- Email: [email protected]
Smoking cessation aids and strategies among former smokers in Canada
Addictive Behaviors 35 (2010) 282–285
Contents lists available at ScienceDirect
Addictive Behaviors
Short Communication
Smoking cessation aids and strategies among former smokers in Canada Rovshan M. Ismailov a, Scott T. Leatherdale a,b,c,⁎ a b c
Department of Population Studies and Surveillance, Cancer Care Ontario, Canada Department of Health Studies and Gerontology, University of Waterloo, Canada Dalla Lana School of Public Health, University of Toronto, Canada
a r t i c l e
i n f o
Keywords: Former smokers Nicotine replacement therapy Pharmaceutical aid
a b s t r a c t Objectives: There is a need to better understand the prevalence of use of pharmaceutical aids among former smokers, and explore concerns that those former smokers may have had about using such products. This paper examines the use of various cessation aids and strategies as well as reasons for not using cessation aids among a nationally representative sample of former smokers from Canada. Methods: Using data from the 2006 Canadian Tobacco Use Monitoring Survey (CTUMS), univariate analyses were performed to examine the use of different cessation aids, strategies to quit smoking, and reasons for not using cessation aids among former smokers who had quit in the previous two years. Results: In 2006, over one in four Canadians (27.1% or about 7.2 million persons) aged 15 and older was a former smoker. Overall, female former smokers were more likely to report that they reduced their consumption of cigarettes as a quitting strategy, whereas male former smokers were more likely to report using a pharmacological aids when quitting. Among reasons given for not using cessation aids, lack of trust that these products would work was the most common (15.4%), following by issue of cost (8.5%), concern about possible side effects (5.8%) and lack of information about products (1.8%). Conclusion: These results suggest that men and women use different approaches to quit smoking. Our findings provide new insight which could be used to target cessation programs to the individuals where they are most likely to be effective. © 2009 Elsevier Ltd. All rights reserved.
1. Background Research has shown that the most common methods for quitting smoking typically do not include any form of formal assistance (e.g., cold turkey or gradually cutting back)(Hughes et al., 1992). In instances when formal cessation aids are used, it is common for smokers to use a pharmaceutical aid. Pharmaceutical aids are often in the form of a nicotine replacement therapy (NRT) (e.g., the nicotine patch or nicotine gum), or in the form of a medication which has an impact on reward pathways in the brain which result in increased success in quitting (e.g., Buprprion/ Zyban) (Peters & Morgan, 2002). Despite possible side effects of using pharmaceutical aids (e.g., cardiovascular or pregnancy-related) or concerns about their use in some populations (e.g., youth, pregnant women), using pharmaceutical aid(s) during quit attempts has been shown to increase cessation rates in the population (Peters & Morgan, 2002) and (Monson, 2005). As such, there is a need to better understand the prevalence of use of pharmaceutical aids during cessation, and explore concerns that smokers may have about using such products when trying
⁎ Corresponding author. Department of Population Studies and Surveillance, Cancer Care Ontario, 620 University Avenue, Toronto ON, Canada M5G 2 L7. Tel.: +1 416 971 9800x3237; fax: +1 416 971 7554. E-mail address: [email protected] (S.T. Leatherdale). 0306-4603/$ – see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2009.10.013
to quit. Using nationally representative data, the aims of the current study were to examine the use of various cessation aids and strategies among former smokers, and to explore the reasons cessations aids were not used among former smokers who have quit in past two years. 2. Methods 2.1. Procedure The present study used data from the 2006 Canadian Tobacco Use Monitoring Survey (CTUMS); a nationally representative survey designed to monitor trends in smoking prevalence (Statistics Canada, 2006). The target population for CTUMS is all persons aged 15 and older living in Canada, excluding residents of Yukon, Nunavut, and the Northwest Territories, and full-time residents of institutions. Data were collected by Statistics Canada between February and December 2006 using computer-assisted interviews by telephone; only direct reports (i.e., not third-party) with selected persons were accepted. A total of 21,976 Canadians responded to the survey; overall the response rate was 69.9%.The sampling design was a two-phase stratified random sample of telephone numbers. The two-phase design was used to increase the representation of people in the 15 to 19 and 20 to 24 age groups. In the first phase, households were
R.M. Ismailov, S.T. Leatherdale / Addictive Behaviors 35 (2010) 282–285
283
Table 1 Use of cessation aids and strategies among former smokers who quit in past two years, by selected characteristics, household population aged 15 or older, Canada, 2006. Source: 2006 Canadian Tobacco Use Monitoring Survey. Use of aids
Use of strategies
Nicotine patch Nicotine gum Product such as “Zyban” At least one of these aids Deal with friend/family member Reduced consumption as a strategy Total '000 Total Sex Men Women a Age group 15–24 25–44 a 45 or older a
243.8 % 26.7
156.6E % 17.1
116.5E % 12.7E
347.5 % 38.0
228.4 % 25.0
370.9 % 40.6
27.5 25.8
21.4E 12.6E
12.0E 13.5E
42.4 33.4
24.4E 25.7
37.3 44.1
9.0⁎E 22.3⁎E 40.6
8.9⁎E 19.3E 18.7E
4.2⁎F 8.4⁎E 22.1E
16.0⁎E 35.6⁎ 51.7
29.2 24.2E 23.9E
53.2 35.0 40.9
⁎Significantly different from estimate for reference category (p < 0.5). E coefficient of variation 16.6% to 33.3%. F coefficient of variation higher than 33.3%. a Reference category.
selected using Random Digit Dialing; in the second phase, one or two individuals (or none) were selected based on household composition. Survey weights were used to adjust for non-response between provinces and groups. A full description of the sampling design is available (Statistics Canada, 2006). 2.2. Measures We defined a former smoker as someone who was previously a current smoker (had smoked at least 100 cigarettes in his/her life), but currently reported that they do not smoke. As per CTUMS guidelines, this was based on the following two questions: “At the present time, do you smoke cigarettes every day, occasionally or not at all?” and “Have you smoked at least 100 cigarettes in your life?” Those who responded “Not at all” to the first question and “Yes” to the second question were defined as former smokers. Among formers smokers, those who reported that they had quit smoking in the previous two years were considered to have quit recently (recent quitters). Recent quitters were also asked about use of cessation aids (i.e. nicotine patch, nicotine gum as well as products that do not contain nicotine such as “Zyban”), reasons for not using cessation aids (i.e. possible side effects, cost issue etc.), and use of cessation strategies (i.e. deal with friend / family member or reduced consumption) when they quit. Demographic information on age and sex were also collected. 2.3. Analyses Data were weighted on sex, age, and province, followed by adjustments for non-response and multiple telephone lines within a household. To account for the survey design effects, standard errors and p-values were estimated, and significance tests were performed using the bootstrap technique. Descriptive analyses of the demographic characteristics for all former smokers were examined. The use of pharmaceutical aids as well as use of cessation strategies were cross-tabulated by age and sex. Similarly, reasons for not using cessation aids among former smokers who quit in past two years were cross-tabulated by age and sex. The statistical package SAS 9.1 was used for all analyses (2003). 3. Results 3.1. Descriptive statistics and smoking history In 2006, more than one in four Canadians (27.1% or about 7.2 million persons) aged 15 or older were former smokers. The
prevalence of former smoking was higher among men (30.9%) in comparison to women (23.4%). Being a former smoker was associated with age, where older Canadians were more likely to be former smokers than younger Canadians (2.3% among those aged 15 to 19 years vs. 42.7% among those aged 65 years or older). Descriptive statistics for the study sample are presented in Appendix Table A. As shown in Appendix Table B, males reported significantly more quit attempts than females. In addition, males reported significantly more number of cigarettes smoked per day than females and those aged 65 or older reported significantly more number of cigarettes smoked per day than other age groups.
3.2. Use of cessation aids and strategies among former smokers who quit in past two years As shown in Table 1, former smokers who quit in the past two years were asked about their use of three different types of smoking cessation aids; 26.7% reported they used a nicotine patch, 17.1% reported that they used nicotine gum, and 12.7% reported that they used a product such as “Zyban”. Overall, 38% of former smokers reported that they had used at least one of these aids. Reporting the use of at least one aid was particularly high among those aged 45 or older (51.7%) and low among those aged 15 to 24 years (16%). Although not statistically different, more men (42.4%) than women (33.4%) reported using at least one cessation aid. Former smokers were also asked about strategies they used in their attempt to quit. Reduced consumption as a strategy was more common than making a deal with a friend or family member (40.6% versus 25% respectively). In particular, reduced consumption was more popular among women (44.1%) than among men (37.3%). Reduced consumption as a strategy was most common among former smokers 15–24 years old (53.2%).
3.3. Reasons for not using cessation aids among former smokers who quit in the past two years As shown in Table 2, the most common reason reported for not using a cessation aid was lack of trust that these products work (15.4%), followed by concerns about their cost (8.5%), and concerns about possible side effects (5.8%). Women were more likely to be concerned about possible side effects compared with men (8.7% and 2.6% respectively). Men, in turn, were more likely than women to report that they did not believe that these
284
R.M. Ismailov, S.T. Leatherdale / Addictive Behaviors 35 (2010) 282–285
Table 2 Reasons for not using cessation aids among former smokers who quit in past two years, by selected characteristics, household population aged 15 or older, Canada, 2006. Source: 2006 Canadian Tobacco Use Monitoring Survey.
Total '000 Total Sex Men Women a Age group 15–24 25–44 45 or older
a
Concern about possible side effects
Does not believe these products work
Not enough information about products
Cost too high
32.7E % 5.8E
86.1 % 15.4
10.2E % 1.8E
47.7E % 8.5E
2.6*F 8.7E
17.8E 13.2E
0.9F 2.6F
8.2F 8.8F;
7.4E 2.4F 9.7F
12.7E 11.0 ⁎E 24.3E
4.6F 0.7F 1.2F
11.0E 8.6F 6.3F
*Significantly different from estimate for reference category (p < 0.5). E coefficient of variation 16.6% to 33.3%. F coefficient of variation higher than 33.3%. a Reference category.
products would work (17.8% vs. 13.2% respectively) and such disbelief was particular frequent among those aged 45 or older (24.3%).
aids as well as some important risk factors (e.g. alcohol use) were available. 5. Conclusion
4. Discussion One of the ways to reduce smoking is to understand factors related to the types of approaches smokers use when trying to quit. Our findings suggest that men were more apt to use pharmacological aids whereas women were more apt to reduce their consumption of cigarettes. We also identified that women appear to be more concerned about possible side effects from smoking cessation aids compared to men. These findings suggest that cessation strategies may need to be differentially targeted to the unique needs of men and women. A meta-analysis of nicotine replacement therapy (NRT) trials has shown that it is equally effective for both men and women at 3 and 6 but not at 12 month of follow up(Cepeda-Benito, Reynoso, & Erath, 2004). Although not statistically significant, we did find that fewer women than men used nicotine-based products as a method for quitting smoking. This suggests that it may be pertinent to target female smokers who are interested in quitting smoking with additional information regarding the potential benefits of using a nicotine-based cessation aid. Additional research is required to replicate our finding in other samples and to better understand why gender differences in NRT use may exist. Both nicotine gum and nicotine patch have been regarded as effective tools for smoking cessation, even among heavy smokers (Tang, Law, & Wald, 1994). It is estimated that as many as every third smoker, irrespective of gender, can quit while using these products, providing that proper supervision is being offered (Tang et al., 1994). Despite this effectiveness, some smokers still have concerns about using these products. Consistent with previous research (Etter & Perneger, 2001), we found that just over one in seven former smokers reported that they do not believe such products work, and a modest number of smokers continue to have concern about possible side effects from using such products. Despite well established and documented low rates of serious adverse effects from NRT (Silagy, Lancaster, Stead, Mant, & Fowler, 2004) and (Fiore, 2000), additional research is required to determine inform smokers that such products are a safe cessation aid to use during a quit attempt. 4.1. Limitations These cross-sectional data do not allow us to infer causality for our findings. No data on certain cessation-related pharmaceutical
These results suggest that men and women use different approaches to quit smoking. Our findings provide new insight which could be used to target cessation programs to the individuals where they are most likely to be effective. Role of Funding Sources We state that this study had no funding involvement.
Contributors Both authors have materially participated in the research and the manuscript preparation. Both authors have approved the final manuscript.
Conflict of Interest There are no conflicts of interest by any author.
Acknowledgements Dr. Leatherdale is a Cancer Care Ontario Research Chair in Population Studies. The authors acknowledge Ms. Margot Shields for reviewing an earlier draft of this manuscript.
Appendix A
Percentage of former smokers, selected characteristics, household population aged 15 or older, Canada, 2006. Source: 2006 Canadian Tobacco Use Monitoring Survey.
Total Sex Men Womena Age group 15–19 20–24 25–34 35–44a 45–64 65 or older a b
Total population
Current and former smokers only
%
%
27.1 30.9 23.4
59.3 b
2.3b 9.1b 17.4b 23.8 37.5b 42.7b
60.4 58.0 13.3b 25.1b 42.2b 54.6 66.5b 84.3b
Reference category. Significantly different from estimate for reference category (p 0.5).
R.M. Ismailov, S.T. Leatherdale / Addictive Behaviors 35 (2010) 282–285
Appendix B
References
Former smokers' mean number of quit attempts and mean number of cigarettes smoked per day before quitting, by selected characteristics, household population aged 15 or older, Canada, 2006. Source: 2006 Canadian Tobacco Use Monitoring Survey. Mean number of quit attempts Mean number of cigarettes per day (SD) (SD) Total Sex Men Womena Age group 15–19 20–24 25–34 35–44a 45–64 65 or older
285
3.0 (4.0)
18.7 (14.0)
3.2 (4.2)b 2.8 (3.7)
21.5 (14.8)b 15.0 (11.9)
2.7 2.8 2.2 3.1 3.4 2.6
(2.8) (4.2) (2.1)b (3.9) (4.5) (3.6)
10.6E (13.3)b 10.7 (8.3)b 11.9 (9.4)b 15.9 (12.0) 20.7 (14.5)b 21.2 (15.0)b
SD: Standard deviation. a Reference category. b Significantly different from estimate for reference category (p < 0.5).
Cepeda-Benito, A., Reynoso, J. T., & Erath, S. (2004). Meta-analysis of the efficacy of nicotine replacement therapy for smoking cessation: Differences between men and women. Journal of Consulting and Clinical Psychology, 72(4), 712−722. Etter, J. F., & Perneger, T. V (2001). Attitudes toward nicotine replacement therapy in smokers and ex-smokers in the general public. Clinical Pharmacology Therapeutics, 69(3), 175−183. Fiore, M. C. (2000). Treating tobacco use and dependence: An introduction to the US Public Health Service Clinical Practice Guideline. Respiratory Care, 45(10), 1196−1199. Hughes, J. R., Gulliver, S. B., Fenwick, J. W., Valliere, W. A., Cruser, K., Pepper, S., et al. (1992). Smoking cessation among self-quitters. Health Psychology, 11(5), 331−334. Monson, A. L. (2005). A review of pharmacological and educational approaches for tobacco cessation. The Internet Journal of Allied Health Sciences and Practice, 3(3). Peters, M. J., & Morgan, L. C. (2002). The pharmacotherapy of smoking cessation. Medical Journal of Australia, 176(10), 486−490. SAS Institute Inc. (2003). The SAS System for Windows. : SAS Institute Inc. Silagy, C., Lancaster, T., Stead, L., Mant, D., & Fowler, G. (2004). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews(3), CD000146. Statistics Canada (2006). Microdata user guide, Canadian Tobacco Use Monitoring Survey. Tang, J. L., Law, M., & Wald, N. (1994). How effective is nicotine replacement therapy in helping people to stop smoking? BMJ, 308(6920), 21−26.
Contents lists available at ScienceDirect
Addictive Behaviors
Short Communication
Smoking cessation aids and strategies among former smokers in Canada Rovshan M. Ismailov a, Scott T. Leatherdale a,b,c,⁎ a b c
Department of Population Studies and Surveillance, Cancer Care Ontario, Canada Department of Health Studies and Gerontology, University of Waterloo, Canada Dalla Lana School of Public Health, University of Toronto, Canada
a r t i c l e
i n f o
Keywords: Former smokers Nicotine replacement therapy Pharmaceutical aid
a b s t r a c t Objectives: There is a need to better understand the prevalence of use of pharmaceutical aids among former smokers, and explore concerns that those former smokers may have had about using such products. This paper examines the use of various cessation aids and strategies as well as reasons for not using cessation aids among a nationally representative sample of former smokers from Canada. Methods: Using data from the 2006 Canadian Tobacco Use Monitoring Survey (CTUMS), univariate analyses were performed to examine the use of different cessation aids, strategies to quit smoking, and reasons for not using cessation aids among former smokers who had quit in the previous two years. Results: In 2006, over one in four Canadians (27.1% or about 7.2 million persons) aged 15 and older was a former smoker. Overall, female former smokers were more likely to report that they reduced their consumption of cigarettes as a quitting strategy, whereas male former smokers were more likely to report using a pharmacological aids when quitting. Among reasons given for not using cessation aids, lack of trust that these products would work was the most common (15.4%), following by issue of cost (8.5%), concern about possible side effects (5.8%) and lack of information about products (1.8%). Conclusion: These results suggest that men and women use different approaches to quit smoking. Our findings provide new insight which could be used to target cessation programs to the individuals where they are most likely to be effective. © 2009 Elsevier Ltd. All rights reserved.
1. Background Research has shown that the most common methods for quitting smoking typically do not include any form of formal assistance (e.g., cold turkey or gradually cutting back)(Hughes et al., 1992). In instances when formal cessation aids are used, it is common for smokers to use a pharmaceutical aid. Pharmaceutical aids are often in the form of a nicotine replacement therapy (NRT) (e.g., the nicotine patch or nicotine gum), or in the form of a medication which has an impact on reward pathways in the brain which result in increased success in quitting (e.g., Buprprion/ Zyban) (Peters & Morgan, 2002). Despite possible side effects of using pharmaceutical aids (e.g., cardiovascular or pregnancy-related) or concerns about their use in some populations (e.g., youth, pregnant women), using pharmaceutical aid(s) during quit attempts has been shown to increase cessation rates in the population (Peters & Morgan, 2002) and (Monson, 2005). As such, there is a need to better understand the prevalence of use of pharmaceutical aids during cessation, and explore concerns that smokers may have about using such products when trying
⁎ Corresponding author. Department of Population Studies and Surveillance, Cancer Care Ontario, 620 University Avenue, Toronto ON, Canada M5G 2 L7. Tel.: +1 416 971 9800x3237; fax: +1 416 971 7554. E-mail address: [email protected] (S.T. Leatherdale). 0306-4603/$ – see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2009.10.013
to quit. Using nationally representative data, the aims of the current study were to examine the use of various cessation aids and strategies among former smokers, and to explore the reasons cessations aids were not used among former smokers who have quit in past two years. 2. Methods 2.1. Procedure The present study used data from the 2006 Canadian Tobacco Use Monitoring Survey (CTUMS); a nationally representative survey designed to monitor trends in smoking prevalence (Statistics Canada, 2006). The target population for CTUMS is all persons aged 15 and older living in Canada, excluding residents of Yukon, Nunavut, and the Northwest Territories, and full-time residents of institutions. Data were collected by Statistics Canada between February and December 2006 using computer-assisted interviews by telephone; only direct reports (i.e., not third-party) with selected persons were accepted. A total of 21,976 Canadians responded to the survey; overall the response rate was 69.9%.The sampling design was a two-phase stratified random sample of telephone numbers. The two-phase design was used to increase the representation of people in the 15 to 19 and 20 to 24 age groups. In the first phase, households were
R.M. Ismailov, S.T. Leatherdale / Addictive Behaviors 35 (2010) 282–285
283
Table 1 Use of cessation aids and strategies among former smokers who quit in past two years, by selected characteristics, household population aged 15 or older, Canada, 2006. Source: 2006 Canadian Tobacco Use Monitoring Survey. Use of aids
Use of strategies
Nicotine patch Nicotine gum Product such as “Zyban” At least one of these aids Deal with friend/family member Reduced consumption as a strategy Total '000 Total Sex Men Women a Age group 15–24 25–44 a 45 or older a
243.8 % 26.7
156.6E % 17.1
116.5E % 12.7E
347.5 % 38.0
228.4 % 25.0
370.9 % 40.6
27.5 25.8
21.4E 12.6E
12.0E 13.5E
42.4 33.4
24.4E 25.7
37.3 44.1
9.0⁎E 22.3⁎E 40.6
8.9⁎E 19.3E 18.7E
4.2⁎F 8.4⁎E 22.1E
16.0⁎E 35.6⁎ 51.7
29.2 24.2E 23.9E
53.2 35.0 40.9
⁎Significantly different from estimate for reference category (p < 0.5). E coefficient of variation 16.6% to 33.3%. F coefficient of variation higher than 33.3%. a Reference category.
selected using Random Digit Dialing; in the second phase, one or two individuals (or none) were selected based on household composition. Survey weights were used to adjust for non-response between provinces and groups. A full description of the sampling design is available (Statistics Canada, 2006). 2.2. Measures We defined a former smoker as someone who was previously a current smoker (had smoked at least 100 cigarettes in his/her life), but currently reported that they do not smoke. As per CTUMS guidelines, this was based on the following two questions: “At the present time, do you smoke cigarettes every day, occasionally or not at all?” and “Have you smoked at least 100 cigarettes in your life?” Those who responded “Not at all” to the first question and “Yes” to the second question were defined as former smokers. Among formers smokers, those who reported that they had quit smoking in the previous two years were considered to have quit recently (recent quitters). Recent quitters were also asked about use of cessation aids (i.e. nicotine patch, nicotine gum as well as products that do not contain nicotine such as “Zyban”), reasons for not using cessation aids (i.e. possible side effects, cost issue etc.), and use of cessation strategies (i.e. deal with friend / family member or reduced consumption) when they quit. Demographic information on age and sex were also collected. 2.3. Analyses Data were weighted on sex, age, and province, followed by adjustments for non-response and multiple telephone lines within a household. To account for the survey design effects, standard errors and p-values were estimated, and significance tests were performed using the bootstrap technique. Descriptive analyses of the demographic characteristics for all former smokers were examined. The use of pharmaceutical aids as well as use of cessation strategies were cross-tabulated by age and sex. Similarly, reasons for not using cessation aids among former smokers who quit in past two years were cross-tabulated by age and sex. The statistical package SAS 9.1 was used for all analyses (2003). 3. Results 3.1. Descriptive statistics and smoking history In 2006, more than one in four Canadians (27.1% or about 7.2 million persons) aged 15 or older were former smokers. The
prevalence of former smoking was higher among men (30.9%) in comparison to women (23.4%). Being a former smoker was associated with age, where older Canadians were more likely to be former smokers than younger Canadians (2.3% among those aged 15 to 19 years vs. 42.7% among those aged 65 years or older). Descriptive statistics for the study sample are presented in Appendix Table A. As shown in Appendix Table B, males reported significantly more quit attempts than females. In addition, males reported significantly more number of cigarettes smoked per day than females and those aged 65 or older reported significantly more number of cigarettes smoked per day than other age groups.
3.2. Use of cessation aids and strategies among former smokers who quit in past two years As shown in Table 1, former smokers who quit in the past two years were asked about their use of three different types of smoking cessation aids; 26.7% reported they used a nicotine patch, 17.1% reported that they used nicotine gum, and 12.7% reported that they used a product such as “Zyban”. Overall, 38% of former smokers reported that they had used at least one of these aids. Reporting the use of at least one aid was particularly high among those aged 45 or older (51.7%) and low among those aged 15 to 24 years (16%). Although not statistically different, more men (42.4%) than women (33.4%) reported using at least one cessation aid. Former smokers were also asked about strategies they used in their attempt to quit. Reduced consumption as a strategy was more common than making a deal with a friend or family member (40.6% versus 25% respectively). In particular, reduced consumption was more popular among women (44.1%) than among men (37.3%). Reduced consumption as a strategy was most common among former smokers 15–24 years old (53.2%).
3.3. Reasons for not using cessation aids among former smokers who quit in the past two years As shown in Table 2, the most common reason reported for not using a cessation aid was lack of trust that these products work (15.4%), followed by concerns about their cost (8.5%), and concerns about possible side effects (5.8%). Women were more likely to be concerned about possible side effects compared with men (8.7% and 2.6% respectively). Men, in turn, were more likely than women to report that they did not believe that these
284
R.M. Ismailov, S.T. Leatherdale / Addictive Behaviors 35 (2010) 282–285
Table 2 Reasons for not using cessation aids among former smokers who quit in past two years, by selected characteristics, household population aged 15 or older, Canada, 2006. Source: 2006 Canadian Tobacco Use Monitoring Survey.
Total '000 Total Sex Men Women a Age group 15–24 25–44 45 or older
a
Concern about possible side effects
Does not believe these products work
Not enough information about products
Cost too high
32.7E % 5.8E
86.1 % 15.4
10.2E % 1.8E
47.7E % 8.5E
2.6*F 8.7E
17.8E 13.2E
0.9F 2.6F
8.2F 8.8F;
7.4E 2.4F 9.7F
12.7E 11.0 ⁎E 24.3E
4.6F 0.7F 1.2F
11.0E 8.6F 6.3F
*Significantly different from estimate for reference category (p < 0.5). E coefficient of variation 16.6% to 33.3%. F coefficient of variation higher than 33.3%. a Reference category.
products would work (17.8% vs. 13.2% respectively) and such disbelief was particular frequent among those aged 45 or older (24.3%).
aids as well as some important risk factors (e.g. alcohol use) were available. 5. Conclusion
4. Discussion One of the ways to reduce smoking is to understand factors related to the types of approaches smokers use when trying to quit. Our findings suggest that men were more apt to use pharmacological aids whereas women were more apt to reduce their consumption of cigarettes. We also identified that women appear to be more concerned about possible side effects from smoking cessation aids compared to men. These findings suggest that cessation strategies may need to be differentially targeted to the unique needs of men and women. A meta-analysis of nicotine replacement therapy (NRT) trials has shown that it is equally effective for both men and women at 3 and 6 but not at 12 month of follow up(Cepeda-Benito, Reynoso, & Erath, 2004). Although not statistically significant, we did find that fewer women than men used nicotine-based products as a method for quitting smoking. This suggests that it may be pertinent to target female smokers who are interested in quitting smoking with additional information regarding the potential benefits of using a nicotine-based cessation aid. Additional research is required to replicate our finding in other samples and to better understand why gender differences in NRT use may exist. Both nicotine gum and nicotine patch have been regarded as effective tools for smoking cessation, even among heavy smokers (Tang, Law, & Wald, 1994). It is estimated that as many as every third smoker, irrespective of gender, can quit while using these products, providing that proper supervision is being offered (Tang et al., 1994). Despite this effectiveness, some smokers still have concerns about using these products. Consistent with previous research (Etter & Perneger, 2001), we found that just over one in seven former smokers reported that they do not believe such products work, and a modest number of smokers continue to have concern about possible side effects from using such products. Despite well established and documented low rates of serious adverse effects from NRT (Silagy, Lancaster, Stead, Mant, & Fowler, 2004) and (Fiore, 2000), additional research is required to determine inform smokers that such products are a safe cessation aid to use during a quit attempt. 4.1. Limitations These cross-sectional data do not allow us to infer causality for our findings. No data on certain cessation-related pharmaceutical
These results suggest that men and women use different approaches to quit smoking. Our findings provide new insight which could be used to target cessation programs to the individuals where they are most likely to be effective. Role of Funding Sources We state that this study had no funding involvement.
Contributors Both authors have materially participated in the research and the manuscript preparation. Both authors have approved the final manuscript.
Conflict of Interest There are no conflicts of interest by any author.
Acknowledgements Dr. Leatherdale is a Cancer Care Ontario Research Chair in Population Studies. The authors acknowledge Ms. Margot Shields for reviewing an earlier draft of this manuscript.
Appendix A
Percentage of former smokers, selected characteristics, household population aged 15 or older, Canada, 2006. Source: 2006 Canadian Tobacco Use Monitoring Survey.
Total Sex Men Womena Age group 15–19 20–24 25–34 35–44a 45–64 65 or older a b
Total population
Current and former smokers only
%
%
27.1 30.9 23.4
59.3 b
2.3b 9.1b 17.4b 23.8 37.5b 42.7b
60.4 58.0 13.3b 25.1b 42.2b 54.6 66.5b 84.3b
Reference category. Significantly different from estimate for reference category (p 0.5).
R.M. Ismailov, S.T. Leatherdale / Addictive Behaviors 35 (2010) 282–285
Appendix B
References
Former smokers' mean number of quit attempts and mean number of cigarettes smoked per day before quitting, by selected characteristics, household population aged 15 or older, Canada, 2006. Source: 2006 Canadian Tobacco Use Monitoring Survey. Mean number of quit attempts Mean number of cigarettes per day (SD) (SD) Total Sex Men Womena Age group 15–19 20–24 25–34 35–44a 45–64 65 or older
285
3.0 (4.0)
18.7 (14.0)
3.2 (4.2)b 2.8 (3.7)
21.5 (14.8)b 15.0 (11.9)
2.7 2.8 2.2 3.1 3.4 2.6
(2.8) (4.2) (2.1)b (3.9) (4.5) (3.6)
10.6E (13.3)b 10.7 (8.3)b 11.9 (9.4)b 15.9 (12.0) 20.7 (14.5)b 21.2 (15.0)b
SD: Standard deviation. a Reference category. b Significantly different from estimate for reference category (p < 0.5).
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