Gender differences in the real-world effectiveness of smoking cessation medications: Findings from the 2010–2011 Tobacco Use Supplement to the Current Population Survey

• Published in: Drug and alcohol dependence 2017-09, Vol.178, p.485-491
• Main Authors: Smith, Philip H., Zhang, Ju, Weinberger, Andrea H., Mazure, Carolyn M., McKee, Sherry A.
• Format: Article
• Language: English
• Subjects: Cessation; Clinical research; Clinical trials; Cross-Sectional Studies; Dietary Supplements; Drug addiction; Drugs; Effectiveness; Efficacy; Female; Gender; Gender aspects; Gender differences; Gender Identity; Generalizability; Health Behavior; Humans; Male; Mathematical models; Men; Nicotine; Patch; Pharmacology; Polls & surveys; Propensity; Propensity Score; Sex differences; Sex Factors; Smokers; Smoking; Smoking - epidemiology; Smoking cessation; Smoking Cessation - methods; Surveys and Questionnaires; Tobacco; Tobacco Use - epidemiology; Tobacco Use Cessation Devices; Transdermal nicotine; Varenicline; Varenicline - therapeutic use
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2017.05.046

•Use of varenicline improved odds of 30-day abstinence among women.•Use of transdermal nicotine improved odds of 30-day abstinence among men.•Advantage of varenicline over transdermal nicotine was greater for women than men. Meta-analyses of clinical trial data have identified clinically relevant gender differences in the efficacy of smoking cessation pharmacotherapy. It is unclear whether these findings are generalizable to smokers quitting in real-world contexts. Using Tobacco Use Supplement to the Current Population Survey (TUS-CPS) 2010–2011 cross-sectional data, we generated propensity score matched samples of smokers who quit either unassisted by medication, using only varenicline, or using only transdermal nicotine patch (TNP). We used generalized estimating equations to estimate gender differences in the comparative effectiveness of these cessation options for achieving 30-days of abstinence, adjusting for potential confounders. When stratified by gender, TNP was significantly more effective than unassisted quit attempts for men (OR=1.37; 95%CI=1.02,1.83; p=0.03), but not for women (OR=0.96; 95%CI=0.71,1.31; p=0.82). Varenicline was significantly more effective than unassisted quit attempts for women (OR=1.63; 95%CI=1.16, 2.31; p=0.005), but not men (OR=1.35; 95%CI=0.94,1.96; p=0.11). Varenicline was also more effective than TNP for women (OR=1.51; 95%CI=0.12,2.05; p=0.007) but not men (OR=0.92; 95%CI=0.65,1.31; p=0.64). A significant gender by medication interaction was found only for the comparison of varenicline to TNP (OR=1.64; 95%CI=1.04,2.61; p=0.04). Findings for varenicline vs. TNP were consistent with clinical trial data, showing greater differences in effectiveness for women compared to men. Results lend support to the generalizability of clinical trial findings, highlighting the importance of considering gender when offering treatment for smoking cessation.