Extended treatment of older cigarette smokers
Extended treatment of older cigarette smokers
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DOI：
10.1111/j.1360-0443.2009.02548.x
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发表时间：
2009-06-01
期刊：
影响因子：
6
通讯作者：
Prochaska, Judith J.
中科院分区：
文献类型：
--
作者：
Hall, Sharon M.;Humfleet, Gary L.;Prochaska, Judith J.
烟草依赖治疗在1年内实现了25-30%的戒烟率。低发病率可能反映了未能将烟草依赖概念化为一种慢性疾病。本研究的目的是确定在>= 50岁的吸烟者中扩展的认知行为和药物干预的功效，并确定功效是否存在性别差异。参与者完成了为期12周的治疗，包括团体咨询，尼古丁替代疗法（NRT）和安非他酮。参与者，独立于吸烟状态，然后随机分配到后续条件：（i）标准治疗（ST;无进一步治疗）;（ii）延长NRT（E-NRT; 40周尼古丁口香糖可用性）;（iii）扩展认知行为治疗（E-CBT; 40周内11次认知行为会话）;或（iv）E-CBT + E-NRT（E-合并; 11个认知行为阶段加40周尼古丁口香糖的可用性）。主要结果变量是在第24、52、64和104。最具临床意义的发现是治疗条件、时间和治疗x时间相互作用的显著主效应。E-CBT条件产生了在整个2年研究期间保持的高戒烟率[第24周（58%），第52周（55%），第64周（55%）和第104周（55%）]，并且在此期间比E-NRT和ST显著更有效。没有其他治疗条件与ST有显著差异。没有发现性别的影响。扩展的认知行为治疗可以为男性和女性产生高而稳定的戒烟率。NRT不会增加扩展CBT的疗效，并可能妨碍其疗效。需要研究来确定这些结果是否可以在更大年龄范围的样本中复制，并通过添加NRT以外的药物来改善。
Tobacco dependence treatments achieve abstinence rates of 25-30% at 1 year. Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder. The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers >= 50 years of age, and to determine if gender differences in efficacy existed.Open randomized clinical trial.A free-standing, smoking treatment research clinic.A total of 402 smokers of >= 10 cigarettes per day, all 50 years of age or older.Participants completed a 12-week treatment that included group counseling, nicotine replacement therapy (NRT) and bupropion. Participants, independent of smoking status, were then assigned randomly to follow-up conditions: (i) standard treatment (ST; no further treatment); (ii) extended NRT (E-NRT; 40 weeks of nicotine gum availability); (iii) extended cognitive behavioral therapy (E-CBT; 11 cognitive behavioral sessions over a 40-week period); or (iv) E-CBT plus E-NRT (E-combined; 11 cognitive behavioral sessions plus 40 weeks nicotine gum availability).Primary outcome variable was 7-day point prevalence cigarette abstinence verified biochemically at weeks 24, 52, 64 and 104.The most clinically important findings were significant main effects for treatment condition, time and the treatment x time interaction. The E-CBT condition produced high cigarette abstinence rates that were maintained throughout the 2-year study period [(week 24 (58%), 52 (55%), 64 (55%) and 104 (55%)], and was significantly more effective than E-NRT and ST across that period. No other treatment condition was significantly different to ST. No effects for gender were found.Extended cognitive behavioral treatments can produce high and stable cigarette abstinence rates for both men and women. NRT does not add to the efficacy of extended CBT, and may hamper its efficacy. Research is needed to determine if these results can be replicated in a sample with a greater range of ages, and improved upon with the addition of medications other than NRT.