Smoking cessation programs should be tailored to age

A new study shows that obstacles to smoking cessation and motives for quitting smoking vary with age.

The study presented at CHEST 2007, the 73rd annual international scientific assembly of the American College of Chest Physicians (ACCP), found that smokers over age 65 reported quitting smoking due to physician pressure and stress due to a major health problem, while smokers under age 65 reported cigarette cost and tobacco odor as reasons for quitting.

“The current common perception among the medical community is that if smokers age 65 and older haven't quit by now, they can't or won't quit – a perception which may lead physicians to focus less on their older patients' smoking habit,” said lead study author Virginia Reichert, NP, Center for Tobacco Control, North Shore-LIJ Health System, Great Neck, New York. “Our results show that older smokers are motivated to quit smoking by very different factors compared with younger smokers. If these factors are addressed, we may see cessation rates improve for both age groups.”

Ms. Reichert and colleagues from the Center for Tobacco Control at North Shore-LIJ compared health status and motives and obstacles for quitting smoking between 1,909 smokers under age 65 (younger smokers) and 143 smokers over age 65 (older smokers) who were attending a 6-week comprehensive cessation program. Older smokers were more likely than younger smokers to have a recent hospitalization (23% vs 13%), comorbid cardiac disease (78% vs 38%), cancer (20% vs 7%), and/or chronic obstructive lung disease/asthma (37% vs 23%). Regarding motivation, older smokers cited pressure by their physician and stress of a major health problem as main reasons for quitting. Younger smokers attributed their reasons for quitting to the cost of cigarettes, tobacco odor, and general health concerns.

“If the cost of cigarettes hasn't made the older smoker quit by now, they are not as likely to be affected by the rising costs as much as younger smokers may be,” said Ms. Reichert. “On the other hand, younger smokers may not have experienced health effects from their smoking, but they may have felt the impact of the cost of cigarettes/cigars.”

Obstacles to smoking cessation also varied by age group. Younger smokers were more likely than older smokers to report concerns of weight gain (30% vs 15%), stress management (59% vs 45%), fear of failure (15% vs 8%), handling social situations (24% vs 7%), and cravings (44% vs 36%) as obstacles to quitting smoking. Furthermore, 54% of older smokers and 69% of younger smokers reported not wanting to give up their first cigarette in the morning as an obstacle to quitting smoking. Young smokers also believe that trying to quit “cold turkey” is best, when in reality, only 7% of smokers achieve long-term abstinence without professional help.

“To be most effective, treatment plans and education should be relevant to each group's concerns,” said Ms. Reichert. She suggests that health-care providers offer weight management programs and stress management strategies as part of the treatment and relapse prevention programs for younger smokers, while older smokers may be more successful with physician encouragement and knowledge of how smoking is influencing their current health conditions.

“Tobacco-related diseases are major causes of death in the United States,” said Alvin V. Thomas, Jr., MD, FCCP, President of the American College of Chest Physicians. “The more we know about what motivates smokers to quit their habit and what personal obstacles they face in doing so, the more we can tailor smoking cessation programs to fit the individual needs of our patients.”

http://www.chestnet.org/