Use Of Smoking Cessation Pharmacotherapy Research Articles

Prevalence and predictors of smoking cessation among smokers receiving smoking cessation intervention in primary care in Qatar: a 6-month follow-up study.

To estimate the rate and predictors of smoking cessation in smokers attending smoking cessation clinics in primary care settings in Qatar. A cross-sectional study was conducted among 759 smokers who had attended any of the 10 smoking cessation clinics in primary health care centers from January 2019 to June 2020. The sociodemographic, clinical, and smoking-related variables were assessed. Tailored behavioral and pharmacotherapy were delivered, and patients were interviewed at 6 months to estimate the 30-day point prevalence abstinence. To identify independent factors associated with smoking cessation, a multivariable logistic regression analysis was performed. The mean age of participants was 40.6 (±11.3), majority being married, Arab and employed, and having a tertiary education. Almost half of the smokers (48.7%) received varenicline alone, 42.6% received NRT, and 31.8% received a combination of both. The selection of drug therapy was based on preferences, experiences, and history of previously encountered adverse effects. The overall 30-day quit rate at 6 months follow-up was 32.4%. About three-quarters (72.5%) of participants had at least one quit attempt and 12.5% had 3 or more attempts. Later age at smoking initiation, lower cigarette consumption at baseline, lower CO concentration at baseline, use of smoking cessation pharmacotherapy, having made fewer quit attempts and non-exposure to secondhand smoke among friends were identified as significant predictors of successful quitting at 6 months. The 30-day quit rate at 6 months follow-up (32.4%) is comparable to the worldwide figure. However, further efforts should be made to plan cost-effective tobacco dependence treatment taking into account predictors and at-risk groups.

Optimal use of smoking cessation pharmacotherapy.

SUMMARYThe most effective intervention for stopping smoking is a combination of professional counselling and pharmacotherapy. Medicines are recommended for all smokers who are motivated to quit and are nicotine dependent.Combination nicotine replacement therapy with a patch and an oral product is more effective than the patch alone. An adequate dose of nicotine must be used for an adequate duration.Varenicline is the most effective oral drug. It is safe in people with stable mental illness.Vaping nicotine is a second-line treatment which can be considered for smokers who are unable to quit with other methods.

Smoking cessation treatment for individuals with comorbid diabetes and serious mental illness in an integrated health care delivery system

IntroductionSmoking is a significant modifiable risk factor for mortality for persons with serious mental illness (SMI), who have a life expectancy 15–20 years shorter than the general population. Individuals with SMI and comorbid diabetes who are smokers face an even higher risk of cardiovascular complications and early death. Yet despite high rates of smoking among people with SMI, tobacco cessation interventions have not been broadly offered to this population. MethodsWe conducted a retrospective cohort study using electronic health records from 2014 in a large integrated care delivery system to examine whether use of smoking cessation pharmacotherapy among smokers with type 2 diabetes varies by serious mental illness (SMI) diagnosis. We analyzed smoking cessation medication prescription fills among adult smokers with diabetes, comparing those with SMI (N = 634) and without SMI (N = 18,021). Risk ratios were adjusted for age, gender, race, urban area type, and medical facility. ResultsOf the SMI group, 19.09% filled at least one smoking cessation prescription compared to 9.73% of the non-SMI group (adjusted risk ratio 1.80 [95% CI 1.52–2.13]; p < .001). For the SMI group, primary care providers wrote 80.24% of prescriptions, while psychiatrists wrote 8.81% of prescriptions. ConclusionsThese findings offer an example of a delivery system with higher uptake of smoking cessation pharmacotherapy among people with SMI than without SMI, and highlight the opportunity to provide more smoking cessation interventions in mental health care settings.

Smoking Cessation Pharmacotherapy Among Smokers Hospitalized for Coronary Heart Disease

This study uses data from the Premier Alliance database to assess factors associated with the use of smoking cessation pharmacotherapy in smokers hospitalized for coronary heart disease.

Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends

Objectives To estimate how far changes in the prevalence of electronic cigarette (e-cigarette) use in England have been associated with changes in quit success, quit attempts, and use of licensed...

Utilization of smoking-cessation pharmacotherapy among chronic obstructive pulmonary disease (COPD) and lung cancer patients

Objective:Smoking is one of the major risk factors causing morbidity and mortality in chronic obstructive pulmonary disease (COPD) and lung cancer patients. Use of smoking cessation pharmacotherapy is an effective way to help quit smoking. The purpose of the study was to determine the prevalence of smoking and the proportion of patients using smoking cessation agents, and to identify the socio-demographic factors that affect the use of these agents among COPD and lung cancer patients.Research design and methods:A retrospective study was done to identify smokers having COPD (ICD-9: 490–492) or lung cancer (ICD-9: 162), and those who use smoking cessation agents from 2006–2010, using Medical Expenditure Panel Survey (MEPS) data. A multiple logistic regression model was built to identify significant socio-demographic predictors associated with the use of smoking cessation agents.Results:Around 16.8% of COPD patients and 15.1% of lung cancer patients reported smoking after diagnosis. Out of the total smokers, 8.8% patients with COPD and 12.6% patients with lung cancer reported use of smoking cessation agents during the 5 year period. Logistic regression showed that odds for smoking cessation use in COPD patients were lower for Hispanics (OR = 0.107, 95% CI 0.023–0.502) and higher for patients having insurance coverage (OR = 3.453, 95% CI 1.240–9.617).Conclusion:Results showed that a large number of patients continued to smoke even after the diagnosis of COPD and lung cancer; whereas only a few among them used smoking cessation agents. Ethnicity disparities and insurance status were associated with the use of smoking cessation agents. Differential use among population sub-groups suggests a requirement for need based smoking cessation programs and appropriate prescription drug coverage. Further research needs to be done to evaluate reasons for disparities in smoking cessation agents’ use. The study had limitations common to research designs based on observational and self-reported datasets.

Response to Kaufman and Harper Letter

Response to Kaufman and Harper Letter

A Longitudinal Study of Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Hospitalizations for Cardiovascular Disease

Insurance coverage of tobacco cessation medications increases their use and reduces smoking prevalence in a population. However, uncertainty about the impact of this coverage on health care utilization and costs is a barrier to the broader adoption of this policy, especially by publicly funded state Medicaid insurance programs. Whether a publicly funded tobacco cessation benefit leads to decreased medical claims for tobacco-related diseases has not been studied. We examined the experience of Massachusetts, whose Medicaid program adopted comprehensive coverage of tobacco cessation medications in July 2006. Over 75,000 Medicaid subscribers used the benefit in the first 2.5 years. On the basis of earlier secondary survey work, it was estimated that smoking prevalence declined among subscribers by 10% during this period. Using claims data, we compared the probability of hospitalization prior to use of the tobacco cessation pharmacotherapy benefit with the probability of hospitalization after benefit use among Massachusetts Medicaid beneficiaries, adjusting for demographics, comorbidities, seasonality, influenza cases, and the implementation of the statewide smoke-free air law using generalized estimating equations. Statistically significant annualized declines of 46% (95% confidence interval 2%-70%) and 49% (95% confidence interval 6%-72%) were observed in hospital admissions for acute myocardial infarction and other acute coronary heart disease diagnoses, respectively. There were no significant decreases in hospitalizations rates for respiratory diagnoses or seven other diagnostic groups evaluated. Among Massachusetts Medicaid subscribers, use of a comprehensive tobacco cessation pharmacotherapy benefit was associated with a significant decrease in claims for hospitalizations for acute myocardial infarction and acute coronary heart disease, but no significant change in hospital claims for other diagnoses. For low-income smokers, removing the barriers to the use of smoking cessation pharmacotherapy has the potential to decrease short-term utilization of hospital services.

A review of the efficacy of smoking-cessation pharmacotherapies in nonwhite populations

Background: Cigarette smoking continues to be the leading cause of preventable morbidity and mortality in the United States. Research suggests that behavioral support strategies and pharmacotherapy can improve abstinence rates. However, both approaches, especially pharmacotherapy, have been understudied in nonwhite US populations. Objective: The aim of this review was to evaluate the efficacy of smoking-cessation pharmacotherapy in nonwhite US populations. Methods: Using search terms smoking cessation, nicotine replacement therapy, bupropion SR, varenicline, minority, ethnicity, African American, black, Hispanic, American Indian, and Alaska Native, a literature search was conducted to identify English-language studies that evaluated the use of smoking-cessation pharmacotherapies in nonwhite patients in MEDLINE (1966\\2-December 2007), International Pharmaceutical Abstracts (1980\\2-January 2008), Database of Abstracts of Reviews of Effectiveness (1990\\2-December 2007), and EMBASE Drugs & Pharmacology (1991\\2-third quarter 2007). Results: Nine studies were identified and assessed. Six studies looked at smoking-cessation pharmacotherapy in black smokers, 1 in Hispanic smokers, 1 in Native American smokers, and 1 in white and nonwhite smokers. In black smokers (N = 410; mean cigarettes per day [cpd], 20.4) who received the nicotine patch versus placebo, the 30-day self-reported abstinence rates were 21.5% versus 13.7% ( P = 0.03) at 10 weeks and 17.1% versus 11.7% ( P = NS) at 6 months. In black smokers (N = 600; mean [SD] cpd, 16.1 [7.5]) who received sustained-release (SR) bupropion 150 mg BID versus placebo for 7 weeks, the 7-day biochemically verified abstinence rates at weeks 6 and 26 were 36.0% versus 19.0% (Δ, 17%; 95% CI, 9.7\\2-24.4; P < 0.001) and 21.0% versus 13.7% (Δ, 7.3%; 95% CI, 1.0\\2-13.7; P = 0.02). Predictors of smoking cessation included use of bupropion SR (abstinence rate, 41.5% vs 21.1%; P<0.001); smoking nonmentholated cigarettes (abstinence rate, 28.3% in mentholated smokers [n = 417] vs 41.5% in nonmentholated smokers [n = 118]; P = 0.006); not smoking within 30 minutes of awakening (abstinence rate, 26.4% [n = 420] in those who did vs 48.7% [n = 115] in those who did not; P < 0.001); and lower baseline salivary cotinine levels (256.8 [137.0] ng/mL in those who became abstinent vs 305.6 [143.4] ng/mL in those who remained smokers; P < 0.001). In black light (≤10 cpd) smokers (N = 753) who received nicotine gum 2 mg, the biochemically verified 7-day abstinence rates at weeks 8 and 26 in mentholated versus nonmentholated smokers were 22.6% versus 26.8% ( P = NS) and 11.2% versus 18.8% ( P = 0.015), respectively; at week 26, the abstinence rates in those who received gum + mentholated cigarettes (n = 309) versus gum + nonmentholated cigarettes (n = 67) were 14% versus 24% ( P = 0.031). In Hispanic smokers (N = 108; mean [SD] cpd, 18.8 [10.2]) who received nicotine patch versus placebo for 10 weeks, 46% versus 26% (χ 2 = 4.01; P = 0.05) were abstinent from weeks 2 to 10 (completed all doses of patch); patients who were more acculturated and received active treatment had a higher abstinence rate than less acculturated patients (63% vs 47%; P value not provided). In Native American smokers (N = 252; cpd not provided) who received nicotine patch + counseling and were followed up at 3, 6, 9, and 12 months, selfreported abstinence rates were 31% (49/156), 30% (21/71), 24% (13/55), and 21% (4/19), respectively (P values not provided). In a 6-month study in white (n = 191) and nonwhite (n = 108) smokers (mean [SD] cpd, 21 [11]) randomized to receive a nicotine patch (n = 144) versus nasal spray (n = 155) for 8 weeks, the carbon monoxide\\2-verified 7-day abstinence rates were 34.7% versus 29.0%; at 6 months, these rates were 18.1% versus 15.5% ( P = NS). In nonwhite patients, logistic regression analysis at 6 months found that a higher proportion of patients randomized to receive nasal spray did not smoke for ≥7 consecutive days (odds ratio, 0.20; 95% CI, 0.05-0.77; P = 0.02). Conclusions: Data from the studies in this review support the use of smoking-cessation pharmacotherapy (nicotine patch and bupropion SR) in nonwhite patients. Black patients, who smoked within 30 minutes of awakening, smoked mentholated cigarettes, and had high salivary cotinine levels may have difficulty quitting regardless of the number of cigarettes smoked per day; therefore, determining the type of cigarettes smoked (mentholated vs nonmentholated) and salivary cotinine levels may be helpful in assessing the severity of smoking addiction and guide pharmacotherapy (eg, starting at higher doses of nicotine-replacement therapy in a light smoker). Other than smoking-cessation behavioral studies, there is a lack of congruent smoking-cessation pharmacotherapy studies in American Indian/Alaska Native, Hispanic, and other ethnic populations.

Cigarette smoking and interest in quitting in methadone maintenance patients

Objectives To examine tobacco use, readiness to quit, and interest in smoking cessation interventions among methadone maintenance patients. Methods Cross-sectional survey of outpatients enrolled in four urban methadone maintenance clinics. Stage of readiness to quit was determined for all smokers, and factors associated with both readiness to quit and interest in attending an on-site smoking cessation program were determined. Results Among 389 patients, 83% were current smokers. Nearly half (48%) of smokers were contemplating quitting, and an additional 22% were in the preparation stage of readiness to quit. In multivariate analyses, lower nicotine dependence, prior use of smoking cessation pharmacotherapy, and lower methadone dose were associated with being in the preparation stage. Patients with more education, Hispanics/Latinos, and patients who had used smoking cessation pharmacotherapy or were in the preparation or contemplation stages of behavior change were more interested in attending an on-site smoking cessation program. Conclusions Tobacco use is highly prevalent among methadone maintenance patients, but we also observed a high level of readiness to quit and interest in smoking cessation. Targeted smoking cessation interventions, including on-site programs, should be developed for methadone maintenance patients.

Disparity in the Use of Smoking Cessation Pharmacotherapy Among Medicaid and General Population Smokers

The prevalence of smoking remains higher among the Medicaid population compared with the general population. To reduce this disparity, the majority of state Medicaid programs now provide coverage for smoking cessation pharmacotherapy. The objectives of this study were to (1) assess awareness of this benefit among Medicaid smokers and (2) compare the use of pharmacotherapy among a sample of Medicaid smokers with smokers in the general population of western New York. This report summarizes findings from two cross-sectional studies conducted in western New York State during 2002 to 2003: (1) Medicaid smokers (n = 1,174) completed an interviewer-administered questionnaire in the Office of Medicaid Management and (2) smokers from the general population (n = 852) completed a telephone survey. The majority of Medicaid smokers (54%) remain unaware of the program benefit providing coverage for smoking cessation pharmacotherapies. Medicaid smokers were much less likely (odds ratio = 0.33, 95% confidence interval = 0.25-0.44) than the general population to report having ever used pharmacotherapies. Highlighting the availability of the smoking cessation pharmacotherapy benefit to Medicaid program participants may be one strategy to enhance quit attempts among this population. Future research should identify other potential barriers to the use of effective pharmacotherapies among poorer smokers.

Medicaid coverage for tobacco-dependence treatments.

Update Health AffairsVol. 20, No. 1: Expanding Health Coverage STATE REPORTMedicaid Coverage For Tobacco-Dependence TreatmentsHelen Halpin Schauffler, Dianne C. Barker, and C. Tracy OrleansPUBLISHED:January/February 2001No Accesshttps://doi.org/10.1377/hlthaff.20.1.298AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSMedicaidState MedicaidSmokingSmoking cessationDiseasesGovernment programs and policiesCost-effectivenessMedicaid coverageFederal health plansDrug therapy Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 24 History Published online 1 January 2001 InformationCopyright 2001 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited byThe Tobacco Control Experience: A Model for Substance Use Prevention?2 March 2019Affordable Care Act Impact on Medicaid Coverage of Smoking-Cessation TreatmentsAmerican Journal of Preventive Medicine, Vol. 54, No. 4Variation in Coverage for Progesterone to Prevent Preterm Birth: A Survey of Medicaid Managed Care OrganizationsWomen's Health Issues, Vol. 27, No. 5Impact of Increasing Coverage for Select Smoking Cessation Therapies With no Out-of-Pocket Cost Among the Medicaid Population in Alabama, Georgia, and MaineJournal of Public Health Management and Practice, Vol. 22, No. 1Impact of Broadened Coverage of Smoking Cessation Treatments on Cardiovascular Disease3 October 2012 | Current Cardiovascular Risk Reports, Vol. 6, No. 6Cancer-Related News from the CDC: State Medicaid Coverage for Tobacco-Dependence TreatmentsOncology Times, Vol. 31, No. 23Treatment of Smokers with Co-Occurring Disorders: Emphasis on Integration in Mental Health and Addiction Treatment SettingsAnnual Review of Clinical Psychology, Vol. 5, No. 1Identifying health disparities across the tobacco continuumAddiction, Vol. 102State Medicaid Coverage for Tobacco-Dependence TreatmentsOncology Times, Vol. 29, No. 12Tobacco Control Interventions in the Emergency Department: A Joint Statement of Emergency Medicine OrganizationsAnnals of Emergency Medicine, Vol. 48, No. 4Tobacco Control Interventions in the Emergency Department: A Joint Statement of Emergency Medicine OrganizationsJournal of Emergency Nursing, Vol. 32, No. 5Prevalence and Trends in Smoking: A National Rural StudyThe Journal of Rural Health, Vol. 22, No. 2Medicaid Coverage For Tobacco-Dependence TreatmentsHealth Affairs, Vol. 25, No. 2Disparity in the Use of Smoking Cessation Pharmacotherapy Among Medicaid and General Population SmokersJournal of Public Health Management and Practice, Vol. 11, No. 4Reimbursement for smoking cessation treatment may double the abstinence rate: results of a randomized trialAddiction, Vol. 100, No. 7A randomized trial to promote pharmacotherapy use and smoking cessation in a Medicaid population (United States)Cancer Causes & Control, Vol. 16, No. 4IMPACT OF NICOTINE REPLACEMENT THERAPY ON SMOKING BEHAVIORAnnual Review of Public Health, Vol. 26, No. 1Effectiveness of a quit and win contest with a low-income populationPreventive Medicine, Vol. 39, No. 3Physician and enrollee knowledge of Medicaid coverage for tobacco dependence treatmentsAmerican Journal of Preventive Medicine, Vol. 26, No. 2Implementation of Evidence-Based Tobacco Use Cessation Guidelines in Managed Care OrganizationsAnnals of Behavioral Medicine, Vol. 27, No. 1Reversal of Misfortune: Viewing Tobacco as a Social Justice IssueAmerican Journal of Public Health, Vol. 94, No. 2Geographic pattern of cancers related to tobacco and alcohol in Connecticut: implications for cancer controlCancer Detection and Prevention, Vol. 28, No. 4Support for Smoking Cessation Interventions in Physician OrganizationsMedical Care, Vol. 41, No. 12Current strategies for cessation of smoking for head and neck cancer patientsCurrent Opinion in Otolaryngology & Head and Neck Surgery, Vol. 10, No. 2