Effectiveness of Switching Smoking-Cessation Medications Following Relapse


      Nicotine dependence is a chronic disorder often characterized by multiple failed quit attempts (QAs). Yet, little is known about the sequence of methods used across multiple QAs or how this may impact future ability to abstain from smoking. This prospective cohort study examines the effectiveness of switching smoking-cessation medications (SCMs) across multiple QAs.


      Adult smokers (aged ≥18 years) participating in International Tobacco Control surveys in the United Kingdom, U.S., Canada, and Australia (N=795) who: (1) completed two consecutive surveys between 2006 and 2011; (2) initiated a QA at least 1 month before each survey; and (3) provided data for the primary predictor (SCM use during most recent QA), outcome (1-month point prevalence abstinence), and relevant covariates. Analyses were conducted in 2016.


      Five SCM user classifications were identified: (1) non-users (43.5%); (2) early users (SCM used for initial, but not subsequent QA; 11.4%); (3) later users (SCM used for subsequent, but not initial QA; 18.4%); (4) repeaters (same SCM used for both QAs; 10.7%); and (5) switchers (different SCM used for each QA; 14.2%). Abstinence rates were lower for non-users (15.9%, OR=0.48, p=0.002), early users (16.6%, OR=0.27, p=0.03), and repeaters (12.4%, OR=0.36, p=0.004) relative to switchers (28.5%).


      Findings suggest smokers will be more successful if they use a SCM in QAs and vary the SCM they use across time. That smokers can increase their odds of quitting by switching SCMs is an important message that could be communicated to smokers.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • U.S. DHSS
        The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General: Reports of the Surgeon General.
        U.S. DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014
        • Joseph A.M.
        • Fu S.S.
        • Lindgren B.
        • et al.
        Chronic disease management for tobacco dependence: a randomized, controlled trial.
        Arch Intern Med. 2011; 171: 1894-1900
        • Borland R.
        • Yong H.H.
        • Balmford J.
        • et al.
        Motivational factors predict quit attempts but not maintenance of smoking cessation: findings from the International Tobacco Control Four country project.
        Nicotine Tob Res. 2010; 12: S4-S11
        • Joseph A.M.
        • Rice K.
        • An L.C.
        • Mohiuddin A.
        • Lando H.
        Recent quitters’ interest in recycling and harm reduction.
        Nicotine Tob Res. 2004; 6: 1075-1077
        • Hughes J.R.
        • Solomon L.J.
        • Naud S.
        • Fingar J.R.
        • Helzer J.E.
        • Callas P.W.
        Natural history of attempts to stop smoking.
        Nicotine Tob Res. 2014; 16: 1190-1198
        • Chaiton M.
        • Diemert L.
        • Cohen J.E.
        • et al.
        Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers.
        BMJ Open. 2016; 6: e011045
        • Borland R.
        • Partos T.R.
        • Yong H.H.
        • Cummings K.M.
        • Hyland A.
        How much unsuccessful quitting activity is going on among adult smokers? Data from the International Tobacco Control Four Country cohort survey.
        Addiction. 2012; 107: 673-682
        • Kasza K.A.
        • Hyland A.J.
        • Borland R.
        • et al.
        Effectiveness of stop-smoking medications: findings from the International Tobacco Control (ITC) Four Country Survey.
        Addiction. 2013; 108: 193-202
        • Fiore M.C.
        • Jaén C.R.
        • Baker T.B.
        • et al.
        Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline.
        U.S. DHHS, Public Health Service, Rockville, MDMay 2008
        • Partos T.R.
        • Borland R.
        • Yong H.H.
        • Hyland A.
        • Cummings K.M.
        The quitting rollercoaster: how recent quitting history affects future cessation outcomes (data from the International Tobacco Control 4-country cohort study).
        Nicotine Tob Res. 2013; 15: 1578-1587
        • Cheong Y.
        • Yong H.H.
        • Borland R.
        Does how you quit affect success? A comparison between abrupt and gradual methods using data from the International Tobacco Control Policy Evaluation Study.
        Nicotine Tob Res. 2007; 9: 801-810
        • Kotz D.
        • Brown J.
        • West R.
        ‘Real-world’ effectiveness of smoking cessation treatments: a population study.
        Addiction. 2014; 109: 491-499
        • Ferguson S.G.
        • Brown J.
        • Frandsen M.
        • West R.
        Associations between use of pharmacological aids in a smoking cessation attempt and subsequent quitting activity: a population study.
        Addiction. 2015; 110: 513-518
        • Tonnesen P.
        • Norregaard J.
        • Sawe U.
        • Simonsen K.
        Recycling with nicotine patches in smoking cessation.
        Addiction. 1993; 88: 533-539
        • Tonnesen P.
        • Mikkelsen K.
        • Norregaard J.
        • Jorgensen S.
        Recycling of hard-core smokers with nicotine nasal spray.
        Eur Respir J. 1996; 9: 1619-1623
        • Gourlay S.G.
        • Forbes A.
        • Marriner T.
        • Pethica D.
        • McNeil J.J.
        Double blind trial of repeated treatment with transdermal nicotine for relapsed smokers.
        BMJ. 1995; 311: 363-366
        • Shiffman S.
        • Dresler C.M.
        • Rohay J.M.
        Successful treatment with a nicotine lozenge of smokers with prior failure in pharmacological therapy.
        Addiction. 2004; 99: 83-92
        • Gonzales D.
        • Hajek P.
        • Pliamm L.
        • et al.
        Retreatment with varenicline for smoking cessation in smokers who have previously taken varenicline: a randomized, placebo-controlled trial.
        Clin Pharmacol Ther. 2014; 96: 390-396
        • Gonzales D.H.
        • Nides M.A.
        • Ferry L.H.
        • et al.
        Bupropion SR as an aid to smoking cessation in smokers treated previously with bupropion: a randomized placebo-controlled study.
        Clin Pharmacol Ther. 2001; 69: 438-444
        • Durcan M.J.
        • White J.
        • Jorenby D.E.
        • et al.
        Impact of prior nicotine replacement therapy on smoking cessation efficacy.
        Am J Health Behav. 2002; 26: 213-220
        • Hughes J.R.
        An updated algorithm for choosing among smoking cessation treatments.
        J Subst Abuse Treat. 2013; 45: 215-221
        • Hughes J.
        An algorithm for choosing among smoking cessation treatments.
        J Subst Abuse Treat. 2008; 34: 426-432
        • Cropsey K.L.
        • Jardin B.F.
        • Burkholder G.A.
        • Clark C.B.
        • Raper J.L.
        • Saag M.S.
        An algorithm approach to determining smoking cessation treatment for persons living with HIV/AIDS: results of a pilot trial.
        J Acquir Immune Defic Syndr. 2015; 69: 291-298
        • Bader P.
        • McDonald P.
        • Selby P.
        An algorithm for tailoring pharmacotherapy for smoking cessation: results from a Delphi panel of international experts.
        Tob Control. 2009; 18: 34-42
        • Thompson M.E.
        • Fong G.T.
        • Hammond D.
        • et al.
        Methods of the International Tobacco Control (ITC) Four Country Survey.
        Tob Control. 2006; 15: iii12-iii18
        • Heatherton T.
        • Kozlowski L.
        • Frecker R.C.
        • Rickert W.
        • Robinson J.
        Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day.
        Br J Addict. 1989; 84: 791-799
        • Lei H.
        • Nahum-Shani I.
        • Lynch K.
        • Oslin D.
        • Murphy S.A.
        “SMART” design for building individualized treatment sequences..
        Annu Rev Clin Psychol. 2012; 8: 21-48
        • SRNT
        Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation.
        Nicotine Tob Res. 2002; 4: 149-159
        • Hughes J.R.
        • Keely J.P.
        • Niaura R.S.
        • Ossip-Klein D.J.
        • Richmond R.L.
        • Swan G.E.
        Measures of abstinence in clinical trials: issues and recommendations.
        Nicotine Tob Res. 2003; 5: 13-25
        • Shiffman S.
        Use of more nicotine lozenges leads to better success in quitting smoking.
        Addiction. 2007; 102: 809-814
        • Balmford J.
        • Borland R.
        • Hammond D.
        • Cummings K.M.
        Adherence to and reasons for premature discontinuation from stop-smoking medications: data from the ITC Four-Country Survey.
        Nicotine Tob Res. 2011; 13: 94-102
        • Heckman B.W.
        • Mathew A.R.
        • Carpenter M.J.
        Treatment burden and treatment fatigue as barriers to health.
        Curr Opin Psychol. 2015; 5: 31-36
        • Chen L.S.
        • Bloom A.J.
        • Baker T.B.
        • et al.
        Pharmacotherapy effects on smoking cessation vary with nicotine metabolism gene (CYP2A6).
        Addiction. 2014; 109: 128-137
        • Bergen A.W.
        • Javitz H.S.
        • Krasnow R.
        • et al.
        Nicotinic acetylcholine receptor variation and response to smoking cessation therapies.
        Pharmacogenet Genomics. 2013; 23: 94-103