When Quitting Smoking, Does ‘Every Try Count’?

Carl V. Phillips | Contributor

The FDA’s latest anti-smoking campaign, entitled “Every Try Counts,” tells smokers not to lament failed quit attempts. Rather, smokers are told that even attempts that quickly end in resuming smoking – as happens for about 90 percent of quit attempts – should be thought of positively, as practice or part of a process. The campaign primarily consists of point-of-sale advertising and a website with associated online tools.

There is little that is novel about this campaign, with its same-old “motivational” messages and tools that serve only as focusing events. The novel bit is telling smokers that it is just fine to try and fail to quit. Perhaps this is helpful, as the FDA claims (though there is no apparent research or analysis to support this assertion). It might be that it raises smokers’ welfare, reducing the typical adding-insult-to-injury effect of being embarrassed about failing. That alone is worth something.

It might even motivate additional quit attempts, some of which will succeed. A few smokers might think, “Ok, I will try to quit today, even though I expect to fail, because that failure is still a success.” This message is consistent with established cognitive-behavioral therapy techniques, in which people are assigned to go out and fail (e.g., to be rejected by a potential new friend or date, or to write a terrible draft chapter of their novel). This can break the paralyzing hesitation to even try due to fear of failure. However, this typically is an explicit exercise in trying to collect failures, and the FDA’s message does not really go far enough to accomplish this.

As it typical for tobacco control, there is no evidence this message will have any benefits. The program will never be seriously evaluated. Tobacco control efforts are based on a vague feeling that the intervention might have some positive effect, with a thick layer of rhetoric, not any real science.

Moreover, there is a serious downside of this message. To the FDA, this is probably seen as a feature, not a bug, which might explain why they are rolling out this message now. Thanks to vaping, it has become increasingly clear to smokers that switching to a low-risk alternative (if that product is at all appealing to them) is much less likely to fail than other methods for quitting. That was actually also true for smokeless tobacco, before vaping, but fewer smokers knew it was a good option.

But the FDA (and their partner in this, the National Cancer Institute) takes the anti-tobacco extremist position, that (approximately) eliminating the health risk by switching is much worse than becoming abstinent of all products. The extremist position is that the total number of product users, rather than health risks or other real concerns, is what matters most. This is why they report “total tobacco product users” – a meaningless statistic for any practical purpose – and bemoan any increase, even when smoking is down and it is only (approximately harmless) vaping that is up.

They would rather have a smoker try to quit through abstinence, and probably fail, than for her to switch to vaping. The message that smokers should delight in their failed quit attempts thus appears to be designed to discourage successful switching.

This message is deadly. A failed quit attempt is not harmless, as I explained in a paper entitled “Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative.” That analysis shows that just a few weeks of additional smoking is more harmful than a lifetime of low-risk product use. Even if we assume the alternative products are somewhat harmful, switching is still lower-risk than the failed quit attempts that the FDA is now encouraging.

If we assume that a low-risk alternative like vaping poses 1 percent the risk of smoking (which is a pessimistic assumption), then just a couple of months of additional smoking poses more health risk than a lifetime of using the alternative. A more realistic (i.e., lower) estimate of the risk from vaping or smokeless tobacco use shrinks this to weeks or days. (And, of course, zero risk reduces it to zero time.) Failed quit attempts cause people to smoke for months or years more, and this increases their health risk.

Put another way, quitting sooner rather than later is what matters most. How likely a smoking cessation method is to succeed is far more important than the method. From a health perspective, a failed quit attempt is more harmful than using an alternative product like vaping, even under the assumption that those products are substantially harmful. Only someone who cares about head counts, rather than body counts, would commend a failed attempt to become abstinent over a more promising attempt to switch.

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Carl V. Phillips

Contributor

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