PREDICTING SMOKING CESSATION - WHO WILL QUIT WITH AND WITHOUT THE NICOTINE PATCH

Objective.-To identify predictors of smoking cessation success or fail ure with and without transdermal nicotine patch treatment. Design.-Two independent randomized, double-blind, placebo-controlled studies usin g the nicotine patch assessing outcome at the end of treatment and at 6-month follow-up; each study used a different mode of adjuvant counse ling. Patients.-Subjects were daily smokers (greater than or equal to 15 cigarettes per day), aged 21 to 65 years with expired air carbon mo noxide levels of at least 10 ppm, and motivated to quit. Eighty-eight subjects participated in study 1, and 112 subjects participated in stu dy 2. Intervention.-Study 1 consisted of 8 weeks of 22-mg nicotine pat ch therapy with intensive group counseling. Study 2 consisted of 4 wee ks of 22-mg nicotine patch therapy and 2 weeks of 11-mg nicotine patch therapy with brief individual counseling. Main Outcome Measures.-The prediction of smoking cessation (at end of treatment and after 6 month s) based on pretreatment and intratreatment measures in smokers using active or placebo nicotine patches. Results.-Pretreatment markers, suc h as the Fagerstrom Tolerance Questionnaire score, number of cigarette s smoked per day, years smoked, expired air carbon monoxide level, or baseline blood nicotine and cotinine levels, showed no consistent rela tionship with successful smoking cessation across both studies. Of the intratreatment markers examined, withdrawal severity and nicotine rep lacement levels also were not consistently predictive of cessation suc cess. However, any smoking during the second week of treatment was a c onsistent and powerful predictor of failure at the end of treatment an d after 6 months. Among active nicotine patch patients who smoked at a ll during week 2 after quitting, 83% and 97% (studies 1 and 2, respect ively) were smoking at 6-month follow-up. Conversely, abstinence durin g the second week of treatment predicted successful smoking cessation. Among active nicotine patch patients who were totally abstinent durin g week 2 after quitting, 46% and 41% (studies 1 and 2, respectively) w ere abstinent at 6-month follow-up. Of all nicotine patch patients in both studies who were smoking at 6-month follow-up, 74% began smoking during week 1 or 2. Among all placebo patch patients who were smoking at 6-month follow-up, 86% began smoking during week 1 or 2. Conclusion s.-Smoking status (abstinent or smoking) during the first 2 weeks of n icotine patch therapy, particularly week 2, was highly correlated with clinical outcome and can serve as a powerful predictor of smoking ces sation. Early smoking behavior also predicted outcome among placebo pa tch users. Traditional measures of dependence are not consistently pre dictive of cessation success. Clinicians are advised to emphasize the importance of total abstinence after a quit attempt and to follow-up w ith patients within the first 2 weeks of quitting; smoking during this critical time should be assessed and treatment may be altered as appr opriate.