Effect of Mailing Nicotine Patches on Tobacco Cessation Among Adult Smokers

Cunningham, John A.; Kushnir, Vladyslav; Selby, Peter; Tyndale, Rachel F.; Zawertailo, Laurie; Leatherdale, Scott T.

doi:10.1001/jamainternmed.2015.7792

Cited by 44 publications

(35 citation statements)

References 23 publications

(29 reference statements)

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“…Fourth, asking whether participants had visited a physician and discussed smoking cessation could have been subject to recall bias. Finally, biochemical verification of smoking status could not be effectively executed [23], therefore cessation outcomes are based on self-report data.…”

Section: Discussionmentioning

confidence: 99%

“…A detailed research protocol of the overall trial design and primary outcomes are published elsewhere [23, 24]. Briefly, the trial employed a single blinded, panel survey design with random assignment to an experimental and a control group.…”

Section: Methodsmentioning

confidence: 99%

“…Studies evaluating these programs have generally revealed that compared to non-treatment cohorts, smokers receiving NRT were able to achieve higher quit rates, and that offering free NRT is an effective intervention in encouraging program participation, improves treatment satisfaction, and is cost-effective [16–20]. Direct causal evidence on the efficacy of large-scale distribution of free NRT has also been recently established, documenting that despite concerns over the ‘real-world’ effectiveness of NRT [21, 22], the mailed distribution of free nicotine patches in absence of behavioral support more than doubled the odds of cessation at a 6-month follow-up [23]. Nonetheless, no previous studies had evaluated whether the provision of free NRT had promoted further help-seeking and what impact that interaction may have had.…”

Section: Introductionmentioning

confidence: 99%

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Impact of large-scale distribution and subsequent use of free nicotine patches on primary care physician interaction

2017

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BackgroundLarge-scale distribution efforts of free nicotine replacement therapy (NRT) have been documented to be cost-effective interventions for increasing smoking quit rates. However, despite nearly a dozen studies evaluating their effectiveness, none have examined whether free NRT provision promotes further primary care help-seeking and the impact that it may have on cessation efforts.MethodsIn the context of a randomized controlled trial, a secondary analysis was conducted on 1000 adult regular smokers randomized to be mailed a 5-week supply of nicotine patches or to a no intervention control group. Recipients and users of free nicotine patches at an 8 week follow-up were successfully case matched to controls based on age, gender, baseline level of nicotine dependence and intent to quit (n = 201 per group). Differences in physician interaction between the two groups were evaluated at both 8 week and 6 month follow-ups. The impact of physician interaction on self-reported smoking abstinence at each follow-up was also examined.ResultsAlthough no differences in physician interaction were noted between groups at the 8 week follow-up, at the 6 month follow-up, nicotine patch users reported greater frequency of discussing smoking with their physician (43.9%), as compared to the control group (30.3%) (p = 0.011). Across both groups, over 90% of those that discussed smoking with a physician were encouraged to quit and approximately 70% were provided with additional support. Separate ANOVAs revealed no significant impact of physician interaction on cessation (p > 0.05), regardless of group or follow-up period, however, at the 6 month follow-up, nicotine patch users who discussed cessation with a physician had made serious quit attempts at significantly greater rates (72.6%), compared to controls (49.1%) (p = 0.007).ConclusionsIrrespective of group, the majority of smokers in the present study did not discuss cessation with their physician. Recipients and users of nicotine patches however, were more likely to discuss smoking with their physician, suggesting that the provision of free NRT particularly to those who are likely to use it may facilitate opportunities for benefits beyond the direct pharmacological effects of the medication.Trial registration clinicaltrials.gov, NCT01429129. Registered: 2 September 2011.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of large-scale distribution and subsequent use of free nicotine patches on primary care physician interaction

2017

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“…First, although evaluating the effectiveness of the mass distribution of nicotine patches specifically among those with current depression or anxiety was of particular interest, these subanalyses were not sufficiently powered to detect differences and were thus deemed inconclusive. Second, despite taking considerable efforts to biochemically validate smoking status,32 this aspect of the trial could not be effectively executed, leading all outcomes to be based on self-report data. As participants were recruited from across all of Canada, with no physical contact similar to other mass distribution efforts, perhaps the difficulty in confirming smoking abstinence via biochemical means is an inherent limitation of pragmatic trials of this nature.…”

Section: Discussionmentioning

confidence: 99%

“…Although that study provided preliminary evidence of reduced NRT effectiveness in recurrent depression, similar to other mass distribution efforts, it did not include a randomly allocated control group to test for the causal effects of NRT. Our recently published trial32 is the only study to employ randomly allocated groups to identify the effectiveness of mailed NRT distribution in the general population. It is, therefore, presently unknown whether the distribution of free NRT is effective in predicting cessation specifically among smokers with mental illness.…”

Section: Introductionmentioning

confidence: 99%

Impact of self-reported lifetime depression or anxiety on effectiveness of mass distribution of nicotine patches

et al. 2016

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Questioning Nicotine Replacement Therapy Without Behavioral Support

2016

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In Reply We recently reported that high body mass index (BMI) and low aerobic fitness in a large cohort of 18-year-old Swedish men were associated with increased risk of hypertension in adulthood. Hypertension was ascertained using all inpatient diagnoses nationwide throughout the study period (1969-2012) and outpatient diagnoses from all specialty clinics between 2001 and 2012. We indicated that hypertension was therefore underreported because we lacked outpatient data before 2001 or from primary care clinics. Dr Brunström raises the question of whether our findings may be attributable to the known associations between high BMI or low aerobic fitness and coronary heart disease or stroke that are likely to receive inpatient or specialty clinic treatment and are also associated with hypertension. We performed sensitivity analyses to explore this possibility further. We found that only a small minority of men who were diagnosed with hypertension (n = 93 035) had a concurrent or earlier diagnosis of ischemic heart disease (n = 13 523 [14.5%]) or stroke (n = 5368 [5.8%]). When we repeated our analyses after excluding these individuals, the findings were largely unchanged. High BMI and low aerobic capacity remained associated with an increased risk of hypertension, independent of family history and socioeconomic factors (BMI, overweight or obese vs normal: incidence rate ratio [IRR], 2.62; 95% CI, 2.57-2.67; P < .001; aerobic capacity, lowest vs highest tertile: IRR, 1.43; 95% CI 1.39-1.46; P < .001). Alternatively, adjusting for ischemic heart disease and stroke as time-dependent variables yielded very similar results. Other findings also were unchanged: high BMI and low aerobic capacity had a negative additive and multiplicative interaction (P < .001), and low aerobic capacity remained a significant risk factor among those with normal BMI (lowest vs highest tertile: IRR, 1.52; 95% CI 1.48-1.57; P < .001). These supplemental findings suggest that the associations we reported were not spuriously caused by ascertainment bias or confounding by ischemic heart disease or stroke. Our findings are also consistent with other epidemiologic and biologic evidence linking obesity or low aerobic fitness with a higher risk of developing hypertension. A number of smaller epidemiologic studies have reported similar associations between high BMI 1,2 or low aerobic fitness 3,4 and risk of hypertension. These studies ascertained hypertension in various ways, including direct blood pressure measurements, 3 chart review, 4 or self-report. 1,2 Experimental studies have shown that the underlying mechanisms are multifactorial and involve increased catecholamine secretion and activity, insulin resistance, and other neuroendocrine and metabolic effects on sympathetic activation and endothelial and vascular dysfunction. 5,6 Because associations between obesity or low aerobic fitness and hypertension are well-established, the main purpose of our study was to explore their interactive effects. We found that high BMI and low aerobic fitness in la...

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Effect of Mailing Nicotine Patches on Tobacco Cessation Among Adult Smokers

Cited by 44 publications

References 23 publications

Impact of large-scale distribution and subsequent use of free nicotine patches on primary care physician interaction

Impact of large-scale distribution and subsequent use of free nicotine patches on primary care physician interaction

Impact of self-reported lifetime depression or anxiety on effectiveness of mass distribution of nicotine patches

Questioning Nicotine Replacement Therapy Without Behavioral Support

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