title: The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  10 clinical centers in the United States and Canada.
  
  
  METHODS
  5887 middle-aged volunteers with asymptomatic airway obstruction.
  
  
  METHODS
  All-cause mortality and mortality due to cardiovascular disease, lung cancer, and other respiratory disease.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Results apply only to individuals with airway obstruction.
  
  
  CONCLUSIONS
  Smoking cessation intervention programs can have a substantial effect on subsequent mortality, even when successful in a minority of participants.
authors.affiliation: University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Anthonisen
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Skeans
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
authors.forename: Jure
authors.initials: J
authors.lastname: Manfreda
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kanner
authors.forename: John E
authors.initials: JE
authors.lastname: Connett
mesh_terms: D001521:Behavior Therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D009241:Ipratropium / Q000627:therapeutic use; D008297:Male; D009026:Mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention
chemical_list: D001993:Bronchodilator Agents; D009241:Ipratropium