Participation in a Smoking Cessation Program: A Population-Based Perspective

doi:10.1016/S0749-3797(18)30993-0

American Journal of Preventive Medicine

Volume 6, Issue 5, September–October 1990, Pages 258-266

https://doi.org/10.1016/S0749-3797(18)30993-0 Get rights and content

We examined factors associated with participation in an HMO-based, self-help smoking cessation trial by comparing participants with nonparticipating smokers who responded to a prior health survey. Recruitment to the trial was accomplished through the HMO’s monthly magazine sent to all enrollee households, and the health survey involved a random sample of the enrollee population. Participants were more likely to be female, older, better educated, and heavier smokers with more attempts to quit in the past. Participants consistently reported poorer levels of health status (self-perceived health and energy, life satisfaction, depression, and symptoms), less healthy lifestyles (exercise and dietary fat), and a greater conviction that smoking cessation would improve how they feel than nonparticipants. These findings confirm previous suggestions that formal cessation programs attract those with a more extensive history of addiction, prior failure, and pathophysiologic effects and may provide clues to increasing motivation among smokers with a greater likelihood of treatment success.

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The diagnosis of a smoking-related disease is a prominent trigger for smoking cessation in a retrospective cohort study
2006, Journal of Clinical Epidemiology
Citation Excerpt :
In the year of diagnosis of myocardial infarction or stroke, the rate of cessation increased 7- to 11-fold; however, the impact of these conditions, as well as of other severe smoking-related diseases (diabetes, cancer), appears to be limited to the time shortly after diagnosis. Our results are consistent with findings from other studies, which suggest that smokers with a poorer health status are more likely to attempt to quit [17], are in later stages of readiness to change [18], are more likely to take part in cessation programs [19], and are more often offered antismoking counseling by general practitioners [20]. Successful smoking cessation in the general population, which is affected by quit attempts and success in quitting among those trying to quit, has been shown to be associated with health status in some [9–11,21,22], but not all previous studies [8,12].
We evaluated the impact of demographic factors, smoking patterns, and the occurrence of smoking-related diseases on smoking cessation, with a particular emphasis on the temporal relationship between diagnosis of smoking-related diseases and cessation.
A cohort was assembled of participants of a general health screening examination aged 50–74 years. Lifetime smoking habits and medical history were obtained by a self-administered questionnaire. In a retrospective cohort study approach, predictors of cessation among ever-smokers (n = 4,575) were identified using the extended proportional hazards model.
Male gender, late onset of smoking, and higher educational level were predictive of cessation. However, the by far strongest predictors of cessation were diagnoses of smoking-related diseases: relative cessation rates in the year of disease occurrence were 11.2 for myocardial infarction (95% confidence interval CI = 8.9–14.0), 7.2 for stroke (95% CI = 5.1–11.6), 2.5 for diabetes mellitus (95% CI = 1.6–4.0) and 4.8 for cancer (95% CI = 3.1–7.4) relative to years before diagnosis of the respective diseases.
Our results underline the key role of perceived detrimental effects of smoking for cessation. When smokers personally experience the health consequences of smoking, many permanently quit.
Perceived quality of life: A neglected component of adolescent health assessment and intervention
2004, Journal of Adolescent Health
The contribution of the construct of perceived quality of life (PQOL) to adolescent health assessment and promotion is discussed. Theory, measurement, and correlates of PQOL in adolescence are reviewed, with a focus on the incremental validity of PQOL data in relationship to more traditional pathology-based health indices. Similar to Diener's proposal [1], which pertained exclusively to adults, we call for the inclusion of PQOL data in national databases that monitor adolescent health outcomes.
Characteristics of cigarette smokers seeking treatment for cessation versus reduction
2004, Addictive Behaviors
Comparisons were made between cigarette smokers seeking treatment to quit smoking and cigarette smokers seeking treatment to reduce the number of cigarettes they smoke. Potential subjects were recruited from the local metropolitan area by advertisement in the local media. A total of 665 cigarette smokers telephoned our clinic to seek treatment for smoking cessation and 565 cigarette smokers telephoned to seek treatment to gradually reduce the number of cigarettes they smoke but not quit smoking. Potential subjects were instructed to call the clinic to find out additional information about the studies, and while on the telephone they were asked questions pertaining to tobacco use and health status. The results show that the two populations are similar in many respects with the following exceptions: smokers seeking treatment to reduce cigarette use tend to smoke more cigarettes per day, are less motivated to quit, make fewer quit attempts, drink more alcoholic beverages per day, and have more health problems (Ps<.05). These results indicate that cigarette smokers seeking treatment for smoking reduction but not cessation may be more dependent smokers who experience more medical disorders.
African American smokers interested and eligible for a smoking cessation clinical trial: Predictors of not returning for randomization
2002, Annals of Epidemiology
PURPOSE: Recruitment is often the rate-limiting step in conducting clinical trials among ethnic minorities. Little is known about participants who consent and enroll into a trial, but do not return for randomization. Why participants fail to return for randomization is largely unknown.
METHODS: We compared 287 enrolled African American smokers who did not return for randomization, to the 500 who returned and were randomized to participate in a clinical trial for smoking cessation in African Americans. Analyses were conducted to identify variables associated with not returning for randomization.
RESULTS: Univariate comparisons found the nonrandomized group to be significantly different from those randomized. Logistic regression showed younger age, less readiness to quit, having been proactively recruited, lacking a regular source of health care, believing that they will be smoking in 6 months, less church attendance, and a lower literacy level to be jointly related with not returning for randomization.
CONCLUSIONS: African American participants who did not return for randomization into a clinical trial were different from those who did. Better understanding of these factors may allow researchers to target recruitment efforts resulting in enhanced accrual in clinical trials and increased efficiency.
Smoking cessation interventions among hospitalized patients: What have we learned?
2001, Preventive Medicine
Background. We conducted a structured review of controlled studies on inpatient hospital-based smoking cessation interventions.
Methods. Electronic searches were conducted with two different search engines, and reference sections of articles located were also reviewed. The RE-AIM framework was used to organize the review around the issues of reach, efficacy, adoption, implementation, and maintenance of interventions.
Results. Thirty-one intervention articles were located, 20 of which included a comparison condition and were included in the review. Overall, a moderate number of studies (13/20) reported on reach, which was highly variable and limited (30–50% in most studies), while few reported on implementation (7/20). Longer term cessation results produced relative risk ratios of 0.9–2.3, with a median of 1.5. Increases in quit rates above the control condition ranged from −1 to 10% (median 4%) among general admission patients and from 7 to 36% (median 15%) among cardiac admission patients. Studies with a dedicated smoking cessation counselor and 3–5 months of relapse prevention had a significant impact on cessation rates. Study settings (adoption) were limited to university, Veterans affairs, and HMO hospitals. Maintenance at the individual level was variable and related to the presence of a relatively intensive initial intervention and a sustained relapse prevention intervention.
Conclusions. Efficacious inpatient smoking programs have been developed and validated. The challenge now is to translate these interventions more widely into practice, given changing hospitalization patterns.
Population-based recruitment for quit-smoking programs: An analytic review of communication variables
1999, Preventive Medicine
Background. Attempts to reduce the prevalence of smoking through quit-smoking programs have been unsuccessful because they have not attracted large numbers of smokers to participate in them.
Method. An analytic review of the literature was conducted to identify potential communication variables that might enhance recruitment for community-based quit-smoking programs. Recruitment was defined as the number of smokers who enroll in a quit-smoking program divided by the estimated number of smokers in the target population.
Results. Thirty-three publications reporting the results of 40 recruitment campaigns were located. The median recruitment rate was 2.0%. Logistic regression was used to examine the effect of six variables on re cruitment rate: the type of program sponsor, the type of program, program costs, use of participation incentives, whether messages were segmented by stage of change, and the type of channel used to send messages. The only significant predictor of recruitment rate was channel type (i.e., the method used to deliver a message). Studies that used interactive recruitment channels (telephone, interpersonal communication) were 66.5 times more effective than those using passive recruitment strategies (mass media, direct mail). Results examining the segmentation of messages by stage of change on recruitment were inconclusive.
Conclusions. Results suggest that researchers and practitioners interested in population-based smoking cessation programs should pay more attention to recruitment methods. The use of interpersonal channels has been underused and appears to be particularly promising for improving the population impact of quit-smoking programs.

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