Characteristics of Participants Who Stop Smoking and Sustain Abstinence for 1 and 5 Years in the Lung Health Study

Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Preventive Medicine (Impact Factor: 3.09). 06/2000; 30(5):392-400. DOI: 10.1006/pmed.2000.0642
Source: PubMed


This study describes baseline and Year 1 predictors of abstinence from smoking for the 3,523 intervention participants who had complete annual 5-year follow-up data in the Lung Health Study (LHS).
The LHS enrolled 5,887 smokers, aged 35 to 60 years, of whom 3,923 were offered a cessation intervention. Of these, 22% achieved biochemically verified abstinence for 5 years. Logistic regressions were performed. The first outcome variable was abstinence from smoking at 1 year. Then for those who were quit at 1 year, the outcome variable was 5 years of sustained abstinence.
All participants who were not using nicotine gum after 1 year in the study were more likely to sustain cessation over 5 years than were gum users at year 1 (OR ranged from 0.31 to 0.44 for four age- and sex-specific groups). Baseline number of previous quit attempts was negatively associated with 5-year quitting success among younger and older men (OR = 0.82 and 0.83). Older participants who were less likely to associate smoking with emotional coping had higher abstinence rates at 5 years of follow-up (OR = 0.89 and 0.84).
Different mechanisms may be responsible for achieving cessation in age/gender groups. These results have implications for planning successful interventions.

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    • "Point prevalence abstinence is high and increases in both programs over time, in SI 39% after 5 years and 52% after 11 years, in UC 22% and 43%, respectively. Participants with sustained abstinence for the first 5-year period are very likely to still be abstinent after 11 years, when validated sustained abstinence is 22% for SI and 6% for UC [34,35]. Blondal et al. report 9% sustained abstinence after six years among smokers in Iceland receiving nicotine patches for five months and 10 individual and group meetings [36]. "
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    ABSTRACT: Achieving lifelong tobacco abstinence is an important public health goal. Most studies use 1-year follow-ups, but little is known about how good these are as proxies for long-term and life-long abstinence. Also, intervention intensity is an important issue for development of efficient and cost-effective cessation treatment protocols. The study aims were to assess the long-term effectiveness of a high- and a low-intensity treatment (HIT and LIT) for smoking cessation and to analyze to what extent 12-month abstinence predicted long-term abstinence. 300 smokers attending dental or general health care were randomly assigned to HIT or LIT at the public dental clinic. Main outcome measures were self-reported point prevalence, continuous abstinence (≥6 months), and sustained abstinence. The study was a follow-up after 5–8 years of a previously performed 12-month follow-up, both by postal questionnaires. Response rate was 85% (n=241) of those still alive and living in Sweden. Abstinence rates were 8% higher in both programs at the long-term than at the 12-month follow-up. The difference of 7% between HIT and LIT had not change, being 31% vs. 24% for point prevalence and 26% vs. 19% for 6-month continuous abstinence, respectively. Significantly more participants in HIT (12%) than in LIT (5%) had been sustained abstinent (p=0.03). Logistic regression analyses showed that abstinence at 12-month follow-up was a strong predictor for abstinence at long-term follow-up. Abstinence at 12-month follow-up is a good predictor for long-term abstinence. The difference in outcome between HIT and LIT for smoking cessation remains at least 5–8 years after the intervention. Trial registration number NCT00670514
    BMC Public Health 06/2013; 13(1):592. DOI:10.1186/1471-2458-13-592 · 2.26 Impact Factor
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    • "A number of other demographic and smoking-related characteristics have been linked to positive cessation outcome, albeit with varying degrees of consistency. These include older age (Murray et al., 2000; Velicer et al.,, 2007), male gender (Ferguson et al., 2003; Dale et al., 2001; Gourlay et al., 1994), being married (Murray et al., 2000; Carlson et al.,, 2000), smoking fewer cigarettes per day (Carlson et al., 2000; Dale et al., 2001), less exposure to smokers in the household (Carlson et al., 2000; Murray et al., 2000), lower severity of nicotine dependence (Ferguson et al., 2003), longer periods of smoking abstinence in the past (Murray et al., 2000; Ward et al., 1997; Garvey et al., 1992), and less alcohol consumption (Garvey et al., 1992; Nides et al., 1995). "
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    ABSTRACT: Identifying predictors of smoking relapse helps to elucidate the challenges of long-term smoking cessation and provides direction for improved treatment development. In this post hoc data analysis, we examined predictors of relapse from end-of-treatment (week 13) through 1-year follow-up (week 52) for treatment-responding participants who achieved the primary efficacy endpoint of 4-week continuous abstinence (weeks 9-12), during two phase III varenicline trials. Of 626 smokers classified as treatment responders for all treatment groups across both trials, 301 (48%) relapsed during follow-up (weeks 13-52). The odds of relapsing were almost 5 times greater (odds ratio [OR]=4.92, 95% confidence interval [CI]: 2.77-8.97; p<.001) for treatment responders who did not initiate continuous abstinence until the final 4 weeks of the treatment period compared with those who initiated continuous abstinence by their quit date. Participants who reported >30 days of abstinence during the year prior to study entry were significantly more likely to relapse than those who reported 0 days of abstinence (OR=2.38, 95% CI: 1.17-5.04; p=.013). Results of these analyses suggest that the ability to quit smoking on the initial quit date and maintain abstinence throughout the treatment period is a good prognostic indicator for long-term abstinence. The relationship between post-treatment relapse and longer pretreatment periods of abstinence is counterintuitive, yet not without precedence in the literature.
    Drug and alcohol dependence 06/2010; 109(1-3):120-5. DOI:10.1016/j.drugalcdep.2009.12.022 · 3.42 Impact Factor
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    • "Contrary to the results of post-hoc analyses examining the relationship between ADHD symptoms and smoking cessation in clinical studies with treatment-seeking smokers (Covey et al., 2008; Humfleet et al., 2005), we did not find evidence to suggest a reduced likelihood of successful smoking cessation among these alcohol-dependent smokers based on the number of selfreported ADHD symptoms during childhood. Instead, demographic and smoking-related characteristics that have been linked to smoking cessation outcomes in general population samples were identified as significant predictors, including older age (Murray et al., 2000; Velicer, Redding, Sun, & Prochaska, 2007), higher income and/or socioeconomic status (Matheny & Weatherman, 1998), and not meeting criteria for nicotine dependence (Ferguson et al., 2003). In contrast to previous findings that men (Ferguson et al.; Murray et al.) and lighter smokers (Carlson, Taenzer, Koopmans, & Bultz, 2000) are more likely to quit than women and heavier smokers, respectively, the opposite was true in the present study. "
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    ABSTRACT: Symptoms of inattention and hyperactivity/impulsivity that fall below the DSM-IV diagnostic threshold for attention-deficit hyperactivity disorder (ADHD) may be associated with the high prevalence of smoking among individuals with alcohol dependence, yet no studies to date have examined the relationship between subthreshold ADHD symptoms and cigarette smoking in this group. We hypothesized that increasing levels of ADHD symptoms would be associated with increasing risk of lifetime smoking and nicotine dependence, concentration problems secondary to nicotine withdrawal, and maintenance of smoking. Participants were alcohol-dependent adults (n = 242) who did not meet criteria for ADHD or a current Axis I disorder other than alcohol and nicotine dependence. All participants were involved in treatment for alcohol dependence but not smoking cessation. The Semi-Structured Assessment for the Genetics of Alcoholism was administered to collect demographic and smoking history data and to assess symptoms of ADHD and other psychiatric disorders. A higher number of self-reported ADHD symptoms were associated with increased likelihood of ever smoking (p = .026), nicotine dependence (p = .017), and impaired concentration as a symptom of nicotine withdrawal (p = .046). There was no relationship between the number of ADHD symptoms and classification as a former versus current smoker (p = .333). Childhood symptoms of inattention and hyperactivity/impulsivity are related to cigarette smoking and nicotine dependence among alcohol-dependent individuals at levels below the ADHD diagnostic threshold. Conceptualization of ADHD symptoms as occurring on a continuum may aid identification of and early intervention for individuals who are at highest risk for initiating smoking and developing nicotine dependence.
    Nicotine & Tobacco Research 03/2010; 12(3):243-50. DOI:10.1093/ntr/ntp200 · 3.30 Impact Factor
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