Pretreatment task persistence predicts smoking cessation outcome.

R. Eisenberger's (1992) learned industriousness theory states that individuals display differing degrees of persistence depending on their history of reinforcement for effortful behavior. These differences may influence the development, maintenance, and cessation of addictive behaviors. In cross-sectional studies, E. P. Quinn, T. H. Brandon, and A. L. Copeland (1996) found that cigarette smokers were less persistent than nonsmokers, and R. A. Brown, C. W. Lejuez, C. W. Kahler, and D. R. Strong (2002) found that smokers who had previously abstained for 3 months were more persistent than those who had never quit. The present study extended these findings by using a prospective design. A pretreatment measure of task persistence (mirror tracing) completed by 144 smokers predicted sustained abstinence throughout 12 months of follow-up. Moreover, persistence predicted outcome independent of other significant predictors: gender, nicotine dependence, negative affect, and self-efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reduction in Amount Smoked Predicts Future Cessation.

The goal of this article is to determine whether reducing cigarette consumption increases the likelihood of future cessation. Data from 3,385 participants who originally took part in the Community Intervention Trial for Smoking Cessation completed detailed tobacco use phone surveys in 1988, 1993, and 2001. Between 1988 and 1993, 15% of smokers reduced their daily cigarette consumption by 50% or more, and 9% of the entire baseline sample maintained this reduction in 2001. Those who reduced more than 50% were 1.7 times more likely to quit smoking by 2001 compared with those who did not reduce. Few smokers are able to reduce their consumption by 50% or more, although those who do are more likely to quit compared with those who do not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In Vivo Versus Imaginal Smoking Cue Exposures: Is Seeing Believing?

Smokers experience cigarette cravings in response to both imaginal and in vivo cigarette cues, and some studies suggest that the magnitude of this reactivity relates to difficulty quitting. Few studies, however, have systematically examined these two paradigms head-to-head. To this end, the authors exposed 225 smokers to imaginal and in vivo smoking cues and measured craving reactions. Results indicated that both imaginal and in vivo smoking cues increased craving. The magnitude of imaginal and in vivo reactions were statistically comparable and were moderately correlated. In vivo, but not imaginal, reactivity was related to duration of previous quits, particularly in men. Findings suggest that although both paradigms induce craving, the in vivo reactivity paradigm may be, at least in men, more effective for predicting smoking cessation failure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smokers’ expectancies for abstinence: Preliminary results from focus groups.

Smokers’ expectancies regarding the effects of cigarette use are powerful predictors of smoking motivation and behavior. However, studies have not investigated the consequences that smokers expect when they attempt to quit smoking: abstinence-related expectancies. The primary goal of this qualitative study was to gain initial insight into smokers’ expectancies for abstinence. Eight focus groups were conducted with 30 smokers diverse with respect to age, gender, and ethnoracial background. Content analyses indicated that smokers anticipate a variety of outcomes from abstinence. The most frequently reported expectancies included pharmacologic withdrawal symptoms, behavioral withdrawal symptoms, decreased monetary expense, and immediate improvement of certain aspects of physical functioning and health. Additional expectancies concerned weight gain, improved attractiveness, enhanced social functioning/self-esteem, long-term health outcomes, and loss of relationships. Finally, a number of relatively unheralded expectancies were revealed. These involved nicotine replacement therapy effectiveness, alcohol and other drug use, cue reactivity, cessation-related social support, aversion to smoking, and “political process” implications. This study provides a preliminary step in understanding smokers’ expectancies for abstinence from cigarettes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement of the effects of abstinence from tobacco: A qualitative review.

This article reviews terms, methodologies, and scales used to describe the effects of abstinence from tobacco in humans. The review suggests operational definitions for withdrawal, offset, novel, and indefinite abstinence effects. The review recommends the use of prospective studies that use smokers trying to quit, multiple data points preabstinence and very soon after abstinence, comparison groups, at least 16 hrs of abstinence, objective measures, measures of clinical significance, and data analytic techniques that allow use of all participants' data. The 8 most commonly used tobacco withdrawal measures differ in coverage, brevity, and use of single vs. multiple items to describe each symptom. Of the measures, 6 consistently increase with abstinence, but no single measure appears superior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional bias in drug dependence: Vigilance for cigarette-related cues in smokers.

Two experiments investigated attentional biases for smoking-related cues in smokers and nonsmokers, using the visual probe task. In Experiment 1, when pictures were displayed for 500 ms, smokers who had made repeated quit attempts showed an attentional bias for smoking-related scenes. Experiment 2 replicated this finding and revealed that when pictures were presented for 2,000 ms, the smoker group as a whole showed vigilance for smoking-related cues, but nonsmokers did not. The findings from the 500-ms exposure condition suggest that initial orienting of attention to smoking cues was associated with repeated unsuccessful attempts at abstinence in smokers. Results are discussed with reference to incentive-sensitization theories of addiction and to component processes of selective attention, such as initial orienting versus maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence for clinical smoking cessation for adolescents.

Objective: This report reviews the evidence that informs the role of health and mental health care providers in addressing youth smoking cessation. Design: Qualitative literature review. Results: Physicians do not consistently screen adolescents for tobacco use and fail to provide recommended cessation advice. Challenges to addressing smoking cessation include the need for procedures to ensure confidentiality and the existence of competing demands to provide other services. Few published studies have specifically addressed the effectiveness of clinical interventions. Interventions that require return visits or follow-up phone contacts are technically difficult to implement in this population. Successful interventions may require resources not available in nonresearch settings. Most studies have used brief clinical intervention as a control condition, making it impossible to evaluate its effectiveness. Conclusion: There is little evidence that supports current clinical smoking cessation guidelines for adolescents. More research is needed to develop inexpensive, efficient clinical interventions that can provide youths access to smoking cessation help. Future challenges include reorganizing clinical systems to offer greater counseling by support staff or in electronic formats and to provide effective booster messages and follow-up care in a population that is difficult to track. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distress tolerance and duration of past smoking cessation attempts.

The present study tested the hypothesis that limited ability to tolerate physical and psychological distress is associated with early relapse from smoking cessation. Specifically, the authors exposed 16 current smokers who had failed to sustain any previous quit attempt for more than 24 hr (immediate relapsers) and 16 smokers with at least 1 sustained quit attempt of 3 months or longer (delayed relapsers) to psychological (mental arithmetic) and physical (carbon dioxide inhalation-breath holding) stressors. Relative to delayed relapsers, immediate relapsers were characterized by higher baseline levels of affective vulnerability, by greater levels of dysphoria and urge to smoke after 12 hr of nicotine deprivation, and by less task persistence on the stressors, suggesting that these may be risk factors for early lapse in the context of quitting smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Revisiting the Factor Structure of the Questionnaire on Smoking Urges.

This study assessed the factor structure of the Questionnaire on Smoking Urges (QSU), a commonly used assessment of cravings for cigarettes, with a sample of smokers presenting for treatment in a smoking cessation trial. On the basis of previous research, three confirmatory factor analytic models were tested. Model 1 hypothesized a 26-item, 2-factor model using the items reported in the original QSU analysis by S. T. Tiffany and D. J. Drobes (1991). Model 2 hypothesized a 12-item, 2-factor model comprised of the 6 most robust items found in each of the 2 factors of the original factor analysis. Using the 12 items from Model 2, Model 3 hypothesized a 12-item, 1-factor model. The 2nd model was found to fit the data best. Reliability was also tested using values obtained in this 2nd model, and these estimates were found to be reasonably good. Future research directions for the QSU are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic reactivity to voluntary hyperventilation challenge predicts distress tolerance to bodily sensations among daily cigarette smokers.

The present investigation examined the extent to which panic reactivity to bodily sensations is related to distress tolerance (DT) among daily smokers. It was hypothesized that panic reactivity to an initial voluntary hyperventilation (i.e., whether participants met criteria for a DSM-IV panic attack; PA) would predict the relative degree of task persistence on a second hyperventilation trial (DT) above and beyond the variance accounted for by anxiety sensitivity (AS), negative affectivity (NA), cigarette smoking rate, and self-reported discomfort intolerance (DI). Participants were 95 daily smokers (58% women; Mage = 29.0, SD = 12.2) who completed a battery of questionnaires and two voluntary hyperventilation procedures. Results indicated PA status significantly predicted DT, above and beyond the theoretically relevant covariates of AS, NA, cigarettes per day, and DI ( p     

Nicotine dependence, depression, and the moderating role of goal cognitions.

The authors examined the moderating role of goal cognitions in the process of nicotine dependence in young adult smokers. A college sample of 85 male and 78 female smokers completed measures of nicotine dependence and psychological distress. They also provided cognitive evaluations for goals related to smoking cessation on scales measuring self-efficacy, value, planning, self-reward, self-criticism, self-monitoring, social comparison, and positive and negative goal-based arousal. As has been previously established, depression had a direct and significant effect on nicotine dependence. Moreover, significant interactions between goal cognitions and depression provided evidence for the hypothesized moderating effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fluoxetine, smoking, and history of major depression: A randomized controlled trial.

The study was a randomized placebo-controlled trial testing whether fluoxetine selectively enhances cessation for smokers with a history of depression. Euthymic smokers with (H+, n = 109) or without (H-, n = 138) a history of major depression received 60 mg fluoxetine or placebo plus group behavioral quit-smoking treatment for 12 weeks. Fluoxetine initially enhanced cessation for H+ smokers (p = .02) but subsequently impaired cessation regardless of depressive history. Six months after quit date, fluoxetine-treated participants were 3.3 times more likely to be smoking (p = .02). Further research is warranted to determine why high-dose fluoxetine produces continuing effects that oppose tobacco abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational interviewing for smoking cessation: A meta-analytic review.

Objective: Motivational interviewing (MI) is a treatment approach that has been widely examined as an intervention for tobacco dependence and is recommended in clinical practice guidelines. Previous reviews evaluating the efficacy of MI for smoking cessation noted effects that were modest in magnitude but included few studies. The current study is a comprehensive meta-analysis of MI for smoking cessation. Method: The meta-analysis included 31 controlled trials with an abstinence outcome variable. Studies with nonpregnant (N = 23) and pregnant samples (N = 8) were analyzed separately. Results: For nonpregnant samples, combined results suggest that MI significantly outperformed comparison conditions at long-term follow-up points (dc = .17). The magnitudes of this result represented a 2.3% difference in abstinence rates between MI and comparison groups. All analyses investigating the impact of moderating participant, intervention, and study design characteristics on outcome were nonsignificant, with the exception of studies including international, non-U.S. samples, which had larger effects overall. Several subgroups of studies had significant combined effect sizes, pointing to potentially promising applications of MI, including studies that had participants with young age, medical comorbidities, low tobacco dependence, and, consistent with clinical practice guidelines, low motivation or intent to quit. Effects were smaller among pregnant samples. In addition, significant combined effect sizes were observed among subgroups of studies that administered less than 1 hr of MI and among studies that reported high levels of treatment fidelity. Conclusions: The results are interpreted in light of other behavioral approaches to smoking cessation, and the public health implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ever Users Versus Never Users of a "Less Risky" Cigarette.

The authors surveyed 173 smokers who purchased and 114 smokers who knew about but did not purchase Eclipse--a tobacco industry product that is advertised as a reduced risk cigarette. Most low-tar/nicotine cigarette users who purchased Eclipse believed Eclipse was safer than low-tar/nicotine cigarettes both for their own health (73%) and for the health of others around them (86%). Additionally, many viewed Eclipse as a step toward quitting (53%). The authors did not identify robust predictors of Eclipse use. At 6 months follow-up, Eclipse users were as likely to have tried to quit as nonusers; however, the small sample size does not rule out the possibility that Eclipse use undermines quit attempts. The authors conclude that almost all users believe Eclipse is safer than low-tar cigarettes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery.

This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (≥ 6 months) were summarized with random effects models. Intervention effects for smoking cessation were significant at posttreatment and comparable for participants in addictions treatment and recovery; however, intervention effects for smoking cessation were nonsignificant at long-term follow-up. Smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs. Short-term smoking cessation effects look promising, but innovative strategies are needed for long-term cessation. Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of dopamine transporter and receptor polymorphisms on smoking cessation in a bupropion clinical trial.

This study examined the role of dopaminergic genes in prospective smoking cessation and response to bupropion treatment in a placebo-controlled clinical trial. Smokers of European ancestry (N=418) provided blood samples for genetic analysis and received either bupropion or placebo (10 weeks) plus counseling. Assessments included the dopamine D2 receptor (DRD2) genotype, dopamine transporter (SLC6A3) genotype, demographic factors, and nicotine dependence. Smoking status was verified at the end of treatment (EOT) and at 6-month follow-up. The results provided evidence for a significant DRD2 × SLC6A3 interaction effect on prolonged smoking abstinence and time to relapse at EOT, independent of treatment condition. Such effects were no longer significant at 6-month follow-up, however. These results provide the first evidence from a prospective clinical trial that genes that alter dopamine function may influence smoking cessation and relapse during the treatment phase. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute nicotine reinforcement, but not chronic tolerance, predicts withdrawal and relapse after quitting smoking.

Little research has examined the association of tobacco dependence with nicotine tolerance or reinforcement in a clinical sample. Smokers preparing to quit smoking participated in laboratory sessions to assess nicotine tolerance on subjective, cardiovascular, and performance measures and to assess nicotine reinforcement using a choice procedure. Participants were then provided with individual counseling (but no medication), made a quit attempt, and were followed for 1 year to determine clinical outcome, as determined by postquit withdrawal and days to relapse. Nicotine tolerance was unrelated to either withdrawal or relapse. However, acute nicotine reinforcement was significantly related to both greater withdrawal and faster relapse. Results challenge the common assumption that nicotine tolerance is closely related to dependence but suggest that nicotine reinforcement may have theoretical and clinical significance for dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cigarette smoking and chewing gum: Response to a laboratory-induced stressor.

The current study examined the anxiolytic effects of cigarette smoking and chewing gum on urge to smoke, withdrawal, and anxiety in response to a public speaking task in 45 undergraduate smokers. Participants were asked to smoke, chew gum, or do nothing in response to the stressor. Participants completed measures of anxiety, withdrawal symptoms, and urge to smoke pre- and poststressor. The smoke group reported fewer urges to smoke pre- and poststressor than the other groups. The smoke and gum groups reported fewer withdrawal symptoms than did the control group poststressor. Chewing gum was helpful in managing levels of withdrawal symptoms compared with the control group. Groups did not differ on measures of anxiety. Results suggest that smoking in response to a stressor may not reduce levels of affective stress. Furthermore, chewing gum may be helpful in managing withdrawal symptoms in response to a stressor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of time perspective in smoking cessation amongst older English adults.

Objective: To study the longitudinal relationship between time perspective and smoking cessation over 4 years of follow-up among a cohort of older English adults and to determine whether the predictive utility of time perspective in smoking cessation. Design: Analysis of data from core members of the English Longitudinal Survey of Ageing who took part in face-to-face interviews in 2002, 2004, and 2006 (n = 7,174). Main Outcome Measures: Time perspective was measured using a question on time period for financial planning. Smoking at baseline and quitting over follow-up was determined through self-report. Results: At baseline, planning for longer periods was associated with lower odds of being a smoker, after controlling for age, gender, and education. Among those who were smokers at baseline, planning for longer periods at baseline was associated with increased odds of quitting over 4 years, after controlling for age, gender, and education. Conclusion: Including help to become more future orientated in smoking cessation interventions may increase their effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)