What predicts a successful smoking cessation attempt?
In a retrospective survey of 2000 subjects those with less than 5 previous cessation attempts as well as perceived helpful support from friends had a greater likelihood of successful smoking cessation.7 In a retrospective review of socioeconomic factors associated with tobacco cessation among 3575 subjects of the CEASE trial, being a homeowner (OR=1.62) and male gender (OR=1.38) increased likelihood of tobacco cessation at 6 months.8 In a retrospective review of 2684 subjects from the Framingham study, women who smoked less that 1 half-pack per day (OR=2.6) and males who were diagnosed with CAD within the past 2 years (OR=1.9) were more likely to maintain abstinence 1 year after the cessation attempt.9 The TABLE summarizes results from 5 studies focusing on a variety of factors and their effects on smoking cessation.
Counseling frequency and duration impact smoking cessation. In a meta-analysis of 23 studies, the odds ratio for cessation was 1.3 (95% CI, 1.01–1.6) for minimal counseling (<3 minutes), 1.6 (95% CI, 1.2–2.0) for low-intensity counseling (3 to 10 minutes), and 2.3 (95% CI, 2.0–2.7) for high-intensity counseling (>10 minutes).10 In a meta-analysis of 35 studies, smoking cessation increased as total contact time for all counseling sessions increased, peaking at 90 minutes (OR=3.0; 95% CI, 2.3–3.8).10 In a meta-analysis of 45 studies, smoking cessation increased as number of person-to-person counseling sessions increased from 2 to 3 sessions (OR=1.4; 95% CI, 1.1–1.7) to 4 to 8 sessions (OR=1.9; 95% CI, 1.6–2.2) to >8 sessions (OR=2.3; 95% CI, 2.1–3.0).10
A meta-analysis of 62 studies found no impact of relaxation/breathing techniques, contingency contracting, weight/diet counseling, cigarette fading, or negative affect counseling on smoking cessation.10 Successful counseling techniques included providing smokers with problem solving skills (OR for successful smoking cessation=1.5; 95% CI, 1.3–1.8), providing intra-treatment social support (OR=1.3; 95% CI, 1.1–1.6), helping smokers obtain extra-treatment social support (OR=1.5; 95% CI, 1.1–2.1), use of rapid smoking (OR=2.0; 95% CI, 1.1–3.5), and use of other “aversive smoking techniques” (OR=1.7; 95% CI, 1.04–2.8).
TABLE
Factors predicting success or failure for a smoking cessation attempt
| PREDICTING SUCCESS | PREDICTING FAILURE | NONCONTRIBUTING | |
|---|---|---|---|
| Lennox and Taylor1 | Fewer previous attempts to stop | Withdrawal symptoms | Age |
| Increased perceived helpful supports from friends | Cravings | Sex | |
| Increased motivation | Smoke exposure (ie, in restaurants with smoking) | Type of support (smoker vs nonsmoker friends) | |
| Heavy smokers (>1 ppd) | Smoking 1/2-1 ppd | Health issues | |
| Reasons for current attempt | |||
| Westman et al2 | Quit date abstinence (OR=10.6) | ||
| Low tobacco dependence (OR=0.7) | |||
| Kenford et al3 | Abstinence of smoking at 2 weeks after a cessation attempt (OR=4.3 and 23.5 in study 1and 2, respectively) | Any use of tobacco within first 2 weeks of a cessation attempt | Number of cigarettes/day |
| Number of years smoked | |||
| Freund et al4 | Men: increased age (OR=1.3), CAD diagnosed in past 2 years (OR=1.9) | Diagnosis of cancer | |
| Women: low number of cigarettes per day (<2 ppd [OR=0.14]; <1/2 ppd [OR=2.6]) higher education level (OR=1.1) | Decreased FEV1 | ||
| Both: married (OR=1.6); hospitalized in past 2 years (OR=1.3) | Baseline alcohol use | ||
| Gender | |||
| Baseline weight (OR=1.1) | |||
| Monsó et al5 | Low number of cigarettes/day (OR=0.80) | CAD (OR=0.48) | Chronic disease (OR=0.95) |
| Older age (OR=1.17) | Lung disease (OR=0.79) | Depression (OR=0.82) | |
| Males (OR=1.38) | |||
| Homeowners (OR=1.62) | |||
| Ppd, packs per day; CAD, coronary artery disease; FEV1, forced expiratory volume in 1 second; OR, odds ratio | |||
Recommendations from others
The US Public Health Service Clinical Practice Guideline (2000)10 supports the following recommendations, based on rigorously conducted meta-analyses: use of office screening systems to identify smokers; physician advice to quit; use of multiple clinician types in smoking cessation counseling; and treatments delivered by telephone counseling, group counseling, and individual counseling, used alone or in combination, as opposed to self-help materials for smoking cessation.
The US Department of Health and Human Services11 recommends that physicians ask and record tobacco-use status and offer smoking cessation advice and treatment at every office visit. They also recommend the “5 A’s” (Ask, Advise, Assess, Assist, and Arrange) for patients who desire smoking cessation and the “5 R’s” motivational intervention (Relevance, Risks, Rewards, Roadblocks, and Repetition) for those who are not ready to quit smoking.
