Smoking cessation: the potential role of risk assessment tools as motivational triggers
- 1Department of Medicine and Psychology, University of Auckland, Auckland, New Zealand
- 2University of Chicago Medical Centre, University of Chicago, Chicago, Illinois, USA
- Correspondence to Dr Robert Young, Department of Medicine, Auckland Hospital, Private Bag 92019, Auckland, New Zealand;
- Received 27 May 2009
- Accepted 19 September 2009
Smoking is the most important and preventable cause of morbidity and premature mortality in developed and developing countries. To date, efforts to reduce the burden of smoking have focused on non-personalised strategies. Anxiety about ill health, especially lung cancer and emphysema, is the foremost concern for smokers and a major reason for quitting. Recent efforts in cessation management focus on behaviour change and pharmacotherapy. The ‘3 Ts’ (tension, trigger, treatment) model of behaviour change proposes that at any one time a smoker experiences varying degrees of motivational tension, which in the presence of a trigger may initiate or enhance quitting. Smokers' optimistic bias (ie, denial of one's own vulnerability) sustains continued smoking, while increasing motivational tension (eg, illness) favours quitting. The 1 year quit rates achieved when smokers encounter a life threatening event, such as a heart attack or lung cancer, are as much as 50–60%. Utilising tests of lung function and/or genetic susceptibility personalises the risk and have been reported to achieve 1 year quit rates of 25%. This is comparable to quit rates achieved among healthy motivated smokers using smoking cessation drug therapy. In this paper we review existing evidence and propose that identifying those smokers at increased risk of an adverse smoking related disease may be a useful motivational tool, and enhance existing public health strategies directed at smoking cessation.
Competing interests RY is an advisor to Synergenz BioScience Ltd that has funded the development of a test for lung cancer susceptibility.
Provenance and peer review Not commissioned; externally peer reviewed.