Researchers reviewing hundreds of recent studies found that most ex-smokers ceased smoking successfully without help and found it less difficult than expected: they urge health authorities to do more to highlight this message and so that smoker’s perceptions are not dominated by messages put out by tobacco control advocates and pharmaceutical companies who are overpromoting the idea that smokers need support like nicotine replacement products to help them quit.

The study was the work of Drs Simon Chapman and Ross MacKenzie from the School of Public Health at the University of Sydney, Australia and you can read a report about it in the 9 February issue of PLoS Medicine.

In their background information, Chapman and MacKenzie wrote that the dominant theme of messages about quitting smoking campaigns emphasize that if smokers are serious about quitting they should seek professional help or use nicotine replacement therapy. This has led to the “medicalisation of smoking cessation”, despite substantial evidence that most ex-smokers quit successfully either by going “cold turkey“, that is giving up all at once, or by reducing their consumption gradually and then giving up.

To arrive at this conclusion the researchers reviewed 511 studies published in 2007 and 2008. They found that the studies repeatedly showed that two-thirds to three-quarters of ex-smokers stop smoking without help, and most of them say that it was less difficult than they had expected.

The authors also found a dominance of pharmaceutical company-sponsored intervention studies, and cited a recent review of randomized controlled trials on nicotine replacement therapy that showed that 51 per cent of industry-funded trials reported significant cessation effects, while only 22 per cent of the non-industry supported ones did.

They also found that many of the assisted cessation studies, but hardly any of the unassisted cessation studies, were done by researchers supported by a pharmaceutical company that made smoking cessation products.

The authors wrote that they believe there are three “drivers” that force research on smoking cessation to concentrate on assisted cessation and neglect unassisted smoking cessation. These are what they describe as the “dominance of interventionism”, the “increasing medicalisation and commodification of cessation”, and the persistent yet erroneous tendency to quote the “hardening” hypothesis”.

By the “hardening hypothesis”, they mean the suggestion that where you have areas where not many people smoke, or where the most progress in quitting has been made, the smokers who remain are a “hard core” that resists interventions, the idea being that those who have already quit were less dependent on nicotine and thus found it easier to give up, or they were more motivated to quit.

The authors said this hypothesis was so attractive that it caused the US National Cancer Institute to devote an entire monograph to it. Supporters of the hardening hypothesis argue that a greater proportion of today’s smokers are “hard core” and more addicted because the non-addicted ones have already joined the ranks of ex-smokers.

The authors said the hardening hypothesis has been heavily criticised, and quoted some evidence in support of this claim. For instance, data on smoking in the US for 2006-2007 shows that in those states with low smoking prevalence, there has been a a significant fall in the average number of cigarettes smoked daily, in the proportion of smokers who light up within 30 minutes of waking, and also in the proportion of those who smoke every day. This is “compelling evidence against the hardening hypothesis”, they wrote, because you would expect to see an opposite pattern if only hard core smokers were left.

They concluded that:

“Public sector communicators should be encouraged to redress the overwhelming dominance of assisted cessation in public awareness, so that some balance can restored in smokers’ minds regarding the contribution that assisted and unassisted smoking cessation approaches can make to helping them quit smoking.”

“The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences.”
Simon Chapman, Ross MacKenzie
PLoS Medicine, Published 09 Feb 2010

Source: Public Library of Science.

Written by: Catharine Paddock, PhD