Analysis of six waves of longitudinal data from the United States, Canada, the United Kingdom, and Australia revealed that higher socioeconomic position is associated with a higher probability of adopting abrupt versus gradual smoking cessation.
Considering that there is some evidence that abrupt quitting is associated with better cessation outcomes (Cheong et al., 2007
; West et al., 2001
) than gradual quitting, studying the predictors of abrupt quitting as was done in this research may help us to gain a better understanding of why certain sociodemographic groups are not as successful in quitting as others. Greater use of cutting down might be a reason why smokers from more disadvantaged socioeconomic backgrounds are sometimes found to have less success in quitting (Fernandez et al., 2006
; West et al.) and why sometimes females are found to be less successful than males (Bjornson et al., 1995
; Wetter et al., 1999
We note that our study used a self-reported measure of gradual quitting. Respondents were asked whether they stopped smoking suddenly or gradually reduced the number of cigarettes they smoked. Similar measures have been employed in the studies that have shown that the gradual method is associated with a lower cessation rate than the abrupt method (Cheong et al., 2007
; West et al., 2001
). On the other hand, many of the studies that have reported the gradual method to be associated with a higher cessation rate define this method as substantial reduction in the number of cigarettes smoked over a specified period of time. For example, in trials conducted by Cinciripini et al. (1994
, they defined scheduled reduction as reducing baseline cigarette consumption by a factor of one third in the first week and an additional reduction of one third of the baseline consumption in the second week. In the third, that is, the final week, the number of cigarettes per day was reduced every 2 days by a factor of one third of the previous day. It is plausible that discrepant findings about the cessation outcomes of gradual versus abrupt method are due to how gradual quitting is defined.
Our analysis showed that prior intention to quit and self-efficacy to quit were not associated with abrupt versus gradual quitting, suggesting that motivation is not a contributing factor to why gradual quitters are sometimes shown to be less successful in quitting and contributing to the debate in this area. Our results are consistent with a study conducted by Hughes (2007)
who asked the following question from a group of current smokers who had tried to quit in the past year: “In your most recent attempt to stop smoking, did you quit smoking gradually or abruptly?” The study showed no difference between abrupt and gradual quitters in terms of their intention to quit in the next 1 month or next 6 months or confidence in their ability to quit. Our finding, however, was not consistent with report of Peters, Hughes, Callas, and Solomon (2007)
that compared with smokers whose goal was to quit gradually, those whose goal was to quit abruptly had a higher score on an index of readiness to quit in the near future. A possible reason for this inconsistency may be that both our study and Hughes’ study inferred motivation from reports about intention to quit and self-efficacy to quit, while Peters et al.’s report inferred motivation from behavior over the next 30 days (Hughes).
Our analysis showed that smokers who call a quitline or use stop-smoking medication for help in quitting are less likely to quit abruptly. This is surprising given that official recommendations, such as the U.S. Clinical Practice Guidelines (Fiore et al., 2008
), suggest that smokers who want to quit should do so abruptly. Similarly, instructions for the use of nicotine replacement therapies indicate that they should not be used when the user is still smoking but as soon as the smoker smokes his/her last cigarette (Rose, Behm, Westman, & Kukovich, 2006
). Also, the smoking cessation clinics within the U.K.'s National Health System (McNeill, Raw, Whybrow, & Bailey, 2005
) recommend abrupt quitting and provide help to smokers who adopt this method. More research needs to be done on why users of stop-smoking medications and quitlines are more likely than others to adopt gradual versus abrupt quitting. It is worth noting that Cheong et al. (2007)
found that smokers who adopted gradual quitting were more likely to successfully quit if they also used stop-smoking medication, which may suggest that some experimentation with the use of stop-smoking medication while cutting down on smoking may in fact be beneficial.
Our findings regarding the association of abrupt quitting with sociodemographic characteristics (education, age, gender, and race/ethnicity) were inconsistent with Hughes’ (2007)
who found no association. Our results indicated that individuals who were less than 40 years old, male, or White/English speaking were more likely to adopt abrupt versus gradual quitting. A possible reason for the discrepancy is that our research had higher power due to large sample size (n
= 5,629), whereas Hughes’ study had a low power with a sample size of 134 (Hughes).
The main limitation of this study was its reliance on self-reports of the quit attempt, which may have occurred some months before the interview. This is common to all studies of this phenomenon to date. Although we do not expect that the outcome of an attempt would influence memories of how it took place or that such memories would be influenced by the factors we have studied here, we cannot rule out these possibilities. Furthermore, we cannot rule out recall bias being a plausible explanation, at least in part, for the lower report of abrupt quitting among the socially disadvantaged since this group is more likely to have shorter or brief attempts (Fernandez et al., 2006
), which are more easily forgotten. Another limitation might be the variation in understanding of what constitutes abrupt cessation. It is possible that some who claim to have quit abruptly may have cut down consumption prior to the quite date but do not see this activity as part of the quit attempt. The strengths of this study were the representative nature of the samples and the inclusion of a wide range of smokers.