Relapse and risk perception among members of a smoking cessation clinic

Assessed perceptions of the health risks associated with smoking in comparison with not smoking among members of smoking cessation clinics. We measured these perceptions at three different time periods during the clinic, and then again at a 6-month follow-up. Results indicated that members who were abstinent at the follow-up had lowered their perceptions of the likelihood of contracting smoking-related illnesses (e.g., emphysema) if they were not smoking. In contrast, those who had relapsed lowered their perceptions of the health risks associated with smoking, but not their perceptions of nonsmoking disease vulnerability. The implications of these changes in risk perception for therapy involvement are discussed.     

The effects of beliefs about smoking and health on smoking cessation

The purpose of this study was to examine whether beliefs of an American sample about smoking and health, as defined by cognitive orientation theory, would determine those smoking cessation program participants who would become abstainers and those who would not. Although the smoking cessation program was not designed to influence the specific kinds of beliefs studied, subscales measuring two of the four types of beliefs differentiated participants who would become abstainers from those who would not. Abstainers tended to have stronger goal beliefs about their desire to quit smoking, and stronger beliefs about the health-related implications of smoking. Participants' beliefs that they could resist an urge to smoke, which implied the use of coping skills, were more important in determining who would abstain from smoking than was their confidence that they could quit smoking, which implied the use of willpower.     

Concordance of self-reported abstinence and measurement of expired air carbon monoxide in a self-help smoking cessation treatment

Some self-help programmes for smoking cessation obtain abstinence data entirely from participants' self-reports. This may lead to overestimation of efficacy. In the present study, the relationship between self-reported abstinence and expired-air carbon monoxide was evaluated at the 12-mo. follow-up in 200 smokers who had participated in a self-help programme for smoking cessation conducted by mail. Analysis indicated a close relationship between carbon monoxide levels and self-reports of smoking status; concordance was about 90%. Studies of the efficacy of self-help programmes for smoking cessation should include some sort of objective verification of self-reported abstinence.     

Knowledge about the deleterious effects of smoking and its relationship to smoking cessation among pregnant adolescents

Smoking cessation among pregnant adolescents remains a complex and unresolved issue. The purpose of this study was to examine adolescents' knowledge of the detrimental effects of smoking on pregnant women and fetuses and its relationship to efforts to quit smoking. The sample consisted of 71 pregnant adolescents, and a three-group randomized intervention design-Teen FreshStart (TFS), Teen FreshStart with buddy (TFSB), and usual care control (UCC)-was used. Instruments included a demographic questionnaire, a smoking history questionnaire, and an 11-item scale measuring knowledge of the effects of smoking during pregnancy. For the entire sample, knowledge scores increased significantly (p = .000) from T1 (preintervention) to T2 (postintervention), and the adolescents who quit smoking had significantly higher knowledge at T2 (p = .028) and greater increases (T1 to T2) in their knowledge (p = .019) than did those who did not quit. Together, the TFS and TFSB groups had significantly higher knowledge at T2 (p = .017) and a significantly greater increase in knowledge from T1 to T2 (p = .005) than did the UCC group. This also held true when the TFS and TFSB groups were examined individually. Each had significantly higher knowledge at T2 (TFS, p = .029; TFSB, p = .008) and a significantly greater increase in knowledge from T1 to T2 (TFS, p = .007; TFSB, p = .009) than did the UCC group. Furthermore, despite the small sample sizes, within-group comparisons showed (a) no significant differences between quitters and nonquitters in the UCC group, (b) significantly higher knowledge at T2 (p = .052) and a trend indicating greater increases in knowledge from T1 to T2 (p = .092) for the quitters compared with the nonquitters in the TFS group, and (c) a trend for adolescents in the TFSB group who quit smoking to have greater increases in knowledge compared with those who did not quit (p = .158). These results indicate the need for continued inquiry into the relationship between pregnant teenagers' health knowledge and decisions to stop smoking.     

The effectiveness of smoking cessation programs: Determinants and outcomes

Abstract

In this review, smoking cessation is discussed from a stress and coping perspective. Nicotine has been found to produce potentially reinforcing effects. Smoking cessation is best characterized as a process with various stages, of which the stage of relapse remains a major area for intervention research. Mood and expectancies appear to be major determinants of behavior in this stage. Social support apparently still needs conceptual refinement before it may be applied effectively in interventions. Effects of multicomponent treatment has been found to be increased when combined with nicotine replacement therapy. Notwithstanding the sometimes modest quit rates, smoking cessation has been found to be cost-effective among high-risk groups, both from an economical and health perspective. New research should focus on emotional and cognitive processes involved in cessation, in particularly self-efficacy expectations. While public policies may be most efficient in reducing the number of smokers in our society, an increasing number of smokers will be confronted with the addictive character of their smoking.     

Nature and role of change in anxiety sensitivity during NRT-aided cognitive-behavioral smoking cessation treatment

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M (age) = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.     

Long-term smoking intervention at the worksite: effects of quit-smoking groups and an "enriched milieu" on smoking cessation in adult white-collar employees

Maximizing the potential of worksites for smoking intervention remains elusive. We hypothesized that long-term effectiveness of group intervention would be enhanced when offered within an "enriched milieu" (full program) compared with relative isolation (group only). The data failed to support the hypothesis. Although sustained abstinence rates were higher at full-program sites (50%) than at group-only sites (44%), the difference did not achieve statistical significance. Initial (35% vs. 47%) and 12-month (18% vs. 22%) quit rates at full-program and group-only sites also failed to demonstrate the "benefit" of the "enriched milieu."     

Long-term psychological sequelae of smoking cessation and relapse.

The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts.     

Distress tolerance and duration of past smoking cessation attempts

The present study tested the hypothesis that limited ability to tolerate physical and psychological distress is associated with early relapse from smoking cessation. Specifically, the authors exposed 16 current smokers who had failed to sustain any previous quit attempt for more than 24 hr (immediate relapsers) and 16 smokers with at least 1 sustained quit attempt of 3 months or longer (delayed relapsers) to psychological (mental arithmetic) and physical (carbon dioxide inhalation-breath holding) stressors. Relative to delayed relapsers, immediate relapsers were characterized by higher baseline levels of affective vulnerability, by greater levels of dysphoria and urge to smoke after 12 hr of nicotine deprivation, and by less task persistence on the stressors, suggesting that these may be risk factors for early lapse in the context of quitting smoking.     

Psychogenic death: individual effects of sorcery and taboo violation

Can social causes directly effect physiological processes? In many parts of the world, there are reports that those who have broken a ritual prohibition or hold that they are victims of sorcery give up and die, a phenomenon labelled by anthropologists as voodoo death. The mechanisms for this remain controversial. The features include: lethargy, lack of motivation, extreme guilt, social withdrawal, reduced appetite and thirst, and ultimately death. Although a belief in the power of sorcery is rare among indigenous white British people, it is not uncommon among ethnic minorities and may be diagnosed as a delusion. The author reports two cases from his own clinical experience in a Western setting that raise the question as to whether the phenomenon is similar to depression and what can be done about it. In one case, the victim made a rapid recovery once the curse was removed. Is death really an individual or a social phenomenon?     

Predicting attempts and sustained cessation of smoking after the introduction of workplace smoking bans

Examined predictors of smoking cessation attempts and predictors of the outcome of those attempts after the introduction of a workplace smoking ban. Smokers were surveyed in the month before the ban came into force, and variables collected at that time were used to predict outcomes 6 months later. Data from 491 respondents who were smokers at the time of the initial survey were used, and a set of potential predictor variables was chosen on both theoretical and empirical grounds. Making a cessation attempt was predicted by the strength of desire to quit and, to less extent, by not having been subject to extensive restrictions on smoking before the mandated ban, having tried to quit before, perceiving oneself high in ability to quit, and being worried about smoke at work. For the outcome of cessation attempts among those who tried, success was best predicted by low levels of a composite habit strength variable and, to less extent, by desire to quit, no previous attempts to quit, the existence of social supports for quitting, and educational status. Although cognitive variables were important in predicting attempts, they played only a minor role in predicting maintenance. Behavioral and environmental variables contributed slightly to prediction of attempts and strongly to prediction of maintenance.     

Subjective and reinforcing effects of smoking during negative mood induction

Two notions strongly held by many smokers are that negative mood increases smoking behavior and that this increase is due to the ability of smoking to alleviate negative affect. This study used a modified mood induction procedure to examine both the impact of smoking on induced mood, as well as the effect of induced mood on actual smoking behavior. Forty-eight smokers were randomly assigned to a smoking or a water-drinking comparison group. Each participant attended 3 sessions during which 1 of 3 mood states (positive, negative, or neutral) was induced. Contrary to expectation, smoking did not attenuate negative affect. However, negative mood induction subsequently quickened latency to smoke and increased number of puffs consumed ad lib.     

A Worksite smoking cessation intervention involving the media and incentives

This study evaluated an attempt at 38 workplaces to help employees stop or reduce their levels of smoking. In past research, worksite support groups, in combination with a media smoking cessation program and self-help manuals, were found to be effective in helping employees quit smoking. Unfortunately, recidivism was found at the follow-up evaluations. The present study replicated the results of the previous worksite smoking cessation program with support groups, a television intervention, and self-help manuals. At this postpoint, 42% of employees provided groups plus incentives were abstinent compared to only 15% who were only provided self-help materials. An important difference in this study was that there were also monthly follow-up support groups and incentives. Work settings can be a source of stress and conflict, which can precipitate relapse. At a 12-month follow-up, 26% of those participants who were provided support and incentives were abstinent compared to 16% who were only provided the self-help materials.     

Effects of an Internet-based voucher reinforcement program for smoking abstinence: a feasibility study

The present study tested the feasibility of an Internet-based method to obtain objective evidence of smoking abstinence and to deliver vouchers for evidence of abstinence. Four heavy smokers participated in this 4-week study. Twice daily, participants made video recordings of themselves providing a breath carbon monoxide (CO) sample with a Web camera. The video was sent electronically to the smoking clinic. Participants could earn vouchers for gradual reductions in breath CO during an initial shaping condition, and then for achieving abstinence (CO < or = 4 ppm). Vouchers could be exchanged for merchandise at select Internet vendors. Relative to baseline conditions, participants substantially reduced their smoke intake, and 3 achieved sustained periods of abstinence. The study suggests that an Internet-based voucher reinforcement program is a feasible method to promote abstinence from cigarette smoking.     

Reduction of anxiety sensitivity in relation to nicotine withdrawal symptoms during smoking cessation: an examination among successful quitters

Anxiety sensitivity has been implicated as a potential risk factor for post-quit withdrawal symptoms. The present study examined relations between the extent of change in anxiety sensitivity and the course of nicotine withdrawal symptoms experienced during the initial two weeks of a quit attempt among treatment-seeking smokers. The sample consisted of 29 adult daily smokers (34% female; M_age = 47.7, SD = 13.1) who successfully quit and maintained their abstinence. After adjusting for the effects of gender, treatment condition, use of nicotine replacement therapy, nicotine dependence, alcohol use problems, baseline levels of anxiety sensitivity, and reductions in negative affect, greater reductions in anxiety sensitivity were related to faster decreases in withdrawal symptoms. The current data suggest that there may be merit to employ anxiety sensitivity reduction methods for the management of emergent withdrawal symptoms in smoking cessation treatment.     

Practicing and arguing for abstinence from smoking: A test of the double forced compliance paradigm

An experiment was conducted within a new paradigm for Festinger's theory of dissonance (1957): the double forced compliance paradigm (Joule, 1986a). Double compliance was used to test dissonance reduction following the execution of not just one, as in the classical paradigm, but two forced compliance behaviours. The first behaviour involved abstinence from smoking, and the second, writing a text for or against smoking. Based on the radical conception of the theory of dissonance (Beauvois and Joule, 1981; Joule, 1986b), subjects were expected to find tobacco deprivation more difficult after having written a text against smoking than before, and easier after having written a text in favour of smoking. The results confirmed these predictions.