Individual Smoking Cessation Research Articles

Smoking Cessation and Alcohol Consumption in Individuals in Treatment for Alcohol Use Disorders

Most individuals with alcohol use disorders are dependent on both alcohol and nicotine, and combined use of both substances is more damaging to health than use of either alone. Although research indicates that alcoholics can quit smoking, discrepant results have been reported regarding whether smoking cessation is associated with increased risk of alcohol relapse. The purpose of this paper was to examine the relationship between smoking cessation and alcohol consumption using data from Project MATCH. Of the 1,307 participants who smoked at any point during the study, 160 (12%) quit. Quitters consumed less alcohol than those who continued smoking. In addition, quitters demonstrated a significant reduction in alcohol consumption at the time of smoking cessation, which was sustained for six months post-cessation. These findings suggest that individuals in treatment for alcohol use disorders who are motivated to stop smoking can safely be encouraged to do so without jeopardizing their sobriety.

Does stage‐based smoking cessation advice in pregnancy result in long‐term quitters? 18‐month postpartum follow‐up of a randomized controlled trial

To evaluate the effect on quitting smoking at 18 months postpartum of smoking cessation interventions based on the Transtheoretical Model (TTM) delivered in pregnancy compared to current standard care. It has been claimed that TTM-based interventions will continue to create quitters after the end of the intervention period. Cluster randomized trial. Antenatal clinics in general practices in the West Midlands, UK. A total of 918 pregnant smokers originally enrolled in the trial, of which 393 women were followed-up at 18 months postpartum. One hundred general practices were randomized into the three trial arms. Midwives in these practices delivered three interventions: A (standard care), B (TTM-based self-help manuals) and C (TTM-based self-help manuals plus sessions with an interactive computer program giving individualized smoking cessation advice). Self-reported continuous and point prevalence abstinence since pregnancy. When combined together, there was a slight and not significant benefit for both TTM arms compared to the control, with an odds ratio (OR) 95% confidence interval (CI) of 1.20 (0.29-4.88) for continuous abstinence. For point prevalence abstinence, the OR (95%CI) was 1.15 (0.66-2.03). Seven of the 54 (13%) women who had quit at the end of pregnancy were still quit 18 months later, and there was no evidence that the TTM-based interventions were superior in preventing relapse. The TTM-based interventions may have shown some evidence of a short-term benefit for quitting in pregnancy but no benefit relative to standard care when followed-up in the longer-term.

Multicomponent individualized smoking cessation intervention for patients with lung disease

This paper reports a study examining the process and outcomes of a long-term, multicomponent smoking cessation intervention for patients with lung disease initiated while hospitalized and provided over 1-year postdischarge. Successful smoking cessation interventions are of primary importance for people with lung disease. Initiation of such an intervention in hospital settings is particularly important as patients may be especially motivated to quit as a result of strong perceptions of vulnerability while hospitalized for a smoking-related disease. Tailoring the intervention to each person's needs is a promising approach to practice. All patients who smoked and were admitted to a pulmonary unit over 2 years were invited to participate in this quasi-experimental study (n = 85), and 69 continued beyond the first month. The intervention was shaped by the TransTheoretical Model and used nicotine replacement therapy, along with individual and group counselling and support grounded in the nurse-patient relationship. The intervention was provided during hospitalization and by telephone after discharge at 1 week, and 1, 3, 6 and 12 months. At 12-months postdischarge, 39% of the patients reported continuous abstinence from smoking from the time they joined the programme and 52% were not smoking at that time. No relationship was found between abstinence and the number of quit attempts, readiness to quit, nicotine dependency and length of hospital stay. Readiness to quit had increased and nicotine dependency decreased significantly by the end of the programme. No gender differences were found for the main variables. Comprehensive, individualized smoking cessation interventions for hospitalized patients having lung disease, with a 1-year follow-up, was successful. Abstinence was high in comparison with other studies. This may in part be explained by significantly enhanced motivation to quit during the smoking cessation programme.

Smoking Cessation Services in U.S. Methadone Maintenance Facilities

Most patients in drug treatment smoke cigarettes. This study established the prevalence and types of nicotine dependence services offered in methadone and other opioid treatment clinics in the United States. A cross-sectional survey was conducted of all outpatient methadone maintenance clinics in the United States. One person in a leadership position from each clinic was surveyed. The 20-minute survey was collected by phone, fax, or mail, according to responder preference. Fifty-nine percent of the clinics (408 of 697 clinics) responded. The sample was very similar to all outpatient methadone maintenance clinics in the United States in size, region, and ownership. In the 30 days before the survey, respondents reported that their clinics provided the following services to at least one patient: 73 percent provided brief advice to quit, 18 percent offered individual or group smoking cessation counseling, and 12 percent prescribed nicotine replacement therapy. However, the services were provided to very few patients. Clinics with written guidelines that required them to address smoking were much more likely to provide services than those without guidelines. Private for-profit clinics were significantly less likely than public or private nonprofit clinics to treat nicotine dependence. Most respondents (77 percent) reported that their staff were interested in receiving training in nicotine dependence treatment, and more than half (56 percent) had at least one staff member ("champion") with a strong interest in treating nicotine dependence. A vast majority of methadone patients smoke; yet in the 30 days before the survey only one out of three facilities provided counseling to any patients and only one out of ten prescribed nicotine replacement therapy to any patients. A dual strategy of requiring clinics to provide comprehensive nicotine dependence services and training staff to provide these services may provide the incentive and support necessary for the widespread adoption of treatment for nicotine dependence in methadone facilities.

Essential communication skills in individual smoking cessation

When dealing with smokers it is important to realize that nicotine addiction plays a major role. Minimal clinic smoking cessation advice by a physician is a powerful motivation to quit and even short intervention (<3 minutes) is effective especially when repeated. There is a dose-response relationship between the number and duration of sessions and quit rate. The optimum programme contains 4-5 sessions of 10-15 minutes duration during the first six weeks after quit day. It is essential that smokers select a target quit day and stop smoking completely on that day as even a few cigarettes per day in the first weeks are strongly related to relapse. Administration of nicotine replacement products or bupropion may double success rates. The communication with smokers should be emphatic and adjusted to the level of change. Barriers to successful smoking cessation and structured interventions are described. The use of the five As to motivated smokers and the five Rs to smokers not ready to quit is recommended. Telephone and written material may supplement clinic visits in the follow-up period.

Implementation of AHRQ smoking-cessation guidelines in a thoracic surgical clinic: A pilot study

1026 Background: AHRQ (formerly AHCPR) guidelines suggest that medical clinics adopt a policy to ask all patients about smoking status, advise smoking cessation, assess willingness to quit, assist efforts, and arrange follow-up. In 2000, AHRQ guidelines were implemented in the thoracic surgical clinic at City of Hope National Medical Center, an NCI comprehensive cancer center in Duarte, California. We performed a quality-assurance audit to determine the level of success in guideline implementation. Methods: A retrospective review was conducted of all patients attending the thoracic surgical clinic over a two-year period. Data collected included age, gender, smoking status, pack-year consumption, and diagnosis. Chart review determined compliance of clinic personnel in placement of color-coded stickers identifying smoking status and inclusion of smoking status and cessation advice in medical records. Results: Results: 76 individuals were current smokers at the time of the first clinic visit, 58 with subsequent visits during the period studied. Table 1. While 95 % of charts contained information identifying smoking status, few documented advice or assistance given on every visit. Only 48 (67%) charts carried an identifying sticker, although an additional nine charts (11.8 %) may have carried stickers before pages were removed to comply with HIPPA regulations. Conclusions: This retrospective review shows limited success in fostering smoking cessation in individuals with diseases caused by tobacco products – including lung cancer – despite implementation of AHRQ guidelines. Close monitoring of compliance with guidelines is required to achieve a high percentage of identification of smoking status using chart stickers and clinic notes. A higher rate of success in smoking cessation might be achieved in conjunction with a dedicated smoking cessation counseling program. No significant financial relationships to disclose.

DNA repair activity for oxidative damage and risk of lung cancer.

Although smoking is a major cause of lung cancer, only a proportion of smokers develop lung cancer, suggesting a genetic predisposition in some individuals. Because tobacco smoking is associated with the increased formation of DNA lesions, including those induced from oxidative damage, we investigated whether the activity of the DNA repair enzyme 8-oxoguanine DNA N-glycosylase (OGG), which repairs the oxidative DNA lesion 8-oxoguanine, is associated with lung cancer. We conducted a molecular epidemiologic case-control study that included 68 case patients with non-small-cell lung cancer and 68 healthy control subjects, frequency matched for age and sex. Enzymatic OGG activity was determined in protein extracts prepared from peripheral blood mononuclear cells or lung tissue by assaying the cleavage product of a radiolabeled synthetic DNA oligonucleotide containing an 8-oxoguanine residue. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined by conditional logistic regression. All statistical tests were two-sided. OGG activity was lower in peripheral blood mononuclear cells from case patients than in those from control subjects. After adjustment for age and smoking status, individuals in the lowest tertile of OGG activity had an increased risk of non-small-cell lung cancer compared with individuals in the highest tertile (OR = 4.8, 95% CI = 1.5 to 15.9). The adjusted OR associated with a unit decrease in OGG activity was statistically significantly increased (OR = 1.9, 95% CI = 1.3 to 2.8). There was no interaction between OGG activity and smoking status. The estimated relative risk of lung cancer for smokers with low OGG activity was 34- or 124-fold higher for smokers with a low OGG activity of 6.0 or 4.0 U/ micro g protein, respectively, than for nonsmokers with a normal OGG activity of 7.0 U/ micro g protein, illustrating the cumulative effect of low OGG activity and smoking. Low OGG activity is associated with an increased risk of lung cancer. Although prospective studies are needed to validate the results, they suggest that smoking cessation in individuals with reduced OGG activity might be an effective strategy in lung cancer prevention.

Decrease in risk of lung cancer death in males after smoking cessation by age at quitting: findings from the JACC study.

To evaluate the impact of smoking cessation in individuals and populations, we examined the decrease in risk of lung cancer death in male ex‐smokers by age at quitting in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (JACC Study), which was initiated from 1988 to 1990 in Japan. For simplicity, subjects were limited to male non‐smokers, and former/current smokers who started smoking at ages 18‐22, and 33 654 men aged 40‐79 years were included. We modeled the mortality rates in non‐smokers and current smokers, and compared the rates in ex‐smokers with those expected from the model if they had continued smoking. During the mean follow‐up of 8.0 years, 341 men died from lung cancer. The mortality rate ratio for current smokers, compared to non‐smokers, was 5.16, and those for ex‐smokers who had quit smoking 0‐4, 5‐9,10‐14,15‐19 and >20 years before were 4.84, 3.19, 2.03,1.29 and 0.99, respectively. The functions of 3.20×l0‐7×(age)45 and 1.96×lO‐5×(age‐29.6)4.5 fitted the observed mortality rates (per 100 000 person‐years) in non‐smokers and continuing smokers, respectively. A greater decrease in lung cancer mortality was estimated among those who quit smoking at younger ages. Stopping smoking earlier in life appears preferable to keep the individual risk low. The absolute rate, however, substantially decreased after smoking cessation even in those who quit at ages 60‐69, reflecting the high mortality rate among continuing smokers in the elderly.

Smoking cessation and the course of Crohn's disease: An intervention study

To evaluate the benefit of smoking cessation in individuals with Crohn's disease, we performed an intervention study in a large cohort of smokers with the disease. Repeated counseling to stop smoking, with easy access to a smoking cessation program, was given to 474 consecutive smokers with Crohn's disease. Patients who stopped smoking for more than 1 year (quitters) were included in a prospective follow-up study, which compared disease course and therapeutic needs with 2 control groups, continuing smokers and nonsmokers, paired for age, gender, disease location, and activity. There were 59 quitters (12%). Predictors of quitting were the physician, previous intestinal surgery, high socioeconomic status, and in women, oral contraceptive use. During a median follow-up of 29 months (1-54 months), the risk of flare-up in quitters did not differ from that in nonsmokers and was less than in continuing smokers (P < 0.001). Need for steroids and for introduction or reinforcement of immunosuppressive therapy, respectively, were similar in quitters and nonsmokers and increased in continuing smokers. The risk of surgery was not significantly different in the 3 groups. Patients with Crohn's disease who stop smoking for more than 1 year have a more benign disease course than if they had never smoked.

Birth and first-year costs for mothers and infants attributable to maternal smoking

Maternal smoking during pregnancy has been linked to high costs. This study estimates the magnitude of excess costs attributable to smoking during pregnancy for mothers and infants. The model estimates smoking-attributable costs for 11 infant and maternal conditions. From a claims database of 7784 mothers and 7901 infants who had deliveries during 1996, we estimated total cost over the infants' first year of life for each mother and infant and identified each complication of interest, based on ICD-9 codes. The average cost for smokers and non-smokers could not be computed directly because smoking status is not available in claims data. Therefore, the population attributable risk percentage (PAR%) due to smoking for each complication was identified from the literature. Multiple linear regression was used to provide estimates of the incremental cost associated with each smoking-related complication. The total cost attributable to smoking was computed as a function of the incremental cost of each complication and the PAR% for each complication. The conditions associated with the largest incremental costs compared to patients without those conditions were abruptio placenta ($23,697) and respiratory distress syndrome ($21,944). Because they were more common, the conditions with the largest smoking-attributable cost were low birth weight ($914) and lower respiratory infection ($428). The sum of the additional costs attributable to smoking for all conditions yielded a total in the first year after birth ranging from $1142 to $1358 per smoking pregnant woman. It was concluded that maternal smoking during pregnancy results in an economic burden to payers and society. These estimates may be useful in formal cost-effectiveness evaluations of individual smoking cessation strategies.

Interaction between the serotonin transporter gene and neuroticism in cigarette smoking behavior.

Cigarette smoking behavior is influenced by both personality traits and inherited factors. Previous research showed that neuroticism-a broad personality domain that includes anxiety, depression, impulsiveness and vulnerability-increases the risk of being a smoker, primarily because of difficulty in quitting. Neuroticism has also been associated with the 5-HTTLPR, a functional polymorphism in the promoter for the serotonin transporter gene. We used population and family-based methods to analyze the joint effects of the 5-HTTLPR and neuroticism on smoking behavior in a population of 759 never, current, and former smokers, all members of sib-pairs. Our main finding is that smoking behavior is influenced by an interaction between neuroticism and 5-HTTLPR genotype. Specifically, neuroticism was positively correlated with current smoking and negatively associated with smoking cessation in individuals and siblings with poorly transcribed 5-HTTLPR-S genotypes, but not in those with the more highly expressed 5-HTTLPR-L genotype. Individuals with both a 5-HTTLPR-S genotype and a high level of neuroticism had the greatest difficulty in quitting smoking. These data, if replicated, suggest that smoking behavior is more strongly influenced by the combination of the serotonin transporter gene and neuroticism than by either factor alone, and that personality scores and 5-HTTLPR genotype may predict the clinical efficacy of certain smoking cessation drugs.

Naltrexone Effects on Short-Term and Long-Term Smoking Cessation

Objectives: This study examined the efficacy of naltrex-one, a long-acting opiate antagonist, as a smoking cessation aid in a double-blind placebo-controlled randomized trial. It was hypothesized that naltrexone would result in higher quit rates at the end of treatment and six months later. Methods: Subjects were 68 smokers aged 18 to 65 who smoked at least 20 cigarettes daily and wished to stop smoking. They took naltrex-one or placebo daily for four weeks and were seen weekly for individual smoking cessation therapy. Results: A statistical trend towards a higher overall cessation rate (cotinine < 15 ng/mL) at end-of-treatment was observed among subjects treated with naltrexone than placebo (46.7% vs. 26.3%, respectively, odds ratio = 2.5, p < .10); however, this difference was attenuated at six months (27% vs. 15%, respectively, odds ratio = 1.9, p = ns). Stratified analysis indicated the usefulness of naltrexone primarily for female smokers and those with a history of major depression. These effects remained six months later. Conclusion: These results provide, at best, mild promise for naltrex-one as a smoking cessation drug and provide another instance of a differential response to nicotine dependence treatment according to gender and depression history.

Smoking Cessation in Individuals with Depression

Current, historical and subclinical depression have been linked to a high incidence of cigarette smoking and smoking cessation relapse. This review discusses the efficacy, suitability and other treatment issues involved in using nicotine replacement therapy, antidepressant treatment and cognitive-behavioural interventions to help depressed smokers quit smoking. It is recommended that prior to choosing a smoking cessation treatment regimen, assessment should be made of: (i) current and past history of depression; (ii) nicotine dependency; and (iii) other risk factors (e.g. family history of depression, past difficulty in quitting) for relapse. For those individuals who are highly nicotine dependent and who have a current or past history of major depressive disorder or who have several risk factors, a combination of antidepressants or cognitive-behavioural treatment and nicotine replacement therapy is recommended. For those individuals who have fewer risk factors, a single modality of treatment may be sufficient.

A comprehensive national minority intervention in tobacco control

Tobacco use is a major cancer risk among minorities, as evidenced by their high cancer mortality rates compared with white populations. Prior public health prevention efforts have concentrated on affecting individual behavior change through education and smoking-cessation techniques. The American Stop Smoking Intervention Study (ASSIST) project, which is sponsored by the National Cancer Institute and the American Cancer Society, is a 7-year research and applications project designed to demonstrate the effectiveness of coalition-based policy interventions on smoking prevention and cessation. ASSIST places major emphasis on the involvement of minority populations in this project as well as all women and youth. Minority involvement is evident through 1) representation and leadership on all levels of ASSIST policy development and administration; 2) inclusion of minority components in all national ASSIST conferences, including minority recruitment, coalition development, and sustainability design; 3) provision of specialized technical assistance and training to the 17 states by the ASSIST Coordinating Center; and 4) incorporation of minority specific activities in the various ASSIST states. Outcome evaluation of the effectiveness of the ASSIST approach will be conducted after the project's completion in 1998. However, early indicators show a marked increase in minority participation. Between 1994 and 1996, there has been an almost four-fold increase in proposed activities to reach underserved and minority communities. Most ASSIST states have formed multicultural coalitions. These results show that 1) intervention models emphasizing community-based policy activities in cancer prevention can address multicultural concerns successfully, 2) linkages with groups with similar multicultural interests increase the likelihood and success of joint cancer control efforts, and 3) policy-based interventions are more likely to have a pronounced effect on decreasing smoking and cancer prevalence than education programs or individual smoking-cessation efforts alone. Cancer 1998;83:1793-1795. © 1998 American Cancer Society.

Individualized smoking cessation counseling during prenatal and early postnatal care

We examined the efficacy of individualized smoking cessation counseling added to obstetricians' and nurse-midwives' advice. In a mixed private and publicly supported prenatal clinic 600 pregnant women who smoked were randomly assigned to receive the usual advice from their obstetrician or nurse-midwife or the usual advice plus individualized smoking cessation counseling. Smoking status was measured by self-report and urinary cotinine/creatinine ratios at 36 weeks and by self-report during long-term postpartum follow-up. Quitting rates during pregnancy were not increased by adding individualized smoking cessation counseling to usual care. At the long-term follow-up, reported quitting rates were significantly greater among intervention group women cared for in the publicly supported clinic than among those receiving the usual care, 14.5% versus 2.5%, p < 0.01. Although adding individual smoking cessation counseling did not increase quitting rates during pregnancy, it should be considered for women in public maternity clinics because of its potential long-term effectiveness.

Reaching mothers of preschool-aged children with a targeted quit smoking intervention.

Younger women smoke at disproportionately higher rates than other women and their smoking has a major impact on the health of their young children. To address this problem, a smoking cessation intervention combining minimal advice and assistance from a community health nurse and a tailored self-help guide was developed for low-income women with young children. The program evaluation results reported here were gathered from women using publicly funded pediatric services in four agencies with 32 clinic sites in central and eastern Pennsylvania. Unlike volunteers in formal cessation programs, the women varied widely in their readiness to quit smoking. Follow-up data were obtained from 1,230 female smokers, aged 18 to 39, after receiving brief, individualized smoking cessation advice and encouragement to read the self-help guide. One year later, 12.5 percent reported quitting smoking, and 20.2 percent reported having made a serious quit attempt that lasted at least 7 days. These results suggest that, even among smokers with low socioeconomic status and wide variation in their readiness to quit, minimal intervention programs requiring modest resources can promote cessation.

Evaluating the effectiveness of the coronary care nurses' role in smoking cessation

Summary The aim of this small‐scale study was to assess the feasibility and impact of an individualized smoking cessation intervention among clients admitted to a coronary care unit with severe angina or a first time myocardial infarction. The intervention involved in‐depth nursing assessment interviews related to client beliefs, motivation and experiences of smoking, culminating in an individualized cessation plan. Participants were offered follow up support during the first year post‐intervention. The findings are highly encouraging with a 77% smoking cessation rate for surviving clients within the intervention group at the end of the first year, and with 75% continued successful smoking cessation amongst surviving clients 2 years post‐intervention.

Predictors of smoking behavior change 6 and 18 months after individual counseling during periodic health examinations

Predictors of smoking behavior change were examined in a randomized controlled trial of individualized smoking cessation counseling delivered by a smoking cessation counselor during periodic health examination. Self-reports of not smoking at 6 and 18 months and attempts to quit were greater, but not significantly so, in the intervention group compared with the usual care group. There was no difference between the intervention group and the usual care group in reported continuous abstinence. Multivariate analysis showed that longer periods of abstinence in the past and having smoking identified as the main problem were important predictors of subsequent quitting. Having fewer other smokers in the household, stronger intentions to stop smoking in the next month, and being in the intervention group were also significant predictors of abstinence at 6 months, but not at 18 months. Those who had tried to quit by 6 months and 18 months were more likely to be in the intervention group, to have greater motivation to stop smoking, and to have more problems of daily living. Supplementing physician's advice with individualized smoking cessation counseling during health maintenance examinations was associated with a greater short-term quit rate and more quit attempts over 18 months than physician advice alone, but did not influence continuous abstinence from cigarettes over this time.

Smoking and Smoking Cessation: Occupational Health Issues

Cigarette smoking is clearly a dangerous health behavior. Worksite cessation programs are a valuable means to reduce the health hazards associated with smoking and to reduce overall employer costs. Occupational health nurses are in a unique position to make a significant impact on employee health by supporting individual cigarette smoking cessation efforts and by promoting the development of organized worksite smoking cessation programs.

The Effects of Different Instructions on Smoking Cessation for Individuals with Different Degrees of Dependence

Therapist instructions and patient expectations appear to yield good treatment results with placebo pills. In this study the smoking cessation rate was studied after administration of a placebo smoking withdrawal chewing gum. Two groups from two factories were recruited and given instructions that they were to receive an effective chewing gum for smoking cessation. One group was told that the gum contained nicotine while the other was told that it worked through its special taste. At follow-up periods of 1, 3 and 8 weeks those given the nicotine instructions were superior to those given the taste instructions, although not significantly so. When nicotine dependence was taken into consideration it was found that the more nicotine dependent half of the subjects responded significantly better to the nicotine instructions as compared to the low dependent subjects.