摘要：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. 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 study 36 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, Farkas 37 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 Lando 40 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.
