Pharmacotherapy for Treating Tobacco Dependence

Sims, Tammy H.; Fiore, Michael C.

doi:10.2165/00023210-200216100-00001

Cited by 33 publications

(26 citation statements)

References 18 publications

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“…77,78 Yet, surprisingly few data exist on the impact of long-term NRT use in terms of health outcomes in the general population. Most data come from clinical trials, which have samples that tend to differ in important ways from general population samples 79 and in which NRT is provided free together with behavioural support, which may affect normal usage patterns.…”

Section: Rationale and Study Aimsmentioning

confidence: 99%

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Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Dobbie

Hiscock

Leonardi‐Bee

et al. 2015

Health Technol Assess

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BackgroundNHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned.ObjectivesThe main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives.DesignThe ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use.SettingThe setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services.ParticipantsThere were 202,804 cases included in secondary analysis and 3075 in the prospective study.InterventionsA combination of behavioural support and stop smoking medication delivered by SSS practitioners.Main outcome measuresAbstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test.ResultsJust over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have remained abstinent than those who were seen by a general practitioner (GP) practice and pharmacy providers [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2 to 4.6]. Clients who received group behavioural support (either closed or rolling groups) were three times more likely to stop smoking than those who were seen by a GP practice or pharmacy providers (OR 3.4, 95% CI 1.7 to 6.7). Satisfaction with services was high and well-being at baseline was found to be a predictor of abstinence from smoking at longer-term follow-up. Continued use of NRT at 1 year was rare, but no evidence of harm from longer-term use was identified from the data collected.ConclusionsStop Smoking Services in England are effective in helping smokers to move away from tobacco use. Using the 52-week CO-validated quit rate of 8% found in this study, we estimate that in the year 2012–13 the services supported 36,249 clients to become non-smokers for the remainder of their lives. This is a substantial figure and provides one indicator of the ongoing value of the treatment that the services provide. The study raises a number of issues for future research including (1) examining the role of electronic cigarettes (e-cigarettes) in smoking cessation for service clients [this study did not look at e-cigarette use (except briefly in the longer-term NRT study) but this is a priority for future studies]; (2) more detailed comparisons of rolling groups with other forms of behavioural support; (3) further exploration of the role of practitioner knowledge, skills and use of effective behaviour change techniques in supporting service clients to stop smoking; (4) surveillance of the impact of structural and funding changes on the future development and sustainability of SSSs; and (5) more detailed analysis of well-being over time between those who successfully stop smoking and those who relapse. Further research on longer-term use of non-combustible nicotine products that measures a wider array of biomarkers of smoking-related harm such as lung function tests or carcinogen metabolites.FundingThe National Institute for Health Research Health Technology Assessment programme. The UK Centre for Tobacco and Alcohol Studies provided funding for the longer-term NRT study.

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Section: Rationale and Study Aimsmentioning

confidence: 99%

“…Altogether, these findings suggest that long-term NRT use is safe and not associated with increased health risks, certainly compared with continued smoking. 78 …”

Section: Longer-term Use Of Nicotine Replacements Therapymentioning

confidence: 99%

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Dobbie

Hiscock

Leonardi‐Bee

et al. 2015

Health Technol Assess

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“…Typically, the dose of nicotine replacement therapy is decreased progressively over 8-12 weeks. 53 For all nicotine replacement products taken by mouth, acidic drinks such as coffee and juice should be avoided for 15 minutes before product use, since they can reduce nicotine absorption.…”

Section: Nicotine Replacement Therapymentioning

confidence: 99%

Treatment of tobacco dependence: integrating recent progress into practice

Foll¹,

George²

2007

Canadian Medical Association Journal

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Smoking is currently responsible for the death of 1 in 10 adults worldwide, or about 5 million deaths each year. Half of the 650 million people who smoke today will eventually be killed by tobacco, 1 and this morbidity and mortality can be mostly avoided if people stop smoking. 2The prevalence of smoking varies greatly around the world. Over 4.5 million people are current smokers in Canada, representing 18% of the population aged 15 years and older.

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“…Continued investigations of NRT with efficacious behavioral programs should be conducted, particularly to establish the optimum dosage and length of treatment with NRT. Some adolescent smokers have nicotine dependence symptoms [82][83][84] , and these individuals may need NRT at higher doses and/or for longer periods than smokers without dependence symptoms 85 . After examining the limited evidence available, however, NRT only appears to have modest efficacy.…”

Section: Discussionmentioning

confidence: 99%

Smoking Cessation for Adolescents: A Review of Pharmacological and Psychosocial Treatments

Schepis

Rao²

2008

CDAR

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Unlike the vast literature on smoking cessation in adults, research in adolescents has gained significant attention only within the last decade. Even with this increase in focus, research into pharmacological aids for smoking cessation in adolescents (e.g., nicotine replacement therapy, bupropion) is a more recent phenomenon and has produced only modest results. While more extensive, much of the research on behaviorally-or psychosocially-based adolescent smoking cessation interventions has been limited by a lack of control for contact time, biochemical verification of self-reported abstinence, and/or a theoretical focus for the interventions. The MEDLINE, PubMed, PSYCInfo CINHAL and Cochrane Systematic Review databases were searched for articles relevant to adolescent smoking cessation treatment. After briefly examining the adolescent smoking cessation research prior to 2000, more recent developments in pharmacological aids and psychological treatment will be reviewed. Investigations have made progress in elucidating efficacious treatments for adolescent smokers, but much work remains to be done in both pharmacological and non-pharmacological areas of treatment. With the current state of the literature as a guide, future directions for research into smoking cessation for adolescents will be proposed.

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Pharmacotherapy for Treating Tobacco Dependence

Cited by 33 publications

References 18 publications

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Treatment of tobacco dependence: integrating recent progress into practice

Smoking Cessation for Adolescents: A Review of Pharmacological and Psychosocial Treatments

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