Impact of referral sources and waiting times on the failure to quit smoking: One-year follow-up of an italian cohort admitted to a smoking cessation service

Lucia Borsari, Simone Storani, Carlotta Malagoli, Tommaso Filippini, Marco Tamelli, Marcella Malavolti, Fausto Nicolini, Marco Vinceti

Research output: Contribution to journalArticle


In Italy, the National Health Service offers specialized evidence-based support to smokers who would like to quit through smoking cessation (SC) services. We conducted a two-year prospective study, involving all 288 subjects treated for smoking cessation at the SC service of Reggio Emilia, to assess the association of referral sources and waiting times with the risk of treatment failure, by following participants up to one year after the quit date. We performed Cox-regression analysis, including demographic and smoking-related characteristics as confounding variables. The treatment failure rate at 12 months was 59.4% (171/288), including only 12 subjects lost to follow-up. The main mode of entry was self-referral (42.4%), followed by 32.6% from general practice, 17.4% from hospital and 7.6% from other sources. Only 27.8% participants were involved in the SC-program within 60 days of the first contact, as the guidelines suggest. The risk of treatment failure at 12 months showed little association with the type of referral source, while it correlated with waiting times ≥ 60 days (hazard ratio = 1.59; 95% confidence interval 1.10-2.29). This study provides evidence of long-term high quit rates from a SC service, with few subjects lost to follow-up and biochemical verification of almost all abstinent subjects. Timeliness in care provision could further improve the outcome.

Original languageEnglish
Article number1234
JournalInternational Journal of Environmental Research and Public Health
Issue number6
Publication statusPublished - Jun 11 2018



  • Referral
  • Smoking cessation
  • Smoking cessation services
  • Tobacco smoking
  • Waiting times

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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