Predictors Of Smoking Cessation Outcomes Research Articles

Data-Driven Approaches to Smoking Cessation Unraveling Predictors of Quitting through Machine Learning

In order to define the usefulness of machine learning in this domain and to pinpoint the machine learning techniques that have been used, a comprehensive review of the literature has been conducted. Multiple searches in MEDLINE, Science Citation Index, Social Science Citation Index, EMBASE, CINAHL Plus, APA PsycINFO, PubMed, Cochrane Central Register of Controlled Trials, and IEEE Xplore were conducted for the current study through December 9, 2022. Studies reporting cigarette smoking cessation results (smoking status and cigarette consumption) as well as a variety of experimental designs (such as cross-sectional and longitudinal) were considered as inclusion criteria. The effectiveness of behavioral markers, biomarkers, and other predictors was evaluated as a predictor of smoking cessation outcomes. Twelve papers were found in our systematic review that met our inclusion criteria. This review includes.

Predictors of smoking cessation outcomes identified by machine learning: A systematic review

This systematic review aims to characterize the utility of machine learning to identify the predictors of smoking cessation outcomes and identify the machine learning methods applied in this area. In the current study, multiple searches occurred through December 9, 2022 in MEDLINE, Science Citation Index, Social Science Citation Index, EMBASE, CINAHL Plus, APA PsycINFO, PubMed, Cochrane Central Register of Controlled Trials, and the IEEE Xplore were performed. Inclusion criteria included various machine learning techniques, studies reporting cigarette smoking cessation outcomes (smoking status and the number of cigarettes), and various experimental designs (e.g., cross-sectional and longitudinal). Predictors of smoking cessation outcomes were assessed, including behavioral markers, biomarkers, and other predictors. Our systematic review identified 12 papers fitting our inclusion criteria. In this review, we identified gaps in knowledge and innovation opportunities for machine learning research in the field of smoking cessation.

Neuroeconomic predictors of smoking cessation outcomes: A preliminary study of delay discounting in treatment-seeking adult smokers

Large proportions of smokers are unsuccessful in evidence-based smoking cessation treatment and identifying prognostic predictors may inform improvements in treatment. Steep discounting of delayed rewards (delay discounting) is a robust predictor of poor smoking cessation outcome, but the underlying neural predictors have not been investigated. Forty-one treatment-seeking adult smokers completed a functional magnetic resonance imaging (fMRI) delay discounting paradigm prior to initiating a 9-week smoking cessation treatment protocol. Behavioral performance significantly predicted treatment outcomes (verified 7-day abstinence, n = 18; relapse, n = 23). Participants in the relapse group exhibited smaller area under the curve (d = 1.10) and smaller AUC was correlated with fewer days to smoking relapse (r = 0.56, p < 0.001) Neural correlates of discounting included medial and dorsolateral prefrontal cortex, posterior cingulate, precuneus and anterior insula, and interactions between choice type and relapse status were present for the dorsolateral prefrontal cortex, precuneus and the striatum. This initial investigation implicates differential neural activity in regions associated with frontal executive and default mode activity, as well as motivational circuits. Larger samples are needed to improve the resolution in identifying the neural underpinnings linking steep delay discounting to smoking cessation.

No differences in delay discounting between smokers with and without HIV.

People with HIV (PWH) smoke cigarettes at much higher rates than the general population and evidence-based cessation methods are less effective, putting PWH at greater risk for negative health outcomes. It is critical to identify the factors that underlie this health disparity. Delay discounting-the decline in the value of a reward when it is delayed-may explain this disparity. This study aimed to (1) compare delay discounting between adult smokers with HIV and without HIV and (2) evaluate whether acute smoking abstinence disproportionately increases delay discounting among smokers with HIV. This sub-study was part of a larger study (NCT03169101) examining predictors of smoking cessation outcomes among smokers with HIV (n = 34) and smokers without HIV (n = 46) at two counterbalanced laboratory sessions (once smoking-as-usual and once following 24-h biochemically confirmed abstinence) then again, after 8 weeks of smoking cessation treatment. There were no significant differences in delay discounting rates between HIV status groups (p = 0.49) or within-subject abstinence effects (p = 0.70). However, smokers without HIV exhibited a significant increase in delay discounting following smoking cessation treatment compared to baseline (p = 0.02), whereas the change among smokers with HIV did not reach statistical significance (p = 0.09). These findings do not support differences in delay discounting as a reason for the lower success rates of HIV+ smokers at quitting. Although delay discounting may not explain the disparity in smoking rates between people with and without HIV, future work should focus on additional correlates of higher smoking rates and lower quit rates among people with HIV.

Boredom susceptibility as predictor of smoking cessation outcomes: Sex differences

Among the smoking motives, boredom relief is one of the most reported by smokers. The tendency to experience boredom has been proposed as a personality trait related to addictive behaviors and other variables such as depression or the perception of environmental reward. Differences in boredom susceptibility have also been observed among men and women. However, so far, there have been few studies investigating the differential impact of boredom susceptibility on both sexes regarding smoking outcomes. The aim of the present study was to analyze the relationship between boredom susceptibility, depressive symptoms, and environmental reward, and the influence of boredom susceptibility separately in men and women on smoking outcomes at 6- and 12-month follow-ups. Our sample was composed of 210 smokers seeking psychological treatment to quit smoking. Results showed that boredom susceptibility was not significantly related to depressive symptoms, but it showed a significant association with a lower perception of environmental reward. Boredom susceptibility was a significant predictor of smoking outcomes in men at the 6- and 12-month follow-ups, whereas in women, this construct was not a significant predictor. These findings support the need to consider sex and personality differences in smoking cessation treatments in order to increase their effectiveness.

Target quit date timing as a predictor of smoking cessation outcomes.

Evidence is mixed on whether timing of a target quit date (TQD) has an effect on quit success. The purpose of this secondary analysis of data from a prospective longitudinal study was to determine if time to TQD was a predictor of smoking abstinence at follow-up. Between 2011 and 2013, a total of 5,793 adult smokers participated in a 1-hr psychoeducation workshop and received 5 weeks of nicotine patch treatment. All participants were required to indicate a TQD within 1 month of the workshop. Latency to TQD was categorized into quartiles: 0 to 1 day (first quartile: 28.1%); 2 to 6 days (second quartile: 22.4%); 7 to 19 days (third quartile: 25.4%); 20-31 days (fourth quartile: 24.0%). Compared with participants who chose an immediate TQD within 1 day of the workshop, odds of having quit smoking at end-of-treatment and 6-month follow-up did not significantly differ among those who set a TQD within 2-6 days (5-weeks: adjusted odds ratio [AOR] = 0.89, p = .315; 6-months: AOR = 0.89, p = .417), but were significantly lower for those who chose a TQD either 7-19 days (5-weeks: AOR = 0.76, p = .023; 6-months: AOR = 0.70, p = .013) or 20-31 days (5-weeks: AOR = 0.64, p = .001; 6-months: AOR = 0.69, p = .017) after the workshop. TQD timing was an independent predictor of smoking cessation outcomes after controlling for potential confounding variables including confidence in quitting ability, importance of quitting, nicotine dependence, and number of nicotine patches used. (PsycINFO Database Record

Pain-related anxiety as a predictor of early lapse and relapse to cigarette smoking.

Although emerging research suggests that pain-related anxiety may play a role in the maintenance of tobacco dependence, no previous work has examined pain-related anxiety as a predictor of smoking cessation outcomes. The current study aimed to test the hypothesis that pain-related anxiety would predict early lapse and relapse to cigarette smoking. These data were collected in the context of a primary study examining the role of emotional vulnerabilities in smoking cessation. The current analyses were conducted among 55 daily cigarette smokers who attempted to quit without psychosocial or pharmacological cessation aids. Pain-related anxiety was assessed at baseline using the Pain Anxiety Symptom Scale-20 (PASS-20). Early lapse and relapse were assessed using timeline follow-back procedures. Cox regression analyses indicated that pain-related anxiety was a significant predictor of both early smoking lapse and relapse such that for every 1-point increase on the PASS-20, the risk of early lapse increased by 3.7% and the risk of early relapse increased by 3.6%. These effects were evident above and beyond the variance accounted for by tobacco dependence, past 4-week pain severity, anxiety sensitivity, and the presence of current Axis I psychopathology. Kaplan-Meier survival analyses further revealed that among early lapsers, greater pain-related anxiety predicted a more rapid trajectory to lapse. Pain-related anxiety was also a significant predictor of early lapse when the sample was limited to smokers with past 4-week pain. These findings lend empirical support to the notion that pain-related anxiety may contribute to the maintenance of tobacco dependence among smokers who experience varying levels of pain intensity. (PsycINFO Database Record

Factor structure of the Smoking Cessation Self-Efficacy Questionnaire among smokers with and without a psychiatric diagnosis.

Cessation self-efficacy has been shown to be a consistent predictor of smoking cessation outcomes. To date, no scale assessing cessation self-efficacy has been validated across smokers with and without a psychiatric diagnosis (current or past). Smokers with a psychiatric diagnosis are typically heavy smokers, have a more difficult time quitting, and are more prone to experience lower self-efficacy. Determining whether smoking cessation self-efficacy scores are invariant across these populations is crucial for future research and intervention strategies. Data from the Flexible and Extended Dosing of Nicotine Replacement Therapy (NRT) and Varenicline in Comparison to Fixed Dose NRT for Smoking Cessation: The FLEX Trial, a randomized control trial for smoking cessation, was used to assess the factor structure of the Smoking Cessation Self-Efficacy Questionnaire (SEQ-12), a 12-item scale assessing an individual's confidence to refrain from smoking. Confirmatory factor analysis (CFA) was used to compare the model's fit between the original factor structure and the present data, and to test for measurement invariance across with a current, past, or no psychiatric diagnosis. Initial support was found for both a 2- and 3-factor structure. Using CFA, only the 3-factor model displayed adequate fit indices (Global Fit Index [GFI] = 0.924). Results from the model comparisons showed no differences between those with a current, past, or no psychiatric diagnosis (cmin (30) = 38.64, p = .134). The 3 factors were highly correlated, indicative of an underlying global factor. The SEQ-12 was found to be measurement invariant across treatment-seeking smokers, with preliminary evidence suggesting it is a valid measurement scale for evaluating overall cessation self-efficacy, regardless of psychiatric status. (PsycINFO Database Record

A measure of perceived pain and tobacco smoking interrelations: pilot validation of the pain and smoking inventory

Mounting evidence indicates that pain can motivate cigarette smoking behavior, smokers have reliably endorsed the use of tobacco to cope with pain, and there is reason to suspect that pain may impede smoking cessation. Smoking-related outcome expectancies are among the best predictors of cigarette consumption and relapse, and the goal of this pilot study was to develop a standardized measure of how tobacco smokers perceive their pain and smoking behavior to be interrelated (i.e. pain as a motivator of smoking, expectancies for smoking as a means of coping with pain, and pain as a barrier to quitting). Participants (N = 75) completed an online survey that was designed to assess interrelations between pain and tobacco smoking. The nine-item Pain and Smoking Inventory (PSI) demonstrated excellent internal consistency (α = .95). As expected, PSI scores were higher among smokers with chronic pain (vs. no pain), and were positively associated with established indices of both pain and tobacco smoking dependence. These results corroborate the notion that smokers can effectively communicate perceptions of interrelations between their pain and smoking behavior. Future research is needed to establish reliability and validity of the PSI among larger, more diverse samples of smokers with varying levels of pain. Future work should also examine PSI scores as predictors of smoking cessation outcomes, and whether PSI data may usefully inform the development of tailored interventions for smokers in pain.

Temperament and impulsivity predictors of smoking cessation outcomes.

AimsTemperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes.MethodsNaturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as “dropout” versus “relapse” versus “abstinence” at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either “relapse” or “abstinence”, based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes.ResultsHigher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months respectively.ConclusionTemperament measures, and specifically novelty seeking and reward dependence, predict smoking cessation treatment retention, whereas persistence, non-planning impulsivity and poor decision-making predict smoking relapse.

Menthol Cigarette Use Predicts Treatment Outcomes of Weight-Concerned Smokers

Studies have shown that individuals who smoke menthol cigarettes are less likely to quit smoking and more likely to relapse during a quit attempt. The current study investigated menthol cigarette use as a potential predictor of smoking cessation outcomes in a sample of treatment-seeking smokers. This is a secondary analysis of data from a randomized controlled trial of low-dose naltrexone augmentation of nicotine replacement designed to examine smoking cessation and postcessation weight gain in weight-concerned smokers. Analyses revealed that menthol use predicted lower quit rates. Among menthol smokers (N = 61), 13% were abstinent at week 26, and among nonmenthol smokers (N = 105), 30% were abstinent (Wald = 4.15, p = .04; odds ratio [OR] = 2.47; 95% CI = 1.04-5.90). Further, menthol smokers who quit smoking gained significantly more weight at week 26 (M = 14.87 lbs, SD = 9.08; t(37) = -2.22, p = .03) than nonmenthol smokers who quit (M = 7.95 lbs, SD = 7.53). Menthol cigarette use has not typically been evaluated as a predictor of smoking cessation outcomes, but emerging evidence suggests that consumption of menthol may make cessation more difficult. This study adds to the literature supporting the claim that smoking menthol cigarettes can have adverse effects on smoking cessation efforts and on other cessation-related outcomes, such as postcessation weight gain.

Breath Holding Duration and Self-Reported Smoking Abstinence Intolerance as Predictors of Smoking Lapse Behavior in a Laboratory Analog Task

Distress intolerance (DI) is elevated in smokers and confers increased risk for relapse following a quit attempt. Intolerance of respiratory distress and of nicotine withdrawal may be particularly relevant predictors of smoking cessation outcomes. However, no studies to date have examined the association between smoking relevant DI and smoking lapse behavior in a laboratory setting. The current study examined whether DI was associated with the risk of initiating smoking in a laboratory-based lapse analog task. This study is a secondary data analysis from a study of the impact of alcohol administration on smoking behavior. Ninety-six cigarette smokers completed measures of DI and a smoking lapse analog task. Breath holding (BH) duration and self-reported intolerance of smoking abstinence were analyzed as predictors of smoking initiation in a survival analysis model. Shorter BH duration was associated with greater risk of smoking initiation, controlling for nicotine dependence, nicotine withdrawal symptoms, and demographics. Self-report measures of smoking abstinence DI were not associated with BH duration or time to smoking initiation when controlling for nicotine dependence severity. BH captures a domain of DI that is specifically associated with a higher risk of initiating smoking in this analog of smoking lapse. The prediction of smoking in an analog lapse task adds to the extant literature identifying an association between DI and smoking lapse and may enable further research to understand and address the mechanism through which BH affects smoking lapse risk.

Preliminary Evidence That Adherence to Counseling Mediates the Effects of Pretreatment Self-efficacy and Motivation on Outcome of a Cessation Attempt in Smokers with ADHD

Few studies have evaluated predictors of smoking cessation outcomes in smokers with attention-deficit/hyperactivity disorder (ADHD), which could help to improve suboptimal treatment outcomes in this population. The purpose of this study was to examine pretreatment thoughts about smoking abstinence (i.e., desire to quit, perceived difficulty quitting, and expected success in quitting) as predictors of smoking cessation outcomes in smokers with ADHD and to determine the extent to which treatment adherence mediates these relationships. Participants were adult smokers with ADHD (n = 255), who were enrolled in a multisite smoking cessation study and received either osmotic-release oral system methylphenidate (OROS-MPH) or placebo in combination with transdermal nicotine replacement and brief cessation counseling. Bootstrapped logistic regression models were generated to test main effects of thoughts about abstinence on smoking cessation outcomes and to examine treatment adherence as a mediator of these relationships. Desire to quit and expected success in quitting, but not perceived difficulty quitting, predicted smoking cessation outcomes, as did all of the treatment adherence variables (i.e., percent sessions attended, counselor ratings of counseling adherence, and percent patch adherence). Counseling adherence partially mediated the relationship between smoking cessation outcomes and both pretreatment desire to quit and expected success. Smokers with ADHD who have higher self-efficacy (i.e., expected success) and motivation (i.e., desire) to quit are more adherent to smoking cessation counseling and have better smoking cessation outcomes. Additional research is needed to determine whether treatment-seeking smokers with ADHD would benefit from an intervention designed to increase self-efficacy and motivation to quit.

Cue-Induced Cigarette Cravings and Smoking Cessation: The Role of Expectancies

Cue-induced cigarette cravings have been oft studied as potentially important predictors of smoking cessation outcomes. The literature on the relationship between cue-induced cravings and cessation, however, remains mixed. One possible explanation for the discrepant results in the literature may be the as-yet untested variability in expectancies of craving. Indeed, as with many interoceptive responses, cravings and their downstream consequences may be influenced by expectancies. To date, no study has examined the influence of expected cravings following smoking cue exposures on actual craving experiences and cessation outcomes. The objective of this study, therefore, was to test the possibility that smokers' expected craving levels in response to smoking cues would be related to actual cravings following cue exposure and that expected cravings would be related to cessation outcomes. Nicotine-dependent adult smokers (n = 153) were exposed to sets of neutral and smoking cues and completed questionnaires assessing (a) prior to the exposures, the cigarette craving levels they expected to experience following the cue exposures and (b) following the exposures, their actual craving levels. Participants also reported the duration of their most recent quit attempt and their perceived future quit difficulty. Findings indicated that expected cravings assessed prior to the cue exposures were significantly related to actual cravings following the exposures. In addition, both expected cravings and actual cravings were related to shorter previous quit duration and higher perceived quit difficulty. Study results highlight the importance of considering both expected and actual cravings in cue-induced craving paradigms.

Genetic predictors of cue- and stress-induced cigarette craving: an exploratory study.

Cigarette cravings in response to environmental cues and stressors are widely recognized as important predictors of smoking cessation outcomes. Accumulating evidence suggests that genetics plays a role in these craving responses, as well as in smoking cessation more generally. Previous studies of genetic polymorphisms have been limited by examination of single candidate genes and the use of broadly defined phenotypes (e.g., smoking history). In addition, research examining the similarities and differences between cue- and stress-induced cravings has been limited, although some evidence has suggested that they may have common genetic underpinnings. In the current study, we examined associations between a panel of 1,350 candidate genetic polymorphisms and craving responses to laboratory smoking cues and stressors. We hypothesized that common genetic polymorphisms would be predictive of both cue- and stress-induced craving. Nicotine-dependent smokers (n = 210) donated a blood sample, were exposed to neutral, smoking-related, and stress-related stimuli, and completed craving questionnaires immediately prior to and following each stimulus. Findings indicated that craving responses to smoking cues and stressors were moderately correlated (r = .44). However, genetic analysis revealed that cue and stress-induced cigarette craving were predicted by different polymorphisms, such that variants in the glycine and dopamine pathways were predictive of cue-induced craving, whereas variants in the stress-corticotropin pathway predicted stress-induced craving. Study results provide no support for the hypothesis that cue- and stress-induced craving have the same genetic predictors.

The role of negative affect in risk for early lapse among low distress tolerance smokers

Individual differences in the ability to tolerate negative affect due to psychological and/or physical discomfort (e.g., distress tolerance) are emerging as an important predictor of smoking cessation outcomes. The purpose of this study was to build on existing evidence by exploring the relationship between levels of distress tolerance (DT) and negative affect on quit date in relation to risk for early lapse. Eighty-one smokers (48% female; M age=42.6 years) who completed laboratory-based, behavioral distress tolerance tasks prior to an unaided quit attempt were categorized into low, average, and high persistence on the tasks. Low persistence smokers were significantly more likely to lapse on the assigned quit day. Among smokers able to achieve abstinence on quit day, low persistence smokers demonstrated higher levels of negative affect and urges compared to high persistence smokers. Further, negative affect-related risk for early lapse was strongest among those with low persistence. These findings suggest that smokers low in distress tolerance may be particularly vulnerable to very early lapse to smoking and that increases in negative affect may contribute to the risk for early lapse in this high-risk group of smokers.

Self-rating depression scale score is a strong independent predictor of smoking cessation outcomes

Self-rating depression scale score is a strong independent predictor of smoking cessation outcomes

Smoking status in the initial weeks of quitting as a predictor of smoking-cessation outcomes in pregnant women

Objective Any smoking during the initial 2 weeks of attempting to quit predicts poor short- and longer-term outcomes in the general population of cigarette smokers. The present study examined whether that rule applies to pregnant women. Methods Data were obtained from 129 women participating in clinical trials on smoking-cessation examining the efficacy of voucher-based incentives delivered contingent on biochemically-verified abstinence or a control condition wherein incentives were given independent of smoking status. Smoking status was assessed in weeks 1 and 2 of the cessation effort and again at an end-of-pregnancy assessment scheduled at weeks 28–32 gestation using self-report and biochemical verification. Results Smoking in weeks 1 or 2 predicted smoking at the end-of pregnancy assessment independent of treatment condition. There was a 79% and 92% chance that those who smoked in weeks 1 or 2 would be classified as smokers at end-of-pregnancy in the contingent-incentive and control conditions, respectively. Conclusions Clinicians assisting pregnant women trying to quit smoking may want to monitor progress in the initial weeks of the cessation effort and consider enhancing/changing the intervention when smoking is detected.