Treating smoking like a chronic health condition — similar, say, to high blood pressure or diabetes — increases the likelihood that smokers will actually kick the addiction, according to a new University of Minnesota study.
In fact, the study found that such an approach was 75 percent more effective in helping individuals give up cigarettes over an 18-month period than the most scientifically accepted types of short-term stop-smoking programs.
“We found that a treatment may be even more effective if it’s tweaked and adjusted and individualized … and if you stick with people over a longer period of time,” said Dr. Anne Joseph, the study’s lead author and a researcher at the U of M’s Masonic Cancer Center.
That’s good news for the approximately 45 million Americans who smoke. As background information in the U of M study points out, surveys have found that more than 75 percent of smokers would like to quit. Indeed, about 30 percent of them try to quit each year.
But less than 10 percent of smokers are successful and able to give up cigarettes for good. Most relapse within three months.
Taking a long-term approach
Standard stop-smoking treatment programs are relatively short. Smokers attend classes or receive some other kind of counseling for six to 12 weeks. They may also be encouraged to use some kind of nicotine replacement therapy (nicotine patches, gum or lozenges).
After the program is over, however, the smokers are left on their own.
Joseph and her U of M colleagues wanted to see if a more long-term disease management approach — one that had quitting smoking as its target goal but which also allowed participants who experienced a relapse to reduce their cigarette use as they prepared themselves for another attempt at quitting — would be more effective.
This is the kind of ongoing care that individuals with a chronic disease such as high blood pressure, diabetes or asthma receive. The patient is continually encouraged to take steps to improve his or her health.
For the study, the U of M researchers recruited 443 volunteers (mean age: 42). All were smokers (mean number of cigarettes smoked daily: 17), and 60 percent were women.
The volunteers were randomized into two groups. One received standard treatment — six telephone counseling calls and eight weeks of nicotine replacement therapy by mail. The other group received a full 52 weeks of telephone counseling and nicotine replacement therapy.
After 18 months (six months after the longer program had ended), 30.2 percent of the volunteers in the long-term group had not smoked for six months. This compared to 23.5 percent in the other group.
In addition, those in the long-term group made significantly more attempts at quitting — an important finding.
“Quitting is tough,” explained Joseph. “It takes most people roughly five times to do it.”
Not quite nagging
The study’s phone counselors used cognitive behavioral techniques and motivational interviewing to encourage the volunteers to stick with the program.
“Someone asked me if our phone calls were nagging — like a mother nagging a child,” said an amused Joseph. “But our calls were different than a mother’s. They were non-judgmental.”
When smokers relapsed, for example, they were simply encouraged to try again, even if that meant smoking a reduced number of cigarettes as they geared up for a second attempt.
In fact, the U of M study is one of the first to evaluate cigarette reduction as a tool toward encouraging people to finally quit.
“It was effective,” said Joseph.
The study’s longer and more intensive treatment program did cost more, however: an average of $718 per participant versus $379 per participant for standard programs.
“That’s about the cost of a single CT scan,” said Joseph. Given the dramatic health benefits associated with quitting smoking, she added, that extra cost is not that alarming.
“I would hazard a guess that even if [the expense of the longer treatment program] is 10 times higher, it would still be cost effective,” she said.