NEW ORLEANS – Low-income smokers prescribed bupropion in primary care settings are less successful with smoking cessation than participants in controlled trials, according to a study presented at the annual conference of the Society of Teachers of Family Medicine.
Multicenter trials indicate that sustained-release bupropion helps 44% quit at 7 weeks, compared with 19% taking a placebo (N. Engl. J. Med. 1997;337:1195–202) and 58% of cigarette smokers quit at 9 weeks, compared with 16% taking a placebo (N. Engl. J. Med. 1999;340:685–91).
But participants in those bupropion trials did not reflect the patient population in Fresno County, according to Evelyn Fang, M.D. The county has a 23% poverty rate (vs. 14% for California), a high rate of stroke and heart disease, and an increasing rate of lung cancer deaths.
Physicians at one family medicine clinic and two internal medicine clinics associated with the University of California, San Francisco, Fresno campus, screened and referred patients to Dr. Fang and her associates. The researchers enrolled 72 participants over 3 months from the University of California, San Francisco, Fresno residency-affiliated training sites.
Dr. Fang, who is no longer with the university, was a clinical instructor in medicine when the study was conducted. John Zweifler, M.D., also of the University of California, San Francisco, Fresno, presented the study at the meeting.
Participants received a free 30-day supply of bupropion with one refill. They took one pill every day for 3 days, then increased to two pills daily, and were advised to stop smoking after 7 days. The researchers surveyed participants by telephone at 30 days and 60 days. A total of 57 patients completed the follow-up and were studied further.
The mean age was 47 years and 65% were female. The group was 61% Caucasian, 19% Hispanic, 18% African American, and 2% Asian. Participants reported a median of two previous attempts to quit smoking and a median of 30 years of cigarette smoking.
A total of 17% stopped smoking at 3 months, as did 18% at 6 months.
Sustained-release bupropion may help low-income smokers in real clinical settings quit smoking, Dr. Zweifler, M.D., said, but the effect was less than half of what has been previously reported in highly controlled trials of more motivated patients.
Limitations of the study include the sample size and lack of a control group. Future studies should assess bupropion in low-income smokers with psychiatric conditions, as well as investigate cost-effective alternatives to assist patients in this population stop smoking, Dr. Zweifler said.