A RESPONSE TO PROCHASKA: LIFE DOES NOT ALWAYS GO ACCORDING TO PLAN; YOUR QUITTING MIGHT NOT EITHER

Authors


We would like to thank Professor Prochaska for his interest in our paper [1] and for the opportunity to respond. Prochaska's primary argument is that setting a quit date cannot be used to understand the utility of planning as a comprehensive process [2]. We agree. However, our research did not portent to address these broad issues. Rather, our research focused on whether giving significant forethought to the time and day when one has their last cigarette influences their likelihood of remaining smoke free. Our question of interest was how far in advance people planned the start of their most recent quit attempt. Our data, and data from others [3–6], suggests planning one's last cigarette well in advance does not necessarily confer a benefit. Our study was not designed to tell us anything about whether preparing to find social support or quit aids can help a person after their quit attempt has started, and we were careful not to draw such conclusions.

A second issue raised by Prochaska was whether planners and non-planners were equivalent on other important variables such as level of nicotine dependence. Close inspection of our analyses shows that we controlled for these variables to allow for a comparison that adjusted for differences between groups.

We agree with Prochaska that the time since the most recent quit attempt has the potential to be a confounder for some of the research where long periods have passed since the most recent quit attempt and the time that information about the quit attempt was collected [3–5]. If this was a valid concern, then we should expect those studies with longer intervals to be different from studies with shorter intervals. However, results among studies with relatively short intervals (<6 months) [1,4] are the same as those with longer intervals.

Professor Prochaska concluded that nothing practical can be learned from the research on unplanned quit attempts. We respectfully disagree. An important consequence of our work is that health professionals and others should emphasize the importance of quitting today or, at least, as soon as possible. Patients need not worry about having elaborate plans to stop using tobacco as a prerequisite for success. The sooner one stops smoking, the sooner health and social benefits can be achieved. The sooner one stops, the sooner one can identify and apply the proper combination of relapse prevention strategies. Clinicians would then need only to inform and encourage people to seek out and utilize appropriate aids (social, pharmacological, behavioural, etc.). Whether a quitter secures nicotine replacement therapy 4 weeks prior to the quit day or an hour after their last cigarette may not matter as much as arranging the appropriate aids once it has been determined that they are needed.

A better understanding of how individuals start and proceed through quit attempts may identify appropriate interventions and when to apply them. Such research helps to recognize that planning does not necessarily have to be conducted before the last cigarette.

Declarations of interest

None.

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