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February 23, 1994

Use of Transdermal Nicotine in a State-Level Prescription Plan for the ElderlyA First Look at 'Real-World' Patch Users

Author Affiliations

From the Fox Chase Cancer Center, Cheltenham, Pa (Dr Orleans and Mss Resch, Noll, and Keintz); the Duke Comprehensive Cancer Center, Durham, NC (Dr Rimer); and the Commonwealth of Pennsylvania Department of Aging, Harrisburg (Ms Brown and Mr Snedden). Drs Orleans and Rimer have received funding for clinical research, educational, and/or consulting activities from Ciba-Geigy Corp, Summit, NJ; Lederle Laboratories, Pearl River, NY; Marion Merrell Dow Inc, Kansas City, Mo; and Parke Davis Pharmaceutical Research Division, Morris Plains, NJ.

JAMA. 1994;271(8):601-607. doi:10.1001/jama.1994.03510320041027

Objective.  —To assess transdermal nicotine use patterns and outcomes in a population of low-income older smokers.

Design.  —A 6-month telephone follow-up survey of smokers filling prescriptions for transdermal nicotine in the first 3 months of 1992.

Setting.  —Pennsylvania's Pharmaceutical Assistance Plan for the Elderly, the nation's largest state-level prescription plan for the elderly.

Population.  —A total of 1070 noninstitutionalized male and female smokers aged 65 through 74 years.

Main Outcome Measures.  —Self-reported physician/pharmacist advice and adjunctive treatments, concomitant smoking, and 6-month smoking abstinence.

Results.  —Respondents were predominantly long-term heavy smokers. They used nicotine patches for an average of 5 weeks, with few reporting use beyond 3 months or recalling bothersome side effects. Most of those with previous quit attempts rated quitting with the patch "easier." The 29% self-reported 6-month quit rate observed is encouraging. However, compliance with patch use guidelines was far from ideal in this high-risk population: only 54% of respondents received any initial advice or materials from their physicians or pharmacists, fewer than 2% took part in a formal clinic or one-to-one treatment program, and almost half (47%) smoked while using the patch, including 20% who smoked every day. Concomitant smoking was strongly associated with failure to achieve abstinence (P<.001). More frequent contact with physicians and/or pharmacists was associated with less concomitant smoking (P<.001) and higher quit rates (P=.005).

Conclusions.  —This survey offers an important first look at problems and prospects for nicotine patch therapy in older adults, with implications for other groups as well. Prospective studies are needed to clarify optimal treatment regimens and adjuncts.(JAMA. 1994;271:601-607)