Randomized trial of the effectiveness of combined behavioral/pharmacological smoking cessation treatment in Syrian primary care clinics

Ward, Kenneth D.; Asfar, Taghrid; Ali, Radwan; Rastam, Samer; Weg, Mark W. Vander; Eissenberg, Thomas; Maziak, Wasim

doi:10.1111/j.1360-0443.2012.04048.x

Cited by 38 publications

(45 citation statements)

References 43 publications

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“…The study was approved by the Institutional Review Boards of The University of Memphis and Syrian Center for Tobacco Studies. Full details of the trial design and its methods are published elsewhere (Ward et al 2013). …”

Section: Methodsmentioning

confidence: 99%

“…Despite the extensive literature on evaluating nicotine withdrawal symptoms in populations from high-income countries (Bidwell et al 2013;Gritz et al 1991;Hendricks and Leventhal 2013;Hendricks et al 2014;Morrell et al 2008;Neiro et al 2014;Piasecki et al 2003;West and Russell 1985;West et al 2008), such information in low-income countries lags behind. Findings from the first cessation trial that was conducted in a low-income country setting (Aleppo, Syria) show that having fewer nicotine withdrawal symptoms during smoking cessation treatment was associated with a greater likelihood of smoking abstinence (Ward et al 2013). Therefore, there is a great need for further examination of the nature of nicotine withdrawal symptoms, and individual factors (e.g., demographic, smoking related and psychosocial) that may influence the severity of these symptoms in low-income countries such as Syria, which as many other Middle Eastern countries has a different smoking profile in comparison to western developed highincome countries (Maziak et al 2004).…”

Section: Introductionmentioning

confidence: 99%

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Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting

Taleb

Ward

Asfar

et al. 2016

Int J Public Health

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting

Taleb

Ward

Asfar

et al. 2016

Int J Public Health

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“…Smokeless tobacco is consumed by a quarter of a billion people living in South Asia, yet there is very little evidence on cessation support interventions in this population. Moreover, nicotine replacement therapy, a cornerstone of pharmacotherapy, has so far failed to show a significant treatment effect in low-income settings [7].…”

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confidence: 99%

Supporting economically disadvantaged tobacco users to help them stop: time to review priorities?

Siddiqi

2014

Addiction

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“…Kenneth Ward and his colleagues assessed the additional impact of nicotine replacement therapy (NRT) for smoking cessation in Syria in a two arm, parallel group, randomized placebo-controlled, double-blind trial [1]. Patients were seen in one of four primary care clinics and in addition to random allocation to active or placebo nicotine patch received brief physician advice and behavioral counseling.…”

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confidence: 99%

Commentary on Ward et al. (2013): Failure to find a treatment effect for NRT in a low‐income country – implications

Lando

2013

Addiction

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Commentary on Ward et al. (2013): Failure to find a treatment effect for NRT in a low-income country -implicationsKenneth Ward and his colleagues assessed the additional impact of nicotine replacement therapy (NRT) for smoking cessation in Syria in a two arm, parallel group, randomized placebo-controlled, double-blind trial [1]. Patients were seen in one of four primary care clinics and in addition to random allocation to active or placebo nicotine patch received brief physician advice and behavioral counseling. No incremental effect was found for active over placebo patch at end of treatment or at follow up. The authors note that this lack of a treatment effect is inconsistent with a large literature derived primarily from efficacy trials. They rule out several possible explanations for their results. Although their statistical power to observe an effect was somewhat limited with a total N of 269, they note that their observed effect was so small as to call into question lack of power as an explanation for their null finding.The overall 1-year prolonged abstinence rates (11.9% for place and 12.7% for active patch) appear relatively low [2]. However, this study appears to be more of effectiveness than an efficacy trial. Given the limited available cessation literature in low-and middle-income countries [3,4], it would be difficult to conclude that these overall long-term abstinence rates are disappointing. The investigators achieved what appears to be a surprising level of engagement by physicians. The five physicians who served as cessation coordinators underwent two hours of initial training in the study protocol and brief intervention strategies followed by six hours of additional training to deliver multiple sessions of behavioral cessation counseling both in person and by telephone. Overall adherence by both physicians and patients was excellent. One would not expect a similar level of engagement by physicians in a high-resource setting [2].Although this relatively small trial cannot prove the null hypothesis that NRT is ineffective in low-resource settings, it does introduce a note of caution. For quite some time, I have had doubts about how extensive a role pharmacotherapy is likely to play as part of cessation treatment in low-and middle-income countries. Cost is an obvious barrier, although there are additional barriers of access and distribution [5]. If behavioral interventions are proven to be effective as a stand-alone approach in low resource settings, this could have important implications.Publication of these results is timely in light of the recent adoption of Article 14 of the WHO Framework Convention on Tobacco Control at the fourth session of the Conference of the Parties in November 2010 [6,7]. Article 14 addresses tobacco dependence and cessation and calls in part for collaborating 'with other Parties to facilitate accessibility and affordability for treatment of tobacco dependence including pharmaceutical products . . .' (emphasis added). Detailed guidelines for implementation of Article 14...

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Randomized trial of the effectiveness of combined behavioral/pharmacological smoking cessation treatment in Syrian primary care clinics

Abstract: Nicotine patches may not be effective in helping smokers in low-income countries to stop when given as an adjunct to behavioural support.

Cited by 38 publications

References 43 publications

Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting

Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting

Supporting economically disadvantaged tobacco users to help them stop: time to review priorities?

Commentary on Ward et al. (2013): Failure to find a treatment effect for NRT in a low‐income country – implications

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