Abstract
Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerström score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1–6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23–1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05–1.11); and being compliant (attending the planned meetings OR 4.36–4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1–6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising.
Highlights
The health consequences of severe tobacco addiction and an increased rate of tobacco consumption are tremendous [1,2]
Documented follow-up data were available for 28,542 interventions for the responding patients (Figure 1); among these, 28% reported 7 or more points on the FTND scale, 58% had smoked at least 20 cigarettes per day and 68% smoked at least 20 pack-years, thereby fulfilling the criteria for heavy smoking
The heavy smokers had a significantly lower rate of continuous abstinence compared with the 33%
Summary
The health consequences of severe tobacco addiction and an increased rate of tobacco consumption are tremendous [1,2]. The Fagerström Test for Nicotine Dependence (FTND) [4] and daily cigarette consumption are two measures that are frequently used to guide therapy. More intensive and longer-lasting smoking cessation programs results in higher rates of continuous abstinence than less intensive interventions, such as brief advice or motivational interviews [2,16,17,18,19,20,21,22]. High-intensity smoking cessation programs generally lead to more continuous abstinence, lower rates of success have been reported among heavy smokers. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); abstinence was approximately 1–6% lower in the heavy smokers than the overall population
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