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: 5.93). 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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Available from: Gregory N Connolly, Dec 12, 2013
    • "number of licenced Nicotine Replacement Therapy (NRT) products have been designed to help motivated smokers cut down and quit (i.e., smoking cessation) as well as reduce the harm to the users and those around them; these products include nicotine patches, nicotine gums, nicotine lozenges, nicotine sprays, and nicotine sub-lingual tablets all of which provide nicotine to the user without delivering carcinogens generated during tobacco combustion in cigarette smoking. However, studies have indicated that NRTs may not be as effective as expected and that relapse rates with or without NRTs are comparable.[2]This may, in part, be due to the lack of behavioral and social components of smoking with use of these products. "
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    ABSTRACT: Carbonyls such as formaldehyde, acetaldehyde, and acrolein have been detected in e-cigarette vapors, with one study (albeit at a higher than the typical voltage) reporting formaldehyde-releasing agents in quantities sufficient to increase the risk of cancer by 5-15 fold when compared with long-term smoking. This study examines the Voke® Inhaler for traces of carbonyls and aims to quantify any that are detected in its aerosol. Three batches of five Voke® devices each were charged with formulation and allowed to rest for 0, 1, and 24 hr respectively, before being sampled. Aerosol from each device was extracted using a linear smoking machine and collected by dissolution into DNPH derivatization solution. Samples of the extract solution were analyzed for carbonyls using UHPLC. Results were reported as μg/8 puffs. Samples were analyzed for the presence of formaldehyde, acetaldehyde, acetone, acrolein, propionaldehyde, crotonaldehyde, butan-2-one, and butyraldehyde. At the given LOD, no carbonyls were detected in 13 of the 15 samples tested. Acetaldehyde was detected in two samples, one tested immediately after charging and the other tested 1 hr after sampling; however, both samples contained the analyte in quantities below its LOQ (3.18 μg/mL). Among various carbonyls, formaldehyde, in particular, has been identified as a known carcinogen by the IARC and as a probable human carcinogen by the US EPA. The absence of measurable quantities of carbonyls in the Voke® Inhaler establishes its clear distinction from e-cigarettes and reflects on a significant advantage of not having a heating element.
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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.
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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.
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