Correspondence programs for smoking cessation and weight control: a comparison of two strategies in the Minnesota Heart Health Program

Mailed invitations to participate in weight loss and/or smoking cessation correspondence programs to 31,400 households in a suburban community. Two programs were offered to randomized subsets of households, a 6-month correspondence program costing +5 and the same program for free but requiring a +60 deposit to be refunded based on success in weight loss or smoking cessation. Overall, sign-up included 1,304 people for weight loss and 142 for smoking cessation. The +5 program was about 5 times as popular as the incentive program. Validated weight change after 6 months averaged about 4 lb for the +5 program and 8 lb for the incentive program. Corresponding rates of smoking cessation were about 9% and 20%, respectively. We conclude that correspondence programs for the promotion of weight control and smoking cessation are potentially cost-effective methods for reaching individuals in the community at large, many of whom would not be interested in clinic-based programs. Issues meriting further research include recruitment, especially of smokers, and evaluation of the relative trade-offs in recruitment success versus efficacy of differing treatment approaches.     

Effects of a televised smoking cessation intervention among low-income and minority smokers

In November 1985, a television smoking cessation program was broadcast for 20 days on the noon and 9 p.m. news. Smokers in West Garfield Park, an inner-city impoverished area of Chicago, were randomly assigned either to a comprehensive intervention or to a no-intervention control condition. Although 100,000 self-help manuals had been distributed throughout Chicago, none of the controls in this low-income area had obtained a manual. The intervention consisted of providing the smokers a self-help manual, the televised broadcast, weekly support meetings, and supportive phone calls. At a 4-month follow-up, 20% of treatment participants were abstinent compared to 9% of controls. The results indicated that intensive supplementary opportunities enhanced participation by low-income smokers in a media smoking cessation program.     

Gender differences in smoking behavior in a university workplace

Behavioral approaches to smoking intervention benefit from an understanding of smoking behavior. We investigated gender differences in smoking behavior by observing 292 men and 648 women smoking in a university workplace. Although men smoked more cigarettes in longer break times than women, there were no gender differences in the time individual cigarettes were lit or time in the mouth. However, men inhaled significnatly more than women. The social environment differed with male smokers talking to equal numbers of men and women, while female subjects talked to more females than males while smoking. In smoking lounges, more women than men held the cigarettes near their face (38 vs. 28%). With increasing age, male smokers took longer breaks, had cigarettes lit for less time, and talked to more men, whereas with increasing age female smokers took fewer puffs and talked to fewer men. Thus men take longer breaks, smoke more cigarettes, and inhale more often than women in a university workplace setting.     

Development and validation of a multidimensional smoking behaviour questionnaire

We administered a 42-item smoking behaviour questionnaire to 150 adult smokers (75 men and 75 women), 18 to 70 years old (M = 37.1 yr., SD = 12.2). A principal component analysis of their responses followed by varimax rotation yielded four factors accounting for about 52% of the total variance: dependence, social integration, regulation of negative affect, and hedonism. Some sociodemographic and dispositional characteristics of the smokers predict these four dimensions. The predictors of each smoking dimension are quite different for male and female smokers.     

Concurrent brief versus intensive smoking intervention during alcohol dependence treatment.

Alcohol dependent smokers (N=118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-min counseling session with 5 min of follow-up. Intensive intervention consisted of three 1-hr counseling sessions plus 8 weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath carbon monoxide, was significantly higher for the intensive treatment group (27.5%) versus the rate for the brief treatment group (6.6%) at 1 month after the quit date but not at 6 months, when abstinence rates fell to 9.1% for the intensive treatment group and 2.1% for the brief treatment group. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short-term tobacco abstinence, other, perhaps more intensive, smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers.     

CO-WORKER SOCIAL SUPPORT IN A WORKSITE SMOKING CONTROL PROGRAM

We evaluated the effects of adding a social support component to a worksite controlled smoking treatment program. Twenty-four participants were randomly assigned to either a controlled smoking or a controlled smoking plus partner support condition. Within a multiple baseline across behaviors design, smokers in both conditions made efforts to achieve sequential 50% reductions in: (a) nicotine content of brand smoked, (b) number of cigarettes smoked per day, and (c) percentage of each cigarette smoked. Self-monitoring records, laboratory analyses of spent cigarette butts, and carbon monoxide determinations indicated that both conditions were effective in producing significant reductions in each of the three target behaviors and in carbon monoxide levels. All participants who quit smoking during the program maintained their abstinence at a 6-month follow-up, and those who did not quit were smoking less at follow-up than they had at pretest on all dependent variables. However, few differences were observed between controlled smoking and controlled smoking plus partner support conditions either during treatment or at the 6-month follow-up. Results are discussed with regard to previous worksite studies, future directions for research on social support, and variables that may have mediated treatment outcome.     

Use of carbon monoxide breath validation in assessing exposure to cigarette smoke in a worksite population

Assessed the usefulness of carbon monoxide (CO) breath validation of self-reported smoking status in a large worksite population (N = 4,647). CO assessment was performed as part of a baseline survey procedure. CO levels differed substantially in relation to self-reported smoking status and amount smoked. Correcting for ambient exposure (estimated by mean CO levels among never smokers) produced more satisfactory results than uncorrected CO levels. Striking company differences were observed in mean CO exposures among self-reported never smokers. An unexpected finding was that 17.1% of current smokers reported smoking less than daily. Although the CO measure was excellent in detecting moderate and heavy smokers, it was inadequate in detecting occasional and light smokers. If detection of occasional or lighter smoking is critical to the purposes of the study, the more expensive (but more accurate) cotinine measure is preferred.     

Predicting Relationship of Smoking Behavior Among Male Saudi Arabian College Students Related to Their Religious Practice

This study describes the relationships of smoking behavior among a sample of male college students in Kingdom of Saudi Arabia (KSA) to their religious practice, parents’ smoking behaviors and attitudes, peers’ smoking behaviors and attitudes, and knowledge about the dangers of smoking. A 49-item questionnaire was developed and pilot tested in KSA. This questionnaire was completed during the academic year 2013 by 715 undergraduate male students at the King Saud University in Riyadh. 29.8 % of the students were smokers (13.8 % cigarette smokers, 7.3 % sheesha smokers, and 27 % cigarette and sheesha smokers). Students in the College of Education were much more likely to be smokers than the students in the College of Science. The differences between the College of Education and the College of Science was statistically significant (χ² = 16.864. df = 1, p = .001). Logistic regression analysis suggested that students who were more faithful in their practice of Islam were 15 % less likely to smoke. Students who were more knowledgeable about the dangers of smoking were 8 % less likely to smoke. The logistic analysis identified peers (friends) as the most powerful factor in predicting smoking. The four-factor model had an overall classification accuracy of 78 %. The need to understand more fully the dynamics of peer relations among Saudi Arabian males as a basis for developing tobacco education/prevention programs. Prevention programs will need to include education and changes in the college level or earlier in KSA.     

Knowledge and beliefs regarding the consequences of cigarette smoking and their relationships to smoking status in a biracial sample

The purpose of this investigation was to evaluate carefully smoking-related knowledge and beliefs and their relationships to smoking status in a large, heterogeneous sample of smokers and nonsmokers in two settings: (a) a large, biracial southern city and (b) a small midwestern community. Participants were 611 (198 male, 413 female) adult respondents to a random-dialing telephone survey in Fargo, North Dakota (n = 200), and Memphis, Tennessee (n = 411). Each participant was given the Smoking Attitudes Survey, which assesses generalized health beliefs as well as health-related problems associated with smoking. Participants' knowledge of smoking-associated diseases (e.g., lung cancer) and of diseases not associated with smoking (e.g., kidney stones) was assessed. Stepwise regression analysis of composite knowledge scores revealed four independent predictors of the health consequences of smoking: education, race, smoking status, and income. Smokers, compared to nonsmokers, reported less knowledge related to the health consequences of smoking, were more likely to be male, were less concerned with the health consequences of smoking, and were more concerned about the health consequences of cholesterol. The best predictor of smokers who had never attempted cessation was their greater concern over weight control when compared to smokers with a history of smoking cessation attempts. The results are discussed in terms of smoking prevention and intervention efforts.     

A National Evaluation of Community-Based Youth Cessation Programs: End of Program and Twelve-Month Outcomes

Most youth cessation treatment research consists of efficacy studies in which treatments are evaluated under optimal conditions of delivery. Less is known about the effectiveness of youth cessation treatments delivered in real-world, community based settings. A national sample of 41 community-based youth cessation programs participated in a longitudinal evaluation to identify site, program, and participant characteristics associated with successful cessation. Validated quit rates were comparable to those in randomized controlled trials; 7-day abstinence at the end of program averaged 14% and 30-day abstinence at 12 months averaged 12%. Multivariate GEE models explored predictors of smoking cessation at the end of the programs and at 12 months. Results showed correlates of both short- and long-term cessation. Findings point to the importance of both individual and community-level variables, including motivation, opportunities for and encouragement to engage in activities outside of academics, having youth participate in treatment before they become highly dependent smokers, and community norms and ordinances that discourage youth purchase, use and possession of tobacco. Providing evidence-based treatment to youth in community-based settings results in successful cessation.     

Predictors of Smoking Status After Eight Years: The Interaction of Stages of Change and Addiction Variables

Abstract

With a smoking rate of 30% of the population Switzerland has one of the highest rates of all industrialised countries. Changes in smoking status over eight years are examined by analysing the course of non-smokers, former smokers and current smokers between 1987 and 1995. Stages of change and addiction variables, as well as their interaction, are analysed for 1987 as predictors of smoking status in 1995.A sample of 953 non-smokers and former and current smokers was interviewed in 1987 and followed up in 1995. Between 1987 and 1995 every fifth non-smoker (20.9%) began smoking. The higher one is in the stage hierarchy the higher the probability of forward than of backward movement. Within the stages of change the likelihood of cessation is moderated by addiction variables. Thus, in the case of contemplating smokers in 1987, the more cigarettes they smoked daily at that time the less likely they were to be former smokers by 1995, but for preparating smokers who had already made an attempt to quit the converse holds - the more they smoked in 1987, the more likely they were to be non-smokers eight years later. The same holds for former smokers in 1987: former moderate smokers then were more likely to relapse than former heavy smokers. The implications for prevention and intervention are discussed.     

Interest in Participating in Smoking Cessation Treatment Among Latino Primary Care Patients

Smoking is the leading preventable cause of disease and death for U.S. Latinos. This study identified correlates of interest in participating in a smoking cessation program among urban Latinos seen in community clinics. Interviews were completed with 141 current smokers. Participants were predominantly Spanish-speaking (93%) males (66%), who were on average 37.6 years old and smoked 8.7 cigarettes per day. Over two-thirds (63%) of participants were “definitely interested” in participating in a smoking cessation program. Participants who smoked more cigarettes per day and reported greater nicotine dependence, depression, and readiness to quit were more likely to be interested, while those employed fulltime were less likely to report high interest. Treatment preferences were consistent with Clinical Practice Guidelines recommending counseling, social support, and pharmacotherapy. Results support recommendations that healthcare providers intervene with all Latino smokers, including light smokers and those who do not report initial interest in smoking cessation.     

The effects of a deposit contract as a component in a behavioural programme for stopping smoking

A contract procedure is described in which a money deposit provided by cigarette smokers at the time of stopping smoking is returned at set intervals contingent on their having not smoked. Outcome results up to 6 months after the stop smoking date are presented for 33 smokers who used this procedure as a component in a behavioural programme, and for 27 smokers who received the same treatment package but without the deposit component. The results for both groups are encouraging, and in the short term the deposit group did significantly better than the no-deposit group. Reasons for the failure of this difference to be maintained are discussed, and it is suggested that long term results would be improved by holding deposits over a longer interval. Other evidence is presented to show that the deposit procedure had a specific effect on smoking rather than a more general effect on attendance rates. Deposit contracts also appear acceptable to smokers. Urinary nicotine analysis appeared effective in deterring as well as detecting faking.     

A population study of low-rate smokers: quitting history and instability over time.

This study used 1 longitudinal and 2 cross-seconal population surveys to compare stability of low-rate daily smokers (less than 5 cigarettes per day) with other daily smokers and occasional smokers. Few low-rate smokers maintained consumption level; 36% retained smoking status after 20 months, compared with 82% and 44% for regular daily and occasional smokers, respectively. In a dynamic process, established smokers quit smoking and/or modified (decreased or increased) consumption. Low-rate and occasional smokers quit at higher rates than regular daily smokers (odds ratios 3:1) but were replenished by new members, many converted from regular daily smoker. The overall trend is an increasing proportion of low-consumption smokers while smoking prevalence declines. The dynamic process has implications for tobacco control efforts and for addiction theory.     

The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation

Presents evidence for the validity of the Contemplation Ladder, a measure of readiness to consider smoking cessation. Analyses of data collected from more than 400 smokers at two worksites before and during a 10-month intervention indicate that Ladder scores were significantly associated with reported intention to quit, number of previous quit attempts, perceived co-worker encouragement to quit, and socioeconomic status. Ladder scores predicted subsequent participation in programs designed to educate workers about their smoking habit and its contingent risks. The Ladder did not predict biochemically validated abstinence of 24 hr or more. To assess its ability to distinguish between groups known a priori to differ in readiness, we administered the Ladder to 36 participants in a clinic-based smoking cessation program. As predicted, clinic patients scored significantly higher than the workers on the Ladder. The importance of distinguishing between smokers at the lowest stages of readiness to quit is discussed.     

Initial Evaluation of an Integrated Treatment for Comorbid PTSD and Smoking Using a Nonconcurrent,Multiple-Baseline Design

The present study examined an integrated treatment for comorbid posttraumatic stress disorder (PTSD) and smoking entitled “Smoke-Free to Overcome PTSD: An Integrated Treatment” (STOP IT program). A nonconcurrent multiple-baseline design was used with six community-recruited adult smokers with PTSD to investigate both patient acceptance of the treatment and its initial efficacy on both PTSD and smoking. Potential order effects of exposure-based and affect management components were also examined. A gold-standard assessment strategy that included the Clinician Administered PTSD Scale (Blake et al., 1995) and biochemical verification of self-reported smoking status was employed to measure primary targets of treatment. Results suggested that the STOP IT program was well tolerated. There were clinically significant improvements in PTSD outcomes, but only temporary reductions in smoking. Participants’ relatively low posttreatment smoking levels increased by the follow-up assessment, although not to baseline levels. Treatment component order did not appear to affect treatment outcomes, but those who were assigned to the exposure-focused writing prior to affect management training condition appeared more likely to discontinue treatment before beginning exposure. These preliminary data support the safety, acceptability, and potential efficacy of the STOP IT program. Future investigation of the STOP IT program should include testing the incremental efficacy of increasing the dose of smoking-focused intervention, as well as randomized controlled tests of the treatment that employ gold standards for treatment outcome research.     

Positive psychotherapy for smoking cessation: Treatment development,feasibility, and preliminary results

Low positive and high negative affect (NA) predict low rates of smoking abstinence among smokers making a quit attempt. Positive psychotherapy can both increase positive affect (PA) and decrease NA and, therefore, may be a useful adjunct to behavioral smoking counseling. The purpose of the present study was to assess the feasibility and acceptability of a positive psychotherapy for smoking cessation (PPT-S) intervention that integrates standard smoking cessation counseling with nicotine patch and a package of positive psychology interventions. We delivered PPT-S to 19 smokers who were low in PA at baseline. Rates of session attendance and satisfaction with treatment were high, and most participants reported using and benefiting from the positive psychology interventions. Almost one-third of the participants (31.6%) sustained smoking abstinence for six months after their quit date. Future studies to assess the relative efficacy of PPT-S compared to standard smoking cessation treatment are warranted.     

Prevalence and predictors of transitions in smoking behavior among college students.

The prevalence of smoking among college students is surprisingly high and represents a significant public health issue. However, there are few longitudinal studies of smoking in this population. This study examined the prevalence and predictors of transitions in smoking behavior among a cohort of 548 college students. Over the course of 4 years, 87% of daily smokers and almost 50% of occasional smokers continued to smoke. Among nonsmokers, 11.5% began smoking occasionally and none became daily smokers. In general, predictors of smoking behavior change were significant only among baseline occasional smokers and included gender, smoking outcome expectancies, and affect regulation expectations. Peer and parental smoking, demographics, affect, stress, and alcohol use were generally not predictive of change. Tobacco control interventions targeted at college students are clearly warranted.