title: Predictors of adherence to pharmacological and behavioral treatment in a cessation trial among smokers in Aleppo, Syria.
abstract: BACKGROUND
  The development of evidence-based smoking cessation programs is in its infancy in developing countries, which continue to bear the main brunt of the tobacco epidemic. Adherence to treatment recommendations is an important determinant of the success of smoking cessation programs, but little is known about factors influencing adherence to either pharmacological or behavioral treatment in developing countries settings. Our study represents the first attempt to examine the predictors of adherence to cessation treatment in a low-income developing country.
  
  
  METHODS
  Predictors of adherence to pharmacological and behavioral treatment were identified by analyzing data from a multi-site, two-group, parallel-arm, double-blind, randomized, placebo-controlled smoking cessation trial in primary care clinics in Aleppo, Syria. Participants received 3 in-person behavioral counseling sessions plus 5 brief follow-up phone counseling sessions, and were randomized to either 6 weeks of nicotine or placebo patch.
  
  
  RESULTS
  Of the 269 participants, 68% adhered to pharmacological treatment, while 70% adhered to behavioral counseling. In logistic regression modeling, lower adherence to pharmacological and behavioral treatment was associated with higher daily smoking at baseline, greater withdrawal symptoms, and perception of receiving placebo instead of active nicotine patch. Women showed lower adherence than men to behavioral treatment, while being assigned to placebo condition and baseline waterpipe use were associated with lower adherence to pharmacological treatment.
  
  
  CONCLUSIONS
  Adherence to cessation treatment for cigarette smokers in low-income countries such as Syria may benefit from integrated cessation components that provide intensive treatment for subjects with higher nicotine dependence, and address concurrent waterpipe use at all stages.
authors.affiliation: Department of Epidemiology, Florida International University, Miami, FL, USA. Electronic address: zbent002@fiu.edu.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Ben Taleb
authors.affiliation: Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA; Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ward
authors.affiliation: Syrian Center for Tobacco Studies, Aleppo, Syria; University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Taghrid
authors.initials: T
authors.lastname: Asfar
authors.affiliation: Department of Epidemiology, Florida International University, Miami, FL, USA; Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen.
authors.forename: Raed
authors.initials: R
authors.lastname: Bahelah
authors.affiliation: Department of Epidemiology, Florida International University, Miami, FL, USA; Syrian Center for Tobacco Studies, Aleppo, Syria.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001521:Behavior Therapy / Q000379:methods / Q000706:statistics & numerical data*; D003906:Developing Countries; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011203:Poverty; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000523:psychology; D013593:Syria; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*; D055815:Young Adult; D016903:Drug Monitoring
keywords: Adherence; Cessation; Cigarettes; Developing countries; Smoking