Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel; Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. Chan School of Public Health, Boston, MA, USA.
Department of Statistics and Operations Research, The Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Ramat-Aviv, Israel.
Prev Med. 2021 Sep;150:106567. doi: 10.1016/j.ypmed.2021.106567. Epub 2021 May 3.
Smoking cessation medications (SCMs) are an evidence-based cornerstone of comprehensive tobacco control programs globally. However, the impact of SCMs on population smoking prevalence is controversial, with inconsistencies between randomized controlled trials (RCTs) and population-based observational studies. We estimated SCM impact on permanent cessation and population smoking prevalence by extrapolating efficacy estimates from meta-analyses of RCTs, using the standard population impact formula: efficacy*reach. We calculated the potential SCM impact under a range of assumptions for permanent cessation (20%,14%), behavioral support (yes/no), reach (40%-2%), and underlying smoking prevalence. Assuming behavioral support for all, depending on reach, 8%-0.3% of smokers are expected to quit permanently. Without behavioral support, permanent cessation is estimated to be 6.4%-0.2%. Assuming an underlying population smoking prevalence of 14%, (current U.S. prevalence), the maximum impact on population smoking prevalence is 1.12%. Impact on prevalence increases with increasing underlying country-specific levels of prevalence. With current U.S. levels of reach, behavioral support and smoking prevalence, we estimate that, based on a single course of treatment, 2.3% of smokers would quit permanently, contributing to a 0.3% decrease in population level smoking prevalence. Even under ideal conditions, the potential of current first-line SCMs to increase cessation in a substantial proportion of smokers, and reduce population smoking prevalence, is limited. In order to avert the predicted billion tobacco-caused deaths in this century, "safe and effective" medications are not sufficient: SCMs with high population impact are urgently needed. Policies to ensure the availability and accessibility of highly efficacious SCMs, with behavioral support, are crucial.
戒烟药物 (SCMs) 是全球综合烟草控制计划的循证基石。然而，SCMs 对人群吸烟率的影响存在争议，随机对照试验 (RCTs) 和基于人群的观察性研究之间存在不一致。我们通过从 RCTs 的荟萃分析中推断疗效估计值，使用标准人群影响公式：疗效覆盖范围，来估计 SCM 对永久性戒烟和人群吸烟率的影响：efficacyreach。我们计算了在一系列假设下的 SCM 潜在影响，包括永久性戒烟（20%，14%）、行为支持（是/否）、覆盖范围（40%-2%）和基础吸烟率。假设所有吸烟者都接受行为支持，根据覆盖范围的不同，预计有 8%-0.3%的吸烟者会永久性戒烟。如果没有行为支持，预计永久性戒烟的比例为 6.4%-0.2%。假设基础人群吸烟率为 14%（目前美国的流行率），对人群吸烟率的最大影响为 1.12%。随着基础国家特定流行率的增加，对流行率的影响也会增加。在美国目前的覆盖范围、行为支持和吸烟流行率下，我们估计，根据单一疗程的治疗，2.3%的吸烟者将永久性戒烟，这将使人群吸烟流行率降低 0.3%。即使在理想的情况下，目前一线 SCM 增加大部分吸烟者戒烟率并降低人群吸烟率的潜力也是有限的。为了避免本世纪预计有 10 亿人死于烟草，“安全有效”的药物是不够的：迫切需要具有高人群影响力的 SCM。确保提供和获取具有行为支持的高效 SCM 的政策至关重要。
