About the Blog Author-John R. Hughes, MD
John R. Hughes, MD is Professor of Psychiatry, Psychology and Family Practice at the University of Vermont. Dr. Hughes is board certified in Psychiatry and Addiction Psychiatry. His major focus has been clinical research on tobacco use. Dr. Hughes received the Ove Ferno Award for research in nicotine dependence and the Alton Ochsner Award Relating Smoking and Health. He is a co-founder and past president of the Society for Research on Nicotine and Tobacco, and the Association for the Treatment of Tobacco Use and Dependence. Dr. Hughes has been Chair of the Vermont Tobacco Evaluation and Review Board which oversees VT’s multi-million dollar tobacco control programs. He has over 400 publications on nicotine and other drug dependencies and is one of the world’s most cited tobacco scientist. Dr. Hughes has been a consultant on tobacco policy to the World Health Organization, the U.S. Food and Drug Administration, and the White House. His current research is on how tobacco users and marijuana users stop or reduce use on their own, novel methods to prompt quit attempts by such users, whether smoking cessation reduces reward sensitivity and whether stopping e-cigarettes causes withdrawal. Dr Hughes has received fees from companies who develop smoking cessation devices, medications and services, from governmental and academic institutions, and from public and private organizations that promote tobacco control.
An analysis of the large PATH survey reports that 26% of US adults are current tobacco users and 18% are cigarette smokers (NEJM 376:342, 2016). Thus, 1/3rd of tobacco use is from products other than cigarettes. The two most common non-cigarette tobacco products in the study were cigars (7%) and ecigs (5%).
A major question now becomes is what is our goal with treatment: abstinence from cigarettes (clearly the most harmful), abstinence from the more harmful combustible....
The Tobacco Addiction Group of Cochrane (of which I am a member) published six new or revised meta-analyses of treatments for tobacco dependence. I am a big fan of the Cohrane reviews because they are all done using the same methods, usually locate all the available trials, and use rigorous methods.
An updated review of motivational interviewing (MI) located 28 studies and found MI moderately increased cessation by 1.3 fold compared to brief advice....
Although there has much press about e-cigarettes recently, we should not forget that smokeless tobacco use is increasing in the US. For example, in a very recent survey, 2.4% of Americans were currently using smokeless vs 2.3% using e-cigarettes (Lee et al, Preventive Med 62:14-19). A recent Cochrane review concluded that person-to-person counseling was helpful for cessation of smokeless tobacco. However, neither NRT nor bupropion was consistently effective. One study...