RESEARCH PAPER
Effectiveness of smoking reduction intervention for hardcore smokers
 
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1
School of Public Health, The University of Hong Kong, Hong Kong, China
2
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
3
Global Health Program, Duke Kunshan University, Kunshan, China
4
Duke Global Health Institute, Duke University, Durham, USA
5
Department of Medicine, Boston University Medical Center, Boston, USA
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School of Nursing, The University of Hong Kong, Hong Kong, China
CORRESPONDING AUTHOR
Yee Tak Derek Cheung   

School of Public Health, The University of Hong Kong, Hong Kong, China
Publish date: 2015-04-02
 
Tobacco Induced Diseases 2015;13(April):9
KEYWORDS
ABSTRACT
Background:
The prevalence and correlates of hardcore smokers, who have high daily cigarette consumption, no quitting history and no intention to quit, have been studied in several western developed countries, but no previous trials of smoking cessation have tested intervention effectiveness for these smokers. The current study examined if hardcore smokers can benefit from smoking reduction intervention to achieve cessation, and explored the underlying reasons.

Methods:
A posteriori analysis was conducted on data from a randomized controlled trial of smoking reduction intervention on 1,154 smokers who did not want to quit. Odds ratios of 7-day point prevalence of abstinence, smoking reduction by at least 50% and quit attempt at the 6-month follow-up comparing subgroups of smokers were analyzed.

Results:
In hardcore smokers, the odds ratio comparing the quit rate between the intervention and control group was 4.18 (95% CI: 0.51-34.65), which was greater than non-hardcore smokers (OR = 1.58, 95% CI: 0.98-2.54). The number needed to treat for hardcore and non-hardcore smokers was 8.33 (95% CI: 5.56-16.67) and 16.67 (95% CI: 8.33-233.64), respectively. In smokers who did not have quit attempt experience and those who smoked more than 15 cigarettes daily, the odds ratio comparing intervention and control group was 3.29 (95% CI: 0.72-14.98) and 1.36 (95% CI: 0.78-2.36), respectively.

Conclusions:
The a posteriori analysis provided pilot results that smoking reduction intervention may be effective to help hardcore smokers to quit and reduce smoking. Having no previous quit attempt was identified as more important than having large cigarette consumption in explaining the greater effectiveness of the intervention.

 
REFERENCES (31)
1.
World Health Organization. WHO report on the global tobacco epidemic, 2011. Geneva: World Health Organization, 2008; 2011.
 
2.
Hyland A, Borland R, Li Q, Yong H-H, McNeill A, Fong GT, et al. Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15 suppl 3:iii83–94.
 
3.
Emery S, Gilpin EA, Ake C, Farkas AJ, Pierce JP. Characterizing and identifying “Hard-core” smokers: implications for further reducing smoking prevalence. Am J Public Health. 2000;90(3):387–94.
 
4.
Koplan JP, An WK, Lam RMK. Hong Kong: a model of successful tobacco control in China. Lancet. 2010;375(9723):1330–1.
 
5.
Census & Statistics Department (Hong Kong SAR government). Thematic household survey, report no. 53: pattern of smoking. Hong Kong: Census & Statistics Department; 2013.
 
6.
Leung DYP, Chan SSC, Lam TH. Prevalence and characteristics of hardcore smokers in Hong Kong. Hong Kong: The University of Hong Kong; 2011.
 
7.
Augustson EM, Marcus SE. Use of the current population survey to characterize subpopulations of continued smokers: a national perspective on the “hardcore” smoker phenomenon. Nicotine Tob Res. 2004;6(4):621–9.
 
8.
Costa ML, Cohen JE, Chaiton MO, Ip D, McDonald P, Ferrence R. “Hardcore” definitions and their application to a population-based sample of smokers. Nicotine Tob Res. 2010;12(8):860–4.
 
9.
Jarvis MJ, Wardle J, Waller J, Owen L. Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study. BMJ. 2003;326(7398):1061.
 
10.
Ferketich AK, Gallus S, Colombo P, Pacifici R, Zuccaro P, La Vecchia C. Hardcore smoking among Italian men and women. Eur J Cancer Prev. 2009;18(2):100–5.
 
11.
Lund M, Lund KE, Kvaavik E. Hardcore smokers in Norway 1996–2009. Nicotine Tob Res. 2011;13(11):1132–9.
 
12.
Carpenter MJ, Hughes JR, Solomon LJ, Callas PW. Both smoking reduction with nicotine replacement therapy and motivational advice increase future cessation among smokers unmotivated to quit. J Consult Clin Psychol. 2004;72(3):371–81.
 
13.
Etter J-FPMPH, Laszlo ERNBA, Perneger TVMDP. Postintervention effect of nicotine replacement therapy on smoking reduction in smokers who are unwilling to quit: randomized trial. J Clin Psychopharmacol. 2004;24(2):174–9.
 
14.
Chris TB, Jean-Pierre Z, Tobias D, Xandra Van B, Ånnik R, Ake W, et al. Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety. BMJ. 2000;321:329–33.
 
15.
Rennard SI, Glover ED, Leischow S, Daughton DM, Glover PN, Muramoto M, et al. Efficacy of the nicotine inhaler in smoking reduction: a double‐blind, randomized trial. Nicotine Tob Res. 2006;8(4):555–64.
 
16.
Batra A, Klingler K, Landfeldt B, Friederich HM, Westin A, Danielsson T. Smoking reduction treatment with 4-mg nicotine gum: a double-blind, randomized, placebo-controlled study. Clin Pharmacol Ther. 2005;78(6):689–96.
 
17.
Asfar T, Ebbert JO, Klesges RC, Relyea GE. Do smoking reduction interventions promote cessation in smokers not ready to quit? Addict Behav. 2011;36(7):764–8.
 
18.
Chan SSC, Leung DYP, Abdullah ASM, Wong VT, Hedley AJ, Lam T-H. A randomized controlled trial of a smoking reduction plus nicotine replacement therapy intervention for smokers not willing to quit smoking. Addiction. 2011;106(6):1155–63.
 
19.
World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.
 
20.
Augustson EM, Barzani D, Rutten LJF, Marcus S. Gender differences among hardcore smokers: an analysis of the tobacco use supplement of the current population survey. J Womens Health (15409996). 2008;17(7):1167–73.
 
21.
Ip DT, Cohen JE, Bondy SJ, Chaiton MO, Selby P, Schwartz R, et al. Do components of current ‘hardcore smoker’ definitions predict quitting behaviour? Addiction. 2012;107(2):434–40.
 
22.
Jarvis MJ, Sims M, Gilmore A, Mindell J. Impact of smoke-free legislation on children’s exposure to secondhand smoke: cotinine data from the Health Survey for England. Tob Control. 2012;21(1):18–23.
 
23.
Richard JC, David LS. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995;310:452–4.
 
24.
Vangeli E, Stapleton J, Smit ES, Borland R, West R. Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. Addiction. 2011;106(12):2110–21.
 
25.
Jardin BF, Carpenter MJ. Predictors of quit attempts and abstinence among smokers not currently interested in quitting. Nicotine Tob Res. 2012;14(10):1197–204.
 
26.
Diemert LM, Bondy SJ, Brown KS, Manske S. Young adult smoking cessation: predictors of quit attempts and abstinence. Am J Public Health. 2013;103(3):449–53.
 
27.
Shiffman S, Ferguson SG, Strahs KR. Quitting by gradual smoking reduction using nicotine gum: a randomized controlled trial. Am J Prev Med. 2009;36(2):96–104.e101.
 
28.
Wennike P, Danielsson T, Landfeldt B, Westin Å, Tønnesen P. Smoking reduction promotes smoking cessation: results from a double blind, randomized, placebo-controlled trial of nicotine gum with 2-year follow-up. Addiction. 2003;98(10):1395–402.
 
29.
Bolliger CT, Zellweger J-P, Danielsson T, Biljon XV, Robidou A, Westin Å, et al. Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety. BMJ. 2000;321(321):329–33.
 
30.
Chaiton MO, Cohen JE, Frank J. Population health and the hardcore smoker: Geoffrey Rose revisited. J Public Health Policy. 2008;29(3):307–18.
 
31.
Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: 2008 update. Rockvill: MD: Department of Health and Human Services; 2008.
 
 
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