Perceived stress, quitting smoking, and smoking relapse.

Assessed perceptions of stress prior to quitting smoking and at 1, 3, and 6 mo after quitting in 211 Ss. Analyses provide evidence for a relation between changes in stress levels and changes in smoking status. Ss who failed to quit smoking for more than 24 hrs maintained a relatively high and consistent level of stress over the 6-mo period. For continuously abstinent Ss, stress decreased as duration of abstinence increased. Increased stress with relapse was found across all time periods, and decreased stress after quitting was observed at 2 time periods. The relationship between smoking and stress may be bidirectional. (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)     

Cognitive-behavioral intervention increases abstinence rates for depressive-history smokers.

Describes the test of the hypothesis that a cognitive-behavioral mood management intervention would be effective for smokers with a history of major depressive disorder (MDD). The method was randomized trial; the assessments occurred at Weeks 0, 8, 12, 26, and 52. Ss were 149 smokers (aged 18–65 yrs); 31% had a history of MDD. All received 2 mg of nicotine gum. Mood management was provided in 10 group sessions over 8 wks. Standard treatment was provided in 5 group sessions over 8 wks. Outcome was continuous abstinence. History-positive Ss were more likely to be abstinent when treated with mood management. Treatment condition differences were not significant for history-negative Ss. For history-positive Ss, less anger at baseline predicted abstinence. For history-negative Ss, more years smoked and higher baseline carbon monoxide predicted abstinence. Cognitive-behavioral therapy did not affect mood after quitting. Abstinence predictors differed as a function of baseline diagnosis. (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)     

Behavioral and physiological effects of low-nicotine cigarettes during rapid smoking.

Compared the effects of rapid smoking using medium-tar/nicotine or low-tar/nicotine cigarettes on physiological and behavioral responses in a randomized, double-blind clinical trial with 24 Ss. Results show equivalent heart rate, blood pressure, and carbon monoxide levels after rapid smoking either low- or medium-yield cigarettes. Behavioral topography measures differed significantly when low-nicotine cigarettes were smoked. Also, Ss who did remain abstinent at subsequent follow-up showed less change in rated aversiveness during rapid smoking than Ss who did not remain abstinent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measures of affect and nicotine dependence predict differential response to smoking cessation treatments.

126 smokers were randomly assigned to 6-session smoking cessation treatments consisting of 1 of 2 counseling strategies (skills training or support) and 1 of 2 nicotine exposure strategies (nicotine gum or rapid smoking). Counseling and nicotine strategies were completely crossed: All 4 combinations resulted in equivalent 1-yr abstinence rates. Skills training produced higher initial cessation and more coping responses posttreatment than did support. Rapid smoking, but not nicotine gum, produced tachycardia to the taste of cigarettes posttreatment, consistent with cigarette aversion. The treatments were differentially effective among subpopulations of smokers: Ss high in pretreatment negative affect responded best to support counseling; those low in pretreatment negative affect responded best to skills training. Self-reports of pretreatment craving predicted response to the nicotine-exposure treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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

A comparison of alternative theoretical approaches to smoking cessation and relapse.

139 smokers (mean age 40.6 yrs) were randomly assigned either to (a) a traditional treatment program that used contingency contracting and emphasized the necessity for absolute abstinence (AA) or (b) a relapse-prevention (RP) treatment that focused on gradual acquisition of nonsmoking skills. It was hypothesized that the RP treatment would be less successful initially but would result in better maintenance skills and show a lesser relapse rate during a 1-yr follow-up. Each program was evaluated in 2 formats: group-based treatment and self-help materials. Results indicate comparable 1-yr abstinence rates for all treatments, although more Ss dropped out of the self-help formats. Ss in the RP intervention were more likely to lapse sooner after quitting and were more likely to quit again during the 1-yr maintenance period. Women were more successful in the RP program, and men had greater success with the AA approach. (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)     

Preventing relapse to cigarette smoking by behavioral skill training.

Two relapse prevention conditions (skills training vs discussion control) were crossed with 2 levels of aversive smoking (6- vs 30-sec inhalations). 135 smokers were recruited, and 123 of them completed treatment. Ss completed an assessment battery that included the Profile of Mood States and the State–Trait Anxiety Inventory. Differences in abstinence rates and in number of cigarettes smoked favoring the skills training condition were found at 6 and 52 wks from study start. Analyses indicated that at 52 wks, lighter smokers (20 cigarettes/day or fewer at pretreatment) were more likely to be favorably affected by the skills training condition than heavier smokers. Ss assigned to the skills training condition were more likely to report use of coping skills, but they did not differ from the discussion condition in perceived costs and benefits of change or of smoking, or in mood dysphoria or physical complaints. Abstinent Ss reported less mood disturbance than nonabstinent Ss at Weeks 3, 6, and 26 and fewer physical complaints at Week 52. The relation of these findings to a model of maintenance of therapeutic change is discussed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of cigarette smoking on perception of thermal pain.

The effects of cigarette smoking on pain perception were evaluated in 18 healthy smokers. Thermal pain stimuli were used to assess pain detection threshold and tolerance and to collect subjective ratings of the intensity and unpleasantness of painful stimuli. After overnight abstinence, pain perception was evaluated before and after 3 experimental treatments. Participants smoked normal cigarettes, smoked denicotinized cigarettes, or remained abstinent. Smoking normal cigarettes produced relative increases in pain tolerance compared with abstinence. Smoking denicotinized cigarettes produced intermediate effects on tolerance not different from the other 2 treatments. Effects were not detected for pain threshold or subjective pain ratings. Results suggest that cigarette smoking can have antinociceptive effects, which may depend both on nicotine and on other factors associated with smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of behavior modification approaches to smoking reduction.

Compared 2 experimental treatments for the modification of cigarette smoking with 2 control conditions, using a refined methodology for collecting daily smoking records and providing for an examination of therapist effects. 65 undergraduates served as Ss. The 1st experimental treatment employed a stimulus satiation technique in which Ss smoked 3 cigarettes on each smoking occasion. The 2nd, a hierarchy approach, involved gradual reduction beginning with the period of the day judged easiest for relinquishing cigarettes. In 1 control treatment, Ss used a pill designed to coat the mouth to make cigarettes aversive; the other control groups were instructed to quit entirely. Each of the 4 conditions showed its own characteristic reduction curve and all reduced to a mean level below 25% of base. There was a significant effect of therapist during treatment, but none at 6-mo follow-up by which time all groups had shown a considerable relapse. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of excessive and rapid smoking in the modification of chronic smoking behavior.

In a study of aversive control of smoking behavior, 27 females and 18 males (mean age, 30.9 yrs; mean yrs as a smoker, 13.1; mean baseline cigarettes/day, 31.6) were randomly assigned to rapid smoking, excessive smoking, or control conditions. Ss attended 6 treatment sessions over a 1-wk period. Prescribed smoking was carried on in both the laboratory and outside environment. A breath test measuring concentration of carbon monoxide in the bloodstream was used as a check on the reliability of self-reports. Overall, there was a statistically reliable treatment effect, according to measures of percentage reductions in smoking and Ss maintaining total abstinence. However, treatment effect had disappeared at 12-mo follow-up. Experimental and control groups showed considerable relapse independent of condition, with only 20% of Ss remaining abstinent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two-year efficacy and safety of rapid smoking therapy in patients with cardiac and pulmonary disease.

Tested rapid smoking therapy in 18 smokers (mean age 45.8 yrs) with documented cardiopulmonary disease. Myocardial ischemia and cardiac arrhythmia were monitored in Ss and 3 additional patients after 12 hrs of tobacco abstinence, normal smoking, and rapid smoking. No evidence of myocardial ischemia or significant arrhythmia developed. Results of therapy were followed up biochemically 12- and 24-mo posttreatment and compared to a waiting-list control group. Results show that 50% of Ss had not smoked posttreatment through a 2-yr follow-up period, while all control Ss had smoked by the 2-yr follow-up. It is concluded that rapid smoking therapy is safe and effective in patients with mild to moderate cardiopulmonary disease and for those who have had uncomplicated heart attacks. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experimental evidence for a causal relationship between smoking lapse and relapse.

In this study, the authors prospectively evaluated the impact of a smoking lapse on relapse probability. After 4 days of smoking abstinence, 60 smokers were randomly assigned to smoke 5 nicotine-containing or 5 denicotinized cigarettes, or to remain abstinent (no lapse) during a 4-hr time period. Afterward, smoking abstinence was encouraged with monetary incentives, and smoking behavior was tracked for 6 days. Relative to the no-lapse condition, exposure to either of the cigarette types more than doubled the probability of subsequent smoking. Smoking outcomes did not differ between nicotine-containing and denicotinized cigarettes. The data suggest that stimulus factors may play an important role in lapse to relapse processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine gum and behavioral treatment in smoking cessation.

120 Ss (who smoked a mean of 30.5 cigarettes/day) were assigned either to intensive behavioral treatment, to nicotine gum in a low-contact treatment, or to the intensive behavioral plus nicotine gum treatment. At each assessment, Ss reported the number of cigarettes smoked in the previous 24 hrs and provided blood samples; assessments were conducted at 0, 3, 12, 26, and 52 wks. Results show that the combined treatment produced higher abstinence rates than the other 2 conditions at all assessments. These differences were significant at 3, 12, and 26 wks, but not at 52 wks. Nicotine dependence was assessed by blood cotinine levels, scores on a dependence scale, and by number of cigarettes smoked at pretreatment. It was found that Ss with high blood cotinines were more likely to be helped by nicotine gum treatment than were less dependent Ss. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trans-situational consistency in smoking relapse.

Explored the consistency of experiences of temptation to smoke in 57 ex-smokers who called a relapse-prevention hotline on 2 occasions. Ss had smoked at least 10 cigarettes per day for 1 yr and had been abstinent for at least 2 days prior to calling. Only modest transsituational consistency was observed. Social aspects of relapse situations showed the most consistency. Behavioral coping showed modest transsituational consistency, whereas cognitive coping showed no stability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive reactions to tobacco predict relapse after cessation.

Among chronic smokers, individual differences in subjective reactions to smoking may characterize important facets of nicotine dependence that relate to abstinence-induced craving, withdrawal symptom profiles, and risk for relapse. Although the negative reinforcing properties of smoking have achieved prominent positions in models of relapse (Baker, Brandon, & Chassin, 2004), vulnerability to relapse risk may also arise from seeking positive reinforcement from smoking (Shiffman & Kirchner, 2009). In this study, 183 cessation-motivated smokers provided subjective craving, positive and negative reactions to standardized cigarettes following overnight abstinence. Level of craving, negative mood, and positive mood after overnight abstinence were significantly predictive of withdrawal on quit-day. Increased positive reactions to smoking were uniquely predictive of relapse after quitting (Hazard Ratio = 1.22, p