Smoking Cessation Process Research Articles

The relative role of nicotine dependence and smoking-related cognitions in adolescents’ process of smoking cessation

The present study evaluates the role of distinct components of nicotine dependence (craving, withdrawal, behavioural dependence) in comparison to smoking-related cognitions (attitudes, perceived social approval, self-efficacy) in adolescent smoking cessation. In the process towards smoking cessation, we distinguish between distinct behavioural transitions, respectively, short-term abstinence, reduction in smoking behaviour and prolonged cessation, to evaluate differences in cessation-related antecedents as a function of varying behavioural outcomes. A total of 850 adolescent smokers (age 14–16) participated in the present study. Smoking behaviour was assessed 1 year after baseline. Results showed that all dependence components had a distinct role in the prediction of behavioural change towards cessation. Furthermore, each behavioural transition was predicted by a distinct set of variables, indicating that contributions of cessation-related factors vary across the course towards cessation. Overall, our findings suggest that smoking-related cognitions are particularly relevant in the initiation of behavioural change, such as short-term abstinence, whereas nicotine dependence, craving in particular, becomes increasingly important in the prediction of maintained behavioural change, such as prolonged cessation. Implications encompass enhanced attention to the multidimensional nature of nicotine dependence and the value of comparing different behavioural outcomes in a comprehensive understanding of cessation-related factors.

Enjoyment of smoking and urges to smoke as predictors of attempts and success of attempts to stop smoking: A longitudinal study

Background‘Enjoyment’ and ‘addiction’ have been proposed as opposing reasons why people continue to smoke despite the manifest dangers. This study examined the roles of these as barriers to smoking cessation. Methods2257 smokers taking part in a national household survey completed postal-follow-up questionnaires 6 months later. Enjoyment of smoking was measured at baseline as was strength of urges to smoke during a normal smoking day as a subjective marker of addiction. Smoking status, quit attempts and quit success were assessed at follow-up. Data on age, sex, social grade and method of cessation support used were also collected. Associations between baseline measures and smoking outcomes were assessed using logistic regression. ResultsOnly enjoyment of smoking predicted whether a quit attempt was made (OR=0.70, p<0.001, 95% CI=0.62–0.78) and only strength of urges to smoke predicted whether a quit attempt was successful (OR=0.70, p<0.001, 95% CI=0.57–0.87). This pattern of results remained when controlling for sociodemographic factors and method of support used. ConclusionsBoth enjoyment of smoking and strength of urges to smoke are important in the smoking cessation process, but in different ways. Interventions to promote cessation need to address both in order to maximise the rate of quit attempts and their chances of success.

Evolución de la ansiedad en el proceso de dejar de fumar en fumadores que acuden a una Unidad de Tabaquismo

To assess the evolution of anxiety during the smoking cessation process (3 months) and early smoking relapse, in a group of smokers seeking treatment for giving up smoking. Analytical, prospective and longitudinal study. sex, age, marital status, educational level, anxiety and depression background, use of psychopharmacological drugs, cigarettes smoked per day, co-oximetry, nicotine dependence (Fagerström Test for Nicotine Dependence) and state and trait anxiety (State-Trait Anxiety Inventory). Trait anxiety was assessed at the same time as medical history and state anxiety over the following sessions: Medical history session, day prior to stopping smoking, the day after, and at one week, one month and three months. Continuous abstinence was assessed by self-report and confirmed by co-oximetry ≤ 10 ppm. 569 patients, 288 men (50.6%) and 281 women (49.4%), mean age 43 years, mean cigarettes per day 23, average score on Fagerström Test 6. State anxiety levels decreased during the smoking cessation process, and these levels were maintained three months later. Women scored higher on state and trait anxiety, and so did smokers who took psychopharmacological drugs. Relapsing patients had higher levels of state anxiety in the session prior to relapse. State anxiety decreases during the smoking cessation process, remaining at the same level after 3 months. There is a need to incorporate behavioural strategies in smoking cessation treatment.

Use of mentholated cigarettes: what can we learn from national data sets?

Use of mentholated cigarettes: what can we learn from national data sets?

A Targeted Review of Smoking Cessation Aids and Their Pharmacology for the Pharmacy Technician

Objective: To review the pharmacologic treatment options available for smoking cessation. Data Synthesis: Nicotine replacement therapy (NRT) has a less rapid onset than that of nicotine received from smoking; therefore, it does not cause the same pleasurable response but helps to decrease the cravings. NRT is available over the counter as a gum, lozenge, and patch. NRT is also available by prescription as a nasal spray and inhaler. Information is also provided on the dosing and adverse effect profiles of 2 non-NRT prescription products used for smoking cessation including bupropion SR and varenicline. Conclusions: It is important for pharmacy technicians to be aware of the NRT and non-NRT products available both over the counter and by prescription so that they can better work with the pharmacist to aid patients in the smoking cessation process. Current guidelines do not specify any of the medications as first line. Patients should be educated on all of the options available so that they can decide which option they think will help them succeed.

Nicotine Withdrawal Symptoms in Adolescent and Adult Twins

We examined the variation and heritability of DSM-IV nicotine withdrawal (NW) in adult and adolescent male and female twin cigarette smokers (who reported smoking 100 or more cigarettes lifetime). Telephone diagnostic interviews were completed with 3,112 Australian adult male and female smokers (53% women; age: 24-36) and 702 Missouri adolescent male and female smokers (59% girls; age: 15-21). No gender or cohort differences emerged in rates of meeting criteria for NW (44%). Latent class analyses found that NW symptoms were best conceptualized as a severity continuum (three levels in adults and two levels in adolescents). Across all groups, increasing NW severity was associated with difficulty quitting, impairment following cessation, heavy smoking, depression, anxiety, conduct disorder and problems with alcohol use. NW was also associated with seeking smoking cessation treatment and with smoking persistence in adults. The latent class structure of NW was equally heritable across adult and adolescent smokers with additive genetic influences accounting for 49% of the variance and the remaining 51% of variance accounted for by unique environmental influences. Overall, findings suggest remarkable similarity in the pattern and heritability of NW across adult and adolescent smokers, and highlight the important role of NW in psychiatric comorbidity and the process of smoking cessation across both age groups.

Explorations of Self-Efficacy: Personal Narratives as Qualitative Data in the Analysis of Smoking Cessation Efforts

AbstractResearch has found that an individual's perceived self-efficacy, supported by goals and the acceptance of potential obstacles, has the ability to assist in behaviour modification. By examining the narratives of cardiovascular patients undergoing smoking cessation counselling, this study highlights factors that individuals communicate in their narratives regarding changes to self-efficacy throughout the process of smoking cessation. Narrative analysis is used to establish those factors that cardiovascular patients assert to be the motivating or impeding factors in their smoking cessation efforts, particularly in relation to their initial readiness to quit smoking. The study's findings illustrate the social, physical and psychological barriers and motivating factors that exist for cardiovascular patients in the process of quitting smoking. The current study supplements past research illustrating that in-hospital programs are among the most influential smoking intervention strategies because they can be tailored to each patient's specific health problems and personal and social circumstances. The study concludes that the relationship formed between patients and intervention specialists can assist in raising an individual's self-efficacy to end an addictive behaviour.

Coping with temptations and adolescent smoking cessation: An initial investigation

Although a great deal of research focuses on adolescent cigarette smoking, little is known about the process by which adolescents attempt to stop smoking. Resisting temptations to smoke is one of the key challenges encountered by individuals who attempt smoking cessation. A large body of literature has examined coping with temptation among adult smokers, and research on this issue for adolescents is lacking. To further our understanding in this area, the present study reports on an initial examination of the Smoking Temptation Coping Questionnaire (STCQ). The STCQ, which assesses coping in a social pressure situation involving cigarettes, was adapted from the Temptation Coping Questionnaire, a brief self-report measure of adolescent coping with temptations to use alcohol and other drugs. The present study included 109 adolescent participants (aged 14-19 years) in a naturalistic study of smoking self-change. Participants completed baseline and 6-month follow-up interviews. Exploratory factor analysis of the STCQ coping scale yielded a single factor including six strategies for coping with temptations. Analyses provided support for the concurrent, predictive, and construct validity of the STCQ. In particular, the coping scale score significantly predicted prospective duration of abstinence for adolescents who engaged in smoking cessation efforts. These results provide preliminary support for the utility of the STCQ. In addition, findings support the role of temptation coping in the adolescent smoking cessation process.

Cognitive and behavioral predictors in the process of smoking cessation during pregnancy: Testing for discontinuity patterns in the Transtheoretical Model

The aim of the study was to assess predictive power of cognitive variables and health-promoting behaviors for the process of smoking cessation described in terms of the Transtheoretical Model (TTM). Participants in the study were 150 women (mean age 26.93, SD = 4.56 years), in uncomplicated pregnancy. Cigarette smokers constituted 29.3% of the sample, while the rest had previously quitted smoking (in that number 42.1% during pregnancy). Beliefs and expectations were measured by means of scales developed by the author, while health-related behaviors were assessed using the Health Behavior Inventory (HBI) by Z. Juczynski, supplemented with pregnancy-specific behaviors. TTM discontinuity patterns were tested in the study using polynomial-based orthogonal contrasts. Statistically significant linear trends were found for expectations concerning the infant’s health state and the course of delivery, for beliefs about the effect of maternal smoking on infant health, as well as for pregnancy health behaviors. The obtained results were confirmed by hierarchical regression analysis, with smoking cessation explained to a larger extent by cognitive factors than by health-related behaviors. This may suggest that the TTM is a “pseudo-stage” model, and a general change of the variables under study is of greater importance for the process of smoking cessation than focusing on the TTM stages.

Young Adult Smoking Behavior: Implications for Future Population Health

To qualitatively project the future health burden of tobacco from present-day young adult smoking behavior. Population surveys in California (2002) and nationally (1978-80, 2001-03). In 2002, 40% of California young adult smokers were nondaily smokers, 24% had quit at some time for >or=6 months, 45% said they smoked less now than previously, and 68% thought they would quit within 5 years. Interest in quitting was high, and most were actively engaged in the smoking cessation process. Young adult smoking behavior changed from 1978-80 to 2001-03. The future health burden from smoking will be less for the current generation of young adults.

Patterns of Use of an Automated Interactive Personalized Coaching Program for Smoking Cessation

Background The QuitCoach, an “expert system” program of tailored advice for smoking cessation developed in Australia, has been publicly available since July 2003, albeit with limited promotion. The program is designed to be used on multiple occasions, guiding the user through the process of smoking cessation in the manner of a “life coach”. Email reminders are sent at scheduled intervals to prompt optimal and repeated use.Objectives The aims of this study were to characterize QuitCoach users and to determine what characteristics of smokers affect their participation over time. Of particular interest was whether users tend to return following a relapse and, thus, use the program as a tool for relapse prevention or recovery. We also explored patterns of change associated with returns to the site, whether prompted by reminder emails or not prompted at all.Methods Between July 2003 and June 2007, 28,247 individuals completed an initial assessment on the QuitCoach, of whom 83.7% (n = 23,656) registered. Data were collected during a 10-minute online questionnaire that all users completed in order to obtain tailored cessation advice. This included questions concerning basic demographic information, quitting history, current smoking status and cigarette consumption, stage of change, and use of pharmacotherapy.Results The median age of users was 34 years, and 62% were female. Most (96%) were current smokers. Overall, 91% were planning to quit in the next 30 days, and half (49.9%) had set a quit date. Those who had recently relapsed to smoking following a quit attempt made up 37%. Among registered users, 27% returned for a second visit, a median 9 days after their first. Overall, a third visit was completed by 11% and 2% returned within 2 days. Women, older smokers, those who had recently quit, and those using pharmacotherapy were more likely to return. From the second visit on, most people who completed an assessment had quit. Likelihood of responding to a prompt to return was largely unrelated to user characteristics or cessation outcome.ConclusionsInternet-based programs have considerable potential to reach large numbers of smokers at low cost. The QuitCoach is attracting considerable use, with most using it to make a quit attempt and, for those who continue to use the QuitCoach, to help them stay quit. Nonetheless, most users only visited the site once, suggesting improved strategies are needed for encouraging repeated use.

Hyperlipidemia, eating disorders, and smoking cessation

The present article is intended to review the recent literature on three topics that are very important in pediatric office practice: hyperlipidemia, eating disorders, and smoking cessation. Review of the current literature will help pediatricians understand current data on the pathophysiology, diagnosis, and treatment of hyperlipidemia in childhood and adolescence. This article also provides practitioners with a summary of the most current literature on identifying the characteristics and risk factors of pediatric patients with eating disorders. The article concludes with a summary of recent literature on smoking prevention and cessation methods. The current literature shows that practitioners must be more aggressive in screening patients for hyperlipidemia. Education regarding the prevention of hyperlipidemia is also essential. Recent work has further identified the characteristics and risk factors of patients with eating disorders. Further, recent literature has studied innovative tools that can be employed by patients interested in smoking cessation. Hyperlipidemia, eating disorders, and smoking are three extremely important problems that negatively impact the lives of children and adolescents. Pediatricians should regularly screen their patients for hyperlipidemia and eating disorders. Practitioners should assist their pediatric patients with the process of smoking cessation.

Cigarro "companheiro": o tabagismo feminino em uma abordagem crítica de gênero

This article presents the main results of a study that examined the symbolic and material meanings of women's smoking, adopting a critical and qualitative gender approach. Semi-structured interviews were held with 14 women smokers in different stages of the smoking cessation process. The research locus was a tobacco treatment program located in a public hospital in Rio de Janeiro, Brazil. The findings showed how deeply smoking is interwoven in these women's social and gender trajectories, playing a decisive support role when they have to deal with various difficulties in life. The cigarette as a "companion" emerged as the main empirical category, as something always available to quell anxiety and loneliness, as well as a source of pleasure and relaxation. The critical gender approach evidenced how women's reproductive and productive work overload reinforces their tobacco dependency. In health care, in order to attain women smokers' adherence to the arduous cessation process, it is crucial to consider the complex relations between social and gender dimensions when cigarettes are viewed as a "companion".

Mechanisms of adolescent smoking cessation: Roles of readiness to quit, nicotine dependence, and smoking of parents and peers

Multiple levels of influence should be considered in interventions aimed at the adolescent smoker, including psychological, addiction, peer and parental influences. However, the mechanism by which these variables influence the process of smoking cessation in adolescents is not well elucidated. Therefore, this prospective study tested two models among 850 adolescent smokers, specifying the direct and indirect relations between adolescents’ readiness to quit smoking, levels of nicotine dependence, and smoking behavior of their parents and friends. One year later smoking cessation was assessed. Results showed that, among adolescent smokers, readiness to quit was positively associated with quit attempts, while nicotine dependence was inversely associated with successful cessation. Instead of a direct relation, parental and peers’ smoking were inversely related to smoking cessation through nicotine dependence. The findings emphasize that interventions should be developed and tested within and outside the school setting, as well as within the family situation. In addition, the strong impact of nicotine dependence on successful cessation indicates that a more direct approach is needed to lower nicotine dependence among adolescents.

The combination of sertraline with buspirone for smoking cessation process—The effectiveness and adverse events

The combination of sertraline with buspirone for smoking cessation process—The effectiveness and adverse events

HEALTHCARE PROVIDERS (PRESCRIBERS VS NONPRESCRIBERS) KNOWLEDGE OF TOBACCO-RELATED ISSUES INCLUDING DRUG INTERACTIONS WITH NICOTINE

PURPOSE: Healthcare providers (HCPs) must understand the smoking cessation process to successfully treat patients for tobacco dependence. We have demonstrated previously that HCPs often advise patients to quit smoking but rarely assist patients through the quitting process. We reviewed the responses of “Prescribers” (NP, PA, MD, DO) vs. “Non-Prescribers” (Pharmacist, RN, Social worker, CASAC Counselor, Respiratory Therapist, and students) to an anonymous survey given to attendees prior to a full-day tobacco dependence treatment conference.

Smoking cessation readiness: Are your patients ready to quit?

To explore the assessment of patient readiness to receive smoking cessation interventions using the transtheoretical model (TTM) and the five stages of change; and to give the primary care provider an evidence-based toolkit to assist in evaluating for readiness and supporting the smoking cessation process. Evidence-based literature, theoretical framework, and peer-reviewed articles. Utilizing the TTM along with proper training and education of the provider and patient increases the probability that smoking cessation will occur. Combinations of pharmaceutical and nonpharmaceutical interventions are the most effective in smoking cessation. Providers can be prepared at every patient visit to address the smoking cessation needs of all patients. The toolkit provided in this article will help facilitate evaluation of readiness and support of effective, long-term smoking cessation and reduce eventual smoking-related morbidities.

“I did it my way”—An explorative study of the smoking cessation process among Danish youth

To explore the smoking cessation process of adolescents and their attitudes and beliefs towards smoking cessation and cessation interventions. Focus group discussions and individual interviews during April-May 2004 with 26 persons aged 15-21 years who all initiated a quit attempt on 1 January 2004. The approach towards all stages of the youth smoking cessation process varied greatly among both successful and unsuccessful quitters. Apart from 'commitment' or the amount of energy put into a cessation attempt, there were no differences in the way successful and unsuccessful quitters approached the quit attempt. 'Smoking friends' and 'social support' were important for maintaining cessation. Further, participants had negative attitudes towards formalized smoking cessation interventions. There are many approaches to the smoking cessation process. Whether an attempt is successful depends more on individual conditions and the amount of commitment invested in the attempt than on the specific cessation strategy used. Future adolescent smoking cessation interventions should be flexible regarding both structure and content and should focus on the individual learning process, rather than adhering to rigid cessation strategies.

Ecological momentary assessment of adolescent smoking cessation: A feasibility study

Attempts to quit smoking by adolescents typically fail, even when aided by psychosocial and pharmacological treatments. Gaining a better understanding of the process of smoking cessation and relapse in this population could lead to improved treatments and increases in cessation rates. Ecological momentary assessment (EMA) has been used to describe the relapse process among adults, but not among adolescents. This study examined the feasibility of using EMA to examine relapse among adolescent smokers. Participants (N = 13) used a hand-held computer for 3 weeks to report on their smoking behavior, affect state, and exposure to smoking cues during a quit attempt (7 days prequit, 14 days postquit). All of the participants recorded a quit attempt and at least one lapse during the monitoring interval. Compliance with the protocol was generally high but decreased slightly over time. As with adults, evidence indicated that lapses were associated with craving, negative affect, and smoking cues. These data support the feasibility and potential value of using EMA with adolescent smokers.

Determination and support as successful factors for smoking cessation

This study aimed to analyze determination and support as successful factors for smoking cessation. Qualitative study in which 16 individuals from Porto Alegre, Brazil, who had ceased smoking for more than six months, with score > or = 5 according to Fagerström scale, were interviewed. Information was examined through Content Analysis according to the following steps: pre-analysis, material investigation and result treatment. Smoking cessation was a consequence of a group of factors, with determination (the will to cease smoking and the difficulty to cease smoking) and the received support (occupational; family; social, and spiritual, and through a specific course and support groups) as the focus of this article. The results suggest that the smoker's determination to cease smoking together with the support of society segments and the benefits from that are helpful factors in the smoking cessation process.