New study finds no clear evidence that nicotine “preloading” helps smokers to quit | University of Oxford

There is insufficient evidence to show that using nicotine patches for four weeks before a quit attempt (known as “preloading”) improves long-term smoking abstinence, finds a trial published by The BMJ this week.

The researchers found that nicotine preloading reduces craving intensity and seems to make quitting easier, but that this beneficial effect may have been masked by a concurrent reduction in the use of varenicline in the period after quit day. As varenicline is the most effective smoking cessation drug, this may have undermined the benefit of preloading.

Nicotine patch

If it were possible to overcome this unintended consequence, nicotine preloading “could lead to a worthwhile increase in long term smoking abstinence,” they say.

The research was funded by the National Institute for Health Research.

Although there have been several new drugs for tobacco cessation since the 1970s, treatment has remained largely the same, with behavioural support to motivate and strengthen a person’s resolve to remain abstinent and drugs to reduce the strength of urges to smoke after quit day.

Some studies have suggested that using nicotine replacement therapy before a quit attempt is more effective than when used in the conventional way to support abstinence, while other studies suggest preloading has no effect.

A research team from the UK Centre for Tobacco and Alcohol Studies, led by Professor Paul Aveyard at the University of Oxford, set out to examine the effectiveness of a nicotine patch worn for four weeks before a quit attempt. Continue reading

Advertisements

Stubbing out the public health problem of an era | Blog piece by Tim Coleman | #myresearchlegend

Sir Richard Doll had an illustrious career. Through his efforts, the world learned much about the causes of cancer and the dangers of asbestos, radiation and, of course, smoking. Following his research into smoking and lung cancer during the 1950s, the realisation dawned that tobacco use was the public health problem of the era and not a harmless pastime. We all know what’s happened since. How many other 20th century epidemiologists have had such a transformative impact on peoples’ understanding of the determinants of disease?

myresearchlegendricharddollblog

To what extent do I consider Sir Richard Doll to be a research ‘legend’? I’m not sure I’ve earned the right to bestow that honour, so I’ve taken advice. The Cambridge English Dictionary says a ‘legend’ is “someone very famous and admired, usually because of their ability in a particular area”. Just considering the one area of Doll’s work emphasised above, this is a no-brainer; ‘legend’ threshold is clearly surpassed. Don’t take my word for this, though, Google ‘Richard Doll’ and see if you can find reason to disagree.

Am I hasty in allocating ‘legend’ status? Doll certainly changed the world’s knowledge of many illnesses; shouldn’t an NIHR research legend demonstrate clear NHS impact too? Fortunately Doll’s influence here doesn’t disappoint, even if one again only considers smoking. I am a GP. How would this be different if Sir Richard had never lived? Firstly, I’d probably smoke. A pipe would give me more gravitas than cigarettes and I’d have to either smoke in my consulting room, like some doctors did, or schedule regular ‘pipe breaks’ into my day. I would be blissfully ignorant about harms from smoking and more likely to offer patients cigarettes than help with stopping, even if they developed lung cancer or heart disease.

Smoking Kills

Thankfully, Sir Richard did exist. Although I tried smoking as a teenager, a friend’s mum made me think again and I didn’t ever fully adopt the habit. Immature, teenage me was saved from smoking because Doll had shown how harmful smoking is. Fast forward to my GP work in 2018; again due to Doll, I fully realise that smoking kills my patients and wrecks their lives.

crop.jpgAlso, due to research which was only possible because of his early work, I can offer smokers numerous types of cessation support. It’s even possible to refer on to Stop Smoking Services (SSS) for specialist help, though a major cloud on the horizon is that these vital services are no longer universal; they are endangered.

Through their work at the Statistical research Unit of the MRC, Doll and Hill demonstrated that smoking causes lung cancer; before this smoking was ubiquitous across social classes and many doctors smoked. By 1954, the government accepted the link and the middle classes started quitting in droves. When he died in 2005, Doll would very likely have been delighted that UK smoking rates were falling fast. However, improvements were chiefly amongst the better off, so smoking had become disproportionately concentrated amongst society’s poorest. Given his well-documented non-conformist views, my bet is that he would have been saddened that those with most to gain benefited least from such massive social change. Nevertheless, he might have been heartened by the government’s national and vigorous action against smoking. Back then, although SSS were a very new NHS entity, it was mandatory for Primary Care Trusts to deliver them and SSS were closely performance-managed by the then Department of Health. Any smoker could access services’ evidenced-based support to increase their chances of permanent cessation.

Smoking Prevention

Worldwide, legions of researchers, including me, have followed Doll by trying to find ways of treating or preventing smoking. Few epidemiologists have caused such a seismic shift in the international research agenda. Take a look at the thousands of randomised controlled trials (RCTs) reviewed in the tobacco section of the Cochrane Library. All of these studies test interventions against smoking. This necessary work continues today and NIHR is a leading supporter funding, for example, the largest ever RCTs of Nicotine Replacement Therapy used in pregnancy* or for ‘preloading’.

The NHS is 70. Celebrating research legends is a great idea but it’s important we remember what they did and why they are lauded. It took almost half a century after Doll and Hill’s landmark paper for the NHS to implement national treatment services for smokers, and sadly less than 20 years later these have become an optional extra with patchy coverage across the country. Smoking is less prevalent than in the past but there are still millions of UK citizens who want to stop and can’t manage this alone. Smoking is still a national problem and requires a national NHS response. A crucial component of this response should be to help quitters by giving them the very best support.

Sir Richard’s work has had a great impact, as all research should. The demise of SSS suggests we risk forgetting this when instead we should continue to build on his significant achievements.

*More information on the trial: Double-blind, randomised, placebo-controlled trial of nicotine replacement therapy (NRT) in pregnancy – SNAP is available on the NIHR Journals Library website.

Tim Coleman, Professor of Primary Care, Faculty of Medicine & Health Sciences
University of Nottingham and NIHR Senior Investigator

The NIHR is highlighting seven research legends whose work has shaped the NHS, as part of its celebrations for the NHS’s 70th birthday and the NIHR’s I Am Research campaign.

Original post on NIHR website. – Posted: 04 May 2018

Nicotine & Tobacco: Current issues, Policy and Practice / 21st – 24th May 2018 / University of Stirling

Building on our previous CPD courses on tobacco control and alcohol policy, the UK Centre for Tobacco and Alcohol Studies is delighted to be offering our Nicotine & Tobacco CPD course at the University of Stirling in 2018!

Please note: If you book on/before 28th February 2018, the cost is: £499, or £649 for students seeking accreditation. 

The course, successfully introduced in 2015, is aimed at professionals working in a range of organisations who are interested in public health and policy in the UK or internationally. In addition to the topics covered at previous tobacco CPDs, this year we will be examining the current, up to date evidence on tobacco harm reduction, electronic cigarettes and other nicotine-containing devices.

On successful completion of the module, students will be able to:

• Describe and discuss patterns of tobacco consumption, prevalence and addiction and the rise of e-cigarette use.
• Assess key milestones in tobacco and nicotine policy and the contribution of policy in developing and implementing effective interventions.
• Critically discuss the role of commercial interests, including the tobacco industry, in promoting tobacco use and recent controversies regarding the e-cigarette industry.
• Describe and discuss the range of effective interventions to reduce tobacco use and the place of tobacco harm reduction, including e-cigarettes, in addressing tobacco use.
• Assess the potential impact of current and emerging tobacco control priorities on different population groups, including tobacco harm reduction approaches.
• Discuss principles of media advocacy as applied to current issues in tobacco control.


*NEW FOR 2018*

ADDITIONAL BREAKOUT SESSIONS RELEVANT TO INTERNATIONAL TOBACCO CONTROL!

TAXATION & ILLICIT TOBACCO
Deborah Arnott, Action on Smoking & Health (ASH)
SMOKELESS TOBACCO
Prof. Kamran Siddiqi, University of York
TOBACCO MARKETING
Crawford Moodie, University of Stirling

Presentations from the 2017 e-cigarette summit | November 2017

The 5th annual E-Cigarette Summit was held at the Royal Society in London on Friday 17th November 2017. Linda Bauld, Robert West and several other members of the UKCTAS network presented their research at the event to a large audience of other scientists, policy makers, medical and public health professionals and e-cigarette stakeholders. The presentations included the latest evidence on the safety of e-cigarettes for users and bystanders, usage in young people and non-smokers, advertising and marketing, use in public places and the conflicts arising from the tobacco industry’s dual corporate ownership of tobacco harm reduction products and cigarettes.

To view the slides from each presentation and the full list of videos click here.

Robert West (University College London) & Linda Bauld (University of Stirling):

Panel Discussion:

Lion Shahab (University College London) & Jamie Hartmann-Boyce (University of Oxford):

Deborah Arnott (ASH) & Martin Dockrell (Public Health England):

See more information about the event and view each of the lecture slides.

 

Society for the Study of Addiction – Annual Conference 2017

9th – 10th November 2017
Crowne Plaza, Newcastle, UK

Confirmed sessions include:

  • Sport & exercise in addiction and recovery with personal reflections from Clarke Carlisle.
  • End of life care for people with substance problems.
  • The psychedelic renaissance in addiction treatment.
  • Pathways to amphetamine type stimulant use.

Capture.JPG


NEW for 2017: The ADDICTION DEBATE

‘This Society believes it is appropriate to expand the concept of addiction to behaviours such as internet use’

With Professor Robert West & Professor Mark Griffiths


SSA PhD Symposium 2017

New for 2017, the SSA’s PhD Symposium will be held the day before our annual Conference, in the same venue.

The SSA’s symposium for PhD students is now in its ninth year. This event aims to bring together PhD students studying addiction-related topics so they can network, present their work in a low-key, supportive environment and share their ups and downs. It welcomes full and part-time students, studying in a range of disciplines including social sciences, laboratory sciences and health services research. The day includes presentations from students at various stages in the PhD process and some close to or who have recently submitted their thesis.

There is a social event in the evening of the PhD Symposium, and throughout the day there is plenty of opportunity to talk to other delegates.

 

For more information about this event please visit: www.addiction-ssa.org/symposium

 

UKCTAS comment on the latest tobacco control plan for England: “Towards a smoke-free generation”

The new tobacco control plan, ‘Towards a smoke free generation’ is a welcome restatement of the government’s commitment to reduce the prevalence, and hence the burden of death and disability caused, by smoking. The recognition that harm reduction strategies can play a key role in achieving these ambitions is applauded, and puts the UK at the forefront of global tobacco policy. However, the ambition to reduce adult smoking in England from 15.5% to 12% by 2022, representing as it does a reduction of 0.5 of a percentage point per year, is modest given that smoking prevalence has fallen by 2.9 percentage points in the last three years.

Recognising reducing smoking in pregnancy as a priority, and aiming to reduce prevalence in pregnancy to 6% or less, is welcome but will not be achieved without adequate resources, improved care pathways and addressing significant gaps in training for midwives and obstetricians. The commitment to make NHS inpatient mental health settings smoke-free by 2018 is long overdue, but it is disappointing that the same strong commitment is not extended to other NHS settings.

The ambition to make stop-smoking services more available is also welcome, but like the commitments to NHS settings and for pregnancy requires funding: when public health budgets are being slashed, how will local authorities afford to increase their smoking service provision?

What matters now is delivery: Action to achieve and exceed these ambitions is the next and crucial step

PDF of the Press Release