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In This Issue of JAMA |

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JAMA. 2014;311(2):113-115. doi:10.1001/jama.2013.279262.
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50 Years of Tobacco Control

Edited by Helene M. Cole, MD, and Howard Bauchner, MD

Tobacco-related events Interactive


To assess the efficacy of maintenance smoking cessation pharmacotherapy for patients with serious mental illness and tobacco dependence, Evins and colleagues randomly assigned 61 individuals with schizophrenia or bipolar disease who had achieved tobacco abstinence after 12 weeks of open-label varenicline treatment to receive either 40 additional weeks of varenicline or placebo—both with relapse-prevention–focused cognitive behavior therapy (CBT). The authors found that compared with CBT alone, maintenance pharmacotherapy with CBT improved long-term abstinence rates at the end of treatment and 6 months after treatment discontinuation.

Ebbert and colleagues assessed the efficacy of combining paharmacotherapies for tobacco dependence in a randomized trial of 506 adult smokers who received 12 weeks’ treatment with varenicline and sustained-release bupropion or varenicline and placebo. The authors report that compared with varenicline alone, combined use of varenicline and bupropion increased prolonged abstinence but not 7-day point-prevalence abstinence at 12 and 26 weeks. Neither outcome was significantly different at 52 weeks.

To derive estimates of reductions in smoking-related mortality associated with tobacco control from 1964 to 2012, Holford and colleagues analyzed data on smoking history, mortality, and smoking-related disease from nationally representative surveys and epidemiologic studies. The authors compared actual smoking-related mortality with estimated mortality under hypothetical no-tobacco-control scenarios and report that tobacco control was associated with an estimated 8 million fewer tobacco-attributable premature deaths.

Cook and colleagues analyzed data from 2 nationally representative surveys of noninstitutionalized US adults to examine trends in smoking among individuals with mental illness and found that between 2004 and 2011, smoking rates decreased less among persons with mental illness than among persons without mental illness. Patients with mental illness who received mental health treatment in the previous year were more likely to quit smoking than were those not in treatment.

Ng and colleagues analyzed national and multinational data on smoking prevalence, tobacco production, and cigarette manufacture to provide estimates of the prevalence of daily smoking and cigarette consumption by age and sex in 187 countries from 1980 to 2012. The authors report that the overall prevalence of daily smoking decreased between 1980 and 2012; however, because of global population growth, the number of smokers increased significantly, and modeled prevalence rates and cigarette consumption exhibited substantial variation across age, sex, and countries.

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In a meta-analysis of data from 12 Cochrane reviews (267 randomized clinical trials; 101 804 patients) of the efficacy and safety of smoking cessation pharmacotherapies, Cahill and colleagues found that the 3 first-line treatments—nicotine replacement therapy (NRT), bupropion, and varenicline—resulted in higher rates of smoking cessation than placebo and that varenicline and combination NRT were most effective for achieving and maintaining cessation.

JAMA and The Medical Letter on Drugs and Therapeutics have launched a collaboration to provide JAMA readers access to quality information about pharmaceuticals. This Medical Letter article on electronic cigarettes describes the device and summarizes the evidence relating to efficacy and safety. An Editorial by Zuccotti and Livingston discusses the JAMA-Medical Letter collaboration.

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