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Nicotine replacement therapy for smoking cessation in the "real world"
... Many studies have shown the effectiveness of Nicotine Replacement Therapy [19,20,21,22,23] and Motivational Interviewing [24,25,26,27] On the one hand, Cigarette smoking is a common behaviour among prisoners and is part of the prison culture [31,32]. On the other hand, cigarette smoking is a risk factor for AIDS [33]. ...
... In addition, it is a motivational aid to encourage smokers to measure their progress in terms of smoking cessation. The spectrum grading of this instrument includes non-smokers (0-6), borderline smokers (7-9), low-addicted smokers (10-15), moderately addicted smokers (16)(17)(18)(19)(20)(21)(22)(23)(24)(25), heavily addicted smokers (26)(27)(28)(29)(30)(31)(32)(33)(34)(35), and very heavy addicted smokers (+36) [37]. It should be noted that each prisoner receiving a score of more than 10 was considered as a smoker in this study. ...
This study aims to determine the effectiveness of the SCP (MI+NRT) for smoker prisoners living with HIV. The study design was semi-experimental with pre-test, post-test, follow-up, and a control group. As many as 34 smoker prisoners living with HIV were selected by convenience sampling and randomly assigned to an experimental group and a control group. The experimental group received the SCP, while the control group received no treatment. The research measurement instruments comprised FTND and BMS. MANCOVA models were employed to test the hypothesis. The results showed that the indicators of 'quit smoking' reduced among prisoners in the experimental group.
... In relation with treatment of smoking quit, participants who received a pharmaceutical assistance by nicotine replacement therapy (Nicotine patch) had a significant higher successful cessation rate than those who did not. The benefit of NRT has been supported by several studies [31,32]. A Cochrane review published in 2012 concluded that NRTs increase the rate of quitting by 50 to 70% [32]. ...
... Ecological Momentary Assessment (EMA) methods collect real-time data within participants' natural settings, using repeated measurements of momentary states and behaviors which characterize participants' real-world experiences over a given period of time (Shiffman 2007). We collected EMA data to characterize adolescents' moods, behaviors, and activities of their close friends. ...
Limited research is available that explains
complex contextual and interactive effects of microsystems
such as family relationships, peer networks, and place based
influences have on urban adolescent substance use.
We contend that research into these complex processes is
improved by integrating psychological, social, and geographic
data to better understand urban adolescent substance
use involvement. Accordingly, we tested a
longitudinal, 3-way moderation model to determine if the
direct effect of teen–parent relationships on substance use
involvement is moderated by peer network characteristics,
which in turn is moderated by the risk and protective
attributes within urban adolescents’ activity spaces, among
a sample of 248 adolescents. Results revealed that peer
networks moderate the effects of relations with parents on
substance use involvement for those adolescents with
higher levels of risk attributes within their activity space,
but not for those who spend time in locations with less risk.
Thus, the teen–parent relationship interacts with peer network
characteristics, for those urban adolescents whose
activity space is constituted within high-risk environments.
We conclude that peer networks have important interactive
effects with family relationships that influence substance
use, and that this is particularly salient for young adolescents
who are exposed to risky environments. This finding
underscores the importance of continued study into the
interrelations among microsystems of urban adolescents,
and provides further support that substance use is a social
practice that is constituted within the unique geography of
young adolescents’ lives.
... It is possible that SCC users did not employ NRT appropriately, thus reducing any effect thereof. 17 Another finding of note was that, overall, SCC user satisfaction was very high and that such satisfaction was significantly associated with the maintenance of cessation. Currently, little is known about associations between the satisfaction of those who use clinics and smoking-cessation outcomes. ...
We identified factors associated with relapse after 6 months of smoking cessation (late relapse) among males of the Republic of Korea. Of the 222,707 smokers who visited public health center-based smoking cessation clinics (SCCs) between January 1, 2009 and mid-December 2009, we included 1720 individuals who successfully completed a 6-month smoking cessation program at an SCC. These participants were selected via a random stratified sampling design and completed an SCC user satisfaction survey between December 31, 2009 and January 6, 2010. Multiple logistic regression was used to identify factors associated with late relapse, and path analysis was employed to explore relationships among these factors. The frequency of late relapse was 21.6% (n = 372). Residence in a metropolitan area, low socioeconomic status, and the use of nicotine replacement therapy (NRT) were associated with statistically significant increases in late relapse, whereas greater access to counseling and more satisfaction with the SCC were associated with reduced late relapse. The path analysis showed that a greater number of cigarettes smoked daily and a younger age at smoking initiation exerted significant indirect effects on late relapse when NRT was employed. Residence in a metropolitan area indirectly prevented late relapse as counseling frequency increased. NRT use, counseling frequency, and SCC user satisfaction were affected by both smoking behavior and socioeconomic status. Relapse prevention efforts should concentrate on increasing both counseling frequency and SCC user satisfaction. Future studies should focus on the effect of NRT on the maintenance of long-term cessation at the population level in real-world settings.
Nicotine replacement therapies (NRTs) have been demonstrated to be effective in clinical trials but may have lower efficacy when purchased over-the-counter (OTC). Premature discontinuation and insufficient dosing have been offered as possible explanations. The aims are to (a) investigate the prevalence of and reasons for premature discontinuation of stop-smoking medications (including prescription only) and (b) how these differ by type, duration of use, and source (prescription or OTC).
The sample includes 1,219 smokers or recent quitters who had used medication in the last year (80.5% NRT, 19.5% prescription only). Data were from Waves 5 and 6 of the International Tobacco Control (ITC) Four-Country Survey.
Most of the sample (69.1%) discontinued medication use prematurely. This was more common among NRT users (71.4%) than in users of bupropion and varenicline (59.6%). OTC NRT users were particularly likely to discontinue (76.3%). Relapse back to smoking was the most common reason for discontinuation of medication reported by 41.6% of respondents. Side effects (18.3%) and believing that the medication was no longer needed (17.1%) were also commonly reported. Of those who completed treatment, 37.9% achieved 6-month continuous abstinence compared with 15.6% who discontinued prematurely. Notably, 65.6% who discontinued because they believed the medication had worked were abstinent.
Premature discontinuation of stop-smoking medications is common but is not a plausible reason for poorer quit outcomes for most people. Encouraging persistence of medication use after relapse or in the face of minor side effects may help increase long-term cessation outcomes.
Telephone services that offer smoking-cessation counseling (quitlines) have proliferated in recent years, encouraged by positive results of clinical trials. The question remains, however, whether those results can be translated into real-world effectiveness.
We embedded a randomized, controlled trial into the ongoing service of the California Smokers' Helpline. Callers were randomly assigned to a treatment group (1973 callers) or a control group (1309 callers). All participants received self-help materials. Those in the treatment group were assigned to receive up to seven counseling sessions; those in the control group could also receive counseling if they called back for it after randomization.
Counseling was provided to 72.1 percent of those in the treatment group and 31.6 percent of those in the control group (mean, 3.0 sessions). The rates of abstinence for 1, 3, 6, and 12 months, according to an intention-to-treat analysis, were 23.7 percent, 17.9 percent, 12.8 percent, and 9.1 percent, respectively, for those in the treatment group and 16.5 percent, 12.1 percent, 8.6 percent, and 6.9 percent, respectively, for those in the control group (P<0.001). Analyses factoring out both the subgroup of control subjects who received counseling and the corresponding treatment subgroup indicate that counseling approximately doubled abstinence rates: rates of abstinence for 1, 3, 6, and 12 months were 20.7 percent, 15.9 percent, 11.7 percent, and 7.5 percent, respectively, in the remaining subjects in the treatment group and 9.6 percent, 6.7 percent, 5.2 percent, and 4.1 percent, respectively, in the remaining subjects in the control group (P<0.001). Therefore, the absolute difference in the rate of abstinence for 12 months between the remaining subjects in the treatment and control groups was 3.4 percent. The 12-month abstinence rates for those who made at least one attempt to quit were 23.3 percent in the treatment group and 18.4 percent in the control group (P<0.001).
A telephone counseling protocol for smoking cessation, previously proven efficacious, was effective when translated to a real-world setting. Its success supports Public Health Service guidelines calling for greater availability of quitlines.
To determine whether over-the-counter (OTC) nicotine replacement therapy (NRT) is pharmacologically efficacious, whether it produces abstinence rates similar to those in prescription settings, and to estimate the long term (that is, greater than six month) abstinence rate with OTC NRT.
Systematic literature review.
Medline, Psych Abstracts, bibliographies, requests of scientists.
Studies comparing OTC NRT versus OTC placebo or studies comparing OTC NRT versus prescription NRT that reported abstinence rates and for which a full study report was available.
Two of the authors independently reviewed studies and compared results.
Meta-analysis was performed by first testing for homogeneity across studies, then combining odds ratios (ORs) weighting by inverse variance and proportions weighting by study sample size.
One OTC NRT versus OTC placebo nicotine gum study was excluded due to small sample size and different setting. The four remaining studies were randomised trials of nicotine versus placebo patch with ORs of 2.1-3.2. These outcomes were homogenous and when combined resulted in an OR favouring NRT of 2.5 (95% confidence interval (CI) 1.8 to 3.6). Among the two randomised and two non-randomised trials of OTC NRT versus prescription NRT, one small study had an OR of 0.3, two others had ORs of 1.0 and 1.4, and a fourth study had an OR of 3.6. These results were not homogenous; however, when combined via a random effects model the estimated OR was not less than 1.0--that is, OR 1.4 (95% CI 0.6 to 3.3). The long term (that is, greater than six months) quit rates for OTC NRT was 1% and 6% in two studies and 8-11% in five other studies. These results were not homogenous; however, when combined the estimated OR was 7% (95% CI 4% to 11%).
OTC NRT is pharmacologically efficacious and produces modest quit rates similar to that seen in real world prescription practice.
In 1996, the US Food and Drug Administration (FDA) approved switching nicotine gum and patch from prescription to over-the-counter (OTC) status. Some expressed concerns that broader availability and lack of physician control might increase persistent use of nicotine replacement therapy (NRT)-that is, use beyond the period specified by the FDA approved label.
To estimate the incidence of persistent use of OTC nicotine gum and patch for periods of > 3 months, > or = 6 months, > or = 12 months, and > or 24 months.
Analysis of NRT purchase patterns in data from a population based panel of US households that electronically scanned all household purchases between January 1997 and March 2000.
In a national panel of 40,000 US households, 2690 recorded NRT purchases.
Among 805 households that purchased nicotine gum, 2.3% of new purchase incidents led to continuous monthly purchase of gum for > or = 6 months. For nicotine patches (2050 households) the percentage was 0.9%. For both gum and patch, the incidence of persistent purchase dropped below 0.4% by 24 months. Allowing one month gaps within a "continuous" purchase run resulted in increased estimates (for gum: 6.7% for > or = 6 months and 1.0% for > or = 24 months; for patch: 1.7% for > or = 6 months and 0.05% for > or = 24 months).
Persistent use of nicotine gum and patch is very rare and has not increased with the transition to OTC use, despite removal of physician oversight.
This study assessed smokers' beliefs about nicotine and the safety of nicotine medications and examined how these beliefs influence the use of nicotine medications. The data for this paper came from a nationally representative, random-digit-dialed telephone survey of 1,046 adults (18 years of age and older) current cigarette smokers conducted between May and September 2001. Respondents were questioned about their use of stop smoking medications, beliefs about nicotine, and the safety/efficacy of nicotine medications. Nearly all adult smokers in our survey had heard of nicotine patches (97%) or gum (94%), with lower levels of awareness reported for the nicotine inhaler (41%), and nasal spray (9%). Thirty-eight percent of smokers had previously used nicotine medications, with the nicotine patch being the most commonly used medication. The data reveal that most smokers are misinformed about the health risks of nicotine and the safety/efficacy of nicotine medications. Approximately half incorrectly reported that the reduction in nicotine in cigarettes has made cigarettes less dangerous to health and only one-third correctly reported that nicotine patches were less likely to cause a heart attack than smoking cigarettes. Smokers who were more knowledgeable about the health risks of nicotine and the safety and efficacy of nicotine medications were more likely to report past use of nicotine medications. Misperceptions about the health risks of nicotine and the safety/efficacy of nicotine medications may discourage some smokers from considering the use of these medications to help them stop smoking.
To assess differences in demographic and smoking characteristics between smokers who have and have not used nicotine replacement therapy (NRT).
Mail survey of US smokers from a national research panel.
Smokers 18 years and over who returned a survey on smoking (n = 9630). The sample was weighted to match the US smoker population on age and sex.
Compared smokers who had/had not used NRT in a quit attempt (ever NRT use or over the counter (OTC) NRT use) on: demographic characteristics, nicotine dependence, history of craving and withdrawal, expected difficulty quitting, and self reported history of smoking related medical illness and psychopathology.
NRT users (both ever-users and OTC users) were more likely to be older, male, and better educated. They were also heavier smokers, had experienced more craving and withdrawal upon quitting, and scored higher on measures of dependence. These differences were evident among light smokers, and remained even when smoking rate and time to first cigarette were controlled.
Smokers who elect to use NRT differ from non-NRT users in ways that predispose them to failure in cessation. Controlling for smoking rate and time to first cigarette does not eliminate these differences, even among light smokers. These differences must be considered when comparing the effectiveness of NRT among samples of smokers who self select their treatment and are likely to bias such outcome comparisons.
Increasing smoking cessation rates is an important goal in preventing lung cancer and chronic obstructive pulmonary disease. Nicotine replacement therapy (NRT) has been found in clinical trials to improve the chances of success at stopping, but recent cross-sectional survey data have raised doubts as to whether it is effective when used by smokers making quit attempts unsupervised outside clinical trials. Because of biases inherent in cross-sectional surveys, this issue can only be adequately addressed using longitudinal studies. This paper reports the first study of its kind to examine the issue.
The ATTEMPT cohort is a multinational cohort study with data collection by the internet which recruited smokers of > or = 5 cigarettes per day aged 35-65 years who were intending to stop smoking within the next 3 months. Phase 1 began in spring 2003 and involved 2009 smokers from the USA, UK, Canada and France. Phase 2 involved 3645 smokers and included the same countries plus Spain. Follow-up assessments were carried out every 3 months. 492 smokers who made a quit attempt without formal behavioural support or bupropion in the first 3-month follow-up period were identified from phase 1, 357 of whom were followed up for a further 6 months. The phase 2 sample involved 906 smokers making quit attempts, 732 of whom were followed up. At baseline, demographic characteristics, smoking history and nicotine dependence were assessed. Smokers who made quit attempts were questioned on methods used to aid them. The main outcome measure was self-report of complete abstinence throughout both the 3-month periods following the quit date.
35.6% of smokers followed up in phase 1 and 29.6% of those followed up in phase 2 used NRT. The odds ratios comparing abstinence for 6 months in those using and those not using NRT, adjusting for nicotine dependence, were 3.0 (95% CI 1.2 to 7.5) for the phase 1 sample and 2.1 (95% CI 1.0 to 4.1) for the phase 2 sample. The difference in success rates between those using NRT and those not using it, adjusted for the Fagerstrom test for nicotine dependence (FTND) score, was 6% in the phase 1 sample and 3.7% in the phase 2 sample. The improved odds of success were not explicable in terms of motivation to use some form of aid to cessation or differential loss to follow-up.
NRT use by smokers making self-initiated quit attempts without formal behavioural support is associated with improved long-term abstinence rates.
The need for randomization as a means of controlling confounders is accentuated in the study of intended effects (efficacy) as compared with unintended ones (toxicity). The basic reason is that the indication for intervention is inherently a confounder in the study of efficacy but not of toxicity, whereas contraindications represent only a minor confounder even in toxicity research. Moreover, control of the indication in non-experimental terms is commonly infeasible owing to the complexity and subtlety of the indication.
Measures of quitting activity are important both to evaluate public health interventions and to predict the likelihood of future quitting in the individual smoker. In population surveys, such measures are generally based on recall and thus may lack validity. In this article, we present the results of a 1-year quitting history of 8924 persons from a random-digit dialed population survey conducted in California in 1990. Respondents often forgot dates of quit attempts other than the most recent. Also, our results suggest that respondents may not recall short quit attempts at all, especially if they took place more than a few months before the interview. Thus, accurate population measures of relapse rates or quitting activity should rely on recall only for the last few months before the interview. Using data from quit attempts that took place within 4 months of the interview, actuarial analysis showed that 71.1% of attempts lasted at least 2 days, 58.5% at least 3 days, but only 39.2% lasted a week or more; this rate dropped to 19.6% at 1 month and to 14.1% at 3 months. As a predictive measure, a quit attempt that lasted a week or longer in the last year appears less biased by recall than any attempt of a day or longer in the last year.
Despite the availability of efficacious treatments for bipolar disorder, their effectiveness in general clinical practice is greatly attenuated, resulting in what has been called an 'efficacy-effectiveness gap'. In designing VA Cooperative Studies Program (CSP) Study #430 to address this gap, nine principles for conducting an effectiveness (in contrast to an efficacy) study were identified. These principles are presented and discussed, with specific aspects of CSP #430 serving as illustrations of how they can be implemented in an actual study. CSP #430 hypothesizes that an integrated, clinic-based treatment delivery system that emphasizes (1) algorithm-driven somatotherapy, (2) standardized patient education, and (3) easy access to a single primary mental health care provider to maximize continuity-of-care, will address the efficacy-effectiveness gap and improve disease, functional, and economic outcome. It is an 11-site, randomized controlled clinical trial of this multi-modal, clinic-based intervention versus usual VA care running from 1997 to 2003. The trial has enrolled 191 subjects in each arm, using minimal exclusion criteria to maximize the external validity of the study. Subjects are followed for 3 years. The intervention is highly specified in a series of operations manuals for each of the three components. Several continuous quality improvement (CQI) interventions, process measures, and statistical techniques deal with drift of care in both the intervention and usual care arms to ensure the internal validity of the study. CSP #430 is designed to have impact well beyond the VA, since it evaluates a basic health care operational principle: that augmenting ambulatory access for major mental illness will improve outcome and reduce overall treatment costs. If results are positive, this study will provide a reason to reconsider the prevailing trend toward limitation of ambulatory services that is characteristic of many managed care systems today.
To assess smoking cessation rates achieved with nicotine gum and patch in simulated over-the-counter (OTC) and actual prescription (Rx) settings.
Separate open-label studies with gum and patch in OTC and Rx settings.
There were multiple samples: OTC gum: 2981 smokers; OTC patch: 2367; Rx gum: 324; Rx patch: 669.
All smokers received active nicotine replacement. In the OTC setting, smokers self-selected doses of nicotine gum (2 or 4 mg Nicorette) or patch (21, 14 or 7 mg NicoDerm CQ). No intervention was provided. In the Rx setting, smokers were prescribed gum or patch by their physician.
Biochemically verified continuous smoking abstinence was assessed at 6 weeks (28-day abstinence) and 6 months.
OTC success rates were consistently higher than Rx rates: differences were significant at 6 weeks for both patch [OR = 1.45 (1.05-1.98)] and gum [OR 2.92 (1.58-5.40)], and remained significant at 6 months for patch [OR = 3.63: (1.74-7.61)] but not gum [OR = 1.37: (0.73-2.58)]. Among OTC gum users. 16.1% were abstinent at 6 weeks and 8.4% at 6 months. For Rx gum users, abstinence rates were 7.7% at 6 weeks and 7.7% at 6 months. With OTC patch, 19.0% were abstinent at 6 weeks and 9.2% at 6 months. With Rx patch. abstinence rates were 16.0% at 6 weeks and 3.0% at 6 months.
Smoking cessation rates achieved with nicotine gum and patch under OTC conditions were as good as those under real-world prescribing conditions.
Successful smoking cessation is a major public health goal. In controlled clinical trials, nicotine replacement therapy (NRT) and the antidepressant bupropion have been shown to significantly increase cessation rates only for moderate to heavy smokers (> or = 15 cigarettes/d). Nicotine replacement therapy is heavily promoted to the general population by both the pharmaceutical industry and tobacco control advocates.
To examine trends in smoking cessation, pharmaceutical cessation aid use, and success in cessation in the general California population.
The large population-based California Tobacco Surveys of 1992, 1996, and 1999, including 5247 (71.3% response rate), 9725 (72.9% response rate), and 6412 (68.4% response rate) respondents, respectively.
Rates of cessation attempts (> or = 1 day) among smokers in the last year, use of pharmaceutical aids (mostly over-the-counter products since 1996), and cessation success.
Between 1992 and 1999, cessation attempts among California smokers increased 61.4% (from 38.1% to 61.5%), and NRT use among quitters increased 50.5% (from 9.3% to 14.0%). A total of 17.2% of quitters used NRT, an antidepressant, or both as an aid to cessation in 1999. In 1996 and 1999, the median duration of aid use (14 days) was much less than recommended, and only about 20% of users had adjuvant one-on-one or group behavioral counseling. Use of NRT increased short-term cessation success in moderate to heavy smokers in each survey year. However, a long-term cessation advantage was only observed before NRT became widely available over-the-counter (August 1996). In 1999, no advantage for pharmaceutical aid users was observed in either the short or long term for the nearly 60% of California smokers classified as light smokers (<15 cigarettes/d).
Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation in California smokers.
Background:
The aim of nicotine replacement therapy (NRT) is to replace nicotine from cigarettes. This reduces withdrawal symptoms associated with smoking cessation thus helping resist the urge to smoke cigarettes.
Objectives:
The aims of this review were:to determine the effectiveness of the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers and tablets) in achieving abstinence from cigarettes, or a sustained reduction in amount smoked; to determine whether the effect is influenced by the clinical setting in which the smoker is recruited and treated, the dosage and form of the NRT used, or the intensity of additional advice and support offered to the smoker; to determine whether combinations of NRT are more effective than one type alone; to determine its effectiveness compared to other pharmacotherapies.
Search strategy:
We searched the Cochrane Tobacco Addiction Group trials register in March 2004.
Selection criteria:
Randomized trials in which NRT was compared to placebo or to no treatment, or where different doses of NRT were compared. We excluded trials which did not report cessation rates, and those with follow up of less than six months.
Data collection and analysis:
We extracted data in duplicate on the type of participants, the dose, duration and form of nicotine therapy, the outcome measures, method of randomization, and completeness of follow up. The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. For each study we calculated summary odds ratios. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed effect model.
Main results:
We identified 123 trials; 103 contributing to the primary comparison between NRT and a placebo or non-NRT control group. The odds ratio (OR) for abstinence with NRT compared to control was 1.77 (95% confidence intervals (CI): 1.66 to 1.88). The ORs for the different forms of NRT were 1.66 (95% CI: 1.52 to 1.81) for gum, 1.81 (95% CI: 1.63 to 2.02) for patches, 2.35 (95% CI: 1.63 to 3.38) for nasal spray, 2.14 (95% CI: 1.44 to 3.18) for inhaled nicotine and 2.05 (95% CI: 1.62 to 2.59) for nicotine sublingual tablet/lozenge. These odds were largely independent of the duration of therapy, the intensity of additional support provided or the setting in which the NRT was offered. In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2 mg gum (OR 2.20, 95% CI: 1.85 to 3.25). There was weak evidence that combinations of forms of NRT are more effective. Higher doses of nicotine patch may produce small increases in quit rates. Only one study directly compared NRT to another pharmacotherapy. In this study quit rates with bupropion were higher than with nicotine patch or placebo.
Reviewers' conclusions:
All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) are effective as part of a strategy to promote smoking cessation. They increase the odds of quitting approximately 1.5 to 2 fold regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT.
To describe the use of treatment for tobacco dependence in relation to insurance status and advice from a healthcare provider in a population-based national sample interviewed in 2000.
Analyses are based on 3996 adult smokers who participated in the National Health Interview Survey in 2000, and who provided information on tobacco-cessation treatments used at their most recent quit attempt occurring in the last year. Age-adjusted and weighted categorical analysis was used to compute prevalence estimates of self-reported treatments (pharmacotherapy and behavioral counseling) for tobacco dependence. Multivariate logistic regression analyses were used to examine factors associated with use of treatments.
Overall, 22.4% of smokers who tried to quit in the previous year used one or more types of cessation aid compared to 15% in 1986. Treatment usually involved pharmacotherapy (21.7%) rather than behavioral counseling (1.3%). Smokers attempting to quit were more likely to use cessation aids if covered by private (25.4%) or military (25.0%) insurance than by Medicare (17.8%), Medicaid (15.5%), or no insurance (13.2%). In a multivariate analysis of factors related to use of cessation aids, advice from a healthcare provider to quit smoking and the number of cigarettes smoked per day were significant predictors of treatment use, regardless of insurance status.
Cessation aids are under-used across insurance categories. Advice by a healthcare provider to quit is associated with increased use of effective therapies for tobacco dependence. Systematic efforts are needed to eliminate barriers to appropriate treatment.
To assess the efficacy of World Wide Web-based tailored behavioral smoking cessation materials among nicotine patch users.
Two-group randomized controlled trial.
World Wide Web in England and Republic of Ireland.
A total of 3971 subjects who purchased a particular brand of nicotine patch and logged-on to use a free web-based behavioral support program.
Web-based tailored behavioral smoking cessation materials or web-based non-tailored materials.
Twenty-eight-day continuous abstinence rates were assessed by internet-based survey at 6-week follow-up and 10-week continuous rates at 12-week follow-up.
Using three approaches to the analyses of 6- and 12-week outcomes, participants in the tailored condition reported clinically and statistically significantly higher continuous abstinence rates than participants in the non-tailored condition. In our primary analyses using as a denominator all subjects who logged-on to the treatment site at least once, continuous abstinence rates at 6 weeks were 29.0% in the tailored condition versus 23.9% in the non-tailored condition (OR = 1.30; P = 0.0006); at 12 weeks continuous abstinence rates were 22.8% versus 18.1%, respectively (OR = 1.34; P = 0.0006). Moreover, satisfaction with the program was significantly higher in the tailored than in the non-tailored condition.
The results of this study demonstrate a benefit of the web-based tailored behavioral support materials used in conjunction with nicotine replacement therapy. A web-based program that collects relevant information from users and tailors the intervention to their specific needs had significant advantages over a web-based non-tailored cessation program.
This survey was performed to determine the patterns of surgical care provided patients with non-small cell lung carcinoma (NSCLC).
In 2001, the American College of Surgeons carried out a patient care survey of 729 hospitals to retrieve information of NSCLC patients' history, evaluation, pathology, and surgical treatment.
Inclusion criteria were met by 40,090 patients: of whom 11,668 (29.1%) were treated surgically; 74.2% alone and 25.8% as part of multimodality therapy. Of these patients, 59.5% were in stage I, 17.5% in stage II, 17.0% in stage III, and 6.0% in stage IV. Surgery patient demographics were the following: 55% male and 45% female; 46.8% 70 years or older; and 76.3% had significant comorbidities. Tumor characteristics: squamous 28%, adenocarcinoma 37.6%, other 34.4%. Staging: in addition to radiologic examinations, preoperative mediastinoscopy was performed in 27.1% of operated patients with node biopsy in only 46.6% of these procedures. Operations: wedge resection 15.6%, lobectomy 70.8%, pneumonectomy 13.6%. Surgical margins were positive in 7.8%, but only 65.2% had frozen section analysis. Perioperative mortality was 5.2%, but was 4.0% in nontransfused patients and 12.7% in transfused patients and was 3.2% in high-volume (more than 90 operations per year) versus 4.8% in low-volume hospitals (p < 0.001).
(1) Patients being operated for NSCLC are elderly with significant comorbid conditions. (2) More patients than previously are female and have adenocarcinoma. (3) Mediastinoscopy is infrequently performed and lymph nodes are biopsied in less than 50% of them. (4) Lobectomy is the most common operation, and positive surgical margins are too frequent. (5) Operative mortality is reasonable but transfusion is a marker for increased risk and outcomes are superior in high-volume hospitals. (6) Hospitals with higher volume had fewer perioperative deaths.
The finding that smokers who used more pieces of nicotine gum achieved better treatment outcomes has been interpreted to indicate that the use of more pieces of gum leads to better treatment outcomes. However, these correlational findings are subject to at least three alternate explanations: (1) reverse causation; (2) a confounding third variable; or (3) behavioral processes. We tested these alternative explanations in secondary analyses of data from a clinical trial of nicotine lozenges.
Subjects (n = 1030) who quit smoking for at least 2 weeks in a placebo-controlled trial of nicotine lozenges were studied. Lozenge use was recorded daily; outcome was assessed as carbon monoxide (CO)-verified 28-day continuous abstinence at 6 weeks.
To refute the reverse causation hypothesis we analyzed data on compliance during a period when subjects were abstinent: high use of active lozenge was associated with greater success; for each additional lozenge used, the odds of success increased by 10%. The third variable and behavioral processes hypotheses both predict that high lozenge use will be associated with improved outcomes even in the placebo condition. However, our analyses showed that this was not the case. Further, greater use of lozenges increased the active-placebo difference, as would be expected under a pharmacological explanation of compliance effects.
The analyses rebut the alternative explanations, and suggest that use of more nicotine lozenges is causally associated with better quit rates.
There is considerable variability in reported postoperative mortality and risk factors for mortality after surgery for lung cancer. Population-based data provide unbiased estimates and may aid in treatment selection.
All patients diagnosed with lung cancer in Norway from 1993 to the end of 2005 were reported to the Cancer Registry of Norway (n = 26 665). A total of 4395 patients underwent surgical resection and were included in the analysis. Data on demographics, tumour characteristics and treatment were registered. A subset of 1844 patients was scored according to the Charlson co-morbidity index. Potential factors influencing 30-day mortality were analysed by logistic regression.
The overall postoperative mortality rate was 4.4% within 30 days with a declining trend in the period. Male sex (OR 1.76), older age (OR 3.38 for age band 70-79 years), right-sided tumours (OR 1.73) and extensive procedures (OR 4.54 for pneumonectomy) were identified as risk factors for postoperative mortality in multivariate analysis. Postoperative mortality at high-volume hospitals (> or = 20 procedures/year) was lower (OR 0.76, p = 0.076). Adjusted ORs for postoperative mortality at individual hospitals ranged from 0.32 to 2.28. The Charlson co-morbidity index was identified as an independent risk factor for postoperative mortality (p = 0.017). A prediction model for postoperative mortality is presented.
Even though improvements in postoperative mortality have been observed in recent years, these findings indicate a further potential to optimise the surgical treatment of lung cancer. Hospital treatment results varied but a significant volume effect was not observed. Prognostic models may identify patients requiring intensive postoperative care.
Quit attempts and use of smoking cessation treatments in the USA: an analysis of the 2003 current population survey. Poster presented at the Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2007, Austin, Texas, USA.
- S Shiffman
- S Brockwell
- JL Pillitteri
Wearing nicotine patches continuously for three weeks during a cessation attempt improves short-term efficacy. Poster presented at the Annual Meeting of the Society for Research on Nicotine and Tobacco; February 2007, Austin, Texas, USA.
- S Shiffman
- S Brockwell
- J Gitchell