Adolescent reasons for quitting smoking: Initial psychometric evaluation.

Most adolescent smokers report intentions to quit, and the majority attempt cessation. However, little is known regarding the relationship between adolescent motives for cessation and smoking cessation efforts. To this end, the present study describes an initial evaluation of the psychometric characteristics of the Adolescent Reasons for Quitting scale (ARFQ), a measure of adolescent motives for smoking cessation. Participants were 109 current smoking high school students assessed at baseline and 6-month follow-up. The ARFQ item content and format was developed in a separate qualitative study with 36 high school students who had previously attempted to quit smoking. Exploratory factor analyses of ARFQ items yielded 3 subscales: Short-Term Consequences, Social Disapproval, and Long-Term Concerns. Validation analyses were conducted in relation to concurrent intentions to stop smoking and prospective smoking cessation attempts, providing evidence of concurrent, predictive, and discriminant validity. In particular, the Social Disapproval and Long-Term Concerns subscales significantly predicted subsequent cessation attempts. As such, the ARFQ may prove valuable for informing interventions to encourage adolescent smoking cessation. (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.     

Chorioretinal damage caused by the excision of choroidal neovascularization

BACKGROUND: In recent years many longitudinal studies have examined the predictors of smoking acquisition. However, only a few studies have focused on the precursors of smoking cessation. The current study is one of the first concentrating on longitudinal predictors of young people's smoking cessation. METHODS: Subjects were 215 smokers ages 14-15 years who were reinterviewed 3 years later. These smokers were allocated to four groups based on their motivation to quit and actual quitting behavior at the last wave. Independent variables were smoking-specific cognitions, social influences, and aspects of smoking habits. RESULTS: Univariate comparisons between the four groups showed that those with a positive attitude toward smoking and lower self-efficacy were less likely to be motivated to quit 3 years later. No long-term effects of environmental influences were found. Aspects of smoking habits, such as intensity and frequency of smoking, and the context of cigarette use affected the motivation to quit. Logistic regression analyses were conducted to examine differences in predictors between the groups in more detail. These analyses revealed that differences mainly in attitudes and self-efficacy affected whether subjects were absolutely not motivated to quit or had actually quit 3 years later. Differences in smoking behavior affected the allocation to the more closely related groups (e.g., preparing versus quitting). CONCLUSIONS: Adolescents' motivation to quit is affected by smoking-related cognitions and habitual factors. More research is needed to decide whether the relation between intensity and frequency of smoking and the likelihood to quit later on should be interpreted in terms of differences in smoking initiation or in terms of preparation to quit.     

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.     

Desire and efforts to quit smoking among cigarette smokers in Wisconsin

This research studied the desire and attempts of cigarette smokers in Wisconsin to quit smoking. Data were based on the 1993 Wisconsin Division of Health's Behavioral Risk Factor Surveillance System (BRFSS). Among the 23% of respondents who were current smokers, 79% said they wanted to quit smoking and 60% said they had quit smoking for a day or more in the preceding year. High rates of wanting to quit and having tried to quit were found in all demographic subgroups of smokers studied. Compared to lighter smokers, heavy cigarette smokers (20 or more cigarettes per day) were less likely to have tried quitting in the past year, but were almost as likely to want to quit. These results demonstrate the great demand for smoking cessation services among smokers in Wisconsin and support for efforts to increase the use and effectiveness of these interventions.     

P300 delay and attenuation in schizophrenia: reversal by neuroleptic medication

PURPOSE: To examine parental influences on two transitions in the adolescent smoking uptake process: from never having smoked to experimentation and from experimentation to established smoking. METHODS: Using data from the longitudinal Teenage Attitudes and Practices Survey of 1989-1993, we related perceived parental concern about their adolescents' future smoking, parental smoking status, problem-solving communication between parent and adolescent, demographics, and other factors at baseline to experimentation by follow-up among those who had never puffed on a cigarette (n = 4149). We also related these factors at baseline to reaching a lifetime level of smoking of at least 100 cigarettes by follow up among those who had experimented but smoked < 100 cigarettes (n = 2684) in univariate and multivariate analyses. RESULTS: Among never-smokers, baseline susceptibility to smoking and having male best friends who smoke predicted experimentation in the next 4 years. Among experimenters, susceptibility to smoking, having male or female best friends who smoked, and lack of parental concern about future smoking distinguished those who progressed to established smoking by follow-up. Furthermore, communicating with parents first about serious problems was protective against progression from experimentation to established smoking. CONCLUSION: Interventions aimed at reducing adolescent smoking should encourage cessation for parents who smoke and help parents communicate strong anti-smoking norms to children and adolescents and maintain strong lines of communication with them.     

Genetic analysis of inflammation, cytokine mRNA expression and disease course of relapsing experimental autoimmune encephalomyelitis in DA rats

Past history of major depression is more common in smokers than in non-smokers. We have shown in a previous study that lifetime prevalence of major depression is higher in dependent smokers and they have lower monoamine oxidase-A and -B activities than non-smokers. Because several studies have found an association between MAO-B activity and depression we analysed data of these smokers to assess whether past history of major depression is associated with reduced monoamine oxidase activities (A and B) or not. Further, we tried to characterize smokers with past history of major depression and its effect on withdrawal symptoms. The data of 88 dependent smokers (Fagerstr?m Tolerance Questionnaire score > or = 6 and smoking > or = 20 cigarettes/day) who participated in a smoking cessation study were analysed. Smokers with past history of major depression but without current illness did not differ in demographic and smoking characteristics from smokers without past history of major depression. Smokers with past history of major depression were mainly women and had lower body mass index. Adjusted for gender and body mass index dependent smokers with or without past history of depression had similar MAO-A and MAO-B activities but smokers with past history of major depression had significantly lower resting plasma norepinephrine levels. Smokers with past history of depression had not significantly higher ratings for depression (Montgomery-Asberg Depression Rating Scales) and anxiety (Hamilton Anxiety Scales) and smoking cessation did not exacerbate these ratings (assessed up to 3 months) and none had depressive episode during the postcessation period up to one year. Past history of depression was associated with higher scores on 'expressed sadness' and 'depressive mood'. Abstinent smokers with past history of depression had significantly higher ratings in one of the seven ratings of a 6 months period for craving (day 28), anxiety (day 7) and total withdrawal symptom score (day 7) when compared to those who had no past history of major depression. It is concluded that (i) past history of major depression is more frequent in female smokers; (ii) smokers with past history of depression may have more intense withdrawal symptoms (craving and anxiety) at some time after cessation: and (iii) past history of depression does not affect monoamine oxidase activities, therefore, reduced monoamine oxidase activities found in previous studies are possibly characteristic features of smoking.     

An investigation of predictors of nicotine abstinence in a smoking cessation treatment study of smokers with a past history of alcohol dependence.

This study investigated predictors for smoking abstinence at 12-week follow-up among 85 smokers with a past history of alcohol dependence enrolled in a smoking cessation trial. Length of alcohol abstinence at time of enrollment and longest previous period of smoking abstinence were significantly associated with smoking status at follow-up. Multiple logistic regression with these variables entered as predictors suggested that longest previous period of smoking abstinence partially mediated the relationship between length of alcohol abstinence at enrollment and smoking status at follow-up. Additional research is warranted to identify predictors of nicotine abstinence and smoking relapse in this population and to understand the factors that mediate the relationship between length of alcohol abstinence at enrollment and smoking outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment for depression in smoking cessation.

Cigarette smokers with past major depressive disorder (MDD) received 8 group sessions of standard, cognitive–behavioral smoking cessation treatment (ST; n?=?93) or standard, cognitive–behavioral smoking cessation treatment (ST) plus cognitive–behavioral treatment for depression (CBT-D; n?=?86). Although abstinence rates were high in both conditions (ST, 24.7%; CBT-D, 32.5%, at 1 year) for these nonpharmacological treatments, no main effect of treatment was found. However, secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking (≥25 cigarettes a day) at baseline. Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST (odds ratios?=?2.3 and 2.6, respectively). Results suggest that CBT-D provides specific benefits for some, but not all, smokers with a history of MDD. (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.     

Social cognitive mediators of adolescent smoking cessation: Results from a large randomized intervention trial.

Only one prior study has examined why adolescent smoking cessation interventions are effective. To address this understudied and important issue, we examined whether a large adolescent smoking cessation intervention trial's outcomes were mediated by social cognitive theory processes. In a randomized trial (N = 2,151), counselors proactively delivered a telephone intervention to senior year high school smokers. Mediators and smoking status were self-reported at 12-months postintervention eligibility (88.8% retention). At least 6-months abstinence was the outcome. Among all enrolled smokers, increased self-efficacy to resist smoking in (a) social and (b) stressful situations together statistically mediated 55.6% of the intervention's effect on smoking cessation (p p     

Prevalence and a drug use development model for the study of adolescent drug use in Japan

The purposes of this study were to estimate the prevalence of drug use, to examine the correlation between drug use and drinking/smoking in Japan, and to test a developmental model of adolescents' drug use based on three basic theories of deviance: Strain, Social control, and Differential association. The survey was conducted from April to May, 1996, in 14 public high schools in Tokyo, using anonymous self-reporting. A total of 4,171 (99.45%) students responded to our questionnaire. It included central concept items in the three deviant theories, beliefs about the ill effects of drugs, sex, grades, etc. The following findings were obtained: 1) Among the subjects, 255 students (6.1%) reported drug use within the past year. Of these drug users, 73.3% used drugs soon after being "tempted" by friends. Responding to "When was it.", as a first year junior high school was the most common first experience, and the next most common was during the sixth year of elementary school. 2) Drinking and smoking appeared to be gateway drugs for adolescents in Japan as has been shown in the United States. 3) Multiple regression and logistic multiple regression analyses suggested that differential association variables were far more powerful predictors of adolescent drinking, smoking and drug use than either the control or strain variables. Results provided modest support for the Differential Association Theory as an explanation of drug use. 4) LISREL's goodness-of-fit statistic indicated a much better fit between the model and the data. (CN: 282, GFI: 0.967, AGFI: 0.941). These findings show two processes by which adolescents become involved in drug use. Strain and Social Control do not directly affect drug use. However, Social Control is important because it works indirectly, through Differential Association resulting in drug use. Second, though weaker, Differential Association appears to lead to dangerous beliefs in drug use followed by actual drug use.     

Nicotine dependence subtypes among adolescent smokers: Examining the occurrence, development and validity of distinct symptom profiles.

To increase understanding of the etiology and epidemiology of nicotine dependence among adolescent smokers, the present study examined the occurrence and development of distinct nicotine dependence symptom profiles in a sample of adolescent smokers. A total of 25 secondary schools throughout the Netherlands participated in a 1-year longitudinal study. Multiple dimensions of nicotine dependence were assessed, at two time points, among 641 adolescents (aged 14–17 years) who were classified as smokers. Results showed 4 distinct, yet stable, nicotine dependence subtypes that could be characterized by quantitative as well as qualitative differences. The symptom profiles were similar for males and females but differentially associated with previously identified correlates of nicotine dependence, namely parental smoking, peer smoking, and depressive mood. Finally, differential links of the 4 subtypes were found with regard to smoking uptake and cessation. The finding of qualitative different subgroups of adolescent smokers may have important implications for intervention efforts regarding nicotine dependence and smoking cessation. Such efforts may need to be tailored to the specific subgroups’ needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Factors associated with participation, attrition, and outcome in a smoking cessation program at the workplace.

Of 66 24–58 yr old smokers in 2 worksites, 67% participated in a smoking cessation program. 55% completed the program. Of those, 29% had quit smoking by posttest, and 17% were abstinent at the 6-mo follow-up. Different variables predicted participation, attrition, and outcome. Significant predictors of smokers who participated were length of cessation in previous abstinence attempts, number of years they smoked, and belief regarding personal vulnerability in contracting a smoking-related disease. Levels of pretest carbon monoxide and attitudes regarding adoption of smoking restrictions in the worksite predicted attrition. Posttest cessation was related to nicotine levels of cigarette brand smoked at pretest and pretest beliefs regarding postcessation weight gain. Abstinence at the 6-mo follow-up was predicted by number of co-workers who smoked and pretest concerns related to postcessation weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of smoking cessation during pregnancy on preterm delivery and low birthweight

BACKGROUND: Evidence exists that maternal cigarette smoking is associated with preterm birth. Our purpose was to investigate the relation between maternal smoking cessation at different points during pregnancy and the preterm delivery rate and low birthweight. METHODS: Data from the 1988 National Health Interview Survey were analyzed. The study included women who gave birth to children within 6 years of the 1988 interview date (N = 4876). Preterm delivery and infant low birthweight were the main outcome measures. These measures were compared with maternal smoking status during pregnancy. Logistic regression models were computed to control for maternal age at the time of birth, parity, race, and total family income. RESULTS: Women who did not smoke cigarettes during pregnancy were less likely to give birth prematurely (5.9% vs 8.2%, P = .003) or give birth to a low-birthweight baby (5.5% vs 8.9%, P < .001) than women who smoked at some time during the year before giving birth. A significant association existed between maternal smoking status and both preterm delivery and low birthweight. Compared with those who smoked beyond the first trimester, those who quit smoking within the first trimester had reductions in the proportion of preterm deliveries (6.7% vs 9.1%) and low birthweight infants (7.9% vs 9.6%). CONCLUSIONS: Low birthweight and preterm delivery are reduced in women who stop smoking in the first trimester of pregnancy.     

Pregnancy smoking cessation: a case of mistaken identity

This study examined the process of change in pregnancy smoking cessation, using the stages and processes of change from the Transtheoretical Model, to compare women who stopped smoking during pregnancy with women who were in the process of smoking cessation, but were not pregnant. Differences in smoking cessation process activity and abstinence self-efficacy were hypothesized between the pregnant and nonpregnant groups of women. Study participants were 89 pregnant women who quit smoking, 28 nonpregnant women in the action stage of smoking cessation, and 92 nonpregnant women in the preparation stage. The Smoking Cessation Processes of Change Scale and the Smoking Abstinence Self-Efficacy Scale served as dependent measures. One-way MANOVA and follow-up Newman-Keuls comparisons indicated significant differences between pregnant and nonpregnant women in their levels of process activity and self-efficacy. Pregnancy smoking cessation differed dramatically from the process of nonpregnancy smoking cessation. Pregnant quitters were not engaging in experiential and behavioral processes at levels associated with the action stage of change. Low levels of process use and high efficacy indicated an externally (for the baby) motivated stopping rather than an internal, intentional process of change, which may account for high relapse rates postpartum.     

Morphology and ultrastructure of the antennal chemoreceptors and mechanoreceptors of worker Coptotermes formosanus Shiraki

Data on respiratory symptoms and smoking for 2749 white American high school students from two linked surveys, separated by a one year lapse, are presented. There was a significantly higher likelihood of smoking at second survey among those who had initial symptoms. (There had been no educational efforts linking smoking and respiratory symptoms in the interim.) This difference was almost entirely contributed by those who had been ex-smokers and light (less than or equal to four cigarettes/day) smokers at first survey. Initial ex-smokers and light smokers also had, overall, least fixed smoking habits. Whatever the initial smoking or symptom status, symptoms at second survey were far more likely with current smoking. Controlling for initial symptom and smoking status, the gradient of symptoms between current smokers and non-smokers was over two and a half fold, except among those who had had symptoms and had not been smoking, and whose initial symptoms presumably arose from causes other than current cigarette smoking. Even among that group, symptoms at second survey were half as likely again among those who reported having become smokers (p less than-001). There were also strong linear trends of increased likelihood of symptoms with increased numbers of cigarettes smoked. Symptom rates at second survey of those who had symptoms a year earlier, and who stopped smoking during the year, were not as low as for those who also stopped smoking, but who had not had initial symptoms, suggesting that symptoms associated with smoking were not completely reversible in the time interval of this study. The difference, however, was not significant.     

Postpartum return to smoking: Staging a "suspended" behavior.

Two hundred fifty-six pregnant women who had quit smoking were classified into the precontemplation (PC), contemplation (C), preparation (PA), or action (A) stages of change for postpartum smoking cessation based on a 3-item algorithm assessing personal goals, self-efficacy, and smoking behavior. Logistic regression and event history analyses indicated group differences in return to smoking at 6 weeks and 3, 6, and 12 months postpartum. The percentage of women who returned to postpartum smoking was highest in the precontemplation stage and decreased with each subsequent stage, that is, at 6 weeks 83% of PCs, 64% of Cs, 35% of PAs, and 24% of As had returned to smoking. Results lend support for the stages of change for postpartum smoking abstinence. Stage-based interventions may be developed to assist women in maintaining abstinence postpartum. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Providers' experiences caring for adolescents who smoke cigarettes.

Objective: To describe providers' experiences screening for and counseling adolescent patients who smoke cigarettes. Design: Eight qualitative focus groups were conducted with 51 health care providers in primary care settings. Focus groups were video- and audiotaped; tapes were transcribed for coding by an interdisciplinary team using the constant comparative method. Main Outcome Measures: Providers reported experiences screening for and managing adolescent patients who reported smoking cigarettes. Results: Providers expressed confidence in their ability to screen adolescent patients for tobacco use, particularly as part of regularly scheduled preventive and medical visits. Providers reported difficulty balancing screening for smoking with their concern for maintaining rapport with their adolescent patients. In addition, providers reported that adolescent smoking patterns differed from those of adults, and consequently, providers were not certain at what level of smoking an adolescent required intervention. Furthermore, providers were unclear regarding what interventions were recommended for and effective with adolescents. Conclusion: Providers are interested in adolescent evidence-based screening methods and cessation interventions that are supportive of a nonjudgmental and empathic approach to caring for adolescent smokers, particularly those with irregular and situational smoking patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)