Continuation of smoking cessation and following weight change after intervention in a healthy population with high smoking prevalence

Smoking prevalence among males is conspicuously high in Asian countries including Japan. There are few prospective intervention studies on the duration of smoking cessation within regions with a high prevalence of smokers, such as Asia. We investigated the extent to which subjects continued abstaining from smoking after receiving smoking cessation support provided for all smokers in an occupational setting, regardless of their willingness to quit smoking. The subjects were 251 male workers who were smokers and had received a smoking cessation intervention in 1997 in an occupational setting. Smoking cessation rates and body mass index (BMI) at 10, 18, 30, 42, 54, and 66 months after the initial intervention were confirmed during annual health check-ups. Those who quit smoking following the intervention and continuously abstained from smoking throughout the study period were separately examined for BMI. After five years, 10.6% of the smokers continued smoking cessation. Of the abstainers who quit following the intervention, the abstinence rate decreased in the first and second year, but it stabilized at approximately 45% after the third year. High nicotine dependence and a self-reported lack of willingness to quit smoking did not lower long-term abstinence rates. Abstainers initially gained 1.55 BMI on average, but decreased the weight gain to 0.96 BMI over six years. Introducing smoking cessation support without nicotine replacement therapy is an effective long-term strategy in a healthy population with a high smoking prevalence. Abstainers maintain their smoking cessation if they refrain from smoking for three years.     

Smoking cessation intervention for female prisoners: addressing an urgent public health need

Objectives. We tested the efficacy of a combined pharmacologic and behavioral smoking cessation intervention among women in a state prison in the southern United States.Methods. The study design was a randomized controlled trial with a 6-month waitlist control group. The intervention was a 10-week group intervention combined with nicotine replacement therapy. Two hundred and fifty participants received the intervention, and 289 were in the control group. Assessments occurred at baseline; end of treatment; 3, 6, and 12 months after treatment; and at weekly sessions for participants in the intervention group.Results. The intervention was efficacious compared with the waitlist control group. Point prevalence quit rates for the intervention group were 18% at end of treatment, 17% at 3-month follow-up, 14% at 6-month follow-up, and 12% at 12-month follow-up, quit rates that are consistent with outcomes from community smoking-cessation interventions.Conclusions. Female prisoners are interested in smoking cessation interventions and achieved point-prevalence quit rates similar to community samples. Augmenting tobacco control policies in prison with smoking cessation interventions has the potential to address a significant public health need.Smoking is the leading preventable cause of death in the United States.¹ Smoking prevalence and associated morbidity and mortality have decreased in the general US population; however, smoking prevalence remains 3 to 4 times higher among prisoners than in the nonincarcerated adult population.² The most common medical problems of prisoners are smoking related, including heart, circulatory, respiratory, kidney, and liver problems and diabetes.³ Medical care for prisoners consumes 11% of correctional budgets and is expected to double in 10 years, in part because of high rates of smoking and associated medical conditions.⁴ The continued high prevalence of smoking among prisoners has important public health implications because of the increasing incarceration rate in the United States,⁵ high prevalence of comorbid psychiatric and substance abuse disorders associated with nicotine dependence, and low natural rates of smoking cessation among prisoners.Among incarcerated men, 70%–80% are current smokers.^2,6–11 Smoking prevalence among incarcerated women ranges from 42% to 91%, 2 to 4 times higher than among women in the general population.^2,12,13 Prisoners are also more likely to have comorbid conditions—psychiatric disorders and substance dependence—associated with greater nicotine dependence and less likelihood of smoking cessation in the absence of intensive interventions.¹⁴Over the past 10 years, because of concerns about secondhand smoke, threats of litigation, and desires to protect employee and prisoner health, reduce prison health care expenditures, and limit prisoner amenities, correctional facilities have implemented smoking bans and restrictions. Smoking bans in prisons differ from smoking bans in other settings. Prisoners are confined and have no legitimate opportunities to smoke for the duration of their sentence. Hence, they have no recourse except to quit smoking—usually “cold turkey” and without smoking cessation treatment or nicotine replacement—or to obtain cigarettes or tobacco from the underground prison economy. Prison smoking bans often have unintended consequences: prisoners continue to smoke, and a thriving contraband economy grows to meet the demand for cigarettes.^8,9,15,16From a public health perspective, temporary cessation of smoking because of punitive smoking restrictions is different from “quitting” smoking.¹⁷ Indeed, 97% of people in a smoke-free jail returned to smoking within 6 months of release, suggesting that smoking bans or restrictions during incarceration are unlikely to have a marked effect on the lifetime prevalence of smoking.¹⁸ The National Commission on Correctional Health Care, in its 2002 report on the health status of soon-to-be-released inmates, recommended that all inmates be provided with a smoke-free environment and that smoking cessation programs be offered to staff members and inmates. Offering smoking cessation programs along with smoking restrictions might increase the likelihood of tobacco control in the prison environment and sustained smoking cessation after release.¹⁹ However, the need for smoking cessation interventions shown to be effective in correctional settings remains virtually ignored, despite the enormous human, health, and economic costs of smoking among prisoners.^13,19,20Among the burgeoning literature on smoking cessation with other populations, we could locate only 2 published papers of smoking cessation interventions with prisoners. Edinger et al. conducted 2 small studies of self-control procedures for smoking cessation among male prisoners.²¹ Their studies had methodological limitations, including small sample sizes (N = 14 and N = 28), significant treatment attrition, and lack of biological verification of treatment outcomes. Richmond et al. reported a pilot study with 30 male prisoners who received 2 sessions of cognitive–behavioral counseling, nicotine replacement therapy, buproprion, and self-help materials.²² Self-reported smoking verified through levels of expired carbon monoxide (CO) was assessed 6-months after intervention. At 6 months, 26% had verified point-prevalence abstinence, and 22% had continuous abstinence. Overall, these studies are notable for their small sample sizes and focus on male prisoners.To our knowledge, our study is the first-ever randomized clinical trial of smoking cessation with female prisoners. We examined the efficacy of a combined behavioral and pharmacologic intervention compared with a waitlist control group. The study was designed to overcome the limitations of previous studies and to focus on female prisoners. We anticipated that the group exposed to the intervention would have superior quit rates at all time points compared with the waitlist control group.     

Effectiveness of a clinic-based strategy for implementing the AHRQ Smoking Cessation Guideline in primary care

BACKGROUND: The Agency for Healthcare Research and Quality Smoking Cessation Practice Guideline recommends systematic assessment of smoking status and counseling of smokers at every visit, but the actual effectiveness of the guideline in primary care practice is unknown. METHODS: We conducted a nonrandomized, controlled before-after trial of a guideline-derived intervention that includes routine identification and brief counseling of smokers by nurses and medical assistants, coupled with free nicotine replacement therapy (NRT) and telephone counseling of those smokers who are willing to make a quit attempt, and feedback on performance of guideline-recommended activities. The intervention was pilot tested at 1 family practice (FP) clinic over a 2-month period; patterns of usual care were observed concurrently at four control FP clinics. We obtained exit interviews of 651 consecutive adult smokers who presented for routine, nonemergency care. Abstinence (7-day point prevalence) was determined by telephone interview during 6-month follow-up. RESULTS: Concordance with guidelines was significantly greater for all recommended actions at the test site during the intervention versus baseline (P < or = 0.05). Significantly more intervention versus baseline patients at the test site reported abstinence at 2-month follow-up (21 vs. 4%, P = 0.0004), and more patients tended to be abstinent at 6-month follow-up (21 vs. 11%, P = 0.08). No significant differences in 2- or 6-month quit rates between intervention and baseline patients were observed at the control sites. CONCLUSIONS: Implementation of a guideline-driven smoking cessation intervention that focuses primarily on smokers who are interested in making a quit attempt is associated with increased abstinence in primary care practice.     

Is stress management training a useful addition to physician advice and nicotine replacement therapy during smoking cessation in women? Results of a randomized trial

PURPOSE: To determine whether a stress management (SM) program could improve cessation rates when added to usual care (UC) among women attempting to quit smoking. DESIGN: Randomized controlled trial conducted during a 12-month period. SETTING: Smoking cessation clinics located within two tertiary care centers in Ottawa, Ontario. SUBJECTS: A total of 332 women smokers 19 years or older who smoked 10 or more cigarettes per day were recruited via advertisements. INTERVENTION. Either UC (physician advice and nicotine replacement therapy) or UC plus an eight-session group SM training program (coping skills development relevant to smoking-specific and generic stressors). MEASURES: Point prevalence abstinence 2 and 12 months after study intake. A secondary outcome of interest was change in perceived stress during the intervention period. RESULTS: On an intent-to-treat basis, the addition of SM to UC had no incremental effect on 2- or 12-month abstinence rates. Abstinence rates at 2 months were 26.2% vs. 31.7% in the UC and SM groups, respectively (p = .59). At 12 months, the rates were 18.5% vs. 20.7% (p = .86). When quit rates were compared including only participants who demonstrated adequate adherence to the intervention protocol, there was a significant difference between the UC and SM groups at 2 months (34.9% vs. 48.7%; adjusted odds ratio, 1.88; 95% confidence interval, 1.04-3.42; p = .04) but not at 12 months (23.0% vs. 28.2%; adjusted odds ratio, 1.24; 95% confidence interval, .64-2.41; p = .53). There was a significant reduction in perceived stress from preintervention to postintervention; however, this decrease was not moderated by group assignment. CONCLUSION: The addition of SM in our setting neither increased abstinence rates nor reduced perceived stress over and above UC in women motivated to quit smoking. Poor attendance at the SM intervention undermined its effectiveness.     

Effectiveness of smoking cessation interventions: review of evidence and implications for best practice in Australian health care settings

OBJECTIVE: To review the evidence of the effectiveness of various smoking cessation methods and appropriateness for use in Australian health care settings. METHODS: Cochrane and other existing reviews and meta-analyses of evidence were the basis for the review. Systematic literature searches were also conducted to identify relevant controlled trials published internationally between January 1999 and May 2002. The main inclusion criteria for studies were use of a controlled evaluation design and an outcome measure of continuous abstinence from smoking for at least five months. A three-tiered grading system for strength of evidence was used. RESULTS: Clinic and hospital systems to assess and document tobacco use and routine provision of cessation advice can double long-term quit rates. While brief intervention can achieve a significant effect at population level, at individual level there is a strong dose response between the number and length of sessions of tobacco cessation counselling and its effectiveness. Effective behavioural interventions can increase cessation rates by 50-100% compared with no intervention. Some pharmacotherapies are safe and also help to substantially increase cessation rates. CONCLUSIONS: Effective behavioural and pharmacological methods of tobacco cessation are available. IMPLICATIONS: Every smoker should be offered evidence-based advice and treatment to quit smoking. This includes pharmacotherapy, unless contra-indicated. Health professionals and health care settings can play a significant role in motivating and assisting smokers to quit.     

A survey of characteristics of smokeless tobacco users in a treatment program

OBJECTIVE: To determine the characteristics and outcomes of smokeless tobacco (ST) users receiving interventions in an outpatient tobacco-dependence treatment program. METHODS: Survey was mailed with telephone follow-up to ST users treated during a 2-year period. RESULTS: Nicotine replacement therapy and family and social support were the most helpful intervention components in maintaining tobacco abstinence. Continuing ST users face significant barriers to abstinence such as high levels of nicotine dependence, lack of motivation, nicotine withdrawal symptoms, and stress. CONCLUSIONS: Enhancing confidence in their ability to quit, managing stress, prescribing bupropion SR, offering nicotine replacement therapy to relieve withdrawal symptoms, and providing ongoing support may be important for ST users in tobacco- dependence treatment programs.     

A smoking cessation intervention among tuberculosis patients in rural China

Objective: To assess the integration of a smoking cessation intervention into routine tuberculosis (TB) services.Method: Consecutive TB patients registered from 1 March to 31 August 2010 were enrolled in an intervention for self-reported smoking to promote tobacco cessation during treatment for TB. Information on the harmful health effects of tobacco smoke and smoking and TB were provided to TB patients who self-reported as current smokers. Smoking status was reassessed at every follow-up visit during anti-tuberculosis treatment with reinforced health messages and advice to quit.Results: Of 800 TB patients enrolled, 572 (71.5%) were male and 244 (30.5%) were current smokers. Females were more likely to be non-smokers (100% vs. 35.8%, P < 0.001). Of the 244 current smokers, 144 (59.0%) started smoking at <20 years, 197 (80.7%) consumed ⩾20 cigarettes per day, 211 (86.5%) had perceived smoking dependence and 199 (81.6%) had made no attempt to quit before the diagnosis of TB. Of the 244 current smokers, 234 (95.9%) were willing to quit, and 156 (66.7%) reported abstinence at month 6. Challenges to implementing smoking cessation intervention were identified.Conclusion: The majority of current smokers among TB patients were willing to quit and remained abstinent at the end of anti-tuberculosis treatment. This intervention should be scaled up nationwide.     

控烟条例实施1年对北京市15岁及以上人群烟草使用的影响

目的 评价“你戒烟 我支持 – 北京市出租车驾驶员健康关爱项目”的戒烟效果。 方法 2017年9 — 12月招募并入选103名北京市吸烟的出租车驾驶员。由北京某三甲医院戒烟门诊向参加者提供免费戒烟服务,包括戒烟药物（伐尼克兰）、心理行为干预与随访管理。同时组织单位给予该项目大力支持并进行多次媒体宣传。在戒烟门诊首诊时收集参加者的基线信息,并在首诊后第1、4、8、12周和第24周进行随访,收集参加者的吸烟行为变化、伐尼克兰服用情况及不良反应情况等信息。 结果 参加者在第4、8周和第12周的7天时点戒烟率分别为39.8 %、43.7 %和54.4 %,第5～8周和第9～12周的持续戒烟率分别为38.8 %和45.6 %。尼古丁依赖程度和持续用药时间是戒烟成功的影响因素。 结论 该项目实施的提供戒烟门诊专业戒烟服务联合单位支持和媒体宣传等综合措施,可有效促进出租车驾驶员戒烟,具有推广应用价值。     

Reducing smoking prevalence in Australian prisons: a review of policy options

Smoking of tobacco products is a major public health challenge in prison settings in most countries. Although tobacco use was tolerated by custodial authorities for many decades, the overwhelming evidence of the adverse public health effects of tobacco on both the smokers and those in the vicinity of exhaled or passive smoke, coupled with the risk of litigation by inmates involuntarily exposed to tobacco smoke, has recently prompted custodial authorities to implement tobacco control strategies to minimise both health and legal risks. The author examines the appropriateness of common policy initiatives put forward for reducing smoking prevalence in Australian prisons and suggests that, currently, apart from total prohibition and restriction on brands of tobacco, several policies and strategies may be utilised in combination to reduce smoking prevalence in prison settings, subject to their appraisal in terms of both effectiveness and cost-effectiveness, careful adaptation to prison conditions, and consistent implementation.     

Smokeless tobacco cessation intervention for college athletes: results after 1 year.

OBJECTIVES: The purpose of this study was to determine the efficacy of a college-based smokeless tobacco cessation intervention targeting college athletes. METHODS: Sixteen colleges were matched for prevalence of smokeless tobacco use in their combined baseball and football teams and randomly assigned within college pairs to the intervention or the control group. One-year prevalence of cessation among smokeless tobacco users was determined by self-report of abstinence for the previous 30 days. Differences between groups were analyzed in a weighted version of the Fisher 1-sided permutation test for paired samples after adjustment for significant predictors of quitting other than the intervention (i.e., smokeless tobacco uses per week and most frequently used brand). RESULTS: Cessation prevalences were 35% in the intervention colleges and 16% in the control colleges when subjects with unknown quit status were defined as nonquitters. After adjustment for other significant predictors of quitting, the difference of 19% increased to 21%. The intervention effect increased with level of smokeless tobacco use. CONCLUSIONS: This intervention was effective in promoting smokeless tobacco cessation, especially among those who were more frequent users.     

Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study

Background

There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.

Methods

An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate.

Results

A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB treatment alone (77.5% vs. 8.7%; p < 0.001). Furthermore, at the end of TB treatment (6 months or later), there were significantly higher rates of treatment default (15.2% vs. 2.5%; p = 0.019) and treatment failure (6.5% vs. 0%; p = 0.019) in the DOTS group than in the SCIDOTS group.

Conclusion

This study provides evidence that connecting TB-tobacco treatment strategy is significant among TB patients who are smokers. The findings suggest that the integrated approach may be beneficial and confer advantages on short-term outcomes and possibly on future lung health of TB patients who quit smoking. This study may have important implications on health policy and clinical practice related to TB management among tobacco users.     

2015-2018年央补项目戒烟门诊患者首诊后1个月随访时戒烟率影响因素分析

目的 评估中央补助地方戒烟门诊项目实施效果,探索影响吸烟者戒烟成功的因素,以指导戒烟服务的提供和戒烟门诊工作的开展。方法 采用人群现场干预研究,由经过项目培训的医务人员,对吸烟者进行面对面访谈,完成调查问卷,并进行心理行为干预。已配备戒烟药物的医院,为患者开具相应药物。首诊1个月后开展随访干预,获得1个月随访7 d时点戒烟率。结果 1个月随访7 d时点戒烟率为34.1%。多元logistic回归结果显示, ≥60岁患病人群戒烟可能性最大;自身患病、首诊非每天吸烟、准备在30 d内戒烟、使用酒石酸伐尼克兰和盐酸安非他酮的患者,戒烟成功的可能性更大;未就业者相对于就业者更不利于戒烟;每日吸烟量越大、吸烟年限越长、晨起后第一支烟越急迫的患者,戒烟的可能性越小;是否有戒烟史对戒烟可能性没有影响。结论 从1个月随访时7 d时点戒烟率看,央补戒烟门诊项目戒烟干预有效。应加大对吸烟者的宣传,戒烟越早越有效。使用酒石酸伐尼克兰和盐酸安非他酮等药物能增加戒烟的可能性,应加强戒烟门诊有效药物的配备率。戒烟门诊医务人员帮助患者在戒烟过程中克服戒断症状很重要。     

Smoking cessation intervention in a large randomised population-based study. The Inter99 study

BACKGROUND: Several large and well-conducted community interventions have failed to detect an effect on prevalence of smoking. METHODS: Two thousand four hundred eight daily smokers in all motivational stages were actively recruited and included in a randomised population-based intervention study in Copenhagen, Denmark. All smokers completed a questionnaire and underwent a health examination and a lifestyle consultation. Daily smokers in the high intensity intervention group were offered assistance to quit in smoking cessation groups. RESULTS: The validated abstinence rate at 1-year follow-up was 16.3% in the high intensity group and 12.7% in the low intensity group compared with a self-reported abstinence rate of 7.3% in the background population. The adjusted odds ratio of abstinence in the high intervention group was significantly higher, OR = 2.2 (1.6-3.0) than in the background population, also in the 'intention-to-treat' analyses, OR = 1.5 (1.1-2.0). Higher socioeconomic status, higher age at onset of daily smoking, and a higher wish to quit were predictors of success. CONCLUSION: In a population-based setting, using active recruitment and offering assistance to quit, it was possible to include many smokers and to achieve a significantly higher validated abstinence in the high intensity intervention than in the background population, even when using 'intention-to-treat' analyses.     

Predictors of smoking behavior change 6 and 18 months after individual counseling during periodic health examinations

Predictors of smoking behavior change were examined in a randomized controlled trial of individualized smoking cessation counseling delivered by a smoking cessation counselor during periodic health examination. Self-reports of not smoking at 6 and 18 months and attempts to quit were greater, but not significantly so, in the intervention group compared with the usual care group. There was no difference between the intervention group and the usual care group in reported continuous abstinence. Multivariate analysis showed that longer periods of abstinence in the past and having smoking identified as the main problem were important predictors of subsequent quitting. Having fewer other smokers in the household, stronger intentions to stop smoking in the next month, and being in the intervention group were also significant predictors of abstinence at 6 months, but not at 18 months. Those who had tried to quit by 6 months and 18 months were more likely to be in the intervention group, to have greater motivation to stop smoking, and to have more problems of daily living. Supplementing physician's advice with individualized smoking cessation counseling during health maintenance examinations was associated with a greater short-term quit rate and more quit attempts over 18 months than physician advice alone, but did not influence continuous abstinence from cigarettes over this time.     

Design and conduct of a pragmatic randomized controlled trial to enhance smoking-cessation outcomes with exercise: The Fit2Quit study

BackgroundMost smokers want to stop smoking and many try to quit. However abstinence rates are low and most smokers do not manage to abstain for even a week. Relapse to smoking can be related to the occurrence of tobacco withdrawal symptoms (e.g., sleep disturbance, irritability, and craving) and weight gain. If regular exercise mitigates these effects it could have potential as an aid to smoking cessation. The aim of the Fit2Quit study is to determine the effects of a home and community-based exercise intervention on smoking abstinence at six months when used as an adjunct to usual care (telephone smoking-cessation counseling and nicotine replacement therapy; NRT).Methods/designA prospective parallel two-arm randomized controlled trial. Participants (n = 1400, 700 per arm) will be randomized to a structured home and community-based exercise program plus usual care (behavioral counseling and NRT) or to usual-care alone. It is targeted that at least 25% of the sample will be of Māori ethnicity (New Zealand indigenous). Outcomes to be measured using intention-to-treat analysis include: seven-day point prevalence of smoking abstinence verified by salivary cotinine (primary outcome); 6 months continuous abstinence; body mass index (BMI); cardio-respiratory fitness; physical activity levels; and cost effectiveness.DiscussionThe Fit2Quit study is an example of a large, pragmatic randomized controlled trial in a community setting. Specific components of the exercise intervention are outlined in detail.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12609000637246.     

Promoting abstinence among relapsed chronic smokers: the effect of telephone support.

OBJECTIVES: The present study used telephone support both to sustain abstinence and to encourage renewed quit attempts in smokers who had completed an intensive smoking cessation clinic. METHODS: Subjects were hard-core smokers (n = 1083) who had attended a multisession cessation clinic. They were then assigned randomly to receive telephone support (intervention calls 3, 9, and 21 months after the targeted cessation clinic quit date) or no further intervention. RESULTS: In the intervention condition, subjects who relapsed were significantly more likely to resume abstinence (that is, to recycle) than those in the comparison condition at follow-up (6 months: 17.8% vs 11.3%; 24 months: 25.7% vs 18.2%). Telephone support was not effective in preventing relapse, and overall differences in abstinence outcome were not significant. CONCLUSIONS: The major hypothesis of the current study--that telephone support would enhance the resumption of abstinence--received partial support. However, there was no evidence either of an overall treatment effect or of an effect in preventing relapse. Telephone outreach may be more effective in the context of self-help or other less intensive interventions.     

The smoking cessation efficacy of varying doses of nicotine patch delivery systems 4 to 5 years post-quit day

BACKGROUND: This study was undertaken to evaluate the long-term smoking cessation efficacy of varying doses of transdermal nicotine delivery systems 4 to 5 years post-quit day. METHODS: A follow-up study was conducted 48 to 62 months after quit day among patients who were enrolled in the Transdermal Nicotine Study Group investigation. The latter study included group smoking cessation counseling and randomized assignment to 21, 14, or 7 mg nicotine patches or placebo patches. Seven of nine smoking cessation research centers participated in the long term follow-up investigation. RESULTS: The self-reported continuous quit rate among patients originally assigned 21 mg (20.2%) was significantly higher than rates for patients assigned 14 mg (10.4%), 7 mg (11.8%), or placebo patches (7.4%). Log rank survival analysis found no difference in relapse rates after 1 year postcessation. Smokers under age 30 years were significantly less likely to be abstinent at long term follow-up compared to smokers > or = 30 years of age (3 vs 13%, respectively). Mean weight gain in confirmed continuous quitters was 10.1 kg in men and 8.0 kg in women. Of the 63 continuous abstainers surveyed, 30 respondents (48%) reported that they no longer craved cigarettes, and no individual reported daily craving for cigarettes. CONCLUSIONS: Nicotine patch therapy with 21 mg/day patches resulted in a significantly higher long-term continuous abstinence rate compared to lower dose patches and placebo. Relapse rates among the various treatment conditions were similar after 1 year postcessation.