Comparison of two approaches in promoting smoking cessation among smokers attending an outpatient clinic : a randomized controlled trial

Abstract

Smoking, is a major cause of preventable death and diseases, causing 8 million deaths worldwide annually. Local studies reported that 68% of cardiac patients and more than 70% of smokers with diabetes remained in the precontemplation stage after receiving a smoking cessation intervention. An intervention with nicotine replacement therapy (NRT) is effective, but some evidence found that Chinese smokers’ acceptance and adherence to NRT are low. Moreover, some patients with chronic diseases may hesitate to use NRT. An innovative smoking cessation intervention may serve as an alternate strategy on the usual practice. This study examined the feasibility of implementing smoking cessation interventions in an outpatient clinic and compared the effectiveness of two approaches: quit immediately (QI) and cut down to quit: (CDTQ). This open-label trial of 100 adult smokers ran from June 2014 to November 2016. The study used block randomization to assign subjects to a group. Both groups received a booklet about smoking cessation and a brief intervention based on the AWARD model. Smokers in CDTQ group when advised to reduce cigarette consumption by 15% in the first week, 30% in the first month and 50% in the third month, and eventually quit smoking within six months, plus an education card and a smoking reduction plan. The smokers in the QI group received the same brief intervention but were advised to quit abruptly instead of cut down to quit. Both groups received four booster interventions via telephone. At the 6-month follow-up, self-reported 7-day point prevalence rates were 18.0% in the QI group and 4.0% in the CDTQ group. At 12-month follow-up, the self-reported 7-day point prevalence rates were 12.0% in QI group and 4.0% in the CDTQ group. No statistically significant difference in smoking reduction (at least 50% cigarette consumption) existed between the QI and CDTQ groups at the 6-month (31.7% vs. 22.9%, adjusted OR = 0.640, 95% CI = 0.250–1.641) and 12-month (34.1% vs. 20.8%, adjusted OR = 0.509, 95% CI = 0.200–1.296) follow-ups. This study demonstrated the feasibility of implementing smoking cessation interventions in an outpatient clinic. This study showed that QI might be a more effective approach than CDTQ at 6-months, but not at 12-months. There are several recommendations for future research. First, there is a need to simplify CDTQ instructions, particularly for the older and less well-educated smokers. Second, it is necessary to have a closer follow-up with smokers to monitor their cigarette consumption and adherence. Third, it is important to increase smokers’ autonomy by allowing them to select their quitting schedules. Fourth, this study revealed that smokers could afford to receive more comprehensive smoking cessation intervention in an outpatient clinic. A more comprehensive intervention that focuses on the skills to overcome nicotine cravings and withdrawal symptoms is recommended for future studies. Additionally, to enhance the effectiveness of the intervention, healthcare professionals can actively refer smokers to existing smoking cessation services for more comprehensive counselling.