Cessation Research

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Cessation Research

• Tobacco Control Research Symposium
• 17 October 2006
• Michele Grigg
• Sharon Ponniah
• Chris Bullen/Simon Thornley

2
Reviewing progress

• Progress in research of relevance to Maori,
  inequalities, and Pacific people?
• Areas no longer relevant?
• Any emerging research gaps/needs?

3
Where is cessation?

• Surveillance of Maori cessation rates (p26)
• Surveillance of Pacific peoples cessation rates
  (p26)
• Effectiveness of cessation programmes (p27)

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Progress in cessation research

• HRC-funded research 05/06 and 06/07 rounds
  future rounds?
• NHF and CanSoc funded research
• MoH tobacco monitoring and surveillance programme
• Quitline programme evaluation

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Examples of work underway

• MoH tobacco use survey Sharon Ponniah
• Auckland University projects Chris Bullen/Simon
  Thornley

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New Zealand Tobacco Use Survey

• Sharon Ponniah (Project manager)

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NZTUS 2006 ? 2009

• CAPI data collection
• New Zealand population (15-64 years)
• Objectives
• Provide a measure for the prevalence of smoking
  annually,
• Collect valid and reliable measures of tobacco
  use including consumption, initiation, addiction,
  quitting, relapse and exposure to second-hand
  smoke,
• Collect comprehensive measures of, knowledge,
  attitudes and beliefs about tobacco smoking and
  control,
• Provide reliable measures for populations of
  interest NZ Maori, Pacific people, Asians and
  15-19 year olds,
• Monitor changes in tobacco use, quitting
  behaviour, and attitudes and beliefs about
  tobacco over time.

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Modules

• Adult component (20) /youth component (15-19)
• Modules prevalence, smoking history,
  consumption, intensity, addiction, quitting,
  attitudes, pregnancy (youth specific)
• Cessation component is core, with approx 30
  questions
• quit attempts, quitting advice and quitting aids
• Examples of questions
• In the last 5 years, have you tried to quit
  smoking?
• The last time you attempted to quit, did you
  receive any help or advice on how to quit from a
  health worker or a stop-smoking programme?

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Sampling

• Stratified, clustered sampling
• Main sample and Screened sample
• Interviewing over three month period
• Allows collection of trends over time
• In 2006 NZTUS
• 500 meshblocks 5,782 completed interviews
• Response rate 75.39 (10)
• Smokers n 1606 non-smokers 4176
• Maori n 1087 Pacific 582 Asian 700 and
  Euro/Other 3413

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Further Information

• National Research Bureau (NRB) is contracted to
  collect NZTUS data
• Key prevalence estimates due to be released in
  Tobacco Facts, October 31st 2006
• NZTUS 2006 report due for release in March 2007
• http//www.moh.govt.nz/phi/surveys/tus

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Trials and Tribulations of Smoking Cessation
Research CTRU Experience

• Chris Bullen, Simon Thornley

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Clinical Trials Research Unit

• Improving health through innovative research
• Programme of cessation research
• STOMP, Smoking IQ (PQNIQ, SONIQ, RELIQ), STOMP 2,
  NEWS

School of Population Health
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Nicotine Replacement Therapy

• Dominant pharmacotherapy for smoking
• Efficacy of active NRT over placebo
  well-established
• Absolute quit rates are low (10-30) and
  effectiveness in practice as low as 7 at 6
  months
• How can the effectiveness of existing nicotine
  replacement therapies be enhanced?

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PQNIQ

• Single blind, randomised controlled trial,
  comparing smokers taking NRT (patches or gum) for
  2 weeks prior to the Quit day, with those
  starting NRT as per usual practice
• Participants
• Otherwise healthy smokers gt10 cigarettes/day
• Intervention
• NRT 2 weeks prior to quit day cf. usual practice
• Outcome
• quit at six months

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SONIQ

• A randomised trial of increasing choice of
  nicotine replacement therapies
• Current practice based around use of one form of
  NRT, usually patch
• Does increased access and choice of NRT delivery
  method improve quit rates?
• Participants - Otherwise healthy relapsed
  smokers gt10 cigarettes/day
• Intervention
• Outcome - quit at six months

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NEWS

• Niconovum Evaluation of Withdrawal relief Study
• A single blind, randomised, cross-over trial of
  three novel NRTs (NicoNovum pouch, mouth spray
  and lozenge) on the relief of tobacco withdrawal
  symptoms

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Niconovum products
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Design
Drug admin.
Withdrawal Scales
Baseline W After O/N abst.
Ad lib NRT use
Evening CO test WD scale over day/hour Last day -
compare drugs
CO after cigarette Rate cigarette
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Where to from here?

• NRT studies currently available NRT, new NRT
  products, slow cessation
• Novel methods of recruitment (e.g. Quitline) and
  verification (Nicalert, voice)
• Specific groups e.g. COPD
• New pharmacotherapies - Varenicline, Cytisine

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Acknowledgements

• Health Research Council
• National Heart Foundation
• The Quit Group
• Niconovum

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Cessation research gaps?

• Gaining knowledge from overseas and applying to
  NZ
• New ways of using nicotine replacement therapies
• Removing barriers to accessing effective
  pharmacotherapies
• New pharmacotherapies
• But need to assess applicability and relevance
  for NZ, especially for ethnic groups, eg Maori

26
Cessation research gaps?

• Quitting behaviours resulting from other tobacco
  control initiatives. What are the effects of
  other initiatives?
• Coordination required.
• Youth cessation any progress on what works?

27
A cessation strategy?

• To identify cessation research priorities
• To give direction to the sector
• To identify programmes and services required
• To assist with linkages and coordination
• For workforce development
• Using the revised Cessation Guidelines as a
  starting point.

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Cessation Research

• Tobacco Control Research Symposium
• 17 October 2006
• Michele Grigg
• Sharon Ponniah
• Chris Bullen/Simon Thornley