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.     

Thought control strategies in schizophrenia: a comparison with non-patients

This study tested the hypothesis that patients with a diagnosis of schizophrenia would report the use of different thought control strategies in comparison with non-patients. The Thought Control Questionnaire [TCQ; Wells, A. & Davies, M. (1994). The thought control questionnaire: a measure of individual differences in the control of unwanted thoughts. Behaviour Research and Therapy, 32, 871–878.] was administered to 22 patients who met DSM-IV criteria for schizophrenia and 22 non-patients. The results showed that schizophrenic patients used different thought control strategies (more worry and punishment-based strategies, less distraction-based strategies) in comparison with non-patients. The theoretical and clinical implications of these findings are discussed.     

Program adherence and coping strategies as predictors of success in a smoking treatment program

Ninety-four participants in a 6-week behaviorally oriented smoking cessation program were administered weekly questionnaires assessing their use of the major program recommendations and other quitting strategies throughout treatment. An "affect-regulation" coping inventory was administered at the beginning and end of treatment as well. Adequate adherence was reported for most of the program recommendations. Although a composite measure of adherence did not predict quitting success, adherence and coping assessments were associated with maintenance of treatment gains. Short-term maintenance was associated with an extensive affect-regulation repertoire and use of "stimulus control" strategies during the program, and long-term maintenance was associated with consistent self-monitoring of smoking during treatment. These prospective findings highlight some behavioral characteristics that may be useful targets in future efforts to foster maintenance of smoking behavior change.     

A comparison of a self-control and a contract procedure for weight control

A self-control procedure involving the use of behavior modification techniques was compared with a contract system and an attention-placebo control group. One study revealed significant losses for both treatments after 12 weeks with the contract group losing more; however, a ten month follow-up revealed that the weight loss was not permanent. A second study found no differences between a self-control group and a control group after 16 weeks. Reasons for the poor long-term results of these and other weight-control programs were discussed.     

Elements of effective weight control programs: Implications for exercise and sport psychology

Abstract

Research on elements of effective weight control programs may have important implications for applied exercise and sport psychology. Eight of 11 elements were derived from the scientific literature: (1) quality of the initial assessment; (2) completeness of the cognitive-behavior therapy component; (3) completeness of the nutritional component; (4) emphasis on exercise; (5) training and skills of staff; (6) frequency of sessions and duration of the program; (7) management of the weight losers' social environments; (8) use of protein sparing modified fasting. The remaining 3 elements were selected based on clinical judgment; (9) reasonableness of costs; (10) ethics (including the use of scientific knowledge); and (11) flexibility of treatment. The gestalt of these elements represents a very comprehensive, intensive, and long-term approach to treating obesity. When all of these elements are operational, a treatment program can help many obese clients develop the super-normal self-regulatory skills that seem necessary to overcome the formidable psychological and behavioral barriers to permanent weight control. The implications of this perspective for cognitive-behavioral interventions designed to promote adherence to exercise and training regimens and to improve sport performance are considered. The primary conclusion is that more complete assessments and much longer and more intensive interventions and evaluations may be needed to promote robust changes in applied exercise and sport contexts.     

Secondary smoking prevention in a university setting: a randomized comparison of an experiential, theory-based intervention and a standard didactic intervention for increasing cessation motivation.

OBJECTIVE: College may represent an untapped opportunity to reach the growing number of student smokers who are at risk of progressing toward regular smoking. The aim of this study was to test the efficacy of a theory-based experiential intervention for increasing motivation to quit smoking and reducing smoking behavior. DESIGN: This study used a 3-arm, randomized design to examine the efficacy of an experiential secondary prevention intervention. The control groups included a traditional didactic smoking intervention and an experiential intervention on nutrition. MAIN OUTCOME MEASURES: The 2 primary dependent variables were change in self-reported intention to quit smoking, measured pre- and postintervention, and change in smoking behavior over the month following the intervention. RESULTS: As hypothesized, the experiential smoking intervention was more effective than either control group in increasing immediate motivation to quit, but the effect was found only among female participants. At 1-month follow-up, both smoking interventions produced higher rates of smoking cessation and reduction than did the nutrition control condition. CONCLUSION: Findings support the potential efficacy of an intensive experiential intervention for female smokers.     

The international provision of pharmaceuticals: a comparison of two alternative argumentative strategies for global ethics

Millions of people in the developing world lack access to curative drugs. Pogge identifies the cause of this problem as a lack of redistribution across borders. In contrast, this article shows that institutional shortcomings within developing countries are the main issue. These different explanations are the result of diverging analytic approaches to ethics: a cosmopolitan approach versus an ordonomic approach. This article compares both approaches with regard to how they conceptualize and propose to solve the problem of providing life-saving pharmaceuticals to the poor in developing countries.     

Dissociation in the laboratory: a comparison of strategies

Several methods for inducing dissociation in the laboratory were examined in a sample of 78 undergraduate students. Participants scoring high or low on the Dissociative Experiences Scale participated in three dissociation challenge conditions: (a) dot-staring task, (b) administration of pulsed photic and audio stimulation and (c) stimulus deprivation. Participants recorded their dissociative experiences both before and after each of the three challenge conditions. Across conditions, high DES participants reported significantly more dissociative sensations than low DES participants, even after controlling for pre-challenge dissociation. Moreover, regardless of DES status, pulsed photo and audio stimulation produced the greatest level of dissociative symptoms. The findings suggest that the induction of dissociative symptoms in a nonclinical sample is easily accomplished in the laboratory and that those who report more dissociative symptoms in their day-to-day life exhibit more pronounced dissociative symptoms when undergoing dissociative challenge in the laboratory. Implications for the study and treatment of dissociative symptoms are discussed.     

Outcomes of a traditional weight control program and a nondiet alternative: a one-year comparison.

The purpose of this study was to evaluate the effectiveness of a traditional weight control program and nondiet alternative in improving behavioral (e.g., restrained, emotional, and external eating), psychological (e.g., body preoccupation, physical self-esteem), and biomedical (e.g., body weight, blood pressure, cholesterol) outcomes. There were 2 intervention groups--traditional weight control (TWC) and Diet Free Forever (DFF); a nonvolunteer comparison group; and a control group, all made up of employees of 3M (N = 357). The 2 intervention groups participated in 10-week eating programs. Outcome variables were assessed at baseline, at 10 weeks for the intervention groups only, and again at 1 year. At baseline, the 2 intervention groups had higher restrained, external, and emotional eating scores, greater body preoccupation, and lower physical self-esteem than the comparison and control groups. They also weighed more. At 1 year, both intervention groups had decreased their body preoccupation and increased their physical self-esteem. Participants in the DFF program reduced their restrained eating, whereas those in the TWC program increased their restrained eating. Neither eating program had an impact on the biomedical outcomes.     

Increasing intervention implementation in general education following consultation: a comparison of two follow-up strategies

This study examined two strategies for increasing the accuracy with which general education teachers implemented a peer tutoring intervention for reading comprehension. The intervention was implemented for 5 elementary school students who had been referred for consultation services. Initial implementation of the intervention by the teachers was variable, and the data exhibited a downward trend. When consultants held brief daily meetings with the teachers to discuss the intervention, implementation improved for 2 of 5 participants. Four of the teachers implemented the intervention at levels substantially above baseline during the performance feedback condition, whereas implementation for 1 teacher increased following discussion of an upcoming follow-up meeting with the principal. Student reading comprehension scores improved markedly during the peer tutoring intervention. Three students maintained these gains 4 weeks after the intervention ended. The implications of these findings for the maintenance of accurate treatment implementation in applied settings are discussed.     

Testing the co-existence of two timing strategies for motor control in a unique task: The synchronisation spatial-tapping task

The control of rhythmic action sequences may involve two distinct timing strategies, i.e., event-based and emergent timing, which are usually revealed through finger-tapping and circle-drawing tasks, respectively. There is a lively debate concerning the possibility of coexistence of the two modes of timing for the execution of a single task. If one considers emergent timing as simply an absence of explicit representation of a time interval, then by definition, the two modes of timing cannot coexist. However, if one considers that emergent timing engages control of another motor parameter, e.g., a control of movement through space rather than time, then the possibility of coexistence needs to be reassessed. In the present study, we designed a hybrid of finger-tapping and circle-drawing tasks for which the demands for space and time control were present at the same time in order to reassess the coexistence hypothesis. Seventy-eight participants performed a spatial-tapping task in which finger taps were to be produced in synchrony with a regular metronome to 6 visual targets presented around a virtual circle. The metronome set ten distinct tempi (1100–300 ms). Using autocorrelation analyses on timing variables, we show that motor timing was event-based at slow tempi and emergent at faster tempi. Through an analysis of the trajectory, we confirm that an increase in the spatial control of movement took place congruently with a switch from event-based to emergent timing modes. At these fast tempi, timing and spatial errors were correlated but only at the specific target location for which a dynamical anchor point was revealed. Hence, we conclude that the coding of emergent timing has a spatial nature from which emerge timing regularities. This spatio-temporal strategy insures the performance of sequential motor actions when cognitive effort is too high for the use of pure event-based timing strategies.     

Family interaction and child psychopathology: A comparison of two observation strategies

We examined two systems of assessing family interactions that are in common usage: a home based observation of free parent-child interaction and a clinic based observation of a structured mother-child problem solving discussion. Participants were 18 depressed, 27 conduct disordered and 16 comparison children and their mothers. Results indicated that: 1) these observations may yield very different data about child, and to a lesser extent, parent behavior, 2) parental affect in the clinic was related to their level of aversive behaviour in the home, 3) levels of both aversive and positive behavior for children and their mothers were correlated within each setting, 4) accuracy of diagnostic classifications made on the basis of the observational data were highest for comparison and conduct disordered children, but lowest for depressed children observed in the clinic, and 5) the inclusion of data on mothers' behavior increased classification accuracy for conduct disordered children only.     

Work site group meetings and the effectiveness of a televised smoking cessation intervention

At the work site, smoking accounts for increased health care expenses and worker absenteeism due to smoking-related illness and reduced productivity and lost wages. Developing comprehensive and accessible smoking cessation programs at the work site is an important objective for health care professionals. In this study, employees of 43 corporations participated in a televised smoking cessation program accompanied by self-help manuals. The media component involved presenting a smoking cessation program on a network television affiliate station during the 4:30 p.m. and 10:00 p.m. news for 20 days. Employees at half the corporations also had access to semiweekly self-help group meetings. Adding self-help support groups to a program involving self-help manuals and the media reports was found to significantly increase abstinence and its maintenance over time. The implications of using the media, self-help groups, and work site locations in large-scale community-based interventions are discussed.     

Predictors of smoking cessation in Taiwan: using the theory of planned behavior

This study aimed to explore the factors predicting the intention to quit smoking and the subsequent behavior 6 months later using the theory of planned behavior (TPB). Data were obtained from 145 smokers who attended a smoking cessation clinic in a community hospital. All participants completed a questionnaire which included demographic information, TPB-based items, perceived susceptibility and previous attempts to quit. The actual quitting behavior was obtained by follow-up phone calls 6 months later. The TPB constructs explained 34% of the variance in intention to quit smoking. By adding perceived susceptibility, the explained variance was significantly improved to 40%. The most important predictors were perceived behavior control and perceived susceptibility, followed by attitude. Subjective norm did not contribute to the prediction of intention. Attitude and perceived behavior control contributed to the prediction of actual quitting behavior, but intention, subjective norm and perceived susceptibility did not. Our findings support that the TPB is generally a useful framework to predict the intention to quit smoking in Taiwan. The inclusion of perceived susceptibility improved the prediction of intention. With regards to successfully quitting, attitude and perceived behavior control played more crucial roles than other TPB constructs. Smoking cessation promotion initiatives focusing on reinforcing cessation belief, enhancing a smoker’s perception of their capability to quit smoking, and persuading smokers that they can overcome cessation barriers to cessation could make subsequent interventions more effective.     

Changes in information as a function of a culturally appropriate smoking cessation community intervention for Hispanics

Tested a 7-month, media-based, community intervention among Hispanics in San Francisco designed to change levels of information on the damaging effects of cigarette smoking and on the availability of culturally appropriate cessation services. Three community-wide surveys of Hispanics were conducted with independent random samples, two as baselines (n = 1,660 and 2,053) and one postintervention (n = 1,965). Results showed that changes in the level of awareness of cessation services had taken place after implementation of the intervention. Furthermore, those changes took place primarily among the less acculturated Spanish-speaking Hispanics who were the target of the intervention. The changes in information reported here demonstrate that a culturally appropriate information dissemination campaign that utilizes multiple channels can produce changes in a community's level of information even when the campaign is implemented for a relatively short period.