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)     

Sex differences in predictors of adolescent smoking cessation.

Sex differences in predictors of smoking cessation were investigated among 337 male and 490 female participants in the RAND adolescent panel study. Participants reported smoking at least 11–20 times during the past year at Grade 10, with cessation defined as not smoking during the past year at Grade 12. Controlling for demographics, sex-specific analyses indicated that girls who quit smoking within 2 years had friends who smoked less frequently, perceived less parental approval of their smoking, had weaker intentions to continue smoking, used marijuana less frequently, attended fewer different schools, were more likely to have an intact nuclear family, experienced greater peer support, and rated themselves as healthier. Similar analyses for boys yielded results that were generally weaker and nonsignificant, with smoking quantity accounting for several associations in the sex-specific models. Despite these differences, interaction tests revealed significant sex differences for only three predictors. Implications of these results for understanding adolescent smoking cessation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy and smoking cessation: A meta-analysis.

According to relapse models, self-efficacy (SE), or confidence in one's ability to abstain, should predict the outcome of an attempt to quit smoking. We reviewed 54 studies that prospectively examined this relationship. The relationship between SE and future smoking depended upon the population studied and the timing of the SE assessment. The relationship between SE and future smoking was modest when SE was assessed prior to a quit attempt; SE scores were .21 standard deviation units (SD) higher for those not smoking at follow-up than for those who were smoking. The relationship was stronger (.47 SD) when SE was assessed post-quit. However, this effect was diminished when only abstainers at the time of the SE assessment were included in analysis (.28 SD). Controlling for smoking status at the time of SE assessment substantially reduced the relationship between SE and future smoking. Although SE has a reliable association with future abstinence, it is less robust than expected. Many studies may overestimate the relationship by failing to appropriately control for smoking behavior at the time of the SE assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivation for smoking cessation among pregnant women.

The authors evaluated an expanded measure of intrinsic and extrinsic motivation for smoking cessation in a population-based sample of 897 pregnant smokers (500 current smokers and 397 recent quitters). The measure assessed motivation related to pregnancy and parenthood in addition to general intrinsic and extrinsic dimensions. Current smokers at baseline who quit smoking by 28 weeks of pregnancy (n?=?102) had significantly higher baseline levels of pregnancy-related motivation than continuing smokers. Extrinsic and pregnancy motivation dropped between baseline and 28 weeks of pregnancy among continuing smokers. Higher levels of intrinsic relative to extrinsic motivation at baseline were associated with sustained abstinence during the first 2 months postpartum. Results suggest that both general and pregnancy-specific motivation are important for smoking cessation and relapse prevention during pregnancy. Interventions to enhance the salience of health benefits over and above those related to pregnancy and other intrinsic benefits of a greater sense of self-control could protect against postpartum relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of gender in social control of smoking cessation.

This study of 93 men and 117 women smokers during an ongoing quit attempt examined the roles of gender and social network influences on quitting. For men, social influences appeared to positively affect their ability to reduce their smoking but were less effective for women. Specifically, increased reports of a spouse or partner's influence, and family and friends' influence, were associated with greater reductions in men's smoking 2 days and 4 months post quit date, respectively. In contrast, for women, greater reports of spouse or partner influence and of family and friends' influence were associated with smaller reductions in smoking. Sex differences in social control strategies and perceived autonomy supportiveness of those strategies are discussed as possible explanations for these results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancy priming of smoking cessation messages enhances the placebo effect of tailored interventions.

Objective: Previous research (Webb, Simmons, & Brandon, 2005) suggested that smokers' reactions to self-help materials were more positive if they believed that the materials had been personally tailored to their individual characteristics and if they held expectancies that tailored interventions are superior to standard, or generic, interventions. The authors' objective in the current study was to replicate and extend this research by testing the efficacy expectancy priming before intervention delivery. Design: In a 2 × 2 factorial experiment, 210 smokers (M = 23 cigarettes/day) recruited from the community (62% female; 92% Caucasian; mean age = 49) were randomly assigned to 1 of 4 conditions: placebo-tailored intervention/no priming, placebo-tailored intervention/priming, standard intervention/no priming, or standard intervention/priming. The tailoring-related expectancies of participants' in the priming conditions were primed before they were presented with the respective intervention booklets. Main Outcome Measures: Content evaluations, readiness to quit smoking, cessation self-efficacy, smoking-related knowledge, and progress toward quitting (behavior changes). Assessments occurred by mail at baseline and at 1-month postintervention. Results: Similar to the earlier study, the placebo-tailored booklets produced superior evaluations and smoking-related cognitive and behavioral changes. Moreover, the pretreatment expectancy priming successfully altered participants' tailoring-related expectancies and also produced superior evaluations and outcomes. Conclusion: Findings support a causal role of tailoring-related expectancies on the efficacy of tailored interventions and suggest that interventions can be enhanced via expectancy priming. (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)     

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)     

Evaluating three theory-based interventions to increase physicians' recommendations of smoking cessation services.

Objective: To evaluate three theory-based interventions aimed at increasing the rate at which primary care physicians recommend smoking cessation services to smokers. Design: Primary care physicians (n = 251) were randomized to one of four conditions: (a) information based on social cognitive theory (SCT) targeting outcome expectations, (b) information based on SCT + elaboration likelihood model, (c) feedback based on self-perception theory, or (d) control. Main Outcome Measures: Intentions to recommend and self-reported recommendations of smoking cessation services 1 week postintervention. Results: Data were analyzed using covariance and mean structure analysis. Compared with the control group, only the SCT group reported more frequently recommending services (mean difference = 1.1 recommendations per week, Cohen's d = 0.46) and higher intentions. Mediation analysis was consistent with increased intentions resulting from changes in outcome expectations. There was no evidence that changes in intentions explained self-reported behavior change. Conclusion: The study provides preliminary “proof of principle” for further studies incorporating more robust outcome measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional bias predicts outcome in smoking cessation.

Most attempts to quit smoking end in failure, with many quitters relapsing in the first few days. Responses to smoking-related cues may precipitate relapse. A modified emotional Stroop task-which measures the extent to which smoking-related words disrupt performance on a reaction time (RT) task-was used to index the distracting effects of smoking-related cues. Smokers (N=158) randomized to a high-dose nicotine patch (35 mg) or placebo patch completed the Stroop task on the 1st day of a quit attempt. Smokers using an active patch exhibited less attentional bias, making fewer errors on smoking related words. Smokers who showed greater attentional bias (slowed RT on the first block of smoking words) were significantly more likely to lapse in the short-term, even when controlling for self-reported urges at the test session. Attentional bias measures may tap an important component of dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine withdrawal in smokers with current depressive disorders undergoing intensive smoking cessation treatment.

The authors investigated withdrawal in smokers with current threshold and subthreshold depressive disorders (N = 21) who were participating in a pilot study of intensive counseling interventions for smoking cessation. The majority of participants (67%) were taking antidepressants when they entered the trial. Withdrawal symptoms were compared in prolonged abstainers versus nonabstainers across a 12-week treatment period and at the 3-month follow-up assessment visit. Prolonged abstinence was associated with an increase in positive affect and a decrease in depressive symptoms and craving over time. Nonabstinence was associated with little overall change in these variables from treatment onset to the 3-month follow-up. At the 3-month follow-up, 44% of prolonged abstainers were in complete remission of their baseline depressive disorders, compared with 0% remission among nonabstainers. Findings suggest that within the context of an intensive smoking cessation intervention, some smokers with current depressive disorders may experience significant improvement in affective and craving symptoms. Findings also suggest that abstinence may be associated with improvement in affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of depressed mood on smoking cessation: Mediation by postcessation self-efficacy.

This study evaluated the relationship between precessation depressed mood and smoking abstinence and assessed the mediation of this effect by postcessation self-efficacy, urges to smoke, nicotine withdrawal, and coping behavior. The sample included 121 smokers previously treated in a randomized controlled trial involving behavior therapy and the nicotine patch. The results showed that precessation depressed mood was inversely related to 6-month abstinence. This effect remained significant after controlling for treatment, possible depression history, baseline smoking rates, and several other demographic factors. Postcessation self-efficacy, at the 2-, 4-, and 8-week postquit assessments, was the strongest mediator of the effects of precessation depressed mood on abstinence, accounting for 32%, 38%, and 48% of the effect of mood on abstinence, respectively. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal analysis of abstinence-specific social support and smoking cessation.

Objectives: (1) To replicate previous research finding that abstinence-specific social support during the active phase of quitting predicts short- and long-term smoking cessation treatment outcome. (2) To describe time-related changes in abstinence-specific support, including how support provided during middle and later phases of the quitting process is associated with treatment outcome. Design: Combined data from three randomized clinical trials of smoking cessation treatment (N = 739) were analyzed using logistic regression and analysis of variance. Main Outcome Measures: Measures included the Partner Interaction Questionnaire (PIQ; Cohen & Lichtenstein, 1990), a measure of smoking-related social support, and smoking status according to 7-day point-prevalence abstinence. Results: Longitudinal analyses found that positive support peaked at week 12, decreasing thereafter. Positive support provided after week 12 did not differentiate between those who never quit smoking, those who quit and relapsed, and those who maintained abstinence. In contrast, negative support was monotonic and was useful at follow-up points for distinguishing between outcome groups. Conclusion: These results suggest that positive and negative support are both important factors in the early phase of quitting, but it is the continued minimization of negative support that best predicts maintenance of nonsmoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hostility and smoking cessation treatment outcome in heavy social drinkers.

Hostility is a multifaceted construct encompassing affective, behavioral, and cognitive aspects. There is preliminary evidence linking hostility to poorer outcomes in smoking cessation treatment; however, it is unclear which components of hostility are most important in cessation. In this study, the authors examined multiple aspects of trait hostility in 92 heavy social drinkers who were seeking smoking cessation treatment. Consistent with their hypothesis, the authors found that the cognitive component of hostility was most relevant to smoking cessation outcome. Specifically, those who expressed bitterness about their lives and tended to believe that they had poor luck and had gotten a raw deal out of life had poor smoking cessation outcomes. Cognitive measures of hostility also predicted greater nicotine withdrawal symptoms 1 week after quitting smoking. Other components of hostility including anger and both physical and verbal aggression did not significantly predict smoking outcome or nicotine withdrawal. Further examination of how a hostile worldview contributes to smoking cessation failure is warranted, as this facet of hostility may prove a valuable target for smoking cessation interventions. (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)     

Short- and long-term smoking cessation for three levels of intensity of behavioral treatment.

Efficacy and costs of 3 levels of medical–behavioral treatment intensity in conjunction with nicotine replacement therapy (NRT) were compared in 240 one-pack-a-day smokers: (a) a low-intensity (LI) group that received 8 weeks of NRT (n?=?80) and 1 advice and education (A&E) session with a nurse practitioner (NP); (b) a moderate-intensity (MI) group that was provided NRT and 4 A&E sessions with an NP (n?=?80), and (c) a high-intensity (HI) group that received treatment combining NRT, 4 A&E sessions, and 12 weeks of individualized cognitive–behavioral therapy (n?=?80). Biochemically confirmed abstinence rates at 9, 26, and 52 weeks posttreatment initiation were highest for the HI (45%, 37%, 35%) group, followed by the LI (35%, 30%, and 27%) and MI (27%, 12%, 12%) groups. Group differences approached statistical significance at 9 weeks and were statistically significant at both 26 and 52 weeks. The cost of LI treatment was $308, that of MI was $338, and the HI treatment cost was $582. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental smoking cessation and child daily smoking: A 9-year longitudinal study of mediation by child cognitions about smoking.

Objective: This study investigated to what extent the prospective relationship between parental smoking cessation and child daily smoking is mediated by child cognitions about smoking. Design: The study drew its sample from the 40 Washington State school districts involved in the Hutchinson Smoking Prevention Project. The predictor variable of parental smoking cessation was measured during third grade. The mediator measures, consistent with the Theory of Planned Behavior and Social Cognitive Theory, were measured during ninth grade, and the smoking status outcome was measured during twelfth grade. Main Outcome Measures: Smoking status at twelfth grade. Results: Negative general attitudes toward smoking, attitude that cigarette smoke is bothersome, and tobacco refusal self-efficacy together significantly mediated 49% of the prospective relationship between parental smoking cessation and child daily smoking. Conclusion: Parental smoking cessation before children reach third grade may lead children to develop more negative cognitions about smoking, and, in turn, reduce their risk of smoking. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Are most precontemplators contemplating smoking cessation? Assessing the validity of the stages of change.

Objective: To assess the validity of the stages of change (SOC) algorithm for current smokers. Design: This study was a mail-based, cross-sectional survey study of 242 adult smokers. Main Outcome Measures: The main outcome measures were the SOC algorithm and a variety of alternative questionnaire items measuring motivation to quit smoking. Results and Conclusion: The results revealed that the SOC algorithm systematically underestimated motivation to quit smoking relative to a variety of other measures. Further, the stages of change do not appear to be qualitatively distinct categories. More than half the precontemplators were contemplating cessation, and many precontemplators intended to quit. Most contemplators were not merely contemplating cessation but rather were trying to quit currently. In summary, there is a divergence between the concepts underlying the SOC-precontemplation, contemplation, and preparation-and the operational definitions of these concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contextual correlates of adolescents' self-efficacy after smoking cessation.

Recent research has shown that daily changes in self-efficacy predict lapses and relapse into smoking after quitting among adolescent daily smokers, but it is not known if and how momentary self-efficacy is associated with affect-motivational states and external contexts. In the present study, 134 adolescent daily smokers were monitored daily during 1 week prior to and 3 weeks after they began their quit attempt. Participants completed questions on smoking, self-efficacy, affect-motivational states (craving and negative affect), and external contexts (seeing others smoke, experiencing a stressful event, and alcohol and coffee consumption) three times a day. Affect-motivational states as well as all external contexts (except for coffee consumption) were associated with lower self-efficacy when participants were still abstinent, but also after they had lapsed. Associations between the situational contexts and self-efficacy did not largely depend on individual characteristics such as baseline self-efficacy and age. Among girls, however, the negative associations between self-efficacy and negative affect and drinking alcohol were found to be stronger. These results show that adolescents' self-efficacy during a quit attempt may be responsive to affect-motivational states and external contexts, both before and after lapsing. (PsycINFO Database Record (c) 2011 APA, all rights reserved)