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Taylor GM, Treur JL. An application of the stress-diathesis model: A review about the association between smoking tobacco, smoking cessation, and mental health. Int J Clin Health Psychol 2023; 23:100335. [PMID: 36247407 PMCID: PMC9531043 DOI: 10.1016/j.ijchp.2022.100335] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022] Open
Abstract
Background Worldwide, approximately 24% of all adults smoke, but smoking is up to twice as prevalent in people with mental ill-health. There is growing evidence that smoking may be a causal risk factor in the development of mental illness, and that smoking cessation leads to improved mental health. Methods In this scholarly review we have: (1) used a modern adaptation of the Bradford-Hill criteria to bolster the argument that smoking could cause mental ill-health and that smoking cessation could reverse these effects, and (2) by considering psychological, biological, and environmental factors, we have structured the evidence to-date into a stress-diathesis model. Results Our model suggests that smoking is a psychobiological stressor, but that the magnitude of this effect is mediated and modulated by the individual's diathesis to develop mental ill-health and other vulnerability and protective factors. We explore biological mechanisms that underpin the model, such as tobacco induced damage to neurological systems and oxidative stress pathways. Furthermore, we discuss evidence indicating that it is likely that these systems repair after smoking cessation, leading to better mental health. Conclusion Based on a large body of literature including experimental, observational, and novel causal inference studies, there is consistent evidence showing that smoking can negatively affect the brain and mental health, and that smoking cessation could reverse the mental ill-health caused by smoking. Our model suggests that smoking prevention and treatment strategies have a role in preventing and treating mental illness as well as physical illness.
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Affiliation(s)
- Gemma M.J. Taylor
- Department of Psychology, University of Bath, 10 West, Bath BA2 7AY, United Kingdom,Corresponding author.
| | - Jorien L. Treur
- Department of Psychiatry, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Gorniak B, Yong HH, Borland R, Cummings KM, Thrasher JF, McNeill A, Hyland A, Fong GT. Do post-quitting experiences predict smoking relapse among former smokers in Australia and the United Kingdom? Findings from the International Tobacco Control Surveys. Drug Alcohol Rev 2022; 41:883-889. [PMID: 34882878 PMCID: PMC9064888 DOI: 10.1111/dar.13419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/26/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Many smokers attempt to stop smoking every year, but the vast majority of quit attempts fail. This study examined prospectively the association between post-quitting experiences and smoking relapse among ex-smokers in Australia and the United Kingdom. METHODS Data came from 584 adult ex-smokers from Australia and the United Kingdom who participated in Wave 9 of the International Tobacco Control Four Country Survey and successfully followed up a year later (Wave 10). Binary logistic regression was used to examine whether baseline post-quitting experiences predicted relapse back to smoking at follow-up. RESULTS Ex-smokers who perceived their stress coping ability had gotten worse since quitting were more likely to relapse back to smoking compared to their counterparts who reported no change (odds ratio = 5.77, 95% confidence interval = 1.64, 20.31, P < 0.01). Ex-smokers who reported their homes had become fresher and cleaner post quitting were less likely to relapse compared to those who did not notice any change (odds ratio = 0.34, 95% confidence interval = 0.13, 0.93, P < 0.05). Perceived changes in life enjoyment, negative affect control, social confidence, work performance, leisure time and financial situation did not independently predict relapse. No country differences were found. DISCUSSION AND CONCLUSIONS The study showed that ex-smokers' relapse risk was elevated if they perceived any negative impact of quitting on their stress coping whereas relapse risk was reduced if they perceived any positive impact of quitting on the home (e.g. fresher and cleaner). Helping ex-smokers to develop alternative stress coping strategies and highlighting the positive impacts of quitting smoking on the homes may help protect against smoking relapse.
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Affiliation(s)
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Shaping Public hEalth poliCies To Reduce ineqUalities and harM (SPECTRUM), Usher Institute, Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, USA
| | - Geoffrey T Fong
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Department of Psychology, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
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Taylor GM, Lindson N, Farley A, Leinberger-Jabari A, Sawyer K, Te Water Naudé R, Theodoulou A, King N, Burke C, Aveyard P. Smoking cessation for improving mental health. Cochrane Database Syst Rev 2021; 3:CD013522. [PMID: 33687070 PMCID: PMC8121093 DOI: 10.1002/14651858.cd013522.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a common perception that smoking generally helps people to manage stress, and may be a form of 'self-medication' in people with mental health conditions. However, there are biologically plausible reasons why smoking may worsen mental health through neuroadaptations arising from chronic smoking, leading to frequent nicotine withdrawal symptoms (e.g. anxiety, depression, irritability), in which case smoking cessation may help to improve rather than worsen mental health. OBJECTIVES To examine the association between tobacco smoking cessation and change in mental health. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the trial registries clinicaltrials.gov and the International Clinical Trials Registry Platform, from 14 April 2012 to 07 January 2020. These were updated searches of a previously-conducted non-Cochrane review where searches were conducted from database inception to 13 April 2012. SELECTION CRITERIA: We included controlled before-after studies, including randomised controlled trials (RCTs) analysed by smoking status at follow-up, and longitudinal cohort studies. In order to be eligible for inclusion studies had to recruit adults who smoked tobacco, and assess whether they quit or continued smoking during the study. They also had to measure a mental health outcome at baseline and at least six weeks later. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcomes were change in depression symptoms, anxiety symptoms or mixed anxiety and depression symptoms between baseline and follow-up. Secondary outcomes included change in symptoms of stress, psychological quality of life, positive affect, and social impact or social quality of life, as well as new incidence of depression, anxiety, or mixed anxiety and depression disorders. We assessed the risk of bias for the primary outcomes using a modified ROBINS-I tool. For change in mental health outcomes, we calculated the pooled standardised mean difference (SMD) and 95% confidence interval (95% CI) for the difference in change in mental health from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For the incidence of psychological disorders, we calculated odds ratios (ORs) and 95% CIs. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using I2. We conducted subgroup analyses to investigate any differences in associations between sub-populations, i.e. unselected people with mental illness, people with physical chronic diseases. We assessed the certainty of evidence for our primary outcomes (depression, anxiety, and mixed depression and anxiety) and our secondary social impact outcome using the eight GRADE considerations relevant to non-randomised studies (risk of bias, inconsistency, imprecision, indirectness, publication bias, magnitude of the effect, the influence of all plausible residual confounding, the presence of a dose-response gradient). MAIN RESULTS We included 102 studies representing over 169,500 participants. Sixty-two of these were identified in the updated search for this review and 40 were included in the original version of the review. Sixty-three studies provided data on change in mental health, 10 were included in meta-analyses of incidence of mental health disorders, and 31 were synthesised narratively. For all primary outcomes, smoking cessation was associated with an improvement in mental health symptoms compared with continuing to smoke: anxiety symptoms (SMD -0.28, 95% CI -0.43 to -0.13; 15 studies, 3141 participants; I2 = 69%; low-certainty evidence); depression symptoms: (SMD -0.30, 95% CI -0.39 to -0.21; 34 studies, 7156 participants; I2 = 69%' very low-certainty evidence); mixed anxiety and depression symptoms (SMD -0.31, 95% CI -0.40 to -0.22; 8 studies, 2829 participants; I2 = 0%; moderate certainty evidence). These findings were robust to preplanned sensitivity analyses, and subgroup analysis generally did not produce evidence of differences in the effect size among subpopulations or based on methodological characteristics. All studies were deemed to be at serious risk of bias due to possible time-varying confounding, and three studies measuring depression symptoms were judged to be at critical risk of bias overall. There was also some evidence of funnel plot asymmetry. For these reasons, we rated our certainty in the estimates for anxiety as low, for depression as very low, and for mixed anxiety and depression as moderate. For the secondary outcomes, smoking cessation was associated with an improvement in symptoms of stress (SMD -0.19, 95% CI -0.34 to -0.04; 4 studies, 1792 participants; I2 = 50%), positive affect (SMD 0.22, 95% CI 0.11 to 0.33; 13 studies, 4880 participants; I2 = 75%), and psychological quality of life (SMD 0.11, 95% CI 0.06 to 0.16; 19 studies, 18,034 participants; I2 = 42%). There was also evidence that smoking cessation was not associated with a reduction in social quality of life, with the confidence interval incorporating the possibility of a small improvement (SMD 0.03, 95% CI 0.00 to 0.06; 9 studies, 14,673 participants; I2 = 0%). The incidence of new mixed anxiety and depression was lower in people who stopped smoking compared with those who continued (OR 0.76, 95% CI 0.66 to 0.86; 3 studies, 8685 participants; I2 = 57%), as was the incidence of anxiety disorder (OR 0.61, 95% CI 0.34 to 1.12; 2 studies, 2293 participants; I2 = 46%). We deemed it inappropriate to present a pooled estimate for the incidence of new cases of clinical depression, as there was high statistical heterogeneity (I2 = 87%). AUTHORS' CONCLUSIONS Taken together, these data provide evidence that mental health does not worsen as a result of quitting smoking, and very low- to moderate-certainty evidence that smoking cessation is associated with small to moderate improvements in mental health. These improvements are seen in both unselected samples and in subpopulations, including people diagnosed with mental health conditions. Additional studies that use more advanced methods to overcome time-varying confounding would strengthen the evidence in this area.
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Affiliation(s)
- Gemma Mj Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amanda Farley
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | | | - Katherine Sawyer
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | | | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Naomi King
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Chloe Burke
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Conti AA, Tolomeo S, Steele JD, Baldacchino AM. Severity of negative mood and anxiety symptoms occurring during acute abstinence from tobacco: A systematic review and meta-analysis. Neurosci Biobehav Rev 2020; 115:48-63. [PMID: 32454051 DOI: 10.1016/j.neubiorev.2020.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 01/20/2023]
Abstract
This review was conducted with the following goals: To quantify the severity of mood and anxiety symptoms emerging during acute abstinence from tobacco (1). To explore sex differences related to the experience of specific symptoms (2). To investigate the early time course of symptoms (3). A meta-analysis was performed from 28 studies assessing mood and anxiety symptoms during the earliest phases of tobacco abstinence (up to 24 hrs post-quit) conducted from 1999 to 2019. Results revealed a significant (p < 0.0001) increase in 'anxiety', 'anger/irritability', 'depressed mood /sadness', and composite negative affect ('NA') in the 24 hours following smoking cessation. The largest effect size was detected for 'anxiety' (0.63). A qualitative analysis was performed to investigate sex differences and the time course of the specific symptoms. Results indicated that female smokers may experience worse mood symptoms compared to male smokers and that these symptoms may emerge within 3 hrs post-quit. Smoking cessation programs should implement sex-tailored interventions in order to improve their effectiveness, while future research should focus on alternative methods of nicotine administration.
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Affiliation(s)
- A A Conti
- University of St Andrews, School of Medicine, Division of Population and Behavioural Science, UK
| | - S Tolomeo
- National University of Singapore (NUS), Department of Psychology, Singapore
| | - J D Steele
- University of Dundee, School of Medicine, Division of Imaging Science and Technology, UK
| | - A M Baldacchino
- University of St Andrews, School of Medicine, Division of Population and Behavioural Science, UK.
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Taylor GMJ, McNeill A, Farley A, Lindson N, Aveyard P. Smoking cessation for improving mental health. Hippokratia 2020. [DOI: 10.1002/14651858.cd013522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gemma MJ Taylor
- University of Bath; Addiction and Mental Health Group (AIM), Department of Psychology; Bath UK
| | - Ann McNeill
- Institute of Psychiatry, Psychology & Neuroscience, King's College London; UK Centre for Tobacco and Alcohol Studies, National Addiction Centre; London UK
| | - Amanda Farley
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Edgbaston Birmingham West Midlands UK B15 2TT
| | - Nicola Lindson
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
| | - Paul Aveyard
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
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Hovhannisyan K, Günther M, Raffing R, Wikström M, Adami J, Tønnesen H. Compliance with the Very Integrated Program (VIP) for Smoking Cessation, Nutrition, Physical Activity and Comorbidity Education Among Patients in Treatment for Alcohol and Drug Addiction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2285. [PMID: 31261620 PMCID: PMC6650928 DOI: 10.3390/ijerph16132285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 12/20/2022]
Abstract
Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29-0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00-1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.
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Affiliation(s)
- Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden.
| | - Michelle Günther
- Skånevård Kryh, Medicon Village, Region Skåne, 223 81 Lund, Sweden
| | - Rie Raffing
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden.
- Clinical Health Promotion Centre, WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57-59, Entr. 5, 2000 Frederiksberg, Denmark.
| | - Maria Wikström
- Student Health, Malmö University, Neptuniplan 7, 21118 Malmö, Sweden
| | - Johanna Adami
- President Office, Sophiahemmet University, Box 5605, 114 86 Stockholm, Sweden
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden
- Clinical Health Promotion Centre, WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57-59, Entr. 5, 2000 Frederiksberg, Denmark
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Song F, Bachmann MO, Aveyard P, Barton GR, Brown TJ, Maskrey V, Blyth A, Notley C, Holland R, Sutton S, Brandon TH. Relapse to smoking and health-related quality of life: Secondary analysis of data from a study of smoking relapse prevention. PLoS One 2018; 13:e0205992. [PMID: 30458010 PMCID: PMC6245517 DOI: 10.1371/journal.pone.0205992] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/03/2018] [Indexed: 12/27/2022] Open
Abstract
Background Previous studies have shown that smoking and smoking cessation may be associated with health-related quality of life (HRQoL). In this study, we compared changes in HRQoL in people who maintained abstinence with people who had relapsed to smoking. Methods This was a secondary analysis of data from a trial of a relapse prevention intervention in 1,407 short-term quitters. The European Quality of Life -5 Dimensions (EQ-5D) measured HRQoL at baseline, 3 and 12 months. Smoking outcome was continuous abstinence from 2 to 12 months, and 7-day smoking at 3 and 12 months. We used nonparametric test for differences in EQ-5D utility scores, and chi-square test for dichotomised response to each of the five EQ-5D dimensions. Multivariable regression analyses were conducted to evaluate associations between smoking relapse and HRQoL or anxiety/depression problems. Results The mean EQ-5D tariff score was 0.8252 at baseline. People who maintained abstinence experienced a statistically non-significant increase in the EQ-5D score (mean change 0.0015, P = 0.88), while returning to smoking was associated with a statistically significant decrease in the EQ-5D score (mean change -0.0270, P = 0.004). After adjusting for multiple baseline characteristics, the utility change during baseline and 12 months was statistically significantly associated with continuous abstinence, with a difference of 0.0288 (95% CI: 0.0006 to 0.0571, P = 0.045) between relapsers and continuous quitters. The only difference in quality of life dimensions between those who relapsed and those who maintained abstinence was in the proportion of participants with anxiety/depression problems at 12 months (30% vs. 22%, P = 0.001). Smoking relapse was associated with a simultaneous increase in anxiety/depression problems. Conclusions People who achieve short-term smoking abstinence but subsequently relapse to smoking have a reduced quality of life, which appears mostly due to worsening of symptoms of anxiety and depression. Further research is required to more fully understand the relationship between smoking and health-related quality of life, and to develop cessation interventions by taking into account the impact of anxiety or depression on smoking.
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Affiliation(s)
- Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, United Kingdom
- * E-mail:
| | - Max O. Bachmann
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, United Kingdom
| | - Garry R. Barton
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, United Kingdom
| | - Tracey J. Brown
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, United Kingdom
| | - Vivienne Maskrey
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, United Kingdom
| | - Annie Blyth
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, United Kingdom
| | - Caitlin Notley
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, United Kingdom
| | - Richard Holland
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Research Park, Norwich, United Kingdom
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Thomas H. Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa FL, United States of America
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Offer and Use of Smoking-Cessation Support by Depression/Anxiety Status: A Cross-Sectional Survey. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Higher levels of anxiety and depression have been found to be associated with greater difficulty in stopping smoking. This raises the question as to whether mood disturbance may be associated with exposure to, and use of, quitting support.Aims: This study examined whether General Practitioner (GP) advice and/or offer of support, or stop-smoking service use differed between smokers reporting or not reporting depression/anxiety.Methods: Data came from the Smoking Toolkit Study. Participants were 1,162 English adults who reported currently smoking or having stopped within the past 12 months, aged 40+ years, surveyed between April and September 2012. Anxiety/depression was assessed by the mood disturbance item of the EuroQol five dimensions questionnaire (EQ-5D). This was compared to recall of GP quit advice and/or support, and stop-smoking aid use adjusting for age, gender, and social grade.Results/Findings: Smokers reporting depression/anxiety were more likely to recall being offered advice and support to stop smoking by their GP (OR = 1.50, 95% C.I. = 1.05–2.13). However, there were no significant differences in use of stop-smoking aids during the past year.Conclusions: Smokers reporting depression/anxiety are more likely to be offered stop-smoking support by their GPs, but this does not appear to translate into stop-smoking aid use, despite high motivation to quit. Given higher nicotine dependence in this group, mental health specific support may need to be offered, and more needs to be done to make this offer of aid attractive.
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Joly B, Perriot J, d’Athis P, Chazard E, Brousse G, Quantin C. Success rates in smoking cessation: Psychological preparation plays a critical role and interacts with other factors such as psychoactive substances. PLoS One 2017; 12:e0184800. [PMID: 29020085 PMCID: PMC5636087 DOI: 10.1371/journal.pone.0184800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/31/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The aim of this study was to identify factors associated with the results of smoking cessation attempts. METHODS Data were collected in Clermont-Ferrand from a smoking cessation clinic between 1999 and 2009 (1,361 patients). Smoking cessation was considered a success when patients were abstinent 6 months after the beginning of cessation. Multivariate logistic regression was used to investigate the association between abstinence and different factors. RESULTS The significant factors were a history of depression (ORadjusted = 0.57, p = 0.003), state of depression at the initial consultation (ORa = 0.64, p = 0.005), other psychoactive substances (ORa = 0.52, p<0.0001), heart, lung and Ear-Nose-Throat diseases (ORa = 0.65, p = 0.005), age (ORa = 1.04, p<0.0001), the Richmond test (p<0.0001; when the patient's motivation went from insufficient to moderate, the frequency of abstinence was twice as high) and the Prochaska algorithm (p<0.0001; when the patient went from the 'pre-contemplation' to the 'contemplation' level, the frequency of success was four times higher). A high score in the Richmond test had a greater impact on success with increasing age (significant interaction: p = 0.01). In exclusive smokers, the contemplation level in the Prochaska algorithm was enough to obtain a satisfactory abstinence rate (65.5%) whereas among consumers of other psychoactive substances, it was necessary to reach the preparation level in the Prochaska algorithm to achieve a success rate greater than 50% (significant interaction: p = 0.02). CONCLUSION The psychological preparation of the smoker plays a critical role. The management of smoking cessation must be personalized, especially for consumers of other psychoactive substances and/or smokers with a history of depression.
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Affiliation(s)
- Bertrand Joly
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Jean Perriot
- Dispensaire Emile Roux, Centre d'Aide à I'Arrêt du Tabagisme (IRAAT), Centre de Lutte Anti-Tuberculeuse (CLAT), Clermont-Ferrand, France
| | - Philippe d’Athis
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Emmanuel Chazard
- Univ. Lille, CHU Lille, Department of Public Health, Lille, France
| | - Georges Brousse
- Psychiatry B-Department of Addictology, Université Clermont 1, UFR Médecine, Clermont-Ferrand, and CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
- INSERM, CIC 1432, Dijon, France; Dijon UniversityHospital, Clinical Investigation Center, Clinicalepidemiology/ Clinical trials unit, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- * E-mail:
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Depression among current, former, and never smokers from 2005 to 2013: The hidden role of disparities in depression in the ongoing tobacco epidemic. Drug Alcohol Depend 2017; 173:191-199. [PMID: 28209289 PMCID: PMC5366262 DOI: 10.1016/j.drugalcdep.2016.11.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND After declining sharply for many years, the prevalence of smoking has remained fairly stable over the past decade. One possible explanation is that there has been an increase in the prevalence of barriers to cessation, like depression, among remaining smokers. OBJECTIVES To estimate changes in the prevalence of depression among current, former and never smokers in the United States (U.S.) population from 2005 to 2013 overall and by age, gender, and income. METHODS Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons ages 12 and over (N=496,805). The prevalence of past 12-month depression was examined annually among current (past 12-month), former (not past 12-month), and lifetime non-smokers from 2005 to 2013. Data were re-analyzed stratified by age, gender, and household income, and adjusted for demographics. RESULTS Depression appears to have significantly increased in the United States from 2005 to 2013 among current, former, and never smokers. Depression prevalence increased among current smokers overall, but the increase among former and never smokers was even more prominent. Striking temporal changes emerged by age, gender and income. Specifically, (1) depression increased significantly among current smokers aged 12-17 (from 16% to 22%, p-value=0.0002) and the prevalence was consistently more than twice as high as that of never smokers; (2) depression increased among male smokers (6.19%-7.82%, p-value=0.0099); (3) depression increased significantly among smokers in the highest income group (6.36% to 8.91%, p-value=0.0400). Throughout this period, the prevalence of depression among current smokers was consistently twice as high as among former and never smokers. DISCUSSION Public health efforts aimed at decreasing the prevalence of smoking should take depression into account, a common and modifiable barrier whose treatment may help to increase successful smoking cessation. Future work is needed to disentangle the role of smoking and other factors that lead to increases in depression in the US population.
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