title: A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation.
abstract: OBJECTIVE
  To examine the population effectiveness of nicotine replacement therapies (NRTs), either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions.
  
  
  METHODS
  A prospective cohort study was conducted in three waves on a probability sample of 787 Massachusetts adult smokers who had recently quit smoking. The baseline response rate was 46%; follow-up was completed with 56% of the designated cohort at wave 2 and 68% at wave 3. The relationship between relapse to smoking at follow-up interviews and assistance used, including NRT with or without professional help, was examined.
  
  
  RESULTS
  About one-fourth of recent quitters at each wave reported to have relapsed by the subsequent interview. Odds of relapse were unaffected by use of NRT for >6 weeks either with (p=0.117) or without (p=0.159) professional counselling and were highest among prior heavily dependent persons who reported NRT use for any length of time without professional counselling (OR 2.68).
  
  
  CONCLUSIONS
  This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts. Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programmes and policies.
authors.affiliation: Center for Global Tobacco Control, Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA. halpert@hsph.harvard.edu
authors.forename: Hillel R
authors.initials: HR
authors.lastname: Alpert
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Connolly
authors.forename: Lois
authors.initials: L
authors.lastname: Biener
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009538:Nicotine / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D016540:Smoking Cessation; D000074606:Smoking Prevention; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018722:Nicotinic Agonists; D009538:Nicotine