Smoking Cessation Pharmacotherapy, Even Without Counseling, Remains a Cornerstone of Treatment

Abstract

In this issue of the Journal, Leas and colleagues report results from a prospective observational study of smokers making a quit attempt that concludes, “…the simple provision of pharmaceutical aids to smokers does not appear to be an effective way to increase the proportion who successfully quit for the long term” (1). Despite the rigorous methodological aspects of this study, we believe this conclusion is overstated for three main reasons: the conflicting body of evidence from large effectiveness randomized controlled trials (RCTs), which do not suffer from confounding; residual confounding, particularly by smoker type; and recall bias tending to under capture failed quit attempts that did not involve pharmacotherapy. While this study could bring useful attention to the benefits of counseling, it would be harmful if it discouraged cessation medication use when counseling was unavailable. The investigators analyzed data from the nationally representative Tobacco Use Supplement to the Current Population Study (CPS-TUS) overlap sample featuring two surveys administered to the same individuals one year apart (2002–2003 and 2010–2011). Respondents who were smoking every day or some days at the time of the first survey, and who indicated at follow-up that they had made a quit attempt during the past 12 months, were asked about use of any US Food and Drug Administration (FDA)–approved smoking cessation medications to support the quit attempt. Those who self-reported abstinence for…