The use of smoking cessation intervention programs and nicotine replacement therapy can be effective for some current smokers, researchers from the Medical University of South Carolina, Charleston, and the University of Minnesota, Minneapolis reported in two separate articles in Archives of Internal Medicine.

As background information to the first article, the authors wrote:

“Despite advances in clinical care and policy, rates of smoking cessation have held constant in the past decade, indicating a need for novel approaches.”

Matthew J. Carpenter, Ph.D. and team carried out a randomized nationwide human study to see how effective smoking cessation interventions might be for current smokers who were not motivated to give up.

849 regular smokers who were not motivated to quit were randomly selected into two groups:

  • PQA (practice quit attempt) only group – the aim here is to raise motivation, coping skills and confidence
  • PQA + NT (nicotine replacement therapy) group – same as the group above, but with nicotine lozenges added to improve attitudes toward pharmacotherapy and promote the usage of extra cessation resources

82% of those in the PQA+NT group and 85% in the PQA only group took part in at least one PQA.

Four weeks after treatment had ended:

  • 22% of those in the PQA+NT group had made a 24-hour quit attempt
  • 13% of those in the PQA only group made a 24-hour quit attempt

Twelve weeks after treatment had ended:

  • 32% of those in the PQA+NT group had made a 24-hour quit attempt
  • 23% of those in the PQA only group made a 24-hour quit attempt

At final follow-up:

  • 49% of those in the PQA+NT group had made some kind of attempt to quit
  • 40% of those in the PQA only group had made some kind of attempt to quit
  • 43% of those in the PQA+NT group had made a 24-hour quit attempt
  • 34% of those in the PQA only group made a 24-hour quit attempt

The researchers concluded:

“In summary, providing brief NT sampling to smokers who do not want to quit, when used within a behavioral exercise of a PQA, is efficacious to motivate unmotivated smokers toward quitting. Considering the stagnant incidence of quit attempts in the past decade, this novel and easy-to-use cessation induction strategy holds promise for translation to primary care settings.”

Anne M. Joseph, M.D. and team set out to determine what impact a 12-month long telephone-based chronic disease management intevention can have on tobacco dependence compared to 8-week long evidence based treatment.

They carried out a randomized, controlled trial with 443 participants, all of them regular smokers at the time. Each participant was called by telephone five times for counseling; they also received nicotine replacement therapy (NRT) by post for four weeks. They were then split up into two groups:

  • UC (usual care) group – they received no additional phone calls
  • LC (longitudinal care) group – they received counseling and NRT for another 48 weeks

At 18 months, 30.2% of those in the LC group had not smoked for six months, compared to 23.5% in the UC group.

Further analysis revealed that in the LC group, quit attempts during the previous 12 months, how many cigarettes they smoked per day at the start of the study, and cigarettes smoked in the past week were closely linked to prolonged abstinence at 18 months. The median percentage of days with no cigarettes was 57.1 in the LC group compared to 30.1 in the UC group.

Considerably more attempts at giving up smoking were made by those in the LC group than in the UC group.

Among those who continued smoking, cutting down on cigarettes was more prevalent in the LC group than the UC group – however, the difference was only statistically relevant at 12 months.

The authors concluded:

“This randomized controlled trial shows that a smoking intervention based on chronic disease management principles of care – targeting the goal of quitting smoking but incorporating failures, setting interim goals and continuing care until the desired outcome is achieved – is approximately 75 percent more effective at accomplishing long-term abstinence than delivery of a discrete episode of care for smoking cessation.”

First research letter – Yin Cao, M.P.H., from the Harvard School of Public Health in Boston and team set out to find out what the relationship might be between time since quitting plus age when quitting with total cause-specific mortality among US male doctors.

They gathered data on 19,705 male doctors from the Physicians’ Health Study. 6.7% of them were smoking at the time of the study while 41.7% used to smoke. During the 386,772 person-years of follow up 5,594 of the doctors died.

Crude mortality rates were:

  • 11.5% for lifetime non-smokers
  • 16.6% for ex-smokers
  • 26.1% for current smokers

13.7% of current smokers who died were younger than 65 years of age, compared to 8.3% of lifetime non-smokers.

Ex-smokers had a considerably lower risk of death within ten years of giving up, compared to current smokers; this risk was further reduced after another ten years.

Even though the heavy regular smokers had the highest chances of dying compared to ex-smokers and light smokers, that risk goes down 44% within ten years of giving up.

Second research letter – G. David Batty, Ph.D., of University College London, England, and team followed up on the Whitehall Smoking Cessation Survey thirty years later. This was a study of male civil servants in London. They wrote to surviving participants with a questionnaire which asked them about their current smoking status as well as their health, in order to determine what long-term impact the smoking cessation intervention had.

1,445 males were randomly selected into two groups:

  • Intervention group – a 15-minute session with one member of the study’s clinical staff, smoking risks were explained comprehensively. A week later there was another session, during which a smoking record card was given. This card had to be completed daily for three weeks. Further sessions occurred at ten weeks and then again at six months.
  • Normal care group – no smoking cessation intervention was given.

After one year, 39% of those in the intervention group said they were not smoking any more, compared to just 9% in the normal care group. After six months, the figures were 36% and 14% respectively.

The follow up after thirty years showed that 81% of the survivors in the intervention group were not smoking, compared to 79% in the normal care group. The authors also reported a slightly lower chance of dying in the intervention group than in the normal care group – just a 0.4 life year difference.

Written by Christian Nordqvist