Abstract 981: Factors affecting success in smoking cessation for veteran smokers
Authors: Emuwa Chinenye O. , Hargreaves Margaret K. , Qu Lei , Wen Wanqing , Moriarty Cynthia , Levine Robert S. , Cui Yong 
Published: February 2011

Abstract
Objective: Cigarette smoking is a serious, but preventable, risk factor for many types of cancer. U.S. veterans have a high rate of cigarette smoking, but there is paucity of data on smoking cessation issues in this population. We systematically examined factors associated with smoking cessation and six-month relapse in a smoking cessation program for veterans.
Methods: Included in the analysis were 223 veteran smokers who participated in a group-based smoking cessation program at the Alvin C York Veterans Affair Medical Center between 1999 and 2002. Baseline data were collected from initial evaluation and medical chart abstraction, including socio-demographics, environmental factors, smoking behaviors, smoking history, and medical conditions. The Fagerstrom Test for Nicotine Dependence (FTND) was used to measure the degree of nicotine dependence. The Beck Depression Inventory (BDI) was used to assess depressive symptoms. A 5-point Likert scale was used to estimate patient confidence in the ability to quit smoking (“not at all sure”, “not too sure”, “fairly sure”, “quite sure”, and “extremely sure”). The intervention involved four group therapy sessions consisting of counseling and use of nicotine replacement and/or bupropion to aid quitting. Smoking status of the initial quitters was followed at six-months after cessation. Logistic regression was used to identify factors associated initial cessation. The Cox Proportional Hazards model was employed to identify risk factors associated with relapse within six months, and the Kaplan-Meier analysis was used to evaluate the effects of these risk factors on the relapse process.
Results: Of 223 program participants, 189 (84.7%) reported having stopped smoking by the program completion, and the abstinence rate at the end of the six months was 31.8%. Factors positively associated with initial quit included educational level, currently employed, previous attempts at quitting, period of previous quitting, perceived confidence to quit, and number of sessions attended; while factors inversely associated with initial quit were age, amount of current smoking and heaviest smoking, BDI score, and FTND score. Six risk factors for six-month relapse after initial quit were identified and their effects on the relapse process can be categorized into two patterns. The influence of age, number of sessions attended, number of smoking coworkers, and a history of schizophrenia on the relapse curve occurred within several days after cessation, while household income and age at smoking initiation showed a delayed action that affected the relapse process after several weeks post quit.
Conclusion: Age and number of sessions attended affected both initial cessation and the relapse process, while other factors influenced initial cessation and the relapse process differentially. The information will be useful in developing effective strategies to increase success in smoking cessation.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 981.