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Duffy SA, Ignacio RV, Kim HM, Geraci MC, Essenmacher CA, Hall SV, Chow A, Pfeiffer PN, Sherman SE, Bohnert KM, Zivin K, Barnett PG. Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration. Tob Control 2018; 28:540-547. [PMID: 30181383 DOI: 10.1136/tobaccocontrol-2018-054473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In 2003, the Veterans Health Administration (VHA) implemented a directive that cessation pharmacotherapy be made available to all who use tobacco and are interested in quitting. Despite the efficacy of cessation pharmacotherapy shown in clinical trials, the generalisability of the results in real-world settings has been challenged. Hence, the specific aim of this study was to determine the effectiveness of cessation pharmacotherapies in the VHA. METHODS This retrospective cohort study used VHA's electronic medical record data to compare quit rates among those who use tobacco and who did vs. did not receive any type of cessation pharmacotherapy. Included were 589 862 Veterans identified as current tobacco users during fiscal year 2011 who had not received cessation pharmacotherapy in the prior 12 months. Following a 6-month period to assess treatment, quit rates among those who were treated versus untreated were compared during the 7-18 months (12 months) post-treatment follow-up period. The estimated treatment effect was calculated from a logistic regression model adjusting for inverse probability of treatment weights (IPTWs) and covariates. Marginal probabilities of quitting were also obtained among those treated versus untreated. RESULTS Adjusting for IPTWs and covariates, the odds of quitting were 24% higher among those treated versus untreated (OR=1.24, 95% CI 1.23 to 1.25, p<0.001). The marginal probabilities of quitting were 16.7% for the untreated versus 19.8% for the treated based on the weighted model. CONCLUSION The increased quit rates among Veterans treated support the effectiveness and continuation of the VHA tobacco cessation pharmacotherapy policy.
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Affiliation(s)
- Sonia A Duffy
- College of Nursing, Ohio State University, Columbus, Michigan, USA.,Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Rosalinda V Ignacio
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hyungjin Myra Kim
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark C Geraci
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, Illinois, USA
| | - Carol A Essenmacher
- Department of Veterans Affairs, Battle Creek VA Medical Center, Battle Creek, Michigan, USA
| | - Stephanie V Hall
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Adam Chow
- Department of Veterans Affairs, Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Paul N Pfeiffer
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott E Sherman
- Department of Veterans Affairs, VA New York Harbor Healthcare System, New York, New York, USA.,Department of Population Health, NYU School of Medicine, New York University, New York, USA
| | - Kipling M Bohnert
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Zivin
- Department of Veterans Affairs, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul George Barnett
- Department of Veterans Affairs, Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
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Regan S, Reyen M, Richards AE, Lockhart AC, Liebman AK, Rigotti NA. Nicotine replacement therapy use at home after use during a hospitalization. Nicotine Tob Res 2011; 14:885-9. [PMID: 22121242 DOI: 10.1093/ntr/ntr244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION We assessed whether providing inpatient smokers with nicotine replacement therapy (NRT) to relieve withdrawal symptoms while hospitalized was associated with self-initiated NRT use soon after hospital discharge. METHODS We conducted an observational study of 1,895 cigarette smokers admitted to a large hospital over 24 months (July 2007 through June 2009) and seen by a tobacco counselor during hospitalization. Participants were surveyed at 2 weeks after discharge to assess postdischarge NRT use. We calculated adjusted rate ratios (ARRs) for the effect of NRT use in the hospital on the rate of NRT use after discharge, adjusting for gender, age, hospital service, intention to quit, baseline smoking level, length of stay, and counseling duration. RESULTS 62 percent (1,166/1,895) of enrolled participants received NRT during hospitalization. The survey response rate was 72%. 42 percent (544/1,293) of survey respondents reported initiating postdischarge NRT use within 2 weeks of discharge. NRT use after discharge was more likely to be reported by those who used it in hospital whether they had ever used it prior to hospitalization (ARR: 5.64, 95% CI: 3.95-8.05) or had never used it before (ARR: 4.68, 95% CI: 3.25-6.73). CONCLUSIONS Smokers who received NRT during a hospitalization were more likely to use it after discharge compared with those who did not use NRT in hospital. By encouraging use of this effective cessation aid, supplementing counseling with NRT for hospitalized smokers may promote smoking cessation efforts after discharge.
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Affiliation(s)
- Susan Regan
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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Hughes JR, Peters EN, Naud S. Effectiveness of over-the-counter nicotine replacement therapy: a qualitative review of nonrandomized trials. Nicotine Tob Res 2011; 13:512-22. [PMID: 21471303 DOI: 10.1093/ntr/ntr055] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM Randomized trials conducted in over-the-counter (OTC) settings have shown that nicotine replacement therapy (NRT) is effective. This paper reviews nonrandomized tests of the effectiveness of OTC NRT. METHODS Literature search via computer and other methods located (a) retrospective cohort studies of users versus nonusers of OTC NRT and (b) studies of quit rates before versus after NRT went OTC or before versus after NRT was given free to quitline callers. The methods were too heterogeneous to allow meta-analysis. RESULTS The results were similar for cohort and pre- versus post-studies. Most of the studies found numerically greater quitting among NRT users than nonusers. Often when NRT was not found effective, other assumed effective treatments (e.g., phone counseling) were also not found effective, suggesting biased or insensitive study methods. Only about half of the studies found statistically greater quitting among NRT users, and the most rigorous studies did not find greater quitting among users. Many studies found selection bias, for example, NRT users are more dependent smokers. CONCLUSIONS Some lines of evidence appear to confirm the effectiveness of OTC NRT, but others do not. We believe further secondary analyses using nonrandomized comparisons are unlikely to resolve this issue due to sensitivity, specificity, and selection bias problems.
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Affiliation(s)
- John R Hughes
- Department of Psychiatry, University of Vermont, UHC Campus, 1 South Prospect Street, Burlington, VT 05401, USA.
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Hughes JR, Marcy TW, Naud S. Interest in treatments to stop smoking. J Subst Abuse Treat 2009; 36:18-24. [PMID: 18550319 PMCID: PMC2635950 DOI: 10.1016/j.jsat.2008.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 04/01/2008] [Accepted: 04/11/2008] [Indexed: 10/22/2022]
Abstract
We surveyed 884 Vermont (VT) tobacco smokers by random digit dialing to determine past and future use of treatment. Among those who had recently attempted to quit, 61% had ever used a treatment, 21% had ever used a psychosocial treatment, and 57% had used a medication. Among those who planned to quit in the next month, 68% stated they would use a treatment, 35% would use a psychosocial treatment, and 62% would use a medication. The major predictors of past or future use of treatment were greater cigarettes per day, older age, being a woman, and seeing a health professional. Although this survey suggests many smokers have used or plan to use a smoking cessation treatment, program data indicate less than 10% of VT smokers who try to quit use the state quitline, counseling, or free medication provision. Why smokers do not use these treatments needs to be determined.
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Affiliation(s)
- John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
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Alberg AJ, Patnaik JL, May JW, Hoffman SC, Gitchell J, Comstock GW, Helzlsouer KJ. Nicotine Replacement Therapy Use Among a Cohort of Smokers. J Addict Dis 2008; 24:101-13. [PMID: 15774414 DOI: 10.1300/j069v24n01_09] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) has been shown to assist smokers to stop smoking in randomized trials, but little is known about its use in the general population. METHODS As part of ongoing follow-up of a cohort established in 1989 in Washington County, Maryland, a questionnaire mailed in 1998 included a question about ever use of the two NRT products then available over-the-counter: nicotine gum and nicotine patch. This study reports on ever use of NRT among the 1,954 respondents who were current smokers in 1989 and subsequently provided data on NRT use and smoking habits in 1998. RESULTS Overall, 36% of the smokers in 1989 had ever used NRT in some form by 1998; 10% used gum only, 16% used patch only, and 10% used both gum and patch. Number of cigarettes smoked per day at baseline was the strongest predictor of ever use of NRT (ptrend < 0.001). Compared to nonusers, ever users of NRT were more likely to have more than 12 years of education (p < 0.01) and be 25-54 years old at baseline (p < 0.001). When NRT use was assessed in relation to smoking status in 1998, 30% of NRT ever users compared to 39% of nonusers had quit smoking (p < 0.01). Among persistent smokers, the likelihood of reducing the number of cigarettes smoked per day was similar between NRT ever users (40%) and nonusers (41%). CONCLUSIONS Ever use of NRT was common among this cohort of smokers, particularly among heavy smokers. Compared to nonusers, ever users of NRT were less likely to have stopped smoking and equally likely to cut down the frequency of smoking. This may reflect a tendency to turn to NRT for help after failing to quit by other means.
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Affiliation(s)
- Anthony J Alberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Hammond D, Reid JL, Driezen P, Cummings KM, Borland R, Fong GT, McNeill A. Smokers' use of nicotine replacement therapy for reasons other than stopping smoking: findings from the ITC Four Country Survey. Addiction 2008; 103:1696-703. [PMID: 18821877 PMCID: PMC4605436 DOI: 10.1111/j.1360-0443.2008.02320.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To measure the prevalence and correlates of nicotine replacement therapy (NRT) use for reasons other than quitting smoking among smokers in four countries. DESIGN AND SETTING Population-based, cross-sectional telephone survey with nationally representative samples of adult smokers in Canada, the United States, the United Kingdom and Australia, conducted in 2005. PARTICIPANTS A total of 6532 adult daily smokers in Canada (n = 1660), the United States (n = 1664), the United Kingdom (n = 1617) and Australia (n = 1591). MEASUREMENTS Survey questions included demographics, smoking behaviour, use of NRT and reasons for NRT use, as well as access and availability of NRT. FINDINGS Approximately 17% of smokers surveyed had used NRT in the past year. Among NRT users, approximately one-third used NRT for a reason other than quitting smoking, including temporary abstinence or reducing the number of cigarettes smoked. The prevalence of non-standard NRT use was remarkably consistent across countries. Using NRT for reasons other than quitting was associated with higher education level, heavier smoking, having no quit intentions, having no past-year quit attempts, the type of NRT product used and accessing NRT without a prescription. CONCLUSIONS The use of NRT for purposes other than quitting smoking is fairly common and may help to explain the difficulty in detecting significant quitting benefits associated with NRT use in population studies. Tobacco control policies, including the accessibility of NRT, may have important implications for patterns of NRT use.
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Affiliation(s)
- David Hammond
- Department of Health Studies & Gerontology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Jessica L. Reid
- Department of Health Studies & Gerontology, University of Waterloo, Waterloo, Ontario, Canada
| | - Pete Driezen
- Population Health Research Group, University of Waterloo, Waterloo, Ontario, Canada
| | - K. Michael Cummings
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | | | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Ann McNeill
- School of Community Health Sciences, University of Nottingham, Nottingham, UK
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Piper ME, Federman EB, McCarthy DE, Bolt DM, Smith SS, Fiore MC, Baker TB. Efficacy of bupropion alone and in combination with nicotine gum. Nicotine Tob Res 2008; 9:947-54. [PMID: 17763111 PMCID: PMC3030120 DOI: 10.1080/14622200701540820] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this double-blind, placebo-controlled smoking cessation treatment study, 608 participants were randomly assigned to receive active bupropion and active 4-mg gum (AA, n = 228), active bupropion and placebo gum (AP, n = 224), or placebo bupropion and placebo gum (PP, n = 156). Relative to the PP group, the AA and AP groups were each significantly more likely to be abstinent at 1 week, end of treatment, and 6 months but not at 12 months postquit. After the first week postquit there were no differences in abstinence rates between the AA and AP groups. We found no significant individual difference variables that moderated outcome beyond 1 week postquit.
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Affiliation(s)
- Megan E Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI 53711, USA.
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Burns ME, Rosenberg MA, Fiore MC. Use and employer costs of a pharmacotherapy smoking-cessation treatment benefit. Am J Prev Med 2007; 32:139-42. [PMID: 17196785 DOI: 10.1016/j.amepre.2006.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 09/08/2006] [Accepted: 10/02/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Employers cite a lack of information on the cost of insurance coverage for smoking-cessation treatment as a barrier to its provision. This study describes the use of a new insurance benefit for smoking-cessation pharmacotherapy, and its pharmaceutical costs to a large public employer between 2001 and 2003. METHODS Annual enrollment and pharmaceutical claims data were collected from the health plans that contracted with the Wisconsin Department of Employee Trust Funds (ETF). State employees, retirees, and adult dependents who obtained health insurance through the ETF constituted our sample, approximately 150,000/year. Pharmacotherapy benefit use was defined as a paid claim for one of four U.S. Food and Drug Administration-approved smoking-cessation medications. Pharmaceutical cost was defined as the ingredient cost (+) dispensing fee (-) member copayment. Analyses included estimation of the proportion of smokers who used the benefit each year and across 3 years, the average annual cost per user, and the per member per month (PMPM) pharmaceutical cost to the employer. Data were collected from 2001 to 2004 and analyzed in 2005-2006. RESULTS Annual benefit use among smokers ranged from 6% to 7% with a 3-year rate of approximately 17%. The PMPM cost of the covered pharmacotherapy was approximately 0.13 dollars. CONCLUSIONS The cost to employers of providing insurance coverage for smoking-cessation pharmacotherapy to their employees is low. By informing insurance purchasing decisions, these results may facilitate the adoption of such coverage, with the goal of ultimately reducing the proportion of employees who smoke.
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Affiliation(s)
- Marguerite E Burns
- University of Wisconsin School of Medicine and Public Health, Department of Population Health Sciences, Madison, Wisconsin 53726, USA.
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Rasch A, Greiner W. Effekte einer Erstattung der Kosten für Raucherentwöhnungsmaßnahmen durch die Krankenversicherung. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2006. [DOI: 10.1007/s11553-006-0033-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The authors review developments in understanding smoking cessation interventions over the past decade. Noteworthy is the unprecedented growth of research and knowledge that has left a deeper understanding of how best to use new and existing behavioral and pharmacologic tools and strategies to help smokers quit. The status of public-health-level interventions is evaluated, questions are raised concerning their efficacy, and suggestions are offered for further refinement of these intervention strategies. Development of cessation guidelines is reviewed, and the state of knowledge concerning behavioral and pharmacologic interventions is summarized. The authors also present agendas for behavioral and pharmacologic research related to smoking cessation and discuss individual difference factors among smokers that may prove to be important in designing new and refining existing treatments.
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Affiliation(s)
- Raymond Niaura
- Centers for Behavioral and Preventive Medicine, Brown Medical School, the Miriam Hospital, Providence, Rhode Island 02903, USA.
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