Ongoing Self-Engagement in Quit Attempts and Cessation Outcomes Among Rural Smokers Who Were Unable to Quit After 2 Years of Repeated Interventions

Authors

  • Siu-kuen Azor Hui PhD, MSPH,

    1.  Department of Psychosocial and Behavioral Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvannia
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  • Niaman Nazir MBBS, MPH,

    1.  Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas
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  • Babalola Faseru MD, MPH,

    1.  Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas
    2.  Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas
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  • Edward F. Ellerbeck MD, MPH

    1.  Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, Kansas
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  • Funding: This research was supported by grant number CA 1102390 from the National Cancer Institute at the National Institutes of Health.

  • Acknowledgments: The authors thank the volunteers who participated in this research and the primary care doctors in the Kansas Physicians Engaged in Prevention Research network who opened their practices to this study.

  • For further information, contact: Edward F. Ellerbeck, MD, MPH; University of Kansas School of Medicine Department of Preventive Medicine and Public Health, MS 1008; 3901 Rainbow Blvd; Kansas City, KS 66160; e-mail: eellerbe@kumc.edu.

Abstract

Purpose: As many smokers experience repeated failures with cessation attempts, it has been postulated that we may create a cadre of highly resistant smokers who are unlikely to engage in treatment or succeed in quitting. Our purpose was to follow a group of recalcitrant rural smokers and examine their ongoing engagement in smoking cessation activities.

Methods: At the end of a 24-month disease management program for rural smokers, we identified participants who reported ongoing daily smoking despite exposure to 4 previous cycles of smoking cessation interventions. At month 36 (1 year after conclusion of the study), we contacted these participants and assessed changes in smoking status and ongoing engagement in cessation activities over the preceding 6 months. We assessed quit attempts and use of pharmacotherapy during the prior 6 months, as well as smoking abstinence at 36 months.

Findings: Among 333 recalcitrant smokers, 49% reported at least one 24-hour quit attempt during the preceding 6 months, 29% tried smoking cessation pharmacotherapy, and 5% quit smoking. Significant predictors of having at least one 24-hour quit attempt were lower numbers of cigarettes smoked per day, being in preparation stage of change, and more pharmacotherapy-assisted quit attempts during the original 24-month trial. Higher motivation to quit and more previous pharmacotherapy-assisted quit attempts significantly predicted cessation medication use. Use of varenicline was strongly associated with cessation.

Conclusions: Many recalcitrant rural smokers continue to engage in treatment and make quit attempts even in the absence of active interventions.

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