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Analyzing milestones in smoking cessation: illustration in a nicotine patch trial in adult smokers.

Shiffman S, Scharf DM, Shadel WG, Gwaltney CJ, Dang Q, Paton SM, Clark DB

Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15213, USA. shiffman@pitt.edu

Tests of addiction treatments seldom reveal where treatment exercises its effect (i.e., promoting initial abstinence, preventing lapses, and/or impeding progression from lapse to relapse). The authors illustrate analyses distinguishing effects on these milestones in a randomized trial of high-dose nicotine patch (35 mg; n = 188) versus placebo (n = 136) in adult smokers, who used electronic diaries to monitor smoking in real time during 5 weeks of treatment. High-dose patch promoted initial abstinence (hazard ratio [HR] = 1.3) and decreased the risk of lapsing among those who achieved abstinence (HR = 1.6). The biggest effect of treatment was to prevent progression to relapse among those who had lapsed (HR = 7.1). Analysis of effects by milestones may enhance understanding of cessation treatments and their mechanisms of action.

Published 2 May 2006 in J Consult Clin Psychol, 74(2): 276-85.
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