Behavioral counseling and varenicline treatment for smoking cessation

Abstract

Background: Smoking remains the primary preventable cause of death and illness in the U.S. Effective, convenient treatment programs are needed to reduce smoking prevalence.

Purpose: This study compared the effectiveness of three modalities of a behavioral smoking-cessation program in smokers using varenicline.

Methods: Current treatment-seeking smokers (n=1202) were recruited from a large healthcare organization between October 2006 and October 2007. Eligible participants were randomized to one of three smoking-cessation interventions: web-based counseling (n=401); proactive telephone-based counseling (PTC; n=402); or combined PTC and web counseling (n=399). All participants received a standard 12-week FDA-approved course of varenicline. Self-report determined the primary outcomes (7-day point prevalent abstinence at 3- and 6-month follow-ups); the number of days varenicline was taken; and treatment-related symptoms. Behavioral measures determined utilization of both the web- and Phone-based counseling.

Results: Intent-to-treat analyses revealed relatively high percentages of abstinence at 3 months (38.9%, 48.5%, 43.4%) and at 6 months (30.7%, 34.3%, 33.8%) for the web, PTC, and PTC-web groups, respectively. The PTC group had a significantly higher percentage of abstinence than the web group at 3 months (OR=1.48, 95% CI=1.12, 1.96), but no between-group differences in abstinence outcomes were seen at 6 months.

Conclusions: Phone counseling had greater treatment advantage for early cessation and appeared to increase medication adherence, but the absence of differences at 6 months suggests that any of the interventions hold promise when used in conjunction with varenicline.

Figure 1

Timeline of study activities PTC, proactive telephone-based counseling

Figure 2

Participant disposition Note: After treatment assignment, some participants did not participate in the behavioral interventions. A few who had participated did not set a target date to quit smoking, one of the required steps to initiate the varenicline prescription. * Not attempted: Because the timing for interviews was based on the target quit date, no attempt was made to contact participants at 3 months if they had not set a quit date (n=33). Other participants were not attempted for interviews if they had requested no further participation (n=16 at 3 months, n=48 at 6 months) or had passed away (n=1 at each time point). PTC, proactive telephone-based counseling