Discussion
fatigue, UC
Adaptation to varenicline and/or bupropion + NP after the failure of NP monotherapy did not significantly improve abstinence rates for Black adults who smoke relative to continued treatment with NP. The lack of treatment association was not explained by group differences in interest of quitting at study onset, early response to NP, or cessation fatigue.The lack of treatment association is largely explained by a lower-than-expected effect of adapted therapy, with ADT rescuing only 5% of adults who smoke as opposed to the 15% anticipated. That UC worked as well as ADT is encouraging given that UC requires fewer components, is less costly, and is easier to manage within the health care system. Our findings add to a growing body of literature suggesting that multicomponent interventions increase participant burden and decrease adherence without conferring additional treatment benefit and lead to lower rates of abstinence than interventions with fewer components.The lack of treatment association is also explained by the fact that nearly one-third of those in ADT never required adaptation (ie, remained on NP monotherapy). Participants who responded to NP during the first 2 weeks had 5 times greater odds of achieving abstinence at the primary end point relative to those who did not respond. This finding is consistent with the tipping point hypothesis, which suggests that individuals close to a hypothetical tipping point benefit greatly from limited and varied interventions, while those far from the tipping point benefit very little from even a strong intervention.The quit rates achieved overall were lower than projected and lower than those achieved by Black adults who smoke and were using NP patch therapy in similar studies,