Self-Reported Exposure to Policy and Environmental Influences on Smoking Cessation and Relapse: A 2-Year Longitudinal Population-based Study
Abstract
:1. Introduction
- multicomponent mass media campaigns coordinated with interventions;
- multicomponent telephone support systems (quitlines);
- screening, advice, and cessation assistance by health care providers;
- reductions in patient costs for cessation treatment (including coverage of all Food and Drug Administration [FDA]-approved medications and cessation assistance); and
- increases in the unit price of tobacco products (e.g., tax increases).
2. Methods
2.1. Data
2.2. Outcome Definitions
2.3. Predictor Variable Definitions
2.4. Statistical Analysis
3. Results
3.1. Sample Characteristics
3.2. Quit Attempts
3.3. Maintaining Successful Quit Attempt
3.4. Relapse
4. Discussion
Limitations
Acknowledgements
- Ethics ClearanceThe study protocol was approved by the institutional review boards of RTI International and the New York State Department of Health.
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ATS Sample of Current and Recent Quitters Who are Eligible for and Agreed to ACS Follow-up (N = 6,108) | |||||||||
---|---|---|---|---|---|---|---|---|---|
Variable | Did Not Complete Followup Interview (N = 2,847) | Completed First Followup Interview (N = 3,261) | Completed First and Second Follow-up Interviews (N = 1,142) | ||||||
n | N | % or Mean | n | N | % or Mean | n | N | % or Mean | |
Demographics | |||||||||
Age | |||||||||
18–34 | 876 | 2,839 | 30.9% | 612 | 3,244 | 18.9% | 200 | 1,137 | 17.6% |
35–54 | 1,328 | 2,839 | 46.8% | 1,551 | 3,244 | 47.8% | 562 | 1,137 | 49.4% |
55+ | 635 | 2,839 | 22.4% | 1,083 | 3,244 | 33.4% | 375 | 1,137 | 33.0% |
Race/ethnicity | |||||||||
White | 2,063 | 2,847 | 72.5% | 2,565 | 3,261 | 78.7% | 907 | 1,142 | 79.4% |
African American | 316 | 2,847 | 11.1% | 366 | 3,261 | 11.2% | 134 | 1,142 | 11.7% |
Hispanic | 318 | 2,847 | 11.2% | 197 | 3,261 | 6.0% | 55 | 1,142 | 4.8% |
Other | 150 | 2,847 | 5.3% | 133 | 3,261 | 4.1% | 46 | 1,142 | 4.0% |
Gender | |||||||||
Female | 1,622 | 2,847 | 57.0% | 1,985 | 3,261 | 60.9% | 701 | 1,142 | 61.4% |
Male | 1,225 | 2,847 | 43.0% | 1,276 | 3,261 | 39.1% | 441 | 1,142 | 38.6% |
Insurance | |||||||||
Private | 1,496 | 2,716 | 55.1% | 1,797 | 3,104 | 57.9% | 668 | 1,085 | 61.6% |
Medicare | 272 | 2,716 | 10.0% | 448 | 3,104 | 14.4% | 146 | 1,085 | 13.5% |
Medicaid | 397 | 2,716 | 14.6% | 406 | 3,104 | 13.1% | 127 | 1,085 | 11.7% |
None | 551 | 2,716 | 20.3% | 453 | 3,104 | 14.6% | 144 | 1,085 | 13.3% |
Region | |||||||||
Capital | 378 | 2,820 | 13.4% | 419 | 3,243 | 12.9% | 155 | 1,137 | 13.6% |
Central | 418 | 2,820 | 14.8% | 498 | 3,243 | 15.4% | 182 | 1,137 | 16.0% |
Metro | 1,300 | 2,820 | 46.1% | 1,331 | 3,243 | 41.0% | 459 | 1,137 | 40.4% |
Western | 724 | 2,820 | 25.7% | 995 | 3,243 | 30.7% | 341 | 1,137 | 30.0% |
Smoking status | |||||||||
Current smoker | 2,395 | 2,847 | 84.1% | 2,655 | 3,261 | 81.4% | 979 | 1,142 | 85.7% |
Recent quitter | 452 | 2,847 | 15.9% | 606 | 3,261 | 18.6% | 163 | 1,142 | 14.3% |
Key Predictors | |||||||||
Presence of children in householda | |||||||||
No children younger than 18 in household | 1,661 | 2,845 | 58.4% | 2,159 | 3,258 | 66.3% | 759 | 1,141 | 66.5% |
Children younger than 18 in household | 1,184 | 2,845 | 41.6% | 1,099 | 3,258 | 33.7% | 382 | 1,141 | 33.5% |
Other smokers in household | |||||||||
No other smokers in household | 1,246 | 1,783 | 69.9% | 1,766 | 2,406 | 73.4% | 577 | 745 | 77.4% |
Other smokers in household | 537 | 1,783 | 30.1% | 640 | 2,406 | 26.6% | 168 | 745 | 22.6% |
Intention to quit | |||||||||
Do not intend to quit | 1,472 | 2,063 | 71.4% | 1,678 | 2,331 | 72.0% | 604 | 850 | 71.1% |
Intend to quit | 591 | 2,063 | 28.6% | 653 | 2,331 | 28.0% | 246 | 850 | 28.9% |
Self-efficacy scale | — | 1,337 | 3.1 | — | 1,513 | 3.10 | — | 535 | 3.1 |
Quit attempts | |||||||||
Did not make a quit attempt in past 12 months | 1,219 | 2,390 | 51.0% | 1,292 | 2,649 | 48.8% | 477 | 977 | 48.8% |
Made a quit attempt in past 12 months | 1,171 | 2,390 | 49.0% | 1,357 | 2,649 | 51.2% | 500 | 977 | 51.2% |
Duration of longest prior quit attempt | — | 875 | 29.8 | — | 778 | 29.2 | — | 320 | 27.8 |
Beliefs about smoking’s effects | |||||||||
Do not think smoking affects health | 266 | 1,023 | 26.0% | 250 | 1,066 | 23.5% | 119 | 485 | 24.5% |
Think smoking affects health | 757 | 1,023 | 74.0% | 816 | 1,066 | 76.5% | 366 | 485 | 75.5% |
Health history | |||||||||
Never told have heart disease, stroke, emphysema, or cancer | 215 | 230 | 93.5% | 470 | 545 | 86.2% | 349 | 405 | 86.2% |
Ever told have heart disease, stroke, emphysema, or cancer | 15 | 230 | 6.5% | 75 | 545 | 13.8% | 56 | 405 | 13.8% |
Health history | |||||||||
Heaviness of smoking scale | — | 2,328 | 2.1 | — | 2,594 | 2.26 | — | 961 | 2.4 |
Hardcore smoking status | |||||||||
Not a hardcore smoker | 2,073 | 2,395 | 86.6% | 2,238 | 2,655 | 84.3% | 809 | 979 | 82.6% |
Hardcore smoker | 322 | 2,395 | 13.4% | 417 | 2,655 | 15.7% | 170 | 979 | 17.4% |
Home smoking ban | |||||||||
No home smoking complete ban | 1,796 | 2,840 | 63.2% | 2,120 | 3,258 | 65.1% | 756 | 1,142 | 66.2% |
Home smoking complete ban | 1,044 | 2,840 | 36.8% | 1,138 | 3,258 | 34.9% | 386 | 1,142 | 33.8% |
Tax evasion | |||||||||
No tax-free purchase | 1,637 | 2,100 | 78.0% | 1,642 | 2,247 | 73.1% | 625 | 872 | 71.7% |
Tax-free purchase | 463 | 2,100 | 22.0% | 605 | 2,247 | 26.9% | 247 | 872 | 28.3% |
Price paid per pack | — | 1,663 | 4.34 | — | 2,024 | 4.16 | — | 684 | 4.19 |
Health care professional (HCP) asked about smoking status | |||||||||
Did not visit HCP or HCP did not ask if smoke | 928 | 2,385 | 38.9% | 838 | 2,647 | 31.7% | 307 | 976 | 31.5% |
HCP asked if smoke | 1,457 | 2,385 | 61.1% | 1,809 | 2,647 | 68.3% | 669 | 976 | 68.5% |
HCP advised to quit | |||||||||
Did not visit HCP or HCP did not give advice | 1,139 | 2,383 | 47.8% | 1,064 | 2,648 | 40.2% | 388 | 976 | 39.8% |
HCP gave advice | 1,244 | 2,383 | 52.2% | 1,584 | 2,648 | 59.8% | 588 | 976 | 60.2% |
HCP assisted | |||||||||
Did not visit HCP or HCP did not give assistance | 1,672 | 2,374 | 70.4% | 1,726 | 2,641 | 65.4% | 620 | 974 | 63.7% |
HCP gave assistance | 702 | 2,374 | 29.6% | 915 | 2,641 | 34.6% | 354 | 974 | 36.3% |
Use of quitline | |||||||||
Did not call quitline | 2,699 | 2,825 | 95.5% | 3,029 | 3,234 | 93.7% | 1,059 | 1,131 | 93.6% |
Called quitline | 126 | 2,825 | 4.5% | 205 | 3,234 | 6.3% | 72 | 1,131 | 6.4% |
Use of NRT | |||||||||
Did not use NRT | 2,265 | 2,658 | 85.2% | 2,442 | 3,006 | 81.2% | 888 | 1,082 | 82.1% |
Used NRT | 393 | 2,658 | 14.8% | 564 | 3,006 | 18.8% | 194 | 1,082 | 17.9% |
Use of NRT from quitline | |||||||||
Did not use free NRT from quitline | 1,456 | 1,496 | 97.3% | 1,976 | 2,071 | 95.4% | 583 | 619 | 94.2% |
Used free NRT from quitline | 40 | 1,496 | 2.7% | 95 | 2,071 | 4.6% | 36 | 619 | 5.8% |
Insurance coverage for NRT | |||||||||
No insurance coverage for NRT | 2,313 | 2,419 | 95.6% | 2,320 | 2,470 | 93.9% | 1,003 | 1,077 | 93.1% |
Insurance covers NRT | 106 | 2,419 | 4.4% | 150 | 2,470 | 6.1% | 74 | 1,077 | 6.9% |
Variable | Model Assessing each Predictor Independent of Other Predictors but Adjusted for Core Controls | Full Model |
---|---|---|
Number of Observations | 1,609 | |
Core | ||
Children under 18 a | 1.21*; (1.01–1.45) | 1.13; (0.87–1.47) |
Other smokers in household b | 0.79**; (0.66–0.94) | 0.95; (0.74–1.23) |
Beliefs about Quitting | ||
Intention c | 5.70**; (4.53–7.18) | 2.96**; (2.20–3.97) |
Self-efficacy c,d | 1.47**; (1.30–1.66) | — |
Quit History | ||
Quit attempts c | 7.08**; (5.91–8.47) | 4.80**; (3.66–6.31) |
Duration of longest prior quit c,d | 1; (1.00–1.01) | — |
Motivation | ||
Think smoking affects health c,d | 0.92; (0.62–1.37) | — |
Ever told have heart disease, stroke, emphysema, or cancer c,d | 1.04; (0.78–1.40) | — |
Nicotine Dependence | ||
Heaviness of smoking index c | 0.80**; (0.76–0.84) | 0.86**; (0.80–0.93) |
Hardcore smoking indicator d | 0.15**; (0.11–0.20) | — |
External Influences | ||
Home smoking complete ban c | 1.45**; (1.20–1.76) | 1.27; (0.95–1.68) |
Purchased from tax-free source c,e | 0.60**; (0.48–0.75) | 0.97; (0.74–1.29) |
Price paid per pack c,e | 1.20**; (1.13–1.28) | 1.03; (0.95–1.11) |
Health care professional asked if smoke c,f | 1.31; (0.98–1.76) | 1.27; (0.80–2.01) |
Health care professional gave cessation advice c,f | 1.23; (0.98–1.54) | 0.88; (0.60–1.29) |
Health care professional provided cessation assistance c,f | 1.41**; (1.17–1.71) | 1.16; (0.85–1.59) |
Called Quitline c | 1.91**; (1.35–2.70) | 1.14; (0.68–1.89) |
NRT c | 3.80**; (2.99–4.82) | 1.26; (0.87–1.83) |
Free NRT from Quitline c | 2.99**; (1.76–5.09) | — |
Insurance coverage for NRT c | 2.05**; (1.29–3.23) | — |
Confirmed awareness of cessation ads c,g | 1.02; (0.81–1.28) | 1.10; (0.77–1.58) |
GRP cessation ads only c,g | 1.00; (0.90–1.12) | 0.97; (0.83–1.14) |
Model Assessing each Predictor Independent of Other Predictors but Adjusted for Core Controls | Full Model | |
---|---|---|
Number of Obs in the logit model | 1320 | |
Explanatory Variables | ||
Core | ||
Children under 18 a | 1.04 (0.55–1.96) | 0.91 (0.40–2.09) |
Other smokers in household b | 0.39* (0.18–0.84) | 0.76 (0.32–1.80) |
Beliefs about quitting | ||
Intention c | 4.12** (2.17–7.81) | 2.17* (1.02–4.66) |
Self-efficacy c | 1.93** (1.26–2.95) | — |
Quit History | ||
Duration of longest prior quit c,d | 1.00 (1.00–1.01) | — |
Motivation | ||
Think smoking affect health c,d | 0.95 (0.41–2.20) | — |
Ever told have heart disease. Stroke, emphysema, or cancer c,d | 0.75 (0.25–2.24) | — |
Nicotine Dependence | ||
Heaviness of smoking index c | 0.68** (0.55–0.83) | 0.75* (0.58–0.97) |
Hard core smoking indicator c,g | — | — |
External and policy influence | ||
Home smoking complete ban c | 2.61** (1.44–4.72) | 2.1 (0.94–4.70) |
Purchased from tax free source c,e | 0.5 (0.21–1.19) | 0.71 (0.27–1.88) |
Price paid per pack c,e | 1.05 (0.85–1.30) | 0.8 (0.60–1.05) |
Called NY Quitline f | 0.56 (0.20–1.60) | 0.54 (0.15–1.97) |
NRT f | 2.19** (1.24–3.86) | 2.95** (1.36–6.38) |
Free NRT from QL f | 1.49 (0.51–4.37) | — |
Insurance coverage of used NRT f | 2.45* (1.11–5.39) | — |
Confirm awareness of cessation antitobacco ads (baseline) c,h | 1.72 (0.74–4.00) | 1.71 (0.54–5.36) |
GRP for cessation ads only c,h | 0.85 (0.58–1.25) | 0.89 (0.53–1.52) |
Variable | Model Assessing each Predictor Independent of Other Predictors but Adjusted for Core Controls | Full Model |
---|---|---|
Number of Observations | 398 | |
Core | ||
Children under 18 a | 1.19 (0.75–1.89) | 1.39 (0.80–2.42) |
Other smokers in household b | 1.97** (1.21–3.22) | 2.08* (1.17–3.71) |
Motivation | ||
Ever told have heart disease, stroke, emphysema, or cancer c,d | 1.06 (0.52–2.14) | — |
External Influences | ||
Home smoking complete ban c | 0.63* (0.41–0.96) | 0.71 (0.43–1.16) |
Called Quitline a | 3.17** (1.69–5.93) | 1.96 (0.92–4.18) |
NRT a | 1.31 (0.80–2.13) | 1.31 (0.80–2.13) |
Free NRT from Quitline a | 1.33 (0.48–3.65) | — |
Insurance coverage of NRT a | 1.44 (0.65–3.22) | — |
Confirmed awareness of cessation ads c,e | 1.07 (0.58–1.94) | 1.28 (0.61–2.68) |
GRP cessation ads only c,e | 1.02b (0.76–1.36) | 0.80 (0.58–1.12) |
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Nonnemaker, J.; Hersey, J.; Homsi, G.; Busey, A.; Hyland, A.; Juster, H.; Farrelly, M. Self-Reported Exposure to Policy and Environmental Influences on Smoking Cessation and Relapse: A 2-Year Longitudinal Population-based Study. Int. J. Environ. Res. Public Health 2011, 8, 3591-3608. https://doi.org/10.3390/ijerph8093591
Nonnemaker J, Hersey J, Homsi G, Busey A, Hyland A, Juster H, Farrelly M. Self-Reported Exposure to Policy and Environmental Influences on Smoking Cessation and Relapse: A 2-Year Longitudinal Population-based Study. International Journal of Environmental Research and Public Health. 2011; 8(9):3591-3608. https://doi.org/10.3390/ijerph8093591
Chicago/Turabian StyleNonnemaker, James, James Hersey, Ghada Homsi, Andrew Busey, Andrew Hyland, Harlan Juster, and Matthew Farrelly. 2011. "Self-Reported Exposure to Policy and Environmental Influences on Smoking Cessation and Relapse: A 2-Year Longitudinal Population-based Study" International Journal of Environmental Research and Public Health 8, no. 9: 3591-3608. https://doi.org/10.3390/ijerph8093591