Want to Quit Smoking?  Study Says Success Can Improve Significantly When Drug Therapy is Combined with Behavioral Counseling

MENLO PARK, California – October 28, 2003 – Smokers who want to quit by taking the drug bupropion SR (marketed by GlaxoSmithKline as Zyban®) could see a substantial increase in their chances for quitting when the drug is taken in combination with a moderate level of behavioral modification counseling, according to a new study led by researchers at independent research institute SRI International.

The study shows that a combination of bupropion SR with minimal or moderate behavioral counseling results in a “quit rate” of 24% to 33% after one year, compared to a CDC-reported 5% quit rate for “self-quitters” after a three-month period (those who quit “cold turkey” without some form of assistance).

The study evaluated the effectiveness of different doses of the bupropion SR in combination with behavioral counseling support, which was provided through the Center for Health Promotion at the Group Health Cooperative (GHC) health care system in the State of Washington. For this open-label trial, a total of 1,524 adult smokers interested in quitting were randomly assigned to receive one of four combinations of bupropion SR (150 mg or 300 mg) and behavioral counseling (minimal or moderate intensity), and queried about their smoking status at three and 12 months.

The findings indicate that at three months, more people on the 300-mg dose than those on the 150-mg dose reported not smoking (30.9% versus 24.2%). After one year's time, however, quit rates were not significantly better at the higher dosage (a result similar to one of the drug's clinical efficacy trials).

While after one year the drug dosage was no longer related to the number of people reporting not smoking, the type of behavioral treatment was significantly related to reports of nonsmoking. Those participants who were assigned to moderate-intensity behavioral intervention via the CHP Free & Clear smoking cessation program had a 21% greater chance of quitting than those who received minimal-intensity behavioral intervention. The group that combined the 300-mg dose and the moderate-intensity behavioral counseling achieved a 33.2% nonsmoking rate, higher than the other three groups. This was possibly due to the increased use of behavioral skills, a feature of the yearlong Free & Clear counseling program.

Moderate-intensity behavioral intervention included a mailing of self-help materials, an in-depth phone assessment and counseling intervention, four brief pre-scheduled follow-up calls, and access to a toll-free “Quitline” for a full year, where counselors provided individualized counseling for participants on motivation, quitting and avoiding the return to smoking. Minimal-intensity behavioral intervention included a mailing of tailored self-help materials and a quit-day phone call.

The results suggest that health care systems can decrease tobacco use rates among their enrollees if they provide modest interventions such as those described above.

Other results of the study indicate that at three months, the 300-mg dose was associated with a significantly increased frequency of self-reported symptoms such as difficulty sleeping and concentrating, shakiness/tremor, and gastrointestinal problems. The proportion of those who indicated that they deliberately took less bupropion SR than prescribed was significantly greater among those prescribed 300 mg as compared to those assigned to receive 150 mg.

“Even with a combination of treatments, quitting smoking remains a difficult achievement for many people. The toll of smoking on our health and health care system is very high. SRI has a long-standing commitment to addressing the important field of nicotine addiction and will continue its research in not only improving the effectiveness of existing smoking cessation therapies, but in developing entirely new treatments as well,” said Gary Swan, Ph.D., director of SRI's Center for Health Studies and the report's lead author.

SRI designed and led the National Cancer Institute-funded study. A research article describing the outcomes of the study titled “Effectiveness of Bupropion SR for Smoking Cessation in a Health Care Setting: A Randomized Trial” has been published in the October 27 edition of Archives of Internal Medicine.

The paper's authors also include Tim McAfee, M.D., M.PH. (Chief Medical Officer of the GHC Center for Health Promotion), Susan J. Curry, Ph.D. (formerly with GHC and now affiliated with the School of Public Health, University of Illinois at Chicago), Lisa M. Jack (SRI), Harold Javitz, Ph.D. (SRI), Sara Dacey, M.D. (GHC), and Katherine Bergman, R.Ph. (GHC).

About SRI International

Silicon Valley-based SRI International is one of the world's leading independent research and technology development organizations. Founded as Stanford Research Institute in 1946, SRI has been meeting the strategic needs of clients for more than 55 years. The nonprofit research institute performs contract research and development for government agencies, commercial businesses and private foundations. In addition to conducting contract R&D, SRI licenses its technologies, forms strategic partnerships and creates spin-off companies.

SRI's Center for Health Sciences uses a multidisciplinary research approach to address complex challenges that arise at the interface of the basic sciences, clinical medicine, health care economics, and the regulatory and legal environments. Capabilities include clinical trials design, management, and analysis; health surveys; disease follow-ups; long-term tracking of study populations; and disease-related psychological and behavioral assessments. The Center also provides education on behavioral risk factors and offers cost-effectiveness analyses and litigation support.

About the Group Health Cooperative

Founded in 1947, Group Health is a consumer-governed, nonprofit health care system that coordinates care and coverage. Based in Seattle, Group Health and Group Health Options, Inc., serve 562,000 members in Washington and Idaho.

###