Women are half as likely to quit smoking as men, according to research presented at the 2019 Canadian Cardiovascular Congress. Affordability of smoking cessation medications was another barrier to success.

Tobacco smoking is the leading cause of preventable death around the world. Smoking cessation programmes help some people quit, but few studies have assessed their effectiveness in certain populations. This study examined the predictors of success in quitting or reducing smoking in patients attending a smoking cessation clinic at St. Michael's Hospital, an inner-city cardiac centre.

The retrospective analysis included 233 patients who attended the clinic at least twice between 2008 and 2018. Participants received individualised medical counselling, and if necessary, prescription of medications, such as nicotine replacement therapy (gum, lozenge, patch, inhaler, spray), bupropion, and varenicline, according to the patient's preferences and contraindications.

The average age of patients was 56 years and 35% were female. Participants reported smoking an average of 18 cigarettes per day for 37 years. Two-thirds (66%) had dyslipidaemia, 66% had hypertension, 44% had coronary artery disease, and 28% had depression or anxiety.

After six months, 58 (25%) of participants had quit smoking and 68 (29%) had reduced the daily number of cigarettes by more than 50%. In logistic regression analysis, the total number of visits (odds ratio (OR) 6.35), varenicline use (OR 2.40), female sex (OR 0.49), and medication affordability (OR 0.33), were independently associated with quitting or reducing smoking by more than 50%.

Varenicline decreases withdrawal symptoms 

Dr Gonzaga Carvalho said: "Female sex and medication affordability were independent predictors of inability to quit or significantly reduce tobacco smoking. Previous research has shown that a policy to cover the financial costs of smoking cessation medications improves quit rates.

"The number of clinic visits was the strongest predictor of successfully quitting or reducing smoking. This highlights the importance of these appointments, when counselling was provided, and medication was reviewed and adjusted as needed."

Prior studies have shown that varenicline use is associated with greater success in quitting smoking when compared to placebo and other medications, and the current study agrees with these findings.

"Varenicline decreases withdrawal symptoms and may have reduced craving for nicotine among our patients, potentially reducing relapse,’"said Dr Gonzaga Carvalho.

"Our study emphasises the need for sex-specific interventions and financial coverage of smoking cessation medications. Our message to smokers is that smoking cessation is achievable with help. Get assistance and connect to a smoking cessation programme, where individual needs will be assessed, and a plan to quit smoking will be developed. The sooner, the better."