Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005353.
Cahill K, Ussher M.
Abstract
BACKGROUND: Rimonabant is a selective type 1 cannabinoid (CB1) receptor antagonist. It may assist with smoking cessation by restoring the balance of the endocannabinoid system, which can be disrupted by prolonged use of nicotine. Rimonabant also seeks to address many smokers' reluctance to persist with a quit attempt because of concerns about weight gain.
OBJECTIVES: To determine whether selective CB1 receptor antagonists increase the numbers of people stopping smoking To assess their effects on weight change in successful quitters and in those who try to quit but fail.
SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Review Group specialized register for trials, using the terms 'rimonabant' and 'smoking' in the title or abstract, or as keywords. We also searched MEDLINE, EMBASE, CINAHL and PsycINFO, using major MESH terms. We acquired electronic or paper copies of posters of preliminary trial results presented at the American Thoracic Society Meeting in 2005, and at the Society for Research on Nicotine and Tobacco European Meeting 2006. We also attempted to contact the authors of ongoing studies of rimonabant, and Sanofi Aventis (manufacturers of rimonabant).
SELECTION CRITERIA: Types of studiesRandomized controlled trialsTypes of participantsAdult smokersTypes of interventionsSelective CB1 receptor antagonists, such as rimonabant.Types of outcome measuresThe primary outcome is smoking status at a minimum of six months after the start of treatment. We preferred sustained cessation rates to point prevalence, and biochemically verified cessation to self-reported quitting. We regarded smokers who drop out or are lost to follow up as continuing smokers. We have noted any adverse effects of treatment.A secondary outcome is weight change associated with the cessation attempt.
DATA COLLECTION AND ANALYSIS: Two authors checked the abstracts for relevance, and attempted to acquire full trial reports. One author extracted the data, and a second author checked them.
MAIN RESULTS: We found three trials which met our inclusion criteria, covering 1567 smokers (cessation: STRATUS-EU and STRATUS-US), and 1661 quitters (relapse prevention: STRATUS-WW). At one year, the pooled odds ratio (OR) for quitting with rimonabant 20 mg was 1.61 (95% confidence interval (CI) 1.12 to 2.30). No significant benefit was demonstrated for rimonabant at 5 mg dosage. Adverse events included nausea and upper respiratory tract infections.In the relapse prevention trial, smokers who had quit on the 20 mg regimen were 1(1/2) times more likely to remain abstinent on either active regimen than on placebo; the OR for the 20 mg maintenance group was 1.49 (95% CI 1.09 to 2.04, and for the 5 mg maintenance group 1.51 (95% CI 1.11 to 2.07). There appeared to be no significant benefit of maintenance treatment for the 5 mg quitters.Weight gain was reported to be significantly lower among the 20 mg quitters than in the 5 mg or placebo quitters. During treatment, overweight or obese smokers tended to lose weight, while normal weight smokers did not.
AUTHORS' CONCLUSIONS: From the preliminary trial reports available, rimonabant 20 mg may increase the odds of quitting approximately 1(1/2)-fold. Adverse events include nausea and upper respiratory tract infections; the risk of serious adverse events is reported to be low. The evidence for rimonabant in maintaining abstinence is inconclusive. Rimonabant 20 mg may moderate weight gain in the long term.

Plain language summary
Rimonabant is a selective CB1 receptor antagonist which may help smokers to quit, and may also reduce the amount of weight gained during the quitting process

Long-term use of nicotine can upset the endocannabinoid system in the brain, which controls food intake and energy balance. Rimonabant may help smokers to quit by rebalancing the system, which then reduces nicotine and food cravings. We searched our own specialised register of controlled trials. We also contacted Sanofi-Aventis, the manufacturers of rimonabant, and researchers who presented early findings at conferences. We found two randomized controlled trials (RCTs) of rimonabant for smoking cessation, covering 1567 smokers, and one RCT of rimonabant for relapse prevention covering 1661 quitters. Although full trial reports are not yet published, our own analyses show that rimonabant at the 20 mg dose increased by 1-fold the odds of not smoking at one year, compared with placebo. Rimonabant 5 mg did no better than placebo at any time point. In the relapse prevention trial, smokers who quit successfully on rimonabant 20 mg were 1 times more likely to remain abstinent on active treatment (5 mg or 20 mg) than on placebo. For those who quit successfully on 5 mg, neither active nor placebo treatment appeared to benefit them in avoiding relapse. This inconsistent picture makes it difficult to find a clear benefit for rimonabant in preventing relapse. Although the evidence on weight change is sparse in these trials, weight gain was reported to be significantly lower among the 20 mg quitters than in the 5 mg or placebo quitters. During treatment, overweight or obese smokers tended to lose weight on 20 mg, while normal weight smokers did not. Main side effects were nausea and upper respiratory tract infections, and serious harms were reported to be low.

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005353/frame.html

Abstract Background To calculate a pooled estimate of relative risk (RR) of lung cancer associated with exposure to passive smoking in never smoking women exposed to smoking spouses. This study is an updated meta-analysis that also assesses the differences between estimated risks according to continent and study type using meta-regression.

Methods From a total of 101 primary studies, 55 studies are included in this meta-analysis, of which, 7 are cohort studies, 25 population-based case-control and 23 non-population-based case-control studies. Twenty previously published meta-analyses are also reviewed. Fixed and random effect models and meta-regression are used to obtain pooled estimates of RR and P-value functions are used to demonstrate consistency of results.

Results The pooled RR for never-smoking women exposed to passive smoking from spouses is 1.27 (95% CI 1.171.37). The RR for North America is 1.15 (95% CI 1.031.28), Asia, 1.31 (95% CI 1.161.48) and Europe, 1.31 (1.241.52). Sequential cumulative meta-analysis shows no trend. There is no strong evidence of publication bias.

Conclusions The abundance of evidence, consistency of finding across continent and study type, doseresponse relationship and biological plausibility, overwhelmingly support the existence of a causal relationship between passive smoking and lung cancer.

Keywords passive smoking, lung cancer, meta-analysis
IJE Advance Access published online on August 9, 2007
International Journal of Epidemiology, doi:10.1093/ije/dym158

Richard Taylor*, Farid Najafi and Annette Dobson
School of Population Health, University of Queensland, Australia.
* School of Population Health, University of Queensland, Herston Road, Herston, Queensland 4006, Australia.
E-mail: r.taylor@sph.uq.edu.au

Maps showing the health and income profile of every council in England are being published by the government on 22 June 2007.

The charts, published for the second year running, are designed to help local officials identify areas and populations where public health needs improvement.

They show that Chiltern in Buckinghamshire has the lowest number of deaths from smoking with 147 people dying per 100,000, while Kensington and Chelsea in central London has the fewest dying from cancer -- 81 deaths per 100,000 people.

Summarised at a regional level, the charts show that people in the North West are the most likely to die from smoking related diseases.

Public Health Minister Caroline Flint said the maps would help local government and the National Health Service decide where to target resources to deal with health inequalities.

"One of our priority areas is smoking, we already know 10 million adults smoke but knowing where the local problem areas are helps target quit smoking programmes effectively," she said.

Source: ASH daily news and Department of Health, 22 June 2007
Article Link: http://tinyurl.com/3bpe8d

The Health Department reported significant progress in helping New Yorkers live healthier lives. In its third annual report on the City's Take Care New York health policy, the agency reports that the New Yorkers met the program for reducing smoking some two years ahead of schedule.

Launched in 2004, TCNY aimed to reduce the city's smoking rate to 18% by 2008. But the report shows that the rate fell to 17.5% in 2006, thanks to the City's aggressive anti tobacco campaign. The cigarette tax, the Smokefree Air Act, sustained hard hitting advertising, and nicotine replacement giveaways all played a role. Altogether, New York City now has 240,000 fewer smokers than it had in 2002.

Sources: ASH daily news (www.ash.org.uk) and MediLexicon, 14 August 2007
Article Link: http://tinyurl.com/yub2km

As Congress considers an increase in cigarette taxation, USA Today reported in its Friday editions that higher state taxes on cigarettes are producing significant declines in tobacco consumption.

The newspaper, conducting its own analysis of taxation and consumption figures, said the degree of decline in smoking appears to be tied directly to the size of the tax increase.

For example, cigarette sales fell 18 percent in North Carolina last year after the state tax was raised in two steps to 35 cents from 5 cents, the newspaper said.

In Connecticut, per capita consumption of cigarettes has fallen by 37 percent since 2002 while state taxes have increased from 50 cents per pack to $1.51, according to the newspaper.

The Senate last week approved a $35 billion tobacco tax increase as a way to pay for expanded government health care for children. Whilst the House of Representatives has proposed its own plan to provide health care to children through higher tobacco taxes and cuts in payments to private insurers in the Medicare Advantage program for the elderly.
Research shows that health concerns, tax increases and higher retail prices have all played a roll in the decline. It noted a Congressional Budget Office estimate that smoking falls 2.5 percent to 5 percent for every 10 percent increase in the price of cigarettes.
Sources: www.tobacco.org and Reuters, 10 August 2007 Article Link: http://tinyurl.com/326fby

Cigarette sales fell by 6.9 per cent as the smoking ban was introduced in England and Wales.

In the four weeks to July 28 smokers bought just over three billion cigarettes in Britain, down from the same period last year, according to the consumer research group AC Nielsen.

Anti-smoking campaigners have welcomed the steep decline, which is in line with similar falls that followed the introduction of smoking bans in Ireland in 2004 and Scotland last year.

Amanda Sandford of the health campaign group ASH, said: It's very encouraging. We hope this is indicative of people taking steps to give up smoking altogether.

A spokesman for Imperial Tobacco, the biggest player in the British cigarette market, said: What tends to happen following the introduction of smoking bans is an initial sharp drop in volumes, which then ameliorates over time.

Before the ban, Imperial Tobacco, which controls more than 46 per cent of total volumes, said that it expected duty paid market volumes to fall by 3 per cent over 12 months.

Whilst Borders, the book chain, said that sales of anti-smoking books by Allen Carr and the hypnotist Paul McKenna have risen by almost 260 per cent on average across their British stores.

Sources: ASH daily news (www.ash.org.uk) and The Times Online, 21 August
Article Link: http://tinyurl.com/2c79cc

The number of people trying to give up smoking in Barking and Dagenham has almost doubled since the introduction of the smoking ban.

Figures released by the Barking and Dagenham Primary Care Trust reveal that number of smokers referred to its stop smoking service in June and July this year doubled compared with the same two months last year.

Health advocates have lauded the ban as the most significant public health initiative in a generation.

Stop smoking service head Nicola Hill said: The scientific and medical evidence is clear, secondhand smoke is a killer. There is no safe level of exposure.

The smokefree law which bans smoking indoors in pubs, clubs and other workplaces has created a supportive environment for people wanting to kick the habit, she said.

The number of smokers asking for support to stop smoking increased following the smoking bans in Ireland and Scotland, and so we were prepared for the big increase in people contacting the Barking and Dagenham stop smoking service.

This is a very positive sign because smokers attending the service are four times more likely to quit than those attempting to do so on their own.

Source: ASH Daily News (ww.ash.org.uk) and Barking and Dagenham Recorder, 06 September 2007
Link: http://tinyurl.com/yob46x

Professor Shu-Hong Zhu, from the University of California, told international delegates attending the Oceania Tobacco Control conference that the number of quit attempts is key to success and asked delegates to shift their focus from the quality of smoker's quit attempts to the quantity of attempts.
Professor Ahu said A natural response to this problem is to encourage smokers to use cessation aids or behavioural counselling. These do increase the odds that smokers will successfully quit, but I would argue that increasing the frequency of quit attempts is as important.
Applying a simple mathematical model to various population data, Professor Zhu demonstrated that increasing the frequency of quit attempts in the general population leads to a quicker drop in smoking prevalence than increasing the use of cessation aids.
Professor Zhu noted that in California, smokers on average tried 12 to 14 times before quitting for good; 12 if they used cessation aids, and 14 if they did not. These figures have stayed fairly constant since data collection began in the early 1990s, even though the availability of cessation aids has increased.
What this means is that quitting aids reduce the overall number of attempts that are needed. But smokers still have to make multiple attempts, with or without these aids.
Ideally, all quit attempts would involve a cessation aid, counselling, or some other form of assistance, said Professor Zhu.
But it's not realistic to think that every quit attempt will be aided. The real key to speeding up the process is to encourage them to keep trying.
Professor Zhu, who directs California's statewide Quitline, said that among smokers who call the Quitline, the most common excuse given for not trying to quit is, I haven't got my patches yet.
The California Quitline has served more than 430,000 callers since its inception in 1992. In our experience it's best not to make people think quitting aids are essential for success. They're really just a tool to make quitting a little easier.
What is interesting about prompting more smokers to give up is that it creates a perception for the remainder that everybody is doing it. It helps to establish a norm of quitting, which can further increase the likelihood that smokers will try. Changing the impression that smokers have about what other smokers are doing can be a very effective tool in encouraging more attempts.

Source: ASH Daily News (www.ash.org.uk) and Scoop Health, 06 September 2007
Link: http://tinyurl.com/ytrqk7

THREE influential health organisations - the National Heart Foundation, the Cancer Council and Action on Smoking and Health - say Australia could be smoke-free in a decade with full government commitment.
The groups believe Australia could emulate a campaign in New Zealand that calls for smoking to be phased out over the next 10 years. It would be possible if federal and state governments increased funding for anti-smoking measures and phased in restrictions slowly.
"We support the New Zealanders and we think Australia could achieve that as well," the Heart Foundation's national tobacco spokesman, Maurice Swanson, said, from the Oceania Tobacco Control Conference in Auckland. "Subject to an appropriate level of commitment from the Australian Federal Government, it is possible that Australia could be smoke-free within 10 years."
Source: www.tobacco.org and AAP (Australian Associated Press)
Date: 2007-09-06 Author: AAP
URL: http://www.smh.com.au/news/national/groups-want-nation-smoke-free-in-10-years/2007/09/05/1188783320072.html ID: 252047

According to a 2006 survey by the Centers for Disease Control and Prevention, at least 22% of high school students in American smoke cigarettes everyday. In fact, even if the study indicated that smoking had already declined over the last four years, the statistics still show that one in five Americans still smoke cigarettes. A 2005 study revealed that more than 20% of adults in the United States are smokers. While smoking rates among high school students have been on a decline since 1997, the rate of teenagers who smoke is equal to, and in some cases, higher than that of adults. The younger the individuals start smoking, the more likely that they will continue smoke as an adult. Given these figures, it is not surprising that smoking is the leading cause of premature deaths in the United States.

The question is still begging to be asked: Why do teens smoke? . . .

Joining a program that helps people quit smoking; and consulting a doctor about medications that reduce the craving to smoke may also help. Others succeed by using alternative methods like hypnosis. Although it may be a very hard habit to break, quitting smoking is one of the best things people can do to improve their sex lives and their over-all health.
Sources: www.tobacco.org and ArticlesBase
Date: 2007-09-07
URL:
http://www.articlesbase.com/health-articles/cigarette-smoking-is-dangerous-to-your-sexual-health-210591.html

Nabi Biopharmaceuticals said the nine-month results from the ongoing trial of its nicotine conjugate vaccine (NicVAX) are positive.

The Miami-based drug maker said the data for the vaccine, being developed to treat nicotine addiction and prevent smoking relapse, has enabled Nabi to determine what it believes is the most effective dose and schedule.

Nabi said the data shows effectiveness in continuous abstinence rates by dose and by antibody response.

Sources: www.tobacco.org and Business Journal of South Florida
Date: 2007-09-06, 997-2007
URL: http://www.bizjournals.com/southflorida/stories/2007/09/03/daily30.html

The head of the World Health Organization, the United Nations' health watchdog, said that the world has more to lose than to gain from the tobacco industry.

Margaret Chan, director-general of WHO, said at the 58th WHO Western Pacific Regional Committee "It is correct to say that tobacco as an industry brings income to countries but one has to do a full economic analysis. You also need to look at the other side of the equation."

"When you do that full evaluation, the damage due to tobacco is much greater than economic incomes rising from tobacco," Chan said.

She also underlined her agency's very strong position on tobacco control, urging members to implement the WHO Framework Convention on Tobacco Control.

The 58th WHO Regional Committee for the Western Pacific is currently underway bringing more than 400 health officials from the agency's 31 regional member states to South Korea.
Source: ASH daily news (www.ash.org.uk)