ARRA Investments in Nicotine Addiction Research
Public Health Burden
Tobacco use remains the leading cause of preventable morbidity and mortality in the United States, resulting in over 400 million deaths per year. Public health interventions and biomedical advances have led to dramatic reductions in the prevalence of tobacco use; however millions of Americans remain addicted to tobacco products. This ARRA “Signature Project” highlights the urgent need for additional research into the development of more effective therapeutic and preventative interventions.
Seventy percent of patients who smoke say they want to quit, but only 7.9 percent are able to do so without help.
And while current medications exist to aid tobacco cessation, less than 5% of individuals remain tobacco-free 1 year after quitting. Therefore, novel approaches to smoking cessation are needed. A variety of ARRA-funded grants are exploring innovative treatment strategies for nicotine addiction. Examples are:
A nicotine vaccine, a new approach for smoking cessation/relapse prevention, works by stimulating the body’s immune system to produce antibodies to nicotine that bind the drug while still in the bloodstream, preventing it from reaching the brain and exerting its effects. Several grants are funded to improve the efficacy of a nicotine vaccine and to expedite its continued development towards FDA approval. Among these: (a) Animal models are being improved to more closely simulate the human route of nicotine intake, while (b) human studies are using brain imaging to clarify mechanisms underlying vaccine efficacy to further improve immunotherapy for smoking addiction, and (c) effectiveness trials are comparing placebo vs. vaccine treatment in smokers who want to quit.
A project testing the combination of currently marketed tobacco products with reduced tobacco toxicant exposure and existing medications to taper patients to the sole use of medicinal nicotine products prior to complete cessation. This approach may provide a novel method to help people who are unable to quit through traditional cessation methods or may improve on existing medications.
Genetic factors may partially determine an individual's vulnerability to tobacco addiction and their ability to quit. Several ARRA grants are attempting to identify these genetic factors, which may inform the development of prevention and treatment interventions for tobacco addiction.
The disrupted ability to control and regulate impulses and emotions (i.e., inhibitory control-IC) is one of the core features of addiction. This project will help identify genes that are associated with IC and determine how both genes and IC are related to smoking withdrawal and risk for relapse.
Smoking usually begins during adolescence, but its likelihood varies from person to person. Using rodent models, this project will identify genetic and gene expression differences that contribute to differences in the propensity of initiating and continuing voluntary nicotine intake in adolescence.
One grant will evaluate how specific genetic variants, which have been shown to increase the risk for tobacco smoking and nicotine dependence, affect the subjective experience and physiological responses to nicotine in humans. This knowledge could propel the development of personalized and more effective strategies for smoking cessation and prevention.
Despite a decrease in the prevalence of tobacco use in the general population, smoking prevalence is still high among certain populations. ARRA funds supporting research in this area include:
Medications for treating tobacco addiction in patients with schizophrenia, since up to 90% of patients smoke. This project will investigate the safety and efficacy of the FDA-approved medication Varenicline for smoking cessation without exacerbation of psychotic symptoms.
Treatment for individuals in correctional facilities, whose smoking rates are approximately three times that of the general population. Notably minorities, people from low SES environments, and those with mental illness are all overrepresented in correctional facilities. This grant will evaluate the ability of tailored behavioral interventions to increase smoking quit rates and decrease health disparities among individuals recently released from prison.
Delivery of evidence-based tobacco treatment in a free clinic setting to increase its accessibility. Individuals without health insurance are 1.5 times more likely to smoke yet are less likely to receive cessation help than those that are insured.
New Ways to Reach Smokers
ARRA funds supporting research into new forms of communication could potentially revolutionize the manner in which tobacco cessation programs are delivered. Examples are:
Young adult smokers typically have limited access to healthcare and under-utilize smoking cessation services. A grant will study the feasibility and acceptability of delivering an evidence-based smoking cessation program through text messaging, a popular form of communication used by young adults.
Tobacco quitlines have enormous potential to optimize the reach and population impact of smoking cessation interventions. This grant will evaluate the ability of a web-enabled cellular phone providing a menu of evidence-based treatment components to improve the delivery and use of quitlines.
A brief physician-delivered smoking cessation intervention using the 5 A's (Ask, Advise, Assess, Assist, Arrange) has been shown effective in reducing smoking, but is not widely adopted in routine practice settings. This grant will assess the 5A's intervention delivered via computer-based technology. If outcomes are comparable, the practical and economic implications of its use should ultimately reduce tobacco mortality and morbidity rates in this country.
, -- Immunization to Block the Effects of Nicotine--Pentel, Paul R (MN).; (b) 1R01DA025598-01 --Innovative Interventions for Smoking Cessation--Hatsukami, Dorothy K.; (MN) (c) 1RC2DA028837-01 --Phase III Study of a Nicotine Vaccine for Smoking Cessation-- Kessler, Paul D. (MD)
-- Innovative interventions for smoking cessation -- Hatsukami, Dorothy (MN)
-- Genetic basis of smoking abstinence, smoking reinforcement and inhibitory control -- Kollins, Scott H (NC)
-- Neuron-Specific Candidate Gene Expression and Adolescent Vulnerability to Smoking -- Sharp, Burt (TN)
-- Variants in Nicotine Receptors and Pharmacogenetics -- Chen, Xiangning (VA)
-- Varenicline and smoking cessation in schizophrenia -- Fatemi, Seyyed Hossein (MN)
-- Sustaining Tobacco Abstinence after Incarceration -- Clarke, Jennifer (RI)
-- Implementation & Dissemination of Evidence-Based Tobacco Cessation Strategies in Free Clinics -- Foley, Kristie (NC)
-- Examining Text Message Intervention for Smoking Cessation -- Bock, Beth C (RI)
-- Comparative Effectiveness of Web-based Mobile Support for the DC Tobacco Quitline -- Kirchner, Thomas (DC)
-- Computer vs. Therapist-Delivered Brief Intervention for Drug Abuse in Primary Care -- Svikis, Dace S (VA)
Page Last Updated on June 30, 2018
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