Gold Standard Program for Heavy Smokers in a Real-Life Setting

Abstract

Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerström score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1–6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23–1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05–1.11); and being compliant (attending the planned meetings OR 4.36–4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1–6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising.

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“…Number of pack‐years was calculated as (number of cigarettes per day/20) × number of years smoked. A cutoff value of 20 pack‐years has been used in previous studies to define heavy smoking . Former smokers (n = 42) were excluded from analyses because of unclear reporting of former smoking status.…”

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Intensive Smoking Cessation Interventions in Denmark - Based on data from the Danish Smoking Cessation Database

“…ISCI, such as GSP, has an effect across socioeconomic and vulnerable groups, including smokers diagnosed with SMD. Previous studies on GSP have found similar results in disadvantaged 94 , heavy 95 , pregnant 159 , elderly 160 and, most recently, young 161 groups of smokers, and the programme has also proven to be effective in randomised and controlled trials 127,162 .…”

“…In contrast, the difference in proportions between those who wants to quit in the two groups is only 6% 84 (table 2). Research of real-life data shows nearly the same effect for disadvantaged groups and heavy smokers as for the background population: 26-29% versus 33% remain smoke-free six months after a GSP 94,95 . It is appropriate to examine whether this result also applies to patients with SMD or whether there is a need to develop new programmes for this important subgroup of smokers.…”