Motivational Interviewing for encouraging quit attempts among unmotivated smokers: Study protocol of a randomized, controlled, efficacy trial

ABSTRACT: BACKGROUND: Although current clinical practice guidelines recommend Motivational Interviewing for use with smokers not ready to quit, the strength of evidence for its use is rated as not optimal. The purpose of the present study is to address key methodological limitations of previous studies by ensuring fidelity in the delivery of the Motivational Interviewing intervention, using an attention-matched control condition, and focusing on unmotivated smokers whom meta-analyses have indicated may benefit most from Motivational Interviewing. It is hypothesized that MI will be more effective at inducing quit attempts and smoking cessation at 6-month follow-up than brief advice to quit and an intensity-matched health education condition. METHODS: A sample of adult community resident smokers (N= 255) who report low motivation and readiness to quit are being randomized using a 2:2:1 treatment allocation to Motivational Interviewing, Health Education, or Brief Advice. Over 6 months, participants in Motivational Interviewing and Health Education receive 4 individual counseling sessions and participants in Brief Advice receive one brief in-person individual session at baseline. Rigorous monitoring and independent verification of fidelity will assure the counseling approaches are distinct and delivered as planned. Participants complete surveys at baseline, week 12 and 6-month follow-up to assess demographics, smoking characteristics, and smoking outcomes. Participants who decide to quit are provided with a self-help guide to quitting, help with a quit plan, and free pharmacotherapy. The primary outcome is self-report of one or more quit attempts lasting at least 24 hours between randomization and 6-month follow-up. The secondary outcome is biochemically confirmed 7-day point prevalence cessation at 6-month follow-up. Hypothesized mediators of the presumed treatment effect on quit attempts are greater perceived autonomy support and autonomous motivation. Use of pharmacotherapy is a hypothesized mediator of Motivational Interviewing's effect on cessation. DISCUSSION: This trial will provide the most rigorous evaluation to date of Motivational Interviewing's efficacy for encouraging unmotivated smokers to make a quit attempt. It will provide also provide effect-size estimates of MI's impact on smoking cessation to inform future clinical trials and inform the clinical practice guidelines. Trial registration ClinicalTrials.gov NCT01188018.     

Getting focused: missed opportunities for smoking interventions for pregnant women receiving Medicaid

BACKGROUND: The prevalence of smoking, and cessation and relapse rates for pregnant women have health and financial implications. Our objectives were to describe smoking among pregnant smokers receiving Medicaid including characteristics associated with reporting discussion of smoking with providers and the association between those discussions with quitting and maintenance. METHODS: Analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 15 states for 20,287 women with Medicaid for prenatal care during 1998-2000. RESULTS: Thirty-four percent of women smoked before pregnancy (N = 7,686). Most smokers (93%) and nonsmokers (88%) reported discussions about smoking during prenatal care. Women were less likely to have discussed smoking if they were lighter smokers (OR = 1.47; CI = 1.03, 2.12), or reported a previous low-birthweight infant (OR = 1.72; CI = 1.03-2.86). Women reporting discussions (compared to those not) were less likely to quit (ARR = 0.70: CI = 0.59-0.91). Quitters reporting discussions (compared to those not) were no more likely to maintain cessation (ARR = 0.89; CI = 0.7, 1.21). CONCLUSIONS: Smoking cessation interventions can be improved for pregnant women receiving Medicaid, especially if focused to address individual needs of light smokers, those with previous low-birthweight infants, or those who find it most difficult to quit.     

Latinos report less use of pharmaceutical aids when trying to quit smoking

BACKGROUND: Latino smokers are more likely than white non-Latino smokers to attempt cessation, but less likely to receive cessation advice from physicians or to use nicotine replacement therapy (NRT). Proposed underlying causes have included lighter smoking, lower financial status, and less healthcare access. This study assessed these factors as possible explanations for disparate rates of smoking-cessation support. METHODS: Data were analyzed from a random, population-level telephone survey of Colorado adults that interviewed 10,945 white non-Latino respondents and 1004 Latino respondents. For the current analysis, main outcome measures were receipt of physician advice to quit smoking, use of NRT, and use of bupropion or other anti-depressant for smoking cessation. RESULTS: Latino smokers reported higher prevalence of quit attempts (71.5% v 61.6%, p <0.01) but less physician advice to quit smoking (46.4% v 56.2%, p <0.05) and less use of NRT or an anti-depressant for cessation (10.6% v 24.8%, p <0.0001). Adjusted for potentially confounding factors, the odds ratio (OR) for less Latino use of cessation medications was substantial and significant (full model OR=0.31; 95% confidence interval, 0.17 to 0.57). The adjusted OR for physician cessation advice was not significant. CONCLUSIONS: Population-level differences in health status, smoking level, financial status, or healthcare access do not explain why Latino smokers less often use proven pharmaceutical aids to increase cessation. Further research is needed to understand these disparities, and greater effort is needed to deliver cessation support to Latino smokers seeking to quit.     

Smoking behaviors and regular source of health care among African Americans

OBJECTIVES: The purpose of the study was to determine associations between having a regular source of health care, advice from a physician to quit smoking, and smoking-related behaviors among African American smokers. METHODS: A secondary analysis was conducted on data obtained from an intervention study with a posttest assessment of the effectiveness of smoking status as a vital sign. The setting was an adult walk-in clinic at a large inner-city hospital and 879 African American adult current smokers were examined. RESULTS: Among African American smokers, there was an association between having a regular source of health care and planning to quit smoking within the next 30 days (OR = 1.46; 95% CI: 1.04-2.05), receiving physician advice to quit (OR = 1.46; 95% CI: 1.02-2.10), and smoking < or =10 cigarettes a day (OR = 1.42; 95% CI: 1.00-2.03). CONCLUSIONS: African American current smokers with a regular source of health care were further along the quitting process than those without a regular source of health care. Our findings indicate a potential benefit of complementing programs that increase physician cessation advice rates with policies that increase rates of health insurance and the likelihood that individuals have a regular source of health care.     

甘肃省15～69岁现在吸烟者戒烟意愿及影响因素

  目的  了解甘肃省现在吸烟者的戒烟意愿以及影响因素,为烟草防控工作提供科学依据。  方法  采用多阶段抽样方法,随机抽取15~69岁现在吸烟者作为调查对象。采用《全国居民吸烟情况调查问卷》开展面对面调查,分析不同特征现在吸烟者的戒烟意愿,采用Logistic回归分析模型分析现在吸烟者戒烟意愿的影响因素。  结果  甘肃省现在吸烟者的戒烟意愿为16.4%（95%CI:15.5%~17.3%）,农村地区（OR=1.199,95%CI:1.022~1.408,P=0.026）、家中禁止吸烟（OR=1.767,95%CI:1.273~2.454,P=0.001）、12个月内就医时医务人员劝阻吸烟（OR=1.599,95%CI:1.359~1.842,P < 0.001）、去过戒烟门诊（OR=3.089,95%CI:2.031~4.698,P < 0.001）、初中、高中、大专及以上文化程度（OR=1.383,95%CI:1.101~1.736;OR=1.627,95%CI:1.252~2.116;OR=1.374,95%CI:1.009~1.873,均有P < 0.05）、高烟草危害知识得分为1~,3~,5~6（OR=1.248,95%CI:1.030~1.514;OR=1.574,95%CI:1.289~1.922;OR=2.288,95%CI:1.879~2.786,均有P < 0.05）是现在吸烟者戒烟意愿的促进因素;年龄20~、30~岁组以及烟龄20~、30~年是现在吸烟者戒烟意愿的阻碍因素。  结论  甘肃省现在吸烟者戒烟意愿总体不高,今后应进一步在全社会普及烟草危害知识,加强医务人员戒烟服务能力培训,在诊疗过程中开展戒烟服务,同时应鼓励和支持医疗机构加快戒烟门诊建设。     

Cigarette smoking and smoking cessation among persons with chronic obstructive pulmonary disease

PURPOSE: To identify factors predictive of smoking cessation among adults with chronic obstructive pulmonary disease (COPD). Data from the 1997 to 2002 National Health Interview Surveys were analyzed for adults at least 25 years of age with COPD using logistic regression. RESULTS: Of the adults with COPD, 36.2% were current smokers. Of the current smokers and former smokers who had quit smoking during the past year, 22.9% reported not receiving cessation advice from a health care professional during the past year Although half of smokers with COPD had attempted to quit during the past year, only 14.6% were successful. Attempting to quit was negatively associated with heavy drinking but positively associated with being younger and having cardiovascular diseases, lung cancer, and activity limitation due to lung problems. Factors predictive of successful cessation included being at least 65 years old, not being poor, and activity limitation due to lung problems. CONCLUSION: This study underscores the importance of continuing to develop smoking cessation strategies for COPD patients and implementing clinical guidelines on smoking cessation among health care providers.     

Influence of recruitment strategy on the reach and effect of a web-based multiple tailored smoking cessation intervention among Dutch adult smokers

This study investigated the influence of two different recruitment strategies on the reach and effect of a web-based multiple tailored smoking cessation program. From May 2009 until June 2010, Dutch adult smokers were recruited via mass media or general practices. Those who completed the baseline questionnaire were followed up during 6 weeks (two follow-ups). Differences between the two samples were assessed regarding baseline characteristics, retention rates, quit attempts and 24-hour point prevalence abstinence. Smokers recruited via general practices (N = 409) were significantly lower educated, less addicted, more motivated to quit smoking and to maintain non-smoking, more often female and more often suffering from cardiovascular or respiratory diseases than mass media respondents (N = 1154). They showed higher retention rates and were more likely to report a quit attempt (64.3 versus 50.7%) and abstinence (43.3 versus 33.1%). More respondents could be recruited via mass media, while general practices respondents showed higher retention rates and were more successful in quitting smoking, though these effects became non-significant when controlling for experimental condition and baseline differences. The choice for a particular recruitment strategy appeared to determine the number and type of smokers recruited and might consequently influence the intervention's potential public health impact.     

Approach on smoking cessation by training public health providers

The study evaluated the results of a smoking cessation training program including 40 public health providers from November 2004 to March 2007. A total of 3,419 smokers received minimum individual intervention and 982 had group intervention. Of all, 9.2% quit smoking. The main difficulties for smoking cessation reported by health providers were: low patient compliance (11%); lack of medications (38%); and lack of health unit infrastructure/support (29%). The training allowed to reaching out a larger population through smoking cessation approaches at health units.     

Smoking habits and smoking cessation among North Carolina nurses

A 1987 questionnaire survey of a 1% random sample (n = 356) of registered nurses in North Carolina provided data on the smoking habits and smoking cessation. Fifty-six percent were never smokers; 19% were current smokers. Among the ever smokers, 31% had quit smoking for at least one year. Twenty-two percent of the former smokers had smoked less than 5 years and 39% less than 10 years before quitting. Anecdotal notes from never smokers suggested that their major deterrent to smoking was their own parents smoking. Concerns about the addictive smoking behavior and health effects of smoking observed in their parents as well as concerns about potential health risks to themselves deterred them from smoking. Concerns about the adverse consequences of smoking was the most influential factor influencing smoking cessation and reduction of cigarette smoking. Friends' and family's encouragement to stop smoking was the most influential external factor motivating nurses to quit or reduce cigarette consumption. Fifty-seven percent of the former smokers quit smoking after one or two attempts while 53 of the current smokers had tried to quit 3 or more times - 90% had tried at least once to quit smoking; however, only 18% of the current smokers had abstained for more than one year during any of their attempts to quit. Implications of the results include: (1) smoking cessation programs for nurses in the workplace may have considerable impact since the majority of nurses who smoke are tying to quit; (2) relapse prevention strategies need to be an integral part of such smoking cessation programs including involvement of family and friends to support the smokers in their cessation efforts.     

Smoking patterns and use of cessation interventions during pregnancy

BACKGROUND: Pregnant smokers should be counseled to quit smoking and offered effective cessation interventions. To improve understanding of how best to increase smoking-cessation rates during pregnancy, this study analyzed population-based surveillance data to describe women's smoking patterns and the use of cessation services during pregnancy. METHODS: Data were analyzed from the 2004 and 2005 New Jersey Pregnancy Risk Assessment Monitoring System, a population-based survey of postpartum women (n=4473). Measures of behaviors included the timing of quit relative to the learning of pregnancy, provider assistance, the use of cessation interventions, and barriers to quitting. Analyses were done in 2007 and 2008. RESULTS: An estimated 16.2% (95% CI=15.1, 17.3) of women smoked before pregnancy. Of these, 49.8% quit before entering prenatal care, and 5.2% quit after entering prenatal care. Almost all women reported that their prenatal care provider asked if they smoked, but only 56.7% reported that a provider counseled them to quit smoking. Only 11.5% of women who smoked in late pregnancy used a cessation method, including self-help materials (6.3%); medications (3.9%); face-to-face counseling (1.7%); telephone-based counseling (1.5%); Internet-based counseling (1.3%); and a class or program (1.0%). The most frequently reported barriers to quitting were cravings for a cigarette, stress, and being around people who smoked. CONCLUSIONS: Nearly half of pregnant New Jersey smokers quit before prenatal care, and very few quit later. Few continuing smokers used a smoking-cessation method when trying to quit or cut back. Efforts should be intensified to increase the knowledge, promotion, and referral to effective interventions to help pregnant smokers quit.     

Helping Smokers Quit: Understanding the Barriers to Utilization of Smoking Cessation Services

Context: Counseling smokers to quit smoking and providing them with pharmaceutical cessation aides are among the most beneficial and cost‐effective interventions that clinicians can offer patients. Yet assistance with quitting is not universally covered by health plans or offered by all clinicians. Analysis of stakeholders' perspectives and interests can identify the barriers to more widespread provision of cessation services and suggest strategies for the public policy agenda to advance smoking cessation. Methods: Review of literature and discussions with representatives of stakeholders. Findings: All stakeholders—health plans, employers, clinicians, smokers, and the government—face barriers to broader smoking cessation activities. These range from health plans' perceiving that covering counseling and pharmacotherapy will increase costs without producing commensurate health care savings, to clinicians' feeling unprepared and uncompensated for counseling. Like other preventive measures aimed at behavior, efforts directed at smoking cessation have marginal status among health care interventions. State governments can help correct this status by increasing Medicaid coverage of treatment and expanding coverage for state employees. The federal government can promote the adoption of six initiatives recommended by a government subcommittee on cessation: set up a national quit line, develop a media campaign to encourage cessation, include cessation benefits in all federally funded insurance plans, create a research infrastructure to improve cessation rates, develop a clinician training agenda, and create a fund to increase cessation activities through a new $2 per pack cigarette excise tax. Both the federal and state governments can increase cessation by adopting policies such as the higher cigarette tax and laws prohibiting smoking in workplaces and public places. Conclusions: Public policy efforts should assume greater social responsibility for smoking cessation, including more aggressive leadership at the state and federal levels, as well as through advocacy, public health, and clinician organizations.     

Smoking cessation and lung cancer mortality in a cohort of middle-aged Canadian women

PURPOSE: To determine the impact of smoking cessation on lung cancer mortality among women. METHODS: Survival analysis is used to assess the effect of smoking cessation on lung cancer death in the dietary cohort of 49,165 women aged 40 to 59 years enrolled in the Canadian National Breast Screening Study. RESULTS: During an average of 10.3 years of follow-up, 106 women died of lung cancer. The risk of lung cancer mortality among women who quit before age 50 (HR=0.26; 95% CI, 0.13-0.55 among women who quit at ages 40-49) or quit in the previous 10 years (HR=0.39; 95% CI, 0.22-0.69) is substantially lower than the risk among current smokers. Women who quit after age 40 or have quit for less than 20 years are at substantially higher risk of lung cancer mortality compared with never smokers. Both duration of smoking cessation and age at quitting have independent effects on lung cancer mortality, after controlling for number of cigarettes smoked per day and number of years smoked, as well as other potential confounding variables. CONCLUSION: These findings suggest that programs and policies to promote early cessation of smoking and prevention of relapse should be a public health priority.     

Motives for smoking cessation are associated with stage of readiness to quit smoking and sociodemographics among German industrial employees

PURPOSE: To test the relationships among particular motives for smoking cessation, stage of readiness to quit (preparation or contemplation), and sociodemographic characteristics. DESIGN: A cross-sectional study to examine attitudes toward and use of health promotion at the worksite, using a self-administered questionnaire. SETTING: Two German metal companies. SUBJECTS: Of 1641 responding employees (response rate 65% in company A and 44% in company B), 360 smokers who intended to quit immediately (n = 105) or in the near future (n = 255) were analyzed. MEASURES: The questionnaire comprised of sociodemographic characteristics, smoking behavior, smoking history, readiness to quit smoking, motives to quit, such as coworkers' complaints and health-related or financial concerns. Chi-squared tests and multiple logistic regression analyses were performed. RESULTS: Health-related reasons (94%) predominated financial (27%) or image-related (14%) reasons for smoking cessation. Participants in the cessation preparation group were more likely to report an awareness of being addicted (79.6% vs. 58.2%; p < .001) and the negative public image (22.5% vs. 11.6%; p < .01) as reasons for quitting compared with those in the contemplation group. In multivariable regression models, the motives for smoking cessation, including reduced performance, family's and coworkers' complaints, pregnancy/children, and negative public image, but not health-related and financial concerns, differed significantly by gender, age, marital status, education, and occupational status. CONCLUSIONS: Motives for smoking cessation vary according to the individual's level of readiness to quit and sociodemographic background.     

Views of Ontarians about health professionals' smoking cessation advice

BACKGROUND: Health professionals have important roles in helping smokers quit. However, it is not known how the public, especially smokers, view smoking cessation advice from different health professionals. METHODS: We added questions regarding opinions and experiences with health professionals' smoking cessation advice to the 2002 CAMH Monitor, an annual random-digit-dialled survey of adult Ontarians. We report on how good a source of advice physicians, pharmacists, and dentists are perceived to be, how likely smokers are to consult each of these professionals, who smokers would ask for advice on the use of NRT, and advice received by smokers in the past year. RESULTS: About two thirds of respondents viewed physicians as a very good source of advice on quitting, compared to just over one third and about one quarter who thought this of pharmacists and dentists, respectively. Over half of current smokers would be very likely to ask a physician for quit advice, compared to about 20% and only 3% for a pharmacist or a dentist, respectively. Among smokers, over 40% would first ask a physician for advice on NRT; about 20% would first ask a pharmacist. About 42% and 8% of current smokers reported that they received advice in the past year from a physician and pharmacist, respectively. INTERPRETATION: Smokers are receptive to quit advice from physicians, but less likely to ask other health professionals. Few smokers received advice from pharmacists and dentists. Increasing the reach of quit advice requires both increased professional intervention and education of the public.     

天津市居民吸烟及戒烟状况调查分析

目的：了解天津市居民吸烟状况、戒烟想法及戒烟方法的应用,为有针对性地在居民中开展健康教育活动提供依据,同时为制定相关控烟政策提供基础数据。方法使用 PPS 法(按规模大小成比例的概率抽样)在每个区抽取3个街道,共计16个区。使用 PPS 在每个街道抽取2个居委会抽样单位,采用随机抽样方法在每个居委会抽取70个家庭户,每个家庭户采用 KISH 表抽取1名调查对象,每个居委会完成50份调查问卷。结果男性现在吸烟率为42.35%,女性现在吸烟率为10.32%,男性吸烟率高于女性(χ2=760.956,P <0.05),不同文化程度居民吸烟率差异有统计学意义(χ2=95.605,P <0.05)。男性与女性现在吸烟者戒烟意愿差异无统计学意义(χ2=2.959,P >0.05),不同吸烟量的现在吸烟者戒烟意愿差异有统计学意义(χ2=30.434,P <0.05),随着吸烟者吸烟量的增大,想戒烟的比例也在逐渐降低。89.18%现在吸烟者选择靠自己毅力戒烟,7.06%选择拨打戒烟热线。在过去12个月,有42.25%医护人员建议吸烟者戒烟。非吸烟者对主动吸烟及吸入二手烟的危害知晓率高于吸烟者,有戒烟想法的人主动吸烟及吸入二手烟的危害知晓率高于吸烟者。结论应积极开展控烟工作,有针对性地对男性、女性吸烟者开展控烟干预工作,加大戒烟门诊、戒烟热线的宣传,提高医务人员的戒烟知识和戒烟技巧,广泛宣传主动吸烟与被动吸烟的危害,同时政府部门加强控烟法律执行力度,保证人民群众不受二手烟的危害。     

The feasibility of a proactive stepped care model for worksite smoking cessation

Worksite smoking cessation interventions have achieved some success, but until recently have only intervened on those smokers at a stage of readiness to volunteer to participate in cessation programs. The present study assesses whether a sustained, proactive smoking cessation program based on a stepped care model that targets all smoking employees in the worksite can actually be delivered. In one worksite in Seattle (N = 273), a worksite-wide survey with a 99.3% response rate identified 53 smokers; subsequent new-hires added an additional 14 smokers to the worksite. This study delivered increasingly intensive intervention to those smoking employees who failed to quit smoking during the study period of 1.5 years. Telephone contacts (every 3 months) provided motivational messages tailored to the smokers' stage of cessation. Subsequent more intensive steps included self-help manuals and referrals to formal programs. The intervention also used community organization strategies, such as employee guided worksite activities to complement the individual and stepped strategies. In the study period, 18% of the smokers quit smoking. Participation rates in activities were good and on average worksite smokers moved over one stage of change from baseline toward quitting smoking.     

Peer Reviewed: Lost Opportunities for Smoking Cessation Among Adults With Diabetes in Florida (2007) and Maryland (2006)

Introduction

Diabetes organizations recommend that people with diabetes should not smoke because of increased risk of diabetes complications. We describe smoking rates and health care service use among adults with diabetes in Florida and Maryland and identify the role of dentists in offering smoking cessation advice and services.

Methods

We analyzed data from 3 state telephone surveys: the 2007 Florida Behavioral Risk Factor Surveillance Survey (n = 39,549), the 2007 Florida Tobacco Callback Survey (n = 3,560), and the 2006 Maryland Adult Tobacco Survey (n = 21,799).

Results

Findings indicated that 15.7% of adults with diabetes in Florida and 11.6% of adults with diabetes in Maryland currently smoke. Current smoking among people with diabetes was associated with age, education, income, and race/ethnicity. Almost all respondents with diabetes who were current smokers in Florida (92.9%) and Maryland (97.7%) had visited a doctor or health care professional in the past year, and less than half had visited a dentist (40.7% and 44.8%, respectively). Both in Florida and Maryland, approximately two-thirds of adults with diabetes who were smokers and had visited a dentist in the past year had not received advice to quit (63.8% and 63.9%, respectively). In contrast, most adults with diabetes who were smokers and had visited a doctor or health care professional had received advice to quit smoking (95.3% and 84.9%, respectively).

Conclusion

Dentists are in a unique position to identify and demonstrate the oral effects of smoking in patients with diabetes. These data support continued smoking cessation training and education of oral health professionals.     

北京市社区吸烟者尝试戒烟行为及其影响因素研究

目的调查分析北京市成年吸烟者的尝试戒烟行为及影响因素。方法2018年12月至2019年8月,基于流行病学横断面研究,采用面对面问答式问卷调查。调查对象为18岁以上的社区吸烟者,调查内容包括基本人口学信息、烟草使用情况、尝试戒烟行为、烟草相关知识的认知、戒烟支持环境评估等;采用描述性分析统计调查对象的戒烟尝试行为,并采取χ2检验对其戒烟尝试行为与其社会人口学指标、烟草使用情况、烟草相关问题认知、戒烟支持环境等因素进行关联分析;采用二分类Logistic回归进一步探讨各因素与尝试戒烟行为的关系。结果共纳入449名调查对象,其中男性410人(91.3%),尝试戒烟与未尝试戒烟的分别为272人(60.6%)和177人(39.4%);月收入水平、烟草相关知识评估得分、周围人对戒烟的支持程度、过去1年是否就医、就医次数、过去1年是否有医务人员规劝戒烟、是否被医务人员询问过吸烟情况等因素为尝试戒烟行为的相关因素(P<0.05);Logistic回归分析显示,使尝试戒烟行为可能性提高的因素有月收入水平(OR=1.271,95%CI:1.081~1.493)、周围人对戒烟的支持(OR=1.251,95%CI:1.035~1.512)、过去1年有医务人员建议戒烟(OR=2.382,95%CI:1.054~5.381)。结论健康状况、环境支持、危害认知、经济水平、医生劝导等因素皆影响着尝试戒烟行为,自我毅力不足和他人影响是导致戒烟失败的主要原因。将社区场所作为干预基本单位,结合专业指导,形成医院-社区-线上综合联动的戒烟干预模式,是烟草依赖管理模式优化的新思路。     

Acceptance of the smoking cessation intervention in a large population-based study: the Inter99 study

AIMS: Potential exists for improving the impact of quit-smoking programmes, by recruiting smokers in early motivational stages, by using active recruitment strategies, and by offering professional assistance to quit. METHODS: This was a randomized population-based intervention study, in Copenhagen, Denmark. A total of 2,408 daily smokers in all motivational stages were included. All participants completed a questionnaire, and underwent a health examination and a lifestyle consultation. Smokers in the high-intensity intervention were offered assistance to quit smoking in smoking cessation groups. RESULTS: Before the lifestyle consultation only 11% of the smokers stated that they planned to quit within one month. After the lifestyle consultation 27% accepted smoking cessation in groups and an additional 12% planned to quit without assistance. Of the smokers who accepted smoking cessation groups 23% had not been planning to quit before the lifestyle consultation. Being a woman, having high tobacco consumption, having a long smoking history, having tried to quit within the previous year, and having a higher motivation to quit predicted participation in smoking cessation groups. CONCLUSIONS: It was possible to recruit a large number of smokers in early motivational stages by using active recruitment strategies and by offering assistance to quit. Lifestyle consultations markedly increased the number of smokers willing to try to quit. Smokers preferred assistance to quit in a smoking cessation group to quitting on their own; therefore, it is important to improve recruitment strategies for smoking cessation programmes.     

Predictors of attempted quitting and cessation among young adult smokers

BACKGROUND: This study compared young adult nonsmokers (n = 1216), light smokers (n = 406), and regular smokers (n = 360) on demographic, psychosocial, and behavioral characteristics, as well as identified predictors of attempted quitting and 6-month cessation among regular smokers. METHOD: Participants were recruited from middle schools in 1985 (age 13) and assessed repeatedly through 2001 (age 29). Mail surveys were used to obtain information on smoking status and hypothesized predictors of cessation at age 23, and quit attempts and cessation occurring between ages 23-39 among regular smokers. Logistic regression analysis was used to identify predictors of quit attempts and 6-month cessation. RESULTS: Among initial smokers, 76% attempted to quit and 26% quit for 6 months or longer between ages 23-29. Higher rates of substance use, illegal activity, poor mental health, and victimization were found among regular smokers than nonsmokers and lighter smokers at age 23. However, multivariate analyses indicated that these problems were less relevant to quitting than social transitions and interpersonal factors, demographics (e.g., race/ethnicity), and health status. CONCLUSIONS: Different risk and protective factors are relevant to understanding why smokers attempt to quit versus why they are able to quit for 6 months or longer. We discuss implications of these findings for cessation interventions and programs for young adults.