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Keywords:

  • Planned quits;
  • quit dates;
  • smoking cessation

Claims have been made that research on unplanned quit attempts raises major challenges for smoking cessation programs and for health behavior change theories. These studies supposedly indicate that a majority or a substantial proportion of quit attempts are unplanned (i.e. made spontaneously without advanced planning) [1–4]. Further, these studies supposedly indicate that compared to planned attempts, unplanned attempts are at least as successful for smoking cessation. The study of Sendzik et al. reveals some of the major flaws of this type of research that seriously challenge the claims made by proponents of unplanned quit attempts [5].

First, ‘planned quit’ attempts is a misnomer. All that defines a ‘planned’ quit is setting a quit date. Setting a quit date can be as short as the same day or as long as a month ahead [2,3]. Are there any health behavior change theories or cessation programs that would propose a plan that only included setting a quit date? Setting a quit date is only one variable in an appropriate plan. Such research is based on a leap of logic that claims a part equals the whole.

Look what happens when more components of a plan are included. The data used by Sendzik et al. contains a much broader set of variables than most other studies. These included 20+ components that could be part of a quit plan, such as the use of six different pharmacotherapies, help from a dentist, doctor or pharmacist and 11 types of formal support, such as hypnosis, acupuncture, group counseling, addiction counseling, websites and self-help programs. In addition, about 90% of the entire sample had a support person available for their quit attempts. The authors affirmed that: ‘Quit aid use during a quit attempt was seen as a potential proxy measure of a developed quit plan . . .’. However, as in the literature, the use of such treatments or aids was not part of the definition of a planned quit attempt. What happens if we count these components of a ‘developed quit plan’? Of the 26.4% of the sample who supposedly used ‘unplanned quit attempts’, 57.6% used quit aids that would be proxies for a ‘developed quit plan’. Multiplying these two percentages means that only 15.2% of the sample reported no evidence of using a planned quit attempt. This small percentage raises serious questions about the frequent claims that unplanned quit attempts are very common, if not the norm.

To their credit, the authors raise important questions about whether unplanned attempts are truly made without planning and how researchers define planning. It seems a little late to raise such key questions after research on ‘unplanned quit attempts’ have been used to attack health behavior change theories and almost all smoking cessation programs that apply ‘developed quit plans’. [6]

Other key questions need to be raised. How can one justify comparing supposed success rates of those who plan to those who may not, when those who plan have much higher rates of being very addicted (58.5% versus 33.5%) and perceive quitting as very hard (43.3% versus 26.7%). Unplanned quit attempts may be perceived as being spontaneous, but they are certainly not random. Imagine a randomized controlled trial (RCT) with such differences of severity of the problem in the two treatment groups. One would conclude that the study is too confounded to draw any reasonable conclusions.

Consider other confounders, such as time since the most recent quit attempts. Some studies have a mean of 13 years since the last quit attempt [1], while others limit the time to 10 years [3]. Is memory not confounded by trying to recall whether a quit attempt 10–13 years ago was set the same day, the day before or months before?

Then consider the criteria used for ‘successful’ quit attempts. Did the quit attempt last a week, a month or 6 months? In an RCT it would not matter. If the person was smoking at final follow-up, their quit attempts would be considered failures.

So what has the research taught us about ‘unplanned quit attempts’? Practically nothing and nothing practical. Imagine practicing spontaneous smoking cessation. Would you follow the old road to recovery where you wait for a crisis, such as a heart attack, before smokers would be motivated or prepared to quit? Would you ignore thousands of RCTs that support evidence-based treatments that are organized around components of a developed quit plan? Or could you just ignore the problem, confident in the belief that spontaneous cessation, like spontaneous combustion, can light a fire under smokers that will be more effective than any plan or any aid that the science of cessation has generated?

References

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  2. Declaration of interests
  3. References