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Most ex-smokers quit cigarettes without medication or help

Research overemphasises importance of aids to quitting smoking

OnMedica staff

Tuesday, 09 February 2010

Most ex-smokers gave up unaided but this message is hugely underplayed in tobacco control campaigns, argue Australian authors in PLoS Medicine. They call for more positive and realistic messages to be given to smokers about quitting.

Simon Chapman and Ross Mackenzie, from the School of Public Health at the University of Sydney, say that "medicalisation of smoking cessation" has occurred, which leads many people, including health professionals, to believe – wrongly – that nicotine replacement therapy (NRT) and other pharmaceutical aids or professional help are essential to quit smoking.

They conducted a review of more than 500 studies published in 2007 and 2008 and found that unaided cessation was by far the most common method used by most successful ex-smokers. Between two-thirds and three-quarters of ex-smokers had quit without assistance, either by going "cold turkey" or by cutting down and then stopping completely. Additionally, most ex-smokers said quitting was less difficult than they had expected.

However, unaided cessation was underrepresented in published research, which is dominated by industry-funded studies into pharmaceutically aided cessation. In trials of NRT, 51% of industry-funded studies reported significant cessation effects against 22% of non-industry-funded studies.

They say that although NRT, other prescribed drugs, and professional counselling or support help many smokers, they are “certainly not necessary for quitting”. They cite several factors associated with motivating quit attempts and successful unaided cessation, including bold pack warnings, support from family and friends, smoke-free homes and workplaces, increasing price and hard-hitting awareness campaigns.

The authors argue that: “Along with motivational ‘why’ messages designed to stimulate cessation attempts, smokers should be repeatedly told that cold turkey and reducing-then-quitting are the methods most commonly used by successful ex-smokers, that more smokers find it unexpectedly easy or moderately difficult than find it very difficult to quit, that many successful ex-smokers do not plan their quitting in advance, and that ‘failures’ are a normal part of the natural history of cessation – rehearsals for eventual success … Talk of unassisted cessation being ‘the enemy’ of evidence-based cessation should be roundly criticised as both incorrect and unhelpful.”

They conclude that: “public sector communicators should be encouraged to redress the overwhelming dominance of assisted cessation in public awareness, so that some balance can restored in smokers’ minds regarding the contribution that assisted and unassisted smoking cessation approaches can make to helping them quit smoking.”

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