Predictors of adherence to pharmacological and behavioral treatment in a cessation trial among smokers in Aleppo, Syria

Introduction:  The development of evidence-based smoking cessation programs is in its infancy in low income countries like Syria, which are suffering the brunt of the tobacco epidemic.  Adherence to treatment recommendations is an important determinant of the success of smoking cessation programs, but little is known about factors influencing adherence to either pharmacological or behavioral treatment in such countries.  Our study represents the first attempt to examine the predictors of adherence to cessation treatment in any low-income country.

Methods: We examined correlates of adherence to pharmacologic (nicotine patch) and behavioral treatment (in-person + phone contact) in a multi-site, two-group, parallel-arm, double-blind, randomized, placebo-controlled smoking cessation trial in primary care clinics in Aleppo, Syria. All subjects received 3 in-person behavioral counseling sessions plus 5 brief follow-up phone counseling sessions, and were randomized to receive either 6 weeks of nicotine patch or placebo patch. 

Results: Of the 269 participants, 68% were adherent to patch, and 70% adhered to behavioral counseling. In logistic regression modeling, participants with higher daily smoking at baseline, greater withdrawal symptomatology, and who believed they were receiving placebo instead of active nicotine patch were less adherent to both behavioral and pharmacological treatment.  In addition, women were less adherent to behavioral treatment than men, and being assigned to the placebo condition and baseline waterpipe smoking were associated with less adherence to pharmacologic treatment.  

Conclusion: Our findings suggest that cigarette smokers in low-income countries like Syria may benefit from integrated cessation components that provide modified intensive treatment for subjects who have higher withdrawal symptoms, heavier cigarettes smoking and concurrently use waterpipe.