Natural History of Attempts to Stop Smoking

Introduction: This study provides a prospective fine-grain description of the incidence and pattern of intentions to quit, quit attempts, abstinence, and reduction in order to address several clinical questions about self-quitting. Methods: A total of 152 smokers who planned to quit in the next 3 months called nightly for 12 weeks to an Interactive Voice Response system to report cigarettes/day, quit attempts, intentions to smoke or not in the next day, and so forth. No treatment was provided. Results: Most smokers (60%) made multiple transitions among smoking, reduction, and abstinence. Intention to not smoke or quit often did not result in a quit attempt but were still strong predictors of a quit attempt and eventual abstinence. Most quit attempts (79%) lasted less than 1 day; about one fifth (18%) of the participants were abstinent at 12 weeks. The majority of quit attempts (72%) were not preceded by an intention to quit. Such quit attempts were shorter than quit attempts preceded by an intention to quit (<1 day vs. 25 days). Most smokers (67%) used a treatment, and use of a treatment was nonsignificantly associated with greater abstinence (14 days vs. 3 days). Making a quit attempt and failing early predicted an increased probability of a later quit attempt compared to not making a quit attempt early (86% vs. 67%). Smokers often (17%) failed to report brief quit attempts on an end-of-study survey. Conclusions: Cessation is a more chronic, complex, and dynamic process than many theories or treatments assume.