So what, then, is the best to way to convince smokers to stop for good? Giving them information about their individual risk of serious illness may be a good place to start, according to a paper published in the current issue of the Postgraduate Medical Journal.
The article endorses a new model for smoking cessation to help doctors engage smokers more effectively by using what it calls 'motivational tension' – anxiety based on a smoker's perception of harms versus benefits. Health concerns are an important factor in motivating smokers to quit; smoking cessation rates appear to be greatest where smokers have suffered, or been shown to be personally at risk of, life threatening complications from their smoking.
In this setting, risk assessment tools that identify those at greatest risk, such as spirometry (a puff test to measure lung function) and genetic susceptibility testing, appear to help engage smokers and improve their smoking cessation rates. When smokers see their individual risk as a result of lung function or genetic tests, that new personalized information is likely to trigger a quit attempt, and will make that quit attempt more likely to succeed. This is very similar to cholesterol and blood pressure testing in the context of cardiovascular risk assessment and treatment.
According to studies cited in the article, genetic testing for smoking-related disease demonstrated utility for all smokers and found no evidence of fatalism in higher risk people or reduced motivation for those at lower risk levels.
Smokers' attitudes about whether to carry on smoking are based on how they balance the perceived "benefits" against their understanding about the harm it causes, and their individual vulnerability to this harm, according to studies cited in the article. Even relatively small triggers can change this balance, prompting a quit attempt.
Recent research shows says smoking cessation 'interventions' by doctors that give both a trigger for action and also provide support such as medication or anti-smoking counseling may be the most effective way to help smokers quit.
Dr Young, an Associate Professor in the Schools of Biological Sciences and Medicine at the University of Auckland in New Zealand, has led a research program which combines genetic and non-genetic factors to show smokers and ex-smokers their own risk of lung cancer. Preliminary studies show that over 50% of smokers taking the test take positive steps such as quitting, reducing their cigarette intake or setting a quit date. Further studies are planned to assess smoker's actions after taking the test.
"Personalized risk assessment has been the mainstay of coronary artery disease prevention and has resulted in significant mortality reduction over the last decade," said Dr. Young. "Such an approach could be equally applied to smoking cessation, now that we have predictive risk assessment tools that identify those at greatest risk of lung-related illness from smoking."
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