First Smoke-Free Day Crucial to Success When Quitting Smoking, Duke Researchers Find

Researchers at Duke University Medical Center and the Durham V. A. MedicalCenter say the psychological impact of taking even a single puff of a cigaretteon a preset "quit day" means a smoker will probably go back tosmoking within 6 months.

Based on a study of 200 smokers who wanted to quit, the researchersconcluded that people who can't go "cold turkey" likely havea high physiologic nicotine craving and probably won't be successful quittingon their own with nicotine patches.

"Few studies have been done to determine which smokers are morelikely to benefit from nicotine patches," said Dr. Eric Westman, thestudy's lead author. "This is important because a failed quit attemptcan be demoralizing and discourage many people from trying again. As physicians,we need to be able to give our patients the best shot at quitting. Thisstudy is a step in that direction."

Although nicotine skin patches double the chances of long-term successwhen quitting smoking, only about one in four smokers who use the patchis still smoke-free after 6 months.

One-Day Observational Test of Nicotine Patch Proposed

Westman, assistant professor of medicine at Duke and medical directorof the Duke-V. A. Nicotine Research Program, and colleagues FrederiqueBehm, Dr. David Simel, and Jed Rose, coinventor of the nicotine skin patch,reported their findings in the February 10, 1997, issue of the Archivesof Internal Medicine. Based on their findings, the researchers proposea simple one-day observational test to identify which smokers are morelikely to be successful quitting smoking using nicotine skin patches. Thestudy was supported by the Department of Veterans Affairs.

"We found that people who smoke on their quit day are much morelikely to go back to smoking within 6 months," said Westman. "Thisfinding contradicts the common idea that people can cheat, even just alittle, and still quit smoking. Our findings indicate that setting a definitequit date, and sticking to it, is important for long-term success.

In addition, Westman notes, knowing nicotine patches may not work cansave patients considerable money. Over-the-counter nicotine patches costan average of $4 a day or $220 for an 8-week treatment.

Previous studies used a 2-week trial period to determine which smokersare likely to be successful quitting smoking using a nicotine patch, atan average cost of $56. The Duke study narrows that window to one day,which could save the smoker both money and frustration.

"If the smoker still craves cigarettes using a single patch afterone day, a physician could suggest adding a second patch, or suggest amore intensive method," said Westman.

The researchers conducted two sequential studies with healthy smokerswho smoked at least one pack of cigarettes a day and wanted to quit smoking.The smokers selected a quit date 2 weeks in advance to prepare themselvesfor the quit attempt. Smokers completed a daily diary of the number ofcigarettes smoked and any withdrawal symptoms and cravings they experienced.Any self-reported smoking, even one puff, was counted as smoking in theanalysis.

The researchers found that 25% of people were still not smoking after6 months, which is comparable to other such studies. Of these, only 3 of31 had smoked on the quit date. Conversely, 106 of 173 people who wereunsuccessful had smoked on the quit date. Of those who smoked on the quitdate and also had a high nicotine craving, 98% went back to smoking after6 months.

Questions Devised to Help Guide Use of Patches

Based on their findings, the researchers have developed a simple seriesof questions to guide smokers and their doctors in determining whethernicotine patches are for them.

Did the person smoke on the quit date? If so, the odds of being smoke-freeat 6 months are tenfold less than if he or she did not smoke on the quitdate. For example, if a person's chance of quitting smoking at 6 monthsis 1 in 4, this drops to 1 in 40 if the person smokes on the quit date.

Does the person smoking have a high or low nicotine craving? If cravingsare low, the person has a fourfold better chance of success. The studyshowed that among smokers who didn't smoke on the quit date, 41% of thelow-craving group were still smoke-free after 6 months, as compared withonly 18% of the high-craving group.

The researchers measured nicotine dependence by asking subjects suchquestions as how many cigarettes they smoke, how often they smoke, andhow early in the morning they have their first cigarette.

"Now that nicotine skin patches are available over the counter,many smokers are trying to use them to quit smoking on their own,"Westman said. "Our study shows that while nicotine patches are aneffective therapy for some smokers, others may need to include counselingand other therapies as part of their quit attempt."