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15 February 2005 | Volume 142 Issue 4 | Pages 233-239
Background: Randomized clinical trials have not yet demonstrated the mortality benefit of smoking cessation.
Objective: To assess the long-term effect on mortality of a randomly applied smoking cessation program.
Design: The Lung Health Study was a randomized clinical trial of smoking cessation. Special intervention participants received the smoking intervention program and were compared with usual care participants. Vital status was followed up to 14.5 years.
Setting: 10 clinical centers in the United States and Canada.
Patients: 5887 middle-aged volunteers with asymptomatic airway obstruction.
Measurements: All-cause mortality and mortality due to cardiovascular disease, lung cancer, and other respiratory disease.
Intervention: The intervention was a 10-week smoking cessation program that included a strong physician message and 12 group sessions using behavior modification and nicotine gum, plus either ipratropium or a placebo inhaler.
Results: At 5 years, 21.7% of special intervention participants had stopped smoking since study entry compared with 5.4% of usual care participants. After up to 14.5 years of follow-up, 731 patients died: 33% of lung cancer, 22% of cardiovascular disease, 7.8% of respiratory disease other than cancer, and 2.3% of unknown causes. All-cause mortality was significantly lower in the special intervention group than in the usual care group (8.83 per 1000 person-years vs. 10.38 per 1000 person-years; P = 0.03). The hazard ratio for mortality in the usual care group compared with the special intervention group was 1.18 (95% CI, 1.02 to 1.37). Differences in death rates for both lung cancer and cardiovascular disease were greater when death rates were analyzed by smoking habit.
Limitations: Results apply only to individuals with airway obstruction.
Conclusion: Smoking cessation intervention programs can have a substantial effect on subsequent mortality, even when successful in a minority of participants.
*For a list of members of the Lung Health Study Research Group, see the Appendix.
Editors' Notes
Context
Contribution
Implications
–The Editors
Author and Article Information
From University of Manitoba, Winnipeg, Manitoba, Canada; University of Minnesota, Minneapolis, Minnesota; Johns Hopkins University, Baltimore, Maryland; and University of Utah, Salt Lake City, Utah.
Grant Support: Lung Health Study III was supported by a cooperative agreement with the National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI-1U10-HL59275).
Potential Financial Conflicts of Interest: Honoraria: J.E. Connett (National Institutes of Health/National Heart, Lung, and Blood Institute); Grants received: J.E. Connett (National Institutes of Health/National Heart, Lung, and Blood Institute).
Requests for Single Reprints: John E. Connett, PhD, Coordinating Centers for Biometric Research, University of Minnesota, 2221 University Avenue SE, Room 200, Minneapolis, MN 55414-3080; e-mail, john-c{at}ccbr.umn.edu.
Current Author Addresses: Dr. Anthonisen: University of Manitoba, Respiratory Hospital, 810 Sherbrook Street, Room 319, Winnipeg, Manitoba R3A 1R8, Canada.
Ms. Skeans and Dr. Connett: University of Minnesota, Coordinating Centers for Biometric Research, 2221 University Avenue SE, Room 200, Minneapolis, MN 55414-3080.
Dr. Wise: Johns Hopkins Asthma and Allergy Center, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224.
Dr. Manfreda: University of Manitoba, Respiratory Hospital RS 115, 810 Sherbrook Street, Winnipeg, Manitoba R3A 1R8, Canada.
Dr. Kanner: University of Utah Medical Center, Pulmonary Division, 701 Wintrobe Building, 50 North Medical Drive, Salt Lake City, UT 84132.
Author Contributions: Conception and design: N.R. Anthonisen, R.A. Wise, R.E. Kanner, J.E. Connett.
Analysis and interpretation of the data: N.R. Anthonisen, M.A. Skeans, R.A. Wise, J.E. Connett.
Drafting of the article: N.R. Anthonisen, M.A. Skeans, J. Manfreda, R.E. Kanner.
Critical revision of the article for important intellectual content: N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett.
Final approval of the article: N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett.
Provision of study materials or patients: R.A. Wise, R.E. Kanner.
Statistical expertise: M.A. Skeans, J.E. Connett.
Obtaining of funding: R.A. Wise, R.E. Kanner, J.E. Connett.
Collection and assembly of data: R.A. Wise, J.E. Connett. ARTICLE
The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality
A Randomized Clinical Trial
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