Usage patterns of stop smoking medications in Australia, Canada, the United Kingdom, and the United States: findings from the 2006-2008 International Tobacco Control (ITC) Four Country Survey.

Brian V Fix,Geoffrey T Fong,Cheryl Rivard,David Hammond,K Michael Cummings,Andrew Hyland,Ann Mcneill,Ron Borland

doi:10.3390/ijerph8010222

Abstract

Varenicline is a new prescription stop smoking medication (SSM) that has been available in the United States since August 1, 2006, in the United Kingdom and other European Union countries since December 5, 2006, in Canada since April 12, 2007, and in Australia since January 1, 2008. There are few population-based studies that have examined use rates of varenicline and other stop smoking medications. We report data from the ITC Four Country survey conducted with smokers in the US, UK, Canada, and Australia who reported an attempt to quit smoking in past year in the 2006 survey (n = 4,022 participants), 2007 (n = 3,790 participants), and 2008 surveys (n = 2,735 participants) Respondents reported use of various stop smoking medications to quit smoking at each survey wave, along with demographic and smoker characteristics. The self-reported use of any stop smoking medication has increased significantly over the 3 year period in all 4 countries, with the sharpest increase occurring in the United States. Varenicline has become the second most used stop smoking medication, behind NRT, in all 4 countries since being introduced. Between 2006 and 2008, varenicline use rates increased from 0.4% to 21.7% in the US, 0.0% to 14.8% in Canada, 0.0% to 14.5% in Australia, and 0.0% to 4.4% in the UK. In contrast, use of NRT and bupropion remained constant in each country. Males and non-whites were significantly less likely to report using any SSM, while more educated smokers were significantly more likely to use any SSM, including varenicline. Our findings suggest that the introduction of varenicline led to an increase in the number of smokers who used evidence-based treatment during their quit attempts, rather than simply gaining market share at the expense of other medications. From a public health perspective, messages regarding increased success rates among medication users and the relative safety of stop smoking medications should be disseminated widely so as to reach all smokers of all socioeconomic classifications equally.

Highlights

Pharmacological treatments such as nicotine replacement therapy (NRT), sustained-release bupropion, and varenicline are effective in terms of diminishing the severity of withdrawal symptoms and reducing the chance of relapse in smokers who make a quit attempt [1,2,3,4]
Given the number of pharmacotherapies shown to be effective in aiding smoking cessation attempts, United States Clinical Practice Guidelines recommend the use of pharmacotherapy for all smokers who want to make a quit attempt, so as long as no contraindications for medication use are present [5,7]
Results from the 2006, 2007, and 2008 International Tobacco Control (ITC) 4 country surveys indicate that the self-reported use of any stop smoking medication among participants who reported making a quit attempt has steadily increased over this three year period in all 4 countries

Summary

Introduction

Pharmacological treatments such as nicotine replacement therapy (NRT), sustained-release bupropion, and varenicline are effective in terms of diminishing the severity of withdrawal symptoms and reducing the chance of relapse in smokers who make a quit attempt [1,2,3,4]. In the United Kingdom, the government provides stop smoking medications through the National Health Service prescription program [6] and the NHS Stop Smoking Services. Varenicline, a partial agonist of the nicotinic acetylcholine receptor, (Chantix® in the United States and Champix® in the United Kingdom, Australia, and Canada) is a prescription stop smoking medication; clinical studies suggest that varenicline has demonstrated clinical efficacy as a stop smoking medication with relative risks for quitting approximately 2.5–3 times that of a placebo [13,14,15]. Australia, and Canada, corresponding to the time period when varenicline was made available as a government approved stop smoking medication in each of these four countries. Characteristics of users of different types of stop smoking medications are compared

Experimental Section

Results

Characteristics of Medication Users

Discussion and Conclusions