key: cord-0043882-8emzhqu3
authors: nan
title: From the IASLC Tobacco Control Committee
date: 2020-05-26
journal: J Thorac Oncol
DOI: 10.1016/j.jtho.2020.04.008
sha: 6616be11ad288f94542ebce59efbad28ed93eda2
doc_id: 43882
cord_uid: 8emzhqu3

nan

This study assessed data from the Korean Welfare Panel Study (2014) (2015) (2016) (2017) to evaluate the impact of the 2015 cigarette tax increase on 2114 Korean adults who smoked before the tax increase in terms of quit attempts, successful quitting and smoking intensity. Following the tax increase, 60.9% of baseline smokers attempted to quit and 34.7% of the attempters succeeded in quitting. More quit attempts and successful quitting were observed in smokers aged 65 years and light smokers versus those aged 35-44 years and heavy smokers (p<0.01 and p<0.05, respectively). Successful quitting was not significantly associated with income levels while failure in quitting was linked to depressive symptoms, first cigarette use before age 19 and smoking a pack or more a day at baseline. Reduced smoking intensity after the tax increase was observed in continued smokers (p<0.001) but not in light smokers, young smokers and high-income smokers. In summary, the findings suggest implementation of periodic cigarette tax increase and address depressive symptoms in smoking cessation programs. Lee B, Seo D-C. Effects of an 80% cigarette price increase on quit attempts, successful quitting and smoking intensity among Korean adult smokers: results from nationally representative longitudinal panel data. Tobacco Control. 2020:tobaccocontrol-2019-055518. https://doi.org/10.1136/tobaccocontrol-2019-055518.

Does free nicotine replacement improve smoking cessation rates in cancer patients?

This is an 18-month pilot smoking cessation program that provided free nicotine replacement therapy (nrt) in 2017 to 117 cancer patients who are current or recent smokers. Significantly higher rates of patient referral and patient attending a referral appointment were observed in 2018 versus 2015-2016 (p < 0.001 and p < 0.001, respectively). Complete smoking cessation was reported in 35.2% of patients and decreased cigarette smoking was found in 45.1%. Although no significant predictive factor of smoking cessation was observed, initial cigarette use (>10 vs. 10 initial cigarettes) was predictive of smoking reduction (odds ratio: 5.04; p ¼ 0.011). To conclude, the pilot study demonstrated improved rates of referral and acceptance of nrt versus historical rates, and reduced cigarette use or quitting entirely were observed in most referred patients. Arifin AJ, McCracken LC, Nesbitt S, Warner A, Dinniwell RE, Palma DA, et al. Does free nicotine replacement improve smoking cessation rates in cancer patients? Curr Oncol. 2020;27(1):14-8. Epub 2020/03/29. https://doi.org/1 0.3747/co.27.5267. PubMed PMID: 32218655; PubMed Central PMCID: PMCPMC7096202.

A unification of purpose and strategy. That is what we identified in last month's News as the surest way to deal with the tobacco pandemic of the last 100 years. No one, but no one reading this column will be ignorant of COVID-19, the viral pandemic that has affected us all, turned lives upside down and inverted values and expectations with a suddenness that none of us knew -before now -that we could tolerate. The experience varies around the world, tragic and horrific in some countries, blunted and surreal in others, with the differences dependent on many things including luck, governmental cohesion, the ability of societies to manage important public health strategies and the skills and valiant devotion of frontline clinical workers. Spain was unlucky to import the virus with returning football fans. Australia and New Zealand have fortunate remote geography. South Korea's government has a co-ordinated approach. The government of the United States does not. Germany has combined lockdown with a massive increase in ICU capacity. Italy fought to keep up with the demands on its healthcare system. With its shock and distracting awe, COVID-19 threatens us in many ways including its ability to block other things, like tobacco control, from view. A paper in the British Journal of General Practice (1) addresses possible cracks in tobacco control that could widen during this time. High levels of stress, isolation, loss of comfort from family and friends and helplessness in the face of uncertainty may, notes the paper, result in relapses and higher levels of smoking. The benefits of workplace smoking bans and lifestyle changes that help with cessation have evaporated in the face of lockdowns and social isolation policies. The UK has devoted years of effort to reduce smoking levels. However, in the Tobacco News Update last month (2) the British Government's target of smoke-free (that is 5% average adult smoking prevalence) by 2030 appeared shaky in the face of socioeconomic divide. If England, notes the BJGP author, is "on a final.difficult stretch" (ref 1 para 6) towards a smoke-free society, then the impact of COVID-19 may shatter that aim. Low socioeconomic status accompanies higher smoking rates (3), which may in themselves act as a proxy for social disadvantage. Similar low socioeconomic status may amplify the force of COVID-19, with mitigation measures such as self-quarantine proving difficult, impossible or even deadly for the disadvantaged (4). COVID-19 itself may pose an increased risk to smokers. Distracted by the drama of the news and the seductive compulsion of corona-caseometers we may, implies the BJGP author, forget to work on smoking cessation. Recommendations to minimize this risk, mitigation measures perhaps, include tracking the smoking history at every consultation, opportunistically offering cessation advice, watching out for increased smoking, messaging at-risk patients electronically and the provision of directed relapse prevention advice. Another recent addition to the COVID-19 literature provides a systematic review (as far as is possible this early on) of the relationship between the viral infection and the practice of tobacco smoking (5) . This paper has been summarized in this issue's Research Watch section but in brief the authors analyzed five studies that were selected for relevance to the current pandemic, all from the Chinese experience with sample sizes ranging from 41 to over a thousand patients, covering the period from December 2019 to January 2020. The studies compared current or former smoking rates according to COVID-19 outcomes (such as severity, ICU care and mortality) and found (with variations in sample size and statistical strength) that current or former smokers had a tendency towards poorer outcomes. The literature on COVID-19 and smoking is very young; a new paper that analyzes factors associated with disease severity in a cohort from New York has been released as a preprint, prior to medical review (6) . It contains some interesting findings including risk factors for hospitalization (older age, higher BMI, heart failure) and for critical illness (hypoxaemia and high inflammatory blood markers) in a group of over 4000 patients treated within an academic health system in New York City in March and April 2020. The paper concludes that smoking history is not associated with outcomes although closer reading confirms the need for proper peer review. The methods section reports that much information on these cases comes from the electronic health record without specific details on smoking information. Never smokers are grouped with unknown smokers and there is little or no information on duration or intensity of smoking. In the heat of a rising crisis, this sort of slow-medicine, preventative-health detail may not be a priority but the conclusion may not hold in the presence of more accurate information. Electronic health records may greatly underestimate smoking history (7), a limitation that may affect the analysis presented in this study. It is probably too early in the pandemic to confirm a strong association between smoking and COVID-19 outcomes or risk. However, WHO points to concerns about tobacco and waterpipe use, as a cause of cardiorespiratory disease and as a public and social activity that may enhance viral transmission (8) . The advice refers to cardiovascular and respiratory complications from smoking and notes that data from the Chinese epidemic associates much higher COVID-19 mortality with underlying disease such as heart disease, diabetes, hypertension, COPD and cancer. Tobacco may heighten the risk of COVID-19, according to WHO, through aggravation of underlying co-morbidities, through higher risk of COVID-19 cardiac complications and, in an epidemiological sense, through the greater likelihood of transmission between smokers who share the waterpipe. So how do we think about tobacco control in the context of COVID-19? The COVID-19 pandemic may mimic the tobacco pandemic at warp speed, sneaking past governments, bearing down on innocent lives and detonating death rates into the tens of thousands. They both need high level medical care, technological innovation and the brilliant insights of scientific minds to save thousands. They both need the quiet determination of sustained public health measures to flatten the curve and save millions. A recent interview (9) with an Australian climate change expert, Professor Will Steffen from the Australian National University, identified some commonalities between climate change (a slow disaster) and COVID-19 (a rapid one) that we here at the News have applied to tobacco control. There are three key lessons:

Listen to the science

Take action early, before the crisis reaches its peak

Once in a crisis, then dealing with it takes precedence over other things

COVID-19: Risk of increase in smoking rates among England's 6 million smokers and relapse among England's 11 million ex-smokers. BJGP Open

Trends in the prevalence of smoking by socio-economic status

Socioeconomic gradient in health and the covid-19 outbreak

COVID-19 and smoking: A systematic review of the evidence

Factors associated with hospitalization and critical illness among 4,13 patients with COVID-19 disease in

Pack-Year Cigarette Smoking History for Determination of Lung Cancer Screening Eligibility. Comparison of the Electronic Medical Record versus a Shared Decision-making Converstaion

Tobacco Free Initiative. Tobacco and waterpipe use increases the risk of suffering from COVID-19

Saturday AM. SAT 11 APR e How the US botched its pandemic response