Lower Likelihood Of Smoking Cessation Research Articles

Evaluation of factors affecting smoking cessation in people treated with Varenicline

Objective: Aim of the study is to evaluate factors affecting treatment success among individuals receiving varenicline therapy for smoking cessation. Material and Methods: This research was carried out at Istanbul Medeniyet University Göztepe Training and Research Hospital between January 2018 and January 2019. A total of 209 patients in the smoking cessation outpatient clinic who were treated with varenicline Varenicline were constituted into the study group. The Fagerstrom Nicotine Dependence Level Test (FTND) was used to determine individuals' nicotine addiction levels, and the Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression levels. Results: There were 90 (43.1%) women and 119 (56.9%) men in the study group and mean age was 41.34 ± 10.93 (21-64) years. Overall, 63.2% (n=132) of varenicline recipients quit smoking. The frequency of quitting smoking due to physician advice was higher in those who quit than those who did not (p=0.011). Multiple logistic regression revealed that the independent factors associated with the lower likelihood of smoking cessation were higher number of cigarettes per day (p=0.008), higher HADS-Total score (p<0.001), post-treatment nervousness (p=0.046), and post-treatment depressive mood (p=0.007), whereas being able to remain smoke-free for longer periods in previous quitting attempts was associated with higher likelihood of success (p=0.005). Conclusion: The success of smoking cessation with varenicline therapy is lower in the presence of the following factors: having high risk for anxiety and depression, smoking a greater number of cigarettes per day, shorter periods of remaining smoke-free in previous quitting attempts, and experiencing nervousness during withdrawal. Receiving physician advice to quit also appears to increase the chance of quitting smoking. Keywords: Smoking; Smoking Cessation; Smoking Cessation Agents; Varenicline; Anxiety; Depression

Cigarettes Smoking Pattern in Patient with Urothelial Carcinoma of the Bladder after Smoking Cessation in Tertiary Hospital

Background: Urothelial carcinoma is the most widely recognized histologic type of bladder cancer. Smoking duration and intensity associated with tumour aggressiveness and recurrence. This study aims to examine smoking behavioural change in patients with bladder urothelial carcinoma who were given an intervention for smoking cessation. Methods: A cross-sectional study (2009 – 2019) was conducted. Subjects were divided into three groups: patients who had smoked <20 cigarettes per day for ≤30 years; patients who had smoked for 31–40 years or had smoked >20 cigarettes per day for ≤30 years; and patients who had smoked for >40 years. General characteristics, educational level and quit levels are noted. These data were obtained from the medical record and anamnesis by telephone. Result: A total of 325 patients with urothelial cancer between 2009-2019 were involved. 273 (84%) patients were male, aged 58.71 ± 12.8 years. 40.9% had a history of smoking for >40 years, 66.5% of patients did not quit smoking at all. There was a significant difference in smoking cessation rates between groups with a history of different smoking intensities (p = 0.000). Mann-Whitney U test showed that there was a significant difference between the group who had a history of smoking <20 cigarettes for ≤30 years and the group who smoked for 31-40 years or >20 cigarettes per day for ≤30 years with the group who smoked for >40 years (p = 0.000 on both comparisons). 135 (41.5%) patients were in the lower education group.Conclusion: The patient’s history of heavy smoking intensity and lower educational level was associated with a lower likelihood of smoking cessation. Urologists must play an important role in the education and intervention process to support patients to quit smoking. A guide/guideline is needed and it could be through a special smoking clinic for counselling or treatment.

Smoking cessation after acute coronary syndrome: A systematic review and meta-analysis.

Smoking cessation is an effective secondary prevention measure after acute coronary syndrome (ACS). We conducted a systematic review with the aim to better understand which patients have a greater propensity to quit smoking and the risk factors for continued smoking after ACS. We searched MEDLINE and EMBASE for studies that evaluated smoking cessation after ACS. The pooled rate of smoking cessation across included studies was performed. Random effects meta-analysis for different variables and their association with smoking cessation was conducted. A total of 39 studies with 11228 patients were included in this review. The pooled rate of smoking cessation following ACS across 38 studies was 45.0%. Factors associated with greater likelihood of smoking cessation were attendance at cardiac rehabilitation (OR 1.90 95% CI 1.44-2.51), married/not alone (OR 1.68 95% CI 1.32-2.13), intention/attempt to quit smoking (OR 1.27 95% CI 1.11-1.46), diabetes mellitus (OR 1.24 95% CI 1.03-1.51) and hospitalised duration (OR 1.09 95% CI 1.02-1.15). Variables associated with a lower likelihood of smoking cessation were depression (OR 0.57 95% CI 0.43-0.75), chronic obstructive pulmonary disease/lung disease (OR 0.73 95% CI 0.57-0.93), previous admission with acute myocardial infarction/cardiac admission (OR 0.61 95% CI 0.47-0.80), cerebrovascular disease/transient ischaemic attack (OR 0.42 95% CI 0.30-0.58) and unemployment (OR 0.37 95% CI 0.17-0.80). The majority of smokers with an ACS continue to smoke after admission. Patients attending cardiac rehabilitation show increased odds of quitting while people who are depressed and those with chronic lung disease were less likely to quit smoking and should be targeted for intensive smoking cessation interventions.

Depressive symptoms predict smoking cessation in a 20-year longitudinal study of adult twins

Depression has been suggested to hinder smoking cessation, especially when co-occurring with nicotine dependence. The study aimed to examine the longitudinal association of depressive symptoms with smoking cessation among daily smokers. The study utilized adult Finnish twin cohort where 1438 daily smokers (mean age: 38.3, range: 33–45) in 1990 were re-examined for their smoking status in 2011. We assessed baseline depressive symptoms with the Beck Depression Inventory, and the self-reported smoking status at follow-up. The methods included multinomial logistic regression and time to event analyses, adjusted for multiple covariates (age, sex, marital status, social class, heavy drinking occasions, and health status) and smoking heaviness at baseline assessed by cigarettes per day (CPD). Additionally, within-twin-pair analyses were conducted. Results indicated that moderate/severe depressive symptoms at baseline were associated with a lower likelihood of smoking cessation two decades later. Adjusting for covariates, those with moderate/severe depressive symptoms (vs. no/minimal depressive symptoms) had 46% lower likelihood of quitting (relative risk ratio, RRR = 0.54, 95% CI: 0.30–0.96). After including CPD, the association of depressive symptoms with smoking cessation attenuated modestly (RRR = 0.62, 95% CI: 0.34–1.12). Further, time to event analysis for quitting year since baseline yielded similar findings. In the within-pair analysis, depressive symptoms were not associated with quitting smoking. The results suggest that reporting more depressive symptoms is associated with a lower likelihood of smoking cessation during a 20-year period. The baseline amount of smoking and familial factors partly explain the observed association. Smoking cessation programs should monitor depressive symptoms.

Darker skin color is associated with a lower likelihood of smoking cessation among males but not females

Darker skin color is associated with discrimination and unfair treatment and may contribute to persisting health disparities. This study examined whether darker skin color was associated with smoking cessation and whether this association was moderated by sex and race. This study also explored whether biological and psychosocial factors, including nicotine and cotinine concentrations, discrimination, distrust, and neuroticism, mediated this association. The data for this study came from a prospective smoking cessation intervention that included 224 Black and 225 White adults from Kansas City, Missouri. Skin color was assessed using a DermaSpectrometer to measure melanin contained within the skin. Point prevalence smoking abstinence was biochemically-verified and assessed at weeks 4 and 26. Hierarchical logistic regression analyses were conducted to evaluate hypothesized relations between skin color and smoking cessation. Interactions between race and sex with skin color were also evaluated. While skin color was not associated with smoking cessation in the overall sample or among Blacks only, results indicated that sex moderated the effect of skin color on smoking cessation after adjusting for race and other covariates. Among males, darker skin color was associated with lower odds of achieving smoking abstinence at weeks 4 (OR = 0.60 [95% CI = 0.36, 0.99]) and 26 (OR = 0.52 [95% CI = 0.29, 0.91]). Skin color did not predict smoking cessation among females. Skin color was positively correlated with discrimination (r = 0.15, p = 0.02), cynicism/distrust (r = 0.14, p = 0.03) and neuroticism (r = 0.24, p < 0.01) among males only. However, these factors did not mediate the association between skin color and smoking cessation. Skin color may contribute to cessation-related health disparities among Black males, but more research is needed to understand the psychosocial and biological mechanisms through which skin color influences tobacco cessation.

Childhood Adversity Interacts With Adult Stressful Events to Predict Reduced Likelihood of Smoking Cessation Among Women but Not Men

Research has documented important sex differences in associations between early stress, stress-sensitization, and psychiatric outcomes. The current study investigated whether sex differences in stress-sensitization extended to cigarette smoking cessation. Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions (waves 1 and 2), selecting for current daily and non-daily smokers at wave 1 (daily smokers: n=3,499 women, 3055 men; non-daily smokers: n=451 women, 501 men). Three-way interactions between sex, childhood adversity, and past year stressful life events were modeled in the prediction of smoking cessation. Among women, stressful life events were more strongly related to lower likelihood of smoking cessation for those with a history of childhood adversity than those without. This relationship was not found among men. The stress-sensitization model may be applicable to women with regards to smoking cessation, supporting further exploration of stress-sensitization as a prevention and clinical target for smoking cessation.

CHRNA5 risk variant predicts delayed smoking cessation and earlier lung cancer diagnosis--a meta-analysis.

Recent meta-analyses show strong evidence of associations among genetic variants in CHRNA5 on chromosome 15q25, smoking quantity, and lung cancer. This meta-analysis tests whether the CHRNA5 variant rs16969968 predicts age of smoking cessation and age of lung cancer diagnosis. Meta-analyses examined associations between rs16969968, age of quitting smoking, and age of lung cancer diagnosis in 24 studies of European ancestry (n = 29 072). In each dataset, we used Cox regression models to evaluate the association between rs16969968 and the two primary phenotypes (age of smoking cessation among ever smokers and age of lung cancer diagnosis among lung cancer case patients) and the secondary phenotype of smoking duration. Heterogeneity across studies was assessed with the Cochran Q test. All statistical tests were two-sided. The rs16969968 allele (A) was associated with a lower likelihood of smoking cessation (hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.91 to 0.98, P = .0042), and the AA genotype was associated with a four-year delay in median age of quitting compared with the GG genotype. Among smokers with lung cancer diagnoses, the rs16969968 genotype (AA) was associated with a four-year earlier median age of diagnosis compared with the low-risk genotype (GG) (HR = 1.08, 95% CI = 1.04 to 1.12, P = 1.1*10(-5)). These data support the clinical significance of the CHRNA5 variant rs16969968. It predicts delayed smoking cessation and an earlier age of lung cancer diagnosis in this meta-analysis. Given the existing evidence that this CHRNA5 variant predicts favorable response to cessation pharmacotherapy, these findings underscore the potential clinical and public health importance of rs16969968 in CHRNA5 in relation to smoking cessation success and lung cancer risk.

Frequency and characteristics associated with exposure to tobacco direct mail marketing and its prospective effect on smoking behaviors among young adults from the US Midwest.

We examined the exposure to tobacco direct mail marketing and its effect on subsequent smoking behaviors in a US Midwest regional cohort of young adults. Data were collected from 2622 young adults (mean age = 24 years) in 2010 to 2011 (baseline) and 2011 to 2012 (follow-up). We collected information on demographics, tobacco use, and exposure to tobacco direct mail materials in the previous 6 months at baseline. Smoking behaviors were reassessed at follow-up. We investigated the characteristics associated with receiving these materials at baseline, and the associations between receiving cigarette coupons in the mail at baseline and smoking behaviors at follow-up. Thirteen percent of participants reported receiving tobacco direct mail materials in the previous 6 months. Receipt of these materials was associated with age, education, and tobacco use (P < .05). Among those who received these materials, 77% and 56% reported receiving coupons for cigarettes and other tobacco products, respectively. Among baseline nonsmokers and ex-smokers, receiving coupons was associated with becoming current smokers at follow-up (P < .05). Among baseline current smokers, receiving coupons was associated with lower likelihood of smoking cessation at follow-up (P < .05). Tobacco direct mail marketing promoted and sustained smoking behaviors among US Midwest young adults. Regulating this marketing strategy might reduce the prevalence of smoking in this population.

Socioeconomic Indicators Associated with Initiation and Cessation of Smoking among Women in Seoul

BackgroundWhile smoking prevalence in Korean men has been decreasing, it is increasing in Korean women. Little is known about women's smoking inequalities in Korea. This study was conducted to investigate the association of socioeconomic indicators with the initiation and cessation of smoking among Korean women.MethodsThis was a cross-sectional study on 9,089 women aged 25-64 years from the 2008 Seoul Community Health Survey. The data on smoking and socioeconomic status were obtained through face-to-face interviews. Smoking initiation rate was defined as the proportion of the individuals who had started smoking at least one cigarette among all subjects. Smoking cessation rate was calculated by dividing the number of individuals who had quit smoking by the number of ever smokers. Education level, total family income and occupation were investigated as socioeconomic indicators.ResultsEducation level was significantly associated with both initiation and cessation of smoking. Lower educated women had a higher likelihood of smoking initiation (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.17 to 2.51) but lower likelihood of smoking cessation (OR, 0.38; 95% CI, 0.22 to 0.66) than higher educated women. Smoking initiation rate was higher in manual workers (OR, 1.65; 95% CI, 1.20 to 2.27) than in non-manual workers. However, there were no significant differences of both initiation and cessation of smoking according to total household income.ConclusionThis study shows that there are smoking inequalities among Korean women. It is thought that education level and occupation are important determinants of women's smoking status.

FDA Finding May Curb Mentholated Cigarette Availability

T he availability of menthol cigarettes increases the likelihood that youths and African Americans will become habitual smokers, making menthols a greater public-health hazard than regular brands, the U.S. Food and Drug Administration’s Tobacco Products Scientific Advisory Committee (TPSAC) said at its mid-March meeting. “The availability of menthol cigarettes has an adverse impact on public health by increasing the number of smokers and increasing the number of avoidable deaths and premature mortality,” said committee member Mark Stuart Clanton, M.D., chief medical officer of the American Cancer Society’s High Plains Division. However, the committee found insuffi cient evidence to conclude that smoking menthols increases the likelihood of addiction among all adults. Nor did evidence indicate that mentholated brands are more dangerous than regular cigarettes, which increase lung and other cancers, heart disease, emphysema, and other chronic conditions. The TPSAC’s conclusions came after a year-long review of epidemiological and physiological studies of menthol smokers in the past decade. The committee’s fi ndings could lead to stepped-up FDA regulation of mentholated brands, which could go as far as a ban. The FDA has until mid-June to issue its fi nal review of the evidence. Agency officials were noncommittal about what actions they might take in response to the TPSAC report. “We do recognize the strong interest in this issue,” said Lawrence Deyton, M.D., director of the Center for Tobacco Products at FDA. “Now it’s up to us to do our job.” The 2009 Tobacco Control Act, which created TPSAC and gave the FDA the authority to regulate tobacco, targeted menthol cigarettes as the fi rst product for heightened scrutiny because of mounting evidence that mentholated brands ultimately lead to lifelong smoking by youths and minorities. The consensus statement of the eight-member panel (three industry representatives on the committee were not allowed to vote on the fi nal recommendations) said the evidence was suffi cient to reach that conclusion. The committee found that menthol brands increase experimentation and regular smoking, as well as increase the likelihood of addiction in young smokers and African-Americans, 80% of whom prefer menthols. It also found that smoking menthols makes the success of smokingcessation programs less likely. “Youths who initiate with menthol cigarettes are more likely to become daily, regular smokers than those who initiate with nonmenthol cigarettes, [and] adolescent menthol smokers have a higher prevalence of addiction than those who smoke nonmenthol cigarettes,” Clanton said. Also, “the availability of menthol cigarettes results in lower likelihood of smoking cessation in AfricanAmericans [than that for] nonmenthol cigarettes.”

Associations of CYP2A6 genotype with smoking behaviors in southern China

To investigate the association of CYP2A6 genetic polymorphisms with smoking-related phenotypes in Chinese smokers. Case-only genetic association study. Southern China. A total of 1328 Han Chinese smokers who participated in a community-based chronic disease screening project in Guangzhou and Zhuhai from 2006 to 2007. All participants answered a structured questionnaire about socio-demographic status and smoking behaviors and informative alleles were genotyped for the cytochrome P450 2A6 (CYP2A6) gene (CYP2A6*4,*5,*7,*9 and *10). The frequencies of CYP2A6*4, *5, *7, *9 and *10 alleles were 8.5, 1.2, 6.3, 13.5 and 2.4%, which corresponded to 48.9, 15.4, 24.2 and 11.5% of participants being classified as normal, intermediate, slow and poor metabolizers, respectively. Multivariate analyses in male smokers demonstrated that compared with normal metabolizers, poor metabolizers reported smoking fewer cigarettes per day [adjusted odds ratio (OR) = 0.49; 95% confidence interval (CI): 0.32-0.76], started smoking regularly later in life (adjusted OR = 1.55; 95% CI: 1.06-2.26) and, among former smokers, reported smoking for a shorter duration prior to quitting (adjusted OR = 0.33; 95% CI: 0.12-0.94). However, poor metabolizers were less likely to quit smoking and remain abstinent than normal metabolizers (adjusted OR = 0.54; 95% CI: 0.34-0.86). Reduced metabolism function of cytochrome P450 2A6 in smokers appears to be associated with fewer cigarettes smoked, later initiation of smoking regularly, shorter smoking duration and lower likelihood of smoking cessation.

Adolescent Attributes and Young Adult Smoking Cessation Behavior

This study collected data five times between 1983 and 2002 from 400 participants who originally came from upstate New York. These participants completed structured interviews as did their mothers three times. LISREL analysis generally supported the hypothesized model. The results indicated that having parents who smoked and having low educational aspirations and expectations were associated with being unconventional, which, in turn, was related to having low emotional control and reporting more internalizing behaviors. Internalizing behaviors were directly associated with a lower likelihood of smoking cessation, as was parental smoking. Research and clinical implications are discussed and the limitations noted.

Depressive symptoms, drinking problems, and smoking cessation in older smokers

This study modeled the predictive association between depressive symptoms and smoking cessation in a sample of 442 late-middle-aged smokers; assessments occurred at four time-points across a 10-year period. In addition, the study examined the role of baseline drinking problems in moderating the relationship between depressive symptoms and smoking cessation. Findings supported hypotheses. More depressive symptoms prospectively predicted a lower likelihood of smoking cessation. In addition, the presence of baseline drinking problems strengthened the relationship between depressive symptoms and a lower likelihood of smoking cessation. Understanding the mechanisms underlying depression and cigarette smoking among older adults is applicable to secondary prevention and treatment and suggests additional public health benefits from treating depression in older persons.