Test Your Knowledge: Ten Questions on Tobacco Addiction

Question 6. Based on the best available clinical evidence, how much does nicotine-replacement therapy increase the odds of quitting? 1.5to 2-fold 2to 4-fold 5to 7-fold Question 7. Which one of the following statements best refl ects the evidence on different forms and doses of nicotine-replacement therapy for treating nicotine addiction? There is good evidence that therapy provided in the form of gum is superior to therapy in the form of a nasal spray or an inhaler at achieving abstinence. There is good evidence that oral therapy is superior to patches at achieving abstinence. In highly dependent smokers, there is good evidence that a 4-mg dose of gum is more effective than a 2-mg dose in achieving abstinence.

Question 6.Based on the best available clinical evidence, how much does nicotine-replacement therapy increase the odds of quitting?There is good evidence that therapy provided in the form of gum is superior to therapy in the form of a nasal spray or an inhaler at achieving abstinence.
There is good evidence that oral therapy is superior to patches at achieving abstinence.
In highly dependent smokers, there is good evidence that a 4-mg dose of gum is more effective than a 2-mg dose in achieving abstinence.
Question 8. Which one of the following antidepressants is most likely to increase the odds of quitting smoking?Gavin Yamey is a senior editor at PLoS Medicine.E-mail: gyamey@plos.orgDOI: 10.1371/journal.pmed.0020351

Question 9. Which one of the following best refl ects the evidence on smoking-cessation interventions to increase the chances of quitting?
There is good evidence that acupuncture is more effective than control (sham acupuncture).
There is good evidence that hypnotherapy increases rates of abstinence at six months more than no treatment.
Although physicians commonly advise their patients to quit, there is no good evidence that such advice increases the odds of quitting.
Although training health professionals to ask patients about smoking and to offer them treatment leads to an increase in the number of smokers offered advice and support, there is no evidence that such training leads to more people quitting.
Question 10.Which one of the following is likely to be the most effective at helping smokers quit?
Group behavioral therapy Self-help materials Opioid antagonists (such as naltrexone)

Answer 1. About 5 million
The World Health Organization states: "With 4.9 million tobacco-related deaths per year, no other consumer product is as dangerous, or kills as many people, as tobacco" [1].Answer 3. 85% About 85% of the world's smokers live in developing countries [1].

Answer 4. Physical or sexual abuse
Risk factors for smoking in adolescence include lower socioeconomic status, family stress, psychological distress (especially depressive symptoms), exposure to physical or sexual abuse, and parents who smoke.Closeness to parents and participation in extracurricular activities appear to be protective [1].
Answer 7. In highly dependent smokers, there is good evidence that a 4-mg dose of gum is more effective than a 2mg dose in achieving abstinence.
A Cochrane systematic review of nicotine-replacement therapy for smoking cessation found no evidence that one form of therapy is better than any other, but it did fi nd that in highly dependent smokers, there was a signifi cant benefi t of 4-mg gum compared with 2-mg gum (OR, 2.20; 95% CI, 1.85-3.25)[1].
Answer 9.Although training health professionals to ask patients about smoking and to offer them treatment leads to an increase in the number of smokers offered advice and support, there is no evidence that such training leads to more people quitting.A Cochrane systematic review of randomized trials of training health-care professionals about smoking cessation found that such training "had a measurable effect on professional performance" [1].Training led to an increase in the number of people identifi ed as smokers by health professionals and the number of smokers offered advice and support, but there was no strong evidence that training led to a change in smoking behavior.A systematic review of 22 randomized trials of acupuncture failed to detect an effect of acupuncture on smoking cessation when compared to sham acupuncture at any time point (including at six and 12 months) [2].
A systematic review of nine trials that compared hypnotherapy with 14 different control interventions was unable to show that hypnotherapy had a greater effect on six-month quit rates than other interventions or no treatment [3].Heterogeneity between trials prevented the authors from being able to calculate a pooled OR.
In a systematic review of physicians' advice on quitting, pooled data from 17 randomized trials of brief advice versus no advice (or usual care) showed a small but signifi cant increase in the odds of quitting (OR, 1.74; 95% CI, 1.48-2.05)[4].This increase equates to an absolute difference in the cessation rate of about 2.5%.
Yamey G (2005)  Test your knowledge: Ten questions on tobacco addiction.PLoS Med 2(9): e351.Copyright: © 2005 Gavin Yamey.This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.