Article

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: 5.15). 01/2012; 22(1). DOI: 10.1136/tobaccocontrol-2011-050129
Source: PubMed

ABSTRACT 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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    • "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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    • "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; www.fda.gov/TobaccoControlAct). "
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    • "NRT in the forms of patch, gum, and lozenge are available in the United States without a physician’s prescription. Despite this, NRT remains underused (15–17), particularly among racial/ethnic minority populations such as Asian Americans. For example, population-based surveys showed that 83% of current Chinese smokers and 68% of current Vietnamese smokers quit without using smoking cessation aids (3,18). "
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