SMOKING-BEHAVIOR ON THE FIRST DAY OF A QUIT ATTEMPT PREDICTS LONG-TERM ABSTINENCE

Background: The nicotine patch has been widely used for smoking cessat ion, but not all smokers quit using the patch. Knowing which smokers a re likely to succeed with the nicotine patch may improve the efficienc y of nicotine patch use.Objective: To identify predictors of smoking a bstinence using baseline characteristics, smoking behavior, and withdr awal symptoms. Methods: Using 2 randomized clinical trials of pharmaco logic treatment, brief counseling, and quit date formats in the outpat ient research clinic setting, predictors of smoking cessation were der ived in 1 sample (n=159), then prospectively validated in an independe nt sample (n=48). Subjects smoked 1 pack of cigarettes per day or more and were motivated to quit smoking. Self-report of abstinence at 6 mo nths verified by exhaled carbon monoxide of 8 ppm or less was used. Re sults: Abstinence at 6 months was 24% in the derivation set and 25% in the validation set. Using logistic regression, a model containing qui t date abstinence (odds ratio, 10.6; 95% confidence interval [CI], 2.9 -38.7) and baseline nicotine dependence (odds ratio, 0.75; 95% CI, 0.6 -1.0 per unit increase in Fagerstrom score) provided the optimal predi ctive ability and was validated in the independent set. Quit date abst inence improved the likelihood of B-month abstinence by 4.1 over basel ine (95% CI, 2.6-6.4) for low-nicotine-dependent smokers and 1.2 (95% CI, 0.6-2.2) for high-nicotine-dependent smokers. Quit date smoking al tered the likelihood of 6-month abstinence by 0.2 (95% CI, 0.0-0.8) fo r low-dependent smokers and 0.1 for high-dependent smokers (95% CI, 0. 0-0.6). Conclusions: Abstinence on the quit date and low-nicotine depe ndence improve the likelihood of smoking abstinence at 6 months. Smoki ng on the quit date may be an indication for postponing the cessation attempt or adjusting the therapy for smoking cessation.