Factors Influencing Smoking Cessation Success in an Outpatient Clinic: A Cross-Sectional Study

Year 2025, Volume: 26 Issue: 4, 485 - 496, 30.12.2025

Hasan Özcan Demir , Furkan Alp Eren , Hacer Hicran Mutlu

https://doi.org/10.51982/bagimli.1706693

Abstract

Objective: Smoking remains a major global health issue, contributing to millions of preventable deaths annually. Effective smoking cessation strategies combine pharmacotherapy and behavioral support, yet real-world data on factors influencing treatment success in outpatient settings, particularly in Türkiye, are limited. The aim of this study was to evaluate the effectiveness of pharmacological treatment in a smoking cessation outpatient clinic and identify factors associated with cessation success.
Method: This cross-sectional observational study included 203 adult smokers initiating pharmacological treatment at a tertiary hospital in Istanbul between April and October 2023. After excluding 22 patients lost to follow-up, 181 participants were analyzed. Data were collected via face-to-face interviews, the Fagerström Test for Nicotine Dependence (FTND), and 3-month follow-up calls. Bivariate analyses and multivariate logistic regression identified predictors of cessation success.
Results: At 3-month follow-up, 28.6% of participants successfully quit smoking. Significant predictors of cessation included follow-up attendance (OR=0.18, p<0.001), lower nicotine dependence (OR=1.33, p=0.011), combination therapy (bupropion + nicotine replacement therapy; p=0.001), and employment status (OR=0.39, p=0.036). Age, gender, education, and income were not significantly associated with outcomes.
Conclusion: Pharmacotherapy, particularly combination therapy, combined with follow-up visits and tailored to nicotine dependence levels, enhances smoking cessation success. Sustained behavioral support and adherence-focused strategies are critical for optimizing outcomes in clinical practice.

Keywords

Smoking Cessation , Tobacco Use Disorder , Treatment Outcome , Pharmacotherapy

Ethical Statement

This study was conducted at the Family Medicine Smoking Cessation Outpatient Clinic of a tertiary care hospital in Istanbul, and was approved by the Clinical Research Ethics Committee of Istanbul Medeniyet University Göztepe Training and Research Hospital with the decision number 2023/0246 dated April 12, 2023. Written informed consent was obtained from all participants. The study was carried out in accordance with the principles of the Declaration of Helsinki.

Sigara Bırakma Polikliniğinde Tedavi Başarısını Etkileyen Faktörler: Kesitsel Bir Çalışma

Abstract

Amaç: Sigara kullanımı, her yıl milyonlarca önlenebilir ölüme neden olan küresel bir sağlık sorunudur. Etkili sigara bırakma stratejileri farmakoterapi ve davranışsal desteği birleştirse de, özellikle Türkiye’de ayakta tedavi ortamlarında tedavi başarısını etkileyen faktörler üzerine gerçek dünya verileri sınırlıdır. Bu çalışmanın amacı sigara bırakma polikliniğinde farmakolojik tedavinin etkinliğini değerlendirmek ve bırakma başarısı ile ilişkili faktörleri belirlemektir.
Yöntem: Bu kesitsel gözlemsel çalışma, Nisan-Ekim 2023 tarihleri arasında İstanbul’daki bir üçüncü basamak hastanede farmakolojik tedavi başlatan 203 yetişkin sigara içicisini içermiştir. Takipte kaybedilen 22 hasta hariç tutularak, 181 katılımcı analiz edilmiştir. Veriler yüz yüze görüşmeler, Fagerström Nikotin Bağımlılığı Testi (FTND) ve 3 aylık takip aramaları yoluyla toplanmıştır. İkili analizler ve çok değişkenli lojistik regresyon, bırakma başarısının öngörücülerini belirlemiştir.
Bulgular: Üç aylık takipte, katılımcıların %28,6’sı sigarayı başarıyla bırakmıştır. Bırakma başarısının anlamlı öngörücüleri arasında takip vizitlerine katılım (OR=0,18, p<0,001), düşük nikotin bağımlılığı (OR=1,33, p=0,011), kombine tedavi (bupropion + nikotin replasman tedavisi; p=0,001) ve istihdam durumu (OR=0,39, p=0,036) yer almıştır. Yaş, cinsiyet, eğitim ve gelir düzeyi ile sonuçlar arasında anlamlı bir ilişki bulunmamıştır.
Sonuç: Farmakoterapi, özellikle kombine tedavi, takip vizitleriyle desteklendiğinde ve nikotin bağımlılık düzeyine göre uyarlandığında sigara bırakma başarısını artırmaktadır. Sürekli davranışsal destek ve uyum odaklı stratejiler, klinik uygulamalarda sonuçları optimize etmek için kritik öneme sahiptir.

Keywords

Sigara Bırakma , Tütün Kullanım Bozukluğu , Tedavi Sonucu , Farmakoterapi

Ethical Statement

Bu çalışma, İstanbul’daki bir üçüncü basamak sağlık kuruluşunun Aile Hekimliği Sigara Bırakma Polikliniği’nde yürütülmüş olup, İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Klinik Araştırmaları Etik Kurulu tarafından 12.04.2023 tarihli ve 2023/0246 sayılı karar ile etik kurul onayı alınmıştır. Çalışmaya katılan tüm bireylerden yazılı bilgilendirilmiş onam alınmıştır. Araştırma sürecinde Helsinki Bildirgesi ilkelerine uyulmuştur.

References

• World Health Organization. Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco (Accessed 26.04.2025)
• Bilir N, Çakır B, Dağlı E, et al. Tobacco Control in Turkey. Copehnhagen, World Health Organization.
• Le Foll B, Piper ME, Fowler CD, et al. Tobacco and nicotine use. Nat Rev Dis Primers 2022; 8(1): 19.
• Rennard SI, Daughton DM. Smoking cessation. Clin Chest Med 2014; 35(1): 165-176.
• Nadkarni A, Gaikwad L, Sequeira M, et al. Behavioral interventions for tobacco cessation in low- and middle-income countries: a systematic review and meta-analysis. Nicotine Tob Res 2025; 27(5): 575–585.
• Argüder E, Karalezli A, Hezer H, et al. Factors affecting the success of smoking cessation. Turk Thorac J 2013; 14(3): 81-87.
• Heckman CJ, Egleston BL, Hofmann MT. Efficacy of motivational interviewing for smoking cessation: a systematic review and meta analysis. Tob Control 2010; 19(5): 410–416.
• Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev 2016; 3(3): 82-86.
• Fiore M, Jaén CR, Baker TB, et al. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med 2008; 35(2): 158-176.
• Patel AR, Panchal JR, Desai CK. Efficacy of varenicline versus bupropion for smoking cessation: a systematic review and meta-analysis of randomized controlled trials. Indian J Psychiatry 2023; 65(5): 526–533.
• Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013; 2013(5): CD009329.
• Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012; 11: CD000146.
• Chang PH, Chiang CH, Ho WC, et al. Combination therapy of varenicline with nicotine replacement therapy is better than varenicline alone: a systematic review and meta-analysis of randomized controlled trials. BMC Public Health 2015; 15: 689.
• Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet 2016; 387(10037): 2507–2520.
• Hughes JR, Stead LF, Hartmann-Boyce J, et al. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2014; 11(11): CD000031.
• Acar T, Gallagher C, Gören Y, et al. Determinants of smoking cessation outcomes and reasons for relapse in patients admitted to a smoking cessation outpatient clinic in Turkey. Int J Environ Res Public Health 2024; 21(3): 310.
• Bayram T, Görçin Karaketir Ş, Özer F, et al. Accessibility of smoking cessation clinics in Turkey: a descriptive study among a population of smokers in İstanbul. Turk J Public Health 2022; 20(3): 280–293.
• Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström test for nicotine dependence: a revision of the fagerström tolerance questionnaire. Br J Addict 1991; 86(9): 1119-1127.
• Uysal MA, Kadakal F, Karşidağ C, et al. Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tuberk Toraks 2004; 52(2): 115-121.
• Marqueta A, Nerín I, Gargallo P, Beamonte A. Gender differences in success at quitting smoking: short- and long-term outcomes. Adicciones 2016; 29(1): 13-21.
• Chatkin JM, Abreu CM, Blanco DC, et al. No gender difference in effectiveness of smoking cessation treatment in a Brazilian real-life setting. Int J Tuberc Lung Dis 2006; 10(5): 499-503.
• Esmer B, Sengezer T, Aksu F, et al. Clinical, sociodemographic and tobacco-use factors associated with smoking cessation rates at three years follow-up, Ankara, Turkey. Tob Prev Cessat 2019; 5(12): 47.
• Oshio T. Association between successful smoking cessation and changes in marital and job status and health behaviours: evidence from a 10-wave nationwide survey in Japan. BMC Public Health 2018; 18(1): 1051.
• Luu NM, Tran TTH, Luong NK, et al. Smoking cessation, quit attempts and predictive factors among Vietnamese adults in 2020. Asian Pac J Cancer Prev 2023; 24(5): 1701-1710.
• Fagan P, Shavers V, Lawrence D, et al. Cigarette smoking and quitting behaviors among unemployed adults in the United States. Nicotine Tob Res 2007; 9(2): 241-248.
• Monsó E, Campbell J, Tønnesen P, et al. Sociodemographic predictors of success in smoking intervention. Tob Control 2001; 10(2): 165-169.
• Nargis N, Yong HH, Driezen P, et al. Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: emerging evidence from the global adult tobacco surveys and international tobacco control surveys. PLoS One 2019; 14(9): 220-223.
• Irvin Vidrine J, Reitzel LR, Wetter DW. The role of tobacco in cancer health disparities. Curr Oncol Rep 2009; 11(6): 475-481.
• İpek E. Türkiye’de alkol katılım ve tüketim kararları üzerine ampirik bir çalışma. Sosyoekonomi 2019; 27(41): 57-70.
• Dikmen N. Türkiye’de sigara tüketimi ve tüketimi etkileyen değişkenler üzerine bir model çalışması. Atatürk Üniversitesi İktisadi Ve İdari Bilimler Dergisi 2010; 19(1): 1-19.
• Erdem F, Altun M, Üçüncü E, et al. Aile hekimliği polikliniğinde sigara bırakma durumunun değerlendirilmesi. Turkish Journal of Family Medicine and Primary Care 2021; 15(4): 707-714.
• Solak ZA, Göksel T, Erdinç E, Üstün H. Sigara ile ilişkili ciddi akciğer hastalığı olanların sigara içen yakınlarında sigara bırakma tedavisinin başarısı. Turk Thorac J 2002; 3(3): 248-252.
• Gao X, Shen F, Li S, et al. The estimated influence of assumed physicians’ advice for tobacco smoking cessation among current smokers in Shanghai, China: A cross-sectional study. Tobacco Induced Diseases 2022; 20(10): 86.
• Lee CW, Kahende J. Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health 2007; 97(8): 1503-1509.
• Onen ZP, Sen E, Eriş Gülbay B, et al. Farklı tedavi yöntemlerinin sigara bırakma başarısı üzerine etkileri [Comparing the effectiveness of different treatment modalities on the smoking cessation rates]. Tuberk Toraks 2010; 58(4): 385-392.
• Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999; 340(9): 685-691.
• Santiago-Torres M, Mull KE, Sullivan BM, et al. Evaluating the impact of pharmacotherapy in augmenting quit rates among Hispanic adults in an app-delivered smoking cessation intervention: secondary analysis of a randomized controlled trial. JMIR Form Res 2025; 9(1): e69311.
• Livingstone-Banks J, Vidyasagaran AL, Croucher R, et al. Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev 2025; 4(4): CD015314.
• Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013; 2013(5): CD009329.
• Dale LC, Glover ED, Sachs DP, et al. Bupropion for smoking cessation: predictors of successful outcome. Chest 2001; 119(5): 1357-1364.
• Chatkin JM, Mariante de Abreu C, Haggsträm FM, et al. Abstinence rates and predictors of outcome for smoking cessation: do Brazilian smokers need special strategies? Addiction 2004; 99(6): 778-784.
• Yaşar Z, Kar Kurt Ö, Talay F, Kargı A. One-year follow-up results of smoking cessation outpatient clinic: factors affecting the cessation of smoking. Eurasian J Pulmonol 2014; 16(2): 99-104.
• Pekel Ö, Ergör G, Günay T, et al. Smoking cessation and the effect of nicotine dependence on relapse rate in Izmir, Turkey. Turk J Med Sci 2015; 45(4): 895-901.
• Halpern MT, Warner KE. Motivations for smoking cessation: a comparison of successful quitters and failures. J Subst Abuse 1993; 5(3): 247-256.
• Murriky A, Allam E, Alotaibi H, et al. The relationship between nicotine dependence and willingness to quit smoking: a cross-sectional study. Prev Med Rep 2025; 53(1): 103066.