Study Shows Nagging Undermines Success of Stop-Smoking Efforts

BUFFALO, N.Y. -- Researchers at the University at Buffalo have shown what persons trying to quit smoking have known all along -- nagging doesn't help.

Participants in a study of 1,552 smokers who called a hot line to request self-help information on how to stop, but did not quit, reported more nagging when they tried to stop smoking than people who quit, or those who stopped smoking for a short time but started again.

Those who were successful were more likely to be college graduates, to consider themselves to be in excellent health and to be confident of their ability to stay off cigarettes.

• Non-quitters were more likely to have other smokers in the home than the other two groups.

• Heavier smokers were more hesitant to try to quit, but once they make the attempt, they are as likely to succeed as light smokers.

• A trial run at quitting seemed to be necessary for some smokers before they are able to stop for good.

The research, supported by a grant from the National Cancer Institute, was published in a recent issue of Public Health Reports.

"Most of what we know about smoking is derived from research on subjects attending formal treatment programs, despite the fact that 92 percent of ex-smokers have quit on their own," said Carlos Roberto Jaén, M.D., UB assistant professor of family medicine and social and preventive medicine and lead author of the study.

"It is important to recognize what factors are likely to influence the effectiveness of smoking cessation attempts among these persons who have succeeded without formal programs."

Participants in the study were interviewed when they called a stop-smoking hot line and again six months later. They were classified into three groups based on their responses during the follow-up interview -- 242 quitters, 497 recidivists, and 813 non-quitters.

Non-quitters were defined as persons who reported they didn't try to quit after calling the hot line or who weren't able to quit for more than a day. Recidivists were defined as participants who said they quit for more than a day, but were smoking at the time of the follow-up interview, or had been off cigarettes for less than a month at follow-up.

Quitters were defined as those who said they were not smoking at the time of the follow-up interview and had been off cigarettes for more than a month. The average length of time off cigarettes in this group was 4 1/2 months.

A comparison of demographic information, attitudes, smoking history and health status among the three groups showed that a supportive social environment was critical to efforts to stop. Non-quitters reported less helpful support than quitters and recidivists. Three times more non-quitters as quitters reported being nagged. Non-quitters also were more likely to be non-white.

Quitters were more likely to be college graduates than non-quitters and recidivists, findings showed. They also were more likely to perceive a benefit from quitting, and were more confident of their ability to stay off cigarettes for at least six months than the other two groups.

A somewhat puzzling finding indicated that smokers in this study who considered themselves to be in excellent health were more likely to quit than those who gave themselves a less favorable health rating. Jaén speculated that this group may have had more energy and motivation to quit than those who considered themselves less healthy, and may have been more attuned to the type of message that prompted participants to call the hot line initially.

Jaén, who was appointed recently to a national panel charged with developing clinical guidelines for smoking prevention and cessation, pointed to several useful findings from the study that could benefit all health practitioners in helping their patients to stop smoking.

"This study substantiates the notion that a supportive environment and a feeling of confidence in the ability to succeed are very important to people attempting to stop smoking," he said. "It also emphasizes the need for early intervention, before the negative health consequences of smoking are apparent."

"Heavy smokers can be told with confidence that they are as likely to succeed as light smokers," he said. "In addition, the research reinforces the notion that efforts to strengthen motivation are likely to encourage more non-quitters to attempt to stop."

Contributing to the study, in addition to Jaén, were K. Michael Cummings, Ph.D., UB associate research professor and director of smoking cessation at Roswell Park Cancer Institute, and Maria Zielezny, Ph.D., and Robert O'Shea, Ph.D., UB associate professors of social and preventive medicine.