Quit Smoke
Even Hard-Core Smokers Can Quit
A combination of intensive, personalized telephone counseling and medication helped even long-time heavy smokers kick the habit, researchers from the University of Minnesota say.
In their study, smokers who used this strategy were more successful at quitting than smokers who relied on their primary care doctors to help them quit. After a year, 13% of the people in the phone counseling group were still smoke-free, while just 4% in the regular care group were. The results are published in the Archives of Internal Medicine.
That difference was larger than the researchers expected, said Lawrence C. An, MD, the doctor who led the study. An, a general internist and assistant professor of internal medicine at the University of Minnesota, thinks the counseling program worked better because it gave smokers ongoing, long-term support that changed to meet their needs.
"We know it's hard to quit smoking and it's important to have follow-up, and that's the opportunity over the phone," he said. "We're able to get to know the individual and come up with a personalized plan."
That personalization can be important, said Dawn Wiatrek, director of the American Cancer Society's Quitline. She was not involved in the current study. While people who use these services may make multiple quit attempts, this does not mean they will not ultimately succeed. The counseling they receive gives them important knowledge and skills to build on, according to Wiatrek.
"People learn from each attempt what worked and what didn't," she explained.
A Pack a Day for 40 Years
The current study involved 837 heavy smokers (nearly all of them men) who were patients at several Veterans Affairs medical centers in the Midwest. Half of the people in the study said they'd been smoking for more than 40 years, and half of them smoked more than 26 cigarettes a day (a typical pack has 20).
Nearly 40% of the people were so addicted to smoking they said they woke up in the middle of the night to have a cigarette. The fact that the people in the study were such heavy smokers makes the results that much more impressive, An said.
"There is a kind of notion, true or untrue, that as smoking rates go down, you end up with this hard-core group of smokers who are resistant to treatment, and no one has ever shown that phone counseling would be effective for those smokers," he said. "We show that phone counseling does work for those smokers."
Wiatrek also found that result impressive.
"This group is not normally a focus group of phone counseling," she said. "I think it's great phone counseling is working for them, too."
Usual Care Helpful, but Brief
An and his colleagues randomly assigned 420 of the smokers to usual care -- they received self-help pamphlets about quitting and were able to see their regular doctor for more help. Nearly all of the people in this group saw a doctor within a year of the study starting. Of those, 98% said their doctor had talked to them about quitting, though the conversations were usually brief -- 5 minutes or so. Half said their doctor had offered them medication to help them quit.
Those rates of discussing quitting and offering medication are higher than national averages, An said. But there's only so much a doctor can do during an office visit.
"The VA is doing a very good job in terms of what doctors can do in clinics," he said. "They're ahead of the curve, but even though they're ahead of the curve, offering phone counseling is better than that."
Comprehensive Care Over the Phone
The remaining 417 smokers (the intervention group) were enrolled in a phone care program designed by the researchers. It combined telephone counseling with easy access to cessation medication. The people in this group got a series of phone calls over 2 months from trained counselors, and were encouraged to use nicotine replacement or other medications to help them quit. The study doctors gave them prescriptions for the medication in consultation with their primary care doctors as needed.
People in the phone care group made more quit attempts than people in the regular care group, and they made more use of counseling services (mostly by phone, but also on-on-one and in groups) and medications. Just 18% of the people in the usual care group used both counseling and medication to help them quit, compared to 88% of people in the phone care group.
That's why the phone care strategy was so successful, An said.
"People who used both [medications and counseling] quit at about the same rate," he explained, "but we had more people using both in the intervention group."
Wiatrek isn't surprised by that finding. "We see that consistently with the ACS Quitline," she said. "Coupling counseling and medication is certainly more effective."
An said all health services -- including the VA -- should consider adding a phone care component to their quitting programs.
"Once you have a [cessation] system in place, adding phone care is going to be beneficial," he said. "We're limited in what we can do in the clinic. We're limited to brief interventions, and one of the best things we can do is get patients hooked up with programs that can give them real support and treatment over time."
Wiatrek said smokers who want to quit can call the ACS toll-free at 1-800-ACS-2345 to be directed to a quitline in their state and request self-help materials. People who live in states without quitlines can get information about participating in a clinical trial of cessation strategies.
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Citation: "Benefits of Telephone Care Over Primary Care for Smoking Cessation." Published in the March 13, 2006, Archives of Internal Medicine (Vol. 166, No. 5:536-542). First author: Lawrence C. An, University of Minnesota.
A combination of intensive, personalized telephone counseling and medication helped even long-time heavy smokers kick the habit, researchers from the University of Minnesota say.
In their study, smokers who used this strategy were more successful at quitting than smokers who relied on their primary care doctors to help them quit. After a year, 13% of the people in the phone counseling group were still smoke-free, while just 4% in the regular care group were. The results are published in the Archives of Internal Medicine.
That difference was larger than the researchers expected, said Lawrence C. An, MD, the doctor who led the study. An, a general internist and assistant professor of internal medicine at the University of Minnesota, thinks the counseling program worked better because it gave smokers ongoing, long-term support that changed to meet their needs.
"We know it's hard to quit smoking and it's important to have follow-up, and that's the opportunity over the phone," he said. "We're able to get to know the individual and come up with a personalized plan."
That personalization can be important, said Dawn Wiatrek, director of the American Cancer Society's Quitline. She was not involved in the current study. While people who use these services may make multiple quit attempts, this does not mean they will not ultimately succeed. The counseling they receive gives them important knowledge and skills to build on, according to Wiatrek.
"People learn from each attempt what worked and what didn't," she explained.
A Pack a Day for 40 Years
The current study involved 837 heavy smokers (nearly all of them men) who were patients at several Veterans Affairs medical centers in the Midwest. Half of the people in the study said they'd been smoking for more than 40 years, and half of them smoked more than 26 cigarettes a day (a typical pack has 20).
Nearly 40% of the people were so addicted to smoking they said they woke up in the middle of the night to have a cigarette. The fact that the people in the study were such heavy smokers makes the results that much more impressive, An said.
"There is a kind of notion, true or untrue, that as smoking rates go down, you end up with this hard-core group of smokers who are resistant to treatment, and no one has ever shown that phone counseling would be effective for those smokers," he said. "We show that phone counseling does work for those smokers."
Wiatrek also found that result impressive.
"This group is not normally a focus group of phone counseling," she said. "I think it's great phone counseling is working for them, too."
Usual Care Helpful, but Brief
An and his colleagues randomly assigned 420 of the smokers to usual care -- they received self-help pamphlets about quitting and were able to see their regular doctor for more help. Nearly all of the people in this group saw a doctor within a year of the study starting. Of those, 98% said their doctor had talked to them about quitting, though the conversations were usually brief -- 5 minutes or so. Half said their doctor had offered them medication to help them quit.
Those rates of discussing quitting and offering medication are higher than national averages, An said. But there's only so much a doctor can do during an office visit.
"The VA is doing a very good job in terms of what doctors can do in clinics," he said. "They're ahead of the curve, but even though they're ahead of the curve, offering phone counseling is better than that."
Comprehensive Care Over the Phone
The remaining 417 smokers (the intervention group) were enrolled in a phone care program designed by the researchers. It combined telephone counseling with easy access to cessation medication. The people in this group got a series of phone calls over 2 months from trained counselors, and were encouraged to use nicotine replacement or other medications to help them quit. The study doctors gave them prescriptions for the medication in consultation with their primary care doctors as needed.
People in the phone care group made more quit attempts than people in the regular care group, and they made more use of counseling services (mostly by phone, but also on-on-one and in groups) and medications. Just 18% of the people in the usual care group used both counseling and medication to help them quit, compared to 88% of people in the phone care group.
That's why the phone care strategy was so successful, An said.
"People who used both [medications and counseling] quit at about the same rate," he explained, "but we had more people using both in the intervention group."
Wiatrek isn't surprised by that finding. "We see that consistently with the ACS Quitline," she said. "Coupling counseling and medication is certainly more effective."
An said all health services -- including the VA -- should consider adding a phone care component to their quitting programs.
"Once you have a [cessation] system in place, adding phone care is going to be beneficial," he said. "We're limited in what we can do in the clinic. We're limited to brief interventions, and one of the best things we can do is get patients hooked up with programs that can give them real support and treatment over time."
Wiatrek said smokers who want to quit can call the ACS toll-free at 1-800-ACS-2345 to be directed to a quitline in their state and request self-help materials. People who live in states without quitlines can get information about participating in a clinical trial of cessation strategies.
-------------------------------------------------------------------------------
Citation: "Benefits of Telephone Care Over Primary Care for Smoking Cessation." Published in the March 13, 2006, Archives of Internal Medicine (Vol. 166, No. 5:536-542). First author: Lawrence C. An, University of Minnesota.
