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Measures of smoking cessation activity range from intention/desire to quit, to number and length of quit attempts, to point prevalence cessation, to long-term sustained abstinence [1]. Many tobacco control interventions such as media campaigns, worksite restrictions, and taxes influence adult tobacco use by prompting quit attempts. Quit attempts can be defined in at least two ways: any quit attempt vs. a quit attempt that lasted at least 24 hours. The 24 hour duration criteria in the latter is presumably meant to distinguish highly motivated (i.e. serious) from less motivated (i.e. less-serious) attempts, and is commonly reported in the literature [2]. However, the implicit assumption is that motivation is the major variable determining ability to quit for 24 hours. An alternative view is that severity of nicotine dependence, not motivation, is the major determinant [3]. In fact, several studies indicate that a sizable proportion of smokers who make an attempt to quit do not last even one day. For example, 13–23% of self-quitters relapse within 24 hours [4,5].

We know of no data on whether smokers whose quit attempt lasts for 24 hours or more are more motivated to quit or are less dependent (or both) than those whose quit attempt lasts less than 24 hours. We used data from a recent study of ours to test this. This prior study tested smoking reduction and the USPHS ‘5Rs’ motivational counseling as methods to induce unmotivated smokers to consider and try abstinence [6]. Briefly, our study randomized smokers (n = 616) who did not plan to quit in the next month to receive either telephone-based reduction counseling vs. motivational counseling vs. no treatment. At 1.5, 3 and 6 months, we asked participants if they had made any quit attempts since the last follow-up and whether any of these quit attempts lasted more than 24 hours. Of the entire study sample, 283 (46%) self-reported one or more quit attempts during the six months of the follow-up. Among these, 149 made one attempt, 71 made two, and 63 made three or more attempts during the 6 months. Of the 283 participants who made a quit attempt, 224 made at least one attempt that lasted at least 24 hours and 59 did not.

Age, gender, and race did not differ across quit attempt groups. As expected, smokers who made a quit attempt were more motivated to quit at baseline (as indicated by stage of change and contemplation ladders) than smokers who did not make a quit attempt (Table 1). Those who made a quit attempt were not less dependent as measured by the FTND or other proxy measures of dependence, though those who made a 24 hour quit attempt reported a prior history of more attempts than those without a quit attempt. This suggests a previous history of 24 hour quit attempts may serve as a success experience that might make management of subsequent efforts to quit less difficult. Most importantly, smokers who were able to quit for more than 24 hours on at least one attempt were neither more motivated nor less dependent than smokers who were not able to quit for 24 hours on any attempt. When we reran the analyses and entered treatment assignment, use of NRT, and the total number of quit attempts made as co-variates, the findings did not change.

Table 1.  Baseline characteristics of smokers by definition of quit attempt
 No QA1 (n = 333)QA1 < 24 h (n = 59)QA1 ≥ 24 h (n = 224)
  • a

    ,b Non-alike lettered superscripts within same row reflect significant group differences, P < 0.05.

  • 1

    QA = Quit Attempt

  • 2

    Fagerstrom Test for Nicotine Dependence

Demographic Characteristics
 Age (SD)39.0 (13)43.1 (14)38.7 (13)
 % Female71%71%68%
 % Caucasian90%85%88%
Motivation Characteristics
 Stages of Change
  % Precontemplation76%a53%b53%b
  % Contemplation22%41%41%
  % Preparation 2% 7% 6%
 Readiness to Quit Ladder (0–10 scale)
  Readiness to quit in next month 2.0 (2.6)a 3.5 (3.1)b 3.2 (3.1)b
  Readiness to quit in next 6 months 4.2 (3.2)a 6.0 (3.4)b 6.0 (3.0)b
 Self-Efficacy (9–45 scale)20.2 (5.8)18.9 (5.2)19.5 (5.5)
Dependence Characteristics
 FTND2 5.4 (2.2) 5.6 (2.1) 5.6 (2.3)
 Cigarettes/Day22.1 (9.5)23.5 (10.6)21.6 (9.3)
 Age began smoking16.2 (6.7)16.3 (3.6)15.8 (3.1)
 ♯ Previous 24 h quit attempts 2.8 (4.0)a 2.8 (3.3)a,b 4.3 (7.9)b

In summary, our results suggest smokers who achieved 24 hours of abstinence as part of a quit attempt are no more motivated and no less dependent than smokers who attempt to quit but who fail to abstain for 24 hours. Although the 24 hour criterion may be useful to predict eventual cessation, we conclude that it does not appear to be a marker for serious vs. less-serious attempts to quit.

References

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  2. References
  • 1
    Burns, D., Anderson, C. , Major, J. , Vaughn, J. & Shanks, T. (2000) Cessation and cessation measures among adult daily smokers: national and state-specific data. In: Population Based Smoking Cessation: Proceedings of a conference on What Works to Influence Cessation in the General Population. Smoking and Tobacco Control Monograph No 12, pp. 2598. Bethesda, MD: National Cancer Institute.
  • 2
    USDHS (1999) Cigarette smoking among adults—United States, 1999. MMWR, 50, 869873.
  • 3
    USDHS (1988) The Health Consequences of Smoking: nicotine addiction. A report of the Surgeon General. Washington, DC: US Government Printing Office.
  • 4
    Garvey, A. , Bliss, R. , Hitchcock, J., Heinhold, J. & Rosner, B. (1992) Predictors of smoking relapse among self-quitters: a report from the Normative Aging Study. Addictive Behaviors, 17, 367377.
  • 5
    Marlatt, G. , Curry, S. & Gordon, J. (1988) A longitudinal analysis of unaided smoking cessation. Journal of Consulting and Clinical Psychology, 56, 715720.
  • 6
    Carpenter, M. , Hughes, J., Solomon, L. & Callas, P. (2004) Both smoking reduction with nicotine replacement therapy and motivational advice increase future cessation among smokers unmotivated to quit. Journal of Consulting and Clinical Psychology, 72, 371381.