Tobacco Dependence: A Comprehensive Guide to Prevention and Treatment

Description:

This book is a guide to pharmacotherapy treatment of tobacco dependence. The 2020 American Thoracic Society clinical practice guidelines on treating tobacco dependence serves as the cornerstone for this work with its robust discussion of recommended treatment options and how to tailor treatment to specific patient populations. Tobacco dependence remains a major health concern for many adults and given the dramatic increase of youth electronic cigarette use, clinicians need a singular resource to treat these different populations. This book addresses that by following the three main points of how to best address the adverse impact of tobacco use on public health: 1) prevent initiation of tobacco use; 2) understand mechanisms of addiction; 3) effectively treat tobacco dependence.
The book begins by describing the current patterns of product use, the adverse impact of tobacco on global health, and tobacco-related health disparities. Authors discuss both combustible and electronic tobacco products, as well as current research on the adverse impact of vaping and associated flavorings including menthol, role of the e-cigarette in cessation, and treatment of adolescent nicotine dependence. Chapters conclude with a discussion of specific tobacco control policies to improve overall public health.
This is an ideal guide for pulmonologists, pediatricians, primary care physicians and other specialty providers who see patients with nicotine dependence. This book is also of interest to public health professions to help inform public health campaigns and treatment offerings to reduce overall tobacco product use through prevention and treatment.

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Preface

Tobacco use and dependence causes or aggravates nearly all the pulmonary diseases seen in clinical practice. Overall the use of tobacco products has declined significantly since the original 1964 Surgeon General report on smoking. However, there is a great need for continued vigilance, research, and commitment to treatment to counteract the adverse impact of tobacco use on public health, particularly in socially disadvantaged populations. Consistently, systematic reviews and clinical guidelines have shown that there is a well-defined neurophysiologic basis for tobacco dependence and that tobacco dependence can be effectively treated. Yet most patients are not provided effective tobacco dependence treatment due to multiple clinician barriers, including lack of clinician education, as well as time and resource constraints.

In order to address the adverse impact of tobacco use it is important to (1) prevent initiation of tobacco use, (2) understand mechanisms of addiction, and (3) effectively treat tobacco dependence. Therefore, the purpose of this book is to provide an in-depth discussion of the basic science that underpins the diagnosis, severity, and treatment of tobacco dependence as well as the clinical art and practice of treating tobacco use and dependence. All clinicians can benefit from a greater understanding of the mechanisms of tobacco dependence and evidence-based methods for treatment. Furthermore, in order to impact overall public health it is important to consider policies and community programs that can broadly reduce tobacco use and increase access to treatment.

This book will follow current trends in tobacco research and clinical practice by focusing on (1) the impact of tobacco products on health and health disparities, and (2) guidelines for treatment of tobacco dependence, including nonpharmacologic approaches and pharmacotherapy. The recent American Thoracic Society clinical practice guidelines on initiating pharmacotherapy for tobacco dependence will be the cornerstone for a robust discussion of recommended treatment options and how to tailor treatment to specific patient populations and settings. Given the dramatic increase of youth electronic cigarette use, we will discuss current research on the health effects of vaping and associated flavorings including menthol products, and the treatment of adolescent nicotine dependence. We will conclude with avi
discussion on promoting training and education in tobacco dependence, increasing access to treatment, and specific tobacco control and tobacco treatment policies to improve overall public health.

Overall the intent of this book is to provide a practical overview of tobacco dependence to help clinicians and medical trainees feel empowered to assess and treat individuals with tobacco use and dependence. Our hope is that this book can provide a foundational primer of tobacco dependence for medical education training to ensure all clinicians have a strong knowledge base to adequately treat individuals with tobacco use and dependence.

We are astounded by the amazing effort of all of the authors, who bring significant clinical expertise and willingness to share their knowledge on this topic. We are so grateful to the support of Springer Science and Business Media for the support of this book, especially Margaret Moore and Prakash Jagannathan. Finally we are grateful to the many mentors, colleagues, and friends we have been fortunate to work with and who have supported us in this work.

Baltimore, MD, USA Michelle N. Eakin
Boston, MA, USA Hasmeena Kathuria

Table of contents :

Preface
Contents
Contributors
Chapter 1: Current Patterns of Tobacco Use and Health Disparities
Introduction
Health Equity in the Context of Tobacco and Understanding Tobacco-Related Disparities
Why Should We Recognize Tobacco-Related Disparities?
Poorer Outcomes for Those Who Face Disparities
Higher Cost for Those Who Face Disparities
Higher Tobacco Use and Secondhand Smoke Exposure Among Those Impacted by Tobacco-Related Disparities
Patterns of Tobacco Use in Various Populations
Age
Education
Gender
Race/Ethnicity
Income/Poverty
Other Tobacco Products (OTP)
Secondhand Smoke Exposure
Sexual Orientation and Gender Identity
Substance Use and Mental Health Disorders
Occupation and Veteran Status
Disability
Geography
Incarcerated People
Why Do Tobacco-Related Disparities Exist?
Social Determinants of Health
Targeted Marketing by the Tobacco Industry
Lack of Comprehensive Policies
Changing US Population
What Can We Do to Eliminate Disparities and Achieve Health Equity?
Increasing Diversity of the Healthcare Team
Address Inequities in Research
Solving Inequalities in Access, Quality of Care, and Socioeconomic Status
Implementing Appropriate Tobacco Control Policies
References
Chapter 2: Adverse Effects of Tobacco Products (Cigarettes, E-Cigarettes, Hookah, Smokeless Tobacco) Use on Health
Introduction: Impact on Health of All Tobacco Products
Mechanism of Injury of Tobacco Products
Pathophysiology
Oxidative Stress
Genetics and Epigenetics
Endothelial Dysfunction
Inflammation and Infection
Hemodynamic Effects
Thrombogenic Effects
Hormonal Alterations
Lipid Abnormalities
Specific Pathophysiology Related to Modes of Delivery and Additive Toxins
Cigarettes
Hookah
Vaping and Electronic Nicotine Delivery Systems (ENDS)
Smokeless Tobacco
Organ-Specific Morbidity and Mortality Attributed to Tobacco Product Use
Pulmonary Manifestations
Acute Respiratory Infection
Chronic Obstructive Pulmonary Disease (COPD)
Asthma
Respiratory Bronchiolitis Associated Interstitial Lung Disease (RB-ILD)
Desquamative Interstitial Pneumonia (DIP)
Pulmonary Langerhans Cell Histiocytosis (PLCH)
Cardiovascular Manifestations
Subclinical Atherosclerosis
Peripheral Arterial Disease
Coronary Heart Disease
Cerebrovascular Disease
Aortic Aneurysm
Atrial Fibrillation
Oncological Manifestations
Lung
Head and Neck
Gastrointestinal (Esophageal, Gastric, Colorectal, Hepatobiliary, Pancreas)
Genitourinary
Blood
Reproductive Manifestations
Female Reproductive Health
Male Reproductive Health
Pregnancy Complications
Perinatal and Infant Morbidity and Mortality
Endocrine Manifestations
Neuropsychiatric Manifestations
Miscellaneous Manifestations
Health Benefits of Cessation
Summary
References
Chapter 3: Neurobiology and Mechanisms of Nicotine Addiction
Introduction
Neurobiology of Nicotine Addiction
Acetylcholine (ACh)
Nicotine
nAChR Subtypes and Their Role in Nicotine Dependence
Nicotine Pharmacology
Case Creator: Dr. Hyma Gogineni
Low Dose Nicotine
Neurocognitive Effects of Nicotine
Nicotine Withdrawal Symptoms (NWS)
Case Creator: Dr. David Sachs
Nicotine Toxicity and Teratogenicity
Cues Support Nicotine and Tobacco Use
Pharmacogenomics
Case Creator: Dr. Hyma Gogineni
Mental Health Disorders
Existing Pharmacotherapies and nAChR Targets
Initial Screening and Management
New Developments
Summary
References
Chapter 4: Pharmacotherapy for the Treatment of Tobacco Dependence
Introduction
Controller Medications
Varenicline
Bupropion
Nicotine Patch
Reliever Medications
Nicotine Gum and Lozenge
Nicotine Inhaler
Nicotine Nasal Spray
Practical Considerations
Maximizing Initial Effectiveness
Combination Therapy
Common Treatment Moderators
Psychiatric Comorbidities
Patients Not Ready to Quit
Managing Side Effects
Relapse Prevention
Conclusion
References
Chapter 5: Non-Pharmacologic Approaches to Tobacco Cessation
Behavioral and Non-Pharmacological Approaches to Tobacco Cessation
Conceptual Models
Delivery Modalities
Implementation Challenges
Special Topics
Quitting Smokeless Tobacco
Quitting Nicotine Replacement Therapy
COVID-19 and Tobacco Cessation: Recent Evidence
Transcranial Magnetic Stimulation (TMS)
Special Populations
Racial and Ethnic Minority Populations
American Indian/Alaskan Native Populations
Sexual Minorities
Smoking and Pregnancy
Shifting Patterns of Tobacco Use
Young Adults
Conclusion and Recommendations
References
Chapter 6: Tobacco Dependence and Marginalized Populations: Key Considerations for Health Care Providers
Background: Tobacco, Marginalized Populations, and Health Inequities
Approaches to Tobacco Control, Management, and Treatment
Health Care Providers’ Role in Addressing Tobacco Health Disparities
Conclusion
References
Chapter 7: Treating Nicotine Dependence in the Pediatric Setting: Adolescents and Caregivers Who Smoke
Introduction
The Pediatric Setting Offers a Unique Opportunity and Responsibility to Address Smoking
Caregiver Smoking
Caregivers Who Smoke: An Opportunity and a Responsibility
Epidemiology of Caregiver Smoking
North America
Outside North America
Caregiver Smoking Is Concerning for Dependents
Secondhand and Thirdhand Smoke
SHS and THS Are Associated with Adverse Health Consequences
SHS Is Associated with Increased Risk of Subsequent Child Smoking
Screening for and Addressing Caregiver Smoking
Treatment of Caregiver Smoking
Counseling
Nicotine Replacement Therapy
Bupropion
Varenicline
Pediatric Smoking and Vaping
Epidemiology of Pediatric Smoking and Vaping
The Health Effects of Adolescent Vaping Are Concerning
Adolescents Should Be Screened for e-Cigarette Use
Treatment of Adolescent Nicotine Use Disorder
Summary
References
Chapter 8: Treatment of Tobacco Dependence in the Inpatient Setting
Treatment of Tobacco Dependence in the Inpatient Setting
Benefits of Inpatient Tobacco Treatment Programs
Structure of Inpatient Tobacco Treatment Programs
Identification of Patients
Staff and Providers
Billing and Funding
Integration in the Electronic Health Record (EHR)
Inpatient Counseling Strategies
Bedside Counseling
Post-Discharge Counseling
Inpatient Pharmacotherapy Considerations
Types of Medication
Post-Discharge Medications
Summary, Challenges, and Future Directions
References
Chapter 9: Integration of Tobacco Dependence Treatment in Lung Cancer Screening and Other Ambulatory Care Settings
Introduction
Cessation Related Risk Reduction in Lung Cancer Screening, Cancer Care, and Beyond
Lung Cancer Screening
Lung Cancer
Cancer Treatment
Non-Cancer Related Conditions
Marginalized Populations and Tobacco Use Disorder
Systemic and Structural Racism and Cessation Services
Quality and Personalized Patient Engagement
Quality Healthcare Underpinnings
Healthcare Provider Positionality, Implicit Bias, and Stigma
Patient- and Family-Centered Care and Communication
Lung Cancer Screening: An Opportunity for Patient-Centered Tobacco Treatment Care
Lung Cancer Screening
Shared Decision-Making Visits in Lung Cancer Screening
Tobacco Cessation in Lung Cancer Screening
Tobacco Use Disorder as a Chronic and Relapsing Condition Requires Comprehensive Cessation Services
Tobacco Treatment Recommendations
More Quit Attempts But Dismal Dissemination and Uptake of Cessation Services
Key Components of Integrated Tobacco Treatment in Clinical Care
National Call for Integration of Tobacco Treatment in Clinical Care
Collaborative and Comprehensive Patient-Centered Care
Healthcare Workforce Bridging Health Equity and Gaps in Cessation Services
Considerations for Pragmatic Integration of Tobacco Treatment in Clinical Care
Emerging Implementation Research for Tobacco Cessation Services in Cancer and Lung Cancer Screening
Proposed Models for Integration of Cessation Services in Lung Cancer Screening
Critical Components of Tobacco Cessation Services on the Front Lines
Leveraging the Electronic Health Record to Support Integration of End-to-End Cessation Services
Leveraging Telehealth to Facilitate Integration of Equitable Access to Care
Making the Economic Business Case for Integrating Tobacco Treatment into Clinical Care
Conclusion
References
Chapter 10: Bringing Treatment to the Patients: Community-Based Tobacco-Dependence Treatment and Interventions
Community Health and Population Health
Social Networks
Housing Units
Faith-Based Organizations
School-Based Communities
Principles of Community Engagement
References
Chapter 11: E-Cigarette: Friend or Foe?
Introduction
E-Cigarette and Its Components
Harmful Effects on the Body
Marketing
Addictive Potential
Perception
Gateway to Tobacco Use
Gateway to Illicit Drug Use
Failures in Tobacco Cessation
Success in Tobacco Cessation
Comparison to Nicotine-Replacement Therapies
Pathway to Dual Use
Public Health Community Recommendations
Conclusion
References
Chapter 12: Role of Menthol and Other Flavors on Tobacco and Nicotine Product Use
Sensory Effects and Biological Mechanisms
Tobacco Industry Marketing and Target Markets
Health Messaging
African-Americans
Women
Youth
Consumer Perceptions
Disparities in Use of Menthol Tobacco Products
Landscape for Menthol Tobacco and Nicotine Products in the USA
Market Share for Menthol Cigarettes
Flavored E-Cigarettes
Current US Regulations on Flavors in Tobacco and Nicotine Products
Initiation and Progression to Regular Use
Dependence
Cessation
Other Tobacco and Nicotine Products
Solutions to Combat Flavored Tobacco Use
Policy
Reducing Disparities and Promoting Health Equity
Cessation Resources
Concluding Thoughts
References
Chapter 13: Promoting Training and Education in Tobacco Dependence Treatment
Introduction
Delivery of Tobacco Curriculum in Various HCP Fields
Medical Students
Graduate Medical Education Trainees
Nursing Trainees
Pharmacy Trainees
Learning Content for Core Competencies in Evidence-Based Treatment of Tobacco Dependence
Learning Strategies in an Educational Program for Tobacco Dependence Treatment
Cognitive (C) and Skill (S) Objectives by Competency Area
Delivery Methods
Didactic Sessions
Simulation Sessions
Bedside Teaching
Multimedia
Online Resources and Toolkits
Summary
References
Chapter 14: Increasing Access to Treatment for Nicotine Dependence
Introduction
Barriers to Successful Provider-Led Treatment
Expanding Access to Cessation Support
Granting Prescribing Authority to Community Pharmacists
Standardizing Quitline-Delivered Care
Smartphone and App-Based Nicotine Dependence Interventions
Targeted Interventions for High-Risk Populations
Veterans Affairs and Department of Defense
Individuals Experiencing Homelessness
LGBTQ+ Communities
Providing Culturally Focused Treatments
Native Americans
African Americans
Hispanics/Latinx
Insurance Coverage of Treatment for Nicotine Dependence
Conclusion
References
Chapter 15: Tobacco Control Policies to Reduce Tobacco Use
Introduction
Federal Policy and Legislation
Milestones Achieved
The Tobacco Control Act Was Signed into Law in 2009
The “Deeming Rule” Was Finalized in 2016
Tobacco 21 Became a Nationwide Law in 2019
FDA’s Role to Reduce Death and Disease from Tobacco Use: Progress, Pitfalls, Loopholes, and Challenges
Graphic Warning Labels
Menthol
Nicotine Standards in Combustible Cigarettes
Synthetic Nicotine
Issue Orders for the Marketing of New Products
Beyond the FDA: Other Federal Actions to Decrease Death and Disease from Tobacco Use
The Centers for Disease Control and Prevention (CDC)
National Institutes of Health (NIH)
Centers for Medicare and Medicaid Services (CMS)
State Policy and Advocacy
National and State Tobacco Control Program (NTCP)
Advocacy and Tobacco Control Organizations
Smoke-Free Policy
Increase Tobacco Taxes and Equalize Taxes Across All Tobacco Products
Access to Cessation Services
Increase Funding for State Tobacco Control Programs
Pass Laws to Prohibit Sale of Flavored Tobacco Products, Including Menthol Cigarettes
Global Tobacco Control
Summary
References
Index