Nicotine replacement therapy and smoking cessation intervention programs are associated with positive outcomes among current smokers, according to two studies in the November 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. “Despite advances in clinical care and policy, rates of smoking cessation have held constant in the past decade, indicating a need for novel approaches,” the authors write as background information in one of the articles.
In the first article, Matthew J. Carpenter, Ph.D., of the Medical University of South Carolina, Charleston, and colleagues conducted a nationwide randomized clinical trial to examine the efficacy of a smoking cessation intervention among current smokers with no motivation to quit. A total of 849 current smokers unmotivated to quit were randomized to a practice quit attempt (PQA) alone or to nicotine replacement therapy (NT) sampling within the context of a PQA (PQA + NT). The PQA was designed to increase motivation, confidence and coping skills, while the combination of a PQA with nicotine therapy sampling added samples of nicotine lozenges to enhance attitudes toward pharmacotherapy and to promote use of additional cessation resources.
Across the intervention period, 82 percent of PQA + NT participants and 85 percent of PQA participants engaged in at least one PQA. By four weeks following the end of treatment, 22 percent of PQA + NT participants and 13 percent of PQA participants had made a 24-hour quit attempt. By 12 weeks following the end of treatment, the rates were 32 percent and 23 percent respectively, while at the final follow-up, the PQA + NT group had a significantly higher incidence of any quit attempt (49 percent vs. 40 percent) and any 24-hour quit attempt (43 percent vs. 34 percent) when compared with the PQA group.
“In summary, providing brief NT sampling to smokers who do not want to quit, when used within a behavioral exercise of a PQA, is efficacious to motivate unmotivated smokers toward quitting,” the authors conclude. “Considering the stagnant incidence of quit attempts in the past decade, this novel and easy-to-use cessation induction strategy holds promise for translation to primary care settings.”
In a second report, Anne M. Joseph, M.D., of the University of Minnesota, Minneapolis, and colleagues conducted a randomized controlled trial to compare telephone-based chronic disease management (one-year; longitudinal care) with evidence based treatment (eight weeks; usual care) for tobacco dependence. The trial included 443 current smokers who each received five telephone counseling calls and nicotine replacement therapy by mail for four weeks. Participants were then randomized to usual care (UC; two additional telephone calls) or longitudinal care (LC; continued counseling and nicotine replacement therapy for an additional 48 weeks).
At 18 months, six-month prolonged abstinence was 30.2 percent in the LC group and 23.5 percent in the UC group. Additional analysis showed that the LC treatment arm, quit attempts in the previous year, cigarettes per day at baseline and cigarettes smoked in the past week (as reported at day 21) were significantly associated with prolonged abstinence at 18 months. The median (midpoint) percentage of days reporting no cigarette use was 57.1 percent in the LC group and 30.1 percent in the UC group.
The authors also found that participants in the LC group made significantly more quit attempts than those in the UC group. Among participants who did not quit smoking, there was more smoking reduction in the LC group compared with the UC group, but these differences were statistically significant only at 12 months.
“This randomized controlled trial shows that a smoking intervention based on chronic disease management principles of care – targeting the goal of quitting smoking but incorporating failures, setting interim goals and continuing care until the desired outcome is achieved – is approximately 75 percent more effective at accomplishing long-term abstinence than delivery of a discrete episode of care for smoking cessation,” the authors conclude.
Additionally, two research letters examine smoking cessation rates in two long-term follow-up studies. In the first research letter, Yin Cao, M.P.H., with Harvard School of Public Health, Boston, and colleagues examined the relationship of time since quitting and age at smoking cessation with total and cause-specific mortality among U.S. male physicians. Using data from the Physicians’ Health Study, the authors examined data on 19,705 male physicians, 41.7 percent of whom were past smokers, and 6.7 percent were current smokers. A total of 5,594 deaths occurred during the 386,772 person-years of follow up, and the crude mortality rates were 11.5, 16.6 and 26.1 per 1,000 person-years for never, past, and current smokers, respectively. Among 612 deaths in current smokers, 13.7 percent died before the age of 65 years, compared with 8.3 percent of never smokers.
Compared with current smokers, risk of death was significantly reduced among past smokers within 10 years of quitting. By 20 years after quitting, the risk was further reduced, to the level of never smokers. Although current heavy smokers had the highest risk of death compared with current light and past smokers, the risk of death could be reduced by 44 percent for this group within 10 years of quitting and reach a similar risk as never smokers after more than 20 years.
A second research letter provides follow-up results for smoking behavior three decades after participation in the Whitehall Smoking Cessation Survey, a study of male civil servants in London, England. G. David Batty, Ph.D., of University College London, England, and colleagues mailed surviving Whitehall study members a questionnaire regarding current smoking behavior and health to assess the long-term impact of a smoking cessation intervention.
The original study included 1,445 men who were randomized to the intervention group or “normal care” group. The intervention included a 15-minute consultation with one of the study’s clinical staff during which the risks of smoking were outlined at length, followed-up with another appointment one week later at which each member was given a smoking record card to be completed daily over the following three weeks. Further 15-minute interviews took place at the research center at 10 weeks and six months. The “usual care” group received no smoking cessation intervention.
At the one-year follow-up, the prevalence of self-reported abstinence from smoking in the intervention group (39 percent) was substantially higher that in the normal care group (9 percent). Corresponding figures for the three-year follow-up were 36 percent and 14 percent, respectively. A re-survey of participants after 30 years showed that most survivors in both the intervention and control groups had stopped smoking (81 percent and 79 percent, respectively). Additionally, the authors found that overall risk of death was slightly lower for participants in the intervention group than for those in the control group. Although the difference was not statistically significant, it corresponds to an estimated 0.4 life-years gained.
Material adapted from JAMA.
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