Factors associated with successful smoking cessation among adolescent smokers undergoing a smoking cessation program involving nicotine replacement therapy

OBJECTIVE: To identify factors associated with successful smoking cessation among adolescent smokers in a smoking cessation program involving nicotine replacement therapy. METHODS: We recruited adolescent smokers who were prepared to quit smoking and participated in the smoking cessation program in Kanagawa prefecture. All participants fulfilled a questionnaire beforehand, covering gender, age at the beginning of the study, age at onset of smoking, the number of quit attempts, the number of cigarettes per day and the smoking status of their families and friends. Seven nicotine patches (nicotine 52.5 mg/day) were given to them free of charge for daily use. Their smoking status and the use of nicotine patches were confirmed by telephone or postcard at the 1 and 6 month follow-ups. The relationships between successful smoking cessation and different factors among eligible participants were analyzed using the Fisher's exact test and the Mann-Whitney U test. RESULTS: The subjects included 39 adolescent smokers (mean 16.4 years). The mean age at onset of smoking and the mean duration of smoking were 13.3 years and 2.3 years, respectively. The average daily number of cigarettes smoked was 12.8. Of 39 eligible participants at the one month follow up, 14 (35.9%) were found to be abstaining from smoking. The subjects treated with nicotine patches were significantly more likely to be abstinent than those without them (P<0.05). However, no significant associations with other factors were found. Of 39 participants at the six months follow up, 10 (25.6%) were still abstinent but there were no significant associations with any of the factors, including use of nicotine patches. Subjects living with smokers were significantly less likely to be successful in their efforts to quit than those living with non-smokers (P< 0.05). There were no significant associations with other factors, including using nicotine patches. No adverse events relating to the use of the nicotine patches were encountered during the study period. CONCLUSION: The smoking cessation program involving NRT provided for adolescent smokers appeared effective at the one month follow up. Those adolescents living with smokers had more difficulties in quitting smoking than those with non-smokers at the 6 month follow up. In order to increase the number of adolescent smokers in the smoking cessation study, the need to obtain parental consent might be considered as a barrier to be overcome. Additionally, more effective follow-up procedures should be considered for the purpose of avoiding dropouts during the study.     

Gender differences in predictors for long-term smoking cessation following physician advice and nicotine replacement therapy.

We evaluated gender differences in demographic, smoking history, nicotine dependence, transtheoretical, and perceived stress variables as predictors of smoking cessation. Participants (n = 381) smoked at least 15 cigarettes per day and were motivated to quit. The outcome variable was 7-day abstinence at 1-year follow-up. Predictor variables included: age, education level, number of years smoking, cigarettes per day, quit attempts, nicotine dependence, stage of change, decisional balance, processes of change, self-efficacy, and perceived stress. Logistic regression analysis was used to derive predictive models for women and men. In women, lower scores for pre- and mid-treatment perceived stress significantly increased the likelihood of being abstinent at follow-up. For men, a higher level of education or number of quit attempts lasting > 24 hours in the past year, along with less frequent use of behavioural processes of change at baseline increased the probability of being abstinent at follow-up.     

Ethnic disparities in the use of nicotine replacement therapy for smoking cessation in an equal access health care system

PURPOSE: To examine ethnic variations in the use of nicotine replacement therapy (NRT) in an equal access health care system. DESIGN: Cross-sectional survey. SETTING: Eighteen Veterans Affairs medical and ambulatory care centers. SUBJECTS: A cohort of male current smokers (n = 1606). MEASURES: Use of NRT (nicotine patch or nicotine gum), ethnicity, sociodemographics, health status, smoking-related history, and facility prescribing policy. RESULTS: Overall, only 34% of African-American and 26% of Hispanic smokers have ever used NRT as a cessation aid compared with 50% of white smokers. In the past year, African-American smokers were most likely to have attempted quitting. During a serious past-year quit attempt, however African-American and Hispanic smokers reported lower rates of NRT use than white smokers (20% vs. 22% vs. 34%, respectively, p = .001). In multivariate analyses, ethnicity was independently associated with NRT use during a past-year quit attempt. Compared with white smokers, African-American (adjusted odds ratio, .53; 95% confidence interval, .34-.83) and Hispanic (adjusted odds ratio, .55; 95% confidence interval, .28-1.08) smokers were less likely to use NRT. CONCLUSIONS: Assessment of variations in use of NRT demonstrates that African-American and Hispanic smokers are less likely to use NRT during quit attempts. Future research is needed on the relative contributions of patient, physician, and system features to gaps in guideline implementation to provide treatment for ethnic minority smokers.     

Nicotine replacement and behavioral therapy for smoking cessation in pregnancy

BACKGROUND: This study examines whether adding nicotine replacement therapy (NRT) to cognitive-behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation. METHODS: An open-label randomized trial (Baby Steps, n=181) of CBT-only versus CBT+NRT (choice of patch, gum, or lozenge; 1:2 randomization) was used. Data were collected from 2003 through 2005; analyses were conducted in 2006 and 2007. Outcomes were biochemically validated self-reported smoking status at 7 weeks post-randomization, 38 weeks gestation, and 3 months postpartum. RESULTS: Women in the CBT+NRT arm were almost three times more likely than women in the CBT-only arm to have biochemically validated cessation at both pregnancy time points (after 7 weeks: 24% vs 8%, p=0.02; at 38 weeks gestation: 18% vs 7%, p=0.04), but not at 3 months postpartum (20% vs 14%, p=0.55). Recruitment was suspended early by an Independent Data and Safety Monitoring Board when an interim analysis found a higher rate of negative birth outcomes in the CBT+NRT arm than in the CBT-only arm. In the final analysis, the difference between the arms in rate of negative birth outcomes was 0.09 (p=0.26), when adjusted for previous history of preterm birth. CONCLUSIONS: The addition of NRT to CBT promoted smoking cessation in pregnant women. This effect did not persist postpartum. More data are needed to determine safety parameters and to confirm the efficacy of NRT use during pregnancy.     

Alcohol history and smoking cessation in nicotine replacement therapy, bupropion sustained release and varenicline trials: a review

AIMS: We conducted a review of published reports of smoking cessation pharmacotherapy trials in order to address the following: (i) the generalizability of findings to smokers with a history of alcohol problems; (ii) the extent to which alcohol use affects smoking cessation overall and the efficacy of pharmacotherapy specifically and (iii) the effect of smoking cessation on alcohol use. METHODS: We located published reports of nicotine replacement therapy (NRT), bupropion sustained release (SR) and varenicline clinical trials using an approach based on prior Cochrane reviews. The reports were searched for alcohol-related inclusion/exclusion criteria and for findings related to alcohol. RESULTS: The present review included 212 published reports from 149 trials. Alcohol-related exclusion criteria appeared frequently (41.6% of trials)--45/125 NRT trials (36%), 15/22 bupropion SR trials (68.2%) and 3/3 varenicline trials--and most commonly involved exclusion of participants with either current or recent alcohol problems. Most studies failed to provide any baseline alcohol-related characteristics. Eleven trials reported on the relationship between alcohol history and likelihood of smoking cessation. In the majority of these studies, smokers with a past history of alcohol problems were not at a disadvantage, although contrary findings exist. Only two studies examined the potential influence of smoking cessation on alcohol use. CONCLUSIONS: Smokers with alcohol problems, particularly those with current or recent problems, are underrepresented in studies of approved pharmacotherapy for smoking cessation. Future trials should assess alcohol use at baseline and during treatment and examine reciprocal influences between alcohol consumption and smoking cessation.     

Use of a liquid nicotine delivery product to promote smoking cessation

Background  

Despite access to various pharmacotherapies and counseling support to aid cessation, smokers typically demonstrate quit rates below 50%. This report describes the results of a Phase 2a study exploring the efficacy of a liquid nicotine delivery system as an aid to smoking cessation assessed after 12 weeks of therapy.     

The efficacy of nicotine gum in group-centered smoking cessation therapy in a family practice

The efficacy of nicotine gum in conjunction with group support for smoking cessation was examined. Of 388 participants enrolled in the smoking cessation program, lapse-free abstinence rates of 38 percent and 30 percent were obtained at six and 12 months follow-up, respectively. One-year abstinence rates were confirmed by the measurement of expired carbon monoxide levels. One third of claimed abstainers were randomly selected at one-year follow-up for confirmation, with a resultant 3 percent deception rate. When this deception rate was applied to the overall results, six-month and 12-month abstinence rates became 36 percent and 29 percent, respectively. These abstinence rates suggest an efficacious role for nicotine gum in association with group support.     

Telephone support as an adjunct to transdermal nicotine in smoking cessation.

OBJECTIVES: Transdermal nicotine patches have shown considerable promise in improving smoking cessation outcomes. The present study assessed telephone support as an adjunct to a managed care-based, single-session group orientation smoking cessation program with nicotine patch therapy. METHODS: The unit of randomization was the orientation session (n = 35). Subjects (n = 509) were randomly assigned to a group session without telephone support, the session plus access to a toll-free help line, or the session with telephone help line plus active telephone outreach. RESULTS: Contrary to hypothesis, there were no differences between treatment conditions. Overall abstinence rates were 22% at 6 months and 21% at 1 year. Fewer than 1% of eligible subjects called the toll-free help line. An average of 3.8 of a possible 4 calls were completed in the telephone outreach condition. CONCLUSIONS: Abstinence results obtained in this program were comparable to those obtained with more extensive counseling. However, there was no evidence of benefit from telephone support beyond the initial physician-led group orientation session.     

Effect of nicotine patch on energy intake and weight gain in postmenopausal women during smoking cessation

IntroductionPost-cessation weight gain is a commonly cited barrier to smoking cessation. Some evidence suggests that nicotine replacement therapy may limit post-cessation weight gain by reducing energy intake. This project aims to assess differential changes in energy intake and body weight during smoking cessation in a sample of postmenopausal women randomized to receive 21 mg nicotine or placebo patch for 12 weeks.MethodsPostmenopausal women who smoked ≥ 10 cigarettes/day were enrolled in this double-blind randomized placebo-controlled study. Total energy intake (via four-day food diaries), body mass index (BMI; kg/m²), cigarettes/day and smoking status (self-report verified by exhaled carbon monoxide) were assessed at three time points: 2 weeks prior to quit date,12 weeks after quit date, and 12 months after smoking cessation treatment.ResultsParticipants (n = 119) were, on average, 55.8 ± 6.7 years old with a baseline BMI of 27.0 ± 5.2 and average cigarette/day was 21.1 ± 8.6. At Week 12, participants randomized to nicotine patch increased their mean caloric intake by 146.4 ± 547.7 kcal/day whereas those on placebo patch decreased their caloric intake by 175.3 ± 463.2 (f-value = 10.1, p-value = 0.002). Despite the differences in caloric intake, body weight remained similar between groups.ConclusionsThe results of this study indicate that nicotine patch may increase energy intake during treatment, and does not prevent post-cessation weight gain in postmenopausal smokers. Additional research is needed to replicate these findings and assess whether different forms of nicotine replacement therapy influence caloric intake and post-cessation weight gain in postmenopausal smokers.     

Determinants of smoking status: cross-sectional data on smoking initiation and cessation

BACKGROUND: Cigarette smoking is known to increase the risk of chronic disease. Improved understanding of factors that contribute to smoking initiation and cessation may help to underpin strategies that lead to smoking behavior change. METHODS: Cross-sectional data obtained from 11,967 men and women, aged 20-65 years, were used to study associations with smoking initiation and smoking cessation within the general population. Information on smoking habits, socio-demographic factors and psychosocial factors were collected through self-administered questionnaires. Multiple logistic regression analyses were undertaken by gender. RESULTS: Adverse childhood experiences and personality characteristics (including extraversion, neuroticism and hostility) were found to be related to smoking initiation. Age, marital status and tobacco-related factors were consistently associated with smoking cessation. Older people, married persons and those who smoked more cigarettes per day had a higher likelihood of quitting, both for men and women. CONCLUSIONS: Smoking initiation was found to be associated with adverse childhood events and with measures of personality whereas smoking cessation was associated predominantly with socio-demographic and tobacco use-related factors.     

Smoking cessation or reduction with nicotine replacement therapy: a placebo-controlled double blind trial with nicotine gum and inhaler

Background  

Even with effective smoking cessation medications, many smokers are unable to abruptly stop using tobacco. This finding has increased interest in smoking reduction as an interim step towards complete cessation.