"Tobacco Free With FDNY": the New York City Fire Department World Trade Center Tobacco Cessation Study.
BACKGROUND
After the World Trade Center (WTC) collapse, 15% (1,767) of rescue workers from the Fire Department of the City of New York (FDNY) considered themselves to be current cigarette smokers. Post-WTC collapse, 98% reported acute respiratory symptoms, and 81% reported health concerns. Nonetheless, 29% of current smokers increased tobacco use, and 23% of ex-smokers resumed cigarette smoking.


OBJECTIVE
To determine the effect of a comprehensive tobacco-cessation program using combination tobacco-dependency treatment medications adjusted to the individual's daily tobacco use.


METHODS
FDNY cigarette smokers enrolled in "Tobacco Free With FDNY," a no-cost quit-smoking program providing counseling, support, and medications. At the end of the 3-month treatment phase and at the 6-month and 12-month follow-up visits, abstinence rates were confirmed by expired carbon monoxide levels or by the verification of a household member.


METHODS
FDNY Bureau of Health Services between August 1, 2002 and October 30, 2002.


METHODS
A total of 220 current cigarette smokers from the FDNY.


RESULTS
At study enrollment, the mean (+/- SD) tobacco use was 20 +/- 7 cigarettes per day, and the mean tobacco dependency, as assessed by a modified Fagerstrom test score, was 6.7 +/- 2.5 (maximum score, 10). Based on tobacco use, 20% of enrollees used three types of nicotine medications, 64% used two types, 14% used one type, and 3% used no medications. Additionally, 14% of enrollees used bupropion sustained release. The confirmed continuous abstinence rates were 47%, 36%, and 37%, respectively, after 3 months of treatment and at the 6-month and 12-month follow-up. Abstinence rates did not correlate with the history of tobacco use but correlated inversely with tobacco dependency. Adverse events and maximal nicotine medication use were unrelated, and no one experienced a serious adverse event.


CONCLUSIONS
Tobacco dependency treatment using combination nicotine medications is effective and safe. Future studies should consider the following: (1) both history of tobacco use and withdrawal symptoms to determine the number and dose of nicotine medications; and (2) continuing combination treatment for > 3 months.
Bars
Matthew P
MP
Chief Medical Officer, Office of Medical Affairs, New York City Fire Department, 9 Metrotech Ctr, Brooklyn, NY 11201, USA.
Banauch
Gisela I
GI
Appel
David
D
Andreachi
Michael
M
Mouren
Philippe
P
Kelly
Kerry J
KJ
Prezant
David J
DJ
D016642:Bupropion / Q000008:administration & dosage*; D037001:Directive Counseling; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage*; D005390:Fires; D005500:Follow-Up Studies; D006801:Humans; D009519:New York City; D009538:Nicotine / Q000008:administration & dosage*; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D018635:Rescue Work; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*
D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine