Abstinence from smoking ten years after participation in a randomized controlled trial of a self-help program
Introduction
Clinical interventions for smoking cessation produce the highest abstinence rates, but they also produce the lowest participation rates (Lando, 2006). In contrast, self-help interventions achieve lower abstinence rates, but can reach a larger percentage of the eligible population than clinical interventions, and are more cost-effective. The aim of self-help interventions is to provide some of the benefits of intensive clinical interventions without the need to attend treatment sessions.
Several approaches have been proposed to increase the efficacy of self-help interventions, including personalized written feedback (Becoña & Vázquez, 2001a) and telephone support (see An et al., 2006, Pan, 2006, Stead et al., 2007), both for increasing abstinence rates and for reducing relapse rates after self-help programs, since they both provide personalized support. Increasing the intensity of intervention by providing telephone support appears to increase quit rates, especially in the case of proactive calls from a counselor. For example, Míguez, Vázquez and Becoña (2002) and Míguez and Becoña (2008) assessed the effect of providing telephone support throughout a self-help treatment program, obtaining significantly better results over a 1-year follow-up compared to the same treatment without such support.
Studies that have assessed self-help interventions for smoking cessation usually report data obtained over a follow-up period of up to one year, which is the minimum recommended at a scientific level (West, Hajek, Stead, & Stapleton, 2005). Indeed, the majority of treatments for smokers involve maximum follow-ups of a year. More long-term follow-ups have been employed in clinical interventions (e.g., Becoña and Vázquez, 1998, Froján and Olivares, 1999, Vázquez and Becoña, 1996, Yudkin et al., 2003), in epidemiological studies (e.g., Godtfredsen, Holst, Prescott, Vestbo, & Osler, 2002) and in large-scale community interventions, such as COMMIT (Hyland et al., 2004). However, in behavioral self-help treatments there are no studies that continue beyond the 1-year point, since doing so involves enormous difficulties and considerable experimental mortality and, as is well known, high attrition rates limit the generalizability and statistical power of a study. In fact, even with follow-ups of 12 months or less some studies report sample drop-out rates of the order of 40–50% (e.g., Lipkus et al., 2004, McAlister et al., 2004). Moreover, in the case of smoking cessation, long-term follow-up is particularly important in view of the known tendency for long-term relapse.
The aim of this study was, first of all, to analyze the duration of the effects of telephone support combined with a behavioral self-help intervention for smoking cessation, 10 years after the end of the treatment. And secondly, to analyze the evolution of their smoking over this 10-year period, the number of attempts made to give up smoking and the length of abstinence achieved in each attempt.
Section snippets
Sample
The sample was made up of 200 smokers who had participated in a self-help program for smoking cessation ten years previously (see Míguez et al., 2002). Participants were randomly assigned to group A (100 subjects who received the mailed multicomponent behavioral program; mean age 35.1 years, SD = 8.8; pretreatment cigarette consumption 28.0 cigarettes per day, SD = 10.3) or group B (100 subjects who received the mailed program plus six telephone calls from a therapist during the program period;
Attrition
At the one-year follow-up, data had been obtained from 98.5% of the sample, that is, 197 participants. At ten years 93.5% of the sample original were found, that is, 187 of the 200 that had participated in the program (from the mail group — the group that received the program through the mail but received no telephone counseling — 4 could not be found and 2 had died; from the group that received telephone support, 3 could not be found and 4 had died). Thus, for the total sample, 7 could not be
Discussion
The Smoking Cessation Program by mail used in this study is an intervention alternative suitable for helping those who want to give up smoking and cannot or do not want to attend clinical treatment programs. This intervention makes it possible to reach large numbers of smokers, so that it has a greater impact on the population than clinical interventions. Moreover, it is more economical and convenient for the smokers themselves.
The present study shows that it is possible to carry out long-term
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