PREDICTING SMOKING CESSATION - WHO WILL QUIT WITH AND WITHOUT THE NICOTINE PATCH
PREDICTING SMOKING CESSATION - WHO WILL QUIT WITH AND WITHOUT THE NICOTINE PATCH
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DOI：
10.1001/jama.271.8.589
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发表时间：
1994-02-23
影响因子：
120.7
通讯作者：
BAKER, TB
中科院分区：
文献类型：
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作者：
KENFORD, SL;FIORE, MC;BAKER, TB
客观。-确定使用和不使用尼古丁透皮贴剂治疗的戒烟成功或失败的预测因素。设计。-两项独立的随机、双盲、安慰剂对照研究，使用尼古丁贴片评估治疗结束时和6个月随访时的结局;每项研究使用不同的辅助咨询模式。病人。-受试者是每日吸烟者（每天大于或等于15支香烟），年龄在21至65岁之间，呼气一氧化碳水平至少为10 ppm，并有戒烟动机。88名受试者参加了研究1，112名受试者参加了研究2。干预。-研究1包括8周的22 mg尼古丁贴片治疗和强化团体咨询。研究2包括4周的22 mg尼古丁贴片治疗和2周的11 mg尼古丁贴片治疗，并进行简短的个体咨询。主要结果测量。基于使用活性尼古丁贴片或安慰剂尼古丁贴片的吸烟者的治疗前和治疗内测量结果，预测戒烟（治疗结束时和6个月后）。结果。-治疗前标志物，如Fagerstrom耐受性问卷评分、每天吸烟数量、吸烟年数、呼气一氧化碳水平或基线血液尼古丁和可替宁水平，在两项研究中均未显示与成功戒烟的一致关系。在检查的治疗内标记物中，戒断严重程度和尼古丁替代水平也不能始终预测戒烟成功。然而，在治疗的第二周内吸烟是治疗结束时和6个月后失败的一致和有力的预测因素。在戒烟后第2周内吸烟的活性尼古丁贴片患者中，83%和97%（分别为研究1和2）在6个月随访时吸烟。相反，在治疗的第二周戒烟预测成功戒烟。在戒烟后第2周内完全戒烟的活性尼古丁贴片患者中，46%和41%（研究1和2分别）在6个月随访时戒烟。在两项研究中，在6个月随访时吸烟的所有尼古丁贴片患者中，74%在第1或2周开始吸烟。在6个月随访时吸烟的所有安慰剂贴剂患者中，86%在第1周或第2周开始吸烟。结论。尼古丁贴片治疗前2周（尤其是第2周）的吸烟状态（戒烟或吸烟）与临床结局高度相关，可作为戒烟的有力预测因素。早期吸烟行为也可以预测安慰剂贴剂使用者的结局。传统的依赖性测量方法并不能始终如一地预测戒烟成功。建议临床医生强调戒烟尝试后完全戒烟的重要性，并在戒烟后的前2周内对患者进行随访;应评估这一关键时期的吸烟情况，并酌情改变治疗。
Objective.-To identify predictors of smoking cessation success or failure with and without transdermal nicotine patch treatment. Design.-Two independent randomized, double-blind, placebo-controlled studies using the nicotine patch assessing outcome at the end of treatment and at 6-month follow-up; each study used a different mode of adjuvant counseling. Patients.-Subjects were daily smokers (greater than or equal to 15 cigarettes per day), aged 21 to 65 years with expired air carbon monoxide levels of at least 10 ppm, and motivated to quit. Eighty-eight subjects participated in study 1, and 112 subjects participated in study 2. Intervention.-Study 1 consisted of 8 weeks of 22-mg nicotine patch therapy with intensive group counseling. Study 2 consisted of 4 weeks 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 months) based on pretreatment and intratreatment measures in smokers using active or placebo nicotine patches. Results.-Pretreatment markers, such as the Fagerstrom Tolerance Questionnaire score, number of cigarettes smoked per day, years smoked, expired air carbon monoxide level, or baseline blood nicotine and cotinine levels, showed no consistent relationship with successful smoking cessation across both studies. Of the intratreatment markers examined, withdrawal severity and nicotine replacement levels also were not consistently predictive of cessation success. However, any smoking during the second week of treatment was a consistent and powerful predictor of failure at the end of treatment and after 6 months. Among active nicotine patch patients who smoked at all during week 2 after quitting, 83% and 97% (studies 1 and 2, respectively) were smoking at 6-month follow-up. Conversely, abstinence during the second week of treatment predicted successful smoking cessation. Among active nicotine patch patients who were totally abstinent during week 2 after quitting, 46% and 41% (studies 1 and 2, respectively) were 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. Conclusions.-Smoking status (abstinent or smoking) during the first 2 weeks of nicotine patch therapy, particularly week 2, was highly correlated with clinical outcome and can serve as a powerful predictor of smoking cessation. Early smoking behavior also predicted outcome among placebo patch users. Traditional measures of dependence are not consistently predictive of cessation success. Clinicians are advised to emphasize the importance of total abstinence after a quit attempt and to follow-up with patients within the first 2 weeks of quitting; smoking during this critical time should be assessed and treatment may be altered as appropriate.