The effect of five smoking cessation pharmacotherapies on smoking cessation milestones.

Abstract

Objective-Most smoking cessation studies use long-term abstinence as their primary outcome measure. Recent research suggests that long-term abstinence may be an insensitive index of important smoking cessation mechanisms. The goal of the current study is to examine the effects of five smoking cessation pharmacotherapies using Shiffman et al. 's (2006) approach of examining the effect of smoking cessation medications on three process markers of cessation or smoking cessation "milestones": initial abstinence, lapse, and the lapse-relapse transition.Method-The current study (N = 1504, 58% female, 84% Caucasian) examines the effect of five smoking cessation pharmacotherapy treatments vs. placebo (bupropion, nicotine lozenge, nicotine patch, bupropion + lozenge, patch + lozenge) on Shiffman et al.'s smoking cessation milestones over 8 weeks following a quit attempt. Results-Resultsshow that all five medication conditions decreased rates of failure to achieve initial abstinence and most (with the exception of the nicotine lozenge) decreased lapse risk, however only the nicotine patch and bupropion + lozenge conditions affected the lapse-relapse transition.Conclusions-These findings demonstrate that medications are effective at aiding initial abstinence and decreasing lapse risk, but generally do not decrease relapse risk following a lapse. The analysis of cessation milestones sheds light on important impediments to long-term smoking abstinence, suggests potential mechanisms of action of smoking cessation pharmacotherapies, and identifies targets for future treatment development.Much smoking cessation research has used long-term abstinence to evaluate the efficacy of cessation treatments. Recently, Shiffman and colleagues (2006) introduced the notion that successful cessation may be viewed as being dependent upon several component events that Corresponding Author: Sandra Japuntich, Ph.D., Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford St., 9 th Fl., Boston, MA, 02114, (617) 726-7886, sjapuntich@partners.org. The authors are solely responsible for the analyses, content, and writing of this article. The authors have full control of all primary data, and they agree to allow the journal to review the data if requested.We declare that this research complies with the current laws of the United States of America. All participants gave written informed consent, and the study was approved by the Institutional Review Board. NIH Public AccessAuthor Manuscript J Consult Clin Psychol. Author manuscript; available in PMC 2011 March 16. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript they term "milestones." These include: ability to stop smoking (achieve short-term abstinence), avoid a lapse (smoking on a single day), and if a lapse occurs, avoid a relapse (a return to daily smoking; Shiffman et al., 2006). Parsing the multicomponential process of smoking cessation into meaningful subunits may provide insight into the process of cessation and relapse, and provide ...

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic

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Leveraging Genomic Data in Smoking Cessation Trials in the Era of Precision Medicine: Why and How

“…75 In treatment evaluation research, a series of survival analyses can be used to test whether treatment condition influences the time to each milestone, providing clues as to how effective treatments work. 75,76 An assumption here is that these milestones are differentially sensitive to medication effects and their relations with omic determinants. For instance, there is some evidence that the effects of medication early in the quit attempt (e.g., on initial abstinence) are especially sensitive to medication benefit.…”