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Does Nicotine Replacement Therapy Help Smokers To Quit?
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Jonathan Foulds, PhD posted:
A new study has recently gained substantial media attention, with the authors claiming that nicotine replacement may not help smokers to quit smoking. The study recruited 4991 smokers and recent ex-smokers via telephone survey in 2001 and 2002, and then again 2003-4 when 2805 (56%) were reached, and again in 2005-6 when 1916 were reached (38% of original sample). The study focused on those who at one of the first two interviews claimed they had quit smoking in the previous 2 years, and then were later interviewed again (728). The main finding was that the chances of relapsing were not significantly different between those who had previously used NRT to quit, either with or without professional counseling. The authors concluded that these results "raise serious questions regarding the population-level effectiveness of widely popular smoking cessation medications used with or without behavioral counseling." They then suggest that increases in insurance "coverage for individual treatment must not be at the expense of public health programs and policy interventions that have proven effective in promoting cessation."
There are many serious problems with this study (such as the low 38% overall follow-up rate), but the main problems lie with the misunderstanding of the purpose of tobacco dependence treatment and the misinterpretation of the data presented. Nicotine replacement therapy is currently marketed for short term use as an aid to smoking cessation. Counseling is similarly primarily conducted to help current smokers to successfully quit. Both of these interventions have been shown to increase the chances that smokers will successfully quit, but there is no evidence, from randomized controlled trials or population studies suggesting that after the medication or counseling has stopped that the relapse rate is dramatically different than from smokers who quit without treatment. So the benefit of treatment is of increasing the initial quit rates, meaning that even with similar relapse rates, there are more long term quitters. So for this study to ignore the first part, the "getting quit" and then focus on the second part, the "staying quit" and to find no difference is really unsurprising .
There are other surprising weaknesses in this report, including a failure to cite other population studies that fail to support the claimed findings of this study. For example, a population-based study published by West and colleagues in 2007 concluded that NRT use by smokers making self-initiated quit attempts without behavioral support is associated with improved long term abstinence rates. Amazingly the authors failed to cite recent population-based studies from their own state finding that use of a comprehensive tobacco cessation pharmacotherapy Medicaid benefit was associated with a significant decrease in smoking prevalence and claims for hospitalizations for acute myocardial infarction and acute coronary heart disease .
So does this recent study show that NRT doesn't help smokers to quit? No. Despite the headlines, this wasn't even a study of whether NRT use helps smokers to quit. Rather it was a rather weak study of whether people who quit smoking a long time ago have a tendency to relapse long after. The sad reality is that relapse continues. But of course this is a long recognized characteristic of an addiction, not a new finding. So this study has little bearing on the solid evidence that nicotine replacement therapy helps smokers to quit, and that tobacco treatment remains one of the most cost effective healthcare interventions available.
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Jonathan Foulds, PhD. is a Professor of Public Health Sciences at Penn State University, College of Medicine. After obtaining a first class honors deg...More

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