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)     

Hostility, cigarette smoking, and responses to a lab-based social stressor.

High-trait hostility is associated with persistent cigarette smoking. To better understand mechanisms that may account for this association, we examined the effects of acute smoking abstinence and delayed versus immediate smoking reinstatement on responses to a social stressor among 48 low hostile (LH) and 48 high hostile (HH) smokers. Participants completed two laboratory sessions, one before which they had smoked ad lib and one before which they had abstained for the prior 12 hr. During each session, participants completed a stressful speaking task and then smoked immediately after the stressor or after a 15-min delay. The effect of immediate versus delayed smoking reinstatement on recovery in negative mood was significantly moderated by hostility. When reinstatement was delayed, HH participants showed significant increases in negative mood over time, whereas LH participants showed little change. When reinstatement was immediate, HH and LH smokers showed similar significant decreases in negative mood. Smoking abstinence did not moderate hostility effects. Cigarette smoking may prevent continuing increases in negative mood after social stress in HH smokers, which may partially explain their low rates of quitting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Depression and smoking cessation: Characteristics of depressed smokers and effects of nicotine replacement.

Previous research has linked depression to difficulties in smoking cessation. The authors followed 269 smokers who attempted to quit smoking for 3 months. Participants were given nicotine gum (2 or 4 mg) or placebo gum and brief counseling. The study found that 34% of the smokers met the criterion for current depression using the Center for Epidemiological Studies Depression Scale. Depressed smokers relapsed significantly earlier than the nondepressed. Nicotine gum was significantly more effective than placebo gum among all smokers. The benefits of nicotine gum were particularly apparent among the depressed. Only 12.5% of depressed smokers quit successfully with placebo gum for 3 months, whereas 29.5% quit with nicotine gum. Depressed smokers reported more stress, less coping resources, more physical and psychological symptoms, and more frequent smoking in the presence of negative affect than did the nondepressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding smoking cessation: The role of smokers' quit history.

Many studies have found smokers' quit history to correlate with quitting smoking, but little is known about the psychological processes explaining this relationship. This study uses the integrative model of behavioral prediction to examine how quit history affects quit intention. Data from 3,428 Dutch smokers demonstrate that quit history affects (a) beliefs about quitting and (b) the degree to which self-efficacy predicts quit intention. It seems that a relatively unsuccessful history of prior quit attempts reduces self-efficacy over quitting and strengthens the relationship of self-efficacy with the intention to quit. The results are used to call for more process-oriented research in order to advance our understanding of the relationship between quit history and quit intention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case management

BACKGROUND: Effecting smoking cessation among adolescents provides an opportunity to reduce smoking levels among teens and among the adults those teens are soon to become. Better understanding of high school students' cessation behavior is needed to inform the development of effective strategies to support teen quitting. METHODS: Data from 1,210 established smokers among 6,427 12th graders from rural and suburban communities in Washington State were used to determine the frequency of a declared intention to quit, one or more quit attempts in the past year, ongoing quitting, and the attainment of long-term cessation. Logistic regression models investigated the association of these outcomes with the extent of peer smoking, age of becoming a regular smoker, sex, and grade point average (GPA). RESULTS: A serious intention to quit was declared by 67% of established smokers, and at least one attempt to quit was made in the past 12 months by 60%. However, only 21% of those who had attempted to quit in the past year were still abstaining at the time of the survey, and overall, merely 3% had achieved cessation beyond 12 months. The likelihood of success of quit attempts was strongly dependent on the extent of smoking among peers. Subjects who had become regular smokers at the youngest ages were more likely to undertake a quit attempt than those who started older. Females were less successful than males in attaining ongoing abstinence. Cessation behavior showed no clear association with students' GPA. CONCLUSIONS: A high fraction of high school smokers want to quit, but are unsuccessful in doing so. Thus, there is a need for programs to provide cessation skills to young smokers already motivated to quit.     

Rebound following failure to quit smoking: The effects of attributions and self-efficacy.

In this study the authors examined the process of rebound from failure, operationalized as a deliberate quit attempt within 6 months of failure in which the participant achieved at least 24 hr of abstinence, in a group of 63 smokers who failed to quit smoking. Guided, in part, by G. A. Marlatt and J. R. Gordon's (1985) abstinence violation effect model, the authors evaluated participants' reactions to failure by assessing causal attributions and self-efficacy immediately after the end of the failed quit effort and used these to predict rebound 3 and 6 months later in correlational and logistic regression analyses. Results showed that participants who rebounded attributed their prior failure to more unstable causes and had higher levels of self-efficacy following failure. Participants who rebounded also reported significantly more helpful attributional influences on their initial cessation effort. Logistic regression analyses indicated that more unstable reasons for failure to quit and helpful attributions moderately predict subsequent rebound. These effects are not mediated by self-efficacy. (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)     

Debunking myths about self-quitting: Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves.

This article examines data from 10 long-term prospective studies (N?>?5,000) in relation to key issues about the self-quitting of smoking, especially those discussed by S. Schachter (see PA, Vols 58:7407 and 68:10809). When a single attempt to quit was evaluated, self-quitters' success rates were no better than those reported for formal treatment programs. Light smokers (20 or less cigarettes per day) were 2.2 times more likely to quit than heavy smokers. The cyclical nature of quitting was also examined. There was a moderate rate (mdn?=?2.7%) of long-term quitting initiated after the early months (expected quitting window) of these studies, but also a high rate (mdn?=?24%) of relapsing for persons abstinent for six months. The number of previous unsuccessful quit attempts was unrelated to success in quitting. Finally, there were few occasional smokers (slips) among successful long-term quitters. We argue that quitting smoking is a dynamic process, not a discrete event. (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)     

Characteristics of smokers who attempt to quit and of those who recently succeeded

Although a high percentage of smokers attempt to quit each year, success rates are low. Thus, public health strategies must not only convince some smokers to attempt cessation, but also improve the success rate among other smokers already motivated to quit. Specific cessation strategies may be required for smokers in these two groups. This study compares sociodemographic and health behavior characteristics of smokers who have and have not attempted to quit and of those who recently succeeded. To determine whether these characteristics vary for men and women, we stratified analyses on gender. Data were obtained from random sample health surveys conducted 1981-1982 and 1983-1984 in two New England communities. Analyses include data on 2,086 respondents who reported smoking cigarettes in the previous year. Men and women were equally likely both to attempt cessation and to quit. Except for an inverse association with age, attempting to quit was not associated with sociodemographic variables. In men and women, attempts were associated with encouraging others to quit and attempting to increase exercise. Successful cessation attempts were associated with not living with a smoker in women; marital status, attempted weight loss, and increased age in men; and with efforts to increase exercise in both men and women. These characteristics could be useful in targeting smokers who attempt to quit, but fail. Improving the success rate in this group could greatly reduce smoking prevalence in the community.     

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)     

The theory of planned behavior and smoking cessation.

A sample of 84 smokers attending health promotion clinics in a primary care setting completed questionnaires that assessed the main constructs of the theory of planned behavior, perceived susceptibility, and past cessation attempts. Regression analyses revealed that intention to quit smoking was primarily predicted by perceived behavioral control and perceived susceptibility. At 6-month follow-up, the making of a quit attempt was predicted by intention and the number of previous quit attempts, whereas the length of the quit attempt was predicted solely by the length of the longest recent quit attempt. The results suggest that interventions should focus on perceptions of susceptibility and control to increase smokers' motivation to quit. However, further work is required to identify the social cognitive variables that ensure that initial quit attempts are translated into longer term abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking prevalence, quit attempts and successes

OBJECTIVES: This article provides a brief overview and update of Canadian smoking trends since 1966. It presents the characteristics of daily smokers who have successfully quit as well as those who have tried to quit but continue to smoke daily. DATA SOURCES: The time series smoking data are from a variety of surveys. The analyses pertaining to individuals who tried to quit smoking and those who successfully quit are based on a Health Canada-sponsored supplement to the 1994/95 National Population Health Survey (NPHS). MAIN RESULTS: In contrast to the overall trend, smoking rates among teens have been rising in the 1990s. Approximately 16% of daily smokers reported that they had recently stopped smoking. The majority of former daily smokers indicated that their main reason for quitting was concern about their future health. The vast majority reported that they had gone cold turkey. About four in ten daily smokers reported that they had tried, unsuccessfully to quit smoking in the 12 months before their NPHS interview.     

Anxiety sensitivity and panic reactivity to bodily sensations: Relation to quit-day (acute) nicotine withdrawal symptom severity among daily smokers making a self-guided quit attempt.

The current investigation explored the main and interactive effects of panic attacks in response to laboratory-induced bodily sensations and anxiety sensitivity in predicting acute nicotine withdrawal symptoms among daily smokers making a self-guided quit attempt. Participants were 99 daily smokers (58% women; Mage = 28.4 years, SD = 11.7) who completed a battery of questionnaires, a voluntary hyperventilation challenge, and a measure of nicotine withdrawal symptoms 12 hr after making a self-guided quit attempt. Results indicated that the interaction of anxiety sensitivity and panic responsivity to the challenge predicted quit-day nicotine withdrawal symptom severity above and beyond the main effects (p     

Stress, depressive symptoms, and smoking cessation among pregnant women.

Perceived stress and depressive symptoms were examined as correlates and predictors of smoking cessation during pregnancy in a sample of 819 pregnant smokers (454 baseline smokers and 365 baseline quitters). Women who quit early in pregnancy had lower levels of stress and depressive symptoms than baseline smokers. Adjusting for level of addiction and other demographic factors related to stress and depressive symptoms eliminated the significant association between depressive symptoms and smoking cessation. Lower levels of stress and depressive symptoms were not predictive of cessation in later pregnancy. Prenatal healthcare providers should continue to assess level of addiction and provide targeted intensive cessation interventions. Interventions that reduce stress and depression may also be of benefit to women who are continuing smokers in early pregnancy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategies for smoking cessation

Smoking cessation strategies should be geared to the target group's level of motivation to quit, and degree of tobacco addiction. Motivational interventions (e.g. media campaigns) aim to encourage more people to try to stop smoking. Treatment interventions (e.g. nicotine replacement) aim to increase the chances of a quit attempt being successful. In populations which have already been saturated by motivational interventions, the overall effect of adding further motivational interventions may be rather small, and possibly non-existent in heavy smokers. As a population's smoking prevalence declines, so the balance of interventions should shift from motivational to treatment approaches. Nicotine replacement is an effective smoking cessation aid and should form the basis for treating moderate to heavy smokers. There may be a case for the development of more specialist clinics to treat motivated but addicted smokers and train health professionals how to apply effective smoking cessation methods as part of their routine work.     

Smokers’ thoughts and worries: A study using ecological momentary assessment.

Objective: The purpose of this study was to investigate smokers’ thoughts and worries about their smoking behavior. Researchers have sometimes asked smokers to make such self-assessments but typically using retrospective summary judgments. Design: Using ecological momentary assessment, community and student smokers reported five times daily during two separate 1-week intervals. Main Outcome Measures: Smokers reported their thoughts about smoking, worries about smoking, and level of contemplation to quit smoking. Results: Smokers reported thinking negatively about their smoking 26.8% of the time they had a cigarette. The most frequent thoughts reported by smokers related to immediate reinforcement of smoking (e.g., “How I smell like cigarettes”). However, smokers reported more intense worry about thoughts related to health concerns (e.g., “Symptoms I'm having because of smoking”). The occurrence of negative thoughts was significantly and positively related to contemplation about quitting, worry about smoking, and risk perceptions. Finally, self-reported worry intensity was more strongly related to contemplation of quitting than negative thought occurrence. Conclusion: Our results show that thoughts about smoking (i.e., cognitions) and feelings about smoking (i.e., worry) are loosely connected and it is feelings rather than cognitions that are most related to contemplation to quit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lower task persistence in smokers with schizophrenia as compared to non-psychiatric control smokers.

One contributing factor to difficulty in quitting smoking may be task persistence, which can be viewed as a behavioral manifestation of distress tolerance, and describes the act of persisting in a difficult or effortful task. Task persistence was assessed in smokers with schizophrenia and schizoaffective disorder (SZ/SA; N = 71) and non-psychiatric controls (N = 78) before a quit attempt. These data support the hypothesis that smokers with SZ/SA display less task persistence than do non-psychiatric controls when persistence is measured via mirror tracing and a 2-item persistence measure. Lower persistence may partially explain the reduced smoking cessation successes of smokers with SZ/SA as compared to the general population. These data also replicate findings regarding relationships between histories of ability to quit smoking and task persistence and expand them to a new population of smokers. The absence of a diagnostic status by length of previous abstinence interaction suggests that the contribution of task persistence to smoking cessation is similar for smokers with and without schizophrenia. Future studies should evaluate the ability of task persistence to predict abstinence from cigarettes prospectively among smokers with schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)