title: Differential Efficacy of Nicotine Replacement Among Overweight and Obese Women Smokers.
abstract: BACKGROUND
  Rates of obesity are higher among more dependent smokers and 37%-65% of smokers seeking cessation treatment are overweight or obese. Overweight or obese smokers may possess metabolic and neurobiological features that contribute to difficulty achieving cessation using front-line nicotine replacement products. Attention to factors that facilitate effective cessation treatment in this vulnerable population is needed to significantly reduce mortality risk among overweight and obese smokers.
  
  
  METHODS
  This secondary analysis of 2 large trials of transdermal nicotine replacement in general medical practices evaluated the hypothesis that higher body mass index (BMI) would moderate the efficacy of the nicotine patch. We examined the potential for gender to further moderate the relationship between BMI and treatment efficacy.
  
  
  RESULTS
  In the placebo controlled trial (N = 1,621), 21-mg patch was no more effective than placebo for assisting biochemically verified point prevalence abstinence up to 1 year after quitting for women with higher BMI, but appeared to be effective for men at normal or high BMI (gender × BMI beta = -0.22, p = .004). We did not find differential long-term cessation outcomes among male or female smokers in the 15-mg patch trial (n = 705). However, we observed significantly higher rates of early lapse among women with higher BMI treated with nicotine patch across both trials.
  
  
  CONCLUSIONS
  These results suggest that increased BMI may affect the efficacy of nicotine patch on reducing risk of early lapse in women. Additional research is needed to explore mechanisms of risk for decreased efficacy of this commonly used cessation aid.
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, CA; dstrong@ucsd.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Strong
authors.affiliation: Center for Education and Research in Family and Community Medicine, Division of General Internal Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA;
authors.forename: Sean P
authors.initials: SP
authors.lastname: David
authors.affiliation: Department of Oncology, University of Oxford, Oxford, UK;
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Johnstone
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
authors.affiliation: Childhood Cancer Research Group, University of Oxford, Oxford, UK;
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
authors.affiliation: MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology, University of Bristol, Bristol, UK.
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Munafò
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000279:Administration, Cutaneous; D015992:Body Mass Index; D004311:Double-Blind Method; D005500:Follow-Up Studies; D009538:Nicotine / Q000008:administration & dosage; D009765:Obesity / Q000188:drug therapy / Q000453:epidemiology; D050177:Overweight / Q000188:drug therapy / Q000453:epidemiology; D012907:Smoking / Q000188:drug therapy / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome; D000094422:Secondary Data Analysis
chemical_list: D009538:Nicotine