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DURHAM, N.C. -- Researchers at Duke University Medical Center and the Durham V.A. Medical Center say the psychological impact of taking even a single puff of a cigarette on a pre-set "quit day" means a smoker will probably go back to smoking within six months.

The researchers studied 200 smokers who wanted to quit and concluded that people who can't go "cold turkey" likely have a high physiological nicotine craving and probably won't be successful quitting on their own with nicotine patches.

"Few studies have been done to determine which smokers are more likely to benefit from nicotine patches," said Dr. Eric Westman, the study's lead author. "This is important because a failed quit attempt can be demoralizing and discourage many people from trying again. As physicians, we need to be able to give our patients the best shot at quitting. This study is a step in that direction."

Although nicotine skin patches double the chances of long-term success quitting smoking, only about one in four smokers who use the patch is still smoke free after six months. Westman, assistant professor medicine at Duke and medical director of the Duke-V.A. Nicotine Research Program, and colleagues Frederique Behm, Dr. David Simel and Jed Rose, co-inventor of the nicotine skin patch, reported their findings in the Feb. 10, 1997, issue of the Archives of Internal Medicine. Based on their findings, the researchers propose a simple one-day observational test to identify which smokers are more likely to be successful quitting smoking using nicotine skin patches. The study was supported by the Department of Veterans Affairs.

"We found that people who smoke on their quit day are much more likely to go back to smoking within six months," said Westman. "This finding contradicts the common idea that people can cheat, even just a little, and still quit smoking. Our findings indicate that setting a definite quit date, and sticking to it, is important for long-term success."

In addition, Westman notes, knowing nicotine patches may not work can save patients considerable money. Over-the-counter nicotine patches cost an average of $4 a day or $220 for an eight-week treatment.

Previous studies used a two-week trial period to determine which smokers are likely to be successful quitting smoking using a nicotine patch, at an average cost of $56. The Duke study narrows that window to one day, which could save the smoker both money and frustration.

"If the smoker still craves cigarettes using a single patch after one day, a physician could suggest adding a second patch, or suggest a more intensive method," said Westman.

The researchers conducted two sequential studies with healthy smokers who smoked at least one pack of cigarettes a day and wanted to quit smoking. The smokers selected a quit date two weeks in advance to prepare themselves for the quit attempt. Smokers completed a daily diary of the number of cigarettes smoked, and any withdrawal symptoms and cravings they experienced. Any self-reported smoking, even one puff, was counted as smoking in the analysis.

They found 25 percent of people were still not smoking after six months, which is comparable to other such studies. Of these, only 3 of 31 had smoked on the quit date. Conversely, 106 of 173 people who failed had smoked on the quit date. When the researchers combined smoking on the quit date and nicotine craving, they found of those who smoked on the quit date and also had a high nicotine craving, 98 percent were back to smoking after six months.

Based on their findings, the researchers have developed a simple series of questions to guide smokers and their doctors in determining if nicotine patches are for them.

Did the person smoke on the quit date? If so, the odds of being smoke free at six months are tenfold less than if he or she had not smoked on the quit date. For example, if a person's chances of quitting smoking at six months is one in four, it is one in 40 if the person smokes on the quit date. Does the person smoking have a high or low nicotine craving? If cravings are low, the person has a fourfold better chance of success. The study showed that among smokers who didn't smoke on the quit date, 41 percent of the low-craving group were still smoke-free after six months, versus only 18 percent of the high-craving group.

The researchers measured nicotine dependence by asking questions such as how many cigarettes they smoke, how often, and how early in the morning they have their first cigarette.