Intensive smoking cessation programme reports limited success at 6 months

The scale of the problem of smoking, often highlighted in discussions of the abacavir data with a comment such as patients would reduce their risk more from stopping smoking rather than discontinuing abacavir’ is not only unhelpful for non- and ex-smokers, but also of limited benefit for current smokers who have unsuccessfully tried to quit.

Karen Tashima presented results showing a limited 6 month success rate (~10%) in around 450 HIV-positive US smokers (average 18/day), randomised to more intense motivational interventions (ME; 4 long (30 minute) counselling sessions) compared to standard of care (SC; 2 brief 3 minute sessions), both with nicotine patches. While the study as a whole found no additional benefit to the ME programme, it had significant differences by race.

Only around 50% and 60% of patients attended the 2- and 4-month follow-up visits with an increase to 72% at 6-month possibly related to greater financial compensation at that time point. Overall, 6-month quit rates by intent-to-treat analysis were 9% (9% ME, 10% SC, p = 0.76).

Higher quit rates were seen among Hispanic patients (19% overall, 14% ME, 24% SC) and lowest among African Americans (5% overall, 9% ME, 0% SC), with significant differences in the standard care arm (p = 0.01). Failure to use nicotine replacement predicted smoking at 6 months (p<0.05).

Multivariate predictors of 6-month smoking abstinence among patch users included black race vs white (p=0.003), baseline self-ability or change in self-ability to refuse ciarettes (p<0.001), change in belief to quit (p=0.003).

Comment

Most commentators found these results depressing, including the presenter, although it was also pointed out that many people need to attend several programmes before they are successful.

Indeed, 68% of participants had previously used nicotine patches and 20% had previously managed to quit for over one year: highlighting the fragility of even these modest success rates.

Patients did not have to express an interest in trying to quit and the financial reimbursement may have encourged particpants with a low motivation. This intervention may have looked more impressive if patients had been selected more appropriately.