TRANSDERMAL NICOTINE THERAPY AND PRIMARY-CARE - IMPORTANCE OF COUNSELING, DEMOGRAPHIC, AND PARTICIPANT SELECTION FACTORS ON 1-YEAR QUIT RATES

Objective: To evaluate the smoking cessation efficacy of nicotine patc h therapy as an adjunct to low-intensity, primary care intervention. D esign: Randomized, placebo-controlled, double-blind, multisite trial. Settings: Twenty-one primary care sites in Nebraska. Patients: A total of 369 smokers of 20 or more cigarettes per day. Intervention: Two br ief primary care visits for smoking Intervention with 10 weeks of acti ve or placebo patch therapy. Main Outcome Measures: Confirmed self-rep orted abstinence 3, 6, and 12 months after the quit day. Results: Comp ared with placebo control subjects, participants assigned nicotine pat ches had higher 3-month (23.4% vs 11.4%; P<.01) and 6-month (18.5% vs 10.3%; P<.05) abstinence rates. The 1-year abstinence rates for the ac tive and placebo patch groups were 14.7% and 8.7%, respectively (P =.0 7). Of smokers aged 45 years and older, 9 (18.8%) of 48 using active p atches compared with 0 of 31 using placebo patches achieved 12-month a bstinence (chi(2) = 6.56, P<.05). Among those with high nicotine depen dency scores (Fagerstrom score greater than or equal to 7), 1-year abs tinence rates were significantly higher in the nicotine patch group (1 9.1%) compared with the placebo group 15.0%) (chi(2) = 10.7; P = .001) . However, there was no significant difference in 1-year quit rates fo r participants with low Fagerstrom scores (<7). Conclusions: Nicotine patch therapy enhanced 6-month quit rates as an adjunct to brief prima ry care intervention. The highest quit rates were achieved by particip ants who specifically contacted the site to enroll in the study or to obtain a prescription for nicotine patches. Differences in participant selection factors may account, in part, for the lower smoking cessati on rates associated with primary care intervention. Duration of counse ling, patient age, and Fagerstrom scores may be important factors rela ted to the long-term smoking cessation success of nicotine patch thera py.