Natural History of Attempts to Change Smoking in Self-Quitters

1. Natural History of Attempts to Change Smoking in Self-Quitters John R Hughes, Laura J Solomon, James Fingar, Shelly Naud, John E Helzer University of Vermont

2. Purpose of Study • To describe the patterns of smoking change (i.e. quit attempts, reduction, lapses, and relapses) among self-quitters • To determine if cognitions or environmental cues most determine onset of a quit attempt

3. Rationale • Many longitudinal studies examine what happens after a quit attempt, none have examined what happens before a quit attempt • Most descriptions of smoking cessation are based on the small percent of smokers willing to attend a research study

4. Methods • 152 smokers who planned to quit in the next 3 months • Recruited from across US • No treatment provided • Conducted by phone, mail and internet

5. Methods • Called nightly into IVR for 3 month • Reported smoking (cigs/day and quit attempt) • Reported intentions daily (“Do you plan to smoke tomorrow?”)

6. Sample Characteristics • Mean age = 45 • 67% women • 23% minorities • Mean cigs/day = 19 • Mean FTND = 5.3 • More like self-quitters than treatment seekers

7. Examples of changes in cessation, reduction, and intention

8. Major results • 52% had multiple (> 3) episodes of intention to quit • 60% of smokers had multiple episodes of abstinence and reduction • Among the days of intended abstinence, only 85% resulted in a quit attempt • 65% of quit attempts began in the morning

9. Major Results • 72% of quit attempts were not preceded by intention to quit • Unintended quit attempts were less, not more, successful than intended quit attempts (< 1 day vs 25 days) • Reduction was as common an outcome as abstinence

10. Major results • Making a failed quit attempt early in the study predicted a greater, not smaller, probability of a later quit attempt • On the longest quit attempt of each smoker, 48% lasted less than a day • 18% of quit attempts resulted in abstinence at the end of the study • When a lapse occurred, 60% of the time smokers immediately returned to daily smoking

11. Major Results • When asked about quitting at the end of the study, 17% of smokers stated they did not make a quit attempt but during the study reported a quit attempt. Most forgetting of quit attempts was for attempts that did not last for a day

12. Limitations • Asking daily about quitting may have influenced outcomes • The sample was of those planning to quit in next 3 months (about 30% of US smokers)

13. Conclusions • Smoking cessation attempts are much more complex than most assume • Smokers had multiple and often rapid attempts to stop or reduce during the 3 months • Most intentions do not result in quit attempts

14. Conclusions • Most quit attempts were unplanned • Unplanned quit attempts were less successful • Reduction was as common as cessation • Failed quit attempts do not produce less motivation to quit • Half of quit attempts failed the first day • Smokers often forget about short quit attempts

15. Implications • A failed quit or reduction attempt is a marker for more attempts to change in the near future • Failure to quit does not result in less interest in quitting in the near future • We need to encourage smokers to return after failure, including proactive contacts after failure

16. Studies with the Highest Long-Term (> 1 Yr) Quit Rates Are Those That Included Recontacting Failures • MRFIT, 81 41% • Lung Health, 01 35% • Hall, 04 52%

17. Association for the Treatment of Tobacco Use and Dependence An organization of providers dedicated to the promotion of and increased access to evidence-based tobacco treatment for the tobacco user. www.attud.org