Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerstr？m Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerstr？m score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1–6% lower in the heavy smokers than the overall population. Attending GSP with an individual format ( vs. group/other, OR 1.23–1.44); in a hospital setting ( vs. pharmacy/municipality services, OR 1.05–1.11); and being compliant (attending the planned meetings OR 4.36–4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1–6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising.
Heatherton, T.F.; Kozlowski, L.T.; Frecker, R.C.; Fagerstr？m, K.O. The fagerstr？m test for nicotine dependence: A revision of the fagerstr？m tolerance questionnaire. Br. J. Addict. 1991, 86, 1119–1127, doi:10.1111/j.1360-0443.1991.tb01879.x.
Olsen, K.R.; Bilde, L.; Juhl, H.H.; Kjaer, N.T.; Mosbech, H.; Evald, T.; Rasmussen, M.; Hiladakis, H. Cost-effectiveness of the Danish smoking cessation interventions: Subgroup analysis based on the Danish Smoking Cessation Database. Eur. J. Health Econ. 2006, 7, 255–264, doi:10.1007/s10198-006-0362-1.
Baker, T.B.; Piper, M.E.; McCarthy, D.E.; Bolt, D.M.; Smith, S.S.; Kim, S.-Y.; Colby, S.; Conti, D.; Giovino, G.A.; Hatsukami, D.; et al. Time to first cigarette in the morning as an index of ability to quit smoking: Implications for nicotine dependence. Nicot. Tob. Res. 2007, 9, S555–S570, doi:10.1080/14622200701673480.
Rasmussen, M.; Ammari, A.B.H.; Pedersen, B.; T？nnesen, H. Smoking cessation intervention activities and outcome before, during and after the national Healthcare Reform in Denmark. Clin. Health Promot. 2012, 2, 26–35.
Neumann, T.; Rasmussen, M.; Ghith, N.; Heitmann, B.L.; T？nnesen, H. The Gold Standard Programme: Smoking cessation interventions for disadvantaged smokers are effective in a real-life setting. Tob. Control 2012, doi:10.1136/tobaccocontrol-2011-050194.
Hiscock, R.; Judge, K.; Bauld, L. Social inequalities in quitting smoking: What factors mediate the relationship between socioeconomic position and smoking cessation? J. Public Health 2011, 33, 39–47, doi:10.1093/pubmed/fdq097.
Lemmens, V.; Oenema, A.; Knut, I.K.; Brug, J. Effectiveness of smoking cessation interventions among adults: A systematic review of reviews. Eur. J. Cancer Prev. 2008, 17, 535–544, doi:10.1097/CEJ.0b013e3282f75e48.
Pisinger, C.; Vestbo, J.; Borch-Johnsen, K.; Thomsen, T.; J？rgensen, T. Acceptance of the smoking cessation intervention in a large population-based study: The Inter99 study. Scand. J. Public Health 2005, 33, 138–145, doi:10.1080/14034940410028370.
Fidler, J.A.; Shahab, L.; West, R. Strength of urges to smoke as a measure of severity of cigarette dependence: Comparison with the Fagerstr？m Test for Nicotine Dependence and its components. Addiction 2011, 106, 631–638, doi:10.1111/j.1360-0443.2010.03226.x.
Li, M.D.; Cheng, R.; Ma, J.Z.; Swan, G.E. A meta-analysis of estimated genetic and environmental effects on smoking behavior in male and female adult twins. Addiction 2003, 98, 23–31, doi:10.1046/j.1360-0443.2003.00295.x.
Le Strat, Y.; Rehm, J.; Le Foll, B. How generalisable to community samples are clinical trial results for treatment of nicotine dependence: A comparison of common eligibility criteria with respondents of a large representative general population survey. Tob. Control 2011, 20, 338–343, doi:10.1136/tc.2010.038703.
Baha, M.Y.; Le Faou, A.-L. Smoking cessation interventions offered to French adult light smokers: A heterogeneous population with specific needs. Eur. Add. Res. 2010, 16, 162–169, doi:10.1159/000314360.
Schuurmans, M.M.; Diacon, A.H.; van Biljon, X.; Bolliger, C.T. Effect of pre-treatment with nicotine patch on withdrawal symptoms and abstinence rates in smokers subsequently quitting with the nicotine patch: A randomized controlled trial. Addiction 2004, 99, 634–640, doi:10.1111/j.1360-0443.2004.00711.x.