Moderators of Real-World Effectiveness of Smoking Cessation Aids: A Population Study

Summary of Study

Bottom Line: Smoking cessation was significantly improved among smokers who used e-cigarettes (with a particularly strong association in men) or varenicline, older smokers who used prescription nicotine replacement therapy (NRT), and smokers from lower social grades who used websites. The odds of cessation was significantly lower among users of NRT bought over the counter. There was no significant association between use of any other cessation aid and abstinence.

This is the first evidence from a population sample of the comparative real‐world effectiveness of all of the main smoking cessation aids. Use of e-cigarettes, varenicline, or prescription NRT was found to increase the chances of successful quitting, but there was limited evidence that other cessation aids independently promoted abstinence in adjusted models.

Understanding whether and how far cigarette addiction and socioeconomic status, and other sociodemographic characteristics like age and sex, moderate the effectiveness of smoking cessation aids in the real world would have important implications. It could help treatment providers to tailor recommendations on cessation aids to those most likely to help the user achieve abstinence.

The study population comprised 18,929 respondents who reported a quit attempt in the last 12 months, of whom 15,949 (84.3%) were current smokers and 2,980 (15.7%) were abstinent at the time of the survey.  A total of 10,581 respondents (55.9%) had used one or more of the smoking cessation aids during their most recent quit attempt.

The majority had used NRT bought over the counter (27.5%), followed by e-cigarettes (12.7%), prescription NRT (8.5%), varenicline (5.5%) and face-to-face behavioral support (4.6%). The remainder of cessation aids had been used by <2% of participants. Most participants who reported using a cessation aid reported using just one aid in their most recent quit attempt.

Self-reported abstinence rates were highest among users of e-cigarettes (21.2%), followed by varenicline (20.4%) and websites (18.6%). Analyses that adjusted for use of other cessation aids, but no covariates indicated that users of e-cigarettes and varenicline were significantly more likely to be abstinent than those who did not use these cessation aids.

Users of NRT bought over the counter were significantly less likely to be abstinent, as were younger smokers who used prescription NRT and those from lower social grades who used telephone support. Use of bupropion, face-to-face behavioral support, written self-help materials, websites, and hypnotherapy were not significantly associated with abstinence after adjustment for use of other cessation aids.

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