Effectiveness of residential versus outpatient therapy for smoking cessation: The START randomized clinical trial.

Autor: Dickreuter JL; Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Schmoor C; Clinical Trials Unit, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Jähne A; Rhein-Jura Klinik, Bad Säckingen, Germany., Bengel J; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany., Pschichholz B; Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Lorz C; Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Schulz C; Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Vozelj J; Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany., Leifert JA; Comprehensive Cancer Center (CCCF), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.; Breisgau-Klinik, Bad Krozingen, Germany.
Jazyk: angličtina
Zdroj: Addiction (Abingdon, England) [Addiction] 2024 Oct; Vol. 119 (10), pp. 1762-1773. Date of Electronic Publication: 2024 Jul 10.
DOI: 10.1111/add.16594
Abstrakt: Background and Aims: Tobacco smoking represents a major cause for preventable death and morbidity. Results from non-randomized studies suggest that smoking cessation therapy in a residential setting might be a new viable way to facilitate smoking abstinence. We aimed to test the effects of residential multicomponent group therapy for smoking cessation compared with outpatient group therapy.
Design: Prospective parallel-group open-label randomized superiority trial, with assessments at baseline, 6 and 12 months.
Setting: Recruitment throughout Germany via media advertisements.
Participants: Adult smokers (≥10 cigarettes/day) randomly assigned to residential (n = 157) or outpatient (n = 158) therapy. 51.8% female; mean age 53.2 years; mean years of smoking 34.4.
Intervention and Comparator: Residential 9-day smoking cessation group therapy comprising six daily therapy sessions and supportive interventions for cessation and daily structure embedded in the routines of a somatic rehabilitation center, compared with weekly outpatient smoking cessation group therapy (3-7 weeks) provided in routine care courses close to the participants' places of residence, both including at least 9 h of behavioral therapy.
Measurements: Co-primary outcomes were self-reported continuous 6- and 12-month abstinence (hierarchically ordered). Primary analyses were conducted in the therapy-uptake population including participants who started therapy with sensitivity analyses in the intention-to-treat population of all randomized participants.
Findings: Intervention uptake rates were 87.3% (n = 137) in the residential and 60.1% (n = 95) in the outpatient group. In the therapy-uptake population, abstinence rates were 46.7% in the residential versus 26.3% in the outpatient group at 6 months (odds ratio [OR] = 2.46, 95% confidence interval [CI] = 1.39-4.33, P = 0.0019) and 39.4% versus 24.2% at 12 months (OR = 2.04, 95% CI = 1.14-3.64, P = 0.017). Biochemically validated abstinence rates at 12 months were 33.1% in the residential versus 17.4% in the outpatient group (OR = 2.35, 95% CI = 1.22-4.51, P = 0.011). In the intention-to-treat population, self-reported and biochemically validated abstinence rates at 12 months were 34.4% in the residential versus 14.6% in the outpatient group (OR = 3.08, 95% CI = 1.77-5.34, P < 0.0001) and 28.6% versus 10.3% (OR = 3.48, 95% CI = 1.85-6.52, P = 0.0001), respectively.
Conclusions: Residential therapy exclusively for smoking cessation is feasible and effective and could be a beneficial new treatment for smokers.
(© 2024 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)
Databáze: MEDLINE
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