Public health focus: effectiveness of smoking-control strategies - United States

Article Abstract:

Physicians should give each of their smoking patients information on how to quit, and should reinforce the program by setting target dates, referring the patient to a community program, and prescribing nicotine gum or patches to help the patient quit. Ninety percent of successful quitters used a self-help program to do so, and most quit cold turkey. Self-help kits are more cost-effective than smoking cessation programs. The National Cancer Institute and the American Cancer Society are both funding community-based smoking-cessation programs. Women, blacks and individuals with little education are less likely to quit, and these groups should be targeted. It is also important to reduce the number of individuals who take up smoking, usually when they are teenagers. This could be done by increasing taxes on cigarettes, restricting cigarette advertising, and enforcing laws that prohibit the sale of cigarettes to minors.

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Treatment of nicotine dependence: is more better?

Article Abstract:

Two 1995 studies provide conflicting evidence of the effectiveness of high-dose nicotine patches in smoking cessation programs. One study found that most smokers do not get enough nicotine from the standard 22-milligram (mg) patch and may do better on a higher dose. The other study found no differences in quit rates between smokers who used a 22-mg patch and those who used a 44-mg patch. Even so, smokers who cannot quit on 22-mg patches should be offered a higher dose because quitting is the most important outcome. One of the studies also varied the supportive materials and counseling the smokers received and found that intensive counseling had no greater effect than a simple pamphlet. This is important because it means that over-the-counter treatment could be fairly effective. However, smokers who have psychiatric disorders or other forms of drug abuse should be offered group counseling.

Editorial, Transdermal medication, Transdermal drug delivery systems, Dosage and administration

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Recent Advances in the Pharmacotherapy of Smoking

Article Abstract:

Physicians should prescribe nicotine replacement substances for all smokers who want to quit. Nicotine gum and patches are now available without a prescription. Nicotine can also be delivered as a nasal spray or through an inhaler. The antidepressant drug bupropion hydrochloride is also effective as a smoking cessation agent. All of these therapies lead to a doubling of the quit rate compared with a placebo. Behavioral counseling can also be offered. Treatments should be individualized based on patient preference.

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