Temporal contiguity in electric aversion therapy for cigarette smoking

Seventy dependent heavy smokers (32 cigarettes per day) were randomly assigned to one of five treatment and control procedures: (1) electric aversion therapy, involving ten 20-trial sessions of shocks contiguous with the smoking act. (2) simulated electric aversion. with non-contiguous shocks, (3) non-shock smoking sessions, to control for stimulus satiation and negative practice effects. (4) simple support and attention from therapist, (5) no-treatment. Before treatment, simple ‘self-monitoring’ and ‘self-control’ reduced cigarette consumption by an average of 12% (p < 0.001) and 26% (p < 0.001) respectively. Thirty-four of the 56 treated subjects (61%) were able to stop smoking compared with two out of fourteen (14%) of the no-treatment controls (p < 0.005). Treatment was highly effective at reducing and stopping smoking during the 4-week course and for 2 weeks afterwards (p < 0.005). Its effect was rapid, but not immediate. Outcome was virtually decided after 1 week (five sessions); subjects who had not stopped or almost stopped at this stage were most unlikely to respond later on (p < 0.001). All four treatments were equally effective, regular attendance for 15 min of simple support being as effective as the treatments involving additional 45-min sessions with a second therapist. The effects of contiguous vs non-contiguous shocks did not differ. A motor response was conditioned in 19 of the 28 subjects who received shocks but this was therapeutically irrelevant. The clinical outcome depended on the kind of subject rather than the kind of treatment. Those who were depressed, with poor psychiatric adjustment and a high Eysenck-Scale P score tended to do badly, while those who initially expressed high confidence in the outcome were more likely to succeed (p < 0.001). It is concluded that traditional conditioning processes do not contribute significantly to the clinical response of human subjects to electric aversion therapy for cigarette smoking.     

Aversive smoking therapies: A conditioning analysis of therapeutic effectiveness

Rapid smoking (RS) and a less aversive rapid-puffing (RP) treatment were compared on ability to enhance the impact of a behavioral-counseling (BC) procedure on psychophysiological, attitudinal and behavioral response to cigarettes. Data reveal that both aversive smoking treatments resulted in less smoking once treatment began, reduced smoking in post-treatment taste tests, and superior follow-up performance at 6 months and 1 yr. At 1 yr, RS S s achieved the highest number of days abstinent of any group. Regression analyses showed that Ss' confidence ratings of remaining abstinent were highly predictive of follow-up status, and that these ratings were related to number of cigarettes smoked during treatment and amount of smoking during post-treatment taste tests.     

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.     

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.     

Effects of biochemical validation of self-reported cigarette smoking on treatment success and on misreporting abstinence

Many investigators have reported that cigarette smokers who are trying to quit often falsely report being abstinent at the end of treatment. Unfortunately, much of the previous research designed to investigate this problem has been flawed, making the results difficult to interpret. We attempted to avoid these flaws and to investigate the measurement of alveolar carbon monoxide (CO) levels to validate self-reported smoking rates at the end of treatment. Participants in behavioral cessation clinics were randomly assigned to one of three conditions that varied in timing of exposure to information regarding CO measurement: at the beginning of treatment (demonstration of CO measurement, discussion of smoking effects on CO levels, and notification that individual CO levels would be measured at the conclusion of the clinic), at the end of treatment (demonstration, discussion, and notification of CO measurement prior to self-reports of smoking levels), or at the end of treatment (demonstration and discussion of CO measurement subsequent to self-reports of smoking levels). CO levels of all participants were measured at the end of treatment after they reported their current smoking levels. Only 16% of self-reports of abstinence were not verified by CO measurement. Smokers who observed the CO demonstration at the beginning of treatment were significantly more likely than the other two groups to achieve abstinence at the end of treatment and significantly less likely to misreport abstinence. Clinical and research implications of these results are discussed.     

Aversive cigarette smoking with an habitual, excessive smoker.

A 39-yr.-old patient was exposed to aversive cigarette smoking consisting of rapid smoking, handling of cigarette litter, and warm smoky air for 6 wk. He reduced from a baseline of 140 cigarettes per day to less than 20 at end of treatment. Follow-ups at 1, 2, 3, 6, and 9 mo. indicated a smoking rate of approximately 25% of baseline.     

Self-efficacy and social support as predictors of smoking after a quit attempt

Abstract

The current study examined self-efficacy and social support as predictors of maintenance after an attempt to stop smoking. As in previous studies, self-efficacy at the end of treatment was a significant predictor of reported smoking during the follow-up period. At 3 months after treatment the prediction from self-efficacy was weaker than a prediction from the level of post-treatment smoking. However at 10 months self-efficacy was the strongest predictive variable assessed in the study. In contrast, social support for the quit attempt was not a significant predictor of maintenance at any stage. The results provided qualified support for the contention that self-efficacy can often be a more powerful predictor than previous performance attainments, especially under conditions of greater situational change.     

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.     

Adherence across behavioral domains in treatment promoting smoking cessation plus weight control.

The authors tested whether adherence to simultaneous health behavior changes was unitary or domain specific among 76 women who modified smoking, eating, and physical activity to accomplish smoking cessation plus weight control. Random-effects regression analyses showed that adherence to both smoking and diet plans declined linearly and covaried positively; their association tended to grow stronger over time. In contrast, physical activity plan adherence did not change over time and was unrelated to other domains. At the end of treatment, 65%, 30.5%, and 25% adhered well or excellently to smoking, diet, and activity treatments, respectively. Findings support both unitary and domain-specific aspects of adherence and suggest that among smokers, smoking and eating behaviors may have similarities unshared by physical activity.     

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.     

Randomized Controlled Trial of a Smartphone Application as an Adjunct to Acceptance and Commitment Therapy for Smoking Cessation

There is a major public health need for innovative and efficacious behavioral and cognitive interventions for smoking cessation. This randomized controlled trial evaluated the efficacy of an acceptance and commitment therapy (ACT) smartphone application in augmenting ACT group treatment for smoking cessation. One hundred fifty adults smoking 10 or more cigarettes per day were randomly assigned to 6 weekly group sessions of behavioral support, ACT, or ACT combined with the smartphone application. Access to the app was provided from the start of the in-person treatment until the 6-month follow-up assessment. Participants were encouraged to make their quit attempts after the third session, and the posttreatment assessment occurred 3 weeks later. Measures of smoking status and ACT processes were obtained at baseline, posttreatment, and 6-month follow-up. Biochemically verified quit rates in the combined, ACT, and behavioral support groups were 36% (p = .079 relative to ACT; p = .193 relative to behavioral support), 20% (p = .630 relative to behavioral support) and 24% at posttreatment, as compared with 24% (p = .630 relative to behavioral support), 24% (p = .630 relative to behavioral support) and 20% at follow-up. There was no significant difference (p = > .999) in the primary outcome of biochemically verified 7-day point-prevalence abstinence at 6-month follow-up between the combined and ACT groups. The combined group reported significantly greater smoking reduction, acceptance and present-moment awareness than the behavioral support group at posttreatment, but not at follow-up. There were no significant differences between the groups in positive mental health. Contrary to hypotheses, the ACT group did not display significant improvements in positive mental health or ACT processes relative to the behavioral support group at posttreatment or follow-up. Implications and directions for future research are discussed.     

Social influences on smoking in middle-aged and older women

The purpose of this study was to examine the role of 2 types of social influence--general social support and living with a smoker--on smoking behavior among middle-aged and older women in the Women's Health Initiative (WHI) Observational Study. Participants were postmenopausal women who reported smoking at some time in their lives (N=37,027), who were an average age of 63.3 years at baseline. Analyses used multiple logistic regression and controlled for age, educational level, and ethnicity. In cross-sectional analyses, social support was associated with a lower likelihood and living with a smoker was associated with a higher likelihood of being a current smoker and, among smokers, of being a heavier smoker. Moreover, in prospective analyses among baseline smokers, social support predicted a higher likelihood and living with a smoker predicted a lower likelihood of smoking cessation 1-year later. Further, in prospective analyses among former smokers who were not smoking at baseline, social support predicted a lower likelihood and living with a smoker predicted a higher likelihood of smoking relapse 1-year later. Overall, the present results indicate that social influences are important correlates of smoking status, smoking level, smoking cessation, and smoking relapse among middle-aged and older women.     

Effects of dopamine transporter and receptor polymorphisms on smoking cessation in a bupropion clinical trial.

This study examined the role of dopaminergic genes in prospective smoking cessation and response to bupropion treatment in a placebo-controlled clinical trial. Smokers of European ancestry (N=418) provided blood samples for genetic analysis and received either bupropion or placebo (10 weeks) plus counseling. Assessments included the dopamine D2 receptor (DRD2) genotype, dopamine transporter (SLC6A3) genotype, demographic factors, and nicotine dependence. Smoking status was verified at the end of treatment (EOT) and at 6-month follow-up. The results provided evidence for a significant DRD2 * SLC6A3 interaction effect on prolonged smoking abstinence and time to relapse at EOT, independent of treatment condition. Such effects were no longer significant at 6-month follow-up, however. These results provide the first evidence from a prospective clinical trial that genes that alter dopamine function may influence smoking cessation and relapse during the treatment phase.     

A randomized trial of a self-help smoking cessation intervention in a nonvolunteer female population: testing the limits of the public health model.

Reaching nonvolunteer female smokers with effective smoking cessation programs is a critical public health challenge. Smokers (N = 2,786) among 15,004 female members of a health maintenance organization who completed a routine needs assessment were invited into the "UCLA Preventive Health Behavior Study," consisting of five telephone interviews over 2 years assessing health practices. Participants (N = 1,396) were randomized into experimental or control conditions of an unsolicited, mailed, self-help smoking cessation program. Subjects were not alerted to the link between the program and the health study. Smoking status was assessed at 1, 6, 12, and 18 months. Across all subjects, point prevalence at 18 months was 18.62, and continuous abstinence was 2.71%. No difference was found between treatment and control groups regarding smoking status or readiness to stop smoking--raising questions about the value of mailing cessation materials to nonvolunteers. Quit rates increased over the 18-month follow-up; those still smoking at 18 months reported increased readiness to quit. Predictors at each follow-up point were examined multivariately.     

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.     

Restricted Environmental Stimulation Therapy and Behavioral Self-Management in Smoking Cessation1

The relative impacts on smoking behavior of restricted environmental stimulation therapy (REST), behavioral self-management, and the combination were compared. Fifteen smokers from the community were treated in each of the three conditions and followed over a 12-month period. The combined treatment was very successful compared to standard smoking interventions (a mean of 66% reduction from baseline smoking rate and 53% of subjects completely abstinent on the 1-year follow-up), and subjects in this group smoked significantly less than those in either the REST or behavioral self-management only condition. Furthermore, subjects receiving REST, alone or in combination, were significantly less likely to relapse following treatment. The results were taken to support the importance of addressing multiple change objectives in smoking cessation programs.     

Postpartum return to smoking: staging a "suspended" behavior.

Two hundred fifty-six pregnant women who had quit smoking were classified into the precontemplation (PC), contemplation (C), preparation (PA), or action (A) stages of change for postpartum smoking cessation based on a 3-item algorithm assessing personal goals, self-efficacy, and smoking behavior. Logistic regression and event history analyses indicated group differences in return to smoking at 6 weeks and 3, 6, and 12 months postpartum. The percentage of women who returned to postpartum smoking was highest in the precontemplation stage and decreased with each subsequent stage, that is, at 6 weeks 83% of PCs, 64% of Cs, 35% of PAs, and 24% of As had returned to smoking. Results lend support for the stages of change for postpartum smoking abstinence. Stage-based interventions may be developed to assist women in maintaining abstinence postpartum.     

Changes in smoking behavior after a myocardial infarction

Among 383 participants in a longitudinal study of myocardial infarction (MI) patients, 230 smoked at the time of the MI. Posthospital smoking status was based on self-report for the day of follow-up, whereas information about length of continuous cessation was not available. Six months after the heart attack, 40.6% of the smokers had resumed smoking, whereas 49.4% smoked at a 3- to 5-year (M = 43-month) follow-up. Resumption of smoking within 6 months after the heart attack was associated with an increase in anxiety and depression during the first weeks after discharge, less cardiac health knowledge, and a less severe MI. In patients who relapsed at a later point, resumption of smoking was associated with a subsequent decline in general cardiac health knowledge, as well as in correct understanding of smoking at a risk factor. Long-term changes in smoking status were also related to previous heart disease, premorbid work instability, age, and severity of the MI. The results indicate that antismoking counseling of MI patients should not be limited to the health risks associated with smoking and that training in coping with negative affects without smoking may be valuable in promoting smoking cessation.     

Nicotine withdrawal in smokers with current depressive disorders undergoing intensive smoking cessation treatment.

The authors investigated withdrawal in smokers with current threshold and subthreshold depressive disorders (N = 21) who were participating in a pilot study of intensive counseling interventions for smoking cessation. The majority of participants (67%) were taking antidepressants when they entered the trial. Withdrawal symptoms were compared in prolonged abstainers versus nonabstainers across a 12-week treatment period and at the 3-month follow-up assessment visit. Prolonged abstinence was associated with an increase in positive affect and a decrease in depressive symptoms and craving over time. Nonabstinence was associated with little overall change in these variables from treatment onset to the 3-month follow-up. At the 3-month follow-up, 44% of prolonged abstainers were in complete remission of their baseline depressive disorders, compared with 0% remission among nonabstainers. Findings suggest that within the context of an intensive smoking cessation intervention, some smokers with current depressive disorders may experience significant improvement in affective and craving symptoms. Findings also suggest that abstinence may be associated with improvement in affect.