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NICOTINE GUM HELPS SOME (BUT ONLY SOME) SMOKERS QUIT.

Interventions aimed at helping patients stop smoking have had mixed results at best, and a series of articles in the current issue of JAMA demonstrates that heterogeneity within the smoking population may explain why.

Killen and colleagues at the Stanford Stop Smoking Project compared clinical and psychological correlates of heavy smoking in a population of 380 smokers, and found that heavy smokers (more than 24 cigarettes per day) had more signs of physical dependence than light smokers. These same investigators also report on a randomized trial in which nicotine gum was associated with higher tobacco-abstinence rates at six months than was placebo.

Overall success at smoking cessation, even with nicotine gum, however, is not common. Wilson and colleagues describe a trial in which physicians were randomly assigned to treat their patients with different types of antismoking interventions. Patients who received nicotine gum plus counseling had a three-month abstinence rate of 8.8 percent, while patients who received usual care had a rate of 4.4 percent -- statistically significant, but not impressive.

These results and others in the same issue lead Henningfield to call on physicians to recognize physical dependence in individual patients and target interventions, such as nicotine gum, appropriately.

— THL

Published in Journal Watch General Medicine September 23, 1988

Citation(s):

Henningfield J E. Improving the diagnosis and treatment of nicotine dependence. JAMA 1988 Sep 16 260 1613-1614.

• Medline abstract (Free)

Wilson D M; Taylor W; Gilbert J R et al. A randomized trial of a family physician intervention for smoking cessation. JAMA 1988 Sep 16 260 1570-1574.

• Medline abstract (Free)

Fortmann S P; Killen J D; Telch M J; Newman B. Minimal contact treatment for smoking cessation: a placebo controlled trial of nicotine polacrilex and self- directed relapse prevention: initial results of the Stanford Stop Smoking Project. JAMA 1988 Sep 16 260 1575-1580.

• Medline abstract (Free)

Killen J D; Fortmann S P; Telch M J; Newman B. Are heavy smokers different from light smokers? A comparison after 48 hours without cigarettes. JAMA 1988 Sep 16 260 1581-1585.

• Medline abstract (Free)