Snowball sampling by mail: application to a survey of smokers in the general population

BACKGROUND: In a series of surveys intended for current and former smokers but sent to a random sample of the general population, we asked never smokers and smokers who did not wish to participate to transmit the questionnaire to any ever smoker they knew. We compared participants who received the questionnaire directly from us (original participants) to participants who received it from an addressee (secondary participants). METHODS: Questionnaires on smoking were mailed to 3300 residents of Geneva (Switzerland) in 1997, and returned by 1167 people (35%). RESULTS: The final sample consisted of similar numbers of original participants (n = 578, primary response rate = 18% of total sample, or about 46% of ever smokers) and secondary participants (n = 566). Original participants were 1.7 years older than secondary participants (P = 0.03) and were more likely to be men (50% versus 43%, P = 0.009). Proportions of current smokers, stages of change, confidence in ability to quit smoking, cigarettes per day and attempts to quit smoking were similar in the two groups. Secondary participants had lower self-efficacy scores (-0.30 standard deviation (SD) units, P < 0.03), and they derived more pleasure from smoking (+0.25 SD units, P = 0.04). Among ex-smokers, direct participants were less active than secondary participants in coping with the temptation to smoke (-0.58 SD units, P = 0.002). Associations between smoking-related variables were similar in original and secondary participants. CONCLUSION: Allowing non-eligible addressees to transmit the questionnaire to someone else doubled the response rate, produced moderate bias on some variables only and had no detectable impact on associations between smoking-related variables.     

拒烟自我效能、吸烟合理化信念与戒烟意愿的关联——基于上海336名男性吸烟者调查问卷的分析

目的探索影响吸烟者戒烟意愿的因素,为开展有针对性的戒烟干预提供参考。方法采用目的抽样方法从上海市4个居民社区和3家公司中招募吸烟者进行线上问卷调查,问卷调查内容包括一般人口学特征、戒烟意愿、吸烟状态、吸烟成瘾性、烟草危害认知、拒烟自我效能、吸烟合理化信念等信息。采用独立样本t检验、χ2检验以及多因素logistic回归分析进行统计学分析。结果共回收有效问卷336份。吸烟者的年龄为（37.1±10.2）岁,58.3%的文化水平为大专、本科及以上,平均每日吸烟量为（11.46±7.22）支,吸烟者中属于轻度尼古丁依赖者较多（58.3%）,计划在未来6个月内戒烟者248名（73.8%）。与低拒烟自我效能者相比,高拒烟自我效能的吸烟者具有戒烟意愿的可能性更大（OR=2.406,95%CI:1.357~4.267）;低吸烟合理化信念的吸烟者较高吸烟合理化信念者更有可能具有戒烟意愿（OR=2.112,95%CI:1.167~3.821）。结论吸烟者拒烟自我效能和吸烟合理化信念可对其戒烟意愿分别产生积极和消极的影响,开展控烟工作时可以关注吸烟者拒烟自我效能的提升和吸烟合理化信念的纠正,从而提高吸烟者的戒烟意愿。     

Association of sociodemographic factors, smoking-related beliefs, and smoking restrictions with intention to quit smoking in Korean adults: findings from the ITC Korea Survey

Background

Few studies have reported the factors associated with intention to quit smoking among Korean adult smokers. This study aimed to examine sociodemographic characteristics, smoking-related beliefs, and smoking-restriction variables associated with intention to quit smoking among Korean adult smokers.

Methods

We used data from the International Tobacco Control Korea Survey, which was conducted from November through December 2005 by using random-digit dialing and computer-assisted telephone interviewing of male and female smokers aged 19 years or older in 16 metropolitan areas and provinces of Korea. We performed univariate analysis and multiple logistic regression analysis to identify predictors of intention to quit.

Results

A total of 995 respondents were included in the final analysis. Of those, 74.9% (n = 745) intended to quit smoking. In univariate analyses, smokers with an intention to quit were younger, smoked fewer cigarettes per day, had a higher annual income, were more educated, were more likely to have a religious affiliation, drank less alcohol per week, were less likely to have self-exempting beliefs, and were more likely to have self-efficacy beliefs regarding quitting, to believe that smoking had damaged their health, and to report that smoking was never allowed anywhere in their home. In multiple logistic regression analysis, higher education level, having a religious affiliation, and a higher self-efficacy regarding quitting were significantly associated with intention to quit.

Conclusions

Sociodemographic factors, smoking-related beliefs, and smoking restrictions at home were associated with intention to quit smoking among Korean adults.Key words: intention to quit, sociodemographic factors, smoking-related beliefs, smoking restrictions, smokers     

Quit attempts among African American teenage smokers seeking treatment: gender differences

BACKGROUND: African Americans experience disproportionate smoking-related mortality. Because established smoking during youth predisposes to adult smoking and serious health consequences, characterizing ethnic differences in adolescent smokers' self-quit attempts may inform ethnic-specific approaches to youth smoking cessation. METHODS: African American and European American teenage smokers applying to a teenage smoking cessation study (2000-2003) provided smoking-related data, including characteristics of previous cessation attempts and prior use of nicotine replacement therapy (NRT). Tobacco dependence was assessed using the Fagerstrom Test of Nicotine Dependence (FTND). RESULTS: Of 980 (15.5 +/- 1.3 years, 41.8% African American, 59.9% female) participants, African Americans boys were significantly less likely than European American boys to report a prior quit attempt (OR = 0.35, 95% CI 0.17-0.73, P = 0.0049) or to have used NRT (OR = 0.60, 95% CI 0.36-0.998, P = 0.049) after adjusting for years smoked and FTND score. African American girls were more likely to report a prior request for cessation treatment than European American girls after adjusting for FTND and years smoked (OR = 2.19, 95% CI 1.37-3.48, P = 0.001). CONCLUSIONS: While increasing education and outreach to African American boys and enhancing access to formal cessation programs for African American girls who smoke may be beneficial, our findings warrant extension to non-treatment-seeking teenage smokers.     

Smoking by French general practitioners: behaviour, attitudes and practice

INTRODUCTION: This paper examines smoking prevalence, sociodemographic factors and the medical practice of French general practitioners. METHOD: Data from the 1998 cross-sectional national survey of 2,073 GPs. The questionnaire was administered by telephone. A response rate of 67% was attained. Instrumentation included questions about medical practice, sociodemographic characteristics, and health behaviour. Bivariate and multiple logistic regression (MLR) analyses were conducted. RESULTS: Almost one-third (32.1%) of physicians were current smokers. A significantly higher proportion of male (33.9%) were smokers compared to women (25.4%, p<0.001) and men were more likely to be former smokers (49.1% versus 31.7%). Two-thirds of physicians reported recommending nicotine replacement therapy to their patients. MLR shown that former smokers were more likely (OR = 1.51, 95% CI, 1.24-1.83) to indicate that their help in getting patients to quit was not effective compared to smokers. Also, physicians who were 'dissatisfied' with the profession were more likely (OR = 0.75, 95% CI, 0.60-0.92) to report their help as not effective than those who were 'satisfied'. CONCLUSION: These data support the need for greater professional participation in reducing smoking among general practitioners in France and greater education concerning the vital role of physicians in promoting cessation among the general population. KEY POINTS: This study examines smoking habits among French GP's, intervention practices, and opinions about their ability to help patients quit smoking. This study found a smoking prevalence rate of 32.1%, 33.9% of male physicians were smokers and 25.4% of women. This study found a smoking prevalence rate of 32.1%, 33.9% of male physicians were smokers and 25.4% of women.     

A survey of smoking and quitting patterns among black Americans.

A sample of adult Black policyholders of the nation's largest Black-owned life insurance company was surveyed in 1986 to add to limited data on smoking and quitting patterns among Black Americans, and to provide direction for cessation initiatives targeted to Black smokers. Forty per cent of 2,958 age-eligible policyholders for whom current addresses were available returned a completed questionnaire. Population estimates for smoking status agree closely with national estimates for Blacks age 21-60 years: 50 per cent never-smokers; 36 per cent current smokers; 14 per cent ex-smokers. Current and ex-smokers reported a modal low-rate/high nicotine menthol smoking pattern. Current smokers reported a mean of 3.8 serious quit attempts, a strong desire and intention to quit smoking, and limited past use of effective quit smoking treatments and self-help resources. Correlates of motivation to quit smoking were similar to those found among smokers in the general population, including smoking-related illnesses and medical advice to quit smoking, previous quit attempts, beliefs in smoking-related health harms/quitting benefits, and expected social support for quitting. Methodological limitations and implications for the design of needed Black-focused quit smoking initiatives are discussed.     

I will quit tomorrow... Statistical portrayals of "dissonant smokers''

BACKGROUND: This article aims to profile dissonant smokers (smokers who want to quit) from various viewpoints: smoking habits, reasons to quit, methods of quitting, health and socio-economic status. METHODS: We used data from a random phone survey (n=13,685, people aged 12-75, including 2,715 dissonant smokers, interwiewed from November to December, 1999). A cluster analysis was performed in order to identify contrasted profiles of dissonant smokers. RESULTS: 33.1% of French aged 12-75 were current smokers, and among them 58.7% were "dissonant smokers" (they want to quit). Five different profiles of dissonant smokers were studied. Two of them (representing 4 million people) gathered moderate and quite healthy smokers, with many previous smoking cessation attempts. They preferred cessation without medical help and they were not very afraid of smoking-related diseases. A third profile (representing two million people) gathered younger smokers, not really committed to quit since they postponed this project for at least one year, but sensitive to cigarette price. The last two profiles brought together smokers who were for the most part addicted to tobacco. They were also more willing to accept medical help in order to quit smoking. One of these profiles gathered smokers (representing one million people) who were very afraid of smoking-related diseases and affected by poor health and social handicaps. CONCLUSIONS: The variety of dissonant smokers profiles underlines the need to diversify action against tobacco. Moreover, we have to pay attention to the impact of recent fear-arousing media campaigns. They certainly increase awareness of smoking-related health damages. Nevertheless, concerning addicted smokers who already want to quit but are affected by poor health and social handicaps, such campaigns may only increase psychological distress.     

Smoking-related attitudes and their sociodemographic correlates among Mexican-origin adult smokers

The purpose of the study was to describe smoking-related knowledge and attitudes of a specific group of Latino smokers, and to identify sociodemographic correlates. This study is one of the few to provide information about smoking-related psychosocial variables and their correlates among a Latino subgroup. A survey was administered to a volunteer sample of adult smokers of Mexican-origin (n = 278) to assess their sociodemographic characteristics, and smoking-related knowledge and attitudes. Measures of smoking-related attitudes targeted six constructs: self-efficacy for quitting smoking, anticipated outcomes, intentions to quit, normative expectations, social support, and barriers to quitting. Smoking/cessation knowledge was assessed with a 14 item test. This sample of smokers had high knowledge and positive attitudes about quitting smoking. Several sociodemographic variables were associated with attitudinal knowledge variables, although no consistent pattern of association was seen. Results underscore the complexity between smoking-related attitudes and sociodemographic factors, and are discussed in terms of implications for culturally-tailored interventions.     

Knowledge, attitudes and practices regarding smoking cessation among Chinese affiliates of women's organisations in Hong Kong

Volunteers and staff of women's organisations who are highly active in engaging and providing community service can be recruited to motivate female smokers to quit. We described the knowledge and attitudes regarding tobacco control and smoking cessation among these affiliates in Hong Kong and identified factors associated with the practices of cessation interventions. Eight of 14 women's organisations joining the Women Against Tobacco Taskforce agreed to participate. All staff, volunteers, and members of the eight organisations were invited to complete a self-administered anonymous questionnaire during July and August 2006. A total of 623 out of 771 (80.8%) affiliates responded. Their knowledge on smoking and health (mean = 3.91, SD = 1.44 on a range of 0-7), smoking related diseases (mean = 2.91, SD = 0.97 on a range of 0-4), and women-specific diseases (mean = 2.93, SD = 1.87 on a range of 0-6), was considered to be inadequate. They had positive attitudes towards tobacco control (mean = 3.31, SD = 0.55) and their own role in smoking cessation counselling (mean = 3.19, SD = 0.56) on a 4-point Likert scale and 39.3% reported had attempted to offer quitting advice. Logistic regression analysis found that participants having direct contact with smokers who had a positive attitude towards their own role in smoking cessation counselling (OR = 2.57; 95% CI = 1.67-3.95) and better knowledge of smoking and smoking-related diseases (OR = 1.35; 95% CI = 1.06-1.71) were more likely to provide cessation counselling after controlling for gender; knowledge on smoking and health, and women-specific diseases; attitude towards tobacco control, negative and positive attitudes towards female smokers, and perceived self-efficacy in smoking cessation counselling. Women's organisations showed limited support towards tobacco control and their affiliates had a limited knowledge on smoking and health but had positive attitudes. Appropriate training, capacity building and establishing rapport with women's organisations are needed to promote smoking cessation and to support tobacco control in the community.     

Motivating parents of kids with asthma to quit smoking: the PAQS project

The Parents of Asthmatics Quit Smoking (PAQS) project contrasts two theory-based smoking cessation interventions for parents of children with asthma, and compares mechanisms of behavior change within and across theoretical perspectives. We hypothesize that enhancing the perception of risk to self and child will motivate smoking cessation more than standard approaches that emphasize building self-efficacy and coping skills for quitting in a population that is largely not motivated to quit smoking. Smokers (n = 288) and their asthmatic children who receive nurse-delivered in-home asthma education (as part of the insurance carrier's standard of care) are randomized into one of two treatment conditions: (1) the Behavioral Action Model (BAM), in which nurses emphasize goal setting and skill building to enhance self-efficacy to quit smoking, or 2) the Precaution Adoption Model (PAM), in which nurses tailor the intervention to the smoker's readiness to quit and incorporate biomarker feedback [i.e. level of carbon monoxide exposure to the smoker and level of environmental tobacco smoke (ETS) exposure to the child] in order to increase risk perception in smokers. In both conditions, smokers who are ready to quit receive the nicotine patch. Analyses will examine (1) quit rates, ETS level and motivation to quit as the primary dependent variables, (2) mediators of behavior change between and within conditions, and (3) relations between parent smoking outcomes and child asthma morbidity (i.e. ER visits and asthma symptoms) post-treatment. Results will help tailor interventions to this population, and identify mechanisms of behavior change that result in adaptive health outcomes for smokers and their children who have asthma.     

Acceptability and impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital

OBJECTIVE: To assess the impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital in Switzerland. METHODS: In 2003, smoking was allowed everywhere in psychiatric units. In 2004, smoking was prohibited everywhere except in smoking rooms. In 2006, smoking rooms were removed and smoking was totally prohibited indoors. Patients and staff were surveyed in 2003 (n=106), 2004 (n=108), 2005 (n=119) and 2006 (n=134). RESULTS: Exposure to environmental tobacco smoke (ETS) decreased after the partial ban and further decreased after the total ban. Among patients, after the total ban, more smokers attempted to quit smoking (18%) relative to before the total ban (2%, odds ratio=10.1, p=0.01). More smokers said that hospital staff gave them nicotine replacement products after the total ban (52%), compared with before (13%, odds ratio=7.6, p<0.001). Many participants (55%) commented that the total ban was too strict, and most (64%) preferred the partial ban. CONCLUSIONS: The partial ban decreased exposure to ETS and the total ban further improved the situation and increased the proportion of smokers who attempted to quit smoking and received nicotine medications. The total ban was loosely enforced and was overall acceptable, but most participants preferred a partial ban.     

The role of parents' health in their offspring's intentions to quit smoking

BACKGROUND: Motivating cessation among young smokers is an important challenge for smoking reduction programs. This research examines the role of perceived illness in smoking parents as a motivator for cessation in young smokers. METHODS: Two nationally representative samples of young U.S. smokers (ages 14 to 22 and 18 to 25 in 2002) assessed perceptions of parent health, quit intentions, risk perceptions and affective expectations for smoking to test the hypothesis that perceived illness in smoking parents motivates quitting by linking unfavorable emotional reactions to the smoking experience. RESULTS: Approximately 88% of young smokers reported that parents who smoked were in less than very good health compared to 54% of smokers whose parents did not smoke. Unlike young smokers whose parents did not smoke, the quit intentions of those whose parents smoked were directly related to the perceived ill health of their parents. Affective expectations rather than perceived risk of smoking appeared to mediate these relations. CONCLUSION: Youth smoking cessation programs could benefit from targeting smokers whose parents smoke and are likely to show the long-term effects of smoking-related illness.     

Associations between smoking prevalence, stages of change, cigarette consumption, and quit attempts across the United States

BACKGROUND: We tested whether across the 50 U.S. States, smoking prevalence was associated with smoking behavior among smokers. METHODS: We used published data on smoking prevalence, cigarette consumption, and quit attempts by State from the Behavioral Risk Factor Surveillance System (BRFSS) for 1993, 1996, and 1999, and published data on the distribution of smokers by stage of change in each State from the Current Population Survey (CPS). Data were weighted for the population size in each State. RESULTS: For 1993, we found no statistically significant association between smoking prevalence and stages of change. For 1996 and 1999, across the 50 States, each additional percentage point in smoking prevalence was associated with, respectively, 0.62% and 1.19% more smokers in the "precontemplation" stage, that is, smokers not intending to quit smoking (both P < 0.01), with, respectively, 0.82% and 1.21% more "heavy" smokers who smoked 21-40 cigarettes per day (both P 相似文献   

Knowledge of health effects and intentions to quit among smokers in India: findings from the Tobacco Control Policy (TCP) India pilot survey

Awareness of the health risks of smoking is an important factor in predicting smoking-related behaviour; however, little is known about the knowledge of health risks in low-income countries such as India. The present study examined beliefs about the harms of smoking and the impact of health knowledge on intentions to quit among a sample of 249 current smokers in both urban and rural areas in two states (Maharashtra and Bihar) from the 2006 TCP India Pilot Survey, conducted by the ITC Project. The overall awareness among smokers in India of the specific health risks of smoking was very low compared to other ITC countries, and only 10% of respondents reported that they had plans to quit in the next six months. In addition, smokers with higher knowledge were significantly more likely to have plans to quit smoking. For example, 26.2% of respondents who believed that smoking cause CHD and only 5.5% who did not believe that smoking causes CHD had intentions to quit (χ2 = 16.348, p < 0.001). Important differences were also found according to socioeconomic factors and state: higher levels of knowledge were found in Maharashtra than in Bihar, in urban compared to rural areas, among males, and among smokers with higher education. These findings highlight the need to increase awareness about the health risks of smoking in India, particularly in rural areas, where levels of education and health knowledge are lower.     

Peer Reviewed: Smoking, Barriers to Quitting, and Smoking-Related Knowledge, Attitudes, and Patient Practices Among Male Physicians in China

Introduction

Successful interventions to reduce the high rate of smoking among male physicians in China might contribute to reduction in tobacco use in the country overall. Better characterization of smoking, barriers to quitting, and smoking-related knowledge, attitudes, and patient practices in this physician population will help plan such interventions and provide baseline data to evaluate their effectiveness.

Methods

A self-administered survey of smoking-related knowledge, attitudes, behaviors, and patient practices was conducted among health care professionals in 2 large teaching hospitals in China.

Results

Of 103 male physicians, those who smoked (n = 51) had a more limited knowledge of smoking-related disease and were less likely to advise patients to quit smoking compared with nonsmoking physicians (n = 52). More than one-fourth (29%) of nonsmoking physicians accepted gift cigarettes, and these physicians were less likely to ask their patients about their smoking status than those who did not accept gift cigarettes. Seventy-five percent of smokers reported that their hospitals did not help them quit, and only 19% reported receiving training in how to help their patients quit.

Conclusion

High rates of smoking, gifting of cigarettes, limited support for physician quitting, and limited training on cessation approaches may compromise the ability of male physicians in China to effectively treat their patients who smoke.     

Smoking prevalence, behaviour and nicotine addiction among coal workers in Zonguldak, Turkey

To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X-rays and pulmonary function tests were performed to evaluate patients' related diseases and complications. Smoking status of the workers was as follows; Sixty-nine never smokers (17.7%), 62 ex-smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 +/- 4.2 versus 15.0 +/- 4.0). The most common reason for starting smoking was smoking interest (50%) and friends' influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking-related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0-3 points), moderate (4-6) and severe (7 or more) addiction ratios were found to be 39.1%, 44.2% and 16.7% respectively. Ex-smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.     

Reach, efficacy, and cost-effectiveness of free nicotine medication giveaway programs.

In an effort to increase access to evidence-based smoking cessation therapies, regional tobacco control programs in New York State implemented different interventions to make free nicotine patches and gum available to smokers wishing to quit. In one region, eligible smokers were sent a voucher redeemable at a local pharmacy for a 2-week supply of either nicotine patches or gum. In other regions, smokers received either a 1-week supply or a 2-week supply of nicotine patches sent to their home. In New York City, eligible smokers received a 6-week supply of nicotine patches and a follow-up phone call. All of the programs utilized the state's Smokers' Quitline to screen and register eligible smokers for the free medication. The reach of the different programs was evaluated by computing the proportion of eligible smokers within a given area enrolled in the program and tracking call volume to the Quitline before, during, and after the free giveaway promotions. Efficacy was evaluated by a telephone follow-up survey of program participants conducted 4 months after enrollment to measure use of the medications and smoking behavior. The quit rate of program participants was contrasted with the quit rate computed from an earlier follow-up survey of Quitline callers who were not provided nicotine replacement therapy (NRT). Free nicotine patches or gum was sent to 40,090 smokers representing about 2.9 percent of eligible heavy smokers (10+ cigarettes per day) in the state. In each time period and location where free NRT was offered, call volume to the Quitline increased dramatically. Quit rates varied in relationship to the supply of NRT sent to participants, but in all cases was higher than the quit rate observed among smokers not sent NRT (21%-35% vs 12%). The offer of free NRT appears to be a cost-effective method to induce large numbers of smokers to make a quit attempt.     

Will genetic testing for complex diseases increase motivation to quit smoking? Anticipated reactions in a survey of smokers.

The aim of this study was to improve understanding of smokers' potential reactions to genetic testing for smoking-related diseases. One thousand twenty-four respondents completed a postal survey; 186 were smokers. Questions addressed anticipated psychological and behavioral reactions to genetic test results using hypothetical scenarios. Of smokers, 65% anticipated being motivated to quit smoking upon receiving a positive genetic test result; 39% anticipated being demotivated by a negative result. More smokers anticipated being depressed in response to receiving a positive result for cancer than for heart disease (40% vs. 24%). Anticipated motivation was associated with higher desire to quit and lower nicotine addiction, anticipated depression with poorer understanding of genetic testing, and anticipated demotivation with lower education. Smokers who have a high desire to quit may use genetic testing as a motivational tool. Understanding of genetics may be important in determining how individuals respond to genetic tests for complex diseases.     

The effects of implementing a smoking cessation intervention in Spain on morbidity,mortality and health care costs

OBJECTIVE: We estimated the effect that a smoking cessation intervention in the Spanish population of smokers would have on smoking-related morbidity, mortality and health care costs. METHODS: We adopted the model Health and Economic Consequences of Smoking sponsored by the WHO Health Organization and developed by the The Lewin Group. The smoking cessation intervention proposed includes pharmacological treatment to 35% of smokers who are trying to quit smoking and obtains a quit rate of 7.2%. The diseases studied are: lung cancer, heart disease, stroke, chronic obstructive pulmonary disease, asthma exacerbation, and low birth weight. The smoking-related cases of disease and of averted death and the reduction in health care expenditure due to the intervention were estimated. RESULTS: Without intervention, at year 1 of the model, 2,136,094 smokers would be affected by some smoking-related disease; health care expenditure would be 4,286 million e and deaths attributable to smoking would total 26,537. The proposed intervention would prevent 2,613, 9,192, 17,415 and 23,837 cases of smoking-related disease at years 2, 5, 10 and 20 of the model, respectively. The saving in accumulated health care costs would amount to 3.5 million e at year 2 and 386 million e over 20 years. The accumulated prevented deaths are 284 at year 2 and 9,205 over 20 years. The intervention would save a total of 78,173 life-years by the end of the period considered. CONCLUSIONS: The availability of new effective smoking cessation interventions and the increase in accessibility to such interventions may contribute significantly to reducing morbidity, mortality and health care costs associated with smoking in Spain.