Nicotine Patch Therapy Research Articles

A Controlled Trial of Bupropion Added to Nicotine Patch and Behavioral Therapy for Smoking Cessation in Adults With Unipolar Depressive Disorders

Although there is a strong relationship between depression and smoking, most nicotine dependence treatment trials exclude depressed smokers. Our objective was to determine whether bupropion improves abstinence rates and abstinence-associated depressive symptoms when added to transdermal nicotine replacement therapy (NRT) and group cognitive behavioral therapy (CBT) in smokers with unipolar depressive disorder (UDD). Adult smokers with current (n = 90) or past (n = 109) UDD were randomly assigned to receive bupropion or placebo added to NRT and CBT for 13 weeks. In the primary analysis, with dropouts considered smokers, 36% (35/97) of those on bupropion and 31% (32/102) on placebo attained biochemically validated 7-day point prevalence abstinence at end of treatment (not significant). Because of a high dropout rate (50%) and a significant difference in abstinence status at dropout by treatment group, a traditional intent-to-treat analysis with last observation carried forward imputation of abstinence status was performed. In this secondary analysis, 56% (54/97) of those on bupropion and 41% (42/102) on placebo met criteria for abstinence at end of trial, chi2 = 4.18, P = 0.04. Nicotine replacement therapy usage and absence of a comorbid anxiety disorder predicted abstinence. Abstinence was associated with increased depressive symptoms, regardless of bupropion treatment. Thus, in the primary analysis, bupropion neither increased the efficacy of intensive group CBT and NRT for smoking cessation in smokers with UDD nor prevented abstinence-associated depressive symptoms. Bupropion seemed to provide an advantage for smoking cessation for those who remained in the trial. The dropout rate was high and was characterized by a higher prevalence of current comorbid anxiety disorder. Given the high abstinence rate achieved with CBT plus NRT, a ceiling effect related to the high level of intervention received by all subjects may have prevented an adequate test of bupropion.

Smoking cessation among patients in an emergency chest pain observation unit: Outcomes of the Chest Pain Smoking Study (CPSS)

This study examines the efficacy of a smoking cessation intervention on abstinence rates and motivation to quit smoking. Participants were adult smokers (N = 543) who presented to the emergency department with chest pain and who were admitted to an observation unit for 24-hour observation to rule out myocardial infarction. Participants were randomly assigned to either usual care or a tailored intervention employing motivational interviewing and telephone follow-up. All individuals choosing to quit were offered nicotine patch therapy. Follow-up assessments were conducted at 1, 3 and 6 months. Abstinence (7-day point prevalence) rates were significantly greater among participants receiving the tailored intervention compared with those given usual care (OR = 1.62, 95% CI [1.05-2.50]). The largest difference occurred at 1 month: 16.8% of usual care and 27.3% of the tailored intervention group were abstinent, with differences decreasing over time. One-third of participants who were quit at month 6 were late quitters whose initial abstinence began after the 1-month follow up. In addition to treatment assignment, psychosocial variables including motivation to quit, confidence, reduced temptation to smoke in response to negative affect, and the perception that their chest pain was related to their smoking, were significant predictors of cessation. Tailored interventions are effective in promoting initial quit attempts for emergency chest pain patients admitted to an observation unit. Additional intervention may be needed to assist late quitters and to prevent relapse.

Registered Nurse Initiation of a Tobacco Intervention Protocol

This article summarizes the development and implementation of a registered nurse-initiated protocol to intervene with hospitalized patients who are tobacco-dependent, may be experiencing tobacco withdrawal, and who are hospitalized in a smoke-free environment. Tobacco use is the leading cause of preventable death in the United States. Hospitalization provides a unique teachable moment to treat tobacco dependence. Nurses can be effective in talking with patients about tobacco use. The clinical nurse specialist spheres of influence model and the role of the clinical nurse specialist were important for developing a tobacco use intervention protocol. A multi-disciplinary team created key objectives. These included identifying and assessing all patients who use tobacco, providing treatment to manage both withdrawal and address tobacco dependence, providing comfort to patients while hospitalized in a tobacco-free environment, encouraging lifelong cessation. The bedside admitting nurse was chosen as the pivotal professional to trigger tobacco use interventions. A protocol was finalized that requires the bedside nurse to assess all patients for past and current tobacco use. The nurse is then prompted to (1) provide information about tobacco dependence and treatment, (2) ask if the patient wants nicotine patch therapy to address withdrawal and, (3) order a consult with a specialist at the patient's request. Extensive and varied educational programs were developed to support the implementation of the protocol. The tobacco use intervention protocol has become important for providing assessment and intervention to patients who use tobacco. It has increased the number of specialist consults provided to patients. It has increased compliance with quality reporting data by national quality accrediting bodies.

Treatment of Tobacco Dependence

Cigarette smoking continues to cause substantial death and disability, but more than 1 in 5 adults smoke despite the desire among most smokers to stop and the availability of effective treatments. A systematic process to identify all smokers is crucial. Because tobacco dependence is characterized by relapses and remissions, clinicians should be ready to engage smokers and reengage relapsed smokers with options for new medication strategies and additional counseling resources.

Nicotine patch therapy prior to quitting smoking: a meta‐analysis

To evaluate the incremental efficacy of starting nicotine patch treatment prior to quitting compared to the current regimen of starting patch treatment on the target quit day. Meta-analysis of four eligible studies using pre-cessation patch treatment, located by database search and contacts with cessation researchers. The studies all compared starting treatment with nicotine patch prior to the target quit date to starting active treatment at the quit date, some in the context of concurrent mecamylamine treatment. The primary end-point for the analysis was continuous abstinence for at least 28 days assessed at 6 weeks following quit day; 6-month outcomes were also examined. Compared to starting active patch treatment on quit day, pre-cessation treatment with nicotine patches was found to double the odds of quitting. This was true both at 6 weeks [pooled odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.31-2.93] and 6 months (pooled OR = 2.17, 95% CI: 1.46-3.22) treatment outcomes. Mecamylamine co-treatment did not modify these effects. Across the four studies analyzed, pre-cessation patch treatment was found to produce a robust increase in quit rates compared to current regimens starting patch at quit day. Pre-cessation patch use represents a promising innovation in smoking cessation therapy with potential beneficial implications for improved public health by further increasing quitting success.

Meta-analysis of studies investigating one-year effectiveness of transdermal nicotine patches for smoking cessation

The one-year effectiveness of transdermal nicotine patches versus placebo patches for smoking cessation based on continuous or sustained abstinence was studied. A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials up to April 2006 was conducted. Articles containing relevant keywords were reviewed by two evaluators independently. To be considered for inclusion in the meta-analysis, studies had to be randomized clinical trials with a transdermal nicotine patch group and a placebo patch group, had to include at least one year of follow-up, had to have abstinence biochemically verified, and had to include the odds ratio (OR) as an outcome measure. Sixteen trials met the selection criteria. The total number of subjects was 9457 (6084 in the nicotine patch group and 3373 in the placebo patch group). The pooled OR for smoking abstinence at one year for the nicotine patch group versus the placebo patch group was 1.79 (95% confidence interval [CI], 1.55-2.08). The pooled OR for one-year continuous or sustained abstinence for the nicotine patch compared with placebo, excluding four studies reporting only point-prevalence abstinence, was 1.75 (95% CI, 1.49-2.05). A meta-analysis of trials of transdermal nicotine patch therapy versus placebo for smoking cessation yielded ORs for smoking abstinence of about 1.8 at one year after the start of therapy. ORs were similar whether the endpoint was point-prevalence abstinence, continuous or sustained abstinence, or both.

Concurrent brief versus intensive smoking intervention during alcohol dependence treatment.

Alcohol dependent smokers (N=118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-min counseling session with 5 min of follow-up. Intensive intervention consisted of three 1-hr counseling sessions plus 8 weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath carbon monoxide, was significantly higher for the intensive treatment group (27.5%) versus the rate for the brief treatment group (6.6%) at 1 month after the quit date but not at 6 months, when abstinence rates fell to 9.1% for the intensive treatment group and 2.1% for the brief treatment group. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short-term tobacco abstinence, other, perhaps more intensive, smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers.

An intensive group therapy programme for smoking cessation using nicotine patch and internet mailing supports in a university setting

Despite the growing literature on workplace tobacco control policies, very few studies have evaluated the role of smoking cessation programme as one of these policies in a university setting. We aimed to investigate the efficacy of intensive cessation programme delivered in a group format using nicotine patch therapy and internet mailing supports for our university employees. From January 2003, we conducted the group therapy programme for smoking cession seven times in Okayama University, Japan. This programme consisted of nicotine patch therapy and on-line supporting system. Smoking status was regularly assessed by direct interviews. A total of 102 employees were enrolled in this programme, of whom 101 initiated their smoking cessation. One hundred participants (99%) received nicotine patch therapy, and its toxicities were generally mild. Of the 94 employees who could be follow-up for a year after the cessation, 50 (53%) sustained abstinence for a year. Multivariate analysis revealed that writing and sending e-mail messages within the first 1 week were significant factors affecting long-term cessation. The type of position also affected the cessation rate. This study suggests that our programme in a university setting seems to be effective mainly because of peer-supports among the participants through regular face-to-face meetings and their own mailing supports.

Nicotine percentage replacement among smokeless tobacco users with nicotine patch

To obtain preliminary evidence on the safety and efficacy of high dose nicotine patch therapy among smokeless tobacco (ST) users who consume ≥3 cans of ST per week, we conducted a randomized, placebo-controlled clinical trial with 42 ST users randomized to nicotine patch doses of 21, 42, and 63 mg/day or placebo. Serum nicotine concentrations were measured during ad libitum ST use and nicotine replacement therapy, and percentages of nicotine replacement were calculated. We observed substantial inter-subject variability in nicotine concentrations with ad lib ST use. The mean percentage replacement of ad lib ST use serum nicotine concentrations approximated 100% with the 42 mg/day patch dose (mean ± S.D., 98.4% ± 45%). Dosing with the 21 mg/day nicotine patch was associated with mean “under-replacement” (53.2% ± 17.1%), and the 63 mg/day nicotine was associated with mean “over-replacement” (159.2% ± 121.9%). We observed symptoms of nausea consistent with nicotine toxicity in two subjects in the 63 mg/day group while no subjects in the 42 mg/day reported these symptoms. We conclude that the use of 42 mg/day nicotine patch therapy is safe and should be considered as initial therapy in the clinical setting among ST users who use ≥3 cans/week.

Effect of high-dose nicotine patch therapy on tobacco withdrawal symptoms among smokeless tobacco users

No pharmacotherapies have been shown to increase long-term (> or = 6-month) abstinence rates among smokeless tobacco (ST) users. Available evidence suggests that underdosing may occur with standard-dose nicotine replacement therapy (NRT) in ST users. We investigated the effect of high-dose nicotine therapy on tobacco withdrawal symptoms among ST users in a randomized, controlled clinical pilot study. A total of 42 ST users using at least 3 cans or pouches per week were randomized to nicotine patch doses of 63, 42, or 21 mg/day or placebo for 8 weeks. Multiple daily assessments of tobacco withdrawal and nicotine toxicity were obtained with an electronic diary. During the first week of nicotine patch therapy, we observed a dose-response relationship such that higher nicotine patch doses were associated with less decreased arousal (chi2 = 6.87, p = .009), less negative affect (chi2 = 3.85, p = .05), and less restlessness (chi2 = 3.90, p = .048). During the second week, higher nicotine patch doses were associated with less decreased arousal (chi2 = 6.77, p = .009). Overall, the frequency of nicotine toxicity symptoms did not differ by dose group. Of specific symptoms, nausea was observed to be more frequent in the 63 mg/day dose group compared with placebo (p = .035). In conclusion, high-dose nicotine patch therapy resulted in a greater reduction of tobacco withdrawal symptoms among ST users using at least 3 cans per week. High-dose nicotine patch therapy is safe and well tolerated in this population of tobacco users.

Expressive writing as a smoking cessation treatment adjunct for young adult smokers

This investigation evaluated the efficacy of expressive writing as a treatment adjunct to a brief office smoking cessation intervention plus nicotine patch therapy in young adults. Participants aged 18-24 years were randomized to a brief office intervention (n=99) or to an expressive writing plus brief office intervention (n=97). Both conditions received four individual visits plus 6 weeks of nicotine patch therapy, which began on the quit date following the week 2 visit. Participants in the expressive writing plus brief intervention condition wrote for 2 consecutive days before and 3 consecutive days after the quit date. The brief office intervention group completed a control writing assignment. At end of treatment (week 8), biochemically confirmed 7-day point-prevalence abstinence for the expressive writing plus brief office intervention condition was significantly greater than for the brief office condition (33% vs. 20%, p=.043, OR=2.0, 95% CI=1.0-3.7, from a logistic regression adjusting for gender). At 24 and 52 weeks, abstinence rates were similar for the brief office intervention versus expressive writing plus brief office intervention (12% vs. 11% at 24 weeks; 11% vs. 11% at 52 weeks). The results suggest that expressive writing has promise as a smoking cessation treatment adjunct for young adults. Lengthier interventions or the use of boosters should be tested to extend treatment effects. However, participants reported a low level of enthusiasm for the expressive writing, which may be a barrier to implementing it over a longer time frame. Therefore, other modes of delivering expressive writing to young adult cigarette smokers should be explored.

High-dose nicotine patch therapy for smokers with a history of alcohol dependence: 36-week outcomes

This study reports findings from an investigation of the efficacy of high-dose nicotine patch (NP) therapy for heavy smokers with a history of alcohol dependence. One hundred thirty participants were randomly assigned to 42 or 21 mg of transdermal nicotine. Follow-up assessments were conducted at 4, 12, 24, and 36 weeks. Differences between dose conditions were nonsignificant, although, unexpectedly, outcomes favored participants in the 21-mg NP condition. Nicotine abstinence rates in the 21- and 42-mg NP conditions on Week 36 follow-up were 16.9% and 9.2%, respectively. Patch condition did not interact with severity of nicotine dependence. However, nicotine abstinence at follow-up was related to a longer length of alcohol abstinence. No evidence was found for better outcomes as a function of the percentage of baseline cotinine replaced by NPs. Future research should focus primarily on investigating ways to improve smoking quit rates for smokers in early alcohol recovery.

A Controlled Trial of Naltrexone Augmentation of Nicotine Replacement Therapy for Smoking Cessation

Many smokers remain refractory to current therapies, which only partially address weight gain after smoking cessation. Thus, this study evaluated whether naltrexone hydrochloride augmentation of nicotine patch therapy improves smoking abstinence and reduces postcessation weight gain more than nicotine patch therapy alone and at what dose. Six-week double-blind placebo-controlled trial with follow-up in an outpatient research center. Four hundred individuals who smoked 20 or more cigarettes daily were randomly assigned to treatment for 6 weeks with a 21-mg nicotine patch and oral naltrexone hydrochloride (0, 25, 50, or 100 mg/d) after equal random treatment assignment and followed up for 1 year after randomization. The a priori specified primary end points were prolonged 4-week cigarette abstinence after a 2-week grace period in the intent-to-treat sample and weight gain in these abstainers. We found no significant differences in prolonged 4-week abstinence (P = .49) or 6-week continuous abstinence after the quit date (P = .12) during treatment in the intent-to-treat analysis. Among 295 treatment completers, the 100-mg dose was associated with higher continuous abstinence rates (71.6%) compared with placebo (48%) (odds ratio, 2.73; 95% confidence interval, 1.39-5.39; P<.01). Among continuous abstainers, the 25-mg naltrexone hydrochloride group gained significantly less weight (mean +/- SEM, 0.7 +/- 0.31 kg) than the placebo group (mean +/- SEM, 1.9 +/- 0.33 kg; P<.01). Similar naltrexone dose effects on weight were found for those with prolonged abstinence and treatment completers, irrespective of abstinence. The 100-mg dose of naltrexone hydrochloride appears the most promising for augmenting the efficacy of the nicotine patch on smoking cessation outcomes but requires further study. The significant weight reduction with low-dose naltrexone therapy suggests that it may be useful as a second-line treatment for weight-concerned smokers.

Table of Contents

The Brown University Digest of Addiction Theory and ApplicationVolume 25, Issue 7 p. 1-8 Table of Contents First published: 10 July 2006 https://doi.org/10.1002/data.20023AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Contingency Management Efficacious for Treatment of Stimulant Dependence Substance Abusers, Therapists' Views of Working Alliance Weaken Over Time Alcoholism Associated with Elevated Levels of Cognitive Impulsivity SSRI Plus Psychotherapy Benefits Depressed Adolescents with SUDs No Significant Difference Between Low-Dose, High-Dose Nicotine Patch Therapy Table 1: 7-Day Point Prevalence Abstinence Rates Innovative Computer Program Helps Reduce Drinking Relapse Following Discharge Internet and Telephone Treatment for Smoking Cessation: The iQUITT Study Volume25, Issue7July 2006Pages 1-8 RelatedInformation

Treating nondepressed smokers with alcohol dependence in sustained full remission: nicotine patch therapy tailored to baseline serum cotinine.

Studies of the efficacy of nicotine replacement therapy among alcoholic smokers have produced mixed findings. Our objective was to examine the smoking abstinence rate in smokers in sustained full remission from alcoholism (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) who are receiving nicotine patch therapy with the dose tailored to the baseline serum cotinine concentration. In this pharmacological relapse prevention study for 195 smokers with alcohol dependence in sustained full remission, the primary aim was to determine the 7-day point prevalence smoking abstinence rate at the end of 8 weeks of nicotine patch therapy in doses projected to achieve 100% venous replacement. Nicotine patch dose was based on the baseline serum venous cotinine as follows: (1) participants with < or = 200 ng/ml received a patch dose of 22 mg per day; (2) those with 201-300 ng/ml received a 33-mg dose per day, and (3) those with > 300 ng/ml received a 44-mg dose per day. A second (steady-state) serum cotinine concentration was obtained between weeks 2 and 7 to determine the percentage replacement. The point prevalence smoking abstinence rate at the end of the 8 weeks of nicotine patch treatment was 51% (95% confidence interval [CI]: 45%-58%) which is higher than would be expected, and percent replacement of > 80% was achieved in 49 of 85 (58%) tobacco-abstinent subjects. Higher cigarettes per day (odds ratio [OR] = 1.030, 95% CI: 1.004-1.057, p = .023) and a history of depressed mood on the Diagnostic Interview Schedule (OR = 1.940, 95% CI: 1.044-3.605, p = .036) were found to be multivariate independent predictors of smoking at week 8. However, percentage replacement did not predict smoking abstinence. We achieved > 80% replacement in most subjects, and there was no evidence of severe nicotine toxicity associated with the tailored dose of nicotine patch therapy.

Randomized controlled trial of a web‐based computer‐tailored smoking cessation program as a supplement to nicotine patch therapy

To assess the efficacy of World Wide Web-based tailored behavioral smoking cessation materials among nicotine patch users. Two-group randomized controlled trial. World Wide Web in England and Republic of Ireland. A total of 3971 subjects who purchased a particular brand of nicotine patch and logged-on to use a free web-based behavioral support program. Web-based tailored behavioral smoking cessation materials or web-based non-tailored materials. Twenty-eight-day continuous abstinence rates were assessed by internet-based survey at 6-week follow-up and 10-week continuous rates at 12-week follow-up. Using three approaches to the analyses of 6- and 12-week outcomes, participants in the tailored condition reported clinically and statistically significantly higher continuous abstinence rates than participants in the non-tailored condition. In our primary analyses using as a denominator all subjects who logged-on to the treatment site at least once, continuous abstinence rates at 6 weeks were 29.0% in the tailored condition versus 23.9% in the non-tailored condition (OR = 1.30; P = 0.0006); at 12 weeks continuous abstinence rates were 22.8% versus 18.1%, respectively (OR = 1.34; P = 0.0006). Moreover, satisfaction with the program was significantly higher in the tailored than in the non-tailored condition. The results of this study demonstrate a benefit of the web-based tailored behavioral support materials used in conjunction with nicotine replacement therapy. A web-based program that collects relevant information from users and tailors the intervention to their specific needs had significant advantages over a web-based non-tailored cessation program.

Safety and Efficacy of the Nicotine Patch and Gum for the Treatment of Adolescent Tobacco Addiction

To determine the safety and efficacy of the nicotine patch and gum for adolescents who want to quit smoking. Double-blind, double-dummy, randomized, 3-arm trial with a nicotine patch (21 mg), nicotine gum (2 and 4 mg), or a placebo patch and gum; all participants received cognitive-behavioral group therapy. Inner-city, outpatient clinic on the East Coast. Subjects. Thirteen- to 17-year-old adolescents who smoked > or =10 cigarettes per day (CPD), scored > or =5 on the Fagerstrom Test of Nicotine Dependence, and were motivated to quit smoking. Intervention. Twelve weeks of nicotine patch or gum therapy with cognitive-behavioral therapy, with a follow-up visit at 6 months (3 months after the end of treatment). Safety assessed on the basis of adverse event reports for all 3 groups, prolonged abstinence, assessed through self-report and verified with exhaled carbon monoxide (CO) levels of < or =6 ppm, in intent-to-treat analyses, and smoking reduction (CPD and thiocyanate concentrations) among trial completers. A total of 120 participants were randomized (72% white, 70% female; age: 15.2 +/- 1.33 years; smoking: 18.8 +/- 8.56 CPD; Fagerstrom Test of Nicotine Dependence score: 7.04 +/- 1.29) from 1999 to 2003. Participants started smoking at 11.2 +/- 1.98 years of age and had been smoking daily for 2.66 +/- 1.56 years; 75% had at least 1 current psychiatric diagnosis. Mean compliance across groups was higher for the patch (mean: 78.4-82.8%) than for the gum (mean: 38.5-50.7%). Both the patch and gum were well tolerated, and adverse events were similar to those reported in adult trials. Changes in mean saliva cotinine concentrations throughout treatment were not statistically significant. Intent-to-treat analyses of all randomized participants showed CO-confirmed prolonged abstinence rates of 18% for the active-patch group, 6.5% for the active-gum group, and 2.5% for the placebo group; the difference between the active-patch and placebo arms was statistically significant. There was no significant effect of patch versus gum or gum versus placebo on cessation outcomes. Abstinence rates at the 3-month follow-up assessment were sustained but were not significantly associated with treatment group. Mean smoking rates, but not CO or thiocyanate concentrations, decreased significantly in all 3 arms but not as a function of treatment group. Nicotine patch therapy combined with cognitive-behavioral intervention was effective, compared with placebo, for treatment of tobacco dependence among adolescent smokers. Decreases in the numbers of cigarettes smoked appeared to be offset by compensatory smoking. Additional study of nicotine gum, with enhanced instructional support, is needed to assess its efficacy among adolescent smokers.

The Effect of Nicotine Patch Therapy on Depression in Nonsmokers

Prior uncontrolled studies of nonsmokers with major depressive disorder (MDD) indicate rapid reduction in depressive symptoms with nicotine patch therapy. This randomized, double blind, placebocontrolled pilot study examined the effect of nicotine patch therapy on depressive symptoms in non—medicated nonsmokers with current MDD. Due to recruitment difficulties, only 7 were enrolled and of these 6 (5 females, 1 male) completed the study. Participants received either placebo (n =4) or active (n =2) patch therapy for 8 days. They completed daily clinic visits during patch therapy and a final visit on Day 12. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HRSD). The mean change in HRSD scores of all participants decreased (p =0.021) from baseline by Day 1 of patch use. Similar decreases in HRSD scores were observed for placebo and active patch groups. Among the placebo participants, the mean HRSD score decreased (p =0.038) by Day 2. The study needs replication with a larger sample and utilizing novel recruitment strategies.

Integrating smoking cessation treatment into primary care: an effectiveness study

Background. Lack of interest has been cited as a reason not to offer cessation assistance to smokers, but research suggests that smokers accept treatments offered proactively. This study assessed acceptability, utilization, and effectiveness of free smoking cessation treatment among diverse primary care patients. Method. Medical assistants invited 4,174 adult smokers to participate. Enrollees (1,869) self-selected or were assigned to receive free nicotine patch therapy alone or in combination with the Committed Quitters® program, and for some, individual counseling. Results. In nearly 68% of cases, patients accepted a treatment invitation; 77% of eligible smokers enrolled; 85% of these picked up free patches. Given a choice of treatments, 75% of participants elected a psychosocial treatment in addition to patch therapy. Thirteen percent of treatment initiators achieved biochemically confirmed 7-day point-prevalence abstinence at 1 year, with no significant treatment effects. Minority patients showed greater initial interest but less utilization did than White patients. Conclusions. Free, readily accessible smoking cessation treatment offered in primary care settings was accepted and used by the majority of unselected smokers of diverse racial/ethnic origins. Psychosocial treatment components did not significantly increase abstinence rates. Barriers, rather than lack of interest, may keep minority smokers from using cessation treatments.

The effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia

The purpose of this study was to determine the effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. This was a longitudinal study and sixty-eight schizophrenic patients were assigned to 8 weeks of a nicotine-patch therapy program or a control group. The generalized estimating equation analysis revealed that there were significant reductions in the subjects’ nicotine dependence (Fagerstrom Tolerance Questionnaire), the number of cigarettes per day, and CO levels over an 8-week period of nicotine-patch therapy and 3-month follow-up. The point-prevalence rates of abstinence from smoking were an abstinence of 26.9% at 8 weeks and 26.9% at a 3-month follow-up. At the 3-month follow-up, the rate of continuous smoking abstinence in the nicotine-patch group was 23.1%.