Rather than quitting cold turkey, more smokers are seeking assistance to help them quit smoking, and it seems to improve their odds of success, according to a new study.

"Our findings refute some earlier suggestions that smoking-cessation programs may not have sufficient public health impact to justify their existence," said lead author Shu-Hong Zhu, PhD, of the University of California, San Diego. Zhu and colleagues surveyed 4,480 individuals in California who had attempted to quit smoking in the previous year. Nearly 20 percent of these individuals had used at least one of the following methods to help them quit: self-help materials, counseling, or nicotine replacement therapy (NRT), the researchers found. Approximately 3 percent of the people read self-help materials, 3 percent used counseling, 12 percent employed NRT, and 2 percent used a combination of counseling and NRT. Women were more likely to seek help than men; heavy smokers used these methods more frequently than light smokers; and whites used them more frequently than Hispanics. As smokers aged, they were more likely to seek help in quitting--the oldest survey participants sought assistance at three times the frequency of the youngest. Use of these smoking cessation aids increased the odds of success in quitting smoking, the researchers found. Approximately 15 percent of those who sought assistance had managed to abstain from cigarettes for 12 months, compared with 7 percent of those who quit without assistance. The study results appear in the May 2000 issue of the American Journal of Preventive Medicine. These findings differ significantly from those of a 1986 survey. Approximately 8 percent of smokers surveyed in the previous study reported using assistance, and these individuals were half as successful as individuals who did not seek assistance. When they compared the 1986 study with the current one, Zhu and colleagues found that the smokers who sought help in the early study smoked more--an average of 25.6 cigarettes per day, compared with an average of 18.7 in the present study. The two studies may have had varying results "because different levels of nicotine dependence may lead to different levels of responsiveness to treatments," said Zhu. Also, the researchers suggest that California anti-smoking campaigns and increased restrictions on indoor smoking over the past 10 years may have indirectly increased the effectiveness of smoking cessation efforts. "The world of tobacco control has changed significantly since the publication of the paper. The current social climate makes smoking much less desirable," said Zhu. Other developments since 1986 include the nicotine patch and nicotine gum, both of which became available over the counter in 1996, and Bupropion, a non-nicotine smoking cessation agent not included in the current study, since it became available after the survey was conducted. Some health insurance plans now cover NRT in conjunction with behavioral counseling, and many states fund local cessation programs. Also, physicians may encourage individuals to seek assistance. "In recent years, clinicians have increased emphasis on assessment of smoking status during routine health care visits," said Zhu. Future studies should compare the use of assistance in states with strong tobacco regulation programs--such as Massachusetts and California--with states without such programs, according to the researchers. "At least in societies such as that of the United States, where spending on the public health campaign against smoking is significant, assistance with smoking cessation holds substantial promise in increasing the number of successful quitters in the general population," concluded Zhu. The data collection for this research was funded by the California Department of Health Services. The analysis and writing were funded by a grant from the National Cancer Center Institute.

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