Clinical Prediction Model for Predicting Risk of Failure from Non-Pharmacological Treatment in Smoking Cessation
Article Sidebar
Main Article Content
Abstract
In Thailand, smoking cessation treatment primarily relies on counseling. Identifying patients at risk of treatment failure early could help healthcare providers tailor more effective interventions. This study aimed to develop a clinical prediction model to assess the risk of failure in non-pharmacological smoking cessation therapy. Retrospective cohort data were collected from medical records at the Rangsit FahSai Clinic, Rangsit University, between June 18, 2014, and November 16, 2023. The primary outcome was treatment failure at six months post-treatment. Stepwise backward logistic regression was used to develop the model. Discriminative performance was assessed using the area under the receiver operating characteristic (ROC) curve, while calibration was evaluated with calibration plots and the Hosmer-Lemeshow goodness-of-fit test. A total of 316 participants were included, with an 81.3% treatment failure rate. Clinical prediction factors included stage of change, severity of nicotine dependence, gender, having a spouse/partners/children, and health issues. The model showed acceptable discrimination (AUC = 0.76, 95% CI [0.69, 0.82]) and accurate predictions, as indicated by the calibration plot and the Hosmer-Lemeshow goodness-of-fit test (p = 0.479). Patients scoring 5.5 or higher on the 11-point prediction model should be considered for pharmacological interventions to improve cessation outcomes.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
• Caponnetto, P., & Polosa, R. (2008). Common predictors of smoking cessation in clinical practice. Respiratory Medicine, 102(8), 1182–1192. https://doi.org/10.1016/j.rmed.2008.02.017
• Centers for Disease Control and Prevention (CDC). (2021). A practical guide to help your patients quit using tobacco. https://www.cdc.gov/tobacco/hcp/patient-care/clinical-cessation-tools.html
• Choi, H.-S., Sohn, H.-S., Kim, Y.-H., & Lee, M.-J. (2012). Bogeonso geumyeon keullinik yukgaewol geumyeonseonggongja-ui geumyeon jisok silpae yoin [Factors associated with failure in the continuity of smoking cessation among 6-month smoking cessation successes in public health center smoking cessation clinics]. Journal of the Korea Academia-Industrial Cooperation Society, 13(10), 4653–4659. https://doi.org/10.5762/KAIS.2012.13.10.4653
• Esen, A. D., Soylem, Y., Arica, S., Belgin, G., & Gonultas, N. (2020). Factors affecting success and abstinence within a smoking cessation clinic: A one-year follow-up study in Turkey. Tobacco Prevention & Cessation, 6, Article 71. https://doi.org/10.18332/tpc/130471
• European Network for Smoking and Tobacco Prevention (ENSP). (2020, October 14). 2020 guidelines for treating tobacco dependence. https://ensp.network/2020-guidelines-english-edition/
• Fu, R., Schwartz, R., Mitsakakis, N., Diemert, L. M., O’Connor, S., & Cohen, J. E. (2022). Predictors of perceived success in quitting smoking by vaping: A machine learning approach. PLOS ONE, 17(1), Article e0262407. https://doi.org/10.1371/journal.pone.0262407
• Gourlay, S. G., Forbes, A., Marriner, T., Pethica, D., & McNeil, J. J. (1994). Prospective study of factors predicting outcome of transdermal nicotine treatment in smoking cessation. British Medical Journal, 309(6958), 842–846. https://doi.org/10.1136/bmj.309.6958.842
• Kim, Y., & Cho, W. K. (2014). Factors associated with successful smoking cessation in Korean adult males: Findings from a national survey. Iranian Journal of Public Health, 43(11), 1486–1496. https://ijph.tums.ac.ir/index.php/ijph/article/view/3847
• Klemperer, E. M., Mermelstein, R., Baker, T. B., Hughes, J. R., Fiore, M. C., Piper, M. E., Schlam, T. R., Jorenby, D. E., Collins, L. M., & Cook, J. W. (2020). Predictors of smoking cessation attempts and success following motivation-phase interventions among people initially unwilling to quit smoking. Nicotine & Tobacco Research, 22(9), 1446–1452. https://doi.org/10.1093/ntr/ntaa051
• Lai, C. C., Huang, W. H., Chang, B. C., & Hwang, L. C. (2021). Development of machine learning models for prediction of smoking cessation outcome. International Journal of Environmental Research and Public Health, 18(5), Article 2584. https://doi.org/10.3390/ijerph18052584
• Lin, B., Xie, L., Xie, X., Yan, Y., Zhang, L., & Xiao, L. (2023). Predictors for quitting smoking in smoking cessation clinics among female smokers in China. Tobacco Induced Diseases, 21, Article 26. https://doi.org/10.18332/tid/159132
• Longyhore, D. S., & Dombrowski, S. K. (2020). Smoking cessation. In S. Sutton (Ed.), McGraw-Hill’s NAPLEX® review guide (4th ed.). McGraw-Hill Education.
• Mandrekar, J. N. (2010). Receiver operating characteristic curve in diagnostic test assessment. Journal of Thoracic Oncology, 5(9), 1315–1316. https://doi.org/10.1097/JTO.0b013e3181ec173d
• Matichon. (2020, July 17). Doen na “Klinik Fah Sai” chuai khon Thai loek buri khayai kan borikan su chumchon [Moving forward with the “FahSai Clinic” to help Thais quit smoking and expand services to communities]. https://www.matichon.co.th/news-monitor/news_2269946
• Metz, C. N., Gregersen, P. K., & Malhotra, A. K. (2005). Metabolism and biochemical effects of nicotine for primary care providers. Medical Clinics of North America, 88(6), 1399–1413. https://doi.org/10.1016/j.mcna.2004.06.004
• Monsó, E., Campbell, J., Tønnesen, P., Gustavsson, G., & Morera, J. (2001). Sociodemographic predictors of success in smoking intervention. Tobacco Control, 10(2), 165–169. https://doi.org/10.1136/tc.10.2.165
• National Drug Information. (2024). Banchi ya lak haeng chat lae lakthan choeng prajak [National list of essential medicines and evidence-based guidelines]. https://ndi.fda.moph.go.th/drug_national
• National Statistical Office. (2025, April 1). Kan samruat sathanakan kan sub buri lae kan duem khrueang duem thi mi aenkoho khong prachakon Pho. So. 2567 [The 2024 survey on smoking and drinking situation of the population]. https://www.nso.go.th/nsoweb/storage/survey_detail/2025/20250324110058_77905.pdf
• Perkins, K. A. (2012). Smoking cessation in women. Special considerations. CNS Drugs, 15(5), 391–411. https://doi.org/10.2165/00023210-200115050-00005
• Qiu, D., Chen, T., Liu, T., & Song, F. (2020). Smoking cessation and related factors in middle-aged and older Chinese adults: Evidence from a longitudinal study. PLOS ONE, 15(10), Article e0240806. https://doi.org/10.1371/journal.pone.0240806
• Rungreunghiranya, S., & Krobthong, A. (2021). Naew patibat samrap phesatchakon nai kan hai kham pruksā phuea loek buri [Practice guidelines for pharmacists in providing smoking cessation counseling]. Sintaweekit.
• Sherman, J. J. (2013a). Counseling and motivational interviewing. In A. W. Ellis & J. J. Sherman (Eds.), Community and clinical pharmacy services: A step-by-step approach (pp. 29–48). McGraw-Hill.
• Sherman, J. J. (2013b). Smoking cessation. In A. W. Ellis & J. J. Sherman (Eds.), Community and clinical pharmacy services: A step-by-step approach (pp. 161–196). McGraw-Hill.
• Soares de Azevedo, R. C., & Fernandes, R. F. (2011). Factors relating to failure to quit smoking: A prospective cohort study. São Paulo Medical Journal, 129(6), 380–386. https://doi.org/10.1590/S1516-31802011000600003
• Sornpaisarn, B., Parvez, N., Chatakan, W., Thitiprasert, W., Precha, P., Kongsakol, R., Saengow, U., & Rehm, J. (2022). Methods and factors influencing successful smoking cessation in Thailand: A case-control study among smokers at the community level. Tobacco Induced Diseases, 20, Article 67. https://doi.org/10.18332/tid/150345
• Tin, T. S., Sallehuddin, B. A. B., Murniati, H. H., Swinder, J., Al Sadat, N., & Saimy, I. (2012). Factors associated with success or failure of quit attempts: A clinical approach for lung cancer prevention. Asian Pacific Journal of Cancer Prevention, 13(1), 175–179. https://doi.org/10.7314/APJCP.2012.13.1.175
• Tobacco Use and Dependence Guideline Panel. (2008, May). Treating tobacco use and dependence: 2008 update. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK63943/
• Zhou, X., Nonnemaker, J., Sherrill, B., Gilsenan, A. W., Coste, F., & West, R. (2009). Attempts to quit smoking and relapse: Factors associated with success or failure from the ATTEMPT cohort study. Addictive Behaviors, 34(4), 365–373. https://doi.org/10.1016/j.addbeh.2008.11.013
• Zhu, N., Lin, S., Cao, C., Xu, N., Yu, X., & Chen, X. (2020). Nomogram to predict successful smoking cessation in a Chinese outpatient population. Tobacco Induced Diseases, 18, Article 86. https://doi.org/10.18332/tid/127736
• Zhu, N., Lin, S., Dai, L., Yu, H., Xu, N., Huang, W., & Yu, X. (2022). Abrupt versus gradual smoking cessation with pre-cessation varenicline therapy for Chinese treatment-seeking smokers: A retrospective, observational cohort study. Tobacco Induced Diseases, 20, Article 29. https://doi.org/10.18332/tid/145993
