title: Ongoing self-engagement in quit attempts and cessation outcomes among rural smokers who were unable to quit after 2 years of repeated interventions.
abstract: OBJECTIVE
  As many smokers experience repeated failures with cessation attempts, it has been postulated that we may create a cadre of highly resistant smokers who are unlikely to engage in treatment or succeed in quitting. Our purpose was to follow a group of recalcitrant rural smokers and examine their ongoing engagement in smoking cessation activities.
  
  
  METHODS
  At the end of a 24-month disease management program for rural smokers, we identified participants who reported ongoing daily smoking despite exposure to 4 previous cycles of smoking cessation interventions. At month 36 (1 year after conclusion of the study), we contacted these participants and assessed changes in smoking status and ongoing engagement in cessation activities over the preceding 6 months. We assessed quit attempts and use of pharmacotherapy during the prior 6 months, as well as smoking abstinence at 36 months.
  
  
  RESULTS
  Among 333 recalcitrant smokers, 49% reported at least one 24-hour quit attempt during the preceding 6 months, 29% tried smoking cessation pharmacotherapy, and 5% quit smoking. Significant predictors of having at least one 24-hour quit attempt were lower numbers of cigarettes smoked per day, being in preparation stage of change, and more pharmacotherapy-assisted quit attempts during the original 24-month trial. Higher motivation to quit and more previous pharmacotherapy-assisted quit attempts significantly predicted cessation medication use. Use of varenicline was strongly associated with cessation.
  
  
  CONCLUSIONS
  Many recalcitrant rural smokers continue to engage in treatment and make quit attempts even in the absence of active interventions.
authors.affiliation: Department of Psychosocial and Behavioral Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Siu-Kuen Azor
authors.initials: SK
authors.lastname: Hui
authors.forename: Niaman
authors.initials: N
authors.lastname: Nazir
authors.forename: Babalola
authors.initials: B
authors.lastname: Faseru
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
mesh_terms: D000293:Adolescent; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D057566:Self Report; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D055815:Young Adult