1. Laws/Policies ABSTRACT Problem: A challenge for tobacco control practitioners is getting smokers to quit using cessation methods. To increase the proportion of smokers who use cessation methods it is important to understand the reasons why smokers don’t use them. Methods: Utilized 2003 Adult Tobacco Survey Data to assess reasons Vermont smokers who’ve made a quit attempt in the past year did not use cessation methods, by gender and age. Results: Of smokers making a quit attempt in the last year and not using a cessation method, 17.1%, 20.9%, 38.5%, 32.7% and 27.2% hadn’t heard of the nicotine patch, gum, inhaler, quit line or group counseling, respectively. Of those, who’d heard of the cessation method, potential side effects were reported most frequently as the reason for not using the patch (58.4%), while ‘doesn’t work’ (17.7%) was most often cited by Quit Line non-users. The patterns were the same by age and gender, for both patch and quit line non-users. Gum non-users cited potential side effects (34.3%) most often as the reason for not using it; however, male (28.2%) and aged 45+ (29.4%) non-users more often said it didn’t work. Inhaler non-users most often cited cost (40.1%); while female inhaler non-users most often reported potential side effects (45.7%). Among non-users of group counseling, ‘doesn’t work’ (21.9%) and cost (22.3%) were listed equally often; male and female non-users cited ‘doesn’t work’ (25.7%) and cost (26.5%) most frequently. Conclusions: Much work remains to reduce misperceptions surrounding use of cessation methods. BACKGROUND Approximately forty percent of smokers attempt to quit smoking each year (1). However, only 20% of those trying to quit seek help in making the effort successful (2). Smokers attempting to quit with no help are less successful than smokers who use help. Less than 10% of those who quit “cold turkey” are successful long-term (2, 3); use of cessation aids increases the quit success rate to 15 – 30% (4). The types of help available to smokers trying to quit include counseling, both group and telephone and pharmacotherapies, including nicotine replacement therapy (NRT) and non-nicotine therapy. NRT products approved for use include gum, transdermal patch, nasal spray, inhaler, and lozenges (2,4). Non-nicotine therapies include Bupropion (Zyban), Nortiptyline and Clonidine (2). METHODS The ATS is a telephone survey conducted on a sample of 2,000 Vermont adults annually since 2001 (2005 survey is currently in development). A complex sampling method is used, through which over- samples of smokers and 18-24 year olds are collected. Data is weighted to represent the Vermont population. On the ATS, current smokers are defined as those having smoked at least 100 cigarettes in their lifetime and who currently smoke some days or every day. Questions regarding the reasons for not using various nicotine replacement therapies when quitting were added beginning in 2002. Analyses were conducted on the 2003 ATS dataset using SAS. To account for the complex nature of the survey, 95% confidence intervals were calculated using SUDAAN. RESULTS Current Smoker Quit Attempt Methods Used (Figure 1): Overall, 44.7% of Vermont current smokers made at least one attempt to quit smoking the last year. Of those, more than 65% reported not using each type of cessation aid. Non-usage ranged from 66% (95% C.I. 60.5%, 71.5%) for the nicotine patch to 95.2% (95% C.I. 92.8%, 97.6%) for the nicotine inhaler. Reasons for Not Using Various Cessation Aids – Overall, by Gender and by Age (Figures 2 - 4): Of respondents who didn’t use each cessation method, 82.9%, 79.1%, 61.4%, 72.8%, and 67.3% had heard of the nicotine patch, gum, inhaler, group counseling and quit line, respectively (data not shown). Of those who’d heard of the nicotine patch, the ‘risk of side effects’ was cited most often as a reason for not using this method (58.4%, 95% CI - 54% to 62.8%); a trend that held for both genders and age groups. Non-users of the nicotine gum also most often reported ‘risk of side effects’ as a reason for not using it (34.3%, 95% CI – 30.5%, 38.1%). This held true for female (40.0%) and younger (38.9%) non- users of the gum; however males (28.2%) and older (29.4%) more often reported ‘it doesn’t work’ as a reason for not using the gum. Among those who’d heard of the nicotine inhaler, ‘cost’ (40.1%, 95% CI – 35.8%, 44.4%) was most often reported as a reason for non-use. Females (45.7%), most often reported the ‘risk of side effects’ as their reason for not using the inhaler. Group counseling non-users, reported ‘doesn’t work’ (21.9%, 95% CI – 18.2%, 25.6%) and ‘cost’ (22.3%, 95% CI – 19.1%, 25.5%) equally as often as reasons for not participating in this type of counseling. Female (26.5%) and younger (24.0%) non-users more often reported cost as a reason for not participating; male (25.7%) and older (23.6%) non-users reported ‘doesn’t work’ as a reason. Respondents who’d heard of the quit line and didn’t use it, most often reported ‘doesn’t work’ as a reason for not utilizing the quit line (17.7%, 95% CI – 14.6, 20.8%). The same was true among all sub-groups, though small numbers limit the use of these sub-group analyses. Note that respondents were also asked if there were ‘other’ reasons for not using each cessation method. That data is not presented here. CONCLUSION The use of NRT and other cessation aids, such as counseling, to increase the success of a quit attempt has been well documented. A key question as tobacco cessation and prevention programs mature is why aren’t smokers using the aids available to them when they quit? In Vermont, all counseling types – both group and Quit Line - are provided free of charge. Most people can also get NRT either free or at a reduced fee. This data shows that misperceptions, overall and among most subgroups, are a main reason smokers do not use cessation aids. Risk of side effects and belief that they don’t work were also cited as reasons for not using NRT or counseling. This data doesn’t provide the answer to the question of how to get more people to use cessation aids, but it does help give direction to the efforts we’re making to increase NRT and counseling use. Much work remains to eliminate misperceptions and educate smokers about the safety of NRT and counseling, but we are making strides. Further analyses are planned, using more recent data, and include exploring the ‘other’ reasons listed by respondents. Assessment of Why Vermont Smokers Did Not Use Cessation Methods 2003 Adult Tobacco Survey Data Jessie Brosseau, MPH and Jason Roberts, MPH Vermont Department of Health REFERENCES 1.Centers for Disease Control and Prevention. Cigarette Smoking Among Adults – United States, 2002. MMWR Morb Mortal Wkly Rep. 2004; 53(20): 427-431. 2.Rigotti, N. Treatment of Tobacco Use and Dependence. NEJM. 2002; 346(7): 506-512. 3.A Clinical Practice Guideline for Treating Tobacco Use and Dependence: A US Public Health Service Report. JAMA 2000; 283(24): 3244-54. 4. Silagy C., Lancaster T., et al. Nicotine Replacement Therapy for Smoking Cessation. Cochrane Database of Systematic Reviews. 2004;(3):CD000146 Nicotine Patch Nicotine Gum Nicotine Inhaler Group Counseling # Quit Line** # Nicotine Patch Nicotine Gum Nicotine Inhaler Group Counseling # Quit Line** #