Proactive tobacco cessation: you can lead a smoker to water, but ¦

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No Cigs for You!A new study published in the current JAMA Internal Medicine investigates whether a proactive approach to providing smokers with counseling, information and evidence-based treatments, improves the likelihood of quitting, and if so, by how much as compared to usual care.

The authors are a multi-center group, led by Drs. Steven Fu and Michelle van Ryn from the Minneapolis VA System and the Mayo Clinic, respectively. They and their colleagues at NYU and the Tampa VA Hospital recruited about 5,000 smokers, who were randomly divided into usual care and proactive care groups. The latter were outreached contacted by the clinical staff, and offered a choice of various smoking cessation services, each evidence-based, according to the article. The outreach component included mailed solicitations, followed by telephone contact, the goal of which was to motivate smokers to seek treatment from among the choice menu. Usual care depended on the study subjects requesting advice from their primary care physician on smoking cessation, or the physician advising the patient without being asked. The proactive group was offered the choice of phone-delivered cessation services or in-person communication. The medications utilized were the evidence-based FDA-approved therapies.

Among the of the original group who responded to the final follow-up survey (n=3400), the success rate defined as any 6-month period during the one-year follow-up being tobacco-abstinent was 13.5 percent in the proactive group, while the usual-care group s successful abstinence rate was a mere 10.9 percent. This was deemed more effective than usual care, since the 2.6 percent differential was statistically significant.

ACSH s Dr. Gil Ross was not highly impressed by this improvement: Under these circumstances, even those success rates are much greater than might be expected absent the clinical study environment. But they are not inconsistent with other figures for FDA-approved treatments, as smokers using one or a combination of these products have been shown to stay cigarette-free for one year at a less-than-one-in-ten rate. Be that as it may, expect the tobacco-control community to jump with joy over this tiny improvement in thoroughly unacceptable cessation rates and at what expense, I wonder. All that outreach cannot have been cheap, to get such a paltry benefit. It s just too bad that reduced-harm cessation methods, such as snus or electronic cigarettes, were not tested as well.