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. 2003 Feb;53(487):101–107.

Predictors of long-term outcome of a smoking cessation programme in primary care.

Gonzalo Grandes 1, Josep M Cortada 1, Arantza Arrazola 1, Jon P Laka 1
PMCID: PMC1314508  PMID: 12817354

Abstract

BACKGROUND: It would be helpful for general practitioners to know which smokers are the most or the least likely to achieve long-term cessation, so that efforts in promoting lifestyle changes can be prioritised. AIM: To identify predictors of abstinence and assess effectiveness over a two-year follow-up of a smoking cessation programme in routine general practice. DESIGN OF STUDY: Quasi-experimental non-randomised controlled trial. SETTING: Primary healthcare centres of the Basque Health Service, Spain. METHOD: All smokers attending seven intervention (n = 1203) and three control (n = 565) practices during one year (from September 1995 to October 1996) were included. The associations between attempts to stop smoking, relapses, and sustained biochemically confirmed abstinence between 12 and 24 months' follow-up, with baseline characteristics and patients' preference with regard to three possible therapeutic options, were assessed by means of logistic regression and survival analyses. RESULTS: Sustained abstinence was biochemically confirmed in 7.3% of smokers in the intervention practices (relative probability = 2.8, 95% confidence interval [CI] = 1.6 to 4.7; probability difference = 4.7%, 95% CI = 2.7% to 6.7%); in 5% of smokers who received advice and a handout (adjusted odds ratio [AOR] = 1.9, 95% CI = 1.0 to 3.4), in 16% who received advice, a handout and follow-up (AOR = 6.6, 95% CI = 2.9 to 14.6), and in 22% who received advice, a handout, follow-up and nicotine patches (AOR = 13.1, 95% CI = 6.6 to 25.9). Positive predictors included previous attempts to stop smoking (AOR = 1.8, 95% CI = 1.1 to 2.7), and age (for each 10 years AOR = 1.32, 95% CI = 1.13 to 1.44). The Fagerström nicotine dependence score was negatively associated (for each point AOR = 0.89, 95% CI = 0.82 to 0.97). CONCLUSION: The intensity of the programme can be tailored to the probability of long-term cessation estimated by the statistical model including these predictors.

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Selected References

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  1. Ashenden R., Silagy C., Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract. 1997 Apr;14(2):160–176. doi: 10.1093/fampra/14.2.160. [DOI] [PubMed] [Google Scholar]
  2. Bjornson W., Rand C., Connett J. E., Lindgren P., Nides M., Pope F., Buist A. S., Hoppe-Ryan C., O'Hara P. Gender differences in smoking cessation after 3 years in the Lung Health Study. Am J Public Health. 1995 Feb;85(2):223–230. doi: 10.2105/ajph.85.2.223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blondal T., Gudmundsson L. J., Olafsdottir I., Gustavsson G., Westin A. Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up. BMJ. 1999 Jan 30;318(7179):285–288. doi: 10.1136/bmj.318.7179.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dale L. C., Glover E. D., Sachs D. P., Schroeder D. R., Offord K. P., Croghan I. T., Hurt R. D. Bupropion for smoking cessation : predictors of successful outcome. Chest. 2001 May;119(5):1357–1364. doi: 10.1378/chest.119.5.1357. [DOI] [PubMed] [Google Scholar]
  5. Etter J. F., Perneger T. V., Ronchi A. Distributions of smokers by stage: international comparison and association with smoking prevalence. Prev Med. 1997 Jul-Aug;26(4):580–585. doi: 10.1006/pmed.1997.0179. [DOI] [PubMed] [Google Scholar]
  6. Fiore M. C., Novotny T. E., Pierce J. P., Hatziandreu E. J., Patel K. M., Davis R. M. Trends in cigarette smoking in the United States. The changing influence of gender and race. JAMA. 1989 Jan 6;261(1):49–55. [PubMed] [Google Scholar]
  7. Grandes G., Cortada J. M., Arrazola A. An evidence-based programme for smoking cessation: effectiveness in routine general practice. Br J Gen Pract. 2000 Oct;50(459):803–807. [PMC free article] [PubMed] [Google Scholar]
  8. Gritz E. R., Thompson B., Emmons K., Ockene J. K., McLerran D. F., Nielsen I. R. Gender differences among smokers and quitters in the Working Well Trial. Prev Med. 1998 Jul-Aug;27(4):553–561. doi: 10.1006/pmed.1998.0325. [DOI] [PubMed] [Google Scholar]
  9. Heatherton T. F., Kozlowski L. T., Frecker R. C., Fagerström K. O. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991 Sep;86(9):1119–1127. doi: 10.1111/j.1360-0443.1991.tb01879.x. [DOI] [PubMed] [Google Scholar]
  10. Jackson P. H., Stapleton J. A., Russell M. A., Merriman R. J. Predictors of outcome in a general practitioner intervention against smoking. Prev Med. 1986 May;15(3):244–253. doi: 10.1016/0091-7435(86)90044-7. [DOI] [PubMed] [Google Scholar]
  11. Kenford S. L., Fiore M. C., Jorenby D. E., Smith S. S., Wetter D., Baker T. B. Predicting smoking cessation. Who will quit with and without the nicotine patch. JAMA. 1994 Feb 23;271(8):589–594. doi: 10.1001/jama.271.8.589. [DOI] [PubMed] [Google Scholar]
  12. Kviz F. J., Clark M. A., Crittenden K. S., Warnecke R. B., Freels S. Age and smoking cessation behaviors. Prev Med. 1995 May;24(3):297–307. doi: 10.1006/pmed.1995.1048. [DOI] [PubMed] [Google Scholar]
  13. Mallin Robert. Smoking cessation: integration of behavioral and drug therapies. Am Fam Physician. 2002 Mar 15;65(6):1107–1114. [PubMed] [Google Scholar]
  14. Monsó E., Campbell J., Tønnesen P., Gustavsson G., Morera J. Sociodemographic predictors of success in smoking intervention. Tob Control. 2001 Jun;10(2):165–169. doi: 10.1136/tc.10.2.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Norman G. J., Velicer W. F., Fava J. L., Prochaska J. O. Cluster subtypes within stage of change in a representative sample of smokers. Addict Behav. 2000 Mar-Apr;25(2):183–204. doi: 10.1016/s0306-4603(99)00054-4. [DOI] [PubMed] [Google Scholar]
  16. Prochaska J. O., Goldstein M. G. Process of smoking cessation. Implications for clinicians. Clin Chest Med. 1991 Dec;12(4):727–735. [PubMed] [Google Scholar]
  17. Richmond R. L., Kehoe L. A., Webster I. W. Multivariate models for predicting abstention following intervention to stop smoking by general practitioners. Addiction. 1993 Aug;88(8):1127–1135. doi: 10.1111/j.1360-0443.1993.tb02132.x. [DOI] [PubMed] [Google Scholar]
  18. Rohren C. L., Croghan I. T., Hurt R. D., Offord K. P., Marusić Z., McClain F. L. Predicting smoking cessation outcome in a medical center from stage of readiness: contemplation versus action. Prev Med. 1994 May;23(3):335–344. doi: 10.1006/pmed.1994.1047. [DOI] [PubMed] [Google Scholar]
  19. Russell M. A., Merriman R., Stapleton J., Taylor W. Effect of nicotine chewing gum as an adjunct to general practitioner's advice against smoking. Br Med J (Clin Res Ed) 1983 Dec 10;287(6407):1782–1785. doi: 10.1136/bmj.287.6407.1782. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Russell M. A., Wilson C., Taylor C., Baker C. D. Effect of general practitioners' advice against smoking. Br Med J. 1979 Jul 28;2(6184):231–235. doi: 10.1136/bmj.2.6184.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Senore C., Battista R. N., Shapiro S. H., Segnan N., Ponti A., Rosso S., Aimar D. Predictors of smoking cessation following physicians' counseling. Prev Med. 1998 May-Jun;27(3):412–421. doi: 10.1006/pmed.1998.0286. [DOI] [PubMed] [Google Scholar]
  22. Stapleton J. A., Sutherland G., Russell M. A. How much does relapse after one year erode effectiveness of smoking cessation treatments? Long-term follow up of randomised trial of nicotine nasal spray. BMJ. 1998 Mar 14;316(7134):830–831. doi: 10.1136/bmj.316.7134.830. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Swan G. E., Jack L. M., Ward M. M. Subgroups of smokers with different success rates after use of transdermal nicotine. Addiction. 1997 Feb;92(2):207–217. [PubMed] [Google Scholar]
  24. Velicer W. F., Fava J. L., Prochaska J. O., Abrams D. B., Emmons K. M., Pierce J. P. Distribution of smokers by stage in three representative samples. Prev Med. 1995 Jul;24(4):401–411. doi: 10.1006/pmed.1995.1065. [DOI] [PubMed] [Google Scholar]

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