Tobacco Dependence: A Comprehensive Guide to Prevention and Treatment

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