Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades?

Abstract

This paper reviews the literature on smoking cessation interventions, with a focus on the last 20 years (1991 to 2010). These two decades witnessed major development in a wide range of cessation interventions, from pharmacotherapy to tobacco price increases. It was expected that these interventions would work conjointly to increase the cessation rate on the population level. This paper examines population data from the USA, from 1991 to 2010, using the National Health Interview Surveys. Results indicate there is no consistent trend of increase in the population cessation rate over the last two decades. Various explanations are presented for this lack of improvement, and the key concept of impact = effectiveness × reach is critically examined. Finally, it suggests that the field of cessation has focused so much on developing and promoting interventions to improve smokers' odds of success that it has largely neglected to investigate how to get more smokers to try to quit and to try more frequently. Future research should examine whether increasing the rate of quit attempts would be key to improving the population cessation rate.

Figure 1

Annual cessation rates for U.S. smokers from 1991 to 2010. Top panel is for smokers of all ethnicities, and bottom panel is for smokers who are non-Hispanic White. Data are from the National Health Interview Survey. Responses from proxies are not included. The 1992 data were adjusted by imputation to account for missing values caused by skip pattern errors. Results were weighted to be representative of the national population of adults aged 18 years and older in each survey year.

Figure 2

Percentage of quit attempts aided with medication, percentage achieving 3-month abstinence, and percentage making a quit attempt (the 1992 survey only asked about nicotine gum use). Top panel is for smokers of all ethnicities and bottom panel is for smokers who are non-Hispanic White. Data are from the National Health Information Survey (NHIS) in 1992, 2000, 2005, and 2010. Results were weighted to be representative of the national population of adults aged 18 years and older in each survey year.

Figure 3

Percentage of smokers making a quit attempt, for smokers of all ethnicities and non-Hispanic White smokers. Data are from the National Health Interview Survey. The 1992 data were adjusted by imputation to account for missing values caused by skip pattern errors. From 1991 to 1995, only daily smokers were asked whether they had made a quit attempt. Results were weighted to be representative of the national population of adults aged 18 years and older in each survey year.