BACKGROUND & AIMS: :Gender-specific associations between prenatal smoking and birthweight, and neonate intensive health care were studied. Cross-sectional data from 11,583 newborns in the continuous National Health and Nutrition Examination Survey (NHANES) 2003-2008 early childhood data sets were used. Change in infant birthweight and likelihood of receiving neonatal intensive care by prenatal smoking exposure were assessed. Multivariable regression models were used to assess the influence of prenatal smoking on birthweight and likelihood of receiving intensive neonatal health care. Compared with infants from nonsmoking mothers, prenatal smoking associated with significant decrease in infant birthweight, -203.0 g ± 32.5, P < 0.001. The change in birthweight differed between infant boys, -220.2 g ± 44.5, and girls, -184.1 g ± 38.8. Newborns exposed to prenatal smoking were more likely to have low birthweight, odds ratio 1.46, P < 0.03, and to receive neonatal intensive health care, odds ratio 1.20; P < 0.04. It is imperative that prenatal counseling emphasizes prenatal maternal smoking.

背景与目标： ：研究了产前吸烟与出生体重之间的性别特异性关联以及新生儿重症监护。在连续的2003-2008年全国健康和营养检查调查（NHANES）中，使用了来自11,583名新生儿的横断面数据。评估了婴儿出生体重的变化以及通过产前吸烟暴露获得新生儿重症监护的可能性。多变量回归模型用于评估产前吸烟对出生体重的影响以及接受强化新生儿保健的可能性。与非吸烟母亲的婴儿相比，产前吸烟与婴儿出生体重显着降低相关，为-203.0 g±32.5，P <0.001。出生体重的变化在男婴为-220.2 g±44.5和女婴为-184.1 g±38.8之间。暴露于产前吸烟的新生儿更可能具有较低的出生体重，比值比为1.46，P <0.03，并且接受新生儿重症监护，比值比为1.20； P ＜0.04。产前咨询必须强调产前孕妇吸烟。

BACKGROUND & AIMS: AIM:To develop a simple and accurate method for quantifying 8-isoprostane in plasma by employing a combination of two-step solid-phase extraction of samples and a commercially available ELISA kit, and by this method to examine the effects of drinking and smoking habits against the levels of plasma 8-isoprostane in healthy Japanese volunteers. METHODS:Plasma 8-isoprostane was extracted with ODS gel suspension followed by NH(2) Sep-Pak column. The 8-isoprostane fractions were assayed using a commercially available ELISA kit. We measured plasma 8-isoprostane levels in 157 healthy Japanese volunteers divided into three groups (64 non-habitual drinkers, 56 moderate drinkers and 37 habitual drinkers) according to their alcohol consumption per week. Genotypes of aldehyde dehydrogenase 2 (ALDH2) were also determined to investigate the plasma 8-isoprostane levels with reference to drinking habits. In addition, the plasma 8-isoprostane levels of 96 non-smokers and 61 smokers from the same subjects were compared. RESULTS:Our method fulfilled all the requirements for use in routine clinical assays with respect to sensitivity, intra- and inter-assay reproducibility, accuracy and dynamic assay range. Significant increases of plasma 8-isoprostane levels were observed in female habitual drinkers when compared with those of non-habitual drinkers (t = 5.494, P<0.0001) as well as moderate drinkers (t = 3.542, P<0.005), and 8-isoprostane levels were also significantly different between ALDH2*2/1 and ALDH2*1/1 in the female habitual drinkers (t = 6.930, P<0.0001), suggesting that excessive drinking of alcohol may increase oxidization stress, especially in females. On the contrary, no significant difference of the plasma 8-isoprostane levels was observed between non-smokers and smokers. CONCLUSION:Our present method was proved to be a simple and accurate tool for measuring plasma 8-isoprostane. However, the clinical utility of plasma 8-isoprostane for drinking and smoking habits was limited since elevated 8-isoprostane levels were observed in female heavy drinkers, and no association was found between smokers and nonsmokers.

背景与目标： 目的：通过结合两步固相萃取样品和市售ELISA试剂盒，开发一种简单而准确的定量血浆中8-异前列腺素的方法，并以此方法检查饮酒和吸烟习惯的影响健康的日本志愿者中血浆8-异前列腺素水平的变化。
方法：用ODS凝胶悬浮液，然后用NH（2）Sep-Pak柱提取血浆8-异前列腺素。使用市售ELISA试剂盒测定8-异前列腺素级分。我们根据每周的酒精摄入量，对157名健康的日本志愿者的血浆8-异前列腺素水平进行了测量，这些志愿者分为三组（64名非习惯性饮酒者，56名中度饮酒者和37名习惯性饮酒者）。还确定了醛脱氢酶2（ALDH2）的基因型，以参考饮酒习惯研究血浆8-异前列腺素水平。此外，比较了来自同一受试者的96名非吸烟者和61名吸烟者的血浆8-异前列腺素水平。
结果：我们的方法满足了常规临床测定中灵敏度，测定内和测定间重现性，准确性和动态测定范围的所有要求。与非惯常饮酒者（t = 5.494，P <0.0001）和中度饮酒者（t = 3.542，P <0.005）和8-习惯饮酒者相比，女性惯常饮酒者血浆8-异前列腺素水平显着增加。在女性习惯性饮酒者中，ALDH2 * 2/1和ALDH2 * 1/1之间的异前列腺素水平也存在显着差异（t = 6.930，P <0.0001），这表明过量饮酒可能会增加氧化应激，尤其是女性。相反，在非吸烟者和吸烟者之间未观察到血浆8-异前列腺素水平的显着差异。
结论：我们的现有方法被证明是一种简单而准确的测量血浆8-异前列腺素的工具。但是，血浆8-异前列腺素在饮酒和吸烟习惯中的临床应用受到限制，因为在女性大量饮酒者中观察到8-异前列腺素水平升高，并且在吸烟者和不吸烟者之间未发现关联。

BACKGROUND & AIMS: :Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.

背景与目标： ：包括澳大利亚原住民卫生工作者（AHWs）在内的澳大利亚原住民吸烟率是非原住民人口的两倍。这项研究利用概念图方法论来确定和优先考虑与文化相关的策略，以促进AHW中的戒烟。利益相关者的参与者包括AHW，其他卫生服务员工和烟草控制人员。通过34次访谈，3个焦点小组和一个利益相关者研讨会，集体讨论了戒烟策略（n = 74）。利益相关者将策略分为有意义的组，并根据感知到的重要性和可行性对它们进行评级。使用多维缩放和层次聚类分析开发了概念图。描绘了十个独特的戒烟策略组，这些策略针对个人，家庭和同龄人，社区，工作场所和公共政策。除更广泛的策略解决了使吸烟永久化和使戒烟困难的社会和环境压力外，还代表了戒烟资源和服务。在政府协调的卫生服务机构与社区控制的卫生服务机构中，参与者对集群的重要性和可行性的看法有所不同。对于脆弱人群中的卫生服务工作者，这些发现显然暗示着除了传统的烟草控制策略外，还需要有针对性的策略来减轻社会和环境压力。概念图已应用于知识翻译中，以指导针对AHW的戒烟计划的开发。

BACKGROUND & AIMS: :Previous research indicates that tobacco craving predicts relapse to smoking among adult smokers attempting to quit. We hypothesized a similar relationship between craving and lapse (any smoking following a period of abstinence) among adolescent smokers during the treatment phase of a clinical trial. A visit was considered a lapse visit if the participant reported smoking or had a carbon monoxide level of 7 ppm or greater subsequent to an abstinent visit. A total of 34 participants (mean age = 14.9 years [SD = 1.3]; mean cigarettes/day = 18.0 [SD = 7.6]; mean Fagerström Test for Nicotine Dependence score = 6.8 [SD = 1.34]; 65% female), were included in the present analysis of 167 treatment visits. Logistic regression analyses showed a positive relationship between degree of craving, measured by the Questionnaire on Smoking Urges, and lapse during smoking cessation treatment (p = .013). Additionally, linear regression analyses demonstrated a strong positive association between cigarettes smoked per day and craving scores (p<.001). Taken together with other data, these findings suggest that degree of craving might influence tobacco abstinence for adolescent smokers. Thus monitoring and addressing craving appears useful to increase the success of adolescent smoking cessation.

背景与目标： ：先前的研究表明，对烟草的渴望可以预测试图戒烟的成年吸烟者会再次吸烟。我们假设在临床试验的治疗阶段，青少年吸烟者的渴望与失误（戒酒一段时间后吸烟）之间存在类似的关系。如果参与者在戒酒后报告吸烟或一氧化碳水平为7 ppm或更高，则该访问被视为失访。共有34名参与者（平均年龄= 14.9岁[SD = 1.3]；平均每天吸烟= 18.0 [SD = 7.6]；平均Fagerström尼古丁依赖性评分测试= 6.8 [SD = 1.34]； 65％为女性）目前对167次治疗就诊的分析中已包括在内。 Logistic回归分析显示，渴望度（由吸烟率问卷调查得出）与戒烟治疗期间的消退之间呈正相关（p = 0.013）。此外，线性回归分析表明每天吸烟与渴望分数之间有很强的正相关性（p <.001）。结合其他数据，这些发现表明，渴望程度可能会影响青少年吸烟者的戒烟。因此，监测和解决渴望对增加青少年戒烟的成功率似乎是有用的。

BACKGROUND & AIMS: :The objective of this work was to characterize trends over time in urinary excretion of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) among cigarette smokers in the US. We identified 35 studies presenting data that either reported, or could be converted to, common units of total urinary NNAL excretion as pmol/mg creatinine. The studies spanned 18years, reported urinary NNAL excretion estimates for 61 defined populations, and included a combined total of 3941 study participants. Analyses show that urinary NNAL excretion trends downward with study publication year, and the trend is statistically significant. The trend does not appear to be accounted for by a reduction in cigarettes smoked per day by study participants over the same time period. This trend is consistent with reductions in tobacco specific nitrosamine (TSNA) levels in both cigarette tobacco filler and mainstream cigarette smoke observed over the past decade and with efforts by the tobacco industry and the agricultural community to reduce levels of TSNAs in tobacco and cigarette smoke.

背景与目标： ：这项工作的目的是表征美国吸烟者中4-（甲基亚硝胺基）-1-（3-吡啶基）-1-丁醇（NNAL）随时间的排泄趋势。我们鉴定了35项研究，这些研究报告的数据报告或可以转换为总尿液NNAL排泄的常见单位为pmol / mg肌酐。这项研究历时18年，报告了61个特定人群的尿NNAL排泄量估计值，并且总共包括3941名研究参与者。分析显示，随着研究出版年份的增加，尿液NNAL排泄量呈下降趋势，并且该趋势具有统计学意义。研究参与者在同一时期内每天吸烟量的减少似乎不能解释这一趋势。这种趋势与在过去十年中观察到的卷烟烟草填充剂和主流卷烟烟雾中特定于烟草的亚硝胺（TSNA）水平的降低以及烟草业和农业界为降低烟草和卷烟烟雾中TSNA含量所做的努力是一致的。

BACKGROUND & AIMS: AIMS:Lack of adherence to smoking cessation medication regimens is assumed to play a significant role in limiting their effectiveness. This study aimed to assess evidence for this assumption. METHODS:A systematic search was conducted, supplemented by expert consultation, of papers reporting on randomized trials and observational studies examining the association between adherence to cessation medication and the success of quit attempts. To rule out reverse causality, only studies where adherence was assessed prior to relapse were included. Five studies met the inclusion criteria and results were extracted independently by two researchers. Heterogeneity between studies precluded a pooled analysis of the data. RESULTS:Studies varied widely with regard to both the definition of adherence and outcome measures. The included studies only addressed adherence to nicotine replacement therapy. One study of lozenge use found that the amount of medication used between 1 and 2 weeks after the quit date predicted abstinence at 6 weeks [adjusted odds ratio (OR) for 'high' versus 'low' lozenge use 1.25; 95% confidence interval (CI) = 1.05-1.50; P < 0.02]. Similarly, one study found a significant impact of oral nicotine consumption during the first week on abstinence at 4 weeks (adjusted OR per additional mg/day = 1.05; CI = 1.01-1.10). Another study found that participants using nicotine replacement therapy for at least 5 weeks were significantly more likely to self-report continuous abstinence at 6 months. The remaining two studies failed to find a significant effect of treatment duration on outcome at 1 and 2 years but had very low power to detect such an effect. CONCLUSIONS:There is modest evidence to support the assumption that lack of adherence to nicotine replacement therapy regimens undermines effectiveness in clinical studies.

背景与目标： 目的：假设缺乏坚持戒烟药物方案在限制其有效性方面起着重要作用。这项研究旨在评估这一假设的证据。
方法：进行了系统的搜索，并有专家咨询的补充，报告了有关随机试验和观察性研究的论文，这些研究探讨了坚持戒断药物与戒烟成功之间的关系。为了排除反向因果关系，仅包括在复发前评估依从性的研究。五项研究符合纳入标准，结果由两名研究人员独立提取。研究之间的异质性排除了对数据进行汇总分析的可能性。
结果：关于依从性的定义和结果测量的研究差异很大。纳入的研究仅针对坚持尼古丁替代疗法。一项关于锭剂使用的研究发现，戒烟日期后1至2周内使用的药物量预计在6周时会出现戒断[对于“高”锭剂和“低”锭剂使用，校正后的优势比（OR）为1.25； 95％置信区间（CI）CI = 1.05-1.50; P <0.02]。同样，一项研究发现在第一个星期口服尼古丁对禁食4周有显着影响（调整后的OR /每增加1 mg /天= 1.05； CI = 1.01-1.10）。另一项研究发现，使用尼古丁替代疗法至少5周的参与者在6个月时自我报告连续禁欲的可能性更高。其余两项研究未能发现治疗持续时间对1年和2年结局有显着影响，但检测这种效果的能力非常低。
结论：有少量证据支持以下假设：缺乏对尼古丁替代疗法的依从性破坏了临床研究的有效性。

BACKGROUND & AIMS: :There is growing preclinical evidence for the involvement of glutamate in the behavioral actions of nicotine. The aim of this study, was to investigate the role of N-methyl-D-aspartate (NMDA) receptors in the cognitive and subjective effects of smoking in humans. Sixty regular smokers took part in this double-blind placebo controlled study, that investigated the effect of the NMDA-antagonist memantine (40 mg) and the nicotinic-receptor antagonist mecamylamine (10 mg) on smoking-induced improvement in performance of a task of sustained attention and on smoking-induced changes in subjective effects and craving. Increases in subjective ratings of 'buzzed' following smoking were reversed by memantine, but not by mecamylamine. In contrast, improvement on a Rapid Visual Information Processing task by smoking was opposed by mecamylamine, but not by memantine. Smoking reduced craving for cigarettes, but neither drug altered this effect. Our results suggest that glutamatergic mechanisms may have differential involvement in the subjective and cognitive actions of smoking. Further investigations using different ligands are warranted to fully characterize the role of glutamate underlying the consequences of smoking behavior.

背景与目标： ：越来越多的临床前证据表明谷氨酸参与尼古丁的行为活动。这项研究的目的是调查N-甲基-D-天冬氨酸（NMDA）受体在吸烟对人类的认知和主观影响中的作用。 60名常规吸烟者参加了这项双盲安慰剂对照研究，该研究调查了NMDA拮抗剂美金刚（40 mg）和烟碱样受体拮抗剂美卡明胺（10 mg）对吸烟引起的一项任务的改善的作用。持续关注和吸烟引起的主观效果和渴望的变化。美金刚可以逆转吸烟后“嗡嗡”的主观评分，但美卡敏不能逆转。相比之下，美卡明胺反对吸烟改善快速视觉信息处理任务，而美金刚胺则反对。吸烟减少了对香烟的渴望，但是没有一种药物改变了这种效果。我们的结果表明，谷氨酸能机制可能在吸烟的主观和认知行为中有不同的参与。有必要使用不同的配体进行进一步研究，以充分表征谷氨酸在吸烟行为后果中的作用。

BACKGROUND & AIMS: BACKGROUND:General practitioners' (GPs) negative beliefs about smoking cessation services may act as barriers to them recommending such services to smokers motivated to stop smoking. METHODS:In Study 1, 25 GPs from 16 practices across London were interviewed in this qualitative study. Framework analysis was used to identify key themes in GPs' beliefs about smoking cessation services. In Study 2, a convenience sample of 367 GPs completed an internet-based survey. Path-analysis was used to examine relationships between beliefs identified in Study 1 and intentions to recommend smoking cessation services. RESULTS:In Study 1, GPs felt that smoking cessation assistance was best provided by others. GPs favoured local services (i.e. practice nurses offering stop smoking support) over central services (i.e. offered through the Primary Care Trust), mainly because these were seen as more personalised and accessible for patients. These beliefs appeared to influence GPs' beliefs about the effectiveness of services. In Study 2, GPs' beliefs had a large effect on their intentions to recommend both central services, (f2 = .79) and local services, (f2 = 1.04). GPs' beliefs about effectiveness and cost-effectiveness were key predictors their intentions to recommend central services and local services. Beliefs about the level of personalisation offered and smokers' likelihood of attending services had indirect effects on intentions to recommend services operating via beliefs about effectiveness. CONCLUSION:GPs vary in their perceptions of the effectiveness of smoking cessation services and their intentions to recommend these services vary in line with these beliefs. Interventions aimed at increasing the likelihood with which GPs recommend these services may therefore be more effective if they addressed these beliefs.

背景与目标： 背景：全科医生对戒烟服务的消极信念可能会阻碍他们向有志于戒烟的吸烟者推荐此类服务。
方法：在这项定性研究中，研究1采访了伦敦16家医院的25名全科医生。框架分析用于确定全科医生对戒烟服务的信念中的关键主题。在研究2中，一个367名GP的便利样本完成了一项基于Internet的调查。路径分析用于检验研究1中确定的信念与推荐戒烟服务的意图之间的关系。
结果：在研究1中，家庭医生认为其他人最好提供戒烟帮助。全科医生相对于中央服务（即通过初级保健基金会提供的服务）偏爱本地服务（即提供戒烟支持的执业护士），主要是因为这些服务被视为对患者更具个性化和可及性。这些信念似乎影响了全科医生对服务有效性的信念。在研究2中，GP的信念对推荐中央服务（f2 = .79）和本地服务（f2 = 1.04）的意图产生了很大影响。全科医生对有效性和成本效益的信念是他们打算推荐中央服务和本地服务的主要预测指标。关于提供的个性化水平的信念以及吸烟者参加服务的可能性，通过对有效性的信念对推荐服务的意图产生了间接影响。
结论：全科医生对戒烟服务有效性的看法各不相同，因此推荐这些服务的意图也因这些信念而异。因此，如果他们解决了这些信念，旨在增加全科医生推荐这些服务可能性的干预措施可能会更加有效。

BACKGROUND & AIMS: :The study evaluated the relationship of psychopathology to treatment response of 208 smokers prescribed transdermal nicotine (8 weeks). Participants were relatively high functioning (DSM-IV axis V score) outpatients in a university-based clinic. The primary study objective was to determine whether patients with a history of either a DSM-IV axis I or II diagnosis would have poorer during treatment response (patch adherence, smoking) and lower rates of smoking cessation at post-patch follow-up (study weeks 9, 26, 52) than those without a diagnosis. While there was some indication that patients with a history of psychopathology wore the patch less frequently, psychopathology was not associated with during- and post-treatment smoking.

背景与目标： ：该研究评估了208名处方透皮尼古丁吸烟者的心理病理学与治疗反应的关系（8周）。参加者是大学诊所中功能较高的患者（DSM-IV轴V评分）。主要研究目的是确定既有DSM-IV轴I或II病史的患者在治疗反应期间（贴片依从性，吸烟）是否较差，并且在贴片后随访时是否戒烟率较低（研究） 9、26、52周）。尽管有迹象表明有精神病理学史的患者佩戴该贴片的频率较低，但精神病理学与治疗期间和治疗后的吸烟无关。

BACKGROUND & AIMS: This study investigates the incidence trends of urinary bladder cancer in Sweden from 1960 through 1993 (a total of 46,211 cases). Age-standardized incidence rates increased among men from 14.6 per 10(5) in 1960 to 33.5 in 1993 and among women from 4.8 to 8.8, corresponding to an average annual increase of 2.4 percent (95 percent confidence interval [CI]) = 2.0-2.7 percent) and 1.1 percent (CI = 0.9-1.4 percent), respectively. The largest increase occurred in the oldest age-groups. The proportion of patients with transitional cell carcinoma increased in men from 66.0 percent in 1960-64 to 93.6 percent in 1990-93 and in women from 61.0 percent to 89.4 percent. The proportion of patients with papillomas decreased, whereas those with adenocarcinoma and squamous cell carcinoma were stable. Regression modeling (based on the period 1960-89) showed a strong linear effect due to either period and/or cohort. Among men, additional non-linear effects by both period and cohort were obtained. The cohort effects were more important. Cohort data on having smoked daily showed considerable similarities with the estimated cohort-effects. Our findings suggest that the increase of tobacco smoking in successive generations can explain the increase in incidence rates of bladder cancer in Sweden, whereas improved diagnostic activities and registration are less likely to explain fully the changes in incidence rates.

背景与目标： 这项研究调查了瑞典从1960年到1993年的膀胱癌的发病趋势（共46,211例）。男性的年龄标准化发病率从1960年的每10（5）中的14.6（10）增加到1993年的33.5，女性的年龄则从4.8增加到8.8，相当于每年平均增长2.4％（95％置信区间[CI]）= 2.0-分别为2.7％和1.1％（CI = 0.9-1.4％）。增长最大的是年龄最大的年龄组。男性中移行细胞癌患者的比例从1960-64年的66.0％增加到1990-93年的93.6％，女性从61.0％增加到89.4％。乳头状瘤患者的比例下降，而腺癌和鳞状细胞癌患者的比例稳定。回归建模（基于1960-89年期间）由于周期和/或同类群组而显示出强大的线性效应。在男性中，通过周期和队列均获得了额外的非线性效应。队列效应更为重要。每天吸烟的队列数据显示与估计的队列效应有很大的相似性。我们的发现表明，连续几代吸烟的增加可以解释瑞典膀胱癌的发病率增加，而诊断活动和登记的改善不太可能完全解释发病率的变化。

BACKGROUND & AIMS: BACKGROUND:Taking regular exercise, whether cardiovascular-type exercise or resistance exercise, may help people to give up smoking, particularly by reducing cigarette withdrawal symptoms and cravings, and by helping to manage weight gain. OBJECTIVES:To determine the effectiveness of exercise-based interventions alone, or combined with a smoking cessation programme, for achieving long-term smoking cessation, compared with a smoking cessation intervention alone or other non-exercise intervention. SEARCH METHODS:We searched the Cochrane Tobacco Addiction Group Specialised Register for studies, using the term 'exercise' or 'physical activity' in the title, abstract or keywords. The date of the most recent search was May 2019. SELECTION CRITERIA:We included randomised controlled trials that compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme alone or another non-exercise control group. Trials were required to recruit smokers wishing to quit or recent quitters, to assess abstinence as an outcome and have follow-up of at least six months. DATA COLLECTION AND ANALYSIS:We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison, as either smoking cessation or relapse prevention. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. MAIN RESULTS:We identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group-based cardiovascular-type exercise supplemented by a home-based exercise programme and combined with a multi-session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi-session cognitive behavioural smoking cessation programme alone. Overall, we judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. Among the 21 studies analysed, we found low-certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). We excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular-type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular-type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when we excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, we found very low-certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long-term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). AUTHORS' CONCLUSIONS:There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions.

背景与目标： 背景：定期进行锻炼，无论是心血管运动还是抵抗运动，都可以帮助人们戒烟，特别是通过减少戒烟症状和渴望，以及帮助控制体重增加。
目的：与单独戒烟干预措施或其他非运动干预措施相比，要确定单独以运动为基础的干预措施或与戒烟计划相结合实现长期戒烟的有效性。
搜索方法：我们在标题，摘要或关键字中使用了“锻炼”或“体育活动”一词，搜索了Cochrane烟草成瘾小组的专门登记册以进行研究。最近一次搜索的日期是2019年5月。
选择标准：我们纳入了随机对照试验，将单独的锻炼计划或作为戒断计划的辅助手段的锻炼计划与单独的戒断计划或另一个非运动对照组进行比较。需要进行试验以招募希望戒烟或最近戒烟的吸烟者，以评估戒酒的结果，并进行至少六个月的随访。
数据收集与分析：我们遵循标准的Cochrane方法。至少六个月后，使用最严格的定义，以意图治疗为基础对戒烟进行了测量。在可能的情况下，我们为每个研究计算了戒烟的风险比（RRs）和95％置信区间（CIs）。我们根据比较类型将符合条件的研究分组，包括戒烟或预防复发。我们在适当的情况下使用Mantel-Haenszel随机效应模型进行了荟萃分析。
主要结果：我们鉴定了24项符合条件的试验，共有7279名成年受试者被随机分配。两项研究的重点是预防最近戒烟的吸烟者的复发，其余22项研究与希望戒烟的吸烟者戒烟有关。十一项研究仅针对女性，一项针对男性。大多数研究招募了相当不活跃的人。大多数试验采用有监督的，基于小组的心血管运动，并辅以基于家庭的运动计划，并与多阶段认知行为戒烟计划相结合。在大多数情况下，比较者仅是一个多阶段认知行为戒烟计划。总体而言，我们认为两项研究的偏倚风险较低，11的偏倚风险较高，11的偏倚风险尚不清楚。在分析的21项研究中，我们发现了不确定性证据，受限于潜在的出版偏倚和不精确性，比较了运动加戒烟支持与单独戒烟支持对戒烟结局的影响（RR 1.08，95％CI 0.96至1.22） ； I2 = 0％； 6607名参与者）。我们没有从这项分析中排除一项研究，因为未报告研究组的戒烟率。根据所促进的运动类型，没有亚组差异的证据。考虑的亚组为：单独的心血管运动（17项研究），单独的阻力训练（一项研究），心血管类型和阻力运动的组合运动（一项研究）和未指定的运动类型（两项研究）。当我们排除偏倚风险高的试验，特殊人群的试验或干预与对照组之间戒烟干预支持不匹配的试验时，结果没有明显改变。在这两项预防复发的研究中，我们发现，由于受到偏倚和不精确风险的限制，非常低的证据表明，与单纯预防复发相比，在预防复发中增加锻炼并不能改善长期禁欲（RR 0.98，95％CI 0.65。 1.47； I2 = 0％； 453位参与者）。
作者的结论：没有证据表明与单独戒烟相比，在戒烟支持中增加锻炼能提高戒酒的能力，但证据不足以评估是否有适度的益处。由于担心试验中的偏倚，不精确和发表偏倚，估计治疗效果的确定性很低或非常低。因此，将来的试验可能会改变这些结论。

BACKGROUND & AIMS: BACKGROUND:Evidence-based smoking cessation guidelines recommend nicotine replacement therapy (NRT), bupropion SR and varenicline as first-line therapy in combination with behavioural interventions. However, there are limited data to guide clinicians in recommending one form over another, using combinations, or matching individual smokers to particular forms. OBJECTIVE:To develop decision rules for clinicians to guide differential prescribing practices and tailoring of pharmacotherapy for smoking cessation. METHODS:A Delphi approach was used to build consensus among a panel of 37 international experts from various health disciplines. Through an iterative process, panellists responded to three rounds of questionnaires. Participants identified and ranked "best practices" used by them to tailor pharmacotherapy to aid smoking cessation. An independent panel of 10 experts provided cross-validation of findings. RESULTS:There was a 100% response rate to all three rounds. A high level of consensus was achieved in determining the most important priorities: (1) factors to consider in prescribing pharmacotherapy: evidence, patient preference, patient experience; (2) combinations based on: failed attempt with monotherapy, patients with breakthrough cravings, level of tobacco dependence; (3) specific combinations, main categories: (a) two or more forms of NRT, (b) bupropion + form of NRT; (4) specific combinations, subcategories: (1a) patch + gum, (1b) patch + inhaler, (1c) patch + lozenge; (2a) bupropion + patch, (2b) bupropion + gum; (5) impact of comorbidities on selection of pharmacotherapy: contraindications, specific pharmacotherapy useful for certain comorbidities, dual purpose medications; (6) frequency of monitoring determined by patient needs and type of pharmacotherapy. CONCLUSION:An algorithm and guide were developed to assist clinicians in prescribing pharmacotherapy for smoking cessation. There appears to be good justification for "off-label" use such as higher doses of NRT or combination therapy in certain circumstances. This practical tool reflects best evidence to date of experts in tobacco cessation.

背景与目标： 背景：基于证据的戒烟指南建议将尼古丁替代疗法（NRT），安非他酮SR和伐尼克兰作为一线疗法并结合行为干预。但是，只有有限的数据可以指导临床医生推荐一种形式而不是另一种形式，使用组合或将单个吸烟者与特定形式相匹配。
目的：为临床医生制定决策规则，以指导不同的处方实践和戒烟药物治疗的量身定制。
方法：采用Delphi方法在由37名来自各个健康学科的国际专家组成的小组之间建立共识。通过反复的过程，小组成员回答了三轮问卷。参与者确定并排序了他们用来定制药物疗法以帮助戒烟的“最佳实践”。由10位专家组成的独立小组对结果进行了交叉验证。
结果：对所有三回合的回应率均为100％。在确定最重要的优先事项上达成了高度共识：（1）处方药物治疗时要考虑的因素：证据，患者喜好，患者经验； （2）组合的依据是：单一疗法的尝试失败，渴望突破的患者，对烟草的依赖程度； （3）具体组合，主要类别：（a）两种或更多种形式的NRT，（b）安非他酮形式的NRT； （4）特定组合，子类别：（1a）贴片胶，（1b）贴片吸入器，（1c）贴片锭剂； （2a）安非他酮贴剂，（2b）安非他酮胶； （5）合并症对药物治疗选择的影响：禁忌症，对某些合并症有用的特定药物治疗，双重用途药物； （6）监测频率由患者需要和药物治疗类型决定。
结论：开发了一种算法和指南来协助临床医生开处方戒烟药物。在某些情况下，使用“非标签”用途（例如更高剂量的NRT或联合疗法）似乎有充分的理由。该实用工具反映了迄今为止戒烟专家的最佳证据。

BACKGROUND & AIMS: INTRODUCTION:There is growing attention to social mobility's impact on tobacco use, but few studies have differentiated the two conceptually distinct mechanisms through which changes in social class can affect tobacco smoking: the class status effect and the mobility effect. AIMS AND METHODS:I applied Diagonal Reference Modeling to smoking and heavy smoking among respondents of the 1991 China Health and Nutrition Survey who were revisited two decades later in 2011 (n = 3841, 49% male, baseline mean age was 38 years). I divided the sample into six social classes (non-employment, self-employed, owners, workers, farmers, and retirees) and measured social mobility by changes in income and occupational prestige. RESULTS:About 61.7% of men were smokers and those from the classes of workers, owners, and self-employees consumed more cigarettes compared to the unemployed, but women smokers (3.7%) tend to be from the lower classes (unemployed and farmers). Controlling for social class, each 1000 Yuan increase in annual income led to smoking 0.03 more cigarettes (p < .05) and 1% increase (p < .05) in the likelihood of heavy smoking among men, but the income effect is null for women. Upwardly mobile men (a 10-points surge in occupational prestige) smoked like their destination class (weight = 78%), whereas men with downward mobility were more similar to peers in the original class (weight = 60%). CONCLUSIONS:Contrary to the social gradient in smoking in other industrial countries, higher class status and upward mobility are each associated with more smoking among Chinese men, but not among women. IMPLICATIONS:Tobacco control policies should prioritize male smoking at workplaces and the instrumental purposes of using tobacco as gifts and social lubricant. Taxation may counter the surge in smoking brought by individuals' income increase after upward mobility. Caution should be paid to women joining the similar social gradient in smoking as they gain foothold in the labor market.

背景与目标： 简介：人们越来越关注社会流动性对烟草使用的影响，但是很少有研究区分社会阶层变化可影响吸烟的两种概念上不同的机制：阶级地位效应和流动性效应。
目的和方法：我在19​​91年中国健康与营养调查的受访者中对吸烟和重度吸烟应用了对角参考模型，他们在二十年后的2011年进行了重新调查（n = 3841，男性为49％，基线平均年龄为38岁）。我将样本分为六个社会类别（非就业，个体经营，所有者，工人，农民和退休人员），并通过收入和职业声望的变化来衡量社会流动性。
结果：大约61.7％的男性是吸烟者，与失业者相比，来自工人，所有者和自雇工人阶级的人们吸烟更多，但女性烟民（3.7％）的吸烟者往往来自较低阶层的人群（失业者和农民） 。如果控制社会阶层，则每增加1000元的年收入，可使吸烟者增加0.03支卷烟（p <.05），男性吸烟率增加1％（p <.05），但收入影响无效。女性。向上流动的男性（职业声望提高了10分）吸烟，如目的地班级（体重= 78％），而行动不便的男性与原始班级的同龄人（体重= 60％）更相似。
结论：与其他工业化国家的吸烟社会梯度相反，较高的阶级地位和向上的流动性与中国男性吸烟增加有关，而女性之间则没有。
含义：烟草控制政策应优先考虑在工作场所男性吸烟，以及使用烟草作为礼物和社会润滑剂的工具性目的。税收可以抵消个人因向上流动后收入增加而引起的吸烟激增。当妇女在劳动力市场中站稳脚跟时，应谨慎对待加入类似社会梯度吸烟的妇女。

BACKGROUND & AIMS: BACKGROUND:Using smokeless tobacco and smoking are behaviors that increase the risk of developing oral cancer, soft-tissue lesions, caries, periodontal disease and other oral conditions. The author conducted a study to examine use of smokeless tobacco and smoking by adolescents. METHODS:The study was a cross-sectional analysis of participants with complete data regarding smoking, smokeless tobacco use and other variables of interest from the 2011 national Youth Risk Behavior Surveillance System survey (n = 9,655). The author performed descriptive analysis and multivariable logistic regression analyses. RESULTS:The unadjusted odds ratio for smokeless tobacco use and smoking was 9.68 (95 percent confidence interval [CI], 7.72-12.13; P < .0001), and the adjusted odds ratio was 3.92 (95 percent CI, 2.89-5.31; P < .0001). Adolescents who used smokeless tobacco were more likely to be male, to smoke and to have engaged in binge drinking. CONCLUSION:Adolescents who were using smokeless tobacco were more likely to be engaging in concomitant smoking and to be participating in other risk-taking behaviors. Practical Implications. Dentists are involved in helping patients with tobacco-use cessation. The association of smoking with using smokeless tobacco needs to be considered in the design of tobacco-use cessation programs for adolescents.

背景与目标： 背景：使用无烟烟草和吸烟是增加患口腔癌，软组织损伤，龋齿，牙周疾病和其他口腔疾病的风险的行为。作者进行了一项研究，以检查无烟烟草的使用和青少年吸烟。
方法：本研究是对参与者的横断面分析，这些参与者具有有关吸烟，无烟烟草使用和2011年全国青少年风险行为监视系统调查（n = 9,655）感兴趣的其他变量的完整数据。作者进行了描述性分析和多变量logistic回归分析。
结果：无烟烟草使用和吸烟的未调整比值比为9.68（95％置信区间[CI]，7.72-12.13； P <.0001），调整后的比值比为3.92（95％CI，2.89-5.31； P <.0001）。使用无烟烟草的青少年更有可能是男性，吸烟和狂饮。
结论：使用无烟烟草的青少年更有可能伴随吸烟并参与其他冒险行为。实际影响。牙医参与了帮助戒烟患者的工作。在设计青少年戒烟计划时需要考虑吸烟与使用无烟烟草的联系。

BACKGROUND & AIMS: PURPOSE OF REVIEW:Modified risk products (MRP) are promoted as a safer alternative to traditional combustion cigarettes (TCC) in chronic smokers. Evidence for their lower hazardous profile is building, despite several controversies. Yet, it is unclear whether individual responses to MRP differ among consumers. We hypothesized that different clusters of subjects exist in terms of acute effects of MRP. RECENT FINDINGS:Pooling data from a total of 60 individuals, cluster analysis identified at least three clusters (labelled 1 to 3) of subjects with different electronic vaping cigarettes (EVC) effects and at least two clusters (labelled 4 to 5) of subjects with different heat-not-burn cigarettes (HNBC) effects. Specifically, oxidative stress, platelet aggregation, and endothelial dysfunction after EVC were significantly different cluster-wise (all p < 0.05), and oxidative stress and platelet aggregation after HNBC were significantly different (all p < 0.05). In particular, subjects belonging to Cluster 1 appeared to have less detrimental responses to EVC usage than subjects in Cluster 2 and 3, as shown by non-significant changes in flow-mediated dilation (FMD) and less marked increase in Nox2-derived peptide (NOX). Conversely, those assigned to Cluster 3 had the worst reaction in terms of changes in FMD, NOX, and P-selectin. Furthermore, individuals belonging to Cluster 4 responded unfavorably to both HNBC and EVC, whereas those in Cluster 5 interestingly showed less adverse results after using HNBC than EVC. Results for main analyses were consistent employing different clusters, tests, and bootstrap. Individual responses to MRP differ and smokers aiming at using EVC or HNBC as a risk reduction strategy should consider trying different MRP aiming at finding the one which is less detrimental, with subjects resembling those in Cluster 1 preferably using EVC and those resembling Cluster 5 preferably using HNBC.

背景与目标： 审查目的：在慢性吸烟者中，改良风险产品（MRP）可以作为传统燃烧卷烟（TCC）的更安全替代品而推广。尽管存在一些争议，但其危害性较低的证据正在建立。但是，目前尚不清楚消费者对MRP的个人反应是否有所不同。我们假设就MRP的急性影响而言存在不同的受试者群体。
最近的发现：收集来自总共60个个体的数据，进行聚类分析，发现至少三个聚类（标记为1至3）的受试者具有不同的电子烟（EVC）效果，并且至少两个聚类（标记为4至5）的受试者具有不同的电子烟。不同的不燃热卷烟（HNBC）效果。具体来说，EVC后的氧化应激，血小板聚集和内皮功能紊乱呈簇状显着不同（均p << 0.05），HNBC后的氧化应激和血小板聚集均显着不同（均p << 0.05）。特别是，属于簇1的受试者似乎比簇2和3的受试者对EVC的使用具有较少的有害反应，如血流介导的扩张（FMD）的无显着变化和Nox2衍生肽的明显增加（ NOX）。相反，就FMD，NOX和P-选择素的变化而言，分配给第3组的反应最差。此外，属于群集4的个体对HNBC和EVC的反应都较差，而有趣的是，属于群集5的个体使用HNBC后的不良反应比EVC少。采用不同的聚类，测试和引导程序，主要分析的结果一致。个体对MRP的反应各不相同，以吸烟者为目标，使用EVC或HNBC作为降低风险的策略，应考虑尝试不同的MRP，以寻找危害较小的个体，受试者类似于集群1的受试者，最好使用EVC，而集群5的受试者，最好使用EVC HNBC。