Comparison of two self-help smoking cessation booklets

OBJECTIVE: To compare two self-help smoking cessation booklets distributed to callers to a Quitline telephone service in Queensland (Australia). DESIGN: Callers were randomised to receive either a structured 14-day quit programme (Time to quit) or another booklet and described four broad stages of quitting (Can quit). Approximately one month later, these callers were interviewed by telephone. MAIN OUTCOME MEASURES: Self-reported smoking status at one month and recent quit attempts together with process measures. RESULTS: Altogether, 521 callers (78.3%) were interviewed. They were heavier smokers when compared with all Queensland smokers: on average they had smoked for more than 15 years, smoked nearly 25 cigarettes per day, and almost two-thirds had attempted to quit smoking in the past year. In each group, significant proportions either did not begin to use the booklet (50.5-56.0%), or did not complete its use (77.4-82.3%). There were no differences in the self-reported quit rates at one month (17.0% vs 16.1%; p = 0.93). In an ordinal regression modelling procedure involving age, sex, number of recent quit attempts, number of cigarettes smoked per day, smoking status of partner, number of five closest friends who smoke, education, and booklet received, only the number of cigarettes smoked per day was significantly related to smoking status at one month. CONCLUSIONS: Callers to telephone Quit-line services are typically heavier smokers than the general smoking population, and simple strategies, such as self-help booklets, appear to achieve relatively high success. Nevertheless, there is potential to improve the effectiveness of these materials by making a range of materials available and encouraging callers to make a serious attempt to quit smoking.     

Social class, education, and smoking cessation: Long-term follow-up of patients treated at a smoking cessation unit.

Our objective was to examine social class and educational differences in long-term smoking cessation success among a cohort of smokers attending a specialized smoking clinic. We studied sustained abstinence after cessation among 1,516 smokers (895 men and 621 women) treated for smoking cessation between 1995 and 2001 at a university teaching hospital in the metropolitan area of Barcelona, Spain. We calculated 1-year and long-term (up to 8-year) abstinence probabilities by means of Kaplan-Meier curves and the hazard ratio of relapse by means of Cox regression, after adjusting for other predictors of relapse. Overall abstinence probability was .277 (95% CI = .254-.301). Men and women in social classes IV-V had significant hazard ratios of relapse after long-term follow-up (men: 1.36, 95% CI = 1.07-1.72; women: 1.60, 95% CI = 1.24-2.06), as compared with patients in social classes I-II. The same independent effect was observed for education: Men and women with primary or less than primary studies had higher hazard ratios of relapse (men: 1.75, 95% CI = 1.35-2.25; women: 1.92, 95% CI = 1.51-2.46), as compared with patients with a university degree. Similar estimates were obtained after adjustment for stage of change, Fagerstr?m score for nicotine dependence, and type of treatment. Patients of lower socioeconomic status are at higher risk of relapse, and this association is independent of other well-known predictors of relapse. Social differences have to be taken into account in the clinical setting when tailoring specific actions to treat smoking dependence.     

Dimensions of depressive symptoms and smoking cessation.

Because different psychopathologic components of depressive symptoms may have distinct etiologies, examining their differential effects on smoking cessation may elucidate mechanisms underlying the smoking-depression relationship. Negative affect (NA), somatic features (SF), low positive affect/anhedonia (PA), and interpersonal disturbance (IP) have been identified as unique dimensions of depression that can be measured using the Center for Epidemiologic Studies Depression Scale (CESD). This study examined common and unique associations between CESD subscales and baseline smoking characteristics, nicotine withdrawal, and relapse in 157 participants enrolled in a smoking cessation trial for heavy social drinkers. Each dimension was univariately associated with negative and positive reinforcement smoking motives. Only SF had unique relations with tolerance smoking motives and univariate associations with nicotine dependence severity. Only PA predicted cessation-related changes in withdrawal symptoms on quit day. Analyses predicting abstinence at 8, 16, and 26 weeks post quit date showed that NA, SF, and PA each univariately predicted relapse, ps< or =.0083. Only low PA predicted poorer outcomes incrementally to the other dimensions, even when controlling for level of nicotine dependence, smoking frequency, and history of major depression, p = .0018. Interventions targeting anhedonia and low positive affect may be useful for smokers trying to quit.     

Parental smoking cessation and children's smoking: mediation by antismoking actions.

The present study investigated whether parents' antismoking actions mediated the prospective relationship between parental smoking cessation and children's smoking. Smoking status of parents (predictor) was assessed when their children were in 3rd grade, parental antismoking actions (mediators) were assessed when their children were in 11th grade, and children's smoking status (outcome) was assessed when they were in 12th grade. In 20 Washington state school districts, data were collected from 1,600 children (49% female, 91% White) and from their parents. Results showed that children's odds of daily smoking were reduced by 39% (95% CI = 24%-51%) for those whose parents had quit smoking, compared with those whose parents were current smokers. Asking to sit in nonsmoking sections of public establishments was a significant (p<.01) mediator that explained 64% of the association between parental smoking cessation and children's smoking. However, not allowing smoking in the home and asking others not to smoke around them were not significant mediators (p = .10, and p = .06, respectively). In conclusion, asking to sit in a nonsmoking section of a public establishment substantially mediates the relationship between parental smoking cessation and children's smoking.     

Social context variables as predictors of smoking cessation

OBJECTIVE: To examine positive and negative social support and other selected social context variables (age, education, marital status, gender, and exposure to other smokers inside and outside the home) as predictors of smoking cessation in non-hospitalised adults with diagnosed cardiovascular disease at follow up after one, six, and 12 months. DESIGN: Discriminant function analyses (DFA) and longitudinal "lag" analyses. SUBJECTS: 137 Non-hospitalised adults with diagnosed cardiovascular health problems. RESULTS: Examination of the concurrent DFAs revealed significant univariate F ratios for the predictor variables of gender and marital status at one year and low negative support at all three follow ups. Quitters reported significantly lower levels of negative support than non-quitters over the course of the year and tended to be male and married. Longitudinal "lag" analyses, however, revealed that higher positive social support at one month and higher negative support at six months were both predictive of smoking cessation at one year. At one year more men than women and more married than not married smokers were successful in quitting. No effects for age, education, or exposure to others smoking inside or outside the home were found on any of the concurrent DFAs or longitudinal analyses. CONCLUSION: A series of concurrent DFAs revealed that positive support was a significant predictor of quitting at one year and negative support was predictive of not quitting at all three follow ups. Longitudinal "lag" analyses showed that positive support at one month and negative support at six months both predicted quitting at one year. Being male and married were found to contribute to quitting on both sets of analyses. The effects for positive and negative support on the smoking behaviour of adults with cardiovascular disease tended to change over the course of a year. These findings suggest that positive and negative social support may have differential effects over time. As the smoker moves along the "quitting trajectory" it may be that more "nagging" or negative interactions are needed at some point to get smokers to quit, if positive support has not worked or is not working. Progression of disease also may have served as a stimulus for family members and friends to become more insistent and negative about the person's continued smoking. More research is needed to examine the quitting process to determine which and how social context variables contribute.


     

Improvement in skin color achieved by smoking cessation

It has been well known that habitual smoking accelerates premature skin ageing recognized as ‘smoker's face’. However, the effect of smoking cessation on the appearance of skin has not been elucidated. The aim of this study was to evaluate objectively the effect of smoking cessation on the skin's appearance. The stratum corneum carbonyl protein level and skin colour of the cheek and the hand were measured. The change before and during the smoking cessation treatment (0, 2, 4, 8 and 12 weeks), and the success or failure in smoking cessation, was compared and examined. Eighty‐four cases who had smoking cessation treatment were examined. The level of the stratum corneum carbonyl protein did not show any difference comparing before and after treatment for the smoking cessation success group and the failure group. The lightness of skin colour showed an upward tendency 4–12 weeks after starting the treatment in the success group and increased significantly compared with the failure group. The redness showed a significant decrease in comparison with before the treatment, and it also showed a significant decrease compared with the failure group. The yellowness did not show any clear tendency. Also, the haemoglobin showed a decreased tendency. Furthermore, multivariate statistical analysis showed a possibility that the lightness and haemoglobin could be changed by smoking cessation treatment. In conclusion, our study showed that an upward tendency of skin lightness was seen to correspond with a haemoglobin decrease accompanied by smoking cessation. If we can easily measure skin improvement as an effect of smoking cessation, it is thought to be a useful aid for smoking cessation support.     

A meta-analysis of acupuncture techniques for smoking cessation

OBJECTIVE: To determine the effectiveness of acupuncture for smoking cessation and to examine whether any individual aspect of trials is associated with an effect. DATA SOURCES: All randomised controlled trials of acupuncture for smoking cessation that were listed in computerised databases or reference lists of relevant articles. STUDY SELECTION: All randomised single-blind studies that compared acupuncture with sham acupuncture. DATA EXTRACTION: Methodological data were extracted for quality assessment. Outcome data were extracted for rates of total smoking cessation at three intervals: early after treatment and after six and 12 months follow up. DATA SYNTHESIS: Results were expressed as odds ratios of success over failure in intervention over control groups. The combined odds ratio for all studies was calculated. Repeated meta-analyses were subsequently performed on subsets of studies combined according to defined characteristics: acupuncture technique, number of attendances, country of origin, status of journal, and control procedure. The overall quality of studies was poor. The combined odds ratio for smoking cessation calculated for the earliest results after the end of treatment was 1.20 (95% confidence intervals (95% CIs) = 0.98 to 1.48). The combined odds ratio for smoking cessation after six months was 1.29 (95% CI = 0.82 to 2.01), and after 12 months was 1.03 (95% CI = 0.73 to 1.46). There were no significant effects of relevance among subsets of studies grouped according to defined characteristics. CONCLUSIONS: Acupuncture was not superior to sham acupuncture for smoking cessation; no particular aspect of acupuncture technique was associated with a positive effect. The conclusions are limited by methodological inadequacies of studies and by the absence of testable hypotheses; design of future trials should avoid these deficiencies.     

Bibliographical analysis of research on smoking cessation therapy

OBJECTIVE: To compare the growth of research on treatments for smoking with that for similar medical/behavioural disorders. DESIGN: We surveyed Medline for 1967-1994 for articles on smoking, alcohol, anxiety, and obesity disorders. MAIN OUTCOME MEASURE: Number of articles published in two-year intervals. RESULTS: The number of articles per year on smoking/nicotine in humans increased fivefold from 1967 to 1994 compared with twofold for Medline as a whole. The rate of growth of empirical studies of treatment for smoking was as great as, or greater than, that for alcohol, anxiety, or obesity problems. In recent years, the rate of publication has continued to increase for drug treatments for smoking, has plateaued for brief advice, and has declined for behaviour therapy. CONCLUSION: Research on smoking is increasing as much as, if not more than, research in several similar disorders. The one area of apparent decline in smoking research is behaviour therapy for smoking cessation.




     

Nortriptyline for smoking cessation: a review.

This article reviews the efficacy of nortriptyline for smoking cessation based on a meta-analysis of the Cochrane Library. Six placebo-controlled trials have shown nortriptyline (75-100 mg) doubles quit rates (OR = 2.1). Between 4% and 12% of smokers dropped out because of adverse events, but no serious adverse events occurred. The efficacy of nortriptyline did not appear to be related to its antidepressant actions. Nortriptyline is an efficacious aid to smoking cessation with a magnitude of effect similar to that for bupropion and nicotine replacement therapies. Whether nortriptyline produces serious side effects at these doses in healthy, nondepressed smokers remains unclear because it has been tested in only 500 smokers. The finding that nortriptyline and bupropion are effective for smoking cessation but that selective serotonin-reuptake inhibitors are not suggests that dopaminergic or adrenergic, but not serotonergic, activity is important for cessation efficacy. Until further studies can verify a low incidence of significant adverse events, nortriptyline should be a second-line treatment for smoking cessation.     

Hypnosis for smoking cessation: a randomized trial

The purpose of this study was to determine whether hypnosis would be more effective in helping smokers quit than standard behavioral counseling when both interventions are combined with nicotine patches (NP). A total of 286 current smokers were enrolled in a randomized controlled smoking cessation trial at the San Francisco Veterans Affairs Medical Center. Participants in both treatment conditions were seen for two 60-min sessions, and received three follow-up phone calls and 2 months of NP. At 6 months, 29% of the hypnosis group reported 7-day point-prevalence abstinence compared with 23% of the behavioral counseling group (relative risk [RR] = 1.27; 95% confidence interval, CI 0.84-1.92). Based on biochemical or proxy confirmation, 26% of the participants in the hypnosis group were abstinent at 6 months compared with 18% of the behavioral group (RR = 1.44; 95% CI 0.91-2.30). At 12 months, the self-reported 7-day point-prevalence quit rate was 24% for the hypnosis group and 16% for the behavioral group (RR = 1.47; 95% CI 0.90-2.40). Based on biochemical or proxy confirmation, 20% of the participants in the hypnosis group were abstinent at 12 months compared with 14% of the behavioral group (RR = 1.40; 95% CI 0.81-2.42). Among participants with a history of depression, hypnosis yielded significantly higher validated point-prevalence quit rates at 6 and 12 months than standard treatment. It was concluded that hypnosis combined with NP compares favorably with standard behavioral counseling in generating long-term quit rates.     

A study of smoking and smoking cessation on the curricula of UK medical schools

Objectives: To identify current practice in teaching on smoking and smoking cessation in UK medical schools, and establish whether newly qualified UK doctors feel prepared to deliver smoking cessation interventions.

Design: Search of published curricula from all UK medical schools; questionnaire surveys of all UK medical school deans and UK qualified pre-registration house officers (PRHOs).

Participants: Deans or nominated representatives from all 24 UK medical schools with current undergraduates, and all UK qualified PRHOs.

Main outcome measures: Inclusion and organisation in curriculum of 15 predefined core topics related to smoking (deans); perceived readiness to deliver smoking cessation interventions (PRHOs).

Results: There was no mention of smoking or smoking cessation in the published curriculum material of 10 (42%) medical schools. Deans reported compulsory teaching on a mean (SD) of 9.5 (2.8) core topics, while PRHOs recalled compulsory teaching in only 6.6 (3.2). Training in clinical aspects of smoking cessation was particularly neglected, with 60% of PRHOs reporting that they graduated unable to deliver smoking cessation interventions in accordance with national guidelines. Only 17% of PRHOs felt well prepared to deliver advice on using nicotine replacement therapy, and 5% on bupropion.

Conclusions: Teaching on smoking cessation in UK medical schools is inadequate.