Natural history of attempts to stop smoking

Abstract

Introduction: This study provides a prospective fine-grain description of the incidence and pattern of intentions to quit, quit attempts, abstinence, and reduction in order to address several clinical questions about self-quitting.

Methods: A total of 152 smokers who planned to quit in the next 3 months called nightly for 12 weeks to an Interactive Voice Response system to report cigarettes/day, quit attempts, intentions to smoke or not in the next day, and so forth. No treatment was provided.

Results: Most smokers (60%) made multiple transitions among smoking, reduction, and abstinence. Intention to not smoke or quit often did not result in a quit attempt but were still strong predictors of a quit attempt and eventual abstinence. Most quit attempts (79%) lasted less than 1 day; about one fifth (18%) of the participants were abstinent at 12 weeks. The majority of quit attempts (72%) were not preceded by an intention to quit. Such quit attempts were shorter than quit attempts preceded by an intention to quit (<1 day vs. 25 days). Most smokers (67%) used a treatment, and use of a treatment was nonsignificantly associated with greater abstinence (14 days vs. 3 days). Making a quit attempt and failing early predicted an increased probability of a later quit attempt compared to not making a quit attempt early (86% vs. 67%). Smokers often (17%) failed to report brief quit attempts on an end-of-study survey.

Conclusions: Cessation is a more chronic, complex, and dynamic process than many theories or treatments assume.

Figure 1.

Participant flow. Note. IVR = Interactive Voice Response. ^aAll percentages given are among those in the box.

Figure 2.

Examples of multiple transitions across intention, smoking, reduction, and abstinence states for six participants. Columns represent days of the study. Rows represent individual participants. Black boxes represent a day of intentional abstinence. Gray boxes represent a day of reduction in cigarettes/day by ≥50%. An I represents a day in which, on the night before, smokers reported they planned not to smoke that day.