Rapid smoking and self-control in the modification of smoking behavior.

Investigated the efficacy of combining rapid smoking aversion and training in self-control skills for maintaining nonsmoking. 50 habitual smokers (26 males, 24 females; mean age 33 yrs) were assigned to a 3-wk treatment program emphasizing rapid smoking plus self-control, rapid smoking plus filler discussion, normal-paced (placebo) smoking plus self-control, or the placebo smoking procedure plus filler discussion. At the 13-wk follow-up, the performance of the combined rapid smoking plus self-control program was not superior to rapid smoking plus discussion. In fact, Ss in the combined program performed worse (had a higher mean smoking rate and a smaller percentage of abstinence) at both treatment termination and follow-up. Self-control did improve performance in placebo smoking Ss. Differences associated with self-control were not statistically significant. Rapid smoking was found to be significantly more effective than the placebo smoking when data from non-married treatment pairs were considered. Possible explanations for the negative impact of self-control on rapid smoking are outlined. Locus of control scores and extended experimenter–S contact after termination were not related to treatment performance. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral self-control of smoking through aversive conditioning and self-management.

Evaluated self-control variants of aversive conditioning and self-management procedures for the modification of cigarette smoking. 16–37 yr old smokers (90% undergraduates) were assigned to 10 treatment conditions arranged in a 2?×?5 (Self-Management?×?Aversive Conditioning) factorial design; another 20 smokers were included in a no-apply control group. Five varieties of aversive conditioning were used: aversive conditioning, placebo shock, therapist-delivered shock, S-delivered shock, and imagined aversive scene. Half of the smokers under each variety of aversive conditioning received additional training in a package of self-management techniques. Smokers were seen by individual therapists in 6 sessions over 3 wks. The treatment effects of aversive conditioning were negligible, and in some instances they were surpassed by the effects of controls for nonspecific treatment factors and placebo effects. The addition of self-management to aversive conditioning significantly reduced smoking beyond aversive conditioning effects over a 20-wk follow-up. However, no treatment combination led to reductions in smoking beyond controls for nonspecific factors, nor were reductions maintained over follow-up times. Implications for behavioral self-control strategies are discussed. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of Payment for Reduced Carbon Monoxide Levels and Noncontingent Payments on Smoking Behaviors in Cocaine-Abusing Outpatients Wearing Nicotine or Placebo Patches.

In a 2-week intervention to reduce cigarette smoking among outpatients in treatment for cocaine addiction, 20 subjects were randomly assigned to a contingent group, receiving monetary vouchers for breath samples with carbon monoxide (CO) levels of 8 ppm or less, or to a noncontingent group, receiving vouchers regardless of CO level. Subjects wore either nicotine or placebo patches in a randomized crossover design. Contingent subjects had significantly lower CO levels and met the 8 ppm target significantly more often than did noncontingent subjects; however, number of cigarettes reported smoked did not differ between groups. Use of nicotine patches resulted in CO levels significantly lower than did use of placebo patches, but levels still exceeded 8 ppm regardless of type of patch. Because contingent reward helped cocaine-dependent smokers achieve nonsmoking CO targets, behavioral antismoking interventions merit continued study in similar populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aversive conditioning: Learning or dissonance reduction?

Hypothesized that the theory of cognitive dissonance could account for the results of aversive conditioning therapy. 30 male smokers, who desired to stop the habit, were assigned to 1 of 3 conditions. The conditioning (C) group received shock contingent on smoking; the pseudoconditioning (PC) group received shock in an irrelevant situation; and the control (Con) group replicated the C group treatment, but received no shock. All groups reduced smoking significantly. Results are consistent with the hypothesis. Factors of belief, expectancy, and cognitive consistency are important in behavior therapies and process studies are required to substantiate theoretical assumptions about why psychotherapies are successful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contingency management interventions for treating the substance abuse of adolescents: A feasibility study.

This article reports on the feasibility of using a contingency management intervention with adolescent smokers that has proven efficacious in adult substance abuse treatment. The study used 8 adolescent participants in an A (1 week)-B (1 week)-A (1 week) reversal design. During the 2 baseline phases, no contingencies were placed on cigarette smoking, and adolescent received money noncontingently. During the experimental intervention week, adolescents received payment contingent on not smoking. The magnitude of reimbursement available during the baseline and intervention was effective in reducing smoking, both in terms of increasing the total number of abstinences and consecutive abstinences. In addition, changes in adolescents' affective states during smoking cessation were found. Anxiety, depression, anger, and fatigue were reported, and these negative states ceased once smoking resumed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Transdermal Nicotine During Imaginal Exposure to Anxiety and Smoking Cues in College Smokers.

In a 2 (patch) × 2 (smoking) × 2 (anxiety) mixed design, 52 undergraduate smokers randomly received a nicotine (21 mg) or placebo patch. After a 4-hr nicotine absorption/deprivation period, participants imagined several scenarios varying in cue content: (a) anxiety plus smoking, (b) anxiety, (c) smoking, and (d) neutral. Although smoking urge increased in both the nicotine and placebo conditions after the absorption/deprivation period, those who received the placebo reported significantly greater urge. During the cue reactivity trials, a significant Patch × Smoking × Anxiety interaction effect was observed for urge. However, participants who received nicotine still experienced moderate urges, indicating that nicotine did not attenuate cue-elicited urge. Transdermal nicotine did not diminish anxiety during the absorption/deprivation period or in response to the cues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of nicotine nasal spray on smoking cessation. A randomized, placebo-controlled, double-blind study

BACKGROUND: Nicotine replacement therapies have proved to be of value in smoking cessation. However, not all smokers can use the nicotine gum or nicotine patch owing to side effects. In addition, the absorption of nicotine from these formulas is slow compared with smoking. A nicotine nasal spray delivers nicotine more rapidly. The objective of this study was to evaluate the efficacy and safety of the nicotine nasal spray for smoking cessation. METHODS: Subjects were recruited through advertisements in newspapers and among patients referred to the smoking cessation clinic at Sahlgren's Hospital, G?teborg, Sweden. Two hundred forty-eight smokers were treated in small groups with eight counseling sessions over 6 weeks. At their first group session, subjects were randomized to a group receiving nicotine spray (n = 125), 0.5 mg of nicotine per single spray, or to a placebo group (n = 123). The procedure was double blind. Success rates were measured up to 12 months. The nonsmoking status was verified by expired carbon monoxide less than 10 ppm. RESULTS: Significantly more subjects in the nicotine group were continuously abstinent for 12 months than in the placebo group (27% vs 15%; odds ratio, 2.16; 95% confidence interval, 1.15 to 4.12). Ten of the 34 abstinent subjects in the nicotine group used the spray for 1 year. Mild or moderate side effects were rather frequent for both sprays, but they were significantly more for the nicotine spray. Subjects with high scores (> 7) on Fagerstr?m's tolerance questionnaire had a significantly lower success rate with placebo than with the nicotine spray. For subjects with low scores, there was no difference. CONCLUSION: Nicotine nasal spray in combination with group treatment is an effective aid to smoking cessation.     

Depression and smoking cessation: Characteristics of depressed smokers and effects of nicotine replacement.

Previous research has linked depression to difficulties in smoking cessation. The authors followed 269 smokers who attempted to quit smoking for 3 months. Participants were given nicotine gum (2 or 4 mg) or placebo gum and brief counseling. The study found that 34% of the smokers met the criterion for current depression using the Center for Epidemiological Studies Depression Scale. Depressed smokers relapsed significantly earlier than the nondepressed. Nicotine gum was significantly more effective than placebo gum among all smokers. The benefits of nicotine gum were particularly apparent among the depressed. Only 12.5% of depressed smokers quit successfully with placebo gum for 3 months, whereas 29.5% quit with nicotine gum. Depressed smokers reported more stress, less coping resources, more physical and psychological symptoms, and more frequent smoking in the presence of negative affect than did the nondepressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of impulsive behavior in adolescent smokers and nonsmokers.

Robust associations have been identified between impulsive personality characteristics and cigarette smoking during adolescents, indicating that impulsive behavior may play an important role in the initiation of cigarette smoking. The present study extended this research by using laboratory behavioral assessments to explore relationships between three specific dimensions of impulsive behavior (impulsive decision-making, inattention, and disinhibition) and adolescent cigarette smoking. Participants were male and female adolescent smokers (n = 50) and nonsmokers (n = 50). Adolescent smokers were more impulsive on a measure of decision-making; however, there were significant smoking status by gender interaction effects for impulsive inattention and disinhibition. Male smokers were most impulsive on the measure of inattention, but male smokers were least impulsive on the measure of disinhibition. Correlations between biomarkers of smoking and impulsive inattention and disinhibition were found for females but not males. The current findings, coupled with previous findings (Reynolds et al., 2007), indicate there may be robust gender difference in associations between certain types of impulsive behavior and cigarette smoking during adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of sustained-release bupropion and placebo for smoking cessation

BACKGROUND AND METHODS: Trials of antidepressant medications for smoking cessation have had mixed results. We conducted a double-blind, placebo-controlled trial of a sustained-release form of bupropion for smoking cessation. We excluded smokers with current depression, but not those with a history of major depression. The 615 subjects were randomly assigned to receive placebo or bupropion at a dose of 100, 150, or 300 mg per day for seven weeks. The target quitting date (or "target quit date") was one week after the beginning of treatment. Brief counseling was provided at base line, weekly during treatment, and at 8, 12, 26, and 52 weeks. Self-reported abstinence was confirmed by a carbon monoxide concentration in expired air of 10 ppm or less. RESULTS: At the end of seven weeks of treatment, the rates of smoking cessation as confirmed by carbon monoxide measurements were 19.0 percent in the placebo group, 28.8 percent in the 100-mg group, 38.6 percent in the 150-mg group, and 44.2 percent in the 300-mg group (P<0.001). At one year the respective rates were 12.4 percent, 19.6 percent, 22.9 percent, and 23.1 percent. The rates for the 150-mg group (P=0.02) and the 300-mg group (P=0.01) -- but not the 100-mg group (P=0.09) -- were significantly better than those for the placebo group. Among the subjects who were continuously abstinent through the end of treatment, the mean absolute weight gain was inversely associated with the dose (a gain of 2.9 kg in the placebo group, 2.3 kg in 100-mg and 150-mg groups, and 1.5 kg in the 300-mg group; P= 0.02). No effects of treatment were observed on depression scores as measured serially by the Beck Depression Inventory. Thirty-seven subjects stopped treatment prematurely because of adverse events; the frequency was similar among all groups. CONCLUSIONS: A sustained-release form of bupropion was effective for smoking cessation and was accompanied by reduced weight gain and minimal side effects. Many participants in all groups were smoking at one year.     

Effectiveness of the 4-mg dose of nicotine polacrilex for the initial treatment of high-dependent smokers

PURPOSE: To determine the effectiveness of the 4-mg and 2-mg dosages of nicotine polacrilex vs placebo through the first 6 weeks of treatment (during which 75% of relapse occurs when there is no treatment) in assisting high-dependent smokers to stop smoking when instructed to use a fixed number (12 pieces) of medication daily. SUBJECTS AND METHODS: Ninety high-dependent (Fagerstr?m Tolerance Questionnaire score > or = 7 plus baseline carbon monoxide level > 15 ppm) healthy male and female smokers, highly motivated to quit smoking, were enrolled in a 6-week, randomized, double-blind, placebo-controlled trial in which they were instructed to use 12 pieces per day of their assigned dosage formulation: 4 mg, 2 mg, or 0.5 mg (placebo) of nicotine polacrilex. The behavioral intervention did not depend on providing any special psychological training, skills, or services but rather employed a standard medical practice model that could easily be implemented by any primary care physician. RESULTS: Sustained abstinence from weeks 2 through 6, determined at each visit by absolutely no cigarette use plus a carbon monoxide level of 8 ppm or lower was 59% (4-mg group), 30% (2-mg group), and 39% (placebo group) (P < .02). For the 55 of the 90 smokers who met the originally planned definition of high dependence (Fagerstr?m Tolerance Questionnaire score > or = 7 plus baseline smoking serum cotinine level > 250 ng/mL plus baseline carbon monoxide level > 15 ppm), results were 63% (4-mg group), 25% (2-mg group), and 25% (placebo group) (P < .02). In addition, the 4-mg dose produced statistically significantly higher abstinence rates in compliant subjects (P < .02) and also in subjects with high baseline serum continine levels who were compliant (P < .01) than did either the 2-mg dose or placebo. CONCLUSIONS: It appears that the 4-mg dose of nicotine polacrilex is the drug and dose of choice for the initial phase of tobacco dependence treatment in high-dependent smokers; the 2-mg dose of nicotine polacrilex is not better than placebo during the first 6 weeks of treatment for high-dependent cigarette smokers, and thus should not be used for these patients during the initial treatment phase.     

Hospital smoking bans and employee smoking behavior: Results of a national survey

OBJECTIVE: To examine the impact of workplace smoking bans on smoking behavior of employees. PARTICIPANTS: A total of 1469 current or former smokers (intervention group) employed in smoke-free hospitals and 920 current or former smokers (comparison group) employed in non-smoke-free workplaces were surveyed to determine smoking behavior. DESIGN: This cross-sectional study is part of a larger, ongoing prospective study. The study design was quasi-experimental. We randomly selected sites consisting of a hospital and a corresponding community. Furthermore, we randomly selected subjects from hospitals and their corresponding communities. MAIN OUTCOME MEASURES: Postban quit ratio and progression along the stages-of-change continuum. METHODS: The Cox proportional hazards model was used to compare the postban quit ratio between the intervention and comparison groups. The Cochran-Mantel-Haenszel analysis of variance statistic was used to compare groups on the stages-of-change variables. RESULTS: Beginning with the smoking ban and continuing for 5 years after implementation, statistically significant differences in the postban quit ratio were observed between employees of smoke-free hospitals who were smokers and counterparts in the community (P<.001). Despite preban differences in smoking intensity, the overall difference in postban quit ratios remained significant even after multivariate adjustment for socioeconomic, demographic, and smoking intensity variables. For those sites that were 5 years postban, the quit ratio was 0.506 in smoke-free workplaces compared with 0.377 in workplaces where smoking was permitted. In all but 1 category, the intervention group was further along the stages-of-change continuum toward quitting smoking than the comparison group (P<.001). CONCLUSION: American hospitals' experiences with smoking bans, which directly affect more than 5 million workers, should be examined by other industries as a method of improving employee health. Workplace smoking bans could also be effective in saving lives, reducing health care costs, addressing safety concerns, and decreasing operating and maintenance expenses of employers.     

Effect of internal and external control upon changes in smoking behavior.

Current evidence indicates that a personality measure which involves the extent to which a person perceives reinforcements as either internally or externally controlled (Internal-External scale, I-E) is significantly related to verbal as well as other behavioral measures of attitudes. The recent Surgeon General's report on smoking afforded an opportunity to study the relationship of the I-E variable to both attitudinal and behavior changes associated with smoking. The study was conducted 1 week after the release of the government report on smoking. Results indicate that (a) both male and female smokers are significantly more externally controlled than are nonsmokers; (b) smokers who were convinced by the evidence in the report had lower external control scores than those who were not convinced; and (c) among males, those who stopped smoking following the report were more internally oriented than those who continued smoking. It was concluded that the I-E dimension (which is independent of extroversion-introversion) may be an important personality variable in relation to smoking behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smokers on Bloemfontein schools: profile and standpoint

Primary prevention is now the first priority of research on smoking. A study was made of 1 505 children of 12 high schools situated in a conservative Afrikaans-speaking community in an attempt to determine the characteristics of the smoking and non-smoking groups. Of the total group 16% were smokers. The male/female ratio was 3:1. The mean age at which smoking commenced was 15,5 years. A positive relationship was found between the smoking habits of the smokers and those of their parents and best friends. The majority of pupils think that smoking is addictive. In addition, they believe that it is unhealthy and leads to poor sporting achievements. The great majority of smokers and non-smokers agree that non-smokers do better at school. Fathers of both smokers and non-smokers do not favour the habit. Ninety per cent of the boys and 83% of the girls started smoking between 12 and 18 years of age. The critical age for a preventive programme is thus 11 years.     

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.     

The relative importance of socially induced tension and behavioral contagion for smoking behavior.

Assigned 144 college students to 1 of 4 social situations in which Ss were led to believe that they were to be evaluated and had to wait in a room with the evaluators or that they were waiting with other Ss, who were actually confederates and who engaged the real S in friendly conversation. In these situations the confederates were either smoking or not smoking. Results indicate that, although the anxiety manipulation was effective in raising Ss' arousal levels (Ss' self-reports and observers' subjective ratings) in the evaluation condition, only the presence of other people smoking significantly increased the number of Ss who smoked in the situations; this result applied only to "light" smokers. However, the presence of confederates who were smoking significantly increased the number of minutes the Ss smoked during the condition for both light and heavy smokers, suggesting a ceiling effect for heavy smokers. Tension reduction is not viewed as an adequate explanation for cigarette smoking behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of Type A behavior pattern in smokers to carbon monoxide exposure and smoking topography.

Compared exposure to cigarette smoke in 42 graduate and undergraduate student smokers assessed for the Type A behavior pattern. After controlling for smoking rate and cigarette carbon monoxide yield, Type As' alveolar carbon monoxide (COa) levels were higher than Type Bs', and Jenkins Activity Survey scores were correlated with COa. To determine the source of this difference, smoking topography was measured in 10 Type As and 10 Type Bs. Results suggest that consummatory behaviors of Type As may help account for the Type A–coronary heart disease relationship for smokers. Due to increased smoke exposure, Type A smokers may also be at greater risk for cancer and lung disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of social reinforcement on the level of abstraction in schizophrenics.

This study was designed to investigate (1) the effects of the nature of contingent vs. noncontingent social reinforcement upon the level of abstraction in schizophrenics as measured on a proverbs task, (2) the generalization of this behavior to another verbal conceptual task administered under neutral conditions, and (3) the predictive and construct validity of the Ullmann-Giovannoni Process-Reactive Self-Report Scale. 64 male schizophrenics were assigned to 4 treatment groups: contingent positive, noncontingent positive, contingent negative, and control. The results indicated that only the contingent positive Ss significantly increased their level of performance on the proverbs task and showed generalization. The other 3 groups showed no significant differences. Validity evidence for the Process-Reactive Scale and marital status was obtained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks.

This study examined treatment outcomes among smokers with single versus multiple behavioral risks. Data were drawn from smokers (N = 2,326) participating in 3 population-based, multibehavioral studies targeting cigarette smoking, high-fat diets, and high-risk sun exposure. Outcomes were compared for participants at risk for smoking only (13%), smoking plus 1 additional risk factor (37%), and smoking plus 2 additional risk factors (50%). The smoking only group tended to be female, older, more educated, lighter smokers, in the preparation stage of change for smoking, with more previous quit attempts and longer periods of abstinence. At 12 and 24 months follow-up, treatment of 1 or 2 coexisting risk factors did not decrease the effectiveness of smoking cessation treatment, and treatment for the coexisting factors was effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assigned Versus Perceived Placebo Effects in Nicotine Replacement Therapy for Smoking Reduction in Swiss Smokers.

In this report, the authors explore the relationships of perceived treatment to outcome in a large, placebo-controlled trial of nicotine replacement treatment for smoking reduction. In the original study (J. F. Etter, E. Laszlo, J. P. Zellweger, C. Perrot, & T. V. Perneger, 2002), which was conducted in French-speaking Switzerland, smokers were randomly assigned to receive nicotine, matching placebo products, or no intervention. At the end of the 6-month study, participants were asked to guess whether they had received nicotine or placebo. In the present analysis, the authors examined the difference in smoking reduction between those who believed they had received nicotine and those who believed they had received placebo. Regardless of actual treatment, smokers who believed they had received nicotine had significantly better outcome than those who believed they had received placebo. (PsycINFO Database Record (c) 2010 APA, all rights reserved)