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The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality
A Randomized Clinical Trial
- Nicholas R. Anthonisen, MD;
- Melissa A. Skeans, MS;
- Robert A. Wise, MD;
- Jure Manfreda, MD;
- Richard E. Kanner, MD;
- John E. Connett, PhD; and
- for the Lung Health Study Research Group*
- 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.
Abstract
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.
Article and Author Information
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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).
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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).
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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.
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Current Author Addresses: Dr. Anthonisen: University of Manitoba, Respiratory Hospital, 810 Sherbrook Street, Room 319, Winnipeg, Manitoba R3A 1R8, Canada.
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Ms. Skeans and Dr. Connett: University of Minnesota, Coordinating Centers for Biometric Research, 2221 University Avenue SE, Room 200, Minneapolis, MN 55414-3080.
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Dr. Wise: Johns Hopkins Asthma and Allergy Center, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224.
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Dr. Manfreda: University of Manitoba, Respiratory Hospital RS 115, 810 Sherbrook Street, Winnipeg, Manitoba R3A 1R8, Canada.
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Dr. Kanner: University of Utah Medical Center, Pulmonary Division, 701 Wintrobe Building, 50 North Medical Drive, Salt Lake City, UT 84132.
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Author Contributions: Conception and design: N.R. Anthonisen, R.A. Wise, R.E. Kanner, J.E. Connett.
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Analysis and interpretation of the data: N.R. Anthonisen, M.A. Skeans, R.A. Wise, J.E. Connett.
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Drafting of the article: N.R. Anthonisen, M.A. Skeans, J. Manfreda, R.E. Kanner.
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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.
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Final approval of the article: N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett.
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Provision of study materials or patients: R.A. Wise, R.E. Kanner.
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Statistical expertise: M.A. Skeans, J.E. Connett.
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Obtaining of funding: R.A. Wise, R.E. Kanner, J.E. Connett.
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Collection and assembly of data: R.A. Wise, J.E. Connett.
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