Randomized trial of the effectiveness of combined behavioral/pharmacological smoking cessation treatment in Syrian primary care clinics

Authors

  • Kenneth D. Ward,

    Corresponding author
    1. Syrian Center for Tobacco Studies, Aleppo, Syria
    • Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
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  • Taghrid Asfar,

    1. Syrian Center for Tobacco Studies, Aleppo, Syria
    2. Department of Epidemiology & Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
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  • Radwan Al Ali,

    1. Syrian Center for Tobacco Studies, Aleppo, Syria
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  • Samer Rastam,

    1. Syrian Center for Tobacco Studies, Aleppo, Syria
    2. University of Aleppo School of Medicine, Aleppo, Syria
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  • Mark W. Vander Weg,

    1. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
    2. Department of Psychology, University of Iowa, Iowa City, IA, USA
    3. The Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
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  • Thomas Eissenberg,

    1. Syrian Center for Tobacco Studies, Aleppo, Syria
    2. Institute for Drug and Alcohol Studies, and Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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  • Wasim Maziak

    1. Syrian Center for Tobacco Studies, Aleppo, Syria
    2. Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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Correspondence: Kenneth D. Ward, School of Public Health, University of Memphis, Memphis, TN 38152, USA.

E-mail: kdward@memphis.edu

Abstract

Aims

Effectiveness of nicotine replacement therapy (NRT) for smoking cessation has not been evaluated in low income countries, such as Syria, where it is expensive and not widely available. We evaluated whether nicotine patch boosts smoking cessation rates when used in conjunction with behavioral support in primary care clinics in Aleppo, Syria.

Design

Two arm, parallel group, randomized, placebo controlled, double-blinded multi-site trial.

Setting

Four primary care clinics in Aleppo, Syria.

Participants

 Two hundred and sixty-nine adult primary care patients received behavioral cessation counseling from a trained primary care physician and were randomized to receive six weeks of treatment with nicotine versus placebo patch.

Measurements

Primary end-points were prolonged abstinence (no smoking after a 2-week grace period) at end of treatment, and 6 and 12 months post-quit day, assessed by self-report and exhaled carbon monoxide levels of <10 p.p.m.

Findings

Treatment adherence was excellent and nicotine patch produced expected reductions in urges to smoke and withdrawal symptoms, but no treatment effect was observed. The proportion of patients in the nicotine and placebo groups with prolonged abstinence was 21.6% and 20.0%, respectively, at end of treatment, 13.4% and 14.1% at 6 months, and 12.7% and 11.9% at 12 months.

Conclusions

 Nicotine patches may not be effective in helping smokers in low-income countries to stop when given as an adjunct to behavioural support.

Ancillary