Quitting smoking isn't easy for most people but medication and counseling can help them succeed, according to the results of two new studies.
In the first of the two reports published in the Archives of Internal Medicine, a team led by Dr Anne Joseph, co-leader of the Prevention & Etiology Research Program at the Masonic Cancer Center at the University of Minnesota, tried helping people by keeping in touch with them and reminding them to quit smoking.
"We looked at a model that treated smoking as a chronic condition like high blood pressure or diabetes," Joseph said. "We know that using a combination of behavioural therapy and medication therapy, people do better than quitting on their own," she said.
For the study, more than 400 smokers received counseling over the phone along with nicotine replacement therapy (such as patches, gums, lozenges) for a month. Next, the participants were randomly assigned to receive two final calls, or more calls plus nicotine replacement therapy for another 48 weeks.
After 18 months, 30% of those who received calls and nicotine replacement hadn't smoked for six months compared with 23.5% of those who didn't receive long-term help, the researchers found.
In addition, people given long-term counseling tried to stop smoking more often than those who received only a few calls. And among those given long-term counseling, even those who did not quit smoked less than the people who received only a few calls.
Joseph's team assumed people would fail along the way and make several attempts to quit. The researchers reframed that into a positive step, she said.
"This approach takes a chronic disease treatment model, instead of a one-shot model," she explained. "If you want to quit smoking, you have to keep working at it and having your treatment adjusted to accommodate the possibility that it might not work the first time. That doesn't mean it's not going to work in subsequent attempts," Joseph added.
"If someone has tried and failed, they should try again," agreed Patricia Folan, director of the Center for Tobacco Control at the North Shore-LIJ Health System in Great Neck, NY. "People often try to quit five to seven times before they're successful," Folan pointed out.
"The fact that long-term care, like ongoing support, results in better quit rates makes sense as we believe that nicotine addiction is like other addictions such as heroin or alcohol, which have been clearly shown to be best managed with ongoing long-term interventions," said Dr. Norman Edelman, chief medical officer for the American Lung Association.
However, if the method in Joseph's study was to be widely used by hospitals or health care providers, that would likely be more expensive than current approaches, Edelman added, and cost-effectiveness would first need to be analyzed.
In another new study, researchers from the Medical University of South Carolina wanted to see if a smoking cessation program that included nicotine replacement therapy and counseling could help people quit even though they had no desire to stop smoking.
"Nicotine replacement therapy is proven as an effective smoking cessation medication, yet few smokers use it," said lead researcher Matthew Carpenter, an associate professor in the department of psychiatry.
Although most smokers are interested in quitting, many are hesitant to try quitting in the near future. In addition, many smokers have misconceptions about what nicotine replacement therapy is, how it works, and its safety, Carpenter noted.
The team randomly assigned more than 800 smokers to various programs. Some practiced quitting alone and some with the help of nicotine replacement therapy. Those given no nicotine replacement therapy received help in motivation, confidence and coping skills.
At four weeks, 22% of those who received counseling and nicotine replacement therapy had tried to stop smoking for a day, as did 13% of those who received counseling alone. At final follow-up after treatment was stopped, 49% of those who received nicotine replacement therapy had made an attempt to quit versus 40% of those given counseling alone, the researchers found.
"Compared to those who did not receive nicotine replacement therapy samples, those who did showed stronger motivation, higher confidence and more favorable attitudes towards nicotine replacement therapy," Carpenter said.
Nicotine replacement therapy a trial
The study suggests nicotine replacement therapy could be marketed for trial use, which might be attractive to a greater number of smokers, he noted.
However, Edelman doesn't think this study went on long enough to draw any definitive conclusions. "The study had no long-term follow-up, thus lacking what I consider to be the gold standard of smoking-cessation experimentation," he said.
Two research letters published in the same journal issue drove home that point. In the first, G. David Batty, of University College London, England and colleagues followed up people who took part in the Whitehall Smoking Cessation Survey three decades ago.
In that study, about 1,450 men either received information on the dangers of smoking or no information. After 30 years, most of those still living had quit smoking - 81% in the group that got counseling and 79% in the group that didn't, the investigators found.
In addition, the overall risk of death was slightly lower for people who received counseling; and while the difference was not statistically significant, it was about 0.4 life-years gained, the researchers said.
In the other letter, researchers looked at the benefit of not smoking in cutting the odds of dying young. The team led by Yin Cao, from the Harvard School of Public Health, collected data on more than 19,000 men who took part in the Physicians' Health Study.
Among these men, 42% had been smokers and nearly 7% still were. About 5,600 men died in the follow-up period. Of the more than 600 deaths among smokers, nearly 14% died before they reached age 65, compared with about 8% of those who had never smoked, the researchers found.
The highest death risk was among those who smoked the most, but that risk could be cut by 44% within 10 years after quitting, and after 20 years it was the same as if they never smoked, the study found.
"Reduction of mortality should not be considered to be the only important outcome measure of smoking-cessation programs," Edelman said. "There is considerable morbidity, such as disability, effects of treatment for heart and lung disease, etc., to be taken into account."
David Abrams, executive director of the Schroeder Institute on Tobacco Research and Policy Studies at the American Legacy Foundation, said that evidence-based treatments "will double to quadruple your chance of successful quitting" compared to willpower alone.
For more about quitting smoking, visit smokefree.gov.
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