Self-help books and amount of therapist contact in smoking cessation programs.

Evaluated 2 self-help behavior therapy books (B. G. Danaher and E. Lichtenstein, 1978; O. F. Pomerleau and C. S. Pomerleau, 1977) for stopping smoking against a widely available minimal treatment program. A 3?×?2 factorial design was employed to evaluate the 3 treatments under both self-administered and therapist-administered conditions. 85 chronic cigarette smokers (mean age 37.3 yrs) participated in the 8-wk treatment programs and a 6-mo follow-up. Dependent variables included self-monitored number of cigarettes smoked daily, CO concentrations in expired breath samples, dosage scores based on topographical aspects of smoking behavior, and adherence and cost-effectiveness measures. Under self-administered conditions, the minimal treatment program was at least as effective as the behavior therapy books. On the self-report measures, therapist contact was associated with improved treatment outcome for the behavior therapy programs but not for the control condition. Reliable between-groups differences were not consistently observed on CO levels. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telephone counseling for smoking cessation: Effects of single-session and multiple-session interventions.

Smokers (N?=?3,030) were randomized to receive 1 of 3 interventions: (a) a self-help quit kit, (b) a quit kit plus 1 telephone counseling session, or (c) a quit kit plus up to 6 telephone counseling sessions, scheduled according to relapse probability. Both counseling groups achieved significantly higher abstinence rates than the self-help group. The rates for having quit for at least 12 months by intention to treat were 5.4% for self-help, 7.5% for single counseling, and 9.9% for multiple counseling. The 12-month continuous abstinence rates for those who made a quit attempt were 14.7% for self-help, 19.8% for single counseling, and 26.7% for multiple counseling. A dose–response relation was observed, as multiple sessions produced significantly higher abstinence rates than a single session. The first week after quitting seems to be the critical period for intervention. (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)     

Are we pushing the limits of public health interventions for smoking cessation?

Notes that self-help strategies represent an approach to potentially cost-effective smoking intervention that can be conveniently used by large numbers of smokers. It is argued that a comprehensive strategy for smoking control should include persistent messages to stop smoking (or not to start), continuously available supports for smoking cessation provided through multiple channels in the community, and environmental incentives that reinforce nonsmoking behavior. Such a strategy implies political involvement and the influencing of public policy on the part of psychologists and other providers directed toward action. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating autonomous motivation for smoking cessation.

Physicians used either an autonomy-supportive or a controlling interpersonal style to counsel smokers based on National Cancer Institute guidelines. Physician autonomy support was rated from audiotapes, and patients' perceived competence and autonomous motivation for quitting were self-reported on questionnaires. Validated point prevalences for 6, 12, and 30 months and for continuous cessation were examined. The intervention did not have a direct effect on quit rates; however, structural equation modeling supported the self-determination process model of smoking cessation. The model indicated that the autonomy-supportive intervention was rated as more autonomy supportive, that rated autonomy support predicted autonomous motivation, and that autonomous motivation predicted cessation at all points in time. Perceived competence contributed independent variance to cessation only at 6 months. (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.     

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)     

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)     

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)     

Intrinsic and extrinsic motivation for smoking cessation.

An intrinsic–extrinsic model of motivation for smoking cessation was evaluated with 2 samples (ns?=?1,217 and 151) of smokers who requested self-help materials for smoking cessation. Exploratory and confirmatory principal components analysis on a 36-item Reasons for Quitting (RFQ) scale supported the intrinsic–extrinsic motivation distinction. A 4-factor model, with 2 intrinsic dimensions (concerns about health and desire for self-control) and 2 extrinsic dimensions (immediate reinforcement and social influence), was defined by 20 of the 36 RFQ items. The 20-item measure demonstrated moderate to high levels of internal consistency and convergent and discriminant validity. Logistic regression analyses indicated that smokers with higher levels of intrinsic relative to extrinsic motivation were more likely to achieve abstinence from smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine patch and paroxetine for smoking cessation.

Smokers (N?=?224) were randomized to 1 of 3 groups: (a) transdermal system (TNS) + placebo; (b) TNS + paroxetine (20 mg); (c) TNS + paroxetine (40 mg). Assignment to treatment was double-blind. Nicotine patch (TNS) treatment was provided for 8 weeks; paroxetine or placebo was provided for 9 weeks. Abstinence rates at Weeks 4, 10, and 26 were as follows: (a) TNS + placebo: 45%, 36%, and 25%; (b) TNS + paroxetine (20 mg): 48%, 33%, and 21 %; (c) TNS + paroxetine (40 mg): 57%, 39%, and 27%. The differences were not statistically significant. The combined treatment was more effective in reducing both craving and depression symptoms associated with smoking cessation. A subgroup analysis comparing compliant participants was also conducted. Abstinence rates at Weeks 4, 10, and 26 were as follows: (a) TNS + placebo: 46%, 35%, and 24%; (b) TNS + paroxetine (20 mg): 64%, 43%, and 33%; (c) TNS + paroxetine (40 mg): 74%, 51%, and 38%. The differences between paroxetine groups and placebo at Week 4 were statistically significant. Although paroxetine may add value to the current standard of care in excess of potential risk, more conclusive evidence is needed. (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)     

Buspirone use for smoking cessation

The results of buspirone efficacy have been inconsistent and contradictory. The rate of smoking abstinence has been reported to range from 36% to 88% and 16% to 89% in buspirone and placebo treatment groups, respectively. Only one controlled study reported buspirone efficacy in reducing nicotine withdrawal symptoms, although it was based on a small sample population and only 4 weeks of follow-up. The most recent studies have been unable to demonstrate the efficacy of buspirone in smoking cessation or in the relief of withdrawal symptoms. A placebo-controlled, randomized trial with a large number of patients, relatively high doses of buspirone (30-60 mg/d), strict abstinence criteria, long-term follow-up, and the inclusion of smokers with general anxiety or anxiety reported in previous quit attempts is needed to further evaluate buspirone efficacy in smoking cessation and the reduction of nicotine withdrawal symptoms. The treatment effects of buspirone could then be specifically tested as a function of alleviating the anxiety component of the smoking withdrawal syndrome. Finally, buspirone may prove to be an alternative in patients unsuccessful with or unable to tolerate transdermal nicotine therapy. How buspirone compares with bupropion therapy for smoking cessation is also unknown.     

A critical review of research related to family physician-assisted smoking cessation interventions

A review of family physician-assisted smoking cessation research indicates that the family practice setting affords an excellent opportunity to intervene with a large proportion of smokers, at a time when they are receptive to health promotion messages. Outcome data at 6- and 12-month follow-up intervals indicate the value of combining 3 key strategies in achieving optimal results: physician advice and support, nicotine replacement therapy, and cognitive-behavioural counselling. The authors' review identifies questions that need to be addressed in future research: How can barriers to program delivery be overcome in the family practice setting? What is the best way to ensure optimal integration of the 3 key strategies? Which follow-up intervals are appropriate (e.g., 6 months, 12 months, 18 months) given the finding that relapse is common and that most smokers make several quit attempts before stopping for good?     

Absentminded lapses during smoking cessation.

Although it is widely believed that drug cravings are responsible for drug use and relapse, S. T. Tiffany (1990) has proposed a cognitive model in which drug use is triggered not by craving but by the cuing of automatized action plans. The purpose of this study was to examine the lapse episodes from an ecological momentary assessment (EMA) study of smokers attempting to quit for evidence of automatic, or absentminded, lapses with slight or no urges to smoke, in keeping with S. T. Tiffany's (1990) model. Qualitative analysis of 270 EMA reports made by 41 smokers during the first 14 days of quitting identified 15 (6%) absentminded lapses. Quantitative urge levels were significantly lower during absentminded lapses compared with nonabsentminded lapses; however, urges were not very low. Results indicate that absentminded lapses may occur but are probably relatively rare. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in smoking cessation.

Gender differences in smoking quit rates are frequently reported and are the subject of much speculation. This study examined the generalizability of gender differences in abstinence across study sites, treatments, and time of relapse, as well as potential mediators and moderators of gender effects. Participants were smokers who participated in 3 randomized clinical trials of the nicotine patch (N?=?632). Men had higher cessation rates than women at all follow-ups. The impact of gender on abstinence was unaffected by controlling for study site, treatment. or time of relapse. There was little evidence for mediation or moderation of this relation by any of a host of predictor variables. The magnitude and consistency of the gender differential, coupled with an inability to account for it, highlights a compelling need for additional research specifically aimed at elucidating the relation between gender and abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight gain following smoking cessation.

Smoking generally suppresses body weight below "normal," and smoking cessation allows weight to return to normal. This weight gain following cessation appears to be due to a transient increase in eating coupled with the removal of acute metabolic effects of each cigarette, with no change in physical activity. Nevertheless, tobacco smoke (and specifically nicotine) does not appear to be simply either an anorectic or a thermogenic agent. Although there may be no easy explanation for the effects of smoking on energy balance, the most parsimonious explanation may be that smoking lowers body weight "set point" and cessation raises set point. The transient changes in eating are therefore secondary to the changes in body weight set point. This notion is supported by animal research with nicotine as well as with other drugs, and it is also supported less directly by the pattern of changes observed with changes in smoking status among humans. A set-point explanation for weight gain after smoking cessation may also help explain the lack of success of interventions designed to prevent this weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled smoking cessation trial for substance-dependent inpatients.

Smoking treatment for newly recovering drug and alcohol-dependent smokers in a residential rehabilitation program was examined. The randomly assigned conditions (n?=?50 each) were multicomponent smoking treatment (MST), MST plus generalization training of smoking cessation to drug and alcohol cessation (MST+G), or usual care (UC). Fifty participants who declined smoking treatment (treatment refusers) also were studied. Both treatment conditions achieved continuous smoking abstinence rates (MST: 12%. MST+G: 10%, at 12-month follow-up) that were significantly higher than in the UC condition (0%). The MST condition had a continuous drug and alcohol abstinence rate that was significantly higher than that of the MST+G condition (40% vs. 20% at 12-month follow-up) although neither differed significantly from that of the UC condition (33%). These results support the feasibility of smoking treatment for this population and provide information regarding appropriate treatment components. (PsycINFO Database Record (c) 2010 APA, all rights reserved)