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Nicotine & Tobacco Research Advance Access published online on April 24, 2009
Nicotine & Tobacco Research, doi:10.1093/ntr/ntp047
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Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco

Sustained-release bupropion for hospital-based smoking cessation: A randomized trial

Joel A. Simon, Carol Duncan, Joy Huggins, Sharon Solkowitz and Timothy P. Carmody

Joel A. Simon, M.D., M.P.H., General Internal Medicine Section, Medical Service, Department of Veterans Affairs Medical Center, and Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, CA
Carol Duncan, R.D., M.P.H., General Internal Medicine Section, Medical Service, Mental Health Service, Department of Veterans Affairs Medical Center and Departments of Medicine and Psychiatry, University of California, San Francisco, CA
Joy Huggins, M.A., Mental Health Service, Department of Veterans Affairs Medical Center and Department of Psychiatry, University of California, San Francisco, CA
Sharon Solkowitz, M.P.H., Mental Health Service, Department of Veterans Affairs Medical Center and Department of Psychiatry, University of California, San Francisco, CA
Timothy P. Carmody, Ph.D., Mental Health Service, Department of Veterans Affairs Medical Center and Department of Psychiatry, University of California, San Francisco, CA

Corresponding Author:Joel A. Simon, M.D., M.P.H., General Internal Medicine Section (111A1), Medical Service, Department of Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA. Telephone: 415-750-2093; Fax: 415-379-5573; E-mail: joel.simon{at}ucsf.edu


  Abstract

Introduction: Bupropion is a first-line pharmacological aid for smoking cessation; however, no clinical trials have been conducted in a general population of hospitalized smokers.

Methods: We enrolled 85 smokers in a hospital-based randomized smoking cessation trial conducted at the San Francisco Veterans Affairs Medical Center. A total of 42 participants received a 7-week course of sustained-release bupropion and 43 participants received placebo. All participants received cognitive–behavioral counseling. We screened 14,997 patients, of whom 25% were current smokers. Of the 536 smokers who met the entry criteria, 451 opted not to enroll. We determined on-medication, end-of-medication, 3-month, and 6-month smoking cessation rates.

Results: At the end of 7 weeks of drug treatment, self-reported quit rates were equivalent in the bupropion and placebo arms, 37% versus 33%, respectively (p = .82). The validated quit rates for the bupropion and placebo groups were 27% versus 29%, respectively (p = 1.00). At 6 months, the self-reported quit rates were 29% in the bupropion group and 41% in the placebo group (p = .36). In a comparison of 6-month quit rates, validated either by salivary cotinine or by spousal proxy, we found nonsignificantly higher quit rates in the placebo group than in the bupropion group, 31% versus 15% (p = .12).

Discussion: The addition of sustained-release bupropion to counseling did not increase quit rates, but the study was underpowered. Because of the secular trend toward shorter hospital stays, recruitment was very difficult, raising questions regarding the feasibility of future hospital-based smoking cessation trials and interventions.

Received: April 23, 2008; Accepted: January 30, 2009
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