Residual outcome expectations and relapse in ex-smokers

Relative Deprivation Leads to the Endorsement of "Anti-Chicken Soup" in China

"Anti-chicken soup" (ACS) persuades people to yield to reality and give up rather than encouraging people to work hard as "chicken soup" does. The current study explored whether people with a higher level of relative deprivation (RD) would be more likely to endorse ACS. We found that people with high-measured (Study 1) and manipulated (Study 2) RD were more likely to endorse ACS. Study 2 also suggested that the effect was mediated by self-handicapping. It seems that relatively deprived individuals may adopt the strategy of self-handicapping so that they could attribute their failure to external causes, which in turn leads to lower motivation to try their best and ultimately the endorsement of ACS.

Psychometric investigation of the Chinese version of the Habit, Reward and Fear Scale (HRFS)

BACKGROUND

Tobacco use is one of the most important risk factors for health, and China is the largest producer and consumer of tobacco in the world. Monitoring and controlling the tobacco epidemic is an important issue. However, the motivation underlying smoking behavior is complex and specific to the individual. The Habit, Reward and Fear Scale (HRFS) is a feasible tool to evaluate this complex motivation.

OBJECTIVES

To validate the psychometric properties of the HRFS Chinese version (HRFS-C) and to assess the relationship between motivation and smoking behavior.

METHOD

We recruited 967 participants through social media and assessed their smoking behavior with three instruments: the Fagerstrom Test for Nicotine Dependence-Chinese version (FTND-C), the Questionnaire on Smoking Urges-Brief Scale-Chinese version (QSU-brief-C), and the HRFS-C. Ultimately, we retained 700 valid data points. Cronbach's α and split-half tests were used to evaluate the reliability. Confirmatory factor analysis, Pearson's r and an analysis of variance (ANOVA) were used to evaluate the validity. In addition, linear regression was used to explore the relationship among the three instruments. The HRFS-C showed good homogeneity (α = 0.965), concurrent validity, and discriminant validity. A significant linear relationship was observed among the FTND-C, QSU-brief-C, and HRFS-C (p < .001).

CONCLUSION

The motivation measured by the HRFS-C can significantly predict nicotine dependence and craving in the smoking population. The HRFS-C can be used to carry out targeted interventions for addicted patients (e.g., motivational enhancement therapy).

What kind of smoking identity following quitting would elevate smokers relapse risk?

BACKGROUND

Research has suggested that smokers who quit smoking and continue to identify themselves as a smoker versus a non-smoker are at greater risk of relapse. This study examines the relationship between post-quit smoker identities and relapse risk of former smokers in Australia and the UK comparing those who still identified as a smoker with firm choice to no longer smoke versus those not expressing a firm choice. Cross-country differences were examined.

METHODS

Data analysed came from 544 former smokers (quit 1 month or more) who participated in the Australian and UK Waves 9 (2013) and 10 (2014) of the International Tobacco Control (ITC) surveys. Post-quit smoker identities were assessed at baseline and smoking relapse at follow-up.

RESULTS

Baseline self-reported smoker identity independently predicted smoking relapse at 12-month follow-up (p < .01). Compared with the subgroup who identified themselves as smokers trying to quit, those who identified themselves as smokers who had chosen to no longer smoke (OR = 0.01, 95% CI = 0.01-0.25, p < .001), ex-smokers (OR = 0.05, CI = 0.01-0.25, p < .001) or non-smokers (OR = 0.07, CI = 0.02-0.37, p < .001) were less likely to relapse at follow-up. No cross-country differences were found.

CONCLUSIONS

Following quitting, smokers who maintained a smoker identity with a firm choice to no longer smoke or adopted a non-smoker or ex-smoker identity were less likely to relapse than those who failed to do so, suggesting that a clear rule/commitment to not smoke and/or a shift to a non-smoking identity may be protective of relapse.

Predicting Smoking Lapses in the First Week of Quitting: An Ecological Momentary Assessment Study

Objectives:

This study focused on lapse shortly after an attempt to quit smoking. Ecological momentary assessment (EMA) studies have mapped real-time situational factors that induce lapses in everyday life. However, the possible role of nonsmoking intention is disregarded in the dynamic context of daily life, whereas intention plays a key role in behavior change and shifts during smoking cessation. This study therefore aimed to capture the influence of intention on lapse, next to the known risk factors of negative affect, low self-efficacy, craving, positive outcome expectations towards smoking (POEs), being around smokers, and stress. It is hypothesized that scores on these factors shift during the day, especially shortly after quitting, which may induce lapse. Based on behavioral explanation models, intention is hypothesized to mediate the influence of the mentioned factors on lapse.

Methods:

An EMA study was conducted among 49 self-quitters in the first week of smoking cessation.

Results:

Generalized Linear Mixed Model regression analyses revealed that low nonsmoking intentions, low self-efficacy, and being around smokers (estimates were, respectively, −0.303, −0.331, and 2.083) predicted lapse. Nonsmoking intention partially mediated the influence of self-efficacy on lapse. Nonsmoking intention was predicted by not being around smokers, high self-efficacy, and low POEs (estimates were, respectively, −0.353, 0.293, and −0.072).

Conclusions:

This small-scale EMA study confirms the importance of nonsmoking intention on lapse, next to self-efficacy and being around smokers. It adds insights into the mediating role of intention on the relationship between self-efficacy and lapse, and into the predictors of nonsmoking intention.

Cultural Values Moderate the Impact of Relative Deprivation

Relative deprivation (RD) is the judgment that one or one’s ingroup is worse off compared with some relevant standard coupled with feelings of dissatisfaction, anger, and resentment. RD predicts a wide range of outcomes, but it is unclear whether this relationship is moderated by national cultural differences. Therefore, in the first study, we used national assessments of individual-collectivism and power distance to code 303 effect sizes from 31 different countries with 200,578 participants. RD predicted outcomes ranging from life satisfaction to collective action more strongly within individualistic nations. A second survey of 6,112 undergraduate university students from 28 different countries confirmed the predictive value of RD. Again, the relationship between individual RD and different outcomes was stronger for students who lived in more individualistic countries. Group-based RD also predicted political trust more strongly for students who lived in countries marked by lower power distance. RD effects, although consistent predictors, are culturally bounded. In particular, RD is more likely to motivate reactions within individualistic countries that emphasize individual agency and achievement as a source of self-worth.

Do predictors of smoking relapse change as a function of duration of abstinence? Findings from the United States, Canada, United Kingdom and Australia

AIMS

To estimate predictors of time to smoking relapse and test if prediction varied by quit duration.

DESIGN

Longitudinal cohort data from the International Tobacco Control Four-Country survey with annual follow up collected between 2002 and 2015.

SETTING

Canada, United States, United Kingdom and Australia.

PARTICIPANTS

A total of 9171 eligible adult smokers who had made at least one quit attempt during the study period.

MEASUREMENTS

Time to relapse was the main outcome. Predictor variables included pre-quit baseline measures of nicotine dependence, smoking and quitting-related motivations, quitting capacity and social influence, and also two post-quit measures, use of stop-smoking medications and quit duration (1-7 days, 8-14 days, 15-31 days, 1-3 months, 3-6 months, 6-12 months, 1-2 years and 2+ years), along with socio-demographics.

FINDINGS

All factors were predictive of relapse within the first 6 months of quitting but only wanting to quit, quit intentions and number of friends who smoke were still predictive of relapse in the 6-12-month period of quitting [hazard ratios (HR) = 1.20, P < 0.05; 1.13, P < 0.05; and 1.21, P < 0.001, respectively]. Number of friends smoking was the only remaining predictor of relapse in the 1-2 years quit period (HR = 1.19, P = 0.001) with none predictive beyond the 2-year quit period. Use of stop-smoking medications during quit attempts was related negatively to relapse during the first 2 weeks of quitting (HR = 0.71-0.84), but related positively to relapse in the 1-6-month quit period (HR = 1.29-1.54). Predictive effects of all factors showed significant interaction with quit duration except for perceiving smoking as an important part of life, prematurely stubbing out a cigarette and wanting to quit.

CONCLUSIONS

Among adult smokers in the United States, Canada, United Kingdom and Australia, factors associated with smoking relapse differ between the early and later stages of a quit attempt, suggesting that the determinants of relapse change as a function of abstinence duration.

An experimental test to reveal negative side-effects of high treatability information on preventative health behaviour

OBJECTIVES

When the course of a disease can be positively changed by health professionals the disease can be indicated as 'highly treatable'. This 'high treatability information' (HTI) may have negative side-effects on people's preventative motivation. This study examined the effects of HTI regarding skin cancer on preventative motivation.

DESIGN

This study employed a 2 (high treatability (HTI) versus low treatability (LTI)) × 2 (high versus low susceptibility)-experiment with a hanging control group. (family) History and self-efficacy were assessed as moderators. Participants (N = 309) were randomly assigned to one of the five conditions.

MAIN OUTCOME MEASURES

The main outcome was intention to engage in preventative actions regarding skin cancer.

RESULTS

HTI significantly lowered the intention compared to LTI, under the condition of high susceptibility in people with low self-efficacy. In addition, in people with a (family) history of skin cancer, HTI significantly lowered the intention compared to the no-information group.

CONCLUSION

HTI regarding skin cancer can cause a drop in the preventative motivation. The effects can be conceptualised as negative side-effects of HTI. As substantial proportions of the general population have a (family) history of skin cancer or low self-efficacy, the side-effects may be widespread, possibly increasing the incidence of skin cancer.

Parental smoke exposure and the development of nicotine craving in adolescent novice smokers: the roles of DRD2, DRD4, and OPRM1 genotypes

BACKGROUND

Among adolescent novice smokers, craving is often the first, and is the most reported, symptom of nicotine dependence. Until now, little has been known about the development of craving symptoms in novice smokers. The aim of this study was to identify specific genetic (i.e., DRD2 Taq1A, DRD4 48 bp VNTR, and OPRM1 A118G polymorphisms) and environmental mechanisms that underlie the emergence of both cue-induced and cognitive craving among adolescent novice smokers.

METHOD

A five-wave longitudinal, genetically-informed survey study was conducted with intervals of four months. The sample included 376 early adolescent smokers (12-13 years of age at baseline). Self-report questionnaires were completed regarding smoking behavior, observed parental smoking behavior, and both cue-induced and cognitive craving.

RESULTS

Data were analyzed with a latent growth curve approach. For both cue-induced and cognitive craving, significant interaction effects were found for DRD2 Taq1A with parental smoke exposure. A1-allele carriers did not seem to be influenced by the environment with regard to craving development. Adolescents who are homozygous for the A2-allele and who are more exposed to parental smoking experience the highest levels of both types of craving over time. No significant interaction effects were found between parental smoke exposure and DRD4 48 bp VNTR or OPRM1 A118G.

CONCLUSIONS

Previous studies identified DRD2 Taq1A A1-allele carriers as vulnerable to developing nicotine dependence. However, this study showed that parental smoking increased the chances of developing dependence more rapidly for early adolescents who are considered to be less sensitive to the rewarding effects of nicotine according to their DRD2 Taq1A genotype. It is thus especially important that these young people not be exposed to smoking in their social environment.

Positive smoking outcome expectancies mediate the relation between alcohol consumption and smoking urge among women during a quit attempt

Social learning models of addiction hypothesize that situational factors interact with cognitive determinants to influence a person's motivation to use substances. Ecological momentary assessment was used to examine the association between alcohol consumption, smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 113 female smokers who enrolled in a study that tested an individually tailored smoking cessation treatment. Participants carried a palm-top personal computer for 7 days and were instructed to complete 4 random assessments each day and to initiate an assessment when they were tempted to smoke. Multilevel mediational analyses were used to examine (a) the effects of alcohol consumption before time j and positive smoking outcome expectancies at time j on smoking urge at time j + 1 (Model 1) and (b) the effects of alcohol consumption before time j and smoking urge at time j on positive smoking outcome expectancies at time j + 1 (Model 2). Model 1 found a significant effect of alcohol consumption before time j on smoking urge at time j + 1 (p = .04), and this effect was significantly mediated by positive smoking outcome expectancies at time j (p < .0001). Model 2 failed to find a significant effect of alcohol consumption before time j on positive smoking outcome expectancies at time j + 1. The findings suggest that alcohol consumption is significantly associated with increased positive smoking outcome expectancies that, in turn, are associated with increased smoking urge in women seeking to quit smoking.

Experimentally induced states of mind determine abstinent smokers' level of craving in reaction to smoking-cues

Introduction

The present study aims to contribute to our knowledge on the causes of variations in experienced craving of (ex)smokers. The general idea is tested that when (ex)smokers are exposed to a smoking-cue, their level of craving is determined by the momentary state of mind through which the smoking-cue is interpreted.

Methods

A cue-reactivity paradigm in temporary abstinent smokers is applied to trigger craving responses under different experimentally induced states of mind. Craving is assessed with a three-item self-report measure. In study 1 (N = 120) a self-affirmation procedure is applied right before abstinent smokers were exposed to their own smoking paraphernalia. In study 2 (N = 140) abstinent smokers received bogus feedback inducing a high or low self-efficacy and strong or weak positive outcome expectations.

Results

Study 1 showed a significant interaction: When involvement was high, self-affirmation increased the level of craving but when involvement was low self-affirmation lowered craving. Study 2 also showed a significant interaction: Only when the positive outcome expectation of smoking were high, self-efficacy lowered the level of craving. All analyses were controlled for the number of cigarettes smoked a day and number of past quit attempts.

Conclusions

The present studies provide experimental evidence that levels of craving can be determined by momentary states of mind. This theoretical perspective can be integrated in existing conditioning and social cognitive learning perspectives on craving and substance use.

The Malay version of the brief questionnaire on smoking urge: translation and psychometric properties of the questionnaire

This study aimed to evaluate the psychometric properties of Malay translated version of the brief questionnaire of smoking urges (QSU-Brief). The translation procedure was done following the standard guidelines. The reliability and validity of the Malaysian version scale were evaluated based on the data collected from 133 Malaysian smokers. The internal consistency was calculated to assess the reliability. Factor analysis and construct validity were performed to validate psychometric properties of the scale. Total Cronbach's alpha of the scale was 0.806. The exploratory factor analysis revealed two factors that accounted for 66.15% of the explained total variance. The first component consisted of items 1, 3, 6, 7, and 10, while the second component included the rest. The QSU-Brief total score had a significant positive relationship with exhaled CO level (r=0.24; P=0.005), number of cigarettes smoked per day (r=0.30; P<0.001) and other clinical factors. Items 2 and 5 loaded strongly on factor 2, whereas both items loaded ambivalently on two factors in the previous studies. This discrepancy might be clarified by language differences. The Malaysian QSU-Brief is a good candidate for evaluating urge to smoke in both clinical practice and clinical trials.

The effectiveness of the Allen Carr smoking cessation training in companies tested in a quasi-experimental design

Background

The Allen Carr training (ACt) is a popular one-session smoking cessation group training that is provided by licensed organizations that have the permission to use the Allen Carr method. However, few data are available on the effectiveness of the training.

Methods

In a quasi-experimental design the effects of the existing practice of providing the ACt to smokers (n = 124) in companies on abstinence, were compared to changes in abstinence in a cohort of similar smokers in the general population (n = 161). To increase comparability of the smokers in both conditions, smokers in the control condition were matched on the group level on baseline characteristics (fourteen variables) to the smokers in the ACt. The main outcome measure was self-reported continuous abstinence after 13 months, which was validated using a CO measurement in the Act condition.

Results

Logistic regression analyses showed that when baseline characteristics were comparable, significantly more responding smokers were continuously abstinent in the ACt condition compared to the control condition, Exp(B) = 6.52 (41.1% and 9.6%, respectively). The all-cases analysis was also significant, Exp(B) = 5.09 (31.5% and 8.3%, respectively).

Conclusion

Smokers following the ACt in their company were about 6 times more likely to be abstinent, assessed after 13 months, compared to similar smokers in the general population. Although smokers in both conditions did not differ significantly on 14 variables that might be related to cessation success, the quasi-experimental design allows no definite conclusion about the effectiveness of the ACt. Still, these data support the provision of the ACt in companies.

Explaining young adults' drinking behaviour within an augmented Theory of Planned Behaviour: temporal stability of drinker prototypes

OBJECTIVES

Prototypes (i.e., social images) predict health-related behaviours and intentions within the context of the Theory of Planned Behaviour (TPB). This study tested the moderating role of temporal stability of drinker prototype perceptions on prototype-intentions and prototype-behaviour relationships, within an augmented TPB. The study examined abstainer, moderate drinker, heavy drinker, tipsy, and drunk prototypes.

DESIGN AND METHODS

An online prospective study with 1-month follow-up was conducted among 410 young adults (18-25 years old, Mage = 21.0, SD = 2.14, 21.7% male). Assessed were prototype perceptions (favourability and similarity, T1, T2), stability of prototype perceptions, TPB variables (T1), intentions (T2), and drinking behaviour (T2). Intention analyses were corrected for baseline behaviour; drinking behaviour analyses were corrected for intentions and baseline behaviour.

RESULTS

Hierarchical regressions showed that prototype stability moderated the relationships of drunk and abstainer prototype similarity with intentions. Similarity to the abstainer prototype explained intentions to drink sensibly more strongly among individuals with stable perceptions than among those with unstable perceptions. Conversely, intentions were explained stronger among individuals with stable perceptions of dissimilarity to the drunk prototype than among those with unstable perceptions. No moderation effects were found for stability of favourability or for relationships with behaviour.

CONCLUSIONS

Stable prototype similarity perceptions were more predictive of intentions than unstable perceptions. These perceptions were most relevant in enhancing the explanation of young adults' intended drinking behaviour. Specifically, young adults' health intentions seem to be guided by the dissociation from the drunk prototype and association with the abstainer prototype. Statement of contribution What is already known on this subject? Prototypes have augmented the Theory of Planned Behaviour in explaining risk behaviour. Temporal stability has been shown to successfully extend the TPB in explaining intentions. Temporal stability of TPB variables can moderate the relationships with behaviour and intentions. What does this study add? Stability of prototype perceptions moderates the prototype-intentions relationship. Stability of abstainer and drunk prototype similarity enhances the explanation of (intentional) drinking. Stable prototype perceptions are more explanatory than unstable perceptions.

Heaviness of smoking predicts smoking relapse only in the first weeks of a quit attempt: findings from the International Tobacco Control Four-Country Survey

INTRODUCTION

The Heaviness of Smoking Index (HSI) is the measure of dependence most strongly predictive of relapse. However, recent research suggests it may not be predictive of longer-term relapse. Our aim was to examine its predictive power over the first 2 years after quitting and explore whether use of stop-smoking medications is a moderator.

METHODS

Data (n = 7,093) came from the first 7 waves (2002-2009) of the International Tobacco Control Four-Country Survey, an annual cohort survey of smokers in Canada, the United States, the United Kingdom, and Australia. HSI and its 2 components (cigarettes per day [CPD] and time to first cigarette [TTFC]) were used to predict smoking relapse risk in the 2 years after the start of a quit attempt.

RESULTS

Scores on HSI and its components all strongly predicted relapse, but there was an interaction with time (p < .001). These measures were strong predictors of relapse within the first week of quitting (hazard ratios [HR] = 1.17, 1.24, and 1.30 for HSI, CPD, and TTFC, respectively; all p < .001), less predictive of relapse occurring between 1 week and 1 month, and not clearly predictive beyond 1 month. Among those using medication to quit, hazard ratio for HSI (HR = 1.11, p < .001) was significantly lower than for those not using (HR = 1.24, p < .001) in the first week but not beyond.

CONCLUSIONS

HSI and its 2 components are strong predictors of short-term smoking relapse, but they rapidly lose predictive power over the first weeks of an attempt, becoming marginally significant at around 1 month and not clearly predictive beyond then.

The importance of practitioner smoking status: a survey of NHS Stop Smoking Service practitioners

OBJECTIVE

To investigate the smoking status of stop smoking practitioners, the impact of this on their practice, and clients' quit rates.

METHODS

Smoking cessation practitioners in the UK NHS Stop Smoking Service were asked about their smoking status, client quit rates and practitioner-client interaction, using an online survey. Associations between responses were investigated using logistic regression.

RESULTS

51% of the sample (N=484) were ex-smokers. Most practitioners had been questioned about their smoking status by clients, with more never than ex-smokers claiming that this reduced their confidence when advising. Never smokers more frequently reported that clients questioned their ability as a practitioner, but no significant difference in quit rates was reported between never and ex-smokers.

CONCLUSION

Although evidence suggests smokers believe many practitioners are never smokers, this survey found that this is not true. Research investigating how many smokers might not be seeking support to quit because of this could be beneficial.

PRACTICE IMPLICATIONS

Raising awareness of the similarity of quit rates achieved by never and former smoker practitioners, and the experience practitioners draw upon when offering advice, might encourage greater use of the NHS SSS. It could also be beneficial to improve training in never smokers to address confidence issues.

Situational and affective risk situations of relapse and the quality of implementation intentions in an e-health smoking relapse prevention programme

The quality of coping plans made to deal with personal smoking related risk situations and the relation between plan quality (PQ) and continued smoking abstinence (CA) were assessed. The respondents (N = 563) were smokers who had made a coping planning assignment in the experimental conditions of a larger randomized controlled trial. Descriptive and logistic regression analyses were conducted. The specificity of the plans made was related to short and long-term CA and was significantly lower for plans made to deal with situational situations. More research on how to foster specificity and target the difficulties that quitters have with specifying plans for affective situations is required.

Preventing smoking relapse via Web-based computer-tailored feedback: a randomized controlled trial

Background

Web-based computer-tailored approaches have the potential to be successful in supporting smoking cessation. However, the potential effects of such approaches for relapse prevention and the value of incorporating action planning strategies to effectively prevent smoking relapse have not been fully explored. The Stay Quit for You (SQ4U) study compared two Web-based computer-tailored smoking relapse prevention programs with different types of planning strategies versus a control group.

Objectives

To assess the efficacy of two Web-based computer-tailored programs in preventing smoking relapse compared with a control group. The action planning (AP) program provided tailored feedback at baseline and invited respondents to do 6 preparatory and coping planning assignments (the first 3 assignments prior to quit date and the final 3 assignments after quit date). The action planning plus (AP+) program was an extended version of the AP program that also provided tailored feedback at 11 time points after the quit attempt. Respondents in the control group only filled out questionnaires. The study also assessed possible dose–response relationships between abstinence and adherence to the programs.

Methods

The study was a randomized controlled trial with three conditions: the control group, the AP program, and the AP+ program. Respondents were daily smokers (N = 2031), aged 18 to 65 years, who were motivated and willing to quit smoking within 1 month. The primary outcome was self-reported continued abstinence 12 months after baseline. Logistic regression analyses were conducted using three samples: (1) all respondents as randomly assigned, (2) a modified sample that excluded respondents who did not make a quit attempt in conformance with the program protocol, and (3) a minimum dose sample that also excluded respondents who did not adhere to at least one of the intervention elements. Observed case analyses and conservative analyses were conducted.

Results

In the observed case analysis of the randomized sample, abstinence rates were 22% (45/202) in the control group versus 33% (63/190) in the AP program and 31% (53/174) in the AP+ program. The AP program (odds ratio 1.95, P = .005) and the AP+ program (odds ratio 1.61, P = .049) were significantly more effective than the control condition. Abstinence rates and effects differed per sample. Finally, the results suggest a dose–response relationship between abstinence and the number of program elements completed by the respondents.

Conclusion

Despite the differences in results caused by the variation in our analysis approaches, we can conclude that Web-based computer-tailored programs combined with planning strategy assignments and feedback after the quit attempt can be effective in preventing relapse 12 months after baseline. However, adherence to the intervention seems critical for effectiveness. Finally, our results also suggest that more research is needed to assess the optimum intervention dose.

Trial Registration

Dutch Trial Register: NTR1892; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1892 (Archived by WebCite at http://www.webcitation.org/693S6uuPM)

The social support and social network characteristics of smokers in methadone maintenance treatment

BACKGROUND

Previous studies have shown social support and social network variables to be important factors in smoking cessation treatment. Tobacco use is highly prevalent among individuals in methadone maintenance treatment (MMT). However, smoking cessation treatment outcomes in this vulnerable subpopulation have been poor and social support and social network variables may contribute.

METHODS

The current study examined the social support and social network characteristics of 151 MMT smokers involved in a randomized clinical trial of smoking cessation treatments. Participants were 50% women and 78% Caucasian. A high proportion (57%) of MMT smokers had spouses or partners who smoke and over two-thirds of households (68.5%) included at least one smoker.

RESULTS

Our sample was characterized by relatively small social networks, but high levels of general social support and quitting support. The number of cigarettes per day was found to be positively associated with the number of smokers in the social network (r = .239, p < .05) and quitting self-efficacy was negatively associated with partner smoking (r = -.217, p < .001).

CONCLUSIONS

Findings are discussed in the context of developing smoking cessation interventions that address the influential role of social support and social networks of smokers in MMT.

Motivation, Cognitive, and Affective Factors that Predict Smoking Relapse: A Cross-Sectional Study in a Filipino Sample

In the plethora of international research on smoking relapse there are findings that suggest distinct ethnocultural differences in relapse predictors. This study aimed to uncover cognitive and affective factors that contribute to relapse in a sample of Filipino adult smokers (N = 115). Using discriminant function analysis, results suggest that self-efficacy, outcome expectancy, craving and the subdomains of motivation to change contemplation and action are accurate relapse predictors, whereas negative emotional states are not. An integrative framework was used in the discussion to account for inconsistencies in the results. Implications for understanding the relapse cycle, the connection between smoking relapse and substance use, as well as suggestions for future studies on smoking relapse, are also discussed.

Relative Deprivation

Relative deprivation (RD) is the judgment that one is worse off compared to some standard accompanied by feelings of anger and resentment. Social scientists use RD to predict a wide range of significant outcome variables: collective action, individual achievement and deviance, intergroup attitudes, and physical and mental health. But the results are often weak and inconsistent. The authors draw on a theoretical and meta-analytic review (210 studies composing 293 independent samples, 421 tests, and 186,073 respondents) to present a model that integrates group and individual RD. RD measures that (a) include justice-related affect, (b) match the outcome level of analysis, and (c) use higher quality measures yield significantly stronger relationships. Future research should focus on appropriate RD measurement, angry resentment, and the inclusion of theoretically relevant situational appraisals. Such methodological improvements would revitalize RD as a useful social psychological predictor of a wide range of important individual and social processes.

The role of self-efficacy, recovery self-efficacy, and preparatory planning in predicting short-term smoking relapse

OBJECTIVES

This study aims to identify the role of self-efficacy, recovery self-efficacy, and preparatory planning with regard to short-term smoking relapse. We also assessed whether the importance of these variables differed for smokers quitting individually and without help (self-quitters) and smokers quitting with the help of a smoking cessation course (group quitters).

DESIGN

A longitudinal quasi-experimental study with follow-ups at 1 and 3 months after the quit attempt was conducted in order to assess the role of baseline self-efficacy, recovery self-efficacy, and preparatory planning on short-term relapse.

METHODS

The recruitment included adult daily smokers (N= 121), quitting in a smoking cessation course (N= 57) and self-quitters (N= 64). Respondents received internet-based questionnaires 2 weeks before quitting (baseline) and 1 and 3 months after the quit attempt. Predictors of relapse were analysed using logistic regression analyses.

RESULTS

Relapse at 1 and 3 months after the quit attempt was predicted by low levels of baseline self-efficacy. Simple slope analyses revealed that less preparatory planning significantly predicted relapse at 1 month after the quit attempt among group quitters, but not among self-quitters. Recovery self-efficacy was only predictive of relapse after 1 month when self-efficacy was excluded from the analyses. Moreover, among group quitters, the results indicated a borderline significant curved relation between recovery self-efficacy and relapse after 1 month.

CONCLUSIONS

Our results suggest that more research is needed on the role of preparatory planning and recovery self-efficacy. Moreover, we recommend incorporating self-efficacy increasing techniques in relapse-prevention interventions.

'I'm better off now': the role of temporal comparisons and exposure evaluations in smoking cessation

Two new psychological concepts related to relapse in smoking cessation were tested. 'Temporal comparisons' are ex-smokers' evaluations of their present situation compared to their situation as a smoker. 'Exposure evaluations' are evaluations of situations ex-smokers encountered when they used to smoke. In a cohort study among 323 ex-smokers, both concepts significantly predicted relapse after six months. Moreover, the relationship between temporal comparisons and relapse was mediated by exposure evaluations. In addition, this relationship also depended on self-efficacy; particularly when self-efficacy was low, temporal comparisons predicted relapse. These data provide new theoretical and practical perspectives to relapse.

Mixed feelings: ambivalence as a predictor of relapse in ex-smokers

OBJECTIVES

Ambivalence can be viewed as a normal temporary psychological state in a decision process, for example, on quitting smoking. However, when ambivalence is still present after the decision has been made, it may undermine the motivation to stick to the decision. In smoking cessation, ambivalence can be expected to increase the risk for relapse.

DESIGN

In a cohort of 352 ex-smokers, felt ambivalence measured at baseline was used to predict relapse after 1 month.

RESULTS

Firstly, felt ambivalence was a predictor of relapse. Secondly, felt ambivalence moderated the strength of the relation between a psychological determinant of behaviour and actual behaviour: anticipated negative self-evaluative emotions only predicted relapse when felt ambivalence was low. Thirdly, the relation of felt ambivalence with relapse was partly mediated by ex-smokers' evaluations of risk situations (situations in which they used to smoke in the past).

CONCLUSION

Ambivalence is related to relapse in different ways and in ex-smokers it may be conceptualized as a non-optimal decision process. Although the role of felt ambivalence needs further study, the data suggest that ambivalence must be taken into account in the practice of relapse prevention.

Factors underlying smoking relapse prevention: results of an international Delphi study

No definitive picture of the factors determining smoking relapse exists, and many smoking relapse prevention programmes have only modest behavioural effects. This study aims to identify the level of consensus among and compare the opinions of two groups of experts (researchers and coaches who provide smoking cessation courses) regarding factors already studied in relation to smoking relapse, factors that have not yet been addressed and ideas on how to improve prevention programmes. A three-round Delphi method was employed. In the first round, 15 researchers completed an electronic questionnaire on factors associated with relapse. The results were used to develop a structured questionnaire for the second round, which was completed by 47 researchers and 61 coaches. The second-round results were then presented to the same experts in the third round, enabling them to re-rate their answers. Results revealed high consensus on some factors already identified as predicting relapse (e.g. self-efficacy), new factors (e.g. action planning) and several methods to improve prevention programmes. Generally speaking, the researchers and coaches provided similar suggestions. The results paint a picture of the current state of knowledge on relapse-related factors and point the way to areas for further research.

Smoking intentions and mood preceding lapse after completion of treatment to aid smoking cessation

OBJECTIVE

To examine the situation preceding "late" smoking relapse, particularly the availability of tobacco, mood and intentions at first lapse.

METHODS

A questionnaire was sent to 1439 adults identified as abstinent after treatment with a National Health Service stop-smoking clinic over the previous 3 years. Relapsers were asked where they had obtained their first cigarette, their mood and intentions immediately before first lapse.

RESULTS

40% (n = 556) responded, of whom 35.8% (n = 199) had relapsed. At the time of first lapse, only 27.1% had made a decision to return to smoking while 48.9% intended to smoke only one or two cigarettes before stopping again. In 45.7% of cases, respondents bought cigarettes to smoke again. Prior to lapse the majority (53.8%) reported "really needing a cigarette". Similarly 53.8% reported being miserable at the time, while only 16% were happy.

CONCLUSION

The most common pattern of late lapse appears to be intending to suspend the quit attempt temporarily in circumstances of needing to smoke and of negative emotional state, and in many cases cigarettes are actually sought out.

PRACTICE IMPLICATIONS

Promoting strong 'not a puff' rules, a non-smoker identity and identifying negative mood as a potential vulnerability are important components of relapse prevention intervention.

Postquitting experiences and expectations of adult smokers and their association with subsequent relapse: findings from the International Tobacco Control (ITC) Four Country Survey

INTRODUCTION

This paper explores postquitting experiences and expectations of adult ex-smokers and their utility as predictors of smoking relapse after prolonged abstinence.

METHODS

Data are from 1,449 ex-smokers (providing 2,234 observations) recruited as smokers as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, the United Kingdom, and the United States) but surveyed after they had quit. Controlling for length of time quit, reported postquitting experiences, and expectations assessed at one of three waves were used as predictors. Smoking status (whether they had relapsed) at the next wave was used as the outcome of interest.

RESULTS

Postquitting experiences and expectations, such as capacity to enjoy life's simple pleasures, ability to cope with stress, ability to control negative emotions, and health concerns, changed systematically over time but at different rates. The trajectory of change for life enjoyment and health concerns followed a rapidly asymptoting logarithmic function, while that of stress and negative affect coping followed a slower asymptoting square root function. After controlling for sociodemographic and abstinence duration, only reported decline in capacity to control negative affect since quitting was associated with increased relapse risk.

DISCUSSION

The varying patterns of change in postquitting experiences suggest that psychological gains over time following smoking cessation do not all occur at the same rate. The relative importance of each factor in maintaining abstinence is also not the same with deficits in perceived control of negative emotions being the only one predictive of subsequent relapse. Strategies to improve impulse control over negative emotions postquitting may help to reduce relapse risk.

The natural history of quitting smoking: findings from the International Tobacco Control (ITC) Four Country Survey

AIMS

To describe the long-term natural history of a range of potential determinants of relapse from quitting smoking.

DESIGN, SETTING AND PARTICIPANTS

A survey of 2502 ex-smokers of varying lengths of time quit recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, United Kingdom, United States) across five annual waves of surveying.

MEASUREMENTS

Quitters were interviewed by telephone at varying durations of abstinence, ranging from 1 to 1472 days (about 4 years) post-quitting. Smoking-related beliefs and experiences (i.e. urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) were included in the survey.

FINDINGS

Most theorized determinants of relapse changed over time in a manner theoretically associated with reduced risk of relapse, except most notably the belief that smoking controls weight, which strengthened. Change in these determinants changed at different rates: from a rapidly asymptoting log function to a less rapidly asymptoting square-root function.

CONCLUSIONS

Variation in patterns of change across time suggests that the relative importance of each factor to maintaining abstinence may similarly vary.

Predictors of smoking relapse by duration of abstinence: findings from the International Tobacco Control (ITC) Four Country Survey

AIM

To explore predictors of smoking relapse and how predictors vary according to duration of abstinence.

DESIGN, SETTING AND PARTICIPANTS

A longitudinal survey of 1296 ex-smokers recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, United Kingdom and United States). Measurements Quitters were interviewed by telephone at varying durations of abstinence (from 1 day to approximately 3 years) and then followed-up approximately 1 year later. Theorized predictors of relapse (i.e. urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) and nicotine dependence were measured in the survey.

FINDINGS

Relapse was associated with lower abstinence self-efficacy and a higher frequency of urges to smoke, but only after the first month or so of quitting. Both these measures mediated relationships between perceived benefits of smoking and relapse. Perceived costs of smoking and benefits of quitting were unrelated to relapse.

CONCLUSIONS

Challenging perceived benefits of smoking may be an effective way to increase abstinence self-efficacy and reduce frequency of urges to smoke (particularly after the initial weeks of quitting), in order to reduce subsequent relapse risk.

Self-efficacy and smoking cessation: a meta-analysis

According to relapse models, self-efficacy (SE), or confidence in one's ability to abstain, should predict the outcome of an attempt to quit smoking. We reviewed 54 studies that prospectively examined this relationship. The relationship between SE and future smoking depended upon the population studied and the timing of the SE assessment. The relationship between SE and future smoking was modest when SE was assessed prior to a quit attempt; SE scores were .21 standard deviation units (SD) higher for those not smoking at follow-up than for those who were smoking. The relationship was stronger (.47 SD) when SE was assessed post-quit. However, this effect was diminished when only abstainers at the time of the SE assessment were included in analysis (.28 SD). Controlling for smoking status at the time of SE assessment substantially reduced the relationship between SE and future smoking. Although SE has a reliable association with future abstinence, it is less robust than expected. Many studies may overestimate the relationship by failing to appropriately control for smoking behavior at the time of the SE assessment. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Validity and reliability of Kano Test for Social Nicotine Dependence

PURPOSE

"Social nicotine dependence" is a newly-coined phrase for describing a psychological and psychosocial state associated with smoking. That new dependence is defined as a misperception of smoking caused by smokers' attempts, for example, to deny the ill effects of tobacco and/or to justify themselves by regarding smoking as acceptable cultural and social behavior. It can be quantified by a 10-item questionnaire, the Kano Test for Social Nicotine Dependence (KTSND). We examined the internal consistency as well as the criterion-related and construct validity and factor structure of KTSND.

METHODS

Self-administered questionnaires including the KTSND, smoking status, and stages in quitting smoking only for current smokers were collected from 666 industrial workers.

RESULTS

The internal consistency of the KTSND assessed by Cronbach's alpha coefficient was 0.77. In addition, we found that an 8-item combination from among 10 items had a higher coefficient of 0.80. KTSND scores differed among three groups of smoking status as a criterion. Factor analysis clarified two potential factors: "an overestimation of smoking's effects to enhance physical and mental status" and "an insistence on smoking as acceptable cultural and social behavior."

CONCLUSION

The KTSND proved to be valid in terms of the internal consistency and the inclusion of two key aspects of the misperception of smoking.

Gender specific differences in the pros and cons of smoking among current smokers in Eastern Kentucky: implications for future smoking cessation interventions

This study investigated gender differences in the perceived "pros" and "cons" of smoking using the constructs of decisional balance (DB) and stage of change from the Transtheoretical Model. The population distribution for stage of change among a population-based, cross-sectional survey of 155 current smokers over 40 years was: precontemplation (22.6%), contemplation (41.9%), preparation (35.5%). Results of stepwise regression models indicated significant gender differences in DB were in the preparation stage of change; scores on the DB measure increased 3.94 points (95% CI: 1.94, 5.93) for male smokers. Interventions targeting the "pros" and "cons" of smoking may need to be gender specific.

An integration of parents' and best friends' smoking, smoking-specific cognitions, and nicotine dependence in relation to readiness to quit smoking: a comparison between adolescents with and without asthma

OBJECTIVE

To study the impact of parents' and best friends' smoking, nicotine dependence, and craving on smoking-specific cognitions, and readiness to quit in adolescents with and without asthma.

METHODS

Structural equation analyses were applied to data from a sample of 1,120 daily smoking adolescents, 83 of whom had asthma.

RESULTS

Adolescents with asthma felt more ready to quit, and cognitions were more strongly related to readiness to quit among adolescents with asthma than among adolescents without asthma. Moreover, best friends' smoking seemed more relevant to the cognitions of adolescents with asthma. Nicotine dependence and craving were strongly related to cognitions, and to readiness to quit in both groups. The relation between craving and readiness to quit, however, was stronger among participants with asthma.

CONCLUSIONS

Reduction of nicotine dependence and craving is essential for both groups. Youth with asthma may benefit even more from cognitive-based cessation services than healthy youth. The finding that adolescents with asthma are relatively more ready to quit, and that their cognitions are more easily affected can be turned into advantages in asthma-specific cessation services.

Craving e dependência química: conceito, avaliação e tratamento

O craving ou fissura, cuja definição mais comum é o desejo intenso por uma substância, é um conceito controverso entre os pesquisadores da área da dependência química. OBJETIVO: Realizar revisão teórica a respeito do craving nos bancos de dados PsycInfo, Medline, ProQuest e Science Direct. MÉTODO: As palavras-chave utilizadas foram craving, dependence e drug e o período pesquisado foi entre 1995 e 2007. RESULTADOS: Os resultados demonstraram que são encontrados diversos significados para o craving, alguns se restringindo a desejo, e outros, considerando-o não só como desejo, mas como antecipação do resultado positivo do uso da substância, alívio dos sintomas de abstinência ou afeto negativo e intenção de fumar, o que reflete uma visão multidimensional deste construto. A etiologia do craving pode ser explicada por intermédio dos modelos: comportamental, cognitivo ou psicossocial e neurobiológico, porquanto a opção por um destes influencia a avaliação e o manejo. CONCLUSÃO: Conclui-se quanto à multidimensionalidade do craving e quanto à necessidade de que seja utilizado um modelo biopsicossocial que integre os diversos modelos no tratamento de dependentes químicos. Destaca-se a importância da realização de mais estudos para a compreensão do craving em função deste ser um dos principais riscos de recaída.

The motivation to stay abstinent in ex-smokers: comparing the present with the past

Little is known about the motivation of ex-smokers to stay abstinent. In the present study we argue that ex-smokers compare their present to their past when they still smoked to conclude whether they make good progress towards a satisfactory state of continued abstinence. These temporal comparisons are thought to be central in the motivation to stay abstinent in ex-smokers. The power of temporal comparisons to predict relapse was tested in two related samples of ex-smokers (N=152 and N=197), together with two other relevant psychological factors; positive outcome expectations of smoking and self-efficacy expectations. In the first sample of ex-smokers, only temporal comparisons predicted relapse after 2 months. In the second sample of ex-smokers, temporal comparisons mediated the relation between perceived positive outcomes of smoking and relapse after 6 months. In addition, in predicting relapse after 6 months, temporal comparisons interacted with self-efficacy. The present study suggests that temporal comparisons comprise the cognitive aspect of the motivation of ex-smokers to stay abstinent. This conceptualization of the motivation in ex-smokers can be used in practice to prevent relapse.

What are the differences in decisional balance and self-efficacy between Turkish smokers in different stages of change?

This paper reports the results of an examination of decisional balance (pros and cons of smoking), and self-efficacy constructs, sociodemographic and smoking-related variables among smokers from different stages of change as proposed by the transtheoretical model. A convenience sample of 398 smokers completed the research instrument. Almost 60% of the sample were in the precontemplation stage. The results indicated that pros of smoking dropped significantly from precontemplation to contemplation and preparation but then increased again for the action stage smokers. Cons of smoking increased almost linearly from precontemplation to preparation stages and they were the highest for the action stage. Self-efficacy also increased in a linear fashion and preparation and action stages were significantly higher than the precontemplation and contemplation stages. There were also significant differences among stages of change of groups on age, years of education, and smoking duration and number of quit attempts. Results underlined the importance of finding alternatives that may substitute for the pros of smoking and interventions for changing the cognitive evaluations related to cons of smoking. Additionally, smokers may gain from approaches that focus on encouraging and reinforcing self-efficacy during the action and maintenance stages to ensure a long-term positive outcome.

Dynamic self-efficacy and outcome expectancies: prediction of smoking lapse and relapse

According to social learning models of drug relapse, decreases in abstinence self-efficacy (ASE) and increases in positive smoking outcome expectancies (POEs) should foreshadow lapses and relapse. In this study, the authors examined this hypothesis by using ecological momentary assessment data from 305 smokers who achieved initial abstinence from smoking and monitored their smoking and their ASE and POEs by using palmtop computers. Daily ASE and POEs predicted the occurrence of a 1st lapse on the following day. Following a lapse, variations in daily ASE predicted the onset of relapse, even after controlling for concurrent smoking. ASE and POEs generally neither mediated nor moderated each other's effects. These data emphasize the role of dynamic factors in the relapse process.

Can transtheoretical model measures predict relapse from the action stage of change among ex-smokers who quit after calling a quitline?

This study explored whether transtheoretical model (TTM) measures could predict relapse from the action stage, i.e., during the first 6 months of smoking cessation. Predictors of relapse were examined between time 2 (3-month) and time 3 (6-month) assessments (n = 247), and also between time 3 (6-month) and time 4 (12-month) assessments (n = 204). Consistent predictors of relapse included lower self-efficacy and determination to quit and higher temptations to smoke. Some predictors of relapse changed according to how long a person had already been quit for. Contrary to the TTM, greater behavioral change process use predicted relapse among people who had already quit for less than a month, and did not prevent relapse among those who had already quit for a month or more between time 2 and time 3. Cross-sectional analyses showed significant decreases in temptations to smoke and in the use of some of the change processes, which stabilised at about 1 month post-cessation. The findings suggest that there may be a stage boundary at around 1 month post-cessation, and question the homogeneity, and hence validity, of the TTM-defined action stage of change.

Ongoing interpretations of accomplishments in smoking cessation: positive and negative self-efficacy interpretations

Smokers and ex-smokers are considered to make ongoing interpretations of their accomplishments in terms of their ability to refrain from smoking. We assessed positive self-efficacy interpretations (PSEint) and negative self-efficacy interpretations (NSEint) as the frequencies with which smokers and ex-smokers experience thoughts, such as "I think my attempt to quit will be successful" and "I notice that I am not so sure anymore that I can quit." In the present study, we investigated PSEint and NSEint and the proportion of PSEint in a cohort of 704 smokers and ex-smokers, assessed twice with an interval of 7 months. The results indicate that PSEint and NSEint are distinct factors with moderate to low correlations with conventional measures of the pros of quitting, the pros of smoking, and self-efficacy. Furthermore, the relations among these factors differed strongly between smokers and ex-smokers. PSEint predicted quitting in smokers while NSEint predicted relapse in ex-smokers. It is concluded that self-efficacy interpretations are important novel predictors of smoking cessation that can be assessed using only a few items.