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A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation
  1. Hillel R Alpert1,
  2. Gregory N Connolly1,
  3. Lois Biener2
  1. 1Center for Global Tobacco Control, Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  2. 2Center for Survey Research, University of Massachusetts, Boston, Massachusetts, USA
  1. Correspondence to Hillel R Alpert, Center for Global Tobacco Control, Harvard School of Public Health, 401 Park Drive, Landmark Building, Floor 3E, Boston, MA 02215, USA; halpert{at}


Objective To examine the population effectiveness of nicotine replacement therapies (NRTs), either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions.

Methods A prospective cohort study was conducted in three waves on a probability sample of 787 Massachusetts adult smokers who had recently quit smoking. The baseline response rate was 46%; follow-up was completed with 56% of the designated cohort at wave 2 and 68% at wave 3. The relationship between relapse to smoking at follow-up interviews and assistance used, including NRT with or without professional help, was examined.

Results About one-fourth of recent quitters at each wave reported to have relapsed by the subsequent interview. Odds of relapse were unaffected by use of NRT for >6 weeks either with (p=0.117) or without (p=0.159) professional counselling and were highest among prior heavily dependent persons who reported NRT use for any length of time without professional counselling (OR 2.68).

Conclusions This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts. Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programmes and policies.

  • Smoking cessation
  • nicotine replacement therapy
  • cohort studies
  • public policy
  • smoking-caused disease
  • fire safety
  • prevalence
  • taxation and price
  • environmental tobacco smoke
  • harm reduction
  • advertising and promotion
  • advocacy
  • anti-tobacco media campaigns
  • cessation

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  • Funding This work was supported by a grant from the National Cancer Institute, State and Community Tobacco Control Interventions Research Grant Program (grant number 2R01 CA86257-05). The sponsor had no role in the study design; collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the paper for publication.

  • Correction notice This article has been corrected since it was published Online First. The Results section of the Abstract now begins: About one-fourth of recent quitters.The first paragraph of Results now reads: Of these, 480 (61.0%) completed the second wave interview. One-fourth (25.2%) of these reported to have relapsed to smoking by the second wave interview. A total of 364 adults who completed the second wave interview reported having recently quit smoking. Three-fourths (78.2%) of those who completed the second wave interview also completed the third wave interview (n = 285), and 27.4% of these reported having relapsed to smoking by the third wave interview. In Table 2, the items under ‘Race’ now read Non-Caucasian and Caucasian, respectively.

  • Competing interests None.

  • Ethics approval University of Massachusetts, Boston.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are not available for public sharing.