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Comparative Study
. 2013 Jan;108(1):193-202.
doi: 10.1111/j.1360-0443.2012.04009.x. Epub 2012 Aug 14.

Effectiveness of stop-smoking medications: findings from the International Tobacco Control (ITC) Four Country Survey

Karin A Kasza  1 , Andrew J Hyland, Ron Borland, Ann D McNeill, Maansi Bansal-Travers, Brian V Fix, David Hammond, Geoffrey T Fong, K Michael Cummings
Affiliations
Comparative Study

Effectiveness of stop-smoking medications: findings from the International Tobacco Control (ITC) Four Country Survey

Karin A Kasza et al. Addiction. 2013 Jan.

Abstract

Aim: To evaluate the population effectiveness of stop-smoking medications while accounting for potential recall bias by controlling for quit attempt recency.

Design: Prospective cohort survey.

Setting: United Kingdom, Canada, Australia and the United States.

Participants: A total of 7436 adult smokers (18+ years) selected via random digit dialling and interviewed as part of the International Tobacco Control Four Country Survey (ITC-4) between 2002 and 2009. Primary analyses utilized the subset of respondents who participated in 2006 or later (n = 2550).

Measurements: Continuous abstinence from smoking for 1 month/6 months.

Findings: Among participants who recalled making a quit attempt within 1 month of interview, those who reported using varenicline, bupropion or nicotine patch were more likely to maintain 6-month continuous abstinence from smoking compared to those who attempted to quit without medication [adjusted odds ratio (OR) 5.84, 95% confidence interval (CI) (2.12-16.12), 3.94 (0.87-17.80), 4.09 (1.72-9.74), respectively]; there were no clear effects for oral NRT use. Those who did not use any medication when attempting to quit tended to be younger, to be racial/ethnic minorities, to have lower incomes and to believe that medications do not make quitting easier.

Conclusions: Consistent with evidence from randomized controlled trials, smokers in the United Kingdom, Canada, Australia and the United States are more likely to succeed in quit attempts if they use varenicline, bupropion or nicotine patch. Previous population studies that failed to find an effect failed to control adequately for important sources of bias.

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Conflict of interest statement

Declaration of interest: K. Michael Cummings has served as a paid consultant on smoking cessation to Pfizer and Novartis, has received payment from Pfizer and GlaxoSmithKline for lectures on smoking cessation to health professionals, and has served as a paid expert witness in litigation against the tobacco industry. All other authors declare no conflicts of interest.

Major funders of the ITC Four Country Survey: US National Cancer Institute (P50 CA111326, P01 CA138389, R01 CA100362, R01 CA125116), Canadian Institutes of Health Research (57897, 79551, and 115016), National Health and Medical Research Council of Australia (265903, 450110, and 1005922), Cancer Research UK (C312/A3726, C312/A6465, and C312/A11039), Robert Wood Johnson Foundation (045734), and Canadian Tobacco Control Research Initiative (014578), with additional support from the Propel Centre for Population Health Impact, the Ontario Institute for Cancer Research, and the Canadian Cancer Society Research Institute. None of the sponsors played any direct role in the design or conduct of the study; the collection, management, analysis or interpretation of the data; in the preparation of the manuscript, or in the decision to submit the manuscript for publication.

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