Quotes

“More than 75 percent of current smokers report they would like to quit, and more than 30 percent of smokers attempt to quit each year,” said lead author Anne M. Joseph. “Given these statistics, you’d assume that these smokers would achieve success in eliminating the habit, yet less than 10 percent will achieve long-term abstinence. Most will experience a relapse within three months of their treatment.”

“Smoking reduction might decrease nicotine dependence and increase a smoker’s motivation to quit,” said Joseph. “We might then see additional attempts to quit the habit.”

“This randomized controlled trial shows that a smoking intervention based on chronic disease management principles of care – targeting the goal of quitting smoking but incorporating failures, setting interim goals and continuing care until the desired outcome is achieved – is approximately 75 percent more effective at accomplishing long-term abstinence than delivery of a discrete episode of care for smoking cessation,” the authors conclude.

Full Text

MINNEAPOLIS / ST. PAUL (November 28, 2011) – A chronic disease management approach including continued counseling and nicotine replacement therapy may increase the odds that current smokers will quit the habit, according to new research from University of Minnesota Medical School cancer prevention experts.

In fact, the strategy may outpace current intervention methodologies, according to the authors.

According to the study’s lead author, Masonic Cancer Center researcher Anne M. Joseph, M.D., M.P.H., smoking cessation rates have remained unchanged the past decade despite advances in both clinical care and policy changes. To increase these rates, researchers need to develop new approaches to reducing tobacco.

“More than 75 percent of current smokers report they would like to quit, and more than 30 percent of smokers attempt to quit each year,” said Joseph. “Given these statistics, you’d assume that these smokers would achieve success in eliminating the habit, yet less than 10 percent will achieve long-term abstinence. Most will experience a relapse within three months of their treatment.”

Current treatment strategies often involve behavioral and pharmacologic interventions, but haven’t historically incorporated principles of chronic disease management, such as continuity of care, self-management and seeking steady care improvement over extinction of symptoms.

But Joseph and colleagues said that positioning smoking reduction as an immediate goal within a chronic disease management approach may keep smokers engaged in the quitting process.

“Smoking reduction might decrease nicotine dependence and increase a smoker’s motivation to quit,” said Joseph. “We might then see additional attempts to quit the habit.”

Joseph and her colleagues conducted a randomized controlled trial to compare telephone-based chronic disease management (one-year; longitudinal care) with evidence based treatment (eight weeks; usual care) for tobacco dependence. The trial included 443 current smokers who each received five telephone counseling calls and nicotine replacement therapy by mail for four weeks. Participants were then randomized to usual care (UC; two additional telephone calls) or longitudinal care (LC; continued counseling and nicotine replacement therapy for an additional 48 weeks).

At 18 months, six-month prolonged abstinence was 30.2 percent in the LC group and 23.5 percent in the UC group. Additional analysis showed that the LC treatment arm, quit attempts in the previous year, cigarettes per day at baseline and cigarettes smoked in the past week (as reported at day 21) were significantly associated with prolonged abstinence at 18 months.

The median percentage of days reporting no cigarette use was 57.1 percent in the LC group and 30.1 percent in the UC group.

The authors also found that participants in the LC group made significantly more quit attempts than those in the UC group. Among participants who did not quit smoking, there was more smoking reduction in the LC group compared with the UC group, but these differences were statistically significant only at 12 months.

“This randomized controlled trial shows that a smoking intervention based on chronic disease management principles of care – targeting the goal of quitting smoking but incorporating failures, setting interim goals and continuing care until the desired outcome is achieved – is approximately 75 percent more effective at accomplishing long-term abstinence than delivery of a discrete episode of care for smoking cessation,” the authors conclude.

The latest study appears in the November 28 issue of JAMA’s Archives of Internal Medicine, alongside research from the Medical University of South Carolina, Charleston, which demonstrates nicotine replacement therapy and smoking cessation intervention programs are also associated with positive outcomes.