- Join Freedom From Smoking
- Online Support Community
- About the Program
- Success Stories
- Help Your Employees Stop Smoking
- Stop smoking support programs
- Quit Smoking
- Smoking Cessation
- Individual Counselling
- Group Work
- How do I access help with smoking?
- How much will it cost?
- Request an Appointment
- Resources to help you quit
- Medicines to help you quit
- Smoking cessation with smartphone applications (SWAPP): study protocol for a randomized controlled trial
- What to Expect from a Smokers Anonymous Meeting
- Finding a Smokers Anonymous Meeting
- What to Expect at Your First Meeting
- Nicotine and Tobacco Recovery Program
- Nicotine is a powerful, highly-addictive drug.
- Alcohol and tobacco—Can AA Groups help to break the connection?
Join Freedom From Smoking
Online Support Community
Chat and connect with other quitters who understand what you are going through on our Inspire.com online community, Quit Now: Freedom From Smoking®. Signing up for a profile is quick, easy and free to access at any time. Start a conversation and meet other quitters, share your quit date and see if there are others who are quitting at the same time. Moderated by Lung HelpLine staff, the online community is a supportive and helpful resource throughout your quit attempt and beyond.
About the Program
The Freedom From Smoking® program has helped hundreds of thousands of people quit smoking since its first release in 1981. Learn more about the program and how it can help you, too!
“They gave me a quit date. I did everything they told me to do and I have never smoked again. They gave me the tools that showed me when I smoked and why I was smoking. It was like a miracle, truly like a miracle. I just kept going—and I’m still going.” —Glady
Read what others have to say about winning their freedom from smoking!
Help Your Employees Stop Smoking
Freedom From Smoking is used by employers, hospitals, health plans and other organizations to help the individuals they serve become smokefree for life. We can help build corporate cessation programs utilizing any of our Freedom From Smoking services, including Freedom From Smoking Plus, Group Clinics, The Guide to Help You Quit Smoking and our Corporate Telephonic Program which provides one-on-one counseling to employees through our Lung HelpLine. Learn more.
Stop smoking support programs
You can find out about smoking cessation programs from:
- Your doctor or local hospital
- Your health insurance plan
- Your employer
- Your local health department
- The National Cancer Institute Quitline at 877-448-7848
- The American Cancer Society Quitline at 800-227-2345
- The American Lung Association www.lung.org/stop-smoking/join-freedom-from-smoking, which has online and phone advice programs
- State programs in all 50 states and the District of Columbia at 1-800-QUIT-NOW (1-800-784-8669)
The best smoking cessation programs combine numerous approaches and target the fears and problems you have when quitting. They also provide ongoing support for staying away from tobacco.
Be wary of programs that:
- Are short and offer no help over time
- Charge a high fee
- Offer supplements or pills that are only available through the program
- Promise an easy path to quitting
Telephone-based services can help you design a stop smoking program that meets your needs. These services are easy to use. The counselors can help you avoid common mistakes. This kind of support can be as effective as face-to-face counseling.
Telephone programs are often available on nights and weekends. Trained counselors will help you set up a support network for quitting and help you decide which stop smoking aids to use. Choices may include:
- Nicotine replacement therapy
- Support programs or classes
Let your friends, family, and coworkers know of your plans to stop smoking and your quit date. It helps for people around you to be aware of what you are going through, especially when you are grumpy.
You may also want to seek out other types of support, such as:
- Your family doctor or nurse.
- Groups of ex-smokers.
- Nicotine Anonymous (nicotine-anonymous.org). This organization uses a similar approach as Alcoholics Anonymous. As part of this group, you will be asked to admit that you are powerless over your addiction to nicotine. Also, a sponsor is often available to help you get through urges to smoke.
SMOKING PROGRAMS AND CLASSES
Stop smoking programs can also help you find a quitting method that suits your needs. They will help you be aware of problems that come up while you’re trying to quit and offer tools to cope with these problems. These programs can help you avoid making common mistakes.
Programs may either have one-on-one sessions or group counseling. Some programs offer both. Programs should be run by counselors who are trained to help people quit smoking.
Programs that provide more sessions or longer sessions have a better chance of success. The American Cancer Society recommends programs with the following features:
- Each session lasts at least 15 to 30 minutes.
- There are at least 4 sessions.
- The program lasts at least 2 weeks, although longer is usually better.
- The leader is trained in smoking cessation.
Internet-based programs are also becoming more available. These services send you personalized reminders using e-mail, texting, or other methods.
Nicotine is one of the most heavily used addictive drugs as well as the leading preventable cause of disease, disability, and death in the United States. (1)
The tar in cigarettes increases a smoker’s risk of lung cancer, emphysema, and bronchial disorders. The carbon monoxide in smoke increases the chance of cardiovascular diseases. (2)
What happens when I quit smoking?
According to the National Institute on Drug Abuse (NIDA), for up to 6 weeks after smokers quit, their brain cells have more nicotine-binding receptors than nonsmokers. It’s believed the brain develops extra receptors to accommodate the large doses of nicotine from tobacco and that the resulting expanded receptor pool helps to contribute to cravings and other discomforts of smoking withdrawal. (3)
While your cravings may continue for some time (most cravings to smoke last less than 3 minutes), the health benefits of smoking cessation(4) begin almost immediately:
- Within 20 minutes, your heart rate and blood pressure drop
- Within 12 hours, the carbon monoxide level in your blood stream drops to normal
- Within 72 hours, the nicotine from smoking has left your body
- Within 3 months, your circulation and lung function will improve
- After 9 months, you’ll cough less and breathe easier
- After 1 year, your risk of coronary heart disease is cut in half
- After 5 years, your risk of cancer of the mouth, throat, esophagus, and bladder are cut in half
- After 10 years, you are one-half as likely to die from lung cancer and your risk of larynx or pancreatic cancer decreases
- After 15 years, your risk of coronary heart disease is the same as a non-smoker’s risk
Additionally, you’ll save money, smell better, and stop exposure to second-hand smoke for those around you.
Remember the cravings that you experience while quitting are a sign of healing, and not a sign of disaster!
A Participant’s Greeting and Experience
I guess you are here because you have just quit smoking, or you are thinking of quitting. Maybe you are not sure whether you should quit. If you aren’t here because of smoking, use this to return to the SMART home page. Otherwise, get comfortable, look around, and hopefully, you will decide to dig a bit deeper into SMART.
My name is Bob. I actually arrived here in early 2007 looking for a way to quit drinking. I was given a pamphlet by my doctor with some websites to look into. One was SMART. My last drink was 02/22/2007. I take most of the credit for my quit, but SMART played an important role.
In May 2008, it was apparent that my 40+ year smoking career needed to end. I had been trying to quit for years, mostly thinking “I really need to quit these things” as I lit another. Sound familiar? Through a series of events, I decided on May 09, 2008 that I had smoked my last cigarette on 05/07 at about 10 PM.
Since I had already used SMART to help quit drinking, I figured it should help me maintain my smoking quit. So I went to the Quitters Clubhouse as I call it and found a lot of people who were also quitting, trying to quit, or just contemplating quitting. And like a bad odor, I just won’t go away.
So how does SMART work?
To be honest, I don’t know a lot about all of SMART. I used parts of it to help me, but I assure you there is a lot more to it. Which is the good thing about SMART, it provides tools, methods, ideas, camaraderie and you choose how much of you want or need to use.
SMART does not decide for you what you should do. You are empowered to decide for yourself. You own your quit. No one decides if you should or can have another smoke, you do. No one is going to check on you. You know what you are doing and you only have to answer to yourself. SMART offers support, you provide the determination.
Quitting. Quitting smoking might easily be the hardest thing you have ever tried to do. Smart can help in several ways:
- Plan – In my opinion, if you wake up one morning and decide “I think I’ll quit smoking today”, by the time you go to bed that night you will have smoked. You need a plan. Do you quit cold turkey or use an alternate nicotine delivery system? How will you deal with urges; yes you will have urges; the key is to recognize it and plan how to combat them. A plan, preferably written down, is a key component.
- CBA – complete a Cost Benefit Analysis (CBA) worksheet. This is a SMART tool that helps you determine what you like about smoking, and dislike about it, why you want to quit, and why you don’t. Write it down because that makes it real. It is possible that you determine, based on you CBA, that you shouldn’t quit, although, you will probably have written a lot more reasons to quit than not. Once completed, refer to it often to reinforce that you are quitting for good reasons.
- SMART empowers you – No one can make you smoke, make you quit, or even decide if you should. You are the only person who gets to decide what you do. And if you decide to try, you are the only person who can maintain your quit. Conversely, you cannot resume smoking because of something someone else did, didn’t do, said, should have said, etc. It is totally your choice to continue to quit, or not
- Support – There is a quit smoking thread on our message board where you can join others who have quit, or are working on quitting. It is a great place to get support and post milestones. On the Quit Smoking area, there are several threads created to explore quitting; Tips & Tricks; E-cigs, Nicotine Replacement Aids, and many testimonials of people and their progress. Log in and browse around.
- Failure – What if you fail? Statistically, failing is possible, probable. In a nutshell, you failed because you decided to smoke again, no one but you lit the smoke. To me, quitting is easy; you do it every time you put out a smoke; not starting again is the difficult part. But, you cannot quit smoking until you try. Getting your mind wrapped around quitting is the best way to be successful, and that starts with a solid plan, a CBA and knowledge of other SMART tools.
I wish you success with your quit. As I said, it may be the hardest thing you ever do, but the result is very much worth it.
If I can quit smoking, you can also.
Check out Tips to Quit Smoking by Bob S. for helpful information on what others have done to successfully quit their smoking addiction using SMART Recovery.
How to quit smoking with SMART Recovery
SMART Recovery provides its members with tools and support that they can use to help them recover from addictions to drugs or other addictive and negative behaviors.
SMART Recovery’s 4-Point Program® is designed to help you deal with the discomfort of quitting tobacco use:
1. Enhancing & Maintaining Motivation to Quit – Helps you identify and keep up with your reasons to quit smoking. Why do you want to stop smoking? What will keep you focused on that goal?
2. Coping with Urges – Dealing with urges and cravings is part of recovery. SMART has tools designed to you cope with the urges to smoke that can help you stay stopped.
3. Managing Problems – We frequently turn to using unhealthy behaviors to either escape from or avoid addressing problems. SMART Recovery helps you learn problem-solving tools to help manage these challenges along the way.
4. Lifestyle Balance – SMART helps you build skills to balance both short and long-term goals, and pleasures and needs, that were once out of balance.
Where do I go from here?
Getting started with SMART Recovery is easy! If you would like to get started right away, you can join our online support group where you can read, share and learn from our worldwide community of members at any time of the day or night.
You can also find a local SMART Recovery meeting, or, if we don’t have any meetings in your area yet, you can join us at one of our online meetings.
If you’d like to have printed study material, we suggest the SMART Recovery Handbook.
(1)(2)(3) – Source: National Institute on Drug Abuse (NIDA)
(4) – Source: SmokeFree.Gov
How can we help you live without tobacco?
Star Health provides a free service for anyone wanting to address smoking.
There are a number of ways that we can help you reduce or quit smoking so you can lead a healthier life.
During individual counselling you can talk with a specially trained smoking cessation facilitator in a safe place to discuss smoking and how it impacts your life and what it means to you. We can help you find new ways to reduce harm or give up tobacco altogether. We will consider what might work best for you by:
- Exploring your individual needs and providing you with support
- Helping you learn and guide you in finding healthy distractions
- Developing skills to change smoking related behaviour
- Helping you to develop healthier alternatives to managing stress
- Providing information, education and support around medications that assist with smoking cessation such as Nicotine Replacement Therapy, Champix or Zyban.
Together with a counsellor you can learn how to:
- Set realistic goals
- Get the support you need
- Make changes for a healthier lifestyle
- Learn about addiction and unwanted smoking patterns
- Find ways to deal with negative thoughts and feelings that can come with change
- Reward yourself in your successes and develop a positive approach to becoming smoke free.
Group work can provide another type of support. Enquire through intake and referral service to find out what smoking cessation group work is available.
Living Beyond Cigarettes is a course run once or twice a year for people who smoke and live with a mental illness. This can provide a safe space to discuss smoking with other having similar experiences. Together you can look at new ways of reducing harm or giving up smoking.
Group work in the course includes:
- Up to date information and education
- Group discussion and peer support
- Fun activities
- Mindfulness meditation
- Learning about medications that assist smoking cessation
As well as providing the Freedom From Tobacco services above, we can also link you with any other service(s) that you may need. Star Health provides a wide range of health services.
As Star Health is a leading provider of a full range of health and wellbeing services, we ensure a coordinated and multidisciplinary approach to best meet your needs.
All our staff are highly experienced and qualified health professionals.
How do I access help with smoking?
Anyone who is looking for ways to cut down or give up tobacco can access this service. The counselling service is free and available from Monday to Friday, 9am – 5pm.
These services are offered at the following site locations:
- St Kilda
- South Melbourne
Our staff can also visit people who are physically unable to come to our centres.
Additionally, Aboriginal and Torres Strait Islanders may also like to view Smoke Free and Deadly – a collection of stories about tackling smoking shared by Elders and other local Indigenous community members to assist others in address smoking in their lives.
How much will it cost?
This service is free of charge.
Request an Appointment
To request an appointment call 9525 1300 or visit our Service Selector.
Congratulations on making the decision to quit smoking, vaping or using tobacco! You’ve made your health a priority, and you should be proud of yourself. But deciding to quit is just the first step – the rest of the path to successfully quitting may not be as easy for you. That’s when medicines and other resources may be useful to help you stamp out tobacco for good.
Resources to help you quit
You don’t have to do this alone – many people find support groups and hotlines helpful when quitting tobacco. Sometimes just knowing that someone understands and shares your struggle can help you stay smoke-free for good.
- The North American Quitline Consortium is a network of toll-free hotlines and websites. Find your state quitline and resources at map.naquitline.org.
- English: 1-800-QUIT-NOW (1-800-784-8669) or www.smokefree.gov
- Spanish: 1-855-DEJELO-YA (1-855-335-3569) or espanol.smokefree.gov
- Chinese: 1-800-838-8917 or www.asiansmokersquitline.org
- Korean: 1-800-556-5564 or www.asiansmokersquitline.org
- Vietnamese: 1-800-778-8440 or www.asiansmokersquitline.org
- Veterans: 1-855-QUIT VET (1-855-784-8838) or www.publichealth.va.gov/smoking
- TTY: 1-800-332-8615
- English: 1-866-366-3667 or www.gosmokefree.gc.ca/quit
- French: 1-866 JARRETE (1-866-527-7383) or www.vivezsansfumee.gc.ca/abandon
These organizations offer good information online and may have local resources in your area:
- American Heart Association: 1-800-AHA-USA1 or www.heart.org
- American Cancer Society: 1-800-ACS-2345 (1-800-227-2345) or www.cancer.org/healthy/stay-away-from-tobacco
- American Lung Association: 1-800-LUNGUSA (1-800-586-4872) or www.lung.org/stop-smoking
- National Cancer Institute: 1-877-44U-QUIT (1-877-448-7848) or www.smokefree.gov
- Truth Initiative’s Become An Ex: www.becomeanex.org
Many hospitals, healthcare companies and employers offer outpatient and inpatient smoking cessation programs. Insurance may even help with the cost.
What to look for in a cessation program Cessation programs vary. For instance, some may rely on behavior modification, while others include nicotine replacement products or non-nicotine prescription medications. (Always talk to your doctor before starting any medication.) Successful cessation programs share some things in common.
Look for programs that are:
Comprehensive: The best programs consider many factors, including your triggers, lifestyle and past efforts to quit. Your family and friends can play a vital role in helping you quit.
Evidence-based: Successful programs rely on proven science. Seek out approaches that include clinically proven methods, such as counseling, behavioral therapies and consultations with a doctor.
A good fit for you: For some people, messages of support by phone, email or text are crucial, while others respond better to in-person support groups. Set yourself up for success by choosing a program with the right features for you.
Medicines to help you quit
When used correctly, there are several different medicines that can really help you on your path to quitting. Some treatments are aimed at reducing the side effects of quitting, like headaches or irritability, while others help by making nicotine cravings less severe. You might need a nicotine replacement medicine, a non-nicotine replacement medicine or a combination of both. You should talk to your doctor or health care provider about the best treatment plan for you.
Nicotine replacement medicines
Typically, nicotine replacement treatment lasts between two and three months. Even though you can buy several of these products over the counter, you should still talk to your doctor first about which specific type is best for you. Remember, you should NOT use nicotine replacement medicines if you keep smoking, vaping or using other tobacco products. Using both at the same time can be dangerous.
1. Nicotine chewing gum or lozenges
- For decades, nicotine gum has been helping people successfully quit smoking. You can buy the gum or lozenges in a drug store without a prescription. Just be sure to read the directions on the packaging and follow the recommended dosages.
- Chew a piece of gum or suck a lozenge every one-to-two hours while you’re awake, but don’t use more than 20 pieces per day of 4 mg gum or lozenges or 30 pieces per day of 2 mg gum or lozenges. The number of pieces you use each day should decrease over time.
- Don’t drink coffee, orange juice, soda or alcohol for 15 minutes before or while chewing a piece of gum or sucking a lozenge. These drinks make the nicotine replacement less powerful.
- If you don’t use nicotine gum or lozenges correctly, you may have side effects such as discomfort in your mouth and throat.
- You may need to use nicotine gum or lozenges for about three months.
2. Nicotine patch
- You don’t need a doctor’s prescription to buy a nicotine patch.
- Some brands are available in 5, 10 and 15 mg strengths; others come in 7, 14 and 21 mg strengths. What strength you should start with depends on how much you currently smoke. Look for recommended doses on packaging to help you determine where to start.
- Over time, you’ll taper off your dosage and start using lower-strength patches based on your specific brand’s recommended schedule.
- Wear the patch on your chest or high on your arm.
- Put on a new patch every 16 or 24 hours. If you have trouble sleeping or have disturbing dreams, remove the patch before you go to bed and put on a new one first thing when you wake up.
- No need to change your daily routine – with the patch, you can shower, swim and enjoy all your favorite physical activities.
- Side effects may include redness and soreness under the patch. To help reduce side effects, you should change the location of the patch each day.
3. Nicotine spray
- Unlike the first two nicotine replacement options, you will need a prescription from your doctor to buy nicotine spray.
- The spray goes in your nose one or two times per hour when you’re awake.
- The spray may cause coughing, runny nose or watery eyes during the first week or two. These side effects may go away over time.
- You may need to use nicotine spray for up to six months, but you’ll start to taper off at or before three months.
Non-nicotine prescription medicines
Bupropion hydrochloride is a medicine for depression, but it also helps people quit smoking. Brand names include Zyban®, Wellbutrin®, Wellbutrin SR® and Wellbutrin XL®. This medication is also available as a generic. Varenicline is a medicine that can help reduce the cravings for nicotine and its pleasurable effects on the brain. Brand names include Chantix® and Champix®.
These are two commonly prescribed smoking-cessation medicines. For your information and reference, we have included generic names as well as brand names to help you identify what you may be taking. However, the AHA does not recommend or endorse any specific products. If your prescription medication isn’t on this list, remember that your healthcare provider and pharmacist are your best sources of information. It’s important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting your doctor.
- Both medicines block the flow of chemicals in the brain that make you want to smoke.
- Both medicines come in pill form. You start with a low dose and gradually increase up to the full dose.
- It takes about a week for these medicines to work, so you need to start them before you actually quit smoking or vaping.
- Each of these medicines may interact differently with other medicines you’re taking. Make sure your doctor and pharmacist have a complete list of all your medications, including over-the-counter drugs, supplements and herbal medicines.
- You may need to use a non-nicotine prescription medicine for seven to 12 weeks or longer. Follow your doctor’s recommendations.
- When you get ready to stop taking a non-nicotine prescription medicine, you may need to taper off, gradually decreasing the dose before you stop completely.
- The FDA notified the public that varenicline and bupropion have been associated with reports of behavior changes including hostility, agitation, depressed mood and suicidal thoughts or actions. The FDA is requiring the manufacturers of these products to add a warning to the product labeling to alert healthcare professionals to this important new safety information.
- While taking these drugs, if you experience any serious and unusual changes in mood or behavior or feel like hurting yourself or someone else, you should stop taking the medicine and call your healthcare professional right away.
- Friends or family members who notice these changes in behavior in someone who is taking varenicline or bupropion for smoking cessation should tell the person their concerns and recommend that he or she stop taking the drug and call a healthcare professional right away.
However you choose to quit, know that you’re taking an important step toward better health and a longer life. Stick with it and keep trying if you relapse along your journey. It’s worth it.
Tobacco Cessation – Support Group & Resources
(select link to download printable meeting flyer)
Tuesday’s | 4:00 pm – 5:00 pm
Community Cancer Center
Conference Room A & B
Meetings resume Feb 4, 2020
These sessions are tobacco cessation support group meetings made up of men and women helping each other to understand the health dangers of tobacco use, nicotine addiction, identifying behavior and situational triggers, and how to make positive steps toward living their lives free of tobacco and nicotine use.
Research has shown that the best way to quit tobacco use and stay smoke free is to combine a cessation aid (like the patch or nicotine gum) with a strong support system. The members of our support group can coach you through the ups and downs of nicotine withdrawal and quitting.
Being in a support group can also help you develop new skills to conquer your nicotine addiction. In addition, the members of the group who have experienced the same problems can support each other and may suggest new ways of dealing with a particular problem. Most importantly, the largest advantage of joining a support groups is realizing that you are not alone.
No Dues or Fees to join
Ongoing Program with Weekly Meetings
For more information, registration, or questions about programs contact:
CCC Outreach Ed | Program Management
Angelia Freeman | Phone: 541-672-0072
or Email: [email protected]
ADDITIONAL TOBACCO CESSATION RESOURCES
Become an EX
The EX Plan combines expertise from the Mayo Clinic with practical advice from ex-smokers. You won’t just quit smoking. You’ll “re-learn life without cigarettes.”
It doesn’t matter if it’s your first try or your tenth, EX can help you quit and stay quit. Research shows that the more times people come to the EX site, the more likely they are to quit smoking. The three steps in the EX Quit Plan can help you:
Freedom from Smoking Plus
Freedom From Smoking Plus has a great new look, updated content and activities and includes both online and phone support. The program also works well on smartphones and tablets so you can get help quitting smoking whenever, however and wherever works best for you.
Guide to Quitting Smoking
This is an online guide from American Cancer Society on How to Quit Smoking or Smokeless Tobacco. To have the best chance of quitting tobacco and staying quit, you need to know what you’re up against, what your options are, and where to go for help. You’ll find this information here.
Thinking about quitting? Talk with us. We can help.
Are you ready to quit? you are not alone. The My Path program includes resources to help you or your loved ones who are thinking about quitting tobacco and nicotine products for good. Adapt, in cooperation with Umpqua Health Alliance, provides individual and group tobacco cessation counseling for Umpqua Health alliance Medicaid and Medicare health plan members.
This is a 12-step fellowship of men and women helping each other live nicotine-free lives. Nicotine Anonymous welcomes all those seeking freedom from nicotine addiction, including those using cessation programs and nicotine withdrawal aids. The primary purpose of Nicotine Anonymous is to help all those who would like to cease using tobacco and nicotine products in any form. The Fellowship offers group support and recovery using the 12 Steps as adapted from Alcoholics Anonymous to achieve abstinence from nicotine.
Oregon Tobacco Quitline
This is a free program offering tips, information, and one-on-one telephone counseling to anyone looking to quit tobacco use. You will also get assistance in determining if you are eligible for free nicotine gum or patches. Open 7 days a week, 24 hours a day. Call 1-800-QUIT-NOW (1-800-784-8669).
Quit for Life
You can quit. We’ll show you how.
We understand that quitting is about more than just not smoking. When you join our program, a Quit Coach® will help you become an expert in living without tobacco using “The 4 Essential Practices to Quit For Life,” principles based on 25 years of research and experience helping people quit tobacco.
On this site you’ll find support, tips, tools, and expert advice to help you or someone you love quit smoking.
Want to quit but don’t know how?
Get your daily dose of the support you crave. This site is designed and run by people at the National Cancer Institute to help teens take control of their health.
SmokefreeVET is a mobile text messaging service for military Veterans who receive their health care through VA. Visit Tricare to learn more about available tobacco cessation services.
Determination and support as successful factors for smoking cessation
Isabel Cristina EcherI; Sérgio Saldanha Menna BarretoII
IRN, Ph.D. in Medical Clinic, Adjunct Professor, Rio Grande do Sul Federal University School of Nursing, Brazil, e-mail: [email protected]
IIPost-doctoral degree in Health Sciences, Full Professor, Rio Grande do Sul Federal University School of Medicine, Brazil; Head, Pneumology Service, Hospital de Clínicas de Porto Alegre, Brazil, e-mail: [email protected]
This study aimed to analyze determination and support as successful factors for smoking cessation. Qualitative study in which 16 individuals from Porto Alegre, Brazil, who had ceased smoking for more than six months, with score > 5 according to Fagerström scale, were interviewed. Information was examined through Content Analysis according to the following steps: pre-analysis, material investigation and result treatment. Smoking cessation was a consequence of a group of factors, with determination (the will to cease smoking and the difficulty to cease smoking) and the received support (occupational; family; social, and spiritual, and through a specific course and support groups) as the focus of this article. The results suggest that the smoker’s determination to cease smoking together with the support of society segments and the benefits from that are helpful factors in the smoking cessation process.
Descriptors: smoking; smoking cessation; qualitative research
Smoking is a global public health problem, affecting the life of smokers and individuals exposed to smoking and environmental pollution. Around 4 million people die annually in the world of smoking-related diseases. If adequate measures are not taken, in around 2020 smoking will correspond to 10 million deaths/year. From these deaths, 7 million will occur in developing countries(1).
The possibilities to contribute to the smoking cessation process include: cognitive-behavioral approach, pharmacotherapy, clinical monitoring, therapeutic groups and family support. Since the 1980s, the importance of advertising in the media the smoking harms, the advantages of being an ex-smoker and the environmental damages involved in the process has been emphasized, which may also help the cessation and discourage smoking start(2). Although around 80% of the smokers wish to quit smoking, only about 3% actually stop without help annually, which demonstrates the role of health professionals and the society in the promotion of incentives that encourage smoking cessation(3).
The elaboration of this project was encouraged by the belief that knowing and understanding the factors associated with smoking cessation may help increment smokers’ adhesion to the decision of stopping smoking and reduce the number of young people that start smoking.
Although frequent campaigns are made to encourage smoking cessation, little is known about the real reasons that make a person quit. Based on that, a study was developed(4) to investigate the successful factors for smoking cessation, which identified that smoking cessation was a consequence of a group of factors (determination, received support, social restrictions to smoking, information on smoking harms, clarification campaigns, utilization of strategies and benefits related to smoking cessation). This articles analyzes the contribution of smoking cessation determination and received support in the smoking cessation process.
An exploratory-descriptive qualitative study in which 16 individuals from Porto Alegre, RS, were interviewed, recruited from the community through placards, advertising among friends and invitation from participants. The definition of this number occurred through data saturation(5). In order to be included in the study, the individual should have ceased smoking for more than six months and show dependence score > 5 according to Fagerström scale(6), which consists in a questionnaire of six questions, whose scores range from 0 to 10. The dependence degree is classified according to the total score: very low (0 to 2); low (3 and 4); medium (5); high (6 and 7) and very high (8 to 10).
The project was approved by the Research Ethics Committed of the Hospital de Clínicas de Porto Alegre. Everyone agreed to participate in the study by signing the Informed Consent Term. The ethical principles were respected, according to Resolution 196/96 of the National Health Council.
The semi-structured interviews, conducted by the main author at the participants’ homes or work places, presented the main question: “What factors contribute to a successful smoking cessation?”
The results were analyzed by the Content Assessment(7), involving data exploration, systematization and operationalization, classification of statements into units of meaning, ending up with interpretation of categories and possible explanations regarding the investigated phenomenon.
Data confirmation was performed through pair crosscheck mechanism and the participation of an external reviewer(5) that performed interview reading and analysis and elaborated an interpretation summary, obtaining the same results found by the researcher.
In order to keep data secrecy, the declarations were identified by numerical codes that distinguish the interviews and Fagerström scale score (for instance: E1F5 – interviewee 1; scale score 5).
RESULTS AND DISCUSSION
The interviewees were between 24 and 62 years old and presented different occupations (housewife, caretaker, printing technician, actress, student and medium school level and university professor, administrator, laboratory advertiser, massager, administrative assistant and mechanic assistant) and schooling levels, from complete fundamental to post-graduation level. They started smoking when they were between 11 and 22 years old. The smoking habit duration ranged from 9 to 42 years and the amount of cigarettes a day was between 15 and 40, with Fagerström scale score from 5 to 10, mean score: 7.4.
The interviewees ceased smoking through different forms: professional intervention and bupropion (E2F7, E3F10, E6F10, E7F10, E9F9), professional intervention and nicotine gum (E10F10), participation in support groups conducted by a health professional (E2F7, E3F10, E10F10, E11F5, E14F5) and the others did not go through any specific treatment. Regarding previous attempts to cease smoking, they had tried once (E3F10, E4F7, E10F10, E11F5), twice (E2F7, E7F10, E9F9, E15F8, E16F8), three times (E5F6, E12F5, E13F6, E14F5) and the others had not tried at all. The results show that the higher the dependence, the higher the search for professional help and drug utilization. The abstinence period, on the interview occasion, ranged from 8 months to 4 years.
Determination to cease smoking
In this study, determination refers to the will that made smokers keep their smoking cessation decision, despite the adversities that included the remaining smoking will and the cigarette importance in the smoker’s life. The interviewees’ declarations revealed the difficulty they faced in the smoking cessation process and the determination required to remain distant from cigarettes. This category was divided into two subcategories: will to cease smoking and difficulty to cease smoking.
– Will to cease smoking
The interviewees considered as essential the smoker’s decision to cease smoking, without which the commitment to the change does not occur, even with family and professional help and drug utilization.
I decided I would quit, I quit and that was all… The most important thing is your will-power. E1F5
If there’s no strong will-power, you will never get to do it, even with a treatment … E5F6
You must be determined, with strong will-power, because the drug helps, but it doesn’t work alone. E6F10
I guess my determination was persevering, and second, the physicians’ warnings… If I hadn’t had strong will-power, I wouldn’t have done it. E10F10
To some interviewees, the change was preceded by specific situations and/or events that made them see themselves and the smoking habit differently, where the cigarette appears as a problem to be solved. When asked about the change reason, most of them answered that they simply made the decision. The declarations show that without the individual decision, the smoking cessation process does not occur, and that this behavior change is associated with reflection, will and personal determination. The professional and family and social groups may encourage, support and help in this process, but the decision to change must be assumed by the individual.
According to the interviewees, their determination to cease smoking would have been encouraged by several factors (Table 1).
These reasons reveal mainly the need of individual will to change/determination and influences of other people on the smoking cessation decision, such as professionals, family, friends and social communication means, suggesting the importance of the community’s role in individual motivation. It emphasizes the assumption that the motivation to change does not lie only inside the individual, but it involves an interpersonal context.
The results of this study agree with those of other studies that also consider as essential emphasizing the smokers’ motivation and working with their family and friends to encourage them in their decision(8). Motivation is a paramount factor and the health professionals’ action should support smokers for smoking cessation and alert them to smoking risks and cessation benefits(9).
Other studies state that personal motivation is one of the most important factors in smoking cessation and is interconnected with a number of hereditary, psychological, physiological and environmental variables. Making the individual start thinking of quitting smoking is a great step for him/her to effectively cease smoking(8). The results of this study show individual motivation as one of the main factors towards cessation. For this reason, it is necessary to develop actions to encourage and support smoking cessation, which is the best and cheapest form of prevention, treatment and healing of several diseases associated with smoking, aiming at improved quality of life.
– Difficulty to cease smoking
The interviewees reported that they have not restarted smoking due to the intense suffering during the smoking cessation process, which involved aggressive relationship with people, not feeling well with themselves, feeling of failure and the indication of restarting when simply placing a cigarette in between their lips.
I won’t smoke again, I’ll never smoke again. Not because smoking is bad, but to avoid the suffering I went through when I stopped. E2F7
I can’t place a cigarette in between my lips, if I do that, I will want to smoke. Do you know why I do that? Because it’s very difficult to stop smoking … E3F10
Those three first weeks were terrible. I was fighting with the dog, the walls, with everything, it was horrible … You’ve got to be persistent. E10F10
For the interviewees, keeping the control over their behavior between having pleasure to smoke and recognizing smoking harms was described as a difficult phase to go through, and for this reason, determination, responsibility for the change and support are required.
These findings validate the study, in which many patients report great individual and family suffering and little tolerance to the abstinence syndrome, which makes smoking cessation resolution more difficult(8). The interviewees said that professional intervention and drug utilization are important in this phase, in order to minimize the suffering caused by the syndrome of abstinence, this way making smoking cessation more successful.
Some of the interviewees had already experienced in previous attempts to cease smoking the restarting situation, a fact that encouraged them to search for professional help to cease. Literature indicates that restarting should not be considered as a failure, but as a moment of reflection on the factors that made them restart, and better prepare them for the next attempt, since most smokers try to stop three to four times on average until they definitively cease(10-11).
The cognitive-behavioral approach may help support smokers, as it combines cognitive interventions and training of behavioral skills, aiming at cessation and restart preventions(9-10). The adequate approach, according to the interviewees, favored their behavior change.
Regarding the suffering the interviewees went through, it was possible to notice the great satisfaction and pride demonstrated for having ceased smoking, an action that has brought benefits to their lives.
The interviewees reported the need for professional, family, social and spiritual support, conditions that constituted factors that helped overcome the nicotine dependence. This situation agrees with the literature references, which state the smoker needs to create an identification link with a certain person, who could be a brother or sister, relative, neighbor, nurse, physician, etc., to help him/her in this process(12).
This category was subdivided into three subcategories: intervention of qualified professionals and drug utilization, specific course and support groups, family, social and spiritual support.
– Intervention of qualified professionals and drug utilization
The professional intervention was described as an important factor during smoking cessation, and in some situations, the utilization of drugs to help in this process.
The interventions of health professionals often seek to fulfill the individual’s supposable lack of knowledge regarding what caused a certain disease. Innumerous studies have demonstrated the association of smoking with certain diseases. However, although this risk factor may be eliminated, health services have not made people cease smoking(12), which reflects the people’s difficulty to stop smoking.
The fact that smoking cessation interventions have not been integrated into and made available in health routines, as well as the unbelief demonstrated by some professionals regarding nicotine dependence treatments, constitute some obstacles for smoking cessation(8,10).
However, the interventions in this study revealed their potential, according to the declarations that evidence the importance of professional intervention and the benefits of drug utilization.
I wouldn’t do it alone and then I decided to search for help. I had the intervention of a professional. Drugs help a lot, they eliminate the desperation feeling … But we have to stipulate a deadline, the cigarette must disturb us … E2F7
I wouldn’t have done it with just my efforts. I searched for a friend who works with smoking cessation to support me. She prescribed me the medicine. It was essential, 5 days later I didn’t feel like smoking again and then I stopped buying cigarettes. E7F10
The physician said: when you decide to do that, you will never stop trying, die trying, but don’t quit, go for what you want… E9F9
Their statements reveal that the support of a prepared professional seems to be of great importance to overcome stages such as physician visit returning, correct drug utilization and asking for additional help if desired. Besides, they reflect the professionals’ statements in their approaches to stipulate a deadline and keep themselves determined, which seems to have influenced in such way to mobilize and help the smokers.
It is believed that the approach strategies should value the specific aspects of age, focusing the lifestyle and the quality of life and reinforce attitudes and skills to face the situations that lead to smoking.
The challenge is to find out and understand how to help strengthen the motivation to change, and this is an important part of the individual assessment(13). Based on the declarations, it is possible to infer that it should not be assumed that smokers will consider harms or benefits the same way as non-smokers, as the values are different and consequently the approaches must be distinct.
A treatment against dependence has the cognitive-behavioral approach as a central aspect, which combines cognitive interventions and training of behavioral skills aiming at cessation and restart prevention, plus the drug utilization to reduce the desperation feeling and the abstinence symptoms, in such way to make the smoker handle the smoking cessation in a better way(9,14). A study shows that the nicotine replacement therapy increases the abstinence proportion in around 50%(15).
It is recommended to use some special moments to encourage smoking cessation, such as pregnancy and hospitalization period, as well as adopt distinct approaches, according to the age group(16). It is also important to prepare the smoker’s social environment, so that family, friends and co-workers are able to help(9).
Based on the interviews, it is possible to realize the participation of health professionals from different areas (physicians, nurses, dentists) and the population in general is required in the implementation of programs to support smoking cessation. It involves considering this habit as a chronic disease, which may also involve remission and recurrence phases, identifying factors that lead to restart to better prepare them for the next cessation attempt.
– Specific course and support groups
Participating in courses and/or support groups was identified as an efficient strategy to achieve smoking cessation.
I guess the group helps a lot, because the exchanges of experiences are very important. One old woman went out in the rain to buy cigarettes…, she was very ashamed, only smokers understand that … E9F9
I didn’t know all details involved in quitting smoking, I knew them in the group. If you thought of stopping smoking, look for a group that knows how to help. E10F10
First, it’s important to make a personal decision and then look for support, either in groups, individual therapy, or with friends, because it’s more difficult alone. Sharing experiences is important and I recommend it, as I guess it matches what we are looking for, in terms of information, benefits, you have support on the best way to do it … E14F5
An important aspect to a nicotine-dependent person is the difficulty to explain to others how he/she feels. According to the declarations, only smokers understand the difficulty to cease smoking. To them, the participation in support groups is special because their members experience the same problem, have the same difficulties and needs. According to the declarations, the participation in courses and support groups seems to have been effective in terms of providing orientations to the smoker, showing ways to follow and promoting their will to cease smoking.
– Family, social and spiritual support
Stopping smoking does not seem to have been an easy experience; to overcome it, family, social and spiritual support was considered as important by the interviewees. Family is the center of support and encouragement, where the smoker feels secure and can express his/her fears and receive affection that will help him/her face the difficulties. As noticed in the declarations, this support was present and was reported as an important mobilizing factor.
My grandson was 6 years old. He saw campaigns on TV and used to say: ‘Grandma, have you noticed TV is saying cigarette kills?’ That hurt me inside… He said he didn’t want me to die. I kept that inside me and it helped. E6F10
I guess the difference is in the comfort given, in making people who live with the smoker help him/her stop smoking … E7F10
I was smoking on the street, under a tree, enjoying my cigarette, then my son came to me and said: ‘Mom, are you still smoking? … Don’t you understand that with that you will shorten your time with us? … I really want you to stay much longer with me’ … This was an argument that nobody had used, of love, affection. E13F6
The support of family, friends, children and other smokers was determinant to smoking cessation. This way, it is important that close people show interest in helping, provide support and get involved in the situation, helping them overcome the difficulties. According to the interviewees, smokers played an important role in this process, as they did not smoke near them during the cessation process.
For some interviewees, beliefs also seem to have been an important influence on smoking cessation.
I am spiritualized… There’s a moment we can’t do it, I guess we even have to pray and ask. Praying helps a lot. E3F10
I used to meditate a lot. I believe the will to smoke lasts some seconds… I’ve learned how to educate myself in this sense. E4F7
The declarations show the need for support to get to cease smoking and respect the person’s individual pace to cease smoking.
The results of this study suggest that the smoker’s determination to cease smoking and the support from several segments of the society influenced smoking cessation.
The determination to cease smoking was required to enable the behavior change and made smokers keep their decision, despite the adversities, allowing to understand the smoker needs to be aware of the responsibility for his/her health.
The decision to stop smoking would have been motivated, according to the interviewees, by influences of other people, such as relatives, friends and social communication means, and, for this reason, the importance of the participation from all community in the process. The need for special emphasis on motivation should also be noted, without which the participants would not have been able to cease smoking and keep themselves abstinent.
In addition, the professional, family, social and spiritual supports played a relevant role in promoting smoking cessation. Findings allow to infer the importance of health professionals and the society to understand how difficult stopping smoking is and create affective and technical conditions that strengthen the motivation to behavior change, without which smokers will not be able to keep themselves abstinent. For this purpose, it is essential for the multidisciplinary team to include the family in this process, listening to their needs, in order to enable the family to contribute to the treatment. Findings also alert to the need for health team training, availability of effective smoking cessation programs and access to drugs.
Since motivation is an essential factor, one of the actions of health professionals is to always provide orientations to prevent, for example, smokers or his/her family to leave a physician office or hospitalization without the information that smoking causes health harms, even if the individual does wish to cease. This action helps mobilize the smoker and favor his/her behavior change.
Based on the declarations, it is believed that one of the health education alternatives to be performed by the professionals in order to reduce smoking prevalence is to value the participation of smokers in abstinence, therapeutic groups, as models of identification and successful strategy references, as a significant contribution to the implementation of education and health policies for smoking prevention.
We would like to thank professors Anna Luz and José Roberto Goldim and nursing student Giordana Motta. We also thank FAPERGS and CNPq/UFRGS for the scientific funding support and FIPE of the HCPA for the financial support.
2. Repace J, Lowrey A. Indoor air pollution, tobacco smoke and public health. Science 1980;208(2):464-72.
3. Cinciprini PM, Hecht SS, Henningfield JE, Manley MW, Kramer BS. Tobacco addiction: implications for treatment and cancer prevention. J Natl Cancer Inst 1997;86:1852-67.
4. Echer IC. Fatores de sucesso no abandono do tabagismo . Porto Alegre (RS): Faculdade de Medicina/Universidade Federal do Rio Grande do Sul; 2006.
5. Polit D, Beck CT, Hungler BP. Fundamentos em pesquisa em enfermagem. 5. ed. Porto Alegre (RS): ARTMED; 2004.
6. Fagerström KO, Schneider NG, Lunell E. Effectiveness of nicotine patch and nicotine gum as individual versus combined treatment for tobacco withdrawal simptoms. Psychopharmacology 1993;111:271-7.
7. Bardin L. Análise de conteúdo. Lisboa: Edições 70; 1977.
10. Brasil, Ministério da Saúde, Instituto Nacional de Câncer, Coordenação de prevenção e Vigilância. Abordagem e tratamento do fumante: Consenso 2001. Rio de Janeiro (RJ): INCA; 2001.
11. Kirchenchtejn C, Chatkin JM. Dependência da nicotina. J Bras Pneumol 2004 agosto;30(2):11-8.
12. Stuchi RAG, Carvalho EC. Crenças dos portadores de doença coronariana, segundo o referencial de Rokeach, sobre o comportamento de fumar. Rev Latino-am Enfermagem 2003 fevereiro;11(1):74-9.
13. Miller WR, Rollnick S. Entrevista Motivacional: preparando as pessoas para a mudança de comportamentos adictivos. Porto Alegre (RS): ARTMED; 2001.
14. Viegas CCA, Reichert J. Tratamento medicamentoso. J Bras Pneumol 2004 agosto; 30(2):36-40.
15. Otero B, Perez CA, Szklo M, Esteves GA, Pinho MM, Szklo AS, et al. Ensaio clínico randomizado: efetividade da abordagem cognitivo-comportamental e uso de adesivos transdérmicos de reposição de nicotina, na cessação de fumar, em adultos residentes no Município do Rio de Janeiro, Brasil. Cad Saúde Pública 2006;22(2):439-49.
Recebido em: 22.5.2007
Aprovado em: 25.2.2008
Smoking cessation with smartphone applications (SWAPP): study protocol for a randomized controlled trial
This single-blind, two-arm, parallel-group, randomized controlled trial comprises an intensive longitudinal design with three end-of-day diary periods: A baseline diary (3 consecutive days), a challenge diary from 7 days before the self-set quit date, on the self-set quit date until 20 days after the self-set quit date (28 consecutive days) and a follow-up diary 6 months after the self-set quit date (3 consecutive days). See Fig. 1 for the longitudinal design.
The longitudinal study design
Participants of this randomized controlled trial are adult smokers, who smoke at least one cigarette daily , intend to quit smoking during the study, and own a smartphone with access to mobile internet. Moreover, participants should speak German fluently, should not work in 24-h shifts, should not participate in a professional smoking cessation program, and should not already use a smoking cessation smartphone app. Recruitment takes place in Switzerland and is organized via advertisements in newspapers, online platforms and on webpages, flyers and postings in the university, medical facilities and local companies. Interested individuals can complete a prescreening assessment online, for which they provide informed consent and that checks inclusion and exclusion criteria. In case smokers meet all inclusion criteria, they are contacted via email and sent the link for an online end-of-day diary questionnaire for three consecutive days (baseline diary).
After completing the baseline diary participants are contacted and invited to the lab for a background assessment. At the background assessment participants first receive full information on the study, and provide written informed consent. After completing a comprehensive background questionnaire, participants are asked to set a self-set quit date within the next 6 weeks. They are instructed to fill in the online challenge diary from 7 days before the self-set quit date, on the self-set quit date and 20 days after the self-set quit date. During those 28 days all participants receive a daily text message with the link for the questionnaire at seven o’clock in the evening. Subsequently, participants receive an instruction for the personal mobile objective smoking abstinence measure, the iCO Smokerlyzer (Bedfont Scientific Ltd.), and the corresponding smartphone app to measure the exhaled carbon monoxide (CO) daily. A first measurement of CO with the iCO Smokerlyzer is already taken in the lab. Lastly, participants of the intervention group are introduced to the smartphone app (for details on randomization procedure and the intervention see below). Six months after the self-set quit date, participants of both groups are contacted via email and asked to participate in the follow-up diary phase for completing online end-of-day diaries for three consecutive days and daily objective assessments of smoking with the iCO Smokerlyzer.
As a main incentive for study participation, all participants will receive the iCO Smokerlyzer a carbon monoxide monitor for the smartphone, with a value of 60 CHF (= 63 USD). Additionally, with completion of the six-month follow-up, participants from both groups are given entry into a lottery. The lottery has one main prize of 200 CHF (= 209 USD), and 40 prizes with a value of a 50 CHF (= 52 USD) shopping vouchers. Participants in the role of the supporting buddy will be reimbursed with 50 CHF (= 52 USD) with completion of the study.
The randomization comprises a random assignment to one of the two groups (intervention group and control group). Blocking as means of restricted randomization is used: To meet balance and predictability criteria variable blocks (4, 6, 8) are used. Within a block of participants, 50% are assigned to the intervention group and the control group. Before the beginning of the study, a computerized random-number generator (http://www.randomization.com) is used for sequence generation of blocks. This allocation sequence is generated by an assistant not part of the study team and to ensure allocation concealment concealed in a set of sealed, numbered envelopes until group assignment. On the day of the background assessment in the lab, the interviewer conducting the session opens the appropriate numbered envelope and prepares the study material accordingly. Throughout the study, participants are blinded to the group assignment (i.e., single-blind RCT).
Detailed description of intervention procedure and control group
This study has an EMI design and comprises two groups: a SmokeFree Buddy app intervention group and a control group (see below). As described above, at the background assessment all participants are instructed to set a self-set quit date, to fill out the end-of-day diaries for 28 consecutive days and to measure the exhaled carbon monoxide daily during the challenge diary phase using the iCO Smokerlyzer. Setting a self-set quit date comprises the BCT “goal setting of behavior” . The daily CO measure comprises the BCT “feedback on behavior” and “self-monitoring of behavior” . For an overview of the most prominent BCTs included in the study please see Table 1.
Table 1 Overview of intervention components and corresponding most prominent BCTs in intervention group (IG) and control group (CG)
Intervention group: SmokeFree buddy app group
In addition to the instructions of the daily assessments with the iCO Smokerlyzer, target persons of the intervention group will be introduced to the SmokeFree Buddy app and instructed on how to use it during the challenge diary phase (7 days before the self-set quit date, on the self-set quit date until 20 days after the self-set quit date). The SmokeFree Buddy app is a smartphone app that aims at enabling smokers to quit with the help of a self-chosen buddy from one’s social network and offers the possibility of enhancing social support resources and availability directly after a self-set quit attempt in smoker’s everyday life.
Participants of the intervention group have to identify a personal buddy (self-chosen from their personal social network) with whom they will start the smokefree challenge. The smartphone app has a scientific background, and was developed by the Federal Institute of Health in Switzerland in collaboration with the Institut de Santé Globale of the University of Geneva in Switzerland. For more details about the SmokeFree Buddy app please see https://www.smokefree.ch/en/buddy-app/. For an overview of the most prominent BCTs of the SmokeFree Buddy app, please see Table 1.
The SmokeFree Buddy app has the following features: (1) Buddy support. The main feature of the app is a chat function through which the smoker and the personal buddy are connected. The chat is the app’s direct communication channel for all text-messages between the smoker and the buddy. Apart from the text-messages sent, the chat lists all events occurring within the app (e.g. notifications, mood change, bonuses; see below). The app informs the buddy for example about the smoker’s current mood or craving and provides them with the option of reacting immediately, e.g. with a supportive message. The buddy can choose one of many preset messages, which can be customized or supplemented with a personal comment. Unlike anonymous computerized notifications, support through the SmokeFree Buddy app is personal, from a buddy and can be tailored to the smoker’s need. (2) Current mood and notification buttons. The app provides a feature to indicate the current mood state and intensity of the smoker (e.g. joy, depressed, anger) that is also visible for the buddy. Additionally, there are three different notification buttons on the smoker’s side: SOS! (sending an emergency message), desire (communicating an urge/craving to smoke, from 1 to 5 ), and lapse (number of cigarettes smoked). A change in mood or a click on one of the notification buttons directly sends a message to the buddy (via chat), requesting their support as soon as possible. The app provides background information of these different situations and preset messages for the buddy, which can be personalized. (3) Bonuses. With the bonus-feature the buddy can motivate the smoker. Various bonuses are available such as encouraging, confirmation of success or advice for a particular challenge. In the bonus gallery the target persons are able to see the trophies that they have earned any time. (4) Performance statistics. These statistics show the target person’s achievement to date: The number of smoke-free days, the number of cigarettes that the smoker did not smoke (i.e. being smoke-free) and the amount of money he or she was able to save. (5) Knowledge base. A Knowledge base allows smoker and buddy to rapidly retrieve information on smoking and quitting and share it with each other via the chat. There is also a permanent information bar that shows health benefits of stopping smoking over the course of time. Moreover, the app provides contact information to a quit helpline and professional smoking cessation counseling.
After being introduced to the app, participants of the intervention group are instructed to find a buddy with whom they will communicate through the app during their self-set quit attempt. The buddy has to be a non-smoker for at least 6 months . Furthermore, they should also own a smartphone with access to mobile internet, should speak German fluently and should not work in 24 h shift work. The supporting buddy of smokers in the intervention group receives an email with a link to a background questionnaire that checks for eligibility criteria, asks for informed consent, and contains instructions on how to use the app. Moreover, buddies are instructed to also fill out an end-of-day diary from 7 days before the quit date of the smokers, the quit date itself, and 20 days after (challenge diary phase). One day prior to the first diary day, smokers and buddies receive a reminder on how to connect and to use the SmokeFree Buddy app.
The participants in the control group will also announce a self-set quit date, measure the exhaled carbon monoxide daily using the iCO Smokerlyzer and fill out the end-of-day diary for 28 consecutive days during the diary phase. Smokers in the control group will, thus, have the same setting as the intervention group only without the SmokeFree Buddy app.
Smokers in the intervention and control group
The prescreening questionnaire assesses inclusion and exclusion criteria as well as measures on socio-demographics and habitual smoking behavior adapted from Keller et al. . At the background assessment smokers complete a comprehensive questionnaire on current smoking, smoking history, self-regulation (e.g., smoking-specific self-efficacy, action planning, action control) , health status , personality and further potential control variables. Additionally, an objective baseline measure for smoking status is taken using the mobile iCO Smokerlyzer. All three end-of-day diary phases (baseline diary, challenge diary and follow-up diary) include short scales or single items on self-reported daily smoking abstinence, number of cigarettes smoked, quantity and quality of received social support from the buddy and from other network members , quantity and quality of received social control from the buddy and from other network members , self-regulation (e.g., self-efficacy, action planning, action control) , indicators of subjective well-being , relationship quality and further potential control variables. Smokers in the control group do not receive items relating to the buddy. Smokers in the intervention group additionally report on the use of the SmokeFree Buddy app. On the first day of the follow-up diary, smokers are asked to report on their smoking abstinence and lapses since their self-set quit date. During both the 28-days challenge diary and the 3-day follow up diary, all participants measure their daily smoking behavior objectively with their personal mobile iCO Smokerlyzer.
Buddies of smokers in the intervention group
Buddies complete a combined prescreening and background questionnaire, assessing inclusion and exclusion criteria, socio-demographic variables, motivation to assist the smoker, health status , personality, and further control variables. They only participate in the 28-day challenge diary phase that contains relatively parallel items to the diary of the smokers assessing the buddies’ subjective well-being , quantity and quality of provided social support , quantity and quality of provided social control , relationship quality , as well as their perspective on the smoker’s regulation during the quit attempt.
Upon completion of data collection, data will be cleaned and prepared for data analyses. Primary and secondary outcome variables and mediating mechanisms will be checked for distribution, outliers and missing patterns, and appropriate steps will be taken where necessary (cf., ). All analyses follow intention-to-treat principles, taking advantage of all available data points. Low levels of missings will be expected, with previous studies showing high completion rates (> 90%, e.g., ). Intermittent missing data will be handled by maximum likelihood (MI) estimation. Participants who completely drop out of the study will be treated as smokers. Preliminary analysis will include a randomization check to test for baseline differences between intervention and control participants. For the main data analysis, we will use multilevel modeling to account for the nested structure of daily measures within individuals . To examine the first research question on the effects of the intervention using the daily diary, a set of generalized linear mixed models will be performed in SPSS and R. Daily smoking abstinence will be modeled as a function of time group and group by time, testing group differences at the quit date (model 1) and 3 weeks later (model 2) by centering the time variable accordingly. Model 3 will separately test group differences 6 months later. For the primary outcomes of subjectively and objectively reported smoking abstinence (dichotomous), we will use mixed logistic regression analyses. For the secondary outcome of subjectively reported number of cigarettes smoked, a count variable, we will use a negative binomial model with zero inflation . To test the third research question on the mediating mechanisms of the intervention effect, we will use a multilevel approach to mediation analysis based on multilevel structural equation models .
To secure adequate power for the main analysis of the intervention effect on smoking abstinence at the quit date, 3 weeks and 6 months later, we performed a priori sample size calculations using the G*Power program . Based on a power of 0.80 and a two-tailed Type 1 error probability of .05, a total sample size of N = 128 is suitable to detect a 24% difference in smoking abstinence for the intervention group, drawing on meta-analyses of mobile-phone interventions on short and long-term smoking abstinence (RR’s between 1.7 and 2.1 ;). We assumed an abstinence rate of 27% in the control group 6 months after the self-set quit date, based on own previous studies using a highly comparable, albeit correlational, design with daily diaries around a self-set quit date in smokers and their romantic partners . Moreover, attrition rates between 20% (e.g., ) 6 months after the self-set quit date, or below 30% have been reported. Thus, assuming an attrition rate of 25%, the targeted sample size is N = 160 smokers (n = 80 per group) and an additional N = 80 buddies.
The study was approved by the Ethics Committee of the Faculty of Arts and Social Sciences of the University of Zurich, 13 December 2017 (Reference number: 17. 12. 13).
What to Expect from a Smokers Anonymous Meeting
Smokers Anonymous is a self-help smoking cessation group that uses the principles and 12-step method of Alcoholics Anonymous as the basis for its program. The group was formed in the early 1980s under the name Smokers Anonymous, but it changed its name to Nicotine Anonymous in 1990 as a way to include all those who were addicted to nicotine in whatever form. Now, those interested can find Smokers Anonymous meetings at the Nicotine Anonymous website.
Smokers Anonymous, or Nicotine Anonymous, identifies itself as “not a medical organization” and “a fellowship of men and women helping each other to live our lives free of nicotine.” Like Alcoholics Anonymous, the group encourages members to lean on the help of a higher power, but explicitly states that it is not a religious organization. It also does not require members to adhere to any particular creed. Each group is self-governing and there are no compulsory dues or fees. Members meet group expenses through voluntary donations. Addicts can keep their anonymity while receiving support and encouragement from others also striving to beat nicotine addiction. Members give only their first names at meetings.
Did You Know?
- The National Institute on Drug Abuse calls nicotine “the leading preventable cause of disease, disability, and death in the US“
- One drop of purified nicotine can kill a human being.
- Nicotine concentrates in the system of an unborn child. Smoking during pregnancy can kill the baby.
- Almost 50,000 nonsmokers die every year from secondhand smoke exposure that triggered a fatal disease.
Finding a Smokers Anonymous Meeting
The Nicotine Anonymous website offers visitors an easy way to find local Nicotine Anonymous smokers support groups. The “Meetings” tab at the top of the site’s homepage connects to a page with links to search-by-state lists, for those in the United States, or search by country lists for international visitors. The Meetings page also displays the group’s voicemail phone number. The Contact page lists the group’s email addresses and World Services mailing address.
What to Expect at Your First Meeting
Nicotine Anonymous states that the only requirement to join the group is a desire to be free of nicotine addiction. Group members use meeting time to honestly share their struggles with nicotine and receive support from other members. The group adheres to a 12-step recovery model to help members stop using nicotine.
The 12 steps of the Nicotine Anonymous smokers support groups were patterned on the 12-step program of Alcoholics Anonymous, though the two groups are not affiliated. The rough outline of the steps is admission of helplessness, reliance on a higher power, and the decision to turn one’s life over to that higher power. Once this is done, the addict faces and confesses his wrongdoing, makes a list of people he has harmed and does his best to make restitution. After having made restitution, the addict continues to follow a lifestyle of prayer and communion with God and fellowship with others in recovery.
Nicotine Anonymous also uses five tools to help members kick the smoking habit: support group meetings, a phone list of other members who are willing to offer advice and support in the interim, informational books and pamphlets, the help of another member who is able and willing to act as a personal coach to newcomers (also called a sponsor), and service to others still struggling with nicotine addiction.
Don’t try to kick the habit on your own. Let us show you how much better it is when you walk this path with others. Call us at 1-888-287-0471 Who Answers? to find the Nicotine Anonymous smokers support group nearest you.
Nicotine and Tobacco Recovery Program
Whether you are ready to quit today, or simply thinking about it, the Institute for Prevention and Recovery can provide you with the support and tools you need to succeed.
IFPR has helped thousands of people to overcome their addiction to nicotine. Our nicotine and tobacco cessation services are staffed with certified professionals who provide treatment under the Public Health Service Guidelines. Services are provided in Essex, Mercer, Middlesex, Monmouth, Ocean and Union Counties. Funding is provided by the New Jersey Department of Health, Office of Tobacco Control, Nutrition and Fitness.
Contact us for a confidential assessment:
Phone: 833-795-QUIT (833-795-7848)
Email: [email protected]
Nicotine is a powerful, highly-addictive drug.
On average, people try to quit smoking five to seven times before they successfully quit for good.
The Institute for Prevention and Recovery (IFPR) has helped thousands of people to overcome their addiction to nicotine. Our nicotine and tobacco recovery services are staffed with certified professionals who provide treatment under the Public Health Service Guidelines.
Studies show that individuals are four times more likely to quit using tobacco when participating in a structured program as compared to attempting to quit on their own.
Request an Appointment
Learn About OUR IFPR Quit Center
Alcohol and tobacco—Can AA Groups help to break the connection?
By Steven A. Schroeder, MD
It is well known that smoking and drinking go together. People who consume alcohol are much more likely to smoke, and vice versa. For those who struggle with alcoholism, the connection is even tighter, with smoking rates among alcoholics reaching up to ~50%. Studies have shown that brain changes caused by smoking and drinking are addictive and different from the use of either substance alone. Use of one substance can lead to the use of the other, and early exposure to either tobacco or alcohol can lead to addiction in later life. Alcohol increases cravings to smoke, decreases the time between cigarettes, and increases smoking frequency. Similarly, smoking increases alcohol craving, decreases its subjective effects, and leads to greater alcohol consumption. Nicotine may lessen the perception of intoxication, thereby leading to more alcohol consumption during heavy drinking episodes (Schroeder SA. Epilogue to Special Issue on Tobacco and Other Substance Use Disorders: Links and Implications. Am J Drug Alcohol Abuse 2017;43(2):226-9).
The combination of smoking and drinking yields worse health outcomes than using only one substance. Smokers are 2 to 3 times more likely to go on drinking binges than nonsmokers, thereby putting themselves at risk for trauma and other unwise behavior. Persons discharged from the Mayo Clinic with diagnoses of alcohol abuse were much more likely to die from smoking-related illnesses than anything else (Hurt RD, Offord KP, Crogham IT, Gomez-Dahl L, Kottke TE, et al. Mortality following Inpatient Addiction Treatment: Role of Tobacco Use in a Community-based Cohort. JAMA 1996;275:1097-103). And the combination of smoking and drinking drives up the risk of cancer greater than either substance by itself.
Historically, smoking has been tolerated by those who cared for persons with drinking problems, including clinicians, families, and those who drank. There were also myths that stopping smoking might exacerbate drinking. But now we know that the opposite is true—those who are able to stop smoking have a better chance of stopping alcohol use and abuse, in addition to the benefits from being smoke-free (Schroeder SA, Morris CD. Confronting a Neglected Epidemic: Tobacco Cessation for Persons with Mental Illnesses and Substance Abuse Problems. Annu Rev Public Health 2010;31:297-314).
Clearly then, stopping smoking should be a key health goal for the 14 million adult Americans who live with chronic alcohol abuse, plus the several million more who go on periodic drinking binges. One potential resource for breaking the tobacco/alcohol connection is Alcoholics Anonymous (AA), a storied American institution currently serving an estimated 1.2 million persons at 55,000 meeting places scattered throughout the country. It is likely that as many as 500,000 AA members continue to smoke, even those who have overcome their alcoholism. Thus, they may face the same fate as AA founders, Bill Wilson and Dr. Bob Smith, both of whom died of smoking-related illnesses. AA as an organization has not endorsed smoking cessation, citing key organizational principles of fidelity to core mission and local chapter autonomy. Nevertheless, we believe that local AA groups could provide unobtrusive smoking cessation assistance for members interested in quitting. The Smoking Cessation Leadership Center is willing to provide free posters containing the blue Quit Now cards (below) that provide instructions on how to call a toll-free quitline. Such callers have about a 30% chance of quitting smoking, which is much higher than the unassisted rate of about 5%. There is some precedent for using these materials, in that Oxford Houses (self-run, self-supported recovery houses that follow the AA 12-step guidelines) in both Oklahoma and Texas have accepted this offer. If you know of any AA groups willing to accept this offer, please notify us at . It is an opportunity to improve health and save lives.
Quit Now Cards