Levine Michele D, Perkins Kenneth A, Kalarchian Melissa A, Cheng Yu, Houck Patricia R, Slane Jennifer D, Marcus Marsha D
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
Arch Intern Med. 2010 Mar 22;170(6):543-50. doi: 10.1001/archinternmed.2010.33.
We previously documented that cognitive behavioral therapy for smoking-related weight concerns (CONCERNS) improves cessation rates. However, the efficacy of combining CONCERNS with cessation medication is unknown. We sought to determine if the combination of CONCERNS and bupropion therapy would enhance abstinence for weight-concerned women smokers.
In a randomized, double-blind, placebo-controlled trial, weight-concerned women (n = 349; 86% white) received smoking cessation counseling and were randomized to 1 of 2 adjunctive counseling components: CONCERNS or STANDARD (standard cessation treatment with added discussion of smoking topics but no specific weight focus), and 1 of 2 medication conditions: bupropion hydrochloride sustained release (B) or placebo (P) for 6 months. Rates and duration of biochemically verified prolonged abstinence were the primary outcomes. Point-prevalent abstinence, postcessation weight gain, and changes in nicotine withdrawal, depressive symptoms, and weight concerns were evaluated.
Women in the CONCERNS + B group had higher rates of abstinence (34.0%) and longer time to relapse than did those in the STANDARD + B (21%; P = .05) or CONCERNS + P (11.5%; P = .005) groups at 6 months, although rates of prolonged abstinence in the CONCERNS + B and STANDARD + B groups did not differ significantly at 12 months. Abstinence rates and duration did not differ in the STANDARD + B group (21% and 19%) compared with the STANDARD + P group (10% and 7%) at 6 and 12 months, respectively. There were no differences among abstinent women in postcessation weight gain or weight concerns, although STANDARD + B produced greater decreases in nicotine withdrawal and depressive symptoms than did STANDARD + P.
Weight-concerned women smokers receiving the combination of CONCERNS + B were most likely to sustain abstinence. This effect was not related to differences in postcessation weight gain or changes in weight concerns. Trial Registration clinicaltrials.gov Identifier: NCT00006170.
我们之前记录了针对与吸烟相关的体重问题的认知行为疗法（CONCERNS）可提高戒烟率。然而，将CONCERNS与戒烟药物联合使用的疗效尚不清楚。我们试图确定CONCERNS与安非他酮疗法联合使用是否会提高关注体重的女性吸烟者的戒烟率。
在一项随机、双盲、安慰剂对照试验中，关注体重的女性（n = 349；86%为白人）接受了戒烟咨询，并被随机分为2种辅助咨询成分中的1种：CONCERNS或标准组（标准戒烟治疗，增加吸烟话题讨论但无特定体重关注），以及2种药物治疗条件中的1种：盐酸安非他酮缓释片（B）或安慰剂（P），为期6个月。生化验证的长期戒烟率和持续时间是主要结局。评估了点流行率戒烟、戒烟后体重增加以及尼古丁戒断、抑郁症状和体重问题的变化。
在6个月时，CONCERNS + B组的女性戒烟率更高（34.0%），复发时间比标准组 + B（21%；P = 0.05）或CONCERNS + P组（11.5%；P = 0.005）更长，尽管CONCERNS + B组和标准组 + B组在12个月时的长期戒烟率没有显著差异。标准组 + B组在6个月和12个月时的戒烟率和持续时间分别为21%和19%，与标准组 + P组（10%和7%）相比无差异。在戒烟女性中，戒烟后体重增加或体重问题没有差异，尽管标准组 + B组在尼古丁戒断和抑郁症状方面的下降幅度比标准组 + P组更大。
接受CONCERNS + B联合治疗的关注体重的女性吸烟者最有可能维持戒烟。这种效果与戒烟后体重增加的差异或体重问题的变化无关。试验注册clinicaltrials.gov标识符：NCT00006170。
