Evaluating the Effectiveness of a Smoking Cessation Program
Smoking is a major public health problem that causes various diseases and premature deaths. According to the World Health Organization (WHO), more than 8 million people die each year from tobacco use, and most of them are in low- and middle-income countries [1]. Therefore, it is important to develop and implement effective smoking cessation programs that can help smokers quit and prevent relapse.
One of the smoking cessation programs that has been widely used is the nicotine replacement therapy (NRT), which provides smokers with a low dose of nicotine through patches, gums, lozenges, inhalers, or sprays. NRT aims to reduce the withdrawal symptoms and cravings that smokers experience when they stop smoking, and to facilitate the transition to a smoke-free life [2]. However, NRT alone is not sufficient to achieve long-term abstinence, and it needs to be combined with other interventions, such as behavioral counseling, self-help materials, or pharmacological agents [3].
A recent meta-analysis of 133 randomized controlled trials (RCTs) evaluated the effectiveness of different smoking cessation interventions, including NRT, in terms of abstinence rates at six months or longer [4]. The results showed that NRT increased the odds of quitting by 50% compared to placebo or no intervention, and that the effect was similar across different types of NRT products. Moreover, the combination of NRT and behavioral counseling was more effective than NRT alone, with an odds ratio of 1.82. The authors concluded that NRT is an effective and safe smoking cessation intervention that should be offered to all smokers who want to quit, along with other supportive measures.
However, some limitations of this meta-analysis should be noted. First, the quality of the included RCTs varied widely, and some of them had high risk of bias due to inadequate randomization, allocation concealment, blinding, or attrition. Second, the definition and measurement of abstinence were not consistent across the studies, and some of them used self-reported outcomes without biochemical verification. Third, the duration and intensity of the behavioral counseling were not standardized, and some studies did not report the details of the intervention. Fourth, the heterogeneity among the studies was high, and some subgroups of smokers (such as pregnant women, adolescents, or dual users) were underrepresented or excluded. Therefore, more rigorous and comprehensive RCTs are needed to confirm the effectiveness of NRT and other smoking cessation interventions in different populations and settings.
References
[1] World Health Organization. Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco. Accessed January 15, 2024.
[2] Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016;3:CD008286.
[3] Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;5:CD009329.
[4] Hartmann-Boyce J, Chepkin SC, Ye W et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev. 2018;5:CD000146.
