Understanding the evidence about the comparative success of smoking cessation methods: choice, second-order preferences, tobacco harm reduction, and other neglected considerations

Note that this is a working paper, not a study per se. The first version appeared on Nov 2014, this version is dated 22 February 2015

Published: Not yet

Positive: Yes

Link to publication: http://ep-ology.com/2014/11/24/working-paper-phillips-nissen-rodu-understanding-the-evidence-about-the-comparative-success-of-smoking-cessation-methods-choice-second-order-preferences-tobacco-harm-reduction-and-other-neglecte/


Carl V Phillips

Catherine M Nissen

Brad Rodu


The extensive research on choices about smoking and the methods people use to quit is almost always interpreted in naïve and unhelpful ways. This is partially due to treating smoking cessation as if it were medical disease treatment, despite the fundamental differences, most notably that smoking is a choice that has benefits as well as costs]. The main problem, however, seems to be a failure to recognize what it means when someone indicates they want to quit smoking. An understanding of the preferences that motivate smoking and cessation allows us to categorize would – be quitters, par ticularly identifying the difference between first – and second – order preferences for quitting. This demonstrates the absurdity of attempts to determine what cessation method is “best” or even “better”, as well as explaining the frequent failure of medical interventions. This analysis offers advice for both readers of the research and those who wish to quit smoking.


There are an enormous number of studies of smoking cessation methods, and a new wave that includes e – cigarettes has begun. However, these seem to play the role of Rorschach test rather than aid to useful policy and education, or perhaps the “support, not enlightenment” role of the lamppost for the inebriated. They are interpreted as supporting the observer’s political bias about cessation methods, which may be based on other empirical observations or mere ideology. Even attempts at unbiased observations suffer from a failure to understand that the study of consumer preferences differs dramatically from medical treatment research, and must be interpreted with the eye of a social scientist.

Consideration of the different categories of smokers presented here is crucial to both an informed interpretation of research and useful advice for smokers. Methods to aid smokers to understand their true preferences, and thus what might be a desirable quitting approach, follow naturally from these observations, particularly helping smokers to reflect on their motivations and desires. Standard methods for categorizing smokers or including covariates in studies can help discriminate among these categories of would – be quitters, but are likely to only be useful if explicitly interpreted in that context. For example, intensity – of – desire variables, like the standard “how soon after you wake up do you have your first cigarette”, might be used to identify subjects who are more likely to be in Category 1 rather than one of the other categories and thus allow better interpretation of the data. Blindly throwing those variables into statistical models without such structure, however, is unlikely to be particularly informative.

Unbiased and thoughtful interpretation of smoking cessation study results could provide much useful information about how to advise smokers who want to quit. But very little of that seems to be occurring. If helping people who want to quit, or want to want to quit – rather than just generating revenue or rhetoric – is the goal of the research, then some more serious attention to the nature of the phenomena being studied is in order, with smokers seen as consumers with first – and second – order preferences that drive their behavior, rather than as patients with an illness for whom assigning a cure would be appropriate.

Full text: phillips-nissen-rodu-smoking-or-quitting-neglected-considerations