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Schlam TR, Baker TB, Piper ME, Cook JW, Smith SS, Zwaga D, Jorenby DE, Almirall D, Bolt DM, Collins LM, Mermelstein R, Fiore MC. What to do after smoking relapse? A sequential multiple assignment randomized trial of chronic care smoking treatments. Addiction 2024; 119:898-914. [PMID: 38282258 PMCID: PMC11098029 DOI: 10.1111/add.16428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024]
Abstract
AIM To compare effects of three post-relapse interventions on smoking abstinence. DESIGN Sequential three-phase multiple assignment randomized trial (SMART). SETTING Eighteen Wisconsin, USA, primary care clinics. PARTICIPANTS A total of 1154 primary care patients (53.6% women, 81.2% White) interested in quitting smoking enrolled from 2015 to 2019; 582 relapsed and were randomized to relapse recovery treatment. INTERVENTIONS In phase 1, patients received cessation counseling and 8 weeks nicotine patch. Those who relapsed and agreed were randomized to a phase 2 relapse recovery group: (1) reduction counseling + nicotine mini-lozenges + encouragement to quit starting 1 month post-randomization (preparation); (2) repeated encouragement to quit starting immediately post-randomization (recycling); or (3) advice to call the tobacco quitline (control). The first two groups could opt into phase 3 new quit treatment [8 weeks nicotine patch + mini-lozenges plus randomization to two treatment factors (skill training and supportive counseling) in a 2 × 2 design]. Phase 2 and 3 interventions lasted ≤ 15 months. MEASUREMENTS The study was powered to compare each active phase 2 treatment with the control on the primary outcome: biochemically confirmed 7-day point-prevalence abstinence 14 months post initiating phase 2 relapse recovery treatment. Exploratory analyses tested for phase 3 counseling factor effects. FINDINGS Neither skill training nor supportive counseling (each on versus off) increased 14-month abstinence rates; skills on versus off 9.3% (14/151) versus 5.2% (8/153), P = 0.19; support on versus off 6.6% (10/152) versus 7.9% (12/152), P = 0.73. Phase 2 preparation did not produce higher 14-month abstinence rates than quitline referral; 3.6% (8/220) versus 2.1% [3/145; risk difference = 1.5%, 95% confidence interval (CI) = -1.8-5.0%, odds ratio (OR) = 1.8, 95% CI = 0.5-6.9]. Recycling, however, produced higher abstinence rates than quitline referral; 6.9% (15/217) versus 2.1% (three of 145; risk difference, 4.8%, 95% CI = 0.7-8.9%, OR = 3.5, 95% CI = 1.0-12.4). Recycling produced greater entry into new quit treatment than preparation: 83.4% (181/217) versus 55.9% (123/220), P < 0.0001. CONCLUSIONS Among people interested in quitting smoking, immediate encouragement post-relapse to enter a new round of smoking cessation treatment ('recycling') produced higher probability of abstinence than tobacco quitline referral. Recycling produced higher rates of cessation treatment re-engagement than did preparation/cutting down using more intensive counseling and pharmacotherapy.
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Affiliation(s)
- Tanya R Schlam
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel Almirall
- Institute for Social Research and Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, School of Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Visscher K, Everaars B, Suijkerbuijk AW, Lambooij M, de Wit GA. Intended changes in smoking behaviour of Dutch young adults after an increase in excise tax: a cross-sectional survey. BMJ Open 2023; 13:e065535. [PMID: 38154901 PMCID: PMC10759063 DOI: 10.1136/bmjopen-2022-065535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/17/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES Increasing the price of tobacco is one of the most effective measures to reduce the prevalence of smoking. In the Netherlands, the excise tax on tobacco increased by €1.14 in 2020, raising the price of a standard package of cigarettes to €8.00. This study investigates how young adults intend to change their smoking behaviour in the case of hypothetical price increases of a pack of cigarettes, and which background characteristics are associated with intended behaviour change. DESIGN A cross-sectional online survey was carried out between September and November 2020. Smokers indicated how they would react to several hypothetical increases in price. Four behavioural options were investigated: smoking less, quitting smoking, switching to another/cheaper product and buying cheaper cigarettes cross-border. PARTICIPANTS Data were obtained from 776 Dutch smokers between 15 and 25 years. RESULTS At a hypothetical price of €10 per package, most respondents reported an intention to smoke less (67%), followed by switching to another/cheaper product (61%), quitting smoking (49%) and shopping for cigarettes cross-border (47%). Prior quit attempts, agreeing with the increase in excise tax and the intention to quit smoking in the future increased the odds of changing behaviour. Higher self-efficacy decreased the odds of behavioural change. CONCLUSION Many young adults intend to change their smoking behaviour in the event of increased prices. Although intended behaviour can deviate significantly from actual behaviour, an increase in excise tax may result in a significant amount of quit attempts and reduced smoking among young adults.
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Affiliation(s)
- Kirsten Visscher
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Babette Everaars
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Anita Wm Suijkerbuijk
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mattijs Lambooij
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - G Ardine de Wit
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Health Sciences, VU Amsterdam, Amsterdam, The Netherlands
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Zhang Z, Huang M, Chen T. Probability and predictors of long-term smoking relapse among Chinese adult smokers: A longitudinal study. Prev Med Rep 2023; 36:102482. [PMID: 37920593 PMCID: PMC10618515 DOI: 10.1016/j.pmedr.2023.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
Numerous smokers attempt to quit smoking, but most cessation efforts prove unsuccessful. Scarce evidence exists regarding predictors of long-term relapse in China. This study aims to evaluate the probability of relapse and examine factors may contribute to relapse among Chinese adults. A dynamic cohort of 6,036 observations on 2,378 adult quitters was constructed from the China Family Panel Studies in 2010, 2012, 2014, 2016 and 2018. The life table method was employed to calculate the probability of relapse for long-term smoking abstinence. Multivariate complementary log-log survival models were developed to examine the predictors of smoking relapse. We found that the probability of relapse decreased as the duration of abstinence increased, with rates of 49.07 %, 20.05 %, 10.29 %, and 6.63 % at 2, 4, 6, and 8 years of abstinence, respectively. The cumulative probability of relapse within 8 years was 65.89 %. Age ≥65 years, higher educational attainment, respiratory disease, and a satisfying lifestyle were associated with a reduced likelihood of relapse. Conversely, higher occupational prestige, alcohol drinking, cohabitant smoking, and greater future confidence were associated with an increased risk of relapse. These findings demonstrated that the probability of relapse decreased progressively over time, with most relapses occurring in the initial two years following quit attempts. Predictors of Chinese quitters' relapse behavior in our study were similar to those in previous studies. Drinking and cohabitant smoking were identified as strong predictors of relapse in this population.
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Affiliation(s)
| | | | - Ting Chen
- School of Public Health, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
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Cassidy DG, Wang XQ, Mallawaarachchi I, Wiseman KP, Ebbert JO, Blue Star JA, Aycock CA, Estevez Burns R, Jones JR, Krunnfusz AE, Halbert JP, Roy NM, Ellis JM, Williams JB, Klesges RC, Talcott GW. Tobacco quitline performance: Comparing the impacts of early cessation and proactive re-engagement on callers' smoking status at follow-up at 12 months. Tob Induc Dis 2023; 21:24. [PMID: 36798676 PMCID: PMC9923459 DOI: 10.18332/tid/159125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION While tobacco Quitlines are effective in the promotion of smoking cessation, the majority of callers who wish to quit still fail to do so. The aim of this study was to determine if 12-month tobacco Quitline smoking cessation rates could be improved with re-engagement of callers whose first Quitline treatment failed to establish abstinence. METHODS In an adaptive trial, 614 adult smokers, who were active duty, retired, and family of military personnel with TRICARE insurance who called a tobacco Quitline, received a previously evaluated and efficacious four-session tobacco cessation intervention with nicotine replacement therapy (NRT). At the scheduled follow-up at 3 months, callers who had not yet achieved abstinence were offered the opportunity to re-engage. This resulted in three caller groups: 1) those who were abstinent, 2) those who were still smoking but willing to re-engage with an additional Quitline treatment; and 3) individuals who were still smoking but declined re-engagement. A propensity score-adjusted logistic regression model was generated to compare past-7-day point prevalence abstinence at 12 months post Quitline consultation. RESULTS Using a propensity score adjusted logistic regression model, comparison of the three groups resulted in higher odds of past-7-day point prevalence abstinence at follow-up at 12 months for those who were abstinent at 3 months compared to those who re-engaged (OR=9.6; 95% CI: 5.2-17.8; Bonferroni adjusted p<0.0001), and relative to those who declined re-engagement (OR=13.4; 95% CI: 6.8-26.3; Bonferroni adjusted p<0.0001). There was no statistically significant difference in smoking abstinence between smokers at 3 months who re-engaged and those who declined re-engagement (OR=1.39; 95% CI: 0.68-2.85). CONCLUSIONS Tobacco Quitlines seeking to select a single initiative by which to maximize abstinence at follow-up at 12 months may benefit from diverting additional resources from the re-engagement of callers whose initial quit attempt failed, toward changes which increase callers' probability of success within the first 3 months of treatment. TRIAL REGISTRATION This study is registered at clinicaltrials.gov (NCT02201810).
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Affiliation(s)
- Daniel G. Cassidy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Xin-Qun Wang
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Kara P. Wiseman
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Jon O. Ebbert
- Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, United States
| | - John A. Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Chase A. Aycock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Rosemary Estevez Burns
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - John R. Jones
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Andrea E. Krunnfusz
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Jennifer P. Halbert
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Natalie M. Roy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Jordan M. Ellis
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Juinell B. Williams
- Department of Psychology, East Carolina University, Greenville, United States
| | - Robert C. Klesges
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Gerald W. Talcott
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States,Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
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Cadham CJ, Liber AC, Sánchez-Romero LM, Issabakhsh M, Warner KE, Meza R, Levy DT. The actual and anticipated effects of restrictions on flavoured electronic nicotine delivery systems: a scoping review. BMC Public Health 2022; 22:2128. [PMCID: PMC9675183 DOI: 10.1186/s12889-022-14440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To synthesize the outcomes of policy evaluations of flavoured electronic nicotine delivery systems (ENDS) restrictions. Data sources PubMed, Scopus, Embase and Web of Science before May 3, 2022. Study selection Studies that report sales, behaviour, or compliance outcomes related to implemented or hypothetical ENDS flavour restrictions. Data extraction Restriction details, whether implemented or hypothetical, whether additional products were restricted, jurisdictional level, study locations, and outcomes classified by sales, behaviour, and compliance. Data synthesis We included 30 studies. Of those, 26 were conducted exclusively in the US, two in India, and two surveyed respondents in multiple countries, including the US. Twenty-one evaluated implemented restrictions, while nine considered hypothetical restrictions. Five studies evaluated product sales, 17 evaluated behaviour, and 10 evaluated compliance, with two studies reporting multiple outcomes. Two studies reported an increase and one a reduction in cigarette sales following restrictions, while three reported reductions in ENDS sales. Behavioural studies presented a mixed view of the impacts of regulations on ENDS and cigarette use. However, the use of disparate outcomes limits the comparability of studies. Studies of hypothetical restrictions suggest decreased ENDS use, increased cigarette use, and increased use of illicit markets. Studies of compliance with flavoured product restrictions that included ENDS found that 6–39% of stores sold restricted flavoured products post-restrictions. Online stores remain a potential source of restricted products. Conclusion Our findings highlight the need for additional research on the impacts of ENDS restrictions. Research should further evaluate the impact of restrictions on youth and adult use of nicotine and tobacco products in addition to the effects of restrictions in countries beyond the US to enable a robust consideration of the harm-benefit trade-off of restrictions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14440-x.
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Affiliation(s)
- Christopher J. Cadham
- grid.214458.e0000000086837370Department of Health Management and Policy, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI USA
| | - Alex C. Liber
- grid.213910.80000 0001 1955 1644Cancer Prevention and Control Program, Georgetown University-Lombardi Comprehensive Cancer Center, 3300 Whitehaven St, Washington, DC USA
| | - Luz María Sánchez-Romero
- grid.213910.80000 0001 1955 1644Cancer Prevention and Control Program, Georgetown University-Lombardi Comprehensive Cancer Center, 3300 Whitehaven St, Washington, DC USA
| | - Mona Issabakhsh
- grid.213910.80000 0001 1955 1644Cancer Prevention and Control Program, Georgetown University-Lombardi Comprehensive Cancer Center, 3300 Whitehaven St, Washington, DC USA
| | - Kenneth E. Warner
- grid.214458.e0000000086837370Department of Health Management and Policy, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI USA
| | - Rafael Meza
- grid.214458.e0000000086837370Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2013 USA
| | - David T. Levy
- grid.213910.80000 0001 1955 1644Cancer Prevention and Control Program, Georgetown University-Lombardi Comprehensive Cancer Center, 3300 Whitehaven St, Washington, DC USA
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Treatment History and Interest in Injectable Opioid Agonist Treatment With Hydromorphone Among People Who Inject Drugs. J Addict Med 2022:01271255-990000000-00101. [PMID: 36255107 DOI: 10.1097/adm.0000000000001093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Injectable opioid agonist treatment (iOAT) is a novel approach to treating opioid use disorder (OUD) that is typically reserved for treatment-experienced persons who inject drugs (PWID) with long-standing OUD. This study examined PWID's past OUD treatment histories and their attitudes toward iOAT with hydromorphone. METHODS This cross-sectional study recruited syringe services program participants with OUD in New York City. Participants self-reported past OUD care episodes (detoxification; outpatient, inpatient, or medication treatment; or mutual aid groups) and current interest in iOAT with hydromorphone (assessed on a 4-point scale with 3 or 4 considered "interested"). Participants with 2 or more treatment episodes in the past 5 years were considered treatment-experienced. We examined whether the number of past care episodes was associated with interest in iOAT. RESULTS Of 108 PWID, most participants were male (68.5%) and Hispanic (68.5%) with a mean age of 43 years (±10.8). Nearly all (98.1%) had severe OUD and had received past OUD care (96.3%), with the mean number of care episodes being 17.4 (SD, ±15.9). Most participants (59.8%) were treatment-experienced. Interest in iOAT with hydromorphone was high (64.8%), but there was no significant association between total past care episodes and expressing interest in iOAT (odds ratio, 1.02; 95% confidence interval, 0.99-1.05). CONCLUSION Participants were highly treatment-experienced, and iOAT interest was high regardless of prior OUD treatment. New OUD treatment options, such as iOAT with hydromorphone, would be welcomed by PWID whose OUD has not remitted with conventional treatment as well as other PWID.
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Understanding the role of e-cigarette use in smoking cessation based on the stages of change model. PLoS One 2022; 17:e0274311. [PMID: 36084052 PMCID: PMC9462758 DOI: 10.1371/journal.pone.0274311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Objective We explored the role of e-cigarette use in smoking cessation based on the stages of change (SOC) model, which is a framework for describing the process of smoking cessation. Methods We used nationwide, cross-sectional data on adults (19+ years) from the seventh Korea National Health and Nutrition Examination Survey (KNHANES, 2016–2018) and restricted the participants to 3,929 recent smokers, consisting of current smokers and recent quitters (≤2 years). A multinomial logistic regression analysis was performed to reveal the relationships between e-cigarette use and cigarette quitting behaviors (e.g., current quitting status, past quit attempts, intention to quit, and duration of quitting) and all stages in smoking cessation, with adjustment for sociodemographic and smoking-related factors. Results E-cigarette use was positively related to past quit attempts, while not having quit, intention to quit, and longer duration of quitting. Based on the cessation stages, current and former e-cigarette users were significantly more likely to be in the ‘Precontemplation’ and ‘Contemplation’ stages than never users, while not to be in the ‘Preparation’ and ‘Action’ stages. Current users were particularly less likely to be in the ‘Maintenance’ stage compared to never users. Conclusion E-cigarette use was closely linked with early-stage behavior than late-stage behavior in the smoking cessation process. E-cigarettes might promote quit attempts and short-term quitting in some smokers, but the negative role of inducing smokers to continue cigarette smoking with no immediate quit-intention for future attempts is dominant in the real world.
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Bray M, Chang Y, Baker TB, Jorenby D, Carney RM, Fox L, Pham G, Stoneking F, Smock N, Amos CI, Bierut L, Chen LS. The Promise of Polygenic Risk Prediction in Smoking Cessation: Evidence From Two Treatment Trials. Nicotine Tob Res 2022; 24:1573-1580. [PMID: 35170738 PMCID: PMC9575976 DOI: 10.1093/ntr/ntac043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/14/2021] [Accepted: 02/14/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Tobacco use disorder is a complex behavior with a strong genetic component. Genome-wide association studies (GWAS) on smoking behaviors allow for the creation of polygenic risk scores (PRSs) to approximate genetic vulnerability. However, the utility of smoking-related PRSs in predicting smoking cessation in clinical trials remains unknown. AIMS AND METHODS We evaluated the association between polygenic risk scores and bioverified smoking abstinence in a meta-analysis of two randomized, placebo-controlled smoking cessation trials. PRSs of smoking behaviors were created using the GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN) consortium summary statistics. We evaluated the utility of using individual PRS of specific smoking behavior versus a combined genetic risk that combines PRS of all four smoking behaviors. Study participants came from the Transdisciplinary Tobacco Use Research Centers (TTURCs) Study (1091 smokers of European descent), and the Genetically Informed Smoking Cessation Trial (GISC) Study (501 smokers of European descent). RESULTS PRS of later age of smoking initiation (OR [95% CI]: 1.20, [1.04-1.37], p = .0097) was significantly associated with bioverified smoking abstinence at end of treatment. In addition, the combined PRS of smoking behaviors also significantly predicted bioverified smoking abstinence (OR [95% CI] 0.71 [0.51-0.99], p = .045). CONCLUSIONS PRS of later age at smoking initiation may be useful in predicting smoking cessation at the end of treatment. A combined PRS may be a useful predictor for smoking abstinence by capturing the genetic propensity for multiple smoking behaviors. IMPLICATIONS There is a potential for polygenic risk scores to inform future clinical medicine, and a great need for evidence on whether these scores predict clinically meaningful outcomes. Our meta-analysis provides early evidence for potential utility of using polygenic risk scores to predict smoking cessation amongst smokers undergoing quit attempts, informing further work to optimize the use of polygenic risk scores in clinical care.
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Affiliation(s)
| | | | - Timothy B Baker
- Department of Medicine, School of Medicine and Public Health, Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI, USA
| | - Douglas Jorenby
- Department of Medicine, School of Medicine and Public Health, Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI, USA
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Louis Fox
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Faith Stoneking
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA,The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher I Amos
- Department of Medicine, Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX, USA,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Laura Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA,The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Li-Shiun Chen
- Corresponding Author: Li-Shiun Chen, MD, MPH, ScD, Department of Psychiatry (Box 8134), Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. Telephone: 314-362-3932; Fax: 314-362-4247; E-mail:
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A population-level analysis of changes in Australian smokers' preferences for smoking cessation support over two decades - from 1998 to 2017. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 19:100342. [PMID: 35024667 PMCID: PMC8669336 DOI: 10.1016/j.lanwpc.2021.100342] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Encouraging and assisting smokers to quit remains a key public health goal. Government and commercial initiatives have nudged smokers towards supported cessation. We tracked long-term trends in Australian smokers’ quit attempt methods across 20 years. Methods Data from 11,917 smokers were collected from an annual, cross-sectional, face-to-face, random and representative population survey. The survey measured demographic characteristics, tobacco use, recent quit attempts, nicotine dependence, quit intentions, and recent methods used when attempting to quit. Quit attempt preferences were analysed over time and by smoker characteristics. Findings Each year, more smokers attempted to quit than remained quit, with a stable trend over time. Socioeconomic disadvantage and mental health conditions are more likely among smokers, but there was no difference in quit attempts by these characteristics. Quit attempts have risen among those aged 60 years and over whereas other age groups have remained stable. Although trending downwards, unassisted quitting remained the most common method: 1998: 61% and 2017: 40%. Asking a doctor for help/advice (34%) was the most common assisted method in 2017, increasing from 18% in 1998. Methods of quitting varied by smoker characteristics, with supported methods used more often by older, more dependent, socio-economically disadvantaged smokers and those with a mental health condition. Interpretation The relative stability of recent quit attempts, persistence in unassisted quitting, and fluctuating preferences for supported cessation methods indicate that it is important for clinicians and policy makers to continue to support quit attempts through a variety of options, tailored to smoker's needs.
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Borland R, Le Grande M, Heckman BW, Fong GT, Bickel WK, Stein JS, East KA, Hall PA, Cummings KM. The Predictive Utility of Valuing the Future for Smoking Cessation: Findings from the ITC 4 Country Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020631. [PMID: 35055452 PMCID: PMC8776177 DOI: 10.3390/ijerph19020631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 02/01/2023]
Abstract
Background: Delay discounting (DD) and time perspective (TP) are conceptually related constructs that are theorized as important determinants of the pursuit of future outcomes over present inclinations. This study explores their predictive relationships for smoking cessation. Methods: 5006 daily smokers at a baseline wave provided 6710 paired observations of quitting activity between two waves. Data are from the International Tobacco Control (ITC) smoking and vaping surveys with samples from the USA, Canada, England, and Australia, across three waves conducted in 2016, 2018 and 2020. Smokers were assessed for TP and DD, plus smoking-specific predictors at one wave of cessation outcomes defined as either making a quit attempt and/or success among those who tried to quit which was ascertained at the subsequent survey wave. Results: TP and DD were essentially uncorrelated. TP predicted making quit attempts, both on its own and controlling for other potential predictors but was negatively associated with quit success. By contrast, DD was not related to making quit attempts, but high DD predicted relapse. The presence of financial stress at baseline resulted in some moderation of effects. Conclusions: Understanding the mechanisms of action of TP and DD can advance our understanding of, and ability to enhance, goal-directed behavioural change. TP appears to contribute to future intention formation, but not necessarily practical thought of how to achieve goals. DD is more likely an index of capacity to effectively generate competing future possibilities in response to immediate gratification.
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Affiliation(s)
- Ron Borland
- School of Psychological Sciences, University of Melbourne, Parkville 3010, Australia;
- Correspondence:
| | - Michael Le Grande
- School of Psychological Sciences, University of Melbourne, Parkville 3010, Australia;
| | - Bryan W. Heckman
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (B.W.H.); (K.M.C.)
- Center for the Study of Social Determinants of Health, Meharry Medical College, Nashville, TN 37208, USA
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (K.A.E.); (P.A.H.)
- Ontario Institute for Cancer Research, Toronto, ON N2L 3G1, Canada
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA 24016, USA; (W.K.B.); (J.S.S.)
| | - Jeff S. Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA 24016, USA; (W.K.B.); (J.S.S.)
| | - Katherine A. East
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (K.A.E.); (P.A.H.)
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Peter A. Hall
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (K.A.E.); (P.A.H.)
| | - Kenneth Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (B.W.H.); (K.M.C.)
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11
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Buchanan T, Magee CA, V See H, Kelly PJ. Tobacco harm reduction: are smokers becoming more hardcore? J Public Health Policy 2021; 41:286-302. [PMID: 32366990 DOI: 10.1057/s41271-020-00226-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We undertook a systematic review to identify and summarise studies on hardcore smoking and hardening to: determine the degree of variability in definitions of hardcore smoking and hardening; assess the evidence for claims that smokers are becoming increasingly hardened within the context of harm reduction as a policy initiative; and identify the determining characteristics of a hardcore smoker. We searched five electronic databases from 1970 to mid-April 2018 using the search term "smok* AND hard* AND (tobacco OR cigar* OR nicotin*)". We included studies if they included a definition of hardcore smokers and/or hardening, and provided a prevalence rate for hard core smokers or empirical evidence for hardening. Definitions of hardcore smoker varied substantially across studies. Hardening was not evident in the general smoking population and we found mounting evidence of softening occurring in smoking populations. These results indicate that hardening of smokers is not occurring and that calls for policy interventions on this basis should be challenged.
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Affiliation(s)
- Tanya Buchanan
- School of Psychology, University of Wollongong, Building 41, Northfields Avenue, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.
| | - Christopher A Magee
- School of Psychology, University of Wollongong, Building 41, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Hayley V See
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Building 41, Northfields Avenue, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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12
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Stepankova L, Kralikova E, Zvolska K, Pankova A, Adamcekova Z, Kuhn M, Noland D. Comparison between success rates for smokers re-treated by a smokers' clinic and success rates for smokers treated for the first time. Addiction 2021; 116:346-355. [PMID: 32592219 DOI: 10.1111/add.15175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/19/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022]
Abstract
AIMS To compare success rates and characteristics of smokers treated a second time by a smokers' clinic with success rates of their first treatment. DESIGN Retrospective cohort study. SETTING Tobacco Dependence Treatment clinic in Prague, Czech Republic, between 2005 and 2017. PARTICIPANTS A total of 5225 smokers treated either once (n = 5006, single treatment sample, SS) or also second time (n = 219, re-treated sample, RS), on average 4.47 years after the first visit. INTERVENTION Smokers received intensive treatment of tobacco dependence with pharmacotherapy options. Outcomes were evaluated after 1 year. In case of failure or relapse, participants could undergo re-treatment in the same setting at least 1 year after the start of the first treatment. MEASUREMENTS Twelve-month self-reported continuous abstinence; CO-validated (≤ 6 parts per million); number of visits; type of pharmacotherapy; mental health history; Fagerström Test for Cigarette Dependence; time between first and second treatment. RESULTS The abstinence rate in the SS was 34.8% [95% confidence interval (CI) = 33.4%, 36.1%] and in the RS was 37% (95% CI = 30.6%, 43.8%) and 39.7% (95% CI = 33.2%, 45.5%) for their first and second treatments, respectively. The samples were comparable on smoking and socio-demographic characteristics and pharmacotherapy used, but the RS in the second treatment had a higher prevalence of diagnosed mental health disorder at 39.3% (95% CI = 32.8%; 46.1%) compared with 23.7% (95% CI = 22.5%; 24.9%) in the SS. Participants who initiated their second quit attempt 1 to 2 years after the first one were less successful than those who initiated their second quit attempt later (25 versus 43%; P < 0.05). The results of the first treatment cycle were not found to be a reliable predictor for outcomes of the second cycle of treatment in univariate or multivariate logistic regression (odds ratio = 1.35, 95% CI = 0.70-2.63, P = 0.373). CONCLUSION In Prague, Czech Republic, smokers re-attending stop-smoking treatment more than 2 years after their previous quit attempt appear to achieve similar success rates to those being treated for the first time.
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Affiliation(s)
- Lenka Stepankova
- Centre for Tobacco Dependence, 3rd Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Eva Kralikova
- Centre for Tobacco Dependence, 3rd Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.,Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Kamila Zvolska
- Centre for Tobacco Dependence, 3rd Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Alexandra Pankova
- Centre for Tobacco Dependence, 3rd Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.,Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Czech Republic
| | - Zuzana Adamcekova
- Centre for Tobacco Dependence, 3rd Medical Department, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Matyas Kuhn
- Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Derek Noland
- Behavioral Health and Wellness Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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13
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Dugas EN, Sylvestre MP, Wellman RJ, O'Loughlin J. Does use of other tobacco products change when cigarette smoking status changes: A descriptive study of young adults. Addict Behav 2020; 107:106404. [PMID: 32222562 DOI: 10.1016/j.addbeh.2020.106404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whether polytobacco use or nicotine dependence (ND) change when cigarette smoking status changes in young adults is an understudied issue. Our objective was to describe use of other tobacco products (OTPs) and ND according to change in cigarette smoking status over four years in young adults. METHODS We drew data from a longitudinal study of 1294 adolescents age 12-13 at inception in 1999-2000 and followed into young adulthood. Among 790 participants with data at age 20 and 24, 22% had never smoked cigarettes; 37% were "sustained smokers"; 9% were "relapsers"; 10% had quit 1-3 years ago; and 22% had quit ≥4 years ago. We described past-year OTP (i.e., cigars/cigarillos, waterpipe, sundry tobacco products (i.e., pipe, bidis, chewing tobacco, snuff)) use and ND over 4 years in these groups. RESULTS At age 20, sustained smokers reported using a mean(SD) of 1.1(0.9) OTP in the past-year; relapsers reported 0.5(0.6); shorter-term quitters reported 0.9(0.7); longer-term quitters reported 0.3(0.6); and never smokers reported 0.2(0.4). There was no change in OTP use or ND in never smokers and longer-term quitters. Shorter-term quitters reduced the number of OTPs by -0.5(95% confidence interval: -0.7,-0.3) on average over 4 years; sustained smokers decreased by -0.2(-0.3,-0.1). Relapsers increased by 0.6(0.4,0.7) on average. CONCLUSIONS OTP use and ND were stable in early adulthood among never smokers, sustained smokers and longer-term quitters, but fluctuated in parallel with stopping and starting to smoke. Research is needed to ascertain the underpinnings of these fluctuations and whether they help or hinder cessation.
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Affiliation(s)
- Erika N Dugas
- Centre de recherche du centre hospitalier de l Université de Montréal (CRCHUM), Montreal, QC, Canada.
| | - Marie-Pierre Sylvestre
- Centre de recherche du centre hospitalier de l Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Robert J Wellman
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Jennifer O'Loughlin
- Centre de recherche du centre hospitalier de l Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada.
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14
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Simonavicius E, McNeill A, Brose LS. Transitions in smoking and nicotine use from 2016 to 2017 among a
UK
cohort of adult smokers and ex‐smokers. Drug Alcohol Rev 2020; 39:994-1005. [DOI: 10.1111/dar.13063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Erikas Simonavicius
- Department of Addictions Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - Ann McNeill
- Department of Addictions Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - Leonie S. Brose
- Department of Addictions Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
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15
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Klemperer EM, Hughes JR, Naud S. Reduction in Cigarettes per Day Prospectively Predicts Making a Quit Attempt: A Fine-Grained Secondary Analysis of a Natural History Study. Nicotine Tob Res 2020; 21:648-654. [PMID: 29579250 DOI: 10.1093/ntr/nty056] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 03/21/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Reducing cigarettes per day (CPD) aided by medication increases quit attempts (QA) among smokers not trying to quit. If this is due to reducing CPD per se, then a greater reduction should predict making a QA. AIMS AND METHODS In this secondary analysis, 132 smokers completed nightly calls to report CPD, intention to quit tomorrow, and QAs over 12 weeks. We provided no treatment. We identified episodes of reduction and tested whether (1) percent reduction in CPD, (2) absolute reduction in CPD, (3) duration of reduction, or (4) CPD on the final day predicted a QA immediately after a reduction episode. We tested this separately among reduction episodes that began with and without an intention to quit. RESULTS Among the 1179 episodes that began without intention to quit, all four measures of reduction predicted making a QA. Greater percent reduction, longer duration, and fewer CPD on the final day were retained in a multivariate model (all p < .05). Among the 85 episodes that began with intention to quit, greater percent reduction and greater absolute reduction predicted making a QA. Only mean percent reduction was retained in a multivariate model (p < .001). CONCLUSIONS Our results replicate and extend earlier studies by using fine-grained analyses and examining immediately proximal QAs in a sample of self-quitters. Findings suggest that reducing CPD per se increases the probability of a QA among smokers without intention to quit in a dose-related manner. Whether this is the case among smokers who intend to quit remains unclear. IMPLICATIONS Reducing CPD appears to be an effective strategy to increase the probability of making a QA for the majority of smokers who do not intend to quit in the near future. However, our findings are mixed regarding the effectiveness of reducing among smokers who intend to quit. Clinical interventions and policies that promote reducing CPD are likely to be an effective way to increase QAs. Reduction may be especially helpful for smokers who have not responded to traditional advice to stop abruptly.
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Affiliation(s)
- Elias M Klemperer
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT.,Department of Psychological Science, University of Vermont, Burlington, VT
| | - John R Hughes
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT.,Department of Psychological Science, University of Vermont, Burlington, VT
| | - Shelly Naud
- Department of Biostatistics, University of Vermont, Burlington, VT
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16
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Klemperer EM, Hughes JR, Naud S. Distal Measurements Can Produce False Negative Results: A Prospective Secondary Analysis of a Natural History Study. Nicotine Tob Res 2019; 21:1727-1730. [PMID: 29800312 DOI: 10.1093/ntr/nty110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/24/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Most prospective studies of quit attempts (QAs) or abstinence measure the ability of variables to predict quitting many weeks or months later. This design ignores more proximal fluctuations in the predictor that may be more relevant. The present secondary analysis compares 6-week (distal) and daily (proximal) changes in cigarettes per day (CPD) as predictors of making a QA. METHODS Daily smokers reported CPD and QAs nightly throughout a 12-week natural history study. We provided no treatment. In the distal analysis, we tested whether reduction in CPD between baseline and 6 weeks predicted making a QA during the following 6 weeks. In the proximal analysis, we identified episodes of one or more days of ≥10% reduction in CPD and tested whether reduction predicted making a QA on the day immediately after the reduction episode. We tested the following predictors: (1) reduction in CPD of ≥10% (yes/no), (2) percent reduction, (3) absolute magnitude of reduction, and (4) CPD at the end of reduction. RESULTS In the distal analysis, reduction did not predict making a QA. In the proximal analysis, any reduction (OR = 3.0), greater percent reduction (OR = 1.6), greater absolute reduction (OR = 1.3), and fewer CPD on the final day of an episode (OR = 11.8) predicted making a QA the next day (all p < .001). DISCUSSION Relying on distal measurements to identify causes of a behavior may produce false-negative results. Increased use of technological advances will make assessments of the more valid proximal measurements more feasible. IMPLICATIONS This secondary analysis tested distal and proximal predictors of making a quit attempt among the same participants and found that distal tests did not, but proximal tests did predict quit attempts. Relying on distal measurements may result in false negatives.
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Affiliation(s)
- Elias M Klemperer
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont.,Department of Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont
| | - John R Hughes
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont.,Department of Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont
| | - Shelly Naud
- Department of Biostatistics, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont
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17
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Thomas DP, Lyons L, Borland R. Predictors and reasons for starting and sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers. Drug Alcohol Rev 2019; 38:244-253. [DOI: 10.1111/dar.12917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 01/11/2023]
Affiliation(s)
- David P. Thomas
- Tobacco Control Research, Menzies School of Health ResearchCharles Darwin University Darwin Australia
| | - Louise Lyons
- Public Health and ResearchVictorian Aboriginal Community Controlled Health Organisation Melbourne Australia
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18
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Schensul JJ, Begum S, Nair S, Oncken C. Challenges in Indian Women’s Readiness to Quit Smokeless Tobacco Use. Asian Pac J Cancer Prev 2018; 19:1561-1569. [PMID: 29936780 PMCID: PMC6103596 DOI: 10.22034/apjcp.2018.19.6.1561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: In India, there are few cessation programs for women smokeless tobacco (SLT) users who want to quit.
This paper uses Fishbein’s IM model to identify women SLT users’ challenges to quitting and multilevel correlates of
“readiness to quit”. Methods: A survey of SLT use among women of reproductive age was conducted in 2010-13 in an
urban slum community of Mumbai with a representative sample of 409 married women aged 18 to 40 years using at least
one type of SLT daily. Data were analyzed using frequencies, bivariate statistics and logistic regression. Results: Social
influences to continue SLT use included husband’s use (71%), family influence and positive beliefs and norms about use.
Pressure to quit from significant others influenced past quit attempts but media had no effect on reported behavior. Four
groups represented different readiness to quit statues based on intention to quit and past quit/reduce attempts. Seventeen
percent had no intention of quitting or reducing; their husbands were more likely to be tobacco users. Half of (52%)
the sample had attempted to quit/reduce tobacco and intended to do so in the future. These women were depressed.
Fifteen percent had tried to quit but did not intend to again. Correlates were positive beliefs and norms about SLT and
withdrawal symptoms. Conclusions: Cessation programs should be made available to women, addressing correlates of
women’s readiness to quit statuses. Results suggest the need for more complex social/contextual approaches to sustained
cessation of SLT use including addressing depression and withdrawal, improved media messages and campaigns tailored
to women, and support from family members.
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Affiliation(s)
- Jean J Schensul
- Institute for Community Research, 2Hartford Square West, Ste 100, Hartford, USA.
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19
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Balogh E, Faubl N, Riemenschneider H, Balázs P, Bergmann A, Cseh K, Horváth F, Schelling J, Terebessy A, Wagner Z, Voigt K, Füzesi Z, Kiss I. Cigarette, waterpipe and e-cigarette use among an international sample of medical students. Cross-sectional multicenter study in Germany and Hungary. BMC Public Health 2018; 18:591. [PMID: 29724200 PMCID: PMC5934788 DOI: 10.1186/s12889-018-5494-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background Tobacco use is the leading preventable cause of death worldwide. Besides cigarette smoking, waterpipe and e-cigarettes are gaining popularity among young adults. Medical students’ smoking behavior is of particular interest because of their impending role in health promotion as future physicians. Aim of our study is to examine the prevalence and predictors of cigarette, waterpipe and e-cigarette use and the association of tobacco use with self-reported health status in an international sample of medical students. Methods In a multicenter cross-sectional study data on different aspects of health behavior were collected from medical students of 65 nationalities using a self-administered questionnaire in Germany (Dresden, Munich) and Hungary (Budapest, Pécs). The survey was conducted among 1st, 3rd and 5th year students. To explore associations between smoking behavior and socio-cultural factors Pearson’s chi2-tests and multivariate binary logistic regression analyses were performed. Results The largest subpopulations were formed by German (n = 1289), Hungarian (n = 1055) and Norwegian (n = 147) students. Mean age was 22.5 ± 3.3 years. Females represented 61.6% of the sample. In the whole sample prevalence of cigarette smoking was 18.0% (95% CI 16.6–19.4%), prevalence of waterpipe use was 4.8% (95% CI 4.0–5.7%), that of e-cigarette 0.9% (95% CI 0.5–1.2%). More males (22.0%) than females (15.5%) reported cigarette smoking. The lowest prevalence of cigarette smoking was found among Norwegian students (6.2%). Cigarette smokers were older, waterpipe users were younger than non-users. E-cigarette use was not associated with age of the students. Religious involvement was protective only against cigarette smoking. Financial situation showed no association with any kind of tobacco consumption. Cigarette smokers and e-cigarette users were less likely to report very good or excellent health status. Conclusions Cigarette smoking is still the most popular way of consuming tobacco, although alternative tobacco use is also prevalent among medical students. To further health consciousness, medical schools should pay more attention to students’ health behavior, especially their smoking habits. Tobacco prevention and cessation programs for medical students should consider not only the health risks of cigarette smoking but the need to discourage other forms of tobacco use, such as waterpipe.
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Affiliation(s)
- Erika Balogh
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti str 12, Pécs, 7624, Hungary.
| | - Nóra Faubl
- Department of Behavioral Sciences, University of Pécs Medical School, Szigeti str 12, Pécs, 7624, Hungary
| | - Henna Riemenschneider
- Department of General Practice, Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Péter Balázs
- Department of Public Health, Faculty of Medicine, Semmelweis University Budapest, Nagyvárad tér 4, Budapest, 1089, Hungary
| | - Antje Bergmann
- Department of General Practice, Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Károly Cseh
- Department of Public Health, Faculty of Medicine, Semmelweis University Budapest, Nagyvárad tér 4, Budapest, 1089, Hungary
| | - Ferenc Horváth
- Department of Public Health, Faculty of Medicine, Semmelweis University Budapest, Nagyvárad tér 4, Budapest, 1089, Hungary
| | - Jörg Schelling
- Department of General and Family Medicine, Medical Faculty, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - András Terebessy
- Department of Public Health, Faculty of Medicine, Semmelweis University Budapest, Nagyvárad tér 4, Budapest, 1089, Hungary
| | - Zoltán Wagner
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti str 12, Pécs, 7624, Hungary
| | - Karen Voigt
- Department of General Practice, Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Zsuzsanna Füzesi
- Department of Behavioral Sciences, University of Pécs Medical School, Szigeti str 12, Pécs, 7624, Hungary
| | - István Kiss
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti str 12, Pécs, 7624, Hungary
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20
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Borland R, Li L, Balmford J. The association between the nature of the goal committed to and quitting smoking. HEALTH EDUCATION RESEARCH 2017; 32:546-554. [PMID: 29112754 DOI: 10.1093/her/cyx066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
Commitments to goals are theorized to affect behavior change outcomes, but competing theories argue for hard to achieve goals and strategic sub-goals as optimum strategies for success. This study aimed to explore whether the nature of the goal affects smoking cessation outcomes. A total of 1043 participants in a randomized controlled trial of variations to an automated computer generated cessation advice program, who had made a quit attempt were asked at 1 month post quit about the initial goal they had set at the time of making the attempt. They were also followed up at 6 months post quit. Compared with those reporting 'seeing how it will go', those who reported the goal of 'taking it a cigarette at a time' were less likely to be quit at 1 month, while those with the most ambitious goal, to 'never smoke again', were more likely to be quit, and were more likely to maintain abstinence for 6 months. Indeed, 'taking it a cigarette at a time' was associated with greater short-term relapse. There is likely to be a benefit in encouraging smokers to set ambitious long-term goals rather than setting intermediate or non-specific goals.
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Affiliation(s)
- Ron Borland
- Nigel Gray Fellowship Group, Cancer Council Victoria, 615 St Kilda Rd, Melbourne 3004, Australia
| | - Lin Li
- Nigel Gray Fellowship Group, Cancer Council Victoria, 615 St Kilda Rd, Melbourne 3004, Australia
| | - James Balmford
- Nigel Gray Fellowship Group, Cancer Council Victoria, 615 St Kilda Rd, Melbourne 3004, Australia
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Petersen A, Mermelstein R, Berg KM, Baker TB, Smith SS, Jorenby D, Piper ME, Schlam TR, Cook JW. Offering smoking treatment to primary care patients in two Wisconsin healthcare systems: Who chooses smoking reduction versus cessation? Prev Med 2017; 105:332-336. [PMID: 28988997 PMCID: PMC6211191 DOI: 10.1016/j.ypmed.2017.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 01/30/2023]
Abstract
Smokers unwilling to make a quit attempt can still benefit from smoking intervention. However, it is unclear what proportion of smokers will enter such a Motivation phase intervention, and whether such an intervention attracts different types of smokers than does abstinence oriented treatment. We conducted a study from June 2010 to October 2013 based on a chronic care model of tobacco treatment among study eligible primary care patients (N=1579; 58% women, 89% White) presenting for regular health care visits in southern Wisconsin, U.S. Medical assistants, prompted via the electronic health record (EHR), invited smokers (n=10,242) to learn more about treatment options to help them either reduce their smoking or quit. Of those invited to learn more who were then reached by study staff, 10.2% (n=1046) reported interest in reduction treatment and 24% (n=2465) reported interest in cessation treatment. Patients who selected and ultimately entered reduction (n=492) versus cessation (n=1087) were more likely to report: older age; a history of anxiety; lower motivation to quit; lower primary dependence motives; more close friends or family who smoke; and a greater interval since their last quit attempt. Results suggest that Motivation phase treatment aimed at smoking reduction may increase the proportion and range of smokers inducted into tobacco treatment.
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Affiliation(s)
- Angela Petersen
- VA San Diego Healthcare System, 8950 Villa La Jolla Dr. Ste B109, La Jolla, CA 92037, United States; University of California, San Diego, La Jolla, CA 92093, United States.
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, 544 Westside Research Office Bldg., 1747 West Roosevelt Rd., Chicago, IL 60608, United States
| | - Kristin M Berg
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Doug Jorenby
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Tanya R Schlam
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Way, Madison, WI 53792, United States
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Levshin V, Slepchenko N. Determinants of smoking cessation and abstinence in a Russian smoking-cessation center. Tob Prev Cessat 2017; 3:124. [PMID: 32432198 PMCID: PMC7232794 DOI: 10.18332/tpc/76623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/07/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking prevalence in Russia is one of the highest in the world. It leads to significant damage to the National Health Service. The purpose of the present research was to assess the effectiveness of a qualified smoking-cessation (SC) center in Moscow, and to identify the main determinants of smoking cessation. METHODS The subjects of this study were a cohort of smokers (n=524) who had attended the SC service in Moscow between 2012-2015. They were followed, for at least 6 months after receiving the professional counselling in smoking cessation, to assess the results of the assistance and to identify determinants of successful smoking cessation. RESULTS Of the smokers, 19% succeeded in reducing by more than half the number of smoked cigarettes, more than 46% of patients completely stopped smoking for different terms: 38% for more than a month and 24% for more than half a year. Odds ratios (ORs) indicated that the probability of successful smoking cessation significantly increased if there was a previous success in smoking cessation: OR 3.71 (95% CI 1.70-8.12); and if there was a high level of motivation to stop smoking OR 4.3 (95% CI 1.92-5.61). The probability of successful smoking cessation decreased with intensity of smoking > 10 cigarettes a day: OR 0.57 (95% CI 0.31-1.02); and an elevated (>7 points) Fagerström-test score OR 0.64 (95% CI 0.37-1.07). CONCLUSIONS Degree of motivation and willingness to quit smoking were the principal determinants of the effectiveness in the attempt to quit smoking within our study cohort.
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Burris JL, Riley E, Puleo GE, Smith GT. A longitudinal study of the reciprocal relationship between ever smoking and urgency in early adolescence. Drug Alcohol Depend 2017; 178:519-526. [PMID: 28719886 PMCID: PMC5555077 DOI: 10.1016/j.drugalcdep.2017.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/18/2017] [Accepted: 06/03/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Among early adolescents in the United States (U.S.), the prevalence of cigarette smoking is at its lowest level in recent decades. Nonetheless, given the risks of smoking in early development, it remains critically important to study both risk factors for smoking and risks from smoking. This longitudinal study with U.S. early adolescents examines smoking initiation and tests a model of reciprocal prediction between ever smoking and the personality trait of urgency (i.e., mood-based impulsivity), a trait that increases risk for multiple forms of dysfunction. METHODS Participants (n=1906; 90% 10-11 years old, 50% female, 39% racial minorities at baseline) completed questionnaires 1-2 times per year starting in 5th grade and ending in 9th grade. Structural equation modeling allowed tests of bidirectional relationships between ever smoking and urgency controlling for pubertal status and negative affect at each wave. RESULTS Incidence of ever smoking increased from 5% to 27% over time, with current smoking around 5% at the last wave. Urgency at each wave predicted ever smoking at the next wave above and beyond covariates and prior smoking (all p<0.01). Likewise, with one exception, ever smoking predicted an increase in urgency at the subsequent wave above and beyond covariates and prior urgency (all p<0.05). CONCLUSION Results show that risk for smoking increases with higher levels of urgency and urgency increases secondary to engagement in smoking. Future work should therefore explore urgency as a point of prevention for smoking and smoking cessation as a means to mitigate mood-based impulsivity.
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Affiliation(s)
- Jessica L. Burris
- Department of Psychology and Markey Cancer Center, University of Kentucky, Lexington, KY, USA, University of Kentucky, 206 Combs Cancer Research Building, Lexington, KY 40536-0096, USA;
| | - Elizabeth Riley
- Department of Psychology, University of Kentucky, 171 Funkhouser Dr., Lexington, KY 40506-0044, USA.
| | - Gabriella E. Puleo
- Department of Psychology, University of Kentucky, Lexington, KY, USA, University of Kentucky, 171 Funkhouser Dr., Lexington, KY 40506-0044, USA;
| | - Gregory T. Smith
- Department of Psychology, University of Kentucky, Lexington, KY, USA, University of Kentucky, 105 Kastle Hall, Lexington, KY 40506-0044, USA;
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Heckman BW, Cummings KM, Kasza KA, Borland R, Burris JL, Fong GT, McNeill A, Carpenter MJ. Effectiveness of Switching Smoking-Cessation Medications Following Relapse. Am J Prev Med 2017; 53:e63-e70. [PMID: 28336353 PMCID: PMC5522631 DOI: 10.1016/j.amepre.2017.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/16/2016] [Accepted: 01/23/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Nicotine dependence is a chronic disorder often characterized by multiple failed quit attempts (QAs). Yet, little is known about the sequence of methods used across multiple QAs or how this may impact future ability to abstain from smoking. This prospective cohort study examines the effectiveness of switching smoking-cessation medications (SCMs) across multiple QAs. METHODS Adult smokers (aged ≥18 years) participating in International Tobacco Control surveys in the United Kingdom, U.S., Canada, and Australia (N=795) who: (1) completed two consecutive surveys between 2006 and 2011; (2) initiated a QA at least 1 month before each survey; and (3) provided data for the primary predictor (SCM use during most recent QA), outcome (1-month point prevalence abstinence), and relevant covariates. Analyses were conducted in 2016. RESULTS Five SCM user classifications were identified: (1) non-users (43.5%); (2) early users (SCM used for initial, but not subsequent QA; 11.4%); (3) later users (SCM used for subsequent, but not initial QA; 18.4%); (4) repeaters (same SCM used for both QAs; 10.7%); and (5) switchers (different SCM used for each QA; 14.2%). Abstinence rates were lower for non-users (15.9%, OR=0.48, p=0.002), early users (16.6%, OR=0.27, p=0.03), and repeaters (12.4%, OR=0.36, p=0.004) relative to switchers (28.5%). CONCLUSIONS Findings suggest smokers will be more successful if they use a SCM in QAs and vary the SCM they use across time. That smokers can increase their odds of quitting by switching SCMs is an important message that could be communicated to smokers.
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Affiliation(s)
- Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - Ron Borland
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, Kentucky; Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, King's College London, Strand, London, United Kingdom
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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Mathew AR, Heckman BW, Meier E, Carpenter MJ. Development and initial validation of a cessation fatigue scale. Drug Alcohol Depend 2017; 176:102-108. [PMID: 28531766 PMCID: PMC5802379 DOI: 10.1016/j.drugalcdep.2017.01.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/25/2017] [Accepted: 01/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Smoking cessation fatigue, or tiredness of attempting to quit smoking, has been posited as a latent construct encompassing loss of motivation, loss of hope in cessation success, decreased self-efficacy, and exhaustion of self-control resources. Despite the potential clinical impact of characterizing cessation fatigue, there is currently no validated measure to assess it. Using a rational scale development approach, we developed a cessation fatigue measure and examined its reliability and construct validity in relation to a) smokers' experience of a recently failed quit attempt (QA) and b) readiness to engage in a subsequent QA. METHODS Data were drawn from an online cross-sectional survey of 484 smokers who relapsed from a QA within the past 30days. RESULTS Exploratory factor analysis identified three factors within the 17-item Cessation Fatigue Scale (CFS), which we labeled: emotional exhaustion, pessimism, and devaluation. High internal consistency was observed for each factor and across the full scale. As expected, CFS overall was positively associated with withdrawal severity and difficulty quitting. CFS was negatively associated with previously validated measures of intention to quit, self-efficacy, and abstinence-related motivational engagement, even after adjusting for nicotine dependence. CONCLUSIONS Findings provide initial validation for a new tool to assess cessation fatigue and contribute needed information on a theory-driven component of cessation-related motivation and relapse risk.
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Affiliation(s)
- Amanda R Mathew
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA
| | - Ellen Meier
- Department of Psychiatry, University of Minnesota, F282/2A West Building, 2450 Riverside Avenue South, Minneapolis, MN 55454, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA
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Heckman BW, MacQueen DA, Marquinez NS, MacKillop J, Bickel WK, Brandon TH. Self-control depletion and nicotine deprivation as precipitants of smoking cessation failure: A human laboratory model. J Consult Clin Psychol 2017; 85:381-396. [PMID: 28333537 PMCID: PMC5364802 DOI: 10.1037/ccp0000197] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The need to understand potential precipitants of smoking relapse is exemplified by relapse rates as high as 95%. The Self-Control Strength model, which proposes that self-control is dependent upon limited resources and susceptible to fatigue, may offer insight into relapse processes. The current study tested the hypothesis that self-control depletion (SCD), produced from engagement in emotional suppression, would serve as a novel antecedent for cessation failure, as indexed by a validated laboratory analogue of smoking lapse and relapse. We also examined whether SCD effects interacted with those of a well-established relapse precipitant (i.e., nicotine deprivation). Craving and behavioral economic indices (delay discounting and demand) were tested as hypothesized mechanisms for increased cessation failure. Ultimately, a moderated mediation model was used to test nicotine deprivation as a hypothesized moderator of SCD effects. METHOD We used a 2 × 2 (12-hr deprivation vs. no deprivation; SCD vs. no SCD) factorial between-subjects design (N = 128 smokers). RESULTS The primary hypothesis of the study was supported, as SCD increased lapse behavior (p = .04). Nicotine deprivation significantly increased craving, cigarette demand, delay discounting, and lapse behavior. No main effects were found for SCD on putative mediators (i.e., craving, demand, and discounting), but the SCD and deprivation manipulations interacted upon craving (p = .04). The moderated mediation model was significant. SCD was found to increase craving among nicotine deprived smokers, which mediated effects on lapse behavior. CONCLUSIONS SCD appears to play an important role in smoking relapse and may be a viable target for intervention. (PsycINFO Database Record
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Affiliation(s)
- Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | | | | | - James MacKillop
- Department of Psychiatry & Behavioural Neurosciences, Peter Boris Centre for Addictions Research, McMaster University
| | - Warren K Bickel
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion Research Institute
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Zampier VSDB, Silva MHD, Jesus RRD, Oliveira PPD, Jesus MCPD, Merighi MAB. Maintenance of tobacco withdrawal by former smokers: a phenomenological study. Rev Gaucha Enferm 2017; 38:e2017-27. [PMID: 29791541 DOI: 10.1590/1983-1447.2017.04.2017-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/04/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the experience of former smokers maintaining tobacco abstinence. METHODS Qualitative research using the theoretical-methodological reference of the Social Phenomenology, as defined by Alfred Schütz. The phenomenological interview was carried out in 2016 with 12 former smokers from a city in the state of Minas Gerais, Brazil. The statements were organized into categories and discussed based on the literature. RESULTS The maintenance of tobacco abstinence was revealed in the categories: "Health, sociability, and financial gains"; "Living with the urge to smoke and with the increase of body weight"; "Self-determination and use of replacement strategies"; and "Staying away from cigarettes." CONCLUSIONS These results alert health professionals to the need to provide support to former smokers so they can remain smoke-free. This implies considering not only the negative effects of the tobacco abstinence, but also the social context in which former smokers are inserted that might have an impact on the maintenance or not of the cigarette withdrawal.
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Affiliation(s)
| | | | - Rodolfo Ribeiro de Jesus
- Faculdade de Medicina de Juiz de Fora, Universidade Presidente Antônio Carlos, Juiz de Fora, Minas Gerais, Brazil
| | - Paloma Prata de Oliveira
- Faculdade de Enfermagem, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Borland R. CEOS Theory: A Comprehensive Approach to Understanding Hard to Maintain Behaviour Change. Appl Psychol Health Well Being 2016; 9:3-35. [DOI: 10.1111/aphw.12083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cooper J, Borland R, McKee SA, Yong HH, Dugue PA. Depression motivates quit attempts but predicts relapse: differential findings for gender from the International Tobacco Control Study. Addiction 2016; 111:1438-47. [PMID: 26888199 PMCID: PMC4940212 DOI: 10.1111/add.13290] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/15/2015] [Accepted: 12/21/2015] [Indexed: 12/22/2022]
Abstract
AIMS To determine whether signs of current depression predict attempts to quit smoking, and short-term abstinence among those who try, and to test moderating effects of gender and cessation support (pharmacological and behavioural). DESIGN Prospective cohort with approximately annual waves. Among smokers at one wave we assessed outcomes at the next wave using mixed-effects logistic regressions. SETTING Waves 5-8 of the Four Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, USA, UK and Australia. PARTICIPANTS A total of 6811 tobacco smokers who participated in telephone surveys. MEASUREMENTS Three-level depression index: (1) neither low positive affect (LPA) nor negative affect (NA) in the last 4 weeks; (2) LPA and/or NA but not diagnosed with depression in the last 12 months; and (3) diagnosed with depression. Outcomes were quit attempts and 1-month abstinence among attempters. FINDINGS Depression positively predicted quit attempts, but not after controlling for quitting history and motivational variables. Controlling for all covariates, depression consistently negatively predicted abstinence. Cessation support did not moderate this effect. There was a significant interaction with gender for quit attempts (P = 0.018) and abstinence (P = 0.049) after controlling for demographics, but not after all covariates. Depression did not predict abstinence among men. Among women, depressive symptoms [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.49-0.81] and diagnosis (OR = 0.46, 95% CI = 0.34-0.63) negatively predicted abstinence. CONCLUSIONS Smokers with depressive symptoms or diagnosis make more quit attempts than their non-depressed counterparts, which may be explained by higher motivation to quit, but they are also more likely to relapse in the first month. These findings are stronger in women than men.
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Affiliation(s)
- Jae Cooper
- Cancer Council Victoria, Melbourne, Australia
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Australia
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Chaiton M, Diemert L, Cohen JE, Bondy SJ, Selby P, Philipneri A, Schwartz R. Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open 2016; 6:e011045. [PMID: 27288378 PMCID: PMC4908897 DOI: 10.1136/bmjopen-2016-011045] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The number of quit attempts it takes a smoker to quit successfully is a commonly reported figure among smoking cessation programmes, but previous estimates have been based on lifetime recall in cross-sectional samples of successful quitters only. The purpose of this study is to improve the estimate of number of quit attempts prior to quitting successfully. DESIGN We used data from 1277 participants who had made an attempt to quit smoking in the Ontario Tobacco Survey, a longitudinal survey of smokers followed every 6 months for up to 3 years beginning in 2005. We calculated the number of quit attempts prior to quitting successfully under four different sets of assumptions. Our expected best set of assumptions incorporated a life table approach accounting for the declining success rates for subsequent observed quit attempts in the cohort. RESULTS The estimated average number of quit attempts expected before quitting successfully ranged from 6.1 under the assumptions consistent with prior research, 19.6 using a constant rate approach, 29.6 using the method with the expected lowest bias, to 142 using an approach including previous recall history. CONCLUSIONS Previous estimates of number of quit attempts required to quit may be underestimating the average number of attempts as these estimates excluded smokers who have greater difficulty quitting and relied on lifetime recall of number of attempts. Understanding that for many smokers it may take 30 or more quit attempts before being successful may assist with clinical expectations.
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Affiliation(s)
- Michael Chaiton
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lori Diemert
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
| | - Joanna E Cohen
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan J Bondy
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Robert Schwartz
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Varenicline impairs extinction and enhances reinstatement across repeated cycles of nicotine self-administration in rats. Neuropharmacology 2016; 105:463-470. [DOI: 10.1016/j.neuropharm.2016.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 01/10/2023]
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DeLaughter KL, Sadasivam RS, Kamberi A, English TM, Seward GL, Chan SW, Volkman JE, Amante DJ, Houston TK. Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation. JMIR Serious Games 2016; 4:e3. [PMID: 27229772 PMCID: PMC4901191 DOI: 10.2196/games.4566] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/23/2015] [Accepted: 01/08/2016] [Indexed: 12/04/2022] Open
Abstract
Background Smoking is still the number one preventable cause of death. Cravings—an intense desire or longing for a cigarette—are a major contributor to quit attempt failure. New tools to help smokers’ manage their cravings are needed. Objective To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings. Methods We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014. Results Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource www.decide2quit.org linked to the game. Conclusions Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions. Trial Registration Clinicaltrials.gov NCT00797628; https://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6hbJr6LWG)
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Bold KW, Rasheed AS, McCarthy DE, Jackson TC, Fiore MC, Baker TB. Rates and predictors of renewed quitting after relapse during a one-year follow-up among primary care patients. Ann Behav Med 2015; 49:128-40. [PMID: 24796541 DOI: 10.1007/s12160-014-9627-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Most people who quit smoking relapse within a year of quitting. Little is known about what prompts renewed quitting after relapse or how often this results in abstinence. PURPOSE This study seeks to identify rates, efficacy, and predictors of renewed quit attempts after relapse during a 1-year follow-up. METHODS Primary care patients in a comparative effectiveness trial of smoking cessation pharmacotherapies reported daily smoking every 6-12 weeks for 12 months to determine relapse, renewed quitting, and 12-month abstinence rates. RESULTS Of 894 known relapsers, 291 (33%) renewed quitting for at least 24 h, and 99 (34%) of these were abstinent at follow-up. The average latency to renewed quitting was 106 days and longer latencies predicted greater success. Renewed quitting was more likely for older, male, less dependent smokers, and later abstinence was predicted by fewer depressive symptoms and longer past abstinence. CONCLUSIONS Renewed quitting is common and produces meaningful levels of cessation.
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Affiliation(s)
- Krysten W Bold
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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Predictors of Successful Quitting among Thai Adult Smokers: Evidence from ITC-SEA (Thailand) Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12095-109. [PMID: 26404335 PMCID: PMC4626957 DOI: 10.3390/ijerph121012095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 11/17/2022]
Abstract
This study uses longitudinal data from the International Tobacco Control Southeast Asia (ITC-SEA Thailand) survey to explore patterns and predictors of successful quitting among Thai adult smokers as a function of time quit. A cohort of a representative sample of 2000 smokers was surveyed four times from 2005 to 2009. A sample of 1533 individuals provided data for at least one of the reported analyses. Over the four years of follow-up, 97% made attempts to quit. Outcomes were successful quitting/relapse: (a) quit attempts of at least one month (short-term relapse, 43%) (57% remaining quit); (b) surviving at least six months (medium-term) (31%); (c) relapse between one and six months (45%); (d) having continuously quit between Waves 3 and 4 (sustained abstinence) (14%); and (e) relapse from six months on (44%) compared to those who continuously quit between Waves 3 and 4 (56%). Predictors for early relapse (<1 month) differ from longer-term relapse. Age was associated with reduced relapse over all three periods, and was much stronger for longer periods of abstinence. Cigarette consumption predicted relapse for short and medium terms. Self-assessed addiction was predictive of early relapse, but reversed to predict abstinence beyond six months. Previous quit history of more than one week was predictive of early abstinence, but became unrelated subsequently. Self-efficacy was strongly predictive of abstinence in the first month but was associated with relapse thereafter. Some determinants of relapse change with time quit, but this may be in somewhat different to patterns found in the West.
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Hughes JR, Naud S, Fingar JR, Callas PW, Solomon LJ. Do environmental cues prompt attempts to stop smoking? A prospective natural history study. Drug Alcohol Depend 2015; 154:146-51. [PMID: 26190558 PMCID: PMC4540219 DOI: 10.1016/j.drugalcdep.2015.06.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We prospectively tested whether environmental cues prompts attempts to stop smoking. METHODS We recruited 134 smokers who intended to quit in the next 3 months to complete nightly calls to report cues as well as smoking status, intentions to smoke or not on the next day, and quit attempts over 12 weeks. We provided no treatment. RESULTS Participants averaged 6.5 cues/week. The most common cues were embarrassment, cost of cigarettes and messages in the media. The number of cues over a 7-day period predicted the incidence of a quit attempt on the eighth day (e.g. from 1.5% when no cues occurred to 3% when 7 cues occurred during the 7 days). This effect was dose-dependent and was due to both between and within-subject predictors. Five cues predicted quit attempts. A cue that made smokers concerned about the cost of cigarettes appeared to be the strongest cue. Cues on the day prior were not more powerful predictors than more distal cues. Intention to not smoke the next day on the evening prior to the eighth day was a partial mediator of the effect of cues on quit attempts. Retrospective recall of cues was poor. CONCLUSIONS Our results suggest the occurrence of cues may be a cause of quit attempts and that programs to increase the frequency of cues may increase quit attempts. Further research should examine whether environmental cues and introspective states (e.g. self-efficacy) interact to prompt quit attempts.
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Affiliation(s)
- John R Hughes
- Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT 05401, USA.
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT 05401, USA
| | - James R Fingar
- Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT 05401, USA
| | - Peter W Callas
- Department of Medical Biostatistics, University of Vermont, Burlington, VT 05401, USA
| | - Laura J Solomon
- Department of Family Medicine, University of Vermont, Burlington, VT 05405, USA
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Khara M, Okoli C, Nagarajan VD, Aziz F, Hanley C. Smoking cessation outcomes of referral to a specialist hospital outpatient clinic. Am J Addict 2015; 24:561-70. [PMID: 26303966 DOI: 10.1111/ajad.12259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/23/2015] [Accepted: 07/03/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hospital visits are an opportunity to engage smokers in tobacco treatment. However, little is known about engagement in follow-up referrals. The purpose of this study is to report the rates of program engagement and smoking cessation outcomes of patients referred to a specialist outpatient tobacco treatment program after a hospital visit or other referral. METHODS A retrospective chart review was used to examine the outcomes of 486 participants referred to a hospital-based smoking cessation clinic provided by tobacco treatment specialists. Referral sources, demographics and smoking, medical, psychiatric, and substance use history were obtained. The main outcomes of interest were engagement in the program and 7-day point-prevalence of smoking abstinence. RESULTS Sixty-eight percent of participants who were referred to the program were considered "engaged," of which 70% were from hospitals, 4% from community programs, 11% were from general practitioners, and 16% were self-referrals. Thirty-percent (98/331) of engagers were abstinent by time of chart review (30% from the hospital, 8% from community programs, 19% from general practitioners, and 39% of self-referrals). Having quit for 1 month or longer at the past quit attempt, greater confidence in quitting smoking, lower expired carbon monoxide levels at baseline, and greater duration in the program were significant predictors of successful smoking cessation. DISCUSSION AND CONCLUSION Providing tobacco treatment follow-up and referral for smokers after a hospital visit is important to enhance smoking cessation efforts. SCIENTIFIC SIGNIFICANCE Referral to evidence-based tobacco treatment after hospital visits is effective. Models of tobacco treatment based on sources of referral should further be explored.
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Affiliation(s)
- Milan Khara
- Vancouver General Hospital, Smoking Cessation Clinic, Vancouver, British Columbia, Canada
| | - Chizimuzo Okoli
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | | | - Faisal Aziz
- Vancouver General Hospital, Smoking Cessation Clinic, Vancouver, British Columbia, Canada
| | - Catherine Hanley
- Vancouver General Hospital, Smoking Cessation Clinic, Vancouver, British Columbia, Canada
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Nicholson AK, Borland R, Davey ME, Stevens M, Thomas DP. Past quit attempts in a national sample of Aboriginal and Torres Strait Islander smokers. Med J Aust 2015; 202:S20-5. [DOI: 10.5694/mja15.00202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/06/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Maureen E Davey
- Aboriginal Health Service, Tasmanian Aboriginal Centre, Hobart, TAS
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Nicholson AK, Borland R, Davey ME, Stevens M, Thomas DP. Predictors of wanting to quit in a national sample of Aboriginal and Torres Strait Islander smokers. Med J Aust 2015; 202:S26-32. [DOI: 10.5694/mja15.00199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/11/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Maureen E Davey
- Aboriginal Health Service, Tasmanian Aboriginal Centre, Hobart, TAS
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Thomas DP, Panaretto KS, Stevens M, Borland R. Dependence in a national sample of Aboriginal and Torres Strait Islander daily smokers. Med J Aust 2015; 202:S39-44. [DOI: 10.5694/mja15.00105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
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Effects of Encouraging Rapid Implementation and/or Structured Planning of Quit Attempts on Smoking Cessation Outcomes: a Randomized Controlled Trial. Ann Behav Med 2015; 49:732-42. [DOI: 10.1007/s12160-015-9706-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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McCarthy DE, Ebssa L, Witkiewitz K, Shiffman S. Paths to tobacco abstinence: A repeated-measures latent class analysis. J Consult Clin Psychol 2015; 83:696-708. [PMID: 25867447 DOI: 10.1037/ccp0000017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Knowledge of smoking change processes may be enhanced by identifying pathways to stable abstinence. We sought to identify latent classes of smokers based on their day-to-day smoking status in the first weeks of a cessation attempt. We examined treatment effects on class membership and compared classes on baseline individual differences and 6-month abstinence rates. METHOD In this secondary analysis of a double-blind randomized placebo-controlled clinical trial (N = 1,433) of 5 smoking cessation pharmacotherapies (nicotine patch, nicotine lozenge, bupropion SR, patch and lozenge, or bupropion SR and lozenge), we conducted repeated-measures latent class analysis of daily smoking status (any smoking vs. none) for the first 27 days of a quit attempt. Treatment and covariate relations with latent class membership were examined. Distal outcome analysis compared confirmed 6-month abstinence rates among the latent classes. RESULTS A 5-class solution was selected. Three-quarters of smokers were in stable smoking or abstinent classes, but 25% were in classes with unstable abstinence probabilities over time. Active treatment (compared to placebo), and particularly the patch and lozenge combination, promoted early quitting. Latent classes differed in 6-month abstinence rates and on several baseline variables, including nicotine dependence, quitting history, self-efficacy, sleep disturbance, and minority status. CONCLUSIONS Repeated-measures latent class analysis identified latent classes of smoking change patterns affected by treatment, related to known risk factors, and predictive of distal outcomes. Tracking behavior early in a change attempt may identify prognostic patterns of change and facilitate adaptive treatment planning.
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Affiliation(s)
| | - Lemma Ebssa
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey
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Cowie GA, Swift E, Partos T, Borland R. Quitting activity and tobacco brand switching: findings from the ITC-4 Country Survey. Aust N Z J Public Health 2015; 39:109-13. [PMID: 25827182 PMCID: PMC4506928 DOI: 10.1111/1753-6405.12323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/01/2014] [Accepted: 10/01/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Among Australian smokers, to examine associations between cigarette brand switching, quitting activity and possible causal directions by lagging the relationships in different directions. METHODS Current smokers from nine waves (2002 to early 2012) of the ITC-4 Country Survey Australian dataset were surveyed. Measures were brand switching, both brand family and product type (roll-your-own versus factory-made cigarettes) reported in adjacent waves, interest in quitting, recent quit attempts, and one month sustained abstinence. RESULTS Switching at one interval was unrelated to concurrent quit interest. Quit interest predicted switching at the following interval, but the effect disappeared once subsequent quit attempts were controlled for. Recent quit attempts more strongly predicted switching at concurrent (OR 1.34, 95%CI=1.18-1.52, p<0.001) and subsequent intervals (OR 1.31, 95%CI=1.12-1.53, p=0.001) than switching predicted quit attempts, with greater asymmetry when both types of switching were combined. One month sustained abstinence and switching were unrelated in the same interval; however, after controlling for concurrent switching and excluding type switchers, sustained abstinence predicted lower chance of switching at the following interval (OR=0.66, 95%CI=0.47-0.93, p=0.016). CONCLUSIONS The asymmetry suggests brand switching does not affect subsequent quitting. IMPLICATIONS Brand switching does not appear to interfere with quitting.
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Affiliation(s)
- Genevieve A. Cowie
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria
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Durkin S, Brennan E, Coomber K, Zacher M, Scollo M, Wakefield M. Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers. Tob Control 2015; 24:ii26-ii32. [PMID: 28407608 PMCID: PMC4392190 DOI: 10.1136/tobaccocontrol-2014-052058] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/12/2014] [Accepted: 01/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Plain packaging (PP) with larger graphic health warnings (GHWs) was implemented in Australia in late 2012. This study examined effects of these packaging changes on short-term changes in quitting-related cognitions and behaviours. METHODS We used a series of cohorts of Australian adult cigarette smokers originally sourced from a nationally representative cross-sectional tracking survey, followed up approximately 1 month after their baseline interview (n(weighted)=5441). Logistic regression analyses compared changes in seven quitting-related outcomes over this 1-month follow-up period for the cohorts surveyed before PP, over the period of transition to PP, and during the first year of PP, adjusting for baseline levels of the outcome and covariates. RESULTS Compared to the referent group of smokers who completed their follow-up survey pre-PP, those who were followed-up in the early transition period showed significantly greater increases in rates of stopping themselves from smoking (OR=1.51, 95% CI (1.08 to 2.10)) and higher quit attempt rates (OR=1.43, 95% CI (1.00 to 2.03)), those followed-up in the late transition period showed greater increases in intentions to quit (OR=1.42, 95% CI (1.06 to 1.92)) and pack concealment (OR=1.55, 95% CI (1.05 to 2.31)), and those followed-up in the first year of PP showed higher levels of pack concealment (OR=1.65, 95% CI (1.01 to 2.72)), more premature stubbing out of cigarettes (OR=1.55, 95% CI (1.01 to 2.36)), and higher quit attempt rates (OR=1.52, 95% CI (1.01 to 2.30)). CONCLUSIONS These findings provide some of the strongest evidence to date that implementation of PP with larger GHWs was associated with increased rates of quitting cognitions, microindicators of concern and quit attempts among adult cigarette smokers.
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Affiliation(s)
- Sarah Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kerri Coomber
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Meghan Zacher
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Michelle Scollo
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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Ferguson SG, Brown J, Frandsen M, West R. Associations between use of pharmacological aids in a smoking cessation attempt and subsequent quitting activity: a population study. Addiction 2015; 110:513-8. [PMID: 25393225 DOI: 10.1111/add.12795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 09/22/2014] [Accepted: 10/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Modelling the population impact and cost-effectiveness of smoking cessation aids is limited by lack of knowledge about how the use of aids changes across quit attempts. Here we test whether the quit method used in a previous attempt influences (i) future decisions to quit and/or (ii) treatment/s used during subsequent attempts. DESIGN AND SETTING Data came from the Smoking Toolkit Study, a United Kingdom national household survey. PARTICIPANTS AND MEASURES Smokers (n = 5489) who completed a baseline and 6-month follow-up questionnaire. Respondents were asked what treatment/s, grouped as: prescription medication/s [bupropion, varenicline or nicotine replacement therapy (NRT)], over-the-counter NRT or unaided that they had used in their most recent quit attempt (at baseline), and any use of treatment/s for a quit attempt in the last 3 months at follow-up. RESULTS Smokers who had tried to quit at baseline were more likely to report having tried to quit again prior to follow-up [all odds ratios ≥ 2.19 relative to no attempt at baseline, P < 0.001]. Smokers who tried to quit using pharmacological aids were more likely to try to quit again at follow-up (all ORs ≥ 2.19 relative to no attempt at baseline, P < 0.001). Smokers tended to re-try aids used in baseline attempts in future attempts (all ORs ≥ 1.48 relative to no attempt at baseline, P < 0.01). CONCLUSIONS Smokers who have tried to quit in the past year are more likely to try to quit again within 6 months regardless of whether they used a pharmacological aid, and they are more likely to re-try aids they had used previously.
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Brennan E, Durkin S, Coomber K, Zacher M, Scollo M, Wakefield M. Are quitting-related cognitions and behaviours predicted by proximal responses to plain packaging with larger health warnings? Findings from a national cohort study with Australian adult smokers. Tob Control 2015; 24:ii33-ii41. [PMID: 28407610 PMCID: PMC4401338 DOI: 10.1136/tobaccocontrol-2014-052057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 11/12/2022]
Abstract
Background Implementation of tobacco plain packaging (PP) with larger graphic health warnings (GHWs) in Australia had positive effects on responses reflecting the specific objectives of the PP policy and on follow-up quitting-related cognitions and behaviours. The aim of this study was to examine predictive relationships between these proximal and distal outcomes. Methods A nationally representative sample of Australian adult cigarette smokers completed a baseline survey and a 1-month follow-up survey within the first year of policy implementation (n(weighted)=3125). Logistic regression analyses tested whether baseline measures of cigarette appeal, GHW effectiveness, perceived harm and concern/enjoyment predicted each of seven follow-up measures of quitting-related cognitions and behaviours, adjusting for baseline levels of the outcome and covariates. Results In multivariable models, we found consistent evidence that several baseline measures of GHW effectiveness positively and significantly predicted the likelihood that smokers at follow-up reported thinking about quitting at least daily, intending to quit, having a firm date to quit, stubbing out cigarettes prematurely, stopping oneself from smoking and having attempted to quit. Two of the quitting-related outcomes were also predicted by feeling more smoking-related concern than enjoyment. A smaller number of the appeal variables were prospectively associated with quitting-related outcomes, while believing that brands do not differ in harmfulness did not positively predict any outcomes. Conclusions These findings provide an initial insight into the pathways through which PP with larger GHWs may lead to changes in smoking behaviour. Future research should examine whether the effects are conditional on individual demographic and smoking characteristics.
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Affiliation(s)
- Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Sarah Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kerri Coomber
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Meghan Zacher
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Michelle Scollo
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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Burris JL, Heckman BW, Mathew AR, Carpenter MJ. A mechanistic test of nicotine replacement therapy sampling for smoking cessation induction. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 29:392-9. [PMID: 25347021 DOI: 10.1037/adb0000035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Studies that explore the mechanisms of treatment effect are needed in the area of smoking cessation induction, the primary goal of which is to promote the occurrence of a quit attempt among individuals who report little interest in smoking cessation. This study tested the mediational effect of 5 psychological variables (motivation to quit, abstinence self-efficacy, knowledge of nicotine replacement therapy (NRT), and both positive and negative attitudes toward NRT) on the relationship between NRT sampling and smoking outcomes. Adults who reported low levels of intention to quit in the next month (n = 593) were recruited for a nationwide randomized clinical trial of NRT sampling. Participants provided self-report data via telephone interview on multiple occasions, with the final follow-up at 6 months. Motivation to quit, and to a lesser degree, abstinence self-efficacy at the end of the 6-week intervention best accounted for the effect of NRT sampling as a promoter of quit attempts, smoking reduction, and 7-day point prevalence abstinence. Providing smokers with free NRT samples, in addition to encouraging them to engage in temporary abstinence, results in meaningful change in motivation and self-efficacy, which in turn influence smoking outcomes. Cessation induction interventions should aim to increase motivation to quit and abstinence self-efficacy, above and beyond any efforts to increase knowledge or prompt attitudinal shifts. (PsycINFO Database Record
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Affiliation(s)
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | | | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
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Falkenstein MJ, Rogers K, Malloy EJ, Haaga DAF. Predictors of Relapse Following Treatment of Trichotillomania. J Obsessive Compuls Relat Disord 2014; 3:345-353. [PMID: 25405081 PMCID: PMC4231486 DOI: 10.1016/j.jocrd.2014.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study sought to identify predictors of relapse in a behavior therapy trial for trichotillomania (TTM), or hair-pulling disorder. Relapse is common after treatment for TTM, and only a few studies have examined what might predict relapse. METHOD Data was examined from a TTM treatment study with a stepped-care approach (step 1. web-based self-help; step 2. individual behavior therapy) (N = 60). Implications of significant predictive relations were illustrated by constructing Probability of Treatment Benefit (PTB) charts (Lindhiem, Kolko, & Cheng, 2012), which quantify the probability of maintaining gains according to predictors of maintenance. RESULTS Abstinence at the conclusion of treatment and lower TTM severity during initial response significantly predicted maintenance. Abstinence periods prior to treatment, residual urges after achieving abstinence, pre-treatment TTM severity, intrinsic motivation, and treatment compliance did not predict maintenance. CONCLUSIONS Post-treatment abstinence and lower TTM severity during initial response predicted maintenance. Replications of this research are needed to determine the usefulness of these possible predictors in identifying relapse-prone patients, with the aim of improving clinical decision-making and developing strategies to help these patients better maintain gains. This is the first TTM study to use PTB charts, which can help clarify the meaning of prognostic analyses.
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Hughes JR, Solomon LJ, Naud S, Fingar JR, Helzer JE, Callas PW. Natural history of attempts to stop smoking. Nicotine Tob Res 2014; 16:1190-8. [PMID: 24719491 PMCID: PMC4184396 DOI: 10.1093/ntr/ntu052] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/06/2014] [Indexed: 01/26/2023]
Abstract
INTRODUCTION This study provides a prospective fine-grain description of the incidence and pattern of intentions to quit, quit attempts, abstinence, and reduction in order to address several clinical questions about self-quitting. METHODS A total of 152 smokers who planned to quit in the next 3 months called nightly for 12 weeks to an Interactive Voice Response system to report cigarettes/day, quit attempts, intentions to smoke or not in the next day, and so forth. No treatment was provided. RESULTS Most smokers (60%) made multiple transitions among smoking, reduction, and abstinence. Intention to not smoke or quit often did not result in a quit attempt but were still strong predictors of a quit attempt and eventual abstinence. Most quit attempts (79%) lasted less than 1 day; about one fifth (18%) of the participants were abstinent at 12 weeks. The majority of quit attempts (72%) were not preceded by an intention to quit. Such quit attempts were shorter than quit attempts preceded by an intention to quit (<1 day vs. 25 days). Most smokers (67%) used a treatment, and use of a treatment was nonsignificantly associated with greater abstinence (14 days vs. 3 days). Making a quit attempt and failing early predicted an increased probability of a later quit attempt compared to not making a quit attempt early (86% vs. 67%). Smokers often (17%) failed to report brief quit attempts on an end-of-study survey. CONCLUSIONS Cessation is a more chronic, complex, and dynamic process than many theories or treatments assume.
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Affiliation(s)
- John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT;
| | - Laura J Solomon
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - James R Fingar
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - John E Helzer
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Peter W Callas
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
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Balmford J, Swift E, Borland R. Reported planning before and after quitting and quit success: retrospective data from the ITC 4-Country Survey. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:899-906. [PMID: 25134049 DOI: 10.1037/a0035711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Planning before quitting smoking is widely believed to be beneficial and is usually recommended in cessation counseling, but there is little evidence on the efficacy of specific planning activities. Using data from 1140 respondents who reported quit attempts at Wave 8 of the ITC 4-Country Survey, we analyzed use of 8 specific planning strategies before (5) and after (3) implementation of a quit attempt, in relation to cessation outcomes, delay in implementation of the attempt, and recent quitting history. Most participants reported some planning both before and after quitting, even among those reporting quitting 'spontaneously.' Younger smokers, those who cut down before quitting, and users of stop-smoking medication were more likely to report planning. Those who planned prequit were also more likely to plan postquit. Unexpectedly, we found no clear benefit of planning on short-term (1 month) cessation outcomes, whereas one prequit strategy (practicing not smoking) was negatively related to outcome. There was evidence for a predicted moderating effect of recent quitting experience on planning for the prequit task 'practice replacement strategies.' This predicted quit success among those with multiple quit attempts in the past year, but failure among those without. This finding suggests that the quality of planning may be critical. More research, particularly on the moderating effect of quit experience, and where measures of planning are collected before outcomes become evident, is needed before clear recommendations can be made on the utility of various forms of planning for the success of quit attempts.
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Affiliation(s)
- James Balmford
- VicHealth Centre for Tobacco Control, Cancer Council Victoria
| | - Elena Swift
- VicHealth Centre for Tobacco Control, Cancer Council Victoria
| | - Ron Borland
- VicHealth Centre for Tobacco Control, Cancer Council Victoria
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Partos TR, Borland R, Thrasher JF, Li L, Yong HH, O'Connor RJ, Siahpush M. The predictive utility of micro indicators of concern about smoking: findings from the International Tobacco Control Four Country study. Addict Behav 2014; 39:1235-42. [PMID: 24813549 DOI: 10.1016/j.addbeh.2014.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 03/18/2014] [Accepted: 04/02/2014] [Indexed: 11/28/2022]
Abstract
This study explored the association between six "micro indicators" of concern about smoking (1. stubbing out cigarettes before finishing; 2. forgoing cigarettes due to packet warning labels; thinking about... 3. the harms to oneself of smoking; 4. the harms to others of one's smoking; 5. the bad conduct of tobacco companies; and 6. money spent on cigarettes) and cessation outcomes (making quit attempts, and achieving at least six months of sustained abstinence) among adult smokers from Australia, Canada, the United Kingdom, and the United States of America. Participants were 12,049 individuals from five survey waves of the International Tobacco Control Four Country Survey (interviewed between 2002 and 2006, and followed-up approximately one year later). Generalized estimating equation logistic regression analysis was used, enabling us to control for within-participant correlations due to possible multiple responses by the same individual over different survey waves. The frequency of micro indicators predicted making quit attempts, with premature stubbing out, forgoing, and thinking about the harms to oneself of smoking being particularly strong predictors. An interaction effect with expressed intention to quit was observed, such that stubbing out and thinking about the harms on oneself predicted quit attempts more strongly among smokers with no expressed plans to quit. In contrast, there was a negative association between some micro indicators and sustained abstinence, with more frequent stubbing out, forgoing, and thinking about money spent on cigarettes associated with a reduced likelihood of subsequently achieving sustained abstinence. In countries with long-established tobacco control programs, micro indicators index both high motivation by smokers to do something about their smoking at least partly independent of espoused intention and, especially those indicators not part of a direct pathway to quitting, reduced capacity to quit successfully.
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Affiliation(s)
- Timea R Partos
- The Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Ron Borland
- The Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Health Sciences Building, 215, 800 Sumter Street, Columbia, SC 29208, USA.
| | - Lin Li
- The Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Hua-Hie Yong
- The Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA. Richard.O'
| | - Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA.
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