![]() Those who will have an easier time quitting will succeed on early attempts, whereas those who struggle may repeatedly try and relapse, making the average success rate for early quit attempts higher than subsequent ones. We should expect that the average chance of success will decrease over repeated quit attempts. However, the real number of attempts needed to succeed should be even higher, as the assumption of independence of quit attempts is not realistic. 4, 9, 14, 15 Thus, we should expect, a priori, that the lifetime number of quit attempts should be substantially higher than the five to seven attempts figure. If it does take five to seven attempts on average as suggested, then one must assume that the success rate for each attempt is somewhere between 14% and 20%-a figure that does not consistently align with the literature for long-term success. If we assume that each quit attempt is an independent event, this allows us to use basic probability to come up with the geometric mean, which is calculated by dividing 1 by the probability of that event. ![]() If it did take five to seven attempts to quit successfully, at an average of one quit attempt per year, we would expect to see very few smokers over the age of 30 years. 13 While Borland’s study does not directly address the question of average number of quit attempts taken before quitting successfully, it demonstrates that smokers attempt to quit at the rate of approximately once per year. Borland et al used data from the longitudinal International Tobacco Cohort to estimate that the average smoker had made 40 attempts by the age of 40. One study suggests that these estimates are too low. Consequently, we should expect that the real number of attempts prior to quitting successfully should be substantially higher than these estimates. 13 These estimates are also biased as they only account for successful quitting among people who are able to quit and do not consider all quit attempts from those whose data were censored-those who have yet to succeed. The number of recalled quit attempts is significantly lower in cross-sectional assessments compared with longitudinal assessments. However, the use of cross-sectional data has severe limitations, as it depends on a smoker's ability to remember past quit attempts over a lifetime. 11 Similarly, the estimate of 12–14 attempts reported by Zhu et al 12 was derived from cross-sectional data in California. 10 The cross-sectional Canadian Tobacco Use Monitoring Survey reported that former smokers had 3.2 prior quit attempts. For instance, a recent Gallup poll of Americans found that former smokers had made an average of 6.1 quit attempts before quitting successfully. Current estimates appear to come from recalled lifetime quit attempts among smokers who had successfully quit. We know that the likelihood of quitting smoking on any given quit attempt is low 9 however, providing an accurate determination of the number of quit attempts the average smoker takes to succeed is extremely difficult. 5 One document on smoking cessation by a maker of smoking cessation medication 6 cites that most smokers quit five to seven times before they succeed, referencing a review article, 7 which refers to a 1995 Epidemiological Review article 8 that only indirectly refers to this statistic. 4 Many practitioners believe that it takes five to seven attempts. 3 The Centers for Disease Control and Prevention suggests 8–11 attempts before quitting permanently. For instance, the American Cancer Society suggests that it takes 8–10 quit attempts, 2 while the Australian Cancer Council suggests that it is 12–14 attempts. Alternatively, knowing the average number of quit attempts may be a deterrent to continue trying.įor this reason, the number of quit attempts it takes before smokers are successful at quitting is a statistic that figures prominently in much of the literature on smoking cessation programmes. This information can be used to inform smoking cessation advice and important messages to stay engaged in the process of quitting. Knowing how many quit attempts it takes an average smoker to quit is important as it can frame different narratives about the quitting process. Smoking cessation is a difficult and complex process, and smokers use many methods and approaches to achieve cessation. Mark Twain is reported to have said, ‘Quitting smoking is easy: I've done it thousands of times’. 1 Yet, despite the widespread awareness of the harms of smoking, millions continue to smoke around the world partly due to the difficulty it takes to quit smoking. Five million deaths each year are attributable to smoking, with an estimated rise to as much as 10 million deaths per year by the 2030s. Tobacco use is the number one cause of preventable mortality.
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