The effect of nicotine patch therapy on depression in nonsmokers: a preliminary study

Prior uncontrolled studies of nonsmokers with major depressive disorder (MDD) indicate rapid reduction in depressive symptoms with nicotine patch therapy. This randomized, double-blind, placebo-controlled pilot study examined the effect of nicotine patch therapy on depressive symptoms in non-medicated nonsmokers with current MDD. Due to recruitment difficulties, only 7 were enrolled and of these 6 (5 females, 1 male) completed the study. Participants received either placebo (n = 4) or active (n = 2) patch therapy for 8 days. They completed daily clinic visits during patch therapy and a final visit on Day 12. Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HRSD). The mean change in HRSD scores of all participants decreased (p = 0.021) from baseline by Day 1 of patch use. Similar decreases in HRSD scores were observed for placebo and active patch groups. Among the placebo participants, the mean HRSD score decreased (p = 0.038) by Day 2. The study needs replication with a larger sample and utilizing novel recruitment strategies.

Differences in adolescent smoker and nonsmoker perceptions of strategies that would help an adolescent quit smoking

This study assessed adolescent smoker and nonsmoker perceptions of strategies that would help an adolescent smoker in his or her attempt to stop smoking. Surveys were distributed primarily in the schools at 4 geographic and ethnically diverse study sites. Respondents were 965 adolescents (49% female; 46% minority). Current smokers (n = 232) were asked to rate the extent to which they agreed or disagreed that supportive behaviors of friends and family, quitting strategies, or learning about quitting strategies would be helpful if they decided to quit. Nonsmokers (n = 733) were asked to indicate the degree to which they agreed or disagreed that these behaviors and strategies would be helpful if a friend decided to quit. Responses to each of the 33 attitude items were rated on a 5-point scale ranging from strongly disagree to strongly agree. Marked differences were observed between smokers and nonsmokers in the level of agreement on each item. In general, smokers reported far less enthusiasm for cessation strategies than nonsmokers. After adjusting for gender, age, and other covariates, smoking status was the strongest independent predictor of the number of items endorsed as agree or strongly agree. The results have implications for the design of peer-based and other interventions for adolescent smokers.

Change in smoking status after spiral chest computed tomography scan screening

BACKGROUND

Cancer screening may provide a "teachable moment" for the reduction of high-risk behaviors. The current study evaluated smoking behavior changes in current and former smokers after low-dose, fast spiral chest computed tomography scan (CT) screening for lung carcinoma.

METHODS

The study was comprised of 901 current smokers and 574 former smokers who participated in a low-dose, fast spiral chest CT scan screening study for lung carcinoma. Demographic, pulmonary function, screening recommendations, and smoking history variables were evaluated as predictors of self-reported point prevalence smoking abstinence 1 year after screening.

RESULTS

Of the current smokers at baseline, 14% reported smoking abstinence at follow-up. Older age and poorer lung function were associated with smoking abstinence. Ninety percent of former smokers reported smoking abstinence at a 1-year of follow-up. A longer duration of smoking abstinence at baseline was found to be predictive of abstinence in this group.

CONCLUSIONS

The 14% smoking abstinence rate was higher than would be expected for spontaneous rates of smoking cessation. Therefore, screening may provide a teachable moment for smokers. Low-dose, fast spiral chest CT scan screening recommendations were not found to be associated with smoking behavior change in either group. Further research is needed to evaluate the potential avenues through which lung carcinoma screening can be used as an opportunity for providing effective nicotine interventions.

Depressed versus nondepressed young adult tobacco users: Differences in coping style, weight concerns and exercise level

Undergraduates age 18 to 24 years (n=656) completed questionnaires assessing tobacco use, depressive symptoms, coping responses, weight concerns, and exercise. The majority of participants were female (72%), White/non-Hispanic (95%), and in the 1st or 2nd year of college (80%). Current tobacco users (n=236) had a higher frequency of depression (40%) than never tobacco users (32%; p=.05). Tobacco users classified as depressed (Center for Epidemiological Studies Depression Scale [CES-D] score a 16) reported greater weight concerns and more frequent maladaptive coping in response to negative mood than tobacco users classified as nondepressed (CES-D score<16). Multivariate logistic regression analysis indicated that higher maladaptive coping and lower level of exercise were significantly associated with depression among tobacco users.

Predictors of 6-month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence

This study examined baseline characteristics associated with abstinence from tobacco 6 months after treatment for nicotine dependence. A total of 1224 cigarette smokers (619 females, 605 males) receiving clinical services for treatment of nicotine dependence between January 1, 1995 and June 30, 1997 were studied. The intervention involves a 45-min consultation with a nicotine dependence counselor. A treatment plan individualized to the patient's needs is then developed. The main outcome measure was the self-reported 7-day point prevalence abstinence from tobacco obtained by telephone interview 6-months after the consultation. A bootstrap resampling methodology for predictor variable selection was used to identify a set of multivariate predictors of 6-month tobacco abstinence. Five variables were multivariately associated with tobacco abstinence: male gender, no current psychiatric diagnosis, higher stage of change, longest duration of previous abstinence from tobacco of <1 or > or =30 days, and Fagerström Test for Nicotine Dependence (FTND) score of < or =5. Assessment of these variables may be useful clinically by assisting health care providers in tailoring nicotine dependence interventions to enhance outcomes.

Exercise interventions for smokers with a history of alcoholism: exercise adherence rates and effect of depression on adherence

This study examined the adherence rates and the effect of depression on adherence in two studies conducted among smokers with a past history of alcoholism. In both studies, subjects participated in a 12-session group-based exercise intervention for smoking cessation. The target quit date (TQD) was Session 8. Participants in Study 1 were 73 smokers (43% female). Exercise instructions began at Session 8 and continued through Session 12. Mean frequency and number of minutes of exercise decreased during the 4 weeks of exercise treatment (P<.001). Study 2, conducted with 18 smokers (50% female), examined the feasibility of commencing exercise at Session 1, well before the TQD. The mean number of minutes exercised increased from Sessions 1 to 12 (P=.013). In both studies, average session attendance was high (82%). Combining subjects from both studies, depressed smokers at baseline reported greater mean frequency of exercise per week than nondepressed smokers (P=.05). The results suggest that depressed smokers can be engaged in an exercise program. Further research is needed to determine if commencing exercise early during treatment, prior to the TQD, improves adherence.

Treatment of tobacco dependence in alcoholics

Because of the high morbidity and mortality that alcoholic smokers experience from tobacco-caused diseases, treatment for tobacco dependence among alcoholics is warranted. Much progress has been made during the last decade in addressing tobacco dependence in alcoholism treatment units. Treatment of tobacco dependence in alcoholic smokers does not seem to cause excessive relapse to drinking and, in fact, stopping smoking may enhance abstinence from drinking. Therefore, treatment for alcoholic smokers should take place whenever and wherever the patient comes in contact with the health care system. Because alcoholic smokers as a rule are more dependent on nicotine than their nonalcoholic counterparts, they may need more intensive pharmacotherapy and behavioral therapy. Because many of them have experienced 12-step approaches to recovery, that same technology can be used to initiate and maintain abstinence from tobacco use. Moreover, several pharmacologic options exist to treat tobacco dependence in alcoholic smokers. However, the efficacy of several pharmacologic therapies for alcoholic smokers needs to be tested. In addition, further research is needed on effective treatments for recovering alcoholics of various racial/ethnic backgrounds.

Relationship of tobacco use to depressive disorders and suicidality among patients treated for alcohol dependence

This population-based, retrospective cohort study examined the association of tobacco use and diagnosis of a depressive disorder (DD) and suicide attempts (SA) before and after discharge from an inpatient addiction program (IAP). All 813 Olmsted County, Minnesota residents (537 males, 276 females) admitted for the first time to the IAP for treatment of alcoholism during the period 1972-1983 were studied. Tobacco use status at admission was classified as ever (current or former use) (85.5%), never (8.6%), or missing (5.9%). Subjects were followed through 1994. Current or former use of tobacco was markedly lower among those with a prior diagnosis of DD than those without this diagnosis (73.6% vs. 89.3%, p<0.001). Although females were more likely to have a diagnosis of DD and were less likely to have ever used tobacco than males, gender did not explain the relationship between tobacco use and DD. Tobacco use status was unrelated to a DD diagnosis after discharge from the IAP and was not associated with SA.

Prevention of tobacco use in adolescents: review of current findings and implications for healthcare providers

This paper reviews recent research on adolescent smoking initiation and youth tobacco prevention and control strategies. Gender, ethnicity, family factors, and genetics are associated with smoking initiation and adolescent tobacco use. Evidence indicates that comprehensive tobacco control programs are an effective strategy for reducing adolescent smoking, and even modest gains from prevention and cessation efforts could lead to substantial reductions in the morbidity and mortality costs of smoking. Clinicians have an important role in prevention and treatment of tobacco use in adolescents, and the rate of delivery of clinical preventive services in this area should be increased. Consequently, clinicians working with adolescents should be familiar with established guidelines regarding tobacco use prevention and treatment and use general outpatient office visits as an important opportunity to prevent tobacco use.

Smoking behavior of 226 patients with diagnosis of stage IIIA/IIIB non-small cell lung cancer

There is limited research of smoking cessation following diagnosis of lung cancer. This prospective study assessed cigarette smoking behavior among 226 patients (142 males, 84 females) prior to, at the time of, and after the diagnosis of unresectable stage IIIA/IIIB non-small cell lung cancer and entry into a phase III trial examining combined thoracic radiation therapy and chemotherapy. Their mean +/-S.D. age was 62.7+/-9.4 years and 95.6% were Caucasian. Of 215 patients with a history of cigarette smoking, 69% (148/215) stopped smoking prior to entry in the trial, 9% (20/215) stopped smoking at some point during the course of the trial, 11% (24/215) continued smoking throughout the trial, 7% (16/215) were smoking at baseline but did not report subsequent smoking status, and smoking status at study entry was missing for the remaining patients. The majority of lung cancer patients were able to stop smoking. A notable subset of patients continued smoking despite diagnosis of lung cancer, enrollment in a clinical trial, treatment-related toxicity, and encouragement from clinicians to stop smoking. Smoking cessation interventions are needed for lung cancer patients who continue to smoke.

Utility and accuracy of collateral reports of smoking status among 256 abstinent alcoholic smokers treated for smoking cessation

This study examined the utility and accuracy of collateral reports of smoking status among 256 abstinent alcoholic smokers (140 males, 116 females) treated for smoking cessation. Data were gathered prospectively from two randomized clinical trials of behavioral smoking cessation treatment conducted in San Diego, CA. The mean age of the participants was 42.0 years (S.D.= 10.0) and 93% were Caucasian. Self-reported smoking status was obtained at posttreatment (1 week after the target quit date) and at 1 year. Collateral reports obtained by telephone and expired air carbon monoxide (CO) levels of < 10 ppm were used to confirm self-reported smoking status. Collateral reports were available for 89.1% of subjects at posttreatment and 90.6% of subjects at 1 year. The smoking abstinence rates were similar when using collateral reports or CO confirmation of smoking status at both time points. Collateral reports refuted self-reported abstinence as often or more than CO levels, and showed relatively high concordance with CO levels. In conclusion, collateral reports have utility and are reasonably accurate for confirming self-reported smoking status in clinical trials of smoking cessation for abstinent alcoholic smokers.

Tobacco use outcomes among patients with lung cancer treated for nicotine dependence

PURPOSE

There is a current lack of consensus about the effectiveness of nicotine dependence treatment for cancer patients. This retrospective study examined the 6-month tobacco abstinence rate among lung cancer patients treated clinically for nicotine dependence.

PATIENTS AND METHODS

A date-of-treatment matched case control design was used to compare lung cancer patients (201 lung cancer patients, 41% female) and nonlung cancer patients (201 controls, 45% female) treated in the Mayo Clinic Nicotine Dependence Center between 1988 and 2000. The intervention involves a brief consultation with a nicotine dependence counselor. A treatment plan individualized to the patient's needs is then developed. The primary end point was the self-reported, 7-day point prevalence abstinence from tobacco at 6-month follow-up.

RESULTS

At baseline, compared with the controls, the lung cancer patients were significantly older (P <.001), reported higher motivation to stop smoking (P =.003), and were at a higher stage of change (P =.002). The 6-month tobacco abstinence rate was 22% for the lung cancer patients compared with 14% of the control patients (P =.024). After adjusting for age, sex, baseline cigarettes smoked per day, and stage of change, no significant difference was detected between lung cancer patients and controls on the tobacco abstinence rate.

CONCLUSION

The results suggest that nicotine dependence treatment is effective for patients with a diagnosis of lung cancer. The majority of lung cancer patients were motivated to stop smoking.

Effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a history of alcohol dependence

This study examined the effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a past history of alcohol dependence. Participants (24 women, 27 men) were randomly assigned to behavioral counseling (BC) or behavioral counseling plus cognitive-behavioral mood management training (CBT). The Hamilton Rating Scale for Depression (HRSD; M. Hamilton, 1967) was administered to assess baseline depressive symptoms. Participants who received CBT and had higher HRSD scores were more likely to achieve short-term abstinence from smoking and attend more treatment sessions than those with lower depression scores, whereas for BC participants the effect of HRSD scores was the opposite. Smokers with a history of alcohol dependence reporting high levels of depressive symptoms may benefit from a mood management intervention.

Effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a history of alcohol dependence

This study examined the effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a past history of alcohol dependence. Participants (24 women, 27 men) were randomly assigned to behavioral counseling (BC) or behavioral counseling plus cognitive-behavioral mood management training (CBT). The Hamilton Rating Scale for Depression (HRSD; M. Hamilton, 1967) was administered to assess baseline depressive symptoms. Participants who received CBT and had higher HRSD scores were more likely to achieve short-term abstinence from smoking and attend more treatment sessions than those with lower depression scores, whereas for BC participants the effect of HRSD scores was the opposite. Smokers with a history of alcohol dependence reporting high levels of depressive symptoms may benefit from a mood management intervention.

Behavioral treatment for smokers with a history of alcoholism: predictors of successful outcome

This study examined baseline predictors associated with smoking abstinence among 205 smokers (113 men, 92 women) with a past history of alcoholism. Their mean age was 41.8 years, and 93% were Caucasian. Participants were randomly assigned to standard treatment (ST), behavioral counseling plus exercise (BEX), or behavioral counseling plus nicotine gum (BNIC). Factors multivariately associated with point-prevalence smoking abstinence at posttreatment (1 week after target quit date) were a longer duration of prior smoking abstinence and an interaction between treatment group and having an active 12-step sponsor. ST was more effective for those with an active sponsor, whereas both BEX and BNIC were more effective for those without an active sponsor. At 1-year follow-up, independent predictors of point-prevalence smoking abstinence were a lower Fagerström Tolerance Questionnaire score (K. O. Fagerström, 1978) and fewer years of smoking.

Persistence of depressive symptoms in adolescents

To examine factors related to the persistence of depressive symptoms, we used a longitudinal follow-up survey of 1,176 adolescents aged 12 to 18 in the United States who reported notable depressive symptoms at baseline. Adolescents were interviewed by telephone at baseline in 1989 and at follow-up in 1993. The outcome of interest was a self-report measure of depressive symptoms experienced within the past 12 months at follow-up. Overall, 38.5% of adolescents reported persistent depressive symptoms. Marked gender differences were found, with 44.5% of girls reporting notable depressive symptoms at follow-up compared with 28.2% for boys. Moreover, current established smokers or experimenters were significantly more likely to report notable depressive symptoms compared with never smokers (42.2%, 41.4% and 33.6%, respectively). Significant multivariate predictors of notable depressive symptoms at follow-up were female gender, change in sleep problems from 1989 to 1993, change in cigarette smoking status from 1989 to 1993, engaging in physical fights, and lack of participation in sports. Many adolescents report continued depressive symptoms over a period spanning four years. Several predictors of persistent depression were identified that could be important components of interventions targeting depressed adolescents.

A community-wide smoking cessation program: Quit and Win 1998 in Olmsted county

BACKGROUND

Quit and Win is a community-wide stop smoking contest to help cigarette smokers stop smoking and educate the general public concerning smoking hazards.

METHODS

All community residents, 15 years of age or older, were eligible to participate in either the stop smoking contest or the supporter contest. A random telephone survey to local households was conducted before and after the Quit and Win contest to assess the level of knowledge and attitude changes about smoking.

RESULTS

Of the 304 smokers enrolled in the contest, 42% self-reported continuous tobacco abstinence for the 4-week contest period and 11% were abstinent at 1 year postcontest. Significant predictors for tobacco abstinence during the contest were formal education beyond high school, absence of other smokers in the household, having a support person enrolled in the support person contest, and the type of relationship that the support person had with their smoker. Survey results showed that this contest changed some local attitudes and increased general knowledge of smoking hazards.

CONCLUSIONS

Community-wide stop smoking contests can be used to engage smokers and their support in the community and can be successful in reducing tobacco use.

Behavioral treatment for smokers with a history of alcoholism: predictors of successful outcome

This study examined baseline predictors associated with smoking abstinence among 205 smokers (113 men, 92 women) with a past history of alcoholism. Their mean age was 41.8 years, and 93% were Caucasian. Participants were randomly assigned to standard treatment (ST), behavioral counseling plus exercise (BEX), or behavioral counseling plus nicotine gum (BNIC). Factors multivariately associated with point-prevalence smoking abstinence at posttreatment (1 week after target quit date) were a longer duration of prior smoking abstinence and an interaction between treatment group and having an active 12-step sponsor. ST was more effective for those with an active sponsor, whereas both BEX and BNIC were more effective for those without an active sponsor. At 1-year follow-up, independent predictors of point-prevalence smoking abstinence were a lower Fagerström Tolerance Questionnaire score (K. O. Fagerström, 1978) and fewer years of smoking.

Tobacco use outcomes of adolescents treated clinically for nicotine dependence

OBJECTIVE

To evaluate the tobacco use outcomes and baseline characteristics of adolescents treated for nicotine dependence.

DESIGN

Retrospective cohort study.

SETTING

Mayo Clinic Nicotine Dependence Center, Rochester, Minn.

PATIENTS

Ninety-six adolescents (60 boys, 36 girls) receiving clinical services for treatment of nicotine dependence between January 1, 1988, and November 30, 1997. Their mean age was 15.6 years (range, 11-17 years), and 91.7% were white.

INTERVENTION

The Nicotine Dependence Center intervention involves a 45-minute consultation with a nicotine dependence counselor. A treatment plan individualized to the patient's needs is then developed. Telephone follow-up is conducted at 6 and 12 months. As part of this study, a long-term follow-up was conducted by telephone at a mean of 5.3 years (range, 1.6-10.6 years) following the intervention.

MAIN OUTCOME MEASURES

Self-reported 7-day point-prevalence abstinence from tobacco at 6 and 12 months, and 30-day point-prevalence tobacco abstinence at the long-term follow-up.

RESULTS

The tobacco abstinence rates were 17.7% (17/96 patients) at 6 months, 7.3% (7/96 patients) at 12 months, and 11.5% (11/96 patients) at the long-term follow-up. A high proportion of the sample had smoking-related medical morbidity and psychiatric diagnoses documented in the medical record prior to or at the time of the intervention.

CONCLUSIONS

Adolescents utilize the medical community to seek treatment for nicotine dependence. The 6-month tobacco abstinence rate is higher than the estimates of the natural history of smoking cessation in adolescents. Medical and psychiatric diagnoses are common in this population.

Relationship of mood disturbance to cigarette smoking status among 252 patients with a current mood disorder

BACKGROUND

The relationship between cigarette smoking and mood has received increasing attention. This retrospective study evaluated the relationship between mood disturbance and cigarette smoking status among patients with a current mood disorder. The association between level of nicotine dependence and severity of mood disturbance was also evaluated among current smokers.

METHOD

Retrospective data for 252 patients (63.5% male, 85.0% white) admitted for treatment of a mood disorder at the San Diego Veteran Affairs Mental Health Clinical Research Center between November 1988 and June 1997 were studied. All current cigarette smokers at admission (N = 126) were matched with nonsmokers (N = 126) on the primary DSM-IV Axis I mood disorder diagnosis, admission status (inpatient or outpatient), gender, age (+/- 5 years), and ethnicity. The Hamilton Rating Scale for Depression (HAM-D), the Beck Depression Inventory, and the Profile of Mood States (POMS) were administered to patients on admission. Conditional logistic regression analysis for matched sets with a backward elimination was used to identify factors independently predictive of current smoking status.

RESULTS

A greater number of cups of coffee consumed per day (p = .002), a history of alcoholism (p = .004), and higher POMS fatigue subscale scores (p = .007) were predictive of current smoking status. Among current smokers, the HAM-D terminal insomnia item was positively associated with mean number of cigarettes smoked per day (p = .012).

CONCLUSION

Cigarette smoking should be addressed in the treatment of patients with a current mood disorder. Smokers experience greater levels of fatigue than nonsmokers. In addition, higher cigarette consumption levels are associated with mild-to-severe symptoms of terminal insomnia.

The effects of transdermal nicotine therapy for smoking cessation on depressive symptoms in patients with major depression

This study examines the effects of transdermal nicotine patches for smoking cessation on depressive and withdrawal symptoms among 38 non-medicated subjects with Major Depressive Disorder. The study was conducted over a 29-day period, which included a 7 day baseline phase, a 14 day treatment phase, and an 8 day placebo phase. During the treatment phase subjects received either active nicotine patches (N = 18) or placebo patches (N = 20) that were administered in a randomized, double-blind fashion. The target quit date (TQD) was day 8. Significantly, more subjects in the placebo group than in the nicotine group resumed smoking following the TQD (50% vs. 22%). There was little evidence for effects of active nicotine patches on measures of mood (HRSD, BDI, POMS) or withdrawal symptoms among subjects that remained abstinent throughout the study (N = 24). Those who resumed smoking had more severe withdrawal symptoms than those who remained abstinent. One patient in the placebo group (n = 20) became more depressed after 2 weeks of abstinence. None of the patients in the nicotine group (n = 18) became more depressed.