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)     

Extended telephone counseling for smoking cessation: Does content matter?

Telephone counseling is a popular modality for smoking cessation treatment; however, little attention has been paid to evaluating the efficacy of different contents of calls. This study compared 2 types of proactive telephone calls following a group program. Participants were randomized to receive either: (a) basic content, consisting primarily of support; or (b) enhanced content, tailored to the stage of cessation (still smoking, abstinent, or relapsed) and targeting factors hypothesized to be related to success (motivation, self-efficacy, and negative mood). There was a significant interaction between treatment condition and gender. For men, the enhanced condition produced better abstinence rates through 15 months and lower relapse rates. For women, the basic condition was better. History of depression did not interact with condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pathophysiological basis for informed preoperative smoking cessation counseling

Associations among seven apolipoprotein B (APOB) gene polymorphisms [C-T promoter site; Leu-Ala-Leu signal peptide (SP) insertion/deletion; AG C,G site at codon 71; AG A1,D site at codon 591; XbaI site at codon 2488; AG H,I site at codon 3611; and AG T,Z site at codon 4154] were investigated in 195 members of an Orang Asli (aborigine) population from western Malaysia. Frequencies of the rare alleles for all these polymorphisms turned out to be low when compared with European but not Asian populations. The AG H,I site was not polymorphic. The highly polymorphic sites are in linkage disequilibrium among themselves, as shown by their delta values: SP 24,27 and AG C,G, 0.68; SP 24,27 and AG A1,D, 0.71; XbaI and AG C,G, 0.64; XbaI and AG A1,D, 0.57; SP 24,27 and XbaI, 0.48; and AG C,G and AG A1,D, 0.68. Ten unequivocal haplotypes on the basis of six sites (excluding the promoter polymorphism) were observed, and they represent 80% of the sample. The frequency of haplotype SP27,G,A1,X-,I,T, defined by the common homozygotes at all the sites for the APOB gene was 0.7, compared with 0.22 in Europeans. The ancestral haplotype SP27,G,D,X-,I,T was present at low frequency (0.01) in both the Orang Asli and Europeans. A cladogram constructed on the basis of haplotypes in the Orang Asli shows two different lines of evolution and that other haplotypes evolved by subsequent mutations on the ancestral haplotype.     

Effectiveness of physicians-in-training counseling for smoking cessation in African Americans

This study examined the effectiveness of smoking cessation counseling by physicians-in-training (residents) with African-American patients. One hundred fifty-eight family and internal medicine residents at a large urban public general hospital participated in the study; two thirds of the residents underwent a 2-hour smoking cessation training program. Ninety-two of the trained physicians counseled from 1 to 18 patients. The majority of physicians were male, with 8% being current smokers. Over a 26-month period, 1086 patients were randomly assigned to intervention and control (usual care) groups. Mean patient age was 44 years, mean years smoking was 25, and mean number of cigarettes smoked per day was 14. There were no differences in biochemically validated smoking cessation rates between the intervention and control groups at 3 or 12 months postenrollment (2% versus 1.8% and 2.2% versus 2.8%, respectively). Losses to follow-up were high at both 3 and 12 months (38% and 40% respectively). Implications for future trials in minority populations are discussed. A brief physician-based smoking cessation message does not appear to be an effective strategy for use with African-American smokers in a large urban public general hospital.     

Missed opportunities for prevention: smoking cessation counseling and the competing demands of practice

Activating mutations in and expression of the Ha-ras gene were examined in benign and malignant female Sprague-Dawley rat mammary gland tumors induced by the heterocyclic amine 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) and promoted by a diet high in polyunsaturated fat. Ha-ras mutations were detected in codons 12 and 13 by selective polymerase chain reaction amplification of mutated sequences and nucleotide sequencing. The percentage of Ha-ras mutations in carcinomas from PhIP-treated rats was significantly higher in rats on a low-fat diet than in rats on a high-fat diet (82% (nine of 11) vs 26% (seven of 27), respectively, P < 0.01). In addition, whereas 56% of the carcinomas with Ha-ras mutations from rats on a low-fat diet carried double Ha-ras mutations, none of the carcinomas from rats on a high-fat diet had double mutations. Ha-ras mutations were also detected in benign tumors (largely adenomas) induced by PhIP in rats on different diets; two of eight and three of four benign tumors examined from rats on low-fat and high-fat diets, respectively, had Ha-ras mutations, suggesting that activating Ha-ras mutations alone are not sufficient for PhIP-induced tumors to become malignant. No differences were observed in the level of Ha-ras mRNA expression in the different groups. In our animal model, a high-fat diet increased the incidence and percentage of malignant PhIP-induced mammary gland tumors yet decreased the percentage of carcinomas showing Ha-ras mutations. Thus, the complement of genetic alterations associated with PhIP-induced mammary gland carcinogenesis is probably altered by the level of dietary fat.     

The nicotine patch in smoking cessation. A randomized trial with telephone counseling

BACKGROUND: This study was conducted to determine the efficacy of the nicotine patch in smoking cessation when combined with self-help materials, three brief visits, and telephone counseling. METHODS: One hundred fifty-nine healthy volunteers who smoked at least one pack of cigarettes per day and desired to quit smoking were enrolled in a double-blind trial with 6-week treatment and 6-month follow-up periods. After review of self-help materials, subjects were randomly assigned to regimens of nicotine or placebo patches. Subjects wore two patches per day for 4 weeks (25 mg of nicotine per 24 hours), then one patch per day for 2 weeks. Return visits were at the ends of weeks 4 and 6. Telephone counseling was given during weeks 1, 2, 3, and 5. Abstinence at 6 weeks was defined as zero cigarettes smoked for the previous 28 days, verified by exhaled carbon monoxide less than 8 ppm at 4 weeks and 6 weeks. Abstinence at 3 and 6 months was defined as self-report of zero cigarettes since the previous contact, verified by carbon monoxide value at 6 months. RESULTS: Abstinence rates at 6 weeks, 3 months, and 6 months were 29.5%, 21.8%, and 20.5% in the active group, and 8.8%, 3.8%, and 2.5% in the placebo group (P < or = .001 for each comparison), respectively. Skin irritation was the main side effect, causing 1.3% to drop out. CONCLUSION: The nicotine patch is efficacious in smoking cessation over a 6-month period, when combined with only self-help materials, three brief visits, and telephone counseling.     

Combined effects of venlafaxine, nicotine replacement, and brief counseling on smoking cessation.

In this study, 147 smokers were randomly assigned to receive either venlafaxine or placebo in conjunction with behavioral counseling (9 weekly sessions) and transdermal nicotine replacement therapy (22 mg/day). Patients began medication 2 weeks before quitting and continued for 18 weeks after quitting, with the daily dose titrated from 150 to 225 mg. in response to symptoms of negative affect and relapse. The results showed no main effect of treatment on abstinence. Post hoc analysis revealed that both at the end of treatment and at the 1-year follow-up smokers consuming less than a pack of cigarettes a day benefited from the addition of venlafaxine to the treatment regimen. Venlafaxine also reduced negative affect for all smokers for up to 6 weeks postcessation. The findings suggest that venlafaxine could have some role to play in the treatment of lighter smokers, in addition to the expected benefits of nicotine replacement therapy and behavioral counseling. (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)     

Telephone counseling via cassette tapes.

Describes a telephone tape program designed to provide basic mental and physical health information to callers. Each tape, lasting approximately 8–20 min, deals with the causes of a specific concern, suggestions whereby the listeners may help themselves, and referral sources for the problem. Preliminary information suggests that telephone tapes offer a relatively inexpensive, effective mental health communication system, offering anonymity to the listener with suggestions for the utilization of more traditional mental health resources. (2 ref) (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)     

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)     

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)     

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)     

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)     

Self-efficacy and smoking cessation: A meta-analysis.

According to relapse models, self-efficacy (SE), or confidence in one's ability to abstain, should predict the outcome of an attempt to quit smoking. We reviewed 54 studies that prospectively examined this relationship. The relationship between SE and future smoking depended upon the population studied and the timing of the SE assessment. The relationship between SE and future smoking was modest when SE was assessed prior to a quit attempt; SE scores were .21 standard deviation units (SD) higher for those not smoking at follow-up than for those who were smoking. The relationship was stronger (.47 SD) when SE was assessed post-quit. However, this effect was diminished when only abstainers at the time of the SE assessment were included in analysis (.28 SD). Controlling for smoking status at the time of SE assessment substantially reduced the relationship between SE and future smoking. Although SE has a reliable association with future abstinence, it is less robust than expected. Many studies may overestimate the relationship by failing to appropriately control for smoking behavior at the time of the SE assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of an intensive depression-focused intervention for smoking cessation in pregnancy.

Objective: The objective of this study was to evaluate a depression-focused treatment for smoking cessation in pregnant women versus a time and contact health education control. We hypothesized that the depression-focused treatment would lead to improved abstinence and reduced depressive symptoms among women with high levels of depressive symptomatology. No significant main effects of treatment were hypothesized. Method: Pregnant smokers (N = 257) were randomly assigned to a 10-week, intensive, depression-focused intervention (cognitive behavioral analysis system of psychotherapy; CBASP) or to a time and contact control focused on health and wellness (HW); both included equivalent amounts of behavioral and motivational smoking cessation counseling. Of the sample, 54% were African American, and 37% met criteria for major depression. Mean age was 25 years (SD = 5.9), and women averaged 19.5 weeks (SD = 8.5) gestation at study entry. We measured symptoms of depression using the Center for Epidemiological Studies–Depression Scale (Radloff, 1977). Results: At 6 months posttreatment, women with higher levels of baseline depressive symptoms treated with CBASP were abstinent significantly more often, F(1, 253) = 5.61, p = .02, and had less depression, F(1, 2620) = 10.49, p = .001, than those treated with HW; those with low baseline depression fared better in HW. Differences in abstinence were not retained at 6 months postpartum. Conclusions: The results suggest that pregnant women with high levels of depressive symptoms may benefit from a depression-focused treatment in terms of improved abstinence and depressive symptoms, both of which could have a combined positive effect on maternal and child health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of nicotine fading and relapse prevention on smoking cessation.

In a pilot study, a combined nicotine-fading/relapse-prevention program for 24 smokers (mean age 38.6 yrs) achieved a 46% abstinence rate at 6-mo follow-up. The combined program was then compared to conditions in which 46 smokers (mean age 34.8 yrs) received nicotine fading or relapse prevention only or combination treatment. There was no difference among groups in abstinence or rate at any follow-up point, and overall abstinence levels were only 15% and 9% at 6-mo and 1-yr follow-ups, respectively. Groups receiving nicotine fading tended to retain lower estimated nicotine intake levels. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)