Tailored interventions for motivating smoking cessation: using placebo tailoring to examine the influence of expectancies and personalization.

The present study examined mechanisms underlying the effectiveness of tailored interventions for motivating smoking cessation. The study used a placebo-tailoring design to test whether the efficacy of tailoring was due, in part, to personalized features in addition to the theoretically based content. Two hundred forty adult smokers were randomized to 1 of 3 conditions: standard booklet, minimally personalized booklet, or extensively personalized booklet. The interventions varied in their degree of ostensible tailoring, yet the actual smoking-related content of the booklets was identical. A dose-response relationship was hypothesized, with the greatest apparent tailoring producing the most positive outcomes. This pattern was found for evaluation of the booklets, with trends for readiness to change and self-efficacy increases. Moreover, as hypothesized, the effect of the interventions on readiness was moderated by participants' expectancies about tailoring.     

Comparing gain- and loss-framed messages for smoking cessation with sustained-release bupropion: a randomized controlled trial.

Prospect theory suggests that because smoking cessation is a prevention behavior with a fairly certain outcome, gain-framed messages will be more persuasive than loss-framed messages when attempting to encourage smoking cessation. To test this hypothesis, the authors randomly assigned participants (N=258) in a clinical trial to either a gain- or loss-framed condition, in which they received factually equivalent video and printed messages encouraging smoking cessation that emphasized either the benefits of quitting (gains) or the costs of continuing to smoke (losses), respectively. All participants received open label sustained-release bupropion (300 mg/day) for 7 weeks. In the intent-to-treat analysis, the difference between the experimental groups by either point prevalence or continuous abstinence was not statistically significant. Among 170 treatment completers, however, a significantly higher proportion of participants were continuously abstinent in the gain-framed condition as compared with the loss-framed condition. These data suggest that gain-framed messages may be more persuasive than loss-framed messages in promoting early success in smoking cessation for participants who are engaged in treatment.     

Facilitating autonomous motivation for smoking cessation.

Physicians used either an autonomy-supportive or a controlling interpersonal style to counsel smokers based on National Cancer Institute guidelines. Physician autonomy support was rated from audiotapes, and patients' perceived competence and autonomous motivation for quitting were self-reported on questionnaires. Validated point prevalences for 6, 12, and 30 months and for continuous cessation were examined. The intervention did not have a direct effect on quit rates; however, structural equation modeling supported the self-determination process model of smoking cessation. The model indicated that the autonomy-supportive intervention was rated as more autonomy supportive, that rated autonomy support predicted autonomous motivation, and that autonomous motivation predicted cessation at all points in time. Perceived competence contributed independent variance to cessation only at 6 months.     

Assessing outcome in smoking cessation studies.

Outcome measures for smoking cessation are reviewed and evaluated, including 3 self-report measures and 3 biochemical validation measures. Point prevalence reflects the percentage of participants taking action, prolonged abstinence reflects those in the maintenance stage, and continuous abstinence reflects those who progress from action to maintenance without lapsing or relapsing. Biochemical assessments are primarily measures of point prevalence abstinence. The desirability of biochemical validation is a particularly controversial and critical issue. Three factors affect the accuracy of self-report: Type of Population, Type of Intervention, and Demand Characteristics. False-negative rates are generally low. Three broad issues impact on decisions to use biochemical validation: (a) alternative explanations for false positives, (b) refusal rate problems, and (c) the effect of inaccuracy on intervention assessment.     

Evidence for clinical smoking cessation for adolescents.

OBJECTIVE: This report reviews the evidence that informs the role of health and mental health care providers in addressing youth smoking cessation. DESIGN: Qualitative literature review. RESULTS: Physicians do not consistently screen adolescents for tobacco use and fail to provide recommended cessation advice. Challenges to addressing smoking cessation include the need for procedures to ensure confidentiality and the existence of competing demands to provide other services. Few published studies have specifically addressed the effectiveness of clinical interventions. Interventions that require return visits or follow-up phone contacts are technically difficult to implement in this population. Successful interventions may require resources not available in nonresearch settings. Most studies have used brief clinical intervention as a control condition, making it impossible to evaluate its effectiveness. CONCLUSION: There is little evidence that supports current clinical smoking cessation guidelines for adolescents. More research is needed to develop inexpensive, efficient clinical interventions that can provide youths access to smoking cessation help. Future challenges include reorganizing clinical systems to offer greater counseling by support staff or in electronic formats and to provide effective booster messages and follow-up care in a population that is difficult to track.     

Attentional bias predicts outcome in smoking cessation.

Most attempts to quit smoking end in failure, with many quitters relapsing in the first few days. Responses to smoking-related cues may precipitate relapse. A modified emotional Stroop task-which measures the extent to which smoking-related words disrupt performance on a reaction time (RT) task-was used to index the distracting effects of smoking-related cues. Smokers (N = 158) randomized to a high-dose nicotine patch (35 mg) or placebo patch completed the Stroop task on the 1st day of a quit attempt. Smokers using an active patch exhibited less attentional bias, making fewer errors on smoking-related words. Smokers who showed greater attentional bias (slowed RT on the first block of smoking words) were significantly more likely to lapse in the short-term, even when controlling for self-reported urges at the test session. Attentional bias measures may tap an important component of dependence.     

Accelerated intermittent theta burst stimulation in smoking cessation: No differences between active and placebo stimulation when using advanced placebo coil technology. A double-blind follow-up study

ObjectiveThis study aims to investigate the longer-term effects of accelerated intermittent theta burst stimulation (aiTBS) in smoking cessation and to examine whether there is a difference in outcome between active and placebo stimulation. The present study constitutes an ancillary study from a main Randomized Controlled Trial (RCT) evaluating the acute effects of aiTBS in smoking reduction.MethodA double-blind randomized control trial was conducted where 89 participants were randomly allocated to three groups (transcranial magnetic stimulation (TMS)&N group: active aiTBS stimulation combined with neutral videos; TMS&S group: active aiTBS stimulation combined with smoking-related videos; Placebo group: placebo stimulation combined with smoking-related videos). Nicotine dependence, tobacco craving, perceived stress and motivation to quit smoking were measured after completion of 20 aiTBS sessions and during various follow ups (post one week, post one month and post six months).ResultsOur results show that the positive effect on nicotine dependence and tobacco craving that occurred at the end of treatment lasts at least one month post treatment. This effect seems to dissipate six months post treatment. No significant differences were found between the three groups.ConclusionBoth active and placebo stimulation were equally effective in reducing nicotine dependence and tobacco craving up to one month after the end of treatment.     

Sex differences in predictors of adolescent smoking cessation.

Sex differences in predictors of smoking cessation were investigated among 337 male and 490 female participants in the RAND adolescent panel study. Participants reported smoking at least 11-20 times during the past year at Grade 10, with cessation defined as not smoking during the past year at Grade 12. Controlling for demographics, sex-specific analyses indicated that girls who quit smoking within 2 years had friends who smoked less frequently, perceived less parental approval of their smoking, had weaker intentions to continue smoking, used marijuana less frequently, attended fewer different schools, were more likely to have an intact nuclear family, experienced greater peer support, and rated themselves as healthier. Similar analyses for boys yielded results that were generally weaker and nonsignificant, with smoking quantity accounting for several associations in the sex-specific models. Despite these differences, interaction tests revealed significant sex differences for only three predictors. Implications of these results for understanding adolescent smoking cessation are discussed.     

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.     

Facets of the NEO-PI-R and smoking cessation

Knowing more about the personality of smokers may help to increase the effectiveness of smoking cessation treatments and can contribute to relapse prevention. The aim of the present study was to analyze the influence of 30 specific facets of the Five-Factor Model of personality on the outcomes at the end of treatment and at 12-month follow-up, in a sample of 281 smokers seeking psychological treatment to stop smoking. Personality facets were assessed with the Revised NEO Personality Inventory (NEO-PI-R). Results showed that nicotine dependence and several facets of personality (Self-discipline, Depression, Aesthetics, Trust, and Modesty) contribute to explain short- and long-term outcomes after smoking cessation. These findings support the need of integrate information about individual smoker’s personality facets into smoking cessation programs.     

A meta-analytic comparison of the effectiveness of smoking cessation methods.

Meta-analysis was used to cumulate the results from 633 studies of smoking cessation, involving 71,806 subjects, that reported the proportion of successful quits. Self-care methods do not appear to be as effective as formal intervention methods. Instructional programs involving physicians were not more effective than other instructional programs. Conditioning-based techniques such as aversive methods had success rates similar to those of instructional methods, and among the instructional methods, those incorporating social norms and values were more successful than those relying solely on didactic approaches. Cumulation of quit rates from all available control groups indicated that, on average, 6.4% of the smokers could be expected to quit smoking without any intervention. This figure must be subtracted from the raw success rate to obtain the net success rate for each program. Directions for future research are discussed.     

Effects of gender in social control of smoking cessation.

This study of 93 men and 117 women smokers during an ongoing quit attempt examined the roles of gender and social network influences on quitting. For men, social influences appeared to positively affect their ability to reduce their smoking but were less effective for women. Specifically, increased reports of a spouse or partner's influence, and family and friends' influence, were associated with greater reductions in men's smoking 2 days and 4 months post quit date, respectively. In contrast, for women, greater reports of spouse or partner influence and of family and friends' influence were associated with smaller reductions in smoking. Sex differences in social control strategies and perceived autonomy supportiveness of those strategies are discussed as possible explanations for these results.     

Interest in smoking cessation among emergency department patients.

The authors interviewed adult patients presenting to 4 Boston emergency departments (EDs) about their smoking, quit attempts, and interest in an outpatient referral. Of the 539 patients enrolled, 26% were current smokers. Of the current smokers, 72% had tried to quit in the past year, and 34% wanted an outpatient referral. Current smokers were younger than nonsmokers and were less likely to have a high school education, primary care provider, and private insurance. The findings of this study reinforce the potential benefit of routine screening for smoking and interest in quitting in the ED. Because many underinsured Americans use the ED as a source of regular health care, the public health implications of increasing screening, counseling, and referral for smokers are substantial.     

Alcohol dependence and the priming effect.

The concepts of loss of control and craving are reviewed and relevant experimental findings are discussed. Speed of drinking is proposed as a behavioural measure of craving and an experiment is described to test the hypothesis that craving is primed by a moderate dose of alcohol (45 gm). The hypothesis was confirmed, but only for the severely dependent alcoholics. The results indicated that the behavioural measure of craving and the assessment of severity of dependence were crucial. Failure to measure either of them would have resulted in failure to identify a priming effect.     

Rated helpfulness and partner-reported smoking cessation support across the pregnancy-postpartum continuum.

Support interventions have not changed smoking cessation rates significantly. The pregnancy-postpartum continuum presents a unique opportunity to examine patterns of support. Expectant couples (N = 477) were surveyed twice during pregnancy and 3 times postpartum. Partners reported positive and negative smoking-specific support; women reported the helpfulness of partner support. Linear trends suggest that women viewed support as more helpful during pregnancy than during postpartum. Partners' provision of positive support across the continuum depended on their smoking; provision of negative support depended on women's smoking. Partners who smoked provided lower levels of both positive and negative support, especially postpartum. Women who smoked throughout the pregnancy perceived their partner's negative support as helpful. Implications are that partners who smoke may need help staying engaged in the support process. Partners may provide negative support in response to women's smoking cues. Women who are struggling with cessation may not view negative support as negative.     

Perceptual priming enhances the creation of new episodic memories

In recent years, most studies of human memory systems have placed the emphasis on differences rather than on similarities. The present study sought to assess the impact of perceptual priming on the creation of new episodic memories. It was composed of three distinct experimental phases: (1) an initial study phase, during which the number of repetitions of target words was manipulated; (2) a perceptual priming test phase, involving both target and new control words, which constituted the incidental encoding phase of (3) a subsequent Remember/Know/Guess recognition task. Results showed that the greater the perceptual priming at encoding, the more the episodic memory performance was enhanced, whereas no such relation was found for know judgments or feeling of familiarity. Furthermore, the words that were associated with the creation of new episodic memories had been perceptually primed to a greater extent during the incidental encoding phase than the words that were subsequently judged to be known or forgotten. These results suggest that the perceptual contents of episodic memories are constituted by the very perceptual representations that generate priming effects. Potential mechanisms linking perceptual priming to the creation of episodic memories are discussed.