title: Action to stop smoking in suspected tuberculosis (ASSIST) in Pakistan: a cluster randomized, controlled trial.
abstract: BACKGROUND
  Tobacco use is responsible for a large proportion of the total disease burden from tuberculosis. Pakistan is one of the 10 high-burden countries for both tuberculosis and tobacco use.
  
  
  OBJECTIVE
  To assess the effectiveness of a behavioral support intervention and bupropion in achieving 6-month continuous abstinence in adult smokers with suspected pulmonary tuberculosis.
  
  
  METHODS
  Cluster randomized, controlled trial. (Current Controlled Trials: ISRCTN08829879)
  
  
  METHODS
  Health centers in the Jhang and Sargodha districts in Pakistan.
  
  
  METHODS
  1955 adult smokers with suspected tuberculosis.
  
  
  METHODS
  Health centers were randomly assigned to provide 2 brief behavioral support sessions (BSS), BSS plus 7 weeks of bupropion therapy (BSS+), or usual care.
  
  
  METHODS
  The primary end point was continuous abstinence at 6 months after the quit date and was determined by carbon monoxide levels in patients. Secondary end points were point abstinence at 1 and 6 months.
  
  
  RESULTS
  Both treatments led to statistically significant relative risks (RRs) for abstinence compared with usual care (RR for BSS+, 8.2 [95% CI, 3.7 to 18.2]; RR for BSS, 7.4 [CI, 3.4 to 16.4]). Equivalence between the treatments could not be established. In the BSS+ group, 275 of 606 patients (45.4% [CI, 41.4% to 49.4%]) achieved continuous abstinence compared with 254 of 620 (41.0% [CI, 37.1% to 45.0%]) in the BSS group and 52 of 615 (8.5% [CI, 6.4% to 10.9%]) in the usual care group. There was substantial heterogeneity of program effects across clusters.
  
  
  CONCLUSIONS
  Imbalances in the urban and rural proportions and smoking habits among treatment groups, and inability to confirm adherence to bupropion treatment and validate longer-term abstinence or the effect of smoking cessation on tuberculosis outcomes.
  
  
  CONCLUSIONS
  Behavioral support alone or in combination with bupropion is effective in promoting cessation in smokers with suspected tuberculosis.
  
  
  BACKGROUND
  International Development Research Centre.
authors: University of York, York YO10 5DD, United Kingdom. kamran.siddiqi@york.ac.uk
authors: Kamran
authors: K
authors: Siddiqi
authors: Amir
authors: A
authors: Khan
authors: Maqsood
authors: M
authors: Ahmad
authors: Omara
authors: O
authors: Dogar
authors: Mona
authors: M
authors: Kanaan
authors: James N
authors: JN
authors: Newell
authors: Heather
authors: H
authors: Thomson
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D001521:Behavior Therapy / Q000191:economics; D016642:Bupropion / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010154:Pakistan; D012424:Rural Population; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000517:prevention & control; D014505:Urban Population; D055815:Young Adult
chemical_list: D016642:Bupropion