BACKGROUND & AIMS: :Soybean [Glycine max (L.) Merr.] embryogenic cultures were transformed by particle bombardment with the feedback-insensitive tobacco anthranilate synthase (AS) gene ASA2 driven by the CaMV 35S promoter and selected using hph as the selectable marker gene. Only one of eight regenerated lines that set seed and contained ASA2 expressed the gene highly and contained increased free tryptophan (Trp) levels in leaves, seeds and embryogenic cultures. Leaf extracts of the ASA2 expressing line contained about twice as much AS enzyme activity as the untransformed control and this activity was only slightly more feedback-insensitive. Amino acid analysis showed that both leaves and embryogenic tissue cultures of the ASA2 expressing line had four to five-times the normal levels of free Trp and slightly higher free tyrosine and phenylalanine. The seed total Trp content was only slightly increased. Metabolic profiling-analysis by GC-MS detected no other consistent differences. These studies show that the ASA2 gene can be expressed in soybean and that modest changes in Trp synthesis occurs.

背景与目标： : 大豆 [Glycine max (L.) Merr。] 用反馈不敏感的烟草邻氨基苯甲酸合酶 (AS) 基因ASA2进行粒子轰击转化，该基因由CaMV 35s启动子驱动，并使用hph作为选择标记基因进行选择。结实种子并含有ASA2的八个再生品系中只有一个高度表达该基因，并在叶片，种子和胚发生培养物中含有增加的游离色氨酸 (Trp) 水平。ASA2表达系的叶片提取物的酶活性是未转化对照的酶活性的两倍，并且该活性仅对反馈不敏感。氨基酸分析表明，ASA2表达系的叶片和胚发生组织培养物的游离Trp水平是正常水平的4至5倍，游离酪氨酸和苯丙氨酸略高。种子总Trp含量仅略有增加。通过gc-ms进行的代谢分析没有发现其他一致的差异。这些研究表明，ASA2基因可以在大豆中表达，并且Trp合成发生适度变化。

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： : 澳大利亚原住民，包括土著卫生工作者 (ahw)，吸烟率是非土著人口的两倍。这项研究利用概念映射方法来确定和确定与文化相关的策略以促进ahw戒烟。利益相关者参与者包括AHWs，其他卫生服务员工和烟草控制人员。通过34次访谈，3个焦点小组和利益相关者研讨会，对戒烟策略 (n = 74) 进行了头脑风暴。利益相关者将策略分为有意义的组，并根据感知的重要性和可行性对其进行评分。使用多维缩放和分层聚类分析开发了概念图。描述了十种独特的戒烟策略，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。除更广泛的策略外，还提供了戒烟资源和服务，以解决使吸烟永久化并使戒烟困难的社会和环境压力源。与社区控制相比，在政府协调的卫生服务中工作的参与者对集群的重要性和可行性的评价有所不同。对于弱势人群中的卫生服务工作者，这些发现显然暗示了除了传统的烟草控制策略之外，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ahw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，对烟草的渴望预示着试图戒烟的成年吸烟者的吸烟复发。我们假设在临床试验的治疗阶段，青少年吸烟者的渴望和戒烟 (禁欲一段时间后吸烟) 之间存在相似的关系。如果参与者报告吸烟或在禁欲访视后一氧化碳水平达到7 ppm或更高，则该访视被认为是短暂访视。共有34名参与者 (平均年龄 = 14.9岁 [SD = 1.3]; 平均香烟/天 = 18.0 [SD = 7.6]; 平均fagerstr ö m测试的尼古丁依赖性评分 = 6.8 [SD = 1.34]; 65% 名女性) 被包括在167治疗访问的当前分析中。Logistic回归分析显示，通过吸烟冲动问卷测量的渴望程度与戒烟治疗期间的失误之间存在正相关关系 (p = .013)。此外，线性回归分析表明，每天吸烟与渴望得分之间存在很强的正相关 (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，监测和解决渴望似乎有助于提高青少年戒烟的成功率。

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： : 这项工作的目的是描述美国吸烟者中4-(甲基亚硝基氨基)-1-(3-吡啶基)-1-丁醇 (NNAL) 的尿排泄随时间的趋势。我们确定了35项研究，这些研究提供的数据要么报告了，要么可以转换为总尿NNAL排泄的常见单位，即pmol/mg肌酐。这项研究历时18年，报告了61个定义人群的尿NNAL排泄估计值，总共包括3941名研究参与者。分析表明，随着研究发表年份的增加，尿NNAL排泄量呈下降趋势，并且该趋势具有统计学意义。在同一时期，研究参与者每天吸烟的减少似乎并不能解释这种趋势。这一趋势与过去十年中观察到的卷烟烟草填料和主流卷烟烟气中烟草特定亚硝胺 (TSNA) 水平的降低以及烟草业和农业界为降低烟草和卷烟烟气中的TSNA水平而做出的努力是一致的。

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：

BACKGROUND & AIMS: BACKGROUND:The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women. METHODS:This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors. RESULTS:We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum. CONCLUSIONS:We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Lung cancer has been the most common type of cancer in the world for several decades, and by 2008, there were approximately 1.61 million new cases, representing 12.7 % of all new cancers. It has been well known for many years that smoking causes lung cancer. Tobacco control measures have been regarded as the principal causes of the declines in smoking-related mortality, including mortality from lung cancer. METHODS:The Joinpoint Regression Program was used to analyze the long-term trends in lung cancer incidence rates from 1983 to 2008 in urban Shanghai. In addition, this study estimates how many fewer cases of lung cancer have occurred in urban Shanghai because of tobacco control activities. RESULTS:The lung cancer incidence rate among males decreased slightly by 0.6 % [95 % confidence interval (95 % CI) -0.1 to 1.3 %] from 1983 to 1999 and then declined rapidly at a rate of 3.8 % (95 % CI 2.1-5.4 %). Among females, the cancer incidence rate decreased by 0.1 % (95 % CI -0.2 to 0.5 %) from 1983 to 2008. Overall, we estimated that approximately 2,711 cases of lung cancer were averted among urban men in Shanghai between 2000 and 2008 because of the reduction in tobacco smoking. CONCLUSION:The reduction in tobacco smoking is a major factor in the decrease in the incidence rate of lung cancer. Sustained progress in tobacco control is essential.

背景与目标：

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行为。这项研究的目的是研究N-甲基-D-天冬氨酸 (NMDA) 受体在人类吸烟的认知和主观影响中的作用。60名普通吸烟者参加了这项双盲安慰剂对照研究，研究了NMDA拮抗剂美金刚 (40 mg) 和烟碱受体拮抗剂美加明胺 (10 mg) 对吸烟引起的持续关注任务性能的改善以及吸烟引起的主观影响和渴望变化的影响。美金刚逆转了吸烟后 “嗡嗡声” 的主观评分的增加，但美加明胺却没有。相反，美加明胺反对吸烟对快速视觉信息处理任务的改善，但美金刚反对。吸烟减少了对香烟的渴望，但两种药物都没有改变这种效果。我们的结果表明，谷氨酸能机制可能对吸烟的主观和认知作用有不同的参与。需要使用不同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：

BACKGROUND & AIMS: OBJECTIVE:This study used statewide administrative data sets to estimate the prevalence of tobacco use among persons with mental illnesses who were accessing public-sector mental health care in Colorado and to determine the relationships between tobacco use and primary diagnosis and alcohol and drug use. METHODS:This study utilized the Colorado Client Assessment Record to examine predictors of tobacco use among 111,984 persons with mental illnesses who were receiving services in the public mental health system. RESULTS:Thirty-nine percent of the sample (N=43,508) used tobacco. Multiple logistic regression analysis found that schizophrenia, schizoaffective disorder, and bipolar disorder (p<.001 for all), and depression or dysthymia (p<.01) were associated with greater tobacco use than other diagnoses. Significant differences in tobacco use existed across gender, age group, race or ethnicity, and substance use categories. CONCLUSIONS:Findings suggest that an administrative database is a low-burden means of identifying persons at high risk of tobacco use to inform resource allocation.

背景与目标：

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吸烟者处方经皮尼古丁 (8周) 的心理病理学与治疗反应的关系。在大学诊所中，参与者的门诊患者功能相对较高 (dsm-iv axis V评分)。主要研究目标是确定具有dsm-iv轴I或II诊断史的患者在治疗反应 (贴片依从性，吸烟) 期间是否较差，并且在贴片后随访时戒烟率较低 (研究第9、26周，52) 比没有诊断的人。尽管有迹象表明有精神病理学史的患者较少佩戴该贴片，但精神病理学与治疗期间和治疗后吸烟无关。

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： 本研究调查了瑞典1960年1993年 (共46,211例) 膀胱癌的发病率趋势。男性的年龄标准化发病率从14.6/10(5) 1960年增加到33.5 1993年，女性从4.8年增加到8.8年，对应的年平均增加分别为2.4% (95% 置信区间 [CI] = 2.0%-2.7%) 和1.1% (CI = 0.9%-1.4%)。最大的增长发生在年龄最大的年龄组。移行细胞癌患者的比例从1960-64岁的66.0% 增加到1990-93岁的93.6%，从61.0%-89.4% 岁的女性增加。乳头状瘤患者的比例降低，而腺癌和鳞状细胞癌患者的比例稳定。回归模型 (基于时期1960-89) 显示出由于时期和/或队列的强烈线性效应。在男性中，获得了经期和队列的额外非线性效应。队列效应更为重要。每天吸烟的队列数据显示出与估计的队列效应相当相似。我们的发现表明，连续几代人吸烟的增加可以解释瑞典膀胱癌发病率的增加，而改善的诊断活动和登记不太可能完全解释发病率的变化。

BACKGROUND & AIMS: :Plant-mediated RNAi has been developed as a powerful weapon in the fight against agricultural insect pests. The gap gene hunchback (hb) is of crucial importance in insect axial patterning and knockdown of hb is deforming and lethal to the next generation. The peach potato aphid, Myzus persicae (Sulzer), has many host plants and can be found throughout the world. To investigate the effect of plant-mediated RNAi on control of this insect, the hb gene in M. persicae was cloned, plant RNAi vector was constructed, and transgenic tobacco expressing Mphb dsRNA was developed. Transgenic tobacco had a different integration pattern of the transgene. Bioassays were performed by applying neonate aphids to homozygous transgenic plants in the T2 generation. Results revealed that continuous feeding of transgenic diet reduced Mphb mRNA level in the fed aphids and inhibited insect reproduction, indicating successful knockdown of the target gene in M. persicae by plant-mediated RNAi.

背景与目标： : 植物介导的RNAi已被开发为对抗农业害虫的有力武器。gap基因驼背 (hb) 在昆虫轴向图案化中至关重要，并且hb的敲除正在变形并致死下一代。桃马铃薯蚜虫Myzus persicae (Sulzer) 具有许多寄主植物，在世界各地都可以找到。为了研究植物介导的RNAi对该昆虫的控制作用，克隆了桃蚜中的hb基因，构建了植物RNAi载体，并开发了表达Mphb dsRNA的转基因烟草。转基因烟草具有不同的转基因整合模式。通过将新生蚜虫应用于T2代的纯合转基因植物进行生物测定。结果表明，连续饲喂转基因饮食可降低饲喂蚜虫中的Mphb mRNA水平并抑制昆虫繁殖，表明植物介导的RNAi成功敲除了桃蚜中的靶基因。

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.

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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.

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