Prospective Study of Factors Predicting Outcome of Transdermal Nicotine Treatment in Smoking Cessation

Objective: To assess the factors associated with cessation of smoking with transdermal nicotine and brief behavioural counselling.

Design: Interviews, treatment, and follow up for 26 weeks.

Subjects: 1481 subjects recruited by mass media publicity who smoked > or = 15 cigarettes a day and were motivated to stop smoking.

Interventions: Twelve weeks' treatment with transdermal nicotine and brief behavioural counselling at monthly visits.

Main Outcome Measure: Sustained smoking cessation for the 28 days before the visit at week 26 verified by expired carbon monoxide concentrations. The logistic regression analysis included all subjects.

Results: Most subjects were dependent on nicotine, and the mean (SD) number of cigarettes smoked a day was 32 (12). Overall, 316/1481 subjects (21.3%) stopped smoking. Factors associated with stopping were being male (adjusted odds ratio 2.0; 95% confidence interval 1.5 to 2.7), age > or = 40 years (1.5; 1.1 to 2.0), living with a spouse or partner (1.5; 1.1 to 2.1), motivation ("want to quit" 1.7; 1.2 to 2.3), and concern about weight gain (1.7; 1.3 to 2.2). Negative associations were smoking marijuana (0.4; 0.2 to 0.8) and the presence of other smokers in the household (0.8; 0.6 to 0.9). Almost all subjects who smoked three or more cigarettes in the first four weeks of treatment resumed smoking in the long term (525/547, 96%).

Conclusions: Age, sex, marital status (living with a spouse or partner), motivation, concern about weight gain, recent marijuana smoking, and other smokers in the household were baseline factors associated with differences in outcome of smoking cessation attempts. Smoking three or more cigarettes in the first few weeks after stopping strongly predicted long term relapse.