Our Clinical Trial: Seven Years of Follow-up Shows that the Switch to Smokeless is Stable

Seven Year Follow-up of Smoking Cessation with Smokeless Tobacco. Published in the Journal of Psychoactive Drugs, Volume 37, pages 105-108, January 2005. By Ken Tilashalski, Brad Rodu and Philip Cole (UAB TRF).

Birmingham, AL - A ground-breaking clinical study of a novel tobacco harm reduction strategy shows that smokeless tobacco can help inveterate smokers quit smoking indefinitely. 

The study, appearing in the Journal of Psychoactive Drugs, reports on subjects who were contacted seven years after completion of a quit-smoking program that replaced cigarettes with 98% safer smokeless tobacco products.  The article reports that 75% of smokers who had quit with smokeless tobacco at one year, were smoke-free at seven years.  In contrast, among smokers who had failed to quit with smokeless, only 29% were smoke-free at the seven-year mark.

“Very few quit-smoking programs have attempted to measure success rates for periods exceeding 12 months, primarily because of abysmal long-term results,” said Dr. Brad Rodu, professor of pathology and a senior scientist at the University of Alabama at Birmingham (UAB) Comprehensive Cancer Center.     
 
In 1998, the authors reported on one-year success rates from the first and only clinical trial using smokeless tobacco as a nicotine substitute.  That study, which appeared in the American Journal of Medicine, reported quit rates of 31% among men and 19% among women using smokeless tobacco.  (“Smoking cessation” was defined as self-reported smoking abstinence for the four weeks before contact.)  Prior to that study, most participants (87.5%) had failed to quit with prescription nicotine products, and over one-half (56.3%) had used both nicotine patch and gum.  The new research involves six additional years of data involving the same individuals.

Dr. Rodu said the UAB smoking cessation strategy differs in two important ways from conventional approaches.  First, it uses minimal intervention -- each participant attended only a single counseling session.  “Most quit-smoking strategies require intensive behavioral modification and frequent counseling sessions to deal with nicotine withdrawal issues.  These are expensive and impractical.” 

Dr. Rodu continued, “Because smokeless products are 98% safer than cigarettes, a second important feature of our strategy is that nicotine maintenance with smokeless is permanent, if necessary.  Conventional cessation programs employ nicotine substitutes only temporarily to wean individuals from cigarettes, since their goal is nicotine abstinence.  But abstinence is not necessary to obtain the health benefits of smoking cessation.” 

The authors point out that nicotine medications “deliver inadequate nicotine concentrations and they are expensive, making them unappealing to inveterate smokers.  The current practice of limiting nicotine substitutes to temporary use as an aid to smoking cessation is unfortunate.  By requiring smokers to abstain from nicotine use, that strategy makes overcoming nicotine addiction a higher priority than overcoming smoking and smoking-induced disease.” 

The article, “Seven Year Follow-Up of Smoking Cessation with Smokeless Tobacco,” is authored by Ken Tilashalski, DMD,  Associate Professor, Department of Diagnostic Sciences, UAB School of Dentistry; Rodu; and Philip Cole, MD, DrPH, Professor Emeritus, Department of Epidemiology, UAB School of Public Health.

The research was supported by the Tobacco Research Fund (UAB). The sponsor had no knowldege, scientific input or other influence regarding this study. 

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