1. Natural History of Attempts to Change Smoking in Self-Quitters John R Hughes, Laura J Solomon, James Fingar, Shelly Naud, John E Helzer University of Vermont

2. Purpose of Study To describe the patterns of smoking change (i.e. quit attempts, reduction, lapses, and relapses) among self-quitters To determine if cognitions or environmental cues most determine onset of a quit attempt

3. Rationale Many longitudinal studies examine what happens after a quit attempt, none have examined what happens before a quit attempt Most descriptions of smoking cessation are based on the small percent of smokers willing to attend a research study

4. Methods 152 smokers who planned to quit in the next 3 months Recruited from across US No treatment provided Conducted by phone, mail and internet

5. Methods Called nightly into IVR for 3 month Reported smoking (cigs/day and quit attempt) Reported intentions daily (“Do you plan to smoke tomorrow?”)

6. Sample Characteristics Mean age = 45 67% women 23% minorities Mean cigs/day = 19 Mean FTND = 5.3 More like self-quitters than treatment seekers

7. Examples of changes in cessation, reduction, and intention

8. Major results 52% had multiple (> 3) episodes of intention to quit 60% of smokers had multiple episodes of abstinence and reduction Among the days of intended abstinence, only 85% resulted in a quit attempt 65% of quit attempts began in the morning

9. Major Results 72% of quit attempts were not preceded by intention to quit Unintended quit attempts were less, not more, successful than intended quit attempts (< 1 day vs 25 days) Reduction was as common an outcome as abstinence

10. Major results Making a failed quit attempt early in the study predicted a greater, not smaller, probability of a later quit attempt On the longest quit attempt of each smoker, 48% lasted less than a day 18% of quit attempts resulted in abstinence at the end of the study When a lapse occurred, 60% of the time smokers immediately returned to daily smoking

11. Major Results When asked about quitting at the end of the study, 17% of smokers stated they did not make a quit attempt but during the study reported a quit attempt. Most forgetting of quit attempts was for attempts that did not last for a day

12. Limitations Asking daily about quitting may have influenced outcomes The sample was of those planning to quit in next 3 months (about 30% of US smokers)

13. Conclusions Smoking cessation attempts are much more complex than most assume Smokers had multiple and often rapid attempts to stop or reduce during the 3 months Most intentions do not result in quit attempts

14. Conclusions Most quit attempts were unplanned Unplanned quit attempts were less successful Reduction was as common as cessation Failed quit attempts do not produce less motivation to quit Half of quit attempts failed the first day Smokers often forget about short quit attempts

15. Implications A failed quit or reduction attempt is a marker for more attempts to change in the near future Failure to quit does not result in less interest in quitting in the near future We need to encourage smokers to return after failure, including proactive contacts after failure

16. Studies with the Highest Long-Term (> 1 Yr) Quit Rates Are Those That Included Recontacting Failures MRFIT, 8141% Lung Health, 0135% Hall, 0452%

17. Association for the Treatment of Tobacco Use and Dependence An organization of providers dedicated to the promotion of and increased access to evidence-based tobacco treatment for the tobacco user. www.attud.org