An analysis of tobacco cessation quit aids and quit attempts from a national study on tobacco cessation
Haydu, Michael Christopher
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BACKGROUND: Since the initial report on the negative effects of smoking by the Surgeon General's Advisory Committee, the components of cigarettes and tobacco smoke and the mechanisms by which these cause disease have been studied extensively. Despite the well-documented health consequences associated with tobacco use, nearly 70 million Americans over the age of 12 actively use tobacco products, with 57.5 million of these (22.1% of the U.S. population in this age range) actively smoking cigarettes. Understanding how nicotine addiction develops and reinforces itself is important context for understanding the high prevalence of quit interest among smokers and the high relapse rates associated with quit attempts. While the increased availability of different, clinically proven tobacco cessation aids should lower the barrier associated with tobacco abstinence, the prevalence of quit aid use still remains low among those attempting to quit smoking. This study examines quit interest in active smokers, the quit attempts attempted by current and former smokers, the prevalence of tobacco cessation aid use in these quit attempts, and the perceived efficacy of certain quit aids. METHODS: This study was conducted in the Emergency Departments of ten hospitals nationwide by the National Association of Research Associates Programs in 2012. This study utilized trained research staff to enroll non-emergent patients and visitors over the age of 18 years old, obtaining demographical information and a detailed history of tobacco use from the participant. This included such information as current tobacco use status, how many cigarettes were consumed during a typical day, how many times they had attempted to abstain from tobacco use in the past, if they had used any tobacco cessation aids during those quit attempts, and, if so, how effective they believed these aids were. Participants were also asked to rate their readiness to quit smoking and intent to quit smoking, markers this study used to analyze quit interest. RESULTS: Of those approached, 10,303 study participants were selected for inclusion in this study, reporting tobacco use for longer than one month at any point in their life. 50.5% reported current tobacco use, while 46.8% reported current abstention from smoking. A majority of active smokers expressed interest in initiating tobacco cessation, with 55.2% reporting they were ready to quit smoking, though a smaller majority (51.9%) of active smokers reported that they intended to quit smoking. Most smokers reported at least 1 quit attempt in the past, with 76.5% of former smokers reporting that they quit within 1 to 5 attempts. Only 30.7% of study participants reported ever using some form of tobacco cessation aid in previous quit attempts, with nicotine replacement therapy use being the most commonly reported, and with pharmacological interventions more commonly reported than counseling-based cessation interventions. A majority of participants who reported using nicotine replacement gum and lozenges (57.8% and 49.5%, respectfully) reported that they were not helpful in aiding their cessation attempts, with only 30.1% of gum and 38.7% of lozenge users reporting a positive effect. CONCLUSIONS: The results indicated that among active smokers, smokers that reported smoking less (only some days or fewer cigarettes per day) were more likely to express interest (readiness and intent) in initiating tobacco cessation than those that reported smoking more (every day or more cigarettes per day). Quit interest also appeared to be lowest in 18-25 year olds, with this age group also reporting the lowest proportion of quit attempts, a finding that differed from another national tobacco survey. The prevalence of quit aid use in our study was comparable to another national tobacco survey, but our findings for the prevalence of unassisted quit attempts did not coincide with results found in other studies. These results also indicated that cessation aid use increased with increased number of quit attempts. Though we found that former smokers were more likely to indicate that NRT products were helpful than active smokers were, we were unable to fully analyze the perceived effects of cessation aid use due to the loss of some of this data. In light of the limitations of this study, further study needs to be conducted to better understand the perceived effect of tobacco cessation aids and how this might differ from the efficacy values found in clinical trials. In order to make findings more comparable to other tobacco surveys, future studies should also be designed around clear and common definitions for active tobacco use and quit interest, and a focus on quit attempts should be modulated by some degree of recency (e.g., quit attempts made within the previous year or two years).