Smoking Cessation Trends: A Comparative Literature Review

Introduction and Scope of the Review

This paper presents a chronologically organized literature review comparing trends in smoking cessation. The chronological approach helps interpret how studies have been conducted over time to investigate smoking trends and their impact on the cessation of this health-risking habit. It also makes visible which factors have attracted the most research attention across different periods.

Age and Gender Trends in Smoking Cessation

An early relevant study was conducted in Taiwan, observing the time trend for smoking cessation alongside secondhand smoke exposure (Chiang & Chang, 2016). Demographic characteristics and relevant variables were taken into account. The results showed that older people had higher smoking cessation rates than younger ones. Among females, the persistence for smoking was greater than among men, meaning women were less inclined toward cessation.

A gender-focused study similarly found that women have a harder time quitting smoking than men (Smith et al., 2016). Although the study did not employ a time trend, it still provides substantial evidence that former women smokers were more likely to return to current smoking. The abstinence rate for women was lower than for men, especially over longer periods.

Two distinct trends were explored in a 2019 study in which gender and geographical location were examined in relation to smoking cessation across particular decades. The results showed that women around age 30 who were born between 1980 and 2010 had higher rates of smoking cessation in most regions, while men showed greater cessation rates during the 2000s — specifically in Eastern, Southern, and Western Europe (Pesce et al., 2019).

Another study was conducted to determine trends in tobacco use and smoking cessation, with age as the primary focus. Analyzing trends from 2001 through 2014, the researchers drew on data from the Behavioral Risk Factor Surveillance System (BRFSS) for individuals aged 65 and older (Nishi et al., 2019). The results showed that only two individuals per year claimed Medicare counseling services for tobacco cessation at the outset. When Medicare and CMS introduced new counseling session types in subsequent years, the counseling rate increased considerably from 2012 to 2014.

Geographic and Social Norm Influences

One of the more recent studies revealed that social norms around smoking were evident across particular time periods, suggesting that time-trend analysis has been of ongoing interest to researchers. The geographical regions selected — Canada, the United Kingdom, the United States, and Australia — were drawn from the longitudinal International Tobacco Control Four Country Survey, spanning wave 1 through wave 9 (2002 to 2015) (East et al., 2021). When close friends smoked, cessation rates were lower among daily smokers, and this pattern remained consistent between 2002 and 2015, except in 2006 and 2007, when cessation was observed to be higher. This pattern was most pronounced in the United States and least pronounced in the United Kingdom relative to Canada and Australia.

A long-term epidemiological study also examined hazards of smoking alongside cessation trends. Covering smoking-related diseases and deaths from 1960 to 2020, it found that the prevalence of former smokers in their middle years was high, and that this group quit smoking more effectively than older or younger cohorts (Jha, 2020). Tobacco control is comparatively more feasible for this age group. When there is a long delay between the start of the habit and an attempt to quit, cessation becomes more difficult, and many individuals relapse.

Conclusion and Implications for Cessation Interventions

The literature review demonstrates that most studies have been conducted using time and age trends, while some focus specifically on gender trends in smoking cessation. The time trends examined cover cessation patterns from as early as 1960 or 1980 through to 2010 or 2019. Moreover, females have been found to experience greater difficulty quitting smoking, and their periods of abstinence tend to be shorter than those of men. This stands in contrast to evidence that younger women around age 30 show higher cessation rates — most likely linked to pregnancy-related health motivations. Older adults also tend to quit once diagnosed with serious illnesses such as COPD. Social norms and demographic characteristics further play significant roles: when close friends smoke and when education levels are lower, individuals find it harder to quit, regardless of whether they are daily or former smokers.

Comparing age and time trends suggests that smoking cessation interventions depend primarily on behavioral and pharmacological therapies (United States Public Health Service Office of the Surgeon General, 2020). The combination of both approaches has been found to be most effective; however, when used separately, each approach can still be effective for specific ethnic groups, age groups, genders, or socioeconomic classes. A time-trend framework may be particularly valuable for studying cessation interventions, since people of different age groups are aging through different historical periods. Their willingness to quit at a particular age can be examined more precisely within that framework. For example, a person who was a teenager in the 1980s and is now an adult in the 2000s could be studied comparatively for the onset of smoking, the duration of the habit, and their readiness to quit in adulthood.

References

Chiang, C. & Chang, H. (2016). A population study on the time trend of cigarette smoking, cessation, and exposure to secondhand smoking from 2001 to 2013 in Taiwan. Population Health Metrics, 14. https://doi.org/10.1186/s12963-016-0109-x

East, K. A., Hitchman, S. C., McNeill, A., Ferguson, S. G., Yong, H., Cummings, K. M., Fong, G. T., & Borland, R. (2021). Trends in social norms towards smoking between 2002 and 2015 among daily smokers: Findings from the International Tobacco Control Four Country Survey (ITC 4C). Nicotine and Tobacco Research, 23(1), 203–211.

GBD 2019 Tobacco Collaborators. (2021). Spatial, temporal and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019. The Lancet. )01169-7

He, H., Pan, L., Cui, Z., Sun, J., Yu, C., Cao, Y., Wang, Y., & Shan, G. (2020). Smoking prevalence, patterns, and cessation among adults in Hebei province, Central China: Implications from China National Health Survey (CNHS). Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.00177

Jha, P. (2020). The hazards of smoking and the benefits of cessation: A critical summation of the epidemiological evidence in high-income countries. eLife, 9, e49979.

Nishi, S. P. E., Zhou, J., Kuo, Y., Sharma, G., & Goodwin, J. (2019). Trends in tobacco use and tobacco cessation counseling codes among Medicare beneficiaries, 2001–2014. BMC Health Services Research, 19. https://doi.org/10.1186/s12913-019-4368-7

Pesce, G., Marcon, A., Calciano, L., Perret, J. L., Abramson, M. J., Bono, R., Bousquet, J., Fois, A. G., Janson, C., Jarvis, D., Jogi, R., Leynaert, B., & Nowak, D. (2019). Time and age trends in smoking cessation in Europe. PLOS ONE, 14(2). https://doi.org/10.1371/journal.pone.0211976

Smith, P. H., Bessette, A. J., Weinberger, A. H., Sheffer, C. E., & McKee, S. A. (2016). Sex/gender differences in smoking cessation: A review. Preventive Medicine, 92, 135–140. https://doi.org/10.1016/j.ypmed.2016.07.013

United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. (2020). Smoking cessation: A report of the Surgeon General — Chapter 6, interventions for smoking cessation and treatments for nicotine dependence [Internet]. US Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK555596/