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Am Fam Physician. 2006;74(7):1203-1204

Light smoking (i.e., 10 cigarettes or less per day) is a prevalent problem in the United States and is particularly evident in younger persons, women, and blacks. However, it is still neglected by clinical trials. Light smoking appears to be associated with quit rates no higher than those among heavier smokers, and the quit rates may be particularly low in blacks. To improve treatment strategies, Nollen and associates attempted to identify predictors of quitting among light smokers, focusing particularly on known factors predictive of quitting in adults.

The study was a randomized trial comparing nicotine gum with health education counseling or motivational interviewing among light smokers who are black. Of 1,012 eligible smokers, 755 were enrolled and followed for six months. Serum cotinine, a marker of nicotine exposure, was assessed at baseline. Smoking history, dependence, and motivation and confidence for quitting were recorded. In addition, patients were assessed for social support, alcohol use, depression, stress, and perceived self-efficacy. The primary outcome variable was serum cotinine level at six months.

Of the 637 patients who completed the six-month study, 95 (14.9 percent) quit smoking and 542 (85.1 percent) remained smokers. Health education counseling was more benficial than motivational interviewing. The results of a trial reporting benefits from counseling, but not from gum, are detailed in a separate article currently in press.

Investigators were able to identify predictive factors for quitting above and beyond the specific treatments. Univariate predictors of quitting included male sex, older age, higher income, fewer cigarettes smoked per day, lower baseline cotinine, higher body mass index (BMI), smoking nonmentholated cigarettes, waiting at least 30 minutes after waking to smoke, increased confidence, sense of increased support, and completion of counseling sessions. The accompanying table shows the results of a multivariate final analysis.

Health education counseling resulted in the highest quit rates among light smokers who are black. The association between higher BMI and quit rates may have been because of less concern about weight control or more concern about obesity-related comorbidities. The authors conclude that because health education provided at regular intervals for a minimum of six sessions did facilitate quitting, persons with negative predictive factors may require a more prolonged, intense effort with targeted counseling addressing issues surrounding factors like poverty (and the potential of associated stress), weight concerns, and nicotine dependence.

Increased odds (% probability)
Higher body mass index (4 per unit increase)
Older age (3 per year)
Decreased odds (% probability)
Female sex (54)
Higher baseline cotinine (5 per 10-unit increase)
Low income (40 per $1,800 per month)
Failure to complete counseling sessions (52)

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Copyright © 2006 by the American Academy of Family Physicians.

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