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.     

Nicotine gum dose and weight gain after smoking cessation.

The authors examined weight gain in 79 abstinent cigarette smokers during treatment with placebo or with 2 mg or 4 mg of nicotine gum. Results indicated that nicotine gum suppressed weight gain in a linear fashion with increasing nicotine dose. At 90 days postcessation, placebo gum users gained 3.7 kg, 2-mg gum users gained 2.1 kg, and 4-mg gum users gained 1.7 kg. Assessment of nicotine replacement by means of pre- and postcessation salivary cotinine levels revealed that smokers who replaced a greater percentage of their baseline cotinine levels during treatment gained less weight. Percentage of baseline cotinine replaced remained related to weight gain after the number of pieces of gum used was controlled. Implications for smokers hoping to minimize postcessation weight gain are discussed. (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)     

How much weight gain occurs following smoking cessation: A comparison of weight gain using both continuous and point prevalence abstinence.

Estimates of postcessation weight vary widely. This study determined the magnitude of weight gain in a cohort using point prevalence and continuous abstinence criteria for cessation. Participants were 196 volunteers who participated in a smoking cessation program and who either continuously smoked (n?=?118), were continuously abstinent (n?=?51), or who were point prevalence abstinent (n?=?27) (i.e., quit at the 1-year follow-up visit but not at others). Continuously abstinent participants gained over 13 lbs. (5.90 kg) at 1 year, significantly more than continuously smoking (M?=?2.4 lb.) and point prevalence abstinent participants (M?=?6.7 lbs., or 3.04 kg). Individual growth curve analysis confirmed that weight gain and the rate of weight gain (pounds per month) were greater among continuously smoking participants and that these effects were independent of gender, baseline weight, smoking and dieting history, age, and education. Results suggest that studies using point prevalence abstinence to estimate postcessation weight gain may be understanding postcessation weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse following smoking cessation: A situational analysis.

Data on the antecedents of relapse crises (actual or near lapses in abstinence) were collected from 183 former smokers who called a relapse-counseling hotline. Most relapse crises were associated with anxiety, anger, and depression. One-third of relapse crises were associated with positive feeling states and were frequently precipitated by other smokers, eating, and alcohol consumption. Withdrawal symptoms played a part in only half of the episodes. Ss' coping responses rather than situational antecedents distinguished relapse crises resulting in smoking from those in which abstinence was maintained. A combination of cognitive and behavioral responses was most successful. Behavioral coping was subject to situational influences; Ss who had been drinking alcohol were less likely to engage in behavioral coping, and depression diminished its effectiveness. Cognitive coping responses, which were less affected by these variables, may be critical components of former smokers' coping repertoires. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking-specific weight gain concerns and smoking cessation in a working population.

Smoking cessation rates, progression in stage of change for smoking cessation, and serious quit attempts were examined over 2 years in a cohort of 242 men and women smokers (mean age 39.7 years, mean body mass index [BMI] 26.3) as a function of expressing concern about gaining weight because of quitting smoking. Participants were employees of 25 companies who were in a worksite health promotion program aimed at reducing risk factors for cardiovascular disease. Multivariate odds ratios (controlled for age, education, job class, sex, and BMI) for quitting smoking, attempting to quit smoking, and progressing in stage of change for smoking cessation as a function of weight concern were not significant. Interactions between sex and weight concern, and BMI and weight concern were also not significant. These findings, in a working, predominantly blue-collar population, and those of other studies, suggest that concern about gaining weight is, at best, a weak predictor of change in smoking behavior among most smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of weight change following smoking cessation

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

Changes in energy balance following smoking cessation and resumption of smoking in women.

Caloric intake, resting metabolic rate (RMR), leisure-time physical activity, and sensitivity and preference for sweet taste were prospectively examined in 7 female smokers across 3 weeks during periods of normal smoking (Week 1), complete cessation (Week 2), and resumption of smoking (Week 3). Energy balance changed significantly across weeks, as caloric intake increased (largely as a result of alcohol consumption) and RMR decreased during cessation, followed by decreased caloric intake and increased RMR with resumption of smoking. Activity and taste sensitivity and preference remained unchanged. Smoking cessation may thus cause rapid change in energy balance, which is quickly reversed on resumption of smoking. (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)     

Is leptin sensitivity the link between smoking cessation and weight gain?

We performed a case-control study to investigate the association of the poor metaboliser genotype of the cytochrome P450 2D6 gene with Parkinson's disease (PD). Genotyping was determined by the polymerase chain reaction followed by digestion with restriction enzymes. The poor metaboliser genotype was more frequent in 112 patients with PD than in 206 matched controls (odds ratio 1.7, 95% CI: 0.94-2.45). A meta-analysis of these results together with ten other published studies gave a pooled odds ratio for the poor metaboliser genotype of 1.47 (95% CI: 1.18-1.96, P=0.01). Thus, the poor metaboliser genotype has a small but highly significant association with PD which would be easily missed in small studies. Research now should focus on the mechanism of this association.     

Smoking cessation and weight gain.

Investigated determinants of weight gain after quitting smoking in 2 smoking treatment outcome studies in which 255 Ss (mean age 37 yrs) participated. It was hypothesized that (a) abstinence would result in weight gain; (b) postquitting weight gain would be predicted by pretreatment tobacco use, a history of weight problems, and eating patterns; and (c) relapse to smoking would follow weight gain. The 1st 2 hypotheses were confirmed. Year-long abstainers gained more weight than relapsers. Most of the weight gain occurred during the 1st 6 mo following quitting. Number of cigarettes smoked at pretreatment and past maximum body weight correlated positively with weight gain. Scores on a measure of eating control in specific situations, especially emotional ones, explained 27% of the variance in weight gain among abstinent Ss at a 1-yr follow-up. A measure of persistent hunger also predicted weight gain at a 1-yr follow-up. Eating disinhibition scores, number of cigarettes smoked at pretreatment, and maximum body weight were not correlated among Ss abstinent for the year. Disinhibition score and maximum body weight, however, correlated positively in the entire sample of Ss. Contrary to the 3rd hypothesis, greater weight gain during the 1st mo predicted continued abstinence, not relapse. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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

Self-help interventions for smoking cessation.

Self-help interventions for smoking cessation are an important bridge between the clinical and public health approaches to smoking cessation. The current literature on self-help interventions is encouraging but incomplete. Although their quit rates are lower than those of more intensive programs, self-help interventions could have a large public health impact because of their potential for widespread distribution. Studies comparing self-help to more intensive treatment suggest that long-term cessation rates for self-help programs are potentially as high as rates for face-to-face interventions, with lower quit rates for self-help programs that are likely due to differences in program adherence. Tailored materials and personalized adjuncts (e.g., written feedback or telephone counseling) that promote program adherence may increase cessation rates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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 through self-control procedures.

21 underweight (at least 10%) undergraduates were assigned to either a self-reinforcement condition, a self-punishment condition, or to a discussion-reflection control condition. Ss received 1 weekly treatment session over a 5-wk period. Following treatment, the self-reinforcement groups gained significantly more pounds (kilograms) than either the self-punishment or the control group. This effect was maintained at a 12-wk follow-up. The punishment and control groups did not differ significantly at posttest or at follow-up. Similar results were obtained when percentage of weight change was analyzed, with the treatment effect significant at follow-up. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shaping smoking cessation in hard-to-treat smokers.

Objective: Contingency management (CM) effectively treats addictions by providing abstinence incentives. However, CM fails for many who do not readily become abstinent and earn incentives. Shaping may improve outcomes in these hard-to-treat (HTT) individuals. Shaping sets intermediate criteria for incentive delivery between the present behavior and total abstinence. This should result in HTT individuals having improving, rather than poor, outcomes. We examined whether shaping improved outcomes in HTT smokers (never abstinent during a 10-visit baseline). Method: Smokers were stratified into HTT (n = 96) and easier-to-treat (ETT [abstinent at least once during baseline]; n = 50) and randomly assigned to either CM or CM with shaping (CMS). CM provided incentives for breath carbon monoxide (CO) levels OR = 42, 95% CI [5.9, 307]) than with CMS, in which the difference between HTT and ETT participants was not significant. Assignment to CMS predicted membership in the improving (p = .002) as compared with the poor outcomes cluster. Conclusion: Shaping can increase CM’s effectiveness for HTT smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing outcome in smoking cessation studies.

Outcome measures for smoking cessation are reviewed and evaluated, including 3 self-report and 3 biochemical-validation measures. Point prevalence reflects the percentage of participants taking action, prolonged abstinence reflects those in the maintenance stage, and continuous abstinence reflects those who progress from action to maintenance without lapsing or relapsing. Biochemical assessments are primarily measures of point prevalence abstinence. The desirability of biochemical validation is a particularly controversial and critical issue. Three factors affect the accuracy of self-report: type of population, type of intervention, and demand characteristics. False-negative rates are generally low. Three broad issues impact on decisions to use biochemical-validation: (1) alternative explanations for false positives, (2) refusal rate problems, and (3) the effect of inaccuracy on intervention assessment. (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)