Nicotine replacement: Effects on postcessation weight gain.

Examined nicotine replacement effects on postcessation weight gain in smoking cessation clinic volunteers using objective indices of cigarette smoking, gum use, and body weight. After they achieved abstinence, subjects were randomly assigned to either active nicotine or placebo gum conditions for 10 weeks, during which smoking status was carefully monitored. Analyses revealed strong evidence for a gum effect on weight gain, with active gum users gaining a mean total of 3.8 lbs compared with 7.8 lbs for placebo gum users at the end of the 10-week trial. Evidence for a dose–response relation was found, suggesting that more gum use (≥6.5 pieces/day) resulted in greater weight suppression. Placebo gum subjects reported greater postcessation increases in eating and hunger compared with active gum subjects. The implications of the weight suppression effect of nicotine gum for smoking cessation treatments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking cessation in peri- and postmenopausal women: A review.

A substantial portion of smokers are peri- or postmenopausal women. Cigarette smoking and menopause have overlapping negative health consequences and may act synergistically to contribute to worse health outcomes in this population. Little is known about issues specific to peri- and postmenopausal women attempting to quit smoking; however, it can be hypothesized that they face unique challenges in quitting smoking. Particularly, negative affect and vasomotor menopausal symptoms may make smoking cessation particularly challenging in this group of women. Peri- and postmenopausal women are also more prone to weight gain following smoking cessation, and concerns about postcessation weight gain may contribute to reduced motivation to quit smoking or to relapse to smoking. Recent evidence suggests that estrogen level may be positively associated with nicotine reward, which may aid in the smoking cessation efforts of postmenopausal women while possibly contributing to worse outcomes in perimenopausal women. Unfortunately, no known studies have compared premenopausal women with peri- or postmenopausal women on smoking cessation outcome variables. Studies in postmenopausal women indicate that hormone therapy (HT) use does not affect nicotine withdrawal, smoking cessation outcomes, or weight gain following smoking cessation; however, a lack of randomized trials limits the strength of these conclusions. Evidence of the effects of HT on mood following smoking cessation is conflicting. Further research is needed to identify the unique factors influencing smoking cessation in peri- and postmenopausal women and to develop and test interventions that target these variables in a way that improves cessation rates among this population. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Reconciling conflicting findings regarding postcessation weight concerns and success in smoking cessation.

Correlates of concern about weight gain following smoking cessation and self-efficacy about controlling weight gain were examined in 940 men and 1,166 women who were surveyed on 2 occasions as part of a randomized trial of work-site interventions for smoking cessation. Weight concerns were positively associated with female sex, body weight, dieting for weight control, nicotine addiction, and social encouragement to quit. Bivariate analyses replicated prior findings that elevated weight concerns are associated with a reduced likelihood of quitting smoking, at least in women. Analyses controlling for demographics, nicotine dependence, and social factors replicated prior findings that weight concerns are not negatively related to smoking cessation and that some measures of concern are positively related to cessation. These analyses suggest that conflicting findings found in this literature are due primarily to how weight concerns are defined and whether covariates like nicotine addiction are used in data analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in nicotine versus nonnicotine reinforcement as determinants of tobacco smoking.

Nicotine replacement is less effective for smoking cessation in women than men. A possible explanation is that nicotine intake may be a less reinforcing consequence of tobacco smoking in women versus men, whereas nonnicotine aspects of smoking may be more reinforcing. Recent research suggests that nicotine self-administration is less robust in women, that women may reduce their smoking to a lesser degree following nicotine preloading, and that women may be less sensitive to interoceptive stimulus (or subjective) effects of nicotine. There does not seem to be a generalized insensitivity or hypersensitivity to nicotine in women. In contrast, women may be more responsive to the nonnicotine stimuli of smoking. These findings are consistent with other research indicating that women are less able than men to detect interoceptive stimuli (physiological changes). If confirmed, these sex differences could have important clinical implications; nicotine replacement may warrant a less important role in smoking cessation, whereas interventions to counter the nonnicotine aspects of smoking may need to be emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating orientation, postcessation weight gain, and continued abstinence among female smokers receiving an unsolicited smoking cessation intervention.

Predictors of weight gain following smoking cessation were assessed among 1,219 female smokers enrolled in a health maintenance organization. Women randomized to the treatment group received a cessation intervention without regard to their interest in quitting smoking. It was hypothesized that cessation would result in subsequent weight gain and postcessation weight gain would be associated with scores on a modified Restraint Scale, the Disinhibition Scale, and a scale assessing tendency to eat during periods of negative affect. Persons who abstained from smoking over the 18-month study gained more weight than did intermittent smokers and continuous smokers, and among 762 women who reported at least 1 on-study attempt to quit smoking, 36% gained weight. Weight gain was associated with disinhibited eating and negative affect eating but not with restrained eating. Weight gain also was associated with continued abstinence from smoking. (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)     

Smoking abstinence, eating style, and food intake.

Individual differences in weight gain after smoking cessation may reflect differences in eating restraint that exist before cessation. It was hypothesized that abstinent smokers with high scores on the Eating Inventory Disinhibition Scale would be more likely to overeat than nonabstinent smokers with lower Disinhibition Scale scores. Forty smokers completed the Eating Inventory and the Profile of Mood States (POMS). Subjects were randomly assigned to 24-hr cigarette abstinence or to continued smoking. Subjects then participated in an ice cream tasting task, after which they were free to eat as much ice cream as they wanted. The hypothesis was confirmed. Exploratory analyses indicated that eating behavior items predicted the amount eaten and that weight fluctuation items did not. The POMS Confusion Scale scores were highest for abstinent subjects who scored high on the Disinhibition Scale. A parallel but nonsignificant relation was observed for POMS Tension Scale scores. The meaning of these data for the relation between smoking cessation and weight gain is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight gain as a function of smoking cessation and 2-mg nicotine gum use among middle-aged smokers with mild lung impairment in the first 2 years of the Lung Health Study.

Assessed the extent and predictors of weight change among sustained nonsmoking special intervention participants in the Lung Health Study. The intervention included a 12-session group program and 2-mg nicotine gum. At 12 mo, female sustained quitters (SQs; n?=?248) had gained a mean of 8.4% (5.3 kg) of their baseline weight, whereas male SQs (n?=?443) had gained 6.7% (5.5 kg). By 24 mo, female SQs had gained 9.8% of their baseline weight compared with 6.9% for men. Nicotine gum usage delayed a portion of the weight gain. Multiple regression analysis showed that weight gain at 12 mo was associated with a higher baseline salivary cotinine level, a lower baseline body mass index, drinking less alcohol per week, and a lower cotinine level at 12 mo (indicating less or no nicotine gum use). Moderate weight gain may be a long-term consequence of smoking cessation, a portion of which can be delayed with 2-mg nicotine gum. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex dfferences in the relation of mood to weight gain after quitting smoking.

Weight gain with smoking cessation is well documented. In this study the authors explored the impact of mood state on weight gain after quitting. Data of 350 participants enrolled in 2 smoking cessation trials were analyzed; primary analyses assessed the relation of affective factors to weight gain in abstinent participants only. Weight gain was predicted by abstinence status. Depression history, gender, and mood change from pre- to postcessation assessments were included in a model predicting weight gain in abstinent participants at the end of smoking cessation treatment (N?=?201) and at 1-year follow-up (N?=?87). At posttreatment, depression history positive women gained more than depression negative women, whereas depression history positive men gained less than depression history negative men. At 1-year follow-up, weight gain was predicted by improved mood in "normal" men and by worsened mood in both depression history positive and negative women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are weight concerns predictive of smoking cessation? A prospective analysis.

Participants in an 8-session, community-based smoking cessation intervention rated whether they would stay quit if they experienced weight gain. The majority reported that they would not relapse to smoking, even after a 20-lb. (9.07-kg) weight gain. Those who were weight concerned were more likely to be female, to weigh less and be normal or underweight, and to report chronic dieting. This group was also significantly less likely to be abstinent posttreatment, and at the 1-, 6- and 12-month follow-ups. Individuals presenting for formal smoking cessation interventions may be less weight concerned than the general population of smokers. However, weight-concerned smokers who do present for treatment are less likely to quit smoking. Implications for recruitment and intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between smoking and body weight in a population of young military personnel.

Evidence indicates that middle-aged smokers weigh less than nonsmokers and that smoking cessation reliably produces weight gain, but recent studies have questioned the weight control "benefits" of smoking in younger populations (the time that people typically initiate smoking). The relationship between smoking and body weight was evaluated in all U.S. Air Force Basic Military Training recruits during a 1-year period (n?=?32,144). Those who smoked prior to Basic Military Training (n?=?10,440) were compared to never smokers or experimental smokers. Results indicated that regular-current smoking had no relationship to body weight in women (p? >?.05) and a very small effect in men (p?     

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)     

Concern about weight gain associated with quitting smoking: Prevalence and association with outcome in a sample of young female smokers.

This study investigated the relationship between weight gain concern and outcomes of a large-scale smoking cessation study among 506 young female smokers attending Planned Parenthood clinics. Results of this prospective study did not support the clinical importance of weight gain concerns. Using an index of weight concern that was predictive in previous research, baseline weight concern was unrelated to smoking cessation efforts, whether participants made a quit attempt, reduced the number of cigarettes they smoked, or reported a change in self-efficacy for stopping smoking. Both the overall level of concern expressed in this sample of predominantly White young women and the lack of relationship between weight gain concern and smoking cessation outcomes suggest that weight gain concern may not be a critical factor for cessation programs targeting similar female smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The nicotine inhaler in smoking cessation

BACKGROUND: Nicotine replacement therapy has been shown to improve success rates in smoking cessation treatment. However, the available products cause adverse effects, which prevent some smokers from using them. A new method of delivering nicotine via inhaler supplies nicotine orally through inhalation from a plastic tube. This mode of delivering nicotine resembles smoking, as it includes handling and active inhalation. OBJECTIVES: To assess the efficacy and safety of the nicotine inhaler as an aid in smoking cessation. METHODS: A 1-year, randomized, double-blind, placebo-controlled study was conducted in a smoking cessation clinic. Two hundred forty-seven smokers who smoked at least 10 cigarettes per day and who had previously made a serious attempt to stop smoking using nicotine chewing gum were recruited through advertisements. Randomization to treatment or control conditions were made at the first group session, with 123 participants receiving nicotine inhalers and 124 receiving placebo inhalers. The inhalers were distributed at the second session and participants were allowed to use the inhalers for 6 months. MAIN OUTCOME MEASURE: Biochemically verified continuous abstinence from smoking after 2 and 6 weeks and at 3, 6, and 12 months. RESULTS: Significantly more participants who had used the nicotine inhalers were continuously abstinent compared with those who had used the placebo inhalers. The respective success rates after 12 months were 28% and 18% (P = .046). At 6 months, 20 participants (16%) in the nicotine group were still using the inhaler, compared with 4 (3%) in the control group (P < .001). CONCLUSION: The nicotine inhaler was an effective smoking cessation aid that produced a few mild and transient adverse effects.     

Gender differences in response to nicotine replacement therapy: Objective and subjective indexes of tobacco withdrawal.

K. A. Perkins (see record 1996-00322-006) recently proposed that nicotine reinforcement controls smoking to a greater degree among men than women and that consequently, nicotine replacement therapy (NRT) during smoking cessation should benefit men more than women. The authors tested this hypothesis. Polysomnographic measures of sleep and self-report indexes of tobacco withdrawal were collected pre- and postcessation from an active nicotine patch group and a placebo patch group in a randomized, double-blind clinical trial (N?=?34). Objective sleep parameters supported Perkins's hypothesis and indicated that among women, NRT may be less effective at suppressing certain withdrawal responses compared with men and may produce some iatrogenic effects. Valid and reliable self-report measures of withdrawal did not reveal gender differences in response to NRT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Increased saliva cotinine concentrations in smokers during rapid weight loss.

Although the effect of smoking cessation on weight gain is well-documented, little is known about the effect of weight loss on smoking. The association between saliva cotinine levels and weight loss was examined in a group of 9 obese female smokers during participation in a protein-sparing modified fast (Optifast). For the 1st 3 mo of treatment, Ss consumed only the protein-sparing supplement; for the next 3 mo, food was gradually reintroduced. Body mass index and saliva cotinine concentration were assessed at study entry and at 3 and 6 mo. A significant weight loss was noted at 3 and 6 mo, yet the cotinine level increased significantly over this time. It is unclear whether the cotinine increase is due to metabolic changes or an actual increase in nicotine intake. The results suggest that smoking-related health risks may increase during periods of significant weight loss. (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)     

Neural mechanisms underlying nicotine dependence

There is little doubt that many habitual smokers find it difficult to quit the habit because they have become addicted to the nicotine present in the smoke. This paper addresses some of the pharmacological mechanisms underlying this addiction and discusses how an understanding of these mechanisms may contribute to the more effective use of nicotine replacement therapy during smoking cessation. It considers critically the evidence that the "rewarding" properties of nicotine, which serve to reinforce drug-seeking behaviour, are related to stimulation of the mesolimbic dopamine system of the brain. The critique focuses specifically on the evidence that many central nicotinic receptors, including those which mediate the effects of the drug on dopamine secretion, are readily desensitized by chronic exposure to agonist and that hypotheses which assume that nicotine inhaled from tobacco smoke invariably results in stimulation of the receptors must be treated with caution. Nicotinic receptors in the brain are, however, heterogeneous in nature with different molecular structures and pharmacologies. It is concluded that the reinforcing properties of nicotine sought by smokers may reflect both stimulation and desensitization of the different nicotinic receptor populations, and that smokers may adjust their smoking habits to achieve the balance of receptor stimulation and desensitization which they find most reinforcing. It seems likely that the efficacy of the different nicotine formulations during the treatment of smoking cessation may also reflect their ability to stimulate or desensitize brain nicotinic receptors.     

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)