Changes in self-efficacy resulting from unaided attempts to quit smoking.

Investigated changes in smoking self-efficacy as a result of successful and unsuccessful quit attempts. The sample consisted of 182 smokers (aged 19–70 yrs) who planned to quit smoking without professional assistance. Prior to a self-selected quit date, smoking self-efficacy was assessed. Quit status was determined 1, 6, and 12 mo after the quit date. Self-efficacy was reassessed at the 12-mo follow-up. At 12 mo the sample consisted of 44 quitters, 24 continuous smokers, 102 relapsers, and 12 Ss whose smoking status was uncertain. Self-reports of cessation were corroborated by collateral report and confirmed by saliva cotinine analysis. As predicted, quitters increased their self-efficacy, and continuous smokers decreased their self-efficacy from the prequit baseline to the 12-mo follow-up. Relapsers' self-efficacy also dropped significantly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of initial smoking cessation and relapse through the first 2 years of the Lung Health Study.

Analyses were made separately for men and women of the predictors of end-of-treatment (4 months) smoking cessation and subsequent relapse at 12 and 24 months among 3,923 participants enrolled in the Lung Health Study's 12-week cognitive–behavioral group smoking cessation program. Nicotine gum (2 mg) was available to all participants. Men were more likely than women to quit smoking initially, but relapse rates were similar for both genders. Baseline variables associated with initial quitting for both genders included greater education, lower nicotine dependence, and fewer respiratory symptoms. The best predictor of relapse between 4 and 12 months was smoking at least 1 cigarette between quit day and 4 months. Nicotine gum use at 12 months predicted relapse by 24 months for both genders. Greater social and environmental support for quitting smoking were the only factors that predicted both initial quitting and relapse for both genders. Clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized, controlled trial of adding expired carbon monoxide feedback to brief stop smoking advice: Evaluation of cognitive and behavioral effects.

Objective: To determine the effect of adding biomarker feedback (expired air carbon monoxide) to standard quit advice on cognitive antecedents of behavior change and smoking cessation and to identify potential effect moderators and mediators. Design: Smokers (N = 160) were randomized to a control (quit advice plus leaflet) or an intervention condition (as control group plus carbon-monoxide level feedback). Cognitive measures were assessed immediately after the intervention and behavioral measures at 6 months' follow-up. Main Outcome Measures: Primary outcome measures were threat and efficacy appraisal, fear arousal, and intention to stop smoking. Secondary outcome measures were quit attempts within the last 6 months and 7-day point prevalence abstinence. Results: Threat appraisal was significantly enhanced in the intervention compared with the control group, t(158) = 2.29, p = .023, as was intention to stop smoking in the next month, t(151) = 2.9, p = .004. However, this effect on intention to stop smoking was short-lived. Groups did not differ in terms of quit attempts or abstinence at follow-up, but the intervention increased the likelihood of cessation in smokers with higher self-efficacy, χ2(1) = 5.82, p = .016. Conclusions: Carbon-monoxide level feedback enhances the effect of brief quit advice on cognitive antecedents of behavior change and smoking cessation rates but further research is required to confirm the longevity of this effect and its applicability to smokers with low self-efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chorioretinal damage caused by the excision of choroidal neovascularization

BACKGROUND: In recent years many longitudinal studies have examined the predictors of smoking acquisition. However, only a few studies have focused on the precursors of smoking cessation. The current study is one of the first concentrating on longitudinal predictors of young people's smoking cessation. METHODS: Subjects were 215 smokers ages 14-15 years who were reinterviewed 3 years later. These smokers were allocated to four groups based on their motivation to quit and actual quitting behavior at the last wave. Independent variables were smoking-specific cognitions, social influences, and aspects of smoking habits. RESULTS: Univariate comparisons between the four groups showed that those with a positive attitude toward smoking and lower self-efficacy were less likely to be motivated to quit 3 years later. No long-term effects of environmental influences were found. Aspects of smoking habits, such as intensity and frequency of smoking, and the context of cigarette use affected the motivation to quit. Logistic regression analyses were conducted to examine differences in predictors between the groups in more detail. These analyses revealed that differences mainly in attitudes and self-efficacy affected whether subjects were absolutely not motivated to quit or had actually quit 3 years later. Differences in smoking behavior affected the allocation to the more closely related groups (e.g., preparing versus quitting). CONCLUSIONS: Adolescents' motivation to quit is affected by smoking-related cognitions and habitual factors. More research is needed to decide whether the relation between intensity and frequency of smoking and the likelihood to quit later on should be interpreted in terms of differences in smoking initiation or in terms of preparation to quit.     

Efficacy of a smoking cessation program for hospital patients

BACKGROUND: Hospitalization may be an opportune time to change smoking behavior because it requires smokers to abstain from tobacco at the same time that illness can motivate them to quit. A hospital-based intervention may promote smoking cessation after discharge. METHODS: We tested the efficacy of a brief bedside smoking counseling program in a randomized controlled trial at Massachusetts General Hospital, Boston. The 650 adult smokers admitted to the medical and surgical services were randomly assigned to receive usual care or a hospital-based smoking intervention consisting of (1) a 15-minute bedside counseling session, (2) written self-help material, (3) a chart prompt reminding physicians to advise smoking cessation, and (4) up to 3 weekly counseling telephone calls after discharge. Smoking status was assessed 1 and 6 months after hospital discharge by self-report and validated at 6 months by measurement of saliva cotinine levels. RESULTS: One month after discharge, more intervention than control patients were not smoking (28.9% vs 18.9%; P=.003). The effect persisted after multiple logistic regression analyses adjusted for baseline group differences, length of stay, postdischarge smoking treatment, and hospital readmission (adjusted odds ratio, 2.19; 95% confidence interval, 1.34-3.57). At 6 months, the intervention and control groups did not differ in smoking cessation rate by self-report (17.3% vs 14.0%; P=.26) or biochemical validation (8.1% vs 8.7%; P=.72), although the program appeared to be effective among the 167 patients who had not previously tried to quit smoking (15.3% vs 3.7%; P=.01). CONCLUSIONS: A low-intensity, hospital-based smoking cessation program increased smoking cessation rates for 1 month after discharge but did not lead to long-term tobacco abstinence. A longer period of telephone contact after discharge might build on this initial success to produce permanent smoking cessation among hospitalized smokers.     

The relationship between self-efficacy and reductions in smoking in a contingency management procedure.

Social–cognitive and behavioral theories of change disagree on what the relevant controlling variables for initiating behavior change are. Correlations between baseline smoking cessation self-efficacy and the changes in breath carbon monoxide (CO) and the reduction in breath CO and increases in smoking cessation self-efficacy from baseline were obtained from a contingency management smoking cessation procedure. A test of the difference between the cross-lag correlations suggested a nonspurious causal relationship between smoking cessation self-efficacy and changes in breath CO. Path analyses showed that decreases in breath CO (reductions in smoking) predicted later increases in smoking cessation self-efficacy. Baseline self-reports of smoking cessation self-efficacy were not significantly correlated with subsequent changes in breath CO. Rather, significant correlations were found between reductions in breath CO and later increases in smoking cessation self-efficacy. These results suggest that self-efficacy may be a cognitive response to one’s own behavior, and are inconsistent with a social–cognitive view of self-efficacy’s role in behavior change. Implications for the development of smoking cessation programs and health-promoting behavior changes in general are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior therapy and the transdermal nicotine patch: Effects on cessation outcome, affect, and coping.

The process and outcome of a smoking cessation program using behavior therapy alone (BT) or behavior therapy plus the nicotine patch (BTP) was studied in 64 participants. Participants quit smoking on a target date after a period of ad libitum smoking, cognitive-behavior therapy preparing them for cessation, and behavioral rehearsal for high-risk situations, including stress management, and coping with negative affect. Abstinence was significantly higher for the BTP group versus the BT group from the end of behavioral treatment (79% vs. 63%) through the 3-month follow-up (pp?=?.06) and 12-month marks (p?=?38% vs. 22%). More general distress was observed among BT versus BTP participants ( i.e., increased withdrawal, tension, fatigue, and coping frequency with decreased coping effort; coping-to-urge ratio). The coping behavior of the BTP group may have been more effective than that of the BT group, as indicated by their significantly higher level of self-efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with participation, attrition, and outcome in a smoking cessation program at the workplace.

Of 66 24–58 yr old smokers in 2 worksites, 67% participated in a smoking cessation program. 55% completed the program. Of those, 29% had quit smoking by posttest, and 17% were abstinent at the 6-mo follow-up. Different variables predicted participation, attrition, and outcome. Significant predictors of smokers who participated were length of cessation in previous abstinence attempts, number of years they smoked, and belief regarding personal vulnerability in contracting a smoking-related disease. Levels of pretest carbon monoxide and attitudes regarding adoption of smoking restrictions in the worksite predicted attrition. Posttest cessation was related to nicotine levels of cigarette brand smoked at pretest and pretest beliefs regarding postcessation weight gain. Abstinence at the 6-mo follow-up was predicted by number of co-workers who smoked and pretest concerns related to postcessation weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic effects of self-efficacy on smoking lapses and relapse among adolescents.

Objective: The present study examined whether dynamic day-to-day variations in self-efficacy predicted success in quit attempts among daily smoking adolescents. Design: A sample of 149 adolescents recorded their smoking and self-efficacy three times per day during 1 week prior to and 3 weeks after a quit attempt. Main Outcome Measures: The first lapse, second lapse, and relapse after at least 24 hours of abstinence from smoking were the main outcome measures. Results: Self-efficacy was relatively high and moderately variable prior to the first lapse, but decreased and became more variable thereafter. Lower self-efficacy as measured at the lapse assessment significantly increased the risk that a second lapse and relapse would occur. Individual differences in baseline self-efficacy did not predict any of the treatment outcomes. The time-varying analyses, however, showed that lower self-efficacy on a given day predicted the first lapse, the second lapse, and relapse on the succeeding day. Daily concomitant smoking (any smoking on the preceding day) was not significantly related to relapse. Conclusion: The present results emphasize the importance of self-efficacy among adolescents in cessation and highlight the need for dynamic formulations and assessments of adolescents' self-efficacy and relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The instability of health cognitions: Visceral states influence self-efficacy and related health beliefs.

Objective: To determine how visceral impulses, such as hunger and drug craving, influence health beliefs. Design: The authors assessed smokers' self-efficacy and intentions to quit while in a randomly assigned state of cigarette craving or noncraving (Study 1), and assessed dieters weight-loss beliefs while hungry or satiated (Study 2). Main outcome measures: Self-efficacy, smoking cessation, weight-loss goals. Results: The authors found, in both the context of smoking and weight-loss, that participants in a cold (e.g., satiated) state had different health beliefs than participants in a hot state (e.g., hungry). Specifically, in Study 1, the authors found that smokers who experienced cigarette craving had lower self-efficacy than did satiated smokers. Consequently, smokers who craved a cigarette had less intention to quit smoking in the future compared with satiated smokers. In Study 2, the authors found that hungry dieters had less self-efficacy than did satiated dieters. This difference led hungry dieters to form less ambitious future weight-loss goals and view prior weight-loss attempts with more satisfaction. Conclusion: These findings contribute to our understanding of the nature of health beliefs and reveal that health beliefs are more dynamic than previously assumed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress and unaided smoking cessation: A prospective investigation.

A prospective design was used to determine the outcomes associated with unaided smoking cessation and the influence of stress on cessation. Heavy smokers (N?=?308) completed stress-related measures and were then recontacted at 1, 6, and 12 mo. At each follow-up, they indicated their smoking status (which was confirmed by collateral report and biochemical tests) and completed several stress-related questionnaires. Results indicate that 33% of Ss smoked continuously throughout the year, 39% quit briefly but subsequently relapsed, and 15% quit (confirmed biochemically). An additional 7% reported they had quit, but this could not be confirmed, and 6% were lost to follow-up. Compared with nonquitters, quitters reported less perceived stress, greater self-efficacy, greater use of problem solving and cognitive restructuring, and less reliance on wishful thinking, self-criticism, and social withdrawal. A model to forecast quitting was built and cross-validated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy and smoking reexamined: Construct validity and clinical utility.

131 clients (mean age 39 yrs) in a smoking cessation program rated their confidence (self-efficacy) in their ability to resist smoking at the end of treatment and throughout a 6-mo follow-up period. Consistent with previous findings, posttreatment scores significantly predicted subsequent smoking status. When concurrent smoking was partialed out, efficacy remained predictive but to a much lesser degree. The partial correlations also indicated that when pitted against concurrent smoking, confidence scores retain some unique predictive power but do not operate as a powerful mediator of the effects of concurrent behavior. Factor analysis of posttreatment scores revealed that efficacy ratings are primarily unidimensional and not situation specific. Efficacy ratings made 2 mo after treatment were quite predictive of future relapse. These analyses suggest that efficacy ratings, although generally not a mediating variable, can be useful predictors of relapse, particularly when assessed during the maintenance phase of treatment. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Success attributions for stopping smoking during pregnancy, self-efficacy, and postpartum maintenance.

Relapse prevention has focused on failure, not success attributions. This study of 392 privately insured women who stopped smoking during pregnancy found that the stability dimension of success attributions for pregnancy smoking cessation predicted abstinence at all postpartum time points (i.e., 6 weeks and 3, 6, and 12 months); for 277 women who continued abstinence to 6 weeks postpartum, the 6-week postpartum stability attribution predicted later time points, as did 6-week self-efficacy. Internality predicted smoking at the next time point only, and controllability was not a predictor. More than 50% said the baby was the reason for pregnancy smoking cessation, and 6-week abstinence; stability and internality ratings varied but not controllability. An exploratory test of the relation of self-efficacy and success attributions indicated that self-efficacy fully mediated the effect of stability. Success attributions may merit more attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer-based smoking cessation interventions in adolescents: description, feasibility, and six-month follow-up findings

The impact of adolescent smoking cessation clinics has been disappointing due to low participation rates, high attrition, and low quit rates. This paper describes two computerized self-help adolescent smoking cessation intervention programs: 1) a program utilizing the expert system which is based on the transtheoretical model of change and 2) a popular action-oriented smoking cessation clinic program for teens which was modified for computer presentation. High participation rates in the program among 132 smokers demonstrate the high feasibility and acceptability of the programs. Quit rates of up to 20% were observed during the intervention, and an additional 30% made unsuccessful quit attempt(s). The 6-month follow-up findings indicated that adolescents were poorly prepared to maintain abstinence.     

A randomized trial of a self-help smoking cessation intervention in a nonvolunteer female population: Testing the limits of the public health model.

2,786 smokers among 15,004 female members of a health maintenance organization who completed a routine needs assessment were invited into a preventive health behavior study, consisting of 5 telephone interviews over 2 yrs assessing health practices. 1,396 participants were randomized into experimental or control conditions of an unsolicited, mailed, self-help smoking cessation program. Ss were not alerted to the link between the program and the health study. Smoking status was assessed at 1, 6, 12, and 18 mo. Although quit rates were higher than in the general population and were comparable to volunteer samples in self-help smoking cessation trials, there was no differential effect of the targeted intervention on the experimental group compared with the control group. Data indicate that mass mailing of cessation materials is not a useful form of cessation intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of quitting and dropout among women in a clinic-based smoking cessation program.

Most cessation studies assume that dropouts are smokers. Instead, the authors analyzed these outcomes separately using multinomial regression to model the relative risk of quitting versus continued smoking and dropping out. Female (N = 281) smokers were randomly assigned to a 12-week smoking cessation program plus either a 3-times-per-week exercise program or a contact control wellness program. Higher body mass index and longer prior quit attempts predicted cessation. Self-efficacy was associated with a lower likelihood of dropout. Greater nicotine dependence and lower education predicted continued smoking or dropout versus quitting among exercisers. Patterns of smoking, dropping out, and quitting between Weeks 5 and 12 were different between exercisers and controls. Dropouts should be considered as a separate category from smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy and smoking cessation: A meta-analysis.

According to relapse models, self-efficacy (SE), or confidence in one's ability to abstain, should predict the outcome of an attempt to quit smoking. We reviewed 54 studies that prospectively examined this relationship. The relationship between SE and future smoking depended upon the population studied and the timing of the SE assessment. The relationship between SE and future smoking was modest when SE was assessed prior to a quit attempt; SE scores were .21 standard deviation units (SD) higher for those not smoking at follow-up than for those who were smoking. The relationship was stronger (.47 SD) when SE was assessed post-quit. However, this effect was diminished when only abstainers at the time of the SE assessment were included in analysis (.28 SD). Controlling for smoking status at the time of SE assessment substantially reduced the relationship between SE and future smoking. Although SE has a reliable association with future abstinence, it is less robust than expected. Many studies may overestimate the relationship by failing to appropriately control for smoking behavior at the time of the SE assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized Controlled Trial for Behavioral Smoking and Weight Control Treatment: Effect of Concurrent Versus Sequential Intervention.

The authors compared simultaneous versus sequential approaches to multiple health behavior change in diet, exercise, and cigarette smoking. Female regular smokers (N = 315) randomized to 3 conditions received 16 weeks of behavioral smoking treatment, quit smoking at Week 5, and were followed for 9 months after quit date. Weight management was omitted for control and was added to the 1st 8 weeks for early diet (ED) and the final 8 weeks for late diet (LD). ED lacked lasting effect on weight gain, whereas LD initially lacked but gradually acquired a weight-suppression effect that stabilized (p = .004). Behavioral weight control did not undermine smoking cessation and, when initiated after the smoking quit date, slowed the rate of weight gain, supporting a sequential approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A fine-grained analysis of the role of self-efficacy in self-initiated attempts to quit smoking.

The relation between self-efficacy ratings and smoking behavior was explored among 36 people who were trying to quit smoking on their own. Ss self-monitored high-risk situations, coping efforts to withstand the temptation to smoke, and self-efficacy in coping with similar temptations for 4 weeks after quitting. Self-efficacy ratings were significantly related to the outcome of these situations, with Ss reporting higher efficacy ratings after situations in which they did not smoke as opposed to those in which they did smoke. Self-efficacy was predictive of smoking outcome, but there was considerable intersubject variability in the strength of the relation between efficacy and smoking behavior. Both efficacy and previous smoking behavior predicted smoking outcome equally well, however. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prospective relationships between smoking and weight in a young, biracial cohort: the Coronary Artery Risk Development in Young Adults Study

This study examined the relationship between smoking status and weight change from baseline to Year 7 in a large biracial cohort, the Coronary Artery Risk Development in Young Adults study. Unadjusted for covariates, only male smokers weighed less than nonsmokers, with no effect among women. Adjusted for covariates, male and female smokers weighed less than nonsmokers at baseline, adjusted for age, total energy intake, alcohol intake, and physical fitness. Over the 7-year follow-up, all smoking status groups gained weight, including continuous smokers and initiators. Weight gain was greatest among those who quit smoking. Weight gain attributable to smoking cessation was 4.2 kg for Whites and 6.6 kg for Blacks. Smoking had a small weight-attenuating effect on Blacks. No such effects, however, were observed among Whites. These results suggest, at least in younger smokers, that smoking has minimal impact on body weight.