Effect of cost on the self-administration and efficacy of nicotine gum: A preliminary study

doi:10.1016/0091-7435(91)90046-7

Preventive Medicine

Volume 20, Issue 4, July 1991, Pages 486-496

https://doi.org/10.1016/0091-7435(91)90046-7 Get rights and content

Abstract

Methods. One hundred six smokers seen in a family practice received brief physician advice and a prescription for nicotine gum. Smokers were randomly assigned to pay $20, $6, or $0/box of nicotine gum and followed for 6 months.

Results. Decreased cost increased the incidence of obtaining gum, the amount of gum used, and the incidence of long-term use (P < 0.05). Decreased cost also increased cessation attempts and 1-week cessation (P < 0.05) and appeared to increase abstinence at 6-month follow-up (19% vs 6% vs 8%, P < 0.10). Cost-benefit estimates suggest that an insurance plan, HMO, etc., would recoup any costs in subsidizing nicotine gum and perhaps incur a net financial gain.

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Le tabagisme est un enjeu majeur de santé publique ; un fumeur sur deux qui poursuit sa consommation de tabac toute sa vie décédera d’une maladie en lien avec cet usage. En France, il est chaque année responsable de plus de 70 000 décès. Le bénéfice de l’arrêt du tabac se manifeste par une diminution de la mortalité ou de la morbidité induites par sa consommation. Les données récentes relèvent une augmentation de la prévalence du tabagisme dans les catégories socioéconomiques les plus défavorisées. L’amélioration de la lutte contre le tabagisme passe par une meilleure compréhension des déterminants du tabagisme au sein de ces populations. Ils sont aussi facteurs d’échecs du sevrage lors de la tentative d’arrêt. Cette revue générale précise les différents facteurs socioéconomiques et éducationnels impliqués dans la consommation de tabac ou le résultat de la tentative d’arrêt, en se basant sur les données de la littérature internationale. Son objectif est de proposer des voies d’optimisation de la prise en charge de l’aide à l’arrêt du tabagisme des publics socialement défavorisés.
Smoking is a major of public health policy issue; one in two lifelong smokers will die from a disease related to tobacco use. In France, smoking is responsible for more than 70,000 deaths every year. The benefits linked to stopping smoking include reduced mortality and morbidity related to the use of tobacco. Recent data show an increase in the prevalence of smoking in the lowest socioeconomic population. Tobacco control needs a better understanding of the determinants of smoking in this population, which are also factors in the failure of cessation attempts. Based on international literature, this review specifies the educational and socioeconomic factors involved in tobacco smoking and in the result of an attempt to quit. Its aim is to propose ways to improve the management of smoking cessation in a socially deprived population.
Behavioral cessation treatment of waterpipe smoking: The first pilot randomized controlled trial
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Withdrawal symptomatology was assessed using the Minnesota Nicotine Withdrawal Scale (MNWS) (Cappelleri et al., 2005). We calculated the mean of eight scale items to obtain a total withdrawal score: anxiety, depression/feeling blue, difficulty concentrating, hunger, increased appetite, insomnia, irritability/frustration/anger, and restlessness (Hughes & Hatsukami, 1986; Hughes, Wadland, Fenwick, Lewis, & Bickel, 1991). Depressive symptomatology was assessed with the Center for Epidemiologic Studies Depression Scale (Hughes & Hatsukami, 1998; Radloff, 1977; Thomas, Jones, Scarinci, Mehan, & Brantley, 2001).
Waterpipe use has increased dramatically in the Middle East and other parts of the world. Many users exhibit signs of dependence, including withdrawal and difficulty quitting, but there is no evidence base to guide cessation efforts.
We developed a behavioral cessation program for willing-to-quit waterpipe users, and evaluated its feasibility and efficacy in a pilot, two arm, parallel group, randomized, open label trial in Aleppo, Syria. Fifty adults who smoked waterpipe ≥ 3 times per week in the last year, did not smoke cigarettes, and were interested in quitting were randomized to receive either brief (1 in-person session and 3 phone calls) or intensive (3 in-person sessions and 5 phone calls) behavioral cessation treatment delivered by a trained physician in a clinical setting. The primary efficacy end point of the developed interventions was prolonged abstinence at three months post-quit day, assessed by self-report and exhaled carbon monoxide levels of < 10 ppm. Secondary end points were 7 day point-prevalent abstinence and adherence to treatment.
Thirty percent of participants were fully adherent to treatment, which did not vary by treatment group. The proportions of participants in the brief and intensive interventions with prolonged abstinence at the 3-month assessment were 30.4% and 44.4%, respectively. Previous success in quitting (OR = 3.57; 95% CI = 1.03–12.43) predicted cessation. Higher baseline readiness to quit, more confidence in quitting, and being unemployed predicted a better adherence to treatment (all p-values < 0.05).
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In clinical trials, up to 30% of patients use NRT products beyond the recommended 3-month period (Hajek, Jackson, & Belcher, 1988; Shiffman, Hughes, Di Marino, & Sweeney, 2003b; Hughes et al., 1991a; Steinberg, Foulds, Richardson, Burke, & Shah, 2006; Johnson, Hollis, Stevens, & Woodson, 1991; Hatsukami, Huber, Callies, & Skoog, 1993; Hughes, 1989). However, participants in clinical trials usually receive the gum for free, and having to pay for it decreases utilization (Hughes, Wadland, Fenwick, Lewis, & Bickel, 1991b). Taking a substance over a longer time than intended is a criterion for drug dependence (American Psychiatric Association, 1994), but long-term use does not necessarily imply dependence, because dependence requires other criteria, in particular unsuccessful attempts to quit and withdrawal symptoms upon cessation.
We conducted an Internet survey in 2004–2007 in 526 daily users of the nicotine gum, to assess use of, and dependence on the nicotine gum in former smokers. We used modified versions of the Nicotine Dependence Syndrome Scale (NDSS-G), the Cigarette Dependence Scale (CDS-G) and the Fagerström Test (FTND-G). After 30 days, 155 participants (29%) indicated their gum use. Higher dependence on the gum predicted a lower chance of stopping using it at follow-up (odds ratio = 0.36 for each standard deviation unit on CDS-G, p = 0.001). More long-term (> 3 months) than short-term (< = 3 months) users of the gum agreed with: “I use the nicotine gum because I am addicted to it” (83% vs. 7%, p < .001), and fewer long-term users reported that they used the gum to avoid relapsing to smoking (42% vs. 92%, p < .001). Long-term users had higher ratings of dependence on the gum than short-term users, as assessed with NDSS-Gum, CDS-Gum and FTND-Gum (all p < .001). Most long-term users reported symptoms of dependence on the nicotine gum. Lower levels of dependence on the gum predicted cessation of gum use. However, long term use of the nicotine gum has no known serious adverse consequence, and may be beneficial if it prevents late relapse.
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^☆: This research was supported by a grant (DA-04066) and Research Scientist Development Award (DA-00109) from the National Institute on Drug Abuse. Merrell-Dow Research Institute provided nicotine gum.

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ArticleEffect of cost on the self-administration and efficacy of nicotine gum: A preliminary study☆

Abstract

Soc Sci Med

J Health Econ

J Subst Abuse

Lancet

Meta-analysis of randomized controlled trials of nicotine chewing gum

Lancet

Paying for outpatient prescription drugs and related services in third-party programs

Med Care Rev

Nicotine gum: Does providing it free in a smoking cessation program alter success rates?

Effect of nicotine chewing gum as an adjunct to general practitioners' advice against smoking

Br Med J

Article
Effect of cost on the self-administration and efficacy of nicotine gum: A preliminary study☆