A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation

Center for Global Tobacco Control, Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA.
Tobacco control (Impact Factor: 5.93). 01/2012; 22(1). DOI: 10.1136/tobaccocontrol-2011-050129
Source: PubMed


OBJECTIVE: To examine the population effectiveness of nicotine replacement therapies (NRTs), either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions. METHODS: A prospective cohort study was conducted in three waves on a probability sample of 787 Massachusetts adult smokers who had recently quit smoking. The baseline response rate was 46%; follow-up was completed with 56% of the designated cohort at wave 2 and 68% at wave 3. The relationship between relapse to smoking at follow-up interviews and assistance used, including NRT with or without professional help, was examined. RESULTS: About one-fourth of recent quitters at each wave reported to have relapsed by the subsequent interview. Odds of relapse were unaffected by use of NRT for >6 weeks either with (p=0.117) or without (p=0.159) professional counselling and were highest among prior heavily dependent persons who reported NRT use for any length of time without professional counselling (OR 2.68). CONCLUSIONS: This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts. Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programmes and policies.

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Available from: Gregory N Connolly, Dec 12, 2013
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    • "In a study of 787 adult smokers in Massachusetts who had recently quit smoking and were evaluated over a 5 y period, the authors concluded that using NRTs is no more effective than trying to quit without the use of NRTs [8]. While clinical studies have found NRTs to be effective versus placebo, this study provides empirical evidence regarding the lack of effectiveness when NRTs are used in the general population [8]. "
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    ABSTRACT: There are a large number of smokers who want to quit smoking but have failed in their attempts to do so, with many having been unsuccessful at quitting multiple times over their lifetime. The existing marketed nicotine replacement therapies (NRT) have only marginal effectiveness and none provide a comparable physiological response to that derived from cigarette smoking; that is, rapid absorption of nicotine from the lung leading to peak levels of nicotine in the bloodstream to target the receptors in the brain. Instead, existing NRTs produce a slower and delayed rise in nicotine blood levels which is less effective at reducing the craving sensations. Published data for electronic cigarettes show that they typically deliver nicotine with a profile closer to that for nicotine patches, with a slow rise that can take 30 to 60 min, or longer, to reach the same peak nicotine concentration that is produced in less than 3 min from a single cigarette. A number of attempts have been made to develop an inhaled product which would deliver the nicotine through the lung and mimic the physiological response from smoking but many of them produced intolerable aversive reactions or delivered an ineffective dose. This paper discusses examples of the potential for the recent inhaled nicotine products in development to be effective as NRTs, but is not meant to be a comprehensive review.
    Asian Journal of Pharmaceutical Sciences 08/2015; DOI:10.1016/j.ajps.2015.07.004
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    • "The long-term effectiveness of NRT seen in clinical trials has been questioned when used in real-world settings and in general populations [11,25,26]. In the present study, we found no effect of NRT use between the first call and the 12-month follow-up in the multivariable analyses, which is consistent with results from the English national quitline study [11]. "
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    ABSTRACT: The Swedish National Tobacco Quitline (SNTQ), which has both a proactive and a reactive service, has successfully provided tobacco cessation support since 1998. As there is a demand for an increase in national cessation support, and because the quitline works under funding constraints, it is crucial to identify the most clinically effective and cost-effective service. A randomized controlled trial was performed to compare the effectiveness of the high-intensity proactive service with the low-intensity reactive service at the SNTQ.
    Tobacco Induced Diseases 06/2014; 12(1):9. DOI:10.1186/1617-9625-12-9 · 1.50 Impact Factor
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    • "The greatest smoking-related mortality is increasingly apparent among economically disadvantaged groups, which, in the United States, includes a disproportionate number of ethnic minorities [5] [6]. Over the past 5 years, the prevalence of adult smokers in the United States has remained constant, and the ratio of former to never smokers (quit ratio) has not changed since 1998 [7]. In 2009, the US Food and Drug Administration (FDA) enacted the Family Smoking Prevention and Tobacco Control Act (TCA) to regulate the manufacture, distribution, and marketing of tobacco products to protect the public from smoking-related mortality and morbidity (Public Law 111- 31; "
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    ABSTRACT: Background: Cigarette smoking has been linked with both increased and decreased risk for Alzheimer's disease (AD). This is relevant for the US military because the prevalence of smoking in the military is approximately 11% higher than in civilians. Methods: A systematic review of published studies on the association between smoking and increased risk for AD and preclinical and human literature on the relationships between smoking, nicotine exposure, and AD-related neuropathology was conducted. Original data from comparisons of smoking and never-smoking cognitively normal elders on in vivo amyloid imaging are also presented. Results: Overall, literature indicates that former/active smoking is related to a significantly increased risk for AD. Cigarette smoke/smoking is associated with AD neuropathology in preclinical models and humans. Smoking-related cerebral oxidative stress is a potential mechanism promoting AD pathology and increased risk for AD. Conclusions: A reduction in the incidence of smoking will likely reduce the future prevalence of AD.
    Alzheimer's and Dementia 06/2014; 10(3):S122-S145. DOI:10.1016/j.jalz.2014.04.009 · 12.41 Impact Factor
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