Predictors of Smoking Reduction and Cessation in a Cohort of Danish Moderate and Heavy Smokers

doi:10.1006/pmed.2001.0852

Preventive Medicine

Volume 33, Issue 1, July 2001, Pages 46-52

https://doi.org/10.1006/pmed.2001.0852 Get rights and content

Abstract

Background. The aim of this study was to examine the extent and gender distribution of unassisted tobacco reduction and cessation in a cohort of moderate and heavy smokers and to identify possible predictor variables associated with these changes in smoking behavior.

Methods. This was a prospective population study of 3,791 moderate and heavy smokers, 15 g tobacco/day or more, who were enrolled in the Copenhagen City Heart Study in 1976–1978 and attended a reexamination 5 years later. Data on smoking behavior were collected at baseline and follow-up. Smoking reduction was defined as a decrease in mean daily tobacco consumption of 10 g or more. Using multivariate logistic regression, subjects who reported reduced smoking or who reported smoking cessation were compared with subjects who continued the habit unchanged.

Results. After 5 years 13% of the men and 9% of the women had reduced their tobacco consumption, and 9 and 7%, respectively, had quit altogether. Smoking reduction was strongly associated with high tobacco consumption (25+ g/day) at baseline and also with severely impaired lung function (FEV₁ <50% predicted) and overweight (BMI >25). Predictors of smoking cessation included impaired lung function and a tobacco consumption of 15–24 g/day. Additional determinants of smoking reduction and cessation such as inhalation habits and sociodemographic variables differed by gender.

Conclusions. Several predictors of smoking reduction and cessation were identified, indicating that these subgroups of smokers differ substantially from continuing smokers. This should be taken into account when assessing potential health benefits from these changes in smoking behavior.

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2022, Addictive Behaviors
Citation Excerpt :
Reducing smoking was associated with higher baseline CPD and menthol use. In general, higher CPD predicts worse quitting success (Godtfredsen et al., 2001). However, consistent with other studies on smoking reduction (Godtfredsen et al., 2001; Berg et al., 2010); we find higher CPD predicts greater reduction.
Homeless populations have high rates of smoking and unique barriers to quitting. General cessation strategies have been unsuccessful in this population. Smoking reduction may be a good intermediate goal. We conducted a secondary analysis to identify predictors of smoking reduction in a cohort of homeless smokers enrolled in a 26-week randomized clinical trial (RCT) targeting smoking cessation.
Data are from an RCT comparing motivational interviewing counseling plus nicotine replacement therapy (NRT) to brief advice to quit (standard care) plus NRT among homeless smokers. Using bivariate analyses and multinomial logistic regression, we compared demographics, health and psychosocial variables, tobacco use, substance use, and NRT adherence among those who reported: quitting; reducing smoking by 50-99%; and not reducing smoking by 50%.
Of 324 participants who completed 26-week follow-up, 18.8% and 63.9% self-reported quitting and reducing, respectively. Compared to those who did not reduce smoking, participants reporting reducing indicated higher baseline cigarette use (OR=1.08; CI:1.04-1.12) and menthol use (OR=2.24; CI:1.05-4.77). Compared to participants who reduced, participants reporting quitting were more likely to be male (OR=1.998; CI:1.00-3.98), experience more housing instability (OR=1.97; CI:1.08-3.59), indicate higher importance of quitting (OR=1.27; CI:1.041.55), have higher NRT adherence (OR=1.75; CI:1.00-3.06), and lower odds of reported illicit drug use (OR=0.48; CI:0.24-0.95).
Over half of participants reduced smoking by at least 50%, indicating reduction is feasible among homeless smokers. Further research is required to understand the impact of reduction on future cessation attempts in homeless smokers. This study shows that reduction is achievable and may be a valid intermediate goal.
Predictors of smoking cessation: A longitudinal study in a large cohort of smokers
2017, Respiratory Medicine
Citation Excerpt :
On the contrary, men with chronic bronchitis at baseline were less likely to quit smoking. There are other prospective studies supporting that chronic bronchitis does not predict smoking cessation [10,12], and we found the same result for asthma, wheeze, and hay fever. In addition, asthma and chronic bronchitis, which started during the study period, were not associated with smoking cessation.
There are few studies on predictors of smoking cessation in general populations. We studied the smoking cessation rate in relation to several potential predictors, with special focus on respiratory and cardiovascular disease.
Smokers (n = 4636) from seven centres in Northern Europe, born between 1945 and 1973, who answered a questionnaire in 1999–2001 (the RHINE study) were followed up with a new questionnaire in 2010–2012. Altogether 2564 answered the questionnaire and provided complete data on smoking. Cox regression analyses were performed to calculate hazard ratios (HRs).
A total of 999 subjects (39%) stopped smoking during the study period. The smoking cessation rate was 44.9/1000 person-years. Smoking cessation was more common with increasing age, higher education and fewer years of smoking. Asthma, wheeze, hay fever, chronic bronchitis, diabetes and hypertension did not significantly predict smoking cessation, but smokers hospitalized for ischaemic heart disease during the study period were more prone to stopping smoking (HR 3.75 [2.62–5.37]).
Successful smoking cessation is common in middle-aged smokers, and is associated with few smoking years and higher education. A diagnosis of respiratory disease does not appear to motivate people to quit smoking, nor do known cardiovascular risk factors; however, an acute episode of ischaemic heart disease encouraged smoking cessation in our study population.
Determinants of Smoking Cessation in Patients With COPD Treated in the Outpatient Setting
2016, Chest
The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke.
In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical and sociodemographic determinants of smoking cessation in 3,233 patients with COPD who smoked on outpatient contact during 2008 to 2012. Using multivariate Cox regression, we calculated hazard ratios (HRs) of quitting.
Within 1 and 5 years from first outpatient contact, the probability of quitting was 19% and 45%, respectively. In adjusted analyses, patients were less likely to quit if they were younger, with an HR of 0.84 (95% CI, 0.71-0.99) for patients aged 50 to 69 years and 0.53 (95% CI, 0.37-0.76) for patients aged 30 to 49, compared with those aged 70 years or older, who had lower income (HR, 0.79; 95% CI, 0.67-0.94), lived alone (HR, 0.75; 95% CI, 0.64-0.88), were unemployed (HR, 0.70; 95% CI, 0.54-0.90), had milder COPD with an HR of 0.67 (95% CI, 0.53-0.84) for Global Initiative for Chronic Obstructive Lung Disease (GOLD) A and 0.61 (95% CI, 0.47-0.80) for GOLD B compared with GOLD D, had Medical Research Council (MRC) dyspnea scale score < 4 (HR 0.80, 95% CI 0.68-0.95), or no history of exacerbations treated on an outpatient basis. (HR, 0.80; 95% CI, 0.68-0.93).
These findings reinforce that young and socioeconomically disadvantaged patients have more difficulties achieving timely smoking cessation. A novel finding is that patients with milder COPD are less likely to quit. The findings suggest a need for interventional studies focusing on these subgroups to ensure abstinence to halt disease progression.
The effect of reducing the number of cigarettes smoked on risk of lung cancer, COPD, cardiovascular disease and FEV<inf>1</inf> - A review
2013, Regulatory Toxicology and Pharmacology
Searches identified 14 studies investigating effects of reducing cigarette consumption on lung cancer, CVD, COPD or FEV₁ decline. Three were case-control studies, six cohort studies, and five follow-up studies of FEV₁. Six studies consistently reported lower lung cancer risk in reducers. Compared to non-reducers, meta-analysis (random-effects) showed significantly lower risk (RR 0.81, 95% CI 0.74–0.88 for any reduction, and RR 0.78, 0.66–0.92 for the greatest reduction), with no between-study heterogeneity. Four cohort studies presented CVD results, the combined RR for any reduction being a non-significant 0.93 (0.84–1.03). An effect of reduction was not consistently seen for COPD or FEV₁ decline. Four cohort studies presented all-cause mortality results, the combined RR of 0.92 (0.85–1.01) being non-significant. The RR of 0.95 (0.88–1.02) for total smoking-related cancer, from three studies, was also non-significant. The evidence has various weaknesses; few studies, few cases in reducers in some studies, limited dose–response data, incomplete adjustment for baseline consumption, questionable accuracy of the lifetime smoking history data in case-control studies, and bias in cohort studies if reducers are likelier than non-reducers to quit during follow-up. Also, the variable definitions of reduction make meta-analysis problematic. Though the results suggest some benefits of smoking reduction, more evidence is needed.
Risk reduction in cigarette smoking: Myths or reality?
2010, Revue des Maladies Respiratoires Actualites
En dehors de l’arrêt, peut-on réduire autrement les risques liés au tabagisme?
Le passage à des cigarettes modifiées, ou encore la réduction de la consommation isolée n’apportent pas de bénéfice. Les traitements substitutifs nicotiniques peuvent engendrer plus d’arrêts ultérieurs.
Other than smoking cessation is it possible to reduce the risks related to smoking in other ways?
Changing to modified cigarettes or reducing isolated consumption have no benefit. Nicotine replacement therapy can lead to more smoking cessation at a later date.
Low-to-moderate alcohol consumption and smoking cessation rates: Retrospective analysis of 4576 elderly ever-smokers
2010, Drug and Alcohol Dependence
Smoking and alcohol consumption are two major risk factors for manifold morbidity and mortality outcomes and are highly correlated with each other. No conclusion has been reached concerning whether cigarette smokers drinking alcohol have more difficulties with smoking cessation. We aimed to elucidate the association of concurrent alcohol consumption with the probability of smoking cessation in non-clinical populations.
Retrospective analysis in 4576 ever-smoking participants of the baseline survey of ESTHER, a population-based study in Germany, aged 50–74 at enrollment in general practitioner offices. Life-course histories of alcohol consumption were obtained from questionnaire items covering exposure intensities at ages 20, 30, 40, 50 and at the time of enrollment. Extended Cox regression modelling allowing for the time-varying nature of alcohol consumption was employed to model the time from smoking initiation to smoking cessation.
Using alcohol abstainers as the reference group and controlling for potential confounders, relative cessation rates (95% CI) increased to 1.17 (1.02, 1.34), 1.36 (1.20, 1.55), 1.45 (1.27, 1.66) and 1.32 (1.13, 1.53) with concurrent consumption of 1–39, 40–99, 100–199 and 200+ g alcohol/week. This pattern persisted in extensive sensitivity analyses.
The results of these analyses of time-varying concurrent alcohol consumption and smoking suggest that drinking low-to-moderate amounts of alcohol as common in the general population might actually facilitate cessation in non-clinical settings.

View all citing articles on Scopus

^☆: This study was supported by grants from the Danish Epidemiology Science Centre, the Danish Ministry of Health, the Health Insurance Fund, the Danish Lung Association, the Danish Heart Foundation, and the Else & Mogens Wedell-Wedellsborg Foundation.

²: To whom reprint requests should be addressed. Fax: (+45) 3332 4240. E-mail: [email protected].

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Regular ArticlePredictors of Smoking Reduction and Cessation in a Cohort of Danish Moderate and Heavy Smokers☆

Abstract

The health benefits of smoking cessation. A report of the Surgeon General, 1990

Smoking: Epidemiology, cessation and prevention

Chest

Smoking cessation 1: An overview of research

Behav Med

Cigarette smoking prevalence, cessation and relapse

Stat Methods Med Res

The global tobacco epidemic

Sci Am

Has smoking cessation ceased? Expected trends in the prevalence of smoking in the United States

Am J Epidemiol

Smoking cessation

Eur Respir Rev

Early intervention in chronic obstructive pulmonary disease—a review of the Lung Health Study results

Med Clin North Am

Baseline factors associated with smoking cessation and relapse

Prev Med

Predictors of quitting smoking: the NHANES I follow-up experience

J Clin Epidemiol

Psychosocial, behavioural and health determinants of successful smoking cessation—a longitudinal study of Danish adults

Tobacco Control

Gender and determinants of smoking cessation. A longitudinal study

Prev Med

Predictors of smoking: the Framingham study

Am J Epidemiol

MMWR

Trends in cigarette smoking cessation in the United States

Tobacco Control

Influence of smoking fewer cigarettes on exposure to tar, nicotine, and carbon monoxide

N Engl J Med

Spontaneous cigarette brand switching: consequences for nicotine and carbon monoxide exposure

Am J Public Health

Regular Article
Predictors of Smoking Reduction and Cessation in a Cohort of Danish Moderate and Heavy Smokers☆