Academic Journal
Main Category: Smoking / Quit Smoking
Article Date: 30 Nov 2011 - 8:00 PST
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According to two investigations published in the Nov. 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, smoking cessation intervention programs as well as nicotine replacement therapy are connected with positive outcomes among individuals who currently smoke.
In one of the reports the researchers state:
"Despite advances in clinical care and policy, rates of smoking cessation have held constant in the past decade, indicating a need for novel approaches."
In the first report, Matthew J. Carpenter, P.h.D., of the Medical University of South Carolina, Charleston, and his team carried out a nationwide randomized clinical trial in order to analyze how effective smoking cessation intervention was among current smokers who have no motivation to quit. 849 current smokers, unmotivated to quit, were enrolled to participate in the study.
Participants were randomized to practice quit attempt (PQA) alone or to nicotine replacement therapy (NT) sampling within the context of a PQA (PAQ + NT). The PQA was designed to enhance participant's confidence, motivation and coping skills. The PAQ combined with nicotine therapy sampling added samples of nicotine lozenges to improve participants' mental outlook toward pharmacotherapy as well as to promote use of further cessation resources.
85% of PQA participants and 82% of PQA with NT participants engaged in at least one PQA across the intervention period. Four weeks after the end of treatment 22% of PQA + NT participants had made a 24-hour quit attempt compared to 13% of PQA participants. By 12 weeks after the end of treatment 32% of PQA + NT participants had made a 24-hour quit attempt compared to 23% of PQA participants. The team discovered that at the final follow-up, PQA + NT participants had a considerably higher incidence of any quit attempt (49%) compared to the PQA group (40%). 43% of PQA + NT participants made a 24-hour quit attempt by the final follow up compared to 34% of PQA participants.
The researchers conclude:
"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."
In the second article, Anne M. Joseph, M.D., of the University of Minnesota, Minneapolis, and her team carried out a randomized controlled trial in order to compare telephone-based chronic disease management (one-year; longitudinal care) with evidence based treatment (eight weeks; usual care) for tobacco dependence.
The researchers enrolled 443 current smokers to participate in the study. Each participant received five telephone counseling calls and nicotine NT via mail for 4 weeks. The team then randomized the participants into two groups. One group received usual care (UC; two additional telephone calls) while the other group received longitudinal care (LC; continued counseling and NT for a further 48 weeks).
At 18 months, six-month prolonged abstinence was 23.5% in the UC group and 30.2% in the LC group. Further examinations revealed that LC group, quit attempts in the previous year, cigarettes per day at baseline as well as how many cigarettes participants smoked in the past week (as reported at day 21) were considerably connected with longer abstinence at 18 months. For the LC group the median (midpoint) percentage of days reporting no cigarette used was 57.1% compared with 30.1% in the UC group.Furthermore, the team discovered that considerably more quit attempts were made among participants in the LC group than those in the UC group. Among those who continued smoking, there was smoking reduction among participants in the LC group than the UC group, although these differences were only statistically considerable at 12 months.
The researchers conclude:
"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 that delivery of a discrete episode of care for smoking cessation."
In addition, two investigation reports analyze smoking cessation rates in two long-term follow-up investigations. In the first report, Yin Cao, M.P.H., with Harvard School of Public Health, Boston, and colleagues used data from the Physicians' Health Study in order to analyze the connection of time since quitting smoking and age at smoking cessation with total and cause-specific death rates among male physicians in the U.S..
The team analyzed data on 19,705 male physicians, 6.7% were current smokers while 41.7% previously smoked. During the 386,772 person-years of follow-up a total of 5,594 deaths occurred. For individuals who never smoked the mortality rate was 11.5 per 1,000 person-years, for those who previously smoked the mortality rate was 16.6 per 1,000 person-years, and for current smokers the mortality rate was 26.1 per 1,000 person-years. Among 612 deaths in current smokers, 13.7% passed away before 65 years of age, in comparison with 8.3% of individuals who never smoked.
Risk of death was considerably reduced among previous smokers within one decade of quitting compared with those who currently smoke. After two decades, the risk was reduced even further, to the level of individuals who never smoked. Even though, current heavy smokers had the greatest risk of death in comparison with current light smokers and previous smokers, within one decade of quitting the habit the risk of death may be reduced by 44% for this group and after 20 years could reach a risk level similar to those who have never smoked.
The second report reveals follow-up results for smoking behavior 30 years after participation in an investigation (Whitehall Smoking Cessation Survey) of male civil servants in London, England. In order to assess the long-term impact of smoking cessation intervention, G. David Batty, P.h.D., of University College London England, and colleagues mailed surviving Whitehall study participants survey about their current smoking behavior and health.
1,445 men participated in the Whitehall Smoking Cessation Survey and were randomized to either the "normal care" group or the intervention group. Participants in the intervention group received a 15-minute consultation with one of the investigations clinical staff who outlined the risks of smoking together with a follow-up appointment one week later at which each participant received a smoking record card to be filled out each day over the next three weeks. Additional 15-minute consultations were conducted at the research center at 10 weeks and 6 months. Participants in the "usual care" group received no smoking cessation intervention.
The authors discovered that at the one-year follow-up, the prevalence of participants in the intervention group reporting abstinence from smoking was 39% considerably higher than participants in the normal care group (9%). Similar figures were observed for the three-year follow up 36% for participants in the intervention group vs. 14% in the normal care group.
After three decades, a re-survey of participants revealed that the majority of surviving participants in both the intervention and control groups had given up smoking (81% and 79%, respectively.) Furthermore, they discovered that overall risk of death was slightly lower for those in the intervention group compared to participants in the control group. Even though the difference was not statistically considerable, it equates to an estimated 0.4 life-years gained.
Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
MLA
8 Dec. 2011.
Please note: If no author information is provided, the source is cited instead.
posted by Mike Morgan on 30 Nov 2011 at 2:25 pm
Electronic cigarettes are another option now to reduce tobacco use.
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