This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (212)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Who Will Quit With and Without the Nicotine Patch

Susan L. Kenford; Michael C. Fiore, MD, MPH; Douglas E. Jorenby, PhD; Stevens S. Smith, PhD; David Wetter, MS; Timothy B. Baker, PhD

JAMA. 1994;271(8):589-594.

Abstract
Objective.
—To identify predictors of smoking cessation success or failure with and without transdermal nicotine patch treatment.

Design.
—Two independent randomized, double-blind, placebo-controlled studies using the nicotine patch assessing outcome at the end of treatment and at 6-month follow-up; each study used a different mode of adjuvant counseling.

Patients.
—Subjects were daily smokers (15 cigarettes per day), aged 21 to 65 years with expired air carbon monoxide levels of at least 10 ppm, and motivated to quit. Eighty-eight subjects participated in study 1, and 112 subjects participated in study 2.

Intervention.
—Study 1 consisted of 8 weeks of 22-mg nicotine patch therapy with intensive group counseling. Study 2 consisted of 4 weeks of 22-mg nicotine patch therapy and 2 weeks of 11-mg nicotine patch therapy with brief individual counseling.

Main Outcome Measures.
—The prediction of smoking cessation (at end of treatment and after 6 months) based on pretreatment and intratreatment measures in smokers using active or placebo nicotine patches.

Results.
—Pretreatment markers, such as the Fagerstrom Tolerance Questionnaire score, number of cigarettes smoked per day, years smoked, expired air carbon monoxide level, or baseline blood nicotine and cotinine levels, showed no consistent relationship with successful smoking cessation across both studies. Of the intratreatment markers examined, withdrawal severity and nicotine replacement levels also were not consistently predictive of cessation success. However, any smoking during the second week of treatment was a consistent and powerful predictor of failure at the end of treatment and after 6 months. Among active nicotine patch patients who smoked at all during week 2 after quitting, 83% and 97% (studies 1 and 2, respectively) were smoking at 6-month follow-up. Conversely, abstinence during the second week of treatment predicted successful smoking cessation. Among active nicotine patch patients who were totally abstinent during week 2 after quitting, 46% and 41% (studies 1 and 2, respectively) were abstinent at 6-month follow-up. Of all nicotine patch patients in both studies who were smoking at 6-month follow-up, 74% began smoking during week 1 or 2. Among all placebo patch patients who were smoking at 6-month follow-up, 86% began smoking during week 1 or 2.

Conclusions.
—Smoking status (abstinent or smoking) during the first 2 weeks of nicotine patch therapy, particularly week 2, was highly correlated with clinical outcome and can serve as a powerful predictor of smoking cessation. Early smoking behavior also predicted outcome among placebo patch users. Traditional measures of dependence are not consistently predictive of cessation success. Clinicians are advised to emphasize the importance of total abstinence after a quit attempt and to follow-up with patients within the first 2 weeks of quitting; smoking during this critical time should be assessed and treatment may be altered as appropriate.

(JAMA. 1994;271:589-594)

Author Affiliations
From the Center for Tobacco Research and Intervention (Ms Kenford, Drs Fiore, Jorenby, Smith, and Baker, and Mr Wetter) and the Section of General Internal Medicine, Department of Medicine (Drs Fiore and Jorenby), University of Wisconsin Medical School, and the University of Wisconsin Comprehensive Cancer Center (Drs Fiore, Jorenby, and Baker), Madison; and Department of Psychology, University of Wisconsin, Madison (Ms Kenford, Drs Smith and Baker, and Mr Wetter). Drs Fiore, Jorenby, Smith, and Baker, Ms Kenford, and Mr Wetter have conducted research funded in part by CIBA-GEIGY Corp, Edison, NJ; Elan Pharmaceuticals Ltd, Athlone, Ireland; and Lederle Laboratories, Wayne, NJ. Dr Fiore has also received honoraria for educational activities from CIBA-GEIGY Corp, Lederle Laboratories, Marion Merrell Dow Inc, Kansas City, Mo, and Parke-Davis, Morris Plains, NJ.

Footnotes
Reprint requests to Center for Tobacco Research and Intervention, University of Wisconsin Medical School, 7275 Medical Sciences Center, 1300 University Ave, Madison, WI 53706-1532 (Dr Fiore).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The role of nicotine replacement therapy in early quitting success
Amodei and Lamb
Nicotine Tob Res 2009;0:ntp164v1-ntp164.
ABSTRACT | FULL TEXT  

A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies
Piper et al.
Arch Gen Psychiatry 2009;66:1253-1262.
ABSTRACT | FULL TEXT  

Treating Tobacco Dependence in a Medical Setting
Hurt et al.
CA Cancer J Clin 2009;59:314-326.
ABSTRACT | FULL TEXT  

The Wisconsin Predicting Patients' Relapse questionnaire
Bolt et al.
Nicotine Tob Res 2009;11:481-492.
ABSTRACT | FULL TEXT  

Extending Contingency Management to the Treatment of Methamphetamine Use Disorders
Higgins
Am. J. Psychiatry 2006;163:1870-1872.
FULL TEXT  

Pharmacotherapy for Nicotine Dependence
Henningfield et al.
CA Cancer J Clin 2005;55:281-299.
ABSTRACT | FULL TEXT  

Pharmacotherapy and Pharmacogenetics of Nicotine Dependence
Berrettini and Lerman
Am. J. Psychiatry 2005;162:1441-1451.
ABSTRACT | FULL TEXT  

Smoking Cessation Strategy Use Among Pregnant Ex-Smokers
Scheibmeir et al.
West J Nurs Res 2005;27:411-427.
ABSTRACT  

Treating Tobacco Dependence: State of the Science and New Directions
Lerman et al.
JCO 2005;23:311-323.
ABSTRACT | FULL TEXT  

Effectiveness of Implementing the Agency for Healthcare Research and Quality Smoking Cessation Clinical Practice Guideline: A Randomized, Controlled Trial
Katz et al.
JNCI J Natl Cancer Inst 2004;96:594-603.
ABSTRACT | FULL TEXT  

Individualizing Nicotine Replacement Therapy for the Treatment of Tobacco Dependence: A Randomized Trial
Lerman et al.
ANN INTERN MED 2004;140:426-433.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Pharmacological Interventions for Smoking Cessation: a Literature Review and a Decision Analytic Analysis
Song et al.
Med Decis Making 2002;22:S26-S37.
ABSTRACT  

Sociodemographic predictors of success in smoking intervention
Monso et al.
Tobacco Control 2001;10:165-169.
ABSTRACT | FULL TEXT  

Bupropion for Smoking Cessation : Predictors of Successful Outcome
Dale et al.
Chest 2001;119:1357-1364.
ABSTRACT | FULL TEXT  

A Clinical Practice Guideline for Treating Tobacco Use and Dependence: A US Public Health Service Report
The Tobacco Use and Dependence Clinical Practice G
JAMA 2000;283:3244-3254.
ABSTRACT | FULL TEXT  

Cigarette consumption and sales of nicotine replacement products
Hu et al.
Tobacco Control 2000;9 :ii60-ii63.
ABSTRACT | FULL TEXT  

Nicotine Patch Therapy in 101 Adolescent Smokers: Efficacy, Withdrawal Symptom Relief, and Carbon Monoxide and Plasma Cotinine Levels
Hurt et al.
Arch Pediatr Adolesc Med 2000;154:31-37.
ABSTRACT | FULL TEXT  

Opening the window of opportunity: encouraging patients to stop smoking
RICHMOND
Heart 1999;81:456-458.
FULL TEXT  

Randomized Trial of Acupuncture for Nicotine Withdrawal Symptoms
White et al.
Arch Intern Med 1998;158:2251-2255.
ABSTRACT | FULL TEXT  

Transdermal Nicotine Therapy and Primary Care: Importance of Counseling, Demographic, and Participant Selection Factors on 1-Year Quit Rates
Daughton et al.
Arch Fam Med 1998;7:425-430.
ABSTRACT | FULL TEXT  

Usage patterns of transdermal nicotine when purchased as a non-prescription medicine from pharmacies
Shaw et al.
Tobacco Control 1998;7:161-167.
ABSTRACT | FULL TEXT  

The Nicotine Inhaler in Smoking Cessation
Hjalmarson et al.
Arch Intern Med 1997;157:1721-1728.
ABSTRACT  

Childhood Poisoning Involving Transdermal Nicotine Patches
Woolf et al.
Pediatrics 1997;99:e4-e4.
ABSTRACT | FULL TEXT  

Smoking Behavior on the First Day of a Quit Attempt Predicts Long-term Abstinence
Westman et al.
Arch Intern Med 1997;157:335-340.
ABSTRACT  

The Safety of Transdermal Nicotine as an Aid to Smoking Cessation in Patients with Cardiac Disease
Joseph et al.
NEJM 1996;335:1792-1798.
ABSTRACT | FULL TEXT  

Cost-effectiveness of the Transdermal Nicotine Patch as an Adjunct to Physicians' Smoking Cessation Counseling
Fiscella and Franks
JAMA 1996;275:1247-1251.
ABSTRACT  

The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline
Smoking Cessation Clinical Practice Guideline Pane et al.
JAMA 1996;275:1270-1280.
ABSTRACT  

Nicotine Medications for Smoking Cessation
Henningfield
NEJM 1995;333:1196-1203.
FULL TEXT  

An Analysis of the Effectiveness of Interventions Intended to Help People Stop Smoking
Law and Tang
Arch Intern Med 1995;155:1933-1941.
ABSTRACT  

Effectiveness of the 4-mg Dose of Nicotine Polacrilex for the Initial Treatment of High-Dependent Smokers
Sachs
Arch Intern Med 1995;155:1973-1980.
ABSTRACT  

Recent Advances: Cardiology - I: Treatment of myocardial infarction, unstable angina, and angina pectoris
McMurray and Rankin
BMJ 1994;309:1343-1350.
FULL TEXT  

Prospective study of factors predicting outcome of transdermal nicotine treatment in smoking cessation
Gourlay et al.
BMJ 1994;309:842-846.
ABSTRACT | FULL TEXT  

WHICH PATIENTS WITH NICOTINE PATCHES WILL QUIT SMOKING?
JWatch General 1994;1994:6-6.
FULL TEXT  

The Paradox of Tobacco Control
Satcher and Eriksen
JAMA 1994;271:627-628.
ABSTRACT  

Smoking and Young Women: The Physician's Role in Stopping an Equal Opportunity Killer
Kaufman
JAMA 1994;271:629-630.
ABSTRACT