'Real-world' effectiveness of smoking cessation treatments: a population study.

BACKGROUND AND AIMS There is a need for more evidence on the 'real-world' effectiveness of commonly used aids to smoking cessation from population-level studies. This study assessed the association between abstinence and use of different smoking cessation treatments after adjusting for key potential confounding factors. DESIGN Cross-sectional data from aggregated monthly waves of a household survey: the Smoking Toolkit Study. SETTING England. PARTICIPANTS A total of 10 335 adults who smoked within the previous 12 months and had made at least one quit attempt during that time. MEASUREMENTS Participants were classified according to their use of cessation aids in their most recent quit attempt: (i) medication (nicotine replacement therapy, bupropion or varenicline) in combination with specialist behavioural support delivered by a National Health Service Stop Smoking Service; (ii) medication provided by the prescribing health-care professional without specialist behavioural support; (iii) nicotine replacement therapy (NRT) bought over the counter; and (iv) none of these. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including tobacco dependence. FINDINGS Compared with smokers using none of the cessation aids, the adjusted odds of remaining abstinent up to the time of the survey were 3.25 [95% confidence interval (CI) = 2.05-5.15] greater in users of prescription medication in combination with specialist behavioural support, 1.61 (95% CI = 1.33-1.94) greater in users of prescription medication combined with brief advice and 0.96 (95% CI = 0.81-1.13) in users of NRT bought over the counter. CONCLUSIONS After adjusting for major confounding variables such as tobacco dependence, smokers in England who use a combination of behavioural support and pharmacotherapy in their quit attempts have almost three times the odds of success than those who use neither pharmacotherapy nor behavioural support. Smokers who buy nicotine replacement therapy over the counter with no behavioural support have similar odds of success in stopping as those who stop without any aid.

[1]  Thomas R Fanshawe,et al.  Combined pharmacotherapy and behavioural interventions for smoking cessation. , 2016, The Cochrane database of systematic reviews.

[2]  L. Stead,et al.  Antidepressants for smoking cessation. , 2014, The Cochrane database of systematic reviews.

[3]  K. Cummings,et al.  Effectiveness of stop-smoking medications: findings from the International Tobacco Control (ITC) Four Country Survey. , 2013, Addiction.

[4]  K. Cummings,et al.  Systematic biases in cross-sectional community studies may underestimate the effectiveness of stop-smoking medications. , 2012, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[5]  R. West,et al.  Does it matter who you see to help you stop smoking? Short-term quit rates across specialist stop smoking practitioners in England. , 2012, Addiction.

[6]  Lisa Szatkowski,et al.  The impact of the Quality and Outcomes Framework (QOF) on the recording of smoking targets in primary care medical records: cross-sectional analyses from The Health Improvement Network (THIN) database , 2012, BMC Public Health.

[7]  M. Kivimäki,et al.  Implementation of workplace-based smoking cessation support activities and smoking cessation among employees: the Finnish Public Sector Study. , 2012, American journal of public health.

[8]  R. West,et al.  Very low rate and light smokers: smoking patterns and cessation-related behaviour in England, 2006-11. , 2012, Addiction.

[9]  S. Leatherdale,et al.  Assessment of validity of self-reported smoking status. , 2012, Health reports.

[10]  James F. Thrasher,et al.  Cessation assistance reported by smokers in 15 countries participating in the International Tobacco Control (ITC) policy evaluation surveys. , 2012, Addiction.

[11]  M. Raw Framework Convention on Tobacco Control (FCTC) Article 14 guidelines: a new era for tobacco dependence treatment. , 2011, Addiction.

[12]  R. West,et al.  Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. , 2011, Addiction.

[13]  Kenneth W Lin,et al.  Nicotine receptor partial agonists for smoking cessation. , 2011, American family physician.

[14]  A. Hyland,et al.  Self-Reported Exposure to Policy and Environmental Influences on Smoking Cessation and Relapse: A 2-Year Longitudinal Population-based Study , 2011, International journal of environmental research and public health.

[15]  J. Hughes,et al.  Effectiveness of over-the-counter nicotine replacement therapy: a qualitative review of nonrandomized trials. , 2011, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[16]  L. Brose,et al.  What makes for an effective stop-smoking service? , 2011, Thorax.

[17]  R. West,et al.  'The smoking toolkit study': a national study of smoking and smoking cessation in England , 2011, BMC public health.

[18]  S. Zubrick,et al.  Non-specific psychological distress, smoking status and smoking cessation: United States National Health Interview Survey 2005 , 2011, BMC public health.

[19]  R. West,et al.  Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerström Test for Nicotine Dependence and its components. , 2011, Addiction.

[20]  G. Fong,et al.  The use of cessation assistance among smokers from China: Findings from the ITC China Survey , 2011, BMC public health.

[21]  C. Patten,et al.  Failure to report attempts to quit smoking. , 2010, Addictive behaviors.

[22]  Masakazu Nakamura,et al.  Smoking cessation patterns and predictors of quitting smoking among the Japanese general population: a 1-year follow-up study. , 2010, Addiction.

[23]  R. West,et al.  Factors associated with the use of aids to cessation in English smokers. , 2009, Addiction.

[24]  Robert West,et al.  Attempts to quit smoking and relapse: factors associated with success or failure from the ATTEMPT cohort study. , 2009, Addictive behaviors.

[25]  R. West,et al.  Explaining the social gradient in smoking cessation: it’s not in the trying, but in the succeeding , 2008, Tobacco Control.

[26]  Tobacco Use and Dependence Guideline Panel Treating Tobacco Use and Dependence: 2008 Update , 2008 .

[27]  Paraskevi Argyropoulou,et al.  Smoking cessation in clinical practice: predictors of six-month continuous abstinence in a sample of Greek smokers. , 2008, Primary care respiratory journal : journal of the General Practice Airways Group.

[28]  S. Shiffman,et al.  Use of smoking-cessation treatments in the United States. , 2008, American journal of preventive medicine.

[29]  Jennifer W. Kahende,et al.  Factors associated with successful smoking cessation in the United States, 2000. , 2007, American journal of public health.

[30]  R. West,et al.  Is nicotine replacement therapy for smoking cessation effective in the “real world”? Findings from a prospective multinational cohort study , 2007, Thorax.

[31]  Robert West,et al.  Can We Trust National Smoking Prevalence Figures? Discrepancies Between Biochemically Assessed and Self-Reported Smoking Rates in Three Countries , 2007, Cancer Epidemiology Biomarkers & Prevention.

[32]  L. Stead,et al.  Group behaviour therapy programmes for smoking cessation. , 2017, The Cochrane database of systematic reviews.

[33]  S. Shiffman,et al.  Characteristics of selectors of nicotine replacement therapy , 2005, Tobacco Control.

[34]  Robert West,et al.  Outcome criteria in smoking cessation trials: proposal for a common standard. , 2005, Addiction.

[35]  Richard Doll,et al.  Mortality in relation to smoking: 22 years' observations on female British doctors. , 1980, British medical journal.

[36]  L. Stead,et al.  Physician advice for smoking cessation. , 2004, The Cochrane database of systematic reviews.

[37]  I Campbell,et al.  Nicotine replacement therapy in smoking cessation. , 2003, Thorax.

[38]  S. Shiffman,et al.  A meta-analysis of the efficacy of over-the-counter nicotine replacement , 2003, Tobacco control.

[39]  E. Gilpin,et al.  Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking cessation. , 2002, JAMA.

[40]  M. Fiore,et al.  Treating tobacco use and dependence: an evidence-based clinical practice guideline for tobacco cessation. , 2002, Chest.

[41]  R. Perera,et al.  Nicotine replacement therapy for smoking cessation. , 2012, The Cochrane database of systematic reviews.

[42]  J. Pierce,et al.  Smoking cessation with and without assistance: a population-based analysis. , 2000, American journal of preventive medicine.

[43]  L. Stead,et al.  Anxiolytics and antidepressants for smoking cessation. , 2000, The Cochrane database of systematic reviews.

[44]  J R Hughes,et al.  Antidepressants for smoking cessation. , 2007, The Cochrane database of systematic reviews.

[45]  L. Stead,et al.  Group behaviour therapy programmes for smoking cessation. , 2000, The Cochrane database of systematic reviews.