MedicalResearch.com Interview with:
John Cunningham, PhD
Senior Scientist, Social & Epidemiological Research
Centre for Addiction and Mental Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Cunningham: Nicotine Replacement Therapy (NRT) has been found to improve tobacco cessation success rates in clinical trials where there is accompanying behavioral support. However, population survey data has indicated that people who purchase NRT as part of a quit attempt are no more successful at quitting smoking than people who don’t use NRT as part of their quit attempt. While causal statements about the effectiveness of NRT cannot be made based on the population survey findings, it does raise concerns about the effectiveness of NRT when there is no accompanying behavioral support.
Our trial used an interesting design where participants were recruited for a longitudinal survey about their patterns of smoking. As part of this survey, participants were asked if they would be interested in nicotine patches to help them quit smoking, if they were offered for free. Of those participants who said they were interested, a randomized half were actually sent a five-week supply of nicotine patches. The other half of participants were not sent the nicotine patches and were, in fact, unaware that nicotine patches were sent to others in the trial. Participants were followed-up at 8 weeks and 6 months, with those participants receiving free-of-charge nicotine patches being more likely to report current abstinence compared to those participants not sent the free nicotine patches (30-day self-reported abstinence at 6-months was 7.6% versus 3.0% respectively; odds ratio (OR), 2.65; 95% CI, 1.44 – 4.89, p = .002).
Medical Research: What should clinicians and patients take away from your report?
Dr. Cunningham: There is clear evidence that the use of NRT with accompanying behavioral support leads to higher chances of successfully quitting smoking as compared to using NRT alone. However, if behavioral support is unavailable, or hard to access, then using NRT by itself will increase chances at successfully quitting smoking.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Cunningham: There are many research questions that deserve attention. These include:
1) There are ongoing public health initiatives where subsidized or free-of-charge NRT is distributed in pharmacies or by postal mail. Providing 5 weeks or NRT is cheaper than providing the 12 weeks recommended by best practice, allowing more people to be provided with NRT. However, 5 weeks or NRT may be less effective that 12 weeks are promoting tobacco cessation. What is the best amount of NRT to be provided in order to optimize tobacco cessation with the largest number of recipients?
2) In some countries, the prevalence of smoking is higher in rural or remote regions than in urban settings. In addition, access to health care is often more challenging in such regions because of large geographic distances and low population density. Would programs that distribute free-of-charge NRT by postal mail be especially helpful in these regions?