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Help smokers quit whether they ask or not: study

A woman uses her mobile phone while holding a cigarette in London
A woman uses her mobile phone while holding a cigarette in London

By Amy Norton

NEW YORK (Reuters Health) - Doctors should automatically offer smokers help with quitting, without waiting for signs that they're ready to kick the habit, researchers say.

Right now, the general guidelines for doctors say that they should ask smokers about their willingness to quit. Then if the patient seems motivated, the doctor should offer help.

But in a new research review, UK investigators found that offering quit help to all smokers seems more effective.

Looking at 13 past clinical trials, the researchers found that some smokers at least attempted to quit after getting simple advice from their doctor -- namely, that they should kick the habit for the sake of their health.

But actual assistance in quitting -- either counseling on behavior changes or nicotine replacement therapy -- worked better.

Based on three studies, the researchers say, such help could prompt an additional 40 percent to 60 percent of smokers to at least try quitting, versus advice alone. And all three of the studies offered help to smokers without first checking their "willingness to quit."

The findings are published in the journal Addiction.

Official guidelines in the U.S. and UK suggest that doctors first gauge patients' willingness to quit before offering them help. And that's probably based at least partly on "common sense," said Dr. Paul Aveyard, lead researcher on the new study.

That is, why spend time discussing treatment with someone who doesn't want it?

There's also the theory in psychology that people go through stages of thinking about change before they are actually ready to do it, noted Aveyard, a professor of behavioral medicine at the University of Birmingham.

"I guess what we are saying is that people are sometimes ready to take action without having thought about it prior to that," Aveyard told Reuters Health in an email. "Make them a good offer and they'll act."

The results are based on 13 studies that looked at various ways for doctors to encourage smokers to quit.

In some trials, researchers compared advice to quit against doing nothing. Overall, just over one-third of smokers who received advice tried to quit in the following months to one year, versus about 24 percent of smokers given no advice.

The majority did not go on to kick the habit. But the advice group was 47 percent more likely to be successful.

Still, other studies suggested that actual help from a doctor beat advice alone.

Several trials compared "assistance" against mere advice to quit. That assistance meant either a discussion of behavioral tactics -- like setting a "quit date" -- or nicotine replacement therapy.

Overall, smokers who got behavioral help were 69 percent more likely to take a stab at quitting than advice-only smokers: more than half tried, though just five percent ended up staying abstinent for six months to a year.

The pattern was similar with nicotine replacement therapy. When doctors offered it, smokers were 39 percent more likely to try quitting, compared with advice only.

They were also more likely to be abstinent long-term. But the number was small: about nine percent managed to stay smoke-free for six months to a year, versus six percent of smokers given only advice.

That was based on four clinical trials, three of which offered smokers nicotine replacement therapy regardless of their willingness to quit.

According to Aveyard's team, offering all smokers help could make a significant difference in the real world.

If you assume that 20 percent of smokers would, on their own, try to quit in the six months after a doctor's visit, then offering them actual assistance at that visit could boost that figure to 35 percent, the researchers say.

"We know that doctors know they should talk to their patients more often about stopping smoking than they do, but they have two big concerns," Aveyard said.

One, he noted, is that doctors don't want to "preach to their patients."

Another obstacle is time: Doctors don't think they have enough of it to counsel smokers about their options for quitting.

Aveyard, who is a general practitioner, said that he typically asks smokers if they know that cessation help would boost their chances of quitting versus doing it on their own. Then he asks if they'd like a referral to a colleague who can explain the options to them.

Of course, there's still the bigger issue -- kicking the smoking habit for good is tough.

The U.S. Department of Health and Human Services says that 36 percent of the nation's smokers try to quit each year. But only three percent succeed in quitting for six months or more.

Many smokers need to try a few different tactics before they find the one that works for them.

But by offering all smokers some help, Aveyard said, there will be more long-term quitters simply because there will be more people trying.

Nicotine replacement gums, patches, nasal sprays and inhalers cost between $3 and $6 each day they are used. Other options include the prescription drugs varenicline (Chantix) and bupropion (Zyban and generics); the medications help some smokers, but have also been linked to the risk of suicidal thoughts and other mental problems.

Aveyard and another researcher on the study have served as consultants for companies that make smoking cessation medications.

SOURCE: http://bit.ly/xOOGNv Addiction, online December 18, 2011.

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