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)     

Nicotine gum and behavioral treatment: A placebo controlled trial.

Subjects (N?=?139) were assigned to intensive behavioral or to low-contact smoking treatment and to 2-mg nicotine gum or to placebo gum in a 2?×?2 factorial design. The 2-mg gum produced higher abstinence rates than did the placebo. Subjects receiving the low-contact condition plus the 2-mg nicotine gum had excellent abstinence rates at both 26 weeks (56% abstainers) and 52 weeks (50% abstainers). Smokers who scored at the median on a measure of physical dependence to nicotine were more likely to benefit by nicotine gum treatment than subjects who scored either higher or lower, but this relation was nonsignificant. The results of this study are compared with an earlier nonblind trial. (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)     

Nicotine gum and self-help behavioral treatment for smoking relapse prevention: Results from a trial using population-based recruitment.

Smokers aged 18–65 yrs (N?=?1,044) who were able to quit for 24 hr were randomized using a 2?×?2 factorial design to compare nicotine gum to no gum use and self-help materials to no use of materials. All participants were offered a $100 incentive to quit and stay quit for 6 months. Six month abstinence was 27% in the gum groups, compared with 19% in the no-gum group (p?=?.002). Compared with the no-gum group, relapse occurred at a significantly lower rate in the gum group for the entire 12 months of follow-up There was no significant main effect for the self-help materials, no interaction between gum and materials, and no evidence that the effectiveness of gum differed between the sexes or between heavy and light smokers. Nicotine gum is an effective adjunct to minimal-contact smoking cessation materials plus monetary incentive in a population-based sample of smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment for depression in smoking cessation.

Cigarette smokers with past major depressive disorder (MDD) received 8 group sessions of standard, cognitive–behavioral smoking cessation treatment (ST; n?=?93) or standard, cognitive–behavioral smoking cessation treatment (ST) plus cognitive–behavioral treatment for depression (CBT-D; n?=?86). Although abstinence rates were high in both conditions (ST, 24.7%; CBT-D, 32.5%, at 1 year) for these nonpharmacological treatments, no main effect of treatment was found. However, secondary analyses revealed significant interactions between treatment condition and both recurrent depression history and heavy smoking (≥25 cigarettes a day) at baseline. Smokers with recurrent MDD and heavy smokers who received CBT-D were significantly more likely to be abstinent than those receiving ST (odds ratios?=?2.3 and 2.6, respectively). Results suggest that CBT-D provides specific benefits for some, but not all, smokers with a history of MDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine patch and self-help video for cigarette smoking cessation.

A total of 424 smokers were randomized in a 2?×?2 factorial experiment. A pharmacologic factor contained 2 levels: transdermal nicotine patch (TNP; 21 mg) and placebo. A self-help behavioral treatment factor contained 2 levels: video-enhanced self-help treatment manual and self-help treatment manual only. At 2 months, TNP produced a higher level of abstinence (36%) than placebo (20%), p?     

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)     

Efficacy of forced smoking cessation and an adjunctive behavioral treatment on long-term smoking rates.

This study evaluated the efficacy of a 6-week forced ban on smoking and brief behavioral counseling on long-term smoking rates. Participants were active-duty enrollees in U.S. Air Force basic military training over a 1-year period (N?=?25,996). All participants were under a 6-week ban from tobacco products, and 75% were randomized to a brief smoking cessation intervention, with the other 25% randomized to a control condition. At 1-year follow-up, 18% of smokers were abstinent; women, ethnic minorities, and those intending to stay quit at baseline were more likely to be abstinent. Among smokers not planning to remain abstinent at baseline, those receiving the intervention were 1.73 times more likely to be abstinent. Over time, substantial smoking initiation occurred among nonsmokers (8% of never smokers, 26% of experimental smokers, and 43% of ex-smokers). Forced cessation is associated with good levels of long-term cessation, and brief behavioral interventions enhance cessation in certain subgroups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine–mecamylamine treatment for smoking cessation: The role of pre-cessation therapy.

The nicotinic antagonist mecamylamine was evaluated in a randomized smoking cessation trial. Four groups of participants (n?=?20 per group) received nicotine plus mecamylamine, nicotine alone, mecamylamine alone, or no drug for 4 weeks before cessation. After the quit-smoking date, all subjects received nicotine plus mecamylamine treatment for 6 weeks. Nicotine skin patches (21 mg/24 hr) and mecamylamine capsules (2.5–5.0 mg twice per day) were used. Precessation mecamylamine significantly prolonged the duration of continuous smoking abstinence; abstinence rates at the end of treatment were 47.5% with mecamylamine and 27.5% without mecamylamine. Nicotine + mecamylamine reduced ad lib smoking, smoking satisfaction, and craving more than either drug alone. Moreover, the orthostatic decrease in blood pressure caused by mecamylamine was offset by nicotine. Mecamylamine before smoking cessation may be an effective adjunct to nicotine patch therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multicenter trial of fluoxetine as an adjunct to behavioral smoking cessation treatment.

The authors evaluated the efficacy of fluoxetine hydrochloride (Prozac; Eli Lilly and Company, Indianapolis, IN) as an adjunct to behavioral treatment for smoking cessation. Sixteen sites randomized 989 smokers to 3 dose conditions: 10 weeks of placebo, 30 mg, or 60 mg fluoxetine per day. Smokers received 9 sessions of individualized cognitive-behavioral therapy, and biologically verified 7-day self-reported abstinence follow-ups were conducted at 1, 3, and 6 months posttreatment. Analyses assuming missing data counted as smoking observed no treatment difference in outcomes. Pattern-mixture analysis that estimates treatment effects in the presence of missing data observed enhanced quit rates associated with both the 60-mg and 30-mg doses. Results support a modest, short-term effect of fluoxetine on smoking cessation and consideration of alternative models for handling missing data. (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)     

Influence of antidepressant pharmacotherapy on behavioral treatment adherence and smoking cessation outcome in a combined treatment involving fluoxetine.

The authors examined whether serum fluoxetine levels influence behavioral treatment adherence and smoking cessation outcome. Nondepressed smokers (N?=?989) from 16 centers were randomized on a double-blind basis to receive either fluoxetine (30 or 60 mg) or placebo plus 9 sessions of behavioral smoking cessation treatment. Fluoxetine and norfluoxetine blood levels were assayed 1 week after the quit date. Logistic regression was used to predict treatment completion and cessation outcome, controlling for gender, age, treatment site, and degree of nicotine dependence. Higher steady-state fluoxetine blood levels (fluoxetine?+?norfluoxetine) predicted less likelihood of dropping out, χ2(1, N?=?820)?=?3.9, p?N?=?513)?=?18.1, p?     

Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms.

Objective: Depressive symptoms are associated with poor smoking cessation outcomes, and there remains continued interest in behavioral interventions that simultaneously target smoking and depressive symptomatology. In this pilot study, we examined whether a behavioral activation treatment for smoking (BATS) can enhance cessation outcomes. Method: A sample of 68 adult smokers with mildly elevated depressive symptoms (M = 43.8 years of age; 48.5% were women; 72.7% were African American) seeking smoking cessation treatment were randomized to receive either BATS paired with standard treatment (ST) smoking cessation strategies including nicotine replacement therapy (n = 35) or ST alone including nicotine replacement therapy (n = 33). BATS and ST were matched for contact time and included 8 sessions of group-based treatment. Quit date was assigned to occur at Session 4 for each treatment condition. Participants completed a baseline assessment; furthermore, measures of smoking cessation outcomes (7-day verified point-prevalence abstinence), depressive symptoms (Beck Depression Inventory–II; Beck, Steer, & Brown, 1996), and enjoyment from daily activities (Environmental Reward Observation Scale; Armento & Hopko, 2007) were obtained at 1, 4, 16, and 26 weeks post assigned quit date. Results: Across the follow-ups over 26 weeks, participants in BATS reported greater smoking abstinence (adjusted odds ratio = 3.59, 95% CI [1.22, 10.53], p = .02) than did those in ST. Participants in BATS also reported a greater reduction in depressive symptoms (B = ?1.99, SE = 0.86, p = .02) than did those in ST. Conclusions: Results suggest BATS is a promising intervention that may promote smoking cessation and improve depressive symptoms among underserved smokers of diverse backgrounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a treatment approach combining nicotine gum with self-guided behavioral treatments for smoking relapse prevention.

1,218 smokers able to quit smoking for 48 hr were randomly assigned to one of 12 cells in a 4?×?3 fully crossed factorial experiment. A pharmacologic factor contained four levels: nicotine polacrilex (gum) delivered ad lib or on a fixed regimen, placebo gum, and no gum. A self-guided behavioral treatment factor contained three levels: self-selected relapse prevention modules, randomly administered modules, and no modules. Those receiving nicotine gum were more likely to be abstinent at the 2- and 6-month follow-ups. The fixed regimen accounted for most of the effect for gum. There was no effect for the relapse prevention module factor. Men and women showed a differential treatment response. Men who received nicotine gum were more likely to be abstinent at each follow-up (2, 6, and 12 months). No treatment was significantly better among women. We conclude that research on different gum chewing regimens is warranted and that further examination of possible gender differences in response to replacement therapy is needed. (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)     

Nicotine poisoning and rapid smoking.

Notes that there are some similarities between nicotine poisoning and symptoms experienced by Ss after rapid smoking (RS). Pharmacological evidence suggests that nicotine poisoning may be the aversive component in the RS paradigm and that hazardous dosage levels are theoretically possible. The need for normative data on the amount of nicotine absorbed by Ss during RS is emphasized, along with methodological issues related to the use of low-nicotine cigarettes and whether the curtailment of nicotine content would weaken the efficacy of the RS treatment. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promoting smoking cessation among cancer patients: a behavioral model

The smoking cessation clinical practice guideline recently published by the Agency for Health Care Policy and Research (AHCPR) summarizes current knowledge on smoking cessation treatments. Among its recommendations, the guideline encourages physicians to motivate patients who indicate that they are not yet ready to quit smoking. Because medical training typically emphasizes pharmacologic rather than behavioral treatment, we believe that physicians caring for cancer patients may benefit from more extensive instruction in motivating patients to quit smoking. This article describes how a contemporary theoretical approach, the transtheoretical model of change, can be used to promote behavioral change. Multiple studies, primarily in the field of smoking cessation, provide strong empiric support for use of this model in clinical practice. The model consists of five stages of smoking cessation that describe different levels of readiness to quit: precontemplation, contemplation, preparation, action, and maintenance. A diagnostic tool is presented, and specific smoking cessation counseling strategies are suggested for each stage of change. Implications for the use of the model by physicians who counsel and treat smokers are discussed.     

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)     

Group treatment versus individual initiative in the cessation of smoking.

Matched 173 smokers who completed the Seventh-Day Adventist Five-Day Plan to Stop Smoking with 175 Ss who attempted to stop smoking without group treatment. A 6-mo follow-up indicated that differences in success rates favored the treated group but were entirely attributable to differences between females. Males were unaffected by treatment. Questionnaire responses identified a number of personal characteristics which differentiated between male and female successes and failures. (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)