Who will relapse? Symptoms of nicotine dependence predict long-term relapse after smoking cessation

Does smoking cessation improve health-related quality-of-life?

This article examines whether smokers who enrolled in a community-based smoking cessation program and were successful in quitting for a six-month period had better health-related quality-of-life at six months relative to those who relapsed. An observational, longitudinal design was used; the sample included 350 participants 18-65 years of age. Health-related quality-of-life was measured using a broad array of indicators of physical and mental health. Six-month outcomes were compared between successful quitters and relapsers using analysis of covariance. Those who quit for six months had better psychological well-being, cognitivefunctioning, energy/fatigue, sleep adequacy, selfesteem, sense of mastery, and worse role functioning at six months than those who continued to smoke (p values > .05). No differences were observed in physical and social functioning, pain, or current health perceptions. There were no significant differences at enrollment in health-relatedquality-of-life between those who quit subsequently and those who relapsed, thus quality-of-life measures did not predict smoking status. We conclude that smokers who quit can possibly anticipate improvements in a range of mental health outcomes within six months, which could become an additional incentive to quit. Subsequent smoking cessation studies should include health-related quality-of-life measures to determine the generalizability of these findings.

Pathways linking socioeconomic status and postpartum smoking relapse

BACKGROUND

Low socioeconomic status (SES) exacerbates the high rate of smoking relapse in women following childbirth.

PURPOSE

This study examined multiple models of potential mechanisms linking SES and postpartum smoking relapse among women who quit smoking due to pregnancy.

METHODS

Participants were 251 women enrolled in a randomized clinical trial of a new postpartum smoking relapse prevention intervention. Four models of the prepartum mechanisms linking SES and postpartum smoking relapse were evaluated using a latent variable modeling approach.

RESULTS

Each of the hypothesized models were a good fit for the data. As hypothesized, SES indirectly influenced postpartum smoking relapse through increased prepartum negative affect/stress, reduced sense of agency, and increased craving for cigarettes. However, the model that included craving as the sole final pathway between SES and relapse demonstrated superior fit when compared with all other models.

CONCLUSIONS

Findings have implications for future interventions that aim to reduce postpartum relapse.

Using treatment process data to predict maintained smoking abstinence

OBJECTIVES

To identify distinct subgroups of treatment responders and nonresponders to aid in the development of tailored smoking-cessation interventions for long-term maintenance using signal detection analysis (SDA).

METHODS

The secondary analyses (n = 301) are based on data obtained in our randomized clinical trial designed to assess the efficacy of extended cognitive behavior therapy for cigarette smoking cessation. Model 1 included only pretreatment factors, demographic characteristics, and treatment assignment. Model 2 included all Model 1 variables, as well as clinical data measured during treatment.

RESULTS

SDA was successfully able to identify smokers with varying probabilities of maintaining abstinence from end-of-treatment to 52-week follow-up; however, the inclusion of clinical data obtained over the course of treatment in Model 2 yielded very different partitioning parameters.

CONCLUSIONS

The findings from this study may enable researchers to target underlying factors that may interact to promote maintenance of long-term smoking behavior change.

Using decision tree analysis to identify risk factors for relapse to smoking

This research used classification tree analysis and logistic regression models to identify risk factors related to short- and long-term abstinence. Baseline and cessation outcome data from two smoking cessation trials, conducted from 2001 to 2002 in two Midwestern urban areas, were analyzed. There were 928 participants (53.1% women, 81.8% White) with complete data. Both analyses suggest that relapse risk is produced by interactions of risk factors and that early and late cessation outcomes reflect different vulnerability factors. The results illustrate the dynamic nature of relapse risk and suggest the importance of efficient modeling of interactions in relapse prediction.

Exploring refinements in targeted behavioral medicine intervention to advance public health

BACKGROUND

Similar to other fields, a targeted behavioral medicine perspective can aid decision-making related to participant-intervention matching.

PURPOSE

To present one potentially useful definition of intervention targeting activity; describe potential targeting domains of particular relevance to behavioral medicine; discuss different statistical approaches to aid the targeted intervention development process; and discuss the challenges and opportunities accompanying the incorporation of targeted intervention development methods into behavioral randomized clinical trial (RCT) research.

METHODS

Drawing from recent conceptual work by the MacArthur group and other scientists in the field, methods and approaches to undertaking moderator analysis are discussed.

RESULTS

Examples of moderator analyses are provided which reflect the different statistical methods and variable domains that may serve as moderators of intervention success.

CONCLUSIONS

The recommended exploratory work can help to make the most efficient use of RCTs to identify the best paths for subsequent RCT development in a resource-constrained era.

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.

Role of nicotine dependence in smoking relapse: results from a prospective study using population-based recruitment methodology

Results of a prospective examination of factors influencing smoking relapse are reported for a sample of smokers (N = 522) obtained through population-based recruitment. All subjects were given a modified Fagerstrom Tolerance Questionnaire (modified FTQ), which is a 5-item self-report instrument characterizing smokers according to their degree of nicotine dependence. At 30 days post-cessation, those placing in the lowest quartile of the modified FTQ at baseline had the highest survival rate (79%) and those placing in the highest quartile at baseline had the lowest survival (non-relapse) rate (43%). The difference in survival among the groups was statistically significant (p < .001). At 12 months, those placing in the lowest quartile of baseline cigarette consumption had the highest survival rate (34%) and those placing in the highest quartile had the lowest survival rate (14%; p < .001). It seems increasingly clear that level of dependence, even as indexed by comparatively crude self-report measures such as amount smoked is associated with the rate and pattern of smoking relapse.

Does over-the-counter nicotine replacement therapy improve smokers' life expectancy?

OBJECTIVE

To determine the public health benefits of making nicotine replacement therapy available without prescription, in terms of number of quitters and life expectancy.

DESIGN

A decision-analytic model was developed to compare the policy of over-the-counter (OTC) availability of nicotine replacement therapy with that of prescription ([symbol: see text]) availability for the adult smoking population in the United States.

MAIN OUTCOME MEASURES

Long-term (six-month) quit rates, life expectancy, and smoking attributable mortality (SAM) rates.

RESULTS

OTC availability of nicotine replacement therapy would result in 91,151 additional successful quitters over a six-month period, and a cumulative total of approximately 1.7 million additional quitters over 25 years. All-cause SAM would decrease by 348 deaths per year and 2940 deaths per year at six months and five years, respectively. Relative to [symbol: see text] nicotine replacement therapy availability, OTC availability would result in an average gain in life expectancy across the entire adult smoking population of 0.196 years per smoker. In sensitivity analyses, the benefits of OTC availability were evident across a wide range of changes in baseline parameters.

CONCLUSIONS

Compared with [symbol: see text] availability of nicotine replacement therapy, OTC availability would result in more successful quitters, fewer smoking-attributable deaths, and increased life expectancy for current smokers.

A nurse-managed smoking cessation program for hospitalized smokers

OBJECTIVES

This study evaluated a nurse-managed smoking cessation program for smokers hospitalized for a variety of conditions.

METHODS

Hospitalized patients who smoked prior to hospitalization and who were motivated to quit (n = 660) were randomized to intervention or usual-care groups and followed for the next year. The intervention included a meeting with the nurse-case manager; the use of a videotape, workbook, relaxation audiotape, and nicotine replacement therapy; and nurse-initiated phone contacts after discharge.

RESULTS

The 12-month confirmed cessation rates were 21% and 31% for, respectively, the usual-care and intervention groups (odds ratio = 1.7; 95% confidence interval = 1.1, 2.3).

CONCLUSIONS

A nurse-managed smoking cessation intervention can significantly increase cessation rates for hospitalized patients.