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.     

Quitting smoking: The importance of non-smoker identity in predicting smoking behaviour and responses to a smoking ban

Objective: We examined how ‘smoker’ and ‘non-smoker’ self- and group-identities and socio-economic status (SES) may predict smoking behaviour and responses to antismoking measures (i.e. the Dutch smoking ban in hospitality venues). We validated a measure of responses to the smoking ban.

Design: Longitudinal online survey study with one-year follow-up (N = 623 at T1 in 2011; N = 188 at T2 in 2012) among daily smokers.

Main outcome measures: Intention to quit, quit attempts and ‘rejecting’, ‘victimizing’, ‘socially conscious smoking’ and ‘active quitting’ responses to the smoking ban.

Results: Non-smoker identities are more important than smoker identities in predicting intention to quit, quit attempts and responses to the smoking ban, even when controlling for other important predictors such as nicotine dependence. Smokers with stronger non-smoker identities had stronger intentions to quit, were more likely to attempt to quit between measurements, and showed less negative and more positive responses to the smoking ban. The association between non-smoker self-identity and intention to quit was stronger among smokers with lower than higher SES.

Conclusion: Antismoking measures might be more effective if they would focus also on the identity of smokers, and help smokers to increase identification with non-smoking and non-smokers.     

Perceived stress, quitting smoking, and smoking relapse

Assessed perceptions of stress prior to quitting and at 1, 3, and 6 months following quit date. Self-reported smoking status was augmented by a bogus pipeline procedure at each interview, and abstinence at 6 months was verified by carbon monoxide and saliva cotinine. The analyses provide strong evidence for a relation between changes in stress levels and changes in smoking status. Those who failed to quit smoking for more than 24 hr maintained a relatively high and consistent level of stress over the entire 6-month period. For those remaining continuously abstinent over the course of the study, stress decreased as duration of abstinence increased. Increases in stress with relapse were found across all three panel lags (prequit to 1 month, 1 to 3 months, and 3 to 6 months), and decreases in stress with quitting were found across the two lags where that comparison was possible. The possibility that the relation between smoking and stress is bidirectional is discussed as a possible interpretation of the results.     

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.     

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.     

CONTINGENCY MANAGEMENT PROMOTES SMOKING REDUCTIONS IN RESIDENTIAL SUBSTANCE ABUSE PATIENTS

Rates and consequences of cigarette smoking are more severe in substance abusers. In this 12‐week pilot study, residential substance abuse treatment patients received standard care for smoking cessation (n = 12) or prize contingency management (n = 12) for expired carbon monoxide (CO) tests ≤ 8 ppm and salivary cotinine < 10 ng/ml, which are indicative of smoking abstinence. Percentage of negative CO tests and the highest number of consecutive negative CO tests were greater in contingency management compared to standard care.     

VOUCHER‐BASED CONTINGENT REINFORCEMENT OF SMOKING ABSTINENCE AMONG METHADONE‐MAINTAINED PATIENTS: A PILOT STUDY

This study evaluated the efficacy of a contingency management (CM) intervention to promote smoking cessation in methadone‐maintained patients. Twenty participants, randomized into contingent (n = 10) or noncontingent (n = 10) experimental conditions, completed the 14‐day study. Abstinence was determined using breath carbon monoxide and urine cotinine levels. Contingent participants received voucher‐based incentives for biochemical evidence of smoking abstinence. Noncontingent participants earned vouchers independent of smoking status. Contingent participants achieved significantly more smoking abstinence and longer durations of continuous smoking abstinence than did noncontingent participants. These results support the potential efficacy of using voucher‐based CM to promote smoking cessation among methadone‐maintained patients.     

A preparation for the experimental analysis of human cigarette smoking behavior

A preparation for the experimental analysis of cigarette smoking is described in detail. The preparation permits the intensive study of cigarette smoking in individual subjects under controlled laboratory conditions. A variety of behavioral and physiological measures used include rate and pattern of puffing, duration of each puff, time spent smoking cigarettes, expired air carbon monoxide levels, cigarette butt weights, and subjective rating scales of various aspects of smoking. The preparation is reliable and permits relatively unobtrusive monitoring of smoking performance. Cigarette smoking occurs in orderly patterns, within subjects; it varies as a function of number of cigarettes provided and hours of smoking deprivation.     

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.     

Personality traits, perceived risk, and risk-reduction behaviors: a further study of smoking and radon.

Personality traits and risk perceptions were examined as predictors of changes in smoking behavior. Participants (N = 697) were part of a randomized controlled trial of interventions to reduce exposure to the combined hazard of radon and cigarette smoke. Participants with higher perceived risk at baseline for the combination of smoking and radon were more likely to have a more restrictive household smoking ban in place at 12-month follow-up (p < .05). Risk perceptions also predicted reductions in the total number of cigarettes smoked in the home for participants in the video intervention who had high or moderate levels of extraversion (p < .01). Greater perceived risk predicted whether highly or moderately conscientious women quit smoking (p < .05). The moderating effects of personality traits should be considered when evaluating risk-reduction interventions.     

An examination of the relationships between cannabis use,driving under the influence of cannabis and risk-taking on the road

IntroductionSome studies have suggested that regular cannabis users appear to exhibit a general reckless driving style that may contribute to an inflated estimate of collisions related to driving under the influence of cannabis (DUIC) among this group.ObjectiveThis study investigated whether patterns of cannabis use would predict levels of self-reported unsafe driving behaviours and levels of performance observed in a driving simulator.MethodThe study investigated 48 young cannabis users with respect to frequency of cannabis consumption, alcohol use, driving exposure, self-reported dangerous driving habits, impulsivity, sensation seeking and performance in a driving simulator.ResultsCannabis use was positively associated with DUIC, with sensation seeking and with self-reports of risky driving. An ANOVA confirmed a significant effect of levels of consumption of cannabis among participants on self-report risk-taking in driving. Moreover, the observed behaviours during the simulation tasks correlated with risky driving habits, and with the self-reported frequency of driving in the hour following smoking cannabis or immediately after drinking alcohol.ConclusionSince cannabis usage and DUIC appear to be related to an overall reckless style of driving, it is proposed that public safety policies should be more holistic, simultaneously targeting multiple on-road dangerous behaviours for intervention.     

Correlates of household smoking bans in low-income families of children with and without asthma

Exposure to secondhand smoke (SHS) harms all children's health, especially children with asthma. Yet, children with asthma are as likely to live with smokers as healthy children. Household smoking bans are being advocated to reduce children's harm from SHS. To measure the effect of household smoking bans on child SHS exposure and to examine correlates of strict smoking bans in a low-income, diverse sample, 91 children with asthma were matched to 91 healthy children. All had at least one smoker living in their homes. Nicotine dosimeters, child cotinine assays, and maternal reports quantified child SHS exposures. Maternal reports of household smoking rules, behaviors, and beliefs, and other family characteristics were also gathered. The presence of a strict household smoking ban vastly reduced children's SHS exposures and was associated with fewer cigarettes smoked by the mother and by other family members, the belief that SHS was a personal health risk, having children with asthma, and living in a single-family home. Many children are exposed to high levels of SHS at home. Strict household smoking bans greatly decrease, but do not eliminate children's SHS exposure. Even in disadvantaged families, mutable factors were associated with strict smoking bans. Increased dissemination and use of established public health strategies are needed to reduce children's SHS exposures.     

Impulsivity as a predictor of smoking and alcohol consumption

This prospective study examined the relationships between impulsivity, smoking and alcohol use in a large non-clinical sample of 601 men and 4832 women working in 12 Finnish hospitals. Data on impulsivity, smoking and alcohol consumption were collected by two questionnaires with a two-year interval. At baseline, impulsivity was associated with smoking and alcohol use. After controlling for baseline smoking, impulsivity predicted increased number of cigarettes smoked per day in women (p=0.08), but not in men. After controlling for alcohol use at baseline, impulsivity predicted increased alcohol consumption similarly in both genders (p<0.01). Higher impulsivity was also associated with increased likelihood of taking up smoking or becoming a heavy drinker (p<0.05). This evidence suggests that impulsivity contributes to increasing health risk behaviours.     

Personality predictors of smoking behavior in a sample of physicians

Abstract

The smoking status of 239 physicians was obtained from a mail survey in 1981. MMPI data, which had been obtained from these men 25 years earlier, was used to prospectively predict smoking status at follow-up. Those who never smoked had scores indicative of social conventionality (low scores on L, Pd, and Schubert scales; high scores on Ego-control). A similar pattern was found among smokers who quit after a relatively short smoking history. Compared to ex-smokers, those who continued to smoke at the time of follow-up were characterized by high scores on the Pd and Ma scales. These results were discussed in terms of a multi-stage conceptualization of the smoking cessation process.     

Predictors of risk for smoking relapse in men and women: A prospective examination

The current study examined whether prequit trait negative mood and smoking motives have different predictive patterns of smoking relapse in men and women. Thirty-three female (mean age ± SEM: 34.9 ± 2.5) and 38 male (mean age ± SEM: 37.1 ± 2.3) smokers interested in smoking cessation completed forms on smoking history, negative mood (i.e., depression, anxiety, and anger), stress, and smoking motives. Participants also provided samples for measurement of cotinine and carbon monoxide. Then, they set a quit date and were required to abstain from smoking at least for 24 hours. Participants were followed up for 12 months postcessation to measure their smoking status. Cox proportional hazard models revealed that motivation to reduce craving was a unique predictor of smoking relapse in men, while depressive mood, anxiety, anger, and perceived stress were predictive of time to relapse among women. These findings remained significant after statistically controlling for smoking-related variables, providing preliminary evidence that different factors may be associated with nicotine withdrawal and smoking relapse in men and women. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

When saying no leads to compliance: The door-in-the-face technique for changing attitudes and behaviors towards smoking at work

IntroductionThe aim of this action research was to encourage workers to comply with an anti-smoking charter and get them to effectively reduce their tobacco use. Two change procedures were compared: a classic one based on an information campaign and an original one based on the door-in-the-face technique.MethodForty-three smoking workers participated in this study. They were assigned to one of the two groups: information campaign group or door-in-the-face group. Two types of measures were administered. The first assessed self-reported attitudes towards smoking, such as perceived dependence (Fagerström Test); the second assessed effective behavior, such as number of cigarettes smoked and physiological nicotine addiction.ConclusionTaken together, the results show that the door-in-the-face technique was more effective than the information campaign. These results are discussed in light of the social acceptability of the initial refusal.     

Clustering of diet,physical activity and smoking and a general willingness to change

Addressing multiple health behaviours are important in preventing disease and mortality. The present study investigated the clustering of health behaviours, cognitive determinants and stages of change in 2827 adults for the lifestyle factors of physical activity, fruit, vegetable and fat consumption and smoking. The results showed that only 3% of the total population met recommended guidelines for all of the five behaviours. Behaviours were found to be weakly associated. Behaviour-specific cognitions and stages of change for the behaviours clustered more strongly, however. With respect to diet and physical activity, respondents in the preparation stage for one behaviour were likely also to be preparing to change another behaviour. Possible mechanisms for the apparent general willingness to change multiple behaviours are discussed, as well as potential implications for health promotion practice.     

Self-efficacy expectations with regard to different tasks in smoking cessation

Abstract

Self-efficacy expectations are important psychological determinants of smoking cessation. The present study aimed at exploring different sorts of self-efficacy. The following self-efficacy scales were composed: Emotional self-efficacy, Social self-efficacy, Skill self-efficacy, Relapse self-efficacy and Try self-efficacy. In a sample of 752 smokers with low motivation to quit, two subsequent self-report measurements of self-efficacy were conducted. Firstly, we investigated to what extent potential sources of self-efficacy - quitting history and smoking behavior -were related to the types of self-efficacy. The explained variance in self-efficacy scores ranged from 4.4% to 23.1%, and in all five types of self-efficacy, smoking behaviour explained a higher percentage of self-efficacy than quitting history. The number of past quit attempts was only related to Relapse self-efficacy. Secondly, we investigated to what extent the different types of self-efficacy at T1 were predictive of quitting behavior measured at T2. The results showed that only Skill self-efficacy was predictive of quitting activity between Tl and T2. Point prevalence quitting at T2 was predicted by Skill self-efficacy and Relapse self-efficacy. The latter type of self-efficacy, however, was a negative predictor of quitting. The different types of self-efficacy can be mapped on two dimensions: The extent to which the means to accomplish a certain task are specified in the questionnaire item; and the phase of behavior change to which the self-efficacy tasks are relevant. Based on the findings from the predictive validity, it is concluded that the more clearly the means to accomplish the task are specified, the more valid the self-efficacy judgements are.     

Obsessive-compulsive symptoms and cigarette smoking: an initial cross-sectional test of mechanisms of co-occurrence

ABSTRACT

Tobacco addiction and obsessive-compulsive symptoms (OCS; intrusive thoughts or impulses that cause distress and rituals) are both mediated by compulsivity and negative reinforcement. Little evidence exists to guide theory, research, treatment, and population-based prevention of this co-occurrence. We propose a conceptual model of OCS-smoking co-occurrence in which smokers with elevated OCS capitalize on smoking to assuage OCS. This secondary analysis examined associations between OCS levels and self-reported smoking motives that are model-concordant: i) negative reinforcement—smoking for relief; ii) sensorimotor—benefits of behaviors and sensations of the tobacco self-administration ritual; and iii) habitual—smoking without conscious control. A community sample of cigarette smokers enrolled in a cessation trial (N = 458; 47.2% female; M _age = 36.9; SD = 13.6) completed pre-quit self-report measures of OCS levels and smoking motives. Regression models adjusted for sociodemographic covariates and non-OCS psychopathologies indicated that OCS level was positively associated with each model-concordant motive. OCS level was also correlated with tobacco dependence severity and greater withdrawal symptom severity experienced during previous quit attempts. Those with higher OCS report greater motivation to smoke for negative reinforcement, sensorimotor behavioral-ritualistic, habit/automaticity, and stimulation reasons. Further examination of the proposed model of OCS-smoking co-occurrence is warranted to guide theory and intervention for this population.     

Smoking in movies, implicit associations of smoking with the self, and intentions to smoke

We examined whether identifying with a film character who smokes increases implicit associations of the self with smoking. Undergraduate men were randomly assigned to view film clips in which the male protagonist either smoked or did not smoke. We measured subsequent levels of self-smoking associations using a reaction time task, as well as self-reported beliefs about smoking and smokers. Greater identification with the smoking protagonist predicted stronger implicit associations between the self and smoking (for both smokers and nonsmokers) and increased intention to smoke (among the smokers). Stronger implicit self-smoking associations uniquely predicted increases in smokers' intentions to smoke, over and above the effects of explicit beliefs about smoking. The results provide evidence that exposure to smoking in movies is causally related to changes in smoking-related thoughts, that identification with protagonists is an important feature of narrative influence, and that implicit measures may be useful in predicting deliberative behavior.