Sex dfferences in the relation of mood to weight gain after quitting smoking.

Weight gain with smoking cessation is well documented. In this study the authors explored the impact of mood state on weight gain after quitting. Data of 350 participants enrolled in 2 smoking cessation trials were analyzed; primary analyses assessed the relation of affective factors to weight gain in abstinent participants only. Weight gain was predicted by abstinence status. Depression history, gender, and mood change from pre- to postcessation assessments were included in a model predicting weight gain in abstinent participants at the end of smoking cessation treatment (N?=?201) and at 1-year follow-up (N?=?87). At posttreatment, depression history positive women gained more than depression negative women, whereas depression history positive men gained less than depression history negative men. At 1-year follow-up, weight gain was predicted by improved mood in "normal" men and by worsened mood in both depression history positive and negative women. (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)     

Smoking cessation and weight gain.

Investigated determinants of weight gain after quitting smoking in 2 smoking treatment outcome studies in which 255 Ss (mean age 37 yrs) participated. It was hypothesized that (a) abstinence would result in weight gain; (b) postquitting weight gain would be predicted by pretreatment tobacco use, a history of weight problems, and eating patterns; and (c) relapse to smoking would follow weight gain. The 1st 2 hypotheses were confirmed. Year-long abstainers gained more weight than relapsers. Most of the weight gain occurred during the 1st 6 mo following quitting. Number of cigarettes smoked at pretreatment and past maximum body weight correlated positively with weight gain. Scores on a measure of eating control in specific situations, especially emotional ones, explained 27% of the variance in weight gain among abstinent Ss at a 1-yr follow-up. A measure of persistent hunger also predicted weight gain at a 1-yr follow-up. Eating disinhibition scores, number of cigarettes smoked at pretreatment, and maximum body weight were not correlated among Ss abstinent for the year. Disinhibition score and maximum body weight, however, correlated positively in the entire sample of Ss. Contrary to the 3rd hypothesis, greater weight gain during the 1st mo predicted continued abstinence, not relapse. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early and late weight gain following smoking cessation in the Lung Health Study

The authors examine weight gains associated with smoking cessation in the Lung Health Study (1986-1994) over a 5-year follow-up period. A cohort of 5,887 male and female smokers in the United States and Canada, aged 35-60 years, were randomized to either smoking intervention or usual care. Among participants who achieved sustained quitting for 5 years, women gained a mean of 5.2 (standard error, 5.0) kg in year 1 and a mean of 3.4 (standard error, 5.5) kg in years 1-5. Men gained a mean of 4.9 (standard error, 4.9) kg in year 1 and a mean of 2.6 (standard error, 5.8) kg in years 1-5. In regression analyses, smoking-change variables were the most potent predictors of weight change. Participants going from smoking to quit-smoking in a given year had mean weight gains of 2.95 kg/year (3.61%) in men and 3.09 kg/year (4.69%) in women. Over 5 years, 33% of sustained quitters gained > or = 10 kg compared with 6% of continuing smokers. Also among sustained quitters, 7.6% of men and 19.1% of women gained > or = 20% of baseline weight; 60% of the gain occurred in year 1, although significant weight gains continued through year 5. The average gains and the high proportions of sustained and intermittent quitters who gained excessive weight suggest the need for more effective early interventions that address both smoking cessation and weight control.     

Concern about weight gain associated with quitting smoking: Prevalence and association with outcome in a sample of young female smokers.

This study investigated the relationship between weight gain concern and outcomes of a large-scale smoking cessation study among 506 young female smokers attending Planned Parenthood clinics. Results of this prospective study did not support the clinical importance of weight gain concerns. Using an index of weight concern that was predictive in previous research, baseline weight concern was unrelated to smoking cessation efforts, whether participants made a quit attempt, reduced the number of cigarettes they smoked, or reported a change in self-efficacy for stopping smoking. Both the overall level of concern expressed in this sample of predominantly White young women and the lack of relationship between weight gain concern and smoking cessation outcomes suggest that weight gain concern may not be a critical factor for cessation programs targeting similar female smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms, stress, and weight concerns among African American and European American low-income female smokers.

The relationships between perceived stress, depressive symptoms, concern about weight gain and smoking dependence were examined among 83 European American and 175 African American female smokers bringing children to pediatric clinics serving a low-income population. Among African American women, but not European American women, greater stress and more depressive symptoms predicted greater smoking dependence, and less concern about weight gain predicted greater smoking dependence. Multivariate analyses confirmed the bivariate relationships among stress, depressive symptoms, and smoking dependence among African American women but reduced the relationship between weight concern and smoking dependence. The stronger relationships among stress, depressive symptoms, and smoking dependence among African American women may be indicative of smoking patterns more associated with affect regulation than are the smoking patterns of European American women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delay discounting predicts postpartum relapse to cigarette smoking among pregnant women.

Delay discounting (DD), a measure of impulsivity, describes the rate at which rewards lose value as the delay to their receipt increases. Greater discounting has been associated with cigarette smoking and various other types of drug abuse in recent research. The present study examined whether DD predicts treatment outcome among cigarette smokers. More specifically, the authors examined whether baseline discounting for hypothetical monetary rewards predicted smoking status at 24 weeks postpartum among women who discontinued smoking during pregnancy. Participants were 48 pregnant women (10.5 = 4.1 weeks gestational age at study entry) who participated in a clinical trial examining the use of incentives to prevent postpartum relapse. Several sociodemographic characteristics (being younger, being less educated, and reporting a history of depression) assessed at study entry were associated with increased baseline DD, but in multivariate analyses only DD predicted smoking status at 24 weeks postpartum. Greater baseline DD was a significant predictor of smoking status at 24 weeks postpartum. DD was reassessed periodically throughout the study and did not significantly change over time among those who eventually resumed smoking or those who sustained abstinence. The results extend the association of DD with risk for substance abuse to pregnant and recently postpartum cigarette smokers and demonstrate a significant relationship between DD and treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight suppression and weight rebound in ex-smokers treated with fluoxetine.

Fluoxetine's effect (30 mg, 60 mg, and placebo) on postcessation weight gain was studied among participants from a randomized, double-blind 10-week smoking cessation trial who met strict criteria for abstinence and drug levels. It was hypothesized that (a) fluoxetine would dose-dependently suppress postcessation weight gain and (b) drug discontinuation would produce dose-dependent weight rebound. During the on-drug phase, placebo participants gained weight linearly (M?=?2.61 kg), exceeding both fluoxetine groups (30-mg M?=?1.33 kg, 60-mg M?=?1.25 kg). Weight suppression was initially greater for 60 mg than 30 mg, but both were followed by weight gain. Six months off-drug produced greater dose-dependent weight rebound for 60 mg than 30 mg or placebo. Considering both on- and off-drug phases, weight gain for 60 mg of fluoxetine (M?=?6.5 kg) was comparable with that for placebo (M?=?4.7 kg) but greater than that for 30 mg (M?=?3.6 kg). Fluoxetine appears to forestall postcessation weight gain, allowing time for the weight-conscious smoker to focus on quitting smoking rather than on preventing weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resisting tempting foods and smoking behavior: Implications from a self-control theory perspective.

Objective: Individuals may desire to diet or restrain from eating certain foods while attempting to quit smoking out of concern for weight gain. However, previous research and clinical tobacco treatment guidelines suggest that concurrent dieting may undermine attempts to quit smoking. The current study applied the self-control strength model, which posits that self-regulation relies on a limited strength that is consumed with use, to test whether resisting tempting sweets would lead to a greater likelihood of subsequent smoking. Design: Participants were 101 cigarette smokers randomly assigned to resist eating either from a tempting plate of sweets or from a plate of less tempting vegetables. All participants were then given a 10-min recess. Main Outcome Measures: Whether participants smoked during the break, measured with a breath carbon monoxide sample, served as the primary dependent variable. Results: As predicted, participants who resisted sweets were more likely to smoke during the break (53.2%) than those who resisted vegetables (34.0%), χ2(1, N = 101) = 3.65 p     

Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation.

Correlates of concern about weight gain following smoking cessation and self-efficacy about controlling weight gain were examined in 940 men and 1,166 women who were surveyed on 2 occasions as part of a randomized trial of work-site interventions for smoking cessation. Weight concerns were positively associated with female sex, body weight, dieting for weight control, nicotine addiction, and social encouragement to quit. Bivariate analyses replicated prior findings that elevated weight concerns are associated with a reduced likelihood of quitting smoking, at least in women. Analyses controlling for demographics, nicotine dependence, and social factors replicated prior findings that weight concerns are not negatively related to smoking cessation and that some measures of concern are positively related to cessation. These analyses suggest that conflicting findings found in this literature are due primarily to how weight concerns are defined and whether covariates like nicotine addiction are used in data analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are weight concerns predictive of smoking cessation? A prospective analysis.

Participants in an 8-session, community-based smoking cessation intervention rated whether they would stay quit if they experienced weight gain. The majority reported that they would not relapse to smoking, even after a 20-lb. (9.07-kg) weight gain. Those who were weight concerned were more likely to be female, to weigh less and be normal or underweight, and to report chronic dieting. This group was also significantly less likely to be abstinent posttreatment, and at the 1-, 6- and 12-month follow-ups. Individuals presenting for formal smoking cessation interventions may be less weight concerned than the general population of smokers. However, weight-concerned smokers who do present for treatment are less likely to quit smoking. Implications for recruitment and intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in food intake and activity after quitting smoking.

Quitting smoking often results in weight gain. The causes of the gain are not known. The present study evaluated changes in calories, total sugars, sucrose, fat, protein, and nonsugar carbohydrates as well as changes in activity levels after quitting smoking. Ninety-five subjects were randomly assigned to either early (Week 2) or late (Week 6) quit dates. Subjects were assessed on weight, food intake, activity levels, and smoking levels at baseline, at Weeks 4 and 8, and at Weeks 12 and 26 postquit. The results indicated significant increases in calories, sucrose, and fats 2 weeks after the quit date. Changes for total sugars were less consistent. Activity levels did not change significantly. Early caloric increases predicted weight gain at 26 weeks for abstinent women. No relation was found for abstinent men, but interpretation of this finding is weakened by a small subsample size. Abstinent subjects gained over 9 lbs by 26 weeks postquit. Despite this gain, Week 26 results showed that caloric intake for abstinent women was approximately equal to that observed at baseline, whereas that for abstinent men had dropped significantly. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking cessation in peri- and postmenopausal women: A review.

A substantial portion of smokers are peri- or postmenopausal women. Cigarette smoking and menopause have overlapping negative health consequences and may act synergistically to contribute to worse health outcomes in this population. Little is known about issues specific to peri- and postmenopausal women attempting to quit smoking; however, it can be hypothesized that they face unique challenges in quitting smoking. Particularly, negative affect and vasomotor menopausal symptoms may make smoking cessation particularly challenging in this group of women. Peri- and postmenopausal women are also more prone to weight gain following smoking cessation, and concerns about postcessation weight gain may contribute to reduced motivation to quit smoking or to relapse to smoking. Recent evidence suggests that estrogen level may be positively associated with nicotine reward, which may aid in the smoking cessation efforts of postmenopausal women while possibly contributing to worse outcomes in perimenopausal women. Unfortunately, no known studies have compared premenopausal women with peri- or postmenopausal women on smoking cessation outcome variables. Studies in postmenopausal women indicate that hormone therapy (HT) use does not affect nicotine withdrawal, smoking cessation outcomes, or weight gain following smoking cessation; however, a lack of randomized trials limits the strength of these conclusions. Evidence of the effects of HT on mood following smoking cessation is conflicting. Further research is needed to identify the unique factors influencing smoking cessation in peri- and postmenopausal women and to develop and test interventions that target these variables in a way that improves cessation rates among this population. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Residual outcome expectations and relapse in ex-smokers.

From a social cognitive theoretical point of view, strong positive outcome expectations of smoking are a cause of relapse in smoking cessation, working in concert with self-efficacy. This study investigated whether and to what extent this could be verified in a sample of ex-smokers. Some (N=324) ex-smokers were followed for 7 months. At Time 1 (T1) and Time 2 (T2), participants filled in a self-report questionnaire assessing residual outcome expectations (ROEs), self-efficacy, craving for tobacco, and smoking behavior, which was sent and returned by mail. First, prospective analyses showed that ROEs assessed at T1 predicted relapse reported at T2 over and above self-efficacy. Second, the influence of ROEs (and self-efficacy) on relapse was mediated by craving experience. Third, the hypothesized interactions between ROEs and self-efficacy were significant and meaningful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of monetary contingencies on smoking relapse: Influences of trait depression, personality, and habitual nicotine intake.

Of 56 male smokers, 34 were randomly assigned (by 60% random odds) to quit smoking immediately, whereas the remaining 22 were assigned to quit after an additional 31 days. Compensation ($300) was contingent on abstinence for a minimum of 31 or 2 days (depending on random assignment) and completion of all experimental sessions. Contingencies for the immediate-quit group required 31 days of abstinence; those for the delayed-quit group required only 2 days of abstinence. Contingency duration (31 vs. 2 days) predicted days to relapse. All but 4 of the 31-day contingency participants maintained abstinence for at least 31 days, whereas only 3 of the 2-day contingency group abstained for 31+ days. However, 31-day contingencies did not result in longer postcontingency time to relapse. Higher trait neuroticism, depression, and psychopathic deviate scores predicted decreased time to relapse. Prequit cotinine concentrations and Fagerstr?m Tolerance Questionnaire scores failed to predict time to relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How much weight gain occurs following smoking cessation: A comparison of weight gain using both continuous and point prevalence abstinence.

Estimates of postcessation weight vary widely. This study determined the magnitude of weight gain in a cohort using point prevalence and continuous abstinence criteria for cessation. Participants were 196 volunteers who participated in a smoking cessation program and who either continuously smoked (n?=?118), were continuously abstinent (n?=?51), or who were point prevalence abstinent (n?=?27) (i.e., quit at the 1-year follow-up visit but not at others). Continuously abstinent participants gained over 13 lbs. (5.90 kg) at 1 year, significantly more than continuously smoking (M?=?2.4 lb.) and point prevalence abstinent participants (M?=?6.7 lbs., or 3.04 kg). Individual growth curve analysis confirmed that weight gain and the rate of weight gain (pounds per month) were greater among continuously smoking participants and that these effects were independent of gender, baseline weight, smoking and dieting history, age, and education. Results suggest that studies using point prevalence abstinence to estimate postcessation weight gain may be understanding postcessation weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is weight gain after smoking cessation inevitable?

Weight gain after smoking cessation was studied in a naturalistic setting where (1) all smokers quit and (2) risk factors for postcessation weight gain were modified. Participants were 332 military recruits (227 men, 105 women), 86 of whom were smokers who quit during 6 weeks of basic training. Results showed no significant weight changes for smokers who quit. Pretest smoking rates and feat of weight gain were unrelated to changes in weight. Results suggest that an intensive program that limits access to alcohol and foods that are high in fat and that increases physical activity can attenuate weight gain after smoking cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiovascular reactivity as a predictor of relapse in male and female smokers.

Examined the role of psychophysiological reactivity to general stressors measured before smoking cessation as a predictor of relapse in individuals who quit for a minimum of 12 hrs and were then followed for a 12-mo interval. The study group consisted of 132 (56.9%) female and 100 (43.1%) male participants in a formal smoking cessation program. The reactivity measures were taken while the Ss were still smoking. Heart rate and blood pressure measurements were taken while Ss were resting, performing mental arithmetic, and delivering a speech and after Ss had been standing for 2 min. In the sample as a whole and for women, a higher level of systolic blood pressure reactivity to the cognitive challenge was associated with a shorter time to relapse. In men, greater systolic blood pressure decline to standing was significantly associated with a shorter time to relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamic Self-Efficacy and Outcome Expectancies: Prediction of Smoking Lapse and Relapse.

According to social learning models of drug relapse, decreases in abstinence self-efficacy (ASE) and increases in positive smoking outcome expectancies (POEs) should foreshadow lapses and relapse. In this study, the authors examined this hypothesis by using ecological momentary assessment data from 305 smokers who achieved initial abstinence from smoking and monitored their smoking and their ASE and POEs by using palmtop computers. Daily ASE and POEs predicted the occurrence of a 1st lapse on the following day. Following a lapse, variations in daily ASE predicted the onset of relapse, even after controlling for concurrent smoking. ASE and POEs generally neither mediated nor moderated each other's effects. These data emphasize the role of dynamic factors in the relapse process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight suppression predicts weight gain over treatment but not treatment completion or outcome in bulimia nervosa.

The authors attempted to replicate previous findings that weight suppression is a significant predictor of treatment completion and treatment outcome (M. L. Butryn, M. R. Lowe, D. L. Safer, & W. S. Agras, 2006) and weight gain over treatment (M. R. Lowe, W. Davis, D. Lucks, R. A. Annunziato, & M. L. Butryn, 2006) among women with bulimic disorders. The authors also examined 2 alternative measures of weight variability. Participants were 132 women with bulimia nervosa treated with cognitive-behavioral therapy. Participants who dropped out of treatment did not have significantly higher levels of weight suppression than did treatment completers. Among those who completed treatment, weight suppression did not significantly predict binge eating and purging at post-treatment. Weight suppression did significantly predict weight change and, in particular, weight gain (≥5 kg) over treatment. Alternative measures of weight variability did not significantly predict treatment completion or treatment outcome, but 1 measure significantly predicted weight gain over treatment. In conclusion, the authors failed to replicate the previous finding that weight suppression predicts treatment compliance and treatment outcome, but they did replicate the finding that weight suppression predicts weight gain over treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)