title: Randomized trial of the effectiveness of combined behavioral/pharmacological smoking cessation treatment in Syrian primary care clinics.
abstract: OBJECTIVE
  Effectiveness of nicotine replacement therapy (NRT) for smoking cessation has not been evaluated in low income countries, such as Syria, where it is expensive and not widely available. We evaluated whether nicotine patch boosts smoking cessation rates when used in conjunction with behavioral support in primary care clinics in Aleppo, Syria.
  
  
  METHODS
  Two arm, parallel group, randomized, placebo controlled, double-blinded multi-site trial.
  
  
  METHODS
  Four primary care clinics in Aleppo, Syria.
  
  
  METHODS
  Two hundred and sixty-nine adult primary care patients received behavioral cessation counseling from a trained primary care physician and were randomized to receive six weeks of treatment with nicotine versus placebo patch.
  
  
  METHODS
  Primary end-points were prolonged abstinence (no smoking after a 2-week grace period) at end of treatment, and 6 and 12 months post-quit day, assessed by self-report and exhaled carbon monoxide levels of <10 p.p.m.
  
  
  RESULTS
  Treatment adherence was excellent and nicotine patch produced expected reductions in urges to smoke and withdrawal symptoms, but no treatment effect was observed. The proportion of patients in the nicotine and placebo groups with prolonged abstinence was 21.6% and 20.0%, respectively, at end of treatment, 13.4% and 14.1% at 6 months, and 12.7% and 11.9% at 12 months.
  
  
  CONCLUSIONS
  Nicotine patches may not be effective in helping smokers in low-income countries to stop when given as an adjunct to behavioural support.
authors.affiliation: Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN 38152, USA. kdward@memphis.edu
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
authors.forename: Taghrid
authors.initials: T
authors.lastname: Asfar
authors.forename: Radwan
authors.initials: R
authors.lastname: Al Ali
authors.forename: Samer
authors.initials: S
authors.lastname: Rastam
authors.forename: Mark W Vander
authors.initials: MW
authors.lastname: Weg
authors.forename: Thomas
authors.initials: T
authors.lastname: Eissenberg
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D016739:Behavior, Addictive / Q000517:prevention & control*; D002248:Carbon Monoxide / Q000032:analysis; D003376:Counseling; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage; D011320:Primary Health Care; D015397:Program Evaluation; D057566:Self Report; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013593:Syria; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009538:Nicotine; D002248:Carbon Monoxide