Prediction of smoking relapse: Analyses of temptations and transgressions after initial cessation.

Different types of "relapse crises" and associated coping responses were associated with the resumption of smoking using a prospective design. One hundred and two previously heavy smokers (M?=?23.9 cigarettes a day) who achieved initial abstinence through a smoking cessation program were interviewed by telephone at 1, 2, and 3 months posttreatment. At each assessment, subjects described relapse crises, situations in which they were tempted to smoke or actually smoked but resumed abstinence (lapsed). Prospective analyses indicated that any smoking lapse is strongly related to subsequent relapse. Situational characteristics of relapse crises and the number of cognitive and behavioral coping responses reported during crises were only modestly consistent over time and were unrelated to later relapse. Confidence ratings and situational attributions about the relapse crises were also not prospectively associated with eventual relapse. Subanalyses suggested that lapses associated with urges and emotional (guilt) responses and lapses occurring in frequent situations are more likely to result in relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight gain as a function of smoking cessation and 2-mg nicotine gum use among middle-aged smokers with mild lung impairment in the first 2 years of the Lung Health Study.

Assessed the extent and predictors of weight change among sustained nonsmoking special intervention participants in the Lung Health Study. The intervention included a 12-session group program and 2-mg nicotine gum. At 12 mo, female sustained quitters (SQs; n?=?248) had gained a mean of 8.4% (5.3 kg) of their baseline weight, whereas male SQs (n?=?443) had gained 6.7% (5.5 kg). By 24 mo, female SQs had gained 9.8% of their baseline weight compared with 6.9% for men. Nicotine gum usage delayed a portion of the weight gain. Multiple regression analysis showed that weight gain at 12 mo was associated with a higher baseline salivary cotinine level, a lower baseline body mass index, drinking less alcohol per week, and a lower cotinine level at 12 mo (indicating less or no nicotine gum use). Moderate weight gain may be a long-term consequence of smoking cessation, a portion of which can be delayed with 2-mg nicotine gum. (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.     

Long-term psychological sequelae of smoking cessation and relapse.

The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect. However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of smoking cessation and maintenance

Previous work has shown that the study of host immune responses against Mycobacterium tuberculosis, the causative agent of tuberculosis, requires the availability of multiple mycobacterial antigens. Since purification of protein from M. tuberculosis cells is extremely cumbersome, we developed a protocol for purifying milligram amounts of ten recombinant antigens of M. tuberculosis from E. coli cells. Purified proteins were immunologically active and free of contaminants that confound interpretation of cell-based immunological assays. The method utilizes a three-step purification protocol consisting of immobilized metal-chelate affinity chromatography, size exclusion chromatography and anion-exchange chromatography. The first two chromatographic steps yielded recombinant protein free of protein contaminants, while the third step (anion-exchange chromatography) efficiently removed E. coli lipopolysaccharide, a potent polyclonal activator of lymphoid cells. The recombinant proteins were immunologically indistinguishable from their native (i.e., purified from M. tuberculosis) counterparts. Thus the method provides a way to utilize recombinant proteins for immunological analyses that require highly purified antigens.     

Effects of nicotine fading and relapse prevention on smoking cessation.

In a pilot study, a combined nicotine-fading/relapse-prevention program for 24 smokers (mean age 38.6 yrs) achieved a 46% abstinence rate at 6-mo follow-up. The combined program was then compared to conditions in which 46 smokers (mean age 34.8 yrs) received nicotine fading or relapse prevention only or combination treatment. There was no difference among groups in abstinence or rate at any follow-up point, and overall abstinence levels were only 15% and 9% at 6-mo and 1-yr follow-ups, respectively. Groups receiving nicotine fading tended to retain lower estimated nicotine intake levels. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of weight change following smoking cessation

Smoking behavior and weight change over a 5-year period were studied in 1,749 adult males of the Normative Aging Study. While men who quit smoking generally gained more weight than those in other smoking categories, 36% either lost weight or maintained the same weight after quitting. The major research focus was to predict the direction of weight change after smoking cessation. Among the characteristics most related to weight gain after quitting were heavier tar consumption, younger age, and leanness of body build. Conversely, traits related to weight loss were lighter smoking, older age, and stoutness of build.     

Self-efficacy and relapse in smoking cessation: A replication and extension.

In an effort to replicate and extend findings by M. M. Condiotte and E. Lichtenstein (see record 1982-01877-001), the relationship of a measure of self-efficacy—the Confidence Questionnaire—to posttreatment smoking status was assessed. Ss were 74 smokers (mean age 37 yrs). End-of-treatment self-efficacy scores were significantly correlated with follow-up smoking status at 3-mo and 6-mo follow-up, but not at 1 yr. When only Ss who were abstinent at termination were considered, self-efficacy still correlated significantly with 3-mo follow-up but not with 6-mo or 1-yr smoking status. Smoking during treatment was associated with lower end-of-treatment efficacy scores. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of alternative theoretical approaches to smoking cessation and relapse.

139 smokers (mean age 40.6 yrs) were randomly assigned either to (a) a traditional treatment program that used contingency contracting and emphasized the necessity for absolute abstinence (AA) or (b) a relapse-prevention (RP) treatment that focused on gradual acquisition of nonsmoking skills. It was hypothesized that the RP treatment would be less successful initially but would result in better maintenance skills and show a lesser relapse rate during a 1-yr follow-up. Each program was evaluated in 2 formats: group-based treatment and self-help materials. Results indicate comparable 1-yr abstinence rates for all treatments, although more Ss dropped out of the self-help formats. Ss in the RP intervention were more likely to lapse sooner after quitting and were more likely to quit again during the 1-yr maintenance period. Women were more successful in the RP program, and men had greater success with the AA approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who will relapse? Symptoms of nicotine dependence predict long-term relapse after smoking cessation.

Results of a prospective examination (n?=?618) of factors associated with smoking relapse are reported. At 1-yr follow-up, a modified version of the Fagerstrom Tolerance Questionnaire (Dependence Index; DI) and a measure of craving entered the logistic model (odds ratio of 2.7 [p?p?p?p?     

The influence of situation and coping on relapse crisis outcomes after smoking cessation.

Examines the influence of situational characteristics and coping on the outcome of a relapse crisis for 232 Ss followed for 1 month after a self-initiated smoking cessation attempt. Survival of a relapse crisis was most strongly related to the number of coping strategies used. All coping strategies were equally effective; furthermore, combining cognitive and behavioral coping strategies was not more effective than using multiple cognitive or multiple behavioral strategies. During the second half of the follow-up period (Weeks 3 and 4 postcessation), the presence of smokers resulted in a decreased likelihood of coping and an increased likelihood of smoking. In addition, active coping was marginally related to higher baseline levels of motivation to quit. When motivation and the presence of smokers were controlled, however, coping still significantly predicted outcome. Results are discussed with reference to previous relapse studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low-dose nicotine nasal spray use and effects during initial smoking cessation.

The purposes of this study were to determine if smokers wanting to quit smoking would use a low-dose nicotine nasal spray (i.e., acceptability) and what effect this spray use would have on withdrawal during the 1st week of cessation. Smokers (n?=? 52) were assigned double-blind to either placebo or nicotine spray (1.5 μg/kg. or approx. 0.1 mg, per spray) for ad lib use during the first week of cessation. All received group behavioral counseling. There was no difference in continuous 1-week abstinence (daily COa?     

Predictors of long-term smoking cessation in head and neck cancer patients

Cigarette smoking is a major risk factor for head and neck cancer, and individuals who continue to smoke past diagnosis and treatment are at elevated risk for further disease. In a randomized controlled trial, a state of the art provider-delivered smoking cessation intervention was compared to a usual care advice control condition. The intervention consisted of surgeon- or dentist-delivered advice to stop smoking, a contracted quit date, tailored written materials, and booster advice sessions. Subjects were 186 patients with newly diagnosed first primary squamous cell carcinomas of the upper aerodigestive tract who had smoked cigarettes within the past year. At randomization, 88.2% of subjects were current smokers. At 12-month follow-up, 70.2% of subjects completing the trial (n = 114) were continuous abstainers; among baseline smokers alone the continuous abstinence (CA) rate was 64.6%. The cotinine validation rate at 12 months was 89.6%. Modeling techniques were utilized in order to derive expected CA rates, which included noncompleter subjects (n = 72). The CA rate expected at 1 year for the entire patient population was 64.2%, and for smokers alone the expected CA rate was 59.4%. Logistic regression analysis carried out on baseline smokers identified predictors of 12-month CA status. These included medical treatment, stage of change, age, nicotine dependence, and race. The intervention effect was not significant, although the sign of the effect was positive. Based on these findings, we recommend systematic brief advice to stop smoking for head and neck cancer patients, with a stepped care approach for patients less able to quit.     

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)     

The effect of anticipatory strategies on the first day of smoking cessation.

The authors tested a model hypothesizing the predictors and the effects of anticipatory strategy use on the 1st day of smoking cessation using data from 63 participants in an ecological momentary assessment study of smoking cessation. Remaining abstinent on the 1st day of cessation was not associated with mean level of urges to smoke during tempting situations but was associated with anticipatory strategy use, which accounted for 18% of the variance. Getting rid of cigarettes contributed the most to this effect (β?=?-.397). Getting rid of cigarettes was itself predicted by 2 variables, lower nicotine dependence (β?=?-.264) and attending a formal smoking cessation class (β?=?.305), which accounted for 15% of its variance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A contingency-management intervention to promote initial smoking cessation among opioid-maintained patients.

Prevalence of cigarette smoking among opioid-maintained patients is more than threefold that of the general population and associated with increased morbidity and mortality. Relatively few studies have evaluated smoking interventions in this population. The purpose of the present study was to examine the efficacy of contingency management for promoting initial smoking abstinence. Forty methadone- or buprenorphine-maintained cigarette smokers were randomly assigned to a contingent (n = 20) or noncontingent (n = 20) experimental group and visited the clinic for 14 consecutive days. Contingent participants received vouchers based on breath carbon monoxide levels during Study Days 1 to 5 and urinary cotinine levels during Days 6 to 14. Voucher earnings began at $9.00 and increased by $1.50 with each subsequent negative sample for maximum possible of $362.50. Noncontingent participants earned vouchers independent of smoking status. Although not a primary focus, participants who were interested and medically eligible could also receive bupropion (Zyban). Contingent participants achieved significantly more initial smoking abstinence, as evidenced by a greater percentage of smoking-negative samples (55% vs. 17%) and longer duration of continuous abstinence (7.7 vs. 2.4 days) during the 2 week quit attempt than noncontingent participants, respectively. Bupropion did not significantly influence abstinence outcomes. Results from this randomized clinical trial support the efficacy of contingency management interventions in promoting initial smoking abstinence in this challenging population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influences of gender and weight gain on short-term relapse to smoking in a cessation trial.

Few researchers have studied whether weight gain has an impact on short-term relapse to smoking. The authors of this study investigated predictors of relapse among 989 participants (60% women) in a randomized, double-blind, 10-week multicenter trial to determine the effect of fluoxetine (30 or 60 mg) versus placebo in combination with behavioral counseling for smoking cessation. Medication compliance and smoking status were biochemically verified. At Visit 2, participants were asked to set a quit date within the subsequent 2 visits. A proportional hazards regression model was used to predict risk of relapse within the first 3 months of quitting. Weight gain predicted relapse, but for men only. Female gender also predicted relapse. The results led the authors to question whether postcessation weight gain interventions should be restricted to women smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of five smoking cessation pharmacotherapies on smoking cessation milestones.

Objective: Most smoking cessation studies have used long-term abstinence as their primary outcome measure. Recent research has suggested that long-term abstinence may be an insensitive index of important smoking cessation mechanisms. The goal of the current study was to examine the effects of 5 smoking cessation pharmacotherapies using Shiffman et al.'s (2006) approach of examining the effect of smoking cessation medications on 3 process markers of cessation or smoking cessation milestones: initial abstinence, lapse, and the lapse–relapse transition. Method: The current study (N = 1,504; 58.2% female and 41.8% male; 83.9% Caucasian, 13.6% African American, 2.5% other races) examined the effect of 5 smoking cessation pharmacotherapy treatments versus placebo (bupropion, nicotine lozenge, nicotine patch, bupropion + lozenge, patch + lozenge) on Shiffman et al.'s smoking cessation milestones over 8 weeks following a quit attempt. Results: Results show that all 5 medication conditions decreased rates of failure to achieve initial abstinence and most (with the exception of the nicotine lozenge) decreased lapse risk; however, only the nicotine patch and bupropion + lozenge conditions affected the lapse–relapse transition. Conclusions: These findings demonstrate that medications are effective at aiding initial abstinence and decreasing lapse risk but that they generally do not decrease relapse risk following a lapse. The analysis of cessation milestones sheds light on important impediments to long-term smoking abstinence, suggests potential mechanisms of action of smoking cessation pharmacotherapies, and identifies targets for future treatment development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived stress, quitting smoking, and smoking relapse.

Assessed perceptions of stress prior to quitting smoking and at 1, 3, and 6 mo after quitting in 211 Ss. Analyses provide evidence for a relation between changes in stress levels and changes in smoking status. Ss who failed to quit smoking for more than 24 hrs maintained a relatively high and consistent level of stress over the 6-mo period. For continuously abstinent Ss, stress decreased as duration of abstinence increased. Increased stress with relapse was found across all time periods, and decreased stress after quitting was observed at 2 time periods. The relationship between smoking and stress may be bidirectional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)