BMJ 1994;309:842-846 (1 October)

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Prospective study of factors predicting outcome of transdermal nicotine treatment in smoking cessation

S G Gourlay, A Forbes, T Marriner, D Pethica, J J McNeil 

Department of Social and Preventive Medicine, Monash University, Melbourne, Australia 3168 Ciba-Geigy New Zealand, Auckland, New Zealand Correspondence to: Dr S G Gourlay, Department of Social and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran, Australia 3181.

Abstract

Objective : To assess the factors associated with cessation of smoking with transdermal nicotine and brief behavioural counselling.
Design : Interviews, treatment, and follow up for 26 weeks.
Subjects : 1481 subjects recruited by mass media publicity who smoked >=15 cigarettes a day and were motivated to stop smoking. Interventions - Twelve weeks' treatment with transdermal nicotine and brief behavioural counselling at monthly visits.
Main outcome measure : Sustained smoking cessation for the 28 days before the visit at week 26 verified by expired carbon monoxide concentrations. The logistic regression analysis included all subjects.
Results : Most subjects were dependent on nicotine, and the mean (SD) number of cigarettes smoked a day was 32 (12). Overall, 316/1481 subjects (21.3%) stopped smoking. Factors associated with stopping were being male (adjusted odds ratio 2.0; 95% confidence interval 1.5 to 2.7), age >=40 years (1.5; 1.1 to 2.0), living with a spouse or partner (1.5; 1.1 to 2.1), motivation ("want to quit" 1.7; 1.2 to 2.3), and concern about weight gain (1.7; 1.3 to 2.2). Negative associations were smoking marijuana (0.4; 0.2 to 0.8) and the presence of other smokers in the household (0.8; 0.6 to 0.9). Almost all subjects who smoked three or more cigarettes in the first four weeks of treatment resumed smoking in the long term (525/547, 96%).
Conclusions : Age, sex, marital status (living with a spouse or partner), motivation, concern about weight gain, recent marijuana smoking, and other smokers in the household were baseline factors associated with differences in outcome of smoking cessation attempts. Smoking three or more cigarettes in the first few weeks after stopping strongly predicted long term relapse.

Clinical implications

  • Clinical implications

  • Transdermal nicotine treatment is now commonly used to help patients give up smoking

  • Success rates are twice as high in treated subjects than in those with placebo, but predictors of outcome are not yet established

  • Treated subjects are unlikely to give up if they smoke three or more cigarettes in the first four weeks after starting treatment

  • Factors associated with higher success rates were being male, age over 40, being married or living with a partner, high motivation, and concern about weight gain

  • Recent marijuana smoking was strongly associated with lower success rates

  • Intervention for modifiable negative factors might improve a smoker's chance of success


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