Which smoking cessation product is better for people trying to wean themselves from cigarettes: nicotine gum, the patch, a new nasal spray or an inhaler that mimics the hand and mouth actions one uses to smoke?

A new study of 504 smokers, one of the first to directly compare common nicotine replacement products, has found little difference in effectiveness.

A team of British researchers led by Peter Hajek of the Royal London School of Medicine and Dentistry, sought to determine the relative effectiveness and ease of use of four smoking cessation products.

The study, which appeared in the Sept. 27 issue of the Archives of Internal Medicine, was limited to people over the age of 18 who had smoked an average of half a pack a day, were in good health and had not tried to quit in the previous three months by using a nicotine replacement product.

Participants in the study were required to buy nicotine replacement products for half price, unlike many previous studies that have provided the aids for free. Hajek and his team said they imposed this rule to mimic real-life conditions.

Hajek and his colleagues at the University of London found no significant differences in abstinence, cravings or withdrawal symptoms among the four groups. At the end of 12 weeks about one in five people in each group had managed to stay off cigarettes.

There were differences, however, in the ease of use and compliance rates. Smokers were most likely to use the patch at its recommended dose. Some used the gum, inhaler or spray more sparingly than was recommended, possibly to save money.

--Sandra G. Boodman


Older heart attack patients covered by HMOs receive care that compares favorably with treatment of those covered by traditional health insurance plans, a Minnesota study reports.

The findings suggest that the quality and timeliness of emergency care for older heart attack patients "are generally similar for HMO and [fee-for-service] insurance coverage," researchers concluded.

HMO patients were slightly more likely to receive two types of care that can play an important role in treatment of heart attacks: aspirin therapy and use of emergency transit.

Researchers said the study is the first large comparison of elderly heart attack patients covered by HMOs with those covered by traditional fee-for-service plans.

The study is based on medical records of more than 2,300 heart attack patients aged 65 or older at 20 hospitals in four Minnesota cities: Minneapolis, St. Paul, Duluth and St. Cloud.

Researchers said they undertook the study to test the widespread concern "that health maintenance organizations (HMOs) may withhold or delay the provision of urgent, essential care, especially for vulnerable patients like the elderly."

But the new work "strongly suggests that no indicators of the quality of urgent care for elderly patients with [heart attack] are lower under HMO versus [fee-for-service] insurance coverage" in Minnesota, they concluded.

Patient care was compared on several measures: use of an ambulance; whether or not treatment was delayed more than six hours from onset of symptoms; how long it took to get an electrocardiogram of the heart; and whether eligible patients were given three medications known to benefit heart attack patients: aspirin, anti-clotting drugs and beta-blockers.

By all of those standards, HMO patients received care that, on average, was the same as or better than non-HMO patients.

The study was conducted by researchers at Harvard Medical School and Harvard Pilgrim Health Care in Boston; the University of Massachusetts Medical School, Meyers Primary Care Institute and Fallon Healthcare System in Worcester, Mass; and the Healthcare Education and Research Foundation in St. Paul. The findings appeared last month in the Archives of Internal Medicine.

--Don Colburn


A decline in consumption of hard liquor may help explain the steady drop since the 1970s in U.S. death rates from cirrhosis, a new study suggests.

Chronic, heavy drinking of any alcoholic beverage can cause cirrhosis, a condition in which the liver is gradually destroyed by inflammation and scarring. But the new analysis by researchers at the University of California at San Francisco (UCSF) suggests that distilled spirits may be especially implicated in the pattern of cirrhosis deaths.

U.S. mortality rates from cirrhosis rose by 75 percent between 1950 and the early 1970s. In 1973, when the cirrhosis mortality rate peaked, 33,350 Americans died of the disease--a rate of 14.9 deaths per 100,000 people. Cirrhosis mortality then began to decline, even as per capita alcohol consumption continued to rise to a peak in the early 1980s of 10.45 liters of alcohol per capita among people of drinking age.

By 1993, the cirrhosis death rate had dropped to 7.9 deaths per 100,000 people. Meanwhile, alcohol consumption had declined moderately, to 8.36 liters per capita by the mid-1990s.

The UCSF scientists also examined consumption trends for spirits, beer and wine. Consumption of hard liquor peaked in the early 1970s and then declined, in a pattern that closely reflects cirrhosis mortality rates. In contrast, beer consumption rose steadily during the 1970s and wine consumption remained relatively constant.

Roy Roizen, a sociologist on the UCSF research team, said the striking link between per capita consumption of spirits and cirrhosis death rates has not been previously reported and deserves further investigation.

The study appeared in the Sept. 11 issue of the British Medical Journal.

--Susan Okie