Gender differences in the outcome of an unaided smoking cessation attempt

Tobacco Dependence Curricula in US Osteopathic Medical Schools: A Follow-up Study

Context: Tobacco use is the leading preventable cause of illness and death in the United States. A 1998 survey of US osteopathic medical schools identified deficiencies in tobacco dependence curricula.

Objective: To assess the current content and extent of tobacco dependence education and intervention skills in US osteopathic medical school curricula.

Design: An electronic survey.

Setting: Osteopathic medical schools with students enrolled for the 2009-2010 academic year.

Participants: Twenty-seven osteopathic medical school deans or their designated administrators.

Main Outcome Measures: Reported instruction in 7 basic science and 6 clinical science content areas (elective or required) and hours of tobacco dependence education were assessed and compared with the 1998 data.

Results: The mean (standard deviation) number of content areas reported as covered in 2010 was 10.6 (2.3) (6.1 [1.2] basic science areas, 4.6 [1.3] clinical science areas). Seventeen of 27 respondents (63%) reported that smokeless tobacco content was covered at their school, and 9 of 27 (33%) reported that the stages of change counseling technique was covered. Compared with 1998, a significant increase was noted in the percentage of schools covering tobacco dependence (92.6% in 2010 compared with 57.9% in 1998, P=.0002). Reported hours of tobacco dependence instruction were also significantly higher in 2010 compared with those in 1998 (Fisher exact test, P<.05). No statistically significant changes were found in the proportion of schools covering all 13 content areas (15.7% vs 22.2%), the proportion covering motivational interviewing in detail (26.3% vs 33.3%), or the proportion requiring curricula on smokeless tobacco (57.9% vs 59.3%).

Conclusion: Osteopathic medical school respondents reported more instruction on tobacco dependence in 2010 compared with those in 1998. However, some important basic science and clinical science content areas are not being adequately taught in US osteopathic medical schools.

Mesolimbic dopamine and habenulo-interpeduncular pathways in nicotine withdrawal

The majority of people who attempt to quit smoking without some assistance relapse within the first couple of weeks, indicating the increased vulnerability during the early withdrawal period. The habenula, which projects via the fasciculus retroflexus to the interpeduncular nucleus, plays an important role in the withdrawal syndrome. Particularly the α2, α5, and β4 subunits of the nicotinic acetylcholine receptor have critical roles in mediating the somatic manifestations of withdrawal. Furthermore, withdrawal from nicotine induces a hypodopaminergic state, but there is a relative increase in the sensitivity to phasic dopamine release that is caused by nicotine. Therefore, acute nicotine re-exposure causes a phasic DA response that more potently reinforces relapse to smoking during the withdrawal period.

Pilot randomized controlled trial of web-based acceptance and commitment therapy for smoking cessation

OBJECTIVE

Web-based smoking cessation interventions have high reach, but low effectiveness. To address this problem, we conducted a pilot randomized controlled trial of the first web-based acceptance and commitment therapy (ACT) intervention for smoking cessation. The aims were to determine design feasibility, user receptivity, effect on 30-day point prevalence quit rate at 3 months post-randomization, and mediation by ACT theory-based processes of acceptance.

METHODS

Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (N = 222), which compared web-based ACT for smoking cessation (WebQuit.org) with the National Cancer Institute's Smokefree.gov-the U.S. national standard for web-based smoking cessation interventions.

RESULTS

We recruited 222 participants in 10 weeks. Participants spent significantly longer on the ACT WebQuit.org site per login (18.98 vs. 10.72 min; p = .001) and were more satisfied with the site (74% vs. 42%; p =.002). Using available follow-up data, more than double the fraction of participants in the ACT WebQuit.org arm had quit smoking at the 3-month follow-up (23% vs. 10%; OR = 3.05; 95% CI = 1.01-9.32; p = .050). Eighty percent of this effect was mediated by ACT theory-based increases in total acceptance of physical, cognitive, and emotional cues to smoke (p < .001).

CONCLUSIONS

The trial design was feasible. Compared with Smokefree.gov, ACT had higher user receptivity and short-term cessation, and strong evidence of theory-based mechanisms of change. While results were promising, they were limited by the pilot design (e.g., limited follow-up), and thus a full-scale efficacy trial is now being conducted.

Predictors of success for smoking cessation at the workplace: a longitudinal study

BACKGROUND

The effectiveness of worksite interventions to reduce smoking is debatable.

OBJECTIVES

A comprehensive smoking cessation intervention was implemented in a community of more than 17,000 employees at three different health care companies. The primary endpoint was abstinence at 24 months (self-reported and confirmed by exhaled carbon monoxide ≤ 6 parts per million). Predictors of long-term abstinence were analysed by multivariable regression analysis.

METHODS

The study was designed as an investigator-initiated and investigator-driven, open, multicentre, cohort study; 887 smokers were enrolled in the programme. The intervention included intensive individual counselling as well as nicotine replacement and/or bupropion according to individual preferences. Re-interventions for relapse were offered during the 24-month follow-up.

RESULTS

The abstinence rate was 37% at 24 months and did not differ among the various medication groups (p > 0.05 for all). Predictors of successful cessation were higher age (odds ratio, OR 1.47, 95% confidence interval, CI 1.08-2.00, p < 0.01), breathlessness on exertion (OR 2.26, 95% CI 1.1-4.9, p = 0.03), and a higher educational level (OR 1.81, 95% CI 1.06-3.09, p = 0.03). Higher Fagerström (OR 0.76, 95% CI 0.59-0.97, p < 0.01) and craving scores (OR 0.75, 95% CI 0.63-0.89, p < 0.01), chronic sputum production (OR 0.52, 95% CI 0.31-0.87, p = 0.01) and use of antidepressants (OR 0.54, 95% CI 0.32-0.91, p = 0.02) were associated with ongoing smoking.

CONCLUSION

A comprehensive smoking cessation intervention at the workplace achieves high, stable, long-term abstinence rates. Elderly, well-educated employees with breathlessness on exertion have higher odds of quitting smoking. In contrast, those with high physical dependency and more intense craving, and those reporting use of antidepressant medication or sputum production have poorer chances to quit.

Proximity to a tobacco store and smoking cessation: a cohort study

BACKGROUND

It is not clear whether the availability of tobacco affects the likelihood of smoking cessation. We examined whether the proximity to a tobacco store and the number of stores were associated with smoking cessation, and compared results for proximity variables based on walking and straight-line (as the crow flies) distance.

METHODS

The study population consisted of 8751 baseline smokers from the Finnish Public Sector study in 1997-2005. Smoking intensity (cigarettes/day) was determined at baseline and smoking cessation was determined from a follow-up survey in 2008-2009. Proximity was measured using straight-line and walking distance from home to the nearest tobacco store, and another exposure variable was the number of stores within 0.50 km from home. We calculated associations with log-binomial regression models, adjusting for individual-level and area-level confounders.

RESULTS

Of the participants, 3482 (39.8%) quit smoking during the follow-up (mean follow-up 5.5 years, SD 2.3 years). Among men who were moderate/heavy smokers at baseline and lived <0.50 km walking distance from the nearest tobacco store, the likelihood of smoking cessation was 27% (95% CI 12% to 40%) lower compared with those living ≥0.50 km from a store. Having even one store within 0.50 km walking distance from home decreased cessation in men who were moderate/heavy smokers by 37% (95% CI 19% to 51%). No decrease was found for men who were light smokers at baseline or for women.

CONCLUSIONS

Living within walking distance of a tobacco store reduced the likelihood of smoking cessation among men who were moderate/heavy smokers.

Randomized trial of the effectiveness of combined behavioral/pharmacological smoking cessation treatment in Syrian primary care clinics

AIMS

Effectiveness of nicotine replacement therapy (NRT) for smoking cessation has not been evaluated in low income countries, such as Syria, where it is expensive and not widely available. We evaluated whether nicotine patch boosts smoking cessation rates when used in conjunction with behavioral support in primary care clinics in Aleppo, Syria.

DESIGN

Two arm, parallel group, randomized, placebo controlled, double-blinded multi-site trial.

SETTING

Four primary care clinics in Aleppo, Syria.

PARTICIPANTS

 Two hundred and sixty-nine adult primary care patients received behavioral cessation counseling from a trained primary care physician and were randomized to receive six weeks of treatment with nicotine versus placebo patch.

MEASUREMENTS

Primary end-points were prolonged abstinence (no smoking after a 2-week grace period) at end of treatment, and 6 and 12 months post-quit day, assessed by self-report and exhaled carbon monoxide levels of <10 p.p.m.

FINDINGS

Treatment adherence was excellent and nicotine patch produced expected reductions in urges to smoke and withdrawal symptoms, but no treatment effect was observed. The proportion of patients in the nicotine and placebo groups with prolonged abstinence was 21.6% and 20.0%, respectively, at end of treatment, 13.4% and 14.1% at 6 months, and 12.7% and 11.9% at 12 months.

CONCLUSIONS

 Nicotine patches may not be effective in helping smokers in low-income countries to stop when given as an adjunct to behavioural support.

Effects of Disasters on Smoking and Relapse: An Exploratory Study of Hurricane Katrina Victims

BACKGROUND

Psychosocial stress maintains cigarette use and precipitates relapse, but little is known about how natural disasters in particular affect smoking.

PURPOSE

To determine the feasibility of recruiting victims soon after a natural disaster for a survey study, and to assess the types and determinants of changes in smoking behavior resulting from exposure to the disaster.

METHODS

A convenience sample of 35 Hurricane Katrina refugees who had smoked more than 100 cigarettes in their lifetime were surveyed one month after the storm to evaluate changes in smoking behavior.

RESULTS

Among a small sample of former smokers, more than half relapsed after Katrina, citing stress, urge, and sadness. Among current smokers, 52% increased their smoking after Katrina by more than half a pack per day on average. Most individuals who increased their smoking or relapsed expressed interest in receiving cessation assistance within the next month.

DISCUSSION

Stress-related increases in smoking and relapse may be common after a natural disaster.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Health education professionals have an important role to play in responding to changes in tobacco use in the aftermath of disasters. Educational interventions to discourage tobacco use as a coping strategy may be especially warranted given the high level of interest expressed in smoking cessation.

Altered hypothalamic response to food in smokers

BACKGROUND

Smoking cessation is often followed by weight gain. Eating behaviors and weight change have been linked to the brain response to food, but it is unknown whether smoking influences this response.

OBJECTIVE

We determined the influence of smoking status (smokers compared with nonsmokers) on the brain response to food in regions associated with weight changes in nonsmokers.

DESIGN

In study 1, we used functional MRI (fMRI) to identify regions of the brain associated with weight change in nonsmokers. BMI and the brain response to a milk shake, which is a palatable and energy-dense food, were measured in a group of 27 nonsmokers (5 men). Sixteen subjects (3 men) returned 1 y later for BMI reassessment. The change in BMI was regressed against the brain response to isolate regions associated with weight change. In study 2, to determine whether smokers showed altered responses in regions associated with weight change, we assessed the brain response to a milk shake in 11 smokers. The brain response to a milk shake compared with a tasteless control solution was assessed in 11 smokers (5 men) in comparison with a group of age-, sex- and body weight-matched nonsmokers selected from the pool of nonsmokers who participated in study 1.

RESULTS

The response in the midbrain, hypothalamus, thalamus, and ventral striatum was positively associated with weight change at the 1-y follow-up in 16 nonsmokers. Compared with nonsmokers, smokers had a greater response to milk shakes in the hypothalamus.

CONCLUSION

Smokers display an altered brain response to food in the hypothalamus, which is an area associated with long-term weight change in nonsmokers.

Sex differences in nicotine dependence among addictions clients accessing a smoking cessation programme in Vancouver, British Columbia, Canada

Most individuals in drug treatment programmes use tobacco and are dependent on nicotine. For 323 participants (65% men, mean age = 49.3 years) with a history of substance use disorder (SUD) and/or psychiatric disorders (PD) enrolled in a tobacco dependence clinic programme, we compared baseline characteristics among women and men and examined factors associated with nicotine dependence (ND). Individuals with mood, anxiety and psychotic disorders were more likely to be female, whereas men were more likely to be characterized by alcohol, cocaine and marijuana use, older age, older age at smoking initiation and higher confidence in quitting smoking scores. In stratified multivariate analyses, among women, history of an anxiety disorder and a greater number of cigarettes smoked per day were associated with higher ND scores; among men, a greater number of cigarettes smoked per day and higher confidence in quitting scores were associated with higher ND scores. Given the differences in smoking, SUD and PD histories between women and men accessing addiction treatment, and differential associations with ND, it is important to further explore factors that may enhance tailored treatments and inform future studies examining biological and psychosocial factors for tobacco use in SUD and PD treatment populations.

Gender differences in craving and cue reactivity to smoking and negative affect/stress cues

There is evidence that women may be less successful when attempting to quit smoking than men. One potential contributory cause of this gender difference is differential craving and stress reactivity to smoking- and negative affect/stress-related cues. The present human laboratory study investigated the effects of gender on reactivity to smoking and negative affect/stress cues by exposing nicotine dependent women (n = 37) and men (n = 53) smokers to two active cue types, each with an associated control cue: (1) in vivo smoking cues and in vivo neutral control cues, and (2) imagery-based negative affect/stress script and a neutral/relaxing control script. Both before and after each cue/script, participants provided subjective reports of smoking-related craving and affective reactions. Heart rate (HR) and skin conductance (SC) responses were also measured. Results indicated that participants reported greater craving and SC in response to smoking versus neutral cues and greater subjective stress in response to the negative affect/stress versus neutral/relaxing script. With respect to gender differences, women evidenced greater craving, stress and arousal ratings and lower valence ratings (greater negative emotion) in response to the negative affect/stressful script. While there were no gender differences in responses to smoking cues, women trended towards higher arousal ratings. Implications of the findings for treatment and tobacco-related morbidity and mortality are discussed.

The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults

Background

Research suggests that ACEs have a long-term impact on the behavioral, emotional, and cognitive development of children. These disruptions can lead to adoption of unhealthy coping behaviors throughout the lifespan. The present study sought to examine psychological distress as a potential mediator of sex-specific associations between adverse childhood experiences (ACEs) and adult smoking.

Method

Data from 7,210 Kaiser-Permanente members in San Diego California collected between April and October 1997 were used.

Results

Among women, psychological distress mediated a significant portion of the association between ACEs and smoking (21% for emotional abuse, 16% for physical abuse, 15% for physical neglect, 10% for parental separation or divorce). Among men, the associations between ACEs and smoking were not significant.

Conclusions

These findings suggest that for women, current smoking cessation strategies may benefit from understanding the potential role of childhood trauma.

Gender Differences in Smoking Behaviour and Cessation

This article reviews the literature to compare differential outcomes among men and women after smoking cessation, assess barriers they may face during cessation and provide recommendation to address gender-specific challenges in smoking cessation interventions. There is some evidence that women achieve lower abstinence rates than men after a quit attempt with nicotine replacement therapy, as well as without pharmacotherapy, and several underlying mechanisms were discussed to account for these findings. These include: (a) women have specific genetic variants that affect pharmacokinetics and pharmacodynamics of the medication, (b) hormonal influences increase nicotine metabolism and withdrawal symptoms, (c) women are more responsive to nonpharmacological aspects of smoking than men, (d) women are more vulnerable to depression and negative mood than men, (e) weight concerns are greater barriers for women than for men and (g) women receive less effective social support than men during a quit attempt. Gender-specific counselling that accounts for these factors and addresses the different needs of men and women may be a promising approach to improve long-term abstinence rates. However, more research is required to identify gender-related underlying mechanisms of differential smoking cessation outcomes, develop tailored interventions that account for gender differences and study the implementation and outcomes of gender-responsive treatment approaches.

Predictors of risk for smoking relapse in men and women: a prospective examination

The current study examined whether prequit trait negative mood and smoking motives have different predictive patterns of smoking relapse in men and women. Thirty-three female (mean age±SEM: 34.9±2.5) and 38 male (mean age±SEM: 37.1±2.3) smokers interested in smoking cessation completed forms on smoking history, negative mood (i.e., depression, anxiety, and anger), stress, and smoking motives. Participants also provided samples for measurement of cotinine and carbon monoxide. Then, they set a quit date and were required to abstain from smoking at least for 24 hours. Participants were followed up for 12 months postcessation to measure their smoking status. Cox proportional hazard models revealed that motivation to reduce craving was a unique predictor of smoking relapse in men, while depressive mood, anxiety, anger, and perceived stress were predictive of time to relapse among women. These findings remained significant after statistically controlling for smoking-related variables, providing preliminary evidence that different factors may be associated with nicotine withdrawal and smoking relapse in men and women.

Peering through the smoke: the effect of parental smoking behavior and addiction on daily smokers' attentional bias to smoking cues

Although previous research has demonstrated that individuals with parents who smoke are more likely to become smokers and are less successful in smoking cessation efforts compared with those without a smoking parent, the reasons for this link have not been established. In the current study, implicit attentional bias to smoking-related cues was investigated in college-age smokers, based on models of addiction that suggest that attention to drug-related cues plays an important role in drug addiction. Sixty-one participants completed a dot-probe task to measure attentional bias to smoking-related and matched non-smoking-related control pictures. Results indicated that while those who reported smoking occasionally did not demonstrate an attentional bias, daily smokers who had a smoking parent showed more of an attentional bias to the smoking cues than those without a smoking parent, but only to cues that did not contain human content. In addition to parental influence, nicotine dependence explained a significant portion of the variance in the attentional bias for daily smokers. Implications for models of nicotine addiction and the development of smoking cessation programs are discussed.

Withdrawal from chronic nicotine exposure alters dopamine signaling dynamics in the nucleus accumbens

BACKGROUND

Unaided attempts to quit smoking commonly fail during the first 2 weeks of the nicotine withdrawal syndrome. Alterations in dopamine (DA) signaling correlate with withdrawal from chronic nicotine exposure, but those changes have not been well-characterized.

METHODS

Mice were administered nicotine in their drinking water for 4 or 12 weeks. Then nicotine was withheld for 1 to 10 days while DA signaling was characterized with in vivo microdialysis or fast-scan cyclic voltammetry.

RESULTS

Upon withdrawal of nicotine, the basal DA concentration in the nucleus accumbens decreased as measured by microdialysis. The length of time that the low basal DA state lasted depended on the length of the chronic nicotine treatment. Microdialysis indicated that acute re-exposure to nicotine during withdrawal temporarily reversed this hypodopaminergic state. Voltammetry measurements supported the microdialysis results by showing that nicotine withdrawal decreased tonic and phasic DA release. The basal DA concentration and tonic DA signals, however, were disproportionately lower than the phasic DA signals. Therefore, the phasic/tonic DA signaling ratio was increased during the withdrawal period.

CONCLUSIONS

The relative increase in the sensitivity of DA release to phasic stimulation suggests an increase in the signal-to-noise relationship of DA signaling during the withdrawal period. Therefore, the DA signal produced by acute nicotine re-exposure produces a DA response that might reinforce relapse to drug use (i.e., smoking). Because the basal DA concentration is low during withdrawal, therapies aimed at elevating the background DA signal represent a reasonable treatment strategy for nicotine-dependent individuals attempting to quit.

Neurophysiology of Nicotine Addiction

Tobacco use is a major health problem, and nicotine is the main addictive component. Nicotine binds to nicotinic acetylcholine receptors (nAChR) to produce its initial effects. The nAChRs subtypes are composed of five subunits that can form in numerous combinations with varied functional and pharmacological characteristics. Diverse psychopharmacological effects contribute to the overall process of nicotine addiction, but two general neural systems are emerging as critical for the initiation and maintenance of tobacco use. Mesocorticolimbic circuitry that includes the dopaminergic pathway originating in the ventral tegmental area and projecting to the nucleus accumbens is recognized as vital for reinforcing behaviors during the initiation of nicotine addiction. In this neural system β2, α4, and α6 are the most important nAChR subunits underlying the rewarding aspects of nicotine and nicotine self-administration. On the other hand, the epithalamic habenular complex and the interpeduncular nucleus, which are connected via the fasciculus retroflexus, are critical contributors regulating nicotine dosing and withdrawal symptoms. In this case, the α5 and β4 nAChR subunits have critical roles in combination with other subunits. In both of these neural systems, particular nAChR subtypes have roles that contribute to the overall nicotine addiction process.

Nicotine dependence and psychological distress: outcomes and clinical implications in smoking cessation

Nicotine dependence is characteristically a chronic and relapsing disease. Although 75%-85% of smokers would like to quit, and one-third make at least three serious lifetime attempts, less than 50% of smokers succeed in stopping before the age of 60. Relevant and complex factors contributing to sustained cigarette consumption, and strongly implicated in the clinical management of smokers, are the level of nicotine dependence and psychological distress. In this review of the literature, these two factors will be examined in detail to show how they may affect smoking cessation outcome and to encourage clinicians to assess patients so they can offer tailored support in quitting smoking.

Menstrual cycle phase at quit date and smoking abstinence at 6 weeks in an open label trial of bupropion

BACKGROUND

Quit attempts may have different outcomes based on menstrual cycle phase on quit day. This is the first preliminary study examining whether smoking cessation outcomes vary by menstrual cycle phase of quit date in women receiving a 6-week open trial of sustained release (SR) bupropion.

METHODS

Thirty-three treatment-seeking premenopausal women were studied. Abstinence outcomes were compared for women quitting during the luteal versus follicular phase.

RESULTS

Women receiving bupropion SR whose self-selected quit date occurred in the luteal phase had significantly higher rates of point prevalence abstinence during the final week of a 6-week post-quit treatment period than women quitting in the follicular phase (62.5% versus 29.4%; p<0.05). A similar, but non-significant, pattern of findings was demonstrated for continuous abstinence during the treatment phase and for point prevalence abstinence at 3-month follow-up.

CONCLUSIONS

Women receiving bupropion SR were significantly more likely to be abstinent at treatment completion if quitting occurred during the luteal phase. This is consistent with recent findings of outcome related to cycle phase at quit date in the absence of pharmacotherapy, and differs from findings utilizing nicotine replacement. Results add to emerging data suggesting that smoking cessation interventions with varying mechanisms of action may result in different outcomes for premenopausal women based on gonadal hormones at quit date.

Tobacco use and cessation among women: research and treatment-related issues

The prevalence of tobacco use in women has increased over the past century. This has resulted in dramatic increases in smoking-related lung diseases, such as chronic obstructive pulmonary disease (COPD) and lung cancer. There is growing literature suggesting that women may be more susceptible than men to the effects of tobacco and to the development of COPD. Women may also have specific barriers that interfere with smoking cessation. This article addresses possible differences in lung function decline and nicotine metabolism in women compared to men. Differences in COPD between the sexes are discussed. Finally, barriers to smoking cessation in women are presented.

Tobacco treatment practices of pharmacists in Montana

OBJECTIVES

To assess the tobacco treatment practices of Montana pharmacists, evaluate pharmacist interest in addressing tobacco use, and identify perceived barriers to delivery of tobacco cessation services.

DESIGN

Descriptive, nonexperimental, cross-sectional study.

SETTING

Montana in February 2007.

PARTICIPANTS

192 pharmacists attending an annual continuing professional education program.

INTERVENTION

Attendees at 11 meeting sites throughout the state completed the survey.

MAIN OUTCOME MEASURES

Pharmacists' use of the U.S. Clinical Practice Guideline 5 A's (ask, advise, assess, assist, and arrange) in regard to tobacco cessation services.

RESULTS

Of program attendees, 76% (192 of 253) completed the 35-item survey. More than one-half (58%) of respondents were men, and 90% were white. Respondents were licensed for a median of 22.5 years and dispensed a median of 1,000 prescriptions per week. The percent of pharmacists who treated one or more patients using the 5 A's in the preceding 30 days were as follows: asked about tobacco use, 39%; advised to quit smoking, 54%; assessed for readiness to quit smoking, 36%; assisted with quitting (i.e., cessation counseling), 46%; assisted with advice to use nonprescription cessation medication, 62%; assisted with advice to use prescription cessation medication, 54%; arranged for a follow-up appointment for additional counseling, 6%; and referred to a tobacco quit line, 23%. Most respondents (58%) reported that providing cessation services within routine practice was moderately or highly feasible. The most frequently cited barriers to providing cessation services included lack of time (52%), reimbursement (26%), and training (19%).

CONCLUSION

Few Montana pharmacists are routinely asking patients about tobacco use in a typical month. However, the majority of pharmacists reported that it would be feasible to provide more tobacco cessation activities within routine pharmacy practice. Addressing barriers related to workload, reimbursement, and training would likely increase the number of pharmacists who provide tobacco cessation services.

Intolerance for Smoking Abstinence Questionnaire: psychometric properties and relationship to tobacco dependence and abstinence

While smokers' ability to tolerate emotional or physical distress has been associated with length of smoking cessation, there is no measure of ability to tolerate smoking abstinence discomfort specifically, which may be more heuristic than a measure of tolerance of general emotional stress or physical discomfort.

METHODS

Questionnaires completed by 300 smokers assessed inability to tolerate smoking abstinence discomfort (IDQ-S), general physical discomfort (IDQ-P), and general emotional discomfort (IDQ-E), so that shared variance among these measures could be assessed.

RESULTS

The IDQ-S has three reliable components: withdrawal Intolerance, Lack of Cognitive Coping, and Pain Intolerance. The 14-item IDQ-P and 9-item IDQ-E each consist of one reliable component. Intercorrelations suggest only modest shared variance. Support for construct and discriminant validity was seen. Two scales of the IDQ-S showed excellent convergent validity, correlating with smoking use, dependence, motivation, and length of past smoking cessation, while IDQ-P and IDQ-E correlated with few indices of use or dependence and not with smoking cessation.

CONCLUSIONS

The final 17-item IDQ-S with two scales is reliable and valid, and more heuristic than measures of general physical or emotional discomfort intolerance as a correlate of motivation and past success with smoking cessation.

Personalized smoking cessation: interactions between nicotine dose, dependence and quit-success genotype score

Improving and targeting nicotine replacement therapy (NRT) are cost-effective strategies for reducing adverse health consequences for smokers. Treatment studies document the efficacy of precessation NRT and support important roles for level of nicotine dependence and precessation smoking reduction in successful quitting. However, prior work has not identified the optimal precessation dose or means for personalizing NRT. Genome-wide association has identified groups of genomic markers associated with successful quitting, allowing us to develop a v1.0 "quit-success" genotype score. We now report influences of v1.0 quit-success genotype score, level of dependence and precessation smoking reduction in a smoking cessation trial that examined effects of 21 versus 42 mg/24 h precessation NRT. Four hundred seventy-nine smokers were randomized to 21 or 42 mg NRT, initiated 2 wks prior to target quit dates. We monitored self-reported abstinence and end-expired air carbon monoxide (CO). Genotyping used Affymetrix arrays (Santa Clara, CA, USA). The primary outcome was 10-wk continuous smoking abstinence. NRT dose, level of nicotine dependence and genotype scores displayed significant interactive effects on successful quitting. Successful abstinence also was predicted by CO reductions during precessation NRT. These results document ways in which smoking cessation strategies can be personalized based on levels of nicotine dependence, genotype scores and CO monitoring. These assessments, taken together, can help match most smokers with optimal NRT doses and help rapidly identify some who may be better treated using other methods.

Predictors of post-treatment relapse to smoking in successful quitters: pooled data from two phase III varenicline trials

BACKGROUND

Identifying predictors of smoking relapse helps to elucidate the challenges of long-term smoking cessation and provides direction for improved treatment development.

METHODS

In this post hoc data analysis, we examined predictors of relapse from end-of-treatment (week 13) through 1-year follow-up (week 52) for treatment-responding participants who achieved the primary efficacy endpoint of 4-week continuous abstinence (weeks 9-12), during two phase III varenicline trials.

RESULTS

Of 626 smokers classified as treatment responders for all treatment groups across both trials, 301 (48%) relapsed during follow-up (weeks 13-52). The odds of relapsing were almost 5 times greater (odds ratio [OR]=4.92, 95% confidence interval [CI]: 2.77-8.97; p<.001) for treatment responders who did not initiate continuous abstinence until the final 4 weeks of the treatment period compared with those who initiated continuous abstinence by their quit date. Participants who reported >30 days of abstinence during the year prior to study entry were significantly more likely to relapse than those who reported 0 days of abstinence (OR=2.38, 95% CI: 1.17-5.04; p=.013).

CONCLUSION

Results of these analyses suggest that the ability to quit smoking on the initial quit date and maintain abstinence throughout the treatment period is a good prognostic indicator for long-term abstinence. The relationship between post-treatment relapse and longer pretreatment periods of abstinence is counterintuitive, yet not without precedence in the literature.

Acculturation differentially predicts smoking cessation among Latino men and women

OBJECTIVES

The current study examined the influence of gender, acculturation indicators, and their interaction on smoking cessation among Latinos.

METHODS

Logistic regression analysis was used to examine the main effects of gender, acculturation indicators, and their interactions on self-reported 7-day abstinence at 12-week follow-up among 271 Latino smokers seeking cessation counseling.

RESULTS

Analyses revealed significant main effects for several acculturation indicators and significant interactions of gender with number of years lived in the United States, proportion of life lived in the United States, and preferred media language (all P values <0.05). Follow-up analyses indicated no significant relationships between abstinence and acculturation indicators among women. Among men, abstinence rates increased with years in the United States, proportion of life in the United States, and preferred media language of English.

CONCLUSIONS

Greater acculturation predicted higher abstinence rates, but this relationship was restricted to men. This study is among the first to examine the effects of gender and acculturation on smoking abstinence among Latinos. Findings highlight the need for research focused on mechanisms underlying these relationships.

Patterns of self-selected smoking cessation attempts and relapse by menstrual phase

Clinical studies are emerging which suggest that sex hormones may play a role in quit attempts and relapse. The present study aim is to determine if menstrual phase plays a role on a second self-selected quit attempt and subsequent relapse during a twenty-six week follow-up. Participants (n=138) were 29.7+/-6.5 years old and smoked 16.1+/-4.8 cigarettes per day. Participants were more likely to self-select a second quit date during the Follicular (F) phase (59.4%) than Luteal (L) phase (40.6%, p=0.033) and were also more likely to relapse during the F phase than the L phase (59.7% vs. 40.3%, p=0.043, respectively). Those who self-selected to quit in the L phase experienced a significantly longer time to relapse than those who chose the F phase (median of 3 days vs. 2 days, respectively; Hazard Ratio=1.599, p-value=0.014). This confirms previous work suggesting quit dates in the F phase are associated with worse smoking cessation outcomes. Additional research is needed to investigate how this relationship may vary with the use of pharmacotherapy.

Self-change strategies in smokers and former smokers: Spanish adaptation of the SCS-CS and SCS-FS

The purpose of this study was to validate and adapt the Self-Change Strategies in Current Smokers (SCS-CS) and the Self-Change Strategies in Former Smokers (SCS-FS) (Christie & Etter, 2005) to the Spanish population. We also wished to analyze the differences in the self-change strategies used as a function of gender. Participants were 370 subjects (190 smokers and 180 former smokers) who were recruited by means of the "snowball" method. The alpha coefficients for the SCS-CS and the SCS-FS were .86 and .87, respectively. Both scales present satisfactory psychometric properties, so they are shown to be useful instruments to use in the Spanish population. The SCS-CS score showed that male smokers used more self-change strategies than females (46.6 vs. 11.9, p < .01), specifically, more cognitive strategies. In the SCS-CS, men scored higher than women (49 vs. 12.08, p < .01), in both the group of cognitive and behavioral strategies. The psychological mechanisms used to control the smoking habit are the same in men as in women, but the men tend to use a larger number of strategies. Treatments to quit smoking do not need to be substantially different, but they should be more intensive in the case of women smokers.

Gender differences among smokers receiving interventions for tobacco dependence in a medical setting

OBJECTIVE

The purpose of this study was to assess differences between women and men receiving treatment for tobacco dependence through a clinical treatment program.

METHODS

We conducted a retrospective review of clinical data collected on 2139 ambulatory and 1259 hospitalized smokers receiving individualized tobacco dependence treatment from Jan 1, 2004 to Dec 31, 2005 through the Mayo Clinic Nicotine Dependence Center.

RESULTS

Overall, female smokers smoked less than males (p<0.001); were less likely to have received treatment for alcoholism (p<0.001); were more likely to have received treatment for past depression (p<0.001); were also less likely to have started smoking prior to 18 years of age (p=0.004 and p=0.008 for ambulatory and hospitalized patients, respectively); were less likely to be married (p<0.001); were less likely to be tobacco dependent (hospitalized smokers only p=0.04); and were more likely to have received a prescription for a smoking cessation medication (ambulatory smokers only, p=0.034). After adjustment for baseline characteristics, women and men did not differ in tobacco abstinence outcomes.

CONCLUSION

Although many gender differences are present among patients treated in a large ambulatory and hospital based tobacco treatment programs, gender is not associated with failure to achieve smoking abstinence.

Gender effects on mood and cigarette craving during early abstinence and resumption of smoking

Women are more likely than men to relapse after initiating abstinence from cigarette smoking. The reasons for this phenomenon are unclear but may relate to negative mood, cigarette craving, or other symptoms of nicotine withdrawal. We addressed this issue in a study of 26 female and 38 male smokers. The Profile of Mood States, Shiffman-Jarvik Withdrawal Scale, and Urge to Smoke Scale were administered twice in each of two test sessions on different days. One session began within 1 hr after smoking ad libitum and the other followed overnight abstinence (>13 hr). On each test day, the two assessment blocks were separated by a 5-10-min break, during which each participant smoked one cigarette. In the first test block, both men and women reported higher scores after >13 hr abstinence than after <1 hr abstinence on the tension-anxiety and anger-hostility subscales of the Profile of Mood States, and for the craving and psychological symptoms of the Shiffman-Jarvik Withdrawal Scale. Scores of female subjects showed significantly larger differences between sessions on the tension-anxiety subscale and a trend toward significance (p = .050) on the anger-hostility subscale of Profile of Mood States than those of males. Moreover, on the tension-anxiety subscale, women also reported a greater reduction than men from smoking one cigarette after overnight abstinence. The findings indicate that overnight abstinence produces more negative mood symptoms and cigarette craving in female smokers than in males, and that resumption of smoking produces greater relief from these symptoms in female smokers. These differences may contribute to the greater likelihood of relapse when women try to quit smoking.

Gender differences among hardcore smokers: an analysis of the tobacco use supplement of the current population survey

BACKGROUND

Despite significant declines in smoking rates in the United States, a substantial percentage of adults continue to smoke. Improved understanding of current smokers and their contact with sources of cessation support future tobacco control efforts. Recent evidence suggests that hardcore smokers, established smokers without a history of quit attempts, have less contact with cessation support. Although gender is among the major factors that influence smoking cessation, no research is available on gender differences among hardcore smokers.

METHODS

Demographic, environmental, and smoking-related characteristics of female hardcore smokers and male hardcore smokers and other female smokers were examined. Data from 17,777 smokers from the 2003 Current Population Survey Tobacco Use Supplement were analyzed.

RESULTS

Compared with female hardcore smokers, male hardcore smokers were more likely to have contact with smoking restrictions at work (OR = 1.69) and at home (OR = 1.45). Compared with female hardcore smokers, female other smokers were more likely to have seen a healthcare provider during the past year who advised them to quit smoking (OR = 1.39) and more likely to have smoking restrictions at work (OR = 1.25) and at home (OR = 2.32)). Measures of nicotine dependence suggested that female hardcore smokers were less dependent than male hardcore smokers but more dependent than other female smokers.

CONCLUSIONS

The sociodemographic and healthcare access variations in tobacco use identified in our analyses have significant public health implications and underscore the vital need for clinical and scientific advances in tobacco use prevention and control efforts.

Menstrual phase effects on smoking cessation: a pilot feasibility study

BACKGROUND AND OBJECTIVES

A growing body of research suggests that nicotine withdrawal and cigarette craving may vary across the menstrual cycle and that the luteal phase of the cycle may be associated with increases in each. This potential relationship suggests that careful timing of quit attempts during the menstrual cycle may improve initial success at abstinence, although there are no direct tests of this approach yet published. Our objectives were to preliminarily test the effect of timing of quit attempts for smoking cessation relative to menstrual cycle and to identify methodological procedures that could guide subsequent, larger clinical trials.

METHODS

In this pilot study, we randomized female smokers aged 18-40 who were not currently using hormonal contraception to quit smoking during either the follicular (n = 25) or luteal phase (n = 19) of their menstrual cycle. Participants were provided with two sessions of smoking cessation counseling (90 minutes total). All participants were provided with a transdermal nicotine patch contingent on maintenance of abstinence throughout the course of the 6-week study.

RESULTS

Among participants who initiated treatment, received the patch, and made a quit attempt (n = 35), carbon monoxide-verified repeated point prevalence abstinence 2 weeks after the target quit date was higher in the follicular than the luteal group (32% vs. 19%, respectively; OR = 2.0, 95% CI = 0.4-9.8). Within the overall study population, this difference was slightly lower (24% vs. 16%; OR = 1.7, 95% CI = 0.4-7.8).

CONCLUSIONS

Timing quit attempts based on menstrual phase is feasible. Insights gained from this study and the recommendations made herein may inform future research on this important clinical question.

Menstrual phase effects on smoking relapse

AIMS

To examine if menstrual phase affects relapse in women attempting to quit smoking.

DESIGN

An intent-to-treat randomized smoking cessation trial where women were assigned to quit smoking in either the follicular (F) or luteal (L) menstrual phase and were followed for up to 26 weeks. They were assessed for relapse by days to relapse and relapse phase to determine if those who begin a quit attempt during the F phase were more successful than those who begin during the L phase.

SETTING

Tobacco Use Research Center, University of Minnesota, Minneapolis, Minnesota.

PARTICIPANTS

A total of 202 women.

MEASUREMENTS

Latency to relapse from continuous and prolonged abstinence, point prevalence, phase of relapse, first slip within the first 3 and 5 days post-quit date, subject completion rates and symptomatology (i.e. withdrawal and craving).

FINDINGS

The mean days to relapse from continuous abstinence and relapse from prolonged abstinence for the F group were 13.9 and 20.6 days, respectively, and 21.5 and 39.2 days, respectively, for the L group. Using point prevalence analysis at 14 days, 84% of the F group had relapsed compared with 65% of the L group [chi(2)=10.024, P=0.002; odds ratio (OR) = 2.871, 95% confidence interval (CI), 1.474-5.590]. At 30 days, 86% of the F group relapsed, compared with 66% of the L group (chi(2)=11.076, P=0.001; OR=3.178, 95% CI, 1.594-6.334).

CONCLUSION

Women attempting to quit smoking in the F phase had less favorable outcomes than those attempting to quit in the L phase. This could relate to ovarian hormones, which may play a role in smoking cessation for women.

Effects of a body image challenge on smoking motivation among college females

OBJECTIVE

Previous correlational and quasi-experimental research has established that weight concerns and negative body image are associated with tobacco smoking, cessation, and relapse, particularly among young women. This study examined the causal influence of body image upon smoking motivation by merging methodologies from the addiction and body image literatures.

DESIGN

Using a cue-reactivity paradigm, the study tested whether an experimental manipulation designed to challenge women's body image-specifically, their weight dissatisfaction-influenced their motivation to smoke. Female college smokers (N= 62) were included in a 2 X 2 factorial, within-subjects design (body image cues X smoking cues).

MAIN OUTCOME MEASURES

Self-reported urge to smoke was the primary dependent measure, with skin conductance as a secondary measure.

RESULTS

As hypothesized, the presentation of smoking images and thin model images produced greater urges to smoke than control images. Additionally, trait weight concerns moderated the effect of the body image manipulation such that those women with greater weight concerns produced greater craving to the thin model image (when smoking cues were not present).

CONCLUSION

These findings provide initial evidence that situational challenges to body image are causally related to smoking motivation.

Explaining the convergence of male and female smoking prevalence in Australia

OBJECTIVE

To examine changes in age of tobacco experimentation and progression to daily smoking in men and women between birth cohorts that differ in exposure to public health programmes that aim to discourage smoking.

DESIGN

Analysis of national cross-sectional household surveys of smoking patterns, conducted in Australia in 2001 and 2004. SETTING AND PARTICIPANTS Australian adults aged 22 years and over in 2001 and 2004 who responded to the National Drug Strategy Household Survey.

MAIN OUTCOME MEASURES

Prevalence of tobacco experimentation and progression to daily smoking by age 21, estimated by sex and birth cohort. Odds of tobacco experimentation and progression to daily smoking by age 21 estimated by sex for each birth cohort, with corrections for the effects of 'forward telescoping' in recalling age of use.

RESULTS

Sex differences in smoking prevalence are smaller in younger birth cohorts. Tobacco experimentation has increased among women, while progression to daily smoking has decreased among men.

CONCLUSIONS

Sex differences in smoking experimentation and progression to daily smoking have decreased in younger birth cohorts. However, a significant proportion of younger males and females continue to experiment with tobacco and become daily smokers despite strong public health efforts to discourage smoking. More research is needed to determine why sex differences in smoking behaviour are not evident in younger birth cohorts.

Smoking cessation: significance and implications for children

A number of people in the USA who are still current smokers remain a staggering figure. Although this number continues to decrease, there is still a considerable amount of second-hand smoke. More importantly and for the purpose of this review, the detrimental effects of passive smoke in children is significant. We will not review the specific health effects of passive smoke, but for pediatricians, in particular, it is important to place in perspective programs that are available to influence the parents of children to stop smoking. Indeed, approximately 25% of all children aged 3-11 live in a household with at least one smoker. Despite the increasing number of communities in the states that have instituted restrictions or complete bans on smoking in the workplace and in many public areas, the principal site of smoking remains the home.

Genetic polymorphisms in dopamine-related genes and smoking cessation in women: a prospective cohort study

Background

Genes involved in dopaminergic neurotransmission have been suggested as candidates for involvement in smoking behavior. We hypothesized that alleles associated with reduced dopaminergic neurotransmission would be more common in continuing smokers than among women who quit smoking.

Methods

The study included 593 women aged 26–65 years who participated in a twelve month smoking cessation trial conducted in 1993–1994. Participants were contacted three years after the trial to obtain updated smoking history and biological specimens. Seven polymorphisms were assessed in genes involved in dopamine synthesis (tyrosine hydoxylase [TH]), receptor activation (dopamine receptors [DRD2, DRD3, DRD4]), reuptake (dopamine transporter [SLC6A3]), and metabolism (catechol-o-methyltransferase [COMT]). Smoking cessation was assessed as "short-term" quitting (abstinence for the seven days before the conclusion of the trial) and "long-term" quitting (abstinence for the six months before a subsequent interview conducted several years later).

Results

We observed no association of any polymorphism with either short- or long-term quitting. Although some relative risk estimates were consistent with weak associations, either the direction of effect was opposite of that hypothesized, or results of the short- and long-term cessation endpoints differed. However, effect modification on smoking cessation was observed between DRD2 Taq1A and SLC6A3 VNTR polymorphisms, DRD3 Ser/Gly and d,1-fenfluramine, and DRD4 VNTR and d,1-fenfluramine.

Conclusion

Although these results fail to support prior findings of independent associations of these polymorphisms with smoking status, our exploratory findings suggestive of gene-gene and gene-treatment interactions warrants further investigation.

[Smoking cessation counseling center in a French hospital: Effectiveness at one year and predictors of outcome]

OBJECTIVE

To assess the effectiveness at 1 year of a hospital clinic providing individual management of persons seeking to stop smoking and the factors predictive of failure.

METHODS

This prospective descriptive study included smokers seeking assistance at this hospital clinic over a 1-year period. This analysis excludes persons with schizophrenia and those who came only to a first consultation. Treatment methods were those recommended by the 1998 consensus conference: nicotine substitutes or slow-release bupropion, depending on the level of nicotine dependence, cognitive-behavioral therapy appropriate for smoking in all cases, and the prescription before cessation of a selective serotonin re-uptake inhibitor (SSRI) for patients with anxiety or depressive disorders. Assessment was based on patients' self-report at 3 months, 6 months and 1 year.

RESULTS

Of 99 smokers who came for at least one consultation, 38 were excluded and 61 were considered in the analysis. At one year, 18 patients (29.5%) were still not smoking. Of the 43 patients who resumed smoking, 27 (63%) did so during the first three months after cessation. According to the multivariate analysis, only female sex (p = 0.0173) and early end to follow-up (p = 0.0023) were significantly associated with the risk of relapse at 1 year.

CONCLUSION

The study confirmed the usefulness of specialized medical support over a one-year period and highlighted the difficulties of smoking cessation for women, who appear to need a new not yet invented approach. The other standard factors predictive of failure were not observed, possibly because of either the broad prescription of SSRIs in cases of anxiety- or depression-related comorbidity or the statistical limitations associated with the population size.

Menstrual cycle phase effects on nicotine withdrawal and cigarette craving: a review

Evidence suggests that women are less likely to quit smoking than are men. This may reflect differences in nicotine dependence and, more specifically perhaps, nicotine withdrawal and craving. However, there is conflicting research on gender differences on the experience of withdrawal and craving. Menstrual cycle effects may moderate this relationship. Given hormonal changes during the menstrual cycle, abstinence-related symptoms such as withdrawal and craving may vary as a function of menstrual phase as well. This qualitative review summarizes the modest but expanding body of research in this area. One of the challenges inherent in interpreting this literature is the difficulty in distinguishing withdrawal symptomatology from premenstrual symptomatology. Methodological variation, including limited sample size and possible selection bias, in which several studies finding null effects excluded women with severe premenstrual dysphoric disorder, may explain some of the inconsistent findings across studies. Nonetheless, some of the 13 studies included in this review found heightened experiences of withdrawal or craving within the latter days of the menstrual cycle (i.e., the luteal phase). Further research is necessary to replicate these findings, but they may suggest the need for focused cessation treatment during the luteal phase or quit attempts that are well timed relative to specific menstrual phases.

Autonomy (vs. sociotropy) and depressive symptoms in quitting smoking: evidence for trait-congruence and the role of gender

According to Beck's cognitive theory of depression, autonomy (high achievement concerns) and sociotropy (high interpersonal concerns) are vulnerability factors for depression when achievement or interpersonal stressors, respectively, are experienced. This hypothesis was tested among men and women attempting to quit smoking, an achievement stressor that can provoke depressive symptoms. Smokers recruited from the community (N=210) provided information about their quit attempt through mailed questionnaires. For the 48-h period following the quit, relationships among autonomy, sociotropy, coping, depressive symptoms and lapsing were assessed. Structural equation models supported the trait-congruence hypothesis because greater autonomy, but not sociotropy, was associated with elevated depressive symptoms among both men and women smokers. However, results were stronger for men (beta=.47, p=.0001) than for women (beta=.20, p=.05). After accounting for autonomy's relationship with depressive symptoms, greater autonomy was inversely associated with lapsing among men (beta=-.35, p=.01), but not women. Results point to the potential usefulness of a theoretical approach to understanding relationships between depressive symptoms and smoking cessation, and indicate that autonomous personality may be an important factor in smoking cessation in men.

Hypothalamic–Pituitary–Adrenocortical responses to psychological stress and risk for smoking relapse

Stress is a commonly reported precipitant of relapse to substance use. There is a growing recognition of the need to understand psychobiological alterations in the stress response among chronic drug users, and to determine how they may precipitate relapse. This paper focuses on the hypothalamic-pituitary-adrenocortical (HPA) response to stress among dependent smokers. Nicotine acutely activates the HPA axis, and increased HPA activity has been linked to attenuated CNS nicotinic receptor sensitivity. We will review a series of studies demonstrating that steep decline in cortisol concentrations during early abstinence and hyporesponsiveness to stress predict shorter time to relapse. Our studies show that hormonal associations with smoking relapse tend to be more consistent in men, while intensity of withdrawal symptoms tend to be consistent predictors of smoking relapse in women. We propose that perturbed HPA activity during early smoking abstinence exacerbate withdrawal symptoms and may contribute to the rapid relapse observed in the majority of smokers. Our results also reinforce the need for gender-specific investigation of mechanistic and interventional strategies to combat nicotine addiction.

An intervention study of smoking cessation with feedback on genetic cancer susceptibility in Japan

BACKGROUND

To evaluate whether feedback of genetic information regarding an L-myc polymorphism, identified as impacting on tobacco-related cancer risk, has an influence on smoking cessation, an intervention study was conducted.

METHODS

We recruited smokers from first-visit outpatients at Aichi Cancer Center Hospital. Six hundred and seventeen participated and were allocated into two groups: the biomarker feedback group (BF) and the follow-up smoking status group (FS). The subjects were asked for their smoking status at enrolment and at 3- and 9-month follow-ups. BF subjects were notified about their L-myc genotype.

RESULTS

The smoking cessation rate at 9-month follow-up was essentially the same for both BF and FS cases, at 18.8% and 17.0%, respectively (P = 0.798). However, a difference in the rate was evident with non-cancer subjects (12.7% and 8.4%, respectively, P = 0.237), especially in females (15.0% and 4.2%, respectively, P = 0.024). The non-cancer subjects informed of their genotype were more likely to quit smoking than the FS patients; particularly in those having a risky genotype, this was significant (odds ratio: 2.87, P = 0.003). Again it was most prominent in females.

CONCLUSION

Feedback regarding an L-myc polymorphism did not impact on smoking cessation overall but appeared to benefit smokers without cancer. In addition, gender could affect the response to the feedback.

Racial and ethnic differences in predictors of smoking cessation

Racial/ethnic differences in the determinants of smoking cessation could have important treatment implications. The current study examined racial/ethnic differences in smoking cessation, prospective predictors of cessation, and whether the predictive ability of these factors differed by race/ethnicity. Participants were 709 employed adults recruited through the National Rural Electric Co-op Association or through natural gas pipeline corporations. Data were collected in 1990 and 1994. Although race/ethnicity was not predictive of abstinence, Hispanic, African American, and White smokers displayed differential on tobacco-, alcohol-, and work-related variables. These racial/ethnic differences highlight the specific factors that should be considered when providing smoking cessation treatment to specific populations. Limitations are noted.