Wednesday, September 6, 2017

Do Smokers Quit After Hospital Cessation Trials? Don’t Count on It, or Them

Do smokers lie about quitting?  A new study analyzes smokers’ self-reports of their smoking habits six months after their participation in quit-smoking clinical trials.

Several years ago, researchers recruited sick smokers at a group of hospitals – the Consortium of Hospitals Advancing Research on Tobacco, or CHART – and conducted federally-supported smoking cessation trials.  Now Taneisha Scheuermann et al. in the journal Addiction (abstract here) examine the post-trial results, focusing on levels of cotinine, a nicotine breakdown product, in trial participants’ saliva.

Hospitals in six cities provided 5,827 smoking patients with a variety of quit-smoking interventions.  Six months later, 4,206 of those subjects completed a survey, with 1,708 reporting that they had not smoked in the past seven days.  Nearly 10% of them reported using pharmaceutical nicotine, e-cigarettes or other tobacco harm reduction products in the past seven days; those subjects were among the 530 excluded from the Scheuermann analysis.  Self-described non-smokers were offered $50 to $100 in exchange for saliva samples, but only 923 participants responded; of those, 822 supplied usable samples.

Scheuermann used a standard saliva cotinine cutoff of 10 nanograms per milliliter: participants below this level were considered to be not smoking, while those at or above were still smoking.

Of the 822 participants who reported 7-day abstinence, 347 (42.2%) were dissembling, as their saliva cotinine levels indicated they were smoking. 

That so many individuals failed to quit evidences a fact that tobacco prohibitionists often ignore: The vast majority of smokers are unable or unwilling to quit.  The 475 verified quitters constituted roughly 8% of the 5,827 patients who started the trials – a percentage that is consistent with the quit rate among the general population.  Also note that these smokers were recruited during a hospitalization, when their focus on health issues might have increased their motivation to quit.

Treating smokers as social outcasts may influence their decision to lie about the results of their quit attempts.

The CHART study was supported from 2009 to 2014 by five NIH grants costing taxpayers $15.5 million.     


Anonymous said...

Maybe NRT just doesn't work.

Nicotine Substitution Does Not Reduce Intensity of Withdrawal Symptoms in Hospitalised Smokers: Presented at ERS

“VIENNA, Austria — September 22, 2009 — Offering nicotine substitution to smokers hospitalised for elective surgery does not have a significant effect on reducing cravings or other nicotine withdrawal symptoms, according to a phase 3 study presented here at the 19th Annual Congress of the European Respiratory Society (ERS).

In addition, no further differences were seen in rates of smoking cessation 1 to 6 months following the study.

“Hospitals have been smoke free by law since 2006 in Belgium, so we saw in-hospital smoking cessation as a teachable moment for patients,” explained Kris Nackaerts, MD, University Hospitals Leuven, Leuven, Belgium, on September 16.”

Have they even got the right plant chemical?


Chris Lalonde said...

Lokk on the bright side: they spent $15,500,000 to help 475 smokers quit. That's a scant $32,600 each!

Unknown said...

You mention a very important issue: a (perhaps unintended) consequence of the stigmatization of smokers is that the latter tend to downplay how much (or how frequently) they smoke in all sorts of studies, specially those based on questionnaires. A good example is the study "An Epidemiological Study of Population Health Reveals Social Smoking as a Major Cardiovascular Risk Factor" []. The authors report higher risks (OR) in hypertension and cholesterol in "social" (occasional) smokers than in frequent (current) smokers, which would imply a strange lack of dose-effect reaction.

However, when you go though the paper, you find (in the "Limitations" section) the authors admitting that their classification of "social" and "current" smokers was based on self reported, and thus is not reliable, which introducing a potentially damaging classification bias. Such bias can easily demolish their results. Nevertheless, the article (and the press release) states that "social smoking" is a "Major Cardiovascular Risk Factor", when it is more likely that the "social smokers" played down how much they really smoke in the questionnaires because of the stigma (participants were recruited from participants in health surveys, which means a biased sample with high representation of smokers who are aware of the health risks of smoking). As long as "de-normalization" of smoking is in full swing, smokers will continue to lie about their smoking habits. This is bad for public health research.