HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Figures Only Full Text (PDF) All Versions of this Article: AJPH.2005.083527v1 97/8/1503    most recent Submit a response View responses View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (14) Citing Articles via Google Scholar Google Scholar Articles by Lee, C.-w. Articles by Kahende, J. Search for Related Content PubMed PubMed Citation Articles by Lee, C.-w. Articles by Kahende, J. Related Collections Smoking Cessation Tobacco Control

Chung-won Lee, PhD, MA and Jennifer Kahende, PhD

At the time of the study, the authors were with the Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga.

Correspondence: Requests for reprints should be sent to Chung-won Lee, PhD, CDC/Global AIDS Program, HIV Prevention Branch, 1600 Clifton Rd, NE, MS E-04 Atlanta, GA 30333 (e-mail: clee2{at}cdc.gov).

	ABSTRACT

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 

Objectives. Each year, nearly 2 in 5 cigarette smokers try to quit, but fewer than 10% succeed. Taking a multifaceted approach to examine the predictors of successfully quitting smoking, we identified factors associated with successful quitting so that cessation programs could be tailored to those at highest risk for relapse.

Methods. Using data from the 2000 National Health Interview Survey, we employed multiple regression analysis to compare demographic, behavioral, and environmental characteristics of current smokers who tried unsuccessfully to quit in the previous 12 months with characteristics of those able to quit for at least 7 to 24 months before the survey.

Results. Successful quitters were more likely than those unable to quit to have rules against smoking in their homes, less likely to have switched to light cigarettes for health concerns, and more likely to be aged 35 years or older, married or living with a partner, and non-Hispanic White, and to have at least a college education.

Conclusions. Programs promoting smoking cessation might benefit by involving family or other household members to encourage smoke-free homes.

	INTRODUCTION

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
Cigarette smoking is the leading cause of preventable death in the United States. Each year, it kills more than 440 000 Americans,¹ and about 8.6 million people in the United States have illnesses attributable to smoking.² In addition, direct medical costs related to smoking total about $ 75 billion annually.¹ The adverse health effects of cigarette smoking and the benefits of quitting are well documented and widely known to the general public.^3–6 Even so, as of 2003, some 45.4 million US adults (21.6%) were current smokers.⁷

In 2003, the Centers for Disease Control and Prevention (CDC) found from self-reports that 41% of current smokers (20.2 million) had tried to quit smoking for 1 or more days within the previous 12 months.⁷ Many smokers who try to quit cite a desire to improve their health as the main reason.^8,9 Unfortunately, most smokers are not successful in quitting, primarily because they are addicted to nicotine.^10–14 Motivation and readiness to quit are predictors of successful quitting, but dependence on nicotine has been found to be a stronger predictor.¹³

Numerous studies have addressed factors associated with making a quit attempt or with successful smoking cessation. Past studies have examined such demographic factors as gender, age, marital status, income, and education to assess whether they differed between smokers who tried to quit and those who did not try, as well as between successful and unsuccessful quitters.^{5,12,13,15–17} For example, Derby et al.¹⁸ found that for women, successful smoking cessation was associated with not living with a smoker; for men, it was correlated with increased age. Hymowitz et al.¹⁹ found that being older, male, and having higher income predicted cessation, as did 2 behavioral variables—smoking fewer cigarettes and having previous quit attempts. Hatziandreu et al.¹⁰ found that greater educational attainment was positively associated with trying to quit and that people aged 17 to 24 years and those aged 65 or older tried to quit more frequently. In addition, Wilcox et al.²⁰ found that people with higher income and educational levels were more likely to reattempt quitting after a relapse. Similarly, Borland et al.²¹ found that having higher education was a predictor of successfully quitting, but they found that having previous quit attempts was a predictor of relapse to smoking.

The environment in which an addictive behavior such as smoking occurs is a significant factor in determining whether or not that behavior is maintained.²² Several studies found that being in daily contact with other smokers reduced the likelihood of success in quitting.^23–25 Similarly, Senore et al.²⁶ and Gourlay et al.²⁷ found that the likelihood of success in quitting was lower among smokers who lived with other smokers than among those who did not. Farkas et al.²⁸ found that bans in both the workplace and in the home were significant predictors of successful quitting. Correspondingly, Woodruff et al.²⁹ found a lower prevalence of smoking among workers employed in jobs with smoke-free policies. Other studies have found that bans on smoking in the workplace increase cessation and promote reduction in cigarette consumption.^30–32

With regard to quit-related behaviors and methods of quitting, past studies have been inconsistent. Some found that switching to low-tar cigarettes helped smokers to quit,^33–35 but a large, prospective, population-based study³⁶ found that this practice was not associated with the number of quit attempts. Giovino et al.³⁵ found that the consumption of low-tar cigarettes was associated with decreased quit rates. From the California Tobacco Survey, Farkas³⁷ found that "fading" in smoking (i.e., reducing consumption) increased the probability of cessation. In the same survey, it was also observed that heavy smokers (those who smoked more than 15 cigarettes a day) were less successful at quitting in the preceding 18 months than light smokers.^37,38 Cinciripini et al.³⁹ compared 2 cessation methods—gradual reduction in cigarette consumption and "cold turkey"—and found that groups that gradually increased the time interval between cigarettes were more successful at quitting than groups that did not. McGovern and Lando⁴⁰ found that switching brands to reduce nicotine consumption increased the probability of cessation.

Gilpin and Pierce found that people often do not accurately remember past quit attempts other than the most recent one.⁴¹ A cross-sectional study of lung health by Murray et al.⁴² found that the number of quit attempts had a negative impact on smoking abstinence for men but no relationship to abstinence among women. Raw et al.⁴³ reported that it took smokers 3 to 4 quit attempts before they could quit completely. The US Public Health Service (PHS) Clinical Practice Guideline states that both having social support during quit attempts and a longer time before the first cigarette of the day increase the likelihood of quitting, because a shorter time before the first cigarette signals a higher level of addiction.⁴⁴

Most past studies of factors affecting quit attempts and their outcomes have been limited to specific populations or have addressed individual demographic or environmental characteristics. Recognizing the dynamic nature of smoking behavior, Horn,⁴⁵ Prochaska et al.,^46–48 and DiClemente et al.⁴⁹ found that change in smoking behavior followed a series of stages, with each stage individually influenced by different factors. In addition, a few studies have examined several aspects of smokers’ characteristics to determine the predictors of making quit attempts or successful smoking cessation, but almost none of them have taken a holistic approach where smokers’ demographic, behavioral, and environmental characteristics and the methods used to quit are examined together.

In this study, using a representative sample of the US population, we identified statistically significant predictors of successful smoking cessation. To do so, we compared the approaches to smoking cessation of people who recently succeeded in quitting with those of current smokers who attempted but failed to quit in the previous year. Identifying predictors for successful quitting will help to target smoking cessation programs and interventions in the United States.

	METHODS

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
Study Population
We used data from the 2000 National Health Interview Survey (NHIS), a large, population-based, cross-sectional survey of the US civilian noninstitutionalized population that began in 1957. In 2000, data were collected through computer-aided face-to-face interviews conducted at respondents’ homes. The NHIS collects a multitude of information on health-related behaviors, such as cigarette smoking, physical activity, and alcohol use, in addition to demographic characteristics. In 2000, approximately 100 620 people from 38 633 sampled households participated in the survey,⁵⁰ including 32 374 adults (aged 18 years and older). Our analysis was limited to adults who answered questions on tobacco.

In 2000, a special cancer control module was added to the NHIS that included in-depth questions on current and former smokers’ cessation-related behaviors. In the main part of the survey, questions measured respondents’ smoking status (current, former, or never smoker), history of smoking, amount of cigarette use, and among current smokers, whether they had tried to quit during the past year. The cancer control module contained detailed questions on tobacco use and cessation, including age at which smoking started, use of low-tar and low-nicotine cigarettes, quitting methods used among former smokers, whether current smokers had attempted to quit during the past year, and lifetime number of quit attempts. The 2000 NHIS data were therefore used for this study despite the fact that there are more recent NHIS data sets available.

Measures
Dependent variable. We compared recent successful quitters (who had quit 7–24 months earlier and had not relapsed) with current smokers who had a recent failed quit attempt (past 12 months). The successful quitters had responded "yes" to the question, "Have you smoked at least 100 cigarettes in your entire life?"; "not at all" to the question, "Do you now smoke cigarettes every day, some days or not at all?"; and "7–24 months" to the question, "How long has it been since you quit smoking cigarettes?" Since smokers who quit 1 to 6 months earlier are at high risk of relapse, we did not include them as recent successful quitters; some studies have shown that about 65% to 75% would relapse within a year.^42,51,52

Current smokers who had a recent failed quit attempt answered "yes" to the question, "Have you smoked at least 100 cigarettes in your entire life?"; "every day" or "some days" to the question, "Do you now smoke cigarettes every day, some days or not at all?"; and "yes" to the question, "During the past 12 months, have you stopped smoking for more than one day because you were trying to quit smoking?"

The screening process used to select recent successful quitters and current smokers with a recent failed quit attempt is illustrated in Figure 1.

View larger version (20K): [in this window] [in a new window] [Download PPT slide]   FIGURE 1—— Survey screening process used to select recent successful quitters and current smokers with a recent failed quit attempt: National Health Interview Survey, 2000.

Behavioral characteristics included age when respondent started smoking regularly, whether respondent ever switched to low-tar or low-nicotine products to reduce health risk, and lifetime quit attempts. The question "How old were you when you first started to smoke fairly regularly?" was asked of both former and current smokers. On the basis of the distribution of the age at which respondents first smoked cigarettes regularly, we created 3 categories: younger than 15, 15 to 18, and 19 years and older. For lifetime quit attempts, former smokers were asked, "In your whole life, including the last time, how many times did you stop smoking for one day or longer because you were trying to quit smoking?" Current smokers were asked, "In your whole life, how many times have you stopped smoking for one day or longer because you were trying to quit smoking?" On the basis of the distribution of responses to these questions, the number of lifetime quit attempts was categorized as 1, 2, 3 to 5, and 6 or more.

For environmental variables, we examined the presence of (1) smoking in the workplace, (2) a no-smoking policy at work, and (3) smoking in the home. Respondents were asked, "As far as you know, has anyone smoked in your work area in the last week?" The survey also asked, "Does your employer have an official policy that restricts smoking in any way?" To incorporate respondents who were not currently employed, the variable for those 2 questions was categorized as yes, no, and not employed. For the home environment, the survey asked, "During the past week, how many days did anyone smoke cigarettes, cigars, or pipes anywhere inside your home?" Respondents were grouped into less than 1 day per week/rarely/none and 1–7 days per week.

For quitting methods, the NHIS asked former smokers, "When you stopped smoking completely, which of these methods did you use?" It then listed the following methods: stopping all at once, gradually decreasing the number of cigarettes smoked, following instructions in a pamphlet or book, one-on-one counseling, stop-smoking clinic or program, nicotine patch, nicotine-containing gum, nicotine nasal spray, nicotine inhaler, medication (Zyban, bupropion, or Wellbutrin), switched to chewing tobacco or snuff, and any other method. For current smokers, the response options were the same but the question was worded, "The last time you stopped smoking, which of these methods did you use?" Respondents were asked to select all of the quitting methods they used the last time. On the basis of the sample needed to achieve stable estimates, only 3 methods could be examined in the analysis: stopped all at once, gradually decreased the number of cigarettes smoked, and use of a nicotine patch or gum.

Statistical Analysis
Analyses were performed to identify which demographic, behavioral, and environmental characteristics and which quitting methods were associated with successful cessation. Sampling weights were used to account for the NHIS design and to achieve estimates for the US adult population. Statistical packages SAS version 8.2 (SAS Institute Inc, Cary, NC) and SUDAAN version 8.0 (Research Triangle Institute, Research Triangle Park, NC) were used for all analyses. We conducted a preliminary descriptive analysis to examine the distributions of demographic, behavioral, environmental, and quitting method variables, and then we carried out a multivariate logistic regression analysis to identify statistically significant factors of successful smoking cessation.

	RESULTS

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
Study Population
For the 2000 NHIS, the overall adult response rate was 72.1%. Among the 32 374 adults who completed the survey, 7421 were current smokers, 6995 former smokers, and 17657 never smokers (smoking status was unknown for 301). Of the 7421 current smokers, 3218 (43.4%) had attempted to quit for longer than 1 day during the previous 12 months. Among former smokers, 363 reported quitting 7 to 12 months before the survey and 409 had quit 13 to 24 months earlier. The 430 people who had quit 1 to 6 months earlier were not included because, as mentioned earlier, they are at high risk of relapse. Thus, among current and former smokers who had attempted to quit during the previous 12 months (n = 4011), 363, or 9.1%, sustained their abstinence for at least 7 to 12 months.

The distribution of the study sample by demographic, behavioral, and environmental characteristics, as well as the quitting methods used the last time respondents either successfully quit or attempted but failed to quit, are shown in Table 1.

Among recent successful quitters, 60% were aged 35 or younger, 81% were non-Hispanic White, 68% were married or living with a partner, and 48% had only a high school education or less. Almost half (46%) had tried to quit 3 or more times, 74% had started to smoke regularly at age 18 or younger, and 16% reported that others at home smoked.

Multivariate Analysis
The odds ratios (with 95% confidence intervals) for successful cessation are shown by type of characteristic in Table 2. All 4 demographic characteristics were significantly associated with cessation. The odds of successful quitting increased with age. People with a college education or more were 1.83 times as likely to be successful quitters as those with less than a high school education. People who were married or living with a partner and non-Hispanic Whites were also more likely to succeed in quitting.

	DISCUSSION

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
We used a large population-based sample of US adults to examine multiple factors that might be associated with successful smoking cessation. By contrast, most earlier studies have examined quit attempts among population subgroups (such as pregnant women, working populations, or specific communities),^{18,19,21,53–55} the impact of individual interventions,^28,36,42 or the influence of specific population or environmental characteristics.^28,51,55 To better guide smokers who wish to quit, we must understand the underlying dynamics of the quitting process with respect not only to smokers’ demographic and behavioral characteristics but also their living and working environments. The significant gap between the proportion of current and former smokers who had tried to quit during the previous year (43%) and those who actually quit for 7 or more months (9%) by itself reflects the reality that intentions alone are not enough.

We found that having a smoke-free home, having a no-smoking policy at work, being aged 35 or older, having a college education or more, being married or living with a partner, being a non-Hispanic White, having only 1 lifetime attempt to quit, and not switching to low-tar or low-nicotine products for health reasons were significantly associated with cessation. The significant influence of 2 environmental factors (smoke-free home and no-smoking policy at work) was found in several earlier studies. For example, using US population-based survey data, Farkas et al.²⁸ found that working in a smoke-free workplace and living under a partial or total home smoking ban were positively associated with successful cessation. In a multivariate study that examined predictors of cessation, Hymowitz et al.¹⁹ identified the absence of other smokers in the household as a significant predictor. Finally, Derby et al.,¹⁸ Borland et al.,²¹ and McMahon and Jason⁵⁶ identified the positive influence of social support on sustained cessation after the implementation of a smoking ban for workers.

Similar to our findings, having higher education,^21,53,55 being married,¹⁸ and older age¹⁹ have all been identified by others as determinants of successful cessation. Data on the relationship of gender to cessation have been contradictory, with some studies finding men more likely to be successful quitters^19,55,57 and others^53,56,58 finding no relationship with gender.

Regarding behavioral characteristics, our finding of a negative correlation between multiple attempts to quit and successful cessation accords well with the findings of Borland et al.²¹ and Murray et al.⁴² The latter group found that male participants who had more quit attempts at baseline were less likely to sustain cessation over 5 years. On the other hand, Hymowitz et al.¹⁹ reported that having more than 1 previous quit attempt was associated with successful cessation. Although Hyland et al.³⁶ found that switching to a low-tar cigarette did not alter the likelihood of successful cessation over a 2-year period, our multivariate analysis found that switching to low-tar or low-nicotine products was negatively associated with successful cessation. Although a few previous studies^19,52,54 have identified older age of initiation as a significant predictor of successful cessation, we found no relationship between age at which a person started smoking and successful cessation.

Several limitations to the present study need to be noted. First, because the NHIS is a US-based study of civilian, noninstitutionalized people, some groups of interest (e.g., the military, those in extended care facilities, the homeless, people living abroad) were excluded. Second, because we relied on self-reports to determine smoking status, smoking could be underreported through respondents’ wish to give a socially desirable response.^59,60 Recent studies, however, have shown that self-reports and biochemical measurements of serum cotinine concentration (which indicate exposure to tobacco smoke) provide similar estimates of smoking prevalence in the United States.⁶¹

Third, we did not have information on the number of cigarettes smoked by former smokers. Past studies^{19,53,55,58,62} have found that heavy smokers are less likely than light smokers to succeed in quitting. We also could not examine the number and duration of quitting methods used because the information was unavailable in the data set. The association between the use of quitting methods and cessation outcome may vary depending on the number and duration of methods used. Although our study did not identify a significant impact of nicotine replacement therapy on cessation outcome, clinical trials have found that the use of such therapy and nonnicotine medications such as sustained-release Bupropion double long-term abstinence rates.⁴⁴ Finally, we limited successful quitters to those who quit for 7 to 24 months, but some people will relapse after more than 2 years of quitting,⁴² and thus our analysis probably included some people who did not quit permanently.

This study may have several important implications for policy. The significant impact of a no-smoking policy in the work-place, also shown by several past studies to be related to cessation, indicates that its implementation will help those who intend to quit to succeed. Currently, 7 US states have comprehensive smoke-free policies for most enclosed workplaces and public settings, including bars and restaurants.⁶³ In one prominent success story, 10 years after passing a statewide smoke-free workplace law, California is experiencing a significant decrease in tobacco use among youths, is limiting exposure to environmental tobacco smoke for many of its citizens, and is helping many smokers to quit through its antismoking programs and policies.⁶⁴ The PHS Clinical Practice Guideline⁴⁴ recommends that smokers be counseled to ask for social support from their spouse or partner, friends, and coworkers. The present study suggests that cessation programs need to take a holistic approach. Because smokers’ demographic characteristics, smoking-related behaviors, and daily living and working environments significantly affect their ability to quit, effective programs will need to involve not only smokers who intend to quit but also their family members, friends, and colleagues, and at the same time implementing smoke-free policies that support cessation.

	Acknowledgments

 
We thank Ralph Caraballo and Anne Malacher for their thoughtful comments on the article.

	Footnotes

 
Peer Reviewed

Note. The views expressed in this article are that of the authors and do not necessarily reflect the views of the Centers for Disease Control and Prevention.

Contributors
C. Lee originated the study, conducted the data analysis, and led the writing. J. Kahende assisted with the interpretation of the findings and the writing and reviewed drafts of the article.

Accepted for publication July 15, 2006.

	References

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
1. Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1995–1999. MMWR Mortal Wkly Rep. 2002;51:300–303.

2. Centers for Disease Control and Prevention. Cigarette smoking-attributable morbidity—United States, 2000. MMWR Morb Mortal Wkly Rep. 2003; 52:842–844.[Medline]

3. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Ga: National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.

4. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, DC: Public Health Service, Center for Disease Control; 1964. PHS publication 103.

5. The Health Benefits of Smoking Cessation. A Report of the Surgeon General. Atlanta, Ga: National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990. DHHS publication (CDC) 90-8416.

6. Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years’ observation on male British doctors. BMJ. 1994;309:901–911.[Abstract/Free Full Text]

7. Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2003. MMWR Morb Mortal Wkly Rep. 2005;54:509–513.[Medline]

8. Gilpin E, Pierce JP, Goodman J, Burns D, Shopland D. Reasons smokers give for stopping smoking: do they relate to success in stopping? Tob Control. 1992;1:256–263.

9. Centers for Disease Control and Prevention. Smoker’s beliefs about the health benefits of smoking cessation: 20 US communities. MMWR Morb Mortal Wkly Rep. 1990;39:653–656.[Medline]

10. Hatziandreu EJ, Pierce JP, Lefkopoulou M, et al. Quitting smoking in the United States in 1986. J Natl Cancer Inst. 1990;82:1402–1406.[Abstract/Free Full Text]

11. Killen JD, Fortmann SP, Kraemer HC, Varady A, Newman B. Who will relapse? Symptoms of nicotine dependence predict long-term relapse after smoking cessation. J Consult Clin Psychol. 1992;60:797–801.[CrossRef][Web of Science][Medline]

12. Venters MH, Kottke TE, Solberg LI, Brekke ML, Rooney B. Dependency, social factors, and the smoking cessation process: The Doctors Helping Smokers Study. Am J Prev Med. 1990;6:185–193.[Web of Science][Medline]

13. Hymowitz N, Sexton M, Ockene J, Grandits G. Baseline factors associated with smoking cessation and relapse. MRFIT Research Group. Prev Med. 1991; 20:590–601.[CrossRef][Web of Science][Medline]

14. Fagerstrom KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav. 1978;3:235–241.[CrossRef][Web of Science][Medline]

15. Fisher EB, Lichtenstein E, Haire-Joshu D. Multiple determinants of tobacco use and cessation. In: Orleans CT, Slade J, eds. Nicotine Addiction: Principles and Management. New York, NY: Oxford University Press; 1993:59–88.

16. Berman BA, Gritz ER. Women and smoking: current trend and issues for the 1990s. J Subst Abuse. 1991;3:221–238.[Medline]

17. Royce JM, Hymowitz N, Corbett K, Hartwell TD, Orlandi MA. Smoking cessation factors among African Americans and whites. COMMIT Research Group. Am J Public Health. 1993;83:220–226.[Abstract/Free Full Text]

18. Derby CA, Laster TM, Vass K, Gonzalez S, Carleton RA. Characteristics of smokers who attempt to quit and of those who recently succeeded. Am J Prev Med. 1994;10:327–334.[Web of Science][Medline]

19. Hymowitz N, Cummings MK, Hyland A, Lynn WR, Pechacek TF, Hartwell TD. Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob Control. 1997;6(suppl 2):S57–S62.[Free Full Text]

20. Wilcox NS, Prochaska JO, Velicer WF, DiClemente CC. Subject characteristics as predictors of self-change in smoking. Addict Behav. 1985;10:407–412.[CrossRef][Web of Science][Medline]

21. Borland R, Owen N, Hill D, Schofield P. Predicting attempts and sustained cessation of smoking after the introduction of workplace smoking bans. Health Psychol. 1991;10:336–342.[CrossRef][Web of Science][Medline]

22. Orford J. Excessive Appetites: A Psychological View of Addictions. Chichester, England: Wiley; 1985.

23. Richmond RL, Kehoe LA, Webster IW. Multivariate models for predicting abstention following intervention to stop smoking by general practitioners. Addiction. 1993;88:1127–1135.[CrossRef][Web of Science][Medline]

24. Herbert JR, Kristeller J, Ockene JK, et al. Patient characteristics and the effect of three physician-delivered smoking interventions. Prev Med. 1992;21:557–573.[CrossRef][Web of Science][Medline]

25. Richmond RL, Austin A, Webster IW. Predicting abstainers in a smoking cessation programme administered by general practitioners. Int J Epidemiol. 1988; 17:530–534.[Abstract/Free Full Text]

26. Senore C, Battista RN, Shapiro SH, et al. Predictors of smoking cessation following physicians’ counseling. Prev Med. 1998;27:412–421.[CrossRef][Web of Science][Medline]

27. Gourlay SG, Forbes A, Marriner T, Pethica D, McNeil JJ. Prospective study of factors predicting outcome of transdermal nicotine treatment in smoking cessation. BMJ. 1994;309:842–846.[Abstract/Free Full Text]

28. Farkas AJ, Gilpin EA, Distefan JM, Pierce JP. The effects of household and workplace smoking restrictions on quitting behaviours. Tob Control. 1999;8:261–265.[Abstract/Free Full Text]

29. Woodruff TJ, Rosbrook B, Pierce J, Glantz SA. Lower levels of cigarette consumption found in smoke-free workplaces in California. Arch Intern Med. 1993; 153:1485–1493.[Abstract/Free Full Text]

30. Stillman FA, Becker DM, Swank RT, et al. Ending smoking at the Johns Hopkins Medical Institutions. An evaluation of smoking prevalence and indoor air pollution. JAMA. 1990;264:1565–1569.[Abstract/Free Full Text]

31. Sorsensen G, Rigotti N, Rosen A, Pinney J, Prible R. Effects of a worksite nonsmoking policy: evidence for increased cessation. Am J Public Health. 1991;81:202–204.[Abstract/Free Full Text]

32. Kinne S, Kristal AR, White E, Hunt J. Work-site smoking policies: their population impact in Washington State. Am J Public Health. 1993;83:1031–1033.[Abstract/Free Full Text]

33. Kozlowski LT, Goldberg ME, Sweeney CT, et al. Smoker reactions to a "radio message" that light cigarettes are as dangerous as regular cigarettes. Nicotine Tob Res. 1999;1:67–76.[Abstract]

34. Kozlowski LT, Goldberg ME, Yost BA, White EL, Sweeney CT, Pillitteri JL. Smokers’ misperceptions of light and ultra-light cigarettes may keep them smoking. Am J Prev Med. 1998;15:9–16.[CrossRef][Web of Science][Medline]

35. Giovino GA, Tomar SL, Reddy MN, et al. Attitudes, knowledge, and beliefs about low-yield cigarettes among adolescents and adults. In: The FTC Cigarette Test Method for Determining Tar, Nicotine, and Carbon Monoxide Yields of US Cigarettes. Report of the NCI Expert Committee. Bethesda, Md: National Cancer Institute; 1994:39–57. NIH publication 96-4028, Smoking and Tobacco Control Monograph no. 7.

36. Hyland A, Hughes JR, Farrelly M, Cummings KM. Switching to lower tar cigarettes does not increase or decrease the likelihood of future quit attempts or cessation. Nicotine Tob Res. 2003;5:665–671.[Abstract]

37. Farkas AJ. When does cigarette fading increase the likelihood of future cessation? Ann Behav Med. 1999;21:71–76.[CrossRef][Web of Science][Medline]

38. Farkas AJ, Pierce JP, Zhu SH, et al. Addiction versus stages of change models in predicting smoking cessation. Addiction. 1996;91:1271–1280.[CrossRef][Web of Science][Medline]

39. Cinciripini PM, Lapitsky L, Seay S, Wallfisch A, Kitchens K, Van Vunakis H. The effects of smoking schedules on cessation outcome: can we improve on common methods of gradual and abrupt nicotine withdrawal? J Consult Clin Psychol. 1995;63:388–399.[CrossRef][Web of Science][Medline]

40. McGovern PG, Lando HA. Reduced nicotine exposure and abstinence outcome in two nicotine fading methods. Addict Behav. 1991;16:11–20.[CrossRef][Web of Science][Medline]

41. Gilpin E, Pierce JP. Measuring smoking cessation: problems with recall in the 1990 California Tobacco Survey. Cancer Epidemiol Biomarkers Prev. 1994;3:613–617.[Abstract]

42. Murray RP, Gerald LB, Lindgren PG, Connett JE, Rand CS, Anthonisen NR. Characteristics of participants who stop smoking and sustain abstinence for 1 and 5 years in the Lung Health Study. Prev Med. 2000; 30:392–400.[CrossRef][Web of Science][Medline]

43. Raw M, McNeill A, West R. Smoking cessation guidelines for health professionals. A guide to effective smoking cessation interventions for the health care system. Thorax. 1998;53(suppl 5):S1–S19.[Free Full Text]

44. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence, Clinical Practice Guideline. Rockville, Md: Public Health Service; June 2000.

45. Horn D. A model for the study of personal choice health behavior. Int J Health Educ. 1976;19:89–98.[Web of Science]

46. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: towards an integrative model of change. J Consult Clin Psychol. 1983; 51:390–395.[CrossRef][Web of Science][Medline]

47. Prochaska JO, DiClemente CC, Velicer WF, Ginpil S, Norcross JC. Predicting change in smoking status for self-changers. Addict Behav. 1985;10:395–406.[CrossRef][Web of Science][Medline]

48. Prochaska JO, Velicer WF, DiClemente CC, Fava J. Measuring processes of change: applications to the cessation of smoking. J Consult Clin Psychol. 1988; 56:520–528.[CrossRef][Web of Science][Medline]

49. DiClemente CC, Prochaska J, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS. The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol. 1991;59:294–304.

50. National Health Interview Survey, 2000 [machine-readable data file and documentation]. Hyattsville, Md: National Center for Health Statistics; 2002. Available at: http://www.cdc.gov/nchs/nhis.htm. Accessed May 14, 2007.

51. Bjornson W, Rand C, Connett JE, et al. Gender differences in smoking cessation after 3 years in the Lung Health Study. Am J Public Health. 1995;85:223–230.[Abstract/Free Full Text]

52. West R, Mcewen A, Bolling K, Owen L. Smoking cessation and smoking patterns in the general population: a 1-year follow-up. Addiction. 2001;96:891–902.[CrossRef][Web of Science][Medline]

53. Rose JS, Chassin L, Presson CC, Sherman SJ. Prospective predictors of quit attempts and smoking cessation in young adults. Health Psychol. 1996;15:261–268.[CrossRef][Web of Science][Medline]

54. Yu SM, Park CH, Schwalberg RH. Factors associated with smoking cessation among US pregnant women. Matern Child Health J. 2002;6:89–97.[CrossRef][Medline]

55. Hennrikus DJ, Jeffery RW, Lando HA. The smoking cessation process: longitudinal observations in a working population. Prev Med. 1995;24:235–244.[CrossRef][Web of Science][Medline]

56. McMahon SD, Jason LA. Social support in a work-site smoking intervention. A test of theoretical models. Behav Modif. 2000;24:184–201.[Abstract/Free Full Text]

57. Women and Smoking: A Report of the Surgeon General. Washington, DC: Public Health Service, Office of the Surgeon General; 2001.

58. Centers for Disease Control and Prevention. Smoking cessation during previous year among adults—United States, 1990 and 1991. MMWR Morb Mortal Wkly Rep. 1993;42:504–507.[Medline]

59. Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84:1086–1093.[Abstract/Free Full Text]

60. Klebanoff MA, Levine RJ, Clemens JD, DerSimonian R, Wilkins DG. Serum cotinine concentration and self-reported smoking during pregnancy. Am J Epidemiol. 1998;148:259–262.[Abstract/Free Full Text]

61. Caraballo RS, Giovino GA, Pechacek TF, Mowery PD. Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: Third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol. 2001;153:807–814.[Abstract/Free Full Text]

62. Cohen S, Lichtenstein E, Prochaska JO, et al. Debunking myths about self-quitting. Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves. Am Psychol. 1989;44:1355–1365.[CrossRef][Medline]

63. Centers for Disease Control and Prevention. State Tobacco Activities Tracking and Evaluation (STATE) System. Available at: http://www.cdc.gov/tobacco/statesystem. Accessed May 14, 2007.

64. California Department of Health Services. California’s 15-year-old tobacco control program keeps promise to California voters. Available at: http://www.dhs.ca.gov/tobacco/documents/press/PressRelease01-25-05.pdf. Accessed March 2, 2005.

This article has been cited by other articles:

				N. Amodei and R. J. Lamb The role of nicotine replacement therapy in early quitting success Nicotine Tob Res, January 1, 2010; 12(1): 1 - 10. [Abstract] [Full Text] [PDF]

				A. L. Mills, K. Messer, E. A. Gilpin, and J. P. Pierce The effect of smoke-free homes on adult smoking behavior: A review Nicotine Tob Res, October 1, 2009; 11(10): 1131 - 1141. [Abstract] [Full Text] [PDF]

				T. Lincoln, R. W. Tuthill, C. A. Roberts, S. Kennedy, T. M. Hammett, E. Langmore-Avila, and T. J. Conklin Resumption of Smoking After Release From a Tobacco-Free Correctional Facility Journal of Correctional Health Care, July 1, 2009; 15(3): 190 - 196. [Abstract] [PDF]

				H. Sienkiewicz-Jarosz, P. Zatorski, A. Baranowska, D. Ryglewicz, and P. Bienkowski Predictors of Smoking Abstinence After First-Ever Ischemic Stroke: A 3-Month Follow-Up Stroke, July 1, 2009; 40(7): 2592 - 2593. [Abstract] [Full Text] [PDF]

				J. A. Stapleton, F. Keaney, and G. Sutherland Illicit drug use as a predictor of smoking cessation treatment outcome Nicotine Tob Res, June 1, 2009; 11(6): 685 - 689. [Abstract] [Full Text] [PDF]

				D. M. Bolt, M. E. Piper, D. E. McCarthy, S. J. Japuntich, M. C. Fiore, S. S. Smith, and T. B. Baker The Wisconsin Predicting Patients' Relapse questionnaire Nicotine Tob Res, May 1, 2009; 11(5): 481 - 492. [Abstract] [Full Text] [PDF]

				K. M. Dollar, G. G. Homish, L. T. Kozlowski, and K. E. Leonard Spousal and Alcohol-Related Predictors of Smoking Cessation: A Longitudinal Study in a Community Sample of Married Couples Am J Public Health, February 1, 2009; 99(2): 231 - 233. [Abstract] [Full Text] [PDF]

				H. Xiao, C. D. Hoffman, G. Brito, C. L. Laton, and S. B. Johnson PREVENTING SMOKING RELAPSE IN THE CAROLINAS Am J Public Health, March 1, 2008; 98(3): 389 - 390. [Full Text] [PDF]

				C. G. Husten Smoking Cessation in Young Adults Am J Public Health, August 1, 2007; 97(8): 1354 - 1356. [Full Text] [PDF]

eLetters:

This Article Abstract Figures Only Full Text (PDF) All Versions of this Article: AJPH.2005.083527v1 97/8/1503    most recent Submit a response View responses View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (14) Citing Articles via Google Scholar Google Scholar Articles by Lee, C.-w. Articles by Kahende, J. Search for Related Content PubMed PubMed Citation Articles by Lee, C.-w. Articles by Kahende, J. Related Collections Smoking Cessation Tobacco Control