使用尼古丁口香糖帮助非习惯性吸烟者戒烟：一项随机临床试验。
Using Nicotine Gum to Assist Nondaily Smokers in Quitting: A Randomized Clinical Trial.
机构信息
Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Nicotine Tob Res. 2020 Mar 16;22(3):390-397. doi: 10.1093/ntr/ntz090.
INTRODUCTION
Non-daily intermittent smokers (ITS) comprise 30% of US adult smokers. ITS smoke for nicotine and have trouble quitting, but tend to smoke in particular situations. This study tested the effect of nicotine gum, used to prevent or react to situational temptations, for helping ITS quit.
METHODS
ITS (smoking 4-27 days/month) seeking help quitting were randomized to 2 mg nicotine gum (n = 181) or placebo (n = 188), to be used to anticipate or react to temptations to smoke, for 8 weeks. Participants received up to six sessions of behavioral counseling. The primary outcome was 6-month biochemically verified continuous abstinence; analyses also examined 14-day point-prevalence abstinence at multiple time points, and used event-history analyses to assess progression to abstinence, lapsing, and relapsing. Analyses adjusted for group differences in age and baseline smoking, and considered several potential moderators of treatment effects.
RESULTS
Nicotine gum did not significantly improve outcomes on any measure. Biochemically verified 6-month continuous abstinence rates were 7.2% for active gum and 5.3% for placebo (AOR = 1.39, 0.58-3.29, p > .25). ITS with any degree of dependence (Fagerstrom Test of Nicotine Dependence scores >0) showed poorer outcomes on multiple endpoints, and did more poorly on active gum on some outcomes. Gum use was low, starting at 1 gum per day on average and declining over time.
CONCLUSIONS
Nicotine gum (2 mg), used intermittently, did not improve cessation rates among ITS, including those demonstrating some degree of dependence.
IMPLICATIONS
Nicotine replacement has been extensively tested with daily smokers, especially those who smoke relatively heavily. Nondaily smoking is now common, creating a need for treatment for ITS. Despite evidence that ITS' smoking is motivated by nicotine-seeking, a theoretically and empirically derived situational approach to using acute nicotine replacement was not successful at helping ITS quit. Gum use was low; whether higher or more frequent dosing is needed, or whether an entirely different approach is needed, is not clear. Effective treatment options are needed for ITS, especially those with some degree of dependence.
简介
非每日间断吸烟者（ITS）占美国成年吸烟者的 30%。ITS 为了获取尼古丁而吸烟，并且难以戒烟，但往往在特定情况下吸烟。本研究测试了尼古丁口香糖的效果，尼古丁口香糖用于预防或应对情境诱惑，以帮助 ITS 戒烟。
方法
寻求帮助戒烟的 ITS（每月吸烟 4-27 天）被随机分为 2 毫克尼古丁口香糖（n=181）或安慰剂（n=188），用于预测或应对吸烟的诱惑，为期 8 周。参与者接受了最多六次行为咨询。主要结果是 6 个月的生物化学验证连续戒烟；分析还检查了多个时间点的 14 天点流行戒烟率，并使用事件历史分析评估戒烟进展、复发和复发。分析调整了组间在年龄和基线吸烟方面的差异，并考虑了治疗效果的几个潜在调节因素。
结果
尼古丁口香糖在任何测量指标上都没有显著改善结果。生物化学验证的 6 个月连续戒烟率分别为活性口香糖组的 7.2%和安慰剂组的 5.3%（AOR=1.39，0.58-3.29，p>.25）。任何程度依赖（尼古丁依赖测试评分>0）的 ITS 在多个终点上表现出较差的结果，并且在一些结果上表现出对活性口香糖的较差结果。口香糖的使用量较低，平均每天使用 1 片，并且随着时间的推移逐渐减少。
结论
间歇性使用 2 毫克尼古丁口香糖并未提高 ITS 的戒烟率，包括那些表现出一定程度依赖的患者。
意义
尼古丁替代物已广泛用于每日吸烟者的治疗，特别是那些吸烟相对较多的人群。非每日吸烟现在很常见，这就需要为 ITS 提供治疗方法。尽管有证据表明 ITS 的吸烟是为了获取尼古丁，但使用急性尼古丁替代物的理论和经验衍生的情境方法并没有成功帮助 ITS 戒烟。口香糖的使用量较低；是否需要更高或更频繁的剂量，或者是否需要完全不同的方法，尚不清楚。需要为 ITS 提供有效的治疗选择，特别是那些有一定程度依赖的患者。
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