed sessions in which choices between smoking normal nicotine content (NNC) (15.8mg/g) and VLNC (0.4mg/g) cigarettes were concurrently available. In Condition 1, choices for both products were available ad-lib at an equal cost of 10 responses/choice. In Condition 2, VLNCs were again available ad-lib at 10 responses/choice, but NNCs were available on a progressive-ratio (PR) schedule wherein response cost (and unit price) increased following each NNC choice (10,160,320…8400 responses/choice). Results were analyzed using ANOVAs and a binomial test (p<.05). Results: Participants preferred NNCs over VLNCs in Condition 1, but shifted preference to VLNCs in Condition 2 (p<.001) immediately before the point in the PR progression where unit price for NNCs exceeded unit price for VLNCs (p<.001). Additionally, this preference shift corresponded with reduced total cigarette consumption compared to Condition 1 levels (p<.001). Conclusions: These results suggest that unit price of nicotine underpins cigarette preference and may provide a metric by which regulators can predict product preference and potentially impact it through policy. These results also demonstrate that VLNCs sustain lower smoking rates than NNCs even under acute laboratory conditions.